Mobility status after inpatient stroke rehabilitation: 1-year follow-up and prognostic factors

OBJECTIVES: To evaluate the stability of mobility status achieved by stroke patients during hospital rehabilitation treatment over time and to identify reliable prognostic factors associated with mobility changes. DESIGN: Follow-up evaluation in consecutive first-ever stroke patients 1 year after hospital discharge. Multiple logistic regressions were used to analyze increases and decreases in Rivermead Mobility Index (RMI) scores (dependent variables) between discharge and follow-up. Independent variables were medical, demographic, and social factors. SETTING: Rehabilitation hospital. PATIENTS: A cohort of 155 patients with sequelae of first stroke, with a final sample of 141. MAIN OUTCOME MEASURES: Mobility status at 1-year follow-up, as measured by the RMI, and odds ratios (OR) for improvement and decline in mobility. RESULTS: Functionally, 19.9% improved the mobility levels achieved during the inpatient rehabilitation treatment; levels of 42.6% worsened. Patients with global aphasia (OR = 5.66; 95% confidence interval [CI], 1.50-21.33), unilateral neglect (OR = 3.01; 95% CI, 1.21-7.50), and age 75 years or older (OR = 5.77; 95% CI, 1.42-23.34) had a higher probability of mobility decline than the remaining patients. Postdischarge rehabilitation treatment (PDT), received by 52.5% of the final sample, was significantly and positively associated with mobility improvement (OR = 5.86; 95% CI, 2.02-17.00). Absence of PDT was associated with a decline in mobility (OR = 3.73; 95% CI, 1.73-8.04). CONCLUSIONS: In most cases, mobility status had not yet stabilized at hospital discharge. PDT was useful in preventing a deterioration in mobility improvement achieved during inpatient treatment and in helping increase the likelihood of further mobility improvement.     

伴血小板减少原发性抗磷脂综合征的临床特征及相关因素分析

目的:分析伴血小板减少原发性抗磷脂综合征（PAPS）的临床特征、与血小板减少相关的危险因素以及疾病复发风险。方法:回顾性分析2009年至2019年间于北京协和医院住院治疗的PAPS患者,比较血小板减少（PLT<100×10 9/L）和血小板正常患者的临床和实验室检查结果,分析血小板减少患者的临床特征和未来症...     

儿童噬血细胞综合征预后危险因素分析

目的 探讨儿童噬血细胞综合征(HPS)预后相关危险因素.方法 采用同顾性分析的方法,对2007年3月至2011年3月我院收治的50例HPS患儿血清学、病理学改变及预后资料进行系统分析.按随访患儿的生存情况分为生存组和死亡组,采用单因素和多因素Logistic回归分析影响患儿预后的危险因素.结果 50例HPS患儿中男30例,女20例,发病年龄3个月～10岁,46例患儿血清白蛋白、NK细胞及胆碱酯酶较正常值范围降低,大部分患儿血清铁蛋白升高伴有凝血功能异常和脂质代谢紊乱.40例患儿骨髓中出现吞噬细胞,35例患儿EBV-IgM抗体阳性,随访37例患儿中25例死亡,其中13例于住院1个月内死亡.单因素分析结果显示,与生存组比较死亡组患儿血清白蛋白、胆碱酯酶、NK细胞活性均降低,凝血酶原时间延长.多因素Logistic回归分析结果显示,病程＞1个月、白蛋白＜25 g/L、胆碱酯酶＜2000 U/L,NK细胞活性为0～3％、EBV-IgM抗体阳性与预后显著相关(P值均＜0.05).结论 HPS患儿病情凶险,病死率高,病程＞1个月、白蛋白低、胆碱酯酶和NK细胞活性低、EBV-IgM抗体阳性是影响患儿预后的主要危险因素.     

Evolution of headache in childhood and adolescence: an 8-year follow-up

Objective . Headache is a notable problem in clinical practice and a frequent symptom in childhood and adolescence. The main aim of the present study is to analyze the evolution of migraine and tension headache (TH) using an 8-year follow-up. Method . 100 subjects (F60, M40; mean age 17.9; SD 2.6; range 12–26), randomly selected among all patients first seen in 1988 at the Headache Center, were directly contacted. We employed IHS criteria both in 1988 (the data were taken by the clinical charts) and 1996. We took into account changes in headache types and improvement, unchanging, worsening or remission of headache. This analysis was made with regard to gender differences and age at onset of headache, too. The chi-squared test is employed. Findings . High tendency to remit (34%) or improve (45%) was recorded. A worsening situation was seen in 6% and an unchanging situation in 15%. In 1988, we had 57% migraine without aura (MwoA), 7% migraine with aura, 28% episodic tension-type headache (ETTH), and 8% chronic TH (CTTH). In 1996, we saw 30% MwoA, 2% MwA, 31%, ETTH, and 3% CTH. Migraine shows a lower tendency to remit than TH (28.1% vs 44.4%) MwoA persists in the same form in 43.8% and becomes ETH in 26.3%. ETTH persists in the same form in 26.3% and changes in MwoA in 10.7%. Of headache-free subjects, we recorded a high tendency to remit (34%) and improve (95%); 13 were females (21.7%) and 21 were males (52.5%). The course of headache is not related to age at onset. Conclusion . Headache with juvenile onset changes its characteristics over time, with a high tendency to remit (mostly in males) or improve. The implications for pathophysiology and the role of hormonal factors are called into question.     

Age-related macular degeneration in newly diagnosed type 2 diabetic patients and control subjects: a 10-year follow-up on evolution, risk factors, and prognostic significance

OBJECTIVE: To investigate the evolution of visual acuity, age-related macular degeneration (AMD), and its relation to 10-year cardiovascular mortality and risk factors in patients with newly diagnosed type 2 diabetes and control subjects. RESEARCH DESIGN AND METHODS: A 10-year prospective study consisting of a representative group of 133 (70 men, 63 women) newly diagnosed type 2 diabetic patients diagnosed at health centers between 1979 and 1981 and 144 (62 men, 82 women) nondiabetic control subjects recruited from the population register was performed. The frequency of AMD was determined by grading of 45 degrees stereoscopic fundus photographs. The subjects were studied at baseline and after 5 and 10 years. RESULTS: By the 10-year follow-up, visual acuity had declined more markedly in the diabetic patients than in the control subjects. Although the frequency of AMD was nearly the same in both groups (11-19%), it decreased visual acuity earlier in the diabetic patients than in the control group. AMD at baseline predicted 10-year cardiovascular mortality independently of adjustment for other risk factors in the diabetic patients (odds ratio [95% CI] 4.7 [1.1-19.3], P = 0.033). CONCLUSIONS: Visual acuity deteriorated earlier in newly diagnosed type 2 diabetic patients than in the control group although the cross-sectional frequency of AMD was nearly the same in both groups. Interestingly, AMD was an independent risk factor for cardiovascular mortality in type 2 diabetic patients, but the background mechanism(s) behind this association is unknown.     

视网膜母细胞瘤的生存率和预后因素研究

目的研究视网膜母细胞瘤(Rb)的生存率及预后因素。方法随访1997～2001年102例Rb患者的生存状况,进行Rb的生存率和相关预后因素分析。结果随访102例Rb患者,平均随访时间为45.2个月。81例存活(79.4%),21例死亡(20.6%);1、3、5年的生存率分别为87.25%、81.37%和78.79%。单眼、双眼患者生存率分别为84.52%和54.55%,差异有统计学意义(P<0.01);病程≤6个月的生存率为85.36%,病程>6个月的生存率为58.33%,两者差异有统计学意义(P<0.01);12例眶组织侵犯,存活5例,死亡7例,生存率为41.67%,眶组织未受侵犯组生存率为83.78%,两者差异有统计学意义(P<0.01);10例进行眼球保守治疗,5例成功;93例Ⅰ期行眼球摘除术的患者中,84例行Ⅰ期义眼座植入术,其中73例(86.9%)存活,11例(13.1%)死亡。结论 102例Rb患者42个月后生存率达到78.72%。双眼患者、病程>6个月和眶组织侵犯者预后较差,生存率低。Rb患者有一定的保守治疗成功率,Rb患者行眼球摘除术时,可选择联合行Ⅰ期义眼座植入。     

他汀类药物在糖尿病患者心血管事件一级预防中的新证据和新指南

大量的循证医学证据证实了他汀类药物的心血管事件二级预防作用。但是,他汀类药物在心血管事件一级预防中患者是否获益目前仍有争论。糖尿病本身是冠心病的等危症,无心血管疾病的糖尿病患者使用他汀类药物进行心血管事件一级预防应视为非糖尿病患者的二级预防。如此推论,糖尿病患者使用他汀类药物进行心血管事件一级预防应该获得肯定。临床真实情况是否如此？近期陆续发表的一些研究,用部分临床研究证据对其进行了初步的分析和探索。     

Onset, prognosis and risk factors for widespread pain in schoolchildren: a prospective 4-year follow-up study

The standard rodent model of itch uses scratching with the hind limb as a behavioral response to pruritic stimuli applied to the nape of the neck. The assumption is that scratching is an indicator of the sensation of itch. But because only one type of site-directed behavior is available, one cannot be certain that scratching is not a response to nociceptive or other qualities of sensations in addition to, or instead of, itch. To extend the model, we administered chemical stimuli to the cheek of the mouse and counted scratching with the hind limb as an indicator of itch and wiping with the forelimb as an indicator of pain. An intradermal injection of histamine and capsaicin, known to evoke predominantly itch and pain, respectively, in humans, each elicited hind limb scratching behavior when injected into the nape of the neck of the mouse. In contrast, when the same chemicals were injected into the cheek of the mouse, there were two site-directed behaviors: histamine again elicited scratching with the hind limb, but capsaicin evoked wiping with the forelimb. We conclude that the "cheek model of itch" in the mouse provides a behavioral differentiation of chemicals that elicit predominantly itch in humans from those that evoke nociceptive sensations. That is, the model provides a behavioral differentiation between itch and pain in the mouse.     

Onset,prognosis and risk factors for widespread pain in schoolchildren: A prospective 4-year follow-up study

Little is known about the epidemiology of widespread pain (WSP) in children and adolescents. This study aims to estimate the new-onset and prognosis of WSP in schoolchildren and investigate factors predicting its development. A prospective study was conducted among 1756 schoolchildren (age 10–12 years) in Southern Finland. At baseline, information was collected on WSP, regional musculoskeletal pain symptoms, depressiveness, fatigue, sleep problems, physical activity and joint hypermobility. These children were contacted again 1 year and 4 years later to determine the outcome and the new-onset of WSP. A total of 1282 children (73%) of the baseline study population were found at both follow-ups. Of the children who had WSP at baseline, 31% and 30% reported persistence/recurrence of symptoms at 1- and 4-year follow-up, respectively. However, only 10% of these children reported WSP at both 1 and 4 years. Of the children who were free of WSP at baseline, 18% reported new-onset WSP at 1-year follow-up and 3% reported these symptoms at both follow-up times. The independent baseline risk factors of WSP were older age (OR 1.3 95% CI 1.0–1.8), female gender (OR 1.4, 1.1–1.9), depressiveness (OR 1.5, 1.1–2.2) and regional back pain symptoms (Neck pain: OR 1.7, 1.1–2.4; Upper back pain: OR 2.1, 1.1–4.1; Lower back pain: OR 3.0, 1.6–5.7). Both psychological factors and somatic pain symptoms predict future development of WSP in adolescents.     

GALOP syndrome: case report with 7-year follow-up

An elderly woman complaining of a gait disorder was found to have the GALOP syndrome (gait ataxia, late-onset polyneuropathy). She exhibited mild distal weakness and sensory loss in the legs, a positive Romberg, and an unsteady gait. Serum immunofixation disclosed a monoclonal IgM-kappa protein. There was specific IgM binding to galopin, a central nervous system white matter antigen. Periodic treatment with intravenous immunoglobulin has alleviated her neurologic symptoms. She has now been followed for 7 years and maintained significant improvement in neurologic symptoms and signs.     

Psychosocial factors and risk of chronic widespread pain: An 11-year follow-up study—The HUNT study

Few studies have used prospective designs in large population surveys to assess the risk of developing chronic widespread pain (CWP). We wanted to examine 1) how many people without CWP developed it after 11 years, and 2) how anxiety, depression, alcohol use, smoking, sleeping problems, and body mass index (BMI) were associated with this development. This study was based on a representative population-based Norwegian cohort attending both the second (1995 to 1997) and the third (2006 to 2008) wave of the Nord-Trøndelag Health Study (HUNT2 and HUNT3, respectively). Only those adults attending both surveys (N = 28,367) were included. Approximately 19,000 individuals without CWP in HUNT2 were assessed for later CWP development in HUNT3, where we looked for symptoms of anxiety, depression, monthly frequency of alcohol use, smoking, sleeping problems, and BMI. Data were analyzed with logistic regression adjusted for age, sex, education, marital status, physical exercise, and pain symptoms not meeting the CWP criteria at baseline. After 11 years, 12% of those without CWP developed CWP. Anxiety and depression, former and current smoking status, BMI < 18.5 kg/m², BMI ? 25 kg/m², and sleeping problems were all associated with an increased risk of CWP. High and moderate levels of alcohol use were associated with a reduced risk of CWP. In summary, this study indicates that CWP develops over a long-term period for a substantial group of healthy people, and that both psychosocial and lifestyle factors influence the risk of CWP onset.     

Neurological manifestations of the antiphospholipid syndrome: risk assessments and evidence-based medicine

The antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterised by autoantibody production and vascular thrombosis or pregnancy morbidity. Autoantibodies generated against phospholipid and phospholipid-binding proteins often impair phospholipid-dependent clotting assays (lupus anticoagulants). These autoantibodies activate endothelial cells, platelets and biochemical cascades and can exist in autoimmune disorders such as lupus. Consistently positive antibodies may worsen the severity of thrombo-occlusive disease. The most common neurological manifestations of APS include stroke and transient ischaemic attacks due to arterial thromboses. Antiphospholipid antibodies may cause additional neurological impairments through both vascular and immune mechanisms. Antiaggregant or anticoagulant therapies are indicated for APS-related ischaemic strokes. Treatment regimens for asymptomatic antibody-positive patients and those with refractory disease remain controversial. There is scant literature on neurological APS manifestations in paediatric patients. Assessment of traditional cardiovascular and inherited thrombophilia risk factors is essential in patients with APS. Modifiable risk factors and valvular heart disease may worsen thrombotic and cerebrovascular outcomes. Alternative therapies such as statins, anti-malarials, angiotensin-converting enzyme inhibitors and thrombin inhibitors warrant further research.     

Non-specific neck pain in schoolchildren: prognosis and risk factors for occurrence and persistence. A 4-year follow-up study

This study investigated the natural course of neck pain (NP) in 9-12-year-olds during a 4-year follow-up. Risk factors for the occurrence and persistence of weekly NP were explored separately for boys and girls. At baseline, 1756 schoolchildren completed a questionnaire eliciting musculoskeletal pain symptoms, other physical, and psychological symptoms and frequency of physical activity, and were tested for joint hypermobility. Symptoms during the preceding three months were asked using a five-level frequency classification. Re-evaluation was performed after one and four years using identical questionnaires. During follow-up, 24% reported none, 71% fluctuating, and 5% persistent weekly NP. The frequency of NP at baseline was linearly related to weekly NP during follow-up in both genders (P<0.001). Furthermore, a significant increasing linear trend towards a more persistent course of NP was seen in children with weekly other musculoskeletal and/or other physical and psychological symptoms at baseline. Among originally neck pain-free pre-/early adolescents, weekly other musculoskeletal pain symptoms (only in girls) and other physical and psychological symptoms (in both genders) predicted the occurrence of weekly NP during follow-up. In conclusion, neck pain in schoolchildren tends to fluctuate, but there also seems to exist a subgroup (5%) with persistent NP already in pre-/early adolescents, or even earlier. Co-occurrence of frequent other musculoskeletal symptoms and/or markers of psychological stress with frequent NP are risk indicators for a more persistent course, at least within next few years. Since adult chronic NP problems might originate in childhood, further studies are needed, including preventive interventions.     

Prognostic factors and clustering of serious clinical outcomes in antiphospholipid syndrome

We assessed whether initial clinical presentations suggestive of antiphospholipid syndrome (APS) predicted the subsequent rate and type of serious clinical outcomes. Eighty-two consecutive patients with anticardiolipin antibodies or lupus anticoagulant were followed for 814 person-years after a first event suggestive of APS (livedo reticularis, thrombocytopenia, autoimmune haemolysis, thrombosis, central nervous system manifestations, recurrent abortions). The hazard of developing a second event was largest in patients with antibodies recognizing beta2 glycoprotein I who had autoimmune haemolysis as the first event (hazard ratio HR 2.70, p=0.018) and smallest in patients without such antibodies who had recurrent abortions as their first event (HR 0.37, p=0.028). Subsequent serious events in patients with venous and arterial thromboses, recurrent abortions, central nervous system manifestations and autoimmune haemolytic anaemia were likely to be of the same type as the presenting event (odds ratio (OR) 3.76, 5.90, 77.7, 6.92, and 7.13, respectively. Adjusting for therapy, the rate of subsequent serious events was 6.86-fold higher (p=0.0001) in patients presenting with two events, 1.56-fold higher (p=0.038) in autoimmune haemolysis presentations, 1.69-fold higher (p=0.004) in patients with anti-beta2-glycoprotein-I antibodies, and 46% (p=0.063) lower in thrombocytopenia presentations. Initial clinical features determine the long-term evolution of APS, and specific types of clinical manifestations cluster during the course of the disease.     

Thrombocytopenia in high‐risk patients with antiphospholipid syndrome

Essentials

• The prevalence of thrombocytopenia in patients with antiphospholipid syndrome is not well defined.
• We studied triple positive patients with antiphospholipid syndrome and its catastrophic variant.
• Prevalence of thrombocytopenia was 6% and 100% in patients who developed the catastrophic form.
• In triple positive patients thrombocytopenia is low and platelets drop during the catastrophic form.

Summary

Background

Thrombocytopenia is the most common non‐criteria hematological feature in patients with antiphospholipid syndrome (APS). This condition is more common in patients with catastrophic APS (CAPS).

Objectives

To evaluate the prevalence of thrombocytopenia in a large series of high‐risk patients with APS, and to assess the behavior of the platelet count during CAPS.

Methods/Patients

This was a cross‐sectional study in which we analyzed the platelet counts of a homogeneous group of high‐risk APS patients (triple‐positive). Six of these patients developed a catastrophic phase of the disease, and the platelet count was recorded before the acute phase, during the acute phase, and at recovery.

Results

The mean platelet count in 119 high‐risk triple‐positive patients was 210 × 10⁹ L^?1. With a cut‐off value for thrombocytopenia of 100 × 10⁹ L^?1, the prevalence of thrombocytopenia was 6% (seven patients). No difference between primary APS and secondary APS was found. In patients who suffered from CAPS, a significant decrease from the basal count (212 ± 51 × 10⁹ L^?1) to that at the time of diagnosis (60 ± 33 × 10⁹ L^?1) was observed. The platelet count became normal again at the time of complete remission (220 ± 57 × 10⁹ L^?1). A decrease in platelet count always preceded the full clinical picture.

Conclusions

This study shows that, in high‐risk APS patients, the prevalence of thrombocytopenia is low. A decrease in platelet count was observed in all of the patients who developed the catastrophic form of the disease. A decrease in platelet count in high‐risk APS patients should be considered a warning signal for disease progression to CAPS.

     

Observed changes in cardiovascular risk factors among high-risk middle-aged men who received lifestyle counselling: a 5-year follow-up

Objective: To examine the long-term impact of health counselling among middle-aged men at high risk of CVD.

Design: An observational study with a 5-year follow-up.

Setting and intervention: All men aged 40 years in Helsinki have been invited to a visit to evaluate CVD risk from 2006 onwards. A modified version of the North Karelia project risk tool (CVD risk score) served to assess the risk. High-risk men received lifestyle counselling based on their individual risk profile in 2006 and were invited to a follow-up visit in 2011.

Subjects: Of the 389 originally high-risk men, 159 participated in the follow-up visits in 2011. Based on their follow-up in relation the further risk communication, we divided the participants into three groups: primary health care, occupational health care and no control visits.

Main outcome measures: Lifestyle and CVD risk score change.

Results: All groups showed improvements in lifestyles. The CVD risk score decreased the most in the group that continued the risk communication visits in their primary health care centre (6.1 to 4.8 [95% CI ?1.6 to ?0.6]) compared to those who continued risk communication visits in their occupational health care (6.0 to 5.4 [95% CI ?1.3 to 0.3]), and to those with no risk communication visits (6.0 to 5.9 [95% CI ?0.5 to 0.4]).

Conclusions: These findings indicate that individualized lifestyle counselling improves health behaviour and reduces total CVD risk among middle-aged men at high risk of CVD. Sustained improvement in risk factor status requires ongoing risk communication with health care providers.

• KEY POINTS

• Studies of short duration have shown that lifestyle changes reduce the risk of cardiovascular disease among high-risk individuals.

• Sustaining these lifestyle changes and maintaining the lower disease risk attained can prove challenging.

• Cardiovascular disease (CVD) risk assessment and individualized health counselling for high-risk men, when implemented in primary health care, have the potential to initiate lifestyle changes that support risk reduction.

• Attaining a sustainable reduction in CVD risk requires a willingness to engage in risk-related communication from both health care providers and the individual at high risk.