Sleep quality,obstructive sleep apnea,and psychological distress in truck drivers: a cross-sectional study

Purpose

Sleep disorders are highly prevalent in truck drivers. The aim of this study is to evaluate the prevalence of self-reported obstructive sleep apnea (OSA) and poor sleep quality in truck drivers, and to analyze the relationship between sleep problems and mental health.

Methods

A total of 526 male truck drivers (mean age 45.9; DS 9.4) responded to a questionnaire about risk factors for OSA (STOP-Bang), sleep quality perception (Pittsburg sleep questionnaire inventory, PSQI), excessive daytime sleepiness (Epworth sleepiness scale, ESS), and psychological disorders (general health questionnaire, GHQ-12).

Results

It was found that 51.1% of the drivers were at risk of OSA, 17.3% had bad sleep quality, and 8.9% had excessive daytime sleepiness (EDS). The association between psychological distress, OSA (OR?=?1.67; CI 95% 0.99–2.83; p?=?0.057), bad sleep quality (OR?=?2.58; CI 95% 1.52–4.37; p?<?0.001), and EDS (OR?=?1.65; CI 95% 0.83–3.30; p?=?0.151) was assessed.

Conclusions

The high prevalence of sleep problems, especially suspected OSA, and low quality of sleep in truck drivers can worsen the general and psychological wellbeing of the workers. Educational programs focusing on sleep hygiene and behavioral interventions are needed to promote adequate sleep habits and improve individual and public health.

     

Methylenetetrahydrofolate reductase C677T polymorphism and susceptibility to epilepsy

Background

Methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism was reported as risk factor for multiple diseases due to its role in conversion of homocysteine to methionine. The aim of the present meta-analysis was to find out the validity of association of C677T polymorphism with epilepsy susceptibility.

Methods

Pubmed, Science Direct, Springer Link and Google Scholar, databases were searched for relevant studies up to January, 31, 2018. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were performed using five genetic models. All statistical analysis was done by MetaAnalyst and Mix programs.

Results

Except recessive model, significant association was found between MTHFR C677T polymorphism and epilepsy risk in other four genetic models (T vs C: OR?=?1.29, 95% CI?=?1.08–1.52, p?=?0.004; TT vs CC: OR?=?1.48, 95% CI?=?1.19–1.82, p?=?0.0003; TT + CT vs CC: OR?=?1.20, 95% CI?=?1.05–1.38, p?=?0.008; TT vs CT + CC: OR?=?1.35, 95% CI?=?1.11–1.62, p?=?0.002). Similarly, in the subgroup analysis based on ethnicity, significant association was found in Asian (T vs C: OR?=?1.85; 95% CI?=?1.15–2.99; p?=?0.03) and Caucasian populations (TT vs CC: OR?=?1.38; 95% CI?=?1.10–1.1.73; p?=?0.005). No evidence of heterogeneity and publication bias was detected in present meta-analysis.

Conclusion

In conclusion, results of present meta-analysis suggested that 677T allele of MTHFR is significantly increases the epilepsy susceptibility.

     

The initial glycemic variability is associated with early neurological deterioration in diabetic patients with acute ischemic stroke

The association between glycemic variability and early neurological deterioration (END) in acute ischemic stroke remains unclear. This study attempted to explore whether initial glycemic variability increases END in diabetic patients with acute ischemic stroke. We enrolled type 2 diabetic patients undergoing acute ischemic stroke from November 2015 to November 2016. A total of 336 patients within 72 h from stroke onset were included. The serum glucose levels were checked four times per day during the initial 3 hospital days. The standard deviation of blood glucose (SDBG) values and the mean amplitude of glycemic excursions (MAGE) were calculated for glycemic variability. END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥?2 points between hospital days 0 and 5. The frequencies of END and HbA1c were significantly different in subjects grouped according to tertiles of MAGE (9.09, 12.07 and 50.00%, p?<?0.001 for END; 7.36?±?1.91, 7.83?±?1.93 and 8.56?±?1.79, p?<?0.001 for HbA1c). Compared to patients without END, patients with END had significantly higher HbA1c levels (8.30?±?1.92 vs 7.80?±?1.93, p?=?0.043), increased SDBG (3.42?±?1.14 vs 2.60?±?0.96, p?<?0.001), and increased MAGE (6.46?±?2.09 vs 4.59?±?1.91, p?<?0.001). In a multivariable logistic regression, stroke etiology (OR 0.675; 95% CI 0.485–0.940, p?=?0.020), baseline NIHSS (OR 1.086; 95% CI 1.004–1.175, p?=?0.040), and MAGE (OR 1.479; 95% CI 1.162–1.882, p?=?0.001) were significantly associated with END. Initial glycemic variability is associated with END in diabetic patients with acute ischemic stroke.     

Long-Term Outcomes in Patients with Anemia And Cerebral Venous Thrombosis

Background

Anemia is associated with unfavorable functional outcome in ischemic and hemorrhagic stroke. However, the relationship between anemia and prognosis in patients with cerebral venous thrombosis (CVT) has not been studied.

Methods

Consecutive CVT patients were retrospectively identified from November 2011, through January 2017. Anemia was defined according to the World Health Organization criteria (non-pregnant female hemoglobin level?<?120 g/L, pregnant female?<?110 g/L and male?<?130 g/L), which was further classified as mild, moderate, and severe anemia according to hemoglobin concentration, and as microcytic, normocytic, and macrocytic anemia according to mean corpuscular volume. Unfavorable outcome was defined as modified Rankin Scale (mRS) of 3–6. Factors such as age, sex, coma, malignancy, intracerebral hemorrhage, and straight sinus and/or deep CVT involved, premorbid mRS were adjusted to evaluate the relationship between anemia and prognosis in CVT patients.

Results

A total of 238 CVT patients were included, among whom 73 patients (30.67%) were diagnosed with anemia. Multivariate logistic regression analysis showed that patients with anemia had a higher risk of mRS of 3–6 (OR?=?3.62; 95% CI, 1.45–9.01; P?=?0.006) and mortality (OR?=?5.46; 95% CI, 1.90–15.70; P?=?0.002). Subgroup analysis showed that severe anemia was independently associated with mRS of 3–6 (OR?=?8.80; 95% CI, 1.90–40.81; P?=?0.005) and mortality (OR?=?9.82; 95% CI, 1.81–53.25; P?=?0.010). Similarly, microcytic anemia increased the risk of mRS of 3–6 (OR?=?4.64; 95% CI, 1.48–14.52; P?=?0.008) and mortality (OR?=?9.68; 95% CI, 2.61–35.91; P?=?0.001). In addition, our study also revealed that lower hemoglobin level, evaluated as a continuous variable, was inversely associated with mRS of 3–6 (OR?=?0.98; 95% CI, 0.96–0.99; P?=?0.007) and mortality (OR?=?0.97; 95% CI, 0.95–0.99; P?=?0.005).

Conclusions

Anemia was a significant and independent predictor of unfavorable functional outcome in patients with CVT.

     

Long non-coding RNA <Emphasis Type="Italic">H19</Emphasis> and <Emphasis Type="Italic">MALAT1</Emphasis> gene variants in patients with ischemic stroke in a northern Chinese Han population

Objectives Long non-coding RNAs (lncRNAs) have been identified as key regulators in the development of atherosclerosis, which is a major cause of ischemic stroke. However, to date, there are no reports on the association between lncRNA gene variation and the risk of ischemic stroke. Therefore, we assessed the association between H19 and MALAT1 gene polymorphisms and susceptibility to ischemic stroke in a northern Chinese Han population. Methods In our study, we genotyped four genetic variations in lncRNA-H19 and -MALAT1 (rs217727, rs2251375, rs619586, and rs3200401) in a case–control study of 567 ischemic stroke patients and 552 control subjects. Results We found that the TT genotype of the rs217727 polymorphism within H19 was significantly associated with increased risk of ischemic stroke in our northern Chinese Han population (odds ration (OR)?=?1.519, 95% confidence interval (CI)?=?1.072–2.152, p?=?0.018). Stratified analysis based on stroke subtype revealed that the increased risk was more evident in small vessel ischemic stroke (OR?=?1.941, 95% CI?=?1.260–2.992, p?=?0.02). Individuals with the TT genotype had a 1.941 times higher risk of small vessel ischemic stroke when compared with the subjects of CC?+?CT. These correlations remained after adjusting for confounding risk factors of stroke (OR?=?1.913, 95% CI?=?1.221–2.998, p?=?0.005). However, there was no significant association between H19 rs2251375 or MALAT1 rs3200401 and ischemic stroke in either total population analysis or subgroup analysis. Conclusion In conclusion, our findings suggest that the H19 rs217727 gene polymorphism contributes to small vessel ischemic stroke susceptibility in the Chinese Han population and may serve as a potential indicator for ischemic stroke susceptibility.     

Community-level social capital,parental psychological distress,and child physical abuse: a multilevel mediation analysis

Purpose

The purpose of this study was to investigate the association between community-level social capital and physical abuse towards children, and the mediating effect of parental psychological distress by multilevel mediation analyses.

Methods

We analyzed data from a population-based study of first-grade elementary school children (6–7 years old) in Adachi City, Tokyo, Japan. The caregivers of first-grade students from all elementary schools in Adachi City (N?=?5355) were asked to respond to a questionnaire assessing parents’ self-reported physical abuse (beating and hitting) and neighborhood social capital. Among them, 4291 parents returned valid responses (response rate 80.1%). We performed multilevel analyses to determine the relationships between community-level parental social capital and physical abuse, and further multilevel mediation analyses were performed to determine whether parental psychological distress mediated the association.

Results

Low community-level social capital was positively associated with physical abuse (both beating and hitting) after adjustment for other individual covariates (beating: middle, OR?=?1.54, 95% CI 1.11–2.13; low, OR?=?1.33, 95% CI 0.94–1.88; and hitting: middle, OR?=?1.35, 95% CI 1.02–1.80; low, OR?=?1.16, 95% CI 0.86–1.57). Multilevel mediation analyses revealed that community-level parental psychological distress did not mediate the association (indirect effect ß?=?0.10, 95% CI ??0.10 to 0.29, p?=?0.34 for beating; ß?=?0.03, 95% CI ??0.16 to 0.23, p?=?0.74 for hitting).

Conclusions

Fostering community-level social capital might be important for developing a strategy to prevent child maltreatment, which may have a direct impact on abusive behavior towards children.

     

Peripheral neuropathy in HIV patients in sub-Saharan Africa failing first-line therapy and the response to second-line ART in the EARNEST trial

Sensory peripheral neuropathy (PN) remains a common complication in HIV-positive patients despite effective combination anti-retroviral therapy (ART). Data on PN on second-line ART is scarce. We assessed PN using a standard tool in patients failing first-line ART and for 96 weeks following a switch to PI-based second-line ART in a large Randomised Clinical Trial in Sub-Saharan Africa. Factors associated with PN were investigated using logistic regression. Symptomatic PN (SPN) prevalence was 22 % at entry (N?=?1,251) and was associated (p?<?0.05) with older age (OR?=?1.04 per year), female gender (OR?=?1.64), Tuberculosis (TB; OR?=?1.86), smoking (OR?=?1.60), higher plasma creatinine (OR?=?1.09 per 0.1 mg/dl increase), CD4 count (OR?=?0.83 per doubling) and not consuming alcohol (OR?=?0.55). SPN prevalence decreased to 17 % by week 96 (p?=?0.0002) following similar trends in all study groups (p?=?0.30). Asymptomatic PN (APN) increased over the same period from 21 to 29 % (p?=?0.0002). Signs suggestive of PN (regardless of symptoms) returned to baseline levels by week 96. At weeks 48 and 96, after adjusting for time-updated associations above and baseline CD4 count and viral load, SPN was strongly associated with TB (p?<?0.0001). In summary, SPN prevalence was significantly reduced with PI-based second-line therapy across all treatment groups, but we did not find any advantage to the NRTI-free regimens. The increase of APN and stability of PN-signs regardless of symptoms suggest an underlying trend of neuropathy progression that may be masked by reduction of symptoms accompanying general health improvement induced by second-line ART. SPN was strongly associated with isoniazid given for TB treatment.     

Relative Telomere Length and Stroke Risk in a Chinese Han Population

This study aimed to further understand the role of relative telomere length (RTL) in susceptibility to stroke and investigate the association regulator of telomere elongation helicase 1 (RETL1) gene polymorphisms and RTL. RTL was measured using the real-time quantitative polymerase chain reaction (qPCR) from 300 stroke patients and 299 healthy controls. Genotyping was performed using the Sequenom MassARRAY platform. The results indicated that stroke patients had significantly shorter median RTL than controls (P?<?0.001). Compared with the longer RTL (≥?0.766), the shorter RTL (<?0.766) was significantly increased the risk of stroke (odds ratio [OR]?=?8.44, 95% confidence interval [CI] 5.42–13.14, P?<?0.001). The RTL was categorized into tertiles, we found that the shorter RTL (0.515–1.366) (OR?=?16.27, 95% CI 7.72–34.29, P?<?0.001) and lowest RTL (<?0.515) (OR?=?30.63, 95% CI 14.27–65.75, P?<?0.001) were significantly increased stroke risk compared with the highest RTL (>?1.366). Stratified analysis showed that the shorter RTL was also significantly increased the risk of stroke compared with the longer RTL in male, age <?60 years and ≥?60 years, except the female participants. In addition, individuals with the genotypes AA (rs2297441) and GG (rs6089953) have shorter telomeres than the genotypes GG (P?=?0.031) and AA (P?=?0.032), respectively. Our results suggested that shorter RTL was associated with an increased risk of stroke. The association was found between the genotypes AA (rs2297441) and GG (rs6089953) and shorter RTL in case group. Further studies in larger sample size and biological functional assays are warranted to validate our findings.     

The urgent neurological consultation in the population of the province of Ferrara,Italy

In the province of Ferrara, Italy, the urgent neurological consultation (UNC) cases in the population correspond to the resident outpatients who undergo a UNC in the ER of the university hospital of Ferrara (UHFe). Thanks to this health organization a retrospective survey identified 612 UNC cases (range of age 7–102 years, median 67,5 years) in the study period giving a period prevalence rate of 173 per 100,000 (95% CI 159.3–187.3) which increased with age (χ² for trend?=?178.4 p?<?0.001). The daily UNC cases (range 0–14, mean?=?7.3, 95% CI 7.1–7.5) followed the Poisson distribution (goodness-of-fit test: λ?=?7.3, χ²?=?8082, 12 freedom degrees, p?>?0.70). The prevalence rate decreased with the distance between the patients’ residence and the UHFe (χ² for trend?=?82.9, p?<?0.001). The commonest clinical conditions requiring UNCs were acute cerebrovascular disorders (28%), headache (14%), and vertigo (9%). The hospital admission rate was 32.5% which increased with age (χ² for trend?=?35.8, p?<?0.001). The commonest discharge diagnoses of the admitted cases were ischemic stroke (57.3%), epilepsy (7%), TIA (6%), and intraparenchymal hemorrhage (5.5%). Acute cerebrovascular disease accounted for 69% of the discharge diagnoses. The survey showed that the UNCs’ demand was higher than previous Italian data confirming that acute cerebrovascular disease is the most frequent acute neurological condition requiring attention in the ER. It also suggested that the UNCs could be poorly appropriate. These findings would require the healthcare administrators attention.     

Association between hyperuricemia and metabolic syndrome in patients suffering from bipolar disorder

Background

Clinical studies have shown that bipolar patients have increased serum uric acid levels. High serum uric acid levels could play a role contributing to high prevalence of metabolic syndrome. Metabolic syndrome is known to increase the risk of developing a number of life threatening diseases including coronary heart disease, hypertension, and type 2 diabetes. This study investigated the association between hyperuricemia and metabolic syndrome and its components in individuals suffering from bipolar disorders.

Methods

This study recruited 318 inpatients suffering from bipolar disorders from Beijing Hui-Long-Guan Hospital in China and 160 healthy subjects from the same region as the controls. We used National Cholesterol Education Program Adult Treatment Panel III Adapted criteria (NCEP ATP-III A) for the diagnosis of metabolic syndrome. Hyperuricemia was determined as serum uric acid level above 420?μmol/L in men and 360?μmol/L in women (N Engl J Med 359(17):1811–1821, 2008).

Results

Among 318 bipolar patients, there was higher prevalence of metabolic syndrome (42.5%) and hyperuricemia (27.7%) than healthy controls (21.9 and 11.9%). Bipolar patients with metabolic syndrome had increased prevalence of hyperuricemia (OR?=?3.0, CI95 [1.7–5.4]). Hypertriglyceridemia and larger waist circumference (WC) were associated with hyperunicemia (OR?=?1.8, CI95 [1.1–3.1], OR?=?1.9, CI95 [1.1–3.4]). Hyperuricemia was associated with metabolic syndrome in bipolar patients (p?<?0.001) and especially with hypertriglyceridemia (OR?=?1.9, CI95 [1.1–3.1] and increased WC (OR?=?2.1 [1.2–4.0]). Bipolar patients over 50?years of age and hyperuricemia were highly prone to develop metabolic syndrome (OR?=?14.0, CI95 [5.0–39.0]).

Conclusions

Hyperuricemia was highly associated with development of metabolic disorder particularly for aged patients suffering from bipolar disorders. Early prevention of hyperuricemia and metabolic syndrome may lead better life for bipolar patients when they get older.

     

Determinants of Anxiety and Depression Among University Students of Lahore

Benefits from an improved understanding of mental health of young adults, particularly students, affecting their academic performance are likely to be numerous. Thus, we aimed at evaluating anxiety and depression among annual and semester university students of Lahore, Pakistan. A cross-sectional study of 7 months duration was designed by enrolling a total of 404 students from two private and two public sector universities of Lahore. We found significant differences in frequency distribution with regard to age (p?=?0.003), marital status (p?=?0.01), living status (p?=?0.004), and reasons affecting of mental health (p?=?0.004) between annual and semester system students. Students enrolled in annual system exhibited higher odds of anxiety, mild (OR 2.7, p?=?0.019), and extremely severe (OR 2.6, p?=?0.002), compared to semester students. In overall assessment of university students, after univariate analysis, multivariate analysis demonstrated significant association of depression with male students (OR 2.3, p?=?0.001), age?≤?22 years (OR 2.8, p?=?0.0005) and living status (OR 5.96, p?=?0.0005). Similarly, as for anxiety, only male students demonstrated higher odds of anxiety (OR 2.8, p?=?0.0005). As expected, compared to a single reason, multiple reasons affecting student’s mental health demonstrated significant association with all three determinants of mental health, i.e., stress (OR 0.36, p?=?0.0005), anxiety (OR 0.31, p?=?0.0005), and depression (OR 0.5, p?=?0.0005). Taken together, these data suggested higher prevalence of anxiety among annual system students, mainly because of studies, while in overall assessment male students and students at an early stage of their life at the university were susceptible to anxiety and depression, probably due to multiple reasons affecting their mental health.     

Semi-quantitative dopamine transporter standardized uptake value in comparison with conventional specific binding ratio in [123I] FP-CIT single-photon emission computed tomography (DaTscan)

Purpose

We developed a new analytical method to quantify the dopamine transporter (DAT) radiation dose in the striatum on [¹²³I] FP-CIT single-photon emission computed tomography (SPECT). This method is based on the dopamine transporter standardized uptake value (DaTSUV). The purpose of this study was to compare DaTSUV with the classical specific binding ratio (SBR) in the discrimination of dopaminergic neurodegenerative diseases (dNDD) from non-dNDD.

Method

Seventy-seven consecutive patients who underwent DaTscan were included. Patients were divided into a dNDD group (n?=?44; 24 men, 20 women; median age 73 years) and a non-dNDD group (n?=?33; 14 men, 19 women; median age 75 years) based on their clinical diagnoses. The relationship between each method was evaluated by Pearson’s correlation coefficient. Differences in SBR and DaTSUV in each group were evaluated by t test. Pairwise comparison of receiver operating characteristic (ROC) curve analysis was performed to compare the discriminating abilities of each method according to the standard error of the area under the curve (AUC). A value of p?<?0.05 was considered statistically significant.

Result

There was a significant strong correlation between DaTSUV and SBR (r?=?0.910 [95% CI?=?0.862–0.942], p?<?0.001). The dNDD group showed significantly lower SBR (3.48 [1.25–7.91] vs 6.58 [3.81–11.1], p?<?0.001) and DaTSUV (4.91 [1.59–13.6] vs 8.61 [2.29–15.6], p?<?0.001) than the non-dNDD group. The discriminating ability of SBR (AUC?=?0.918) was significantly higher than that of DaTSUV (AUC?=?0.838, p?=?0.0176).

Conclusion

DaTSUV has a good correlation with SBR, but it could not exceed SBR for discriminating dNDD from non-dNDD.

     

Anti-vascular endothelial growth factor in glioblastoma: a systematic review and meta-analysis

Glioblastoma is one of the most common primary brain tumors in adults. The current treatment strategies failed to achieve satisfactory outcomes. Anti-vascular endothelial growth factor (anti-VEGF) agents have been proposed to enhance the survival and quality of life in these patients. To investigate this, different databases were searched in addition to hand searching. Relevant studies were screened and only ten randomized controlled trials (RCTs) met the eligibility criteria; six of them were considered for meta-analysis. Eligible RCTs were assessed regarding risk of bias using the Cochrane tool. Relevant data were extracted and meta-analysis was conducted using the random effects model analysis on RevMan software. One thousand seventy-eight patients in the anti-VEGF group and 946 patients in the control group were available for analysis. No statistically significant improvement in the overall survival (OS) was detected for anti-VEGF (OR 0.87, 95% CI 0.7–1.09, p?=?0.23) or bevacizumab subgroup (OR 0.84, 95% CI 0.65–1.08, p?=?0.17) compared to standard therapy alone. However, the progression-free survival (PFS) showed a significant improvement with both anti-VEGF (OR 0.76, 95% CI 0.65–0.89, p?=?0.0007) and bevacizumab subgroup (OR 0.75, 95% CI 0.65–0.87, p?=?0.0001). In conclusion, anti-VEGF agents can improve the PFS but not OS in glioblastoma patients. The current evidence is not satisfactory to declare a new therapeutic line. Further RCTs with sharply determined outcomes and assessment methods are required.     

Evaluation of STESS,mRSTESS, and EMSE to Predict High Disability and Mortality at Hospital Discharge in Ecuadorian Patients with Status Epilepticus

Background

Adequate identification of the severity of status epilepticus (SE) contributes to individualized treatment. The scales most widely used for this purpose are: Status Epilepticus Severity Score (STESS), Epidemiology-Based Mortality Score in Status Epilepticus (EMSE) and modified Rankin Scale STESS (mRSTESS). The aim of this study was to evaluate the performance of the STESS, EMSE and mRSTESS scales to predict high disability and hospital mortality at discharge (HD/HM).

Methods

A prospective study was conducted in which total of 41 patients were registered from November 2015 to January 2018 at Eugenio Espejo Hospital. Clinical variables such as age, sex, clinical status at the beginning of the SE, initial symptom of SE, as well as the STESS, mRSTESS and EMSE variant scales were studied at the time of the diagnosis of SE.

Results

A total of 41 patients were evaluated, of which 8 (19.5%) had HD at hospital discharge and died 13 (31.7%) during their care. The area under the receiver operating characteristic curve to predict HD/HM was 0.71 (95% CI (confidence interval) 0.55–0.87), 0.81 (95% CI 0.67–0.94), 0.89 (95% CI 0.79–0.99), 0.90 (95% CI 0.80–1.0), 0.89 (95% CI 0.78–0.99) for the STESS, mRSTESS, EMSE-EAC (etiology, age, comorbidities), EMSE-EACEG (etiology, age, comorbidities, electroencephalography) and EMSE-ECLEG (etiology, age, level of consciousness at pre-treatment, electroencephalography), variants of EMSE, respectively. The binary logistic regression demonstrated how the following cut-off points were determined: STESS OR (odd ratio) 4.80 (p?=?0.02), mRSTESS OR 7.89 (p?=?0.00), EMSE-EAC OR 22.16 (p?=?0.00), EMSE-ECLEG OR 18.00 (p?=?0.00), EMSE-EACEG OR 14 (p?=?0.00).

Conclusions

All of the evaluated scales (STESS, mRSTESS, and EMSE) were shown to be useful in predicting HD/HM. EMSE was observed to be the most effective of the scales, with relative similarities among the variants.

     

Exercise Dependence and Maladaptive Perfectionism: the Mediating Role of Basic Psychological Needs

The main purpose of the present investigation, based on Self-Determination Theory, was to examine the mediating role of basic psychological needs (Autonomy, Competence, and Relatedness) on the relationship between exercise dependence and maladaptive perfectionism. Participants were 169 Italian subjects, of whom 85 were male and 84 were female (age: M?=?22.76; SD?=?4.99), who regularly performed exercise for more than a year. A Structural Equation Modeling (SEM) analysis showed that the full mediation model in which maladaptive perfectionism was only indirectly related to exercise dependence through needs satisfaction and needs thwarting yielded an acceptable fit χ² (99)?=?175.25, p?<?.01; CFI?=?.93; NNFI?=?.91; SRMR?=?.07, RMSEA?=?.07 (90 % CI?=?.05–.08). Maladaptive perfectionism had a direct positive effect on needs thwarting (β?=?.51, p?<?.001; 95 % CI?=?.35 to .66). Exercise dependence was both positively related to needs satisfaction (β?=?.36, p?<?.001; 95 % CI?=?.13 to .57) and to needs thwarting (β?=?.48, p?<?.001; 95 % CI?=?.24 to .69). Furthermore, psychological needs thwarting exclusively mediates the influence of maladaptive perfectionism on exercise dependence (β?=?.21, p?<?.05; 95 % CI?=?.03 to .39). These findings contribute to better understanding the factors that may underpin the relationship between exercise dependence and perfectionism in light of self-determination theory.     

Prophylactic Anticonvulsants in Intracerebral Hemorrhage

Background and Purpose

Prophylactic anticonvulsants are routinely prescribed in the acute setting for intracerebral hemorrhage (ICH) patients, but some studies have reported an association with worse outcomes. We sought to characterize the prevalence and predictors of prophylactic anticonvulsant administration after ICH as well as guideline adherence. We also sought to determine whether prophylactic anticonvulsants were independently associated with poor outcome.

Methods

We performed a retrospective study of primary ICH in our two academic centers. We used a propensity matching approach to make treated and non-treated groups comparable. We conducted multiple logistic regression analysis to identify independent predictors of prophylactic anticonvulsant initiation and its association with poor outcome as measured by modified Rankin score.

Results

We identified 610 patients with primary ICH, of whom 98 were started on prophylactic anticonvulsants. Levetiracetam (97%) was most commonly prescribed. Age (OR 0.97, 95% CI 0.95–0.99, p < .001), lobar location (OR 2.94, 95% CI 1.76–4.91, p < .001), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR 2.31, 95% CI 1.40–3.79, p = .001), craniotomy (OR 3.06, 95% CI 1.51–6.20, p = .002), and prior ICH (OR 2.36, 95% CI 1.10–5.07, p = .028) were independently associated with prophylactic anticonvulsant initiation. Prophylactic anticonvulsant use was not associated with worse functional outcome [modified Rankin score (mRS) 4–6] at hospital discharge or with increased case-fatality. There was no difference in prescribing patterns after 2010 guideline publication.

Discussion

Levetiracetam was routinely prescribed following ICH and was not associated with worse outcomes. Future investigations should examine the effect of prophylactic levetiracetam on cost and neuropsychological outcomes as well as the role of continuous EEG in identifying subclinical seizures.

     

Minocycline for acute stroke treatment: a systematic review and meta-analysis of randomized clinical trials

Background

Various randomized-controlled clinical trials (RCTs) have investigated the neuroprotective role of minocycline in acute ischemic stroke (AIS) or acute intracerebral hemorrhage (ICH) patients. We sought to consolidate and investigate the efficacy and safety of minocycline in patients with acute stroke.

Methods

Literature search spanned through November 30, 2017 across major databases to identify all RCTs that reported following efficacy outcomes among acute stroke patients treated with minocycline vs. placebo: National Institute of Health Stroke Scale (NIHSS), Barthel Index (BI), and modified Rankin Scale (mRS) scores. Additional safety, neuroimaging and biochemical endpoints were extracted. We pooled mean differences (MD) and risk ratios (RR) from RCTs using random-effects models.

Results

We identified 7 RCTs comprising a total of 426 patients. Of these, additional unpublished data was obtained on contacting corresponding authors of 5 RCTs. In pooled analysis, minocycline demonstrated a favorable trend towards 3-month functional independence (mRS-scores of 0–2) (RR?=?1.31; 95% CI 0.98–1.74, p?=?0.06) and 3-month BI (MD?=?6.92; 95% CI ??0.92, 14.75; p?=?0.08). In AIS subgroup, minocycline was associated with higher rates of 3-month mRS-scores of 0–2 (RR?=?1.59; 95% CI 1.19–2.12, p?=?0.002; I²?=?58%) and 3-month BI (MD?=?12.37; 95% CI 5.60, 19.14, p?=?0.0003; I²?=?47%), whereas reduced the 3-month NIHSS (MD ??2.84; 95% CI ??5.55, ??0.13; p?=?0.04; I²?=?86%). Minocycline administration was not associated with an increased risk of mortality, recurrent stroke, myocardial infarction and hemorrhagic conversion.

Conclusions

Although data is limited, minocycline demonstrated efficacy and seems a promising neuroprotective agent in acute stroke patients, especially in AIS subgroup. Further RCTs are needed to evaluate the efficacy and safety of minocycline among ICH patients.

     

Prevalence of restless legs syndrome in individuals with migraine: a systematic review and meta-analysis of observational studies

Objective

Recent studies have shown an association between migraine and restless legs syndrome (RLS), but RLS prevalence among individuals with migraine differs substantially across studies. The present work aimed to comprehensively assess available evidence to estimate RLS prevalence among individuals with migraine and non-migraine controls.

Method

Web of Science, PubMed, Embase, Chinese National Knowledge Infrastructure, Wanfang, and SinoMed databases were searched for observational and case-control studies of RLS prevalence among individuals with migraine. Eligible studies were meta-analyzed using Stata 12.0 software.

Results

Pooled RLS prevalence in migraine was 19%, and the prevalence was lower in Asia (16%) than outside Asia (21%). Pooled RLS prevalence was 18.8% among individuals with migraine with aura, and 18.5% among individuals with migraine without aura; the RLS prevalence in migraine with aura (MA) was higher than that of migraine without aura (MO) (OR 1.17, 95%CI 1.01–1.34; p?=?0.037). Pooled RLS prevalence in a case-control study was significantly higher among individuals with migraine (17.9%) than among non-migraine controls (7.1%) (OR 2.65, 95%CI 2.26–3.10; p?<?0.001).

Conclusion

Our meta-analysis provides the first reliable pooled estimate of RLS prevalence among individuals with migraine, and it provides strong evidence that RLS risk is higher among individuals with migraine than among controls.