Association of serum uric acid with risk of stroke in US adults: A cross-sectional study from NHANES 1999–2020

Background and aimsThe validity of high uric acid levels as an independent cause of stroke remains controversial, and the association between its low concentration and stroke is unclear. This study determines how different serum uric acid (SUA) levels are associated with stroke risk.MethodsThis cross-sectional study used continuous National Health and Nutrition Examination Survey data in the United States during 1999–2020. The SUA levels of 6.0, 6.8, and 9.0 mg/dL were all considered as cut-off points. Restricted cubic spline interpolation and logistic regression models were used to evaluate the different associations. Subgroup analyses and sensitivity analyses were conducted to evaluate the influence of multiple factors on the outcomes.ResultsThe study included 23,413 participants aged ≥ 20 years. A J-shaped curve existed between SUA and stroke risk, and the risk of stroke was positively correlated with SUA levels in the overall population. Subgroup analysis of all adults in the SUA 6.8–9.0 mg/dL group showed that stroke risk for non-Hispanic white, obese, ex-smoker, and heavy drinking groups was increased, but for the other Hispanic group was reduced. In the SUA < 6.0 mg/dL group, stroke risk for ex-smoker, heavy drinkers, and no chronic kidney disease groups was increased.ConclusionOur findings indicate a J-shaped relationship between SUA levels and stroke risk. Low and high SUA levels increased stroke risk for different populations, except in the other Hispanic population. Early SUA management is highly significant for stroke prevention in high-risk populations.     

“Speaking for” behaviours in spouses of people with aphasia: A descriptive study of six couples in an interview situation

Background: People with aphasia and their spouses frequently meet professionals to discuss health‐related issues. In this situation, which is often in an interview form, various strategies may be employed by spouses to facilitate communication. One of these strategies is “speaking for” the person with aphasia. Aims: (1) To identify the presence of “speaking for” behaviour, to measure the frequency of the spouses' “speaking for” and “rapid speaking for” behaviours, and to describe what preceded and followed these behaviours for all participating couples. (2) To describe each individual couple's patterns of “speaking for” in relationship to the members' perceptions of conversations before and after the onset of aphasia. Methods & Procedures: Six couples were studied in an interactive situation. Both the spouse with aphasia and the non‐aphasic spouse took turns being asked questions in a systematic way. Each member also participated individually in a semi‐structured interview aiming to obtain information on perceptions of communication before and since the aphasia. Outcomes & Results: Analysis of three‐way conversations revealed that all of the spouses without aphasia in this study used some “speaking for” behaviours. However, there was great variability in the frequency of the behaviours within couples. For some couples, “speaking for” the person with aphasia may reduce that person's ability or willingness to participate in conversations. The findings from the semi‐structured interviews suggest that “speaking for” a person with aphasia may be an integral behaviour for some couples that is consistent with pre‐stroke interaction patterns. Conclusions: It is important to consider the “speaking for” behaviour, the impact of this behaviour, and the pre‐stroke interaction pattern when helping couples adjust to the consequences of aphasia.     

Reduced skilfulness of arm motor behaviour among motor stroke patients with good clinical recovery: does it indicate reduced automaticity? Can it be improved by unilateral or bilateral training? A kinematic motion analysis study

Functional cortical reorganisation had been demonstrated to accompany recovery from motor stroke. In agreement with a previous study, quantitative kinematic analysis of aimed movements in 14 almost completely recovered hemiparetic stroke patients and 14 healthy control subjects indicated a reduced skilfulness of both the more ballistic initial movement phase and the more feedback-guided late homing-in phase of aimed movements. By means of two dual motor tasks it was further investigated whether the reduced skilfulness of patients was due to an increased attentional demand and thus a reduced automaticity of motor control. Interference effects by dual tasks, however, were similar for patients and control subjects. Thus, the notion of reduced automaticity could not be supported empirically, and reduced skilfulness seemed rather related to residual pyramidal motor deficits. By means of a repetitive daily training for 1 week based on the Arm Ability Training approach, patients were able to reduce their performance deficits in both movement phases significantly. Whether patients practised with the affected arm or simultaneously with both the affected and non-affected arm only marginally modified outcome, unilateral training being slightly more efficacious. These findings demonstrate that even clinically minor residual motor deficits can be improved by a structured training for the affected arm.     

What is it like to be a person with schizophrenia in the social world? A first-person perspective study on Schizophrenic dissociality--part 1: state of the art

This is a critical review of research on the subjective experience of social dysfunction in persons with schizophrenia. Studies from the phenomenological and cognitive paradigms are examined, and significant outcomes and shortcomings are pointed out. Clinical phenomenologists have mainly interpreted schizophrenic dissociality as an anomaly of prereflexive attunement. The main shortcoming of phenomenological research is that it lacks adequate methodology to collect reliable data since most studies are based on the analysis of a few typical cases. Cognitivism has reliably documented disorders of social functioning in large-scale experimental studies. The main shortcoming of most cognitive paradigms is that they do not properly investigate the personal level of experience in real-world functioning. We conclude that there is a need to reliably collect data through quantitative as well as qualitative methodology as established and accepted by the scientific community in the area of schizophrenic dissociality, reflecting the subjective experiences of people with schizophrenia in the real world.     

Commentary on: “The response and survival of children with recurrent diffuse intrinsic pontine glioma based on phase II study of antineoplastons A10 and AS2-1 in patients with brainstem glioma.” By Burzynski et al.

A potential effective therapy for diffuse intrinsic pontine glioma (DIPG) is far to be developed. There are no “shortcuts” to reach this goal. Only a rigid, scientific, and ethically correct approach can help develop effective therapeutic approaches for such a devastating brain tumor. There are no alternative ways. The children affected by DIPG deserve to become the focus of serious collaborative researches. For these children, there are many “lacks” which should be promptly corrected such as the lack of knowledge, the lack of basic and clinical scientists’ passion to the problem of finding “the solution” for DIPG, the lack of rigid methods to run research in this frustrating field, the lack of research proposals, and the lack of serious, despite not magic, protocols to offer them.     

Commentary on “The Cerebellar System and What it Signifies from a Biological Perspective: A Communication by Christofredo Jakob (1866–1956) Before the Society of Neurology and Psychiatry of Buenos Aires,December 1938”

This commentary highlights a “cerebellar classic” by a pioneer of neurobiology, Christfried Jakob. Jakob discussed the connectivity between the cerebellum and mesencephalic, diencephalic, and telencephalic structures in an evolutionary, developmental, and histophysiological perspective. He proposed three evolutionary morphofunctional stages, the archicerebellar, paleocerebellar, and neocerebellar; he attributed the reduced cerebellospinal connections in humans, compared to other primates, to the perfection of the rubrolenticular and thalamocortical systems and the intense ascending pathways to the red nucleus in exchange for the more elementary descending efferent pathways. Jakob hypothesized the convergence of cerebellar pathways in associative cortical regions, insisting on the intimate collaboration of the cerebellum with the frontal lobe. The extensive lines of communication between regions throughout the association cortex substantiate Jakob’s intuition and begin to outline the mechanisms for substantial cerebellar involvement in functions beyond the purely motor domain. Atop a foundation of anatomical and phylogenetic mastery, Jakob conceived ideas that were noteworthy, timely, and have much relevance to our current thinking on cerebellar structure and function.