Common genetic polymorphisms in pre-microRNAs were associated with increased risk of dilated cardiomyopathy

BackgroundCommon single nucleotide polymorphisms (SNPs) in pre-microRNAs may change their property through altering microRNAs (miRNAs) expression and/or maturation, resulting diverse functional consequences. We conducted a pilot study to test whether SNPs in pre-microRNAs were associated with dilated cardiomyopathy (DCM).MethodsGenotypes of 3 SNPs in pre-miRNAs (has-mir-196a2 rs11614913 C/T, hsa-mir-499 rs3746444 A/G, hsa-mir-146a rs2910164 C/G) in 221 DCM patients and 321 control subjects were determined with the use of PCR-restriction fragment length polymorphism (RFLP) assay.ResultsSignificantly increased DCM risks were found to be associated with variant allele of has-mir-196a2 rs11614913 C/T (T allele) and hsa-mir-499 rs3746444 A/G (G allele) (P < 0.0001, OR = 1.730, 95% CI = 1.345–2.227, and P < 0.0001, OR = 1.794, 95% CI = 1.350–2.385, respectively). We found that increased DCM risk was statistically significantly associated with these 2 SNPs in a dominant model (P = 0.0001 and P < 0.0001 for rs11614913 and rs3746444, respectively). No association between DCM risk and hsa-mir-146a rs2910164 C/G was observed (P = 0.451, OR = 1.102, 95% CI = 0.856–1.418).ConclusionsBoth the has-mir-196a2 rs11614913 C/T and hsa-mir-499 rs3746444 A/G, but not hsa-mir-146a rs2910164 C/G, are associated with a significantly increased risk of DCM, indicating that common genetic polymorphisms in pre-microRNAs are associated with DCM.     

Impact of a Palliative Care Consultation Team on Cancer-Related Symptoms in Advanced Cancer Patients Referred to an Outpatient Supportive Care Clinic

ContextPatients with advanced cancer may develop severe physical and psychosocial symptoms. There are limited data on the impact of an outpatient palliative consultation (PC) team on cancer-related symptoms.ObjectivesTo study the impact of the PC on symptoms in patients with advanced cancer receiving outpatient palliative care.MethodsFour hundred six consecutive patients referred to a supportive care outpatient center (OPC) from January 2006 to June 2007 with complete Edmonton Symptom Assessment Scale (0–10 scale) at the initial and follow-up visits were reviewed. Patient characteristics, change of symptoms at follow-up visit, and response rate were analyzed. Using logistic regression models, the predictors of improvement of pain and fatigue were assessed.ResultsMedian age was 59 years; 53% were female. Median interval between visits was 15 days. Mean scores at baseline and follow-up visits were fatigue 6.8 and 5.3 (P < 0.0001), pain 5.3 and 4.1 (P < 0.0001), depression 3.2 and 2.5 (P < 0.0001), anxiety 3.7 and 2.8 (P < 0.0001), dyspnea 2.7 and 2.5 (P = 0.05), sleep 5 and 4 (P < 0.0001), and well-being 5.2 and 4.4 (P < 0.0001). Dyspnea (odds ratio and P-value, 0.90, 0.03), nausea (0.92, 0.06), and depression (0.91, 0.04) were associated with improvement in fatigue; drowsiness (1.10, 0.04), and feeling of well-being (0.87, 0.02) were associated with improvement in pain.ConclusionThe initial consult by PC achieved significant symptom improvement in patients receiving treatment in the OPC. Further prospective studies are needed.     

Predictors of health-related quality of life after non-catastrophic injury sustained in a road traffic crash

BackgroundHealth-related quality of life (HRQoL) is an important patient-reported outcome that warrants greater attention in individuals who sustained a non-catastrophic injury in a road traffic crash. Additional robust data on HRQoL outcomes after a non-catastrophic injury are needed to effectively identify potential targets for studies of tertiary prevention of poor recovery after a crash.ObjectiveWe assessed the association between non-catastrophic road traffic crash injuries and HRQoL and factors that independently affect long-term HRQoL.MethodsIn this inception cohort study, injured participants (≥ 17 years old) were identified from various sources including hospital emergency departments by a medical examination by a registered healthcare professional in New South Wales (Australia) and followed up after 12 months. HRQoL was measured by the European Quality of Life–5 Dimensions (EQ-5D-3L) and Medical Outcomes Survey Short Form 12 items (SF-12). A range of socio-demographic, pre-injury health, psychological, and injury-related factors were considered potential predictors of HRQoL in regression analyses.ResultsAmong 2019 individuals identified, 1201 (59.5%) were followed up after 12 months. HRQoL significantly improved between baseline and 12-month follow-up: EQ-5D-3L summary score (0.41-unit difference); SF-12 physical component summary score (PCS; 13.6-unit difference) and mental component summary score (MCS; 3.5-unit difference). Over 12 months, HRQoL score was lower for people claiming compensation than others (P < 0.0001). Key predictors of better 12-month EQ-5D-3L summary score and visual analogue scale score for pain were age, not claiming compensation, reduced body mass index, less pain severity, less pain-related disability, and less general psychological distress. Significant predictors of SF-12 PCS score were injury to the neck (P = 0.02) or head or face (P = 0.01), being a driver or passenger at the time of the crash (P < 0.0001), hospital admission (P < 0.0001) and pain severity (P < 0.0001). Baseline variables associated with 12-month SF-12 MCS scores were head or face injury (P = 0.02), pre-injury health (P = 0.04), pre-injury psychological conditions (P = 0.04), trauma-related distress (P = 0.0002) and general psychological distress (P < 0.0001).ConclusionsA wide spectrum of biopsychosocial factors contribute to HRQoL after a road traffic crash injury. These epidemiological data are potentially important because they could identify potential targets for studies of tertiary prevention of persistently poor HRQoL after such an injury.     

Caspase-cleaved fragments of cytokeratin 18 in patients with chronic hepatitis B

BackgroundDuring hepatocyte apoptosis, intermediate filament protein cytokeratin 18 is cleaved by caspases at Asp396 which can be specifically detected by the monoclonal antibody M30 (M30-antigen). In this study, we sought to determine whether serum M30-antigen levels can serve as a useful biomarker of liver injury in the clinical spectrum of HBV infection.MethodsSerum M30-antigen levels were measured in inactive HBV carriers (n = 54), patients with HBeAg-negative chronic hepatitis B (CHB, n = 47), patients with HBeAg-positive CHB (n = 42) and healthy controls (n = 29). All subjects were treatment-naïve.ResultsThere were significant differences in serum M30-antigen levels across the study groups (P < 0.001; Kruskal–Wallis test). Post hoc analyses revealed that M30-antigen levels did not differ significantly between inactive HBV carriers (median 109.6 U/L) and healthy controls (median 106.1 U/L). However, both patients with HBeAg-negative (CHB, median 182.9 U/L, P < 0.001) and HBeAg-positive CHB (median 158.3 U/L, P < 0.001) had significantly higher levels of M30-antigen compared with inactive HBV carriers.ConclusionsHepatocyte apoptotic activity – as reflected by serum M30-antigen levels – is increased in chronic active hepatitis B, but is not associated with the HBeAg status. In contrast, apoptosis does not appear to be a prominent feature of inactive HBV carriers.     

Immunoluminometric assay for quantification of peroxiredoxin 4 in human serum

BackgroundWe describe the validation of a novel assay for the measurement of peroxiredoxin 4 (Prx4), a potentially secreted antioxidant peroxidase, in human serum.MethodsA sandwich immunoluminometric assay (ILMA) was set up applying monoclonal antibodies against the amino-terminus of human Prx4. Prx4 levels have been determined in serum of healthy individuals and patients with sepsis and have been correlated to the clinically established sepsis marker procalcitonin (PCT).ResultsThe sandwich ILMA detected Prx4 in a range between 0.5 and 128 arbitrary (arb.) U/L and had a functional assay sensitivity of 0.51 arb. U/L. Serum Prx4 was stable for at least 72 h at 4 °C and 21 °C and circulated in a complex of about 330 kDa as characterized by size-exclusion chromatography. Patients with sepsis (n = 45; median, 7.7 arb. U/L) showed significantly higher Prx4 serum levels (P < 0.0001) than healthy controls (n = 274; median, 0.71 arb. U/L). Serum Prx4 was positively correlated to PCT (r = 0.63, P < 0.0001).ConclusionThe newly developed assay reliably detected Prx4 in human serum of healthy and critically ill subjects. Elevated Prx4 in serum of patients with various diseases might serve as a biomarker reflecting increased oxidative stress.     

The validity and reliability of the Incremental Shuttle Walk Test and Six-minute Walk Test compared to an Incremental Cycle Test for people who have had a mild-to-moderate stroke

ObjectiveTo determine the construct validity and test re-test reliability of the Six-minute Walk Test (6MWT) and Incremental Shuttle Walk Test (ISWT) in the sub-acute recovery phase following mild-to-moderate severity stroke.Participants40 stroke patients (mean age: 68.27 years, SD: 13.48) of median National Institutes of Health Stroke Scale (NIHSS) score 1.2 (range: 0 to 8) within six months of stroke.MethodEach participant completed one Incremental Cycle Test (ICT) followed by two ISWT and two 6MWT in a randomised order. Pearson’s Correlation Coefficients were used to determine the validity and Bland Altman plots were used to determine the test re-test reliability.ResultsThe Incremental Cycle Test (ICT) was positively correlated with the ISWT (r = 0.59, 95% confidence intervals 0.35 to 0.76, P = 0.001) and the 6MWT (0.55, 0.35 to 0.71, P < 0.001). The correlation of the ICT with the ISWT and 6MWT was higher for the 17 patients with no residual (ISWT: r = 0.79, P < 0.001; 6MWT: 0.826, P < 0.001) compared to mild-to-moderate neurological impairment (ISWT: r = 0.45, P = 0.03; 6MWT: r = 0.38, P = 0.08). Test–retest reliability for both the ISWT and the 6MWT showed that there was some variability between the first and second tests with a better performance on the second test.ConclusionThe ISWT and 6MWT have a significant, modest correlation with the ICT for stroke patients in the sub-acute recovery phase. The ISWT and 6MWT are not strongly correlated with ICT (VO₂ peak) in a stroke population that is disabled. The test–retest reliability of the ISWT and 6MWT indicated that two tests may be needed to accurately assess an individual’s capabilities.     

Long-term high-intensity interval training associated with lifestyle modifications improves QT dispersion parameters in metabolic syndrome patients

BackgroundQT dispersion (QTd) is a marker of myocardial electrical instability, and is increased in metabolic syndrome (MetS). Moderate intensity continuous exercise (MICE) training was shown to improve QTd in MetS patients.ObjectivesTo describe long-term effects of MICE and high-intensity interval exercise training (HIIT) on QTd parameters in MetS.MethodsSixty-five MetS patients (53 ± 9 years) were assigned to either a MICE (60% of peak power output [PPO]), or a HIIT program (alternating phases of 15–30 s at 80% of PPO interspersed by passive recovery phases of equal duration), twice weekly during 9 months. Ventricular repolarization indices (QT dispersion = QTd, standard deviation of QT = sdQT, relative dispersion of QT = rdQT, QT corrected dispersion = QTcd), metabolic, anthropometric and exercise parameters were measured before and after the intervention.ResultsNo adverse events were noted during exercise. QTd decreased significantly in both groups (51 vs 56 ms in MICE, P < 0.05; 34 vs 38 ms in HIIT, P < 0.05). Changes in QTd were correlated with changes in maximal heart rate (r = ?0.69, P < 0.0001) and in heart rate recovery (r = ?0.49, P < 0.01) in the HIIT group only. When compared to MICE, HIIT training induced a greater decrease in weight, BMI and waist circumference. Exercise capacity significantly improved by 0.82 and 1.25 METs in MICE and HIIT groups respectively (P < 0.0001). Lipid parameters also improved to the same degree in both groups.ConclusionIn MetS, long-term HIIT and MICE training led to comparable effects on ventricular repolarization indices, and HIIT might be associated with greater improvements in certain cardiometabolic risk factors.     

The impact of a sense of self-efficacy on the level of stress and the ways of coping with difficult situations in Polish nursing students

IntroductionDuring their first practical classes at a clinical ward nursing students face a new environment; they take on new roles which is associated with stress and a need to handle it.ObjectiveThe aim of this study was to evaluate the effect of a sense of self-efficacy on the level of stress and the ways of coping by Polish nursing students during the first practical classes at a clinical ward.Material and MethodsThe study included 394 undergraduate subjects studying nursing at two universities in Southern Poland. The study used the method of diagnostic questionnaire and estimation. The research tools included: an original questionnaire, Stress Scale (PSS10), Inventory to measure coping with stress (Mini Cope) and Generalized Self-efficacy Scale (GSES). Data analysis was performed using the IBM Statistical Package for Social Sciences, version 21 for Windows. The verification of differences between variables was performed using χ² independence test, Kruskal-Wallis test, and Spearman rank correlation coefficient. The level of significance was accepted at α = 0.005.ResultsThe level of stress and a sense of self-efficacy in majority of tested nursing students were high. The people with low levels of perceived stress had a significantly higher sense of self-efficacy (rhoSpearman = − 0.196; p = 0.0001). The people with a higher sense of self-efficacy significantly more often used active strategies in stressful situations, such as Active coping (rhoSpearman = 0.284; p < 0.0001), Planning (rhoSpearman = 0.318, p ≤ 0.0001), Positive revaluation (rhoSpearman = 0.228, p < 0.0001), Acceptance (rhoSpearman = 0.188; p = 0.0002), Seeking Emotional Support (rhoSpearman = 0.123; p = 0.0143).ConclusionsA sense of self-efficacy had a significant impact on the level of stress and the ways of coping with difficult situations in nursing students.     

Exposure to parental verbal abuse is associated with increased gray matter volume in superior temporal gyrus

ObjectiveExposure to parental verbal aggression (PVA) during childhood increases risk for the development of psychopathology, particularly mood and anxiety disorders. Other forms of childhood abuse have been found to be associated with alterations in brain structure. The aim of this study was to ascertain whether exposure to PVA was associated with discernible effects on brain morphology.MethodsOptimized voxel-based morphometry was performed on 21 unmedicated, right-handed subjects (18–25 years) with histories of PVA and 19 psychiatrically healthy controls of comparable age and gender. Group differences in gray matter volume (GMV) – covaried by age, gender, parental education, financial stress, and total GMV – were assessed using high-resolution, T1-weighted, volumetric MRI data sets (Siemens 3T trio scanner).ResultsGMV was increased by 14.1% in the left superior temporal gyrus (STG, BA 22) (P = 0.004, corrected cluster level). GMV in this cluster was associated most strongly with levels of maternal (ß = 0.544, P < 0.0001) and paternal (ß = 0.300, P < 0.02) verbal aggression and inversely associated with parental education (ß = ? 0.577, P < 0.0001).ConclusionPrevious studies have demonstrated an increase in STG GMV in children with abuse histories, and found a reduction in fractional anisotropy in the arcuate fasciculus connecting Wernicke's and frontal areas in young adults exposed to PVA. These findings and the present results suggest that the development of auditory association cortex involved in language processing may be affected by exposure to early stress and/or emotionally abusive language.     

Free thyroxine and thyroid-stimulating hormone reference intervals in very low birth weight infants at 3–6 weeks of life with the Beckman Coulter Unicel DxI 800

ObjectivesTo establish reference intervals for thyroid stimulating hormone (TSH) and free thyroxine (FT4) at 3–6 weeks of age in very low birth weight (VLBW) infants with the Beckman Coulter Unicel DxI 800 by gender, birth weight (BW) and gestational age (GA) subgroups.Design and methodsA 4 year retrospective cohort of 308 VLBW infants (GA = 27.9 weeks, BW = 992.3 g) was studied. All blood samples for TSH and FT4 were analyzed using the modified fTSH2 (TSH) and two-step competitive enzyme immunoassay (FT4). Reference intervals were evaluated according to the most recent Clinical and Laboratory Standards Institute (CLSI) guidelines.ResultsThe study provides non-parametric 95% reference intervals with associated 90% confidence intervals for FT4 and TSH derived from 308 infants screened at a median of 31 days. The reference intervals for this population are TSH = 1.14–11.04 mIU/L and FT4 = 10.9–21.4 pmol/L. TSH statistically differed according to birth weight (< 1000 g vs 1000–1499 g) while FT4 differed according to gender and gestational age at time of testing (< 32 weeks vs ≥ 32 weeks); however, these differences were not clinically significant and a single reference interval for each analyte is reported.ConclusionThe results of this study highlight the importance and complexity of establishing appropriate reference intervals for thyroid function testing for the preterm population.     

The effect of Chinese herbal medicine on hemorrhagic shock: A systematic review and meta-analysis

BackgroundChinese herbal medicine (CHM) has been widely used in the treatment of hemorrhagic shock (HS) in China. Many controlled trials have been undertaken to investigate its efficacy.ObjectiveTo evaluate the effectiveness and safety of CHM for Hemorrhagic Shock patients.MethodsWe screening the Web of ScienceDirect database, PubMed, the Cochrane Library, EMBASE, China Biomedical Database web (CBM), China National Knowledge Infrastructure (CNKI) and WanFang database (WF), from inception to January 2015. All the randomized controlled trials (RCTs) that compared CHM plus conventional therapy with conventional therapy alone for HS patients were included. Meta-analysis on included studies was performed using fixed-effects model with RevMan 5.2. Risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was used as effect measure. STATA 12.0 was used for publication bias.ResultsFifteen RCTs involving 1076 participants were included in the meta-analysis. CHM combined with conventional therapy was tested to be more effective in reduce mortality (RR = 0.24, 95%CI:0.13–0.46, P < 0.0001), reduce the incidence of MODS (RR = 0.47, 95%CI: 0.34–0.66,P < 0.00001), symptomatic improvement: increase blood pressure (BP) (MD = 8.83, 95%CI:6.82–10.84,P < 0.00001), regulate heart rate (MD = −7.6,95%CI:−9.17 to −6.02,P < 0.00001), increase urine volume (MD = 7.26, 95%CI:5.00–9.53, P < 0.00001), compared with conventional therapy alone. No serious adverse events were reported.ConclusionsCHM combined with conventional therapy seems to be more effective on HS patients. However, the analysis results should be interpreted with caution due to the low methodological quality of the included trials. Future, the rigorously designed, high methodological quality, multicenter and large-scale trials are needed to confirm these conclusions.     

Metabolomic analysis of serum by (1) H NMR spectroscopy in amyotrophic lateral sclerosis

BackgroundAmyotrophic lateral sclerosis (ALS), an invariably fatal neurological disorder shows complicated pathogenesis that poses challenges with respect to diagnosis as well as monitoring of disease progression.MethodsWe investigated metabolite profiles in the serum of 30 patients with ALS, 10 patients of Hirayama disease, which served as a neurological disease control and 25 healthy controls by using (1) H NMR spectroscopy.ResultsCompared to healthy controls, the ALS patients had higher quantities of glutamate (P < 0.001), beta-hydroxybutyrate (P < 0.001), acetate (P < 0.01), acetone (P < 0.05), and formate (P < 0.001), and lower concentrations of glutamine (P < 0.02), histidine (P < 0.001) and N-acetyl derivatives. On the other hand, Hirayama disease patients had significantly higher median concentrations of pyruvate (P < 0.05), glutamate (P < 0.001), formate (P < 0.05) and lower median concentrations of N-acetyl derivatives. Furthermore, we also found that serum glutamate showed a positive correlation (P < 0.001, r = 0.6487) whereas, histidine showed a negative correlation (P < 0.001, r = ? 0.5641) with the duration of the disease in ALS.ConclusionsSuch (1) H NMR study of serum may reveal abnormal metabolite patterns, which could have the potential to serve as surrogate markers for monitoring ALS disease progression.     

Persistence of long term isokinetic strength deficits in subjects with lateral ankle sprain as measured with a protocol including maximal preloading

BackgroundThe assessment of muscle function is a cornerstone in the management of subjects who have sustained a lateral ankle sprain. The ankle range of motion being relatively small, the use of preloading allows to measure maximal strength throughout the whole amplitude and therefore to better characterize ankle muscles weaknesses. This study aimed to assess muscle strength of the injured and uninjured ankles in subjects with a lateral ankle sprain, to document the timeline of strength recovery, and to determine the influence of sprain grade on strength loss.MethodsMaximal torque of the periarticular muscles of the ankle in a concentric mode using a protocol with maximal preloading was tested in 32 male soldiers at 8 weeks and 6 months post-injury.FindingsThe evertor muscles of the injured ankles were weaker than the uninjured ones at 8 weeks and 6 months post-injury (P < 0.0001, effect size = 0.31–0.42). Muscle weaknesses also persisted in the plantarflexors of the injured ankles at 8 weeks (P = 0.0014, effect size = 0.52–0.58) while at 6 months, only the subjects with a grade II sprain displayed such weaknesses (P < 0.0001, effect size 0.27–0.31). The strength of the invertor and dorsiflexor muscles did not differ between sides.InterpretationThe use of an isokinetic protocol with preloading demonstrates significant but small strength deficits in the evertor and plantarflexor muscles. These impairments may contribute to the high incidence of recurrence of lateral ankle sprain in very active individuals.     

Validation of a simple screening test for elementary visuo-spatial perception deficit

ObjectiveThe reliability and validity of a screening test for a deficit in elementary visuo-spatial perception (EVSP) were evaluated.MethodThis prospective study collected performance from 210 typically developing individuals and evaluated the internal consistency of the EVSP screening test. Test–retest reliability was examined with 25 individuals. Validity also involved retrospective clinical data collected from 223 non-typically developing children coming to the hospital for outpatient consultation. Since EVSP matures through childhood, we standardized the EVSP screening test scores by age category and performed Pearson correlations with standardized clinical tests scores.ResultsTest–retest reliability (intraclass correlation coefficient = 0.76) and internal consistency (Cronbach's alpha = 0.76) were satisfactory. Construct validity included correlation with the subtests of the Wechsler Intelligence Scale IV (WISC-IV) involving visuo-spatial analysis (Matrix Reasoning and Block Design, P < 0.01; Symbol Search and Coding, P < 0.05) and was reinforced by the expected non-correlation between the Verbal Comprehension Index and EVSP scoring class. The EVSP scoring class was correlated with Manual dexterity of the M-ABC (P < 0.05) and the Working Memory Index (P < 0.05) of the WISC-IV including the subtest Arithmetic (P < 0.01).ConclusionThis screening test is reliable and valid to evaluate EVSP before more complex cognitive or motor assessment.     

Coordination between pelvis and shoulder girdle during walking in bilateral cerebral palsy

BackgroundStudies revealed that pelvis and shoulder girdle kinematics is impaired in children with the diplegic form of bilateral cerebral palsy while walking. The features of 3D coordination between these segments, however, have never been evaluated.MethodsThe gait analyses of 27 children with bilateral cerebral palsy (18 males; mean age 124 months) have been retrospectively reviewed from the database of a Movement Analysis Laboratory. The spatial–temporal parameters and the range-of-motions of the pelvis and of the shoulder girdle on the three planes of motion have been calculated. Continuous relative phase has been calculated for the 3D pelvis–shoulder girdle couplings on the transverse, sagittal and frontal planes of motion to determine coordination between these segments. Data from 10 typically developed children have been used for comparison.Findings: Children with bilateral cerebral palsy walk with lower velocity (P = 0.01), shorter steps (P < 0.0001), larger base of support (P < 0.01) and increased duration of the double support phase (P = 0.005) when compared to typically developed children. The mean continuous relative phase on the transverse plane has been found lower in the cerebral palsy group throughout the gait cycle (P = 0.003), as well as in terminal stance, pre-swing and mid-swing. The age, gait speed and pelvis range-of-motions on the transverse plane have been found correlated to continuous relative phase on the transverse plane.Interpretation: Compared with typically developed children, children with bilateral cerebral palsy show a more in-phase coordination between the pelvis and the shoulder girdle on the transverse plane while walking.     

Macrophage-inhibitory cytokine-1 (mic-1) in differential diagnosis of dyspnea—A pilot study

BackgroundMacrophage inhibitory cytokine-1 (MIC-1) has recently been associated with markers of heart function.AimThis study sought to verify the relationship between markers of heart function (New York Heart Association classification (NYHA)): left ventricle ejection fraction (LVEF), N terminal prohormone of natriuretic peptide B type (NT-proBNP) and MIC-1. Furthermore, the assessment of the usefulness of these markers for differential diagnosis of the myocardial form of dyspnea was explored.Methods124 patients (65 women and 59 men) were examined for dyspnea without signs of acute coronary syndrome. All patients underwent echocardiography (calculation of left ventricle ejection fraction-LVEF), and serum NT-proBNP, proguanylin as well as MIC-1 were determined. 21 healthy individuals were defined as the control group.Results and discussionPatients were divided into two groups: A—individuals with non-cardiogenic form of dyspnea, n = 77 and B—individuals with cardiogenic ethiology of dyspnea, n = 47. Significant differences between MIC-1 values in individuals with cardiogenic dyspnea (median 2189.6 ng/L) and non-cardiogenic dyspnea (median 232.1 ng/L) were shown. MIC-1 correlated with age, proguanylin, NT-proBNP and negatively with LVEF (P < 0.05). The median values of MIC-1 were closely associated with the NYHA classification (P < 0.05). Division of the group under study according to the cause of dyspnea revealed a significant difference in MIC-1 (P < 0.01). The cut-off of MIC-1 > 444.5 ng/L showed 100% sensitivity and 89.3% specificity for diagnosing cardiogenic dyspnea. After adjustment for age, gender and NT-proBNP, MIC-1 levels were significantly associated with the cardiogenic type of dyspnea (P < 0.05). We also tested the difference in MIC-1 level among the subgroup with the cardiac form of dyspnea (10 individuals suffered from hypertension and 37 patients had no sign of hypertension). Individuals with and without hypertension had no significant difference in MIC-1 level.ConclusionMIC-1 is a new diagnostic marker in the differential diagnosis of dyspnea.     

Outcomes for older adults in inpatient specialist neurorehabilitation

BackgroundInpatient specialist neurorehabilitation in the United Kingdom is based on providing a service to “working-age” adults (<65 years), with little evidence for outcomes for older adults involved with these services.ObjectiveThe aim of this study is to determine any difference in outcome after inpatient neurorehabilitation between younger and older adults assessed as having rehabilitation potential.MethodsA two-centre retrospective review was performed comparing patients aged < 65 and ≥ 65 years by diagnostic group in terms of length of stay, changes in UK Functional Independence Measure + Functional Assessment Measure (UK FIM + FAM) scores and discharge destination.ResultsSix hundred and sixteen patients (32% ≥ 65 years) were included. The 2 age groups did not differ in length of stay (median difference 7 days, 95% confidence interval [CI] −2 to 15, P = 0.112), but both UK FIM + FAM change and efficiency were higher for the older than younger group (median difference 7, 95% CI 2–13, P = 0.006 and 0.10, 0.01–0.19, P = 0.031 respectively). Older age was associated with discharge to long-term care (6% < 65 years; 11% ≥ 65 years, x² = 4.10, P = 0.043). Results and trends were similar in patients with acquired brain injury (n = 429), spinal cord injury (n = 59) and peripheral neuropathy (n = 34) but not progressive neurological disorders (n = 70).ConclusionOlder adults considered to have rehabilitation potential may have greater functional gains from inpatient specialist inpatient rehabilitation than younger adults. Age alone should not exclude admission to inpatient specialist neurorehabilitation.     

Time to be Ready to Void: A new tool to assess the time needed to perform micturition for patients with multiple sclerosis

BackgroundUrgency urinary incontinence is one of the major disabling urinary symptoms in people with multiple sclerosis (PwMS). The warning time (time from first sensation of urgency to voiding or incontinence) only partially reflects the possibility of continence. Other factors such as mobility, difficulties in transfer or undressing can influence this time.ObjectivesThe aim was to create a specific test for PwMS to assess the global time required to be ready to perform micturition and to assess its reliability.MethodsThe Time to be Ready to Void (TRV) was based on 2 timed steps: “mobility” stage, including standing up and walking 6 m to the toilet, and the “settled” stage, starting as soon as the individual opens the toilet door until readiness for micturition. All participants performed the TRV twice. Reliability were assessed by the intraclass correlation coefficient (ICC) and convergent validity by Spearman correlation coefficient.ResultsWe included 71 PwMS (mean [SD] age 54.4 [11.7] years). Inter-rater reliability was excellent for the TRV mobility stage (ICC: 0.97), settled stage (ICC: 0.99) and total test (ICC: 0.99). Test–retest reliability was good for the mobility stage (ICC: 0.88) and total test (ICC: 0.81) and moderate for the settled stage (ICC: 0.67). Test–retest reliability assessed by a Likert-type scale was good for each stage (κ 0.75 and 0.88). The mobility stage was correlated with the scores for the Timed Up and Go test, 10-Meter Walk Test, and Tinetti Mobility Test (ρ = 0.89; ρ = 0.88; ρ = −0.67, respectively; P < 0.0001) and the settled stage with scores for the Tinetti Mobility Test, Functional Independence Measure and Nine Hold Peg test (right) (ρ = −0.48; ρ = −0.36; ρ = 0.31, respectively; P < 0.01). Comprehension, acceptance and relevance were rated good by most participants (97%, 95% and 90%, respectively).ConclusionThe TRV is a new tool to measure the global time needed to be ready to achieve micturition in PwMS. It seems useful in clinical practice for overactive bladder in addition to the classical warning time because it takes into account all the time needed to accomplish micturition (mobility, undressing, installation).     

Characteristics of Advanced Cancer Patients With Cancer-Related Fatigue Enrolled in Clinical Trials and Patients Referred to Outpatient Palliative Care Clinics

ContextLimited published data exist on whether characteristics of patients with advanced cancer enrolled in cancer-related fatigue clinical trials (CCTs) differ from patients in outpatient palliative care clinics (OPCs).ObjectivesThe primary aim of this study was to compare the characteristics of two groups of patients with advanced cancer and moderate-to-severe fatigue: patients in CCTs and patients at an OPC.MethodsWe retrospectively reviewed the records of 337 patients who were enrolled in one of five CCTs for advanced cancer patients at The University of Texas M. D. Anderson Cancer Center as well as the records of 1896 consecutive patients who were referred to our OPC from January 2003 through December 2010. Patients with fatigue scores of ≥4/10 (measured by the Edmonton Symptom Assessment System [ESAS]) were eligible (1252 OPC patients and 337 CCT patients). Patient characteristics, ESAS scores, and survival times were compared using Chi-square tests, Wilcoxon rank sum tests, and the Kaplan-Meier method.ResultsCompared with the CCT patients, OPC patients were more likely to be older (58 vs. 59 years; P = 0.009) and male (38% vs. 52%; P < 0.001). The most common primary cancer type was breast cancer (22%) in the CCT patients and lung cancer (23%) in the OPC patients (P < 0.001). The median ESAS scores in the OPC and CCT groups, respectively, were 6 and 4 for pain (P < 0.001), 7 and 7 for fatigue (P = 0.525), 3 and 2 for depression (P = 0.004), 3 and 2 for anxiety (P < 0.001), 3 and 2 for dyspnea (P < 0.001), and 43 and 32 for the symptom distress score (P < 0.001). The median overall survival times were 17.9 months (95% CI 13.5–22.3 months) in the CCT group and 3.8 months (95% CI 3.5–4.1 months) in the OPC group (P < 0.001).ConclusionBaseline characteristics and overall survival times significantly differed between patients enrolled in the CCT and OPC groups. Therefore, we conclude that the results of CCTs cannot be generalized to patients being treated in OPCs.