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1.
Intracerebral haematoma (ICH) occurs in one-third of patients with aneurysmal subarachnoid haemorrhage (SAH) and is associated
with poor prognosis. Identification of risk factors for ICH from aneurysmal rupture may help in balancing risks of treatment
of unruptured aneurysms. We assessed potential clinical and aneurysmal risk factors for ICH from aneurysmal rupture. In all
310 SAH patients admitted to our service between 2005 and 2007, we compared clinical risk factors (gender, age, smoking, hypertension,
history of SAH and family history) of patients with and without an ICH. From the latest admitted, 50 patients with and 50
without ICH, we compared the location, shape and direction of blood flow of the aneurysms on CT-angiography. Relative risks
(RRs) of ICH were 1.2 (95% confidence interval, CI):0.7–1.8) for males, 1.0 (95%CI:0.7–1.4) for age ≥55 year, 1.0 (95%CI:0.6–1.6)
for smoking, 0.9 (95%CI:0.5–1.5) for hypertension, 0.6 (95%CI:0.1–3.8) for history of SAH and 0.5 (95%CI:0.2–1.3) for family
history of SAH. RRs of ICH were 1.8 (95%CI:1.2–2.5) for MCA aneurysms, 0.5 (95%CI:0.3–1.0) for ICA aneurysms, 0.4 (95%CI:0.1–1.3)
for posterior circulation aneurysms, and 0.7 (95%CI:0.3–1.3) for multilobed aneurysms. The RRs of other aneurysmal characteristics
varied between 0.9 and 1.2. Patients with MCA aneurysms are at a higher risk of developing ICH. The other aneurysmal or clinical
factors have no or only minor influence on the risk of ICH after rupture and are, therefore, not helpful in deciding on treatment
of unruptured aneurysms. 相似文献
2.
Jaume Roquer A. Rodríguez-Campello E. Cuadrado-Godia R. M. Vivanco-Hidalgo J. Jiménez-Conde X. Perich A. Ois 《Journal of neurology》2010,257(6):947-953
Brain ischemic lesions identified by diffusion-weighted imaging (DWI) have been shown to predict high risk of early future
ischemic events in patients with transient ischemic attacks and minor stroke. The aim of this study is to analyze different
brain MRI–DWI patterns in patients with mild-moderate stroke to define acute patterns related with a higher risk of stroke
recurrence in long-term follow-up (from 6 to 36 months). Retrospective review of case series from a prospective stroke record
including 253 patients with mild-moderate stroke (NIHSS from 1 to 7) and acute MRI–DWI lesions. MRI–DWI lesions were analyzed
to determine clinically relevant lesions, based on the number, location, age and affected arterial territories. We defined
three patterns: (1) multiple versus single lesions; (2) single deep versus single cortical lesions; and (3) single lesions
versus multiple lesions affecting different arterial territories and/or of different age. The impact of these patterns on
recurrence was analyzed by Cox regression analysis. 38 patients (15.0%) suffered a recurrence. Univariate analysis showed
the risk of recurrence for each pattern. Pattern 1: patients with multiple lesions had greater risk of recurrence than those
with single lesions (28.2 vs. 9.9%; OR: 3.75 (95% CI: 1.76–7.27), p < 0.0001). Pattern 2: patients with single cortical lesions had higher risk than those with deep lesions (14.3 vs. 6.7% OR:
2.33 (95% CI: 0.86–6.33), p < 0.089). Pattern 3: patients with multiple DWI in different territories or different age had the highest recurrence rate
(30.6%), OR: 4.01 (95% CI: 1.70–9.47), p < 0.001, compared to patients with single lesions. Cox regression analysis adjusted by possible confounders, showed that
for pattern 1 the OR for recurrence was 2.49 (95% CI: 1.27–4.89), p = 0.008; for pattern 2, OR:1.99 (95% CI: 0.74–5.37), p = 0.17; for pattern 3, OR: 2.85 (95% CI: 1.31–6.15), p = 0.008. Brain MRI–DWI patterns assessed in the acute phase of mild-moderate stroke are useful to identify those patients
at high risk of recurrence. 相似文献
3.
Background and purpose: This study investigated whether incompleteness of the anterior part of the circle of Willis affects the occurrence of lacunes in the basal ganglia. Methods: One thousand and seventy‐seven healthy individuals examined by magnetic resonance (MR) imaging and MR angiography were divided into eight subgroups according to our new classification. Results: Logistic regression analysis demonstrated that healthy individuals with incompleteness of the anterior circle of Willis had significantly higher frequency of lacunes [odds ratio (OR): 2.121, 95% confidence interval (CI): 1.477–3.108; or OR: 2.46, 95% CI: 1.377–4.384 in cases without or with fetal type posterior communicating artery, respectively] and higher numbers of lacunes (P < 0.001 or P < 0.001 in cases without or with fetal type posterior communicating artery, respectively) compared to patients with complete circle of Willis. Conclusions: Incompleteness of the anterior part of the circle of Willis significantly affected the occurrence of lacunes. 相似文献
4.
Delayed cerebral ischemia (DCI) is an important cause of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). We studied
differences in incidence and impact of DCI as defined clinically after coiling and after clipping in the International Subarachnoid
Aneurysm Trial. We calculated odds ratios (OR) for DCI for clipping versus coiling with logistic regression analysis. With
coiled patients without DCI as the reference group, we calculated ORs for poor outcome at 2 months and 1 year for coiled patients
with DCI and for clipped patients without, and with DCI. With these ORs, we calculated relative excess risk due to Interaction
(RERI). Clipping increased the risk of DCI compared to coiling in the 2,143 patients OR 1.24, 95% confidence interval (95%
CI 1.01–1.51). Coiled patients with DCI, clipped patients without DCI, and clipped patients with DCI all had higher risks
of poor outcome than coiled patients without DCI. Clipping and DCI showed no interaction for poor outcome at 2 months: RERI
0.12 (95% CI −1.16 to 1.40) or 1 year: RERI −0.48 (95% CI −1.69 to 0.74). Only for patients treated within 4 days, coiling
and DCI was associated with a poorer outcome at 1 year than clipping and DCI (RERI −2.02, 95% CI −3.97 to −0.08). DCI was
more common after clipping than after coiling in SAH patients in ISAT. Impact of DCI on poor outcome did not differ between
clipped and coiled patients, except for patients treated within 4 days, in whom DCI resulted more often in poor outcome after
coiling than after clipping. 相似文献
5.
The role of vaccinations in risk of developing multiple sclerosis (MS) or in risk of relapse has not been well established.
The aim of this study was to estimate the effect of immunizations on risk of developing MS in adults as well as in subsequent
risk of relapse. Systematic search for publications in MEDLINE (1966–January 2011), EMBASE (1977–January 2011) and the Cochrane
Central Register of Controlled Trials (CENTRAL) (1961–January 2011). Both randomized clinical trials and non-randomized studies
addressing the effect of any Center for Diseases Control (CDC) recommended vaccine for children, adults or travelers and BCG
on risk of MS or disease relapse were included. Two reviewers independently extracted information from articles selected using
a predefined datasheet. No significant change in the risk of developing MS after vaccination was found for BCG (OR 0.96, 95%
CI 0.69–1.34), Hepatitis B (OR 1.00, 95% CI 0.74–1.37), Influenza (OR 0.97, 95% CI 0.77–1.23), Measles–Mumps–Rubella (MMR)
(OR 1.02, 95% CI 0.64–1.61), Polio (OR 0.87, 95% CI 0.61–1.25) and Typhoid fever (OR 1.05, 95% CI 0.72–1.53). We found decreased
risk of developing MS for Diphtheria (OR 0.60, 95% CI 0.40–0.90) and Tetanus (OR 0.68, 95% CI 0.54–0.84). Influenza immunization
was also associated with no change in risk of MS relapse (RR 1.24, 95% CI 0.89–1.72). Risk of developing multiple sclerosis
remained unchanged after BCG, Hepatitis B, Influenza, MMR, Polio and Typhoid fever immunization, whereas diphtheria and tetanus
vaccination may be associated with a decreased risk of MS. Further research is needed for the remaining vaccines. 相似文献
6.
Oh Young Bang Bruce Ovbiagele David S. Liebeskind Lucas Restrepo Sa Rah Yoon Jeffrey L. Saver 《Journal of neurology》2009,256(4):591-599
Abstract
Background
Although stroke from large vessel atherothromboembolism has a common pathogenesis, its topographic presentation is variable.
Given the impact of cerebral infarct size and location on incident stroke magnitude and subsequent prognosis, we evaluated
the determinants of cerebral infarct topography among patients with atherosclerotic stroke.
Methods
We analyzed data on 148 consecutive patients admitted over a 4-year period to a university medical center with acute ischemic
stroke within the MCA distribution on DWI, presumed due to atherosclerosis. Based on the DWI data, we divided the patients
into three stroke phenotypes: large cortical, small (< 1 cm in diameter) cortical, and deep pattern. Independent factors for
each stroke phenotype were evaluated using logistic regression.
Results
After adjusting for covariates, premorbid statin use (OR, 3.05; 95 % CI, 1.40–6.65) and older age (OR, 1.05 per 1 year increase;
95 % CI, 1.02–1.08) were independently associated with the small cortical phenotypic pattern. In contrast, younger age (OR,
0.95 per 1 year increase; 95 % CI, 0.92–0.98), premorbid statin non-use (OR, 0.40; 95 % CI, 0.17–0.99), and higher levels
of fasting s-glucose (OR, 1.01 per 1 mg/dl increase; 95 % CI, 1.00–1.02) and admission peripheral WBC counts (OR, 1.13 per
1 × 109 cells/L; 95 % CI, 1.00–1.27) were independently associated with the large cortical pattern. There was no relation between
DWI patterns and LDL-cholesterol levels.
Conclusions
Age, premorbid statin use, s-glucose and WBC count predict atherosclerotic stroke phenotype. Further studies should examine
whether modifying some of these factors may result in more favorable phenotypic patterns.
Electronic Supplementary Material The online version of this article (DOI) contains supplementary material, which is available to authorized users. 相似文献
7.
Kerang Zhang Chunxia Yang Yong Xu Ning Sun Hong Yang Jinli Liu Qi Xu Yan Shen 《Journal of neural transmission (Vienna, Austria : 1996)》2010,117(3):393-401
Alterations in brain-derived neurotrophic factor (BDNF)-signaling pathways may play an important role in the pathophysiology of major depressive disorder (MDD). Several lines of
evidence have suggested that gene–gene interactions may confer susceptibility to MDD. The aim of this study was to analyze
the single and combined effects of genes in the BDNF signal-transduction pathway on MDD in a Chinese population. We recruited 447 patients with MDD and 432 age- and gender-matched
control subjects. Five SNPs in three BDNF signal-transduction pathway genes (BDNF, GSK3B and AKT1) were used in association analyses. An allelic association between the GSK3B SNP rs6782799 and MDD was found in our sample (allelic: χ2 = 5.24, P = 0.022, corrected P = 0.107; genotypic: χ2 = 5.55, P = 0.062) with an odds ratio (OR) of 1.25 (95% confidence interval (CI) 1.03–1.52). Further gene–gene interaction analyses
showed a significant effect of a two-locus BDNF/GSK3B interaction with MDD (GSK3B rs6782799 and BDNF rs7124442) (corrected P = 0.011), and also for a three-locus interaction (GSK3B rs6782799, BDNF rs6265 and BDNF rs7124442) (corrected P = 0.019). Individuals carrying the combination of two risk alleles showed an OR value of 4.00 (95% CI 2.05–7.79), while those
with the combination of three risk alleles gave the largest OR value of 4.46 (95% CI 2.15–9.24). Taken together, these findings
support the assertion that the GSK3B gene is an important susceptibility factor for MDD in a Han Chinese population. 相似文献
8.
Armando Sena Klaus Bendtzen Maria J. Cascais Rui Pedrosa Véronique Ferret-Sena Elisa Campos 《Journal of neurology》2010,257(10):1703-1707
Interferon-beta (IFN-beta) therapy for multiple sclerosis (MS) is associated with a potential for induction of neutralizing
antibodies (NAbs). Because immune reactivity depends on changes in lipoprotein metabolism, we investigated whether plasma
lipoprotein profiles could be associated with the development of NAbs. Thirty-one female MS patients treated with subcutaneously
administered IFN-beta were included. Demographic and clinical characteristics were compared between NAbs response groups using
t tests for continuous and logistic regression analysis and Fisher’s exact tests for categorical data, respectively. Multivariate
logistic regression was used to evaluate the effect of potential confounders. Patients who developed NAbs had lower apoE levels
before treatment, 67 (47–74) mg/L median (interquartile range), and at the moment of NAb analysis, 53 (50–84) mg/L, in comparison
to those who remained NAb-negative, 83 (68–107) mg/L, P = 0.03, and 76 (66–87) mg/L, P = 0.04, respectively. When adjusting for age and smoking for a one-standard deviation decrease in apoE levels, a 5.6-fold
increase in the odds of becoming NAb-positive was detected: odds ratios (OR) 0.18 (95% CI 0.04–0.77), P = 0.04. When adjusting for apoE, smoking habit became associated with NAb induction: OR 5.6 (95% CI 1.3–87), P = 0.03. These results suggest that apoE-containing lipoprotein metabolism and, possibly, tobacco smoking may be associated
with risk of NAb production in female MS patients treated with IFN-beta. 相似文献
9.
Hultén A Jiang GX Wasserman D Hawton K Hjelmeland H De Leo D Ostamo A Salander-Renberg E Schmidtke A 《European child & adolescent psychiatry》2001,10(3):161-169
Background. Adolescents in many countries show high rates of suicide attempts and repetitions of attempts as a common feature. Attempted
suicide is the best predictor of future suicide. Repetition of attempts further increases the risk of suicide. The present
study sought to identify patterns and risk factors for repetition of attempts in older teenagers. Methods. Data were collected by uniform procedures in a longitudinal follow-up study in seven European centres participating in the
WHO/EURO Multicentre Study on Suicidal Behaviour. Information on attempted suicide in the 15–19-year age group during the
period 1989–1995 was analysed. Results. A total of 1,720 attempts by 1,264 individuals over a mean follow-up period of 204 weeks (SD 108.9) were recorded. When life-table
analysis was performed, 24 % of the individuals who had previously attempted suicide made another attempt within one year
after the index attempt, compared with 6.8 % of the “first-evers”, with no major gender difference. Cox regression analysis
revealed that previous attempted suicide (OR 3.3, 95 % CI 2.4–4.4) and use of “hard” methods (OR 1.5, 95 % CI 1.1–2.1) were
both significantly associated with repetition of attempted suicide. Stepwise Cox regression analysis showed that a history
of previous attempted suicide was the most important independent predictor of repetition (OR 3.2, 95 % CI 2.4–4.4). Conclusion. For young suicide attempters, follow-up and adequate aftercare are very important if repetition and risk of suicide are to
be reduced. This applies particularly to those who have already made more than one attempt.
Accepted: 19 February 2001 相似文献
10.
Objective
To test the hypothesis that pre-treatment Creactive protein (CRP) predicts outcome in stroke patients undergoing intravenous
thrombolysis (IVT) treatment.
Methods
We analyzed the data of 111 consecutive patients with IVT within 6 hours of stroke onset for stroke involving the middle cerebral
artery territory and admission CRP ≤ 6 mg/dl.
Results
CRP levels were consistently, yet non-significantly lower in patients with unfavourable outcome definitions. Median (range)
CRP levels were 0.3 (0–5.9) mg/dl vs. 0.4 (0–5.7) mg/dl (p = 0.13) in patients dependent or dead after 3 months (modified
Rankin Scale score > 2; n = 59) vs. independent patients (n = 52); 0.2 (0.1–1.5) mg/dl vs. 0.4 (0–5.9) mg/dl (p = 0.28) in
patients dead after 3 months (n = 14) versus survivors (n = 97); and 0.2 (0.1–0.7) mg/dl vs. 0.4 (0–5.9) mg/dl (p = 0.09)
in patients with significant neurological deterioration within 24 hours (increase in ≥ 4 points on National Institute of Health
Stroke scale; n = 9) vs. patients without early deterioration (n = 102). Independent predictors of dependency/death after
3 months, identified by multivariate logistic regression analyses, were baseline NIHSS score (OR = 1.31, 95 % CI 1.16–1.48,
p < 0.001), time from onset to treatment (OR = 1.01, 95 % CI 1.0–1.02, p = 0.024), and presence of diabetes (OR = 8.16, 95
% CI 1.18–56.5, p = 0.033).
Conclusion
Pre-treatment CRP clearly failed to predict outcome in stroke patients treated with IVT. Our findings contradict previously
published work and highlight the need for further research on this topic. 相似文献
11.
J. Hintikka H. Viinamäki H.-T. Koivumaa-Honkanen P. Saarinen A. Tanskanen J. Lehtonen 《Social psychiatry and psychiatric epidemiology》1998,33(5):235-240
Sociodemographic and clinical risk factors for suicidal ideation have been less studied than risk factors for parasuicide
and suicide. No reports on associations between therapy satisfaction and suicidal ideation among psychiatric patients have
been published. In this study we compared a group of patients with suicidal ideation (n= 84) with a randomly selected group of nonsuicidal patients (n = 166) in community-based psychiatric services. Patients with suicidal ideation felt a need for psychiatric treatment more
often than nonsuicidal patients. They were also more likely to receive antidepressive medication, and weekly therapy sessions
were more common among them. A wish to change therapist (OR 15.6, 95% CI 3.6–67.8), hopeless future orientation (OR 14.8,
95% CI 4.5–48.9), severe depression as evaluated by the Beck Depression Inventory (OR 14.0, 95% CI 4.3–45.2) and dysthymia
(OR 12.8, 95% CI 1.7–97.3) were the factors most strongly associated with suicidal ideation in multivariate analysis. A wish
to change therapist is an expression of therapy dissatisfaction, which may therefore be among the factors most strongly associated
with suicidal ideation in psychiatric patients. To help prevent suicidality among psychiatric patients special attention to
therapy factors is needed.
Accepted: 15 September 1997 相似文献
12.
van Norden AG van Dijk GW van Huizen MD Algra A Rinkel GJ 《Journal of neurology》2006,253(9):1217-1220
Background In patients with SAH the amount of extravasated blood on the initial CT scan is related with delayed cerebral ischemia and
clinical outcome. We investigated the interobserver variation of the Hijdra and Fisher scales for the amount of extravasated
blood and the predictive values of these scales for delayed cerebral ischemia and outcome.
Methods For 132 patients admitted within 48 hours after SAH three observers assessed the amount of blood on the initial CT scan by
means of the Hijdra and Fisher scale. We analyzed interobserver agreement with kappa statistics and used multivariate logistic
regression for the association with delayed cerebral ischemia and clinical outcome.
Results The interobserver agreement of all three pairs of observers was good for the Hijdra scale (kappas for total sum scores ranging
from 0.67 to 0.75) and mild to moderate for the Fisher scale (kappas ranging from 0.37 to 0.55). For the Hijdra scale the
risk of DCI was higher for intermediate (OR 4.2; 95% CI 1.1–16.3) and large (OR 3.6; 95% CI 0.8–16.4) amounts of blood with
small amount as reference. Fisher grade III (OR 1.0; 95% CI 0.2–5.2) and IV (OR 0.3; 95% CI 0.02–4.0) were not related with
DCI. For the Hijdra scale and clinical outcome we found an increasing risk for poor outcome with intermediate (OR 3.9; 95%
CI 1.0–15.9) and large (OR 10.7; 95% CI 2.3–50.1) amounts of blood. Such a relation was not found for Fisher grade III (OR
1.2; 95% CI 0.2–7.0) and IV (OR 0.2; 95% CI 0.01–3.4).
Conclusions For the Hijdra scale we found a distinct better interobserver agreement than for the Fisher score. Moreover, the Hijdra scale
was an independent prognosticator for DCI and clinical outcome, which was not the case for the Fisher score.
Received in revised form: 9 February 2006 相似文献
13.
Kothavale A Banki NM Kopelnik A Yarlagadda S Lawton MT Ko N Smith WS Drew B Foster E Zaroff JG 《Neurocritical care》2006,4(3):199-205
Introduction Cardiac abnormalities that have been reported after subarachnoid hemorrhage (SAH) include the release of cardiac biomarkers,
electrocardiographic changes, and left ventricular (LV) systolic dysfunction. The mechanisms of cardiac dysfunction after
SAH remain controversial. The aim of this study was to determine the prevalence of LV regional wall motion abnormalities (RWMA)
after SAH and to quantify the independent effects of specific demographic and clinical variables in predicting the development
of RWMA.
Methods Three hundred patients hospitalized with SAH were prospectively studied with serial echocardiography. The primary outcome
measure was the presence of RWMA. The predictor variables included the admission Hunt & Hess grade, age, gender, cardiac risk
factors, aneurysm location, plasma catecholamine levels, cardiac troponin I (cTi) level, heart rate (HR), blood pressure,
and phenylephrine dose. Univariate and multivariate logistic regression was performed with adjustment for serial measurements,
reporting olds ratios (OR) and 95% confidence intervals (CI).
Results In this study, 817 echocardiograms were analysed. RWMA were detected in 18% of those studied. The prevalence of RWMA in patients
with Hunt & Hess grades 3–5 was 35%. Among patients with a peak cTi level grater than 1.0 μg/L, 65% had RWMA. Multivariate
analysis demonstrated that high Hunt & Hess grade (OR 4.22 for grade 3–5 versus grade 1–2, p=0.046), a cTi level greater than 1.0 μg/L (OR 10.47, p=0.001), a history of prior cocaine or amphetamine use (OR 5.50, p=0.037), and higher HR (OR 1.34 per 10 bpm increase, p=0.024) were predictive of RWMA.
Conclusions RWMA were frequent after SAH. High-grade SAH, an elevation in cTi levels, a history of prior stimulant drug use, and tachycardia
are independent predictors of RWMA. 相似文献
14.
Using guidelines of the Meta-analysis of Observational Studies in Epidemiology Group, we systematically reviewed the literature
on neonatal jaundice (unconjugated hyperbilirubinemia) and Autism Spectrum Disorder (ASD) in term and preterm infants. Thirteen
studies were included in a meta-analysis. Most used retrospective matched case–control designs. There was significant heterogeneity
(Q = 31, p = 0.002) and no evidence of publication bias (p = 0.12). Overall, jaundice, assessed by total serum bilirubin (TSB), was associated with ASD (OR, 1.43, 95% CI 1.22–1.67,
random effect model). This association was not found in preterms (OR 0.7, 95% CI 0.38–1.02) but deserves further investigation
since other measures of bilirubin such as unbound unconjugated bilirubin may be better predictors of neurotoxicity than TSB
in preterms. 相似文献
15.
Xiu-Hua Bi Hua-Lu Zhao Zhen-Xin Zhang Qian Liu Jun-Wu Zhang 《Journal of neural transmission (Vienna, Austria : 1996)》2010,117(4):499-503
Folate deficiency and elevated plasma homocysteine play important roles in pathogenesis of Alzheimer’s disease (AD). The aim
of this study was to test the association of folate metabolism-related genes, cystathionine beta-synthase gene (CβS) and 5, 10-methylenetetrahydrofolate dehydrogenase gene (MTHFD1), with sporadic AD. The CβS 844ins68 polymorphism was determined by PCR and the MTHFD1 G1958A single nucleotide polymorphism (rs2236225) by PCR-RFLP. No significant difference of allele and genotype contributions
of the CβS polymorphism between AD cases and controls was detected, before and after stratification by APOE ε4-carrying status, age/age at onset and genders. No significant difference of allele and genotype contributions of the MTHFD1 polymorphism between AD cases and controls was detected in total samples. When stratified by age/at onset age, we found that
A allele and AA genotype frequencies in cases were higher than in controls and the differences were close to significant [A
vs. G, P = 0.032, Odds ratio (OR) 1.642, 95% CI 1.040–2.591; AA + GA vs. GG, P = 0.068, OR 1.665, 95% CI 0.961–2.885; AA vs. GG, P = 0.059, OR 3.458, 95% CI 0.894–13.369] in <65 years groups, which suggested that the MTHFD1 G1958A A allele might be a weak risk factor for early onset AD although it needs further confirmation. 相似文献
16.
17.
Bjerkeset O Nordahl HM Larsson S Dahl AA Linaker O 《Social psychiatry and psychiatric epidemiology》2008,43(3):192-199
Background Our aims were to examine the stability of self-rated anxiety and depression symptoms and the predictors for change in case-level
status after 4 years in a general population sample.
Methods Prospective cohort study. Based on the total score on the Hospital Anxiety and Depression rating scale (HADS-T) in HUNT 2
(1995–1997), three groups were identified: Level 3 (n = 654, score ≥ 25 points), Level 2 (n = 654, score 19–24 points), and Level 1 (n = 1,308, score < 19 points). The groups were followed up with a mailed questionnaire after 4 years.
Results Among the 1,326 (53% response rate) who participated in the follow-up, 816 (62%) had not changed symptom level. The number
of participants that had crossed the HADS-T caseness level (19 points) was the same in both directions. In non-cases at baseline
(Level 1), lack of friends (OR 2.34, 95% CI 1.28–4.27, P = 0.006) and previous episodes of depression (OR 2.90, 95% CI 1.76–4.78, P < 0.001) predicted HADS-T caseness at follow-up, while higher educational level (OR 0.66, 95% CI 0.46–0.96, P = 0.028) protected from developing caseness level of anxiety and depression. In HADS-T cases (Levels 2 and 3) at baseline,
previous episode(s) of depression (OR 0.36, 95% CI 0.19–0.68, P = 0.002) and being unemployed (OR 0.58, 95% CI 0.34–1.00, P = 0.050) predicted HADS-T caseness at follow-up, whereas a higher educational level (OR 1.83, 95% CI 1.24–2.70, P = 0.002) was associated with remission from HADS-T caseness after 4 years.
Conclusions Though symptom fluctuation was considerable, conventional HADS-T caseness (≥19 points) was a reliable and valid predictor
for high long-term symptom stability of anxiety and depression in our general population sample. 相似文献
18.
Calcium Homeostasis During Magnesium Treatment in Aneurysmal Subarachnoid Hemorrhage 总被引:1,自引:0,他引:1
Objective Magnesium treatment in patients with subarachnoid hemorrhage (SAH) can result in hypocalcemia; this hypocalcemia increases
the risk of delayed cerebral ischemia (DCI) and poor outcome. We assessed whether low serum levels of total calcium in patients
with SAH treated with magnesium is mediated by parathyroid hormone (PTH) or calcitriol, and whether increased PTH or low serum
levels of ionized calcium are associated with an increased risk of DCI and poor outcome.
Patients and Methods We studied 167 patients included in a randomized, placebo controlled trial on magnesium in SAH. Mean serum magnesium during
treatment was related to mean serum levels of ionized calcium, PTH and calcitriol with linear regression. Hypocalcemia (Ca2+) and high serum PTH were related to the occurrence of DCI by means of the Cox proportional hazards model and to poor outcome
by logistic regression.
Results Serum magnesium was inversely related to ionized calcium (B = −0.1; 95% CI −0.12 to −0.06), but not to PTH or calcitriol. Neither hypocalcemia nor high serum PTH was related to DCI.
Hypocalcemia did not increased the risk for poor outcome (OR 1.2; 95% CI 0.6–2.3). In the subgroup of patients with known
PTH (n = 67), high serum PTH increased the risk for poor outcome (OR 5.4; 1.6–18.9).
Conclusions Magnesium treatment in patients with SAH leads to hypocalcemia without effect on outcome. PTH is related to poor outcome,
but this is independent of magnesium therapy. 相似文献
19.
Objective Research on status inconsistency (SI) and its impact on mental health has been dormant for many years. This study tested the
association between SI and emotional distress, anxiety and mood disorders.
Methods Data were gathered from the Israel-based component of the World Mental Health Survey (n = 4,859). SI was defined by the combination of high education (13+ years) with low income (1st decile). Mood and anxiety
disorders were diagnosed with the composite international diagnostic instrument (CIDI), and emotional distress was measured
with the 12-item general health questionnaire (GHQ-12).
Results Multivariate analysis showed increased risk for mood or anxiety disorders among SI subjects (n = 231), odds ratio (OR) = 1.75, 95% confidence interval (95% CI) 1.13–2.63. The estimate was slightly attenuated when marital
status was added to the model (OR = 1.55, 95% CI 1.0–2.39). SI subjects showed higher GHQ-12 scores.
Conclusion SI, which can disrupt an individual’s sense of coherence, is associated, although not causally, with increased 12 month prevalence
rates for mood or anxiety disorders and with higher psychological distress. 相似文献
20.
Khalid A. Hanafy R. Morgan Stuart Luis Fernandez J. Michael Schmidt Jan Claassen Kiwon Lee E. Sander Connolly Stephan A. Mayer Neeraj Badjatia 《Journal of clinical neuroscience》2010,17(1):22-25
Poor admission clinical grade is the most important determinant of outcome after aneurysmal subarachnoid hemorrhage (aSAH); however, little attention has been focused on independent predictors of poor admission clinical grade. We hypothesized that the cerebral inflammatory response initiated at the time of aneurysm rupture contributes to ultra-early brain injury and poor admission clinical grade. We sought to identify factors known to contribute to cerebral inflammation as well as markers of cerebral dysfunction that were associated with poor admission clinical grade. Between 1997 and 2008, 850 consecutive SAH patients were enrolled in our prospective database. Demographic data, physiological parameters, and location and volume of blood were recorded. After univariate analysis, significant variables were entered into a logistic regression model to identify significant associations with poor admission clinical grade (Hunt–Hess grade 4–5). Independent predictors of poor admission grade included a SAH sum score >15/30 (odds ratio [OR] 2.3, 95% confidence interval [CI] 1.5–3.6), an intraventricular hemorrhage sum score >1/12 (OR 3.1, 95% CI 2.1–4.8), aneurysm size >10 mm (OR 1.7, 95% CI 1.1–2.6), body temperature ?38.3 °C (OR 2.5, 95% CI 1.1–5.4), and hyperglycemia >200 mg/dL (OR 2.7, 95% CI 1.6–4.5). In a large, consecutive series of prospectively enrolled patients with SAH, the inflammatory response at the time of aneurysm rupture, as reflected by the volume and location of the hemoglobin burden, hyperthermia, and perturbed glucose metabolism, independently predicts poor admission Hunt–Hess grade. Strategies for mitigating the inflammatory response to aneurysmal rupture in the hyper-acute setting may improve the admission clinical grade, which may in turn improve outcomes. 相似文献