Cognitive impairment, fatigue, and cytokine levels in patients with acute myelogenous leukemia or myelodysplastic syndrome

BACKGROUND: The objective of the current study was to assess the correlations between cognitive function, fatigue, quality of life, and circulating cytokine levels in patients with acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS). METHODS: Fifty-four patients with AML/MDS were seen for pretreatment evaluation of their cognitive function and symptoms. Fifty percent of the sample was reevaluated 1 month later, when response to protocol chemotherapy was assessed. RESULTS: A significant proportion of patients had impaired cognitive function prior to the institution of chemotherapy. Sixty-five percent of patients also experienced significant fatigue. Levels of the circulating cytokines interleukin 1 (IL-1), IL-1 receptor antagonist (IL-1RA), IL-6, IL-8, and tumor necrosis factor-alpha (TNF-alpha) were elevated highly compared with normal controls. Higher IL-6 levels were associated with poorer executive function, whereas higher IL-8 levels were associated with better memory performance. IL-6, IL-1RA, and TNF-alpha levels were related to ratings of fatigue. Fatigue and cognitive dysfunction were unrelated. Hemoglobin levels were not associated significantly with either cognitive dysfunction or fatigue. Patients who obtained a complete response tended to have better fine motor control at baseline and lower circulating IL-1 levels. Treatment did not have a significant impact on cognition, although fatigue levels tended to increase. CONCLUSIONS: Patients with AML/MDS are highly symptomatic and experience cognitive impairment and fatigue before the initiation of their treatment. The current results indicated a correlation between these symptoms and levels of circulating cytokines, providing some support to the hypothesis that cancer-related symptoms are related at least in part to cytokine-immunologic activation. Elucidation of immunologic correlates of symptoms will allow for targeted interventions.     

Endovascular management of extracranial carotid artery dissection achieved using stent angioplasty

BACKGROUND AND PURPOSE: Dissection of the carotid artery can, in certain cases, lead to significant stenosis, occlusion, or pseudoaneurysm formation, with subsequent hemodynamic and embolic infarcts, despite anticoagulant therapy. We sought to determine the therapeutic value of stent-supported angioplasty retrospectively in this subset of patients who are poor candidates for medical therapy. METHODS: Five men and five women (age range, 37-83 years; mean age, 51.2 years) with dissection of the internal (n=9) and common (n=1) carotid artery were successfully treated with percutaneous endovascular balloon angioplasty and stent placement. The etiology was spontaneous in five, iatrogenic in three, and traumatic in two. Seven of the treated lesions were left-sided and three were right-sided. RESULTS: The treatment significantly improved dissection-related stenosis from 74+/-5.5% to 5.5+/-2.8%. Two occlusive dissections were successfully recanalized using microcatheter techniques during the acute phase. Multiple overlapping stents were needed in four patients to eliminate the inflow zone and false lumen and establish an angiographically smooth outline within the true lumen. There was one case of retroperitoneal hemorrhage, but there were no procedural transient ischemic attacks (TIAs), minor or major strokes, or deaths (0%). Clinical outcome at latest follow-up (16.5+/-1.9 months) showed significant improvements compared with pretreatment modified Rankin score (0.7+/-0.3 vs 1.8+/-0.44) and Barthel index (99.5+/-0.5 vs 80.5+/-8.9). One delayed stroke occurred in a treated patient with contralateral carotid occlusion following a hypotensive uterine hemorrhage at 8 months; the remaining nine patients have remained free of TIA or stroke. CONCLUSION: In select cases of carotid dissection associated with critical hemodynamic insufficiency or thromboembolic events that occur despite medical therapy, endovascular stent placement appears to be a safe and effective method of restoring vessel lumen integrity, with good clinical outcome.     

Primary stenting for high-grade basilar artery stenosis

We report two patients with symptomatic high-grade stenosis of the basilar artery refractory to appropriate maximal medical therapy in whom endovascular stenting was performed successfully without preliminary balloon angioplasty. Excellent angiographic results were achieved and there were no procedural or periprocedural complications. The patients were asymptomatic and neurologically intact at a mean clinical follow-up of 6.5 months. Primary stenting of basilar artery stenosis may be an alternative to balloon angioplasty for patients with symptomatic lesions refractory to medical therapy or in whom anticoagulation is contraindicated.     

Trunk muscle response to lifting unbalanced loads with and without knowledge of centre of mass

OBJECTIVE: To examine the effects of lifting a bin with a variable centre of mass on muscle activity, with and without knowledge of the centre of mass. BACKGROUND: Numerous parameters related to lifting have been examined yet the effects of changing the load centre of mass in two dimensions, with or without knowledge, has not been examined. METHODS: Participants lifted a 6 kg industrial tote bin with a 7 and 11 kg mass randomly placed in each of nine compartments, into which the interior of the bin was partitioned. Participants were not restricted in lifting style other than using the handles, which were equipped with force gauges. Two series (9 lifts per series) were completed using the 7 kg load without knowledge of the load placement and one series with knowledge of the load placement. One series was completed using an 11 kg mass without knowledge of load placement. Electromyographic activity of the upper and lower erector spinae, latissimus dorsi and the external obliques were collected bilaterally. RESULTS: Left and right muscle pairs demonstrated mirror images for all muscles with lowest activity levels when the load was placed nearer the lifter in the sagittal plane. Peak electromyographic activity of the upper erector spinae and latissimus dorsi increased with the weight in the compartments nearest the body and/or the ipsilateral handle. Conversely, peak electromyographic activity of the lower erector spinae and the obliques increased when the weight was on the contralateral side. Peak upper erector electromyographic activity reached up to 41% of maximum and the lower erectors reached 50% of maximum, while the obliques and latissimus dorsi were below 5% and 7%, respectively. No electromyographic activity differences were found between the known and unknown load placements. DISCUSSION: A segmental control strategy appears to exist during lifting that works from the upper to lower torso based on peak electromyographic activity activity. When lifting a bin with a varied centre of mass, highest peak electromyographic activity for the upper and lower erector spinae occurred when the load is closest to the body, regardless of load knowledge. Based on our findings with asymmetrical loads, we conclude that the moments acting on the wrist play an important role in spinal loading and must be included in future studies. RELEVANCE: Asymmetrical loads are often encountered in daily life. Regardless of the lifter's knowledge of the balance of the load, the differential and asymmetrical loading of the muscles of the back play a role in the development of low back pain.