Depression in stroke patients 7 years following stroke

OBJECTIVE: To study the frequency of depression in stroke patients many years following stroke, most previous studies having concentrated on the first few years. METHOD: Participants of a previous study of post-stroke depression (99 stroke patients and 28 control subjects) were re-examined 7 years later. Depression was diagnosed using research diagnostic criteria. The test battery comprised the Mini Mental State Examination, the Raven Matrices A+B and Word Pair Learning. Subjective experience of changes in memory, concentration, mood, irritability and fatigue during the 7-year period was also examined. RESULTS: Twenty per cent of the stroke patients fulfilled the criteria for major or minor depression compared with 11% of the control subjects. No differences in cognitive function were found between depressed and non-depressed stroke patients. The stroke patients reported experiencing more lability of mood and irritability during the 7-year period following stroke than the control subjects. Depressed stroke patients experienced more impairment of concentration and memory function than non-depressed stroke patients. CONCLUSION: Affective symptoms are common among stroke patients 7 years following stroke.     

The association between vascular endothelial growth factor, microvessel density and clinicopathological features in invasive cervical cancer

OBJECTIVE: The aim of this study was to analyse the vascular endothelial growth factor (VEGF) expression in a series of cervical carcinomas and to compare the results with the microvessel density (MVD) and clinicopathological features. STUDY DESIGN: The immunoreactivity for VEGF was studied in 130 invasive cervical carcinomas and in 22 patients with a carcinoma in situ of the cervix. The results were compared with the MVD. RESULTS: Staining for VEGF of less then 50% per slide occurred in 80% of the invasive carcinomas and in 82% of the in situ carcinomas. The median MVD was 261 vv/mm(2) (range: 11-1000) in the invasive group and 146 vv/mm(2) (range: 25-536) in the in situ group. Unlike the microvessel density there was no association between VEGF expression and survival. The MVD was higher in VEGF poorer (<50%) tumours (P=0.055). Beside tumour histology (P=0.012) there were no other significant relationships between the remaining histopathological findings and VEGF expression. CONCLUSION: Tissue VEGF expression has no prognostic value in contrast with the MVD in patients with invasive cervical cancer.     

24-hour indirect calorimetry in mechanically ventilated critically ill patients.

BACKGROUND: Energy imbalance in critically ill, mechanically ventilated patients may lead to medical complications. The nutrition care team needs accurate, noninvasive, rapid methods to estimate energy requirements. We investigated whether brief measurements of indirect calorimetry at any time of the day would give valid estimates of 24-hour energy expenditure (EE). METHODS: EE of 12 mechanically ventilated critically ill patients (6 men, 6 women, mean +/- SD age 67 +/- 18 years, weight 70.2 +/- 8.8 kg) was recorded every minute during 24 hours by indirect calorimetry. All patients were continuously fed enteral nutrition. RESULTS: Mean +/- SD EE was 1658 +/- 279 kcal/d (6941 +/- 1167 kJ/d). Within patients, EE during the day fluctuated by 234 kcal in the most constant patient to 1190 kcal in the least constant patient, with a mean fluctuation of 521 kcal (12 patients). No statistically significant difference (p = .53) in mean EE between morning (6-12 hours, 1676 kcal), afternoon (12-18 hours, 1642 kcal), evening (18-24 hours, 1658 kcal), and night (0-6 hours, 1655 kcal) was found. A 2-hour instead of a 24-hour measurement resulted in a maximal error of 128 kcal (536 kJ), which was <10% of the average EE. The maximal error decreased with longer time intervals. CONCLUSIONS: In mechanically ventilated critically ill patients, 24-hour indirect calorimetry measurements can be replaced by shorter (>/=2 hours) measurements. Time of day did not affect EE.     

Major clinical events, signs and severity assessment scores related to actual survival in patients who died from primary biliary cirrhosis. A long-term historical cohort study

BACKGROUND/AIMS: One of the prognostic methods for survival in primary biliary cirrhosis (PBC) is the Mayo model, with a time-scale limited to 7 years. The aim of our study was to assess how major clinical events, signs, several severity assessment methods and Mayo survival probabilities fit in with actual patient survival, by using yearly observations until 0.5 years before patient death from PBC. METHODOLOGY: Data of 32 patients dying from PBC were collected prior to death at -0.5, -1, -2 etc. years (median: -5 years, range: -16 to -0.5 years). Major events registered were: first occurrence of ascites, upper gastrointestinal bleeding or manifest hepatic encephalopathy and signs, first observation of spider naevi or purpura. Severity assessment methods applied (all with scores and classes) were: Mayo (M), Child-Campbell (C), Pugh-Child (P), Pugh-Child-PBC (PP), 'Child-Pugh' (CP), and Ascites Nutritional State-Child (ANS). Fifty percent survival estimates were calculated from Mayo scores. Severity assessment method variables were: ascites (C, P, PP, CP, ANS), encephalopathy (C, P, PP, CP), nutritional state (C, ANS), edema (M), age (M), serum albumin (M, C, P, PP, CP), bilirubin (C, M, P, PP, CP), and prothrombin time (M, P, PP, CP). RESULTS: In 27 out of 32 patients a major event occurred, always between -6 and -0.5 years (median: -1 year) and, never between -16 and -7 years (p < 0.0001). A sign was first observed in 30/32 between -14 and -0.5 years (median: -2 years). Compared to the total population, a sign, and even more so, an event indicated a shorter survival (p = 0.004 and p = 0.0002, respectively). The median 50% estimated survival (predicted by the Mayo model) fitted the actual survival from -6 to -0.5 years (r = -0.7, p < 0.0001), but not from -16 to -7 years (r = -0.1, p = 0.4). All -6 to -0.5-year severity scores correlated (p < 0.0001) both with actual survival (M, C, P, PP, and CP r = 0.7; ANS r = 0.5) and with estimated M 50% survival (C, P, PP, CP r = -0.9; ANS r = -0.6; M score: -0.99), but none with actual survival from -16 to -7 years, except for M, slightly (r = -0.3, p = 0.04). A nomogram for mean C, CP, M and ANS scores related to actual survival was constructed for the -6 to -0.5-year period. The C and CP classes A, B, and C did not appear to distinguish sufficiently into actual survival, whereas the M classes did. CONCLUSIONS: The occurrence of a major event appeared to exclude survival over 6 years. In these final 6 years, Child-Campbell, Mayo and Pugh scores correlated equally well with actual survival and better than Ascites/Nutritional State score. In our PBC patients, Campbell was an excellent alternative for Pugh; for Pugh, the original Child-Turcotte variable limits were fully sufficient.     

Build-up modification of commercial diodes for entrance dose measurements in 'higher energy' photon beams.

BACKGROUND AND PURPOSE: Several commercially available p-type diodes do not provide sufficient build-up for in-vivo dosimetry in 'higher' energy photon beams, and only limited information could be found in the literature describing the correction factor variation and/or the achievable accuracy for in-vivo dosimetry methods in this energy range. The first aim of this study is to assess and analyze the variation of diode correction factors for entrance dose measurements at higher photon energies. In a second step the total build up thickness of the diode has been modified in order to minimize the correction factor variation. MATERIALS AND METHODS: Diode correction factors accounting for non-reference conditions (field size, source surface distance, tray, wedge, and block) are determined in 18-25 MV photon beams provided by different treatment units for Scanditronix p-type diodes recommended for higher energy photon beams: old type and new type EDP-20, and EDP-30 diodes. Hemispherical build-up caps of different materials (copper, iron, lead) are used to increase the total build-up thickness. Perturbation effects with and without additional build-up caps are assessed for the three diode types. RESULTS: For unmodified diodes field size correction factors (C(FS)) vary between 1.7% and 6%, dependent on diode type and treatment unit. For example, for an old type EDP-20 the C(FS) variation at 18 MV is much higher on a GE linac (5%) as compared to the Philips machine (1.7%). Depending on diode type, this variation can be reduced to 1-2% when adding additional build-up. The variation of source to surface distance correction factors is almost independent of build-up thickness. By adding additional build-up the influence of trays and blocks can be almost eliminated. CONCLUSIONS: The correction factor variation of unmodified diodes reflects the variation of the electron contamination with treatment geometry. A total build-up thickness of 30 mm is found to be the 'best compromise' for the three types of diodes investigated when measuring entrance doses in the energy range between 18 and 25 MV.     

In vivo laxity of stable versus anterior cruciate liagment-injured knees using a navigation system: a comparative study

We compared antero-posterior translation and internal–external rotation of the tibia in stable knees without anterior cruciate ligament (ACL) injury with those of ACL injured knees using a navigation system and suggest an objective data. Forty-four patients treated for a meniscal tear without ACL injury were allocated to stable group, and 41 patients were allocated to ACL injury group. Antero-posterior displacement and rotation of knees were measured in 0, 30, 60 and 90 degrees of flexion using navigation. Mean anterior displacements were 3.6 ± 2.0, 6.7 ± 2.7, 6.0 ± 2.4 and 4.7 ± 1.8 mm at 0, 30, 60 and 90 degrees of flexion, respectively, in stable group, and 6.8 ± 3.6, 14.7 ± 3.5, 11.9 ± 4.6 and 8.5 ± 4.0 mm in ACL injury group. Mean total rotation values were 18.8 ± 4.5°, 31.4 ± 4.2°, 30.1 ± 5.1° and 29.2 ± 5.9° in stable group and 22.7 ± 6.9°, 37.6 ± 5.8°, 34.0 ± 9.4° and 31.8 ± 8.8° in ACL injury group. Quantitative values of antero-posterior translations and rotations of stable and ACL injured knees were obtained using a navigation system. The laxity data may be useful to establish the diagnosis of an ACL injury and evaluation of post-operative results.     

Initial validation of a novel ECGI system for localization of premature ventricular contractions and ventricular tachycardia in structurally normal and abnormal hearts

Background

View into Ventricular Onset (VIVO) is a novel ECGI system that uses 3D body surface imaging, myocardial CT/MRI, and 12?lead ECG to localize earliest ventricular activation through analysis of simulated and clinical vector cardiograms.

Growth hormone (GH) treatment decreases postprandial remnant-like particle cholesterol concentration and improves endothelial function in adult-onset GH deficiency

Premature atherosclerosis is a clinical feature in adult-onset GH deficiency. Evidence is accumulating that disturbances in triglyceride metabolism, reflected by abnormalities in circulating remnant lipoproteins, are associated with increased atherogenic potential. In a case-controlled intervention study, we investigated postprandial lipoprotein metabolism using a new remnant lipoprotein method based on immunoseparation principle [RLP-cholesterol (RLP-C)]. In addition, we analyzed retinyl ester (RE) analysis in plasma and in Sf < 1000 fraction. Endothelial function was assessed as flow-mediated dilatation (FMD). Eight patients diagnosed with acquired adult-onset GH deficiency and eight controls matched for gender, age, body mass index, and apolipoprotein (apo) E genotype were enrolled in the study. Oral vitamin A fat loading tests were performed at baseline in both groups and after 6 months of treatment with recombinant human GH (rh-GH) in the adult-onset GH-deficient patients. Adult-onset GH-deficient patients had significantly higher fasting RLP-C, postprandial RLP-C concentrations (plasma RLP-C, 0.29 +/- 0.14 mmol/L; and incremental area under the curve-RLP-C, 2.13 +/- 1.60 mmol*h/L, respectively) than controls (0.19 +/- 0.06 mmol/L and 1.05 +/- 0.72 mmol*h/L (P: < 0.05), respectively). They also had significantly higher postprandial RE in plasma and Sf < 1000 fraction. Treatment with rh-GH significantly reduced postprandial RLP-C concentrations (incremental area under the curve-RPL-C 0.73 +/- 0.34 mmol*h/L; P: < 0.05) but had no effects on the fasting RLP-C concentrations (0.317 +/- 0.09 mmol/L, P: < 0.05), or on the postprandial RE in plasma and in Sf < 1000 fraction. Endothelial function measured as FMD was improved from 5.9 +/- 3.3% to 10.2 +/- 4.0% (P: < 0.05) in patients treated with rh-GH. It is concluded that patients with adult-onset GH deficiency have increased levels of fasting and postprandial RLP-C and an impaired endothelial function as measured as FMD. Treatment with rh-GH resulted in a decrease of postprandial RLP-C concentration, thereby improving the postprandial atherogenic lipoprotein profile and improvement of endothelial function, however, the clearance of large chylomicron particles as reflected by RE remained disturbed.     

Adjunctive bright light in non-seasonal major depression: results from patient-reported symptom and well-being scales

OBJECTIVE: In this study, we tested the efficacy of bright light therapy as an adjunct to antidepressant treatment (sertraline) in patients with non-seasonal major depression. METHOD: In a randomized double-blind controlled trial, 102 patients were treated for 5 weeks with either white bright light (10.000 lx, 1 h/day) or red dim light (50 lx, 30 min/day). All patients received sertraline in a dosage of 50 mg daily. The self-assessment scales used were the Major Depression Inventory (MDI), the Psychological General Well-Being Scale (PGWB) and the Symptom Check List (SCL-90R). RESULTS: On all three questionnaires the score differences between baseline and endpoint were greatest in the bright light group. On the SCL-90R, the difference reached statistical significance. Results and effect sizes are compared with results from Danish national population studies applying PGWB and SCL-90R. CONCLUSION: The results advocate the use of bright light as an adjunct treatment of non-seasonal depression.