Motor outcomes during hospitalization in Parkinson's disease patients: A prospective study

BackgroundRetrospective studies suggest that many Parkinson's disease patients have a worsening of their motor status during hospitalization. We aimed to quantify this prospectively, and study possible contributing factors.MethodsOver one year we included all consecutive Parkinson's disease patients, newly admitted to a Dutch teaching hospital. We analyzed complications, interventions, and medication distribution. At inclusion and at discharge we assessed the motor status with the Unified Parkinson's Disease Rating Scale Part III (UPDRS-III).Results48% of 46 admitted patients had complications, mainly confusion/delirium (24%) and infections (15%). At discharge 28% of the patients had a worse motor function with a mean increase of more than 5 points on the UPDRS-III. Medication errors occurred in 39%. This is the most important risk factor (p < 0.000) for motor function deterioration, followed by infections during hospitalization, and not being in control of own Parkinson's disease medication. 24% of patients were allowed to take control of their own Parkinson's disease medication, none of these patients did deteriorate.ConclusionsThis prospective study shows that a substantial part of hospitalized PD patients has a significant worse motor function at discharge mainly due to medication errors and infections. Quality of care could be improved by addressing preventable errors and allow patients to take control of their own Parkinson's disease medication.     

Alginate–lanthanide microspheres for MRI-guided embolotherapy

In cancer therapy, a promising treatment option to accomplish a high tumor-to-normal-tissue ratio is endovascular intervention with microsized particles, such as embolotherapy. In this study, alginate microspheres (ams) were prepared with the JetCutter technique, which is based on cutting a sodium alginate solution jet stream into small droplets of uniform size which are then cross-linked with different lanthanides or iron-III, resulting in microspheres of a predefined size which can be visualized by magnetic resonance imaging (MRI). The microspheres were investigated for their size and morphology (light microscopy and scanning electron microscopy analysis), cation content and MRI properties. The lanthanide-ams formulations, with a uniform size of 250 μm and a cation content between 0.72–0.94%, showed promising results for MR imaging. This was further demonstrated for Ho³⁺-cross-linked alginate microspheres (Ho³⁺-ams), the most potent microsphere formulation with respect to MR visualization, allowing single sphere detection and detailed microsphere distribution examination. Intravascular infusion of Ho³⁺-ams by catherization of ex vivo rabbit and porcine liver tissue and assessment of the procedure with MRI clearly showed accumulation and subsequently embolization of the targeted vessels, allowing accurate monitoring of the microsphere biodistribution throughout the tissue. Therefore, the different alginate–lanthanide microsphere formulations developed in this study show great potential for utilization as image-guided embolotherapy agents.     

Change in Proportional Protein Intake in a 10-Week Energy-Restricted Low- or High-Fat Diet,in Relation to Changes in Body Size and Metabolic Factors

ObjectiveTo investigate in a secondary analysis of a randomised trial the effects of a low-/high-fat diet and reported change from baseline in energy% from protein (prot%), in relation to changes in body size and metabolic factors.MethodsObese adults (n = 771) were randomised to a 600 kcal energy-deficient low-fat (20-25 fat%) or high-fat (40-45 fat%) diet over 10 weeks. Dietary intake data at baseline and during the intervention were available in 585 completers. We used linear regression to calculate the combined effects of randomised group and groups of prot% change (<−2 /−2 to 2/>2) on outcomes.ResultsThe low-fat group with >2 prot% increase lost 1.1 kg more weight (p = 0.03) and reduced cholesterol by 0.25 mmol/l more (p = 0.003) than the high-fat group with >2 prot% decrease. These differences were 2.5-fold and 1.8-fold greater than the differences between the low-fat and high-fat groups while not considering prot% change. The high-fat group reduced plasma triglycerides more than the low-fat group, but not compared to those in the low-fat group with >2 units prot% increase (p fat-protein interaction = 0.01).ConclusionsUnder energy restriction, participants on a low-fat diet who had increased the percentage energy intake from protein showed the greatest reduction in weight and cholesterol, and a triglyceride reduction equally large to that of participants on a high-fat diet.Key Words: Obesity, Dietary fats, Dietary proteins, Lipids, Blood glucose     

Increase in Skin Autofluorescence and Release of Heart‐Type Fatty Acid Binding Protein in Plasma Predicts Mortality of Hemodialysis Patients

Advanced glycation end‐products (AGEs) are uremic toxins that accumulate progressively in hemodialysis (HD) patients. The aim of this study was to assess the 1‐year increase in skin autofluorescence (ΔAF), a measure of AGEs accumulation and plasma markers, as predictors of mortality in HD patients. One hundred sixty‐nine HD patients were enrolled in this study. Skin autofluorescence was measured twice, 1 year apart using an AGE Reader (DiagnOptics Technologies BV, Groningen, The Netherlands). Besides routine blood chemistry, additional plasma markers including superoxide dismutase, myeloperoxydase, intercellular adhesion molecule 1 (ICAM‐1), C‐reactive protein (hs‐CRP), heart‐type fatty acid binding protein (H‐FABP), and von Willebrand factor were measured at baseline. The mortality of HD patients was followed for 36 months. Skin autofluorescence values of the HD patients at the two time points were significantly higher (P < 0.001) than those of healthy subjects of the same age. Mean 1‐year ΔAF of HD patients was 0.16 ± 0.06, which was around seven‐ to ninefold higher than 1‐year ΔAF in healthy subjects. Multivariate Cox regression showed that age, hypertension, 1‐year ΔAF, hs‐CRP, ICAM‐1, and H‐FABP were independent predictors of overall mortality. Hypertension, 1‐year ΔAF, hs‐CRP, and H‐FABP were also independent predictors of cardiovascular mortality. One‐year ΔAF and plasma H‐FABP, used separately and in combination, are strong predictors of overall and cardiovascular mortality in HD patients.     

D-dimer levels in assessing severity and clinical outcome in patients with community-acquired pneumonia. A secondary analysis of a randomised clinical trial

BackgroundD-dimer levels are in several studies elevated in patients with CAP. In this study we assess the use of D-dimer levels and its association with severity assessment and clinical outcome in patients hospitalised with community-acquired pneumonia.MethodsIn a subset of randomised trial patients with community-acquired pneumonia serial D-dimer levels was analysed. CURB-65 scores were calculated at admission.ResultsA total of 147 patients were included. D-dimer levels at admission were higher in patients with severe CAP (2166 ± 1258 versus1630 ± 1197 μg/l, p = 0.03), with clinical failure at day 30 (2228 ± 1512 versus 1594 ± 1078 μg/l, p = 0.02) and with early failure (2499 ± 1817 μg/l versus 1669 ± 1121 μg/l, p = 0.01). Non-survivors had higher D-dimer levels (3025 ± 2105 versus 1680 ± 1128 μg/l, p = 0.05). None of the 16 patients with D-dimer levels < 500 μg/l died. In multivariate analysis D-dimer levels were not associated with clinical outcome. D-dimer levels have poor accuracy for predicting clinical outcome at day 30 (AUC 0.62, 95% CI 0.51–0.73) or 30 day mortality (AUC 0.71 (95% CI 0.51–0.91)). Addition of D-dimer levels to CURB-65 did not increase accuracy. No differences were observed in serial D-dimer levels between patients with clinical success or failure at day 30.ConclusionD-dimer levels are elevated in patients with CAP. Significantly higher D-dimer levels are found in patients with clinical failure and with severe CAP. D-dimer levels as single biomarker or as addition to the CURB-65 have no added value for predicting clinical outcome or mortality. D-dimer levels < 500 μg/l may identify candidates at low risk for complications.     

Intussusceptive angiogenesis: a biologically relevant form of angiogenesis

Angiogenesis, i.e. the development and growth of blood vessels, is a major topic of research as it plays an important role in normal development and in various pathologies. Recent evidence revealed the existence of different mechanisms of blood vessel growth, including sprouting and intussusceptive angiogenesis, vascular mimicry, and blood vessel cooption. The latter two have only been observed in tumor growth, but sprouting and intussusceptive angiogenesis also occur in healthy, physiologically growing tissues. Despite this variety of angiogenic mechanisms, most of the current research is focused on the mechanism of sprouting angiogenesis because this mechanism was first described and because most existing experimental models are related to sprouting angiogenesis. Consequently, the mechanism of intussusceptive angiogenesis is often overlooked in angiogenesis research. Here, the mechanism of intussusceptive angiogenesis is reviewed and the current techniques and models for investigating intussusceptive angiogenesis are summarized. In addition, other mechanisms of vascular growth are briefly reviewed.