Pervasive E-health Services Using the DVB-RCS Communication Technology

Two-way satellite broadband communication technologies, such as the Digital Video Broadcasting with Return Channel via Satellite (DVB-RCS) technology, endeavour to offer attractive wide-area broadband connectivity for telemedicine applications, taking into consideration the available data rates, Quality of Service (QoS) provision, survivability, flexibility and operational costs, even in remote areas and isolated regions where the terrestrial technologies suffer. This paper describes a wide-area tele-medicine platform, specially suited for homecare services, based on the DVB-RCS and Wi-Fi communication technologies. The presented platform combines medical data acquisition and transfer, patient remote monitoring and teleconference services. Possible operational scenarios concerning this platform and experimental results regarding tele-monitoring, videoconference and medical data transfer are also provided and discussed in the paper.     

Unintentional overestimation of an expected antihypertensive effect in drug and device trials: Mechanisms and solutions

In clinical practice we pay close attention to choosing an appropriate intervention for patients and performing it safely. We may put less thought into how to measure the effect without bias.     

D-dimer, factor VIII and von Willebrand factor predict a non-dipping pattern of blood pressure in hypertensive patients

Aim

The aim of this study is to assess whether the haemostatic markers D-dimer, factor VIII (FVIII) and von Willebrand factor (VWF) are predictive of non-dipping status in treated hypertensive patients; so, as easy available laboratory data can predict non-dipping pattern and help with the selection of the patients whom circadian blood pressure should be re-examined.

Patients and methods

Forty treated hypertensive patients with essential hypertension were included in the study. Twenty-four-hour ambulatory blood pressure monitoring was performed in all patients. Daytime and nocturnal average systolic, diastolic and mean blood pressures were calculated. Patients were characterised as “non-dippers” on the basis of a less than 10 % decline in nocturnal blood pressure (BP); either systolic or diastolic or mean (MAP). D-dimer as marker of fibrinolytic function, FVIII activity and VWF antigen as marker of endothelial dysfunction were measured on plasma. The predictive efficiency was analysed by receiver operating characteristic (ROC) curves. Youden index was used for the estimation of the cut-off points and the associated values for sensitivity and 1-specificity.

Results

Plasma levels of D-dimer, FVIII and VWF were significantly higher in non-dippers as compared with dippers, irrespective of the classification used (BP index); all P < 0.05. The ROC curves indicated a good diagnostic efficiency for D-dimer (AUC^ROC = 0.697, 0.715 and 0.774), FVIII (AUC^ROC = 0.714, 0.692 and 0.755) and VWF (AUC^ROC = 0.706, 0.740 and 0.708) in distinguishing non-dipping pattern (systolic, diastolic or mean) in the study population; all P < 0.05. Among the three haemostatic markers, D-dimer presents the most satisfactory sensitivity/1-specificity for the differentiation of non-dippers, with a cut-off point >168 ng/ml (sensitivity/1-specificity for systolic BP non-dippers of 0.789/0.381, for diastolic BP non-dippers 0.923/0.444 and for MAP non-dippers 0.875/0.375).

Conclusion

In conclusion, D-dimer has a good predictive value for non-dipping pattern and the decision for the 24-h ambulatory blood pressure re-monitoring among dippers could rely on its values.     

Endothelin-1 Plasma Levels in Hemodialysis Treatment—The Influence of Type 2 Diabetes

In patients on chronic hemodialysis the prevalence of atherosclerosis is increased and is by far the leading cause of morbidity and mortality. Endothelin-1, an endothelium-derived peptide with vasoconstrictive and mitogenic effects on vascular smooth muscles, is involved in the pathogenesis of atherosclerosis. The aim of the present study was to investigate the time course of plasma endothelin-1 levels during a hemodialysis session and to explore the influence of preexisting type 2 diabetes mellitus. Forty-five clinically stable hemodialysis patients (21 females, 24 males; mean age 62 ± 12 years) were evaluated. Patients with type 2 diabetes (n = 11) were compared with the group of patients without diabetes (n = 34). Relative blood volume (BV) changes (hemoglobinometry) and blood pressure (BP) was measured. Samples were taken before, every hour during, and after hemodialysis. Plasma endothelin-1 levels were measured by enzyme-linked immunoassay (ELISA) and results were corrected according to hemoconcentration. Hemodialysis with an ultrafiltration of 2215 ± 952 mL was performed. Total BV at the end of hemodialysis was 89.3% ± 8.3% of the pretreatment volume. Plasma endothelin-1 was enhanced in hemodialysis patients compared to normal subjects and increased from 1.28 ± 0.47 before to 1.44 ± 0.54 pg/mL (ref. 0.3–0.9) at the end of hemodialysis (p < 0.05). The BV change (r = 0.41) and the BP (mean BP: r = 0.34) correlated with plasma endothelin-1 at the end of hemodialysis (p < 0.05). The levels of endothelin-1 were significantly higher in the group of dialysis patients with type 2 diabetes compared to nondiabetics in all measurements (p < 0.05). These findings suggest a potential role of endothelin-1 in the pathogenesis of vascular dysfunction in diabetes mellitus. The dialysis procedure per se, through vasoconstriction due to BV decrease, local endothelial injury (a.v. fistula), or bioincompatibility reactions (foreign surface contact) may additionally alter endothelial cell functions.     

12-Month stability of neurological soft signs in stabilized patients with schizophrenia

Abstract

Objective: Neurological soft signs (NSS) are a group of minor non-localizable neurological abnormalities found more often in patients with schizophrenia. The aim of the current study was to investigate their temporal stability and relationship to the overall outcome over a 12-month period.

Material and methods: The study sample included 133 stabilized patients suffering from schizophrenia (77 males and 56 females; aged 33.55?±?11.22?years old). The assessment included the application at baseline and after 12?months of the Neurological Evaluation Scale (NES), and a number of scales assessing the clinical symptoms and adverse effects. The statistical analysis included ANOVA, exploratory t-test and Pearson correlation coefficients with Bonferroni correction.

Results: In stabilized patients, NSS are stable over a 12-month period with only the subscale of NES-sensory integration manifesting a significant worsening, while, in contrast, most of the clinical variables improved significantly. There was no relationship of NES scores with the magnitude of improvement. The only significant negative correlation was between NES-motor coordination and Positive and Negative Syndrome Scale-GP change at 1 year.

Discussion: The results of the current study suggest that after stabilization of patients with schizophrenia, there are probably two separate components, a ‘trait’ which is stable over a 12-month period, and a ‘degenerative’ component with a tendency to worsen probably in parallel with the progression of the illness and in correlation with the worsening of negative symptoms. However, the statistical support of the ‘degenerative’ component is weak.

• Significant outcomes

• Neurological softs signs are stable over a 12-month period, with the exception of ‘sensory integration’ which manifests significant improvement irrespective of treatment response.

• They do not respond to treatment with antipsychotics.

• They do not constitute a prognostic factor to predict improvement over a period of 1 year. Neurological soft signs constitute a trait symptom of schizophrenia which is stable though time.

• Limitations

• All the subjects have been previously hospitalized which may represent a more severe form of schizophrenia.

• Also, all patients were under antipsychotic and some also under benzodiazepine medications.

• Patients with comorbid somatic disorders were excluded which may decrease generalizability of results.