Duration of disease does not equally influence all aspects of quality of life in Parkinson’s disease

Health related quality of life (HRQoL) is negatively impacted in patients suffering from Parkinson’s disease (PD). For the specific components that comprise HRQoL, the relationship between clinical variables, such as disease duration, is not fully characterized. In this cross-sectional study (n = 302), self-reported HRQoL on the Parkinson’s Disease Questionnaire (PDQ-39) was evaluated as a global construct as well as individual subscale scores. HRQoL was compared in three groups: those within 5 years of diagnosis, those within 6–10 years of diagnosis, and those greater than 11 years since diagnosis. Non-parametric analyses revealed lower HRQoL with increasing disease duration when assessed as a global construct. However, when subscales were evaluated, difficulties with bodily discomfort and cognitive complaints were comparable in individuals in the 1–5 years and 6–10 year duration groups. Exploratory regression analyses suggested disease duration does explain unique variance in some subscales, even after controlling for Hoehn and Yahr stage and neuropsychiatric features. Our findings show that HRQoL domains in PD patients are affected differentially across the duration of the disease. Clinicians and researchers may need to tailor interventions intended to improve HRQoL at different domains as the disease progresses.     

Reconsidering the role of hypothermia in management of severe traumatic brain injury

Over the past two decades there has been considerable interest in the use of hypothermia in the management of severe traumatic brain injury. However despite promising experimental evidence, results from clinical studies have failed to demonstrate benefit. Indeed recent studies have shown a tendency to worse outcomes in those patients randomised to therapeutic hypothermia. In this narrative review the pathophysiological rationale behind hypothermia and the clinical evidence for efficacy are examined. There would still appear to be a role for hypothermia in the management of intractable intracranial hypertension. However optimising therapeutic time frames and better management of strategies for complications will be required if experimental evidence for neuroprotection is to be translated into clinical benefit.     

Cognitive Function,Sarcopenia, and Inflammation Are Strongly Associated with Frailty: A Framingham Cohort Study

BackgroundFrailty is an important contributor to morbidity and mortality in chronic liver disease. Understanding the contributors to frailty has the potential to identify individuals at risk for frailty and may potentially provide targets for frailty-modifying interventions. We evaluated the relationship among cognitive function, inflammation, and sarcopenia and frailty.MethodsUsing cohorts from the Framingham Heart Study (2011-2014), we evaluated for factors associated with frailty. Exposures included cognitive tests (combined Trails A/B test, Animal Naming Test, and combined Digit Span Forward/Backward test), inflammation (interleukin-6 and tumor necrosis factor receptor II), and sarcopenia (creatinine-to-cystatin C ratio). We performed linear and logistic regression to identify the relationship between these exposures and the Liver Frailty Index (LFI).ResultsThe study population (N = 1208) had a median age of 70 years, was 56% female, and 48.5% had evidence of liver disease. The combined Trails A/B test (β 0.05, P < .001), creatinine-to-cystatin C (β -0.17, P = .006), and both inflammatory markers, interleukin-6 levels (β 0.16, P = .002) and tumor necrosis factor receptor II (β 0.21, P = .04), were independently associated with the LFI. Using an LFI cutoff of ≥4.5 to define frailty, Trails A/B (odds ratio [OR] 1.21, 95% confidence interval [CI] 1.07-1.37), Animal Naming Test (OR 0.64, 95% CI 0.42-0.97), sarcopenia (OR 0.10, 95% CI 0.01-0.73), and interleukin-6 (OR 4.99, 95% CI 1.03-15.53) were all associated with frailty. Although liver disease did not modify the relationship between the LFI and the Trails A/B test, interleukin-6 was significantly associated with the LFI only in the presence of liver disease.ConclusionsCognitive performance, inflammation, and sarcopenia, each highly prevalent in cirrhosis, are associated with the LFI in this population-based study of persons without cirrhosis. Further research is warranted for interventions aiming to prevent frailty by tailoring their approach to the patient's underlying risk factors.     

Infective Endocarditis-Associated Purpura and Glomerulonephritis Mimicking IgA Vasculitis: A Diagnostic Pitfall

BackgroundPurpura and glomerulonephritis are typical presentations in IgA vasculitis. Infective endocarditis mimicking IgA vasculitis by presenting with glomerulonephritis and purpura is rarely reported.MethodsWe searched for cases with infective endocarditis-associated purpura and glomerulonephritis in a tertiary hospital in China and retrospectively reviewed their clinicopathological features. Differential diagnosis and treatment in patients with infective endocarditis-associated purpura and glomerulonephritis were discussed.ResultsA total of 20 cases with infective endocarditis-associated purpura and glomerulonephritis were identified among 548 cases with infective endocarditis in our center during an 8-year period: 7 of the 20 cases (35%) were initially misdiagnosed as IgA vasculitis and 10 cases (50%) presented with left-sided endocarditis caused by Streptococcus viridans. Fever (100%, 20 out of 20), prior valvular deformities (80%, 16 out of 20), cardiac murmur (95%, 19 out of 20), splenomegaly (84%, 16 out of 19), embolism (55%, 11 out of 20), and hypocomplementemia (76%, 13 out of 17) were present in most patients. Crescents and mesangial hypercellularity with or without endothelial hypercellularity were the primary findings on light microscopy, with C3-dominant deposition on immunofluorescence. But IgA-dominant staining was also observed (40%, 2 out of 5). In patients with rapidly progressive glomerulonephritis, patients with complete recovery of renal function had shorter disease duration and higher ratio (67% vs 20%) of immunosuppressive therapy compared with patients with partial recovery.ConclusionsInfective endocarditis-associated glomerulonephritis and purpura can closely mimic IgA vasculitis. Differential diagnosis is challenging, particularly when typical presentations of infective endocarditis are absent. In adults with presentations like IgA vasculitis, infective endocarditis should be evaluated through comprehensive clinical and pathological investigations. Immunosuppressive therapy can be considered in patients with severe glomerulonephritis who do not improve after proper anti-infective therapy.     

Comparison of the efficacy and safety of the adalimumab biosimilar TQ-Z2301 and adalimumab for the treatment of Chinese patients with active ankylosing spondylitis: a multi-center,randomized, double-blind,phase III clinical trial

Clinical Rheumatology - To assess the clinical equivalence of TQ-Z2301, a biosimilar of adalimumab, to the reference adalimumab in the treatment of Chinese patients with active ankylosing...     

Myocardial involvement in idiopathic inflammatory myopathies: a multi-center cross-sectional study in the CRDC-MYO Registry

Clinical Rheumatology - This study aimed to investigate the associated factors of myocardial involvements (MIs) in patients with idiopathic inflammatory myopathies (IIMs). In this multi-center...     

miR-214-5p通过靶向调控PTEN的表达对破骨分化和骨质疏松的影响

 目的 探讨miR-214-5p通过靶向调控PTEN的表达对破骨分化和骨质疏松的影响。方法 选取2019-03至2020-05在空军军医大学唐都医院外科进行脊柱手术的骨质疏松患者20例(骨质疏松组),同时选取非骨质疏松症患者20例为对照组,抽取两组骨髓血。将miR-214-5pmimics(miR-214-5pmimics组)、miR-214-5p空质粒(miR-214-5pvector组)、shZFAS1载体(sh PTEN组)、shZFAS1空载体(sh vector组)转染到骨质疏松患者细胞,对照组细胞不进行任何转染处理。采用RT-qPCR 检测骨髓单个核细胞中的miR-214-5p和PTEN mRNA及 Raw264.7单核巨噬细胞中NFaTc1、MMP9、TRAP、CTSK的mRNA水平;通过TRAP染色检测TRAP染色的阳性率;通过Western blot 检测PTEN、NFATc1、AKT和PI3K蛋白水平。结果 骨质疏松组miR-214-5p水平的表达明显高于对照组(P＜0.001),骨质疏松组PTEN的表达显著低于对照组(P=0.009);miR-214-5pmimics组中TRAP表达阳性率明显高于对照组和miR-214-5p vector组(P＜0.001);sh PTEN组中TRAP表达阳性率明显高于对照组和sh vector组(P＜0.001);miR-214-5p mimics组中的NFaTc1、MMP9、TRAP和CTSK水平显著高于对照组(P<0.001);sh PTEN组中的NFaTc1、MMP9、TRAP和CTSK水平显著高于对照组(P<0.001);与miR-214-5p mimics组相比,miR-214-5pmimics+PTEN组中TRAP表达阳性率显著降低(P＜0.001)。结论 骨质疏松症患者的骨髓单个核细胞中miR-214-5p表达上调,miR-214-5p可以调控PTEN表达,过表达miR-214-5p可能通过靶向PTEN促进破骨细胞分化。