Validation du CHIP (questionnaire de coping) dans une population française atteinte de maladies neurologiques

Introduction

While conceived in the 1960's by Lazarus, the concept of coping was a long time coming in the field of neurological diseases. So far, no valid instrument has been available in French for assessing the style of coping of patients with neurological diseases.

Methods

We used Coping with Health Injuries and Problems (CHIP), which was conceived for patients with chronic diseases. We proceeded to a factorial analysis in a population of 307 patients with multiple sclerosis (MS) or Parkinson's disease (PD) in order to identify the factors observed in this population.

Results

We finally retained a model with six factors, which saturated on 24 items and explained 48% of the total variance. Factors we found included palliative coping and distraction, both known for the original instrument, and four new factors: emotional regulation, seeking of well-being/self-preservation, seeking of information and cognitive avoidance.

Discussion

Tools for assessing coping in a setting of chronic diseases must be adapted to specific diseases. In this new validation, CHIP appeared to be well adapted to the specific features of neurological disorders. This instrument would be useful for the neurologist to better understand the specific ways by which patients cope with their disease. Such knowledge would certainly have a positive effect on the patient-neurologist relationship. Moreover, a better understanding of patients’ coping strategies in neurological diseases could pave the way for specific preventive interventions focusing on using coping strategies to promote better adaptation.     

Agreement between multi-detector-row CT angiography and US-ECD in quantification of carotid artery stenosis and plaque characterization

Purpose

The purpose of this work was to evaluate the agreement between ultra-sound echo-color Doppler (US-ECD) and multi-detector-row CT angiography (MDCTA) in the quantification of carotid artery stenosis as well as plaque characterization.

Materials and methods

From January 2012 to January 2013 forty-five patients who underwent both MDCTA and US-ECD for the study of carotid arteries, were evaluated (33 males, 12 females; age range 43–70 years; mean age of 59.6 years). For all subjects the following parameters were analyzed: stenosis degree by using the NASCET method, plaque morphology (regular versus irregular), type of the plaque (fatty, mixed and calcified) and presence of ulcerations. Statistical analysis was performed to calculate concordance between the two techniques employed.

Results

The agreement observed in the quantification of carotid artery stenosis was 94.4% with a kappa value of 0.9306 (95% confidence interval of 0.8612–1.0). In the definition of the type of plaque, the observed agreements were 91.1% and the kappa value was 0.8815 (95% confidence interval: 0.7920–0.9709). In the definition of plaque ulceration, the observed agreements were 88.4% but the kappa value was only 0.325 (95% confidence interval: 0.201–0.449). Agreement observed in the evaluation of plaque morphology was 78.3% with a kappa value of 0.513 (95% confidence interval: 0.452–0.574).

Conclusion

We observed a good agreement between US-ECD and MDCTA in the quantification of carotid artery stenosis and the assessment of plaque type. There was, however, a poor agreement in the evaluation of plaque ulceration. The use of US-ECD and MDCTA provides different results in the evaluation of plaque. Our results suggest that information derived from US-ECD should be always critically compared with other diagnostic techniques.     

ADC value as a predictor for myelin loss/Preservation in MS plaques with different enhancement pattern in correlation with disease activity

Background

MS plaques display different pattern of enhancement with variable clinical course. The purpose is to assess the role of ADC value as a predictive for MS histologic changes with different enhancing pattern and its correlation with disease activity.

Determinants of the fluorescence emission spectrum of atheromatous plaques treated with haematoporphyrin in vitro

Studies were carried out on atheromatous plaques which had been incubated with the fluorescent dye haematoporphyrin. By varying the wavelength of excitation, it was possible to obtain fluorescence signals from different depths in plaque, since enhanced tissue penetration occurs when the wavelength of exciting light is increased. Moreover, the presence of ulcerated regions altered both excitation and emission spectra. These results suggest that corresponding measurements using laser/fibre-optic systems may be used to characterize plaques in vivo.     

Analysis of staining methods for different cortical plaques in Alzheimer's disease

This study evaluated current methods for demonstrating and categorizing cortical plaques, with the aim of establishing objective methodology for future diagnostic evaluation. Analysis of four methods of tissue processing revealed that the highest numbers of plaques were identified in formalin-fixed, paraffin-embedded tissue regardless of the stain used. Analysis of three silver stains and four immunohistochemical dilutions of an antibody to A4 protein revealed that the recent silver method published by Garvey et al. [(1990) J Histotechnol 14: 39–42] was equivalent to A4 immunohistochemistry in demonstrating the highest number of plaques. Plaque differentiation was easier and more reliable in silver compared to A4-stained sections, although the number of identifiable small compact plaques was significantly reduced in silverstained sections. These studies show that plaque differentiation may be compromised by tissue processing and staining protocols. The establishment of superior methods may provide better diagnostic resolution for patients with Alzheimer's disease.Funded by the National Health and Medical Research Council of Australia and the Australian Alzheimer's Association     

Multiple Sclerosis in an Individual with Intellectual Disability

Multiple sclerosis (MS) is a neurological disorder that affects mostly young adults. Because of the complex mixture of neurological symptoms and cognitive-emotional changes during active phases of the disorder, MS can be confused with several psychiatric disorders. This case study of an individual with a mixed mood disorder, MS and Intellectual and Developmental Disability (IDD) illustrate the complex nature of this problem.     

子宫下段瘢痕妊娠保守治疗24例临床分析

目的：探讨药物保守治疗剖宫产术后子宫下段瘢痕部位妊娠的保守治疗。方法：选择2004年4月～2013年2月收入我院剖宫产手术瘢痕妊娠患者24例,采用米非司酮联合甲氨喋呤（ MTX）药物治疗,检测β－HCG下降水平、脐动脉阻力指数。结果：治疗前脐动脉阻力指数（RI）为0．58±0．18,治疗5天后为（0．46±0．13）,治疗7天后RI升高为（0．85±0．18）,治疗前后相比,差异有统计学意义。治疗前血β－hCG 为4157 U／I （213～8927 U／L ）;治疗5天后血β－hCG升高至6518．2 U／L （298～10093U／L）;治疗7天后血β－hCG下降至2730．7U／L（159～5144U／L）,治疗前后差异有统计学意义。结论：米非司酮联合甲氨喋呤药物治疗安全有效。     

Alzheimer disease therapeutics: Focus on the disease and not just plaques and tangles

The bulk of AD research during the last 25 years has been Aβ-centric based on a strong faith in the Amyloid Cascade Hypothesis which is not supported by the data on humans. To date, Aβ-based therapeutic clinical trials on sporadic cases of AD have been negative. Although most likely the major reason for the failure is that Aβ is not an effective therapeutic target for sporadic AD, initiation of the treatment at mild to moderate stages of the disease is blamed as too late to be effective. Clinical trials on presymptomatic familial AD cases have been initiated with the logic that Aβ is a trigger of the disease and hence initiation of the Aβ immunotherapies several years before any clinical symptoms would be effective. There is an urgent need to explore targets other than Aβ. There is now increasing interest in inhibiting tau pathology, which does have a far more compelling rationale than Aβ. AD is multifactorial and over 99% of the cases are the sporadic form of the disease. Understanding of the various etiopathogenic mechanisms of sporadic AD and generation of the disease-relevant animal models are required to develop rational therapeutic targets and therapies. Treatment of AD will require both inhibition of neurodegeneration and regeneration of the brain.     

重视颈动脉斑块稳定性研究

随着老龄化的进程,脑血管疾病已经成为我国致死和致残的三大原因之一。脑血管病与颈动脉粥样硬化斑块密切相关。血管狭窄不是导致脑卒中的唯一原因,许多中-重度颈动脉狭窄患者并无脑血管疾病的发生,颈动脉不稳定斑块是引起脑卒中的重要原因,因此重视动脉斑块稳定性的研究对预防脑血管病有重要意义。     

冠心病患者心脏结构改变与颈动脉内膜中层厚度的相关性研究

目的探讨颈动脉内膜中层厚度(IMT)及斑块积分与冠心病患者室间隔及左室重量指数的相关性。方法采用高分辨率血管超声法检测76例冠心病患者及30例正常对照组患者IMT、斑块积分及心脏结构;对冠心病患者进行冠脉造影,左主干、左前降支、左回旋支及右冠状动脉四根血管中任何一支狭窄≥50%的患者诊断为冠心病。结果冠心病患者IMT为(1.03±0.32)mm。冠心病患者颈动脉斑块积分情况为:0级28例,1级25例,2级18例,3级5例。冠心病患者心脏超声结果显示:室间隔厚度为(11.26±1.87)mm,左室后壁厚度为(9.74±1.22)mm,左室重量指数(LVMI)为(155.27±18.10)g/m2。冠心病患者室间隔与颈动脉内膜厚度存在负相关(r=-0.345,P<0.05);LVMI与IMT存在正相关(r=0.369,P<0.05);在排除患者年龄、性别及体重指数因素影响之后,室间隔、LVMI与颈动脉内膜厚度仍存在相关(r分别为-0.361及0.367,P<0.05)。室间隔及LVMI与颈动脉斑块积分无相关性。结论在冠心病患者中,室间隔与IMT存在负相关,LVMI与IMT存在正相关,通过超声检测冠心病患者IMT,可能有助于预测患者心脏结构的改变。