Corpus callosum alterations in very preterm infants: perinatal correlates and 2 year neurodevelopmental outcomes

The aim of this study was to relate altered corpus callosum (CC) integrity in 106 very preterm (VPT) infants (< 30 weeks' gestational age or < 1250 g birth weight) at term equivalent to perinatal predictors and neurodevelopmental outcomes at two years. T1 and diffusion magnetic resonance images were obtained. The CC was traced, and divided into six sub-regions for cross-sectional area and shape analyses. Fractional anisotropy, mean, axial and radial diffusivity were sampled within the CC, and probabilistic tractography was performed. Perinatal predictors were explored. The Bayley Scales of Infant Development (BSID-II) was administered at two years. Intraventricular hemorrhage was associated with a smaller genu and altered diffusion values within the anterior and posterior CC of VPT infants. White matter injury was associated with widespread alterations to callosal diffusion values, especially posteriorly, and radial diffusivity was particularly elevated, indicating altered myelination. Reduced CC tract volume related to lower gestational age, particularly posteriorly. Reduced posterior callosal skew was associated with postnatal corticosteroid exposure. This more circular CC was associated with delayed cognitive development. Higher diffusivity, particularly in splenium tracts, was associated with impaired motor development. This study elucidates perinatal predictors and adverse neurodevelopmental outcomes associated with altered callosal integrity in VPT infants.     

患者自控镇静用于眼底手术的临床研究

目的探讨球后阻滞眼底手术患者应用异丙酚和瑞芬太尼自控镇静(PCS)的优越性。方法42例择期球后阻滞眼底手术患者,随机分为3组:P组15例,应用1%异丙酚;R组15例,应用0.5%异丙酚+0.001%瑞芬太尼;C组12例,空白对照组。PCS组(P组、R组)采用爱朋全自动注药泵,选择负荷剂量+持续背景输注+PCS(LCP模式)静脉输注异丙酚和(或)瑞芬太尼。术中监测BP、HR、SpO2、RR、听觉诱发电位(AAI)、镇静评分(Ramsay评分)、患者合作评分、术者满意度,术后随访患者满意度和不良反应发生情况。结果三组术前情况差异无统计学意义。术后MAP、HR、SpO2和AAI差异无统计学意义(P>0.05)。R组RR显著低于P组、C组(P<0.05),PCS组的镇静评分、合作评分、满意度评分、球后阻滞疼痛评分明显优于C组(P<0.05),PCS组用药量个体差异较大。三组均无术后恶心、呕吐等现象。结论应用异丙酚、瑞芬太尼进行PCS可安全用于球后阻滞眼底手术,是一种适用于不同患者的较理想的方法。     

Association of Posttraumatic Stress Symptom Severity With Health-Related Quality of Life and Self-Reported Functioning Across 12 Months After Severe Traumatic Brain Injury

Objective

To investigate the relation between posttraumatic stress (PTS) symptom severity and health-related quality of life (HRQoL) after severe traumatic brain injury (TBI).

Management and survival of screen-detected prostate cancer patients who might have been suitable for active surveillance

OBJECTIVE: Screening practices for prostate cancer have resulted in an increasing incidence of prostate cancers. Our knowledge about which prostate cancers are life threatening and which are not is limited. Thus, for ethical, medical, and economic reasons we need to define which patients can be managed by active surveillance. METHODS: From 1993 through 1999, men from the Rotterdam section of the European Randomized study of Screening for Prostate Cancer (ERSPC) were screened by two strict protocols, which were based on prostate-specific antigen (PSA), digital rectal examination, and transrectal ultrasound. For this study, men with criteria that reflect current active surveillance studies were selected: those with a biopsy Gleason score < or =3+3 in two or fewer cores, with a PSA density <0.2 and a maximum PSA-level of 15 ng/ml. Clinical stage had to be T1C or T2. RESULTS: Of the 1,014 prostate cancers detected in the prevalence screen, 293 men (28.9%) met the criteria for active surveillance. Their mean age was 65.7 and the mean PSA level was 4.8 ng/ml. Radical prostatectomy was elected by 136 men (46.4%), radiotherapy by 91 (31.1%), and watchful waiting by 64 (21.8%). The mean follow-up was 80.8 months. The eight-year prostate cancer-specific survival was 99.2%; the overall survival was 85.4%. Nineteen men who chose watchful waiting changed to definitive treatment during follow-up. CONCLUSION: Only three men died of prostate cancer, none of whom were on watchful waiting. Our observations provide preliminary validation of the arbitrary selection criteria for active surveillance.     

Cognitive intrusion of pain and catastrophic thinking independently explain interference of pain in the activities of daily living

Patients with musculoskeletal illness often report that pain interferes with their ability to engage in activities of daily living. Catastrophic thinking is consistently depicted as an important cognitive factor that hinders adjustment to pain. Current research has also shown that pain negatively impacts an individual's ability to maintain attention on the task at hand. While a measure of the experience of cognitive intrusion of pain (ECIP) has been recently developed to quantify the extent of that impact, little research has explored this issue in everyday settings. This study tested the mediating roles of cognitive intrusion of pain and pain catastrophizing scale (PCS) on the association of pain intensity with pain interference in 142 patients with upper-extremity musculoskeletal illness. We found that both cognitive intrusion of pain (b = 0.136, bootstrap SE = 0.048, 95% BCa CI [0.052, 0.245]) and pain catastrophizing (b = 0.114, bootstrap SE = 0.044, 95% BCa CI [0.047, 0.221]) partly and independently mediated the relationship between pain intensity and pain interference. Although comparable, the mediation effect of cognitive intrusion of pain was slightly larger than that of pain catastrophizing (25.7%, bootstrap SE = 0.094 vs. 21.5%, bootstrap SE = 0.080). Results suggest that pain sensations can interfere with activities of daily living through two distinct mechanisms. A combination of traditional cognitive behavioral therapy and mindfulness skills training targeting both pain catastrophizing and cognitive intrusion has the potential to decrease pain interference and help patients return to normal healthy living in spite of acute or persistent pain.     

The impact of critical illness on perceived health-related quality of life during ICU treatment, hospital stay, and after hospital discharge: a long-term follow-up study

BACKGROUND: The time course of changes in health-related quality of life (HRQOL) following discharge from the ICU and during a general ward stay has not been studied. We therefore studied the immediate impact of critical illness on HRQOL and its recovery over time. METHODS: In a prospective study, all patients admitted to the ICU for > 48 h who ultimately survived to follow-up at 6 months were included. The Medical Outcomes Study 36-item short form was used to measure HRQOL before ICU admission, at discharge from the ICU and hospital, and at 3 and 6 months following discharge from the ICU and hospital. An age-matched healthy Dutch population was used as a reference. RESULTS: Of the 451 included patients, 252 could be evaluated at 6 months (40 were lost to follow-up, and 159 died). Pre-ICU admission HRQOL in survivors was significantly worse compared to the healthy population. Patients who died between ICU admission and long-term follow-up had significantly worse HRQOL in all dimensions already at ICU admission when compared to the long-term survivors. HRQOL decreased in all dimensions (p < 0.001) during ICU stay followed by a rapid improvement during hospital stay, gradually improving to near pre-ICU admission HRQOL at 6 months following ICU discharge. Physical functioning (PF), general health (GH), and social functioning (SF) remained significantly lower than pre-ICU admission values. Compared to the healthy Dutch population, ICU survivors had significantly lower HRQOL 6 months following ICU discharge (except for the bodily pain score). CONCLUSIONS: A sharp multidimensional decline in HRQOL occurs during ICU admission where recovery already starts following ICU discharge to the general ward. Recovery is incomplete for PF, GH, and SF when compared to baseline values and the healthy population.     

后路单开门颈椎管扩大椎板成形术治疗OPLL效果分析

目的探讨后路单开门颈椎管扩大椎板成形术治疗颈椎后纵韧带骨化症患者的临床效果.方法将200例颈椎后纵韧带骨化症患者,根据手术方法不同分为研究组与对照组,每组100例,分别予以后路单开门椎管扩大成形术及前路椎体次全切减压融合术,术后观察12个月.于术前及术后1个月、12个月采用日本矫形外科协会评分系统评定神经功能,采用视觉模拟疼痛评分法评定疼痛状况;比较两组颈椎矢状位参数、颈椎脊髓整体后移距离、脊髓前缘后移距离、脊髓膨胀度.结果(1)术后1个月、12个月两组日本矫形外科协会评分系统评分均显著高于术前(P<0.01),视觉模拟疼痛评分法评分均显著低于术前(P<0.01);术前及术后1个月、12个月两组日本矫形外科协会评分系统、视觉模拟疼痛评分法评分比较差异均无统计学意义(P>0.05).(2)术后12个月两组颈椎矢状面轴向距离均较术前显著增大(P<0.01);术前及术后12个月两组颈椎Cobb角、颈椎矢状面轴向距离比较差异均无统计学意义(P>0.05).(3)术后12个月研究组颈椎脊髓整体后移距离为(2.21±0.54)mm、脊髓前缘后移距离为(1.85±0.37)mm,脊髓膨胀度测定值显著大于对照组(P<0.01).结论后路单开门颈椎管扩大椎板成形术治疗颈椎后纵韧带骨化症患者临床效果显著,对患者的颈椎脊髓整体后移距离、脊髓前缘后移距离、脊髓膨胀度的改善作用显著优于前路椎体次全切减压融合术.