Objective
Blood biomarkers have not been widely investigated in poststroke epilepsy. In this study, we aimed to describe clinical factors and biomarkers present during acute stroke and analyze their ...association with the development of epilepsy at long term.
Methods
A panel of 14 blood biomarkers was evaluated in patients with ischemic and hemorrhagic stroke. Biomarkers were normalized and standardized using Z‐scores. Stroke and epilepsy‐related variables were also assessed: stroke severity, determined by National Institutes of Health Stroke Scale (NIHSS) score, stroke type and cause, time from stroke to onset of late seizures, and type of seizure. Multiple Cox regression models were used to identify clinical variables and biomarkers independently associated with epilepsy.
Results
From a cohort of 1115 patients, 895 patients were included. Mean ± standard deviation (SD) age was 72.0 ± 13.1 years, and 57.8% of patients were men. Fifty‐one patients (5.7%) developed late seizures, with a median time to onset of 232 days (interquartile range IQR 86‐491). NIHSS score ≥8 (P < .001, hazard ratio HR 4.013, 95% confidence interval CI 2.123‐7.586) and a history of early onset seizures (P < .001, HR 4.038, 95% CI 1.802‐9.045) were factors independently associated with a risk of developing epilepsy. Independent blood biomarkers predictive of epilepsy were high endostatin levels >1.203 (P = .046, HR 4.300, 95% CI 1.028‐17.996) and low levels of heat shock 70 kDa protein‐8 (Hsc70) <2.496 (P = .006, HR 3.795, 95% CI 1.476‐9.760) and S100B <1.364 (P = .001, HR 2.955, 95% CI 1.534‐5.491). The risk of epilepsy when these biomarkers were combined increased to 17%. The area under the receiver‐operating characteristic (ROC) curve of the predictive model was stronger when clinical variables were combined with blood biomarkers (74.3%, 95% CI 65.2%‐83.3%) than when they were used alone (68.9%, 95% CI 60.3%‐77.6%).
Significance
Downregulated S100B and Hsc70 and upregulated endostatin may assist in prediction of poststroke epilepsy and may provide additional information to clinical risk factors. In addition, these data are hypothesis‐generating for the epileptogenic process.
•Having a job is one of the predictors of good quality of life in patients with epilepsy.•Unemployment and work disability are very common among patients with epilepsy.•Higher frequency of seizures ...is a clinical factor associated with unemployment and work disability.•Depressive symptoms and a worse quality of life have been also associated with unemployment.
The impact of epilepsy on work disability remains unclear. The aim of this study was to determine the percentage of patients with epilepsy who are unemployed or on temporary or permanent disability leave and to analyze associated clinical factors.
We performed an observational cross-sectional study of consecutively recruited patients with epilepsy seen at a specialized epilepsy unit or admitted to the epilepsy monitoring unit of a tertiary referral hospital. We analyzed the percentage of patients who were actively employed, unemployed, and on temporary or permanent disability leave. The groups were compared for sociodemographic data (age, sex, marital status, and type of work), clinical data (type of epilepsy, disease duration, monthly seizure frequency, and presence of anxiety or depression), treatment-related factors, and quality of life.
We included 742 patients (53% male, mean age 44.3 ± 13.7 years old): 40.5% were employed, 29.2% were unemployed, 19% were on temporary disability leave, and 11.1% had a permanent work disability. Depressive symptoms and poorer quality of life were associated with unemployment (OR 2.3, p = 0.02 and OR 1.8, p = 0.01), temporary disability leave (OR 1.4, p = 0.05 and OR 1.7, p = 0.02), and permanent work disability (OR 1.9, p = 0.01 and OR 2.2, p = 0.01). Low-skilled work was also predictive of unemployment (OR 1.9, p = 0.04), temporary disability leave (OR 2.8, p = 0.03), and permanent work disability (OR 1.7, p = 0.04). A higher monthly seizure frequency was associated with permanent work disability (OR 2.01, p = 0.02).
Less than 50% of patients with epilepsy in our setting are working. Factors associated with unemployment and work disability are a higher frequency of seizures, low-skilled work, depressive symptoms, and poor quality of life.
The objective of this study was to evaluate a novel automated test based on ultrasound cervical texture analysis to predict spontaneous Preterm Birth (sPTB) alone and in combination with Cervical ...Length (CL). General population singleton pregnancies between 18 + 0 and 24 + 6 weeks' gestation were assessed prospectively at two centers. Cervical ultrasound images were evaluated and the occurrence of sPTB before weeks 37 + 0 and 34 + 0 were recorded. CL was measured on-site. The automated texture analysis test was applied offline to all images. Their performance to predict the occurrence of sPTB before 37 + 0 and 34 + 0 weeks was evaluated separately and in combination on 633 recruited patients. AUC for sPTB prediction before weeks 37 and 34 respectively were as follows: 55.5% and 65.3% for CL, 63.4% and 66.3% for texture analysis, 67.5% and 76.7% when combined. The new test improved detection rates of CL at similar low FPR. Combining the two increased detection rate compared to CL alone from 13.0 to 30.4% for sPTB < 37 and from 14.3 to 42.9% sPTB < 34. Texture analysis of cervical ultrasound improved sPTB detection rate compared to cervical length for similar FPR, and the two combined together increased significantly prediction performance. This results should be confirmed in larger cohorts.
Multiple sclerosis (MS) is a chronic demyelinating autoimmune disease of the central nervous system. Current therapies decrease the frequency of relapses and limit, to some extent, but do not prevent ...disease progression. Hence, new therapeutic approaches that modify the natural course of MSneed to be identified. Tolerance induction to self‐antigens using monocyte‐derived dendritic cells (MDDCs) is a promising therapeutic strategy in autoimmunity. In this work, we sought to generate and characterize tolerogenic MDDCs (tolDCs) from relapsing‐remitting (RR) MSpatients, loaded with myelin peptides as specific antigen, with the aim of developing immunotherapeutics for MS. MDDCs were generated from both healthy‐blood donors and RR‐MSpatients, and MDDCmaturation was induced with a proinflammatory cytokine cocktail in the absence or presence of 1α,25‐dihydroxyvitamin‐D3, a tolerogenicity‐inducing agent. tolDCs were generated from monocytes of RR‐MSpatients as efficiently as from monocytes of healthy subjects. The RR‐MStolDCs expressed a stable semimature phenotype and an antiinflammatory profile as compared with untreated MDDCs. Importantly, myelin peptide‐loaded tolDCs induced stable antigen‐specific hyporesponsiveness in myelin‐reactive T cells from RR‐MS patients. These results suggest that myelin peptide‐loaded tolDCs may be a powerful tool for inducing myelin‐specific tolerance in RR‐MS patients.
Aims. Patients admitted to epilepsy monitoring units (EMUs) for diagnostic and presurgical evaluation have an increased risk of seizure‐related injury, particularly in the many cases in which ...medication is withdrawn. The purpose of this study was to assess the prevalence of adverse events (AEs) in this setting and to analyse associated clinical factors and costs.
Methods. We evaluated consecutive patients admitted to an EMU at a tertiary care hospital over a 10‐year period based on a descriptive, longitudinal study. We analysed the occurrence of AEs (traumatic injury, psychiatric complications, status epilepticus, cardiorespiratory disturbances, and death), investigated potential risk factors using univariate and multivariate logistic regression analysis, and compared admission costs between patients with and without AEs.
Results. In total, 411 EMU admissions were studied corresponding to 352 patients (55% women; mean SD age: 41.7 12.1 years). Twenty‐five patients (6%) experienced an AE. The most common event was traumatic injury (n=9), followed by status epilepticus (n=8), psychiatric complications (n=7), and cardiorespiratory disturbances (n=1). On comparing patients with and without AEs, we observed that the former were more likely to experience generalized seizures (OR: 7.81; 95% CI: 3.51‐12.23; p<0.001) or have more seizures overall during admission (OR: 3.2; 95% CI: 1.42‐6.8; p=0.002). Patients with AEs also had longer EMU stays (6.91 2.64 vs 5.08 1.1; p=0.004), longer hospital stays (8.45 3.6 vs 5.18 1.2; p<0.001), and higher costs (€7277.71 €2743.9 vs €5175.7 €1182.5; p<0.001).
Conclusion. Patients with generalized seizures and more seizures during admission were at greater risk of AEs, which were associated with higher admission costs.
Aim
To evaluate the efficacy of the reduction of visual and auditory stimuli on pain during venipuncture in premature newborns of 32–36 weeks of gestation.
Design
Open, randomized, non‐blind parallel ...clinical trial.
Method
Study to take place at the neonatal intensive care unit of a University Hospital in 2019–2021. Fifty‐six recently born babies between 32‐36 weeks of gestation will participate. The dependent variable is the level of pain determined using the premature infant pain profile instrument. The intervention will be assigned randomly using the random.org software. Data analysis will be carried out using the IBM SPSS v.25 software assuming a level of significance of 5%.
Discussion
The evidence for the efficacy of reducing sensory stimulation and its effect on pain in minor procedures has not been studied in depth. There are no studies that evaluate the reduction of visual and auditory stimuli in a combined way.
Impact
It is easy to incorporate the reduction of visual and auditory stimuli into nursing practice. The results of this study could have a direct impact on clinical practice.
Trial registered at clinicaltrials.gov: NCT04041635
目的
评价减少视觉和听觉刺激对32˜36周妊娠早产儿静脉穿刺疼痛的影响
设计
开放式随机非盲平行临床试验。
方法
2019年至2021年期间,对某大学附属医院新生儿重症监护室开展该研究。56名32~36周妊娠早产儿参与了该研究。依变量是使用早产儿疼痛曲线仪确定的疼痛水平。
讨论
尚未深入研究在小手术中减少感官刺激的有效性及其对疼痛的影响。目前尚无有关以综合方式评估视觉和听觉刺激减少的研究。
影响
将减少视觉和听觉纳入护理实践中是很容易实现的。该研究结果可能会对临床实践产生直接影响。
试验注册地址
clinicaltrials.gov;注册编号:NCT04041635
Patients with cirrhosis often develop malnutrition and micronutrient deficiencies, leading to a worse prognosis and increased mortality. Our main goal was to assess the prevalence of micronutrient ...deficiencies in patients with decompensated cirrhosis. This was a prospective single-center study including 125 consecutive patients hospitalized for acute decompensation of cirrhosis (mostly of alcoholic etiology). A blood test including trace elements and vitamins was performed on admission. The main micronutrient deficiencies observed were vitamin D (in 94.5%), vitamin A (93.5%), vitamin B6 (60.8%) and zinc (85.6%). Patients in Child-Pugh class C had lower levels of vitamin A (
< 0.0001), vitamin E (
= 0.01) and zinc (
< 0.001), and higher levels of ferritin (
= 0.002) and vitamin B12 (
< 0.001) than those in Child-Pugh class A and B. Patients with a higher model of end-stage liver disease (MELD) score had lower levels of vitamin A (
< 0.0001), vitamin E (
< 0.001), magnesium (
= 0.01) and zinc (
= 0.001), and higher levels of ferritin (
= 0.002) and vitamin B12 (
< 0.0001). Severe hepatic insufficiency correlated with lower levels of zinc, vitamin E and vitamin A, and higher levels of vitamin B12 and ferritin.
Chronic alcohol consumption is a well-known etiological factor for both chronic pancreatitis (CP) and liver cirrhosis. However, there is discussion over how often these two entities are present ...together in the same patient. The main goal of our study is to establish the prevalence of CP and low fecal elastase (FE-1) in patients with decompensated liver disease (DLD). In addition, we aim to identify the demographic, epidemiological and clinical factors associated with EPI and CP in patients with decompensated liver cirrhosis. This was an observational single-center study including 119 consecutive patients hospitalized for acute decompensation of cirrhosis, mostly of alcoholic etiology. Patients underwent computed tomography (CT) or magnetic resonance imaging (MRI) to assess the radiological features of CP. We also performed two FE-1 tests and complete blood tests to assess the presence of exocrine pancreatic insufficiency (EPI) and nutritional status, including micronutrients. The results of our study show that 32 patients (26.9%) had low fecal elastase suggesting EPI and 11 (9.2%) had CP. Patients meeting radiological CP criteria had lower FE-1 than patients without CP. There were no statistically significant differences in micronutrient deficiencies according to the presence of CP or not. Likewise, we did not find any statistically significant differences in micronutrient deficiencies among patients with normal and low FE-1 indicative of EPI. FE-1 alone may not be suitable for assessing EPI in patients with acute DLD. Detecting co-existing pancreatic disease may be important in a subset of patients with DLD, when the FE-1 levels are significantly low, potentially suggestive of a pancreatic anomaly. Moreover, the clinical manifestations of EPI and CP are not useful in detecting CP in DLD patients. Likewise, CP cannot explain all causes of EPI in these patients.
Insomnia is highly prevalent in patients with substance use disorders (SUD), and it has been related to a worse course of addiction. Insomnia during detoxification in a hospital has not been ...adequately studied. This study aims to compare sociodemographic, clinical, and psychopathological characteristics of SUD patients undergoing a detoxification program, by comorbidity and insomnia symptoms.
We recruited 481 patients who received pharmacological and psychotherapeutic treatment for detoxification. They were evaluated through semi-structured interviews, standardized questionnaires, and a specific sleep log. A bivariate and multivariate analysis of the data was performed.
Insomnia was reported by 66.5% patients, with sleep-maintenance insomnia the most frequent issue, followed by early morning awakening and sleep-onset insomnia. Patients with alcohol use disorder and cannabis use disorder had higher prevalence of sleep-onset insomnia. Patients with cocaine and heroin use disorder had higher prevalence of sleep-maintenance insomnia. Independent factors that allowed the identification of insomnia symptoms included being female (OR: 3.43), polysubstance use (OR: 2.85), comorbid anxiety disorder (OR: 2.02), and prior admission for detoxification (OR: 1.22).
Insomnia symptoms are very prevalent in patients admitted for detoxification. The diagnosis and therapeutic strategies for the insomnia symptoms should be improved, especially in women and in patients with greater addiction severity and with anxiety disorders.
Summary
Background
Treatment with tolerogenic dendritic cells (TolDC) is a promising, cell‐based strategy to regulate autoimmune diseases such as multiple sclerosis (MS) in an antigen‐specific way. ...This technique involves the use of TolDC from MS patients cultured in the presence of vitamin D3 (VitD3) and pulsed with myelin peptides to induce a stable hyporesponsiveness in myelin‐specific autologous T cells.
Aim
The purpose of this study was to analyze the in vivo effect of VitD3‐TolDC treatment on experimental autoimmune encephalomyelitis, an animal model of MS.
Methods
Bone marrow‐derived TolDC cultured in the presence of VitD3 and pulsed with peptide 40–55 of the myelin oligodendrocyte glycoprotein (MOG40–55) were administrated preventively, preclinically, and therapeutically to EAE‐induced mice.
Results
We found that VitD3‐TolDC‐MOG treatment showed a beneficial effect, not only decreasing the incidence of the disease but also reducing the severity of the clinical signs mediated by induction of regulatory T cells (Treg), as well as IL‐10 production and reduction of Ag‐specific lymphoproliferation. Our results support VitD3‐TolDC‐peptide(s) treatment as a potential strategy to restore tolerance in autoimmune diseases such as MS.
PDF
