Background and purpose
The aim of this study was to examine non‐motor symptoms in different Parkinson's disease (PD) motor subtypes and their associations with quality of life (QoL).
Methods
A total ...of 132 patients with early PD with comprehensive motor examinations and non‐motor symptom assessments were included. Motor subtypes were classified based on Stebbins’ method. Non‐motor symptoms were assessed by the Non‐Motor Symptom Scale (NMSS) and validated by more comprehensive instruments, including the Pittsburgh Sleep Quality Index (PSQI) and Fatigue Severity Scale (FSS). QoL was measured by the Parkinson's Disease Questionnaire‐8.
Results
We identified 66 patients (50%) with tremor‐dominant (TD) subtype, 47 (35.6%) with postural instability and gait disorder (PIGD) subtype and 19 (14.4%) with Intermediate subtype. By comparing NMSS scores, patients with the PIGD subtype had more severe sleep impairment and fatigue (domain 2 score: 5.64 vs. 2.52, P < 0.001), urinary symptoms (domain 7 score: 6.96 vs. 3.48, P = 0.005) and overall more severe non‐motor symptoms (NMSS total score: 25.89 vs. 17.27, P = 0.031), compared with patients with the TD subtype. Validation using the PSQI and FSS again suggested that patients with the PIGD subtype had independently and significantly more severe sleep impairment (PSQI score: 5.57 vs. 4.29, P = 0.020) and fatigue (FSS score: 34.81 vs. 25.85, P = 0.003) compared with patients with the TD subtype. Several non‐motor symptoms had significant associations with QoL, among which sleep impairment and fatigue (P < 0.0001, partial r2 = 0.273) explained the largest proportion of QoL variability in patients with PD.
Conclusions
Patients with the PIGD subtype had more severe sleep impairment, fatigue and urinary disturbance compared with patients with the TD subtype. Sleep impairment and fatigue were the most important factors affecting QoL independent of motor subtypes. Prompt identification and treatment of these non‐motor symptoms may improve patients’ QoL.
Background and purpose
There have been few long‐term studies that have characterized and charted the clinical progression of Parkinson's disease (PD). This study was therefore undertaken to ...understand the natural clinical evolution of treated PD patients and to identify the variables that predict greater progression in these patients.
Methods
A longitudinal linear mixed model analysis of motor score progression was performed on 576 PD patients derived from the National Neuroscience Institute Movement Disorders Database. Clinical and demographic variables were taken at baseline and formed the subgroups for comparison (gender, age at diagnosis, subtype, Mini‐Mental State Examination score and baseline motor score). Motor score progression was calculated at each patient follow‐up time point as the difference between Unified Parkinson's Disease Rating Scale (UPDRS) motor score at baseline and follow‐up scores.
Results
The overall annual motor score progression as measured by the change of UPDRS motor scores from baseline ranged from 0.62% to 3.67%. There are three distinct phases: improvement, stability, and steady progression. Patients returned to baseline score 2–2.5 years after diagnosis, with stability lasting to 7 years, followed by a period of steady progression. When analyzed longitudinally, male gender (P < 0.03), older age at diagnosis (P < 0.05), akinetic‐rigid subtype (P < 0.04), cognitive impairment (P < 0.005) and lower baseline motor score (P < 0.04) were associated with greater progression of motor scores.
Conclusions
Our results show that, when measured clinically, motor progression was non‐linear and that it occurred in distinct phases, all of which were affected by baseline demographic and clinical variables such as gender, age at diagnosis, disease subtype, cognitive status and baseline motor score.
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Background and purpose
This study quantified the total brain and periventricular white matter hyperintensity (WMH) burdens in patients with early Parkinson’s disease (PD) and explored their ...associations with cardiovascular risk factors and cognitive performance.
Methods
A total of 175 non‐demented patients with early PD who had undergone baseline brain magnetic resonance imaging were included. Comprehensive neurocognitive testing was conducted to identify PD with mild cognitive impairment (PD‐MCI) and to evaluate performances in individual cognitive domains. Cardiovascular risk was expressed as a modified Framingham 10‐year cardiovascular risk score (mFRS).
Results
A total of 53.7% of this early PD cohort fulfilled the diagnostic criteria for PD‐MCI. An increase in mFRS was significantly associated with increases in the total brain WMH (P = 0.015) and periventricular WMH (P = 0.040) burden, independent of age and gender. The periventricular WMH burden was significantly associated with PD‐MCI (P = 0.046) in early PD, independent of cardiovascular risk factors. Patients in the 5th quintile of periventricular WMH burden were 8.6 times more likely to have PD‐MCI compared with patients in the 1st quintile of periventricular WMH burden (P = 0.004). However, total brain WMH burden was not associated with PD‐MCI (P = 0.158). In individual cognitive domains, heavier periventricular WMH burden was associated with worse executive function and visuospatial function independent of cardiovascular risk factors.
Conclusion
Periventricular WMHs are a useful imaging biomarker for cognitive impairment in early PD. Cardiovascular risk factors, although associated with periventricular WMHs, were unable to fully explain the association between periventricular WMHs and cognitive impairment in early PD.
To compare the effectiveness and safety of pharmacological thrombolysis and mechanical thrombectomy.
This review was conducted in accordance with the PRISMA guidelines. Pooled proportions and ...subgroup analysis were calculated for primary and secondary patency rates, technical success, clinical success, major and minor complications rates.
This systematic review identified a total of 6,492 studies of which 17 studies were included for analysis. A total of 1,089 patients comprising 451 (41.4 %) and 638 (58.6 %) patients who underwent thrombolysis and mechanical thrombectomy procedures, respectively, were analysed. No significant differences were observed between thrombolysis and mechanical thrombectomy procedures in terms of technical success, clinical success, major and minor complications rates, primary and secondary patency rates; however, subgroup analysis of overall arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) demonstrated a significantly higher rate of major complications within the AVF group (p=0.0248).
The present meta-analysis suggests that pharmacological thrombolysis and mechanical thrombectomy procedures are similarly effective and safe; however, AVFs are subject to higher major complications compared to AVGs.
•Thrombosis is a major complication of arteriovenous fistulas and grafts.•Common treatments include thrombolysis and mechanical thrombectomy.•Thrombolysis and mechanical thrombectomy are similarly effective treatments.
Where have all the hip fractures gone? Wong, K. C.; Cheok, J. W. G.; Tay, K. X. K. ...
Osteoporosis international,
10/2020, Letnik:
31, Številka:
10
Journal Article
Study design
Cross-sectional cohort analysis of patients with Modic Changes (MC).
Objective
Our goal was to characterize the molecular and cellular features of MC bone marrow and adjacent discs. We ...hypothesized that MC associate with biologic cross-talk between discs and bone marrow, the presence of which may have both diagnostic and therapeutic implications.
Background data
MC are vertebral bone marrow lesions that can be a diagnostic indicator for discogenic low back pain. Yet, the pathobiology of MC is largely unknown.
Methods
Patients with Modic type 1 or 2 changes (MC1, MC2) undergoing at least 2-level lumbar interbody fusion with one surgical level having MC and one without MC (control level). Two discs (MC, control) and two bone marrow aspirates (MC, control) were collected per patient. Marrow cellularity was analyzed using flow cytometry. Myelopoietic differentiation potential of bone marrow cells was quantified to gauge marrow function, as was the relative gene expression profiles of the marrow and disc cells. Disc/bone marrow cross-talk was assessed by comparing MC disc/bone marrow features relative to unaffected levels.
Results
Thirteen MC1 and eleven MC2 patients were included. We observed pro-osteoclastic changes in MC2 discs, an inflammatory dysmyelopoiesis with fibrogenic changes in MC1 and MC2 marrow, and up-regulation of neurotrophic receptors in MC1 and MC2 bone marrow and discs.
Conclusion
Our data reveal a fibrogenic and pro-inflammatory cross-talk between MC bone marrow and adjacent discs. This provides insight into the pain generator at MC levels and informs novel therapeutic targets for treatment of MC-associated LBP.
The use of TEGDMA as a diluent comonomer in the formulation of hydrophobic adhesives for ethanol wet-bonding is a concern, due to its leaching potential, higher water sorption, and ...bio-incompatibility. This study tested the hypothesis that hydrophobic bonding to acid-etched dentin may be accomplished with the use of ethanol-solvated BisGMA only. Phosphoric-acid-etched, oxalate-occluded, deep coronal dentin bonded under 20 cm water pressure with experimental BisGMA adhesives by ethanol wet-bonding exhibited tensile strengths that were not significantly different from that achieved with OptiBond FL bonded according to the manufacturer-recommended protocol, with similar acid-/base-resistant hybrid layers, resin tags, and nanoleakage distribution. Ethanol replacement of water-saturated dentin produced wider interfibrillar spaces, more extensive shrinkage of the collagen fibrils, and narrower hybrid layers. Experimental BisGMA adhesives provide the proof of concept that relatively hydrophobic resins may be coupled to acid-etched dentin by increasing its hydrophobic characteristics via ethanol replacement. They should be further optimized before clinical application.
The different morphological stages of microglial activation have not yet been described in detail. We transected the olfactory bulb of rats and examined the activation of the microglial system ...histologically. Six stages of bidirectional microglial activation (A) and deactivation (R) were observed: from stage 1A to 6A, the cell body size increased, the cell process number decreased, and the cell processes retracted and thickened, orienting toward the direction of the injury site; until stage 6A, when all processes disappeared. In contrast, in deactivation stages 6R to 1R, the microglia returned to the original site exhibiting a stepwise retransformation to the original morphology. Thin highly branched processes re-formed in stage 1R, similar to those in stage 1A. This reverse transformation mirrored the forward transformation except in stages 6R to 1R: cells showed multiple nuclei which were slowly absorbed. Our findings support a morphologically defined stepwise activation and deactivation of microglia cells.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background: Mesenchymal stem cells (MSCs) represent a promising alternative form of cell-based therapy for cartilage injury. However, the capacity of MSCs for chondrogenesis has not been fully ...explored. In particular, there is presently a lack of studies comparing the effectiveness of MSCs to conventional autologous chondrocyte (autoC) treatment for regeneration of full-thickness cartilage defects in vivo.
Hypothesis: Treatment with allogenic undifferentiated MSCs (alloMSCs) results in superior cartilage tissue regeneration profiles when compared with autoC for repair of focal articular cartilage defects.
Study Design: Controlled laboratory study.
Methods: Full-thickness articular cartilage defects were created on the weightbearing surface of the medial femoral condyles in both knees of New Zealand White rabbits (N = 30). Six weeks after the defect was induced, the right knee was treated with either alloMSCs (n = 12) or autoC (n = 18), while the left knee remained untreated (control). The rabbits were sacrificed at 6 months after treatment for assessment of cartilage tissue regeneration, which included the Brittberg morphologic score, histologic grading by O’Driscoll score, and quantitative analysis of glycosaminoglycans per total protein content.
Results: Apart from significantly higher Brittberg scores in the alloMSC treatment group (8.8 ± 0.8) versus the autoC treatment group (6.6 ± 0.8) (P = .04), both treatments showed similar cartilage regenerative profiles. All outcome measures were significantly higher in the treatment groups compared with their respective controls (P < .05).
Conclusion: AlloMSCs have similar effectiveness as autoC for repair of focal cartilage defects. Both treatments resulted in superior tissue regeneration compared with untreated defects.
Clinical Relevance: The results have an implication of supporting the potential use of MSCs for cartilage repair after sports injuries or diseases, in view of similar efficacy but less patient morbidity and potential cost savings as compared with conventional autoC therapy.
Nanotechnology is often associated with materials fabrication, microelectronics, and microfluidics. Until now, the use of nanotechnology and molecular self assembly in biomedicine to repair injured ...brain structures has not been explored. To achieve axonal regeneration after injury in the CNS, several formidable barriers must be overcome, such as scar tissue formation after tissue injury, gaps in nervous tissue formed during phagocytosis of dying cells after injury, and the failure of many adult neurons to initiate axonal extension. Using the mammalian visual system as a model, we report that a designed self-assembling peptide nanofiber scaffold creates a permissive environment for axons not only to regenerate through the site of an acute injury but also to knit the brain tissue together. In experiments using a severed optic tract in the hamster, we show that regenerated axons reconnect to target tissues with sufficient density to promote functional return of vision, as evidenced by visually elicited orienting behavior. The peptide nanofiber scaffold not only represents a previously undiscovered nanobiomedical technology for tissue repair and restoration but also raises the possibility of effective treatment of CNS and other tissue or organ trauma.
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