A rare case of lupus cerebritis presenting as ictal epileptic headache: A case report.

Ictal epileptic headache, characterized by headache as the sole symptom of a seizure attack, is a rare condition. In this case report, we present a 52-year-old female with a history of systemic lupus erythematosus who sought medical attention at the headache clinic due to a new type of headache. The headache was described as an intense painful wave followed by a dull headache, without autonomic symptoms or migrainous features. Magnetic resonance imaging revealed an enhancing lesion in the left hippocampus in addition to two other lesions in the corpus callosum and left parieto-occipital lobe. Electroencephalography during the headache episodes showed epileptic discharges originating from the left fronto-temporal region. The patient was initiated on levetiracetam, which resulted in the resolution of both the epileptic discharges and the headaches. This case underscores the significance of considering ictal epileptic headache as a potential secondary cause for headaches, particularly in patients with underlying conditions that may predispose them to epilepsy, such as systemic lupus erythematosus.

Sustained delivery of chABC improves functional recovery after a spine injury.

INTRODUCTION: Chondroitinase ABC (chABC) is an enzyme could improve regeneration and thereby improving functional recovery of spinal cord injury (SCI) in rodent models. Degradation of the active enzyme and diffusion away from the lesion are the causes of using hydrogels as a scaffold to deliver the chABC into the lesion site. In this meta-analysis, we investigated the effects of chABC embedded in a scaffold or hydrogel on the functional recovery after SCI. METHOD: Databases were searched based on keywords related to chABC and spinal cord injury (SCI). Primary and secondary screening was performed to narrow down study objectives and inclusion criteria, and finally the data were included in the meta-analysis. The standard mean difference of the score of the functional recovery that measured by Basso, Beattie, Bresnahan (BBB) test after SCI was used to analyze the results of the reported studies. Subgroup analysis was performed based on SCI model, severity of SCI, transplantation type, and the follow-up time. Quality control of articles was also specified. RESULTS: The results showed that embedding chABC within the scaffold increased significantly the efficiency of functional recovery after SCI in animal models (SMD = 1.95; 95% CI 0.71-3.2; p = 0.002) in 9 studies. SCI model, severity of SCI, injury location, transplantation type, and the follow-up time did not affect the overall results and in all cases scaffold effect could not be ignored. However, due to the small number of studies, this result is not conclusive and more studies are needed. CONCLUSION: The results could pave the way for the use of chABC embedded in the scaffold for the treatment of SCI and show that this method of administration is superior to chABC injection alone.

OnabotulinumtoxinA in chronic migraine: is the response dose dependent?

BACKGROUND: OnabotulinumtoxinA has been widely used for control of chronic migraine. The aim of the current study was to evaluate the efficacy of different doses of the onabotulinumtoxinA therapy in patients with chronic migraine. METHODS: This is a retrospective paired comparison study on patients with chronic migraine who received at least 3 rounds of 150 units of onabotulinumtoxinA followed by at least 3 rounds of 200 units of onabotulinumtoxinA. The data from the patient-reported questionnaires about headache days, severe headache days and wearing off periods were reviewed. RESULTS: A total of 175 patients were included in this study. The headache days and severe headache days decreased from 13.62 ± 10.79 and 5.88 ± 6.73 to 11.02 ± 10.61and 4.01 ± 4.89 days, after increase in the onabotulinumtoxinA dose, respectively (P < 0.001 for both comparisons). The favorable effect of the 200 units compared to the 150 units of the onabotulinumtoxinA, was independent from the headache location and the duration of the onabotulinumtoxinA 150 units therapy; and persisted as patients continued to receive the higher dose of onabotulinumtoxinA. Increase in the onabotulinumtoxinA dose was also associated with a decreased wearing off period (P < 0.05). CONCLUSION: We found that increase in the onabotulinumtoxinA is associated with fewer headache and severe headache days. Future randomized clinical trials are needed to confirm the dose-dependent response to onabotulinumtoxinA.

Cerebral Blood Flow Response During Bolus Normal Saline Infusion After Ischemic Stroke.

GOALS: We quantified cerebral blood flow response to a 500 cc bolus of 0.9%% normal saline (NS) within 96 hours of acute ischemic stroke (AIS) using diffuse correlation spectroscopy (DCS). MATERIALS AND METHODS: Subjects with AIS in the anterior, middle, or posterior cerebral artery territory were enrolled within 96 hours of symptom onset. DCS measured relative cerebral blood flow (rCBF) in the bilateral frontal lobes for 15 minutes at rest (baseline), during a 30-minute infusion of 500 cc NS (bolus), and for 15 minutes after completion (post-bolus). Mean rCBF for each time period was calculated for individual subjects and median rCBF for the population was compared between time periods. Linear regression was used to evaluate for associations between rCBF and clinical features. RESULTS: Among 57 subjects, median rCBF (IQR) increased relative to baseline in the ipsilesional hemisphere by 17% (-2.0%, 43.1%), P< 0.001, and in the contralesional hemisphere by 13.3% (-4.3%, 36.0%), P < .004. No significant associations were found between ipsilesional changes in rCBF and age, race, infarct size, infarct location, presence of large vessel stenosis, NIH stroke scale, or symptom duration. CONCLUSION: A 500 cc bolus of .9% NS produced a measurable increase in rCBF in both the affected and nonaffected hemispheres. Clinical features did not predict rCBF response.

Symptomatic Carotid Occlusion Is Frequently Associated With Microembolization.

BACKGROUND AND PURPOSE: Symptomatic carotid artery disease is associated with significant morbidity and mortality. The pathophysiologic mechanisms of cerebral ischemia among patients with carotid occlusion remain underexplored. METHODS: We conducted a prospective observational cohort study of patients hospitalized within 7 days of ischemic stroke or transient ischemic attack because of ≥50% carotid artery stenosis or occlusion. Transcranial Doppler emboli detection was performed in the middle cerebral artery ipsilateral to the symptomatic carotid. We describe the prevalence of microembolic signals (MES), characterize infarct topography, and report clinical outcomes at 90 days. RESULTS: Forty-seven patients, 19 with carotid occlusion and 28 with carotid stenosis, had complete transcranial Doppler recordings and were included in the final analysis. MES were present in 38%. There was no difference in MES between those with carotid occlusion (7/19, 37%) compared with stenosis (11/28, 39%; P=0.87). In patients with radiographic evidence of infarction (n=39), 38% had a watershed pattern of infarction, 41% had a nonwatershed pattern, and 21% had a combination. MES were present in 40% of patients with a watershed pattern of infarction. Recurrent cerebral ischemia occurred in 9 patients (19%; 6 with transient ischemic attack, 3 with ischemic stroke). There was no difference in the rate of recurrence in those with compared to those without MES. CONCLUSIONS: Cerebral embolization plays an important role in the pathophysiology of ischemia in both carotid occlusion and stenosis, even among patients with watershed infarcts. The role of aggressive antithrombotic and antiplatelet therapy for symptomatic carotid occlusions may warrant further investigation given our findings.

Prophylactic Use of Antiepileptic Drugs in Patients with Spontaneous Intracerebral Hemorrhage.

BACKGROUND: The effect of prophylactic antiepileptic drugs (AEDs) on mortality and functional outcome in patients with intracerebral hemorrhage (ICH) is uncertain. METHODS: We used data from the Virtual International Stroke Trials Archive (VISTA) to evaluate the effect of prophylactic AEDs on ICH outcome. Univariate and multivariate logistic and Cox regression models were designed to determine the impact of prophylactic AEDs on mortality and disability, defined as a modified Rankin Scale (mRS) greater than 3 at 90 days following ICH. RESULTS: Of the 802 patients with ICH, 81 (10%) received prophylactic AEDs. Patients who received AED prophylaxis had higher ICH volume (median 23.2 cm(3) [IQR 10.5-38.0] versus 14.3 cm(3) [IQR 7.1-27.0], P= .001) and ICH score (median 1 cm(3) [IQR 0-2] versus 1 cm(3) [IQR 0-1], P = .03). In univariate analyses, AED prophylaxis was associated with higher probability of mRS greater than 3 at 90 days (62% versus 49%, P = .03) and a trend towards increased mortality (27% versus 18%, P = .06). Although seizure did not influence ICH outcome, any AED prophylaxis and phenytoin use in particular were both associated with mRS greater than 3 at 90 days (OR 1.66 [1.04-2.66], P = .03 for any AED; OR 1.97 [1.06-3.67], P = .03 for phenytoin prophylaxis) in univariate analyses. After adjustment for components of the ICH score, none of these associations remained significant. CONCLUSION: Patients with higher ICH scores and larger hemorrhages are more likely to receive prophylactic AEDs. We found no independent effect of prophylactic AED treatment on outcome after ICH.

Non-linear contribution of serum vitamin D to symptomatic diabetic neuropathy: A case-control study.

AIMS: Vitamin D deficiency has recently been speculated to be associated with increased risk of diabetes neuropathy (DN). The aim of this study was to evaluate the odds of symptomatic DN across serum vitamin D levels. METHODS: All patients with DM were assessed using diabetic neuropathy symptoms and diabetic neuropathy examination score. Overall, 150 cases with DN and 600 controls were included. Serum 25-hydroxyvitamin D (25-OH-D) was measured to determine vitamin D status. RESULTS: A non-linear association between 25-OH-D and suffering from symptomatic DN was observed which was extracted after stratifying the ORs across different serum 25-OH-D levels. When compared to individuals with 25-OH-D of 30-40 ng/mL, patients with deficient (<20 ng/mL) vitamin D levels had higher odds of having symptomatic DN (OR: 2.04, 95%CI: 0.99-4.02, P=0.054). Participants with vitamin D values of greater than 40 ng/mL were also more likely to exhibit symptomatic DN (fully adjusted OR: 4.29, 95%CI: 1.59-11.55). CONCLUSIONS: We hypothesize a non-linear contribution of serum vitamin D to symptomatic DN occurrence, which emphasizes that administration of vitamin D should be monitored and evaluated more carefully, especially in patients with diabetes.

Revising the fasting glucose threshold for detection of cardiovascular risk factors: analysing two representative population-based studies of more than 50,000 Iranians in 3 years: The National Survey of Risk Factors for Non-Communicable Diseases of Iran.

OBJECTIVES: To study the prevalence of cardiovascular risk factors across different glycaemia strata and to assess the optimal cut-off value of fasting plasma glucose (FPG) to identify the constellation of cardiovascular risk factors. METHODS: Data of the National Survey of Risk Factors for Non-Communicable Diseases of Iran (SURFNCD 2005-2007) were analysed. Prevalence rates of obesity, central obesity, hypertension and hypercholesterolemia of individuals with Impaired Fasting Glucose (IFG) were compared with those of individuals with normal fasting glycaemia and newly diagnosed diabetes. Optimal FPG cut-point to diagnose subjects with cardiovascular risk factors was assessed. RESULTS: Prevalence of each and combinations of cardiovascular risk factors were higher among subjects with IFG compared to those with normal fasting glycaemia. The areas under the curve (AUC) for detecting cardiovascular risk were highest at FPG values of 90 mg/dL. FPG of 90 mg/dL was the optimal cut-off and, in comparison to 100 mg/dL, corresponds to correct detection of 26-29% of obese, 22-27% of centrally obese, 26-29% of hypertensive and 25-30% of hypercholesterolemic individuals. CONCLUSIONS: IFG and even lower levels of FPG are associated with high prevalence of cardiovascular risk factors in Iranian adults. This study suggests the FPG cut-off to be revised at 90 mg/dL to identify people with increased cardiovascular risk.

Association of vaspin with metabolic syndrome: the pivotal role of insulin resistance.

BACKGROUND: Previous studies evaluating the relationship between serum vaspin concentrations and metabolic syndrome (MetS) have yielded contrasting results. Additionally, contribution of general and abdominal obesity, chronic inflammation, and insulin resistance to this relationship remains unknown. METHODS: In a cross-sectional setting, we investigated the association between vaspin and MetS in 145 subjects ranging from normoglycemia to type 2 diabetes. Vaspin concentrations were measured using enzyme-linked immunosorbent assay. RESULTS: Women had 29% higher vaspin concentrations compared with men. Subjects with MetS (51% of all participants) had higher vaspin concentrations (P=0.019 in women and P<0.001 in men). In logistic regression, vaspin significantly predicted raised fasting plasma glucose (P<0.001), and raised triglycerides (P<0.001) after controlling for age in both sexes. Moreover, vaspin was the significant predictor for reduced high-density lipoprotein cholesterol and raised waist circumference in women and men, respectively. Considering MetS as a whole, vaspin predicted MetS even after adjustment for age, medications, diabetes, total cholesterol, and waist circumference in both sexes (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.36 to 11.05; P=0.011 for women; OR, 3.16; 95% CI, 1.28 to 7.78; P=0.012 for men). However, this relationship rendered nonsignificant after introducing homeostasis model assessment of insulin resistance (HOMA-IR) in women (P=0.089) and high-sensitivity C-reactive protein (P=0.073) or HOMA-IR in men (P=0.095). CONCLUSION: Vaspin is associated with some but not all components of MetS. Vaspin is a predictor of MetS as a single entity, independent of obesity. This relationship is largely ascribed to the effects of insulin resistance and chronic inflammation.

Risk of coronary heart disease associated with metabolic syndrome and its individual components in Iranian subjects: a matched cohort study.

BACKGROUND AND OBJECTIVES: To evaluate the risk of coronary heart disease (CHD) associated with metabolic syndrome (MetS) and its individual components in a representative sample of diabetic and nondiabetic Iranians. Moreover, we aimed to define the most hazardous MetS components. METHODS: Two cohorts consisting of 1737 nondiabetic and 2385 diabetic participants were followed for the first CHD event during 8.5 years (until December 2013). RESULTS: MetS is defined as having 3 individual components associated with increased risk of CHD (hazard ratio [HR] for MetS: in the unadjusted were 2.85 [2.27-3.57] and in the fully adjusted model 1.80 [1.42-2.28]). MetS was associated with lower hazard of CHD in subjects older than 65 (HR: 1.50 vs. 3.47; P for interaction < .05) and in men (HR: 1.68 vs. 4.87; P for interaction < .05). Presence of 4 of 5 individual MetS components increased the risk of CHD associated with MetS as a constellation. The value of MetS is augmented in the presence of low high-density lipoprotein-cholesterol (HR: 5.74 [2.52-13.08]) versus its absence (HR 1.91 [1.33-2.75]), high triglycerides (HR: 3.39 [1.38-8.34] vs. 1.99 [1.40-2.82] in its absence) and elevated blood pressure (HR: 2.61 [1.43-4.76] vs. 1.80 [1.26-2.58] in its absence). CONCLUSIONS: We address the value of MetS components in the prediction of CHD and in the absence of traditional risk factors. This study provides evidence for the synergistic effect of MetS components on the incidence of CHD.

CA 19-9 is associated with poor glycemic control in diabetic patients: role of insulin resistance.

BACKGROUND: CA19-9 is considered a tumor marker. Reports have suggested higher CA19-9 levels in diabetic patients even with no malignancy. Our aim was to reveal the relation of CA19-9 with glycemic control in diabetic and non-diabetic subjects. For the first time we considered diabetes as an outcome based on a cut-off where the association of CA19-9 with diabetes is considerable. METHODS: The study was carried out at an outpatient metabolism clinic. A total of 422 consecutive participants were enrolled. Subjects with prior diagnosis of any cancer, renal, endocrine, or hepatic problems were not included. Age, gender, and medications as well as weight, height, and BMI were recorded. Creatinine, fasting plasma glucose (FPG), post-prandial plasma glucose (PPPG), fasting plasma insulin, HbA1c, C-peptide, HOMA-IR, and CA 19-9 were measured. RESULTS: In all, 266 (63.03%) subjects had recently been diagnosed with diabetes. CA19-9 was significantly higher in the diabetic group (16.73 +/- 13.83 vs. 11.93 +/- 11.42, p < 0.001). BMI, waist circumference, FPG, and HbA1c were higher in quartiles with greater CA19-9 levels. Number of diabetic subjects in each quartile had a stepwise increase (48%, 56%, 72%, and 77%, p < 0.01). FPG, PPPG, HbA1c, and HOMA-IR were directly correlated with CA19-9 levels independent of age, gender, and BMI. We presume the 10.83 U/mL value for CA19-9 to be the optimal cut-off in indicating diabetes status (sensitivity: 0.63, specificity: 0.55). CONCLUSIONS: Otherwise normal diabetic subjects have greater CA19-9 values. CA19-9 should be interpreted with regard to diabetes status. We suggest that CA19-9 levels above 10.83 U/mL in the absence of other pathologies are in favor of glycemic impairments. CA19-9 values greater than 34.30 U/mL may accompany an 84% frequency of diabetic subjects especially in settings such as referral metabolism clinics. CA19-9 values of less than 6.46 U/mL are likely to rule out the presence of diabetes, especially while testing in general population.

Homocysteine and metabolic syndrome: from clustering to additional utility in prediction of coronary heart disease.

BACKGROUND: The association between homocysteine (Hcy) and metabolic syndrome (MetS)-related disorders remains to be unveiled. First, the role of Hcy-MetS interaction in prediction of coronary heart disease (CHD) was assessed. Next, we investigated whether serum Hcy improves CHD risk-prediction beyond MetS and traditional risk factors (TRFs). DESIGN: A prospective study of 5893 community-dwelling participants (two sub-cohorts, 3286 diabetic and 2607 non-diabetic; ∼ 8.5 years of follow-up). METHODS: Clustering of Hcy with MetS components was assessed using exploratory factor-analysis. Cox regression hazard ratio (HR) was used to predict CHD using Hcy level and MetS status. Baseline model included MetS and TRFs. Addition of Hcy and hyper-homocysteinemia (HHcy) to the baseline model was evaluated in two separate models. RESULTS: Hcy was correlated with MetS components, especially with systolic blood pressure. The factor linking MetS to CHD is the factor through which Hcy is linked to MetS. HHcy and MetS interacted as risk factors for CHD. CONCLUSION: Hcy adds to the value of MetS and TRFs for CHD risk-prediction by reclassifying around 47.3-49.0% of the overall and 21.6-28.1% of the intermediate-risk population.

Predictive ability of C-reactive protein for early mortality after ischemic stroke: comparison with NIHSS score.

We aimed to compare the association of high-sensitivity C-reactive protein (CRP) and National Institutes of Health Stroke Scale (NIHSS) score with mortality risk and to determine the optimal threshold of CRP for prediction of mortality in ischemic-stroke patients. A series of 162 patients with first-ever ischemic-stroke admitted within 24 h after onset of symptoms was enrolled. CRP and NIHSS score were estimated on admission and their predictive abilities for mortality at 7 days were determined by logistic-regression analyses. Receiver-Operating Characteristic (ROC) curves were depicted to identify the optimal cut-off of CRP, using the maximum Youden-index and the shortest-distance methods. Deceased patients had higher levels of CRP and NIHSS on admission (8.87 ± 7.11 vs. 2.20 ± 4.71 mg/l for CRP, and 17.31 ± 6.36 vs. 8.70 ± 4.85 U for NIHSS, respectively, P < 0.01). CRP and NIHSS were correlated with each other (r (2) = 0.39, P < 0.001) and were also independently associated with increased risk of mortality [odds ratios (95 % confidence interval) of 1.16 (1.05-1.28) and 1.20 (1.07-1.35) for CRP and NIHSS, respectively, P < 0.01]. The areas under the ROC curves of CRP and NIHSS for mortality were 0.82 and 0.84, respectively. The CRP value of 2.2 mg/l was identified as the optimal cut-off value for prediction of mortality within 7 days (sensitivity: 0.81, specificity: 0.80). Thus, CRP as an independent predictor of mortality following ischemic-stroke is comparable with NIHSS and the value of 2.2 mg/l yields the optimum sensitivity and specificity for mortality prediction.

The role of metabolic syndrome and related clinical variables in determining CEA levels.

OBJECTIVES: The aim of the study was to investigate how metabolic syndrome (MetS) and related clinical variables correlate with high levels of carcinoembryonic antigen (CEA). MATERIAL AND METHODS: Variables related to MetS as well as the serum CEA levels of 366 subjects were assayed. Logistic regression analyses were used to determine the associations between various clinical variables and high CEA levels, which were defined as values greater than the median (i.e., 1.4 ng/mL). RESULTS: MetS, as an entity, and diabetes were more prevalent in subjects with high CEA levels (for MetS: 64.2% in subjects with CEA≥1.4 vs. 51.1% in subjects with CEA<1.4 ng/mL, p<0.05; for diabetes: 72.6% vs. 59.1% respectively, p<0.05). Waist circumference, triglycerides, fasting plasma glucose (FPG), homeostasis-model assessment of insulin resistance index (HOMA-IR), and HbA1c as well as systolic and diastolic blood pressures were directly associated with CEA levels, after adjusting for age and sex (p<0.05). Subjects with a greater number of MetS components tended to have high CEA levels. Multivariate regression analysis revealed that the association of waist circumference and FPG with CEA is independent of other MetS components, age and sex. CONCLUSIONS: MetS and related clinical variables contribute to CEA values. Thus, the reference interval of CEA may differ according to the clinical status of the subjects.

Cigarette smoking and associated risk of multiple sclerosis in the Iranian population.

Exposure to cigarette smoke is emerging as an environmental risk factor for multiple sclerosis (MS). We investigated the possible association between environmental tobacco smoke, its cumulative exposure, and MS risk. We used data from the Iranian Multiple Sclerosis Registry to identify a case-control of 662 patients who had MS and a comparison group of 394 patients. Information regarding current smoking status, including the number of cigarettes smoked per day, duration, and smoking pack-years indicative of cumulative dose of tobacco smoked was obtained. We analyzed the incidence of MS among ever-smokers who had been smokers during their disease course and prior to disease onset in comparison with never-smokers who had never been exposed by calculating the odds ratio (OR) with a 95% confidence interval (CI) employing logistic regression. Of the 662 MS patients, there were 523 women (79.0%) and 139 men (21.0%), with a mean age of 31 ± 10.0 years at disease onset. The risk for MS was increased among ever-smokers (OR = 1.78, 95% CI = 1.22-2.59, p = 0.03) compared to never-smokers. As compared with never smokers, the OR for patients with 6-10 pack years was 2.91 for men (95% CI = 1.11-9.47, p = 0.03) and 1.69 for women (95% CI = 1.02-6.45, p = 0.04). Our results demonstrate that cigarette smoking is significantly associated with an increased risk for MS. The risk effects of smoking were more noticeable in male patients and at higher tobacco doses.

Cytometric profiling in various clinical forms of multiple sclerosis with respect to CD21+, CD32+, and CD35+ B and T cells.

BACKGROUND: We aimed to evaluate the frequency of various types of B and T cells expressing CD21, CD32, and CD35 in multiple sclerosis (MS) clinical courses. METHODS: Peripheral blood mononuclear cell from 30 MS patients (17 relapsing remitting [RRMS], six secondary progressive [SPMS], and seven primary progressive MS [PPMS]) and 18 healthy subjects were analyzed. All patients were in acute attack. Healthy controls were matched for age and gender ratio. The frequencies of various subsets of B and T cells were determined using flow cytometry. RESULTS: The frequency of CD4+T cells was lower in MS patients compared to control subjects (41.14 ± 9.45% vs. 46.88 ± 6.98%, respectively, P < 0.05). The CD32+ fraction of CD4+T cells and the CD21+ fraction of CD8+T cells were higher in MS patients (2.85 ± 3.72% vs. 1.06 ± 0.62% for CD32+CD4+T cells, 2.71 ± 1.86% vs. 1.16 ± 0.99% for CD21+CD8+T cells in MS patients and control subjects, respectively, P < 0.05). After dividing subjects by type of MS course, higher values of these two T cell subsets were found in SPMS patients compared to control subjects (P < 0.05). Further, RRMS patients had lower levels of CD32+CD4+T cells than SPMS patients and also they had lower levels of CD32+CD8+T cells than PPMS patients (P < 0.05). However, neither the expression of CD35 on T cells nor the various B cell subsets were statistically different between the compared groups. CONCLUSIONS: Our findings demonstrate that T cell subsets expressing CD21 and CD32 may differ with respect to the presence or clinical forms of MS disease. By contrast, CD35+T cells and different subsets of B cells are not altered in various MS clinical courses.

Atypical language lateralization: an fMRI study in patients with cerebral lesions.

Differences in the lateralization of language processes between healthy subjects and patients with neurological complaints other than epilepsy have been less documented than those between healthy subjects and epilepsy patients. Moreover, the contribution of factors such as the location and type of lesion in determining interhemispheric shift of language function is poorly understood. Sixty-seven patients who underwent presurgical evaluations at the Medical Imaging Center of the Imam Khomeini University Hospital, Tehran, and the same number of healthy controls, were recruited. The laterality index (LI) of language activation, calculated from two separate functional magnetic resonance imaging tasks, was compared between the patients and the age-/gender-/handedness-matched controls. Chi square testing showed that the percentages of subjects with "typical" and "atypical" language dominance in the patient group were significantly different from the percentages recorded in the matched healthy controls for both tasks (p<0.005). Lesion type, lesion location, lesion hemisphere, presenting symptom and patient gender had no statistically significant effect on the hemispheric LI (p>0.05). In a logistic regression model including all potential determinants of atypical LI, age emerged as the only independent predictor (p<0.05, odds ratio=0.9). Abnormal language lateralization is found in patients with a variety of cerebral lesions and with a diversity of clinical manifestations. In our selected population, symptom duration, lesion hemisphere and anatomical site of the lesion were not found to impact significantly on the development of an abnormal LI while patient age can independently predict the presence of an atypical LI.

The inverse relation of CA-125 to diabetes, metabolic syndrome, and associated clinical variables.

OBJECTIVE: We aimed to evaluate the association of carbohydrate antigen 125 (CA-125; also known as cancer antigen 125) with various anthropometric and metabolic measures and also with diabetes and metabolic syndrome. METHODS: A total of 357 diabetic and nondiabetic subjects were enrolled. CA-125, anthropometric parameters, lipids, blood pressure, as well as glycemic and insulin resistance measures were assessed. Metabolic syndrome was defined according to the International Diabetes Federation (IDF) criteria. RESULTS: CA-125 was lower in subjects with diabetes and/or metabolic syndrome [median (interquartile range) of 8.20 (5.70-11.57) and 9.55 (6.50-16.25) U/mL for diabetic and nondiabetic subjects, respectively, P<0.05; 8.11 (5.90-11.45) and 9.50 (6.34-14.76) U/mL for subjects with metabolic syndrome and those without metabolic syndrome, respectively, P<0.05]. Anthropometric measures, dyslipidemia, insulin resistance, and blood pressure were inversely associated with CA-125 (P<0.05); waist circumference and body mass index were also identified as the strongest determinants of CA-125 (P<0.001). Using multiple linear regression models, waist circumference (ß=-0.088, P<0.01), apolipoprotein B (ß=-0.027, P<0.05), and systolic blood pressure (ß=-0.054, P<0.05) were independently associated with CA-125. However, none of insulin resistance measures remained in the model after adjusting for other clinical variables. CONCLUSION: CA-125 is inversely correlated with diabetes status, metabolic syndrome, and their associated anthropometric and metabolic measures. Furthermore, CA-125 is independently associated with waist circumference, apolipoprotein B, and systolic blood pressure, but not with any insulin resistance measures.