Living in a rural area: a potential risk factor for falls in people with Parkinson disease.

INTRODUCTION: Falls are prevalent in patients with Parkinson disease (PD). Previous work focused on the impact of motor and non-motor symptoms on falls and ignored the impact of environmental factors, such as residence, economic level, and nursing status. The aim of this study was to investigate the prevalence and risk factors of falls in patients with PD and explore the impact of residence on falls. METHODS: A cross-sectional study of 100 patients with PD was carried out. Patients were recruited from Anhui Provincial Hospital (Hefei, Anhui province, China) between July 2017 and December 2020. Participants were grouped based on whether they had fallen in the previous 3 months, and demographic information was collected through detailed interviews. In addition, severity of motor symptoms, cognitive function, and self-care abilities were assessed with the Unified Parkinson's Disease Rating Scale part III (UPDRS-III), the Hoehn-Yahr (H&Y) scale, the Mini-Mental State Examination (MMSE), and the Barthel Index. The results were analyzed using student t-test, Mann-Whitney U-test, χ2 test and multivariate binary logistic regression analyses. RESULTS: A total of 42% of the patients had fallen in the previous 3 months. The patients who had fallen were older and with a longer disease period, a higher UPDRS-III score, a higher H&Y stage, a lower MMSE score, and a lower Barthel Index score (all p<0.05). According to the logistic regression analysis, living in a rural area (odds ratio (OR)=3.34, 95% confidence interval (CI) 1.15-9.65), MMSE<24 (OR=4.79, 95%CI 1.17-19.65), having sleep disorders (OR=4.97, 95%CI 1.74-14.2), and having a high UPDRS-III score (OR=1.07, 95%CI 1.02-1.11) were independent risk factors for falls. The incidence of falls was higher in rural areas. Urban and rural patients showed different levels of disease severity; rural patients had higher H&Y stages, higher UPDRS-III scores and lower Barthel Index scores. CONCLUSION: Falls are caused by a variety of factors in people with PD. Multidimensional factors should be considered comprehensively to develop a personalized plan to prevent falls in PD patients.

Combination of clinical and spectral-CT iodine concentration for predicting liver metastasis in gastric cancer: a preliminary study.

PURPOSE: This study aimed to determine the diagnostic efficacy of various indicators and models for the prediction of gastric cancer with liver metastasis. METHODS: Clinical and spectral computed tomography (CT) data from 80 patients with gastric adenocarcinoma who underwent surgical resection were retrospectively analyzed. Patients were divided into metastatic and non-metastatic groups based on whether or not to occur liver metastasis, and the region of interest (ROI) was measured manually on each phase iodine map at the largest level of the tumor. Iodine concentration (IC), normalized iodine concentration (nIC), and clinical data of the primary gastric lesions were analyzed. Logistic regression analysis was used to construct the clinical indicator (CI) and clinical indicator-spectral CT iodine concentration (CI-Spectral CT-IC) Models, which contained all of the parameters with statistically significant differences between the groups. Receiver operating characteristic (ROC) curves were constructed to evaluate the accuracy of the models. RESULTS: The metastatic group showed significantly higher levels of Cancer antigen125 (CA125), carcinoembryonic antigen (CEA), IC, and nIC in the arterial phase, venous phase, and delayed phase than the non-metastatic group (all p < 0.05). Normalized iodine concentration Venous Phase (nICVP) exhibited a favorable performance among all IC and nIC parameters for forecasting gastric cancer with liver metastasis (area under the curve (AUC), 0.846). The combination model of clinical data with significant differences and nICVP showed the best diagnostic accuracy for predicting liver metastasis from gastric cancer, with an AUC of 0.897. CONCLUSION: nICVP showed the best diagnostic efficacy for predicting gastric cancer with liver metastasis. Clinical Indicators-normalized ICVP model can improve the prediction accuracy for this condition.

PD-1/PD-L1 governed cross-talk of exhausted CD8+ T and memory B cells in systemic lupus erythematosus.

BACKGROUND: Indeterminate readout of the quantitative interferon-γ release test (QFT) for Mycobacterium tuberculosis screening is a specific laboratory finding for systemic lupus erythematosus (SLE), which may be due to T-cell exhaustion and abnormal programmed death receptor 1 (PD-1)/programmed death-ligand 1 (PD-L1) signalling. METHODS: We enrolled 104 patients with SLE and 225 with other rheumatic musculoskeletal diseases (RMDs) who presented to the outpatient clinic between 2020 and 2023. Twenty healthy donors served as the controls. The QFT was performed in all participants, and those with indeterminate results were compared among the groups. Immunophenotyping and functional assays were performed using blood mononuclear cells. Interferon (IFN)-γ was detected in vitro and ex vivo in patients with SLE with indeterminate or negative QFT results, before or after rituximab therapy. RESULTS: 104 patients with SLE had a significantly higher rate of indeterminate QFT results was significantly higher (17.31%) than that of 225 patients with RMD (3.56%). Patients with SLE with indeterminate QFT had more active disease (SLEDAI-2K, mean 10.94 vs 4.02, p<0.0001), including a higher incidence of active nephritis (55.56% vs 29.07%). Indeterminate QFT in SLE is mainly caused by an insufficient IFN-γ response in CD8+T cells with exhausted immunophenotypes. The abnormal interaction between exhausted PD-1 high CD8+ T cells and activated PD-L1 low memory B cells in SLE can be reversed with a PD-1 agonist or increased PD-L1 expression. Rituximab treatment indirectly reversed this IFN-γ response. CONCLUSION: The PD-1/PD-L1 signalling pathway, which governs the crosstalk between exhausted CD8+ T cells and activated memory B cells, is a mechanistic explanation for insufficient interferon-γ response in patients with SLE.

Follow-Up Infarct Volume Prediction by CTP-Based Hypoperfusion Index, and the Discrepancy between Small Follow-Up Infarct Volume and Poor Functional Outcome-A Multicenter Study.

(1) Background: Follow-up infarct volume (FIV) may have implications for prognostication in acute ischemic stroke patients. Factors predicting the discrepancy between FIV and 90-day outcomes are poorly understood. We aimed to develop a comprehensive predictive model of FIV and explore factors associated with the discrepancy. (2) Methods: Patients with acute anterior circulation large vessel occlusion were included. Baseline clinical and CT features were extracted and analyzed, including the CTP-based hypoperfusion index (HI) and the NCCT-based e-ASPECT, measured by automated software. FIV was assessed on follow-up NCCT at 3−7 days. Multiple linear regression was used to construct the predictive model. Subgroup analysis was performed to explore factors associated with poor outcomes (90-mRS scores 3−6) in small FIV (<70 mL). (3) Results: There were 170 patients included. Baseline e-ASPECT, infarct core volume, hypoperfusion volume, HI, baseline international normalized ratio, and successful recanalization were associated with FIV and included in constructing the predictive model. Baseline NIHSS, baseline hypertension, stroke history, and current tobacco use were associated with poor outcomes in small FIV. (4) Conclusions: A comprehensive predictive model (including HI) of FIV was constructed. We also emphasized the importance of hypertension and smoking status at baseline for the functional outcomes in patients with a small FIV.

Apparent diffusion coefficient histogram analysis to preoperative evaluate intracranial solitary fibrous tumor: Relationship to Ki-67 proliferation index.

PURPOSE: To explore the value of apparent diffusion coefficient (ADC) histogram analysis in preoperative evaluating intracranial solitary fibrous tumor (SFT) and further investigate the relationship between ADC histogram parameters and the Ki-67 proliferation index. METHODS: From January 2014 to March 2022, 37 patients with intracranial SFT (grade 2, n = 20; grade 3, n = 17) who underwent preoperative diffusion-weighted imaging were enrolled in this study. For each tumor, nine histogram parameters were automatically extracted and selected using MaZda software based on the axial ADC maps of the whole tumor, including mean, variance, skewness, kurtosis, as well as the 1st, 10th, 50th, 90th, and 99th percentile ADC (Perc.01, Perc.10, Perc.50, Perc.90, Perc.99). Differences in ADC histogram parameters between grade 2 and 3 intracranial SFT were compared. Receiver operating characteristic (ROC) curves were drawn to determine the diagnostic performance, and Pearson's correlation coefficient was used to investigate the relationship between these parameters and the Ki-67 proliferation index. RESULTS: The mean, Perc.01, Perc.10, Perc.50, Perc.90, and Perc.99 were significantly lower in grade 3 than in grade 2 intracranial SFT (all P < 0.05). ROC analysis showed that these parameters can effectively distinguish between the two groups, with Perc.01 generating the best differentiation performance. Significant negative correlations were also observed between these parameters and the Ki-67 proliferation index (r = -0.436 ~ -0.522, all P < 0.05). However, there was no significant difference in variance, skewness, or kurtosis between the two groups (all P > 0.05). CONCLUSIONS: ADC histogram analysis enables effective preoperative distinction of grade 2 and grade 3 intracranial SFT.

Clinico-radiological nomogram for preoperatively predicting post-resection hepatic metastasis in patients with gastric adenocarcinoma.

OBJECTIVE: To establish and validate a model comprising clinical and radiological features to pre-operatively predict post-resection hepatic metastasis (HM) in patients with gastric adenocarcinoma (GAC). METHODS: We retrospectively analyzed 461 patients (HM, 106 patients); and non-metastasis (NM, 355 patients) who were confirmed to have GAC post-surgery. The patients were randomly divided into the training (n = 307) and testing (n = 154) cohorts in a 2:1 ratio. The main clinical risk factors were filtered using the least absolute shrinkage and selection operator algorithm according to their diagnostic value. The selected factors were then used to establish a clinical-radiological model using stepwise logistic regression. The Akaike's information criterion and receiver operating characteristic (ROC) analyses were used to evaluate the prediction performance of the model. RESULTS: Logistic regression analysis showed that the peak enhancement phase, tumor location, alpha-fetoprotein, cancer antigen (CA)-125, CA724 levels, CT-based Tstage and arterial phase CT values were important independent predictors. Based on these predictors, the areas under the ROC curve of the training and testing cohorts were 0.864 and 0.832, respectively, for predicting post-operative HM. CONCLUSION: This study built a synthetical nomogram using the pre-operative clinical and radiological features of patients to predict the likelihood of HM occurring after GAC surgery. It may help guide pre-operative clinical decision-making and benefit patients with GAC in the future. ADVANCES IN KNOWLEDGE: 1. The combination of clinical risk factors and CT imaging features provided useful information for predicting HM in GAC.2. A clinicoradiological nomogram is a tool for the pre-operative prediction of HM in patients with GAC.

A Comparison of Pain between Parkinson's Disease and Multiple System Atrophy: A Clinical Cross-Sectional Survey.

Background: Pain is frequent in Parkinson's disease (PD) and Parkinson-plus syndrome. This study aimed to assess the prevalence, characteristics, therapy (especially the effect of dopaminergic therapy), and associated symptoms of pain in Parkinson's disease and multiple system atrophy (MSA) patients. Methods: Seventy-one PD patients, sixty-five MSA patients, and forty age-matched healthy controls were enrolled and evaluated by using the German pain questionnaire and visual analogue scale (VAS). In addition, the influence of pain in PD patients on anxiety, depression, and the quality of life was assessed with the Hospital Anxiety and Depression Scale (HADS) and Parkinson's Disease Questionnaire (PDQ-39). Results: Compared to that of the healthy controls, the PD and MSA patients had a significantly higher presence of pain (P < 0.01, P < 0.01). PD patients had a higher presence of pain than MSA patients (P=0.007). No difference in VAS scores was observed between the PD and MSA patients (P=0.148). A total of 21 PD patients (42.85%) with pain and 13 MSA patients (43.33%) with pain received treatment. A total of 13 PD patients with pain and 6 MSA patients with pain had an improved pain intensity after using dopaminergic medication. The differences in the disease duration, Hoehn and Yahr stages, and scores on the Unified Parkinson's Disease Rating Scale motor score, HAD-D, HAD-A, and PDQ-39 were significant between the PD patients with and without pain. Conclusion: PD and MSA patients are prone to pain with insufficient treatment. Pain interventions should be provided as soon as possible to improve the patient's life.