The Association between Ankle-Brachial Index/Pulse Wave Velocity and Cerebral Large and Small Vessel Diseases in Stroke Patients.

(1) Background: The study investigated whether the ankle-brachial index (ABI) and pulse wave velocity (baPWV) could reflect the severity of small vessel disease (SVD) and large artery atherosclerosis (LAA). (2) Methods: A total of 956 consecutive patients diagnosed with ischemic stroke were prospectively enrolled from July 2016 to December 2017. SVD severity and LAA stenosis grades were evaluated via magnetic resonance imaging and carotid duplex ultrasonography. Correlation coefficients were calculated between the ABI/baPWV and measurement values. Multinomial logistic regression analysis was performed to determine predictive potential. (3) Results: Among the 820 patients included in the final analysis, the stenosis grade of extracranial and intracranial vessels was inversely correlated with the ABI (p < 0.001, respectively) and positively correlated with the baPWV (p < 0.001 and p = 0.004, respectively). Abnormal ABI, not baPWV, independently predicted the presence of moderate (adjusted odds ratio, aOR: 2.18, 95% CI: 1.31-3.63) to severe (aOR: 5.59, 95% CI: 2.21-14.13) extracranial vessel stenosis and intracranial vessel stenosis (aOR: 1.89, 95% CI: 1.15-3.11). Neither the ABI nor baPWV was independently associated with SVD severity. (4) Conclusions: ABI is better than baPWV in screening for and identifying the existence of cerebral large vessel disease, but neither test is a good predictor of cerebral SVD severity.

A New Instrument Combines Cognitive and Social Functioning Items for Detecting Mild Cognitive Impairment and Dementia in Parkinson's Disease.

Background: The commonly used screening tests for Parkinson's disease (PD) are the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE), both of which only focus on cognitive function. A composite assessment that considers both cognitive and social dysfunction in PD would be helpful in detecting mild cognitive impairment (MCI) and PD dementia (PDD). Objective: We aimed to simplify the commonly used tools and combine cognitive and social functioning tests to detect early MCI and PDD. Materials and Methods: A total of 166 participants (84 PD patients and 82 healthy) were recruited who completed the MMSE, MoCA, PD social functioning scale (PDSFS), clock drawing test, activities of daily living, comprehensive neuropsychological assessment (e.g., executive, attention, language, memory, and visuospatial functions), and movement disorder society (MDS)-unified PD rating scale. According to the MDS diagnostic criteria, the patients were grouped into PD-nonMCI, PD-MCI, or PDD. Results: To detect PD-MCI, the optimal cut-off scores for the simplified MoCA and the combined test were 9 and 35. The discrimination values measured by the area under the receiver operating characteristic curve (AUC) of the two tests were 0.767 (p < 0.001) and 0.790 (p < 0.001). When the simplified MoCA was 7 or the combined test 30, the patients would be classified as having PDD. The AUCs of the two tests were 0.846 (p < 0.001) and 0.794 (p = 0.003). Conclusion: We suggest considering both cognitive and social functions when detecting PD-MCI and PDD.

Investigating the interaction between neuropsychiatry features and daily activities on social function in patients with Parkinson's disease with mild cognitive impairment.

BACKGROUND: Social functioning is crucial for daily living and is an essential indicator of dementia in patients with Parkinson's disease. The pattern of social functioning in patients with Parkinson's disease without dementia (i.e. those who are cognitively intact or have mild cognitive impairment (PD-MCI)) and its determinants are unclear. AIMS: In exploring the heterogeneity of social functioning among patients with Parkinson's disease-associated dementia, we determined the optimal cut-off score of the Parkinson's Disease Social Functioning Scale (PDSFS) for patients with PD-MCI, and the variables influencing patients' social functioning. METHOD: A total of 302 participants underwent the Mini-Mental State Examination (MMSE) and PDSFS; 120 patients with Parkinson's disease completed the measurements (MMSE, Activities of Daily Living Scale and Neuropsychiatric Inventory). Group comparisons, receiver operating characteristic curves, Spearman correlation and multiple and hierarchical regression analyses were conducted. RESULTS: The PD-MCI group scored the lowest on the PDSFS (F = 10.10, P < 0.001). The PDSFS cut-off score was 53 (area under the curve 0.700, sensitivity 0.800, specificity 0.534). The MMSE (ß = 0.293, P = 0.002), Activities of Daily Living Scale (ß = 0.189, P = 0.028) and Neuropsychiatric Inventory (ß = -0.216, P = 0.005) scores predicted the PDSFS score. Further, there was an interaction effect between the Activities of Daily Living Scale and Neuropsychiatric Inventory scores on the PDSFS score (ß = 0.305, P < 0.001). CONCLUSIONS: We determined a PDSFS cut-off score for detecting PD-MCI and found that patients with PD-MCI have social dysfunction. Future research should focus on the effects of neuropsychiatry symptoms and activities of daily living on social functioning, and tailor the intervention programme for patients with Parkinson's disease.

The Impact of Antiplatelet Use on the Risk of Intracerebral Hemorrhage in Patients with Alzheimer's Disease: A Nationwide Cohort Study.

BACKGROUND: Antiplatelet use on the risk of intracerebral hemorrhage (ICH) in patients with Alzheimer's disease (AD) has not yet been completely elucidated. OBJECTIVE: This large epidemiologic study aims to estimate the risk of ICH in AD patients treated with antiplatelet therapy (APT). METHODS: Using data from Taiwan's National Health Insurance Research Database, ICH risk in APT-treated AD patients with a validated diagnosis (N = 824) was determined. AD without APT and non-AD with and without APT comparison cohorts were selected. To adjust for confounders and competing risk of death, inverse probability of treatment weighting using propensity scores and competing risks regression (CRR) were applied. Cox proportional hazards regression analysis estimated ICH risk in all cohorts comparing with non-AD without APT. RESULTS: Among the 824 AD patients with APT, 79.6% were prescribed aspirin. ICH incidence rates in the AD (with/without APT) and non-AD (with/without APT) cohorts were 2.88/2.70 and 2.24/1.20 per 1,000 person-years, respectively. Overall, AD with (adjusted hazards ratio (aHR), 2.29; 95% CI, 1.19-4.38) and without (aHR, 1.97; 95% CI, 1.08-3.61) APT and non-AD with APT (aHR, 1.80; 95% CI, 1.34-2.42) were at a higher risk and had elevated subdistribution HR obtained from CRR than non-AD without APT controls. However, the risk was comparable between the AD cohorts with and without APT (HR, 1.16; 95% CI, 0.51-2.66). CONCLUSIONS: Our study indicated both the APT and non-APT users in AD population yielded higher ICH risks. However, whether APT use potentiate the risk of ICH in AD patients may warrant further evaluation.

Evaluating the effectiveness of different beta-adrenoceptor blockers in heart failure patients.

BACKGROUND: According to guidelines and pivotal trials, ß-blockers are associated with better survival in patients with heart failure (HF). However, the superiority of any ß-blockers is still unclear. METHODS: This retrospective cohort study was conducted using the National Health Insurance Research Database in Taiwan to evaluate the effectiveness of ß-blockers and compare the clinical outcomes of different ß-blockers in patients with HF. We enrolled patients diagnosed with HF between 2005 and 2012. We then stratified the ß-blockers according to the starting dose: lower in group 1 and higher in group 2. A time-dependent Cox proportional hazards regression model was applied to evaluate the effectiveness of the ß-blockers. RESULTS: A total of 14,875 patients with HF were identified during the study period. After propensity-score matching, 5688 patients were included in both the ß-blocker user and nonuser groups. We found that group 2 carvedilol and group 2 bisoprolol significantly reduced the risk of death and hospitalization for HF, whereas metoprolol did not. Compared with group 2 carvedilol, survival was not significantly different for group 2 bisoprolol (adjusted hazard ratio=1.18, 95% confidence interval=0.88-1.58). CONCLUSION: From results, carvedilol and bisoprolol were associated with better outcomes, with no difference between these two ß-blockers in patients with HF in Taiwan.

Lanthanum cobaltite perovskite supported on zirconia as an efficient heterogeneous catalyst for activating Oxone in water.

Zirconia-supported LaCoO3 perovskite (LaCoO3/ZrO2 (LCZ)) is prepared and adopted for the first time as a heterogeneous catalyst for activating Oxone to degrade organic pollutants. The resulting LCZ exhibits a significantly higher surface area (i.e., 10 times) than bulk LaCoO3 powder as nanoscale LaCoO3 particles were easily afforded on the surface of ZrO2 support. As Rhodamine B (RB) decolorization is selected as a model test to evaluate catalytic activity for activating Oxone, LCZ showed a much higher catalytic activity to activate Oxone than LaCoO3 even though LCZ contained only 12.5wt% of LaCoO3. LCZ-activated Oxone also remained effective for RB decolorization even in the presence of salts and other organic contaminant. The mechanism of RB decolorization by LCZ-activated Oxone was revealed and involved sulfate radical and other reactive oxygen species. The mechanism of Oxone activation by LCZ could be owing to both La3+ and Co3+ of LCZ. LCZ was recycled to activate Oxone for RB decolorization over multiple times without loss of catalytic activity. These results demonstrate that LCZ is a promising LaCoO3-based nanocomposite as a heterogeneous catalyst for activating Oxone to degrade organic pollutants.

The evaluation of ß-adrenoceptor blocking agents in patients with COPD and congestive heart failure: a nationwide study.

OBJECTIVE: ß-Blockers are safe and improve survival in patients with both congestive heart failure (CHF) and COPD. However, the superiority of different types of ß-blockers is still unclear among patients with CHF and COPD. The association between ß-blockers and CHF exacerbation as well as COPD exacerbation remains unclear. The objective of this study was to compare the outcome of different ß-blockers in patients with concurrent CHF and COPD. PATIENTS AND METHODS: We used the National Health Insurance Research Database in Taiwan to conduct a retrospective cohort study. The inclusion criteria for CHF were patients who were >20 years old and were diagnosed with CHF between January 1, 2005 and December 31, 2012. COPD patients included those who had outpatient visit claims ≥2 times within 365 days or 1 claim for hospitalization with a COPD diagnosis. A time-dependent Cox proportional hazards regression model was applied to evaluate the effectiveness of ß-blockers in the study population. RESULTS: We identified 1,872 patients with concurrent CHF and COPD. Only high-dose bisoprolol significantly reduced the risk of death and slightly decreased the hospitalization rate due to CHF exacerbation (death: adjusted hazard ratio [aHR] =0.51, 95% confidence interval [CI] =0.29-0.89; hospitalization rate due to CHF exacerbation: aHR =0.48, 95% CI =0.23-1.00). No association was observed between ß-blocker use and COPD exacerbation. CONCLUSION: In patients with concurrent CHF and COPD, ß-blockers reduced mortality, CHF exacerbation, and the need for hospitalization. Bisoprolol was found to reduce mortality and CHF exacerbation compared to carvedilol and metoprolol.