Influence of inflammatory status in the acute phase of stroke on post-stroke depression.

BACKGROUND: Thirty percent of stroke patients will suffer from post-stroke depression (PSD). Recent data suggest that inflammation accounts for a substantial amount of depression. Our primary objective was to assess the association between standard inflammation biomarkers in the acute phase of stroke and PSD at three months. The secondary objective was to elaborate a predictive model of PSD from clinical, biological and radiological data. METHODS: We performed a retrospective analysis of a single-centre cohort of stroke patients with a three-month follow-up. Serum levels of C-reactive protein (CRP), fibrinogen, leukocyte count and neutrophil to lymphocyte ratio (NLR) were tested at admission and at peak. Mood was assessed at three months using the depression sub-scale of the Hospital Anxiety and Depression Scale (HADS). Association between inflammation biomarkers and HADS was evaluated with multi-linear regression adjusted on clinical and radiological parameters. Logistic predictive models of PSD at three months, with and without inflammation biomarkers, were compared. RESULTS: Three hundred and forty-eight patients were included, of whom 20.06% developed PSD. Baseline and peak values of all inflammatory markers were associated with the severity of PSD at three months. Area under the curve for the receiver operating characteristic curve of PSD prediction was 0.746 (CI 95% 0.592-0.803) with selected inflammation biomarkers and 0.744 (CI 95% 0.587-0.799) without. CONCLUSION: Most inflammation biomarkers are weakly associated with PSD, adding negligible value to predictive models. While they suggest the implication of inflammation in PSD pathogenesis, they are useless for the prediction of PSD, underscoring the need for more specific biomarkers.

Lumbar spinal muscles and spinal canal study by MRI three-dimensional reconstruction in adult lumbar spinal stenosis.

BACKGROUND: Lumbar spinal stenosis is degenerative disc disease most common manifestation. If stenosis degree seems poorly related to symptom severity, lumbar muscles role is recognized. Many studies report imaging methods, to analyze muscle volumes and fat infiltration (FI), but remain limited due to the difficulty to represent entire muscle volume variability. Recently a 3D muscle reconstruction protocol (using the deformation of a parametric specific object method (DPSO) and three-point Dixon images) was reported. It offers the ability to evaluate, muscles volumes and muscle FI. PURPOSE: To describe, in a lumbar spinal stenosis population, muscle volumes, muscle FI and lumbar spinal canal volume with 3D MRI images reconstructions. MATERIALS AND METHODS: Ten adults presenting L4-L5 lumbar stenosis, were included. After specific MRI protocol, three-dimensional, muscle and spinal canal, reconstructions were performed. Muscle (psoas and paraspinal muscles) volumes and fat infiltration (FI), the spinal canal volume, age, and height were correlated one to each other with Spearman correlation factor. An ANOVA was performed to evaluate the intervertebral level influence (P≤0.05). RESULTS: Muscle volumes correlated with height (r=0.68 for psoas). Muscles FI correlated with age (r=0.66 for psoas) and lumbar spinal canal volume (r=0.91). Psoas and paraspinal volumes were maximum at L3-L4 level whereas FI increased from L1-L2 to L5-S1 level. DISCUSSION: These first results illustrate the importance to consider muscles entirely and report correlations between muscles FI, lumbar spinal canal volume and age; and between muscle volumes and patients height. Muscle degeneration seems more related to muscle FI than muscle volume. LEVEL OF EVIDENCE: 3.

Sagittal spine posture assessment: feasibility of a protocol based on intersegmental moments.

Evaluation of spinal posture has recently benefited from the contribution of three-dimensional reconstruction technologies that have helped improve our understanding of this dynamic balance. The aim of this study was to present the preliminary results of a three-dimensional protocol to analyze postural balance. This analytical method is not limited by certain constraints of the radiological approach and evaluates postural balance using a new approach taking into account the net efforts of different intersegmental centers. These preliminary results show the technical feasibility of the protocol. Its future development and clinical use could provide a better understanding of postural balance disorders, and help evaluate the impact of surgical correction on spinal balance.

[Interest of performing systematically the protein profile in an internal medicine department. National survey and prospective study on 229 admissions]. / Intérêt de la réalisation systématique du profil protéique d'orientation dans un service de médecine interne. Enquête nationale des pratiques et étude prospective sur 229 admissions.

INTRODUCTION: Despite a wide national use, the usefulness of the protein profile has only been evaluated in a small number of studies, essentially in patients with unknown diagnoses. METHODS: We conducted a survey on 339 french internal medicine departments to evaluate how the protein profile was used in these services. Concomitantly we achieved a prospective study on 229 patients in our department, with a mean follow up of 9 months, to evaluate how did the protein profile influence the diagnosis process. RESULTS: We received 183 responses to our national survey: the protein profile was available in 110/183 (60%) departments with 94/110 (85%) using it during hospitalisation and 20/94 (21.3%) using it systematically. Among the 229 protein profile analysed in our department, 44 (19.2%) were considered useful with 20 (8.7%) of them allowing the diagnosis of a new pathology. If the profile had not been done systematically, the physicians of our department would have performed the profile in 102/229 (44.5%) cases, whereas seven (3%) useful profiles would not have been done. CONCLUSION: We think that the profile has a consistent interest in hospitalized patients with a known or unknown pathology but performing systematically such a test appears to be of limited benefit.