RESUMO
BACKGROUND: A mean of 10 years elapse before patients with Parkinson's disease (PD) reach Hoehn & Yahr (H&Y) stage 4, and 14 years for stage 5. A small proportion of PD patients survive and are ambulatory for ≥ 20 years. We sought to identify features associated with long-duration PD (dPD). METHODS: This five-center, case-control study compared 136 PD patients with ≥ 20 years of duration and H&Y stage ≤ 4 (dPD) to 134 H&Y-, age- and gender-matched PD patients between 10 and 15 years of disease (cPD). RESULTS: By study design, there were no between-group differences in age, gender and H&Y. dPD subjects were younger at onset (p < 0.0001), had more psychosis (p: 0.038), were receiving higher levodopa equivalent daily doses (p: 0.02), were predominantly left-handed (p: 0.048), and had greater frequency of left-sided onset (p: 0.015) compared to cPD subjects. Both groups had similar rates of resting tremor, dementia and REM sleep behavior disorder. CONCLUSIONS: Early disease onset, left-handedness and left-sided onset are associated with long disease and ambulatory PD survival. The neurobiological basis of the prognostic value of lateralization deserves further investigation.
Assuntos
Lateralidade Funcional/fisiologia , Levodopa/uso terapêutico , Doença de Parkinson/fisiopatologia , Transtorno do Comportamento do Sono REM/fisiopatologia , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Demência/complicações , Progressão da Doença , Feminino , Humanos , Longevidade/fisiologia , Masculino , Pessoa de Meia-Idade , Transtorno do Comportamento do Sono REM/complicações , Tremor/complicaçõesRESUMO
OBJECTIVES: To assess the efficacy of anti-viral therapy on hepatitis B virus associated glomerulonephritis (HBV-GN). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We searched PubMed, Embase and Cochrane Library for prospective controlled trials which assessed the efficacy of anti-viral therapy on HBV-GN in adult or pediatric patients between January, 1970 and October, 2010. Results were summarized using fixed-effects model because of an absence of heterogeneity among the studies (I(2) = 0%). RESULTS: Six trials with a total of 159 patients were included; among them five trials were specified as hepatitis B virus-associated membranous glomerulonephritis (HBV-MN). In adult patients, the incidence of proteinuria remission, not only total remission (complete remission CR + partial remission PR) (2.97 to 109.93, P = 0.002) but also CR (1.18 to 16.11, P = 0.03), significantly increased in the anti-viral treatment. In pediatric patients, only the incidence of total remission (1.77 to 17.75, P = 0.003) was increased significantly; the incidence of CR was not pooled with clinical and statistical heterogeneity (I(2) = 81.5%, P = 0.004).Combine the data from adult and pediatric patients with HBV-MN, the same results were found. All the results of proteinuria remission kept with virologic response (VR), including HBeAg conversion (5.68 to 40.04, P < 0.00001) and reduction of HBV-DNA (5.60 to 463.16, P = 0.0005). CONCLUSIONS: Antiviral therapy including IFN and lamivudine is effective on remission of proteinuria, HBeAg clearance, and HBV-DNA reduction.