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1.
BMC Palliat Care ; 20(1): 181, 2021 Nov 25.
Artigo em Inglês | MEDLINE | ID: mdl-34823512

RESUMO

BACKGROUNDS: Early integration of palliative care for terminally ill non-cancer patients improves quality of life. However, there are scanty data on Palliative Care Consultation Service (PCCS) among non-cancer patients. METHODS: In this 9-year observational study Data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill non-cancer patients with 9 categories of diagnoses who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in categories of diagnosis throughout study period, duration of PCCS, patient outcomes, DNR declaration, awareness of disease by patients and families before and after PCCS. RESULTS: In total, 536 non-cancer patients received PCCS from 2011 to 2019 with an average age of 70.7 years. The average duration of PCCS was 18.4 days. The distributions of age, gender, patient outcomes, family's awareness of disease before PCCS, and patient's awareness of disease after PCCS were significantly different among the diagnoses. Organic brain disease and Chronic kidney disease (CKD) were the most prevalent diagnoses in patients receiving PCCS in 2019. For DNR declaration, the percentage of patients signing DNR before PCCS remained high throughout the study period (92.8% in 2019). Patient outcomes varied according to the disease diagnoses. CONCLUSION: This 9-year observational study showed that the trend of PCCS among non-cancer patients had changed over the duration of the study. An increasing number of terminally ill non-cancer patients received PCCS during late life, thereby increasing the awareness of disease for both patients and families, which would tend to better prepare terminally ill patients for end-of-life as they may consider DNR consent. Early integration of PCCS into ordinary care for terminally non-cancer patients is essential for better quality of life.


Assuntos
Neoplasias , Cuidados Paliativos , Idoso , Humanos , Neoplasias/terapia , Qualidade de Vida , Encaminhamento e Consulta , Taiwan , Doente Terminal
2.
Brain Sci ; 11(10)2021 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-34679396

RESUMO

This study aimed to understand the impact of sex on the neurocognitive function of patients with Parkinson's disease (PD). Ninety-four participants with idiopathic PD and 167 age-matched healthy individuals as normal controls (NCs) were recruited and underwent comprehensive neuropsychological assessments. Sex differences were found in NCs, but not in patients with PD. Among male participants, patients with PD showed worse performance on the Digit Symbol Substitution (DSS) (p < 0.001) test and Symbol Search (SS) (p < 0.001) than NCs. Among female participants, patients with PD showed worse performance on the category score of the Modified Wisconsin Card Sorting Test (p < 0.001), SS (p < 0.001), and pentagon copying (p < 0.001) than NCs. After controlling for the effects of age and years of education, Hoehn and Yahr stage was found to predict the performance of the Color Trails Test part A (ßA = 0.241, pA = 0.036), Stroop Color and Word Test (ß = -0.245, p = 0.036), and DSS (ß = -0.258, p = 0.035) in men with PD. These results indicate the differential effect of sex on the neurocognitive function among healthy aging and PD populations. The disappearance of sex differences, which is present in healthy aging, in patients with PD suggests a gradual loss of the neuroprotective effect of estrogen after the initiation of the neurodegenerative process. This study also found mental flexibility and visuospatial function to be the susceptible cognitive domains in women with PD, while the disease severity could predict the working memory and processing speed in men with PD.

3.
J Parkinsons Dis ; 2021 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-34569974

RESUMO

BACKGROUND: Hypomimia is a clinical feature of Parkinson's disease (PD). Based on the embodied simulation theory, the impairment of facial mimicry may worsen facial emotion recognition; however, the empirical results are inconclusive. OBJECTIVE: We aimed to explore the worsening of emotion recognition by hypomimia. We further explored the relationship between the hypomimia, emotion recognition, and social functioning. METHODS: A total of 114 participants were recruited. The patients with PD and normal controls (NCs) were matched for demographic characteristics. All the participants completed the Mini-Mental State Examination and the Chinese Multi-modalities Emotion Recognition Test. In addition to the above tests, the patients were assessed with the Movement Disorder Society-Unified Parkinson's Disease Rating Scale and Parkinson's Disease Social Functioning Scale (PDSFS). RESULTS: Patients with PD with hypomimia had worse recognition of disgust than NCs (p = 0.018). The severity of hypomimia was predictive of the recognition of disgust (ß= -0.275, p = 0.028). Facial emotion recognition was predictive of the PDSFS score of PD patients (ß= 0.433, p = 0.001). We also found that recognizing disgust could mediate the relationship between hypomimia and the PDSFS score (ß= 0.264, p = 0.045). CONCLUSION: Patients with hypomimia had the worst disgust facial recognition. Hypomimia may affect the social function of PD patients, which is related to recognizing the expression of disgust. Emotion recognition training may improve the social function of patients with PD.

4.
Healthcare (Basel) ; 9(9)2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34574891

RESUMO

Drug-resistant epilepsy (DRE) is a chronic neurological disorder with somatic impacts and increased risk of metabolic comorbidities. Oxidative stress might play an important role in metabolic effects and as a regulator of seizure control, while coenzyme Q10 (CoQ10) could improve insulin sensitivity through antioxidant effects. We aimed to investigate the association between CoQ10 level and clinical outcome, represented by the seizure frequency and quality of life, in DRE patients. DRE patients (N = 33) had significantly higher serum insulin levels and lower scores on the physical domain of the World Health Organization Quality of Life questionnaire (WHOQoL) than gender-age matched controls. The serum CoQ10 level (2910.4 ± 1163.7 ng/mL) was much higher in DRE patients than the normal range. Moreover, the serum CoQ10 level was significantly correlated with the seizure frequency (r = -0.412, p = 0.037) and insulin level (r = 0.409, p = 0.038). Based on stratification by insulin resistance (HOMA-IR > 2.4), the subgroup analysis showed that patients with a greater HOMA-IR had higher CoQ10 levels and lower seizure frequency, and had a significantly worse quality of life. In summary, CoQ10 could be a mediator involved in the mechanism of epilepsy and serve as a biomarker of the clinical outcome in DER patients.

5.
J Pers Med ; 11(9)2021 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-34575712

RESUMO

Background: The objective is to study whether the cardiovascular protective effects of colchicines could be applied to non-cardiogenic ischemic stroke (IS) patients. Patients and Methods: Non-cardiogenic IS patients were identified from the National Health Insurance Research Database. Eligible patients were divided into chronic and non-chronic use categories based on their long-term status of colchicine use. The non-chronic use category was subdivided into (1) non-user and (2) new user groups while the chronic use category was divided into (3) former user and (4) long-term user groups according to the patient's recent status of colchicine use. Inverse probability of treatment weights for propensity scores was used to balance the baseline characteristics. The primary outcome was recurrent IS, which was compared within the non-chronic use and chronic use categories. Results: In the non-chronic use category, the number of patients was 355,498 and 912 in the non-user and new user groups, respectively. In the chronic use category, the number of patients was 4737 and 4354 in the former user and long-term user groups, respectively. In the non-chronic use category, patients in the new user group had a marginally lower risk of recurrent IS at 6-months (subdistribution hazard ratio [SHR], 0.95; 95% confidence interval [CI], 0.94-0.97) and 2-years (SHR, 0.92; 95% CI, 0.91-0.93) follow up. In the chronic use category, patients in the long-term user group also had a marginally lower risk of recurrent IS at 6-months (SHR, 0.87; 95% CI, 0.86-0.88) and 2-years (SHR, 0.87; 95% CI, 0.86-0.88) follow up. The effect of colchicine on the reduced risk of recurrent IS was more favorable in patients who also used statins. Conclusions: Recent colchicine use in acute non-cardiogenic IS patients is associated with marginal fewer incidences of recurrent IS. Patients with concurrent statin use may have more profound protective effects.

6.
Acta Neurol Taiwan ; 30(1): 39-42, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34549400

RESUMO

PURPOSE: Case presentation of newly diagnosed systemic lupus erythematosus (SLE) presenting initially as Tolosa-Hunt syndrome (THS). STUDY DESIGN: Retrospective clinical case. METHOD: Case report. RESULTS: A healthy young man developed acute binocular diplopia within 2 days without other neurological deficits. Bilateral 6th cranial nerve palsy was observed with general reduction in the visual field test. Emergent brain magnetic resonance image (MRI) was performed, which revealed severe inflammation in the cavernous sinus, superior orbital fissure, and apex of the orbit. No cavernous thrombosis or intracranial lesion was shown in the MRI. THS was diagnosed and the patient's CN 6 palsy recovered quickly after corticosteroid treatment. However, severe anaemia was discovered during admission (Hb=6.0), so the patient was evaluated by profound laboratory tests, which revealed SLE. CONCLUSION: With painful ophthalmoplegia, cavernous sinus syndrome is highly suspected. THS is one of the differential diagnoses for cavernous sinus syndrome. THS is a rare disease, recognized by the National Organization for Rare Disorders, and characterized by inflammatory changes in the cavernous sinus, superior orbital fissure and/or orbital apex under image study. The inflammatory changes are mostly idiopathic, but secondary causes such as sarcoidosis or other autoimmune diseases need to be ruled out. Physicians should be aware of possible underlying conditions, such as immunosuppressed status as in SLE, as the true cause of THS.


Assuntos
Seio Cavernoso , Lúpus Eritematoso Sistêmico , Síndrome de Tolosa-Hunt , Seio Cavernoso/diagnóstico por imagem , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Síndrome de Tolosa-Hunt/diagnóstico , Síndrome de Tolosa-Hunt/etiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-34574805

RESUMO

Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987-0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574-2.458), patients' awareness after PCCS (OR 0.754, 95% CI 0.635-0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients.


Assuntos
Neoplasias , Cuidados Paliativos , Humanos , Neoplasias/terapia , Qualidade de Vida , Encaminhamento e Consulta , Taiwan/epidemiologia , Doente Terminal
8.
Biomedicines ; 9(7)2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34356837

RESUMO

After stroke, dynamic changes take place from necrotic-apoptotic continuum, inflammatory response to poststroke neurogenesis, and remodeling of the network. These changes and baseline brain pathology such as small vessel disease (SVD) and amyloid burden may be associated with the occurrence of early or late poststroke cognitive impairment (PSCI) or dementia (PSD), which affect not only stroke victims but also their families and even society. We reviewed the current concepts and understanding of the pathophysiology for PSCI/PSD and identified useful tools for the diagnosis and the prediction of PSCI in serological, CSF, and image characteristics. Then, we untangled their relationships with blood pressure (BP) and blood pressure variability (BPV), important but often overlooked risk factors for PSCI/PSD. Finally, we provided evidence for the modifying effects of BP and BPV on PSCI as well as pharmacological and non-pharmacological interventions and life style modification for PSCI/PSD prevention and treatment.

9.
BMJ Open ; 11(8): e049795, 2021 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-34362805

RESUMO

OBJECTIVES: Self-rated health (SRH) is an assessment and predictor of health based on an individual's general condition; however, evidence of the value of SRH for predicting frailty remains scarce for older Asian adults. This study aimed to evaluate the relationship between SRH score trajectory and frailty among older individuals in Taiwan. DESIGN: An 8-year retrospective cohort study. SETTING: Data were retrieved from the Taiwan Longitudinal Study on Aging from 1999 to 2007. PARTICIPANTS: Respondents aged 53-69 years old who were not frail or disabled in 1999 (n=1956). PRIMARY AND SECONDARY OUTCOME MEASURES: Frailty was defined using the Fried criteria. The group-based trajectory modelling technique was used to estimate SRH trajectories. Logistic regression analysis was used to examine the associations between changes in SRH and frailty. RESULTS: Four SRH trajectory classes were identified across the 8-year follow-up: 232 participants (11.9%) were classified into the constantly poor SRH group, 1123 (57.4%) into the constantly fair SRH group, 335 (17.1%) into the constantly good SRH group and 266 (13.6%) into the good-to-fair SRH group. After adjusting for gender, age, level of education, income, social participation, health behaviours and major comorbidities, it was found that age, poor income satisfaction, without job and constantly poor SRH were associated with increased risk of frailty, while constantly good SRH (OR 0.04, 95% CI (0.01 to 0.32)) and good-to-fair SRH (OR 0.19, 95% CI (0.06 to 0.63)) were associated with reduced risks of frailty. CONCLUSIONS: Constantly poor SRH was associated with an increased risk of frailty in older age. SRH in older adults should be recognised as a predictive tool for future frailty. Diet and exercise interventions may help to prevent frailty among high-risk older individuals with constantly low SRH.


Assuntos
Fragilidade , Idoso , Envelhecimento , Fragilidade/epidemiologia , Humanos , Vida Independente , Estudos Longitudinais , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia
10.
Cancers (Basel) ; 13(16)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34439331

RESUMO

Chemotherapy-induced cognitive impairment (CICI) is an adverse side effect of cancer treatment with increasing awareness. Hippocampal damage and related neurocognitive impairment may mediate the development of CICI, in which altered neurogenesis may play a role. In addition, increased inflammation may be related to chemotherapy-induced hippocampal damage. Memantine, an uncompetitive N-methyl-D-aspartate (NMDA) receptor antagonist that may enhance neurogenesis and modulate inflammation, may be useful for treating CICI. To test this hypothesis, paclitaxel was administered to eight-week-old male B6 mice to demonstrate the relationship between CICI and impaired neurogenesis, and then, we evaluated the impact of different memantine regimens on neurogenesis and inflammation in this CICI model. The results demonstrated that both the pretreatment and cotreatment regimens with memantine successfully reversed impaired neurogenesis and spatial memory impairment in behavior tests. The pretreatment regimen unsuccessfully inhibited the expression of peripheral and central TNF-α and IL-1ß and did not improve the mood alterations following paclitaxel treatment. However, the cotreatment regimen led to a better modulatory effect on inflammation and restoration of mood disturbance. In conclusion, this study illustrated that impaired neurogenesis is one of the mechanisms of paclitaxel-induced CICI. Memantine may serve as a potential treatment for paclitaxel-induced CICI, but different treatment strategies may lead to variations in the treatment efficacy.

11.
J Alzheimers Dis ; 83(2): 569-579, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34334409

RESUMO

BACKGROUND: Differences exist regarding post-stroke cognitive outcomes. OBJECTIVE: The aim of this study investigates the potential factors associated with post-stroke cognitive performance and trajectories. METHODS: We performed a prospective cohort study using serial monitoring of cognitive function over a 1-year period after a first-ever ischemic stroke. Small vessel disease (SVD) burden and hippocampal atrophy (HA) were evaluated using the modified cerebral small vessel disease scores (mCSVD) and medial temporal atrophy score (MTA) scores. A generalized estimating equation (GEE) model and a group-based trajectory model (GBTM) was used to analyze the potential factors associated with post-stroke cognitive outcomes. RESULTS: A total of 112 patients were enrolled. The GEE model showed that all patients, regardless of initial cognitive performance, had a tendency to show an increase in the Montreal Cognitive Assessment over time. The cognitive performance was better in male patients with higher education levels (p = 0.046 and p < 0.001, respectively), but tended to be worse in patients with higher SVD burden and HA. The GBTM model grouped patients into low, intermediate, and high performance (LP, IP, and HP) after stroke. A higher SVD burden, rather than HA and initial stroke severity and location, independently predicted a higher odds of poor post-stroke cognitive trajectory (being in the LP group) after stroke (adjusted odds ratio 2.74, 95%CI 1.09-6.86). CONCLUSION: In patients with first-ever mild stroke, cognitive improvement over time was evident. The detrimental impact of the SVD burden may outweigh the effect of HA or acute stroke insult on the post-stroke cognitive trajectory during the 1-year follow-up.

12.
PLoS Med ; 18(7): e1003707, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34280191

RESUMO

BACKGROUND: Angiotensin receptor blockers (ARBs) may have protective effects against dementia occurrence in patients with hypertension (HTN). However, whether telmisartan, an ARB with peroxisome proliferator-activated receptor γ (PPAR-γ)-modulating effects, has additional benefits compared to other ARBs remains unclear. METHODS AND FINDINGS: Between 1997 and 2013, 2,166,944 type 2 diabetes mellitus (T2DM) patients were identified from the National Health Insurance Research Database of Taiwan. Patients with HTN using ARBs were included in the study. Patients with a history of stroke, traumatic brain injury, or dementia were excluded. Finally, 65,511 eligible patients were divided into 2 groups: the telmisartan group and the non-telmisartan ARB group. Propensity score matching (1:4) was used to balance the distribution of baseline characteristics and medications. The primary outcome was the diagnosis of dementia. The secondary outcomes included the diagnosis of Alzheimer disease and occurrence of symptomatic ischemic stroke (IS), any IS, and all-cause mortality. The risks between groups were compared using a Cox proportional hazard model. Statistical significance was set at p < 0.05. There were 2,280 and 9,120 patients in the telmisartan and non-telmisartan ARB groups, respectively. Patients in the telmisartan group had a lower risk of dementia diagnosis (telmisartan versus non-telmisartan ARBs: 2.19% versus 3.20%; HR, 0.72; 95% CI, 0.53 to 0.97; p = 0.030). They also had lower risk of dementia diagnosis with IS as a competing risk (subdistribution HR, 0.70; 95% CI, 0.51 to 0.95; p = 0.022) and with all-cause mortality as a competing risk (subdistribution HR, 0.71; 95% CI, 0.53 to 0.97; p = 0.029). In addition, the telmisartan users had a lower risk of any IS (6.84% versus 8.57%; HR, 0.79; 95% CI, 0.67 to 0.94; p = 0.008) during long-term follow-up. Study limitations included potential residual confounding by indication, interpretation of causal effects in an observational study, and bias caused by using diagnostic and medication codes to represent real clinical data. CONCLUSIONS: The current study suggests that telmisartan use in hypertensive T2DM patients may be associated with a lower risk of dementia and any IS events in an East-Asian population.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/uso terapêutico , Demência/epidemiologia , Demência/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Telmisartan/uso terapêutico , Idoso , Grupo com Ancestrais do Continente Asiático , Estudos de Coortes , Feminino , Humanos , Masculino , Taiwan/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-34069375

RESUMO

Screening mammography is used worldwide for the early detection of breast cancer in women experiencing no symptoms. The Breast Imaging Reporting and Database System (BI-RADS) is used to report mammographic findings. However, little is known about the clinical characteristics of Asian women with BI-RADS category 0, and we aimed to explore such characteristics in the context of Taiwan. This retrospective cross-sectional study was conducted using data from a single tertiary medical center. We examined the association of blood test data and estrogen exposure-related medical histories with BI-RADS reports from screening mammography of 4280 women between 1 January 2010 and 31 July 2019. The data of 4280 participants were evaluated, and they were categorized into BI-RADS category 0 (n = 413; 9.6%) and 1-5 (n = 3867; 90.4%) subgroups. In a multivariate analysis, breast surgery history and premenopausal status had a positive relationship with a category 0 status, with respective risk increases of 64% and 34% (p = 0.010 and 0.013). Hormone contraceptive use for ≥5 years was a negative independent predictor of having a category 0 status. In conclusion, breast surgery history and premenopausal status significantly increased the likelihood of individuals having incomplete mammographic findings, even when they were older than 45 years. Identifying related factors before screening mammography is helpful for clinical physicians to arrange more proper and alternative examination and obtain a definite diagnosis.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico por imagem , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Humanos , Mamografia , Estudos Retrospectivos , Taiwan/epidemiologia
15.
J Clin Med ; 10(6)2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33801050

RESUMO

BACKGROUND: This study was to evaluate the correlation of the hypoperfusion intensity ratio (HIR) with the collateral score from multiphase computed tomography angiography (mCTA) among patients with large vessel stroke. METHOD: From February 2019 to May 2020, we retrospectively reviewed the patients with large vessel strokes (intracranial carotid artery or proximal middle cerebral artery occlusion). HIR was defined as a Tmax > 10 s lesion volume divided by a Tmax > 6 s lesion volume, which was calculated by automatic software (Syngo.via, Siemens). The correlation between the HIR and mCTA score was evaluated by Pearson's correlation. The cutoff value predicting the mCTA score was evaluated by receiver operating characteristic analysis. RESULT: Ninety-four patients were enrolled in the final analysis. The patients with good collaterals had a smaller core volume (37.3 ± 24.7 vs. 116.5 ± 70 mL, p < 0.001) and lower HIR (0.51 ± 0.2 vs. 0.73 ± 0.13, p < 0.001) than those with poor collaterals. A higher HIR was correlated with a poorer collateral score by Pearson's correlation. (r = -0.64, p < 0.001). The receiver operating characteristic (ROC) analysis suggested that the best HIR value for predicting a good collateral score was 0.68 (area under curve: 0.82). CONCLUSION: HIR is a good surrogate of collateral circulation in patients with acute large artery occlusion.

16.
Front Neurol ; 12: 645444, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33927682

RESUMO

Background: Breakthrough strokes during treatment with aspirin, termed clinical aspirin treatment failure (ATF), is common in clinical practice. The burden of cerebral small vessel disease (SVD) is associated with an increased recurrent ischemic stroke risk. However, the association between SVD and ATF remains unclear. This study investigated the prevalence and clinical characteristics of SVD in stroke patients with ATF. Methods: Data from a prospective, and multicenter stroke with ATF registry established in 2018 in Taiwan were used, and 300 patients who developed ischemic stroke concurrent with regular use of aspirin were enrolled. White matter lesions (WMLs) and cerebral microbleeds (CMBs) were identified using the Fazekas scale and Microbleed Anatomical Rating Scale, respectively. Demographic data, cardiovascular comorbidities, and index stroke characteristics of patients with different WML and CMB severities were compared. Logistic regression analyses were performed to explore the factors independently associated with outcomes after ATF. Results: The mean patient age was 69.5 ± 11.8 years, and 70.0% of patients were men. Among all patients, periventricular WML (PVWML), deep WML (DWML), and CMB prevalence was 93.3, 90.0, and 52.5%, respectively. Furthermore, 46.0% of the index strokes were small vessel occlusions. Severe PVWMLs and DWMLs were significantly associated with high CMB burdens. Patients with moderate-to-severe PVWMLs and DWMLs were significantly older and had higher cardiovascular comorbidity prevalence than did patients with no or mild WMLs. Moreover, patients with favorable outcomes exhibited significantly low prevalence of severe PVWMLs (p = 0.001) and DWMLs (p = 0.001). After logistic regression was applied, severe WMLs predicted less favorable outcomes independently, compared with those with no to moderate PVWMLs and DWMLs [odds ratio (OR), 0.47; 95% confidence interval (CI), 0.25-0.87 for severe PVWMLs; OR, 0.40; 95% CI, 0.21-0.79 for severe DWMLs]. Conclusions: SVD is common in stroke patients with ATF. PVWMLs and DWMLs are independently associated with functional outcomes in stroke patients with ATF. The burden of SVD should be considered in future antiplatelet strategies for stroke patients after ATF.

17.
Int J Gen Med ; 14: 539-548, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33658831

RESUMO

Purpose: To investigate the potential of standing 8-electrode bioelectrical impedance analysis (BIA) for assessing visceral fat area (VFA) and body fat mass (BFM) in athletes. Materials and Methods: A total of 95 subjects (50 males and 45 females) were recruited. VFA and BFM measurements were obtained using three standing 8-electrode BIA devices, InBody230, InBody770, and IOI353. These acquired VFA and BFM were expressed as VFAIOI353, VFAInBody230, VFAInBody770 V, BFMIOI353, BFMInBody230, and BFMInBody770, respectively. As reference measurement, the VFA acquired from computer tomography (CT) was expressed as VFACT, and the BFM measured by dual-energy X-ray absorptiometry (DXA) was denoted as BFMDXA. Results: The coefficient of determination (r2) in regression analysis between the measurements by VFAIOI353, VFAInBody230, VFAInBody770 and VFACT were 0.425, 0.492, and 0.473, respectively. Also, the limits of agreement (LOA) obtained from Bland-Altman analysis were -25.18 to 56.62, -29.74 to 62.44, and -32.96 to 71.93 cm2. For BFM, r2 in regression analysis between the measurements by BFMIOI353, BFMInBody230, BFMInBody770 and BMFDXA were 0.894, 0.950, and 0.955, respectively; LOA were -7.21 to 5.75, -4.70 to 4.05, and -5.48 to 3.05 kg, respectively. Conclusion: The results showed when assessing BFM, these instruments delivered comparable measurements, and the degree of agreement ranged from excellent to moderate compared with the reference method. However, when assessing VFA, the agreements were weak. Therefore, the application of standing 8-electrode BIA devices for assessing athletes' VFA still needs improvement.

18.
BMC Geriatr ; 21(1): 59, 2021 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446114

RESUMO

BACKGROUND: Dementia in the oldest-old is projected to increase exponentially as is the burden of their caregivers who may experience unique challenges and suffering. Thus, we aim to investigate which factors are associated with older caregivers' burden in caring demented outpatients in a multicenter cohort. METHODS: Patients and their caregivers, both aged ≧65 years, in the National Dementia Registry Study in Taiwan (T-NDRS) were included in this study. Caregiver burden was measured with the short version of the Zarit Burden Interview (ZBI). The correlations between the ZBI scores and characteristics of caregivers and patients, including severity of dementia, physical comorbidities, instrumental activities of daily living (IADL), neuropsychiatric symptoms assessed by the Neuropsychiatric Inventory (NPI), and family monthly income, were analyzed. RESULTS: We recruited 328 aged informal caregiver-patient dyads. The mean age of caregivers was 73.7 ± 7.0 years, with female predominance (66.8%), and the mean age of patients was 78.8 ± 6.9 years, with male predominance (61.0%). Multivariable linear regression showed that IADLs (ß = 0.83, p < 0.001) and NPI subscores of apathy (ß = 3.83, p < 0.001)and irritability (ß = 4.25, p < 0.001) were positively associated with ZBI scores. The highest family monthly income (ß = - 10.92, p = 0.001) and caregiver age (ß = - 0.41, p = 0.001) were negatively correlated with ZBI scores. CONCLUSIONS: Older caregivers of older demented patients experience a higher care burden when patients had greater impaired functional autonomy and the presence of NPI symptoms of apathy and irritability. Our findings provide the direction to identify risky older caregivers, and we should pay more attention to and provide support for these exhausted caregivers.


Assuntos
Atividades Cotidianas , Cuidadores , Idoso , Idoso de 80 Anos ou mais , Fardo do Cuidador , Estudos de Coortes , Efeitos Psicossociais da Doença , Feminino , Humanos , Masculino , Taiwan/epidemiologia
19.
Biomedicines ; 9(1)2020 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-33374377

RESUMO

BACKGROUND: The challenge of differentiating, at an early stage, Parkinson's disease from parkinsonism caused by other disorders remains unsolved. We proposed using an artificial neural network (ANN) to process images of dopamine transporter single-photon emission computed tomography (DAT-SPECT). METHODS: Abnormal DAT-SPECT images of subjects with Parkinson's disease and parkinsonism caused by other disorders were divided into training and test sets. Striatal regions of the images were segmented by using an active contour model and were used as the data to perform transfer learning on a pre-trained ANN to discriminate Parkinson's disease from parkinsonism caused by other disorders. A support vector machine trained using parameters of semi-quantitative measurements including specific binding ratio and asymmetry index was used for comparison. RESULTS: The predictive accuracy of the ANN classifier (86%) was higher than that of the support vector machine classifier (68%). The sensitivity and specificity of the ANN classifier in predicting Parkinson's disease were 81.8% and 88.6%, respectively. CONCLUSIONS: The ANN classifier outperformed classical biomarkers in differentiating Parkinson's disease from parkinsonism caused by other disorders. This classifier can be readily included into standalone computer software for clinical application.

20.
Stroke ; 51(12): 3756-3759, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33121385

RESUMO

BACKGROUND AND PURPOSE: Contrast-induced encephalopathy (CIE) is a rare and underrecognized complication after endovascular thrombectomy (EVT) for acute ischemic stroke. This study investigated the incidence and risk factors of CIE in patients who underwent EVT. METHODS: Consecutive patients with acute ischemic stroke who received EVT between September 2014 and December 2019 at 2 medical centers were included. CIE was diagnosed on clinical criteria of neurological deterioration or delayed improvement within 24 hours after the procedure that was unexplained by the infarct or hemorrhagic transformation and radiological criterion of edematous change extending beyond the infarct core accompanied by contrast staining. RESULTS: Of 421 patients with acute ischemic stroke who received EVT, 7 (1.7%) developed CIE. The manifestations included worsening of focal neurological signs, coma, and seizure. Patients with CIE were more likely to experience contrast-induced acute kidney injury than were those without CIE, but the volume of contrast medium was comparable between the two groups. The independent risk factors for CIE included renal dysfunction (defined as an estimated glomerular filtration rate <45 mL/min per 1.73 m2; odds ratio, 5.77 [95% CI, 1.37-24.3]; P=0.02) and history of stroke (odds ratio, 4.96 [95% CI, 1.15-21.3]; P=0.03). Patients with CIE were less likely to achieve favorable functional outcomes (odds ratio, 0.09 [95% CI, 0.01-0.87]; P=0.04). CONCLUSIONS: CIE should be suspected in patients with clinical worsening after EVT accompanied by imaging evidence of contrast staining and edematous changes, especially in patients with renal dysfunction or history of stroke.


Assuntos
Encefalopatias/induzido quimicamente , Meios de Contraste/efeitos adversos , Procedimentos Endovasculares , AVC Isquêmico/cirurgia , Complicações Pós-Operatórias/induzido quimicamente , Trombectomia , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Encefalopatias/diagnóstico por imagem , Encefalopatias/epidemiologia , Encefalopatias/fisiopatologia , Edema Encefálico/induzido quimicamente , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/fisiopatologia , Meios de Contraste/administração & dosagem , Feminino , Humanos , Incidência , AVC Isquêmico/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Tomografia Computadorizada por Raios X
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