Data_Sheet_1_The impact of the COVID-19 pandemic on palliative care practice: A survey of clinical oncologists.pdf

BackgroundPalliative care is an essential intervention to improve the quality of life for patients with cancer, whereas the ongoing COVID-19 pandemic poses a challenge to supportive and palliative care providers. This survey aims to explore the current status of palliative care practice for cancer and the influence of COVID-19, from the perspective of oncologists.MethodsThe semi-structure electronic questionnaire was designed. Mixed-mode surveys including electronic questionnaires, face-to-face interactions, and telephone interviews were adopted according to the willingness of respondents. Face-to-face and telephone interviews were based on same questions in the online questionnaire. Participants working in cancer-related departments with frontline palliative care experience during the COVID-19 outbreak were included. Surveys covered experiences and perspectives regarding the impact of COVID-19 on clinical work, personal lives, and palliative care practice. Suggestions on coping strategies were further proposed and qualitatively analyzed.ResultsThirty-seven oncologists participated in this study from September 2021 to January 2022. The majority of them believed COVID-19 significantly and negatively affected their clinical work routines (75.7%), personal daily lives (67.6%), and palliative care practice (64.9%). Most specialists considered that currently the palliative care system remained underdeveloped (73.0%), and other factors besides COVID-19 were associated with this situation (78.4%). Seventeen participants further made suggestions on how to promote palliative care during COVID-19, and three themes emerged through the qualitative analysis: (1) Remote or online service (88.2%); (2) Publicity, education, or shared decision-making for patients (29.4%); (3) Guidelines, training, or programs for care providers (23.6%).ConclusionOncologists consider that COVID-19 has an adverse impact on their palliative care practice and daily routine. In addition to COVID-19, other factors affecting palliative care should not be neglected. Corresponding measures are warranted to encourage palliative care practice during COVID-19.</p

Five-year Prognosis after Mild to Moderate Ischemic Stroke by Stroke Subtype: A Multi-Clinic Registry Study

<div><p>Background and Purpose</p><p>Mild to moderate ischemic stroke is a common presentation in the outpatient setting. Among the various subtypes of stroke, lacunar infarction (LI) is generally very common. Currently, little is known about the long-term prognosis and factors associated with the prognosis between LI and non-LI. This study aims to compare the risk of death and acute cardiovascular events between patients with LI and non-LI, and identify potential risk factors associated with these outcomes.</p><p>Methods</p><p>A total of 710 first-ever ischemic stroke patients (LI: 474, non-LI: 263) from 18 clinics were recruited consecutively from 2003 to 2004. They were prospectively followed-up until the end of 2008. Hazard ratios and 95% confidence intervals were calculated using multivariable Cox proportional hazards regression.</p><p>Results</p><p>After a 5-year follow up, 54 deaths and 96 acute cardiovascular events occurred. Recurrent stroke was the most common cause of death (19 cases, 35.18%) and new acute cardiovascular events (75 cases, 78.13%). There were no significant differences between patients with LI and non-LI in their risks of death, new cardiovascular events, and recurrent stroke after adjusting for age, sex, hypertension, diabetes, cardiac diseases, body mass index, dyslipidemia, smoking, alcohol consumption, ADL dependence, and depressive symptoms. Among the modifiable risk factors, diabetes, hypertension, ADL dependency, and symptoms of depression were independent predictors of poor outcomes in patients with LI. In non-LI patients, however, no modifiable risk factors were detected for poor outcomes.</p><p>Conclusion</p><p>Long-term outcomes did not differ significantly between LI and non-LI patients. Detecting and managing vascular risk factors and depression as well as functional rehabilitation may improve the prognoses of LI patients.</p></div

Additional file 1: of A case of rapid-onset dystonia-parkinsonism accompanied by pyramidal tract impairment

HSP-associated and SCA-associated genes included in the gene sequencing of the patient. (DOC 98 kb

Prognosis of 710 patients with first ischemic stroke.

<p>LI, Lacunar Infarction; non-LI, non-lacunar infarction, including thrombotic brain infarction and cardioembolic stroke; Acute CVD, acute cardiovascular diseases including acute myocardial infarction, sudden death and acute stroke; AMI, acute myocardial infarction; IS, Ischemic stroke; ICH, intracerebral hemorrhage; SAH, subarachnoid hemorrhage.</p

Baseline characteristics in LI and non-LI patients 3-month after first ischemic stroke.

<p>IS, Ischemic stroke; LI, Lacunar Infarction; non-LI, non-lacunar infarction, including thrombotic brain infarction and cardioembolic stroke; SBP, Systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; TC, Total cholesterol; TG, Triglyceride; HDL-C, High-density lipoprotein cholesterol; LDL-C, Low-density lipoprotein cholesterol; BMI, Body mass index; BI, Bathel index.</p

Survival models for determinants of 5-year mortality, incidence of acute CVD events and recurrent stroke events in LI.

*<p>Adjusted for age, gender, hypertension, diabetes, dislipidemia, cardiac disease, overweight or obesity, smoking status, drinking status, BI index, depression symptoms LI, Lacunar Infarction; Acute CVD, acute cardiovascular diseases including acute myocardial infarction, sudden death and acute stroke; Recurrent stroke including ischemic stroke, intracerebral hemorrhage and subarachnoid hemorrhage. HR, Hazard ratio; CI, Confidence interval; BI, Bathel index.</p

Aberrant Functional Organization within and between Resting-State Networks in AD

<div><p>Altered functional characteristics have been reported in amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD); nonetheless, comprehensive analyses of the resting-state networks (RSNs) are rare. This study combined multiple imaging modalities to investigate the functional and structural changes within each RSN and between RSNs in aMCI/AD patients. Eight RSNs were identified from functional MRI data from 35 AD, 18 aMCI and 21 normal control subjects using independent component analysis. We compared functional connectivity (FC) within each RSN and found decreased FC in the several cognitive-related RSNs in AD, including the bilateral precuneus of the precuneus network, the posterior cingulate cortex and left precuneus of the posterior default mode network (DMN), and the left superior parietal lobule of the left frontoparietal network (LFP). We further compared the grey matter volumes and amplitudes of low-frequency fluctuations of these regions and found decreases in these measures in AD. Importantly, we found decreased inter-network connectivity between the visual network and the LFP and between the anterior and posterior DMNs in AD. All indices in aMCI patients were numerically between those of controls and AD patients. These results suggest that the brain networks supporting complex cognitive processes are specifically and progressively impaired over the course of AD, and the FC impairments are present not only within networks but also between networks.</p></div

Scatter plots of intra-network FCs (A), ALFFs (B), and GMVs (C) versus MMSE scores.

<p>The circles represent the Alzheimer’s disease subjects and the squares represent the amnestic mild cognitive impairment subjects. Abbreviations: ALFF, amplitude of low-frequency fluctuation; B, bilateral; FC, functional connectivity; GMV, grey matter volume; L, left; MMSE, Mini-Mental State Examination; PCC, partial correlation coefficient; PCC^a, posterior cingulate cortex; Pcu, precuneus; R, right; SPL, superior parietal lobule.</p

Correlations between MMSE scores and functional/structural indices.

<p>Note: <i>P</i> values were adjusted for multiple comparisons using the Bonferroni correction.</p><p>Abbreviations: ALFF, amplitude of low-frequency fluctuation; B, bilateral; FC, functional connectivity; GMV, grey matter volume; L, left; MMSE, Mini-Mental State Examination; PCC, partial correlation coefficient; PCC^a, posterior cingulate cortex; Pcu, precuneus; R, right; SPL, superior parietal lobule.</p

Brain areas with significant differences in FC across groups.

<p>Abbreviations: AD, Alzheimer’s disease; B, bilateral; BA, Brodmann’s area; FC, functional connectivity; L, left; LFP, left frontoparietal network; MNI, Montreal Neurological Institute; NC, normal controls; PCC, posterior cingulate cortex; Pcu, precuneus; pDMN, posterior default mode network; R, right; RSN, resting-state network; SPL, superior parietal lobule.</p