Impact of time on improvement of outcome after stroke

Contains fulltext : 51306.pdf (publisher's version ) (Closed access)BACKGROUND AND PURPOSE: Longitudinal conducted studies show that neurologic and functional recovery show faster recovery in the first weeks poststroke. The aim of the present study was to study the effects of progress of time on observed improvements in motor strength, synergisms, and activities during the first 16 weeks poststroke. METHODS: Based on data from a previous study, 101 patients with first-ever ischemic middle cerebral artery strokes were prospectively investigated during the first 16 weeks after stroke. Progress of time was categorized into 8 biweekly time intervals and was used as the independent covariate in a first-order longitudinal regression model. The biweekly time change (progress of time) was related to improvement in upper and lower limb motor recovery assessed with Fugl-Meyer score and Motricity Index, reduction in visuospatial inattention based on the letter cancellation task, and improvement in walking ability, dexterity, and activities of daily living measured with the Functional Ambulation Categories, Action Research Arm test, and Barthel Index. RESULTS: Time explained a significant change of 8.4 (42%) measurement units on the Barthel Index for the first 10 weeks poststroke, 1.1 (22%) measurement units on Functional Ambulation Categories, and 19% on the Action Research Arm test for the first 6 and 8 weeks poststroke. Approximately 25% (for Fugl-Meyer-arm) to 26% (for Motricity Index-arm) of the significant change in measurements units was explained by time alone for the upper limb compared with 33% for Fugl-Meyer-leg and 39% for Motricity Index-leg of the lower limb. Time accounted for a reduction of 16% in the letter cancellation task. Observed associations did not change after controlling for covariates such as age, gender, hemisphere of stroke, type of stroke, or intervention. CONCLUSIONS: Progress of time is an independent covariate that reflects spontaneous recovery of body functions and activities explaining &16% to 42% of the observed improvements in the first 6 to 10 weeks after stroke onset

Initiation of insulin glargine in patients with Type 2 diabetes in suboptimal glycaemic control positively impacts health-related quality of life. A prospective cohort study in primary care

Aims To study prospectively the impact of initiating insulin glargine in suboptimally controlled insulin-naïve patients with Type2 diabetes on health-related quality of life in relation to glycaemic control. Methods Insulin-naïve Dutch patients with Type2 diabetes in suboptimal glycaemic control (Hb

Septal ablation in hypertrophic obstructive cardiomyopathy improves systolic myocardial function in the lateral (free wall): a follow-up study using CMR tissue tagging and 3D strain analysis

Aims: Alcohol septal ablation (ASA) has been successful in the treatment of symptomatic hypertrophic obstructive cardiomyopathy (HOCM). The aim of this study is to evaluate the effects of ethanol-induced myocardial infarcts on regional myocardial function using cardiac magnetic resonance (CMR) tissue tagging and 3-dimensional (3D) strain analysis. Methods and results: In nine patients (age 52±15 years) who underwent ASA, CMR was performed prior to and 6 months after the procedure. Regional myocardial mass was evaluated using cine imaging. Myocardial tagging was used to calculate systolic 3D myocardial strain values. These strain values were used to calculate the shortening index (SI), a robust parameter for myocardial contraction. Maximum end-systolic (ES) SI and systolic SI rate were quantified in three circumferential segments: septum, adjacent, and remote (lateral) myocardium. Compared with baseline, septal and non-septal mass decreased at follow-up (from 72±27 to 59±21 g; P=0.008 and from 131±34 to 109±30 g; P=0.008, respectively). In the septum, maximum ES SI and SI rate remained unchanged after ASA. In adjacent myocardium, ES SI remained unchanged, whereas SI rate improved (from -56.5±21.1 to -70.0±16.7%/s; P=0.02). Both ES SI and SI rate improved significantly in remote myocardium (from -16.9±2.8 to -18.8±3.2%; P=0.02 and from -70.3±9.2 to -86.1±15.0%/s; P=0.01, respectively). Conclusion: Reduction of left ventricular (LV) outflow tract obstruction in symptomatic HOCM is associated with a significant reduction in myocardial mass and improvement of intramural systolic function in the lateral (remote) wall, indicating reversed LV remodelling. © The European Society of Cardiology 2006. All rights reserved

Biomechanical mechanisms underlying treatment effects of exercise therapy in patients with knee osteoarthritis: data from a randomized controlled trial

The aim of this paper is to briefly show the importance of the spatial organisation and of the temporal evolution of road transport in Belgium (freight, passengers). Attention is particularly put on the negative externalities produced by this transportation mode type (pollution, road damages, road accidents).L'objectif de cet article est de montrer brièvement l'importance de l'organisation spatiale et de l'évolution temporelle du transport routier de marchandises et de passagers en Belgique. Une attention particulière est portée aux externalités négatives produites par ce mode de transport (pollution, dégradations routières, accidents de la route).Het opzet van deze bijdrage bestaat erin om op een beknopte wijze het belang aan te tonen van de ruimtelijke organisatie en evolutie doorheen de tijd van het wegtransport in België (perso-nen zowel als vracht). Er is ook aandacht besteed aan negatieve externaliteiten veroorzaakt door dit type van transportmodus.Thomas Isabelle, Verhetsel Ann. Transport routier et mobilité durable : un état de la question pour la Belgique. In: Hommes et Terres du Nord, 1999/3. La Belgique. pp. 198-204

Endothelial dysfunction and low-grade inflammation are associated with greater arterial stiffness over a 6-year period

Endothelial dysfunction and low-grade inflammation are associated with cardiovascular disease. Arterial stiffening plays an important role in cardiovascular disease and, thus, may be a mechanism through which endothelial dysfunction and/or low-grade inflammation lead to cardiovascular disease. We investigated the associations between, on the one hand, biomarkers of endothelial dysfunction (soluble endothelial selectin, thrombomodulin, and both vascular and intercellular adhesion molecules 1 and von Willebrand factor) and of low-grade inflammation (C-reactive protein, serum amyloid A, interleukin 6, interleukin 8, tumor necrosis factor-α and, soluble intercellular adhesion molecule 1) and, on the other hand, arterial stiffness over a 6-year period, in 293 healthy adults (155 women). Biomarkers were combined into mean z scores. Carotid, femoral, and brachial arterial stiffness and carotid-femoral pulse wave velocity were determined by ultrasonography. Measurements were obtained when individuals were 36 and 42 years of age. Associations were analyzed with generalized estimating equation and adjusted for sex, height, and mean arterial pressure. The endothelial dysfunction z score was inversely associated with femoral distensibility (β:-0.51 [95% CI:-0.95 to-0.06]) and compliance coefficients (β:-0.041 [95% CI:-0.076 to-0.006]) but not with carotid or brachial stiffness or carotid-femoral pulse wave velocity. The low-grade inflammation z score was inversely associated with femoral distensibility (β:-0.51 [95% CI:-0.95 to-0.07]) and compliance coefficients (β:-0.050 [95% CI:-0.084 to-0.016]) and with carotid distensibility coefficient (β:-0.910 [95% CI:-1.810 to-0.008]) but not with brachial stiffness or carotid-femoral pulse wave velocity. Biomarkers of endothelial dysfunction and low-grade inflammation are associated with greater arterial stiffness. This provides evidence that arterial stiffening may be a mechanism through which endothelial dysfunction and low-grade inflammation lead to cardiovascular disease

Long-Term Outcome after Joint Bleeds in Von Willebrand Disease Compared to Haemophilia A: A Post Hoc Analysis

Thrombosis and Hemostasi

Accelerometer Measured Levels of Moderate-to-Vigorous Intensity Physical Activity and Sedentary Time in Children and Adolescents with Chronic Disease: a Systematic Review and Meta-Analysis

Context: Moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) are important for child and adolescent health. Objective: To examine habitual levels of accelerometer measured MVPA and ST in children and adolescents with chronic disease, and how these levels compare with healthy peers. Methods: Data sources: An extensive search was carried out in Medline, Cochrane library, EMBASE, SPORTDiscus and CINAHL from 2000–2017. Study selection: Studies with accelerometer-measured MVPA and/or ST (at least 3 days and 6 hours/day to provide estimates of habitual levels) in children 0–19 years of age with chronic diseases but without co-morbidities that would present major impediments to physical activity. In all cases patients were studied while well and clinically stable. Results: Out of 1592 records, 25 studies were eligible, in four chronic disease categories: cardiovascular disease (7 studies), respiratory disease (7 studies), diabetes (8 studies), and malignancy (3 studies). Patient MVPA was generally below the recommended 60 min/day and ST generally high regardless of the disease condition. Comparison with healthy controls suggested no marked differences in MVPA between controls and patients with cardiovascular disease (1 study, n = 42) and type 1 diabetes (5 studies, n = 400; SMD -0.70, 95% CI -1.89 to 0.48, p = 0.25). In patients with respiratory disease, MVPA was lower in patients than controls (4 studies, n = 470; SMD -0.39, 95% CI -0.80, 0.02, p = 0.06). Meta-analysis indicated significantly lower MVPA in patients with malignancies than in the controls (2 studies, n = 90; SMD -2.2, 95% CI -4.08 to -0.26, p = 0.03). Time spent sedentary was significantly higher in patients in 4/10 studies compared with healthy control groups, significantly lower in 1 study, while 5 studies showed no significant group difference. Conclusions: MVPA in children/adolescents with chronic disease appear to be well below guideline recommendations, although comparable with activity levels of their healthy peers except for children with malignancies. Tailored and disease appropriate intervention strategies may be needed to increase MVPA and reduce ST in children and adolescents with chronic disease