Podcasts about conclusion patients

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.06.12.141945v1?rss=1 Authors: von Schwanenflug, N., Krohn, S., Heine, J., Paul, F., Pruess, H., Finke, C. Abstract: Introduction: Anti-N-methyl-d-aspartate receptor encephalitis (NMDARE) is an autoimmune disorder associated with severe neuropsychiatric symptoms. While patients with NMDARE exhibit disrupted functional connectivity (FC), these findings have been limited to static connectivity analyses. This study applies time-resolved FC analysis to explore the temporal variability of large-scale brain activity in NMDARE and to assess the discriminatory power of functional brain states in a supervised classification approach. Methods: Resting-state fMRI data from 57 patients with NMDARE and 61 controls was included. To capture brain dynamics, four discrete connectivity states were extracted and state-wise group differences in FC, occurrence, dwell time and transition frequency were assessed. Furthermore, logistic regression models with embedded feature selection were trained for each state to predict group status in a leave-one-out cross validation scheme. Results: Patients showed FC alterations in three out of four states. Besides a reduction in hippocampal-frontal connectivity, we observed connectivity decreases within the default mode network and between frontal areas and subcortical as well as visual regions, which remained undetected in static FC. Furthermore, patients displayed a shift in dwell time from the weakly connected dominant state to a higher connected, but less frequent state, accompanied by increased transition frequencies. Discriminatory network features and predictive power varied dynamically over states, reaching up to 78.6% classification accuracy. Conclusion: Patients showed state-specific alterations in FC along with a shift in dwell time and increased volatility of state transitions. These measures were associated with disease severity and duration, highlighting the potential of spatiotemporal dynamics in FC as prognostic biomarkers in NMDARE. Copy rights belong to original authors. Visit the link for more info

Background: Despite the high prevalence and impact of episodic breathlessness, information about characteristics and patterns is scarce. Aim: To explore the experience of patients with advanced disease suffering from episodic breathlessness, in order to describe types and patterns. Design and participants: Qualitative design using in-depth interviews with patients suffering from advanced stages of chronic heart failure, chronic obstructive pulmonary disease, lung cancer or motor neurone disease. As part of the interviews, patients were asked to draw a graph to illustrate typical patterns of breathlessness episodes. Interviews were tape-recorded, transcribed verbatim and analysed using Framework Analysis. The graphs were grouped according to their patterns. Results: Fifty-one participants (15 chronic heart failure, 14 chronic obstructive pulmonary disease, 13 lung cancer and 9 motor neurone disease) were included (mean age 68.2 years, 30 of 51 men, mean Karnofsky 63.1, mean breathlessness intensity 3.2 of 10). Five different types of episodic breathlessness were described: triggered with normal level of breathlessness, triggered with predictable response (always related to trigger level, e. g. slight exertion causes severe breathlessness), triggered with unpredictable response (not related to trigger level), non-triggered attack-like (quick onset, often severe) and wave-like (triggered or non-triggered, gradual onset). Four patterns of episodic breathlessness could be identified based on the graphs with differences regarding onset and recovery of episodes. These did not correspond with the types of breathlessness described before. Conclusion: Patients with advanced disease experience clearly distinguishable types and patterns of episodic breathlessness. The understanding of these will help clinicians to tailor specific management strategies for patients who suffer from episodes of breathlessness.

Background/Aims: Chronic hypercortisolism in Cushing’s disease (CD) hasbeen suggested to contribute to an altered personality profile in thesepatients. We aimed to test this hypothesis and attempted to determinethe effects of disease- and treatment-related factors that mightmoderate an altered personality in CD. Methods: We assessed 50 patientswith CD (74% biochemically controlled) and compared them to 60 patientswith non-functioning pituitary adenomas (NFPA) and 100 age-andgender-matched mentally healthy controls. Personality was measured bytwo standardized personality questionnaires, TPQ (Cloninger PersonalityQuestionnaire) and EPQ-RK (Eysenck Personality Questionnaire-RK).Results: Compared to mentally healthy controls, CD patients reportedsignificantly less novelty-seeking behaviour, including less exploratoryexcitability and less extravagance. On harm avoidant subscales, theypresented with more anticipatory worries and pessimism, higher fear ofuncertainty, shyness with strangers, fatigability and asthenia.Moreover, CD patients appeared to be less extraverted, more neurotic andsocially desirable. CD patients differed from NFPA patients in terms ofhigher neuroticism scores, and NFPA patients did not show alterednovelty-seeking behaviour or extraversion. In the subgroup analysis, CDpatients with persistent hypercortisolism displayed significantly higherfear of uncertainty, fatigability and asthenia, indicating high harmavoidance in total, than those in biochemical remission. Conclusion:Patients with CD showed a distinct pattern of personality traitsassociated with high anxiety in combination with traits of lowexternalizing behaviour. Such personality changes should be taken intoaccount in the diagnosis and treatment of CD patients, as they mightinterfere with the patient-physician communication and/or challenge thepatients’ social and psychological functioning.

Background: No data are available about the sports activity of patients with bone-conserving short-stem hip implants. Hypothesis: Patients can return to a good level of sports activity after implantation of a short-stem hip implant. Study Design: Case series; Level of evidence, 4. Methods: The sports activity level of 68 patients (76 hips) after short-stem hip arthroplasty was assessed for a minimum of 2 years after implantation. In addition to the clinical examination, a detailed evaluation of the patients’ sports pattern was obtained. Furthermore, the results were analyzed with regard to gender (female and male) and age (55 years). Results: After a mean of 2.7 years, patients showed a Harris Hip Score (HHS) of 93.6, a Western Ontario and McMaster Universities Arthritis Index (WOMAC) score of 9.5, and a University of California, Los Angeles (UCLA) activity score of 7.6, with each individual participating on average in 3.5 different disciplines after surgery compared with 3.9 before surgery. High-impact activities decreased significantly postoperatively, whereas low-impact activities increased significantly. The duration of the sports activities remained stable, while the frequency actually increased. In contrast, men participated preoperatively in more sports than women (4.3 men vs 3.3 women). However, because of a pronounced decrease in high-impact activities by men, both genders participated in an equal number of sports postoperatively (3.5 men vs 3.5 women). Finally, 45% (n = 31) reported at least one activity that they missed. Most of them were disciplines with an intermediate- or high-impact level. Conclusion: Patients with a short-stem hip implant can return to a good level of activity postoperatively. Participation in sports almost reached similar levels as preoperatively but with a shift from high- to low-impact activities. This seems desirable from a surgeon’s point of view but should also be communicated to the patient before hip replacement

AIM: The aim of this retrospective trial was to investigate differences in mesiodistal and vestibulo-oral crown sizes of naturally, fully-erupted permanent maxillary teeth between patients with and without palatal canine displacement. PATIENTS AND METHOD: 115 patients (mean age: 14 years 10 months; females: 77 males: 38) treated in the Department of Orthodontics, University of Munich were included in the study. 65 of the patients showed at least one palatally-displaced canine. Diagnosis and the location of the displacement were determined on the basis of standardized radiographs and confirmed by surgical documentation. Each maxillary tooth's mesiodistal and vestibulo-oral width was measured using a dial caliper on each dental cast. Excluded were partially-erupted teeth and surfaces with caries or restorations that had to be measured. An analysis of available space was made by evaluating the pre-treatment dental casts of all patients included in the study. RESULTS: Comparing the tooth widths of patients with unilateral canine displacement with the corresponding contralateral quadrants, we noted a statistically significant difference, namely that the central and lateral incisors and the canines of the affected side were narrower than those of the non-affected side in the same patient. Moreover, the displaced upper canines showed an increase in vestibulo-oral dimension. Overall tooth width (including all tooth groups) in patients with palatally-displaced canines was significantly less than that in the control group. However, when comparing the crown diameters of unilaterally- and bilaterally-affected patients, no differences in tooth-size were observed. The space-analysis showed excessive dental-arch space in patients with a palatally-displaced canine. CONCLUSION: Patients affected by palatal canine displacement showed significantly smaller maxillary tooth size.