Background: Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intra-arterial thrombolysis. The limited knowledge on the outcome after a conventional treatment ap...Background: Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intra-arterial thrombolysis. The limited knowledge on the outcome after a conventional treatment approach comes from a few small case series of highly selected patients. Abstract:Objective: to provide more data on the outcome of conventional treatment. Methods: Data were analysed on patients from three centres with symptomatic basilar artery occlusion treated conventionally. Conventional therapy was defined as treatment with antiplatelets, anticoagulation, or both. Results: Data were available on 82 patients. The case fatality was 40%. Among survivors, 65%remained dependent (Rankin score 4-5). Patients younger than 60 years (odds ratio = 3.1 (95%confidence interval, 1.0 to 9.5)) and those with a minor stroke (OR = 3.1 (1.0 to 9.6)) were more likely to have a good outcome (Rankin score 0-3). Patients with a progressive stroke were less likely to have a good outcome (OR = 0.3 (0.08 to 1.2)) than patients with a maximum deficit at onset or fluctuating symptoms at presentation. Conclusions: Conventional treatment of symptomatic basilar artery occlusion is associated with a poor outcome in almost 80%of patients, which emphasises the importance of the search for a more effective treatment approach.展开更多
Objective: To examine whether intravenous recombinant tissue plasminogen activator (rt-PA) treatment given in the acute phase of ischaemic stroke has a favourable effect on cognitive and functional outcome at six mont...Objective: To examine whether intravenous recombinant tissue plasminogen activator (rt-PA) treatment given in the acute phase of ischaemic stroke has a favourable effect on cognitive and functional outcome at six months post-stroke. Methods: The present study included 92 patients with a first-ever symptomatic infarct, of whom 25 (27 %) were subjected to rt-PA treatment in the first three hours post-stroke. Multivariate logistic regression analyses adjusted for stroke severity, education, age, and sex were performed to examine whether rt-PA treatment influenced cognitive outcome (assessed with a neuropsychological examination covering 7 cognitive domains), basic ADL independence (modified Barthel Index ≥19), and instrumental ADL independence (Frenchay Activities Index ≥15) after six months. Results: The adjusted odds ratio for intact cognition was 1.0 (95%CI 0.2 to 4.3), that for basic ADL outcome 13.5 (95%CI 1.4 to 129.4) and for instrumental ADL 7.1 (95%CI 1.2 to 42.2). Conclusion: Our findings suggest that rt-PA treatment is associated with a favourable basic and instrumental ADL outcome, but not with a beneficial cognitive outcome after 6 months.展开更多
Background: Determinants of survival and of risk of vascular events after tra nsient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospec...Background: Determinants of survival and of risk of vascular events after tra nsient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patien ts after TIA or minor ischaemic stroke (Rankin grade≤ 3), after 10 years or mor e. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial (recruitment in 1986- 89; arterial ca use of cerebral ischaemia). We included 24 hospitals in the Netherlands that rec ruited at least 50 patients. Primary outcomes were all- cause mortality and the composite event of death from all vascular causes, non- fatal stroke, and non - fatal myocardial infarction. We assessed cumulative risks by Kaplan- Meier a nalysis and prognostic factors with Cox univariate and multivariate analysis. Fi ndings: Follow- up was complete in 2447 (99% ) patients. After a mean follow- up of 10.1 years, 1489 (60% ) patients had died and 1336 (54% ) had had at le ast one vascular event. 10- year risk of death was 42.7% (95% CI 40.8- 44. 7). Age and sex- adjusted hazard ratios were 3.33 (2.97- 3.73) for age over 65 years, 2.10 (1.79- 2.48) for diabetes, 1.77 (1.45- 2.15) for claudication, 1. 94 (1.42- 2.65) for previous peripheral vascular surgery, and 1.50 (1.31- 1.71 ) for pathological Q waves on baseline electrocardiogram. 10- year risk of a vascular event was 44.1% (42.0- 46.1). After falling in the first 3 years, yearly risk of a vascular ev ent increased over time. Predictive factors for risk of vascular events were sim ilar to those for risk of death. Interpretation: Long- term secondary preventio n in patients with cerebral ischaemia still has room for further improvement.展开更多
Aims: To study whether arterial stiffness is related to risk of new vascular events in patients with manifest arterial disease and to examine whether this relation varies between patients who differ with respect to ba...Aims: To study whether arterial stiffness is related to risk of new vascular events in patients with manifest arterial disease and to examine whether this relation varies between patients who differ with respect to baseline vascular risk, arterial stiffness, or systolic blood pressure(SBP). Methods and results: The study was performed in the first consecutive 2183 patients with manifest arterial disease enrolled in the SMART study(Second Manifestations of ARTerial disease), a cohort study among patients with manifest arterial disease or cardiovascular risk factors. Common carotid distension(i.e. the change in carotid diameter in systole relative to diastole) was measured at baseline by ultrasonography. With the distension, several stiffness parameters were determined. In the entire cohort, none of the carotid artery stiffness parameters was related to the occurrence of vascular events. However, decreased stiffness was related to decreased vascular risk in subjects with low baseline SBP. The relation of carotid stiffness with vascular events did not differ between tertiles of baseline risk and carotid stiffness. Conclusion: Carotid artery stiffness is no independent risk factor for vascular events in patients with manifest arterial disease. However, in patients with low SBP, decreased carotid stiffness may indicate a decreased risk of vascular events.展开更多
Background and Purpose -Because intracranial aneurysms develop during life, patients with subarachnoid hemorrhage (SAH) and successfully occluded aneurysms are at risk for a recurrence. We studied the incidence of and...Background and Purpose -Because intracranial aneurysms develop during life, patients with subarachnoid hemorrhage (SAH) and successfully occluded aneurysms are at risk for a recurrence. We studied the incidence of and risk factors for recurrent SAH in patients who regained independence after SAH and in whom all aneurysms were occluded by means of clipping. Methods -From a cohort of patients with SAH admitted between 1985 and 2001, we included those patients who were discharged home or to a rehabilitation facility. We interviewed these patients about new episodes of SAH. We retrieved all medical records and radiographs in case of reported recurrences. If patients had died, we retrieved the cause of death. We analyzed the incidence of and risk factors for recurrent SAH by Kaplan-Meier curves and Cox regression analysis. Results -Of 752 patients with 6016 follow-up years (mean follow up 8.0 years), 18 had a recurrence. In the first 10 years after the initial SAH, the cumulative incidence of recurrent SAH was 3.2%(95%confidence interval [CI], 1.5%to 4.9%) and the incidence rate 286 of 100 000 patient-years (95%CI, 160 to 472 per 100 000). Risk factors were smoking (hazard ratio [HR], 6.5; 95%CI, 1.7 to 24.0), age (HR, 0.5 per 10 years; 95%CI, 0.3 to 0.8) and multiple aneurysms at the time of the initial SAH (HR, 5.5; 95%CI, 2.2 to 14.1). Conclusions -After SAH, the incidence of a recurrence within the first 10 years is 22 (12 to 38) times higher than expected in populations with comparable age and sex. Whether this increased risk justifies screening for recurrent aneurysms in patients with a history of SAH requires further study.展开更多
Background: Determinants of survival and of risk of vascular events after transient ischaemic attack(TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospecti...Background: Determinants of survival and of risk of vascular events after transient ischaemic attack(TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patients after TIA or minor ischaemic stroke(Rankin grade≤3), after 10 years or more. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial(recruitment in 1986-89; arterial cause of cerebral ischaemia). We included 24 hospitals in the Netherlands that recruited at least 50 patients. Primary outcomes were all-cause mortality and the composite event of death from all vascular causes, non-fatal stroke, and non-fatal myocardial infarction. We assessed cumulative risks by Kaplan-Meier analysis and prognostic factors with Cox univariate and multivariate analysis. Findings: Follow-up was complete in 2447(99%) patients. After a mean follow-up of 10.1 years, 1489(60%) patients had died and 1336(54%) had had at least one vascular event. 10-year risk of death was 42.7%(95%CI 40.8-44.7). Age and sex-adjusted hazard ratios were 3.33(2.97-3.73) for age over 65 years, 2.10(1.79-2.48) for diabetes, 1.77(1.45-2.15) for claudication, 1.94(1.42-2.65) for previous peripheral vascular surgery, and 1.50(1.31-1.71) for pathological Q waves on baseline electrocardiogram. 10-year risk of a vascular event was 44.1%(42.0-46.1). After falling in the first 3 years, yearly risk of a vascular event increased over time. Predictive factors for risk of vascular events were similar to those for risk of death. Interpretation: Long-term secondary prevention in patients with cerebral ischaemia still has room for further improvement.展开更多
2017年9月的末尾，在经历了坚持不懈的努力和漫长的等待之后，Maasand Kempen医院终于在比利时的马泽克开业了。这个医院是由荷兰de Jong Gorte—maker Algra设计事务所和比利时ar-te设计公司共同设计，并在Stabo工程公司的鼎力支持下...2017年9月的末尾，在经历了坚持不懈的努力和漫长的等待之后，Maasand Kempen医院终于在比利时的马泽克开业了。这个医院是由荷兰de Jong Gorte—maker Algra设计事务所和比利时ar-te设计公司共同设计，并在Stabo工程公司的鼎力支持下完美竣工。展开更多
Aim: Previously, we found a beneficial effect of 2 mo supplementation of infant formula with long-chain polyunsaturated fatty acids (LC-PUFA) on neurological condition at 3 mo in healthy term infants. The aim of the p...Aim: Previously, we found a beneficial effect of 2 mo supplementation of infant formula with long-chain polyunsaturated fatty acids (LC-PUFA) on neurological condition at 3 mo in healthy term infants. The aim of the present follow-up study was to evaluate whether the effect on neurological condition persists until 18 mo. Methods: A prospective, double-blind, randomized control study was conducted. Three groups were formed: a control (CF:n = 169), an LC-PUFA-supplemented (LF:n = 146) and a breastfed (BF:n = 159) group. Information on potential confounders was collected at enrolment. At the age of 18 mo, neurodevelopmental condition was assessed by the age-specific neurological examination of Hempel and the Bayley scales. The Hempel assessment resulted in a clinical neurological diagnosis, a total optimality score and a score on the fluency of motility. The Bayley scales resulted in mental and psychomotor developmental indices. Attrition at 18 mo was 5.5%and non-selective. Multivariate regression analyses were carried out to evaluate the effect of type of feeding while adjusting for confounders. Results: None of the children had developed cerebral palsy and 23 (CF: n = 8; LF: n = 10; BF: n = 5) showed minor neurological dysfunction. The groups did not show statistically significant differences in clinical neurological condition, neurological optimality score, fluency score, and the psychomotor and mental development indices. Multivariate analysis confirmed that there was no effect of type of feeding on neurological condition. Conclusion: This study indicates that the beneficial neurodevelopmental effect of 2 mo LC-PUFA supplementation in healthy term infants can not be detected at the age of 18 mo.展开更多
BACKGROUND AND PURPOSE Knowledge about risk factors contributes to understanding the pathophysiological mechanisms that cause intracranial aneurysm rupture and helps to develop possible treatment strategies.We aimed t...BACKGROUND AND PURPOSE Knowledge about risk factors contributes to understanding the pathophysiological mechanisms that cause intracranial aneurysm rupture and helps to develop possible treatment strategies.We aimed to study lifestyle and personal characteristics as risk factors for the rupture of intracranial aneurysms.METHODS We performed a case-control study with 250 patients with an aneurysmal subarachnoid hemorrhage and 206 patients with an unruptured intracranial aneurysm.All patients with an aneurysmal subarachnoid hemorrhage and patients with a unruptured intracranial aneurysm were asked to fill in a structured questionnaire about their lifestyle and medical history.For patients with an unruptured intracranial aneurysm,we also collected data on the indication for imaging.With logistic regression analysis,we identified independent risk factors for aneurysmal rupture.RESULTS Reasons for imaging in patients with an unruptured intracranial aneurysm were atherosclerotic disease(23%),positive family history(18%),headache(8%),preventive screening(3%),and other(46%).Factors that increased risk for aneurysmal rupture were smoking(odds ratio,1.9;95% confidence interval,1.2-3.0) and migraine(2.4;1.1-5.1);hypercholesterolemia decreased this risk(0.4;0.2-1.0),whereas a history of hypertension did not independently influence the risk.CONCLUSIONS Smoking,migraine and,inversely,hypercholesterolemia are independent risk factors for aneurysmal rupture.Data from the questionnaire are insufficient to conclude whether hypercholesterolemia or its treatment with statins exerts a risk-reducing effect.The pathophysiological mechanisms through which smoking and migraine increase the risk of aneurysmal rupture should be investigated in further studies.Although a history of hypertension does not increase risk of rupture,a sudden rise in blood pressure might still trigger aneurysmal rupture.展开更多
The relationships between kinematic characteristics of sitting posture during reaching movements of the dominant arm and 1)the kinematics of the reaching move ment itself and 2) functional performance during daily lif...The relationships between kinematic characteristics of sitting posture during reaching movements of the dominant arm and 1)the kinematics of the reaching move ment itself and 2) functional performance during daily life activities (PEDI) we re assessed in 51 sitting preterm children with cerebral palsy (CP). The childre n were 2-11 y, 33 had spastic hemiplegia (SH) and 18 bilateral CP (Bi-CP). The data were compared with those of 26 typically developing children (TD). Sitting posture before the onset of reaching of children with CP differed from that of TD children: they sat with a more reclined pelvis and a more collapsed trunk. Th e more reclined pelvic position was associated with a better quality of reaching movements. The different sitting postures of pelvis and trunk were not related to functional performance during daily life activities. Displacement of the head , trunk, and pelvis of the children with CP did not differ from that of the TD c hildren. Nevertheless, in the children with CP a more stable head, a more mobile trunk, and a more stable pelvis were related to better functional performance a nd/or a better quality of reaching. This suggests that physiotherapeutic guidanc e of children with CP should focus rather on the latter postural parameters than on the different sitting posture of pelvis and trunk.展开更多
Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilat...Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilateral CP (Bi-CP). Reference data of 29 typically developing children were present. The results indicated that the quality of reaching movements from the dominant arm of children with CP was significantly worse than that of typically developing children. This held true in particular for the children with Bi-CP. For example, reaching movements of children with CP took more time and consisted less often of one movement unit. The quality of reaching was related to the severity of lesion present on the neonatal ultrasound scan of the brain, the severity of motor disorder, the degree of spasticity, and the ability to perform activities of daily life. The last indicates that movements of the dominant arm in children with spastic hemiplegia and Bi-CP deserve clinical attention.展开更多
文摘Background: Most data on the outcome of basilar artery occlusion are from recent case series of patients treated with intra-arterial thrombolysis. The limited knowledge on the outcome after a conventional treatment approach comes from a few small case series of highly selected patients. Abstract:Objective: to provide more data on the outcome of conventional treatment. Methods: Data were analysed on patients from three centres with symptomatic basilar artery occlusion treated conventionally. Conventional therapy was defined as treatment with antiplatelets, anticoagulation, or both. Results: Data were available on 82 patients. The case fatality was 40%. Among survivors, 65%remained dependent (Rankin score 4-5). Patients younger than 60 years (odds ratio = 3.1 (95%confidence interval, 1.0 to 9.5)) and those with a minor stroke (OR = 3.1 (1.0 to 9.6)) were more likely to have a good outcome (Rankin score 0-3). Patients with a progressive stroke were less likely to have a good outcome (OR = 0.3 (0.08 to 1.2)) than patients with a maximum deficit at onset or fluctuating symptoms at presentation. Conclusions: Conventional treatment of symptomatic basilar artery occlusion is associated with a poor outcome in almost 80%of patients, which emphasises the importance of the search for a more effective treatment approach.
文摘Objective: To examine whether intravenous recombinant tissue plasminogen activator (rt-PA) treatment given in the acute phase of ischaemic stroke has a favourable effect on cognitive and functional outcome at six months post-stroke. Methods: The present study included 92 patients with a first-ever symptomatic infarct, of whom 25 (27 %) were subjected to rt-PA treatment in the first three hours post-stroke. Multivariate logistic regression analyses adjusted for stroke severity, education, age, and sex were performed to examine whether rt-PA treatment influenced cognitive outcome (assessed with a neuropsychological examination covering 7 cognitive domains), basic ADL independence (modified Barthel Index ≥19), and instrumental ADL independence (Frenchay Activities Index ≥15) after six months. Results: The adjusted odds ratio for intact cognition was 1.0 (95%CI 0.2 to 4.3), that for basic ADL outcome 13.5 (95%CI 1.4 to 129.4) and for instrumental ADL 7.1 (95%CI 1.2 to 42.2). Conclusion: Our findings suggest that rt-PA treatment is associated with a favourable basic and instrumental ADL outcome, but not with a beneficial cognitive outcome after 6 months.
文摘Background: Determinants of survival and of risk of vascular events after tra nsient ischaemic attack (TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patien ts after TIA or minor ischaemic stroke (Rankin grade≤ 3), after 10 years or mor e. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial (recruitment in 1986- 89; arterial ca use of cerebral ischaemia). We included 24 hospitals in the Netherlands that rec ruited at least 50 patients. Primary outcomes were all- cause mortality and the composite event of death from all vascular causes, non- fatal stroke, and non - fatal myocardial infarction. We assessed cumulative risks by Kaplan- Meier a nalysis and prognostic factors with Cox univariate and multivariate analysis. Fi ndings: Follow- up was complete in 2447 (99% ) patients. After a mean follow- up of 10.1 years, 1489 (60% ) patients had died and 1336 (54% ) had had at le ast one vascular event. 10- year risk of death was 42.7% (95% CI 40.8- 44. 7). Age and sex- adjusted hazard ratios were 3.33 (2.97- 3.73) for age over 65 years, 2.10 (1.79- 2.48) for diabetes, 1.77 (1.45- 2.15) for claudication, 1. 94 (1.42- 2.65) for previous peripheral vascular surgery, and 1.50 (1.31- 1.71 ) for pathological Q waves on baseline electrocardiogram. 10- year risk of a vascular event was 44.1% (42.0- 46.1). After falling in the first 3 years, yearly risk of a vascular ev ent increased over time. Predictive factors for risk of vascular events were sim ilar to those for risk of death. Interpretation: Long- term secondary preventio n in patients with cerebral ischaemia still has room for further improvement.
文摘Aims: To study whether arterial stiffness is related to risk of new vascular events in patients with manifest arterial disease and to examine whether this relation varies between patients who differ with respect to baseline vascular risk, arterial stiffness, or systolic blood pressure(SBP). Methods and results: The study was performed in the first consecutive 2183 patients with manifest arterial disease enrolled in the SMART study(Second Manifestations of ARTerial disease), a cohort study among patients with manifest arterial disease or cardiovascular risk factors. Common carotid distension(i.e. the change in carotid diameter in systole relative to diastole) was measured at baseline by ultrasonography. With the distension, several stiffness parameters were determined. In the entire cohort, none of the carotid artery stiffness parameters was related to the occurrence of vascular events. However, decreased stiffness was related to decreased vascular risk in subjects with low baseline SBP. The relation of carotid stiffness with vascular events did not differ between tertiles of baseline risk and carotid stiffness. Conclusion: Carotid artery stiffness is no independent risk factor for vascular events in patients with manifest arterial disease. However, in patients with low SBP, decreased carotid stiffness may indicate a decreased risk of vascular events.
文摘Background and Purpose -Because intracranial aneurysms develop during life, patients with subarachnoid hemorrhage (SAH) and successfully occluded aneurysms are at risk for a recurrence. We studied the incidence of and risk factors for recurrent SAH in patients who regained independence after SAH and in whom all aneurysms were occluded by means of clipping. Methods -From a cohort of patients with SAH admitted between 1985 and 2001, we included those patients who were discharged home or to a rehabilitation facility. We interviewed these patients about new episodes of SAH. We retrieved all medical records and radiographs in case of reported recurrences. If patients had died, we retrieved the cause of death. We analyzed the incidence of and risk factors for recurrent SAH by Kaplan-Meier curves and Cox regression analysis. Results -Of 752 patients with 6016 follow-up years (mean follow up 8.0 years), 18 had a recurrence. In the first 10 years after the initial SAH, the cumulative incidence of recurrent SAH was 3.2%(95%confidence interval [CI], 1.5%to 4.9%) and the incidence rate 286 of 100 000 patient-years (95%CI, 160 to 472 per 100 000). Risk factors were smoking (hazard ratio [HR], 6.5; 95%CI, 1.7 to 24.0), age (HR, 0.5 per 10 years; 95%CI, 0.3 to 0.8) and multiple aneurysms at the time of the initial SAH (HR, 5.5; 95%CI, 2.2 to 14.1). Conclusions -After SAH, the incidence of a recurrence within the first 10 years is 22 (12 to 38) times higher than expected in populations with comparable age and sex. Whether this increased risk justifies screening for recurrent aneurysms in patients with a history of SAH requires further study.
文摘Background: Determinants of survival and of risk of vascular events after transient ischaemic attack(TIA) or minor ischaemic stroke are not well defined in the long term. We aimed to restudy these risks in a prospective cohort of patients after TIA or minor ischaemic stroke(Rankin grade≤3), after 10 years or more. Methods: We assessed the survival status and occurrence of vascular events in 2473 participants of the Dutch TIA Trial(recruitment in 1986-89; arterial cause of cerebral ischaemia). We included 24 hospitals in the Netherlands that recruited at least 50 patients. Primary outcomes were all-cause mortality and the composite event of death from all vascular causes, non-fatal stroke, and non-fatal myocardial infarction. We assessed cumulative risks by Kaplan-Meier analysis and prognostic factors with Cox univariate and multivariate analysis. Findings: Follow-up was complete in 2447(99%) patients. After a mean follow-up of 10.1 years, 1489(60%) patients had died and 1336(54%) had had at least one vascular event. 10-year risk of death was 42.7%(95%CI 40.8-44.7). Age and sex-adjusted hazard ratios were 3.33(2.97-3.73) for age over 65 years, 2.10(1.79-2.48) for diabetes, 1.77(1.45-2.15) for claudication, 1.94(1.42-2.65) for previous peripheral vascular surgery, and 1.50(1.31-1.71) for pathological Q waves on baseline electrocardiogram. 10-year risk of a vascular event was 44.1%(42.0-46.1). After falling in the first 3 years, yearly risk of a vascular event increased over time. Predictive factors for risk of vascular events were similar to those for risk of death. Interpretation: Long-term secondary prevention in patients with cerebral ischaemia still has room for further improvement.
文摘Aim: Previously, we found a beneficial effect of 2 mo supplementation of infant formula with long-chain polyunsaturated fatty acids (LC-PUFA) on neurological condition at 3 mo in healthy term infants. The aim of the present follow-up study was to evaluate whether the effect on neurological condition persists until 18 mo. Methods: A prospective, double-blind, randomized control study was conducted. Three groups were formed: a control (CF:n = 169), an LC-PUFA-supplemented (LF:n = 146) and a breastfed (BF:n = 159) group. Information on potential confounders was collected at enrolment. At the age of 18 mo, neurodevelopmental condition was assessed by the age-specific neurological examination of Hempel and the Bayley scales. The Hempel assessment resulted in a clinical neurological diagnosis, a total optimality score and a score on the fluency of motility. The Bayley scales resulted in mental and psychomotor developmental indices. Attrition at 18 mo was 5.5%and non-selective. Multivariate regression analyses were carried out to evaluate the effect of type of feeding while adjusting for confounders. Results: None of the children had developed cerebral palsy and 23 (CF: n = 8; LF: n = 10; BF: n = 5) showed minor neurological dysfunction. The groups did not show statistically significant differences in clinical neurological condition, neurological optimality score, fluency score, and the psychomotor and mental development indices. Multivariate analysis confirmed that there was no effect of type of feeding on neurological condition. Conclusion: This study indicates that the beneficial neurodevelopmental effect of 2 mo LC-PUFA supplementation in healthy term infants can not be detected at the age of 18 mo.
文摘BACKGROUND AND PURPOSE Knowledge about risk factors contributes to understanding the pathophysiological mechanisms that cause intracranial aneurysm rupture and helps to develop possible treatment strategies.We aimed to study lifestyle and personal characteristics as risk factors for the rupture of intracranial aneurysms.METHODS We performed a case-control study with 250 patients with an aneurysmal subarachnoid hemorrhage and 206 patients with an unruptured intracranial aneurysm.All patients with an aneurysmal subarachnoid hemorrhage and patients with a unruptured intracranial aneurysm were asked to fill in a structured questionnaire about their lifestyle and medical history.For patients with an unruptured intracranial aneurysm,we also collected data on the indication for imaging.With logistic regression analysis,we identified independent risk factors for aneurysmal rupture.RESULTS Reasons for imaging in patients with an unruptured intracranial aneurysm were atherosclerotic disease(23%),positive family history(18%),headache(8%),preventive screening(3%),and other(46%).Factors that increased risk for aneurysmal rupture were smoking(odds ratio,1.9;95% confidence interval,1.2-3.0) and migraine(2.4;1.1-5.1);hypercholesterolemia decreased this risk(0.4;0.2-1.0),whereas a history of hypertension did not independently influence the risk.CONCLUSIONS Smoking,migraine and,inversely,hypercholesterolemia are independent risk factors for aneurysmal rupture.Data from the questionnaire are insufficient to conclude whether hypercholesterolemia or its treatment with statins exerts a risk-reducing effect.The pathophysiological mechanisms through which smoking and migraine increase the risk of aneurysmal rupture should be investigated in further studies.Although a history of hypertension does not increase risk of rupture,a sudden rise in blood pressure might still trigger aneurysmal rupture.
文摘The relationships between kinematic characteristics of sitting posture during reaching movements of the dominant arm and 1)the kinematics of the reaching move ment itself and 2) functional performance during daily life activities (PEDI) we re assessed in 51 sitting preterm children with cerebral palsy (CP). The childre n were 2-11 y, 33 had spastic hemiplegia (SH) and 18 bilateral CP (Bi-CP). The data were compared with those of 26 typically developing children (TD). Sitting posture before the onset of reaching of children with CP differed from that of TD children: they sat with a more reclined pelvis and a more collapsed trunk. Th e more reclined pelvic position was associated with a better quality of reaching movements. The different sitting postures of pelvis and trunk were not related to functional performance during daily life activities. Displacement of the head , trunk, and pelvis of the children with CP did not differ from that of the TD c hildren. Nevertheless, in the children with CP a more stable head, a more mobile trunk, and a more stable pelvis were related to better functional performance a nd/or a better quality of reaching. This suggests that physiotherapeutic guidanc e of children with CP should focus rather on the latter postural parameters than on the different sitting posture of pelvis and trunk.
文摘Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilateral CP (Bi-CP). Reference data of 29 typically developing children were present. The results indicated that the quality of reaching movements from the dominant arm of children with CP was significantly worse than that of typically developing children. This held true in particular for the children with Bi-CP. For example, reaching movements of children with CP took more time and consisted less often of one movement unit. The quality of reaching was related to the severity of lesion present on the neonatal ultrasound scan of the brain, the severity of motor disorder, the degree of spasticity, and the ability to perform activities of daily life. The last indicates that movements of the dominant arm in children with spastic hemiplegia and Bi-CP deserve clinical attention.
