Sleep Disturbance Correlates With White Matter Hyperintensity in Patients With Subcortical Ischemic Vascular Dementia.

Sleep Disturbance Correlates With White Matter Hyperintensity in Patients With Subcortical Ischemic Vascular Dementia.

J Geriatr Psychiatry Neurol. 2013 Jun 19;
Cheng CY, Tsai CF, Wang SJ, Hsu CY, Fuh JL

Background:Subcortical ischemic vascular dementia (SIVD) caused by small-artery disease, and hypoperfusion is a major cause of vascular cognitive impairment. Little is known about the relationship between sleep disturbance and white matter hyperintensity (WMH). We investigated the association between sleep disturbance and WMH, measured by magnetic resonance imaging (MRI), in patients with SIVD.Methods:Patients with SIVD recruited from our outpatient clinic completed the Sleep Disturbance Symptom Questionnaire (SDSQ) and Geriatric Depression Scale-short form (GDS-S) and underwent brain MRI. Total SDSQ scores were calculated by summing frequency ratings of the instrument’s 20 items. We graded WMH on brain MR images using a visual rating scale ranging from 0 (barely detectable) to 9 (extensive changes).Results:We enrolled 72 patients (31 men, 41 women; mean age, 75.9 ± 7.9 years) with SIVD. The SDSQ scores were positively correlated with WMH grading (r = .337, P = .001) and tended to be associated with higher GDS-S scores (r = .268, P = .022). Patients with diabetes mellitus tended to display higher mean WMH severity than those without diabetes (4.2 vs 3.3, P = .022). After controlling for confounding factors, the multivariate regression model showed that WMH severity was significantly associated with sleep disturbance (P = .002).Conclusions:This study showed that manifestations of sleep disturbance were significantly associated with WMH severity, with most symptoms related to daytime hypersomnolence. Disruption of the frontal-subcortical neuronal circuit might play a role in sleep disturbance in patients with SIVD. HubMed – depression


A prospective randomized study of ropivacaine wound infusion versus intrathecal morphine with intravenous fentanyl for analgesia in living donors of liver transplantation.

Liver Transpl. 2013 Jun 21;
Lee SH, Gwak MS, Choi SJ, Park HG, Kim GS, Kim MH, Ahn HJ, Kim J, Kwon CH, Kim TS

Postoperative analgesia and care for living liver donors have become a particular interest to clinicians as the living donor liver transplantation increased. Local anesthetics-based analgesia has been known to provide effective pain control. In this prospective randomized study, we compared the postoperative analgesic efficacy of local anesthetic-based analgesia (Painbuster) with opioid-based analgesia (intrathecal morphine (ITM) with intravenous (IV) fentanyl) in liver donors. Forty adult donors were randomly allocated into 2 groups: ITM-IV fentanyl group (n=19) and Painbuster group (n=21). Donors in Painbuster group received 0.5% ropivacaine via a multi-orifice catheter (On-Q Painbuster) placed at the wound. Donors in ITM-IV fentanyl group received intrathecal morphine sulfate (400ug) preoperatively and a continuous IV fentanyl infusion, postoperatively. The visual analogue scale (VAS) at rest and coughing, and rescue IV fentanyl and meperidine consumptions were assessed for 72 hours postoperatively. Side effects including sedation, dizziness, nausea, vomiting, pruritus, respiratory depression, wound seroma or hematoma, and first time to flatus were recorded. The VAS at rest during the first postoperative 12 hours was significantly less in ITM-IV fentanyl group. At other times the VAS was comparable between the groups. In Painbuster group, rescue IV fentanyl and meperidine uses were significantly reduced at 24-48 hours and 48-72 hours after surgery compared to the first 24 hours postoperatively. Time to first flatus was significantly reduced in Painbuster group. There was no difference in side effects. In conclusion, analgesia was more satisfactory with ITM-IV fentanyl than that with Painbuster during the first 12 hours after surgery, but became comparable thereafter with shortened bowel recovery in Painbuster group. Concurrent use of ITM with Painbuster may be considered in future investigation. Liver Transpl, 2013. © 2013 AASLD. HubMed – depression


Prevention of Depression With Escitalopram in Patients Undergoing Treatment for Head and Neck Cancer: Randomized, Double-blind, Placebo-Controlled Clinical Trial.

JAMA Otolaryngol Head Neck Surg. 2013 Jun 20; 1-9
Lydiatt WM, Bessette D, Schmid KK, Sayles H, Burke WJ

IMPORTANCE Major depressive disorder develops in up to half the patients undergoing treatment for head and neck cancer, resulting in significant morbidity; therefore, preventing depression during cancer treatment may be of great benefit. OBJECTIVE To determine whether prophylactic use of the antidepressant escitalopram oxalate would decrease the incidence of depression in patients receiving primary therapy for head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS A randomized, double-blind, placebo-controlled trial of escitalopram vs placebo was conducted in a group of nondepressed patients diagnosed as having head and neck cancer who were about to enter cancer treatment. Patients were stratified by sex, site, stage (early vs advanced), and primary modality of treatment (radiation vs surgery). MAIN OUTCOME AND MEASURE The primary outcome measure was the number of participants who developed moderate or greater depression (scores on the Quick Inventory of Depressive Symptomology-Self Rated of ?11). RESULTS From January 6, 2008, to December 28, 2011, 148 patients were randomized. Significantly fewer patients receiving escitalopram developed depression (24.6% in the placebo group vs 10.0% in the escitalopram group; stratified log-rank test, P = .04). A Cox proportional hazards regression model compared the 2 treatment groups after controlling for age, baseline smoking status, and stratification variables. The hazard ratio of 0.37 (95% CI, 0.14-0.96) demonstrated an advantage of escitalopram (P = .04). Patients undergoing radiotherapy as the initial modality were significantly more likely to develop depression than those undergoing surgery (radiotherapy compared with surgery group; hazard ratio, 3.6; 95% CI, 1.38-9.40; P = .009). Patients in the escitalopram group who completed the study and were not depressed rated their overall quality of life as significantly better for 3 consecutive months after cessation of drug use. CONCLUSIONS AND RELEVANCE In nondepressed patients undergoing treatment for head and neck cancer, prophylactic escitalopram reduced the risk of developing depression by more than 50%. In nondepressed patients who completed the trial, quality of life was also significantly better for 3 consecutive months after cessation of drug use in the escitalopram group. These findings have important implications for the treatment of patients with head and neck cancer. TRIAL REGISTRATION Identifier: NCT00536172. HubMed – depression


Educational and homeownership inequalities in stroke incidence: a population-based longitudinal study of mid-aged women.

Eur J Public Health. 2013 Jun 20;
Jackson CA, Jones M, Mishra GD

We aimed to determine which socioeconomic status measures are associated with stroke risk in mid-aged women and assess the contribution of lifestyle, biological and psychosocial factors to observed associations.We included women born in 1946-51 from the Australian Longitudinal Study on Women’s Health, who were surveyed every 3 years. Using generalized estimating equation analysis, we determined the association between socioeconomic status and stroke at the subsequent survey, adjusting for time-varying covariates. For significant associations, we calculated the contribution of individual mediating factors in explaining these associations.Among 11 468 women aged 47-52 years, 177 strokes occurred during a 12-year follow-up. Education (odds ratio lowest vs. highest 2.45, 95% confidence interval: 1.40-4.30) and homeownership, but not occupation or managing on income, were significantly associated with stroke. After full adjustment, the overall association between education and stroke was non-significant. Lifestyle (smoking, exercise, alcohol and body mass index), biological (hypertension, diabetes, heart disease and hysterectomy/oophorectomy) and psychosocial (depression and marital status) factors explained 38% of the association in the lowest versus highest education groups. Lifestyle and biological factors together accounted for 34%. Mediators accounted for 29% of the association between homeownership and stroke, with lifestyle and psychosocial factors responsible for most of this attenuation. However, a significant association remained in fully adjusted models (odds ratio non-homeowner vs. homeowner 1.63, 95% confidence interval: 1.12-2.38).Lower education level is associated with increased stroke risk in mid-aged women, and is partially mediated by known risk factors, particularly lifestyle and biological factors. Non-homeownership is associated with increased stroke risk, but the underlying mechanism is unclear. HubMed – depression



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