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Recommendations for the Pre-operative Assessment in non-cardiac Surgery Comments on the 2014 Guidelines of the ESC/ESA
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Evaluation of C-terminal Agrin Fragment as a marker of muscle wasting in patients after acute stroke during early rehabilitation.
Full text linkBACKGROUND
C-terminal Agrin Fragment (CAF) has been proposed as a novel biomarker for sarcopenia originating from the degeneration of the neuromuscular junctions. In patients with stroke muscle wasting is a common observation that predicts functional outcome. We aimed to evaluate agrin sub-fragment CAF22 as a marker of decreased muscle mass and physical performance in the early phase after acute stroke.
METHODS
Patients with acute ischaemic or haemorrhagic stroke (n = 123, mean age 70 ± 11 y, body mass index BMI 27.0 ± 4.9 kg/m(2)) admitted to inpatient rehabilitation were studied in comparison to 26 healthy controls of similar age and BMI. Functional assessments were performed at begin (23 ± 17 days post stroke) and at the end of the structured rehabilitation programme (49 ± 18 days post stroke) that included physical assessment, maximum hand grip strength, Rivermead motor assessment, and Barthel index. Body composition was assessed by bioelectrical impedance analysis (BIA). Serum levels of CAF22 were measured by ELISA.
RESULTS
CAF22 levels were elevated in stroke patients at admission (134.3 ± 52.3 pM) and showed incomplete recovery until discharge (118.2 ± 42.7 pM) compared to healthy controls (95.7 ± 31.8 pM, p < 0.001). Simple regression analyses revealed an association between CAF22 levels and parameters of physical performance, hand grip strength, and phase angle, a BIA derived measure of the muscle cellular integrity. Improvement of the handgrip strength of the paretic arm during rehabilitation was independently related to the recovery of CAF22 serum levels only in those patients who showed increased lean mass during the rehabilitation.
CONCLUSIONS
CAF22 serum profiles showed a dynamic elevation and recovery in the subacute phase after acute stroke. Further studies are needed to explore the potential of CAF22 as a serum marker to monitor the muscle status in patients after stroke
Body weight changes and incidence of cachexia after stroke.
Full text linkBACKGROUND
Body weight loss is a frequent complication after stroke, and its adverse effect on clinical outcome has been shown in several clinical trials. The purpose of this prospective longitudinal single-centre observational study was to investigate dynamical changes of body composition and body weight after ischemic stroke and an association with functional outcome.
METHODS
Sixty-seven consecutive patients (age 69 ± 11 years, body mass index 27.0 ± 4.1 kg/m , 42% female patient, mean ± SD) with acute ischemic stroke with mild to moderate neurological deficit (National Institute of Health Stroke Scale median 4, ranged 0-12) were analysed in the acute phase (4 ± 2 days) and at 12 months (389 ± 26 days) follow-up. Body composition was examined by dual energy X-ray absorptiometry. Cachexia was defined according to the consensus definition by body weight loss ≥5% within 1 year and additional clinical signs. Lean tissue wasting was considered if a ratio of upper and lower limbs lean mass sum to squared height (kg/m ) was ≤5.45 kg/m for female patient and ≤7.25 kg/m for male patient.
RESULTS
According to the body weight changes after 12 months, 42 (63%) patients had weight gain or stable weight, 11 (16%) patients had moderate weight loss, and 14 (21%) patients became cachectic. A relative decline of 19% of fat tissue and 6.5% of lean tissue was observed in cachectic patients, while no changes of lean tissue were observed in non-cachectic patients after 12 months. The modified Rankin Scale was 48% higher (2.1 ± 1.6, P < 0.05), Barthel Index was 22% lower (71 ± 39, P < 0.01), and handgrip strength was 34% lower (21.9 ± 13.0, P < 0.05) in cachectic compared to non-cachectic patients after 12 months. The low physical performance if defined by Barthel Index <60 points was linked to the lean tissue wasting (OR 44.8, P < 0.01), presence of cachexia (OR 20.8, P < 0.01), and low body mass index <25 kg/m (OR 11.5, P < 0.05). After adjustment for cofounders, lean tissue wasting remained independently associated with the low physical performance at 12 months follow-up (OR 137.9, P < 0.05).
CONCLUSIONS
In this cohort study, every fifth patient with ischemic stroke fulfilled the criteria of cachexia within 12 months after index event. The incidence of cachexia was 21%. Cachectic patients showed the lowest functional and physical capacity
Rechtsventrikuläre und hepatische Funktion bei Patienten mit chronischer Herzinsuffizienz und kardialer Kachexie
No full textRight ventricular and liver function in patients with chronic heart failure and cardiac cachexia
No full textHintergrund: Die Pathophysiologie der kardialen Kachexie ist zurzeit nicht
vollständig geklärt. Wir untersuchten den Zusammenhang zwischen
rechtsventrikulärer (RV) und hepatischer Funktion und kardialer Kachexie.
Methoden: Wir schlossen 118 Patienten mit linksventrikulärer Ejektionsfraktion
(LVEF) ≤40% ein und unterteilten diese in drei Gruppen: Patienten in New York
Heart Association (NYHA)-Klasse II (n=59), NYHA-Klasse III ohne Kachexie
(n=41) und NYHA-Klasse III mit Kachexie (n=18). Bei allen Patienten wurden
Blutanalysen, Echokardiographie und Spiroergometrie durchgeführt. Ergebnisse:
Eine eingeschränkte systolische RV-Funktion (tricuspid annular plane systolic
excursion [TAPSE] ≤15 mm) bestand bei 80% der kachektischen Patienten. Beim
Vergleich der Patienten in NYHA-Klasse II mit nicht-kachektischen und mit
kachektischen Patienten in NYHA-Klasse III fanden wir einen kontinuierlichen
Abfall der systolischen RV-Funktion (Median TAPSE 19 [Interquartilsabstand;
IQR: 16-23] mm vs. 16 [IQR: 13-19] mm vs. 14 [IQR: 9-15] mm; Kruskal-Wallis
p10
mmHg: 6.8 vs. 27.5 vs. 75.0%; p<0.001) als Hinweis auf eine höhergradige
Rechtsherzinsuffizienz bei kardialer Kachexie. Die systolische und
diastolische Funktion des linken Ventrikels unterschieden sich zwischen den
kachektischen und nicht-kachektischen Patienten in NYHA-Klasse III nicht
signifikant. Die Serumkonzentration der alkalischen Phosphatase und des
direkten Bilirubins korrelierten mit TAPSE und RAP und waren am höchsten in
den kachektischen Patienten (alle p-Werte ≤0.002), was auf eine
stauungsbedingte Cholestase hinweisen könnte. Im Vergleich zu nicht-
kachektischen Patienten wiesen kachektische Patienten niedrigere
Serumkonzentration von Albumin auf. Die multivariable Regressionsanalyse
zeigte eine unabhängige Assoziation von eingeschränkter RV-Funktion,
cholestatischen Leberfunktionsparametern und Albumin mit kardialer Kachexie.
Zusammenfassung: Patienten mit kardialer Kachexie zeigen häufiger eine
höhergradige Rechtsherzinsuffizienz, cholestatische Leberdysfunktion und
Hypoalbuminämie im Vergleich zu nicht-kachektischen Patienten im gleichen
Krankheitsstadium und mit ähnlicher linksventrikulärer Funktion.Background: The mechanisms involved in cardiac cachexia remain poorly
understood. We examined the association of right ventricular (RV) and hepatic
dysfunction with cardiac cachexia. Methods: We prospectively enrolled 118
patients with left ventricular ejection fraction (LVEF) ≤40% who were
subgrouped as follows: New York Heart Association (NYHA) class II (n=59), NYHA
class III without cachexia (n=41) and NYHA class III with cachexia (n=18). All
patients underwent blood collection, echocardiography and exercise testing.
Results: Reduced systolic RV function (tricuspid annular plane systolic
excursion [TAPSE] ≤15 mm), was present in 80% of cachectic patients. When
comparing NYHA class II patients vs. non-cachectic and cachectic NYHA class
III patients we found a stepwise decrease in systolic RV function (median
TAPSE 19 [interquartile range; IQR: 16-23] mm vs. 16 [IQR: 13-19] mm vs. 14
[IQR: 9-15] mm, respectively; Kruskal-Wallis p<0.001) and an increase in right
atrial pressure (RAP; >10 mmHg: 6.8 vs. 27.5 vs. 75.0%, respectively;
p<0.001), indicating a higher degree of congestive right heart failure in
cardiac cachexia. Systolic and diastolic function of the left ventricle did
not differ between non-cachectic and cachectic patients in NYHA class III.
Serum alkaline phosphatase and direct bilirubin correlated with TAPSE and RAP,
and were highest in cachectic patients (all p≤0.002), suggesting cholestatic
dysfunction due to liver congestion. As expected, cachectic patients had lower
levels of serum albumin compared to non-cachectic patients. In multivariable
regression analysis, RV dysfunction, cholestatic liver parameters and albumin
were independently associated with the presence of cardiac cachexia.
Conclusion: Patients with cardiac cachexia display a more pronounced degree of
right heart failure, cholestatic liver dysfunction and hypoalbuminemia
compared to non-cachectic patients of similar LVEF and NYHA class
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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