Clinical Functional Changes Research Articles

Assessment of clinical functional changes and quality of life in bronchial asthma

Our research was conducted at the multidisciplinary clinic of the Tashkent Medical Academy.Clinical functional changes were conducted among 46 patients with bronchial asthma.The average duration of the disease is 24,2 years.When we analyzed the patients with bronchial asthma, the degree of clinical functional changes in patients increased with the increase of disease. Indicators of obstructive disorders a significant decrease in peak expiratory flow rate ( PEFR) up to 55,6±6.9% and Lung capacities up to 69.7±6.4% confirms the nature of clinical signs and obstructive disorders.PEFR showed a significant decrease from 78% to 35% with the severity of the disease stage in BA patients and an increase in clinical symptoms depending on the level of the disease

Biological and clinical manifestations of Huntington’s disease in gene carriers very far from predicted onset

IntroductionCrucial to the future success of treatments in Huntington’s disease is identifying a timepoint where there is a measurable biomarker of early neurodegeneration without detectable changes in clinical function. By performing deep phenotyping in premanifest gene carriers (preHD) further from predicted onset than previously studied, we aimed to identify this timepoint and the best measures for efficacy endpoints in future therapeutic trials.MethodsWe recruited 64 young adult preHD, approximately 24 years from predicted clinical onset, and 67 matched controls. All participants underwent detailed cognitive and neuropsychiatric assessments, multi-modal imaging and collection of blood and cerebrospinal fluid (CSF).ResultsWe found no significant evidence of cognitive or psychiatric impairment in preHD (minimum q>0.22). The PreHD cohort had smaller putamen volumes (q=0.03), but this was not related to predicted years to onset. There were no group differences in other brain imaging measures (q>0.16). CSF and plasma neurofilament light (NfL) (q<0.0001 and q=0.01) and YKL-40 (q=0.03) were elevated in preHD.ConclusionWith normal brain function but with sensitive measures of neurodegeneration starting to rise, this stage of preHD may represent an optimal time to initiate future disease-modifying prevention treatments. CSF NfL appears more sensitive at this time than plasma NfL to monitor treatment response.p.d.zeun@gmail.com

Effectiveness of proximal tibial tubercle transfer in patients with patella baja after total knee arthroplasty

PurposePatella baja after total knee arthroplasty (TKA) is a common problem that is usually treated via proximal transfer of the tibial tubercle. As the long-term outcomes of this procedure are unclarified, this study aimed to investigate the changes in clinical function and radiographic patellar height during five years of follow-up.MethodsSixty patients with patella baja after TKA who underwent proximalisation of the tibial tubercle were followed up for a mean of 71 months (range 21–153 months). The pre- and postoperative range of motion (ROM) and clinical scores (Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)) were compared. The radiographic patellar height was measured with the Caton-Deschamps index (CDI), Blackburne-Peel ratio (BP), and modified Insall-Salvati index (MIS).ResultsProximalisation of the tibial tubercle resulted in a significant improvement in the ROM from 80° to 88°. The KSS and WOMAC did not improve or even worsened after the intervention. The radiographic patellar height immediately after tibial tubercle transfer was not better than prior to the intervention (CDI 0.72 vs. 0.63, p = 0.72; BP 0.66 vs. 0.61, p = 0.72; MIS 1.59 vs. 1.55, p = 1.00) and further decreased significantly so that the mean final values were worse than the values in the native joint (CDI 0.59 vs. 0.78, p = 0.001; BP 0.58 vs. 0.74, p = 0.001; MIS 1.39 vs. 1.81, p < 0.001).ConclusionProximalisation of the tibial tubercle in patients with patella baja after TKA does neither lead to significant improvements in the clinical outcome nor in the radiographic patellar height during long-term follow-up.Level of evidenceIII

Electrophysiological intermediate biomarkers for oxidative stress in schizophrenia

ObjectiveDiverse electrophysiological abnormalities have been associated with schizophrenia, but the underlying causes remain elusive. We tested whether the altered oxidative stress in schizophrenia contributes to the electrophysiological abnormalities. MethodsWe used an auditory oddball task to measure mismatch negativity (MMN) and gamma band response on 29 schizophrenia patients and 25 normal controls. Oxidative stress was assessed by monomeric glutathione (GSH, reduced form) and glutathione disulfide (GSSG, oxidized form). ResultsPatients had reduced MMN (p=0.015) and reduced power of gamma band responses at 21–40Hz and 41–85Hz (all p<0.001). GSH was significantly lower (p<0.001) while %GSSG was higher (p=0.023) in patients compared with controls. MMN was correlated with GSH in controls; while 21–40Hz responses were correlated with GSH in patients. Lower GSH and higher GSSG levels were associated with low community functioning (p=0.018). Multivariate mediation modeling showed that gamma band at 21–40Hz was a significant mediator for GSH effect on community functions. ConclusionsHigh beta/low gamma range (21–40Hz) responses may be an intermediate biomarker indexing oxidative stress and its effect on clinical functions. SignificanceElectrophysiological abnormalities and associated clinical functional changes may in part be associated with heightened oxidative stress in schizophrenia.

Bilateral Bispectral Index Monitoring During Suppression of Unilateral Hemispheric Function

Bispectral Index (BIS) has been used to monitor level of "sedation" based on the electroencephalogram (EEG). Patients evaluated for surgery to control a seizure disorder undergo Wada testing, during which one hemisphere is rendered functionally inactive after injecting a short-acting barbiturate. We surmised that the BIS values would reflect these functional changes. Eight epileptic patients were enrolled. A full array of 21 EEG electrodes and 2 BIS XP (Quatro) strips over each frontal region of the scalp were applied. The EEG was continuously recorded. BIS values from each hemisphere were recorded every minute. Angiography was performed by advancing a catheter into each internal carotid artery. Amobarbital or methohexital was injected until the patient developed a hemiparesis. The EEG confirmed a significant lateralized cortical effect of the barbiturate. Repeated measures analysis of variance was used to analyze the differences between the BIS values from monitor electrode strips placed on the left (left BIS) and the right (right BIS) sides of the head as well as the differences in the left and right BIS values before and after each injection of the barbiturate. Injection of barbiturate into either the left or right internal carotid artery produced a significant change on the 21-electrode EEG. However, there was no difference between left BIS to right BIS values (P = 0.84). With repeated injections of barbiturates, some patients became sedated. At these times, both left BIS and right BIS values decreased together before and after injection of barbiturate. The BIS monitor was unable to distinguish significant hemispheric EEG and clinical functional changes except when the patient became sedated.