Characterisation of Disease Patterns of Dermatomyositis with Different Initial Manifestations

Objectives To study the characteristics and prognosis of dermatomyositis (DM) with different initial symptoms. Patients and methods: A retrospective analysis was performed on the patients who were first diagnosed with DM from 1 Jan. 2019 to 1 Jan. 2021. According to different initial symptoms, patients were divided into five groups, including rash, myasthenia, arthritis, respiratory symptom and atypical symptom group. Clinical and laboratory data were recorded. All patients were followed up until 31st May 2021. Results In total 136 patients, rash (40%) was the most common initial symptoms of DM, followed by respiratory symptoms (22%), arthritis (20%), muscle weakness (10%) and atypical symptoms (8%). Rash groups and atypical groups had a higher positive rate of anti-TIF1γ antibodies than arthritis groups and respiratory symptom groups (P < 0.05). Respiratory symptom and arthritis groups had a higher positive rate of anti-Ro52 antibodies than rash and myasthenia groups (P < 0.05). Respiratory groups had a higher incidence of ILD than rash and atypical groups. The FVC and DLCO in respiratory group were significantly lower than rash, arthritis and atypical groups (P < 0.05). The 3-year survival rate of rash groups was significantly higher than myasthenia groups and arthritis groups (P < 0.05). Conclusions DM patients with different initial manifestations had different pulmonary function tests, myositis antibodies and prognosis.

Geriatric depression and quality of life in atrial fibrillation: the geriatric population analysis

Background and purpose Arrhythmias such as atrial fibrillation (AF) is often associated with depression, with vague anxiety about symptom and the risk of serious complication such as stroke or heart failure. In the geriatric population, geriatric depression often occurs with an increase of physical illness and has substantial costly and quality of life implications for functionality and life satisfaction. However, few studies have investigated relationship between geriatric depression and Quality of Life (QoL), and arrhythmia symptoms (palpitation, dyspnea and chest discomfort). Method Between November 2019 and October 2020, elderly people (≥65 years) who participated in the AF awareness symposium were enrolled in this study. They were divided into 4 groups according to the presence or absence of chest symptom and AF, and were examined geriatric depression by Geriatric depression scale (GDS)-15 and Quality of Life (QoL) by the 12-item Short- Form Health Survey (SF-12) including physical and mental health status. Results Of the 1511 subjects, 1364 were analyzed after excluding 147 with missing values. Among them, 911 were in the non-AF group without symptom (Group A), 43 in the AF group without symptom (group B), 323 in the non-AF group with symptom (group C), and 87 in the AF group with symptom (group D). Geriatric depression rates (defined as GDS-15 ≥10) were 2.7% in non-symptomatic group (2.7% in A [n=25] and 2.3% in B [n=1]) and 7.8% in symptomatic group (7.4% in C [n=24] and 9.2% in D [n=8]). (P&lt;0.05) In multivariate regression analysis, an increased risk of geriatric depression was observed in groups C and D (group C: odds ratio [OR]=2.54, CI: 1.40, 4.61, P&lt;0.01 and group D: OR=3.13 CI: 1.16, 7.57, P=0.02). The mean values of physical and mental health status in SF-12 were 48.5 (±7.9) and 56.7 (±6.8) in A, 44.6 (±10.7) and 57.3 (±7.3) in B, 45.0 (±9.9) and 53.8 (±7.7) in C, and 43.4 (±10.8) and 54.8 (±8.6) in D, respectively. Physical health status in SF-12 was associated with group C (C vs A: estimate −2.95 [CI: −4.03, −1.87], p&lt;0.01) and D (D vs A: estimate −2.93 [CI: −4.88, −0.97], p&lt;0.01), other than heart failure, older age and female. Mental health status in SF-12 was associated with group C (C vs A: estimated −2.34 [CI: −3.72, −1.42], p&lt;0.01), heart failure, hypertension, older age, female and group D (D vs A: estimate −1.63 [CI: −3.31, 0.05], p=0.06), but not statistically significant. Individuals with arrhythmia symptom (group C and D) had lower physical and mental health status than those without (group A and B) (P&lt;0.05). Conclusion Older adults with arrhythmia symptoms were more likely to have geriatric depression and low QoL, especially those with symptomatic AF, with a geriatric depressive complication rate of 9.2%. Further studies are needed to investigate whether improving physical health status can improve QoL and geriatric depression. FUNDunding Acknowledgement Type of funding sources: None.

Illness-Related Cognition, Distress and Adjustment in Functional Stroke Symptoms, Vascular Stroke, and Chronic Fatigue Syndrome

Background: High rates of psychological distress are reported in functional conditions and vascular stroke, but there is limited understanding of how patients with functional neurological symptoms in stroke settings respond to symptoms. Aims: This study compared patients with functional stroke symptoms to those with vascular stroke and chronic fatigue syndrome (CFS). Methods: A prospective cohort of 56 patients with functional stroke symptoms were age-gender matched to patients with vascular stroke and CFS. Analysis of variance compared groups on cognitive and behavioral responses to symptoms, psychological distress, and functioning. Sensitivity analyses controlled for known confounders. The proportions of clinical anxiety and depression were compared between groups. Results: The functional stroke symptom group had a higher proportion of clinical anxiety cases than the CFS group, and a higher proportion of clinical depression cases than the vascular stroke group. Patients with functional stroke symptoms reported the highest rate of “damage beliefs” and “all-or-nothing” behaviors and greater symptom focusing and resting behavior than patients with vascular stroke. Limitations: Larger cohorts and a longitudinal design would strengthen study findings. Conclusion: Compared to patients with vascular stroke or CFS, patients with functional stroke symptoms show a somewhat distinct profile of illness-related beliefs and behaviors, as well as higher rates of clinical anxiety. Understanding such group differences provides some insights into aetiology and cognitive-behavioral responses. Appropriate support and referral should be available to patients with functional stroke symptoms to address distress and reduce the likelihood of severe impairment.

The Relation of Vitamin D Blood Level with Statin-Associated Muscle Symptoms (SAMS)

Aims: This work evaluates the vitamin D status in patients with statins- associated muscle symptoms. Study Design: A case control prospective study. Place and Duration of Study: Neurology Department, Mansoura University, Mansoura, Egypt, between June 2020 and May 2021. Methodology: Total of 85 participants included in this study, 60 participants of them have chronic Stroke and ischemic heart disease, treated by different kinds of statins and 25 participants were healthy controlled individuals. The 60 patients were 35 males (55%) and 25 females (45%), with age ranging from 40 to 70 years. The 60 participants were divided into two groups: The first group included (30 patients) treated with statins and they did not have Statin-Associated Muscle Symptoms (SAMS).The second group included (30 patients) also treated with Statin and they complained of SAMS. The third group is the control group, which contains the 25 participants who were healthy people. The control group included15 males (55%) and 10 females (45%) with age ranged from 35 to 65 years. Laboratory investigations were conducted on all participants in this study. The participants were subjected to total of 5 laboratory tests, which include: (1) Vitamin D (Enzyme immunoassay method), (2) Total CK (Enzymatic method), (3) Total Cholesterol and Triglycerides (Enzymatic method), (4)High density lipoproteins Cholesterol (Precipitation method), (4)Low density lipoproteins Cholesterol (Freid Wald equation), and (5) C – reactive protein (CRP: Latex Agglutination Method) was done beside elecetrophysiology study ( Needle electromyography (NEMG) was include). Results: Out of 60 patients the statistical readings of Vitamin D levels for the studied groups, demonstrating a significant statistical difference in Vitamin D levels between patients complaining of statin-associated muscle symptoms group (P≤0.001), and the other groups with lowest mean of (26.30 ±3.75), while patient without statin-associated muscle symptom group had the mean rating of (29.33 ±3.69), and the control group had the highest mean of (30.14 ±3.57). Conclusion: There is a positive relationship between vitamin D deficiency and statin-associated muscle symptoms. Vitamin D status may play an important role in diagnosis and management of SAMS. Further studies are needed to evaluate the relationship between vitamin D and SAMS.

Posttraumatic stress disorder and growth: Examination of joint trajectories in children and adolescents

Positive health endpoints are not the opposite of negative endpoints. Previous studies examining posttraumatic stress disorders (PTSD) and posttraumatic growth (PTG) trajectories have overlooked the co-existence of PTSD and PTG, making it difficult to accurately distinguish individuals with various posttraumatic presentations, causing the effects of targeted interventions to be discounted. To fill this gap, the current study sought to examine joint PTSD and PTG trajectories in children and adolescents. Eight hundred and seventy-six Chinese children and adolescents were recruited to complete self-report questionnaires 6, 12, and 18 months after the Ya'an earthquake. Multiple-process growth mixture modeling analysis was used to test the study proposal. Five distinct joint PTSD and PTG trajectory types were found: recovery, growth, struggling, resistant, and delayed symptoms. Female students and students who felt trapped or fearful were more likely to be in the struggling group, and students who experienced injury to themselves or family members were more likely to belong to the delayed symptom group. These findings suggest that postdisaster psychological services should be provided to relieve delayed symptoms in individuals who experience injury to themselves or their family members, and individuals in the struggling group should be supported to achieve growth.

Symptom Clusters and Quality of Life in Ambulatory Patients With Multiple Myeloma

Purpose: The aim of this study was to investigate the symptom clusters and associated clinical factors in ambulatory multiple myeloma patients undergoing medication therapy. We also aim to determine the correlations between symptom clusters and the patients’ quality of life. Methods: A total of 174 multiple myeloma patients hospitalized in the hematology day unit were included in this study. A cross-sectional survey aimed to examine the symptoms and quality of life was conducted. The symptoms were assessed by the Chinese version of Condensed Memorial Symptom Assessment Scale. The quality of life was measured with the Functional Assessment of Cancer Therapy-General. Principal component analysis was used to identify symptom clusters. Independent-Samples t test and Chi-square test were used for comparisons between groups. Spearman’s Rank Correlation Analysis was used to identify correlations.Results: We identified three symptom clusters in multiple myeloma patients: psychological, pain-dry mouth-difficulty sleep, and fatigue symptom cluster. For each symptom cluster, the patients could be categorized in severe-symptom group or mild-symptom group based on the distress of the symptoms. The patients in each group exhibited differential demographic and clinical features. The distress of each symptom cluster was adversely correlated with patients’ quality of life.Conclusions: The ambulatory multiple myeloma patients undergoing medication therapy experience multiple symptoms, which can be categorized into three symptom clusters. The distress of each symptom cluster was associated with patients’ demographic and clinical characteristics. The presence and distress of these symptom clusters have adverse impact on patient’s quality of life.

Specific microstructural changes of the cervical spinal cord in syringomyelia estimated by diffusion tensor imaging

The microstructure of the spinal cord in syringomyelia has not been well studied. The aim of this study was to evaluate the microstructure of the cervical cord in patients with syringomyelia using diffusion tensor imaging (DTI) and to investigate the association between DTI parameters and the size of the syrinx cavity. Thirty patients with syringomyelia and 11 age-matched controls were included in this study. DTI and T1/T2-weighted MRI were used to estimate spinal microstructure. The patients were divided into a clinical symptom group (group A) and a non-clinical symptom group (group B) according to ASIA assessments. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values (mm2/s) were measured and compared between patients and controls. Correlation between FA/ADC and the size of the syrinx cavity was examined with a bivariate analysis. FA values were lower (P < 0.000) and ADC values were higher (P < 0.000) compared to the controls at the level of all syrinxes examined in patients with syringomyelia; both FA values and ADC values reached normal values either above or below the syrinx levels (all P > 0.05). FA values and ADC values at all cervical levels were not significantly different either in controls or outside of the syrinx (all P > 0.05). FA values of group A was significantly lower than those of group B (P < 0.000). There was a negative association between FA values and the size of syrinx cavity, and a positive association between ADC values and the size of syrinx cavity (FA: P < 0.05, ADC: P < 0.05). The microstructure of the cervical spinal cord is different across all patients with syringomyelia. DTI is a promising tool for estimating quantitative pathological characteristics that are not visible with general MRI.

Trajectories of Change in an Open-Access Internet-Based Cognitive Behaviour Program for Childhood and Adolescent Anxiety: Open Trial (Preprint)

BACKGROUND Although evidence for the efficacy of internet-based cognitive behaviour therapy (iCBT) in the treatment of childhood anxiety has continued to grow, there is scant empirical research investigating the timing of benefits made in iCBT programs (e.g. early or delayed). OBJECTIVE The objective of our study was to examine patterns of symptom trajectories (changes in anxiety) across an iCBT program for anxiety (BRAVE Self-Help). METHODS Participants were 10,366 Australian youth with elevated anxiety aged 7-17 years (4,140 children aged 7-12 years; 6,226 adolescents aged 12-17 years) who registered for the BRAVE Self-Help program. Participants self-reported on their anxiety symptoms at baseline/Session 1 and then at the commencement of each subsequent session. RESULTS Results found that young people completing the BRAVE Self-Help program tend to fall into two trajectory classes that can be reliably identified in terms of high versus medium baseline levels of anxiety and subsequent reduction in symptoms. Both high and medium anxiety severity trajectory classes show significant reductions in anxiety, with the greatest level of change being achieved within the first six sessions for both classes. However, those in the moderate anxiety severity class tend to show reductions in anxiety symptoms to levels below the elevated range, whereas those in the high symptom group tend to remain in the elevated range despite improvements. CONCLUSIONS These findings suggest that those in the high severity group who are not responding well to iCBT on a self-help basis, may benefit from additional support provided alongside the program or a stepped-care approach where progress is monitored and support can be provided as necessary. CLINICALTRIAL n/a

Eating disorder symptoms and foraging for food related items

Background Foraging tasks have recently been increasingly used to investigate visual attention. Visual attention can be biased when certain stimuli capture our attention, especially threatening or anxiety-provoking stimuli, but such effects have not been addressed in foraging studies. Methods We measured potential attentional bias associated with eating disorder symptoms to food related stimuli with our previously developed iPad foraging task. Forty-four participants performed a foraging task where they were instructed to tap predesignated food related targets (healthy and unhealthy) and other non-food objects and completed four self-report questionnaires measuring symptoms of eating disorders. Participants were split into two groups based on their questionnaire scores, a symptom group and no symptom group. Results The foraging results suggest that there are differences between the groups on switch costs and target selection times (intertarget times) but they were only statistically significant when extreme-group analyses (EGA) were used. There were also notable food versus non-food category effects in the foraging patterns. Conclusions The results suggest that foraging tasks of this sort can be used to assess attentional biases and we also speculate that they may eventually be used to treat them through attention bias modification. Additionally, the category effects that we see between food items and other items are highly interesting and encouraging. At the same time, task sensitivity will need to be improved. Finally, future tests of clinical samples could provide a clearer picture of the effects of eating disorder symptoms on foraging for food.

Characteristics of hip impingement syndrome in patients with multiple hereditary exostoses

Backgrounds This study aimed to investigate the characteristic deformities of the hip in multiple hereditary exostoses patients (MHE) and its association with the hip impingement syndrome. Materials and methods Between 2001 and 2019, total 51 patients (102 hips) were evaluated in this study. Patients with MHE were classified to femoro-acetabular impingement (FAI) symptom group, ischio-femoral impingement (IFI) symptom group and non-impingement symptom group by comparing the symptoms, clinical signs and imaging studies. To assess the morphometry of the hip in patients with MHE, the femoral neck-shaft angle, Sharp’s acetabular angle and center-edge (CE) angle were evaluated. Alpha angle was further evaluated to investigate the FAI using radiographs, and the minimum ischio-femoral distance was further measured to investigate the IFI using computed-tomographic (CT) study. Results On hip impingement symptom analysis, FAI symptom and IFI symptom were confirmed in 14 hip joints and 18 hip joints, respectively. Unlike general population, the number of the hip with IFI-symptom was higher than those with FAI symptom in this study. In morphometric evaluation of MHE hips, coxa valga was most prominent deformity with occasional tendency of mild acetabular dysplasia. In a comparison of morphometric study between the impingement symptom group and non-symptom group, the FAI symptom showed significant differences of morphometric measure values than those of the non-symptom group (FAI symptom group vs. Non-FAI symptom group; Femoral neck-shaft angle (153.9 vs 142.6), Sharp’s angle (45.0 vs 41.5), CE angle (21.1 vs 28.8) and alpha angle (76.7 vs 57.9)). Similarly, the IFI symptom group also showed significant differences of morphometric measure values than those of the non-symptom group (IFI-symptom vs. Non-IFI symptom; Femoral neck-shaft angle (150.9 vs 142.7), Sharp’s angle (44.7 vs 41.4), CE angle (21.1 vs 29.3) and alpha angle (73.3 vs 56.8)). In addition, the minimum ischio-femoral distance measured using CT was significantly decreased in the IFI symptom group (IFI symptom group: 6.6, Non-IFI symptom group: 16.4). Conclusion The results suggest that the characteristic deformities represented by coxa valga in the MHE hip act as an offset for FAI symptoms, on the contrary, act as a trigger for IFI symptoms. Level of evidence Level III.