Background Anti-NMDA-receptor GluN1 antibodies (NMDAR1-abs) are present in an autoimmune encephalitis with severe neuropsychiatric symptoms. We aimed to estimate the impact of serum NMDAR1-abs on... Show moreBackground Anti-NMDA-receptor GluN1 antibodies (NMDAR1-abs) are present in an autoimmune encephalitis with severe neuropsychiatric symptoms. We aimed to estimate the impact of serum NMDAR1-abs on depressive symptoms years after first-ever ischemic stroke (IS).Methods Data were used from the PROSpective Cohort with Incident Stroke-Berlin (PROSCIS-B; NCT01363856). Serum NMDAR1-abs (IgM/IgA/IgG) were measured within 7 days after IS using cell-based assays. We defined seropositivity as titers >= 1:10, thereof low titers as <= 1:100 and high titers as >1:100. We used the Center for Epidemiological Studies-Depression (CES-D) scale to measure depressive symptoms at year one, two and three following IS. We calculated crude and confounder adjusted weighted generalized linear models to quantify the impact of NMDAR1-abs on CES-D assessed at three annual time-points.Results NMDAR1-abs were measured in 583 PROSCIS-B IS patients (mean age = 67 [SD = 13]; 42%female; median NIHSS = 2 [IQR = 1-4]) of whom 76 (13%; IgM: n = 49/IgA: n = 43/IgG: n = 2) were seropositive, 55 (9%) with low and 21 (4%) with high titers. CES-D regarded over all follow-up time-points was higher in seropositive patients (beta(crude) = 2.56 [95%CI = -0.34 to 5.45]; beta(adjusted) = 2.26 [95%CI = -0.68 to 5.20]) and effects were highest in patients with high titer (low titers: beta(crude) = 1.42 [95%CI = -1.79 to 4.62], beta(adjusted) = 0.53 [95%CI = -2.47 to 3.54]; high titers: beta(crude) = 5.85 [95%CI = 0.20 to 11.50]; beta(adjusted) = 7.20 [95%CI = 0.98 to 13.43]).Conclusion Patients with serum NMDAR1-abs (predominantly IgM&IgA) suffer more severe depressive symptoms after mild-to-moderate IS compared to NMDAR1-abs seronegative patients. Show less
Atherosclerosis - the pathophysiological mechanism shared by most cardiovascular diseases - can be directly or indirectly assessed by a variety of clinical tests including measurement of carotid... Show moreAtherosclerosis - the pathophysiological mechanism shared by most cardiovascular diseases - can be directly or indirectly assessed by a variety of clinical tests including measurement of carotid intima-media thickness, carotid plaque, ankle-brachial index, pulse wave velocity, and coronary artery calcium. The Prospective Studies of Atherosclerosis (Proof-ATHERO) consortium (https://clinicalepi.i-med.ac.at/research/proof-athero/) collates de-identified individual-participant data of studies with information on atherosclerosis measures, risk factors for cardiovascular disease, and incidence of cardiovascular diseases. It currently comprises 74 studies that involve 106,846 participants from 25 countries and over 40 cities. In summary, 21 studies recruited participants from the general population (n = 67,784), 16 from high-risk populations (n = 22,677), and 37 as part of clinical trials (n = 16,385). Baseline years of contributing studies range from April 1980 to July 2014; the latest follow-up was until June 2019. Mean age at baseline was 59 years (standard deviation: 10) and 50% were female. Over a total of 830,619 person-years of follow-up, 17,270 incident cardiovascular events (including coronary heart disease and stroke) and 13,270 deaths were recorded, corresponding to cumulative incidences of 2.1% and 1.6% per annum, respectively. The consortium is coordinated by the Clinical Epidemiology Team at the Medical University of Innsbruck, Austria. Contributing studies undergo a detailed data cleaning and harmonisation procedure before being incorporated in the Proof-ATHERO central database. Statistical analyses are being conducted according to pre-defined analysis plans and use established methods for individual-participant data meta-analysis. Capitalising on its large sample size, the multi-institutional collaborative Proof-ATHERO consortium aims to better characterise, understand, and predict the development of atherosclerosis and its clinical consequences. (c) 2020 S. Karger AG, Basel Show less
Munter, L. de; Polinder, S.; Haagsma, J.A.; Kruithof, N.; Ree, C.L.P. van de; Steyerberg, E.W.; Jongh, M. de 2020
Objective: To describe the prevalence and prognostic factors of symptoms of anxiety and depression and posttraumatic stress symptoms (PTSS) after injury in the clinical trauma population.Design:... Show moreObjective: To describe the prevalence and prognostic factors of symptoms of anxiety and depression and posttraumatic stress symptoms (PTSS) after injury in the clinical trauma population.Design: Multicenter, prospective, observational cohort study.Setting: Ten hospitals in Noord-Brabant, The Netherlands.Participants: Four thousand two hundred thirty-nine adult patients (N=4239) admitted due to injury between August 2015 and December 2016.Interventions: Patients were asked to complete a questionnaire at 1 week and at 1, 3, 6, and 12 months after injury.Main Outcome Measures: The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive symptoms and the Impact of Event Scale was used to assess PTSS.Results: The prevalence of symptoms of anxiety and depression decreased from 10% and 12%, respectively, at 1 week after injury to 7% and 7% at 12 months after injury. Acute traumatic stress symptoms were present in 13% at 1 week and PTSS was prevalent in 10% of the participants at 12 months after injury. Strong prognostic factors for poor psychological outcome in multivariable logistic mixed models were preinjury frailty, psychological complaints and nonworking status preinjury, female sex, low educational level, and accident category (ie, traffic accident, work-related accident, or accidents at home compared to sport injuries).Conclusions: Psychological distress is a common health problem during the first year after injury. Important prognostic factors for psychological distress include psychological complaints before injury and frailty. Early recognition of psychological problems after injury could facilitate discussion between caregivers and patients and improve recovery. (C) 2019 by the American Congress of Rehabilitation Medicine Show less
