Recovery from prolonged disorders of consciousness: A dual-center prospective cohort study in China

BACKGROUND

Recent innovations in intensive care have improved the prognosis of patients with severe brain injuries and brought more patients with disorders of consciousness (DoC). Data are lacking regarding the long-term outcomes of those patients in China. It is necessary to study the long-term outcomes of patients with prolonged DoC in light of many factors likely to influence crucial decisions about their care and their life.

AIM

To present the preliminary results of a DoC cohort.

METHODS

This was a two-center prospective cohort study of inpatients with vegetative state (VS)/unresponsive wakefulness syndrome (UWS). The study outcomes were the recovery from VS/UWS to minimally conscious state (MCS) and the long-term status of patients with prolonged DoC considered in VS/UWS or MCS for up to 6 years. The patients were evaluated using the Glasgow coma scale, coma recovery scale-revised, and Glasgow outcome scale. The endpoint of follow-up was recovery of full consciousness or death. The changes in the primary clinical outcome improvement in clinical diagnosis were evaluated at 12 mo compared with baseline.

RESULTS

The study population included 93 patients (62 VS/UWS and 31 MCS). The post-injury interval range was 28-634 d. Median follow-up was 20 mo (interquartile range, 12-37 mo). At the endpoint, 33 transitioned to an emergence from MCS or full consciousness, eight had a locked-in syndrome, and there were 35 patients remaining in a VS/UWS and 11 in an MCS. Seven (including one locked-in syndrome) patients (7.5%) died within 12 mo of injury. Compared with the unresponsive group (n = 52) at 12 mo, the responsive group (n = 41) had a higher proportion of males (87.8% vs 63.5%, P = 0.008), shorter time from injury (median, 40.0 d vs 65.5 d, P = 0.006), higher frequency of vascular etiology (68.3% vs 38.5%, P = 0.007), higher Glasgow coma scale score at admission (median, 9 vs 6, P < 0.001), higher coma recovery scale-revised score at admission (median, 9 vs 2.5, P < 0.001), at 1 mo (median, 14 vs 5, P < 0.001), and at 3 mo (median, 20 vs 6, P < 0.001), lower frequency of VS/UWS (36.6% vs 90.0%, P < 0.001), and more favorable Glasgow outcome scale outcome (P < 0.001).

CONCLUSION

Patients with severe DoC, despite having strong predictors of poor prognosis, might recover consciousness after a prolonged time of rehabilitation. An accurate initial diagnosis of patients with DoC is critical for predicting outcome and a long-term regular follow-up is also important.

Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients

PURPOSE

Diabetic peripheral neuropathy (DPN), a common microvascular complication of diabetes, is linked to glycaemic derangements. Glycaemic variability, as a pattern of glycaemic derangements, is a key risk factor for diabetic complications. We investigated the association of glycaemic variability with DPN in a large-scale sample of type 2 diabetic patients.

METHODS

In this cross-sectional study, we enrolled 982 type 2 diabetic patients who were screened for DPN and monitored by a continuous glucose monitoring (CGM) system between February 2011 and January 2017. Multiple glycaemic variability parameters, including the mean amplitude of glycaemic excursions (MAGE), mean of daily differences (MODD), standard deviation of glucose (SD), and 24-h mean glucose (24-h MG), were calculated from glucose profiles obtained from CGM. Other possible risks for DPN were also examined.

RESULTS

Of the recruited type 2 diabetic patients, 20.1% (n = 197) presented with DPN, and these patients also had a higher MAGE, MODD, SD, and 24-h MG than patients without DPN (p < 0.001). Using univariate and multiple logistic regression analyses, MAGE and conventional risks including diabetic duration, HOMA-IR, and hemoglobin A1c (HbA1c) were found to be independent contributors to DPN, and the corresponding odds ratios (95% confidence interval) were 4.57 (3.48-6.01), 1.10 (1.03-1.17), 1.24 (1.09-1.41), and 1.33 (1.15-1.53), respectively. Receiver operating characteristic analysis indicated that the optimal MAGE cutoff value for predicting DPN was 4.60 mmol/L; the corresponding sensitivity was 64.47%, and the specificity was 75.54%.

CONCLUSIONS

In addition to conventional risks including diabetic duration, HOMA-IR and HbA1c, increased glycaemic variability assessed by MAGE is a significant independent contributor to DPN in type 2 diabetic patients.

[Effect of acupoint catgut embedding on motor function and serum high sensitivity C-reactive protein and IL-6 levels in patients with acute cerebral infarction]

OBJECTIVE

To evaluate the effect of acupoint catgut embedding on motor function in patients with acute cerebral infarction (ACI), and to explore its mechanism.

METHODS

Sixty-three ACI patients were randomly assigned to acupuncture group (n = 30) and catgut embedding group (n = 33). Patients of the acupuncture group received acupuncture stimulation of Baihui (GV 20), Neiguan (P 6), Sanyinjiao (SP 6), Taichong (LR 3), etc. and scalp-point Motor Area, Sensory Area, Balance Area, once daily, 5 times a week for 20 times. Patients of the catgut embedding group received catgut embedding at the acupoints same to acupuncture group, once every 10 days, 3 times altogether. Additionally, both groups received regular treatment of neurology (controlling blood pressure, blood sugar and blood lipids levels, physical therapy, etc.) and early rehabilitation training (limb otor training). The patients' functional mobility was evaluated by simplified Fugl-Meyer Assessment Scale (FMA) and Modified Bathel Index Scale (MBI). The level of serum high sensitivity C-reactive protein (hs-CRP) was detected using latex agglutination reaction method; and serum in terleukin-6 (IL-6) content measured by enzyme-linked immunosorbent assay.

RESULTS

lts After 30 days' treatment, the mean scores of FMA and MBI were significantly increased in both acupuncture group and catgut embedding grou p (P < 0.05), suggesting an improvement of the cerebral infarction patient's functional mobility after the treatment. The therapeutic effect of the catgut embedding was obviously superior to that of the acupuncture grou p (P < 0. 05). The mean contents of serum IL-6 and hs-CRP of the two groups were significantly decreased after the treatmen t (P < 0.05), suggesting a reduction of proinflammatory cytokine and inflammatory mediator levels, respectively. The levels of both serum IL-6 and hs-CRP of the catgut embedding group were markedly lower than those of the acupuncture group ( P < 0.05).

CONCLUSION

ion Acupoint catgut embedding therapy is effective in improving cerebral infarction patients' functional mobility, which is related to its action in inhibiting inflammatory reaction in the early stage of cerebral ischemic injury.