Objective To compare the effects of group-based and individual-based Tai Chi training on nonmotor symptoms in patients with mild to moderate Parkinson's disease. Design Randomized controlled pilot study. Methods 36 community-dwelling patients with Parkinson's disease (PD) were randomly assigned to either group-based training group (n = 19) or individual-based group (n = 17). Both groups received same content of Tai Chi training 3 times a week for 13 weeks. Participants were also asked to perform home exercises daily. The Non-Motor Symptoms Scale was used to assess global nonmotor symptoms change. Sleep quality, depression, and cognition were evaluated by Parkinson's Disease Sleep Scale, Hamilton Depression Scale, and Beijing version-Montreal Cognitive Assessment, respectively. Home exercise compliance was recorded. Results There was no significant difference between two groups at baseline. After 13 weeks, there were no statistical significance between two groups. However, the within-group effect was different. Participants in group-based and individual-based groups showed a significant improvement on global nonmotor symptoms (P < 0.001, P = 0.004) and sleep (P < 0.001, P < 0.001). But only group-based training patients presented a significant improvement in cognitive impairment compared with baseline (P = 0.002, P − 0.116). For depression, no group gained a significant improvement(P = 0.123, P = 0.170). Group-based participants had a higher home-exercise compliance rate (HeCR) than individual-based participants did (P = 0.019), and HeCR showed a moderate correlation with MoCA-BJ and NMSS scores changes in this study. Conclusion Group-based Tai Chi training is considered to be a more effective and a more labor-saving method in the clinical settings, and patients tend to have a higher compliance rate in their home exercise program. This study is registered with ChiCTR-IPR-17010388.
Bartonella species are fastidious, aerobic bacteria that are transmitted by blood-sucking arthropods. Bartonella spp. are responsible for cat scratch disease, Carrion’s disease, bacillary angiomatosis and trench fever. On the other hand, Bartonella vinsonii is rarely reported in the literature and there exist a few reports of systemic infection caused by Bartonella vinsonii in patients with acquired immunodeficiency syndrome. A 31-year-old male (diagnosed with AIDS six years ago) had persistent fever and ulceration in the right knee. The elevated levels of inflammatory markers suggested an infectious aetiology. Despite the negative findings of blood culture, metagenomic Next-Generation Sequencing of plasma detected Bartonella vinsonii . The polymerase chain reaction of whole blood and Sanger sequencing confirmed the mNGS findings. Immunohistochemical staining had later suggested bacillary angiomatosis, which was consistent with Bartonella infection. Following antibiotic treatment, the ulcers subsided significantly, but a high fever persisted. The patient died due to sudden respiratory failure.
BackgroundT2T, achieving a DAS28 score lower than 2.6 (remission) or below 3.2 (low disease activity), is the main management strategy recommended by ACR and EULAR. HAQ is the most widely used in assessments of physical function in RA. However, the T2T may not always associate with good HAQ.ObjectivesTo quantify phenomenon of mismatch between the T2T and the HAQ in RA patients and identify influential factors from real-world data mining in SSDM.MethodsSSDM is a novel mobile tool of disease management. The patients were trained to master SSDM by health care professionals and conducted their DAS28 and HAQ self-assessments. The data were synchronized to the mobile of physicians and uploaded onto cloud for analysis.ResultsFrom Jun 2014 to Jan 2019, 44,698 RA patients from 587 hospitals in China used SSDM, of which 32,058 patients made 67,845 DAS28 and HAQ self-assessments. The T2T rates were 27% at baseline, and 60% after 6 months among 4,768 patients who have been followed up longer than 6 months.In 25,820 assessments of patients who achieved T2T at baseline or repeat assessments, 76% (19,552) assessments had normal physical function (HAQ = 0), but 24% (6,268) were with HAQ score higher than 0, which mean score for 8 functional tests was 3.67, indicating physical dysfunction. The “Bend down to pick up clothing from the floor” was the one being affected most, with a mean score of 0.81, significantly higher than other functional test score, P<0.001. The mean numbers of tender and swollen joints among T2T patients were 1.53 and 1.32 respectively. The analysis of correlation between physical dysfunction and the affected joints showed the knees were the major contributor to the mismatch, following by wrist and shoulders. Table 1 showed the mean scores for each functioning category in HAQ and the top target joints.In patients who did not achieve T2T, 32% had HAQ scores of 0, showing that these patients had normal physical function despite failure in achieving T2T. The mean number of tender and swollen joints in these patients was 4.31 and 2.85, respectively. The affected joints were mainly hand joints. According to the cluster weights for the impacts of affected joints on physical function, the weighted coefficient of affected joints impacting factors (IF) on physical function was obtained. The highest IF was for knee (4), followed by wrist (3.4), shoulder (2.3), middle finger (2.1), elbow (2), index finger (2), other fingers (1), respectively.Conclusion1/4 RA patients suffer from physical dysfunctions even though T2T are achieved. Diseased knees, wrists and shoulders are the top three joints that lead to corresponding physical dysfunctions and contribute to a mismatch between T2T and HAQ. Conversely, diseased elbow and finger joints are less likely to cause physical dysfunction. Therefore, not all joints are equal. Joints of knees, wrists and middle fingers deserve higher IF (2.1-4) in evaluation of disease activity. T2T guided by current DAS28 lead to mismatch with HAQ and may be misleading. A modified DAS28 should be co...
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