Lymphopenia and neutropenia are associated with subsequent incident proteinuria in Danish patients with systemic lupus erythematosus.

Objective: The aim of this study was to investigate whether incident proteinuria in patients with systemic lupus erythematosus (SLE) was preceded by changes in blood lymphocytes and neutrophil counts and/or neutrophil-lymphocyte ratio (NLR).Method: SLE patients with no proteinuria before or at the time of classification were included. Longitudinal data on SLE manifestations, vital status, and SLE-associated medications were collected during clinical visits and chart review. Laboratory data were collected through a nationwide database. Lymphopenia, severe lymphopenia, and neutropenia were defined as values below 0.8 × 109, 0.5 × 109, and 2.0 × 109 cells/L, respectively. High NLR was defined as values above the median. Proteinuria was defined by at least two measurements of elevated urine protein excretion (> 0.5 g/day). Hazard ratios (HRs) were calculated by Cox modelling using time-dependent continuous and binary covariates based on multiple laboratory measurements adjusted for use of immunosuppressants.Results: In total, 260 SLE patients were available for the analysis, of whom 30 (12%) developed incident proteinuria following the diagnosis of SLE. Median follow-up time was 73.5 months. Lymphocyte and neutrophil counts, but not NLR, were associated with incident proteinuria. HRs for incident proteinuria were 2.71 for lymphopenia [95% confidence interval (CI) 1.20-6.11], 4.73 for severe lymphopenia (95% CI 1.93-11.59), and 2.54 for neutropenia (95% CI 1.14-5.65).Conclusion: Lymphopenia and neutropenia predicted the risk of first-time proteinuria independently of immunosuppressants.

Reliability of the international spinal cord injury bowel function basic and extended data sets.

STUDY DESIGN: This study was designed as an international validation study. OBJECTIVE: The objective of this study was to assess the inter-rater reliability of the International Spinal Cord Injury Bowel Function Basic and Extended Data Sets. SETTING: Three European spinal cord injury centers. METHODS: In total, 73 subjects with spinal cord injury and a history of bowel dysfunction, out of which 77% were men and median age of the subjects was 49 years (range 20-81), were studied. The inter-rater reliability was estimated by having two raters complete both data sets on the same subject. First and second tests were separated by 14 days. Cohen's kappa was computed as a measure of agreement between raters. RESULTS: Inter-rater reliability assessed by kappa statistics was very good (≥0.81) in 5 items, good (0.61-0.80) in 11 items, moderate (0.41-0.60) in 20 items, fair (0.21-0.40) in 11 and poor (<0.20) in 5 items. CONCLUSION: Most items within the International Spinal Cord Injury Bowel Function Data sets have acceptable inter-rater reliability and are useful tools for data collection in international clinical practice and research. However, minor adjustments are recommended.

Urinary incontinence in spinal cord injured individuals 10-45 years after injury.

STUDY DESIGN: Epidemiological follow-up study. OBJECTIVE: To evaluate urinary incontinence and its management in a population of individuals with long-term spinal cord injury (SCI). SETTING: Clinic for Spinal Cord Injuries and Department of Urology, Copenhagen University Hospital, Rigshospitalet, Denmark. METHODS: Retrospective data collection from the patient records and information from a follow-up questionnaire of traumatic SCI individuals at least 10 years after injury. A total of 236 patients participated (84.6% response), 82% males and 18% females, 47% tetraplegic and 53% paraplegic, injured between 1956 and 1990. Age at the time of follow-up was 28-84 years (mean 50.5 years). Years of follow-up were 10-45 years (mean 24.1 years). RESULTS: A total of 43% of the participants reported incontinence from less than once a week to daily. There was a significant linear trend across the groups of incontinence with more paraplegics reporting daily incontinence compared with tetraplegics. A higher proportion of participants using clean intermittent catheterization reported incontinence (56%) compared with participants using other bladder-emptying methods. Only 19% of the participants used medication for the management of incontinence. CONCLUSION: Urinary incontinence is a common problem in individuals with SCI. Only a minority of individuals used medication for the treatment of incontinence. SPONSORSHIP: This study was carried out as a part of the primary author's PhD study, financed by the Medicon Valley Academy and Coloplast A/S.

Home aids and personal assistance 10-45 years after spinal cord injury.

OBJECTIVE: Assessment of home aids, adaptations and personal assistance received after traumatic spinal cord injury (SCI). SETTING: Clinic for Spinal Cord Injuries, Denmark. Uptake area, 2.5 million inhabitants. STUDY DESIGN AND METHODS: Cross-sectional follow-up with retrospective data from medical files. MATERIALS: Individuals with traumatic SCI before 1 January 1991, still in regular follow-up and with sufficient medical record. In all, 279 were included, and 236 answered the questionnaire (193 men and 43 women), with a response rate of 84.6%. Mean age at follow-up was 50.5 years, and mean follow-up time, 24.1 years. One hundred and twenty-six were paraplegic and 110, tetraplegic. Responders and non-responders were comparable. RESULTS: Most common aids or adaptations reported were commode/shower chair on wheels or a seat (69%), grab bar by the toilet (41%), electrical bed (44%), special mattress (28%), lift/hoist (20%), computers (39%) and kitchen tools or cutlery with special handles (14%). In all, 7.6% of the participants reported no aids. Eighty-two percent answered 'Yes' to the question 'Have the aids, you currently or previously needed, been available to you?' The majority reported that their source of information about aid had been various journals and magazines. Twenty-one percent had personal helpers, with 60 h per week in median (range 2-168). Thirty-three percent received domestic help with 2.5 h per week in median (range 0.5-37). Eight percent had a home nurse. A total of 98.7% were living in their own homes. CONCLUSIONS: This is the first study of a representative SCI population giving information on home aids. Individuals with SCI in Denmark seem to be sufficiently supplied with aids and personal assistance.

Bladder emptying over a period of 10-45 years after a traumatic spinal cord injury.

STUDY DESIGN: Epidemiological follow-up study. OBJECTIVE: To examine the bladder-emptying methods at least 10 years after a traumatic spinal cord injury (SCI). SETTING: Clinic for Para- and Tetraplegia and Department of Urology, Rigshospitalet, Copenhagen University Hospital, Denmark. METHODS: Retrospective data collection from patient records and data collected with a follow-up questionnaire. The response rate was 84.6% corresponding to 236 SCI individuals, injured in 1956-1990. There were 82/18% male/female patients and 47/53% tetraplegic/paraplegic. Age at the time of follow-up was 50.5 years in mean (range 28-84). Years from time of injury were 24.1 years in mean (range 10-45). RESULTS: The use of clean intermittent catheterisation (CIC) rose from 11% at the initial discharge to 36% at the time of follow-up. The use of suprapubic tapping fell from 57 to 31% in the same period, while the use of Crede manoeuvre rose from 5 to 19%. During follow-up, 46% changed bladder-emptying method. The results showed the following trends in change of method: a high proportion of discontinuation in normal bladder emptying, suprapubic tapping and abdominal pressure and a high proportion of continuation when using CIC. 28% found their bladder-emptying method to be a problem; of these 58% were tetraplegic. Of the participants using CIC, 92% reported using hydrophilic-coated catheters. CONCLUSIONS: Changing of bladder-emptying method among SCI individuals over time is common. CIC alone or in combination with another bladder-emptying method is the most frequently used method of bladder emptying. SPONSORSHIP: The study was carried out as part of the primary author's PhD-study, which was financed by Medicon Valley Academy and Coloplast A/S.

Mobility aids and transport possibilities 10-45 years after spinal cord injury.

STUDY DESIGN: A cross-sectional survey with retrospective data. OBJECTIVE: Follow-up information on the use of mobility aids and transportation possibilities in a chronic traumatic spinal cord injury (SCI) population. SETTING: Clinic for Para- and Tetraplegia at Rigshospitalet, University hospital, Denmark (CPT). The uptake area is East Denmark with a population of 2.5 million inhabitants. METHODS: Survey on date of birth, gender, time of SCI, cause of SCI, neurological level and functional classification from medical files were combined with information concerning mobility aids and transport possibilities at the time of follow-up from a mailed questionnaire. MATERIAL: Individuals with traumatic SCI before 1 January 1991 were still in regular follow-up at CPT, and with sufficient medical record. A total of 279 were included, out of which 236 answered the questionnaire. Of the 193 men and 43 women injured from 1956 to 1990 the response rate was 84.6%. Age at the time of follow-up was 50.5 years in mean, and follow-up time was 24.1 years in mean. In all, 126 were paraplegic and 110 tetraplegic. Responders and nonresponders were comparable. RESULTS: In all, 3.4% used no special mobility aids at all. In total, 49 used crutches or rolling walkers and 26 lower extremities bracing, but mostly in combination with a wheelchair. Standing frame and stand-up wheelchair were used by men only. Manual wheelchair was used by 83.5% and electrical wheelchair by 27%, and the latter more by the tetraplegics. In all, 9.3% had neither a manual nor an electrical wheelchair. Overall, 86.4% had a passenger van or another car. Women used a car less often. Passenger vans were more often used by tetraplegics. CONCLUSION: Nearly all SCI participants had mobility aids of some sort, and 90.7% had either a manual or an electrical wheelchair or both. Most had a passenger van or another type of car for transportation. These facilities are important for the individuals to obtain an independent living.

Vasopressin and oxytocin: modulators of neurohypophysial blood flow.

We examined the role of arginine vasopressin (AVP) as a mediator of neurohypophysial (NH) blood flow regulation in anesthetized dogs. First, we evaluated the NH hyperemia that occurs during hemorrhagic hypotension in the presence (n = 7) and absence (n = 7) of the selective AVP-V1 receptor antagonist [d(CH2)5Tyr(Me)]AVP. AVP-V1 blockade did not alter NH transient or steady-state flow responses to a standardized decrease to 80 mmHg mean arterial blood pressure. We then determined whether exogenous AVP alters NH and regional cerebral blood flow (CBF) (n = 8). Sequential intracarotid infusions resulted in sagittal sinus blood AVP concentrations ranging from 6.97 +/- 3.3 x 10(3) to 2.45 +/- 0.47 x 10(6) pg/ml. No change in NH blood flow (control 428 +/- 162 vs. 487 +/- 75 ml.min-1.100 g-1) was observed even at the highest blood level. However, CBF at the highest AVP level increased from a control value of 20 +/- 3 to 40 +/- 4 ml.min-1.100 g-1, while cerebral oxygen consumption remained unchanged. Administration of a selective AVP-V1 receptor antagonist, [d(CH2)5Tyr(Me)]AVP, blocked AVP-induced elevation in CBF in a third set of dogs (n = 5). Oxytocin was also given by intracarotid infusion at a constant rate (1-200 micrograms/ml) in a final group (n = 5). NH blood flow was unchanged at all doses, whereas CBF increased from control (24 +/- 2 to 38 +/- 5 ml.min-1.100 g-1) at the highest dose. (ABSTRACT TRUNCATED AT 250 WORDS)

Effect of preischemia cyclooxygenase inhibition by zomepirac sodium on reflow, cerebral autoregulation, and EEG recovery in the cat after global ischemia.

Zomepirac sodium (ZS) (5 mg/kg i.v.) was used to evaluate the effects of preischemia cyclooxygenase inhibition on CBF (as assessed by 133Xe clearance), CBF-PaCO2 responsiveness, and electrophysiologic (EEG) parameters before and after a 15-min period of complete global ischemia produced by four-vessel occlusion and mild hypotension. During the 15-min period of ischemia, CBF was essentially zero. Following reflow all groups displayed an initial hyperemia as compared with control (92 +/- 11 vs. 141-146 ml/100 g/min). Saline-treated animals during reflow displayed a delayed hypoperfusion (26 +/- 3 ml/100 g/min), which showed no improvement during the 2-h reflow period prior to death. In contrast, ZS-treated animals during reflow displayed significantly higher flows during the hypoperfusion phase (72 +/- 9 ml/100 g/min). The CBF-PaCO2 response displayed an approximately sevenfold reduction in slope at 2 h after reflow in saline-treated animals. This decrease in PaCO2 reactivity was not observed in the ZS-pretreated animals. With regard to EEG, all animals showed a total flattening during the 15 min of ischemia. In saline-treated animals only one of seven showed any sign of even marginal recovery. In ZS-treated animals EEG activity showed prominent recovery in seven of seven. Brainstem auditory evoked potentials were monitored and showed prominent recovery of amplitude and latency in ZS but not saline-treated animals during reflow.