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Objective:To explore the characteristics of sleep disorders in patients with Parkinson's disease (PD) and its correlation with homocysteine.Methods:Totally 75 PD patients hospitalized in the department of neurology from January 2017 to June 2021 were selected and divided into sleep disorder group ( n=39) and non-sleep disorder group ( n=36)according to polysomnography, Parkinson's disease sleep scale(PDSS) and Epworth sleepiness scale(ESS). The basic clinical data, hematological examination results, scale evaluation data and polysomnography monitoring data of the above patients were collected during hospitalization to analyze the sleep characteristics of patients with Parkinson's disease and its correlation with homocysteine.SPSS 26.0 statistical analysis software was used for t test, Mann-Whitney U test, Pearson analysis, Spearman analysis and multivariate Logistic analysis. Results:The sleep efficiency (56.82±19.07)%, N2 phase ratio(48.67±17.70)%, N3 phase ratio(9.20%(19.00%)) and the leg movement micro-arousal index(0(1.20)) in the sleep disorder group were lower than those in the non-sleep disorder group (sleep efficiency (82.15±5.55)%, N2 phase ratio(57.02±2.80)%, N3 phase ratio(20.01%(3.93%)), the leg movement micro-arousal index(1.15(1.80)). The differences were statistically significant ( t/ Z=-6.087, -2.905, -3.773, -3.683, all P<0.05). The proportion of AHI (0.90(14.60)), N1 stage (19.50%(15.70%)), and periodic limb index (0(24.80)) in sleep disorder group were higher than those in non-sleep disorder group (AHI (0.60(0.30)), N1 stage (12.15%(3.15%)), and periodic limb index (0(0)). The difference was statistically significant ( Z=2.154, 5.250, 3.559, all P<0.05). The homocysteine (15.80(3.90) μmol/L), NMSS-insomnia correlation score (3.00(5.00)), MDS-UPDRS-Ⅰ(7.00 (10.00)), MDS-UPDRS-Ⅲ (23.00 (16.00)) in the sleep disorder group were higher than those in the non-sleep disorder group (homocysteine (14.10 (4.20)μmol/L), NMSS-insomnia correlation score (0(1.00)), MDS-UPDRS-Ⅰ(3.00 (2.00)), MDS-UPDRS-Ⅲ (17.00 (4.00)), and the differences were statistically significant( Z=2.557, 4.487, 2.952, 2.180, all P<0.05). The NMSS-olfactory correlation scores (2.00(4.00)) and PDSS (99.00 (40.00)) were lower than those in the non-sleep disorder group (NMSS-olfactory correlation scores (4.50 (7.00)) and PDSS (122.00 (28.00)), and the differences were statistically significant ( Z=2.450, 4.126, both P<0.05). Hcy was positively correlated with sleep disorder in PD patients ( r=0.297, P<0.05). Binariate logistic regression analysis showed that elevated homocysteine level might be a risk factor for sleep disorder in PD patients ( β=0.193, OR=1.213, 95% CI=1.029-1.430). Conclusion:Parkinson's disease patients with sleep disorder have the characteristics of sleep structure disorder, often accompanied by more serious motor disorders, and the olfactory function impairment is relatively mild. Elevated homocysteine levels may be a risk factor for sleep disorder in Parkinson's disease.
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Objective@#To investigate the relationship between menopausal status at different FPG levels and the risk of new onset of impaired fasting glucose (IFG) and type 2 diabetes mellitus (T2DM).@*Methods@#Female subjects were selected from the females who joined in the epidemiological survey between May and September in 2009 in six counties of Guanlin Village and Xushe Village in Yixing City in Jiangsu Province by cluster sampling method. Subjects with diabetes at baseline or pre-menopause with age above 65 years old or surgical menopause were excluded. Finally there were 2 084 eligible subjects included in this study. According to FPG at baseline, subjects were categorized into two groups as normal FPG group (FPG<5.6 mmol/L) and IFG group (5.6≤FPG≤6.9 mmol/L). Follow-up study was conducted from May in 2014 to January in 2016. Cox regression model was used to investigate the association between menopausal factors and IFG and T2DM among groups based on FPG.@*Results@#The average age of subjects at baseline was 58.08 (51.74-65.82) years old, and the number of post-menopausal women was 1 631 (78.3%). The number of subjects in normal FPG group was 1 569 (75.3%), and in IFG group was 515 (24.7%). There were 104 subjects with new onset T2DM among which 34 subjects from normal FPG group and 70 subjects from IFG group. And there were 199 subjects with new onset IFG in normal FPG group. Among subjects with normal FPG, the incidence density of IFG in post-menopausal women (2 752/100 000 person-years) was statistically higher than that in premenopausal women (1 670/100 000 person-years) (P<0.001). After age and BMI adjusted, post-menopausal women had a higher risk of having IFG in normal FPG subjects with hazard ratio (HR) at 2.60 (P<0.001). Among subjects with normal FPG, the risk of new onset IFG decreased in post-menopausal women with menopause age increasing after age and BMI adjusted, with HR at 0.96 (P=0.046). No statistical association was found between menopausal factors and risk of T2DM either in the overall subjects or in the subgroups(P>0.05).@*Conclusion@#Menopause can increase the risk of IFG incidence in subjects with normal FPG. The incidence of IFG decreases with the menopause age increasing.
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Objective To investigate the effects of dexmedetomidine preventive on chronic postsurgical pain (CPSP) in patients undergoing hysterectomy.Methods Eighty patients scheduled for elective abdominal hysterectomy,aged 18-65 years,ASA physical status Ⅰ or Ⅱ were recruited,and randomly divided into dexmedetomidine group (group D) and the control group (group C).All patients received total intravenous anesthesia with propofol and remifentanil.The patients in group D were administered intravenously dexmedetomidine 0.5μg·kg-1 ·h-1 from anesthesia induction to extubation at the end of surgery,while the patients in group C were administered normal saline 0.125 ml·kg-1· h-1.All patients received patient-controlled analgesia with fentanyl postoperatively.Intraoperative vital signs,the dose of analgesic and sedatives,and adverse reactions were recorded.CPSP and neuropathic pain (NP) were evaluated through the telephone follow-up in 3,6 and 12 months postoperatively.Results The peri-operative vital signs of both groups were stable,and no obvious adverse reaction were observed.The dosage of tramadol used for resue analgesia in group D was lower than that in group C [(58.8±15.4) mg vs (78.9±24.5) mg,P＜0.05].Seventy-one of eighty patients completed all follow-up (37 in group D,34 in group C).The incidence of CPSP in postoperative 3,6 and 12 months were 10.8％,5.4 ％,2.7 ％ in group D,significantly lower than 35.3 ％,26.5 ％,17.6％ in group C,respectively (P＜0.05).The incidence of NP in postoperative 3 and 6 months were 2.7％,0％,significantly lower than 17.6％,14.7％ in group C,respectively (P＜0.05).Conclusion Dexmedetomidine preventive analgesia alleviate chronic post-hysterectomy pain.
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Cystic echinococcosis is one of the most widespread and severe zoonotic helminthic diseases .To understand the phylogeny and genetic polymorphism Echinococcus granulosus (E .granulosus) prevailed in south region of Qinghai Prov-ince ,partial fragment of cytochrome oxidase Ⅰ (COX Ⅰ ) gene sequences were used to infer the phylogenetic relationship of 59 collected samples of E .granulosus in Qinghai Province .Total 72 sequences (13 sequences from GenBank) were aligned using CLUSTAL X ,and then ,Bayesian analyses were performed in Mrbayes-3 .1 .2 .The results revealed that Echinococcus spp .isolates did not form a monophyletic group .The most samples clustered with E . granulosus strain (G1) (AB297617) , but showed high genetic polymorphism .Another three samples clustered with E .multilocularis (AB018440) ,while they showed complex phylogenetic relationships among them ,further indicating that Echinococcus spp .isolates from Qinghai Prov-ince may has a more complex evolutionary history than expected .
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Objective To investigate how to avoid and deal with injuries to the aberrant right posterior hepatic duct during laparoscopic cholecystectomy (LC).Method We studied 1 710 patients who underwent LC in our unit from January 2011 to November 2013.There were 5 patients with right posterior hepatic duct abnormally,and this paper analysed the cases.Results In the 5 patients,one patient had the right posterior hepatic duct draining into the gallbladder body (Ⅰ A type),two patients had the right posterior hepatic duct draining into the cystic duct (ⅢA type),and two patients had the cystic duct draining into the right posterior hepatic duct (ⅢB type).There was no damage to the right posterior hepatic duct during operation.One patient was converted from LC to open operation.The major aberrance was class Ⅲ.Conclusions Variant bile duct is an important cause of bile duct injuries during LC.The right posterior hepatic duct variation is the most common form.To raise our vigilance and fully understand the types of aberrant right posterior hepatic duct,reasonable use of preoperative MRCP and intraoperative cholangiography in selected patients are fundamental.Aberrant right posterior hepatic duct injuries can effectively be avoided.