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Objective:To compare the differences in N-acetylaspartate/creatine(NAA/Cr), N-acetylaspartate/choline(NAA/Cho)and choline/creatine(Cho/Cr)in different brain regions of patients with different motor subtypes of Parkinson's disease(PD)or essential tremor(ET)using proton magnetic resonance spectroscopy( 1H-MRS), and to provide an imaging basis for the diagnosis of different PD subtypes and their differential diagnosis from ET. Methods:92 PD outpatients and inpatients, ET patients and healthy individuals receiving check-ups at our hospital from June 2018 to May 2021were retrospectively enrolled and divided into four groups: tremor-dominant(TD)(n=45), postural instability and gait disorders(PIGD)(n=47), ET(n=44), and healthy controls(n=40). Participant clinical information was collected and bilateral basal ganglia and cerebellar cortex 1H-MRS examinations were performed for each group.Values of NAA/Cr, NAA/Cho and Cho/Cr of the basal ganglia and the cerebellar cortex were compared between the groups. Results:NAA/Cr and NAA/Cho values in the basal ganglia were 1.65±0.19 and 1.55±0.20 for the TD group and 1.48±0.11 and 1.46±0.17 for the PIGD group, respectively, lower than in the control group(NAA/Cr: 1.92±0.28; NAA/Cho: 2.08±0.34)and the ET group(NAA/Cr: 2.10±0.16; NAA/Cho: 2.23±0.23), with statistical significance( P<0.05), whereas Cho/Cr values for the former two groups(TD: 1.07±0.25; PIGD: 1.02±0.13)were higher than in the latter two groups(control: 0.92±0.27; ET: 0.91±0.21), with statistical significance( P<0.05). NAA/Cr values of the basal ganglia in the PIGD group were lower than in the TD group( P<0.05). NAA/Cr, NAA/Cho and Cho/Cr values of the basal ganglia in the ET group were not statistically different compared with those in the control group( P>0.05). In the cerebellar cortex, NAA/Cr(0.72±0.16)and NAA/Cho(0.78±0.14)in the ET group were lower than in the control group(0.92±0.20)and(1.12±0.17), the TD group(0.90±0.14); (1.10±0.13)and the PIGD group(0.89±0.25)and(1.08±0.17)( P<0.05). NAA/Cr, NAA/Cho and Cho/Cr values of the cerebellar cortex for the TD group, the PIGD group and the control group had no statistical difference( P>0.05). Conclusions:1H-MRS can detect brain metabolic changes with damage or loss of neurons in the basal ganglia of PD patients and the cerebellar cortex of ET patients, potentially providing an objective imaging basis for early diagnosis of PD, its subtyping and the differential diagnosis from ET.
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Objective:To investigate the indwelling time of nasointestinal tube and the safety of delayed use, and to analyze the main influencing factors.Methods:216 patients with indwelling nasointestinal tube were analyzed retrospectively by designing a survey from 2018 to 2020. Receiver operating characteristic curve (ROC) analysis method was used to analyze the threshold of pipe blocking time.Results:Among the 216 patients, the shortest indwelling time was 7 days and the longest was 120 days. The incidence rate of tube blockage, aspiration and accidental extubation was 6.02%(13/216), 2.78%(6/216) and 1.39%(3/216), respectively. Statistical analysis of 13 patients with tube occlusion showed that the incidence of tube occlusion was related to the indwelling time and the speed of pumping (χ 2=46.056, 36.564, P<0.05). In addition, the duration of nasointestinal tube use not only affected the incidence of tube occlusion, but also was related to the incidence of aspiration. With the prolongation of catheter insertion time, the rate of tube occlusion and the incidence of aspiration also increased significantly (χ 2=13.190, P<0.05). ROC curve was used to analyze the correlation between the indwelling time of the feeding tube and the occlusion. The area under the ROC curve was 0.933 (95% CI: 0.886-0.981, P<0.001), the Youden index was 0.829, and the cut-off value of the best indwelling time was 52.5 d. The sensitivity and specificity of the method for determining the occurrence of pipe blockage were 92.3% and 90.6%. Conclusions:It is safe and feasible to extend the indwelling time of nasointestinal tube appropriately, which can reduce the discomfort caused by frequent replacement of nasointestinal tube in patients with long-term enteral nutrition, and reduce the medical cost at the same time. However, when the indwelling time exceeds the threshold, the probability of tube blockage increases significantly, so we should maintain the catheter or replace it in time.
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Objective To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction,and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score.Methods One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke (the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score,patients in the cerebral infarction group were divided into 3 subgroups:NIHSS score 0-4 group(n=32),NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28).The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups:(1)the traditional treatment group(n=44),taking routine drugs for cerebral infarction;(2) the special treatment group (n =42),taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups.Results In patients with acute cerebral infarction,the time-domain parameters of normal-to-normal intervals (NNI),standard deviation of normal-to-normal intervals(SDNN),square root of the mean squared successive differences between normal-to-normal RR intervals (RMSSD),percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50),frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P＜0.05).While,pulse rate and frequency domain parameters of sympathetic vagus balance index (LF/HF)were significantly increased (P ＜ 0.05).The time-domain parameters (NNI,SDNN,RMSSD and PNN50) and frequency domain parameters(LF,HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P＜0.05).The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P＜0.05),and the frequency domain parameters(LF/HF) were increased(P＜0.05)in NIHSS score ≥ 15 group compared with in NIHSS score 5-15 group(P＜0.05).Compared with pro-treatment,the special treatment group after treatment showed that the time domain parameters(NNI,SDNN,RMSSD and PNN50)and frequency domain parameters(LF and HF) were significantly increased (P ＜ 0.05),the frequency domain parameters(LF/HF) were significantly reduced (P ＜ 0.05) and the incidence of cardiac complication (total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P＜0.05).As compared with the traditional treatment group after treatment,the special treatment group after treatment showed that the time domain parameters(NNI,SDNN,RMSSD and PNN50)and frequency domain parameters (LF and HF) were significantly increased (P ＜ 0.05),frequency domain parameters(LF/HF) were significantly reduced (P ＜ 0.05) and the total incidence of cardiac complication were significantly reduced(18.4％ or 7 cases vs.40.0％ or 16 cases,P＜0.05).Conclusions The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores,which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke,early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke.
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Objective@#To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction, and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score.@*Methods@#One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke(the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score, patients in the cerebral infarction group were divided into 3 subgroups: NIHSS score 0-4 group(n=32), NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28). The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups: (1)the traditional treatment group(n=44), taking routine drugs for cerebral infarction; (2)the special treatment group(n=42), taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups.@*Results@#In patients with acute cerebral infarction, the time-domain parameters of normal-to-normal intervals(NNI), standard deviation of normal-to-normal intervals(SDNN), square root of the mean squared successive differences between normal-to-normaI RR intervals(RMSSD), percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50), frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P<0.05). While, pulse rate and frequency domain parameters of sympathetic vagus balance index(LF/HF)were significantly increased(P<0.05). The time-domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF, HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P<0.05). The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P<0.05), and the frequency domain parameters(LF/HF)were increased(P<0.05)in NIHSS score ≥15 group compared with in NIHSS score 5-15 group(P<0.05). Compared with pre-treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), the frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the incidence of cardiac complication(total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P<0.05). As compared with the traditional treatment group after treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the total incidence of cardiac complication were significantly reduced(18.4% or 7 cases vs.40.0% or 16 cases, P<0.05).@*Conclusions@#The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores, which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke, early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke.
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Objective To discuss the correlation between levels of hs-CRP,IL-6 and MMP-9 with cerebral microbleeding (CMB).Methods A total of 201 of non-acute ischemic cerebrovascular were collected and performed heal MRI+ susceptibility-weighted imaging(SWI).The patients were divided into the CMB group(49 cases) and non-CMB group(152 cases) according to the SWI examination results.The clinical data were recorded in the two groups.The levels of inflammatory mediators high-sensitivity C-reactive protein (hs-CRP),interleukin-6 (IL-6) and matrix metalloproteinase-9(MMP-9) were tested.The Logistic regression analysis was used to analyze the relation between the levels of hs-CRP,IL-6 and MMP-9 with cerebral microbleeding.Results The levels of inflammatory mediators hs-CRP,IL-6 and MMP-9 in the CMB group were significantly higher than those in the non-CMB group (P＜0.05).The logisticMultivariate logistic regression analysis showed that the levels of hs-CRP,IL-6 and MMP-9[OR value(95％CI):1.745(1.342-2.270),1.223(1.018-1.533),1.284(1.082-1.423),P＜0.05)] were the risk factors of CMB after adjusting the influence of age,sex and traditional risk factors.Conclusion The levels of inflammatory mediators hs-CRP,IL-6 and MMP-9 are closely associated with CMB,which participate in CMB occurrence.
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Objective To discuss the correlation between levels of hs-CRP,IL-6 and MMP-9 with cerebral microbleeding (CMB).Methods A total of 201 of non-acute ischemic cerebrovascular were collected and performed heal MRI+ susceptibility-weighted imaging(SWI).The patients were divided into the CMB group(49 cases) and non-CMB group(152 cases) according to the SWI examination results.The clinical data were recorded in the two groups.The levels of inflammatory mediators high-sensitivity C-reactive protein (hs-CRP),interleukin-6 (IL-6) and matrix metalloproteinase-9(MMP-9) were tested.The Logistic regression analysis was used to analyze the relation between the levels of hs-CRP,IL-6 and MMP-9 with cerebral microbleeding.Results The levels of inflammatory mediators hs-CRP,IL-6 and MMP-9 in the CMB group were significantly higher than those in the non-CMB group (P＜0.05).The logisticMultivariate logistic regression analysis showed that the levels of hs-CRP,IL-6 and MMP-9[OR value(95％CI):1.745(1.342-2.270),1.223(1.018-1.533),1.284(1.082-1.423),P＜0.05)] were the risk factors of CMB after adjusting the influence of age,sex and traditional risk factors.Conclusion The levels of inflammatory mediators hs-CRP,IL-6 and MMP-9 are closely associated with CMB,which participate in CMB occurrence.
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<p><b>OBJECTIVE</b>To explore the clinical effects of acupressure at Neiguan (PC 6) combined with press needles for prevention of gastroscopy-induced nausea and vomiting.</p><p><b>METHODS</b>One hundred and twenty patients who were scheduled to gastroscopy for the first time were randomly assigned into an acupressure group and a combined treatment group, 60 cases in each one.The patients in the two groups were treated with acupressure at Neiguan (PC 6) 15 min before gastroscopy; moreover, the patients in the combined treatment group were additionally treated with press needles at Neiguan (PC 6) until the end of gastroscopy. The time of gastroscopy-induced nausea and vomiting, VAS-based nausea and vomiting scale and the state-trait anxiety inventory were compared between the two groups.</p><p><b>RESULTS</b>The time of gastroscopy-induced nausea and vomiting in the combined treatment group was lower than that in the acupressure group (<0.05); the score of VAS-based nausea and vomiting scale in the combined treatment group was lower than that in the acupressure group (<0.05); the state-trait anxiety inventory was not significantly different between the two groups, before and after gastroscopy (all>0.05).</p><p><b>CONCLUSIONS</b>Acupressure at Neiguan (PC 6) combined with press needles can relieve gastroscopy-induced nausea and vomiting without increasing anxiety.</p>
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Objective To explore characteristics of sleep structure and the correlation with cognitive function in cerebral infarction combined with obstructive sleep apnea hypopnea syndrome (CI-OSAHS).Methods The patients with CI-OSAHS and OSAHS in Department of Neurology and Breathing Sleep Monitoring Room of Tianjin Medical University General Hospital from December 2009 till March 2011 were collected All the patients completed polysomography(PSG).Sixty patients were selected and divided into 3 groups based on PSG.These 3 groups were combined group 20 persons (CI-OSAHS),OSAHS group 20persons (OSAHS) and control group 20 persons (without cerebral infarction obstructive sleep apnea hypopnea syndrome).All the patients completed image examinations ( CT and MRI ) evaluation of the cognitive function by Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment(MoCA).Results Sleep structure:the awake time,non-rapid eye movement sleep (NREM) 1,NREM 2 and NREM periods in combined group and OSAHS group were significantly longer,the NREM3 + 4 and rapid eye movement(REM) periods were shorter than the control group.The NREM and NREM 1 periods in combined group were longer,the NREM 3 +4 and REM periods were shorter than the OSAHS group.The correlation analysis of cognitive function and breathing disorders and low oxygen related index:there was negative correlation between the total scores of cognitive function (MMSE and MoCA)and apnea hyponea index,oxygen desaturation index (ODI) ( MMSE r =-0.450,-0.671,MoCA r =-0.486,- 0.494,all P ＜0.05) while,was positive correlation between them and noctumal average hypoxemia and minimum hypoxemia ( MMSE r =0.477,0.485,MoCA r =0.507,0.482,all P ＜0.05) in the OSAHS group.There was negative correlation between ODI,arousal index and the total scores of MoCA in the combined group (MoCA r=-0.463,0.480,both P＜0.05),there was correlation between the total scores of MMSE and the other sleep parameters,but,there was no difference in statistics.The correlation analysis of cognitive function and sleep stages:There was positive correlation between the total scores of cognitive function ( MMSE and MoCA) and the NREM 3 + 4 periods ( r =0.521,0.474,both P ＜ 0.05 ) while,there was negative correlation between the total scores of MMSE and the N REM 1 + 2 periods (r =-0.458,P ＜ 0.05 )in the OSAHS group.There was positive correlation between the REM period and the total scores of MoCA (r =0.472,P ＜ 0.05 ).There was correlation between the total scores of MMSE and the sleep structure,but,there was no difference in statistics in combined group.Conclusions Patients with OSAHS have obvious sleep structure disorder.The awake time and light sleep periods are significantly longer than the control group,while,the deep sleep and REM periods are significantly shorter than the control group.The NREM 1 of the patients with CI-OSAHS is longer than the patients with OSAHS.The higher the AHI,the lower the night blood oxygen,the more obvious cognitive dysfunction The longer the awake time,the longer the light sleep,the shorter the deep sleep and REM periods,the more serious cognitive dysfunction.The correlation between the cognitive impairment and low oxygen is more apparent than sleep structure.There is apparent correlation among the total scores of MoCA,the degree of hypoxia and sleep structure in the patients with CI-OSAHS.The total scores of MoCA are more sensitivity than MMSE in mild vascular cognitive impairment.