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Objective:To evaluate the effect of general anesthesia on microelectrode recording (MER) during deep brain stimulation (DBS) of subthalamic nucleus (STN) in the patients with primary Parkinson′s disease (PD).Methods:Forty-four patients of both sexes with primary PD (duration of disease ≥ 5 yr and/or obvious symptom fluctuation), undergoing bilateral STN DBS from March 2008 to March 2018, aged<80 yr, were selected and divided into 2 groups by a random number table method: awake group ( n=26) and general anesthesia group ( n=18). In awake group, 0.5% ropivacaine was used for incision infiltration at skin incision.Patients in GA group received propofol and remifentanil by target-controlled infusion with Narcotrend to monitor the depth of anesthesia, and 0.5% ropivacaine was used for incision infiltration at skin incision.The total number of trajectories and length of STN were recorded during MER.Movement disorders were evaluated at 1 week before surgery and 6 months after surgery, and the improvement rate of dyskinesia was calculated.The postoperative anesthesia-, hardware- and stimulation-related complications were recorded. Results:There were no significant differences between the two groups in the total number of trajectories, length of STN and improvement rate of postoperative movement disorders ( P>0.05). Conclusion:General anesthesia does not affect the MER during STN DBS in the patients with primary PD.
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Objective To investigate the application and value of entacapone in 6-18F-fluoro-L-dopa (18F-DOPA) PET/CT imaging on Parkinson's disease (PD).Methods From July 2016 to September 2017,44 PD patients (24 males,20 females,age:(51.3±11.0) years) and 14 healthy volunteers (7 males,7 females,age:(57.6± 14.4) years) who underwent 18F-DOPA PET/CT imaging were enrolled.They were divided into 4 groups:PD1 group with entacapone treatment (n=24);PD2 group without entacapone treatment (n=20);healthy control group with entacapone treatment (HC1,n=6);healthy control group without entacapone treatment (HC2,n =8).The striatal-to-occipital ratio (SOR) was calculated.Two-sample t test and receiver operating characteristic (ROC) curve analysis were used to analyze the data.Results The striatum was more clear and the uptake of cerebral cortex decreased significantly in PD1 and HC1 groups.The SOR of contralateral anterior putamen,posterior putamen and caudate nucleus in PD1 group were 15％,14％ and 15％ higher (t values:2.92,3.11,2.49,all P＜0.05) than those in PD2 group,and SOR of ipsilateral anterior putamen,posterior putamen and caudate nucleus in PD1 were 17％,21％ and 17％ higher (t values:2.90,3.56,3.00,all P＜0.05).SOR of left anterior putamen,posterior putamen and caudate nucleus in HC1 group were improved 29％,35％ and 27％ (t values:3.64,3.48,4.48,all P＜0.05) compared to those in HC2 group,and SOR of right anterior putamen,posterior putamen and caudate nucleus in HC1 group were improved 29％,28％ and 29％ (t values:2.92,2.73,3.61,all P＜0.05).The area under curve (AUC) for SOR of the left anterior and posterior putamen and the right posterior putamen in subjects with entacapone treatment were 0.999,0.999 and 0.972,which were far greater than 0.865,0.889 and 0.848 (z values:3.24,3.03,2.77,all P＜0.01) in those without entacapone treatment.The AUC for SOR of the right anterior putamen,the left caudate nucleus and the right caudate nucleus subjects with entacapone treatment were 0.927,0.941 and 0.906,respectively,which were also significantly greater than 0.754,0.766 and 0.696 (z values:2.01,2.36,2.17,all P＜0.05) in subjects without entacapone treatment.Conclusion Entacapone can increase the uptake of 18F-DOPA in the striatum of patients with PD,and it can improve the efficiency of 18F-DOPA to distinguish patients with PD from normal people.
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Objective To investigate the clinical characteristics of bilateral medial medullary infarction (BMMI). Methods The clinical data, cranial magnetic resonance imaging (MRI) and prognosis at 3 months follow-up of 13 patients with BMMI were analyzed, retrospectively. Results The common symptoms and signs of BMMI were quadriplegia in 13 cases), dizzy in 10 cases, dysarthria in 8 cases, hypoglossal nerve palsy in 8 cases)and dyspnea in 3 severe cases. The disease had an acute onset with rapid progress and reached peak between day 3 and 6. There were ten cases with moderate to severe disability at 3 months follow-up. The risk factors were hypertension, hyperlipidemia and diabetes. MRI diffusion weighted imaging showed hyperintense signals in the bilateral medial medulla with classical "heart-"shape (6 cases) and "Y-" shape (6 cases). Magnetic resonance angiography showed unilateral vertebral artery stenosis or occlusion in most patients. Conclusion BMMI is a rare cerebrovascular disease with a poor outcome. MRI diffusion weighted imaging is of great value in the early diagnosis.
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Objective To investigate the association between the nutritional status and related factors in patients with Parkinson's disease (PD).Methods Seventy-two patients with PD (PD group) and 71 age-and sex-matched healthy controls (control group) were enrolled in this study from September 2014 to November 2017 at the First Affiliated Hospital of Sun Yat-sen University.Their serum nutritional indices,including serum albumin,prealbumin,transferrin,free fatty acid and retinol conjugated protein,were collected.The PD participants were interviewed and assessed using motor and non-motor scales,including Hoehn and Yahr stage,Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS),Non-Motor Symptoms Questionnaire for Parkinson's Disease (NMSS),Mini-Mental State Examination (MMSE),Unified Dyskinesia Rating Scale (UDysRS) and 39-item Parkinson's Disease Questionnaire (PDQ-39).Their medication dosage was indicated by daily levodopa equivalent doses (LEDD).Body mass index (BMI) was used to determine their nutritional status,with abnormal nutritional status defined as BMI lower than 20 kg/m2.Results Levels of serum albumin (41.60 (40.28,43.98) g/L vs 44.00 (42.30,46.20) g/L,Z=4.500,P＜0.01),transferrin ((2.32±0.34) g/L vs (2.51±0.34) g/L,t=-3.305,P=0.001),and free fatty acid (418.00 (289.75,637.25) μmol/L vs 547.00 (386.00,699.00) μmol/L,Z=2.079,P=0.038) of the PD group were significantly lower than those of the control group.There was a significant negative correlation between serum albumin and MDS-UPDRS-Ⅱ score (r=-0.254,P=0.031),MDS-UPDRS-Ⅳ score (r=-0.256,P=0.030),years of dyskinesia (r=-0.240,P=0.043),years of motor fluctuation (r=-0.304,P=0.009) and LEDDs (r=-0.321,P=0.006).Disease duration was negatively correlated with serum albumin (r=-0.285,P=0.015) and transferrin (r=-0.275,P=0.019),and age (r=-0.252,P=0.032) was negatively correlated with prealbumin.The forward binary Logistic regression model indicated that abnormal nutritional status was closely associated with rigidity (OR=1.171,95％CI 1.013-1.354,P=0.032),akinesia (OR=1.070,95％CI 1.000-1.144,P=0.048),UDysRS score (OR=1.051,95％CI 1.004-1.099,P=0.032),MDS-UPDRS-Ⅳ score (OR=1.177,95％CI 1.018-1.360,P=0.027) and MMSE score (OR=0.821,95％CI 0.678-0.994,P=0.043),but not correlated with tremor and axial symptoms.Compared with PD patients with abnormal nutritional status,PD patients with normal nutritional status had higher MMSE scores (28.00 (27.00,29.00) vs 28.00 (25.00,28.00),Z=-2.060,P=0.039),lower rigidity (9.60±3.83 vs 12.00±4.29,t=-2.264,P=0.027),akinesia (19.98 ± 8.00 vs 24.42:±:8.06,t=-2.071,P=0.042) and MDS-UPDRS-Ⅳ scores (8.00 (5.00,11.00) vs 10.00 (9.00,13.00),Z=2.642,P=0.008).Conclusions PD patients tend to have a lower serum nutritional indices.PD patients with lower levels of serum nutritional indices are characterized by more severe motor complication,longer disease duration,older age and higher LEDD.PD patients with abnormal nutritional status have worse cognition and more severe motor symptoms (rigidity,akinesia and motor complication).
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Objective To investigate the clinical values of L-6-18 F-fluoro-3,4-dihydroxyphenylala-nine ( 18 F-DOPA) PET in the diagnosis and severity assessment of early-stage Parkinson's disease ( PD) . Methods Thirty-eight patients (24 males, 14 females; age:34-74 years) with early-stage PD (Hoehn-Yahr ( H-Y) staging:1-2) and 5 age-matched healthy volunteers ( all males;age:45-65 years) from July 2016 to March 2017 were included and underwent 18 F-DOPA PET scan in this retrospective study. The stria-tal-to-occipital ratio ( SOR) was calculated and compared between PD patients and healthy volunteers. The unified PD rating scale ( UPDRS) Ⅲ score and H-Y staging were used to evaluate the clinical symptoms. Two-sample t test and Pearson correlation analysis were used. Results In the control group, 18 F-DOPA SORs in bilateral putamen and caudate nucleus were 2.50±0.24 and 2.61±0.23, respectively. In PD group, the SORs of ipsilateral and contralateral putamen nucleus were 2.02±0.27 and 1.80±0.26 respectively, lower than those in the control group ( t values:-4.006,-5.440, both P<0.01) . The SORs of ipsilateral and contralater-al caudate nucleus were 2.16±0.32 and 2.08±0.28 respectively, lower than those in the control group ( t val-ues:-2.990,-4.047, both P<0.01). The SORs of contralateral putamen and caudate nucleus were signifi-cantly lower than those of the ipsilateral striatum respectively (t values:-6.431,-3.837, both P<0.01). Fur-thermore, the SORs in the striatum (putamen and caudate nucleus) were negatively correlated with UPDRSⅢscore, H-Y staging, and duration of disease (r values:from-0.526 to-0.369, all P<0.05). Conclusions 18F-DOPA PET can reflect the changes in the striatum neurons, and it may be an important method in the diag-nosis and assessment of early-stage PD patients.
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Objective To investigate the clinical value of [11C]CFT PET in the diagnosis and severity assessment of Parkinson disease (PD). Methods Thirty-eight patients with PD at various Hoehn & Yahr (H&Y) stages were included and underwent a [11C]CFT PET scan. The correlation between [11C]CFT uptake and unified Parkinson disease rating scale part III (UPDRS III) of PD patients was evaluated by calculating Pearson’s regression coefficient. Statistical parametric mapping (SPM) analysis was performed to compare the difference of dopamine transporter (DAT) distribution between ear-ly and advanced PD patients. Results There was a significant reduction of [11C]CFT uptake in the bilateral striatum of PD patients. There was a significant negative correlation between clinical scores of UPDRS III, rigidity, bradykinesia, pos-ture, gait and [11C]CFT uptake in the striatum. The SPM analysis revealed a significant and asymmetric decrease of [11C] CFT uptake in the striatum, predominantly on the putamen and caudate nucleus contralateral to the onset limb, in the posterior area of ipsilateral putamen in early PD (H&Y 1-2) patients compared with the normal controls. There was a sig-nificant symmetric decrease of [11C]CFT uptake in both putamen and caudate nucleus in advanced PD (H&Y 3-5) pa- tients, compared with normal controls. Compared with early PD patients, the reduction of DAT was more severe in bilater-al caudate nucleus and the ipsilateral putamen in the advanced PD patients. Conclusions [11C]CFT PET is a sensitive biomarker in the diagnosis and assessment of disease severity of PD patients.
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Objective To investigate the risk factors of obstruction of central venous catheter(CVC)in the intensive care unit(ICU). Methods One hundred and thirty-three adult patients in ICU with CVC were included in the study. The difference of the position of catheters, duration of indwelling catheters,selection of sealing solution,blood platelet(PLT)count,prothrombin time(PT),international normalized ratio(INR),activated partial thromboplatin time(APTT),thrombin time(TT)and fibrinogen(FBG)were studied between two groups of patients(with and without the obstruction of CVC).Results In 117 cases,there were no catheter obstruction,accounting for 88.0%. Catheter obstruction occurred in 16 cases,accounting for 12.0%,10 cases of which the catheters were partially blocked,accounting for 7.5%and in 6 cases completely blocked,accounting for 4.5%.There were significant differences in the duration of indwelling catheters,PLT and FBG levels between the two groups of patients(all P0.05).Conclusion Prolonged time of indwelling CVC,high levels of PLT and clotting fibrinogen are the risk factors of the obstruction of CVC in ICU patients.