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Objective:To compare the gait characteristics of cognitive and motor dual task walking (DTW) in patients with cerebral small vessel disease (CSVD), and determine the best gait parameters to diagnose CSVD and judge the severity of the disease.Methods:A total of 106 patients with CSVD and 21 healthy individuals were included from September 1, 2020 to July 1, 2021 in the Seventh Medical Center of Chinese People′s Liberation Army General Hospital. According to the Fazekas scores, the subjects were divided into mild ( n=34, 1 point), moderate ( n=34, 2 points), severe ( n=38,3 points) groups and control group ( n=21). Participants were recorded parameters under single task walking (STW) and DTW conditions, and calculated dual task effect (DTC) through the difference between single task and dual task. The differences in gait variances and their DTC were shown by generalized estimation equations when performed in STW and DTW and 4 groups of the severity of disease. Post-hoc comparisons were corrected using Bonferroni′s method. Spearman analyses were applied to explore the correlations between gait parameters and their DTC during STW or DTW and severity of disease. Based on the Logistic model, combining predictors or probabilities were gained and applied to establish receiver operating characteristic curve in order to calculate sensitivity, specificity, and the area under the curve. Results:In the control group, there was no statistically significant difference in gait parameters between STW and DTW. In the CSVD group, the gait parameters of STW were significantly better than cognitive or motor DTW (all P<0.05). In the control group, there was no statistically significant difference in basic gait parameters under different tasks (all P>0.05). In cognitive DTW, temporal gait parameters (stride frequency and stride time) deteriorated significantly only in moderate and severe groups [stride frequency:moderate group 100.220±1.795/min,severe group 94.525±2.139/min;stride time:moderate group (1.227±0.024) s, severe group (1.299±0.031) s], but spatial parameters [stride length: control group (1.050±0.021) m, mild group (0.974±0.022) m, moderate group (0.903±0.025) m, severe group (0.793±0.026) m; stride speed: control group (0.944±0.028) m/s, mild group (0.866±0.030) m/s, moderate group (0.751±0.027) m/s, severe group (0.606±0.022) m/s] were significantly different among all groups (except the control group and mild group;all P<0.05). The DTC of all gait parameters during cognitive DTW was higher than that during motor DTW (all P<0.05) for CSVD patients. While no any difference was found between cognitive DTW and motor DTW in the control group (all P>0.05). Similarly, the temporal parameters′ DTC of cognitive DTW was abnormal only in the late stage of disease, while the spatial parameters′ DTC showed statistically significant difference among all the groups (including the control group and the mild group;all P<0.05). Correlation coefficients of the spatial parameters and their DTC in condition of cognitive DTW were significantly higher than temporal parameters and their DTC (0.50< r<0.64 vs 0.15< r<0.39). The area under curve of the combined predictor was significantly higher than that of any single index. Conclusions:Cognitive DTW can better reflect the abnormal gait of CSVD patients. The spatial parameters and DTC of cognitive DTW could effectively diagnose CSVD and distinguish the disease of severity. And DTC might be better indicators. For diagnosis of CSVD, there was no significant discrepancy between the spatial parameters and DTC, but the combined predictor could significantly improve the sensitivity and reduce the false negative rate.
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Dual task walking (DTW) refers to the task of performing another attentional demand while walking naturally. It is quite common in our daily life, such as having a conversation while walking, or taking a call while crossing the street. People can simultaneously perform dual tasks normally. However, the performance of dual tasks will decline when the gait is impaired or cognitive dysfunction occurs.Neurodegenerative disease (NDD) is mainly characterized by motor and cognitive dysfunction, which seriously affects patients' ability of daily living activities. In recent years, studies on DTW in patients with NDD have found that decreased performance of DTW may be a feature of NDD patients, which may have important clinical value for early identification of NDD and predict disease progression. In the future, effective DTW training may improve the patients' ability of daily living activities, and it is important for the rehabilitation of NDD patients. This article mainly reviews the definition, common methods and mechanisms of DTW, as well as the clinical research findings and applications of DTW in patients with NDD, and provides theoretical basis for further clinical research.
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Objective The multiple malformation of upper eyelid,including the excessive width of fold line,sunken and/or multiple folded upper eyelid are the common complications after blepharoplasty.The aim of this study was to investigate the clinical effect of orbital septum fat redistribution on correcting these deformities.Methods From September 2015 to September 2017,38 patients with multiple malformations of upper eyelid were treated.The incision of upper eyelid and the excessive skin was designed and resected.After completely relieving the scar adhesion zones,we set the lateral orbital septum fat free and transposed it to the inner side of orbital septum or superior border of tarsus with suturing fixation.Then we routinely completed the double eyelid operation.Results Thirty-eight patients with multiple malformations of upper eyelid were treated successfully.The patients were followed up for 6 months to one year,and the results were totally satisfactory.The operation was not performed again.Conclusions The orbital septum fat redistribution can successfully correct the multi ple malformation of upper eyelid.It should become a regular procedure in blepharoplasty.
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Dual task walking ( DTW) refers to the task of performing another attentional demand while walking naturally. It is quite common in our daily life,such as having a conversation while walking,or taking a call while crossing the street. People can simultaneously perform dual tasks normally. However,the performance of dual tasks will decline when the gait is impaired or cognitive dysfunction occurs. Neurodegen-erative disease (NDD) is mainly characterized by motor and cognitive dysfunction,which seriously affects patients' ability of daily living activities. In recent years,studies on DTW in patients with NDD have found that decreased performance of DTW may be a feature of NDD patients,which may have important clinical val-ue for early identification of NDD and predict disease progression. In the future,effective DTW training may improve the patients' ability of daily living activities,and it is important for the rehabilitation of NDD pa-tients. This article mainly reviews the definition,common methods and mechanisms of DTW,as well as the clinical research findings and applications of DTW in patients with NDD,and provides theoretical basis for further clinical research.
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Objective To investigate the effect of maternal separation (MS) on cognitive function in adult male rats through the expression of neuronal nitric oxide synthase (nNOS) in hippocampus, and to reveal the roles of early life stress (ELS) on neural development in rats. Methods Healthy SD pregnant rats (n=12) were randomly divided into maternal separation group (MS group) and control group (NMS group) (n=6 for each group). The newborn rats in the MS group were separated from the mother rats for 3 h every day from postnatal day 3 to 22 whereas no intervention was taken in the NMS group. At the age of 10 weeks, Morris water maze was used to test the learning and memory abilities of two groups of offspring male rats. Neuron immunofluorescence staining was used to examine the number and distribution of neurons in dentate gyrus (DG) of two groups of offspring male rats. Western Blot method was used to detect nNOS, eNOS, Bax/BCL2, Caspase-3 and P53 levels in the hippocampus of the two groups. Ki67/DCX immunofluorescence staining were used to examine the proliferation and differentiation of neurons in the DG area of the hippocampus. TUNEL staining was used to detect the neuronal degeneration and death in the DG area of the hippocampus. Results Behavioral tests showed that the escape latency of male rats in MS group was prolonged, the target quadrant residence time and the number of platform crossing decreased (P<0.05) compared with NMS group. Compared with NMS group, the number of normal and degenerated neurons in hippocampal DG area of MS group had no significant change (P＞0.05). However, the expression of nNOS and eNOS in hippocampus was decreased (P<0.05) and the expression of Bax/BCL2 was increased (P<0.05), but the expression of caspase-3 and P53 remained unchanged (P＞0.05). In addition, Neuronal proliferation and differentiation were decreased and apoptosis was increased in MS group (P<0.05). Conclusion Repeated MS reduces the expression levels of nNOS in the hippocampus, affects the neuronal function in the DG area, and has a long-term influence on the neurodevelopment, which results in cognitive deficits related to learning and memory abilities in adult rats.
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Objective@#To investigate the clinical and immunological laboratory features and gene mutation in a female patient who carried a germline gain-of-function mutation in STAT3.@*Method@#A patient with lymphadenopathy and pancytopenia, visited the Department of Rheumatology and Immunology of Children′s Hospital of Chongqing Medical University in May 2016. The clinical and laboratory characteristics, results of immunophenotyping and exome sequencing were analyzed retrospectively and related literature was reviewed.@*Result@#The patient was a four years old girl. The clinical manifestation consisted of autoimmune pancytopenia, lymphadenopathy and recurrent infections. Multiple exams showed that peripheral blood leukocyte count was (2.2-4.9)×109/L, red blood cell count was (2.09-5.75)×109/L, hemoglobin level was 64-165 g/L, platelet count was (52-138) ×109/L. Percentages of lymphocyte subsets showed that CD3+ T lymphocyte was 0.716 0 (CD4+ T lymphocyte was 0.326 0, CD8+ T lymphocyte was 0.323 0 and CD4- CD8-T TCRαβ+ lymphocyte was 0.029 0), CD19+ B lymphocyte was 0.235 0 (transitional B was 0.004 3), NK was 0.032 0. Percentages of CD4+ T lymphocyte release IL-4, IFN-γ, IL-17 and IL-21 were 0.014 9, 0.213, 0.024 0 and 0.021 0, respectively. Lymphocyte proliferation function and TCRVβ diversity were normal. The serum immunoglobulin levels were 16.4 g/L (IgG), 1.53 g/L (IgA), 3.99 g/L (IgM) and 3.20 kU/L (IgE). The patient carried a missense variant in the 21st exon of STAT3, c. 1974G>C, p.K658N, which was previously described as a gain-of-function mutation. The patient was treated with methylprednisolone and prednisone intermittently. There were significant improvements of hepatosplenomegaly, lymphadenopathy and pancytopenia. We searched internal database and literature for cases with gain-of-function mutations in STAT3. A total of 19 cases were identified, all were non-Chinese. Among 16 cases who had clinical data, age of onset of 11 patients was less than 5 years. 14 cases had autoimmune hemolytic anemia, autoimmune thrombocytopenia or autoimmune neutropenia. Twelve patients had lymphadenopathy while 11 had infections and 5 had endocrine abnormalities.@*Conclusion@#The patient with Primary immunodeficiency disease (PID) due to gain-of-function mutation in STAT3 gene often has early-onset autoimmune disorders, lymphadenopathy and recurrent infections. Since the routine immunological examination may be normal or slightly abnormal, comprehensive evaluation of immune function should be done. Genetic testing ultimately helps to confirm the diagnosis.
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Objective@#To investigate the clinical and immunological laboratory features, mutations in SH2D1A gene and SAP protein expression in four children of two families with X-linked lymphoproliferative disease type 1(XLP-1).@*Method@#Four patients (Family A including Patient 1 and Patient 2, Family B including Patient 3 and Patient 4) and their maternal relatives were enrolled in this study. The clinical manifestation, EBV infection status and chest CT scan were analyzed. The absolute and relative numbers of lymphocyte subsets, T lymphocyte proliferative response, SAP protein expression were assessed by flow cytometry. Quantification of signal joint TCR rearrangementexcision circle (sjTRECs), CDR3 spectratyping of TCRvβ and gene mutation of SH2D1A were detected by PCR based on genomic DNA or cDNA.@*Result@#Four male patients from two families were diagnosed with XLP-1. The ages of disease onset were more than 1 year, more than 1 year, more than 1 month and 6 months. The ages at diagnosis were nine years and ten months, sixteen years and eight months, fourteen years and ten months, four years and nine months. All patients had recurrent infections and EBV infection. Patients 1, 2, and 3 had agammaglobulinemia and Patient 4 had hypogammaglobulinemia. Chest CT scan showed all patients had atelectasis and pneumonia, and Patient 3 had bronchiectasis. Patient 3 was diagnosised as Burkitt lymphoma. For immunological function, all patients exhibited reduced CD4/CD8 ratios, increased numbers of exhausted T lymphocyte, decreased number of NK cell. The numbers of total B lymphocyte and naïve B lymphocyte were normal, but the number of memory B lymphocyte declined in all cases. Four patients′ copy numbers of sjTRECs were low and CDR3 spectratypings of TCRvβ showed mildly skewed. But their T lymphocyte proliferative response was normal. SAP protein expression in four cases were measured by flow cytometry. Two patients from Family A were absent and two patients from Family B showed decreased values. SH2D1A gene sequence analysis showed that the patients of Family A harbored a nonsense mutation (c.163 C>T; p.R55X) in exon 2. Their mother and two sisters were carriers. A missense mutation of SH2D1A gene (c.278 G>A; p.G93D) in exon 3 was found in the patients of Family B. The mother was carrier. Four patients remain survived, Patient 3 gave up treatment, other three patients received IVIG therapy.@*Conclusion@#Four patients with XLP-1 from two families characterized by agammaglobulinemia have an extreme vulnerability to Epstein-Barr virus (EBV) infection. The functions of T cell, B cell and NK cell are impaired at different stages. The detection of SAP protein and SH2D1A gene are the key methods for diagnosis of XLP-1.
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Objective To explore the methods and clinical effects of dimple plasty with syringe needle guiding.Methods From February 2008 to May 2012,36 dimple plasties in 21 patients were performed with using a syringe needle guiding the absorbable suture,including 15 cases in bilateral side and 6 cases in unilateral side.There were 4 cases in unilaterally right side and 2 cases in unilaterally left side.Two patients with inborn dimple in unilateral side received the dimple plasty in the other side for facial symmetry.Results 34 dimples in 21 patients were satisfied with the results.Two dimples were re-operated after three months because of disappearance.There were scleromas in 2 cases,which was disappeared by hot compress in three months.There were no hemotoma and infection in 21 patients.Conclusions The procedure of dimple plasty under syringe neddle guiding is safe,reusable and effective.It is a minimally invasive surgery and the patients are satisfied with the dynamic results after operation.
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Objective To investigate the change of umbilical cord blood gas from early-stage neonates with pregnancy-induced hypertension syndrome (PHIS) affected mothers and its influence upon internal environment of body,and to evaluate the significance of postpartum umbilical cord blood gas analysis.Methods Retrospective study of 101 neonates(born of 97 PHIS-affected mothers),41 cases of mild group,34 cases of moderate group,26 cases of severe group,and enrolled 52 neonates born of non-PHIS mothers as the control group.Prior to neonate's first breath,umbilical cord artery blood gas analysis was performedimmediately to determine the values of pH,arterial carbon dioxide partial pressure (PaCO2),arterial oxygen tension (PaO2),HCO3-,base excess (BE),and Apgar score was completed within 1 min after birth.Results The pH,PaO2,HCO3-,BE in severe group was significantly lower than those in mild group,moderate group,and control group [7.16 ± 0.18 vs.7.25 ± 0.09,7.22 ± 0.11,7.29 ± 0.08 ; (12.01 ± 2.75) mmHg (1 mmHg =0.133 kPa) vs.(18.35 ± 1.75),(14.21 ± 2.01),(22.23 ± 1.45) mmHg; (17.11 ± 2.42) mmoFL vs.(19.82 ±3.85),(17.32 ± 3.21),(22.56 ± 3.38) mmol/L; (-9.15 ± 0.32) mmol/L vs.(-7.95 ± 0.60),(-7.21 ± 0.08),(-6.76 ± 0.03) mmol/L] (P ＜ 0.05),the PaCO2 in severe group was significantly higher than that in mild group,moderate group,and control group [(61.84 ± 32.93) mmHg vs.(54.48 ± 12.82),(58.38 ± 15.32),(51.66 ± 10.52) mmHg] (P ＜ 0.05),Apgar score 1 min after birth was positively correlated with umbilical arterial pH (P ＜ 0.05),the lower Apgar score,the lower pH.Among 65 cases of Apgar score ≤ 7 scores,37 cases of acidosis (pH ＜ 7.20),the incidence rate was 56.92％ (37/65) ; among 88 cases of Apgar score ≥ 8 scores,11 cases of acidosis,the incidence rate was 12.50％ (11/88),the difference was statistically significant (P ＜ 0.01).Conclusions Umbilical cord blood gas analysis is more objective than Apgar score,which could reflect neonate's hypoxia-ischemia degree bore of PIHS mothers,as well as contributed to the assessment of neonate' s prognosis.Conventional umbilical cord blood gas analysis is necessary for neonates bore of PIHS-affected mothers.Enhanced monitoring should be performed in a timely manner on those neonates born after intrauterine distress signs or with low Apgar score,the prevention and therapy as early as possible can improve the quality of birth.
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BACKGROUND: More and more patients with periodontal disease require orthodontic treatments. Thus, the remodeling process and its mechanism of inflammatory periodontal tissues become a hot point during orthodontic tooth movement.OBJECTIVE: To observe the remodeling of inflammatory periodontal tissues during orthodontic tooth movement.METHODS: A total of 50 Sprague Dawley rats were randomly divided into the control and periodontitis groups. In the periodontitis group, rats were established periodontitis models. After that, all rats were prepared for orthodontic tooth movement models. The remodeling of periodontal tissues was observed by hematoxylin-eosin staining at 1, 3, 5, 7 and 14 days after orthodontic tooth movement.RESULTS AND CONCLUSION: The movement distance of the periodontitis group was greater than that of the control group. At 0-7 days after orthodontic force application, there was obviously bone resorption at the pressure side and the bone formation was inhibited at the tension side; at 14 days after force application, the bone resorption was diminished, associated with large numbers of multinucleated osteoclasts at the pressure sides in both groups. The findings showed that rats with periodontitis suffered more periodontal traumatism during orthodontic tooth movement, thus, treatment should be delayed until the inflammatory signs were controlled and the local inflammatory was eliminated.