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Multiple sclerosis is a severe autoimmune inflammatory disease mainly involving the central nervous system. In recent years, the exploration of the mechanism of nerve injury in multiple sclerosis has made great progress. At the same time, disease-modifying therapeutic drugs with different targets are also emerging. Understanding of the mechanisms of nerve injury in multiple sclerosis can help clinicians comprehensively understand the evolution of disease-modifying therapeutic targets of this disorder. Here, the mechanisms of nerve injury in multiple sclerosis and the relationship with the evolution of disease-modifying therapeutic targets are reviewed.
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Objective:To analyze the healing effect of paeoniflorin on the wound of rats and regulation of NGF/Akt/GSK3β pathway on rats with diabetic foot.Methods:60 rats were randomly divided into normal control group, model group, low, medium and high dose paeoniflorin groups, 12 rats in each group. Diabetic foot model was established by intraperitoneal injection of streptozotocin (STZ) and electrothermal scald. Paeoniflorin groups were injected intraperitoneally with 20 mg/kg, 40 mg/kg and 80 mg/kg paeoniflorin, once a day for 21 days. The wound healing rate of the rats was measured. The fasting blood glucose was measured by blood glucose meter, HbAlc, TC, LDL-C and TG were measured by automatic biochemical analyzer. Serum CRP, IL-6, IL-1β and TNF-α were measured by ELISA. The histopathological changes of the wound were examined by HE staining, the levels of NGF, Akt and GSK3 β mRNA in skin tissue were measured by real-time quantitative polymerase chain reaction (RTq-PCR), the protein and phosphorylation levels of NGF, Akt and GSK3 β were determined by Western blot.Results:Compared with the model group, the healing rate the rats' wounded surface in the low, medium and high dose groups of paeoniflorin was increased ( P<0.05). The levels of fasting blood glucose, HbAlc, TC, LDL-C, TG levels and serum CRP, IL-6, IL-1β, TNF-α was decreased ( P<0.05). The expression of rat skin tissue NGF mRNA (0.83±0.12, 3.17±0.11, 4.54±0.25 vs. 0.31±0.06), Akt mRNA (1.71±0.14, 2.96±0.27, 4.10±0.34 vs. 0.97±0.20) increased ( P<0.05), expression of GSK3β mRNA (4.28±0.35, 2.82±0.14, 1.22±0.33 vs. 7.62±0.43) decreased ( P<0.05), expression of NGF (0.46±0.02, 0.70±0.04, 0.87±0.04 vs. 0.30±0.06), Akt (0.51±0.09, 0.63±0.03, 0.79±0.06 vs.0.41±0.05),p-NGF/NGF (0.47±0.06, 0.61±0.04, 0.83±0.07 vs. 0.25±0.03), p-Akt/Akt(0.54±0.08, 0.83±0.11,0.96±0.07 vs. 0.13±0.05) was increased( P<0.05), the expression of GSK3β (0.67±0.05, 0.54±0.04,0.45±0.03 vs. 0.86±0.05), and the ratio of p-GSK3β/GSK3β (0.78±0.09, 0.64±0.07, 0.42±0.07 vs. 0.97±0.05) was decreased ( P<0.05), and the changes of each index were dependent on the dose of paeoniflorin. Conclusion:Paeoniflorin can regulate the level of blood glucose and blood lipid, inhibit the level of serum inflammatory factors and promote the healing of the wound in diabetic foot rats, and its mechanism may be related to the regulation of NGF/Akt/GSK3β pathway.
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Objective:To observe the effect of enriched rehabilitation on dual-task gait disorder after a transient ischemic attack (TIA) and explore its mechanism.Methods:Sixty TIA patients were randomly divided into a control group and an observation group, each of 30. Another 30 healthy counterparts were selected to form a healthy control group. All of the TIA patients were given routine medication to lower blood pressure and improve brain function, while the observation group was additionally provided with enriched rehabilitation training for 12 weeks. Before and after the intervention, the gait and cognitive functioning of all of the subjects were quantified and their event-related potentials (P300s) and serum brain-derived neurotrophic factor (BDNF) levels were also measured.Results:Before the treatment there were significant differences between the TIA groups and healthy controls in all of the measurements, but there were no significant differences between the control and observation groups. After the treatment, no significant improvement was observed in any of the control group′s results, but there was significant improvement in the observation group′s gait parameters, cognitive functioning, average serum BDNF concentration and in the average latency and amplitude of its P300 signals.Conclusions:Enriched rehabilitation can improve the gait of TIA patients, perhaps through increasing their serum BDNF concentration and improving their cognition.
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Objective:To investigate clinicopathological features of hypopigmented mycosis fungoides (HMF) and hypopigmented interface T-cell dyscrasia (HITCD) .Methods:A total of 41 patients with cutaneous hypopigmented lymphoproliferative diseases, who had complete clinicopathological data, were collected from Department of Dermatology, the Third People′s Hospital of Hangzhou from January 2015 to September 2020, and the clinicopathological and immunophenotypic features were analyzed. Comparisons of normally distributed measurement data were carried out using t test, comparisons of categorical data using Chi-square test or Fisher′s exact test, and comparisons of ranked data between 2 groups using rank-sum test. Results:All of the 41 patients clinically presented with irregular hypopigmentation, some of which was accompanied by erythema or furfuraceous scales. In terms of pathological features, 21 patients showed infiltration and aggregation of atypical lymphoid cells in the epidermis, which was consistent with typical pathological features of mycosis fungoides, and they were diagnosed with HMF; 20 patients showed vacuolar degeneration of the basal layer, accompanied by infiltration of lymphoid cells and mild epidermotropism, and they were diagnosed with HITCD. All immune cells expressed T-cell phenotype, and epidermal lymphocytes expressed a CD8-dominated phenotype in 14 (67%) cases of HMF and 13 (65%) of HITCD. In the epidermis, the total number of lymphocytes was significantly higher in the HMF group than in the HITCD group ( t= 1.81, P= 0.012) ; in the dermis, the number of CD4 + lymphocytes and CD8 + lymphocytes, and the total number of lymphocytes were all significantly higher in the HMF group than in the HITCD group ( t= 2.64, 1.51, 2.60, P= 0.012, 0.002, 0.001, respectively) . All patients were treated with narrow-band ultraviolet B radiation. Among 34 patients who completed the follow-up, 30 achieved complete clearance of skin lesions without recurrence, including all patients with HITCD, and 4 with HMF achieved partial regression of the lesions. Conclusions:Compared with HMF, HITCD presents different pathological characteristics and benign biological behaviors. Thus, HITCD should be distinguished from HMF as an independent disease. Phototherapy alone is effective for the treatment of HITCD.
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Objective:To explore the value of series situational simulation teaching combined with symptoms-centered integrated teaching mode in clinical clerkship of obstetrics and gynecology.Methods:A total of 181 students from Batch 2016 of Clinical Medicine (experimental group) were enrolled to receive the series situational simulation teaching combined with symptoms-centered integrated teaching mode. The teaching results were evaluated by formative evaluation scores and questionnaire, compared with 195 students from Batch 2015 (control group). The statistical analysis was performed with SPSS 21.0.Results:Scores of formative evaluation in experimental group [(88.66±5.92) points] was higher than those in control group [(81.11±7.36) points], with statistically significant differences ( P<0.05). Satisfaction of students for teaching flexibility, teaching innovation, learning interest and clinical thinking in experimental group was greater than that of students in control group ( P<0.05). Meanwhile, compared with the control group, teachers from experimental group were more satisfied with teaching flexibility, teaching integration, students' participation and activity in classroom and cultivation of the clinical thinking ability and post competences ( P<0.05). Conclusion:The series situational simulation teaching combined with symptoms-centered integrated teaching mode can help students to form a systemic knowledge system, cultivate their clinical thinking ability and establish a holistic view of disease.
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Objective:To observe the effect of enriched rehabilitation training on cognitive function, plasma mir-146a-5p microRNA precursor levels and inflammatory factors in persons with post-stroke cognitive impairment (PSCI).Methods:Fifty-eight persons with PSCI were randomly divided into an observation group and a control group, each of 29. The observation group was given enriched rehabilitation training, while the control group was provided with conventional cognitive rehabilitation training. The Montreal Cognitive Assessment Scale (MoCA), the Digit Span Test (DST), parts A and B of the Trail Making Test (TMT A-B) and the Modified Barthel Index (MBI) were used to assess the subjects′ cognitive functioning and their ability in the activities of daily living (ADL). Plasma levels of mir-146a-5p, IL-6 and TNF-α were detected before and after the treatment.Results:After treatment, the average MOCA, DST and MBI scores, as well as the average TMT A-B times had improved significantly for both groups. However, the observation group′s averages were significantly better than those of the control group on all three tests. After the treatment, the average plasma expression of miR-146a-5p had increased significantly in both groups, but the increase in the observation group was significantly greater. Plasma IL-6 and TNF-α levels were significantly lower than before the treatment, with the average TNF-α level in the observation group significantly lower than that of the control group.Conclusions:Enriched rehabilitation training can improve the cognition of stroke survivors more effectively than conventional cognitive rehabilitation training. That may be related to the up-regulation of plasma miR-146a-5p and reducing inflammation.
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In medical field, the demand of high-level applied statistical talents is becoming more and more urgent, and the number of medical colleges to train graduate students of Master of Applied Statistics (MAS) is increasing gradually. Taking Chongqing Medical University as an example, this article introduces the objective, orientation and training mode of MAS education, analyzes the main characteristics of MAS professional education and talent training, discusses the problems mainly on training system and teaching base, combined with the interview results of MAS graduate students studying in CMU, and puts forward target suggestions including expanding the enrollment scale, optimizing the "two-tutorial system", advancing the training system and developing new teaching bases, to provide reference and experience for the teaching and training of MAS graduate students in medical colleges.
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Objective:To compare enhancement patterns of combined hepatocellular-cholangiocarcinoma (CHC) in CEUS and CECT/MRI and to explore the role of imaging, the discordance of imaging findings and tumor markers, differences in tumor markers in the diagnosis of CHC.Methods:Thirty-five CHCs from July 2011 to August 2019 in Third Central Hospital of Tianjin confirmed by pathological diagnosis were retrospectively reviewed. The enhancement patterns of CHCs on CEUS and CECT/MRI were compared. A combination of the discordance of CEUS and CECT/MRI, the discordance of elevated tumor markers and imaging findings and the discordance of tumor markers was applied to diagnose CHC.Results:About 62.9% and 37.1% lesions showed the HCC and ICC enhancement patterns on CEUS, while 48.6%, 31.4% and 20% lesions showed the HCC, ICC and CHC enhancement patterns, on CECT/MRI, respectively. For 12 lesions with a diameter≤3.0 cm, all of which presented HCC enhancement patterns on CEUS, and 91.7% lesions showed HCC enhancement pattern and 9.3% lesions showed ICC enhancement pattern on CECT/MRI, respectively. For 23 lesions with a size >3.0 cm, 43.5% and 56.5% of which showed the HCC and ICC enhancement patterns on CEUS, respectively. And 26.1%, 43.5% and 30.4% of the lesions showed the HCC, ICC and CHC enhancement patterns on CECT/MRI, respectively. If the discordance of CEUS and CECT/MRI, the discordance of image features and tumor markers, or simultaneous elevation of AFP and CA19-9, were used as diagnostic information, 78.6% of the lesions met at least one of the three criteria.Conclusions:CHCs show different enhancement patterns on CEUS and CECT/MRI. With the increase of size of tumors, the enhancement patterns of CHCs have changed from HCC-like to ICC-like or CHC-like. Combination of the discordance of CEUS and CECT/MRI, the discordance of imaging findings and tumor markers and differences in tumor markers can improve the detection rate of CHCs.
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Objective:To explore the clinical value of Liver Imaging Reporting and Data System (LI-RADS) version 2017 with contrast-enhanced ultrasound (CEUS) for the risk prediction of hepatocellular carcinoma (HCC).Methods:Five hundred and seventy-one patients with HCC risk factors had received CEUS examination in Tianjin Third Central Hospital, 270 patients with 295 nodules were enrolled in this study according to the inclusion criteria. The final diagnostic reference standard was decided by surgical pathology or ultrasound-guided biopsy pathology. Each nodule was classified according to CEUS LI-RADS v2017. The diagnostic accuracy of CEUS LI-RADS v2017 for the prediction of HCC was analyzed retrospectively.Results:Of all 295 nodules, 95 nodules were diagnosed by surgical pathology and 200 nodules by ultrasoud-guided biopsy pathology, among which with 245 HCC, 13 intrahepatic cholangiocarcinoma (ICC), 8 combined hepatocellular cholangiocarcinoma(CHC), 2 metastatic neoplasm of other cellular origin and 27 benign nodules.The numbers of LR-3, LR-4, LR-5 and LR-M categories were 16(5.4%), 28(9.5%), 183(62.0%), 68(23.1%) and the positive predictive value (PPV) of LR-3, LR-4 and LR-5 were 43.8%, 60.7%, 98.4% for HCC, respectively. The sensitivity, specificity and positive predictive value of LR-5 category for HCC were 73.5%, 94.0%, 98.4%, respectively. 60.3%(41/68) LR-M category nodules were pathologically confirmed to be HCC.Conclusions:CEUS LI-RADS v2017 classification standard has reliable risk prediction value for patients with high risk factors of HCC, of which the LR-5 category has higher PPV for HCC. However, the differential diagnosis between HCC and other non-HCC malignancies still remains to be further studied for LR-M observations.
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Objective@#To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis, and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC).@*Methods@#One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study. The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed. The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months. The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared. A new diagnostic strategy, which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study.@*Results@#The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814(P>0.05), the sensitivity were 79.1%, 81.4%, specificity were 92.6%, 81.5% and diagnostic accuracy were 82.3% and 81.4%, respectively. By combination of CEUS and EOB-MRI, the area under the ROC curve was 0.831, without difference from CEUS, EOB-MRI (0.831 vs 0.858, 0.814; all P>0.05); its sensitivity was 66.3%, specificity was 100% and diagnostic accuracy was 74.3%. The area under the ROC curve of the new diagnostic strategy, combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934, which was larger than that of CEUS, EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858, 0.814, 0.831; all P<0.05). The sensitivity, specificity and diagnostic accuracy of new strategy were 94.2%, 92.6% and 93.8%, respectively.@*Conclusions@#The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions, which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI.
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Objective@#To explore the value of superb micro-vascular imaging(SMI) combined with conventional ultrasound in differential diagnosis of polypoid lesions of gallbladder.@*Methods@#The ultrasonographic and pathological datas of 67 patients with polypoid lesions of gallbladder (of ≥1 cm) in diameter were analyzed retrospectively. According to the pathological results, the patients were divided into tumorous polyp group and non-tumorous polyp group.Conventional ultrasound, SMI and contrast-enhanced ultrasound (CEUS) were performed in all patients before operation, and the basal width, continuity of cystic wall and internal blood flow morphology of polyps were evaluated. The ROC curve was used to calculate the area under the curve and the optimum boundary value of tumorous polyps, the sensitivity and specificity of SMI combined with conventional ultrasound in the diagnosis of neoplastic polyps were calculated according to the optimal threshold. Kappa consistency test was used to analyze the consistency between microblood flow ability and CEUS shown by SMI technique.@*Results@#Of the 67 patients, 22 cases were neoplastic polyps, and 45 cases were non-neoplastic polyps.The polyps were scored quantitatively by SMI combined with conventional ultrasound (0-9 points) and the ROC curve was plotted with, area under curve 0.893(95% CI 0.792-0.994). The sensitivity, specificity and accuracy of diagnosing neoplastic polyps with score (≥4.5) were 77.3%, 93.3% and 88.1%, respectively. Compared with the score of CEUS for microblood flow display (0-4 points), the Kappa values of CDFI, SMI was 0.186, 0.688. SMI and CEUS have good consistency.@*Conclusions@#SMI combined with conventional ultrasound is helpful in differential diagnosis of polypoid lesions of gallbladder, with a high diagnostic value. SMI and CEUS have good consistency in the display of micro-blood flow. It can provide a new diagnostic basis for differential diagnosis of polypoid lesions of gallbladder.
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Objective To explore the value of superb micro-vascular imaging(SMI)combined with conventional ultrasound in differential diagnosis of polypoid lesions of gallbladder.Methods The ultrasonographic and pathological datas of 67 patients with polypoid lesions of gallbladder (of ≥1 cm) in diameter were analyzed retrospectively.According to the pathological results,the patients were divided into tumorous polyp group and non-tumorous polyp group.Conventional ultrasound,SMI and contrast-enhanced ultrasound (CEUS) were performed in all patients before operation,and the basal width,continuity of cystic wall and internal blood flow morphology of polyps were evaluated.The ROC curve was used to calculate the area under the curve and the optimum boundary value of tumorous polyps,the sensitivity and specificity of SMI combined with conventional ultrasound in the diagnosis of neoplastic polyps were calculated according to the optimal threshold.Kappa consistency test was used to analyze the consistency between microblood flow ability and CEUS shown by SMI technique.Results Of the 67 patients,22 cases were neoplastic polyps,and 45 cases were non-neoplastic polyps.The polyps were scored quantitatively by SMI combined with conventional ultrasound(0-9 points) and the ROC curve was plotted with,area under curve 0.893 (95％ CI 0.792-0.994).The sensitivity,specificity and accuracy of diagnosing neoplastic polyps with score(≥4.5) were 77.3％,93.3％ and 88.1％,respectively.Compared with the score of CEUS for microblood flow display(0-4 points),the Kappa values of CDFI,SMI was 0.186,0.688.SMI and CEUS have good consistency.Conclusions SMI combined with conventional ultrasound is helpful in differential diagnosis of polypoid lesions of gallbladder,with a high diagnostic value. SMI and CEUS have good consistency in the display of micro-blood flow.It can provide a new diagnostic basis for differential diagnosis of polypoid lesions of gallbladder.
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Objective To compare the diagnostic efficacies of contrast-enhanced ultrasonography (CEUS) and gadoxetic acid-enhanced magnetic resonance imaging (EOB-MRI) in the diagnosis of liver nodules ≤2.0 cm in patients with cirrhosis,and to explore the clinical values of combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI in the diagnosis of early hepatocellular carcinoma (HCC).Methods One hundred and thirteen nodules with diameters lower than 2.0 cm in 98 patients from February to December 2016 in Tianjin Third Central Hospital were included in this retrospective study.The enhancement patterns of nodules in CEUS and EOB-MRI were analyzed.The reference standard was pathological diagnosis or substantial lesion growth at a follow-up of at least 6 months.The efficiencies of CEUS and EOB-MRI in the diagnosis of liver lesions with a diameter lower than 2.0 cm were compared.A new diagnostic strategy,which combines the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was presented to diagnose the early HCC in this study.Results The area under the ROC curve of CEUS and EOB-MRI were 0.858 and 0.814 (P ＞ 0.05),the sensitivity were 79.1％,81.4％,specificity were 92.6 ％,81.5 ％ and diagnostic accuracy were 82.3 ％ and 81.4 ％,respectively.By combination of CEUS and EOB-MRI,the area under the ROC curve was 0.831,without difference from CEUS,EOB-MRI (0.831 vs 0.858,0.814;all P ＞0.05);its sensitivity was 66.3 ％,specificity was 100％ and diagnostic accuracy was 74.3％.The area under the ROC curve of the new diagnostic strategy,combining the arterial phase of CEUS and hepatobiliary phase of EOB-MRI was 0.934,which was larger than that of CEUS,EOB-MRI and the combination of CEUS and EOB-MRI(0.934 vs 0.858,0.814,0.831;all P ＜0.05).The sensitivity,specificity and diagnostic accuracy of new strategy were 94.2％,92.6％ and 93.8％,respectively.Conclusions The new diagnostic strategy based on the arterial phase of CEUS and hepatobiliary phase of EOB-MRI improves the sensitivity and accuracy in detecting small lesions,which can be used as a complementary diagnostic enhancement pattern for lesions with an atypical enhancement pattern in CEUS or EOB-MRI.
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Recently,the U.S.Food and Drug Administration has granted premarket approval for bilateral anterior thalamic nucleus stimulation as adjunctive treatment for reducing the frequency of partial-onset seizures in adults who are refractory to three or more antiepileptic medications.The anterior nucleus of the thalamus (ANT) is a primary component of the limbic system (the Papez circuit),which represents a fundamental pathway for seizure propagation.Scholars speculated that ANT is an anatomic target that may halt or influence seizure propagation or epileptogenic foci originating within the limbic system.Some suggestions on the possible factors associated with the efficacy of ANT stimulation put forward by experts are helpful.However,given the limited clinical data,there is a lack of valid predictors of individual treatment response.Most importantly,rational patient selection relies on a detailed and careful anatomo-electro-clinical analysis for individualized treatment.
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To explore the changes of serum miR-375 and its target genes in patients with allergic rhinitis (AR) before and after treatment and its significance. Methods: A total of 120 AR patients treated in Wuhan Fourth Hospital were selected as an observation group (AR group), and 120 healthy volunteers served as a control group. Real-time quantitative polymerase chain reaction was used to detect the expression changes of miR-375 and its predicted target genes, such as 3-phosphoinositide-dependent protein kinase-1 (PDK1), protein kinase B (AKT1), Janus kinase 2 (JAK2), and signal transducer and activator of transcription 3 (STAT3), as well as inflammatory factors, such as tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-10 (IL-10), and interleukin-13 (IL-13) in the AR group before and after treatment. According to the relative expression levels of miR-375 and target genes, the AR patients were also subdivided into a high expression group and a low expression group for comparative analysis. Results: Before treatment, the level of miR-375 in the serum in the AR group was higher than that in the control group (P<0.01); the expressions of PDK1, AKT1, JAK2 and STAT3 in the plasma in the AR group were lower than those in the control group (all P<0.01); the plasma levels of TNF-α, IL-6, IL-10, and IL-13 in the AR group were higher than those in the control group (all P<0.05). After treatment, compared with the control group, the level of miR-375 in the serum was down-regulated (P<0.01), while the levels of target genes (PDK1, AKT1, JAK2 and STAT3) were up-regulated (all P<0.05), and the levels of TNF-α, IL-6, IL-10, and IL-13 were down-regulated in the AR group (all P<0.05). The total effective rate, total nasal symptom score (TNSS), symptom improvement time, and incidence of adverse reactions in the AR groups with high expression of miR-375 and low expression of target genes before treatment were better than those in the correspending groups with low expression of miR-375 and high expression of target genes (all P<0.05). Conclusion: MiR-375 might be a potential predictor of treatment response for AR patient, which might be related to the plasma levels of its target genes and inflammatory factors.
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Humans , Interleukin-6 , MicroRNAs , Rhinitis, Allergic , STAT3 Transcription Factor , Tumor Necrosis Factor-alphaABSTRACT
Objective To find a simple, sensitive and effective method to predict the occurrence of cogni-tive impairment in patients after a transient ischemic attack ( TIA) . Methods Thirty-six persons who had survived a first TIA and could walk independently were selected into a TIA group, with another 36 healthy counterparts chosen to form a control group. Those in both groups were given a gait analysis during dual-task walking at the outset and then assessed using the MoCA scale 12 months later. Statistical analyses were conducted to assess the reliability of gait pa-rameters in predicting cognitive dysfunction, and the area under the receiver operating characteristics curve was calcu-lated. Results On the day after enrollment the variation in step length among the TIA patients with an abnormal step length was compared with variation among the normal controls and among the TIA patients with non-abnormal step-size. The differences were significant. The average walking speed of the TIA patients with an abnormal average walking speed was significantly different from that of the control group and that of the TIA patients with non-abnormal average speed. On the day after enrolling, the accuracy rate of the control group in the dual-task walking test was sig-nificantly better than that of any of the TIA patients, and the accuracy rate of the TIA patients with an abnormal gait in the dual-task walking test was significantly lower than that of the patients with a non-abnormal gait. Twelve months later the number of patients whose MoCA scores were less than 26 in the abnormal gait group was compared with that in the normal gait group, and the difference was statistically significant. The area under the receiver operating charac-teristics curve suggests that both the incidence of step length variation and the average stepping speed could signifi-cantly predict the occurrence of cognitive dysfunction 12 months later. Conclusion Quantitative analysis of gait while dual-task walking can effectively predict the occurrence of cognitive impairment in patients with TIA, and can detect abnormalities earlier than the MoCA scale test.
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Objective To develop new scales on the severity of myasthenia gravis ( MG) which are suitable for clinical practice in China .Methods A final version of new comprehensive scale was developed by item optimization from a preliminary scale established by combination of Delphi method and previous evaluation of items from source scales .With the original quantitative data from 60 MG patients, items were selected on the basis of interobserver and test-retest reliability of items , the contributions of items on internal consistency and construct validity of the preliminary scale .Evaluation of this final scale includes internal consistency, interobserver and test-retest reliability, construct validity and correlation with currently used scales.A self-rating version was simplified from the final scale by including items that can be measured by patients, which was then evaluated in 57 generalized MG patients.Results One item ( palpebral fissure ) was deleted from the preliminary scale due to poor interobserver and test-retest reliability.The remaining nine items constituted the final comprehensive scale which covered six commonly involved muscle groups in MG.All items in the comprehensive scale had fair to excellent interobserver reliability ( K=0.43-0.80, P<0.01) and fair to excellent test-retest reliability ( K =0.41 -1.00, P<0.01) .The comprehensive scale had acceptable internal consistency (Cronbach ɑ=0.63), excellent interobserver reliability (intraclass correlation coefficient (ICC) =0.88, P<0.01) and test-retest reliability (ICC=0.86, P<0.01).The comprehensive scale had four common factors and good construct validity ( cumulative dedication rate 68.46％).There was high correlation between the comprehensive scale and Myasthenia Gravis Composite ( MGC ) , Absolute and Relative Score of MG ( ARS-MG ) and Quantitative Myasthenia Gravis score (QMGs) ( r=0.87 -0.90, P<0.01), and moderate correlation between the comprehensive scale and Myasthenia Gravis Activities of Daily Living (MG-ADL) (r=0.68, P<0.01).A self-rating scale was developed by deleting ocular and facial items and keeping the remaining six items , which covers the bulbar , limb, neck and respiratory muscles.Internal consistency (Cronbach ɑ=0.69), interobserver reliability and test-retest reliability (ICC=0.90 for both, P<0.01) of the self-rating scale were better than those of the comprehensive scale.The self-rating scale had two common factors and good construct validity ( cumulative dedication rate 64.24％) .There was high correlation between the self-rating scale and the comprehensive scale, MGC and ARS-MG (r=0.74-0.86, P<0.01), and moderate correlation between the self-rating scale and QMGs and MG-ADL ( r=0.55 -0.68, P<0.01 ) .Conclusions Item optimization was performed from a preliminary scale established by Delphi method .A new comprehensive scale and a self-rating scale were developed .The comprehensive scale and self-rating scale had good reliability and validity , which can be used to assess the severity of MG reliably and effectively .
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Objective To investigate the sleep quality and influencing factors in patients with stable myasthenia gravis (MG).Methods From September 2015 to February 2017,151 cases of stable MG were enrolled in the department of neurology,West China Hospital,Pittsburgh sleep quality index (PSQI) was used to evaluate their sleep quality;Spearman analysis was used to analyze the influencing factors (clinical data,quality of life,anxiety and depression).Results Spearman test analysis showed that PSQI was positively correlated with age,duration,myasthenia gravis quality of life 15 (MG-QOL15),Hamilton Anxiety Scale 14 (HAMA14),Hamilton Depression Scale 24 (HADA24) (P ＜ 0.05).Stepwise regressionanalysis further revealed that life quality was the best predictor of reduced sleep quality (t =3.161,P =0.002),followed by anxiety (t =2.495,P =0.014) and age (t =2.356,P =0.020).Conclusions There are many influencing factors of stable MG wnich more attentions should be paid on.
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Objective To analyze Glisson system-related complications after percutaneous thermal ablation of liver cancer and the relationship with tumor location.Methods Data of 2 218 case-times of ultrasound-guided percutaneous thermal ablation in 1 879 patients with liver cancer were retrospectively analyzed.Four types were defined according to the relative position between the tumor and Glisson system:Tumor close to the first branch of the portal vein (type Ⅰ),the second branch of the portal vein (type Ⅱ),the third branch of the portal vein (type Ⅲ) and far away from portal vein (type Ⅳ).Types Ⅰ to Ⅲ were classified as close to Glisson system group,while type Ⅳ was classified as far away from Glisson system group.The Glisson system-related complications (cholesteatoma,bile leakage,serious biliary stricture,cholangiobronchial fistula,arterio-venous fistula and arterial aneurysm) were analyzed.Results Glisson system-related severe complications occurred after 20 case-times (20/2 218,0.90 ％) of thermal ablation.The incidence of Glisson system-related severe complications in close to Glisson system group (1.81 ％ [16/886]) was higher than that in far away from Glisson system group (0.30％ [4/1 332],P＜0.001).The incidence of Glisson system-related severe complications of type Ⅰ,Ⅱ,Ⅲ and Ⅳ was 6.35％ (4/63),3.52％ (5/142),1.03％ (7/681) and0.30％ (4/1 332),respectively (P＜0.001).Glisson system-related mild complications included liver function damage (280 case-times),portal thrombosis (156 case-times) and slight cholangiectasis (82 case-times).The incidences of the three Glisson system-related complications mentioned above decreased from type Ⅰ to Ⅳ.Conclusion Percutaneous thermal ablation is safe in treating patients with tumors close to Glisson system.But the risk of incidence of Glisson system-related severe complications is higher when the tumor is close to the more advanced branch of portal vein.
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Objective To investigate the curative effect of Zhizhukuanzhong capsule combined with Deanxit in the treatment of functional dyspepsia ( FD) of spleen -deficiency and qi -stagnation.Methods Seventy -six patients with FD were randomly divided into three groups .A group (24 cases)_was given Zhizhukuanzhong combined with Deanxit,B group (26 cases) was given Zhizhukuanzhong ,C group (26 cases) received trimebutine dispersible tablets treatment.After treatment for 8 weeks,the symptoms of indigestion,depressive state and therapeutic effect were observed.Results Before treatment,there were no statistically significant differences in the symptoms of dyspepsia (all P>0.05).After treatment,the symptoms of dyspepsia were improved in different degree ,the effective rates of A, B,C three groups were 91.6%,65.4% and 42.3%,respectively,there was no statistically significant difference between A group and B group(χ2 =1.579,P=0.209);there was statistically significant difference between A group and C group(χ2 =13.549,P=0.000);there was no statistically significant difference between B group and C group (χ2 =2.786,P=0.09).The FD patients complicated with varying degrees of anxiety and depression ,there was no statistically significant difference among the three groups before treatment (P>0.05).After treatment,comparison of HAMA and HAMD scores among the three groups:there were statistically significant differences between A group and B group (tHAMA =6.839,tHAMD =4.607,all P<0.05),A group and C group (tHAMA =20.069,tHAMD =15.342,all P<0.01),B group and C group (tHAMA =11.951,tHAMD =12.071,all P<0.01).After treatment,the HAMA,HAMD scores of A group and B group were significantly decreased compared with before treatment ( A group tHAMA =52.758,tHAMD=49.970,B group tHAMA =30.230,tHAMD =17.151,all P<0.01).Those in C group had no statistically significant decline compared with before treatment (tHAMA =7.845,tHAMD =3.530,all P>0.05).The adverse reactions of A group were mainly weakness ,dizziness,drowsiness,which were alleviated within 2 weeks.The adverse reactions of B group were slight stomach disease and stool frequency increased ,which not affected the treatment.The adverse reactions of C group were digestive tract symptoms ,which lasted for more than 2 weeks.Conclusion Zhizhukuanzhong capsule combined with Deanxit in the treatment of FD of spleen -deficiency and qi -stagnation can obtain good curative effect,it is safe,convenient,and with minor side effects,good compliance.