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Objective:We evaluated frailty in elderly hospitalized patients with atrial fibrillation and analyzed the relevance, consistency, and diagnostic power of different frailty tools.Methods:From September 2018 to April 2019, a total of 197 elderly patients with atrial fibrillation aged ≥ 65 years in Beijing Hospital, Chinese PLA General Hospital, and Beijing Tsinghua Changgung Hospital were prospectively enrolled.Five frailty tools, including the clinical frailty scale(CFS), FRAIL scale(FRAIL), Fried frailty phenotype(Fried), Edmonton frail scale(EFS), and comprehensive geriatric assessment-frailty index(CGA-FI), were used for frailty assessment.Results:A total of 197 hospitalized elderly patients with atrial fibrillation were enrolled, with an average age of(77.5±7.1)years old(57.4% male). The prevalence of frailty, according to the five frailty tools, were 25.4%(FRAIL), 27.9%(EFS), 34.5%(Fried), 40.6%(CFS), and 42.6%(CGA-FI), respectively.CFS had a good correlation(correlation coefficient 0.80)and and consistency(Kappa value 0.71, 95% CI 0.61~0.81)with CGA-FI.The combined frailty index was used as the gold standard for frailty diagnosis.The results showed that CFS and CGA-FI had high diagnostic sensitivity(95.9 % and 98.0 %, respectively)and specificity(77.7 % and 75.7 %, respectively). Conclusions:Frailty is common in elderly hospitalized patients with atrial fibrillation, showing multidimensional features, and physical weakness is not prominet.CFS and CGA-FI are recommended for the assessment of frailty in patients with atrial fibrillation, which had good correlation and consistency.
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Objective:To compare the clinical effects between Dynesys dynamic stabilization with microendoscopic discectomy (MED) and posterior lumbar interbody fusion (PLIF) treatment for the degenerative lumbar spinal stenosis in the elder, and to evaluate clinical advantages of Dynesys with MED according to enhanced recovery after surgery (ERAS).Methods:All of 79 cases (male 31, female 48) who suffered from the degenerative lumbar spinal stenosis were include mean age 67.32±5.88 years (from 60 to 81 years) during January 2012 to December 2017. Thirty-nine patients received Dynesys dynamic stabilization with MED (Dynesys group) and 40 cases undergone PLIF (fusion group). The operative time, blood loss, drainage, length of hospital stay, and complications were compared between the two groups. The visual analog scale (VAS), Oswestry disability index (ODI) were used to assess efficacy. The range of motion (ROM) of the lumbar spine and the adjacent segment by dynamic radiographs between two groups were reviewed to evaluate radiological results.Results:The fusion group was larger than Dynesys group in operation time (271.00±57.19 min vs. 193.85±32.17 min), blood loss (458.25±136.85 ml vs. 316.41±87.64 ml), drainage (143.12±47.46 ml vs. 101.67±31.23 ml) and length of hospital stay (15.70±3.01 d vs. 13.38±2.72 d) with statistics differences ( P<0.05). There was a significant difference in VAS and ODI between the two groups at the final follow-up, and Dynesys group was superior to the fusion group (VAS: 1.51±1.21 vs. 2.40±1.48, t=2.910, P=0.005; ODI: 11.90%±6.15% vs. 17.73%±6.85%, t=3.974, P<0.001). The lumbar ROM of Dynesys group increased comparing with the fusion group at post-operation one year (19.21°±6.08° vs. 14.08°±5.80°, t=0.425, P<0.001) and final follow-up (20.56°±6.37° vs. 16.33°±6.94°, t=2.828, P=0.006). ROM of the adjacent segment increased in fusion group at final follow-up (7.45°±2.45°) compared to pre-operation (4.68°±1.98°) and post-operation one year (4.83±1.43°) with significant difference ( F=24.437, P<0.001). The rate of epidural damage, delayed union, surface infection, internal fixation loose, thrombus, pulmonary infection, bedsore, reoperation of the fusion group were all higher than Dynesys group. Conclusion:The Dynesys with MED demonstrated better clinical and radiological results than fusion for degenerative lumbar spinal stenosis. As a method of safety and efficiency, the Dynesys and MED can speed up postoperative recovery of elderly patients in line with ERAS.
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Objective:To investigate the effect of postsynaptic density-95(PSD-95)on long-term learning and memory impairment in neonatal rats induced by sevoflurane anesthesia.Methods:A total of 54 SD rats aged 7 days of SPF grade were randomly divided into 3 groups: control group (exposed to air), model group (exposed to 2.1% sevoflurane, 4 h/d, consecutive 3 days) and PSD-95 inhibitor group (inhaled sevoflurane+ intraperitoneal injection NA-1, consecutive 5 days), with 18 rats in each group.Morris water maze test and new object recognition test were used to detect the ability of visuospatial learning and memory and recognition memory of rats in each group.RT-qPCR was used to detect the mRNA levels of kalirin, Rac1 and PSD-95 in rat hippocampus.The expressions of kalirin, Rac1, PSD-95 and apoptosis related proteins Caspase-3, Bcl-2 and Bax in rat hippocampus were detected by Western blot.The expression levels of kalirin and Rac1 in hippocampus were detected by immunohistochemistry.SPSS 23.0 software was used for statistical analysis.Repeated measurement ANOVA and one-way ANOVA was used for comparing among groups.Results:Repeated measurement ANOVA showed that in the water maze test, the interaction between time and group of platform seeking latency and swimming distance of the three groups were significant ( Ftime×group=36.539, 41.548, both P<0.01). Simple effect analysis showed that the platform latency and swimming distance in the model group from day 2 to 6 were longer than those in the control group (platform latency from day 2 to 6: t=14.039, 17.147, 13.155, 13.831, 27.247, all P<0.01; swimming distance from day 2 to 6: t=10.122, 20.987, 7.267, 10.011, 8.121, all P<0.01). Compared with the model group, from day 2 to 6, the platform latencies of PSD-95 inhibitor group were prolonged( t=7.948, 14.768, 11.582, 12.832, 24.346, all P<0.01) and the swimming distances were increased( t=8.235, 24.325, 11.234, 12.031, 7.036, all P<0.01). The new object recognition test found that the new object exploration time in the model group was significantly longer than that in the control group ((21.30±2.27)s, (19.21±1.42)s, t=1.843, P<0.01), and the new object exploration time in the PSD-95 inhibitor group was significantly longer than that in the model group ((26.83±2.13)s, t=4.844, P<0.01). The difference index of novel objects in the model group was significantly lower than that in the control group ((0.41±0.12), (0.59±0.10), t=3.416, P<0.01), and the difference index of novel objects in the PSD-95 inhibitor group was significantly lower than that in the model group ((0.37±0.08), t=0.696, P<0.05). The qRT-PCR results showed that the expressions of Rac1, kalirin and PSD-95 mRNA in the model group were significantly lower than those in the control group ( t=9.969, 3.954, 6.561, P<0.05), and the expressions of Rac1, kalirin and PSD-95 mRNA in the PSD-95 inhibitor group were significantly lower than those of the model group ( t=2.132, 2.251, 3.502, all P<0.05). Immunohistochemistry results showed that the kalirin in the hippocampus CA1 area of the model group was significantly lower than that in the control group((8.18±1.94) vs (15.47±3.35), t=11.47, P<0.01), and kalirin in the PSD-95 inhibitor group was significantly lower than that in the model group((4.98±1.53), t=10.28, P<0.01); Rac1 in the model group was significantly lower than that in the control group ((3.72±1.53), (8.17±2.91), t=6.76, P<0.01), and the Rac1 in the PSD-95 inhibitor group(2.73±0.37) was significantly lower than the model group ( t=4.72, P<0.05). Western blot results showed that Caspase-3((1.37±0.16) vs (0.54±0.01), t=5.71, P<0.01) and Bax((1.87±0.31) vs (1.23±0.25), t=12.01, P<0.01) protein levels in the model group were significantly higher than those in the control group.Caspase-3 and Bax protein levels in the PSD-95 inhibitor group were significantly higher than those in model group (Caspase-3: (1.79±0.17), t=9.87, P<0.01; Bax: (2.19±0.21), t=16.19, P<0.01). The Bcl-2 protein level in the model group was significantly lower than that of the control group ((1.22±0.21) vs (1.96±0.38), t=11.92, P<0.01). And the Bcl-2 protein level in the PSD-95 inhibitor group (1.01±0.19) was significantly lower than that in the model group ( t=10.73, P<0.01). Conclusion:Sevoflurane anesthesia can damage the long-term learning and memory function and reduce the expression of PSD95 protein in neonatal rats.Inhibiting the expression of PSD95 can aggravate this damage, which may be related to the synaptic plasticity and apoptosis of neurons involved in PSD95.
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Objective To analyze the cause of the misdiagnosis of hepatolithiasisGassociated intrahepatic cholangiocarcinoma (IHHCC)by CT/MRI,and to improve early imaging diagnostic rate of IHHCC.Methods Thirteen patients histopathologically confirmed IHHCC after operation were retrospectively analyzed.1 1 cases had CT scans with contrast enhancement.5 cases had MRI scans with contrast enhancement and magnetic resonance cholangiopancreatography(MRCP).Combining with the imaging features of IHHCC (including the soft tissue mass shadow in the bile duct,the dilation and stenosis of the bile duct,the shriveling of the liver capsule,and etc.),medical history and serum tumor markers,misdiagnosis causes were analyzed.Results The causes of misdiagnosed IHHCC:(1 )High density bile duct stones in CT imaging concealed the soft tissue of adjacent cholangiocarcinoma;(2)The inconsistence of the degree and location of dilated bile duct with the location and size of bile dult stone was ignored;(3)Soft tissue lesions of cholangiocarcinoma with delayed enhancement were not carefully observed,or prolonged delayed scanning was not performed;(4)MRI scans and MRCP could show the tendrilGlike dilated intrahepatic bile duct,the filling defect of the bile duct wall with focally eccentric thickening,and stiffness of the bile duct;(5)Elder patients,long course of disease,recurrent attacks and increased CA19G9/CEA level could be factors related to IHHCC.Conclusion The early stage of hepatolithiasis combined with cholangiocarcinoma is easy to be misdiagnosed for cholelithiasis and cholangitis.DelayGenhanced CT,MRI scanning and MRCP are helpful to improve preoperative diagnostic rate for the patients with elder age,longer course of disease,repeated onset,increased CA1 9G9/CEA level and inconsistent degree of peripheral biliary dilatation with the size and location of the calculi.
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Objective To investigate the application of remote monitoring systems for cardiac implantable electronic devices (CIED) and its success rate of data transmission in elderly patients.Methods A total of 97 elderly patients who had previously undergone procedures for pacemaker implantation,implantable cardioverter defibrillators (ICD) or cardiac resynchronization therapy (CRT) with remote monitoring capabilities between January 2013 and October 2016 at our hospital were enrolled.We evaluated the effect of the remote monitoring systems for data transmission,compared the outpatient follow-up rates between the groups one year after implantation,and conducted a telephone survey of patients.Results A total of 97 elderly patients,including 70 with pacemakers,20 with ICD and 7 with CRT,were enrolled in this study.Participants had a mean age of (78.2-±-6.4) years and 64 were male (66.0％).The Home Monitoring system was used for 85 cases and the Merlin.net remote monitoring system was used for 12 cases.Overall,95 patients (97.9 ％) completed the remote monitoring procedure,68 patients (70.1％) completed the outpatient follow-up,and 90 patients (92.8％) completed the telephone survey during a one-year follow-up period.The satisfaction rate for the remote monitoring systems was 94.4％ (85 patients),and 80 patients (90.0％％) expressed a willingness to continue to use the remote monitoring system if a replacement was needed.Conclusions For elderly patients with CIED,the remote monitoring systems can improve the follow-up rate with a high degree of satisfaction.
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Objective To investigate the effects of dexmedetomidine on postoperative cognitive dysfunction (POCD) in patients with obstructive sleep apnea. Methods A total of 50 patients with obstructive sleep apnea were divided into 2 groups: a dexmedetomidine group and a control group. Dexmedetomidine and 0.9% saline solution were given before and during the operation in the dexmedetomidine group and the control group respectively. MMSE scores were estimated at different time, and the concentration of serum S100β and NSE were detected before anesthesia at 3 h, 6 h, 24 h and 48 h after operation. Results One day after surgery, MMES score decreased significantly in both groups,of which MMES was notably higher in the DEX group than that in the control group (P<0.05). In both groups, S100βand NSE levels were significantly higher at T2, T3 and T4 than those at T1, and were the highest at T3 (P<0.05). S100β and NSE levels were significantly lower in the DEX group than those in the control group (P<0.05). Conclusion Dexmedetomidine can reduce the incidence of POCD in patients with obstructive sleep apnea. Its mechanism may relate to neuroprotection.
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Objective To investigate the correlation between the location of ruptured intracranial vertebral artery dissecting aneurysm (VADA)and the outcome after endovascular treatment. Methods Thirty-six patients with ruptured intracranial VADA undergoing endovascular treatment were enrolled retrospectively. According to the relationship between VADA and the location of the opening of posterior inferior cerebellar artery(PICA),they were divided into 3 groups:proximal to PICA group (n=13), distal to PICA group (n=13),and PICA involvement group (n=10). The demographic data, vascular risk factors, clinical features, imaging features, endovascular treatment mode, postoperative complications, and differece of the good outcome rate(defined as the modified Rankin scale 0-2)after 6 months of treatment were compared.Results Seven patients in the proximal to PICA group received reconstructive endovascular treatment (RET), and 6 received endovascular internal trapping(EIT);the good outcome rate was 100%(13/13).Seven patients in the distal to PICA group received RET,6 were treated with EIT;the good outcome rate was 84.6%(11/13).Four patients in the PICA involvement group received RET,and 6 received EIT,and 2 of them received contralateral vertebral artery retrograde PICA stenting combined with VADA segment and proximal vertebral artery coil embolization;the good outcome rate was 60.0%(6/10). There were significant differences in the overall outcome good rate among the 3 groups (P<0.05). The good outcome rate in the PICA involvement group was significant lower than that in the proximal to PICA group,and significantly lower than that in the proximal to PICA combined with distal to PICA group(P<0.05).Multivariate logistic regression analysis showed that only Fisher grade 3-4 was the independent risk factor for poor outcome (odds ratio 28.0, 95% confidence interval 1.71-458.82; P=0.020). Conclusions The surgical options of endovascular treatment for ruptured intracranial VADA needs to evaluate the relationship between the location of dissecting aneurysms and the PICA origin. The risk of endovascular treatment in patients with intracranial VADA involving the origin of PICA is higher and it may affect the outcome.
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Objective To observe the safety and efficacy of different periprocedural anticoagulation strategies in patients undergoing catheter ablation of atrial ifbrillation. Methods Eighty-five patients aged over 75 undergoing catheter ablation of atrial fibrillation from Jul 2011 to Nov 2013 were enrolled. They all took warfarin and transesophageal echocardiograms were performed to rule out left atrium appendage thrombus before ablation. They were divided into 3 groups. In Group 1 (30 cases), warfarin was stopped and bridged with low molecular weight heparin (LMWH) 3 days before procedure and LMWH bridging followed by warfarin alone after procedure. In Group 2 (32 cases), warfarin was continued during periprocedural period. In Group 3 (23 cases), Dabigatran or Rivaroxaban alone was used 4 hours after procedure respectively. Unfractionated heparin was used during procedure in all three groups. These three anticoagulation strategies were compared in bleeding, embolism events and other complications during 3-month follow-up. Results In Group 1, there were 1 new-onset ischemic stroke during hospitalization, 7 lower extremity hematomas, 1 subdural hemorrhage during 3-month follow-up and 6 minor bleeding events. In Group 2, there were 4 lower extremity hematomas and 4 minor bleeding events during 3-month follow-up. As for Group 3, only 2 lower extremity hematomas during hospitalization was observed in each without any minor bleeding events during follow-up. Conclusions Catheter ablation in elderly atrial ifbrillation patients was safe and effective in general. Compared with traditional anticoagulation strategy, continuing warfarin or novel oral anticoagulants could reduce bleeding complications without increasing thromboembolism risk.
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Objective To investigate the clinical outcomes of the medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular for the flatfoot related with accessory navicular.Methods From March 2009 to October 2011,13 patients (16 feet) with flatfoot related with accessory navicular received treatment by the medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular.There were 4 males and 9 females,with an average age of 41.3 years (range,18-64 years).All patients had obvious valgus calcaneus,the angle of which was 11.3°± 1.4°.According to AOFAS ankle-hindfoot scores,the arch height,calcaneus inclination angle (CI),talocalcaneal angle (TC),talar first metatarsal angle (TMT) on the lateral weight-bearing radiograph of foot,and the talocalcaneal angle (TC),talar first metatarsal angle (TMT) on the AP view of the weight-bearing radiograph of foot,and the heel valgus alignment on axial radiographs of the hindfoot were measured on the X-ray film.Results All patients were followed up for 12 to 31 months,with the average of 16.8 months.Eleven patients (13 feet) felt no pain 6 months after operation,while 2(3 feet) felt pain after long walking.There was no complication,including infection,nerve injury,un-union,and so on.The average AOFAS ankle-hindfoot score improved from 56.4-±6.4 preoperatively to 88.1±2.8 at the last follow-up.Radio graphically,all parameters were statistically significant between pre-operation and the last follow-up,including the arch height,CI,TC,TMT modifying from 3.8±0.3 mm,9.5°±1.1°,47.3°±2.5°,17.6°±1.6° to 12.0±1.1 mm,20.1°±1.5°,32.3°±2.5°,6.8°±1.0° respectively on the lateral weight-bearing view; TC improving from 39.5°±2.3° to 26.2°±2.0°and TMT improving from 15.2°±1.7° to 6.3°±1.0° on the AP weight-bearing view.Conclusion The medial displacement calcaneal osteotomy with reconstruction of posterior tibial tendon insertion on navicular is a good choice for the treatment of flatfoot related with accessory navicular with excellent clinical outcomes.
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Objective To explore the manifestations of chest multi-slice spiral CT in patients with initial infection of swine-origin influenza A (H1N1) virus (S-OIV). Methods The chest multi-slices spirals CT images of 19 firstly diagnosed patients with swine-origin influenza A (H1N1) in our institution were retrospectively studied. CT manifestations were evaluated by three experienced radiologists. Location, appearance of lung abnormalities, abnormal distribution, pleural effusion and others (pericadiaum, lymphadenopathy and pleural thickening) were observed and quantitatively analyzed. The correlation of ground-glass and consolidation CT scores with the fever time was studied. Results The abnormal CT findings were observed bilaterally in 18 of 19 subjects including ground-glass (n= 3), consolidation (n=3 ), consolidation accompanied with ground-glass (n=12). Most of these lesions were distributed diffusively (n=14) while the others located in the middle and low lobes (n= 4). Unilateral (n=3) or bilateral (n=2) pleural effusion were observed. Lymphadenopathy (n=2), effusion of pericadium (n=1), pleural thickening (n=1) and cardiac enlargement (n=2) were also found in patients with H1N1. CT scores of ground-glass were 4. 25(n=2),3.75 (n=1),2.25(n=1),1.75(n=1),1.00(n=6),0.75(n=2), 0.50(n=2),0(n=4).CT scores of consolidation were4.25(n=1),4.00(n=1),3.75 (n=1), 2.75(n=1),1.25(n=3),1.00(n=2),0.75(n=2),0.50(n=1),0.25(n=3),0(n=4). CT scores of ground-glass were significantly correlated with the fever time (r= 0.776, P < 0.01), CT scores of consolidation had no correlation with the fever time(r=0.322,P > 0.01). Conclusions The most common CT findings in patients with S-OIV infection are diffuse distribution of bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. The increasing of ground-glass's range could be the marker of progression of H1N1 pulmonary infection at initial stage.
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Objective To summarize the clinical experience of endovascular intervention for intra-cranial aneurysms, especially in the respect of the technique and management of intra-operative complications. Method The clinical data of 60 patients with intra-cranial aneurysms treated with endovascular intervention in the past 3 years were analyzed. The relevant literature especially with regard to the practical technique described was reviewed so as to potentiall minimize and properly manage the intra-operative complications. Results A total of 69 sacciform aneurysms and one dissecting aneurysm located at left vertebral artery (VA) were detected by using digital subtraction angiography (DSA) in 60 patients. There were 65 saccular aneurysms obliterated with constructive approach, and five of them treated with stent-assisted technique and four of them treated with ballon-assisted technique. The VA dissecting aneurysm was obliterated with coils by deconstructive approach with complete occlusion of its parent vessel. There were a total of 53 complete occlusions of aneurysms accounted for 76.81% of 69 sacciform aneurysms in 51 patients ( 85 % ) and eight subtotal occlusion of aneurysms (95 % ～ 99 % occlusion) accounted for 13.56% of total sacciform aneurysms in five patients (8.47%) and four incomplete occlusion of aneurysms ( ＜ 95% occlusion) accounted for 6.78% of total sacciform aneurysms in three patients (5.08%), and one was failure in operation. The rupture of aneurysms occurred during operation in4 patients (6.78%). Two senile patients suffered from intra-opeartive symptomatic thromboembolisn. One patient had stent shifting and spring coil dislocated and moved into the M3 segment of the ipsilateral MCA. Vasospasm occurred in 15 patients during operation, and most of them received endovascular intervention 3 days after the initial ictus. The rate of good recovery was 93.3% at discharge from hospital (the modified Rankin Scales, mRS＜ 2). There were 55 patients followed up for up 24 months after discharge, and excellent recovery rate was found in 51 patients ( mRS ＜ 2), and 3 died.During the follow-up period, no aneurismal recanalization or rupture was noticed in all patients. Conclusions The endovascular intervention is a safe and effective approach to the intra = cranial aneurysms. Advances in the skill of technique and proper management will decrease the complications during operation and improve the prognosis of patients.
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Objective To study the clinical and pathological manifestations of microsporidian encephalitis.Methods The clinical findings and the brain pathological features of a patient with microsporidian encephalitis hospitalized in 2004 were studied.Results The onset was subacute or chronic. The body temperature was usually normal or below 37.5℃,but it rose when patient's condition deteriorated and coma appeaxed.The patient had hypoimmunity but without human immunodeficiency virus infection. Multifocal lesions in the whole brain,signs of meningeal irritation and infective myelogram were observed. Rheumatoid factor increased in the early stage and indirect bilirubin,proteins in cerebrospinal fluid(CSF), and immunoglobulin IgG,IgA increased in the middle stage.Cytological examination of CSF showed lymphocyte reaction.Blood routine test showed normal eosinophil granulocyte count.The patient was found to have pleurisy,peritonitis and cystitis.Brain magnetic resonance image(MRI)manifested plaque-like isometric T1 weight image and long T2 weight image signal in white matter of bilateral cerebral hemisphere and cerebella where FLAIR sequence showed hyperintensity.No apparent mass was identified.Contrast- enhanced MRI scan showed patchy and ring-like intensification.The neural system impairments were permanent and not improved after treatment.The pathology of brain tissue showed neuronal degeneration, karyopycnosis and Derivasculitis.The infectious agents were observed in the cytoplasm of neurons.Wister rats had muhiple organ inflammatory reaction 2 weeks after intraperitoneal inoculation of the patient's CSF and a large quantity of pathogens were found in the peritoneal lavage fluid.Conclusions The patient was PAS staining method is useful for detecting the pathogen in neurons and the rate can be raised by animal intraperitoneal cultivation