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Objective:Shizukuishi scoring method was used to compare the diagnostic value of parotid gland and submandibular gland scintigraphy for Sj?gren's syndrome (SS).Methods:Parotid gland and submandibular gland scintigraphy were conducted in 124 SS patients and 91 control subjects respectively, the results of scintigraphy of each gland were evaluated by excretion rate and 0-3 points per gland, the diagnostic accuracy of parotid and submandibular gland scintigraphy was compared by receiver operating characteristic curve (ROC).Results:The score of parotid scintigraphy was 0-6, with the cut-off value of 2, the sensitivity for diagnosis of SS was 76.9%, the specificity was 72.6%, the area under the curve (AUC) was (0.798±0.030). The score of submandibular scintigraphy was 0-6, with the cut-off value of 2. The sensitivity for diagnosis of SS was 78.0%, the specificity was 78.2%, the area of AUC was 0.854±0.026.Conclusion:The diagno-stic value of the submandibular gland scintigraphy is good.
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Clinical decision-making is a series of activities of medical scheme selection, which determines the direction of medical behavior and the level of patients' welfare. In practice, clinical decision-making is not only restricted by medical technology factors, but also by non-technical factors. Therefore, it is necessary to analyze and predict the possible influence of non-technical factors in clinical decision-making. Game theory is a scientific system of strategic choice, which can effectively predict and analyze the impact of non-technical factors on clinical decision-making process. According to the game analysis results between doctors and patients, medical management and pharmaceutical enterprises, we can predict the non-technical impacts in clinical decision-making and their influence paths, guide clinical decision-makers to choose excellent strategies, abide by rationality and give up moderately, so as to improve the level of clinical decision-making and the welfare of patients.
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Objective To investigate the clinical effect of root canal filled epoxy resin paste in the treatment of periapical periedontitis.Methods From January 2017 to January 2018,60 cases of periapical periodontitis in the Fourth People's Hospital of Tongxiang were selected and divided into two groups according to the random table method,with 30 cases in each group.The observation group was treated with root canal filling with epoxy resin paste,while the control group was treated with traditional root canal paste.The two groups were first examined by X ray examination before treatment,to determine the periodontal root tip condition,conventional pulp opening,root canal preparation and irrigation,and pullout.The pain effects of the two groups after 1 week of treatment were compared,and the efficacy of 6 months after treatment was compared.Results The pain level 0 in the observation group at 1 week after treatment (66.67％) was significantly higher than that in the control group (36.67％) (μ =5.41,P =0.019).The effective rate at 6 months after treatment in the observation group (90.00％) was higher than that in the control group (63.33％) (μ =5.96,P =0.013).Conclusion The root canal filling epoxy resin paste has significant clinical effect in the treatment of periapical periodontitis,and it is worthy of clinical application.
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Objective To clarify the diagnostic value of salivary gland ultrasonography in Sj(o)gren's syndrome (SS),and its correlation with the disease activity index and important organs involvement were analyzed.Methods A total of 116 patients with SS were involved,including 71 cases of primary SS and 45cases of secondary SS.Ultrasonography examination of major salivary glands was conducted for these patients,at the same time the clinical data including inflammatory parameters,the immunological parameter and the involved systems were collected.Ultrasonography examination was conducted in 49 cases as the control group.Use t test,x2test and analysis of variance for statistical analysis.Results The positive rate of salivary gland uhrasonography in SS (56/116,48.3％) was significantly higher than that of the normal control groups (1/49,2.0％),(The chi-square value was 32.57,P＜0.05),the sensitivity of salivary gland ultrasonography in primary SS (62.0％) was obviously higher than secondary SS (27％),(The Chi-square value was 13.75,P＜0.01).The specificity of salivary gland ultrasonography was 98％.The scores of salivary gland ultrasonography had shown positive correlation with the erythrocyte sedimentation rate,the levels of Immunoglobulin (Ig)G,and RF(r=0.234,0.353,0.176;P=0.002,0.000,0.013),and negative correlation with the white blood cell count (r=-0.292,P=0.000).Conclusion Salivary gland ultra-sonography provides additional evidence for the diagnosis of SS,particularly in primary SS groups.The scores of ultrasonography are correlated with inflammatory biomarkers,indicating that salivary gland ultrasonography is related to disease activity.
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Objective To derive a questionnaire to assess the risk of developing motor complications through a 3-year prospective investigation on 71 patients of Parkinson' s disease (PD) in the out clinic at our hospital.Methods Three years after the first assessment,71 PD out patients were reassessed using various scales,including Unified Parkinson Disease Rating Scale,Hoehn-Yahr grade,Mini Mental State Exam,Hamilton Depression Scale and Hamilton Anxiety Scale.Results The incidence of motor complications was 43.6％ (31/71).Logistic regression analysis showed that the prognostic factors for motor fluctuation were age of onset ≤ 54 (OR =6.4,95％ CI 1.7-24.5,P =0.006),the occurrence of swallowing difficulty (OR =3.8,95 ％ CI 1.0-14.1,P =0.04) and depression (OR =4.0,95 ％ CI 1.1-13.7,P =0.03),and the prognostic factors for dyskinesia were age of onset ≤54 (OR =48.5,95％ CI 1.9-121.0,P:0.02),the occurrence of falling (OR =64.1,95％ CI 2.9-142.2,P =0.008) and the daily levodopa dosage ＞ 600 mg(OR =17.5,95％ CI 1.1-276.2,P =0.04).Based on the regression model,the assessment questionnaire for motor complicationsincludes the followings:the questionnaire for motor fluctuations:the age of onset ≤54,2 points; the occurrence of swallowing difficulty,1 point; the occurrence of depression,1 point; the questionnaire for dyskinesia:the onset age ≤54,2 points; the occurrence of falling,3 points; daily levodopa dosage ＞ 600 mg,2 points.In all patients in this study,21.7％ (10/46) was asscssed to a total scorc of 0-1 which is associated with a low risk of motor fluctuation,8/16 had a score of 2 which is associated with intermediate risk and 8/9 got a score of 3-4 associated high risk; 10.2％ (5/49) had a score of 0-2,a low risk of dyskinesia,4/13 had a score of 3-4,a intermediate risk and 7/9 got a score of 5-7 which is associated with a high risk.Conclusions Age onset ≤54,the occurrence of swallowing difficulty,falling and depression,daily levodopa dosage ＞ 600 mg were considered to be the prognostic factors of motor complications in PD.The questionnaire may help to stratify PD patients into low-risk,medium-risk and high-risk groups for motor complications and the higher the score in the questionnaire is related to the higher risk of motor complications.
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Objective To observe progression of motor symptoms and occurrence of motor complications in parkinsonian patients and investigate the rate of progression of motor symptoms and risk factors of motor complications.Methods One hundred and thirty patients diagnosed with PD in 2007 in Department of Neurology,Xinhua Hospital were followed up for 3 years.The Unified Parkinson' s Disease Rating Scale (UPDRS) and H-Y staging were used to assess and follow up motor symptoms and occurrence of motor complications,and analyze the rate of progression of motor symptoms and risk factors of motor complications with statistics.Results ( 1 ) Mean annual growth in H-Y staging was 2.5％,and UPDRS motor scores was 3.1％ ; the incidence of dysphagia at endpoint in patients was increased by 23.0％ compared with baseline; incidence of falls was increased by 16.7％;(2)Daily levodopa dose at endpoint ( OR =1.004,95％ CI 1.001—1.006,P =0.008 ) was independent risk factors with dyskinesia; While duration ( OR =1.637,95％ CI 1.083—2.473,P =0.019 ),levodopa treatment duration ( OR =0.698,95％ CI 0.494—0.987,P =0.042 ),daily levodopa dose at haseline ( OR =1.005,95％ CI 1.001—1.010,P =0.016) and at endpoint ( OR =1.014,95 ％ CI 1.001 —1.027,P =0.032 ) were risk factors with motor fluctuations.Conclusions As the disease progresses,motor function in parkinsonian patients gradually worsens,the incidence of swallowing difficulty and of falls is increased,and the incidence of motor complications is increased.The total exposure to levodopa in parkinsonian patients is predictor for motor complications.
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Objective To assess the development,progression and change of nonmotor symptoms in patients with Parkinson' s disease and its impact on patients' quality of life.Methods Eighty-seven consecutive patients with idiopathic Parkinson' s disease were studied.Parkinsonian status was assessed at baseline and 3 years follow-up using Unified Parkinson' s Disease Rating Scale (UPDRS) part Ⅲ & Ⅳ,Nonmotor Symptoms Questionnaire (NMSQuset),Parkinson-related quality of life (PDQ) scales.Paired ttest,Chi-square test,Spearman rank order correlation and hierarchical regression of the major statistical procedures were employed.Results At 3 years follow-up,compared to baseline,the UPDRS Ⅲ score (22.21 ±11.31 vs 30.49± 11.68),UPDRS Ⅳ score(1.00±1.54 vs 2.94±3.12),NMS score (7.98±3.96 vs 12.35 ± 5.12) and PDQ score (28.11 ± 22.88 vs 36.65 ± 26.95) were significantly higher ( t =- 5.54,- 5.75,- 6.46,- 5.29,all P =0.000,respectively).The aggravation of motor and nonmotor symptoms caused the decline of quality of life.The prevalence of constipation,problem of remembenng thing,nocturia ranked tops,and depression,and anxiety were still in the middle,compared with baseline.The prevalence of pains,sweating,dribbling,sense of incomplete emptying etc were significantly increased during the follow-up,△R2 were 21.6％ and 23.4％ respectively,resulting in the deterioration of quality of life.Conclusions PD nonmotor symptoms appear from the early stage.The motor and nonmotor symptoms aggravate over time.
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Objective To study the incidence of rapid eye movement sleep behavior disorder (RBD) and its impact on the clinical manifestations of patients with Parkinson' s disease (PD). Methods One hundred and twenty-four PD patients were included into this study and each of them was given the non motor symptoms questionnaire (NMSquest) to investigate the incidence of RBD. The PD patients were then divided into the RBD group and non RBD group, according to their answers to the NMSquest. Then the clinical differences were investigated between PD patients with and without RBD on the aspects of demographic characters, Hoehn-Yahr (H-Y) stage, the scores of Unified Parkinson Disease Rating Scale (UPDRS) sub-items, the incidence of non motor symptoms, and the dysfunctions of non motor systems (cognitive impairment, anxiety, depression and sleep disorders ). The evaluation tools of non motor functions include Mini Mental State Exam ( MMSE), Hamilton Depression Scale (HAMD), Parkins' s Disease Sleep Scale (PDSS) and Epworth Sleepiness Scale (ESS). Results ( 1 ) 62.9% (78/124) of the PD patients have been experiencing RBD. (2) The course of the disease in RBD group ( 3.8 ± 2.8 ) was significantly shorter than non RBD group (5.0 ± 2.5, t = - 1. 972, P = 0. 048 ) while the sex, age, onset age and the mode of onset, Levodopa dose equivalents (LDE) and the kinds of medicines showed no difference between the two groups. (3) H-Y stage, the scores of UPDRS sub-items and the incidence of motor complications showed no difference between RBD and non RBD group. (4) Most of the non motor symptoms, including the gastrointestinal dysfunctions, autonomic dysfunctions, mood disorders and sleep disturbances, occurred much frequently in RBD group, however, the scores of MMSE, HAMD, HAMA,PDSS and ESS showed no difference between the RBD and non RBD group. Conclusion RBD commonly occurred in PD patients, and PD patients with RBD have a tendency to suffer from dysfunction of non motor systems.
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Objective To determine the prevalence of rapid eye movement(REM)sleep behavior disorder(RBD)in patients with Parkinson' s disease(PD)and to investigate the risk factors of PD-RBD and its effect on the progress of PD. Methods Using the minimal diagnostic criteria of parasomnias described in the International Classification of Sleep Disorders-Revised(ICSD-R)to diagnose clinically probable RBD(cpRBD), patients were assessed by Unified Parkinson's Disease Rating Scale(UPDRS),MMSE, Montreal Cognitive Assessment(MoCA)at baseline and followed for 2.5 years. Results The frequency of cpRBD ranged from 35.6%(47/132)to 41.7%(55/132)during the study period. 11.4% (15/132)patients dropped out from the study. Lower MoCA score and type of onset are independent factors with cpRBD; Lower MoCA score(OR =0. 817 ,P =0. 004)is the risk factor while tremor(OR =0. 247 ,P =0. 020)is the protective factor. PD in patients with PD-RBD may progress more rapidly than non PD-RBD patients(UPDRS Ⅲ change from baseline 9. 86 ± 4. 96 vs 6. 76 ± 4. 26, t = 2. 909, P = 0. 005; H-Y change from baseline 0. 77 ± 0. 54 vs 0. 33 ± 0. 49, t = 3. 664, P = 0. 000). Conclusion RBD may be a symptom predictive for rapid PD progression, declining cognition and psychosis.
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Objective To assess the prevalance and distribution of pain in Parkinson' s disease (PD) patients, and to describe the relationship between pain and development of disease and its impact on the quality of life. Methods 113 PD patients were assessed with Visual Analog Scale (VAS), Brief Pain Inventory (BPI), Unified Parkinson' s Disease Rating Scale (UPDRS), Hoehn-Yahr Scale (H-Y), Hamilton Anxiety and Depression Scale (HRSD, HAMA) and Pittsburgh Sleep Quality Index (PSQI). Patients were divided into no pain group, PD-pain group and non-PD-pain group. PD-pain group was divided into PD-pain direct group and PD-pain indirect group. And statistical analysis was performed for each group. Results The incidence of PD-pain was 42. 5% (48/113). And compared with no pain group, PD-pain group had earlier age at onset of disease, longer duration, higher HAMA, HRSD, UPDRS and H-Y score, higher daily L-dopa dose, with statistical significance. Compared with non-PD pain group, the differences in the onset of age (57.4±9.6 vs 65.9±8.7, t= -2.596, P =0.012), HRSD(12. 9±7.9 vs 8.7±3.7, t =2.605, P=0.014) and VAS (61.6±25.9 vs 38.0 ± 30. 1, U = -2.290, P =0.022) were also statistically significant. BPI was different between PD-pain direct group and PD-pain indirect group except normal work and relations with other people. Conclusion Pain is frequent in Parkinsonian population. Most pain was chronic and related to PD (PD-pain). These patients always have earlier onset age and poorer quality of life.
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Objective To systemically evaluate the therapeutic effect of pramipexole in treating Parkinson's disease. Methods Pubmed, Embase, Cochrane Database were used to search for randomized control trials (RCTs) on Parkinson's disease treated with pramipexole. Meticulous data wre extracted and meta-analysis was performed according to a preset protocol. Results Ten RCTs involving 1738 patients were included. The results of meta-analysis showed that pramipexole decreased the total scores of unified Parkinson's disease rating scale [UPDRS, WMD=-10.01,95%CI (-12.76,-7.26)],UPDRS part [WMD=-2.44,95%CI(-2.93,-1.95)],and UPDRS partⅢ[WMD=-6.61,95%CI(-8.38,-4.84)]. Pramipexole also reduced the score of UPDRS part Ⅳ[WMD=-0.73,95%CI(-1.16,-0.30)] in advanced patients(P＜0.05＝.Three studies referred to the effect of pramipexole in treating parkinsonian tremor. However there was a clinical heterogeneity among the studies, and two of them revealed a significant difference. Conclusions Pramipexole might improve motor symptoms and the quality of life in advanced patients, as well as improve tremor, which needs more RCTs to be confirmed.
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Objective This study was designed tO survey the prevalence,distribution of nonmotor symptoms(NMS)in Parkinson disease(PD)and their relationship with disease severity and duration. Methods We used Unified Parkinson Disease Rating Scale(UPDRS)part Ⅲ,V,the PD NMS Questionnaire,activities of daily living(ADL)and mini-mental state examination(MMSE)to assess motor and non-motor symptoms in 81 patients with Parkinson disease. Results In PD,a range of NMS occurred across all disease stages.Each PD patient had 7 different NMS on average.The problems of remembering thing,constipation and nocturia ranked top 3 of NMS in patients with PD.There was a significant association of total NMS score with H-Y stage(P<0.01)and UPDRS Ⅲscore(P<0.01).There was a negative correlation between NMS score and ADL score(P<O.05),but no relationship of total NMS score was found with disease age,duration,sex distribution,daily dose of L-dopa or subtype of PD. Conclusions NMS in PD are common and frequent.PD-NMS affect patients'quality of life,just like motor symptoms,and should be well recognized and treated.
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Objective To study the efficacy of entacapone for motor fluctuations in Parkinson's disease. Methods Pubmed, Embase, Cochrane Database were searched for randomized controlled trial studies (RCTs) on entacapone compared to placebo in the treatment of Parkinson' s disease with motor fluctuations. Data were extracted and evaluated by two reviewers independently with designed extractian form. Revman 4. 2. 10 software was used for data analysis. Results Ten RCTs involving 2212 patients were included. The Results showed that entaeapone tends to increase "on" time, decrease "off" time and daily levodopa dosage (WMD=-1.41,95% CI -2. 09- -0.72) and improve "on" time motor symptoms and the quality of life. But it might increase the rate of dyskinesia (OR=2.00, 95% CI 1.55-2.58).Conclusion The systematic review indicates that entaeapone might be an effective agent for parkinsonian patients with motor fluctuations and more high quality RCTs with the same effect measures are required.
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Objective To survey the prevalence and distribution of dyskinesia and motor fluctuations, and to investigate the factors related to the dyskinesia and motor fluctuations. Methods The detailed information were recorded, patients were rated by Unified Parkinson's disease rating scald (UPDRS) and Hoehn-Yahn stage. The occurrence of dyskinesia and motor fluctuations were recorded according to UPDRS Ⅳ. Results One hundred and twenty-two patients receiving levodopa treatment for at lease 6 months were involved. Fifteen (12.3%) were experiencing dyskinesia and 41(33.6%) motor fluctuations. The age of onset(OR=0.907,P<0.01) and daily levodopa dose (95% CI 1.000-1.004, OR=1.002, P<0.05) were independent factors with dyskinesia; while the age of onset (OR=0.922, P<0.05), levodopa treatment duration (OR=1.234, P<0.05), daily levodopa dose (95% CI 1.002-1.008, OR=1.005, P<0.01) and Hoehn-Yahn stage (OR=1.869, P<0.05) were independent factors of motor fluctuations. Conclusions The rate of motor complications was lower than the results surveyed in European countries. The likelihood of occurrence of dyskinesia and motor fluctuations is increased in those on high daily levedopa dose. The concomitant use of other medication to reduce levedopa dose might delay the motor complications.
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Objective To evaluate the efficiency of interventional treatment for primary liver cancer with spontaneous rupture. Methods Three cases of spontaneous rupture of primary liver cancer were undertaken hepatic arterial chemoembolization with prior chemo-infusion and followed by gelfoam partical and stripes for embolization Results 3 cases of massive type of primary liver carcinoma with spontaneous rupture were all successfully once embolized, including one with additional super liquefied lipiodal as embolic agent who has been survived for more than 20 months. Conclusions Hepatic arterial chemo-embolization shows prominent hemostasis during emergency for spontaneous rupture of primary hepatic carcinoma providing double effectiveness of hemostasis and treatment.