The electrophysiological features of patients with anti-neurofascin 155 IgG4 antibodies positive chronic inflammatory demyelinating polyradiculoneuropathy / 中华神经科杂志

Objective:To investigate the electrophysiological features of patients with anti-neurofascin 155 (NF155) IgG4 antibodies positive chronic inflammatory demyelinating polyradiculoneuropathy (CIDP).Methods:The electrophysiological data of 6 anti-NF155 IgG4 antibodies positive CIDP patients in Beijing Tiantan Hospital, Capital Medical University from September 2018 to May 2021 were retrospectively analyzed. Parameters studies included standard motor and sensory nerve conduction studies, electromyography (EMG) and F waves studies. Correlation analysis was made to explore the relationships between clinical indicators and electrophysiological data.Results:There was statistically significant difference in the motor nerve conduction study on abnormal rate of tibial nerve (χ 2=11.08, P=0.011). Motor nerve conduction abnormalities were presented in a majority of patients with decreased motor conduction velocity (MCV) and prolonged distal motor latency (DML). There was no statistically significant difference in the overall abnormal rate between lower limbs and upper limbs (30/32, 93.8% vs 22/22, 100.0%; χ 2=1.43, P=0.508), sensory nerve conduction and motor nerve conduction (52/54, 96.3% vs 42/42, 100.0%; χ 2=1.59, P=0.503). There was statistically significant difference in the overall abnormal rate in median nerve, ulnar nerve and sural nerve (χ 2=14.96, P=0.001;χ 2=10.00, P=0.007; χ 2=9.95, P=0.008),and absent sensory nerve action potential was the most common abnormality in sensory nerve conduction abnormalities. The abnormal rate of EMG was 9/14, which was constituted by upper limbs (4/8) and lower limbs (5/6), and the spontaneous activity accompanied with prolonged duration and increased amplitude of motor unit action potential was common. Significant negative correlations were established between disease duration and compound muscle action potential (CMAP) amplitude and negative area of ulnar nerve ( r=-0.84, P=0.036; r =-0.76, P=0.011), and the correlations between age and MCV of median nerve and ulnar nerve were also found ( r=0.89, P=0.019; r=0.95, P=0.003). The DML of median nerve was negatively correlated with CMAP amplitude ( r=-0.63, P=0.049). Moreover, the correlation analysis revealed associations of the F wave latency with the DML, CMAP amplitude and MCV of tibial nerve ( r= 0.90, P=0.039; r=-0.96, P=0.012; r=-0.96, P=0.010). Conclusions:The motor nerve and sensory nerve, the myelin sheath and axon of peripheral nerves in anti-NF155 IgG4 CIDP patients were largely affected. The CMAP amplitude and negative area of ulnar nerve might be of certain clinical value in reflecting the disease duration.The younger the patients, the more severe the demyelination degree of the upper limbs. The F wave latency of tibial nerve not only reflected the abnormal proximal conduction, but also the distal damage degree of myelin sheath and axon.

Revaluation of clopidogrel: let the data speak for themselves / 华中科技大学学报（医学）（英德文版）

Clopidogrel was believed to be superior to aspirin by the well-known CAPRIE trial. However, no other large clinical trials demonstrated the same results, but all focused on the combination use of clopidogrel with aspirin, and combination therapy in CREDO was called the "Emperor's New Clothes". However, no one overturned the results of these clinical trials by quantitatively analyzing them. We reviewed ten large-scale clinical trials about clopidogrel. On the basis of results of CAPRIE, CREDO and CHARISMA trials, we re-estimated their minimal sample sizes and their powers by three well-established statistical methodologies. From the results of CAPRIE, we inferred that the minimal sample size should be 85 086 or 84 968 but its power was only 30.70%. A huge gap existed. The same was also true of CREDO and CHARISMA trials. Moreover, in CAPRIE trial, 0 was included in the 95% confidence interval and 1 was included in the 95% confidence interval for the relative risk. There were some paradoxical data in CAPRIE trial. We are led to conclude that the results in CAPRIE, CREDO, and from the subgroup analysis in CHARISMA trials were questionable. These results failed to demonstrate that clopidogrel was superior to aspirin or that clopidogrel used in combination with aspirin was better than aspirin alone. The cost-effectiveness analyses by some previous studies were not reliable.

Clinical analysis of 53 cases of cerebral venous sinus thrombosis / 中国综合临床

Objective To analyze the clinical characteristics of cerebral venous sinus thrombosis(CVST)and evaluate the diagnosis and treatment.Methods All the medical records,including age,mode of onset,clinical manifestations,findings of neuro-imaging and prognosis were analyzed.retrospectively in 53 cases with CVST from August 2003 to May 2008 in Beijing Tian Hospital.Results Of the 53 cases(22 men,31 women),aged from 15 to 52(mean 34.92±9.69)years.Acute or sub-acme onset accounted mostly.The principal clinical characteristics were headache and vomit,weak sight,diplopia,focal deficit,conscious disturbance and seizures.The neuro-imaging findings of CVST were venous sinus occlusion and local infarction,sometimes accompanied by capillary hemorrhage or haematoma.The major treatment involve dehydration,anticoagulation,and thrombolysis or stent implanted.After the treatment,12 cases recovered completely,37 improved,2 invalided,and 2 cases discharged for herniation of brain.Conclusion Improvement in awareness of CVST and prompt MRI in combination with MRV examination is the key to accurate diagnosis and timely therapy.The treatment of CVST should be based on anticoagulatin,and acompanyed.by thrombolysis or stent implanted in cerebral venous sinus on the baisis of effect.

Significance of detection of Tau protein and β amyloid protein levels in cerebrospinal fluid in patients with mild cognitive impairment / 中国康复理论与实践

@#ObjectiveTo study the levels of Tau protein and β amyloid protein(Aβ) in cerebrospinal fluid(CSF) in patients with mild cognitive impairment(MCI) and their significance of diagnosis. MethodsSensitive enzyme linked immunosorbent assay were performed to detect the CSF levels of Tau protein and Aβ in 32 patients with MCI and 15 healthy controls. ResultsSignificant elevation of the level of Tau protein and decrease of the level of the Aβ were observed in patients with MCI compared with healthy controls.ConclusionThe assays of the CSF Tau and Aβprotein levels can provide valuable biological marker for the diagnoses and treatment of MCI.

Study the distribution of pathogenic bacterium and its sensitivity to antibiotic in severe cerebral vascular disease patients with nosocomial pneumonia / 临床神经病学杂志

Objective To study the distribution of pathogenic bacterium and its sensitivity to antibiotic in severe cerebral vascular disease patients with nosocomial pneumonia.Methods Retrospective studies were done in 42 cases of severe cerebral vascular disease patients in neurological intensive care unit (NICU). Secretion from lower respiratory tract was cultivated and done medicine sensitive test at 3 d、4 d、5 d、9 d、16 d after hospitalized,then the etiologic data of nosocomial pneumonia were analyzed.Results Among 42 cases,15 pathogenic microorganisms and 163 strains were cultivated, the fisrt 4 strains were Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella and Enterobacter cloacae. The results of medicine sensitive test indicated that Gram-negative bacteria was sensitive to Imipenem,and Gram-positive bacteria was sensitive to Vancomycin.Conclusions The main pathogen of nosocomial pneumonia in severe cerebral vascular disease patients may be Staphylococcus aureus,Pseudomonas aeruginosa. Staphylococcus aureus was sensitive to Vancomycin,so Vancomycin can be act as the first choice drug to deal Gram-positive bacteria. Pseudomonas aeruginosa is relatively sensitive to Amikacin and Ciprofloxacin,while Imipenem is the second, but drug fast is to cephalosporins. So the first two antibiotics can be as the experience drugs to deal Pseudomonas aeruginosa.