Trans-cranial Doppler predicts early neurologic deterioration in anterior circulation ischemic stroke after successful endovascular treatment / 中华医学杂志(英文版)

BACKGROUND@#Early neurologic deterioration (END) may occur in patients with anterior circulation ischemic stroke (ACIS) after receiving endovascular treatment (EVT). Hemodynamic insufficiency, re-occlusion, and post-re-canalization hyper-perfusion are likely to play a critical role in END. We hypothesized that hemodynamic changes can predict END in patients with ACIS post-successful EVT using trans-cranial Doppler (TCD).@*METHODS@#We utilized a prospectively maintained database of ACIS patients treated with EVT between September 2016 and June 2018 in the Xuanwu Hospital, Capital Medical University. TCD parameters including peak systolic velocity (PSV), bilateral mean flow velocity (MFV), and pulse index (PI) were determined via the middle cerebral arteries within 72 h post-EVT. A logistic regression model was applied to detect independent predictors for END.@*RESULTS@#Totally, 112 EVT patients were included in this study and 80/112 patients experienced successful re-canalization with <50% residual stenosis, while 17/80 (21.3%) patients suffered END, for which vasogenic cerebral edema (11/17) was considered as a leading role and followed by symptomatic intra-cranial hemorrhage (4/17) and ischemia progression (2/17). For the 80 patients, the PSV (median: 127 cm/s vs. 116 cm/s, P = 0.039), the ratio of ipsilateral-MFV/contra-lateral-MFV (iMFV/cMFV) (median: 1.29 vs. 1.02, P = 0.036) and iMFV/mean blood pressure (MBP) (median: 0.97 vs. 0.79, P = 0.008) in END patients were higher than those of non-END. Using the receiver-operating characteristic curve to obtain cut-off values for PSV, PI, iMFV/cMFV, and iMFV/MBP for END, we found that PI ≥0.85 (odds ratio: 11.03, 95% confidence interval: 1.92-63.46, P = 0.007) and iMFV/MBP ≥0.84 (odds ratio: 9.20, 95% confidence interval: 2.07-40.84, P = 0.004) were independent predictors of END in a multivariate logistic regression model, with a sensitivity of 82.4% and 76.5% and a specificity of 42.9% and 66.7%, respectively, and had the positive predictive values of 29.0% and 38.2%, and negative predictive values of 90.0% and 91.3%, with an area under the receiver-operating characteristic curve of 0.57 and 0.71, respectively.@*CONCLUSION@#TCD examination of EVT patients may be used as a real-time tool to detect END predictors, such as the higher PI and iMFV/MBP, allowing for better post-thrombectomy management in ACIS patients.

The prognosis of hepatitis E superinfection in hospitalized chronic hepatitis B patients in China: A systematic review and Meta-analysis / 中华疾病控制杂志

@#Objective To evaluate the prevalence and prognosis of hepatitis E virus ( HEV) su- perinfection in patients with chronic hepatitis B ( CHB) ． Methods Electronic databases of Pubmed， CNKI，and Wanfang were searched，and references of the relevant articles for literatures associated with HEV superinfection in CHB patients in China published during 2008－2019 were screened． Studies which met the inclusion and exclusion criterias were selected and related data were pooled for analysis． The Ｒ 3. 5. 2 and Ｒevman 5. 3 were used to measure heterogeneity with the I2 statistic and pooled incidence and odds ratio ( OＲ) ． Ｒesults 28 literatures were eligible for inclusion． The results showed the rate of HEV superinfection in hospitalized CHB ( CHB-HEV) patients was 13. 6% ( 95%CI: 12. 5% －14. 9%) ． The pooled incidence of liver failure in CHB-HEV patients was 34. 7% ( 95%CI: 29. 6%－40. 1%) ，which was higher than CHB patients ( OＲ= 10. 9，95%CI: 6. 8－17. 4) ，CHB patients superinfected with hepatitis A virus ( CHB-HAV) ( OＲ= 3. 8，95%CI: 2. 4－6. 2) ，and hepatitis E patients ( OＲ= 5. 1，95%CI: 3. 8－ 6. 8) ． The pooled mortality of CHB-HEV patients was 13. 8% ( 95%CI: 10. 3－17. 8) ，which was higher than CHB patients ( OＲ = 8. 5，95%CI: 4. 0－18. 3) ，CHB-HAV patients ( OＲ = 14. 4，95%CI: 4. 8－ 42. 9) ，and hepatitis E patients ( OＲ= 4. 4，95%CI: 3. 0－6. 4) ． Conclusion In China，HEV sueperinfection on chronic hepatitis B patients are common，and is an important cause of liver failure and death．

Neurophysiological predictors of aphasia recovery in patients with large left-hemispheric infarction: a mismatch negativity study / 中华医学杂志(英文版)

BACKGROUND@#Although the rehabilitation of aphasia has been extensively studied, the prediction of language outcome still has not received sufficient attention. The aim of this study was to predict the language outcome using mismatch negativity (MMN) in patients with large left-hemispheric infarction.@*METHODS@#MMN was elicited by an oddball paradigm in which a standard tone (1000 Hz) and deviant tone (1500 Hz) were presented at 90% and 10% of the number of tones, respectively. The mean amplitudes and laterality indexes (LIs) of MMN were measured over the prefrontal, frontal, central, parietal, temporal, and perisylvian electrodes and both hemispheres during the first 7 days (session 1) and 10 to 20 days (session 2) post-onset. Mixed three-way analysis of variance (ANOVA) was used to investigate differences in these factors between two aphasia groups (the good recovery group and poor recovery group). The predictive value of the most significant LI was also compared with the score of National Institutes of Health Stroke Scale score and low-density volume on computed tomography.@*RESULTS@#A total of 18 patients were enrolled in this study. Mixed three-way ANOVA showed no interaction effect of session × region of interest (ROI) × group (F [3.59, 57.38] = 1.301, P = 0.282) and no interaction effect of ROI × group (F [1.81, 29.01] = 0.71, P = 0.487) and session × group (F [1.00, 16.00] = 0.084, P = 0.776) for MMN amplitude. No interaction effect of session × ROI × group (F [1.79, 28.58] = 0.62, P = 0.530), but an interaction effect of session × group (F [1.00, 16.00] = 5.21, P = 0.036) was found for LIs. In the poor recovery group, the LIs of MMN over all the ROIs, except the parietal area, became more negative at session 2 than those at session 1 (P -0.36 over the perisylvian area suggested good recovery, but a score <-0.36 suggested poor recovery. The LI cut-off value of -0.36 had the highest sensitivity (90.0%) and specificity (87.5%) for predicting a good language outcome at 3 months post-stroke.@*CONCLUSION@#LIs of MMN amplitudes at approximately 2 weeks post left-hemisphere stroke serve as more sensitive predictors of language outcome, among which the LI over the perisylvian area exhibits the best predictive value.

Neurophysiological predictors of aphasia recovery in patients with large left-hemispheric infarction: a mismatch negativity study / 中华医学杂志(英文版)

Background@#Although the rehabilitation of aphasia has been extensively studied, the prediction of language outcome still has not received sufficient attention. The aim of this study was to predict the language outcome using mismatch negativity (MMN) in patients with large left-hemispheric infarction.@*Methods@#MMN was elicited by an oddball paradigm in which a standard tone (1000 Hz) and deviant tone (1500 Hz) were presented at 90% and 10% of the number of tones, respectively. The mean amplitudes and laterality indexes (LIs) of MMN were measured over the prefrontal, frontal, central, parietal, temporal, and perisylvian electrodes and both hemispheres during the first 7 days (session 1) and 10 to 20 days (session 2) post-onset. Mixed three-way analysis of variance (ANOVA) was used to investigate differences in these factors between two aphasia groups (the good recovery group and poor recovery group). The predictive value of the most significant LI was also compared with the score of National Institutes of Health Stroke Scale score and low-density volume on computed tomography.@*Results@#A total of 18 patients were enrolled in this study. Mixed three-way ANOVA showed no interaction effect of session × region of interest (ROI) × group (F [3.59, 57.38] = 1.301, P = 0.282) and no interaction effect of ROI × group (F [1.81, 29.01] = 0.71, P= 0.487) and session × group (F [1.00, 16.00]= 0.084, P= 0.776) for MMN amplitude. No interaction effect of session × ROI × group (F [1.79, 28.58] = 0.62, P = 0.530), but an interaction effect of session × group (F [1.00, 16.00] = 5.21, P = 0.036) was found for LIs. In the poor recovery group, the LIs of MMN over all the ROIs, except the parietal area, became more negative at session 2 than those at session 1 (P < 0.05), but this effect was not observed in the good recovery group. Additionally, significant differences were observed in the LIs at session 2 between the two groups (P < 0.05). The LI over the perisylvian area at session 2 had the highest predictive value with an area under the curve of 0.963 (95% confidence interval: 0.884–1.000). An LI score >-0.36 over the perisylvian area suggested good recovery, but a score <-0.36 suggested poor recovery. The LI cut-off value of-0.36 had the highest sensitivity (90.0%) and specificity (87.5%) for predicting a good language outcome at 3 months post-stroke.@*Conclusion@#LIs of MMN amplitudes at approximately 2 weeks post left-hemisphere stroke serve as more sensitive predictors of language outcome, among which the LI over the perisylvian area exhibits the best predictive value.

An Investigation and Suggestions for the Improvement of Brain Death Determination in China / 中华医学杂志(英文版)

Background@#Brain death is the irreversible cessation of the function of the brain including the brainstem. In 2013, the Brain Injury Evaluation Quality Control Centre (BQCC) of the National Health and Family Planning Commission issued criteria and practical guidelines for the determination of brain death. This study aimed to evaluate whether the institutions have adopted these guidelines and to make suggestions for the improvement of the current criteria and practical guidelines for brain death determination in China.@*Methods@#Consecutive brain death cases from 44 hospitals were evaluated for summary statistics for the following data: the performance of BQCC criteria and practical guidelines, clinical examination, apnea testing, ancillary testing, and the number of examinations as well as the waiting periods between examinations and details of who determined brain death. Data analysis was conducted from January 2013 to December 2017.@*Results@#A total of 550 cases were obtained. All patients were determined to have deep coma and met the prerequisites for clinical testing. The performance rates of four brainstem reflex examinations (except cough reflex) ranged from 97.5% to 98.0%, and the completion rate as well as the coincidence rate were both 100.0%. The 238 cases (50.7%) completed apnea testing, and 231 cases (42.0%) had to stop apnea testing during the examination because of instability. The performance rates of the three ancillary tests, including electroencephalogram, short-latency somatosensory evoked potential, and transcranial Doppler, were 89.5%, 67.5%, and 79.5%, respectively; furthermore, the coincidence rates were 98.6%, 96.5%, and 99.5%, respectively. The combination of two ancillary tests was more accurate than one single ancillary test. A total of 401 (72.9%) cases successfully underwent two separate examinations to determine brain death with at least a 12-h waiting period. All brain death cases were determined by at least two qualified physicians.@*Conclusion@#This study might provide suggestions for brain death determination in China.

Study of Simplified Coma Scales: Acute Stroke Patients with Tracheal Intubation / 中华医学杂志(英文版)

<p><b>Background</b>Whether the Glasgow Coma Scale (GCS) can assess intubated patients is still a topic of controversy. We compared the test performance of the GCS motor component (GCS-M)/Simplified Motor Score (SMS) to the total of the GCS in predicting the outcomes of intubated acute severe cerebral vascular disease patients.</p><p><b>Methods</b>A retrospective analysis of prospectively collected observational data was performed. Between January 2012 and October 2015, 106 consecutive acute severe cerebral vascular disease patients with intubation were included in the study. GCS, GCS-M, GCS eye-opening component, and SMS were documented on admission and at 24, 48, and 72 h after admission to Neurointensive Care Unit (NCU). Outcomes were death and unfavorable prognosis (modified Rankin Scale: 5-6) at NCU discharge. The receiver operating characteristic (ROC) curve was obtained to determine the prognostic performance and best cutoff value for each scoring system. Comparison of the area under the ROC curves (AUCs) was performed using the Z- test.</p><p><b>Results</b>Of 106 patients included in the study, 41 (38.7%) patients died, and 69 (65.1%) patients had poor prognosis when discharged from NCU. The four time points within 72 h of admission to the NCU were equivalent for each scale's predictive power, except that 0 h was the best for each scale in predicting outcomes of patients with right-hemisphere lesions. Nonsignificant difference was found between GCS-M AUCs and GCS AUCs in predicting death at 0 h (0.721 vs. 0.717, Z = 0.135, P = 0.893) and 72 h (0.730 vs. 0.765, Z = 1.887, P = 0.060), in predicting poor prognosis at 0 h (0.827 vs. 0.819, Z = 0.395, P = 0.693), 24 h (0.771 vs. 0.760, Z = 0.944, P = 0.345), 48 h (0.732 vs. 0.741, Z = 0.593, P = 0.590), and 72 h (0.775 vs. 0.780, Z = 0.302, P = 0.763). AUCs in predicting death for patients with left-hemisphere lesions ranged from 0.700 to 0.804 for GCS-M and from 0.700 to 0.824 for GCS, in predicting poor prognosis ranged from 0.841 to 0.969 for GCS-M and from 0.875 to 0.969 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h (P > 0.05). No significant difference between GCS-M AUCs and GCS AUCs was found in predicting death (0.964 vs. 0.964, P = 1.000) and poor prognosis (1.000 vs. 1.000, P = 1.000) for patients with right-hemisphere lesions at 0 h. AUCs in predicting death for patients with brainstem or cerebella were poor for GCS-M (<0.700), in predicting poor prognosis ranged from 0.727 to 0.801 for GCS-M and from 0.704 to 0.820 for GCS, with no significant difference between GCS-M AUCs and GCS AUCs within 72 h (P > 0.05). The SMS AUCs (<0.700) in predicting outcomes were poor.</p><p><b>Conclusions</b>The GCS-M approaches the same test performance as the GCS in assessing the prognosis of intubated acute severe cerebral vascular disease patients. The GCS-M could be accurately and reliably applied in patients with hemisphere lesions, but caution must be taken for patients with brainstem or cerebella lesions.</p>

Progresses of Single Molecular Fluorescence Resonance Energy Transfer in Studying Biomacromolecule Dynamic Process / 分析化学

Biomacromolecules participate in various kinds of vital processes. Observing and analyzing their structural dynamic and the dynamic processes of intermolecular interaction at molecular level is important for understanding the action mechanism. Since its advent, single molecular fluorescence resonance energy transfer (SM-FRET) has demonstrated its great potential in studying the conformational change and interaction process of biomacromolecules, and a series of new mechanisms have been revealed. This review summarized recent progresses of SM-FRET in studying protein structural dynamic, nucleic acid structural dynamic, protein-protein and protein-nucleic acid interactions.

Early Neurological Deterioration after Recanalization Treatment in Patients with Acute Ischemic Stroke: A Retrospective Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Early neurological deterioration (END) is a prominent issue after recanalization treatment. However, few studies have reported the characteristics of END after endovascular treatment (EVT) as so far. This study investigated the incidence, composition, and outcomes of END after intravenous recombinant tissue plasminogen activator (IV rt-PA) and EVT of acute ischemic stroke, and identified risk factors for END.</p><p><b>METHODS</b>Medical records of patients who received recanalization treatment between January 1, 2014, and December 31, 2015 were reviewed. Patients were classified into IV rt-PA or EVT group according to the methods of recanalization treatment. The END was defined as an increase in the National Institutes of Health Stroke Scale (NIHSS) ≥4 or an increase in Ia of NIHSS ≥1 within 72 h after recanalization treatment. Clinical data were compared between the END and non-END subgroups within each recanalization group.</p><p><b>RESULTS</b>Of the 278 patients included in the study, the incidence of END was 34.2%. The incidence rates of END were 29.8% in the IV rt-PA group and 40.2% in the EVT group. Ischemia progression (68.4%) was the main contributor to END followed by vasogenic cerebral edema (21.1%) and symptomatic intracranial hemorrhage (10.5%). Multivariate logistic regression showed that admission systolic blood pressure (SBP) ≥160 mmHg (odds ratio [OR]: 2.312, 95% confidence interval [CI]: 1.105-4.837) and large artery occlusion after IV rt-PA (OR: 3.628, 95% CI: 1.482-8.881) independently predicted END after IV rt-PA; and admission SBP ≥140 mmHg (OR: 5.183, 95% CI: 1.967-13.661), partial recanalization (OR: 4.791, 95% CI: 1.749-13.121), and nonrecanalization (OR: 5.952, 95% CI: 1.841-19.243) independently predicted END after EVT. The mortality rate and grave outcome rate at discharge of all the END patients (26.3% and 55.8%) were higher than those of all the non-END patients (1.1% and 18.6%; P < 0.01).</p><p><b>CONCLUSIONS</b>END was not an uncommon event and associated with death and grave outcome at discharge. High admission SBP and unsatisfactory recanalization of occluded arteries might predict END.</p>

HIV-infected female sex workers' high risk behavior and attitude changes in Kaiyuan City, Yunnan Province, China / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the attitude and sexual behavior status and change among HIV positive female workers in entertainment sites in Kaiyuan city, Yunnan province, China. The key information should be applied in the integrated intervention program in future.</p><p><b>METHODS</b>A cohort survey among HIV positive female workers was conducted during 12 months, between 2010 and 2012. All the risk sexual behavior and attitude were collected for assessment for the potential secondary transmission to sexual partners.</p><p><b>RESULTS</b>Of 99 HIV positive women who sell sex in Kaiyuan city, 99 participated in the survey at baseline, 80, 80, 75, and 75 at 3-, 6-, 9-, and 12-month follow-ups. The percentage of participants who reported consistently used condoms in the last one month ranged between 94.5% and 95.5%. The client volume in the last one month, income per sex and age group were significant related with non-insistent condom use with their clients.</p><p><b>CONCLUSION</b>It was suggested that integrated intervention program package should include 100 percent condom use promotion for the HIV positive FSW with all sexual partners, and also, include socially support involved.</p>

The Prevalence of HIV Drug Resistance among Treatment-failure Individuals and Treatment-naïve Individuals in China: A Meta-analysis / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To understand drug resistance prevalence among treatment-failure and treatment-naïve HIV-positive individuals in China.</p><p><b>METHODS</b>We searched five electronic databases (Wanfang, CNKI, CQVIP, SinoMed, and Pubmed) for studies of HIV drug resistance. Random-effects models were carried out to estimate the prevalence of drug resistance among treatment-failure and treatment-naïve individuals, respectively.</p><p><b>RESULTS</b>The estimated nationwide rates of HIV drug resistance to any-class drugs among treatment-failure and treatment-naïve individuals were 57% (95% CI: 49%-65%) and 3.23% (95% CI: 2.47%-4.07%), respectively. Among the drug classes, the prevalence of resistance to PIs was low (1.45%; 95% CI: 0.73%-2.33%) in treatment-failure individuals, although high rates of resistance to NNRTIs (54%; 95% CI: 45%-63%) and NRTIs (40%; 95% CI: 32%-49%) were found. Resistance to any-class drugs, NNRTIs and NRTIs manifested regional differences, but resistance to PIs did not. Positive correlations were observed between resistance to NNRTIs and NRTIs among treatment-failure and treatment-naïve individuals, respectively.</p><p><b>CONCLUSION</b>The prevalence of HIV drug resistance to NNRTIs and NRTIs among treatment-failure individuals was high. In contrast, the prevalence of drug resistance among treatment-naïve individuals was low. The epidemics of drug resistance matched current treatment strategies and interventions in China. Surveillance for HIV drug resistance is necessary to assess the sustainability and durability of current treatment regimens.</p>

An overview of neurocritical care in China: a nationwide survey / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Little quantitative evidence was available regarding the development of NICUs in China. The purpose of this survey was to evaluate the current situation of neurointensive care units (NICUs) across China.</p><p><b>METHODS</b>The directors of NICUs from 100 tertiary care hospitals across China were contacted and asked to complete a closed response questionnaire regarding their NICUs. Basic information, equipment, and technology information available in the units, as well as staffing information were investigated.</p><p><b>RESULTS</b>Seventy-six questionnaires were returned (a 68% response rate). Of 76 NICUs, 43 units constituted the majority. The number of each NICU bed varied from 4 to 45, occupying 2%-30% of the total department beds. Over 70% of NICUs were equipped with many emergency treatment equipments as well as physiological and biochemical monitoring equipments, while 34%-70% of NICUs still lacked some kinds of equipments such as defibrillators. Some specialist equipments were still partially lacking in 62%-95% of NICUs. A vast majority of the NICUs were equipped with neurocritical care directors, full-time attending physicians, and head nurses, but full-time NICU residents and neurocritical care nurses were still lacking in nearly half (53%) and one-third (33%-37%) of NICUs, respectively. In 76 NICUs, full-time neurointensivists and nurses added up to 359 and 852, respectively. In addition, 78%-97% of all the surveyed NICUs were severely short of non-neurological professional staffs.</p><p><b>CONCLUSION</b>In China, neurocritical care has developed rapidly, but there is still a shortage of well-equipped and well-staffed NICUs across the nation currently.</p>

Evaluation of neuro-intensive care unit performance in China: predicting outcomes of Simplified Acute Physiology Score II or Glasgow Coma Scale / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II (SAPS II) and Glasgow Coma Scale (GCS) in neuro-intensive care unit (N-ICU) patients.</p><p><b>METHODS</b>A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance.</p><p><b>RESULTS</b>There was a significant difference between the SAPS II or GCS score at four time points (F = 16.110, P = 0.000 or F = 8.108, P = 0.000). The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference (F = 116.771, P = 0.000 or F = 65.316, P = 0.000). Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 (sensitivity of 85.2% and specificity of 74.3%) and 6 (sensitivity of 70.6% and specificity of 65.0%). The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis.</p><p><b>CONCLUSIONS</b>The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.</p>

Hepatitis C virus genotypes in China: a systematic review / 中华流行病学杂志

Objective To provide information on the geographical distribution of hepatitis C virus (HCV) genotype and subtypes in the Chinese population.Methods A comprehensive search was carried out in CHKD (China Hospital Knowledge Database),Wanfang (Chinese),CBMDisc and PubMed databases to identify all the papers being published on HCV genotypes/serotypes and subtypes in China.All studies were grouped according to the sites,period and objects of the studies,to analyse the distribution of HCV genotype.Results A total of 140 studies were included in this Meta-analysis program,which contained 168 records.We found that the predominate genotypes in China were 1 b and 2a subtype,and the distributions of HCV subtypes were different in the western or southern parts of the country.Subtypes 3a,3b and 6a had been significantly increased along with the decrease of subtypes 1b and 2a.There were various HCV subtypes among injection drug users with subtypes 3a,3b and 6a found among them.Conclusion The distribution of HCV genotypes and subtypes in the Chinese population had changed significantly.

Primary risk factors of hepatitis C virus infection: a Meta-analysis / 中华流行病学杂志

Objective To provide evidence for decision-making on primary hepatitis C prevention through analyzing the main risk factors of hepatitis C virus infection. Methods A comprehensive search was carried out in China Hospital Knowledge Database (CHKD), Wanfang Data, EBSCO, FMJS and Elsevier databases to identify all case-control and cohort studies published from 1994 to 2010 that evaluated the risk factors on the transmission of hepatitis C virus. Data manipulation and statistical analyses were performed using Stata 11.0 and RevMan 5.0 softwares.Results A total of 25 case-control studies were included in this Meta-analysis, which contained 4370 cases and 8606 controls. In univariate analysis, the pooled odds ratio (OR) and 95％ confidence interval (CI) on the risk factors associated with HCV seropositivity were "blood transfusion" 4.23 (2.82-6.35) , "having had surgical operations" 2.13 (1.70-2.67) , "intravenous drug use" 52.28(34.12-80.11 ), "having sex with intravenous drug users" 7.19 ( 3.13- 16.51 ), "histories of having had STDs" 3.43 (2.70-4.34). In multivariate analysis, pooled OR and 95％CI of the risk factors associated with HCV seropositivity were: having had following "histories as blood transfusion" 6.03 (3.97-9.15), "surgeries" 2.10( 1.44-3.07), "intravenous drug use" 44.90(31.13-64.76), "having sex with intravenous drug users" 3.87(2.07-7.24), "having STDs" 2.05(1.19-3.52). Conclusion Blood transfusion、 intravenous drug use and having sex with intravenous drug users were the risk factors of HCV infection. Due to existing biases, the relationship between having had surgical operations and HCV infection was inconclusive. There appeared weak correlation between STDs and HCV infection,but the result was not so stability.

Electroencephalographic patterns and prediction of outcome in comatose survivors after cardiopulmonary resuscitation / 中国脑血管病杂志

Objective: To explore the opportunity of electroencephalographic (EEG) evaluation and the prognostic value of the EEG patterns in comatose survivors after cardiopulmonary resuscitation (CPR). Methods: Sixty-four comatose survivors were selected for EEG evaluation after CPR. Acccording to the time intervals of the first EEG monitoring, the patients were divided into 1-3 day, 4-7 day, and >7 day groups. The EEG monitoring included generalized suppression, burst-suppression, alpha or theta coma, and slow wave increase patterns. The endpoint of clinical outcome (Glasgow Outcome Scale score) was evaluated at 6 months. The 4 types of EEG patterns were calculated respectively, and the prognostic sensitivity, specificity, positive predictive value, false positive rates, and total consistent rates during the 3 time intervals were predicted. Results: The generalized suppression pattern had a higher sensitivity (67%-80%) and specificity (100%) in predicting unfavorable prognosis within 7 days after CPR; the burst suppression pattern had a higher specificity (100%) in predicting unfavorable prognosis within 7 days, however, its sensitivity was low (6%-8%); The slow wave increase pattern had high sensitivity (100%) and specificity (91%-94%) in predicting favorable prognosis within 7 days; and the sensitivity was 3%-40%, and specificity was 50%-67% in predicting unfavorable prognosis in the alpha or theta coma pattern. Conclusion: The early (within 7 days) EEG after CPR may accurately and reliably show that both the generalized suppression and burst-suppression patterns predict the unfavorable prognosis; the slow wave increase pattern can accurately and reliably predict favorable prognosis; and the alpha or theta coma pattern cannot favorably predict prognosis.

Evaluation of coma patients after cardiopulmonary resuscitation / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Coma after cardiopulmonary resuscitation (CPR) is commonly seen in daily clinical practice. How to objectively evaluate brain function after CPR is essential to the following treatment. Coma patients after CPR had been studied prospectively at the Neuro-Intensive Care Unit of Xuanwu Hospital since 2002. In this study, we focused on the topic of how to evaluate the severity of coma after CPR.</p><p><b>METHODS</b>From April 2002 to November 2004, patients in coma 24 hours after CPR were monitored, the evaluation methods included Glasgow coma score (GCS), brain stem reflection, and spinal reflection. Laboratory evaluation included electroencephalography (EEG), brainstem auditory evoked potential (BAEP), short latency somatosensory evoked potential (SLSEP), and transcranial Doppler (TCD).</p><p><b>RESULTS</b>Twenty-four of 35 patients (68.57%) were in deep coma. The GCS was 3 except for 2 patients; EEG was evaluated not less than grade IV except for 4 patients, BAEP was evaluated as grade III except for 3 patients, and SLSEP was evaluated as grade III except for 1 patient. Twenty-four patients died within 1 month and 11 of them (45.83%) were determined as brain death. Glasgow outcome score (GOS) was evaluated as grade I. Eleven of the 35 patients survived and their consciousness changed from deep coma to coma vigil. EEG was evaluated as gradeIin 5 patients, BAEP and SLSEP were evaluated as grade I in 3 patients, and GOS was all evaluated as grade II among the 11 patients. Two patients (18.18%) regained consciousness in 35 and 90 days after cardiopulmonary resuscitation and GOS was evaluated as grade IV and III, respectively.</p><p><b>CONCLUSION</b>Combined or continuous evaluation of clinical examinations and laboratory tests can accurately and objectively determine brain function after CPR.</p>

Study on special pattern of the EEG-RAWOD of acute massive ischemic infarction / 中华神经科杂志

Objectives To study a special pattern of electroencephalogram (EEG),regional attenuation without Delta in massive cerebral ischemic infraction and evaluate its clinical value.Methods All the 47 cases diagnosed as massive cerebral infraction were continuously observed and evaluated in the period of 2004 to 2006 for EEG,short-latency somatosensory evoked potential (SLSEP).Glasgow coma scale (GCS) and the National Institutes of Health Stroke Scale (NIHSS) were also rated.EEG monitoring was performed every 1 to 3 day,but at least one time for patient with deteriorated condition.The outcome was evaluated with Glasgow outcome scale (GOS).Results 47 cases were performed 70 times of EEG all together,among whom 32 cases (68.1%) showed RAWOD in EEG.The positive rate of RAWOD was 76.9% within 24 hours of onset,but it was 28.6% in CT in the same time.The GCS and NIHSS of two groups had significant differences (P

Evaluation of persistent vegetative state of 34 patients / 中华神经科杂志

Objective To investigate an accurate,reliable and objective method to evaluate persistent vegetative state at bedside.Methods The brain function of 34 cases with persistent vegetative state as a result of acute brain injury was evaluated,involving clinical examinations and neuroelectrophysiological evaluations(EEG,BAEP,SLSEP).Results The most common cause of brain damage was anoxic encephalopathy(30/34,88.2%).The patients were in mild,moderate or deep coma with complete or partial existence of brainstem reflection,activities distributed by cerebral nerves,voluntary extremity activities,spinal cord reflection and automatic spinal cord reflection as well as partial existence of pathologic reflection.According to the Young Criteria of EEG,64.5%(20/31)and 29.0%(9/31)of the cases were in grade Ⅰ and Ⅵ respectively,6.5%(2/31)were in grade Ⅲ and Ⅳ.According to the Cant Criteria of evoked potential,34.8%(8/23),21.7%(5/23)and 43.5%(10/23)of the cases were in gradeⅠ,Ⅱ and Ⅲ of brainstem auditory evoked potential,respectively.43.5%(10/23),4.4%(12/23) and 52.2%(12/23)were in grade Ⅰ,Ⅱ and Ⅲ of short-latency somatosensory evoked potential respectively.29.4%(10/34)of 34 cases died,and 11.8%(4/34)resuscitated during 35—90 days. Conclusion Combination of multiple neuroelectrophysiological tests was an accurate,reliable and objective approach to evaluate the brain function of patients with persistent vegetative state,which provides evidence for decision-making in agrypnotic therapy.