Long-term follow-up results and risk factors of bleeding among very elderly patients with non-valvular atrial fibrillation / 中华全科医师杂志

Objective:To investigate the long-term follow-up results and the risk factors of bleeding among very elderly patients with non-valvular atrial fibrillation (NVAF).Methods:A total of 177 patients with NVAF admitted in Beijing Hospital from January 2016 to July 2016 were enrolled in the study, including 107 very elderly patients (aged≥80 years) and 70 elderly patients (aged 65-80 years). The demographic information, comorbid diseases, lifestyles, antithrombotic therapy, thromboembolism risks, bleeding risks, and medical history were documented. Patients were followed up for 5 years and the events of death, thromboembolism, bleeding and major bleeding were recorded.Results:There was no significant difference in the incidence of thromboembolic events between the two groups (15.9%(17/107) vs. 14.3%(10/70), P>0.05). The proportions of bleeding events and severe bleeding events in the very elderly group were higher than those in the elderly group (45.8%(49/107) vs.10.0%(7/70), 14.0%(15/107) vs. 1.4%(1/70), both P<0.05). According to the bleeding events during follow-up, very elderly patients were divided into bleeding group ( n=49) and non-bleeding group ( n=58). Compared with the non-bleeding group, patients in the bleeding group had an older age, a higher proportion of chronic cardiac insufficiency, chronic kidney disease, malignant tumor, bleeding history and higher bleeding risk score (HAS-BLED score) (all P<0.05). Multivariate logistic regression model analysis showed that age, HAS-BLED score, history of bleeding, and complicated malignant tumor were independent risk factors for bleeding events in very elderly patients with NVAF (all P<0.05). Conclusions:Very elderly patients with NVAF have a similar risk of thromboembolism compared with the younger elderly, but have significantly higher risk of the bleeding and major bleeding. Age, HAS-BLED score, bleeding history, and malignant tumor are independent risk factors for bleeding events in very elderly NVAF patients.

Study on imaging features of asymptomatic cerebral small vessel disease and related factors in the elderly population / 中华老年医学杂志

Objective:To investigate the incidence, neuroimaging features, and related factors for asymptomatic cerebral small vessel disease(CSVD)in the elderly population.Methods:A total of 201 elderly people with no neurological disease history who had undergone brain magnetic resonance imaging(MRI)examination from October 2019 to August 2020 were enrolled.We calculated the total CSVD score for each participant based on lacunar infarcts(LIs), white matter hyperintensities(WMH), enlarged perivascular spaces(EPVS), and cerebral microbleeds(CMBs)(0-4 points).CSVD neuroimaging features and the correlation between CSVD markers and clinical variables were analyzed.Results:In this study, 133 cases(66.2%)showed MRI features consistent with CSVD.Of whom, LIs were present in 44(21.9%), high-grade PVWMH in 88(43.8%), high-grade DWMH in 30(14.9%), basal ganglia EPVS in 61(30.3%), and CMBs in 92(45.8%).Total CSVD burden score( OR=1.876, 95% CI: 1.045-3.364, χ2=4.441, P=0.035), PVWMH( OR=2.821, 95% CI: 1.517-5.244, χ2=10.752, P=0.001), DWMH( OR=2.130, 95% CI: 1.108-4.092, χ2=5.145, P=0.023), and EPVS( OR=3.258, 95% CI: 1.675-6.334, χ2=12.129, P=0.000)were associated with hypertension.Total CSVD burden score, PVWMH, DWMH, EPVS, and CMB were correlated with increasing age( P<0.05).LIs was positively correlated with PVWMH( b=0.231, P=0.001), DWMH( b=0.247, P=0.000)and EPVS( b=0.215, P=0.001).There was a positive relationship between PVWMH and DWMH( b=0.546, P=0.000)as well as EPVS( b=0.388, P=0.000).DWMH was also positively correlated with EPVS( b=0.357, P=0.000)and CMB( b=0.177, P=0.009). Conclusions:The incidence of asymptomatic CSVD is high in the elderly population.The total CSVD score is a useful measure to evaluate asymptomatic cerebral small vessel disease in the elderly population.Neuroimaging features of asymptomatic CSVD are mainly correlated with age and hypertension.

Relationship between cerebral small vessel disease and thyroid hormones in the elderly / 中华老年医学杂志

Objective:To investigate the relationship between cerebral small vessel disease and thyroid hormones in the elderly.Methods:A total of 314 subjects aged ≥60 years with records of head magnetic resonance image(MRI), serum thyroid function tests and physical examinations collected in the Department of Health Care Neurology of Beijing Hospital from May 2019 to November 2020 were consecutively included for this cross-sectional study.Participants were assigned into the cerebral small vessel disease group if their head MRI presentations met the following standards: the Fazekas score ≥3 points; the Fazekas score ≥2 points, with 1 cavity; new subcortical infarcts; or cerebral microhemorrhage.Differences in thyroid function were compared between the cerebrovascular disease group(n=129)and the group without cerebrovascular disease(control group, n=185).Results:A total of 314 subjects were enrolled, of whom 129 met the head MRI standards for cerebrovascular disease, and 185 who did not meet the standards entered the control group.Comparison of thyroid function found a statistically significant difference in FT3( t=3.270, P=0.001)between the two groups.As for the association of a specific type of cerebral small vessel disease with thyroid function, there was a statistically significant difference in the FT3 level between the lacunar infarction group and the non-lacunar infarction group( t=3.106, P=0.002)and between the cerebral microhemorrhage group and the non-cerebral microhemorrhage group( t=2.125, P=0.034). Groups with different Fazekas scores in white matter hyperintensity showed statistically significant differences in rT3( F=3.092, P=0.027), FT3( F=5.427, P=0.001)and FT4( F=2.646, P=0.049). After correction for hyperlipidemia, rT3 and FT4, it was found that age( OR=1.044, 95% CI: 1.022-1.067, P=0.000), hypertension( OR=0.533, 95% CI: 0.294-0.963, P=0.037)and FT3( OR=0.276, 95% CI: 0.159-0.478, P=0.000)were related to cerebral small vessel disease. Conclusions:FT3 levels at the lower end of the normal range are associated with cerebral small vessel disease in the elderly.

Clinical features of corticobasal syndrome and associated chronic pain:analysis of 8 cases / 中华全科医师杂志

Objective:To investigate the clinical features and associated chronic pain in corticobasal syndrome (CBS).Methods:Clinical data of 8 patients diagnosed as probable CBS or possible CBS admitted to Beijing Hospital during January 2010 to June 2020 were retrospectively analyzed. The clinical information included sex, age, course of disease, chief complaint, neurological examination, blood biochemistry, tumor marker, infection and other laboratory tests; the neuropsychological evaluation included Mini-Mental State Examination (MMSE) scale and Hamilton Depression Scale (HAMD); the imaging studies included cranial magnetic resonance imaging (MRI) and/or 18F-Fluorodeoxyglucose positron emission tomography ( 18F-FDG PET). Results:The main clinical manifestations were asymmetrical movement disorders, including rigidity, tremor, myoclonus and abnormalities in posture and gait. Patients showed poor response to levodopa treatment. Among 8 patients, 7 had apraxia, 5 patients had alien hand, and 5 patients had various degrees of cognitive dysfunction. The cranial MRI demonstrated mild cerebral atrophy which was slightly more severe in the contralateral side of the initially affected limb in 7 of the 8 patients. The 18F-FDG PET scan revealed asymmetric decreased metabolism in the frontal, parietal, temporal, and occipital lobe, as well as in basal ganglia, which was more severe in the contralateral side of the initially affected limb in 5 of the 8 patients. Six of the 8 patients were associated with pain, including dystonic pain in 3 patients, neuropathic pain in 1 patient, musculoskeletal pain in 1 patient, and unexplained pain in 1 patient. Pain was the onset symptom in 1 patient and pain was relieved by taking levodopa in another patient. Conclusions:CBS is characterized by asymmetric dyskinesia and cognitive impairment, and often associated with apraxia, cortical sensory deficits, and alien limb. The MRI and PET are helpful for CBS diagnosis. Pain may be one of the common non-motor symptoms in CBS.

Drug therapy for epilepsy in the elderly / 中华老年医学杂志

Epilepsy is a common disease in the elderly, but drug therapy for epilepsy faces difficulties due to comorbidities, drug combinations and altered pharmacokinetics in the elderly.This article reviews the selection, adverse reactions, metabolism and drug interactions of epilepsy drugs in the elderly.

Delirium superimposed on dementia in the elderly:A research progress / 中华老年医学杂志

Dementia superposed on delirium is common in the elderly.It has poor prognosis,high in-hospital mortality,increased medical costs and high risk of rehospitalization,causing the serious consequences on the health.This paper reviews the concept,epidemiology,risk factors,clinical manifestations,assessment methods,diagnosis,and treatment of delirium superimposed on dementia.

Spontaneous spinal subarachnoid hemorrhage: a case report and literature review / 中华老年医学杂志

Objective To investigate the clinical,laboratory and MRI imaging features of a spontaneous spinal subarachnoid hemorrhage(S-SAH)so as to improve the recognition of spontaneous (S-SAH).Methods The data of clinical,laboratory,MRI imaging features,treatment and prognosis of the spontaneous(S-SAH)were collected and statistically analyzed.Relevant literatures were then reviewed.Results The patient was a 75-year-old woman with neuromyelitisoptica spectrum disorders.During the course of hospitalization for intravenous infusion of high-dose methylprednisolone,the patient suffered from a sudden and severe migrating back pain that gradually progressed from the back to the neck and head,and signs of meningeal irritation occurred.After the exclusion of aortic dissection,acute coronary syndrome,pulmonary embolism,and fractures,further MRI scans of the head and spinal cord were performed.The MRI confirmed subarachnoid hemorrhage located in spinal cord and posterior cranial foss,and the diagnosis was spontaneous S-SAH.Conclusions Migrating back pain combined with signs of meningeal irritation is a characteristic clinical manifestation of S-SAH,and a prompt MRI evaluation of spinal cord is helpful to improve the early diagnosis and treatment.

Expression of plasma thrombospondin-1 in renal interstitial fibrosis / 中南大学学报(医学版)

OBJECTIVE@#To observe the expression of plasma thrombospondin-1(TSP-1) at different time in protein-overload rats and to analyze the relationship between plasma TSP-1 expression and renal interstitial fibrosis.@*METHODS@#Forty-five male Sprague-Dawley rats were randomly divided into a bovine serum albumin (BSA) group and a control group after uninephrectomization. Rats with protein overload nephropathy induced by intraperitoneally injected BSA were used as a model (control group received saline). At the 1st, 5th, and 9th weekend, the level of 24 h proteinuria and renal function was assessed. Pathological changes were observed by electron and fluorescent microscopy. The expression of plasma TSP-1 was detected by Western blot. The relationship between plasma TSP-1 and tubulointerstitial lesions (TIL) score was analyzed.@*RESULTS@#Twenty-four hour proteinuria and blood urea nitrogen (BUN) significantly increased in protein-overload rats compared with those in the control group. While protein-overload rats developed more severe fibrosis in the tubular and interstitium. Glomerulosclerosis index and TIL score were upregulated compared with those in the control group. The expression of TSP-1 increased significantly at the 5th and 9th weekend. The expression of TSP-1 was positively correlated with TIL score (r=0.836, P<0.01).@*CONCLUSION@#Plasma TSP-1 expression is positively correlated with renal interstitial fibrosis in protein-overload rats. Plasma TSP-1 may be used for an important biomarker of renal interstitial fibrosis.

A comparative study of single fiber electromyography and repetitive nerve stimulation of the same extensor digitorum communis muscle in patients with myasthenia gravis / 中华物理医学与康复杂志

Objective To investigate the possible causes of the different diagnostic sensitivity of voluntary single fiber electromyography (SFEMG) and repetitive nerve stimulation(RNS) in patients with myasthenia gravis (MG). Methods The voluntary SFEMG and RNS at low rates were recorded successively from the same extensor digitorum communis (EDC) muscle on the same day in 67 patients with MG. Results The diagnostic sensitivity of SFEMG and RNS was 92.5% and 50.7%, respectively, with the former statistically significantly higher than the later. The percentage of decrement of RNS was positively correlated with 3 SFEMG parameters, i.e. the mean jitter, percentage of abnormal pairs of potential and percentage of impulse blocking. Among the 34 cases with significant decrement on RNS, 2 had no impulse blocking and the maximum decrement reached 62%, while 33 cases with normal RNS had up to 58% of impulse blocking. Conclusion The voluntary SFEMG was more sensitive than RNS in diagnosing MG even in the same muscle. The blocking phenomenon observed in voluntary SFEMG was not completely corresponding to the decrement in RNS.The possible explanations were partly because that RNS recorded the total muscle fibers response in surface of the muscle and SFEMG examined the increasing or blocking at individual motor end-plates, and partly because that the voluntary SFEMG and RNS might explored endplates belonging to different motor units.

Initial application of brain protection device in dilatation and stenting of carotid and vertebral artery stenosis / 中华外科杂志

<p><b>OBJECTIVE</b>To report the initial application of brain protection device in the dilatation and stenting of atherosclerotic stenosis of the carotid and vertebral artery.</p><p><b>METHODS</b>Eighteen patients with 21 atherosclerotic stenoses of the carotid or vertebral artery underwent dilatation and/or stenting with brain protection device (filterwire or angioguard). The clinical results were summarized and the indispensability and feasibility of the device was discussed.</p><p><b>RESULTS</b>With the aid of brain protection device, endovascular dilatation and (or) stenting were performed in all the patients with 21 stenoses of the carotid or vertebral artery. The interventional manipulation was successful and no complications occurred.</p><p><b>CONCLUSIONS</b>Brain protection device is helpful to decrease the embolic complication caused by atherosclerotic plaque and thromboembolus and to increase the security of interventional therapy, during the dilatation and/or stenting of stenosis of the carotid or vertebral artery.</p>