Application progress of endocrine hormones in adolescent idiopathic scoliosis / 中国学校卫生

Abstract@#Adolescent idiopathic scoliosis (AIS) is the most common spinal deformity. With increasing incidence in recent years, it has become an important public health problem threatening the health of adolescents. Adolescence is an important period for accelerated human growth and development, and endocrine hormones will change significantly during this period. Studies have shown that melatonin, estrogen, vitamin D and leptin are closely related to the production and development of scoliosis. Exploring the role of endocrine hormones in the pathogenesis of AIS can provide a reference for the prevention and treatment of AIS.

The value of transcranial Doppler sonography and digital subtraction angiography in evaluating collateral circulation in ischemic stroke and its correlation with prognosis / 中国医师进修杂志

Objective:To explore the value of transcranial Doppler sonography (TCD) and digital subtraction angiography (DSA) in evaluating collateral circulation in ischemic stroke (IS) and its correlation with prognosis.Methods:The 350 IS patients admitted to Shaoxing People′s Hospital from January 2017 to December 2020 were selected as the research objects. According to the results of DSA, they were divided into collateral circulation group and non-collateral circulation group. According to the prognosis, they were divided into good prognosis group and poor prognosis group. The consistency between the evaluation results of collateral circulation on IS of TCD and DSA was analyzed, and its correlation with prognosis was analyzed.Results:The DSA results showed that among 350 patients, 118 had no collateral circulation and 232 had collateral circulation, including 130 cases of grade 1 collateral circulation and 102 cases of grade 2 collateral circulation. TCD results showed that there were 117 cases without collateral circulation and 233 cases with collateral circulation, including 131 cases with grade 1 collateral circulation and 102 cases with grade 2 collateral circulation. The consistency test showed that the evaluation results of TCD on collateral circulation was highly consistent with the gold standard DSA ( Kappa>0.9, P<0.05). Repeated measures analysis of variance showed that time-point effects, inter-group effects, time-point and inter-group interaction effects can significantly affect the changes in modified Rankin scale(mRS) scores ( P<0.05); and the mRS scores in the collateral circulation group were less than those in the non-collateral circulation group at admission the hospital, discharge of the hospital and 3 months after discharge the hospital: (1.89 ± 0.82) scores vs. (2.98 ± 0.98) scores, (1.13 ± 0.53) scores vs. (2.45 ± 0.80) scores, (0.50 ± 0.45) scores vs. (1.86 ± 0.80) scores, there were statistical differences ( P<0.05). The collateral circulation rate in the good prognosis group was higher than that in the poor prognosis group: 78.95%(150/190) vs. 47.50%(76/160), there was statistical difference ( P<0.05). Conclusions:The evaluation value of TCD for IS collateral circulation is high, and collateral circulation is closely related to prognosis.

Effects of emergency medical service on prognosis of ischemic stroke patients treated with intravenous thrombolysis / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of emergency medical service (EMS) on the prognosis of ischemic stroke patients treated with intravenous thrombolysis.@*METHODS@#Clinical data of 2123 ischemic stroke patients treated with intravenous thrombolysis in 70 hospitals in Zhejiang province were retrospectively analyzed. There were 808 patients sent to the hospital by ambulance (EMS group) and 1315 patients by other transportations (non-EMS group). Good outcome was defined as modified Rankin Scale (mRS) ≤ 2 at 3-month. The onset to needle time (ONT), onset to door time (ODT), door to needle time (DNT) and outcome were compared between EMS group and non-EMS group. Binary logistic regression was used to explore the influencing factors for the outcome at 3-month.@*RESULTS@#Compared with the non-EMS group, patients in the EMS group were older, with higher baseline National Institute of Health Sroke Scale (NIHSS) score, and had a higher proportion of atrial fibrillation (all 0.05). Binary logistic regression showed that EMS was not independently associated with good outcome (=0.856, 95%:0.664-1.103, >0.05).@*CONCLUSIONS@#EMS had not improve the outcome of patients receiving intravenous thrombolysis in Zhejiang province.

Advanced treatment time improves outcomes of patients with ischemic stroke undergoing reperfusion therapy / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of treatment time on the outcome of patients with ischemic stroke undergoing reperfusion therapy.@*METHODS@#The clinical data of 3229 ischemic stroke patients who received intravenous thrombolysis with or without arterial thrombolysis from 71 hospitals in Zhejiang province from June 2017 to September 2018 were retrospectively reviewed. The good outcome was defined as modified Rankin Scale (mRS) ≤ 2. Binary logistic regression analysis was used to investigate the association of door to needle time (DNT), or door to reperfusion time (DRT) with the outcomes in patients treated by intravenous thrombolysis or bridging arterial thrombolysis, respectively.@*RESULTS@#Binary logistic regression showed that DNT (=0.994, 95%:0.991-0.997, <0.01) or DRT (=0.989, 95%:0.983-0.995, <0.01) were independently associated with good outcomes, respectively. Every hour decreases in DNT resulted in a 4.7%increased probability of functional independence (mRS 0-2) in patients treated by intravenous thrombolysis; Every hour decreases in DRT was associated with a 11.4%increased probability of functional independence in patients treated by intravenous thrombolysis with arterial thrombolysis.@*CONCLUSIONS@#Good outcomes are associated with lower DNT in ischemic stroke patients treated by intravenous thrombolysis or lower DRT in patients treated by intravenous thrombolysis bridging arterial thrombolysis.

Association of atrial fibrillation with hemorrhagic transformation after intravenous thrombolysis in patients with ischemic stroke / 浙江大学学报·医学版

OBJECTIVE@#To investigate the association of atrial fibrillation (AF) with hemorrhagic transformation (HT) in patients with ischemic stroke treated by intravenous thrombolysis.@*METHODS@#Clinical data of 3272 patients treated by intravenous thrombolysis from 71 hospitals in Zhejiang Province during June 2017 and December 2018 were retrospectively reviewed. Intracranial HT was defined as intracranial hemorrhage suggested by imaging examination 24 hours after intravenous thrombolysis. Patients were dichotomized into HT group (=533) and non-HT group (=2739). The association of AF and HT was analyzed by univariate analysis and binary logistic regression.@*RESULTS@#Compared with the non-HT group, the HT group were older, had longer onset to needle time (ONT), higher baseline National Institute of Health Stroke Scale (NIHSS) score, higher baseline glucose level, and higher AF rate (<0.05 or <0.01). Binary logistic regression analysis revealed that AF was independently associated with HT (=2.527, 95%:2.030-3.146, <0.01).@*CONCLUSIONS@#AF is independently associated with the occurrence of HT in ischemic stroke patients treated with intravenous thrombolysis.

Analysis of intravenous thrombolysis time and prognosis in patients with in-hospital stroke / 浙江大学学报·医学版

OBJECTIVE@#To compare the time delay between in-hospital stroke and out-of-hospital stroke patients, and to explore the influence factors for the prognosis of in-hospital stroke patients treated by intravenous thrombolysis.@*METHODS@#Clinical data of 3050 patients with ischemic stroke who received intravenous thrombolysis in 71 hospitals in Zhejiang province from June 2017 to September 2018 were analyzed. Differences of time delay including door to imaging time (DIT), imaging to needle time (INT) and door to needle time (DNT) between in-hospital stroke (=101) and out-of-hospital stroke (=2949) were observed. The influencing factors for the outcome at 3 month after intravenous thrombolysis in patients with in-hospital stroke were analyzed using binary logistic regression analysis.@*RESULTS@#Patients with in-hospital stroke had longer DIT[53.5 (32.0-79.8) min vs. 20.0 (14.0-28.0) min, <0.01], longer IDT[47.5(27.3-64.0)min vs. 36.0(24.0-53.0)min, <0.01], and longer DNT[99.0 (70.5-140.5) min vs. 55.0 (41.0-74.0) min, <0.01], compared with patients with out-of-hospital stroke; patients in comprehensive stroke center had longer DIT[59.5(44.5-83.3) min vs. 37.5(16.5-63.5) min, <0.01], longer DNT[110.0(77.0-145.0) min vs. 88.0 (53.8-124.3) min, <0.05], but shorter INT[36.5(23.8-60.3)min vs. 53.5 (34.3-64.8) min, <0.05], compared with patients in primary stroke center. Age (=0.934, 95% 0.882-0.989, <0.05) and baseline National Institute of Health Stroke Scale score (=0.912, 95% 0.855-0.973, <0.01) were independent risk factors for prognosis of in-hospital stroke patients.@*CONCLUSIONS@#In-hospital stroke had longer DIT and DNT than out-of-hospital stroke, which suggests that a more smooth thrombolysis process of in-hospital stroke should be established.

Effect of different working time on the prognosis of ischemic stroke patients undergoing intravenous thrombolysis / 浙江大学学报·医学版

OBJECTIVE@#To investigate the effect of working time on the prognosis of patients with ischemic stroke undergoing intravenous thrombolysis.@*METHODS@#Clinical data of 3050 patients with ischemic stroke received intravenous thrombolysis from 71 hospitals in Zhejiang Province during June 2017 and September 2018 were retrospective analyzed. Whole day of Saturday and Sunday were defined as weekend; whole day of Monday to Friday were defined as weekdays; Monday to Friday 8:00-17:00 were defined as daytime of weekdays; Monday to Friday 17:01-07:59 on next day were defined as nights of weekdays; unconventional working time were defined as weekend and nights of weekdays. Good outcome was defined as mRS 0-2 at 3 months. Univariate analyses of baseline and prognostic variables in group of weekend and weekdays, nights of weekdays and daytime of weekdays, unconventional working time and daytime of weekdays were performed. Binary logistic regression was used to investigate whether weekend, nights of weekdays and unconventional working time were independent predicting factors of outcome after intravenous thrombolysis, respectively.@*RESULTS@#There was no difference in 7-day mortality, 3-month mortality and good outcome at 3-month between weekend group and weekdays group, nights of weekdays group and daytime of weekdays group, unconventional working time group and daytime of weekdays group (all >0.05). Binary logistic regression results showed that weekends, nights of weekdays and unconventional working time were not independent predicting factors for outcome after intravenous thrombolysis (all >0.05).@*CONCLUSIONS@#The working time has not affected the outcomes of patients with ischemic stroke undergoing intravenous thrombolysis in studied hospitals of Zhejiang province.

Effect of small-dose Lorazepam on residual dizziness in elderly benign paroxysmal positional vertigo after successful particle repositioning maneuver / 中华老年医学杂志

Objective To evaluate the effect of small-dose Lorazepam on residual dizziness in elderly patients with benign paroxysmal positional vertigo (BPPV) after successful particle repositioning maneuver (PRM).Methods A total of 268 patients aged 60 years and over, who were diagnosed as BPPV and underwent successful treatment of PRM, were randomly assigned to medication group and control group.The patients in the medication group were prescribed low-dose lorazepam for 1 week (0.25 mg/time, 3 times/d), whereas the patients in the control group were not prescribed any medication.Hamilton Anxiety Scale (HAMA) was employed to evaluate the anxiety status of patients before and after PRM, and the effect of small-dose lorazepam on residual dizziness was accessed by using the Dizziness Handicap Inventory (DHI) scale and the Activities-specific Balance Confidence (ABC) scale in elderly BPPV patients after PRM.Results No difference in HAMA scores was found between the two groups (t=-0.316, P=0.753) before PRM.The medication group (t=19.931, P=0.000) and the control group (t=26.930, P=0.000) showed a significant improvement in HAMA scores after PRM versus before PRM.However, HAMA scores after PRM was lower in the medication group than in the control group (t=14.967, P=0.000).The medication group had significant improvements after PRM versus before PRM in the following: DHI scores (t=43.661, P=0.000), functional (t=32.326, P=0.000981), emotional (t=31.981, P=0.000), physical (t=14.330, P=0.000) subscale scores, as well as in the ABC scores (t=-23.248, P=0.000).The improvements were also found in the control group in DHI scores (t=46.282, P=0.000), functional (t=32.117, P=0.000), emotional (t=34.563, P=0.000),physical (t=13.182, P=0.000) subscale scores, as well as in the ABC scores(t=-24.536, P=0.000)after PRM versus before PRM.However, after PRM the total DHI score, functional,emotional and physical subscale scores were lower in medication group than in control group (t=5.994, 3.206, 4.757 and 2.851, respectively, P=0.009, 0.002, 0.000 and 0.005).The ABC scores were higher in medication group than in control group (t=2.678, P=0.008) after PRM.Conclusions The elderly patients with BPPV are often accompanied by symptoms of anxiety.The small-dose Lorazepam can alleviate residual dizziness in elderly BPPV patients after successful PRM.

Clinical characteristics and nursing care of patients with peripartum reversible posterior leukoencephalopathy syndrome / 中国实用护理杂志

Objective To analyze the clinical and nursing care of peripartum reversible posterior leukoencephalopathy syndrome (RPLS).Methods Thirty five cases with peripartum RPLS were retrospectively reviewed.Results All patients developed acutely,22.9％ in the antepartum period and 77.1％ in the postpartum period.The major clinical characteristics were headache (65.7％),seizures(62.9％),visual disturbances (54.3％),altered mental status (22.9％).The most common abnormality on neuro-imaging was edema predominantly involving the cortex and subcortical white matter in the posterior portions of the cerebral hemispheres,including the occipital lobes (77.1％),parietal lobes (65.7％),temporal lobes (28.6％) and frontal lobe (20.0％).MR diffusion-weighted imaging and ADC mapping revealed vasogenic edema.The treatments included aggressive blood pressure control and anticonvulsants with special nursing care.The clinical symptoms and the lesions on neuroimaging improved or resolved within 1 day to 2 months.Conclusions The prognosis for peripartum RPLS is ensured as long as the diagnosis is made properly and reasonable application of care program.

Comparison and improvement of in predicting the short-term prognosis of transient ischemic attack between ABCD and ABCD2 scores / 中华老年医学杂志

Objective To compare the short term prognostic values between the four scores including ABCD,ABCD2,ABCD+ low density lipoprotein (ABCD+ LDL),ABCD2 + LDL after transient ischemic attack (TIA).Methods 235 TIA patients were evaluated according to ABCD score,ABCD2 score,ABCD + LDL score and ABCD2 + LDL score.The occurrence of cerebral infarction was observed at day 2 and 7.The predictive value was compared between the four scores by using receiver operating characteristic (ROC) curve.Patients were classified into 3 risk groups:lowrisk group,moderate-risk group and high-risk group according to ABCD2 L score,and the stroke incidence was compared between the 3 groups by using x2 test.Results The area under ROC curves (AUCs) of ABCD、ABCD2、ABCDL and ABCD2L was 0.68 (95％CI:0.59-0.76),0.71 (95％CI:0.62-0.80),0.73 (95％CI:0.65-0.82) and 0.77 (95％CI:0.69-0.84) in predicting the risk of cerebral infarction at day 2,and were 0.73 (95％CI:0.66-0.81),0.77 (95％CI:0.70 0.84),0.80(95％CI:0.74-0.87) and 0.83 (95％CI:0.76-0.89) in predicting the risk of cerebral infarction at day 7 respectively.Patients were divided into 3 groups:low-risk group (score 0-2) (n =28),moderate-risk group (score 3-5) (n=143) and high-risk group (score 6-8) (n=45) according to ABCD2L score.There were significant differences in stroke incidence at day 2 and 7 between the 3groups (0％,9.1％ vs.32.8％,0％,11.9％ vs.56.3％,x2=26.15,58.87,both P＜0.05).Conclusions ABCD2 score is better than ABCD score in predicting the short-term prognosis of transient ischemic attack.Combining ABCD2 score with LDL can significantly increase the predictive value of ABCD2 score.

Effect of sleep position on lateral-predominance in posterior semicircular canal benign paroxysmal positional vertigo in the elderly patients / 中华老年医学杂志

Objective To investigate the frequency of posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in each ear,and to explore the effect of sleep position in lateral-predominance of ear by PC-BPPV during sleep onset in elderly patients. Methods Totally 114 patients aged (67.4±7.5) years with unilateral PC BPPV confirmed by a positive Dix Hallpike test,were retrospectively reviewed.All patients included in the study were able to define a leteral predominant,favorate head-lying side (right,left or supine position) during sleep onset. Results The Dix Hallpike test was found to be positive on the right side in 72 patients and positive on the left side in 42 cases.During sleep onset,61 patients habitually laid their head on the right side,34 laid their head on the left,and the remaining 19 cases on the supine position.Among 114 cases with positive Dix Hallpike test,there were 78 cases with the same side between affected ear and sleep position (52 cases right,26 cases left),36 cases with different side (9 cases with right position and left positive Dix Hallpike test,8 cases left position and right positive Dix Hallpike test,19 cases slept in a supine position including 12 cases with right positive Dix Hallpike test and 7 cases with left positive).The association between affected ear and head-lying side during sleep onset was statistically significant (x2 =35.737,P＜0.01) and Pearson coefficient of continency was 0.4885. Conclusions Among the elderly,right-sided PC-BPPV is popular,and these patients favorite right head-lying position during sleep.There is association between the affected side by PC-BPPV and the head-lying side during sleep.

The characteristics of Parkinson's disease with dementia and Alzheimer's disease with impaired cognitive function / 中华内科杂志

Objective To analyze the characterization of cognitive function in Parkinson's disease with dementia and Alzheimer's disease. Methods Cognitive function was examined in Parkinson's disease with dementia (PDD) patients ( n = 30) , Alzheimer's disease (AD) patients ( n = 30) and healthy elderly control subjects ( n = 60) . Neuropsychological evaluation contained semantic fluency test, phonemic fluency test, action fluency test, objective and action naming tests. Results In PDD group , the score of semantic fluency test is 9. 33 ±2. 78, 6. 17 ± 1.67 of phonemic fluency test and 7.03 ±2. 34 of action fluency test,it is 6.90 ±2.47, 7.87±2.01,8.30±3. 17 of AD group. The score of objective and action naming tests is 36.33 ±3.39, 17.63 ±2. 17 in PDD group,while AD patients is 33.23 ±3.56 and 22.33 ±2.37. The verbal fluency tests and naming tests were impaired in PDD and AD patients compared with the healthy elderly control group (P ＜ 0. 01 ), phonemic fluency, action fluency and action naming were more impaired in PDD patients compared with the AD group , while semantic fluency and objective naming were more impaired in AD patients (P ＜ 0. 01 ). Conclusions Executive function deficit and naming impairment are found in PDD and AD patients, it shows that PDD is characterized by the addition of cortical dysfunction upon a predominant and progressive fronto-subcortical impairment. There is subcortical dysfunction in AD patients.