RESUMEN
Guillain-Barré syndrome (GBS) defines a kind of Immune-mediated acute inflammatory peripheral neuropathy. Miller-Fisher Syndrome (MFS) is a special variant of GBS, with mostly one-way course and rare clinical recurrence. Only a few recurrent cases have been reported in China. Here we report a case of a young male patient with double vision and progressive aggravation of limb numbness, acute onset, with symptoms of upper respiratory tract infection before onset, accompanied by pupil abnormalities and autonomic nervous dysfunction, who was was admitted to our hospital for similar symptoms 3 years ago and was improved by immunotherapy. The patient had a triad of “ataxia, areflexia and ophthalmoplegia”. Cerebrospinal fluid showed protein-cell separation. Serum anti-Sulfatides antibody IgM, anti-GT1a antibody IgG, anti-GQ1b antibody IgG and anti-GM3 IgM were positive. Recurrent MFS was diagnosed and the symptoms improved after immunotherapy. This case suggests that MFS is clinically heterogeneous, a few patients can present with relapse and generally have a better prognosis with immunotherapy. Pre-existing infection and anti-GQ1b antibody production may be predisposing factors for MFS recurrence.
RESUMEN
Objective:To explore the impact of hypophosphatemia on the occurrence and prognosis of critically ill patient.Methods:The clinical data of critically ill patients admitted to the intensive care unit (ICU) of Tianjin First Central Hospital from October 2021 to April 2022 were retrospectively analyzed. Patients were divided into hypophosphatemia group (serum phosphorus level < 0.80 mmol/L) and non-hypophosphatemia group (serum phosphorus level ≥ 0.80 mmol/L) when they were admitted to the ICU. The following variables were also collected, including gender, age, acute physiology and chronic health evaluationⅡ(APACHE Ⅱ), sequential organ failure assessment (SOFA), serum phosphorus level, serum calcium level, serum magnesium level, white blood cell count (WBC), neutrophil count (NEU), lymphocyte count (LYM), neutrophil/lymphocyte ratio (NLR), C-reactive protein (CRP), presence of infection and infection site, length of hospital stay, ICU stay, 28-day mortality, and mechanical ventilation time. Multivariate Logistic regression analysis was used to evaluate the relationship between each variable and the 28-day mortality. The receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) and 95% confidence interval (95% CI) were calculated to evaluate the predictive value of serum phosphorus levels for the prognosis of ICU patients. Results:A total of 263 patients were enrolled, including 54 patients with hypophosphatemia and 209 patients without. The SOFA score, LYM level and the infection rate of patients in the hypophosphatemia group were significantly higher than those in the non-hypophosphatemia group [SOFA score: 6.70±3.17 vs. 5.64±3.59, LYM (×10 9/L): 0.99±0.54 vs. 0.77±0.54, infection rate: 77.78% (42/54) vs. 59.33% (124/209), all P < 0.05], the NLR was significantly lower than that of the non-hypophosphatemia group [10.67 (7.08, 18.02) vs. 12.25 (7.25, 21.68), P < 0.05]. The length of hospital stay, ICU stay, and mechanical ventilation duration in the hypophosphatemia group were significantly longer than those in the non-hypophosphatemia group [length of hospital stay (days): 15 (11, 28) vs. 12 (6, 21), length of ICU stay (days): 10.35±7.80 vs 7.15±6.61, mechanical ventilation duration (days): 3 (0, 12) vs. 2 (0, 5), all P < 0.05]. There was no significant difference in the 28-day mortality between the hypophosphatemia group and the non-hypophosphatemia group [9.26% (5/54) vs. 11.00% (23/209), P > 0.05]. Multivariate Logistic regression analysis showed that APACHE Ⅱ score [odds ratio ( OR) = 1.188, 95% CI was 1.110-1.271], CRP ( OR = 1.016, 95% CI was 1.007-1.026), and NLR ( OR = 1.002, 95% CI was 0.996-1.008) were independent risk factors affecting the 28-day mortality of critically ill patients in ICU (all P < 0.05). ROC curve analysis showed that the AUC of serum phosphorus levels for predicting the length of hospital stay of critically ill patients in ICU > 10 days, ICU stay > 5 days, and mechanical ventilation duration > 5 days were 0.701 (95% CI was 0.632-0.770), 0.771 (95% CI was 0.691-0.852), 0.617 (95% CI was 0.541-0.692), respectively, all P < 0.01. Conclusion:Hypophosphatemia has some predictive value for the length of hospital and ICU stay and mechanical ventilation time in critically ill patients, but it cannot predict the 28-day mortality.
RESUMEN
Background Lipid metabolism in liver shows circadian-dependent profiles. The hepatotoxicity of environmental chemicals is dependent on circadian time. Objective To observe the effects of bisphenol A (BPA) exposure at different zeitgeber time (ZT) on hepatic and blood lipid metabolism and decipher the underlying mechanisms related to circadian rhythm in mice. Methods Thirty-five female C57BL/6J mice were sacrificed every 4 h in a light-dark cycle (12 h/12 h). The liver tissues were collected to describe the circadian profiles of hepatic Rev-erba, Bmal1, Clock, Srebp1c, and Chrebp mRNA expression levels within 24 h. Thirty female mice were divided into 6 groups by the timing (ZT3 represents the 3 h after light on, ZT15 represents the 3 h after light off) and dose (50 or 500 μg·kg−1·d−1) of BPA exposure to observe hepatotoxicity. Mice were gavaged with designed doses of BPA once per day for 4 weeks. Mice were maintained with ad libitum access to food and water and measured body weight weekly. After the experiment, mice were euthanatized and liver tissues were separated to determine the biochemical indicators of lipid metabolism and lipid metabolism- and circadian-related gene mRNA expressions. Results Hepatic Rev-erba, Bmal1, Clock, Srebp1c, and Chrebp mRNA expression levels were rhythmic during a 24 h period in mice. At ZT3 and ZT15, BPA did not alter body weight, plasma glucose, plasma total cholesterol, plasma low density lipoprotein cholesterol, and plasma triglycerides (P>0.05). The plasma high density lipoprotein cholesterol decreased in the 50 μg·kg−1·d−1 BPA group at ZT3 by 14.56% compared with the control group (P<0.05). The liver triglycerides increased in the 50 μg·kg−1·d−1 BPA group at ZT15 by 115.20% compared with the control group (P<0.05). BPA decreased Srebp1c mRNA expression level when dosing at ZT3 and increased Chrebp, Srebp1c, and Acc1 mRNA expression levels when dosing at ZT15 compared with the control group (P<0.05). BPA increased Bmal1 mRNA expression level and decreased Rev-erbα mRNA expression level at ZT3 exposure and decreased Bmal1 and increased Rev-erbα mRNA expression level at ZT15 exposure (P<0.05). Conclusion BPA exposure at light or dark period has different effects on hepatic lipid metabolism in mice. Hepatic lipid deposit appears when BPA is dosed at dark period. Rev-erbα-Bmal1 regulation circuits and the subsequent upregulation of Srebp1c and Chrebp and the target gene Acc1 may be involved.
RESUMEN
Although the neuropathologic changes and diagnostic criteria for the neurodegenerative disorder Alzheimer′s diseasehave been established, the clinical symptoms are very different largely.The clinical symptoms of its special type frontal lobe variant and behavioral variant frontotemporal dementia are very similar, which brings great challenges to the differential diagnosis.Therefore, we report a patient with progressive cognitive impairment, early significant executive dysfunction and abnormal behavior, and magnetic resonance imaging showed significant frontotemporal atrophy.It is easy to be misdiagnosed as behavioral variant frontotemporal dementia.However, multimodal functional neuroimaging results show that neuropathological changes are more likely to be frontal variant Alzheimer′s disease.This study shows that the use of detailed neuropsychological tests, biological markers and multimodal neuroimaging to identify these atypical syndromes will help to improve the accuracy of diagnosis and patient management.
RESUMEN
Objective@#To explore the effect of metabolic syndrome(MetS) and its individual components on cognitive impairment and neurological dysfunction in patients after acute ischemic stroke.@*Methods@#A total of 733 patients with acute ischemic stroke aged 60 to 83 years admitted in Tianjin Huanhu hospital from January 2010 to May 2018 were enrolled in this cross-sectional study.The patients were divided into the non-metabolic syndrome(non-MetS) group and the metabolic syndrome(MetS) group according to the diagnostic criteria of metabolic syndrome.Cognitive functions were evaluated by using the Montreal Cognitive Assessment(MoCA) and Mini-Mental State Examination(MMSE). Neuropsychiatric behavior was assessed by using the Neuropsychiatric Inventory(NPI) questionnaire.Emotional state was examined according to the 21-item Hamilton Depression Rating Scale(HAMD-21). The degree of neurological impairment after stroke was evaluated by using the National Institutes of Health Stroke Scale(NIHSS). The activity of daily living was evaluated by Barthel index and the Activity of Daily Living(ADL) scale.The overnight fasting blood samples were obtained in order to determine biochemical indicators.@*Results@#The average age of first-onset of ischemic stroke was earlier, and the body mass index(BMI) was higher in the MetS group than in the non-MetS group(P<0.05). The levels of high sensitivity C-reactive protein(hs-CRP), total cholesterol(TC), triglyceride(TG), low-density lipoprotein cholesterol(LDL-C), homocysteine(Hcy), fasting plasma glucose(FPG) and haemoglobin A1c(HbA1c) were higher, and the level of high-density lipoprotein cholesterol(HDL-C) was lower in the MetS group than in the non-MetS group(P<0.05). In addition, the proportions of patients with hypertension, type 2 diabetes and smokers were higher in the MetS group than in the non-MetS group(P<0.05). The scores of MMSE, MoCA and BI were lower and the scores of NIHSS, NPI-Q and HADM-21 were higher in the MetS group than in the non-MetS group.MetS could increase the risk of cognitive impairment in patients after acute ischemic stroke(OR=3.169, 95% CI: 1.110-9.048). After adjusting for socio-demographic and clinical covariates, the estimated OR value for increasing the risk of cognitive impairment was further increased in MetS(OR=4.741, 95% CI: 2.027-7.427). Furthermore, the increased numbers of MetS components were significantly associated with the cognitive impairment in patients after stroke.With the increasing number of MetS components, the scores of MoCA and BI were decreased, and the scores of ADL, NIHSS, NPI-Q, HADM-21 and Hachinski ischemic scale(HIS) were increased.With the increasing number of MetS components, the degree of neurological impairment and the risk of injury were increased.@*Conclusions@#MetS is associated with the decline of cognitive function, neuromotor dysfunction and the increased risk for neuropsychological disorders in patients after acute ischemic stroke.
RESUMEN
Objective To explore the effect of metabolic syndrome(MetS) and its individual components on cognitive impairment and neurological dysfunction in patients after acute ischemic stroke.Methods A total of 733 patients with acute ischemic stroke aged 60 to 83 years admitted in Tianjin Huanhu hospital from January 2010 to May 2018 were enrolled in this cross-sectional study.The patients were divided into the non-metabolic syndrome(non-MetS) group and the metabolic syndrome(MetS) group according to the diagnostic criteria of metabolic syndrome.Cognitive functions were evaluated by using the Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE).Neuropsychiatric behavior was assessed by using the Neuropsychiatric Inventory(NPI) questionnaire.Emotional state was examined according to the 21-item Hamilton Depression Rating Scale (HAMD-21).The degree of neurological impairment after stroke was evaluated by using the National Institutes of Health Stroke Scale(NIHSS).The activity of daily living was evaluated by Barthel index and the Activity of Daily Living(ADL) scale.The overnight fasting blood samples were obtained in order to determine biochemical indicators.Results The average age of first-onset of ischemic stroke was earlier,and the body mass index(BMI) was higher in the MetS group than in the non-MetS group (P ＜ 0.05).The levels of high sensitivity C-reactive protein (hsCRP),total cholesterol (TC),triglyceride (TG),low-density lipoprotein cholesterol (LDL-C),homocysteine(Hcy),fasting plasma glucose (FPG) and haemoglobin A1c (HbA1c) were higher,and the level of high-density lipoprotein cholesterol(HDL-C) was lower in the MetS group than in the non-MetS group(P ＜0.05).In addition,the proportions of patients with hypertension,type 2 diabetes and smokers were higher in the MetS group than in the non-MetS group(P＜0.05).The scores of MMSE,MoCA and BI were lower and the scores of NIHSS,NPI-Q and HADM-21 were higher in the MetS group than in the non-MetS group.MetS could increase the risk of cognitive impairment in patients after acute ischemic stroke(OR =3.169,95 ％ CI:1.110-9.048).After adjusting for socio-demographic and clinical covariates,the estimated OR value for increasing the risk of cognitive impairment was further increased in MetS(OR =4.741,95 ％ C1:2.027-7.427).Furthermore,the increased numbers of MetS components were significantly associated with the cognitive impairment in patients after stroke.With the increasing number of MetS components,the scores of MoCA and BI were decreased,and the scores of ADL,NIHSS,NPI-Q,HADM-21 and Hachinski ischemic scale (HIS) were increased.With the increasing number of MetS components,the degree of neurological impairment and the risk of injury were increased.Conclusions MetS is associated with the decline of cognitive function,neuromotor dysfunction and the increased risk for neuropsychological disorders in patients after acute ischemic stroke.
RESUMEN
Objective To explore the diagnostic value of Alzheimer-associated neuronal thread protein(AD7C-NTP)and olfactory function in the differentiation of three types of dementia,and to evaluate their clinical application value.Methods Mini-Mental State Examination (MMSE)and Montreal Cognitive Assessment(MoCA)were applied to evaluate cognitive function of all subjects with Alzheimer disease(AD),frontotemporal dementia (FTLD),or mixed dementia (MD).Enzyme-linked immunosorbent assay(ELISA)was used to detect the expression levels of AD7c-NTP in urine.T&T test method was applied to detect the olfactory function.Spearman rank correlation was used to evaluate the correlation of urine AD7c NTP with MMSE and MoCA scores.Results There was no significant difference in the demographic profile (except age)among three types of dementia of AD,FTLD and MD(F =4.05,P =0.02).Among the three dementia groups,the mean age of the MD group was highest.The statistically significant difference in MMSE scores was found among the three groups(F 3.79,P=0.03),while there was no significant difference inMoCAand NPI scores among the three dementia groups.The levels of the urine AD7c-NTP were different among the three dementia groups,but without statistical significance(H 1.25,P =0.53).Additionally,the FTLD group had the highest urine AD7c NTP level.Spearman rank correlation analysis showed no correlation of AD7c-NTP with MMSE and MoCA(r =0.18,P =0.25;r =0.14,P =0.39,respectively).No differences in olfactory function of the recognition domain(H =3.40,P=0.18)and in the detection domain(H =2.07,P=0.36)were found among three dementia groups of AD,FTLD and MD.Conclusions The level of urine AD7c-NTP is not of clinical significance in differentiating three types of dementia,and it is not correlated with the MMSE and MoCA scores.This study fails to find the clinical value of olfactory function test for distinguishing three types of dementia.
RESUMEN
Autoimmune encephalitis with GABAB receptor antibodies has been rarely reported.Two cases of GABAB receptor antibodies encephalitis were presented here.Epilepsy was the onset symptom,followed by declined consciousness and frequent seizures.Fever was presented in the whole course of the disease.Myorhythmia of the two hands and pilomotor seizures were shown in the later course of the disease.No specificity was demonstrated in electroencephalograms and magnetic resonance imaging.Sensitive response was shown to the first-line immunotherapy.
RESUMEN
Objective To investigate the changes in cortical excitability and inhibitory circuits of patients with Alzheimer's disease (AD) or behavioral variant frontotemporal dementia (bvFTD) using transcranial magnetic stimulation (TMS).Methods Forty-four patients with AD,30 patients with bvFTD and 44 healthy controls were enrolled in the study.The epidemiological data of all subjects were collected.Each participant received a neurological evaluation and neuropsychologic tests which included Mini-Mental State Examination (MMSE),Activities of Daily Living (ADL) and Hamilton Rating Scale for Depression (HAMD).Neurophysiological evaluations including resting motor threshold (rMT),active motor threshold (aMT) and cortical silent period (CSP) were conducted by means of TMS.Neurophysiological parameters were compared among groups.Results There were significant differences in MMSE,ADL and HAMD assessments among 3 groups,but no significant differences between AD and bvFTD groups.There were significant changes in left rMT(46.52％ ± 8.77％,52.00％ ± 7.30％ and 52.14％ ± 8.27％,F =6.295,P=0.003),left aMT(29.68％ ±7.01％,35.13％ ±8.46％ and 35.39％ ±7.24％,F=7.735,P=0.001) and right rMT(47.82％ ±7.94％,52.07％ ±8.77％ and 53.12％ ±8.61％,F=4.772,P=0.010) among 3 groups.AD patients showed significantly reduced left rMT and aMT comparing to bvFTD patients (P =0.017 and 0.008 respectively) and controls (P =0.005 and 0.002 respectively).In addition,AD patients had a significant decrease in right rMT comparing to controls (P =0.011).There were no statistically significant differences in TMS parameters between bvFTD patients and controls.Conclusions AD is associated with hyperexcitability of the motor cortex,whereas the lack of changes in motor cortical excitability is found in bvFTD.TMS technique may be helpful in differential diagnosis between AD and bvFTD.
RESUMEN
Objective To study the CT and MRI characteristics of myxoid soft tissue tumours.Methods Fifty-three myxoid soft tissue tumours pathologically confirmed were retrospectively studied.MR and CT scan were performed before operation.Noncontrast T1 and T2 weighted images,fat-suppressed T2 weighted images were obtained before contrast-enhanced scan with fat-suppressed T1 weighted sequence was underwent.Plain and contrast-enhanced CT was performed with tube potential of 120 kV,matrix 512 × 512,and automatic tube current modulation technique.Results There were 18 myxoid liposarcoma,3 ganglioneuroma,8 myxofibrosarcoma,2 extraskeletal myxoid chondrosarcoma,10 intramuscular myxoma,and 2 juxta-articular myxoma.Microscopic examination showed myxoid soft tissue tumours which were consisted of abundant myxoid stroma with tumour cells and blood vessels associated with fibrous bands.Low density in CT images,hypointensity in T1 weighted images,significantly hyperintense in T2 weighted images were their common manifestations in the area of abundance of extracellular myxiod matrix.Plain CT images demonstrated equidensite,T1 weighted images isointensity,and fat-suppressed T1 weighted images significant enhancement relatively in the areas of increased number of tumor cells.Hemorrhage,necrosis and capsule of the lesion were revealed in high grade malignant tumors.The septa can be identified in most of myxoid tumours of soft tissue.Conclusion CT and MRI can definitely show the image characteristics of myxiod soft tissue tumours,which can help make a qualitative diagnosis before operation.
RESUMEN
Objective The purpose of this study was to investigate the differences of cognitive impairment and neuropsychiatric behavior disturbances between Alzheimer's disease (AD) and frontotemporal dementia (FTD) patients,as well as their relationships with dementia severity.Methods A total of 38 FTD patients and 46 AD patients were recruited in this study.The Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) were used to evaluate the degree of cognitive impairments.The Neuropsychiatric Inventory Brief Questionnaire Form (NPI) and Frontal Behavioral Inventory (FBI) were used to measure behavioral disturbances.The 21-items Hamilton Depression Rating Scale (HAMD-21) was used to evaluate the mental or emotional state of patients.Clinical dementia rating scale (CDR) was used to divide the dementia severity.Results FTD patients were younger ((70.13 ± 8.36) years vs (66.46 ± 7.04) years,t =2.124,P =0.037),earlier at age of onset ((68.58 ± 8.51) years vs (64.43 ± 6.82) years,t =2.396,P =0.019),with lower MoCA scores (12.50 (8.00,16.25) vs 17.00(10.75,21.00),Z=-2.428,P=0.015),higher NPI (15.00(7.00,25.50)vs 9.50(4.00,17.75),Z=-2.251,P=0.024),FBI (21.00(13.00,27.00)vs 16.00(10.75,23.00),Z=-2.159,P=0.031),FBI-A (13.00 (8.00,16.00)vs 9.00(6.00,12.00) Z=-2.159,P=0.041),FBI-B (9.00(7.00,14.00) vs 7.00(3.00,11.00),Z=-2.051,P=0.040) and HAMD-21 scores (7.00(2.75,14.00) vs 5.00 (3.00,8.00),Z =-2.061,P =0.039).A detail analysis of different cognitive domains showed the executive functions (Z =-2.140,P =0.032),language (Z =-3.357,P =0.001),abstraction (Z =-2.498,P =0.012) and delayed recall (Z =-4.317,P =0.000) of the MoCA scale were lower in FTD patients than that in AD patients,while AD patients had lower scores in memory (Z =-1.999,P =0.046) and orientation (Z =-2.941,P =0.003) of the MMSE scale.Within the subscale scores of the NPI,the agitation (Z =-3.255,P =0.001),disinhibition (Z =-3.093,P =0.002) and irritability (Z =-2.214,P =0.027) scores were higher in FTD patients than in AD patients.The total scores of NPI (r=0.279,P=0.010),FBI (r =0.353,P=0.001),FBI-A (r=0.386,P=0.000) and FBI-B (r =0.273,P =0.012) were positively correlated with the CDR scores,whereas MoCA scores were negatively correlated with the CDR scores (r =-0.760,P =0.000).The subscale scores on MoCA and NPI areas changed corresponding with dementia severity in both groups.Conclusions The cognitive function,behavioral and psychological symptoms between FTD and AD patients are different.FTD patients have poorer executive function,language,abstraction and delayed recall ability,whereas AD patients perform worse in memory and orientation.With the progression of the disease,FTD patients gradually emerged disorientation,while the cognitive impairment in AD patients almost affected all the areas.FTD patients are more likely to have agitation,disinhibition and irritability behavior,and AD patients are more likely to have depression in the late stage.Dynamic evaluation of the cognitive function,behavioral and psychological symptoms in clinical practice can help to distinguish FTD and AD.
RESUMEN
Objective:To investigate the attentional bias for negative emotional facial expressions in major depressive disorder(MDD).Methods:Twenty MDD participants were selected from a larger pool of patients (n=35),diagnosed as depression with the Chinese Classification and Diagnostic Criteria of Mental Disorders Version 3 (CCMD-3),according to the Hamilton Depression Scale (HAMD) and Beck Depression Inventory (BDI).And 20 non-depression control participants(NC)matched with MDD group on age,gender and education level.All participants completed an exogenous cueing task which consisted of two kinds of cue types(valid and invalid trial)and two kinds of face types(neutral faces and negative faces).Results:Patients with MDD showed more larger cue validity effect for negative faces compared with neutral faces(21.73 ms vs.3.91 ms,P<0.01).They showed a stronger attentional engagement for negative faces in comparison with non-depressed participants(17.25 ms vs.1.64 ms,P<0.001).The NC group directed attention away from negative faces,more rapidly disengaging their attention compared with MDD,but the differences showed no significant(-1.50 ms vs.0.57 ms,P>0.05).Conclusion:These results support the assumption that MDD is associated with attentional bias for negative information,and deficits protective bias for it.