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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.
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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.
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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.
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Objective To explore the ability of ABCD2 score + Low density lipoprotein (LDL)(ABCD2L) in predicting early stroke risk after transient ischemic attack (TIA) . Method A total of 165TIA patients were evaluated and classified according to ABCD2 score and ABCD2L score. The occurrences of cerebral infarction were observed at 2th day or 7th day. ROC curve was used to compare the predictive vaule of two scores. Furthermore, according to these two scores, these patients were classified into three risk groups (low, moderate and high ), observed their stroke rate , and compared the differences of three groups with x2 test. Results The two-day risk of stroke was 13.33% and the seven-day risk of stroke was 20. 0% in 165 patients. When the occurrences of cerebral infarction were observed in two days, the area under the curves (AUC) of ABCD2 and ABCD2L was 0. 76 and 0. 80; observed in seven days, the AUC of two scores was 0. 73 and 0. 79. According to the risk stratification of ABCD2 score, in three risk groups,the two-day risk of stroke was 1.9%, 14. 9% and 30. 8%; the seven-day risk of stroke was 3. 8%, 21.8%and 46. 2% ( P ＜ 0. 05 ) . According to the risk stratification of ABCD2 L score, the two-day risk of stroke was 0%, 7. 8% and 31.1% ; the seven-day risk of stroke was 0%, 12. 6% and 44. 4% ( P ＜ 0. 05 ).Conclusions The predictive accuracy of the ABCD2L score is significantly higher than that of ABCD2 score. Furthermore, individuals at high early risk of stroke after TIA can be identified according to the risk stratification of ABCD2L score.
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Objective To explore the effects of lamotrigine (LTG) on cognitive function and the quality of life (QOL) in patients with partial epilepsy. Methods Twenty six patients with newly diagnosed partial epilepsy were randomly divided into 2 different groups using oral administration of LTG and carbamazepine (CBZ) respectively. By neuropsychological test scores and the Quality of Life in Epilepsy Inventory (QOLIE-31) The cognitive function and QOL were assessed before and 16 weeks after the treatment. A battery of neuropsychological tests comprised WAIS digital span test (WDST), verbal fluency test (VFT), trail making test (TMT, parts A and B), stroop color word test (SCWT), Wisconsin card sorting test (WCST), delayed logical memory test, delayed optical memory test, arithmetic ability and digital symbol conversion test. Results The repeated assessments for the patients taking LTG were associated with significant improvements in many domains. When comparing the results at the end of 16 weeks with the baseline results, the verbal fluency were improved, the time of trail making test parts A and B were shortened, the WCST correct number and classification were improved, and the persistent error number and operation time of WCST were declined as well, digital symbol conversion was increased, delayed logic memory and optical memory were improved (t=3. 043, -3. 287,-2. 543,3. 167,3. 028,-2. 191, -3. 216,3. 061,3. 036, 3. 021 ,all P<0. 01 or P<0. 05). When comparing the efficacy of LTG with the CBZ group, the time of stroop color word test was shortened, digital symbol conversion was increased and arithmetic ability was improved (t= 3. 167,2. 142,2. 101, P<0.01 or P<0. 05). Compared with the baseline, both LTG group and CBZ group showed that the overall QOL, overall health, cognitive function and social function scores were improved (LTG group: t= 3. 321,2. 462,3. 294,3. 512;CBZ group: t=3. 314, 3. 149,3. 294,3. 202,all P<0.05). When comparing LTG group with CBZ group after therapy, cognitive function and social function scores were obviously improved (t = 2. 257,2. 140, both P< 0. 05), and the worry about seizure declined (t=2. 147,P<0. 05). Conclusions LTG may improve the cognitive function and QOL in patients with newly diagnosed partial epilepsy.
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Vascular endothelial growth factor (VEGF) has drawn extensive attention from all over the world because of its promising therapeutic prospect. However, recent studies have found that VEGF may promote the occurrence and development of atherosclerosis. The article reviews the molecule characteristics, receptor, expression regulation and function of VEGF, as well as its relationship with atherosclerosis.