Comparison of domestic and imported hemostatic clips in preventing delayed post-polypectomy bleeding after endoscopic resection of colorectal polyps larger than 10 mm / 中华消化内镜杂志

Objective:To compare the efficacy of domestic and imported hemostatic clips in preventing delayed post-polypectomy bleeding (DPPB) after endoscopic resection of colorectal polyps ≥ 10 mm.Methods:Clinical data of 789 patients who underwent endoscopic resection of colorectal polyps (polyp diameter ≥10 mm) in Beijing Friendship Hospital, Capital Medical University from January 2018 to December 2019 were collected. The patients were divided into DPPB group ( n=15) and non-DPPB group ( n=774). Univariate and multivariate logistic regression models were used to analyze the influential factors for DPPB. The patients using one type of hemostatic clip were divided into the domestic hemostatic clip group ( n=499) and the imported hemostatic clip group ( n=208). The efficacy of hemostatic clips in preventing DPPB in the two groups was compared. Results:Among the 789 patients undergoing endoscopic resection of colorectal polyps, 1.9% (15/789) suffered from DPPB. Multivariate logistic regression analysis showed that pedunculated polyp was an independent risk factor for DPPB ( OR=6.621, 95% CI: 2.278-19.241, P=0.001), and closure of mucosal defect was an independent protective factor for DPPB ( OR=0.169,95% CI: 0.050-0.570, P=0.004). Regardless of physician experience, there was no significant difference between the domestic and imported hemostatic clip group in preventing DPPB after endoscopic resection of colorectal polyps ≥10 mm [experienced physicians: 1.8% (7/385) VS 0.6% (1/175), χ2=1.314, P=0.445; common physicians: 2.6% (3/114) VS 3.0% (1/33), χ2=0.010, P>0.999]. The domestic hemostatic clip group paid for less medical expenses than the imported hemostatic clip group (experienced physicians: 1 433.51±889.02 yuan VS 3 033.97±1 686.87 yuan, t<0.001 , P<0.001; common physicians: 1 181.58±815.29 yuan VS 3 303.46±1 690.43 yuan, t<0.001 ,P<0.001). Conclusion:Pedunculated polyp is an independent risk factor for DPPB after endoscopic resection of colorectal polyp larger than 10 mm, and clipping can significantly reduce the risk for DPPB. There is no significant difference in the prevention of DPPB between domestic and imported clips, but domestic clips compared with imported clips yield less medical burden, which are suitable for promotion to primary hospitals and major clinical centers.

A multicenter clinical study of risk factors for abdominal pain and distension in sedation-free colonoscopy / 中华消化内镜杂志

Objective:To analyze the risk factors for the most common adverse events, i.e. abdominal pain and distension in sedation-free colonoscopy.Methods:This was a multicenter clinical study, in which clinical data of patients including outpatients and inpatients who underwent selective sedation-free colonoscopy at six gastrointestinal endoscopy centers from July 2017 to December 2019 were collected, including patients' general information, complicating diseases, examination time, examination results, and occurrence of adverse events of abdominal pain and distension. Univariate and multivariate logistic regression was performed to analyze the risk factors for adverse events of abdominal pain and distension during sedation-free colonoscopy.Results:A total of 2 394 patients underwent sedation-free colonoscopy, among whom 690 (28.8%) suffered from abdominal pain, and 1 151 (48.1%) experienced abdominal distension. The results of multivariate logistic analysis showed that overweight ( OR=1.33, 95% CI:1.09-1.62, P=0.005), obesity ( OR=1.55, 95% CI:1.14-2.11, P=0.005) and combination of hypertension ( OR=1.58, 95% CI:1.23-2.02, P<0.001) were independent risk factors for abdominal pain during sedation-free colonoscopy, and overweight ( OR=1.40, 95% CI:1.17-1.68, P<0.001) and combination of hypertension ( OR=1.39,95% CI:1.10-1.76, P=0.006) were independent risk factors for abdominal distension during sedation-free colonoscopy. Conclusion:Obesity, overweight and combination of hypertension are independent risk factors for abdominal pain, and overweight and combination of hypertension are independent risk factors for abdominal distension during sedation-free colonoscopy.

Impact of situational sport games on gross movements and social development among children aged 4-5 years old / 中国学校卫生

Objective@#To explore the impact of situational sport games on gross movement and social development among children aged 4-5 years, and to provide references for promoting the healthy development of preschool children.@*Methods@#Seventy one children aged 4-5 were randomly selected from one public kindergarten in Beijing during Apr. to Jul. of 2019 and were randomly divided into experimental group ( n =36, 8 week situational sports game intervention) and control group ( n =35, regular learning and playing). The Test of Gross Motor Development (TGMD-3) and social development scale for children aged 3-9 were used to assess gross movement and social development, respectively, which were then compared and analyzed.@*Results@#Before intervention, the total score of gross motor development[intervention group (42.63±7.62), control group (43.00±9.16)] and social development[intervention group (211.88±6.68), control group (212.71±9.80)] showed no significant differences between the two groups( t =-0.18，-0.37， P >0.05). After intervention, increases in gross motor development[intervention group (67.80±9.80), control group (45.68±9.47)] and social development level[intervention group (228.30±6.37), control group (214.71±8.65)] were observed in both groups( t =25.82，3.22；15.90，2.13， P <0.05), with gross movement and social development scores higher in intervention group than that of the control group( t =9.66，7.54， P <0.05).@*Conclusion@#8 week situational sports games can promote gross movement and social development of 4-5 year old children. It is suggested that interventions to promote early childhood development should be aware of multiple dimensions of development.

Establishment and clinical significance of reference intervals of thyroid function indicators of pregnant women in different pregnancy in Yangzhou / 中华地方病学杂志

Objective:By establishing the reference intervals of free thyroxine (FT 4), thyroid stimulating hormone (TSH) and thyroid peroxidase antibody (TPOAb) of pregnant women in different pregnancy in Yangzhou, and analyzing the dynamic trends of each indicator, so as to provide a basis for timely and accurate diagnosis of thyroid disease during pregnancy, and promote prenatal and postnatal care. Methods:Clinical data of 3 726 healthy early (1 747 cases), middle (1 481 cases), and late (498 cases) pregnant women were collected from the Department of Perinatal and Health Care in Yangzhou Women and Children Hospital, the Affiliated Hospital of Yangzhou University Medical College from October 2017 to October 2018. At the same time, data of 407 non-pregnant women in the same period were collected as normal controls. The levels of serum FT 4, TSH and TPOAb in each stage of pregnancy were detected by Beckman automatic chemiluminescence analyzer. The reference interval was established by using the 95% reference value of the bilateral limit, and the differences of early, middle and late pregnancy were compared. Results:There were significant differences in FT 4 levels between early, middle and late stages of pregnancy ( H = 82.56, P < 0.01), with the early stage higher than the middle stage ( P < 0.01) and the middle stage higher than the late stage( P < 0.01). The difference of TSH levels was statistically significant ( H = 91.27, P < 0.01), in which the early stage was lower than the middle stage ( P < 0.01), and the middle stage was lower than the late stage ( P < 0.01). There was a statistically significant difference in TPOAb levels ( H = 30.36, P < 0.01). There was no significant difference between the early stage and the middle stage ( P > 0.05), and the early and middle stages were higher than the late stage ( P < 0.01). The reference intervals of thyroid function index in different pregnancies were, early pregnancy: FT 4 8.28 - 15.66 pmol/L, TSH 0.11 - 4.23 mU/L, TPOAb 0.10 - 16.46 U/ml; middle pregnancy: FT 4 7.38 - 14.36 pmol/L, TSH 0.13 - 4.67 mU/L, TPOAb 0.10 - 18.97 U/ml; and late pregnancy: FT 4 6.33 - 11.39 pmol/L, TSH 0.40 - 3.96 mU/L, TPOAb 0.10 - 6.17 U/ml. Conclusions:There are significant differences in serum thyroid function indicators in different pregnant women. Establishing reference intervals of thyroid function indicators in different stages of pregnancy have important clinical significance for diagnosis of thyroid disease and eugenics.

Preliminary application of video head impulse test in the diagnosis of vertigo / 临床耳鼻咽喉头颈外科杂志

OBJECTIVE@#To investigate clinical application of head impulse test with video recording eye movements in the diagnosis of vertigo.@*METHOD@#The video head impulse test(vHIT) was used to measure the eye saccades and velocity gain in 95 patients with vertigo which were divided into two groups, peripheral vertigo (47 cases) and central vertigo(48 cases); the characteristics of eye saccades and velocity gain of six semicircular canals in different patients with vertigo were analyzed, and were compared between the two groups.@*RESULT@#The vHIT result in patients with peripheral vertigo: in 22 patients (23 affected ears) with Meniere's disease, 21 ears were abnormal (91. 3%); the vHIT results in 4 patients with vestibular schwannoma, 2 patients with vestibular neuritis, 5 patients with delayed endolymphatic hydrops, 6 patients with sudden hearing loss accompanied vertigo, and 8 patients with vestibular dysfunction, were abnormal with correct saccades and/or lower velocity gain of vHIT. The abnormal vHIT results were also found in 35 of 48 patients (72. 9%) with central vertigo, which including posterior cerebral circulation ischemia(7 patients), cerebral infarction/stroke(6 patients), and dizziness with vertigo(17 patients) and others(18 patients). Abnormal rate of vHIT in patients with peripheral vertigo was 95. 7% (45/47), which was significantly higher than that (72. 9%) in patients with central vertigo.@*CONCLUSION@#It is easy to perform the vHIT which without adverse reactions. We can record high-frequency characteristics of vestibular-ocular reflex among six semicircular canals through vHIT. The vHIT results which show the function of vestibular ocular reflex in different diseases with vertigo, can help discriminate peripheral vertigo from central vertigo, and it is a practical assessment method for vertigo.

Characteristics of memory-guided saccade in Parkinson' s disease / 中华神经科杂志

Objective To investigate characteristics of memory-guided saccade in Parkinson' s disease (PD),and to evaluate the application of memory-guided saccade in diagnosing PD.Methods Fiftythree subjects with early- or mid- stage PD were chosen as PD group,meanwhile,36 age-matched healthy subjects were chosen as control group.Memory-guided saccade test and event-related potential P300 were performed in all subjects,and results of the two groups were compared; furthermore,results of subgroups comprised of 29 patients with early-stage PD were analyzed.Results In comparison with control group,memory-guided saccade in PD group showed decreased velocity and primary gain,prolonged latency,extremely increased incidence of unwanted saccade and multi-step saccade ( U =124.000,37.000;both P ＜0.01 ),such abnormalities has already stood out even in subgroup comprised of early-stage PD patients.Meanwhile,latency of event-related potential P300 in PD group was prolonged compared with control group ((384.76 ± 34.48) ms vs (352.42 ± 24.99) ms,t =- 4.791,P ＜ 0.01 ).Multi-step saccade measurement demonstrated excellent sensitivity (96.2％ ) and specificity (94.4％) in the ability to discriminate PD patients from controls.Conclusion Memory-guided saccade in PD patients shows highly abnormal which may reflect the impairment of pontine saccade pathway and the dysfunction of frontal lobe.Memory-guided saccade test may be a useful examination in assisting the diagnosis of PD.

Analysis on the changes of palpebral fissure caused by neostigmine test with videonystagmography / 中华神经科杂志

Objective To quantitatively analyze the palpebral fissure changes in the neostigrnine tests with videonystagmography.Methods Thirty-five patients with myasthenia gravis ( MG),21 non-MG patients and 23 healthy volunteers were intramuscular injected with neostigmine methylsulfate(0.02 mg/kg) and atropine(0.5 mg).The width of palpebral fissure was measured before and after the injection for one hour( once every 10 minutes).The differences of palpebral fissure width of each time point within each group and between groups were analyzed quantitatively with repetitive measure ANOVA.Results There was a significant difference of palpebral fissures (mm) width at different time points within the MG group( before the test:4.67 ± 1.87,after the test:10 min:0.88 ±0.96,20 min:1.49 ± 1.38,30 min:1.71 ± 1.53,40 min:1.77 ± 1.82,50 min:1.79 ± 1.52,60 min:1.62 ± 1.68 ; F =11.202,P =0.002).There were also significant changes of palpebral fissures width in the MG group compared to the non-MG group and the normal control group (F =15.569,P ＜ 0.01; F =15.104,P ＜ 0.01 ).There was alsostatistical significance in the rate of change between these groups.Receiver operating characteristic analytical procedure indicated that 1.17 mm or 17.5％ was of better diagnostic capability in the neostigmine test.Conclusions Measuring palpebral fissure width with videonystagmography could be seen as an objective and accurate method.A patient with palpebral fissure width higher than 1.17 mm or 17.5％ should be highly suspected as MG.

Analysis of the first failure organ and sequential failure on mutiple organ failure in the elderly / 中国医师进修杂志

Objective To provide a scientific basis for early clinical diagnosis and treatment as well as secondary and tertiary protection through 10 years inquiry of multiple organ failure in the elderly(MOFE).Results Among 153 MOFE cases,the first inducement of 89.5%(137/153) patients was infection,among which 93.4% (128/137) was pulmonary infection.The vertical percentage of the first failure organ was as follows: pulmonary (39.0%,60/154),heart (19.5%,30/154),brain (14.9%,23/154),kidney (10.4%,16/154),alimentary canal (8.4%,13/154),liver (6.5%,10/154);while the horizontal percentage was as follows: pulmonary (42.9%,60/140),heart (40.9%,56/137),kidney (32.6%,30/92),brain (21.9%,23/105),alimentary canal ( 14.5%,9/62).The survival time of the first organ failure from shortness to length was as follows: pulmonary,brain,heart,kidney.Conclusions Most MOFE cases have pulmonary failure at first.The organs failure sequence is pulmonary,heart,brain and kidney in order.

Central vestibular impairment in patients with CADASIL / 中国神经精神疾病杂志

Objective To evaluate the vestibular function in patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Methods Seventeen CADASIL patients were recruited in the present study and 17 healthy volunteers served as control subjects. Electronystagmogram examinations including gaze nystagmus test, spontaneous nystagmus test, saccade test, pursuit test, optokinetic nystagmus test and caloric test were performed in the subjects. Results Neither patients nor controls had gaze nystagmus or spontaneous nystagmus. There was no difference in the latency and velocity of saccade movement between patients and controls. The accuracy of the saccade movement, the accuracy in leftward saccade, was significantly lower in CADASIL group compared with controls. The pursuit movement gains was also significantly lower in CADASIL group than in control group(G_L:0.79±0.08, G_R:0.76±0.12)(t=-3.739、-2.911,P <0.05) compared with controls(G_L:0.87±0.04, G_R:0.86±0.06).The optokinetic nystagmus gains were significantly decreased in CADASIL group(G_L:0.79±0.17,G_R:0.78±0.18)(t=-2.342、-2.335,P<0.05) compared with controls(G_L:0.90±0.08,G_R:0.89±0.09). The caloric test was performed in one CADASIL patient and the result revealed an incomplete fixing inhibition. CADASIL group was further divided into normal subgroup and abnormal subgroup based on the pursuit curve. The comparison between those two subgroups demonstrated a significant correlation between the pursuit movement and the symptoms of vertigo or dizziness(P<0.05). Conclusions The central vestibular function is impaired in CADASIL patients and the abnormal vestibular function is related to the symptom of vertigo or dizziness in CADASIL patients.

Tracing eyeball movements in Parkinson' s disease / 中华神经科杂志

Objective To evaluate the eyeball movement examination on Parkinson' s disease (PD) and investigate their vestibular function.Methods Thirty healthy volunteers and 55 PD patients served as subjects.Thirty-one patients had bradykinesia, 23 patients had resting tremor at first visit and 1 had both.Electronystagmogram examinations were performed in all the subjects.The eyeball movment gain (G) of PD group was compared with controls and the difference between the bradykinesia group and resting tremor group was analyzed.Dissymmetry of the bilateral pursuit movement was investigated.Results The eyeball movement gains decreased in PD patients (Left G 0.79±0.10, Right G 0.78±0.11) significantly (U = 394.500, t = 3.547, P < 0.01) compared with controls (Left G 0.86±0.05, Right G 0.85±0.06).There was no difference (t = -0.100,2.005, P0.05) between the bradykinesia group (Left G 0.79± 0.14,Right G 0.74±0.14) and the resting tremor group ( Left G 0.79±0.06,Right G 0.81±0.07).The dissymmetry of the bilateral movement increased significantly (U = 755.500, P < 0.05) in PD group (1.03±0.97) than in controls (0.87±0.86).Conclusion The velocity of the eyeball movement has decreased in patients with PD.There is no difference of the pursuit gain between bradykinesia group and the resting tremor group.The bilateral vestibular function is involved dissymmetrically.

Alternation of Saccadic System in Patients with Parkinson's Disease(review) / 中国康复理论与实践

@#The saccadic movement of patients with Parkinson's disease was abnormal and might be related to the severity of the disease.The abnormal saccadic movement was not related to the symptoms of Parkinson's disease directly,the accesses of controlling limbs' and eyes' movement are comparatively independent.

Study of the eye movements system of the patients with vertebral-basilar insufficiency / 中国康复理论与实践

@# ObjectiveTo investigate the characteristic and the function of the eye movements system of the patients with vertebral-basilar insufficiency (VBI).Methods83 patients with VBI and 57 healthy controls were tested with electronystagmogram instrument,include saccade test, Eye Tracking Test (ETT) and optokinetic test(OKN).Results and ConclusionDelay lower accuracy of saccade test, decreased gain of OKN, asymmetry of horizontal ETT were showed in the patients with VBI.