Analysis of clinical characteristics of non-valve atrial fibrillation and acute ischemic stroke in the very elderly patients / 中华老年医学杂志

Objective To compare the clinical characteristics of patients with non-valve atrial fibrillation(NAVF)and acute ischemic stroke(AIS) between two groups:aged ≥80 years versus 60-79 years.Methods One hundred and five inpatients with NVAF and AIS,treated in Neurological Department Beijing Hospital from November 2009 to November 2014,were divided into two groups of the very elderly patients (≥ 80 years,n =44) and old patients (60-79 years,n =61).Baseline data and clinical characteristics of patients with NAVF and AIS were retrospectively compared between the two groups to explore their risk factors,subtypes of AIS,the complications and prognosis.Results Age was the risk factor for stroke in the very elderly patients with NAVF.Compared with old patients group,the very elderly patients were associated with significantly higher baseline NIHSS(National Institutes of Health Stroke Scale) (11.59 ± 7.76 vs.6.03±7.12,t=3.80,P=0.000).The rates of mRS(modified Rankin Scale)≥3(poorer clinical turnover)1 or more month after AIS was 21.3％ in the old patients versus 56.8％ in the very elderly patients(x2 =13.96,P＜0.01).Moreover,anterior circulation infarction was the main subtypes of AIS in the very elderly patients versus old patients(x2 =12.28,P =0.020).Meanwhile,the very elderly patients versus the old patients had markedly higher rates of complications of AIS,such as pneumonia (65.9％ vs.27.9％;x2 =14.53,P ＜ 0.05),gastrointestinal bleeding(36.4％ vs.13.1％;x2 =7.84,P＜0.05),acute coronary syndrome or heart failure(34.1％ vs.11.5％;x2 =7.89,P＜0.05).Conclusions The very elderly patients versus the old patients show that risk factors for NVAF with AIS are more often the ageing and smoking,and that anterior cerebral circulation is more often affected.The degrees of NVAF and AIS severity are higher,the more complications are found,and the prognosis is worse.

Cerebral amyloid angiopathy-associated intracerebral hemorrhage in the very elderly : clinical manifestations, diagnosis and treatment / 中华老年医学杂志

Objective To analyze the clinical manifestations,diagnosis and treatment of cerebral amyloid angiopathy (CAA) associated intracerebral hemorrhage.Methods The clinical manifestations,treatment and prognosis of CAA associated intracerebral hemorrhage were analyzed in 4 patients who were identified as CAA-related hemorrhage (CAAH) by pathology.Results All of the 4 patients showed massive lobar intracranial hemorrhage,and underwent craniotomy evacuation of hematoma.One patient had postoperative hemorrhage,and 2 patients were treated with recombinant activated factor Ⅶ after operation.In the next 6 months,re-hemorrhage was found in 3 patients in whom one patient died due to massive hemorrhage.Conclusions CAAH has varied clinical manifestations with high risk of cerebral hemorrhage,and pathological diagnosis is necessary for a definite diagnosis.The very elderly patients with CAAH can benefit from the craniotomy evacuation of hematoma.Although surgery for massive hemorrhage has risks in very elderly patients,it is a better treatment to save their lives.

Incidence and correlative risk factors of aspiration in Alzheimer's disease patients with aspiration pneumonia / 中国康复理论与实践

@#ObjectiveTo investigate the incidence and correlative risk factors of aspiration in Alzheimer disease (AD) patients with aspiration pneumonia. MethodsData of 88 cases with AD were retrospectively investigated. Several possible correlative risk factors were analyzed with multiple Logistic regression. Results38 cases with AD complicated aspiration pneumonia during the observation period [average (3.51±0.25) years].The total average annual incidence of aspiration pneumonia in AD was 12.3%. The annual incidence of aspiration pneumonia in mild AD, moderate AD and severe AD were 11.1%,12.3%,17.6% respectively.The correlative risk factors of aspiration in AD patients with aspiration pneumonia were severity of AD,application of neurosedatives, silent bilateral basal ganglia lacunar infarction (SBI), decrease of activity of daily living (ADL) and leukoaraiosis (LA). ConclusionAspiration pneumonia is a common complication occurring not only in severe AD but also in mild and moderate AD.

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.

A neuropsychological study of Alzheimer disease and mild cognitive impairment / 中华老年医学杂志

Objective To study the neuropsychological features of patients with Alzheimer disease (AD) and mild cognitive impairment (MCI). Methods Fifty-two AD, 26 MCI and 24 healthy aging cases were investigated by the clinical evaluation and a series of neuropsychological tests which include mini-mental state examination (MMSE), clinical dementia rating scale (CDR), activity of daily living scale (ADL) and clinical memory scale (CMS). Results The scores of the neuropsychological tests in AD,MCI and normal control groups were as follows: MMSE scores were 18. 9?5. 1, 26. 9?2. 1, 29. 0?1.1 respectively; ADL scores were 48. 3?17. 7, 26. 7?9. 3, 22. 1?4.1 respectively; Memory Quotient(MQ)scores were 52. 5?26. 7, 81. 3?10. 8, 101. 8?11. 6; CMS scores were 52. 5?26. 7, 81. 3?10. 8, 101. 8?11. 6 respectively. All neuropsychological tests except ADL in MCI group were significantly lower than those in the normal controKall P

Clinical and electrophysiological study of chronic inflammatory demyelinating polyneuropathy / 中国组织工程研究

ObjectiveTo investigate the clinical and electrophysiological features of chronic inflammatory demyelinating polyneuropathy (CIDP) . MethodsThe clinical symptoms and signs of 11 patients with CIDP were studied, motor conduction velocity( MCV), sensory con-duction velocity (SCV) and Electromyography (EMG) were also respectively carried out on 54 motor nerves, 28 sensory nerves and 21 musclesof these 11 cases. The amplitudes of compound muscle action potential(CAMP) obtained from distal and proximal ends were compared to as-certain the presence of conduction block(CB) by stimulating the segments starting from the distal ends. ResultsMore than 3 nerves werefound involved in 10 out of 11 cases, slow MCV were found in 52%, prolongation of the distal latency in 64%, reduction of the amplitudes ofCAMP in 68%,CB in 26%,slow SCV in 85. 7%. EMG revealed neurogenic damage in 81%. ConclusionCIDP is a peripheral de- myelinating neuropathy involving not only the prox imal and distal segments but also the sensory and motor nerves. If there were no conditionsto perform nerve biopsy, testing of protein in CSF and electrophysiology mightbe of important diagnostic value for CIDP.

Establishment and function of neurological intensive care units / 中华医院管理杂志

The authors give an account of the historical development of neurological intensive care and its current status in China and put forward the view that establishment of neurological intensive care units can improve the level of neurological departments in delivering emergency treatments and give impetus to the improvement of expertise in diagnosing and treating acute neurological diseases. It will also play a key role in clinically conducting encephalic resuscitation and hibernation therapy, finely monitoring changes of intracranial physiologic indexes by electro physiological methods, further clarifying organ failure resulting from cerebral and neural failure, and promoting the study of nerve grafting and regeneration. Neurological intensive care units can serve as both the teaching base for training professional staff and the research base for advancing neurological emergency medicine.