Changes and correlation of serum Hcy levels in diabetic patients complicated with acute cerebral infarction / 公共卫生与预防医学

Objective To analyze the changes and correlation of serum Hcy level in patients with type 2 diabetes mellitus (T2DM) complicated with acute cerebral infarction (AIS). Methods A total of 427 T2DM patients admitted to our hospital from June 2019 to June 2021 were selected and divided into the control group (T2DM, n=129) and experimental group (T2DM combined with AIS, n=298) according to whether the patients were complicated with AIS. According to NIHSS score, the patients in the experimental group subsequently were divided into the mild group (NIHSS score 15 points, n=35). According to infarct size, the patients in the experimental group were divided into the lacunar cerebral infarction group (n=57), small area cerebral infarction group (n=45) and large area cerebral infarction group (n=27). The basic data of all patients, including age, gender, history of hypertension, stroke and smoking, were collected by self-made scale. The levels of FBG, TG, LDL-C, SBP and serum Hcy were compared between the groups. Logistic regression analysis was used to screen the independent risk factors for development of AIS in T2DM patients. Spearman was applied to analyze the correlation between serum Hcy level and the degree of neurological impairment as well as infarct area in T2DM patients with AIS. Results There were statistically significant differences in age, history of hypertension, stroke, smoking, and the levels of TG, LDL-C, FBG, SBP, Hcy between the control and experiment groups (P1=0.459, r2=0.513, P<0.05). Conclusions T2DM patients with old age, poor control of smoking, blood glucose, blood pressure and blood lipids are at greater risk of AIS development. The serum Hcy level of T2DM patients with AIS is significantly increased, which can be monitored to determine the degree of neurological impairment and infarct area of T2DM patients with AIS..

Systematic Evaluation of Clinical Efficacy and Safety of Traditional Chinese Medicine for Post Stroke Cognitive Impairment / 中国实验方剂学杂志

Objective:To evaluate the efficacy and safety of traditional Chinese medicine (TCM) in the treatment of post stroke cognitive impairment (PSCI). Method:Seven databases, including CNKI, WanFang, VIP, CBM, PubMed, The Cochrane library and ClinicalTrials.gov, were electronically searched for relevant randomized controlled trials (RCTs) of TCM in the treatment of PSCI. The Cochrane risk of bias assessment tool was used to evaluate the methodological quality of the included studies, descriptive analysis was carried out on the included studies, and the Meta quantitative analysis was carried out with RevMan 5.3 software. Result:A total of 16 RCTs were included with 1 296 participants, and they were assigned to the intervention group (n=649) and the control group (n=647). The results showed that TCM combined with western medicine group and TCM group were better than western medicine group in improving the scores of Montreal Cognitive Assessment (MoCA), Mini-mental State Examination (MMSE), Barthel Index (BI), Activity of Daily Living (ADL), Chinese stroke scale (CSS) and National Institutes of Health stroke scale (NIHSS) of PSCI patients, and no serious adverse events were observed. Conclusion:TCM has potential advantages in improving the cognitive function of patients with PSCI, and it also has certain efficacy in improving the daily living ability and neurological impairment symptoms, and no serious adverse events have been observed. Due to the low quality of methodology included in the studies, in order to provide reliable basis for clinical decision-making, high-quality of RCTs are still needed to study the efficacy and safety of TCM for PSCI.

Sanfilippo Syndrome: The Tale of a Challenging Diagnosis

Abstract Sanfilippo syndrome or mucopolysaccharidosis III (MPS III), includes a group of four autosomal recessive lysosomal storage disorders caused by deficient activity of enzymes involved in the catabolism of heparan sulfate. The four types of MPS III are recognized in accordance with the deficient enzyme, resulting in the accumulation of heparan sulfate with particularly deleterious effects in the central nervous system. The incidence of MPS III remains to be established in Latin American countries. We describe the journey of a patient with MPS IIIB whom, even in the presence of speech delay and deterioration, behavioral problems and motor incoordination, showed unaltered urinary glycosaminoglycans (GAGs) levels. An investigation for MPS was undertaken and enzyme analysis indicated a deficiency of alpha-N-acetylglucosaminidase, leading to the diagnosis of MPS IIIB. With the correct diagnosis, the patient's symptoms could be properly managed, and the parents received appropriate genetic counseling. The present case report reinforces the need of investigating MPS III in patients with language delay and/or regression, neurological impairment and behavioral alterations, even when urinary GAGs are within normal range. A definitive diagnosis ends the diagnostic journey and enables the medical team and family to provide a better care for the child.

Advances in the application of enteral nutrition in children / 中华实用儿科临床杂志

Enteral nutrition (EN) is the preferred method of clinical nutrition treatment for children.Different EN preparations and feeding methods were chosen according to the age and condition of the children.Breast milk is the best food for infants.For infants with intractable diarrhea after infection,using breast milk as enteral nutrition preparation can promote the recovery of the disease.Total enteral nutrition can be used as the preferred induction therapy for children with Crohn's disease.Individualized diets simulating the nutritional components of enteral nutrition preparations are also being studied.Early EN is not only safe for children with acute pancreatitis,but also can better reduce pain and shorten the average length of hospital stay.Gastrostomy can be considered in children with neurological impairment who need long-term EN.Early EN has been shown to reduce complications,hospital stay and improve prognosis in critically ill children.

A literature review on adverse outcomes resulting from lack of pharmaconutrients in critically-ill neurological patients / 中华临床营养杂志

Pharmaconutrients refer to macronutrients,micronutrients,microecologics,and nucleotides.Informed by large randomized clinical trials,people have become increasingly prudent in using pharmaconutrients.Critically-ill neurological patients are intensive care patients who have neurological impairment,and therefore command extra caution in using pharmaconutrients.This article reviews the latest studies on the use of pharmaconutrients in this group of patients.

HCV Extrahepatic Events: Cryoglobulinemic Syndrome – A Case Report in an Over-70-Year Old Patient.

Mixed Cryoglobulinemia (MC) is the most severe among the extrahepatic manifestations of hepatitis C virus. It is a circulating immune disease due to a virus-induced proliferative disorder of B lymphocytes, mainly involving low and medium-sized vessels. Diagnosis of cryoglobulinemia is based upon the presence in the serum of immunoglobulins which may reversibly precipitate at temperature inferior to 37°C. Presentation of Case: In the present paper we report an interesting case of a 72-year-old man with MC. The two main findings in MC are vasculitis and neuropathic syndrome. Cryoglobulinemic syndrome is characterized by purpura, which is one of the earliest and common clinical manifestations in over 80% of the cases. In this case report the neurological picture is represented by severe sensorimotor polyneuropathy, characterized by burning dysesthesia and lack of sensitivity and strength in the limbs. Discussion and Conclusion: The therapeutic approach to the patient with cryoglobulinemic syndrome should be tailored to the clinical characteristics of the patient and the degree of disease activity. The present clinical picture occurring with severe neurological impairment may be included among the most severe forms of the disease.

Dandy Walker variant mimicking as cerebral palsy with severe neurological impairment.

Dandy Walker Variant (DWV) is a less severe form of the spectrum of Dandy Walker Malformation (DWM). The DWM is a rare congenital intracranial posterior fossa malformation comprising cystic dilatation of the fourth ventricle, complete or partial agenesis of the cerebellar vermis and an enlarged posterior fossa. Clinically it presents with variable degrees of neurological impairment. Definitive diagnosis of DWM or DWV depends on neuroimaging as most of the clinical signs are not conclusive. This child was clinically suspected as spastic quadriplegic cerebral palsy had incidental finding of DWV on neuroimaging. Hence a definitive diagnosis of DWV was made by MRI in this case. Here we discuss the clinical and radiological aspects of this case with DWV without other associated anomalies yet presenting with clinically significant neurological impairment.

The effects of hyperbaric oxygen therapy on cerebral edema and neural function after minimally invasive surgery for intracerebral hemorrhage / 中华物理医学与康复杂志

Objective To investigate the influence of early hyperbaric oxygen (HBO) therapy on cerebral edema and neural function in patients after minimally invasive surgery for intracerebral hemorrhage (ICH).Methods A random number table was used to divide 148 ICH surgery patients into a control group (n =75) and a treatment group (n =73).In the treatment group,HBO was administered in 51 cases 6-24 hours after surgery and then once a day for twenty days.Cerebral edema volume was measured by brain CT before the operation and on the 3rd,7th,14th and 21st day after the surgery.Neurological impairment was scored at the same time points.Results Average cerebral edema volume was significantly smaller in the treatment group than in the control group on the 7th,14th and 21st days,but not on the 3rd day.The neurological impairment scores (NIS) after therapy were significantly lower than that before therapy in both groups.The two groups' average scores were not significantly different before the operation or on the 3rd day,but they were significantly lower in the treatment group thereafter.Conclusion Early HBO therapy can significantly reduce cerebral edema and contribute to nerve functional recovery in patients after minimally invasive ICH surgery.

Aporte del estudio por imágenes en el estudio de alteraciones respiratorias en niños con limitaciones neurológicas / Contribution of imaging in the study of the respiratory complications in the neurologically impaired child

Neurologically impaired children have a high incidence of coexistent respiratory problems, of multifactorial etiology. Among the main related factors are: ineffective cough, hypersalivation, dysphagia, gastroesophageal reflux and lung restriction secondary to chest wall deformity. Because of this, patients with cerebral palsy and neuromuscular diseases present a high prevalence of pulmonary aspiration, which has very varied and sometimes complex clinical manifestations. a variety of imaging exams are available to clarify the etiological diagnosis of the neurological affectation (Computed Tomography -CT- and magnetic Resonance –mR), and evaluate the gastrointestinal compromise of this patients, including the diagnosis of anterograde and retrograde aspiration (upper gi Barium Radiography and Videofluoroscopic swallowing study). An early and accurate imaging diagnosis allows an appropriate clinical management, which anticipates the possible complications and allows us to choose the therapies that improve the quality of life of these children.

Los niños con severos déficits neurológicos tienen una alta incidencia de problemas respiratorios, de etiología multifactorial. Entre los factores asociados destacan la tos inefectiva, sialorrea, disfagia, reflujo gastroesofágico y restricción pulmonar secundaria a deformidades de la caja torácica. Por lo anterior, los pacientes con parálisis cerebral y enfermedades neuromusculares presentan una alta incidencia de aspiración pulmonar cuyas manifestaciones clínicas son variadas y a veces complejas. La imaginología cuenta con exámenes que resultan de utilidad en precisar el diagnóstico etiológico del compromiso neurológico (tomografía computarizada, TC, y resonancia magnética), diagnosticar y evaluar el compromiso pulmonar (radiografías simples y TC) y valorar el compromiso gastrointestinal, incluyendo el diagnóstico de aspiración anterógrada y retrógrada (radiografía de esófago-estómago-duodeno y videofluoroscopía de deglución). Un adecuado diagnóstico por imágenes permite un manejo clínico adecuado que se anticipe a las posibles complicaciones y permita elegir terapias que mejoren la calidad de vida de estos niños.

Changes of serum C-reactive protein and neuron-specific enolase levels in patients with acute cerebral infarction and relative study / 中国医师进修杂志

Objective To investigate the changes of serum C-reactive protein(CRP)and neu-ron-specific enolase(NSE)levels in patients with acute cerebral infarction(ACI)and their relations with in farct size,severity of neurological impairment.Methods The levels of serum CRP,NSE were measured in 60 patients(ACI group)within 72 hours after infarction and 40 normal controls(control group).The severity of neurological impairment of patients with ACl was assessed by National Institutes of Health Stroke Scale (NIHSS)at admission.Results The mean levels of serum CRP and NSE in ACI group were higher than those in control group, (6.95±2.34)mg/L vs(2.21±1.05)mg/L,P＜0.01, (22.39±4.72)μg/L vs(7.16±2.63)μg/L,P＜0.01,respectively.Higher levels of CRP and NSE were obviously associated with larger infarct size and more severe neurological impairment.The changes of CRP and NSE levels correlated with scores of NIHSS(r=0.51,r=0.44,all P＜0.01)significantly.CRP levels were positively correlated with those of NSE(r=0.57,P＜0.01).Conclusion The levels of serum CRP and NSE can be used as an important biological marker to estimate the size of infarct and the severity of neurological impairment in ACI.

Resultados del tratamiento quirúrgico de las fracturas toracolumbares tipo C de la AO / Results of the surgical treatment of type C AO thoracolumbar fractures

AO Type C Thoracolumbar fractures are the most complex and unstable spine injuries, with a high frecuency of neurological impairment. The goal of this study is to describe the clinical characteristics, management and outcome in worker’s compensation patients with type C AO thoracolumbar fractures that were surgically treated in our hospital between January 1994 and December 2004. We collected 88 patients, 68 of them had work related accidents. Four patients were discarded because of insufficient data. The median follow up was 58 months. Of the 64 patients evaluated (mean age 35.7 years), 94 percent were men. The most common mechanism of injury was height fall (41 percent). Associated injuries occurred in 80 percent of the patients (23 percent had another spine fracture). Neurological impairment was present in 64 percent, 22 percent had incomplete, while 42 percent had complete impairment. The majority of the patients presented a C3 AO thoracolumbar fracture (50 percent). The average preoperative time was 6 days (range 0-64). The mean time of surgery was 224 minutes (range 80-640). Only 9.3 percent of the patients required a complementary anterior approach. The median hospitalization time was 61 days (6-275) and the mean postoperative rest was 9.8 months (1.4-34). We had 11 acute complications and 6 delayed complications. Return to work occurred in 64 percent of the patients, while 59 percent was compensated. Among the patients presenting partial neurological impairment, 50 percent improved at least one degree in the Frankel scale.

Las fracturas tóracolumbares tipo C de la AO corresponden a las lesiones espinales más complejas e inestables, con una alta incidencia de compromiso neurológico. El objetivo del presente estudio es describir las características clínicas, manejo y evolución de los pacientes accidentados del trabajo, con fracturas tóracolumbares tipo C de la AO, operados en nuestro hospital. Revisamos en forma retrospectiva los casos entre enero de 1994 y diciembre de 2004. Recolectamos 88 pacientes, 68 de los cuales correspondían a accidentados del trabajo. Cuatro casos fueron eliminados por información incompleta. La mediana de seguimiento fue de 58 meses. De los 64 pacientes evaluados (edad promedio 35,7 años),el 94 por ciento eran hombres. El mecanismo de lesión más común fue caída de altura (41 por ciento). Un 80 por ciento de los pacientes presentaron lesiones asociadas (23 por ciento con fractura de columna a otro nivel). Un 64 por ciento ingresó con compromiso neurológico, de los cuales, el 22 por ciento fue parcial y 42 por ciento completo. La mayoría de las fracturas fueron tipo C3 de la clasificación AO (50 por ciento). El tiempo promedio preoperatorio fue de 6 días (0-64). La duración promedio de la cirugía fue de 224 minutos (80-640). Un 9,3 por ciento de los pacientes requirió de una vía anterior complementaria. La mediana de hospitalización fue de 61 días (6-275) y el tiempo promedio de reposo post operatorio fue de 9,8 meses (1,4-34 meses). Hubo 11 complicaciones precoces y 6 tardías. Un 64 por ciento retornó al trabajo y un 59 por ciento fue indemnizado. De los pacientes con compromiso neurológico parcial, un 50 por ciento recuperó al menos un grado en la escala de Frankel.

The relationship between apoptosis and neurological impairment in experimental intracerebral hemorrhage in rats / 中华物理医学与康复杂志

Objective To investigate the relationship between the apoptosis,expressions of Bcl-2 and Bax protein in perihematomal brain regions of rats and neurologic dysfunctions after intracerebral hemorrhage (ICH). Methods Seventy Sprague-Dawley rats were divided randomly into two groups:an experimental group and a control group.A model of ICH was established by injection of 0.5 U bacterial collagenaseⅦinto the caudate nucleus in the rats.Neurological impairment was evaluated at 6 h,12 h,24 h,48 h,72 h,7 d and 14 d after 1CH,respectively, before the rats were sacrificed.TUNEL method was used to detect apoptosis,and SP method to detect expressions of Bcl-2 and Bax protein in the perihematomal brain tissues.Results Neurological impairment occurred in all the rats after ICH,and peaked at 48 h after ICH.The apoptosis and expressions of Bcl-2 and Bax protein were peaked at 48 h,6 h and 48 h after ICH,respectively.Conclusion The degree of the neurological impairment after ICH is parallel to that of the apoptosis.Apoptosis may play an important role in neurological impairment after ICH.

Post-stroke Depression and Rehabilitation of Neurological Function / 中国心理卫生杂志

Objective:To detect depression in stroke patients and observe its influence on rehabilitation of neurological function and the effect of fluxetine therapy Methods:132 acute stroke patients (78 with infarction, 54 with hemorrhage) were included in the study After inclusion, we did five times of assessments at the end of 2 weeks, 1 month, 3 months, 6 months and 1 year respectively using HAMD assessment to determine whether there had depression or not, as well as SSS (modified Edingburgh-Scandinavian Scoring Scale) for neurological function, ADL (activity of daily living), and self rate depression and anxiety (Zung's self rate depression scale and anxiety scale) Of those with depression, 25 received fluxetine 20mg/d, other 32 with only regular treatment of stroke as control Results:According to results of HAMD, 59 of the 132 had depression (44 7%) The rate of depression had no significant difference between male and female, between those with infarction and with hemorrhage Depression had negative influence on neurological function and activity of daily living Depression had no relation to location, size and unilateral or bilateral of the loci Fluxetine improved depression, neurological function and activity of daily living from 3 months after stroke; its influence on neurological impairment was most significant at 1 year after stroke Conclusion: Post stroke depression is common after cerebral infarction or hemorrhage, it has negative influence on rehabilitation of neurological function and activity of daily living Fluxetine improves both neurological impairments and activity of daily function, as the same time of its improvement of depression

Congenital Kyphosis Due to Dorsal Hemivertebra in Adult: A case report

Kyphotic deformity arising from the failure in formation of a vertebral body is an uncommon condition showing late complications of gross spinal angulation, paraplegia, impaired bladder function and cardiopulmonary deficiencies. Congenital hemivertebra constitute approximately 6% of anomalies associated with congenital spinal deformities. The natural course of this disease remains unpredictable, especially regarding the development of neurological impairment. Only a few numbers of patients with severe kyphosis due to congenital dorsal hemivertebra have been reported. We present a 40-year-old man with severe thoracic kyphosis. Gait difficulty due to paraplegia occurred at the age of fifteen with progressive development of the right lower limb pain and later impairment of bladder function. He had no cardiopulmonary deficiencies. Radiological findings showed a wedge shaped dorsal hemivertebra and cord compression at the eleventh level of thoracic vertebra. In view of the poor prognosis of surgical intervention he was fitted with an Jewett brace so that further neurological impairment was avoided. We report a rare case of congenital kyphosis due to dorsal hemivertebra in adult with progressive neurological impairment.

Study on the Relationship between the TCM Syndromes and Neurological Impairment of Stroke / 中医杂志

Objective To study on the relationship between the TCM Syndromes and neurological impairment of stroke patients.Methods The clinical data of ischemic stroke which based on the clinical information collecting platform was extracted to test whether there was a linear relationship between the Criterion for Diagnosis and Differentiation of Syndromes of Stroke (CDDSS) and National Institutes of Health Stroke Scale (NIHSS) by means of SPSS 12.0 and genetic algorithm.If there was not a linear relationship between CDDSS and NIHSS,the nonlinear relationship was to be tested by means of BP nerve net,LVQ nerve net,Fuzzy ARTMAP nerve net and Support Vector Machine (SVM).Results There was no linear relationship existed between CDDSS and NIHSS with the application of SPSS 12.0 and genetic algorithm.There existed a complicated nonlinear relationship between CDDSS and NIHSS by using BP nerve net,LVQ nerve net,Fuzzy ARTMAP nerve net and Support Vector Machine (SVM).Conclusion Between CDDSS and NIHSS,there isn't a linear relationship,but a complicated nonlinear relationship.