Anti-mGluR5 encephalitis with mental disorders as the initial symptom： a case report / 四川精神卫生

This article reported the clinical features of a rare patient with anti-metabotropic glutamate receptor 5 （mGluR5） encephalitis with mental disorders as the initial symptom， so as to provide references for clinical diagnosis and treatment. The patient was a 38-year-old male， developed pharyngeal pain as prodromal symptoms， and the main clinical manifestations included rapidly progressive memory loss， anxiety and depression， and psychomotor excitement symptoms including irritability and impulsive behaviors. The disease had a progressive deterioration. In the most severe state， the patient became unconscious in a shallow coma， with further cognitive decline， hallucinations and delusions， and lack of self-awareness. Both cerebrospinal fluid and serum anti-mGluR5 antibody were strongly positive （1∶100）. After two sessions of hormone shock therapy， the patient showed significantly improvement in consciousness， cognitive， emotional and psychiatric dimensions.

Correlation between serum adiponectin levels and post-stroke cognitive impairment / 国际脑血管病杂志

Objective To investigate the correlation between serum adiponectin levels and post-stroke cognitive impairment (PSCI). Methods From January 2018 to December 2018, consecutive patients with ischemic stroke admitted to the Departments of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, Dongguan Changping Hospital, and Jiangsu Provincial Second Chinese Medicine Hospital were enrolled. Serum adiponectin concentration was detected by radioimmunoassay. The cognitive function assessment was performed 1 month after the onset of stroke using the Montreal Cognitive Assessment (MoCA). The total score of MoCA <22 was defined as PSCI. Univariate analysis was used to compare the baseline data between groups, and multivariate logistic regression analysis was used to determine the association between serum adiponectin levels and PSCI. Results A total of 257 patients with acute ischemic stroke were enrolled, with age 66.5 ± 9.9 years, 139 (54.1% ) males, and 91 (35.4% ) with PSCI. Age (68.2 ± 8.1 years vs. 65.6 ± 10.8 years; t=2.007, P=0.046 ), homocysteine (16.0 ± 6.2 μmol/L vs. 14.5 ± 4.5 μmol/L; t= 2.208, P= 0.028 ), and high-sensitivity C-reactive protein ( 7.0 [3.3-9.9] mg/L vs. 4.7 [2.2-9.6] mg/L; Z=2.346, P=0.019 ) as well as the proportion of hypertension (64.8% vs. 50.6% ; χ2 =4.824, P=0.028), diabetes (33.0% vs. 21.1% ; χ2 =4.392, P=0.036), leuko-araiosis (47.2% vs. 32.5% ; χ2 =5.422, P=0.020) and diffusion weighting imaging-Alberta Stroke Project early CT score 0-7 (59.3% vs. 41.4% ; χ2 =6.942, P=0.008) in the PSCI group was significantly higher than that of the non-PSCI group, while the adiponectin level was significantly lower than that of the non-PS-CI group (5.4 [3.5-8.4] mg/L vs. 7.0 [5.3-9.3] mg/L; Z=3.624, P=0.001 ). Multivariate logistic regression analysis showed that after adjusting for the confounding factors, the lower serum adiponectin level was an independent risk factors for PSCI (the 1st quartile group vs. the 4th quartile group: odds ratio 2.152, 95% confidence interval 1.119-5.039; P=0.047). Conclusions Low serum adiponectin level might be an independent risk factor for PSCI in patients with ischemic stroke.

Serum adiponectin predicts post-stroke depression in patients with ischemic stroke / 国际脑血管病杂志

Objective To investigate the predictive value of serum adiponectin (APN) for post-stroke depression (PSD) in patients with ischemic stroke. Methods Patients with acute ischemic stroke admitted to the Departments of Neurology, the Affiliated Brain Hospital of Guangzhou Medical University, and Dongguan Changping Hospital were enrolled prospectively from September 2016 to January 2018. Serum APN levels were measured by radioimmunoassay the next day after admission. PSD was diagnosed by using the Diagnostic and Statistical Manual of Mental Disorders (4th Edition) at one month after discharge. The baseline clinical features in the PSD group and the non-PSD group were compared. Multivariable logistic regression analysis was used to determine the risk factors for PSD. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of APN for PSD. Results A total of 220 patients were enrolled, including 57 (25.9%) in the PSD group and 163 (74.1%) in the non-PSD group. The proportion of patients with diabetes (P=0.020) and living alone (P=0.012), as well as age (P=0.17), homocysteine (P=0.009), C-reactive protein ( P=0.001), and National Institutes of Health Stroke Scale score ( P=0.007) in the PSD group were significantly higher than those in the non-PSD group, while the APN level was significantly lower than that in the non-PSD group (P=0.003). Multivariate logistic regression analysis showed that the 4th quartile of serum APN level was used as a reference, the 1st quartile of APN level was an independent risk factor for PSD (odds ratio, 4 .202, 95% confidence interval 1.401-12.067; P=0.013). ROC curve analysis showed that the area under the curve of serum APN level for predicting PSD was 0.642 (95% confidence interval 0.564-0.721; P=0.001). The optimal cutoff value was 6.4 mg/L, and its sensitivity of predicting PSD was 63.2%, the specificity was 63.8%, the positive predictive value was 83.3%, and the negative predictive value was 57 .7%. Conclusion Serum APN has a certain predictive value for PSD in patients with ischemic stroke.

Clinical and neuropsychological characteristics of general paresis misdiagnosed as primary psychiatric disease.

BACKGROUND: Neurosyphilis is caused by the invasion of Treponema pallidum into the central nervous system. General paresis (GP) is a type of neurosyphilis. The main manifestation of general paresis is dementia; however, this is different from the other types of dementia, which can be cured by adequate doses of penicillin in the early stage. Neurosyphilis is the "great imitator" because it can mimic many types of medical disorders. In addition, the manifestations of neurosyphilis are not typical. Psychiatric disorders as a cause of general paresis have become more common due to the use of antibiotics. Patients with a psychiatric manifestation are often misdiagnosed. The purpose of this study was to explore the differences in the clinical and neuropsychological characteristics of general paresis between patients misdiagnosed as having a primary psychiatric disease and patients diagnosed correctly upon seeing a doctor. The results may assist clinicians in the early identification of neurosyphilis with a mental disorder. METHOD: The demographic and clinical manifestations, laboratory tests, and neuroimaging and neuropsychological characteristics were analysed in 55 general paresis patients with psychiatric disorders, including 29 patients misdiagnosed as primary psychiatric disease and 26 patients diagnosed as having general paresis after being seen once by a doctor. RESULT: All of the patients had positive assay results for cerebral spinal fluid (CSF) Treponema pallidum hemagglutination (TPHA). Only 43.3 % of misdiagnosed patients and 30.8 % of general paresis patients had positive results for the CSF rapid plasma reagin (RPR) test; 96.4 % patients had abnormal neuroimaging. Mood disturbances were the most common psychiatric disorder in the general paresis patients, especially agitation, between the two groups (patients with general paresis who were misdiagnosed as having primary psychiatric disease and patients who had never been misdiagnosed) (p = 0.011). CONCLUSION: Our findings reinforce the importance of performing serologic testing for syphilis. This should be a part of the evaluation of patients with psychiatric disorders, especially patients with cognitive impairment. When the syphilis serology is positive, the patient should be examined thoroughly for neurosyphilis by lumbar puncture. Brain imaging could also aid the physician in discriminating these patients from those with a functional mental disorder.

The study of plasma levels of sCD40 and sCD40L in Alzheimer’s disease and mild cognitive impairment / 中国神经精神疾病杂志

Objective To explore the plasma levels of soluble CD40 (sCD40) and soluble CD40 ligand (sCD40L) in the patients with Alzheimer’s disease (AD) and those with amnestic mild cognitive impairment (aMCI). Methods The levels of plasma sCD40 and sCD40L were measured in 20 patients with AD, 35 patients with aMCI, and 32 cognitively normal controls (NC) using commercially available ELISAs. The cognitive function of AD and aMCI patients was mea?sured by mini-mental state examination (MMSE). Results There were significant differences in plasma sCD40 among AD, aMCI and NC groups (P<0.05) as the medians (the upper and lower quartiles) of plasma levels were 123.3 (97.4, 149.5) pg/mL, 102.9 (63.6, 124.0) pg/mL and 70.66 (51.0, 90.8) pg/mL, respectively. There were significant differences in plasma sCD40L among AD, aMCI and NC groups (P<0.05) as plasma levels were 537.0 (316.0, 1134.0) pg/mL, 316.0 (190.0,546.0) pg/mL and 167.0 (107.5,478.0) pg/mL. A negative correlation between the plasma concentrations of sCD40L and the MMSE scores was found in aMCI patients (r=-0.736, P<0.001). Conclusions There are relevant chang?es of plasma sCD40 and sCD40L levels in patients with AD and aMCI. The present results suggest that plasma levels of sCD40 and sCD40L may be appropriate biomarkers for AD patients and indicate that CD40-CD40L signaling may be in?volved in AD pathophysiology.

Comparison of therapeutic effect between skin flap-extension auricular reconstruction and improved Brent au-ricular reconstruction / 局解手术学杂志

Objective To compare the rate of postoperative complications and satisfaction between skin flap -extension auricular recon-struction ( hereinafter flap-extension ) and improved Brent auricular reconstruction ( hereinafter improved Brent ) .Methods From October 2009 to October 2014, totally 199 patients who have been diagnosed as congenital microtia and received auricular reconstruction were divided into two groups.Group A (159 patients) received flap-extension and Group B (40 patients) received improved Brent.The medical records, pre-and post-surgery photos of all patients were analyzed and satisfaction of patients was collected by the telephone follow -up.Results Pa-tients in both of the two groups were satisfied with their therapies .There were 47 cases of complications in Group A (29.6%, 47/159) and 5 cases of complications in Group B (12.5%, 5/40).The postoperative complications were significantly different between the two groups (P<0.05).Conclusion There was no difference in patients ’ satisfaction between the two methods ,but the postoperative complications of improved Brent were much lower .

The study on the relationship between the 1h-proton magnetic resonance spectroscopy and cognitive im-pairment in patients with general paresis of the insane / 中国神经精神疾病杂志

Objective We aimed to use 1H-MRS to characterize metabolite concentrations in the bilateral hippo?campus in GPI patient. Methods Metabolite ratios in the bilateral hippocampus were compared between patients with GPI (n=52) and Normal Control (NC) (n=38). Clinical neurological tests were measured in all subjects and were correlat?ed to the metabolite concentrations. Results The GPI patients showed significantly lower concentrations of N-acetylas?partate(NAA)/creatine(Cr) ratios in the bilateral hippocampus region compared to the NC subjects. There was significant?ly difference in the NAA/Cr ratios between the mild GPI dementia and the severe GPI dementia groups on the left hippo?campus region. We found that the NAA/Cr ratios concentrations were positively correlated with Mini Mental state Exami?nation (MMSE) and Montreal Cognitive Assessment scale (MoCA) scores in the left hippocampus region and the mI/Cr ra?tios concentrations were positively correlated. Conclusions GPI Patients have neuronal dysfunction in the bilateral hippo?campus. The severity of cognitive impairments is associated with the severity of the damage in the left side.

Intramedullary nail or anatomical plate internal fixation for closed reduction of femoral shaft fracture: comparison of fracture stability / 中国组织工程研究

BACKGROUND:Closed reduction of femoral shaft fracture is a common orthopedic fracture type,and can be treated conservatively,but comminuted fracture and serious conditions should be treated by surgery.Intramedulary nail and anatomical plate are commonly used for internal fixation,the choice of the two materials for the femoral fixation remains controversial.OBJECTIVE:To compare and analyze the clinical prognosis and fracture stability in closed reduction of femoral shaft fractures with intramedulary nail or anatomical bone plates.METHODS:From January 2011 to December 2013,86 patients with femoral shaft fracture recruited from Jiangdu People's Hospital of Yangzhou were involved in the retrospective study.Al patients were divided into two groups,receiving intramedulary nail and anatomical bone plates,respectively.Clinical prognosis,fracture stability and adverse events in the two groups were compared.RESULTS AND CONCLUSION:The intraoperative blood loss and postoperation drainage volume in the intramedulary nail group were significantly lower,while the operation time and fracture healing time were significantly shorter than the anatomical bone plates group (P＜0.05).The excelent and good rate was higher in the two groups,and there was no significant difference between the two groups,although the rate in intramedulary nail group was higher than anatomical bone plates group (P＞0.05).The adverse reactions inintramedulary nail group were significantly less than anatomical bone plates group (9％,35％,P＜0.05).Compared with the intramedulary nail group,more cases in anatomical bone plates group appeared poor fixation and fixator rupture,the incidence of complications was higher,and postoperative stability was poorer.Experimental findings indicate that,both intramedulary nail and anatomical bone plates can achieve good outcomes in the treatment of closed reduction of femoral shaft fractures,but the intramedulary nailing causes fewer trauma,lower incidence of adverse events,and better compatibility and stable,it is worthy of clinical application.

Clinical analysis and management of complications of breast augmentation with injected polyacrylamde hydrogel / 局解手术学杂志

Objective To discuss the clinical manifestation and treatment of the complications caused by injected polyacrylamde hydro-gel( PAAG) for breast augmentation. Methods This retrospective research was performed among 212 patients who undergoing breast aug-mentation with injected polyacrylamde hydrogel. The clinical manifestation and treatment outcome of the complications were analyzed and summarized,which is aim to search an effective treatment method. Results For the 212 patients,the main complications were breast multi-ple indurations (131 cases),fever (9 cases),infection (14 cases),breast pain (65 cases),PAAG displacement (28 cases) and secondary deformity or asymmetry (25 cases). 152 cases experienced one clinical symptom,the rest patients simultaneously undergone no less than two clinical symptoms. Patients were received open operation with periareolar incision ( surgery group) or vacuum absorption by needle ( aspira-tion group) for dislodging PAAG. No significant difference was found in wound healing,breast shape satisfaction and pain anesis between the two groups. Whilethe surgery group was better than the aspiration group in efficiency for taking out PAAG and the incidence of reoperation, with statistical significance. Conclusion A plenty of complications occurred after breast augmentation with injected polyacrylamde hydrogel, the method of open operation with periareolar incision is a better way for eliminating PAAG and treating the complications.

Application of cosmetic suture technique for reparation and reconstruction in facial emergency surgery / 局解手术学杂志

Objective To investigate the clinical effect of cosmetic suture technique applied in organs of facial emergency surgery. Methods There were 25 patients who were admitted in our hospital from August 2009 to December 2013. After anatomical reduction and functional restoration, they were given surgery with cosmetic suture technique on the base of debridement. Results All of the patients a-chieved good surgical result, the satisfaction is 100%. After the first stage of operation, 23 patients of them were of no obvious scar and good function recovery. The other 2 patiens also got good effects after secondary surgery. Conclusion Cosmetic suture technique pay attaintion to anatomical and functional restoration. It is of equisite technique, slight injury, less scar after operation and it can maximumly get close to the normal tissue structures and achieve the objective of beauty.

A study of sleep architecture and cognitive functions in dementia with Lewy bodies / 中国医师杂志

Objective To investigate the sleep architecture in dementia with Lewy bodies (DLB),and study the sleep architecture and cognitive functions in DLB.Methods We described polysomnography (PSG) findings in 34 consecutive subjects diagnosed with DLB.All the patients underwent Mini-Mental State Examination (MMSE),Montreal Cognitive Assessment (MoCA),Clinical Dementia Rating (CDR) to quantify cognitive functions.Results (1)Sleep architecture analysis:DLB group compared to normal control group,the sleep period time (SPT) was reduced (P ＜ 0.05),total sleep time (TST) and sleep efficiency (SE) were decreased,total wake time (TWT) and wake after sleep onset (WASO) were increased,1 non-rapid eye movement (NREM) sleep (TS1),2NREM sleep (TS2),total NREM sleep (TNREMS),and REM sleep (TREMS) time were significantly decreased (P ＜0.01).(2)The DLB patients were divided into groups based on MMSE,MoCA,qnd CDR scores,the sleep architecture of each group was no significant difference (P ＞ 0.05).Conclusions Patients with DLB exists sleep architecture disorder.The cognitive functions and sleep architecture changes in patients with DLB have no obvious correlation.It is different from other degenerative dementia.

Interaction of SNP in non-coding region between estrogen receptor alpha gene and brain-derived neurotrophic factor (BDNF) gene in late-onset Alzheimer's disease in southern Chinese Han population / 中国神经精神疾病杂志

Objective To study the interaction of BDNF gene C270T polymorphism and estrogen receptor alpha (ERα)gene Xba Ⅰ loci and Pvu Ⅱ loci polymorphism in late-onset Alzheimer's disease(LOAD)pathogenesis in southern Chinese Han population.Methods BNDF gene C270T locus,ERα gene Xba Ⅰ site and Pvu Ⅱ site polymorphisms were examined in 203 LOAD patients and normal controls using PCR-RFLP technique.Results There was an interaction be-tween BDNF gene and ERα gene,and BDNF gene C270T locus CC genotype and the ERa gene Xba Ⅰ locus xx genotype increased the LOAD incidance risk(OR=2.38,95%CI:1.02～5.53).Conclusions BDNF gene and ERα gene are in-teracted each other in the pathogenesis of LOAD.Patients carrying both BDNF gene C270T locus CC genotype and the ERα gene Xba Ⅰ locus xx genotypes might have an increased risk for LOAD.