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Failure to remyelinate and rewrap the demyelinated axons has been revealed as the major hurdle for treatment of multiple sclerosis (MS), and the bottleneck is the inability of oligodendrocyte progenitor cell (OPC) to differentiate into mature oligodendrocyte. Remyelination is a spontaneous regenerative process, which includes activation, migration and differentiation of OPC, and is believed to protect the axon and further halt neurodegeneration. In recent years, studies have identified many potential drug targets for efficiently promoting OPC differentiation in demyelination models, such as metformin, clemostine, and drug targets as myelin transcription factor 1-like protein (Myt1L), N-methyl-D-aspartic acid (NMDA) receptor, connexin 43 (Cx43), G protein coupled receptor 17 (GPR17), κ opioid receptor (KOR), sterol 14α-demethylase (CYP51), Δ14-sterol reductase (TM7SF2), emopamil-binding protein (EBP). This review summarizes the recent progress on the mechanisms underlying the activation, migration and differentiation of OPC in remyelination with special focus on studies using demyelination models of MS, which may provide insights of further exploring new therapeutic strategies for MS.
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Spinal surgery is a technically demanding and challenging procedure because of the complicated anatomical structures of the spine and its proximity to several important tissues. Surgical landmarks and fluoroscopy have been used for pedicle screw insertion but are found to produce inaccuracies in placement. Improving the safety and accuracy of spinal surgery has increasingly become a clinical concern. Computerassisted navigation is an extension and application of precision medicine in orthopaedic surgery and has significantly improved the accuracy of spinal surgery. However, no clinical guidelines have been published for this relatively new and fast-growing technique, thus potentially limiting its adoption. In accordance with the consensus of consultant specialists, literature reviews, and our local experience, these guidelines include the basic concepts of the navigation system, workflow of navigation-assisted spinal surgery, some common pitfalls, and recommended solutions. This work helps to standardize navigation-assisted spinal surgery, improve its clinical efficiency and precision, and shorten the clinical learning curve.
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Objective To explore the application value of short latency somatosensory evoked potentials (SLSEP) as a tool for preoperative assessment of surgical or interventional treatment in patients with severe aneurysmal subarachnoid hemorrhage (aSAH). Methods A prospective observational cohort study was conducted. The patients with severe aSAH with a WFNS grade of Ⅳ or Ⅴ admitted to intensive care unit (ICU) of Beijing Tiantan Hospital of Capital Medical University from November 2016 to April 2017 were enrolled. The patients received SLSEP monitoring within 12 hours after onset, and the monitoring results were classified according to the Judson scale. Meanwhile, the findings on cerebral CT scans at admission were evaluated by the modified Fisher classification. The follow-up was performed at 3 months after aSAH ictus based on the modified Rankin scale (mRS), and a mRS score 0-3 was defined as favorable outcome, 4-6 was defined as unfavorable outcome. For statistical evaluation, demographic, clinical, neuroimaging and SLSEP data were evaluated by univariate analysis to identify the risk factors associated with prognosis;afterwards, those factors were analyzed by multivariate Logistic regression; also the validity was assessed by calculating the respective sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Results A total of 41 patients with aSAH were selected, of which 7 were excluded because of the interference of the SLSEP monitoring results, 34 patients with aSAH were enrolled finally. Among them, 21 were classified in the unfavorable outcome group, while the rest (n = 13) were allocated into the favorable outcome group. No significant difference was found in gender, age, body mass index (BMI), time delay from ictus to treatment or the options for therapeutic methods between the two groups. The findings of univariate analysis, however, showed statistically differences in WFNS grade, the modified Fisher scale and Judson scale of SLSEP between the two groups. Yet, the further validity evaluation for these predictors demonstrated that the sensitivity, specificity, PPV and NPV of WFNS grade of Ⅴ and modified Fisher scale of Ⅳ were all less than 85%, whereas the results for SLSEP Judson scale of Ⅲ were much better (sensitivity: 90.5% vs. 71.4% and 71.4%, specificity: 84.6% vs. 69.2% and 76.9%, PPV: 90.5% vs. 79.0% and 83.3%). In the following multivariate Logistic analysis, only Judson scale of Ⅲ was identified to be the independent risk factor for poor outcome [odds ratio (OR) = 45.73, 95% confidence interval (95%CI) = 4.25-499.31, P = 0.002], while the WFNS grade of Ⅴ (OR = 1.14, 95%CI = 0.12-13.06, P = 0.912) and the modified Fisher scale of Ⅳ (OR = 7.22, 95%CI = 0.51-113.20, P = 0.160) were merely associated with poor outcomes without significant independence. Conclusion In comparison with WFNS grade and the modified Fisher scale, SLSEP seems more accurate in the prediction of long-term outcome of severe aSAH prior to surgical or interventional treatment, and thus may be applied as an effective aid in preoperative assessment.
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Objective To explore the influence of emotional care based on the intrinsic motivation theory in the treatment of patients with ovarian cyst.Methods From September 2014 to October 2016,106 patients with ovarian cysts admitted to our hospital were selected and randomly divided into control group and study group with 53 in each group.The control group and the study group received routine nursing and emotional care based on intrinsic motivation theory,respectively.The two groups were evaluated before and after the intervention using the stages of change readiness and treatment eagerness scale (SOCRATES).Result After intervention,the scores of cognitive sub-scale,hesitation sub-scale and act sub-scales of the study group were higher than those of the control group, with significant difference (P＜0.05).Conclusion Emotional nursing based on intrinsic motivation theory is effective for the improved treatment of patients with ovarian cyst surgery,worth further promotion in clinic.
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Objective To evaluate the diagnostic validity of application of brainstem auditory evoked potential (BAEP) as an ancillary test in patients with brain death.Methods A prospective observational study was conducted. Adult patients (≥ 18 years) with brain death were consecutively admitted to the Department of Intensive Care Unit (ICU) of Beijing Tiantan Hospital Affiliated to Capital Medical University from July 2015 to June 2017, and they further underwent BAEP monitoring. The following findings: absence of all waveforms at bilateral sides, absence of all waveforms except wave-Ⅰonly present at bilateral orunilateral side were set as the positive criteria of BAEP for the diagnosis of brain death, and its diagnostic sensitivity (SEN), positive predictive value (PPV) and false negative rate (FNR) were further assessed.Results A total of 47 patients were enrolled in the study, and the 43 complete BAEP results were analyzed. The SEN, PPV and FNR of the above 3 types of diagnostic criteria (absence of all waveforms, and unilateral or bilateral presence of wave-Ⅰ only) were 100% [95% confidence interval (95%CI) 90-100], 100% (95%CI 89-100), and 0% (95%CI 0-9), respectively.Conclusion As an ancillary test, BAEP has extremely high validity for the diagnosis of patients with brain death, thus it should be used more extensively in clinical practice.
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Detection of ECG characteristic points serves as a first step in many automated ECG analysis techniques. We propose a novel statistical scheme for ECG recognition. We design an effective feature, i.e. the randomly selected signal pair difference (RSSPD) feature, to effectively represent ECG morphology. The RSSPD generates a feature pool of signal pairs, and then a multi-class random forest is adopted in this work to train a classification model to detect all the ECG characteristic points simultaneously. After the post processing stage, the final output is generated. Our work provides robust and accurate detection performance in ECG datasets. The evaluation results on QT database show better detection accuracy compared with other studies.
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Electrocardiography , Signal Processing, Computer-Assisted , Algorithms , Databases, Factual , HumansABSTRACT
Objective To compare the difference in pharmacokinetics characteristics of vancomycin in cerebrospinal fluid between administration by continuous infusion and interim infusion.Methods Twenty postoperative patients in the Department of Neurosurgery of Beijing Tiantan Hospital, Capital Medical University admitted into intensive care unit (ICU) to receive vancomycin for prophylaxis of intracranial infection were enrolled, and they were randomly distributed to a continuous intravenous infusion group and a interim intravenous infusion group, each group 10 cases. In continuous intravenous infusion group, the patients received a loading dose of vancomycin (15 mg/kg) by continuous intravenous pump infusion for 1 - 2 hours followed by 30 mg/kg vancomycin in a constant pump infusion rate for 24 hours; while in interim intravenous infusion group, the patients received 15 mg/kg vancomycin administered by intravenous pump infusion for 1 - 2 hours, once every 12 hours. The concentration of vancomycin in the cerebrospinal fluid at different time points was measured by two-dimensional liquid chromatography (2D-LC) method, the parameters of pharmacokinetics were calculated in the two groups, and the adverse reaction was observed.Results The comparison between the ratio of areas under the concentration-time curves (AUC) and minimum inhibitory concentration (MIC) of the continuous and interim groups showed no significant difference (19.7±14.0 vs. 16.1±6.4,P > 0.05). However, in the continuous intravenous infusion group, the drug concentration reached the peak value (0.96± 0.77)μg/mL at 12 hours, and later revealed a plateau concentration 0.91-0.93μg/mL for 12 hours; while in the intravenous infusion interim group, the drug concentration reached the peak value (0.92±0.47)μg/mL at 16 hours, in the later 2 hours declined to (0.84±0.45)μg/mL, and afterwards still had a tendency of persistent declination. In all the patients, no any adverse reaction related to the drug occurred.Conclusion Continuous intravenous infusion and interim intravenous infusion of vancomycin for the postoperative neurosurgical patients without intracranial infection have the similar efficacy of medication, but the former can achieve the peak concentration faster and later the fluctuation of drug concentration in cerebrospinal fluid is smaller than those in the latter.
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BACKGROUND:Pedicle screw is the major instrumentation of surgery in thoracic spine. However, there have been few reports about pedicle morphology relevant to screw insertion tracts, and few reports comparing the normal adolescents and adolescent idiopathic scoliosis patients. OBJECTIVE:To compare the morphologic characteristics of the thoracic pedicle with regard to safe thoracic pedicle screw placement in normal adolescents and adolescent idiopathic scoliosis patients. METHODS: Thoracic pedicles of thirty-five normal adolescents and thirty-five adolescent idiopathic scoliosis patients were measured with three-dimensional reconstruction CT images. Measured parameters include (1) critical distance: the shortest distance from an entry point to the ventral cortex of the lamina. (2) Safe distance: the distance from the entry point to the tangent of the spinal canal at the medial wal of the pedicle. (3) Pedicle screw length. (4) Pedicle width. (5) Pedicle transverse angle. The dangerous area was defined as the distance between the critical distance and the safe distance. RESULTS AND CONCLUSION: The mean critical distance was (9.2±1.0) mm for the normal adolescents, and (9.4±1.2) mm for the adolescent idiopathic scoliosis patients. Safe distances were significantly less in normal adolescents (14.7±0.8) mm than that of the adolescent idiopathic scoliosis group (15.4±1.4) mm (P < 0.001). The dangerous area was (5.4±0.7) mm for the normal adolescents, which was significantly less than that of the adolescent idiopathic scoliosis patients (6.0±1.0) mm (P < 0.001). Pedicle screw length was (36.6±4.1) mm for the normal adolescents and (37.1±5.3) mm for the adolescent idiopathic scoliosis patients. Pedicle width was (5.8±1.2) mm for the normal adolescents and (5.7±1.7) mm for the adolescent idiopathic scoliosis patients. No significant difference in critical distance, pedicle screw length and pedicle width was found between the two groups (P=0.382, 0.135, 0.293). Pedicle transverse angle decreased gradualy from T1 to T12 in both groups. These results verify that pedicle morphology of many parameters is different between normal adolescents and adolescent idiopathic scoliosis patients, especialy in the apical area of the thoracic curve.
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Objective To investigate the possibility and accuracy of predicting malignant middle cerebral artery infarction (mMCAI) with bedside electroencephalography (EEG). Methods Thirty-five patients with massive hemispheric infarction (MHI) underwent bedside EEG monitoring within 48 h of onset. The EEG indicators were interpreted blindly, and the clinical, laboratory and imaging parameters were analyzed. The patients were divided into mMCAI group and non-mMCAI group according to whether they had occurred mMCAI or not within 7 days of onset. The differences of EEG indicators, clinical, laboratory and imaging parameters between the 2 groups were compared. When the parameters of significant difference and statistical significance appeared the odds ratio (OR) of occurring mMCAI were analyzed, and their accuracy of predicting mMCAI was calculated. Results Of the 35 patients with MHI, 20 were in the mMCAI group and 15 were in the non-mMCAI group. There were significant differences in the EEG indicators (infarction on the contralateral side, including disintegration of occipital α rhythm, generalized slow-wave, dominant frequency wave low amplitude, regional attenuation without delta [RAWOD]pattern, and absence of EEG reactivity), clinical parameters (nausea accompanied with vomiting), and imaging parameters (the infracted area more than the entire MCA territory, and midline shifting 3 to 5 mm at the level of septum pellucidum) between the 2 groups (P < 0. 05). Of those, the risk of mMCAI was the highest in patients with disintegration of occipital a rhythm on the contralateral side of infarction (P = 22. 67, 95% CI 3. 89-132. 10). The sensitivity of predicting mMCAI was 85. 0%, the specificity was 80.0%, the positive predictive value was 85.0%, and the negative predictive value was 80. 0%, which were superior to other EEG indicators and clinical or imaging parameters. Conclusions Bedside EEG indicators can early predict mMCAI, moreover, the predictive accuracy is superior to the clinical and imaging parameters.
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in order to maintain a normal temperature range.
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Objective To investigate the changes of vertebral-basal artery and regional cerebral blood flow(rCBF) in patients with olivopontocerebellar atrophy(OPCA).Methods 10 patients with OPCA were examined by digital subtraction angiography(DSA) and single-photon-emission-computed tomography(SPECT),and compared with the control group(patients with vertigo or transient ischemic attack).Results In OPCA group,there were 5 cases with small vertebral artery(50%),4 cases with single vertebral artery(40%),9 cases with small and little vessels(90%),10 cases with poor stain in later arterial phase(100%) could be seen by DSA.The lower rCBF in cerebellum and brain stem were seen in 8 cases(80%)by SPECT.In control group,there were 3 cases(15%),4 cases(20%),4 cases(20%),3 cases(15%) and 7 cases(35%) respectively.There were significant differences between the two groups(all P
