Study on the relationship of National Institutes of Health Stroke Scale score with heart rate variability and cardiac complication in elderly patients with acute cerebral infarction / 中华老年医学杂志

Objective@#To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction, and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score.@*Methods@#One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke(the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score, patients in the cerebral infarction group were divided into 3 subgroups: NIHSS score 0-4 group(n=32), NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28). The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups: (1)the traditional treatment group(n=44), taking routine drugs for cerebral infarction; (2)the special treatment group(n=42), taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups.@*Results@#In patients with acute cerebral infarction, the time-domain parameters of normal-to-normal intervals(NNI), standard deviation of normal-to-normal intervals(SDNN), square root of the mean squared successive differences between normal-to-normaI RR intervals(RMSSD), percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50), frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P<0.05). While, pulse rate and frequency domain parameters of sympathetic vagus balance index(LF/HF)were significantly increased(P<0.05). The time-domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF, HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P<0.05). The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P<0.05), and the frequency domain parameters(LF/HF)were increased(P<0.05)in NIHSS score ≥15 group compared with in NIHSS score 5-15 group(P<0.05). Compared with pre-treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), the frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the incidence of cardiac complication(total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P<0.05). As compared with the traditional treatment group after treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the total incidence of cardiac complication were significantly reduced(18.4% or 7 cases vs.40.0% or 16 cases, P<0.05).@*Conclusions@#The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores, which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke, early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke.

Study on the relationship of National Institutes of Health Stroke Scale score with heart rate variability and cardiac complication in elderly patients with acute cerebral infarction / 中华老年医学杂志

Objective To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction,and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score.Methods One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke (the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score,patients in the cerebral infarction group were divided into 3 subgroups:NIHSS score 0-4 group(n=32),NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28).The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups:(1)the traditional treatment group(n=44),taking routine drugs for cerebral infarction;(2) the special treatment group (n =42),taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups.Results In patients with acute cerebral infarction,the time-domain parameters of normal-to-normal intervals (NNI),standard deviation of normal-to-normal intervals(SDNN),square root of the mean squared successive differences between normal-to-normal RR intervals (RMSSD),percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50),frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P＜0.05).While,pulse rate and frequency domain parameters of sympathetic vagus balance index (LF/HF)were significantly increased (P ＜ 0.05).The time-domain parameters (NNI,SDNN,RMSSD and PNN50) and frequency domain parameters(LF,HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P＜0.05).The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P＜0.05),and the frequency domain parameters(LF/HF) were increased(P＜0.05)in NIHSS score ≥ 15 group compared with in NIHSS score 5-15 group(P＜0.05).Compared with pro-treatment,the special treatment group after treatment showed that the time domain parameters(NNI,SDNN,RMSSD and PNN50)and frequency domain parameters(LF and HF) were significantly increased (P ＜ 0.05),the frequency domain parameters(LF/HF) were significantly reduced (P ＜ 0.05) and the incidence of cardiac complication (total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P＜0.05).As compared with the traditional treatment group after treatment,the special treatment group after treatment showed that the time domain parameters(NNI,SDNN,RMSSD and PNN50)and frequency domain parameters (LF and HF) were significantly increased (P ＜ 0.05),frequency domain parameters(LF/HF) were significantly reduced (P ＜ 0.05) and the total incidence of cardiac complication were significantly reduced(18.4％ or 7 cases vs.40.0％ or 16 cases,P＜0.05).Conclusions The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores,which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke,early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke.

Objective predictors of 'early tolerance' to ventral intermediate nucleus of thalamus deep brain stimulation in essential tremor patients.

OBJECTIVE: To identify pre-operative clinical and computerized spiral analysis characteristics that may help ascertain which patients with Essential Tremor (ET) will exhibit 'early tolerance' to ventral intermediate nucleus of thalamus (Vim) deep brain stimulation (DBS). METHODS: Identification of comparative characteristics of defined cases of 'early tolerance' versus patients with sustained satisfactory response treated with Vim DBS surgery for medically-refractory ET, based on retrospective chart review by a clinician blinded to the findings of computerized spiral analysis. RESULTS: Statistically significant differences in two spiral analysis indices, SWVI and DoS, were found in the dominant upper limbs of patients who developed 'early tolerance', whereas the clinical characteristics were not significantly different. CONCLUSION: Objective measurements of upper limb kinematics using graphonomic tests like spiral analysis should be considered in the pre-operative evaluation for DBS, especially in the setting of moderate-severe predominantly action and proximal postural tremors. SIGNIFICANCE: Ours is the first investigation looking into the pre-operative clinical and objective physiologic characteristics of the patients who develop 'early tolerance' to Vim DBS for the treatment of essential tremor. The study has significant implications for pre-operative evaluation and potential surgical target selection for the treatment of tremors.

The research and practice on excellent course construction in higher vocational colleges / 中华医学教育探索杂志

Course construction is the groundwork for vocational college to improve education quality. The first thing for the excellent course construction is to raise awareness. The fundamental starting point and destination are benefitial to students. It must start from the teachers themselves, and have entire optimization in the teaching content,teaching methods ,teaching materials, the means of teaching and so on.