Clinical manifestation of non-ketotic hyperglycemia chorea: A case report and literature review.

INTRODUCTION: Chorea is considered a special complication of diabetes mellitus. Here we report a case of chorea associated with non-ketotic hyperglycemia (NKH). PATIENT CONCERNS: The patient was a 79-year-old Asian woman. She had a history of type 2 diabetes mellitus more than 30 years, but with a poor control of blood sugar. She complained of acute onset of right limb involuntary activities, and being admitted to neurology department. DIAGNOSIS: The patient was then diagnosed with NKH chorea. INTERVENTIONS: Intravenous infusion of insulin was given to reduce blood glucose. Haloperidol was used to control motor symptoms. OUTCOMES: Her symptoms improved quickly after treatment. In the past year, the patient's blood sugar was well controlled and her chorea did not recur. LESSONS: If there are sudden abnormal movements in patients, in addition to thinking of chorea, hepatolenticular degeneration and other diseases, we should also pay attention to blood sugar, especially in diabetic patients with poor blood sugar control and negative ketone, we should consider the possibility of NKK chorea. CONCLUSIONS: NKH chorea is a special complication of diabetes.

Clinical Features of Embolic Stroke of Undetermined Source.

Background and Objective: One-third of ischemic strokes have no identifiable cause following standard evaluation. In 2014, researchers have proposed the concept of Embolic Stroke of Undetermined Source (ESUS). The purpose of this study was to report the clinical characteristics of ESUS and its difference from cardiogenic embolism (CE), large-artery atherosclerosis (LA), and small-artery occlusion lacunar (SA). Methods: Acute ischemic stroke (AIS) patients admitted to the department of Beijing Haidian Hospital from January 2017 to December 2017 were prospectively and consecutively enrolled. Base-line characteristics were collected. Stroke etiologies were presented and compared. We compared the clinical features and infarct sites of patients with acute cerebral infarction of different etiologies. Results: A total of 119 AIS patients were analyzed in the study. There were 33 (27.73%) cases in ESUS group, 11 (9.24%) cases in CE group, 45 (37.82%) cases in LAA group and 30 (25.21%) cases in SA group. There were significant differences between the ESUS group and the CE group in the NIHSS score [3 (1.5-5) vs. 6 (2-20), p = 0.007], Modified Rankin Score [19, (57.58) vs. 9, (81.82), p = 0.008], hemorrhagic transformation [0, (0) vs. 5, (45.45), p < 0.001], and left atrial diameter [37.09 ± 3.16 vs. 41.73 ± 5.00, p = 0.001]. ESUS group and LA group have different mRS scores [19, (57.58) vs. 42, (93.33), p < 0.001]. ESUS group and SA group have different mRS scores [19, (57.58) vs. 28, (93.33), p = 0.001]. During 1 year follow-up, there were 5 cases (15.15%) in ESUS group, 3 cases (27.27%) in CE group, 3 cases (6.67%) in LA group, and 1 case (3.33%) in SA group with ischemic stroke (cerebral infarction or transient ischemic attack). Conclusion: ESUS is more similar to atherosclerotic cerebral infarction in clinical features, but the distribution of lesions is more similar to cardiogenic embolism, suggesting that the pathogenesis of ESUS needs to be further explored.

Tianzhi granule improves cognition and BPSD of vascular dementia: a randomized controlled trial.

BACKGROUND AND PURPOSE: Tianzhi granule (TZ) is usually used for patients with vascular dementia (VaD) in China. The aim was to assess the effect of TZ by a randomized clinical trial (RCT). METHODS: A 24-week RCT was conducted in 16 centres. Participants were grouped into TZ, donepezil or placebo. The co-primary outcomes were the Vascular Dementia Assessment Scale-cognitive subscale (VADAS-cog) and Clinician's Interview-based Impression of Change-plus caregiver information (CIBIC-plus). RESULTS: A total of 543 patients with mild to moderate VaD were enrolled, of whom 242 took TZ granules, 241 took donepezil, and 60 took placebo. The least-squares mean changes from baseline and 95% CI were 6.20 (5.31, 7.09) (TZ group), 6.53 (5.63, 7.42) (donepezil group) and 3.47 (1.76, 5.19) (placebo group), both TZ and donepezil showed small but significantly improvement compared with placebo group. The percent of improvement on the global impression which was measured by CIBIC-plus was 73.71% in TZ and 58.18% in placebo, there was significant different between TZ and placebo group (P = 0.004). No significant differences were observed between TZ and donepezil. No significant differences of adverse events were found. CONCLUSIONS: TZ and donepezil could bring symptomatic benefit for mild to moderate VaD. Trial registration The protocol had retrospectively registered at clinical trial.gov, Unique identifier: NCT02453932, date of registration: May 27, 2015; https://www.clinicaltrials.gov/ct2/show/NCT02453932?term=NCT02453932&rank=1.

Autologous Bone Marrow-Derived Stem Cells for Treating Diabetic Neuropathy in Metabolic Syndrome.

Diabetic neuropathy is one of the most common and serious complications of diabetes mellitus and metabolic syndrome. The current therapy strategies, including glucose control and pain management, are not effective for most patients. Growing evidence suggests that infiltration of inflammation factors and deficiency of local neurotrophic and angiogenic factors contribute significantly to the pathologies of diabetic neuropathy. Experimental and clinical studies have shown that bone marrow-derived stem cells (BMCs) therapy represents a novel and promising strategy for tissue repair through paracrine secretion of multiple cytokines, which has a potential to inhibit inflammation and promote angiogenesis and neurotrophy in diabetic neuropathy. In this review, we discuss the clinical practice in diabetic neuropathy and the therapeutic effect of BMC. We subsequently illustrate the functional impairment of autologous BMCs due to the interrupted bone marrow niche in diabetic neuropathy. We anticipate that the functional restoration of BMCs could improve their therapeutic effect and enable their wide applications in diabetic neuropathy.

A review of sleep disorders and melatonin.

Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis and cause significant impairments in social and occupational functions. Although currently approved medications are efficacious, they are far from satisfactory. Benzodiazepines, antidepressants, antihistamines and anxiolytics have the potential for dependence and addiction. Moreover, some of these medications can gradually impair cognition. Melatonin (N-acetyl-5-methoxytryptamine) is an endogenous hormone produced by the pineal gland and released exclusively at night. Exogenous melatonin supplementation is well tolerated and has no obvious short- or long-term adverse effects. Melatonin has been shown to synchronize the circadian rhythms, and improve the onset, duration and quality of sleep. It is centrally involved in anti-oxidation, circadian rhythmicity maintenance, sleep regulation and neuronal survival. This narrative review aims to provide a comprehensive overview of various therapeutic functions of melatonin in insomnia, sleep-related breathing disorders, hypersomnolence, circadian rhythm sleep-wake disorders and parasomnias. Melatonin offers an alternative treatment to the currently available pharmaceutical therapies for sleep disorders with significantly less side effects.