Volume 100 ·  Issue 27 ·  2020

Parkinson's disease (PD) is a common neurodegenerative disease in middle-aged and elderly people. Its clinical features include motor symptoms such as bradylosis, tremor, myotonia and non-motor symptoms (NMS). Common NMS mainly include: neuropsychiatric symptoms (depression, anxiety, psychiatric symptoms, cognitive impairment/dementia, apathy, impulse control and related disorders), autonomic dysfunction (postural hypotension, constipation, salivation, urinary dysfunction, sexual dysfunction, drug-related gastrointestinal discomfort, hyperhidrosis, etc.), sleep-wake disorders (insomnia or sleep fragmentation, excessive daytime sleepiness and sleep episodes, sleep behavior disorders during rapid eye movement), pain, fatigue, olfactory and visual disorders, etc.^[1]。 NMS involves a wide range, with large individual differences, and its symptoms may overlap with PD itself or other comorbid symptoms, which lacks specificity, resulting in difficulties for clinicians to diagnose and treat it.

The inferior vena cava filter (IVCF) is a device designed to prevent pulmonary embolism (PE) caused by embolic shedding of deep vein thrombosis (DVT) of the inferior vena cava system.

To investigate the relationship between different waist-hip ratios and sleep-disordered breathing (SDB) in patients with acute coronary syndrome (ACS) and its effect on patients' long-term prognosis.

A total of 725 patients who were diagnosed with ACS in the emergency ward of Beijing An Zhen Hospital from June 2015 to May 2017 were included, and all the patients were monitored for sleep and breathing. Patients were divided into four groups according to their waist-hip ratios. The differences of SDB-related indicators among the four groups were compared, and the correlation between different waist-hip ratios and SDB was analyzed using multiple logistic regression. COX regression analysis and Kaplan-Meier curve were used to compare the prognostic differences among the four groups.

As the waist-hip ratio increased, the apnea hypopnea index (AHI) (P=0.004) and the proportion of sleep apnea hypopnea syndrome (OSAHS) increased (39.3% vs 46.0% vs 53.2% vs 60.0%, P=0.004). Meanwhile, the number of hypoventilation increased, and the mean and minimum arterial oxygen saturation (SaO₂) decreased (all P<0.001). Logistic regression analysis showed that high waist-hip ratio was significantly related with OSAHS (OR=2.579, 95%CI 1.521-4.373, P<0.001). The survival curves showed the highest incidence of major cardio-cerebral vascular events (MACCE) occurred in the high waist-hip ratio group (Log RankP=0.036). COX regression analysis showed that high waist-hip ratio was an independent risk factor for MACCE in ACS patients (HR=2.855, 95%CI 1.375-5.929, P=0.005).

In ACS patients, central obesity is related with SDB. Patients with high waist-hip ratio have a poor prognosis. Elevated waist-hip ratio and SDB jointly impact the prognosis of ACS patients.

To explore the clinical features and prognostic factors of parainfluenza viral lower respiratory tract infections in adults.

A total of 70 patients withpositive nucleic acid of parainfluenza virus (PIV) admitted to China-Japan Friendship Hospital between August 2016 and November 2019 were enrolled. Multiplex real-time polymerase chain reaction (RT-PCR) assays for viral detection were implemented to specimens (nasopharynx swab, sputum or bronchoalveolar lavage) obtained from all the patients, which was consistent with the diagnosis of lower respiratory tract infection. Patients were divided into two groups depending on the status of immune function (immunocompromised group, n=26; immunocompetent group, n=44), and patients were divided into PIV infection group (n=43) and mixed infection group (n=27) according to whether there was mixed infection. Characteristics including age, gender, underlying diseases, symptoms, disease severity, imaging manifestations, etiology, respiratory failure, mechanical ventilation, vasoactive drug, antimicrobial drug and 30-day mortality between the groups were compared, and the prognostic factors of PIV infections were investigated using Cox regression.

The peak incidence of PIV infection time was in May, August, September and December, accounting for 58.6% of all cases. The enrolled 70 cases included 43 cases with pneumonia, 16 cases with interstitial lung disease and infection, 7 cases with bronchiectasis and infection, and 4 cases with acute exacerbation of chronic obstructive pulmonary disease. Eight patients (11.4%) had no underlying diseases, 21 patients (30.0%) had respiratory failure, 18 patients (25.7%) were treated with mechanical ventilation, 15 patients (21.4%) died within 30 days after admission. The pneumonia severity index score, percentage of patients with ground-glass opacity according CT scan, with honeycomb or reticular pattern, with mechanical ventilation, with respiratory failure, with ICU admission, and 30-day mortality in immunocompromised group were higher than those of immunocompetent group [(91.5 vs 84.0), (60.0% vs 34.1%), (44.0% vs 11.4%), (42.3% vs 15.9%), (50.0% vs 18.2%), (38.5% vs 22.7%), (34.6% vs 13.6%)] (all P<0.05). There were 27 cases (38.6%) with mixed infection, including 17 viruses (24.3%), 19 bacteria (27.1%), 14 (20.0%) fungi (PCP, aspergillus) and 1 (1.4%) Mycobacterium intracellulare. Sixteen patients (59.3%) in the mixed infection group were immunocompromised patients and 21 patients (77.8%) had chronic lung disease. Cox regression analysis showed that mechanical ventilation and interstitial lung disease were independent predictors of prognosis in all patients, and mechanical ventilation was an independent predictor of prognosis in PIV infection group.

Most of the patients with PIV lower respiratory tract infection in adults are complicated with underlying diseases and mixed infection, with a high 30-day mortality. Interstitial lung disease and mechanical ventilation indicate poor prognosis in these patients.

To investigate the value of non-invasive ventilation (NIV) combined with high flow nasal cannula oxygen therapy (HFNCO) in sequential treatment of patients with chronic obstructive pulmonary disease after mechanical ventilation.

Chronic obstructive pulmonary disease with acute exacerbation (AECOPD) patients with invasive mechanical ventilation (MV) and successful withdrawal admitted into Huxi Affiliated Hospital of Jining Medical College from January 2018 to December 2019 were enrolled for perspective study. The patients were divided into treatment group (n=40) and control group (n=33) by random number table method. The treatment group was given NIV and HFNCO, the control group was given NIV treatment alone. Bedside ultrasound was used to measure the patients′ diaphragmatic motion, and the differences between the two groups of patients before treatment, 24, 48 and 72 h after treatment were compared in diaphragmatic excursions during quiet breathing (DEq), diaphragmatic excursions during deep breathing(DEd), diaphragmatic shallow fast breathing index (D-RSBI), arterial oxygen partial pressure (PaO₂), arterial partial pressure of carbon dioxide (PaCO₂), re-tracheal intubation rate, mortality rate for 28 days and average duration of NPPV treatment within 3 days.

There were no statistically significant differences in DEq, DEd, D-RSBI, PaO₂ and PaCO₂ between the two groups before treatment (all P>0.05). After 24 h treatment, DEd decreased in both groups, D-RSBI increased in both groups, However, D-RSBI [(1.33±0.56) vs (1.62±0.59) times·min^-1·mm^-1] in the treatment group was significantly lower than the control group, P=0.034. After 72 h treatment, DEd [(41.4±8.1) vs (37.8±6.0) mm] was significantly higher than the control group, D-RSBI [(1.02±0.27) vs (1.22±0.43) times·min^-1·mm^-1] was significantly lower than the control group (all P<0.05). The average duration of NIV treatment time [(7.5±1.2) vs (9.3±2.6) h] in the treatment group was significantly shorter than that in the control group (P<0.01). There were no statistically significant differences in PaO₂, PCO₂, re-tracheal intubation rate and the mortality rate of 28 days.

NIV combined with HFNCO sequential therapy can effectively relieve diaphragm fatigue and promote recovery of respiratory muscle strength, and it′s better than NIV alone.

To investigate the effect of febrile convulsions on gray matter volume (GMV) in medial temporal lobe epilepsy (mTLE) and its correlation with disease duration.

A retrospective study was conducted to collect 41 mTLE patients with a history of febrile convulsions (mTLE-FC), 42 mTLE patients with no initial precipitating injury (mTLE-noIPI), and 42 normal and age and sex matched normal controls. High-resolution T1-weighted (T₁WI) whole brain MR scans were performed on all subjects. Voxel-based morphometry were used to obtain GMV brain maps, and the GMV differences between the three groups of subjects were compared (P<0.01, GRF corrected). Finally, Spearmen rank correlation analysis was used to explore the correlation between GMV changes and the course of disease.

Compared with the normal control subjects, each mTLE group showed extensive GMV reduction, mainly in the affected hippocampus, thalamus, temporal lobe, and bilateral cerebellum. Further analysis found that mTLE-FC group had more significant reductions in GMV than the mTLE-noIPI group in the affected hippocampus, amygdala, inferior temporal gyrus, contralateral hippocampus, para hippocampus, and inner cingulate gyrus. At the same time, the affected amygdala and hippocampal GMV in the mTLE-FC group was significantly negatively related to the course of disease (r=-0.381, P=0.014), while the mTLE-noIPI group had no downward trend (r=0.081, P=0.611). The atrophic trend of the affected amygdala and hippocampus in patients with mTLE-FC was significantly greater than that in patients with mTLE-noIPI (P=0.029, permutation test).

There is extensive damage to the gray matter structure of bilateral cerebral hemispheres, mainly in the hippocampus, in mTLE patients. The brain damage of mTLE patients with a history of juvenile fever convulsions is more extensive and serious, and the trend of progressive exacerbation with the course of the disease is more obvious, suggesting mTLE associated with juvenile fever convulsions may have different pathophysiological mechanisms.

To investigate the significance of microRNA (miR)-216a, miR-324-5p, miR-29a expression in peripheral blood in patients with acute pancreatitis (AP) and their correlation with liver injury.

It was a case-control study design. To select 130 AP patients admitted from June 2017 to May 2019 in the First People′s Hospital of Shangqiu, and the patients were divided into mild AP group (MAP group) and moderately severe AP group (SAP group) according to the disease severity, or 54 patients in the liver injury group (20 were MAP and 34 were SAP) and 76 in the non-liver injury group(all were MAP) according to liver injury. And another 40 healthy volunteers were selected as the healthy group. The expressions of miR-216a, miR-324-5p and miR-29a in peripheral blood of MAP group, SAP group, healthy group and liver injury group, non-liver injury group were compared, and the correlation between the miRNA levels and clinical indexes was analyzed. The predictive value of miRNA levels in peripheral blood for AP complicated with liver injury was analyzed by receiver operating characteristic (ROC) curve.

The levels of miR-216a and miR-29a in MAP group and SAP group were higher than those in healthy group, and the level of miR-324-5p was lower than that in healthy group (all P<0.01). The levels of miR-216a and miR-29a in SAP group were higher than those in MAP group, and the level of miR-324-5p was lower than that in healthy group (all P<0.01). Balthazar CT Score, acute physiology and chronic health evaluations (APACHE Ⅱ) score, C-reactive protein level, length of hospital stay were positively correlated with the levels of miR-216a and miR-29a in peripheral blood (all P<0.05), and negatively correlated with the levels of miR-324-5p (P<0.05). The levels of miR-216a and miR-29a in the peripheral blood in the liver injury group were higher than those in the non-liver injury group, and they were higher inSAP patients than those in MAP patients in the liver injury group (all P<0.05). The level of miR-324-5p in the peripheral blood in the liver injury group was lower than that in the non-liver injury group, and it was lower in SAP patients than that in MAP patientsin the liver injury group (all P<0.05). The area under ROC curve of miR-216a, miR-324-5p, and miR-29a in peripheral blood to predicate the AP complicated with liver damage was 0.694, 0.750 and 0.814, respectively.

The levels of miR-216a and miR-29a increase in peripheral blood and the level of miR-324-5p decreases in patients with AP, and they are closely related to Balthazar CT score, APACHEⅡ score, C-reactive protein and length of hospital stay. The levels of miR-216a, miR-324-5p, miR-29a has certain predictive value for AP with liver injury, of which miR-29a has the highest predictive value.

To assess the clinical effect of oblique lumbar interbody fusion (OLIF) combined with posterior surgery via Wiltse approach for adult degenerative scoliosis.

The clinical data of 27 patients with adult degenerative scoliosis who received OLIF operation from April 2015 to June 2018 in Tongji Hospital were analyzed retrospectively. There were 17 males and 10 females with an average age of (54±11) years. All patients were treated with OLIF combined with pedicle screw fixation via Wiltse approach. Operation time, blood loss and surgery complications were all recorded. Clinical and radiographic evaluation were investigated at 1 week, 3 months of post operation and final follow-up. Visual analog scale (VAS) for low back pain and leg pain, Oswestry disability index (ODI) for low back pain were used to evaluate the clinical efficacy of surgery. Lumbar coronal cobb angle, lumbar lordosis (LL), pelvic tilt (PT), mismatch of PI and PT, sagittal vertical axis (SVA) were investigated with full spine standing X-ray. The data were compared with factor analysis of variance.

All patients were followed-up for 6-52 months ((30±5) months). The operation time was (235±33) min, the blood loss was (433±62) ml. VAS for low back pain and eg pain and the ODI were significantly improved from 6.8±1.4, 7.3±1.4 and 71%±11% preoperatively to 1.1±1.2, 1.0±0.9 and 17%±6% at the latest follow-up (F=115.302,139.855,291.198, all P<0.05).Lumbar coronal Cobb angle of patients was reduced from 28°±8° preoperatively to 9°±4° at the latest follow-up (F=66.352, P<0.05). The LL was significantly increased from 20°±11° preoperatively to 33°±7° (F=17.678, P<0.05), and PT, PI-LL and SVA were significantly increased from 31°±6°,35°±12° and (90±29) mm preoperatively to 26°±5°, 21°±6° and (32±17) mm at the latest follow-up (F=6.211,23.809,53.372, all P<0.05). There was no severe vascular andnerve injuries during and after operation.

OLIF combined with posterior surgery via Wiltse approach is a safe and effective operation in the treatment of adult degenerative scoliosis with mild to moderate sagittal imbalance, it can correct the coronal and sagittal deformity, and achieve less surgery injury, less complications and good clinical results.

To investigate the effect of 6% hydroxyethyl starch 130/0.4(HES) on protein in severe trauma orthopedic patients after acute hemodilution.

Fourty-eight severe trauma patients who met the inclusion criteria were selected from June 2018 to December 2018 in Yantaishan Hospital, and were randomly divided into two groups (n=24): group A and group B. Group A was ringer′s sodium lactate control group, and group B was HES treatment group. After the tracheal intubation, the patients of group A were infused with 10% blood volume of sodium lactate ringer at 0.5 ml·kg^-1·min^-1, and the patients in group B were infused with 10% blood volume of HES at 0.5 ml·kg^-1·min^-1. Total protein (TP), human serum albumin (HSA), numbers of circulating endothelium cells (CEC), C-reactive protein (CRP), and serum levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-10 and IL-6 were measured immediately after acute hemodilution (T₀), 24 hours (T₁) and 48 hours (T₂) after acute hemodilution. After infusion into human body, HES bond to HSA, and fluorescence spectroscopy was used to analyze the binding relationship between HES and HSA in order to further study the effects of HES on HSA.

The HSA, TP, CEC, TNF-α, IL-6, IL-10, CRP at T₀ of group A were (38±5) g/L, (66±5) g/L, (5.5±0.4)/0.9 μl, (24±5) μg/L, (8.9±0.8) μg/L, (44±6) μg/L, (13.6±1.4) mg/L; While at T ₁ were (33±5) g/L, (60±6) g/L, (10.2±0.7)/0.9 μl, (87±9) μg/L, (38.8±2.3) μg/L, (57±7) μg/L, (23.4±2.4) mg/L. The HSA, TP, CEC, TNF-α, IL-6, IL-10, CRP at T ₀ of group B were(38±4)g/L, (66±5) g/L, (5.4±0.6)/0.9 μl, (24±6) μg/L, (9.1±0.9) μg/L, (45±6) μg/L, (13.4±1.8) mg/L; While at T ₁ were (35±5)g/L, (62±5)g/L, (7.4±0.6)/0.9 μl, (70±8) μg/L, (29.5±3.1) μg/L, (72±6) μg/L, (19.7±2.2) mg/L. HSA and TP decreased at T ₁ in group A as compared with T₀ (P<0.05), contrarily CEC increased significantly at T₁, TNF-ɑ, IL-6, IL-10 and CRP augmented at T₁ and T₂ in two groups (P<0.05). In comparison with the patients of group A, CEC decreased significantly at T₁ (P<0.05). TNF-ɑ, IL-6, CRP reduced significantly at T₁ and T₂ (P<0.05), but IL-10 increased at T₁ and T₂ in group B (P<0.05). The secondary structure of HSA changed after HES was added in the HES solution. The fluorescence intensity of HSA decreased with the increase of HES concentration,which suggested that HES induced HSA fluorescence quenching. HES could bind to Trp-214 residue in HSA at a molecular ration of 1∶1.

6% HES reduces the occurrence of low protein level in severe trauma patients after operation. HES could bind to Trp-214 amino acid residue in HSA and form the complex at a molecular ratio of 1∶1. The formation of HES-HSA complex increases the volume of HES, avoids the vascular leakage, protects the vascular endothelial cells, and induces anti-inflammatory immunity in the patients with capillary syndrome.

To investigate the clinical outcomes and effects of distal oblique osteotomy and the Youngswick osteotomy in the treatment of grade Ⅲ and Ⅳ hallux rigidus.

Totally 29 patients (33 feet) suffered from grade Ⅲ and Ⅳ hallux rigidus who received the distal first metatarsal osteotomy in Ningbo NO.6 Hospital from May 2013 to December 2018 were analyzed retrospectively. Among them, there were 10 males and 19 females. The average age was (56±6) years. Seventeen cases (18 feet) underwent distal oblique osteotomy of the first metatarsal, 12 cases (15 feet) underwent the Youngswick osteotomy. The overall clinical evaluations were investigated before the operation and at the final follow-up, included the visual analogue scale (VAS) of the pain, American Orthopedic Foot & Ankle Society (AOFAS) scores, the motionrange of the first metatarsophalangeal joint and the first metatarsophalangeal joint space. The data before and after operation were compared by paired t test and non-parametric rank sum test.

The operation time were (1.1±0.2) hours and (1.3±0.1) hours, and the intraoperative bleeding was 35 (25, 36) ml and 35 (30, 40) ml in the distal oblique osteotomy and Youngswick osteotomy respectively. All patients were followed up for 12 to 46 months. No nonunion or delayed union occurred in all patients. All patients did not need to be operated again, and no complications such as transferring metatarsalgia, infection and osteonecrosis occurred. In the two groups, the pain VAS score decreased significantly (Z=-3.8, -3.5, both P<0.01), the first metatarsophalangeal joint dorsal extension activity increased (Z=-3.7, -3.4, both P<0.01), the AOFAS score increased (t=28.0, 15.4, both P<0.05) and the first metatarsophalangeal joint space also improved significantly (t=17.7, 14.6, P<0.05) after the operation. There was no significant difference in VAS score, the first metatarsophalangeal joint activity and Horton index between the two groups(Z=-1.3, -0.3, -0.4, all P>0.05), and there was no statistical difference inAOFAS score (t=0.1, P>0.05). But compared with it in the first distal oblique metatarsal osteotomy, the joint space with the Youngswick osteotomy after the operation was larger ((2.4±0.3) mm vs (2.1±0.4) mm, t=2.2, P=0.04).

The oblique metatarsal osteotomy and Youngswick osteotomy can effectively relieve the pain of the hallux rigidus, increase the dorsal extension activity and joint space of the first metatarsophalangeal joint, sink the first metatarsal head, and improve the living conditions of the patients. The results of the distal metatarsal osteotomy and the Youngswick osteotomy in the treatment of stage Ⅲ and Ⅳ patients with rigid are similar, which can delay the progress of the disease.

There are a variety of motor and non-motor symptoms in Parkinson's disease, among which non-motor symptoms have a more serious impact on the quality of life of patients with Parkinson's disease. Improve the non-motor symptoms of Parkinson's disease and help improve the quality of life of patients. Previous studies on non-motor symptoms of Parkinson's disease were mostly single-center and small-sample studies, and the types of non-motor symptoms involved were relatively limited, which could not fully reflect the impact of non-motor symptoms on the quality of life of patients with Parkinson's disease. To this end, the study focused on the impact of non-motor symptoms on the quality of life of patients with Parkinson's disease by analyzing the COPPADIS-2015 study cohort. The cohort was a 5-year multicenter, integrated observational follow-up cohort study nationwide in Spain. A total of 898 follow-up samples were included, and dementia patients were excluded using the Mini-Mental Status Examination Scale (MMSE), and quality of life assessment was performed using the Quality of Life Questionnaire for Parkinson's Patients (PDQ-39), the Subjective Scale for Global Quality of Life (PQ-10) and the EUROHIS-QOL 8 scale, and the motor symptoms of Parkinson's disease were assessed using the modified Hoehn-Yahr staging and the third and fourth parts of the Unified Parkinson's Disease Rating Scale (UPDRS). Nonmotor symptoms of Parkinson's disease were assessed using the Parkinson's Disease Nonmotor Symptom Scale (NMSS), Frozen Gait Questionnaire (FOGQ), Parkinson's Disease Sleep Scale (PDSS), VAS Pain Rating Scale, VAF Fatigue Rating Scale, Beck Depression Scale-Ⅱ (BDI-Ⅱ), Neuropsychiatric Scale (NPI), and Parkinson's Disease Impulse Control Disorder Scale. The study found that patients with PD [n =692, (62.6 ± 8.9) years old, male proportion 60.3%] had better quality of life than healthy controls [n =206, (61.0 ± 8.3) years old, male proportion 49.5%] worse [PDQ-39: (17.1 ± 13.5) score versus (4.4 ± 6.3) score (P<0.0001）； PQ-10: (7.3 ± 1.6) points to (8.1 ± 1.2) points (P<0.0001）； EUROHIS-QOL8: (3.8 ± 0.6) points to (4.2 ± 0.5) points (P<0.0001）]。 In addition, PDQ-39 was significantly correlated with NMSS score, BDI-Ⅱ score and FOGQ score. PQ-10 was significantly associated with mood and gait disorders.

Parkinson's disease is a common neurodegenerative disease that exhibits significant clinical heterogeneity. LRRK2 is the most common pathogenic gene in Parkinson's disease. Patients with LRRK2 pathogenic mutations have similar clinical manifestations to those with sporadic Parkinson's disease. The LRRK2 risk variants (G2385R, R1628P, and S1647T) are associated with an increased risk of developing Parkinson's disease in Asian populations. Previous studies have shown that LRRK2 mutations lead to rapid progression of motor symptoms in patients with Parkinson's disease, but the changing characteristics of non-motor symptoms have not been evaluated. To assess the progressive characteristics of motor and non-motor symptoms in carriers and non-carriers of the specific LRRK2 risk variant in Asian patients with Parkinson's disease, the study conducted a 4-year prospective study. A total of 202 patients with Parkinson's disease (including 133 carriers of the LRRK2 variant and 69 non-carriers) were included in the study for a 4-year follow-up study. Modified Hoehn-Yahr staging, Unified Parkinson's Disease Rating Scale (UPDRS) Part III, Parkinson's Disease Non-motor Symptom Scale, Parkinson's Disease Quality of Life Questionnaire (PDQ-39) were used for assessment. Longitudinal analysis revealed faster progression of Hoehn-Yahr staging in carriers of the LRRK2 risk variant than in non-carriers after 4 years (0.65 for carriers of the risk variant; 0.06 for non-carriers;P =0.041）。 Although the gait and posture scores of UPDRS in carriers of the LRRK2 risk variant were both higher than those in non-carriers, the differences were not statistically significant. Furthermore, unlike carriers of the LRRK2 risk variant, non-carriers showed transient improvement in non-motor symptoms at Visit 2.