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Objective:To study the predictive value of peripheral blood cathepsin (Cat) level on arteriovenous fistula stenosis and therapeutic effect of urokinase combined with argatroban in patients with maintenance hemodialysis (MHD).Methods:The clinical data of 120 patients with MHD from January 2017 to January 2021 in the First Affiliated Hospital of Hebei North University were retrospectively analyzed. Among them, 72 patients had arteriovenous fistula stenosis (stenosis group), and 48 patients had not arteriovenous fistula stenosis (non-stenosis group). The patients in stenosis group were treated with urokinase combined with argatroban, and the therapeutic effect was evaluated; the stenosis degree of arteriovenous fistula stenosis was evaluated by digital subtraction angiography (DSA). The levels of Cat K and S in peripheral blood were detected by enzyme linked immunosorbent assay. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of Cat K and S in peripheral blood on arteriovenous fistula stenosis in patients with MHD. The independent risk factor of arteriovenous fistula stenosis in patients with MHD was analyzed by multivariate Logistic regression analysis.Results:The levels of Cat K and S in peripheral blood in stenosis group were significantly higher than those in non-stenosis group: (404.34 ± 12.43) μg/L vs. (344.22 ± 12.09) μg/L and (124.55 ± 13.43) μg/L vs. (84.60 ± 12.45) μg/L, and there were statistical differences ( t = 26.39 and 16.68, P<0.01). The result of DSA showed that mild stenosis of arteriovenous fistula stenosis was in 33 cases, moderate stenosis in 23 cases, and severe stenosis in 16 cases. The levels of Cat K and S in peripheral blood in patients with moderate stenosis and severe stenosis were significantly higher than those in patients with mild stenosis: (399.83 ± 11.79) and (476.27 ± 12.24) μg/L vs. (372.61 ± 12.88) μg/L, (125.77 ± 12.75) and (151.69 ± 11.86) μg/L vs. (110.54 ± 12.07) μg/L, the indexes in patients with severe stenosis were significantly higher than those in patients with moderate stenosis, and there were statistical differences ( P<0.01). After treatment, excellent was in 40 cases, effective in 23 cases, and ineffective in 9 cases. The levels of Cat K and S in peripheral blood in patients with effective and ineffective were significantly higher than those in patients with excellent: (404.78 ± 10.96) and (491.30 ± 10.26) μg/L vs. (384.52 ± 10.36) μg/L, (121.85 ± 10.99) and (232.65 ± 10.61) μg/L vs. (101.78 ± 10.61) μg/L, the indexes in patients with ineffective were significantly higher than those in patients with effective, and there were statistical differences ( P<0.01). The ROC curve analysis result showed that the area under the curve of Cat K combined with Cat S in peripheral blood in forecasting arteriovenous fistula stenosis in patients with MHD was larger than that of Cat K and S alone (0.699 vs. 0.635 and 0.611), and the accuracy and specificity were also significantly higher (80.83% vs. 48.33% and 60.00%, 89.58% vs. 76.25% and 81.33%), the optimum cut-off values of Cat K and S in peripheral blood were 401.23 and 123.65 μg/L. Multivariate Logistic regression analysis result showed that the levels of Cat K and S in peripheral blood were the independent risk factor of arteriovenous fistula stenosis in patients with MHD ( OR = 1.02 and 1.63, 95% CI 0.90 to 1.93 and 1.33 to 2.32, P<0.01). Conclusions:The levels of Cat K and S in peripheral blood can predict the occurrence and extent of arteriovenous fistula stenosis in patients with MHD, and could also predict the therapeutic effect of urokinase combined with agatroban.
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@#Objective To compare the characteristics of the tremor of multiple system atrophy Parkinsonism type (MSA-P) with Parkinson's disease (PD), and improvement after acute levodopa challenge test. Methods From Match to September 2017, 70 patients with PD and 23 patients with probable MSA-P were included. All the patients were required of rest or postural tremor in at least one extremity or head, and accepted acute levodopa challenge test and analysis for dominant tremor frequency, amplitude and rhythm under resting state, posturing and holding 1000 g state, respectively.Results The score of Unified Parkinson Diease Rating Scale Part III was higher in MSA-P patients than in PD patients (t=-2.098, P<0.05), with less improvement after acute levodopa challenge test (Z=-9.446, P<0.01), while the tremor score and improvement were not significantly different between two groups (P>0.05). There were more frequence with non-alternating or synchronic tremor rhythm (χ2=8.756, P<0.01) and small irregular tremor in rest tremor (χ2=4.788, P<0.05) in MSA-P patients than in PD patients, as well as the high frequency tremor (>6 Hz) in postural tremor (χ2=11.312, P<0.01). The frequency of rest tremor was higher in MSA-P patients than in PD patients (t=-2.119, P<0.05), as well as the frequency of postural tremor with 1000 g (t=-2.274, P<0.05). Both PD and MSA-P patients showed, the lower frequency the postural tremor was, the higher the tremor scores were. There were 25% PD patients with head tremor, while none in MSA-P patients. Tremor score improved more than 30% after acute levodopa challenge test in 22.7% MSA-P patients, but none improved in UPDRS score. The frequence of tremor score improvement was more in female MSA-P patients than in males (P<0.05).Conclusion The features of the tremor are similar in PD and MSA-P, with some differences that MSA-P tend to higher frequency in rest or postural tremor, more non-alternating or synchronic tremor rhythm in rest tremor, and fewer has tremor besides limbs. Some MSA-P patients improve after acute levodopa challenge test, and women may improve more than men.
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@#Objective To compare the characteristics of tremor and non-motor symptoms in patients with essential tremor (ET) and patients with Parkinson's disease developed from essential tremor (ET-PD). Methods From March, 2016 to August, 2017, 30 ET patients and 17 ET-PD patients were investigated with the general questionnaire, Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA), and were measured with transcranial sonography and the frequency, amplitude and contraction patterns of resting and postural tremors. Results Compared with the ET patients, there were more patients reported olfactory dysfunction and rapid eye movement behavior disorder (RBD) in ET-PD patients (χ2>4.656, P<0.05). Meanwhile, the area of hyperechogenicity in substantia nigra was greater (t=2.164, P<0.05), the incidence of lower limb tremor and mandibular tremor was more (χ2>8.745, P<0.01), the frequency of rest and postural tremor in the head and upper limbs was less (t>2.082, P<0.05). The rest and postural tremors in the upper limbs were mainly synchronous in ET patients, whereas it was alternating in ET-PD patients (χ2>3.943, P<0.05). Conclusion Some differences of non-motor symptoms and tremor are found in patients with ET-PD and ET. When ET patients suffer from hyposmia, RBD, or the site, frequency and contraction patterns of tremor changes, they may develop to PD.
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@#Objective To investigate the construct and concurrent validity of the Functional Gait Assessment (FGA) as the measure for balance and gait during walking in Parkinson's disease patients. Methods From March to December, 2011, 121 patients with Parkinson's disease (mean aged 61.9 years) were evaluated with FGA by one rater, as well as the other scales for balance and gait, such as Berg Balance Scale, Functional Ambulation Category, Timed Up and Go Test, Activities-specific Balance Confidence Scale, Movement Disorders Society revision of the Unified Parkinson's Disease Rating Scale part 3, modified Barthel Index, maximum walking speed and Modified Hoehn and Yahr Scale. Principal Component Analysis was used to determine construct validity. Spearman correlation coefficients between the FGA and other measures were used to determine concurrent validity. Results One common factor was extracted, which cumulatively explained 64.0% of the total variance. The FGA correlated moderately with the other measures (r = 0.57-0.85). Conclusion FGA is good in validity for Parkinson's disease patients.
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@#Objective To report a novel case of hereditary spastic paraparesis type 11 (SPG11) first presenting as juvenile Parkinsonism. Methods A 27 years old man first attack at 13 years old was reviewed. Results Parkinsonism-like features, such as tremor, rigidity, bradykinesia and gradually difficulty walking, were complained, and responded to dopaminergic therapy. MRI showed thin corpus callosum and hyper-intense T2WI lesions in periventricular regions. His nerve conduction velocity was normal. Genetic analysis detected two novel mutations, named c.5867-1G>C and c.3687-2A>G, in spastic paraplegia gene 11, which came from his father and mother separately. Conclusion Parkinsonism may be the inaugural presentation of SPG11, and a genetic test may be needed for the child with juvenile Parkinsonism.
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Objective To investigate the reliability of Berg Balance Scale (BBS) applied in patients with Parkinson's disease (PD). Methods 121 PD inpatients from March to December, 2011 were assessed with BBS by 2 raters, and the testing procedure was videoed. One of the raters assessed with BBS via video 4 weeks later. The intraclass correlation coefficient (ICC) and Kappa coefficient between raters and between tests were investigated. Results The ICC was 1.00 of the total score between raters and 0.99 between tests, while the Kappa co-efficient were 0.66 to 0.93 and 0.69 to 0.99 of the items. Conclusion BBS is reliable in interrater and test-retest as applied in PD patients.
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Objective To investigate the effects of intensive interaction on teaching of neurology for postgraduate for master. Methods The postgraduates of grade 2010 study under traditional teaching, and the postgraduates of grade 2012 study under intensive interaction teaching. Results The score of clinical knowledge test and specialized skill test were significantly better in the grade 2012 than in the grade 2010 (P<0.05). The students were satisfied with the intensive interaction teaching. Conclusion The intensive interaction teaching is good for teaching of neurology for postgraduate for master.
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@#Objective To investigate the effects of intensive interaction on teaching of neurology for postgraduate for master. Methods The postgraduates of grade 2010 study under traditional teaching, and the postgraduates of grade 2012 study under intensive interaction teaching. Results The score of clinical knowledge test and specialized skill test were significantly better in the grade 2012 than in the grade 2010 (P<0.05). The students were satisfied with the intensive interaction teaching. Conclusion The intensive interaction teaching is good for teaching of neurology for postgraduate for master.
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Objective To explore the effects of salmeterol/fluticasone propionate complicated or combined with N-acetylcysteine on the pulmonary function and arterial blood gas analysis of the patients with chronic obstructive pulmonary disease (COPD), and to evaluate its curative effect.Methods 84 cases of COPD patients were randomly divided into combination treatment group (n=44)and simple treatment group (n=40).The patients in combination treatment group were treated with salmeterol/fluticasone propionate combinated with N-acetylcysteine while the patients in simple treatment group were treated only with salmeterol/fluticasone propionate, both of which were followed up for 6 months.The changes of pulmonary function (FEV1%FVC,FEV1%Pred,PEF daily variation rate:ΔPEF%)and the arterial blood gas analysis indexes (PaO2 and PaCO2 )of the patients in two groups were recorded before treatment, 3 months after treatment, and 6 months after treatment. Results The FEV1%FVC,FEV1%Pred and PaO2 of the patients in combination treatment group and simple treatment group were obviously increased 3 and 6 months after treatment compared with before treatment (P0.05).TheΔPEF% of the patients in two groups had no significant differences between inter-group and intra-group before and after treatment (P > 0.05 ). Conclusion Combination of salmeterol/fluticasone propionate and N-acetylcysteine can obviously improve the pulmonary function and arterial blood gas analysis indexes of the COPD patients, which is superior to the simple application of salmeterol/fluticasone propionate and has definite and lasting curative effect on the treatment of COPD.
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Objective To examine the changing levels of serum iron and hemoglobin in Streptococcus pneumoniae-induced rat pneumonia model and the relationship among infection severity,serum iron and hemoglobin.Methods Sixty Sprague Dawley (SD)rats were randomly assigned to one of the four groups,1 5 SD rats in each group,including three treatment groups and one control group. Low, medium and high doses of bacteria were administered to the animals in the treatment groups respectively through tracheal cannula.The severity of pneumonia was indicated by the level of bacterial load.The animals in the control group did not receive bacterial challenge.The mean serum iron and hemoglobin levels were calculated on day 3,5, and 7 to analyze the relationship between bacterial dose and serum iron or hemoglobin levels.Results The serum iron level in the animals receiving medium or high doses of bacteria was significantly lower compared with that in control group on day 3 (P=0.009,P=0.005).The serum iron level in the animals receiving low dose of bacteria showed significant difference compared with that in the control group on day 5 (P=0.007).The hemoglobin level in the animals receiving medium or high doses of bacteria was significantly different from that in the control group on day 5 (P=0.031,P=0.046).The hemoglobin level in the animals receiving low dose of bacteria did not show significant difference compared with that in the control group on day 3,5 or 7.The bacterial dose level was negatively correlated with the mean level of serum iron (correlation coefficient r=-0.65,r=-0.53,r=-0.61,respectively).There was no definite correlation between the bacterial dose and the mean hemoglobin level.Conclusions Streptococcus pneumoniae infection may be associated with lower serum iron and hemoglobin levels in rats.The severity of infection is negatively correlated with serum iron level,but not hemoglobin level.
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Objective To explore the relationship between lesion sites of stroke and swallowing function. Methods Ischemic stroke pa-tients consecutively admitted into the stroke unit were screened in this study. The new and previous lesion sites of stroke, dysphagia and aspi-ration under videofluoroscopy (VF) were recorded and their relation was analyzed. Results 211 patients were included and 169 patients had completed the MRI and VF examination. 159 patients had dysphagia and 94 had aspiration under VF. 72 patients (9 missing) were found dis-order in oral phase and 150 in pharyngeal phase. There was no significantly difference in dysphagia under VF and in aspiration among differ-ent lesion sites (P>0.05). Patients with stroke in medulla tended to happen aspiration (P=0.056). Stroke sites above the tentorium of cerebel-lum (P=0.028) or above medulla (P=0.005) may cause disorder in oral phase. Conclusion The stroke injury in brain cortex, white matter, brainstem and cerebellum or hemisphere could lead to dysphagia and aspiration. The injury of medulla may cause aspiration. Lesion of brain hemisphere or above the medulla could result disorder in oral phase of swallowing.
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Objective To study the internal reliability and construct validity of Clinical Memory Scale in patients with Parkinson's dis-ease (PD). Methods 155 PD patients were assessed with Clinical Memory Scale. Results Cronbach'sαof Clinical Memory Scale was 0.772, while split-half reliability coefficient was 0.770. One factor had been extracted with factor analysis, which explained 53.18%of variance, and loaded 5 items. Conclusion Clinical Memory Scale is available for PD patients with acceptable internal reliability and construct validity.
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Objective To investigate the risk factors to acute lung injury based on multiple trauma to provide a theoretical basis for early intervention .Methods The emergency surgical patients with multiple trauma in our hospital from March 2006 to March 2011 were selected .The patients meeting the diagnostic criteria for acute lung injury were taken as the study group and the others as the control group .All patients were enrolled for evaluating the injury severity score (ISS) ,acute physiology and chronic health Ⅱ(APACHE Ⅱ) score and recording smoking ,alcohol abuse ,diabetes mellitus ,number of organ damage ,gastrointestinal bleeding , pulmonary contusion ,diffuse intravascular coagulation (DIC ) ,vomiting ,traumatic shock ,time to correct shock ,blood transfusion . The polymorphism of rs3788853 ,rs13306087 ,rs12709426 of angiotensin-converting enzyme(ACE) gene were analyzed .Results In the study group and the control group ,there were statistical differences in 6 influencing factors of the ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,time to correct shock>6 h(P0 .05);the 6 kinds of influencing factors were risk to acute lung injury based on multi-ple trauma by Logistic regression analysis .Conclusion The ISS ,APACHE Ⅱ score ,blood transfusion ,DIC ,traumatic shock ,long time to correct shock are the risk factors to acute lung injury based on multiple trauma .
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@# Objective To study the characteristic of memory impairment and its related factors in patients with Parkinson's disease (PD). Methods 155 PD patients were assigned to 4 age groups. Clinical memory scale, Hamilton Rating Scale for Depression (HAMD) and Hamilton Rating Scale for Anxiety (HAMA) were used to assess them. Results The memory quotient (MQ) of PD patients were significantly lower than the norm (P<0.01). The scores of associational learning, direct memory, picture recall and portrait association in each age groups were lower than norm (P<0.05), but nonsense figure recognition (P>0.05). The MQ of PD patients was significantly related with education and depression or anxiety (P<0.01), and was not correlated with age, gender and course of disease (P>0.05). Conclusion The MQ of PD patients are lower especially in associational learning, direct memory, picture recall and portrait association. The MQ of PD patients is correlated with education and depression or anxiety significantly.
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@#There are so many ways of assessment on balance, among which scale assessment is the most used method. This article introduced the frequently used balance assessment scales in clinical medicine and researches, such as Berg Balance Scale (BBS), Tinetti Performance Oriented Mobility Assessment (Tinetti POMA), Timed Up and Go Test (TUGT), Activities-specific Balance Confidence Scale(ABC), Brunel Balance Assessment (BBA), Dynamic Gait Index(DGI), Functional Gait Assessment(FGA), Balance Evaluation Systems Test (BEST), and the researches of reliability and validity on those scales. The reliable and valid tools to assess balance and gait are suggested for clinical medicine.
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@#There are so many ways of assessment on balance, among which scale assessment is the most used method. This article introduced the frequently used balance assessment scales in clinical medicine and researches, such as Berg Balance Scale (BBS), Tinetti Performance Oriented Mobility Assessment (Tinetti POMA), Timed Up and Go Test (TUGT), Activities-specific Balance Confidence Scale(ABC), Brunel Balance Assessment (BBA), Dynamic Gait Index(DGI), Functional Gait Assessment(FGA), Balance Evaluation Systems Test (BEST), and the researches of reliability and validity on those scales. The reliable and valid tools to assess balance and gait are suggested for clinical medicine.
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@#Objective To observe the effect of conductive education(CE) combined rehabilitation therapy on stroke patients.Methods 57 stroke patients were assigned to experiment group (25 cases) and control group (32 cases). Both groups received rehabilitation therapy, meanwhile，experiment group received CE. Main outcome measure：①FMA; ②Barthel Index(BI); ③Social function action questionnaire(SFA).Results FMA, BI and SFA increased significantly(P＜0.05)in both groups after treatment. BI and SFA improved more in experiment group than those of control group between group comparisons(P＜0.05).Conclusion Conductive education combined rehabilitation therapy could improve the motor function, ability of daily living and social function action on stroke patients.
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Malignant tumors and the relative medical treatment of western medicine greatly affect the quality of life. This paper described the history and current situation of using acuponcture treating malignant tumor, and pointed out predominance of traditional Chinese medicine in treating tumor is treament based on syndrome differentiation and treatment according to the time of a day, which provides new ideas for acupuncture treatment of malignant tumors.
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@#背景专家委员会制定的卒中康复指南应用于退伍军人健康管理部门及国防部卫生保健系统。方法根据以前发表的指南,委员会利用美国预防服务特别工作组制定的标准,评价了截至到2002年发表的文献。指南根据临床随机化实验、非对照性研究等证据提出建议(如缺乏确定的数据则根据专家组的建议)。结果Ⅰ级水平的建议包括:在多学科康复环境中或卒中单元中传递卒中治疗,通过NI HSS对卒中患者进行评价,早期启动康复治疗,对吞咽困难患者进行吞咽功能筛查,积极进行二级预防,预防深静脉血栓等。推荐应用标准化的评价工具制定适合每个患者的全面的治疗计划。强烈建议进行抗抑郁及情感波动方面的治疗。语言治疗师应评价患者的交流及认知障碍,并在需要时提供治疗。患者、家属及护理者是康复小组的重要成员,应当介入康复的全部疗程。这些建议在以下网站可查询:httP://stroke.ahajournals.org/cgi/content/full/36/9/e100。并附有每项建议的全文证据表。结论这些建议应平等地应用于所有临床环境中的所有卒中康复患者,而不是仅针对联邦医疗系统的临床问题或资源。