Application and effectiveness of SPD management of consumables and reagents in a public hospital / 中华医院管理杂志

In the context of high-quality development in medical institutions, the supply-processing-distribution(SPD) management mode has gradually been widely applied. The authors described in detail the procurement, supply, inventory, distribution, and settlement management of medical consumables and in vitro diagnostic reagents in a certain hospital under the SPD mode. It was found that SPD was conducive to strengthening the supervision of medical consumables and in vitro diagnostic reagents in the hospital, ensuring quality and safety of use, reducing hospital operating costs, and improving hospital′s competitiveness. However, attention should be paid to preventing data security risks, strengthening operational management, and improving the cost-benefit analysis of in vitro diagnostic reagents.

Combination of apparent diffusion coefficient and amplitude-integrated electroencephalogram to predict the outcome of comatose patients with severe traumatic brain injury / 中华危重病急救医学

Objective:To examine whether the combination of quantitative regional apparent diffusion coefficient (ADC) and amplitude-integrated electroencephalogram (aEEG) can predict the outcome of comatose patients with severe traumatic brain injury (sTBI).Methods:A prospective study was conducted. The patients with coma caused by sTBI [Glasgow coma scale (GCS) < 8] admitted to Suqian First Hospital from January 2016 to June 2019 were enrolled. All patients underwent aEEG examination and magnetic resonance imaging (MRI) scan within 1 week after emergency treatment. The ADC values of 9 regions of interest (frontal gray matter and white matter, parietal gray matter and white matter, temporal gray matter and white matter, caudate nucleus of basal ganglia, lenticular nucleus and thalamus) were measured by head MRI, and the mean ADC values of frontal lobe, parietal lobe, temporal lobe and basal ganglia were calculated respectively. According to the follow-up results after 12 months, the differences of each index between patients with poor prognosis [Glasgow outcome score (GOS) 1-2] and patients with good prognosis (GOS 3-5) were compared; the receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive ability of aEEG and ADC for the good prognosis of patients with sTBI, and the predictive value of the combination of aEEG and ADC.Results:A total of 52 patients with sTBI were enrolled, with mean age of (36.7±13.9) years old, 35 of whom were male. Within 12 months follow-up, 29 patients had achieved favorable outcomes and 23 patients had unfavorable outcome. There were 21, 17 and 14 patients with aEEG , and grade, respectively, and 19, 10 and 0 patients had good prognosis respectively. ADC values of 9 regions of interest in patients with good prognosis were significantly higher than those in patients with poor prognosis (×10 -6 mm 2/s: 924±107 vs. 531±87 in frontal gray matter, 804±95 vs. 481±74 in frontal white matter, 831±93 vs. 683±72 in temporal gray matter, 726±87 vs. 654±63 in temporal white matter, 767±79 vs. 690±75 in parietal gray matter, 716±84 vs. 642±62 in parietal white matter, 689±70 vs. 465±68 in caudate nucleus, 723±84 vs. 587±71 in lenticular nucleus, 807±79 vs. 497±67 in thalamus, all P < 0.01). ROC curve analysis showed that the area under ROC curve (AUC) of aEEG for predicting good prognosis of sTBI patients was 0.826, when the cut-off value of aEEG was < 1.5, the sensitivity was 94.7% and the specificity was 72.8%. Among the ADC value prediction abilities in the interested areas, the prediction of ADC value in frontal lobe and basal ganglia area were better than that in sTBI patients. AUC was 0.817 and 0.903 respectively. The best cut-off values were > 726×10 -6 mm 2/s and > 624×10 -6 mm 2/s respectively, the sensitivity of predicting prognosis were both 100%, and the specificity was 63.4% and 61.8%. A model combining frontal ADC and basal ganglia ADC with aEEG was 91.0% sensitive and 93.7% specific for favorable outcome of sTBI patients. Conclusion:Combination of the quantitative measurement of regional ADC and aEEG may be useful for predicting the outcome of the patients with sTBI.

Endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (bridging therapy) for embolic stroke due to cardiac myxoma: a case report / 中华神经科杂志

Myxomas are the most frequent, cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli. The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge. A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple′s Hospital of Huizhou. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset. No intracranial hemorrhage developed. Pathological study of embolus showed a myxoma. A cardiac mass was found in the left atrium and removed surgically three weeks after stroke. Pathological study of the tumor showed a myxoma. At the one-month follow-up after excision of myxoma, the NIHSS score was 1 and the modified Rankin scale score was 0. No recurrence of embolism occurred after surgical resection. Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective, and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.

Endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (bridging therapy) for embolic stroke due to cardiac myxoma: a case report / 中华神经科杂志

Myxomas are the most frequent, cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli. The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge. A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple′s Hospital of Huizhou. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset. No intracranial hemorrhage developed. Pathological study of embolus showed a myxoma. A cardiac mass was found in the left atrium and removed surgically three weeks after stroke. Pathological study of the tumor showed a myxoma. At the one-month follow-up after excision of myxoma, the NIHSS score was 1 and the modified Rankin scale score was 0. No recurrence of embolism occurred after surgical resection. Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective, and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.

Endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (bridging therapy) for embolic stroke due to cardiac myxoma: a case report / 中华神经科杂志

Myxomas are the most frequent,cardiac benign cardiac tumors which often present with stroke caused by tumorous orthrombotic emboli.The treatment of embolic stroke due to cardiac myxoma is still a clinical and technical challenge.A 61-year-old man who had an embolic stroke in the left middle cerebral artery was admitted to the Third Poeple's Hospital of Huizhou.The initial National Institutes of Health Stroke Scale (NIHSS) score was 16.He received endovascular thrombectomy after intravenous recombinant tissue plasminogen activator (rt-PA) one hour after stroke onset.No intracranial hemorrhage developed.Pathological study of embolus showed a myxoma.A cardiac mass was found in the left atrium and removed surgically three weeks after stroke.Pathological study of the tumor showed a myxoma.At the one-month follow-up after excision of myxoma,the NIHSS score was 1 and the modified Rankin scale score was 0.No recurrence of embolism occurred after surgical resection.Endovascular thrombectomy after intravenous rt-PA (bridging therapy) for embolic stroke due to cardiac myxoma is safe and effective,and early resection of atrial myxoma can effectively avoid recurrence of cerebral infarction.

Correlation between cognitive impairment and power of quantitative electroencephalogram in patients with temporal lobe epilepsy / 中华神经科杂志

Objective To assess cognitive impairment and its correlation with power of quantitative electroencephalogram (qEEG) in patients with temporal lobe epilepsy (TLE).Methods Fifty-five patients with TLE seen consecutively in Suqian First Hospital and 40 healthy controls (HC) were assessed by Mini-Mental State Examination (MMSE),Brief Cognitive Battery (BCB) and qEEG.The global interhemispheric and intrahemispheric difference values for power spectral ratios (Dv-PSR) were calculated.Cognitive functions and Dv-PSR of the TLE patients and the HC were compared,and correlation between cognitive impairment and power of qEEG was assessed using Spearman correlation analysis.The significance level was set at P≤0.05.Results Statistical analysis showed that MMSE scores did not have statistically significant difference between the TLE patients and the HC (26.9±2.4 vs 27.3±2.6,t=0.502,P=0.549).However,BCB examination showed that immediate memory,incidental memory,delayed recall,learning test,verbal fluency and recognition differed significantly between the TLE and the HC groups (7.34± 1.33 vs 8.92±1.37,6.05±1.12 vs 7.93±1.20,6.77±1.08 vs 8.19±1.14,11.87±4.47 vs 16.8±4.56,8.52±1.74 vs 9.75 ± 1.36,8.74 ± 1.19 vs 9.87 ± 1.18,respectively;t=2.916,Z=3.204,t=2.549,Z=3.937,t=1.341,t=2.791,P＜ 0.05).Interhemispheric Dv-PSR in frontal,central,temporal and parietal area was higher in the TLE group than in the HC group (0.478±0.043 vs 0.252±0.028,0.441±0.051 vs 0.306±0.039,0.394±0.027 vs 0.247± 0.018,0.511±0.036 vs 0.224±0.021,respectively;t=3.711,2.403,3.144,4.327,P＜0.05),and intrahemispheric Dv-PSR in frontal,central,parietal and occipital area (minus temporal area respectively) was also higher in the TLE group than in the HC group (0.521±0.024 vs 0.221±0.017,0.249±0.012 vs 0.167±0.008,0.187± 0.013 vs 0.104 ± 0.007,0.313 ± 0.021 vs 0.127 ± 0.009,respectively;t=4.208,3.192,2.611,3.737,P＜0.05).Spearman analysis showed positive correlations between intrahemispheric,interhemispheric Dv-PSR and several cognitive domains impairment assessed by BCB (P＜0.05).Conclusion There was mild cognitive impairment in TLE patients,which was significantly associated with Dv-PSR assessed by qEEG,suggesting that Dv-PSR measurement may be used as a marker for cognitive impairment in epilepsy.

The role of amplitude integrated EEG in evaluation of prognosis in comatose patients with severe traumatic brain injury / 中华行为医学与脑科学杂志

Objective To study the clinical value of amplitude integrated EEG(aEEG),EEG reactivity,EEG patterns,and Glasgow Coma Scale(GCS) scores of predicting the prognosis in comatose patients with severe traumatic brain injury.Methods Sixty-four hospitalized comatose patients with severe traumatic brain injury were evaluated by aEEG,EEG reactivity,EEG patterns and GCS and followed up for one year to observe the prognosis of the patients.Results Accuracy of aEEG,EEG reactivity,EEG patterns and GCS in predicting outcomes of comatose patients with severe traumatic brain injury correctly classified as 73.4％,68.8％,73.4％,64.1％ respectively.The accuracy of GCS in evaluating the prognosis of comatose patients with severe traumatic brain injury was lower than that of the other three methods (P＜0.05).There were positive correlations among aEEG,EEG reactivity,EEG patterns,and GCS (r=0.574-0.843,P＜ 0.05).There were positive correlations between aEEG,EEG reactivity,EEG patterns,GCS and the patients' prognosis(r=0.647,0.609,0.621,0.532,P＜ 0.05).Conclusion As a new electroencephalographic technique,aEEG combined with EEG reactivity,EEG patterns,and GCS can be effectively used to evaluate the prognosis of STBI coma patients,which has a certain clinical value.

Influence of SCN1A intronic mutations in mRNA splicing and relation of mRNA splicing changes with phenotype in febrile seizures related epilepsy / 中华神经医学杂志

Objective To study the influence of SCNIA intronic mutations in mRNA splicing in febrile seizures related epilepsy,and investigate the association between splicing changes and genotype-phenotype-inheritance pattern.Methods Molecular cloning of 5 SCN1A intronic mutations was performed in patients with partial epilepsy with antecedent febrile seizures plus (PEFS+) and Dravet syndrome (DS) through constructing mutant and wild-type plasmids of pTragetE2-3-4-5 and E24-25-26 by using Minigene splicing assay,and the in vitro expressions in HENK293 cells were detected.The mRNA splicing changes were analyzed qualitatively and quantitatively by reverse transcription (RT)-PCR and real time quantitative (q)-PCR.Results (1) Using RT-PCR,DS mutants presented a whole exon skipping without significant remain of normal mRNA transcripts,while PEFS+ mutants showed partial exon skipping or intronic insertion with coexistence of normal and aberrant mRNA transcripts.(2) Statistical differences were found between relative quantity (RQ) of aberrant and normal mRNA in PEFS+ mutant (c.473+5G＞A:4.92％±1.05％ and 6.10％±0.21％;c.473+5G＞C:7.97％±1.12％ and 3.94％ ±1.25％) and that in DS mutant (c.602+1G＞A:60.51％±1.81％ and 0.060％±0.022％,P＜0.05);similarly,there were statistical differences between relative RQ of normal and aberrant mRNA in PEFS+ mutant c.4853-25T＞A (71.22％±11.92％ and 7.38％±1.61％) and that in DS mutant c.4853-1G＞C (0.08％±0.01％ and 22.11％±2.83％,P＜0.05).Conclusion The position and difference of splicing patterns of SCNIA intronic mutations are potential molecular pathogenesis for phenotypic difference of febrile seizures related epilepsy.

Postoperative prognostic analysis of patients with MR imaging-negative temporal lobe epilepsy / 中华神经医学杂志

Objective To determine whether unilateral-only interictal discharges on pre-surgical scalp EEG or multimodal pre-surgical evaluation are associated with surgical outcomes in patients with MR imaging-negative temporal lobe epilepsy (TLE) who underwent standard anterior temporal lobectomy (ATL). Methods One hundred and seventeen patients with TLE who underwent standard ATL from January 2000 to December 2013 were enrolled. According to the seizures at interictal period, these patients were divided into unilateral-only interictal discharge group (n=54) and bilateral interictal discharge group (n=63). According to the preoperative assessment, these patients were divided into multimodal evaluation group (n=72, two and above evaluation strategies besides electroencephalogram) and single modal evaluation group (n=45, electroencephalogram+one evaluation strategy). Follow-up for 12 months was performed; postsurgical outcomes included excellent outcome, defined as Engel class I, and non-excellent outcome, defined as Engel II-IV. Kaplan-Meier survival analysis and Cox proportion hazards were performed to compare the prognoses of patients from different groups. Results Totally, 73 patients (62.4%) achieved excellent outcome following ATL. In 54 with unilateral-only interictal discharges, 41 had excellent outcome; and in 63 with bilateral interictal discharge group, 32 patients had excellent outcome; significant difference in percentage of excellent outcome was noted between the two groups (P<0.05). Fifty of 72 patients receiving multimodal pre-surgical evaluation achieved excellent outcome, and 25 of 45 receiving single modal evaluation achieved excellent outcome; significant difference in percentage of excellent outcome was noted between the two groups (P<0.05). However, the patients with unilateral-only interictal discharges receiving multimodal pre-surgical assessment did not achieve further excellent outcomes as compared with those receiving single modal evaluation, without significant difference (P>0.05). Conclusion Multimodal pre-surgical evaluation is associated with better outcomes following standard ATL in the patients with MR imaging-negative TLE; however, for patients with unilateral-only interictal discharges, multimodal pre-surgical evaluation method may be not essential as compared with single modal pre-surgical evaluation method.

Longitudinal study on infantile nocturnal sleep-wake pattern developmental trajectory with Actiwatch / 中华儿科杂志

<p><b>OBJECTIVE</b>To understand the infantile nocturnal sleep-wake pattern developmental trajectory with Actiwatch, which would benefit the clinical assessment of infantile sleep.</p><p><b>METHOD</b>This study was a longitudinal study conducted between 7 Oct, 2009-30 Oct, 2011 in 10 hospitals of 9 cities of China ( Beijing, Xi'an, Qingdao, Wuhan, Changsha, Chongqing, Huzhou, Xiamen and Liuzhou). Actiwatch was used to track the sleep-wake pattern development trajectory of healthy infants in the first year of life in the home setting. Participating infants were followed up at 10th day and 28th day during the first month, and then monthly from the second to the sixth month after birth, and then at ninth and twelve months of age respectively. Meanwhile, infantile sleep was observed continuously for about 60 hours at each visit. According to the characteristics of repeated measurement data of this study, two-level random effect model was adopted to analyze the trend of infantile nocturnal sleep-wake parameters changing with age, and the gender difference.</p><p><b>RESULT</b>A total of 473 healthy infants were included in this study, among whom 246 (52.0%) were boys, and 227 (48.0%) were girls; 355 (75.1%) infants completed the whole year follow-up survey. With infants' age increasing, the latency of infants' nighttime sleep onset decreased from 66.8 minutes on 10th day to 15.5-18.7 minutes at 6-12 months of age. The number of night wakes also decreased with age, while uninterrupted sleep periods lengthened with age. On the 10th day, there were 3.0 times of nightwaking on average, and the longest continuous sleeping interval lasted for 227.6 minutes on average. At 12-month of age, infants could sleep continuously for 350.9 minutes at most on average, while the number of nightwaking decreased to 1.6 times per night on average. Generally, nighttime sleep efficiency increased from 66.3% on the 10th day to 86.3% at 12-month of age. The differences of sleep-wake patterns between boys and girls presented as boys' nocturnal longest uninterrupted sleep period was 19 minutes shorter(266.6 vs. 285.6 min), and the average nighttime sleep efficiency was 2.2% lower (74.2% vs. 76.4%) compared with girls respectively. And the differences of sleep efficiency between boys and girls reduced gradually along with the growth.</p><p><b>CONCLUSION</b>During the first 6 months after birth, infantile sleep-wake pattern undergo obvious change. The capability of sleep-onset and uninterrupted sleep improved with age, and the sleep efficiency increased.</p>

A controlled study of the effectiveness of EEG biofeedback training on-children with attention deficit hyperactivity disorder / 华中科技大学学报（医学）（英德文版）

In order to study the treatment of the children with attention deficit hyperactivity disorder (ADHD), the integrated visual and auditory continuous performance test (IVA-CPT) was clinically applied to evaluate the effectiveness of electroencephalogram (EEG) biofeedback training. Of all the 60 children with ADHD aged more than 6 years, the effective rate of EEG biofeedback training was 91.6% after 40 sessions of EEG biofeedback training. Before and after treatment by EEG biofeedback training, the overall indexes of IVA were significantly improved among predominately inattentive, hyperactive, and combined subtype of children with ADHD (P<0.001). It was suggested that EEG biofeedback training was an effective and vital treatment on children with ADHD.

A Controlled Study of the Effectiveness of EEG Biofeedback Training on Children with Attention Deficit Hyperactivity Disorder / 华中科技大学学报（医学）（英德文版）

Summary: In order to study the treatment of the children with attention deficit hyperactivity disorder (ADHD), the integrated visual and auditory continuous performance test (IVA-CPT) was clinically applied to evaluate the effectiveness of electroencephalogram (EEG) biofeedback training. Of all the 60 children with ADHD aged more than 6 years, the effective rate of EEG biofeedback training was 91.6 % after 40 sessions of EEG biofeedback training. Before and after treatment by EEG biofeedback training, the overall indexes of IVA were significantly improved among predominately inattentive, hyperactive, and combined subtype of children with ADHD (P<0.001). It was suggested that EEG biofeedback training was an effective and vital treatment on children with ADHD.