BACKGROUND:Poisoned patients often suffer damage to multiple systems,and those experiencing central nervous system disorders present more severe conditions,prolonged hospital stays,and increased mortality rates.We aim...BACKGROUND:Poisoned patients often suffer damage to multiple systems,and those experiencing central nervous system disorders present more severe conditions,prolonged hospital stays,and increased mortality rates.We aimed to assess the efficacy of rehabilitation interventions for patients with toxic encephalopathy.METHODS:This retrospective,observational,comparative cohort study was performed at the teaching hospital affiliated of Nanjing Medical University,from October 2020 to December 2022.Patients who met the diagnostic criteria for toxic encephalopathy and exclusion criteria were included,and patients were divided into three subgroups according to Glasgow Coma Scale(GCS).Demographic and clinical characteristics were collected.The effect of the rehabilitation intervention on patients were assessed in the improvement of consciousness status(Glasgow Coma Scale[GCS]score),muscle strength and movement and swallowing function(Fugl-Meyer Assessment[FMA]scale,Water Swallow Test[WST],and Standardized Swallowing Assessment[SSA]).Subgroup analysis was based on different toxic species.RESULTS:Out of the 464 patients with toxic encephalopathy,184 cases received rehabilitation treatments.For the severe toxic encephalopathy patients,patients without rehabilitation intervention have a 2.21 times higher risk of death compared to patients with rehabilitation intervention(Hazard ratio[HR]=2.21).Subgroup analysis revealed that rehabilitation intervention significantly increased the survival rate of patients with pesticide poisoning(P=0.02),while no significant improvement was observed in patients with drug/biological agent poisoning(P=0.44).After rehabilitation intervention,significant improvement in GCS and FMA were observed in severe patients with toxic encephalopathy(P<0.01).CONCLUSION:Active rehabilitation intervention for patients exposed to poisons that can potentially cause toxic encephalopathy may improve the prognosis and reduce the mortality rate in clinical practice.展开更多
Sepsis-associated encephalopathy(SAE) is a brain dysfunction that occurs secondary to infection in the bo characterized by alteration of consciousness, ranging from delirium to coma, seizure or focal neurological sign...Sepsis-associated encephalopathy(SAE) is a brain dysfunction that occurs secondary to infection in the bo characterized by alteration of consciousness, ranging from delirium to coma, seizure or focal neurological signs. S involves a number of mechanisms, including neuroinflammation, in which the interaction between cytokines a acetylcholine results in neuronal loss and alterations in cholinergic signaling. Moreover, the interaction also occurs the periphery, accelerating a type of immunosuppressive state. Although its diagnosis is not specific in biochemis and imaging tests, it could potentiate severe outcomes, including increased mortality, cognitive decline, progress immunosuppression, cholinergic anti-inflammatory deficiency, and even metabolic and hydroelectrolyte imbalan Therefore, the bilateral communication between SAE and the multiple peripheral organs and especially the immu system should be emphasized in sepsis management.展开更多
With the changes of life style, diabetes and its complications have become a major cause of morbidity and mortality. It is reasonable to anticipate a continued rise in the incidence of diabetes and its complications a...With the changes of life style, diabetes and its complications have become a major cause of morbidity and mortality. It is reasonable to anticipate a continued rise in the incidence of diabetes and its complications along with the aging of the population, increase in adult obesity rate, and other risk factors. Diabetic en- cephalopathy is one of the severe microvascular complications of diabetes, characterized by impaired cogni- tive functions, and electrophysiological, neurochemical, and structural abnormalities. It may involve direct neuronal damage caused by intracellular glucose. However, the pathogenesis of this disease is complex and its diagnosis is not very clear. Previous researches have suggested that chronic metabolic alterations, vascular changes, and neuronal apoptosis may play important roles in neuronai loss and damaged cognitive functions. Multiple factors are responsible for neuronal apoptosis, such as disturbed insulin growth factor （IGF） system, hyperglycemia, and the aging process. Recent data suggest that insulin/C-peptide deficiency may exert a primary and key effect in diabetic encephalopathy. Administration of C-peptide partially improves the condition of the IGF system in the brain and prevents neuronal apoptosis in the hippocampus of diabetic patients. Those findings provide a basis for application of C-peptide as a potentially effective therapy for diabetes and diabetic encephalopathy.展开更多
BACKGROUND:Sepsis-associated encephalopathy(SAE) is a critical disease caused by sepsis.In addition to high mortality,SAE can also adversely aff ect life quality and lead to significant socioeconomic costs.This review...BACKGROUND:Sepsis-associated encephalopathy(SAE) is a critical disease caused by sepsis.In addition to high mortality,SAE can also adversely aff ect life quality and lead to significant socioeconomic costs.This review aims to explore the development of evaluation animal models of SAE,giving insight into the direction of future research in terms of its pathophysiology and therapy.METHODS:We performed a literature search from January 1,2000,to December 31,2022,in MEDLINE,PubMed,EMBASE,and Web of Science using related keywords.Two independent researchers screened all the accessible articles based on the inclusion and exclusion criteria and collected the relevant data of the studies.RESULTS:The animal models for sepsis are commonly induced through cecal ligation and puncture(CLP) or lipopolysaccharide(LPS) injection.SAE can be evaluated using nervous reflex scores and sepsis evaluation during the acute phase,or through Morris water maze(MWM),openfield test,fear condition(FC) test,inhibitory avoidance,and other tests during the late phase.CONCLUSION:CLP and LPS injection are the most common methods for establishing SAE animal models.Nervous reflexs cores,MWM,FC test,and inhibitory avoidance are widely used in SAE model analysis.Future research should focus on establishing a standardized system for SAE development and analysis.展开更多
BACKGROUND:Sepsis is a common cause of death in emergency departments and sepsis-associated encephalopathy(SAE)is a major complication.Rosuvastatin may play a neuroprotective role due to its protective effects on the ...BACKGROUND:Sepsis is a common cause of death in emergency departments and sepsis-associated encephalopathy(SAE)is a major complication.Rosuvastatin may play a neuroprotective role due to its protective effects on the vascular endothelium and its anti-inflammatory functions.Our study aimed to explore the potential protective function of rosuvastatin against SAE.METHODS:Sepsis patients without any neurological dysfunction on admission were prospectively enrolled in the“Rosuvastatin for Sepsis-Associated Acute Respiratory Distress Syndrome”study(SAILS trial,ClinicalTrials.gov number:NCT00979121).Patients were divided into rosuvastatin and placebo groups.This is a secondary analysis of the SAILS dataset.Baseline characteristics,therapy outcomes,and adverse drug events were compared between groups.RESULTS:A total of 86 patients were eligible for our study.Of these patients,51 were treated with rosuvastatin.There were significantly fewer cases of SAE in the rosuvastatin group than in the placebo group(32.1%vs.57.1%,P=0.028).However,creatine kinase levels were significantly higher in the rosuvastatin group than in the placebo group(233[22-689]U/L vs.79[12-206]U/L,P=0.034).CONCLUSION:Rosuvastatin appears to have a protective role against SAE but may result in a higher incidence of adverse events.展开更多
Objective:To improve the diagnosis and therapeutic effect of occurrence and development of hyponatremia and disorder of acid-base balance among patients with hepatic encephalopathy(HE) by elucidating the regularity an...Objective:To improve the diagnosis and therapeutic effect of occurrence and development of hyponatremia and disorder of acid-base balance among patients with hepatic encephalopathy(HE) by elucidating the regularity and mechanism,as well as its influence on prognosis.Methods:327 HE patients admitted to our hospital from January 1990 to June 2010 were enrolled.Meanwhile 316 patients hospitalized in the medical department of the same hospital were chosen as the control group.Patients in both groups were given the same methods to measure arterial blood gas parameters(pH value,PaCO2,[HCO3-],TCO2,BE and SaO2),blood biochemistry([Na+],[K+],[Cl-]),liver function,kidney function and blood glucose,serum sodium,and thereupon tocalculate the anion gap(AG) and the potential [HCO3-],and acid-base balance disorder.Results:Among the 327 HE patients,hyponatremia was found in 188 cases(57.4%),of whom 132 patients died(70.2%).While among the 316 patients in control group,68 presented with hyponatremia(21.5%),and 19 died(27.9%).The incidence and mortality were significantly different between the two groups(P<0.001).All the 327 patients presented with different degrees of acid-base balance disorder and 178 died(54.4%),in whom 164(50.2%) belonged to simple acid-base balance disorder and 74(45.1%) died,136(41.6%) were dual acid-base balance disorder and 80(58.8%) died,27(8.2%) were triple acid-base disturbance and 24(88.9%) died.Whereas in the control group only 83 patients(26.2%) were recognized as simple and dual acid-base balance disorder,and 18(21.7%) died.There was higher incidence of acid-base balance disorder and mortality rate in HE group than control one(P<0.001).Conclusion:Hyponatremia is valuable to judge HE patients' prognosis.The key parameters in the judgment and evaluation on acid-base balance disorder among HE patients are the change of pH values and serum electrolyte values.When pH value ≤ 7.30 or > 7.55,it generally suggests a poor prognosis.展开更多
Objective:To evaluate the changes of brainstem auditory evoked potential (BAEP) in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods: BAEPs were performed in 32 controls and 40 patien...Objective:To evaluate the changes of brainstem auditory evoked potential (BAEP) in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods: BAEPs were performed in 32 controls and 40 patients. Wave Ⅰ , Ⅱ , Ⅲ ,Ⅳ, Ⅴ latencies and Ⅰ-Ⅲ , Ⅲ-Ⅴ , Ⅰ-Ⅴ interpeak latencies were measured, respectively. Results: Abnormalities of BAEPs in 13 patients (13/40, 32 ％). Among the13 abnormal BAEPs, 3 displayed prolongation of latency to waves in one side, no potential in another side; 5 displayed a similar abnormality which was bilateral prolongation of latency to waves ;and another 5 displayed unilateral latency delay. Compared wave Ⅰ , Ⅱ , Ⅲ , Ⅳ, Ⅴ latencies and Ⅰ-Ⅲ , Ⅲ-Ⅴ , Ⅰ-Ⅴ interpeak latencies in the patients and the controls, there were no significant differences (P＞0.05). Conclusion: BAEPs can be used for evaluating the diagnostic and prognostic values in the cases of delayed encephalopathy after acute carbon monoxide poisoning.展开更多
The authors investigated 242 patients after radiotherapy for nasopharyngeal carcinoma (NC).Of whom 84 developed radiation encephalopathy (REP), the incidence rate(IR) of REP was 34.7%.In various factors associated wit...The authors investigated 242 patients after radiotherapy for nasopharyngeal carcinoma (NC).Of whom 84 developed radiation encephalopathy (REP), the incidence rate(IR) of REP was 34.7%.In various factors associated with REP, the irradiation source, total r展开更多
Radiation encephalopathy(REP) after radiotherapy was investigated by magnetic resonance imaging (MRI) in 84 patients with nasopharyngeal carcinoma(NC). The lesions were found mainly in the bilateral temporal lobes, br...Radiation encephalopathy(REP) after radiotherapy was investigated by magnetic resonance imaging (MRI) in 84 patients with nasopharyngeal carcinoma(NC). The lesions were found mainly in the bilateral temporal lobes, brain stems and cerebella. In T1-weighte展开更多
INTRODUCTION Hashimoto’s encephalopathy presents with high serum antithyroid antibody concentra-tions in association with an excellent response to immunosuppressant therapies such as corticosteroids.1 Females were fo...INTRODUCTION Hashimoto’s encephalopathy presents with high serum antithyroid antibody concentra-tions in association with an excellent response to immunosuppressant therapies such as corticosteroids.1 Females were four to five times more likely to be affected by this condi-tion,with a mean age of onset between 41 and 48 years2,though rare occasional paediatric presentations were also reported.展开更多
In order to probe into an optimal method for locating radiation encephalopathy (REP) after radiotherapy for nasopharyngeal carcinoma (NC), 84 consecutive patients with REP who were treated in Nanfang Hospital were obs...In order to probe into an optimal method for locating radiation encephalopathy (REP) after radiotherapy for nasopharyngeal carcinoma (NC), 84 consecutive patients with REP who were treated in Nanfang Hospital were observed and their clinical data analysed in comparison with the findings from magnetic resonance imaging (MRI)from 1986 through 1993. The results showed that the early symptoms and signs of REP are mainly mental symptoms due to lesions of the temporal lobes, and signs of the pyramidal tract and cranial nerve lesion syndromes which are associated with brain-stem injury. The clinical features of REP might be classified into 3 stages: early response, state of relative rest and delayed response in the light of the course of the disease. Clinical symptoms included 3 circumstances :general symptoms, local signs of the nervous system and no obvious symptoms, and may be classified into 3 types :temporal lobes, brain stem, and cerebellum types. In this series of patients, 9.5% had no clinical symptoms. It can be seen that the diagnosis of REP could not depend on its clinical manifestations only. It was suggested that the lesions of the temporal lobes is easy to be seen by CT, but MRI examination is needed for displaying the lesions of the brain stem and cerebellum.展开更多
Objective:To investigate the morphological changes of the neuronal neurites in diabetic rabbit brain. Methods: Twenty- four New Zealand White rabbits were divided into 2 groups: control group and type Ⅱ diabetic grou...Objective:To investigate the morphological changes of the neuronal neurites in diabetic rabbit brain. Methods: Twenty- four New Zealand White rabbits were divided into 2 groups: control group and type Ⅱ diabetic group induced by high - carbohydrate and high- fat diet. The levels of blood sugar and insulin were detected at week 0(w0), w4, w8, w13, w18, w23 and w28. Brain tissue was stained by Nissl staining and immunolistochemistry with a specific antibody to neurofilament proteins. Result: In diabetic rabbits, the amount of large pyramidal neuron was significantly reduced, and neuronal neurites became swollen, whorled, disrupted and changed in caliber. In hippocampus CA1 region neurofilament staining was very weak. Conclusion: Neurotoxicity of chronic hyperglycemia might be relevant to vascular chronic complications, which affected the expression of NF and led to neurophysiological and structural changes in the brain of rabbits with type Ⅱ diabetes.展开更多
BACKGROUND:This study aimed to determine the effects of sepsis on brain integrity,memory,and executive function.METHODS:Twenty sepsis patients who were not diagnosed with sepsis-associated encephalopathy(SAE)but had a...BACKGROUND:This study aimed to determine the effects of sepsis on brain integrity,memory,and executive function.METHODS:Twenty sepsis patients who were not diagnosed with sepsis-associated encephalopathy(SAE)but had abnormal electroencephalograms(EEGs)were included.The control group included twenty healthy persons.A neuropsychological test of memory and executive function and a brain magnetic resonance imaging scan were performed.The volumes of cortex and subcortex were measured using the FreeSurfer software.Acute Physiology and Chronic Health Evaluation II(APACHE II)score was used to determine the disease severity.RESULTS:In the sepsis group,the levels of immediate free recall,immediate cued recall,and delayed cued recall in the California Verbal Learning Test-II(CVLT-II)were significantly lower;the explicit memory(recollection process)in the process dissociation procedure test was lower;and the volumes of the left and right hippocampi were significantly lower compared with the control group.The volume of the presubiculum in the hippocampus of sepsis patients showed statistically signifi cant decrease.In the sepsis group,the volumes of the left and right hippocampi were negatively correlated with the APACHE II score and positively with immediate free recall,immediate cued recall,and delayed cued recall in the CVLT-II;moreover,the hippocampal volume was significantly correlated with recollection but not with familiarity.CONCLUSIONS:Patients with abnormal EEGs during hospitalization but with no SAE still have reduced hippocampal volume and memory defi cits.This fi nding indicates that sepsis leads to damage to specifi c parts of the hippocampus.展开更多
Administration of iodinated contrast agents can give rise to allergic/hypersensitivity reactions and contrast-induced nephropathy.In extremely rare cases,intravascularly administered iodinated contrast agents can trig...Administration of iodinated contrast agents can give rise to allergic/hypersensitivity reactions and contrast-induced nephropathy.In extremely rare cases,intravascularly administered iodinated contrast agents can trigger contrast-induced encephalopathy(CIE)in patients undergoing percutaneous coronary intervention(PCI).[1]Here,we describe the case of a male patient diagnosed with CIE after undergoing PCI with a non-ionic contrast agent,iodixanol.This is the first such case to be reported in a patient undergoing hemodialysis after kidney transplantation.展开更多
Objective To investigate the clinical neurological manifestations of Takayasu arteritis (TA). Methods A retrospective study was conducted with 63 consecutive TA cases admitted to Peking Union Medical College Hospital ...Objective To investigate the clinical neurological manifestations of Takayasu arteritis (TA). Methods A retrospective study was conducted with 63 consecutive TA cases admitted to Peking Union Medical College Hospital from January 2009 to May 2010. All the patients fulfilled the diagnostic criteria of TA by the American College of Rheumatology. Among the 63 TA patients, 27 with neurological manifestations were included in the present study. All the patients were evaluated using standardized neurological examination, sonography, computed tomography (CT) angiography, and cerebral CT or magnetic resonance imaging. Results Dizziness and visual disturbance were the most common symptoms, which occurred in 20 (74.1%) and 16 (59.3%) patients respectively. Another common symptom was headache, observed in 15 (55.6%) patients. Six (22.2%) patients had suffered from ischemic stroke; 7 (25.9%) patients had epileptic seizures. Two (7.4%) patients were diagnosed as reversible posterior encephalopathy syndrome (RPES) based on typical clinical and imaging manifestations. Conclusions Neurological manifestations are common symptoms in TA patients in the chronic phase, including dizziness, visual disturbance, headache, ischemic stroke, seizures, and some unusual ones such as RPES. We suggested RPES be included into the differential diagnosis of acute neurological changes in TA.展开更多
Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms hav...Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms have been applied to these conditions, they are all characterized by acute elevations in blood pressure and evidence of end-organ injury. Prompt, but carefully considered therapy is necessary to limit morbidity and mortality. A wide range of pharmacologic alternatives are available to the practitioner to control blood pressure and treat complications in these patients. The management of the elderly patient with hypertensive crises needs to include close monitoring and a gentle decline in blood pressure to avoid catastrophic complications, exacerbation of ischemic myopathy, and vascular insufficiency.展开更多
基金funded by the National Natural Science Foundation of China(82372214).
文摘BACKGROUND:Poisoned patients often suffer damage to multiple systems,and those experiencing central nervous system disorders present more severe conditions,prolonged hospital stays,and increased mortality rates.We aimed to assess the efficacy of rehabilitation interventions for patients with toxic encephalopathy.METHODS:This retrospective,observational,comparative cohort study was performed at the teaching hospital affiliated of Nanjing Medical University,from October 2020 to December 2022.Patients who met the diagnostic criteria for toxic encephalopathy and exclusion criteria were included,and patients were divided into three subgroups according to Glasgow Coma Scale(GCS).Demographic and clinical characteristics were collected.The effect of the rehabilitation intervention on patients were assessed in the improvement of consciousness status(Glasgow Coma Scale[GCS]score),muscle strength and movement and swallowing function(Fugl-Meyer Assessment[FMA]scale,Water Swallow Test[WST],and Standardized Swallowing Assessment[SSA]).Subgroup analysis was based on different toxic species.RESULTS:Out of the 464 patients with toxic encephalopathy,184 cases received rehabilitation treatments.For the severe toxic encephalopathy patients,patients without rehabilitation intervention have a 2.21 times higher risk of death compared to patients with rehabilitation intervention(Hazard ratio[HR]=2.21).Subgroup analysis revealed that rehabilitation intervention significantly increased the survival rate of patients with pesticide poisoning(P=0.02),while no significant improvement was observed in patients with drug/biological agent poisoning(P=0.44).After rehabilitation intervention,significant improvement in GCS and FMA were observed in severe patients with toxic encephalopathy(P<0.01).CONCLUSION:Active rehabilitation intervention for patients exposed to poisons that can potentially cause toxic encephalopathy may improve the prognosis and reduce the mortality rate in clinical practice.
基金supported by National Natural Science Foundation of China (81272089, 81130035, 81372054, and 81121004)the National Basic Research Program of China (2012CB518102)the "Twelve-Five Plan" for Military Scientific Foundation (BWS12J050)
文摘Sepsis-associated encephalopathy(SAE) is a brain dysfunction that occurs secondary to infection in the bo characterized by alteration of consciousness, ranging from delirium to coma, seizure or focal neurological signs. S involves a number of mechanisms, including neuroinflammation, in which the interaction between cytokines a acetylcholine results in neuronal loss and alterations in cholinergic signaling. Moreover, the interaction also occurs the periphery, accelerating a type of immunosuppressive state. Although its diagnosis is not specific in biochemis and imaging tests, it could potentiate severe outcomes, including increased mortality, cognitive decline, progress immunosuppression, cholinergic anti-inflammatory deficiency, and even metabolic and hydroelectrolyte imbalan Therefore, the bilateral communication between SAE and the multiple peripheral organs and especially the immu system should be emphasized in sepsis management.
文摘With the changes of life style, diabetes and its complications have become a major cause of morbidity and mortality. It is reasonable to anticipate a continued rise in the incidence of diabetes and its complications along with the aging of the population, increase in adult obesity rate, and other risk factors. Diabetic en- cephalopathy is one of the severe microvascular complications of diabetes, characterized by impaired cogni- tive functions, and electrophysiological, neurochemical, and structural abnormalities. It may involve direct neuronal damage caused by intracellular glucose. However, the pathogenesis of this disease is complex and its diagnosis is not very clear. Previous researches have suggested that chronic metabolic alterations, vascular changes, and neuronal apoptosis may play important roles in neuronai loss and damaged cognitive functions. Multiple factors are responsible for neuronal apoptosis, such as disturbed insulin growth factor （IGF） system, hyperglycemia, and the aging process. Recent data suggest that insulin/C-peptide deficiency may exert a primary and key effect in diabetic encephalopathy. Administration of C-peptide partially improves the condition of the IGF system in the brain and prevents neuronal apoptosis in the hippocampus of diabetic patients. Those findings provide a basis for application of C-peptide as a potentially effective therapy for diabetes and diabetic encephalopathy.
基金supported by the National High Level Hospital Clinical Research Fund (2022-PUMCH-B-109)CAMS Innovation Fund for Medical Sciences (CIFMS)(2021-1-I2M-020)。
文摘BACKGROUND:Sepsis-associated encephalopathy(SAE) is a critical disease caused by sepsis.In addition to high mortality,SAE can also adversely aff ect life quality and lead to significant socioeconomic costs.This review aims to explore the development of evaluation animal models of SAE,giving insight into the direction of future research in terms of its pathophysiology and therapy.METHODS:We performed a literature search from January 1,2000,to December 31,2022,in MEDLINE,PubMed,EMBASE,and Web of Science using related keywords.Two independent researchers screened all the accessible articles based on the inclusion and exclusion criteria and collected the relevant data of the studies.RESULTS:The animal models for sepsis are commonly induced through cecal ligation and puncture(CLP) or lipopolysaccharide(LPS) injection.SAE can be evaluated using nervous reflex scores and sepsis evaluation during the acute phase,or through Morris water maze(MWM),openfield test,fear condition(FC) test,inhibitory avoidance,and other tests during the late phase.CONCLUSION:CLP and LPS injection are the most common methods for establishing SAE animal models.Nervous reflexs cores,MWM,FC test,and inhibitory avoidance are widely used in SAE model analysis.Future research should focus on establishing a standardized system for SAE development and analysis.
基金This research received funding from the CAMS Innovation Fund for Medical Sciences(CIFMS)(2020-I2M-C&T-B-014,2021-I2M-1-020).
文摘BACKGROUND:Sepsis is a common cause of death in emergency departments and sepsis-associated encephalopathy(SAE)is a major complication.Rosuvastatin may play a neuroprotective role due to its protective effects on the vascular endothelium and its anti-inflammatory functions.Our study aimed to explore the potential protective function of rosuvastatin against SAE.METHODS:Sepsis patients without any neurological dysfunction on admission were prospectively enrolled in the“Rosuvastatin for Sepsis-Associated Acute Respiratory Distress Syndrome”study(SAILS trial,ClinicalTrials.gov number:NCT00979121).Patients were divided into rosuvastatin and placebo groups.This is a secondary analysis of the SAILS dataset.Baseline characteristics,therapy outcomes,and adverse drug events were compared between groups.RESULTS:A total of 86 patients were eligible for our study.Of these patients,51 were treated with rosuvastatin.There were significantly fewer cases of SAE in the rosuvastatin group than in the placebo group(32.1%vs.57.1%,P=0.028).However,creatine kinase levels were significantly higher in the rosuvastatin group than in the placebo group(233[22-689]U/L vs.79[12-206]U/L,P=0.034).CONCLUSION:Rosuvastatin appears to have a protective role against SAE but may result in a higher incidence of adverse events.
文摘Objective:To improve the diagnosis and therapeutic effect of occurrence and development of hyponatremia and disorder of acid-base balance among patients with hepatic encephalopathy(HE) by elucidating the regularity and mechanism,as well as its influence on prognosis.Methods:327 HE patients admitted to our hospital from January 1990 to June 2010 were enrolled.Meanwhile 316 patients hospitalized in the medical department of the same hospital were chosen as the control group.Patients in both groups were given the same methods to measure arterial blood gas parameters(pH value,PaCO2,[HCO3-],TCO2,BE and SaO2),blood biochemistry([Na+],[K+],[Cl-]),liver function,kidney function and blood glucose,serum sodium,and thereupon tocalculate the anion gap(AG) and the potential [HCO3-],and acid-base balance disorder.Results:Among the 327 HE patients,hyponatremia was found in 188 cases(57.4%),of whom 132 patients died(70.2%).While among the 316 patients in control group,68 presented with hyponatremia(21.5%),and 19 died(27.9%).The incidence and mortality were significantly different between the two groups(P<0.001).All the 327 patients presented with different degrees of acid-base balance disorder and 178 died(54.4%),in whom 164(50.2%) belonged to simple acid-base balance disorder and 74(45.1%) died,136(41.6%) were dual acid-base balance disorder and 80(58.8%) died,27(8.2%) were triple acid-base disturbance and 24(88.9%) died.Whereas in the control group only 83 patients(26.2%) were recognized as simple and dual acid-base balance disorder,and 18(21.7%) died.There was higher incidence of acid-base balance disorder and mortality rate in HE group than control one(P<0.001).Conclusion:Hyponatremia is valuable to judge HE patients' prognosis.The key parameters in the judgment and evaluation on acid-base balance disorder among HE patients are the change of pH values and serum electrolyte values.When pH value ≤ 7.30 or > 7.55,it generally suggests a poor prognosis.
基金Supported by the Department of Education in Henan (2000320042)
文摘Objective:To evaluate the changes of brainstem auditory evoked potential (BAEP) in patients with delayed encephalopathy after acute carbon monoxide poisoning. Methods: BAEPs were performed in 32 controls and 40 patients. Wave Ⅰ , Ⅱ , Ⅲ ,Ⅳ, Ⅴ latencies and Ⅰ-Ⅲ , Ⅲ-Ⅴ , Ⅰ-Ⅴ interpeak latencies were measured, respectively. Results: Abnormalities of BAEPs in 13 patients (13/40, 32 ％). Among the13 abnormal BAEPs, 3 displayed prolongation of latency to waves in one side, no potential in another side; 5 displayed a similar abnormality which was bilateral prolongation of latency to waves ;and another 5 displayed unilateral latency delay. Compared wave Ⅰ , Ⅱ , Ⅲ , Ⅳ, Ⅴ latencies and Ⅰ-Ⅲ , Ⅲ-Ⅴ , Ⅰ-Ⅴ interpeak latencies in the patients and the controls, there were no significant differences (P＞0.05). Conclusion: BAEPs can be used for evaluating the diagnostic and prognostic values in the cases of delayed encephalopathy after acute carbon monoxide poisoning.
文摘The authors investigated 242 patients after radiotherapy for nasopharyngeal carcinoma (NC).Of whom 84 developed radiation encephalopathy (REP), the incidence rate(IR) of REP was 34.7%.In various factors associated with REP, the irradiation source, total r
文摘Radiation encephalopathy(REP) after radiotherapy was investigated by magnetic resonance imaging (MRI) in 84 patients with nasopharyngeal carcinoma(NC). The lesions were found mainly in the bilateral temporal lobes, brain stems and cerebella. In T1-weighte
文摘INTRODUCTION Hashimoto’s encephalopathy presents with high serum antithyroid antibody concentra-tions in association with an excellent response to immunosuppressant therapies such as corticosteroids.1 Females were four to five times more likely to be affected by this condi-tion,with a mean age of onset between 41 and 48 years2,though rare occasional paediatric presentations were also reported.
文摘In order to probe into an optimal method for locating radiation encephalopathy (REP) after radiotherapy for nasopharyngeal carcinoma (NC), 84 consecutive patients with REP who were treated in Nanfang Hospital were observed and their clinical data analysed in comparison with the findings from magnetic resonance imaging (MRI)from 1986 through 1993. The results showed that the early symptoms and signs of REP are mainly mental symptoms due to lesions of the temporal lobes, and signs of the pyramidal tract and cranial nerve lesion syndromes which are associated with brain-stem injury. The clinical features of REP might be classified into 3 stages: early response, state of relative rest and delayed response in the light of the course of the disease. Clinical symptoms included 3 circumstances :general symptoms, local signs of the nervous system and no obvious symptoms, and may be classified into 3 types :temporal lobes, brain stem, and cerebellum types. In this series of patients, 9.5% had no clinical symptoms. It can be seen that the diagnosis of REP could not depend on its clinical manifestations only. It was suggested that the lesions of the temporal lobes is easy to be seen by CT, but MRI examination is needed for displaying the lesions of the brain stem and cerebellum.
基金These authors contribute equally to this work.Supported by the Hunan science fourndation(JJY2069)
文摘Objective:To investigate the morphological changes of the neuronal neurites in diabetic rabbit brain. Methods: Twenty- four New Zealand White rabbits were divided into 2 groups: control group and type Ⅱ diabetic group induced by high - carbohydrate and high- fat diet. The levels of blood sugar and insulin were detected at week 0(w0), w4, w8, w13, w18, w23 and w28. Brain tissue was stained by Nissl staining and immunolistochemistry with a specific antibody to neurofilament proteins. Result: In diabetic rabbits, the amount of large pyramidal neuron was significantly reduced, and neuronal neurites became swollen, whorled, disrupted and changed in caliber. In hippocampus CA1 region neurofilament staining was very weak. Conclusion: Neurotoxicity of chronic hyperglycemia might be relevant to vascular chronic complications, which affected the expression of NF and led to neurophysiological and structural changes in the brain of rabbits with type Ⅱ diabetes.
基金the Shanxi Province Key Scientific and Technological Project(2016YFJH2-05)the Youth Project of the Second Affi liated Hospital of Xi’an Jiaotong University(YJ[QN]201523).
文摘BACKGROUND:This study aimed to determine the effects of sepsis on brain integrity,memory,and executive function.METHODS:Twenty sepsis patients who were not diagnosed with sepsis-associated encephalopathy(SAE)but had abnormal electroencephalograms(EEGs)were included.The control group included twenty healthy persons.A neuropsychological test of memory and executive function and a brain magnetic resonance imaging scan were performed.The volumes of cortex and subcortex were measured using the FreeSurfer software.Acute Physiology and Chronic Health Evaluation II(APACHE II)score was used to determine the disease severity.RESULTS:In the sepsis group,the levels of immediate free recall,immediate cued recall,and delayed cued recall in the California Verbal Learning Test-II(CVLT-II)were significantly lower;the explicit memory(recollection process)in the process dissociation procedure test was lower;and the volumes of the left and right hippocampi were significantly lower compared with the control group.The volume of the presubiculum in the hippocampus of sepsis patients showed statistically signifi cant decrease.In the sepsis group,the volumes of the left and right hippocampi were negatively correlated with the APACHE II score and positively with immediate free recall,immediate cued recall,and delayed cued recall in the CVLT-II;moreover,the hippocampal volume was significantly correlated with recollection but not with familiarity.CONCLUSIONS:Patients with abnormal EEGs during hospitalization but with no SAE still have reduced hippocampal volume and memory defi cits.This fi nding indicates that sepsis leads to damage to specifi c parts of the hippocampus.
基金supported by the China Postdoctoral Science Foundation(2019M650032)the China Scholarship Council(CSC) award(201706210415)
文摘Administration of iodinated contrast agents can give rise to allergic/hypersensitivity reactions and contrast-induced nephropathy.In extremely rare cases,intravascularly administered iodinated contrast agents can trigger contrast-induced encephalopathy(CIE)in patients undergoing percutaneous coronary intervention(PCI).[1]Here,we describe the case of a male patient diagnosed with CIE after undergoing PCI with a non-ionic contrast agent,iodixanol.This is the first such case to be reported in a patient undergoing hemodialysis after kidney transplantation.
文摘Objective To investigate the clinical neurological manifestations of Takayasu arteritis (TA). Methods A retrospective study was conducted with 63 consecutive TA cases admitted to Peking Union Medical College Hospital from January 2009 to May 2010. All the patients fulfilled the diagnostic criteria of TA by the American College of Rheumatology. Among the 63 TA patients, 27 with neurological manifestations were included in the present study. All the patients were evaluated using standardized neurological examination, sonography, computed tomography (CT) angiography, and cerebral CT or magnetic resonance imaging. Results Dizziness and visual disturbance were the most common symptoms, which occurred in 20 (74.1%) and 16 (59.3%) patients respectively. Another common symptom was headache, observed in 15 (55.6%) patients. Six (22.2%) patients had suffered from ischemic stroke; 7 (25.9%) patients had epileptic seizures. Two (7.4%) patients were diagnosed as reversible posterior encephalopathy syndrome (RPES) based on typical clinical and imaging manifestations. Conclusions Neurological manifestations are common symptoms in TA patients in the chronic phase, including dizziness, visual disturbance, headache, ischemic stroke, seizures, and some unusual ones such as RPES. We suggested RPES be included into the differential diagnosis of acute neurological changes in TA.
文摘Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms have been applied to these conditions, they are all characterized by acute elevations in blood pressure and evidence of end-organ injury. Prompt, but carefully considered therapy is necessary to limit morbidity and mortality. A wide range of pharmacologic alternatives are available to the practitioner to control blood pressure and treat complications in these patients. The management of the elderly patient with hypertensive crises needs to include close monitoring and a gentle decline in blood pressure to avoid catastrophic complications, exacerbation of ischemic myopathy, and vascular insufficiency.
