OBJECTIVES:The neutrophil-to-lymphocyte ratio (NLR) is an easily accessible biomarker that has been shown to predict the prognosis of acute ischemic stroke (AIS) patients. This study aimed to investigate the association between NLR on admission and within 24 hours after thrombolysis in A IS patients receiving intravenous thrombolysis (IVT) and the severity of stroke, infarction volume, hemorrhagic transformation (HT), and 90-day outcome. METHODS:Retrospective cohort study of 171 consecutive patients, the NLR value was calculated according to neutrophil and lymphocyte counts both on admission and after IVT. We defined the NLR value on admission as pre-IVT NLR and after IVT within 24 hours was defined as post-IVT NLR. We used the modified Rankin scale (mRS) to assess the 90-day outcome for AIS patients. Regression analyses were performed, adjusting for confounders. RESULTS:(1) Post-IVT NLR level was increased in the poor prognosis group, the moderate to severe group, large infarct volume group, and HT group. (2) In multivariate logistic regression analysis, the level of post-IVT NLR and post-IVT platelet-to-lymphocyte ratio (PLR) were correlated with the 90-day prognosis of AIS. Post-IVT NLR was an independent risk factor for predicting the prognosis of AIS patients with an adjusted OR of 1.212 (p = 0.001). Post-IVT NLR demonstrated superior prognostic accuracy compared to post-IVT PLR (AUC 0.738 vs. 0.601, p = 0.001), though remained inferior to NIHSS score (AUC 0.793) and infarction volume (AUC 0.808). CONCLUSION:Post-IVT NLR is related to the severity of stroke, infarction volume, HT, and 90-day outcome in AIS patients receiving IVT. Post-IVT NLR was an independent predictor (p = 0.001, OR 1.212) for predicting the prognosis of AIS.

Guillain-Barré syndrome (GBS) is a peripheral neuropathy mediated by immunoglobulin G (IgG) autoantibodies, which can cause acute flaccid paralysis. Miller-Fisher syndrome (MFS) is a variant of GBS, and in some cases, MFS may overlap with GBS (MFS-GBS overlap syndrome), potentially delaying the disease’s progression. Apart from intravenous immunoglobulin (IVIg) and plasma exchange (PLEX), which are currently the clinical standard of care. However, at least 20–30

Background: The use of antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), has been linked to adverse effects on bone health, but findings are conflicting. This study aimed to quantify the associations between newer antidepressants and bone mineral density (BMD) and fracture risk through a comprehensive meta-analysis. Methods: Observational studies on the association between the use of novel antidepressants and BMD and hip fracture were systematically searched in PubMed, Embase, CINAHL, Cochrane Library, and Scopus. Random effects meta-analyses were conducted to pool results across the eligible studies. The heterogeneity, publication bias, and influence were assessed extensively. Results: 14 eligible studies with 1,417,134 participants were identified. Antidepressant use was associated with significantly lower BMD compared to non-use at all skeletal sites examined, with pooled standardized mean differences (SMD) ranging from –0.02 (total hip) to –0.04 (femoral neck). Importantly, antidepressant use was associated with a 2.5-fold increased risk of hip fracture (pooled odds ratio (OR) 2.50, 95% CI 2.26–2.76). While heterogeneity was detected, the overall findings were robust in sensitivity analyses. Conclusions: This meta-analysis provided strong evidence that novel antidepressants, especially widely used SSRIs, have detrimental impacts on bone health. The observed associations with decreased BMD and doubled hip fracture risk have important clinical implications.

OBJECTIVE:To investigate the correlation between the urinary microalbumin/creatinine ratio (UACR) and the occurrence and severity of leukoaraiosis.METHODS:A total of 323 patients were retrospectively recruited. Demographic, clinical, and laboratory data were collected at the time of admission, and the UACR was calculated based on the levels of urinary microalbumin and creatinine. All patients showed improvement in cranial magnetic resonance imaging (MRI) examination. The subjects were divided into leukoaraiosis and non-leukoaraiosis groups according to the results of the cranial MRI examination. According to the Fazekas standard score, the patients in the leukoaraiosis group were divided into the mild leukoaraiosis group: Fazekas (1-2 points), moderate leukoaraiosis group: Fazekas (3-4points); and severe leukoaraiosis group: Fazekas (5-6 points).RESULTS:A regression analysis was performed to adjust for confounding factors. (1) Compared with the non-leukoaraiosis group, UACR level was higher in the leukoaraiosis group at admission, and the difference between the groups was statistically significant (p < 0.05). (2) In the multivariate logistic regression analysis, UACR was correlated with the occurrence of leukoaraiosis, which may be an independent risk factor. (3) The UACR levels increased gradually in the mild, moderate and severe leukoaraiosis groups, and the difference was statistically significant (p< 0.05). (4) In the ordered multi-category logistic regression analysis, UACR was correlated with the severity of leukoaraiosis, which may be an independent risk factor.CONCLUSION:UACR is associated with the occurrence and severity of leukoaraiosis, and may be an independent risk factor.

目的 分析帕金森病(PD)患者的幽门螺杆菌(Hp)感染情况.方法 选取2020年1月至2021年9月在温州市人民医院门诊和住院初次诊断为PD的患者60例(PD组)和健康体检者60例(对照组),行13C尿素呼气试验,比较两组对象Hp阳性率.将PD组分为阳性者和Hp阴性者,采用世界运动障碍学会统一 PD综合评定表(MDS-UPDRS)评分,比较Hp阳性者和Hp阴性者上述评分.Hp阳性者根除Hp后,比较治疗前后MDS-UPDRS第Ⅲ部分运动功能检查评分.结果 PD组Hp感染率48.33％,高于对照组25.00％(P＜0.05).PD组中Hp阳性者MDS-UPDRS总分和第Ⅲ部分运动功能检查评分均高于阴性组(均P＜0.01).PD组中Hp阳性者根除Hp后第川部分运动功能检查评分低于治疗前(P＜0.01).结论 PD患者Hp感染率高,将Hp阳性患者作为重点筛查群体可协助PD诊断,根治Hp后可改善PD患者的运动功能.

目的 分析帕金森病患者肠道菌群的变化及与临床特征的相关性.方法 选择2017年11月至2019年2月温州市人民医院神经内科诊治的帕金森病患者(PD组)和同期健康体检者(HC组),各30例.对PD组进行统一帕金森病评分量表第三部分(UPDRSⅢ)、Hoehn&Yahr分级量表(H-Y分级)、简易精神状态检查量表(MMSE)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、帕金森病自主神经症状量表(SCOPA-AUT)、Wexner便秘评分等评估.采集两组对象血液、粪便样本,通过16S-rDNA测序确定微生物种类并进行微生物分类分析,利用生物信息学方法对比PD组和HC组之间的差异菌群,并对PD组患者菌群丰度和临床特征进行相关性分析.结果 PD组和HC组菌群多样性比较,差异无统计学意义(P>0.05).PD组患者粪便中门水平疣微菌门、黏胶球形菌、异常球菌的丰度高于HC组,属水平毛螺旋菌属、链球菌属、克雷伯菌属、伯劳特菌属丰度低于HC组,埃希菌属、瘤胃球菌属、巨单胞菌属、阿克曼菌属、巨型球菌属、颤杆菌属、伯克菌属、埃森博格拉菌属、异味杆菌属、丹毒丝菌科未命名属、脱硫弧菌属、普雷沃菌属、单胞菌属、脱硫弧菌科未命名属、嗜胨菌属丰度高于HC组,差异均有统计学意义(均P<0.05).UPDRSⅢ与脱硫弧菌呈正相关(rho=0.482,P<0.05).HAMA、HAMD与巨型球菌属呈正相关(rho=0.524、0.429,P<0.05).SCOPA-AUT与普雷沃菌属呈负相关(rho=-0.558,P<0.05).MMSE与埃森博格拉菌属呈负相关(rho=-0.547,P<0.05).结论 PD组和HC组的菌群结构在门、属水平上均有明显的差异.PD组患者肠道菌群中条件致病菌的增多及短链脂肪酸产生菌减少.帕金森病菌群变化与临床特征有一定相关性.

目的 分析阿尔茨海默病(AD)患者的步态特点,了解其步态规律,指导临床治疗及康复.方法 收集AD患者40例,健康人群40例为对照.采用RSscan足底压力测试系统进行生物力学数据采集,获得足底压力动态参数.结果 AD组左步长、右步长均短于对照组,差异有统计学意义(P<0.05);AD组左足M5区域压力小于对照组,差异有统计学意义(P<0.05);AD组在右足HM、HL区域压力小于对照组,右足MF区域压力大于对照组,差异有统计学意义(P<0.05);AD组在左足M3、M5区域冲量小于对照组,差异有统计学意义(P<0.05);AD组在右足HM、HL区域冲量小于对照组,右足MF区域冲量大于对照组,差异有统计学意义(P<0.05);AD组在在左支撑相前期、左支撑相中期持续时间大于对照组,右首次触地期、左支撑相末期持续时间小于对照组,差异有统计学意义(P<0.05).结论 AD患者存在步长减小,步态不稳等步态障碍特征.足底压力测定有利于医师定量分析患者步态障碍的特点和程度,进而针对性康复训练.

目的:分析脑白质疏松(LA)相关的危险因素.方法:选取2019年7月至2020年12月温州市人民医院神经内科188例住院患者,根据是否存在LA分为病例组(78例)和对照组(110例).分别收集两组年龄、性别、高血压病、糖尿病、血生化、尿微量白蛋白等指标.对两组资料进行单因素比较,对有意义因素进行多因素logistic回归分析.结果:单因素分析中病例组年龄、同型半胱氨酸、高血压病、尿微量白蛋白阳性显著高于对照组,差异有统计学意义(P<0.05);经过多因素logistic回归分析显示年龄(OR=1.163,95％CI=1.107～1.221,P<0.001)、尿微量白蛋白阳性(OR=2.599,95％CI=1.132～5.966,P=0.024)、高血压病(OR=2.767,95％CI=1.223～6.261,P=0.015)仍是LA的独立危险因素.结论:年龄、尿微量白蛋白阳性、高血压病与LA独立相关.

目的:探究美多巴与普拉克索治疗帕金森病的效果和对生活质量及尿酸水平的影响.方法:选择2018年5月～2020年4月到某院将治疗帕金病的患者作为本研究的观察对象,病例样本为74例,随机将患者分为单一组与联合组各37例.单一组患者予以美多巴进行治疗,联合组患者在单一组的给药基础上添加普拉克索进行药物联合治疗,对比两组患者的临床疗效与尿酸水平变化,再使用生活质量量表(SF-36)评估患者生活质量.结果:治疗后,联合组患者生活质量量表评分中的社会关系、心理状况、生理状况、独立性、环境评分均优于单一组患者,其差距具统计学意义(P<0.05);联合组治疗总有效率优于单一组(94.59％>78.38％),其差距具统计学意义.治疗前两组患者尿酸水平比较,无明显差异;在治疗后单一组尿酸水平为(286.64±35.58)μmo1/L,联合组患者尿酸水平为(342.47±29.82)μmo1/L,组间差距较为显著,具统计学意义(P<0.05).结论:美多巴与普拉克索治疗帕金森病,可取得较为显著的疗效,并有效提高患者的生活质量.

PURPOSE:To characterize retinal capillary complexity by optical coherence tomography angiography in Parkinson disease. METHOD:Twenty-five Parkinson disease patients and 25 age- and gender-matched healthy controls were recruited. Optical coherence tomography angiography and optical coherence tomography imaged the superficial and deep retinal capillary plexuses and retinal structure. Retinal capillary skeleton density, retinal capillary perfusion density, and fractal dimension analysis of retinal capillary complexity were performed in the total annular zone and quadrant sectors. The thickness of retinal nerve fiber layer, ganglion cell layer and inner plexiform layer, and total retinal thickness were extracted from retinal structural images. Relationships among the retinal capillaries, retinal structure, and clinical parameters were analyzed. RESULTS:The superficial retinal capillary plexus in Parkinson disease patients had lower retinal capillary skeleton and perfusion densities and capillary complexity in the total annular zone and all quadrant sectors compared with healthy control subjects. The deep retinal capillary plexus retinal capillary complexity was decreased in the total annular zone and the superior and inferior quadrants. The retinal capillary complexity in the inferior quadrant was negatively correlated with the best-corrected visual acuity and disease duration (r = -0.61, r = -0.43, respectively, both P < 0.05). CONCLUSION:As determined by fractal analysis, retinal capillary complexity can be an objective biomarker in Parkinson disease.

目的 分析帕金森病(PD)患者的步态特点,了解其步态规律,指导临床治疗及康复.方法 收集PD患者40例,正常对照40例.采用RSscan足底压力测试系统进行生物力学数据采集,获得足底压力动态参数.结果 帕金森组左步长(37.96±16.13)、右步长(34.32±19.69)均小于对照组[(54.15±8.02)、(54.39±10.92)],差异有统计学意义(P<0.05);帕金森组在左足M3、M4、M5、HM区域压力[(76.63±47.71)、(60.16±39.27)、(48.24±30.04)、(107.12±52.83)]小于对照组(94.22±25.04)、(86.91±35.68)、(86.91±35.68)、(136.45±22.26)],差异有统计学意义(P<0.05);帕金森组右足M3、HM、HL区域压力[(67.10±54.72)、(120.38±60.99)、(100.61±43.84)小于对照组[(90.73±27.53)、(165.58±44.10)、(140.07±44.73)],右足M2、MF区域压力[(79.96±122.31)、(165.58±113.43)]、大于对照组[(55.30±40.50)、(126.72±41.20)],差异有统计学意义(P<0.05);帕金森组在左足M4、M5区域冲量[(21.69±15.52)、(17.17±11.89)]小于对照组[(31.34±15.26)、(29.83±15.45)],差异有统计学意义(P<0.05);帕金森组在右足M5、MF区域冲量[(14.01±11.64)、(69.77±55.11)]大于对照组[(10.02±4.68)、(38.02±19.44)],差异有统计学意义(P<0.05);帕金森组在左支撑相前期持续时间(67.63±18.16)大于对照组(60.26±9.17),左支撑相末期、右支撑相末期持续时间[(25.58±15.02)、(23.00±11.90)]小于对照组[(34.58±7.24)、(31.60±10.40)],差异有统计学意义(P<0.05).结论 PD患者行走时第五跖骨、中足部受力明显,重心前倾,全脚掌离地过快,形成慌张步态.足底压力测定有利于医生定量分析患者步态障碍的特点和程度,进而针对性康复训练.

目的 探讨载脂蛋白E(ApoE)基因多态性与高脂血症患者降脂疗效的相关性,指导临床合理用药.方法 选取高脂血症患者100例,每晚睡前口服阿托伐他汀20mg降脂治疗,治疗4周,治疗前后检测血清血脂指标.计算治疗前后LDL-C下降率,以LDL-C在治疗前后下降率40％为界,分为他汀治疗高疗效组56例和他汀治疗低疗效组44例.采用实时荧光定量PCR法检测ApoE基因.结果 100例高脂血症患者共检出E2/3、E2/4、E3/3、E3/4 4种基因型和82、ε3、ε4 3种等位基因,E2/2、E4/4 2种基因型未检出.E2型基因组、E4型基因组与E3型基因组TC、HDL-C、LDL-C水平比较差异均有统计学意义(均P＜0.05),其中E4型基因组TC、LDL-C水平最高.他汀治疗低疗效组E3/3基因型检出率、ε3等位基因检出率均低于他汀治疗高疗效组,E3/4基因型检出率、ε4等位基因检出率均高于他汀治疗高疗效组,两组比较差异均有统计学意义(均P＜0.05). 结论 ApoE基因多态性与高脂血症患者降脂疗效相关性较大,84等位基因影响阿托伐他汀降脂疗效.

目的 探讨急性脑出血患者血清封闭蛋白5(claudin 5,CLDN5)、紧密连接蛋白1(zonula occludens 1,ZO1)在自发性脑出血血肿体积扩大判断中的价值.方法 选取2016年6月至10月自发性脑出血患者共89例.记录患者年龄、性别、高血压病史、格拉斯哥昏迷评分(GCS)评分、就诊时间、出血部位、初次出血量等一般资料,入院后即采用ELISA法检测静脉血CLDN5、ZO1水平.入院24h内复查头颅CT并计算出血量,根据血肿是否扩大分为扩大组和稳定组,分析CLDN5、ZO1水平与血肿扩大的关系.结果 自发性脑出血血肿扩大患者的外周血CLDN5、ZO1水平(456.05±114.48)、(244.90±66.53)pg/ml明显增高,与血肿稳定组(293.17±82.64)、(194.63±42.09)pg/ml比较,差异均有统计学意义(均P<0.05).扩大组、稳定组GCS评分比较,差异均有统计学意义(均P<0.05).多因素logistic回归分析发现,CLDN5和ZO1水平是自发性脑出血血肿扩大的独立危险因素.CLDN5预测血肿扩大的AUC为0.853(95％CI:0.766～0.941,P<0.001),ZO1的AUC为0.754(95％CI:0.651～0.857,P<0.001).结论 CLDN5、ZO1水平在自发性脑出血血肿扩大患者中明显升高,是血肿扩大的独立危险因素,可用于早期预测血肿是否会扩大.

目的 分析高龄患者围术期脑卒中的危险因素并探讨相关血清学指标预测脑卒中的价值.方法 收集我院围术期脑卒中且年龄≥60岁的患者48例,采用多因素Logistic回归模型分析围术期脑卒中的危险因素,同时绘制中性粒细胞与淋巴细胞计数比值(NLR)和纤维蛋白原(FIB)预测脑卒中的受试者工作(ROC)曲线.结果 多因素分析显示围手术期患者合并有高血压病、糖尿病、脑卒中史、FIB和NLR升高是发生脑卒中的危险因素;同时NLR和FIB预测围术期脑卒中的曲线下面积分别为0.754和0.566,NLR预测脑卒中的最佳诊断点为3.05,敏感度和特异度分别为73.4％和77.2％.结论 高血压病、糖尿病、脑卒中史、FIB和NLR升高是围术期脑卒中发生的危险因素,同时NLR可作为一项早期预测指标,对早期发现围术期脑卒中具有一定价值.

Objective:To explore the effect of the BPPV precision manipulation treatment. Method:With 3D SLICER software we segment structure such as semicircular canal, eye ball, orbital and ear rod from MRI or CT volume data of patients which underwent MRI or CT scaning of inner ear, for measuring the spatial direction of semicircular canals and building semicircular canal modules with standard space coordinate system and embedding into 3D PDF files. Result:With the slice that divide the semicircular canal equally as the semicircular canal plane and the eyeball as reference object to determine whether it is symmetric, it is not only intuitive but also reliable for measuring the angle between the posterior semicircular canal. 3D PDF is intuitive, rotation angle can be adjusted according to the individual differences in the process of manipulation treatment, to observe and demonstrate the theoretical reduction effect before the actual operation. Conclusion:By reconstruction the three-dimensional semicircular canal structure from the inner ear image data of patients and measurement of the semicircular canal space direction, it is of a certain significance for BPPV precision manipulation treatment.

ObjectiveTo observe the effect of butylphthalide combined with alpha lipoic acid in the treatment of diabetic peripheral neuropathy.MethodsSixty diabetic peripheral neuropathy patients were randomly divided into the observation group and the control group, with 30 cases in each. On the basis of the conventional treatment of diabetes,the observation group was given butylphthalide combined with alpha lipoic acid, the control group was given alpha lipoic acid,for 4 weeks. Before and after treatment,the efficient rate,nerve conduction velocity between two groups were compared.ResultsAfter treatment,the motor nerve conduction velocity(MCV) and sensory nerve conduction velocity(SCV)of the observation group and the control group were higher than those before treatment, the difference were statistically significant(t=12.87,12.00,28.53,20.51, 9.41,7.40,9.70,7.27, P<0.05). After treatment, the MCV and SCV of the observation group were higher than the control group,the difference were statistically significant(t=3.05,5.02,5.50,5.47,P<0.05). The total effective rate of the observation group was 93.33%, the control group was 73.33%, the total effective rate of the two groups was statistically significant (χ2=4.32,P<0.05).ConclusionThe treatment of butylphthalide combined with alpha lipoic acid on diabetic peripheral neuropathy is effective.