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June 2013, Volume 16, No.17 Abstracts

 Whether and How to Make Interventions to Hyperhomocysteinemia

ZHU Xiu-fang.School of Pharmacy, Yancheng Health Vocational and Technical College, Yancheng 224006, China

Abstract Hyperhomocysteinemia,an independent risk factor for angiemphraxis,is closely related to cardiovascular and cerebrovascular events.Healthy living habits and a list of medicines such as folic acid and B vitamins can reduce the level of homocysteine effectively. However, interventions to hyperhomocysteinemia have been proved, by some studies, to be ineffective. Therefore, whether and how to intervene remains a controversial issue.This article summarizes the intervention measures for hyperhomocysteinemia. Healthy living habits are essential in preventing hyperhomocysteinemia and cardiovascular, cerebrovascular events.

Key words Hyperhomocysteinemia; Cardiovascular disease; Cerebrovascular disorders

Electroencephalogram and Brainstem Auditory Evoked Potential Determining Dynamically Delayed Encephalopathy after Acute Carbon Monoxide Poisoning

WANG Chuan-sheng, ZHANG Ping, HAN Yong-kai, et al.The Second Affiliated Hospital of Xinxiang Medical College, Xinxiang 453002, China

Abstract Objective To observe the dynamic changes of electroencephalogram(EEG) and brainstem auditory evoked potential(BAEP) in patients with acute carbon monoxide poisoning(ACMP), to find out their predictive values for delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Methods A total of 83 acute carbon monoxide poisoningACMP patients were divided, according to occurrence of DEACMP, into groups DEACMPn=32 and non-DEACMP(n=51.Patients were given EEG and BAEP on days 1~5, 8~12, 18~22, 28~32, 38~42, 52~57.The abnormal rates of EEG, BAEP at different time points were compared, and the sensitivity and specificity of EEG, BAEP or of their combination calculated in predicting DEACMP.Results The abnormal rates of the 1st, 4th, 5th, 6th EEG measurement were significantly higher in DEACMP group than those in non-DEACMP group(P0.05); The abnormal rates of the 1st, 3rd, 4th, 5th, 6th BAEP higher in DEACMP group than in non-DEACMP group(P0.01).The first EEG was abnormal in 58 patients(69.9%), including 27 patients who developed to DEACMP.The sensitivity of EEG predicting DEACMP was 84.4%(27/32), specificity was 39.2%(20/51).The first BAEP was abnormal in 23 patients(27.7%), including 19 patients who developed to DEACMP.The sensitivity of BAEP predicting DEACMP was 59.4%19/32, specificity was 92.2%47/51.The sensitivity of EEG combined with BAEP was 93.7%, if 1 item being positive was taken as positive, the sensitivity was 93.7%,specificity was 36.1%; If 2 items being positive was taken as positive, the sensitivity was 50.1%, specificity was 95.2%.Dynamical EEG or BAEP showing condition of abnormality-improvement-reabnormality predicted highly the incidence of DEACMP.Conclusion Early dynamical EEG and BAEP are of great significance and clinical values after ACMP, which is worth popularizing and applying.

Key words Carbon monoxide poisoning; Delayed encephalopathy; Electroencephalogram; Evoked potentials, auditory, brain stem

Serum IL-18 Levels and Its Clinical Significance in the Blood of Patients with Delated Encephalopathy after Acute Carbon Monoxide Poisoning

ZHANG Ping, WANG Chuan-sheng,HAN Yong-kai, et al.The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang 453002, China

Abstract Objective To investigate the relationship between dynamic changes of serum IL-18 level and mechanism of delayed encephalopathy after acute carbon monoxide poisoningDEACMPto find potential cytokine variation during DEACMP occurrence and to provide evidence for further study on immunological mechanism of DEACMP.

Methods 40 DEACMP patients admitted to the Neurology Department of our hospital from January 2009 to January 2011 were selected as DEACMP group and another 36 healthy people underwent physical examination in the same period were selected as control group.Enzyme-linked Immunoassay(ELISA) method was used to detect the levels of IL-18 in acute stage and recovery stage,and the results were compared with the control group.

Results The levels of IL-18 in DEACMP patients〔(29.7±8.4ng/L、(28.3±7.9ng/L were significantly higher than the control group〔(24.1±5.3ng/L, 24.1±5.3ng/L both in acute stage and recovery stage(t=3.433, P=0.001; t=2.693, P=0.009).In DEACMP group, the IL-18 level in acute stage was significantly higher than that of recovery stage(t=2.421, P=0.020).

Conclusion IL-18 might be involved in the occurrence of DEACMP in a delayed immunologic way,and play a part in its development.

Key words Carbon monoxide poisoning; Hypoxia-ischemia, brain; Interleukin-18; Enzyme-linked immunosorbent assay

Serum IGF-1 Level in Patients with Delayed Encephalopathy after Acute Carbon Monoxide Poisoning and Its Clinical Significance

GU Jia-peng,WANG Ji-kang,ZHANG Ping,et al.The Second Affiliated Hospital of Xinxiang Medical University,Xinxiang 453002,China

Abstract Objective To investigate the dynamic changes of level of serum insulin-like growth factor-1(IGF-1) and its clinical significance in patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Methods 33 DEACMP patients were selected form November 2007 to Jun 2008, IGF-1 level was assayed with enzyme-linked immunno-sorbent assay(ELISA).Their condition changes were evaluated with Activity of Daily Living Scale(ADL),Information-Memory-Concentration Test(IMCT) and Hasegawas Dementia Scale(HDS).The above indexes were compared with those of 32 acute carbon monoxide poisoning(ACMP) patients without occurrence of DEACMP(ACMP group) and of 32 healthy subjects(control group).Results (1) IGF-1 at acute stage was significantly lower in DEACMP group(136.10±51.51) μg/L than in control group(192.91±145.97)μg/L,P0.05,there was no significant difference in IGF-1 at acute stage between groups DEACMP and ACMP〔(156.51± 93.13)μg/L,between groups ACMP and control(P0.05).IGF-1 was higher at recovery stage〔(187.69±92.46)μg/L than at acute stage in DEACMP group,the difference was significant(P0.05).(2) ADL,HDS,IMCT at acute stage was significantly different from those at recovery stage in DEACMP group(P0.05).(3)IGF-1 was negatively correlated with ADL in DEACMP group(r=-0.377,P=0.03).Conclusion IGF-1,protecting probably DEACMP patients from brain damage,may be used as one of indexes for clinical outcomes and therapeutic effectiveness assessment.

Key words Carbon monoxide poisoning; Hypoxia-ischemia, brain; Insulin like growth factor

Relationship of Latent Phase to Severity and Prognosis in Patients with Delayed Encephalopathy after Acute Carbon Monoxide Poisoning

WANG Chuan-sheng, ZHANG Ping, HAN Yong-kai, et al.The Second Affiliated Hospital of Xinxiang Medical Collage, Xinxiang 453002, China

Abstract Objective To explore the relationship of latent phaseLPto severity and prognosis in patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Methods A total of 327 DEACMP patients were divided, according to LP length, into groups Short LPLP20 d, n=174, Long LPLP21 d, n=153.Patients severity and prognosis were evaluated with ADL, IMCT, HDS to determine efficacy after 30 d, 180 d of onset.Results No significant difference was noted in ADL, IMCT and HDS between 2 groups in most severe periodP0.05.There was significant difference in ADL, IMCT and HDS between 2 groups in recovery periodP0.01.The cure rate was 71.26%124/174in Short LP group, 88.89%136/153in Long LP group, the difference was significant(χ2=15.52, P=0.01.Conclusion The length of LP is not so related to severity of patients disease, but it may be an indicator for prognostic judgment, namely, the longer LP is, the better the prognosis is.

Key words Carbon monoxide poisoning; Delayed encephalopathy; Latent phase; Prognosis

Significance of Plantar Pressure Balance and Gait Stability in Early Prevention and Cure of Diabetic Foot

HU Yi-bin, MENG Xiao-jing.Nanfang Hospital of Southern Medical University, Guangzhou 510515, China

Abstract Objective To explore the clinical significance of plantar pressure equilibrium and gait stability in early prevention and treatment of diabetic foot(DF).

Methods Forty-two DF patients(Wanger classification=0) were divided randomly into groups therapy and control,21 in each.Belgian-footscan plantar pressure gait detection system was used to monitor dynamical plantar pressure and static impulse in 2 groups,and then made personalized programs to balance plantar pressure based on the monitoring data in therapy group.Control group received conventional treatment without personalized programs.Two groups were followed up for 1 year, to observe the plantar pressure, gait stability curve, incidence of foot ulcers, impulse before and after treatment.

Results No significant difference in plantar pressure between 2 groups before treatment(P0.05).After 1 year of treatment, the pretreatment pressures of the 3rd, 4th, 5th metatarsal base of control group were higher than those in control group before treatment and those in therapy group after treatment, the differences were significant(P0.05).There was no significant difference in plantar pressure in therapy group between post- and pre-treatments(P0.05).After treatment, the gait balance curve fluctuated remarkably and gravity pressure distribution curve was a little short of smoothness(namely gait stability was not good) in control group, while in therapy group no obvious fluctuation was noted, the plantar pressure distribution was balanced.The incidences of foot ulcers were 42.9%(9/21) in control group, 14.3%(3/21) in therapy group, the difference was significant(P0.05).There was significant difference in the proportion of impulse65%42.9%9/21 vs.14.3%3/21)〕 between control group and therapy group(P0.05).

Conclusion Plantar pressure change is one of the important causes of diabetic foot ulcers.Early detection and evaluation of plantar pressure of diabetic patients is very important, and positive and effective measures to balance plantar pressure can reduce incidence of foot ulcers, to decrease amputation rate from source to guarantee the quality of life of diabetes patients.

Key words Diabetic foot; Plantar pressure; Gait; Impluse; Foot ulcer

The Relationship between Sleep Structure and Cognitive Function in Cerebral Infarction Patients Combined with Obstructive Sleep Apnea Hypopnea Syndrome

YU Xiao-hong, ZHANG Lin-hong.Department of Neurology, Wuhan Central Hospital, Wuhan 430014, China

Abstract Objective To discuss the correlation between sleep structure and cognitive function in cerebral infarctionCIpatients combined with obstructive sleep apnea hypopnea syndromeOSAHS.Methods Polysomnography was performed and Mini-mental state examinationMMSE, Montreal Cognitive AssessmentMoCAwere used to evaluate cognitive function.A correlation test was performed by Spearman correlation analysis on cognitive function and parameter, staging of sleep apnea.Results In sleep structure and cognitive score, the proportion of non-rapid eye movementNREMstaging and NREM 1 staging was higher in group A than in group B, that of NREM 3+4 staging, rapid eye movementREMstaging lower than in group B, MMSE, MoCA scores lower than in B group, the difference was significantP0.05.MMSE was positively correlated with night mean SaO2 , night lowest SaO2 , NREM 3+4 stagingr=0.445, 0.430, 0.491, P<0.05, negatively correlated with AHI, SaO2 reduction indexODI, NREM 1+2 stagingr=-0.428, -0.640, -0.436, P<0.05, and not correlated linearly with microarousal index, REM staging in group AP>0.05.MoCA was positively correlated with night mean SaO2 , night lowest SaO2 r=0.441, 0.427, P<0.05, negatively correlated with AHI, ODI, NREM 1+2 stagingr=-0.457, -0.463,-0.378, P<0.05, and not correlated linearly with microarousal index, NREM 3+4 staging, REM staging in group AP>0.05.MMSE was not correlated linearly with night mean SaO2 , night lowest SaO2 , AHI, ODI, microarousal index, NREM 1+2 staging, NREM 3+4 staging or REM staging in group BP0.05.MoCA was negatively correlated with ODI, microarousal indexr=-0.433, -0.448, P0.05, positively with REM stagingr=0.440, P0.05, not correlated linearly with night mean SaO2 , night lowest SaO2 , AHI, NREM 1+2 staging, NREM 3+4 staging in group BP0.05.Conclusion CI patients combined with OSAHS have obvious sleep structure disorders and severe damages of cognitive function, showing that OSAHA may aggravate neurological damages and cognitive function disorders in CI patients.

Key words Sleep apnea,obstructive; Cerebral infarction; Sleep disorders; Sleep structure; Cognitive function

Relationship between Advanced Glycation End-products and Cardiorenal Syndrome

MA Xiang-yu, ZHANG Jin-ying, SHEN De-liang, et al.Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Abstract Objective To investigate the relationship of advanced glycation end-productsAGEsto cardiorenal syndromeCRSto find its role in CRS physiopathologic mechanism to provide basis for its clinical treatment.Methods A total of 186 patients and healthy subjects were divided, according to presence or absence of heart and kidney damages, into groups A(control group, n=51), B(with simple heart failure, n=48), C (with simple renal failure, n=46), D(with CRS, n=41).The levels of AGEs, B-type natriuretic peptide(BNP), serum creatinine(Scr), cystatin C(Cys-C) were determined.The influencing factors of short-term prognoses of CRS patients were analyzed by follow-up of group D.Results AGEs level was higher in group D than groups A, B, C〔(7.38±0.70mg/L, 0.90±0.34mg/L, 2.61±1.00mg/L, 4.37±0.52mg/L, P0.05.AGEs were positively correlated with BNP, Scr, Cys-C, the coefficient correlations were 0.769, 0.723, 0.848, respectively.AGEs were one of the adverse factors of short-term prognoses of CRS patients.Conclusion AGEs, closely related to CRS and having important influences on its short-term prognoses, may play an important role in CRS physiopathologic mechanism.

Key words Advanced glycation end-products; Cardiorenal syndrome; Relationship; Prognosis

Impact of Coronary Angiography on QRS Duration

WANG Xi, QIU Chun-guang, HAN Zhan-ying, et al.Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

Abstract Objective To observe the effects of coronary angiographyCAGon QRS duration.

Methods A retrospective analysis was done in 125 patients given CAG from June 2011 to April 2012, in whom 98 were diagnosed as coronary artery diseaseCAD)(lesion group, including 33 cases of 1-vessel disease, 38 of 2-vessel, 27 of 3-vessel, and 27 normal subjectscontrol group.The parameters of all subjects were collected and the changes of QRS duration and their influencing factors were compared before and after CAG operations.

Results QRS duration was longer after operation than before operation〔(3.18±5.30ms, 95%CI2.25, 4.12, P=0.000.The prolongation of QRS durationQRS variability, ΔQRSincreased in lesion group as compared with that in control group after operation〔(3.96±5.70ms vs.0.37±1.47ms, P0.05.The prolongation of QRS duration was positively correlated with the number of diseased coronary arteriesCAafter CAG operationsB=2.455, 95%CI

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