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Abstract:With profound understanding of Parkinson’s disease (PD), non-motor symptoms have been considered as an important part of its symptomatology. In addition to the high prevalence, the occurrence of hyposmia may also be used to differentiate PD from atypical and secondary parkinsonism. Studies on the gastrointestinal symptoms among PD patients showed that the risk of PD was increased to six-fold in people with constipation, and the α-synuclein deposition and Lewy bodies were found in the enteric nervous system. psychiatric symptoms such as rapid eye movement (REM) sleep behavior disorder (RBD), depression, anxiety and hallucinations, and delusions significantly impaired the quality of life in PD patients, and those patients with idiopathic RBD were at approximately higher risk for PD and other neurodegeneration diseases. Non-motor symptoms may become a breakthrough in early diagnosis of PD and should be paid more attention.

Abstract:Objective To explore the relationships between restless legs syndrome (RLS) and the motor symptoms or non-motor symptoms (NMS) in patients with Parkinson’s disease (PD). Methods Totally 165 PD patients were collected and divided into RLS group and non-RLS (NRLS) group according to the scores of RLS-RS and a comparison study was conducted by using related motor symptoms and NMS scales. Results (1) 42.4% of PD patients were accompanied by RLS. RLS group had significantly longer disease duration than NRLS group (P＜0.05). (2) There were significant differences in Hoehn-Yahr Stage and UPDRS Ⅲ score between RLS and NRLS groups (P＜0.05). (3) There were significant differences in the incidences of wearing-off and dyskinesia between the two groups (P＜0.05); There was no significant difference in the incidence of “on-off” phenomenon between the two groups (P＞0.05). (4) The numbers of NMS in RLS group was significantly more than that in NRLS group (P＜0.05). The incidences of recent memory loss, depression, anxiety, distraction, apathy and sexual dysfunction in RLS group were significantly higher than that in NRLS group (P＜0.05). (5) The scores of UPDRS Ⅰ, HAMD, HAMA, PSQI, FS-14, FSS and SCOPA-AUT in RLS group were significantly increased compared with NRLS group (P＜0.05). The scores of MoCA, MAES, ESS and RBD were not significantly different between the two groups (P＞0.05). (6) The scores of UPDRS Ⅱ and PDQL were significantly different between the two groups (P＜0.05). Conclusion RLS is one of the common NMS in PD, which is associated with their severity of motor symptoms and movement complications. PD patients with RLS have more NMS and show the high incidences of some NMS. PD patients with RLS present severer disturbances in spirit, emotion, automatic function and sleep, which dramatically compromise the activities of daily living and quality of life.

Abstract:Objective To investigate the clinical features and associated factors in Parkinson’s disease (PD) accompanied with depression. Methods All the 178 patients with identified PD admitted in the Department of Neurology and Department of Geriatrics of Beijing Tiantan Hospital from October 2013 to February 2015 were recruited in this study. According to the results of Hamilton Depression Scale-24 (HAMD-24), they were divided into depression group (n＝107) and non-depression group (n＝71). Both groups were evaluated by motor symptoms and complications, non-motor symptoms, activities of daily living and quality of life. Results Depression group had remarkable differences with non-depression group in education level (P＜0.05), disease duration (P＜0.05), score of unified Parkinson’s disease rating scale Ⅲ (UPDRS-Ⅲ, P＜0.001 ), Hoehn-Yahr (P＜0.01), score of UPDRS-Ⅳ (P＜0.001), score of Montreal cognitive assessment (MoCA, P＜0.05), result of 14 items fatigue scale (FS-14, P＜0.001), result of rapid eye movement sleep behavior disorder screening questionnaire (RBDSQ, P＜0.01), result of restless leg syndrome rating scale (RLSRS, P＜0.001), score of UPDRS-Ⅱ (P＜0.001), result of 39 items Parkinson’s disease quality of life questionnaire (PDQL-39, P＜0.001), and incidence of anxiety (P＜0.05). Logistic regression analysis showed that the scores of Hamilton anxiety Scale (HAMA, OR＝1.282, P＜0.001) and UPDRS-Ⅱ (OR＝1.149, P＜0.05) were the risk factors for PD with depression. Conclusion PD patients with depression have higher incidences of motor symptoms and complications than non-depression PD patients, and are prone to anxiety, cognitive impairment, sleep disorders, fatigue, restless legs and other non-motor symptoms. Anxiety and reduced activities of daily living increase the risk of PD with depression. Depression exerts serious impact on quality of life in PD patients.

Abstract:Objective To determine the clinical value of triple stimulation technique (TST) in the assessment of cortico-spinal tract impairment in patients with atypical parkinsonism. Methods Six patients with atypical parkinsonism (5 cases of parkinsonian variant of multiple system atrophy and 1 of progressive supranuclear palsy) admitted in our hospital in July 2009 were recruited in this study. Another 12 age-matched subjects (7 healthy volunteers and 5 non-central nervous system involvement patients) served as controls. All the subjects were examined with conventional motor evoked potential (MEP) test and TST at abductor digiti minimi. Resting motor threshold (RMT), central motor conduction time (CMCT), MEP latency and TST amplitude ratio (TSTtest/TSTcontrol) were assessed, and their correlation to the age and disease duration were analyzed. Results The TST amplitude ratio was significantly decreased [(40.7±18.6)% vs (96.8±3.0)%, P＝0.001] in atypical parkinsonism along with increased RMT [(63.3±5.2) vs (48.6±8.4), P＝0.001] when compared with controls. But there was no significant difference in CMCT and MEP latency between the 2 groups (P＞0.05). Neither conventional MEP nor TST showed significant correlation with age or disease duration, but TST amplitude ratio showed negative correlation trend with disease duration. Conclusion TST is superior to conventional MEP in the assessment of cortico-spinal tract impairment in atypical parkinsonism.

Abstract:Objective Alpha-synuclein has been suggested to be related with the etiology of Parkinson’s disease (PD) and other neurodegenerative disorders. Hypoxia injury has been indicated to be associated with α-synuclein accumulation. But no report has linked the α-synuclein with the pathogenesis of stroke. This study aimed to investigate the level of oligomeric forms of α-synuclein in the patients with acute ischemic stroke (AIS). Methods Fifty-five patients with PD, 55 patients with AIS and 55 healthy individuals were recruited in this study. Their blood samples were characterized by a sandwich ELISA with purified recombinant α-synuclein as a test standard for further detection. Results The level of oligomeric α-synuclein in the red blood cells was (0.41±0.14), (0.82±0.55), and (1.01±0.56)mmol/L respectively for the healthy control, PD and AIS groups. The AIS group had significantly higher α-synuclein level compared with either the healthy controls (P＜0.001, 95%CI＝0.426?0.773) or the PD patients (P＝0.027, 95%CI 0.022?0.369). Conclusion The level of oligomeric α-synuclein in red blood cells is significantly higher in patients with AIS, which may be involved in the pathophysiological changes in AIS, while its clinical significance requires further exploration.

Abstract:Objective To determine the diagnostic value of transcranial sonography (TCS) in diagnosis of Parkinson’s disease (PD). Methods Fifty-eight PD patients and 60 patients with essential tremor (ET) admitted in our hospital from September 2013 to March 2014 were subjected in this study. They all received TCS examination. The area of the substantia nigra hyperechogenicity was measured and its ratio to the area of the whole midbrain area (S/M) was calculated. The sensitivity and specificity of TCS for the diagnosis of PD were determined by receiver operating characteristic (ROC) curve. Results The area of substantia nigra hyperechogenicity and the S/M ratio were greater in PD patients than in ET ones (P＜0.05). When the hyperechogenicity was used in diagnosis of PD, the area under the ROC curve was 0.801. The sensitivity was 74.1%, and the specificity was 76.7% when the critical value was set at 0.205. Conclusion TCS Is one of the valuable auxiliary examinations in diagnosis of idiopathic PD, and also of certain value in the differential diagnosis of PD with ET.

Abstract:Objective To determine the relationship of the plasma homocysteine (Hcy) level with Parkinson’s disease (PD) with or without L-dopa treatment. Methods According to the UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria, 161 identified PD in- and out-patients admitted in the Fifth Hospital of Peking University from May 2011 to March 2013 were enrolled in this study. They were 88 males and 73 females, at age of (64.36±11.06) years, and suffered from PD for 0.5?22 (6.3±5.4) years. Another 80 age- and sex-matched healthy volunteers taking physical examination during the same period served as normal controls. The plasma levels of Hcy, Vit B12 and folic acid were measured and compared between the 2 groups. Univariate linear regression analysis was carried out for the correlation of the plasma levels of Hcy, Vit B12 and folic acid with the duration and dosage of L-dopa treatment, motor complications, anxiety, depression and dementia incidence. The causing factors of hyperhomocysteinemia (HHcy) in PD patients was also analyzed. The polymorphisms of MTHFR and COMT genes were detected in the 161 PD patients and 240 normal individuals. Results The plasma Hcy level was (17.65±9.36)μmol/L for the 161 PD patients, which was significantly higher than that in the normal controls [(10.12±3.20)μmol/L, P＜0.001]. Among the 6 factors (sex, age, duration and dosage of L-dopa treatment, plasma levels of folic acid and Vit B12), univariate linear regression analysis showed that L-dopa treatment caused the incidence of HHcy (P＜0.01). The causes of HHcy were mainly normal folate and Vit B12 levels in PD patients (more than 84%), which indirectly suggesting that there were some mutations in the relative enzymes regulating the metabolism of Hcy. There was no obvious difference in the distribution of COMT and MTHFR polymorphism between PD group and control group (P＞0.05). Based on Hcy level, PD patients were subdivided into HHcy and mormal Hcy group, the frequency distributions of C677T alleles and genotypes were significantly different between HHcy group and normal Hcy group. There were 77 PD patients out of 161 with HHcy. Excluding 22 cases without L-dopa treatment, there were 35 from the left 55 cases having motor fluctuations (63.6%), 3 having dyskenisia (5.5%), 30 having anxiety and depression (54.5%), and 12 having dementia (21.8%). Conclusion PD patients with L-dopa treatment are prone to having HHcy, and HHcy exacerbates the severities or increases the incidences of motor complications, anxiety, depression and dementia in PD patients with L-dopa treatment.

Abstract:Objective Till now, there is lack of evidence on the initial medication for patients with de novo Parkinson’s disease (PD) in China. We aimed to explore the status and influencing factors of the medication by a cross-sectional study about the selection of initial medication for the patients from different regions. Methods Clinical data of 342 PD patients from the Outpatient Department of the Aerospace Central Hospital and the Specialized PD Clinic of Beijing Tiantan Hospital from August 2014 to April 2015 were collected in this study. Their gender, age of onset, disease duration, type of initial medication, and Hoehn-Yahr staging score were recorded and classified. Results The cohort had a median onset age of 50.9 years, median duration of 6.7 years, and an average Hoehn-Yahr staging score of 2.43. For them, there were 4 types of initial drugs, that is, levodopa (LD), dopamine agonist (DA), LD＋DA, and non-LD and non-DA. The first one was the most commonly used as initial drug in the study, accounting for 51.8%. What’s more, it was still the first choice (41.0%) for the young onset patients (age of onset younger than 40 years; this finding was different from other studies). But in recent 5 years, there was a trend of using DA as initial option for de novo PD patients, which may be due to the update of guideline. Conclusion LD is still the main first option for initial medication in de novo PD patients at variable ages in clinical practice.

Abstract:Objective To determine the effect of Compound Danshen Dripping pills on hemorrheology in acute coronary syndrome (ACS) patients before and after percutaneous coronary intervention (PCI) in order to investigate the clinical value of the pills on treatment of the disease. Methods A total of 90 patients with confirmed ACS undergoing PCI in our department from January 2011 to December 2013 were recruited in this study. Before treatment, they were randomly divided into 3 groups, that is, group A, group B, and group C, with 30 cases in each group. The patients of group A took 10 pills, 3 times per day besides conventional medication after PCI. Those of group B were given 20 pills followed by PCI surgery and took 10 pills, 3 times per day besides conventional medicine (the same as group A) after PCI. The patients of group C were treated with conventional therapy after PCI. Hemorrheological parameters were measured before and in 3 months after surgery. Results Compared with the parameters before treatment, whole blood viscosity at low and high shear rates were significantly lower in the 3 groups (P＜0.05), more significant changes were found in group A and B when compared with group C (P＜0.05). In addition, group A and group B had significant differences in erythrocyte aggregation rate and fibrinogen level compared with group C (P＜0.05). However, plasma viscosity was decreased in the 3 groups after treatment, but the difference was not statistically significant. Conclusion Compound Danshen Dripping pills combined with conventional medication significantly improve the hemodynamic parameters in ACS patients after PCI.

Abstract:Objective To determine the effect of fudosteine on the percentages of Th1 and Th2 cells and the serum levels of interferon-γ (IFN-γ) and interleukin-4 (IL-4) in severe obstructive sleep apnea syndrome (OSAS) patients. Methods Fifty-seven severe OSAS in- and out-patients and 20 simple snorers who were treated in the Wuxi People’s Hospital from April 2013 to December 2014 were recruited in this study. All the participants were male, and aged from 55 to 76 (67.0±6.4) years. According to apnea hypopnea index (AHI), the cohort was divided into 3 groups, that is, control group (simple snorers, AHI≤5, n＝20), OSAS group (AHI＞40, n＝28) and OSAS＋fudosteine group (AHI＞40, taking fudosteine for 2 weeks, n＝29). The proportions of Th1 and Th2 cells were detected by flow cytometry, while the serum contents of IFN-γ and IL-4 were evaluated by ELISA. Results There was no significant difference in the age and body mass index (BMI) among the 3 groups (P＞0.05). Compared with the control group, the proportion of Th1 was increased obviously in OSAS group [F(2,74)＝85.06, P＜0.01], meanwhile, the level of IFN-γ (Th1 related cytokine) was also significantly elevated [F(2,74)＝131.4, P＜0.01]. Compared with OSAS group, both the proportion of Th1 [F(2,74)＝85.06, P＜0.01] and level of IFN-γ [F(2,74)＝131.4, P＜0.01] were decreased markedly in OSAS＋fudosteine group. However, there was no statistical difference in the proportion of Th2 cells [F(2,74)＝2.66, P＝0.08] and serum level of IL-4 [F(2,74)＝2.29, P＝0.11] among the 3 groups. Conclusion Th1 cells are activated obviously in the patients with severe OSAS, and more Th1 related cytokines are secreted, while, no obvious alternations of Th2 cells and related cytokine are found. Fudosteine inhibits the excessive activation of Th1 cells and excessive secretion of Th1 related cytokine.

Abstract:Objective To investigate the effect of lower-extremity strength training and knee joint control training on genu recurvatum and function of lower limbs in the stroke patients. Methods According to our inclusion and exclusion criteria, 15 subjects at an average age of 54.3 years were selected in this study. They were randomly divided into treatment group (n＝8) and control group (n＝7). Conventional rehabilitation training was given to the both groups, and the resistance training of quadriceps femoris and hamstrings as well as the knee joint control training were performed on the treatment group additionally. The degree of genu recurvatum, the score of Fugl-Mayer motor assessment (FMA), modified Ashworth scale (MAS) for grading spasticity, maximum walking speed of 10m, mean of step length, maximum isometric strength of quadriceps femoris and hamstrings were measured in the 2 groups before and 6 weeks after training. The results were compared between the 2 groups. Results After 6 weeks’ training, the treatment group had the degree of genu recurvatum decreased by 8.1° (correct rate accounting for 68%, P＜0.01), FMA score increased by 14.43, the MAS decreased by 1 grade in average ( better than the control group, P＜0.05), and the maximum walking speed in 10m increased by 19.19m/min and the mean step length elevated by 14.11 compared with the control group (P＜0.01). The strengthes of quadriceps femoris and hanmstrings were increased by 48.26% and 48.08% respectively (P＜0.05) in the treatment group, significantly improved compared with the control group (P＜0.01). Conclusion Strengthening the training in quadriceps femoris and hamstrings as well as knee joint control training improves the state of genu recurvatum, and is helpful to the activities of the lower limbs in the stroke patients.

Abstract:Objective To determine the clinical efficiency and safety of Shuanghuanglian (freeze-dried) powder injection combined with famciclovir in treatment of herpes zoster. Methods A total of 63 elderly patients with herpes zoster admitted in the Third Outpatient Department and the Dermatology Center of Beijing Military General Hospital between March 2012 to March 2015 were prospectively enrolled and then randomly divided into 2 groups. The observation group (n=31) received a venous injection of Shuanghuanglian freeze-dried powder injection (derived from Chinese herbs), and antiviral drug (famciclovir), painkiller (Pregabalin capsule), nerve nutrition, and acupuncture and cupping therapy. The control group (n=32) were treated as the same as the observation group except for the venous injection of Shuanghuanglian freeze-dried powder injection. The therapeutic efficiency was evaluated based on the times of stopping blistering and crusting, and the pain relief in the 2 groups. Results After treatment, the total effective rate was up to 96.77% for the observation group, while 81.25% for the control group, with significant difference between them (P＜0.05). There were only mild adverse reactions observed in the 2 groups, but no statistical difference was found (P＞0.05). Conclusion Shuanghuanglian (lyophilized) powder injection is safe and effective in treatment of senile herpes zoster when combined with conventional anti-virus, pain relief, acupuncture and cupping, and neurotrophic drugs. It can significantly shorten the course and alleviate the pain for the patients.

Abstract:Objective To explore the clinical features of multiple organ dysfunction syndrome in the elderly (MODSE) induced by pulmonary infection in the patients over 80 years old. Methods A retrospective study was carried out on 97 patients over 80 years old with MODSE induced by pulmonary infection in our department from January 2006 to December 2013. Their chronic diseases and involved damaged organs were analyzed. Results Among the 97 cases, 97.94% were accompanied with more than 3 chronic diseases, and some even were accompanied with 10 chronic diseases. There were 12.37% cases at early failure stage and 87.63% at the failure stage. There were 45.36% cases having more than 4 involved organs, and some even had 6 damaged organs. Lungs, heart, kidneys, peripheral circulation and gastrointestinal tract were commonly damaged, and the lungs were the most common, accounting for 87.63%. In the damaged organs, more than 90% of the lung, heart, gastrointestinal tract and peripheral circulation were at the failure stage. The first failure organ of MODSE induced by pulmonary infection included lung, heart, kidney and gastrointestinal tract in the cohort, and the lungs took first rank. The incidence of first failure of certain organ was higher in the patients with organ dysfunction than those with normal organ function (P＜0.05). Conclusion MODSE induced by pulmonary infection in the patients over 80 years old is characterized with more chronic diseases, damaged organs, and serious damage. The lungs are the most commonly involved first failure organ, and the other dysfunction organs also have higher rates of first failure.

Abstract:Objective To investigate the efficacy and safety of half-dose tirofiban, a platelet glycoprotein Ⅱb/Ⅲa receptor antagonist, in the elderly patients during preoperative transition period before receiving coronary artery bypass grafting. Methods A total of 117 patients [aged 60?75(67.76±3.07) years] with non-ST segment elevation acute coronary syndrome(NSTE-ACS) admitted to our hospital from January 2012 to December 2014 were enrolled in this study. All the patients were diagnosed as three-vessel disease and/or left main coronary diseases by coronary arteriography, and required surgical treatment of coronary artery bypass grafting (CABG). Upon termination of dual antiplatelet therapy, the cohort was randomly divided into half-dose tirofiban plus low molecular weight heparin (LMWH) group (group A, n＝60), and simple LMWH group (group B, n＝57). The patients of group A were subjected to half-dose tirofiban after coronary arteriography till 12h before the surgery and subcutaneous injection of LMWH till 24h before surgery. While those of group B only received subcutaneous injection of LMWH as in group A. Additionally, conventional medical treatment was also given to each patient. The following parameters were compared between the 2 groups, including baseline levels, bleeding, as well as major adverse cardiovascular events (MACE) during transition period, such as intractable angina, nonfatal myocardial infarction, malignant arrhythmia and cardiac death. Results No significant difference was found in the baseline data between the 2 groups (P＞0.05). For the MACEs, the incidence of intractable angina was lower in group A than in group B [33.3% (20/60) vs 57.9% (33/57), P＝0.01], and so were those of nonfatal myocardial infarction, malignant arrhythmia and cardiac death, though no significant difference was observed (P＞0.05). In group A, epistaxis (n＝1) and hemorrhoidal bleeding (n＝1) was noted, while in group B, 1 case with gum bleeding was seen. No statistical difference was observed in the amounts of bleeding during and after operation between the 2 groups [intra-operative: (564.17±125.58) vs (542.46±94.46)ml, P＝0.30; post-operative (4.63±1.40) vs (4.39±1.28)u; P＝0.32]. Conclusion Compared with simple LMWH, continued preoperative administration of half-dose tirofiban in combination with LMWH can effectively decrease the incidence of adverse cardiovascular events, but have no effect on the bleeding volume during peri-operative period in the elderly NSTE-ACS patients undergoing CABG.

Abstract:Objective To investigate the clinical characteristics and pathogenesis of wasp sting in the elderly in order to improve the rescue success rate. Methods Two hundreds and twenty-one patients suffering from acute wasp sting admitted in Zhushan County People’s Hospital from January 2009 to December 2013 were enrolled in this study, and assigned into different groups according to their ages, the elderly group (n＝56, ≥60 years old) and non-elderly group (n＝165, ＜60 years old). Their incidences of multiple organ dysfunction, prognosis and clinical outcomes were analyzed and compared. Results After acute wasp sting, the incidences of liver and cardiovascular dysfunction were 55.36% and 32.14%, respectively in elderly group, while in non-elderly group, the incidences were 56.97% and 36.97% respectively. There were 35 patients developing to multiple organ dysfunction syndrome (MODS) in elderly group, accounting for 62.50%, and 94 patients in non-elderly group (56.97%), but no significant difference was seen between the 2 groups (P＞0.05). The mortality was 62.50% in elderly group (2 cases) and 56.97% in non-elderly group (2 cases, P＞0.05). Conclusion The most commonly damaged organs are liver and cardiovascular system in either elderly or non-elderly patients following acute wasp sting. And, there is no obvious difference in the incidence of MODS and mortality between the 2 different aged groups.

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Abstract:We reported an 87-year-old female patient who suffered from acute kidney injury (AKI) associated with hypercalcemia crisis. The patient had a history of chronic kidney disease (CKD), with main manifestations of fatigue, anorexia, lower extremity weakness, and elevated serum creatinine (Scr) and serum calcium. We made differential diagnosis and dominant position between CKD on AKI (A on C) and hypercalcemia carefully. After further questioning the medical history combined with electrocardiographic findings, the diagnosis of vitamin D intoxication was established for the patient. All the symptoms of the patient were relieved after stopping all calcium and vitamin D preparations, being fully hydrated with appropriate diuretic, as well as salmon calcitonin intramuscularly therapy for 10d. It is suggested that attention be paid to medication education and personalized medical therapy for the elderly, especially those with CKD, and electrocardiography and other non-invasive examination are of clinical significances in early diagnosis.

Abstract:Atrial fibrillation (AF) is one of the clinically most common sustained arrhythmia, with high incidence and major hazards. In recent years, great achievements have been made in its non-pharmacologic therapeutic strategies. Among them, pulmonary vein isolation (PVI) is recommended by recent guidelines as an effective procedure to control AF, and its efficacy is higher in paroxysmal AF than in persistent and long-standing persistent AF. This article reviewed and summarized the state-of-the-art of adjunct ablation strategies for patients with persistent AF, including linear ablation, ablation of complex fractionated atrial electrograms (CFAE), ablation of ganglionated plexi, dominant frequency, rotors and other anatomical sites frequently involved in AF triggers.