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25 February 2022, Volume 21 Issue 01 Previous Issue    Next Issue

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Effect of game-based EEG neurofeedback training on improvement of cognitive function MA Shaochen, GUO Xin, WANG Mingwei, WANG Huijun, YU Qijun, SU Wenyue, WANG Hualong, MA Qinying 2022, 21 (01):  41-45.  DOI: 10.16150/j.1671-2870.2022.01.009 Abstract ( 316 )   HTML ( 10 )   PDF (521KB) ( 175 )   Objective: To observe the effect of game-based EEG neurofeedback system on improvement of cognitive function in the patients with cognitive impairment. Methods: Fifty-two patients with cognitive impairment, mainly memory decline, were included, and the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment Scale (MoCA) and Alzheimer′s Disease Assessment Scale-Cognitive section(ADAS-cog) were conducted in the patients to evaluate cognitive impairment. Five days later, each patient was given 30-min EEG neural feedback training, once a day for 10 consecutive days. The EEG was detected before and after training, and MMSE, MoCA and ADAS-cog scores were also evaluated after training. Results: The scores of MMSE, MoCA and ADAS-cog scales after training were all higher(26.06±2.95, 21.88±3.94, 12.15±5.15) than those before training (23.10±2.82, 18.63±4.10, 14.76±5.30) (P<0.05). Before training, the scores of memory on MMSE, MoCA and ADAS-cog scales were 1.55±0.77, 1.33±1.28, 4.35±1.11, respectively, while the above scores increased to 2.16±0.80, 2.29±1.34, 3.93±1.30(P<0.001) after training. The EEG after training showed that the complexity of EEG was improved than that before training, mainly in the left frontal lobe. Conclusions: The game-based EEG neurofeedback system training can significantly improve cognitive function and EEG complexity in the left prefrontal lobe. Figures and Tables | References | Related Articles | Metrics

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Effects of mindfulness-based stress reduction on mood disorders and sleep in patients with Alzheimer′s disease in the context of COVID-19 FU Conghui, XU Ying, SU Wei, WEN Jing, LIU Zhifang, ZHU Qian, ZHANG Jingyi, XIONG Zemin, CHEN Lanlan, JIA Jie 2022, 21 (01):  46-51.  DOI: 10.16150/j.1671-2870.2022.01.010 Abstract ( 252 )   HTML ( 7 )   PDF (697KB) ( 103 )   Objective: To investigate the effects of MBSR(mindfulness-based stress reduction)-based mental rehabilitation intervention on mood disorders and sleep status of patients with mild to moderate Alzheimer′s disease (AD) in long-term hospital during closed management of COVID-19 pandemic. Methods: A total of 70 patients with mild to moderate AD who were admitted to hospital before January 2020 were enrolled. All patients received an 8-week psychological rehabilitation intervention based on MBSR from February 11, 2020 to April 30, 2020. Prior to the intervention, general patient data were collected, including Hamilton Anxiety Scale(HAMA), The 15-item Geriatric Depression Scale(GDS-15) and Pittsburgh Sleep Quality Index(PSQI) and other assessment scales were used for initial assessment of each enrolled patient, and re-assessment was performed at the end of the 8-week intervention. After the initial assessment, correlation analysis was conducted between general patient data and the results of the initial assessment in patients. Results: It revealed that anxiety, depression, sleep status of patients were negatively correlated with their education level (R<-0.4; P≤0.01); the sleep status score of patients was positively correlated with the degree of anxiety and depression (R>0.4; P≤0.01); GDS, HAMA and PSQI scores of the patients were significantly improved after 8 weeks of intervention compared with the initial evaluation(P<0.05). Conclusions: Mental rehabilitation intervention based on MBSR during closed management due to COVID-19 can improve anxiety, depression and other mood disorders and sleep status of patients with long-term inpatient mild to moderate AD. Figures and Tables | References | Related Articles | Metrics

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Metagenomic analysis of gut microbiota and antibiotic resistome in girls with precocious puberty XU Fei, YIN Mingyue, WANG Wei, DONG Zhiya, LU Wenli, YU Yi, WANG Xinqiong, WANG Junqi, XIAO Yuan 2022, 21 (01):  52-61.  DOI: 10.16150/j.1671-2870.2022.01.011 Abstract ( 280 )   HTML ( 6 )   PDF (1767KB) ( 128 )   Objective: To investigate the gut microbiota distribution and antibiotic resistant genes (ARGs) carrying- status in the girls with precocious puberty (PP). Methods: A total of 29 girls were enrolled in the study, including 21 girls with precocious puberty (PP) [11 girls with central precocious puberty (CPP group), 10 girls with premature thelarche (PT group)], and 8 age-matched healthy girls (NC group). The fecal samples were analyzed to explore difference in composition of gut microbiota and ARGs numbers between the PP (CPP+PT) and NC groups using shotgun metagenomic sequencing. Results: The composition and abundance of gut microbiota in the PP girls were different from the NC girls. The relative abundances of top three gut microbiota in CPP, PT and NC girls were 50.03%, 37.73% and 67.61% for Firmicutes, 33.00%, 43.26% and 10.32% for Bacteroidetes, and 4.26%, 4.22% and 11.16% for Actinobacteria. Compared with the NC girls, the PP girls had a significantly higher abundance of Bacteroidetes (P=0.034) and much lower abundance of Firmicutes (P=0.006) and Actinobacteria (P<0.000 1). It revealed that there were 257, 273 and 240 species of ARGs identified in the CPP, PT and NC girls, respectively. The PP girls had more ARGs types and higher abundance of tetracyclines and macrolide ARGs than the NC girls. Conclusions: Compared with the NC girls, the PP girls have a different distribution of gut microbiota and more species of ARGs enriching in tetracyclines and macrolides. It indicates that the dietary and environmental antibiotic exposure may influence the gut microbiota distribution in children, which may be associated with the pathogenesis of PP. Figures and Tables | References | Related Articles | Metrics

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Clinical isolates of multi drug resistant bacteria in a hospital from 2017 to 2021 in Jiading District of Shanghai LI Li, ZHU Yongzhen, ZHOU Min, QIAN Jia, FANG Lili 2022, 21 (01):  62-67.  DOI: 10.16150/j.1671-2870.2022.01.012 Abstract ( 234 )   HTML ( 4 )   PDF (679KB) ( 66 )   Objective: To analyze detection rate and changing trend of clinical multi-drug resistant bacteria(MDRB) in recent 5 years, and explore drug resistance characteristics of carbapenem resistant gram-negative bacteria, so as to provide reference for nosocomial infection prevention and control and empirical treatment of antibiotics in clinical practice. Methods: Seven kinds of MDRB isolated from clinical specimens of hospitalized patients during January 2017 to December 2021 were retrospectively analyzed, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococcus (VRE), extended spectrum β-lactamases producing Escherichia coli (ESBL-eco), extended spectrum β-lactamases producing Klebsiella pneumoniae (ESBL-kpn), carbapenem resistant Enterobacteriaceae (CRE), carbapenem resistant Acinetobacter baumannii (CR-AB) and carbapenem resistant Pseudomonas aeruginosa (CR-PA). The rate of carbapenem resistant gram-negative bacilli to common antibiotics and the carbapenemase production of CRE strain were analyzed with SPSS 20.0. Results: VRE was not detected in this study. Except ESBL-eco, the isolated rates of the other five MDRB increased in the past five years. The detection rates of MRSA, ESBL-kpn, CRE, CR-AB and CR-PA fluctuated between 37.0%-53.6%, 19.3%-34.3%, 2.5%-10.6%, 34.1%-63.4% and 11.3%-22.8%, respectively. It revealed that 65.4% CRE, 72.0% CR-AB, and 59.3% CR-PA isolates were isolated from ICU. The resistant rates of CRE and CR-AB to quinolones, cephalosporins and β-Lactamase inhibitor complex were 90.0%. Among 272 CRE strains, 221 strains were Klebsiella pneumoniae, accounting for 81.3%. The carbapenemase was detected in 90 strains of CRE, in which three kinds of carbapenemases (KPC, NDM and IMP) were detected and the constituent ratio of KPC enzyme was 90.0%. Conclusions: The isolated rates of six MDRB in this study are much lower than the average level in Shanghai and national tertiary hospitals in the same period, but the isolated rates of MRSA, ESBL-kpn, CRE, CR-AB and CR-PA show an upward trend, which should be paid attention to, especially the carbapenem resistant gram-negative bacteria in ICU. In this study, 90 strains of CRE tested produced three kinds of carbapenem enzymes, in which KPC enzymes showed a high proportion. Figures and Tables | References | Related Articles | Metrics

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Study on application of bone algorithm combined with ASIR-V in coronary stent imaging HUANG Qiong, WU Mengxiong, DONG Haipeng, YAN Fuhua, ZHANG Xuekun 2022, 21 (01):  68-73.  DOI: 10.16150/j.1671-2870.2022.01.013 Abstract ( 227 )   HTML ( 3 )   PDF (640KB) ( 62 )   Objective: To investigate the efficacy of bore algorithms combined with adaptive statistical iterative reconstruction-V (ASIR-V) in coronary stent imaging. Methods: A total of 42 patients with coronary stent implantation in our hospital were enrolled during December 2020 to March 2021. All 42 patients underwent CCTA (coronary computed tomography angiography) reexaminations using GE Revolution CT machine. The standard algorithm(Stand) and bone algorithm(Bone) were used to reconstruct the original data, combined with the iterative reorganization technology ASIR-V weight (30%, 60%). So there were four groups images, including S30 (Stand-30%)、S60 (Stand-60%)、B30 (Bone-30%) and B60 (Bone-60%). The image quality of four groups (S30/S60, B30/B60, S30/B30 and S60/B60) was evaluated by subjective (liket5 score method) and objective (quantitative measurement of image signal-to-noise ratio, contrast-to-noise ratio, and difference in CT value between stent lumen and descending aorta), respectively. Results: In terms of subjective evaluation, the scores of S30, S60 were 3.54±0.60, 3.51±0.60, which were much lower than those of B30, and B60 (4.15±0.67, 4.49±0.56), respectively. There was significant difference between B60 and B30 in the bone algorithm group(P<0.05), but there was no significant difference between S60 and S30 in standard algorithm group (P>0.05). In terms of objective evaluation, S60 had the highest scores (SNR: 18.3±2.56, CNR: 26.3±6.35). For CT difference values between stent lumen and descending aorta, there was no significant difference between S30 and S60, and between B30 and B60(P>0.05), while there was significant difference between S30 and B30, S60 and B60(P<0.05), and the difference of B60 was the least (36.41±79.37). Conclusions: Bone algorithm combined with the ASIR-V weight of 60% is conducive to display of the coronary stent lumen and stent wall, and may provide higher quality images for the clinical practice. Figures and Tables | References | Related Articles | Metrics

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Study on differential diagnosis of malignant and benign ovarian tumors through IOTA simple rules YANG Bowen, JIANG Meijiao, CHEN Hui 2022, 21 (01):  74-79.  DOI: 10.16150/j.1671-2870.2022.01.014 Abstract ( 283 )   HTML ( 8 )   PDF (812KB) ( 81 )   Objective: To validate the value of IOTA simple rules (SR) in differential diagnosis of malignant and benign ovarian tumors preoperatively in a single center in Chinese population. Methods: A total of 278 patients admitted for ova-rian tumors surgery in Department of Obstetrics and Gynecology, Ruijin Hospital were enrolled. All patients underwent ultrasound examination preoperatively, and 278 ovarian tumors were detected and classified as malignant (including 75 cases of borderline), benign lesions (175 cases) and uncertain lesions (37cases) using SR. Compared with the results of postoperative pathology examination, the sensitivity, specificity of SR in diagnosing malignant tumor as well as the area under receiver operating characteristic (ROC) curve were calculated. Results: The postoperative pathology examination showed that there were 203 benign tumors and 75 malignant ones. It indicated that SR identified 86.2% benign tumors (175 out of 203) and 68.0% malignant tumors (51 cases out of 75), 15 cases were missed or misdiagnosed and 37 cases got uncertain results. Among ultrasonic features of SR, M4 (irregular multilocular-solid tumor with largest diameter ≥100 mm) had the highest predictive value (90.5%) for malignant tumors, while B3 (acoustic shadow) had the highest predictive value (100.0%) for benign tumors. In 241 patients (excluding uncertain cases), the sensitivity and specificity of SR in diagnosing ovarian tumors was 86.4%, 96.2%, respectively. In 278 patients, as the uncertain cases diagnosed with SR were classified to be malignant tumors, the sensitivity was 89.3%, specificity was 86.2%, and AUC was 0.88. However, as uncertain cases were classified to be benign ovarian, the sensitivity and specificity of SR in diagnosing tumors was 68.0% and 96.6%, and the AUC was 0.82. The efficacy between the two methods was different(P=0.04). Eight benign cases were misdiagnosed as malignancy, and the review showed that the possibility of malignancy should be considered when the inner wall of the cystic mass was not smooth, papillary processes attached to the wall, or the size of cystic mass was more than 10 cm. Seven malignant cases were misdiagnosed as benign ones. It indicated that benign mass should be considered when the solid part had insufficient blood supply or even no blood flow on ultrasound imaging. Conclusions: SR is suitable to be applied to Chinese female in diagnosing ovarian tumor. IOTA SR may have better efficacy when the uncertain cases diagnosed with SR are classified as malignant tumors Figures and Tables | References | Related Articles | Metrics

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Autosomal dominant polycystic kidney disease complicated with pulmonary embolism: a case report and literature review CAI Xiaoting, YI Huahua, LIN Jiayuan, CHEN Ling 2022, 21 (01):  80-85.  DOI: 10.16150/j.1671-2870.2022.01.015 Abstract ( 214 )   HTML ( 3 )   PDF (1260KB) ( 74 )   Objective: To analyze the clinical data of a patient diagnosed as autosomal dominant polycystic kidney disease (ADPKD) complicated with pulmonary embolism (PE), and review reported cases in data base to explore the diagnosis and treatment in the ADPKD patients with venous thromboembolism(VTE). Methods: A 45-year-old male diagnosed as ADPKD [also had polycystic liver disease (PLD)] and pulmonary embolism (PE) was admitted in our hospital, and the clinical manifestations and laboratory results were analyzed. The diagnosis and treatment in the patients with ADPKD complicated with VTE were reviewed through searching PubMed and entire database. Results: The ADPKD patient with PLD, presenting with chest pain and shortness of breath, was diagnosed as PE using pulmonary ventilation perfusion examination and as deep VTE through imaging of deep venous. The MRI enhancement of the upper abdominal organs showed the stenosis lesions in hepatic segment of inferior vena cava, and polycystic liver combined with polycystic kidney. The heterozygous variation of PKD1 gene and PROS1 gene were detected by the whole exon sequencing. A total of 15 ADPKD patients complicated with deep VTE were reviewed. Among them, all cases had inferior vena cava thrombosis (IVCT), 13 cases had PLD, 2 cases had hepatic vein thrombosis, 12 cases had VTE, and 2 cases had PE. The symptoms of 10 ADPKD patients were relieved after anticoagulation treatment with heparin and warfarin, while 5 patients needed hardener or inferior vena cava filter placement or surgical treatment. Conclusions: The polycystic kidney(PKD) and PLD are not considered as the most common causes for VTE, which are easy to be ignored in medical practice. The ADPKD patients usually complicated with PLD, which may cause compression of inferior vena cava and lead to embolism. The primary treatment is anticoagulation, and the adjuvant therapy is relief of cyst compression. Figures and Tables | References | Related Articles | Metrics

Case report

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Early-onset Alzheimer′s disease complicated with cerebral amyloid angiopathy: A case report HUANG Pei, REN Rujing, PAN Yu, LIN Guozhen, WANG Gang 2022, 21 (01):  86-89.  DOI: 10.16150/j.1671-2870.2022.01.016 Abstract ( 247 )   HTML ( 7 )   PDF (899KB) ( 103 )   Alzheimer′s disease (AD) and cerebral amyloid angiopathy (CAA) have close clinical and pathological relationships. In this paper, a 54-year male patients with AD and CAA is reported. AD is diagnosed according to A/T/N biomarker framework, and the clinical diagnosis of CAA is based on Boston Diagnostic criteria 2.0. So far, it has not been reported in China. At the same time, the abnormal changes of β-amyloid protein (Aβ) in this case were confirmed by cerebrospinal fluid detection and neuromolecular imaging. Finally, through the review of the literature, it is expounded that the deposition of Aβ is the common pathology of CAA and AD, leading to cognitive dysfunction and neurological dysfunction. For CAA, the major event in the pathogenesis is vascular Aβ deposition, while for AD is inflammatory plaque Aβ deposition in the brain. The pathological changes of both are driven by Aβ clearance disorders. However, mechanisms of brain injury between them were different. The mechanism of AD-related brain injury is mainly related to synaptic and neuron loss caused by Aβ deposition, while CAA-related brain injury is more likely to be caused by vascular dysfunction, vascular integrity damage, hemorrhage or cerebral hypoperfusion. Since obvious clinical heterogeneity in AD, for patients with AD and without intracerebral hemorrhage, routine screening magnetic sensitivity weighted imaging scanning is needed to exclude CAA. Figures and Tables | References | Related Articles | Metrics

Review articles

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Advance in study on influencing factors, evaluation and intervention of subjective cognitive decline YANG Xiaochen, ZHU Yuan, SUN Qiong, YU Xiaoping, ZHANG Xian 2022, 21 (01):  90-94.  DOI: 10.16150/j.1671-2870.2022.01.017 Abstract ( 400 )   HTML ( 14 )   PDF (591KB) ( 181 )   Alzheimer's disease (AD) is a common chronic neurodegenerative disease in the elderly, and Subjective cognitive decline (SCD) is considered as the pre-clinical stage of AD. Early identification and intervention of SCD play an important role in preventing and delaying the occurrence and development of AD. This article reviews the research progress of influencing factors, evaluation and intervention of SCD. In terms of demographic factors, age, marriage and years of education all affect the occurrence and development of SCD. In our daily habits, swallowing and mastication, sleep, anxiety and depression, exercise and social/emotional support all affected subjective cognition. In addition, some chronic diseases, such as oral diseases, chronic kidney diseases and cardiovascular diseases, play a driving role in the occurrence and development of SCD diseases to varying degrees. The methods of screening and evaluation of SCD mainly include imaging examination, humoral marker examination and neuropsychological examination. Imaging examination provides objective data for the screening and evaluation of SCD. However, due to the limited sample size and mostly cross-sectional studies, more studies are needed. The examination of body fluid marker has certain accuracy, but it has not been spread because of its invasive operation. Neuropsychological examination has the advantages of convenience and low cost, which is the focus of current screening methods. At present, a lot of specific screening assessment questionnaire for SCD has been developed, and further reliability and validity tests need to be carried out. At present, interventions for SCD patients are very limited and lack of high-quality studies, which can be divided into three aspects: lifestyle change, cognitive function training and mental health related interventions, and further intervention studies need to be carried out. References | Related Articles | Metrics

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Study on detection of insulin autoimmune antibodies: limitation and countermeasures CHEN Xuyang, GU Weiqiong 2022, 21 (01):  95-98.  DOI: 10.16150/j.1671-2870.2022.01.018 Abstract ( 332 )   HTML ( 6 )   PDF (463KB) ( 107 )   Insulin autoimmune antibodies (IAA) detection are commonly applied to diagnosis of type 1 diabetes mellitus(T1DM), prediction of incidence risk and disease outcomes. It can also be used for the diagnosis of insulin autoimmune syndrome (IAS) and exogenous insulin antibodies syndrome (EIAS). The problem is that IAA has different subtypes which may lead to uncertainties in the prediction and diagnosis of T1DM since the existing clinical detection technology is limited to subdivide them. Meanwhile, the diabetes complicated with IAS or T1DM complicated with EIAS bring more difficulty in detecting IAA subtype as differentiating endogenous etiology(T1DM and IAS) from exogenous etiology (EIAS). In recent years, the studies on IAA affinity, isotype and antigenic epitope may enable laboratory detection to classify IAA groups, which is worth paying attention to. References | Related Articles | Metrics