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Objective To investigate the feature of the morphology changes in the upper airway in patients with acute cerebral infarction and to find a new method to prevent and cure cerebral infarction.Methods Sixty-six patients with cerebral infarction confirmed by brain MRI or CT scan(within 3 weeks of onset) were recruited.The patients were examined by upper airway MRI scan and polysomnography (PSG).Then the patients were divided into obstructive sleep apnea hypopnca syndrome(OSAHS)group and non-OSAHS group.In addition.16 patients showing OSAHS but without stroke history(OSAHS nonstroke group)were included in the study.The sagittal and horizontal lengths of the nasopharynx,palatopharynx,glossopharynx and hypopharynx were measured and their closs-sectional areas were calculated.The length,thickness and cross-sectional area of the palate were also measured.Statistic analysis of each data among the groups was performed using SPSS software.Results Among 66 cases with acute cerebral infarction,75.8 % (50/66)were diagnosed with OSAHS.The anteropesterior diameer,left and right diameters and smallest section area in upper airway were all smaller in the OSAHS group with acute cerebral infaretion than those in the non-OSAHS group and OSAHS non-stroke group.The narrowest segments in upper airway were nasopharynx and ompharynx.which are caused by shortened left and right diameters.The area of the soft palate in the OSAHS-stroke group was significant bigger((452.2±99.6)mm2)than that in non-OSAHS group((350.0±69.4)mm2,t:4.575,P<0.05).The lowest SO2 in OSAHS-stroke group(68.9 % ±10.5 % )was the lowest among three groups.The more severe the airway constriction was.the higher the apnea-hypopnea index(AHI)was and the lower the lowest SO2 was.Conclusion Patients withl stroke show higher incidence of OSAHS and present more severe multilevel upper airway constriction.Upper airway constriction may be the new target of early treatment for better prognosis of cerebral infarction.

Objective To observe the effect of Shenfu injection on fluid intake volume of resuscitation therapy for patients with septic shock. Methods The clinic data of 36 patients with septic shock admitted to Department of Critical Care Medicine of the Affiliated Hospital of Hangzhou Normal University from June 2010 to June 2013 were retrospectively analyzed. All the patients were treated with western conventional medicine. Twenty cases treated with western medicine combined with Shenfu injection (intravenous drip 100 mL once daily, half of a month was a therapeutic course) were defined as Shenfu group; the rest 16 cases treated with western medicine only were assigned as control group. The following data after treatment for 6, 24, and 72 hours in the two groups were compared:liquid intake and urine volumes, system vascular resistance index (SVRI), mean arterial pressure (MAP), cardiac index (CI), and case fatality rate in 28 days. Results There were no significant differences in the liquid intake volume in 6 hours after treatment (mL:3 101±219 vs. 3 329±295, P>0.05), the urine volumes in 6, 24 and 72 hours after treatment (mL, 6 hours:701±229 vs. 651±292, 24 hours:1 870±566 vs. 1 697±618, 72 hours:7 396±2 546 vs. 5 987±2 497), and the levels of SVRI in 24 hours after treatment between Shenfu group and control group (kPa·s·L-1·m-2:802±158 vs. 741±106, all P>0.05). The total liquid intake volumes (mL) in 24 hours and 72 hours after treatment in Shenfu group were significantly less than those in the control group (24 hours:4 544±425 vs. 4 996±396, 72 hours:10 985±891 vs. 11 612±807, both P<0.05). The SVRI, MAP, and CI in 72 hours of Shenfu group were significantly higher than those of control group [SVRI (kPa·s·L-1·m-2): 1 361±182 vs. 1 163±183, MAP (mmHg, 1 mmHg = 0.133 kPa): 76.2±6.1 vs. 71.8±6.3, CI (mL·s-1·m-2):76.2±7.5 vs. 70.8±7.2, all P<0.05], and the 28-day mortality rate in Shenfu group was significantly lower than that of control group [25.0%(5/20) vs. 62.5%(10/16), P<0.05]. Conclusion The application of Shenfu injection was favorable to the reduction of liquid intake volume in 72 hours after treatment that may be beneficial to the fluid limitation management in the course of treatment for septic shock.

Objective To evaluate the clinical efficacy and adverse reactions of alizarin combined with anti-tuberculosis therapy for multidrug resistant pulmonary tuberculosis (MDR-PTB).Methods A total of 200 confirmed MDR-PTB patients admitted in the Affiliated Hospital of Hangzhou Normal University during June 2013 and June 2015 were enrolled in the study.Patients were randomly divided into study group and control group (100 in each).Both groups were given standard anti -tuberculosis treatment for 8 months, and additional alizarin was given to study group .Chi-square test was used to assess the differences in clinical efficacy, sputum negative conversion rate, cavity closure and lesion absorption rate , as well as the incidence of adverse reactions between two groups ( including patients categorized according to TCM syndrome ). Results There were 39 markedly effective cases, 51 improved cases, 10 ineffective cases in study group, and 22 markedly effective cases, 35 improved cases, 43 ineffective cases in the control group.The total effective rate in study group was significantly higher than that in control group (90% vs.57%, χ2 =28.262, P <0.01).For patients with TCM syndrome differentiation as phlegm -heat stagnating lung and those with qi-stagnation induced blood-stasis, alizarin combination therapy had significantly higher total effective rate than standard anti -tuberculosis treatment (78.78% vs.63.33%, χ2 =7.187, P <0.05;95.74% vs.42.31%, χ2 =73.997, P <0.01), but the difference was not observed in patients with TCM syndrome differentiation as deficiency of qi and blood (95.00% vs.88.89%, χ2 =5.025, P >0.05). There was no significant difference in sputum negative conversion rate between two groups (76% vs.55%,χ2 =2.190, P >0.05).The cavity closure and lesion absorption rate in study group ( 91%) was significantly higher than that in the control group (54%,χ2 =38.294, P <0.01).The adverse reaction rate in study group was 27%, which was significantly lower than that in control group (66%, χ2 =30.570, P <0.01).Conclusion Alizarin in combination with standard anti -tuberculosis therapy can improve the clinical efficacy and reduce adverse reactions in treatment of MDR -PTB.

OBJECTIVETo investigate the impact of obstructive sleep apnea-hypopnea syndrome (OSAHS) on cerebral microbleeds (CMBs) in patients with cerebral infarction.

METHODSConsecutive patients with acute cerebral infarction who had cerebral microbleeds shown by susceptibility-weighted imaging (SWI) were enrolled to undergo polysomnography (PSG). The patients were divided into two groups, namely non-OSAHS group with apnea-hypopnea index (AHI) less than 5 and OSAHS group with greater AHI, and the clinical and radiological features of cerebral microbleeds were compared between them.

RESULTSForty-nine patients were enrolled in this study, including 27 (55.1%) with both cerebral infarction and OSAHS and 22 (44.9%) with cerebral infarction but not OSAHS. A comparison of the risk factors showed that hypertension, a smoking history, and a history of stroke were more prevalent in patients with OSAHS than in those without OSAHS (P<0.05). The incidences of subclinical stroke in OSAHS and non-OSAHS patients were 37.0% (10/27) and 9.0% (2/22) (P<0.05), respectively. Neurological imaging revealed a greater number of cerebral microbleeds in OSAHS group than in non-OSAHS group (P<0.05). In OSAHS patients, 77.8% of the microbleeds were distributed in cortical-subcortical areas, 55.6% in the basal ganglia area, and 25.9% in the infratentorial area, as compared to the percentages of 50.0%, 40.9% and 50.0% in non-OSAHS patients, respectively (P<0.05). In OSAHS patients, 40.7% also had leukoaraiosis, and 48.1% had two or more causes, as compared to the percentages of 13.6% and 18.2% in non-OSAHS patients, respectively (P<0.05).

CONCLUSIONSOSAHS can be a risk factor for cerebral microbleeds. Patients with both cerebral infarction and OSAHS tend to have greater and more extensive lesions of cerebral microbleeds, more complicated cause of the disease, and a grater likeliness of stroke recurrence.

Aged ; Cerebral Hemorrhage ; etiology ; pathology ; Cerebral Infarction ; pathology ; Female ; Humans ; Male ; Middle Aged ; Risk Factors ; Sleep Apnea, Obstructive ; complications ; pathology

Objective To investigate the relationships between the clinical and subclinical REM sleep behavior disorder(sRBD)and the cognitive function in patients with PD. Methods We enrolled 53 patients with PD from the Second Affiliated Hospital of Nanchang University. The age ,gender and education level of each patient were recorded. Patients with dementia were excluded. The correlative scales were assessed by the form of face to face,including Montreal cognitive function score(MoCA),Unified Parkinson Disease Rating Scale(UPDRS), Parkinson Disease Sleep Scale (PDSS) and so on. The sleep quality was assessed by polysomnography(PSG), meanwhile PD patients were divided into the RBD group(PD-RBD),the subclinical RBD group(PD-sRBD)and the normal REM group(PD-REM)based on the polysomnography. The cognitive function was compared among the three groups. Results (1)MoCA score of PD patients in the RBD group was lower than that in the normal REM group(P = 0.032.(2)No significant difference was observed in the cognitive function between the sRBD group and the normal REM group.(3)Length of morbidity of PD patients with RBD was longer than that of PD patients with sRBD(P=0.021). Conclusions The presence of RBD may be an important relative factor for the develop-ment of cognitive dysfunction in PD patients. We haven′t detected that the subclinical RBD was associated with the cognitive dysfunction in patients with PD. It is not clear whether the subclinical RBD in PD patients develops to RBD in all patients,which needs further investigation.

Purpose To evaluate left ventricular systolic function of patients with obstructive sleep apnea syndrome (OSAS).Materials and Methods Sixty OSAS patients were divided into 16 cases in mild OSAS group,18 cases in medium OSAS group and 26 cases in severe OSAS group in line with polysomnography results.20 healthy people were in the control group.Two-dimensional speckle tracking imaging was adopted to measure left ventricular global longitudinal strain (GLS),global radial strain (GRS),global circumferential strain (GCS),Endo-LS,Mid-LS and Epi-LS of left ventricular long axial section and EndoCS,Mid-CS and Epi-CS of short axial section in OSAS group and control group.Results ① There was no obvious change of GLS and GCS in mild OSAS group and compared with those in control group (P＞0.05),GRS was increased (P＜0.05).GLS,GRS and GCS in medium OSAS group was decreased when compared with those in control group,and the difference was of statistical significance (P＜0.05).GLS in severe OSAS group was reduced compared with that in control group,mild and medium OSAS group and GRS and GCS were also reduced compared with that in control group and mild OSAS group.The difference was of statistical significance (P＜0.05).② OSAS group was represented by Endo-LS reduction and as OSAS worsened,Endo-LS reduced section was enhanced.③ Starting from medium OSAS group,myocardial circumference strain began to decrease,which was represented by Endo-CS and Mid-CS reduction.Conclusion Adoption of two-dimensional speckle tracking imaging for left ventricular global and layered myocardial strain could figure out early stage left ventricular systolic function disorder in OSAS patients,providing more valuable information for clinical activities and guidance of early intervention for OSAS patients.

Sleep-related eating disorder (SRED) is a sleep disorder characterized by repeated involuntary eating and drinking. The clinic of this disease is not rare, but few reports are noted in China; doctors and patients lack of knowledge. This paper reviews the literature on SRED, summarizes the shortcomings of existing research, and proposes future research directions, aiming to provide references for researchers to further explore this field.

Objective　To analyze characteristics of video polysomnography （V-PSG） for different clinical phenotypes of sleep related rhythmic movement （SRRM）. Methods　The clinical data of patients with sleep related rhythmic movement diagnosed by video polysomnography（V-PSG） monitoring in our sleep center from December 2017 to August 2020 were analyzed retrospectively，their genders，ages，first episode time，clinical types and PSG results were statistically analyzed. Results　A total of 21 SSRM patients were performed in 959 sleep monitoring cases，including 16 males （76.2%） and 5 females （23.8%）. The mean age was 27.29±11.64 years old，and 17 cases were ≥18 years old. SSRM first occurred in 9 adults （42.9%），4 children （19%），4 patients （19.0%） with unclear onset age，and 4 patients （19.0%） with adolescent onset. The movement frequency of 21 cases （100%） was lower than 0.5 times per second. The clinical manifestations were head shaking type in 10 cases （47.6%），body shaking type in 1 case （4.8%） and mixed type in 10 cases （47.6%）. 14 cases occurred REM in SSRM cases （66.7%），NREM2 2 cases （9.5%%），NREM2+REM3 cases （14.3%），and awake 2 cases （9.5%）. PSG showed that the sleep efficiency of SSRM patients was decreased，the latency period of REM was prolonged and the total waking time after sleep was prolonged，and the total sleep time and sleep stage ratio were approximately normal. Hamilton anxiety score was greater than 8 in 12 cases （57.14%）. Conclusion　Adult SSRM is not uncommon，and it is mostly the first episode in adult life. In adults，SSRM is mainly manifested as head shaking type and mixed type，and the occurrence frequency of REM is the highest. The clinical significance of SSRM and its relationship with REM sleep need to be further studied and evaluated.