1.Study on the dose of esketamine during general anesthesia maintenance in elderly patients undergoing radical resection of esophageal cancer
Lin LIN ; Li KONG ; Songmei MA ; Keke WANG ; Xiaohui DONG
Chinese Journal of Endocrine Surgery 2025;19(5):778-782
Objective:To analyze the efficacy of different doses of esketamine in maintaining general anesthesia in elderly patients undergoing radical resection of esophageal cancer.Methods:A total of 98 elderly patients who underwent radical resection of esophageal cancer and admitted from Jun. 2023 to May. 2025 in Shangqiu First People’s Hospital were selected and divided into Group A ( n=50, 0.25 mg·kg -1·h -1) and Group B ( n=48,0.5 mg·kg -1·h -1) according to the dose of esketamine. The following situations between the two groups were compared: (1) hemodynamics [mean arterial pressure (MAP), heart rate (HR) ] before anesthesia induction (T0), 30 minutes after the start of the operation (T1), and at extubation (T2) ; (2) Stress inflammatory indicators [norepinephrine (NE), C-reactive protein (CRP) ] before the operation and 1 day after the operation; (3) Analgesia status [Dosage of propofol and remifentanil, remedial analgesia rate, and the degree of analgesia was evaluated by visual analogue scale (VAS) 2 hours after the operation]; (4) Postoperative recovery [postoperative eye-opening time, extubation time, anesthesia recovery time, and postoperative recovery quality was evaluated using the Chinese version of the 15-item Quality of Recovery (QoR-15) Scale 1 day after the operation]; (5) Safety. Results:(1) At time T1, MAP of both groups was lower than that at time T0,and at time T2, MAP of group B was higher than that at time T1 ( P<0.05). At times T1 and T2, HR of both groups was lower than that at time T0, and HR of both groups at time T2 was higher than that at time T1 ( P<0.05). At time T1, MAP and HR in group B were lower than those in group A ( P<0.05). (2) The dosages of propofol and remifentanil in group B were lower ( P<0.05) ,while the comparison of remedial analgesia rate and VAS score between the two groups showed P>0.05. (3) One day after the operation,the levels of serum NE and CRP in both groups were higher than those before the operation,while those in group B were even lower ( P<0.05). (4) The incidence of adverse reactions in group B (20.83%) was slightly higher than that in group A (10.00%). (5) The eye-opening time,extubation time and anesthesia recovery time after surgery in group B were all longer than those in group A ( P<0.05), while the comparison of QoR-15 scores between the two groups showed P>0.05. Conclusions:In the maintenance of general anesthesia for elderly patients undergoing radical resection of esophageal cancer, the intraoperative hemodynamic fluctuations of low-dose esketamine are smaller. Although the dosages of propofol and remifentanil are higher and the postoperative recovery time is longer, there are no significant differences in analgesic effect, adverse reactions or recovery quality, while the stress and inflammatory responses of high-dose esketamine are smaller.
2.Study on the dose of esketamine during general anesthesia maintenance in elderly patients undergoing radical resection of esophageal cancer
Lin LIN ; Li KONG ; Songmei MA ; Keke WANG ; Xiaohui DONG
Chinese Journal of Endocrine Surgery 2025;19(5):778-782
Objective:To analyze the efficacy of different doses of esketamine in maintaining general anesthesia in elderly patients undergoing radical resection of esophageal cancer.Methods:A total of 98 elderly patients who underwent radical resection of esophageal cancer and admitted from Jun. 2023 to May. 2025 in Shangqiu First People’s Hospital were selected and divided into Group A ( n=50, 0.25 mg·kg -1·h -1) and Group B ( n=48,0.5 mg·kg -1·h -1) according to the dose of esketamine. The following situations between the two groups were compared: (1) hemodynamics [mean arterial pressure (MAP), heart rate (HR) ] before anesthesia induction (T0), 30 minutes after the start of the operation (T1), and at extubation (T2) ; (2) Stress inflammatory indicators [norepinephrine (NE), C-reactive protein (CRP) ] before the operation and 1 day after the operation; (3) Analgesia status [Dosage of propofol and remifentanil, remedial analgesia rate, and the degree of analgesia was evaluated by visual analogue scale (VAS) 2 hours after the operation]; (4) Postoperative recovery [postoperative eye-opening time, extubation time, anesthesia recovery time, and postoperative recovery quality was evaluated using the Chinese version of the 15-item Quality of Recovery (QoR-15) Scale 1 day after the operation]; (5) Safety. Results:(1) At time T1, MAP of both groups was lower than that at time T0,and at time T2, MAP of group B was higher than that at time T1 ( P<0.05). At times T1 and T2, HR of both groups was lower than that at time T0, and HR of both groups at time T2 was higher than that at time T1 ( P<0.05). At time T1, MAP and HR in group B were lower than those in group A ( P<0.05). (2) The dosages of propofol and remifentanil in group B were lower ( P<0.05) ,while the comparison of remedial analgesia rate and VAS score between the two groups showed P>0.05. (3) One day after the operation,the levels of serum NE and CRP in both groups were higher than those before the operation,while those in group B were even lower ( P<0.05). (4) The incidence of adverse reactions in group B (20.83%) was slightly higher than that in group A (10.00%). (5) The eye-opening time,extubation time and anesthesia recovery time after surgery in group B were all longer than those in group A ( P<0.05), while the comparison of QoR-15 scores between the two groups showed P>0.05. Conclusions:In the maintenance of general anesthesia for elderly patients undergoing radical resection of esophageal cancer, the intraoperative hemodynamic fluctuations of low-dose esketamine are smaller. Although the dosages of propofol and remifentanil are higher and the postoperative recovery time is longer, there are no significant differences in analgesic effect, adverse reactions or recovery quality, while the stress and inflammatory responses of high-dose esketamine are smaller.
3.Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging for axillary lymph node metastasis in breast cancer patients with low HER-2 expression
Xue ZHU ; Keke LI ; Ying LIU ; Wenjuan MA ; Hongwei DONG
Chinese Journal of Medical Physics 2025;42(4):466-470
Objective To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the diagnosis of axillary lymph node metastasis(ALNM)in breast cancer patients with low HER-2 expression.Methods A total of 297 breast cancer patients with low HER-2 expression treated at the Affiliated Hospital of Xuzhou Medical University were enrolled and divided into ALNM group(n=71)and non-ALNM group(n=226)according to whether there was ALNM.All patients underwent DCE-MRI,and DCE-MRI derived parameters were collected and analyzed.Logistic regression analysis was used to identify the risk factors for ALNM,and the efficacy of DCE-MRI in diagnosing ALNM was assessed using receiver operating characteristic curve.Results Significant differences were observed between two groups in lesion distribution,TNM staging,vascular invasion,and most DCE-MRI derived parameters including short-to-long axis ratio,Ve,Ktrans,Kep,ADC and SER(all P<0.05).Multivariate regression analysis revealed that the short-to-long axis ratio,Ve,Ktrans,Kep,ADC and SER were significant risk factors for ALNM in breast cancer patients.Comparative analysis demonstrated that the combination of DCE-MRI derived parameters yielded a maximum area under the curve of 0.976,with a sensitivity of 91.5%and a specificity of 92.9%.Conclusion DCE-MRI is an effective tool for determining the presence of ALNM in breast cancer patients with low HER-2 expression,providing significant diagnostic evidence for clinical practice.
4.Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging for axillary lymph node metastasis in breast cancer patients with low HER-2 expression
Xue ZHU ; Keke LI ; Ying LIU ; Wenjuan MA ; Hongwei DONG
Chinese Journal of Medical Physics 2025;42(4):466-470
Objective To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in the diagnosis of axillary lymph node metastasis(ALNM)in breast cancer patients with low HER-2 expression.Methods A total of 297 breast cancer patients with low HER-2 expression treated at the Affiliated Hospital of Xuzhou Medical University were enrolled and divided into ALNM group(n=71)and non-ALNM group(n=226)according to whether there was ALNM.All patients underwent DCE-MRI,and DCE-MRI derived parameters were collected and analyzed.Logistic regression analysis was used to identify the risk factors for ALNM,and the efficacy of DCE-MRI in diagnosing ALNM was assessed using receiver operating characteristic curve.Results Significant differences were observed between two groups in lesion distribution,TNM staging,vascular invasion,and most DCE-MRI derived parameters including short-to-long axis ratio,Ve,Ktrans,Kep,ADC and SER(all P<0.05).Multivariate regression analysis revealed that the short-to-long axis ratio,Ve,Ktrans,Kep,ADC and SER were significant risk factors for ALNM in breast cancer patients.Comparative analysis demonstrated that the combination of DCE-MRI derived parameters yielded a maximum area under the curve of 0.976,with a sensitivity of 91.5%and a specificity of 92.9%.Conclusion DCE-MRI is an effective tool for determining the presence of ALNM in breast cancer patients with low HER-2 expression,providing significant diagnostic evidence for clinical practice.
5.The correlation between thrombolysis decision-making anxiety and decision-making duration among surrogate decision-makers of patients with acute ischemic stroke
Caixia YANG ; Keke MA ; Lina GUO ; Xiaofang DONG ; Yapeng LI ; Yuanli GUO
Chinese Journal of Behavioral Medicine and Brain Science 2024;33(2):133-139
Objective:To explore the anxiety level, influencing factors among surrogate decision-makers of patients with acute ischemic stroke during thrombolysis decision-making, and their correlation with decision-making duration.Methods:Acute ischemic stroke patients and their surrogate decision-makers who visited the Emergency Department of the First Affiliated Hospital of Zhengzhou University from September 2019 to December 2021 were selected as the research subjects.Sociodemographic data and disease related data of patients and surrogate decision-makers were collected.Surrogate decision-makers were evaluated with the state-trait anxiety inventory, decision participation expectation scale, Wake Forest physician trust scale, and perceived social support scale.SPSS 26.0 software was used for data processing.Pearson correlation analysis, Spearman correlation analysis and ridge regression analysis were used for statistical analysis.Results:The score of state anxiety of decision-makers was (49.47±9.04), and 18.2% (70/383) of decision-makers had a decision duration exceeding 15 minutes.The score of state anxiety of decision-makers was positively correlated with decision duration ( r=0.189, P<0.001). The influencing factors of state anxiety level of decision-makers included sociodemographic factors (age of decision-makers and patients, relationship between payers and patients, whether decision-makers bear the current medical expenses, type of medical insurance for patients), psychological factors (trust level in physicians, perceived social support), factors related to patient disease (numbers of stroke relapses, National Institutes of Health stroke scale scores for patients), characteristics of the decision-making process (whether patients participate in the decision-making process, and the role of decision-makers in the decision-making process) (all P<0.05). Conclusion:Most surrogate decision-makers experience anxiety.Medical staff should pay attention to the emotions of decision-makers and adopt appropriate communication skills when communicating with informed consent for thrombolysis, alleviate the anxiety of surrogate decision-makers, so as so reduce the decision-making duration.
6.Molecular mechanism of lenvatinib resistance in hepatocellular carcinoma
Xiaomeng YAO ; Keke SUN ; Yunkai LIN ; Hui WANG ; Liwei DONG ; Lei CHEN ; Heping HU
Journal of Clinical Hepatology 2024;40(12):2524-2530
Hepatocellular carcinoma is the most common malignancy of the liver and poses serious health burdens on China and the whole world. However, most patients with hepatocellular carcinoma are already in the advanced stage at the time of diagnosis, with fewer opportunities for surgery and limited treatment options. In recent years, the advances in molecular targeted therapies have brought new hope for patients with advanced hepatocellular carcinoma. Among these therapies, lenvatinib is the second first-line drug after sorafenib approved by the US Food and Drug Administration for the treatment of advanced hepatocellular carcinoma, and it has attracted widespread attention for its powerful anti-tumor properties. However, the efficacy of lenvatinib is severely limited by its drug resistance. This article reviews the research advances in the molecular mechanisms of lenvatinib resistance in hepatocellular carcinoma and discusses possible ways to improve the efficacy of lenvatinib, so as to improve its efficacy.
7.Surveillance of bacterial resistance in tertiary hospitals across China:results of CHINET Antimicrobial Resistance Surveillance Program in 2022
Yan GUO ; Fupin HU ; Demei ZHU ; Fu WANG ; Xiaofei JIANG ; Yingchun XU ; Xiaojiang ZHANG ; Fengbo ZHANG ; Ping JI ; Yi XIE ; Yuling XIAO ; Chuanqing WANG ; Pan FU ; Yuanhong XU ; Ying HUANG ; Ziyong SUN ; Zhongju CHEN ; Jingyong SUN ; Qing CHEN ; Yunzhuo CHU ; Sufei TIAN ; Zhidong HU ; Jin LI ; Yunsong YU ; Jie LIN ; Bin SHAN ; Yunmin XU ; Sufang GUO ; Yanyan WANG ; Lianhua WEI ; Keke LI ; Hong ZHANG ; Fen PAN ; Yunjian HU ; Xiaoman AI ; Chao ZHUO ; Danhong SU ; Dawen GUO ; Jinying ZHAO ; Hua YU ; Xiangning HUANG ; Wen'en LIU ; Yanming LI ; Yan JIN ; Chunhong SHAO ; Xuesong XU ; Wei LI ; Shanmei WANG ; Yafei CHU ; Lixia ZHANG ; Juan MA ; Shuping ZHOU ; Yan ZHOU ; Lei ZHU ; Jinhua MENG ; Fang DONG ; Zhiyong LÜ ; Fangfang HU ; Han SHEN ; Wanqing ZHOU ; Wei JIA ; Gang LI ; Jinsong WU ; Yuemei LU ; Jihong LI ; Qian SUN ; Jinju DUAN ; Jianbang KANG ; Xiaobo MA ; Yanqing ZHENG ; Ruyi GUO ; Yan ZHU ; Yunsheng CHEN ; Qing MENG ; Shifu WANG ; Xuefei HU ; Wenhui HUANG ; Juan LI ; Quangui SHI ; Juan YANG ; Abulimiti REZIWAGULI ; Lili HUANG ; Xuejun SHAO ; Xiaoyan REN ; Dong LI ; Qun ZHANG ; Xue CHEN ; Rihai LI ; Jieli XU ; Kaijie GAO ; Lu XU ; Lin LIN ; Zhuo ZHANG ; Jianlong LIU ; Min FU ; Yinghui GUO ; Wenchao ZHANG ; Zengguo WANG ; Kai JIA ; Yun XIA ; Shan SUN ; Huimin YANG ; Yan MIAO ; Mingming ZHOU ; Shihai ZHANG ; Hongjuan LIU ; Nan CHEN ; Chan LI ; Jilu SHEN ; Wanqi MEN ; Peng WANG ; Xiaowei ZHANG ; Yanyan LIU ; Yong AN
Chinese Journal of Infection and Chemotherapy 2024;24(3):277-286
Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in tertiary hospitals in major regions of China in 2022.Methods Clinical isolates from 58 hospitals in China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2022 Clinical &Laboratory Standards Institute(CLSI)breakpoints.Results A total of 318 013 clinical isolates were collected from January 1,2022 to December 31,2022,of which 29.5%were gram-positive and 70.5%were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species(excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi)was 28.3%,76.7%and 77.9%,respectively.Overall,94.0%of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 90.8%of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis showed significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 94.2%in the isolates from children and 95.7%in the isolates from adults.The resistance rate to carbapenems was lower than 13.1%in most Enterobacterales species except for Klebsiella,21.7%-23.1%of which were resistant to carbapenems.Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.1%to 13.3%.The prevalence of meropenem-resistant strains decreased from 23.5%in 2019 to 18.0%in 2022 in Pseudomonas aeruginosa,and decreased from 79.0%in 2019 to 72.5%in 2022 in Acinetobacter baumannii.Conclusions The resistance of clinical isolates to the commonly used antimicrobial agents is still increasing in tertiary hospitals.However,the prevalence of important carbapenem-resistant organisms such as carbapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a downward trend in recent years.This finding suggests that the strategy of combining antimicrobial resistance surveillance with multidisciplinary concerted action works well in curbing the spread of resistant bacteria.
8.Antimicrobial resistance profile of clinical isolates in hospitals across China:report from the CHINET Antimicrobial Resistance Surveillance Program,2023
Yan GUO ; Fupin HU ; Demei ZHU ; Fu WANG ; Xiaofei JIANG ; Yingchun XU ; Xiaojiang ZHANG ; Fengbo ZHANG ; Ping JI ; Yi XIE ; Yuling XIAO ; Chuanqing WANG ; Pan FU ; Yuanhong XU ; Ying HUANG ; Ziyong SUN ; Zhongju CHEN ; Jingyong SUN ; Qing CHEN ; Yunzhuo CHU ; Sufei TIAN ; Zhidong HU ; Jin LI ; Yunsong YU ; Jie LIN ; Bin SHAN ; Yunmin XU ; Sufang GUO ; Yanyan WANG ; Lianhua WEI ; Keke LI ; Hong ZHANG ; Fen PAN ; Yunjian HU ; Xiaoman AI ; Chao ZHUO ; Danhong SU ; Dawen GUO ; Jinying ZHAO ; Hua YU ; Xiangning HUANG ; Wen'en LIU ; Yanming LI ; Yan JIN ; Chunhong SHAO ; Xuesong XU ; Wei LI ; Shanmei WANG ; Yafei CHU ; Lixia ZHANG ; Juan MA ; Shuping ZHOU ; Yan ZHOU ; Lei ZHU ; Jinhua MENG ; Fang DONG ; Zhiyong LÜ ; Fangfang HU ; Han SHEN ; Wanqing ZHOU ; Wei JIA ; Gang LI ; Jinsong WU ; Yuemei LU ; Jihong LI ; Qian SUN ; Jinju DUAN ; Jianbang KANG ; Xiaobo MA ; Yanqing ZHENG ; Ruyi GUO ; Yan ZHU ; Yunsheng CHEN ; Qing MENG ; Shifu WANG ; Xuefei HU ; Hua FANG ; Penghui ZHANG ; Bixia YU ; Ping GONG ; Haixia SHI ; Kaizhen WEN ; Yirong ZHANG ; Xiuli YANG ; Yiqin ZHAO ; Longfeng LIAO ; Jinhua WU ; Hongqin GU ; Lin JIANG ; Meifang HU ; Wen HE ; Jiao FENG ; Lingling YOU ; Dongmei WANG ; Dong'e WANG ; Yanyan LIU ; Yong AN ; Wenhui HUANG ; Juan LI ; Quangui SHI ; Juan YANG ; Abulimiti REZIWAGULI ; Lili HUANG ; Xuejun SHAO ; Xiaoyan REN ; Dong LI ; Qun ZHANG ; Xue CHEN ; Rihai LI ; Jieli XU ; Kaijie GAO ; Lu XU ; Lin LIN ; Zhuo ZHANG ; Jianlong LIU ; Min FU ; Yinghui GUO ; Wenchao ZHANG ; Zengguo WANG ; Kai JIA ; Yun XIA ; Shan SUN ; Huimin YANG ; Yan MIAO ; Jianping WANG ; Mingming ZHOU ; Shihai ZHANG ; Hongjuan LIU ; Nan CHEN ; Chan LI ; Cunshan KOU ; Shunhong XUE ; Jilu SHEN ; Wanqi MEN ; Peng WANG ; Xiaowei ZHANG ; Xiaoyan ZENG ; Wen LI ; Yan GENG ; Zeshi LIU
Chinese Journal of Infection and Chemotherapy 2024;24(6):627-637
Objective To monitor the susceptibility of clinical isolates to antimicrobial agents in healthcare facilities in major regions of China in 2023.Methods Clinical isolates collected from 73 hospitals across China were tested for antimicrobial susceptibility using a unified protocol based on disc diffusion method or automated testing systems.Results were interpreted using the 2023 Clinical & Laboratory Standards Institute (CLSI) breakpoints.Results A total of 445199 clinical isolates were collected in 2023,of which 29.0% were gram-positive and 71.0% were gram-negative.The prevalence of methicillin-resistant strains in Staphylococcus aureus,Staphylococcus epidermidis and other coagulase-negative Staphylococcus species (excluding Staphylococcus pseudintermedius and Staphylococcus schleiferi) (MRSA,MRSE and MRCNS) was 29.6%,81.9% and 78.5%,respectively.Methicillin-resistant strains showed significantly higher resistance rates to most antimicrobial agents than methicillin-susceptible strains (MSSA,MSSE and MSCNS).Overall,92.9% of MRSA strains were susceptible to trimethoprim-sulfamethoxazole and 91.4% of MRSE strains were susceptible to rifampicin.No vancomycin-resistant strains were found.Enterococcus faecalis had significantly lower resistance rates to most antimicrobial agents tested than Enterococcus faecium.A few vancomycin-resistant strains were identified in both E.faecalis and E.faecium.The prevalence of penicillin-susceptible Streptococcus pneumoniae was 93.1% in the isolates from children and and 95.9% in the isolates from adults.The resistance rate to carbapenems was lower than 15.0% for most Enterobacterales species except for Klebsiella,22.5% and 23.6% of which were resistant to imipenem and meropenem,respectively .Most Enterobacterales isolates were highly susceptible to tigecycline,colistin and polymyxin B,with resistance rates ranging from 0.6% to 10.0%.The resistance rate to imipenem and meropenem was 21.9% and 17.4% for Pseudomonas aeruginosa,respectively,and 67.5% and 68.1% for Acinetobacter baumannii,respectively.Conclusions Increasing resistance to the commonly used antimicrobial agents is still observed in clinical bacterial isolates.However,the prevalence of important crabapenem-resistant organisms such as crabapenem-resistant K.pneumoniae,P.aeruginosa,and A.baumannii showed a slightly decreasing trend.This finding suggests that strengthening bacterial resistance surveillance and multidisciplinary linkage are important for preventing the occurrence and development of bacterial resistance.
9.Analysis of the predictive value of amplitude integrated electroencephalogrphy and brainstem auditory evoked potentials for cognitive and affective disorder in patients with cerebral small vessel disease
Rui WANG ; Keke HAN ; Yonggang HAO ; Lihui YANG ; Wanli DONG
Chinese Journal of Cerebrovascular Diseases 2024;21(12):813-822
Objective Exploring the predictive value of amplitude integrated electroencephalography(aEEG)and brainstem auditory evoked potentials(BAEP)in cognitive and affective disorders related to cerebral small vessel disease(CSVD).Methods Retrospectively,100 patients with CSVD who visited the Department of Neurology at the Fourth Affiliated Hospital of Soochow University from January 2021 to February 2024 were included in the CSVD group.From January 2021 to February 2024,100 healthy people who underwent physical examination in the Physical Examination Center of the Fourth Affiliated Hospital of Soochow University and matched with the CSVD group for age and sex were prospectively included as the control group.Basic and clinical data were collected and compared between the CSVD group and the control group,including age,sex,years of education,hypertension,diabetes,smoking,drinking,total cholesterol,triglycerides,low-density lipoprotein cholesterol(LDL-C),C-reactive protein(CRP),galactin-3(Gal-3),cystatin C,homocysteine(Hcy),blood Tau protein,and glial fibrillary acidic protein(GFAP).Cognitive function was assessed using the mini-mental state examination(MMSE)and the Montreal cognitive assessment(MoCA)scale,with a MMSE score<24 and a MoCA score<25 indicating cognitive impairment.affective disorders were assessed using the Hamilton anxiety scale(HAMA)and the Hamilton depression scale(HAMD),with a HAMA score ≥ 14 or a HAMD score ≥20 indicating the presence of affective disorders.The scores of the above four scales were compared between the CSVD group and the control group.aEEG and BAEP data were collected and compared between the CSVD group and the control group.aEEG results were evaluated based on a composite score of background activity stability,sleep-wake cycle,lower boundary amplitude,and narrowband width,with a score of 0-3 indicating aEEG abnormalities.In the BAEP waveform,the Ⅰ,Ⅲ,and Ⅴ waves and the inter-wave intervals of Ⅰ-Ⅲ,Ⅲ-Ⅴ and Ⅰ-Ⅴ were observed and recorded,along with their peak latencies and inter-peak latencies.If the latency of each wave is prolonged>mean+3 standard deviations and/or the interwave period is prolonged>mean+3 standard deviations,it was considered a BAEP abnormality.CSVD patients were divided into cognitive impairment and non-cognitive impairment based on MMSE scale score and MoCA scale score,and all CSVD patients were divided into affective disorder and non-affective disorder based on HAMA score and HAMD score.The independent variables with statistically significant differences and no collinearity in the univariate analysis of cognitive and affective disorders in CSVD patients were included in the multivariate Logistic regression analysis,and the statistically significant factors were used to form the multivariate model.The area under the receiver operating characteristic(ROC)curve was used to analyze the predictive value of the multi-factor model for CSVD-related cognitive and affective disorders.Results(1)The proportion of hypertension patients,the levels of CRP,Gal-3,cystatin C,Hcy,Tau protein,GFAP,HAMA and HAMD scores in the CSVD group were higher than those in the control group(all P<0.05),and the MMSE and MoCA scale were lower than those in the control group(both P<0.05).The scores of continuity,sleep-wake cycle,lower boundary amplitude and narrow band width of aEEG in the CSVD group were lower than those in the control group(all P<0.05).The peak latency and interpeak latency of BAEP in the CSVD group were higher than those in the control group(all P<0.05).(2)There were 52 patients with cognitive impairment and 48 patients with non-cognitive impairment in CSVD patients.There were 36 patients with affective disorder and 64 patients with non-affective disorder.There were 17patients with both cognitive and affective disorders.The age,Tau protein,GFAP,the proportion of patients with abnormal aEEG and the proportion of patients with abnormal BAEP in patients with cognitive impairment were higher than those in patients without cognitive impairment(all P<0.05).The age of patients with affective disorder,the proportion of patients with abnormal aEEG and the proportion of patients with abnormal BAEP were higher than those of patients without affective disorder(all P<0.05).(3)Multivariate Logistic regression analysis showed that the risk of cognitive impairment in patients with abnormal aEEG CSVD was 4.364 times higher than that in patients with normal aEEG CSVD(OR,4.364,95%CI 1.554-12.252,P=0.005).The risk of cognitive impairment in patients with abnormal BAEP CSVD was 3.218 times higher than that in patients with normal BAEP CSVD(OR,3.218,95%CI 1.218-8.503,P=0.018).The ROC curve was used to analyze the predictive value of the multi-factor model jointly constructed by aEEG abnormalities and BAEP abnormalities for CSVD cognitive impairment.The results showed that the area under the ROC curve was 0.732,the sensitivity was 76.38%,and the specificity was 82.59%.(4)Multivariate Logistic regression analysis showed that the risk of affective disorder in patients with abnormal aEEG CSVD was 3.203 times higher than that in patients with normal aEEG CSVD(OR,3.203,95%CI 1.288-7.966,P=0.012).The risk of affective disorder in patients with abnormal BAEP CSVD was 2.553 times higher than that in patients with normal BAEP CSVD(OR,2.553,95%CI 1.011-6.446,P=0.047).The ROC curve was used to analyze the predictive value of the multi-factor model jointly constructed by aEEG abnormalities and BAEP abnormalities for CSVD affective disorders.The results showed that the area under the ROC curve was 0.700,the sensitivity was 74.21%,and the specificity was 83.49%.Conclusions The abnormality of aEEG and BAEP are important factors in constructing the prediction model of cognitive and affective disorders in CSVD patients.The multi-factor model constructed by aEEG and BAEP has certain value in predicting CSVD-related cognitive and affective disorders.
10.Analysis of the predictive value of amplitude integrated electroencephalogrphy and brainstem auditory evoked potentials for cognitive and affective disorder in patients with cerebral small vessel disease
Rui WANG ; Keke HAN ; Yonggang HAO ; Lihui YANG ; Wanli DONG
Chinese Journal of Cerebrovascular Diseases 2024;21(12):813-822
Objective Exploring the predictive value of amplitude integrated electroencephalography(aEEG)and brainstem auditory evoked potentials(BAEP)in cognitive and affective disorders related to cerebral small vessel disease(CSVD).Methods Retrospectively,100 patients with CSVD who visited the Department of Neurology at the Fourth Affiliated Hospital of Soochow University from January 2021 to February 2024 were included in the CSVD group.From January 2021 to February 2024,100 healthy people who underwent physical examination in the Physical Examination Center of the Fourth Affiliated Hospital of Soochow University and matched with the CSVD group for age and sex were prospectively included as the control group.Basic and clinical data were collected and compared between the CSVD group and the control group,including age,sex,years of education,hypertension,diabetes,smoking,drinking,total cholesterol,triglycerides,low-density lipoprotein cholesterol(LDL-C),C-reactive protein(CRP),galactin-3(Gal-3),cystatin C,homocysteine(Hcy),blood Tau protein,and glial fibrillary acidic protein(GFAP).Cognitive function was assessed using the mini-mental state examination(MMSE)and the Montreal cognitive assessment(MoCA)scale,with a MMSE score<24 and a MoCA score<25 indicating cognitive impairment.affective disorders were assessed using the Hamilton anxiety scale(HAMA)and the Hamilton depression scale(HAMD),with a HAMA score ≥ 14 or a HAMD score ≥20 indicating the presence of affective disorders.The scores of the above four scales were compared between the CSVD group and the control group.aEEG and BAEP data were collected and compared between the CSVD group and the control group.aEEG results were evaluated based on a composite score of background activity stability,sleep-wake cycle,lower boundary amplitude,and narrowband width,with a score of 0-3 indicating aEEG abnormalities.In the BAEP waveform,the Ⅰ,Ⅲ,and Ⅴ waves and the inter-wave intervals of Ⅰ-Ⅲ,Ⅲ-Ⅴ and Ⅰ-Ⅴ were observed and recorded,along with their peak latencies and inter-peak latencies.If the latency of each wave is prolonged>mean+3 standard deviations and/or the interwave period is prolonged>mean+3 standard deviations,it was considered a BAEP abnormality.CSVD patients were divided into cognitive impairment and non-cognitive impairment based on MMSE scale score and MoCA scale score,and all CSVD patients were divided into affective disorder and non-affective disorder based on HAMA score and HAMD score.The independent variables with statistically significant differences and no collinearity in the univariate analysis of cognitive and affective disorders in CSVD patients were included in the multivariate Logistic regression analysis,and the statistically significant factors were used to form the multivariate model.The area under the receiver operating characteristic(ROC)curve was used to analyze the predictive value of the multi-factor model for CSVD-related cognitive and affective disorders.Results(1)The proportion of hypertension patients,the levels of CRP,Gal-3,cystatin C,Hcy,Tau protein,GFAP,HAMA and HAMD scores in the CSVD group were higher than those in the control group(all P<0.05),and the MMSE and MoCA scale were lower than those in the control group(both P<0.05).The scores of continuity,sleep-wake cycle,lower boundary amplitude and narrow band width of aEEG in the CSVD group were lower than those in the control group(all P<0.05).The peak latency and interpeak latency of BAEP in the CSVD group were higher than those in the control group(all P<0.05).(2)There were 52 patients with cognitive impairment and 48 patients with non-cognitive impairment in CSVD patients.There were 36 patients with affective disorder and 64 patients with non-affective disorder.There were 17patients with both cognitive and affective disorders.The age,Tau protein,GFAP,the proportion of patients with abnormal aEEG and the proportion of patients with abnormal BAEP in patients with cognitive impairment were higher than those in patients without cognitive impairment(all P<0.05).The age of patients with affective disorder,the proportion of patients with abnormal aEEG and the proportion of patients with abnormal BAEP were higher than those of patients without affective disorder(all P<0.05).(3)Multivariate Logistic regression analysis showed that the risk of cognitive impairment in patients with abnormal aEEG CSVD was 4.364 times higher than that in patients with normal aEEG CSVD(OR,4.364,95%CI 1.554-12.252,P=0.005).The risk of cognitive impairment in patients with abnormal BAEP CSVD was 3.218 times higher than that in patients with normal BAEP CSVD(OR,3.218,95%CI 1.218-8.503,P=0.018).The ROC curve was used to analyze the predictive value of the multi-factor model jointly constructed by aEEG abnormalities and BAEP abnormalities for CSVD cognitive impairment.The results showed that the area under the ROC curve was 0.732,the sensitivity was 76.38%,and the specificity was 82.59%.(4)Multivariate Logistic regression analysis showed that the risk of affective disorder in patients with abnormal aEEG CSVD was 3.203 times higher than that in patients with normal aEEG CSVD(OR,3.203,95%CI 1.288-7.966,P=0.012).The risk of affective disorder in patients with abnormal BAEP CSVD was 2.553 times higher than that in patients with normal BAEP CSVD(OR,2.553,95%CI 1.011-6.446,P=0.047).The ROC curve was used to analyze the predictive value of the multi-factor model jointly constructed by aEEG abnormalities and BAEP abnormalities for CSVD affective disorders.The results showed that the area under the ROC curve was 0.700,the sensitivity was 74.21%,and the specificity was 83.49%.Conclusions The abnormality of aEEG and BAEP are important factors in constructing the prediction model of cognitive and affective disorders in CSVD patients.The multi-factor model constructed by aEEG and BAEP has certain value in predicting CSVD-related cognitive and affective disorders.

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