Objective:To investigate the relationship between plasma phosphorylated α-synuclein (ps129-α-syn) and cognitive function in Parkinson disease (PD).Methods:This study recruited 90 PD patients who were hospitalized in the Department of Neurology, Henan province people's hospital from March 2019 to June 2020.Forty healthy middle-aged and elderly people with normal cognitive function who came to the hospital for physical examination were selected during the same period.Clinical characteristics and blood samples were collected.Patients with PD were classified into those with normally cognitive (PD-NC), mild cognitive impairment (PD-MCI), and dementia (PDD). The enzyme-linked immunosorbent assay was used to measure the plasma ps129-α-syn.Correlations between plasma ps129-α-syn and clinical characteristics such as disease duration, Hoehn-Yahr stage (H-Y), unified Parkinson's disease rating scale (UPDRS), Montreal cognitive assessment (MoCA), 14-item Hamilton anxiety rating scale (HAMA-14), the 24-item Hamilton depression rating scale (HAMD-24), levodopa equivalent daily dosage (LEDD), the scale of outcomes in Parkinson's disease for autonomic symptoms, SCOPA-AUT) were analyzed using Pearson or Spearman correlation analysis.Multiple linear regression analysis was used to evaluate the factors affecting the cognitive function of PD.Results:Plasma ps129-α-syn in PD patients was higher than that in healthy controls((19.44±8.93)μg/L, (10.78±5.87)μg/L, ( t=5.615, P<0.01). Plasma ps129-α-syn was higher in PD-MCI group((19.64±7.77)μg/L)and PDD group((23.79±9.47)μg/L) compared with that in PD-NC group((13.37±5.40)μg/L)( P<0.05). Plasma ps129-α-syn was positively correlated with H-Y ( r=0.404, P<0.01), UPDRS-Ⅲ( r=0.275, P=0.009), UPDRS-total ( r=0.211, P=0.046) and SCOPA-AUT( r=0.335, P=0.001). Plasma ps129-α-syn was negatively associated with MoCA ( r=-0.459, P<0.01). Multiple linear regression analysis suggested disease duration ( t=-4.618, P<0.01), ps129-α-syn( t=-3.792, P<0.01) and UPDRS-total ( t=-2.826, P=0.006) were independently associated with cognitive function.Plasma ps129-α-syn could discriminate between PD-NC and PD cognitive function impairment with an AUC of 0.7797 (95% CI: 0.686 3-0.873 2, P<0.01). Conclusions:Plasma ps129-α-syn is correlated with cognitive function and the severity of motor symptoms in PD patients, and have high sensitivity and specificity in diagnosing PD cognitive dysfunction.Therefore, plasma ps129-α-syn can serve as a biomarker to assess cognitive function in PD.

OBJECTIVETo investigate the safety and feasibility of forgoing postoperative nasogastric tube decompression in minimally invasive esophagectomy for patients with esophagus carcinoma.

METHODSClinical data of 90 eligible patients who underwent elective minimally invasive esophagectomy in our department from January 2012 to May 2013 by the same surgical team were retrospectively analyzed. Among them, 45 patients did not receive the use of postoperative nasogastric tube decompression and 45 patients received nasogastric tube decompression after operation. The observation parameters included the time to first flatus, the time to intake of fluid diet, the duration of postoperative hospitalization, pharyngalgia, vomiting, and postoperative complications, as well as the need for placing or replacing the nasogastric tube.

RESULTSThe incidence of pharyngalgia was significantly higher in nasogastric tube group (100% vs 44.4%, P<0.001). The time to intake of fluid diet [median 2 d(2-4 d) vs. median 9 d(7-20 d), P<0.001] and the time to first flatus [median 3 d(3-8 d) vs. median 6 d(3-9 d), P<0.001] were all significantly shorter in non-nasogastric tube group as compared to nasogastric tube group. Compared with the nasogastric tube group, the non-nasogastric tube group had shorter postoperative hospital stay (P<0.001). There were no significant differences in the incidence of postoperative complications and vomiting between two groups.

CONCLUSIONMinimally invasive esophagectomy without the use of postoperative nasogastric tube decompression is safe and feasible, which can improve recovery and shorten postoperative hospital stay.

Decompression ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Humans ; Incidence ; Intubation, Gastrointestinal ; Minimally Invasive Surgical Procedures ; methods ; Postoperative Complications ; Postoperative Period ; Retrospective Studies

Objective:To investigate the role of plasma neurofilament light chain (NfL) in diagnosing and differentiating Parkinson's disease (PD) and multiple system atrophy-Parkinsonian subtype (MSA-P).Methods:Forty PD patients and 23 MSA-P patients admitted to Department of Neurology, Henan Provincial People's Hospital from June 2019 to December 2021 were recruited; 27 healthy subjects accepted physical examination during the same period were selected as controls. Ultrasensitive Simoa technology was used to measure the plasma NfL. Differences in clinical data and plasma NfL were compared among all subjects. Correlations of plasma NfL with clinical characteristics, such as disease course, Hoehn-Year (H-Y) staging, Unified Parkinson's Disease Rating Scale (UPDRS), Montreal Cognitive Assessment (MoCA), Scale for Outcomes in Parkinson's Disease for Autonomic Symptoms (SCOPA-AUT) and levodopa equivalent daily dosage (LEDD), were analyzed with Pearson correlations. Receiver operating characteristic (ROC) curve was used to analyze the value of plasma NfL in diagnosing and differentiating PD and MSA-P.Results:Compared with MSA-P group, PD group had significantly longer disease course and statistically lower scores of UPDRS-II and SCOPA-AUT ( P<0.05). The plasma NfL in MSA-P group, PD group and healthy control group was decreased successively ([37.69±10.47] pg/mL, [17.85±4.23] pg/mL, [12.86±3.14] pg/mL, respectively), with statistical differences ( P<0.05). In MSA-P patients, Pearson correlations showed positive correlation between plasma NfL and age ( r=0.442, P=0.035); and Partial correlations showed positive correlations between plasma NfL and scores of UPDRS-I and UPDRS-III ( P<0.05), and plasma NfL showed no significant correlation with H-Y staging, UPDRS-III, MoCA, LEDD or SCOPA-AUT scores ( P>0.05). In PD patients, Pearson correlations showed that plasma NfL was positively correlated with age ( r=0.342, P=0.031); partial correlations showed that plasma NfL was positively correlated with H-Y staging and UPDRS-III, and negatively correlated with MoCA scores ( P<0.05); plasma NfL showed no significant correlation with disease course, scores of UPDRS-I and UPDRS-II, LEDD, and SCOPA-AUT scores ( P>0.05). ROC curve showed that the area under the curve (AUC) of plasma NfL in diagnosing PD was 0.814 (95% CI: 0.712-0.920, P<0.001); AUC of plasma NfL in differentiating and diagnosing PD and MSA-P was 0.980 (95% CI: 0.954-1.000, P<0.001); AUC of plasma NfL in diagnosing MSA-P was 0.998 (95% CI: 0.993-1.000, P<0.001). Conclusions:Plasma NfL is correlated with severity of motor symptoms in MSA-P patients; plasma NfL is correlated with cognitive function and disease course in PD patients. Besides, plasma NfL has high sensitivity and specificity in differentiating PD and MSA-P, therefore, plasma NfL could serve as a biomarker to diagnosis and differentiate PD.

Objective:To compare magnetic resonance imaging (MRI)-based and computed tomography (CT)-based target volume delineation and dose coverage in partial breast irradiation (PBI) for patients with breast cancer, aiming to explore the application value of MRI localization in PBI after breast-conserving surgery.Methods:Twenty-nine patients with early breast cancer underwent simulating CT and MRI scans in a supine position. The cavity visualization score (CVS) of tumor bed (TB) was evaluated. The TB, clinical target volume (CTV), planning target volume (PTV) were delineated on CT and MRI images, and then statistically compared. Conformity indices (CI) between CT- and MRI-defined target volumes were calculated. PBI treatment plan of 40 Gy in 10 fractions was designed based on PTV-CT, and the dose coverage for PTV-MRI was evaluated.Results:The CVS on CT and MRI images was 2.97±1.40 vs. 3.10±1.40( P=0.408). The volumes of TB, CTV, PTV on MRI were significantly larger than those on CT, (24.48±16.60) cm 3vs. (38.00±19.77) cm 3, (126.76±56.81) cm 3vs. (168.42±70.54) cm 3, (216.63±81.99) cm 3vs. (279.24±101.55) cm 3, respectively, whereas the increasing percentage of CTV and PTV were significantly smaller than those of TB. The CI between CT-based and MRI-based TB, CTV, PTV were 0.43±0.13, 0.66±0.11, 0.70±0.09( P<0.001), respectively. The median percentage of PTV-MRI receiving 40 Gy dose was 81.9%(62.3% to 92.4%), significantly lower than 95.6%(95.0%~97.5%) of PTV-CT. Conclusions:The CVS between CT and MRI is not significantly different, but the MRI-based TB, CTV, PTV are significantly larger than CT-based values. The PTV-MRI is of underdose if PBI treatment plan is designed for PTV-CT. As a supplement of CT scan, MRI can enhance the accuracy of TB delineation after breast-onserving surgery.

Objective:To investigate the urodynamic characteristics in Parkinson's disease(PD)versus multiple system atrophy(MSA)patients with lower urinary tract symptoms(LUTS).Methods:We performed a retrospective study in PD and MSA patients admitted to the First Affiliated Hospital of Zhengzhou University and undergone urodynamic examinations from January 2016 to June 2019.A total of 178 patients, mean age(59.2±9.7)years were enrolled, with 64 PD patients, 74 MSA patients and 40 normal controls.Urodynamic parameters included maximum flow rate(Qmax), post-voided residual urine volume(PVR), bladder compliance(BC), overactive bladder(OAB), maximum cystometric capacity(MCC)and detrusor pressure at maximum flow rate(PdetQmax). Bladder function was assessed.Results:Frequent urination(68.8%)was the most common LUTS in PD patients, as opposed to urinary retention(91.9%)in MSA patients.The Qmax, PdetQmax and incidence of OAB were higher and the PVR were lower in PD patients than in MSA patients [free-flow(FF)-Qmax: (13.5±7.1)ml/s vs.(10.1±5.2)ml/s, U=26.98, P<0.01]; pressure-flow study(PFS)-Qmax: [(13.6±5.7)ml/s vs.(10.5±3.3)ml/s, U=34.90, P<0.01]; PFS-PdetQmax: [(23.9±11.3)cm H 2O vs.(16.3±8.6)cmH 2O, U=35.04, P<0.01]; OAB: (46.9% vs.27.0%, χ2=5.85, P<0.01); FF-PVR: [(30.4±20.0)ml vs.(161.7±79.8)ml, U=-71.81, P<0.01]; PFS-PVR: [(65.9±30.7)ml vs.(212.6±83.0)ml, U=-65.29, P<0.01]. Compared with the control group, the incidences of OAB and PFS-PVR were increased and the MCC and PdetQmax were decreased in the PD group(OAB: 46.9% vs.7.5%, χ2=6.15, P<0.018); PFS-PVR: [(65.9±30.7)ml vs.(22.2±10.4)ml, U=47.25, P<0.01]; MCC: [(305.1±79.7)ml vs.(389.6±65.2)ml, U=-52.13, P<0.01]; PdetQmax: [(23.9±11.3)cmH 2O vs.(37.3±10.3)cmH 2O, U=-49.88, P<0.01]. Compared also with the control group, the MSA group had a lower Qmax, PdetQmax and MCC, FF-Qmax: [(10.1±5.2)ml/s vs.(16.3±4.7)ml/s, U=-50.11, P<0.01]; PFS-Qmax: [(10.5±3.3)ml/s vs.(13.1±5.0)ml/s, U=-27.54, P<0.05]; PdetQmax: [(16.3±8.6)cmH 2O vs.(37.3±10.3)cmH 2O, U=-84.92, P<0.01]; MCC: [(284.3±71.8)ml vs.(389.6±65.2)ml, U=-39.31, P<0.01], a higher PVR, lower bladder compliance(BC)and a higher incidence of OAB(FF-PVR: [(161.7±79.8)ml vs.(22.0±13.0)ml, U=84.82, P<0.01]; PFS-PVR: [(212.6±83.0)ml vs.(22.2±10.4)ml, U=112.54, P<0.01]; BC: (28.4% vs.7.5%, χ2=6.81, P<0.01); OAB: (27.0% vs.7.5%, χ2=17.62, P<0.01). Conclusions:PD and MSA patients with LUTS have bladder dysfunction.MSA patients have more serious bladder dysfunction than PD patients.

Objective:To investigate the effect of Donepezil treatment on the expression of high mobility group box 1 protein(HMGB1)in serum and cerebrospinal fluid in Alzheimer's disease patients.Methods:This is a single-center observational stady.A total of 120 Alzheimer's disease patients admitted in our hospital from March 2017 to may 2019 were randomly divided into the control group receiving the routine drug therapy(n=60)and the Donepezil group receiving Donepezil hydrochloride(5 mg/d)as an add-on to medicine of control group(n=60). The expression levels of HMGB1 in serum and cerebrospinal fluid, Alzheimer's disease assessment scale(ADAS-Cog), mini-mental state examination(MMSE)scores, activities of daily living(ADL)and neuropsychiatric inventory(NPI)were compared before versus after 1 month of treatment.Results:After the Donepezil treatment, the ADAS-Cog score was lower, MMSE score was higher, ADL score was higher and NPI score was lower in the Donepezil group than in the control group(25.2± 2.7 vs.33.4± 3.6, 23.3± 2.1 vs.19.4±1.9, 56.3±2.1 vs.46.9±1.6, 16.2±2.3 vs.22.3± 2.6, P<0.05). After the Donepezil treatment, the levels of HMGB1 in serum[(45.3±5.3)μg/L vs.(56.3±4.4)μg/L]and in cerebrospinal fluid[(39.2±3.3)μg/L vs.(47.1±3.9)μg/L]were lower in the Donepezil group than in the control group(all P<0.05). Conclusions:Donepezil treatment can downregulate the HMGB1 expression levels in serum and cerebrospinal fluid in Alzheimer's disease patients, which may related to the improvement of cognitive function in Alzheimer's disease patients.