Objective:To investigate the correlation between thyroid function and the total cerebral small vessel disease score in the elderly.Methods:This cross-sectional study included elderly people who underwent physical examinations at the Geriatrics Department of Beijing Hospital from April 2019 to December 2020. Participants were devided into 5 groups based on the total score of cerebral small vessel disease: 0, 1, 2, 3, and 4. General clinical data were collected through physical examination reports and outpatient medical records. All participants underwent a 3T brain magnetic resonance imaging (MRI), scan and data were collected to calculate the total cerebral small vessel disease score. Fasting venous blood samples were taken in the morning to measure thyroid hormone levels. Relationships between thyroid hormone levels and lacunar infarcts, microbleeds, white matter hyperintensities (WMH), enlarged perivascular spaces, and total cerebral small vessel disease score were analyzed using Spearman correlation. Multivariate ordinal logistic regression was also used to analyze factors associated with total cerebral small vessel disease score.Results:A total of 545 elderly individuals were included, with a mean age of (75.16±9.18) years, and 505 (92.7%) were male. The number of subjects with a total cerebral small vessel disease score of 0 were 207 (38.0%), 1 were 182 (33.4%), 2 were 99 (18.2%), 3 were 41 (7.5%), and 4 were 16 (2.9%). Statistical significant differences were found in age, fasting blood glucose, systolic blood pressure, triiodothyronine (TT3), free triiodothyronine (FT3), and the proportion of hypertensive patients among the groups (all P<0.05). Spearman correlation analysis showed that TT3 ( r=-0.138, P=0.001) and FT3 ( r=-0.213, P<0.001) were negatively correlated with total cerebral small vessel disease score. Multivariate ordinal logistic regression analysis revealed that age was independently and positively associated with total cerebral small vessel disease score ( OR=1.139, 95% CI: 1.087-1.193, P<0.001), while FT3 was independently and negatively associated with total cerebral small vessel disease score ( OR=0.331, 95% CI: 0.118-0.929, P=0.009). Conclusion:In the elderly population, FT3 levels are independently and negatively associated with total cerebral small vessel disease score.

Objective:To analyze the effect of carbapenem antibiotics on the blood concentration of valproate(VPA)in elderly patients with epilepsy, while also exploring the potential drug interactions between carbapenem antibiotics and VPA, as well as possible solutions.Methods:This retrospective study included patients aged 80 years and older who were treated with a combination of VPA and carbapenem antibiotics in the Department of Geriatrics at Beijing Hospital from January 2017 to December 2022, as well as older hospitalized patients with epilepsy.Data collected encompassed patients' demographic information, details related to epilepsy, information on infection medications, changes in VPA blood concentration, clinical management, and clinical outcomes.Results:A total of 12 patients were included in the study.The average age of the participants was 92±7.0 years.The baseline dosage of VPA was 1 000 mg(range: 650 to 1 250 mg), and the baseline VPA serum concentration was 56.59 mg/L(range: 38.00 to 61.73 mg/L)during treatment with carbapenem antibiotics.Nine patients experienced seizure recurrence during the combination therapy, representing 75% of the total cohort.The VPA dosage was increased in 10 patients, with a mean increase of 522 mg(range: 200 to 892 mg), and the duration of this dosage increase was 8 days(range: 7 to 9 days).All patients exhibited a decrease in VPA serum concentration, with the lowest concentration decreasing by an average of 71.9%±15.69%.The VPA serum concentration during carbapenem treatment was significantly lower than both the baseline and post-withdrawal concentrations, measuring 12.30 mg/L(range: 10.49 to 22.47 mg/L)compared to 56.59 mg/L(range: 38.00 to 61.73 mg/L)( Z=-3.059, P=0.002)and 43.74 mg/L(range: 41.48 to 73.14 mg/L)( Z=-2.803, P=0.005). Conclusions:Carbapenems can markedly decrease serum concentrations of VPA and heighten the incidence of seizures in elderly patients with epilepsy.Increasing the dose of VPA may not enhance its serum concentration; therefore, we recommend avoiding the concomitant use of VPA and carbapenems.

Objective:To investigate the correlation between thyroid function and the total cerebral small vessel disease score in the elderly.Methods:This cross-sectional study included elderly people who underwent physical examinations at the Geriatrics Department of Beijing Hospital from April 2019 to December 2020. Participants were devided into 5 groups based on the total score of cerebral small vessel disease: 0, 1, 2, 3, and 4. General clinical data were collected through physical examination reports and outpatient medical records. All participants underwent a 3T brain magnetic resonance imaging (MRI), scan and data were collected to calculate the total cerebral small vessel disease score. Fasting venous blood samples were taken in the morning to measure thyroid hormone levels. Relationships between thyroid hormone levels and lacunar infarcts, microbleeds, white matter hyperintensities (WMH), enlarged perivascular spaces, and total cerebral small vessel disease score were analyzed using Spearman correlation. Multivariate ordinal logistic regression was also used to analyze factors associated with total cerebral small vessel disease score.Results:A total of 545 elderly individuals were included, with a mean age of (75.16±9.18) years, and 505 (92.7%) were male. The number of subjects with a total cerebral small vessel disease score of 0 were 207 (38.0%), 1 were 182 (33.4%), 2 were 99 (18.2%), 3 were 41 (7.5%), and 4 were 16 (2.9%). Statistical significant differences were found in age, fasting blood glucose, systolic blood pressure, triiodothyronine (TT3), free triiodothyronine (FT3), and the proportion of hypertensive patients among the groups (all P<0.05). Spearman correlation analysis showed that TT3 ( r=-0.138, P=0.001) and FT3 ( r=-0.213, P<0.001) were negatively correlated with total cerebral small vessel disease score. Multivariate ordinal logistic regression analysis revealed that age was independently and positively associated with total cerebral small vessel disease score ( OR=1.139, 95% CI: 1.087-1.193, P<0.001), while FT3 was independently and negatively associated with total cerebral small vessel disease score ( OR=0.331, 95% CI: 0.118-0.929, P=0.009). Conclusion:In the elderly population, FT3 levels are independently and negatively associated with total cerebral small vessel disease score.

Objective:To analyze the effect of carbapenem antibiotics on the blood concentration of valproate(VPA)in elderly patients with epilepsy, while also exploring the potential drug interactions between carbapenem antibiotics and VPA, as well as possible solutions.Methods:This retrospective study included patients aged 80 years and older who were treated with a combination of VPA and carbapenem antibiotics in the Department of Geriatrics at Beijing Hospital from January 2017 to December 2022, as well as older hospitalized patients with epilepsy.Data collected encompassed patients' demographic information, details related to epilepsy, information on infection medications, changes in VPA blood concentration, clinical management, and clinical outcomes.Results:A total of 12 patients were included in the study.The average age of the participants was 92±7.0 years.The baseline dosage of VPA was 1 000 mg(range: 650 to 1 250 mg), and the baseline VPA serum concentration was 56.59 mg/L(range: 38.00 to 61.73 mg/L)during treatment with carbapenem antibiotics.Nine patients experienced seizure recurrence during the combination therapy, representing 75% of the total cohort.The VPA dosage was increased in 10 patients, with a mean increase of 522 mg(range: 200 to 892 mg), and the duration of this dosage increase was 8 days(range: 7 to 9 days).All patients exhibited a decrease in VPA serum concentration, with the lowest concentration decreasing by an average of 71.9%±15.69%.The VPA serum concentration during carbapenem treatment was significantly lower than both the baseline and post-withdrawal concentrations, measuring 12.30 mg/L(range: 10.49 to 22.47 mg/L)compared to 56.59 mg/L(range: 38.00 to 61.73 mg/L)( Z=-3.059, P=0.002)and 43.74 mg/L(range: 41.48 to 73.14 mg/L)( Z=-2.803, P=0.005). Conclusions:Carbapenems can markedly decrease serum concentrations of VPA and heighten the incidence of seizures in elderly patients with epilepsy.Increasing the dose of VPA may not enhance its serum concentration; therefore, we recommend avoiding the concomitant use of VPA and carbapenems.

Objective:To explore the effect of acceptance and commitment nursing therapy on the psychological resilience and post-traumatic growth of patients with hematopoietic stem cell transplantation.Methods:From January 2018 to December 2019, convenience sampling method was used to select 88 patients who underwent hematopoietic stem cell transplantation in Ningbo First Hospital as the research object. All patients were divided into control group and intervention group with the method of random number table, with 44 cases in each group. Control group was treated with conventional nursing care and medication, and intervention group received acceptance and commitment nursing therapy on this basis. We compared the scores of psychological resilience, post-traumatic growth and quality of life of patients between two groups before and after intervention.Results:Before intervention, there was no statistically significant difference in the total scores of psychological resilience, post-traumatic growth, quality of life and scores in each dimension between two groups ( P>0.05) . After intervention, the total scores of psychological resilience, post-traumatic growth and quality of life of intervention group were higher than those of control group, and the differences were statistically significant ( P<0.05) . Conclusions:Acceptance and commitment nursing therapy can improve the psychological resilience, post-traumatic growth and quality of life of patients with hematopoietic stem cell transplantation, which is worthy of clinical promotion.

Leucine rich glioma inactivated 1 (LGI1) is a protein which is identified as the target involving in autoimmune encephalitis. Seizures and cognitive declines are two main symptoms of LGI1-antibody encephalitis. However, autonomic dysfunction symptoms are not prominent as seizures and cognitive defection and are easily overlooked by physicians. We reported a case with LGI1-antibody encephalitis whose onset symptoms were autonomic dysfunction including sweating, orthostatic hypotension. The features of this case was described in detail and the related literatures were reviewed in order to enhance the knowledge of the disease.

Objective To compare the clinical characteristics of patients with non-valve atrial fibrillation(NAVF)and acute ischemic stroke(AIS) between two groups:aged ≥80 years versus 60-79 years.Methods One hundred and five inpatients with NVAF and AIS,treated in Neurological Department Beijing Hospital from November 2009 to November 2014,were divided into two groups of the very elderly patients (≥ 80 years,n =44) and old patients (60-79 years,n =61).Baseline data and clinical characteristics of patients with NAVF and AIS were retrospectively compared between the two groups to explore their risk factors,subtypes of AIS,the complications and prognosis.Results Age was the risk factor for stroke in the very elderly patients with NAVF.Compared with old patients group,the very elderly patients were associated with significantly higher baseline NIHSS(National Institutes of Health Stroke Scale) (11.59 ± 7.76 vs.6.03±7.12,t=3.80,P=0.000).The rates of mRS(modified Rankin Scale)≥3(poorer clinical turnover)1 or more month after AIS was 21.3％ in the old patients versus 56.8％ in the very elderly patients(x2 =13.96,P＜0.01).Moreover,anterior circulation infarction was the main subtypes of AIS in the very elderly patients versus old patients(x2 =12.28,P =0.020).Meanwhile,the very elderly patients versus the old patients had markedly higher rates of complications of AIS,such as pneumonia (65.9％ vs.27.9％;x2 =14.53,P ＜ 0.05),gastrointestinal bleeding(36.4％ vs.13.1％;x2 =7.84,P＜0.05),acute coronary syndrome or heart failure(34.1％ vs.11.5％;x2 =7.89,P＜0.05).Conclusions The very elderly patients versus the old patients show that risk factors for NVAF with AIS are more often the ageing and smoking,and that anterior cerebral circulation is more often affected.The degrees of NVAF and AIS severity are higher,the more complications are found,and the prognosis is worse.

We reviewed medical data of 22 patients receiving intravenous thrombolysis therapy for acute isehemic stroke and evaluated our efforts of promoting intravenous thrombolysis for acute ischemic stroke.The mean in-hospital delay was 107 minutes.The most common reason was waiting for the results of laboratory tests.Only 6 cases received a standard dose of recombinant tissue plasminogen activator (rtPA) at 0.9 mg/kg.Only one patient had asymptomatic intracranial hemorrhage.No symptomatic hemorrhage occurred.Intravenous thrombolysis for ischemic stroke had excellent safety profile.Intravenous thrombolysis for ischemic stroke should be promoted under the guidance of standardized protocol according to the national guideline.

ObjectiveTo analyze cerebral hemorrhagic infarction (HI) and relative factors with the database of Standard Stroke Registry (SSR).Methods1 487 consecutive patients with acute ischemic stroke admitted within 3 days after onset were analyzed with SSR.ResultsHI was observed in 11% of patients, of whom 51% were diagnosed as having cardiogenic embolism. In patients with supratentorial infarction of cardiac origin, 28% had HI (mild 67%, moderate 23, hematoma 10%). On multiple logistic regression analysis, independent factors related with HI were found to be age, prosthetic cardiac valve and NIHSS scores at admission. Patients with more severe HI were associated with a poorer outcome at discharge. Clinical outcome tended to be better in patients receiving thrombolytic agents than in those without receiving agents, while the incidence of HI was slightly more frequent in the former.Conclusion It is confirmed that the SSR database is useful for understanding and analyzing the status of stroke diagnosis and management throughout the nation, and revisions are needed in some formats.

OBJECTIVETo report the initial application of brain protection device in the dilatation and stenting of atherosclerotic stenosis of the carotid and vertebral artery.

METHODSEighteen patients with 21 atherosclerotic stenoses of the carotid or vertebral artery underwent dilatation and/or stenting with brain protection device (filterwire or angioguard). The clinical results were summarized and the indispensability and feasibility of the device was discussed.

RESULTSWith the aid of brain protection device, endovascular dilatation and (or) stenting were performed in all the patients with 21 stenoses of the carotid or vertebral artery. The interventional manipulation was successful and no complications occurred.

CONCLUSIONSBrain protection device is helpful to decrease the embolic complication caused by atherosclerotic plaque and thromboembolus and to increase the security of interventional therapy, during the dilatation and/or stenting of stenosis of the carotid or vertebral artery.

Adult ; Aged ; Angioplasty, Balloon ; adverse effects ; methods ; Carotid Stenosis ; therapy ; Female ; Follow-Up Studies ; Humans ; Intracranial Embolism ; etiology ; prevention & control ; Male ; Middle Aged ; Protective Devices ; Stents ; adverse effects ; Vertebrobasilar Insufficiency ; therapy