Objective To investigate the risk factors associated with onset of vertebrobasilar doli-choectasia(VBD)symptoms in elderly patients.Methods A retrospective study was conducted on 206 elderly VBD patients admitted in Chinese PLA General Hospital between July 2014 and July 2024.Based on the presence of VBD-related symptoms or not,they were divided into a symptom-atic group(112 cases)and an asymptomatic group(94 cases).All patients underwent cranial mag-netic resonance angiography(MRA)and MRI.And routine blood tests were performed and related indicators were detected,including following parameters:neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammation(SII)index,total cholesterol(TC),low-density lipoprotein choles-terol(LDL-C),and C-reactive protein(CRP).Multivariate logistic regression analysis was per-formed to identify risk factors associated with symptomatic progression in elderly VBD patients.Results The symptomatic group showed significantly higher SII index and NLR,longer bilateral vertebral artery length,and larger proportion of elevated vertebral artery confluence when compared with the asymptomatic group(P＜0.05,P＜0.01).Significant differences were also observed be-tween the two groups in basilar artery height grade and proportion of basilar artery hyperintensity of vessel wall signal(BA-HVS,P＜0.01).Multivariate logistic regression analysis revealed that elevated vertebral artery confluence and high-grade basilar artery hyperintensity of vessel wall signal were risk factors for symptomatic onset in elderly VBD patients.The risk of symptomatic onset in elderly VBD patients with elevated confluence of the vertebral artery was 2.143 times higher than in those without elevation(95％CI:1.144-4.013,P=0.017).Similarly,the risk in elderly VBD patients with high-grade basilar artery hyperintensity of vessel wall signal was 4.113 times higher than in those without such signal(95％CI:2.213-7.646,P=0.000).Conclusion Elevated vertebral artery confluence and high-grade basilar artery hyperintensity of vessel wall signal may serve as clinical indicators for monitoring disease progression in elderly patients with VBD,thereby facilitating the optimization of clinical management strategies in the patients.

Objective To investigate the clinical and radiological features of patients with different phenotypes of multiple system atrophy （MSA）. Methods A total of 400 patients with MSA who attended the outpatient service or were hospitalized in Department of Neurology，Chinese PLA General Hospital，were enrolled，among whom there were 294 patients with MSA-cerebellar type （MSA-C） and 106 patients with MSA-Parkinsonian type （MSA-P）. The t-test and the chi-square test were used to analyze the clinical manifestations，radiological features，and blood biochemical indicators of the two groups. Results As for clinical manifestations，there were significant differences in cerebellar symptoms，constipation，and Babinski sign between MSA-C patients and MSA-P patients （P<0.05）. As for radiological features，positron emission tomography/computed tomography （PET/CT） showed that MSA-P patients had a typical reduction in DAT uptake in the putamen and the caudate nucleus，while magnetic resonance imaging showed that compared with the MSA-C group，the MSA-P group had a significantly higher proportion of patients with putamen fissure sign or white matter demyelination； for MSA-C patients，PET/CT showed cerebellar hypometabolism，and magnetic resonance imaging showed the cross sign and high signal intensity in the pontine arm，as well as a significantly higher proportion of patients cerebellar and pontine atrophy than MSA-P patients （P<0.05）. As for laboratory markers，MSA-P patients had a significantly lower level of uric acid than MSA-C patients （P=0.029）. Conclusion Patients with different subtypes of MSA have specific clinical features，radiological features，and uric acid level，which has a certain significance in the accurate diagnosis of MSA.

Objective To evaluate the impact of different exercise frequencies on the symptoms,quality of life,and duration of rehabilitative effects in patients with Parkinson's disease(PD).Methods A total of 90 PD patients(Hoehn and Yahr stage ≤3,receiving continuous dopaminer-gic stimulation)admitted in Department of Neurology of Chinese PLA General Hospital were en-rolled and randomly divided into groups G1,G2 and G3,with 30 participants in each group.They received rehabilitation exercises of Parkinson's Wellness Recovery(PWR)1 h per time,at differ-ent frequencies,that is,once(G1),twice(G2)and three times(G3)a week,for totally 6 months.Unified Parkinson's disease rating scale(UPDRS),levodopa equivalent dose,10-meter walk test(10-MWT),Fullerton advanced balance(FAB)Scale,trail making test-A(TMT-A),nine-hole peg test(9-HPT)and Parkinson's disease questionare-39(PDQ-39)were applied to evaluate the efficacy of the rehabilitation.Results The PDQ-39 score was significantly decreased in all the three groups after PWR exercise(P＜0.05,P＜0.01).Compared with the corresponding levels before intervention,the group G2 had obviously lower 10-MWT score and higher FAB score(P＜0.05),and the group G3 obtained notably decreased scores in UPDRS,UPDRS-Ⅲ,10-MWT,TMT-A,9-HPT,and PDQ-39[30.72±11.31 vs 31.41±10.42,P=0.001;19.21±9.72 vs 20.17±8.80,P=0.001;7.38(6.26,8.49)s vs 7.48(6.53,8.56)s,P=0.004;53.97±8.74 s vs 54.07±8.62 s,P=0.026;38.71(33.71,49.71)s vs 38.90(33.78,49.82)s,P=0.001;28.00(14.50,36.00)vs 30.00(15.50,38.50),P=0.001],and increased FAB score[23.00(16.00,33.00)vs 21.00(16.00,32.00),P=0.005].In addition,the patients in the G3 group experienced the most pronounced re-habilitation effect immediately after exercise,but,all aforementioned indicators remained augmen-ted even 4 weeks after exercise.Conclusion Exercise rehabilitation three times weekly can greatly enhance the motor function of PD patients,ameliorate non-motor symptoms,and the overall quali-ty of life,with the beneficial effects persisting for a minimum of 4 weeks.

Objective To evaluate the impact of different exercise frequencies on the symptoms,quality of life,and duration of rehabilitative effects in patients with Parkinson's disease(PD).Methods A total of 90 PD patients(Hoehn and Yahr stage ≤3,receiving continuous dopaminer-gic stimulation)admitted in Department of Neurology of Chinese PLA General Hospital were en-rolled and randomly divided into groups G1,G2 and G3,with 30 participants in each group.They received rehabilitation exercises of Parkinson's Wellness Recovery(PWR)1 h per time,at differ-ent frequencies,that is,once(G1),twice(G2)and three times(G3)a week,for totally 6 months.Unified Parkinson's disease rating scale(UPDRS),levodopa equivalent dose,10-meter walk test(10-MWT),Fullerton advanced balance(FAB)Scale,trail making test-A(TMT-A),nine-hole peg test(9-HPT)and Parkinson's disease questionare-39(PDQ-39)were applied to evaluate the efficacy of the rehabilitation.Results The PDQ-39 score was significantly decreased in all the three groups after PWR exercise(P＜0.05,P＜0.01).Compared with the corresponding levels before intervention,the group G2 had obviously lower 10-MWT score and higher FAB score(P＜0.05),and the group G3 obtained notably decreased scores in UPDRS,UPDRS-Ⅲ,10-MWT,TMT-A,9-HPT,and PDQ-39[30.72±11.31 vs 31.41±10.42,P=0.001;19.21±9.72 vs 20.17±8.80,P=0.001;7.38(6.26,8.49)s vs 7.48(6.53,8.56)s,P=0.004;53.97±8.74 s vs 54.07±8.62 s,P=0.026;38.71(33.71,49.71)s vs 38.90(33.78,49.82)s,P=0.001;28.00(14.50,36.00)vs 30.00(15.50,38.50),P=0.001],and increased FAB score[23.00(16.00,33.00)vs 21.00(16.00,32.00),P=0.005].In addition,the patients in the G3 group experienced the most pronounced re-habilitation effect immediately after exercise,but,all aforementioned indicators remained augmen-ted even 4 weeks after exercise.Conclusion Exercise rehabilitation three times weekly can greatly enhance the motor function of PD patients,ameliorate non-motor symptoms,and the overall quali-ty of life,with the beneficial effects persisting for a minimum of 4 weeks.

Objective To investigate the risk factors associated with onset of vertebrobasilar doli-choectasia(VBD)symptoms in elderly patients.Methods A retrospective study was conducted on 206 elderly VBD patients admitted in Chinese PLA General Hospital between July 2014 and July 2024.Based on the presence of VBD-related symptoms or not,they were divided into a symptom-atic group(112 cases)and an asymptomatic group(94 cases).All patients underwent cranial mag-netic resonance angiography(MRA)and MRI.And routine blood tests were performed and related indicators were detected,including following parameters:neutrophil-to-lymphocyte ratio(NLR),systemic immune-inflammation(SII)index,total cholesterol(TC),low-density lipoprotein choles-terol(LDL-C),and C-reactive protein(CRP).Multivariate logistic regression analysis was per-formed to identify risk factors associated with symptomatic progression in elderly VBD patients.Results The symptomatic group showed significantly higher SII index and NLR,longer bilateral vertebral artery length,and larger proportion of elevated vertebral artery confluence when compared with the asymptomatic group(P＜0.05,P＜0.01).Significant differences were also observed be-tween the two groups in basilar artery height grade and proportion of basilar artery hyperintensity of vessel wall signal(BA-HVS,P＜0.01).Multivariate logistic regression analysis revealed that elevated vertebral artery confluence and high-grade basilar artery hyperintensity of vessel wall signal were risk factors for symptomatic onset in elderly VBD patients.The risk of symptomatic onset in elderly VBD patients with elevated confluence of the vertebral artery was 2.143 times higher than in those without elevation(95％CI:1.144-4.013,P=0.017).Similarly,the risk in elderly VBD patients with high-grade basilar artery hyperintensity of vessel wall signal was 4.113 times higher than in those without such signal(95％CI:2.213-7.646,P=0.000).Conclusion Elevated vertebral artery confluence and high-grade basilar artery hyperintensity of vessel wall signal may serve as clinical indicators for monitoring disease progression in elderly patients with VBD,thereby facilitating the optimization of clinical management strategies in the patients.

Objective:To investigate the impact of group-based rehabilitation exercise on motor and non-movement symptoms of Parkinson's disease(PD).Methods:A total of 88 patients from out-patient and in-patient services at our hospital were randomly assigned to an early exercise group(E-EG), a late exercise group(L-EG), and a control group(CG)using a randomized delayed-start design.Patients in the E-EG carried out a rigorous, formal group exercise program, one hour per session, twice per week, for 18 months(May 2018-November 2019). Patients in the L-EG took part in the exercise program in the final 6-12 months of the study.We assessed outcomes using the Unified Parkinson's Disease Rating Scale(UPDRS), Parkinson's disease questionnaire-39(PDQ-39 Q), trail-making test part A & B, nine-hole peg test(9-HPT), 30 second sit to stand test(30s SST), 10 m walk test(10 m W), mini-balance evaluation systems test(Mini-BEST), Fullerton Advanced Balance(FAB)Scale and time up and go(TUG)test.Results:Compared with pre-exercise levels, patients with PD in the E-EG had lower performance in UPDRS(17.5±8.3 vs.20.0±8.6, t=-2.2, P=0.02)and lower performance in PDQ-39(27.2±2.1 vs.29.0±9.8, t=-2.6, P=0.001)after exercise.Moreover, compared with pre-exercise levels, patients with PD in the E-EG showed decreased post-exercise performance in trail-making test part B(114.2±25.5 vs.129.8±28.4, t=-2.3, P=0.02)and in 9-HPT(33.7±7.3 vs.39.6±9.3, t=-2.6, P=0.001). Conclusions:The practice of group-based rehabilitation exercise can improve movement abilities and quality of life in PD patients, especially if implemented early.Targeted rehabilitation exercise should be taken as part of the treatment strategy for PD patients as early as possible to deliver the best benefits.

Purpose: Transcutaneous electrical neural stimulation (TENS), as a non-invasive modality, has been clinically used as an alternative treatment for children with overactive bladder (OAB). We conducted a pooled analysis to explore the effect of TENS on OAB. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline was followed in this study. The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases, as well as the reference lists of the retrieved studies, were used to find trials relevant for assessing the use of TENS to treat OAB. Results: Of the 246 records identified, 8 publications were analyzed in our study. Our analysis found that TENS resulted in a greater decrease of wet days/wk, daily voiding frequency, daily incontinence episodes, and daily number of voids than was observed in the control group. Furthermore, TENS-treated patients showed similar visual analogue scale (VAS) scores to patients in the control group, demonstrating that the application of TENS did not increase patients’ discomfort and pain. TENS had a relative advantage in the number of partial responses, but no clear differences were found in frequency of no response or a full response compared to the control group. In urodynamic testing, TENS led to obvious improvements in average voided volume and maximum voided volume in children with OAB. Conclusions TENS had a remarkable effect on the improvement of urodynamic indexes and objective OAB symptoms without a significant increase in VAS scores for children with OAB.

Parkinson's disease is characterized by progressive motor dysfunction owing to degeneration of dopaminergic neurons in the substantia nigra and other nuclei.Recently,the bilateral high frequency stimulation of the subthalamic nucleus deep brain stimula tion (STN-DBS) as the treatment of PD was famous with good curative effect.But postoperative apathy as its side-effect impact on the therapeutic effect and the quality of life of patients seriously,which drawn the attention of clinicians.In this article,we summarized the incidence,manifestation and treatment of postoperative apathy and tried to provide some ideas for clinicians.

OBJECTIVETo investigate the risk factors for post-stroke pneumonia and assess the value of A(2)DS(2) score in predicting post-stroke pneumonia in elderly stroke patients.

METHODSThe clinical data were retrospectively collected from elderly stroke patients from January, 2007 to December, 2012. A(2)DS(2) score was then assigned using the clinical information from the medical record. The ability of the score to discriminate between patients with post-stroke pneumonia and those without was quantified using ROC analysis. The calibration of the score was analyzed using Hosmer-Lemeshow goodness-of-fit test.

RESULTSA total of 131 elderly male stroke patients were enrolled in this study, among whom the incidence of post-stroke pneumonia was 29.01%. The independent risk factors for post-stroke pneumonia identified included moderate (P=0.0081, OR: 5.6089; 95%CI: 1.5663-20.0854) and severe (P=0.0048, OR: 44.4827; 95%CI: 3.1847-621.3126) neurological impairment, dysphagia (P=0.0005, OR: 7.5265; 95%CI: 2.4282-23.3292), and atrial fibrillation (P=0.0226, OR: 4.1778; 95%CI: 1.2221-14.2825). The incidence of post-stroke pneumonia ranged from 2.2% in patients with a A(2)DS(2) score less than 3 to 75% in those with a score higher than 8. The C-statistic of A(2)DS(2) score for predicting post-stroke pneumonia was 0.86 (95%CI: 0.784-0.911) by the ROC analysis. The A(2)DS(2) score was well calibrated to predict post-stroke pneumonia in elderly patients by Hosmer-Lemeshow test (7.083, P=0.528).

CONCLUSIONThe A(2)DS(2) score can be useful for predicting post-stroke pneumonia and for routine monitoring of high-risk elderly stroke patients in the clinical setting.

Aged ; Aged, 80 and over ; Atrial Fibrillation ; complications ; China ; Deglutition Disorders ; complications ; Humans ; Incidence ; Male ; Pneumonia ; epidemiology ; etiology ; prevention & control ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stroke ; complications

Objective To investigate the risk factors for post-stroke pneumonia and assess the value of A2DS2 score in predicting post-stroke pneumonia in elderly stroke patients. Methods The clinical data were retrospectively collected from elderly stroke patients from January, 2007 to December, 2012. A2DS2 score was then assigned using the clinical information from the medical record. The ability of the score to discriminate between patients with post-stroke pneumonia and those without was quantified using ROC analysis. The calibration of the score was analyzed using Hosmer-Lemeshow goodness-of-fit test. Results A total of 131 elderly male stroke patients were enrolled in this study, among whom the incidence of post-stroke pneumonia was 29.01%. The independent risk factors for post-stroke pneumonia identified included moderate (P=0.0081, OR: 5.6089; 95%CI: 1.5663-20.0854) and severe (P=0.0048, OR:44.4827;95%CI:3.1847-621.3126) neurological impairment, dysphagia (P=0.0005, OR:7.5265;95%CI: 2.4282-23.3292), and atrial fibrillation (P=0.0226, OR: 4.1778; 95%CI: 1.2221-14.2825). The incidence of post-stroke pneumonia ranged from 2.2% in patients with a A2DS2 score less than 3 to 75% in those with a score higher than 8. The C-statistic of A2DS2 score for predicting post-stroke pneumonia was 0.86 (95%CI: 0.784-0.911) by the ROC analysis. The A2DS2 score was well calibrated to predict post-stroke pneumonia in elderly patients by Hosmer-Lemeshow test (7.083, P=0.528). Conclusion The A2DS2 score can be useful for predicting post-stroke pneumonia and for routine monitoring of high-risk elderly stroke patients in the clinical setting.