ObjectiveTo explore the expression of growth associated protein-43 (GAP-43) in spasm segment and expansion segment of hirschsprung disease (HD), and to explore the pathogenesis of HD. MethodsThe expression of GAP-43 in 30 patients with HD who underwent surgical resection for absence of enteric plexuses from Jan. 2012 to Jun. 2013 in Shen zhen Children's Hospital were analyzed by using immunohistochemistry method and real-time PCR method. Aganglionic tissues of all patients were included as spasm group, and ganglionic tissues of the same patients were served as expansion group. Then comparison of the expression levels of GAP-43 mRNA and its protein between 2 groups was performed. Resultsof real-time RCR showed that the expression level of GAP-43 mRNA in expansion group was higher than that of spasm group (0.119 0 vs. 0.052 8, P<0.05). Immunohistochemistry results showed that GAP-43 protein expressed both in the myenteric plexus and ganglionic plexus of submucos in all patients, but lighter in spasm group. Compared with ganglionic plexus of circular muscle layer and longitudinal muscle layer/ganglionic plexus of submucosa in expansion group, the average optical density values at corresponding sites of intestinal tissues in spasm group were both lower (P<0.05). ConclusionExpression of GAP-43 protein is lower in spastic intestinal tissue of patients with HD, which suggests that down-regulation of GAP-43 protein may be a risk factor for HD.
Objective To systematically review the effect of percutaneous acupoint electrical stimulation (TEAS) on heart rate variability (HRV). Methods The PubMed, Embase, Ovid MEDLINE, Cochrane Library, CNKI, WanFang Data, VIP, and CBM databases were electronically searched to collect randomized controlled trials (RCTs) on the effects of percutaneous acupoint electrical stimulation on heart rate variability from inception to February 28, 2023. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 14 RCTs involving 719 patients were included. The results of meta-analysis showed that SDNN (MD=12.95, 95%CI 9.18 to 16.72, P<0.01), RMSSD (MD=1.81, 95%CI 0.10 to 3.53, P=0.04), pNN50 (MD=1.75, 95%CI 1.02 to 2.48, P<0.01), HF (SMD=0.27, 95%CI 0.01 to 0.52, P=0.04), LF/HF (MD=?0.07, 95%CI ?0.12 to ?0.03, P<0.01), ln-LF (MD=0.63, 95%CI 0.25 to 1.01, P<0.01), ln-HF (MD=1.05, 95%CI 0.60 to 1.49, P<0.01), mean RR (MD=?11.86, 95%CI ?21.77 to ?1.96, P=0.02), and HR (SMD=?0.43, 95%CI ?0.66 to ?0.20, P<0.01) all showed improvement compared with the control group. However, there were no significant differences between the two groups in LF (SMD=0.15, 95%CI ?0.10 to 0.40, P=0.23), LF norm (SMD=0.24, 95%CI ?0.10 to 0.58, P=0.16) or HF norm (SMD=0.25, 95%CI ?0.47 to 0.97, P=0.5). TEAS on PC6: SDNN, pNN50, HF, LF/HF, LF norm, HF norm, ln-LF, ln-HF, and HR all showed improvement compared with the control group. However, there were no significant differences between the two groups in RMSSD, LF, or RR interval. Conclusion This study supports the improvement of heart rate variability by transcutaneous acupoint electrical stimulation and PC6 acupoint selection. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To observe the changes of visual pathway of central nervous system in patients with glaucoma.Methods Thirty-five subjects were enrolled in this prospective study. There were seven patients of chronic primary angle closure glaucoma with bilateral visual field defects, 12 patients of primary open angle glaucoma with bilateral visual field defects, and 16 normal subjects. GE Signa HD 1.5 T magnetic resonance scanners and head eight phased array were used. The mean fractional anisotropy (FA) and the mean average diffusion coefficient (DCavg) of white matter tracts in visual pathway of bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation were measured by diffusion tensor imaging, meanwhile the white matter tracts were reconstructed by fiber tracking system. The volumes of lateral geniculate body were measured by coronal proton density weighted magnetic resonance imaging.Results The differences of FA among bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation were statistically significant (F=25.985，20.626，12.262，22.399，21.708，24.994，22.774；P＜0.05). There was no difference of DCavg among bilateral optic nerve, optic chiasma, bilateral optic tract，bilateral optic radiation（F=2.097，2.178，0.530，0.983，0.608, 0.866, 1.504；P＞0.05）. The differences of volume of lateral geniculate body among three groups were statistically significant （F=18.631，17.274；P＜0.05）. Conclusion There is degeneration in visual pathway of central nervous system in patients with glaucoma.
ObjectiveTo observe and analyze the clinical characteristics and correlation between the eye and nervous system in children with infantile gangliosideosis.MethodsFrom November 2018 to January 2021, 3 children with infantile ganglion lipidosis diagnosed by genetic examination in the Department of Ophthalmology and Neurology, Beijing Children's Hospital of Capital Medical University, and through China National Knowledge Infrastructure and Wanfang database and The National Library of Medicine of the United States (PubMed) were searched, and 53 cases of Chinese infantile gangliosideosis diagnosed by gene, enzyme activity or pathological examination were selected and a total of 56 cases were included in the study. The searching time was from the establishment of the database to February 2021, and the search keywords are "gangliosideosis", "cherry-spot" macula and "Chinese". The demographic characteristics of 56 cases of children and other system manifestations were analyzed such as eyes, nervous system, skin, bones. According to the presence or absence of cherry-spot (CS) on the fundus examination, the children were divided into a fundus CS group (group A) and a fundus without CS group (group B), with 20 and 27 cases, respectively. The age of onset, gender, different types and neurological manifestations of the two groups of children were compared and analyzed. The non-parametric rank sum test was used for age comparison between groups; the χ2 test or Fisher's exact test were used for the comparison of gender, disease type and incidence between groups.ResultsAmong the 56 children, 27 were males and 29 were females; the median age of onset was 7.0 months. There were 33 and 23 cases of GM1 and GM2, respectively. Among 44 children with visual function examination records, 41 cases (93.2%, 41/44) were unable to follow the visual object. Of 47 children who underwent ocular fundus examination, 20 cases (42.6%, 20/47) had CS on the fundus. The main manifestations of the nervous system are neuromotor development regression or retardation (100%, 56/56), convulsions (58.1%, 25/43), and "startle" phenomena (89.7%, 26/29). Among 42 patients with brain magnetic resonance imaging examination records, 39 cases (92.9%) were abnormal. The incidence of "startle" and seizures in group A was higher than that in group B, and the difference was statistically significant (χ2=5.815, 6.182, P=0.021, 0.013).Conclusios Chinese infantile gangliosideosis is more common in GM1 type. Ocular visual impairment is the visual object as the main manifestation, the incidence of fundus CS is 42.6%, and the symptoms of neurological damage in children with CS are more severe.
Heart rate variability time and frequency indices are widely used in functional assessment for autonomic nervous system (ANS). However, this method merely analyzes the effect of cardiac dynamics, overlooking the effect of cardio-pulmonary interplays. Given this, the present study proposes a novel cardiopulmonary coupling (CPC) algorithm based on cross-wavelet transform to quantify cardio-pulmonary interactions, and establish an assessment system for ANS aging effects using wearable electrocardiogram (ECG) and respiratory monitoring devices. To validate the superiority of the proposed method under nonstationary and low signal-to-noise ratio conditions, simulations were first conducted to demonstrate the performance strength of the proposed method to the traditional one. Next, the proposed CPC algorithm was applied to analyze cardiac and respiratory data from both elderly and young populations, revealing that young populations exhibited significantly stronger couplings in the high-frequency band compared with their elderly counterparts. Finally, a CPC assessment system was constructed by integrating wearable devices, and additional recordings from both elderly and young populations were collected by using the system, completing the validation and application of the aging effect assessment algorithm and the wearable system. In conclusion, this study may offers methodological and system support for assessing the aging effects on the ANS.
ObjectiveTo systematically evaluate the clinical value of machine learning (ML) for predicting the neurological outcome of out-of-hospital cardiac arrest (OHCA), and to develop a prediction model. MethodsWe searched the PubMed, Web of Science, EMbase, CNKI, Wanfang database from January 1, 2011 to November 24, 2021. Studies on ML for predicting neurological outcomes in OHCA pateints were collected. Two researchers independently screened the literature, extracted the data and evaluated the bias of the included literature, evaluated the accuracy of different models and compared the area under the receiver operating characteristic curve (AUC). ResultsA total of 20 studies were included. Eleven of the studies were from open source databases and nine were from retrospective studies. Sixteen studies directly predicted OHCA neurological outcomes, and four predicted OHCA neurological outcomes after target temperature management. A total of seven ML algorithms were used, among which neural network was the ML algorithm with the highest frequency (n=5), followed by support vector machine and random forest (n=4). Three papers used multiple algorithms. The most frequently used input characteristic was age (n=19), followed by heart rate (n=17) and gender (n=13). A total of 4 studies compared the predictive value of ML with other classical statistical models, and the AUC value of ML model was higher than that of classical statistical models. ConclusionExisting evidence suggests that ML can more accurately predict OHCA nervous system outcomes, and the predictive performance of ML is superior to traditional statistical models in certain situations.
ObjectiveTo evaluate the role of N-methyl-D-aspartate (NMDA) receptor in central nervous system (CNS) injury of obstructive jaundice. MethodThe related literatures about NMDA receptor and the CNS injury caused by hyperbilirubinemia were retrieved and reviewed. ResultsThe CNS injury of obstructive jaundice was related to overactivation of NMDA receptor, which finally resulted in degeneration and necrosis of nerve cells. The NMDA receptor antagonist MK-801 could relieve the CNS injury of obstructive jaundice. ConclusionsNMDA receptor plays an important role in the CNS injury caused by hyperbilirubinemia, and the blocker of NMDA receptor has protective effects in this process. However, there is no report of MK-801 in clinical application when hyperbilirubinemia happened.
Objective To investigate the clinical features, diagnosis and treatment of symptomatic epilepsy complicated with central nervous system leukemia (CNSL) recurrence after acute lymphoblastic leukemia (ALL) treatment in children. MethodsThe clinical data of a child with secondary recurrence of CNSL complicated with symptomatic epilepsy after ALL treatment admitted to the Department of Pediatrics of the Second Affiliated Hospital of Auhui Medical University from December 2020 to February 2023 were retrospectively analyzed, and the relevant literature was reviewed and discussed. ResultsPatient was ALL for nealy two years after treatment in the central nervous system leukemia relapse of concurrent symptomatic epilepsy, two of the central nervous system leukemia relapse when starting symptoms are seizure, the first recurrence was status epilepticus, second recurrence of concurrent limb hemiplegia symptoms, cerebrospinal fluid, cranial magnetic resonance (MRI) and abnormal changes of electroencephalogram and clinical features, the abnormal changes of brain MRI lesions and electroencephalogram did not disappear. Chemotherapy, intrathecal injection and radiotherapy were given for the primary treatment, follow up CAR-T immunotherapy, and the treatment was successively combined with nalproate and levetiracetam. Currently, the seizures were controlled. ConclusionFor children with ALL, the recurrence of CNSL should be warned after the end of treatment. Cerebrospinal fluid, cranial imaging and electroencephalogram examination should be completed in time to confirm the diagnosis. If the crania imaging lesions persist after treatment and abnormal electroencephalogram discharge does not disappear, the possibility of CNSL recurrence should be warned when the epileptic seizures are repeated. On the basis of primary disease active treatment, combination of antiseizure medications is preferable.
Objective To develop a novel prediction model based on cerebrospinal fluid (CSF) lactate for early identification of high-risk central nervous system (CNS) infection patients in the emergency setting. Methods Patients diagnosed with CNS infections admitted to the Department of Emergency Medicine of West China Hospital, Sichuan University between January 1, 2020 and December 31, 2023 were retrospectively selected. Patients were classified into a survival group and a death group according to their 28-day survival status, and clinical characteristics were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of 28-day mortality, which were subsequently used to construct a nomogram. Results A total of 173 patients were included, comprising 135 in the survival group and 38 in the death group. Multivariate analysis identified the Acute Physiology and Chronic Health Evaluation Ⅳ (APACHE Ⅳ) score [odds ratio (OR)=1.027, 95% confidence interval (CI) (1.002, 1.055), P=0.034], CSF lactate [OR=1.147, 95%CI (1.025, 1.286), P=0.018], and interleukin-6 [OR=1.002, 95%CI (1.001, 1.004), P=0.002] as independent predictors of 28-day mortality. The integrated model combining APACHE Ⅳ score, CSF lactate, and interleukin-6, demonstrated superior predictive performance compared with the APACHE Ⅳ score alone (P=0.020), and showed good calibration (Hosmer-Lemeshow P=0.50). Conclusions This tool may provide a useful instrument for emergency physicians to assess the 28-day mortality risk in patients with CNS infections, potentially facilitating early and targeted interventions for high-risk individuals. However, as the findings of this study are derived from a single-center retrospective dataset, the clinical applicability of this model requires further external validation through large-scale, prospective, multicenter studies to evaluate its generalizability.
ObjectiveTo summarize the current research progress on the changes of enteric glial cells (EGCs) in intestinal motility disorders and its possible molecular mechanisms in regulating intestinal motility.MethodThe literatures related to the EGCs and intestinal dysmotility were collected and analyzed.ResultsThe EGCs were involved in the occurrence and development of intestinal motility disorders, and there were abnormalities in the quantity, receptor, and phenotype in the different dysmotility diseases such as the postoperative ileus, Hirschsprung disease, inflammatory bowel disease, diabetes and so on. It could sense the neuronal signals and communicate with the enteric neurons via Ca2+ response and connexin-43 to affect the intestinal motility.ConclusionStudy of role and mechanism of EGCs in intestinal motor dysfunction is helpful to discovery new targets for treatment of these diseases.