The application of dopamine agonists in Parkinson’s disease has been a hot topic in recent years. Can dopamine receptor agonists serve as the initial drugs for Parkinson’s disease? Does it improve the natural history of patients? Has it neuroprotective role? When and how to use dopamine receptor agonists? This article provides evidence on the pros and cons of dopamine receptor agonists in the treatment of Parkinson’s disease for helping clinical decision making.
Objective To investigate the long-term prognosis of cerebral venous sinus thrombosis (CVST) and to identify the early predictors of poor outcome. Methods We performed a prospective register study on the prognosis of CVST patients. All patients were followed up continuously. The primary endpoint was death or dependence as assessed by the modified Rankin Scale (mRS) score gt;2 at month 6. A multivariable logistic regression model was applied to identify the predictors of outcome. Results A total of 52 CVST patients were included. The rates of recurrence and death at month 6 were 13.5% and 7.7%, respectively, and 29.9% of the patients were dead or dependent at month 6. The multivariable logistic regression analysis revealed that the predictors of death or dependence at month 6 were intracranial parenchymal lesion (OR=14.62, 95%CI 2.36 to 90.36) and delayed diagnosis (OR=13.14, 95%CI 1.90 to 90.84). Conclusion In China, CVST is still a disease that may lead to death or dependence. Its long-term prognosis is relatively poor compared to that reported in western patients. This difference may due to the delayed diagnosis of CVST in China.
ObjectiveTo investigate the capability and demands of medical students of medical information retrieval, and to provide information for medical information literacy education.MethodsWe conducted an online questionnaire survey among medical students from 15th to 21st July, 2019, aiming to analyze basic characteristics of the subjects and their ways and capability to acquire medical information, and evaluated their demands and satisfaction about relevant courses.ResultsFour hundred and nine valid questionnaires were collected. The average age of the respondents was (21±3) years old. Among the respondents, 279 (68.2%) were female, 290 (70.9%) were undergraduates, and 187 (45.7%) majored in clinical medicine. The mostly accessed ways to obtain medical information were textbooks (87.8%) and search engines (84.4%). Among Chinese literature databases, the most commonly used was China National Knowledge Infrastructure (67.7%), followed by Wanfang (54.3%). As for English literature databases, the most commonly used was PubMed (66.0%), while the proportions of respondents who used other databases was less than 1/4. As for the problems when obtaining information, 84.8% of the respondents supposed that no access to some online databases was the main problem. Obtaining information from search engine scored the highest [(3.21±1.00) points, 5 points totally] when they were asked to self-evaluate their ability to obtain medical information by different methods. In terms of training demands, the need for courses about literature authenticity and accuracy evaluation was the highest [(4.05±1.07) points, 5 points totally]. The trainings were expected to be conducted within 1-2 years after enrollment (83.9%). Training through professional courses (86.8%) was the most welcomed training form, followed by courses on MOOC (51.3%), an online course platform. More than 50% of the respondents were satisfied with the current relevant courses and trainings.ConclusionBoth the students’ capability of medical information retrieval and the design of relevant trainings should be improved to better prepare the medical students for further clinical practice and scientific research.
Objective To investigate the relationship between systemic inflammation response index (SIRI) and early neurological deterioration (END) and 3-month prognosis in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke treated at West China Hospital of Sichuan University and Deyang People’s Hospital between April 2020 and October 2020 were collected. Clinical data were collected using a unified case form and outcomes were followed up for 3 months. According to the poor prognosis, the patients were divided into END group and non-END group. The multivariate logistic regression analysis was used to explore the relationship of SIRI, END and 3-month prognosis. We drew receiver operating characteristic curve to evaluate the value of related factors in predicting the occurrence of END and poor prognosis after 3 months. Results A total of 242 patients were included, of which 47 (19.42%) were in the END group. There were statistically significant differences between the two groups in National Institutes of Health stroke Scale (NIHSS) score on admission, hypertension, creatinine, urea nitrogen, neutrophils count, lymphocyte count, neutrophil count/lymphocyte count ratio (NLR), lymphocyte count/monocyte count ratio, platelet count/lymphocyte count ratio, complications (besides cerebral edema) and SIRI (P<0.05). Logistic regression analysis showed that NIHSS score on admission, hypertension, SIRI and NLR were independent risk factors for END (P<0.05). SIRI had better predictive value for the occurrence of END than NLR (P<0.05). Compared with the non-END group, the patients in the END group had worse prognosis at 3-month [44.7%(21/47) vs. 17.4% (34/195), P<0.05]. NIHSS score on admission had predictive value for clinical prognosis of acute ischemic stroke patients at 3-month. Conclusion SIRI is an independent risk factor for END in patients with acute ischemic stroke, and there is no independent correlation with the 3-month prognosis.
Objectives To assess the efficacy and safety of dl-3-butylphthalide for patients with acute ischemic stroke. Methods We collected randomized controlled trials, which compared dl-3-butylphthalide agents with placebo or open control in patients with acute ischaemic stroke, by searching the electronic bibliographic databases, scanning references listed in articles and handsearching journals. Meta-analysis was conducted based on the methods recommended by the Cochrane Collaboration. Results Twenty-one trials involving 2 123 patients were included, of which 2 were placebo-controlled and 19 were open-label controlled. Meta-analysis of 10 trials (n=958), in which neurological deficits were assessed by CSS, suggested that there were significant differences favoring butylphthalide in the mean change of neurological deficits’ score during the treatment period [MD=2.30, 95%CI (1.57, 3.03)]. Meta-analysis of 6 trials (n=590), in which neurological deficits were assessed by NIHSS, also favored butylphthalide [MD=2.06, 95%CI (0.65, 3.46)]. Adverse events (AEs) were reported in 13 trials. Gastrointestinal discomfort (1.7%~8%) and abnormal liver function including abnormal ALT (1.4%~17.5%) and abnormal AST (1.9%~8.82%) were the two most common AEs. However, no severe adverse events (SAEs) were reported. Numbers of dead and dependent patients at the end of followup (at least three months) were not reported in the 21 included trials. Quality of life was not assessed in any of the trials. Conclusion Dl-3-butylphthalide can improve the neurological function after acute ischemic stroke and appears to be safe. However, further study is needed to confirm its effects for lowering rates of death and dependency.
Severe/massive ischaemic stroke is difficult to treat and has poor prognosis. There are limited studies for specific treatment of these conditions and no consensus on their definitions. This proposal suggests definitions and a flowchart for the diagnosis and treatment of these conditions. We focus on predicting and preventing malignant oedema at an early stage, monitoring the level of consciousness and vital signs, and the prevention and management of complications (eg. pulmonary infections). We particularly provide suggestions for the treatment with intravenous thrombolysis, endovascular treatment, antiplatelet and anticoagulation. More studies are warranted to support individualised management of infarct swelling, intracranial hypertension and early rehabilitation for severe/massive ischaemic stroke.
Massive cerebral infarction with malignant brain edema has poor prognosis with very high mortality, despite aggressive medical treatment. Surgical decompression is recommended by Chinese and international clinical guidelines for patients with massive cerebral infarction, however, there is no standardized diagnosis and treatment protocol in clinical practice. Following the principle of evidence-based medicine and based on the diagnosis and treatment norms of the participating hospitals of Severe Ischaemic Stroke Collaboration in recent years, we recommend this consensus statement of the standardized surgical decompression for malignant brain edema in massive cerebral infarction.