Objective To propose the terminology of acoustic hypersensitivity, and investigate its clinical features and relationship with tinnitus. Methods A total of 214 patients with acoustic hypersensitivity or tinnitus as their first chief complaint were recruited and studied between January 2014 to January 2016. Detailed information of clinical manifestations, accompanying symptoms and related medical history were collected in the patients with acoustic hypersensitivity. Patients were instructed to complete the Hyperacusis Questionnaire and the Self-rating Anxiety Scale. The Tinnitus Evaluation Questionnaire was used to evaluate tinnitus severity in patients with tinnitus. Results Among the patients with acoustic hypersensitivity as their first chief complaint, 93.3% had tinnitus; 47.3% of the patients with tinnitus as their first chief complaint had acoustic hypersensitivity and the prevalence of acoustic hypersensitivity increased as the tinnitus severity increased. In terms of onset of the two symptoms, simultaneous acoustic hypersensitivity and tinnitus occurred in 55.1% of the patients, acoustic hypersensitivity occurred after tinnitus in 34.7% of the patients, and acoustic hypersensitivity occurred before tinnitus in 10.2% of the patients. Most patients with acoustic hypersensitivity as the first chief complaint felt uncomfortable to any sounds that are louder than usual. The main manifestations included feeling disturbed, echoing in the ear or head, ear fullness or pain. Discomfort in 68.6% of the patients disappeared when there was no environmental sound. It was found that hearing loss, ear fullness, vertigo, and anxiety were usually present in patients with acoustic hypersensitivity, and 28.6% of the patients with acoustic hypersensitivity had a history of noise exposure. Conclusions Acoustic hypersensitivity occurs together with tinnitus for the majority of time, which shows a close relationship between these two symptoms. However, acoustic hypersensitivity shows different clinical manifestations from tinnitus. It is important to unify the terminology and standardize the concept of acoustic hypersensitivity among clinicians. It is also critical to conduct more clinical research in terms of diagnosing and evaluating acoustic hypersensitivity.
ObjectiveTo analyze the clinical characteristics of thrombo embolism (TE) in Chinese hypertrophic cardiomyopathy (HCM) patients. MethodsThis study retrospectively analyzed HCM patients admitted to West China Hospital of Sichuan University. The endpoints were defined as a composite of TE events, including ischemic stroke, transient ischemic attack, and peripheral arterial embolization. ResultsA total of 537 HCM patients were included with a median follow-up of 4.2 years. Forty-two patients reached the TE endpoint and the incidence was 1.9%. The annual incidence of TE was approximately 1.1% and 6.6% for HCM patients without/with atrial fibrillation, respectively. The recurrence rate of TE was high (approximately 26.2%). The mean age was 66.4±13.7 years for the first TE, and the incidence of TE was significantly increased at age ≥70 years. ConclusionThe incidence of TE is high in HCM patients, especially in those with atrial fibrillation, and the recurrence rate of TE is also high.
ObjectiveTo analyze the clinical presentations and radiological characteristics of pulmonary vein stenosis after radiofrequency ablation. MethodsClinical and radiological data of 2 patients with pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation were retrospectively analyzed and literatures were reviewed. ResultsBoth patients had undergone circumferential pulmonary vein isolation. The symptoms appeared approximately 2 months after the operation. The major symptoms were cough, hemoptysis, exacerbation of dyspnea and chest pain. Both patients were misdiagnosed as other diseases such as pneumonia in other hospitals, and the anti-infection therapy was invalid. Both CT scans showed parenchymal exudative consolidation with varying degrees of interstitial septal thickening and small nodules. Both patients were confirmed as pulmonary vein stenosis by CT angiography. Literature review identified 21 cases of pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation. The main clinical features are hemoptysis, chest pain, shortness of breath and cough. The most common features of thoracic radiological imaging are consolidation, groud-glass attenuation, pleural effusion and interstitial septal thickening. ConclusionsIf a patient presents with hemoptysis, dyspnea, chest pain or other clinical manifestations after ablation therapy and image findings show parenchymal exudative consolidation with interstitial septal thickening and multiple small nodules, the possibility of pulmonary vein stenosis should be considered. Contrast-enhanced CT combined with pulmonary vein imaging technology can clearly show the opening diameter of each pulmonary vein and its branches, so it is an important non-invasive examination method for the evaluation and diagnosis of pulmonary vein stenosis.
ObjectiveTo explore the clinical features and prognosis of ischemic cerebral infarction in young population,and to provide a reference for clinical prevention of cerebral infarction in young population. MethodsA total of 547 patients with ischemic cerebral infarction diagnosed between January 2008 and June 2013 were included,and the difference in clinical data and outcomes between young and old patients were retrospectively compared. ResultsThe 547 patients included 233 young and 314 old patients,and there were more male patients in young group.As compared to the old group,the proportion of hypertension was significantly lower in young group (51.9%,64.3%;P=0.004);while smoking (51.9%,5.7%;P=0.000) and alcoholism (53.2%,28.3%;P=0.000) were significantly higher in young group.Moreover,there were more patients with vascular malformations in young group than that in old group (7.3%,3.2%;P=0.028).And there were also more patients in young group received thrombolytic therapy and antiplatelet therapy (98.3%,86.9;P=0.000),and the prognosis of young patients was significantly better than that of old patients. ConclusionThe prognosis of young patients with ischemic stroke prognosis is relatively good,and changing bad habits would be an effective measure to prevent and reduce the occurrence of ischemic cerebral infarction in young population.
ObjectiveTo observe the clinical and fundus imaging features of acute macular neuroretinopathy (AMN) associated with COVID-19. MethodsA retrospective case study. A total of 32 eyes of 18 patients diagnosed of AMN associated with COVID-19 at Chengdu Aidi Eye Hospital from December 2022 to February 2023 were included. All patients had a history of fever 1 to 5 days prior to ocular onset and tested positive for SARS CoV-2 antigen. All patients were examined by best-corrected visual acuity (BCVA), color fundus photography, scanning laser ophthalmoscope (SLO), infrared fundus photography (IR), and optical coherence tomography (OCT); OCT angiography, visual field and multifocal electroretinogram (mf-ERG) were performed in 6 patients (11 eyes), 3 patients (6 eyes) and 1 patient (2 eyes), respectively. Follow-up time was 8-10 weeks. The clinical and fundus imaging features were observed and analyzed.ResultsThere were 6 males (12 eyes) and 12 females (20 eyes), aged from 15 to 36 years, with the mean age of (28.00±5.86) years. Fourteen patients were bilateral and 4 patients were unilateral. The time from the onset of eye symptoms to seeing a doctor was ranged from 1 day to 8 weeks. Among them, 6 patients (10 eyes) visited the doctor within 3 days of onset, while 12 patients (22 eyes) visited the doctor after 3 days of onset. The BCVA was 0.80±0.29. Fundus color photography and SLO examination showed that only 2 patients (4 eyes) showed sheet or petal-like dark red lesions in the macular area, and no obvious abnormal changes were observed in other patients. No obvious abnormalities were found in AF examination of all patients. IR examination showed no significant abnormality in 6 cases which came to hospital within 3 days after the onset, but irregular hyporeflective dark shadow lesions in the macular region of patients with more than 3-day course of disease was observed. OCT examinations of all eyes showed hyperreflective band or patchy lesion on the outer plexiform layer (OPL) and outer nuclear layer (ONL) and affect the ellipsoid zone (EZ) and interdigitation zone (IZ). In 11 eyes of 6 patients undergoing OCTA examination, the blood flow density of the choroidal capillary layer in the focal area decreased. In 6 eyes of 3 patients who underwent visual field examination, the physiologic scotoma was slightly enlarged. One patient (2 eyes) receiving mf-ERG showed a concave reduction in macular center amplitude. The hyperreflective band lesion on OPL and ONL disappear rapidly within 2 weeks, while the continuity of EZ recovered slowly, and the disruption of IZ kept existing for more than 10 weeks. ConclusionsMost AMN associated with COVID-19 are young women; IR showed irregular weak reflex in the lesion area. OCT showed strong OPL and ONL reflection. OCTA was characterized by decreased blood flow density in the choroidal capillary layer of the focal area.
ObjectiveTo evaluate the clinical features of the retroperitoneal paralangliomas. MethodClinical data of 34 patients with retroperitoneal paragangliomas who underwent surgery in our hospital between January 2005 and January 2015 were enrolled, all patients diagnosed by pathological examination. ResultsClinical manifestation: hypertension (n=4) and headache (n=1) were the main symptoms in all 5 patients with functional tumor. Abdominal distension (n=14) or abdominal pain (n=11) were the initial symptoms in patients with nonfunctional tumor, gastrointes-tinal obstruction was observed in 1 patient, the other 3 patients were diagnosed accidently among the 29 patients with nonfunctional tumors. Blood and urine catecholamines increased notly in 5 patients with functional tumor, increased mildly in 2 patients with nonfunctional tumor; and remained at a normal level in the other patients. All the 34 patients underwent surgery, 4 patients with nonfunctional tumors who suffered from vessel wrapped needed tumor resection combining with main vessel resection or reconstruction, 1 of the 4 patients presented with vascular wall invasion. Two patients presented with lymph-vascular invasion of patients didn't received vessel resection or reconstruction. The mean value of diameter of these tumors was (9.5±5.1) cm (3.5-18.5 cm). Twenty four tumors had complete capsule, the other 10 had partial capsule; 32 tumors were well differentiated, and other 2 patients had apparent strange nucleus. Among the 34 patients, G1 tumors were confirmed in 14 patients and G2 tumors were confirmed in 20 patients. All the 34 patients were followed up with a mean value of follow-up time of 52 months (1-105 months). During the follow-up period, 6 patients suffered from recurrence and 6 patients died. The 1-year and 5-year survival rates were 86.0% and 81.5%, respectively. ConclusionsRadical resection may be the only measure to cure retroperitoneal paragangliomas. Tumor combining with vascular resection or reconstruction provide a chance for patients with ‘unresectable tumors’.
ObjectiveAnalyze the clinical features of epilepsy induced by tuberous sclerosis complex (TSC) to improve diagnosis and treatment level of this disease, and improve the prognosis. MethodsThe clinical data of 54 patients with epilepsy induced by TSC from May, 2012 to May, 2015 were analyzed together with the physical data, clinical presentations, EEG, imaging findings, treatment, prognosis and follow-up. Summarizing the clinical features of epilepsy induced by TSC. ResultsPatients with different epilepsy onset age, whether or not combined spasm, differences in intelligence status were statistically significant (P < 0.05); Patients with different gender, skin lesions, types of seizures, differences in intelligence status were no statistical significance (P > 0.05); Patients with different gender, epilepsy onset age, differences in patients with spasm were statistically significant (P < 0.05); Patients with different family history, skin lesions, types of seizures, differences in patients with spasm were not statistically significant (P > 0.05). Patients with different intelligence status, difference of medication quantity was statistically significant (P < 0.05); Patients with different gender, onset age, family history, skin lesions, whether or not combined spasm, types of seizures, difference of medication quantity was not statistically significant (P > 0.05). ConclusionsEpilepsy is the most common neurological manifestations in TSC, mostly onset in early childhood. Seizure types are different from one to another. Patients can be combined with skin damage and mental retardation. Positive rate of EEG and head imaging examination are high, seizure control rate is low. Patients need long-term follow-up and timely adjustment of treatment. Intelligence status is related to epilepsy onset age, spasm. Patients with spasm are related to different gender, epilepsy onset age. Medication quantity is related to intelligence status.
Glioma related epilepsy (GRE) is a complication that seriously affects the quality of life and treatment process of glioma patients. The genes and biomolecules in the tumor microenvironment may contribute to the mechanisms and pathways of epilepsy. In addition, it has been found that epileptic seizures can promote the growth of brain tumors, making controlling epilepsy a key factor in treating brain tumors., However, in current understanding, not all genetic molecular features carried by gliomas themselves are involved in the pathogenesis of GRE. With the deepening understanding of GRE, it has been discovered that some molecular features of gliomas are involved in the pathogenesis of GRE, mainly through the Ras/Raf/MAPK (MEK)/ERK and PI3K/AKT/mTOR pathways, which are also involved in the pathogenesis of gliomas. In 2021, the World Health Organization (WHO) classified diffuse gliomas into two categories: adult and pediatric, and further subdivided them into types such as astrocytoma, oligodendroglioma, and glioblastoma. This classification helps to more accurately understand and apply the molecular characteristics of gliomas, promote the standardization of tumor pathological diagnosis, and may have an impact on the treatment and prognosis evaluation of GRE. This review links genes and biomolecules in the tumor microenvironment through the latest WHO classification, summarizes previous research and recent findings, and provides a deeper understanding of the molecular characteristics of gliomas and their relationship with epilepsy related molecular pathways. It explores more effective treatment methods to suppress epilepsy symptoms and tumor growth, which is of great significance for improving the diagnosis and treatment of GRE.
ObjectiveTo investigate the clinical characteristics of non-tuberculous mycobacterium (NTM) pulmonary disease and pulmonary tuberculosis, as well as the bacterial distribution of NTM pulmonary disease. Methods The bacterial distribution and clinical characteristics of 104 patients with NTM lung disease hospitalized in Jiangxi Provincial People’s Hospital from May 2017 to May 2020 were retrospectively analyzed, as well as the clinicplal characteristics of 155 patients with tuberculosis hospitalized during the same period. Results The age of NTM lung disease group [(60±15) years] was higher than that of tuberculosis group [(55±19) years]. There were statistically significant differences in basic diseases (such as malignant tumor, type 2 diabetes, old tuberculosis, bronchiectasis), laboratory examination (such as blood routine examination, albumin) and chest imaging characteristics between the two groups (P<0.05). There was no significant difference in clinical symptoms (such as cough, sputum or fever) (P>0.05). The common underlying diseases of NTM lung disease were malignant tumor (29%), bronchiectasis (21%), chronic obstructive pulmonary disease (19%), etc. The common clinical symptoms of NTM lung disease included cough, sputum, fever, hemoptysis, chest tightness and shortness of breath, and other non-specific respiratory symptoms. The common manifestations of NTM lung disease on chest high-resolution CT (HRCT) included patchy images (82%), mediastinal lymph node enalargement (35%), pleural thickening (31%), pleural effusion (26%) and other signs. The isolates of NTM included Mycobacterium avium (50%), Mycobacterium intracellulare (21%), Mycobacterium chelonae/abscessus (14%), Mycobacterium fortuitum (5%), Mycobacterium gordonae (4%), Mycobacterium gilvum (3%), and Mycobacterium smegmatis (3%). Multivariate Logistic regression analysis showed that advanced age (OR=1.027) was a risk factor for NTM lung disease. Conclusions The clinical manifestations of NTM lung disease and tuberculosis are similar and difficult to distinguish. For male patients over 60 years old with malignant tumor, old tuberculosis, bronchiectasis and other basic diseases, and the chest HRCT findings are mainly bronchiectasis, NTM lung disease should be actively excluded. There is little difference in clinical manifestations between different strains of NTM lung disease, and the treatment cycle of NTM lung disease is long and easy to be interrupted, requiring enhanced follow-up.
ObjectiveTo explore the relationship between morning symptoms and other clinical characteristics in patients with chronic obstructive pulmonary disease (COPD), and to look for related risk factors affecting morning symptoms.MethodsThis cross-sectional observational study included 153 patients with stable COPD. Morning symptoms were evaluated with the Chinese-version of Chronic Obstructive Pulmonary Disease Morning Symptom Diary (Ch-COPD-MSD). And modified version of the British medical association respiratory questionnaire (mMRC), COPD assessment test (CAT), questionnaire clinical COPD questionnaire (CCQ) score were scored, and the BODEx index was calculated.ResultsA total of 153 stable COPD patients were included. The patients aged 59.6±7.6 years with a mean forced expiratory volume in one second of (52.0±20.7)% predicted (FEV1%pred). The median score of morning symptoms was 31.00. Morning symptoms severity was different between GOLD groups A to D: median (interquartile range) score in GOLD A was 23.50 (20.00 - 27.25), in GOLD B was 31.00 (26.00 - 38.00), in GOLD C was 30.00 (23.75 - 35.75), and in GOLD D was 36.50 (27.00 - 47.50) (P<0.001). Meanwhile, under different mMRC, CAT, CCQ scores, the difference in the median score of morning symptoms was statistically significant (all P=0.000). Score of morning symptoms was negatively correlated with the FEV1%pred (r=–0.24, P<0.001), and positively correlated with the score of mMRC, CAT, CCQ, and the BODEx index (r value was 0.50, 0.60, 0.53, 0.40, respectively, P<0.001). Multiple linear regression analysis showed that CAT score was the important factor associated with morning symptoms severity in COPD (B=0.829, P<0.001).ConclusionsMorning symptoms are associated with multiple clinical indicators for assessing the severity of COPD, and health status is the most strongly associated with morning symptoms. Clinical evaluation of morning symptoms in patients with COPD can be helpful in comprehensive assessment of the patient’s condition.