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Background and Purpose: Microanatomy studies reveal that most penetrating branches of middle cerebral artery (MCA) arise from the dorsal-superior surface of the trunk. Using high-resolution MRI, we sought to explore the plaque distribution of MCA atherosclerosis and its clinical relevance in relation to the orifices of penetrating arteries., Methods: We retrospectively analyzed the imaging and clinical data of 86 patients with atherosclerotic MCA stenosis. On high-resolution MRI, plaques were categorized based on the involvement of the superior, inferior, ventral, or dorsal MCA wall. The relationship of plaque distribution and clinical presentation was analyzed., Results: A total of 92 stenotic MCAs (40 symptomatic and 52 asymptomatic) on 828 image slices were studied. Overall, of the 251 slices with identified plaques, plaques were more frequently located at the ventral (44.8%) and inferior (31.7%) wall as compared with the superior (14.3%) and dorsal wall (9.0%; P<0.001). Symptomatic MCA stenosis had more superior (P=0.016) and less inferior (P=0.023) wall plaques than asymptomatic stenosis. Within the group of symptomatic MCA stenosis, vessels with penetrating artery infarctions had more superior (P=0.001) but less ventral (P=0.038) and inferior (P=0.024) plaques than without penetrating artery infarctions., Conclusions: MCA plaques tend to locate opposite to the orifices of penetrating arterial branches. Further studies are required to investigate whether MCA plaque distribution is an independent determinant of stroke occurrence and its subtypes.

In the crystal structure of the title compound, C(8)H(6)N(2)O(3), the mol-ecules are linked by a pairs of inter-molecular N-H⋯O hydrogen bonds, forming inversion dimers. The aldehyde group is in the same plane as the pyrimidine ring [with a maximum deviation of 0.083 (2) Å for the O atom), and the linear propargyl group [C-C-C = 178.99 (19)°] makes a dihedral angle of 74.36 (13)° with the ring.

Immune colloidal gold (ICG) technique is a simple, rapid, accurate diagnosis method. At present, ICG technique has been widely applied in the accessory diagnosis of parasitoses, and this article reviews the latest progress of ICG technique applied in parasitology.

Background and Purpose: There were limited data on the long-term outcome of patients with symptomatic intracranial atherosclerotic stenosis ≥70% after Wingspan stenting. Using our Wingspan cohort data and the data from the Warfarin and Aspirin for Symptomatic Intracranial Atherosclerotic Disease (WASID) as a historical control, we tested the hypothesis that stenting provided no benefit over antithrombotic therapy alone for these high-risk patients., Methods: Between January 2007 and February 2009, 100 consecutive patients with intracranial atherosclerotic stenosis ≥70% and symptoms within 90 days were enrolled into this prospective single-center Wingspan cohort study and followed up until the end of February 2010. Stenosis was measured per the WASID criteria. One-year risk of primary end point (any stroke or death within 30 days and ipsilateral ischemic stroke afterward) was compared with that of ipsilateral ischemic stroke in the WASID patients with ≥70% stenosis., Results: The stent placement success rate was 99%. All patients but 1 had clinical follow-up of ≥12 months. During a mean follow-up of 1.8 years, 9 patients developed primary end point events (5 within 30 days and 4 afterward). The 1-year risk of the outcome events was lower than that in similar WASID patients: 7.3% (95% CI, 2.0% to 12.5%) versus 18% (95% CI, 13% to 24%; P<0.05)., Conclusions: The clinical outcome of Wingspan stenting for high-risk intracranial atherosclerotic stenosis patients in this high-volume center study compares favorably with that of antithrombotic therapy alone. A randomized trial comparing medical therapy alone with medical therapy plus Wingspan stenting, conducted at high-volume centers, is needed to confirm the stenting benefit.

Background and Purpose: Some patients with posterior reversible encephalopathy syndrome (PRES) present with atypical clinical and neuroimaging findings. The purpose of this study is to review the clinical and neuroimaging findings in patients diagnosed with PRES., Methods: We retrospectively included all patients diagnosed with PRES between January 2005 and March 2009. We reviewed demographic, clinical and laboratory data, neuroimaging findings, and prognosis., Results: Twenty-four patients were included with a median age of 19 years. The clinical presentations included seizures (91.7%), headache (83.3%), visual disturbance (62.5%), encephalophathy (29.2%), and paralysis (8.3%). Co-morbidities included systemic lupus erythematous (29.2%), kidney disease (20.8%), eclampsia (20.8%), renal artery stenosis (12.5%), Takayasu arteritis (4.2%), Sheehan's syndrome (4.2%), allergic purpura (4.2%), and acute intermittent porphyria (4.2%). Acute elevation of blood pressure was found in 22 patients (91.7%). Ten patients (41.7%) used steroids or immunosuppressants, three (12.5%) had acute renal failure before the symptoms. Atypical neuroimaging features included involvement of the frontal lobe (54.2%), basal ganglia (4.2%) or cortex (8.3%), and irreversible lesions (3/18, 16.7%)., Conclusions: A large proportion of patients with PRES may present with atypical neuroimaging findings. Apart from the known risk factors, such as hypertension, immunosuppressants, and renal failure of various etiologies may be the precipitants of PRES., (© 2010 by the American Society of Neuroimaging.)

Background: Dystonia is defined as the presence of sustained involuntary muscle contractions, often leading to abnormal posture and movement. DYT1 is caused by a mutation in the TOR1A gene, whilst mutations in THAP1 gene have been identified as responsible for DYT6. The relative frequency and phenotype differences between DYT1 and DYT6 amongst Chinese primary dystonia patients have not been well-characterized., Patients and Methods: One hundred eleven unrelated Chinese patients with primary dystonia were screened for mutations in TOR1A and THAP1 genes, and correlate this with clinical presentation. Exon 5 of TOR1A and all three exons and exon-intron conjunctions in THAP1 were screened by direct sequencing., Results: Three subjects were found to have the GAG deletion in the TOR1A gene, and two patients were detected with THAP1 gene mutations/variations (c.224A>T, c.449A>C). The overall mutation frequency was 4.5% in this cohort with TOR1A mutations found in 2.7% and THAP1 mutations found in 1.8%. No mutations were detected in the controls composed of 100 normal Chinese subjects. The clinical presentations of the DYT1 cases included onset in the limbs that could progress to the generalized dystonia within several years but without cranial involvement. Whilst in the DYT6 cases, the onset was cranial or cervical and progresses very slowly., Conclusion: The major clinical differences between DYT1 and DYT6 dystonia in China were the cranial involvement in DYT6 and progress to general dystonia within several years in DYT1., (© 2010 The Author(s). European Journal of Neurology © 2010 EFNS.)

Background and Purpose: Stroke risk of asymptomatic atherosclerotic middle cerebral artery (MCA) stenosis has not been well studied. This study was designed to investigate stroke risk and prognostic factors of asymptomatic atherosclerotic MCA stenosis., Materials and Methods: A total of 200 consecutive patients who visited the transcranial Doppler ultrasound (TCD) laboratory of our hospital and who met the following criteria were prospectively enrolled in this study: diagnosed as MCA stenosis due to atherosclerosis by TCD, age above 40 years old, no history of ischemic stroke or transient ischemic attack (TIA), no ipsilateral carotid artery stenosis. The mean follow-up time was 38.3 ± 9.9 (range 4 to 60) months., Results: Thirteen patients were lost to follow up. Seven patients (3.8%) developed ischemic stroke or TIA during the follow-up period, with an occurrence rate of 0.5% in the first year and 1.6% in the second year. Three were in the blood supply region of diseased vessels, three were in the contralateral hemisphere and one case of TIA occurred in the posterior circulation. Univariate analysis showed that diabetes mellitus (DM) (X²=9.168, p=0.002) and carotid atherosclerotic plaque (X²=4.403, p=0.036) were associated with higher risk of stroke occurrence in this cohort., Conclusions: The stroke risk in patients with asymptomatic atherosclerotic MCA stenosis was low and remained stable during follow up. Higher risk of stroke occurrence is associated with DM and carotid atherosclerotic plaque., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Objective: Plasma levels of matrix metalloproteinase-9 (MMP-9) and serum level of high-sensitivity C reactive protein (hs-CRP) were detected to investigate their distributions between patients with stable stroke and those with asymptomatic intracranial artery stenosis and to explore their clinical significance., Methods: The mean level of the serum hs-CRP of the group with recurrent stroke (2.34 mg/L) was the highest, followed by that of the group with the stable stroke (1.45 mg/L), asymptomatic intracranial artery stenosis (1.31 mg/L) and control group (0.96 mg/L) (P = 0.001). The level of the MMP-9 was in sequence of recurrent stroke group (121.82 ± 72.99) µg/L > asymptomatic intracranial artery stenosis group (119.18 ± 80.01) µg/L > stable stroke group (112.76 ± 59.66) µg/L, while no statistical significance was found among groups (P = 0.947). However, the level of MMP-9 of three patient groups (118.08 ± 71.06) µg/L was significant higher than control group (57.55 ± 10.44) µg/L (P < 0.001). The spearman analysis for the relationship showed that the concentration of MMP-9 was positively associated with that of hs-CRP (r = 0.337, P < 0.001)., Conclusions: The hs-CRP maintained a high level in stable stage of stroke. The MMP-9 level in the patients group was significant higher than control group and the level of MMP-9 was positively associated with that of hs-CRP which suggested MMP-9 might be correlated with atherosclerosis other than stroke occurrence.

Objective: Recently, the technique of high-resolution magnetic resonance imaging (HR-MRI) has been developed to depict intracranial artery wall. We aimed to compare the vessel wall properties between symptomatic and asymptomatic atherosclerotic middle cerebral arteries (MCA) using HR-MRI., Methods: We studied 26 patients with symptomatic and 35 patients with asymptomatic MCA stenosis. Routine cranial MRI, magnetic resonance angiography and HR-MRI were performed on each patient. The cross-sectional images of MCA wall on HR-MRI were compared between the two groups., Results: The degree of MCA stenosis was similar between the two groups (67.9% vs 63.9%, P=0.327). On HR-MRI, eccentric plaques were observed in 26 (100%) symptomatic and 28 (80%) asymptomatic stenosis. In the remaining seven (20%) asymptomatic stenosis, only constrictive remodeling (vessel shrinkage) was observed. Compared with the asymptomatic group, symptomatic MCA stenosis had a larger wall area (P<0.001), greater remodeling ratio (P<0.001), higher prevalence of expansive remodeling (outward expansion of the vessel wall) (P=0.003) and lower prevalence of constrictive remodeling (P=0.008)., Conclusions: Different vessel wall properties on HR-MRI were observed between symptomatic and asymptomatic MCA stenosis. Further prospective studies are required to investigate whether HR-MRI is a helpful tool in stratifying stroke risk in patients with MCA atherosclerotic disease., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

A generalized exponential spectrum model is derived, which considers finite turbulence inner and outer scales and has a general spectral power law value between the range 3 to 5 instead of standard power law value 11/3. Based on this generalized spectrum model, a new generalized long exposure turbulence modulation transfer function (MTF) is obtained for optical plane and spherical wave propagating through horizontal path in weak fluctuation turbulence. When the inner scale and outer scale are set to zero and infinite, respectively, the new generalized MTF is reduced to the classical generalized MTF derived from the non-Kolmogorov spectrum.

Objective: To outline the clinical features of Kennedy disease in Chinese patients., Methods: The peripheral blood was collected from the male lower motor neuron disease patients of our inpatients and outpatients from July 2005 to September 2008. Then the genome DNA was extracted and the target gene amplified by polymerase chain reaction and sequenced. The clinical data of positive samples were analyzed and summarized., Results: The number of expanded CAG repeats of 12 patients ranged from 43 to 57. And the number of CAG repeats was inversely correlated with the age of onset (r = -0.756, P < 0.005). The first symptom of all of these patients was extremity weakness. The progression of disease was slow. One of the patients died from pneumonia. And the whole disease course lasted for 14 years., Conclusion: As an adult onset degenerative disease with a slower clinical progression, Kennedy disease has its own characteristics of inheritance pattern and natural course. It can be accurately diagnosed by androgen receptor gene analysis.

Background: Sleep disturbance is common in patients with emphysema. This study aimed to develop a novel model of sleep-related hypoxemia (SRH) in emphysema (SRHIE) with rats, and to explore the inflammatory status of SRHIE in lung, liver, pancreas, carotid artery and whole blood., Methods: Seventy-five male Wistar rats were assigned to 5 groups with 15 per group according to the exposure conditions. The protocols varied with the degree of hypoxia exposure and severity of pre-existing emphysema caused by cigarette smoke exposure: (1) SRH control (SRHCtrl) group, sham smoke exposure (smoke exposure, exposed to smoke of 15 cigarettes twice everyday, 16 weeks) and SRH exposure (12.5% O2, 3 hours, SRH exposure, divide total hypoxia time (1.5 hours or 3 hours) into 4 periods evenly (22.5 minutes or 45 minutes) and distribute these hypoxia periods evenly into physiological sleep time of rats identified by electroencephalogram, week 9 to week 16); (2) Emphysema control (ECtrl) group, smoke exposure and sham SRH exposure (21% O2, 3 hours); (3) Short SRH in emphysema (SRHShort) group, smoke exposure and short SRH exposure (12.5% O2, 1.5 hours); (4) Mild SRH in emphysema (SRHMild) group, smoke exposure and mild SRH exposure (15% O2, 3 hours); (5) Standard SRH in emphysema (SRHStand) group, smoke exposure and SRH exposure (12.5% O2, 3 hours). ECtrl, SRHShort, SRHMild and SRHStand groups were groups with emphysematous rats. Two days before the end of exposure, 5 rats in each group were randomly selected for arterial blood gas analysis. In the rest 10 rats in each group, we obtained blood samples and bronchoalveolar lavage fluid (BALF) for routine tests. We also obtained tissue blocks of lung, liver, pancreas, and right carotid artery for pathologic scoring and measurements of liver oxidative stress (measuring hepatic oxidative stress enzymes, superoxide dismutase (SOD) activity, catalase (CAT) activity and malondialdehyde (MDA) concentration)., Results: Emphysematous groups had higher mean linear intercept (MLI) and mean alveolar number (MAN) values than SRHCtrl group. MLI values in SRHStand group were the highest (all P < 0.05). O2Sat in SRHStand rats when SRH exposure was (83.45 ± 1.76)%. Histological scores of lung, liver, pancreas and right carotid artery were higher in emphysematous groups than SRHCtrl group, and SRHStand group were the highest (all P < 0.05) (SOD and CAT values were lower and MDA values were higher in groups with emphysema than without and in SRHStand group than in ECtrl group (all P < 0.05)). MDA values were the highest in SRHStand group (all P < 0.05). Total cellular score in BALF and White blood cell (WBC) in whole blood were the highest in SRHStand group (all P < 0.05). Lymphocyte ratios were the highest in SRHStand group both in BALF and blood (all P < 0.05). Red blood cell (RBC) and hemoglobin in emphysematous groups were higher than that in SRHCtrl group, and SRHStand group were higher than ECtrl group (all P < 0.05)., Conclusions: With a proper novo model of SRHIE with Wistar rats, we have demonstrated SRH may aggravate the degree of emphysematous changes, polycythemia, oxidative stress and systematic inflammation. SRH and emphysema may have a synergistic action in causing systematic damages, and lymphocyte may be playing a central role in this process. Longer duration and more severe extent of SRHIE exposure also seem to result in more serious systematic damages. The mechanisms of all these concerned processes remain to be studied.

Background: Involvement of peripheral nerves in dermatomyositis (DM) and polymyositis (PM) is less well known. In the present study we retrospectively analyzed the clinical and electrophysiological records of hospital inpatients with a diagnosis of DM or PM to investigate the association of DM/PM and peripheral neuropathy., Methods: The data of inpatients diagnosed with DM or PM were collected in Peking Union Medical College Hospital, and 186 patients (118 patients with DM and 68 with PM) were retrospectively analyzed. Nerve conduction studies (NCSs) of the median nerve, ulnar nerve, posterior tibial nerve, and common peroneal nerve were examined simultaneously., Results: There were 71 (38.2%) patients with abnormal NCS findings, 37 (19.9%) with pure motor involvement (decreased compound muscle action potential, CMAP), and 34 (18.3%) with peripheral neuropathy. Of the 34 peripheral neuropathy patients, 14 (7.5%) had polyneuropathy, 1 (0.5%) had multiple mononeuropathy, 16 (8.6%) had carpal tunnel syndrome (CTS), 1 (0.5%) had trigeminal sensory neuropathy, 1 (0.5%) had ulnar sensory neuropathy, and 1 (0.5%) had brachial plexus involvement. The prevalence of malignant disease (3/34, 8.8%), other connective tissue diseases (CTDs) (7/34, 20.6%) and diabetes (6/34, 17.6%) was significantly greater in DM/PM patients with peripheral neuropathy (chi(2) = 15.855, P = 0.000) compared with DM/PM patients without involvement of peripheral nerves (5/115, 4.3% and 7/115, 6.1%, respectively)., Conclusions: Peripheral neuropathy in DM/PM often suggests a complication with cancer, other CTDs, diabetes or CTS. From a practical point of view, NCS for DM/PM may help find the underlying disorders.

Background: Amyotrophic lateral sclerosis (ALS) is a progressive degenerative disease characterized by the loss of motor neurons in the spinal cord, brainstem, and cerebral cortex, which results in muscle weakness, atrophy. Sporadic ALS (SALS) accounts for about 90% of ALS cases, but the etiology is largely unknown. Most of the researchers consider it to be a complex disease. There have been several genome-wide association (GWA) studies reporting several single nucleotide polymorphisms (SNPs) which are susceptible to ALS, but no data of Asians (including Chinese) yet. We investigate whether the polymorphism of rs10260404 in DPP6 gene is associated with SALS in Chinese Han origin to compare the ethnic differences between Chinese Han origin and other populations., Methods: The genomic DNA was extracted from the leukocytes of whole blood samples in 58 Chinese Han patients with SALS and 52 healthy controls. The asymmetric PCR was processed in the presence of an unlabeled probe that contained the rs10260404 locus. The product was genotyped on a light scanner using high resolution melting method and some were confirmed with sequencing., Results: The rs10260404 polymorphism was in Hardy-Weinberg equilibrium in patients and controls. The CC genotype and the C allele were similar in patients compared with healthy subjects and not associated with an increased risk of Chinese SALS patients (chi(2) = 0.29, OR = 1.26, 95% CI 0.55 - 2.87, P > 0.05)., Conclusions: The rs10260404 is not associated with ALS susceptibility in Chinese people with Han origin which may be due to ethnic differences. More study with large number of cases in Chinese population is really necessary.

Objectives: To develop an intermittent hypoxia/reoxygenation (IH/ROX) rabbit carotid artery model and then investigate the inflammation status of rabbit carotid artery endothelium after IH exposure and its relationship with leptin., Materials and Methods: After anesthetization, rabbit's right common carotid artery was cleared of surrounding tissue with anatomic microscope, cannulated to its distal part and the proximal part was ligated. Preparations were challenged by changing the PO(2) of the gas mixture equilibrating the perfusate. Alternate perfusing (2 mL/min) of equilibrated perfusate bubbled with normoxia or hypoxia gas mixtures formed IH/ROX cycles in the right carotid common artery, simulating the pattern of hypoxic episodes seen in obstructive sleep apnea (OSA), or continuous perfusing of hypoxia perfusate to form continuous hypoxia (CH) modes. Sixty adult male New Zealand White rabbits (2.5-3.0 kg) were separated into six groups, ten per group. Groups were: A, intermittent normoxia (IN) group, perfused with perfusion equilibrated with 21% O(2) [PO(2) about 141 +/- 2.87 mmHg] for 15 s and 21% O(2) for 1 min 45 s, 60 cycles; B, severe IH group, 5% O(2) [PO(2) about 35.2 +/- 1.27 mmHg] 15 s and 21% O(2) 1 min 45 s, 60 cycles; C, mild IH group, 10% O(2) [PO(2) about 54.3 +/- 3.31 mmHg] 15 s and 21% O(2) 1 min 45 s, 60 cycles; D, severe IH+Lep group, protocol was the same with severe IH group; E, CH group, IN for 1 h 45 min and then 5% O(2) for 15 min; and F, Lep group, the same with IN group. Right common carotid artery parts distal to the cannula were harvested after exposure, and endothelial cell layers were gotten from longitudinal outspread vessels. Nuclear factor kappaB (NFkappaB) DNA binding activities of partial cell layers were measured with electrophoretic mobility shift assay in the IN group, severe IH group, mild IH group, and CH group nuclear extracts. The other part of the cell layers in the IN group, severe IH group, severe IH+Lep group, and Lep group were cultured for 2 h, and during the culture procedure, recombinated human leptin solutions were added to culture dishes of severe IH+Lep group and Lep group (resulted concentration, 10 ng/mL). Enzyme-linked immunosorbent assay was used to analyze medium interleukin-6 (IL-6) concentrations, reverse transcription polymerase chain reaction was used to analyze endothelial cell Ras homology A (RhoA) mRNA expression levels. Statistical analysis was done with SPSS 11.5 software package., Results: NFkappaB DNA binding activities were significantly different between groups (F = 112.428, P < 0.001). This activity in the severe IH group (4.27 +/- 0.64) was higher than that in the mild IH group (2.33 +/- 0.45, P < 0.001), IN group (1.00 +/- 0.26, P < 0.001), and CH group (1.15 +/- 0.36, P < 0.001). RhoA mRNA expression levels were different in groups (F = 26.634, P < 0.001).This level in the severe IH+Lep group (2.54 +/- 0.53) was higher than that in the severe IH group (1.57 +/- 0.44, P = 0.002), IN group (1.00 +/- 0.31, P < 0.001), and Lep group (1.31 +/- 0.30, P < 0.001). IL-6 concentrations were different in groups (F = 79.922, P < 0.001). IL-6 concentration in the severe IH+Lep group (1591.50 +/- 179.57 pg/mL) was higher than that in the severe IH group (1217.20 +/- 320.62 pg/mL, P = 0.036), IN group (325.40 +/- 85.26 pg/mL, P < 0.001), and Lep group (517.40 +/- 183.09 pg/mL, P < 0.001)., Conclusions: IH/ROX activated the inflammation pathway significantly in the endothelium, which was more intensive than CH and intensity-dependent. When exposed to both IH/ROX and leptin, inflammation occurs more dramatically. It means that synergic activating roles were performed by IH/ROX and leptin. This study may have a clinical implication that IH can cause endothelial damage through activated inflammation in OSA patients, and if the OSA patients have obesity at the same time, the endothelial damage or the inflammation would be more significant because of elevated leptin level as a synergic factor.

Objective: Three-dimensional time-of-flight magnetic resonance angiography (3D TOF MRA) has been wildly used in the diagnosis of intracranial artery diseases, but it only shows the arterial lumen and does not delineate the vessel wall. The aim of this study was to assess whether high resolution cross sectional magnetic resonance imaging (HRMRI) could compensate the limitation of 3D TOF MRA in the atherosclerotic disease of middle cerebral artery (MCA)., Methods: Fourty-eight suspected patients with atherosclerotic stenosis of MCA underwent 3D TOF MRA and HRMRI with a 3T scanner. The HRMRI was performed in 49 MCAs perpendicular to the M1 segment with T2-weighted imaging. Findings of HRMRI were compared with that of 3D MRA., Results: HRMRI displayed the artery wall clearly, and showed 37 abnormalities, including 20 plaques and 17 wall thickening. The inter-observer reproducibility was moderate for wall abnormalities with k=0.75 (95% CI 0.59-0.91), and excellent for plaques with k=0.91 (95% CI 0.80-1.03). 3D TOF MRA showed 34 stenoses at the M1 segment. Five normal MCAs on 3D TOF MRA had abnormal wall (3 plaques and 2 wall-thickening) on HRMRI. Two stenoses on 3D TOF MRA showed normal wall structure on HRMRI, indicating a possible negative remodeling phenomenon., Conclusions: High-resolution MR imaging can clearly depict the wall structure of middle cerebral arteries. As a complementary method, HRMRI may compensate the limitation of 3D TOF MRA and help to detect atherosclerotic lesions not visualized by MRA.

Objective: To investigate the characteristics of cerebral artery lesions in patients with limb-shaking transient ischemic attacks (LS-TIA) and its treatment., Methods: We retrospectively analyzed the clinical data of 20 patients with LS-TIA who received treatment in Peking Union Medical College Hospital from 2005 to 2008., Results: Critical stenosis or occlusion of contralateral arteries were found in the siphonic part of internal carotid artery (ICA) in 6 patients, terminal ICA or proximal middle cerebral artery (MCA) in 6 patients, and distal MCA in 1 patient. Seven patients had proximal ICA occlusion. The brain MRI showed typical watershed cerebral infarctions in 8 patients. EEG studies failed to show epileptiform activity associated with LS-TIA, but found focal frontotemporal lobe slow activity in 6 patients, which was consistent with hypoperfusion area in CT perfusion. Six patients received surgical revascularization and no one recurred., Conclusion: Intracranial artery including the siphonic part of ICA, terminal ICA and proximal MCA stenosis is the main underlying cause of LS-TIA in Chinese, and surgical revascularization may be effective in abolishing the attacks.

Objective: To elucidate the clinical and imaging characters of reversible posterior encephalopathy syndrome (PRES) and to discuss the etiological factors and the probable pathogenesis., Method: Retrospective analysis of basal diseases, clinical manifestations and imaging characters of 13 PRES patients was conducted with follow-ups., Results: The common associated diseases are various kinds of kidney disease and renal inadequacy, eclampsia of gravidity and postpartum, connective tissue disease and immunosuppressives, et al. The main clinical manifestations are headache, convulsion, poor vision, changes of psychology or consciousness. The radiological findings are multifocal, symmetrical and posteriorly distributed in the cerebral hemispheres involving bilateral grey and white matter abnormalities in occipital, parietal and frontal regions. The majority of patients with PRES have an excellent prognosis., Conclusion: The etiological factors and pathogenesis of PRES are different and not all of them are reversible. Thus it is decisive to take specific and appropriate measures.

Background and Objective: To study the prevalence of variable number of tandem repeats (VNTR) polymorphism in platelet membrane glycoprotein (GP) Ib alpha in a Chinese Han population and to determine the relationship between VNTR polymorphisms and aspirin resistance., Methods: Three hundred healthy individuals and 110 patients with cerebral infarction volunteered to participate in this study. The genotype status of all participants was determined by polymerase chain reaction-restriction fragment length polymorphism analysis. Platelet aggregation in patients with cerebral infarction receiving aspirin (100 mg/day) for at least 7 days, was measured by optical transmission aggregometry., Results and Discussion: Only three alleles of GP Ib alpha, namely, B, C and D, were found. Type A was not found in the Chinese Han participants. Aspirin-sensitive patients were significantly more often of CC genotype than aspirin-semi-responders., Conclusions: Only three types of alleles B, C and D were detected in the north-eastern region of China. The CC genotype of the VTNR polymorphism in GPIb appears to be more sensitive to the inhibitory action of low-dose aspirin.

Objective: To assess the efficacy of phase-weighted imaging in differentiating multiple system atrophy (MSA) from idiopathic Parkinson disease (IPD)., Methods: A phase-weighted sequence was performed covering striatum in 21 patients with MSA, 20 patients with IPD, and 26 age-matched healthy volunteers after conventional brain magnetic resonance imaging examination on a 3.0T magnetic resonance imaging system. An experienced neuroradiologist who were blind to the clinical diagnosis applied region of interest (ROI) on post-processing phase images to measure the phase shift value of bilateral globus pallidus, putamen, and caudate head., Results: The phase shift values at bilateral putamen of MSA group were significantly lower than those of IPD group and control group (P < 0.05), while phase shift values at other locations of MSA group were not statistically different from those of other groups. The phase shift values showed no statistical difference between IPD group and control group at all regions., Conclusion: Quantitative phase-weighted imaging is a useful sequence to reflect the abnormal iron accumulation in brains of patients with movement disorders and is helpful in the differential diagnosis between MSA and IPD.

Objective: To investigate the clinical, electromyographic, and magnetic resonance imaging (MRI) manifestations of the patients with cervical spondylotic myelopathy (CSM) and the correlation among them., Method: 96 CSM patients, 56 males and 40 females, aged 53 (2/32-72), underwent electromyography (EMG) of the deltoid muscle (C5), biceps muscle of arm (C6), common extensor muscle of fingers (C7), and short abductor muscle of thumb and abductor muscle of little finger (C8-T), and MRI of the cervical vertebrae before surgical treatment. The clinical symptoms were graded according to the Japanese Orthopaedic Association (JOA) scoring system. The correlation among the JOA score, MIR classification, and EMG manifestation was analyzed., Results: EMG showed that 61 of the 96 patients (64%) with root injury at C5, 6, 7, and 8. Those positive in EMG showed higher severity in MRI (Z=2.863, P=0.004). The JOA score was not correlated with the degree of spinal cord compression demonstrated by MRI and the EMG results., Conclusion: The root injury rate is high in the CSM patients. The patients positive in EMG have severe MRI results. No clear correlation is between the severity of clinical symptom and MRI of cervical vertebrae and root injury demonstrated by EMG. Hence, treatment should be considered by integration of EMG, MRI and JOA scores.

Purpose: The dynamic variance of cerebral blood flow velocity (CBFV), monitored by transcranial doppler (TCD), can reveal the integrated effects of cardio-cerebral vascular autoregulation. We investigated the characteristics of CBFV curve during active standing in multiple system atrophy (MSA), Parkinson's disease (PD) and healthy volunteers., Methods: The CBFV curve of middle cerebral arteries was recorded using TCD in 22 patients with probable MSA; 20 PD patients and 20 volunteers matched for age. All individuals started in a supine posture, followed by abrupt standing for 2 min before returning to supine. The features of CBFV curve were compared among the groups., Results: In the healthy volunteers, the CBFV decreased following standing up but quickly rebounded and reached the same or greater level as the supine baseline. Afterwards, the CBFV decreased abruptly to a sustained level, lower than the supine baseline, forming a spike wave that appeared in CBFV curve. This spike wave was present in 5/22 of MSA, significantly less than PD patients (18/20) and volunteers (20/20) (P<0.001). The CBFV decrease after standing showed no significant difference between MSA than PD (9+/-7 vs. 6+/-3 cm/s, P=0.163)., Conclusions: The different pattern of CBFV curves during active standing suggests MSA may possess cardio-cerebral vascular modulation different from PD. The clinical value of the CBFV curve in differentiating MSA from PD needs further investigation.

Nutrients in animal manure are valuable inputs in agronomic crop production. Timely and reliable information on animal manure nutrient content will facilitate the utilization of manure as organic fertilizer and reduce any associated potential environmental problems. The objective of this study was to investigate the feasibility of using multiple linear regression (MLR), polynomial regression, and artificial neural network (ANN) models to determine nutrient content in dairy manure. Fresh manure samples (n = 86) from Holstein dairy cattle were collected from 34 dairy farms located in Beijing city, China. All samples were analyzed for nutrient content (ammonium nitrogen, total potassium, total nitrogen, and total phosphorus) by standard laboratory methods. The physicochemical properties (specific gravity, electrical conductivity, and pH) of dairy manure samples were measured. Relationships between nutrient content and physicochemical properties were explored by MLR, polynomial regression, and ANN models. Several parameters (R(2), modeling efficiency statistic, mean squared error of prediction, mean bias, linear bias, and maximum bias) were calculated to evaluate model performance. The residual analysis results indicated that all MLR models for the testing data set had significant mean and linear bias. When compared with MLR and polynomial regression models, the ANN model for all nutrient contents had better performance with higher R(2) and modeling efficiency statistics and lower mean squared error of prediction, mean bias, linear bias, and maximum bias. These findings demonstrated that the ANN model may be an appropriate tool to predict dairy manure nutrient content.

Vertigo, a common clinical complaint, is closely linked with neurologic diseases. This article summarizes many neurologic diseases (including stroke, migraine, epileptic vertigo, psychiatric abnormalities, rotational vertebrobasilar insufficiency, and multiple sclerosis) with vertigo as one of its main symptoms, and introduces the diagnostic methods of vertigo.

Objective: To explore the value of anal sphincter electromyography (ASEMG), orthostatic hypotension (OH), and dizziness in diagnosing multiple system atrophy (MSA)., Method: The characteristics of ASEMG and OH were compared among patients with dizziness (MSA and non-MSA), patients without OH (MSA and non-MSA), and patients with probable MSA (OH and non-OH)., Results: Totally 476 patients underwent ASEMG examinations. Dizziness was the onset symptom in 69 patients. Between the MSA group and non-MSA group, the mean duration of dizziness [(14.6 +/- 2.1) vs. (12.8 +/- 2.0) ms, P < 0.01] and satellite potential occurrence rate [(22.7 +/- 11.8)% vs. (12.2 +/- 8.9)% , P < 0.01] were significantly different, while the OH rate (84.6% vs. 55.2% ) and the difference of the blood pressure between standing and supine positions were not significantly different. In 162 patients with symptom of dizziness, the mean duration of dizziness [(15.3 +/- 2.7) vs. (12.8 +/- 1.9) ms, P < 0.001], satellite potential occurrence rate [(25.4 +/- 12.8)% vs. (13.5 +/- 10.4)%, P < 0.001] , and difference of the diastolic blood pressure [(18.5 +/- 17.0) vs. (11.7 +/- 12.7) mmHg, P < 0.05] were significantly different between the MSA group and non-MSA group, while the normal rate of blood pressure at standing position (60% vs. 41.9%) and the difference of systolic blood pressure were not significantly different. In 146 patients with abnormal blood pressure at standing and supine positions, the mean duration of dizziness [(15.0 +/- 2.4) vs. (12.8 +/- 1.7) ms, P < 0.001] and satellite potential occurrence rate [(22.0 +/- 12.2)% vs. (10.6 +/- 8.5)%, P < 0.001] were significantly different between the MSA group (n = 61) and non-MSA group (n = 85). In 125 patients with probable MSA, the mean duration of dizziness [(15.5 +/- 2.4) vs. (15.9 +/- 2.2) ms, P > 0.05] and satellite potential occurrence rate [(24.3 +/- 12.6)% vs. (22.7 +/- 12.4)%, P > 0.05] were not significantly different between those with OH and those without OH. The rates of dizziness and the percentage of dizziness as the onset symptom were 93.2% and 52.3% in OH group and 44.4% and 8.3% in non-OH group., Conclusions: ASEMG is better than OH in diagnosing patients with dizziness suspected as MSA. Neurogenic lesion can be found by ASEMG in patients without OH, which is helpful in the early diagnosis of MSA.

Objective: To explore the inflammatory reactions, endothelin level and carotid sinus nerve (CSN) afferent activity of carotid body (CB) after intermittent hypoxia/reoxygenation (IH/ROX) exposure of various frequencies in rabbits., Methods: Forty-nine male adult New Zealand white rabbits (2.5-3.0 kg) were separated into 7 groups (n = 7 each). After anesthetization, the right carotid artery and CSN were cleared of surrounding tissues without touching the right CB and the left carotid region. The CSN was unenveloped to partially expose the myelin sheath, and electrodes were placed to the "single" chemoreceptor bundle of the CSN, with CSN afferent activity carefully monitored and recorded. Then the right common carotid artery was exposed, cannulated to distal part and its proximal part was ligated. Preparations were challenged by changing the PO2 of the gas mixture equilibrating the perfusate. Alternatively perfusion (2 ml/min) of equilibrated perfusate bubbled with normoxia or hypoxia gas mixtures formed IH/ROX cycles in right carotid common artery, simulating the pattern of hypoxic episodes seen in obstructive sleep apnea, or with continuously perfusing hypoxia perfusate to form continuous hypoxia (CH) modes. Groups were defined with different frequencies, and groups were: intermittent normoxia group (IN group) (21% O2, 15 s; 21% O2, 1 min 45 s), 10/hr group (5% O2, 15 s; 21% O2, 5 min 45 s), 30/hr group (5% O2, 15 s; 21% O2, 1 min 45 s), 50/hr group (5% O2, 15 s; 21% O2, 57 s), 60/hr group (5% O2, 15 s; 21% O2, 45 s) and 90/hr group (5% O2, 15 s; 21% O2, 25 s). All the above groups were exposed to 60 treatment cycles; continuous hypoxia group (CH group), IN for 1 h 45 min and then 5% O2 for 15 min. After exposure and 30 min of static placing, CSN afferent frequencies (Charge F) were recorded from chemoreceptor bundles, and the right CB was cleared of surrounding tissues and harvested. Interleukin-6 (IL-6), endothelin-1 (ET-1), hypoxia-inducible factor-1 (HIF-1), and vascular endothelial growth factor (VEGF) concentrations of the CB lysate were measured with enzyme linked immuno sorbent assay (ELISA) kits and standardized. Data were analyzed with SPSS 12.0 software package; and after one way analysis of variance (ANOVA) for whole difference, Tamhane's T2 was used for post hoc analysis., Results: IL-6, ET-1 and Charge F increased but then decreased with increasing IH frequencies (F = 25,601.39, 2390.48, 6945.84, all P values < 0.01). IL-6, ET-1 and Charge F levels in 50/hr group were the highest among groups. Charge F levels correlated significantly with IL-6 or ET-1 (with IL-6: r = 0.736, P < 0.01; with ET-1: r = 0.757, P < 0.01, respectively). IL-6, ET-1 and Charge F levels between IN group and CH group were not statistically different (all P values > 0.05). HIF-1 levels elevated gradually (F = 5241.10, P < 0.01) with increasing exposure frequencies, and the CH group had the highest value (all P values < 0.01). VEGF level in CH group was the highest in all groups (all P values < 0.01)., Conclusions: After IH/ROX exposure, afferent activity of CB CSN increases, which significantly correlates with inflammation and vasomotor mechanism of CB. CB inflammation comes not from IH phases but from ROX phases. Increased CB CSN activity results in elevated SNA tension, which plays a key role in the pathogenesis of systemic hypertension. This procedure influenced by IH/ROX frequencies. CH for 15 min causes no definitely damages. However, HIF-1 and VEGF can be considered as members of adaptive pathway during IH/ROX exposure.

Increasing evidences have shown that pathogens might promote atherosclerosis and trigger acute myocardial infarction (AMI). But the conclusions from various studies on the correlation between previous influenza virus (IV) infection and AMI were inconsistent. We conducted a case-control study to assess the association of previous IV infection and AMI. Questionnaire survey was conducted to collect information about demographic characteristics and heart disease risk factors. Fasting blood sample was obtained to measure IgG antibodies to influenza virus A(IV-A), influenza virus B(IV-B), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1) and type-2 (HSV-2), adenovirus (ADV), rubella virus (RV) and Chlamydia pneumoniae (CP) and measure the level of some biochemistry markers. Compared to controls, cases were more likely to have positive IgG antibodies to IV-A and IV-B (IV-A: OR, 3.3; 95%CI, 1.5 to 7.4; IV-B: OR, 17.2; 95%CI, 7.7 to 38.0). After adjustment for potential confounding variables, the risk of AMI was still associated with the presence of IgG antibodies to IV-A (adjusted OR, 7.5; 95%CI, 1.3 to 43.0) and IV-B (adjusted OR, 27.3; 95%CI, 6.6 to 113.8). The study supported the hypothesis that previous IV infection took part in the development of atherosclerosis and trigger the occurrence of AMI.

Background: Repetitive transcranial magnetic stimulation (rTMS) research has mainly been focused on the therapeutic effect of psychiatric disorders and Parkinson's disease. A few studies have shown that rTMS might protect against delayed neuronal death induced by transient ischemia, enhance long-term potentiation in ischemic conditions and affect regional brain blood flow and metabolism. The aim of this study was to determine the effects of repetitive transcranial magnetic stimulation (rTMS) on adenosine triphosphate (ATP) content and microtubule associated protein-2 (MAP-2) expression in rat brain after middle cerebral artery occlusion (MCAO)/reperfusion., Methods: To study the effects of different timecourses of rTMS on ATP content and MAP-2 expression, 90 rats were randomly divided into three groups (30 rats in each group). To study the effects of multiple rTMS parameters on ATP content and MAP-2 expression, the rats in each group were further divided into six subgroups (five rats each). The rats were sacrificed at 1-hour, 24-hour and 48-hour intervals after reperfusion, and the brain tissues were collected for the detection of ATP and MAP-2., Results: rTMS could significantly increase ATP content and MAP-2 expression in the left brain following ischemic insult (P < 0.01) and different rTMS parameters had different effects on the ATP level and the MAP-2 expression in the left striatum. A high-frequency rTMS played an important role in MAP-2 expression and ATP preservation., Conclusions: This study revealed that rTMS induced significant increase of ATP content and MAP-2 expression in the injured area of the brain, suggesting that the regulation of both ATP and MAP-2 may be involved in the biological mechanism of the effect of rTMS on neural recovery. Therefore, rTMS may become a potential adjunctive therapy for ischemic cerebrovascular disease.

Objective: To investigate the differences in etiology, symptoms, treatment, and prognosis between the patients with cerebral venous and sinus thrombosis (CVST) before December 31 2000 and those after that date., Methods: The etiology, symptom, treatment, and prognosis of the 35 CVST patients admitted to Peking Union Medical College Hospital (PUMC) from January 1 1991 to December 31 2000 (Group A, n = 16) and those admitted from January 1 2000 to May 31 2007 (Group B, n = 19) were analyzed and compared., Results: (1) The first two common causes were infection and hematological disease in Group A, while the first two common causes were immune disease and hematological disease in Group B. (2) The common symptoms and signs and positive rates were as follows: headache (86%), seizures (34%), focal neurological deficits (40%), vision deficits (43%), altered consciousness (31%), and papilloedema (60%) without significant differences between these 2 groups. The positive rates of the common symptoms and signs during discharge were as follows: headache (77%), altered consciousness (73%), seizures (67%), focal neurological deficits (57%), vision deficits (43%), and altered consciousness (31%) without significant differences between these 2 groups. (3) 38% of the patients in Group A (n = 6) received anticoagulation therapy, a rate significantly lower than that of Group B (79% , n = 19) (P < 0.05). Four patients in Group B received thrombolytic therapy., Conclusion: The etiological constituents of CVST patients admitted in PUMC has changed, the weight of infection has declined and that of the immune disease has risen. The spectrum of signs remains unchanged; however, the rate of anticoagulation has ascended.

Objective: To investigate the clinical and electrophysiological characteristics of myasthenia gravis with thymoma (MGT)., Methods: The clinical and repetitive nerve stimulation (RNS) data of 72 patients with MGT, 36 males and 36 females, and 63 patients with myasthenia gravis without thymoma (NMGT) were analyzed retrospectively., Results: The onset age of 52 of the 72 MGT patients (72.2%) was 35-59. The average onset age of the MGT patients was 39.5, older than that of the NMGT patients (29.4 yrs), and the course of the MGT patients was 13.1 months, shorter than that of the NMGT patients (29.1 months)The attack rate of the males was not significantly different than that of the females. The proportion of generalized presentation type among the MGT patients was 72.8%, higher than that among the NMGT patients (66.7%), particularly concerning the respiratory muscle (20.8% vs. 9.5%). The average time interval between the onset of symptoms and respiratory or bulbar muscle involvement of the NMGT patients were 12 and 7 months respectively, both remarkably shorter than those of the NMGT patients (26.4 and 11.6 months respectively). The abnormal RNS test yield rate of the MGT patients was 86.9%, higher than, however, not significantly that of the NMGT patients (75.0%). 97.2% of the thymoma and mediastinal abnormality could be detected through computed tomography (CT) scan on thymus. The positive rate of AchRab titer of the MGT patients was 50.0%, not significantly different from that of the NMGT patients (52.4%)., Conclusion: MGT is common in middle-aged people, both male and female. The Course is quickly progressive and generalized skeletal muscles, particularly respiratory muscles, are more involved in the MGT patients than in the NMGT patients. RNS study is a sensitive tool to identify MGT. AchRab may not be the specific antibody for recognizing MGT. CT scan is useful in differentiating thymoma preoperatively.

Aim: To determine the apoptotic effect of recombinant rat Fas Ligand on rat intervertebral disc cells pre-treated with IL-1beta in vitro, and the expression of Fas in cultured rat intervertebral disc cells., Methods: Cells were isolated from the inner annulus fibrosus and transition zones of lumbar discs from Sprague-Dawley rats. The cells were grown in monolayer and divided in 5 treatment groups. IL-1beta (10 ng/mL), FasL (5, 20 ng/mL) with/without IL-1beta (10 ng/mL) pre-treatment was respectively added in Dulbeccoos modified Eagleos medium and Hamos F-12 medium with 1% fetal bovine serum. After 32 h, the cells were stained with annexin V-FITC and propidium iodide to evaluate apoptosis using flow cytometry and to analysis transcription of Fas using RT-PCR., Results: Compared with control group, FasL (20 ng/mL), IL-1beta (10 ng/mL)+FasL (5 ng/mL), and IL-1beta (10 ng/mL)+FasL (20 ng/mL) induced significant apoptosis of the disc cells (P<0.01). Apoptosis was also induced by FasL 5 ng/mL (P<0.05); whereas, apoptosis was not induced by IL-1beta (10 ng/mL) (P>0.05). IL-1beta (10 ng/mL) enhanced the apoptosis-inducing effects of FasL (5 ng/mL) and FasL (20 ng/mL) in disc cells. Fas gene transcription in all groups and Fas expression in the 5 treatment groups were approximately 1.2-2.1-fold greater than control group (respectively, P<0.05). Additionally, Fas expression in FasL with IL-1beta pre-treatment groups were significantly up-regulated than in FasL groups (P<0.01)., Conclusion: The results of this study showed disc cells pre-treated with IL-1beta increased apoptotic rate in response to FasL in vitro and provided insights to understand Fas/FasL system-mediated apoptosis in disc cells which would be enhanced due to inflammation factor in degenerative disc.

Objective: To evaluate the clinic value of blink reflex (BR)., Methods: BR test was conducted among 584 patients with facial spasm (161 cases), face or upper extremities numbness (120 cases), Bell's palsy (102 cases), trigeminal neuralgia (31 cases), ptosis (30 cases), multiple cranial palsy or brain stem lesion (28 cases), cerebral vascular disease (19 cases), lateral face atrophy (16 cases), Guillain-Barré syndrome (13 cases), connective tissue disease (12 cases), diabetic peripheral neuropathy (12 cases), head trauma (11 cases), definite or suspected multiple sclerosis (10 cases), Meige syndrome (9 cases), Parkinson's disease (5 cases), or motor neuron disease (5 cases)., Results: 279 out of the 584 patients (47.77%) showed abnormal BR results. By analyzing of waveform, latency period and difference of bilateral side of BR test, the different BR changes caused by either peripheral damage to trigeminal nerve and facial nerve or by brain stem damages were distinguished., Conclusion: As one convenient test, BR helps locate the lesion of trigeminal nerve or facial nerve and has highly diagnostic value to the lesion of brain stem, even to the subclinical lesion at the early time of some disease without any symptoms. When the BR results are coordinated with those by brain stem auditory evoked potential, the abnormality of brain stem function can be found and located earlier in some situation that can result to brain stem damage such as MS and systematical disease. Coordination of BR with radionuclide study or single-fiber electromyography helps increase the differential diagnosis of spasm of eyelid and MG.

Objective: To explore the clinical significance of serum anti-ryanodine receptor (RyR) antibody in the diagnosis of myasthenia gravis (MG)., Methods: The crude sarcoplasmic reticulum was prepared from rabbit skeletal muscle, and then purified by differential centrifugation to produce the antigen. The serum anti-RyR antibody levels in 74 patients with MG (including 21 patients with comorbidic thymomas) were determined with ELISA., Results: Western blot demonstrated the presence of RyR in purified crude sarcoplasmic reticulum. The positive rate of anti-RyR antibody was significantly higher in MG patients who had comorbidic thymoma compared with those who had no such comorbidity (P < 0.01). Also, the positive rate was closely correlated with the severity of MG., Conclusion: Serum anti-RyR antibody test is helpful in the diagnosis of MG associated with thymoma and can be used to judge the outcome of MG.

Objective: To investigate the appropriate ratio of liquid/powder and use of radiopaque agent in EH composite material for percutaneous vertebroplasty (PVP)., Methods: (1) EH composite material was divided into 6 groups. The material without contrast with the liquid/powder ratios 8:9, 8:8, and 8:7 was classifieds as groups I, II, and III; and the EH composite material with the liquid/powder ratios 8:9, 8:8, and 8:7 and with the addition of 20% barium sulfate by weight was classified as the groups IV, V, and VI. The curing temperature was measured. The bone cement of different groups was made into cylinders to be X-rayed to observe the opacity. Universal tester was used to examine the strength and stiffness. (2) The vertebrae (T8 approximately L5) were isolated from the cadaver of an elder female patient with osteoporosis. Universal tester was used to examine the strength and stiffness of the vertebral bodies (VBs). Osteoporotic vertebral compression fracture (OVCF) model was made. PVP procedure was mimicked by puncturing through the bilateral pedicle of vertebral arch into the anterior 1/3 of the vertebral bodies and the EH composite materials of the groups II and V were injected into the VBs Then the temperatures of the geometric center (CT) and spinal canal posterior wall (PT) of the VBs were measured in a water bath with the temperature of 37 degrees C. Twenty-four hours later the vertebrae underwent X-ray examination to observe the opacity and underwent examination of strength and stiffness with universal tester., Results: (1) The sticking periods (?) of the groups IV, V, and VI were significantly longer than those of the corresponding groups I, II, and III respectively by about 60 s, and the highest temperature of the groups IV, V, and VI were significantly lower than those of the corresponding groups I, II, and III respectively. Addition1 of barium sulfate increased the opacity of the bone cement, but did nor significantly influence the strength of the bone cement. The properties of the group V was the best. (2) The bone cement was easy to be injected into the VBs. The peak PT was not beyond 50 degrees C. After the injection of the bone cement of the groups II, the strength and stiffness of the VB were (1501.6 +/- 5.0) N/mm and (285.6 +/-) N/mm, both significantly higher than those before the injection [(547.5 +/- 3.1) N/mm and (104.1 +/- 1.3) N/mm]; and after the injection of the bone cement of the groups V, the strength and stiffness of the VB were (1355.0 +/- 4.5) N/mm and (257.7 +/- 1.9), both significantly higher than those before the injection [(543.8 +/- 2.7) N/mm and (103.4 +/- 1.1) N/mm]. The opacity of the VBs injected with the bone cement of the group V was better than those injected with the bone cement of the group II., Conclusion: The EH (8/8) with 20% barium sulfate is a proper and effective filling material for the treatment of OVCF.

Objective: To investigate the distribution and clinical manifestations of intracranial arterial occlusive lesions (IAOLs), and their correlation with thyroid function., Methods: We enrolled 7 patients who had Graves' disease (GD) with IAOLs screened and evidenced by transcranial Doppler, then further confirmed with digital substract angiography in 2 patients and magnetic resonance angiography in 5 patients. Brain magnetic resonance imaging (MRI) was performed in all 7 patients. Three patients were followed up., Results: Among 7 patients, 1 was male and 6 were females. The mean age was 32.0 +/- 5.5 (range from 11 to 49) years old. Six of them had symptoms of GD but one was asymptomatic with abnormality of T3, T4, and thyroid stimulating hormone. The lesions of intracranial arteries were symmetrical bilaterally in the internal carotid artery system in 6 patients, as well as asymmetrical in 1 patient Terminal internal carotid artery (TICA) were involved in all 7 patients. Middle cerebral artery (MCA) were involved in 3, anterior cerebral artery in 2, and basilar artery in 1 patient. Net-like collateral vessels and mimic moyamoya disease were observed in the vicinity of the occlusive arteries in 2 patients. All patients presented symptoms of ischemic stroke including transient ischemic attack and/or infarction while IAOLs were found. Three patients had obvious involuntary movements. Brain MRI revealed infarctions located in the cortex, basal ganglion, or hemiovular center in 5 patients. The remaining 2 patients had normal brain MRI. The neurological symptoms were improved concomitant with relief of the thyroid function in 2 patients, while IAOLs were aggravated with deterioration of the thyroid function in 1 patient., Conclusion: IAOLs in patients with GD mainly involve intracranial arteries, especially the TICA and MCA, which is similar to moyamoya disease. The neurological symptoms and severity of involved arteries may relieve while the hyperthyroidism is gradually under control.

Objective: To investigate the correlation between plasma fibrinogen level and cerebral infarction (CI) as well as the difference of fibrinogen among subtypes of CI., Methods: A case-controlled study was conducted with 131 cases of CI and 148 controls. Plasma fibrinogen levels were detected by the Clauss method., Results: High fibrinogen level (3.09 +/- 0.94 g/L) was correlated with CI (OR = 2.47, 95% CI: 1.51-4.04, P < 0.005) at the onset stage of the disease. Persistent high fibrinogen level (3.14 +/- 0.81 g/L) at 6-month after stroke onset was detected and correlated with CI (OR = 4.34, 95% CI: 1.80-10.51, P = 0.001). Higher fibrinogen level was correlated with total anterior circulation infarction (TACI), partial anterior circulation infarction (PACI), and posterior circulation infarction (POCI) (OR = 4.008, P < 0.001). Higher fibrinogen level was correlated with extracranial atherosclerosis (OR = 3.220, P < 0.05, but not with intracranial atherosclerosis., Conclusion: Fibrinogen level may be a risk factor of CI and probably correlates with subtypes of CI and distributions of atherosclerosis.

Objective: To investigate the clinical significance of the serum anti-titin, anti-ryanodine receptor (RyR) antibody level and thymus CT scan in the diagnosis of myasthenia gravis with thymoma., Methods: Totally 32 patients with myasthenia gravis who had received thymectomy were included in the study. Abnormalities were shown under CT scan of thymus in all these patients. The relationships were studied among the pathological diagnosis, CT findings, and serum level of thymoma associated antibodies: anti-titin and anti-RyR antibodies., Results: The pathological diagnosis of thymoma was made in 21 patients and thymus hyperplasia in 11 patients after operation. The sensitivity of CT scan in the diagnosis of thymomas was 90.5%, the specificity of serum thymoma associated antibodies in the diagnosis of thymoma was 100%., Conclusion: The thymoma-associated antibodies test is helpful in the differential diagnosis of thymomas and thymus hyperplasia; when combined with CT scan, it may achieve high sensitivity in the diagnosis of the thymoma.

Objective: To evaluate the therapeutic effect of percutaneous transluminal angioplasty and stenting for occlusive lesions in supra-arch vessels with brain ischemic symptoms., Methods: A total of 56 occlusive lesions of the innominate, subclavian, and internal carotid arteries were treated with angioplasty and intravascular stent placement in 52 patients. The degree of stenosis was more than 60% in all patients and the leading symptom was brain ischemia. In 11 patients, the occluded subclavian artery could not be crossed via the femoral route, therefore the brachial route was used and the occlusion was crossed in a retrograde fashion., Results: Technical success was achieved in 54 of 56 procedures (96.4%). Residual stenosis was less than 30% in all cases. The clinical symptoms improved after procedure in all patients. Complications occurred in 3 of 52 (5.8%) procedures, and the 30-day mortality rate was 0. There were no death and severe stroke in the follow-up period (means 24 months). Restenosis was observed in 2 patients after percutaneous transluminal angioplasty treatment., Conclusion: Percutaneous transluminal angioplasty with or without stenting is a safe and valid choice for treatment of occlusive lesions of supra-arch vessels in patients with cerebral ischemic symptoms.

Objective: To clarify the effects of repetitive transcranial magnetic stimulation (rTMS) on rat motor cortical excitability and neurofunction after cerebral ischemia-reperfusion injury., Methods: After determined awake resting motor threshold (MT) and motor evoked potentials (MEPs) of right hindlimbs, 20 Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) reperfusion injury, then rTMS were applied to rTMS group (n=10) at different time, while control group (n=10) received no stimulation. A week later, MT and MEPs were evaluated again, as well as neurological deficits and infarct volume. The effects of rTMS and MCAO reperfusion injury on these parameters were analyzed., Results: After MCAO reperfusion, both MT level and neurological deficit scores increased, distinct focal infarction formed, and latency of MEP elongated. Compared with the control group, the increased extent of MT and neurological scores of rats receiving rTMS were significantly lower (P < 0.05), as well as the infarct volumes reduced significantly (P < 0.05). But MEP was not affected by rTMS obviously. There was a positive linear correlation between postinjury MT and infarct volume (r = 0.64, P < 0.05)., Conclusion: rTMS may facilitate neurofunction recovery after cerebral ischemia-reperfusion. Postinjury MT could provide prognostic information after MCAO reperfusion injury.

Objective: To investigate the characteristic manifestations of neuropsychiatric systemic lupus erythematosus (NPSLE) in clinical practice., Methods: A total of 198 NPSLE cases from 1998 to 2003 in Peking Union Medical College Hospital, were included. Their clinical manifestations and the results of accessory examination such as serology, lumbar puncture, head magnetic resonance imaging, and electroencephalogram were analyzed., Results: The most frequent manifestations of the NPSLE included: headache, psychiatric disorder, seizure, stroke, and acute confusional state. Fifty-two patients took head magnic resonance imaging, and 34 of them showed abnormal, including stroke attack. Among 48 patients who only had a complaint of headache, the increase of intracranial pressure and cerebral spinal fluid protein was significantly higher than other NPSLE syndromes (P < 0.05)., Conclusion: Diagnosis of NPSLE was mainly based on its clinical manifestations. Head magnetic resonance imaging and cerebral spinal fluid examination may be helpful. More specific accessory examinations require further development.

Objective: To analyze the relationship between tumor necrosis factor-alpha (TNFalpha) gene promoter -308 polymorphism and myasthenia gravis (MG) in Chinese and analyze secretion of TNFalpha in peripheral blood mononuclear cells (PBMC) in MG patients., Methods: A biallelic polymorphism at position -308 in the promoter of TNFalpha gene was screened by PCR amplification and NcoI recognition site. One hundred and twenty-three MG cases and 115 healthy controls were included in this study. MG patients were classified to different groups according to clinical type, age at onset, and sex respectively. PBMC were isolated from 20 patients and 20 healthy controls, and then cultured in the presence or absence of phytohemagglutinin (PHA) and acetycholine receptors (AchR). The supernatants were harvested after incubation and stored until TNFalpha was assayed by enzyme-linked immunosorbent assay., Results: The frequency of TNFalpha-308 allele 2 (A) was found significantly increase in MG patients and showed a trend especially in late onset (> or =40 years) and male patients (P < 0.05). The allele A had no relationship with thymic pathogenesis in MG patients. But frequency of allele A was significantly higher in general type than in ocular type (P < 0.05). MG patients had a higher inducible level of TNFalpha by PHA and AchR, and could be down regulated after treatment., Conclusion: Polymorphism in TNFalpha gene promoter -308 is associated with onset of MG. The microsatellite allele TNFalpha2 confer risk for the development of MG in Chinese patients. MG patients have a higher inducible level of TNFalpha.

Objective: To explore the techniques of stereotactic combined amygdalohippocampotomy for management of medial temporal lobe epilepsy (MTLE)., Methods: The Leksell stereotactic frame was used for all cases, and which almost paralleled the long axis of hippocampus. Stereotactic amygdalohippocampotomy was performed in 23 patients with unilateral medial temporal lobe seizures by using magnetic resonance imaging (MRI) localization for target planning, depth electrode for the electroencephalogram (EEG) monitoring and radiofrequency techniques for lesion production. All procedures were completed under local anesthesia., Results: Pre-lesion spikes or polyspike-waves complex were recorded by a depth electrode in the amygdala and hippocampus region in all patients, and the epileptiform discharges disappeared after the amygdalohippocampotomy. The MRI appearance of the lesion areas after 1 - 2 weeks surgical operation showed that mutiple areas of coagulation necrosis corresponding to the lesion sites were surrounded by zones of edema. Twenty-three patients were followed-up to 8 - 32 months with seizure free 43.48% (10/23), and the general efficiency (seizure reduction >or= 50%) was 91.30% (21/23 cases)., Conclusions: Stereotactic combined lesions of unilateral amygdala and hippocampus for minimally invasive treatment of MTLE is safe and effective, and it is worth to spread in clinical application.

Objective: To study the clinical and electrophysiological features of diabetic peripheral neuropathy in 700 patients to elucidate the relationships between them and evaluate the value of electromyography in the diagnosis of diabetic peripheral neuropathy., Methods: Standard sensory and motor nerve conduction studies were performed in the 700 patients, sensory nerve conduction velocity (SCV), amplitude of sensory nerve action potential (SNAP), distal motor latency (DML) and amplitude of compound muscle action potential (CMAP) of median nerve, ulnar nerve, posterior tibial nerve and common peroneal nerve were studied simultaneously. Needle electromyogram (EMG) test was performed in 239 patients., Results: (1) The most common symptoms of peripheral neuropathy were numbness and pain in limbs, while impaired or lost tendon reflexes were the most common abnormal signs in lower limbs. (2) The abnormal rate of nerve conduction studies was 72.4% in the 700 patients. Slow SCV, prolonged DML and decreased amplitude of SNAP and CMAP were detected. (3) More severe abnormal nerve conduction was found in lower limbs than in upper limbs. The abnormal degree was more severe in sensory nerve than in motor nerve and severity was more in amplitude than in conduction velocity (P < 0.05). (4) Abnormal motor and/or sensory nerve conduction was detected in 67.3% of the patients with clinical manifestations of neuropathy and 5.1% patients without signs or symptoms of neuropathy, while motor or sensory nerve conduction was normal in 27.6% patients with manifestations of neuropathy. Needle EMG showed neurogenic lesion in 4.6% of the patients with normal motor and sensory nerve conduction. (5) polyneuropathy is the most common type of diabetic neuropathy and carpal tunnel syndrome the next., Conclusions: The most common clinical and electrophysiological manifestation of diabetic neuropathy is sensory disturbance, which is more severe in lower limbs. The electrophysiological changes are not always accordant with clinical manifestations. Subclinical diabetic peripheral neuropathy can be detected by electrophysiological tests, which are useful to verify the range and extent of the nerve lesion involved in the early stage of diabetic peripheral neuropathy. Needle EMG is not recommended for screening diabetic neuropathy.

Objective: To assess the significance of single fiber electromyography (SFEMG) in diagnosis of inflammatory myopathies and the correlation with other assistant examination findings., Methods: SFEMG were recorded from the extensor digitorum communis of 34 patients with polymyositis or dermatomyositis and compared with the findings of routine electromyography (EMG), serum creatine kinase (CK) determination, and muscle biopsy., Results: SFEMG recordings in 34 patients were all abnormal. The prominent feature was markedly increased fiber density (FD) with normally or mildly increased jitter. FD ranged from 1.0 to 6.0 (2.34 +/- 0.43). Jitter ranged from 5 to 78 micros (41.6 +/- 10.3 micros). The potential pairs with jitter values greater than 55 micros ranged from 0% to 55% (7.7% +/- 11.8%). Block was detected at one recording site in only one patient. Routine EMG demonstrated myogenic lesions in only 24 patients (70.6%). FD was a little higher in the normal-EMG subgroup or the neurogenic-EMG subgroup than myogenic-EMG subgroup but without statistical significance. Elevated CK levels were found in 75% patients (24/32). FD in the normal CK subgroup was significantly higher than that in the elevated CK subgroup (2.62 +/- 0.40 vs. 2.28 +/- 0.40, P < 0.05). Muscle pathologies were consistent with the diagnosis of myositis in 75% (15/20)., Conclusion: SFEMG is of great value in the diagnosis and disease process understanding of inflammatory myopathies for the clinically suspected patients with normal routine EMG, CK levels, and muscle biopsies.

Objective: To evaluate the effect of tertiary rehabilitation treatment on acute cerebrovascular diseases., Methods: Fifteen tertiary rehabilitation networks were set up throughout the country. 1078 patients with acute cerebrovascular diseases were randomly divided into 2 groups: rehabilitation group and control group, out of which 19 patients died, 157 dropped out, and 7 successive evaluations were completed in 902 patients that. 439 of the remaining 902 patients in the rehabilitation group, 266 males and 173 females, aged 61 +/- 11, 278 cases with cerebral infarction and 161 with cerebral hemorrhage, received routine treatment and early rehabilitation for 28 days in the ward of neurology, and then went home and received community rehabilitation for 6 months or underwent specialized reinforcement training for 2 months and after that went home and received community rehabilitation for 4 months. The 463 patients in the control group, 281 males and 182 females, aged 60 +/- 11, 291 of which with cerebral infarction and 172 with cerebral hemorrhage, received only routine treatment and early rehabilitation for 28 days in the ward of neurology, and then went home to conduct rehabilitation training by themselves or their family members for 6 months. Evaluation was conducted 7 times, with National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer motor function scale, Barthel index, SF-36 scale, Lowenstein occupational therapy cognitive assessment (LOTCA), Westen aphasia battery, Hamilton depression scale, and modified Ashworth spasm scale, one week after the onset and by the ends of 1, 2, 3, 4, 5, and 6 months after the onset respectively., Results: The scores of clinical neurological impairment, Fugl-Meyer scores, SF-36 scores, incidence of PSD, and modified Ashworth scores (for upper and lower limbs) were lower, and LOTCA scores and Barthel indexes were higher at different time points in the rehabilitation group than in the control group; and the differences were statistically significant since the 2nd month after the onset. By the end of the 6th month, the patients of the rehabilitation group basically re-achieved the ability of self-care in daily activities with a Barthel index of 84 +/- 33. The patients of the control group also recovered to a certain degree, however, to a smaller extent in comparison with the rehabilitation group., Conclusion: Tertiary rehabilitation treatment of cerebrovascular diseases is effective in improving motor function, ability of daily living activities, and quality of life and reducing the incidence rates of secondary complications.

Background: Single fiber electromyography (SFEMG) is a sensitive technique for detecting abnormalities in neuromuscular transmission and is mainly used in the diagnosis of neuromuscular junction disorders, such as myasthenia gravis. While the process of denervation-reinnervation in amyotrophic lateral sclerosis (ALS) can also result in immature collateral nerve terminals and instability of neuromuscular transmission, the purpose of this study was to investigate the changes and clinical values of SFEMG in patients with ALS., Methods: Volitional SFEMG was performed on the extensor digitorum communis (EDC) of 78 patients with ALS (men 52, women 26) who had been previously diagnosed by history, clinical features, and neurophysiological studies. The mean jitter, the percentage of jitter >55 micros, the impulse blocking percentage, and fiber density (FD) were determined. These results were compared to normal controls. In addition, the SFEMG indices were analyzed for correlations with the duration of ALS, the EDC strength score on the Medical Research Council (MRC) scale, and spontaneous activity detected by EMG studies., Results: SFEMG indices were abnormal in all patients with ALS. Mean jitter ranged from 30 to 178 micros (mean 80.2 micros); the percentage of jitter >55 micros ranged from 5% to 100% (mean 60.5%). In addition, the impulse blocking percentage ranged from 0% to 90% (mean 28.1%) and FD ranged from 1.4 to 4.1 (mean 2.6). Mean jitter, the percentage of jitter >55 micros, and the blocking percentage in 57 patients with definite or probable ALS were significantly higher than in patients with possible or suspected ALS. MRC scores of the EDC negatively correlated with mean jitter, the percentage of jitter >55 micros, blocking percentage, and FD., Conclusions: SFEMG is the most sensitive tool for diagnosing definite or probable ALS. Increased jitter, blocking percentage, and FD can indicate the degree of immature collateral sprouts and motor end plates resulting from the progressive denervation and reinnervation associated with ALS, and may be helpful in evaluating prognosis.

Background: The aim of this study was to evaluate single fiber electromyography (SFEMG) in the diagnosis of ocular myasthenia gravis (OMG), compared with repetitive nerve stimulation (RNS) and blood concentration of antibody to acetylcholine receptor (AchRAb)., Methods: SFEMG, RNS and AchRAb titration were measured in 90 patients with OMG (44 men, 46 women)., Results: Markedly increased jitter and ratio of block in the frontalis and the extensor digitorum communis (EDC) were observed (83.3% and 61.1%, respectively). The mean jitter was 43.6 +/- 14.5 micros, and the percentages of jitter>55 micros and blocking were 16.9% +/- 19% and 3.5% +/- 9.5% respectively in the EDC. The mean jitter was 64.3 +/- 25.6 micros, and the percentages of jitter > 55 micros and blocking were 33.5% +/- 27.6% and 29.3% +/- 23.2% respectively in the frontalis. The percentage of abnormal RNS was 27.8% (25/90). There was an increased AchRAb titration in 29 (32.2%) of the 90 patients. Increased jitter, blocking was negatively correlated with maximum decrement to RNS (P < 0.01). 11.4% (4/35) of patients with abnormal RNS and 24.1% (7/29) patients with abnormal AchRAb were seen in the patients with normal SFEMG in the EDC., Conclusion: SFEMG test showed the highest sensitivity in the diagnosis of OMG. To our knowledge, the three methods (SFEMG, RNS and AchRAb) are complementary in the diagnosis and differential diagnosis of OMG.

Objective: To study the clinical significance of serum anti-titin antibody level in the diagnosis of myasthenia gravis (MG) with thymoma., Method: The serum anti-titin antibody was analysed by ELISA method in 40 cases of health control group, 90 cases of MG, 17 cases of MG with thymoma and 7 cases of no-MG thymoma. The positive rate was compared among these groups., Results: The positive rate of anti-titin antibody was significantly higher in MG with thymoma patients than MG patients (94% and 3%, P < 0.01). According to the Osserman's classification, anti-titin antibody was present mostly in patients (43%) in IV stage, and also present in 2 cases of 7 who with no-MG thymoma., Conclusion: Serum anti-titin antibody test is helpful in the diagnosis of MG with thymoma.