To evaluate the correlation between “hot cross bun” sign (HCBs) and disease severity in multiple system atrophy (MSA). We recruited patients with probable and possible MSA with parkinsonism (MSA-P) or the cerebellar ataxia (MSA-C) subtypes. Clinical and imaging characteristics were collected and comparison was performed between MSA-C and MSA-P cases. Spearman test was used to evaluate the correlation between HCBs and other variables. Curve estimate and general linear regression was performed to evaluate the relationship between HCBs and the Scale for Assessment and Rating of Ataxia (SARA). Unified Multiple System Atrophy Rating Scale (UMSARS) IV was used to assess the severity of disease. Multinomial ordered logistic regression was used to confirm the increased likelihood of disability for the disease. Eighty-one MSA with HCBs comprising of 50 MSA-C and 31 MSA-P were recruited. We demonstrated that the severity of HCBs showed a positive linear correlation with SARA scores in MSA-C. Multinomial ordered logistic regression test revealed that the increase in the HCBs grade may be associated with an increased likelihood of disability for the disease severity in MSA, especially in those with cerebellar ataxia subtype. We demonstrated that HCBs is a potential imaging marker for the severity of cerebellar ataxia. The increase in the HCBs grade may be associated with an increased likelihood of disability in MSA-C, but not MSA-P cases, suggesting that it may be a useful imaging indicator for disease progression in Chinese patients with MSA-C.

目前阿尔茨海默病尚无确切有效的治疗方法,确诊阿尔茨海默病的患者宜尽早开始高剂量的胆碱酯酶抑制剂治疗.利斯的明透皮贴剂因其药物吸收平稳、不良反应少、使用方便等优势,易于达到早期高剂量,可作为阿尔茨海默病治疗的一种选择.

BACKGROUND AND PURPOSE:The aim of this study was to explore whether cystatin C (CysC) could be used as a potential predictor of clinical outcomes in acute ischemic stroke (AIS) patients treated with intravenous tissue plasminogen activator (IV-tPA).METHODS:We performed an observational study including a retrospective analysis of data from 125 AIS patients with intravenous thrombolysis. General linear models were applied to compare CysC levels between groups with different outcomes; logistic regression analysis and receiver-operating characteristic curves were adopted to identify the association between CysC and the therapeutic effects.RESULTS:Compared with the "good and sustained benefit" (GSB) outcome group (defined as ≥4-point reduction in National Institutes of Health Stroke Scale or a score of 0-1 at 24 h and 7 days) and the "good functional outcome" (GFO) group (modified Rankin Scale score 0-2 at 90 days), serum CysC baseline levels were increased in the non-GSB and non-GFO groups. Logistic regression analysis found that CysC was an independent negative prognostic factor for GSB (odds ratio [OR] 0.010; p = 0.005) and GFO (OR 0.011; p = 0.021) after adjustment for potential influencing factors. Receiver-operating characteristic curves showed the CysC-involved combined models provided credible efficacy for predicting post-90-day favorable clinical outcome (area under the curve 0.86; p < 0.001).CONCLUSIONS:Elevated serum CysC is independently associated with unfavorable clinical outcomes after IV-tPA therapy in AIS. Our findings provide new insights into discovering potential mediators for neuropathological process or treatment in stroke.

There are limited data on vascular, inflammatory, metabolic risk factors of dementia in Parkinson’s disease (PD) with type 2 diabetes mellitus (DM) (PD-DM). In a study of 928 subjects comprising of 215 PD with DM (including 31 PD-DM with dementia, PD-DMD), 341 PD without DM (including 31 PD with dementia, PDD) and 372 DM without PD (including 35 DM with dementia, DMD) patients, we investigated if vascular, inflammatory, metabolic, and magnetic resonance imaging (MRI) markers were associated with dementia in PD-DM. Lower fasting blood glucose (FBG<5mmol/L, OR=4.380; 95%CI: 1.748-10.975; p=0.002), higher homocysteine (HCY>15μmol/L, OR=3.131; 95%CI: 1.243-7.888; p=0.015) and hyperlipidemia (OR=3.075; 95%CI: 1.142-8.277; p=0.026), increased age (OR=1.043; 95%CI: 1.003-1.084; p=0.034) were the most significant risk factors in PDD patients. Lower low-density lipoprotein cholesterol (LDL-C<2mmol/L, OR=4.499; 95%CI: 1.568-12.909; p=0.005) and higher fibrinogen (>4g/L, OR=4.066; 95%CI: 1.467-11.274; p=0.007) were the most significant risk factors in PD-DMD patients. The area under the curve (AUC) for fibrinogen and LDL-C was 0.717 (P=0.001), with a sensitivity of 80.0% for the prediction of PD-DMD. In summary, we identified several factors including LDL-C and fibrinogen as significant risk factors for PD-DMD and these may have prognostic and treatment implications.

Rasagiline is a monoamine oxidase-B inhibitor used for Parkinson’s disease (PD) treatment, but its effectiveness on Chinese patients is unclear. This study aimed to evaluate the efficacy and safety of rasagiline monotherapy in Chinese patients with early PD.

The use of adjunct rasagiline in levodopa-treated patients with Parkinson’s disease and motor fluctuations is supported by findings from large-scale clinical studies. This study is to investigate the efficacy and safety of adjunct rasagiline in Chinese patients with Parkinson’s disease, as a product registration study.

Objective To investigate the effect of curcumin on Aβ production in swAPP HEK293 cells and its preliminary mechanism.Methods swAPP HEK293 was used as cell model,the effect of curcumin (at different time points and of concentration) on cell viability was accessed by MTT assay.After the cells were treated with non-cytotoxic concentration of 5 μmol/L for different time,ELISA was used to detect Aβ production.The concentration and the time point of the strongest inhibitory effect were selected for the following tests.Real time PCR was employed to analyze miR-153 and APP mRNA expression,and Western blot was used to detect APP protein expression.Results As compared with the control group,curcumin of ≤ 5 μmol/L had no toxicity effect on the cell viability (P ＞ 0.05).Curcumin significantly inhibited Aβ production (P ＜ 0.05).Therefore 5 μmol/L curcumin and 24 h were selected as the best concentration and timc.Curcumin of 5 μmol/L had no obvious impact on APP mRNA expression (P ＜ 0.05),whereas markedly decreased APP protein expression.In addition,miR-153 level in the cells was significantly increased by 5 μmol/L curcumin treatment (P ＜ 0.05).Conclusion Curcumin may inhibit Aβ production through up-rcgulating miR-153 level and reducing APP protein expression in swAPP HEK293 cells.

Objective To longitudinally analyze microstructural white matter changes in high risk mild cognitive impairment (MCI) patients with DTI.Methods Structural MRI,DTI and psychometric analyses were performed in 102 individuals with 1 year follow-up.At the end of the follow-up,11 participants were diagnosed with MCI (CN-MCI group),while 91 participants were classified as cognitively stable (CN-stable group).The differences of fractional anisotropy (FA) and mean diffusivity (MD) between the two groups were analyzed,and the relationship with MCIs and cognitive ability was observed with multivariate logistic regression analysis.Results At the baseline assessment,MD of CN-MCI group increased in fornix and left parahippocampal gyrus white matter compared with those of CN-stable group (P＜0.05).For 1-year follow-up reassessment,the MD of CN-MCI group increased in the fornix,left parahippocampal gyrus white matter,left eingulum and splenium,while FA of CN-MCI group reduced in fornix and left parahippocampal gyrus white matter compared with those of CN-stable group (P＜0.05).Multivariate Logistic regression analysis showed that MD of the fornix could be a predictor of conversion from a high risk MCI to MCI,and MD of left parahippocampus gyrus white matter was a risk factor for increased CDR scores.Conclusion For high-risk MCI individuals,microstructural white matter changes may be used as potential imaging biomarkers in the early phase of AD.

AIMS:To compare the once-daily rivastigmine patch 9.5 mg/24 h (10 cm(2) ) versus twice-daily capsule (12 mg/day) in Chinese patients with probable Alzheimer's disease (AD) (mini-mental state examination [MMSE] scores of 10-20).METHODS:The primary objective was to demonstrate the noninferiority of patch to capsule in Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) change from baseline to 24 week. Secondary endpoints included cognition (MMSE), overall clinical response (Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change [ADCS-CGIC]), activities of daily living (Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL]), behavior (Neuropsychiatric Inventory [NPI-12]), and safety.RESULTS:Similar cognitive improvement was observed in both patch (n = 248) and capsule (n = 253) groups. Statistical noninferiority for ADAS-Cog was not established (least-square means difference, 0.1; 95% confidence interval, -1.2; 1.5). Considering all efficacy parameters into account, both treatments showed similar performance at Week 24. Treatment-related adverse events (AEs) were lower for patch (39.7%) compared with capsule (49.8%). Application site pruritus was reported in 10.9% of patients receiving patch; most cases were mild. Gastrointestinal AEs including nausea, vomiting, and diarrhea occurred less frequently in the patch group (15.8% vs. 28.7%).CONCLUSION:Rivastigmine patch 9.5 mg/24 h is effective and well tolerated in Chinese patients with probable AD.

BACKGROUND:The prevalence and factors associated with delays in help seeking for people with dementia in China are unknown. METHODS:Within 1,010 consecutively registered participants in the Clinical Pathway for Alzheimer's Disease in China (CPAD) study (NCT01779310), 576 persons with dementia (PWDs) and their informants reported the estimated time from symptom onset to first medical visit seeking diagnosis. Univariate analysis of general linear model was used to examine the potential factors associated with the delayed diagnosis seeking. RESULTS:The median duration from the first noticeable symptom to the first visit seeking diagnosis or treatment was 1.77 years. Individuals with a positive family history of dementia had longer duration (p = 0.05). Compared with other types of dementia, people with vascular dementia (VaD) were referred for diagnosis earliest, and the sequence for such delays was: VaD < Alzheimer's disease (AD) < frontotemporal dementia (FTD) (p < 0.001). Subtypes of dementia (p < 0.001), family history (p = 0.01), and education level (p = 0.03) were associated with the increased delay in help seeking. CONCLUSIONS:In China, seeking diagnosis for PWDs is delayed for approximately 2 years, even in well-established memory clinics. Clinical features, family history, and less education may impede help seeking in dementia care.

Objective To investigate DTI appearance of early Alzheimer's disease (AD)patients' white matter changes.Methods 35 early AD patients and 35 volunteers were enrolled and examined with DTI scanning.MD and FA were acquired by setting regions of interest.Results MD value of AD group raised mostly,with statistically significant differences in fomix,left temporal lobe between two groups.FA value of AD group reduced mostly,with statistically significant differences in fornix,left temporal lobe between two groups.Conclusions Fornix and left temporal lobe were sensitive organizations for early AD with DTI scan,they were associated with micro-structural changes of white matter in early AD.

Background: The effect of antiplatelet agents for the treatment of acute stroke is less certain than that for the treatment of acute myocardial ischemia. In this study, we investigated whether antiplatelet agents (aspirin, clopidogrel, and ozagrel) demonstrated a favorable effect on functional outcome and cognitive status 3 months poststroke.Methods: We randomly selected 24 hospitals from five different regions in China. Patients without recurrent stroke were recruited and neurological and neuropsychological examinations were performed on these patients at 3 months poststroke. Each patient was diagnosed as having favorable or poor functional outcome and normal cognition or cognitive impairment. Multivariate logistic regression analyses adjusted for sex, age, education, and neurological deficit at stroke onset were performed to examine whether antiplatelet agents exhibited a favorable effect on functional outcome and cognitive status at 3 months poststroke.Results: Of the 518 eligible patients (aged 45-86 years, mean 63.01 +/- 9.99 years), 167 (32.2%) were female. On the basis of univariate analysis, there were significant associations between functional outcome (p = 0.048) and cognitive status (p = 0.026) at 3 months poststroke and the use of antiplatelet agents in acute ischemic stroke. The adjusted odds ratio for favorable functional outcome was 1.81 (95% confidence interval: 1.09-2.99) and for normal cognition 1.67 (95% confidence interval: 1.02-2.74).Conclusion: The use of antiplatelet agents in acute ischemic stroke may have a favorable effect on functional outcome and cognitive status in patients at 3 months poststroke. Copyright (C) 2014, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC. All rights reserved.

With the deepening of the reform of medical system in China and the transforma-tion of modern medical model , cultivating graduates with community service ability is an important task of medical education at present. Through practice activities by forming an undergraduate medical service team, such as community residents health survey, free clinics, health care propaganda, will enhance the students' sense of responsibility and community identity, cultivate their clinical and sci-entific thinking ability and enhance their self-confidence, self-study ability, communication skills and comprehensive quality. It will also promote the community residents to improve the level of health.

目的描述吉兰-巴雷综合征（Guillain-Barré Syndrome GBS）疼痛特点及探讨可能的机制。方法回顾分析31例GBS患者的临床资料并查阅文献。结果58%(18/31)GBS患者有疼痛症状出现,44%(8/18)疼痛症状出现早于肌无力；治疗后大部分疼痛改善，1例出院时仍有明显疼痛，继续口服卡马西平治疗；上呼吸道感染患者中伴发疼痛者最多见。结论吉兰-巴雷综合征（GBS）患者的疼痛症状比较常见，但易被误诊或忽略；有上感前驱史的患者出现疼痛更多见，可能与免疫介导损害有关；持续存在的神经病理性疼痛可能与小纤维数目减少相关。

Objective To observe the efficacy and safety of argatroban in treating acute cerebral infarction. Methods 98 patients with acute cerebral infarction were divided randomly into argatroban group and control group. The control group was given antiplatelet, improve microcirculation,cerebral nerve nutriceutical,statin treatment and other supporting treatment. Results Neurologic impairment of patients in treatment group was obviously improved compared with that of control group (P<0.05).The curative effect of the treatment group was obviously surpassed that of control group (91.6% vs 78.0%). Conclusion Argatroban is safe and effective for the early treatment of acute cerebral infarction.

目的探讨影响延髓梗死患者临床及预后的因素。方法回顾性分析20例延髓梗死患者的临床及影像学资料。结果本组患者均急性或亚急性起病，以眩晕起病多见，饮水呛咳、吞咽困难者病情相对较重。延髓部位的梗死以延髓背外侧多见，但预后均较好。少见的双侧延髓梗死及内侧梗死预后较差。结论延髓病变的预后与梗死部位密切相关，靠近背外侧的延髓梗死相对预后较好，双侧的延髓梗死预后不良，合并其他重要部位梗死及出现感染等并发症的患者预后较差。

目的 探讨粤语版全科医生认知功能评估量表(GPCOG)在广州地区用于痴呆筛查的信度、效度及应用价值.方法 在广州地区随机选择185例研究对象(痴呆组103例,正常对照组82例),采集人口学资料、病史和辅助检查结果,以美国精神病学会<精神疾病诊断与统计手册>修订第4版(DSM-Ⅳ-R)的痴呆诊断标准作为判断标准,使用粤语版GPCOG、简易精神状态检查量表(MMSE)、日常生活能力量表(ADL)等量表进行评估,分析粤语版GPCOG的信度、效度和相关诊断指标.结果 粤语版GPCOG患者部分的内部一致性Cronbach′α系数为0.710,标准化后Cronbach′α系数为0.842,重测信度为0.921.粤语版GPCOG与MMSE评定结果的Pearson相关系数为0.838,与ADL的相关系数为-0.746.粤语版GPCOG筛查痴呆的灵敏度为91.3%、特异度为87.2%,约登指数为0.79,阳性预测值为90.4%,阴性预测值为88.3%,ROC曲线下面积(AUC)为0.896(95%CI:0.816～0.949),标准误为0.031 2.粤语版GPCOG平均耗时为(245±87)s,MMSE平均耗时(465±162)s,两者比较差异有统计学意义(P<0.01).结论 粤语版GPCOG具有良好的信度、效度和诊断价值,与MMSE比较,操作更简便、省时,适合广州地区的医生给中老年人进行认知功能评估,是一种有效的痴呆筛查工具.

目的通过延髓背外侧综合征(LMS)的临床及影像学特征,探讨其病因及发病机制。方法回顾性分析17例临床诊断为延髓背外侧综合征患者的临床资料。结果本组患者均急性或亚急性起病,以眩晕、恶心、呕吐为最常见主诉,查体多见水平眼震、感觉障碍和共济失调,MRI检查有助于明确责任病灶及可能的病因。结论典型的LMS临床少见,大部分表现为部分性或不典型的LMS,其诊断主要依据临床特征及MRI表现,大部分预后较好,少数合并大面积小脑梗死或累及呼吸、循环中枢者预后差。

Objective To study the effect of interlukin 18 gene (IL-18) promoter polymorphisms on its transcriptional activity in patients with Alzheimer's disease (AD) and exposit the relation between IL-18 and AD. Methods We selected the Dual-Luciferase reporter assay system (pGL4.10 [luc2]Basic and pRL-TK) as carrier,and used the genetic recombination and site-directed mutagenesis methods to build the reporter gene plasmids of IL-18 containing different single nucleotide (SNP) polymorphisms; and then, these gene plasmids were transiently transfected into the human embryonic kidney 293 (HEK293) cells.The relative lueiferase activity (RLA) was calculated to explore the role of different SNPs on transcriptional activities of different promoters. Results All IL-18 promoter plasmids were found to have clear promoter activity; the mutational plasmids (RLA values of PGL-AC,PGL-CG and PGL-CC:0.96±0.26,1.02±0.23 and 0.77±0.14) had significantly increased promoter activity as compared with the wild plasmid (RLA value of PGL-AG:0.49± 0.11,P＜0.05); however,two-site mutational plasmid (PGL-CC) showed no significant difference on the promoter activity as compared with the single mutational ones (PGL-AC and PGL-CG,P＞0.05). Conclusion The variations of-607A/C and -137G/C could influence the transcriptional activity of IL-18 gene, and the mutational plasmids (PGL-AC,PGL-CG and PGL-CC) could raise the transcriptional activity,therefore,the expression of protein IL-18 could be elevated,which may play an important role in the neuroinflammation pathogenesis of A D.