Leukoencephalopathy with vanishing white matter (LVWM) is an autosomal recessive disease. Ovarioleukodystrophy is defined as LVWM in females showing signs or symptoms of gradual ovarian failure. We present a 38-year-old female with ovarioleukodystrophy who showed status epilepticus, gait instability, slurred speech, abdominal tendon hyperreflexia, and ovarian failure. Abnormal EEG, characteristic magnetic resonance, and unreported EIF2B5 compound heterozygous mutations [c.1016G>A (p.R339Q) and c.1157G>A (p.G386D)] were found. Furthermore, the present report summarizes 20 female patients with adult-onset ovarioleukodystrophy and EIF2B5 gene mutations. In conclusion, a new genetic locus for LVWM was discovered. Compared with previous cases, mutations at different EIF2B5 sites might have different clinical manifestations and obvious clinical heterogeneity.

Situs inversus totalis (SIT) is a rare congenital malposition marked by a symmetrical "mirror-image" arrangement of all internal organs relative to the midline. The estimated incidence of SIT is 1/10,000–1/20,000, of which 2% to 5% are associated with cardiac abnormalities.1 Stroke in young age has gained more attention with multiple etiologies, of which cardiac abnormalities are highly correlated with it.2 However, stroke in patients with SIT has been rarely reported. Here, we describe a case of a young stroke victim with SIT involving atrial septal defect and ventricular septal defect, which prompts a series of reflective considerations. A 36-year-old woman was admitted to our emergency department for a sudden onset of dysarthria and right extremity weakness for 3.5 h. She had a cesarean delivery 3 months ago and denied any history of hypertension, diabetes, blood transfusion, smoking, or alcohol consumption. Her National Institutes of Health Stroke Scale (NIHSS) was 13 on admission with no aphasia. Neurological examination indicated dysarthria and paresis of right extremities, including upper extremity weakness graded 2/6, while the lower graded 4/6 on the Medical Research Council scale. Urgent computed tomography (CT) of the brain discovered no obvious abnormality(Figure 1A). An emergency cerebral magnetic resonance imaging (MRI) revealed an acute ischemic stroke in the left basal ganglia region (Figure 1B–D). The patient was treated with Alteplase immediately. Two days later, her NIHSS dropped to 2. Ultrasonography of cervical vessels discovered no occlusions or stenoses of the bilateral carotid and the vertebral arteries of the cervical segment. Laboratory tests, including blood tests, coagulation function test, serum biochemical parameters, tests of kidney and liver function, antibody tests (Syphilis, HIV, anti-cardiolipin, and autoimmune vasculitis), and rheumatic immunity-related indicators, were all within normal limits. Unexpected finding stepped by further investigation. On cardiovascular examination, her apex was heard in right 5th intercostal space 0.5 cm lateral to the midclavicular line, with grade 3/6 ejection systolic murmur. A 12-lead electrocardiogram yielded results that were consistent with dextrocardia and sinus bradycardia. Ultrasonic cardiogram revealed complex congenital heart disease, including mesocardiac, corrected transposition of the great arteries, and ventricular septal defect (Figure 2A,B). Computed tomography cardiac angiography (CTCA) revealed SIT with dextrocardia, atrial septal defect, interventricular septal defect, and slightly hydrops pericardia. In addition, the whole heart was enlarged and the arteria pulmonalis were widened slightly, and congenital deletion of the left coronary cycloclade was considered (Figure 2D,E). It was consistent with the chest, abdomen, and cavity of pelvis CT and three-dimensional image (Figure 2C). The patient was started to be treated with oral antiplatelet aggregation with acenterine, and intravenous drip of butylphthalide. However, due to the patient's financial problems, the examination had to be discontinued. At the time of being discharged from the hospital, she recovered well from previous clinical symptoms with an NIHSS score 0, except with subtle deficits of fine finger movements and positive Babinski's sign on the right side. The patient stopped taking the prescribed drugs Aspirin, Edaravone, and Atorvastatin on her own after one month. During the follow-up period, she had been free from cerebrovascular episodes and other cardiac complications for the last 4 years. Situs inversus totalis is a rare abnormality with uncertain pathophysiology. Genetic heterogeneity has proved critical in the variable manifestations,3 and more researches have confirmed the association between cilia-related genes and heterotaxy.4, 5 Most SIT patients are diagnosed incidentally, for presenting with nonspecific symptoms and unrelated conditions. Strokes in young people with SIT are not commonly reported, and the management of this rare group poses a challenge to clinicians. For them, it is critical to identify the etiology, such as structural cardiac abnormalities, which plays an important role in effective secondary prophylaxis. Therefore, for stroke patients, comprehensive cardiac work-ups were essential. As the case in our patient, ultrasound and coronary CT confirmed complex precordial disease, in which she had an atrial septal defect and large arterial torsion. Besides, repeated ECGs did not discover risk factors such as atrial fibrillation or arrhythmias. The term situs and its associated modifiers are used to refer to the entire organism's left–right anatomy. Organ positioning along the left–right axis can be classified into 3 basic classes: situs solitus, referring to the normal left–right anatomical arrangement; SIT, referring to mirror-image reversal of all organs; and heterotaxy, also known as situs ambiguous, referring to any malposition of organs differing from the first two.3, 6 Positional abnormalities are described using the terms right, left, and midline, such as in "left-sided liver." However, it may cause confusion when describing a structure that is already modified in orientation. For example, shall we rename the patient's structures according to their anatomical location, such as describing the patient's two right-sided chambers as his right atrium and right ventricle, or defining them as the left atrium and left ventricle located on the right side? Likewise, it is worthwhile to consider how to label the cranial trunk, internal carotid, and subclavian arteries that emanate from the heart of SIT patients. Classical neuroanatomy, neurophysiology, and neuropathophysiology suggest the brain and limbs have a left–right crossed lateral relationship, e.g., the right side of the brain innervates the strength of left limbs, the left side of the brain senses pain in the right limbs, and the dominant hemisphere in patients with right-handedness is mostly the left side. Therefore, what would be the lateral relationship between the brain and the limbs of a person with SIT? A noninvasive investigation showed that the frontal and occipital petalia were reversed in individuals with SI.7 However, our patient, in accord with a case reported in 1993,8 revealed that the classic "left–right crossover" still exists in SIT individuals, in which a left hemispheric stroke caused aphasia and right hemiplegia. Besides, a number of studies have confirmed that the potential mechanisms of visceral organ asymmetries are not necessarily linked to the functional asymmetry of language and handedness.3, 7, 9 Will the "brain network" distinguish between the classical "left–right crossover" to explain the relationship between brain and limb laterality? More supportive research are required to carry out. The authors declare no conflict of interest. All the data and materials have been presented in the main paper. The patient provided written consent for participation. The patient provided written consent for the disclosure of medical information and images.

本文旨在归纳和总结虢周科教授治疗失眠伴焦虑状态的临床经验和学术思想.虢周科教授为广东省名中医,他认为失眠伴焦虑状态以肝经郁热,阴血不足为核心病机,在治疗上当充分发挥中医药的优势,提出以"解郁安神、滋阴清热"为基本治疗原则.虢教授经过数十年临床经验的积累,凝练出郁乐冲剂作为底方,并兼顾个体症状差异,加减化裁,精准用药,同时注重心理疏导和临床状态的改善,在失眠伴焦虑状态治疗上取得良好疗效.现通过介绍失眠伴焦虑状态的定义、病因病机、遣方用药以及临床医案,总结虢周科教授治疗失眠伴焦虑状态的经验,将名医经验指导临床实践,为临床上治疗该病开拓新思路.

[This retracts the article DOI: 10.2147/DDDT.S161748.].

目的 评价脑髓康方治疗血管性认知障碍(VCI)患者的临床疗效.方法 采取多中心随机研究设计,选取五家三级甲等中医院,筛选受试者454例,纳入符合标准362例,采用随机数字表法分为中药组和西药组,中药组口服脑髓康胶囊(每次3粒,每日3次),西药组口服尼莫地平片(每次20mg,每日3次),连续服药6月.主要结局指标:蒙特利尔认知评估量表(MoCA)评分,次要结局指标:血管性痴呆中医辨证量表(SDSVD)评分、汉密尔顿抑郁量表17项(HAMD-17)评分.结果 与本组治疗前比较,两组治疗6月后 MoCA、SDSVD、HAMD-17评分降低(P＜0.01);中药组MoCA、SDSVD、HAMD-17评分优于西药组(P＜0.01,P＜0.05);MoCA、SDSVD、HAMD-17评分差值高于西药组(P＜0.05,P＜0.01);析因分析提示两组干预因素与病情严重程度差异无统计学意义(P＞0.05).两组不良事件发生率差异无统计学意义(中药组为4.44％,西药组为4.95％,P＞0.05).结论 脑髓康能有效地改善VCI患者的认知评分、中医证候、血管性认知障碍相关的抑郁症状,临床疗效优于尼莫地平,不受疾病严重程度的影响,且安全性较好.

目的:探讨通脉消斑膏对痰瘀互结型颈动脉斑块的临床治疗效果.方法:选取深圳市中医院2021年1月至2021年12月期间收治的60例痰瘀互结型颈动脉粥样硬化患者,随机分成对照组与观察组,各30例.对照组患者给予口服辛伐他汀片治疗,观察组患者在对照组基础上联合外用通脉消斑膏.观察并比较两组患者治疗12周后的疗效、血脂水平〔三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL–C)、低密度脂蛋白胆固醇(LDL–C)〕、斑块指标〔颈动脉内膜中层厚度(IMT)、斑块数量、斑块面积〕的变化.结果:治疗12周后观察组患者的IMT低于对照组,斑块数量少于对照组,差异具有统计学意义(P<0.05);治疗12周后观察组患者的Crouse积分低于对照组,差异具有统计学意义(P<0.05);治疗12周后观察组患者的TC、TG、LDL–C低于对照组,HDL–C高于对照组,差异具有统计学意义(P<0.05);观察组患者治疗总有效率为83.33％,高于对照组的67.67％,差异具有统计学意义(P<0.05).结论:通脉消斑膏联合口服辛伐他汀片治疗颈动脉粥样硬化能明显减轻患者症状,调控血脂水平,有助于稳定粥样斑块,可提高临床疗效.

目的:探讨血管性认知障碍(VCI)患者中医证候分布规律及认知损害特点,为防治VCI提供理论依据.方法:采取多中心、横断面研究,选取5家三级甲等中医院,纳入符合标准362例VCI患者,应用蒙特利尔认知评估量表(montreal cognitive assessment,MoCA)、血管性痴呆中医辨证量表(the scale for the differentiation of syndromes of vascular dementia,SDSVD)进行评估,经过数据处理和统计学分析方法进行比较.结果:VCI患者以肾精亏虚证型最为多见,中医证型组合形式以两种证型或1种证型组合形式为主,其中虚实结合证型例数最多,占54.97％.虚证组与实证组、虚实结合证候2组在体重、BMI指数差异有统计学意义(P＜0.01).实证组在MoCA量表总分、命名因子分明显高于虚实结合证型组,差异有统计学意义(P＜0.05).实证组在延迟回忆因子分与另外2组差异也有统计学意义(P＜0.05).结论:VCI不同虚实证候组的认知功能损害存在差异,VCI患者中医证候以虚实夹杂为主,治疗上首当分清虚实.

[目的]观察通脉消斑膏贴敷人迎穴联合针刺治疗痰瘀互结型颈动脉斑块的临床疗效.[方法]将66例痰瘀互结型颈动脉斑块患者随机分为治疗组和对照组,每组各33例.治疗组给予通脉消斑膏贴敷人迎穴联合针刺风池、人迎、血海、丰隆、足三里、太冲穴治疗,对照组给予口服阿司匹林肠溶片、阿托伐他汀钙片治疗,疗程为12周.观察2组患者治疗前后中医证候积分、血脂水平及颈动脉内膜中层厚度(IMT)的改善情况,评价2组患者的中医证候疗效、颈动脉IMT改善疗效和安全性.[结果](1)研究过程中,2组各脱落3例,最终各有30例患者完成试验.(2)中医证候疗效:治疗12周后,治疗组的总有效率为86.67％(26/30),对照组为60.00％(18/30),组间比较,治疗组的总体疗效和总有效率均明显优于对照组(P<0.05或P<0.01).(3)颈动脉IMT改善疗效:治疗12周后,治疗组的总有效率为56.67％(17/30),对照组为26.67％(8/30),组间比较,治疗组颈动脉IMT改善疗效的总有效率明显优于对照组(P<0.05).(4)治疗后,2组患者的中医证候积分和颈动脉IMT值均较治疗前明显降低(P<0.01),且治疗组对中医证候积分的降低作用明显优于对照组(P<0.05),但2组颈动脉IMT值比较,差异无统计学意义(P>0.05).(5)治疗后,2组患者的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)水平均较治疗前下降(P<0.05),高密度脂蛋白胆固醇(HDL-C)水平均较治疗前升高(P<0.05),但组间比较,差异均无统计学意义(P>0.05).(6)治疗过程中,2组患者的血常规、肝功能、肾功能等安全性指标均无明显异常.[结论]通脉消斑膏贴敷人迎穴联合针刺治疗对痰瘀互结型颈动脉斑块患者具有良好的临床疗效,能减少颈动脉IMT,改善血脂水平,降低中医证候积分.

[目的]观察临床状态医学理念指导下中西医结合诊疗方案治疗失眠障碍患者的临床疗效,为临床治疗失眠障碍提供新的思路与方法.[方法]将62例失眠障碍患者随机分为试验组和对照组,每组各31例.对照组给予常规中西医结合治疗,试验组给予临床状态医学理念指导下中西医结合诊疗方案治疗,疗程为1个月.观察2组患者治疗前后匹兹堡睡眠质量指数(PSQI)、抑郁自评量表(SDS)、焦虑自评量表(SAS)、中医健康状况量表(TCM-HSS)评分的变化情况.[结果](1)治疗过程中,试验组和对照组各脱落1例,最终每组各30例完成试验.(2)PSQI评分方面:治疗后,2组患者PSQI的睡眠质量、入睡时间、睡眠时间、睡眠效率、失眠障碍、催眠药物、日间障碍等各维度评分及其总分均较治疗前改善(P<0.05),且试验组患者对日间功能障碍和PSQI总分的改善作用均明显优于对照组(P<0.05).(3)SAS和SDS评分方面:治疗后,试验组患者的SAS和SDS评分均较治疗前明显改善(P<0.05),而对照组患者均较治疗前略有改善,但差异均无统计学意义(P>0.05);组间比较,试验组对SAS和SDS评分的改善作用均明显优于对照组(P<0.05).(4)TCM-HSS评分方面:治疗后,试验组患者TCM-HSS的精力、疼痛、饮食、大便、小便、睡眠、情绪和健康自我评分均较治疗前改善(P<0.05),对照组患者仅大便、小便、睡眠和健康自我评分较治疗前改善(P<0.05);组间比较,试验组患者对TCM-HSS的精力、疼痛、饮食、大便和情绪评分的改善作用明显优于对照组(P<0.05).[结论]采用临床状态医学理念指导下的中西医结合治疗与常规中西医结合治疗失眠障碍均有明显效果,但临床状态医学理念指导下中西医结合诊疗方案在改善患者失眠状态、焦虑抑郁状态、中医状态方面有独特优势,能够提高患者的生活质量.

Atherosclerosis is the pathophysiological basis of circulatory system diseases. Inflammation is not only a key indicator, but is also the driving force behind these diseases. Atherosclerosis is therefore treated using anti-inflammatory strategies. Chinese herbal medicine is widely used in Asia, China in particular. Naosuikang is a Chinese herbal medicine that has been used clinically, and its clinical efficacy has been confirmed, but its specific mechanism needs further clarification. Exosomes are the transmitters of signals between cells, and they participate in the occurrence and development of inflammation. We hypothesized that Naosuikang uses exosomal microRNA (miRNA) in its role as a treatment for atherosclerosis. In this project, we used atherosclerotic mice as an animal model, treating them with various doses of Naosuikang and observing the external effects of miRNAs on the body. This research will provide insight into the mechanism of action of Naosuikang.

目的 研究脑髓康对动脉粥样硬化小鼠血清miR-21、miR-181b及巨噬细胞炎症反应的影响.方法 选取SPF级雄性ApoE-/-小鼠40只,采用随机数字表法分为动脉粥样硬化模型组、用药组、空白对照组、低分子肝素组各10只,对照组小鼠用普通饲料喂养,用药组小鼠建模成功后给予脑髓康治疗,低分子肝素组皮下注射低分子肝素.HE染色观察四组小鼠组织学,采用实时定量PCR法检测血清中miR-21、miR-181b表达水平及血脂水平[总胆固醇(TC),三酰甘油(TG),低密度脂蛋白胆固醇(LDL-C)],并检测巨噬细胞上清炎症因子[白细胞介素1(IL-1)、白细胞介素6(IL-6)、白细胞介素10(IL-10)、肿瘤坏死因子α(TNF-α)]分泌情况.结果 用药组和低分子肝素组小鼠内皮细胞排列情况接近空白对照组,动脉粥样硬化模型组小鼠血管腔内粥样斑块形成,内皮细胞内膜增厚,细胞排列较乱;模型组血清miR-21表达水平显著高于空白对照组,miR-181b表达水平显著低于空白对照组(P＜0.05),用药组和低分子肝素组血清miR-21表达水平显著低于模型组,miR-181b表达水平显著高于动脉粥样硬化模型组(P＜0.05);模型组IL-1、IL-6、TNF-α水平显著高于空白对照组,IL-10水平显著低于空白对照组(P＜0.05),用药组和低分子肝素组血清IL-1、IL-6、TNF-α水平显著低于动脉粥样硬化模型组,IL-10水平显著高于动脉粥样硬化模型组(P＜0.05);动脉粥样硬化模型组TC、TG、LDL-C水平显著高于空白对照组,用药组和低分子肝素组血清TC、TG、LDL-C水平显著低于动脉粥样硬化模型组.结论 脑髓康能有效调控动脉粥样硬化小鼠血清miR-21、miR-181b表达水平,并有效缓解巨噬细胞炎症反应.

Objective Effective drugs for treating dementia are still rare. Danggui-Shaoyao San(DSS), a traditional Chinese medicine, has been widely used in oriental countries for the treatment of various gynecological diseases. Many studies reported that DSS could ameliorate cognitive impairment. In this study, we aimed to investigate the underlying mechanism of DSS on VCI rats. Methods Chronic cerebral hypoperfusion(CCH) is one of the main causes of Vascular Cognitive Impairment(VCI). CCH resulted in a chain of pathological process, including neuroinflammation, neuronal apoptosis, oxidative stress. The most widely used animal model of VCI is permanent bilateral common carotid artery occlusion(BCCAO) in rats. In this research, we determined whether DSS attenuated cognitive impairment through targeting IKK(I kappa B kinase)/NF-κB(nuclear factor of kappa B) signal pathway in VCI rats. Results Morris water maze and fear conditioning tests results indicated that DSS(7.2g/kg/d) could improve learning and memory ability in VCI rats. We also found DSS significantly elevated the level of LRP1 in the brain of VCI rats and this might indirectly target the IKK/NF-κB signal pathway to exert inhibitory effect on neuroinflammation, neuronal apoptosis and oxidative stress in VCI rats. Conclusion The present researches indicated that DSS might attenuate cognitive impairment through targeting IKK/NF-κB signal pathway in VCI rats and DSS might be a promising agent on Vascular Cognitive Impairment.

目的 通过文献检索、共现分析和聚类分析等文献计量学分析,揭示中医药功能磁共振研究的现状、热点及发展趋势,为该领域今后的相关研究提供参考和依据.方法 系统检索CNKI及Pubmed等多个国内外中英文数据库,采用文献计量学方法,从论文量年度变化、文献来源及研究方向、载文期刊、作者发文数量、核心作者及团队研究方向、关键词聚类六个方面进行分析,基于Gephi进行作者及关键词的共现网络可视化分析.结果 中医药领域fMRI研究在近十年得到显著的发展,临床疗效和中医证候研究是该领域的研究热点.在所纳入的141篇文献中,高达93.19％的研究者发表论文频次小于2,发表频次在3及以上的研究者仅有28人.高质量研究团队多集中在北京.跨学科的研究态势是该领域最大的特点,中医药临床专家需要与影像学、神经信息学、精神病学和认知神经科学等多学科专家进行合作.结论 中医药fMRI研究尚处于发展的初级阶段,科研力量地区分布不均衡,跨学科研究既是机遇也是挑战.随着脑科学背景技术的发展,中医药fMRI研究将涌现更多地原创性发现.

目的:系统评价中医药临床疗效研究中fMRI的应用现状、问题及前景.方法:系统检索国内外多个中文及英文数据库,系统评价BOLD-fMRI、DTI及 1H-MRS在中医药临床疗效研究中的应用.结果:纳入研究的47篇文献中,27篇使用BOLD模态,13篇使用MRS模态,4篇使用DTI模态,3篇同时使用2种模态.目前研究多集中在局部脑区功能和环路异常2个层面,未发现脑网络研究;理论驱动和数据驱动的数据处理方式均得到运用,但ROI的选择存在较高的异质性,限制了DTI和MRS研究结果的可比性.结论:中医药临床疗效的fMRI研究呈爆发态势,但在参数设置方面需更加规范,在多模态融合、节点-环路-网络的靶点选择及数据分析方式等方面应增加研究的广度和深度.

In addition to cognitive impairments, depression symptoms were reported in subcortical vascular mild cognitive impairment. Although hippocampal alterations were associated with cognitive decline in subcortical vascular mild cognitive impairment, the neural mechanism underlying depression symptoms remains unclear. Thus, a cohort of 18 patients with depression symptoms, 17 patients without depression symptoms, and 23 normal controls was used. Functionally, significantly altered resting-state functional connectivity between hippocampal emotional sub-region and right posterior cingulate cortex, between hippocampal cognitive sub-region and right inferior parietal gyrus and between hippocampal perceptual sub-region and left inferior temporal gyrus were identified among three groups. Structurally, significantly altered structural associations between hippocampal emotional sub-region and 6 frontal regions/right pole part of superior temporal gyrus/right inferior occipital gyrus, between hippocampal cognitive sub-region and right orbital part of inferior frontal gyrus /right anterior cingulate cortex, and between hippocampal perceptual and right orbital part of inferior frontal gyrus / left inferior temporal gyrus / left thalamus were identified among the three groups. Further analyses also showed correlations between functional connectivity and depression symptoms and/or cognitive impairments of patients. Together, these results showed different patterns of functional and structural alterations of the hippocampal sub-regions in the subcortical vascular mild cognitive impairment with and without depression, which might be specially associated with the depression symptoms and cognitive impairments in these patients.

BACKGROUND:Late-life depression often coexists with vascular cognitive impairment and affects the quality of life for elders. However, little is known about cortical morphometric interactions between subcortical vascular mild cognitive impairment (svMCI) and concomitant mild depressive symptoms at the early stage.OBJECTIVE:We aimed to investigate cortical alterations of svMCI with and without depressive symptoms and determine whether these parameters are associated with depression symptoms and/or cognitive impairments.METHODS:Surface based morphometry was performed on 18 svMCI patients with depressive symptoms (svMCI + D), 16 svMCI patients without depressive symptoms (svMCI-D), and 23 normal controls (NC).RESULTS:Compared to NC, both svMCI + D and svMCI-D patients exhibited significantly decreased surface area (SA) in many cortical areas. Interestingly, svMCI + D patients showed significantly increased rather than decreased SA in right lateral occipital gyrus (LOG.R), and a consistent trend of increased SA in these areas compared to svMCI-D. In addition, the svMCI + D showed increased gray matter volume of left pericalcarine (periCAL.L) than svMCI-D, whereas svMCI-D showed decreased gray matter volume of periCAL.L than NC. Further correlation analyses revealed that the SA of left superior temporal gyrus (STG.L) and right lateral orbital part of frontal gyrus (lorbFG.R) were significantly correlated with Hamilton depression rating scale of svMCI + D.CONCLUSION:In conclusion, these results extend our insight into svMCI and add weight to reevaluation of concomitant early stage depressive symptoms. Moreover, we suggest that LOG.R∖periCAL.L∖STG.L∖lorbFG.R might serve as sensitive and trait-dependent biomarkers to detect concomitant depressive symptoms in svMCI patients.

Background: Depressive symptoms were thought to increase the risk of vascular dementia. Previous studies reported widespread white matter damages in the subcortical vascular mild cognitive impairment (svMCI), but little is known about the mechanism of depressive symptoms in svMCI. Objective: In the current study, we aim to explore the white matter microstructural alterations in svMCI with depressive symptoms, and their associations with clinical measurements. Methods: Fifty-eight subjects including 18 svMCI with depression (svMCI+D), 17 svMCI without depression (svMCI-D), and 23 normal controls (NC) were included in the study. Voxel-based analyses were performed on fractional anisotropy (FA) and mean diffusivity (MD). Results: Compared to NC, both svMCI groups showed decreased FA in the bilateral insula and the left precentral gyrus, and increased MD in the cerebellum. Compared to svMCI-D, svMCI+D showed increased FA in left precentral gyrus. Moreover, svMCI+D showed significant correlation between the increased MD in the cerebellum and the Hamilton Depression Rating Scale (HAMD) scores. Conclusion: Our findings of white matter alterations might be associated with executive function and memory performance in the svMCI patients. Moreover, the structural alterations in the cerebellum might underlie the mechanism of depressive symptoms in svMCI patients.

OBJECTIVE:To observe the clinical effect of "Yinqi Guiyuan" needling in the treatment of primary insomnia. METHODS:A total of 79 primary insomnia outpatients were randomly divided into treatment group (n=40) and control group (n=39). The patients in the control group were given oral Estazolam tablets once a day, for successive 4 weeks. For patients of the treatment group, Zhongwan (CV12), Xiawan (CV10), Qihai (CV6), Guanyuan (CV4), Baihui (GV20), etc., were punctured with filiform needles for 30 min. The treatment was conducted three times per week for 4 successive weeks. The sleep quality (sleeping quality, falling asleep time, sleep duration, sleep efficiency, sleep disorders, hypnotic and daytime dysfunction, 0 to 21 points) was evaluated by using Pittsburgh Sleep Quality Index (PSQI). The severity of insomnia (self-perception, sleep satisfaction, daytime function damage, sensibility change, and concern for sleep problems, 0 to 28 points) was assessed using insomnia severity index (ISI) score. The therapeutic effect was evaluated according to the PSQI score reduction rate = (pre-treatment PSQI score-post-treatment PSQI score)/pre-treatment PSQI score ×100%. RESULTS:After treatment, the total score of PSQI, ISI and the score of each item were all significantly reduced in the two groups relevant to their own pre-treatment (P<0.05). The total score, and scores of hypnotic and daytime dysfunction were significantly lower in the treatment group than in the control group (P<0.05). Of the 40 and 39 cases in the treatment and control groups, 5 (12.50%) and 4 (10.25%) were cured, 20 (50.00%) and 18 (46.15%) experienced marked improvement, 12 (30.00%) and 13 (33.33%) were effective, and 3 (7.50%) and 4 (10.25%) ineffective, with the total effective rate being 92.50% and 89.74%, respectively. No significant difference was found between the two groups in the effective rate (P>0.05). CONCLUSION:"Yinqi Guiyuan" needling and Estazolam are comparable in treatment primary insomnia, and the former is superior to the latter in avoiding hypnotic drug use and in improving daytime function.

目的 研究脑髓康对血管性认知障碍(VCI)模型大鼠空间记忆能力的影响.方法 应用永久性结扎大鼠双侧颈总动脉造成大鼠慢性脑区灌注不足,制备VCI大鼠模型.给予各组大鼠相应药物灌服4周.应用Morris水迷宫试验检测各组大鼠空间记忆能力的变化,并测定大鼠脑组织中胆碱能相关指标乙酰胆碱(Ach)、胆碱乙酰转移酶(ChAT)及乙酰胆碱酯酶(AchE)含量的变化,以及测定神经生长因子(NGF)和脑源性神经营养因子(BDNF)含量的变化.结果 脑髓康中剂量组(200 mg·kg-1)、高剂量组(400 mg·kg-1)及尼莫地平组能够显著改善VCI大鼠的空间记忆能力(P<0.05,P<0.01);脑髓康中、高剂量组显著提高VCI大鼠脑组织中Ach和ChAT的含量(P<0.05,P<0.01),并且显著提高VCI大鼠脑组织中神经营养因子NGF(P<0.05)及BDNF(P<0.05,P<0.01)的表达水平.结论 脑髓康可以在一定程度上改善VCI模型大鼠的空间记忆能力.脑髓康可能通过调节VCI模型大鼠的胆碱能系统以及提高脑中神经营养因子水平,从而改善VCI模型大鼠的空间记忆能力.