Transcranial ultrasound (TCS) imaging can quantitatively measure third ventricle width (TVW) in Parkinson's (PD) patients, helping physicians detect cognitive dysfunction in PD patients as early as possible. However, the transmitted unified TVW measurement has problems such as low efficiency and unstable measurement. For this reason, this paper proposes an automatic TVW measurement for TCS images. Firstly, to solve the problem of third ventricle detection in the complex background of TCS images, the YOLO-TV improvement model is proposed to improve the detection accuracy. The YOLO-TV model introduces a multi-head attention mechanism in the feature extraction network to enhance the network to extract feature at different scales. Meanwhile, a depth separable path aggregation module is used to improve the channel sensitivity of the feature fusion. Secondly, to solve the problem of third ventricle segmentation measurement, a third ventricle segmentation algorithm based on local intensity features is proposed, which realizes automatic segmentation measurement of third ventricle by calculating the local intensity features of the region and localization of the multi-angle projection method. The detection accuracy of the YOLO-TV model in the validation set reaches 98.50%, and the average measurement deviation between the automatic measurement results of the method proposed in this paper and the manual measurement results of the doctors is 0.089 mm, and the correlation coefficient between the two is 0.9643, which indicates that the method can be used to accurately measure the width of third ventricle.

Background Parkinson’s disease (PD) is a neurodegenerative disorder characterized by the loss of dopaminergic (DA) neurons in the substantia nigra (SN). Microglia-mediated neuroinflammation has been largely considered one of main factors to the PD pathology. MicroRNA-218-5p (miR-218-5p) is a microRNA that plays a role in neurodevelopment and function, while its potential function in PD and neuroinflammation remains unclear. Methods We explore the involvement of miR-218-5p in the PD in a 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced mouse model. The miR-218-5p agomir used for overexpression was delivered into the substantia nigra (SN) by bilateral stereotaxic infusions. The loss of dopaminergic (DA) neurons and microglial inflammation in the SN was determined using Western blotting and immunofluorescence. Motor function was assessed using the rotarod test. RNA sequencing (RNA-seq) was performed to explore the pathways regulated by miR-218-5p. The target genes of miR-218-5p were predicted using TargetScan and confirmed using dual luciferase reporter assays. The effects of miR-218-5p on microglial inflammation and related pathways were verified in murine microglia-like BV2 cells. To stimulate BV2 cells, SH-SY5Y cells were treated with 1-methyl-4-phenylpyridinium (MPP + ) and the conditioned media (CM) were collected. Results MiR-218-5p expression was reduced in both the SN of MPTP-induced mice and MPP + -treated BV2 cells. MiR-218-5p overexpression significantly alleviated MPTP-induced microglial inflammation, loss of DA neurons, and motor dysfunction. RNA sequence and gene set enrichment analysis showed that type I interferon (IFN-I) pathways were upregulated in MPTP-induced mice, while this upregulation was reversed by miR-218-5p overexpression. A luciferase reporter assay verified that Ddx41 was a target gene of miR-218-5p. In vitro, miR-218-5p overexpression or Ddx41 knockdown inhibited the IFN-I response and expression of inflammatory cytokines in BV2 cells stimulated with MPP + -CM. Conclusions MiR-218-5p suppresses microglia-mediated neuroinflammation and preserves DA neurons via Ddx41 /IFN-I. Hence, miR-218-5p- Ddx41 is a promising therapeutic target for PD.

BACKGROUND One-fourth of Parkinson's disease (PD) patients suffer from cognitive impairment. However, few neuroimaging markers have been identified regarding cognitive impairment in PD. OBJECTIVE This study aimed to explore the association between third ventricular width by transcranial sonography (TCS) and cognitive decline in PD. METHOD Participants with PD were recruited from one medical center in China. Third ventricular width was assessed by TCS, and cognitive function was analyzed by the Mini-Mental State Examination (MMSE). Receiver operating characteristic (ROC) analysis and Cox model analysis were utilized to determine the diagnostic and predictive accuracy of third ventricular width by TCS for cognitive decline in PD patients. RESULT A total of 174 PD patients were recruited. Third ventricular width was negatively correlated with MMSE scores. ROC analysis suggested that the optimal cutoff point for third ventricular width in screening for cognitive impairment in PD was 4.75 mm (sensitivity 62.7%; specificity 75.6%). After 21.5 (18.0, 26.0) months of follow-up in PD patients without cognitive impairment, it was found that those with a third ventricular width greater than 4.75 mm exhibited a 7.975 times higher risk of developing cognitive impairment [hazard ratio = 7.975, 95% CI 1.609, 39.532, p = 0.011] compared with patients with a third ventricular width less than 4.75 mm. CONCLUSION Third ventricular width based on TCS emerged as an independent predictor of developing cognitive impairment in PD patients.

BACKGROUND:Parkinson's disease (PD) is characterized by the loss of dopaminergic neurons (DA) and the accumulation of Lewy body deposits composed of alpha-Synuclein (α-Syn), which act as antigenic epitopes to drive cytotoxic T-cell responses in PD. Increased T helper 17 (Th17) cells and dysfunctional regulatory T cells (Tregs) have been reported to be associated with the loss of DA in PD. However, the mechanism underlying the Th17/Treg imbalance remains unknown.METHODS:Here, we examined the percentage of Th17 cells, the percentage of Tregs and the α-Syn level and analysed their correlations in the peripheral blood of PD patients and in the substantia nigra pars compacta (SNpc) and spleen of MPTP-treated mice and A53 transgenic mice. We assessed the effect of α-Syn on the stability and function of Tregs and the differentiation of Th17 cells and evaluated the role of retinoid-related orphan nuclear receptor (RORγt) upregulation in α-Syn stimulation in vivo and in vitro.RESULTS:We found that the α-Syn level and severity of motor symptoms were positively correlated with the increase in Th17 cells and decrease in Tregs in PD patients. Moreover, α-Syn stimulation led to the loss of Forkhead box protein P3 (FOXP3) expression in Tregs, accompanied by the acquisition of IL-17A expression. Increased Th17 differentiation was detected upon α-Syn stimulation when naïve CD4+ T cells were cultured under Th17-polarizing conditions. Mechanistically, α-Syn promotes the transcription of RORC, encoding RORγt, in Tregs and Th17 cells, leading to increased Th17 differentiation and loss of Treg function. Intriguingly, the increase in Th17 cells, decrease in Tregs and apoptosis of DA were suppressed by a RORγt inhibitor (GSK805) in MPTP-treated mice.CONCLUSION:Together, our data suggest that α-Syn promotes the transcription of RORC in circulating CD4+ T cells, including Tregs and Th17 cells, to impair the stability of Tregs and promote the differentiation of Th17 cells in PD. Inhibition of RORγt attenuated the apoptosis of DA and alleviated the increase in Th17 cells and decrease in Tregs in PD.

BackgroundsApathy is common in Parkinson’s disease (PD) but difficult to identify. Growing evidence suggests that abnormal iron metabolism is associated with apathy in PD. We aimed to investigate the clinical features and iron metabolism of apathetic patients with PD, and construct a nomogram for predicting apathy in PD.MethodsData of 201 patients with PD were analyzed. Demographic data, Apathy Scale (AS) assessments, and serum iron metabolism parameters were obtained. Spearman correlations were used to assess relationships between AS scores and iron metabolism parameters, separately for male and female patients. Additionally, a nomograph for detecting apathetic patients with PD was built based on the results of logistic regression analysis.ResultsThe serum transferrin (TRF, p < 0.0024) concentration and total iron binding capacity (TIBC, p < 0.0024) were lower in the apathetic group after Bonferroni correction, and they were negatively associated with AS scores in male participants with PD (TRF, r = −0.27, p = 0.010; TIBC, r = −0.259, p = 0.014). The nomogram was developed by incorporating the following five parameters: age, sex, serum iron concentration, TIBC and Hamilton Depression Rating Scale (HAMD) scores, which showed good discrimination and calibration, with a consistency index of 0.799 (95% confidence interval = 0.732–0.865).ConclusionAbnormal iron metabolism may contribute to apathy in PD, especially among men. TIBC levels in combination with HAMD scores can be effectively used for the prediction of apathetic patients with PD.

目的 报道1例磷脂酶A2第6型基因(Phospholipase A2 type 6,PLA2G6)基因点突变导致的早发型帕金森病,并分析该基因突变患者的临床异质性.方法 应用全外显子测序结合一代测序验证方法对1个家系的6名成员进行基因检测,并结合文献总结PLA2G6基因点突变的早发型帕金森病的特点,以提高其早期诊断率.结果 在6名家系成员中先证者及其2子1女PAL2G6基因存在c.991G>T杂合突变和超氧化物歧化酶1(Superoxide dismutase 1,SOD1)基因存在c.208A>G杂合突变,结合患者的临床表现为运动迟缓和静止性震颤,11 C-CFT脑多巴胺转运体(Dopamine transporer,DAT)正电子发射断层显像(Positron e-mission tomography,PET)示双侧壳核、尾状核头多巴胺功能降低,诊断为早发型帕金森病.结论 早发型帕金森病需要及时进行基因检测,这样便于精准判断疾病,指导临床治疗.

目的 探讨Parkin基因复合杂合突变的早发型帕金森病的临床特点.方法 回顾性分析1例Parkin基因复合杂合突变早发型帕金森病患者的临床资料,并进行文献复习.结果 患者为47岁女性,24年前开始出现运动迟缓、四肢僵硬、震颤.全外显子组基因检测显示,患者Parkin基因存在2处基因突变,c.8TA杂合突变导致其编码蛋白发送p.V3E错义突变;c.850GC杂合突变导致其编码蛋白发生p.G284R错义突变.家系验证结果显示,两处突变分别来自于父母,其余直系亲属均只携带一处杂合突变.结论 Par-kin基因复合杂合突变的早发型帕金森病患者表现为逐渐进展的四肢僵硬、震颤、运动迟缓为主的运动症状.Parkin基因复合杂合突变导致的编码蛋白错义突变可能是PD的重要病因.

Background : Parkinson’s disease (PD) is characterized by impaired mitochondrial function and decreased ATP levels. Glycolysis is upregulated and lactate production is enhanced in PD. Since lactate promotes apoptosis and α-synuclein accumulation in neurons, we hypothesized that the increased lactate resulted from upregulated glycolysis is involved in the apoptosis of dopaminergic neurons in PD. Methods: We examined the expression of hexokinase 2 (HK2) and lactate dehydrogenase (LDH), the key enzymes in glycolysis, and lactate levels in the substantia nigra pars compacta (SNpc) of MPTP-induced mouse model of PD and in MPP + -treated SH-SY5Y cells. We investigated the role of HK2, lactate and AMPK pathway in the apoptosis of dopaminergic neurons by intervened with 3-Brpa, the HK2 inhibitor, in in vivo and in vitro systems. Results: We found that the expression of HK2 and LDHA, and lactate levels were markedly increased in brain SNpc of MPTP-treated mouse and in MPP + -treated SH-SY5Y cells. Meanwhile, the apoptosis of dopaminergic neurons in the mouse model and the apoptosis of the SH-SY5Y in vitro system were increased. Intriguingly, using HK2 inhibitor or siRNA can decrease the lactate levels and suppressed the apoptosis of dopaminergic neurons both in vivo and in vitro. Mechanistically, lactate increased the activity of adenosine monophosphate activated protein kinase (AMPK), and suppressed the phosphorylation of serine/threonine kinase 1 (Akt) and mammalian target of rapamycin (mTOR). Conclusion ：Inhibition of HK2 ameliorate the apoptosis of dopaminergic neurons through downregulating the lactate production and AMPK/ Akt/ mTOR pathway activation in PD.

Parkinson's disease (PD) is characterized by impaired mitochondrial function and decreased ATP levels. Aerobic glycolysis and lactate production have been shown to be upregulated in dopaminergic neurons to sustain ATP levels, but the effect of upregulated glycolysis on dopaminergic neurons remains unknown. Since lactate promotes apoptosis and α-synuclein accumulation in neurons, we hypothesized that the lactate produced upon upregulated glycolysis is involved in the apoptosis of dopaminergic neurons in PD. In this study, we examined the expression of hexokinase 2 (HK2) and lactate dehydrogenase (LDH), the key enzymes in glycolysis, and lactate levels in the substantia nigra pars compacta (SNpc) of a MPTP-induced mouse model of PD and in MPP+-treated SH-SY5Y cells. We found that the expression of HK2 and LDHA and the lactate levels were markedly increased in the SNpc of MPTP-treated mice and in MPP+-treated SH-SY5Y cells. Exogenous lactate treatment led to the apoptosis of SH-SY5Y cells. Intriguingly, lactate production and the apoptosis of dopaminergic neurons were suppressed by the application of 3-bromopyruvic acid (3-Brpa), a HK2 inhibitor, or siRNA both in vivo and in vitro. 3-Brpa treatment markedly improved the motor behaviour of MPTP-treated mice in pole test and rotarod test. Mechanistically, lactate increases the activity of adenosine monophosphate-activated protein kinase (AMPK) and suppresses the phosphorylation of serine/threonine kinase 1 (Akt) and mammalian target of rapamycin (mTOR). Together, our data suggest that upregulated HK2 and LDHA and increased lactate levels prompt the apoptosis of dopaminergic neurons in PD. Inhibition of HK2 expression attenuated the apoptosis of dopaminergic neurons by downregulating lactate production and AMPK/Akt/mTOR pathway in PD.

目的比较早发型帕金森病(Early-onset Parkinson's disease,EOPD)和晚发型帕金森病(Late onset Parkinson's disease,LOPD)患者非运动症状和血生化指标水平的差异,并分析2组患者非运动症状与血生化指标水平的相关性.方法纳入2018年9月 一2020年1月于华中科技大学同济医学院附属同济医院就诊的281例诊断为帕金森病(Parkinson's disease,PD)的患者,按照发病年龄是否>50岁分为EOPD组和LOPD组;采用改良H&Y分级和国际运动障碍协会帕金森病统一评定量表第三部分(MDS-UPDRS-III)用于评估关期运动功能;PD自主神经功能量表(SCOPA-AUT)用于评估自主神经功能障碍;帕金森病睡眠量表(Parkinson disease sleeping scale,PDSS)用于评估睡眠质量;汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)用于评估焦虑抑郁状态;简易智能精神状态检查量表(MMSE)和蒙特利尔认知评估量表(MoCA)用于评估认知功能障碍,其中MoCA经教育程度校正(受教育年限<12年,总分加1分);同时测定血生化指标包括血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(HCY)、叶酸、维生素B12(VitB12)、铁(Fe)、铜(Cu)、铜蓝蛋白(CP)水平.结果(1)LOPD组的SCOPA-AUT得分高于EOPD组,MMSE和MOCA得分低于EOPD组(P<0.05),而2组PDSS,HAMD,HAMA得分无明显差异(P>0.05);(2)LOPD组血清同型半胱氨酸(HCY)、铜(Cu)、铜蓝蛋白(CP)水平均高于EOPD组(P<0.05);(3)EOPD组血清TG水平与MMSE,MOCA评分呈负相关(-0.4

目的 探讨帕金森病(Parkinson disease,PD)患者在经颅中脑超声(transcranial midbrain sonography,TCS)下的黑质高回声与临床特点的关系,以寻找可能影响因素.方法 纳入2017年11月至2019年12月作者医院收治的PD患者200例,进行TCS检查,收集PD患者的一般资料、黑质高回声资料,以及疾病严重程度、生活质量、运动症状、睡眠障碍、血清铜等临床资料,分析黑质高回声的影响因素.结果 共178例PD患者完成TCS,其中男116例、女62例,PD患者黑质高回声面积为(0.395±0.167)cm2;多元逐步线性回归分析显示血清铜(t=2.000,P=0.048)、帕金森病统一评定量表检查(Unified Parkinson??s Disease Rating Scale,UPDRS)第二部分(UPDRSⅡ)得分(t=3.063,P=0.003)是黑质高回声面积的独立影响因素.结论 PD患者的血清铜、UPDRSⅡ得分可能是黑质高回声面积的独立影响因素.

Abstract Substantia nigra (SN) hyperechogenicity measured by transcranial sonography (TCS) is a promising biomarker for Parkinson disease (PD). The aim of this study was to explore the diagnostic accuracy of SN hyperechogenicity (SN+) for differentiating PD from essential tremor (ET). A total of 119 patients with PD, 106 ET patients and 112 healthy controls that underwent TCS from November 2016 to February 2019 were included in this single-center retrospective case–control study. Two reviewers who were blinded to clinical information independently measured the SN+ by TCS imaging. The diagnostic sensitivity, specificity, and accuracy of TCS imaging were evaluated between the PD and healthy controls and between patients with PD and ET. Interrater agreement was assessed with the Cohen κ statistic. TCS imaging of the SN+ allowed to differentiate between patients with PD and ET with a sensitivity (91.6% and 90.8%) and specificity (91.5% and 89.6%) for readers 1 and 2, respectively. Interobserver agreement was excellent (к = 0.87). In addition, measurement of the SN+ allowed to differentiate between patients with PD and healthy subjects with a sensitivity (91.6% and 90.8%) and specificity (88.4% and 89.3%) for readers 1 and 2, respectively. Interobserver agreement was excellent (к = 0.91). Measurement of SN+ on TCS images could be a useful tool to distinguishing patients with PD from those with ET.

目的 报道1例多巴反应性肌张力障碍(Doparesponsive dystonia,DRD)的三磷酸鸟苷环化水解酶I基因(Guanosine triphosphate cyclohydmlase I,GCH1)c.550C>T(p.R184C)杂合突变,并分析该基因突变患者的临床特点.方法 应用全外显子测序结合一代测序验证方法对1个家系的5名成员进行GC H1基因突变分析,并回顾既往文献进行疾病特点总结,以提高对DRD相关基因突变的临床特点及预后的认识.结果 5名家系成员中先证者及其一子一女GCH1基因存在c.550C>T(p.R184C)杂合突变,且该点突变导致GCH1基因所编码的蛋白发生p.R184C错义突变(184位点上的精氨酸变为半胱氨酸).软件分析显示c.550C>T(p.R184C)为可疑致病突变.结论 c.550C>T(p.R184C)突变可能是DRD新的致病位点,此分析扩展了DRD的GCH1基因突变内容,同时也为相关基因的功能验证提供了新的方向.

Objective:To explore the relationship between the changes of midbrain raphe nucleus echo and blood trace metals, non-motor symptoms in patients with Parkinson′s disease (PD).Methods:A total of 177 patients with PD were recruited from Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from November 2017 to December 2019. Their non-motor symptoms were assessed by a series of PD-related scales. All subjects completed transcranial color-coded sonography, and were divided into two groups according to the continuity of raphe nucleus echo. The difference of trace metals in peripheral blood and the scores of non-motor symptoms were analyzed.Results:The serum iron level of PD patients in the continuous echo of raphe nucleus group (117 cases; 15.33 （11.30, 18.93） μmol/L) was higher than that of the discontinuous group (60 cases; 12.52 （4.15, 16.00） μmol/L, t=-2.294, P=0.022), so was the scores of Scale for outcomes in PD for Autonomic Symptoms (34.00 （28.00, 39.00） vs31.00 （26.25, 36.00）， t=-2.044, P=0.041). There was no significant difference in the level of serum copper, hemoglobin, ceruloplasmin, and the scores of Movement Disorder Society Unified Parkinson′s Disease Rating Scale, Parkinson′s Disease Sleeping Scale, 39 items Parkinson′s Disease Questionnaire, Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale between the two groups. Conclusion:There was significant difference in serum iron levels and the scores of SCOPA-AUT between the two groups, but no difference in depression, sleep, and daily living ability.

To determine the diagnostic performance of transcranial sonography (TCS) in assessing increased echogenic area of the substantia nigra (SN) in patients with Parkinson's disease (PD). Institutional review board approval was obtained for this retrospective study. A total of 278 PD patients (mean age: 64.7 ± 9.8 y, 100 women) and 300 healthy control patients (mean age: 63.6 ± 9.3 y, 97 women) were referred for TCS assessment of SN hyper-echogenicity (SN+) from June 2016 to December 2018. Two sonographers independently measured the sizes of the echogenic areas of the SN by TCS imaging in both PD patients and healthy controls. The diagnostic sensitivity, specificity and accuracy of TCS imaging were compared between PD patients and healthy controls. Inter-rater agreement was assessed with the Cohen's κ statistic. The sensitivity, specificity and accuracy of readers 1 and 2, respectively, for the identification of SN+ in TCS were 90.3% and 89.6% (251 and 249 of 278), 89.3% and 88.3% (268 and 265 of 300) and 89.8% and 88.9% (519 and 514 of 578). Inter-observer agreement was excellent (к = 0.84). The area under the receiver operating characteristic curve (AUC) for differentiation of PD patients from healthy controls was 0.92 for reader 1 and 0.91 for reader 2. Cutoff values of 0.20 and 0.21 cm2 were derived from the assessments performed by readers 1 and 2, respectively. We defined 0.20 cm2 as the optimal cutoff value because it had a higher AUC. TCS is a promising diagnostic technique and can be very helpful in differentiating PD patients from healthy individuals.

The molecular mechanism underlying Parkinson's disease (PD), an increasingly common neurodegenerative disease, remains unclear. Long non-coding RNA (lncRNA) plays essential roles in gene expression and human diseases. We hypothesize that lncRNAs are involved in neuronal degeneration of PD. Using microarray, we identified 122 differentially expressed (DE) lncRNAs and 48 DE mRNAs between the circulating leukocytes from PD patients and healthy controls. There were 714 significant correlations (r ≥ 0.8 or ≤-0.8, p < 0.05) among the DE lncRNAs and mRNAs. Gene function and pathway analysis of the 48 DE mRNAs revealed biological pathways related to PD pathogenesis, including immune response, inflammatory response, MAPK, and Jak-STAT pathway. In a cohort of 72 PD patients and 22 healthy controls, the upregulation of four lncRNAs (AC131056.3-001, HOTAIRM1, lnc-MOK-6:1, and RF01976.1-201) in circulating leukocytes of PD patients were further confirmed. These lncRNAs were also upregulated in THP-1 cells, a human monocytic cell line, after inflammatory stimulation. Interestingly, the conditioned culture medium of THP-1 cells or 6-OHDA significantly increased the expression of these lncRNAs in SH-SY5Y cells, a human neuroblastoma cell line expressing dopaminergic markers. Importantly, overexpression of AC131056.3-001 or HOTAIRM1 increased baseline and 6-OHDA-induced apoptosis of SH-SY5Y cells. Taken together, we identified distinct expression profiles of lncRNA and mRNA in circulating leukocytes between PD patients and healthy controls. Dysregulated lncRNAs such as HOTAIRM1 and AC131056.3-001 may contribute to PD pathogenesis by promoting the apoptosis of dopaminergic neuron.

目的 探讨帕金森病(PD)患者脑微出血(CMBs)的相关危险因素.方法 收集128例完成磁敏感加权成像(SWI)序列的原发性PD患者的临床资料,并进行分析.结果 15.6％的PD患者合并CMBs,其中单纯脑叶CMBs占55％,深部或幕下CMBs占45％.CMBs组年龄、高血压及使用抗血小板药物比率显著高于无CMBs组(P ＜0.05～0.01).二元Logisitic回归分析显示,年龄(OR=1.084,95％ CI:1.023～1.149,P=0.007)、高血压(OR=3.210,95％ CI:1.129 ～9.198,P=0.030)是PD合并CMBs的独立危险因素.单纯脑叶CMBs组年龄、病程显著高于非单纯脑叶CMBs组(P＜0.05～0.01).二元Logisitic回归分析显示,年龄是PD患者合并单纯脑叶CMBs的独立危险因素(OR=1.121,95％ CI:1.035～1.214,P=0.005).深部或幕下CMBs组高血压比率显著高于非深部或幕下CMBs组(P＜0.05).二元Logisitic回归分析显示,高血压是PD患者合并深部或幕下CMBs的独立危险因素(OR=6.027,95％ CI:1.459～26.40,P=0.013).结论 年龄、高血压是PD患者CMBs发生的危险因素,控制高血压可能可以减少早中期PD患者CMBs的发生.

Objective To investigate the changes of postural stability in early‐stage Parkinson's disease (PD) patients and analyze the related factors. Methods T hirty untreated early‐stage PD patients admitted to the author's hospital and twenty healthy controls were recruited from February to June in 2019. T he measurement of the posture sway based on the inertial accelerometer were completed. Jerk and root mean square acceleration (RM S) were selected as parameters for the posture sway measurement , w hich were assessed in the antero‐posterior (AP) direction , medio‐1ateral (M L )／left‐right direction and the total vector direction respectively. In different visual status , the difference of parameters between untreated PD group and healthy controls were compared. In different visual status , the difference of postural sway parameters between levodopa treatment and untreated conditions were compared in PD patients. Results (1) Both in the eyes open (EO ) and eyes closed conditions (EC) , Jerk (AP) , Jerk , Jerk (M L ) , RM S (AP) , and RM S of PD group were higher than those in the control group except RMS (M L ) ( P＜0.05) ; (2) In the EC condition , Jerk (AP ) , Jerk , RMS (AP ) , and RM S of PD group and control group were higher than those in the EO condition except RM S (M L ) ( P＜0.05 or P＜ 0.01 ) . T here was no significant difference in the increase rate ／deterioration rate in the sway parameters between the PD group and the control group from the EO condition to the EC condition (P＞0.05) . (3) T here was no significant difference in the sway parameters between untreated and treated patients in the EO condition (P＞0.05) . It was same as in the EC condition except for the increase of RM S (M L ) after treatment (P＝0.047) . Conclusions Early‐stage PD patients also have unstable posture and it will get worse when eyes are closed. Initial regular doses treatment of levodopa has no significant effect on posture stability.

Objective To investigate the correlation of substantia nigra hyperecho with essential tremor (ET) and Parkinson disease (PD).Methods The clinical data of 158 patients with ET or PD who underwent transcranial ultrasonography in Tongji Hospital from March 2016 to March 2018 were retrospectively analyzed.There were 35 patients with ET (ET group),113 patients with PD who had no previous history of ET (PD group),and 10 PD patients with previous history of ET (ET-PD group).And 58 healthy subjects served as controls (control group).The hyperechoic area of substantia nigra in different groups was compared.Results The hyperechoic areas of the substantia nigra were [0 (0,0)]cm2 (control group),[0.27(0,0.41)]cm2 (ET group),[0.33(0.21,0.40)]cm2 (ET-PD group) and [0.35(0.29,0.45)]cm2 (PD group);the differences between control group and ET group,between the ET group and PD group were statistically significant (Z=-5.24,P=0.01;Z=-3.09,P=0.02),and there were no significant difference between the ET group and ET-PD group,between ET-PD group and PD group (Z=-0.98,P=0.32;t=-0.98,P=0.33).The ratio of substantia nigra hyperechoic positive to negative in ET-PD group was 9.00 (9/1),while that in ET group was 0.94 (17/18) (OR=9.53,95％ CI:1.09-83.43,x2=3.91,P=0.04).Conclusion Substantia nigra hyperecho is an objective imaging indicator for patients with ET and PD,and has a certain differential value for their diagnosis.