Objective To investigate alterations of balance function in patients with mild-moderate Alzheimer's disease (AD) and with amnestic mild cognitive impairment (aMCI),and the possibility of using posturography to differentiate aMCI,mild-moderate AD and normal subjects. Methods The balance function of 20 patients with mild-moderate AD and 20 patients with aMCI were evaluated by posturography,and 20 healthy subjects of the same age range were recruited as controls.Results All posturography measures were significantly altered in mild-moderate AD patients compared with normal controls,with limits of stability( ( 15 398 ± 926 ) mm2 vs ( 31 654 ± 2132 ) mm2 ),open-eyed Mean X ( ( 10. 2 ± 4. 1 ) mm vs (5.8 ± 1. 4)mm) ,Mean Y(( -29.8 ± 10.2)mm vs ( -14.9 ±4.4) mm),Max X((30.5 ±9.5)mm vs (18.3 ±4. 1)mm ),Max Y((42.7 ± 11.4)mm vs (23.3 ±6.8)mm),LSKG((528.4 ± 105.4)mm vs (390. 3 ± 68.4 ) mm ),SSKG ( ( 252. 5 ± 89. 7 ) mm2 vs ( 178.8 ± 40. 9 ) mm2 ),close-eyed Mean X ((13. 1 ±4. 5) mm vs (7.9 ± 1.5)mm) ,Mean Y (( -58.2 ± 16. 9) mm vs ( -25.6 ±5.4) mm) ,Max X ((37.7±10.5)mm vs (24.7 ±7.3) mm ),Max Y ((78.5±18.7)mm vs (39.9 ±9.9) mm),LSKG ((816.6±171.3) mm vs (533.5 ±97.4) mm),SSKG((649.0 ± 129.7) mm2 vs (290.5 ±73.3) mm2),respectively ( t = 8.57; open-eyed F = 17.41,38. 10,60. 46,102. 10,29. 31,27. 85; close-eyed F = 37.20,541.79,34. 51,185.56,122. 83,384. 27 ;all P ＜0. 05) ;limits of stability ( (23 921 ± 1637 )mm2 vs (31 654 ±2132 ) mm2 ) and mean Y ( Antero-posterior sway,( - 39. 8 ± 8. 6 ) mm vs ( - 25.6±5.4 ) mm) were the only parameters which discriminated between aMCI and normal controls,respectively ( t = 6. 50,P = 0. 038; t =- 15.34,P = 0. 012). Conclusions Impairment in balance is a feature not only of mild-moderate AD,but also of aMCI,and posturography may be used as a possible test in differentiating between normal subjects,patients with aMCI and patients with mild-moderate AD whose motor performance and balance features are otherwise clinically normal,limits of stability and mean Y are the most sensitive parameters.

Objective To further investigate clinical manifestations and management for thallium poisoning. Methods Clinical data of 6 patients who were hospitalized in Union Hospital of Tongji Medical College in May 2008 with diagnosis of acute or chronic thallium poisoning,were retrospectively analyzed.Results Six patients (4 male and 2 female) ,aged from 12 to 50,came from one family (two sisters with their husbands and sons). Five of them (3 acute and 2 chronic,for the second time in half a year,thallium poisoning) initiated with peripheral neuritis,represented with severe burning pain,numbness,paresthesia in the lower limbs,accompanied with or without gastrointestinal symptoms. A 12 year-old boy with obviously elevated urinary thallium concentration was asymptomatic. Blood and urinary thallium concentrations of the patients were determined by atomic absorption spectrophotometry and were all significantly elevated.Treatment was initiated using potassium supplementation,diuresis,oral laxatives,Prussian blue and intramuscular injection of dimercaptopropansulfonate sodium.Meanwhile two of them were treated with hemoperfusion. Finally,two of them recovered,another two were transferred to a specialized hospital for continuous treatment,and the rest two deteriorated rapidly with occurrence of unconsciousness and died of multiple organ failure. Conclusions The main clinical manifestations of thallium poisoning are multiple peripheral neuritis,gastrointestinal symptoms and dermatological changes. In order to avoid missed diagnosis and misdiagnosis,a high suspicion should be arose for thallium poisoning when a patient suffering from the above symptoms.Prussian blue was considered traditionally as an effective therapeutic strategy for the condition,and hemoperfusion may be a more effective treatment for acute thallium poisoning.

Objective To investigate the reproductive endocrine status of women with epilepsy at childbearing age and to systematically analyze the clinical features of reproductive endocrine disorders,especially polycystic ovarian syndrome (PCOS),to facilitate early detection and timely intervention.Methods In this study,scoring of anthropometry and physical signs,menstrul assessment,examination of sex hormone and pelvic ultrasound in women with epilepsy at childbearing age were performed,and the data such as overweight,central obesity,oligo/amenorrhea,luteinizing hormone (LH)/follicule-stimulating hormone (FSH),hyperandrogenism and polycystic ovary (PCO) were collected. The characteristics of their reproductive endocrine hormone disorders were analyzed statistically. Results The age of these patients was (22. 5 ± 7.0 ) years,and women younger than 30 years old and at their peak fertility accounted for 84. 89%. The prevalence rate of PCOS in women with epilepsy at childbearing age (12. 75% ) was significantly higher than that of ordinary women at childbearing age (7.2%) in China.Highly specific indicators for PCOS were hyperandrogenism (100%),LH/FSH ＞ 2 (93%) and oligo/amenorrhea (90%),whilst the highly sensitive indicators for PCOS were PCO (92%), oligo/amenorrhea (85%) and hyperandrogenism (54%). This study revealed statistically significant difference in LH,LH/FSH and testosterone (T) between PCOS group (LH: (10.24 ± 6.92) IU/L; LH/FSH;(2.20 ± 1.16);T: ( 1.07 ± 0. 35) ng/ml) and non-PCOS group ( LH: (4. 16 ± 2.62 ) IU/L; LH/FSH:( 0. 87 ± 0. 56 );T: (0. 46 ±0. 25) ng/ml,t = -3. 899,-4. 240 and -4. 918 respectively,all P ＜0. 01 ). Conclusions Hormone indices are objective indicators for the diagnosis of PCOS. In clinical practice,attention should be paid to height,weight,abodominal circumference,menstrul history and ultrasound examination of the ovary in women with epilepsy.When reproductive endocrine hormone disorders are suspected from clinical features,the sex hormones (T,LH,and FSH ) should be checked to allow timely detection and early interventions.

Objective To investigate the effect of Exendin-4 (Ex-4) on ischemia/reperfusion (I/R) injury-induced apoptosis in primary rat cortical neurons and the possible underlying mechanisms.Methods Rat cortical neurons were cultured in vitro,identified by NES-immunohistological staining and immunofluorescence staining,and randomly divided into the following groups: control group,I/R group and Ex-4 group.RT-PCR was performed to establish the existence of active glucagon-like peptide-1 receptor (GLP-1R).ELISA was used to measure the neuronal cytoplasmic cAMP level. MTT was used to detect viability. Fluorescent DNA binding dye Hoechest 33258 was used to reveal apoptosis. C/EBP-homologous protein (CHOP) and growth arrest and DNA-damage-inducible gene 34 (GADD34) mRNAs were detected by real-time PCR. Results The apoptosis rate induced by ischemia 6 h/reperfusion 12 h was 77.0% ±5.3% and was decreased to 27.0% ± 3.5% after Ex-4 ( 0. 4 μg/ml ) treating ( t = 19. 462,P ＜ 0. 01 ).Levels of CHOP and GADD34 mRNA in cortical neurons increased since 4 h and peaked at 12 h after reperfusion. Ex-4 group showed a sharp elevation of levels of CHOP and GADD34 mRNA,peaking at 8 h reperfusion,and then tended to decrease.Conclusions Ex-4 has protective effect against rat cortical neurons injury induced by ischemia/reperfusion. The protective effect may be related to inhibition of ESR-related neuron apoptosis via regulation of unfolded protein response.

Objective To study the function of vascular endothelial growth factor (VEGF) in type 2 diabetes model rats and its effect on focal cerebral ischemia induced by middle cerebral artery occlusion in these rats. Methods Focal cerebral ischemia was induced by middle cerebral artery occlusion for 6 hours in type 2 diabetes rats and normal control rats.Blood vessels morphology was examined by ink perfusion,infarct size was measured by TTC and expression of VEGF and CD34 were evaluated by immunohistochemistry staining. Results Ink perfusion revealed increased number of small vessels in type 2 diabetes rats. Infarct size was significantly smaller in type 2 diabetes rats ( ( 80. 07 ± 11.21 ) mm3 ) than that in normal controls ((98. 91 ± 14. 86) mm3,t = 2.48,P = 0. 0326). There were more hemorrhage lesions in the ischemic hemisphere in type 2 diabetes rats when comparing with the controls. VEGF and CD34 showed significantly higher expression in type 2 diabetes rats than in normal controls. Conclusions High expression of VEGF and CD34 are found in type 2 diabetes rats after middle cerebral artery occlusion. There is cerebrolvascular remodeling in diabetes rats. While this diabetes-induced remodeling appears to prevent infarct expansion,the changes also increase the risk of hemorrhagic transformation. The latter may result in poor prognosis.

Objective The method transcranial Doppler (TCD)and end-tidal carbon dioxide partial pressure (ETCO2 ) was used to investigate the cerebrovascular reserve capacity in patients with intracranial artery stenosis.Including the cerebral vasodilator reserve,contracted reserve and the overall reserve.Methods The 72 cases were enrolled in this study,include of 42 patients with one or two sides middle cerebral artery (MCA) stenosis,or other intracranial artery stenosis and 30 normal persons. All the patients were routinely examined with TCD,and the TCD QL software was used to evaluate the cerebrovascular reserve. Hypercapnia was induced by inhaling the CO2 who breathed himself,and hypocapnia was induced by voluntary hyperventilation. The changes of velocities were recorded in both side of MCA,and the ETCO2 was recorded by the external measuring device. Results ( 1 ) The cerebral vasodilator reserve of one side of MCA stenosis group ( ( 3.65% ± 2. 62% )/mm Hg),the heavier side of multi-vessel stenosis group ( ( 1.99% ± 2. 78% )/mm Hg ),and normal control group ( left ( 3.54% ± 1.66% )/ mm Hg; right (3. 81% ± 1.63% )/mm Hg) had significant difference( F = 3. 755 ,P ＜ 0. 05 ). The heavier side of multivessel stenosis group' s cerebral vasodilator reserve were significantly lower than normal control group ( t =- 2. 546,P ＜ 0. 05 ). (2) The overall reserve of one side of MCA stenosis group ( ( 3.22% ± 1. 27% )/mm Hg),the heavier side of multi-vessel stenosis group( (2. 30% ± 1.14% )/mm Hg),and normal control group(left (3. 19% ±0. 81% )/mm Hg;right (3. 23% ±0. 70% )/mm Hg)had significant difference(F=5. 894,P ＜0. 01 ). The heavier side of multi-vessel stenosis group' s overall reserve were significantly lower than normal control group( t = - 3. 357,P ＜ 0. 01 ) and they were also significantly lower than one side of MCA stenosis group (t = 2.471,P ＜ 0. 05 ). (3) The extent of vascular disease correlated inveresely to the cerebral vasodilator reserve( r = - 0. 322,P ＜ 0. 05 ) and the overall reserve( r = - 0. 364,P ＜ 0. 05 ) in the heavier side of patients who have vascular disease.Conclusions ( 1 ) TCD with ETCO2 is a simple,economic and effective method for assessing CVR. (2)The capacity of cerebrovascular reserve was reduced in patients with intracranial artery stenosis.

Objective To study the clinical,pathological characteristics and diagnosis of multiple system atrophy(MSA).Methods Among 4 cases of MSA,2 of them were from clinical data,the other 2were frum pathological data.Two cases verified by autopsy were investigated using Hematoxylin-eosi,Kltiver.Barrera and Gallvas-Braak silver staining and confirmed by immunohistochemistry using ubiquitin,α-synuclein staining.Results All 4 patients were male.aged 51-76.Case No.1 wag diagnosed as Parkinson's svndrome.Case No.2 was diagnosed as spinal ataxia cerebella,and the other two eases were diagnosed as MSA.The following changes were found by pathological studies.Macroscopic atrophies were presented in pens and cerebella.as well as putamen,globus pallidus and substantia nigra.Cerebral ventricles were dilated.Neuronal lOSS and gliosis could be seen at cerebral cortex.nigrostriatal.globus pallidus,pontine nuclei,subslantia innominata,inferior olives,doral motor nucleus of vagus,cerebellum antl intermediolateral column of the spinal cord.In the white matter of these regions cytoplasmic inclusions bodies were extensively present in oligodendrocytes.Conclusions Olivopontocerebellar atrophy mainly shows the,clinical symptoms of pens,cerebellum,and autonomic nerves damage;Shy-Drager syndrome presents mainly with the erecting hypotenstion symptom,while striatonigral degeneration mainly involves extrapyramidal system.As these three diseases share the common basic pathological changes,they are preferred to be classified as the subtype of MSA.

Objectives To study the reliability,validity and feasibility of the Chinese version of memory alteration test(M@T).Methods Cross-sectional survey with a convenience sample was employed to interview 220 elderly people over 60 years old,39 patients with mild cognitive impairment(MCI),20 with Alzheimer's disease(AD),and 161 normal cognitive elderly.The survey was,then evaluated with internal consistency,content validity,criterion validity,principal component/factor analysis and influencing factors.Results A Cronbach's α coefficient of 0.818 was obtained in M@T. The correlation coefficients which were the score of the subtest and the total were 0.5-0.9.The correlation coefficient of the scores of the Mini.mental State Examination(MMSE)and the M@T Was 0.933.The 5 factors were extracted with the factor analysis,which could explain the total variance of 69.449%,and the corresponding factors of the proieets have a satisfied amount of factor loading(≥0.4).There were significant diffeFences in the score of M@T among the different cognitive level groups with good discriminant validity(cognitive normal group:39.0±3.7,MCI group:29.0±3.7,AD group:16.9±3.7;F=498.419,P<0.05).There were no significant differences in the score of M@T among the different gender,age,occupation and education level groups.Conclusions The Chinese version of M@T has good reliability and validity and feasibility.The score of the M@T is not affected by gender,age,occupation,education level and other factors.

Objective To investigate the association between PARK16 gene polymorphism and Parkinson's disease(PD)susceptibility in Chinese Han population.and to analyze its single-nucleotide polymorphism(SNP)genotypes,frequencies and odds ratios(OR)of different genotypes.Methods The association between two SNP loci in PARK16 gene(Rs947211,Rs823128)and PD susceptibility was investigated by TaqMan quantitative polymerase chain reaction(PCR)in 226 PD patients and 362 healthy controls.Allele and genotype frequencies were calculated by the Chi-square test,and the clinical data were also analyzed.Results Three genotypes of Rs947211(GG,AG and AA)account for 34.1%(77/226),46.0%(104/226),19.9%(45/226)in the PD group,and 23.8%(86/362),53.0%(192/362),23.2%(84/362)in the control group,respectively.There was significant difference between two groups (P<0.05).Setting the GG genotype as the reference,OR values of AG and AA genotype were 0.57(95%CI0.38-0.85,P=0.006)and 0.55(95%CI 0.34-0.85,P=0.015),while the OR value for exposure to the A allele(AA+AG)was 0.56(95%CI0.38-0.82,P=0.003).Genotypes of Iate-onset PD were also significantly different from the controls(OR valne of AG=0.46,95%CI 0.27-0.78,P=0.004:OR value of AA=0.35.95%CI 0.18-0.68,P=0.002).And there was no diffefence in clinical features among the 3 genotypes. The frequency of Rs823128, another locus, in PD group was not significantly different from the control group( AA genotype as the reference, OR value of AG was 1. 12, 95% CI 0. 75-1.68, P = 0.568; OR value of GG was 0.99, 95% CI 0.35-2.76, P = 0.994). Conclusion Polymorphism of PARK 16 locus Rs947211 is associated with PD patients in Chinese Han population.

Objective To report the clinical and magnetic resonance imaging(MRI)features of 5 eases with idiopathic orbital myositis.Methods Four females and one male,aged 27 to 57 years,presented department of neurology in the First Hospital of Peking University in October 2008 to September 2009.The duration of disease Was between 3 months and 4 years.Recurrent course appeared in 3 of them.0rbital MRI Was performed in all of them.After diagnosis they underwent long.term corticosteroid treatment.Results All patients presented ocular pain,asymmetrical and incomplete ophthalmoplegia and mild proptosis.EMG revealed no significant decline in repetitive stimulation.Muscle biopsies of limb muscle were unremarkable.Creatine kinase and thyroid function test were in normal limits.MRI revealed unilateral.focal or difluse enlargement and enhancement of extraocular muscles,involving 1 extraocular muscle in 2 cases,2extraocular muscles in 2 cases,more extraocular muscles in 1 case.No evidence indicated bone destruction or cavernous sinus abnormalities.Five Cases showed improvement and remission after long-term administration of steroids.Conclusion Persistent and asymmetrical ophthalmoplegia is connnon in orbital myositis.Extraocular muscle swelling characterized the MRI changes.