Objective To assess the relationship of serum prealbumin level with the severity of acute ischemic stroke (AIS).Methods The clinical data of 2522 AIS patients who were admitted in Peking Union Medical College Hospital from 2000 to 2008 were retrospectively analyzed.The serum prealbumin and hypersensitive C-reactive protein (hs-CRP) levels were evaluated by immunoturbidimetric assay within 24 hours after admission.The AIS severity was evaluated at admission using modified Rankin Scale (mRS).Patients were divided into mild AIS group (mRS score ≤ 3 ) and severe AIS group (mRS score ＞ 3 ).The levels of serum prealbumin and hs-CRP were compared between these two groups,and the relationship between praalbumin and hs-CRP was also analyzed.Results There were 1697 patients in the mild group (average mRS score:1.67) and 825 patients in the severe group ( average mRS score:4.53 ).The severe group had significantly lower prealbumin level [ ( 191.20,82.00)versus (219.18,72.00) mg/L,P =0.000] and higher hs-CRP level [ (6.01,8.22) versus (4.15,6.93) mg/L,P =0.000 ] than the mild group,respectively.Partial regression analysis showed that the stroke severity was negatively correlated with serum prealbumin level (r =-0.115,P =0.000) and positively correlated with hs-CRP level (r =0.098,P =0.000).Serum prealbumin level was inversely correlated with hs-CRP level ( r =- 0.396,P =0.000).Conclusion The prealbumin level is relevant with the severity of AIS and inflammation.

Objective To investigate the clinical feactures of patients with numerous dilated Virchow-Robin space in basal gangalia.Methods Eight patients with cribriform state in striatum in brain MRI at Peking Union Medical College Hospital from March 2013 to October 2013 were enrolled.The clinical data including age,gender,common vascular risk factors and clinical manifestations were analyzed.Cognitive functions,balance and gait disturbance,as well as activity of daily living were assessed.Results All of the eight patients are male,aged from 69 to 80.All the patients had a history of hyperlipidemia,while 7 of them had hypertension.The primary complaint was either gradual motor function decline or memory impairments (3/8),or dizziness (1/8).The other 4 of them were diagnosed as stroke or transient ischemic attack.Among the 8 patients,four had mild deterioration in activity of daily living function (Barthel index 65-85).Cognitive impairment was common (8/8,the Montreal Cognitive Assessment scores 19-27),while word recall was the mostly affected cognitive domain (8/8).Gait and balance dysfunction were found in three patients (3/8,Tinetti scores ≤ 24).Conclusions Man is more likely to have predisposition to cribriform state in striatum.Mild cognitive impairments and gait abnormality are common clinical manifestations of the disease.

Objective To investigate current situation of prescription of traditional Chinese medicine (TCM) for acute stroke patients.Methods From June 2008 to October 2010,with simple cluster sampling,48 centers were randomly assigned to the intervention group receiving a standardized treatment strategy,and the usual care group without specific recommendations for treatment.No specific recommendations or restrictions of TCM were proposed for both groups.Consecutive hospitalized patients with acute ischemic stroke were recruited in this study.Clinical data and treatment strategy (including TCM) were recorded by trained investigators.The prescription of TCM three months prior to admission and at discharge was recorded and analyzed.The chi-square test was used for analysis of qualitative data.Results Totally 3 664 patients were included in the analysis (1 709 patients in standard care group and 1 955 patients in the usual care group) with male to female ratio 2∶ 1.The difference of distribution of age,sex and education level between the two groups was not statistically significant.One hundred and eighty-seven patients (5.10％) had taken TCM three months prior to admission,81.28％ of them only taking one type of TCM,without significant difference between the two groups.The percentage of patients taking TCM at discharge was significantly increased to 30.65％ for all the patients with higher percentage (38.16％) in the usual care group than that in the standard care group (22.06％).The percentage of using more than one type of TCM was also higher in the usual care group (x2 =141.43,P ＜ 0.01).Totally,112 types of TCM were prescribed at discharge.Conclusions Nearly one third of hospitalized patients with acute stroke were prescribed TCM at discharge,with mostly monotherapy and a great variety.

Objective Mini presentation is a new teaching model, which is performed by interns based on a typical case or disease at the medical ward.The aim of our study is to evaluate the effect of mini presentation on clinical neurologic teaching actions, according to a survey results in the interns.Methods A total of eighty-nine clinical medical students in Peking Union Medical College finally responded to the survey questionnaire, including ten questions regarding the mini presentation.Results 69.23% of the interns and 22.3% of the probationers have performed mini presentation at the neurological wards.Conclusion 43.82% of the students agreed that mini presentation was very necessary.80.9% of the students supported that mini presentation was helpful to their clinical reasoning of the neurology.ConclusionsMini presentation could motivate the independent learning interests of the students, and could improve the teaching quality in neurology.It is worth to practice and popularize further.

Objective To examine the recurrent ischemic stroke(RIS)in hospitalized patients predicted by Essen Stroke Risk Score(ESRS)and investigate the effect of intensive antiplatelet therapy in patients with high risk of RIS. Methods Retrospective analysis of patients with acute noncardioembolic ischemic stroke consecutively admitted to Peking Union Medical College Hospital(PUMCH)during 2001-2008. All 1008 patients were included in this study, 377 hospitalized in 2001-2002, 315 in 2005 and 316 in 2008. High risk of RIS was defined as ESRS ≥3. The average ESRS score in three groups and percentage of patients with high risk of RIS in each group were calculated. Risk of RIS was evaluated by comparing the average ESRS score in these three groups. Patients with high risk and taking clopidogrel treatment were also evaluated. Results Average ESRS score was 2. 67 ± 1.47,3.55 ± 1.40 and 3.93 ± 1.48(F= 150. 85,P=0.000)in groups of patients hospitalized in 2001-2002, 2005 and 2008 respectively. A significant difference was shown in percentage of high risk patients with ESRS ≥3 in three groups: as 51.64% in 2001-2002,77. 19% in 2005 and 85. 45% in 2008(X2=98.30,P=0. 000),showing a trend of increasing risk of RIS. Except for patients age, rates of having the risk factors in patients increased significantly, including hypertension, diabetes, myocardial infarction, myocardial diseases, smoking,vascular disease and stroke history. Clopidogrel usage has been increasing to 25.63% in 2008, but was far behind high ratio of high risk RIS patients(85.45%). Conclusions This retrospective study showd an increasing trend in RIS risk during 2001-2008. Identifying high risk patients and applying intensified antiplatelet therapy might play an important role in reducing the risk of RIS.

Objective Percheron artery is an uncommon anatomic variant. Percheron artery infarction with unilateral embryonic posterior cerebral artery ( PCA ) was rarely reported.The aim of this study was to characterize the clinical and imaging patterns of Percheron artery infarction with the unilateral embryonic PCA for early diagnosis and treatment.MethodsClinical and imaging data of 2 patients with Percheron artery infarction were reviewed retrospectively.ResultsTwo patients presented acute coma and one had paroxysmal blurred before coma.On neurological examinations,one patient had vertical gaze palsy besides two were unconsciousness. MRI showed symmetrical high signal intensity on diffusion weighed imaging (DWI)in bilateral paramedian thalami in two patients and a distinct pattern of V-shaped hyperintensity on DWI andFLAIR was present on the midbrain in one patient. Digital subtraction angiography and magnetic resonance angiography demonstrated unilateral embryonic PCA in two patients.ConclusionsThe classical clinical symptoms,symmetrical high signal in bilateral paramedian thalami and V-shaped sign in midbrain on DWI can improve recognition,evaluation and management of Percheron artery infarction.The unilateral embryonic PCA may be underlying risk factor of Percheron artery infarction.

Objective To investigate the prevalence and cardiovascular risk factors of silent brain infarct (SBI) in Shunyi Cohort.Methods This study was based on the population based Shunyi Study in China.One thousand and twenty-seven stroke-free participants older than 35 years,who completed cerebral MRI,were included.Cardiovascular risk factors were assessed by interview,physical examination and blood sample tests.SBI was evaluated on 3D-T1WI,T2WI and FLAIR sequences.Associations between risk factors and SBI were analyzed by Logistic regression and adjusted for age,sex,and relevant confounders.Results One thousand and twenty-seven participants,aged (55.9 ± 9.4) years,37.7％ male,were assessed.One hundred sixty-four participants(16.0％) had SBI on MRI.The prevalence of SBI increased by age (every 10 years,OR=2.12,95％ CI 1.74-2.58,P＜0.01).Hypertension(OR =2.67,95％ CI 1.77-4.04,P＜0.01),diabetes(OR=2.48,95％ CI 1.64-3.76,P＜0.01) and smoking(OR=1.98,95％ CI 1.08-3.62,P =0.028) were significantly associated with SBI.Conclusions The prevalence of SBI in this Chinese population is 16.0％,which increases with age.Hypertension,diabetes and smoking are associated with SBI.

Objective To investigate the association between functional polymorphism IVS8-poly (T) in cystic fibrosis transmembrane conductance regulator (CFTR) gene and prostate cancer risk.Methods A population-based case-control study was conducted including 230 prostate cancer patients and 230 agematched controls.PCR-STRP was used to analysis the IVS8-poly (T) tract in CFTR gene.Results The prevalences of the low expression allele,the IVS8-5T,in prostate cancer patients and controls were 1.52 ％ (7/460) and 5.22 ％ (24/460),respectively (x2 =12.489,P =0.002).Logistic regression analysis confirmed the 5T/7T genotype was in protective association with prostate cancer risk (OR =0.232,P =0.003,95 ％ CI0.090-0.599).Conclusion The low expression CFTR IVS8-5T allele contributes to a reduced risk of prostate cancer in Chinese Han population,and may be a protective factor against prostate cancer.

Objective:To explore whether there were changes in midbrain morphology related to motor function in patients with cerebral small vessel disease (CSVD).Methods:The study was conducted on a subset of patients with CSVD registered at the Department of Neurology of Peking Union Medical College Hospital from 2010 to 2018. All magnetic resonance imaging images were taken with a 3.0 T nuclear magnetic resonance imager. The measurement of anteroposterior diameter of the mesencephalon and the tegmentum of mesencephalon was performed on a personal computer with the image processing software RadiAnt DICOM Viewer. Several clinical manifestations of dyspraxia, dysphagia, dysarthria and dysuria were evaluated by interviewing the patient and family members living with the patient. Kinect depth camera combined with self-developed software platform was used to conduct quantitative evaluation of patients′ motor function. Three parameters, namely walking speed, walking time of three meters and time of standing up and sitting down, were selected from the obtained parameters. SPSS 17.0 software was used for statistical analysis.Results:A total of 176 patients were included, aged 30-88 (64.16±11.57) years. One hundred and fifteen patients were males, accounting for 65.34%. In patients with CSVD, anteroposterior diameter of the mesencephalon and the tegmentum of mesencephalon were negatively correlated with age ( B=-0.032, P<0.001; B=-0.020, P=0.006). The anteroposterior diameter of the mesencephalon was negatively correlated with symptoms of dyskinesia ( OR=0.006, 95% CI 0-0.135, P=0.001), even when the age and gender were adjusted ( OR=0.014,95% CI 0-0.416, P=0.013). The anteroposterior diameter of the mesencephalon was negatively correlated with symptoms of dysuria ( OR=0.046,95% CI 0.002-0.936, P=0.045), but no longer correlated when the age and gender were adjusted. The anteroposterior diameter of tegmentum of mesencephalo was also negatively correlated with symptoms of dyskinesia ( OR=0.035,95% CI 0.002-0.684, P=0.027), but no longer correlated after adjusting for age and gender. Video recording and evaluation of motor function were performed on 87 patients. Spearman correlation analysis showed that none of the three motor function scores was correlated with age or gender. The anteroposteric diameter of the midbrain was positively correlated with walking speed ( r=0.231 ,P=0.040) and negatively correlated with walking time of three meters ( r=-0.304, P=0.005), but not with standing up and sitting down time, while the anteroposteric diameter of tegmentum of mesencephalo was not correlated with all of them. Conclusion:There are changes in mesencephalon morphology in patients with CSVD, structural parameters of mesencephalon are related to motor function and urination function, and mesencephalon atrophy may be an independent related factor for symptoms of dyskinesia in patients with CSVD.

The pediatric reference intervals in clinical laboratory play an important role in diagnosis of illness,therapeutic monitoring,prediction of prognosis and health evaluation.Compared with establishing reference interval for adults,there are more challenges to establish pediatric reference intervals.Therefore,the procedure and key technologies of direct method and indirect method are stated based on the characteristics of children population and pediatric,by which to define,transfer and validate pediatric reference intervals.This study will provide systematically methodological ideas for clinical laboratories to establish pediatric reference intervals.