Objective To evaluate the roles of multi-voxel proton magnetic resonance spectroscopy (1H-MRS) in the early diagnosis of vascular cognitive impairment no dementia (VCIND).Methods Seventy-eight out-patients and inpatients in Department of Neurology, the second Affiliated Hospital of Soochow University from December 2008 to September 2009 were recruited in this case-control study.Their cognitive functions were assessed with a wide range of neuropsychological battery of tests including Montreal cognitive assessment ( MoCA Beijing Version ), auditory verbal learning test ( AVLT), digital span test (DST), Rey-Osterrieth complex figure test (CFT) ,semantic and phonetic fluency tests, digit symbol coding subtest (DSCT), trail making test (TMT), clock drawing test (CDT) and the Stroop color-word test (SCWT).All patients were classified into vascular cognitive impairment no dementia (VCIND) group and cognitive normal control group based on the results of neuropsychological tests.Eighteen patients with VCIND and 18 gender-, age- and education-matched normal control were randomly selected for the following study.With multi-voxel 1H-MRS, the levels of N-acetylaspartartate (NAA), creatine (Cr) and choline (Cho) in gray matters of bilateral frontal lobe, temporal lobe, parietal lobe and thalamus were measured and the ratios of NAA/Cr, Cho/Cr were compared between the two groups.Meanwhile, the correlations between scores of MoCA and its sub-items and the ratios of NAA/Cr, Cho/Cr were analyzed in VCIND group.Informed consent was obtained from all participants and the study was approved by the Ethics Committee of the hospital.Results Compared with control group, the ratios of NAA/Cr were significantly decreased in bilateral gray matters of thalamus ( left, 1.56 ± 0.49 vs 1.89 ± 0.48, F = 11.222, P = 0.002; right,1.63± 0.45 vs 1.86 ± 0.33, F = 5.358, P = 0.027 ).No significant difference were found in NAA/Cr in gray matters of bilateral frontal lobe, temporal lobe, parietal lobe and Cho/Cr in all regions between two groups ( all P ＞ 0.05 ).In VCIND group, the decreased degree of NAA/Cr in bilateral gray matters of thalamus was significantly positively correlated with the MoCA total score ( r = 0.54, 0.44 ) as well as the sub-scores in tested items of memory ( r = 0.61, 0.49 ), attention ( r = 0.43, 0.36 ), language ( r = 0.39,0.31) and visuospatial or executive( r = 0.29 , 0.33, all P＜0.05 orP＜0.01).Conclusions Cognitive impairment in patients with VCIND maybe related to metabolic dysfunction of neurons in bilateral thalamic.Multi-voxel 1H-MRS plays an important role in early diagnosis and monitoring disease progression of VCIND.

Objective To observe the clinical efficacy of stage treatment withTiao He Ying Wei(regulating Ying-nutritional and Wei-defensive qi) needling in treating insomnia.Method A hundred insomnia patients presenting difficulty falling asleep were randomized into group A1 and B1, 50 cases each; 100 insomnia patients presenting difficulty maintaining sleep were randomized into group A2 and B2, 50 cases in each group; 100 insomnia patients presenting early-morning awakening were randomized into group A3 and B3, 50 cases each. Group A1, A2 and A3 were treated withTiao He Ying Wei needling, while group B1, B2 and B3 were treated with conventional medication. The Symptoms score and cerebral blood flow indicators were observed before and after the intervention.Result After the treatment, the symptoms scores were significantly changed in each group (P<0.05). The improvement of symptoms score in group A1 was superior to that in group B1 (P<0.05); the improvement of symptoms score in group A2 was superior to that in group B2 (P<0.05); the improvement of symptoms score in group A3 was superior to that in group B3 (P<0.05). The cerebral blood flow indicators (middle cerebral artery, posterior cerebral artery, anterior cerebral artery, and basilar artery) were significantly changed after the treatment in group A1, A2 and A3 (P<0.05). After the treatment, there were significant differences in comparing the cerebral blood flow indicators between group A1 and B1, A2 and B2, and A3 and B3 (P<0.05).Conclusion Stage treatment withTiao He Ying Wei needling can improve the sleep quality of insomnia patients.

Objective To assess the clinical features of primary biliary cirrhosis(PBC)associated with systemic sclerosis(SSc)in order to facilitate recognition of this overlap syndrome(SSc-PBC). Methods The clinical data of 9 patients with SSc-PBC in Peking Union Medical College Hospital were retrospectively studied with literature review. Results ① Nine patients including 8 female were at a mean age of(54±8)years. Sevene patients initially presented with SSc and developed PBC over(4.3±2.3)years. ② Eight patients were diagnosed limited cutaneous SSc(leSSc), which included 7 patients with CREST syndrome. The most frequent manifestations were Raynaud's phenomenon(8/9)and esophageal dysfunction(8/9). Four patients with PBC manifested subclinically, but laboratory results revealed increased ALP/GGT in most patients(8/9).Two patients received liver biopsies, which confirmed the diagnosis of PBC. ③ Antinuclear antibodies(ANA)and anti-mitochondrial antibody(AMA)were detected in all the patients, among them, 8 with positive anticentromere antibody(ACA)and 8 with positive AMA-M2. ④ UDCA and glucocorticosteroid might help early stage patients with SSc-PBC, but lack efficacy in patients complicated with interstitial lung disease, pulmonary hypertension or cirrhosis. Conclusion PBC might be overlapped with SSc, especially lcSSc(CREST syndrome). Screening of autoantibodies, such as ACA, AMA and AMA-M2, could help rheumatologists early recognition of SSc-PBC and improve the prognosis of this overlap syndrome by early intervention.

Objective To investigate clinical relevance of U1-nuclear ribonucleoprotein antibody (anti-U1 RNP) in Chinese patients with systemic sclerosis (SSc). Methods In total, 131 Chinese patients with SSc were prospectively and consecutively recruited into Scleroderma Trials and Research Group sponsored by European League Against Rheumatism (EUSTAR) from clinical database of Peking Union Medical College Hospital ( PUMCH). Their clinical features, visceral lesions and laboratory findings including detection of anti- U1 RNP were recorded. Relevance between existing anti-U1 RNP and clinical characteristics and other laboratory indicators of SSc was analyzed statistically. Results Eighty-seven of the 131 patients presented as diffused SSc (dSSc) , 36 limited SSc ( lSSc) and eight SSc/systemic lupus erythematosus (SLE) overlap syndrome, with positive rate of anti-U, RNP of 28. 2 (37/131) percent in patients with SSc. Positive rate of anti-U1 RNP in dSSc was similar to that in lSSc groups [28. 7% (25/87) and 25. 0% ( 9/36 ) , respectively, P = 0. 673]. But significantly higher prevalence of pulmonary arterial hypertension and cardiac involvement, and less white blood cell and platelets counts were observed in the patients with positive anti-U1 RNP than in those with negative anti-U1 RNP (all P < 0. 05 ). There was no statistically significant difference in skin sclerosis score and prevalence of arthritis, myositis and interstitial lung disease was observed between those with positive and negative anti-U1 RNP ( P > 0. 05 ) . Detection rate of anti-DNA topoisomerase I ( Scl-70 antibody) was higher in SSc patients with negative anti-U, RNP. Conclusions U1 RNP antibody is a common antibody in Chinese patients with SSc, and detection for it combined with other autoantibodies will be helpful for diagnosing of SSc and predicting development of pulmonary arterial hypertension, cardiac and hematological involvements in them.

Objective:To investigate the predictive value of measurement parameters of left atrial appendage by coronary CTA (CCTA) for the risk of cardiogenic stroke (CS) in patients with nonvalvular atrial fibrillation (NVAF).Methods:The clinical and examination data of 179 patients with NVAF who underwent CCTA examination were retrospectively analyzed. The selected patients were grouped according to the outbreak of acute ischemic stroke and TIA within 2 years after CCTA examination. Patients who met the criteria for CS were selected as cases (87 patients), and those with neither stroke nor TIA as controls (92 patients). The diameter and area of left atrial appendage (LAA) orifice, the LAA depth, and the LAA volume were measured by using dedicated software. The parameter was corrected using the body surface area (BSA) to obtain the correction index of corresponding parameter. The independent samples t test, Mann-Whitney U test, and Chi-square test were used to compare the differences in various indicators between the two groups. Binary logistic regression was used to analyze the impacts of body mass index (BMI), hyperlipidemia, the duration years of atrial fibrillation, left atrial appendage area index (LAAOA Index), and the left atrial appendage emptying fraction (LAAEF) on the risk of CS. The ROC curve was used to evaluate the predictive value of LAAOA Index and LAAEF for the onset of CS. Results:The correction index of the left atrial appendage orifice maximum and minimum diameter, the left atrial appendage orifice area, and the maximum & minimum left atrial appendage volume and the LAAEF in the case group were (1.80±0.21) cm/m 2, (1.19±0.17) cm/m 2, (3.20±0.71) cm 2/m 2, (7.91±1.92) ml/m 2, (5.03±1.40) ml/m 2, (36.20±10.54)%, and those value in the control group were (1.64±0.24) cm/m 2, (1.06±0.19) cm/m 2, (2.65±0.64) cm 2/m 2, (6.61±1.68) ml/m 2, (3.67±1.28) ml/m 2, (45.25±10.07)%, the differences were statistically significant ( t= 4.783, 4.647, 5.481, 4.826, 6.823, and -5.875, all P<0.001). Binary logistic regression analysis showed that the increase in LAAOA Index ( P= 0.005) and the decrease in LAAEF ( P<0.001) were independent risk factors for CS in NVAF patients. The area under the ROC curve (AUC) of LAAOA Index was 0.712 (95%CI 0.639-0.777), and the best diagnostic cut-off was 3.16 cm 2/m 2; the AUC of LAAEF was 0.734 (95%CI 0.663-0.797), the cut-off was 38.71%; the AUC of LAAOA Index-LAAEF was 0.786 (95%CI 0.718-0.843). The difference of AUC value between LAAOA Index and LAAEF was not statistically significant ( Z= 0.448, P= 0.654). The difference of AUC between the LAAOA Index-LAAEF and LAAOA Index ( Z=2.667, P=0.008) and between the LAAOA Index-LAAEF and LAAEF ( Z=2.061, P=0.039) were statistically significant. Conclusions:CCTA can provide a one-stop and relatively accurate evaluation of the size and function of the left atrial appendage by post-processing the coronary vascular scan data. Left atrial appendage measurement parameters from CCTA can be used as a supplement to the CHA2DS2-VASc score, and provide quantitative indicators for the risk assessment of CS in patients with NVAF.