Objective To investigate the clinical significance of serum microRNA-151a-3p (miR-151a-3p) expression in peripheral blood of patients with acute cerebral infarction (ACI), and to analyze the correlation between miR-151a-3p and related inflammatory factors, in order to obtain new evidence and ideas in the diagnosis and treatment of ACI. Methods A retrospective analysis was conducted. The clinical data of patients with ACI admitted to Department of Neurology of People's Hospital of Wuhan University from April to July in 2004 were enrolled. 114 ACI patients with first onset and duration of 2-14 days served as the research objects, and in the same period 58 healthy persons with matched age, and gender served as healthy control group. The risk factors of cerebral infarction in ACI patients and levels of serum miR-151a-3p, interleukins (IL-6, IL-8), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) in all the subjects were completely recorded. The correlation between serum miR-151a-3p and the area and type of cerebral infarction, the causes of infarction as well as the inflammatory cytokines was analyzed. The correlation of 10-year survival rate of patients with different expression levels of miR-151a-3p in patients with ACI was analyzed. Results A total of 114 patients with ACI were enrolled, with 59 male, 55 female, and age ranged 48-63 years with a mean of (55.0±6.7) years. Large infarction was found in 25 cases, middle sized infarction in 26 cases, small infarction in 53 cases, and lacunar infarction in 10 cases. According to the modified Trial of Org 10172 in acute stroke treatment (TOAST), the patients were classified as thrombotic cerebral infarction (AT) 92 cases, embolism (CE) from cardiac origin 10 cases, and small arterial occlusive cerebral infarction (SAD) 12 cases. After eliminating the influence of cerebral infarction risk factors on the expression level of miRNAs, and compared with that of healthy control group, the level of serum miR-151a-3p expression was significantly increased in ACI group (2-ΔΔCt: 2.28±1.85 vs. 1.27±0.98, P < 0.01); the levels of serum miR-151a-3p in large, middle, small, lacunar infarction groups were markedly up-regulated (2-ΔΔCt: 1.78±1.02, 1.92±1.11, 2.22±1.54, 2.61±1.82 vs. 1.27±0.98, all P < 0.05) with no significant difference among different infarction groups. The serum miR-151a-3p expression in AT and CE groups was significantly higher than that of the healthy control group (2-ΔΔCt: 2.01±1.45, 1.99±0.89 vs. 1.27±0.98, both P < 0.05), but no significant difference was found between SAD group and healthy control group (2-ΔΔCt: 1.72±0.30 vs. 1.27±0.98, P > 0.05). The levels of serum IL-6, IL-8, CRP and TNF-α in ACI group were all higher than those of healthy control group [IL-6 (ng/L): 45.21±14.33 vs. 39.70±13.15, IL-8 (μg/L): 29.12±14.92 vs. 22.50±10.12, CRP (mg/L): 6.61±3.02 vs. 5.40±2.75, TNF-α (ng/L): 65.20±16.14 vs. 55.70±14.35, all P < 0.05]. In addition, higher expression of serum pro-inflammatory mediators IL-6, IL-8, CRP and TNF-α were positively correlated with miR-151a-3p (R2 value were 0.092, 0.055, 0.034, 0.036, all P < 0.05). Ten-year survival rate was higher in patients with low expression of miR-151a-3p [with 1.27±1.98 as the boundary, 48.57% (17/35) vs. 34.18% (27/79), log-rank = 3.411, P = 0.045]. Conclusions Up-regulated serum miR-151a-3p may be involved in the pathophysiology of ACI. Therefore, miR-151a-3p may be used as a reference to predict the severity of neurological deficit in clinic.

Objective To study the diagnostic value of single fiber electromyography (SFEMG) in diabetic peripheral neuropathy (DPN).Methods The values of jitter and fiber density (FD) in 36 patients with diabetes mellitus of 2 type were determined by Viking Ⅳ, while conventional nerve conduction studies (NCS) were performed,and the fasting blood glucose and glycosylated hemoglobin A 1C (HbA 1C ) were measured.Results The values of jitter were associated with FD, and both jitter and FD were positively related to HbA 1C .18 cases with abnormal NCS showed increased jitter(11 cases with block),and increased FD in 14 cases; the remaining 18 cases with normal NCS,7 cases with increased jitter(3 cases with block),the increased FD in 5 cases.Conclusion Denervation reinnervation reflected by jitter and FD was associated with the metabolic status. SFEMG could be served as sensitive means to early diagnosis of DPN, and might detect subclinical peripheral neuropathy of diabetes.

Objective To investigate the diagnostic value of F wave in diabetic peripheral neuropathy (DPN).Methods F and M wave parameters were measured in 106 patients with diabetes mellitus and 75 normal persons, including the minimum latency, duration, amplitude and area of F wave, and the amplitude and the area of M wave.Results (1) In the 30 patients with diabetes mellitus without peripheral neuropathy, there were 8 cases with prolonged the duration of F wave, 4 cases with prolonged the minimum latency of F wave, 2 cases with increased in the ratio of the area of F/M wave. (2) The minimum latency prolonged of F wave, the ratio of the amplitude of F/M wave and the ratio of the area of F/M wave significantly increased in the 76 patients with DPN, the duration of F wave prolonged in the mild DPN but no one revealed remarkable abnormal. (3) In the controls, the function of upper limit of the minimum latency of F wave (Y) and leg length (X) was Y=12.3+48.8X 2. Conclusion (1) F wave could be served as sensitive index to the early diagnosis of DPN, and might detect subclinical DPN. (2) The proximal nerve segment could be affected without the lesions of the distal nerve segment in patients with DPN, and it suggested that vascular factor plays an important role in the mechanism of DPN.

Objective To investigate the diagnostic significance of sensory nerve action protential (SNAP) on diabetic neuropathy (DN), through measuring amplitude and amplitude ratio. Methods There were 91 patients with type 2 diabetes involing 51 cases without neurologic symptom/sign as subgroup Ⅰ, 30 cases with mild neuropathy as subgroup Ⅱ and 10 cases with severe neuropathy as subgroup Ⅲ, according to Toronto clinical scoring system (TCSS). Thirty-nine healthy volunteers with age- and gender-matched were served as controls. SNAP were antidromically recorded using surface electrodes. The observed parameters were as follows: conduction velocity and amplitude of median, radial and sural nerve, shorten for Vine, Vra and Vsu and Ame, Ara and Asu, respectively; sural/radial nerve amplitude ratio (SRAR) and median/ radial nerve amplitude ratio (MRAR). Results (1) As compared with the controls (P<0.05),conduction velocity (m/s, Vine : 46. 2 ±7.3, Vra: 45.8±6. 9, Vsu: 30. 3±9. 5) and amplitude (μV, Am: 15.4±10.5, Ar: 16.6±9.8, As: 5.9±6. 3)decreased significantly in subgroup Ⅲ; Vsu (46.2± 4. 7) significantly slowed in subgroup Ⅱ (P = 0. 002) ; both Ame (34. 5 ± 10. 2, 33. 0 ± 14. 6) and Asu (13.8± 5.6, 10.7 ± 5.5) decreased significantly in both subgroup Ⅰ and Ⅱ respectively, with Asu decreasing more significantly in subgroup Ⅱ (Z=- 3.22, P = 0. 001) ; SRAR (0. 432±: 0. 112) was significantly smaller only in subgroup Ⅰ , both SRAR (0. 330 ±0. 102) and MRAR (1. 008 ± 0. 225) were significantly smaller in subgroup Ⅱ. SRAR decreased more significantly in subgroup Ⅱ (t = - 3. 86, P = 0. 003). (2) The abnormal rate of Ame was the highest in subgroup Ⅰ (26. 0%), and Asu in subgroup Ⅱ (41.4%) ; while that of combination of Asu and SRAR (68.9%) was significantly higher than that of Asu alone (x2 = 9. 212, P = 0. 003). (3) TCSS scores were negatively related to Van (r = - 0. 583), Ame (r=-0. 406), Asu (r=-0.620) and SRAR (r=-0.527, all P<0.05), and there was no significant correlation of TCSS scores with MRAR in subgroup Ⅱ; both SRAR (r = -0.435) and MRAR (r = - 0. 319) were negatively related to the diabetic duration (both P < 0. 05). Conclusions In mild or early DN, SNAP amplitude is more sensitive than conduction velocity, combination of SRAR and Vsu may be serve as a useful indication for early diagnosis. In the DN patient, diabetic duration has more influence on the measurement of sensory NCS, and SRAR is related to the severity of neuropathy.

BACKGROUND: After local injection of Botulinum toxin type-A (BoTX-A), not only the function of the neuromuscular conjunction was affected, but also the changes occurred remote from the injected site. F-waves result from the back fire of the motoneuron activation, which may indirectly reflect the functional state of the motoneurons.OBJECTIVE: To evaluate the remote effect of local BoTX-A injection by F-wave test.DESIGN: Self-control study based on patients with movement disorders.SETTING: Neruologic clinic in a university hospital.PARTICIPANTS: Twenty-six patients with movement disorders not received previous local BoTX-A were selected from Neurological Clinic in Renmin Hospital of Wuhan University between September 2002 and July 2003, including 19 cases with hemificiospasm, 5 Meige syndrome and 2 torticollis spasmodicus.INTERVENTIONS: F- and M-waves of ulnar and tibial nerves were recorded before 1, 12 - 24 weeks after local injection of BoTX-A in 26 patients.MAIN OUTCOME MEASURES: The following parameters were analyzed:latency(ML) and amplitude (Mamp) of M-wave, minimal (Fmin) and average latency (Fave), amplitude of negative peak(Famp), duration (Fdur), persistence (Fpcr) and chronodispersion (Fchr) of F-wave.RESULTS: No definite F-response of ulnar nerve stimulation was obtained 1 week after injection in 3 HFS patients (5 nerves) . Fave prolonged significantly on ulnar and tibal nerve and Fdur increased significantly on ulnar nerve 1 week after injection, but there was no significant difference 12 - 24 weeks later, compared with before injection. No significant correlation of the altered F-wave parameters was found with the dosage of BoTX-A.CONCLUSION: Fdur and Fave could sensitively assess the remote effect,which correlates with distance away from the injected muscle, rather than the dosage of BoTX-A.

Objective To analyze the clinical features of rapid eye movement sleep behavior disorder (RBD) in pa?tients with Parkinson’s disease (PD) and investigate correlative factors of RBD. Methods Sixty-three consecutive PD pa?tients were included and classified into PD+RBD group (n=28) and PD-RBD group (n=35) according to REM Sleep Be?havior Disorder Questionnaire (RBDQ-HK). The degree of motor symptoms was compared using Unified Parkinson Dis?ease Rating Scale (UPDRS) and Hoehn&Yahr (H-Y) grade, the incidence of non motor symptoms was compared using non motor symptoms questionnaire (NMSquest), and the cognitive function, anxiety, depression, daytime sleep were com?pared using Montreal Cognitive Assessment (MOCA), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Epworth Sleep Scale (ESS) between the two groups. Results The incidence of RBD in PD patients was 44.4% (28/63). There were longer illness course ( χ2=12.733, P=0.002), older age (t=-2.292, P=0.025), and higher H-Y grades (χ2=7.014, P=0.008) in PD+RBD group, compared with those in PD-RBD group, but there were no significant differences in sex, onset age, onset form and levodapa dose equivalents (LDE) between the two groups. There were higher UPDRSⅡ,Ⅲ scores (t=-2.734, P=0.008; U=3.329, P=0.001) in PD+RBD group. Most of the non motor symptoms, including the gastrointestinal dysfunctions, psychiatric comorbidity and sleep disturbances were more frequent in PD+RBD group (P<0.05), and the incidence of anxiety and depression were higher (χ2=3.958, P=0.047; χ2=10.338, P=0.001), whereas there were no significant differences in cognitive function and daytime sleep between the two groups. In addition, constipation (OR=7.257), illness course (OR=5.389), UPDRS Ⅲ scores (OR=1.060) were correlative with RBD in PD patients. Con?clusion PD patients with longer illness course, older ages, and severe motor and non motor symptoms more likely suffer from RBD. Besides, constipation, long illness course and high UPDRSⅢscores may be risk factors of RBD.

Objective To evaluate the remote effect of local injection of botulinum toxin by use of the F-wave measures. Methods The F-wave responses as well as M-waves were recorded before injection, and at 1 week,12 to 24 weeks after local injection of botulinum toxin type-A (BTX-A) in 26 patients, including 19 with hemi-facial spasm (HFS),5 Meige syndrome and 2 torticollis spasmodicus (TS).The following parameters were analyzed: M-wave latency (ML) and amplitude (Mamp), F-wave minimal latency(Fmin) and average latency(Fave),amplitude (Famp), duration (Fdur), persistence (Fper) and chronodispersion (Fchr). The above parameters were obtained through the electric stimulation of ulnar and tibial nerves, and recorded from the abductor digiti minimi and extensor digitorum brevis, respectively. Results No definite F-wave was obtained by electric stimulation of ulnar nerve at 1 week after injection in 3 HFS patients (5 nerves). The Fave recorded from electric stimulation of ulnar and tibial nerves prolonged significantlyand Fdur from ulnar nerve increased significantly at 1 week after injection, but were not significantly different from those of pre-injection when recorded at 12 to 24 weeks after injection. No significant correlation of the altered F-wave parameters was found with the dosage of BTX-A. Conclusion Fdur and Fave could sensitively assess the remote effect of the local injection of BTX-A, the remote effect might be correlated with the distance between injected muscle and tested muscle, rather than the dosage of BTX-A.

OBJECTIVE:To explore the changes of serum phenytoin levels and its pharmacokinetics in menstrual epilepsy.METHODS:9cases of menstrual epilepsy patients who were treated with phenytoin were collected,whose blood concentra?tions of phenytoin in menstrual period and ovulation period were respectively determined by HPLC,pharmacokinetics study was performed in three of them.RESULTS:The mean serum phenytoin levels in menstrual period and ovulation period were(9.25?2.71)?g/ml and(13.33?3.22)?g/ml,respectively(P

BACKGROUND: Magnetic resonance diffusion tensor imaging (MRDTI) may non-wounded detect damage of fiber in white matter and becomes an effectively way to evaluate upper motor neuron(UMN) impairments.OBJECTIVE: To investigate the clinical significance of MRDTI on amyotrophic lateral selerosis(ALS).DESIGN: Case contrast observation.SETTING: Department of Neurology, Renmin Hospital of Wuhan University.PARTICIPANTS: Twenty ALS patients were selected from Department of Neurology, Renmin Hospital of Wuhan University from April to December 2005. There were 11 males and 9 females, and their ages ranged from 33 to 73 years with the mean age of (51±10) years. All subjects met the diagnostic criteria of ALS set by World Neurology League.Other 15 healthy subjects were collected as control group. There were 8 males and 7 females, and their ages ranged from 31 to 73 years with mean age of (50±11) years. All subjects provided the confirm consent.METHODS: Based on level of upper and lower motor neuron impairments, ALS patients were divided into UMN impairment group (n =16) and lower motor neuron group (n =4). Functional scores of ALS, illness developing velocity and pyramidal sign scores were performed, respectively. All subjects were scanned with DTI at axial view. Regions of interest [subcortical white matter of precentral gyrul and postcentral gyrul (Pre-CG/Post-CG), centrum semiovale and frontal white matter (CS/FWM), peripheral lateral cerebral ventricle, posterior limb of internal capsule (PIC), cerebral peduncle (CP), genu corpus callosum and splenium corpus callosum (GCC/SCC) and dorsal thalamus (DT)] were selected to measure fractional anisotropy (FA) and apparent diffusion coefficient(ADC).MAIN OUTCOME MEASURES: Correlations among FA, ADC, functional score of ALS, illness developing velocity and pyramidal sign scores.RESULTS: Twenty patients and 15 subjects in the control group were involved in the final analysis. ① FA was reduced and ADC increased in the posterior limb of the internal capsule in patients with UMN signs compared to healthy volunteers (t =3.452, 2.670; P ＜ 0.01, 0.05). Nonparametric tests revealed that there was a trend toward reduced FA in the posterior limb of the internal capsule in B group compared to controls (U =11, P =0.057). ② In UMN impairment group, FA in the posterior limb of the internal capsule was positively correlated with the ALS rating scale (r =0.577, P ＜0.05) and negatively correlated with pyramidalsign scores (r = -0.789, P ＜ 0.01 ),CONCLUSION : The impairment of pyramidal tracts can be noninvasively evaluated by diffusion tensor MR in vivo, thus providing useful information in diagnosing and further understanding MND.