Idiopathic rapid eye movement (REM) sleep behavior disorder is recognized as a prodromal stage of α-synucleinopathies such as Parkinson′s disease, Lewy body dementia and multiple system atrophy. It is important to timely identify early predictors that can predict early conversion into α-synucleinopathies. This review provided an update on classic and novel early predictors of α-synucleinopathies in patients with idiopathic REM sleep behavior disorder and provided a comprehensive understanding on the phenotypic transformation of the disease.

Objective To evaluate the prevalence of obstructive sleep apnea syndrome (OSAS) and its characteristics in elderly patients with cardiovascular diseases, and provide reference for the clinical decisions. Methods All patients who were hospitalized in department of cardiovascular medicine from January to June in 2007 were invited to participate in the current study. A total of 317 hospitalized elderly patients were recruited into this study. All participants were assessed by portable bedside nocturnal polysomnograph and Epworth sleepiness scale (ESS). Results Among 317 patients, 281 cases (88.6%) met the criterion of obstructive sleep apnea (OSA) [apnea and hypopnea index (AHI)≥5] and 47 cases (14.8%) met the criteria of obstructive sleep apnea syndrome (OSAS) (AHI≥5 and ESS≥9). When the severity of OSA (as indicated by AHI) was considered as a dependent variable, multiple regression analysis indicated that it was significantly associated with minimal SaO2 and the oxygen desaturation index, while age, habitual snoring, ESS, BMI, mean SaO2 and the duration of SaO2≤ 90% did not show significant effects on the severity of OSA. Conclusions High prevalence of obstructive sleep apnea syndrome (with daytime sleepiness) is found in elderly hospitalized patients and the rate of obstructive sleep apnea is much higher in patients without daytime sleepiness symptoms. Minimal SaO2 and the oxygen desaturation index are the important predicting factors for the severity of OSA, while age, BMI, habitual snoring, sleepiness are not correlated with the severity of OSA after adjusting minimal SaO2 and oxygen desaturation index.

Objective To explore the clinical application value of transparent cap gastroscope in the Billroth Ⅱ procedure after subtotal gastrectomy in patients with bile duct diseases by endoscopic retrograde cholangiopancreatography(ERCP).Methods 20 patients underwent ERCP with Billroth Ⅱ gastrectomy postoperation with biliary diseases were selected as the research subjects,selected the transparent cap gastroscope ERCP,successful intubation received endoscopic sphincterotomy(EST) and(or) endoscopic nasobiliary drainage(ENBD),endoscopic papillary balloon dilatation(EPBD),endoscopic biliary metal stent drainage(EMBE),endoscopic biliary drainage(ERBD) treatment.Results 20 patients with Billroth Ⅱ gastrectomy after angiography were successful,the successful rate was 100.00%,14 cases of EST patients,4 patients underwent EPBD surgery,common bile duct stones all took the net,took the net rate of 100.00%;1 case of bile duct cancer underwent EMRE resection,1 case of bile duct stenosis after biliary tract surgery ERBD operation,hyperamylasemia occurred in 1 case,no serious complications such as bleeding and perforation of digestive tract.Conclusion Billroth Ⅱ gastrectomy postoperative patients with bile duct disease receiving ERCP,endoscopic transparent cap can provide good operative field for jejunal loop inside the mirror,improve the success rate of bile duct intubation,conducive to the removal of stones,improve the success rate of surgery,reduce complications security,safety of operation,and can be used in clinical application.

Objective To summarize the experience of nursing the patients with liver transplantation complicated with early portal vein thrombosis treated with post-embolectomic anticoagulation. Method The clinical data of 5 cases of liver transplantation-induced portal vein thrombosis treated with post-embolectomic anticoagulation was reviewed to summarize the curative effect , key points for disease conditions and anticoagulative nursing. Results The anticoagulative effect was not good in only one case. 4 other cases were recovered by embolectomy and postoperative anticoagulation therapy as well as related nursing measures. Conclusion The nursing measures such as close observation of the disease processing, early reasonable anticoagulation, accurate medication, prevention of patent complication are critical for preventing the recurrence of portal vein thrombosis after liver transplantation.

Objective To evaluate the advantage of single -source spectrum CT in differentiating of calcifi-cation and tophus.Methods 146 cases of clinical suspected patients with gout pain were scaned by single -source spectrum CT,observed the adjacent to the bone and joint hyperplasia and showing characteristics of gout stone,coun-ted quantity,size and position of the sedimentary tophus.Diagnosed by American rheumatism association standard as the gold standard,computed the sensitivity,specific degrees and accuracy of showing tophus of single -source spec-trum CT and conventional CT,and evaluated the advantage of differentiating adjacent to the bone and joint hyperplasia and gout stone of single -source spectrum CT.Results Diagnosis of gout in 105 cases.Scaned 349 joints,positive in 341 of them,The first plantar toe joint involvement was obvious[118,34.60%(118/341)];The result showed that the sensitivities of the tophus,specific and accurate rate of the conventional CT were 63.80%(67 /105),65.85%(27 /41),64.38%(94 /146),which of single -source spectrum CT were 96.19%(101 /105),87.80%(36 /41), 93.84%(137/146),the differences of sensitivity,specificity and accuracy between the two methods were statistical significance(χ2 =34.42,555,38.34,all P <0.05).Conclusion Single -source spectrum CT in gout stone adjacent to the bone and joint has higher sensitivity and accuracy,specific degree,it is higher than conventional CT and provide a new noninvasive imaging technique for the identification of the peripheral bone and joint of the bone.

Objective To investigate the activation of nuclear factor-B (NF-B)and hypoxia-inducible factor-1 (HIF-1)in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods Subjects were classified into mild-to-moderate OSHAS group (n = 16), severe OSAHS group (n = 14) and the matched control group (n=30). Gene and protein expressions of NF-B and HIF-1 were measured by RT-PCR, Western blot in peripheral blood mononuclear cells (PBMC). Results NF-κB p65 mRNA and NF-κB p65 protein,HIF-1α mRNA and HIF-1α protein in PBMC were significantly higher in severe OSAHS group than those in mild–to-moderate group and control group (P<0.01). But there were no significant difference in NF-κB p65 mRNA and NF-κB p65 protein between mild-to-moderate group and control group (P=0.068, P=0.254 respectively). Only gene (P<0.05) not the protein (P=0.777) of HIF-1αwas higher in mild-to-moderate as compared with control group. Both NF-κB p65 mRNA and HIF-1αmRNA were positively correlated with AHI (r=0.493, P=0.006, r=0.508, P=0.004), while negatively correlated with nighttime lowest blood oxygen saturation (LSaO2)(r=-0.488, P=0.006, r=-0.46, P=0.011). There was a positive correlation between NF-κB p65 protein level and AHI (r=0.669, P<0.001). HIF-1αprotein level was positively correlated with AHI, ODI (r=0.628, P=0.001;r=0.480, P=0.018). There were positive correlations between NF-κBp65mRNA and HIF-1αmRNA (r=0.543, P=0.002), NF-κBp65 and HIF-1αprotein respectively (r=0.716, P<0.001). Conclusions As the gene and protein of NF-κB and HIF-1 were up-regulated in patients with OSAHS, and also positively correlated with the severity of sickness. We conclude that both NF-κB and HIF-1 were involed in the pathogenesis of OSAHS.

Objective To investigate the mechanism of AS2 O3 inducing the apoptosis of myelodysplastic syndrome(MDS) cell line SKM-1 .Methods SKM-1 cells were incubated with AS2 O3 ,and then the cellular morphology was observed ,flow cytometry was used to determine the apoptosis ,RT-PCR was used to detect the expressions of Bcl-2 ,Bax and caspase-3 mRNA .Results 0 .25、0 .50 μmol/L AS2 O3 could not markedly induce the apoptosis of SKM-1 cells (P>0 .05) .But 2 .00、8 .00、32 .00 μmol/L of AS2 O3 could obviously promote the apoptosis of SKM-1 cells .With the increase of the acting time and concentration of AS2 O3 ,the apoptosis rate increased ,too(P<0 .01) ,the expressions of anti-apoptotic gene Bcl-2 mRNA decreased (P<0 .01) ,the expressions of promoting apoptosis gene Bax and caspase-3 mRNA increased (P<0 .01 ,P<0 .05) .Conclusion 2 .00、8 .00、32 .00 μmol/L of AS2O3 may promote the apoptosis of SKM-1 cells through down-regulating the expression of Bcl-2 gene and up-regulating the ex-pressions of Bax and caspase-3 genes .

OBJECTIVE: To observe the effects of electroacupuncture treatment on nitrergic neurotransmitter in bladder neck and detrusor of rats with unstable bladder. METHODS: Rat models of unstable bladder were established by operation to induce urethral obstruction. Electroacupuncture treatment was given by acupuncturing Huiyang and Zhonglushu points for a week. Then the neuronal nitric oxide synthase (nNOS)-, endothelial nitric oxide synthase (eNOS)- and inducible nitric oxide synthase (iNOS)-positive cells in bladder neck and detrusor of the rats were observed. RESULTS: The nitrergic neurotransmitter in bladder neck and detrusor were obviously decreased in rats with unstable bladder. The electroacupuncture treatment could significantly increase the contains of NOS in bladder tissue. CONCLUSION: To promote the synthesis and secretion of nitrergic neurotransmitter in bladder tissue may be one of the mechanisms of acupuncture in adjusting bladder function.

Hemodynamics is a discipline that studies the effects of blood flow,blood flow volume and other factors on the arterial wall.Intracranial aneurysm is the main cause of death due to non-traumatic subarachnoid hemonhage,which has brought a heavy burden on society.Therefore,it is very important to make an intensive study of the pathogenesis of aneurysm.With the development of medical imaging technology and fluid mechanics software in recent years,it becomes possible to make the precise and scientific studies of the hemodynamics of intracranial aneurysms.In this paper,the hemodynamic factors inducing the formation of intracranial aneurysm that are proposed by medical experts at home and abroad are reviewed,and the hemodynamic mechanism is discussed.

Objective To explore the prevalence of sialorrhea and its clinical correlation with dysphagia in Chinese patients with Parkinson′s disease ( PD ).Methods One hundred and sixteen consecutive patients with a clinical diagnosis of PD were selected.Demographic data included sex , age, years of education, age at onset of PD, clinical genotype, disease duration, treatment, Hoehn and Yahr (H&Y) stage.Sialorrhea was assessed using the Unified Parkinson′s Disease Rating Scale (UPDRS) Ⅱitem number 6.All patients were studied with videofluoroscopic study of swallowing ( VFSS).Results The prevalence rate of sialorrhea in PD was 59.5% (69/116, 95% CI 50.6%-68.4%).Males were more likely to develop sialorrhea than females (47/70 vs 22/46,χ2 =4.298, P=0.038).PD patients′sialorrhea correlated with oral dysphagia:with food leaking from the mouth ( liquid r=0.229, P=0.014; juice r=0.197, P=0.034;pudding viscosities r=0.231, P=0.013;solid food r=0.255, P=0.006), with more than 1 ml of oral food residues (liquid r=0.319, P<0.01;solid food r=0.185, P=0.047), with delay in food transfer to the root of the tongue (liquid r=0.279, P=0.002; juice r=0.209, P=0.024), and delayed swallow transfer ( pudding viscosities r=0.257, P=0.005).Sialorrhea score was not related to H&Y stage, clinical course and levodopa equivalent doses (LED).The prevalence rate of dysphagia in PD was 87.1%(95% CI 81.0% -93.2%).Liquid was more likely to cause pharyngeal dysphagia ( P=0.03).With the increase in H&Y stage , so did the oral and pharyngeal stages of dysphagia.Late and mid-course was more likely to develop oral and pharyngeal dysphagia than those with early clinical course .Conclusions Sialorrhea and dysphagia are common non-motor symptoms in PD patients.Sialorrhea is more prevalent in males and correlates with oral phase of dysphagia.Liquid is more likely to cause pharyngeal dysphagia.With increase in H&Y stage , so did oral and pharyngeal dysphagia.Even though late clinical course is more likely to develop oral and pharyngeal dysphagia than early clinical course , the comparison between late and intermediate clinical courses does not reach statistical significance .