Objective To evaluate the impact of multiple lacunar infarction (MLI) on the outcomes of mild cognitive impairment (MCI). Methods MCI patients were selected in outpatients and hospitalized patients using a common international standard MCI screen. Magnetic resonance imaging (MRI) and computer tomography (CT) were used to determine the presence of MLI. MCI patients were followed up for 6～24 months and their cognitive status and the impact of MLI on MCI were evaluated using Kaplan-Meier survival analysis. Results One hundred twenty patients were diagnosed as having MCI based on clinical evaluation and neuropsychological assessment. Among them, 43 (35.8%) patients had MLI and the rest 77 (64.1%) patients did not have. Twenty-seven MCI patients with MLI (62.8%) developed dementia, while 15 MCI patients without MLI (19.4%) developed dementia during 6～24 months follow-up. Kaplan-Meier analysis indicated that the incidence of dementia was significantly higher in patients with MLI than in patients without MLI did (P＜0.05). Conclusions MCI patients with MLI are more prone to dementia. These results suggest that early interventions aimed at controlling the modifiable risks are warranted for dementia prevention in MCI patients with MLI.

Objective To identify the metabolic alterations in the prefrontal lobe in male patients with schizophrenia by proton magnetic resonance spectroscopy (~1H-MRS), and to study the relationship between metabolic alterations and executive function. Methods The study was conducted in 26 male schizophrenics with medicine-free for at least 7 days and 28 normal controls. A multi-voxel ~1H-MRS on the prefrontal lobe was performed in all the subjects within 24 hours of admission. Wisconsin Card Sorting Test (WCST) was used to evaluate executive function. The NAA, Cho and Cr were measured and the ratios of NAA/Cr, Cho/Cr and NAA/(Cho+Cr) were calculated. Results Compared with normal controls, the patients demonstrated significantly lower NAA/Cr ratio (t=2.93, P<0.01) in the left prefrontal lobe and poorer performance in WCST (P<0.05). The NAA/Cr ratio in the left prefrontal lobe was positively associated with the responses errors and the perseverative errors of WCST(r=0.45, P＜0.05; r=0.47, P＜0.05)and negatively associated with the categories completed and conceptual level responses(r=-0.54, P＜0.01; r=-0.56, P＜0.01). Conclusions Abnormalities in neuronal function and/or integrity are present in the left prefrontal lobe of male schizophrenics. The neuron damage in the left prefrontal lobe of male schizophrenic may be the primary cause of cognition dysfunction.

Objective To investigate the auditory sensory gating P50 in schizophrenia patients with homicide during three months of follow up. Methods Twenty-five patients with schizophrenia patients with homicide and 27 healthy adults matched with age and education level were recruited in the present study. P50 was recorded in twenty-seven normal controls and twenty-five schizophrenia patients at the baseline. P50 was repeatedly recorded in eleven patients who completed the follow-up at three months following antipsychotics treatment. The psychotic symptoms of patients were assessed with Positive and Negative Syndrome Scale (PANSS) at the same time. Results ①In comparison with normal controls, schizophrenia patients with homicide showed increased S2-P50 amplitude (P<0.01), increased S2/S1 ratio (P<0.01), decreased S1-S2(P<0.05), and 100(1-S2/S1) (P<0.01) at the baseline and after three months treatment. The differences in P50 amplitude, latency, and P50 suppression index between the baseline and after three-month treatment in schizophrenia patients with homicide were not significant (P>0.05). ② Schizophrenia patients with homicide after three-month treatment showed decreased PANSS total scale, positive scale, general psychopathology scale, and six symptoms scales such as lack of response, thought disorder, activation, paranoid, depression, and aggression (P<0.05). ③ No significant correlations were found between the S2/S1 ratio, S2-S1, and 100(1-S2/S1) with disease duration, PANSS scores, and six symptoms scales at either baseline or after three-month treatment (P>0.05). Conclusions Schizophrenia with homicide has sensory gating deficits and P50 suppression index might be a stable trait maker for schizophrenia with homicide.

Objective To investigate the characteristics of memory impairment in patients with amnestic mild cognitive impairment (aMCI). Methods Thirty-five patients with aMCI and 35 healthy adults matched with age and education level were administered with a neuropsychological battery of tests including conception and perception implicit priming tasks (category exemplar, picture identification), as well as explicit memory tasks (immediate recall, delay recall, delay recognition ). Results Compared with healthy elders, patients with aMCI were impaired in the conception implicit priming task(t=-4.33, P<0.01), as well as in explicit memory (immediate recall, t=6.40, P<0.01;delay recall, t=9.29,P<0.01; delay recognition, t=7.65,P<0.01),but not in perception implicit priming task (t=-0.78, P＞0.05).The conception implicit priming is positively correlated with verbal fluency (r=0.74,P<0.01). Conclusions The present results indicate that patients with aMCI are impaired in both explicit memory and conception implicit priming. The conception implicit priming impairment in aMCI may be related to their frontal lobe dysfunction.

Objective To investigate the relationship between C1773T polymorphism of LDL receptor gene (LDLR) and cerebral hemorrhage and the impact of C1773T polymorphism of LDLR on the levels of serum lipids in Chinese Han in Changsha, Hunan province. Methods Two hundred seventy-three cerebral hemorrhage patients and 140 normal controls were recruited in the present study. The C1773T polymorphism of LDLR was analyzed by SNaPshot and direct DNA sequencing. The triglyceride (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) levels were examined using oxidase method. Results The CC, CT and TT genotype frequencies of LDLR polymorphism were 0.703/0.278/0.019、0.707/0.250/0.043 and the allele C and T frequencies of LDLR polymorphism in the cerebral hemorrhage group and the control group were 0.842/0.158,0.832/0.168 respectively. The differences in genotype and allele frequencies of LDLR polymorphism were no significant between cerebral hemorrhage group and the control group (P>0.05). There were no significant differences in the levels of lipids among the CC, CT and TT genotype in either cerebral hemorrhage group or the control group (P＞0.05). Conclusions The LDLR-C1773T polymorphism may not be associated with cerebral hemorrhage nor be related to hyperlipemia in Chinese Han in Changsha.

Objective To assess the effectiveness of initial Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) as predictors for clinical outcomes in patients with top of the basilar syndrome (TOBS).Methods A total of 64 patients with TOBS were selected from Nanjing Stroke Registration Program (NSRP). Initial GCS and NIHSS were retrospectively evaluated by reviewing patients' records for details of clinical presentation and outcomes at 30 days measured by modified Rankin Scale (mRS) score. Patients were categorized as favorable outcome group (mRS 0-3) and unfavorable outcome group (mRS 4-6).Results The mean GCS was lower in the cases with mRS of 4-6 compared with those with mRS of 0-3 (P<0.01) and the mean NIHSS score was higher in favorable outcome group compared with unfavorable outcome group (P=0.011). In multivariate logistic regression analysis, after adjusting for age, gender and treatment approaches, the GCS OR was 0.301(95% CI 0.167～0.542), NIHSS OR was 1.436(95% CI 1.147～1.796), and both of them turned out to be the independent predictors of outcome at 30 days. ROC curve analysis suggested that GCS score of 10 represented a good cut-off point for predicting the outcome with the prognostic sensitivity of 87.9% and specificity of 83.9%. NIHSS score of 14 could also serve as a good cut-off point with the prognostic sensitivity of 63.6% and specificity of 77.4%.Conclusions Conclusions Both GCS and NIHSS can predict outcomes in patients with acute TOBS with GCS score ≤10 and NIHSS score ≥14 as the cutoff points of poor outcome. GCS cutoff point is more strongly predictive of outcome than that of NIHSS.

Objective To investigate the clinical and neuroimaging characteristics of patients with reversible posterior leukoencephalopathy syndrome (RPLS). Methods The etiology, clinical manifestations, neuroimaging features, treatment, and prognosis were retrospectively analyzed in 8 patients (5 males and 3 females) with RPLS. Results The causes of RPLS included systemic lupus erythematosus (2 cases) eclampsia (one case), primary hypertension (one case), fungal encephalitis (one case), multiple myeloma (one case), renal transplantation (one case), immunosuppressant (three cases), chemotherapy (one case) and antifungal agent (one case). The clinical manifestations of these patients included headaches, seizures, visual abnormalities, and consciousness or mental disorders. Magnetic resonance imaging (MRI) of the head mainly showed symmetrical abnormalities in the posterior regions of the brain, as evidenced by low or equal signal on T_1WI, and high signal on T_2WI and FLAIR images. After treatment with antihypertensive agents, dehydration therapy, and heteropathy for 2～3 weeks, the neurological deficits of the patients were almost resolved and the initial lesions disappeared completely or almost completely in all patients at the follow-up MRI. Conclusions RPLS is a clinical entity characterized by reversible white matter damage in posterior brain. Prompt diagnosis and treatment may result in reversible resolution of its clinical symptoms and neuroradiological lesions.

Objective To examine ultrastructural features of the arteriole responsible for intracerebral hemorrhage or the perforating branches artery around hematoma in patients with hypertensive intracerebral hemorrhage and explore the mechanism of hypertensive intracerebral hemorrhage. Methods Twelve hypertensive patients with CT proved intracerebral hemorrhage underwent operation. The small artery specimens were obtained through cortex fistula and their ultrastructures were observed under the electron microscope. Results Twelve specimens including 4 cases of duty arteriolae and 8 cases of perforating branch arteriolae were collected, Different degrees of degeneration were observed in three layers of the arteriola in all 12 specimens. Changes in endothelial cells included endothelial cell necrosis, collapse, or fallen of from endomembrane, accompanied by degeneration of internal elastic membrane, such as uneven thickness, absence of intermittent and medial smooth muscle cell necrosis. Myofilaments in the cytoplasm were condensed to form a high electron-dense cytoplasm. No micro-aneurysm was observed. Conclusions The pathological changes of cerebral small artery walls load-bearing layer in hypertensive patients include internal elastic layer rupture, smooth muscle layer of degeneration, decreased elasticity and increased fragility. Small artery walls may rupture, resulting in bleeding under the condition of rapid dynamic changes of blood flow.

Objective To explore the role of EphB4 in proliferation of glioma cells. Methods The mRNA and protein expressions of EphB4 were detected using RT-PCR, immunochemistry, and Western-blot, respectively. EphB4 siRNA was synthesized and transfected into U251 cells using Lipofectamine 2000. Glioma cell proliferation, apoptosis, and invasion were determined by MTT assay, TUNEL and transwell experiment, respectively. Results The expression (P<0.05) and proliferation of EphB4 were obviously decreased in U251 transfected with EphB4 siRNA and the proliferation was further decreased with the increased concetrations of siRNA. Compared with U251 group and siRNASCR group, EphB4 siRNA at different concentrations (25, 50 or 100 nmol/L) significantly reduced the invasion ability of cells and increased the number of apoptotic cells (P<0.05). Conclusions EphB4 plays an important role in the regulation of glioma cell proliferation, apoptosis and invasion.

Objective To study the effect of lovastatin on the expression and activity of β-site APP cleaving enzyme (BACE1). Methods The SH-SY5Y cells were treated by lovastatin. Cell viability was assessed by MTT assay, and the levels of cholesterol were assayed spectrophotometrically, and the activity of BACE1 was detected by fluorometric assay, and the expression level of BACE1 was detected by Western Blot. Results Compared with the control group, the cholesterol levels were decreased by 33.0% (3.33 vs. 4.97; F=5.13, P =0.020) and the activity of BACE1 was reduced by 13.8% (343.14 vs. 398.22; F=3.773, P =0.035) after 24h treatment of 5μmol/L lovastatin; the cholesterol levels were decreased by 49.2% (2.65 vs. 5.22; F=12.239, P =0.001) and the activity of BACE1 was reduced by 38.0% (274.75 vs. 443.14; F=13.610, P <0.01). Treatment with 5μmol/L lovastatin,for 48 h did affect the expression level of BACE1. Conclusions Lovastatin do not affect the expression level of BACE1, but may inhibit its activity and decrease the cholesterol level, thus providing a new approach to prevent or treat Alzheimer's disease (AD).