Objective To investigate the emotional memory characteristic in patients with leuloaraiosis(LA) and explore the neurobiological mechanisms through observing the changes of emotional memory.Methods Different valence images (including positive,neutral and negative pictures) were used to test twenty-four patients with Leuloaraiosis(LA group)and twenty-four healthy colltrols(HC group) at the same time.The emotional memory was evaluated by the recognition of emotional pictures.Results In appraisal of the emotional pictures,there was no significant difference between patients with LA (positive (10.42±2.30) and neulral (12.87±2.29),respectively) and healthy controls (positive (11.38 ± 3.25) and neutral (12.75 ± 2.86),respectively) in positive and negative appraisal (all P＞0.05).But the negative appraisal decreased between LA group (11.63 ± 1.81) and HC group (12.75 ± 2.02) (P＞ 0.05).Compared with healthy controls (38.08+±5.45),patients with LA(33.67±7.10) showed sharply decline in the emotional images memorizing task(P＜0.05).And the accuracy in recognizing positive and netural valence pictures in patients with LA ((Positive(11.04±2.40) and neulral (10.42±2.93)) was significantly lower than that in healthy controls ((positive(12.79±2.17) and neutral(12.08±2.59))(P＜0.05).But in negative stimulus,there was no significant difference between LA group(13.20± 1.86)and HC group(12.20±2.65) (P＞0.05).In addition the total correct recognition,positive and neutral valence in pictures recognition were negativly correlated with the se verity of white matter lesions in the LA patients group(r=-0.308,P=0.033;r=-0.462,P=0.003;r=-0.352,P=0.014).Conclusion The emotional memory is impaired in patients with LA,and the degree of damage is accompornied with the severity degree of LA.The emotional memory for positive and neutral vanlence pictures is impaired but the emotional memory for neutral is relatively reserved in patients with LA in pictures recognition phase.It suggests that impaired emotional memory with different valences may be related to different neuromechanisms.

Objective To investigate the relationship between obstructive sleep apneahypopnea syndrome (OSAHS) and carotid stenosis in patients with ischemic cerebrovascular disease (ICVD) and to provide reference for developing the intervention strategy of carotid stenosis. Methods Eighty-seven patients with ICVD were screened from Nanjing Stroke Registry Program. The patients were divided into without (n=21), mild(n=24), moderate (n=27) and severe (n = 11) OSAHS groups according to the apnea-hypopnea index (AHI); in addition, the patients were divided into with (n =34) and without carotid stenosis (n=49) groups according to the results of digital subtraction angiography (DSA). The effects of the risk factors for cerebrovascular diseases and OSAHS on carotid stenosis in patients with ICDV were analyzed.Results There were significant differences in the proportions of alcohol consumption (χ2=8.56, P =0. 036), hypertension (χ2 = 13.20, P =0. 004) and carotid stenosis (χ2 =22.97, P =0. 006) between the no OSAHS and the mild, moderate and severe OSAHS groups. The univariate analysis showed that age (OR = 1. 066, 95% CI 1. 023- 1.112; P = 0. 003),hypertension (OR =3.587, 95% CI 1. 294- 9. 949; P =0. 014), alcohol consumption (OR =5.275,95% CI 1.855-15.001; P= 0.002) and OSAHS (OR= 1.073, 95% CI 1.033-1.115; P = 0. 000) were the risk factors for carotid stenosis. The multivariate logistic regression analysis showed that age (OR = 1. 113, 95% CI 1. 047-1. 182; P =0. 001), OSAHS (OR = 1. 096, 95% CI 1. 034-1. 160; P = 0. 000), and alcohol consumption (OR = 4. 292,95% CI 1. 217-15. 139; P = 0. 024) were the independent risk factors for carotid stenosis.Spearman rank correlation analysis suggested that the AHI levels were positively correlated with the degree of carotid stenosis (r = 0. 435, P = 0. 000). There were significant differences among the without stenosis (n =34), unilateral stenosis (n =22), and bilateral stenosis (n=27)groups (12.97 ± 10.04 vs. 21.40 ± 16.38 vs. 29.33 ± 13.81, F= 11.64, P<0.01).Conclusions OSAHS is an independent risk factor for carotid stenosis and it was positively correlated with the severity of carotid stenosis. AHI may reflect the degree of carotid stenosis and the range of neck vascular involvement to some extent.

Objective To investigate the emotional memory impairment in patients with primary insomnia (PI) and explore the neurobiological mechanisms underlying primary insomnia through emotional memory tasks involving different valance of emotional pictures.Methods Thirty patients with primary insomnia(PI group) and twenty healthy controls(HC group) were given emotional memory tasks using positive,neutral and negative valence images.The emotional memory was evaluated by the recognition of emotional pictures.Results Compared with healthy controls (positive (11.60±4.00) , neutral (11.05± 3.73) and negative (12.60± 2.06) , respectively), patients with PI (positive (11.30±3.75),neutral (11.47±3.21) and negative (11.43±4.12) ,respectively) showed no significant difference in appraisal of the emotional pictures (P＞0.05).Compared with healthy controls (43.40± 4.88) for the emotional images memorizing task,patients with PI (39.40±6.43) exhibited evident deficit of all emotional images (P＜0.05).Furthermore, the accuracy in recognizing both positive (12.60± 2.42) and neutral (12.87±3.18) valence pictures were significantly lower in patients with P1 than those in healthy controls(positive (14.05±2.19) and neutral (14.75± 1.80)) (P＜0.05).There was no significant difference in negative stimulus between PI group(13.93±1.76) and HC group(14.70±1.59) (P＞0.05).Conclusion The results suggest thant emotional memory is impaired in patients with PI.Moreover,the emotional memory for positive and neutral vanlence pictures is impaired but the emotional memory for negative is relatively spared in patients with primary insomnia.The results also indicate that impaired emotional memory with different valences may relate with distinct neuromechanisms.

Objective To investigate the relationship between obstructive sleep apnea-hypopnea syndrome(OSAHS)and plasma homocysteine(Hcy)levels in patients with ischemie cerebrovascular disease(ICVD).Methods Seventy-six patients with ICVD were monitored with polysomnography(PSG) for 7-8 hours during sleeping.The levels of fibrinogen(FBG),high density lipoprotein cholesterol(HDLC),low-density lipoprotein cholesterol(LDL-C),triglyceride(TG)and plasma Hey were assessed.Results Of the 76 ICVD patients,57 showed apnea symptom during sleeping,of which 53(69.7%)were diagnosed with OSAHS and 4 with central sleep apnea,According to the mean apnea-hypopnea index (AHI),the severity of apnea was classified as no apnea symptom(19 cases with mean AHI of 2.38±0.96 and Hey level of(8.78 ±2.01)μmol/L),mild apnea(21 cages with mean AHI of 14.14 ±4.37 and Hcy level of(12.91 ±3.00)μmol/L),moderate apnea(24 cases with mean AHI of 29.62±5.81 and Hcy level of(14.85 ±4.15)μmol/L)and severe apnea(8 cases with mean AHI of 46.75±2.82 and Hcy level of(19.30±4.82)μmol/L).The level of Hcy was statistical significant among these 4 groups(F=40.32,P<0.01)and correlated with the mean AHI(r=0.598,P<0.01).Conclusion Patients with ICVD have a high morbidity of OSAHS,mainly suffering from mild to moderate apnea;The plasma Hcy level elevates in the ICVD patients with OSAHS and is correlated with the severity of apnea.

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 evaluate whether MRI fluid attenuated inversion recovery (FLAIR)vascular hyperintensity (FVH) is an effective indicator for severe vascular stenosis or occlusion and disease severities in patients with acute anterior circulation infarction.Methods Three hundred and forty consecutive patients with acute anterior circulation infarction,admitted to our hospital from May 2013 to May 2014,were enrolled as subjects.All subjects were completed brain MR diffusion-weighted imaging (DWI),FLAIR and neck vascular or brain magnetic resonance angiography (MRA).According to the extent of FVH,all subjects were classified into negative FVH and positive FVH groups.Clinical data were obtained and compared among patients with different grades of FVH,and receiver operating characteristic (ROC) curve was used to calculate the sensitivity and specificity of FVH diagnosis of vascular severe stenosis or occlusion.The value of FVH in evaluating the disease severities of patients with large artery atherosclerosis combined with acute cerebral infarction according to new TOAST classification was evaluated.Results FVH was observed in 109 (32.06％) of the 340 patients.Significant differences were noted in the new TOAST classification ratio and vascular stenosis grading between the two groups; in the positive FVH group,the largest ratio was patients with large-artery atherosclerosis (82.6％),while that was patients with small vessel diseases (56.3％); the ratio of patients with severe vascular stenosis and occlusion in positive FVH patients was significantly higher than that in negative FVH patients (34.9％ vs.5.6％,39.5％ vs.0.9％).Spearman rank correlation analysis indicated that the degrees of vascular stenosis of carotid artery-middle cerebral artery were positively correlated to FVH (r=0.599,P=0.000).As compared with the negative FVH group,FVH patients had larger infarct volume and higher initial NIHSS scores (P＜0.05).ROC curve indicated that FVH had a sensitivity of 84.38％ and a specificity of 88.52％ in detecting artery stenosis (area under the curve [AUC]=0.892,95％ CI=0.85-0.94,P＜0.05),and a sensitivity of 88.89％ and a specificity of 85.76％ in detecting the vessel occlusion (AUC=0.929,95％CI:0.89-0.97,P＜0.05).In patients with acute cerebral infarction combined with artery atherosclerosis,patients with high FVH scores showed smaller infarct volumes and slighter neurological symptoms as compared with those with low FVH (P＜0.05).Conclusions FVH predicts vascular severe stenosis or occlusion with high sensitivity and specificity.In severe vascular stenosis or occlusion group,higher FVH scores are associated with lighter strokes.

Objective To investigate the correlations of distribution and grading of deep medullary veins (DMVs) with clinical prognoses of patients with acute anterior circulation infarction by using susceptibility-weighted imaging (SWI).Methods Fifty patients with acute anterior circulation infarction,admitted to our hospital from August 2016 to December 2017,were enrolled in our study.SWI was performed to evaluate the DMVs.Univariate and multivariate Logistic regression models were used to determine the correlation between distribution of DMVs and clinical prognoses of patients.DMVs on the ipsilateral side of the lesions were further graded and analyzed;boxplot was used to describe its relation with modified Rankin scale (mRS) scores of the patients.Results DMVs were observed in 36 patients (72％),with 19 ipsilateral DMVs and 17 contralateral DMVs.The ipsilateral DMVs were independently associated with poor outcome (odds ratio=3.380,95％CI:1.006-11.393,P=0.049).The contralateral DMVs were not independent predictors for outcomes,but appeared commonly in patients with good outcome (44.8％).In patients with ipsilateral DMVs,grading 1,grading 2,and grading 3 were noted in 7,two and three patients,respectively;boxplot analysis showed that DMVs patients of grading 3 had higher mRS scores,with an average of 4.Conclusion The ipsilateral DMVs on SWI are independent predictive biomarkers for poor clinical outcome after stroke,and contralateral DMVs often indicate good prognosis.