BACKGROUND: It is believed that repetitive transcranial magnetic stimulation (rTMS) may produce such neurophysiological effects as regulating regional cerebral blood flow, neurotransmitters, local metabolism, and neuronal remodeling after nerve tissue injuries. The prognosis ofischemic stroke is related with the cortical function reconstruction in the ipsilateral and contralateral hemisphere of the lesion. Currently studies have not defined whether rTMS can affect the cortical function, protect ischemic neurons and promote motor functional recovery after cerebral ischemia.OBJECTIVE: To investigate the effects of rTMS on rat motor cortical excitability and neural function in acute stage of cerebral ischemia-reperfusion injury.DESIGN: Completely randomized experiment.SETTING: Electroneurophysiological Laboratory of Peking Union Medical College Hospital.MATERIALS: The experiment was completed in the Zoological Research Center of Peking Union Hospital from January to June 2004. Totally 22adult male healthy Wistar rats were randomly divided into treatment group and the control group with 11 in each.METHODS: After determination of the average motor threshold of the right hind limbs, which was 22% of the maximum output, the rats were subjected to middle cerebral artery occlusion for 1 hour followed by reperfusion for 72 hours. At each time point of immediately and at 12, 36 and 60 hours after the initiation of reperfusion, the rats in the treatment group received rTMS treatment (20 Hz, 40% maximum output, 5 seconds for each session with an between-session interval of 2 minutes for a total of 10 sessions), and the site for motor threshold evaluation was used for rTMS stimulation; the rats in the control group recevied no treatment after model establishment. Motor threshold testing was performed in both groups 4 hours after the last session of treatment to avoid immediate-early effects of rTMS on the motor threshold. At 24 and 72 hours of reperfusion, the scores of neural function were recorded according to evaluation systems. All the rats with scores between 1 and 3 were enrolled in statistical analysis were evaluated between.MAIN OUTCOME MEASURES: ① Motor threshold of the rats in both groups before and after injury; ② Neural function scores at 24 and 72 hour reperfusion; ③ Infarct volume at 72 hour of reperfusion.RESULTS: Totally 13 rats entered the final result analysis. Before injury,motor threshold in the treatment and control group was similar (P=0.71),and after the injury, the motor threshold of the control group was 1.49times that of the treatment group but such difference was not statistically significant [(41.62±24.73)% vs (28.00±9.35)%, t=-1.17, P=0.27]. At 24hours of reperfusion, the functional scores of the treatment group and control group were not significantly different (P=0.46), but at 72 hours, the scores of the treatment group were significantly lower than that of the control group (1.60±1.52 vs 7.75±3.62, t=-3.57, P=0.004). The average infarct volume of two groups was (62.00±60.88) mm3 and (20.00±12.41) mm3 at 72 hours of reperfusion, respectively, which, after logarithm transformation,was not significantly different between the two group (t=-1.31, P=0.22),but when the infarct volume was transformed into Log10 values, a significant difference occurred between them (P=0.045).CONCLUSION: rTMS may stabilize and prevent the increment of the motor threshold, time-dependently relieve the neural function disability and reduce the infarct volume after cerebral ischemia-reperfusion injury.

Objective To study the correlation of mitochondrial DNA mutation of spermatozoa and change of mitochondria-ultrastructure with male infertility. Methods The techniques of PCR and DNA sequence analysis were used to detect MTCYB and MTATP-6 fragments of 76 samples of semen with poor motility from infertile male.Of these samples five were identified with mitochondrial DNA deletion and transmission electron microscopic observations were made. Results Under the electron microscopic observations the 5 samples were all seen with abnormal volume of mitochondria in most spermatozoa tails either small or big, disorderly located and asymmetrically distributed;the axonemal structures of sperm wrapped in layers of mitochondria. These samples of sperm were noticeably different in form from those from fertile male. Conclusion Sperm mitochondria-ultrastructure change were observed in samples of sperm mitochondrial DNA mutation.Sperm mitochondrial mutation and its mitochondria-ultrastructure affect the energy supply of sperms during the process of fertilization which may result in male infertility.;

Objective To observe the level of serum hepatocyte growth factor (HGF) in patients with impaired glucose tolerance (IGT). Methods Thirty patients with IGT (IGT group), 30 patients with type 2 diabetes mellitns (T2DM) (T2DM group) and 30 healthy controls (control group) were recruited for this study. Such indexes as HGF, fasting plasma glucose (FBG), postprandial plasma glucose (2hPG), glycosylated hemoglobin A1c( GHbA1c ), fasting insulin(FINS), systolic blood pressure(SBP), diastolic blood pressure (DBP) were examined and these related factors were analyzed. Results The levels of serum HGF in IGT group and T2DM group were higher than those in control group [(413.22 ± 102.48), (422.76 ± 126.77 ), ( 120.45 ± 25.11 ) ng/L, respectively ] (P < 0.05 ). There was no significant different between IGT group and T2DM group (P> 0.05). There was positive correlation between HGF and FBG (r = 0.326, P< 0.05 ). Multiple regression analysis indicated significant correlation between HGF and DBP (r = 4.730, P< 0.05). Conclusion Higher levels of HGF are found in IGT patients, which indicates that function of vascular endothelium is abnormal in this period.

Objective To explore the clinical features of nervous system involvement of acquired immunodeficiency syndrome (AIDS).Methods A retrospective clinical analysis of 15 admitted AIDS patients with neurological involvement in our hospital from February 2002 to February 2008.Eight of them visited department of neurology for the first time.Results There were 4 cases of human immunodeficiency virus (HIV) encephalopathy, 1 of them appearanced as general chorea, 1 HIV-associated encephalopathy accompanied with myopathy; 1 progressive multifocal leukoeneephalopathy (PML); 1 PML accompanied with toxoplasmosis; 1 HlV-associated myopathy; 1 multicranial nerve injury companied with myelopathy; 1 peripheral neuropathy; 1 drug-associated neuromuscular disease; 4 meningoencephalitis and 1 brain abscess cases.Conclusion The manifestations and AIDS neurological involvement are varied.A close attention should be paid to screening.

Objective To observe the two different wetting fluid in airway humidification of patients with mechanical ventilation.Methods 40 patients with mechanical ventilation after cardiac surgery in our hospital from January to April,2009,were divided randomly into group A and group B,group A was given 0.45% sodium chloride solution 100ml plus ambroxol 15mg as airway humidification fluid,group B was given sterile water for injection100 ml plus ambroxol 15mg as airway humidification liquid.The amount of sputum aspiration,color,viscosity,the body temperature of patients,the lungs auscultation and chest X-ray were observed.Results No statistical difference was seen in sputum volume,color,viscosity,the body temperature of patients,lungs auscultation as well as chest X ray after mechanical ventilation for 4 hours,8 hours,16 hours,24 hours,1～2 d,3～5 d,6～7 d.No statistical difference was also seen in auscultation of the lung after mechanical ventilation for 4 hours,16 hours,24 hours,1～2 d,3～5 d,6～7 d.But auscultation of the lung in group B was better than that of group A after mechanical ventilation for 8 hours.Conclusions No sufficient fact can prove that different effect exists between 100 ml 0.45% sodium chloride solution plus ambroxol 15mg and 100 ml sterile water for injection plus ambroxol 15mg as airway humidification fluid during mechanical ventilation.

Objective To investigate the changes of cardiac function at pre -and post -treatment in preterm infants with patent ductus arteriosus (PDA)in order to guide drug treatment.Methods Totally 84 preterm infants with PDA admitted to Neonatal Intensive Care Unit of Xuzhou Hospital Affiliated to Medical College of Southeast University from July 201 2 to June 201 4 were divided into 4 groups according to treatment drug:Ibuprofen group (27 cases),Indo-methacin group (24 cases),control group (1 1 cases),and Paracetamol group (22 cases).Patients were also divided into symptomatic PDA group (38 cases)and asymptomatic PDA group (46 cases)according to severity;PDA closed group (69 cases)and PDA unclosed group (1 5 cases)according to sequel.The level of plasma brain natriuretic pep-tide (BNP),cardiac troponin I (cTnI),correct QT intervals dispersion (QTcd)were monitored pre -and post -treat-ment.Data were analyzed by using SPSS 1 9.0 software.Results Three cardiac markers at post -treatment were of no significant difference among 4 treatment drugs.The changes of the cTnI and QTcd at pre -and post -treatment were of no significance.The level of BNP in symptomatic PDA group was significantly higher than that in asymptomatic PDA group at pre -treatment [(378 ±94)ng/L vs (1 47 ±75)ng/L,t =2.584,P =0.01 4].In the symptomatic PDA group,the level of BNP at post -treatment [(1 82 ±81 )ng/L]was significantly decreased than that at per -treatment (t =2.741 ,P =0.009).In the asymptomatic PDA group,there was no significant difference between the pre - and post -treatment [(1 21 ±61 )ng/L]in the level of BNP (t =1 .254,P =0.207).There was no significant difference in the level of BNP at per -treatment between PDA closed group and PDA unclosed group [(274 ±91 )ng/L vs (289 ± 87)ng/L,t =-0.874,P =0.391 ].In PDA closed group,the level of BNP at post -treatment [(1 21 ±74)ng/L] was significantly decreased compared with that at per -treatment (t =3.580,P =0.000).In PDA unclosed group, there was no significant difference between the pre - and post -treatment [(245 ±74)ng/L]in the level of BNP (t =0.854,P =0.392).Conclusion Early medication intervention for symptomatic PDA of preterm infants is benefi-cial for the closure of PDA and for attenuating negative effects on cardiac function of PDA.

Objective To investigate the repeatability of precise radiotherapy placement of self-made adjustable angle wedge plate,negative pressure vacuum pad and conmon soft pillow,corresponding to 3 groups.The study is demonstrated with a thermoplastic membrane immobilization technology in kyphotic deformity patients with head and neck cancer (including primary and secondary),respectively.Methods From Jun 2014 to Apr 2016,48 cases of severe head and neck cancer patients received radiotherapy humpback who were randomly divided into 3 groups.Combined with thermoplastic head and neck shoulder film position fixation,the right foot direction at the end of the skull styloid process layer center was set as a reference point.On the left foot at the end of the direction of styloid process layer center,localization of the origin of the coordinate system in patients around the head and foot,dorsoventrally (x,y,z) analysis of the direction change of position measurement was performed.Results There was no significant difference between the adjustable angle wedge plate and negative pressure vacuum pad groups of the coordinate system (P ＞ 0.05).Compared with common soft pillow group,three dimensional positioning errors and three dimensional coordinate system transfer errors of the adjustable angle wedge plate and negative pressure vacuum pad groups were statistically significantly different (t =-6.99 to-2.69,-5.13 to-2.71,P＜0.05).Conclusions The self-made adjustable angle wedge plate has good repeatability,saves time and money,is simple and durable on precise radiotherapy positioning of kyphotic deformity patients with head and neck cancer.

The comparative analysis of the biological characterization and the genetic background study of EV71 circulating strains is commonly recognized as basic work necessary for development of an effective EV71 vaccine. In this study, we sequenced five EV71 circulating strains, isolated from Fuyang, Hefei, Kunming and Shenzhen city of China and named them FY-23, FY-22, H44, K9 and S1 respectively. The sequence alignment demonstrated their genotypes be C4. The genetic distance of the VP1 gene from these isolates suggested that they were highly co-related with genetic identity similar to other previously reported EV71 strains in China. Additionally, these strains were identified to display some obvious proliferation dynamics and plaque morphology when propagated in Vero cells. However, a distinctive difference in pathogenic ability in neonatal mice was found. Some differences in cross neutralization test & immunogenic analysis were also found. All these results are related to the biological characterization of circulating EV71 strains in China and aid in the development of an EV71 vaccine in the future.

Objective To investigate the incidence rate, onset time and electrophysiological characteristics of rapid eye movement sleep behavior disorder (RBD) and the relationship between RBD and synucleinopathies as well as the electrophysiological diagnostic criteria of RBD in Parkinson' s disease (PD) and multiple system atrophy (MSA). Methods Sleep survey and night video-polysomnography (NPSG)were used to study sleep disturbance of PD and MSA. (1) Subjective sleep assessments: All subjects,including 66 PD patients, 65 age and sex matched healthy controls and 30 MSA patients, completed the sleep questionnaires, and the RBD incidence rate and onset time were got. (2) Objective sleep assessments: 8 PD patients, 13 MSA patients, and 15 age and sex matched healthy controls underwent video-NPSG recording on two consecutive nights. Sleep architect were analyzed. The NPSG characteristics of RBD accompany with PD and MSA were analyzed, and the electrophysiological diagnostic varameters of it were determined. Results Patients with PD or MSA had a higher prevalence of RBD. RBD was found in 59. 1% (39/66) PD patients and 86. 6% (26/30) MSA patients, among those, 46. 2% ( 18/39 ) and 84.6% (22/26) had the waking symptoms of MSA and PD. The main NPSG characteristics of RBD of PD or MSA were chin REM without atonia (RWA) and increased movement. Conclusions The relatively higher RBD prevalence in MSA and PD patients indicates that RBD has close relationship with PD and MSA.Part of patients with RBD preceding neurology disease indicates that RBD may be the early marker of PD and MSA. The main NPSG characteristics of RBD accompany with PD and MSA are chin RWA and the motor manifestations. RWA and phasic EMG activity density are supposed to be the NPSG diagnostic parameters.

Objective To describe the clinical spectrum,especially sleep disorder in three patients diagnosed with Morvan syndrome.Methods Three consecutive patients were identified with Morvan syndrome in the Department of Neurology, Peking Union Medical College Hospital between December 2014 and March 2016.The character in three cases has been studied from several aspects such as clinical presentation, imaging, polysomnography (PSG), cerebrospinal fluid and serum.Results Serum test showed serum contactin-associated protein 2 (CASPR2)antibodies strongly positive (+++) and leucine-rich glioma inactivated protein 1 antibodies positive (+) in three patients.Neuropsychiatric features, neuromyotonia, neuropathic pain, dysautonomia, agrypnia excitata presented in all three patients.The agrypnia excitata was characterized by severe insomnia, excessive motor activity during the night.Agrypnia excitata was diagnosed in three patients according to their history.PSG was finished in case 2 and case 3.PSG in one patient (case 2) documented severe insomnia (sleep efficiency was 59%), lack of cyclic sleep organization with a predominance of stage 1 non-rapid eye movement sleep episodes intermixed with brief rapid eye movement, and a marked reduction of spindles and delta sleep;PSG in another patient (case 3) revealed complete absence of recognizable sleep.Sleep disorders and other symptoms resolved completely or almost completely in two patients (case 1,case 2) who received immunotherapy.Case 3 died from sudden cardiac death before immunotherapy.Conclusions Morvan syndrome usually is associated with high-titer CASPR2 antibodies in serum.Agrypnia excitata is cardinal manifestation of Morvan syndrome in association with a spectrum of neurologic presentations.Early immunotherapy could provide a favorable outcome.