Objective To investigate the clinical and radiological features of patients with different phenotypes of multiple system atrophy （MSA）. Methods A total of 400 patients with MSA who attended the outpatient service or were hospitalized in Department of Neurology，Chinese PLA General Hospital，were enrolled，among whom there were 294 patients with MSA-cerebellar type （MSA-C） and 106 patients with MSA-Parkinsonian type （MSA-P）. The t-test and the chi-square test were used to analyze the clinical manifestations，radiological features，and blood biochemical indicators of the two groups. Results As for clinical manifestations，there were significant differences in cerebellar symptoms，constipation，and Babinski sign between MSA-C patients and MSA-P patients （P<0.05）. As for radiological features，positron emission tomography/computed tomography （PET/CT） showed that MSA-P patients had a typical reduction in DAT uptake in the putamen and the caudate nucleus，while magnetic resonance imaging showed that compared with the MSA-C group，the MSA-P group had a significantly higher proportion of patients with putamen fissure sign or white matter demyelination； for MSA-C patients，PET/CT showed cerebellar hypometabolism，and magnetic resonance imaging showed the cross sign and high signal intensity in the pontine arm，as well as a significantly higher proportion of patients cerebellar and pontine atrophy than MSA-P patients （P<0.05）. As for laboratory markers，MSA-P patients had a significantly lower level of uric acid than MSA-C patients （P=0.029）. Conclusion Patients with different subtypes of MSA have specific clinical features，radiological features，and uric acid level，which has a certain significance in the accurate diagnosis of MSA.

Objective:To investigate the impact of group-based rehabilitation exercise on motor and non-movement symptoms of Parkinson's disease(PD).Methods:A total of 88 patients from out-patient and in-patient services at our hospital were randomly assigned to an early exercise group(E-EG), a late exercise group(L-EG), and a control group(CG)using a randomized delayed-start design.Patients in the E-EG carried out a rigorous, formal group exercise program, one hour per session, twice per week, for 18 months(May 2018-November 2019). Patients in the L-EG took part in the exercise program in the final 6-12 months of the study.We assessed outcomes using the Unified Parkinson's Disease Rating Scale(UPDRS), Parkinson's disease questionnaire-39(PDQ-39 Q), trail-making test part A & B, nine-hole peg test(9-HPT), 30 second sit to stand test(30s SST), 10 m walk test(10 m W), mini-balance evaluation systems test(Mini-BEST), Fullerton Advanced Balance(FAB)Scale and time up and go(TUG)test.Results:Compared with pre-exercise levels, patients with PD in the E-EG had lower performance in UPDRS(17.5±8.3 vs.20.0±8.6, t=-2.2, P=0.02)and lower performance in PDQ-39(27.2±2.1 vs.29.0±9.8, t=-2.6, P=0.001)after exercise.Moreover, compared with pre-exercise levels, patients with PD in the E-EG showed decreased post-exercise performance in trail-making test part B(114.2±25.5 vs.129.8±28.4, t=-2.3, P=0.02)and in 9-HPT(33.7±7.3 vs.39.6±9.3, t=-2.6, P=0.001). Conclusions:The practice of group-based rehabilitation exercise can improve movement abilities and quality of life in PD patients, especially if implemented early.Targeted rehabilitation exercise should be taken as part of the treatment strategy for PD patients as early as possible to deliver the best benefits.

Purpose: Transcutaneous electrical neural stimulation (TENS), as a non-invasive modality, has been clinically used as an alternative treatment for children with overactive bladder (OAB). We conducted a pooled analysis to explore the effect of TENS on OAB. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis guideline was followed in this study. The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases, as well as the reference lists of the retrieved studies, were used to find trials relevant for assessing the use of TENS to treat OAB. Results: Of the 246 records identified, 8 publications were analyzed in our study. Our analysis found that TENS resulted in a greater decrease of wet days/wk, daily voiding frequency, daily incontinence episodes, and daily number of voids than was observed in the control group. Furthermore, TENS-treated patients showed similar visual analogue scale (VAS) scores to patients in the control group, demonstrating that the application of TENS did not increase patients’ discomfort and pain. TENS had a relative advantage in the number of partial responses, but no clear differences were found in frequency of no response or a full response compared to the control group. In urodynamic testing, TENS led to obvious improvements in average voided volume and maximum voided volume in children with OAB. Conclusions TENS had a remarkable effect on the improvement of urodynamic indexes and objective OAB symptoms without a significant increase in VAS scores for children with OAB.

Parkinson's disease is characterized by progressive motor dysfunction owing to degeneration of dopaminergic neurons in the substantia nigra and other nuclei.Recently,the bilateral high frequency stimulation of the subthalamic nucleus deep brain stimula tion (STN-DBS) as the treatment of PD was famous with good curative effect.But postoperative apathy as its side-effect impact on the therapeutic effect and the quality of life of patients seriously,which drawn the attention of clinicians.In this article,we summarized the incidence,manifestation and treatment of postoperative apathy and tried to provide some ideas for clinicians.

OBJECTIVETo investigate the risk factors for post-stroke pneumonia and assess the value of A(2)DS(2) score in predicting post-stroke pneumonia in elderly stroke patients.

METHODSThe clinical data were retrospectively collected from elderly stroke patients from January, 2007 to December, 2012. A(2)DS(2) score was then assigned using the clinical information from the medical record. The ability of the score to discriminate between patients with post-stroke pneumonia and those without was quantified using ROC analysis. The calibration of the score was analyzed using Hosmer-Lemeshow goodness-of-fit test.

RESULTSA total of 131 elderly male stroke patients were enrolled in this study, among whom the incidence of post-stroke pneumonia was 29.01%. The independent risk factors for post-stroke pneumonia identified included moderate (P=0.0081, OR: 5.6089; 95%CI: 1.5663-20.0854) and severe (P=0.0048, OR: 44.4827; 95%CI: 3.1847-621.3126) neurological impairment, dysphagia (P=0.0005, OR: 7.5265; 95%CI: 2.4282-23.3292), and atrial fibrillation (P=0.0226, OR: 4.1778; 95%CI: 1.2221-14.2825). The incidence of post-stroke pneumonia ranged from 2.2% in patients with a A(2)DS(2) score less than 3 to 75% in those with a score higher than 8. The C-statistic of A(2)DS(2) score for predicting post-stroke pneumonia was 0.86 (95%CI: 0.784-0.911) by the ROC analysis. The A(2)DS(2) score was well calibrated to predict post-stroke pneumonia in elderly patients by Hosmer-Lemeshow test (7.083, P=0.528).

CONCLUSIONThe A(2)DS(2) score can be useful for predicting post-stroke pneumonia and for routine monitoring of high-risk elderly stroke patients in the clinical setting.

Aged ; Aged, 80 and over ; Atrial Fibrillation ; complications ; China ; Deglutition Disorders ; complications ; Humans ; Incidence ; Male ; Pneumonia ; epidemiology ; etiology ; prevention & control ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Stroke ; complications

Objective To investigate the risk factors for post-stroke pneumonia and assess the value of A2DS2 score in predicting post-stroke pneumonia in elderly stroke patients. Methods The clinical data were retrospectively collected from elderly stroke patients from January, 2007 to December, 2012. A2DS2 score was then assigned using the clinical information from the medical record. The ability of the score to discriminate between patients with post-stroke pneumonia and those without was quantified using ROC analysis. The calibration of the score was analyzed using Hosmer-Lemeshow goodness-of-fit test. Results A total of 131 elderly male stroke patients were enrolled in this study, among whom the incidence of post-stroke pneumonia was 29.01%. The independent risk factors for post-stroke pneumonia identified included moderate (P=0.0081, OR: 5.6089; 95%CI: 1.5663-20.0854) and severe (P=0.0048, OR:44.4827;95%CI:3.1847-621.3126) neurological impairment, dysphagia (P=0.0005, OR:7.5265;95%CI: 2.4282-23.3292), and atrial fibrillation (P=0.0226, OR: 4.1778; 95%CI: 1.2221-14.2825). The incidence of post-stroke pneumonia ranged from 2.2% in patients with a A2DS2 score less than 3 to 75% in those with a score higher than 8. The C-statistic of A2DS2 score for predicting post-stroke pneumonia was 0.86 (95%CI: 0.784-0.911) by the ROC analysis. The A2DS2 score was well calibrated to predict post-stroke pneumonia in elderly patients by Hosmer-Lemeshow test (7.083, P=0.528). Conclusion The A2DS2 score can be useful for predicting post-stroke pneumonia and for routine monitoring of high-risk elderly stroke patients in the clinical setting.

Objective To investigate the risk factors for post-stroke pneumonia and assess the value of A2DS2 score in predicting post-stroke pneumonia in elderly stroke patients. Methods The clinical data were retrospectively collected from elderly stroke patients from January, 2007 to December, 2012. A2DS2 score was then assigned using the clinical information from the medical record. The ability of the score to discriminate between patients with post-stroke pneumonia and those without was quantified using ROC analysis. The calibration of the score was analyzed using Hosmer-Lemeshow goodness-of-fit test. Results A total of 131 elderly male stroke patients were enrolled in this study, among whom the incidence of post-stroke pneumonia was 29.01%. The independent risk factors for post-stroke pneumonia identified included moderate (P=0.0081, OR: 5.6089; 95%CI: 1.5663-20.0854) and severe (P=0.0048, OR:44.4827;95%CI:3.1847-621.3126) neurological impairment, dysphagia (P=0.0005, OR:7.5265;95%CI: 2.4282-23.3292), and atrial fibrillation (P=0.0226, OR: 4.1778; 95%CI: 1.2221-14.2825). The incidence of post-stroke pneumonia ranged from 2.2% in patients with a A2DS2 score less than 3 to 75% in those with a score higher than 8. The C-statistic of A2DS2 score for predicting post-stroke pneumonia was 0.86 (95%CI: 0.784-0.911) by the ROC analysis. The A2DS2 score was well calibrated to predict post-stroke pneumonia in elderly patients by Hosmer-Lemeshow test (7.083, P=0.528). Conclusion The A2DS2 score can be useful for predicting post-stroke pneumonia and for routine monitoring of high-risk elderly stroke patients in the clinical setting.

Objective To study whether prostaglandin E1 (LipoPGE1) could prevent contrast medium-induced nephropathy (CIN) in patients with coronary heart disease (CHD) plus diabetes mellitus type 2 (DM).Methods Total 198 CHD patients with DM received coronary angiography (CAG) or PCI were randomly divided into PGE1 group and control group.All patients received routine treatment,and the PGE1 group also received 20 ml normal saline and 20 μg PGE1 (intravenous injection,1 time/d) for 10 days.The rate of CIN and the level of serum urea nitrogen (BUN),creatinine (Scr),cystatin C (Cys C) were measured before and 48 hours and 5 days after contrastmedium administration.Results The level of Scr,BUN and Cys C were lower in PGE1 group [(113.92±54.89)μmmol/ L,(7.85±4.05)mmol/L,(1.38±0.34)mg/L]for 48 hours and[(86.72±35.26)μmmol/L,(6.61 ± 3.09 ) mmol/L,( 1.29 ± 0.29) mg/L]for 5 days than in control group [(129.22±50.18)μmmol/L,(9.26±3.95)mmol/L,(1.56±0.23)mg/L]for 48 hours and[(109.83+31.76)μmmol/ L,(8.07±3.11)mmol/L,(1.37±0.21)mg/L]for 5 days (all P＜0.05).The dose of contrast-medium was positively correlated with the level of Scr and BUN (r=0.74,P＜0.05 and r =0.82,P＜0.01,respectively).The patients' renal function in the PGE1 group was better than in control group after contrast-medium administration (P ＜0.05).BUN and Scr were positively correlated with the volume of contrast-medium (r=0.74,P＜0.05,r=0.82,P＜0.01).Conclusions PGE1 may prevent contrast medium-induced nephropathy in patients with CHD combined with DM.

Objective To investigate the effects of intratumoral implantation of ~(32)P-CP-PLLA seeds on the normal canine liver tissue and to exolore the metabolism of ~(32)P-CP-PLLA seeds implanted in the liver of experimental dogs.Methods Twelve beagles were enrolled in this study.The dogs were randomly and equally divided into four groups:group A(185 MBq),group B(370 MBq),group C(740 MBq)and group D(0 MBq).By using laparotomy procedure ~(32)P-CP-PLLA seeds were implanted into dog's liver.CT scan was performed before operation as well as before the dog was sacrificed.All dogs were sacrificed three months after the implantation.Before the procedure and 1,2,4,8 and 12 weeks after the procedure the blood tests and serum biochemical tests were conducted.One dog from group B and group C was selected respectively and was fed in a metabolic cage.Within one month after the procedure the cpm in feces and in urine was determined every 24 hours.One dog was picked out from each of the three groups and was punctured to get its liver tissue for pathologic exam each time at 1,2,4,8 and 12 weeks after the implantation,and SPECT imaging was also performed at the same time.Pathologic study,both macroscopic and microscopic(including optical and electronic microscopy)was made to observe the liver damage after the dog was sacrificed.The statistical analysis was processed by using SPSS 13.0 software and the measuring data were expressed with mean±standard deviation((x)±s).Results Two months after the procedure,serological examination found that the serum alkaline phosphatase(BKP)in both group Band group C was significantly higher than that in other groups,the difference was statistically significant (P ＜0.05),and the BKP levels returned to normal in three months.The postoperative 30-day inspection of the urine showed that the radioactive particles slowly released into the body and eliminated from the body with the urine and feces,mainly through the renal excretion.The 30-day cumulative percentage of eliminated radioactive dose in the urine and in the feces was 6.34% and 11.64% respectively.No sign of particle displacement was found on SPECT imaging.On autopsy three months after the implantation,the size of the radioactive seeds became smaller and fragile.With the radioactive dose used increasing,the area of liver damage at the site of seed implantation became bigger,which was demonstrated on CT scan,macroscopic exam and pathologic study.The local damaged focus of the liver caused by ~(32)P-CP-PLLA seeds was manifested as a spherical lesion which was encysted by a layer of fibrous tissue with an edematous zone peripherally.Conclusion The implantation of ~(32)P-CP-PLLA seeds in dog's liver causes only localized hepatic damage with no general adverse effects.The implanted seeds can slowly release the radioactive dose and will not immigrate to other organs in the body.Besides,the seeds possess excellent stability,targeted orientation and safety.

Objective To investigate the effect of manganese-enhanced MRI (MEMRI) at 7.0T for tracing nerve tracts in rat brain in vivo. Methods With brain stereotactic apparatus, 0.4 μl Mncl_2 with aqueous solution of 1 mol/L was injected into the right somatosensory cortex of 9 SD rats. MR scan was performed for tracing corticospinal tracts and other coherent nerve tracts pre-, and 24, 48, 72 h, 7 days post-injection with 7.0T micro-MRI system, respectively. Results Corticospinal tracts were showed in intact after Mn~(2+) administration from somatosensory cortex, thalamus, cerebral peduncle to pons at the time point of 24, 48, 72 h and 7 days, while the best tdisplaying was achieved at 24-48 h after Mn~(2+) administration. Simultaneously a small quantity of Mn~(2+) reached the opposite somatosensory cortex through the corpus callosum. Conclusion MEMRI for tracing rat nerve tracts can be showed clearly with 7.0T MRI. The location of manganese-enhanced corticospinal tracts in agreement with the rat brain atlas in stereotaxic is in agreement with that Paxinos' published. MEMRI can display the relationship between the two sides of hemisphere, and may play an important role in investigating the brain function and nerve plasticity after nerve injury in vivo.