Objective To investigate the correlation between serum retinol-binding protein 4 (RBP4) level and stroke severity and short-term outcome in patients with acute ischemic stroke.Methods From January 2017 to December 2017,patients with acute ischemic stroke admitted to the Department of Neurobgy,the Third Affiliated Hospital of Anhui Medical University and who did not receive thrombolytic or endovascular treatment were enrolled retrospectively within 2 weeks of onset.The serum RBP4 levels were measured within 24 h of admission and the demographics and baseline clinical data of the patients were documented.On the day of admission,the National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of neurological deficit;≤8 was defined as mild stroke and ＞8 was defined as moderate to severe stroke.The modified Rankin scale was used to assess the short-term outcomes at the time of discharge or 14 days after onset;0 to 2 were defined as good outcomes,and ＞ 2 was defined as poor outcome.Results A total of 235 patients were enrolled,including 101 females (43％) and 134 males (57％);aged (66.8 ± 1.7) years (range 28-93 years).There were 200 mild strokes (85.1％) and 35 moderate to severe strokes (14.9％);171 (72.8％) had good outcomes and 64 (27.2％) had poor outcomes.Univariate analysis showed that the serum RBP4 level in the moderate to severe stroke group was significantly lower than that in the mild stroke group (29.28 ± 10.43 mg/L vs.36.88 ± 10.61 mg/L;t =3.920,P ＜ 0.001),and the RBP4 level in the poor outcome group was significantly lower than that in the good outcome group (32.03 ± 11.33 mg/L vs.37.14± 10.44 mg/L;t=3.264,P=0.001).Multivariate logistic regression analysis showed that the high serum RBP4 level was independently correlated with the milder stroke severity (odds ratio 0.917,95％ confidence interval 0.874-0.962;P ＜0.001) and short-term poor outcome (odds ratio 0.955,95％ confidence interval 0.927-0.983;P =0.002).Conclusion In patients with high serum RBP4 levels,acute ischemic stroke is less severe and better in short-term outcomes.

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.

Objective To investigate the effect of insular on the addiction of nicotine after insular infarction. Methods Totally 35 patients with lesions involving insular infarction were enrolled in insular damage group. The patients matched with the demographic data of the study subjects who did not involve in-sular infarction were the control group(n=114). All patients were given the internationally popular question-naire of smoking urges ( QSU) and fagerstrom test for nicotine dependence( FTND) during hospitalization, and they were followed up 3 months after stroke. The QSU and the minnesota nicotine withdrawal scale ( MNWS) were assessment for patients who did not smoke again and did not relapse,and the QSU and FTND scale were used for the patients who still smoke. Results After 3 months follow-up,the rate of withdrawal from insular damage was 77. 14%,and that in non-insular damage was 52. 63%(χ2=6. 62,P=0. 01),and the MNWS in two groups(insular damage patients (0. 59±0. 97) and non-insular damage patients(1. 15± 1. 29)),the difference was statistically significant (t=-2. 00,P=0. 04). All subjects were evaluated by questionnaire of smoking urges (QSU),among which QSU score was (19. 40±9. 63) in insular damage group and (24. 47±10. 39) in non-insular group,the difference was statistically significant (t=-2. 57,P=0. 01) . Conclusion Patients with insular lesion are more likely to cause withdrawal of nicotine addiction, suggesting that insular may be involved in cognitive processing of addiction.

Objective To assess the cerebrovascular reserve (CVR)and the relationship of CVR with the short-term prognosis in patients with acute atherosclerotic cerebral infarction.Methods A total of 106 patients with unilateral acute (within 72 h) atherosclerotic cerebral infarction (trial group) were selected from December 2016 to December 2017 in the Department of Neurology of the First People's Hospital of Hefei,which were divided into two groups including the lesion group (106 cases) and the nonlesion group (106 cases).The median score of NIHSS in patients was 4(2,5).The control group included 40 healthy controls.The cerebral blood flow reserve and pulsatility index were measured by transcranial Doppler combined with CO2 inhalation test in both the trial group and the control group.According to the rate of change of cerebral blood flow velocity (CBFV),all subjects were divided into two groups including the normal group and the impaired cerebral blood flow reserve group.The changes of CBFV were compared in the control group and the trial group,which was divided into two groups including the group with lesion side and the group with non-lesion side.To evaluate the brain structure reserve the circle of Willis in the trial group was assessed by MRA.According to the integrity of the circle of Willis anterior and posterior circulation all subjects were divided into four groups (type Ⅰ,type Ⅱ,type Ⅲ and type Ⅳ).The effect of the factors,such as diabetes,hypertension,low density lipoprotein (LDL),high density lipoprotein (HDL),smoking,and drinking history,on cerebral blood flow reserve was measured by single-factor analysis.The correlation of NIHSS scores,infarct size and volume with CVR was also measured.All patients in the trial group were treated with drugs and were followed-up for three months.The modified Rankin Scale (Mrs) was used to evaluate the prognosis of the patients.It means poor prognosis if the value of Mrs was more than three.The effects of factors,such as sex,HDL,LDL,diabetes,hypertension,smoking history,drinking history,cerebral blood flow reserve,NIHSS scores,brain structure reserve,infarct location,age,on the prognosis were measured by multivariate Logistic regression.Results The increase rate of CBFV in the lesion-side of patients with atherosclerotic cerebral infarction was 5.94％ (2.18％,10.49％),and the increase rate of pulsatility index was 10.77％ (2.21％,22.62％),which were both lower than the control group (CBFV:11.54％ (5.01％,17.96％),Z =2.547,P＜0.05);pulsatility index:48.36％ (33.93％,64.51％),Z =6.604,P ＜ 0.01).There was significant difference (x2 =4.328,P ＜ 0.05) in the distribution of diabetes,which was 2/14 in the normal group and 43.48％ (40/92) in the impaired cerebral blood flow reserve group.And in the trial group the brain structural reserve was positively correlated to the infarct volume and the NIHSS score,and the rank correlation coefficient was 0.219 and 0.238 respectively (P ＜ 0.05).The prognosis of cerebral blood flow reserve in the normal group was better than the impaired group (x2 =4.155,P ＜ 0.05),for example,the proportion of patients with good prognosis and normal CBFV was 18.84％ (13/69),the proportion of patients with good prognosis but decreased CBFV was 81.16％ (56/69),the proportion of patients with poor prognosis but normal CBFV was 2.70％ (1/37),the proportion of patients with poor prognosis and decreased CBFV was 97.30％ (36/37).The proportion of patients with type Ⅰ and type Ⅲ of the brain structure reserve was 37.68％ (26/69) and 5.80％ (4/69) respectively,whose prognosis was better (x2 =8.456,P ＜ 0.05) than patients with type Ⅱ and type Ⅳ,whose proportion was 43.48％ (30/69) and 13.04％ (9/69).Multivariate Logistic regression analysis showed that NIHSS score,age,and brain structural reserve were risk factors for poor prognosis in the trial group.Normal cerebral blood flow reserve was a protective factor for good prognosis.Conclusions CVR in patients with acute atherosclerotic cerebral infarction is significantly reduced.CVR can be used as an index to evaluate the prognosis of patients who were followed-up for three months.

Objective To investigate the risk factors and MRA manifests in the patients with cortical wa-tershed infarcts(CWSI)or internal watershed infarcts(IWSI).Methods We collected the patients with acute wa-tershed infarcts in our hospital from January 2013 to April 2016.According to the Bogousslavsky classification stan-dard,the patients were divided into two groups:CWSI and IWSI. The two groups were compared in terms of risk factors and MRA manifests. Results We included 36 CWSI and 11 IWSI patients in the study.There were signifi-cant differences in smoke,diabetes mellitus,fasting blood glucose levels and carotid atherosclerotic plaque be-tween the two groups,and so it was with the stenosis of ICA,MCA,ACA,PCA,VA and BA:The stenosis of ICA in the CWSI group was more serious than in the IWSI group,but the stenosis of MCA,ACA,PCA,VA and BA in the IWSI group was more serious than in the CWSI group. Conclusions The pathogenesis of CWSI may be related to the formation of carotid atherosclerotic plaques,carotid stenosis and arterial artery embolism,or plaque shedding and micro emboli removal.The pathogenesis of IWSI may be related to the decrease of the perfusion pres-sure at the end of the intracranial artery.The ratio of IWSI to diabetes mellitus is higher than that of CWSI,suggest-ing that the damage of diabetes to intracranial arteriole is earlier than that of intracranial and extracranial arteries.

Objective To investigate the emotional memory changes in patients with thalamic infarction on different laterals and explore the impact of different emotional valence pictures on the thalamic infarction(TI) patients' memory.Methods 28 patients with thalamic infarction (TI group)and 28 patients who were hospitalized without TI during the same period (control group) were given emotional memory test,a test where they use their emotional memory to evaluate and recognize pictures with different emotional valence,including positive,neutral,and negative valence.Results (1) At the stage of evaluating emotional images,there were no significant difference between patients with TI and control group in positive evaluation (P＞0.05).Compared with control group (neutral(12.96±1.62),negative(13.57±1.37),respectively),neutral and negative recognition scores for emotional pictures of patients with TI (neutral (10.79±2.07),negative (10.96±2.05),respectively) were decreased significantly (positive t =-4.5 and negative t=-5.6,both P＜0.05).(2)At the stage of emotional images memorizing tests,TI group's total scores on re-accessing total emotional pictures were significantly lower than those in control group ((36.14 ± 3.24) vs(41.89 ± 3.43) respectively)) (t=-6.44,P＜0.05).Compared with control group (positive (14.04± 1.29),neutral (13.68±1.56)),patients with TI (positive (10.93± 1.96),neutral(11.25± 1.67)) were decreased significantly in the emotional pictures memorizing tests (t=-7.00,5.61,P＜0.05).But there were no difference in negative stimulus between the two groups (P＞0.05).(3)The score of emotional pictures recognition in patients with LTI (34.43 ± 3.48) were decreased significantly than that in patients with RTI (37.86± 1.83) (t =3.26,P＜ 0.05).The score in recognizing neutral valence images in patients with LTI(10.43± 1.55) were significantly decreased than those in RTI (12.07± 1.38) (t=2.95,P＜0.05).Conclusion Patients with TI may rely on different neural mechanisms to affect the different valence of the emotional memory loop process.The emotional memory impairment in patients with TI at different sides is different.The left thalamus has a greater influence on memory.

The atherosclerotic plaque and stenosis in the carotid artery are the important causes of ischemic stroke. Evaluation of cerebrovascular reserve capacity in patients with carotid stenosis is beneficial to screening high-risk stroke patients. This article reviews the evaluation methodology of cerebrovascular reserve and its application in patients with carotid stenosis.

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 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.