Combination of High-Density Lipoprotein Cholesterol and Lipoprotein(a) as a Predictor of Collateral Circulation in Patients With Severe Unilateral Internal Carotid Artery Stenosis or Occlusion

Background@#and Purpose Collateral circulation is considered an important factor affecting the risk of stroke, but the factors that affect collateral circulation remain unclear. This study was performed to identify the factors associated with collateral circulation, especially blood lipids. @*Methods@#The study involved patients who had undergone digital subtraction angiography and were confirmed as having severe unilateral stenosis or occlusion of the internal carotid artery (ICA). We classified the collateral circulation status of each patient as good (Grade 3 or 4) or poor (Grade 0, 1, or 2) according to the grading system of the American Society of Interventional and Therapeutic Neuroradiology/American Society of Interventional Radiology. We collected data on patients’ characteristics and identified the factors that affect collateral circulation. @*Results@#This study included 212 patients. The multivariate logistic regression analysis showed that the high-density lipoprotein cholesterol (HDL-C) concentration and a complete anterior half of the circle of Willis were independent protective factors for good collateral circulation, whereas elevated lipoprotein(a) [Lp(a)] and serum creatinine concentrations were independent risk factors for good collateral circulation. The area under the receiver operating characteristics curve (AUC) was 0.68 (95% confidence interval [CI], 0.61–0.76) for HDL-C and 0.69 (95% CI, 0.62–0.76) for Lp(a). A binary logistic regression model analysis of the joint factor of HDL-C and Lp(a) yielded an AUC of 0.77 (95% CI, 0.71–0.84). @*Conclusions@#In patients with severe unilateral ICA stenosis or occlusion, the combination of HDL-C and Lp(a) is a useful predictor of collateral circulation.

Progress in the diagnosis and treatment of rapid eye movement sleep behavior disorder / 中国临床药理学与治疗学

Rapid eye movement sleep behavior disorder (RBD) is characterized by dream enactment and rapid eye movement (REM) sleep without atonia. RBD is closely related to α-synucleinopathy disease, including Parkinson's disease (PD), Lewy body dementia (DLB) and multiple system atrophy (MSA). Many studies have discussed the markers, heredity, cognition, autonomic nervous function of RBD, and the predictive value for neurodegenerative diseases. This article reviews the research progress of early markers and treatments in recent years, and discusses future research directions.

Hereditary neuropathy with liability to pressure palsies: a clinical, pathological and genetic study of 11 cases / 中华神经医学杂志

Objective To study the clinical,electrophysiological,athological and genomic features of hereditary neuropathy with liability to pressure palsies (HNPP) and increase the understanding and diagnostic level of this disease.Methods Eleven patients with HNPP,met Gouider diagnostic criteria and admitted to our hospital from March 1999 to December 2014,accepted detailed clinical examinations,electromyogram,sural nerve biopsies.Multiplex ligation-dependent probe amplification was used to detect peripheral myelinprotein 22(PMP22) gene deletion on chromosome 17P11.2.Results Eight patients came from two families and it was consistent with automsomal dominant inheritance.Age at onset was on teen-agers.Clinical manifestations were characterized by recurrent mononeruopathies.Symptoms often disappeared spontaneously after a few days or a few months.Nerve conduction studies showed a sensori-motor demyelinating polyneuropathy with conduction abnormalities preferentially localized at common entrapment sites.The nerve biopsy showed the presence of some large thickened myelinated fibers,but the axons were normal.Gene mutation analysis showed that two patients had large fragment tandem deletions containing PMP22.Conclusions Although HNPP is concerned with heredity,there are also some sporadic cases to be found.Electrophysiologic examination is an important screen method.The definitive diagnosis is dependent on PMP22 mutation detection.

Changes in CD40 expression in the pallium and hippocampus in epileptic rats / 中南大学学报(医学版)

OBJECTIVE@#To investigate the expression of inflammatory molecule CD40 in the pallium and hippocampus of rats after status epilepticus (SE).
@*METHODS@#The expression of CD40 in the pallium, the different areas of hippocampus and the different cells from the lithium-pilocarpine epileptic rats at different time points were examined by immunohistochemistry and double-immunofluorescent labeling.
@*RESULTS@#After SE, CD40 expression was obviously inhibited, especially in hippocampus. CD40 was mainly expressed in the activated microglia. CD40 positive cells reached a peak at the 3rd day and returned to a slightly higher level at the 7th day after SE compared with the level before SE.
@*CONCLUSION@#Elevation of CD40 expression in the activated microglia can promote inflammatory injury of rat's hippocampus, suggesting that CD40 induced-signal pathway is involved in inflammatory injury in the hippocampus after SE.

Idiopathic intracranial hypertension with obstructive sleep apnea: a case report / 中华神经科杂志

Objective To report a case of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA) combined with idiopathic intracranial hypertension (IIH) and review the relationship between the IIH and OSA. Methods A case of increased intracranial pressure in a middle-aged male patient who was diagnosed as IIH after the MRI and angiography ruled out intracranial lesions was reported. This patient presented with drowsiness, obesity and other symptoms. An overnight polysomnography (PSG) confirmed severe OSA. The simple use of intracranial pressure lowering therapy could not achieve sustained effective control of symptoms of high intracranial pressure. The clinical effects of comprehensive treatment for the OSA including CPAP and weight loss were observed. Results After 3 months treatment, the body mass index of this patient dropped from 35.7 to 31.4, apnea hypopnea index dropped from 72.6 to 10. 1, and the minimum SaO2 increased from 67% to 82%. And the symptoms of high intracranial pressure including headache and papillaedema were continuously improved. Conclusion Sleep apnea is a risk factor for IIH, especially for obese male patients. PSG monitoring could help us to find the important but easily overlooked factor of OSA. Taking active measures to treat OSA can effectively relieve the high intracranial pressure symptoms in patients with IIH.

Acute changes of polysomnography in major depressive disorder patients treated with mirtazapine / 中华神经科杂志

Objective To evaluate the acute effects of mirtazapine on sleep polysomnographic variables in patients with major depressive disorder (MDD) using polysomnography (PSG). Methods Twenty-five MDD patients took mirtazapine 15 mg an hour before bedtime during the first three days and then 30 mg during the following four days. Polysomnographic and clinical data were collected at baseline and on the 7th day. Results The scores on the Athens Insomnia Scale (AIS,7.92±3.86,t=10.255,P=0.000), the Hamilton Anxiety Rating Scale (HAMA,6.84±5.57,t=6.137, P=0.000) and the Hamilton Depression Rating Scale (HAMD-17,9.80±4.41,t=12.132,P =0.000) decreased rapidly after a 7-day medication. PSG showed mirtazapine administration significantly increased the total sleep time (402.46±80.75,t=-2.990,P=0.006), the sleep efficiency (76.17%±10.65%,t=-2.750,P=0.011), and the slow wave sleep percentages(19.66%±11.43%,t=3.236, P=0.004) and decreased the wake time after sleep onset (80.38±48.02,t=2.972,P =0.007). However, there was no significant difference in the sleep latency, the number of awakening, the rapid eye movemert (REM) sleep latency, the ratio of REM sleep and the frequency of REM sleep episode. Conclusion Mirtazapine as monotherapy in the treatment of MDD has relieved depressive symptoms rapidly and significantly, increased the total sleep time, the sleep efficiency and the slow wave sleep percentages thus to achieve better sleep quality.

Peripheral neuropathy in multiple sclerosis:an electromyographic and pathological study / 中华神经科杂志

Objective To investgate the electromyographic and pathological features of peripheral nerve involvement in MS,and clarify factors that affect the involvement of PNS Methods Thirty three multiple sclerosis(MS) patients were selected according to Poser's definite diagnosis of MS,without other nervous system disorders and thirty volunteers served as controls All subjects received nerve conduction study:MCV,SCV,F wave and H reflex Sural nerve biopsy and pathological change were observed in light and electronic microscope Results Electromyograph findings:decreased CMAP of the median,tibial and peroneal nerves,and high amplitude of SAP of median and ulnar nerves were observed in MS Our study also showed the prolonged F wave response and H reflex in median and tibial nerves,low F wave rates Electrophysiologic abnormalities in MS showed close relationship to the EDSS,duration and lesion position in spinal cord Sural nerve biopsy revealed myelinated nerve fibers with segmental demyelination by light microscope Inflammatory cellular infiltration and onion bulb formation were not found? Axonal degeneration and laminae dissociation in myelin sheath were demonstrated by electromicroscope Conclusion MS is a demyelinating disease attacking to CNS In some MS patients,both CNS and PNS might be involved at the same time The peripheral demyelinating lesions seem to be common in spinal nerve root But the secondary axonal degeneration in distal segment should be another pathologic feature of MS EMG is a useful test method to evaluate the peripheral nerve damage and prognosis of MS

STUDIES ON THE RELATIONSHIP BETWEEN SUBSTANCE P AND ABNORMAL GASTROINTESTIANL TRANSIT / 药物分析学报

Objective To realize the relationship between substance P(SP) and abnormal gastrointestinal tran- sit. Methods By radioimmunoassay, concentration of SP in sigmoid mucosa was determined in 12 healthy volun- teers, 15 slow and 10 fast transit patients. ResultsThe concentration was (27.68±15.42)μg/g, (24.07+5.76)μg/g and (28.61± 18.34)μg/g,respectively. They had no statistical difference. Conclusion There was no relationship be- tween concentration of SP in sigmoid mucosa and abnormal gastrointestinal transit.