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Abstract:Alzheimer￠s disease (AD) is a neurodegenerative illness characterized by a profound impairment of cognitive function. Mild cognitive impairment (MCI) is characterized by a less severe level of cognitive impairment but with no dementia. MCI has been presumed to be a high-risk for developing dementia, especially AD. Actually, there have been disputes on definition and clinical outcome of MCI. Heterogeneity in the term MCI was demonstrated by both clinical and epidemiological researches. As the “pre-dementia” phase of AD draws more and more attention from researchers, it is essential to understand the changes in definition of MCI. This paper reviewed the changes in concept of MCI, and introduced the new diagnostic criteria of AD proposed by the National Institute (U.S.) Aging-Alzheimer’s disease workgroup.

Abstract:Mild cognitive impairment (MCI) has been described as a transitional state between the cognitive changes of normal aging and dementia, which has a higher risk of conversion to Alzheimer￠s diseases(AD). Therefore, MCI stage may be the most proper time to receive preventive therapy, and it has become the focus of studies. In this paper, we reviewed the recent progress of the neuropsychological testing, biomarker examination, neuroimaging examination, brain electrophysiological examination and treatment in the diagnosis of conversion from mild cognitive impairment to AD.

Abstract:Post-stroke cognitive impairment is common in stroke patients, with the incidence of 21.8%~50.0%. Post-stroke cognitive impairment can be burdensome to the involved individuals, as well as to their family members and the society as a whole. But after the acute stage, the patients have different outcome. The patients who are young and have good cognitive condition before stroke usually demonstrate improved cognition after acute stage; while the patients who are older and have poor cognitive condition before stroke, less education, lower blood pressure, severe myelinopathy and diabetes mellitus, usually had depraved cognition after acute stage. There are still some arguments about the effects of gender, stroke location and stroke risk factors including hypertension, hyperlipidemia, heart disease history and alcohol drinking history on the outcome of post-stroke cognitive impairment.

Abstract:Alzheimer's disease (AD) is an age-related neurological disease that is the leading cause of dementia, characterized by gradual decline of memory, cognitive dysfunction and personality disorder. Epidemiological studies and animal studies have found that low circulating levels of androgen is a risk factor for AD. In this paper, we reviewed the relationship between androgen and AD and the related mechanism.

Abstract:Objective To explore the correlation between vascular cognitive impairment and tea-drinking. Methods A total of 1865 elder individuals aged over 60 years were sampled in 2004 in Beijing. We conducted a population based case-control study on 87 patients with vascular cognitive impairment (case group) and 87 sex- and age-matched controls（control group）. Univariate analysis was conducted firstly, and then multivariate analysis for financial situation，hypertension，tea drinking，education and living area was conducted using logistic model. Results In cross-link analysis, the ORs for tea drinkers who had better financial situation or a higher education level were the least (OR=0.190 and 0.204 respectively). In univariate analysis, tea drinkers in case group were less than those in controls (＝10.508, P＝0.015), and the ORs decreased as the decrease of frequency of tea-drinking. But there was no difference in the sorts of the tea. There were less individuals who had hypertension or worse financial situation in case group than in control group. In multivariate analysis, tea intake was associated with a lower prevalence of cognitive impairment. The OR was 0.513 for individuals who drink tea almost everyday, compared with non-tea-drinkers. Conclusion Tea-drinking may be the protective factor of vascular cognitive impairment.

Abstract:Objective To quantify the degree of unconsciousness with EEG nonlinear dynamics analysis and investigate the changes of EEG nonlinear properties under different statuses in unconscious anoxia-ischemic patients. Methods Thirty unconscious anoxia-ischemic cases were selected as the patient group. Thirty normal conscious patients with stroke were involved as the control group. EEG was recorded under three conditions, including eyes closed, auditory stimuli (verbal and music) and painful stimulio. Nonlinear indices such as correlation dimension, complexity and approximate entropy were calculated for all subjects. Result (1)EEG nonlinear indices of patient group were significantly lower than those of control group for all conditions and all brain regions. There was significant difference between the two groups (P＜0.05). (2)Under the auditory stimulus and painful stimulus states, all EEG nonlinear indices in the control group were higher than those under eyes-closed condition. Nonlinear indices in the patient group had almost no change for different conditions. Conclusion EEG nonlinear analysis may quantify the degree of unconsciousness in anoxia-ischemic patients. The changes of brain function for unconscious subjects could be captured by EEG nonlinear analysis. EEG nonlinear analysis could provide information about the outcome of unconscious anoxia-ischemic patients.

Abstract:Objective To analyze the relation of CYP2D6*10 polymorphism with response to donepezil in patients with Alzheimer￠s disease(AD). Methods A total of 110 AD patients (AD group) and 124 healthy individuals (control group) were recruited for the study. RFLP-PCR was applied to analyze the CYP2D6*10 gene polymorphisms. Besides, the AD patients were ad ministrated with donepezil 5-10 mg/d for 6 months and evaluated by cognition scales (MMSE and ADAS-Cog) before and after therapy. The steady plasma concentration (Cp) of donepezil was measured by HPLC-MS. Results There was no statistical difference in genotypes and allele frequency of CYP2D6*10 between AD group and control group. However, significant differences were found in AD patients on steady concentration of donepezil and cognition scores (MMSE and ADAS-Cog) between CYP2D6*10 mutant genotypes (T/T and C/T group) and wild type (C/C group) (P＜0.05). Conclusions Donepezil is more effective for AD patients carrying CYP2D6*10 mutants than those carrying wild type.

Abstract:Objective To investigate whether Humanin (HN) has an in vivo neuroprotective effect on experimental mice with Alzheimer′s disease (AD) and the possible mechanism. Methods AD models were established by intracerebral injection?of β-amyloid?protein (Aβ). A total of 60 healthy male mice were randomly divided into 3 groups: sham operated group (n = 15), Aβ model group (n = 15) and HN treatment group (n = 30). Changes in expression of OX-42 in hippocampal region were observed by the immunohistochemical method on 3,7,14 days after modeling. Nissl staining was performed to detect the pathological changes of the hippocampal region of different groups of animals. Results The number of OX-42 positive cells in hippocampal region was reduced in HN treatment group on 3,7,14 days (P＜0.05). Pathological changes of the hippocampal region were detected by Nissl staining in both Aβ model group and HN treatment group after surgery, but the inflammatory changes of HN treatment group were less than Aβ model group at each time point. Conclusion In vivo, HN can reduce the expression of OX-42 induced by the toxicity of Aβ25-35 which proved that HN has neuroprotective effect.

Abstract:Objective To investigate the relationship between MCP-1-2518 G/A gene ploymorphisms and coronary heart disease (CHD). Methods The 360 patients were divided into three groups to undergo the coronary angiography (CAG): acute coronary syndrome (ACS) group (n=180), stable angina pectoris (SAP) group (n=120) and control group (n=60)). The severity and extent of coronary lesions was analyzed by CAG and typified by means of Gensini coronary score system. Enzyme-linked immunosorbent assay was used to measure the MCP-1 concentration. PCR-RFLP way was used to measure MCP-1-2518 G/A gene polymorphisms. Results MCP-1 gene polymorphisms GG gene and G allelic gene was significantly higher in ACS group compared with the SAP group and the control group[GG gene: ACS(33.4%), SAP(24.2%), control group(15.0%), P＜0.05; G allelic gene: ACS(51.1%), SAP(40.4%), control group(31.7%), P＜0.05],and was significantly lower in ACS group compared with the SAP group and the control group[AA gene: ACS(31.1%), SAP(43.3%), control group(51.7%), P＜0.05; A allelic gene: ACS(48.9%), SAP(59.6%), control group(68.3%), P＜0.05]. The MCP-1 concentration in GG gene group was significantly higher than that in AG gene group and AA gene group[GG gene: (153±22)ng/L,AG gene: (136±18)ng/L, AA gene: (124±15)ng/L, (P＜0.05)]. The Gensini score of coronary artery lesions was positively correlated with low density lipoprotein cholesterol, free blood glucose, MCP-1-2518 G/A GG gene polymorphisms (P＜0.05) and high density lipoprotein cholesterol was negatively correlated with stenotic degree of coronary artery.Conclusions MCP-1 gene ploymorphisms is positive regulators of coronary artery lesions. The G allelic of MCP-1-2518 G/A polymorphism can increase the MCP-1 expression than A allelic in cononary heart disease.

Abstract:Objective To study the clinical, electrocardiogram and electrocardiographic characteristics of patients with non-compaction of ventricular myocardium (NVM), so as to improve the diagnosis and treatment of the disease. Methods The clinical and electrocardiographic features of 13 NVM cases admitted in Institute of Geriatric Cardiology, Chinese PLA General Hospital between 2009 and 2011 were summarized and analyzed. Combining with reported cases in literatures, the clinical features, electrocardiogram, echocardiogram, treatment measures and prognosis of NVM were discussed. Results The NVM patients ranged from infancy to geriatric age, but more common in middle-aged. Different extent of heart failure and multiple kinds of arrhythmia and ST-T changes were found in all the 13 cases. Echocardiography was the primary means in diagnosis of NVM with high specificity, but the MRI and other examination were also important. Conclusion NVM is a rare congenital heart disease, with heart failure, ventricular arrhythmia and enlargement of the whole heart as the major characteristics. ECG and UCG are helpful for the diagnosis of NVM.

Abstract:Objective The aim of the present study was to evaluate the indication and security of low-calcium dialysate (LCD) for adynamic bone disease (ABD) in senile patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods Twenty-four senile ABD patients(age＞60 years) who underwent CAPD (intact parathyroid hormone(iPTH)＜100 ng/L) were enrolled. LCD (Ca 1.25 mmol/L) was used in dialysis treatment instead of standard-calcium dialysate (SCD, Ca 1.75 mmol/L). At 1-, 2-, 6-, 9-, 12-, 18-month follow up respectively, the biochemical measurements were performed for plasma levels of i-PTH, calcium, phosphorus, calcium-phosphorus product and alkaline phosphatase(AKP). Additionally, the bone mineral density (BMD) was also detected. Results After using LCD, the level of plasma iPTH began to upgrade in the first month; increased evidently in the second month [baseline vs 2-month: (46.16±22.58) vs (131.10±75.78)ng/L, P＜0.01]; increased gradually at month 6, 9 and 12; maintained stable and remained in target range since 12-month(150~300 ng/L). The percentage of patients whose serum iPTH level reached to target range augmented gradually in initial 12 months of treatment, which at month 2, 6, 9, 12 were 53.5%, 57.2%, 66.7%, 72.9% respectively. The percentage did not change significantly during the following 6 months(71.6% and 73.3% at 15- and 18-month respectively). At 2-month, level of serum calcium, phosphorus and calcium-phosphorus product all declined significantly[serum calcium level: (2.60±0.21) vs (2.12±0.18)mmol/L; serum phosphorus level: (1.96±0.53) vs (1.43 ±049)mmol/L; calcium-phosphorus product scores: (63.36±19.14) vs 48.79±20.03)mg2/dl2, P＜0.01]. Meanwhile, the level of serum AKP increased from (107±72)IU/L to (176±89)IU/L (P＜0.05). The incidence of osteoporosis increased by 12.5%. The majority of patients tolerated LCD well, without sufferring from severe hyperspasmia, alteration of psyche, hypotension or catagma. Conclusions LCD can effectively increase iPTH level and improve calcium and phosphorus metabolism in senile ABD patients undergoing CAPD, thus to treat ABD satisfactorily, with good security. However, LCD, to some extent, increases the incidence of osteoporosis. So, for these patients, ABD should be taken into consideration, as well as osteoporosis.

Abstract:Objective To detect the platelet aggregation in elderly patients with hypertension and to determine the frequency of aspirin resistance and its risk factors. Methods A total of 184 elderly patients with hypertension (91 cases in aspirin therapy group and 93 cases in non-aspirin group) and 25 normal controls were enrolled in the study. Platelet aggregation was determined by adenosine diphosphate (ADP) or arachidonic acid (AA) induction and the level of blood thromboxane B2 (TXB2) was determined by ELISA. According to the meassurements, the patients in aspirin therapy group were divided into three groups: aspirin resistance(AR) group, aspirin semiresponder (ASR) group and aspirin sensitivity(AS) group. Differences in clinical data were analyzed to find the related risk factors of AR. Results The platelet aggregation rate in non-aspirin group was higher than that in normal group[(PAgTAA: (47±15)% vs (40±17)%, P＜0.05; PAgTADP: (69±8)% vs (63±6)%, P＜0.01]. The incidence of AR and ASR was 14.29%(13/91)and 28.57%(26/91) in aspirin therapy group. The plasma TXB2 level was higher in both AR group and ASR group than in AS group [(78±5) vs (52±8) μg/L, (64±10) vs (52±8) μg/L, P＜0.01]. The plasma TXB2 level was positively correlated with PAgTAA and PAgTADP(P＜0.01). There were more diabetic patients and smokers in AR and ASR groups than in AS group(P ＜ 0.05). Logistic regression analysis revealed that AR is likely correlated with increased levels of fasting blood-glucose and low density lipoprotein (P=0.002 and P=0.044). Conclusion Elderly patients with hypertension have higher platelet aggregation rate than normal controls. The plasma TXB2 level is positively correlated with AR and may be used as biochemical test marker like platelet aggregation. The increased levels of fasting blood glucose and plasma low density lipoprotein are independent risk factors for AR in elderly patients with hypertension.

Abstract:Objective To investigate the effects of blood glucose level at admission on in-hospital cardiac function in elderly acute myocardial infarction patients. Methods A total of 93 consecutive elderly patients hospitalized for first attack of acute myocardial infarction from January 2009 to August 2010 were enrolled. They were divided into 3 groups according to tertiles of the distribution of glucose level at admission: ＜7.69mmol/L (group A), 7.69-11.36mmol/L (group B), ≥11.36mmol/L(group C). The cardiac function was analyzed. Results Killip class was higher in group C than in group A and B[(2.84±1.02) vs (1.81±0.67) and (2.12±0.96), P＜0.01]. Incidence of arrhythmia was significantly higher in group B and C than in group A[(41.9% vs 35.5% and 9.7%, P＜0.05]. Ordinal logistic regression analysis demonstrated that male(OR=0.339, 95%CI 0.122-0.938, P=0.037), heart rate at admission(OR=1.034, 95%CI 1.006-1.062, P=0.018), peak CK-MB(OR=1.007, 95%CI 1.002-1.011, P=0.003) and blood glucose level at admission(OR=1.117, 95%CI 1.035-1.208, P=0.005) were independent predictors of cardiac function. Conclusion In elderly patients with acute myocardial infarction, hyperglycemia at admission is predictive of poor cardiac function.

Abstract:Objective To investigate the biocharacteristics and myocardium differentiation capacity of human amniotic fluid-derived c-kit+ and c-kit- mesenchymal stem cells in vitro. Methods Fourteen samples of human amniotic fluid were routinely obtained from amniocenteses of second trimester gestation (15-31weeks). C-kit+ amniotic fluid stem (AFS) cells were sorted by flow cytometry and were compared with c-kit- stem cells for the biocharacteristics and adipogenic, osteogenic and myocardium differentiation capacities. Verification and differentiation was evaluated by using RT-PCR and Weston blot. Result Our findings revealed that 16 to 22 weeks of gestation was the optimal duration to obtain c-kit+ stem cells. Following the sorting, c-kit+ cells had similar morphological and proliferative characteristics with the c-kit- AFS cells as demonstrated by growth curves. Both the c-kit+ and c-kit- AFS cells had mesenchymal stem cell characteristics through surface marker identification by flow cytometry and immunocytochemical analysis. They expressed mesenchymal stem cell markers (CD29,CD44,CD73,CD90,CD105) but not hematopoietic stem cells makers(CD34,CD45). The cells were positive for Class I major histocompatibility (MHC) antigens (HLA-ABC), and negative for MHC Class II (HLA-DR). Oct-4 and SSEA-4 expression were stronger in c-kit+ stem cells than in c-kit- stem cells. Both two types of stem cells can differentiate along adipogenic and osteogenic lineages. However, the myocardium differentiation capacity was enhanced in c-kit+ AFS by detecting the GATA-4, cTnT, α-actin, Cx43 mRNA and protein expression through RT-PCR and Western blot analysis after myocardium induction. Only GATA-4, a marker for early stage of immature myocardium like cells, was detected from the myocardium induced c-kit- AFS cells. Conclusion Both c-kit+ and c-kit- amniotic fluid-derived stem cells have mesenchymal stem cells characteristics. They can differentiate along adipogenic and osteogenic lineages. C-kit+ AFS cells may have the potential clinical application for myogenesis in cardiac regenerative therapy.

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Abstract:The urethral sphincter electromyography (US-EMG) and external anal sphincter electromyography (EAS-EMG) has certain significance for the diagnosis of multiple system atrophy (MSA). In this paper, we summarized the anatomical and pathophysiological basis of these two methods, and their methodology, normal and abnormal performance, as well as their roles in the diagnosis of the nervous system diseases. Currently, the significance of these two methods in MSA diagnosis remains controversial; the sensitivity and specificity in the diagnosis of MSA, and the correlations between the mutual differences and clinical characteristics have not been reported. Anal and urethral sphincter EMG manifested as neurogenic changes in multiple system atrophy, so that the examinations can be used as a conventional electrophysiological testing means in diagnosis of suspected MSA; however, further researches are needed for the differential diagnosis and their correlations.

Abstract:Leptin is a protein hormone which is a major product of adipose tissue, and plays an important role in the central regulation of food intake and energy metabolism. Recently, the stomach has been identified as an important source of leptin (gastric leptin). We searched MEDLINE (through PubMed), Science Citation Index (SCI) Expanded, CNKI, and WANFANG Database in April 2011, using the search terms including stomach, gastric and leptin, to seek the data of gastric leptin. The available literature demonstrated that gastric leptin can modulate carbohydrate, protein and fat absorption in the gastrointestinal tract, regulate the cardiovascular function independently, and may have an important effect on the prevention and treatment of obesity. It is also reported that gastric leptin and fat leptin synergistically control feeding behavior and energy storage. In this paper, we reviewed the new roles of gastric leptin reported in recent years, focusing on the nutrient absorption, cardiovascular regulation, food intake and energy balance. More researches to explore and confirm the new roles of gastric leptin are expected.

Abstract:Drugs can effectively improve the symptoms of heart failure. However, cardiac resynchronization therapy is the only effective way to get marked results for the severe heart failure patients with NYHA III-IV. This article reviewed the researches in five aspects: expansion of CRT indications in heart failure, the important roles of QRS duration and morphology in CRT treatment, optimization program regulation and mechanism in CRT, the effects of pole technology and position on response, the prediction factors of response and treatment advances in CRT.