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Dizziness is a common and challenging symptom, which can be caused by different pathophysiological mechanisms and might affect a large number of population. However, up to now, there have been limited research on the characteristics of dizziness as the chief complaint in hospitalized patients in the Department of Neurology. Thus, the aim of this study was to investigate the hospitalized patients with dizziness as their chief complaint in the Department of Neurology.In this cross-sectional study, we conducted a retrospective document analysis of hospitalized patients admitted to a tertiary neurological department with the symptom of dizziness during the period of September 2019 to December 2020. We included 211 patients with dizziness as their chief complaint from 1841 patients admitted to this tertiary neurological department during that period.Of all 1841 hospitalized patients, those with dizziness as the chief complaint accounted for 11.5% and most of their past medical history included hypertension, diabetes, cerebrovascular diseases, dyslipidemia, and coronary heart disease. Among these 211 patients, dizziness was more common in women than in men (p = .004). More patients presented with vertigo (40.8%) and light-headedness (39.8%) than disequilibrium (17.1%) and pre-syncope (2.4%). Nausea (48.3%), vomiting (34.1%), headache (13.3%), walking unsteadily (13.3%), and ear symptoms (12.8%) were the most common concomitant symptoms. Dix-Hallpike test (24.6%) and Romberg's sign (11.4%) were positive in these dizzy patients. Nystagmus (2.4%), vision changes (1.4%), and hearing disorders (8.5%) were relatively rare symptoms. Common auxiliary examinations were performed, such as magnetic resonance imaging (60.2%), computed tomography (31.8%), carotid duplex ultrasound (30.8%), and echocardiography (28.0%). Benign paroxysmal positional vertigo (24.2%) and stroke/transient ischemic attack (19.0%) were confirmed to be common causes of dizziness. Note that 97.2% of dizzy patients were in improved recovery after treatment.The diagnosis and management of dizziness remain a challenge for clinicians. Vertigo and light-headedness were the most common symptoms among different types of dizziness. Benign paroxysmal positional vertigo and stroke/transient ischemic attack were among the leading causes for common dizziness disorders. The prognosis of most dizzy patients was good.

Objective Clinically differentiating multiple system atrophy cerebellar type (MSA-C) and spinocerebellar ataxias (SCAs) is challenging, especially at early disease stages, because of their similarities in clinical manifestation and imaging results. The purpose of this study was to explore the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) for distinguishing between MSA-C and SCAs. Methods A total of 51 subjects, including 33 MSA-C and 18 SCAs, were recruited. Average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contraction and recruitment pattern during maximal voluntary contraction were recorded and analyzed to identify differential diagnostic results of EAS-EMG and US-EMG for MSA-C and SCAs. Results Significant differences in average MUP duration, percentage of polyphasic MUPs, and ratio of simple phase and simple-mix phase using EAS-EMG were noted between patients with MSA-C and SCAs. These same parameters also differed significantly between MSA-C and SCAs male patients using US-EMG. Conclusions EAS-EMG may serve as a potential method for early differential diagnosis between patients with MSA-C and SCAs. Furthermore, US-EMG could be a supplementary method for males when EAS-EMG is not available.

To report a typical case of Morvan syndrome with positive anti-leucine rich glioma-inactivated 1(LGI1) and contactin-associated protein 2 (CASPR2) antibodies in serum and cerebrospinal fluid. A 39-years-old female initially presented weakness of extremeties. The main symptoms included paroxysmal limb pain, wheezing, itching, muscle twitching, epilepsy, hypomnesia, dysphoria, apathy, intractable insomnia, salivation and sweating. Tests of electrolytes found hypokalemia (2.7-3.1 mmol/L) and hyponatremia (130-136 mmol/L). Arterial blood gas analysis showed hypoxemia (oxygen saturation 50%-70%). Total thyroxine (TT4) was elevated to 207 nmol/L with positive thyroid peroxidase antibody (TPO-Ab) and thyroglobulin antibody (TG-Ab). LGI1and CASPR2 antibodies (CBA method) were positive in both serum and cerebrospinal fluid, and the remaining antibodies related to autoimmune encephalitis and paraneoplastic syndrome were negative. Head MRI was almost normal, while mild abnormalities were found in electroencephalogram. Electromyography showed slightly increased voltage of left quadriceps motor unit potential. After treated with corticosteroids, IVIG and mycophenolate mofetil, the patient completely improved. Cognitive function scores recovered from MoCA/MMSE (16/24) to MoCA/MMSE (26/29). Positivity of LGI1/CASPR2 antibodies both in serum/cerebrospinal fluid are rarely seen in patients with Morvan syndrome. Steroids and immunosuppressants are suggested for treatment as early as possible.本文报道血清及脑脊液富亮氨酸胶质瘤失活蛋白1（LGI1）和接触蛋白相关样蛋白2（CASPR2）抗体四阳性导致的典型Morvan综合征1例患者的临床特点及预后。对该Morvan综合征患者行详细的病史询问和体格检查、多次脑脊液检查、头颅影像学、电生理检查以及预后进行分析。临床特点：患者青年女性，39岁，首发症状表现为四肢无力，病程中主要症候包括发作性肢体疼痛、憋喘、瘙痒、肌颤搐、癫痫、记忆力减退、烦躁、淡漠、顽固性失眠、流涎、出汗异常。实验室检查：电解质示低钾血症（2.7~3.1 mmol/L）、低钠血症（130~136 mmol/L）；血气分析示低氧血症（氧分压50%~70%）。甲状腺功能：总甲状腺腺素（TT4）207 nmol/L、甲状腺过氧化物酶抗体（TPO-Ab）15.3 IU/ml、甲状腺球蛋白抗体（TG-Ab）16.9 IU/ml；血清和脑脊液抗LGI1/CASPR2抗体呈四阳性，其他自身免疫相关脑炎及副肿瘤综合征相关抗体均阴性。头颅MRI未见异常；脑电图轻度异常；肌电图示左股四头肌运动单位电位电压略高。治疗及预后：激素+丙种球蛋白+吗替麦考酚酯片联合治疗，患者临床症状完全缓解。治疗前后认知功能评分：治疗前蒙特利尔认知评估量表（MoCA）/简易智力状态检查（MMSE）（16分/24分）、治疗后MoCA/MMSE（26分/29分）。Morvan综合征血清/脑脊液中LGI1/CASPR2抗体四阳性罕见，但临床症候典型，尽早免疫治疗效果显著。.

Background Dizziness is a common and challenging condition among population. There is little published study which surveys the characteristics of dizziness of inpatients in the department of neurology. Objective This study was to investigate the inpatients with dizziness as the chief complaint in a neurology department. Materials and Methods We conducted a retrospective study of inpatients with dizziness attending a tertiary neurological department in Beijing. We audited 211 patients with dizziness as the chief complaint from 1841 patients discharged from our tertiary neurological department. Results The inpatients with dizziness as the chief complaint accounted for 11.5% of all inpatients. Dizziness was more common in women than in men (p=0.004). There were more patients presenting with vertigo (40.8%) and light-headedness (39.8%) than disequilibrium (17.1%) and pre-syncope (2.4%). Nausea (48.3%), vomiting (34.1%), headache (13.3%), walk unsteadily (13.3%) and ear symptoms (12.8%) were the most common accompanying symptoms. Hypertension, diabetes, cerebrovascular diseases, dyslipidemia, and coronary heart disease were the most common diseases in past medical history. Dix-Hallpike test (24.6%) and Romberg’s sign (11.4%) were positive in dizziness patients. Nystagmus (2.4%), vision changes (1.4%) and hearing disorders (8.5%) were relatively rare symptoms. MRI (60.2%), CT (31.8%), carotid duplex ultrasound (30.8%), echocardiography (28.0%) were common auxiliary examination. Benign paroxysmal positional vertigo (24.2%) and stroke/transient ischemic attack (19.0%) were common causes of dizziness. 97.2% of inpatients with dizziness can be improving after treatment. Conclusion Dizziness was a common and challenging condition. Vertigo and light-headedness were the most common dizziness types. Benign paroxysmal positional vertigo and stroke/transient ischemic attack were the common dizziness disorders. The prognosis of most patients with dizziness was good.

Background The differential diagnosis of Parkinson’s disease (PD) with multiple-system atrophy (MSA) is difficult because of their similarity in symptoms and signs. The objective of this study was to investigate the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) in differentiating MSA from PD. Methods A total of 201 patients, — 101 MSA and 100 PD — were recruited in this study. Average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contractions, and recruitment patterns during maximal voluntary contractions were recorded and analyzed to assess diagnostic efficiency of EAS-EMG and US-EMG for MSA. Results Significant differences in average MUP duration and recruitment patterns during maximal voluntary contractions were found between patients with MSA and patients with PD using both EAS-EMG (P

Vestibular migraine (VM) is considered the most common cause of spontaneous episodic vertigo and the second most common cause of vertigo. However, without a biomarker or a complete understanding of the pathophysiology, VM remains underrecognized and underdiagnosed. Therefore, definite diagnostic criteria are urgently needed. Meanwhile, VM should be clearly differentiated from other similar diseases. This paper may help clinicians improve the diagnostic rate of VM and reduce the rate of misdiagnosis. A PubMed search was performed using the following terms: vestibular migraine, migraine-associated vertigo/dizziness, migraine-related vertigo, migraine-related vestibulopathy, benign recurrent vertigo, vertiginous migraine, migraine, headache, vertigo, dizziness, and diagnosis. This paper also summarizes the diagnostic criteria and differential diagnoses of VM. The diagnosis of VM is based on the symptoms, degree, frequency, and duration of the vestibular episodes, a history of migraine, and the temporal association of migraine symptoms with vestibular episodes in at least 50% of cases, while ruling out what may be due to other reasons. In addition to vestibular symptoms and migraine, transient auditory symptoms, nausea, vomiting, and susceptibility to motion sickness may also be associated with VM. Thus, VM should be differentiated from other diseases such as Meniere's disease, benign paroxysmal positional vertigo, migraine with brainstem aura, vestibular neuritis, posterior circulation ischemia, multiple lacunar infarction, vestibular paroxysmia, motion sickness, and episodic ataxia type 2.Only if the diagnostic criteria of VM and differential diagnosis can be mastered clearly, we can make a definite diagnosis and treat patients properly.

Background Lumbar puncture (LP) is an essential part of adult neurology residency training. Technologic as well as nontechnologic training is needed. However, current assessment tools mostly focus on the technologic aspects of LP. We propose a training method—problem- and simulator-based learning (PSBL)—in LP residency training to develop overall skills of neurology residents. Methods We enrolled 60 neurology postgraduate-year-1 residents from our standardized residents training center and randomly divided them into 2 groups: traditional teaching group and PSBL group. After training, we assessed the extent that the residents were ready to perform LP and tracked successful LPs performed by the residents. We then asked residents to complete questionnaires about the training models. Performance scores and the results of questionnaires were compared between the 2 groups. Results Students and faculty concluded that PSBL provided a more effective learning experience than the traditional teaching model. Although no statistical difference was found in the pretest, posttest, and improvement rate scores between the 2 groups, based on questionnaire scores and number of successful LPs after training, the PSBL group showed a statistically significant improvement compared with the traditional group. Findings indicated that nontechnical elements, such as planning before the procedure and controlling uncertainties during the procedure, are more crucial than technical elements. Conclusions Compared with traditional teaching model, PSBL for LP training can develop overall surgical skills, including technical and nontechnical elements, improving performance. Residents in the PSBL group were more confident and effective in performing LP.

Objective To investigate the correlation of 5-hydroxy tryptamine receptor 6 (5-HTR6) gene polymorphism with vestibular migraine (VM). Methods A total of 92 VM patients were enrolled as the observation group, and 100 healthy people receiving physical examinations as the control group. Their general clinical information was collected, and the level of 5-HT in plasma and the vestibular function test indexes were detected. Moreover, the polymorphism of 5-HTR6 rs770963777 was detected with the TaqMan-MGB probe. Results The observation group had a lower level of 5-HT than the control group (P .05). Conclusion The level of 5-HT and the vestibular function test indexes can serve as the effective indicators for observing VM, and the polymorphism of 5-HTR6 rs770963777 site is correlated with VM onset.

Background The differential diagnosis of Parkinson’s disease (PD) with multiple-system atrophy (MSA) is difficult because of their similarity in symptoms and signs. The objective of this study was to investigate the value of external anal-sphincter electromyography (EAS-EMG) and urethral-sphincter electromyography (US-EMG) in differentiating MSA from PD. Methods A total of 201 patients, — 101 MSA and 100 PD — were recruited in this study. Average duration and amplitude of motor unit potentials (MUPs), percentage of polyphasic MUPs, amplitude during strong contractions, and recruitment patterns during maximal voluntary contractions were recorded and analyzed to assess diagnostic efficiency of EAS-EMG and US-EMG for MSA. Results Significant differences in average MUP duration and recruitment patterns during maximal voluntary contractions were found between patients with MSA and patients with PD using both EAS-EMG (P

Background To evaluate pruritus in patients with neuromyelitis optica spectrum disorders (NMOSD) and to characterize the relationship between pruritus and lesions of NMOSD. Methods 61 patients with NMOSD were included in the study and their medical records were reviewed for pruritus, neurological symptoms and magnetic resonance imaging (MRI) images. We focused on the patients’ history of pruritus, especially the severity, duration, region, and the relationship of pruritus with other symptoms of NMOSD. Results Of the 61 patients with NMOSD, 59 had longitudinally extensive transverse myelitis (LETM). 38 of these patients (64.4%) reported pruritus during the course of their illness, with 16 patients reporting pruritus as the initial symptoms followed by limb weakness. In 35 of 38 patients (92.1%), pruritus was located within the dermatomes innervated by the spinal nerves from the involved spinal cord. Conclusion Our results show that pruritus is a common symptom of NMOSD and relates to the lesions in the spinal cord. Pruritus may indicate a new episode of myelitis in patients with NMOSD.

Objectives To investigate the association between cognitive behavior therapy (CBT) and dizziness. Methods The databases including PubMed, Embase, Cochrane Library and Web of science will be searched for randomized controlled trials. Weighted mean difference and 95% confidence interval will be utilized to calculate the effect of CBT on dizziness between the 2 groups. Conclusions This meta-analysis will provide a high-quality synthesis from existing evidence for the relationship between CBT and dizziness. Osf registration number 10.17605/OSF.IO/YNH5W.

Objective Mass lesion presentation of primary angiitis of the central nervous system (ML-PACNS) is a special subtype of primary central nervous system vasculitis, which is difficult to be differentiated from other space-occupying disorders. We aimed to summarize our experience and improve diagnostic techniques of ML-PACNS. Patients and methods Case records for 16 patients treated in the Department of Neurology of Six Medical Center of Chinese PLA General Hospital from December 2008 to November 2019 were examined. All patients were diagnosed with ML-PACNS by pathology. Clinical manifestations, neuroimaging results and pathological features were retrospectively analyzed. Results The 16 patients with ML-PACNS in the cohort (8 males) had a median age of 32 (range 19–56 years). On T1WI and T2WI, 12 cases showed mixed signals and 4 cases showed T1WI hypointense and T2WI hyperintense. Fifteen patients showed DWI hyperintense, of which 9 cases showed hypointense in the middle of the lesion. Gadolinium enhancement of all cases was irregular. All patients had a brain biopsy (stereotactic procedure in 10 and open-wedge surgery in 6) which showed lymphocytic vasculitis in the majority of patients (15/16) and necrotizing vasculitis in one patient. Conclusions ML-PACNS is an important differential candidate for tumefactive demyelinating lesions, CNS infections and brain tumors. Mixed T1WI and T2WI signals as well as central hypointense surrounded by hyperintense lesions on DWI may be useful imaging features for the diagnosis of ML-PACNS which has implications for those who have not yet had a biopsy. ML-PACNS may have different pathological type from PACNS.

Recent genome-wide association studies (GWAS) in European descent population have identified more than 30 independent single-nucleotide polymorphisms (SNPs) associated with Alzheimer’s disease (AD). In the present study, we genotyped 39 AD-risk SNPs in 499 sporadic AD patients and 760 matched healthy controls of Mongolian ethnicity from the Inner Mongolia, China. Further, we investigated whether genetic risk score (GRS) combining multiple AD-risk loci confirmed in our study population could improve AD prediction. Two approaches were used for GRS calculation: a simple risk allele count (cGRS) and a weighted approach (wGRS). The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory ability of the GRS models. Seven SNPs were confirmed associated with AD and four SNPs were associated with AD risk independent of APOE genotypes in our population. GRS based on either seven SNPs or four APOE-independent SNPs were significantly associated with AD risk (P = 2.3E−17~2.0E−6). The AUC for wGRS was significantly greater than for cGRS (0.6416 versus 0.6339, P = 0.0049 for seven SNPs; 0.5857 versus 0.5765, P = 0.0047 for four APOE-independent SNPs). Furthermore, we found that wGRS combining four APOE-independent SNPs and APOE E4 genotypes reached AUC 0.7023, significantly better than the discriminate ability of APOE E4 genotypes alone (AUC = 0.6699, P = 0.0379). The combined model, with an AUC of 0.6989, significantly higher than that of APOE E4 alone (0.6529) (P = 0.0284), for subjects in a validation cohort comprising 250 cases and 380 controls, randomly selected from our original cohort. In summary, we found that wGRS based on four APOE-independent AD risk SNPs may supplement APOE E4 for better assessing individual risk for AD in Mongolian population in China.

IntroductionAlzheimer’s disease (AD) is a neurodegenerative disease which presents with an earlier onset age and increased symptom severity. The objective of this study was to evaluate the relationship between regulation of miRNAs and AD.Material and methodsWe completed the bioinformatic analysis of miRNAs-AD studies through multiple databases such as TargetScan, Database for Annotation, Visualization and Integrated Discovery (DAVID), FunRich and String and assessed which miRNAs are commonly elevated or decreased in brain tissues, cerebrospinal fluid (CSF) and blood of AD. All identified articles were assessed using specific inclusion and exclusion criteria.ResultsMiRNAs related to AD of twenty-eight studies were assessed in this study. A wide range of miRNAs were up-regulated or down-regulated in tissues of AD patient’s brain, blood and CSF. 27 differentially dysregulated miRNAs have identified involved in amyloidogenesis, inflammation, tau-phosphorylation, apoptosis, synaptogenesis, neurotrophism, neurons degradation, activates cell cycle entry. Additionally, our bioinformatics analysis identified the top ten functions of common miRNAs in candidate studies. The function of common up-regulated miRNAs primarily target nucleus and common down-regulated miRNAs primarily target transcription, DNA-templated.ConclusionsComprehensive analysis of all miRNAs studies reveals cooperation in miRNA signatures whether in brain tissues or in CSF and peripheral blood. More and more studies suggest that miRNAs may play crucial roles as diagnostic biomarkers and/or as new therapeutic targets in AD. According to biomarkers, we can identify the preclinical phase early that provides an important time-window for therapeutic intervention.

Background We aimed to determine the risk conferred by metabolic syndrome ( METS ) and diabetes mellitus ( DM ) to recurrent stroke in patients with minor ischemic stroke or transient ischemic attack from the CHANCE (Clopidogrel in High‐risk patients with Acute Non‐disabling Cerebrovascular Events) trial. Methods and Results In total, 3044 patients were included. Patients were stratified into 4 groups: neither, METS only, DM only, or both. METS was defined using the Chinese Diabetes Society ( CDS ) and International Diabetes Foundation ( IDF ) definitions. The primary outcome was new stroke (including ischemic and hemorrhagic) at 90 days. A multivariable Cox regression model was used to assess the relationship of METS and DM status to the risk of recurrent stroke adjusted for potential covariates. Using the CDS criteria of METS , 53.2%, 17.2%, 19.8%, and 9.8% of patients were diagnosed as neither, METS only, DM only, and both, respectively. After 90 days of follow‐up, there were 299 new strokes (293 ischemic, 6 hemorrhagic). Patients with DM only (16.1% versus 6.8%; adjusted hazard ratio 2.50, 95% CI 1.89–3.39) and both (17.1% versus 6.8%; adjusted hazard ratio 2.76, 95% CI 1.98–3.86) had significantly increased rates of recurrent stroke. No interaction effect of antiplatelet therapy by different METS or DM status for the risk of recurrent stroke ( P =0.82 for interaction in the fully adjusted model of CDS ) was observed. Using the METS ( IDF ) criteria demonstrated similar results. Conclusions Concurrent METS and DM was associated with an increased risk of recurrent stroke in patients with minor stroke and transient ischemic attack.

Introduction Human myasthenia gravis (MG) is an autoimmune disorder of the neuromuscular system. Experimental autoimmune myasthenia gravis (EAMG) is a well-established animal model for MG that can be induced by active immunization with the Torpedo californica-derived acetylcholine receptor (AChR). Due to the expensive cost of purifying AChR from Torpedo californica, the development of an easier and more economical way of inducing EAMG remains critically needed. Material and methods Full-length cDNA of the human skeletal muscle AChR α1 subunit was obtained from TE671 cells. The DNA fragment encoding the extracellular domain (ECD) was then amplified by polymerase chain reaction (PCR) and inserted into pET-16b. The reconstructed plasmid was transformed into the host strain BL21(DE3)pLysS, which was derived from Escherichia coli. Isopropyl-β-D-thiogalactopyranoside (IPTG) was used to induce the expression of the N-terminal ECD. The produced protein was purified with immobilized Ni(2+) affinity chromatography and refolded by dialysis. Results The recombinant protein was efficiently refolded to soluble active protein, which was verified by ELISA. After immunization with the recombinant ECD, all rats acquired clinical signs of EAMG. The titer of AChR antibodies in the serum was significantly higher in the EAMG group than in the control group, indicating successful induction of EAMG. Conclusions We describe an improved procedure for refolding recombinant ECD of human muscle AChR. This improvement allows for the generation of large quantities of correctly folded recombinant ECD of human muscle AChR, which provides for an easier and more economical way of inducing the animal model of MG.

To explore the serum levels of lipids and lipoproteins in patients with multiple system atrophy (MSA).From July 2009 to June 2014, a total of 62 MSA patients from the neurology department of our hospital were enrolled as the case group and 63 healthy individuals were enrolled as control group. The serum levels of lipids and lipoproteins were compared between two groups and also analyzed according to gender, age and disease subtypes.Compared with the healthy controls, abnormal rates of high density lipoprotein cholesterol (HDL-C), apolipoproteins A (ApoA) and apolipoproteins B (ApoB) in MSA patients were decreased significantly (P0.01), while there is no difference of abnormal rates in TC, TG and LDL-C. Compared with the healthy controls, the serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), LDL-C, ApoA and ApoB levels in MSA patients were decreased significantly (P0.01). There was no significant difference in TG levels. Compared with female MSA patients, the serum TG and LDL-C in male MSA patients were decreased significantly (P0.05). Compared with male controls, TC, LDL-C, HDL-C, ApoA and ApoB levels of male MSA patients were decreased significantly (P0.05) whilst there was no significant difference in TG level (P0.05). Compared with female controls, the serum TC,TG, HDL-C, ApoA and ApoB levels in female MSA patients were decreased significantly (P0.05) whilst there was no significant difference in LDL-C (P0.05). There was no significant difference in lipid levels between elder patients (age over 65) and younger patients (age under 65) (P0.05). Also no significant difference existed between type C and type P of MSA (P0.05). No significant relationship between course of disease and lipids was found (P0.05).Serum levels of TC, HDL-C, LDL-C, ApoA and ApoB are decreased in MSA patients but all lipid levels are not related to either disease course or subtype, which may indicate that lipids levels are related to the pathogenesis of MSA.

Systemic lupus erythematosus is an autoimmune disease with comprehensive immune cell disorders. Recent studies suggested that pro-inflammatory cytokine IL-17 plays important role in lupus, leaving the cellular sources and their pathogenic and physiologic characters largely unknown. In the current study, by using lupus-prone MRL/lpr mice, we demonstrated that Th17 response prevails in lupus disease regarding significantly accumulated serum IL-17, increased IL-17-producing splenocytes, and elevated phospho-STAT3 in CD4(+) T cells. Intracellular staining revealed that unusual CD4(+)B220(+) T cells are major IL-17-producing cells, whereas conventional CD4(+)B220(-) T cells are major IFN-γ-producing cells. Subsequent studies showed that CD4(+)B220(+) cells contains both αβ and γδ T cells in the spleen and thymus of MRL/lpr mice. Further study showed that around 60% of γδ T cells in MRL/lpr mice co-express both B220 and CD4 on their surface, and are the major RORγt(+) cells in MRL/lpr mice. Finally, CD4(+)B220(+) T cells alone do not proliferate, but could enhance the proliferation and IFN-γ-production of conventional CD4(+)B220(-) T cells. Our findings suggest the pathogenic role of unusual CD4(+)B220(+) T cells in lupus disease in MRL/lpr mice according to their IL-17-producing ability and stimulatory function for conventional CD4(+)B220(-) T cells.

Objective. Systemic lupus erythematosus (SLE) is associated with accelerated atherosclerosis and increased cardiovascular risk. Angiogenic T cells (Tang), a specific T cell subset, have been identified and involved in the repair of damaged endothelium. This study aimed to analyze the Tang cell subsets in relation to disease specific features from SLE patients.Methods. Tang cell subsets were assessed in peripheral blood samples from 41 SLE patients and 22 healthy controls (HC) by flow cytometry on the basis of CD31 and CXCR4 expression on CD3+, CD4+, and CD8+ T cells.Results. The percentage of circulating CD8+CD31+CXCR4+ T cells (CD8+ Tang), but not CD3+CD31+CXCR4+ T cells (Tang) and CD4+CD31+CXCR4+ T cells (CD4+ Tang), in SLE was higher than HC. The percentages of Tang cell subsets in anti-dsDNA-positive SLE patients were significantly increased as compared to their negative counterparts and HC. Additionally, the levels of circulating Tang cell subsets were negatively correlated with age at sampling and at diagnosis, but not disease duration or disease activity.Conclusion. Anti-dsDNA-positivity may identify a group of SLE patients with increased Tang cell subsets and circulating CD8+ Tang cells may be viewed as a potentially useful biomarker of endothelial damage and cardiovascular risk in SLE.

Introduction: Hypertrophic olivary degeneration (HOD) is a rarely neurologic disease, occurring after damage to the dentato-rubro-olivary pathway. Case presentation: A 50-year-old hypertensive man suffered pontine hemorrhage resulting in numerous neurological deficits. Neurologic examination 4 months after the hemorrhage showed mild to moderate improvement. 8 months after the hemorrhage, the patient developed truncal and limb tremors, unsteady gait and dysarthria. Magnetic resonance showed increasing bilateral hypertrophic olivary degeneration. Administration of clonazepam and levodopa were ineffective for symptom relief. Conclusion: This case was presented in order to describe the clinical manifestations of HOD and to recognize the possibility of hypertrophic olivary degeneration after the pontomesencephalic stroke.

To explore the clinical characteristics of vestibular migraine in patients from the clinic and ward of the neurological department in comprehensive hospitals.A total of 226 patients diagnosed as vestibular migraine were enrolled in the study. Clinical data were collected and analyzed, including the medical history, clinical symptoms and signs, as well as the result of diagnostic examinations.The mean age of the patients at the visit was 51.7 years old, with the male to female ratio of 1: 1.48. The occurrence of vertigo and migraine varied in order, with 53.1% (120/226) patients presented migraine several years before vertigo. The duration time of vertigo ranged from seconds to days, with 1.8% (4/226) patients presented no headache during the whole course. Several punctate long T(2) or high FLARE (fluid attented inversion recovery) signals scattered at the centrum ovale.Vestibular migraine has complex mechanism and presents multiple clinical manifestations with certain regularities of the onset. Differential diagnosis should be made from the similar diseases.

To summarize the clinical features, neuroimaging findings and pathological characteristics of pathologically confirmed tumefactive demyelinating lesions (TDL).The clinical features, neuroimaging findings and pathological characteristics were retrospectively collected and analyzed for 58 patients with pathologically confirmed TDLs.For pathological studies, a combination of hematoxylin and eosin staining, myelin staining (Luxol fast blue/periodic acid-Schiff or immunohistochemistry for myelin basic protein), macrophage-specific marker (immunohistochemistry for KiM1P or CD68) and staining for axons (Bielschowski silver impregnation or immunohistochemistry for neurofilament protein) were employed.The mean age of onset was 6-56 (36 ± 13) years. The onsets were acute (n = 21, 36%), subacute (n = 27, 46.5%) and chronic (n = 10, 17.5%). The diagnoses of TDL were confirmed by repeat biopsy and pathological examinations (n = 2, 3.4%).In acute phase, the plaques of lesions were characterized by massive demyelination with relatively axonal preservation associated with prominent reactive astrocytosis and profound infiltrates of macrophages.In plaques of chronic lesions, demyelinated lesions with relative axonal preservation and sharply defined margins were major findings. And myelin-laden macrophages accumulated at the edges of plaques and stayed relatively inactive with densely gliotic center and processbearing astrocytosis.TDL is a distinct entity of demyelinating disease.Even though it is often misdiagnosed as neoplasm in brain, bilateral brain involvements and multiple lesions are more common in TDL. The pathological features of TDL are important for the early diagnosis of this disease and helpful for differentiating with brain tumors and central nervous system vasculitis.

To accumulate clinical experience and to direct clinical work.A total of 208 patients with psychogenic dizziness from department of neurology of Navy General Hospital of PLA were included in the study. Self-rating anxiety scale (SAS), self-rating depression scale (SDS) and Bech-Rafaelsen mania rating scale (BRMS) were used for the evaluation.Among all the patients aged from 17 to 77 (the average age: 52), 152 were female and 56 were male. There were 3 types according to different clinical features and therapy prognosis: anxiety and depression type (176 cases, 84.6%) , hysteria type (18 cases, 8.7%) and mania type (14 cases, 6.7%) . The drugs increasing the concentration of excitatory had a good therapeutic efficacy on anxiety and depression type. Alluding cure had notable effect on hysteria type and mood stabilizer had notable effect on mania type.Women tended to have psychogenic dizziness. It can be divided into three types: anxiety and depression type, hysteria type and mania type. Clinical symptoms and laboratory examination of each type have their own characteristics, and treatment strategies are also different.

To explore the clinical and imaging features of tumefactive demyelinating lesions (TDL) and glioma.The brain computed tomography (CT), magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy ((1)H-MRS) features of 60 pathologically confirmed TDL patients and 65 glioma ones, hospitalized at Navy General Hospital from 2005 to 2013, were reviewed and analyzed.The mean onset age of glioma was significantly older than that of TDL. The onset symptom was headache for TDL and headache and epilepsy for glioma. The features of lesions on brain CT scan: no hyperdensity in TDL group and 39 with hyperdense lesions in glioma group. Tissue necrosis was more frequently found in lesions of glioma than TDL, especially for higher grade glioma. And increased β and γ-Glx on (1)H-MRS was most frequently found in TDL.The onset age of glioma is older than TDL. The headache is the top onset symptoms of TDL and epiplesy occurs frequently only in glioma. The hyperdense lesions on CT scan support more the diagnosis of glioma. The lesions with tissue necrosis may be a diagnostic clue for high grade glioma. On (1)H-MRS, increased β and γ-Glx are most frequently found in TDL. Dynamic observation of imaging changes may be more important for facilitating the diagnosis of TDL, especially in conjunctions with imaging characteristics and clinical features.

To explore the clinical features, neuroimaging and histopathological findings in patients with idiopathic hypertrophic cranial pachymeningitis (IHCP) with a nodular space occupying effect.Four IHCP cases with a nodular space occupying effect diagnosed in our hospital were retrospectively studied.All the 4 patients were men with a mean onset age of 40.25 (33 ∼ 50) years old. They all had long disease duration and relapses. The common symptoms of IHCP were chronic headache, multiple cranial nerve palsies and epileptic seizures. CT and MRI of the brain revealed prominent dural partial thickening, which indicated a mass or nodular space occupying effect that mimicked intracranial tumour-like meningioma. The histopathological findings of dura in 2 cases revealed connective tissue proliferation, scattered neutrophil granulocytes and plasmacytes infiltration. Combination therapy of corticosteroid or/and immunosuppressive drugs was effective for the IHCP patients.IHCP patients with a nodular space occupying effect usually onset with chronic headache and are often recurrent. The combination therapy of corticosteroid or/and immunosuppressive drugs is effective. The image of the brain presents prominent dural partial thickening, indicating a mass or nodular space occupying effect, which often lead to confusion with intracranial tumours or granulomatosis.