Increased Serum Cystatin C in Early Parkinson's Disease with Objective Sleep Disturbances / 中华医学杂志(英文版)

<p><b>Background</b>Sleep disturbance is one of the major non-motor symptoms which cause the disability of Parkinson's disease (PD) patients. Cystatin C (CysC) is a more sensitive biomarker than serum creatinine or estimated glomerular filtration rate. Previous studies have reported altered CysC levels in neurodegenerative disorders and sleep disorders. This study aimed to explore the correlations of serum CysC levels and objective sleep disturbances in early PD.</p><p><b>Methods</b>We recruited 106 early PD patients and 146 age- and sex-matched controls. All participants underwent clinical investigation and video-polysomnography. Sleep parameters and serum levels of CysC were measured. Then, we investigated the relationships between CysC and clinical variables and objective sleep disturbances in early PD patients.</p><p><b>Results</b>The mean serum level of CysC was significantly higher in patients with early PD (1.03 ± 0.19 mg/L) compared to controls (0.96 ± 0.15 mg/L, P = 0.009). There were significantly positive correlations between serum CysC levels and age (r = 0.334, P < 0.001), gender (r = 0.264, P = 0.013), and creatinine levels (r = 0.302, P = 0.018) in early PD patients. Increased serum CysC levels in early PD patients were significantly associated with higher apnea and hypopnea index (AHI) (r = 0.231, P = 0.017), especially hypopnea index (r = 0.333, P < 0.001). In early PD patients, elevated serum CysC levels were positively correlated with oxygen desaturation index (r = 0.223, P = 0.021), percentage of time spent at oxygen saturation (SaO) <90% (r = 0.644, P < 0.001), arousal with respiratory event during sleep (r = 0.247, P = 0.013). On the contrary, the elevated serum CysC levels were negatively correlated with mean and minimal SaO(r = -0.323, -0.315, both P = 0.001) in PD patients.</p><p><b>Conclusions</b>The level of serum CysC was higher in early PD patients. PD patients with elevated serum CysC levels had more respiratory events and more severe oxygen desaturation. Therefore, the serum CysC levels may predict the severities of sleep-disordered breathing problems in early PD patients.</p>

Effect of low-frequency suprathreshold repetitive transcranial magnetic stimulation of the unaffected hemisphere on recovery of motor function in patients with acute stroke / 中华神经医学杂志

Objective To study the effect of low-frequency suprathreshold repetitive transcranial magnetic stimulation (rTMS) of the unaffected hemisphere on recovery of motor function in patients with acute stroke. Methods A total of 26 patients with middle cerebral artery territory infarction were randomly assigned to unaffected hemisphere stimulation group and control group (not receiving any stimulation,n=13).The patients in the stimulation group were treated with rTMS 3 to 5 d after the onset of symptoms with the frequency of 1 Hz and 70％ of the intensity (about 2.1T actual output) and the 1200 pulses per day for 10 consecutive d.The motor evoked potential (MEP) latency,central motor conduction time (CMCT),scores of National Institutes of Health Stroke Scale (NIHSS) and modified Barthel index (MBI) of the affected brain region were recorded on the 1 st of experiment (before the treatment),10 and 40 d after treatment. Results The scores of clinical futction scale and neuroelectrophysiologic parameters before treatment had no statistical significance between the 2 groups (P＞0.05).The scores of clinical function scale after the treatment in the 2 groups were obviously higher than those before treatment (P＜0.05). And the improvement of motor function in the unaffected hemisphere stimulation group was statistically obvious as compared with that in the control group (P＜0.05):the score of NIHSS and the MBI in the stimulation group were obviously higher than those in the control group (P＜0.05).The neuroelectricity physiological indexs in the 2 groups after treatment gained improvement in comparision to those before treatment:the MEP latency on the 40th d of treatment and CMCT on the 10th and 40th d of treatment in the unaffected hemisphere stimulation group was significantly different as compared with those before treatment (P＜0.05); the CMCT on the 10th and 40th d of treatment in the unaffected hemisphere stimulation group was shorter as compared with that in the control group. Conclusion The frequency of 1 Hz and 70％ of the intensity (about 2.1T actual output) in rTMS of the unaffected hemisphere can shorten CMCT and improve the motor function in patients with acute stroke.