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Neurosurgical critical care is playing an increasingly pivotal role in the advancement of neurosurgery. It not only provides perioperative life support for neurosurgical patients but also addresses the treatment of severe cerebrovascular diseases and traumatic brain injury. Over the past two decades, major tertiary hospitals in China have established subspecialties dedicated to neurosurgical critical care. However, at the county level and other grassroots hospitals, the adoption of neurosurgical critical care concepts require further promotion. This paper reviews the development history of the neurosurgical critical care specialty and proposes measures to enhance the diagnostic and treatment capabilities of grassroots hospitals. These measures include standardizing core professional competencies, implementing high-quality multi - disciplinary team, and improving essential hardware configurations, with the goal of achieving standardized diagnosis and treatment in neurosurgical critical care. [ABSTRACT FROM AUTHOR]

The etiology pattern of pituitary diseases is diverse and complex, including pituitary adenoma, Rathke cleft cyst (RCC), pituitary apoplexy, craniopharyngioma, etc. The pituitary is located in the sellar region of the skull base, so transsphenoidal approach is the first choice for pituitary surgery. With the development of endoscopic technology in neurosurgery, more and more neurosurgeons use endoscopic transsphenoidal surgery to treat pituitary diseases. In this paper, we review the recent literature and to present the value of endoscopy for pituitary diseases. [ABSTRACT FROM AUTHOR]

The treatment of pediatric brain tumors is an important branch of pediatric neurosurgery. Children's brain tumors are treated differently from adults because of the unique structure of their physical development. This paper reviews the milestones in the treatment of children's brain tumors at home and abroad and discusses the key technologies for the diagnosis and treatment of children's brain tumors, so as to look into the future. [ABSTRACT FROM AUTHOR]

Because of the complex anatomic relationship and difficult treatment of skull base tumors, a multidisciplinary diagnosis and treatment mode (neurosurgery, otorhinolaryngology, head and neck surgery, oral and maxillofacial surgery, ophthalmology, plastic surgery, etc.) are needed to achieve the purpose of effectively removing tumors, improving function of the nerve and the quality of life. Skull base oncology is regarded as a challenging major in neurosurgery. In order to promote the development of skull base tumor surgery in China, this paper reviews the current situation and existing problems, and looks forward to the future development direction. [ABSTRACT FROM AUTHOR]

Some primary or secondary diseases of the central nervous system are closely related to human immune system. Autoimmune diseases such as multiple Takayasu arteritis (MTA) can cause intracranial vascular lesions. The disorder of autoimmune system can cause limbic encephalitis (LE) and autoimmune hypophysitis (AH). Patients with immunodeficiency disease are prone to opportunistic infections of the nervous system and malignant lymphoma. At present, the pathogenesis of many immune-related diseases in neurosurgery are not clear, and there is a lack of "golden standard" for diagnosis. Some immune-related diseases in neurosurgery, such as human immunodeficiency virus (HIV) encephalopathy and paraneoplastic neurological syndrome (PNS), have low incidence and high clinical misdiagnosis rate. Most of the immune-related diseases in neurosurgery have their own characteristics in terms of pathophysiology, clinical and imaging feature, etc. Understanding these characteristics will be of great help to the diagnosis and differential diagnosis of relevant clinical diseases. This paper intends to briefly describe the common immune-related diseases in neurosurgery, so as to improve clinicians' understanding of immune - related diseases in neurosurgery and even save more patients' lives. [ABSTRACT FROM AUTHOR]

Glioma shows diffuse infiltrative growth in the brain parenchyma. Even following the principle of "maximum safe resection", the residual tumor cells are resistant to adjuvant chemoradiotherapy and continue to invase and migrate in the brain tissue. This is the main reason for the recurrence of glioma and the dissemination in the central nervous system (CNS). As a result, understanding the mode of glioma invasion and migration can provide a new method for the treatment of glioma. This paper reviews our research findings of the invasion and migration of glioma during the period of Twelfth Five-Year Plan for National Economic and Social Development. [ABSTRACT FROM AUTHOR]

Stroke has become the leading common cause of disability and the second most common cause of death in China. Endovascular treatment emerged in recent years as a promising treatment method with a higher recanalization rate and better functional outcome in patients with acute ischemic stroke caused by large vessel occlusion. This paper selected 4 high - quality retrospective studies by Chinese scholars regarding endovascular treatment in patients with acute ischemic stroke, which were published in foreign journals during past 3 years, and focused on study methods and results. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Chinese Journal of Contemporary Neurology & Neurosurgery is the property of Chinese Journal of Contemporary Neurology & Neurosurgery and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Vascular mild cognitive impairment (VaMCI) is the prodromal syndrome of vascular dementia (VaD) and key target for drug treatment. There is controversy over the diagnostic criteria and screening tools of VaMCI, which affects its clinical diagnosis. This paper aims to explore the clinical features, diagnostic criteria and screening technique of VaMCI. Methods Taking "vascular mild cognitive impairment OR vascular cognitive impairment no dementia" as retrieval terms, search in PubMed database from January 1997 to March 2015 and screen relevant literatures concerning VaMCI. According to Guidance for the Preparation of Neurological Management Guidelines revised by European Federation of Neurological Societies (EFNS) in 2004, evidence grading was performed on literatures. Results A total of 32 literatures in English were selected according to inclusion and exclusion criteria, including 3 guidelines and consensus and 29 clinical studies. Seven literatures (2 on Level I, 5 on Level II) studied on neuropsychological features in VaMCI patients and found reduced processing speed and executive function impairment were main features. Two literatures reported the diagnostic criteria of VaMCI, including VaMCI criteria published by American Heart Association (AHA)/American Stroke Association (ASA) in 2011 and "Diagnostic Criteria for Vascular Cognitive Disorders" published by International Society for Vascular Behavioral and Cognitive Disorders (VASCOG) in 2014. Fifteen literatures (4 on Level I, II on Level II) described the diagnostic criteria of VaMCI used in clinical research, from which 6 operational diagnostic items were extracted. Fourteen literatures (4 on Level I, 10 on Level II) described neuropsychological assessment tools for VaMCI screening, and found the 5-minute protocol recommended by National Institute of Neurological Disorders and Stroke - Canadian Stroke Network (NINDS- CSN) was being good consistency with other neuropsychological assessment tools. Conclusions The neuropsychological features of VaMCI have guiding significance for diagnosis. VASCOG diagnostic criteria for VaMCI is practical in clinical practice, and 5-minute protocol is suitable for clinical rapid screening of VaMCI. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a common neurodegenerative disease in the elderly. Early diagnosis and prediction plays an important role in early intervention and delaying disease progression of AD. This paper focused on the principles and process of pattern classification method, and its application in the clinical study and auxiliary diagnosis of AD. The biomarkers, neuroimaging and cognitive ability scales are important features for pattern classification. Various classification algorithms including Bayesian networks, decision trees, support vector machines (SVM) and multilayer perception have been adopted to distinguish AD, mild cognitive impairment (MCI) and normal aging subjects. Besides, they can effectively trace and analyze MCI patients. [ABSTRACT FROM AUTHOR]

In this paper, we have reviewed the central nervous system (CNS) lymphatic circulation and related diseases. The lymphatic system is an important component of circulatory system. However, classic lymphatic vessels consisted of endotheliocytes are not found within CNS. Indeed, the central lymphatic circulation exists. Virchow - Robin space (VRS) is regarded as main component of the central lymphatic circulation, which resembles peripheral lymphatic system functionally and plays an important role in the regulation of CNS homeostasis. VRS plays the function of central lymphatic drainage, through which the macromolecular substances in cerebral interstitial fluid are cleared. Also, VRS is the main part of immune surveillance system. The central lymphatic circulation works crucially in the development of related diseases within CNS, such as lymphostatic encephalopathy, demyelinating diseases, CNS neoplasms, CNS infections, protein conformational diseases, etc. [ABSTRACT FROM AUTHOR]

Background Eccentric exercise or high tension exercise could cause damage to skeletal muscle structure, resulting in deficiency of dystrophin and secondary loss of dystrophin-glycoprotein complex (DGC) from the sarcolemma, which indicated that down-regulation of dystrophin was one of the key points of skeletal muscle injury from eccentric exercise. Duchenne muscular dystrophy (DMD) is caused by mutations of DMD gene, resulting in the absence of dystrophin, which means that skeletal muscles of DMD patients after birth are in the natural state of actual path of force transmission which carried high tension from eccentric exercise. This paper investigated systematically whether expression of DGC is associated with progressive muscle weakness in natural history of DMD, and analyzed the expression of DGC at the sarcolemma of 197 confirmed DMD cases (9 days-12 years old). Methods The expression of α- and β-dystroglycan (DG), β-, γ- and δ-sarcoglycan (SG) and syntrophin at the sarcolemma of DMD patients was analyzed by immunofluorescent staining. Results The study showed that there was no relationship between lack of proteins and progressive muscle weakness with increasing age, although expression of α-and β- dystroglycan- DG, α, β-, γ- and δ-SG and syntrophin at the sarcolemma at different stages of 197 DMD patients (9 days --12 years old) had different degrees of deficiency. Conclusions Deficiency of DGC may occur before birth and DMD patients were recommended to avoid further damage to skeletal muscles from eccentric exercise and high-resistance movement in activities of daily life and rehabilitation training. [ABSTRACT FROM AUTHOR]

Background DMD gene point mutation, mainly nonsense mutation, always cause the most severe Duchenne muscular dystrophy (DMD). However, we also observed some cases of Becker muscular dystrophy (BMD) carrying DMD point mutation. This paper aims to explore the mechanism of DMD point mutation causing BMD, in order to enhance the understanding of mutation types of BMD. Methods Sequence analysis was performed in 11 cases of BMD confirmed by typical clinical manifestations and muscle biopsy. The exon of DMD gene was detected non - deletion or duplication by multiplex ligation - dependent probe amplification (MLPA). Results Eleven patients carried 10 mutation types without mutational hotspot. Six patients carried nonsense mutations [c.5002G>T, p.(Glu1668X); c.1615C > T, p.(Arg539X); c.7105G > T, p.(Glu2369X); c.5287C > T, p.(Arg1763X); c.9284T > G, p. (Leu3095X)]. One patient carried missense mutation [c.5234G > A, p.(Arg1745His)]. Two patients carried frameshift mutations (c.10231dupT, c.10491delC). Two patients carried splicing site mutations (c.4518 + 3A > T, c.649 + 2T > C). Conclusions DMD gene point mutation may result in BMD with mild clinical symptoms. When clinical manifestations suggest the possibility of BMD and MLPA reveals non-deletion or duplication mutation of DMD gene, BMD should be considered. Study on the mechanism of DMD point mutation causing BMD is very important for gene therapy of DMD. [ABSTRACT FROM AUTHOR]

Objective To study clinicopathological features, diagnosis, differential diagnosis and prognosis of mixed adenoneuroendocrine carcinoma (MANEC). Methods One case of MANEC with brain metastasis was reported focusing on the following aspects: clinical manifestations, histopathological features and immunophenotypes, and the relevant literatures were reviewed. Results A 35-year-old male presented headache and vomiting, and his head CT scan showed a lesion located in the right temporal lobe. The tumor was detected after separating the cerebral cortex during the surgery. The tumor diameter was 3 cm. The tumor was soft and rubbery with ill - defined margins, and rich in blood supply. Under optical microscopy, the tumor was consisted of small round cells of the same size, with focal tumor cells arranged around blood vessels in a pseudorosette manner or papillary manner with brisk mitotic activity. The boundary between tumor and brain tissue was ill - defined. By using immunohistochemical staining, the tumor cells were diffusely positive for synaptophysin (Syn) and CD56, and negative for glial fibrillary acidic protein (GFAP), pan cytokeratin (PCK), CD3, CD20, vimentin (Vim), leukocyte common antigen (LCA), thyroid transcription factor-1 (TTF-1), S-100 protein (S-100), neurofilament (NF), nestin (Nes), CK5/6, CK8/ 18 and CD99. Ki - 67 labeling index was about 62% . Sigmoidoscopy was performed later in another hospital and showed a mass in the patient's colon. The colon tumor was biphasic in appearance, and was consisted of two distinct components: isomorphic small round cells and low - middle differentiated adenocarcinoma cells. The small round tumor cells were diffusely positive for Syn and CD56, and negative for PCK. The adenocarcinoma cells showed opposite results. Conclusions MANEC is a rare tumor, which is defined in 2010 by WHO Classification of Digestive, and to the best of our knowledge, MANEC of the colon with brain metastasis has never been described. Therefore, this paper reports the first case of MANEC of the colon with brain metastasis. Definite diagnosis could be made by medical history, typical histopathological characteristics and immunohistochemical expressions. [ABSTRACT FROM AUTHOR]

Malnutrition is common after stroke, usually caused by cognitive disorder, dysphagia, paralysis, sensorimotor disability and visual field defect. Many researches indicate that the initiation of early enteral nutrition in stroke patients would own enormous clinical benefits, including a decrease in the risk of death and infectious diseases, shorter hospital stay and lower health expenditure. However, irregular nutrition management could increase the incidence of hypostatic pneumonia and urinary tract infection. Therefore, both European Society for Parenteral and Enteral Nutrition (ESPEN) and American Society for Parenteral and Enteral Nutrition (ASPEN) recommended that nutrition screening and assessment and nutrition support be initiated as soon as possible, preferably within 24 h of hospital admission, to improve clinical outcomes. Chinese neurologists and patients have accepted this concept and have done many worthful studies in the past few years. This paper summarized the common methods of nutrition assessment and measurement of interstinal barrier function, in order to monitor the nutritional status of stroke patients, and push the establishment and improvement of nutrition support system for stroke patients in China. [ABSTRACT FROM AUTHOR]

Post-stroke depression (PSD) is one of the common complications after stroke. However, it is often overlooked in clinical practice. As a result, many patients have been misdiagnosed or never been diagnosed. Post-stroke depression directly affect cognitive function, late rehabilitation, functional recovery and the quality of life in stroke patients, and is closely related to the high recurrence rate, disability rate and mortality of stroke. In order to deepen the understanding of early and late PSD, this paper summarized recent progress of PSD at home and abroad, and made a brief introduction on the epidemiology, pathogenesis, influencing factors, screening and diagnosis, treatment and prevention of PSD. [ABSTRACT FROM AUTHOR]

Mammalian genomes encode numerous natural antisense transcripts (NATs). These antisense transcripts are now recognized as an important component of molecular mechanisms involved in the regulation of gene expression. NATs are particularly prevalent in the mammalian nervous system. The importance of NATs in the normal functioning of nervous system is becoming increasingly evident. They are not only involved in neuronal differentiation, myelination and ion channel regulation, but also in advanced cognitive processes, such as synapse plasticity and memory formation. This paper focuses on the potential involvement of NATs in various neurodegenerative disorders. [ABSTRACT FROM AUTHOR]

Background Endovascular therapy is the first treatment choice for intracranial aneurysms currently, but it has a high recurrence rate. Some patients require surgical clipping because of the difficulty of re - embolization. This study retrospectively analyzed the clinical data of 11 cases who underwent clipping operation because of the recurrence after endovascular therapy. Combining with domestic and foreign related literatures, this paper discusses the principles and techniques of surgical treatment for recurrent aneurysms. Methods There were a total of 11 patients with 12 recurrent aneurysms after embolization, including 3 anterior communicating artery (ACoA) aneurysms, 3 middle cerebral artery (MCA) aneurysms, 2 posterior communicating artery (PCoA) aneurysms, one anterior cerebral artery (ACA) aneurysm, one vertebral artery (VA) aneurysm, one basilar tip aneurysm and one superior cerebellar artery (SCA) aneurysm. There were 7 small aneurysms and 4 large aneurysms. All patients underwent surgical clipping under microscope. After operation, 11 aneurysms were complete clipped, and one was proximally blocked. The coils were reserved in 7 aneurysms, and were removed or partially removed in 5 aneurysms. Results All patients were followed up for an average of 22 months after surgery. There were 9 cases (9/11) with the Glasgow Outcome Scale (GOS) score improved or remaining unchanged compared with preoperation. One of them presented left limb weakness after operation, with the muscle strength Grade 3, while recovered to Grade 4-5 on discharge. The other 2 patients died after surgery. One case had a critical condition before surgery, and the other was secondary to thrombosis and pneumonia. Both of them had a GOS score of 2 when discharged, and died after discharge. Conclusions There is high surgical difficulty in recurrent aneurysms, however, with adequate preoperative evaluation and surgical design, it can still promise safe and effective results. [ABSTRACT FROM AUTHOR]

Nowadays, the strategies of gene therapy for the treatment of refractory epilepsy (RE) mainly include modulating neurotransmitter systems, neuropeptide Y (NPY) and neurotrophic factors. Among them, the hot target spots include γ-aminobutyric acid (GABA) and its receptor, N-methyl-D- aspartate (NMDA) and its receptor, galanin, NPY and neurotrophic factors. This paper reviews the chief research results, and advantages and disadvantages of studies, and provides evidence for the treatment of refractory epilepsy. [ABSTRACT FROM AUTHOR]

Background Epilepsy is a chronic neurological condition characterized by paroxysm of seizures due to abnormal electrical discharge from central nervous system neurons. Several new antiepileptic drugs (AEDs) were listed over the past two decades, and they were believed to be equally effective and have better tolerability and side effect profiles. This paper aims to evaluate the efficacy and safety of adjunctive topiramate in refractory partial seizures. Methods Relevant research articles about randomized controlled trials of adjunctive topiramate in refractory partial seizures, with topiramate, Topamax, add - on treatment, adjunctive treatment, add - on therapy, adjunctive therapy, refractory partial seizure, refractory partial epilepsy both in Chinese and English as retrieval words, were retrieved from PubMed (1995-2014), Cochrane Central Register of Controlled Trials (CENTRAL, 1995-2014), The Cochrane Database of Systematic Reviews (CDSR, 1995-2014), China National Knowledge Infrastructure (CNKI, 1995-2014) and Wanfang Data (1999-2014). Two reviewers independently evaluated the quality of the included articles and abstracted the data. A Meta-analysis was conducted using RevMan 5.0 software. Results According to the enrollment criteria, 13 prospective, randomized controlled clinical trials with a total of 1622 patients were finally selected. The proportions of patients with reduction in seizure frequency ⩾ 50% (OR = 3.710, 95% CI: 2.870-4.810; P = 0.000), ⩾ 75% (OR = 7.220, 95% CI: 3.310-15.750; P = 0.000) and seizure free (OR = 3.380, 95%CI: 1.720-6.640; P = 0.000) in topiramate group were significantly higher than that in control group. The treatment withdrawal ratio was significantly higher compared to placebo in 600 mg/d and 800 mg/d subgroups, but not in 200 mg/d subgroup (200 mg/d: OR = 2.170, 95%CI: 0.470-9.950, P = 0.320; 600 mg/d: OR = 2.090, 95%CI: 1.020-4.270, P = 0.040; 800 mg/d: OR = 8.000, 95%CI: 1.390-46.140, P = 0.020). The common side effects included somnolence, anorexia, ataxia, aprosexia, dizziness, fatigue, nausea, thinking abnormality, paraesthesia and weight loss. The occurrence rate of side effects in topiramate group was higher than that in control group. Conclusions Topiramate is effective when added to existing therapy in patients with refractory partial seizures. The withdrawal rate of 200 mg/d topiramate is similar to control group. Compared with the control group, adverse effects are more common but mild or moderate, mainly related with the central nervous system. However, trials included in this study are of relatively short duration, and provide no evidence for the long- term efficacy of topiramate. [ABSTRACT FROM AUTHOR]

This paper aims to investigate the relationship between the ratio of low - density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C) and risk factors for acute ischemic stroke, and to investigate the effect of LDL-C/HDL-C on the 3-month outcome of acute ischemic stroke. Based on baseline characteristics and laboratory data on admission, 150 patients with non-cardiac acute ischemic stroke were divided into 2 groups (LDL-C/HDL-C ⩽ 3 and LDL-C/HDL-C > 3). The outcome of 3 months after stroke was analyzed, and the risk factors were compared between 2 groups. There was significant difference in history of diabetes, history of coronary artery disease, history of smoking and atherosclerotic lesions between 2 groups (P < 0.05, for all). After using multifactor stepwise Logistic regression analysis, only the LDL-C/HDL-C ratio > 3 (OR = 1.781, 95%CI: 1.343-2.374; P = 0.001) and National Institute of Health Stroke Scale (NIHSS) score on admission (OR = 1.923, 95%CI: 1.232-5.944; P = 0.032) were significantly and independently predictive for 3-month outcome. Therefore, the ratio of LDL-C to HDL-C serves as a positive predictor of the 3-month clinical outcome of acute ischemic stroke. [ABSTRACT FROM AUTHOR]

This paper aims to investigate the relationship between serum high-sensitivity C-reactive protein (hs-CRP) level and modified TOAST classification as well as OCSP subtypes in patients with acute ischemic stroke. Serum hs-CRP was measured in 240 patients with acute ischemic stroke and 120 normal controls. All patients were classified according to modified TOAST classification and OCSP criteria. Serum hs-CRP levels in acute ischemic stroke group were significantly higher than those in normal control group [(13.68 ± 6.92) mg/L vs (3.98 ± 0.76) mg/L; t = 6.922, P = 0.002]. Among modified TOAST subtypes, the highest serum hs - CRP level was in cardioembolism (CE) group [(16.82 ± 6.16) mg/L], followed by arterothrombosis (AT) group [(15.17 ± 5.68) mg/L], stroke of undetermined etiology (SUD) group [(10.06 ± 3.89) mg/L] and small artery disease (SAD) group [(9.86 ± 3.75) mg/L, P = 0.027]. Among OCSP subtypes, the highest serum hs-CRP level was in total anterior circulation infarct (TACI) group [(17.02 ± 6.98) mg/L], followed by posterior circulation infarct (POCI) group [(15.91 ± 7.12) mg/L], partial anterior circulation infarct (PACI) group [(12.83 ± 4.95) mg/L] and lacunar infarct (LACI) group [(10.61 ± 5.73) mg/L, P = 0.005]. Serum hs - CRP levels are various in different modified TOAST and OCSP subtypes, which may reflect etiological and pathophysiological diversity of acute ischemic stroke, guide clinical treatment and help to predict prognosis. [ABSTRACT FROM AUTHOR]

This paper aims to investigate the curative effect of different surgeries for painful digital proper neuroma. There were 30 patients with painful digital proper neuroma, among whom 11 patients underwent arched double end-to-side neuroanastomosis, 10 patients underwent nerve graft with end-to-end neuroanastomosis, while other 9 patients underwent directly end - to - end neuroanastomosis. The results showed that the two - point discrimination (2 - PD) was (5.01 ± 0.71) mm in arched double end - to - side neuroanastomosis, which was significantly lower than that in nerve graft with end-to-end neuroanastomosis [(7.30 ± 1.21) mm] and directly end - to - end neuroanastomosis [(6.10 ± 1.10) mm; F = 3.144, P = 0.022]. According to Burchiel's efficacy, there were 9 excellent and 2 good fingers in arched double end-to-side neuroanastomosis; 4 excellent, 3 good and 3 fair fingers in nerve graft with end-to-end neuroanastomosis; 4 excellent, 4 good and one fair fingers in directly end-to-end neuroanastomosis. The efficacy of the first group was significantly better than those of the other 2 groups (Z = - 1.927, P = 0.041). The arched nerves of double end-to-side neuroanastomosis is a valuable surgical method for painful digital proper neuroma, which can quickly restore the sensation of fingers, and have better outcome than the other two methods. [ABSTRACT FROM AUTHOR]

This paper aims to observe the therapeutic effect of butylphthalide sodium chloride injection combined with urokinase in the treatment of acute ischemic stroke. A total of 60 patients with acute ischemic stroke were randomly divided into 2 groups: combined treatment group (butylphthalide sodium chloride injection + urokinase, N = 30) and control group (urokinase only, N = 30). National Institute of Health Stroke Scale (NIHSS) and Barthel Index (BI) were used to evaluate the improvement of neurological function and curative effect. Adverse reactions were also observed. As results, the markedly effective rate was 36.67% (11/30) and the total efficiency rate was 93.33% (28/30) in combined treatment group, while they were 10% (3/30) and 56.67% (17/30) in control group. There was significant difference between 2 groups (χ2 = 13.195, P = 0.004). Besides, the neurological function of patients in 2 groups elevated to different degrees at each time point after treatment (P = 0.020). There was no significant difference in the incidence rate of adverse reactions between 2 groups (P = 0.572). The results indicated that the curative effect of butylphthalide sodium chloride injection combined with urokinase in the treatment of acute ischemic stroke is better than that of urokinase. [ABSTRACT FROM AUTHOR]

Objective To assess the efficacy and safety of interferon-beta (IFN-β) as monotherapy versus placebo for patients with relapsing-remitting multiple sclerosis (RRMS). Methods We searched Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, LILACS, PEDRO, China Biology Medicine Disc (CBMDisc), as well as clinical trial registries and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP, retrieval deadline: June 2014). Furthermore, we checked reference lists of published reviews and retrieved articles, and communicated personally with investigators and biotechnology companies participating in trials of IFN-β in an effort to identify further studies or unpublished data. Two review authors independently screened studies, extracted data and evaluated the risk of bias. Formal Meta - analysis were conducted by using Review Manager software (Version 5.3.3) and the impacts of limitations in study design or execution (risk of bias), inconsistency in results, imprecision of results, indirectness of evidence and publication bias on the quality of the body of evidence were assessed. Results A total of 576 articles were retrieved. After screening of titles and abstracts, 26 studies were provisionally selected. The full text of papers were obtained for further assessment of eligibility. Finally, 5 studies were included, involving 2129 patients with RRMS (high-dose IFN-β group: N = 1076; placebo group: N = 1053). All studies were randomized, double-blind, controlled, parallel-group clinical trials with a follow-up for at least one year, evaluating IFN-β versus placebo as monotherapy for patients with RRMS. Most studies had methodological limitations, mainly on a high risk of attrition bias. Moreover, the intention to treat (ITT) principle was not used in data analysis. Data from only 919 patients (43.17%) were available to calculate the primary outcomes at 2 years of follow-up. Meta- analysis indicated IFN-β slightly reduced the number of patients with at least one relapse [risk ratio (RR) = 0.810, 95%CI: 0.740-0.890; P = 0.000] and the number of patients with disability progression during the first 2 years of follow-up (RR = 0.700, 95%CI: 0.550-0.880; P = 0.002). However, the sensitivity analysis (worst-case scenario analysis) showed no treatment effect (RR = 1.110, 95%CI: 0.730-1.680, P = 0.620; RR = 1.310, 95%CI: 0.600-2.890, P = 0.500, respectively). Data from 1581 patients (74.26%) were available to analyze the number of patients with at least one relapse during the first year of follow-up (RR = 0.740, 95% CI: 0.590-0.930; P = 0.010). Absolute risk reduction (ARR) was 13.24% and number needed to treat (NNT) was 8, which meant 8 patients were needed to treat to prevent one patient against relapse. However, the pooled results showed no treatment effect on the annualized relapse rate. The adverse events frequently caused by IFN - β included injection - site reactions, chills, pyrexia, myalgia, influenza - like symptoms, headache, increased alanine aminotransferase (ALT) and increased aspartate aminotransferase (AST). However, the incidences of lymphocytopenia, leucopenia, depression and committed or attempted suicide were not significantly increased by IFN-β. Conclusions There is high-quality evidence to support that IFN-β slightly reduces the number of patients with RRMS having relapse during the first year of follow-up, but the clinical effect beyond one year is uncertain. There is insufficient evidence to determine the efficacy of IFN-β in reducing the number of patients with disability progression. New randomized controlled trials of high quality are needed to assess the long-term efficacy. [ABSTRACT FROM AUTHOR]

In 19th century, neuromyelitis optica (NMO) indicated optic neuritis and myelitis with simultaneous onset of both sides. Later studies proposed that the onset of right or left side optic neuritis could be separated by weeks, months even years. The revolutionary discovery of aquaporin 4 (AQP4) antibody in 2004 by Vanda A Lennon challenged and changed the old concept of NMO. The concept of neuromyelitis optica spectrum disorders (NMOSDs) was proposed in 2007. Since then, a series of different terms have been proposed, including opticospinal multiple sclerosis (OSMS), NMOSDs, spectrum of NMO, expanded spectrum of NMO, etc. Through a summary of different concepts of NMO, this paper will make a comprehensive review on the evolution history of NMO study from 19th to 21st century, and the prospective targets of study will also be proposed. [ABSTRACT FROM AUTHOR]

Due to its special anatomical structures and immune pathophysiological mechanisms, brain damage repair is greatly different from damage repair of other systems. Secondary brain injury and inflammation are closely related. As a "double-edged sword", inflammation scavenges hazardous substances on the early stage of injury, but has side effects on normal brain tissue. The use of immunosuppressive therapy or hypothermia can inhibit immune injury, but the presence of reduced immunity may result in infection and tumorigenesis in the long term. Only reducing the autoimmune attack against brain tissue without affecting other immune capacity of the body will be optimized solution, and this paper will make a review on the research of immune tolerance in the treatment of brain injury with optimized program. [ABSTRACT FROM AUTHOR]

This paper aims to investigate the predictive value of initial intracranial pressure (ICP) for the prognosis of patients with traumatic brain injury (TBI). A prospective observational study was conducted in 118 TBI patients with ICP monitoring. The initial ICP [receiver operating characteristic (ROC) area = 0.725; 95%CI: 0.635-0.815] was similar to admission Glasgow Coma Scale (GCS; ROC area = 0.716; 95% CI: 0.616-0.816) or Marshall classification (ROC area = 0.690; 95% CI: 0.593-0.787) in predicting the prognosis of TBI patients. A Logistic regression analysis showed that initial ICP was associated with poor prognosis in TBI patients (OR = 0.943, 95%CI: 0.899-0.988; P = 0.014). The initial ICP in TBI patients could be used as an independent predictor of TBI patients' outcomes. [ABSTRACT FROM AUTHOR]

The incidence of cryptococcal meningitis (CM) and/or cryptococcal meningoencephalitis raised in recent years. These diseases often have occult onset and non-specific clinical features, so they are difficult to diagnose. This paper reviewed several related articles in the past few years, and found that combined use of repeated smear of cerebrospinal fluid, latex agglutination test and imageological examination is a good way to diagnose CM. Combined and long-term antifungal therapeutic strategy and surgery operation on occasion can improve the prognosis of CM patients. [ABSTRACT FROM AUTHOR]

Paroxysmal autonomic nerve dysfunction is a relatively rare clinical syndrome, and is clinically diagnosed based on the combined presence of sympathetic hyperactivity and parasympathetic hyperactivity. Early diagnosis of paroxysmal autonomic nerve dysfunction is difficult because its early clinical manifestations are complicated and varied, and it is easily misdiagnosed as central high fever, hospital infection, and so on. The causes and mechanism of the disease are complex, and there is no effective preventive measures. This paper will report 4 cases of patients with severe traumatic brain injury (TBI) who suffered from episodes of this disease. The effective therapies include bromocriptine, propranolol, physical cooling and hyperbaric oxygen therapy. The report also provides review of literature about paroxysmal autonomic nerve dysfunction, in order to improve diagnosis and treatment of the disease. [ABSTRACT FROM AUTHOR]

Background The main clinical manifestations of mitochondrial myopathy are chronic limb weakness and muscular soreness. Subclinical peripheral nerve injury is also reported, but acute axonal neuropathy-like syndrome concurrent with lactic acidosis is rare. In this paper the clinical features of 2 patients presenting as acute lactic acidosis and sudden muscle weakness were analyzed. Pathological changes and genetic mutations were detected. Methods Electromyography (EMG) and muscle biopsy were performed. Modified Gomori trichrome (MGT) and succinodehydrogenase (SDH) staining were used to identify pathological changes. Changes of ultra microstructure of muscular tissue were observed under electron microscope. Mitochondrial DNA (mtDNA) full length sequencing was performed using 24 pairs of partially overlapping primers. Results EMG showed a coexistence of neurogenic and myogenic changes. Dramatic decrease of motor nerve amplitude and moderately reduced sensory nerve amplitude were observed but nerve conduction velocity was normal in both patients. Impressive ragged red fibers were seen on MGT staining. Electron microscope showed dramatic mitochondrial abnormalities in Case 1 and paracrystaline inclusions in Case 2. mtDNA sequencing showed 3243A > G mutation in Case 1 and 8344A > G mutation in Case 2. Conclusions Mitochondrial myopathy can present as metabolic crisis like acute lactic acidosis, dyspnea and acute motor axonal neuropathy-like syndrome. It is a life-threatening phenotype that needs more attention. [ABSTRACT FROM AUTHOR]

This paper aims to evaluate the effect of minimally invasive puncture external ventricular drainage (EVD) combined with early lumbar drainage (LD) for clearance of hematoma in the third and fourh ventricles in patients with intraventricular hemorrhage (IVH). Fifty - four IVH patients were analyzed. Twenty-seven patients in combined treatment group were treated with EVD and early LD while others in control group were treated with EVD only. Urokinase was administered into ventricles in all patients. The difference of hematoma clearance rate between 2 groups was compared. Long-term therapeutic effect of the two methods was also evaluated. The results showed that in combined treatment group, cases with 3-day clearance rate over 85% occupied 59.26% (16/27), which was higher than that of control group (22.22%, 6/ 27; x2 =7.670, P = 0.006). Two to three days after surgery, hematoma declined more quickly in combined treatment group comparing with control group (t = 3.475, P =0.001). Long-term effective rate of treatment in combined treatment group was 81.48% (22/27), which was higher than that of control group (55.56%, 15/27; x2 =4.207, P = 0.040). Minimally invasive puncture EVD combined with early LD could increase hematoma clearance rate in the third and fourth ventricles. It is helpful for improving the prognosis of IVH patients. [ABSTRACT FROM AUTHOR]

Glycogen storage disease type II (GSD II) is a rare autosomal recessive hereditary metabolic disorder characterized by progressive atrophy and weakness of skeletal muscle. It can be confirmed by clinical history, acid α - glucosidase (GAA) testing and GAA mutations. Early targeting treatment and nursing can improve the prognosis and quality of life of patients with GSD II. Progress in genetic diagnosis and management of GSD II will be reviewed in this paper. [ABSTRACT FROM AUTHOR]

In order to understand the latest progression on neuromuscular disorders for clinicians, this review screened and systemized the papers on neuromuscular disorders which were collected by PubMed from January 2013 to February 2014. This review also introduced the clinical diagnosis and treatment hightlights on glycogen storage disease type II (GSD II), Duchenne muscular dystrophy (DMD), amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA). The important references will be useful for clinicians. [ABSTRACT FROM AUTHOR]

Intracranial enterogenous cyst is a kind of benign disease. This paper retrospectively analyzed the clinical data of 4 cases with enterogenous cysts, which were confirmed by surgery, pathology and combined with relevant literature to summarize the causes, clinical features, diagnosis and treatment of this disease. It is common in middle - aged women and occurs in the midline region. It is difficult to distinguish intracranial enterogenous cyst from other intracranial cysts, because there are no characteristic changes in imaging or clear diagnostic criteria. It increases the difficulty of preoperative diagnosis and misdiagnosis rate. Diagnosis depends on intraoperative findings and pathological examination. Total resection is the only curative means. [ABSTRACT FROM AUTHOR]

The word "dementia" originates with Dr. Philippe Pinel of France. Back in 1801, Pinel reported a young female patient, aged 34, who was exhibiting some strange symptoms for someone in her age group. Pinel described this woman's condition as "demence", or an incoherence of mental faculties. It was believed that the term "dementia" came from this association. More than a century later (1906), Dr. Alois Alzheimer published a paper on one of his patients who had very similar symptoms and behaviors as Pinel's patient. This description, of a woman known as Auguste D, was the first scientific report of the disease now known as Alzheimer's disease. It is now clear that Alzheimer's disease is a major cause of dementia in elderly people as well as in relatively young adults. Research in the last two centuries has led to a greatly improved understanding of what Alzheimer's disease is, who gets it, and how it develops and affects the brain. Those works are beginning to pay off with better diagnostic techniques, improved treatments, and even potential ways of preventing these diseases. [ABSTRACT FROM AUTHOR]

High-grade gliomas are central nervous system malignancies which are difficult to treat. Surgery, temozolomide combined with radiotherapy postoperatively and adjuvant chemotherapy with temozolomide have been established as the standard treatment options for high-grade gliomas. Nevertheless, the prognosis of patients with high-grade gliomas remains poor. At present, there is no standard therapy for recurrent or relapsed high - grade gliomas. Temozolomide is still an effective drug for the treatment of recurrent high-grade gliomas. According to the characteristics of patients, there have been many kinds of temozolomide administration and other treatments in combination. Individual therapy were paid more attention, so that the patients with high-grade gliomas recurrence could get greater survival benefit. This paper aims to introduce the progress of temozolomide in the treatment of recurrent high-grade gliomas in recent years [ABSTRACT FROM AUTHOR]

Insomnia is one of the common complaints among all clinical departments. In recent years, some studies have demonstrated that insomnia symptoms can be improved or treated by some antidepressants. Based on literature search both at home and abroad, this paper summarized the effect of various antidepressants with different pharmacological properties on sleep, and the progress of clinical application of antidepressants in treating insomnia according to the classification of antidepressant drugs. [ABSTRACT FROM AUTHOR]

Background Epithelioid malignant peripheral nerve sheath tumor (EMPNST) is a rare malignant soft tissue tumor, and is more common in adult male. EMPNST originates from nerve, mainly located in the limbs, head and neck, and spine. It is an aggressive tumor with high tendency for local recurrence, and about half of the cases appear distant metastasis. This paper aims to investigate the clinicopathological features of cervial EMPNST. Methods and Results A 48 - year - old male mainly presented weakness of limbs, expecially left lower extremty with ankle swelling. MRI showed space - occupying lesion in segment C3-5, considering recurrence of intraspinal tumor 2 years after operation. Tumor resection, repairing of spinal dura mater and laminectomy were made from inion to C7 level. It was found during the surgery that most part of the tumor was located in front of C3-5 spinal nerve, left intraspinal and outside of dura mater. Because part of the tumor grew through the opening of titanium plate, the tumor could not be totally removed. According to postoperative histomorphological observation, tumor cells arranged in sheets or nests, and were separated by fibrous tissue. Most tumor cells were epithelioid, while small part of tumor cells were fusiform. Frequent mitotic activity was found, and part of the region appeared focal necrosis. Immunohistochemical staining showed that tumor cells were positive for pan cytokeratin (PCK), epithelial membrane antigen (EMA), vimentin (Vim), synaptophysin (Syn), chromogranin A (CgA), and S?100 protein (S?100); and were negative for actin, desmin (Des), progestrone receptor (PR), glial fibrillary acidic protein (GFAP), CD34, CD31 and HMB45; Ki - 67 labeling index was above 25% . Reticular fiber staining showed that the epithelioid cell nests were surrounded by reticular fibers. Fluorescence in situ hybridization (FISH) detection showed negative for SS18 gene translocation. Combining with the history, the final pathological diagnosis was cervical EMPNST. Conclusion EMPNST lacks of morphological characteristics, and needs to be differentiated from a variety of benign or malignant tumors exhibiting epithelioid features. It is considered that clinical materials, morphological features and immunophenotype are helpful to avoid confusion with other similar lesions. S?100 is not a specific marker, but is a valuable diagnostic index. PCK and EMA can present strongly positive expression. [ABSTRACT FROM AUTHOR]

Neuropathic pain (NP) is a transient dysfunction caused by the damage of peripheral nerve and central nervous system, characterized with hyperalgesia, allodynia and spontaneous pain. Surgical treatment of neuropathic pain has experienced a long process, and plays an important role. This paper reviews recent documents of surgical techniques in the treatment of neuropathic pain. There are three kinds of surgical techniques: neuromodulation, microsurgical lesions and nerve decompression. [ABSTRACT FROM AUTHOR]

Dystonias are heterogeneous hyperkinetic movement disorders characterized by involuntary muscle contractions which result in twisting, repetitive movements and abnormal postures. In recent years, there was a great advance in molecular genetic studies of primary dystonia. This paper will review the clinical characteristics and molecular genetic studies of primary dystonia, including early-onset generalized torsion dystonia (DYT1), whispering dysphonia (DYT4), dopa-responsive dystonia (DYT5), mixed- type dystonia (DYT6), paroxysmal kinesigenic dyskinesia (DYT10), myoclonus-dystonia syndrome (DYT11), rapid-onset dystonia parkinsonism (DYT12), adult-onset cervical dystonia (DYT23), craniocervical dystonia (DYT24) and primary torsion dystonia (DYT25). [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a common neurodegenerative disease in the elderly, and is the most common cause of dementia. Epidemiological studies have discovered that, 44% of patients with AD are associated with sleep disorders and (or) circadian rhythm disorders. Now there are growing evidences indicating that interstitial fluid amyloid - β protein (A β) levels exhibit circadian rhythm fluctuation, and sleep disorders will accelerate the process of Aβ deposition, which may act as a risk factor of AD, suggesting the possible reciprocal interaction between sleep disorders and AD. The mechanism is not yet completely clear. Sleep disorders may be related with the impairments of both sleep - wake regulating system, circadian rhythm regulating system and the change of zeitgeber in AD. Sleep disorders would affect neuronal activity, neurotransmitter secretion, and as a stressor affecting A β processing and metabolism, thus accelerate the pathological process of AD. This paper reviewed the progress in the studies of reciprocal interaction between sleep disorders and Alzheimer's disease and the possible mechanisms. [ABSTRACT FROM AUTHOR]

Sleep -wake disturbances (SWD) after stroke is a sleep -wake disorder resulting from central nervous system lesion caused by stroke. SWD includes hypersomnia, excessive daytime sleepiness (EDS), fatigue and so on. The prevalence rate of SWD is only less than sleep -related breathing disturbances (SBD). Recent studies suggest that SWD is frequent and negatively affects rehabilitation and quality of life of patients with stroke, and treatment of poststroke SWD may favorably influence stroke outcome. SWD may become a new target of treatment and rehabilitation of stroke. This paper reviewed the progress of this issue. [ABSTRACT FROM AUTHOR]