7.0T nuclear magnetic resonance evaluation of the amyloid beta(1–40) animal model of Alzheimer's disease: comparison of cytology verification

3.0T magnetic resonance spectroscopic imaging brain function in Alzheimer＇s disease. However, is a commonly used method in the research ot the role of 7.0T high-field magnetic resonance spectroscopic imaging in brain function of Alzheimer＇s disease remains unclear. In this study, 7.0T magnetic resonance spectroscopy showed that in the hippocampus of Alzheimer＇s disease rats, the N-acetylaspartate wave crest was reduced, and the creatine and choline wave crest was elevated. This finding was further supported by hematoxylin-eosin staining, which showed a loss of hippocampal neurons and more glial cells. Moreover, electron microscopy showed neuronal shrinkage and mitochondrial rupture, and scanning electron microscopy revealed small size hippocampal synaptic vesicles, incomplete synaptic structure, and reduced number. Overall, the results revealed that 7.0T high-field nuclear magnetic resonance spectroscopy detected the lesions and functional changes in hippocampal neurons of Alzheimer＇s disease rats in vivo, allowing the possibility for assessing the success rate and grading of the amyloid beta （1-40） animal model of Alzheimer＇s disease.

开展社区老年患者药学服务的体会

我国已全面进入老龄化社会,老年患者成为社区就诊的主要群体,社区药师要不断探索老年患者药学服务的新模式,使社区药学服务不断完善的同时,提高老年患者的生活质量。本文结合作者的日常工作,总结了社区就诊患者的特点和开展社区药学服务的体会,以供同行参考。

Effect of osteoporosis and intervertebral disc degeneration on endplate cartilage injury in rats

Objective:To investigate the effect of osteoporosis and intervertebral disc degeneration on the endplate cartilage injury in rats.Methods:A total of 48 female Sprague Dawley rats(3 months)were randomly divided into Groups A,B,C and D with 12 rats in each group.Osteoporosis and intervertebral disc degeneration composite model,simple degeneration model and simple osteoporosis model were prepared in Groups A,B and C respectively.After modeling,four rats of each group at 12th.18th and 24th week were sacrificed,Intervertebral height of cervical vertebra C6/C7 was measured.Micro-CT was used to image the endplate of cephalic and caudal cartilage at C6/C7 intervertebral disc.Abraded area rate of C6 caudal and C7 cephalic cartilage endplate was calculated,and then C6/C7 intervertebral disc was routinely embedded and sectioned.stained with safranin O to observe histological changes microscopically.Results:At 12,18 and24 weeks,intervertebral disc height of C6/C7 were(0.58±0.09)mm,(0.53±0.04)mm and(0.04±0.06)mm in Group A rats,(0.55±0.05)mm,(0.52±0.07)mm and(0.07±0.05)mm in Group B rats.At 24th week.intervertebral disc height of Group A rats was significantly lower than that of Group B rats(P<0.05);intervertebral disc height of Groups A and B rats at each time point were significantly lower than that of Groups C and D(P<0.05).There was no significantly statistical difference of intervertebral disc height between Groups C and D(P>0.05).At 12 and 18 weeks,the abraded rate of C6 caudal and C7 cephalic cartilage endplate in Group A rats were significantly higher than that in Groups B.C and D rats(P<0.05);the abraded rate in Group B was significantly higher than that in Groups C and D(P>0.05).Microscopic observation of CT showed that ventral defects in C6caudal or C7 cephalic cartilage endplate in Groups A and B appeared after 12 weeks of modeling;obvious cracks were found in front of the C6 and C7 vertebral body,and cartilage defect shown the trend of"repairing"at 18 and 24 weeks after modeling.Conclusions:Intervertebral disc degeneration and osteoporosis can cause damage to the cartilage endplate.Co-existence of these two factors can induce more serious damage to the endplate.which has possitive correlation with intervertebral disc degeneration.Osteoporosis plays a certain role in intervertebral disc degeneration process,and accelerates the degeneration of intervertebral disc in a specific time window.

Intraoperative hemodynamic parameters of middle cerebral artery and other artery aneurysms utilizing transcranial Doppler ultrasonography

BACKGROUND： Hemodynamic changes accompany the initiation, development and rupture of middle cerebral artery （MCA） aneurysms. The complexity of the intraaneurysmal hemodynamic factors has not been completely clarified by the indirect measures and methods used in previous studies. OBJECTIVE： To evaluate correlations of intraoperative hemodynamic factors to initiation and rupture of MCA aneurysms. DESIGN, TIME AND SETTING： A case-control study was performed at the Department of Neurosurgery, Tiantan Hospital Affiliated to Capital Medical University, China between March and October 2008. PARTICIPANTS： A total of 12 consecutive patients diagnosed with MCA aneurysms （MCA aneurysms group） and five patients without middle cerebral artery aneurysms （with aneurysms located at other arteries, control group） were enrolled at the Department of Neurosurgery, Tiantan Hospital Affiliated to Capital Medical University, China. METHODS： The proximal and distal arteries of MCA aneurysms were exposed visibly in the MCA aneurysm group. The M1 segment of MCA without the aneurysm and the aneurysm on other arteries were also exposed visibly in the control group. Hemodynamic indices were then measured using an intraoperative 16 MHz probe installed in a Multi-Dop TCD8X4 device. MAIN OUTCOME MEASURES： Mean （time-averaged velocity） difference, maximum mean, pulsatility index difference, maximum pulsatility index, resistance index difference, maximum resistance index; correlation of development and rupture of MCA aneurysms to intraoperative hemodynamic factors of the parent artery. RESULTS： A total of 12 patients underwent microsurgery for treatment to occlude 15 MCA aneurysms. Of the 15 MCA aneurysms, 12 were located at the bifurcation, two at the M1 segment and one at the M3 segment; eight of the aneurysms were unruptured and seven were ruptured. The whole indices with combination mean difference, maximum mean, and maximum pulsatility index of the aneurysms were important factors influencing the rupture of MCA aneurysms （t = 2.92, P = 0.03, constant）. A higher velocity intraaneurismal flow at the bifurcation was identified （t = 3.48, P = 0.01, constant）. After the aneurysm was completely occluded, global high-velocity flow could not be detected in the parent arteries （t = 2.57, P=0.03, constant）. CONCLUSION： When short-term high-velocity blood flow is present, aneurysms can be easily initiated and ruptured at the bifurcation of MCA.

Fabrication of magnetically responsive anti-fouling and easy-cleaning nanofiber membrane and its application for efficient oil-water emulsion separation

The magnetically responsive anti-fouling nanofiber membrane(MRANM)was fabricated for efficient oilwater emulsion separation,which could be cleaned using oscillating magnetic field.MRANM was prepared by grafting superparamagnetic Fe_(3)O_(4) nanoparticles onto the surface of electrospun polyacrylonitrile nanofiber membrane(PANM).Compared with PANM,the water contact angle of MRANM decreased from 104°to 0°,indicating that the hydrophilicity of the membrane was significantly improved.For the emulsions of hexadecane,octane and rapeseed oil,the separation efficiency was 98.04%,96.59%and 92.67%,respectively.After the treatments in oscillating magnetic field,the separation efficiency kept above 95%after 8 times recycling,which indicated that the MRANM had good regenerability and reusability.The as-fabricated membrane with magnetic responsiveness facilitated an effective method for solving the membrane fouling problem during practical applications of separation high viscosity oil-water emulsion.

Effect of Xiaobailing Decoction on Melanocytes in Vitro

To observe the effect of Xiaobailing Decoction （消白灵汤） on murine melanocytes in vitro and to explore the mechanism of Xiaobailing Decoction in the treatment of vitiligo. Methods： B-16F10 murine melanoma cells were cultured in 1640 medium and treated respectively with different concentrations （lmg/ml, 2mg/ml, 3mg/ml） of the Chinese drug Xiaobailing Decoction and its main components, the drugs for replenishing the lddney-yang, and the drugs for nourishing blood and activating blood circulation, etc. for 7 days. MMT assay was used to determine the proliferation of B-16F10 murine melanoma cells. NaOH cleavage assay was adopted to measure the melanogenesis of melanocytes. Results：Xiaobailing Decoction, the drugs for replenishing the kidney-yang and the drugs for nourishing blood and activating blood circulation at different concentrations significantly improved the proliferation of B-16F10 murine melanoma cells from the 3rd day to the 5th day （P〈0.05）, with Xiaobailing Decoction at the concentrations of lmg/ml having the most distinct action on promoting the proliferation of melanocytes on the 3rd day （P〈0.001）; And the drugs for replenishing the lodney-yang at the concentrations of 2mg/ml and 3mg/ml and the drugs for nourishing blood and activating blood circulation at 3mg/ml significantly increased melanogenesis of melanocytes （P〈0.05）. Conclusion： Xiaobailing Decoction can promote melanocytic proliferation and melanogenesis in vitro, and it is indicated that the drugs for replenishing the kidney-yang and the drugs for nourishing blood and activating blood circulation play an important role in treating vitiligo.

Prognostic factors influencing clinical outcomes of glioblastoma multiforme

Background Glioblastoma multiforme （GBM） is the most malignant kind of astrocytic tumors and is associated with a poor prognosis. In this retrospective study, we assessed the clinical, radiological, genetic molecular and treatment factors that influence clinical outcomes of patients with GBM. Methods A total of 116 patients with GBM who received surgery and radiation between January 2006 and December 2007 were included in this study. Kaplan-Meier survival analysis and Cox regression analysis were used to find the factors independently influencing patients＇ progression free survival （PFS） time and overall survival （OS） time. Results Age, preoperative Karnofsky Performance Scale （KPS） score, KPS score change at 2 weeks after operation, neurological deficit symptoms, tumor resection extent, maximal tumor diameter, involvement of eloquent cortex or deep structure, involvement of brain lobe, Ki-67 expression level and adjuvant chemotherapy were statistically significant factors （P 〈0.05） for both PFS and OS in the univariate analysis. Cox proportional hazards modeling revealed that age 〈50 years, preoperative KPS score 〉80, KPS score change after operation 〉0, involvement of single frontal lobe, non-eloquent area or deep structure involvement, low Ki-67 expression and adjuvant chemotherapy were independent favorable factors （P 〈0.05） for patients＇ clinical outcomes. Conclusions Age at diagnosis, preoperative KPS score, KPS score change at 2 weeks postoperation, involvement of brain lobe, involvement of eloquent cortex or deep structure, Ki-67 expression level and adjuvant chemotherapy correlate significantly with the prognosis of patients with GBM.

Limbic Encephalitis Associated with Anti-y-aminobutyric Acid B Receptor Antibodies： A Case Series from China

Background： Autoimmune encephalitis associated with antibodies against γ-aminobutyric acid B receptor （GABABR） in patients with limbic encephalitis （LE） was first described in 2010. We present a series of klan Chinese patients tbr further clinical refinement. Methods： Serum and cerebrospinal fluid （CSF） samples from patients referred to the program of encephalitis and paraneoplastic syndrome of Peking Union Medical College Hospital were tested with indirect immunofluorescence. Clinical information of patients with anti-GABABR antibody positivity was retrospectively reviewed, and descriptive statistical analysis was performed. Results： All eighteen anti-GABABR antibody-positive cases had limbic syndromes, and electroencephalogram （EEG） or neuroimaging evidence fulfilled the diagnostic criteria of LE. Four patients had additional antibodies against Hu in serum and one had anti-N-methyl-d-aspartate receptor antibody in both sera and CSF. Seventeen （17/18） patients presented with new-onset refractory seizure or status epileptics. Twelve （12/18） patients had memory deficits, 11 （11/18） patients had personality change, 7 （7/18） patients had disturbance of consciousness, and 3 （3/18） patients showed cerebellar dysfunction. One patient with LE had progressive motor and sensory polyneuropathy. Lung cancer was detected in 6 （6/18） patients. Ten （10/18） patients showed abnormality in bilateral or unilateral mediotemporal region on magnetic resonance imaging. Ten （10/18） patients had temporal lobe epileptic activity with or without general slowing on EEG. Seventeen patients received immunotherapy and 15 of them showed neurological improvement. Four patients with lung cancer died within 1-12 months due to neoplastic complications. Conclusions： Our study demonstrates that most Han Chinese patients with anti-GABABR antibody-associated LE have prominent refractory epilepsy and show neurological improvement on immunotherapy. Patients with underlying lung tumor have a relatively poor prognosis. Testing for anti-GABABR antibodies is necessary for patients with possible LE or new-onset epilepsy with unknown etiology.

Fractionated resection on low grade gliomas involving Broca＇s area and insights to brain plasticity

Background Resent advances on functional mapping have enabled us to conduct surgery on gliomas within the eloquent area. The objective of the article is to discuss the feasibility of a planned fractionated strategy of resection on low-grade gliomas （LGGs） involving Broca＇s area. We report the first surgical series of planned fractionated resections on LGGs within Broca＇s area, focusing on language functional reshaping. Methods Four patients were treated with fractionated operations for LGGs involving Broca＇s area. All cases underwent conventional magnetic resonance （MR） scanning, language functional MR and diffusion tensor imaging （DTI） before operation. The resections were then performed on patients under awake anesthesia using intraoperative electrical stimulation （IES） for functional mapping. Pre- and post-operative neuro-psychological examinations were evaluated.Results Total resections were achieved in all cases as confirmed by the postoperative control MR. After transient language worsening, all patients recovered to normal 3-6 months later. Language functional MR scannings have shown language functional cortical and subcortical pathway reorganization （in the perilesion or contra-lateral hemisphere） after the operation. All patients returned to a normal socioprofessional life. Conclusions By utilizing the dynamic interaction between brain plasticity and fractionated resections, we can totally remove the tumor involving Broca＇s structure without inducing permanent postoperative deficits and even improve the quality of life.

Disruption of δ-opioid receptor phosphorylation at Threonine 161 attenuates morphine tolerance in rats with CFA-induced inflammatory hypersensitivity

Objective Our previous study identified Threonine 161 （Thr-161）, located in the second intracellular loop of the 6-opioid receptor （DOR）, as the only consensus phosphorylation Cdte for cyclin-dqpendent kinase 5 （CdkS）. The aim of this study was to assess the function of DOR phosphorylation by Cdk5 in complete Freund＇s adjuvant （CFA）-induced inflammatory pain and morphine tolerance. Methods Dorsal root ganglion （DRG） neurons of rats with CFA-induced in- flammatory pain were acutely dissociated and the biotinylation method was used to explore the membrane localization of phosphorylated DOR at Thr-161 （pThr-161-DOR）, and paw withdrawal latency was measured after intrathecal delivery of drugs or Tat-peptide, using a radiant heat stimulator in rats with CFA-induced inflammatory pain. Results Both the total amount and the surface localization of pThr-161-DOR were significantly enhanced in the ipsilateral DRG following CFA injection. lntrathecal delivery of the engineered Tat fusion-interefering peptide corresponding to the second intracellular loop of DOR （Tat-DOR-2L） increased inflammatory hypersensitivity, and inhibited DOR- but not μ-opioid receptor-mediated spinal analgesia in CFA-treated rats. However, intrathecal delivery of Tat-DOR-2L postponed morphine antinociceptive tolerance in rats with CFA-induced inflammatory pain. Conclusion Phosphorylation of DOR at Thr-161 by Cdk5 attenuates hypersensitivity and potentiates morphine tolerance in rats with CFA-induced inflammatory pain, while disruption of the phosphorylation of DOR at Thr- 161 attenuates morphine tolerance.

Relationships between hemorrhage, angioarchitectural factors and collagen of arteriovenous malformations

Objective While associations between the angioarchitecture of arteriovenous malformations （AVMs） in the brain and pathological features have been described, here we investigated the relationship between the angioarchitecture, the pathological features of the vessel wall, and hemorrhagic events. Methods The study was conducted on 43 patients： 16 with ruptured AVM （rAVM）, 15 with non-ruptured AVM （nrAVM）, 6 with craniocerebral trauma （control） and 6 with epilepsy （control）. The diagnosis of AVM was confirmed by preoperative digital subtraction angiography. Tissues were stained with hematoxylin and eosin and Masson＇s trichrome （for collagen fibers） to evaluate the vessel wall structure and endothelial integrity. The content and distribution of collagen types I and III in the vessel wall were assessed by immunohistochemical staining. Results In the nrAVM group, the nidus had more draining veins than the rAVM group （P 〈0.05）. Severely damaged endothelial cells, significantly fewer smooth muscle cells in the media, and hyperplasic type-I and -III collagen fibers were found in the rAVM group. The content of collagen types I and III in rAVMs was higher than that in the nrAVM （P 〈0.05） and control groups （P 〈0.01）. Conclusion There is an association between angioarchitectural features such as the number of draining veins and the pathological structure of the AVM wall. These abnormalities may contribute to AVM rupture.

Risk factors and treatments for brain metastasis in patients with adenocarcinoma of the lung: a retrospective analysis of 373 patients

Background: Risk factors and treatments for brain metastasis (BM) in patients with adenocarcinoma have not been fully profiled in previous studies because of the enrolment of patients with tumours of mixed histology. Thus, we specifically addressed the issue in patients with adenocarcinoma. Methods: Clinical data for 373 patients with pathologically confirmed adenocarcinoma were studied retrospectively. Factors including age (≤60 vs.＞60), gender (male vs. female), stage at diagnosis, T status (T1-2 vs. T3-4), N status (N0-1 vs. N2-3), epidermal growth factor receptor (EGFR) mutation status (wild-type vs. mutant) and smoking status (never vs. current) were analyzed. Results: In multivariate analysis, age (P=0.006) and N status (P=0.041) were independent risk factors for BM. In patients with BM, adding systemic therapy to local therapy improved median post-brain-metastasis survival (mPBMS) (P=0.02). However, if stratification was conducted according to the recursive partitioning analysis (RPA) classification or graded prognostic assessment (GPA) scoring, only patients in RPA class Ⅱ (P=0.020) or with GPA score 1.5-2.5 (P=0.032) could benefit from local plus systemic therapy. Those who received both pemetrexed and tyrosine kinase inhibitors (TKIs) as systemic therapies had a longer mPBMS than those who received TKIs alone, regardless of whether local therapy was applied. In patients with EGFR-sensitive mutations, TKIs therapy led to a longer mPBMS than conventional chemotherapy (P=0.002). Conclusions: Adenocarcinoma patients who were younger than 60 years of age and those with N2-3 disease have a significantly higher risk of BM. The addition of systemic therapy to local therapy can significantly prolong mPBMS, but the survival benefit confined in certain populations. Patients with opportunity to receive both pemetrexed and TKIs had the longest mPBMS.

Risk factors of brain metastasis of lung squamous cell carcinoma:a retrospective analysis of 188 patients from single center

Background:To explore risk factors and the efficacy of treatment strategies for brain metastasis (BM) in squamous cell carcinoma (SCC) of the lung.Methods:The clinical data of 188 pathologically confirmed as squamous cell carcinoma or adenosquamous carcinoma patients were studied retrospectively. Factors including age (<60 vs.≥60), gender, stage at diagnosis, T status (T1-2 vs. T3-4), N status (N0-1 vs. N2-3), histology (squamous vs. adenosquamous), smoking history (non-smoker vs. currentsmoker) and serum tumor markers (normal vs. elevated) were analyzed.Results:The incidence of BM was 19.1％(36/188) in our cohort. Patients who were female (p=0.005), had advanced disease at diagnosis (p<0.001), had adenosquamous carcinoma histology (p=0.033) or had elevated serum level of CEA at diagnosis (p<0.001) had significantly higher incidence of BM. In multivariate analysis, female (p=0.034, HR=18.874) and elevated serum level of CEA at diagnosis (p=0.009, HR=19.824) were independent risk factors of BM. BM patients who received additional systemic therapy after local therapy had significantly longer post-BM survival than those who received local therapy only (p=0.004, HR=0.058). Gemcitabine/platinum-containingregimen (GP) and taxans/platinum-containing regimen (TP) led to comparable brain-metastasis-free survival (BMFS) (p=0.10).Conclusions:Females and patients with elevated serum level of CEA at diagnosis had a higher risk of developing BM. The following systemic therapy after local therapy prolonged the survival of BM patient, but the efficacy of GP and TP was comparable in terms of preventing BM.

Advances in the adjuvant chemotherapy of glioblastoma multiforme： opportunities and challenges for the neurosurgeons in China

Glioblastoma multiforme （GBM） is the most common primary malignant brain tumor in adults, which accounts for approximately 50% of all gliomas. Its prognosis is particularly disappointing with a median life expectancy less than a year even when the patients are treated with the most aggressive regimens. Over the past 10 years, a number of trials have tried to establish whether adjuvant chemotherapy, as well as molecularly targeted therapy, provides GBM patients with clinically meaningful benefits.

Randomized Double-Blind Clinical Trial of Moluodan(摩罗丹)for the Treatment of Chronic Atrophic Gastritis with Dysplasia

Objective： To assess the efficacy and safety of Moluodan （摩罗丹~） in treating dysplasia in chronic atrophic gastritis （CAG） patients. Methods： This was a multi-centered, double-blind, randomized controlled trial. The total of 196 subjects were assigned to receive either Moluodan or folic acid in a 2：1 ratio by blocked randomization. Mucosa marking targeting biopsy （MTB） was used to insure the accuracy and consistency between baseline and after 6-month treatment. Primary outcomes were histological score, response rate of pathological lesions and dysplasia disappearance rate. Secondary endpoints included gastroscopic findings, clinical symptom and patient reported outcome （PRO） instrument. Results： Dysplasia score decreased in Moluodan group （P=0.002）, significance was found between groups （P=0.045）. Dysplasia disappearance rates were 24.6% and 15.2% in Moluodan and folic acid groups respectively, no significant differences were found （P=0.127）. The response rate of atrophy and intestinal metaplasia were 34.6% and 23.0% in Moluodan group, 24.3% and 13.6% in folic acid group. Moluodan could improve erythema （P=0.044）, and bile reflux （P=0.059）, no significance between groups. Moluodan was better than folic acid in improving epigastric pain, epigastric suffocation, belching and decreased appetite （P〈0.05）, with symptom disappearance rates of 37% to 83%. Conclusions： Moluodan improved dysplasia score in histopathology, and erythema and bile reflux score in endoscopy, and superior to folic acid in improving epigastric pain, epigastric suffocation, belching and decreased appetite.

Controlling the Recurrence of Pelvic Endometriosis after A Conservative Operation:Comparison between Chinese Herbal Medicine and Western Medicine

Objective： To compare the clinical effect of Chinese medicine （CM） and Western medicine （WM） for controlling the recurrence of pelvic endometriosis after a conservative operation. Methods： The study was a multi-center, randomized, parallel controlled and prospective clinical trial. Patients were randomly divided into two groups： CM group （106 cases） and WM group （102 cases）. Drugs were given to patients during 1--5 days of the first menstruation after a conservative operation in both groups. Patients with stages I and I1 （revised American Fertility Society） were treated for 3 months, while the patients with stages Ill and IV were treated for 6 months. The patients in the CM group were treated using three types of Chinese herbal medicine based on syndrome differentiation. Patients in the WM group were treated using gonadotropin releasing hormone agonist （GnRH-a） or gestrinone. Patients treated with GnRH-a received add-back therapy of Tibolone Tablets once a day after 4 months of treatment. Any cases of dysmenorrheal chronic pelvic pain, menstruation and any adverse reactions of patients were recorded once a month during the preoperative and postoperative periods and once every 3 months during the follow-up period. During the preoperative, postoperative and the follow-up periods, patients underwent type B ultrasonography of the pelvis and measurements of serum CA125 levels, gynecologic examination, routine evaluations of blood, urine, hepatic function （glutamate pyruvate transaminase）, renal function （blood urea nitrogen） and electrocardiograms. Dudng the follow-up period they underwent type B pelvic ultrasonography, measurement of serum CA125 levels and further gynecologic examinations. The two treatments were compared for clinical recurrence rates, pregnancy rates and the incidence of adverse reactions. Results： The incidence and timing of recurrence of endometriosis were not significantly different between the two groups. The first pregnancy achieved by the patient in the CM .qroup was si.clnificantly earlier than that in the WM group （P〈0.05）. Moreover, the incidence of adverse reactions in the WM group was significantly higher than in the CM group （P〈O.01）. Conclusions： Treatment with Chinese herbal medicines prevented the recurrence of endometriosis after a conservative operation, improved the conception rate and showed fewer and lighter adverse reactions than did treatment with WM therapy. Treatment with Chinese herbal medicine meets the need of patients wishing to have a child following endometriosis and is an appropriate form of clinical treatment.

Original article： Anterior and middle skull base reconstruction after tumor resection

Background Surgical management of skull base tumors is still challenging today due to its sophisticated operation procedure. Surgeons who specialize in skull base surgery are making endeavor to promote the outcome of patients with skull base tumor. A reliable skull base reconstruction after tumor resection is of paramount importance in avoiding life-threatening complications, such as cerebrospinal fluid leakage and intracranial infection. This study aimed at investigating the indication, operation approach and operation technique of anterior and middle skull base reconstruction. Methods A retrospective analysis was carried out on 44 patients who underwent anterior and middle skull base reconstruction in the Department of Neurosurgery at Beijing Tiantan Hospital between March 2005 and March 2008. Different surgical approaches were selected according to the different regions involved by the tumor. Microsurgery was carried out for tumor resection and combined endoscopic surgery was performed in some cases. According to the different locations and sizes of various defects after tumor resection, an individualized skull base soft tissue reconstruction was carried out for each case with artificial materials, pedicled flaps, free autologous tissue, and free vascularized muscle flaps, separately. A skull base bone reconstruction was carried out in some cases simultaneously. Results Soft tissue reconstruction was performed in all 44 cases with a fascia lata repair in 9 cases, a free vascularized muscle flap in 1 case, a pedicled muscle flap in 14 cases, and a pedicled periosteal flap in 20 cases. Skull base bone reconstruction was performed on 10 cases simultaneously. The materials for bone reconstruction included titanium mesh, free autogenous bone, and a Medpor implant. The result of skull base reconstruction was satisfactory in all patients. Postoperative early-stage complications occurred in 10 cases with full recovery after conventional treatment. Conclusions The specific characteristics of skull base defects in various regions require different reconstruction materials and methods. The individualized reconstruction based on different skull base defects can achieve satisfactory results.

The Chinese Stroke Association scientific statement:intravenous thrombolysis in acute ischaemic stroke

The most effective medical treatment for acute ischaemic stroke(AIS)is to offer intravenous thrombolysis during the ultra-early period of time after the onset.Even based on the Consensus of Chinese Experts on Intravenous Thrombolysis for AIS in 2012 and 2014 Chinese Guidelines on the Diagnosis and Treatment of AIS,the rate of thrombolysis for AIS in China remained around 2.4%,and the rate of intravenous tissue plasminogen activator usage was only about 1.6%in real world.The indication of thrombolysis for AIS has been expanded,and contraindications have been reduced with recently published studies.In order to facilitate the standardisation of treating AIS,improve the rate of thrombolysis and benefit patients who had a stroke,Chinese Stroke Association has organised and developed this scientific statement.

Prevalence of wearing-off and dyskinesia among the patients with Parkinson’s disease on levodopa therapy: a multi-center registry survey in China's Mainland

Objective:Chronic levodopa(L-dopa)treatment in Parkinson’s disease(PD)is often associated with the development of motor complications,but the corresponding epidemiological data is rare in Chinese PD patients.The present survey was to investigate the prevalence rate of wearing-off(WO)and dyskinesia among the patients with PD in China.Methods:From May 2012 to October 2012,a 3-step registry survey for wearing off(WO)and dyskinesia patients with PD receiving levodopa therapy was performed simultaneously at 28 movement disorders clinics in China.Results:There were 1,558 PD patients fulfilling the inclusion criteria.Among them,1,051 had at least one positive response of 9-item wearing off questionnaire(WOQ-9),724 and 160 patients were finally diagnosed with WO and dyskinesia by movement disorders specialists,respectively.The overall prevalence rates of WO and dyskinesia were 46.5%(95%CI 44.0%-48.9%)and 10.3%(95%CI 8.8%-11.8%),respectively.The mean score of WOQ-9 for those with WO was 3.8(SD=1.8),with movement slowness being the most common motor symptoms and pain/aching being the most common non-motor symptoms.Better improvement of motor symptoms(n=354,87.8%)and long-term disease control and drug selection(n=288,71.5%)were the two most frequently considered factors when movement disorders specialists adjusted therapeutic strategies for patients with WO.Conclusions:This survey provided the first multi-center epidemiological data of motor complications among PD patients on L-dopa therapy from China's Mainland.WO prevalence rate among Chinese PD patients was in line with,while dyskinesia prevalence rate was lower than previous reports from other Countries.

The recommendations of Chinese Parkinson’s disease and movement disorder society consensus on therapeutic management of Parkinson’s disease

Background:Parkinson’s disease(PD)is a chronic,progressive and debilitating disease,which affects over 2.5 million people in China.PD is characterized clinically by resting tremor,muscular rigidity,bradykinesia and postural instability.As the disease progresses,additional complications can arise such as non-motor and neurobehavioral symptoms.Pharmacological treatment and surgical intervention for PD have been implemented in China.Until 10 years ago,there was lack of standardization for the management of PD in different regions and among different physicians,leading to different treatment levels in different regions and different physicians.Since then,the Chinese Parkinson’s Disease and Movement Disorder Society have published three versions of guidelines for the management of PD in China,in 2006,2009 and 2014,respectively.Correspondingly,the overall level of treatment for PD in China improved.Objectives:To update the treatment guidelines based on current foreign and domestic practice guidelines and clinical evidence,and to improve the treatment options available to physicians in the management of PD.Summary:A variety of treatment recommendations in the treatment guidelines have been proposed,including physical activity and disease-modifying medication,which should be initiated at the early-stage of the disease.The principles of dosage titration should be followed to avoid acute adverse reactions to the drugs,to achieve a satisfactory clinical effect with a low dose and to reduce the incidence of long-term motor complications.Moreover,different treatment strategies should be considered at different stages of the disease.Importantly,treatment guidelines and personalized treatments should be valued equally.A set of treatment recommendations has been developed to assist physicians to improve and optimize clinical outcomes for patients with PD in China.