Headache is a common complaint in the elderly.After the age of 65,more than 13% of women and 7% of men have complaint of headache.Although tension headache and migraine are the most common primary headache,we should also recognize that their clinical features are atypical,and we must consider more serious disorders in every elderly patient presenting with a headache.Secondary headache syndromes are also more common in older people.One of these,temporal arteritis,needs to be recognized and promptly treated with corticosteroids to avoid permanent visual loss.Other causes of secondary headache that are common in older people include subdural hematomas,trigeminal neuralgia,herpes zoster infection,malignancies and medicine,etc.So we should pay more attention to the headache in the elderly,and any headache occurring for the first time in someone over the age of 65,or a changing headache pattern in a patient with chronic headaches,necessitates a complete evaluation to look for an underlying cause.

Dystrophinopathies are a group of fatal X chromosome recessive genetic disease. With the application of ventilator technolo-gy, the main causes of death in patients with dystrophinopathies turned from respiratory failure into circulatory failure, and the importance of heart problems has become increasingly prominent. Myocardial damage can be defined with myocardial enzymes, electrocardiogram, ul-trasound cardiogram, cardiac magnetic resonance imaging, etc. Drugs for chronic heart failure remain the most important strategy, and heart transplant or left ventricular assist devices implant may be the alternatives for those in the end.

Objective To study the clinical manifestations and pathological features of distal myopathies, we investigated 71 distal myopathy patients collected in the past 16 years.Methods Clinical manifestations and pathological features of biopsied muscle specimens were summarized and analysed retrospectively. Results Twenty-six of the 71 patients were of Nonaka type, 38 of Miyoshi type, 2 of tibial muscular dystrophy (TMD) type, 4 of Welander type, and 1 of oculophayngodistal myopathy (OPDM) type. Nonaka type is a sporadic or autosomal recessively inherited disorder with preferential involvement of the anterior tibial muscles. In the 26 patients with Nonaka myopathy, the onset age ranged from 8 to 39 years, averaging 24 years, and the disease was rather rapidly progressive. Sternocleidomastoid, biceps brachii muscle, pectoralis major muscle and quadriceps femoris were also involved as the disease advanced. The serum CK was slightly elevated or normal. Muscle biopsies showed rimmed vacuoles markedly without obvious dystrophic features. 15-20-nm cytoplasmic and nuclear filaments were usually seen on electron microscope. The patients with Miyoshi type were characterized clinically by sporadic or autosomal recessive inheritance, preferential gastrocnemius muscle involvement, and dystrophic muscle pathology. Rimmed vacuoles were occasionally seen. Average age of onset was 23 years (range of 8-41 years). As the disease advanced, patients with Miyoshi myopathy occasionally showed apparent proximal muscle involvement. Serum CK was markedly elevated, ranging from 3-180 times than the normal. Welander type was found in four cases. Onset age was from 30 to 46 years. Weakness always began in the finger and wrist extensors. As the disease progressed, symptoms were spreading to the distal lower extremities slowly. The serum CK level was normal or only slightly elevated. Muscle biopsies showed dystrophic features, with rimmed vacuoles occasionally. The oneset ages of two patients with TMD were from 41 to 42 years. Weakness was confined mainly to the anterior tibial muscle. Muscle biopsies revealed fibre necrosis and regeneration. Rimmed vacuoles were present significantly. OPDM was found in a 38-year-old-onset patient with autosomal dominant inheritance and characterized by the weakness of distal lower extremity and development of extraocular muscles, vocal cord and pharyngeal muscle weakness. Muscle biopsies showed rimmed vacuoles without fibre necrosis.Conclusion Five types of distal myopathies were present in China, and Miyoshi and Nonaka myopathies were more common. The clinical and pathological findings of Chinese distal myopthies should be basically similar to those reported by other countries.

Duchenne muscular dystrophy (DMD) is an X-linked recessive neuromuscular disorder, and the carriers of DMD can suffer from cardiac damage without muscle weakness, which can predispose to death. Consequently detecting and preventing cardiac damage in the early stage can improve the carriers' quality of life. The detection of early cardiac abnormalities and the evaluation of cardiac function for carriers mainly rely on the different examination methods, including electrocardiogram, echocardiogram, cardiovascular magnetic resonance, radioactive nuclide myocardial perfusion imaging and coronary angiography. Carriers of DMD with cardiac damage are assessed by different examination methods in different ways.

Objective To observe the pyramidal neurons in the hippocampal CA1 area varying with time after heat stroke in rats. Meth-ods Sprague-Dawley rats were divided into sham group (n=5) and heat stroke group (n=14), and the heat stroke group was divided into 7-day subgroup and 21-day subgroup (n=7 at each group) after heat stroke. Heat stroke group was established model of heat stroke. The brain tissues of rats were observed with Nissl staining to count the living pyramidal neurons in hippocampal CA1 area. Results The number of living pyramidal neurons in hippocampal CA1 area decreased in the heat stroke group (F=11.80, P<0.01), and decreased more in the 21-day subgroup than in the 7-day subgroup (P<0.05). Conclusion Pyramidal neurons in hippocampal CA1 area decrease with time after heat stroke, which may be associated with the learning and memory impairment.

Objective To study the clinical and pathological features of myofibrillar myopathy.Methods Clinical and pathological data of a patient with myofibrillar myopathy were anlysised retrospectively.Results The patient showed middle-aged onset,progressively proximal muscle weakness,mildly general muscle atrophy.Neurogenic changers were found in lower extremities on EMG.On mucle biopsy,cytoplasmic bodies presented in many muscle fibers in which disorganized myofibrillar networks and abnormal desmin aggregates were found,and rimmed vacuoles appeared in muscle fibers.Conclusions There is no specificity of clinical manifestation in myofibrillar myopathy.Cytoplasmic bodies,disorganized myofibrillar networks and abnormal desmin aggregates are the distinctively pathological features in myofibrillar myopathy.

Fractures of the calcaneus are the most common type of tarsal bone injuries, and about 75% of total calcaneal fractures are intraarticular. Despite increasingly more experiences with this type of fractures, however, there is considerable debate regarding their diagnosis and management. Controversies involve the most appropriate classification system, treatment options, indications for surgery, surgical approaches, and postoperative management. On the basis of current main views on the diagnosis and treatment of intraarticular calcaneal fractures, this article holds that for displaced intraarticular calcaneal fractures, operative treatments are superior to conservative ones.

Duchenne muscular dystrophy is the most prevalent muscular dystrophy caused by dystrophin gene mutations. In the central nervous systerm, there are at least six dystrophin isoforms, in which Dp140 is closely associated with cognitive impairment. This paper re-viewed the discovery, structure, gene location, detection methods and function of Dp140.

Malignant hyperthermia is a rare autosomal-dominant genetic disorder. This article would review the advance in the researchs of malignant hyperthermia, including its incidence, pathogenesis and diagnosis.

Amyotrophic lateral sclerosis(ALS)is a rare progressive motor neuron disease.Sialorrhoea is one of the common symptoms which influenced the patient's quality of life.This paper reviewed the treatments for sialorrhoea in ALS patients.