Objective To evaluate the therapeutic effect of single-session repetitive transcranial magnetic stimulation(rTMS) on motor function in Parkinson's disease(PD).Methods Twenty-four PD patients were enrolled into this two-stage study with cross-over design and divided into two groups randomly.The subjects of first group underwent therapeutic rTMS(0.5 Hz,80% of resting motor threshold,1 000 pulses×2,single-session) on primary motor cortex and underwent controlled rTMS with same stimulation parameters on occipital cortex seven days later.The subjects of second group underwent controlled two sessions of rTMS in reverse sequence.The motor function was assessed by Unified Parkinson's Disease Rating Scale(UPDRS) and Visual Analogy Scales.Results The UPDRS improvement(34.2±7.5%,36.5±8.7%) of subjects after therapeutic rTMS on primary motor cortex was significant higher than that(7.2±3.1%,7.4±3.8%) after controlled rTMS on occipital cortex(P<0.01).The duration of therapeutic effect(39±12 minutes,35±11 minutes) was significant higher than that of controlled rTMS.Conclusion The single-session rTMS has therapeutic effect of short duration on motor performance in PD.

Objective To discuss the value of vertebral hemangiomas treated with the CT-guided pereutaneous vertebroplasty (PVP).Methods Forty-two patients with 49 vertebral lesions were guided by CT and injected with bone cement percutaneous into the vertebral.The effectiveness was valued by preoperative and postoperative visual analogue scale (VAS),locomotor activity scores,pain medication scores and comprehensive evaluation of long-term efficacy of WHO criteria,and undertook statistical analysis.Results The success rate in all patients was 100.0％(42/42),no serious complications.All the patients were followed up for 6 - 18 ( 12.50 ± 1.15 ) months,all lesions of the vertebral body imaging showed no tumor recurrence and vertebral collapse.The VAS scores decreased from preoperative (7.64 ± 1.29 ) scores to postoperative 1-3 days (4.82 ± 1.21 ) scores and to postoperative 3 -6 months (0.22 ±0.19) scores (P＜0.05).The locomotor activity scores decreased from preoperative (3.4 ± 0.9) scores to postoperative 1-3 days (2.1 ±0.6) scores and to postoperative 3-6 months (1.0 ±0.3) scores (P＜0.05).The pain medication scores decreased from preoperative ( 1.9 ± 0.6) scores to postoperative 1 - 3 days months ( 1.1 ± 0.2 ) scores and topostoperative 3-6 months (0.2 ± 0.1 ) scores (P ＜ 0.05 ).Comprehensive evaluation of long-term efficacy of WHO criteria:efficiency rate was 97.6％(41/42).Conclusions CT-guided percutaneous vertebroplasty for vertebral hemangioma can effectively relieve the pain caused by vertebral body to increase stability,improve motor function,which is a method with safe,minimally invasion,effect,and is superior than C-arm fluoroscopy.

Objective To investigate the MRI abnormalities and feature of FDG metabolism in the brain of patients with progressive supranuclear palsy.Methods Eleven patients with PSP and 178 patients with PD were prospectively studied with mid-sagittal plain MRI;five patients with PSP and 48 patients with PD were prospectively studied with 18F-FDG PET.Results The atrophy of the midbrain tegmentum and hummingbird sign were demonstrated in all of the PSP patients studied,but were not observed in PD patients.The area of the midbrain on mid-sagittal plain MRI in the patients with PSP was significantly smaller than that in those with PD.The patients with PSP had more prominent decrease of glucose metabolism symmetrically in frontal cortices and lentiform compared with PD.The lentiform in PD showed significant glucose hypermetabolism compared with thalamus.The regional glucose metabolism of PSP was symmetrical while that of PD was asymmetrical in lentiform and thalamus.Conclusion The assessment of the mid-sagittal plain MRI and 18F-FDG PET images may be a useful adjunct to a clinical examination when making a differential diagnosis of PSP with PD.

OBJECTIVE: To summarize the clinical features of epistaxis in the posterior fornix of inferior meatus and its comprehensive treatment measures. METHOD: We collected and retrospectively analyzed the clinical data of 212 cases of epistaxis hospitalized in our department, among which 23 cases were diagnosed as epistaxis in the posterior fornix of inferior meatus. They underwent nasal endoscopic exploration and coagulation surgery with one case under general anesthesia and the other 22 under local anesthesia. The bleeding from olfactory cleft, spheno-ethmoidal recess and the middle nasal meatus were excluded for all the patients during the surgery. After shifting the inferior turbinate inward by fracture, the active bleeding was found in the posterior fornix of inferior meatus, which was stopped immediately by bipolar coagulation. The areas of coagulation and nasal mucosa erosion were packed with nasopore after operation. RESULT: For all the patients, bleeding spots were definitely located during the operation and successfully coagulated. None of them suffered from recurrent-bleeding within 1 week postoperatively. Followed up for 6 to 12 months, there was no epstaxis recurrence or nasal cavity adhesion at the bled side in all patients. CONCLUSION For intractable epistaxis patient, after excluding the bleeding in olfactory cleft, sphenoethmoidal recess and the middle nasal meatus, it should be considered that the bleeding might come from posterior fornix of inferior meatus. It is the key point to thoroughly expose the posterior fornix of inferior meatus by shifting the inferior turbinate inward by fracture and explore for the bleeding spot carefully.
Adult ; Aged ; Epistaxis ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

There are so many ways of assessment on balance, among which scale assessment is the most used method. This article introduced the frequently used balance assessment scales in clinical medicine and researches, such as Berg Balance Scale (BBS), Tinetti Performance Oriented Mobility Assessment (Tinetti POMA), Timed Up and Go Test (TUGT), Activities-specific Balance Confidence Scale(ABC), Brunel Balance Assessment (BBA), Dynamic Gait Index(DGI), Functional Gait Assessment(FGA), Balance Evaluation Systems Test (BEST), and the researches of reliability and validity on those scales. The reliable and valid tools to assess balance and gait are suggested for clinical medicine.

Objective To investigate the feature of cerebral glucose metabolism of dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). Methods Twenty-five DLB patients and Thirty-one PDD patients underwent positron emission tomography(PET) with 18F-fluorodeoxyglucose (18F-FDG) showing glucose metabolism. The region of interest (ROI) was selected from frontal cortex, temporal cortex, parietal cortex, occipital cortex, cerebellum cortex and corpora striata. 18F-FDG metabolism ratios between various cerebral regions and cerebellum cortex were compared as an indicator of regional cerebral glucose metabolic patterns.Results FDG metabolism ratio of frontal cortex, occipital cortex, parietal cortex, temporal cortex and corpus striatum decreased similarly in DLB and PPD (P>0.05). FDG metabolism ratio of occipital cortex decreased more significantly in DLB than in PDD (P<0.01). The decrease of FDG metabolism in corpus striatum of DLB was symmetric. For patients with PDD, FDG metabolism in corpus striatum contralateral to onset side decreased more significantly than that of corpus striatum ipsilateral to onset side (P<0.05). Conclusion There are similarities and discrepancies in cerebral glucose metabolism between DLB and PDD. These features may be useful in differential diagnosis between these two kinds of Lewy body disease.

Objective To evaluate the effect of continuous dopaminergic stimulation on the non-motor symptoms. Methods Fifty-eight patients with Parkinson's disease(PD) following motor fluctuation and non-motor symptom were enrolled in this study. The subjects were treated with levodopa/carbidopa and entacopone for eight weeks. The scores of NMSS, PD fatigue scale, HAMD and Pittsburgh Sleep Quality Index (PSQI) were compared between baseline and endpoint.Results The total scores of NMSS decreased significantly from baseline to endpoint (P<0.05). The scores of endpoint were significantly lower than those of baseline in the urinary, sexual function, depression/anxiety and sleep/fatigue subscale of NMSS; however, there was no significant difference between baseline and endpoint in the gastrointestinal, cardiovascular, hallucination/delusions, attention/memory subscales of NMSS. The scores of endpoint were significantly lower than those of baseline in HAMD, PD fatigue scale and PSQI.Conclusion The continuous dopaminergic stimulation treatment with levodopa/carbidopa and entacapone may improve some respects of non-motor symptom of PD.

Objective To develop an HPLC method for determination of content of ergosterol in cultured Cordyceps militaris and natural Cordyceps sinensis. Methods Diamonsil C18(2) column (150 mm×4.6 mm, 5 μm) was used, with methanol-water (98∶2) as mobile phase, column temperature of 25 ℃ , flow rate of 1.0 mL/min, and detection wavelength of 280 nm. Results The linear range of ergosterol was 0.197 7-3.954 9 μg (r=1.000), and avarage recovery rate was 99.51%, RSD was 0.56% (n=9). Conclusion This method is effective, sensitive and accurate with high repeatability and stability, which is helpful for the determination of ergosterol in the cultured Cordyceps and natural Cordyceps.

Objective To investigate the effect of orphan nuclear receptor NR4A1 expression on oxygenglucose deprivation (OGD)-induced apoptosis in cultured rat cerebellar granule neurons and its possible mechanisms.Methods Primary rat cerebellar granule neurons were cultured for 7 to 8 days,and then treated with OGD.The activity of cultured rat cerebellar granule neurons was assessed by methyl thiazolyl tetrazolium (MTT) assay,apoptosis was detected with flow cytometry,the expressions of NR4A1,caspase-3 and cytochrome c were determined by Western blot analysis,NR4A1 mRNA expression was detected with real-time polymerase chain reaction.The rat cerebellar granule neurons were transfected with lentiviral vector-encoding rat NR4A1.The apoptotic rates and expressions of caspase-3 and cytochrome c in rat cerebellar granule neurons transfected with NR4A1 were detected after OGD.Results The activity of rat cerebellar granule neurons decreased significantly,the apoptotic rate increased significantly,the expressions of NR4A1 mRNA and protein as well as caspase-3 and cytochrome c incrased significantly along with the OGD time.NR4A1 was overexpressed,apoptosis rate was significantly reduced in rat cerebellar granule neurons transfected with NR4A1.The expressions of caspase-3 and cytochrome c were significantly reduced in the rat cerebellar granule neurons transfected with NR4A1 after OGD.Conclusions NR4A1 overexpression may reduce OGD-induced apoptosis in rat cerebellar granule neurons by downregulating the expressions of caspase-3 and cytochrome c.

Objective To explore the method for repair of total avulsion of 2~4 fingers and to find the best procedure. Methods The wrap-round flap with part toenail combind with the dorsal pedical flap to repair soft tissue defect of the dorsal of finger and part of the palmar of finger, the second simepulp flap to repair soft tissue defect of the palmar of finger,transfer of two tissues with one pedicle to repair total avulsion of 2~4 fingers. Results All of 9 composite transplants in 6 cases were survived,the received areas were primary healing in 8 finger,1 case repaired by the bilateral wrap-round flaps and second simepulp flaps for index and middle finger,the distal phalanx of middle finger necrosis because of dislocation of DIP,3 months later,injury healed after the necrosis of phalanx excised,but the nail and the nail bed were dead.Except 1 case which the grafted skin necrotized in the donor area of the big toe,the rest had primary healing.All cases were followed up 6~14 months,the activity of joints were: MP 0-70,PIP 0-40.The repaired pulps had excellent appearance,the nail was fine,1 finger's mail was atrophy and 1 finger's nail was defect.The donor area had good fountion without pain and edema,the grafted skin had normal color and the activity of joints were nomal. Conclusion The wrap-round flap with part toenail combined with the second simepulp flap is a good approach in treatment of the skin avulsion injury in the finger.