Therapeutic hypothermia used for clinical purposes has had a long history. With the continuous development in the intensive care and surface cooling techniques, it has made various large hypothermia clinical trials possible. Studies have found that moderate hypothermia (28～35℃) has significant protective effects on important organs such as heart and brain, and it does not have obvious side effects. Recently, mild hypothermia (32～35℃) has been widely used for cardio-pulmonary-cerebral resuscitation, and its effect is satisfactory.

Objective To explore the nursing care for the stiff-man syndrome patient.Methods Retrospective analysis had been performed for the nursing care of a patient with stiff-man syndrome.Results After 4 weeks of careful treatment and nursing care,the patient was discharged from the hospital.Conclusions Suitable nursing according to patients' condition,medication monitoring,psychological care,safety nursing and health guidance can prevent or delay the development of the disease and promote comprehensive rehabilitation for patients.

Substantia nigra is the largest nuclei in midbrain, which is divided into a compact part and a reticular part. Recent studies have shown that the changes of iron content in reticular part of substantia nigra results in the changes of substantia nigra echogenicity. The substantia nigra detected by transcranial Doppler, according to its echo changes, may provide help for the susceptibility of Parkinson's disease, latency and early diagnosis, as well as for the differential diagnosis of multiple system atrophy and vascular parkinsonism.

Objective To explore the factors affecting the quality of life in patients with Parkinson's disease(PD).Methods The quality of life,severity of disease,activities of daily living,motor responses,mental state and the complications of treatment in 71 patients with PD were evaluated by the PD Quality of Life Questionnaire(PDQL),Unified PD Rating Scale(UPDRS),the Hoehn-Yahr scale,the Schwab and England disability scale,the Hamilton Depression Rating Scale for Depression(HRSD),and meanwhile factors such as age,gender,age of onset,the beginning symptom,the location of onset,smoking,doses of L-dopa and fluctuations etc were evaluated by some methods.Results Bivariate analysis showed that the longer course of disease and treatment,the more doses of L-dopa,the higher scores of UPDRS and the Hoehn-Yahr scale,and depression fluctuations with patients,the worse quality of life they had(P

Objective To identify the association between fatigue and depression in Parkinson's disease(PD).Methods 56 PD patients were enrolled in this study.The degree of fatigue was measured by Fatigue Severity Scale (FSS).Hamilton Depression Scale (24 items) was used to evaluate the degree of depression.PD Quality of Life Questionnaire (PDQL) were tested to evaluate the quality of life in PD patients.While other clinical information such as Unified Parkinson's Disease Rating Scale (UPDRS) Ⅲ,Hoehn-Yahr Scale and modified Webster Scale were investigated.Results The incidence of fatigue in this group is 71.4％ (40/56).Score of HAMD and PDQL exhibited a significant correlation to patients' fatigue,coefficient of partial correlation was 0.451 (P ＜ 0.01),-0.346 (P ＜ 0.05).The incidence of fatigue in non-depressive patients was low,27.3 ％.While in depressive patients,the incidence of fatigue is relatively high,for mild depression 75％,moderate depression 100％,severe depression 100％ respectively.Conclusions Fatigue is a prominent symptom of depression in PD patients,sometimes independent of depression also influencing the patients' quality of life.

Objective To investigate the therapeutic effects of botulinum toxin type A (BTX-A) in elderly patients with primary intractable trigeminal neuralgia.Methods 27 elderly patients with primary intractable trigeminal neuralgia were treated with BTX-A local multiple point injection.The efficacy was assessed by visual analog scores (VAS) before and 1 week,2 weeks,1 month,3 months and 6 months after the treatment.Results VAS scores was (9.2±1.1),(5.8±3.0),(3.6± 2.3),(2.3±2.3),(3.2±2.9) and (4.6±3.2) before and 1 week,2 weeks,1 month,3 months and 6 months after BTX-A treatment respectively.VAS score was gradually decreased,reached the lowest at 1 month after BTX-A injection,and then was gradually increased.There were significant differences in VAS scores between between pre-and post-treatment (P＜0.05).The efficiency was 37.0％,85.2％,92.6％,70.4％ and 59.3％ at 1 week,2 weeks,1 month,3 months and 6 months after the treatment respectively.There were significant differences in efficacy between different time points after the treatment (all P＜0.05).3 patients had the transient numbness of mouth askew and incomplete eyelid closure and recovered spontaneously after 4-8 weeks.No severe adverse effects were found in the other 27 patients.Conclusions BTX-A is safe and effective in the treatment of primary intractable trigeminal neuralgia in elderly patients.

Objective To characterize the changes of retinal structure and visual field mean defects (MD) in early Parkinson's disease (PD) and the related factors.Methods Twenty-five patients with early stage PD and 33 normal controls were enrolled in this study.PD patients were evaluated by unified Parkinson's disease rating scale (UPDRS) and Hoehn-Yahr (H-Y) stage in off period.All subjects undertook retina of retinal nerve fiber layer (RNFL) and macular examinations by optical coherence tomography (OCT),and MD by automatic visual field analyzer.Results (1) The average thicknesses of RNFL and C11 quadrant RNFL were thinner in PD group [(96.2 ±7.6) μm and (124.4 ± 18.4) μm] than in healthy controls [(102.6 ± 5.0) μm and (135.4 ± 21.8) μm,respectively,P =0.000 and P =0.047].Moreover,PD patients had a thinner average thickness of macular[(277.2 ±9.6) μm vs (285.8 ± 12.6)μm,P=0.006],and smaller macular volume compared with controls [(10.0 ± 0.3) mm3 vs (10.3 ±0.4) mm3,P =0.006].However,there was no significant difference in MD between PD and control subjects [(0.43 ± 2.75) dB vs (-0.18 ± 1.41) dB,P =0.322].(2) Pearson's correlation analysis showed that H-Y stage was negative correlated with the average RNFL thickness (r =-0.569),average macular thickness and volume (r=-0.501 and r=-0.417) in PD patients (all P＜0.05).Conclusions PD patients have thinner average thicknesses of RNFL,C11 quadrant RNFL and macular,smaller macular volume than those in normal controls.There were no significant differences in MD between two groups.There were negative relationships between H-Y stage,and retinal thickness and volume of PD patients.

Objective To explore the type and etiology of chronic pain in patients with Parkinson's disease (PD),and to assess the association between pain and cognitive function.Methods A total of 116 PD patients were enrolled in the study and assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn-Yahr Scale (H-Y),Hamilton Depression Rating Scale for Depression(HRSD),Visual Analogue Scale (VAS) and Montreal Cognitive Assessment (MoCA).Results Compared with PD patients without pain,PD patients with pain had higher scores of UPDRS,H-Y and HRSD rating scales.Depression(scores of HRSD) was the only factor associated with pain showed by the Logistic regression model (P =0.007).PD patients with pain had lower scores of delayed recall (P =0.020).PD patients with pain happened before their motor symptoms had a lower score of delayed recall (P =0.015).Conclusions Musculoskeletal pain is the most common type in PD patients with pain.Depression is probably an independent risk factor for pain in PD patients.Delayed recall is the dominant impaired cognitive function.

Objective To detect the change of serum cystatine C ( cys C ) level in Parkinson ’ s disease ( PD ) patients with obstructive sleep apnea-hypopnea syndrome ( OSAHS ) and explore its influencing factors .Methods Fifty-six PD patients with polysomnography examination from July 2011 to December 2013 in the Department of Neurology , the Second Affiliated Hospital of Soochow University were collected.Eighteen healthy controls who took the polysomnography examination during the same period were included.According to the apnea-hypopnea index ( AHI) , PD patients were further divided into two groups:PD with OSAHS group ( n=26 ) , and PD group ( n=30 ).The general conditions , movement function , biochemistry parameters , and sleep parameters were assessed.Statistical analysis was performed using SPSS ver 17.0 software.Results The mean serum levels of cys C in PD with OSAHS group , PD group and control group were (1.05 ±0.17) mg/L, (0.96 ±0.12) mg/L and (0.84 ±0.20) mg/L, respectively.Statistical analysis showed that there was significant difference in the three groups (F=9.184,P<0.05), and the mean serum level of cys C in PD with OSAHS group was the highest.In PD with OSAHS group , Spearman correlation analysis showed a positive and significant correlation between cys C levels and creatinine levels (r=0.459,P =0.018), urea levels (r =0.405,P =0.040), AHI (r =0.482,P =0.013), the oxygen desaturation index (r=0.408,P=0.038), the arousal index (r=0.392,P=0.047) as well as Hoehn and Yahr (H-Y) stage (r=0.467,P=0.016).Correlation was not observed between cys C levels and other clinical parameters (P>0.05).Multivariate analysis showed that creatinine levels (B=0.007,P=0.005), AHI (B=0.004,P=0.013) , H-Y stage (B=0.102,P=0.026) may be influencing factors of cys C levels in PD patients (P<0.05).Conclusions Cys C level is elevated in PD patients, especially in PD patients with OSAHS.The degree of hypoxia and severity of PD is related to the level of cys C in PD patients with OSAHS .

Objective To investigate the substantia nigra (SN) and brainstem raphe (BR) echogenic features of Parkinson's disease (PD) patients with musculoskeletal pain.Methods A total of 115 PD patients recruited in the Second Affiliated Hospital of Soochow University from October 2014 to May 2016 were assessed with the following rating scales:Unified Parkinson's Disease Rating Scale (UPDRS),Hoehn and Yahr Staging Scale (H/Y),Hamilton Rating Scale for Depression (HRSD),Beck Depression Inventory Ⅱ (BDI-Ⅱ) and Visual Analogue Scale (VAS).All the subjects underwent transcranial sonography during the clinical evaluation.And the patients were divided into PD with musculoskeletal pain (n =54) and PD without musculoskeletal pain (n =61) groups,or PD with depression(n =74) and PD without depression(n =41) groups.Results Compared with PD patients without pain,PD patients with musculoskeletal pain had higher scores of UPDRS-Ⅱ,-Ⅲ,HRSD,BDI,NMSQ and H/Y (UPDRS-Ⅱ score:12.56 ±6.01 vs 8.79 ±4.38,t =-3.801,P ＜0.01;UPDRS-Ⅲ score:24.43 ± 12.43 vs 20.07 ± 11.12,t=-1.986,P=0.049;HRSD score:11.65-±6.94 vs 8.38-±5.36,t=-2.844,P=0.005;BDI score:14.09 ±6.20 vs 9.74 ±6.00,t =-3.826,P ＜0.01;NMSQ score:8.57 ± 4.06 vs 5.60 ± 3.38,t=4.193,P＜0.01;H/Y:2.0(1.5,2.6) vs 1.5(1.0,2.0),Z=-3.011,P=0.003).Positive BR was more frequent in depressed than in non-depressed PD patients without pain (63.6％ vs 14.3％;x2 =15.25,P ＜0.01).Positive BR was positively associated with sex(r =0.228,P =0.014),age(r =0.184,P =0.049),disease duration (r =0.196,P =0.035),and depression (r =0.396,P ＜ 0.01).However,positive BR did not correlate with musculoskeletal pain.No correlation was found between positive SN and clinical characteristics of PD patients.Conclusions PD patients with musculoskeletal pain have worse activity of daily living,more severe motor symptoms,more non-motor symptoms,and are more depressed.SN and BR echogenecity do not correlate with musculoskeletal pain,however,hypoechogenic or interrupted BR is associated with depression in PD patients.