Human has used maggot to treat diseases for thousands of years. In recent years, with abuse of antibiotic and the rising incidence of antibiotic resistance, maggot therapy, as a surgical alternative, is mainly applied to treat chronic infected wounds on account of its low cost, efficacy and safety. Its mechanisms are disinfection, bio-debridement and enhancement of tissue regeneration. Maggot therapy which serves as a kind of biological therapy is promising. However, living maggot therapy could result in inevitable complications, so that we should apply traditional Chinese medicine theory to investigate and develop new delivery method of maggot. The review summarizes the past and present of maggot therapy.
Animals ; Chronic Disease ; therapy ; Debridement ; adverse effects ; economics ; history ; methods ; History, 15th Century ; History, 16th Century ; History, 17th Century ; History, 18th Century ; History, 19th Century ; History, 20th Century ; History, 21st Century ; History, Ancient ; History, Medieval ; Humans ; Larva ; growth & development ; physiology ; Medicine, Chinese Traditional ; adverse effects ; economics ; history ; methods ; Treatment Outcome ; Wound Healing ; physiology ; Wound Infection ; therapy

The development of neuroimaging has led to a high diagnostic rate of cerebral small vessel disease (CSVD).The hemorrhage transformation (HT) and clinical prognosis after intravenous thrombolysis in acute ischemic stroke (AIS) with CSVD have become hot topics in recent years.Relevant studies have shown that different subtypes of CSVD may have different influences in HT and clinical prognoses in AIS.In clinic,each subtype of CSVD may not exist alone in one patient,therefore,some scholars put forward the concept of total burden of CSVD to further quantitatively assess the severity of CSVD in the whole brain and their effects on HT and clinical prognosis after intravenous thrombolysis of AIS.This article reviews the researches on HT and clinical prognosis after intravenous thrombolysis in AIS with CSVD.

Homocysteine is a risk factor for ischemic stroke.The association between homocysteine and ischemic stroke has been becoming a hot spot of research all over the world,but has not yet got a consistent result up to now.In this article,we reviewed the pathogenic mechanism,intervention,new treatment strategies,and summarized the current progress of the association of homocysteine with ischemic stroke.

Objective:To improve awareness about infratentorial dural arteriovenous fistula (DAVF).Methods:Three cases of DAVF in the First Affiliated Hospital of Soochow University from September 2017 to September 2019 were retrospectively analyzed in terms of clinical features, cerebrospinal fluid (CSF) analysis, brain imaging and treatment, and followed up through telephone call.Results:Case 1: A 43-year-old woman, in chronic but acute aggravated course, presented with weakness of both lower limbs and urination and defecation dysfunction. Brain magnetic resonance imaging (MRI) revealed abnormal signal in medulla. CSF analysis demonstrated aquaporin-4 antibodies positive. Misdiagnosed as neuromyelitis optica spectrum disorders, the treatment was poor. Then digital subtraction angiography (DSA) showed DAVF at the left infratentorial area, and endovascular treatment was operated. Relapse was not observed in two-year follow up. Case 2: A 57-year-old woman, in chronic progressive course, mainly manifested as memory loss, but progressed with dysphagia, fever, coma. Treatment as “central nervous infection” was poor. Then DSA showed DAVF at the bilateral transverse-sigmoid sinus area, and endovascular treatment was operated with embolized partial fistulas. The patient died from lung infection within two months. Case 3: A 52-year-old man, in subacute course, was treated in the Gastroenterology Department with clinical manifestion of stubborn nausea and vomiting. Brain MRI revealed abnormal signal in medulla, with prominent vessel flow voids nearby. Then DSA showed DAVF at the craniocervical junction, and endovascular treatment was operated. Relapse was not observed in six-month follow up.Conclusions:DAVF has a variety of clinical manifestations, and infratentorial DAVF can manifest as acute neurological dysfunction involving the brain stem, cerebellum, spinal cord, which may be easily misdiagnosed. When brain MRI showed intracranial abnormal signal, the possibility of DAVF should be considered. DSA remains the gold standard to diagnose DAVF. Endovascular embolization is the main treatment of infratentorial DAVF at present. Prognosis depends on clinical presentation and fistula classification.

Objective To compare the regional leptomeningeal (rLMC) scale scores,Miteff scale scores and Tan scale scores to provide the clinical basis for selecting collateral circulation evaluation methods.Methods One hundred and fifteen patients with acute ischemic stroke,admitted to our hospital from August 2013 to February 2017 were chosen in our study.The rLMC scale,Miteff scale,and Tan scale were used to evaluate the collateral circulations of each patient.The credibility and validity of these 3 scales were compared.Modified Rankin scale (mRS) scores at 3 months were followed by 0-2 for good prognosis and 3-6 for poor prognosis.Binary Logistic regression analysis was used to determine the independent prognostic factors of ischemic stroke.Receiver operating characteristic (ROC) curve was used to compare the predictive values of the 3 scales for prognoses of ischemic stroke.Results Intra-observer agreement of the 3 scales from the highest to the lowest was rLMC scale (Kappa=0.871),Tan scale (Kappa=0.842),and Miteff scale (Kappa=0.752).The test-retest reliability of the 3 scales from the highest to the lowest was rLMC scale (Kappa=0.879),Tan scale (Kappa=0.826),and Miteffscale (Kappa=0.775).The validity of the 3 scales from the highest to the lowest was rLMC scale (rs=0.690),Tan scale (rs=0.680),and Miteff scale (rs=0.650).Univariable and multivariable analyses showed that the results of collateral circulation defined by rLMC scale (OR=1.325,95％CI=1.048-1.675,P=0.019),Tan scale (OR=2.938,95％CI=1.115-7.744,P=0.029) and Miteff scale (OR=2.698,95％CI=1.050-6.931,P=0.039) were associated with prognoses of acute ischemic stroke.ROC curve showed that the area under the curve of rLMC scale,Tan scale,and Miteff scale was 0.848,0.799,and 0.759,respectively;there were significant differences among the 3 scoring methods in the area under the curve (P＜0.05),indicating the predictive values of the three to the prognoses:rLMC scale＞Tan scale＞Miteff scale.Conclusions As compared with Miteff scale and Tan scale,rLMC scale has high intra-observer agreement and validity,and is reliable but complicated.The results of collateral circulation defined by these 3 scoring methods are associated with the prognoses of acute ischemic stroke.

OBJECTIVE To study the improvement effect and mechanism of Gubenanshen decoction on menopausal syndrome model rats . METHODS Totally 70 rats were anesthetized and placed on the operating table for bilateral ovariectomy to induce menopausal syndrome model . Other 10 rats without modeling were taken as sham operation group . Sixty model rats were divided into model group ，Gengniananpian group （TCM positive control group ，0.56 g/kg），Estradiol valerate tablet group （chemical drug positive control group ，0.1 mg/kg），Gubenanshen decoction high -dose，medium-dose and low -dose groups （18.0，9.0，4.5 g/kg）， with 10 rats in each group . Model group and sham operation group were given normal saline intragastrically ；administration groups were given relevant medicine intragastrically ，once a day ，for consecutive 4 weeks. After last administration ，the plasma contents of luteinizing hormone （LH），follicle stimulating growth hormone （FSH）and estradiol （E2）were determined .The indexes of uterus，adrenal gland ，spleen and thymus were measured ；pathological changes of rat uterus were observed ；mRNA expressions of kisspenptin 1（Kiss-1），inositol triphosphate receptor 1（IP3R1）and gonadotropin -releasing hormone （GnRH）in hypothalamic tissues were detected ，and the protein expressions of Kiss -1，ERK1/2 and p -ERK1/2 were also detected . RESULTS Compared with sham operation group ，the contents of LH and FSH in the plasma of rats were significantly increased in model group （P＜0.05 or P＜0.01）. The contents of E 2，organ index ，mRNA expressions of Kiss -1，IP3R1 and GnRH and protein expressions of Kiss -1 and p-ERK1/2 were decreased significantly in hypothalamic tissues （P＜0.05 or P＜0.01）. The glands of the uterus were reduced and the cells in the lamina propria were dense . Compared with model group ，above indexes of Gubenanshen decoction groups （except for the content of E 2 in the low -dose group ）were reversed significantly （P＜0.05 or P＜0.01）. The number of uterine glands increased，and single columnar epithelial cells were arranged orderly （except for the low -dose group ）. CONCLUSIONS Gubenanshen decoction can increase mRNA expressions of Kiss -1，IP3R and GnRH and protein expressions of Kiss -1 and p -ERK1/2 in hypothalamic tissues of rats ，and activate GnRH secretion signaling pathways so as to improve the menopausal syndrome .