As a kind of nervous system disease,migraine is more common in female,and has the clinical characteristics of repeated attacks,it is of great significance with standardized treatment in the control of the attacks.Yong female patients with migraine during pregnancy and lactation stage will face lots of special problems because they must first consider the impact of treatment on the mother and fetus.Generally,non-drug therapy is recommended as a first-line treatment,if it is not sufficiently effective,paracetamol is recommended during the pregnancy or sporadic use of sumatriptan,NSAIDs is not recommended during the first or third trimester of pregnancy.Preventive therapy should only be considered in the most severe cases.This review summarized recent documents of the safety of the most used antimigraine medications during pregnancy and breastfeeding,in order to provide treatment recommendations in clinical practice.

Objective To assess the efficacy of whole body diffusion weighted imaging (WB-DWI) in detecting pediatric primary and metastatic malignant tumor. Methods WB-DWI was performed in 62 healthy pediatric volunteers and 40 pediatric patients with confirmed malignant tumors. The healthy volunteers were divided into three groups: 0 to 12 months, more than 12 months to 5 years and more than 5 to 15 years. The characteristics of WB-DWI imaging were analyzed. McNemar test was used to compare the difference of detection on metastasis between WB-DWI and WB-DWI combined with MRI, CT. The mean apparent diffusion coefficient ( ADC ) values of primary tumors and metastases were measured by using paired t test and compared with those of corresponding body regions of control group. Results WB-DWI imaging shows that signal intensity of metaphysis gradually reduces with increasing age in the normal pediatric group. On WB-DWI primary malignant tumors showed 100％ (40/40) high signal intensity and metastases showed high signal intensity in 89.2％ (58/65) on WB-DWI, with a positive predictive value of 90. 6％ (58/64). The detecting rate for metastases increased to 95.4％ (62/65) when WB-DWI was combined with MRL/CT, with a positive predictive value of 95.4％ (62/65) there was no statistically significant difference ( x2 = 2. 25, P ＞ 0. 05 ). The ADC values of primary malignant tumor sites in head ( n = 5), liver(n=6), kidney(n=8), adrenal(n=ll) were (0.76 ±0. 19) ×10-3 , (0. 97 ±0.29) × 10-3,(0. 81 ±0. 12) × 10-3 and (0. 93 ±0. 28) × 10-3mm2/s and those of corresponding body regions of control group were (1.02 ±0. 11) × 10-3,(1.57 ±0.58) × 10-3, (1.19 ±0. 15) × 10-3 and (2.03 ±0.42) ×10-3mm2/s respectively, there were statistically significant difference( t values were 3.54,3. 84,7. 02 and 12. 57 ;P ＜ 0. 05 ). The A DC values of metastases sites in head ( n = 9 ), liver ( n = 13 ), kidney ( n = 17 ),bone(n =7) and lymph node(n =6) were (0. 88 ±0. 12) × 10-3, (0. 98 ±0. 10) × 10-3, (0. 89 ±0. 11 ) × 10-3, (0. 96 ±0. 15) × 10-3 and (0. 83 ±0. 14) × 10-3mm2/s, and those of corresponding body regions of control group were (1.01 ±0.09) × 10-3, (1.45 ±0.39) × 10-3, ( 1.31 ±0.27) × 10-3, ( 1.34 ±0. 20) × 10 -3 and ( 0. 99 ± 0. 08 ) × 10 -3 mm2/s, there were statistically significant difference ( t values 4. 09,45.50,6. 95,14. 00 and 9. 27 ;P ＜ 0. 05 ). Conclusions Increased signal intensity is more frequently observed in metaphysis of long bone in normal children on WB-DWI. With a high detection rate for primary and metastatic malignant tumors, WB-DWI combined with conventional CT; MRI can significantly improve their sensitivity.

Rheumatic diseases such as rheumatoid arthritis and Sjogren′s syndrome can be associated with a wide range of peripheral neuropathy. The diagnosis and treatment are more difficult in rheumatic diseases combined with peripheral neuropathy due to the complex etiology and clinical manifestations. This article reviews the recent progress in the diagnosis and treatment of rheumatic diseases-related peripheral neuropathy.

Objective To report 1 case of iatrogenic botulinum poisoning misdiagnosed as myasthenia gravis,to discuss the clinical manifestation,distinguishing feature and prognosis of iatrogenic botulinum poisoning combined with literature.Methods We briefly introduced one patient with botulinum toxin poisoning misdiagnosed as myasthenia gravis.A 26-year old female was admitted in June 2017 in Gaochun People's Hospital of Nanjing,who received two injections of botulinum toxin 500 U for a short period of time due to cosmetic needs,then she suffered from fatigue,chest distress,eyelid ptosis and other symptoms.The patient was once misdiagnosed as myasthenia gravis,but the results of neostigmine test and repeated nerve stimulation examination were negative.After careful examination of the body (mandibular swelling) and repeated medical history requiring,the final diagnosis was clarified.After the treatment such as fluid infusion for 10 days,her discomforts were relieved.The literature was retrieved from "US National Library of Medicine National Institutes of Health (Pubmed) "," China National Knowledge Infrastructure (CNKI)" and "Wanfang Medicine Data China Information",a total of 17 articles were included in the analysis,including 30 effective cases.We analyzed the general characteristics,clinical manifestations and prognosis of botulinum toxin injection.Results Of the 30 cases,28 cases (96.7％) were female,2 cases (3.0％) were male,aged from 3 to 80 years old.Most of them were botulinum toxin type A,except 2 cases unknown.The clinical onset began from the injection day to 3 weeks after injection.The duration of the disease lasted from 10 days to 6 months.Most of the prognosis was good after treatment.Conclusion Careful attention should be paid to the serious reaction of botulinum toxin to ensure safe medication use.

Restless legs syndrome (RLS) is defined as a sleep-wake disorder, with the key feature being an urge to move, which can be classified as two types as primary RLS and secondary RLS. Iron deficiency is a key role of RLS, low levels of serum ferritin is noted in RLS lab tests. Pathophysiology of RLS is complex, genetic variants, anatomical network vulnerability, neurotransmission abnormalities and abnormal dopaminergic neurotransmission may all contribute to its pathogenesis. The mild RLS can choose non-drug therapy, but most of the patients need drug therapy especially the severe cases. The aboved aspects are discussed in this review based on recent literatures.

By organizing and studying on the original works of LI Wenrong， this paper aimed to explore his theories and methods for treating liver diseases. LI Wenrong believes that the liver is easily prone to physiological disturbances， difficult to pacify， and can be compared to a “chariot” that moves horizontally and vertically， acting as a “general” for both civil and military affairs. Pathologically， liver diseases tend to spread to other organs， resulting in ever-changing pathological changes， often affecting emotional health. In terms of therapeutic methods， LI Wenrong proposes ten methods including draining fire to calm the liver， nourishing water to moisten wood， clearing metal to calm the liver， calming gallbladder and harmonizing liver， subduing yang with shell-drug， treating liver diseases by supplementing spleen， soothing the liver with sweetness， astringing the liver with sourness， relieving the liver with spiciness， and draining the liver with excess-fire. These methods have great guidance and reference value for contemporary clinical practice in traditional Chinese medicine.