Objective To investigate the protective effect of the new type of Tongxinluo (TXL) on blood-brain barrier impairment after cerebral ischemic/reperfusion injury in rats.Methods 78 male Sprague-Dawley rats were randomly divided into sham-operated group (n=6), operated group (n=36) and TXL-treated group (n=36), the latter two groups were divided into 0.5 h, 2 h, 6 h, 12 h, 24 h and 48 h groups (n=6, each) according to the time after cerebral ischemic/reperfusion for 2 h. The rats were pretreated with normal saline or TXL for 7 d. The middle cerebral artery occlusion/reperfusion (MCAO/R) rat model was established by the Longa occlusion method;The serum S100? protein concentrations of different point time were determined by ELISA method and infarct volumes were determined by 2,3,5-triphenyltetrazolium Chloride (TTC) staining method. Results (1) The serum S100? protein level in TXL-treated groups were significantly decreased compared with operated groups at 0.5 h, 2 h, 6 h,12 h and 24 h after MCAO/R (P

Objective To study the changes in the central nervous system in adult mice after various degrees of acute heat stress. Methods Adult mice placed in insulated cages were exposed to 24℃, 34℃, 37℃, 38.5℃, 40℃ or 42℃ for 60min respectively with a constant humidity of 60%. The behavior response was carefully monitored. Rectal temperature was measured before the exposure and after the exposure. Electroencephagrams were taken. Then the hippocampal neurons of these animals were examined with transmission electron microscope. Results Heat stress at 34℃ for 60 min only raised the rectal temperature, and heat stress above 37℃ for 60 min not only raised rectal temperature, but also induced water loss and irritability and attempt to escape. Abnormal EEG with increased amplitude and retarded rhythm could be observed. However, when mice were exposed to 24℃ and 34℃ such behavior did not appear. After exposure to 42℃, EEG frequency increased and pathological changes in hippocampus neurons were found. The main ultrastructural changes included degeneration of hippocampal neurons, expansion of space around capillary, decrease in number of synaptic vesicle, and decomposition of synapse. Conclusion Mice were very sensitive to heat stress. An increase in core temperature could induce behavioral thermoregulation. EEG and electron microscopic study revealed changes in the central nervous system after heat stress. Following exposure to high environmental temperature under 40℃, acute dysfunction of brain was reversible. At 42℃, damage to the brain tissue occurred, and most mice died of heat stroke.

Objective To observe the morphological changes of mice cortex neuron cultured in vitro under different temperature, and the expression of skeleton protein (?-tubulin) in the neuron, and to study the relationship between ?-tubulin and heat shock protein 70 (HSP70). Methods The cerebral cortex neuron of embryonic mice was cultured in vitro. The cultured neuron was put in different temperature 7 days later. To observe the morphological changes of the neuron using optical microscope and the changes of the expression of ?-tubulin and HSP70 under different temperature using laser scanning confocal images. Results Optical microscopy indicated that drifting cells increased, and neural network became sparse in 38℃; some cells necrosed in 39℃; most cells necrosed, cell broke to pieces, axons drifted or disappeared in 42℃. Results of laser scanning confocal images indicated that after hyperthermia the fluorescence intensity of ?-tubulin was lower than that of controls, and the fluorescence intensity declined as the temperature elevated. The fluorescence intensity of HSP70 showed a bell-shape distribution curve, i.e. the highest value emerged at 39℃, whereas the lower values appeared at 37℃ and 42℃. Conclusion Heat stress leaded to the morphological changes of neuron. The disordered of skeleton protein may be responsible for the changes and HSP70 may take part in the process.

Objective To investigate the Relationship between the CYP2C19 polymorphism and the efficacy of triple therapy with lansoprazole on Helicobacter pylori infection. Methods 125 elderly patients diagnosed with H.pylori infection were treated with triple therapy. Polymorphism of CYP2C19 was measured by AS-PCR. 105 young patients were selected as control group. The relationship between the polymorphism and eradication rate were analyzed. Results Among the 125 patients,eradication rate of extensive metabolizer group,internal metabolizer group and poor metabolizer groups was 85.29%,76%and 89.39%, respectively. There was no significant difference between groups (P > 0.05). Eradication rate showed no difference between experimental and control group either (P>0.05)(P>0.05). Conclusion The results suggests that the CYP2C19 polymorphism has no correlation with the eradication rate of Helicobacter pylori infection by triple therapy with lansoprazole in elderly patients.

Neuromyelitis optica spectrum disorder (NMOSD) is a immune-mediated demyelinating disease of the central nervous system, characterized by high recurrence and disability rates. Preventing relapses is crucial in the treatment of this condition. Monoclonal antibodies have emerged as a novel and rapidly evolving clinical therapeutic strategy targeting NMOSD in recent years. An increasing number of studies and clinical trials have also confirmed the effectiveness and safety of monoclonal antibodies. Rituximab, a monoclonal antibody targeting the B-cell surface antigen CD20, has been widely used in the treatment of NMOSD. Currently, in China, the only approved monoclonal antibody for treating NMOSD is Inebilizumab, which targets the B-cell surface antigen CD19. Additionally, various monoclonal antibodies, such as interleukin-6 receptor inhibitors and complement C5 inhibitors, have been used in the treatment of NMOSD. With the deepening of the research on the pathogenesis of NMOSD, the molecular mechanism of disease-related immune network is further clarified, and multi-center clinical trials are widely carried out. More accurate monoclonal antibody treatment strategies for NMOSD will be applied to clinical practice, benefiting more patients.

Transsynaptic retrograde degeneration of optic neuropathy (TRDON) refers to the degeneration and/or apoptosis of presynaptic neurons (retinal ganglion cells) caused by damage to the lateral geniculate body and post-geniculate visual pathway. At present, the pathogenesis of TRDON is secondary apoptosis of P β-type retinal ganglion cells, resulting in the atrophy of optic tract, thinning of the retinal nerve fiber layer and retinal ganglion cell layer thickness and declining of retinal microvascular density, which are consistent with the visual field defect attributed to the primary disease. Of which, the thinning of the retinal ganglion cell layer thickness is considered as the characteristic of TRDON. Now, there is little understanding and related research on TRDON in China. Clinicians should pay attention to the characteristics and severity, occurrence time and location of the above structural changes in these patients through optical coherence tomography, and monitor the activity and progress of the lesions, so as to determine the cut-off point for drug intervention and the drug targets for developing new treatment methods, and bring benefits for patients in partial visual function recovery and disability reduction.

Objective:To observe the clinical characteristics and optical coherence tomography (OCT) features of pseudopapilledema (PPE) combined with peripapillary hyper-reflective ovoid mass-like structures (PHOMS) in children.Methods:A retrospective observational study. From October 2019 to May 2021, total 22 eyes from 12 children diagnosed as PPE combined with PHOMS in the Neuro-ophthalmology Department of The First Hospital of Xi’an (Affiliated of The First Hospital of Northwest University) were recruited. Among the children, 6 were male and 6 were female. The average age was (10.6±2.7) years. The average course from disease onset to diagnosis of PPE combined with PHOMS was (8.0±7.5) months. All patients underwent best corrected visual acuity (BCVA), relative afferent papillary defect (RAPD), Ishihara's test, fundus photography, OCT, fundus autofluorescence (FAF), ocular B-mode ultrasound, visual field and patternvisual evoked potential (P-VEP). The clinical and OCT characteristics of the patients were observed.Results:The anterior segments of the patients were normal. The intraocular pressures and Ishihara's test were all normal. All RAPD were negative. Total 22 eyes, BCVA was 1.0 in 21 eyes and one eye was 0.12. The fundus photography revealed blurred optic discs margin, showing mild to moderate edema-like elevation with more prominent in the nasal parts, presenting as a "C" shape halo. No obvious abnormal fluorescence was observed in FAF. The OCT scan of involvement eyes showed an elevated appearance in vary degrees, and the sharply marginated ovoid hyper-reflective mass-like structures which laterally herniated into the peripapillary region under retinal nerve fiber layer and above the Bruch membrane were detected with consecutive nasal enlargement scanning, corresponding to the nasal parts in the fundus photography. The higher degree of elevation, the larger the volume. Macular retina pigment epithelium layer and ganglion cell thickness were normal. Ocular B-mode ultrasound showed that the head of the optic nerve in the posterior wall of the eyeball (in front of the optic disc) was elevated in all affected eyes, and there was no strong signal echo in it. Visual field examination showed physical blind spot enlargement in 3 eyes and visual field defect in 2 eyes. P-VEP examination showed that the peak was slightly delayed in 3 eyes and the amplitude was slightly reduced in 3 eyes.Conclusions:Enlarged nasal optic disc OCT scan can improve the detection rate of PHOMS. PHOMS were detected bilaterally in the cases with binocular PPE while only in the effected eye in the cases of monocular PPE; the higher degree of PPE, the lager volume of PHOMS. PHOMS were could contribute to the diagnosis of PPE in children.

Currently, coronavirus disease 2019 (COVID-19) is still widely prevalent around the world, leading to a major threat to the global public health. COVID-19 mainly involves the respiratory system, but extrapulmonary manifestations including that of the nervous system also exist in the setting of COVID-19. Misdiagnosis and delayed treatment of the disease may easily cause when ocular, especially neuro-ophthalmological symptoms are the first symptoms in early COVID-19, as the neuroophthalmological manifestations are rarely reported. First-line clinicians need to ask about not only respiratory symptoms such as fever, cough and sore throat, but also diplopia, impaired vision, eye motion pain, abnormal gait or other neurological deficits at the first reception, as these extrapulmonary manifestations are often signs of serious infection. The neuroophthalmological manifestations and possible underlying etiology of COVID-19 were summarized in this review, hoping to provide an early identification and effective treatment of COVID-19 for clinicians. More extensive studies are needed in the future to confirm the causal relationship between COVID-19 and neuroophthalmological disease to provide a sufficient basis for a comprehensive understanding of COVID-19.

Immune checkpoint inhibitors (ICI) have revolutionized the field of oncology by regulating the interaction between immune cells and cancer cells and promoting the disinhibition of the immune system, thus targeting various types of malignant tumors. However, the regulation of the immune system can also trigger related adverse reactions. Currently, there are no specific clinical guidelines for the treatment of these adverse reactions. Treatment decisions largely depend on clinical judgment and experience.The pathogenesis of ICI-related ocular adverse events is not fully understood at present. Further research on the specific mechanisms of action can provide new insights into the early diagnosis and treatment of ICI-related ocular adverse events.

Objective:To preliminary investigate the impact of the diagnosis-related groups (DRG) payment method reform on the diagnosis and treatment of inpatient medical insurance patients with neuromyelitis optica spectrum disorders (NMOSD), and to propose potential improvement strategies.Methods:A single-center, retrospective study. From October 1, 2020, to September 30, 2022, 44 hospitalized medical insurance patients with acute-phase NMOSD diagnosed and treated at the First Affiliated Hospital of Northwest University (Xi'an First Hospital) were included in the study. Among them, there were 11 males and 33 females, with an average age of (40.8±20.2) years. According to the implementation time of DRG payment, patients were divided into two groups: group A, which consists of cases one year before the implementation of DRG payment from October 1, 2020 to September 30, 2021, and group B, which consists of cases one year after the implementation of DRG payment from October 1, 2021 to September 30, 2022, with 20 and 24 cases, respectively. Detailed information such as hospitalization duration, treatment methods, and hospitalization costs of the two groups of patients was collected. Comparative analysis was conducted on hospitalization costs and treatment methods between the two groups. For intergroup comparison, t-test was used for normally distributed data, and Mann-Whitney U test was used for skewed distributed data. Results:Among the 44 patients, 5 cases (5/24, 20.8%) received plasma exchange (PE) treatment, all of whom were in group B. The numbers of patients who received and did not receive intravenous immunoglobulin (IVIG) treatment were 9 and 11 in group A, respectively, and 7 and 12 in group B (except for 5 cases who received PE treatment), respectively. Compared with group A, there was no significant decrease in hospitalization duration ( t=0.004) and total hospitalization costs ( Z=0.036), as well as costs for western medicine ( Z=0.036), examinations ( Z=0.011), laboratory tests ( Z=0.040), treatments ( Z=0.017), and nursing ( Z=3.131) in group B, and the differences were not statistically significant ( P>0.05). For patients receiving PE treatment, except for the cost of western medicine ( Z=0.062, P=0.804), the other costs ( Z=8.288, 5.013, 11.400, 10.925, 9.126) were significantly higher than those of patients not receiving PE treatment, and the hospitalization duration ( t=20.474) was significantly prolonged, with statistically significant differences ( P<0.05). The total hospitalization costs of patients receiving IVIG treatment were significantly higher than those not receiving IVIG treatment in both group A and group B, with statistically significant differences ( Z=7.690, 10.314; P<0.05). There was no statistically significant difference in the comparison of total hospitalization costs between patients receiving IVIG treatment in group A and group B ( Z=0.137, P>0.05). Conclusions:There is no significant decrease in various hospitalization costs of NMOSD medical insurance patients in Xi'an after the implementation of DRG payment, especially for patients receiving PE treatment. It is suggested to optimize the rate stratification of NMOSD patients when implementing DRG payment methods.