Idebenone is a synthetic analogue of coenzyme Q10. As a potent antioxidant,idebenone operates under low oxygen tension situations, protects cell membranes and mitochondria from oxidative damage through inhibiting lipid peroxidation, thereby protects against cerebral ischemia and nervous system damage. Idebenone also interacts with the mitochondrial electron transport chain and maintains the formation of ATP under ischemic conditions. Because idebenone has a good tolerability and safety, it is expected as a neuroprotective agent for the treatment of acute ischernic stroke. Studies in recent years have showed that idebenone has a certain therapeutic effect in a variety of nervous system diseases involving mitochondrial dysfunction and oxidative stress damage, such as mitochodrial encephalomyopathy, lactic acidosis, stroke-like episodes syndrome, Friedreich's ataxia, Alzheimer's diseases, Leber's hereditary optic neuropathy, and Duchenne muscular dystrophy. At present, some clinical trials in the mitochondria-related diseases and neuromuscular diseases are underway, and their results are expected to further expand the indications of idebenone.

Iron is an essential nutrient element for human, but has potential toxicity. Under physiological conditions, the processes of iron absorption, transportation, cellular uptake and utilization, storage, release, excretion as well as regulation of iron metabolism maintain the iron homeostasis. However under pathological conditions, the iron metabolism changes and is associated with the pathological states. In order to realize the relationship between the critical illness status and the iron metabolism, we start with an analysis of the basic processes of iron metabolism in human and the toxicity of iron, followed by summary on the alteration of iron metabolism in the settings of pathological conditions, such as inflammation, infection and anemia, which often occur in critical illness. Then, we discuss the relationship between the prognosis and the parameters of iron metabolism. Moreover, we review the current researches on treatments related to iron metabolism, which involve the iron supplementation, iron chelation and agents regulating iron metabolism.

Neuromyelitis optica ( NMO) is an idiopathic autoimmune inflammatory disorder of the central nervous system ( CNS) that predominantly affects the optic nerves and spinal cord.It is especially common in Asia. An association between NMO and other autoimmune diseases has been frequently reported, which is different from multiple sclerosis( MS) ,this phenomenon may due to different genetic background between these two diseases.There are reports on different populations to make this clear,which showed human leukocyte antigen( HLA) class II distribu-tion was unique entity different between NMO and MS or healthy controls,this would be a great help to make clear the mechanism underlying NMO pathogenesis.

Objective To establish a standardized middle cerebral artery occlusion (MCAO) model with suture method in rabbits and to investigate the value of the assessment for cerebral ischemia with amplitudeintegrated electroencephalogram (aEEG).Methods A total of 34 male New Zealand white rabbits were randomly assigned to either an MCAO group (n =29) or a sham operation goup (n =5).A model of MCAO was induced with intraluminal suture method and the cerebral function monitor was performed.According to 2,3,5-triphenyltetrazolium chloride staining,the MCAO group was further divided into cortex + basal ganglia infarction,basal ganglia infarction,subarachnoid hemorrhage,and non-lesion subgroups.The differences among the physiological indicators,weight,thread end diameter,and insertion length were compared before and after modeling in all subgroups.Results The success rate of MCAO modeling with suture method in rabbits was 62.07％ (18/29),in which 37.93％ (11/29) involved in the cortex and basal ganglia,24.38％ (7/29) only involved in the basal ganglia,17.24％ (5/29) complicated by subarachnoid hemorrhage,and 20.69％ (6/29) had no infarction.There were no significant differences in the body temperature,heart rate,mean arterial pressure and arterial blood pH,oxygen partial pressure,and CO2 partial pressure among all the subgroups before and after modeling.The weight in the non-lesion subgroup was 2.36 ± 0.10 kg,it was significantly lower than 2.55 ± 0.09 kg in the cortex + basal ganglia infarction subgroup (P =0.001) and 2.50 ± 0.12 kg in the basal ganglia infarction subgroup (P =0.017).The length of suture placement in the cortex+basal ganglia infarction subgroup was 5.59 ± 0.24 cm,and it was significantly less than 6.00 ± 0.50 cm in the subarachnoid hemorrhage subgroup (P =0.036).However,it was significantly longer than 5.20 ± 0.50 cm in the non-lesion subgroup (P =0.033).After modeling there were significant differences in aEEG among all subgroups (F =14.059,P =0.000).Compared to before modeling,aEEG decreased 50.02％ (t =9.573,P ＜ 0.001) and 14.20％ respectively after modeling in the cortex + basal ganglia infarction subgroup and the ganglia infarction subgroup (t =2.908,P =0.027).Conclusions A standardized MCAO model in rabbits may be successfully established with suture method.The significantly decreased aEEG indicates that the MCAO model is successful and the lesions involve in the cortex.

Objective To investigate the diagnostic significance of the relative band power(RBP) of EEG in acute focal cerebral ischemia (AFCI). Methods EEG monitoring was performed in 20 patients with AFCI (51 lesions) in neurological intensive care unit (NICU) and 20 patients with normal EEG (control group) in NICU. The changes of bilateral RBP were observed and analyzed comparatively. RBP in the infarction group was compared with that in the control group. The diagnostic capabilities of all wave-band RBPs were assessed with the receiver operating characteristic (ROC) analysis. Results AFCI shoved asymmetry on all the wave-band RBPs. The RBP of of δwave on the lesion side was significantly higher than that on the normal side (P <0.01). RBPs of α, β and θ waves were decreased significantly (P <0.05). RBP of δ wave in the infarction group was increased significantly compared to the control group (P < 0.01 ). RBPs of α and β waves were decreased significantly (P <0.01). The diagnostic accuracy of the RBP of α was the highest, and both β and δ waves also had significance for the diagnosis of AFCI. Conclusions RBP had an important significance for the early diagnosis of AFCI. Conclusions RBP had an important significance for the early diagnosis of AFCI.

Objective To investigate the risk factors for bacterial pneumonia and the predictive value of early serum procalcitonin (PCT) level for bacterial pneumonia and sepsis classification in patients with acute stroke. Methods The patients with acute stroke in neurological intensive care unit were enroled retrospectively and divided into either a bacterial pneumonia group or a non-infection group according to whether they had bacterial pneumonia or not. The former was redivided into a non-severe sepsis subgroup and a severe sepsis subgroup according to the sepsis classification. The demographics, baseline clinical data, and PCT level (the bacterial pneumonia group was the PCT level when infection occurred, the non-infection group was the PCT level within 24 h of admission) were compared. Multivariate logistic regression analysis was used to identify the independent risk factors for bacterial pneumonia. Receiver operator characteristic (ROC) curve was used to analyze the predictive value of serum PCT level for bacterial pneumonia and sepsis
classification. Results A total of 164 patients with acute stroke were enroled in the study, including 114 in the bacterial pneumonia group (66 in the non-severe sepsis subgroup and 48 in the severe sepsis subgroup) and 50 in the non-infection group. There were significant differences in age, fasting blood glucose level, Glasgow coma scale (GCS) score, and PCT level between the bacterial pneumonia group and the non-infection group (P < 0. 05 ). Multivariate logistic regression analysis showed that fasting blood glucose level ≥7 mmol/L (odds ratio [ OR] 8. 488, 95% confidence interval [ CI] 2. 739 - 26. 300; P < 0. 01), GCS score ≤8 (OR 11. 361, 95% CI 2. 175 - 59. 352; P < 0. 01), and PCT level ≥0. 050 ng/ml (OR 16. 715, CI 5. 075 - 55. 049; P < 0. 01) were the independent risk factors for bacterial pneumonia. In the bacterial pneumonia group, the PCT level (median; interquartile range) in the severe sepsis subgroup was significantly higher than that in the non-severe sepsis subgroup (0. 835 [ 0. 164 - 1. 715 ] ng/ml vs. 0. 114 [0. 073 - 0. 275 ] ng/ml; Z = 4. 818, P < 0. 01 ). ROC curve analysis showed that PCT ≥0. 070 ng/ml could better predict the occurrence of bacterial pneumonia in patients with acute stroke, with sensitivity of 84. 2% , specificity of 74. 0% and the area under the ROC curve of 0. 865 (CI 0. 806 - 0. 924, P < 0. 01); PCT 0. 669 ng/mlcould better predict the occurrence of severe sepsis in acute stroke patients with bacterial pneumonia, with sensitivity of 56. 3% , specificity of 92. 4% and the area under the ROC curve of 0. 765 (CI 0. 672 - 0. 858; P < 0. 01). Conclusions The early PCT level ≥0. 050 ng/ml was an independent risk factor for occurring bacterial pneumonia in patients with acute stroke, its level had certaln predictive value for bacterial pneumonia and the severity of infection.

Neurology is one of the most difficult subjects in clinical medical education.How to improve the teaching model of neurology is a crucial problem.The systematic instructional design and problem-based learning (PBL) emerge as mature teaching techniques,and having a broad application prospect.However,simple PBL teaching model has not achieved the desired results,because PBL teaching method pays excessive attention to the subjective initiative of students,but ignores the supervision and assessment mechanisms,such as assessment,feedback,adjustment,which are the major concerns of systematic instructional design.This research tries to combine systematic instructional design with PBL teaching model,and explore the position in neurology teaching.By determining the teaching target,analysis of PBL teaching,writing teaching plans,organization of PBL teaching,feedback to adjust teaching design method,the final summative evaluation is done and the teaching,was completed.After practice tips may bring progress on neurology teaching mode.

Objective To study the prognostic predictive value of quantitative dectroencephalography (qEEG)for patients with large middle cerebral artery infarction (LMCAI).Methods The scores of routine electroencephalography (EEG),qEEG and the Glasgow Coma Scale (GCS) of the patients within 72 hours after symptom onset were recorded.The short-term prognosis (death or survival) was evaluated at 1 month after the onset.The long-term prognosis (good or poor) was evaluated at 3 months after the onset.All the observed data in each prognostic group were compared.Results A total of 105 patients were included in the study.There were significant differences in the margin of amplitude integrated electroencephalogram (aEEG) (upper margin:19.11 ± 7.80 μV vs.11.87 ±6.41 μV;t =2.392,P =0.019; lower margin:11.90 ± 4.78 μV vs.7.58 ± 4.15 μV; t =3.327,P =0.022),Synek-classification (x2 =48.114,P =0.000) between the short-term survival group and the death group; in patients with left LMCAI,there were significant differences in the absolute energy of the β-activity (13.16 ±12.66 μV2 vs.19.20 ±17.96 μV2;t =-2.781,P =0.039),spectral edge frequency 95％ (SEF95％) (9.17 ± 3.24 Hz vs.10.36 ± 3.76 Hz; t =-5.614,P =0.002) between the short-term survival group and the death group.There were significant differences in the age (59.33 ±13.67 years vs.68.87± 10.473 years; t =-3.215,P =0.002),GCS scores (10.86±2.80 vs.9.21 ±2.51;t =2.511,P =0.015),SEF95％ (13.80 ±5.40 Hz vs.10.93 ±4.68 Hz; t ＝2.311,P =0.024) and sides of infarction (x2 =4.737,P =0.030) between the long-term good prognosis group and the poor prognosis group.Conclusion qEEG can be used as an effective means of monitoring for evaluating the prognosis of patients with LMCAI.

Objcctive To investigate the predictive value of the 40 Hz auditory steady-state response (ASSR) in patients with the malignant process of middle cerebral artery territory infarction.Methods The40 Hz ASSR and brainstem auditory evoked potential (BAEP) were performed within 72 hours after patients with middle cerebral artery terrtory infarction admitted in the neuro-intensive care unite (NICU).At the same time,the National Institutes of Health Stroke Scale (NIHSS) scores were assessed.Multivariable logistic regression analysis was used to deterrmine the influencing factors of the malignant process.The relevant indicators of the malignant process were analyzed by the receiver operating characteristic(ROC) curve in order to clear the predictive value of 40 Hz ASSR in the malignant process of middle cerebral artery territory infarction.Results A total of 104 patients with supratentorial middle cerebral artery territory infarction were included.They were divided into the malignant process group (n=59) or the non-malignant process group (n=45).There were significant differences in the baseline NIHSS scores (17.25 ± 7.23 vs.20.40 ± 8.09; t =- 2.055,P =0.043),infarct volume (105.85 ± 73.37 mm3 us.179.15 ± 144.38 mm3; t =-3.011,P =0.004),leukocyte count ([ 10.26 ±3.14] × 109/L vs.[ 13.45 ±5.42] × 109/L; t =-3.336,P =0.001),40 Hz ASSR (Z =-3.237,P =0.001),and short-latency somatosensory evoked potentials (Z =-3.130,P =0.002) grade between the malignant process group and the non-malignant process group.Multivariate logistic regression analysis showed that the40 Hz ASSR (odds ratio [OR] 3.347,95％ confidence interval [CI] 1.630 -6.872; P=0.014),infarct volume (OR 1.006,95％ CI 1.001 - 1.012,P=0.003),and leukocyte count (OR 1.277,95％ CI 1.074 - 1.402; P =0.001) were the independent predictors in patients with the malignant process of middle cerebral artery territory infarction.When the 40 Hz ASSR was grade 3,the sensitivity and specificity of predicting malignant process were 39.5％ and 94.4％.Conclusions The 40 Hz ASSR has an important predictive value in patients with the malignant process of middle cerebral artery territory infarction.

Objective To explore the predictive value of early electroenphalography (EEG) for a malignant course in patients with large middle cerebral artery infarction (LMCAI).Methods Thirty-seven patients (20 patients with a malignant and 17 with a benign course) with stroke of >50% of the middle cerebral artery territory in early CT/MRI scan were included;Glasgow-Pittsberg Coma Scale (24 ±1 vs. 30 ±4, P =0. 003) and National Institutes of Health Stroke Scale (23 ±3 vs. 16 ±4, P =0.000) in the group with a malign course were higher than those in the group with a benign course. Early EEG was recorded within 24 h after ischemic stroke. The correlation between the change characteristics of EEG and a malignant course in patients with LMCAI was analyzed. Results The contralateral occipital background frequencies < 8 Hz (17/20 vs. 3/20, P =0.000), β frequency within the focus ≤20 Hz (19/26 vs. 7/26, P= 0-001), EEG non-reaction to stimuli (11/12 vs. 1/12, P= 0.002),slowing affecting the whole hemisphere in the lesion (17/24 vs. 7/24, P = 0. 008) and focal slowing contralateral to the lesion (16/19 vs. 3/19, P =0. 000) were significantly related with a malignant course. Whereas the contralateral occipital background frequencies ≥8 Hz (14/17 vs. 3/17, P =0. 000),β frequency >20 Hz within the focus (10/11 vs. 1/11, P =0. 001) were related with a benign course. Conclusions Early EEG has a certain predictive value for a malignant course in patients with LMCAI, and it may be used as one of the bedside monitoring approaches of LMCAI.