Stroke is the main cause of death and disability among adults in China and is characterized by high incidence， disability， mortality， and recurrence rates. The combination of traditional Chinese and Western medicine has great potential in treating stroke and its sequelae. The classic traditional Chinese medicine prescription Da Chengqitang （DCQT） has a long history and proven efficacy in treating stroke. Clinically， DCQT is often used to treat stroke and its sequelae. However， the number and quality of clinical trials of DCQT in treating stroke need to be improved. Because of the insufficient basic research， the active ingredients and multi-target mechanism of action of DCQT remain unclear. Our research group has previously confirmed that DCQT can effectively reverse neurological damage， reduce iron deposition， and downregulate the levels of pro-inflammatory cytokines in the rat model of hemorrhagic stroke. The treatment mechanism is related to the nuclear factor erythroid 2-related factor 2 （Nrf2）-mediated signaling pathway and p38 mitogen-activated protein kinase （MAPK） signaling-mediated microglia activation. To clarify the pharmacodynamic basis and anti-stroke mechanism of DCQT， this article reviews the research progress in the treatment of stroke with DCQT in terms of clinical trials， pharmacodynamic material basis， safety evaluation， and mechanisms of absorbed components. This article summarizes 45 major phytochemical components of DCQT， 11 of which are currently confirmed absorbed components. Among them， emodin， rhein， chrysophanol， aloe-emodin， synephrine， hesperidin， naringin， magnolol， and honokiol can be used as quality markers （Q-markers） of DCQT. The mechanism of DCQT in treating stroke is complex， involving regulation of inflammatory responses， neuronal damage， oxidative stress， blood-brain barrier， brain-derived neurotrophic factor， and anti-platelet aggregation. This article helps to deeply understand the pharmacodynamic basis and mechanism of DCQT in treating stroke and provides a theoretical basis for the clinical application of DCQT in treating stroke and the development of stroke drugs.

A case of stress-induced childhood-onset neurodegeneration with ataxia and seizures syndrome due to a compound heterozygous mutation in the ADPRS gene was reported. The child developed episodic ataxia after recurrent upper respiratory tract infections, manifested as unsteady gait, abnormal walking posture, and motor and cognitive regression as the number of episodes increased. Treatment with gammaglobulin in the acute phase transiently improved ataxia symptoms, and hormone therapy was ineffective, however the long-term prognosis was poor, and the patient eventually died due to postictal acute coma. There is no specific treatment for this disease, and the disease progresses rapidly after seizures, with a high mortality rate and poor long-term prognosis.

Objective:To evaluate and compare the clinical efficacy and safety of three different medicated eye patches in the treatment of Demodex blepharitis. Methods:A multicenter, randomized, double-blind, parallel-controlled clinical trial was conducted.A total of 140 patients (280 eyes) with Demodex blepharitis were recruited in Shanghai Jing'an District Shibei Hospital, Xi'an Fourth Hospital and Kunming First People's Hospital from July 2021 to December 2022.The affected eyes were randomly divided into tea tree oil group, okra oil group, basal fluid control group and metronidazole group by the random number table method.Eye patches containing 20% tea tree oil, 1% okra oil, prepared base solution and 2% metronidazole were applied to the eyes for 28 days by the double-blind method.The count of Demodex was evaluated before treatment and on days 14 and 28 of treatment.Ocular surface symptoms were scored according to Ocular Surface Disease Index (OSDI). The degree of congestion at the eyelid margin and cylindrical dandruff at the root of eyelashes were scored under a slit lamp microscope.The effective rate was calculated according to the comprehensive scores above, and the adverse reactions of the subjects were observed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shanghai Jing'an District Shibei Hospital (No.YL-20200320-05). All the subjects were informed of the significance, purpose and method of the study.Written informed consent was obtained from each subject before any medical examination. Results:All subjects completed the treatment and follow-up, and the loss to follow-up rate was 0%.After 14 and 28 days of treatment, the Demodex count was significantly decreased in all groups compared with before treatment (all at P<0.05). After 28 days of treatment, the number of Demodex in tea tree oil group, okra oil group and metronidazole group were significantly lower than that in basal fluid control group, with statistically significant differences (all at P<0.05). The OSDI score, palpebral margin congestion score and cylindrical dandruff score on 14 and 28 days after treatment in tea tree oil group, okra oil group and metronidazole group were significantly lower than before treatment, showing statistically significant differences (all at P<0.05). After 28 days of treatment, the effective rates of tea tree oil group, okra oil group and metronidazole group were 71.4%, 71.4% and 62.9%, respectively, which were significantly higher than 25.7% in basal solution control group.No serious local or systemic adverse reactions were found during the treatment and follow-up. Conclusions:Eye patches containing tea tree oil, okra oil and metronidazole have significant effects on the treatment of Demodex blepharitis, which can improve the biological environment of the palpebral margin and eliminate the inflammation related to blepharitis.

Objective:To develop scientific and practical sensitive indicators with its own characteristics for nursing quality of breast specialty.Methods:A research team was established in August 2018, which searched the databases both at home and abroad, screened and identified relevant literatures according to John Hopkins' evidence level and quality evaluation standards. A sensitive indicator framework for nursing quality of breast specialty was preliminarily formed based on the indicators involved in the literatures. In January 2019, the expert correspondence questionnaire was prepared. Twenty experts were randomly selected from the Qingdao Medical Doctors Association and the Nursing Experts Committee and received two rounds of correspondence consultations using the Delphi method in order to build, modify and confirm the sensitive indicator system for nursing quality of breast specialty.Results:The authority coefficients of the experts in the two rounds of consultation were 0.815 and 0.858; the expert authority coefficient was> 0.80; and the coefficient of variation of each indicator was< 0.30. Eleven sensitive indicators for nursing quality of breast specialty including the awareness rate of functional exercise of the affected limb and lymphedema prevention measures were developed.Conclusions:The sensitive indicators of nursing quality of breast specialty based on the Delphi method is highly practical and credible, which have distinctive specialty characteristics, may be used for the overall care quality assessment and management of breast disease patients, and provide accurate and scientific evaluation for clinical nursing work.

Objective: To investigate the correlation between clinical phenotype, electroencephalogram (EEG) characteristics and genotype in children with Angelman syndrome(AS). Methods: A total of 103 children with AS at Department of Neurology, Children′s Hospital of Fudan University from June 2017 to June 2018, were included in this study.The information of clinical characteristics, EEG manifestations, genotypes as well as the epileptic outcome were collected retrospectively.The correlations between clinical phenotype, genotype, and epileptic outcome were evaluated. Results: (1) Of the 103 cases, 48 were male (46.6%) and 55 were female (53.4%). (2) Genotypes on AS critical region were maternal chromosome 15q11.2-q13 [86.4%(89/103 cases)], paternal uniparental disomy [3.9%(4/103 cases)], imprinting defects [1.9%(2/103 cases)], and mutations in the maternal copy of UBE3A [7.8%(8/103 cases)]. (3) Apparent happy demeanor or smile and general developmental delay were observed in all AS children.Dyskinesia accounted for 98.1% (101/103 cases), followed by oral movement or suck disorders [97.1%(100/103 cases)] and abnormal posture [67.0%(69/103 cases)]. The proportion of acquired small head circumfe-rence or microcephaly, flat occiput or occipital groove and wide-spaced teeth were 61.2%(63/103 cases), 85.4%(88/103 cases) and 44.7%(46/103 cases), respectively.(4) Behavioral problems like fascination with water, sleep problems and feeding difficulties were found in 86.4%(89/103 cases), 89.3%(92/103 cases) and 85.5%(88/103 cases) of the children, respectively.Sleep disorders [94.4%(84/89 cases) vs.57.1%(8/14 cases)] and feeding difficulties [93.3%(83/89 cases) vs.35.7%(5/14 cases)] were more frequently seen in children with maternal absence group, compared those with no absence, and the differences were statistically significant (all P<0.05). (5) Epilepsy was present in 77.7% (80/103 cases) of children with onset age varying from 8 to 72 months and 80.8% (59/73 cases) were developing seizures prior to 3 years old.Children with maternal absence showed more multiple seizure types than those with no absence[41.7%(32/68 cases) vs.0(0 case)], and the difference was statistically significant(P<0.05). Children with well-controlled epilepsy had more atonic seizure, compared with those with poorly controlled seizure [48.3%(14/29 cases) vs.18.5%(4/27 cases)], and the difference was statistically significant(P<0.05). Conclusions Sleep disorders, feeding difficulties in infancy and multiple seizure types are more commonly seen in AS children with maternal absence.Atonic seizure is easier to be controlled over other types of seizures.

Objective To explore the clinical and genetic characteristics, treatment. and prognosis of dopamine responsive dystonia (DRD) in children. Method The clinical data of DRD in 3 children admitted to neurology clinic from January 2014 to August 2017 were retrospectively analyzed. Results Two male children, 20-month-old and 2-year-old respectively, and one 4-year-old female child suffered from hypotonia after birth or one year after birth. Genetic testing found that case 1 had heterozygous mutations in tyrosine hydroxylase (TH) gene, C. G943A (p. G315S) from his mother (PMID 20056467) and C. G739A (p. G247S) from his father (PMID 18554280, 24753243) . Case 2 had a heterozygous mutation, c.454-2A＞G, in GCH-1 gene, which was identified to be from his father (PMID 10732814) . Case 3 had two mutations in TH1 gene, c.580+2T>C from her mother (novel mutation) and c.698G>A (p.R233H) from her father (PMID 9703425) . The mother of case 1 was pregnant again. Prenatal examination revealed that the fetus only carried c.G943A (p.G315S) from the mother. Three patients were treated with a small dose of madopar after diagnosis, and gradually increased to obtain the best effect. After 6-month follow-up, cases 1 and 2 recovered to normal, and case 3 showed significant improvement in dystonia, but left foot deformity. Conclusion DRD can start in infants and young children with atypical early symptoms. Genetic testing can make a definite diagnosis. The family that has proband should undergo prenatal examination.

Particulate matter (PM) researches have long been focused on cardiovascular and puhnonary systems,however,several increasing evidences have showed that PM may be deleterious to human brain development as well.Recently,some studies showed that PM had strongly associated with autism spectrum disorder (ASD) especially PM2.5.Now,the epidemiological and clinical studies on the relationship between ASD and exposure to PM were conducted,expect to be helpful for future ASD etiology research,furthermore to formulate appropriate public policy.

The Autism Spectrum Rating Scale (ASRS) and the Social Responsiveness Scale (SRS) have been widely used for screening autism spectrum disorder (ASD) in the general population during epidemiological studies, but studies of individuals with intellectual disability (ID) are quite limited. Therefore, we recruited the parents/caregivers of 204 ASD cases, 71 ID cases aged 6-18 years from special education schools, and 402 typically developing (TD) children in the same age span from a community-based population to complete the ASRS and SRS. The results showed that the ID group scored significantly lower on total and subscale scores than the ASD group on both scales (P < 0.05) but higher than TD children (P < 0.05). Receiver operating characteristic analyses demonstrated a similar fair performance in discriminating ASD from ID with the ASRS (area under the curve (AUC) = 0.709, sensitivity = 77.0%, specificity = 52.1%, positive predictive value (PPV) = 82.2%) and the SRS (AUC = 0.742, sensitivity = 59.8%, specificity = 77.5%, PPV = 88.4%). The results showed that individuals with ID had clear autistic traits and discriminating ASD from ID cases was quite challenging, while assessment tools such as ASRS and SRS, help to some degree.
Adolescent ; Age Distribution ; Age Factors ; Autism Spectrum Disorder ; complications ; psychology ; Child ; China ; Female ; Humans ; Intellectual Disability ; etiology ; Male ; Psychiatric Status Rating Scales ; Psychometrics ; Retrospective Studies ; Social Behavior ; Statistics, Nonparametric

Objective: To explore the effects of Oxcarbazepine combined with Levetiracetam treatment on electroencephalography (EEG) and serum levels of S-100β, glial fibrillary acidic protein (GFAP) in children with epilepsy. Methods: One hundred and ten children with epilepsy who were admitted to Zhumadian Central Hospital from March 2016 to May 2017 were selected as research subjects.The random number table method was used to divide 55 patients into combined group (treated with Oxcarbazepine plus Levetiracetam) and 55 patients in control group (only treated with Oxcarbazepine). The clinical efficacy, EEG background activity, serum S-100β and GFAP levels were compared between the 2 groups after treatment. Results: The control rate of the combined group was 69.09%, the markedly effective was 18.18%, the effective was 9.09%, and ineffective was 3.64%; the control group had a control rate of 52.73%, markedly effective 20.00%, effective 20.00%, and ineffective 7.27%, respectively.The differences between the 2 groups were statistically significant (Z=-2.012, P=0.044). Before and after treatment, the background activity of EEG in both groups was dominated by alpha wave activity.There was no significant difference in the activity rate of alpha wave, theta wave and delta wave between the 2 groups (all P>0.05). Before treatment, there was no significant difference in serum S-100β and GFAP levels between the 2 groups (all P>0.05). After treatment, serum S-100β [(0.415±0.086) μg/L, (0.473±0.091) μg/L], GFAP [(2.60±0.44) ng/L, (2.93±0.40) ng/L] in the combined group and the control group were significantly lower than before treatment, and the differences were statistically significant (t=6.339, 6.703, 3.001, 3.364, all P<0.05). After treatment, serum S-100β and GFAP levels in the combined group were significantly lower than those in the control group, and the differences were statistically significant (t=3.435, 4.116, all P<0.05). Conclusions Oxcarbazepine combined with Levetiracetam is superior to Oxcarbazepine alone in the treatment of children with epilepsy, as it can reduce the levels of S-100β and GFAP and is worthy of clinical application.

Pttrpose Contrast-enhanced ultrasound (CEUS) is a noninvasive technique that can monitor the blood perfusion of organs.The study aims to discuss the value of CEUS in quantitative analysis of renal microcirculation during resuscitation after hemorrhagic shock (HS).Materials and Methods Forty healthy New Zealand white rabbits were randomly divided into five groups in this prospective study.One group was selected as normal control group (T1),the other four groups were established HS model by using the modified Wiggers's method;one of the four HS groups was taken as shock group (T2),and the other three HS groups were named as 2 h group (T3),6 h group (T4),and 24 h group (T5) according to resuscitation time.CEUS was used to observe the rabbits' renal perfusion and the perfusion parameters were recorded including amplitude of peak intensity (A),time to peak (TTP),area under curve (AUC) and curve rising slope rate (Grad);the correlation of these parameters with histological examination was analyzed.Results Compared with T1 group,The TTP ofT2 group prolonged and the A,AUC and Grad decreased (P＜0.05);the HS model was established successfully.Compared with T2 group,the A,AUC and Grad of T3,T4 groups increased (P＜0.05),but the TTP of T3,T4 groups was not shortened (P＞0.05).The above parameters were all significantly different between T5 group and T2 group (P＜0.05),but the differences did not exist between T5 and T1 groups (P＞0.05),which indicated that the perfusion parameters gradually returned to normal level after resuscitation.The histological staining demonstrated that the renal tubular epithelial cell swelling and vascular congestion gradually restored after resuscitation.Conclusion CEUS can quantitatively assess renal perfusion changes during resuscitation as a noninvasive monitor.