Stroke is an important disease that leads to disability and death in humans and has relatively high disabil-ity and mortality rates.Microglial cells,as an important component of the central nervous system,can be induced into dif-ferent phenotypes of M1 and M2 by pathological stimulation and play a dual role of neurotoxicity and neuroprotection.This article reviews the role of microglial cells in the progression of ischemic stroke and explores the new targets for the treat-ment of ischemic stroke through intervention of microglial cells.

Stroke is one of the main causes of adult disability and death, and ischemic stroke is the most common type of stroke. Therefore, it is of great significance to evaluate the condition and outcome of patients with ischemic stroke timely and accurately. As a cheap, non-invasive and multi-functional technology, electroencephalogram (EEG) can directly reflect the abnormal state of brain function and metabolism, and is more sensitive to brain damage caused by the decreased cerebral blood flow. It has important significance in predicting the outcome of patients with ischemic stroke. This article reviews the changes of EEG after ischemic stroke and the characteristic EEG changes related to the outcome of ischemic stroke.

Objective:To explore the efficacy and safety of Ganhai Weikang capsule (GWC) in the treatment of functional dyspepsia (FD).Methods:A randomized, double-blind, placebo-controlled parallel, multi-center, superiority clinical trial was conducted. From March 2018 to April 2020, totally 324 patients with dyspepsia symptoms, who were diagnosed as chronic non-atrophic gastritis by endoscopy and pathology and met the Rome Ⅳ diagnostic criteria for FD from 7 top hospitals were enrolled, including the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Heilongjiang Hospital of Traditional Chinese Medicine, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Qilu Hospital of Shandong University, the First Affiliated Hospital of Zhejiang University, Beijing Hospital of Traditional Chinese Medicine of Capital Medical University and the Third Xiangya Hospital of Central South University. The patients were randomly divided into the GWC group and the placebo group according to the ratio of 1∶1. The patients of GWC group were given GWC and the patients of placebo group were given GWC capsule simulant. The patients of both groups orally took capsules before meals, 2.4 g each time and 3 times per day, and the course of treatment was 4 weeks. The main efficacy index was the total clinical effective rate after 4 weeks, and the secondary efficacy index was the changes of clinical symptom scores of upper abdominal pain, upper abdominal burning, postprandial fullness and early satiety. The safety index included laboratory tests and adverse events. Chi-square test and Wilcoxon rank sum test were used for statistical analysis.Results:A total of 320 FD patients were enrolled in the full analysis set (FAS), which included 161 cases in GWC group and 159 cases in placebo group. A total of 298 cases were in the per-protocol set (PPS), 149 cases each in GWC group and placebo group. The results of FAS and PPS both showed that the total clinical effective rates of the GWC group were higher than those of the placebo group (84.5%, 136/161 vs. 44.0%, 70/159 and 83.9%, 125/149 vs. 46.3%, 69/149), and the differences were statistically significant ( χ2=57.07 and 46.32, both P<0.001). In addition, the differences of the total score of main symptoms and each symptom (upper abdominal pain, upper abdominal burning, postprandial fullness and early satiety) before and after treatment of GWC group were all higher than those of the placebo group (FAS: 10 (7, 14) vs. 5 (3, 11); 3 (2, 4) vs. 2 (0, 3); 2 (0, 4) vs. 1 (0, 3); 3 (1, 4) vs. 2 (1, 3); 2 (0, 4) vs. 1 (0, 3). PPS: 10 (7, 13) vs. 5 (3, 11); 3 (2, 4) vs. 2 (0, 3); 2 (0, 4) vs. 1 (0, 2); 3 (1, 4) vs. 2 (1, 3); 2 (0, 4) vs.1 (0, 3)), and the differences were statistically significant (FAS: Z=5.80, 5.91, 3.19, 3.72 and 3.30; PPS: Z=5.14, 5.11, 2.86, 3.21 and 2.84; all P<0.01). The results of FAS and PPS indicated that the improvement rates of main symptoms and each symptom (upper abdominal pain, upper abdominal burning, postprandial fullness and early satiety) of GWC group were all higher than those of the placebo group (FAS: 77.8% (54.6%, 91.3%) vs. 42.9% (28.6%, 61.5%); 100.0% (60.0%, 100.0%) vs. 50.0% (25.0%, 60.0%); 100.0% (50.0%, 100.0%) vs. 50.0% (25.0%, 100.0%); 71.4% (33.3%, 100.0%) vs. 41.4% (25.0%, 66.7%); 100.0% (50.0%, 100.0%) vs. 50.0% (20.0%, 100.0%). PPS: 77.8% (54.2%, 89.5%) vs. 44.0% (28.6%, 65.0%); 100.0% (60.0%, 100.0%) vs. 50.0% (25.0%, 100.0%); 100.0% (50.0%, 100.0%) vs. 50.0% (25.0%, 100.0%); 71.4% (33.3%, 100.0%) vs. 46.4% (25.0%, 66.7%); 100.0% (50.0%, 100.0%) vs. 50.0% (20.0%, 100.0%)), and the differences were statistically significant (FAS: Z=8.60, 7.72, 4.98, 4.24 and 5.61; PPS: Z=7.90, 7.03, 4.49, 3.88 and 4.83; all P<0.001). After 2 weeks of treatment, the differences of the total score of main symptoms and score of each symptom (upper abdominal pain, upper abdominal burning and early satiety) before and after treatment of GWC group were all higher than those of the placebo group (5.0 (3.0, 8.0) vs. 4.0 (2.0, 6.0); 2.0 (1.0, 2.0) vs. 2.0 (0.0, 2.0); 1.5 (0.0, 2.0) vs. 1.0 (0.0, 2.0); 1.5 (0.0, 2.0) vs. 1.0 (0.0, 2.0)), and the differences were statistically significant ( Z=2.95, 3.44, 2.43 and 2.79, all P<0.05). There was no significant difference in the incidence of adverse events between the GWC group and the placebo group (0.6%, 1/163 vs. 0, 0/159). Conclusion:The clinical total effective rate of GWC in the treatment of FD is superior to that of placebo and it has good safety.

Cerebral edema and its caused elevated intracranial pressure are one of the main causes of death in patients with acute ischemic stroke. The main pathogeneses of brain edema include cytotoxic edema, ionic edema, and angiogenic edema. At present, the treatment strategies used to control brain edema and reduce intracranial pressure are mainly osmotic drugs and hemicraniectomy decompression, which are symptomatic treatments to reduce intracranial pressure. In recent years, it has been proposed to inhibit the ion channel in the formation of brain edema as a therapeutic target, which provides a new direction for the treatment of brain edema.

Objective By observing the changes of angiogenesis related factors and cerebral perfusion before and after treatment in patients with large area cerebral infarction，the formation of collateral circulation of Salvia miltiorrhiza polyphenolic acid injection and its effect on the improvement of nerve function were discussed.Methods Forty-four patients with large area cerebral infarction were selected，and all subjects were randomly divided into the salvia miltiorrhiza polyphenolic acid treatment group and the conventional treatment group （control group） according to the ratio of 1：1，with sample content of 22 patients in each group. Both groups were treated with cerebral infarction dehydration，cranial pressure reduction and brain protection，and the salvia miltiorrhiza polyphenolic acid treatment group was treated with Salvia miltiorrhiza polyphenolic acid injection on the basis of the above medication. The course of treatment in both groups was 14 days. The changes of VEGF，bFGF，Ang and quasi-continuous arterial spin labeling were observed in the two groups before and 14 days after treatment. Changes in the ratio of cerebral blood flow （CBF） to CBF in the region of interest （ROI） and contralateral image region （CBF lesions/CBFnormal），as well as changes in NIHSS score and mRS score.Results Serum levels of VEGF，bFGF and Ang in the two groups increased after treatment compared with those before treatment，and the difference was statistically significant （P<0.05）.Fourteen days after treatment，serum levels of VEGF，bFGF and Ang in the salvia miltiorrhiza polyphenolic acid treatment group were significantly higher than those in the control group，with statistically significant differences（P<0.05）.After treatment，CBF lesions/CBFnormal in the two groups were increased compared with those before treatment，and the difference was statistically significant（P<0.05）.Fourteen days after treatment，CBF lesions/CBFnormal in the salvia miltiorrhiza polyphenolic acid treatment group were significantly higher than those in the control group，with statistically significant differences（P<0.05）.The NIHSS and mRS scores of the two groups decreased after treatment compared with before treatment，with statistically significant differences（P<0.05），and the salvianolic acid treatment group decreased significantly compared with the control group （P<0.05）.Conclusion Salvia miltiorrhiza polyphenolic acid for injection can promote angiogenesis in patients with large area cerebral infarction，and can significantly improve cerebral blood flow in diseased brain tissue，improve cerebral perfusion，and then effectively improve the symptoms of neurological impairment

White matter hyperintensities (WMHs) are one of the MRI markers of cerebral small vessel disease, which are more common in the elderly, and are closely associated with the clinical manifestations such as cognitive impairment and gait disorder, however, the pathophysiological mechanism is currently unclear. This article expounds the possible pathophysiological mechanisms of WMHs from many aspects, such as hypoperfusion, blood-brain barrier destruction, oxidative stress, inflammation, and genetics.

Speaking lesson is an effective way and teaching skill to prepare lessons for the teaching of anatomy. Taking the speaking lesson design of lecture teaching of the neck as an example, this article shows the teaching of topographic anatomy for "5+3" integrated clinical medical students. Adhering to the teaching concept of "student-centered", we have launched the theoretical teaching of "problem-centered discussion" and the experimental teaching of "operator responsibility system" in groups, with the "thanksgiving" humanistic education running through the whole process of theoretical and experimental courses. The teaching is a good way to cultivate the students' gratitude consciousness and humanistic quality, self-learning ability, critical thinking ability, communication and expression ability, hands-on operation ability and teamwork spirit, which has laid a solid foundation for training medical professionals in the new era.

In recent years, many studies have found that white matter hyperintensity (WMH) of presumed vascular origin is closely related to cognitive impairment, which reflects the negative effects of white matter macrostructure damage on cognition, while diffusion tensor imaging (DTI) can quantify white matter microstructure damage through different imaging parameters. A variety of DTI parameters are associated with cognitive impairment in WMH, and are of great value in early diagnosis, evaluation of progress risk and efficacy of cognitive impairment. On the basis of DTI, the relevant parameters of brain structural network obtained by joint the graph theory analysis method are also considered to be related to the cognitive impairment with WMH. This paper reviews the latest progress of DTI derived parameters, brain structural network parameters and their relations with WMH cognitive impairment.

White matter hyperintensities (WMHs) is a magnetic resonance imaging phenotype of cerebral small vessel disease,which is manifested as diffuse or confluent subcortical white matter.There is usually no clinical manifestation in the early stage of WMHs,and its pathophysiological mechanism has not been fully elucidated.Studies have shown that a variety of factors are associated with WMHs.The article reviews the risk factors for WMHs.

Objective To evaluate the treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.Methods From January 2014 to January 2017,26 patients were operatively treated at Department of Orthopaedics,Tongji Hospital for posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures via a combination of posterolateral and posteromedial approaches.They were 10 men and 16 women,aged from 53 to 67 years(average,61.5 years).The surgery was conducted in prone position via the posterolateral and posteromedial approaches to expose simultaneously the fractures ends at medial,lateral and posterior malleoli for open reduction.The lateral malleolar fractures were fixated with plate,the medial malleolar fractures with screws and posterior malleolar fractures with plate or cannulated screws depending on the size of the fracture blocks.The outcomes were assessed using the ankle-hindfoot scores of American Orthopaedic Foot and Ankle Society(AOFAS) and the visual analogue scale(VAS).Results Of this cohort,22 were followed up for 30 months on average(range,from 18 to 48 months).All the cases healed by the first intension without any infection.Their postoperative X-ray showed bone union after an average of 12.5 weeks(range,from 10 to 15 weeks).No nonunion,loosening or breakage of implants was found.The mean time for walking with full weight-bearing was 13 weeks(range,from 11 to 16 weeks).Their AOFAS ankle-hindfoot scores at the final follow-ups were 85.4(range,from 80 to 92),yielding 13 excellent and 9 good cases with a good to excellent rate of 100%.Their mean VAS scores were decreased significantly from preoperative 8.6±0.6 to postoperative 1.7±0.3(f=153.000,P=0.000).Conclusion In treatment of posterior malleolar two-part fractures complicated with medial and lateral malleolar fractures,a combination of posterolateral and posteromedial approaches in prone position can expose and reduce simultaneously the fractures ends at medial,lateral and posterior malleoli,leading to satisfactory clinical outcomes.