In view of the surgical complexity of parapharyngeal space tumors involved, this paper summarized the disease data of patients with parapharyngeal space tumors involved in the Department of Oral and Maxillofacial Surgery, the First Hospital of Shanxi Medical University from January 2015 to January 2021. It also summarized the surgical approach and mandibular management, so as to explore surgical strategies for different characteristics of parapharyngeal space tumors involved. A total of 49 patients, including 28 males and 21 females, median age 52 years (range 24-72 years). They were treated with four surgical approaches for tumor resection, 25 cervical approach, 5 cheek and neck approach, 3 transoral approach, and 16 cervical-maxillary approach. Among the patients treated with cervical-maxillary approach, 3 patients were treated with mandible square resection, and 6 patients were treated with temporary mandible dissection. Seven cases were treated with tumor resection and partial mandibular resection. There are various surgical approaches and mandibular management methods involving tumors in the parapharyngeal space, and clinical decisions should be made based on tumor diameter, location, boundary, blood supply and pathological types.

Background: and Purpose Non-high-density lipoprotein cholesterol (non-HDL-C), which represents the total cholesterol content of all pro-atherogenic lipoproteins, has recently been included as a new target for lipid-lowering therapy in high-risk atherosclerotic patients in multiple guidelines. Herein, we aimed to explore the relationship between non-HDL-C level and the efficacy and safety of ticagrelor-aspirin versus clopidogrel-aspirin in preventing stroke recurrence. Methods: This study comprised a post hoc analysis of the CHANCE-2 (Ticagrelor or Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events II) trial, from which 5,901 patients with complete data on non-HDL-C were included and categorized by median non-HDL-C levels, using a cutoff of 3.5 mmol/L. The primary efficacy and safety outcomes were recurrent stroke and severe or moderate bleeding within 90 days. Results: Ticagrelor-aspirin significantly reduced the risk of recurrent stroke in patients with low non-HDL-C (71 [4.8%] vs. 119 [7.7%]; adjusted hazard ratio [HR] 0.54; 95% confidence interval [CI], 0.40–0.74), but not in those with high non-HDL-C (107 [7.3%] vs. 108 [7.6%]; adjusted HR, 0.88; 95% CI, 0.67–1.16), compared with clopidogrel-aspirin (P for interaction=0.010). When analyzed as a continuous variable, the benefit of ticagrelor-aspirin for recurrent stroke decreased as non-HDL-C levels increased. No significant differences in the treatment assignments across the non-HDL-C groups were observed in terms of the rate of severe or moderate bleeding (5 [0.3%] vs. 8 [0.5%] in the low non-HDL-C group; 4 [0.3%] vs. 2 [0.1%] in the high non-HDL-C group; P for interaction=0.425). Conclusion CHANCE-2 participants with low non-HDL-C levels received more clinical benefit from ticagrelor-aspirin versus clopidogrel-aspirin compared to those with high non-HDL-C, following minor ischemic stroke or transient ischemic attack.

Objective To investigate the impact of overweight on the prognosis of patients with acute mild ischemic stroke or moderate-high risk transient ischemic attack (TIA). Methods A total of 366 patients with acute mild ischemic stroke or moderate-high risk TIA who carried CYP2C19 loss-of-function alleles were included in the study. Baseline data were collected at admission, and clinical outcomes were collected within 3 months post-onset (primary outcomes: stroke recurrences within 3 months post-onset; secondary outcomes: composite outcome of stroke recurrence or death within 3 months post-onset, vascular events, and quality of life within 3 months). Kaplan-Meier method was used to plot the cumulative incidence curve of outcomes. Multivariate Cox proportional hazards model and multivariate Logistic regression model were used to evaluate the relationship between overweight and clinical outcomes within 3 months post-onset in patientswith ischemic stroke or TIA. The integrated discrimination improvement index (IDI) and net reclassification improvement index (NRI) were calculated to assess the predictive value of adding body mass index (BMI, whether overweight or not) based on traditional models for predicting the prognosis of acute ischemic stroke or TIA. Results After 3 months of follow-up, 28 patients had stroke recurrence, 1 patient died, and 31 patients had vascular events. The Kaplan-Meier cumulative incidence curve showed that the cumulative incidences of stroke recurrence, stroke recurrence or death, and vascular events after 3 months of onset were lower in overweight patients compared with non-overweight patients (Log-rank P < 0.05). Multivariate analysis showed that compared with non-overweight patients, overweight patients had significantly reduced risks of stroke recurrence within 3 months (HR=0.24; 95%CI, 0.08 to 0.71), composite outcome of stroke recurrence or death (HR=0.24; 95%CI, 0.08 to 0.69), and vascular events (HR=0.22; 95%CI, 0.07 to 0.63), and significantly improved quality of life within 3 months (OR=0.39; 95%CI, 0.20 to 0.76). The IDI and NRI calculations showed that compared with traditional models, the new model adding BMI (whether overweight) had significantly improved predictive ability for the prognosis of acute ischemic stroke or TIA. Conclusion Overweight may be a protective factor for the prognosis of TIA patients with acute mild ischemic stroke or moderate-high risk who carry CYP2C19 loss-of-function alleles. Compared with non-overweight patients, overweight patients have reduced risks of stroke recurrence, composite outcome of stroke recurrence or death, and vascular events within 3 months post-onset, and improved quality of life within 3 months post-onset.

Objective To investigate the clinical features of spontaneous hypertensive intracerebral hemorrhage with different loads of cerebral small vessel disease （CSVD） and their association with prognosis.Methods A retrospective analysis was performed for the clinical data of the patients with hypertensive intracerebral hemorrhage who were hospitalized within 3 days after onset in Hebei Yanda Hospital from September 2017 to August 2021. Hematoma volume was calculated based on head CT scan results on admission； the severity of white matter hyperintensity， lacunae， enlarged perivascular spaces， and cerebral microbleeds was evaluated based on head MRI results after admission， and total CSVD score was calculated. The clinical features of spontaneous hypertensive intracerebral hemorrhage with different loads of CSVD and their association with prognosis were analyzed.Results A total of 113 patients with cerebral hemorrhage were included， among whom there were 69 male patients and 44 female patients， with a mean age of（61.89±12.47）years. The univariate linear regression analysis showed that sex and systolic blood pressure were associated with bleeding volume， while total CVSD score was not associated with bleeding volume. The univariate linear regression analysis showed that hypertension， history of intracranial hemorrhage， and total CVSD score were associated with NIHSS score on admission， and the multivariate logistic regression analysis showed that hypertension， history of intracranial hemorrhage， and total CVSD score were independent risk factors for high NIHSS score on admission. The univariate linear regression analysis showed that diabetes， smoking history， and total CVSD score were associated with MRS score on day 90 after discharge， and the multivariate logistic regression analysis showed that diabetes， smoking history， and total CVSD score were independent risk factors for poor prognosis.Conclusion The increase in total CSVD score may lead to the increases in the incidence rate of poor functional prognosis and NIHSS score on admission.
Prognosis

Increasing evidence suggests that atrial fibrillation is associated with an increased risk of cognitive impairment and dementia beyond its association with stroke and mortality. The association is independent of stroke. However, the association between atrial fibrillation and cognitive function has often been overlooked in the management and treatment in clinical practice. There is a lack of consensus on the relationship and its mechanisms between atrial fibrillation and brain dysfunction. Whether treatments targeted atrial fibrillation are effective for brain function remains unknown. Through reviewing relevant literatures, this article analyzed the association between atrial fibrillation and its underlying mechanisms. Furthermore, this article further discussed the effectiveness of atrial fibrillation treatments to cognitive function and brain health.

Chronic dizziness is a common clinical symptom with a complex etiology. With the updating of concepts and technological development in the diagnosis and treatment of dizziness and vertigo，the understanding of chronic dizziness diseases is also constantly improving. Diagnostic standards for some common diseases have been published，and treatment methods supported by evidence-based medicine have been applied in clinical practice. This article takes the concept of chronic dizziness as a starting point，sorts out its underlying pathophysiological mechanisms and common causes，and attempts to establish an effective set of thoughts and methods for the diagnosis and treatment of chronic dizziness. It aims to make a preliminary exploration to improve the diagnosis and treatment level of dizziness diseases.

The 24th National Conference of Neurology of Chinese Medical Association was held in Zhuhai City, Guangdong Province during September 23-26,2021.The conference adopted a combination of online and offline methods, with a total of 2 plenary meetings, 20 special seminars, 284 invited reports, 382 papers exchanged at the conference and 1 088 papers exchanged on the wall. The conference focused on cerebrovascular diseases, epilepsy, cognitive disorders, myopathy, peripheral neuropathy, neurodegenerative diseases, nerve infectious diseases, demyelinating diseases, neuroimmune diseases, genetic and metabolic nerve diseases, nerve rehabilitation, anxiety and depression, headache, sleep disorders, nerve nursing, nerve intervention, neuroimaging, neuroelectrophysiology, translational medicine, precision medicine and other related nervous system diseases. There were more than 7 000 participants who attended this conferece.

Objective: To summarize the clinical manifestations of IgG4-related diseases in the head and neck, explore treatment methods. Methods : The clinical data of 21 patients diagnosed with IgG4-related diseases were retrospectively analyzed. The clinical data and the results of glucocorticoid and immunosuppressive therapy were studied retrospectively. Results: All patients had swollen sclerotic masses, and CT showed irregular high-density masses with uniform enhancement in the enlarged glands. Some patients had mucosal thickening and mass-like changes in theoral cavity, nose, sinuses, throat and other tissues, and most of the patients had cervical lymphadenopathy and elevated serum IgG4 levels (≥ 1.35 g/L). Histopathological examination of affected exosine glands and affected mucosa and lymph nodes in all patients showed infiltration of lymphocytes, plasma cells and IgG4+ plasma cells. In 21 patients, the mass in the affected glands and mucosa (including head, neck and other tissues) disappeared, and the clinical symptoms were relieved after the application of glucocorticoids. However, with a reduction in glucocorticoids, the mass recurred or even worsened. Conclusion For patients with a single mass in the submandibular gland, parotid gland and other salivary glands, as well as lymph node enlargement, CT is the first choice to identify the nature of gland neoplasms. Combined with pathological examination, related auxiliary examination and peripheral blood examination are also needed to obtain a definitive diagnosis. Glucocorticoid therapy is used to achieve a good prognosis, and long-term follow-up and timely adjustment of medication regimens are required.

【Objective】 To detect alleles of rare blood group systems of red blood cells (RBC) of Duffy, Diego, Kidd, Dombrock, MNS, Lutheran, Kell, Colton, Scianna, YT, Knops, Indian and Vel of Li Ethnic Group in Hainan, so as to investigate the distribution characteristics of rare blood group alleles and provide references for safe blood transfusion. 【Methods】 The genotypes of 13 rare blood group systems in 300 Li people in Hainan were analyzed by PCR-SSP, and the gene frequency was analyzed . 【Results】 The allele frequencies of Duffy, Diego, Kidd, Dombrock, MNS, and Lutheran blood group systems of 300 Li people were as follows: Duffy: Fy^a=0.958 3, Fy^b=0.041 7; Diego: Di^a=0.066 7, Di^b=0.933 3; Kidd: Jk^a=0.450 0, Jk^b=0.550 0; Dombrock: Do^a=0.101 7, Do^b=0.898 3; MNS: M=0.818 3, N=0.181 7, S=0.028 3, s=0.971 7, Mur⁺ =0.576 7; Lutheran: Au^a=0.835 0, Au^b=0.165 0. The antigen genes of Kell, Colton, Scianna, Yt, Knops, Indian, Vel blood group systems were not polymorphic, and the genetypes were kk, Co^aCo^a, Sc1Sc1, Yt^aYt^a, Kn^aKn^a, In^bIn^b and Vel⁺, respectively. 【Conclusion】 The allele frequencies of Duffy, Diego, Kidd, Dombrock, MNS and Lutheran blood group systems of Li ethnic group in Hainan were polymorphic, while the allele frequencies of Kell, Scianna, Yt, Knops, Colton, Indian and Vel blood group systems were monomorphic.