2018年·第98卷第33期

As the average life expectancy of residents in our large and medium-sized cities increases, the number of elderly people has surged, and the number of people with cognitive impairment, which is highly associated with aging, has also increased significantly. At present, the effect of drug treatment to treat or delay cognitive impairment is not satisfactory. How to identify cognitive impairment through biomarkers or specific examinations in the ultra-early stage of disease and intervene early should attract clinicians' attention. The prevalence of sleep disorders in patients with cognitive impairment is high. Different forms of sleep disorders suggest different types of cognitive impairment. Sleep disorders not only accelerate cognitive impairment, but also increase the economic and psychological burden of caregivers. It is of great clinical and social significance to systematically evaluate, intervene and manage sleep disorders at any stage of cognitive impairment.

The prevalence of sleep disorders in patients with cognitive impairment is high, and sleep disorders not only accelerate cognitive impairment, but also increase the mortality rate; At the same time, it will increase the financial and psychological burden of caregivers. Therefore, systematic clinical assessment and management of sleep disorders in patients with cognitive impairment has important clinical and social significance. The Sleep Disorder Group of the Neurology Branch of the Chinese Medical Association and other institutions organized experts to review the evidence of relevant papers, meta-analyses and systematic reviews officially published before April 2018, and invited domestic experts from relevant disciplines to discuss and formulate this expert consensus.

Foramen magnum meningioma (FMM) is a special type of skull base meningioma, which can be divided into three types according to the anatomical location: dorsal, lateral and ventral. Although its incidence is not high, it accounts for about 1.8% to 3.2% of all intracranial meningiomas^[1]However, due to its special location, especially ventral meningioma, which is located on the ventral side of the cervical medulla oblongata, with complex adjacent vascular nerve structure and narrow surgical operation space, the surgical treatment of meningioma in this area is challenging and high risk. The application of neuroendoscopy and its technology has opened up a new field for the development of neurosurgery, especially its advantages of using the natural intracranial space with its close observation, high-definition illumination and wide-angle visual field, which fully embodies the new concept of micro-invasive non-traction neurosurgery. At present, there are few reports on the application of transnasal endoscopic approach to treat tumors in the foramen magnum area in the world. Now, a case of ventral meningioma in the foramen magnum area resected by neuroendoscopic nasal-slope-dentate approach is reported in the neurosurgery department of our hospital. The experience of surgical diagnosis and treatment is reported as follows.

Biotin-thiamine responsive basal ganglia disease (BTBGD) was developed in 1998 by Ozand et al., Saudi Arabia^[1]It was first reported that the disease was mainly presented with dystonia and symmetrical basal ganglia region lesions, which responded well to biotin and thiamine therapy in the acute phase. The prevalence of BTBGD is unknown, and the reported cases are mostly found in Saudi Arabians' close relatives who married and gave birth to children. At present, there are only more than 100 cases reported worldwide. In recent years, the disease has also been reported in other populations. Recently, the first case of BTBGD patient was reported in my country^[2]。 Some foreign scholars believe that clinicians' understanding of this disease is insufficient, and there may be misdiagnosis and misdiagnosis of this disease in clinic^[3]。 Therefore, we conducted a systematic retrospective analysis and summary of BTBGD cases that have been reported so far, and put forward the diagnostic criteria of BTBGD "Xuanwu Hospital 2017" for the first time, in order to provide a reference for clinical practice.

The ketogenic diet is a commonly used clinical way to induce ketogenesis in the body, characterized by low protein and carbohydrate (less than 50 g/d), while the fat content is relatively high. The ketogenic diet transforms sugar metabolism into fat oxidation to supply energy, producing ketone bodies mainly composed of β-hydroxybutyric acid, and maintaining the body in a continuous ketogenic state. The ketogenic diet was used in the treatment of epilepsy as early as 1921. In recent years, there is clear clinical evidence to support the improvement of ketogenic diet on weight loss, cardiovascular disease and type 2 diabetes. It is also effective for tumors, polycystic ovary syndrome, etc., and the repairing effect of ketogenic diet on spinal cord injury is also the current research hotspot^[1]。 While paying attention to various clinical effects of ketogenic diet, some scholars have also found that in addition to nausea, vomiting and other gastric discomfort, children treated with long-term ketogenic diet can also have decreased bone density, decreased bone mass, and delayed bone growth^[2]。 This article reviews the research progress of ketogenic diet-induced bone loss and its possible mechanisms.

Necrolytic erythema migrans (NME) was originally a characteristic lesion of glucagonoma. It was first named by Wilkinson in 1973, and in 1979 Mallinson et al.^[1]Glucagonoma (GCGN) and concomitant NME are named glucagonoma syndrome (GS). In recent years, with the increase of NME cases, there are some clinical reports of NME without glucagonoma, which is called pseudoglucagonoma syndrome^[2]。 This article mainly summarizes the latest clinical research progress of NME in terms of pathogenesis (i.e., hyperglucagon and multifactorial malnutrition), clinical manifestations, diagnosis and treatment strategies as follows.