Volume 92  ·   Issue 43  ·  2012

Idiopathic inflammatory demyelinating disease of central nervous system (CNS) is a group of immune-mediated inflammatory demyelinating diseases primary or idiopathic to brain (including optic nerve) and/or spinal cord involvement occurring in a group of immune-susceptible people. Multiple sclerosis (MS) is the most common in Europe and America, while CNS demyelinating diseases such as optic neuromyelitis (NMO) and acute disseminated encephalomyelitis (ADEM) are also common in Asia. Especially in China, with a large population and a wide area, there are often relatively rare clinical types of CNS demyelinating diseases such as tumor-like inflammatory demyelinating diseases (TIDD) and concentric circle sclerosis (Balo's disease). In clinical practice, due to the gap of experience and understanding, doctors may affect the correct diagnosis of CNS inflammatory demyelinating disease, and incorrect diagnosis will inevitably lead to different treatment options, which will lead to poor prognosis. In this paper, combining with the recent clinical research progress at home and abroad and clinical practice, some new views on CNS inflammatory demyelinating disease are elucidated, In order to help neurologists to correctly understand and grasp the concept and related progress in diagnosis and treatment of CNS inflammatory demyelinating disease, and apply it in practice to benefit patients.

multiple sclerosis (MS) has a chronic course of recurrence-remission, and the disease is mainly inflammatory response at the beginning to degenerative response at the later stage.The new drugs for the treatment of MS should have sufficient clinical trial evidence.The best intervention time for MS is early after the onset, and reducing the inflammatory response can reduce the recurrence and delay the progression of dysfunction.Recently, the research hotspot is how to improve the residual nerve function in the stage where degenerative response is dominant.The clinical trial period of MS is usually 2~3 years.During this period, how to observe the influence of drugs on the course of MS is the core of clinical trial prognostic indexes.Fully understanding and applying and improving the existing prognostic indexes will help to better evaluate the new therapies for the treatment of MS.

With the maturity of coronary intervention technique, the number of coronary angiography (coronary angiography for short) in various cardiovascular centers gradually increases, and the incidence of related complications also increases, which attracts more and more people's attention. Among them, contrast induced nephropathy (CIN) is especially common, which may further deteriorate the renal function of patients with original renal insufficiency and increase the mortality rate. Therefore, it is very important to avoid the occurrence of CIN in coronary intervention surgery. There are many methods to prevent CIN, such as hydration therapy, application of diuretics, oral administration of acetylcysteine, etc. Is there a relatively simple and effective new method to prevent CIN? Professor Er and his group from the University of Cologne, Germany, published a study in Circulation (Circulation, 2012, 126: 296-303), using a simple and effective method to prevent CIN.

Objective To analyze the clinical features and brain,spinal cord magnetic resonance imaging (MRI) features of neuromyelitis optica(NMO) patients with positive anti-nuclear antibody serum (ANAs).Methods The clinical data of expanded disability status scale (EDSS) score,duration of the first relieving phase and first year recurrence-positive rate and MRI features of 34 NMO patients at our hospital during the period of 2006-2011 were retrospectively reviewed and divided into two groups according to the outcome of antibodies test:ANAs positive group (n =14) and ANAs negative group (n =20).Results (1)In the ANAs-positive group,the EDSS score of first NMO attack was (2.8 ± 1.1 ),first remission continued to (9±9)months and the first year recurrence-positive rate was 71.0％ ; in the ANAs-negative group,the EDSS score of first NMO attack was 2.3 ± 0.8,first remission continued to (31 ± 39) months and the first year recurrence-positive rate was 30.0％.The differences in the first attack EDSS score,duration of first remission and first recurrence rate between two groups were statistically significant ( P ＜ 0.05 ).(2) Brain damage-positive rate in the ANAs-positive group on prompt MRI was 35.71％ (5/14) and it was higher than that in ANAs-negative group (5/20).But no significant difference existed between two groups.The spinal cord lesions were predominantly located in cervical and thoracic spinal cords simultaneously in both groups (about 50％ respectively).And,in the ANAs-positive group,the cervical lesions involved were much more common than the thoracic counterparts (6/14 vs 1/14).However,in the ANAs-negative group,thoracic segments were usually involved (6/20 vs 4/20).Conclusion With severe neurological deficits in the first clinical attack and a short remission,ANAs-positive NMO patients are more prone to relapse in the first year,brain damage and cervical cord injury.

Objective To summarize the clinical features and neuroimaging findings of the patients with acute disseminated encephalomyelitis (ADEM) involved in corpus callosum (CC) so as to distinguish it from other diseases.Methods A total of 12 ADEM patients with the involvement of CC during the period of 2010-2012 were recruited.There were 9 males and 3 females with a mean age of 31 ± 14 years ( range:10-54).Their clinical and neuroimaging features were retrospectively reviewed and all data analyzed by SPSS 18.0.Results ( 1 ) All of them had an acute or subacute onset.Two patients had a history of vaccination and 5 suffered upper respiratory tract infection or diarrhea.(2)The presenting symptoms included fever (n =5 ),headache (n =4),unsteady gait ( n =2 ),urinary retention ( n =1 ),indifference ( n =1 ) and delirium ( n =1 ).( 3 ) The main clinical symptoms included memory loss ( n =9 ),delirium ( n =5 ),somnolence ( n =4 ),urinary retention ( n =9 ),paraplegia ( n =4) and unsteady gait ( n =5 ).(4) The examinations of cerebrospinal fluid (CSF) revealed increased intracranial pressure ( n =4 ),leucocytosis ( n =3 ) and increased protein ( n =7) of 7 cases.All oligoclonal bands were negative.( 5 ) The lesions were involved in bilateral CCs in 12 patients.Among them,splenium was the most commonly affected (n =9),secondly stem (n =5 ) and lastly genu (n =4).For 6 patients,the intracranial lesions were all in their CCs.And among them,2 cases were involved in spinal cord.Except for CC,there were other focal lesions in brain stem and cerebellum (n =4) and spinal cord (n =6).(6)On magnetic resonance imaging (MRI),all cases showed long T2 signal intensity with blurred images.And among them,2 cases' lesions in brain were discerned only by diffuse weighing imaging (DWI) or T2 fast fluid-attenuated inversion recovery (T2FLAIR) instead of T2-weighted.The lesions of CCs showed on gadolinium-enhanced MRI were significantly enhanced and the shapes were sheet-like (4/6).Spinal cord lesions was found in 6 cases and most spinal cord lesions were discontinuous.And the number of spinal cord segments with lesions was from 4 to 8.The shapes of lesions of spinal cord showed on enhanced MRI were like thin line.(7) Most of them were misdiagnosed as viral encephalitis ( n =5 ),tuberculous meningoencephalitis ( n =1 ) and brain neoplasms ( n =2 ).And another case was admitted into urology surgery ward due to urinary retention.Conclusion There are three key points about the characteristics of the ADEM patients with CC lesions: ( 1 ) They may have an adult male preponderance.The distinctive symptoms include fever,headache,delirium,somnolence,memory loss,unsteady gait and urination disorders,etc..( 2 ) The number of lesions on brain MRI can be multiple or single,especially the lesions of CC ( mostly in splenium).On MRI,all cases showed long T2 signal intensity with blurred images so that DWI and T2 FLAIR may have a higher efficiency of detecting the lesions.In particular,multiple lesions may be all enhanced or not enhanced at equal pace on enhanced MRI.(3)In ADEM patients with CC lesions,many indices of CSF chemical examination,such as increased intracranial pressure,leucocytosis,increased protein,low sugar and low chloride,indicate the presence of intracranial infective diseases.Therefore they are most likely to be misdiagnosed as viral encephalitis or tuberculous meningoencephalitis.However,CC is not the predilection site for viral encephalitis since CC belongs to white matter but not gray matter.So ADEM should be a more appropriate diagnosis for these cases.

Objective To determine the prognostic value of AQP4 antibody in the cohort of Chinese patients with neuromyelitis optica ( NMO),HR-NMO( high-risk NMO) and classic multiple sclerosis (MS).Methods Sera of patients with NMO,HR-NMO and MS were all investigated for the presence of AQP4 antibody by indirect immunofluorescence in human AQP4-transfected cells.The diagnostic and prognostic values of anti-AQP4 antibody were evaluated in 352 patients with NMO ( n =106),HR-NMO ( n =84 )including optico-spinal MS (OSMS),longitudinally extensive transverse myelitis (LETM),recurrent optic neuritis (RON) and optic neuritis (ON) or transverse myelitis (TM) with other antoimmune disease and classic MS (n =162).All patients were followed up at outpatient clinics or by telephone.Results In our study,the anti-AQP4 antibody's seropositivity in all demyelinating cases (n =352) was 31.3％.And 72 (65.5％) seropositive patients presented with severe ON,82(74.5％ ) with TM,60(54.4％ ) with spinalcord lesion more than 3 segments,16( 14.5％ ) had relapses of ON and 38(34.5％ ) relapses of TM during a follow-up period of 24 months.Significant differences existed between anti-AQP4 antibody seropositivity and seronegative in terms of concurrent severe ON,TM,spinal-cord lesion more than 3 segments and relapses of ON and TM (P ＜ 0.05 ).Also,in NMO patient seropositive for anti-AQP4 antibody ( n =78),28 (35.9％)developed relapses of TM.However,in HR-NMO patient with seropositivity (n =28 ),4 (14.3％)developed relapses of ON and 10(35.7％ ) relapses of TM.The relapse of ON or TM occurred in 57/110 seropositive patients versus 17/242 seronegative ones ( P ＜ 0.05 ).Conclusion As compared with antiAQP4 antibody-negative ones,anti-AQP4 antibody-positive patients show significantly higher frequencies of severe ON,TM,longitudinal spinal-cord segments and they are more predisposed to ON or TM relapse.And seropositive NMO and HR-NMO patients are more likely to develop relapses of ON or TM.Anti-AQP4 antibody may play some roles in the diagnosis and prognostic predication of demyelinating diseases in central nervous system.

Objective To explore the clinical safety and efficacy of deep lamellar keratoplasty for corneal macula after viral kerititis.Methods A total of 16 patients (16 eyes) of corneal macula after viral kerititis at our center from January 2009 to June 2011 received anti-virus eye-drops and then underwent deep lamellar keratoplasty when inflammation were dissolved or quiescent.And the corneal graft diaphaneity and corneal graft rejection reactions were observed.Results All 16 patients were recovered with a success rate of 100％.After a follow-up of 18-24 months,all corneal grafts were transparent and best-corrected visual acuity was 0.2-0.6.There was no reoccurrence during the follow-up period.After a follow-up of several months,2 of them had rejection reaction and were controlled after treatment.No rejection reaction occurred during the long-term follow-up.Conclusion As a safe and efficacious procedure, deep lamellar keratoplasty can significantly raise vision acuity with few complications.

Objective To explore the feasibility and efficacy of operating through an anterior approach in the treatment of dumbbell tumor complicating with vertebral destruction in cervical spine.Methods Surgical procedures were performed through an anterior approach in 7 cases of dumbbell tumor complicating with vertebral and transverse process destruction during the period of May 2004 to February 2009.Bone graft and internal fixation were implemented after tumor removal.Results In all 7 cases,tumors were resected completely and no recurrence occurred during a follow-up period of 6-46 months.The symptoms improved greatly postoperatively with fine fusion of graft bone.There was neither loose plate nor cervical instability.Conclusion For huge dumbbell tumor with damaged vertebral body and transverse process in cervical spine,the anterior approach operation will remove tumor entirely and restore the stability of cervical spine so as to prevent spinal cord injury.It is an excellent option of treating dumbbell tumor in cervical spine.

Objective To explore the safe and effective way of nasotracheal intubations in obstructive sleep apnea hypopnea syndrome patients with uvulopalatopharyngoplasty.Methods Upon the approval of the Ethics Committee at Second Affiliated Hospital of Fujian Medical University,from August 2008 to November 2011,90 sleep apnea hypopnea syndrome patients were randomly divided into 3 groups (n =30 each):GlideScope (G),fiberoptic bronchoscope (F) and combination of Glidescope with fiberoptic bronchoscope (G + F).The parameters of tracheal intubation time,placement of endotracheal intubation,tracheal injury and complications were recorded.Also systolic blood pressure (SBP),diastolic blood pressure (DBP),mean arterial pressure (MAP) and heart rate (HR) were recorded at post-induction,the moment of tracheal intubation and post-intubation 1,3,5 min.Rate pressure product (RPP) was calculated at all timepoints as the product of heart rate and SBP during observation.Results All of them underwent successful endotracheal intubation.There were 24 successful cases of intubation during the first attempt in Group G with a success rate of 80％ ; 27 patients successful during the first attempt in group F with a success rate of 90％ ; all in group G + F successful during the first attempt with a success rate of 100％.The rates were significantly different in 3 groups ( P ＜ 0.05 ).Groups G and F patients with failed intubation during the first attempt were of Mallampati Ⅲ/Ⅳ-After induction,SBP,DBP,MAP and RPP were lower in 3 groups ( P ＜ 0.05 ) while HR change was not obvious.Compared with the after induction,the moment of tracheal intubation and after intubation 1 min,3 groups of patients with SBP,DBP,MAP,HR and RPP increased ( P ＜ 0.05 ).Groups F and G + F after intubation in intubated patients and 1 min of SBP,DBP,MAP,HR,RPP were higher than G group ( P ＜ 0.05 ).No difference existed between groups F and G + F.Three groups showed no serious tracheal injury,laryngeal edema,hoarseness or other complications.Conclusion During nasotracheal intubation for Mallampati Ⅰ / Ⅱ patients,GlideScope offers better overall glottic views.For those of Mallampati Ⅲ and Ⅳ,the combination of Glidescope with fiberoptic bronchoscope may achieve a higher success rate and shorter intubation time than the latter alone.

Objective To assess the long-term efficacy and investigate the prognostic factors of cytokine-induced killer (CIK) combined with the sequential transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) on hepatocellular carcinoma (HCC).Method A total of 95 HCC patients with the informed consents received TACE combined with RFA,48 cases of which accepted the CIK via intravenous drop infusion for more than 6 times (study group) while the other 47 cases were enrolled in control group.The following-up duration was more than 3 years.Primary endpoint was the overall survival (OS) and the secondary endpoint was the disease-free survival (DFS).Results 76 patients in all (38 in study group,38 in control group) complied with the study and follow-up (44months in median,10-88 months).No mortality and serve complications were observed in both groups.The ratio for patients with DFS over 1-year,3-year and 5-year were 79％,26％ and 16％ (28 months in median and 32.3 months in mean) while 71％,21％ and 8％ (22 months in median and 23.1 months in mean) for the control group.There was significant difference between the two groups (P =0.001 ).For the OS,the ratio for 1-year,3-year and 5-year in the study group were 92％,53％ and 26％ (38 months in median and 42.5 in mean) and 89％,42％ and 24％ (35months in median and 37 in mean).No significant difference was observed in both groups.ECOG performance status,Hepatitis B virus infection and treatment were the prognostic factors for DFS while ECOG performance status was the only prognosis for OS.Conclusion CIK infusion basing on the TACE combined with RFA can control the recurrence of HCC,decrease the times of TACE or RFA.

Objective To explore the effect of orthotopic liver transplantation (OLT) on portal hypertension by observing the radiological changes of splenic volume and collaterals before and after OLT.Methods In our hospital 56 patients performing OLT due to cirrhosis,portal hypertension and splenomegaly were classified into five groups according to their following-up time:A (≤3 months),B (＞3-6 months),C (＞6-12 months),D (＞12-24 months),and E (＞24 months).Twenty health people were chose as control group (F).The splenic width,thickness,length,volume,diameter of portal and splenic vein and collaterals were measured and observed in every patient of six groups before and after OLT respectively.Results After OLT,the splenic volume decreased by 25.4％,27.8％,21.9％,25.2％,27.7％ in five groups respectively, which was still larger than the normal group (P＜0.05).Gastroesophageal varices in 31 cases (81.6％,31/36) became normal after OLT.The opened umbilical vein disappeared and the postperitoneal varices persisted in five cases after OLT.Conclusions Splenomegaly and opened collaterals can be relieved by OLT effectively.The splenic volume didn't change obviously until it decreased by 25％ in the three months after OLT.Gastroesophageal varices can be removed in most of patients after OLT.The splenomegaly could last paralled with the splenic vein and postperitoneal varices after OLT.After OLT,correct disposal of splenic and collateral changes could improve the success rate and the long-term treatment effect of OLT.

Objective To compare the outcomes of surgical clipping,interventional treatment and conservative treatment of poor-grade aneurysm patients.Methods A total of 119 patients of WFNS( World Federation of Neurosurgical Societies ) grades Ⅳ ( n =73 ) and Ⅴ ( n =46 ) from June 2004 from to December 2011 were analyzed.There were 51 males and 68 female with a mean age of 55.2 years (range:32-77).The approaches included surgical clipping ( n =57 ),interventional embolization ( n =40) and conservative treatment (n =22).Their outcome were assessed with a 3-month follow-up according to the Glasgow outcome score (GOS).Results In surgical clipping group,the prognoses were excellent (5-4points,n =22),poor prognosis (3-2 points,n =30) and death ( 1 point,n =5) ; excellent ( n =26),poor ( n =1 ) and death ( n =13 ) in interventional embolization group ; excellent ( n =0 ),poor ( n =3 ) and death (n =19) in conservative treatment.The excellent outcome of interventional embolism was better than those of surgical clipping and conservative treatment ( P ＜ 0.05 ),but it had higher mortality than surgical clipping (P ＜ 0.05).In conservative treatment group,mortality was significantly higher than the first two groups ( P ＜ 0.05).Conclusion For patients of grade Ⅳ,surgical clipping and interventional embolization may be selected ; for those of grade Ⅴ,interventional embolization can be used as a first choice; for those of grade Ⅳ/Ⅴ with large intracerebral hematoma (hematoma volume ＞ 30 ml), surgical clipping is preferred.

Objective To assessed the relationships between hemoglobin concentration from the patients with abdominal aortic aneurysm (AAA) and its diameter as well as patients' long-term survival.Methods Between January 2002 to June 2012, 255 AAA patients were reviewed retrospectively.The outcomes were compared between 3 groups of different treatments ( excluding 20 cases dead within 30 days).The procedures included open AAA repair ( n =76),endovascular (EVAR) ( n =62) and non-operated (n =97).The mean follow-up period was 63 ±42 months.The association of hemoglobin level with AAA diameter was assessed with multiple linear regression.Kaplan-Meier survival curves of anemic and non-anemic patient groups were compared by the log-rank method in 3 groups.Cox's proportional hazard regression mode was used to determine the effects of anemia on vital status after EVAR,open AAA repair or non-operation.Results A total of 88 (34.5％ ) of AAA patients had anemia.After adjustment for various risk factors,hemoglobin level was inversely correlated with maximal AAA diameter (β =-0.152,P =0.017).During a long-term follow-up,the 5-year survival rates were 56％,51％ and 42％ in anemic patients versus 94％,90％ and 80％ in non-anemic ones.Survival was lower in anemic patients than those without anemia in 3 groups ( P =0.005,0.001,0.025 by log-rank respectively).In three groups,according to multivariable Cox regression analysis,the hemoglobin levels were independently correlated with long-term mortality respectively after adjusting for various risk factors.The hemoglobin levels were correlated with death ( HR:0.923,0.963,0.963 ; P:0.001,0.002,0.028 ; 95％ CI:0.8798-0.970,0.941-0.986,0.932-0.996 ).Conclusion Hemoglobin concentration is independently associated with AAA diameter and reduced long-term survival after undergoing EVAR,open AAA repair and non-operation.

Objective To explore the mechanistic roles of interleukin-6 (IL-6) and matrix metallopeptidase 9 (MMP-9) in cerebral arteriovenous malformation (AVM).Methods A total of 31 AVM patients were admitted into Beijing Tiantan Hospital from October 1,2010 to October 1,2011,including 14 ruptured and 17 non-ruptured ones.Tissue samples were obtained from all 31 patients and 30 epileptics undergoing temporal lobectomy.The blood samples were obtained from all 31 patients preoperatively and 30 healthy controls.Western blot was employed to measure transcription factors nuclear factor-κB (NF-κB),IκB and MMP-9 in tissues.And immunofluorescence was performed to measure the tissue expression of MMP-9 in each group.Gelatin zymography was used to detect the tissue expressions of activated MMP-9 and MMP-2.Results The blood levels of IL-6 in the ruptured group were significantly higher than those in the nonruptured and control groups (33.2 ± 4.8 vs 23.8 ± 1.2 ng/L,P ＜ 0.05 ; 33.4 ± 4.8 vs 15.6 ± 1.0 ng/L,P ＜0.01).Protein expression in the non-ruptured group was greater than that in the normal and ruptured groups( 1.20 ± 0.35 vs 0.34 ± 0.07 ; 1.20 ± 0.35 vs 0.31±0.09,unit:molecular weight ratio of MMP-9 and β-actin),and gelatin zymography showed that the activity of MMP-9 was significantly higher in the ruptured than the non-ruptured and control groups ( 0.98 ± 0.07 vs 0.40 ± 0.09 ; 0.98 ± 0.07 vs 0.30 ±0.07,unit:ratio of MMP-9 and standard).In the ruptured group,active MMP-2 expression was significantly higher than that in the other groups.Conclusion IL-6 may stimulate the transformation of MMP-9 into activated form in ruptured AVM tissues and thus lead to an elevated hemorrhage risk of AVM.

Objective To investigate the effect of silencing P2X7 receptor (P2X7R) by RNA interference on microglial phagocytosis of amyloid-β (Aβ) protein and to explore its possible mechanism.Methods The small interfering RNA (siRNA) targeting the P2X7R gene was identified.The microglial cells activated by Aβ1-42 were infected with the Lipofectamine-siP2X7R and it was designated as siP2X7R group.Microglia infected with Lipofectamine-siNC was designated as siNC group and non-infected cells as con group.The levels of P2X7R mRNA were detected by real-time PCR and the P2X7R protein was determined by Western blotting.The levels of IL-1β and TNF-α were measured by ELISA.The microglial phagocytosis of Aβ1-42 was observed by ELISA and immunocytochemistry staining.Results Detected by the Real-time PCR,the expression level of P2X7R mRNA of siP2X7R group decreased significantly versus siNC and con groups ( P ＜ 0.05 ).The lowered expression of P2X7R protein detected by Western blotting was consistent with Real-time PCR.After RNA interference silencing P2X7R,the levels of IL-1β and TNF-α detected by ELISA in siP2X7R group less than those in con,siNC groups,significantly (P ＜ 0.05 ).In con,siNC and siP2X7R groups respectively,the levels of Aβ1-42 in supernatant were (423 ±20) pg/ml,(417 ±16) pg/ml,(296±30) pg/ml and the levels of Aβ1-42 in the microgtia were (190 ± 37) pg/ml,(187 ±39) pg/ml,(322±26) pg/ml.Compared to siNC and con groups,in siP2X7R group the levels of Aβ1-42 in supernatant decreased (P ＜ 0.05 ) and the levels of Aβ1-42 in the microglia increased (P ＜ 0.05).Aβ1-42 immunofluorescence staining showed that the red fluorescent products were seen in the cytoplasm of most microglias in siP2X7R group,but in con or siNC groups in only few microglias these products were depicted.Conclusions The silence expression of P2X7R by RNA interference effectively decreases the levels of IL-1β and TNF-α released by microglia and promotes microglia to phagocytose Aβ.P2X7R could be used as an effective therapeutic target for RNA interference treatment of Alzheimer's disease.

Objective To explore the effects of FLT3 signaling on the accumulation and maturation of pulmonary conventional dendritic cells (cDCs) and determine whether or not the inhibition of FLT3 signaling may attenuate acute lung inflammation/injury (ALI).Methods C57BL/6 mice were pretreated separately with FLT3-ligand (FLT3L) and lestaurtinib for 5 days.Murine model of ALI was subsequently induced by an intra-tracheal instillation of lipopolysaccharide (LPS) and lung specimens were harvested 24 hours later.The accumulation and maturation status of pulmonary cDCs were assessed by flow cytometry.Lung myeloperoxidase (MPO) activity was measured to evaluate the infiltration of neutrophils.The ratio between transcription factors T-bet and GATA-3 mRNA was determined to estimate the balance of Th1/Th2 response.Lung injury was estimated by lung wet weight/body weight ratio (LWW/BW) and histopathological assessment.Results LPS challenge resulted in rapid accumulation and maturation of pulmonary cDCs.FLT3L pretreatment further stimulated the accumulation and maturation of pulmonary cDCs,leading to a marked deterioration of LWW/BW and lung histopathological changes.Meanwhile,the lung MPO activity and T-bet/GATA-3 mRNA ratio were boosted by the administration of FLT3L.In contrast,the lestaurtinib pretreatment inhibited the accumulation and maturation of pulmonary cDCs,leading to a significant improvement of LWW/BW and lung histopathological changes.The administration of lestaurtinib also suppressed the lung MPO activity and T-bet/GATA-3 mRNA ratio in the lung.Conclusions FLT3 signaling attenuates ALI by regulating the accumulation and maturation of pulmonary cDCs,indicating a potential pharmacotherapy for ALI.

Medical record abstract The patient was a 53-year-old female. She was admitted to China-Japan Friendship Hospital for the first time on July 18, 2011 due to fever for 18 days. The patient developed fever without obvious trigger before 18 days, with the highest temperature of 39℃, fever in the afternoon, no chills, and no respiratory, digestive and urinary symptoms. There was no alopecia, oral ulcer, joint pain, Raynaud's phenomenon, no dry mouth, no dry eyes, etc. Outpatient examination: blood routine: white blood cells 8.08×109/L, hemoglobin 107 g/L, platelet 351×109/L. C-reactive protein (CRP) 141 mg/L, erythrocyte sedimentation rate (ESR): 101 mm/1 h. Urinary routine: red blood cells positive (3 times), tumor markers negative, breast B-ultrasound: breast hyperplasia with duct dilation, abdominal B-ultrasound: fatty liver and liver cyst, pelvic B-ultrasound: uterine fibroids, intravenous infusion of levofloxacin 0.5 for 6 days.

Common minimally invasive surgical approaches in the sellar area mainly include infratemporal keyhole approach, pterional keyhole approach, eyebrow arch keyhole approach, extra lateral keyhole approach, transnasal sphenoidal sinus approach, longitudinal frontal fissure keyhole approach, etc. [1]. Neuroendoscopic microneurosurgery assisted by neuroendoscopy has become more and more mature, with the advantages of not pulling brain tissue and broad visual field [2]. 1. Neuroendoscopic anatomy of related surgical approaches in the sellar area: (1) Neuroendoscopic anatomy of pterional keyhole surgical approach in the sellar area: Neuroendoscopy can observe the ipsilateral optic nerve and the posterolateral superior clinoid process of internal carotid artery, sella tuberosa and the contralateral optic nerve; The pituitary stem, sellar septum, contralateral optic nerve and superior clinoid of contralateral internal carotid artery can be observed by opening the synchronous cistern into the first space; ACA, AComA and their perforator arteries can be seen when the endplate pool is opened; Entering the second space, PComA, AChoA and their penetrating branches can be observed; Opening the arachnoid of the ipsilateral internal carotid artery cistern into the external space of the internal carotid artery can see the bifurcation of the internal carotid artery, the initiation of PComA and AChoA and travel backward [3]. The pterional approach mainly uses the lateral side of the optic nerve as the supplementary side of the optic chiasma, and mainly exposes the lateral and posterior parts of the tumor.

multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system (CNS), which was previously defined as white matter demyelinating disease because the lesions of MS were mainly observed in white matter [1]. However, recent pathological studies of MS have shown that the lesions can also involve gray matter, and 40% ~60% of MS patients have gray matter lesions, and gray matter lesions may be related to cognitive dysfunction of MS patients [2], which also increases the probability of epileptic seizures. Therefore, this paper reviews the clinicopathological research progress of gray matter demyelination in MS.