Objective To summarize the clinical features and outcomes of patients with rhinocerebral mucormycosis involving cranial nerve. Methods and Results Eight pathologic confirmed cases of rhinocerebral mucormycosis with cranial nerves involvement since February 2012 to January 2020 were collected and evaluated. All patients were diagnosed at Beijing Tongren Hospital, Capital Medical University. The main clinical manifestations were headache, eye and face swelling. In addition to the paranasal sinuses, the ocular motor nerve, extraocular muscle, meninges, brain parenchyma, optic nerve, cerebrovascular and vestibulocochlear nerve were also involved. There were 5 patients with the primary disease of type 2 diabetes mellitus, one patient with acute leukemia receiving chemotherapy, one patient with severe aplastic anemia receiving immunosuppressive therapy, and one patient with craniocerebral trauma. Six patients were confirmed by pathological biopsy of paranasal sinus mucosa, the other 2 patients underwent brain parenchymal biopsy and temporal muscle biopsy respectively. In addition to one patient with meningeal involvement who gave up treatment and finally died, the other 7 patients received amphotericin B (one case was combined with posaconazole) or amphotericin B liposome antifungal therapy. Among them 4 patients underwent simultaneous transnasal endoscopic radical lesion removal treatment and 3 patients with brain parenchymal involvement died despite of active treatment. Conclusions The mortality of rhinocerebral mucormycosis with brain parenchyma involvement is extremely high. For patients with sinusitis with immunocompromised state, if there is acute progression of cranial nerve involvement, swelling around the eyes and headache, attention should be paid to the identification of the disease, and antifungal drugs and combined surgery treatment should be given early. Pathological biopsy of the affected mucosal tissue is the first choice for quick diagnosis.

Objective To study the relationship between white matter fiber integrity and cognitive impairment after subcortical infarction, and to explore the possible mechanism with diffusion tensor imaging (DTI). Methods Total of 37 subcortical infarction patients with cognitive impairment were recruitded from March 2016 to December 2018. Montreal Cognitive Assessment (MoCA) was used to evaluate the cognitive function. DTI was performed to obtain the fractional anisotropy (FA) of white matter fiber in the whole brain. The correlation between FA values and MoCA scores was analyzed by Pearson correlation analysis and partial correlation analysis and then the multiple linear regression model was established. Results Correlation analysis showed that decreased FA values in the bilateral external capsule, cingulate gyrus, and superior longitudinal fasciculus (SLF), inferior fronto⁃occipital fasciculus (IFOF), fasciculus，anterior limb of internal capsule, anterior and superior corona radiata were significantly correlated with MoCA scores (P < 0.05, for all). Multiple linear regression analysis showed that MoCA scores affected the SLF (P=0.042) and IFOF (P=0.006). Conclusions Impaired white matter filber integrity of the ipsilesional SLF and IFOF can be imaging biomarkers for cognitive impairment after subcortical infarction.

Brain ⁃ computer interface (BCI) is a cutting ⁃ edge technology of interdisciplinary integration, which has been widely used in many fields. This article introduces the four key parts of BCI technology, including signal acquisition, feature extraction, feature classification and external devices manipulation. This review introduces the application status of BCI in the medical field, we focus on the application of network science and deep learning in BCI, including extracting deeper electroencephalography (EEG) signal representations and achieving high ⁃ precision classification. Lastly, we explore the application prospects and challenges of BCI in the medical field.

Cerebral small vascular disease (cSVD) and frailty are common in the elderly, and they tend to co-exist with similar risk factors. It is important to understand the etiology and pathogenesis of cSVD and frailty,and focus on the research frontier problems. Meanwhile,early diagnosis and intervention of these two diseases can help to improve health and quality of life.

Classical subclavian steal syndrome (SSS) refers to a series of clinical symptoms,such as vertebral⁃basilar artery ischemia and upper extremity arterial ischemia caused by the stenosis or occlusion of the proximal subclavian artery or the innominate artery. In addition, SSS through the bridge of internal mammary artery and similar SSS caused by arterio⁃venous fistula in dialysis are also worthy of attention.

Objective To analyze the clinical features of autonomic nerve dysfunction and sympathetic skin response (SSR) in patients with gout. Methods A total of 25 patients with gout diagnosed from March 2017 to January 2018 were enrolled, including 10 patients with tophus and 8 patients with autonomic nerve dysfunction(symptomatic). EMG was used to detect SSR. Results The main symptoms of autonomic nervous dysfunction in the gout group were abnormal sweat glands. Compared with the normal control group, the lower extremity latency period of patients in the gout group was prolonged (Z=⁃2.136, P =0.033) and the amplitude was reduced (Z =⁃2.959, P =0.003). Lower extremity amplitude of the symptomatic group was lower than that of the normal control group (Z =⁃3.426, P = 0.001) and the asymptomatic group (Z = ⁃3.308, P=0.001). The lower extremity amplitude of patients in tophout group was lower than that in the control group(Z =⁃3.176, P=0.001) and the non⁃tophout group(Z =⁃2.301, P= 0.021), while the lower extremity latency period of patients without tophout was prolonged(Z=⁃2.518, P= 0.120)and the amplitude was reduced(Z=⁃2.327, P=0.020),which were statistically significant different from the control group. Conclusions Abnormal autonomic nerve function exists in gout patients, mainly in lower limb injury, especially in patients with tophus or symptoms of autonomic nerve dysfunction. SSR can objectively evaluate the autonomic nerve function state.

Thalamic stroke accounts for 2%-3% of total cerebrovascular diseases. Thalamus contains multiple complex nuclei with variant blood supplies, therefore thalamic ischemic stroke presents various clinical manifestations which will emerge difficulties in precise clinical diagnosis at acute stage. This review summarizes and integrates thalamic anatomical structure, blood supplies and corresponding clinical manifestations, aiming to provide overview of thalamic ischemic stroke and to improve efficacy of early diagnosis and treatment. DOI: 10.3969/j.issn.1672-6731.2018.12.011

Objective To observe the clinical efficacy of acupuncture trigger point, nerve block and pulse radiofrequency in the treatment of postherpetic neuralgia (PHN). Methods A total of 60 cases with PHN were randomly divided into 3 groups: acupuncture trigger point therapy (group A, N = 20), epidural nerve block (group B, N = 20) and selective dorsal root ganglion (DRG) pulse radiofrequency (group C, N = 20). All patients in 3 groups took gabapentin orally at the same time after treatment. Numerical Rating Scale (NRS) was used to record the degree of pain in 3 groups before and after treatment (2, 4 and 12 weeks after operation). Results Compared with before treatment, NRS scores in 3 groups were significanthly decreased at 2, 4 and 12 weeks after operation (P = 0.000, for all). There was no significant difference on NRS scores among 3 groups before treatment (P > 0.05, for all). Two weeks after operation, NRS scores in group B and C were significantly lower than that in group A (P = 0.013, 0.000), and NRS score in group C was significantly lower than that in group B (P = 0.000). Up to 4 and 12 weeks after operation, NRS score in group C was significantly lower than that in group A (P = 0.000, 0.000) and B (P = 0.000, 0.000), while there was no significant difference on NRS scores between group A and B (P > 0.05). Conclusions Selective dorsal root ganglion pulse radiofrequency is effective in the treatment of PHN, which can relieve the pain quickly and improve the work and life quality of patients.

Objective To investigate the clinicopathological features of Li - Fraumeni syndrome (LFS) manifested as glioblastoma. Methods and Results A 33 - year -old female patient presented hyperspasmia of left extremities. Head MRI showed space - occupying lesion on the right fronto - parietal junction, and contrast - enhanced scanning revealed "garland" enhancement of the lesion. The patient underwent surgical resection. During the operation, an oval tumor was visible after the right parietal cortex was cut open for 2.50 cm, which was about 5 cm × 4 cm × 3 cm in size. The tumor was soft and purple, with clear boundary and rich blood supply, and was totally removed through piecemeal resection. Microscopic examination found obvious dysplasia of glial cells, spindle shape in some areas, and a large number of giant tumor cells. Immunohistochemical staining showed that the tumor cells expressed glial fibrillary acidic protein (GFAP) in cytoplasm and P53 protein in nuclei. Ki-67 labeling index was 25%. Reticular fiber staining was negative. Molecular pathological examination did not detect isocitrate dehydrogenase 1/2 (IDH1/2) gene exon 4 mutation, telomerase reverse transcriptase (TERT) promoter mutation, or methylation of O6-methylguanine-DNA methyltransferase (MGMT). Fluorescence in situ hybridization (FISH) analysis did not reveal codeletion of 1p/19q. The integrated diagnosis was (right parietal) glioblastoma, IDH - wild type (WHO grade Ⅳ). The patient was hospitalized for 15 d and died in 2016. Previous family medical history showed her older sister suffered from right breast cancer, her father died of gastic cancer, her grandmother died of breast cancer, her uncles died of lung cancer and hematopoietic system tumor. Samples from the patient's glioblastoma and right mammary gland invasive duct carcinoma were collected for TP53 gene detection, but no mutation was found. Further, whole exome sequencing (WES) on the patient's freezing blood samples showed TP53 gene c.1009C &gt; T (p.Arg337Cys) pathogenic heterozygous mutation (missense mutation). Combined with the family cancer history, a clinical diagnosis of the patient was Li-Fraumeni syndrome, and her family was Li-Fraumeni syndrome pedigree. Conclusions Li-Fraumeni syndrome is a hereditary tumor syndrome with autosomal dominant inheritance, characterized by high risk of breast cancer, bone and soft tissue sarcoma, brain tumor and adrenocortical cancer, and TP53 gene is the most common gene associated with Li-Fraumeni syndrome.

The term "floppy infant" is used for describing children presenting with muscle hypotonia at or shortly after birth. The clinical manifestation of floppy infants is skeletal muscle hypotonia, which may be caused by a lot of reasons. Primary hypotonia includes central hypotonia, peripheral hypotonia, or mixed hypotonia of both. Partial floppy infant syndrome is hereditary and rare. This article reviews the literatures, mostly retrospective studies, on etiology, clinical manifestations, auxiliary examinations, differential diagnosis, treatment and multidisciplinary management of floppy infant syndrome.