The severity of corneal nerve loss differentiates motor subtypes in patients with Parkinson's disease.

Background: Parkinson's disease (PD) is a heterogeneous movement disorder with patients manifesting with either tremor-dominant (TD) or postural instability and gait disturbance (PIGD) motor subtypes. Small nerve fiber damage occurs in patients with PD and may predict motor progression, but it is not known whether it differs between patients with different motor subtypes. Objective: The aim of this study was to explore whether there was an association between the extent of corneal nerve loss and different motor subtypes. Methods: Patients with PD classified as TD, PIGD, or mixed subtype underwent detailed clinical and neurological evaluation and corneal confocal microscopy (CCM). Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL) were compared between groups, and the association between corneal nerve fiber loss and motor subtypes was investigated. Results: Of the 73 patients studied, 29 (40%) had TD, 34 (46%) had PIGD, and 10 (14%) had a mixed subtype. CNFD (no./mm2, 24.09 ± 4.58 versus 28.66 ± 4.27; p < 0.001), CNBD (no./mm2, 28.22 ± 11.11 versus 37.37 ± 12.76; p = 0.015), and CNFL (mm/mm2, 13.11 ± 2.79 versus 16.17 ± 2.37; p < 0.001) were significantly lower in the PIGD group compared with the TD group. Multivariate logistic regression showed that higher CNFD (OR = 1.265, p = 0.019) and CNFL (OR = 1.7060, p = 0.003) were significantly associated with the TD motor subtype. The receiver operating characteristic (ROC) analysis demonstrated that combined corneal nerve metrics showed excellent discrimination between TD and PIGD, with an area under the curve (AUC) of 0.832. Conclusion: Greater corneal nerve loss occurs in patients with PIGD compared with TD, and patients with a higher CNFD or CNFL were more likely to have the TD subtype. CCM may have clinical utility in differentiating different motor subtypes in PD.

[Risk Assessment and Sources of Heavy Metals in Farmland Soils of Yellow River Irrigation Area of Ningxia].

The farmland environment is directly related to the quality and safety of agricultural products. In order to understand the characteristics and main influencing factors of heavy metals in farmland soil in the Yellow River irrigation area of Ningxia, sampling and monitoring were conducted for five consecutive years from 2017 to 2021, and the distribution characteristics and correlation of heavy metals were analyzed. The pollution status and potential ecological risks of heavy metals were evaluated, and the main sources of heavy metals in farmland were analyzed. The results showed that the average values of Pb, As, Zn, Ni, Cu, Hg, Cr, and Cd in the soil of the Ningxia Yellow River irrigation area were 19.74, 11.67, 66.88, 29.09, 22.55, 0.03, 62.27, and 0.19 mg·kg-1, respectively, which were enriched to some extent compared with the background values of the soil environment in Ningxia. Among them, Hg and Cd had middle- and high-grade ecological risk points; however, none of them exceeded the control value of agricultural land soil pollution risk, and all sampling sites had no high-risk or extremely high-risk levels. The results of source analysis based on positive matrix factorization (PMF) and correlation analysis showed that there were five main sources of heavy metals in farmland soil in the study area: natural sources, mixed sources of industrial and mining activities and the production and life of residents, transportation sources, agricultural production activities sources, and industrial sources, with contribution rates of 26.54%, 25.59%, 22.52%, 15.63%, and 9.72%, respectively. On the whole, the heavy metals in farmland soil in the Ningxia Yellow River irrigation area did not exceed the standard, and there was no high-level ecological risk. The production environment of the farmland soil was good, but the contribution rate of human activities to soil heavy metals was large.

Excessive Daytime Sleepiness in Parkinson's Disease is Related to Functional Abnormalities in the Left Angular Gyrus.

PURPOSE: Excessive daytime sleepiness (EDS) is a common non-motor symptom in Parkinson's disease (PD), but its neuropathology remains elusive. Our goal is to explore the potential neural substrates of EDS in a large sample of individuals with PD. METHODS: We recruited 48 PD patients with and 87 PD patients without EDS. We used resting-state functional magnetic resonance imaging to compare amplitudes of low-frequency fluctuations (ALFF) between the two groups. We also explored functional connectivity (FC) between the entire brain and regions where ALFF differed between the two groups as well as FC between selected regions of interest. Age, Part III of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III) score and use of dopamine receptor agonists were treated as covariates in the comparisons. RESULTS: EDS was associated with significantly lower ALFF in the left angular gyrus, and ALFF in this region correlated negatively with score on the Epworth Sleepiness Scale in patients with PD. EDS was also associated with significantly lower FC between the left angular gyrus and right cerebellum, based on seed-to-voxel and inter-ROI analyses. CONCLUSION: Our results suggest that EDS in PD patients is associated with reduced spontaneous neural activity in the left angular gyrus and with reduced FC between the left angular gyrus and cerebellum. These findings may help understand and treat EDS in PD.

Corneal confocal microscopy differentiates patients with Parkinson's disease with and without autonomic involvement.

Autonomic dysregulation in Parkinson's disease (PD) can precede motor deficits and is associated with reduced quality of life, disease progression, and increased mortality. Objective markers of autonomic involvement in PD are limited. Corneal confocal microscopy (CCM) is a rapid ophthalmic technique that can quantify small nerve damage in a range of peripheral and autonomic neuropathies. Here we investigated whether CCM can be used to assess autonomic symptoms in PD. Based on the scale for outcomes in Parkinson's disease for autonomic symptoms (SCOPA-AUT), patients with PD were classified into those without autonomic symptoms (AutD-N), with single (AutD-S), and multiple (AutD-M) domain autonomic dysfunction. Corneal nerve fiber pathology was quantified using CCM, and the relationship with autonomic symptoms was explored. The study enrolled 71 PD patients and 30 control subjects. Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), corneal nerve fiber length (CNFL), and CNBD/CNFD ratio were lower in PD patients with autonomic symptoms compared to those without autonomic symptoms. Autonomic symptoms correlated positively with CNFD (r = -0.350, p = 0.004), and were not related to Levodopa equivalent daily dose (r = 0.042, p = 0.733) after adjusting for age, disease severity, disease duration or cognitive function. CCM parameters had high sensitivity and specificity in distinguishing patients with PD with and without autonomic symptoms. PD patients with autonomic symptoms have corneal nerve loss, and CCM could serve as an objective ophthalmic imaging technique to identify patients with PD and autonomic symptoms.

Correlation of matrix metalloproteinase 3 and matrix metalloproteinase 9 levels with non-motor symptoms in patients with Parkinson's disease.

Objective: Matrix metalloproteinases (MMPs) are essential for tissue formation, neuronal network remodeling, and blood-brain barrier integrity. MMPs have been widely studied in acute brain diseases. However, the relationship with Parkinson's disease (PD) remains unclear. The purpose of this study was to evaluate the serum MMP3 and MMP9 levels of PD patients and analyze their correlation with non-motor symptoms. Methods: In this cross-sectional study, we recruited 73 patients with idiopathic PD and 64 healthy volunteers. Serum MMP3 and MMP9 levels were measured by enzyme-linked immunosorbent assay (ELISA). Patients with PD were assessed for non-motor symptoms using the Non-motor Symptoms Scale (NMSS) and Parkinson's disease sleep scale (PDSS) and Mini Mental State Examination (MMSE). Results: Serum MMP3 levels were significantly decreased in PD patients, predominantly those with early-stage PD, compared with controls [12.56 (9.30, 17.44) vs. 15.37 (11.33, 24.41) ng/ml; P = 0.004], and the serum MMP9 levels of PD patients were significantly higher than those of healthy controls [522 (419, 729) vs. 329 (229, 473) ng/ml; P < 0.001]. MMP3 levels were positively correlated with the NMSS total score (r = 0.271, P = 0.020) and the single-item scores for item six, assessing the gastrointestinal tract (r = 0.333, P = 0.004), and there was an inverse correlation between serum MMP3 levels and PDSS score (r = -0.246, P = 0.036); meanwhile, MMP9 levels were positively correlated with the NMSS total score (r = 0.234, P = 0.047), and higher serum MMP9 levels were detected in the cognitive dysfunction subgroup than in the cognitively intact subgroup [658 (504, 877) vs. 502 (397, 608) ng/ml, P = 0.008]. Conclusion: The serum MMP3 level of PD patients (especially early-stage patients) was significantly lower than that of the healthy control group, and the MMP9 level was significantly higher than that of the healthy control group. MMP3 and MMP9 levels correlate with sleep disturbance and cognitive function in PD patients, respectively.

Differences in neuroanatomy and functional connectivity between motor subtypes of Parkinson's disease.

Background: The "postural instability/gait difficulty" (PIGD) and "tremor-dominant" (TD) motor subtypes of Parkinson's disease (PD) differ in their clinical manifestations. The neurological basis of these differences is unclear. Methods: We performed voxel-based morphometric analysis and measured amplitudes of low-frequency fluctuation (ALFF) on 87 PIGD patients and 51 TD patients. We complemented this neuroanatomical comparison with seed-to-voxel analysis to explore differences in functional connectivity. Results: The PIGD group showed significantly smaller gray matter volume in the medial frontal gyrus (mainly on the right side) than the TD group. Across all patients, gray matter volume in the medial frontal gyrus correlated negatively with severity of PIGD symptoms after controlling for age (r = -0.250, p = 0.003), but this correlation was not observed in separate analyses of only PIGD or TD patients. The PIGD group showed greater functional connectivity of the right superior frontal gyrus with the left lingual gyrus, right lateral occipital cortex, and right lingual gyrus. ALFF did not differ significantly between the two groups. Conclusion: Postural instability/gait difficulty may be associated with smaller gray matter volume in medial frontal gyrus than TD, as well as with greater functional connectivity between the right superior frontal gyrus and occipital cortex. These results may help explain the clinical differences between the two motor subtypes of PD.

Neuroanatomy and Functional Connectivity in Patients with Parkinson's Disease with or without Restless Legs Syndrome.

INTRODUCTION: Restless legs syndrome (RLS) is a common non-motor symptom in Parkinson's disease (PD), but its pathogenesis remains unclear. This study aimed to explore the potential neural substrates of RLS in a large sample of patients with PD. METHODS: A total of 42 patients with PD with RLS and 124 patients with PD without RLS were prospectively recruited at our hospital between February 2019 and October 2020 and underwent structural and resting-state functional magnetic resonance imaging. Differences between the two patient groups were assessed using voxel-based morphometry and functional connectivity analysis. PD duration, Part III of the Movement Disorder Society's Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III) score, and levodopa equivalent daily dose were treated as covariates. RESULTS: Patients with PD with RLS had significantly larger gray matter volume in the bilateral posterior cingulate cortex than patients with PD without RLS (FDR-adjusted P < 0.05). Compared to patients without RLS, those with RLS had significantly lower functional connectivity between the left central opercular cortex and the bilateral precentral gyri and postcentral gyri (FDR-adjusted P < 0.001). CONCLUSION: Our study provides the first evidence that in patients with PD, RLS is associated with significantly larger gray matter volume in the posterior cingulate cortex and lower resting-state functional connectivity within the sensorimotor network. Our results may help clarify the pathophysiology of RLS in PD and identify possible therapeutic targets.

Structural and functional abnormalities in Parkinson's disease based on voxel-based morphometry and resting-state functional magnetic resonance imaging.

OBJECTIVE: To explore differences in gray matter volume (GMV) and white matter volume (WMV) between patients with Parkinson's disease (PD) and healthy controls, and to examine whether the structural abnormalities correlate with functional abnormalities. METHODS: T1-weighted magnetic resonance imaging and resting-state functional magnetic resonance imaging (fMRI) were performed on 180 patients with PD and 58 age- and sex-matched healthy controls. We used voxel-based morphometry (VBM) to compare GMV and WMV between groups, and resting-state fMRI to compare amplitudes of low-frequency fluctuations (ALFF) in the structurally abnormal brain regions. RESULTS: Structural neuroimaging showed smaller whole-brain GMV, but not WMV, in patients. Furthermore, VBM revealed smaller GMV in the right superior temporal gyrus (STG) and left frontotemporal space in patients, after correction for multiple comparisons. Patients also showed significantly higher ALFF in the right STG. GMV in the right STG and left frontotemporal space in patients correlated negatively with age and scores on Part III of the Movement Disorder Society Unified Parkinson's Disease Rating Scale, but not with PD duration. CONCLUSIONS: Structural atrophy in the frontotemporal lobe may be a useful imaging biomarker in PD, such as for detecting disease progression. Furthermore, this structural atrophy appears to correlate with enhanced spontaneous brain activity. This study associates particular structural and functional abnormalities with PD neuropathology.

Exploring novel systemic therapies for pancreatic cancer: a review of emerging anti-PD-1/PD-L1 combination therapy.

Despite attempts to apply single therapy such as surgical treatment, chemotherapy, or radiotherapy, pancreatic cancer (PC) is still one of the most lethal solid tumors. Moreover, immune checkpoint inhibitors against PD-1/PD-L1, which have shown good efficacies against many other solid tumors, have not shown encouraging results in PC treatment. Therefore, some studies are evaluating the efficacies of combination therapies based on anti-PD-1/PD-L1 for PC. In this review, we summarized the emerging anti-PD-1/PD-L1 combination therapies for PC in these years. We realized that anti-PD-1/PD-L1-based combination therapies have the potential to be efficacious in PC treatment, and further relevant studies are needed. Moreover, we elucidated the reasons for the ineffectiveness of anti-PD-1/PD-L1 alone in PC treatment. We concluded that this was mainly because PC has an immunosuppressive tumor microenvironment and develops drug resistance during treatment. Anti-PD-1/PD-L1-based combination therapeutic regimens that alter the immunosuppressive tumor microenvironment and reduce the development of drug resistance in PC are summarized in this review, and we expect that these regimens will achieve good clinical application prospects.

Differences in Brain Activity Between Dopa-Responsive and -Unresponsive Pain in Parkinson's Disease.

INTRODUCTION: Pain in Parkinson's disease is poorly understood, and most patients with pain do not respond to dopaminergic drugs. We aimed to explore the mechanisms of dopa-responsive and -unresponsive pain by comparing such patients against patients without pain in terms of neural activity and functional connectivity in the brain. METHODS: We prospectively examined 31 Parkinson's patients with dopa-responsive pain, 51 with dopa-unresponsive pain and 93 without pain using resting-state functional magnetic resonance imaging. Neural activity was assessed in terms of the amplitude of low-frequency fluctuation, while functional connectivity was assessed based on analysis of regions of interest. RESULTS: Patients with dopa-unresponsive pain showed significantly higher amplitude of low-frequency fluctuation in the right parahippocampal/lingual region than patients with no pain. However, there was no amplitude difference between the dopa-responsive pain group and the no pain group. Patients with dopa-unresponsive pain also differed significantly from patients with no pain in their functional connections between the superior temporal gyrus and other areas of cerebral cortex, between amygdala and thalamus and between the amygdala and putamen. Patients with dopa-responsive pain differed significantly from patients with no pain in their functional connections between temporal fusiform cortex and cerebellum, between precentral gyrus and temporal fusiform cortex and between precentral gyrus and cerebellum. CONCLUSIONS: Regional neural activity and functional connectivity in the brain differ substantially among Parkinson's patients with dopa-unresponsive pain, dopa-responsive pain or no pain. Our results suggest that dopa-responsive and -unresponsive pain may arise through different mechanisms, which may help guide the development of targeted therapies.

Resting-state functional magnetic resonance imaging in patients with Parkinson's disease with and without constipation: a prospective study.

PURPOSE: The etiology of constipation in Parkinson's disease is largely unknown. The aim of this study was to explore changes in regional neural activity and functional connections associated with constipation in a large cohort of individuals with Parkinson's disease. METHODS: We prospectively recruited 106 patients with Parkinson's disease with constipation and 73 patients with Parkinson's disease without constipation. We used resting-state functional magnetic resonance imaging for the first time to measure differences in regional neural activity and functional connections between the two patient groups. RESULTS: Patients with constipation showed significantly higher amplitude of low-frequency fluctuation than patients without constipation in the right dorsal pons extending into the cerebellum and in the right insula. The two types of patients also showed substantial differences in functional connections linking the superior temporal gyrus, particularly the right superior temporal gyrus, with multiple brain regions. CONCLUSION: Regional neural activity and functional connectivity in the brain differ substantially between patients with Parkinson's disease with or without constipation. These findings provide a foundation for understanding the pathophysiology of constipation in Parkinson's disease and for identifying therapeutic targets.

Autoimmune-mediated secondary-parkinsonism presented with micrographia and cognitive impairment.

Parkinson's disease is a neurodegenerative disorder while secondary-parkinsonism can be caused by infectious, inflammatory, traumatic, vascular, hereditary, paraneoplastic, or even induced by drug/metal poisoning. Here we report an uncommon subacute parkinsonism who presented with micrographia and mild cognitive impairment. The CSF examination showed inflammatory profile and positive anti-NMDAR antibody. The patient showed no improvement with levodopa/benserazide administration but satisfactory response to immunotherapy with methylprednisolone. This case indicated that autoimmune etiology should also be considered in parkinsonism to exclude a treatable condition.

Corneal nerve fiber loss relates to cognitive impairment in patients with Parkinson's disease.

Cognitive impairment in Parkinson's disease (PD) adversely influences quality of life. There is currently no available biomarker to predict cognitive decline in PD. Corneal confocal microscopy (CCM) has been used as a non-invasive tool for quantifying small nerve damage in PD. The present study investigated whether corneal nerve measures were associated with cognitive function in PD. Patients with PD were classified into those with normal cognitive function (PD-CN), mild cognitive impairment (PD-MCI), and dementia (PDD). Corneal nerve fiber density (CNFD), corneal nerve branch density (CNBD), and corneal nerve fiber length (CNFL) were quantified with CCM and compared with a control group. Sixty-five PD patients and thirty controls were studied. CNFD was decreased and CNBD was increased in PD patients compared to controls (P < 0.05). CNBD and CNBD/CNFD ratio was higher in PD-CN compared to controls. CNFD was positively correlated with the Montreal cognitive assessment (MoCA) score (r = 0.683, P < 0.001), but negatively associated with unified Parkinson disease rating scale (UPDRS)-part III (r = -0.481, P < 0.001) and total UPDRS scores (r = -0.401, P = 0.001) in PD patients. There was no correlation between CNFD and Levodopa equivalent daily dose (LEDD) (r = 0.176, P = 0.161). CNFD, CNBD, CNFL, and CNBD/CNFD ratio was lower with increasing Hoehn and Yahr stage. PD patients show evidence of corneal nerve loss compared with controls and corneal nerve parameters are associated with the severity of cognitive and motor dysfunction in PD. CCM could serve as an objective in vivo ophthalmic imaging technique to assess neurodegeneration in PD.

Preliminary study of the toxicity and radioprotective effects of zymosan in vitro and in vivo.

BACKGROUND: This study aimed to confirm the cytotoxicity of zymosan in vitro and in vivo and determine the appropriate treatment time and the dose of zymosan. METHODS: AHH-1 cells and HIECs were administered by 0, 20, 40, 80 or 160 µg/mL zymosan. The CCK-8 assay and flow cytometry were used to evaluate the cell viability and apoptosis 24 h, 48 h, and 72 h after administration. Furthermore, 12 h before irradiation, the cells were treated with 0, 5, 10, or 20 µg/mL zymosan and then irradiated with 4 Gy X-rays. Cell viability and apoptosis were measured by the CCK-8 assay and flow cytometry at 24 h. In addition, the protective effect of zymosan against radiation in vitro was compared to that of 20 µg/mL LPS. In vivo, weight, the spleen index, and the thymus index were measured to evaluate the toxicity of 0, 5, 10, 20, and 10 mg/kg zymosan. In addition, rats were treated with 0, 2, 4, 8, or 10 mg/kg zymosan and then irradiated with 7 Gy X-rays. The survival rate, organ index were evaluated. The protective effect of zymosan against radiation in vivo was compared to that of 10 mg/kg LPS a positive control. RESULTS: The viability and apoptosis of cells treated with different doses and treatment times of zymosan were not different from those of control cells (p < 0.05). Furthermore, cell viability and apoptosis were clearly improved after zymosan preadministration (p < 0.05). The radioprotective effect of zymosan was dose-dependent. In addition, the viability of cells pretreated with zymosan was higher than that of cells pretreated with LPS, and the apoptosis rate of zymosan-treated cells was lower than that of cells pretreated with LPS (p < 0.05). In vivo, weight, the spleen index and the thymus index were significantly decreased by zymosan at a concentration of 20 mg/kg (p < 0.05). Further experiments showed that the concentration at which zymosan exerted radioprotective effects was 10 mg/kg. The survival curves in the irradiated rats were barely separated between the LPS treatment and zymosan treatment. CONCLUSION: Zymosan administration before radiation exposure significantly increased cell viability and the survival rates of rats.

Study on Multifunctional Composite Nanomaterials for Controlled Drug Release in Biomedicine.

Nanoscience is a highly comprehensive, interdisciplinary discipline based on many advanced science and technology, and has developed very rapidly in the past few decades. Nanoscience and technology has been widely used in many fields such as biomedicine, materials science, chemistry, physics, and electronic information engineering. Nanomaterials are widely used due to their many excellent properties such as quantum size effects, small size effects, surface effects, and tunneling effects, and have become hot research areas. It is very suitable as a carrier for antitumor drug molecules, which is conducive to improving drug efficacy and reducing drugs side effects. After selective functionalization, it is highly possible to achieve the loading and release of multiple drug molecules. Based on the magnetic mesoporous Fe3O4-MSNs composite nanoparticles, we have modified a series of organosilane coupling agents on its surface. The most commonly used antitumor drug (adriamycin) in clinical was selected as a model to evaluate the loading and release behavior of modified composite nanoparticles Fe3O4-MSNs on this drug. The results indicate that Fe3O4 is selectively modified after appropriate modification of the silane coupling agent. MSNs carrier can effectively regulate the adsorption and release rate of hydrophilic DOX and hydrophobic PTX, and shows a good drug control ability.

The emerging role of circulating tumor cells in cancer management.

Circulating tumor cells (CTCs) are cells that are shed from the primary tumor and circulate in the blood, and their metastasis and formation of a secondary tumor are closely associated with cancer-related death. Therefore, regulating tumor metastasis through CTCs can be a novel strategy to fight cancer. It has been demonstrated that CTCs can reflect the profile of the primary tumor and provide valuable information about intratumoral heterogeneity and their evolution over time. Moreover, the revelation of the relationship between metastasis and CTCs suggests that CTC regulation represents a promising novel anticancer strategy. Above all, at the molecular level, genetic analysis might be vital in the new era of gene-targeted cancer therapies and contribute to personalized anti-metastasis tumor treatments. In this review, we will focus on the biological significance of CTCs in the peripheral blood and discuss their potential clinical implications in cancer management.

[Laparoscopic selective varicocelectomy versus microscopy-assisted low ligation of the spermatic vein in the treatment of varicocele].

OBJECTIVE: To compare the effects and adverse events of laparoscopic selective varicocelectomy (LV) and microscopy-assisted low ligation of the spermatic vein (MV) in the treatment of varicocele. METHODS: We retrospectively analyzed the clinical data on 310 cases of varicocele treated in our hospital from January 2011 to March 2016, 162 (64 with infertility) by LV with preservation of the testis artery and lymph vessel and the other 148 (69 with infertility) by MV. We followed up the patients for 12 months and made comparisons between the two groups in the operation time, hospital stay, hospital costs, recurrence rate, incidence of complications, and semen quality before and at 3 and 6 months after surgery, and spontaneous pregnancy rate at 12 months postoperatively. RESULTS: The bilateral operation time was markedly shorter in the LV than in the MV group (ï¼»60 ± 16ï¼½ vs ï¼»92 ± 23ï¼½ min, P < 0.05), but no statistically significant differences were found between the two groups in the unilateral operation time (ï¼»38 ± 7ï¼½ vs ï¼»45 ± 10ï¼½ min, P >0.05), hospital stay (ï¼»3.2 ± 0.7ï¼½ vs ï¼»3.5 ± 0.9ï¼½ d, P > 0.05), hospital costs (ï¼»14 862.7 ± 813.2ï¼½ vs ï¼»13 907.3 ± 729.2ï¼½ RMB ¥, P > 0.05), or spontaneous pregnancy rate at 12 months after surgery (35.9% vs 39.1%, P > 0.05). Compared with the baseline, significant improvement was observed in both the LV and MV groups in sperm concentration and the percentage of grade a + b sperm at 6 months postoperatively (P < 0.05), but not at 3 months (P > 0.05). The rate of recurrence was remarkably higher in the LV than in the MV group (7.4% vs 1.4%, P < 0.05) but there were no statistically significant differences between the two groups in the incidence rates of postoperative orchialgia (1.8% vs 0.7%, P > 0.05) and epididymitis (1.2% vs 0, P > 0.05). CONCLUSIONS: For the treatment of varicocele, laparoscopic selective varicocelectomy is comparable to microscopy-assisted low ligation of the spermatic vein in the clinical effect. The former, however, has a significantly higher rate of recurrence than the latter.

Brain injury in combination with tacrolimus promotes the regeneration of injured peripheral nerves.

Both brain injury and tacrolimus have been reported to promote the regeneration of injured peripheral nerves. In this study, before transection of rat sciatic nerve, moderate brain contusion was (or was not) induced. After sciatic nerve injury, tacrolimus, an immunosuppressant, was (or was not) intraperitoneally administered. At 4, 8 and 12 weeks after surgery, Masson's trichrome, hematoxylin-eosin, and toluidine blue staining results revealed that brain injury or tacrolimus alone or their combination alleviated gastrocnemius muscle atrophy and sciatic nerve fiber impairment on the experimental side, simultaneously improved sciatic nerve function, and increased gastrocnemius muscle wet weight on the experimental side. At 8 and 12 weeks after surgery, brain injury induction and/or tacrolimus treatment increased action potential amplitude in the sciatic nerve trunk. Horseradish peroxidase retrograde tracing revealed that the number of horseradish peroxidase-positive neurons in the anterior horn of the spinal cord was greatly increased. Brain injury in combination with tacrolimus exhibited better effects on repair of injured peripheral nerves than brain injury or tacrolimus alone. This result suggests that brain injury in combination with tacrolimus promotes repair of peripheral nerve injury.

Clinical Profiles and Short-Term Outcomes of Acute Disseminated Encephalomyelitis in Adult Chinese Patients.

BACKGROUND AND PURPOSE: Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that predominantly affects children. Previous studies have mostly involved children in Western developed countries. METHODS: This study retrospectively reviewed the clinical profiles of ADEM in adult Chinese patients. RESULTS: ADEM occurred during summer and autumn in about two-thirds of the 42 included patients. Prior infection was found in five patients and no preimmunization was recorded. The most frequent clinical presentations were alterations in consciousness (79%) and behavior changes (69%), followed by motor deficits (64%) and fever (50%). About one-quarter (26%) of the patients showed positive results for oligoclonal bands, and about half of them exhibited increases in the IgG index and 24-hour IgG synthesis rate. Magnetic resonance imaging showed white- and gray-matter lesions in 83% and 23% of the patients, respectively. Steroids were the main treatment, and full recovery occurred in 62% of the patients, with residual focal neurological deficits recorded in a few patients. After a mean follow-up period of 3.4 years, two patients exhibited recurrence and one patient exhibited a multiphasic course. One patient was diagnosed with multiple sclerosis (MS). CONCLUSIONS: With the exception of the seasonal distribution pattern and prior vaccine rate, the clinical profiles of ADEM in adult Chinese patients are similar to those in pediatric populations. No specific markers are available for distinguishing ADEM from MS at the initial presentation. Careful clinical evaluations, cerebrospinal fluid measurements, and neuroradiological examinations with long-term follow-up will aid the correct diagnosis of ADEM.