MANAGEMENT OF BULBAR URETHRAL ISCHEMIC NECROSIS FOLLOWING PELVIC FRACTURE URETHRAL INJURY REPAIR-A SINGLE CENTER EXPERIENCE

Aims & Objectives:About 10% of pelvic fracture injuries are associated with urethral injury. Most of the urethral injuries are successfully repaired by progressive perineal anastomotic urethroplasty. Bulbar urethral ischemic necrosis is a devastating complication seen in 5-8% of failed PFUI repairs. The objective of this study is to present our experience in management of a bulbar urethral ischemic necrosis developed following PFUI repair. Materials & methods:This is a retrospective study done at our institute, which includes data from feb,2003 to feb,2021. This is a descriptive statical analysis. Total 18 patients were managed using various surgical approaches and followed. Out of 18 patients seven patients underwent staged urethroplasty with Results & Observations: success rate of 85.71%,four underwent pedicled preputial skin tube urethroplasty with success rate of 75%,one underwent non transecting augmented urethroplasty with success rate of 100%,three underwent augmented perineal urethrostomy, two underwent continent diversion procedures, one underwent augmented perineal skin tube perineal urethrostomy. Bulbar urethral ischemic necrosi Conclusions: s following PFUI repair although uncommon, is a devastating complication which can be salvaged by various surgical techniques. Type of procedure chosen depends on individual patient and outcomes vary for each type of procedure

MRI cortical thickness of bulbar region and impacts on survival in amyotrophic lateral sclerosis patients / 西安交通大学学报(医学版)

【Objective】 To investigate cortical thickness changes in the face-head region of the primary motor cortex (PMC) and its effect on survival in amyotrophy lateral sclerosis (ALS) patients. 【Methods】 A retrospective analysis was performed on 105 ALS patients who underwent head MRI scan at the same time. The A4hf (face-head) region of PMC was used as the region of interest (ROI). According to clinical symptoms, patients were divided into two groups: bulbar involvement and non-bulbar involvement. The differences of clinical features and cortical thickness in ROI were analyzed. According to the symptoms of bulbar palsy, physical examination of nervous system and EMG of tongue muscle, the patients with bulbar palsy were divided into lower motor neuron (LMN), upper motor neuron (UMN) and LMN+UMN groups. The differences of bulbar subgroup score and ROI of cortical thickness were analyzed. Age at onset, body mass index, delayed time of diagnosis, bulbar subgroup score, and ROI cortical thickness were included in survival analysis. 【Results】 ① The ROI cortical thickness was significantly lower in bulbar involvement group than non-bulbar involvement group (-0.198±0.87 vs. 0.235±0.95, P=0.017). ② There were no significant differences in the bulbar subgroup scores or cortical thickness of ROI between LMN, UMN and LMN+UMN groups (P>0.05). ③ Survival analysis showed age of onset (HR=3.296, 95% CI:1.63-6.664, P=0.001), delayed time of diagnosis (HR=0.361, 95% CI:0.184-0.705, P=0.003), bulbar subgroup score (HR 0.389, 95% CI:0.174-0.868, P=0.021), and ZRE_ROI cortical thickness (HR=2.309, 95% CI:1.046-5.096, P=0.038) were independent influencing factors of ALS survival. 【Conclusion】 Cortical thickness in A4hf (face-head) region can more objectively reflect UMN signs of region bulbar. In addition to age of onset and delayed time of diagnosis, bulbar subgroup score and cortical thickness of face-head region are also independent influencing factors, and cortical thinning in face-head region is a protective factor for survival of ALS patients.

Exploring the globe salvaging treatment options in patients of COVID-19-associated mucormycosis with orbital involvement

Purpose: To explore the various globe salvaging treatment strategies for patients with coronavirus disease 2019?associated mucormycosis (CAM). Methods: This was a prospective interventional analytical study conducted at a Medical College in rural India. A total of 84 patients of CAM admitted between May 2021 and August 2021 were enrolled for the study. Patients with histologically proven CAM with clinical and/or radiological evidence of orbital involvement were divided into three treatment categories based on the site and extent of the lesion. Re?assessment was performed after 7 days. For patients who worsened with the primary approach, orbital exenteration was considered based on a Sion Hospital Scoring System. A novel approach to intra?orbital anti?fungal therapy, site?centered peri?bulbar injection of amphotericin B (SCPeriAmB), was also explored. All the patients were followed up for at least 3 months. Convenience sampling with descriptive statistics was used. Results: Six patients had to finally undergo exenteration by the end of the study period. The rest of the patients were reported to be stable or improved. No mortalities were reported on delaying the exenteration. No adverse events were noted in patients who were given SCPeriAmB. Conclusion: Globe salvaging treatment options should be advocated as a primary approach in patients with CAM. Site?centered peri?bulbar injections can be considered as an approach for delivering intra?orbital anti?fungal therapy in selected patients

Repeated use of fibrin sealants kept at room temperature in conjunctival autografting: An animal study

Purpose: In this study, our aim was to investigate if fibrin adhesives used in conjunctival wound surgery with autologous conjunctival grafts could be used repeatedly at different times after surgical opening. Methods: 40 New Zealand rabbits were used in the study. These animals were divided into four groups, each consisting of 10 rabbits, and hence 20 eyes. In the first group (control group), Tisseel fibrin sealant was used on the day the eye was first opened surgically; in the second group, it was used on the seventh day; on the third group, it was used on the 14th day; and in the fourth group, it was used 28 days after surgical opening. The graft from the inferior bulbar conjunctiva was attached using Tisseel fibrin glue to the superior scleral bed at the location where the superior bulbar conjunctiva was excised in the same eye. Results: No microbial growth was detected in the cultures of the samples tested. There were two partial graft loss in group 2 and there was one partial graft loss in each group of the other groups, and further total graft loss was present in one rabbit in group 3. None of the rabbits had any complications like granuloma, Corneal dellen or infection. Conclusion: Based on these results, fibrin sealants can be used repeatedly by storing them at room temperature. Repeated use of fibrin adhesives will reduce the cost of ophthalmologic surgeries and non?ophthalmologic surgeries

The efficacy of non-transecting uerthroplasty in the management of bulbar urethral stricture / 中华泌尿外科杂志

Objective:To compare efficacy and erectile function outcome of Non-transecting Urethroplasty (NTU)with excision and primary anastomotic urethroplasty(EPA) in the management of bulbar urethral stricture.Method:A retrospective analysis of the case data of 73 patients with bulbar urethral stricture admitted to Shanghai Sixth People's Hospital from January 2016 to December 2019. The patients are 18 to 60 years old, because of the stenosis of the bulbous urethra, the length of the stenosis is less than 2 cm, and there is no history of urethral surgery, no multiple urethral stricture, and no obvious ED before surgery. According to the operation method, the patients were divided into 25 cases in NTU group and 48 cases in EPA group. The ages of the NTU group and the EPA group were (39.2±9.4) years and (42.1±9.3) years, respectively. The course of the disease was 6.0(3.0-14.0) months and 6.5(3.0-11.0) months, respectively, and the body mass index was (23.7±3.2) kg/m 2 and (24.5±2.7) kg/m 2, the preoperative maximum urine flow rate (Q max) was (8.7±4.3) ml/s and (7.9±4.6) ml/s, respectively, and the length of the stenosis was respectively (1.7±0.4) cm and (1.8±0.2) cm, the preoperative International Erectile Function Questionnaire (IIEF-5) was (20.9±1.9) points and (21.3±2.1) points, respectively, the difference was not statistically significant ( P>0.05). The etiology of NTU group and EPA group were 8 cases (32.0%) and 31 cases (64.6%) of trauma, 11 cases (44.0%) and 9 cases (18.8%) of iatrogenic injury, and 6 cases (24.0%) and 8 cases (16.7%), the difference was statistically significant ( P=0.023). All operations were performed by the same team of doctors. The urethral scar was assessed during the operation. If the scar tissue can be completely removed without breaking the urethra, NTU is performed. The distal end of the urethra is cut at the dorsal side of the narrow segment of the urethra, and the urethral scar is removed in a transverse wedge shape. The urethra is sutured; otherwise, EPA is performed, the urethra is completely cut off, the stricture of the urethra and surrounding scar tissue is completely removed, and the urethra end-to-end anastomosis is performed. Record the operation time and intraoperative bleeding. Difficulty urinating after surgery, urethral microscopy and urethral angiography showed that the urethral stricture at the surgical site was defined as a failure of the operation. The urinary catheter was removed 3 weeks after surgery, urine flow rate was measured at 3 weeks, 6 months, and 12 months after surgery, erectile function was evaluated 12 months after surgery, and urethral angiography was performed 1 to 2 years after surgery. Result:All 73 operations in this study were successfully completed. The operation time of NTU group and EPA group were (67.6±11.3) min and (62.7±10.1) min, respectively, and the difference was not statistically significant ( P=0.063); intraoperative blood loss was (71.6±16.2) ml and (86.0±20.8) ml, the difference was statistically significant ( P=0.004). The postoperative median follow-up time was 18.0 months (13-38 months). The surgical success rates of the NTU group and EPA group were 92.0%(23/25) and 93.8%(45/48), respectively. The Q max of the NTU group and the EPA group were (26.7±3.6) ml/s and (28.1±8.7) ml/s, (25.2±3.5) ml/s and (26.7±8.1) ml/s, (25.0±4.3) ml/s and (26.2±7.2) ml/s; the IIEF-5 scores were (21.8±1.6) and (20.6±2.9) points respectively at 12 months after operation, the difference was both No statistical significance ( P>0.05). There was a statistically significant difference in IIEF-5 between NTU group and preoperative ( P=0.023). Conclusion:NTU can achieve the same outcomes as EPA in the management of bulbar urethral stricture. More importantly, the continuance of bulbar urethra is attained and avoiding rupture of bulbar cavernous artery, so as to protect the blood supply of penile and erectile function. NTU is a minimally invasive, feasible surgical method, which is advised for the patients with shorter stricture segment and fewer fibrosis.

Comparison of 0.75 % Ropivacaine with 0.5 % Bupivacaine in Peribulbar Block in Ophthalmic Surgeries

Bupivacaine as local anaesthetic has cardiovascular and neurological toxic effects; ropivacaine on the other hand is known to have fewer side effects. Its safety and some its ability to reduce intra ocular pressure has led to its widespread usage. The aim of our study was to compare the efficacy of inj. Ropivacaine 0.75 % + hyaluronidase 50 IU / mL with inj. bupivacaine 0.5 % + hyaluronidase 50 IU / mL in cataract surgeries under regional anaesthesia. MethodsWe evaluated 60 patients who were posted for small incision cataract surgeries. They were randomly divided by drawing chits in to 2 groups according to the anaesthetics used (ropivacaine / bupivacaine). Evaluation of these patients was done on the basis of sensory onset, motor onset using akinesia score, requirement of rescue analgesic, and time of motor and sensory offset of the local anaesthetic. ResultsInj. ropivacaine 0.75 % showed greater reduction in IOP (p < 0.05). Other parameters such as motor block, sensory block, akinesia score, and requirement of rescue analgesia were comparable between the two groups (p > 0.05). ConclusionsIn patients posted for intra ocular / cataract surgeries, ropivacaine 0.75 % and bupivacaine 0.5 % are comparable, with ropivacaine having better haemodynamic profile and also reduces intra ocular pressure.

Acupuncture at pharyngeal acupoints for true bulbar paralysis after cerebral infarction: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical effect of acupuncture at the affected side and both sides of the pharyngeal acupoints for true bulbar paralysis after cerebral infarction.@*METHODS@#A total of 66 patients with true bulbar paralysis after cerebral infarction were randomly divided into an unilateral group and a bilateral group, 33 cases in each group, 1 case dropped off in each group at last. On the basis of conventional drugs and electro-nape-acupuncture treatment, the patients in the unilateral group were treated with acupuncture at the affected side's , and (Extra), while patients in the bilateral group were treated with acupuncture at the both sides' , and The treatment was performed once a day, 6 days a week, and the clinical effect was assessed after 21-day therapy. The swallowing and vocalization of the two groups were evaluated by dysphagia grading scale, Kubota water swallowing test and GRBAS grading scale before and after treatment.@*RESULTS@#After 21 days of treatment, the scores of the dysphagia grading scale in the two groups were both improved (<0.01), and the unilateral group was superior to the bilateral group (<0.01). The GRBAS grading scale and Kubota water swallowing test grading after treatment were improved in both groups (<0.01), and the unilateral group was superior to the bilateral group (<0.05, <0.01).@*CONCLUSION@#Acupuncture at the pharyngeal acupoints of the affected side achieves much better therapeutic effect on true bulbar paralysis as compared with the acupoints of the bilateral sides.

Bulbar involvement time in spinal-onset amyotrophic lateral sclerosis: Effect on survival / 西安交通大学学报(医学版)

Objective: To explore the effect of bulbar involvement time on survival time of patients with spinal-onset amyotrophic lateral sclerosis (ALS). Methods: We followed up 168 patients with spinal-onset ALS admitted to our hospital from January 2, 2011 to December 31, 2017 until December 31, 2018. Univariate and multivariate analyses were performed to evaluate the affecting factors of the ALS patients' survival time. Kaplan-Meier analysis was made to evaluate the effects of bulbar involvement time on survival time. Results: COX multivariate analysis showed that the risk of death in age-onset <55 y patients was 0.72 times that in age-onset ≥55 y (P=0.09), the risk of death in diagnosis delay time <10.98 m patients was 2.64 times that ≥10.98 m (P<0.001); the risk of death in bulbar involvement time ≥11.5 m and bulbar uninvolvement was 0.30 and 0.32 times respectively that bulbar involvement time <11.5 m (P<0.001). Kaplan-Meier analysis showed differences among bulbar involvement time <11.5 m, ≥11.5 m and bulbar uninvolvement groups (median survival time 20.37 m vs. 40.6 m vs. 39.60 m, Test statistic =39.96, P<0.001). The 2-year, 3-year and 5-year survival rates were 32.17%, 10.80% and 0%, respectively, in bulbar involvement time <11.5 m patients; 89.20%, 57.24% and 10.53% in bulbar involvement time ≥11.5 months patients; and 62.16%, 38.39% and 10.53% in bulbar uninvolvement patients. Conclusion: Similar to the diagnosis delay time and whether to have taken riluzole, the occurrence of bulbar involvement at 11.5 month after onset was an independent risk factor affecting survival time in spinal-onset ALS. The median survival time in patients with bulbar involvement time <11.5 months was significantly shorter than that in patients with bulbar involvement time ≥11.5 months and bulbar uninvolvement.

Needle electromyography of the genioglossus muscle in the detection of amyotrophic lateral sclerosis / 中华神经科杂志

Objective To investigate the diagnostic value of spontaneous activities in genioglossus of amyotrophic lateral sclerosis (ALS).Methods A retrospective analysis of 79 patients diagnosed with ALS from January 2014 to December 2015 in Beijing Tiantan Hospital Affiliated to Capital Medical University was made.The patients were divided into two groups according to the clinical examination:with (44 patients) or without bulbar symptoms (35 patients).The course of disease,spontaneous potentials and ALS-Functional Rating Scale (ALS-FRS) scores were discussed,together with the association between semi-quantitative evaluation of spontaneous potential of the genioglossus and ALS-FRS score.Results In ALS patients,the overall positive rate of glossal spontaneous potentials was 69.6％ (55/79),among which the positive rate was 82.9％ (29/35) in patients with bulbar symptoms and 59.1％ (26/44) in patients without bulbar symptoms,with statistically significant differences between the two groups (x2=5.206,P＜0.05).While the positive rate in sternocleidomastoid was only 13.9％ (11/79),and there was no statistically significant difference between patients with or without bulbar symptoms.Semi-quantitative evaluation of fibrillation potentials in genioglossus muscle was correlated with ALS-FRS score (r=-0.258,P＜0.05).Conclusion Compared with sternocleidomastoid muscle,genioglossus muscle has a higher positive rate of spontaneous potentials and a higher diagnostic value in patients with subclinical bulbar symptoms.

CT-guided Botulinum Toxin Injection into Cricopharyngeus for Dysphagia after True Bulbar Palsy: a Case Report / 中国康复理论与实践

Objective:To explore the effect of CT-guided Botulinum toxin injection into cricopharynx muscle on dysphagia caused by true bulbar palsy. Methods:A case of dysphagia caused by true bulbar palsy was treated with CT-guided Botulinum toxin injection and its therapeutic effect was reported. Results:The patient had dysphagia after brainstem infarction and was diagnosed as true bulbar palsy. After routine rehabilitation of dysphagia and balloon dilatation, her dysphagia relieved, but reappeared three times. Botulinum toxin was injected into the loop pharynx muscle under the guidance of CT, the clinical effect was remarkable, and no recurrence of the disease appeared in the follow-up. Conclusion:CT-guided Botulinum toxin injection into cricopharyngeus is effective on dysphagia caused by true medullary palsy, and the probability of recurrence is small.

Effect of intermittent oro-esophageal tube feeding on dysphagia in acute stroke patients with bulbar or pseudobulbar palsy / 国际脑血管病杂志

Objective To investigate the effect of intermittent oro-esophageal rube feeding (IOE) on dysphagia in acute stroke patients with bulbar or pseudobulbar palsy.Methods From May 2016 to December 2018,patients with acute stroke complicated with bulbar or pseudobulbar palsy admitted to the Department of Neurobgy,Ninghe District Hospital of Tianjin were enrolled retrospectively.They were divided into IOE group and nasogastric gavage tube (NGT) group.The baseline clinical data,swallowing function and nutritional indicators before and after treatment,and the incidence of aspiration pneumonia were collected and compared.Kubota's water swallow test was used to evaluate the swallowing function,and Grade ≥ 3 was defined as poor swallowing function after 30 days of treatment.Multivariate logistic regression analysis was used to determine the independent influencing factors of poor outcomes of swallowing function.Results A total of 92 patients were enrolled,58 were males (63％),and aged 64.3-± 11.2 years;the National Institutes of Health Stroke Scale (NIHSS) score 5.98 ±-2.29;76 patients (82.6％) had cerebral infarction,16 (17.4％) had cerebral hemorrhage;16 (17.4％) had bulbar palsy,and 76 (82.6％) had pseudobulbar palsy.There were 46 cases in each of the IOE group and the NGT group.The improvement of swallowing function and nutritional status at 30 d in the IOE group were significantly better than those in the NGT group (all P ＜0.01),while the incidence of aspiration pneumonia was significantly lower than that in the NGT group (19.6％ vs.39.1％;x2 =4.246,P =0.039).The dysphagia of 70 patients (76.1％) had good outcomes,and that of 22 (23.9％) had poor outcomes.Multivariate logistic regression analysis showed that the NIHSS score on admission (odds ratio [OR] 1.225,95％ confidence interval [CI] 1.221-1.445;P=0.030),bulbar palsy (OR 1.428,95％ CI 1.327-1.545;P＜0.001),and left lesions (OR 1.424,95％ CI 1.352-1.565;P＜0.001) were independently associated with the poor outcomes of swallowing function,while IOE (OR 0.351,95％ CI 0.075-0.643;P ＜0.001) was independently associated with the good outcomes of swallowing function.Conclusion IOE can improve the swallowing function of stroke patients with bulbar or pseudobulbar palsy,and reduce the incidence of aspiration pneumonia while providing good nutritional support.

Accidente cerebrovascular bulbar lateral con trayecto extracraneal de la arteria cerebelosa póstero-inferior / Lateral medullary stroke with extracranial course of the postero- inferior cerebellar artery

Presentamos dos casos de accidente cerebrovascular en sujetos con trayecto extracraneal de la arteria cerebeloso póstero-inferior. Caso 1: varón de 21 años, quien presentó ataxia y dismetría derecha luego de un traumatismo cervical en un partido de rugby. Caso 2: mujer de 56 años, quien inició con vértigo y hemiparesia izquierda luego de esfuerzo físico intenso. En ambos casos, los estudios angiográficos mostraron un trayecto extracraneal de la arteria cerebelosa póstero-inferior. Este vaso raramente se origina por debajo del foramen magno, en relación cercana con las primeras tres vértebras cervicales y la articulación atlanto-axial. En este nivel, está expuesta a daño mecánico causante de disección, como por ejemplo trauma directo, manipulación cervical abrupta o extensión cefálica prolongada. Por lo tanto, en pacientes con accidente cerebrovascular de región lateral de bulbo y trayecto extracraneal de la arteria cerebelosa póstero-inferior se debería considerar esta asociación.

We present two cases of lateral medullary stroke in subjects with extracranial trajectory of the postero-inferior cerebellar artery. Case 1: a 21-year-old male who presented ataxia and right dysmetria after cervical trauma in a rugby match. Case 2: 56-year-old woman, who started with vertigo and left hemiparesis after intense physical effort. In both cases, the angiographic studies showed an extracranial trajectory of the posterior inferior cerebellar artery. This vessel rarely originates below the foramen magnum, in close relationship with the first three cervical vertebrae and the atlanto-axial joint. At this level, it is exposed to mechanical damage causing dissection, such as direct trauma, abrupt cervical manipulation or prolonged cephalic extension. Therefore, this association should be considered in patients with stroke of the lateral region of the bulb and extracranial trajectory of the posterior-inferior cerebellar artery.

Electromyography guided point injection at Renying (ST 9) for post-stroke dysphagia / 中国针灸

<p><b>OBJECTIVE</b>To observe the effect of electromyography (EMG) guided point injection at Renying (ST 9) for post-stroke dysphagia caused by bulbar paralysis, and explore effective treatments for improving swallowing function on the basis of conventional medicine and rehabilitation training.</p><p><b>METHODS</b>A total of 60 patients were randomly divided into an observation group and a control group, 30 cases in each one. The conventional drugs combined with rehabilitation training were given in the control group, the treatment was given once every day. Based on the treatment in the control group, the EMG guided point injection at Renying (ST 9) was added in the observation group, three times a week. All the treatment was given for 2 weeks. drinking test score and Toshima Ichiro swallow test score were observed before and after treatment in the two groups, and the effects were assessed.</p><p><b>RESULTS</b>Toshima Ichiro swallow test score increased after treatment in both groups compared with that before treatment, and drinking test score decreased compared with that before treatment (all <0.05), and the change rate in the observation group was significantly better than that in the control group (both <0.05). The total effective rate of swallowing efficacy in the observation group was 93.3% (28/30), and the cured rate was 46.7% (14/30), which were better than 26.7% (8/30) and 3.3% (1/30) in the control group (both <0.05).</p><p><b>CONCLUSION</b>On the basis of conventional drugs and rehabilitation training, the EMG guided point injection at Renying (ST 9) can effectively increase the swallowing function of patients with post-stroke dysphagia caused by bulbar paralysis .</p>

Síndrome de Wallenberg: reporte de caso / Wallenberg Sindrome: a case report

El Síndrome de Wallenberg representa el 36% de los infartos del tronco cerebral. Se debe a la oclusión de la Arteria cerebelosa posterior inferior, afectando estructuras encontradas en el cerebelo y la parte lateral del bulbo raquídeo. El principal factor de riesgo es la aterosclerosis. El caso se trata de paciente masculino de 57 años de edad con antecedente de Infartos lacunares en cerebelo, Diabetes mellitus tipo 2No controlada, tabaquismo y dislipidemia. Inicia con cuadro clínico de cefalea occipital, intensa, súbita, sin atenuantes concomitantemente vértigo, hipo, nauseas, vómitos y parestesia de miembros inferiores. Al examen físico pulsos periféricos disminuidos, presenta Síndrome de Horner, hipo, hipoestesia en hemicara izquierda y hemicuerpo contralateral, con ataxia, dismetría y disdiadococinesia. Se realiza IRM con difusión con conclusión diagnostica: Imagen hiperintensa de morfología irregular en el contorno lateral izquierdo del bulbo raquídeo por restricción molecular, compatible con evento isquémico (Síndrome Wallenberg). Se indica tratamiento antitrombótico y terapia física. Paciente es evaluado 2 meses después mostrando amplia mejoría de su cuadro. Es un síndrome muy específico, cuya manifestación clínica depende de la región anatómica afectada y abstrae al clínico de otros diagnósticos.

Wallenberg's Syndrome represents 36 % of strokes in the brainstem. It is due to occlusionof the inferior cerebellar artery, affecting structures found in the cerebellum and the lateral part of themedulla oblongata. The main risk factor is atherosclerosis. The case is about a 57-year-old male patient witha history of lacunar infarcts in the cerebellum, type 2 diabetes mellitus, smoking and dyslipidemia. It beginswith an intense and sudden occipital headache, without attenuating, concomitantly vertigo, hiccups, nausea,vomiting and paresthesia of lower limbs. At the physical examination, decreased peripheral pulses presentHorner's syndrome, hypoesthesia, hypoesthesia in left hemiface, and contralateral hemibody, with ataxia,dysmetria and dysdiadochokinesia. MRI was performed with diffusion with diagnostic Hyperintense image ofirregular morphology in the left lateral contour of the medulla oblongata, compatible with ischemic event(Wallenberg syndrome). Antithrombotic treatment and physical therapy was indicated. Patient was evaluated2 months later showing ample improvement. It is a very specific syndrome, whose clinical manifestationdepends on the anatomical region affected and abstracts the clinician from other diagnoses.

Application of disease screening with magnetically controlled capsule endoscopy / 中国内镜杂志

Objective To study the clinical value of magnetically controlled capsule endoscopy in diseases screening. Method We retrospectively analyzed 61 cases which were evaluated by magnetically controlled capsule endoscopy from March 2015 to December 2016. The items include operating time, the divergence rate score and cleanliness score of stomach. The consistency was compared between magnetically controlled capsule endoscopy and gastric duodenal endoscopy. Results 61 upper gastrointestinal tract studies were included. The mean age was (49.4 ± 11.6) years. No capsule retention, perforation or bleeding occurred. There was 98.4% patients, which cleanliness of stomach was good. There was 68.9% patients, which filling degree of stomach was good. The concordance rate of the two tests of gastrduodenoscopy and magnetically controlled capsule endoscopy was 89.9% (80/89). The concordance rate of the two tests was 78.9% (15/19) in esophageal and cardia, 92.9% (52/56) in stomach, 92.9% (13/14) in duodenum. Conclusion Our experience shows that magnetically controlled capsule endoscopy is a safe and useful tool for the diagnosis of upper gastrointestinal tract disease. The detection rate is similar to gastrduodenoscopy.

Brief introduction to Professor Gao Wei-bin's needling technique of 'Ten Acupuncture Skills' / 针灸推拿医学（英文版）

'Ten Acupuncture Skills' refers to ten types of needling techniques for difficult and intractable neurological diseases. It has been summarized by Prof. Gao Wei-bin, a famous traditional Chinese medicine expert in China, based upon his clinical experience for years, including neck acupuncture for bulbar palsy, neck acupuncture for laryngeal muscular paralysis, stuck needling technique for ocular muscular paralysis, electric field therapy at Jiaji (EX-B 2) points for incomplete spinal paraplegia, electroacupuncture (EA) for urination disorder, electric neck acupuncture for waking up and treating various cerebral and nuchal diseases, EA at Jiaji (EX-B 2) points for intractable hiccup, EA at Jiaji (EX-B 2) points for cervical and lumbar spondylopathy, antagonistic EA for post-apoplectic hemiplegia, and EA for facial paralysis. The ten acupuncture skills are summarized in order to guide the clinical application.

Research of serum myoglobin detection in patients with Kennedy's Disease / 临床神经病学杂志

Objective To explore the significance of serum myoglobin detection in the diagnosis and evaluation of Kennedy`s disease (KD).Methods The level of serum myoglobin (Myo) was detected in 60 KD patients and 30 amyotrophic lateral sclerosis (ALS) patients.Results The serum Myo level and abnormal rate in KD group were significantly higher than those in ALS group (all P0.05).There was no overlap of serum Myo level between the two groups.There was no significant difference of serum Myo level and CAG repeated number of ALS (r=-0.193,P>0.05).Conclusion Myo is likely as an easy and sensitive biomarker, used to identify the KD and special type of ALS, and used in the evaluation of the KD condition in the future.

Change of retrobulbar artery hemodynamics and bulbar conjunctival microcirculation indexes of patients with optic atrophy / 国际眼科杂志(Guoji Yanke Zazhi)

AlM:To study and observe the change of retrobulbar artery hemodynamics and bulbar conjunctival microcirculation indexes of patients with optic atrophy.METHODS: Seventy patients with optic atrophy in our hospital from April 2013 to October 2014 were selected as observation group, 70 healthy persons with the same age at the same time were the control group. Retrobulbar artery hemodynamics and bulbar conjunctival microcirculation indexes of two groups were compared, those detection indexes of observation group with different types and severity degree were compared too.RESULTS: The retrobulbar artery hemodynamics and bulbar conjunctival microcirculation indexes of observation group were all worse than those of control group, and the detection results of observation group with severe optic atrophy were worse than those of patients with mild and moderate optic atrophy, and the detection results of patients with moderate optic atrophy were all worse than those of patients with mild optic atrophy ( all P 0. 05). CONCLUSlON: The change of retrobulbar artery hemodynamics and bulbar conjunctival microcirculation indexes of patients with optic atrophy are great, and the influence of the disease severity degree for the detection results are great.

Clinical Characteristics and Genotype-Phenotype Correlation of Korean Patients with Spinal and Bulbar Muscular Atrophy

PURPOSE: Spinal and bulbar muscular atrophy (SBMA) is an X-linked motor neuron disease characterized by proximal muscle weakness, muscle atrophy, and fasciculation. Although SBMA is not uncommon in Korea, there is only one study reporting clinical characteristics and genotype-phenotype correlation in Korean patients. MATERIALS AND METHODS: In this study, age at the onset of symptoms, the score of severity assessed by impairment of activities of daily living milestones, and rate of disease progression, and their correlations with the number of CAG repeats in the androgen receptor (AR) gene, as well as possible correlations among clinical characteristics, were analyzed in 40 SBMA patients. RESULTS: The median ages at onset and at diagnosis were 44.5 and 52.5 years, respectively, and median interval between onset and diagnosis and median rate of disease progression were 5.0 years and 0.23 score/year, respectively. The median number of CAG repeats in the AR gene was 44 and the number of CAG repeats showed a significant inverse correlation with the age at onset of symptoms (r=-0.407, p=0.009). In addition, patients with early symptom onset had slower rate of disease progression. CONCLUSION: As a report with the largest and recent Korean cohort, this study demonstrates clinical features of Korean patients with SBMA and reaffirms the inverse correlation between the age at disease onset and the number of CAG repeats. Interestingly, this study shows a possibility that the rate of disease progression may be influenced by the age at onset of symptoms.

Variante faringo-cérvico-braquial da síndrome de Guillain-Barré:uma causa rara de disfunção bulbar aguda em crianças / Pharyngeal-cervical-brachial variant of Guillain-Barré syndrome:a rare cause of acute bulbar dysfunction in children

Aims: To report a case of pharyngeal-cervical-brachial variant of Guillain-Barré syndrome, which is characterized by rapidly progressivebulbar palsy with upper limb, neck and oropharyngeal involvement. It is a rare disorder in childhood and most cases have been described inadolescents.Case Description: A seven year-old-boy presented with dysarthria, hoarseness, dysphagia, facial diplegia and bilateral progressive upperlimb weakness. These symptoms started two weeks after a gastrointestinal infection. Nerve conduction studies were compatible with an acutedemyelinating polyneuropathy in the upper extremities. Anti-ganglioside antibodies in the serum (anti-GT1a, GD1a, GQ1b) were positiveand Campylobacter jejuni was isolated from stools. The patient was treated with intravenous immunoglobulin and needed ventilatory supportduring the first 12 days of admission. He was discharged at day 15 showing improvement of his neurological deficits. He fully recovered aftereleven months of follow-up.Conclusions: Although pharyngeal-cervical-brachial variant of Guillain-Barré syndrome is uncommon in children, it should be consideredin a child with acute bulbar dysfunction because a timely diagnosis allows the early institution of therapeutic measures that can be lifesaving.

Objetivos: Relatar um caso da variante faringo-cervico-braquial da síndrome de Guillain-Barré, que se caracteriza por paralisia bulbarrapidamente progressiva com envolvimento dos membros superiores, pescoço e região orofaríngea. É um diagnóstico raro na criança, ocorrendoa maioria dos casos em adolescentes.Descrição do Caso: Um menino de sete anos de idade iniciou com queixas de disartria, disfonia, disfagia, diplegia facial e fraqueza muscularprogressiva dos membros superiores. Estes sintomas surgiram duas semanas após uma infeção gastrointestinal. Os estudos eletrofisiológicosforam compatíveis com polineuropatia aguda desmielinizante nos membros superiores. Os anticorpos anti-gangliosídeo no plasma(anti-GT1a, GD1a, GQ1b) foram positivos e Campylobacter jejuni foi isolado nas fezes. O paciente foi tratado com imunoglobulina endovenosae necessitou de suporte ventilatório durante os primeiros 12 dias. Teve alta no 15º dia com melhora dos sintomas neurológicos. Recuperou-setotalmente após 11 meses de seguimento.Conclusões: Apesar da variante faringo-cervico-braquial ser pouco frequente em idade pediátrica, é um diagnóstico que deve ser consideradoperante uma criança com disfunção bulbar aguda, pois a identificação precoce permite instituir rapidamente medidas terapêuticas que podemevitar a morte.