2016年 · 第49卷第07期

After several years of preparation and revision, the highly anticipated "Chinese Guidelines for Clinical Application of Cerebrovascular Ultrasound" has finally been published^[1]Congratulations. Cerebrovascular disease is the leading cause of death and disability in the global population, ranking first in China^[2,3]。 In clinical practice, neurologists have recognized that to diagnose and intervene in stroke, it is necessary to have a comprehensive understanding of the patient's cerebrovascular pathology as soon as possible to better carry out individualized treatment. Vascular ultrasound is one of the most practical examination tools^[4],It can quickly provide good clinical reference materials for neurologists. Almost all hospitals with neurological establishment have transcranial Doppler ultrasound (TCD), which can be called the most widely used examination instrument in the field of clinical neurology in China. With the improvement of economic strength, more and more departments also have vascular color Doppler ultrasound, and its application scope has been expanded from vascular examination to the field of neurological, muscular and other diseases examination, and its economic benefits are undoubtedly. At the same time, however, its social impact has caused concern. At present, owners and operators of ultrasound are limited by the purpose and knowledge background, so they can't provide a very reliable basis for disease diagnosis. To change that, we have compiled this guide.

Ultrasound technology is increasing in clinical application because of its real-time, portable, non-invasive, repeated examination and even long-range monitoring advantages. Even in the widespread application of advanced technologies such as computed tomography, magnetic resonance imaging and angiography, ultrasound can provide a lot of complementary information for it, so it occupies an important position in the diagnosis of nervous system diseases. At present, cerebrovascular ultrasound has expanded from the traditional transcranial Doppler ultrasound (TCD) to the application fields of detecting microembolus, detecting right-to-left shunt (RLS) of cardiac or pulmonary arteriovenous abnormalities, automatic regulation of cerebral blood flow and blood vessels, and clinical diagnosis and even treatment of central nervous system degenerative diseases and peripheral neuropathies.

Stroke has high incidence rate, high recurrence rate, high fatality and disability rate, and heavy disease burden, which has jumped to the first cause of death in China^[1]。 In the current situation of relative lack of effective specific treatment, early prevention is the best way to reduce the burden of stroke disease. Risk assessment is an effective tool to identify the high-risk groups of stroke occurrence and recurrence, and to clarify the priorities of prevention, which is of great significance to the primary and secondary prevention of stroke. There are already some tools to assess the risk of occurrence and recurrence of ischemic stroke at home and abroad, but there is still a lack of standardized recommendations on how to choose various tools in clinical practice. The Neurology Branch of Chinese Medical Association and the Cerebrovascular Disease Group organized experts to comprehensively review domestic and foreign literature, and after many repeated discussions, they reached the following consensus recommendations on the selection of commonly used risk assessment tools, so as to facilitate clinical application.

Susac syndrome, also known as microvascular disease of brain, retina and cochlea, is characterized by acute multiple encephalopathy, branch retinal artery occlusion (BRAO) and sensory deafness^[1]。 In 1979 by Susac et al.^[2]First reported, but not officially named until 1994^[1]。 Susac syndrome is very rare, and more than 300 cases of the disease have been reported worldwide^[3]The clinical and imaging features of a male patient with Susac syndrome are reported.

carotid artery stenting (CAS) has been widely used to prevent cerebral infarction in patients with carotid artery stenosis. Although the probability of intracranial hemorrhage is small, the mortality rate can be as high as 75%^[1]。 We reviewed 116 patients who underwent CAS in our hospital from January 2014 to June 2015 and found 3 (2.6%) patients with intracranial hemorrhage, reported below.

The human body is not only composed of human cells, but also the home of 100 billion microorganisms. Most of these microorganisms live in the human digestive tract, especially in the lower digestive tract (i.e. large intestine). The total number of genes of these microorganisms is about 150 times that of human genes, and they have an important impact on human health and diseases^[1]。 The entire genetic information of these microorganisms is called the "human metagenome". Microorganisms are of great significance to maintain normal human physiological functions. The imbalance of intestinal microbial flora not only produces a variety of gastrointestinal diseases, such as diarrhea, constipation, dysentery, enteritis, ulcerative colitis, etc., but also induces obesity, aging, metabolic syndrome, cardiovascular disease, diabetes, and even cancer^[2,3]。 With deeper understanding of diseases, more and more studies have begun to focus on the effects of gut flora on the central nervous system. We summarize studies related to gut flora and central nervous system diseases as follows.

Duchenne muscular dystrophy (DMD) is a fatal X-linked recessive inherited myopathy, which is closely related to the protein deletion caused by the mutation of dystrophin gene on chromosome Xp21. However, myocyte membrane instability and mechanical damage caused by dystrophin deficiency do not fully explain the persistent skeletal muscle damage in DMD^[1]。 In recent years, more and more studies have shown that immune mechanisms, especially inflammatory response and inflammatory pathway activation, play a key role in the occurrence and development of DMD. Modulation of important targets of inflammatory response will also be a promising therapeutic approach. We will review the immune-related mechanisms and therapeutic advances in DMD.

Because its ligand has not been discovered, the nuclear receptor Tlx is also known as the orphan nuclear receptor. It is not only the main regulator of nerve regeneration, but also plays an important role in the development of tumors. Its unique biological function gives Tlx the potential to be a therapeutic tool for many neurological disorders. We now review the biological functions and clinical application prospects of Tlx as follows.