2017年 · 第50卷第01期

With the Golden Rooster, we have a promising 2017. The Chinese Journal of Neurology (referred to as the Journal for short) has gone through another 20 years of arduous journey after being separated from the Chinese Journal of Neuropsychiatry. And I have been the editor-in-chief of the magazine for nearly 8 years. "8 years" is only a moment in the long river of history, but for the growth of magazine and personal experience is extremely precious, and it is an indelible memory and trace. I am honored to be able to grow and improve together with magazine at this stage. On this occasion of farewell to the old and welcoming the new, on behalf of the editorial board and editorial department of Chinese Journal of Neurology, I would like to express my heartfelt thanks to all readers, authors, editorial boards and reviewers for their hard work over the years, and extend my New Year's greetings and best wishes to you and all colleagues and friends from all walks of life who care and support the magazine!

Since President Obama announced the launch of "precision medicine" in 2015^[1]At the beginning, China also quickly set off an upsurge of "precision medicine", and this concept has been extended to various fields of medicine, including neurodegenerative diseases such as Parkinson's disease and Alzheimer's disease. So what is precision medicine? What conditions are required to implement precision medicine? Is Parkinson's disease, as a classic neurodegenerative disease, suitable for precision medicine? What is particularly important is, how many difficulties need to be overcome in the treatment of Parkinson's disease in my country on the promising road of precision medicine? We will introduce the above issues one by one.

At present, hyaluronic acid injection rhinoplasty has achieved satisfactory results in the vast majority of patients, but there are also reports of serious complications such as blindness and even cerebral infarction^{[1,2,3,4,5,6]}。 We report the data of a patient with left eye blindness and hemorrhagic cerebral infarction caused by nasal and dorsal injection of hyaluronic acid in our department, and analyze its pathogenesis, risk factors, treatment and prognosis, so as to increase clinicians' attention to this disease.

Valproic acid, chemically known as dipropylacetic acid, is one of the first-line anti-epileptic drugs commonly used in clinic. The common adverse reactions are transient digestive symptoms, occasionally severe hepatitis, hyperammonemia, pancreatitis, etc. Valproic acid-associated pancreatitis is rare in clinic, and multiple recurrences are even rarer. 1 case is reported below.

Bedwell reported the first case of non-ketotic hyperglycemia with hemichorea in 1960^[1]。 The typical triad of this disease includes acute onset of hemichorea or throwing syndrome, symptoms contralateral limb striatum T₁WI high signal and high density shadow on CT plain scan, the symptoms disappeared after normal blood sugar^[2]。 The disease is rare, more common in women than in men, and more easily affected in Asian ethnic groups. It may even be the first symptom of diabetic patients. However, there are no epidemiological data to investigate the specific incidence and prevalence^[3,4]。 A case of an elderly female patient we treated is now reported as follows.

McArdle disease, also known as glycogen storage disease V (GSDV), is an autosomal recessive genetic disease caused by muscle phosphorylase deficiency caused by PYGM gene mutation^[1]。 Most of these patients have onset before the age of 20, and the clinical manifestations are exercise intolerance, weakness after exercise, muscle spasm, myalgia, rhabdomyolysis in severe cases, and serum creatine kinase continues to rise (even between attacks). Almost all patients have "second gust" phenomenon, that is, muscle weakness, dyspnea and accelerated heartbeat after strenuous aerobic exercise improve significantly after 10 minutes of rest. Most patients describe this phenomenon as weakness symptom in the early stage of exercise, which can be significantly improved after a short rest. This may be related to the increase of intramuscular blood flow, fat metabolism and enhanced glucose utilization after exercise^[2]。 Two cases admitted to us are reported below.

Parkinson's disease (Parkinson's disease) is a neurodegenerative disease common in middle-aged and elderly people. Clinically, it is characterized by motor symptoms such as resting tremor, bradykinesia, myotonia and postural balance disorder caused by massive degeneration and loss of dopaminergic neurons in substantia nigra. With the deepening of research, scholars have found that in addition to motor symptoms, non-motor symptoms are also common and important clinical signs of Parkinson's disease, and can even occur before motor symptoms. 2003 Braak et al.^[1]The proposed six pathological stages of the onset of Parkinson's disease, namely Braak staging, are of great significance for further understanding the occurrence of non-motor symptoms in Parkinson's disease.

Alzheimer's disease (AD) is a common neurodegenerative disease in the elderly. It has a hidden onset and progressive development. It is clinically characterized by general dementia such as memory impairment, aphasia, apraxia, agnosia, spatial visual impairment, executive dysfunction, personality and behavior changes^[1]。 With the aging of the population, AD has become the fourth major disease that seriously endangers the health of the elderly. Epidemiological surveys show that the incidence of AD doubles for every 5 years of age in the elderly over 65. About 20% to 50% of the elderly over 85 years old suffer from AD. Usually those who develop the disease before the age of 65 are called Alzheimer's disease, while those who develop the disease after the age of 65 are called Alzheimer's disease^[2]。 The pathological characteristics of AD are senile plaque, neurofibrillary tangles, vacuolar degeneration of hippocampal pyramidal cell granules and neuron loss. The etiology of AD is unknown^[3]。 Amyloid beta is an amino acid polypeptide obtained by hydrolysis of amyloid beta precursor proteins. Studies have found that the onset of AD is related to the abnormal precipitation of beta amyloid protein in the brain^[4]。 Amyloid beta has toxic effects on peripheral synapses and neurons, which can disrupt synaptic structures and eventually cause nerve cell death^[5]。

Parkinson's disease (Parkinson's disease) is a common neurodegenerative disease in middle-aged and elderly people, with latent onset and slow progression, which is related to the degeneration and loss of dopaminergic neurons in substantia nigra. With the deepening of the understanding of this disease, in addition to its typical motor symptoms (bradykinesia, quiescent tremor, myotonia), non-motor symptoms (anosmia, sleep disorders, cognitive impairment, psychiatric symptoms and sensory disorders, etc.) also seriously affect the quality of life of patients^[1]。 They may be present before the onset of motor symptoms^[2]But it is often paid attention to in the late stages of disease progression.

Parkinson's disease is a disease with obvious clinical heterogeneity. Besides motor symptoms, non-motor symptoms are also very common. Some non-motor symptoms of Parkinson's disease may appear before motor symptoms and become early warning factors of the disease. Some non-motor symptoms often appear in the later stage of the disease, aggravating disability and affecting the quality of life of patients. In recent decades, with the deepening of research, the prevalence of non-motor symptoms in Parkinson's disease and its importance in the diagnosis and treatment of the disease have been paid more and more attention.

central sleep apnea syndromes (CSA) and obstructive sleep apnea syndromes (OSA) are classified as sleep-related breathing disorders (SRBD) in the International Classification of sleep disorders (ICSD-3)^[1]。 Because the incidence of CSA is significantly lower than that of OSA, accounting for less than 10% of all SRBDs, it has received less attention. Recently, with the popularization of positive pressure ventilation therapy, there are more and more CSA (also known as complex sleep apnea) after positive pressure ventilation therapy, and the unexpected discontinuation of large-scale clinical trials for patients with Chenshi respiratory CSA has made CSA attract more and more attention, and much progress has been made in its treatment. We will review this.