Objective To investigate the effect of small bone-window craniotomy under microscope combined post-operative intracranial pressure monitoring in the treatment of hypertensive hemorrhage. Methods Sixty-eight patients with hypertensive hemorrhage admitted to our hospital from July 2021 to July 2022 were selected and divided into two groups: In the trial group,35 patients underwent small bone-window craniotomy under microscope combined post-operative intracranial pressure monitoring,and in the control group,33 patients only underwent small bone-window craniotomy under microscope.Postoperative complicationsand GOS score were compared between the two groups. Results The incidence of postoperative complications in the trial group were significantly lower than those in the control group ( P<0.05).The GOS score of trial group was significantly higher than that of control group 6 months after operation ( P<0.05). Conclusion Small bone-window craniotomy under microscope combined post-operative intracranial pressure monitoring can improve the prognosis of hypertensive hemorrhage patients,reduce postoperative complications,reduce hospital stay,and improve the quality of life of patients.

Objective To investigate the application value of neuroendoscopy combined with microscope in the resection of cerebellopontine angle epidermoid cyst. Methods he clinical data of 15 cases of cerebellopontine angle epidermoid cyst were retrospectively analyzed.The posterior suboccipital sigmoid sinus approach was adopted in all cases,and the lesions were resected by neuroendoscope combined with microscope. Results All of the 15 patients,12 (80.0%) were completely resected.Subtotal resection was performed in 2 cases (13.3%).The majority was resected in 1 case (6.7%).After 2-22 months follow-up,10 patients with clinical symptoms were relieved.One patient developed new abducens nerve palsy within 1 week after surgery,and one patient developed mild facial paralysis,which returned to normal within 6 months after surgery.One patient developed aseptic meningitis postoperation and was cured by external drainage of lumbar cisterna. Conclusion Microscopy and neuroendoscopy are surgical instruments,both of them have their own advantages and disadvantages.For the operation of complex cerebellopontine angle epidermoid cyst,the advantages of both surgical instruments should be utilized to remove the tumor as much as possible while protecting the patient's neurological function and reducing complications.

Objective To investigate the clinical and imaging manifestations,pathology and treatment of pituicytoma. Methods The clinical data,imaging findings,pathology and treatment of 2 patients who were diagnosed as pituicytoma in our hospital from January 2019 to October 2023 were retrospectively analyzed,and the relevant literature was reviewed. Results There were 2 patients of pituicytoma,1 male and 1 female.The main symptoms include headache and vision decreased,and the head magnetic resonance imaging showed iso-intense on T1 weighted imaging and hypo- or iso-intense on T2 weighted imaging in and above the sellar region,substantial lesions were increased signal intensity after enhancement.Transnasal sphenoid approach under microscope and neuroendoscope were performed respectively.The postoperative pathology was pituicytoma (WHO Grade I),which was not treated with radiotherapy.Two cases were followed up for 4 years and 3 months without recurrence. Conclusion Pituicytoma is rare and easily misdiagnosed,the blood supply of tumor tissue is affluent,total surgical resection is the main way of treatment.

Objective To investigate theresearch on the effect of carmustine combined with temozolomide in the treatment of glioma by regulating the levels of growth factors and their receptors. Methods sA retrospective analysis was conducted to select 122 glioma patients admitted to our hospital from September 2018 to August 2020.All patients underwent surgical resection.According to the chemotherapy regimen, the patients were divided into the temozolomide group and the combination group.The neurological functions of the two groups were compared, ability to carry out activities of daily living, levels of growth factors and their receptors (VEGF, EGF and EGFR), quality of life, levels of T lymphocyte subpopulations, and adverse reactions.Follow-up was conducted until July 2023, and the overall survival and progression-free survival of the two groups of patients were compared. Results Six months post-surgery, patients in the combined therapy group manifested a significantly diminished CSS score (17.05±4.02 vs 26.95±5.30, t=11.742, P=0.000) in contrast to the temozolomide-only group, while their modified Barthel index (75.99±10.05 vs 62.15±9.12, t=7.957, P=0.000) markedly surpassed that of the temozolomide group.The KPS(84.28±8.41 vs 72.92±7.08, t=19.970, P=0.000) and QOL score (44.39±4.51 vs 35.81±3.50, t=11.498, P=0.000) of the combination group were significantly elevated compared to the temozolomide-only group.Further, patients under combined therapy exhibited significantly elevated levels of CD3+ (32.55±3.14 vs 28.67±3.71, t=6.135, P=0.000), CD4+ (56.49±5.03 vs 40.84±4.51, t=17.860, P=0.000), and CD4+/CD8+ ratio (2.41±0.25 vs 1.12±0.17, t=33.827, P=0.000) as opposed to those under temozolomide alone, whereas their CD8+ levels (23.48±2.87 vs 36.71±3.81, t=21.186, P=0.000) were significantly decreased in comparison.Additionally, combined group patients demonstrated significantly reduced levels of VEGF (158.33±19.05 vs 235.59±21.61, t=20.962, P=0.000), EGF (48.11±4.81 vs 80.78±6.54, t=30.702, P=0.000), EGFR (7.05±1.04 vs 11.32±3.09, t=9.727, P=0.000) and VEGFR (2.51±0.38 vs 3.10±0.23, t=10.591, P=0.000) compared to the temozolomide-only group.This denotes a profound augmentation in therapeutic efficacy with the implementation of combined therapy, highlighting the pivotal role of integrated treatment modalities in optimizing clinical outcomes.During treatment, patients in both groups experienced side effects such as nausea, vomiting, leukopenia, thrombocytopenia, anemia, and nephrotoxicity, and the incidence of grade I~ II side effects exceeded grade III~IV, there was no statistical difference between the two groups.significance ( P＞0.05).After 3 years of follow-up, 2 cases in the temozolomide group and 3 cases in the combination group were lost to follow-up.The 3-year overall survival rate in the combination group was 63.96%, which was higher than 48.53% in the temozolomide group, but there was no significant difference ( χ ²=1.847, P=0.174);the 3-year progression-free survival rate of the combination group was 55.56%, which was significantly higher than the 30.88% of the temozolomide group ( χ ²=7.771, P=0.005). Conclusion The administration of Carmustine in conjunction with Temozolomide post-surgery has demonstrated efficacy in augmenting neurological function, bolstering capabilities for conducting daily activities, and enhancing quality of life for glioma patients.This combined treatment approach also aids in the restoration of T lymphocyte subpopulation levels, extends survival duration, and mitigates the proliferation of growth factors.The effectiveness and safety of this therapeutic combination are correlated with its receptor concentration, warranting further clinical investigation and control to validate its benefits and optimize its application in clinical settings.

Objective To explore the application value of 3D printed nasal skull base tumor model in the clinical and teaching of neurosurgery. Methods Total of 13 patients with skull base tumor were selected,the virtual 3D model was reconstructed and the equal-scale tumor model was 3D printed according to the image data before surgery.40 students who participated in the standardized training of residents in the neurosurgery department were selected as teaching objects,and they were randomly divided into the traditional teaching group and the 3D printing model teaching group.The teaching effect of the two teaching modes was evaluated from the examination of theoretical knowledge and clinical skills,the satisfaction of teaching methods,the increase of understanding of neuroanatomical structure,the improvement of three-dimensional space imagination and the stimulation of active learning interest.Before surgery,the surgeon evaluated the spatial location of the tumor,preoperative talk,preoperative planning,intraoperative reference and postoperative anastomosis according to the 3D printed tumor model and traditional image data. Results The virtual 3D model was reconstructed and the equal-scale tumor model was 3D printed before operation in all the 13 patients with skull base tumor.The 3D model clearly showed the tumor and its adjacent skull,blood vessels and nerves.We found that students in the 3D printed model teaching group had better scores in the assessment of theoretical knowledge and clinical skills than those in the traditional teaching group,and the difference between the two groups was statistically significant ( P＜0.05).Moreover,the 3D printed model teaching group was higher than the traditional teaching group in terms of satisfaction with teaching methods,increasing understanding of neuroanatomical structure,improving three-dimensional space imagination and stimulating active learning interest.We also found that,in addition to preoperative planning,the 3D printed model group scored higher than the traditional image group on tumor spatial display,preoperative talk,intraoperative reference,and postoperative anastomosis.The difference between the two groups was statistically significant ( P＜0.05). Conclusion Compared with the traditional surgical planning and clinical teaching based on two-dimensional image data,3D printed tumor model has better surgical planning and clinical teaching value.

Objective To investigate the prognostic value of plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) combined with Glasgow Outcome Scale (GOS) score in assessing the prognostic value of interventional therapy for aneurysmal subarachnoid hemorrhage (aSAH). Methods From June 2018 to December 2020,86 patients with aSAH who received endovascular interventional aneurysm embolization were selected.GOS score was performed at discharge;modified Rankin Scale (mRS) score was performed at 6 months after discharge,with 0 2 being a good prognosis ( n=63);3 6 being a poor prognosis ( n=23).Plasma Lp-PLA2 levels were detected by enzyme-linked immunosorbent assay kit.Logistic multivariate analysis was used to analyze the influencing factors of poor prognosis in patients with aSAH;receiver operating characteristic curve (ROC) was used to analyze the value of Lp-PLA2 and GOS score to evaluate the prognosis. Results Logistic multivariate analysis showed that age (OR=1.834),preoperative Hunt-Hess grade (OR=4.123),aneurysm diameter (OR=5.002),number of aneurysms (OR=2.567),Lp-PLA2 expression level (OR=4.671) and GOS score at discharge (OR=2.678) were independent influencing factors of poor prognosis of aSAH patients ( P＜0.05).The AUCs of Lp-PLA2 and GOS scores for predicting poor prognosis were 0.793 and 0.725,respectively,and the combined AUC was 0.891.The combined prediction had a sensitivity of 87.23% and a specificity of 76.12%. Conclusion Plasma Lp-PLA2 combined with GOS score has important value in evaluating the prognosis of aSAH patients. Conclusion Plasma Lp-PLA2 combined with GOS score has important value in evaluating the prognosis of aSAH patients.

Objective To investigate the effect of serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) on aneurysmal subarachnoid hemorrhage (aSAH) ) value of patient prognosis assessment. Methods A total of 232 aSAH patients who visited our hospital's neurosurgery department from March 2020 to March 2022 were selected as the analysis group,and 114 healthy subjects were selected as the control group.The general clinical data of the research subjects were collected,and the Hunt-Hess grade,modified Fisher grade,and aneurysm rupture size were evaluated and recorded.The venous blood of the patients admitted to the hospital within 24 hours was collected to detect the level of sLOX-1,and the mRS score was used to analyze and compare the good prognosis group and the poor group.For various clinical indicators,Spearman correlation test was used to analyze the correlation between sLOX-1 and the severity of aSAH;multivariate logistic regression was used to analyze the risk factors for the prognosis of patients with aSAH;receiver operating characteristic curve (ROC curve) was used to analyze the relationship between sLOX-1 Evaluation value in the prognosis of aSAH patients. Results The level of serum sLOX-1 in the aSAH group was significantly higher than that in the healthy control group ( P＜0.05),and the level of sLOX-1 in the poor prognosis group was significantly higher than that in the good prognosis group ( P＜0.05).Serum sLOX-1 level was positively correlated with Hunt-Hess classification and modified Fisher classification ( P＜0.001)Logistic regression analysis showed that Hunt-Hess grade (grade 3-5),aneurysm size (≥5 mm),serum sLOX-1 concentration and modified Fisher grade (grade 3-4) were associated with poor postoperative prognosis in patients with aSAH Influencing factors ( P＜0.05),The AUC of serum sLOX-1 for evaluating the prognosis of aSAH patients was 0.739,the cutoff value was 1.68 ng/ml,the sensitivity was 67.82%,the specificity was 76.37%,(Youden index=0.659;95% CI 0.741-0.902). Conclusion The level of serum sLOX-1 is related to the severity of aSAH patients,and is an independent influencing factor for patients with poor prognosis.

Objective To investigate the role ofprotectin D1 on cerebral ischemia reperfusion injury (CIRI) in mice. Methods Ninety C57BL/6 male mice were randomly divided into control group,model group and protectin D1 group.The CIRI model in mice was established by thread embolism method.The mice in the protectin D1 group were injected with 5 mg/kg protectin D1 through the tail vein 30 minutes before ischemia,and the mice in the control group and the model group were given the same amount of normal saline.After 24 hours of reperfusion,the infarct volume,brain water content and blood-brain barrier permeability of mice were measured.The neural function of mice was evaluated by Bederson scoring.The content of interleukin-1β (IL-1β),cyclooxygenase-2 (COX-2),tumor necrosis factor- α (TNF-α),superoxide dismutase (SOD),glutathione (CAT) and malondialdehyde (MDA) in the brain tissue of mice were detected.TUNEL staining was used to evaluate the apoptosis of brain tissue of mice. Results Compared with the control group,the volume of cerebral infarction,brain water content,blood brain barrier permeability,Bederson scoreand adhesion removal time in the model group were significantly increased,and the rotational drop time was significantly decreased ( P＜0.05);Compared with the model group,the volume of cerebral infarction,brain water content,blood brain barrier permeability,Bederson score and adhesion removal time in the protectin D1 group were significantly decreased,and the rotational drop time was significantly decreased ( P＜0.05).Compared with the control group,the level of IL-1β,COX-2 and TNF-α in the model group were increased significantly ( P＜0.05);Compared with model group,the level of IL-1β,COX-2 and TNF-α were significantly decreased ( P＜0.05).Compared with the control group,the contents of SOD and CAT in the model group were decreased significantly,while the content of MDA were increased ( P＜0.05);Compared with the model group,the contents of SOD and CAT in the protectin D1 group were significantly increased,while the contents of MDA was significantly decreased ( P＜0.05).Compared with the control group,the apoptosis index in the model group was increased significantly( P＜0.05);Compared with the model group,the apoptosis index in the protectin D1 group was significantly lower ( P＜0.05). Conclusion Protectin D1 alleviates cerebral ischemia reperfusion injury in mice,and its mechanism is related to reducing inflammatory reaction,oxidative stress and apoptosis.

Objective To explore the neuroprotective effect and potential mechanism of Hirsutine in rat cerebral ischemia-reperfusion injury (CIRI). Methods SD rats were used to establish a middle cerebral artery occlusion reperfusion (MCAO/R) model and were divided into 6 groups ( n=6):Control group; Model group; Hirsutine low-dose (5 mg/kg) group; Hirsutine medium dose (10 mg/kg) group; Hirsutine high-dose (20 mg/kg) group; Edaravone (30 mg/kg,positive control) group.TTC staining was performed on brain tissue,the cerebral infarction and neurobehavioral defects were measured.HE and Nissl staining were used to detect neuronal damage.Tunel staining was used to detect hippocampal cell apoptosis; ELISA method was used to detect the levels of reactive oxygen species (ROS),malondialdehyde (MDA),superoxide dismutase (SOD),and glutathione peroxidase (GSH Px) in brain tissues.Western blotting is used to detect the expression level of proteins related to the mechanism. Results The results showed that Hirsutine treatment significantly reduced cerebral infarction and neuronal damage in MCAO/R rats,and improved brain neurobehavioral deficits.Hirsutine effectively inhibited oxidative stress and cell apoptosis.In addition,Hirsutine activated the PI3K/Akt/Nrf2 pathway in MCAO/R rat neurons. Conclusion Hirsutine improveed oxidative stress and apoptosis in MCAO/R rat brain by activating PI3K/Akt/ Nrf2 signaling pathway,thereby alleviating CIRI-induced neuronal injury.

Objective To analyze the characteristics of blood lipid metabolism in patients with Moyamoya disease(MMD) and the relationship between blood lipid levels and clinical features. Methods The clinical characteristics and blood lipid test results of 214MMD patients in Anhui Provincial Hospital Affiliated to Anhui Medical University from January 2015 to October 2023 were collected,and 214 healthy subjects were selected as the control group.SPSS 26.0 was used to compare the lipid levels and the characteristics of abnormal lipid metabolism in each group,and the correlation between lipid levels and clinical characteristics was analyzed. Results The prevalence of abnormal lipid metabolism in MMD was 50.9%,mainly hypertriglyceridemia and low HDL-C.Compared with the control group,the level of TG in MMD patients was significantly higher ( P＜0.05).With the increase of BMI,the level of TG was higher and the level of HDL-C was lower ( P＜0.05).The levels of TC,TG and LDL-C in ischemic patients were higher than those in hemorrhagic patients. Conclusion Patients with MMD have a high rate of dyslipidemia,mainly hypertriglyceridemia and low HDL-C,especially in patients with cerebral infarction as the first symptom.In clinical work,patients with MMD should be intervened as early as possible.

Objective To explore the efficacy of intraoperative virtual reality (VR) assisted neuroendoscopic hematoma removal and stereotactic drainage in patients with hypertensive intracerebral hemorrhage (HICH) in the basal ganglia region. Methods 106 HICH patients admitted to the hospital from September 2022 to May 2023 were selected as the study subjects.They were divided into group A and group B by random number table method.Group A was treated with intraoperative VR-assisted neural endoscopic hematoma evacuation (NEIHE),and group B was treated with stereotactic intracranial hematoma drainage surgery.The perioperative indicators,puncture conditions,hematoma clearance,and levels of inflammatory indicators before and 3 months after surgery were compared between the two groups,and the prognosis of the two groups 3 months after surgery was observed. Results The surgical time in Group A was longer than that in Group B,and the postoperative hematoma drainage time and hospitalization time were shorter than those in Group B ( P＜0.05).The success rate of the first puncture in Group A was higher than that in Group B,and the hematoma clearance rate on the 1st and 5th day after surgery was higher than that in Group B ( P＜0.05).The levels of serum C-reactive protein (CRP),interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the two groups were lower than those before operation,and those in group A were lower than those in group B at 3 months after operation ( P＜0.05).The National Institutes of Health Stroke Scale (NIHSS) scores of both groups decreased 3 months after surgery,and Group A was lower than Group B.The Barthel (BI) index increased in both groups,and Group A was higher than Group B ( P＜0.05). Conclusion Compared to stereotactic intracranial hematoma drainage,intraoperative VR assisted NEIHE can improve the success rate of intraoperative puncture and hematoma removal rate,shorten the postoperative hematoma drainage time and hospitalization time of patients,reduce the body's inflammatory response,and promote the recovery of neurological function and daily life ability of patients.

Objective Analyze the clinical efficacy of endoscopic assisted subtemporal approach in the treatment of severe brainstem hemorrhage. Methods Retrospective analysis of 78 patients with severe brainstem hemorrhage admitted to our hospital from January 2021 to January 2023,according to the choice of the patients' family members,they were divided into operation group and conservative management.There were 36 cases in the surgical group and 42 cases in the conservative group.The surgical group used endoscope to clear the hematoma through the subtemporal approach,while the conservative group used symptomatic treatment according to the treatment guidelines for cerebral hemorrhage.Compare the complications,clinical prognosis,and changes in serum NSE and S100B levels between the two groups. Results Compared with the conservative group,the number of patients with severe pneumonia,lower limb venous thrombosis,electrolyte disorder and Irritability ulcer in the operation group was less than that in the conservative group.The difference between the two groups was statistically significant ( P＜0.05).By comparing the Glasgow prognostic score (GOS) of the two groups,it was found that the number of patients with normal life and mild disability in the operation group was more than that in the Conservative management group,and the number of patients with severe disability was less than that in the Conservative management group.The difference between the two groups was statistically significant ( P＜0.05).After 1 and 2 weeks of treatment,it was found that the levels of NSE and S100B in the serum of the surgical group were significantly lower than those of the conservative group,with a statistically significant difference ( P＜0.05). Conclusion The treatment of severe brainstem hemorrhage through the infratemporal approach assisted by neuroendoscopy can reduce complications and mortality in patients,and improve their prognosis.

Objective To explore the influence of cerebrospinal fluid extraction on drainage effect and short-term prognosis in patients with hypertensive intracerebral hemorrhage (HICH) on the basal ganglia undergoing puncture and drainage combined with urokinase. Methods Clinical data of 75 HICH patients receiving puncture and drainage combined with urokinas were analyzed retrospectively.Based on the presence or absence of CSF drainage during treatment,the differences of drainage effect,complications and short-term prognosis were compared between the group with cerebrospinal fluid extraction (A group) and the group without cerebrospinal fluid extraction (B group). Results Compared with group A,the residue hematoma volume was lower ( P<0.001) in group B.And the lengths of hospitalisation and drain tube stay were shorter in group B( P=0.002, P=0.003).While no significant differences in the postoperative complications and short-term prognosis were found between the two groups ( P＞0.05).The rate of intracranial infection was significantly elevated in group A( P=0.027).Patients in Group A used less mannitol during hospitalization ( P=0.038). Conclusion It had a better drainage effect without cerebrospinal fluid extraction for HICH in the basal ganglia patients receiving puncture and drainage combined with urokinas.Meanwhile,the risk of intracranial infection and the average length of hospital stay reduced.Patients with intraventricular hemorrhage puncture and drainage combined with urokinas was an effective treatment for HICH on the basal ganglia.

Objective To summarize and analyze the clinical phenotype and genetic characteristics of a family with TSC1 gene mutation in tuberous sclerosis,so as to provide evidence for genetic counseling. Methods The clinical phenotypes of 6 probands and their grandmothers,aunts,aunts,mothers and sisters in the three generations of close relatives of the family were consistent with tuberous sclerosis.The probands and their parents and sisters were amplified by PCR for all coding regions and flanking shear sites of TSC1 and TSC2 genes,and the products were sequenced for mutation analysis.At the same time,35 unrelated normal controls were detected,The correlation between the gene variation and clinical phenotype was further analyzed. Results NM was found in exon 10 of TSC1 gene in proband,mother and sister_ 000368.5:c.917_ The 923upGTGCTAC mutation resulted in abnormal protein level(the amino acid at the position of p.Ser309Cysfs * 34309 changed from serine to cysteine,and from the position of 309,continued translation 34 met the termination codon,resulting in early termination of protein translation).The father did not find the mutation,and the father's clinical phenotype was normal,and the mutation was not detected in 35 normal controls.After searching HGMD database,this mutation is a new mutation,and there has been no report of this mutation in the past,which is consistent with the genetic co-segregation of disease phenotypes in the family. Conclusion TSC1 gene c.917_ The 923 base repeat frameshift mutation may be the cause of tuberous sclerosis in this family.The clinical phenotype of TSC1 gene mutation at the same site in the same family has strong heterogeneity.

Objective To investigate the relationship between serum Vitamin D(VitD) levels and Sympathetic Skin Response(SSR) in patients with Parkinson's disease(PD).To explore whether serum VitD level is involved in the occurrence and development of autonomic nervous dysfunction in PD. Methods 44 patients with PD and 51 healthy subjects matched by age and sex were selected for SSR examination,VitD test and The Scales for Outcomes in Parkinson's Disease for Autonomic function Symptoms,SCOPA-AUT) score.A case-control study was used to compare the differences among the groups. Results Compared with the control group,the SSR amplitude of limbs in PD group was decreased,the latency of left upper limb and right lower limb was prolonged,and the levels of serum 25(OH)D ₂,25(OH)D ₃ and total 25(OH)D were decreased( P＜0.05).2.The serum total 25(OH)D level in 86.7% of PD patients with SSR abnormality was in the deficient group,which was significantly higher than that in the deficient and normal groups( P＜0.01).3.The SCOPA-AUT score of PD patients was positively correlated with the limb latency of SSR( r=0.245, P＜0.01; r=0.398, P＜0.01; r=0.353, P＜0.01; r=0.168, P＜0.01);It was negatively correlated with limb amplitude( r=-0.434, P＜0.01; r=-0.341, P＜0.01; r=-0.367, P＜0.01;-0.289, P＜0.01).4.H&Y grading,UPDRS-Ⅲ and SCOPA-AUT scores of PD patients increased with the decrease of total 25(OH)D levels.Except for the right upper limb amplitude,there were no significant differences in the amplitude of the other limbs of SSR and the latency of the limbs among the three groups( P>0.05).5.Serum total 25(OH)D was significantly negatively correlated with the H&Y grade,UPDRS-Ⅲ and SCOPA-AUT scores of PD patients( r=-0.754, P＜0.01; r=-0.730, P＜0.01; r=-0.726, P＜0.01);There was no significant correlation with latency of left lower limb and amplitude of both lower limbs(P > 0.05),but negative correlation with latency of both upper limb and right lower limb( r=-0.319, P=0.035; r=-0.363, P=0.015; r=-0.355, P=0.018),was positively correlated with the amplitude of the double upper limbs( r=0.381, P=0.011; r=0.342, P=0.023). Conclusion The serum vitamin D level of Parkinson's disease patients decreased significantly,and the incidence of Sympathetic Skin Response abnormalities increased.Serum 25(OH)D deficiency may be involved in the development of autonomic symptoms in Parkinson's disease.