2015年 · 第95卷第45期

The patient was a 28-year-old male. He was admitted to the Department of Neurology, Xiangya Hospital, Central South University on December 25, 2013 due to "numbness and weakness of both lower limbs for 6 days and difficulty in urinating and defecating for 3 days". Previous: From November 18 to 30, 2013, he was hospitalized due to "severe pneumonia and type 1 respiratory failure". After receiving anti-infective treatment such as "moxifloxacin, cefoperazone, sulbactam and vancomycin", his condition improved and he was discharged. At the time of discharge, he still had a little cough and yellow phlegm. Physical examination: muscle strength of both lower limbs 5^–Grade, normal muscle tone of limbs; The middle and lower abdominal wall reflexes were attenuated, knee reflex and Achilles tendon reflex (+ + +), bilateral ankle clonus was positive, and left Papanicolaou sign was suspected positive; Deep and superficial hypoesthesia below T9; It was difficult to establish signs with closed eyes (+), and no abnormalities were found in the remaining NS examination. Auxiliary examinations: muscle enzyme, electrolyte, erythrocyte sedimentation rate (ESR), procalcitonin, five thyroid function tests, coagulation routine, C-reactive protein (CRP), rheumatic factor, rheumatoid factor, antinuclear antibody (ANA), antinuclear antibody profile (ANA profile), anti-centromeric antibody (ACA), anti-double-stranded DNA antibody (anti-dsDNA), anti-soluble antigen antibody (ENA), anti-neutrophil cytoplasmic antibody (ANCA), anti-nucleosome, virus complete set, syphilis antibody, anti-HIV antibody, tuberculosis antibody, tuberculin test, T cell spot detection, parasite, vitamin, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), hematuria light chain, G test, GM test and sputum culture were no abnormalities; Blood routine lymphocytes 0.9 (10⁹/L), monocytes 10.1%; Total serum protein 53.9 g/L, albumin 38.1 g/L, globulin 15.8 g/L; Blood complement C3 788 mg/L, LgM 570 mg/L; CRP 5.2 mg/L. Lumbar puncture pressure 115 mmH₂O (1 mmH₂O =0.009 8 kPa), CSF routine, biochemistry, three major stains, cytology, CRP, rheumatic factor, rheumatoid factor, ESR, immune five items, syphilis antibody, tuberculosis antibody, anti-HIV antibody, C12 were not abnormal; No abnormal cells were observed. Abdominal color Doppler ultrasound showed no obvious abnormalities. Lung CT: 27 Dec 2013 (Figure 1): Diffuse spotty, ground glass-like density increased shadow in both lungs. Cranial MRI (Figure 2): Patchy T was seen on the edge of some lesions in bilateral frontoparietal occipital lobes₁Like low signal, T₂Like hyperintensity foci, the FLAIR sequence showed hyperintensity, and diffuse multiple spotty enhancement foci were seen in the parenchyma after enhancement. Thoracic cord MRI (Figure 3): C7 – T12 spinal cord was significantly swollen throughout the course, with multiple spotty T₁Like low signal, T₂Like high-signal foci, they are not uniformly enhanced after enhancement. Lumbosacral MRI: Stripe-shaped T can be seen in the spinal conus₁Slightly higher signal, T₂Slightly low signal focus, mild enhancement after enhancement.

The patient, a 5-year-old male, was admitted to the hospital on 7-Mar-2015 due to headache for 8 d. The patient developed dull pain in the neck and posterior occipital area without obvious trigger 8 days ago, which attacked 3 to 4 times a day, lasted 2 to 3 minutes and then relieved spontaneously, accompanied by fatigue. Electroencephalogram and transcranial Doppler examination at the outpatient clinic before admission showed normal results. Coagulation function showed: prothrombin time<8.0 s (normal 12-14 s); Prothrombin time activity>200%; International standardized ratio (PT)<0.76； Fibrinogen 1.90 g/L. Magnetic resonance examination: plain MRI of the head showed space-occupying lesions of the fourth ventricle, 32 mm ×36 mm ×40 mm, showing a slightly longer T₁Slightly longer T₂Signal, dilatation of the supratentorial ventricular system; DWI (b =1 000 s/mm²) Diffusion was limited and showed high signal, and the medulla oblongata and bilateral cerebellar hemispheres were compressed and deformed. After injection of Gd-DTPA, the enhanced scan showed that the lesions were uneven and obviously enhanced, and patchy unenhanced low signal could be seen at the edges, which resembled "fist clenching sign" (Figure 1)； MRS scan showed that Lip peak appeared in the lesion area, NAA peak and NAA/Cr ratio decreased compared with contralateral normal brain tissue, and Cho/Cr ratio increased compared with normal brain tissue (Figure 2)。 Proposed diagnosis of ependymoma or medulloblastoma. Abdominal color Doppler ultrasound showed no obvious abnormalities in liver, pancreas, spleen, peritoneum, kidney, ureter and bladder. Preoperative coagulation function test showed prothrombin time 9.30 s; fibrinogen 1.66 g/L; Thrombin time 16.20 s. After correcting the coagulation time, the tumor of the fourth ventricle was resected. Intraoperative findings: the tumor was located and filled the fourth ventricle, gray-red, with abundant blood supply and irregular shape. The tumor had no complete envelope, no obvious boundary with the surrounding normal tissues, and there was a layer of arachnoid separation between the tumor and the floor of the fourth ventricle. Pathology: The gross specimens of tumor tissue were gray-red. Immunohistochemistry: CD (+) , Syn (–), NSE (–), S – 100 (–), CD (–), CD20 (+), Bcl – 2 (–), CD (+), Bcl – 6 (+), Ki – 67 (+ nearly 100%). Pathological diagnosis: (fourth ventricle) Burkitt lymphoma (panel G).

Germ cell tumors are named after histopathology. According to the World Health Organization (WHO) classification criteria, they can be divided into germ cell tumors (GGCT) and non-germ cell neoplastic germ cell tumors (NGGCT). NGGCT can be further divided into choriocarcinoma, teratoma, endodermal sinus tumor and embryonic carcinoma^[1]。 Intracranial germ cell tumors (icGCT), as one of the primary childhood brain tumors, tend to occur in pineal and sellar regions. Germ cell tumors in the sellar area are rarer in clinic, and it is difficult to distinguish them from other lesions in the sellar area because of their diverse imaging manifestations. Some types of tumors lack tumor markers, so they have become difficult in clinical diagnosis and treatment. Its clinical rarity also brings certain difficulties to the standardization of its diagnosis and treatment plan.

Long-term bed braking can lead to serious complications in critically ill patients with mechanical ventilation, such as acquired weakness in intensive care unit (ICU), dysfunction of cardiac and circulatory system, metabolic and mental abnormalities, etc^[1,2,3]。 The above complication will not only prolong the time of mechanical ventilation and ICU stay^[4]It can even seriously impair the rehabilitation of the patient's body function^[5,6]。 In order to prevent the complication of long-term bed braking in patients with mechanical ventilation, early activity is the key measure of prevention. Clinical studies have confirmed that active early activity is a safe and effective strategy for disease prevention and rehabilitation in critically ill patients undergoing mechanical ventilation^{[7,8,9,10,11]}。

executive function is the ability to flexibly integrate and cooperate different cognitive processes to achieve a specific goal. Impairment of executive function is common in patients with vascular cognitive impairment^[1]。 This review reviews the relevant literature on executive function and its localization of brain regions, aiming to provide theoretical basis for the diagnosis and treatment of vascular cognitive impairment and further research. Common classifications of executive functions are as follows: (1) Gioia, etc.^[2]Executive functions are considered to include components such as initiation, switching, planning, organization, self-monitoring, emotional control, and working memory, in addition to components of inhibition control. (2) Pennington and Ozonoff^[3]Executive function is considered to have three dimensions: working memory, inhibitory control and attention flexibility. (3) Collette and Van der Linden^[4]From the perspective of imaging, the executive function is divided into four dimensions: inhibition, transition, refresh and dual-task coordination. Considering the above classification methods, this paper reviews the executive function and its functional brain region localization from three aspects: working memory, selective attention/inhibition control and cognitive flexibility (Figure 1)。