2017年 · 第97卷第43期

With the in-depth development of neuroultrasound work, more and more neurological and surgeons have begun to independently perform cervical vascular ultrasound, transcranial parenchymal ultrasound and peripheral nerve ultrasound. This part can be used for corresponding standardized training for doctors at all levels.

The patient was a 42-year-old female, pregnant with 3 deliveries and 1 pregnancy with^＋6Zhou, with a previous history of uterine fibroids. On the evening of May 13, 2017, there was no obvious trigger for left abdominal pain and he went to the emergency department of our hospital. The emergency ultrasound reported subserous fibroids, and the pedicle was twisted to be discharged and he was admitted to the hospital. He was treated with ceftriaxone anti-inflammatory and fluid rehydration, and the abdominal pain symptoms were relieved. On May 20th, the left lower abdominal pain worsened again, and the symptoms could not be relieved after anti-inflammatory and fluid rehydration treatment, so an emergency laparotomy was performed on the 25th. Laboratory test: high sensitivity C-reactive protein 17.36 mg/L, white blood cells 12.26×10⁹/L, neutrophil ratio 0.806. No obvious abnormalities were found in Yu laboratory tests. Ultrasound examination: A hypoechoic area with a size of about 56 mm ×43 mm ×32 mm was seen in the upper left side of the uterus, which protruded to the outside of the serosa and was oval with clear edges. Capsular echo was seen, and the posterior echo was unchanged. The echo in the mass was inconsistent, and a few liquid dark areas were seen inside. color Doppler flow imaging (CDFI): a little blood flow signal around the mass, but no obvious blood flow signal in the mass; In addition, multiple hypoechoic areas of different sizes were seen in the myometrium of the anterior uterine wall, which were oval in shape. The echoes in the mass were inconsistent, with clear boundaries, capsular echoes were visible, and the posterior echoes were unchanged (Figure 1，Figure 2)。 Abdominal magnetic resonance imaging (MRI) was performed on the 10th day of onset: the morphology of the left ovary was visible, and heterogeneity was seen in the front of the left ovary and the left side of the uterus₁Long T₂Signal mass (Figure 3，Figure 4), about 50 mm ×57 mm ×35 mm in size, with a cord-like short T inside₂Signal, line-like short T was visible at the edge of the mass₁Short T₂Signal and strip-like short T₂Signal (Figure 5，Figure 6)； Diffusion weighted imaging (diffusion weighted imaging, DWI) (b =1 000 s/mm²) The mass showed high intensity, and the apparent diffusion coefficient (ADC) showed high intensity, with an ADC value of 2 535×10^－3mm²/s (Figure 7，Figure 8), DWI (b =0 s/mm) in the lamellar low signal area at the edge of the mass²) is low signal, ADC is low signal, ADC value is 803×10^－3mm²/s (Figure 9，Figure 10)； The mass is connected to the interuterine pedicle. In addition, multiple round long Ts were seen in the myometrium₁Short T₂Signal shadow, the boundary is clearer.

The 11-month-old child was found to have yellow linear spots on the ankle and back of both feet and was seen for 3 months. Three months ago, the parents of the child found several pale yellow stripes on the ankle and back of both feet, but they didn't pay attention to them. The rash gradually thickened and became longer, so they went to the dermatology clinic of Weifang People's Hospital on May 1, 2013. There was no similar medical history in the child's family. Physical examination: The child's vital signs are stable, the general condition is OK, there is no cyanosis, and there is no yellowing stain in the sclera. Cardiopulmonary and abdominal examination showed no abnormalities. Dermatological examination: There is no yellowing stain on the skin and mucosa of the whole body. Several linear pale yellow macules about 3~6 cm long were seen at the folds of the ankle and dorsum of both feet (Figure 1,Figure 2,Figure 3)。 Laboratory test: total cholesterol (TC) 18.5 mmol/L (normal range 2.9-6.3 mmol/L); High density lipoprotein cholesterol (HDL-C) 3.60 mmol/L (normal range 1.16-1.70 mmol/L); Low density lipoprotein cholesterol (LDL-C) 13.88 mmol/L (normal range 2.50-4.30 mmol/L); Triacylglycerol (TG) 0.87 mmol/L (normal range 0.48-1.82 mmol/L); Apolipoprotein-B (apo-B) 2.39 mmol/L (normal range 0.60-1.12 mmol/L); Apolipoprotein A1 (Apo-A1) 1.38 mmol/L (normal range 1.10-1.76 mmol/L); Lipoprotein A was 2.4 mmol/L (normal range 0.0~30.0 mmol/L), and the parents of the child refused to do liver ultrasound, cardiac ultrasound and skin pathology examination. According to the typical clinical manifestations and laboratory examinations of the children, the diagnosis was: palmar striata xanthoma and hyperlipoproteinemia type Ⅱa. The condition improved after giving low-fat diet treatment.

In recent years, CT examination has been used more and more in clinic, and people have paid more and more attention to radiation injury. X-ray can induce many types of DNA damage, including double strand breaks (DSBs), single strand breaks, base damage, deficient purine or pyrimidine sites, glycosyl damage and DNA protein crosslinking, among which DSBs have the strongest killing effect on cells^[1]。 At present, physical methods are used to estimate CT radiation dose, such as volume CT dose index (CTDIvol), dose-length product (DLP), etc. These estimates can calculate radiation dose well, but cannot evaluate the biological damage caused by ionizing radiation to human body. In recent years, a large number of studies have shown that DSBs is a potential biological indicator for evaluating CT radiation damage, which can be labeled with the biological protein γ-H2AX^[2,3,4]。 This paper summarizes the relevant research achievements at home and abroad.

Ischemic stroke accounts for 80% of strokes, and it is very common in clinic. Its recurrence rate, disability rate and mortality rate are high. Numerous studies have confirmed that the inflammatory response plays an important role in the pathological progression of ischemic stroke^[1]。 microglia (MG) is the main immune cell of the central nervous system (CNS) and plays a key role in the inflammatory response in the brain. In recent years, a large number of studies have shown that MG activation after cerebral ischemia has a unique spatial and temporal law, and its different activation phenotypes make it have a dual role of damage protection after cerebral ischemia. This paper reviews the characteristics of MG activation after cerebral ischemia, the main roles of different activation phenotypes, the factors affecting phenotypic changes and their related regulation studies, and provides new ideas for targeted regulation of MG activation and further treatment of ischemic stroke.