2018年·第98卷第37期

The incidence of cardiovascular, cerebral and peripheral vascular diseases in China is increasing year by year, and even in recent years, it has shown a younger trend. Many people without obvious clinical symptoms or young people who have not been diagnosed with cardiovascular and cerebrovascular diseases also have adverse cardiovascular events and even sudden death. Faced with the severe situation of cardiovascular and cerebrovascular diseases, all walks of life in China have gradually shifted from focusing on disease treatment to focusing on disease prevention, disease rehabilitation and whole life cycle management. At present, it is known that the main pathophysiological mechanism of heart, brain, kidney and other tissues and organs lesions is arteriosclerosis, atherosclerosis, stenosis and occlusion of their supply vessels, resulting in damage to vascular structure and function, which in turn leads to the occurrence of adverse vascular events, such as coronary heart disease, stroke, peripheral arterial occlusive disease and even sudden death^[1,2]。 At present, there are many clinical studies related to blood vessels abroad, while most of the domestic research on blood vessels is basic, and there is a lack of large sample and high-quality clinical research data in the field of blood vessels. China has formulated the first guidelines in the field of vascular detection since 2006 (the second edition will be updated in 2011)^[3,4]However, at present, the early comprehensive evaluation system of vascular lesions needs to be improved to improve its clinical practicality, operability and generalizability. Although interventional therapy has become a direct and rapid method to relieve arterial lumen blockage caused by atherosclerotic stenosis, in the face of the increasing number of patients with vascular diseases worldwide, preclinical detection and intensive intervention and reversal of vascular diseases are the only way to ultimately reduce the incidence of clinical cardiovascular events.

According to the "China Cardiovascular Disease Report 2017", the number of cardiovascular diseases in China is 290 million, including 13 million stroke, 11 million coronary heart disease, 4.5 million heart failure and 270 million hypertension^[1],The burden of cardiovascular diseases in China is increasing day by day, which has become a major public health problem. It is urgent to prevent and treat cardiovascular diseases.

The patient was a 55-year-old male. He was admitted to the Second Affiliated Hospital of Fujian Medical University on June 28, 2012 due to fever, dry cough for 7 days and right limb weakness for 1 day. Fever appeared 7 days before admission, body temperature 39 ℃, with dry cough and dizziness, which still fluctuated between 37 and 38.6 ℃ after intravenous antibiotics (unknown) in the local clinic. Cranial CT was performed in our hospital 4 days ago (Figure 1) showed that the sulcus was slightly widened and untreated. When I woke up 1 day ago, I felt numbness and weakness in my right limb, and my speech was vague. It gradually worsened to the point that he could not walk and had difficulty expressing himself. CT of the head in the outside hospital showed "left frontotemporal parietal lobe infarction" (no film was taken). No treatment was made and he was referred to our hospital. He previously denied "sinusitis, mastoiditis, otitis media and odontitis", denied the history of traumatic surgery, did not measure blood pressure, and was addicted to tobacco and alcohol for 25 years. Physical examination at admission: body temperature 38 ℃, pulse 104 beats/min, breathing 20 beats/min, blood pressure 153/92 mmHg (1 mmHg =0.133 kPa), coarse breathing sounds in both lungs, no rales, and no abnormalities in the heart and abdomen. Specialty situation: clear consciousness. Motor aphasia. The right nasolabial fold is shallow, and the tongue is extended to the right. Muscle strength: Right upper limb grade 0, right lower limb grade 3, right limb muscle tone is low. Hypoalgesia in right hemisphere. Soft neck, negative Klinefelter sign. Residual nervous system examination showed no abnormalities. Emergency blood routine: white blood cells 13.8×10⁹/L (↑), neutrophils 84.7% (↑), red blood cells 4.85×10¹²/L, platelets 477×10⁹/L (↑); The complete set of emergency biochemistry and coagulation was normal; Head CT scan + angiography (CTA) showed left frontotemporal parietal lobe infarction, no abnormalities in paranasal sinuses and mastoid area, and multiple branches of left middle cerebral artery occlusion (FIG. 2A,Figure 2B,Figure 2C)； Proposed diagnosis of "(1) cerebral infarction; (2) hypertension? (3) upper respiratory tract infection?" to improve circulation, anti-platelet, lipid-lowering, anti-inflammatory (ceftriaxone + azithromycin), dehydration and other treatments.

A 55-year-old male came to the hospital for more than 10 days with no obvious inducement of skin and sclera yellowing with skin pruritus. Admission examination: Laboratory tests indicated that serum enzymatic bilirubin was increased, and carcinoembryonic antigen (CEA) and carbohydrate antigen 724 (CA72-4) cytokeratin 19 fragment Cyfra21-1 were increased. Ultrasound examination showed that the bile duct in the right lobe of the liver was not dilated; The small bile ducts of the left lobe were all dilated, with poor internal sound transmission, and the left hepatic duct was dilated, with a wider internal diameter of 1.0 cm, and a strip-shaped weak echo with a visible range of 4.2 cm ×0.8 cm, with clear boundaries and no obvious blood flow signal. The common bile duct was dilated, with a wider internal diameter of 1.4 cm, and a weak echo of 2.5 cm ×1.2 cm was seen in the hilar segment, without obvious blood flow signal (Figure 1,Figure 2)。 Suggested obstructive left lobe intrahepatic bile duct, common bile duct dilatation: left hepatic duct and common bile duct hilar weak echo suggested further examination: occupying space? Cholestasis? Magnetic resonance (MR) and magnetic resonance cholangiopancreatography (MRCP) showed dilation of intrahepatic bile duct, left hepatic duct and common hepatic duct in the left lobe of the liver, and congenital bile duct cyst to be excluded (Figure 3，Figure 4)。 After symptomatic treatment, clinical symptoms were relieved, and laboratory indicators dropped back.

The patient was a 76-year-old female. He was admitted to the hospital on October 7, 2017 with neck pain and stiffness accompanied by fever for 3 days without obvious inducement. The neck pain was intermittent, the visual analogue scale (VAS) of neck pain was 7 points, the body temperature was 37.7~38.8 ℃, there was no pain and numbness in the limbs, no walking instability, and the defecation was normal. No previous history of gout or rheumatoid arthritis. Admission physical examination: cervical spine rotation was obviously limited, neck muscles were stiff, and no obvious signs of nerve or spinal cord injury were found. Laboratory test: white blood cells 11.2×10⁹/L (4 to 10×10⁹/L), erythrocyte sedimentation rate 35.4 mm/1 h (0-20 mm/1 h), high-sensitivity C-reactive protein 14.7 mg/L (0-6 mg/L), rheumatoid factor and procalcitonin were normal. Cervical CT scan showed arcuate calcification of the transverse ligament of the atlas posterior to the odontoid process (FIG. 1A) and vertical linear calcification (FIG. 1B)。 According to the patient's medical history, physical signs and auxiliary examinations, odontoid plus coronary syndrome (CDS) can be basically diagnosed. After admission, lornoxicam 8 mg intravenously was administered twice daily, and the starting amount of dexamethasone 10 mg intravenously was administered once daily, which was changed to 5 mg/d after 3 days. After continuous treatment for 5 days, the patient's symptoms were significantly relieved at admission, and the leukocytes, erythrocyte sedimentation rate and high-sensitivity C-reactive protein all returned to normal after re-examination. After six months of follow-up, no neck pain with fever appeared.

Cementless total hip arthroplasty (THA) has emerged as the best option for end-stage hip disease in young active patients^[1,2]。 Despite the great success of cementless THA, with technological advances in prosthesis design, fixation interface and friction interface, there are still problems such as dislocation, unequal length of both lower limbs, aseptic loosening, intraoperative fractures, proximal femoral stress occlusion and persistent thigh pain, prosthesis impingement and other complications^{[3,4,5,6,7,8]}。 Precise prosthesis matching and positioning is essential to enhance prosthesis-bone matching^[9]。 Manual operation may cause intraoperative femoral fracture, the size of femoral stem is too small, and the femoral prosthesis is not well inclined forward, which may lead to poor prosthesis matching. Therefore, in order to improve the 20-year survival rate after THA to>95%, the accuracy in hip reconstruction needs to be maximized. This led to the development of computer-assisted orthopedic surgery (CAOS). Introduction of robotics in hip replacement with the aim of improving preoperative planning, optimizing implant selection and size, and increasing the accuracy of prosthesis positioning. Because of its high accuracy and high stability, this system has been used more and more in the field of joint surgery.

Epilepsy is a chronic neurological disease caused by abnormal and synchronized discharge of neurons in the brain. Due to the influence of irregular and repeated seizures, patients' psychological, cognitive function, mental and emotional problems are caused. The epidemiology of epilepsy patients showed that the incidence of comorbid depression ranged from 8% to 48%, with a mean of 29% and a median of 32%, which was much higher than that of the general population and other patients with chronic diseases^[1]。 Comorbid depression may aggravate the frequency of epileptic seizures, reduce the quality of life of patients, and affect the prognosis. Patients with epilepsy with a history of depression had a 2.2-fold higher risk of developing drug-resistant or refractory epilepsy than those without a history of depression, and the former had a higher probability of failure of surgical treatment^[2]。 Therefore, understanding the pathogenesis of comorbid depression in epilepsy, early recognition and appropriate treatment of comorbid depression have important clinical significance for improving the prognosis of epilepsy patients.