Volume 92  ·   Issue 05  ·  2012

In the past, cervical spondylosis was the core of the diagnosis of cervical degenerative diseases, which was widely used in clinic. However, with the improvement of diagnostic technology, many diseases have defined their unique pathogenesis, so they have proprietary names, such as cervical disc herniation, cervical posterior longitudinal ligament ossification, degenerative cervical spinal stenosis, etc. [1]. The concept of cervical spondylosis has gradually become too broad and vague.At present, cervical spondylosis and degenerative cervical spinal stenosis are often mixed in clinical diagnosis names [2]; There is no distinction between cervical spinal stenosis manifested by imaging and cervical spinal stenosis causing clinical symptoms [3]; Congenital cervical spinal stenosis, developmental cervical spinal stenosis and degenerative cervical spinal stenosis are also confused [4]. In order to facilitate clinical summary and observation of treatment methods, it is necessary to conduct in-depth research on the etiology, pathology, diagnosis and treatment methods of cervical spinal stenosis.

Objective To evaluate the influencing factors of cement leakage in vertebroplasty for the treatment of osteoporosis vertebral compression fracture (OVCF) and vertebral metastases (VM).Methods Retrospective analysis was conducted for 653 vertebrae in 356 patients undergoing vertebroplasty at our hospital from May 2007 to January 2011.251 cases had 438 vertebrae with painful OVCF while 105 cases had 215 vertebrae with VM.Pre-operative computed tomography (CT) was performed to determine the presence of cortical defects or osteolysis and within 3 days after PVP to observe the distribution of polymethylmethacrylate (PMMA) in vertebrae and whether leakage occurred.Volume of PMMA injected into each vertebral body and types of cement leakage were compared between the OVCF and VM groups by Z test or x2.The correlation between cortical defects and cement leakages around vertebrae was assessed with Pearson correlation coefficient. Results The successful rate of PVP was 100％. The mean volume of PMMA injected into each vertebra was (5.0 ±2.0) ml and (4.0 ± 1.7) ml in the OVCF and VM groups respectively (P ＜0.05).Asymptomatic PMMA leakage was demonstrated by CT in 93 vertebrae (21.2％)in the OVCF group and in 53 vertebrae (28.8％ ) in the VM group respectively ( P ＜ 0.05 ).Cement leakages into disk were found in 58 vertebrae in the OVCF group and 16 vertebrae in the VM group respectively (P =0.025).Cement leakages into paravertebral vein were found in 12 vertebrae in the OVCF group and 26 vertebrae in the VM group respectively (P ＜ 0.0001 ).Correlation was found between cortical defects and cement leakage into paravertebral soft tissues in the OVCF group (r =0.14) or in the VM group ( r =0.27),between end-plate defects and cement leakage into disk in the OVCF group ( r =0.29) or in the VM group (r =0.31 ).Conclusion As a common occurrence in vertebroplasty,cement extravasation is well-tolerated in most patients.It occurs more frequently in the patients withVM than those with OVCF,especially in cases of leakage into paravertebral vein.Cement leakage into disc or paravertebral soft tissue is predisposed in vertebrae with end plate,cortical defects or osteolysis.

Objective To evaluate the therapeutic efficacies and surgical procedures of anterior approach for cervical spinal canal stenosis.Methods A total of 162 cases of cervical spinal canal stenosis underwent anterior surgical procedure from March 2007 to March 2010.The operative duration,the volume of blood loss and the days of postoperative hospital stay were recorded and analyzed.The Cobb angle and canal sagittal diameter were measured. The bone graft fusion and nerve functions were evaluated postoperatively.Results The average operative duration was 86.4 minutes with an intraopertive blood loss of 80.2 ml and a postoperative hospital stay of5.3 days.A follow-up visit of 9 - 18 months (average:12.8)showed that bone graft fusion was achieved in all cases and Cobb angle increased by an average of 7.2 degree.The spinal canal sagittal diameter increased by 4.23 mm.And the JOA (Japanese Orthopedic Association) score increased by an average of 6.1 points at 3 Month post-operation. Conclusion For cervical spinal canal stenosis,the pressure comes mostly from the front part.The anterior surgical procedure can decompress directly with a shorter operative duration,a smaller volume of blood loss,a shorter hospitalization stay and an effective recovery of cervical curvature and canal volume.

Objective To explore the outcomes of longitudinal spinous splitting laminoplasty with coral bone (abbreviated as SLAC) for cervical stenosis.Methods A total of 142 patients underwent conventional SLAC while 147 other patients modified SLAC.Assessments were made at pre-operation,postoperation and 3-month follow-up to examine the effects of two surgical approaches on the recovery rate of JOA (Japanese Orthopedic Association) score.The change of cervical alignment,change of cervical motions,axial syndrome,operative duration and intra-operative blood loss were recorded and analyzed with SPSS 13.0.Results No significant difference existed between two groups in the recovery rate of JOA score and intra-operative blood loss.The smaller change of cervical alignment and change of cervical motions were found in the modified SLAC group.The modified SLAC group had fewer patients with axial syndrome during the follow-up period. The operative duration was shorter in the modified SLAC group. Conclusion Preventing muscle injuries in cervical laminoplasty can reduce the incidence of complications.The modified SLAG approach may protect cervical posterior extensor musculature,maintain the cervical lordotic alignment and reduce the incidence of post-operative axial syndrome.

Objective To explore the clinical curative effects of preoperative neoadjuvant chemotherapy (NACT) on locally advanced cervical cancer.Methods A total of 62 patients of stage Ⅰ b2-Ⅱ b cervical cancer received neoadjuvant chemotherapy of paclitaxel plus cisplatin for 2-3 courses.The clinical curative effects were evaluated according to the changes of lesion size,intraoperative conditions and postoperative pathological reactions.Results The overall response rate was 90.32％ (56/62) and the complete response rate 30.65％ (19/62).The tumor volumes decreased after NACT.The differences were significant (P ＜ 0.05).After NACT,56 patients undergoing radical hysterectomy recovered smoothly.The surgical resection rate was 90.32％.Chemotherapeutic reactions of cancerous tissue and a large number of infiltrated lymphocytes were seen in 50 cases.Lymph nodes were positive in 3 cases.There were parametrial invasion ( n =2) and vascular tumor emboli (n =2).Conclusion Preoperative neoadjuvant chemotherapy is efficacious in cervical cancer.The parametrium becomes softer and the tumor staging decreases.

Objective Through determine the copper content of decidua,chorion and blood serum of first pregnancy women with Cu-IUD,we offer date for security of offspring.Methods March 2010 to December 2010,in family planning clinics of the general hospital of Tianjin medical university,we selected twenty-five first pregnancy women with Cu-IUD who intended to terminate pregnancy to be experimental group and twenty-five normal first pregnancy women who intended to terminate pregnancy to be control group,and determined the copper content of decidua,chorion and blood serum in experimental group and control group.Results The copper content of decidua,chorion and blood serum in experimental group is (0.91 ±0.51 )mg/kg,(0.72 ± 0.50) mg/kg,(0.79 ± 0.15 ) mg/L; the copper content of decidua,chorion and blood serum in control group is(0.57 ± 0.21 ) mg/kg,(0.46 ± 0.21 ) mg/kg,(0.71 ± 0.15 )mg/L.The copper content of blood serum has no significant difference between experimental group and control group (P ＞0.05).The copper content of decidua,chorion of experimental group is higher than control group ( P ＜0.05).Conclusion Copper ion released from Cu-IUD only has an influence on the uterus tissues,but having no influence on the copper metabolism all over the body.The effects of high copper content of chorion in first pregnancy women with Cu-IUD on the offspring security will be researched further.

Objective To explore the relationship between the prolactinoma-related microRNAs (miRNA) and the development,growth and hormone secretion of prolactinoma.Methods The technique of Solexa sequencing was employed to analyze the differential expressions of prolactinoma and normal anterior pituitary gland samples. And the stem-loop real-time polymerase chain reaction (PCR) was utilized for confirmation.Results According to the differentially expressed profiles of miRNAs,4 miRNAs were downregulated (miR-130a,miR-199b-3p,miR-200b,miR-125b,P＜0.05) and6 miRNAs up-regulated (miR-342-3p,miR-432,miR-23b,miR-493,miR-493 *,miR-664 *,P ＜ 0.05).The expression levels of miR-493 * and miR-432 had a significant positive correlation with the serum level of prolactin ( r =0.47,P ＜0.05 ; r =0.528,P ＜ 0.01 ) while miR-342-3p a significantly positive correlation with the invasiveness ( r =0.402,P ＜ 0.05 ).Conclusion miRNAs are differentially expressed between normal anterior pituitary gland and prolactinomas,between invasive and localized prolactinomas and among different hormone secretion levels. It suggests that miRNAs may be involved in the physiological process of development,growth and hormone secretion of prolactinoma.

Objective To evaluate the pre- and intraoperative risk factors associated with excessive bleeding during the perioperative period in adult patients undergoing open heart surgery with cardiopulmonary bypass (CPB).Methods A total of 1079 consecutive patients undergoing open heart surgery with CPB from January 2001 to May 2010 were included ( except for emergency operation).The possible risk factors associated with excessive bleeding were retrospectively analyzed.Patients who received ≥7 units of RBC or had a re-operation during which no active bleeding point was found within one day of operation were classified as excessive bleeding.According to the occurrence of excessive bleeding,they were divided into 2 groups:excessive and non-excessive bleeding groups.The possible risk factors associated with excessive bleeding were retrospectively analyzed.Univariate analysis and multivariate Logistic regression analysis were used to examine the relationship between these factors and excessive bleeding. Results Among them,120(11.1％ ) developed excessive bleeding.Multivariate Logistic analysis indicated that the risk factors for excessive bleeding were age ( OR =4.533,95％ CI 2.624 - 7.831 ),previous sternotomy ( OR =2.781,95％ CI 1.410 - 5.486 ),preoperative hematocrit concentration ( OR =0.896,95％ CI 0.861 - 0.932 ),CPB duration ( OR =2.782,95 ％ CI 1.791 - 4.322) and type of procedure ( OR =2.292,95％ CI 1.376 -3.817).Conclusion Age ≥ 65 years,previous sternotomy,preoperative low hematocrit concentration,CPB duration ≥ 120min and complex operation were the significant predictors for excessive bleeding in patient undergoing open heart surgery with CPB.

Objective To evaluate the early outcome of endovascular management of iatrogenic vascular injury (IVI).Methods From July 2002 to July 2010,21 cases of IVI undergoing endovasculr therapy were studied retrospectively.There were aorta injury ( n =2),peripheral artery injury ( n =11 ),visceral artery injury (n =5),arteriovenous injury (n =1) and venous injury (n =2).And the procedures included endograft implantation ( n =15 ),intravascular embolization with coil ( n =4 ),combination of endovascular balloon intervention and percutaneous thrombin injection ( n =1 ) and balloon compression for hemostasis (n =1 ).Results Technical success was achieved in all patients.And clinical success,defined as arrested hemorrhage and hemodynamic stabilization,was obtained in 20 (95.2％) patients.There was one case of intra-operative mortality.After the procedure,there were cerebral infarction ( n =2) and partial renal infarction ( n =1 ). Among them,19 patients received a median follow-up period of 23.9 months ( range:4 - 84 months).Only 1 patient with iliofemoral vein stent implantation developed stent collapse and thrombosis at Week 3.There were no other complications.Conclusion Endovascular therapy is an effective procedure in the management of different types of IVI.Despite its encouraging early results,the long-term outcomes require further follow-ups and observations.

Objective To explore the vascular risk factors and neuropsychological proffles of patientswith magnetic resonance imaging (MRI)-defined subcortical ischemic depression (SID).Methods Thirty-five SID patients,37 patients with subcortical ischemic vascular disease without depression (SIVD) and 40 normal controls (NC) participated in this case-control study.The SID and SIVD groups were recruited from the Department of Neurology,First Affiliated Hospital,Anhui Medical University between October 2010 and September 2011.And the NC group came from Medical Center,First Affiliated Hospital of Anhui Medical University over the same period.The vascular risk factors of all participants were assessed by the Framingham scale.Depression symptoms were assessed by the geriatric depression scale (GDS) and Hamilton depression scale (HAMD) while cognitive functions by the mini-mental state examination (MMSE) and Montreal cognitive clock drawing task (CDT).Results Both the SID ( 12.3 ± 4.7 ) and SIVD (13.5 ± 3.4) groups showed significantly higher Framingham scores than the NC group (8.6 ± 1.8 )(F =20.850,P =0.000).Compared with the NC group (28.3 ± 1.8 ; 23.1 ± 3.4 ; 8.0 ± 1.8 ),the MMSE,MoCA and CDT scores were significantly lower in the SID (26.7 ± 2.5 ; 20.0 ± 4.0; 2.0 ± 2.7 )and SIVD (26.8 ± 1.9 ; 20.7 ± 3.0; 6.1 ± 2.1 ) groups ( P ＜ 0.05 ).There were significantly lower CAMCOG-C scores in the SID ( 82.7 ± 9.0) and SIVD (86.2 ± 6.9) groups versus the NC group (92.3 ±6.2) (P ＜ 0.05 ) and similarly in the SID group versus the SIVD group ( P ＜ 0.05 ).Among the subtests of CAMCOG-C,the orientation,language and memory scores in both SID (9.0 ± 1.4; 24.7 ± 4.0; 19.5 ±3.4) and SIVD (9.4 ± 0.9 ; 25.5 ± 2.1 ; 20.3 ± 2.3 ) groups were significantly lower than those in the NC group (9.9 ± 0.4 ; 27.4 ± 1.9 ; 22.1 ± 2.4) ( P ＜ 0.05 ) ; the praxis scores in the SID group (9.4 ± 1.9)were significantly lower than those in the NC group ( 10.4 ± 1.5 ) ( P ＜ 0.05 ).And the thinking and perception scores in the SID group (5.4 ± 1.7 ; 6.3 ± 1.4) were significantly lower than those in the SIVD (6.2±1.3; 7.0 ±1.4) and NC (6.6 ±1.3; 7.2 ±1.4) groups.In the SID group,no significant correlation was found between the Framingham scores and neuropsychological assessments.There were a negative correlation between the GDS,HAMD scores and MMSE,MoCA,CAMCOG-C and CDT scores (P ＜ 0.05).Conclusion The SID patients demonstrate multiple neuropsychological deficits,especially in thinking,perception and praxis. No significant correlation between vascular risk factors and depression symptoms is found in SID patients.

Objective To explore the pathological changes in patients with leukoaraiosis (LA) by magnetic resonance spectroscopy (MRS) and examine its relationship with cognitive function.Methods Twenty-three LA patients and 23 age and gender-matched healthy subjects were recruited from the Department of Neurology,Beijing Chaoyang Hospital,Capital Medical University between August 2010 and November 2010.All participants underwent the neuropsychological tests.Multi-voxel chemical shift imaging was performed and the regions of interest were positioned in bilateral frontal white matter. The relative metabolite ratios,involving N-acetyl aspartate/choline ratio (NAA/Cho),N-acetyl aspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr),were estimated.The correlation of the MRS data and the performance of cognitive function was analyzed.Results The LA patients were associated with a worse performance of mini mental state examination (MMSE) versus the healthy controls (24 ± 3 vs 28 ± 1,P ＜0.05).Univariate analysis of the MRS data revealed the ratios of NAA/Cho and NAA/Cr significantly decreased in bilateral frontal white matter lesions in the LA group versus the control group ( 1.72 ± 0.20 vs 1.96-±0.36,1.67 ± 0.17 vs 1.85 ± 0.21,P ＜ 0.05 ).The values of NAA/Cr and NAA/Cho in normal appearing white matter increased versus the LA group ( 1.83 ± 0.24 vs 1.72 ± 0.20,1.78 ± 0.28 vs 1.67 ±0.17 ) and decreased versus the control group ( 1.83 ± 0.24 vs 1.96 ± 0.36,1.78 ± 0.28 vs 1.85 ± 0.21 ).But no significant differences were found (P ＞ 0.05 ).The ratio of Cho/Cr did not differ among 3 groups (P＞0.05).The pathological change of NAA/Cr in white matter lesion in LA patients was markedly correlated with the performance of MMSE(r=0.47,P＜0.05).Conclusion NAA may be a marker of axonal loss/dysfunction in LA patients.And the changes of NAA/Cr have a positive correlation with cognitive impairment.

Objective To explore.the expression of cyclinD1 in ovarian carcinoma cell 3AO and analyze its relationship with the proliferation of ovarian cancer cell.Methods Human ovarian epithelium and ovarian cancer cells 3AO were cultured in vito.CyclinD1 genes and proteins were detected by reverse transcription-polymerase chain reaction (RT-PCR) and flow cytometry before and after the activation of cell 3AO by cis-platinum. Also the cell activity and cell cycle were observed. Results Abnormal gene amplification and over-expressions of cyclinD1 were found in ovarian cancer cell while the expression of cyclinD1 was negative in normal ovarian epithelium.Under cis-platinum,different expressions of cyclinD1 genes were found in 3AO by RT-PCR.The higher the concentrations of cisplatin,the lower expressions of cyclinD1 genes.By flow cytometry,it was also found that there were lower expressions of cyclinD1 protein in 3AO under cisplatin than without it. With the rising concentrations of cisplatin,the low expressions of cyclinD1 protein in 3AO were detected.The mean numbers were 105.9,15.42 and 8.59,the cell apoptotic rates 0.63％,9.08％ and 27.41％ and the proliferation index (PI) numbers 38.83％,44.54％,37.31％.The differences were statistically significant (P ＜ 0.01 ).Conclusion The up-regulation of cyclinD1 is detected in ovarian cancer cell.A positive correlation is found between the lower expressions of cyclinD1 and the concentration of cicplatin.There is a close relationship between the expressions of cyclinD1 and ovarian cancer cell activity.

Objective To define the role of interferon-γon radiotherapy of lung cancer and explore a new way to clinical treatment.Methods A549 cells were exposed toγray with or without IFN-γ cotreatment.MTT assay was performed to evaluate cell viability. Western blot was used to observe the expression of P53 protein.Results The results showed that co-treatment of IFN-γ decreased the cell viability significantly compared with the γ ray irradiation group(71.4％ ±2.1％ vs 44.1％ ±3.1％,n =7,P ＜ 0.01 ).In addition,the expression of P53 protein also increased significantly after co-treatment (P ＜0.01) ; Furthermore,the cell cycle was changed obviously in co-treatment group compared with γ ray irradiation group,S phase increased ( 12.9％ vs 20.9％,n =5,P ＜ 0.05 ) and also blocked the G2/M phase (28.8％ vs 38.9％,n=5,P＜ 0.05).Conclusions The results suggested that γray irradiation combined with IFN-γ can increase the efficiency of radiotherapy on A549 cells and there is much broad prospect in the clinical treatment of lung cancer.

Objective To explore the therapeutic efficacy of a novel complex material of shapememory alloy brace and artificial dura (nitinol brace and NormalGEN) for the reconstruction of skull base in a canine model with lateral media skull base defect. Methods The complex of nitinol brace and NormalGEN was developed with corresponding apparatus.A common adult dog model with lateral media skull base defect was established and then reconstructedwith the complex. At Month 3 post-operation,cranial lateral radiographic projection,three-dimensional reconstruction of computer tomography,1.5T magnetic resonance imaging and histopathological examination were detected.Results Five animal models and cranial reconstructions were made. All survived without any complication, such as leakage of cerebrospinal fluid,local tissue eminence and neurological function defect.The imaging detection showed that nitinol brace was distinct and satisfactorily positioned without shift and artifact.And histopathalogical examination showed that granulation tissue substituted NormalGEN and grew around the brace with numerous fibroblasts.Conclusion The complex of shape-memory alloy brace and artificial is suitable for the reconstruction of skull base on dog model with lateral media skull base defect.

Objective To evaluate the inhibition of shRNA mediated by magnetic liposome in the growth of non-small cell lung cancer (NSCLC) under the interference of magnetic field in vitro and in vivo andexplore the effects of magntic field on the efficiency of magnetofection. Methods The plasmid of pGFPshIGF-1R was constructed for expressing GFP and shRNA against IGF-1R. CombiMAG as superparamagnetic iron oxide nanoparticles (SPIONs) and Lipofectamine2000 as cationic liposome comprised the magnetic liposome.pGFPshIGF-1R was transferred into A549 cells by magnetofection under a series of interaction durations and intensity of external magnetic fields.pGFPshIGF-1R was delivered into A549 cells in vitro and injected intravenously into the tumor-bearing mice every 48 h for four doses in vivo by way of lipofection or magnetofection. The magnetofection efficiency was analyzed by cytometry and the potency of IGF-1R knockdown by Western blot.At Week 3 after the 4th injection,the mice were sacrificed and the tumors removed and weighed.The tumor inhibition rate was calculated.Results The interaction durations and intensity of magnetic field could influence the magnetofection efficiency.In vitro,IGF-1R specific-shRNA transfected by lipofection inhibited IGF-1R protein by 56.1％ ± 6.0％ and by liposomal magnetofection by 85.1％ ± 3.0％. In vivo, pGFPshIGF-1R delivered by both lipofection and magnetofection significantly inhibited the tumor growth by 41.3％ ( P ＜ 0.01 ) and 65.2％ ( P ＜ 0.01 ).Conclusions Based on magnetic liposome as gene vectors,magnetofection may become a promising targeted therapy for lung cancer.And the transfection efficiency is influenced by magnetic field.

Objective To explore the effects of a continuous low-dose of X-ray upon neuronal morphology and expression of microtubule associated protein-2 (MAP-2) in hippocampus of young rats.Methods A total of 18 Sprague-Dawley rats aged 35 days were randomly divided into two irradiated groups and one control group ( n =6 each).The irradiated groups received different doses of 0.2 mGy/d,1.0mGy/d for 7 consecutive days while the control group sham radiation.The hippocampal pyramidal cell was observed by HE staining,the expression of MAP-2 by immunohistochemistry and Western blot,and the morphologies of microtubule and synapse in CA1 by electron microscopy.Results ( 1 ) The phenomenon of neurodegeneration was observed in the 1.0 mGy group while the control and 0.2 mGy groups were normal;(2) the average optical density of positive MAP-2 protein significantly decreased in the 1.0 mGy group (0.242 ±0.017) in the region of CA1 versus the control group(0.282 ±0.016) (F =14.419,P =0.005).And the average optical density of positive MAP-2 significantly increased in the 0.2 mGy group (0.331 ±0.017) compared with the control group (F =21.700,P =0.002).The expression of total MAP-2 significantly decreased in the 1.0 mGy group (0.332 ± 0.001 ) versus the control group (0.370 ± 0.012)( F =28.055,P =0.000).And the expression of total MAP-2 significantly increased in the 0.2 mGy group (0.455 ±0.018) versus the control group (F =61.974,P =0.002); (3) there were the reduction of microtubule and the damage of postsynaptic density (PSD) in the 1.0 mGy group in hippocampal CA1.Increased microtubule and normal synapses were found in the 0.2 mGy group in hippocampal CA1.Conclusion The expression of MAP-2 is strongly associated with the integrity of hippocampal neurons in young rats.The 0.2 mGy group may promote the proliferation of hippocampal microtubule in hippocampus and further promote the expression of MAP-2.And the damage of microtubule and PSD on neuron could reduce the expression of MAP-2 in the 1.0 mGy group.

Objective To explore whether or not ginsenoside Rg1 can modify the metabolism of amyloid precursor protein (APP) and the generation of amyloid beta (Aβ) by nuclear factor-kappa B (NF-κB).Methods N2a/APP695 cells,a mutated APP-overexpressing neuronal cell line,was used to mimic the APP metabolism and Aβ generation in vitro.The BACE1 mRNA and protein levels were detected by RTPCR (reverse transcription-polymerase chain reaction) and Western blot respectively.Then the expression levels and subcellular localization of NF-κB were detected by Western blot and confocal laser scanning microscope respectively.Results The treatment of ginsenoside Rg1 at a dose of 2.5 μmol/L decreased the levels of Aβ1-40 and Aβ1-42 ( 13.3 ± 4.3 ) ng/ml vs ( 12.0 ± 5.4 ) ng/ml in N2a/APP695 cells,decreased the protein level of BACE1 ( BACE1/β -actin 0.26 ± 0.05),increased the protein level of NF-κB p65 (p-p65/p65 0.93 ± 0.02) and resulted in the translocation of NF-κB from cytoplasm to nucleus.Quinazoline inhibited the activation of NF-κB with a reduction of p-p65 and p-p65/p65 in N2a/APP695 cells and increased the BACE1 protein level.And the treatment of ginsenoside Rg1 showed similar changes in N2a/APP695 cells when compared with the treatment of quinazoline alone.Conclusion Ginsenoside Rg1 may modify the metabolism of APP by enhancing the nuclear binding of NF-κB to BACE1 promoter and inhibiting the transcription and translation of BACE1.

The patient was a 46-year-old female, married, who had intermittent fever for more than 1 month due to a mass in her left neck for 2 years. Two years ago, the patient found a mass in her left neck, which had a slow increasing trend, sometimes mild pain, without other accompanying symptoms, and was not treated. At the beginning of July 2010, there was intermittent fever without entrapment, and the body temperature was irregular, and the highest could exceed 40℃. Before the fever, there were often obvious chills and chills, and the fever was accompanied by obvious headache, soreness and fatigue in the joints of the limbs and whole body muscles. During the fever, there was intermittent irritating cough with a small amount of white foamy sputum. One week after the onset, there were subcutaneous bleeding spots in the lower limbs and painful oral ulcers. When he went to the local hospital, the laboratory examination showed that the blood cells were reduced in three lines, and the antinuclear antibody (ANA), anti-DS-DNA antibody and rheumatoid factor (RF) were all negative. Positron emission computed tomography (PET-CT) examination showed liver, splenomegaly and gallbladder stones, and left neck mass was also found, with high uptake characteristics, and the maximum SUV value was 52.25.

Most pelvic and abdominal adhesions are secondary to peritoneal injury [1]. Previous surgical history, endometriosis, pelvic inflammatory disease history, intestinal inflammatory disease, radiotherapy, chemical peritonitis, foreign body reaction, etc. can cause pelvic and abdominal adhesions, and the most common is pelvic and abdominal surgery. The incidence of abdominal adhesions after a single laparotomy can be as high as 93%; However, only 10.4% of patients without a history of open surgery developed adhesions [2]. Laparoscopy showed that 56% ~100% of patients had pelvic adhesions after gynecological surgery [3], among which ovarian surgery most often caused postoperative pelvic adhesions [2]. Peritoneal mechanical trauma and peritoneal ischemia caused by surgical operation or traction are the inducers of adhesions formation [45]. Other high-risk factors include foreign bodies such as mesh, talc powder and sutures [4-5].

The patient was a 24-year-old female. She was admitted to Peking Union Medical College Hospital in March 2009 due to intermittent right orbital pain for more than 1 year, right eye movement disorder and diplopia for 7 months. The patient gradually felt right orbital pain since July 2007, which worsened in August 2008, and developed inability to look down and diplopia in her right eye. MRI of the head in an external hospital showed thickening of the superior rectus muscle of the right eye (Figure 1), and was diagnosed as idiopathic orbital inflammatory pseudotumor (IOIP). Since November 2008, prednisone was taken orally at 60 mg/d. After the symptoms improved, prednisone was reduced by 5 mg every 2 weeks, and the condition was repeated when it was reduced to 35 mg/d. He was admitted for further diagnosis and treatment. Since the onset of the disease, he denied fever, rash, myalgia, muscle weakness, no oral ulcer, joint swelling and pain, Raynaud's phenomenon, and no special contact history or family history. Physical examination on admission: swelling of right periorbital area, ptosis of eyelid, limited movement of eyeball up and down, no bulge of eyeball, and decreased vision; There were no abnormal signs in heart, lung and abdomen; There was no tenderness in the muscles of the limbs and muscle strength grade V. Blood examination was normal when admitted to hospital, with erythrocyte sedimentation rate of 5 mm/1 h, C-reactive protein<31mg/L, creatine kinase and thyroid function normal, and anti-nuclear antibody, anti-extractable nuclear antigen antibody and anti-neutrophil cytoplasmic antibody were all negative.

A 56-year-old female was admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine in January 2011 due to chest tightness after activity for more than 2 months. The patient felt chest tightness after activity two months ago, without dyspnea, expectoration or hemoptysis. A plain chest radiograph scan was performed, and it was found that the left upper lung occupied a huge space (Figure 1A). CT examination showed that there was a cystic mass in the left posterior superior mediastinum with clear boundary, and the mass extended into the spinal canal through the intervertebral foramen, corresponding to the enlargement of the left intervertebral foramen on T1 and 2, local bone resorption of the vertebral body, and edge sclerosis (Figure 1B). Thoracic MRI showed that the left posterior superior mediastinum showed abnormal signals of about 6.3 cm ×8cm ×10 cm in size, most of which were cystic, with long T1T2 changes, and the signal at the edge of the mass was higher. The enhanced scan enhanced the edge, and the boundary was clear. The mass extended into the spinal canal through the intervertebral foramen, the bone compression and resorption at the posterior edge of the thoracic vertebrae 1~3 changed, the spinal canal widened, the left intervertebral foramen of the thoracic vertebrae 1~3 enlarged, the spinal cord morphology and signal in the spinal canal were not obviously abnormal, but obvious changes were finally seen, and meningocele was considered (Figure 1C, D). He had smoked for more than 30 years, drank half a pack every day, drank alcohol for more than 3 years, and drank 8 taels of white wine every day, but there was no special remaining. Physical examination: conscious and energetic, no yellowing stain on the skin sclera, no nodular bulge on the limbs and trunk, no skin milk caffeina spots, and armpit chicken