Volume 92  ·   Issue 33  ·  2012

Brain glioma, especially malignant glioma, is harmful and the treatment effect is not satisfactory. The literature reports that the 5-year survival rate of grade IV glioma in the World Health Organization (WHO) is only 9.8% [1]. Recently, with the development of evidence-based medicine, individualized treatment of tumor has been paid more and more attention. This paper reviews the significance of establishing and developing a comprehensive treatment system for glioma by evaluating the effect of individualized surgery, radiotherapy, chemotherapy and biological therapy.

Clinical data A 47-year-old male was admitted to the Fourth Affiliated Hospital of Guangxi Medical University at 5: 00 on March 8, 2011 due to nasopharyngeal carcinoma radiotherapy for 3 days and oral and nasal bleeding. He was in critical condition at the time of admission. The patient was found to have nasopharyngeal carcinoma by physical examination 2 years ago, and was treated with radiotherapy twice in the Affiliated Cancer Hospital of Guangxi Medical University (the dose of radiotherapy is unknown). He was discharged from the hospital after the treatment. After discharge, his general condition was acceptable, with mild restriction of mouth opening. Six months ago, he had right ear pain, a small amount of bleeding in the nasal cavity, and oral ulcer. He performed a biopsy of nasopharyngeal and oral ulcer in the Department of Pathology of Guangxi Medical University. The pathology showed that there was no recurrence of nasopharyngeal carcinoma, so he returned to the local area to continue his normal life. However, there was a small amount of bleeding in the nose when blowing his nose, accompanied by choking and cough.

Objective To discuss the role of ultrasound in examining microcalcification of early breast cancer and its correlation with pathohistological type and grade.Methods 178 lessions in 165 cases of early breast cancer confirmed by pathyology after surgical resection were examed by high frequency ultrasound,meanwhile microcalcification were detected and reported.39 lessions in 32 cases are carcinoma in situ and microinvasive carcinoma of breast.139 lessions in 133 cases are early invasive breast carcinoma that is below 2 cm in diameter and doesn't invasive the lymph node and other parts of the body.To analyse the sensitivety of detection micro-calcification of early breast cancer by ultrasound and its correlation with pathohistolo-gical type and grade.Results The sensitivety is 81.6％ in detecting microcalcification of early breast cancer by ultrasound.There is no significant statistical difference in detecting microcalcification between the two group (P =0.217).There is no significant statistical difference in detecting microcalcification of early invasive breast cancer between the different pathyologic types (P ＞ 0.05),and there are no significant differences in detecting microcalcification of early breast cancer between the different pathyologic grades(group Ⅰ:P =0.202,group Ⅱ:P =0.415).There is significant difference in detecting microcalcification of solid tumor by ultrasounic examination in group Ⅰ between the different pathyologic grades(P =0.029).Conclusion There is higher sensitivety in detecting microcalcification of early breast cancer by ultrasonography.Microcalcification of early breast cancer may be no closely related to pathyologic grades.US has a certain value to clinic in detecting microcalcification of early breast cancer.

Objective To explore the surgical approach of percutaneous double hemisection and evaluate its clinical efficacies.Methods From May 2006 to November 2011,a total of 59 patients were recruited.There were 36 males and 21 females with a mean age of 38.2 years (range:8-62).Forty-two varus and 6 valgus feet underwent percutaneous double hemisection.The 0.5 cm coracoid incision was adopted at the medial and lateral aspects of Achilles tendon.Percutaneous double hemisection was employed according to the deformity angles of varus and valgus feet.Manipulative correction was applied slowly until 30°dorsiflexion of ankle.Short leg cast was immobilized for 5 weeks at 30°dorsiflexion of ankle.The force of Achilles tendon,motion of ankle and Hannover Achilles tendon scores were followed up.Results Fifty-two patients were followed up for a mean period of 16.5 months (range:6-60).Seven patients were lost.At the end of follow-up,48 patients with varus and valgus deformities were corrected effectively.When compared with the normal side,the force of Achilles of the operated side of 50 patients had no change while that of 2 patients decreased slightly; the motion of ankle joint increased from (2.8 ± 0.3) ° preoperatively to (28.5 ± 1.4) °postoperatively (P ＜ 0.05) ; the Hannover Achilles Tendon Scores rose from (68.5-± 3.5)preoperatively to (82.6 ± 4.2) points postoperatively (P ＜ 0.05).The outcomes were excellent (n =44),very good (n =5),good (n =2) and poor (n =1).The excellent and good rate was 94.2％.Conclusion As an effective therapy for Achilles tendon contracture syndrome,percutaneous double hemisection has fewer complications and a faster recovery.

Objective To compare the different evaluations of corneal power in post-laser-assisted in situ keratomileusis(LASIK) eyes and assess the accuracy and differences of intraocular lens (IOL) power prediction with corneal powers through different calculation methods.Methods For this prospective study,71 eyes of 39 candidates undergoing LASIK and 3 months later returning for reexamination were included.All subjects were divided into 2 groups according to the axial length:Group A (23.46-25.97 mm) 44 eyes,Group B (26.00-28.52 mm) 27 eyes.The ranges of spherical equivalents were-1.75--9.50 D with an average of (-4.82 ± 1.98) D.Subjective refraction and Pentacam Scheimpflug analyzer were performed at pre-operation and subjective refraction,IOLMaster and Galilei Ⅱ dual Scheimpflug analyzer at over 3 months post-operation.The following values were obtained:SimK by Galilei Ⅱ dual Scheimpflug analyzer,Kn calculated with Gaussion thick lens formula,Kray with ray tracing method,Kchm calculated with clinical history method and Km by IOLMaster.Repeated measures analysis of variance analyze the differences between SimK,Kn,Kray,Km and Kchm.Repeated measurement analysis of variance was employed to analyze the differences between SimK,Kn,Kray,Km combining intraocular lens power formulaand Kchm combining intraocular lens power formula.Pearson's analysis was performed to analyze the correlations between SimK,Kn,Kray,Km and Kchm.Those combining with formulas for IOL power calculations were also analyzed.P ＜ 0.05 indicated statistical significance.Results The values of SimK,Kn,Kray,Kmand Kchm were(39.02± 1.8),(37.8±1.51),(36.8±1.84),(39.18±1.75)and (38.55 ± 1.83) D respectively.The differences between SimK,Kn,Kray,Km and Kchm had statistical significances (P ＜0.01).High correlations existed between SimK,Kn,Kray,Km and Kchm (r ＞ 0.9,P ＜ 0.01).In the same IOL formula,Kray had the highest IOL power value,Kn followed,Kchm the third,SimK and Km the smallest.Among the IOL formulas,Haigis-L and Haigis predicted the highest IOL power,HofferQ followed,Holladay the third and SRK/T the smallest.Conclusion Kn/Kray combining with Haigis formula may be a new and effective method for predicting the IOL power in post-LASIK eves.

Objective To explore the clinical features,predictive factors and unfavourable prognostic factors of interstitial lung disease (ILD) in the patients with polymyositis and dermatomyositis (PM/DM) so as to provide rationales for early clinical diagnosis and treatment.Methods The medical records of 244 PM/DM patients from Department of Rheumatology & Immunology of Anhui Medical University Affiliated Provincial Hospital from August 2001 to August 2011 were reviewed to analyze the clinical features,predictive factors and unfavourable prognostic factors of ILD in PM/DM patients.Results The major clinical manifestations of PM/DM-ILD included dry cough,chest tightness and shortness of breath during activities and Velcro rale in lower lung.Besides anti-Jo-1 antibody,multivariate unconditional Logistic regression analysis indicated that amyopathic dermatomyositis (ADM),arthralgia/arthritis,fever and Gottron's sign were the predictive factors for the development of ILD in PM/DM patients.ADM and Hamman-Rich-like pattern ILD were the poor prognostic factors while large dose glucocorticoids plus immunosuppressant therapy in the early time was a protective factor for PM/DM-ILD patients.Conclusion Some clinical features are the predictive factors for the development of ILD.ADM and Hamman-Rich-like pattern ILD are poor prognostic factors.Large dose glucocorticoids plus immunosuppressant therapy can significantly improve the prognosis of PM/DM patients.

Objective To determine the effects of disease activity and other risk factors on bone mineral density (BMD) in untreated systemic lupus erythematosus (SLE).Methods Lumbar and hip BMD were determined by dual energy X-ray absorptiometry (DXA)in 50 healthy controls and 120 premenopausal SLE females from Department of Rheumatology & Immunology,Third Hospital of Medical College of Jilin University during the period of 2010-2012.The SLE patients were divided into 2 groups,i.e.untreated and treated with glucocorticoid and immunosuppressives.Simple and multiple linear regression analyses were performed to determine the associations between BMD and disease-related variables.To completely eliminate the influences of glucocorticoid treatment on the results,the untreated SLE patients were chosen to investigate the risk factors with regression analysis.Results In femoral neck,greater trochanter and total hip,both the treated and untreated SLE patients had significantly lower BMD than the healthy controls (P ＜ 0.01).In greater trochanter,the treated SLE group had significantly lower BMD than the untreated group.The BMD of left and right femoral neck of the former were botj-0.06 while that of the later-0.11 and-0.12 respectively (P ＜ 0.05).Regression analysis showed that long disease duration and high (SLE disease activity index) SLEDAI were the risk factors of low BMD (P ＜ 0.05),especially high SLEDAI.Conclusion SLE itself may result in low BMD,especially in patients with high SLEDAI.Hip joints are predominatly affected.Long disease duration is also closely associated with low BMD in SLE.

Objective To compare continuous interscalene brachial plexus block (CISB) in the patients undergoing rotator cuff repair surgery.Methods A total of 60 patients undergoing rotator cuff repair surgery were randomly assigned to either ISB plus GA group (ISB + GA group) or GA group.Preoperatively,an interscalene catheter was placed in the ISB + GA group patients.Both groups received general anesthesia.The intraoperative mean arterial pressure (MAP) at the level of external acoustic meatus was maintained at a target of 60-65 mm Hg with a continuous infusion of remifentanil.Postoperatively,the patients in the ISB + GA and GA groups received CISB and patient controlled intravenous analgesia (PCIA) respectively for 48 h.Results Surgical field conditions were similar in two groups(P =1.000).Compared to the GA group,the consumption of remifentanil [(0.04±0.03)vs(0.14±0.03) μg · kg-1 · min-1,P＜0.01] and the inhalational concentration of sevoflurane(1.80％ ± 0.5％ vs 2.1％ ± 0.5％,P ＜ 0.05) were lower in the ISB + GA group.Compared to the GA group,the values of MAP and heart rate (HR) were lower at all postoperative time-points in the ISB + GA group(P ＜ 0.05).The postoperative measurements of numerical rating pain score (NRPS) were lower (P ＜ 0.01) and the level of patient satisfaction was greater in the ISB + GA group [8(6-10) vs 7 (5-10),P ＜ 0.01].Conclusion In comparisons with GA alone for rotator cuff repair surgery,the combined uses of ISB and GA may achieve a better perioperative control of hemodynamic responses,a markedly reduced consumption of general anesthetics,a rapid recovery of consciousness from anesthesia,superior analgesia with fewer side effects and greater patient satisfaction.

Objective To evaluate the efficacy and safety of low-dose cyclophosphamide plus corticosteroids for type Ⅰ / Ⅱ myasthenia gravis (MG).Methods This trial was prospective,non-random and open-labeled.We selected 160 patients with steroid-insensitive MG from January 1999 to October 2011.Each patient received an oral dose of prednisone 0.5 mg · kg-1 · d-1,cyclophosphamide 8 mg· kg-1 time-1 once weekly intravenously and oral pyridostigmine 36 mg · kg-1 · d-1.The efficacies were assessed by absolute and relative MG scores.The clinical treatment cycle was 30 weeks.Results (1) Among them,74/106 type Ⅰ MG patients (69.9％) reached clinical relative scores ≥95％ in 30 weeks.The total dose of cyclophosphamide was 12 g.And 35/54 type Ⅱ MG patients (64.8％) reached clinical relative scores ≥95％ in 30 weeks.No statistically significant difference existed between two groups (P =0.521).(2)All patients had various degrees of improvement in 30 weeks.The difference was statistically significant by Mann-Whitney U test (P ≤ 0.05).(3) There were minor side effects in these all patients.(4) When the total dose of cyclophosphamide reached 4 g,the cure rate in type Ⅰ patients was higher than that of in type Ⅱ patients (P=0.000).When the total dose of cyclophosphamide reached 12 g,the cure rate in type Ⅱ patients was higher than that of in type Ⅰ patients (P =0.001).(5) The cure dose of cyelophosphamide was 4-8 g in 58.4％ of type Ⅰ patients versus 8-12 g in 61.1％ of type Ⅱ patients.Conclusion The combined treatment of low-dose cyclophosphamide and corticosteroids in glucocorticoid-insensitive type MG (type Ⅰ / Ⅱ) is both effective and safe.And the sensitivity to cyclophosphamide varies for different clinical types.It is higher in type Ⅰ than type Ⅱpatients.

Objective To understand the ovarian ultrasound imaging features in the reproductive age females with polycystic ovary syndrome (PCOS).Methods A total of 396 PCOS patients aged 18-35years were recruited from our gynaecology & endocrinology clinic,including obese (OB-PCOS group,n =153) and non-obese (NOB-PCOS group,n =241).And 635 reproductive period females with normal menstruation for the control group,including obese (OB-CON group,n =72) and non-obese (NOB-CON group,n =563).Questionnaire surveys were conducted on their menstrual history.Vagina or rectum ultrasound methods were employed to determine the values of ovarian follicle number (FN) and ovarian volume (OV).Also the clinical symptom scores and endocrine and metabolic indices were measured.Results (1) As compared to the control group,the values of ovarian FN and OV 95％ site for physiological high limit were 10 and 9.5 ml respectively.(2) In PCOS patients,their ovarian volumes and the number of follicles were significantly higher than those of the control group (P ＜ 0.01).(3) In 90.4％ of these patients,their values were OV ＞ 9.5 ml and/or FN ≥ 10.And in 66.9％ PCOS patients of reproductive age,the polycystic ovarian changes of ultrasound imaging reached the Rotterdam consensus diagnostic criteria.Conclusion The features of ovarian ultrasound imaging in reproductive period PCOS patients are enlarged ovarian volume and increased follicles numbers.The preliminary Chinese ovarian ultrasonographic diagnostic cut-off points have been proposed for reproductive period PCOS patients.

Objective To explore the postoperative recurrence patterns in the patients undergoing potentially curative resection of stage ⅢA-N2 non-small cell lung cancer (NSCLC).Methods A total of 63 patients underwent curative operation from September 2004 to December 2008 at Peking University First Hospital and were pathologically diagnosed as stage Ⅲ A-N2 NSCLC.Their clinical data were retrospectively reviewed.The follow-ups were conducted to detect the recurrent lesions.The recurrence rates at Year 2-3 were calculated by the Kaplan-Meier method while the Cox proportional hazard model was used to assess the risk factors associated with recurrence.Results The 2 and 3-year recurrence rate was 46.6％ and 57.3％ respectively.Only one patient experienced local failure.However,the predominant recurrence pattern was distant failure (27/28).As demonstrated by the univariate Cox regression analysis,4 significant factors associated with recurrence and the arm of lymphatic or vascular invasion (LVI),number of positive N2 station ＞ 1,number of positive node ＞ 3 and involvement of subcarinal lymph nodes were found to increase the risks of failure (P ＜ 0.05).Conclusion Distant failure is the predominant pattern of postoperative recurrence in the patients of stage ⅢA-N2 NSCLC.In addition to LVI,the level of positive N2 station,the number of positive N2 node and the involvement of subcarinal lymph nodes are associated with the postoperative risk of recurrence.

Objective To explore the protective effects of intranasal (IN) dosing of nerve growth factor (NGF) on brain injury induced by organophosphorus compounds (OP) in rats.Methods The OPtreated Sprague-Dawley rats received an intraperitoneal injection of atropine sulphate and pralidoxime at I min after intoxication.Then NGF or saline was dosed via the olfaetory pathway.All rats were sacrificed 24 hours after OP exposure.Damaged nerve cells were estimated on corpus striatum strained with hematoxylineosin (H&E) method.And the activity of acetylcholinesterase (AchE) and the eoncentrations of malondialdehyde (MIA) and reduced glutathione hormone (GSH) in corpus striatum were measured by colorimetric method.Results As assessed by H&E staining,a large number of degenerated and necrotic nerve cells were observed in corpus striatum in rats from in IN saline group.But in IN NGF group,the number of degenerated neurons was smaller than in IN NS group.Following OP exposure,the activity of AchE decreased in corpus striatum in both IN saline and IN NGF groups (0.46 ± 0.11 vs 0.35 ± 0.09 U/mg prot).No significant differences existed between two groups.But the concentrations of MDA in corpus striatum of IN NGF group rats reduced markedly by 25.14％ (4.02 ±0.85 vs 5.37 ± 1.33 nmol/mg prot) and the level of GSH increased sharply by 15.73％ (52.82 ± 2.80 vs 45.64 ± 4.88 mg/g prot) as compared with IN saline group (P ＜ 0.05).Conclusion Intranasal dosing of NGF may improve neuropathology and protect rats against OP-indueed oxidative damage in corpus striatum.

Objective To assess the effects of lipid on ropivacaine-induced convulsion and LD50 in rats and compare with those of the traditional anticonvulsants midazolam and propofol.Methods Protocol 1:A total of 120 SD rats (60 males,60 females),weighing 200-300 g,were randomly assigned into 4 groups with equal males and females:lipid (L),midazolam (M) and propofol (P) and control (C).Rats were pretreated with 10 ml/kg lipid intravenously in group L,saline and 0.23 mg/kg madazolam (10 ml/kg in volume) sequentially in group M,saline and 4 mg/kg propofol (10 ml/kg in volume) in group P and saline 10 ml/kg in group C.Then ropivacaine 44 mg/kg (0.75％) was injected intraperitoneally into each rat.The convulsion rate in each group and the time of convulsion after ropivacaine injection were observed.Meanwhile,the plasma concentration of ropivacaine at the time of convulsion was measured.Protocol 2:Additional 100 male SD rats were used for the measurements of ropivacaine LDS0 with different pretreatments including lipid,midozolam,propofol and saline through the up-and-down method.Rats were randomly assigned into 4 groups similarly as protocol 1.The doses of ropivacaine in each group were determined according to our pilot study and 6 dosage levels with the same interval ratio 8.5 was applied in each group.The doses of these pretreatment drugs and administration methods were similarly as protocol 1.Results The convulsion rate after 44 mg/kg ropivaeaine ip injection was 43.3％ in group C,0％ in group M,13.3％ in group P and 70％ in group L.Lipid increased the convulsion rate significantly.The plasma concentration of ropivacaine at the time of convulsion was 1.65 ±0.30 μg/kg in group C,1.73 ±0.14 μg/kg in group P and 3.45±0.26 μg/kg in group L.The LD50 of ropivacaine in group C was 64.39 mg/kg,88.40 mg/kg in group M and 90.20 mg/kg in group P and 55.45 mg/kg in group L.Conclusions Midazolam and propofol not only decrease the convulsion rate of ropivacaine,but also increase its LD50.Lipid not only increases the convulsion rate of ropivacaine,but also decreases its LD50.The application of lipid for the prevention of local anesthetic toxicity has potential risks.

Objective To explore the impairment mechanisms of blood brain barrier in spinal cord and observe the changes of matrix metalloproteinase-9 (MMP-9) and functional improvement in rats with chronic fluorosis.Methods A total of 120 Wistar rats were divided randomly into 4 groups,high fluoride (fed by water with a high concentration of sodium fluoride at 200 mg/L),high fluoride control (fed by distilled water),defluorination (fed by water with a high concentration of sodium fluoride at 200 mg/L for 12 weeks and then distilled water for 12 weeks) and defluorination control (n =30 each).The urinary contents of fluoride were detect for 4 groups at Weeks 4,8 and 12.The high fluoride and control groups were sacrificed at Week 12 while the defluorination and defluorination control groups at Week 24.Their cervical spinal cords were collected for electron microscope examinations.The expression of MMP-9 protein in thoracic cord was detected by immunohistochemistry and Western blot.Quantitative analysis of function of blood brain cord barrier was performed by the technique of Evans blue.The comparison of measurement data was performed with F test and correlation analysis.The cytological changes of neurons in thoracic spinal cord were detected after chronic fluorosis.Results Under electron microscope,the pathological manifestations of chronic damage in blood brain barrier could be found.As compared with the high fluoride control group,the content of Evans blue increased markedly in spinal cord of the high fluoride group (29.2 ±0.1 vs 0.7 ±0.1 mg/L,P ＜0.01).It was higher in the defluorination group than that in the defluorination control group.But there was no significant difference with the high fluoride group (29.2 ±0.1 vs 28.9 ± 0.2 mg/L,P ＞0.01).And the expression of MMP-9 increased in spinal cord of the fluorosis and defluorination groups in comparison with those in the control group.But no difference existed among them.Conclusion The damage of blood brain barrier of spinal cord occurs probably as a result of a higher expression of MMP-9 in rats with chronic fluorosis.Defluorination for a short time may not recover.

Objective To explore the effects of tyrosine hydroxylase-neurturin (TH-NTN) gene modified bone marrow mesenchymal stem cell (BMSC) transplantation in Parkinson's disease (PD) model rats and the alternations of correlated proteins.Methods The PD rat model was established by the 2-point injection of 6-hydroxydopamine (6-OHDA) into unilateral (right) striatum.Successful modeling rats were separated into PD,BMSC and TH-NTN-BMSC groups.BMSC and TH-NTN-BMSC groups were transplanted into BMSCs and TH-NTN gene modified BMSC cells separately into right striatum.After transplantation,ethology detection in all groups was made with an intraperitoneal injection of apomorphine (APO).Dopamine (DA) and dopacetic acid (DOPAC) in striatum were detected by high performance liquid electrochemical analysis.TH and NTN proteins in right striatum were also analyzed by immunohistochemistry and Western blot.Finally the density of dopamine receptors in post synaptic density of dopaminergic synapses of corpus striatum were compared between each group by post-embedding immunogold electron microscopy.Results After an injection of APO,rotation frequency decreased in TH-NTN-BMSC group,i.e.(5.7 ± 1.3) circles/min versus (10.8 ± 2.2),(9.9 ± 1.2) circles/min in PD and BMSC groups (P ＜0.05).For proteins in right striatum,DA,(0.421 ±0.113) and DOPAC,(0.093 ±0.012) nmol/Lincreased significantly versus (0.208 ± 0.043),(0.043 ± 0.017) nmol/L in PD and (0.231 ± 0.082),(0.044 ± 0.023) noml/L in BMSC groups (P ＜ 0.05).Also a lower density of D2 receptors at (623 ± 96) /μm2 in TH-NTN-BMSC group versus (923 ± 132)/μm2 in PD and (860 ± 116)/μm2 in BMSC groups was also found.Conclusion The combined therapy of TH and NTN genes increases the synthesis of DA and also protects the dopaminergic neurons to achieve double therapeutic effects.It may provide potential innovations of PD genetic therapy.

The patient, a 64-year-old female, came to the outpatient department of general surgery of the Second Affiliated Hospital of Suzhou University because she felt a hard mass in her right lower abdomen for 2 months with abdominal distension, frequent urination, urgency and gradual aggravation of anal distension. The physical examination showed that the abdomen was flat and soft, and an old scar about 10 cm long was seen in the upper abdomen, and an old scar about 5 cm long was seen in the middle of the lower abdomen, which healed well. A mass about 20 cm ×15 cm in size could be seen on the right side of the lower abdomen, with flat umbilical upper boundary, hard texture, no tenderness, clear boundary, no tenderness and rebound pain in the abdomen, liver and spleen were not reached under the costs, mobile voiced sounds (-), intestinal sounds 3~4 times/min, and no hyperactivity. B-ultrasound: mixed abdominal and pelvic occupied mass (Figure 1), considering gynecological tumors, so she was admitted to the gynecological department for further diagnosis and treatment. The patient has been menopausal for 14 years. Since the discovery of pelvic occupied mass, the patient has no nausea and vomiting, no abdominal pain and diarrhea, no abnormal leucorrhea, no abnormal vaginal bleeding, good spirits, good appetite and sleep, normal defecation, and no obvious change in body weight. "Cholecystectomy" was performed in an external hospital 10 years ago, and "tubal ligation and sterilization" was performed 30 years ago.

The posterior lateral complex (PLC), also known as the posterior lateral corner (PLC, posterior lateral corner), is uncommon in clinical injury, and rarely occurs alone. It is often accompanied by anterior cruciate ligament/posterior erueiate ligament (ACL/PCL) tear [1], tibial plateau fracture [2], femoral attachment point avulsion fracture [3-4] and bone contusion [5]. After injury, it can cause knee varus, tibial external rotation and knee reflexion deformity. If not properly treated, it will lead to knee instability and other ligament surgical reconstruction failure [6-7], and even chronic disability due to persistent instability and secondary articular cartilage degeneration. Therefore, the treatment after PLC injury is very important for the stability of knee joint.

A 55-year-old male was admitted to hospital due to severe headache accompanied by vomiting after sudden transient coma for 3 h. Physical examination: body temperature 37℃, pulse 88 beats/min, breathing 20 beats/min, blood pressure 150/90 mm Hg (1 mm Hg =0.133 kPa), vital signs stable, somnolence, bilateral pupils of equal size and circle 0.3 cm, sensitive to light reflex, free movement of limbs, roughly normal muscle strength and muscle tone, symmetrical tendon reflex, Pap sign (-), neck resistance, and left Klinker's sign (+). In 2011, CT plain scan in the emergency department of Lishui Central Hospital showed that the density of lateral fissure cistern, cerebral cistern, longitudinal fissure cistern, canopy and some sulcus on both sides was increased, with cerebral cistern as the main factor, showing "casting" changes.

A 45-year-old female was admitted to the hospital on March 28, 2011. Due to repeated multiple joint swelling and pain for more than 7 months. On August 15, 2010, the patient developed swelling and pain in both hands after excessive push-ups, accompanied by tight skin at the ends of fingers. She visited many hospitals and was diagnosed as "scleroderma". After hormone therapy, it could improve, but the symptoms were repeated, and pain in elbow, shoulder and other joints gradually appeared, accompanied by limited movement. During the course of the disease, there were no white and purple hands, no mouth ulcer, photosensitivity, facial erythema, no cough or dysphagia. The illness was clear, the spirit was slightly poor, the sleep was poor, and the weight lost about 5 kg. Physical examination: vital signs were stable, pulmonary, cardiac and abdominal examination showed no abnormalities, bilateral metacarpophalangeal and proximal interphalangeal joints were swollen and painful, both wrist joints were swollen and painful with limited movement, right shoulder joint was obvious tenderness and limited movement, the distal skin of both hands was tight with obvious vascular pulsation, local skin temperature increased, tenderness was obvious, the palms of both hands were wet, the skin of the right upper arm was tight, and the skin of the right forearm was slightly swollen.

Clinically, nimodipine tablets are often taken orally to prevent delayed cerebral vasospasm after aneurysmal subarachnoid hemorrhage (SAH). In addition, magnesium is also a commonly used neuroprotective agent. A team led by Professor Dorhout Mees SM of Utrecht University Medical Center in the Netherlands conducted a phase 3 clinical trial on the brain protection application of magnesium in subarachnoid hemorrhage. The results of the study were published in the journal The Lancet on July 7, 2012 (Lancet, 2012, 380:44-49). The trial enrolled 1204 adult patients with SAH from 8 medical centers (including 6 centers in the Netherlands, 1 center in Scotland and 1 center in Chile) from April 2004 to September 2011. 606 patients were randomly assigned to the magnesium sulfate treatment group (experimental group) and 597 cases in the control group. One case was not included in the statistical analysis due to the missing random number on the trial package. Within 4 days after subarachnoid hemorrhage, the patients in the experimental group were given 64 mmol/L of magnesium sulfate intravenously daily, and the control group was given placebo. After SAH, magnesium or placebo were given intravenously for 20 days (or discharge or death Renal function was monitored every 2 days. Patients with SAH were also allowed to receive oral therapy with 360 mg/d nimodipine tablets, necessary bed rest, and aneurysm clipping.

I. Foreword The Consensus on the Diagnosis and Treatment of Malignant Glioma of the Central Nervous System in China [1] (hereinafter referred to as the Consensus) has been very popular since its publication in October 2009. In order to meet the needs of the majority of clinical medical workers and patients, in September 2011, the writing group of the Guidelines for the Diagnosis and Treatment of Glioma of the Central Nervous System in China (hereinafter referred to as the Guidelines) added some contents to the consensus after consultation, and then renamed it as the Guidelines. The added contents are: pilocytic astroglioma, dysembryogenic neuroepithelioma, gangliocytoma, gangliocytic glioma, World Health Organization (WHO) grade II glioma (such as diffuse astroglioma, oligodendroglioma and ependymoma, etc.), WHO grade III and IV gliomatosis, medulloblastoma and supratentorial neuroectodermal tumor, etc. Besides neurosurgery experts, the writers of the guidelines also added experts in neuropathology, neuroimaging and rehabilitation. The writing of the guidelines still maintains the consensus procedures: (1) Multidisciplinary experts put forward the problems and categories to be solved in the guidelines.