Volume 95  ·  Issue 15  ·  2015

High-quality guidelines (consensus) have strong guidance for their corresponding fields, which is conducive to the development of disciplines. But no guidelines (consensus) can be perfect or even biased. In order to improve the scientific nature of neurosurgical guidelines in the future and narrow the gap with mature guidelines in developed countries, this issue of Chinese Medical Journal published "Overall Evaluation of Chinese Neurosurgical Guidelines (Consensus)" written by Liu Weiming and other doctors^[1]One article. The author of this article used The latest international Evaluation guideline tool AGREE II (The Appraisal of Guidelines for Research & Evaluation) to evaluate The quality of Guidelines and consensus in The field of neurosurgery in China before September 1, 2014. The author evaluated the distribution and development of the guidelines for neurosurgery in China, the participants in writing the guidelines, the rigor of formulating the guidelines, whether the guidelines are convenient for specific application and popularization, and the independence in the process of writing the guidelines.

Clinical diagnosis and treatment guidelines and consensus are effective means to standardize clinical diagnosis and treatment. Good clinical guidelines can improve the overall diagnosis and treatment level and improve the curative effect, thus benefiting all parties^[1]。 As far as neurosurgery is concerned, it is a rapidly developing discipline. Originally, it was thought that all diseases that could not be treated and operated could be treated by surgery. This requires good clinical guidelines to regulate and lead the development of the discipline. With the establishment and development of evidence-based medicine, the advantages of evidence-based medicine guidelines are gradually established^[2]。

To explore the olfactory function of patients with myasthenia gravis (MG) and analyze the correlation between olfactory dysfunction and clinical characteristics.

A total of 61 MG patients from March to July 2014 and 32 healthy controls (HC) received T&T olfactometer test. Their clinical data were collected. And the relationship of T&T score and clinical characteristics were analyzed.

The identification threshold of T&T olfactometer test was (2.07±1.56) versus (0.31±1.25) for healthy controls. MG patients had a worse performance on olfaction test than healthy controls (t=5.50, P<0.01). By Spearman′s analysis, disease course(r=0.348, P=0.006), QMG scores (r=0.393, P=0.025), ADL scores (r=0.421, P=0.01) and dosing time of pyridostigmine (r=0.295, P=0.025) were positively correlated with T&T scores. However, the dosing times of prednisone (r=0.084, P=0.053) or immunodepressants (r=0.153, P=0.251) were not correlated with T&T scores.

MG patients have poor olfactory sensation. And a potential involvement of non-motor system shall attract the attention of neurologists.

To explore the change patterns, influencing factors and predictors of quality of life for 4 years in patients with Alzheimer′s disease (AD).

A total of 96 mild-moderate AD patients on combined therapies of medicine and recuperation were enrolled. Their clinical symptoms were graded by mini-mental state examination (MMSE), activity of daily living (ADL), global deterioration scale (GDS), neuropsychiatric inventory (NPI), Hamilton depression scale (HRSD), Hamilton anxiety scale (HAMA) and Pittsburgh sleep quality index (PQSI). And their qualities of life were evaluated by Quality of Life-Alzheimer′s Disease (QOL-AD) at baseline and at the end of 1, 2, 3, 4 year.

(1) During a 4-year follow-up, the scores of QOL-AD, MMSE, ADL, GDS, NPI, HRSD, HAMA and PQSI decreased markedly compared with baseline [(17.5±1.9), (12±3), (45±9), (5.2±0.8), (31±11), (20±6), (14±6), (14±4) vs (30.5±4.6), (21±4), (34±10), (3.3±0.9), (22±9), (18±6), (11±4), (12±4)respectively, t=25.31, 15.42, -7.16, -14.83, -5.56, -2.94, -4.45, -5.60, all P<0.01]. With the deterioration of AD, their qualities of life decreased significantly. (2) Spearman′s correlation analysis showed that the scores of 4-year QOL-AD were correlated with the 4-year score changes of MMSE, ADL, GDS (r=0.344, 0.368, 0.213; P=0.002, 0.001, 0.047). (3) Multiple Logistic regression model showed that the baseline scores of NPI and HRSD were strong predictors of loss of quality of life (OR=1.697, 1.269; P=0.000, 0.006). And the area under the curve of receiver operating characteristic (ROC) of NPI and HRSD were 0.918 (95%CI: 0.844-0.991) and 0.878 (95%CI: 0.804-0.953) respectively.

With the deterioration of AD, the quality of life decreases significantly and has correlations with the score changes of MMSE, ADL and GDS. High scores of NPI and HRSD are the important predictors for a loss of quality of life in AD patients. Early detection and timely interventions are necessary.

To assess the neuroimaging features of Parkinson′s Disease and dystonia by transcranial sonography (TCS).

63 Parkinson′s Disease patients, 32 dystonia patients and 81 controls underwent TCS in blind manner. The echo of the substantia nigra (SN) was classified into Ⅰ-Ⅴ as half quantitative data. The echo of SN ≥ Ⅲ was considered to be positively enhanced, the hyperechogenicity were measured and the hyper-substantia nigra/midbrain (S/M ) were calculated. The echo of the lentiform nucleus (LN) was classified into Ⅰ- Ⅲ as half quantitative data. The echo of LN≥Ⅱ was considered to be positively increased and were measured.

Semi-quantitative analysis: the ratio of the patients with SN≥Ⅲ was greater in Parkinson′s Disease patients (60.32%, 38/63) than in dystonia patients (12.50%, 4/32) and normal controls (11.11%, 8/72, χ²=19.67, 36.22, P<0.01, respectively), the ratio of the patients with LN≥Ⅱ was greater in dystonia patients (65.62%, 21/32) than in Parkinson′s Disease patients (20.63%, 13/63) and in controls (8.33%, 6/72,χ²=18.69, 37.83, P<0.01, respectively). Quantitative analysis: the median and quartile (M/Q) of the SN hyperechogenieity area in Parkinson′s Disease patients [0.73(0.53) cm²] was greater than in dystonia patients [0.56(0.53) cm²] and in controls [0.44(0.19) cm^2,H=10.05, P=0.007], the S/M in Parkinson′s Disease patients was greater [15.7%(11.5%)] than in dystonia patients [(13.8%(14.2%)] and in controls [8.9%(2.9%),H=6.96, P=0.031]. The M/Q of LN hyperechogenieity area in dystonia patients was greater [0.50(0.33) cm²] than in Parkinson′s Disease patients [0.45(0.22) cm²] and in controls [0.35(0.17) cm^2,H=10.87, P=0.004].

TCS might find the specific hyperechogenicity of SN in Parkinson′s Disease patients (60.32%) and hyperechogenicity of LN in dystonia patients (65.63%), which could provide useful informations to distinguish Parkinson′s Disease from dystonia.

To explore the levels and evaluations of physical activity (PA) using 5-A counseling model in patients with stable schizophrenia.

A total of 258 patients with stable schizophrenia during February-August in 2014 were selected as research group while 214 healthy subjects as control group. A self-formulated questionnaire was used to assess the PA levels of participants. And a 5-A counseling model (assess, advise, agree, assist and arrange) was used to evaluate the experiences and qualities of PA counseling.

There were significantly fewer people physically active in research group than those in control group (20.1% vs 35.9%). According to the results of PA counseling experience in research group, only 29.5% patients received PA counseling. And the strategies of "advising on personal benefits and principles of intensified PA" were most frequently used while other strategies seldom used.

Most patients with stable schizophrenia are physically inactive and they should receive more PA counseling.

To explore the prevalence and risk factors for the onset of heart failure after right ventricular apical pacing.

The clinical data of 1 343 patients with pacemaker implantation at our hospital from 2003 to 2008 were analyzed retrospectively. And the predictors of heart failure were evaluated by the Cox proportional hazard model and Kaplan-Meier method.

During a median follow-up period of 71 (76±24) months, 303 patients (22.6%) developed a new onset of heart failure. Multivariate Cox analysis revealed that ≥65 years old(hazard ratio 2.37), a history of myocardial infarction(hazard ratio 2.16), VVI mode(hazard ratio 2.37), left ventricular ejection fraction (LVEF) <50%(hazard ratio 2.00), atrioventricular block or atrial fibrillation with slow ventricular rate etiologically(hazard ratio 1.43) were independent risk factors for heart failure( P<0.05). And the risks increased by 19.4%, 33.0%, 20.9%, 38.4%, 17.2% or 25.9% at 71 months respectively.

After right ventricular apical pacing, heart failure is a progressive syndrome correlated with basal cardiac functions, underlying etiologies and age. And right ventricular apical pacing should be avoided in patients with high risk factors.

To investigate the feasibility and application value of AR-Vol measured by GI3DQ method directly.

One hundred and two patients with aortic regurgitation who underwent echocardiographic examination in Tianjin Chest Hospital from February 2014 to October 2014 were selected randomly and divided into two groups: the eccentric group included forty cases with eccentric aortic regurgitation; the central group included sixty and two cases with central aortic regurgitation. AR-Vol were directly measured by GI3DQ method, and then it was calculated by PISA method as the reference standard.

(1) In the eccentric group, the AR-Vol measured by GI3DQ method and PISA method were respectively (44±11) ml and (48±10) ml. In the central group, the AR-Vol measured by GI3DQ method and PISA method were respectively (34±13) ml and (33±13) ml.(2) Paired t test analysis showed significant difference in two methods of the eccentric group (P<0.01); no significant difference was found in two methods of the central group (P=0.202). (3)The correlation coefficients of the AR-Vol measurement by GI3DQ method and PISA method are relatively in two groups: r=0.835, r=0.913; consistency analysis showed differences between the two methods of the eccentric group had statistical significance, and differences between the two methods of the central group had no statistical significance.

In the central aortic regurgitation, AR-Vol measured by GI3DQ method is feasible and accurate compared with the PISA method, which can be used for routine application.

To evaluate the performance of intravoxel incoherent motion (IVIM) diffusion-weighted MR imaging in the differential diagnosis of Angiomyolipoma (AML) , clear cell renal cell carcinoma(clear cell RCC) and non-clear cell renal cell carcinoma(non-clear cell RCC).

Forty-five patients were enrolled and classified into three groups according to the surgical pathology results. There were even amount of subjects (15) in each group of AML group, clear cell RCC group and non-clear cell RCC group(including 6 Papillary RCC and 9 Chromophobe RCC). ALL the patients underwent respiratory-triggered DWI on 3.0T MR system using multi b-values of 0, 20, 50, 100, 150, 200, 400, 600, 800 sec/mm². Pure molecular-based (D), perfusion-related(D^*) and vascular fraction(f) were calculated using a bi-exponential model. Comparisons of derived parameters derived by IVIM-DWI among three groups were performed using One-way ANOVA.

D in clear cell RCC (1.8±1.5)×10^-3mm²/s was significantly higher than that in AML (0.7±0.3)×10^-3mm²/s or non-clear cell RCC (0.9±0.3)×10^-3mm²/s(P<0.05), while no statistical difference was observed between AML and non-clear cell RCC(P=0.807). D^* demonstrated significant difference between AML (33.3±18.2)×10^-3mm²/s and non-clear cell RCC (17.8±17.3)×10^-3mm²/s, (P<0.05). No observed significant difference in f was revealed between any two groups.

Pure water molecules(true diffusion) and capillary microcirculation(pseudo-diffusion) may result in the observed difference of parameters in these three types of renal tumors. D value can contribute to differentiate the clear cell RCC from AML, and between clear cell and non-clear cell RCC as well. D^* value may be applied to differentiate AML from non-clear cell RCC.

To compare the characteristics, causes and relationship to osteoporosis between single and multi-level vertebral compression fractures in elders.

A total of 126 subjects (147 vertebrae) with acute back pain between September 2010 and December 2012 were diagnosed as vertebral fracture through magnetic resonance imaging. And single and multi-level vertebral compression fractures were evaluated on the basis of age, gender, bone mineral density (BMD), level of affected vertebrae and cause of injury.

The subjects with multi-level vertebral fractures were much older and there were more females. Among 39 multi-level fractures, the sites were thoracolumbar junction (n=18, 46.2%) and lumbar (n=11, 28.2%). The causes were metastatic carcinoma (n=9, 23.1%) and mild trauma (n=30, 76.9%). And 16(41.1%) subjects were of mixed type. The mean BMD, as measured by dual-emission X-ray absorptiometry, was 0.51 and 0.68 g/cm³ for multi and single-level vertebral fractures respectively. In subjects with single-level vertebral fracture, 43(49.4%) had vertebral fractures in thoracolumbar junction and 26(29.9%) in lumbar vertebrae. The causes were metastatic carcinoma (n=2, 2.1%) and high-energy trauma (n=73, 83.7%). And 30(34.5%) subjects suffered wedge compression fractures.

The patients with multi-level vertebral fracture are often older females with a lower BMD, a mixed type and vertebral metastatic carcinoma. And their causes are mild outer forces. Yet those with single-level vertebral fracture result from high-energy trauma and belong to the compression type.

To assess the early postoperative clinical and radiographic outcomes after navigation-assisted or standard instrumentation total knee arthroplasty (TKA).

From August 2007 to May 2008, 60 KSS-A type patients underwent 67 primary TKA operations by the same surgical team. Twenty-two operations were performed with the Image-free navigation system with an average age of 64.5 years while the remaining 45 underwent conventional manual procedures with an average age of 66 years. Their preoperative demographic and functional data had no statistical differences (P>0.05). The operative duration, blood loss volume and hospitalization days were compared for two groups. And radiographic data included coronal femoral component angle, coronal tibial component angle, sagittal femoral component angle, sagittal tibial component angle and coronal tibiofemoral angle after one month. And functional assessment scores were evaluated at 1, 3 and 6 months postoperatively.

Operative duration was significantly longer for computer navigation (P<0.05). The average blood loss volume was 555.26 ml in computer navigation group and 647.56 ml in conventional manual method group (P<0.05). And hospitalization stay was shorter in computer navigation group than that in conventional method group (7.74 vs 8.68 days) (P=0.04). The alignment deviation was better in computer-assisted group than that in conventional manual method group (P<0.05). The percentage of patients with a coronal tibiofemoral angle within ±3 of ideal value was 95.45% for computer-assisted mini-invasive TKA group and 80% for conventional TKA group (P=0.003). The Knee Society Clinical Rating Score was higher in computer-assisted group than that in conventional manual method group at 1 and 3 montha post-operation. However, no statistical inter-group difference existed at 6 months post-operation.

Navigation allows a surgeon to precisely implant the components for TKA. And it offers faster functional recovery and shorter hospitalization stay. At 6 months post-operation, there is no statistical inter-group difference in KSS scores.

To explore the treatment outcomes of plate internal and external fixations for distal forearm fractures in children.

From July 2010 to September 2013, a total of 89 children were operated for distal forearm ulnar and radial fractures, including plate fixation (n=46) and external fixation (n=43). Two groups were evaluated in terms of operative duration, bleeding volume, length of incision, hospitalization length, fracture healing time, postoperative complications and Berton evaluation criteria.

As compared with internal fixation group, external fixation group fare better in operative duration, bleeding volume, operation incision length, fracture healing time and postoperative complications with significant differences (P<0.05). And the hospitalization time had no significant difference (P>0.05).

Treating distal forearm fractures with external fixation offers the advantages of simpler handling, lesser injury and better post operative functional recovery in children.

To explore the effects of bone marrow-derived mesenchymal stem cell (MSC) on angiogenesis of cervical cancer cell.

MSCs from umbilical cord were mixed with cervical cancer cell line HeLa cells and subcutaneously plated in armpit area of nude mice to examine the in vivo tumor growth. Micro-vessel density (MVD) in tumor tissue was examined by CD34 immunohistochemical staining. Enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (PCR) were employed to detect the expression of proangiogenesis factors.

MSC could effectively promote the cervical cancer growth in vivo as compared with controls (P<0.05). The immunohistochemical results of CD34 staining showed that MVD of cervical cancer was higher in MSC group than that in control group (P<0.05). And there was a higher expression of vascular endothelial growth factor (VEGF) in MSC than controls.

MSC promotes the in vivo angiogenesis of cervical cancer cell line by VEGF production.

To explore the effects of rosiglitazone, a synthetic ligand of proliferator-activated receptor-γ (PPAR-γ) on vascular endothelial injuries in septic rats.

A total of 40 male Sprague-Dawley rats were randomly divided into 4 groups of vehicle control, lipopolysaccharide (LPS), pretreatment of rosiglitazone (ROSI) and pretreatment of PPAR-γ antagonist 2-chloro-5-nitroaniline (GW9662) (n=10 each). At 4 hours post-intervention, blood samples were collected to detect the expression of PPAR-γ by immunocytochemistry and image analysis. And the following parameters of vascular endothelial injury were measured: Vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), angiopoietin-2 (Ang-2), thrombomodulin (TM), anti-thrombin Ⅲ (AT-Ⅲ), tissue factor (TF), von Willebrand factor (vWF) and circulating endothelial cell (CEC).

① In ROSI group, the expression of PPAR-γ was significantly higher than that in LPS group (P<0.01). In GW9662 group, the expression of PPAR-γ had no significant difference compared to vehicle control group (P>0.05). ② The serum concentrations of VCAM-1, ICAM-1, Ang-2, TM, AT-Ⅲ, TF and vWF were significantly higher in LPS group than those in vehicle control group (P<0.01). The concentrations of these parameters in ROSI group were significantly lower than those in LPS group (P<0.01). In GW9662 group, the concentrations of these parameters had no significant difference compared with LPS group (P>0.05). ③ The numbers of CEC were significantly higher in LPS group than those in vehicle control group (P<0.01). And the numbers of CEC were significantly lower in ROSI group than those in LPS group (P<0.01). In GW9662 group, the numbers of CEC had no significant difference compared with LPS group (P>0.05).

Proliferator-activated receptor-γ agonist improves sepsis-induced vascular endothelial injury. And its mechanism may be through stabilizing vascular endothelial cell for improving serious inflammatory reaction and blood coagulation dysfunction.

A 39-year-old male was admitted to the Department of Rheumatology and Immunology of Peking Union Medical College Hospital in June 2012 due to fatigue for 7 years, lower limb edema for 1 year, headache and diplopia for 1 month. The patient developed fatigue 7 years ago. He went to the local hospital and found that hemoglobin and platelets decreased (details unknown). He was diagnosed with Evans syndrome and was treated with prednisone and human gamma globulin. One year ago, I had low back pain, edema of both lower limbs, and increased foam in my urine. I went to Peking Union Medical College Hospital. Blood routine showed that white blood cells and hemoglobin were normal, and platelets were 56×10.⁹/L; Serum albumin 21 g/L; 24 h urine protein 9.86 g; Antinuclear antibody homogeneous 1:1 280 positive, anti-double-stranded DNA antibody, anti-human globulin (Coomb's) test positive; He was diagnosed as systemic lupus erythematosus (SLE), lupus nephritis (LN), and nephrotic syndrome (NS). He was treated with oral prednisone 60 mg/d and intravenous infusion of cyclophosphamide 1.0 g/month, but the urinary protein decreased unsatisfactorily. He was added with azathioprine 200 mg/d oral, but the urinary protein still did not disappear. 1 month ago, headache, nausea, jet vomiting, accompanied by left eye vision loss, diplopia, left eyelid swelling and hearing loss, tinnitus, loss of consciousness, epilepsy, etc. Ophthalmological examination showed abductor nerve paralysis, papilledema, retinal hemorrhage and conjunctivitis in the left eye. Admitted for further diagnosis and treatment. Past, personal, marriage and childbirth, family history are no different. Physical examination: body temperature 36.6 ℃, heart rate 90 beats/min, 20 breaths/min, blood pressure 150/104 mmHg (1 mmHg =0.133 kPa); The left eyelid was swollen, the abduction of the left eye was limited, the other directional movements and the right eye movement were normal, the vision of both eyes was slightly blurred, there was no visual field defect, the cardiopulmonary and abdominal examination was normal, and the lower limbs could be concave edema. Soft neck, negative meningeal irritation sign, pathological sign not drawn out, laboratory test: blood routine: white blood cells 6.30×10⁹/L, hemoglobin 119 g/L, platelets 12×10⁹/L. Blood biochemistry: Alanine transferase 39 U/L, aspartate transferase 18 U/L, albumin 30 g/L, creatinine 90 μ mol/L. Urine routine: protein>3.0 g/L, red blood cells 2×10^-4/L, 100% abnormal, visible tube type. 24 h urine protein 5.40 g. High sensitivity C-reactive protein 1.49 mg/L, erythrocyte sedimentation rate 27 mm/1 h. Coagulation: prothrombin time 10.8 s, activated partial thromboplastin time 21.7 s, fibrinogen 3.19 g/L, D dimer 13.13 mg/L, INR 0.93, homocysteine 10 μ mol/L. Antinuclear antibody homogeneous 1:80 positive, anti-double stranded DNA antibody 0.1 IU/L, complement C3 0.709 g/L, complement C4 0.182 g/L. Anti-phospholipid antibody negative. Bone marrow smear: active hyperplasia, no abnormalities in granules and erythroid, and many megakaryocytes. Bone marrow biopsy: hematopoietic tissue is slightly reduced, the proportion is roughly normal, and megakaryocytes are visible. Lumbar puncture: CSF pressure>330 mmH₂O (1 mmH₂O =0.0098 kPa), the routine, biochemistry and cytology of cerebrospinal fluid were normal, and the pathogenic examinations of bacteria, fungi and viruses were negative. Cranial magnetic resonance venous angiography (MRV): the left internal jugular vein, bilateral sigmoid sinus, bilateral transverse sinus, sinus sinus, straight sinus and superior sagittal sinus were not developed, and the possibility of thrombosis was high (Figure 1)。

Langerhans histiocytosis (LCH), also known as histiocytosis X, is a non-neoplastic proliferative lesion of unknown cause, which is characterized by pathological proliferation of Langerhans cells^[1]。 LCH can involve multiple organs and systems. Hepatic Langerhans histiocytosis (HLCH) can be part of multisystem lesions of LCH, or it can be limited to the liver. The latter was also known as hepatic eosinophilic granuloma (HEG) in the past. The onset age is mainly in children, but it is rare in adults. In this study, 3 adult patients with HLCH confirmed by pathology were collected, and their clinical and imaging manifestations were analyzed to improve the understanding of this disease.

bone marrow failure syndromes (BMFS) are a group of bone marrow failure diseases arising from damage to hematopoietic stem and/or progenitor cells, involving one or more lineages of blood cells. Clinically, it can be divided into two categories: hereditary and acquired. Acquired BMFS are the most common, while hereditary BMFS are relatively rare. Acquired BMFS are divided into two categories: primary and secondary. Secondary BMFS mainly refer to bone marrow suppression caused by hematopoietic tumors, extramedullary tumors, bone marrow infiltration, radiotherapy, chemotherapy and other factors. Primary BMFS mainly include aplastic anemia (AA), immune-related cytopenia (IRH), hypoproliferative paroxysmal nocturnal hemoglobinuria (PNH), myelodysplastic syndrome (MDS) and unspecified cytopenia (ICUS). This paper focuses on AA and IRH, both of which belong to bone marrow hematopoietic failure caused by abnormal immune mechanism. The main immunopathogenesis of AA is T cell immune abnormality, and cytotoxic T cells (CTL) are the main effector cells. CTL apoptosis of hematopoietic stem progenitor cells through cytotoxicity, resulting in pancytopenia; The main immune pathogenesis of IRH is humoral immune abnormalities, mainly abnormal number and function of B lymphocytes, which in turn produce autoantibodies against immature hematopoietic cells of bone marrow. Bone marrow cell membrane antibodies, as the main effector molecules, destroy or inhibit bone marrow hematopoiesis, and finally cause hemopenia. However, the main pathogenesis of PNH and MDS is due to the abnormality of hematopoietic stem cell plasm, so it is not discussed in this paper.

Pheochromocytoma (PHEO) /paraganglioma (PGL) originates from sites with chromogenic tissue distribution of the sympathetic and parasympathetic chains of the neural crest, PHEO is in the adrenal medulla; The PGL is located in the accessory ganglion of the adrenal diplomatic or parasympathetic nerves from the base of the skull to the pelvis, most commonly in the head and neck, near the abdominal renal vessels or in the Zuckerkandl body, which is located at the onset of the inferior mesenteric artery and is the largest chromiophilic tissue outside the adrenal gland^[1,2]。 pheochromocytoma/paraganglioma (PPGL) accounts for about 0.2% to 0.6% of hypertensive people and about 7% of sympathetic nervous system tumors, with an annual incidence of 0.3/1 000 000. It occurs more often in the age of 20 to 50, with more women than men. Up to 75% were never suspected before their lives, and about 15% were familial^[1]。 The genetic background, clinical presentation and degree of malignancy of PPGL were all different. About 10% to 20% of cases are diagnosed in childhood, slightly more in males. Among children with hypertension, up to 1.7% had catecholamine-secreting tumors^[3]Most of them are pheochromocytomas. PGL from sympathetic nerves is functional, while PGI from parasympathetic nerves is mostly non-functional, depending on the location and type of mutation^[1]。 About 56% of PHEO patients under 18 years old are caused by genetic mutations;<At 10, it is as high as 70%. Hereditary PHEO is often bilateral, while PPGL is often multifocal. In general, multicentric tumors are often highly suggestive of familial disease and are more common in PPGL patients^[4]。 A total of 14 PPGL susceptibility genes have been reported so far: NF1, RET, VHL, SDHD, SDHC, SDHB, EGLN1/PHD2, KIF1, SDH5/SDHAF2, IDH1, TMEM127, SDHA, MAX and HIF2^{[5,6,7,8,9,10,11,12]}。 Among them, the roles of EGLN1/PHD2, KIF1 and IDH1 have not been confirmed by other studies at present, indicating that these gene mutations are not a common cause of hereditary PPGL. EPAS1/HIF2A mutations have also only been reported in a small number of patients^[12], to be confirmed by numerous reports.

The management of primary non-induced epilepsy is a matter of great concern for epilepsy patients and their families, and whether to give intervention is also a question of confusion for clinicians. The study found that 1/3 of the patients with the first non-induced epileptic seizure had a recurrent seizure, and 3/4 of the patients with the second to third seizure had a recurrent seizure^[1]； With the increase of the number of seizures and the prolongation of the natural course of epilepsy before treatment, the effect of drug treatment became worse and worse, and the time between the two seizures was gradually shortened, so the possibility of evolving into active epilepsy increased^[2,3]Therefore, early treatment is recommended for epilepsy patients with more early seizures. However, it is still inconclusive how to deal with epilepsy patients with initial non-induced epileptic seizures or rare early seizures. The new clinical practical definition of epilepsy recently published by the International Anti-Epilepsy Alliance (ILAE) has attracted widespread attention in the epileptic community at home and abroad. The definition is that epilepsy is a brain disease, which can be identified as epilepsy if any of the following conditions meets: (1) at least two non-induced (or reflex) seizures with an interval of>24 h. (2) one non-induced (or reflex) episode and the risk of recurrence is comparable (at least 60%) to the risk of recurrence after two non-induced episodes within the next 10 years. (3) Diagnosis of some epileptic syndrome^[4]。 However, in many cases, it is impossible to accurately judge whether the risk of recurrence is>50%, 60% or 80%. For specific patients, the influence of other clinical factors should be considered, so as to have a more accurate grasp of the patient's treatment opportunity and prognosis. The progress of the factors affecting the prognosis of patients with epilepsy is reviewed.

The Cervical Spine Research Society (CSRS) was founded in 1973. It is an interdisciplinary communication platform involving multidisciplinary organizations to promote the development of basic and clinical Research on Cervical spondylosis. At present, CSRS Europe and CSRS Asia Pacific have developed. The 2014 CSRS Annual Meeting was held in Orlando, USA from December 4 to 6. The Chair of this annual meeting was Professor Darden from Carolina Orthopedic Spine Center in Charlotte, USA. The co-executive chairs are Professor Lehman and Professor Hsu, a Chinese American. The conference selected 58 papers as speeches, 15 posters and 36 electronic posters. This annual meeting continued the tradition of CSRS, and started the 19th cervical spine surgery teaching course on the first day of the annual meeting. Systematic explanation and video demonstration were given from four aspects: cervical spine surgery technique, prognosis evaluation, treatment and complications of cervical spine trauma and cervical spondylotic myelopathy. During the formal meeting, the participants discussed the research progress in the diagnosis, treatment strategy selection, efficacy and prognosis, surgical complications and basic research of cervical spine diseases. This conference attracted more than 300 cervical spine surgeons from all over the world to participate, and the number of Chinese scholars participating is also increasing year by year. This year, more than 20 Chinese scholars attended the conference, including Professor Tian Wei of Jishuitan Hospital and Professor Liu Xiaoguang, Sun Yu and Liu Zhongjun of the Third Hospital of Beijing University. The following is an overview of the hot spots and key issues of this annual meeting.