Volume 95  ·  Issue 17  ·  2015

The successful holding of the 2008 Beijing Olympic Games and the 2013 Nanjing Youth Olympic Games indicates that China is gradually moving from a big sports country to a strong sports country. Undertaking large-scale international comprehensive sports events is a symbol of a country's strong comprehensive national strength and noble national civilization, and it has an infinite promoting role in many fields such as economy, society, culture and environmental sanitation of the host country. However, during the extremely competitive event, facing tens of thousands of athletes, coaches, staff, etc., and facing more professional, specialized and systematic medical needs, how to safeguard athletes' health, prevent the occurrence of sports injury and other diseases, quickly and accurately diagnose and evaluate the degree of sports injury, and provide detailed information for the choice of treatment plan and rehabilitation evaluation is an important topic and huge challenge to the development of sports medicine imaging in China. Therefore, it is necessary to improve the research level of sports medicine imaging in China^[1]It is of great value to give full play to its important role in medical security in large-scale sports games and establish a sports injury imaging diagnosis platform that meets international standards.

To retrospectively analyse the medical imaging examination results of the injuries and illnesses during the 2008 Olympic Games and 2013 China National Games in Shenyang Divison.

Collected and analyzed the health information and medical imaging examination results from Shengjing Hospital of China Medical University during the two games.

There was 9 cases of sports injuries in the 2008 Olympic Games, mainly for knee, ankle ligament injury and muscle sprain , 36 cases of sports injuries in the 2013 China National Games, mainly for head traumas(9 cases), knee injuries(7 cases), ankle injuries(7 cases), shoulder injures(4 cases). Competitions of high risk of being injured were wrestling (10 cases), track and field (8 cases), American football (6 cases). The most common cause of illness were respiratory system (60 cases) and the digestive system (27 cases) in the total 233 cases illnesses in the China National Games.

Different sports have different characteristic, regularity and mechanism of injury.Medical imaging examination has important value in the diagnosis of injury during large games.The respiratory system and digestive system are the most common illnesses and affect the athletes training and competition as important as injuries.So illness is the focus on the medical care assurance of the large games.

To analyze the imaging abnormal findings of ankle injuries in professional soccer player of males.

The thirty-two professional soccer players in local region soccer club had been selected as research objects from March 2014 to January 2015, and all were men.Average age was 22.03±3.0 years old(19-33 years); the average age was 8.6±2.0 years old that began to engage in professional football training, and average time of engaged in football sports was 13±4 years(7-27 years). X-ray examination was used VM DR (Philips Co.), anteroposterior and lateral position of ankle joints.CT scan was used MSCT of 64 rows detector(Aquilion 64, TOSHIBA Co.). After routine scan, raw data was transmitted to the workstation and then reconstructed to be axial, sagittal, coronal imaging. MR examination was used 1.5 T superconducting equipment system(Achieva Dual, Philips Co.) and with ankle joint special phased array coil.TSE sequence be used to scan routine axial T₂-weighted imaging; coronal T₁-weighted imaging; coronal PWI; and sagittal T₂-weighted imaging with fat suppressed.The sagittal PWI scan was used with Isotropic with fat suppressed FFE sequence.

The X-ray examination was finished for 28 person and 51 ankle joints.26 person and 52 ankle joints were completed CT scan and reconstructed imaging for all joints.MR examination was finished in 30 person and 51 ankle joints.On X-ray and CT display that the abnormal changes of the talus is most commonly found that the incidence of "dolphin mouth" like protrusion at posterior edge was 35 ankles (rate of occurrence was 68.6%), the triangle prominence at out edge was 45 ankles (rate of occurrence was 88.2%). It also was found that 8 lateral malleolus have osteophytes, 5 ankles have medial malleolus osteophytes and 12 ankles have loose bodies at posterior ankle. MRI showed that 30 ankles were the anterior talofibular ligaments injury and incidence was 58.82%, 26 ankles were posterior talofibular ligaments injury (incidence was 51.0%), 25 ankles were calcanofibular ligaments injury (incidence was 49.0%), 29 ankles was the synovitis and local effusion at posterior ankle(incidence was 56.9%), the partial ligaments injured of deltoid ligaments were usually found and entirely torn were very rare(only three ankles). The former groups and shallow ligaments of deltoid ligaments were prone to injury.The common tendon disease of injury was tenosynovitis, 18 flexor hallucis longus tenosynovitis, 13 posterior tibialis tenosynovitis, 7 flexor digitorium tenosynovitis, 5 peroneus longus tenosynovitis, 2 peroneus brevis tenosynovitis and 6 Achilles tendinopathy.Tendinosis and tendon degeneration was relatively rare.

The professional soccer players have been easily lead to the anatomic abnormal and pathological changes in the bones, ligaments and tendons due to long-term training and competition.The majority changes were chronic injury. Imaging examination can be found the abnormal changes of ankle and could help athletes, coachs, doctors to understand and assess the ankle structure and functional status.

To explore the anatomy and injuries features of the thumb collateral ligamentat the metacarpophalangeal(MCP) joints.

The study was reviewed and approved by an institutional review board of hospital.Clinical imaging data of 7 healthy volunteers who without injuries and 20 patients with thumb collateral ligament injuries were retrospectively analyzed.All subjects underwent magnetic resonance examination, then comparative analysis of the normal anatomy and the thumb collateral ligament injury at MCP joints of MRI features in healthy volunteers and patients with injury.Imaging findings were compared with the surgical results and confirmed by followed up in patients.

Seven volunteers without ligament injures showed homogeneous low-signal-intensity on T₁-weighted and proton fat saturation sequence(PD-FS) images.The average thickness of the ulnarcollateral ligament is about 2.0 to 2.3 mm, however, the normal radial collateral ligament is thinner, the average thickness is about 1.4-1.5 mm.There were 20 patients with thumb collateral ligament injuresat MCP joints, including 12 cases of ulnar collateral ligament injury and 8 cases of radial collateral ligament injury, which demonstrated poor definition, discontinuity and heterogeneously increased signal intensity in proton fat saturation sequence(PD-FS) of the involved collateral ligament.There was edema in the soft tissues surrounding the injured sites.

MRI is an accurate method for evaluation of the anatomy and pathologic conditions of the thumb collateral ligamentsat MCP joints, and it is a useful tool for early diagnosis and treatment of the thumb collateral ligaments injuries.

To explore the serum level of sclerostin in ankylosing spondylitis (AS) patients and evaluate its diagnostic value and the relationship of sclerostin with inflammation and ossification process in AS.

A total of 75 AS patients and 45 healthy controls were enrolled into this randomized controlled study. The clinical indices (age, gender, course of disease and disease activity), changes in radiographic studies and indices of bone metabolism or inflammation, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were evaluated or measured. The disease activity was assessed by Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis metrology index (BASMI) and Bath arthritis spondylitis radiology index (BASRI). And radiographic changes were evaluated according to the modified Stoke AS spine score (mSASSS) and serum level of sclerostin was measured by enzyme-linked immunosorbent assay (ELISA). The relationship between sclerostin and clinical indices, radiographic scores and inflammatory indices was estimated by SPSS software and the diagnostic value of sclerostin analyzed by receiver operator characteristic (ROC) curve.

The levels of ESR and CRP were higher in AS patients than those in healthy controls. However, serum sclerostin was lower (55.6±19.5 pmol/L) compared with healthy controls (78±27.6 pmol/L, P<0.01). ROC analysis revealed that the diagnostic specificity and sensitivity of sclerostin were 91.5% and 82.02% respectively with a cut-off of 62.75 pmol/L (Youden index 0.735, AUC 0.905, 95%CI 0.812-0.947). And the diagnostic validity was high. No significant correlation existed between sclerostin and ESR, CRP, BASDAI, BASMI and BASFI scores. ESR, CRP, BASDAI, BASMI and BASFI score were improved significantly in AS patients after anti-TNF treatment compared with baseline (P<0.01). There was little difference between BASRI and mSASSS score after anti-TNF treatment compared with baseline (P=0.19, 0.67). A significant negative correlation existed between the radiographic progression in spine of patients with AS and sclerostin serum levels (r=0.768, P<0.01). This correlation became stronger when radiographic scores rose (mSASSS>10,r=0.768, P<0.01) and it diminished when radiographic scores dropped (0<mSASSS<10,r=-0.097, P=0.43).

Serum sclerostin may serve as a diagnostic biomarker of AS and progression index of ossification, especially in late stage of AS. A low serum level of sclerostin in the setting of AS is linked to greater structural damage.

To explore the roles of type Ⅱ collagen C-terminal telopeptide (CTX-Ⅱ), matrix metalloproteinase-13 (MMP-13) and interleukin-6 (IL-6) in lateral compartment wear in varus knee osteoarthritis.

Prospective reviews were conducted for the clinical data of varus knee osteoarthritis patients with lateral compartment wear undergoing total knee arthropalsty from June 2013 to June 2014.The gross findings of lateral compartment articular cartilage were recorded intraoperatively.And the slices were evaluated histologically.Synovial fluid was obtained by arthrocentesis.An equal number of operative patients from varus knee osteoarthritis without lateral compartment wear during the same period were selected and matched with respects to age, varus, preoperative range of motion and radiological grade of knee arthrosis.Synovial fluid concentrations of CTX-Ⅱ, MMP-13 and IL-6 were evaluated.

Histologic examination showed microscopic cartilage degeneration in both groups.The concentrations of CTX-Ⅱ, IL-6 and MMP-13 in synovial fluid from lateral compartment wear group were (111.8±55.7) ng/L, (2.5±1.0) ng/L and (134.4±33.1) μg/L respectively.And there were no differences with control group (91.7±57.1) ng/L, (2.1±0.5) ng/L, (122.7±28.3) μg/L respectively.

The above biochemical factors may not play key roles in lateral compartment wear of varus knee osteoarthritis.

To explore the expression of regulatory B cells (Bregs) in peripheral blood of patients with systemic lupus erythematosus (SLE) and elucidate the function of Bregs in the pathogenesis of SLE.

A total of 38 active SLE patients, 22 inactive SLE subjects and 20 healthy controls were enrolled.The expressions of IL-10⁺CD19⁺Breg and CD19⁺CD24^hiCD38^hiBreg in peripheral blood mononuclear cells (PBMC) were evaluated by flow cytometry.And IL-10 was measured in the culture supermatants by enzyme-linked immunosorbent assay (ELISA).

The expression of IL-10⁺CD19⁺Breg in PBMCs of active SLE patients was (1.54±0.64)%.And it was lower than those in inactive SLE patients (2.42±0.75)% (P<0.01) and healthy controls (4.35±1.00)% (P<0.01). And the expression of CD19⁺CD24^hiCD38^hiBreg was (1.26±0.45)%.Also it was lower than those in inactive SLE subjects (2.01±0.61)% (P<0.01) and healthy controls (3.14±0.87)% (P<0.01). The level of IL-10 significantly decreased in culture supermatants of active SLE patients.And it was lower than those in inactive SLE subjects (P<0.05) and healthy controls (P<0.01). The percentage of IL-10⁺CD19⁺Breg and CD19⁺CD24^hiCD38^hiBreg in PBMCs of SLE patients was positively correlated with the level of IL-10 in culture supernatants (r=0.652, P<0.01 andr=0.574, P<0.01).

The expression of IL-10-related Bregs significantly decreases in PBMCs of active SLE patients. And Bregs may play some role in the pathogenesis of SLE.

To explore the relationship between ambulatory blood pressure and myocardial performance index (MPI) in hypertensive patients.

A total of 76 hospitalized patients with untreated hypertension from January to June 2013 were recruited.They received the examinations of office blood pressure, 24 h ambulatory blood pressure and echocardiography.MPI was determined by the following formula: MPI = (isovolumic contraction time+ isovolumic relaxation time)/ejection time.Based upon left ventricular MPI, they were divided into two groups of MPI >0.47 ( n=38) and MPI ≤0.47 (n=38). The mean levels of office blood pressure, ambulatory blood pressure, blood pressure load, morning blood pressure surge (early morning blood pressure minus the lowest night-time blood pressure) and nocturnal blood pressure changes were compared between two groups.And the determinants of MPI were identified by multivariate regression analysis.

As compared to those with MPI ≤0.47, patients with MPI >0.47 had higher 24 h and daytime systolic blood pressures, 24 h, daytime and nighttime diastolic blood pressures, 24 h, daytime and nighttime systolic blood pressure loads, 24 h, daytime and nighttime diastolic blood pressure loads and morning systolic blood pressure surges (all P<0.05). No inter-group differences existed in the mean levels of office blood pressure, nighttime systolic blood pressure, morning diastolic blood pressure surge, nocturnal systolic or diastolic blood pressure changes (allP>0.05). Multivariate regression analysis showed that nocturnal diastolic blood pressure (β=0.285, P=0.005) and daytime systolic blood pressure load (β=0.397, P<0.001) were independently associated with MPI.And other factors independently associated with MPI were left ventricular mass index (LVMI) and early diastolic mitral annular velocity (Em).

The increases of blood pressure level and blood pressure load are associated with an elevation of left ventricular MPI.

To explore the efficacy and mechanism of hemoperfusion (HP) plus hemodialysis (HD) for peripheral neuropathy of uremic patients on maintenance hemodialysis.

A total of 66 uremic patients on hemodialysis during January 2014 and April 2011 were assigned randomly into HP+ HD, low-flux HD and high-flux HD groups (n=22 each). The serum levels of leptin, endothelin-1 (ET-1), parathyroid hormone (PTH) and β-2 microglobulin were observed pre and post-treatment.And sensory conduction velocity (SCV) was detected simultaneously.

After 12-week treatment, the clinical symptoms of group HP+ HD improved significantly with an effective rate of 90.91% while improvement was not obvious in groups high-flux and low-flux HD with effective rates of 31.82% and 13.64%.In HP+ HD group, the levels of leptin, ET-1, PTH and β-2MG decreased, sensory conduction velocity increased ( P<0.05) and clinical symptoms improved apparently.While in low-flux HD and high-flux HD groups, leptin, ET-1, PTH and β-2MG had no decrease and SCV showed no improvement (P>0.05). Correlation analysis showed that the levels of leptin, ET-1 and β-2MG were negatively correlated with SCV(r=-0.57, r=-0.47, r=-0.56). Yet PTH had no correlation with SCV (r=-0.23).

Hemoperfusion plus hemodialysis may improve the clinical symptoms of peripheral neuropathy of uremic patients on maintenance hemodialysis.And it is probably due to the fact that HP+ HD effectively removes such plasma middle and macromolecular toxins as leptin, ET-1, PTH and β-2MG.

To explore the prevalence, number and size of anastomoses, placenta sharing and placental cord insertion in twin-to-twin transfusion syndrome (TTTS).

A total of 97 monochorionic placentas were collected from June 2013 to June 2014 during fetoscopic laser surgery or selective feticide.After eliminating 23 placentas of selective intrauterine growth restriction (sIUGR), 79 placents were analyzed.There were 24 placentas of TTTS and 32 placentas of normal monochorionic twins (McT) without complex twin preganancy.Placental sharing, placental cord insertion, angioarchitecture and diameter of vascular anastomosis were assessed by placental injection with colored dye and compared between TTTS and McT without complex twin preganancy.

(1) Arterio-arterial (AA) anastomoses were detected in 37.5% of TTTS placentas versus 75.0% in normal McT placentas (P<0.01). (2) The median number of AA anastomoses in TTTS group was significantly less than that in normal group (0.0 vs 1.0,P<0.01). And the median total diameter of AA anastomoses in TTTS group was significantly smaller than that in normal group (0.00 vs 2.25 mm,P<0.01). (3) The incidence of placentas with at least one cord non-central insertion (70.8% vs 62.5%,P>0.05), velamentous insertion (25.0% vs 6.3%,P>0.05) in TTTS and normal McT had no difference respectively.The placental territory discordance (PTD) had no difference between TTTS and normal McT (0.33 vs 0.22,P>0.05).

AA anastomosis occurs less frequently in TTTS placentas, supporting the concept of a protective role of AA anastomoses in TTTS. McT placentas without AA anastomosis have high risk for TTTS.The compensatory ablitiy of AA anastomosis may determine the time of TTTS onset.Non-central or velamentous cord insertion, placental sharing discordance are not risk factors for TTTS.

To explore the restrictive use of episiotomy for low forceps delivery.

A total of 311 low forceps delivery women at ≥37 weeks of gestation with live singleton cephalic pregnancies were recruited from June 2013 to December 2013 at our hospital.Among whom, 117 women underwent no episiotomy another 194 had mediolateral episiotomy.The maternal and neonatal outcomes of two types of episiotomy were compared.

The amount of intra and post-partum hemorrhage, Ⅰ-Ⅱ perineal tearing, time of perineal suturing, perineal pain severity of post-partum 24 h significantly decreased than control group (P<0.05). No statistical significant inter-group differences existed in perineal hematoma, postnatal infection, urinary retention or length of stay after childbirth (P>0.05). And no statistically significant inter-group differences existed in incidence rates of neonatal asphyxia, neonatal birth trauma and newborns into neonatal intensive care unit (NICU) (P>0.05).

During low forceps delivery, restrictive use of episiotomy may decrease the rate of episiotomy, reduce the amount of hemorrhage, minimize maternal injury, relieve pain and have no adverse effects on neonatal morbidities.And it improves the quality of vaginal delivery and demonstrate the concept of mini-invasiveness so that it is worthy of wider promotions.

To explore the value of cervical liquid-based cytology test (LCT) and high-risk human papilloma virus for patients of high-grade squamous intraepithelial lesion (HSIL) excised with positive margins by loop electrosurgical excision procedure (LEEP).

A total of 404 HSIL patients with positive margins by LEEP and a follow-up of 12 months between June 2004 to April 2013 were recruited.The results of LCT, high-risk human papillomavirus (HR-HPV) DNA were analyzed retrospectively.According to the pathological diagnosis of re-operation, the results of LCT and HR-HPV DNA were analytically predicted for focal residue and recurrence.

For patients with HSIL excised with positive margins by LEEP, the re-positive abnormality rate of LCT and/or HPV was 18.7% and the sustained positive rate of LCT and/or HPV 51.1%.The significance prediction of LCT and HR-HPV DNA examination for persistent and recurrent cervical dysplasia had a positive predictive value of 60%, a sensitivity of 100%, a positive likelihood ratio of 2.1, a negative likelihood ratio of 0.5 and an odds ratio of 4.5.

For patients of HSIL excised with positive margins by loop electrosurgical excision procedure, LCT plus HR-HPV test may be effective after operation.And the positive results should be re-evaluated by colposcopy to provide rationales for re-operation.

To evaluate the potential roles of MR perfusion weighted imaging (PWI) in preoperative assessment of vascularity of meningiomas.

39 patients with meningiomas underwent conventional MR and PWI before operation (GradeⅠ32 cases, GradeⅡ+ Ⅲ 7 cases). Immunohistochemical stain methods were used to quantitatively measure the microvessel density(MVD)values in meningiomas after operation.The pulse sequence of PWI was single shot GRE-EPI- T₂^*WI , the cerebral blood volume (CBV) maps were calculated from the original data of perfusion images and the maximum CBV values of meningiomas was acquired from CBV maps through measurement on the region of interest (ROI). The mean maximal relative cerebral blood volume (rCBV) values were calculated by dividing the maximum CBV of a tumor by that of the contralateral white matter.The differences of the mean maximal rCBV values between benign and malignant groups were analysed and commpared with the MVD values.

The mean maximal rCBV values of benign and malignant groups were 9.76±4.68 and 3.57±0.27, respectively.The MVD values of benign and malignant groups were 22±12 and 11±5, respectively.The difference in mean maximal rCBV values between the two groups was statistically significant(t=7.166 , P<0.01). Correlation analysis demonstrated that the mean maximal rCBV values and MVD values had significantly positive correlation (r=0.715 , P<0.01).

The mean maximal rCBV values are feasible for evaluation of microvessel angiogenesis of meningiomas in vivo and useful for predicting tumor grade.

To explore the complications of endoscopic third ventriculostomy (ETV) for hydrocephalus and examine their preventions.

From September 2008 to September 2013, ETV was offered for obstructive hydrocephalus (n=15) and communicating hydrocephalus (n=5). And the prevention and treatment of common complications were analyzed.

All had achieved satisfactory outcomes.For 16 cases, their symptoms and signs disappeared, ventricle returned to normal and interstitial edema resolved; for another 4 cases, there were improvements of symptoms and (or) signs, ventricular shrinking and/or interstitial edema lessening.And the postoperative complications included fever (n=5), poor healing of incision (n=2), scalp hydrops (n=2) and intracranial infection (n=1).

The indications of ETV should be selected strictly according to the specific anatomical characteristics of bottom of third ventricle.And individualized methods of stoma are necessary.And early postoperative lumbar puncture and drainage may obviously reduce complications and improve surgical outcomes.

To explore the anti-nociceptive effects of heme oxygenase 1 (HO-1) on bone cancer pain in mice.

The model of bone cancer pain was established by an inoculation of prostate tumor cell line RM-1 cells into intramedullary space of murine femur.Bone destruction and tumor formation in femur were checked by hematoxylin and eosin staining.The mechanical allodynia and heat hyperalgesia were examined by behavioral testing.After intraperitoneal injections of HO-1 inducer (CoPP) and HO-1 inhibitor (SnPP), the protein content of HO-1 in spinal cord was examined by Western blot.

The invasion of tumor cells into bone and bone destruction were induced by an injection of RM-1 into right femur.The paw withdrawal threshold (PWL) and paw withdrawal latency (PWL) decreased significantly at 7 days after inoculation and maintained for over 21 days.HO-1 inducer CoPP increased PWT and PWL dramatically in mice with bone cancer pain after consecutive intraperitoneal dosing of CoPP for 5 days.However, SnPP unaltered pain behaviors.Western blot showed the expression of HO-1 in spinal cord was up-regulated after an intraperitoneal injection of CoPP and unchanged after an intraperitoneal injection of SnPP.

Intramedullary inoculation of prostate tumor cell line RM-1 cells produces bone cancer and induces bone cancer pain. An up-regulation of HO-1 in spinal cord may alleviate bone cancer pain.

A 21-year-old male, Han nationality, was seen for "weakness of both upper limbs for 3 years". Three years ago, the patient accidentally found weakness in both upper limbs, with weakness in proximal lifting, but he could still lift it, and there was no obvious obstacle in eating and brushing his teeth. After 1 to 2 months, it was relieved, and no diagnosis and treatment were given. Two months later, lumbar compression fracture was caused by trauma, and the proximal weakness of both upper limbs was aggravated again, and the distal ends of both upper limbs were gradually involved, resulting in a loss of fine touch in both hands. In the past year and a half, the patient's symptoms have obviously aggravated, and he can no longer take care of himself in daily life. Since the onset of the disease, there is occasional fleshy sensation in the upper limbs and chest, but there is no numbness and pain in the limbs, no dysarthria, choking and coughing after drinking water, dysphagia, no vision loss and diplopia.

The patient was an 18-year-old male with muscle soreness and weakness in his limbs for 2 d. He was admitted to hospital on July 8, 2014. The patient and three family members all experienced nausea and vomiting after eating self-collected wild fungi for 6~18 h, and self-induced vomiting and catharsis. The patient experienced shoulder and upper arm soreness 48 h after taking mushroom, and lower limb soreness and pain, which progressively aggravated to the point that he could not walk, relieving "soy sauce-colored" urination. The patient had no fever, excessive exercise, no trauma, and no history of drinking alcohol or drugs before illness. Physical examination at admission: body temperature: 36.5 ℃, heart rate: 105 beats/min, respiratory rate: 26 beats/min, blood pressure: 139/84 mmHg (1 mmHg =0.133 kPa), uniform heart rhythm, no pathological murmur, coarse respiratory sound in both lungs, no dry and wet rales, soft abdomen, insufficient liver and spleen. Main positive signs of nervous system: proximal muscle strength of both upper limbs grade 4, distal muscle strength of both upper limbs grade 5-, proximal muscle strength of both lower limbs grade 3, distal muscle strength of both lower limbs grade 4, and decreased muscle tone. The tendon reflexes of the extremities were weakened, and bilateral gastrocnemius tenderness was evident. Blood routine on the day of admission: white blood cells: 11.46×10⁹/L, neutrophils: 0.894, red blood cells 6.13×10¹²/L, hemoglobin 179 g/L, platelets 165×10⁹/L. Urine routine: urine "soy sauce color", pH: 5.0, white blood cells 0~1/HP, red blood cells 0~1/HP, Pro (+ + +), occult blood (-). Creatine kinase (CK) 75 785 IU/L, ECG: sinus tachycardia. HIV antibody negative, TORCH antibody negative. Blood immunology negative. Electromyography of the extremities: myogenic lesions. Symptomatic treatment such as hormones and alkalized urine was given, and the patient's symptoms were aggravated, with dyspnea, weak cough and dysphagia. On July 9, CK continued to rise, and there was myocardial injury (Table 1)。 Electrolytes: serum potassium 5.53 mmol/L, serum sodium Na 134.8 mmol/L, calcium and phosphorus normal. Liver function aspartate aminotransferase, alanine aminotransferase high, bilirubin normal. Kidney function is normal. HA330 blood perfusion was continued three times (once daily) after plasma exchange once on July 9 (60 h after eating mushroom). The symptoms began to improve on the next day of blood purification treatment, and the muscle enzymology review was shown inTable 1After 12 days of treatment, the patient's symptoms disappeared, CK was normal, and the patient was discharged.

Tumors in posterior cranial fossa are closely related to the surrounding cranial nerves, blood vessels and brain stem. The most common complication of surgery is the damage of cranial nerves, which seriously affects the quality of life of patients. At present, precision is the development direction and concept of neurosurgery in the high-tech era^[1]。 Intraoperative neuroelectrophysiological monitoring can monitor the corresponding nerve function while the surgeon removes the tumor tissue in the brain, and protect the nerve function to the maximum extent. From March 2012 to February 2014, the Department of Neurosurgery of Huanhu Hospital performed intraoperative neuroelectrophysiological monitoring of cranial nerves in 50 patients with tumors in the posterior cranial fossa area, and followed up to evaluate the functional preservation of patients' nerves after surgery. The results are reported below.

Ankle injury is a common lower limb injury in athletes, and the incidence rate can reach 21% ~40%. Some studies have shown that if athletes fail to make accurate diagnosis and timely and effective treatment in the early stage after ankle injury, and enter training and competition before the symptoms and signs have completely recovered, it will lead to further serious injury of ankle joint, cause joint dysfunction, and even affect athletes' career^[1,2]。 Therefore, early and accurate diagnosis, effective treatment and rehabilitation after ankle injury are very important for athletes to maintain a good competitive state and prolong their athletic life. Imaging examination methods and diagnostic skills are important links for early detection of lesions in time and accurate diagnosis. This article reviews the problems related to imaging diagnosis of ankle injury.

osteoarthritis (OA) is a chronic progressive joint disease characterized by degeneration of articular cartilage and secondary bone hyperplasia. It is the result of the imbalance of normal synthesis and degradation of articular chondrocytes, extracellular matrix and subchondral bone due to the interaction of mechanical and biological factors. The pathological changes of OA were mainly: focal changes, destruction and defect of articular cartilage, reactive bone hyperplasia and osteophyte formation around the lesion^[1]。 The results of the Global Burden of Disease 2010 (GBD2010) survey show that the global prevalence of knee arthritis is 3.8% and hip arthritis is 0.85%, and the loss of healthy life due to osteoarthritis of the hip and knee increased from 10.5 million people/year in 1990 to 17.1 million people/year in 2010^[2]。 The data show that by 2050, the population over 60 years old will exceed 20% of the global total population, and the prevalence of OA will further increase. The associated medical costs, loss of social productivity and additional economic burden will also increase^[3,4]。 Therefore, it is urgent to find an effective treatment for osteoarthritis. After cartilage injury, it can be partially repaired by itself, but the cartilage tissue produced by it is fibrocartilage instead of normal hyaline cartilage, which lacks the durability and special function of normal cartilage tissue^[5]。 Therefore, once the articular cartilage is destroyed, it is difficult to achieve complete repair. At present, the treatment of OA is mainly a combination of drug and non-drug treatment, and surgery is performed if necessary. The results of the former two can not meet the expectations, surgical treatment increases the financial and psychological burden of patients, and there is still a lack of ideal and effective methods for repairing articular cartilage defects. In recent years, the use of stem cells in the treatment of OA has become a research hotspot, and bone marrow mesenchymal stem cells (BMSCs) as an ideal seed cell for the treatment of OA have made some progress. Although BMSCs avoid the immunogenicity, ethics, law, religion and other problems of embryonic stem cells, there are still many shortcomings, such as limited source, invasive materials, and limited ability to differentiate into chondrocytes. With the intensive research of induced pluripotent stem cells (iPSCs), it may replace BMSCs as the most desirable seed cells in osteoarthritis treatment research.

bile acid sequestrants (BASs) are basic anion exchange resins, which are difficult to dissolve in water and are not easily destroyed by digestive enzymes. They can combine with bile acids to prevent the hepatic and intestinal circulation of bile acids, so that cholesterol in liver cells is continuously converted into bile acids, and a large amount of cholesterol in liver is consumed. It has been proved by clinical trials to be a safe and effective drug to reduce plasma total cholesterol (TC) and low density lipoprotein cholesterol (LDL-C). As a second-generation bile acid chelator, colesevelam hydrochloride continues the advantages of the first-generation bile acid chelator in reducing plasma TC and LDL-C, and its tolerability and safety have also been greatly improved. In 2000, it was approved by the US FDA as a lipid-lowering drug for clinical use^[1,2]。