Volume 94  ·   Issue 35  ·  2014

Dural damage during spinal surgery can cause postoperative cerebrospinal fluid to flow out of the body, including cerebrospinal fluid flow out of the incision or the appearance of cerebrospinal fluid in the drainage. Patients will have low cranial pressure headache, which is aggravated when standing, reduced when lying, nausea, vomiting, dizziness, electrolyte disorder, and even some neurological symptoms. Cerebrospinal fluid leakage not only affects incision healing, but also causes pseudodural cyst, retrograde central nervous system infection, etc. The rate of intracranial infection after spinal surgery was 0.4%^[1]。 The incidence of dural injury in spinal surgery is 1% ~17%^[2]The incidence of cerebrospinal fluid leakage after spinal surgery was 2.31% ~9.37%^[3], the associated incidence of revision surgery was higher. Therefore, cerebrospinal fluid leakage after spinal surgery is one of the common complications of spinal surgery, which needs to be actively treated. Except for a few cases caused by trauma, most of them were caused by iatrogenic injuries. Risk factors for dural injury and cerebrospinal fluid leakage include advanced age, revision surgery, ossification of ligaments, spinal deformity, and unskilled operation techniques. In the elderly patients, the dura thinning, wrinkling and peridural adhesion are prone to dura damage and tear during intraoperative operation. Spinal revision surgery has a higher risk of dural damage due to unclear normal anatomical landmarks and scar adhesion than initial surgery. The main risk factor in cervical spine surgery was ossification of the posterior longitudinal ligament. The dural damage in patients with ossification of the posterior longitudinal ligament was 13.7 times that in patients without ossification of the posterior longitudinal ligament^[4]The incidence of postoperative CSF leakage in patients with thoracic ligamentum flavum ossification is as high as 32%^[5]。 Patients with severe spinal deformity are more prone to dura injury and cerebrospinal fluid leakage due to uneven dura tension distribution and inability to operate according to normal anatomical structure during operation. In addition, due to the operator's unskilled operation technique, insufficient experience, and too rough in separating dural adhesions, it is also easy to lead to dural injury and postoperative cerebrospinal fluid leakage.

In recent years, the academic conferences of lumbar spine at home and abroad have systematically studied and discussed the indications, methods and curative effects of lumbar spinal stenosis surgery, and formed some preliminary clinical guidance. Among them, the guidelines for the diagnosis and treatment of lumbar spinal stenosis formulated by the North American Spine Association in 2011 have been widely recognized. In China, the Annual Academic Meeting (COA) of the Orthopedic Branch of the Chinese Medical Association, the Beijing Annual Academic Meeting (BOA) of the Orthopedic Branch of the Chinese Medical Association and other meetings have also reached some expert consensus on the surgical treatment of lumbar spinal stenosis, but there is a lack of systematic elaboration. Now, through the cooperation of a number of large tertiary hospitals, an expert consensus on the diagnosis and treatment standards of lumbar spinal stenosis has been formed, which I would like to share with my colleagues here.

To explore the distribution of Schmorl′s nodes (SN) in normal adult lumbar spine and determine the association of lumbar disc degeneration and lumbar spine motion.

A total of 1 179 individuals underwent magnetic resonance imaging (MRI) scans. They had an age range of 15-85 years and were grouped by 10 years. The distribution of SNs along lumbar spine and their relationship with age and gender were examined by single factor analysis of variance chi-square test. Spine specialists performed lumbar disc degeneration evaluations through the Pfirrmann′s classification system. The relationship between SNs, age group, disc location and overall grades of lumbar disc degeneration were analyzed by multiple Logistic regression.

The prevalence of SNs was 28.4%. And SNs were observed more frequently in males than females (34.6% vs 20.2%)(P<0.01). No significant inter-group difference existed in the incidence of SNs (P=0.18). SNs were more common at L2 and L3 vertebral bodies (14.3% vs 14.4%) while least common at S1 vertebral body (1.5%). The highest incidence of SNs was found in discs with degeneration grades Ⅲ (41.9%) and Ⅳ (45.3%). The occurrence of SN, aging and disc location were positively correlated with lumbar disc degeneration grade.

With a high incidence in healthy individuals, SNs occur in discs at all degrees of degeneration. And the occurrence of SNs is positively associated with lumbar disc degeneration.

To compare the clinical efficacies of single segment transforaminal lumbar interbody fusion (TLIF) with cage versus autogenous morselized bone for degenerative lumbar spinal stenosis.

A total of 87 patients undergoing single segment TLIF were randomly divided into 2 groups. A cage was implanted into intervertebral space in group A patients while autogenous morselized bone in group B patients. Operative duration, blood loss, length of stay and cost of hospitalization of two groups were recorded. They were followed up at 1 week, 12, 24 months post-operation. Oswestry disability index (ODI), visual analogue scale (VAS) fusion rates, intervertebral space and foramen height restoration, lumbar lordosis and postoperative complications were compared between two groups.

No significant inter-group difference existed in operative duration, blood loss or length of stay. However, the average hospitalization cost in group A were 18% higher than that of group B (P<0.05). Both groups achieved excellent clinical outcomes within 2 years. ODI, VAS score improvement rates and postoperative complication rates were not statistically different. Lumbar fusion rate was 86.7% in group A versus 85.7% in group B after 2 years. And there was no significant difference (P>0.05). The heights of intervertebral space and foramen in group A achieved a better recovery than those of group B. Both groups had similar improvements of lumbar lordosis.

For degenerative lumbar spinal stenosis, usage of interbody cage is more effective in terms of recovery of intervertebral space and foraminal height compared with usage of bone graft. However it brings no better clinical efficacy while the usage of autogenous morselized bone is more cost-effective. Two grafting methods yield similar overall clinical outcomes.

To explore the changes of sagittal balance of cervical spine after open-door expansive laminoplasty.

The clinical and radiological data were analyzed retrospectively for 90 patients undergoing open-door expansive laminoplasty due to cervical spondylotic myelopathy. The Japanese Orthopedic Association (JOA) score and 3 cervical sagittal parameters including C2-C7 SVA, C0-2 Cobb angle and T1-Slope on lateral view radiographs were recorded before operation and at the final follow-up.

The average follow-up period was 16.7 (3-40) months. The post-operative JOA score rose to 14.6±0.2 from pre-operative 12.2±0.3 with 43.5%±4.2% recovery rate. The post-operative values of C2-C7 SVA, C0-2 Cobb angle and T1-Slope were significantly different from pre-operative ones (P=0.022, P<0.001,P=0.002). C2-C7 SVA increased to (23.0±1.2) mm from pre-operative (20.7±1.1) mm. C0-2 Cobb angle increased (23.1±0.8)°from pre-operative (19.9±0.8)°; T1-Slope increased to (26.2±0.7)° from pre-operative (25.1±0.7)°.The changes of C0-2 Cobb angle and T1-Slope were correlated with that of C2-C7 SVA respectively(Pearson=0.469, P<0.001)(Pearson=0.303, P=0.004). Patients with higher preoperative T1-Slope had less JOA improvement(31.5% vs 53.7%, P=0.019)than those with lower preoperative T1-Slope after laminoplasty.

The sagittal balance of cervical spine significantly changes after open-door expansive laminoplasty with forward tilting of cervical vertebra. And compensation occurs by excessive high-strength contraction of posterior muscles to maintain lordosis in upper cervical spine. A higher pre-OP T1-Slope affects the outcomes of open-door expansive laminoplasty.

To investigate the effect of external fixator in posture fixation during the interstitial of ¹²⁵I seeds implantation for head and neck cancer under CT guidance.

20 cases of head and neck cancer patients with CT guided radioactive ¹²⁵I particle implantation were enrolled. 10 patients of group A for external fixator, the other 10 of group B used conventional bind belt. Spiral CT scanning was performed with 5 mm slices, and we chose the first and last serial CT images during the operation for image fusion with automatic registration software, then we could get 3D displacement errors.

Patients in group A of X, Y, Z axis position deviation were 1.06 cm, 1.22 cm and 1.22 cm , respectively. As to group B, they were 8.76 cm (P=0.041), 9.99 cm (P=0.009) and 0.009 cm (P=0.023), respectively.

The external fixator could applied in the treatment of head and neck cancer during CT-guided ¹²⁵I seed implantation, which fixed well in the operation, more comfortable, improve the positioning accuracy and reduce the extra rescanning radiation doses.

To construct different 3-D finite element resurfacing arthroplasty of hip models and to explore the biomechanics influences of cement mantle varying in thickness on stress distribution and stressshielding in the proximal femur following hip resurfacing arthroplasty(RSAH), and evaluate the changes of bone mineral density in femur after RSAH , in order to find the adaptive methods to stem fixing.

A comparative study was carrie out in patients who underwent RSAH .The bone mineral Density of the proximal femur was measured through dual energy X-ray absorptiomenty of the four zone at post-operation and unoperation 6 months .Changes of bone mineral density ratio in proximal femur between post-operation and unoperation were compared and analyzed.the finite element models of RSAH with different thickness of cement mantle and normal femur were developed and stress analysis was performed under the load of body weight.

The mean ration of bone mineral density of proximal femur in zone1, 2 , 3 increased which was no significantly different from other areas (P>0.05), the mean ration of bone mineral density of proximal femur in zone 4 and 5 increased which was significantly different from other areas (P<0.05). Comparing with the 0 mm cement mantle model, the ratio of stress shielding of the cancellous bone around the stem in 1 mm cement mantle model has slightly increased , but also was less than 17%.The ratio of stress shielding was increased obviously in the 2 and 3 mm cement mantle mode and more than 17% in 1, 2 and 5 zone.

The cement around stem not thicker than 1 mm produced slightly effect to the stress decreasing and did not result in marked stress shielding in the proximal femur following RSAH, and the bone stock of proximal femur can be well perserves and recovered .

The diagnosis and surgical treatment of 36 huge mediastinal tumors were summarized in order to evaluate the effect and safety of the operation.

Thirty-six huge mediastinal tumor patients treated in our department from June 2006 to June 2013 were retrospective analyzed, of whom clinical manifestations, diagnosis, surgical treatment and prognosis were carefully collected. Twenty-three cases were men and 13 were women. The average age was 39.2 years old. The pathology turned out to be benign in 23 cases and malignant in 13 cases.

Complete resection was achieved in 34 cases while palliative resection in 2 cases with no perioperative death. Six cases had developed postoperative complications but all recovered after active treatment. Patients who had been diagnosed with benign tumors were all alive after follow-up periods of 6 months to 7 years. Nine malignat tumor patients developed recurrence or metastasis, including seven deaths.

Surgery played a vital role in the diagnosis and treatment of huge mediastinal tumors. Preoperative diagnosis, accurate surgical approach and careful operation were the key to successful treatment. Benign huge mediastinal tumors had excellent prognosis with surgery.

To explore the effects of levonorgestrel intrauterine system on estrogen receptor (ER) and progesterone receptor (PR), insulin-like growth factor-1 (IGF-1) of endometrial polyps and surrounding endometrial tissue.

A total of 250 cases of hysteroscopic resection for endometrial polyps were divided into study group (n=125) with placement of levonorgestrel intrauterine system after hysteroscopic electroresection and control group (n=125) without placement. The intraoperative and postoperative expressions of ER, PR and IGF-1 in endometrial biopsy specimens were measured by immunohistochemistry. They were followed up for 2 years to analyze the recurrence of endometrial polyp.

All patients had successful surgery. When intraoperative and postoperative specimens were compared with regards to the expressions of ER, PR and IGF-1, significant differences existed between two groups. During a 2-year follow-up, the recurrence of endometrial polyp was 10.89% in control group versus 0 in study group.

Levonorgestrel intrauterine system may inhibit the recurrence and formation of endometrial polyp through lowering the expressions of ER, PR and IGF-1.

To explore the value of prenatal ultrasound in assessing thyroid function in fetuses of hyperthyroidism pregnant women and establish the reference values of fetal thyroid transverse diameter and anteroposterior diameter for different gestational weeks.

For observation group, 30 cases of pregnant women diagnosed as hyperthyroidism were recruited from our hospital from November 2012 to November 2013. And another 100 cases of pregnant women during 20 to 40 weeks of gestational weeks were selected into control group. The measured ultrasonic parameters included fetal biparietal diameter, head circumference, abdominal circumference, femur length, amniotic fluid index, heart rate, fetal thyroid transverse diameter, anteroposterior diameter and fetal movement frequency. A fetus was considered as suspected positive when they were less than gestational age, thyroid measurement higher than 95% confidence interval, heart rate over 160 beats/min or less than 120 beats/min. In the observation group, the blood levels of thyroid stimulating hormone and thyroxine were measured after birth.

The regression equation of fetal thymus transverse diameter and GA was: Y=0.053X-0.096, R²=0.758, P<0.05; the regression equation of fetal thymus anteroposterior diameter and GA:Y=0.034X-0.397, R²=0.596, P<0.05. The measured value of 95% confidence interval for 2 cases in observation group exceeded that in control group. There were fetal tachycardia (n=2), bradycardia (n=1), low TSH after birth (n=2), T4 elevation after birth (n=1) and clinical T4 high value (n=1).

Ultrasonic assessment of fetal thyroid function is timely and noninvasive. And it has an irreplaceable value in hyperthyroidism pregnant women. And normal reference values of fetal thyroid measurements are established for 20-40 gestation weeks.

To explore the outcomes of surgery for the treatment of small acoustic neuroma by the neuroendoscope-assisted microsurgery and microscope.

From 2008 to 2013, 42 patients with small acoustic neuroma underwent neuroendoscope-assisted microsurgery (n=20) and microscopic tumoural resection (n=22). Neurophysiological monitoring, 30-degree rigid neuroendoscope and microscope were employed intra-operatively. For the endoscope group, facial nerve and inner acoustic meatus could be visualized distinctly in each aspect, as for the microscope group, microscopic operation could be accomplished directly. The damage extents of facial nerve and inner acoustic meatus were compared between two groups.

Total removal of acoustic neuroma and conservation of facial nerve were achieved in all patients. For the neuroendoscope-assisted group, the postoperative facial functions were GradeⅠ(n=6), GradeⅡ(n=10) and Grade Ⅲ (n=4). Internal acoustic canal was drilled 2-3 mm in 4 patients and no drilling in others. For the microscope group, GradeⅠ(n=5), GradeⅡ(n=6), Grade Ⅲ (n=8) and Grade Ⅲ-Ⅳ (n=3). Internal acoustic canal was drilled at least 3 mm in 12 patients and no drilling in others. No complication such as cerebrospinal fluid leakage occurred during the follow-ups.

Endosocopic operation of acoustic neuroma surgery is superior to microscopic operation in terms of magnification, illumination, wide-angel and angulation. And the former procedure may yield better outcomes through alleviating the damage of facial nerve and decreasing the drilling degree of inner acoustic meatus.

To explore the expressions of matrix metalloproteinases-2 (MMP-2), matrix metalloproteinases-9 (MMP-9) and inducible nitric oxide synthase (iNOS) in cerebral aneurysms, compare them with normal brain vessels tissue so as to gain a better understanding of the pathogenesis of cerebral aneurysms.

Twelve samples of cerebral aneurysms were obtained during operations and 10 cortical arteries as controls during surgery for temporal lobe epilepsy from 2009 to 2012 at Inner Mongolia People′s Hospital and Beijing Tiantan Hospital. The activities of MMP-2, MMP-9 and iNOS in specimens were detected with spectrophotometry and substrate gel zymography.

The MMP-2 and MMP-9 levels in cerebral aneurysm group were (199 598±125 288) gray scale area·mg^-1·L^-1and (719 253±376 519) gray scale area·mg^-1·L^-1.Both in cerebral aneurysm group were significantly higher than that in control group(P<0.05). The TNOS and iNOS levels in cerebral aneurysm group were(23.6±6.6)and(11.4±2.6)U/mgprot. The difference of TNOS level was not significant between aneurysm and control groups (P>0.05) while the levels of iNOS and iNOS/TNOS in cerebral aneurysm group were significantly higher than that in control group (P<0.05).

MMP-2, MMP-9 and iNOS are closely correlated with cerebral aneurysm.

To evaluate the value of judging for the activity in AS by diffusion-weighted sequences (DWI) and enhance sequences MRI(DCE-MRI), to explore the correlation of Apparent diffusion coefficient(ADC) values, intensive rate and the clinical activity index in sacroiliitis (SIJ) of ankylosing spondylitis (AS).

56 patients prospectively choiced and diagnosed were divided into two groupsas, active group (n=32) and chronic group (n=24) by rheumatologist according to BASDAI and laboratory parameters.Twenty healthy adults were as control group. The values of ADC and intensive rate of all sacroiliac joints (SIJs) were measured on MRI. BASDAI score were got by Bath ankylosing spondylitis disease activity index. ESR, CPR and were got by laboratory. Statisticaly to analysis whether the parameters were significantly different amang AS active, chronic, and the control group.To assess the correlation of the values of ADC, intensive rate and BASDAI score, ESR, CPR and in SIJ.

the values of ADC and intensive rate were significantly different among AS active, chronic and the control group.There were the significant correlation between the values of ADC, intensive rate and BASDAI score.

Diffusion-weighted sequences and Contrast-enhanced sequences is superior to other methods in judging the activity in AS.combined with clinical activity index, the accuracy can significantly be improved to explore whether the activities of AS are.

To explore the relationship between the ratio of early diastolic transmitral velocity to early diastolic mitral annular velocity (E/Em) and exercise capacity in patients with atrial fibrillation.

A total of 94 consecutive patients with non-valvular atrial fibrillation and preserved left ventricular ejection fraction admitted into our department from December 2011 to June 2013 were included. Echocardiography and cardiopulmonary exercise test were performed. According to E/Em, they were divided into two groups of normal E/Em (E/Em ≤9) and elevated E/Em (E/Em>9). The parameters of exercise capacity, including VO₂max/kg, anaerobic threshold/kg (AT/kg) and exercise time duration were compared between two groups. And the determinants of VO₂max/kg were identified by multivariate regression analysis.

The number of patients was 57(60.6%) with normal E/Em and 37(39.4%) with elevated E/Em. As compared to those with normal E/Em, the patients with elevated E/Em had lower VO₂max/kg[(26±4) vs (20±4) ml·min^-1·kg^-1,P<0.001], lower AT/kg [(25±4) vs (19±5) ml·min^-1·kg^-1,P<0.001] and shorter exercise time duration [(7.2±1.3) vs (5.8±1.3) min,P<0.001]. Multivariate regression analysis revealed that three significant variables were independently associated with VO₂max/kg: age (r=-0.412, P<0.001), gender((25±5) and (21±4) ml·min^-1·kg^-1for males and females separately, P<0.001)and E/Em (r=-0.535, P<0.001).

E/Em was independently associated with exercise capacity in patients with atrial fibrillation.

To evaluate the usefulness of ratio of early diastolic transmitral flow velocity (E) to mitral annular velocity (e′) calculated by simultaneously recording E and e′ in coronary heart disease (CHD) patients.

A total of 77 CHD patients with preserved systolic functions underwent echocardiography. Left ventricular catheterization was performed to measure left ventricular end diastolic pressure (LVEDP). The accuracy of E/e′ was compared by recording the dual-Doppler and conventional methods for diagnosing diastolic dysfunction and the relationships between N-terminal pro-brain natriuretic peptide (NT-proBNP). The validity of E/e′_{dual Doppler} and combined E/e′_{dual Doppler} and NT-proBNP in estimating left ventricular diastolic dysfunction namely LVEDP ≥12 mmHg (1 mmHg=0.133 kPa) were estimated.

E/e′_{dual Doppler} was correlated with left ventricular end diastolic pressure (LVEDP) and logNT-proBNP (r=0.79, r=0.47, respectively, P<0.01). E/e′_conventional was correlated with LVEDP and logNT-proBNP (r=0.61, P<0.01,r=0.35, P<0.05, respectively). The area under curve(AUC)of E/e′_{dual Doppler} and E/e′_conventional was 0.87 and 0.82. The optimal cut-off of E/e′_{dual Doppler} was 9.2 with a sensitivity of 74% and a specificity of 81%. And the optimal cut-off of plasma NT-proBNP was 108 ng/L with a sensitivity of 69% and a specificity of 86%, AUC 0.79.When E/e′_{dual Doppler} ≥9.2 and NT-proBNP ≥108 ng/L were combined, the sensitivity and specificity for diagnosing diastolic dysfunction were 86% and 69%, AUC 0.89.

The accuracy of E/e′_{dual Doppler} is better than E/e′_conventional for diagnosing left diastolic dysfunction. When E/e′_{dual Doppler} and NT-proBNP are combined, it improves the evaluation accuracy of left diastolic dysfunction.

To explore the distribution and expression of three T-type calcium channel receptors (α1G; α1H; α1I) and understand their protective effects in spiral neurons of C57BL/6J mice.

The distribution and expression of three T-type calcium channel receptors in spiral ganglion neurons were observed by in situ hybridization and reverse transcription-polymerase chain reaction (RT-PCR) in 6-8-week-old C57BL/6J mice. The mice of 24-26-week-old C57BL/6J were divided into 3 groups of zonisamide, benidipine and saline. And the expression changes of calcium-binding proteins calmodulin and calbindin were observed by immunohistochemistry.

Three subunits were expressed in spiral ganglion neurons. The decremented quantities were α1H(24.21±0.10), α1I(14.88±0.04)and α1G(10.42±0.02). The expression level of calmodulin in spiral ganglion neurons was lower in the zonisamide-treated group than that in the saline-treated group (0.336±0.041 vs 0.504±0.020, P<0.05). The expression level of calbindin in spiral ganglion neurons was lower in the zonisamide-(0.482±0.045) and benidipine-treated groups(0.511±0.032)than that in the saline-treated group (0.611±0.035,P<0.05).

The expressions of calcium-binding proteins decrease after 4-week dosing of T-type calcium channel blockers in 24-26-week C57BL/6J mice. It implies a relief of calcium overload. T-type calcium channel blockers may protect the murine spiral ganglion neurons from degeneration.

Tumor stromal cells have the potential of undergoing malignant transformation induced by glioma stem cells (GSCs) in orthotopic glioma model. The purpose of this study was to explore whether malignant transformation of tumor stromal cells induced by GSCs is dependent on specific local microenvironment.

Human glioma stem/progenitor cell line SU3 transfected with red fluorescent protein (SU3-RFP) gene were implanted into the liver of nude mice with whole-body expressing green fluorescence protein (GFP). Then hepatic tumors were harvested to prepare single cell suspension and analyzed with routine pathological examinations. GFP cells with high proliferative abilities were obtained from the cultivation of single cell suspension. Immortalized glioma stromal cells only expressing GFP and double expressing GFP/RFP were further monocloned with micro-pipetting techniques and under continuous passages. Cell phenotypic analysis and tumorigenicity tests were also performed.

SU3-RFP was transplanted into liver with a tumor formation rate of 83%. Immortalized glioma stromal cells were obtained from re-cultured xenograft tumor tissue. Three monoclonal cell lines B4, B9, B10 were established and proved to be host-derived cells. B4 was found to be a fusion cell co-expressing GFP/RFP and dendritic cell markers CD1a, CD83 and CD86. Both B9 and B10 were GFP⁺cells. B9 expressed macrophage markers CD68 and F4/80 while B10 produced fibroblast marker proteins FAP-α, α-SMA and S100. Three cells were all aneuploid with a tumorigenicity rate of 100% in nude mice.

Tumor stromal cells have the potential of malignant transformation in a heterotopic xenograft glioma model. Malignant transformation may also occur outside the central nervous system and contribute to tumor heterogeneity. Further studies are warranted for elucidating the relationship between tumorigenesis, evolution and tumor microenvironment.

panic disorder (PD) is an acute anxiety disorder with recurrent panic attacks as the main clinical manifestation. Clark^[1]The theory of catastrophic cognition holds that panic attacks stem from an unrealistic misjudgment of some somatic sensations by the individual. Our research team used event-related potential (ERP) studies to find^[2]The information gating ability of patients with panic disorder decreases, and some "pseudo-dangerous information" is mistaken for threat information for processing, resulting in inappropriate defense and fear response, and even panic attacks. Therefore, we speculate that the inability of patients with panic disorder to effectively detect, recognize and correct their own false cognition may be an important mechanism for the recurrent occurrence of panic attacks and the difficulty of self-control. error-related negativity (ERN) and error positivity (Pe) are two defined ERP components related to error processing, which can reflect the processing of misinformation in the brain. This study adopts flanker paradigm and ERP technique to discuss the above theoretical assumptions.

Insomnia is a common physiological and psychological disorder, which usually refers to the subjective experience of patients' insatisfaction of sleep time and/or quality and affecting their social function during the day^[1]。 Outpatient patients with insomnia often complain of varying degrees of cognitive decline. Previous studies have also proved that primary insomnia can affect cognitive function, among which learning and memory difficulties are the most common^[2,3,4]。 In recent years, many studies have proved that patients with primary insomnia have extensive memory impairment. A foreign meta-analysis combined with a large number of data showed that episodic memory and working memory were mildly to moderately impaired in patients with primary insomnia^[5]。 Domestic Ge Yijun et al^[6]It was found that both procedural and declarative memory were impaired in patients with primary insomnia. Previous studies of our research group also confirmed impaired prospective memory in patients with chronic primary insomnia^[7]。 Although outpatient insomnia generally reflects different degrees of improvement in memory function after treatment. However, there are few studies at home and abroad on whether the impaired memory function of chronic insomnia can be recovered after treatment. This study adopted a prospective study to observe the episodic memory changes of patients with chronic primary insomnia before and after treatment, and to understand the influence of chronic primary insomnia on episodic memory and prognostic outcome.

Cervical insufficiency (CIC) refers to the inability of the cervix to maintain pregnancy until full term due to anatomical or functional defects. It is one of the main causes of repeated late abortion and premature delivery caused by painless dilatation of the cervix in the middle and third trimester of pregnancy. It generally occurs in 18~22 weeks of pregnancy, and accounts for about 15% of habitual abortion in 16~28 weeks of pregnancy^[1]。 The rate of premature birth in patients with cervical insufficiency is 3.3 times that of non-cervical insufficiency, accounting for 8% ~9% of all premature births, 40% ~50% of natural premature births, and 20% ~30% of premature water rupture^[2]。 The main functional tissues of the cervix in patients with CIC and the latest progress of cervical cerclage in the treatment of CIC are summarized as follows.

Posterior longitudinal ligament ossification (OPLL) is a disease in which heterotopic ossification in the posterior longitudinal ligament of the spine compresses the spinal cord and nerve roots, resulting in impaired function^[1]The concept of cervical posterior longitudinal ligament ossification was established after autopsy of patients with severe spinal symptoms caused by posterior longitudinal ligament ossification^[2]Then it is clear that ossification of spinal ligaments can cause symptoms of spinal cord and nerve roots in patients. Great progress has been made in the epidemiology, natural course, etiology, diagnosis and treatment of this disease. The research progress of natural course of cervical posterior longitudinal ligament ossification is summarized below.

A 34-year-old female was admitted to the hospital on May 2, 2012 due to "limb weakness, dysphagia for 12 days, aggravation with dyspnea for 2 days". The physical examination showed that the body temperature was 36.5 ℃, the heart rate was 76 beats/min, the breathing was 22 beats/min, and the blood pressure was 114/66 mmHg (1 mmHg =0.133 kPa). The fatigue test of both upper eyelids was positive, the abduction of both eyes was 2 mm white, the closing force of both eyelids and lips was significantly weakened, the soft palate was poorly elevated on both sides, the pharyngeal reflex was weakened, the neck turning and shrugging force on both sides was weak, the abdominal bulging force was weak, the muscle strength of the proximal extremities was decreased, and no positive signs were seen in the rest of the nervous system. On admission, neostigmine test was positive, and blood acetylcholine receptor antibody was suspected positive. Repeated electrical stimulation showed 40% attenuation of visible amplitude of orbicularis muscle and deltoid muscle of right eye stimulated at 3 Hz. Single-fiber electromyography showed a significant increase in tremor of right common extensor muscle (mean continuous wave value difference of 69 μ s). Thymus CT enhancement showed space-occupying lesions of anterior superior mediastinum and normal thyroid function. The diagnosis was myasthenia gravis (MG) Osserman classification type III, and the absolute clinical score of MG was 26. An indwelling nasogastric tube was administered with intravenous immunoglobulin needle (IVIg, 0.4 g·kg^–1• d^–1×5 d), supplemented with pyridostigmine bromide tablets 60 mg, 4 times/d. A myasthenic crisis occurred on the 8th day of admission, and ventilation assisted by tracheal intubation and thoracoscopic enlarged thymectomy under general anesthesia was performed. Thymic tissue hyperplasia and tumor-like tissue were observed during the operation. Some external invasion involved pericardium and left mediastinal pleura, and a small amount of adipose tissue could be reached by anterior mediastinum and pericardial fat pad. Pathological examination revealed B3 thymoma with anaplasia. After operation, corticosteroids (methylprednisolone, prednisone) combined with pyridostigmine bromide tablets were always treated. On the 9th postoperative day, tracheotomy was performed due to difficulty in disconnection, and later transferred to the general ward. On May 31, 2012, he had a second myasthenia crisis with cough and fever. In addition to ventilator-assisted ventilation, he was given double filtration plasma exchange therapy (DFPP), 3 times every other day, and his condition improved rapidly and he went offline. However, the absolute clinical score of MG of the patient kept fluctuating between 18 and 25 points. The myasthenic crisis was repeated three times in the next 3 months, and the crisis was quickly relieved after each treatment with DFPP. During this period, on the basis of corticosteroids combined with pyridostigmine bromide, azathioprine tablets 100 mg/d were added to the treatment, but the symptoms did not improve significantly, and then Cyclosporine A (CsA 4 mg · kg^–1• d^–1) After 2 weeks of treatment, the patient was discharged in stable condition, and the blood concentration of CsA at discharge was 55.1 μ g/L. Absolute MG clinical score was 0 at 3 months of discharge follow-up and chest radiotherapy (chest conformal field 10MV – X SAD 100 DT 5000cGy/25F/36d) was performed. After continued follow-up for 18 months, the patient's absolute clinical score of MG remained 0.