Volume 94  ·   Issue 45  ·  2014

In the field of preoperative evaluation of epilepsy, there has been a dispute between the so-called "North American School" and the "French School", with different ideas, techniques and methods. For a long time, the preoperative evaluation of epilepsy in China has been taught by the North American school of thought. This paper gives an overview of the academic thoughts of the French School that are rising in the world at present, and discusses its enlightenment to our country, in order to arouse the attention of domestic comrades.

To explore the effects of levetiracetam (LEV) on the changes of bone mineral density (BMD) and bone metabolism in the treatment of middle-aged and elderly patients with generalized tonic-clonic seizures.

A total of 112 patients with generalized tonic-clonic seizures from October 2012 to March 2014 were selected and divided into LEV and non-medication groups according to therapeutic methods (n=56 each). LEV was administered to LEV group at an initial dosage of 500 mg twice daily. The same dose of LEV could be added every 2 or 3 weeks based on clonic seizure condition and tolerance. And the maximal dosage was 2 000 mg. The therapeutic duration was ≥6 months. No anti-seizure drug was offered for non-medication group. Another 50 healthy subjects served as control group. After 6-month treatment the clinical efficacy of LEV group was evaluated. BMD was detected with bone sonometer (DPX-L) and serum levels of blood calcium (Ca), blood phosphorus (P), alkaline phosphatase and parathyroid hormone were also detected in control group, pre-treatment in non-medication group and post-treatment in LEV group.

The rate of abnormal bone volume in non-medication (28.6%) and LEV groups (48.2%) were evidently higher than that in control group (4.0%)(P<0.05). And it was apparently higher in LEV group than that in non-medication group (P<0.05). BMD decreased obviously at post-treatment than pre-treatment (P<0.05). And the post-treatment levels of Ca and P decreased markedly [(2.12±0.19)vs (2.32±0.23) mmol/L; (0.96±0.01)vs (1.23±0.12) mmol/L] while serum levels of alkaline phosphatase and parathyroid hormone increased significantly in LEV group than pre-treatment [(66±6) vs (33±3) μg/L; (62±5) vs (34±3) pmol/L,P<0.05]. The clinical efficacy of LEV treatment at 1 month was similar to that at 6 months (both 98.21%). And the difference was insignificant (P>0.05).

Single use of LEV is efficacious in the treatment of middle-aged and elderly patients with generalized tonic-clonic seizures. However, both disease and anti-seizure drugs have certain effects on BMD. And long-term application of LEV may lead to bone metabolism dysfunction to some extent.

To explore the lateralizing value of dystonic posturing (DP) of upper limb in patients with refractory mesial temporal lobe epilepsy (MTLE).

Presurgical videotypes of 89 patients staying seizure-free for at least 2 years after temporal lobectomy were retrospectively reviewed. Attention was paid to temporal correlation between occurrence of DP and seizure and the relationship of DP to side of epileptogenic zone (resected side).

DP was observed in 92 complex partial seizure (CPS) from 37(41.6%)patients among 89 patients with a total of 424 CPS. DP was not an initial symptom in the course of CPS and its onset occurred mostly in the middle third of ictus. DP displayed a high positive predictive value of 93.9% for lateralizing a contralateral seizure onset.

DP is a reliable lateralizing sign in patients with MTLE.

To explore the default mode network (DMN) in childhood absence epilepsy (CAE) patients and examine their correlations between functional connectivity (FC) and clinical characteristics.

Fourteen CAE patients and 14 healthy volunteers were prospectively recruited from Henan Provincial People's Hospital from September 2012 to June 2014. FC in DMN of each group, between-group comparison of DMN FC and their relationships with clinical characteristics were respectively analyzed with 3.0T resting-state functional magnetic resonance imaging (fMRI) FC analysis seeding at bilateral precuneus/posterior cingulate cortex (PCC).

Seeding at bilateral precuneus/posterior cingulate cortex (PCC), positive connection was found in bilateral angular gyrus, bilateral superior parietal gyrus, bilateral superior and middle frontal gyrus, bilateral superior medial frontal gyrus, bilateral middle temporal gyrus and bilateral superior and middle occipital gyrus in controls. However, positive connection in CAE patients was observed in bilateral superior parietal gyrus and bilateral superior occipital gyrus. Between-group analysis of DMN connectivity revealed a reduction of DMN FC in bilateral medial orbitofrontal cortex, bilateral anterior cingulate cortex, bilateral superior frontal gyrus, bilateral middle frontal gyrus and left caudate in CAE patients. Moreover, increased DMN FC was present in right paracentral lobule and right middle cingulate gyrus. FC between PCC and bilateral medial orbitofrontal cortex or bilateral superior/middle frontal gyrus correlated negatively with disease duration, but there was no correlation with seizure frequency or initial age.

Brain's default mode network in childhood absence epilepsy is impaired, presumably, as a result of unconsciousness and cognitive impairment during absence seizure. Abnormal DMN activities may be a biomaker of disease progress in absence epilepsy.

To explore the clinical features, the diagnostic and therapeutic strategies and different inflammatory indices for neonatal septic arthritis.

Clinical presentations, laboratory findings, treatment and prognosis of patients with neonatal septic arthritis hospitalized from October 2009 to December 2013 were analyzed retrospectively.

Among 19 cases with septic arthritis in neonates, the sites were hip (n=8), knee (n=7) and shoulder (n=4). And 13 cases had fever. Joint swelling, tenderness, skin temperature and activity limitation were absent in 9 cases. At initial presentations, the positive rates of C-reactive protein (CPR) and procalcitonin (PCT) were 63.2% and 83.3% respectively. And the differences were statistically significant (P<0.05). At Day 1 after admission, the positive rates of CRP, PCT and erythrocyte sedimentation rate (ESR) were 100%, 100% and 41.6% respectively. No difference existed in positive rate between CPR and PCT (P>0.05). The positive rate of ESR was lower than CPR and PCT and the difference was statistically significant (P<0.05). Radiographic examination showed swelling of joint capsule, joint space widening and swelling of joint soft tissue. All were cured and discharged through intravenous antibiotic therapy. 16 cases were followed-up, except for 1 patient with hip disease due to poor rational dislocation motion. And the others were normal.

Neonatal septic arthritis should receive priority attention. With early diagnosis and standard treatment, the prognosis is usually good.

To explore the magnatic resonance imaging (MRI) features of cesarean scar pregnancy (CSP) and analyze the diagnostic value of MRI for early CSP.

The 3.0 T MRI and ultrasonic findings of 81 patients with CSP were analyzed.The sensitivity, specificity and accuracy of two methods was calculated respectively for the diagnosis of CSP.The diagnostic value of each method was evaluated with receiver-operating-characteristics (ROC) analysis.

Among them, the final pathological diagnoses were CSP (n=68) and early uterine pregnancy (n=13). Among 68 cases of CSP, 52 cases were detected and 16 cases incorrectly diagnosed by ultrasound.Among 13 cases of early uterine pregnancy, 11 cases were correctly diagnosed and 2 cases misdiagnosed.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of ultrasound for diagnosing CSP were 76.5%(52/68), 11/13, 77.8%(63/81), 96.3%(52/54) and 40.7%(11/27) respectively.Among 68 cases of CSP, 64 cases were detected and 4 cases incorrectly diagnosed by MRI.Among 13 cases of uterine pregnancy, 10 cases were diagnosed correctly and 3 cases misdiagnosed.The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI for diagnosis of CSP were 94.1%(64/68), 10/13, 91.4%(74/81), 95.5%(64/67) and 10/14 respectively.The ROC analysis yield the area under curve (AUC) of MRI and ultrasonography were 0.941(P=0.000) and 0.867(P=0.000) respectively.

The sensitivity and accuracy of MRI are better than those of ultrasound in the diagnosis of CSP.And MRI is quite important for choosing appropiate therapeutic protocols.

To evaluate the efficacies of radiofrequency ablation (RFA) plus iodine (¹³¹I) tumor necrosis therapy monoclonal antibody (¹³¹I-chTNT) for advanced stage hepatocellular carcinoma.

The clinical data of 38 hepatocellular carcinoma patients confirmed clinically or pathologically were retrospectively analyzed.They were divided into 2 groups (RFA group, n=22; combination group, n=16) according to the treatment mode.The median follow-up period was 31 (8-49) months.Survival was estimated with the Kaplan-Meier method and the survival curve compared by log-rank test.

Thirteen cases in RFA group and 7 cases in combination group died of tumor progression or complications of liver cirrhosis.The median survival time in combination group was significantly than RFA group (43 vs 37 months) (P=0.039). The overall survival rates at 1, 2 and 3 years (100%, 87.5%, 75% respectively) were higher than those in RFA group (81.8%, 58.2%, 51.7% respectively).

For hepatocellular carcinoma with a special site and a diameter ≥5 cm, RFA plus ¹³¹I-chTNT treatment can prolong progression-free survival time.And its short-term curative effect is better than that of RFA therapy.And the long-term outcomes may be further explored by a large-sample, multi-center and randomized trial.

To explore the distribution of high-risk HPV-genotypes in early-stage cervical adenocarcinoma and understand the clinical significance of HPV genotyping.

From June 2000 to May 2010, a total of 101 paraffin surgical specimens of cervical adenocarcinoma were genotyped by nested polymerase chain reaction (nested PCR). The associations of HPV18 with clinicopathological parameters and survival were further analyzed.

DNA extraction was successfully performed for 96 samples.The HPV-positive rate of early-stage cervical adenocarcinoma was 95.8% (92/96). Two common HPV types were HPV16 (59.4%) and HPV18 (60.4%). The prevalence rates of single, double and multiple HPV infections were 22.9%, 32.3% and 40.6% respectively.The positive rates of lymph node metastasis and vascular involvement with HPV18 infection were 27.6% and 22.4% versus 7.9% and 7.9% for those without HPV18 infection.Univariate analysis showed that positive surgical margin, uterine corpus invasion, lymph node metastasis and HPV18 infection were the predictive factors for poor prognosis of patients with cervical adenocarcinoma.Multivariate analysis revealed that lymph node metastasis was an independent prognostic factor for both disease-free and overall survivals.And uterine corpus invasion was an independent prognostic factor of overall survival for early-stage cervical adenocarcinoma patients.

HPV16 and HPV18 are major types responsible for early-stage cervical adenocarcinoma.Infection with HPV18 is prone to lymph node metastasis and vascular involvement.However, there is no correlation with disease-free survival or overall survival.

To explore the efficacy and safety of preventive therapy for iatrogenic active tuberculosis (TB) induced by glucocorticoid.

During 2007-2011, a total of 203 systemic lupus erythematosus (SLE) patients with high-risk active TB, such as a history of TB infection, TB family member and strong positive purified protein derivative (PPD) skin test or hypoalbuminemia and hyperglycemia were enrolled.They were randomly divided into three groups based on whether or not anti-TB treatment was offered at the beginning of glucocorticoid treatment for SLE: simple glucocorticoid group (n=70); glucocorticoid plus rimifon group (n=67); glucocorticoid plus rimifon plus ethambutol group (n=66). Anti-TB treatment was offered at least 12 months for the preventive anti-TB group.And follow-ups were conducted every 2-3 months for 2 year to observe the efficacy and side effects of anti-TB drugs.During this period, anyone with fever and/or cough consulted a physician immediately.

No active TB occurred in anti-TB treatment group.And 8 patients (11.43%) had active TB in simple glucocorticoid group, including hematogenous disseminated TB (n=1), pulmonary TB (n=3), bone TB (n=1), tuberculous meningitis (n=1) and undefined focus TB infection (n=2). And 6/8 cases had active TB within 6 months after using glucocorticoids.According to the study protocol, any case of active TB shall receive 3-4 combined anti-TB drugs for 1 year.The TB conditions of 7/8 patients were better controlled by anti-TB treatment.One patient died of tuberculous meningitis after lost follow-up.Two patients had mild temporary numbness in finger tap of both hands.And 3 patients on double anti-TB drugs showed a mild elevation of liver enzymes.

For high-risk population of active TB, glucocorticoid therapy plus 1 or 2 preventive anti-TB treatment drugs may prevent its occurrence.And there is no serious adverse reaction during preventive anti-TB treatment.

To explore the microbiological etiology of prosthetic knee infections during two-staged revision and analyze antibiotic susceptibility of bacteria so as to provide clinical recommendations for empiric antibiotic therapy.

A retrospective review was performed for 78 hospitalized patients for prothetic knee infections undergoing two-staged revision between January 1, 2007 and February 28, 2014.Suspicious intra-operative tissues were collected and cultured.Microbiological data sets and antibiotic susceptibility of bacteria were analyzed.

Micro-organisms were isolated from 65 patients.The negative culture rate was 16.7%. The most common genus encountered was Gram-positive isolates(75.7%), followed by Gram-negative isolates (20.5%) and fungi isolates (2.7%). Polymicrobialinfections accounted for 15.4% of patients.The most common causative organism of infection was coagulase-negative staphylococci (46.6%) and followed by Staphylococcus aureus (20.5%). The detection rate of methicillin-resistant staphylococcus(MRS) was 34.3%(25/73)and it accounted for 47.5% of staphylococcus.Gram-negative isolates were dominated by Escherichia coli (4/15) and Acinetobacter baumannii (4/15). All A. baumanniiscame from polymicrobial infection.Coagulase-negative staphylococci and A. baumannii were the most common causative organisms of polymicrobial infection.The results of antibiotic susceptibility showed cefazolin and cefuroxime were poorly susceptible to isolates.The drug resistance rates were 43.5% and 53.6%.Some third or fourth generation cephalosporins also have problems of bacterial resistance.Some antibiotics such as vancomycin, linezolid, imipenem, rifampin, cefoperazone/sulbactam and levofloxacin had high rates of drug sensitivity.

Most infections are caused by staphylococci.The proportion of isolated MRS is high.Empiric prophylacticantibiotics therapy may include vancomycin and cefoperazone/sulbactam to cover Gram-positive and Gram-negative organisms.Empiric therapeutic antibiotics therapy includes vancomycin and carbapenems.After the results of antibiotic susceptibility, antibiotics should be timely adjusted.

To evaluate the application value of spectral curve in gemstone spectral imaging (GSI) in evaluating the differentiation state of gastric cancer.

Triple-phase enhanced GSI CT scanning was performed on 65 gastric cancer patients whose differentiation state was later confirmed through gastroscopy. The 101 monochromatic image sets obtained with spectral CT imaging were analyzed with the GSI Viewer software. CT values at 40, 70 and 140 keV images were measured to calculate the slopes for spectral curve in the 40-140, 40-70 and 70-140 keV energy range. They were divided into 3 groups based on the pathological results and the corresponding slope measurements were compared with independent t test. Receiver operating characteristic curves were generated to determine the parameters for optimizing sensitivity and specificity in differentiation state of gastric cancer.

As verified pathologically, there were 21 well-differentiated, 22 moderately-differentiated and 22 poorly-differentiated adenocarcinoma cases. The slope for spectral curve was larger at the foci of gastric cancer than that in normal gastric wall: the lower differentiation state, the larger the slope. During the arterial phase, the slope of the normal gastric wall , well-differentiated adenocarcinoma , moderately-differentiated adenocarcinoma and poorly-differentiated adenocarcinoma in the 40-70 keV energy range was 1.78±0.12, 1.86±0.30, 1.87±0.28, 2.59±0.31, the slopes of well and moderately-differentiated adenocarcinoma and normal gastric wall were significantly different from poorly-differentiated adenocarcinoma in the 40-70 keV energy range (P<0.05), but were not different in the other 2 energy ranges (P>0.05); during the portal vein phase, the slope of the normal gastric wall, well-differentiated adenocarcinoma, moderately-differentiated adenocarcinoma and poorly-differentiated adenocarcinoma in the 40-70 keV energy range was 3.30±1.13, 3.96±0.29, 4.10±1.28, 4.98±2.15, the slopes in all 3 energy ranges were significantly different in each group (P<0.05). Using the slopes in the 40-70 keV energy range, the sensitivities and specificities for determining the differentiation states were >81% and >86% respectively during the arterial phase and >72% and >72% during the portal venous phase.

The spectral curve at the foci of gastric cancer was correlated with the histological differentiation state. And the slope of spectral curve of GSI may offer a new index for evaluating the differentiation state of gastric cancer before operation.

To summarize our experiences of applying percutaneous multiple needle puncturing technique for releasing adductor muscle during total hip arthroplasty (THA) for ischemic necrosis of femoral head and provide rationales for clinical practice.

From January 2008 to December 2012, 36 adult patients with ischemic necrosis of femoral head (36 hips) and 36 adult patients with femoral neck fracture (36 hips) were recruited.The group of ischemic necrosis of femoral head was designated as experiment group in which there were 29 males and 7 females with an average age of 67.9 (60-78) years.According to the Ficat system, there were type Ⅲ (n=24) and type Ⅳ (n=12). The affected leg shortening of this group prior to surgery was over 2 cm.The group of femoral neck fracture was selected as control group in which there were 16 males and 20 females with an average age of 70.1 (60-82) years.According to the Garden system, there were type Ⅲ (n=16) and type Ⅳ (n=20). All cases underwent THA with Press-fit prosthesis.After fixing prosthetic components, leg length discrepancy was corrected.And percutaneous multiple needle puncturing was applied for releasing adductor muscle in experiment group. The follow-up period was 2 years.The safety and efficiency were evaluated by HHS (Harris Hip Score) and the range of motion (ROM) of hip extorsion and abduction.

There was no occurrence of such early complications as palsy of obturator nerve, hematoma in adductor muscle area or serious deep vein embolism.No serious complications of deep infection, femoral head dislocation, recurrent adductor muscle contracture, prosthesis loosening, subsidence, excursion or penetration occurred up until the final follow-up.The range of hip motion of extorsion and abduction: (1) in experimental group, the postoperative ROM(abduction: 44.9±0.8, extorsion: 45.1±0.9)was significantly larger than that of preoperative (abduction: 30.0±4.6, extorsion: 31.5±4.6); (2) the postoperative ROM of experimental group had no significant changes until the final follow-up(abduction: 44.7±0.9, extorsion: 45.25±0.81); (3) at the last time of follow-up, no significant inter-group difference existed in ROM(abduction: 44.86±0.68, extorsion: 45.6±0.8). HHS: (1)in experimental group, HHS increased significantly from 39.64±3.93 preoperatively to 82.8±3.6 at 3 months postoperatively; (2) in two groups, HHS of 2 years postoperation (experimental group: 88.6±4.1, control group: 89.1±4.0) was significantly larger than that of 3 months postoperation(experimental group: 82.8±3.6, control group: 83.1±3.1); (3) at the time of 3 months and 2 years postoperation, no significant inter-group difference existed in HHS.

The technique percutaneous multiple needle puncturing for releasing adductor muscle during THA for ischemic necrosis of femoral head is both safe and efficacious.And it solves the problems of soft tissue balancing mini-invasiveness.

To evaluate the usefulness of virtual reality (VR) technique for individualized preoperative planning of sphenoidal ridge meningioma.

Multiple imaging data of CTA/MR were acquired from 41 surgical patients with sphenoidal ridge meningioma during the period from July 2009 to June 2013 were transferred into the Dextroscope system.A suite of built-in 3D tools enabled users to obtain measurement and simulated intraoperative viewpoint about the lesion and adjacent anatomic structures.A sophisticated preoperative plan was defined.Operative duration, total resection rate, complication rate and KPS scores were compared with control group undergoing routine operation (n=27).

3D stereoscopic VR images in accordance with reality were reconstructed for 41 cases.As compared with control group, VR preoperative plan could shorten operative duration and reduce complication rate (P<0.05). However, there was no improvement in total resection rate or KPS score (P>0.50).

VR technique of Dextroscope system offers comprehensive information of sphenoidal ridge and related neurovascular anatomical structure.Thus it may aid surgical planning and facilitate individualized operation.

To summarize the clinical features, neuroimaging findings and pathological characteristics of pathologically confirmed tumefactive demyelinating lesions (TDL).

The clinical features, neuroimaging findings and pathological characteristics were retrospectively collected and analyzed for 58 patients with pathologically confirmed TDLs.For pathological studies, a combination of hematoxylin and eosin staining, myelin staining (Luxol fast blue/periodic acid-Schiff or immunohistochemistry for myelin basic protein), macrophage-specific marker (immunohistochemistry for KiM1P or CD68) and staining for axons (Bielschowski silver impregnation or immunohistochemistry for neurofilament protein) were employed.

The mean age of onset was 6-56(36±13) years.The onsets were acute (n=21, 36%), subacute (n=27, 46.5%) and chronic (n=10, 17.5%). The diagnoses of TDL were confirmed by repeat biopsy and pathological examinations (n=2, 3.4%). In acute phase, the plaques of lesions were characterized by massive demyelination with relatively axonal preservation associated with prominent reactive astrocytosis and profound infiltrates of macrophages.In plaques of chronic lesions, demyelinated lesions with relative axonal preservation and sharply defined margins were major findings.And myelin-laden macrophages accumulated at the edges of plaques and stayed relatively inactive with densely gliotic center and processbearing astrocytosis.

TDL is a distinct entity of demyelinating disease.Even though it is often misdiagnosed as neoplasm in brain, bilateral brain involvements and multiple lesions are more common in TDL.The pathological features of TDL are important for the early diagnosis of this disease and helpful for differentiating with brain tumors and central nervous system vasculitis.

To explore the effects of serum from ginsenoside saponins (GSS) on the proliferation, differentiation and mineralization in osteoblasts (OB).

Serum from GSS with different doses were fed to calvaria bone specimens from rats. The proliferation of osteoblasts and the alkaline phosphatase (ALP) activity of OB were analyzed. After alizarin red S staining, the area of calcium nodule was calculated to observe the result of serum from GSS on OB mineralization.

Serum from GSS had notable effects on the proliferation of in vitro cultured OB (P<0.01) and remarkably stimulated the mineralization of OB (P<0.05) while its effect on the ALP activity of OB was also marked (P<0.01).

Serum from GSS can promote the proliferation and mineralization ability of OB and significantly accelerate the formation of OB.

To explore the secular trends of operative vaginal delivery (OVD) among nulliparous and multiparous women in southern and northern China.

A population-based perinatal healthcare surveillance system has been established in 26 counties/cities in Zhejiang, Jiangsu and Hebei provinces since 1993.A total of 1 569 381 singleton pregnant women were registered during 1993-2010.Information concerning demographic characteristics and delivery mode was from surveillance records.OVD includes vacuum, forceps, assisted breech and breech extraction.Trend Chi-square test was performed to test the trends in OVD prevalence rate with the calendar years.

78 327 OVDs were identified among 1 317 771 nulliparous women and 8 702 among 251 610 multiparous women respectively.The OVD prevalence rate was 5.9% in nulliparous women and 3.5% in multiparous women.The OVD prevalence rate decreased remarkably by 92.5% from 10.6% (38 536/364 503) during 1993-1995 to 0.8% (691/84 714) during 2006-2010 in nulliparous women and by 90.0% from 5.9% (4 085/69 099) to 0.6% (116/20 280) in multiparous women.Moreover, stratified analyses consistently showed a decreasing trend in the OVD prevalence rate during the 18-year period regardless of living locations, delivery hospitals or demographic characteristics.In nulliparous women, the OVD prevalence rate decreased from 9.4% (5 271/56 163) during 1993-1995 to 1.4% (157/11 030) during 2006-2010 in southern urban area, from 11.8% (32 361/273 274) to 1.4% (402/29 069) in southern rural area and from 2.6% (904/35 066) to 0.3% (132/44 615) in northern rural area, and decreased from 8.6% (5 506/63 796) to 1.3% (208/16 408) at provincial hospitals, from 10.8% (13 659/126 529) to 0.7% (381/55 100) at county hospitals and from 12.1% (19 054/157 439) to 0.8% (100/12 959) at township hospitals.And similar results were further observed in different subgroups stratified by demographic characteristics.In multiparous women, a decreasing trend in OVD prevalence rate during the 18-year period was re-identified in various subgroups.

The OVD prevalence rate in both nulliparous and multiparous women dramatically decreased in China during 1993-2010 and ranked the lowest in the world by 2010.Thus the relevant government departments should be prepared for the expected rebound in the occurrence of OVD given the national health policies of promoting vaginal deliveries.

Distal degloving injury of finger is a difficult injury in hand surgery. The principle of microsurgical repair of finger degloving injury is to complete the tissue coverage, reconstruct the sensation of the finger tip and restore the aesthetic appearance of the affected finger to the maximum extent^[1]。 Because of the large area of skin and soft tissue defects and the combined defects on the dorsal side of the palmar, simple abdominal skin flap or free skin flap is used to repair the affected fingers after operation.^[2,3]。 In order to achieve good repair effect, it is often necessary to combine multiple flaps. According to the principle of flap repair in hand surgery, we used adjacent finger flap with dorsal perforator of the intrinsic finger artery as vascular pedicle to repair distal finger degloving injury, and achieved good curative effect.

Polycystic ovary syndrome (PCOS) is a variation characterized by hyperandrogenism, ovulatory disturbances, and polycystic ovaries, also known as Stein – Leventhal syndrome, associated with obesity, insulin resistance, dyslipidemia, accompanied by a high incidence of impaired glucose tolerance, type 2 diabetes, metabolic disorders^[1]Its incidence in adolescent and childbearing age women is higher, about 10%. At present, the main causes of PCOS are abnormal secretion of luteinizing hormone (LH), dysregulation of ovarian 17-α hydroxylase, genetic and environmental factors, etc. The pathogenesis of PCOS is still controversial. Petrikova et al.^[2]It was once thought that the ovary is an organ susceptible to immune attack, which can be manifested as premature ovarian failure (POF) or PCOS, while thyroid disease is also an autoimmune disease, often manifested as hyperthyroidism and hypothyroidism. Whether or not there is commonality and correlation between the two has caused extensive research. Gleicher et al.^[3]In proposed a view that PCOS and POF are two opposite extremes in the ovarian aging process, almost similar to hyperthyroidism and hypothyroidism of the thyroid gland. Recently, scholars generally believe that the thyroid gland is closely related to PCOS, and a lot of research has been done for this. This article focuses on summarizing the recent research progress related to this, mainly including PCOS and Graves disease, PCOS and hypothyroidism, PCOS and subclinical hypothyroidism, PCOS and autoimmune thyroiditis (AIT).

Since the 1950s, anterior cervical decompression and fusion (ACDF) has become the "gold standard" in the treatment of cervical spondylotic myelopathy and nerve root type^[1]。 However, more and more studies have found that ACDF can lead to changes in cervical spine dynamics, decreased cervical spine mobility, and increased incidence of adjacent segment degeneration/disease (ASD)^[2]。 artificial cervical disc arthroplasty (ACDA) has attracted people's attention and developed rapidly because it can preserve the mobility of cervical replacement segments and has the potential to reduce ASD. At present, it has become an important surgical method for treating cervical diseases^[3,4]。 However, with the extensive clinical application of ACDA, its related complications have gradually attracted the attention of scholars. The complications of ACDA and its countermeasures are now described.

Benign prostatic hyperplasia (BPH) is a common and frequently occurring disease in middle-aged and elderly men. The incidence rate is>50% in men over 60 years old and 90% in men over 85 years old^[1]。 BPH easily leads to lower urinary tract obstruction, including dysuria, frequent urination, urgency, increased nocturia, etc., and eventually causes bladder and kidney damage, which has become one of the important diseases affecting the health of middle-aged and elderly men. At present, drugs are the first-line treatment for the treatment of BPH, which is suitable for moderate degree of lower urinary tract obstruction. The most commonly used drugs are α-1 receptor blockers and 5-α reductase inhibitors. These two drugs can be used alone or in combination. Application can reduce the symptoms of obstruction to a certain extent, but the efficacy is limited^[2,3,4]。 Transurethral prostatectomy (TURP) is currently the most commonly used method to treat patients with severe lower urinary tract obstruction caused by BPH and poor drug therapy. It mostly needs to be performed under general anesthesia, and there is a certain proportion of intraoperative bleeding, postoperative urinary incontinence, sexual dysfunction and other complications^[5]。 There are many reports on the clinical application of various minimally invasive techniques, trying to replace traditional surgical treatment and reduce the risk of treatment, but there are still some problems. In the comprehensive evaluation of efficacy, complication rate, economic cost, safety, etc., no minimally invasive treatment technique has been proven to be superior to TURP^[6,7]Because of the limited time to maintain efficacy after treatment with these minimally invasive techniques. Therefore, there is a need to develop new therapeutic techniques.