Volume 95  ·  Issue 23  ·  2015

Traditional posterior cervical "single-door" spinal canal enlargement is a simple and effective method for the treatment of cervical spondylotic myelopathy (CSM), but long-term follow-up has complications such as poor cervical curvature, cervical stiffness, and "re-closing the door", which directly affects the long-term efficacy of the operation. In recent years, many improved surgical methods have appeared one after another. Now, the application of different modified surgical methods for posterior single-door spinal canal enlargement of cervical spine is discussed.

To compare the accuracy of lower lumbar pedicle screw placement at different levels with or without navigation system.

A prospective randomized controlled trial was conducted for patients undergoing open lumbar surgery with pedicle screws at both L4 and L5 levels from March 2011 to May 2012.The accuracy of pedicle screws at L4 and L5 level were evaluated by three-dimensional postoperative computed tomography (CT). There was no apparent violation of pedicle or <2 mm perforation of pedicle in non-violation group while ≥2 mm perforation of pedicle in violation group.

A total of 188 patients were recruited and assigned randomly into navigation (n=47) and control (n=141) groups.Two groups did not differ in estimated blood loss volume, length of hospital stay, Japanese Orthopedics Association (JOA) score or JOA recovery rate (P>0.05). Navigation group had a longer operative duration (P<0.05). At L4 level, 93/94 screws (98.9%) in navigation group and 273/282 screws (96.8%) in control group did not violate pedicle (P>0.05). At L5 level, 93/94 screws (98.9%) in navigation group and 260/282 screws (92.2%) in control group did not violate pedicle.Thus navigation could achieve a higher accuracy at L5 level (P<0.05).

The profile of L5 pedicle at coronal plane is tilting oval. Screw may easily violate medioinferior part of pedicle and cause injures of nerve root.For improving the accuracy and safety of pedicle screw at L5 level, we recommend using intraoperative three-dimensional navigation for spondylolisthesis or facet hypertrophy, iliac cohesion or junior operator.

Surgical detethering is a traditional treatment for symptomatic tethered cord syndrome.However, such complications as cerebrospinal fluid leakage and neurologic deterioration are common.Homogeneous spinal-shortening axial decompression (HSAD) is a modified procedure of monosegmental spinal-shortening osteotomy and it is a novel surgical alternative of reducing neural tension indirectly.The objective was to evaluate the surgical outcomes of HSAD for tethered cord syndrome.

The surgical outcomes were examined for 15 consecutive patients with tethered cord syndrome undergoing HSAD from April 2010 to July 2014.Improvements of neurological symptoms including urinary dysfunction, lower-extremity motor and sensory disturbances and/or gait abnormalities, low-back and/or lower-extremity pain, bowel incontinence and sexual dysfunction were evaluated.

Their average follow-up period was 21.5 months.The length of spinal column shortening was 17.2±2.9 mm.Urinary dysfunction (n=9) was the most common residual deficit.All 9 patients with urological symptoms reported improvements, although deficits persisted at the last follow-up.All patients with lower-extremity motor dysfunction improved and 4 (50.0%) noted complete resolution of preoperative lower-extremity sensory symptoms.All patients reported immediate low-back or lower-extremity pain relief after HSAD.One patient reported improved sexual functioning and regained complete erectile capabilities.Two patients (11%) experienced less satisfactory symptomatic or functional benefit from HSAD.However, the main objective of surgery was to prevent further worsening of neurological status.Complete bone union at osteotomy site was noted in all cases at the last follow-up.

As a novel surgical option for tethered cord syndrome, HSAD may avoid such complications as cerebrospinal fluid leakage or neurologic deterioration commonly encountered during traditional detethering surgery.All patients gain satisfactory functional outcomes without complications compared to their preoperative symptoms.

To evaluate the safety and efficacy of percutaneous endoscopic lumbar discectomy (PELD) in the treatment of central lumbar disc extrusion via an interlaminar approach.

Between January 2012 and January 2014, 27 low-back pain patients with radicular central lumbar disc herniations underwent percutaneous endoscopic discectomy through an interlaminar approach. The clinical follow-ups were performed at 3 months, 6 months and 1 year with an extensive postoperative questionnaire, including pain visual analog scale (VAS) and Oswestry disability index (ODI).

Mini-invasive operation was completed successfully in all patients.The mean operative duration was 41 (26-83) min and the average postoperative hospitalization time 5 (2-7) days.The postoperative median VAS and ODI scores significant decreased at all timepoints.Twenty-five patients had no longer leg pain.But the recurrence rate of disc herniation stood at 7.4 %.One patient undergo reoperation (microscopic discectomy) and another showed a significant relief in pain symptoms after conservative treatment.

Endoscopic discectomy via an interlaminar approach for central lumbar disc extrusion offers significant advantages of faciliating rehabilitation, reducing complications, minimizing trauma and lowering expenditure.

To explore the outcomes of multiple derotation plus costotransversectomy for patients with severe and rigid scoliosis.

Clinical analyses were conducted for the clinical data of operative duration, blood loss volume and SRS-22 scale. Radiographic data included Cobb angle of coronal curves, apical vertebral translation, coronal balance and sagittal balance. All measurements were taken pre-operation, post-operation and during the final follow-up period.

The mean follow-up period was 4.1±0.7 (3-5.5) years, mean operative duration 33±8.4 min and mean blood loss volume 2303.5±9.0 ml. Preoperative major curves ranged from 65°to 110° Cobb angle. Coronal plane correction of major curve from 10° to 41°Cobb angle (mean 30.8±9.8°). And there was a mean loss of correction of 3.6% during the final follow-up. The magnitudes of thoracic kyphosis and lumbar lordosis were 31.1±12.4°, 45.5±10.5°pre-operation, 25.6±5.5°, 33.43±5.45°post-operation and 28.6±6.1°, 35.26±4.2°during the final follow-up. The apical vertebral translation of major curve was corrected by 73.2%. The coronal imbalance, sagittal imbalance and apical vertebral translation indifferently was 3.2±1.1, 2.3±1.1, 6.35±1.65 cm pre-operation, 0.9±1.0, 0.4±0.5, 2.4±1.2 cm post-operation and 1.2±1.1, 0.6±0.5, 2.6±1.4 cm during the final follow-up. Incomplete thoracic nerve dysfuction occurred in one case and superficial dermatoedge necrosis in another recovered within 2 weeks. Neither malposition of pedicle screw nor complication of instrumentation was found. Excellent outcomes were obtained according to SRS-22 score.

For patients with severe and rigid scoliosis, the technique of multi-rod-derotation and rib resection may achieve a good correction of scoliosis without serious complications and avoid a resection of vertebral column.

To compare the clinical and metabolic effects of drospirenone-estradiol (Angeliq) versus tibolone (Livial) in postmenopausal women.

Twenty-seven postmenopausal women of group 1 took Angeliq (1 dose every two days) while another group 2 (n=26) received tibolone (2.5 mg every two days) as hormone replacement therapy for 12 weeks.A retrospective analysis was used to evaluate the clinical efficacy, safety and risk factors of cardiovascular metabolism.The clinical data were collected before and after treatment, including personal interview, medical examination and ultrasound imaging of pelvic, breast and carotid artery.

No statistically significant inter-group differences existed in age or body mass index.Before treatment, the level of E₂ was (12±10) ng/L, triglyceride (TG) (2.0±1.1) mmol/L, lipoprotein-a (LPa) (47±43) mmol/L in group 1 versus (23±12) ng/L, (1.3±0.7) mmol/L and (28±14) mmol/L in group 2.After 12-week treatment, (30±18) ng/L, (1.6±1.1) mmol/L and (37±36) mmol/L in group 1 versus (23±9) ng/L, (1.1±0.6) mmol/L and (18±12) mmol/L in group 2.A greater incidence of vaginal bleeding and thicker endometrium were found in group 1.

Angeliq can relieve menopausal symptoms.And its functions of regulating lipid metabolism and protecting cardiovascular system are better than those of Livial.However, its wider acceptability is limited by vaginal bleeding, thicker endometrium and breast pain.

To explore the efficacies of embolization in the treatment of nongalenic cerebral arteriovenous fistula (NCAVF).

The clinical data of 16 NCAVF patients (14 from Department of Neurointerventional Medicine, Beijing Tiantan Hospital and 2 from Department of Neurosurgery, Second Municipal Hospital of Yulin) undergoing embolization from April 2008 to October 2014 were analyzed retrospectively.Clinical and imaging follow-ups were conducted.

Among them, 6 patients were embolized with coils alone and the remainder coil plus Onyx glue.The digital subtraction angiography (DSA) images obtained immediately after embolization showed that complete (n=12), near-complete (n=2) and staged (n=2) occlusions of NCAVFs were achieved.One patient recurred during an imaging follow-up period of 3-24 months.All symptoms and signs were relieved after embolization during a clinical follow-up period of 3-38 months.

Embolization with coil or coil-assisted Onyx embolization is both feasible and efficacious for NCAVF.Using coils helps to reduce the velocity of blood flow and assists Onyx in embolizing fistulas in patients with high-flow NCAVF.

To investigate the expression of retinoic acid-Ⅰinducible gene Ⅰ (RIG-Ⅰ) in the muscle tissues from patients with idiopathic inflammatory myopathies(IIMs), and to speculate the possible role of RIG-Ⅰin the immunopathogenesis of IIMs.

Muscle specimens were obtained from 20 dermatomyositis (DM) and 20 polymyositis (PM)patients who underwent muscle biopsies from February 2010 to April 2014 at Qilu hospital affiliated to Shandong University.Besides, 4 facioscapulohumeral muscular dystrophy (FSHD), and 4 non-myopathic patients were taken as control group.All the biopsy specimens were processed with hematoxylin-eosin and immunohistochemical(Mouse anti human RIG-Ⅰantibodies) staining.We also examined the co-localization of RIG-Ⅰand CD303, which is the specific surface marker of plasmacytoid dendridic cells( pDCs), by means of double immunofluorescence staining.Western blot was performed for quantitative analysis.

There was strong expression of RIG-Ⅰ protein in DM/PM muscle tissues while in normal controls was virtually absent.RIG-Ⅰwas specifically expressed in inflammatory cells and vessel endothelium, and nonspecifically expressed in regenerating and necrotic fibers.Besides, strong positive expression was observed in the perimysial perifascicular fibers of DM.In FSHD muscle tissues, only a few regenerating and necrotic fibers was stained nonspecifically for RIG-Ⅰ.However, co-expression of RIG-Ⅰand CD303 was not detected in DM/PM muscles. The mean grey value of RIG-Ⅰobserved in DM (0.901±0.470) and PM (0.630±0.444) group was significantly higher than in control group including Normal (0.003±0.003) and FSHD (0.019±0.013) groups (P<0.05).

RIG-Ⅰmay operate as a mediator in Th1 cytokine-Ⅰinduced chemokine expression, so it is involved in the pathogenesis of IIMs. But RIG-Ⅰmay not play a major role in innate immune reaction mediated by type Ⅰ interferon.

To investigate incidence and clinical features of multiple organ involvement in Chinese patients with Fabry disease.

We collected 151 patients of 31 families with Fabry disease, all of whom were confirmed by classic pathology, decreased α-galactosidase A activity or GLA mutation from the year of 2011 to 2014 in Department of Neurology, Peking University First Hospital.The clinical data included incidence and onset of neuralgia, renal dysfunction, heart disease, hypertension and cerebral stroke.We calculate the incidence of these symptoms and analyze their gender difference using chi-square with SPSS 17.0 software.

Among 31 families with Fabry disease, 151 patients (82 males and 69 females) were affected, including 91 patients (60.26%) with neuralgia, 62 patients (41.06%) with renal disease, 33 patients (21.85%) with heart disease, 33 patients (21.85%) with hypertension, and 21 patients (13.91%) with cerebral stroke. The peak incidence of neuralgia was from 10 to 20 years old, followed by renal disease from 30 to 40 years old, heart disease and stroke from 40 to 50 years old.There is no peak period for hypertension.Except for males with higher incidence of renal dysfunction than females (P<0.05), there were no gender difference in the incidence of other organ involvement.

The incidence and onset of multiple organ dysfunction in Chinese patients with Fabry disease displayed special regularity.Gender difference appeared only in renal disease.

The purpose of this study was to explore the barriers existing in medical settings behind the phenomenon that few suicide attempters were provided by mental health services when they got treatment in the general hospital ED.

An anonymous and voluntary survey was administered among two groups: ED physicians and psychiatrists.Two tertiary general hospitals and one psychiatric hospital were chosen through convenience sampling.Suicide Behavior Attitude Questionnaire and a self-made questionnaire to evaluate barriers were used.

The response rate was 68.7% for ED physicians, and 87.0% for psychiatrists.ED physicians generally scored unfavorably than psychiatrists on many items in SBAQ(P<0.001), but on the item about whether the suicide attempters should have access to mental health services, the median of the scores=10 for both group(P=0.059), meaning highly agree.Some consistent barriers could be summarized from the self-made questionnaire.

The majority of ED physicians in general hospitals still hold some misunderstanding about the suicide attempters, but they fully agree that the suicide attempters should have access to mental health services. The barriers for psychiatrists are clear.The barriers for ED physicians are complicated but workable.

To evaluate the diagnostic value of quantitative Dynamic Contrast Enhanced MRI analysis on pituitary adenoma.

With the standard of pathology and follow-up results, 67 cases of microadenoma, 20 cases of macroadenoma and 15 cases of normal pituitary were selected and taken routine scanning, meanwhile the dynamic contrast-enhanced scanning was performed, then the characteristics of lesions on conventional images were analyzed, and the mean permeability parameters were measured, including transfer rate (K^trans), back flux rate (K_ep), fractional EES volume (V_e) using Tofts model, which were compared with each other among those three groups and between prolactinoma and somatotroph adenoma; finally, the areas under the ROC curve of permeability parameters were compared.

61 cases of 67 cases of pituitary adenoma could be diagnosed by conventional methods, therefore the diagnostic accuracy was 91.1%. The K^trans, K_ep and V_e values were(0.90±0.23)/min, (1.14±0.58)/min, 1.02±0.51 respectively in normal pituitary, and (0.46±0.23)/min , (0.80±0.27)/min, 0.73±0.32 in microadenoma and (0.41±0.25)/min, (0.71±0.48)/min, 0.66±0.40 in macroadenoma.The K^trans and K_ep in normal adenoma were respectively higher than in microadenoma and macroadenoma, and the difference had statistical significance (P<0.05), while the V_e value among these three groups had no statistical significance; the K^trans in prolactinoma was higher than in somatotroph adenoma, and the difference had statistical significance(P<0.05), while the difference of K_ep and V_e between prolactinoma and somatotroph adenoma had no statistical significance.The area under the ROC curve in finding the microadenoma, K^trans, K_ep were 0.915 and 0.738, and the sensitivity of K^trans and K_ep were 92.3% and 53.8%, and the specificity of K^trans and K_ep were 85% and 100%.

Dynamic contrast-enhanced quantitative parameters, K^trans and K_ep are help to the diagnosis of pituitary adenoma, and K^trans exhibits a relatively high diagnostic efficacy, and the value of diagnosis in K^trans is higher than which in MRI conventional method; while K^trans can differentiate certain secreting type of pituitary microadenoma.

To evaluate the relationship between structural integrity of descending motor tracts and motor status in patients with chronic ischemic stroke using diffusion tensor imaging(DTI).

From April 2012 to December 2013, 47 patients with chronic ischemic strok were recruited along with 20 matched normal controls.The DTI data was acquired and preprocessed.Bilateral descending motor tracts includingcorticospinal tract (CST) and alternate motor fibers (aMF) were constructed.The descending motor tracts numberswere acquired and the relationships between laterality indices(LI) of descending motor tracts numbers and FMA were assessed.The patients were grouped into (CST+ aMF) group (group1), no (CST+ aMF) group (group2), CST group (group3) and aMF group (group4) according to the damage morphology of descending motor tracts.Observing the changes of each group.

Ipsilesional CST and theentiredescending motor tracts numbers (aMF+ CST) were lower in the patient group as compared to the control group(P<0.01, CST: 26±30, CST+ aMF: 37±37). The FMA were statistically different between group1, 2, 3(55±12, 16±10, 34±15,F=24.2, P<0.01). The LI of CST and (CST+ aMF)significantly diagnosed motor impairment (P<0.01,r=-0.653; r=-0.692). Meanwhile, it is a stronger parameter when entire descending motor tracts were combined comparing to using the CST only.

The integrity of entire descending motor tracts, not merely the CST, appears to account for stroke recovery.Our results highlight the role of aMFin compensatory function, which may be used as a target in future rehabilitative treatmentsto promoting motor function recovery at the most extent.

To investigate the value of three-dimentional pseudo-continuous arterial spin labeling(ASL) perfusion imaging in differentiating acute cerebral infarction from acute encephalitis.

From September 2013 to September 2014, 42 patients with actue stroke onset and 20 healthy volunteers underwent conventional brain MRI DWI and 3D-ASL Perfusion Imaging in our hospital.Only 20 patients whose lesions located in the middle cerebral artery(MCA) territory were enrolled in this study. Of these cases, 12 cases were diagnosed with acute cerebral infarction, 8 were diagnosed with encephalitis. First, we analyzed the imaging features of the 20 patients and 20 volunteers. Then, CBF values of the lesions in the 20 patients and the gray matter of MCA territory in the 20 volunteers were measured on 3D-pcASL images. Third, the difference of mean CBF values between patients and volunteers were analyzed.

Out of 20 study group, 19 patients whose lesions presented high signal intensity on DWI images, 12 cases were acute cerebral infarction and 8 were encephalitis. All the lesions of 20 cases showed abnormal perfusion on 3D-pcASL images. 3D-pcASL has good consistency with DWI in diagnostic capabilities(χ²=0.565, P=0.01). On 3D-pcASL, 11 acute cerebral infarction patients presented perfusion defects or low perfusion, 1 acute cerebral infarction patients showed high perfusion, 8 encephalitis patients showed inhomogeneous perfusion. The mean value of CBF was (17±6) ml·min^-1·100 g^-1 in 12 acute cerebral infarction patients, (136±69) ml·min^-1·100 g^-1 in 8 encephalitis patients and (68±12) ml·min^-1·100 g^-1 three in 20 healthy volunteers. The difference in mean value of CBF among the three groups was statistically significant(P<0.01).

Acute cerebral infarction often shows low perfusion and acute encephalitis shows high perfusion on 3D-pcASL images, which has a higher application value in diagnosis and differentiation of acute cerebral infarction and encephalitis.

To employ a co-culture system of human mesenchymal stem cells (MSC) and ovarian cancer cells to elucidate the cellular interactions among ovarian tumor microenvironment.

MSC and ovarian cancer cells of SK-OV-3, NIH: OVCAR-3 and SCCOHT-1 were transfected with third-generation lentiviral self-inactivating (SIN) vector containing enhanced green fluorescent protein (eGFP) or mCherry gene. The interactions between MSC and ovarian cancer cells were examined by fluorescence microscopy with appropriate monochrome fluorescence filters and a FITC/TRIC dual band fluorescence filter.Flow cytometry of both cells revealed a differential expression of cell surface markers during co-culturing.Moreover, microarray was used for further analyses of gene variation during co-culturing of both MSC and ovarian cancer cells.

MSCs were successfully isolated from umbilical cords.After 5-6 days co-culturing of lentivirus eGFP-transduced human MSC with mCherry-labeled ovarian cancer cells, there was a growth stimulation of cancer cells by MSC accompanied by an induction of CD90, partial CD73 and CD105 in cancer cells and CD326 in MSC.Microarray data also showed various significant gene variations during co-culturing.

Human MSCs highly stimulate the growth and expression of CD90, partial CD73 and CD105 in ovarian cancer cells during co-culturing.And mutual cellular protein exchanges result in CD326 expression and gene alteration in MSC.

To investigate behavioral changes in a rat hyperlipidemia model induced by high lipid feed combined with depression by Chronic Unpredictable Mild Stress (CUMS).

A total of 40 rats were randomly divided into control (CON), control feed for 9 weeks followed by CUMS for 4 weeks (CON+ CUMS), high fat diet (HFD) and high lipid feed for 9 weeks followed by CUMS for 4 weeks (HFD+ CUMS) (n=10 each). Open-field test was individually measured at baseline, week 9 and week 13.

(1) Serum lipids: total cholesterol [(2.67±0.04)mmol/L, (2.68±0.02)mmol/L]and low density lipoprotein [(1.08±0.03)mmol/L, (1.06±0.01)mmol/L] of HFD and HFD+ CUMS were both significantly higher than those of CON and CON+ CUMS [(1.78±0.12)mmol/L, (0.79±0.04)mmol/L; (1.76±0.09)mmol/L, (0.76±0.06)mmol/L, allP<0.01]. (2) Open-field test: at week 13, compared to CON rats, CON+ CUMS rats exhibited enhanced locomotor activity during the first minute, reduced activity in the center squares and rearing, and increased the number of grooming and defecation (allP<0.05). In comparison to the CON rats, a decrease in total squares in 5 min, central squares and peripheral squares was observed in HFD rats at week 13 (allP<0.05). However, compared with HFD, CON, CON+ CUMS rats, when high lipid feed for 9 weeks combined with depression, significant decrease activities in total squares in 5 min, central squares and peripheral squares were observed in HFD+ CUMS rats at week 13. Besides these, the number of rearing was reduced, however, locomotor activity during the first minute and the number of grooming and defecation was significantly increased (allP<0.001).

Under uncontrolled hyperlipidemia, severe depressive symptoms will present more early once exposure to a series of chronic stressors followed by significant autonomic nervous dysfunctional symptoms.

To explore the drug resistance of Chonglou saponin Ⅶ plus silica nano complex for ovarian cancer.

The method of thiazolyl blue tetrazolium blue (MTT) was employed for determining the proliferation inhibition rate of Chonglou saponin Ⅶ plus silica nano composite for SKOV3/DDP drug-resistant human ovarian cancer cell.Flow cytometry and Hoechst 33342 staining were used for detecting apoptosis rate and cell cycle phase distribution.And the changes of apoptosis-related protein were examined by immunoblot assay.

There were obvious inhibitory effects of Chonglou saponin Ⅶ on cell proliferation.The inhibition rate increased with rising drug concentration with an obvious dose-effect relationship (P<0.05). At the same time, the cell proliferation inhibition rate significantly improved at 48 h versus 24 h (P<0.05). Flow cytometry and Hoechst 33342 staining showed that, after a 24 h treatment of SKOV3/DDP cells with 50 and 100 μmol/L Chonglou saponin Ⅶ, early apoptotic cell ratio significantly increased compared with control group.

The composite of Paris polyphylla saponin Ⅶ and silica nano has obvious proliferation inhibitory effects on SKOV3/DDP cells.And there is a significant concentration dependence and it also has some correlation with time.The above composite can increased the proportion of early apoptotic cell ratio.

To establish lymph node metastasis of breast cancer model in nude mices using MDA-MB-231 cell lines or tumor masses.

Divided twelve female nude mices of five weeks into A, B groups randomly.A group had seven nude mices, B group had five nude mices.A group nude mices were injected with MDA-MB-231 cells suspension into the second right mammary fat pad.Two weeks after emerged tumors, the orthotopic tumors of two nude mices of A group were dissected and then implanted into the second right mammary fat pad of B group nude mices.The other mices of A group continued to be fed.After six weeks of inoculation, we excised the tumors and the swollen lymph nodes in right axilla of all nude mices to make pathological examination.

①A group have a 7/7 tumor formation rate 7 days after implanted, B group was 5/5 5 days after implanted.②The tumor volumes between the two groups had evident difference(P=0.023), and the tumor volume of B group was bigger than A group.③A group had three nude mices which had one tumid lymph node respectively, the lymph node enlargement rate was 3/5; B group only had one nude mice that had one tumid lymph node, the lymph node enlargement rate was 1/5, the lymph node enlargement rate between the two groups showed no significant difference(P=0.524). ④The result of pathology in the two groups testified the tumors were invasive ductal carcinoma.The swollen lymph nodes in A group were reactive hyperplasia lymph nodes; the swollen lymph nodes in B group was metastatic lymph node.

The method of orthotopic implantation with MDA-MB-231 tumor mass to establish lymph node metastasis of breast cancer model in nude mice, can provide a useful mean to research the lymph node metastasis mechanism of breast cancer.

A 47-year-old male was admitted to the hospital on 3 October 2014 due to "inability to speak and right limb weakness for 2 h". Eight hours ago, the patient was working in farmland and was accidentally stung by a large swarm of wasps. He went home and scrubbed himself. Two hours ago, the patient had sudden right limb weakness while taking a bath, unstable right hand grip, with vague speech, no headache, nausea and vomiting. Previous history of hypertension for 2 years, less regular medication. Physical examination: body temperature 37.2℃, pulse 96 beats/min, breathing 24 beats/min, blood pressure 142/87 mmHg (1 mmHg =0.133 kPa), painful face, swelling of left cheek, scattered multiple bite marks on face, back and calf, local redness and swelling, burning sensation, mild tenderness, no petechiae and ecchymosis. Neurological system: Superficial coma, pupil diameter 3 mm, sensitive to light reflex, slightly low muscle tone in extremities, tendon reflex (+ +), bilateral pathological signs (-), remaining body examination does not cooperate. No previous history of smoking or poisoning. Laboratory test: white blood cells 20.58×10⁹/L, neutrophils 0.937, eosinophils 0, monocytes 0.016; Aspartate aminotransferase 52.0 U/L, creatine kinase 252.0 U/L, myoglobin 88.3 μ g/L, high-sensitivity C-reactive protein 1.4 mg/L, randomized blood glucose 10.85 mmol/L; D-dimer 0.28 mg/L and fibrinogen 2.47 g/L. Remaining kidney function, blood lipids, electrolytes, glycosylated hemoglobin, homocysteine, rheumatoid factor, hepatitis B, syphilis and HIV antibodies were normal. Emergency cranial CT: speckled low density shadows in right basal ganglia and left hemioval central area. Cerebral hemorrhage was excluded and "cerebral infarction" was proposed. After treatment with dexamethasone, edaravone, aescin, aspirin, Xingnaojing and fluid rehydration, the patient's consciousness gradually improved, and he was completely awake on the third day, leaving only motor aphasia and right limb paresis. MRI of the brain showed that the left frontotemporal lobe and basal ganglia showed patchy abnormal signal shadows with poor boundary, the maximum cross section was 7.71 cm ×4.27 cm, T₁The image shows a slightly low signal, and there are scattered flakes with a slightly high signal, T₂Image showed a slightly higher signal, water suppression showed a high signal, DWI showed a high signal, and ADC showed a low signal; The left parieto-occipital lobe showed small patches with poor borders and the same signal shadows, with the largest cross section of 2.65 cm ×2.62 cm, and scattered multiple patches of abnormal signal shadows around it; MRA: Absence of left middle cerebral artery and its branches, stenosis of left posterior cerebral artery main trunk and right posterior cerebral artery branches (Figure 1)。 Heart color ultrasound was normal. Carotid color Doppler ultrasound showed only bilateral carotid arteriosclerosis without plaque formation. One week later, the patient's facial swelling basically disappeared, and the sting area was crusted, but he still had motor aphasia, and the grip strength of his right hand was slightly poor, so he could walk and move independently. Reexamination of blood leukocytes 11.93×10⁹/L, neutrophils 0.72, aspartate aminotransferase and blood glucose were normal. Self-discharged. Follow-up 4 months later, there was improvement in speech expression and completely normal limb function, but TCD showed smooth blood flow in the left middle cerebral artery.

The patient, a 50-year-old female, went to the local hospital in April 2013 due to swelling and pain in her left eye for 1 month. No abnormalities were found in the visual acuity and visual field. The MRI of the head showed irregular and slightly long T1/T2 signal nodules in the sellar area of 23 mm ×22 mm ×17 mm, compressing the optic chiasm and uniformly enhancing, considering pituitary adenoma.Figure 1。 Blood human growth hormone (GH), adrenocorticotropic hormone (ACTH), cortisol, prolactin (PRL), and thyroid stimulating hormone (TSH) levels were in the normal range. On April 7, 2013, he underwent transnasal sphenoidal sellar area lesion resection under general anesthesia. The pituitary gland was gray and white, tough in texture and rich in blood supply. Partial resection was performed. Postoperative pathological diagnosis of atypical pituitary adenoma in sellar area (non-functional). Immunohistochemistry: ACTH (-), FSH (-), GH (-), luteinizing hormone (LH) (-), PRL (-), Ki-67 index 40%, P53 (+),Figure 2。 Stereotactic radiotherapy was administered to the sellar region at a dose of 54 Gy/27 F in May 2013. MRI of sellar region after radiotherapy showed that the tumor volume was smaller than before. In August 2013, he developed hoarseness, choking and cough after drinking water, and MRI of the head showed multiple abnormal enhancements in bilateral frontal, parietal and temporal lobes, corpus callosum, midbrain and cerebellum (Figure 1), considering metastatic tumor, so a stereotactic-assisted lower parietal lobe lesion biopsy was performed in Peking Union Medical College Hospital. Postoperative pathological diagnosis: (parietal lobe tumor) active growth with mild abnormal adenopituitary tissue, consistent with metastatic pituitary cancer, immunohistochemistry: ACTH (-), FSH (-), GH (+), LH (-), PRL (-), Ki-67 index 75%, P53 (+) (Figure 2)。 Temozolomide 150 mg·m was administered after operation^-2• d^-11 course and continued with radiotherapy for 30 Gy/15 F. Lower back discomfort occurred in September 2013. Multiple enhanced nodules and line-like foci in the spinal canal were seen on MRI of the whole spinal cord, and spinal cord metastasis was considered (Figure 1)。 Whole body PET-CT scan showed no other systemic metastases. Subsequently, chemoradiotherapy and radiotherapy were not tolerated due to three-line decrease in blood. The patient repeatedly complained of back pain and headache, gave up treatment and died in November 2013.

triangular fibrocartilage complex (TFCC) is the main stable structure of the ulnar side of the wrist joint and the distal radioulnar joint. It has important biomechanical functions. It can decompose and absorb the stress on the ulnar side of the ulna and the wrist bone, so that the wrist joint can move smoothly and the forearm can rotate^[1,2]。 Injury of TFCC is a common cause of ulnar wrist pain^[3]Because of the complex anatomy, some early injuries are often overlooked and misdiagnosed, thus delaying diagnosis and treatment, resulting in affecting the functional recovery and quality of life of patients. Correct understanding and diagnosis of TFCC injury is of great significance to the hand surgeon to formulate appropriate treatment plan and the patient's functional recovery. In this paper, the normal anatomy, injury classification and various related imaging research progress of TFCC are reviewed.

Dendritic cell (DC) and tumor cell (TC) fusion vaccine^[1]And peptide chain vaccines^[2]Both can effectively stimulate the immune response of specific cytotoxic T lymphocytes (CTL), and make the tumor of tumor-bearing mice shrink or even disappear. However, the clinical efficacy has not yet reached the expected value and is being explored.