Volume 95  ·  Issue 27  ·  2015

In recent years, imaging-guided local ablation technique has played an important role in the treatment of liver cancer. Among them, the local ablation treatment represented by radiofrequency ablation (RFA) has the advantages of less trauma, easy operation and remarkable curative effect, which can effectively locally coagulate and inactivate the tumor, and make a breakthrough in the treatment effect of liver cancer^[1]。 RFA is widely used in clinical practice, and its safety and efficacy have been recognized by clinicians. However, the annual incidence of liver cancer in China is high, and there are many large tumors in the middle and late stages at the time of consultation. Most of them are complicated with cirrhosis and poor liver function, and about 70% of them lose the opportunity of surgical resection^[2]Traditional surgical resection treatment also faces the problem of high recurrence rate. Percutaneous minimally invasive ablation for a large number of large liver cancer and recurrent cancer that are not suitable for surgical resection in clinic is difficult and requires high technique. At present, the operators mainly come from doctors in more than ten disciplines such as surgery, internal medicine, interventional department, imaging department or ultrasound department. Influenced by professional limitations, treatment concepts, and judgment on the degree of patients' disease, the treatment effect is uneven, and the recurrence rate and complication rate are high. On the one hand, the clinical demand is large, and on the other hand, it is refractory to treat, which is the bottleneck of RFA treatment in China.

The treatment of primary liver cancer in China has made remarkable progress, among which surgical treatment has played a decisive role. Resection of liver cancer is the most important way to achieve long-term survival by radical therapy. However, the role of surgical resection in the treatment of liver cancer also has certain limits. Non-surgical treatment with local treatment is still the treatment choice for most liver cancer patients, among which local ablation is the first choice for radical treatment for some liver cancer patients who are not suitable for surgery.

Clinical studies have proved that minimally invasive local ablation can achieve satisfactory efficacy and less complications in the treatment of many solid malignant tumors. At present, it is most widely used in the treatment of focal hepatocellular carcinoma (HCC) and secondary liver tumors. It has a wide application range, can treat patients with non-surgical indication and outpatient cases, has low complication and mortality rate immediately after treatment, and has low treatment cost^[1,2,3]。 At present, the most commonly used tumor ablation methods in clinical practice should be mainly divided into two categories: thermal ablation and chemical ablation. The former includes radio frequency, microwave, laser, high intensity focused ultrasound, cryotherapy^[4,5]； The latter consists of injection of ethanol or acetic acid ablation^[6,7]。 A variety of imaging means (e.g., ultrasound, CT, MR, etc.) can guide these treatments. The concept of image guidance is emphasized from the viewpoint of imaging, and it is determined that image guidance is the key to guarantee the success of local treatment. With the advancement of instruments and the adeptness of therapeutic methods, the indications continue to expand. Radiofrequency ablation is increasingly widely used in the treatment of liver tumors, and the understanding of its principle is helpful to select indications and improve treatment equipment. Establishing standards for ablation therapy can help improve communication in this field, promote more accurate comparisons between different techniques, results, and ultimately improve patient treatment results.

Before thermal ablation of liver cancer, detailed imaging examination should be performed. On the one hand, it is necessary to determine whether there is a real lesion in the liver and whether the lesion is a malignant tumor; On the other hand, it is necessary to clarify the location, number, size, blood supply characteristics, growth mode and adjacent relationship of liver tumors, as well as whether there is metastasis in other parts, so as to determine whether thermal ablation treatment can be performed, and then select the appropriate ablation treatment pole (radiofrequency ablation electrode, microwave antenna or cryoprobe), guidance mode and puncture path.

The global incidence of primary liver cancer is increasing year by year, of which hepatocellular carcinoma accounts for 70% to 85%. According to the latest statistics of the World Health Organization, there are 748,300 new cases and 695,900 deaths of primary liver cancer every year, while the number of new cases and deaths of liver cancer in China due to the hepatitis B epidemic is as high as half of the world^[1,2]。 Metastatic cancer is another common malignant tumor of the liver. Gastrointestinal, lung, breast and ovarian cancers are all primary tumors that are prone to liver metastasis. It is reported that 14.5% ~23.0% of colorectal cancer patients have liver metastasis at the same time when the primary tumor is found, and 76.8% of patients will eventually develop liver metastatic cancer^[3]。 For the treatment of liver malignant tumors, partial resection is still the first choice, but surgery is only suitable for 9% to 27% of patients^[4,5]。 Severe secondary cirrhosis and multiple lesions often make many patients with liver cancer lose the opportunity of surgery. In addition, recurrence of tumors occurs frequently after radical resection, and few patients are suitable for reoperation. Therefore, minimally invasive but effective treatment is necessary to improve the prognosis of liver cancer patients. With the development of engineering technology, microwave ablation technology has made rapid progress in the treatment of liver cancer in recent years, and has become an important technology for the treatment of liver cancer, especially for small liver cancer. This technology has become one of the curative methods for early liver cancer except surgical resection and liver transplantation.

With the development and progress of medicine, the treatment methods of liver cancer are constantly updated. Imaging-guided local thermal ablation has become one of the main radical treatment methods for liver cancer, among which radiofrequency ablation (RFA) and microwave ablation (MWA) have been recognized as the first-line treatment methods for early liver cancer. The goal of local thermal ablation therapy for liver cancer is to pursue complete tumor inactivation and avoid complications to the greatest extent. Fully understand and master the causes of thermal ablation complications, prevention and treatment methods, and standardized operation can significantly reduce the occurrence of complications.

Imaging examination is the main method to evaluate the efficacy after liver ablation, which can provide important clinical efficacy-related information. The imaging tests that can be used to evaluate the efficacy after ablation include CT, MR, US, PET, DSA, etc. Among them, CT has become the first choice for evaluating curative effect because of its advantages such as high penetration rate, simple operation, good patient compliance, large examination coverage, complete information such as evaluation form and blood supply. Because of its advantages of multi-parameter imaging and functional imaging, MR has been gradually affirmed in the early detection of residual lesions and the differentiation between postoperative changes and residual and recurrent lesions^[1]。

Iodine-enhanced CT and gadolinium-enhanced MR imaging methods are usually used to judge the efficacy of liver tumor ablation, and their value has been affirmed by many experts. They are the main imaging basis for evaluating the efficacy of ablation, the presence or absence of residual activity and recurrence. Contrast-enhanced ultrasound has some limitations in evaluating the efficacy of routine ultrasound. Contrast-enhanced ultrasound has similar diagnostic value to enhanced CT. It has become one of the effective methods to evaluate the efficacy of ablation in the treatment of liver tumors.

Radiofrequency ablation (RFA) techniques have been widely used in the minimally invasive treatment of hepatocellular carcinoma (HCC), especially in cases where poor liver reserve function cannot tolerate surgical resection or tumor diameter<HCC patients of 3 cm, this technique as a radical treatment means, offers hope for the survival of more patients. Although surgical resection is still considered as the preferred method for the treatment of HCC, after nearly 20 years of clinical application, RFA has achieved good results in the treatment of HCC^[1], diameter<3 cm HCC can achieve results comparable to surgical resection^[2]。 Therefore, this technology has been paid more and more attention and application by surgeons, especially the assistance of laparoscopy, which improves the safety and thoroughness of RFA in the treatment of HCC, and can achieve the purpose of one-time radiofrequency complete ablation for some HCC^[3]。 The understanding of RFA treatment of HCC assisted by laparoscopy under surgical conditions is discussed.

90% of primary liver cancer is hepatocellular carcinoma (HCC), which mostly occurs on the basis of chronic liver disease and its resulting cirrhosis. Therefore, the prognosis of HCC depends not only on oncological factors such as the degree, size, number, location of lesion differentiation, portal vein tumor thrombus and distant metastasis, but also on primary liver diseases (such as hepatitis B, virus replication virus level, alcohol abstinence), liver function reserve status and general condition, and the latter is also an important factor affecting the choice of treatment plan. Therefore, before performing ablation surgery, in addition to comprehensive oncological evaluation of patients, they should also comprehensively evaluate their primary liver disease, liver function reserve status and general condition, and give targeted necessary treatment to achieve the best clinical effect.

The 2011 "Guidelines for Staging and Treatment of Liver Cancer in China" clearly recommended that patients with middle and advanced primary liver cancer need radiotherapy. This is based on a series of reports on the treatment of hepatocellular carcinoma, including the comparison of the effects of radiotherapy and non-radiotherapy. Radiotherapy is one of the comprehensive treatment methods of primary liver cancer. Doctors engaged in the treatment of liver cancer should know its indications, curative effects and corresponding concepts.

Imaging-guided methods for percutaneous radiofrequency ablation of liver cancer include ultrasound, CT, MRI, DSA, etc^[1]。 Ultrasound guidance is the most commonly used method. The DSA fluoroscopic guidance method is used for tumors that have undergone transarterial lipiodol embolization, especially those DSA machines with rotary scan re-imaging capabilities. MRI guidance is rarely used in our country due to its special equipment requirements. CT has strong density resolution and spatial resolution. Combined with enhanced scan and three-dimensional reconstruction, it can clearly show the size, morphology and anatomical relationship with nearby structures, which provides reliable information for conformal ablation treatment. Especially for some small lesions that are deep, hidden and close to the top of the diaphragm, as well as lesions that are difficult to observe by B-ultrasound, CT guidance has more advantages. At the same time, modern CT often has real-time fluoroscopy function, which overcomes the influence of lesion displacement caused by respiratory movement in conventional CT, greatly improves puncture accuracy and saves operation time. The biggest disadvantage of CT is that it has a certain amount of radiation, but by designing a suitable scanning method, the radiation dose will be greatly reduced. Therefore, CT is suitable for various ablation techniques, and is widely used in clinical practice.

To investigate the risk factors of psychiatric symptoms in the process of the treatment of Sheehan's Syndrome(SS).

We collected the clinical data of 119 inpatients diagnosed of SS in Department of Endocrinology, the Second Xiangya Hospital, Central South University from January 2002 to November 2014.Logistic regression analyses were applied to investigate the risk factors of psychoses during the treatment of SS.

We found that among all the 119 subjects, 64 (54%) out of the pathients developed into pituitary crisis over the course of treatment for SS.And, 42 (35%) of the patients had psychiatric symptoms.SS patients with psychiatric symptoms had lower levels of hemoglobin [(96±16) g/L vs (104±23) g/L, (P<0.05)], sodium [(117±12) mmol/L vs (127±12) mmol/L, (P<0.01)], free serum T₃(FT₃)[(1.4±1.0) pmol/L vs (2.1±1.3) pmol/L, (P<0.01)] and free serum T₄(FT₄)[(4.1±2.8) pmol/L vs (6.5±4.9) pmol/L, (P<0.05)], but higher levels of daily dosage of hydrocortisone for the first three days (P<0.05) compared to the group without the same.Upon occurrence of psychiatric symptoms, the daily dosage of hydrocortisone for the first three days was 165 mg.Among them, patients also with pituitary crisis had a higher requirement of hydrocortisone, that is, daily dosage of hydrocortisone for the first three days was 208 mg.Logistic regression analysis showed that sodium(P<0.05,OR<1)and hydrocortisone dosage of the first day(P<0.01,OR>1)were included in the logistic regression equation, suggesting that serum sodium, is a protective factor against psychiatric symptoms(OR=0.950). And the dosage of glucocorticoid required on the first day(OR=1.008)is a risk factor for psychiatric symptoms.

SS patients with severe anterior pituitary dysfuncthion, especially those with pituitary crisis are susceptible to have psychiatric symptoms during glucocorticoid treatment.The dosage of glucocorticoid, especially the first day dosage is one of the risk factors for psychiatric symptoms.

To avoid the injuries of radiation and contrast agent, we assess the efficacy and safety of percutaneous patent ductus arteriosus(PDA) closure by femoral vein approach solely under echocardiography guidance.

From January 2014 to December 2014, 25 patients in Fuwai hospital with PDA were selected, with mean age (4.5±2.1) years and mean body weight (19±7) kg.The mean diameter of PDA was (5.9±1.2) mm.Patients were all treated by percutaneous PDA closure solely by echocardiography guidance in femoral vein.The effect of the procedure was evaluated by echocardiography.Follow-up was given at one month after procedure.

Twenty-three cases were successfully treated with percutaneous PDA closure by femoral vein approach solely under echocardiography guidance, while two patients was closed by femoral artery approach because guide wires could not pass through PDA.The procedural time was (33±5) min. The mean diameter of PDA occluder was (11.4±1.5) mm.Postoperative early trivial residual shunt occurred in three patients.All patients survived with no peripheral vascular injury or complications such as cardiac perforation. Hospitalization time was (3.6±0.8) days.At one month follow-up, no complications such as residual shunt or pericardial effusion were occurred.

Echocardiography guided percutaneous PDA closure by femoral vein approach is safe and effective, and avoids the use of radiation and contrast agents.

To study the compliance and its related factors of gout patients during the intercritical period.

A total of 218 gout patients were recruited.Compliance and cognition of gout were evaluated via telephone interview.Case control study was performed between compliance patients and non-compliance ones to explore the factors affecting patients' compliance.The association between compliance scores and cognition scores was evaluated by linear regression and correlation analysis.

Of 218 patients, 136 valid questionnaires were collected.The investigation showed that 52.9% (72/136) had more than 20 gout attacks so far.Only 15.4% (21/136) patients had no gout attack during the latest one year. The average compliance score was 3.93±1.78 (total score was 8), and the percentage of non-compliance was 69.9% (95/136). Cognition score was 65.63±18.63 (total score was 100). Among the 136 gout patients, 37 patients (27.2%) were non-cognition, 54 (39.7%) were partial-cognition and 45 (33.1%) were fully-cognition.Only 50.7% (69/136) accepted the concept of long term treatment with urate lowering drugs (ULD), 19.9% (27/136) patients knew the uric acid target and 29.4% (40/136) patients had no confidence to control this disease.Case control study revealed that the percentage of non-cognition in non-compliance group was higher than compliance group, and that of partial-cognition and fully-cognition were lower, although differences had no statistical significance (P>0.05). Besides, health insurance was better for compliance group (P>0.05). There was linear correlation between compliance and cognition scores (t=6.83, P<0.01) among gout patients.

This study indicates that efforts should be made to improve recognition and medical coverage for gout, which could be a very rewarding strategy for patients' compliance and gout control.

To analyze clinical features of patients with microscopic polyangiitis (MPA) associated with peripheral neuropathy (PN).

The clinical data of 37 (44.6%) hospitalized MPA patients associated with PN in Peking Union Medical College Hospital from January 2008 to January 2014 was retrospectively analyzed, using the rest 46 hospitalized MPA patients without PN as control.

(1) Out of the 37 MPA patients with PN, there were 15 men and 22 women, with the average age of (64±9) years old and average time between the diagnosis and onset of the disease of 24.5 months.(2) Neurologic manifestations of these patients: mononeuritis multiplex (56.8%) and distal symmetrical polyneuropathy (43.2%) were the predominant peripheral nervous system manifestations.Lower limbs were more frequently affected, and mixed (sensory and motor) or sensory abnormalities were more commonly seen than single motor abnormalities.(3) Compared with MPA patients without PN, the incidence of myalgia and the count of platelet in peripheral blood, erythrocyte sedimentation rate (ESR) were statistically higher, while the serum level of albumin was statistically lower in MPA patients with PN.There were no statistical differences in age, sex, fever, rash, arthritis, interstitial lung disease, gastrointestinal lesions, renal and central nervous system involvement between two groups.(4) The multivariant Logistic regression analysis suggested that thrombocytosis was the risk factor for PN in MPA patients(OR=1.005, P<0.05).

PN is common in MPA patients.Mononeuritis multiplex and distal symmetrical polyneuropathy, mixed neuropathy, and lower limbs involvement are predominant peripheral neurologic manifestations.Thrombocytosis may be one of the risk factors of PN in MPA patients, and PN may have minor effect on the prognosis of MPA.

To evaluate and explore the relationship among the pulmonary artery pressure, Brain natriuretic peptide and the prognosis in the patients with septic shock.

From May 2013 to Oct.2014, 48 patients were treated with Swan-Ganz catheter to monitor the pulmonary artery pressure, the pulmonary vascular resistance, the pulmonary capillary wedge pressure and cardiac output.Testing brain natriuretic peptide, Analysising the differences between survival patients (27 cases) and dead patients (21 cases) in the PAP, PVR, PCWP, CO and BNP, Analysising the correlation between BNP and PAP, PVR, PCWP, CO by Linear correlation analysis.

It is no difference in hemodynamic parameters between dead patients and survival patients when they come in the hospital (P>0.05); it is significant difference in hemodynamic parameters between dead patients and survival patients when they came in the hospital after 48 hours or 72 hours[(20.8±5.8) mmHg vs (34.2±7.4) mmHg,P<0.05], it is no difference in PVR, PCWR and CO at 24 hours, 48 hours or 72 hours.Then it is significant difference in BNP between dead patients and survival patients that they had been entered the hospital after 48 hours or 72 hours[(286.5±75.5) pg/ml vs (675.4±51.3) pg/ml,P<0.05], it has no obvious correlation among the BNP, PAP and CO.

It prompts a poor prognosis if the patients with septic shock had increased the pulmonary artery pressure and the BNP.Therefore it is need focus on pulmonary hypertension, it is different if BNP of plasma in heart failure patients increased, it does not mean heart function failuring, so it can not be used to give a guide to therapy on heart function.

To investigate the arterials adjacent to the lumbar zygapophyseal joints by anatomy and DSA and aimed to provide a safe operation way for the lumbar back and posterolateral surgery by reducing operative hemorrhage in clinical treatment.

We selected 20 adult corpse lumbar departments and discovered the lumbar lateral artery and lumbar transverse process artery.Using anatomical microscope to observe the lumber transverse process artery and dosal artery of 1–4 lumber arteries from the lumbar spine 1/2-4/5.We also selected 20 patients without lumbar disease and used DSA to research their lumbar arteries and the starting, mutation or branch line of other artery sources in vivo.

The anatomy and DSA results showed that the original location of dorsal branch usually at the anterosuperior of L1/2-4/5 foramen intervertebrale outlet area, then distributed to the outside and backside of ZJ.Anterior branch of transverse process sent out and branch into ascending and descending muscle branch.The ascending branch distributed to the below root of upper ZJ and sent out zygapophyseal branches which were distributing to the back of ZJ.The descending branch distributed to the upper root of below ZJ and sent out several muscle branches which were going into muscles in the front.And there were no statistically significant difference between left and right in the body.

The routes of arteries adjacent to ZJ and the relationship between them showed obvious regularity.Mastering its anatomical characteristics could effectively reduce the posterior surgical bleeding, make the operation easier, reduce the important tissue damage and then avoided the postoperative hematoma complications.

To investigate the treatment outcome of superficial temporal artery-middle cerebral artery bypass (STA-MCA) combined with multiple burr hole (MB) in pediatric ischemia moyamoya disease.

A total of 31 pediatric patients with ischemic moyamoya disease who were admitted to Beijing Tiantan hospital from 2010 to 2013 were divided into two groups which were STA-MCA+ MB surgery group (n=16) and STA-MCA surgery only group (n=15).

In all patients, the number of patients with symptom improvement was 24 (77.4%), the number of patients with no symptom improvement was 5 (16.1%) and with symptom deterioration was 2 (6.5%). The postoperative modified rankin scale (mRS) in STA-MCA+ MB group was significantly lower than that in STA-MCA group (P<0.05).

The treatment outcome of STA-MCA combined with MB is superior to STA-MCA bypass surgery only and doesn't increase the incidence of complication.

To observe the therapeutic effect of open reduction Kirschner wire fixation and open reduction external fixation in the treatment of the proximal humeral fractures in children.

Sixty two patients with proximal humeral fractures had received Kirschner wire fixation and external fixation in our hospital from Oct. 2010 to Aug. 2013 were collected.The Kirschner wire fixation group was 40 cases and the external fixation group 22 cases.Comparison the clinical effects of two groups.

Two groups operation time were (40.3±7.2, 62.3±6.7) min, operation amount of bleeding were (28.9±14.5, 71.7±17.5) ml, incision length were (32.4±11.3, 63.3±13.2) cm and postoperative Neer score were(96.8±9.8, 92.3±8.5)respectively.The external fixation group was better than Kirschner wire fixation group in above indexes and the difference was statistical significance (P<0.05), while it showed no significant difference in hospitalization time, fracture healing time and postoperative complications (P>0.05).

For the treatment of children with proximal humeral fractures, the open reduction and external fixation have some advantages, such as simple operation, small metaphyseal damage, fixed reliable for early functional exercises and good results for upper extremity functional recovery.

To explore the accuracy, precision and repeatability of bedside real-time concentration monitoring via helium dilution (RHe) in ventilated dogs with and without acute respiratory distress syndrome (ARDS).

Functional residual capacity (FRC) measurements were performed with computer tomography (FRC_CT) and RHe (FRC_RHe) in 18 adult male beagle dogs. Blood gas analysis was conducted for baseline, post-lung injury and end-of-experiment. Vital signs were monitored continuously. And the differences were compared between two techniques and repeated FRC_RHes.

For healthy lungs, FRC_CT and FRC_RHe were linearly correlated (R²=0.89, P<0.0001). Bias between FRC_RHe and FRC_CT was 6.3±27.6 ml (1.5%±7.1%) with 95% confidence interval limits of -47.7 and 60.3 ml respectively. For ARDS lung, FRC_RHe=0.693×FRC_CT+ 66.4 (R²=0.507, P<0.00 1). Bias between FRC_RHe and FRC_CT was 7.9±271 ml (4.5%±13.6%) with 95% confidence interval limits of -45.3 and 61.1 ml respectively. And the differences of repeated FRC_RHes were -0.1%±5.8% and 0.2%±9% in normal and ARDS lungs respectively.

The technique of bedside RHe may be used for measuring FRC with excellent accuracy, precision and repeatability.

To investigate the protective effects of Purα protein on rat hippocampus DNA damage induced by epilepsy and the effects of Purα protein on the repair of DNA damage.

The Purα overexpressing and siRNA lentiviruses were packagedin vitro and the high tittered virion was injected into rat hippocampus guided by stereotaxic apparatus.14 days later after the lentivirus injection, epileptic onset is induced by intraperitoneal injection of pilocarpine.The experimental animals were executed 1 hour after the epileptic onset and the hippocampus samples were collected for immunohistochemical staining and Western blotting assay was used to examine the pertinent protein expression to investigate the protective effects of Purα on DNA damage and repair.

Immunohistochemical analysis demonstrated that γH2AX, a signal protein of DNA damage, expressed in rat hippocampal CA1 region.20 slides of rat hippocampal CA1 region with the same background and position were chosen for γH2AX positive staining cell analysis with image analysis software iPP6.0 and the cells with positive staining were selected to evaluate the average optical density.Compared with empty vector group (0.40±0.11) and control group (0.42±0.05), the number of positive staining cells in Purα overexpression group (0.15±0.05) was significantly decreased ( P<0.01), while the number increased in Purα silence group (0.68±0.06) (P<0.01). Western blotting analysis showed, compared with empty vector group (0.93±0.11) and control group (1.00±0.00), that the expression levels of proteins related to the DNA repair such as parp-1, was much lower in Purα overexpression group (0.17±0.09), while it increased in Purα silence group (P<0.01).

The DNA damage can occur in the early stage of epilepsy onset, and Purα protein can protect the DNA damage caused by epilepsy and also participate in the repair process of DNA damage.

To explore the effects of transplantation of NT-3 gene modified olfactory ensheathing cells(OECs) on nerve function of rats with experimental autoimmune encephalomyelitis (EAE).

The experimental autoimmune encephalomyelitis model was established in Lewis rats.The animals were randomly divided into 3 group: blank control group(transplantation of saline), OECs transplanted group (transplantation of OECs), and OECs-NT-3 transplanted group(transplantation of NT-3 modified OECs). The neurological function was assessed and recorded every day.The migration and distribution of transplanted cells were observed.The nerve regeneration was valued in the aspect of morphological structure by means of immunohistochemistry and retrograde tracing technique of horseradish peroxidase(HRP).

The neurological functional score of OECs-NT-3 transplanted group was obviously inferior to OECs transplanted group after transplantation (P<0.05). A large number of OECs-NT-3 survived and migrated with axon in OECs-NT-3 transplanted group at Day 28.The number of nerve fibers in one microscopic field was much more in OECs-NT-3 transplanted group (38.8±3.4, Day 28) than those in OECs transplanted group (32.5±2.8, Day 28) (P<0.05). The number of cortex neurons labeled by HRP in OECs-NT-3 transplanted group were significantly higher than those in OECs transplanted group, (P<0.01).

NT-3 gene modified OECs have better capacities of survival and migration in EAE rats.The transplanted OECs-NT-3 can promote the regeneration of axon, reduce the injury of cortical neurons and improve the motor functions of EAE rats.

The pathogenesis of epilepsy has not been fully elucidated, and the curative effect is poor. Recent studies have found that the epigenetic mechanism is closely related to epilepsy, which has become a hot spot in epilepsy research. There are abnormal epigenetic modifications in the pathogenesis of epilepsy, including DNA methylation, chromatin recombination, histone modification and non-coding RNA regulation. In addition, the application of DNA methyltransferase inhibitors and histone acetylation inhibitors has therapeutic effects on epilepsy. This article will review the research progress of the epigenetic mechanism of epilepsy and its epigenetic therapy.

The incidence of ectopic pregnancy is about 2%^[1,2,3]Deaths due to fallopian tube rupture account for 6% of all first-trimester deaths, and recent data in the United States show that 6% of maternal deaths are related to ectopic pregnancy^[4,5,6]。 Because it has a variety of atypical symptoms and signs in the early stage, it is difficult to diagnose quickly. It is often confused with threatened abortion, inevitable abortion or rupture of the corpus luteum when visiting the gynecological emergency department, and it may also be delayed because the patient neglects the pregnancy and goes to the medical and surgical department. Unknown site pregnancy (PUL) was defined as: human chorionic gonadotropin (HCG) positive but no gestational sac was found intrauterine or extrauterine by transvaginal ultrasound and laparoscopy. There are four possibilities of PUL outcome: disappearance of gestational sac, normal intrauterine pregnancy (IUP), EP and persistent PUL. Atypical EP and PUL are potentially dangerous, requiring repeated transvaginal ultrasound (TVS), dynamic monitoring of hormone levels and even dozens of biomarkers, which is time-consuming and laborious, and bears huge risks, so it is necessary to find new stable and accurate diagnostic markers. Senapati and Barnhart^[7]It is considered that the development of biomarkers from basic research to clinical application is divided into four stages: subclinical stage of basic research, clinical test stage, predictive ability analysis stage in retrospective cohort or (and) case-control study and prospective study stage. The same is true for biomarkers associated with normal pregnancy or with EP.

Although the growth rod technology has unparalleled advantages in conservative treatment and fusion surgery, problems are constantly found and improved during its application. There are still many deficiencies and controversies in the application of growth rods, especially the complications and the selection of the timing of distraction, which have not been well solved.