Volume 95  ·  Issue 33  ·  2015

With the continuous development of information construction of medical institutions and the application of hospital information management and Internet, more and more data generated in medical work are collected and stored by hospital information system. In addition to providing useful information for doctors' clinical diagnosis and treatment, various clinical data collected by hospitals in the process of admission and treatment also provide the most realistic sample data for medical research. How to reasonably manage and apply these data is a new challenge for hospital informatization construction in the future. Therefore, the Department of Neurosurgery of Peking Union Medical College Hospital established a database of non-functional pituitary adenomas to preserve and manage the clinical data of patients completely. Pituitary adenomas are a group of benign intracranial tumors of monoclonal origin of adenopituitary gland, accounting for 10% ~15% of intracranial tumors, and are the third most common intracranial tumors, second only to gliomas and meningiomas^[1,2]。 Non-functional pituitary adenomas account for about 30% of all pituitary adenomas^[3]。 Most patients with nonfunctional pituitary microadenomas have no obvious clinical symptoms and are discovered accidentally during autopsy or CT or MRI of the head for other diseases. Symptomatic nonfunctional pituitary adenomas are usually large in volume and can involve surrounding tissues such as cavernous sinus, sphenoid sinus and suprasellar cistern. Transnasal sphenoidal pituitary adenoma resection is the preferred treatment option^[4]。 Since 2012, Peking Union Medical College Hospital has completed about 1,600 pituitary adenoma operations, including about 600 non-functional pituitary adenomas, with abundant clinical resources. Therefore, establishing a database of nonfunctional pituitary adenoma and preserving the clinical data of patients will play an important role in the clinical and basic research of nonfunctional pituitary adenoma. Our work in this area is now reported below.

This study examined the hypothesis that correction of AF with catheter ablation can improve FTR.

Two groups who underwent catheter ablation of atrial fibrillation were compared (From March 2012 to April 2013): 44 patients with FTR; and 44 patients with no or less FTR. To find the predictors of functional tricuspid regurgitation (FTR) in atrial fibrillation patients and assess the effect of catheter ablation on FTR.

In multivariable regression analysis, RA size (OR: 1.377, 95%CI 1.150-1.649, P=0.001)and age (OR: 1.093, 95%CI 1.007-1.185, P=0.03) were associated with FTR. The primary end point was achieved in 54.5%(24/44)of patients with FTR, and 59.1%(26/44)in norml ones(P>0.05). Recurrence (OR: 0.53, 95%CI 0.008-0.331, P=0.002) was the only factor related to unimproved FTR after ablation.

FTR is associated with advancing age and RA dimension; catheter ablation of AF in FTR patients is effective and safe; FTR will be significantly improved in patients maintaining sinus rhythm after catheter ablation of AF.

To explore impact of coronary CT angiography findings on preventive medical treatment and control of coronary artery disease (CAD) risk factors.

Consecutive patients with atherosclerotic plaque detected by coronary CT angiography were enrolled in our study from September 2013 to December 2014, grouped as <50% stenosis and ≥50% stenosis.Baseline and follow-up data were recorded.Comparative analysis was performed both between stenosis groups and pre- and post-CT angiography data.Multivariable Logistic regression were preformed to investigate association between coronary CT angiography findings and subsequent medical therapies.

Totally 160 patients were enrolled in our study, 99 were <50% stenosis and 61 were ≥50% stenosis.Significant reduction of total cholesterol (5.06±1.04 vs 4.54±1.09 mmol/L, P<0.01), low-density lipoprotein cholesterol (3.16±0.95 vs 2.60±0.88 mmol/L,P<0.01), and triglyceride (1.66 (1.14, 2.28) vs 1.55(1.07, 2.05) mmol/L,P=0.004) were observed Pre- versus post-CT angiography.Compared to patients with <50% stenosis, patients with ≥50% stenosis demonstrated more significant reduction with regard to total cholesterol (-0.70±0.94 vs -0.42±0.96 mmol/L, P=0.035) and low-density lipoprotein cholesterol (-0.78±0.99 vs -0.43±0.79 mmol/L, P=0.016). After CT angiography, aspirin (13.8% vs 65.6%, P<0.01) and statin (20.0% vs 71.9%,P<0.01) use were significantly increased, blood pressure medication (53.1% vs 63.1%,P=0.07) use showed no statistical differences.Adjusted for baseline risk factors and pretest medications, CT angiography findings were independently associated with increased post-CT angiography use of aspirin (adjusted OR (95%CI): 3.58(1.61-7.99), P=0.002) and statin (adjusted OR (95%CI): 15.01(4.40-51.22), P<0.01).

Coronary CT angiography findings demonstrated direct impact on subsequent medical therapies and control of CAD risk factors, and offered important guidance for prevention strategies of CAD.

To evaluate the safety and efficiency of transcatheter arterial chemoembolization (TACE) and subsequent radiofrequency ablation (RFA) combined with cytokine-induced killer (CIK) cells transfusion for early-stage hepatocellular carcinoma (HCC).

A retrospective analysis was conducted for 63 early-stage HCC patients who were treated with TACE and sequential RFA in this hospital between July 2001 and January 2012. These patients were divided into two groups: TACE+ RFA+ CIK (31 patients) and TACE+ RFA (32 patients). Overall survival (OS), progression-free survival (PFS) and adverse events were compared between two groups.

The median OS and PFS in the TACE+ RFA+ CIK group were significantly longer than those in TACE+ RFA group (OS: 107.5 vs 61.4 months, respectively, P=0.038; PFS: 43.0 vs 30.0 months respectively, P=0.024). The 3-, 5-and 10-year cumulative overall survival rates in the TACE+ RFA+ CIK group were higher than those in the TACE+ RFA group (93.3%, 77.7% and 35.4% vs 76.7%, 57.7% and 29.3%, respectively). The 1-, 3-, and 5-year cumulative progression-free survival rates were also higher in the TACE+ RFA+ CIK group (93.5%, 66.4% and 28.4% vs 84.4%, 38.5% and 0.1%, respectively). No serious complications were observed in both groups.

This study suggests that CIK cells transfusion is safe, feasible, and superior in prolonging the OS and PFS time of early-stage HCC. However, any conclusions must be confirmed by more clinical studies.

To investigate the relationship of the preoperative HRCT, postoperative pathological subtype and EGFR gene mutation types in the patients of small peripheral lung adenocacinoma confirmed by operation.

Between December 2011 and November 2014, Ninety-four invasive adenocarcinoma patient were selected from 156 patients with pulmonary nodule underwent operation in Beijing Chaoyang hospital.Among them, there were male 37 cases, female 57 cases, age range from 32 to 76, mean age 52.6. All patients underwent complete anatomical lobectomy or wedge resection or segmentectomy, with systematic mediastinal lymph node dissection. The detection indexes included: preoperative HRCT, postoperative pathological subtypes, lymph node; EGFR, Kras, ALK, FGF9 gene expression and so on.

Postoperative pathologic acinar predominant accounted for 33.0%(31/94), papillary predominant type accounted for 25.5%(24/94), Lepidic predominant adenocarcinoma accounted for 19.1%(18/94), 13.8%(13/94) micro papillary predominant, 8.5%(8/94) solid predominant. 7 patients with lymph node positive included 5 cases of stations 11-12, 1 case of station 4 and 1 case of station 7. 36 cases was detected EGFR mutation after operation (38.9%, 36/94), mainly 19⁺ and 21⁺. Compared with the preoperative HRCT findings, there was no significant difference in EGFR mutation group and non mutation group(χ²=1.411, P=0.703). For different types of mutations in EGFR gene, there was no statistical difference (P> 0.05). But the rate of EGFR 21 positive in progression patients was significantly higher than that of EGFR 19 positive patients(χ²=5.779, P=0.016).

There were no significant different between the HRCT manifestations and pathological subtypes in the rate of EGFR gene mutation. EGFR 21 gene mutation was found in double lung metastasis commonly.

To investigate the correlation between the lumbar vertebra bone mineral density(BMD) and age, gender, height, weight, body mass index , waistline, hipline, bone marrow and abdomen fat, and to explore the key factor affecting the BMD.

A total of 72 cases were randomly recruited. All the subjects underwent a spectroscopic examination of the third lumber vertebra with single-voxel method in 1.5T MR. Lipid fractions (FF%) were measured. Quantitative CT were also performed to get the BMD of L3 and the corresponding abdomen subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). The statistical analysis were performed by SPSS 19.0.

Multiple linear regression showed except the age and FF% showed significant difference(P<0.05) , the gender, height, weight, BMI, waistline, hipline, SAT and VAT showed no significant difference (P>0.05). The correlation of age and FF% with BMD was statistically negatively significant (r=-0.830, -0.521, P<0.05). The ROC curve analysis showed that the sensitivety and specificity of predicting osteoporosis were 81.8% and 86.9%, with a threshold of 58.5 years old. And it showed that the sensitivety and specificity of predicting osteoporosis were 90.9% and 55.7%, with a threshold of 52.8% for FF%.

The lumbar vertebra BMD was significantly and negatively correlated with age and bone marrow FF%, but it was not significantly correlated with gender , height, weight, BMI, waistline, hipline, SAT and VAT. And age was the critical factor.

To compare the clinical effect of minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) using a tubular retraction system with traditional transforaminal lumbar interbody fusion(TLIF) for the treatment of lumbar degenerative diseases.

From June 2009 to June 2013, a total of 96 patients in Department of Orthopaedics, Armed Police Jiangxi Corps Hospital, suffering from lumbar degenerative diseases were divided into 2 groups randomly. 42 patients underwent MIS-TLIF using a tubular retraction system. There were 23 males and 19 females with the age of 64.4±4.9. The preoperative diagnosis included lumbar disc herniation with instability(17 cases), lumbar spinal stenosis(13 cases), lumbar degenerative spondylolisthesis(12 cases). 54 patients underwent traditional TLIF. There were 32 males and 22 females with the age of 66.5±7.6. The preoperative diagnosis included lumbar disc herniation with instability(22 cases), lumbar spinal stenosis(17 cases), lumbar degenerative spondylolisthesis(15 cases). The general data, operating time, blood loss and volume of drainage after operation were compared between two groups. VAS, ODI evaluating standards were applied to evaluate the therapeutic effect. The intervertebral fusion were observed by X ray or CT scan.

All patients underwent surgery safely without severe complication occurred. There was no significant difference in operation time between MIS-TLIF group(96±37) min and TLIF group(83±25) min, P>0.05; the blood, volume of drainage after operation in MIS-TLIF group were significantly less than TLIF group(P<0.05). The follow-up time was( 26±7) months in MIS-TLIF group and(27±8) months in TLIF group. Compared with preoperative parameters, the scores of VAS and ODI were significantly decreased after surgery and at the final follow-up in both groups(P<0.05). Compared with TLIF group, VAS in MIS-TLIF group of post-operation and the final follow-up were improved, respectively(P<0.05), but there is no significant difference in ODI score. There occurred cage dislocation with no nerve symptom in MIS-TLIF group in 1 case and fat liquefaction in TLIF group in 1 case. At the follow-up after 6.5 months postoperatively, all the operated segments achieved fusion standard and no internal screw were loose or broken.

MIS-TLIF technique could provide less operation trauma, blood lose and achieve the similar satisfied short-term effect as traditional TLIF.

To analyze the total cost and life quality of the femoral neck fracture patients who received different surgery and supplement comprehensive data of osteoporotic fracture.

One hundred and five patients above 60-year old who were diagnosed femoral neck fracture and received operation in Department of Orthopedics & Traumatology, Beijing Jishuitan Hospital were admitted into our study from August 2013 to December. According to the type of surgery there were 52 and 53 cases in internal fixation (IF) group and hemiarthroplasty (HA) group respectively. At first we collected the medical expense of the patients before and during hospitalization. And then the 1-year medical and non-medical expenses were collected by the cost diary ever 3 months after discharge. At the last follow-up we evaluated the life quality by the EuroQol-5 Dimensions (EQ-5D) and calculated the total cost. Outcome All the patients completed the operation successfully. No nonunion or delayed union cases in IF group, and no cases received revision surgery in both groups. The total average cost was 59 584.9 yuan including 79.1% medical cost and 20.9% non-medical cost. The primary treatment cost accounts for 84.1% of the medical cost. The cost for home care accounts for 90.7% of the non-medical care. The total and medical cost of IF group just account for 40.3% and 38.5% of the HA group and the non-medical showed no significant difference between the 2 groups ( P>0.05). In addition the data of life quality and walking capability also showed no significant difference.

The main cost for the femoral neck fracture is medical expense in 1-year follow-up. Both surgeries can provide satisfactory outcome, however IF may be more cost-effective compared to the HA because of the less total cost.

To analyze the clinical characteristics of patients with candidemia for better clinical diagnosis and management of the disease.

A retrospective study was carried out in 122 patients with confirmed diagnosis of candidemia from January 2010 to June 2014 in West China hospital of Sichuan University. The clinical features, risk factors, laboratory tests, treatments and clinical outcomes were reviewed and analyzed.

The clinical symptoms mainly include chill, shivering and fever (moderate fever or high fever). A total of 85 patients (69.7%) complicated with more than or equal to two kinds of underlying diseases, and 108 patients (88.5%) have more than or equal to three risk factors.There were 82.8% patients with increased white blood cell counts, 49.2% patients with elevated aminotransferase levels and 41.0% patients with increased creatinine levels. The isolated strains were albicans (42, 34.6%), tropicalis (32, 26.2%), glabrata (23, 18.9%) and parapsilosis (18, 14.8%). Susceptibility tests indicated some strains were resistant to antifungal drugs. Sixty-seven patients were cured or improved, 55 died or discharged voluntarily. The mortality rate was 45.1%. The multivariate Logistic regression analysis showed the independent correlative factors of mortality were mechanical ventilation (OR=4.9, P=0.02), malignancy (OR=11.39, P=0.01) and diabetes (OR=5.93, P=0.02). Early empiric anti-fungal therapy helped reduce the fatality rate (OR=0.12, P=0.03).

Actively treating underlying diseases can improve the clinical effect. The key to decrease the mortality is appropriate antifungal chemotherapy.

To analyze the relationship between fasting plasma glucose (FPG) and body mass index (BMI) of pre-pregnancy women and the occurrence of gestational diabetes mellitus(GDM), and to explore aeffective method for GDM screening.

This was a retrospective clinical study includingthepregnant women who underwent screening for GDM recently and also participated in national free preconception health examinationat three medical centers. They were dividedinto normal group and GDM group base on the 2011 diagnosis criteria for GDM of our country.

FPG, BMI and diastolic blood pressure before pregnancy in GDM group were significantlyhigher than those in normal group (P<0.01). Multiple logistic-regressionshowed that the women with higher FPG and BMI level before pregnancyhad higher risk of diagnosis of GDM. The receiver operating characteristic (ROC)curves showed that thearea under the curve (AUC)were 0.600 and 0.632 for FPG and BMI, respectively, in predicting GDM (P<0.01).

The FPG and BMI level of women before pregnancy are valuable predictors for earlydiagnosis of GDM.

To estimate the significance and clinical value of fetal echocardiography in the prenatal test of the grass-roots hospital.

22 570 pregnant women were reviewed, newborns echocardiography were carried out in 19 978 cases. As for the abnormal cases in prenatal screening, the result was compared with the superior hospital diagnosis, also newborns echocardiography was executed to identify the result.

140 cases with fetal cardiac abnormalities had been diagnosed, of which 130 cases confirmed. The diagnosis coincidence rate was 92.9% (130/140) and prenatal positive detection rate was 0.6% (130/22 570). Omission diagnostic rate was 6.2% (8/130). Misdiagnosis rate was 3.8% (5/130). 3 cases were lost to follow-up. 174 cases of newborns cardiac anomalies were diagnosed in postpartum echocardiography.

it is of importance to carry out the fetal echocardiography routine inspection in grass-roots hospitals, of which will facilitated the early detection and diagnosis of congenital heart abnormalities.

To investigate the possible effect and mechanism of N-Acetyl-L-cysteine (NAC) on fibrillar Aβ(25-35)-induced tau hyperphosphorylation.

The phosphorylation of tau was induced by Aβ(25-35) in primary cortical neuron. Neurons were incubated in the absent or present Aβ(25-35), or pre-incubated NAC then co-incubated in Aβ. The measurement of ROS was performed on a microplate fluorometer. The proteins of p35/p25, cdk5, pT205 and pS404 were detected by Western blot.

In Aβ treated group, the ROS, pT205 and pS404 level were obviously higher than that in non-treated with Aβ group for 12 h (t=-6.35, P<0.05;t=-5, P<0.05;t=-4.57, P<0.05). However, in neurons pre-incubated with (10 mmol/L) NAC and then co-incubated with 20 μmol/L Aβ, the ROS, pT205 and pS404 level were significantly decreased compared with that of Aβ group (t=3.47, P<0.05;t=3.88, P<0.05 andt=3.64, P<0.05); Upon Aβ exposure for 12 h, cortical neurons showed a statistically significant increase in p25 when compared to the control group (t=-6.20, P<0.05). However, pre-treatment with NAC showed a decrease in p25 as compared to neurons treated with Aβ alone for 12 h (t=4.72, P<0.05).

NAC attenuated the Aβ(25-35)-induced tau hyperphosphorylation through CDK5 pathway.

To study the effect of miR-199a on the sensitivity of OV2008 and C13* cells to cisplatinand investigate its mechanism of action.

Real-timepolymerase chain reaction(PCR) and Western blot were applied to detect the expressionlevel changes of mammalian target of rapamycin (mTOR) in OV2008 and C13* cells before and after transfecting the cells with the mimicsand inhibitor of miR-199a with Lipofectamine 2000.We constructed luciferase reporter vectors of mTOR and then transfected OV2008 cell swith the mimics of miR-199a with Lipofectamine 2000 to study the regulation of miR-199a's downstream target genes.

The expression level of mTOR was significantly higher in C13* than OV2008 cells (P<0.05). After OV2008 and C13* cells were transfected with the mimics and inhibitorof miR-199a, real-time PCR and Western blot showed that the mimics of miR-199a repressed the expression of mTOR; and the inhibitor of miR-199a promoted the expression of mTOR.After transfecting OV2008 cells with the mimics of miR-199a and luciferase reporter vectors of mTOR, renillaluciferase reporter gene analysis indicated the expression level of mTOR was negatively regulated by miR-199a.

miR-199a regulates the sensitivity of ovarian cancer cells to cisplatin through modulating expression of mTOR, and involves in the cisplatin resistance process of ovarian cancer cells.

To investigat the current status of blood pressure control rate and the use of antihypertensive drugs in elderly patients with coronary heart disease, diabetes mellitusand hypertension.

The elderly coronary heart disease patients with diabetes mellitus and hypertension (≥60 years old) were recruited from 165 hospitals in 21 provinces or cities across China from April to July 2011 in this multicenter, non-intervention and cross-sectional survey. The current status of blood pressure control rate in different antihypertensive target value, methods for application in antihypertensive drugs and standardized treatment recommended by guideline were investigated in the survey.

1 379 cases were eventually selected from the total 7 962 elderly patients (accounted for 17.3%). (1) The blood pressure control rate was 17.1% for antihypertensive target value(<130/80 mmHg); the control rate for 140/80 mmHg was 27.5%; the control rate for 140/90 mmHg was 39.6%; the success rate for 150/90 mmHg were 51.7%; control rate of elderly patient (≥70 years old) gradually increased with increasing of age; success rate of elderly patient(≥85 years old) was the highest, whereas control rate of elderly patient aged 71-71 years old was lowest; success rate for male patients was close to female patients, and success rate for men were slightly higher than those in women; (2) 1 347 cases had clear medication history(32 cases were missed) in the survey, 1 317 effective cases received antihypertensive therapy(effective rate was 97.8%, 1 317/1 347); the more commonly used drugs were angiotensin receptor blockers (ARB) /angiotensin converting enzyme inhibitors (ACEI)(usage rate was 76.8%), followed by dihydropyridine calcium channel blockers (CCB)(65.5%), β-blockers (usage rate was 44.6%), thiazide diuretics (26.3%) respectively; (3)combinations of two drugs was the most common way in antihypertensive medication (accounted for 41.2%), three drugs or more was 28.9%, and single drug was23.9%; CCB was the commonly used single drug (accounted for 8.8%); combinations of CCB and ARB were the most common way in combination of two drugs(11.7%), CCB combined with ARB and β-blockers was frequently used in combination of three drugs or more (9.2%); (4) 987 cases received standardized treatment recommended by guideline (accounted for 76.6%); the percentage of standardized usage in combinations of two drugs was 71.9%, the percentage of standard usage in combinations of three drugs or more was 66.1%.

The percentage of antihypertensive therapy is high, however, the overall blood pressure control rate is low. ACEI /ARB are the major drugs in antihypertensive medication, diuretic drugs are now rarely used; combined medication is the common method of antihypertensive therapy; the consciousness following the guidelines has improved, but still need to be strengthened.

To systematically review the clinical value of sentinel lymph node biopsy (SLNB) in diagnosis of lymph node metastasis in early-stage squamous cell carcinoma of vulva.

Cochrane library, biomedical database (EMbase), PubMed, China national knowledge internet (CNKI), Wang Fang database,《Gynecologic Oncology》,《National Medical Journal of China》and《Chinese Journal of Obstetrics and Gynecology》were searched for literatures from 1990 to 2014 concerning SLNB application in early-stage vulvar squamous cell carcinoma. Literatures were filtrated according to inclusive and exclusive criteria. Meta Disc 1.4 software was used for meta-analysis.

A total of 2 459 literatures were obtained, out of which 29 were eligible for analysis, including 28 in English and 1 in Chinese. Twenty-three studies were prospective and 6 were retrospective, including 1 371 patients with early-stage squamous cell carcinoma of vulva. The sensitivity of SLNB for diagnosis of lymph node metastasis in early-stage vulvar cancer ranged from 66.7% to 100%, and the specificity were 100% in all studies. No significant heterogeneity was found among the results of enrolled studies (I²=12.8%, P=0.270). The data were pooled by fixed effect model, and the pooled sensitivity and specificity were 0.94 (95%CI: 0.91-0.96) and 1.00 (95%CI: 0.99-1.00), respectively. The calculated area under curve (AUC) of summarized Receiver Operating Characteristic (ROC) was 0.987 0. Subgroup analysis showed that the pooled sensitivity of SLNB were 0.92 (95%CI: 0.85-0.97) and 0.94 (95%CI: 0.91-0.97) in studies using single and combined tracers, respectively, and that they were 0.93 (95%CI: 0.90-0.96) and 0.97 (95%CI: 0.90-1.00) in studies with and without ultra-staging techniques, respectively.

SLNB is a highly accurate technique for diagnosis of lymph node metastasis in early-stage squamous cell carcinoma of vulva. The sensitivity and specificity are similar in SLNBs using different techniques.

A 27-year-old female was admitted to the Department of Rheumatology and Immunology of Peking Union Medical College Hospital in June 2013 due to joint pain for 9 years, fever, rash and headache for 4 months. Nine years ago, the patient developed bilateral swelling and pain of wrist, elbow, ankle, knee, multiple metacarpophalangeal joints and proximal interphalangeal joints, accompanied by morning stiffness for about 30 minutes. He was not treated regularly, and intermittently took hormones (specific dosage form unknown) and traditional Chinese medicine, but did not take immunosuppressants. Four months ago, I developed a dark red rash on my cheeks and erythema, ulceration and crusting on both lower limbs, with intermittent fever, with a maximum body temperature of 40 ℃. Without medication, my body temperature dropped to normal spontaneously in 2~3 days, with fever 1~2 times a month, accompanied by headache, mild tingling pain, without nausea, vomiting, rotation of vision, etc. He went to a local hospital and was positive for anti-nuclear antibody, anti-RNP, anti-SM, anti-RO-52 and anti-ribosomal P protein antibody. He was suspected of systemic lupus erythematosus (SLE) and was admitted for further diagnosis and treatment. Since the disease, hair loss is obvious, and body weight decreases by 20 kg. Family history: Both sister and younger sister were diagnosed with SLE, and their parents were in good health. Physical examination: body temperature 38.3 ℃, heart rate 98 beats/min, respiratory rate 18 beats/min, blood pressure 116/80 mmHg (1 mmHg =0.133 kPa); Butterfly pigmentation on both cheeks, scattered crusty rash on lower limbs; The heart rhythm was uniform, the breathing sounds of both lungs were clear, the left upper abdomen was tender, without muscle tension and rebound pain, 5 cm under the costs of the liver and 3 cm under the costs of the spleen. The right wrist joint was swollen and tender (+), the right index finger, middle finger, ring finger and the proximal interphalangeal joint of the left ring finger were swollen and tender (+), and the right knee joint was not swollen and tender (+). Soft neck, Klinefelter sign, Buchner sign (–). Both lower limbs are not swollen. Laboratory test: blood routine: white blood cells 1.52×10⁹/L, lymphocytes 0.35×10⁹/L, hemoglobin 94 g/L, platelets 134×10⁹/L; Negative urine routine; 24 h urine protein quantification 0.15 g; Liver and kidney function: alanine transferase 4 U/L, albumin 25 g/L, creatinine 45 μ mol/L, potassium 2.5 mmol/L; Hypersensitive C-reactive protein 2.95 mg/L, erythrocyte sedimentation rate (ESR) 14 mm/h, complement C3 0.227 g/L, complement C4 0.034 g/L; Immunoglobulin (Ig) G 18.30 g/L, IgA 3.01 g/L, IgM 0.7 g/L; Antinuclear antibody spot type 1:1 280 cytoplasmic type 1:640; Anti-extractable nuclear antigen (ENA) antibodies: anti-SM antibody 1:4, anti-RNP antibody 1:4, anti-SSA antibody 1:4, anti-ribosomal P protein antibody 38 000, 16 500, 15 000. anti-neutrophil cytoplasmic antibodies, anti-cardiolipin antibodies, etc. (-). Procalcitonin<500 ng/L. Electrocardiogram and cardiac ultrasound were basically normal. Abdominal B-ultrasound: diffuse lesions in both kidneys and mild hydrops in both kidneys. There were no obvious abnormalities in chest high-resolution CT and cranial enhanced MRI. Spinal cord puncture was performed, CSF pressure 115 mmH₂O (1 mmH₂O =0.0098 kPa), CSF routine: colorless and transparent, total number of cells 84×10⁶/L, total number of white blood cells 24×10⁶/L, single core 16×10⁶/L, Multi-core 8×10⁶/L. Cerebrospinal fluid biochemistry: protein 0.95 g/L, glucose 0.9 mmol/L (instant finger blood glucose 7.0 mmol/L), chlorine 131 mmol/L. Cerebrospinal fluid bacteria, fungi, viruses and other etiologic examinations (–). After that, the spinal cord puncture was re-examined twice, the routine biochemistry was roughly the same as before, and the third cerebrospinal fluid bacterial culture: Listeria monocytogenes.

The patient, a 63-year-old female, was admitted to the hospital due to "swelling and pain in both knees for 12 years" and aggravation of pain in the left knee for 2 years ". Physical examination on admission: flexion contracture and varus deformity of the left knee. Range of mobility of the left knee joint: flexion 90° and straightening 30°. X-ray showed: both knee joints were varus, skeletal articular surface sclerosis, and medial space narrowing (Figure 1)。 The admission diagnosis was: osteoarthritis of both knees. The left total knee arthroplasty was performed under general anesthesia 3 days after the perfect examination. The operation was smooth, and the postoperative X-ray reexamination showed that the prosthesis was in good position (Figure 2)。 Rivaroxaban 10 mg was routinely administered daily to prevent deep vein thrombosis after surgery. B-ultrasound of deep veins of both lower limbs revealed multiple intramuscular vein thrombosis in the left lower leg 2 days after surgery, and no blood flow signal was observed. Therefore, the oral anticoagulation of rivaroxaban was changed to subcutaneous injection of Kesai 0.6 ml twice daily. B-ultrasound examination of deep veins of both lower limbs was performed again 10 days after operation, which showed that the venous thrombosis of left lower leg improved but there was still intramuscular venous thrombosis, and no influx signal was seen. The patient requested to be discharged from the hospital, and continued to be given oral anticoagulation with rivaroxaban after discharge. He was re-admitted to the hospital 20 days after operation due to swelling and pain in the left lower limb. The B-ultrasound of the deep veins of both lower limbs revealed that there was no obvious thrombosis in the deep veins of both lower limbs, and the left popliteal fossa was aneurysmally dilated, with a size of about 4.1 cm ×3.5 cm ×2.7 cm, showing abundant vortex-like arterial blood flow signals. CT scanning angiography of the lesion showed that after left knee replacement, circular high-density shadow in the soft tissue behind the tibial plateau of the left knee, obvious compression and displacement of the adjacent blood vessels, and increased density in the medullary cavity of the tibia (Figure 3)。 Give reduced activity and observe changes in the condition. Reexamination B-ultrasound showed: aneurysm-like dilatation of the left popliteal fossa, internal thrombosis, about 4.4 cm ×3.9 cm ×3.1 cm in size, solid echo in the interior, 1.6 cm in the thicker part, and rich vortex-like kinetic blood flow signals were seen by color Doppler flow imaging (CDFI), which seemed to be connected to the popliteal artery. Then percutaneous DSA (digital subtraction angiography) arterial angiography was performed under local anesthesia, and a rupture of about 0.5 cm was seen in the anterior wall of the popliteal artery (FIG. 4A), locally forming a tumor cavity (FIG. 4B)。 Embolization was difficult during the operation, so compression bandage of the popliteal fossa of the left lower limb was given, the left lower limb was braked, and the dorsal pedis artery of the left lower limb was observed. After 48 hours, the compression gauze was removed, and the local mass of the left popliteal fossa was examined. The pulsation was obvious when palpated, and the surrounding tissues were unclear. There was no fever in the skin, vascular murmur could be seen during auscultation, and the pulsation of the left dorsal pedis artery was weak. Consult the vascular surgery department and perform surgical treatment.

A 23-year-old female was admitted to the Department of Neurology of the First Affiliated Hospital of Zhengzhou University on January 10, 2014 due to "disorder of consciousness for half a month, right limb weakness with unclear speech for 10 days". Half months before admission, the patient suddenly lost consciousness without obvious trigger, accompanied by nausea and vomiting, and the vomit was stomach content, non-jetting, without caffeine-like substances. The local hospital examined 0.5T skull MRI showed: fresh infarction in the left parieto-occipital lobe, and was treated with "mannitol needle" and other drugs. After 7 hours of onset, consciousness gradually recovered, blindness in the left eye, hemiplegia in the right limb, and motor aphasia. After 2 days, reexamination of 1.5T skull MRI showed: multiple acute infarctions in the right cerebellar hemisphere and left parieto-occipital lobe (Figure 1), 1.5T MRV showed that the superior sagittal sinus was partially unclear, and the left transverse sinus, inferior sagittal sinus and sigmoid sinus were not clearly displayed, and venous sinus thrombosis was suspected. Then he was given symptomatic and supportive treatment with anticoagulant, antiplatelet, lipid-lowering, neurotrophic and other related drugs for 10 days, and his limb weakness improved compared with before, so he was transferred to the First Affiliated Hospital of Zhengzhou University. No previous history of hypertension or diabetes. The patient gave birth to a live baby in a local hospital 50 days ago, and there was no similar patient in the family.

Osteoporosis is a disease of the skeletal system characterized by decreased bone strength and increased risk of fractures. Osteoporosis can be divided into primary osteoporosis and secondary osteoporosis, the latter being any disease and/or drug that affects bone metabolism, among which glucocorticoids (GCs) are the most common drugs. Prolonged (more than 3 months) use of any dose of GCs may lead to osteoporosis, i.e. glucocorticoid-induced osteoporosis (GIOP). The proportion of oral glucocorticoids in postmenopausal women is as high as 4.6%^[1]The incidence of fracture in patients with long-term GCs is 30% to 50%. GIOP focuses on early treatment and prevention, but at present clinicians often do not pay attention to the prevention and treatment of GIOP^[2]。 Less than 15% of patients treated with long-term GCs are given prophylactic anti-osteoporotic therapy, and there are many controversies about cement perfusion vertebroplasty for GIOP vertebral fractures.

Endometriosis (EM) has a variety of clinical manifestations due to its biological behaviors such as hyperplasia, infiltration, metastasis and recurrence, and its diagnosis and treatment are complex. There are many staging methods for EM, but there is no staging system that can comprehensively describe the characteristics of EM lesions and predict related factors such as infertility and pain. The ideal EM staging system has complex requirements: based on clinical experience and scientific basis, enjoying expert consensus, clearly defined terminology, applicable to all cases, reflecting the clinical characteristics of the disease, predicting pain relief rate, predicting fertility, predicting the risk of recurrence, guiding treatment, simple communication with patients, etc.^[1]。 This article mainly reviews the historically authoritative AFS staging system, the ENZIAN classification system describing deep infiltrating endometriosis (DIE), and the EM fertility index (EFI), which has predictive value for infertility.

APOE gene has been widely studied as the most important pathogenic gene in late-onset AD (LOAD). At the same time, recent studies have found that the mutation of the R47H site encoding the type 2 myeloid cell trigger receptor gene (TREM2) is also significantly associated with late-onset Alzheimer's disease. It is suggested that TREM2 gene can inhibit central inflammation and mediate the phagocytosis of A β and apoptotic cell debris by central monocyte phagocytosis system. However, the exact mechanism of its action is not clear at present, and the pathogenesis of its R47H mutation and LOAD pathogenesis is still to be confirmed. This paper reviews the role of TREM2 gene in central inflammation and mediating A β phagocytosis.