Volume 95  ·  Issue 35  ·  2015

To analyze the serum relaxin and clinical character of cervical incompetence patients and normal pregnant women.

A total of 33 cervical incompetence patients (research group) and 33 normal pregnancy women with the same gestational age (control group) were recruited into the study.The serum relaxin level was detected with enzyme labeled immunosorbent assay (ELSIA) in the two groups, and the cervical length of early pregnancy period (cm), body mass index (BMI, kg/m²), frequency of polycystic ovary syndrome (%), gestational diabetes mellitus/diabetes mellitus (%) and outcomes in the two groups were analyzed with independent samples t test and chi-square test.

All the cervical incompetence patients were recruited between Feb. 2008 and Sept. 2012, with the average termination gestational age of 30±6 weeks.Among them, 15 (45.45%) was abortion, 12 (36.36%) was preterm birth, 6 (16.18%) was term birth.The average BMI before pregnancy was 27±4 kg/m^2, and the average serum relaxin was 2 748±82 mg/L; for the 33 patients in the control group, the average termination gestational age was 38±3 weeks, and 1 (3.03%) of them was abortion, 4 (12.12%) was preterm birth, 28 (84.85%) was term birth.The average BMI before pregnancy was 23±3 kg/m^2, the average serum relaxin was 2 602±126 mg/L.Compared with the control group, the research group had more patients who complicated with polycystic ovary syndrome and gestational diabetes mellitus/diabetes mellitus (P<0.01, <0.05) and worse pregnancy outcomes (P<0.01); the average BMI before pregnancy and the average serum relaxin level of the research group were significantly higher than control group (P<0.01,P<0.01). Analysis through the unconditional logistic regression showed that BMI and serum relaxin were both independent risk factors of cervical incompetence.

The high level of serum relaxin is an independent risk factor of cervical incompetence; women with polycystic ovary syndrome may more likely to have cervical incompetence and serum relaxin may have the predictive value for cervical incompetence.

To summarize the clinical effect of C1 lateral mass screw fixation in patients with atlas occipitalization and occipito-cervical instability (OCI).

Patients of atlas occipitalization and OCI from June 2007 to October 2013 which had been treated by C1 lateral mass fixation in our institution were retrospective analyzed.The clinical neurologic function improvement rate and bone fusion rate were investigated at follow-ups.The nuances of the C1 lateral mass insertion were summarized.

Among the 160 patients, 1 patient died, 1 got worse, 1 was stable, 155 got recovery and 2 lost to follow-up.Among the 157 cases within 12-52 months follow-up (mean 34 months), 147 cases got reduction and release from the cervico- medullary junction compression and 10 got no effective reduction which were resumed to anterior decompression at second surgery.At one year follow-up, 155 cases had solid bony fusion and 2 had no evident fusion.The entry point for C1 screw was located at the midpoint of the posterior surface of C1 facet and the screw was directed approximately between 0-40°cephalad and approximately between 0-20°medially.

C1 lateral mass screw fixation is a safe and feasible method and could provide solid stability in patients with atlas occipitalization and OCI.The risk of placement of C1 screw could be decreased to a low rate after the preoperative evaluation and trajectory design.

To investigate the risk factors of osteoporotic fractures (OPF) in patients with RA.

From February 2011 to March 2015, 244 patients with rheumatoid arthritis (RA) were treated in Department of Orthopedics, Huaibei People's Hospital, according to the occurrence of osteoporotic fractures (OPF) into the OPF group (n=31) and the non OPF group (n=213), observed two groups general information, glucocorticoid usinge, -28 joint disease activity score(DAS28), health status Questionnaire (HAQ), C-reactive protein (CRP), anti-cyclic citrullinated peptide (CCP) antibody, erythrocyte sedimentation rate (ESR), etc.

OPF group the mean age and disease duration for (64.3±10.9) years and (9.0±3.3) years were significantly higher than that of non OPF group (57.4±11.2) years and (6.0±2.7) years (P<0.05); OPF group and non OPF group ESR, CRP, anti CCP, HAQ and DAS28 difference was not statistically significant (P>0.05); OPF group sharp score (56.0±18.4), hormone use time (785 d), and hormone cumulant (7 100 mg·d) were significantly higher than that in non OPF group[sharp score(86.1±17.1), hormone use time(191 d), and hormone cumulant(1 900 mg·d)], the difference was statistically significant (P<0.05); OPF femoral neck, Ward area, total femur area and thoracic spine 2-3 bone mineral density T value significantly lower than non OPF group (P<0.05).

Age and osteoporosis are risk factors for the occurrence of osteoporotic fractures in patients with rheumatoid arthritis, so patients should conduct a risk assessment to guide rational drug use.

To evaluate the indications and effect of surgical treatment of basilar invagination (BI) with atlantoaxial dislocation(AAD) on the basis of retrospective analysis of the clinical and imaging data of patients.

Consecutive 21 patients with BI and AAD were surgically treated in Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University from July 2000 to December 2013.There were 10 males and 11 females, aged from 7 to 59 years , with a mean of 36.4 years.The clinical symptoms and signs was recorded , and preoperative imaging examination including anteroposterior, lateral, dynamic films, MRI, CT and 3-dimensional reconstruction views of cervical spine were performed to identify the series.All cases were treated with operation.Neurological function was assessed by JOA scale and NDI score before, after surgery and at final follow-up.The postoperative X-rays, MRI or CT was taken to observed the results of decompression, fixation and fusion.

There were 5 cases operated by posterior approach, combined anterior and posterior approach in 16 cases, atlantoaxial fixation in 2 cases, occipitocervical fixation in 19 cases.The average operation time was 200 mins, blood loss was 230 ml.Except for 2 death cases, 19 cases were followed up, the followed-up was arranged from 13 to 42 months, with an average of 21.6 months.Compared with preoperative parameters (7.8±1.3), the postoperative scores of JOA decreased significantly (14.1±0.5) and at the final follow-up (16.2±0.7)(P<0.05); compared with preoperative parameters (65.7±11.2), the postoperative scores of NDI decreased significantly (28.2±9.6) and at the final follow-up (22.7±7.4)(P<0.05) and no significant difference in JOA or NDI score existed between post-operation and last follow-up (P>0.05). The perioperative complications was discovered in 6 cases, including infection in 2 cases, cerebrospinal fluid(CSF)leakage in 2 cases, respiratory dysfunction, cleft palate in 1 case, respectively.

BI with AAD can be treated by anterior, posterior or combined approaches.Careful evaluation, proper selection of indications and prevention of perioperative complications are important consideration to ensure the success of surgery.

To study the effect of 10-Hydroxycamptotbecine (10-HCPT) on the expression of vascular endothelial growth factor(VEGF) in rheumatoid arthritis synovial fibroblasts (RASFs).

RASFs were isolated form synovial tissue of RA patients and cultured in vitro.10-HCPT(3.0×10^-6 mol/L, 3.0×10^-5 mol/L) and Methotrexate (MTX) (2.0×10^-6 mol/L, 2.0×10^-5 mol/L) with different concentrations were used to treat RASFs for 48 hours, and RASFs without 10-HCPT and MTX treatment were served as the control group.The level of VEGF in the supernatant of RASFs culture was measured by enzyme linked immunosorbent assay (ELISA).

Compared with control group, high and low dose 10-HCPT groups showed significant values on the effect of inhibiting the expression of VEGF in RASFs.Compared with low-dose MTX group, both high and low dose 10-HCPT groups showed significant difference (P<0.05); compared with high-dose MTX group, the high-dose 10-HCPT group had significant difference (P<0.05).

Compared with MTX, 10-HCPT showed significant effect on inhibiting the expression of VEGF in RASFs.

To investigate the relationship between the missed abortion and chromosome abnormality and guide the healthy birth.

From June 2014 to April 2015 in Tianjin central hospital of gynecology and obstetrics, we examined venous blood from 90 missed abortion couples for chromosome karyotype by lymphocyte culture method and we also examined their chromosome karyotype of abortion villus samples by high-throughput sequencing technologies.

Out of the 90 couples' blood chromosome examinations, 7 were abnormal, and the abnormal rate was 3.89%, including 3 cases reciprocal translocation, 2 cases robertsonian translocation and 2 cases inversion.Abortion villus samples from the same population were also checked, of which 85 cases succeeded, with the success rate of 94.4%.Among them, villi chromosome abnormalities were found in 50 cases, including 39 cases with abnormal chromosome numbers, 11 cases with abnormal chromosome structure, and the total abnormal rate was 58.8%.In addition, the villi chromosome abnormality rate of patients with recurrent missed abortion (≥2 times) and first missed abortion were 61.7% and 55.2%, respectively, and the difference was not significant (P>0.05). The villi chromosome abnormality rate of pregnant women with age ≥35 years old was 71.1%, while the pregnant women with aged < 35 years old was 45% (P<0.05).

Chromosome abnormality is an important cause of missed abortion; villi chromosome abnormality rate has nothing to do with the number of missed abortion; pregnant woman with age ≥35 years old is risk factor of the villi chromosome abnormality.

This study sought to identify risk factors of ischemic events and predictors of outcome for spontaneous cervical artery dissection (sCAD).

One hundred and sixty one patients diagnosed as sCAD were classified as patients with (n=77) and without (n=84) cerebral ischemia.Demographics, vascular risk factors and imaging features were compared between the two groups.Multivariate Cox regression analysis was performed to identify predictors of primary end-point events(all cause stroke and death) at follow-up.

Patients with cerebral ischemia had a higher prevelence of hypertension and diabetes mellitus (62.3% vs 41.7%, 14.3% vs 6.2%, P<0.05). Patients with cerebral ischemia were more likely to present with stenosis (61.0% vs 23.8%,P<0.001) and less likely to present with aneurysmal dilatation (19.5% vs 44.0%,P<0.001) and double lumen (22.1% vs 38.1%,P<0.05). There was significant positive association of diabetes mellitus (odds ratio 3.095; 95% confidence interval, 1.273 to 7.524,P=0.013) and stenosis(odds ratio 4.335, 95% confidence interval, 2.123 to 8.854, P<0.001), and an inverse association of aneurysmal dilatation (odds ratio 0.429, 95% confidence interval, 0.198 to 0.930,P=0.032) with occurrence of ischemic events in patients with sCAD.At a mean follow-up of 16.0 months, overall incidence of primary end-point was 9.3%(n=15). Cox regression analysis showed cerebral ischemia at onset, arterial occlusion, obesity or overweightness were significant predictors of the primary endpoint.

This study confirms that diabetes mellitus and arterial stenosis are risk factors of ischemic events for sCAD patients. Cerebral ischemia at onset, arterial occlusion, obesity or overweightness are predictors of primary endpoint at follow-up.

To study the clinical and electrophysiological characteristics of carpal tunnel syndrome (CTS) with cervical spondylotic radiculopathy (CSR) and simple-CTS, and compare the effect of double crush with that of simple entrapment on a nerve and investigate the association between CTS and CSR.

From January 2011 to August 2014, clinical data from 96 patients with double crush syndrome(DCS, CTS with CSR) and 165 patients with simple-CTS were examined, and the electrophysiologic parameters of median nerve in patients with DCS were compared with that in patients with simple-CTS.

In 96 patients with DCS, most of them were female; neck and shoulder pain or simultaneously accompanied by numbness and pain of upper limb was observed in 34 patients, upper limb symptoms and hand weakness and muscle atrophy were observed in the other 62 patients, 124 median nerves with abnormal conduction were found in these DCS patients, including 68 cases with unilateral abnormalities and 28 cases with bilateral abnormalities.Cervical radiculopathies of the C_5-7 mainly involved in patients with DCS.223 median nerves with abnormal conduction found in the 165 patients with simple-CTS, including 107 cases with unilateral abnormalities and 58 cases with bilateral abnormalities. The average sensory nerve conduction velocity (SCV), motor nerve conduction velocity (MCV) and distal motor latency (DML) of median nerve for DCS and simple-CTS were(32±7) m/s vs (35±5) m/s, (55±7) m/s vs (57±5) m/s and (4.6±1.6) ms vs (4.0±0.8) ms, respectively, and their corresponding amplitudes were 6.4 μV vs 9.5 μV, 10.9 mV vs 13.1 mV and 11.3 mV vs 14.1 mV, respectively.The SCV, MCV and DML and their corresponding amplitude of DCS were significantly greater decreased than that of simple-CTS ( P<0.01).

DCS is a common clinical syndrome, and patients with DCS may have neck and shoulder symptoms in addition to the common manifestations of simple-CTS.Abnormal conduction of median nerve of CTS with CSR is more severe than that of simple-CTS, which neurophysiologically proves the association between CTS and CSR and supports double crush hypothesis.

To investigate the early diagnostic value of corneal confocal microscopy by observing corneal innervation alteration in patients with autonomic neuropathy with impaired glucose tolerance.

A total of 50 subjects with neuropathy with impaired glucose tolerance or newly diagnosed type 2 diabetes, including 20 subjects with diabetic autonomic neuropathy (AN) and 30 subjects with non-autonomic neuropathy (NAN) according to the result of cardiovascular autonomic function test, and 50 aged-matched control subjects were included in this study.All the subjects came from the Department of Neurology and Endocrine from Jan to Aug 2014, and underwent a detailed evaluation of neuropathic symptoms, corneal confocal microscopy, the Survey of Autonomic Symptoms, sympathetic skin response and contact heat evoked potential test.

T test indicated patients with AN had significant reductions in nerve branch density (NBD) and nerve fiber density (NFD), and increase in corneal nerve fiber tortuosity (NFT) compared with the NAN patients (t=10.17, 4.81, 7.78; P=0.002, 0.031, 0.003). Though corneal nerve fiber length (NFL) decreased( (15±5) vs (13±5) mm/mm²), there is no statistic significance (t=1.275, P=0.232). Pearson's correlation analysis showed the severity of autonomic neuropathy significantly correlated with cornea nerves damage.The Survey of Autonomic Symptoms (SAS) significantly correlated with NFT, NFD, NFL (r=0.628, -0.304, -0.217; P<0.001,P=0.002, 0.03). NFT was the most significant determinant for the severity of autonomic neuropathy among the four observed parameters.

Corneal confocal microscopy provides a new sensitive non-invasive means to detect autonomic nerve fiber damage in patients with impaired glucose tolerance and would be of value in assessing neuropathic autonomic symptoms in clinical practice and epidemiologic studies.

To analyze the clinical manifestation, laboratory findings, radiological data of anti-N-methyl-D-aspartate (NMDA) receptor encephalitis.

The clinical manifestation, laboratory findings, radiological data of eleven patients with anti-NMDA receptor encephalitis were analyzed.

Main symptoms included epilepsy presented in 9 cases, psychiatric symptom in 7 cases, dyskinesia in 5 cases, autonomic dysfunction in 3 cases.The anti-NMDA receptor antibody was found in all the patients' cerebrospinal fluid (CSF). No teratoma was detected in any of the patients, and 1 case had lung cancer.All the patients received immune therapy.And at discharge, 4 cases recuperated generally, 7 cases had different degrees of dysfunction.After telephone follow-up of 1-18 months, 1 case was lost, 3 cases had complete recovery, and 7 cases had different degrees of sequela.

When Patients without mental illness history presents with unexplained mental symptoms accompanied by seizures, memory impairment, disturbance of consciousness, movement disorders, autonomic dysfunction and other symptoms, anti-NMDA receptor antibodies studies in both serum and CSF should be done as early as possible in order to facilitate early diagnosis, early treatment and improve the prognosis.

To investigate the effects of different electrode exposed end and different ablated time on lesion size of Cool-tip multi-electrode synchronous radiofrequency ablation via switching controller in ex vivo bovine liver.

Twelve combinations of different electrode exposed end (2 cm, 3 cm and 4 cm) were used, and different ablated time (12, 16, 20 and 24 mins) was as experimental parameter.Ablated lesions in longitudinal diameter, transverse diameter and volume were measured.Analyze the factors influencing the lesion size with ANOVA or t test.

The ablated lesions with 3 cm exposed end electrodes were more stable and the spheroidal rate is more close to 1. When ablated 24 mins with 4 cm exposed end electrodes, the longitudinal diameter, transverse diameter and volume were (7.66±0.21), (6.50±0.34) cm and (172±12) cm³, respectively.When the ablated time was constant, the lesions increased with the exposed end length of the electrodes increased. All the data among groups was statistically significant (P<0.01) unless the transverse diameters between 3 and 4 cm exposed end electrode.When the exposed end length of electrodes was constant, the lesions increased with the ablated time increased as a whole.But there was no significant difference in most of the adjacent groups.Only the longitudinal diameters and volumes of 4 cm exposed end electrodes between 20 and 24 min were statistically significant(P<0.05).

Within the experimental range, the lesion size ablated by Cool-tip multi-electrode synchronous radiofrequency ablation via switching controller increased with the electrode exposed end and ablated time increased.The spheroidal rate of the ablated lesions with 3 cm exposed end is more close to 1.

To study effect of tumor suppressor p14ARF on cisplatin-induced apoptosis in human osteosarcoma cells with its molecular mechanisms to provide evidences for increasing chemosensitivity of osteosarcoma.

pcDNA3.1-p14ARF plasmid was stable transfected into MG63 cells lack of p14ARF expression.Expression of p14ARF on mRNA and protein level was evaluated with RT-PCR and Western blot.MG63, MG63-vec and MG63-ARF cells were treated with cisplatin.Cell growth inhibition and IC₅₀ were determined through MTT assay.Apoptosis was detected using fluorescence-activated cell sorting and Hoechst33258 staining.The expression of p53, Bax, p21, Mdm2, Fas, Caspase-3, caspase-9 and PARP was detected with Western blot.RNAi was used to silence p53.Cells were pre-treated with Caspase-9 specific inhibitor Z-LEHD-FMK to determine whether the effect was Caspase-9-dependent.

There was no expression of p14ARF in MG63 and MG63–vec cells but obvious expression in MG63–ARF cells on mRNA and protein level.Cell viability was 84.2%±4.3%, 80.8%±4.3% and 58.9%±5.4% in MG63, MG63–vec, and MG63–ARF cells after treatment of cisplatin for 72 h. IC₅₀ was (11.1±0.6), (10.7±0.9) and (7.2±0.7) μmol/L.The apoptotic rate was 13.6%, 18.5% and 35.9% in groups, There were more obvious apoptotic more changes in MG63–ARF cells than MG63 and MG63–vec cells, and activation of Caspase–3, 9 and PARP on higher level in U2OS–ARF cells after stimulation with cisplatin for 72 h. The expression of p53, Bax, p21, Mdm2 and Fas, in MG63–vec and MG63–ARF cells did not changed ( P>0.05). The expression of p53 was effectively and continuously suppressed by p53–siRNA in U2OS–vec and U2OS–ARF cells.The p53 silencing did not alter the cytotoxicity mediated by cisplatin treatment for 72 h (P>0.05). Cell viability was 96.8%±3.6%, 54.1%±5.7% and 89.5%±5.1% in Z–LEHD–FMK, cisplatin and Z–LEHD–FMK+ cisplatin groups.

p14ARF enhances cisplatin–induced apoptosis in human osteosarcoma MG63 cells in p53–independent caspase–9–dependent pathway, in which the intrinsic mitochondrial apoptotic pathway is involved.

A 27-year-old male, right-handed, was transferred from another hospital to the Department of Neurosurgery, General Hospital of Tianjin Medical University with "weakness of both lower limbs for 1 week". One week before admission, the patient showed a progressive decrease in strength of both lower limbs and limited movement. By the time of admission, he could no longer walk, had no urinary incontinence or retention, and took a flat car to enter the ward. Previous history of gout for 4 years, denied history of trauma and tumor. Physical examination at admission: obese, weight about 110 kg, body mass index (BMI) 32.14, clear, no scoliosis deformity of the spine, multiple subcutaneous nodules palpable on the back of both feet, local skin slightly red, hard at touch, no obvious tenderness, muscle strength of both upper limbs grade V, muscle strength of both lower limbs grade III^–Grade, superficial hypoesthesia below the umbilical level, bilateral Pap sign (+). CT of both feet showed several round-like nodules in the subcutaneous soft tissues of the proximal parts of the 1st to 5th metatarsal bones of both feet, considering gout nodules; CT of the thoracic spine showed that T9~10 intervertebral discs occupied space inside and outside the spinal canal at the level, and extended outward along the intervertebral foramen on both sides, with the left side as the focus (FIG. 1A)； MRI of thoracic vertebra showed: T9~10 intervertebral disc level intraspinal canal extramedullary elliptical T1 and other T2 signal space-occupying lesions, showing uneven enhancement, unclear boundary with surrounding tissues, corresponding segment spinal cord compression deformation, space-occupying nature to be determined (FIG. 1B，Figure 1C)； SPECT showed that abnormal tracer concentration area was found at T9/10 level, and no obvious abnormal tracer concentration area or defect area was found in other parts of the whole body bone (Figure 1D)。 Laboratory test: blood uric acid 754 μ mol/L (normal value 140~414 μ mol/L), white blood cell count 10.4×10⁹/L [normal value (4.0~10.0) ×10⁹/L], erythrocyte count, erythrocyte sedimentation rate, blood urea nitrogen, blood creatinine, HLA-B27, rheumatoid factor, urine protein, tuberculin test and tumor markers were not abnormal. Treatment: Posterior thoracic spinal canal exploration and decompression surgery were performed under general anesthesia. All laminae of T9 and the upper 1/3 laminae of T10 were surgically removed. Exploration under microscope showed that the occupied space was located in the epidural, extending outward along the bilateral T9 and/or 10 intervertebral foramines involving the inside and outside of the spinal canal, with a volume of about 3 cm ×2 cm ×2 cm, white, granular, and smooth edges (FIG. 2A，Figure 2B), after segmented resection, it can be seen that the local dural sac swells well, and the compression of the thoracic cord is relieved. Postoperative pathological diagnosis: granular sediment mass, with a large number of foreign body giant cells in and around it, consistent with tophi (Figure 2C，Figure 2D)。 After operation, rehabilitation guidance and customized protective gear were given. After 2 weeks, the muscle strength of both lower limbs recovered to grade IV, and the blood uric acid was reexamined at 740 μ mol/L. After 4 weeks, he got out of bed and moved, improved and was discharged, and it was recommended to continue treatment to a metabolic disease specialist. After 24 months follow-up, the function of both lower limbs recovered well, and no recurrence was observed.

A 66-year-old woman was admitted for "intermittent abdominal pain with fatigue for half a year". The patient had abdominal pain intermittently without obvious trigger six months ago, which was slightly relieved after eating, accompanied by fatigue and dyspnea after activity. After admission, physical examination showed upper abdominal palpation discomfort, and no pigmentation was seen on the skin and mucosa of the whole body. Laboratory tests: Moderate anemia; Hypoalbuminemia; Positive fecal occult blood test. Gastroscopy: scattered dark spots can be seen in the whole gastric mucosa, with 2 biopsies; Dark spots were seen in the retrobulbar mucosa of the duodenum, and one piece was biopsied. Colonoscopy: Multiple nevus-like black nodules, 0.4 to 0.5 cm in size, were seen in the colon 1 to 7 cm away from the anus, and one piece was biopsied. Abdominal ultrasound: Multiple homogeneous anechoic nodules scattered under the xiphoid process, between the muscular layer of the right abdomen and the left upper abdomen and the peritoneum (FIG. 1A，FIG. 1B), the larger one is 2.2 cm ×1.5 cm, with regular shape and clear boundary, enhanced echo behind it, and rich and disordered blood flow signals can be seen inside (Figure 1C)。 Ultrasound suggested that the abdominal wall occupied multiple mass (superficial position, biopsy if necessary). Ultrasound-guided puncture biopsy of right abdominal wall mass was performed and submitted for examination. Results Return: Biopsy of gastric and duodenal retrobulbar mucosa showed malignant melanoma; The pathology of colon black spot biopsy was malignant melanoma; The pathology of abdominal wall nodule biopsy was malignant melanoma. Because no lesions were found in other parts of this patient, it was diagnosed as "primary malignant melanoma of stomach and intestine".

A 24-year-old male was seen with an occipital mass for 1 year and dizziness for 5 days. The patient had no enlargement of the mass and no pain for 1 year. 5 days ago, sudden dizziness and blurred vision came to the clinic. Physical examination showed that the occipital mass was 5 cm ×3 cm in size, tough in texture, no movement, no tenderness, and no redness and swelling of the scalp. There were no abnormalities in laboratory blood routine and tumor markers such as carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP) and CA125. CT of the brain showed a bone destruction area in the occipital scale, with regular edges and no sclerosis, and the size was 3.6 cm ×4.5 cm; Local soft tissue mass was formed, and the mass was isolow density. The CT value in the low density area was about 19 HU, and the CT value in the isolow density area was about 40 HU (FIG. 1A)。 MR examination of the brain showed that the tumor in T₁WI is an isotropic signal (FIG. 1B), T₂WI is a high and low confounding signal (Figure 1C), the tumor was not uniformly enhanced in the enhancement scan, and there was no enhancement area in the interior, and the edge was obviously enhanced (Figure 1D)； Tumor size 4.5 cm ×3.2 cm ×5.5 cm; The tumor infiltrates brain tissue and superior sagittal sinus (Figure 1D), bilateral parieto-occipital leukoedema (Figure 1C)。 Surgical findings: The median horseshoe incision approach of the posterior occipital was taken, and the skull was defected due to tumor invasion, and the dura mater was destroyed by the tumor. The dura mater was cut along the edge of the tumor. The size of the tumor is 5 cm ×4 cm ×3 cm, the texture is tough, the blood supply to the scalp side is general, the color is pale yellow, the base is attached to the falx cerebri, the blood supply to the tumor on the cerebral surface is abundant, the color is gray-red, and it invades the superior sagittal sinus and sinus sinus. The tumor extensively invaded the brain tissue, and the boundary was unclear. With the assistance of cotton pads, bipolar electrocoagulation was used to separate the tumor edge and brain tissue, and the tumor was subtotally resected in blocks. A small amount of tumor invading the superior sagittal sinus and sinus sinus remained, and it was electrocoagulated and cauterized. After hemostasis, the dura mater was repaired and sutured with artificial meninges, and the defective bone flap was repaired with titanium plate. The tumor invading the skin was carefully separated and removed along the tumor edge. Postoperative pathology showed that the epithelioid tumor cells were arranged in bundles or nests under the fibrous background, and about 50% of the tumor was necrotic; Immunohistochemistry showed that tumor cells HMB45, P63, EMA, S-100, SMA, GFAP, CK (AE1/AE3), CD99, CD34, CD10, CD1a, CD31, CD34, F8, Myogenic, MyoD1 negative, Vitmin positive; Ki-67 can reach 10% ~15% locally and 5% ~10% overall. Sclerosing epithelioid fibrosarcoma was diagnosed. Postoperatively, the patient refused radiotherapy and received only one course of chemotherapy. Brain MRI revealed recurrence after 10 months, chest CT revealed multiple nodules in both lungs after 15 months, suggesting intrapulmonary metastasis, and death after 24 months.

A 52-year-old male was admitted to the Department of Encephalology, Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine on December 25, 2014 due to "disadvantageous left limb movement with disadvantageous language for 9 days". When admitted to the hospital, he saw clear spirit, poor spirit, sleep, agitation, poor movement of the left limb, conscious numbness of the right upper limb and left lower limb, poor speech, occasional choking and cough, occasional sputum, poor appetite, poor sleep, stools for 2 days, and urine adjustment. A previous history of cerebral infarction was 1 month, and a history of diabetes was 3 years. Neurological examination: left metacarpomandibular reflex (+), right Pap sign (+), specialist examination: left upper limb muscle strength grade III, left lower limb muscle strength grade I. Auxiliary examination: Head CT (December 25, 2014) showed: (1) multiple cerebral infarctions and malacia in pons, bilateral basal ganglia region-thalamus, left frontal lobe and bilateral hemioval center; (2) sparse white matter; (3) Brain atrophy. The diagnosis was "acute stage of cerebral infarction". After admission, he was treated with integrated traditional Chinese and western medicine to improve cell metabolism and circulation. Because the patient's right limb was agitated from time to time, he visited Anding Hospital many times and asked for consultation in the psychosomatic department of our hospital. He was treated with alprazolam, zopiclone, trihexyphenidyl hydrochloride, haloperidol and olanzapine for sedation, sleep aid, anticholinergic and antipsychotic treatment. However, the agitation of the limbs could not be alleviated, the movements were violent, and even the property was damaged and the limbs were bruised, so he asked for consultation on January 1, 2015. During sleep, the patient was turbid after waking up, accompanied by disorientation and restlessness, and woke up after about 5 minutes. Contact is acceptable, autonomy is incomplete, speech is unfavorable, right limb has no purpose movement, and cannot be controlled. Ask family members, the patient had been depressed and uncomfortable due to family conflicts, and then had cerebral infarction. The possibility of delirium cannot be ruled out. The prescription is as follows: oral, alprazolam tablets 0.4 mg once in the morning and afternoon, 0.8 mg before bed, sertraline hydrochloride capsules 25 mg with breakfast, increased to 50 mg with breakfast after 4 days, and trazodone hydrochloride 50 mg before bed to achieve sedation and antidepressant treatment. On January 8th, the overall symptoms of the patient were still stable, his mood improved slightly, and he could sleep. In the evening, he had transient visual hallucinations, language disorder and agitation, and it was still necessary to exclude visual hallucinations and falsehoods as delirium. The prescription is as follows: alprazolam tablets 0.2 mg once in the morning and afternoon, 0.6 mg before bedtime, sertraline hydrochloride capsules 75 mg with breakfast, trazodone hydrochloride 75 mg before bedtime, zopiclone 7.5 mg before bedtime, orally; When agitated, add 2 ml of diazepam to push slowly to achieve sedation, antidepressant and sleep-helping effects.

The blood vessel was once considered a "steel" tube. The phenomenon of vascular lumen dilatation with the increase of plaque volume in patients with atherosclerosis caused scholars to study the "vascular wall changes" in the process of disease, and then put forward the concept of "vascular remodeling". Until Gibbons et al.^[1]A more complete concept of vascular remodeling was proposed, namely, the active process of changes in the structure and function of the vascular wall under the joint action of local growth factors, vasoactive substances and mechanical stimulation of blood flow.

Negative symptoms play an important role in the evolution of the course of schizophrenia, easily accompanied by a slow loss of interest and ability during the development of the disease, ultimately leading to severe functional disability. Therefore, it is important to treat negative symptoms early. Because the biological mechanism of negative symptoms is complex, it is difficult to explain with a single biological hypothesis or genetic factors, and there is a lack of effective targeted therapy. At present, there is no satisfactory effective treatment for negative symptoms. Recent research suggests that negative symptoms of schizophrenia may be related to abnormal activation of glutamatergic system and microglia^[1,2,3]。 This article reviews the research progress of biological mechanism and drug therapy related to this part.

Both lopinavir (LPV) and ritonavir (RTV) belong to human immunodeficiency virus (HIV) protease inhibitors, and their compound preparation, lopinavir combined with low-dose ritonavir tablets (LPV/r), is a protease inhibitor drug widely used in the clinical treatment of HIV-1 infection internationally. It is currently used as one of the second-line antiretroviral drugs of choice in China. By interfering with HIV protease, the structural and functional proteins of the virus core cannot be expressed correctly, resulting in the formation of immature and non-infectious virus particles, thus achieving the effect of inhibiting HIV replication. Co-administration of LPV with low-dose RTV can significantly enhance its pharmacokinetic profile and enhance its anti-HIV-1 activity^[1]。 This article mainly reviews its clinical application from the aspects of dose and efficacy, drug resistance and adverse reactions.