Volume 95  ·  Issue 41  ·  2015

On the occasion of the 100th anniversary of the founding of the Chinese Medical Association and the 100th anniversary of the founding of the Chinese Medical Journal, we are inspired to look back on the 80-year history of neurosurgery in China, and we are full of confidence to look forward to the future.

To explore clinicopathological features and prognostic factors of bone metastasis from primary hepatic carcinoma (PHC).

Eighty patients were enrolled with bone metastasis from PHC in Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2014 respectively. The clinicopathological features and prognostic factors of primary tumor were collected and bone metastases. Kaplan-Meier method was adopted for survival analysis. Log-rank method and Cox regression were used for univariate and multivariate analysis.

The median survival was 4.7 (95% CI range from 3.4 to 6.0) months. The 6-, 12-, and 24-month survival was 42.5%, 17.5%, 2.5%, respectively. Univariate analysis indicated that Child-Pugh grading (P<0.01), ECOG score (P=0.014), serum cholinesterase(P=0.002), total bilirubin(P=0.006), ascites(P=0.003), TACE (P<0.01) were significant prognostic factors of survival. Multivariate analysis revealed that Child-Pugh classification (P<0.01), TACE (P<0.01) were independent prognostic factors of survival.

Bone metastasis from PHC patients had poor survival. Patients can benefit from TACE and liver protecting treatment.

To evaluate the safety and efficacy of magnetic resonance guided focused ultrasound surgery (MRgFUS) in treatment for pain palliation of bone metastases.

Eighty-one patients of painful bone metastases were volunteered to screen for this study in Shanghai General Hospital from June 2014 to February 2015. Twenty-three patients among them were treated by MRgFUS, who was more than 18-years old, having the ability to fully understand the informed consent of the research, suffering with pain of numeric rating scale (NRS) ≥4, non-received radiotherapy or chemotherapy for pain palliation of bone metastases in the past two weeks. The NRS, the standard question of Brief Pain Inventory (BPI-QoL), and the standard question of Europe Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Bone Metastases22 (EORTC QLQ-BM22) were respectively recorded before and 1-week, 1-month, 3-month after the treatment. The related adverse events of MRgFUS were observed and recorded in 3 months after the treatment as well.

(1)Twenty-three metastatic bone tumor lesions of 23 patients were treated by MRgFUS, the treatment data was as follows: the meantreatment time was (88±33) minutes, the mean sonication number was 13±8. (2) Adverse events included: pain in therapy area 3/23, which spontaneous relieving within one week; numbness in lower limb (1/23), which relieved after physiotherapy. (3) The NRS of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 6.0±1.5, 3.7±1.7, 3.1±2.0, and 2.2±1.0, which significantly decreased after the treatment (P<0.01). (4) The BPI-QoL score of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 39±16, 27±18, 26±18, and 21±18, which significantly decreased after the treatment (P<0.01). (5) The EORTC QLQ-BM22 score of before treatment and at 1-week, 1-month, and 3-month after treatment respectively was 52±13, 44±12, 42±12, and 39±12, which also significantly decreased after the treatment (P<0.01).

MRgFUS can be used as a non-invasive, safe, and effective method for treating painful bone metastases. Its clinical benefits of pain palliation and patient's quality of life improving are sustained after the treatment at least to 3 months.

To qualitatively and quantitatively evaluate the feasibility of CT virtual unenhanced (VUE) spectral imaging in renal cell carcinoma.

Thirty-six patients with histopathologically proven renal cell carcinoma underwent gemstone spectral imaging (GSI) including ture unenhanced (TUE), arterial, cortex and medullary phase acquisitions.The triphasic GSI dataset was sent to workstation and 3 sets of VUE images (including VUE a, VUE c, VUE m) were obtained by subtract iodine from iodine-water images in the triphasic enhanced GSI images, respectively.The quality of VUE s and TUE images was evaluated on a five-point scale.Interobserver agreement with regard to image quality was assessed using Cohen'sKappa, and four groups of image quality was compared with ANOVA analysis.The contrast-to-noise ratio (CNR) of mass-to-kidney in the TUE and VUE s images was calculated, and difference between these four datasets was compared with ANOVA analysis.Using appearance of masses on triphasic images as a standard, the masses detection ratio of four groups was calculated and compared with chi-square test.

Interobserver agreement with regard to image quality was excellent (κ>0.600). There was no significant difference among the image quality of TUE and triphasic images of VUEs (P>0.05). The CNR of TUE (0.7±0.6) was significant worse than that of triphasic images (1.7±1.0, 1.9±1.2, 2.5±1.4, respectively)(P<0.05). There was no significant difference among the CNR of triphasic images (P>0.05).

VUE images obtain from triphasic phases may be a surrogate for conventional unenhanced scan in renal cell carcinoma diagnosis.

To validate the prevalence, severity, characteristics and coronary calcified score(CACS) of coronary artery plaques in women are different from men.

A total of 3 752 patients with suspected coronary artery disease in the First Affiliated Hospital of China Medical University were enrolled between September 2011 and December 2013. Patients with suspect CAD underwent 256-detecter coronary computed tomography(CCTA) and CACS measurement were enrolled. The differences of sex-associated coronary artery plaques were assessed. The univariable and multivariable Logistic regression were employ to assess the association female and male with coronary artery plaques.

A total of 3 752 patients including 1 832 females and 1 920 males, the average age of the patients was (56 ±11)years. Women were older and less smoker than men. The prevalences of any plaque, 2-, 3-/LM disease and significant/severe stenosis significantly decreased in female than male(all P<0.01). The proportion of non-calcified plaques significantly higher and mixed plaque significantly lower in female than male(allP<0.01). the proportion of women were significantly lower than men in CACS>0( allP<0.01). The similar tendency also happened in four age-matched female and male subgroups. After adjustment, female was the significant protective factor for significant and severe stenosis, 2- and 3-/LM vessel disease, calcified and mixed plaques, and CACS>100(allP<0.01); female was the significant protective factor for non-calcified plaques in the univariate analysis(P<0.01). When the age≥65, female became the significant risk factor for coronary artery plaques(allP<0.01).

Women have less prevalence and extensive coronary artery plaques and lower CACS, the plaque characteristics in women is more frequently composed by non-calcified plaques than men, even after matched by age. With age, female change from a protective factor to a risk factor for coronary artery plaques.

To investigate alternations of heart cavity and great vessel diameters and their risk factors in acromegalic patients.

Ninety-two cases, diagnosed as acromegaly, were selected as research subjects from January 2013 to December 2013 in Peking Union Medical College Hospital. There were 37 males and 55 females with an average age of 41.2 years (SD, 12.5 years, range from 19 to 67 years old). Ninety-two sex and age matched healthy individuals were selected as controls. Disease history, echocardiography, endocrine hormone levels were collected to make contrastive analysis. We analyzed the related risk factors of great vessel diameters expansion with binary logistic regression analysis and finally obtained the OR (odd ratio) and predictive formula.

Left ventricle end-diastolic diameter (LVEDD), left ventricle end-systolic diameter (LVESD), left atrium longitudinal dimension (LALD), right ventricle longitudinal dimension (RVLD), aortic root dimension (AORD), ascending aorta (AA), main pulmonary artery (MPA) were higher in patients with acromegaly than in healthy people, P<0.05. The comparison between expanded vessel diameters and normal vessel diameters in acromegalics showed that difference of disease duration was of statistical significance,OR= 1.011. We got the formula: logit (ADE) =-3.420+ 0.011×duration of disease.

Heart cavity and vessel diameters in acromegalic patients were higher than that in public. Expanding of great vessel diameters mainly depend on duration of disease instead of serum GH and IGF-1 level, and the duration of disease is the risk factor of the expansion of great vessel diameters.

To investigate the pulmonary ultrasound in children with congenital heart disease postoperative invasive ventilator time, non-invasive ventilator use the guide.

Using prospective clinical observation research methods, Randomly divide 100 cases ranged from 6 months to 3 years old in cardiopulmonary bypass after congenital heart disease surgery patients into ultrasound group and control group, 50 cases in each group. All postoperative give positive cardiac function maintenance, diuresis, etc. Ultrasound group adopted the pulmonary ultrasound in children with pulmonary interstitial pulmonary edema monitoring and guide to extubation, enable the timing of the noninvasive ventilator support; Control group based on the bedside chest X-ray lung condition. Compare two groups of children with mechanical ventilation time (including the invasive and noninvasive ventilator support), noninvasive ventilator utilization rate and its accuracy, start the noninvasive ventilator time, the incidence of ventilator associated pneumonia (VAP), secondary tracheal intubation cases and ICU stay time, etc.

The ultrasound group compared with the control group in Invasive ventilator time[(15.0±11.0) vs (20.0±13.5, P=0.043)], noninvasive ventilation time[(38.5±11.8) vs (48.6±21.9, P=0.032)], the number of cases of the use of noninvasive ventilation(10 cases vs 22 cases, P=0.041), the correct use of the number of cases(10 vs 14, P=0.034) and VAP cases(3 vs 8, P=0.044), there was statistical significance, P< 0.05.The ultrasound group of children with ICU stay time was significantly lower than the control group [(66.0±38.9) vs (82.0±42.4,P=0.038)]; Control group had 2 cases with secondary tracheal intubation, ultrasound group one, comparing the two groups has no statistical significance (P> 0.05).

Postoperative children with congenital heart disease using pulmonary ultrasound evaluation of pulmonary interstitial edema, guide the ventilator, it can effectively shorten (invasive and noninvasive mechanical ventilation time and ICU length of hospital stay, lung ultrasound has instant, noninvasive, No radiation, repeatable, pulmonary ultrasound will be important after cardiopulmonary bypass interstitial lung edema diagnosis, evaluation of treatment means and helps to treat critically ill children.

To explore the association between the SNP rs3785143 of NET1 gene and attention-deficit/hyperactivity disorder (ADHD) with and without oppositional defiant disorder (ODD).

Five hundreds and eighty-seven ADHD children with ODD, 1228 ADHD children without ODD and 554 healthy children were recruited from child psychiatric clinics of Peking University Sixth Hospital/Institute of Mental Health and included for genotyping of rs3785143. Comparisons of allelic and genotypic distribution among these groups were conducted.

In ADHD children with ODD, the genotypic distribution was significantly different from controls (P=0.008), showing higher TT frequency in ADHD with ODD (4.3% vs 1.6%, P=0.009). In ADHD children without ODD, the C allele (0.859 vs 0.821, P=0.005) and CC genotype (73.4% vs 65.9%, P=0.001) showed higher frequencies than controls.After controlling the potential influence of age and gender, those associations were retained. To further exclude the potential effect of other comorbidities, we repeated above analyses in pure ADHD and pure ADHD with ODD. In pure ADHD, the C allele (0.870 vs 0.821, P=0.003) and CC genotype (75.8% vs 65.9%, P=0.001) showed higher frequencies than controls; while in pure ADHD with ODD, the TT genotype showed higher frequency than controls (5.1% vs 1.6%, P=0.006).

We replicate the association between the SNP rs3785143 of NET1 gene and ADHD by case-control study.There may be different genetic mechanisms between ADHD with and without ODD.

To study the changes of plasma levels of oxidative stress biomarkers in patients with parkinson's disease (PD), and to explore its association with cognition function.

Seventy-two PD patients from June 2013 to May 2012 were enrolled.All of them were outpatients or inpatients at the First Affiliated Hospital of Nanjing Medical University .And forty-five age- and gender- matched healthy subjects were used as controls. The information including gender, age, illness duration, years of education and Hoehn & Yahr (H-Y) stage were recorded. Cognition function of all the patients with PD and the controls were measured by using Montreal Cognitive Assessment (MoCA) scale. Plasma levels of catalase (CAT), total superoxide dismutase (T-SOD), glutathione peroxidase (GSH-Px), total glutathione (T-GSH) and malondialdehyde (MDA) were measured by ELISA. Then we compared and analyzed the results.

Plasma levels of CAT, T-SOD and T-GSH in PD group were significantly lower than the control group[(159±9) kU/L vs (170±5) kU/L, P< 0.01; (97±24) kU/L vs (124±25) kU/L,P<0.01; (17±10)μmol/L vs (60±51 ) μmol/L,P< 0.01]. Plasma levels of CAT, T-GSH, GSH-Px and MDA were no differences between early PD group (H-Y stage Ⅰ-Ⅱ) and middle-late PD group (H-Y stage Ⅲ or higher) of patients(P>0.05). Plasma levels of T-GSH in PD group with mild cognitive impairment(MCI) were obviously lower than PD group without MCI[(14±7) μmol/Lvs (19±11) μmol/L, P< 0.05]. In PD patients, MoCA scores were positively correlated with years of education (β= 0.634,P= 0.000) and plasma levels of T-GSH (β= 0.204,P= 0.014), and were negatively correlated with H-Y stage (β=-0.194,P= 0.020).

The damage of plasma antioxidant mechanism may be involved in the pathogenesis of patients with PD. Decrease in plasma levels of T-GSH may be associated with MCI in PD patients. Plasma levels of T-GSH may be a potential early predictive index in PD patients with cognitive dysfunction.

To explore the serum levels of lipids and lipoproteins in patients with multiple system atrophy (MSA).

From July 2009 to June 2014, a total of 62 MSA patients from the neurology department of our hospital were enrolled as the case group and 63 healthy individuals were enrolled as control group. The serum levels of lipids and lipoproteins were compared between two groups and also analyzed according to gender, age and disease subtypes.

Compared with the healthy controls, abnormal rates of high density lipoprotein cholesterol (HDL-C), apolipoproteins A (ApoA) and apolipoproteins B (ApoB) in MSA patients were decreased significantly (P<0.01), while there is no difference of abnormal rates in TC, TG and LDL-C. Compared with the healthy controls, the serum total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), LDL-C, ApoA and ApoB levels in MSA patients were decreased significantly (P<0.01). There was no significant difference in TG levels. Compared with female MSA patients, the serum TG and LDL-C in male MSA patients were decreased significantly (P<0.05). Compared with male controls, TC, LDL-C, HDL-C, ApoA and ApoB levels of male MSA patients were decreased significantly (P<0.05) whilst there was no significant difference in TG level (P>0.05). Compared with female controls, the serum TC, TG, HDL-C, ApoA and ApoB levels in female MSA patients were decreased significantly(P<0.05) whilst there was no significant difference in LDL-C (P>0.05). There was no significant difference in lipid levels between elder patients (age over 65) and younger patients (age under 65) (P>0.05). Also no significant difference existed between type C and type P of MSA(P>0.05). No significant relationship between course of disease and lipids was found(P>0.05).

Serum levels of TC, HDL-C, LDL-C, ApoA and ApoB are decreased in MSA patients but all lipid levels are not related to either disease course or subtype, which may indicate that lipids levels are related to the pathogenesis of MSA.

To investigate the osteoporosis prevalence and osteoporosis-related clinical risk factors among healthy elderly male.

A cross-sectional study was conducted from January 2014 to October 2014. Healthy elderly male aged 50 and above from Beijing WangZuo Community who had completed the questionnaire we made were enrolled in this study and accepted bone mineral density (BMD) testing by dual energy X-ray absorptiometry. Subjects were classified as the osteoporosis group (OP group) and the non-osteoporosis group (Non-OP group) according to the WHO criteria, of which osteoporosis was defined arbitrarily when any T-score was -2.5 standard deviations or less at femoral neck, total hip or lumbar spine (L_1-4). The clinical risk factors of each subject including age, body weight, Body Mass Index (BMI), previous fragility fracture history, smoking, alcohol abuse, glucocorticoid therapy and other capable clinical risk factors were collected and compared in OP group and Non-OP group.

In the 346 cases of elderly healthy men, 18.5% had osteoporosis, 55.5% had osteopenia and 26.0% were normal. Femoral neck's and total hip's BMD level decreased with increasing age. However, the trend was not found at lumbar spine site. There appeared to be a significant difference in BMD standard between lumbar vertebral and total hip when compared with age-matched cohorts (P<0.05). Weight, BMI, previous fragility fracture history and smoking were found significant differences between OP group and Non-OP group (P<0.05).

The prevalence of osteoporosis in healthy older men should not be ignored. Low BMI and weight, previous fragility fracture history and smoking history were clinical risk factors of OP in this population.

To explore the change and Significance of RhoA/ROCK signaling pathway in the model with natural degeneration of the rat endplate chondrocytes.

Endplate chondrocytes were selected by enzyme digestion and cultured in vitro to divided into control(P2 cells) , naturally passaged(P5 cells) groups and treatment group(P5+ ROCK Inhibitor Y27632). The phenotype of endplate chondrocytes were identified by toluidine blue stains and F-actin stains.Type Ⅱ collagen, aggrecan and SOX9 genes were examed by Real-time RT-PCR to verify the degeneration model. The RhoA/ROCK signaling pathway related gene ROCK-1, ROCK-2 were detected by RT-PCR and Western blot. The actived RhoA was examed by active-RhoA detection and Western blot.

With the passaging, endplate chondrocytes completely lost the original cell morphology, the levels of type Ⅱ collagen(P5/P2=0.248, P<0.001), aggrecan(P5/P2=0.172,P<0.001)and SOX9(P5/P2 =0.499,P<0.001) significantly reduced. There is also a certain reduction of ROCK-1 (P5/P2=0.652,P<0.001), but ROCK-2 (P5/P2=2.527,P<0.001) expression increased significantly. And the active-RhoA were Significant increased too.ROCK-1 AND ROCK-2 were down-regulated in the treatment group.And type Ⅱ collagen, aggrecan, SOX9 significantly increased.

The degeneration of endplate chondrocytes with decreased ROCK-1 expression but increased active-RhoA and ROCK-2 expression suggest that RhoA/ROCK signaling pathway play an important role in the in vitro degeneration of endplate chondrocytes.Modulating the expression of RhoA/ROCK signaling pathway may be a new method of solving the problem of the degeneration of intervertebral disc.

To evaluate the present clinical effictiveness and its change trend by an updated and cumulative meta-analysis of endoscopic versus microscopic surgery for transsphenoidal pituitary adenoma in China.

We conducted a systematic review of the literature related to theme, and the meta-analysis of the data extracted onto a standard form was conducted by Stata 12.0 software.

Finally 14 studies were included.There were 1 888 patients in total including 962 patients receiving endoscopic surgery and 926 patients undergoing microscopic surgery.Compared with microscopic group, there were significant advantages in endoscopic group including the high rate of complete tumor resection (OR=1.951, 95%CI: 1.525-2.495) and the lower incidence of overall operation complication (OR=0.480, 95%CI: 0.298-0.773)and cerebrospinal fluid leakage (OR=0.592, 95% CI: 0.399-0.878), but the advantage of the incidence rate of diabetes insipidus(OR=0.72, 95%CI: 0.420-1.252) was no statistically significant.Cumulative meta-analysis suggested that the advantage of total resection of tumor has stabilized in 2013.

At present in our country, compared with microscopic group, there were significant advantages in endoscopic group including the rate of complete tumor resection and the incidence of overall operation complications and cerebrospinal fluid leakage, but the advantage of the incidence rate of diabetes insipidus was no statistically significant difference.The follow-up studies related to the rate of total resection of tumor may not change the existing meta-analysis results.

Craniopharyngioma is a common intracranial lesion, which originates from the embryonic residual cells in the nodule of the pituitary stem. Therefore, it is often adjacent or adherent to important structures such as the surrounding optic nerve, pituitary stem and hypothalamus, so there are many postoperative complications and severe patient reactions. Therefore, this study summarized and analyzed the clinical data of 58 cases in the Department of Neurosurgery of Beijing Tiantan Hospital from October 2012 to October 2013, and made a preliminary discussion on the management of postoperative complications of adult craniopharyngioma.

In recent years, with the rapid increase of various vehicles, the occurrence of lower cervical dislocation has been increasing year by year^[1,2]。 At present, the commonly used treatment for lower cervical dislocation is preoperative heavy-weight traction. If the reduction is successful, anterior cervical surgery should be performed. If the reduction fails, posterior surgery or combined posterior-anterior surgery should be performed^[3,4,5,6]。 In this study, the patients with lower cervical dislocation were treated with first-stage anterior cervical decompression and then reduction in emergency department, and good results were achieved.

A 68-year-old male was diagnosed with primary Parkinson's disease in the First Affiliated Hospital of Dalian Medical University 10 years ago, and had a history of hypertension and diabetes for 10 years. At present, in the H-Y stage 3, oral administration of dopaserazide tablets, carbazolidopa controlled-release tablets, entacapone, pramipexole and selegiline, the symptom control is poor, and there is an "on-off" phenomenon. The opening period is about 1 h, accompanied by involuntary movement, posture instability, restlessness, stiffness of limbs, difficulty walking, and sweating all over the body. The UPDRS scores in the on and off periods were 63 and 74. Admission for deep brain electrical stimulation (DBS). The target was the bilateral subthalamic nucleus (STN), and microelectrode recording was performed 10 mm from the target. The temporary irritation symptoms improved satisfactorily, and a permanent electrode (L301, Tsinghua Pinchi) was implanted. Under general anesthesia, a left anterior subcutaneous pulse generator (G102R, Tsinghua Pinchi) was implanted. On the night after surgery, the patient was sleepy and lazy, and could be awakened with reasonable questions and answers. On the first day after surgery, he woke up from general anesthesia and took the same medication as before surgery. The "on-off" phenomenon was significantly reduced, the opening period was prolonged, and the abnormal movement of the opening period disappeared. The UPDRS scores were 38 and 59 in the on and off periods. On the second day after surgery, the patient was somnolent again, accompanied by new symptoms such as hallucinations, unreasonable questions and answers, and groping with both hands. Re-examination of the head CT showed patchy low-density shadows in the cortex around the left electrode and subcortical white matter (Figure 1), MRI undercooperation. On the 4th postoperative day, symptoms returned to baseline levels, with reasonable questions and answers and no groping movements. On the 6th postoperative day, head MRI revealed T₂High signal around the left electrode of WI, with a maximum diameter of about 3.52 cm (Figure 2)。 Dexamethasone 10 mg, once a day, intravenous drip for 3 days; Continue prednisone 30 mg, once a day, orally for 4 days. Retrospective head MRI at 20 days after surgery showed T₂WI hyperintensity resolved significantly (Figure 3)。

The 43-year-old female was admitted to the Department of Obstetrics and Gynecology, Beijing Military Region General Hospital of the People's Liberation Army due to dysmenorrhea for 33 years and aggravation for 3 years. Usually, menstruation was regular, 5~6/33 days, with moderate amount and severe dysmenorrhea. The patient developed dysmenorrhea after menarche, which was unbearable, and intermittently took oral analgesics. It improved before and after giving birth in 1997, and the symptoms of dysmenorrhea worsened in 2005. A mass appeared at the scar of cesarean section consciously, and the menstrual period became larger, harder and tender. The lower abdominal pain accompanied by lumbosacral soreness from 1 d before menstruation to 2 or 3 d after menstruation required oral analgesics, and the pain symptoms gradually decreased after menstruation. In 2010, I experienced anal distension and severe feeling after tenesmus, enlarged mass at the scar, and aggravated menstrual pain. I went to a local hospital, considered abdominal wall incision endometriosis, and recommended surgery. I did not follow the doctor's advice, and then the symptoms progressively aggravated, seriously affecting the quality of life, so I was hospitalized on October 21, 2013. The patient's past history was not special, and there was no history of hormone treatment. Married at the age of 25, with 4 deliveries and 1 delivery, 1 medical abortion and 2 induced abortions. In 1997, she gave birth to a full-term live girl by cesarean section, and she was healthy. Physical examination: body temperature 36.5℃, heart rate 80 beats/min, breathing 18 beats/min, blood pressure 110/70 mmHg (1 mmHg =0.133 kPa), normal development, clear consciousness, cooperative physical examination, no abnormalities in cardiopulmonary auscultation, soft abdomen, a transverse old surgical incision scar about 10 cm long can be seen 3 cm above the pubic symphysis, and a mass about 4.0 cm ×2.5 cm in size can be seen on the left side of the incision scar, with clear boundaries, located subcutaneously, and no obvious tenderness. Gynecological examination: vulva is married, vagina is unobstructed, cervix is smooth, uterus is horizontal, such as the size of 8 weeks of pregnancy, hard in texture, no tenderness, and the double adnexal area is not palpable with obvious abnormalities.

Combination of clopidogrel and aspirin as standard antiplatelet therapy after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). 2003 Müller et al.^[1]Platelet aggregation inhibition was found in 4.7% of PCI patients taking clopidogrel<10%, and is associated with an increased risk of clinical thrombotic events. Studies have found that the antiplatelet effect of clopidogrel is heterogeneous, and 4% ~30% of patients have "clopidogrel resistance" or "platelet hyperreactivity"^[2]。 For this reason, in 2010, the US FDA issued a "black alert", recommending that patients with poor response to clopidogrel may consider drug genetic testing. Individualized treatment of clopidogrel based on laboratory testing has received extensive attention in clinical research and clinical practice, mainly including platelet function testing and drug gene polymorphism testing. This article reviews the research on individual responsiveness differences and individualized treatment of clopidogrel.

Pelvic organ prolapse (POP) is a common disease in multiparous women at all ages, with a prevalence of up to 37%^[1]The pathogenesis of POP is complex and involves many factors^[2]Such as postpartum or multipartum, menopause, advanced age, history of previous pelvic floor surgery, connective tissue disease, low estrogen level, smoking, chronic obstructive pulmonary disease, obesity, long-term increase in abdominal pressure, etc., but damage to pelvic floor supporting tissues such as uterosacral ligament (USL) and main uterine ligament (CL) is an important anatomical cause of its pathogenesis. In recent years, with the continuous exploration of the anatomy of DeLancey's first level, that is, the main ligament-uterosacral ligament complex, and the rapid development of imaging technology, especially studies have shown that the preoperative use of dynamic or functional magnetic resonance imaging (MRI) to evaluate pelvic floor dysfunction can change the initial surgical planning of 67% patients^[3]Therefore, MRI provides a useful tool for evaluating the complex pelvic floor condition of pelvic floor dysfunction, studying the mechanism of POP, achieving precise diagnosis and individualized surgical selection. The anatomical histology and MRI characteristics and clinical application of the principal sacral ligament of the uterus are summarized as follows.

Coronary heart disease is the result of the interaction of immune mechanisms with metabolic risk factors. In the early stage of atherosclerotic lesions, immune cells occupy a dominant position, and their effector molecules can accelerate the progression of the lesions, while the activation of inflammatory response can trigger acute coronary syndrome. The study found that the root cause of acute myocardial infarction in the vast majority of cases is thrombosis on the basis of atherosclerotic plaques. 60% ~70% of patients with acute myocardial infarction develop thrombosis secondary to plaque rupture. Plaque rupture is typically located in the weak areas and incomplete parts of the fibrous cap. Immune cells are abundant in this location, which produce a large number of inflammatory molecules and proteolytic enzymes, which in turn lead to the progression of stable plaque to vulnerable plaque. Once the plaque ruptures, the contents of the plaque (phospholipids, tissue factors, platelet adhesion molecules, etc.) can be exposed to the blood, accelerating thrombosis, blocking blood vessels, and causing acute myocardial infarction. It can be said that acute myocardial infarction is a process of thrombosis and inflammation^[1]。