Volume 96  ·  Issue 03  ·  2016

The successful development of the first CT by Hounsfield in 1972 is considered to be one of the most important achievements of radiodiagnostics after Roentgen discovered X-ray^[1]。 In the past 40 years, CT has experienced from initially only used for brain examination to whole body CT, single-slice spiral CT, multi-slice spiral CT, volume CT, energy spectrum CT, until the latest Revolution CT, which can perfectly integrate fast scanning, low radiation dose and ultra-clear images. With the rapid development of various software and hardware technologies, the application of CT in thoracic diseases is undergoing rapid transformation.

To evaluate the value of grand glass opacity(GGO) on CT as a diagnostic sign of pulmonary fungal infection.

The clinical data of 143 patients treated in department of hematology from January 2007 to June 2015 were analyzed retrospectively, and GGO or other attendant signs were observed.

The cases of fungal infection secondary to acute leukemia(AL), myelodysplastic syndromes(MDS), non-Hodgkin's lymphoma(NHL), multiple myeloma(MM), Hodgkin's lymphoma(HL) were 83, 23, 18, 10, 9, respectively, including 23 patients with hematopoietic stem cell transplantation.Ninety percent(128/143) of patients with GGO changes was accompanied with the presence of neutropenia.GGO was mostly accompanied by funicular inflammatory infiltrating shadows or nodules.The cases of possible invasive pulmonary fungal infections(IPFI), probable IPFI, proven IPFI, undefined IPFI were 56, 15, 4, 26, respectively.The total effective cases after anti-fungal therapy was 92.

Ground glass opacity as sign of pulmonary infection of CT mostly occurred in neutropenia and is more common in patients with acute leukemia or hematopoietic stem cell transplantation.GGO is a diagnostic sign of pulmonary fungal infection and it's indicating that anti-fungal medicine should be considered.

To evaluate the prevalence of perilymphatic involvement and clinicoradiologic characteristics of active pulmonary tuberculosis according to the distribution of micronodules on CT images.

A total of 124 in-patients with active pulmonary tuberculosis in Haihe Clinical College of Tianjin Medical University from September 2013 to March 2015 were enrolled in this study, all patients underwent CT before antituberculosis therapy.A retrospective investigation of CT images focused on the distribution of micronodules, as well as other major CT features of active pulmonary tuberculosis.Clinical and CT findings of the three groups which based on the distribution of micronodules (perilymphatic, centrilobular and mixed) were compared.

All patients existed micronodules.Among these patients, the number of the perilymphatic micronodules, interlobular septal thickening, intralobular septal thickening, bronchial or bronchovascular bundle thickening, galaxy or cluster sign, reversed halo sign was 80(64.5%), 83(66.9%), 56(45.2%), 56(45.2%), 17(13.7%) and 4(3.2%), respectively.There were 35, 36 and 45 cases who were classified into the perilymphatic, centrilobular and mixed groups, respectively.Interlobular septal thickening (88.6% vs 38.9%), intralobular septal thickening (97.1% vs 0), bronchial or bronchovascular bundle thickening (74.3% vs 19.4%) and galaxy or cluster sign (37.1% vs 0) in perilymphatic group were higher than those of centrilobular group, consolidation or macronodule (80% vs 100%) and cavitation (42.9% vs 77.8%) in perilymphatic group were lower than those of centrilobular group. Age (32±16 vs 41±14), the rate of sputum acid-fast bacilli smears staining positive (28.6% vs 58.3%) and sputum culture positive for Mycobacterium tuberculosis (54.3% vs 94.4%) in perilymphatic group were lower than those of centrilobular group.

CT findings representing pulmonary perilymphatic involvement are relatively common in patients with active tuberculosis, galaxy or cluster sign and reversed halo sign are uncommon. The patients with tuberculosis are relatively younger who principally showed pulmonary perilymphatic involvement, and detection of sputum Mycobacterium tuberculosis in these patients is relatively lower.

To evaluate the diagnostic value of CT pulmonary artery (CTPA) imaging with idiopathic pulmonary artery hypertension (IPAH).

A total of 20 patients with right heart catheterization (RHC) proven IPAH were retrospectively analyzed between January 2012 and November 2015.The imaging was analyzed including pulmonary parenchyma, pulmonary interstitial, mediastinal lymph nodes, pericardium and pleural cavity on the CTPA examination.Cardiovascular parameters were measured in CTPA including right ventricle biggest short axis diameter (RVD), left ventricle biggest short axis diameter (LVD), main pulmonary artery diameter (MPAD), right pulmonary artery diameter (RPAD), left pulmonary artery diameter (LPAD), right low pulmonary artery diameter (RLPAD), ascending aorta diameter (AAD) and descending aorta diameter (DAD), and parameters were calculated including the ratio of the main pulmonary and ascending aorta diameter (rPA), the ratio of the ascending and descending aorta diameter (rAD), the ratio of the right ventricular and left ventricular short axis diameter (RV/LV). The relationship between sex, pulmonary, lymph nodes, pericardium, pleural and pulmonary arrery pressure (PAP) was analyzed by Spearman rank correlation analysis.All the parameters between mild-moderate (4 cases) and severe (16 cases) PAH were analyzed by independent sample t test.PAP of different age (<50 years and≥50 years) groups was analyzed by Pearson correlation analysis.

Of 20 cases, 7 cases showed patch exudative change, 5 cases showed"mosaic pattern"inhomogeneous perfusion, 3 cases displayed ill-defined centrilobular nodules, 6 cases manifested mediastinal lymphadenopathy, 10 cases had pericardial effusion including 4 cases of pleural effusion, 4 cases of dilated bronchial artery, 1 cases of secondary right pulmonary artery embolism.When comparing the presence or absence of pleural effusion, these was statistical difference of PAP (r=0.445, P=0.049). LVD, LPAD, RPAD, AAD, DAD and rPA were statistically different between mild-moderate and severe PAH (t values were 3.194, -3.393, -7.771, 10.299, 11.394 and -12.715, respectively, P<0.05). PAP was statistically different between different age groups (r=-0.481, P=0.032).

CTPA is a very important examination for the diagnosis of IPAH.The changes of lung, mediastinum, percardium, pleural cavity and the cardiovascular parameters can help diognose and evaluate IPAH.

To summarize the clinical experience of microsurgical treatment for giant invasive spinal schwannoma assisted by three-dimensional navigation.

A total of 15 cases of giant invasive spinal schwannoma were retrospectively analyzed from 2013 to 2014 in Beijing Jishuitan Hospital.All patients were performed microsurgery assisted by three-dimensional navigation and were followed up for at least 12 months.A modified McCormick Scale was used to assess the patients' neurologic status and change.

Four lesions were in the cervical region, 3 in the sacral, 2 each in the cervicothoracic, lumbar and thoracic regions, 1 each in the thoracolumbar and lumbosacral regions.A total of 28 pedicle screws were placed satisfactorily in the 5 patients with spinal instability.No severe complications were encountered.Gross total resection was performed in 13 of the 15 patients, and subtotal resection performed in 2 patients.Satisfactory decompression was achieved in all patients for neural compression.Postoperative clinical symptoms were improved in all patients, and none of the patients showed loosening or displacement of the implants.

Three-dimensional navigation provides great help for neurosurgeons in surgical treatment of giant invasive spinal schwannoma, and it has great potential in raising the intraoperative localization accuracy, reducing operational damage and surgical complications.Total resection is suggested for giant invasive spinal schwannoma; if not, total resection of the intraspinal portion is recommended.

The research aimed to evaluate the level and clinical significance of serum 25-hydroxyvitamin D in female patients with rheumatoid arthritis (RA).

Totally 82 untreated RA female patients (RA group) and 32 healthy females (control group) were enrolled.According to the disease activity score in 28 joints (DAS28), patients in RA group were divided into remission stage group (<2.6 scores, 32 cases) and active stage group (≥2.6 scores, 50 cases). The correlations of 25-hydroxyvitamin D (25-(OH)-D) level with related indicators were analyzed.

(1)The levels of serum 25-(OH)-D in female RA active stage group were significantly lower than those in control group [(12.5±6.3) μg/L vs (26.6±5.3) μg/L ] ( P<0.01). The levels of serum 25-(OH)-D in female RA remission stage group were significantly lower than those in control group [(14.2±7.2) μg/L vs (26.6±5.3) μg/L] (P<0.01). (2)Serum 25-(OH)-D levels were inversely associated with C reactive protein (CRP), erythrocyte sedimentation rate (ESR), DAS28 score (r=-0.575, r=-0.528, r=-0.354, P<0.05) in female RA active stage group, but not in female RA remission stage group (P>0.05). (3)In active stage group, the 25-(OH)-D levels of premenopausal RA patients were negatively correlated with CRP, ESR, DAS28 (r=-0.707, r=-0.625, r=-0.487, P<0.05), but not in postmenopausal RA patients (P>0.05).

The 25-(OH)-D levels in serum are reduced in female patients with RA.Serum 25-(OH)-D level can be a marker to monitor the disease activity in RA premenopausal female patients.

To explore the characteristics of small-world properties of the brain functional networks in patients with chronic ischemic stroke.

A total of 42 stroke patients and 25 matched healthy volunteers were scanned with BOLD-fMRI and the whole-brain functional networks were constructed.Two sample t-tests were used to evaluate the changes.The properties including E_global, E_local, Lp, Cp, γ, λ, σ.

Within 0.1≤sparsity≤0.2, both groups satisfied the small-world properties(σ>1). However, the Cp and E_local of stroke group was significantly lower (P<0.05).

The networks in both groups still satisfied the small-world but parts of the properties in patients have changed. The reduced properties including Cp and E_local.These changes will provide a new perspective for pathophysiological mechanism and also be helpful for understanding this disease.

To investigate the influence of diastolic filling pattern on the efficacy of cardiac resynchronization therapy (CRT) in patients with non-ischemic cardiomyopathy.

Between January 2012 and September 2013, 100 patients with non-ischemic cardiomyopathy undergoing CRT were enrolled in the study, and all patients were grouped by the pre-CRT diastolic filling pattern as impaired relaxation, pseudonormalized and restrictive filling. After follow up for 12 months, the New York Heart Association (NYHA) Class and echocardiography were used to assess the efficacy of CRT.The endpoint was rehospitalization for heart failure or cardiac death. Kaplan-Meier survival curves were plotted to assess prognosis.

All patients had varying degrees of diastolic dysfunction.Logistic regression analysis indicated that diastolic filling pattern was the independent factor for the response of CRT.(1)The response rate (78.7%) of impaired relaxation group (n=61) was significantly higher than that of the other two groups (P<0.01); postoperative NYHA class, left ventricular ejection fraction (LVEF), fraction shortening (FS), left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) were significantly improved (allP<0.01). (2)For pseudonormalized group (n=18), at the 3^rd month, NYHA class decreased from 3.3±0.5 to 2.3±0.5, LVEF increased from 27%±7% to 31%±6% (both P<0.01), and FS improved significantly (P<0.05); no significant decrease of LVEDV and LVESV was found. At the 6^th month, LVEF improved significantly (P<0.01); LVESV was reduced (P<0.05). (3)In restrictive filling group (n=21), CRT brought short-term improvement in NYHA class but did not induce any significant improvement in LVEF, FS, LVESV and LVEDV.At the 6^th month, there were significant differences in efficacy among the three groups (P<0.05). At the end of follow-up, 5 patients died, and the cumulative endpoint incidence was significantly higher in restrictive filling group (81%) than the other two groups (P<0.05).

In patients with moderate-to-severe heart failure, left ventricular diastolic dysfunction affects the efficacy of CRT, patients with impaired relaxation benefit significantly, pseudonormalized patients take longer to benefit, but patients with restrictive filling do not benefit from CRT.

To observe the quantitative electroencephalogram (qEEG) characteristics of the patients with septic shock in intensive care unit (ICU), and to find the early presence and severity of septic-associated encephalopathy (SAE) in these patients.

During November 2014 to August 2015, 26 cases with septic shock were included from the ICU of the First Affiliated Hospital, Sun Yat-sen University.During the same period, 14 healthy volunteers were included as control. The brain function instrument was used to monitor the patients by the bed, placing leads as the internationally used 10-20 system, bipolar longitudinal F3-P3, F4-P4 four channels, and then consecutive clips of 5 minutes was chosen, using the average value of the clips, the amplitude integrated electroencephalogram (aEEG), relative frequency band energy, spectrum entropy, relative alpha ariability to carry out statistical analysis.And the qEEG features of septic shock patients with different Glasgow coma scale (GCS) levels were also analyzed.

(1) 96% of the patients with septic shock had EEG abnormalities.Alpha frequency band energy, alpha ariability, aEEG amplitude, spectrum entropy decreased significantly (P<0.05=, while the delta frequency band energy significantly increased (P<0.05=. (2) aEEG amplitude decline appeared in 34% of patients with septic shock, and within the septic shock groups, amplitude decreased significantly (P<0.05= in patients with GCS under five.

Patients with septic shock tends to have diffuse inhibition in EEG, and the inhibition degree can reflect cerebral lesion degree; changes of EEG frequency as early warning indicators of brain damage are sensitive, and the decline of amplitude often indicates critical injury.

To explore the effects of innovated technologies and products on improving outcomes and decreasing medical costs by analyzing a total and subtotal medical costs of patients with atlantoaxial disorders.

The medical costs of 1 489 patients with atlantoaxial disorders from Peking University Third Hospital from 2005 to 2014, who received innovated technologies and products treatment were retrospectively analyzed and compared.Descriptive analysis and ANOVA were used for statistical analysis, and SPSS 19.0 was used to analyze data.

From 2005 to 2014, under the situation of a general increase in medical cost by 327%, the total medical costs were stable for patients who used innovated technologies and products for treatment, fluctuating from 20 851 in 2005 to 20 878 in 2014; however, the cases of operation increased year by year, from 88 in 2005 to 163 in 2014; the average length of stay decreased from 21 in 2005 to 10 in 2014; the total cases of transfusion were 22 from 2005 to 2014; the safety, stability and feasibility of the innovated technologies and products were illustrated through the decrease of average length of stay, the reduction of bleeding and the significance of outcomes.

It is illustrated that the innovated technologies and products not only decrease patients' suffering and medical costs but also are safe, stable and feasible.

To investigate the rate of ovarian metastasis and its related factors in patients with cervical adenocarcinoma, and explore whether the ovary should be reserved or not in cervical adenocarcinoma.

The clinical data of 111 patients with cervical adenocarcinoma who received extensive total hysterectomy plus pelvic lymph node resection in Sun Yat-sen Memorial Hospital and Quanzhou Women's and Children's Hospital from January 2008 to December 2014 were collected and analyzed by single factor χ² test and multivariate logistic regression analysis.

The median age of the included 111 cases of cervical adenocarcinoma was 44. Sixty-five of the patients were stage Ⅰb1, while 46 were stage Ⅰb2. The single factor analysis indicated that lymph-vascular space invasion(LSVI), lymph node status, interstitial infiltration depth, parametrial involvement and involvement of cervical body junction were associated with ovarian metastasis. Multivariate analysis indicated that LSVI (HR: 47.01, 95% CI: 2.48-890.03, P=0.010) and lymph node status (HR: 23.58, 95% CI: 1.20-463.21, P=0.038) were independent risk factors for ovarian metastasis.

Ovarian metastasis rate of stage Ⅰb cervical adenocarcinoma is low; patients with age less than or equal to 45 years old, negative LSVI, <1/2 cervical stromal invasion, no lymph node metastasis and no cervical body junction involvement can consider preservation of ovary; but these findings still need to be further confirmed by large randomized controlled trials.

To investigate the association between the serum uric acid (UA) level and amyotrophic lateral sclerosis(ALS).

The serum UA levels were measured from 164 ALS patients and 164 gender and age matched controls. The serum creatinine (Cr) and blood urea nitrogen (BUN) levels were also measured to reduce the bias caused by possible differences in renal excretion function.The differences of the above indexes were compared between the two groups.

The serum UA levels in ALS patients were lower than those in healthy controls ((310±88) μmol/L vs (356±78) μmol/L, P<0.01). The differences were observed in both genders. In a Logistic regression model using ALS as a dependent variable, the serum UA level was significantly associated with ALS. The differences of the serum UA levels in ALS patients stratified by the revised ALS functional rating scale (ALSFRS-R) and the progression rate of ALSFRS-R(ΔFS) were not statistically significant (P>0.05).

ALS patients are found to have significantly lower serum UA levels than healthy individuals. The serum UA level is not involved in disease severity and progression.

To investigate the prevalence and risk factors of mild vision loss in adult patients with type 2 diabetes in Beixinjing Community, Shanghai, China.

A population-based, cross-sectional survey among 2 216 Chinese Han adult patients with type 2 diabetes was conducted from October 2014 to January 2015.Random cluster sampling was used to enroll diabetic patients based on the local Chronic Diseases Prevention and Control System data.The survey was preceded by a pilot study in which operational methods were refined and quality assurance evaluation was carried out.Eligible participants underwent a comprehensive eye examination, including the best corrected visual acuity (BCVA) test using the logarithm of the minimum angle resolution charts.Mild vision loss was defined as BCVA <20/32 to ≥20/63 following the International Council of Ophthalmology (ICO) 2002 definitions.The primary causes of visual impairment and blindness were determined.The prevalence and causes of monocular and binocular mild vision loss were investigated.Logistic regression analysis was used to determine the related risk factors of binocular mild vision loss.

Among 2 582 patients, 2 216 were examined, and the response rate was 85.8%.Monocular mild vision loss was found in 591 patients with a prevalence rate of 26.7%.Binocular mild vision loss was detected in 650 patients, with a prevalence rate of 29.3%.Totally 1 891 eyes were confirmed as mild vision loss.Diabetic retinopathy (27.3%, 517/1 891) were the second leading cause of mild vision loss, after cataract (31.3%, 591/1 891). Binocular mild vision loss of unknown reasons happened in 201 persons.Old age, female gender, lower educational level, higher glycosylated hemoglobin A1c level and longer duration of diabetes were associated with the prevalence of total binocular mild vision loss and binocular mild vision loss of unknown reasons.

The prevalence of mild vision loss is higher among adult patients with type 2 diabetes in Beixinjing Community.Intensive glucose control is recommended to prevent and slow mild vision loss in Chinese Han patients with type 2 diabetes.

To systematically determine the effectiveness of Topiramate to counteract atypical antipsychotic-induced body weight gain and metabolic adversities in patients with psychiatric disorders.

A literature search using MEDLINE, EMBASE, PsycINFO, The Cochrane Library, CNKI, CBM and WanFang Data for randomized, open and double-blind, placebo-controlled trials of Topiramate targeting atypical antipsychotic-induced weight gain was performed.Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies.Then meta-analysis was performed using RevMan 5.2 software.

A total of 10 RCTs was included, consisting of 453 subjects. The results of meta-analysis showed that: compared with placebo, Topiramate was moderate effective in reducing antipsychotics-related weight gain (WMD=-1.82 kg (95%CI: -2.65--0.99), P<0.000 1), BMI increase (WMD=-1.31 kg/m² (95%CI: -1.69--0.93), P<0.000 01) and fasting glucose increase (SMD=-1.15 (95%CI: -1.50--0.79), P<0.000 01); but can not regulate the lipid metabolic disorders (Cholesterol: SMD=-0.23 (95%CI: -0.81-0.35), P=0.44); Triglycerides: SMD=-0.28 (95%CI: -0.75-0.19), P=0.24; HDL: SMD= 0.01 (95%CI: -0.52-0.53), P=0.98); LDL: SMD=-0.39 (95%CI: -0.89-0.11), P=0.13). Meanwhile, when compared with placebo, Positive and Negative Syndrome Scale (PANSS) in patients with schizophrenia did not show obviously clinical improvement in concomitant Topiramate group.

Topiramate can prevent and/or treat atypical antipsychotic induced weight gain and glucose disorder, but current evidence does not support the effect of Topiramate in lipid metabolic regulation and the clinical symptoms improvement assessed by PANSS.

A male patient, born in 1986, was admitted to hospital on May 8, 2014 due to "recurrent centripetal obesity with purple lines on full moon face for 9 years". The patient began to have weight gain with full moon face, acne, purple lines, and fatigue without obvious inducement in December 2005. On February 13, 2006, the patient went to hospital A. Blood cortisol was increased, rhythm disappeared, and adrenocorticotropic hormone (ACTH) was increased (Table 1), 24-h urine free cortisol (24-h UFC) 1 206 μ g/24 h (normal reference value: 30.15~129.13 μ g/24 h), high-dose dexamethasone inhibition test (dexamethasone 2 mg, once/6 h ×8 times) showed that 24-h UFC decreased by 53.4% compared with the basal value, and sellar region enhanced MRI (Figure 1) shows "left deviation of the pituitary stem, suspected low-intensity shadow on the right side of the pituitary gland, excluding pituitary microadenoma", and the clinical diagnosis is "Cushing's disease". On March 17, 2006, transnasal sphenoidal pituitary tumor resection was performed. The pathology showed "anterior and posterior pituitary tissue", and the postoperative symptoms did not improve significantly compared with before. On August 31, 2006, the results showed that the circadian rhythm of blood cortisol disappeared and ACTH was within the normal range (Table 1), adrenal CT plain scan showed "left adrenal gland full" (Figure 2)。 Laparoscopic left adrenalectomy was performed on September 30, 2006. The postoperative pathology showed "nodular hyperplasia of left adrenal gland", and the postoperative symptoms improved significantly. In January 2008, centripetal obesity, acne and purple lines appeared again. On September 16, 2008, he went to Hospital C. The blood cortisol rhythm disappeared and ACTH was significantly increased (Table 1), 24 h UFC 1 068.5 μ g/24 h, low-dose dexamethasone inhibition test was not inhibited, 8 mg high-dose dexamethasone inhibition test was not inhibited (decrease 22%), sellar area enhanced MRI showed "postoperative changes of pituitary tumor". Bilateral inferior petrosal sinus venous blood sampling (BIPSS) was performed. The ACTH ratio of peripheral, left and right inferior petrosal sinuses was 70.1/70.6, 74.8/79.5 and 78.1/80.4 pmol/L, respectively<2。 Considering the possibility of "ectopic ACTH syndrome (EAS)", no clear lesion was found in the examination, and oral ketoconazole was given to treat. After 1 week, the hematuria cortisol decreased significantly, and the medication was interrupted for 3 years, during which the weight was controlled. At the end of 2012, he was discontinued due to ketoconazole deficiency, and he again experienced weight gain with acne. At the end of 2013, he started oral bromocriptine treatment, but the efficacy was not good, and he discontinued it voluntarily in February 2014.

A 51-year-old male was admitted to the Department of Nephrology of Guangzhou Red Cross Hospital on July 20, 2011 due to "low back pain, oliguria and shortness of breath for 17 h". From July 4 to 19, 2011, the patient underwent anti-tuberculosis treatment in the local chest hospital due to pulmonary tuberculosis. The regimen was pasniazid tablets 600 mg, once a day; Althioisonicotinamide tablets 200 mg, 3 times/d; Levofloxacin 0.5 g, once/d. On July 19th, at 10 a.m., because the drug sensitivity test showed that rifampicin was sensitive, 450 mg of rifampicin capsules were taken orally. At 11 a.m., dull pain in the waist, accompanied by shortness of breath, fatigue and chills, and then the fever reached 39.4℃. The local hospital considered rifampicin allergic reaction and gave hormone therapy. In the afternoon of the same day, soy sauce-colored urine was discharged with decreased urine output. Blood tests included creatinine 299 μ mol/L (normal reference value: 62-115 μ mol/L), sodium 146 mmol/L (normal reference value: 135-145 mmol/L), potassium 3.8 mmol/L (normal reference value: 3.5-5.5 mmol/L), total carbon dioxide 9.3 mmol/L (normal reference value: 22-28 mmol/L), alanine aminotransferase 48 U/L (normal reference value: 0-45 U/L), aspartate aminotransferase 477 U/L (normal reference value: 0-45 U/L), total bilirubin 73 μ mol/L (normal reference value: 5.1-23.9 μ mol/L), indirect bilirubin 71.4 μ mol/L (normal reference value: 1.7-6.8 μ mol/L), and 400 ml of sodium bicarbonate solution were supplemented. After being transferred to our hospital at 4 o'clock the next morning. He had been suffering from tuberculosis for 2 years and had two stages of anti-tuberculosis treatment in a local chest hospital (both with rifampicin). Deny history of taking lipid-lowering drugs and ethanol. Physical examination at admission: blood pressure 180/110 mmHg (1 mmHg =0.133 kPa), 35 breaths/min, body temperature 38 ℃. Frightened, irritable. The skin and sclera were mildly yellowed, and there were many ecchymosis on the skin all over the body. A large number of dry and wet rales were smelled in both lungs, and the heart rate was 136 beats/min, and the rhythm was uniform. The abdomen was flat and soft, without tenderness and rebound pain, the liver and spleen were not touched under the costs, and there was no percussion pain in the kidney area. There was no edema in both lower limbs and lumbosacral region.

A 22-year-old female was admitted to our department on 11 November 2011 due to "precordial pain with asthma for 1 week". Half a month before admission, the patient was given oral antibiotics in another hospital due to "red eyes and whole body rash". The specific medication was unknown, and the symptoms of eye disease and rash improved. However, after 1 week, the patient developed sharp pain in the precordial area, which was aggravated by deep breathing, accompanied by palpitations, asthma, fever (body temperature unmeasured), nausea and vomiting, no sore throat and no diarrhea. The patient has lost 7 kg in the past month. He has denied a history of infectious diseases such as hepatitis, schistosomiasis and tuberculosis in the past. His boyfriend is in the active stage of syphilis, and the patient has a history of sexual contact with him.

Extracellular vesicles are a kind of vesicle-like structure that is released from cells into the extracellular space and is wrapped by lipid bilayers and contains protein and nucleic acid components. There are many types of extracellular vesicles, which are different in size, density, sedimentation force and specific markers. Press van der Pol et al.^[1]Extracellular vesicles can be roughly classified into three types: exosomes, microvesicles (MV) and apoptotic bodies.

Cushing's disease is a functional pituitary adenoma (PAs) with adrenocorticotropic hormone (ACTH) secretion – pituitary adrenocorticotropic adenoma (ACTH-PAs), accounting for about 14% of all pituitary adenomas and about 70% of Cushing's syndrome^[1,2]。 The incidence rate of this disease is 39/million in European and American countries, and there is still a lack of large-scale epidemiological data in China^[3]。 Early diagnosis of Cushing's disease is very difficult and prone to misdiagnosis. Patients often see a doctor for a variety of serious complications due to hypercortisolemia, such as hypertension, diabetes, hyperlipidemia, osteoporosis and mental depression. In terms of treatment, for the vast majority of Cushing's patients, pituitary adenoma resection through nasosphenoidal approach is still the first choice of clinical treatment. Radiotherapy, pasireotide, ketoconazole and other drugs are often used as adjuvant treatment for refractory Cushing's disease^[4]。 Although the literature reports that the success rate of surgical operation is 65% ~90%, the recurrence rate of tumor is 3% ~47%, the average recurrence time is 16~49 months, and the prognosis of recurrence patients is poor, and the mortality rate is high^[5]。 At present, the pathogenesis of Cushing's disease is not fully understood. In recent years, the molecular level research on Cushing's disease mainly focuses on the occurrence and development of tumors, tumor invasiveness and hormone secretion, etc. This paper will review the current association analysis of genotype and phenotype of Cushing's disease, potential drug targets and other molecular level research as follows.

Brucellosis is a zoonotic infectious disease, which is a systemic, infectious and allergic disease caused by Brucella infection. The incidence of brucellal spondylitis (BS) in brucellosis is 2% to 65%^[1,2,3]It is suppurative inflammation caused by its infection of intervertebral disc and vertebral body tissue. The onset segment is more common in lumbar vertebra, followed by thoracolumbar segment and cervical vertebra. The pathological manifestation is mainly inflammatory changes of intervertebral disc^[3,4]。 Its occurrence has obvious regional characteristics, and the clinical symptoms can be manifested as lumbar back pain and fever^[5,6,7]。 The progress of clinical treatment of BS is reviewed.