Volume 96  ·  Issue 05  ·  2016

Headache and dizziness are common clinical symptoms, which can be single symptoms or may appear in the form of symptom clusters in patients' complaints. Studies have reported that 21% of dizzy patients have symptoms of headache, and 21% of headache patients have descriptions of dizziness. Vision, vestibular sensation and proprioception together maintain the balance of the body and are related to the vestibular pathway, while headache is related to the pain pathway. Therefore, patients with both headache and dizziness are not only the intersection of clinical symptoms, but also related to the interaction between multiple related neural pathways in pathogenesis, involving neurology, otolaryngology, internal medicine, emergency department, psychiatric psychology, imaging department, etc. When vestibular migraine appears in clinical diagnosis as an independent disease concept, many doctors find it both familiar and unfamiliar. In 1917, Boenheim first proposed the concept of vestibular migraine. Since then, patients with both headache and dizziness have been diagnosed with vestibular migraine, migraine-related vertigo, migraine vertigo, or migraine vestibulopathy. In 2012, the International Headache Society and the International Dizziness Society jointly developed and published the diagnostic criteria for vestibular migraine^[1]At the same time, it was included in the appendix of the third edition of the International Classification of Headache Diseases (ICHD-Ⅲ beta) in 2013^[2]。 In recent years, a large number of studies and explorations have sketched the outline of vestibular migraine in terms of concept, pathogenesis, clinical manifestations, signs, laboratory tests, diagnostic criteria and differential diagnosis, treatment and prevention of related diseases. Paying attention to this disease will help to improve the diagnosis and treatment of headache and dizziness-related diseases, avoid generalization, and avoid creating vestibular migraine as another conceptual trash can.

To investigate the clinical characteristics of Parkinson's Disease (PD) patients with constipation and explore the correlation between constipation and motor symptoms.

The demographic data of outpatients with PD in our hospital was collected. According to Rome Ⅲ criteria, we evaluated the status of constipation in PD patients. Unified Parkinson's disease rating scale part Ⅲ (UPDRSⅢ), mini-mental state examination (MMSE) were performed in all the included patients.

Among the 158 recruited PD patients, 96 (60.8%) patients had constipation. Among these patients, 41(42.7%) patients experienced constipation before motor symptoms. Compared to those without constipation, PD patients with constipation had higher axial scores (6.8±3.4 vs 4.3±2.5, t=-4.887, P=0.000) and gait/postural stability scores (3.9±2.4 vs 2.4±1.5, t=-4.529, P=0.000), higher proportion of axial and gait/postural stability scores in UPDRSⅢ (32%±11% vs 25%±12%, t=-3.485, P=0.001; 18%±9% vs 15%±10%, t=-2.278, P=0.024), more rapid progression of axial and gait/postural stability symptoms (P<0.05). However, there were no differences in other sub-scores and progression of motor symptoms between the two groups (P>0.05). The PD patients with constipation preceding motor symptoms had higher proportion of axial and gait/postural stability scores in UPDRSⅢ (35%±11% vs 30%±10%,t=2.167, P=0.033; 21%±9% vs 16%±8%, t=2.733, P=0.008), indicating these patients may progress more rapidly, meanwhile, they had later onset age, shorter disease duration (P<0.05). Unconditioned Logistic regression showed that axial score was major influencing factor of constipation in PD patients (P=0.000, OR=1.330).

PD patients with constipation have severer axial symptoms, indicating the progression of these patients is relatively rapid, especially those with constipation preceding motor symptoms. It is suggested that axial symptoms and constipation are acted as interactional factors in PD.

To qualitatively and quantitatively compare MSI images and WB images derived from spectral CT imaging with CU images in accessing gastric carcinoma.

The clinical data and imaging findings of 91 cases of gastric carcinomas between December 2013 and May 2015 were analyzed retrospectively. All patients underwent CU CT and enhanced CT with spectral imaging in AP and VP. MSI images were reconstructed based on monochromatic images of 70 keV in AP. WB images were obtained by water-iodine pair substance isolation of the AP images. Two abdominal radiologists independently evaluated the image quality and the depiction of gastric carcinoma in CU, MSI and WB images using a 5-point scale. The sensitivities of gastric cancer were evaluated by using enhanced images as the reference standard.The CT number of various regions, image noise, relative enhancement CT value of tumors and metastasis were measured and calculated on CU and MSI images. The CNR of gastric tumor were measured on CU, MSI and WB images. Effective radiation doses for triple-phase and dual-phase scan were calculated. Differences were tested for statistical significance using the Wilcoxon's signed rank test and the pairedt-test.

Interobserver agreement with regard to image quality and the depiction of gastric carcinoma was good(all kappa>0.70). There was no statistical significant difference in image quality between CU(4.30±0.63) and MSI(4.17±0.58) images(P>0.05), both higher than WB(3.87±0.84) images (bothP<0.01). The depiction of gastric carcinoma in CU(3.86±0.50) and MSI(3.73±0.55) images had no statistical significant difference (P>0.05), and both higher than WB(3.34±0.38) images( bothP<0.01). The sensitivities of CU, MSI and WB images were 91.2%, 95.6%, 93.4%. The CT number of gastric tumors, liver metastasis and aorta, image noise on MSI images were slightly higher than on TNE images(P<0.05). The CT number of gastric tumors, liver metastasis and aorta, image noise on MSI images were slightly higher than on TNE images(P<0.05). The CT number of lymph nodes, liver and muscle, CT relative enhancement value of gastric tumors, lymph nodes and liver metastasis had no significant difference between TNE and MSI images (allP>0.05). The CNR of gastric tumors had significant difference between groups: WB images were higher than MSI and MSI were higher than CU images(allP<0.01). The dose saving by removing the CU was 8.2 mSv(32%).

The MSI images derived from spectral CT can provide comparable image quality to CU images and reliable diagnostic information for gastric tumors, which is superior to WB images, replacing CU images will lower radiation exposure by 32%.

To investigate the functional connectivity (FC) impairments within anterior and posterior default mode networks (aDMN and pDMN) for cirrhosis with minimal hepatic encephalopathy (MHE), and to analyze relationship between DMNs alterations with neurocognitive impairments.

From March 2009 to December 2011, a total of 43 cirrhotic patients without MHE (NMHE groups), 32 cirrhotic patients with current MHE (MHE groups), and 21 healthy controls were recruited in this study. All resting-state fMRI datasets were preprocessed and normalized into standard brain space. Two universal templates for aDMN and pDMN were applied to generate spatial patterns for aDMN and pDMN for each participate by dual regression. One sample t test were analyzed within groups, and one way ANOVA (analysis of variance) were performed to calculate the different FCs within aDMN and pDMN among groups. Additional correlation analysis was performed between different FCs within two DMNs and behavior scores.

Within aDMN, FC of MHE patients were significantly deceased than controls and NMHE groups in right superior frontal gyrus (SFG)/ bilateral medial frontal gyrus (MFG); while within pDMN, FC of MHE patients were significantly increased than controls and NMHE groups in right superior temporal gyrus (STG)/ middle temporal gyrus (MTG) and left cuneus/ bilateral calcarine gyri (one way ANOVA, P<0.01, cluster sizes>40, AlphaSim correction). The FC alterations in those region were significantly correlated with neurocognitive test scores (Pearson correlation coefficient, P<0.05).

Dual regression based aDMN and pDMN method was firstly applied to investigated functional connectivity impairments in MHE patients' brain. Functional deficits were endogenous within aDMN, while functional connectivity was compensatory enhancements within pDMN. These compensatory enhancements indicated that patients with current MHE had the potential to additionally recruit more neurological resource to accomplish the specific actions. Therefore, the alterations of dual regression based aDMN and pDMN can be potential neuroimaging biomarkers for MHE studies.

To establish the gestational age-specific reference ranges for thyroid-related indicators of pregnant women in our hospital, especially for serum thyroid stimulating hormone (TSH) in the first trimester.

A total of 548 pregnant women in the first trimester were collected in Peking University First Hospital from June 2013 to April 2014. Among them, 254 pregnant women with single fetus who conformed to the National Academy of Clinical Biochemistry criteria, without adverse pregnancy outcomes and obstetric complications, were enrolled in the current study. To establish their own self-sequential longitudinal reference intervals, serum TSH, total thyroxine (TT₄) and free thyroxine (FT₄) levels were measured using Siemens detection kits during three different trimesters. Urine iodine (UI) was measured using digestion instrument in some of the pregnant women.

The gestational age-specific reference ranges for thyroid-related indicators of pregnant women in our hospital were as follows: in the first trimester: TSH 0.23-4.08 mU/L, TT₄ 92.59-186.25 nmol/L, FT₄ 13.36-20.81 pmol/L; in the second trimester: TSH 0.78-4.25 mU/L, TT₄ 103.20-180.95 nmol/L, FT₄ 11.57-16.62 pmol/L; in the third trimester: TSH 0.65-4.52 mU/L, TT₄ 78.20-174.70 nmol/L, FT₄ 10.01-20.57 pmol/L. The median level of TSH during 7 to 12 weeks of gestational age was lower than that of 4 to 6 weeks, but with no significant statistical difference (P=0.063). The medians of UI during three trimesters of pregnancy were 211.60 μg/L, 195.55 μg/L and 198.65 μg/L, respectively, which were all classified as adequate iodine status.

The gestational age-specific reference ranges for thyroid-related indicators are different from the kits' reference ranges, which are also different among the three trimesters. It may be more reasonable to establish different reference ranges for thyroid-related indicators at 4 to 6 weeks and 7 to 12 weeks in the first trimester separately.

To study the method of internal fixation by the navigation embedded plate from standard parts database for the distal femoral fractures based on digital design by Mimics software with 3D printing technology, and to explore its feasibility and accuracy.

A total of 21 cases with distal femoral fractures admitted into the Department of Orthopedics, Affiliated Hospital of Putian University were included in this study. Dicom format data of lamellar CT scanning was imported into Mimics software for 3D anatomical modeling and virtual fracture reduction. The steel plates was chose from standard parts database for virtual internal fixation, and to design the navigation module with screw. 3D printing skeleton, steel plates, navigation module, internal fixation implants were simulated based on the printed bones model. Locations of steel plates and screws were determined by the navigation module. Then the sticking effects of navigation module, screws position and postoperative appearance were observed. After second CT scan and 3D reconstruction, 3D registration was performed to obtain the data of the three-dimensional coordinate values of screws entrance points and piercing points to analyze the results.

A total of 21 plates and 180 screws were placed with the assistance of navigation module. CT scanning and 3D reconstruction was performed in twenty-one cases of postoperative bone model. The position of plates was in high accordance with the digital design by Mimics software. There were no significant differences between spatial location of screw entrance points and piercing points. The real operation was quite consistent with preoperative design. Navigation module and the corresponding distal femur bony structure jointed closely. The sticking effects and stability of navigation module were good, which was able to guide placement of steel plates and screws.

These methods can enhance the accuracy of internal fixation of the standard parts database steel plate in distal femur fractures, with the assistance of navigation module.

To investigate the relationship of pre-operative clinical related factors with the outcome of surgical treatment in patients with Hirayama disease.

A total of 46 consecutive patients with Hirayama disease treated by anterior cervical discectomy decompression and fusion in Peking University Third Hospital from October 2006 to January 2014 were reviewed retrospectively. Odom's criteria was used to evaluate the subjective outcome of surgical treatment. Five pre-operative factors were collected including duration of disease at the time of treatment, age of onset, extremity involvement, gross hand function score and fine hand function score. The correlation between these five clinical related factors and postoperative outcome was evaluated with Logistic regression. The receiver operating characteristic (ROC) curve and area under the ROC curve were used to evaluate the significant result of Logistic regression and the optimal diagnostic value.

A total of 40 in 46 (87.0%) patients with complete clinical and radiographic follow-up data were included in this study. The mean follow-up period was 48.6 months (12-98 months). All patients were male. The outcome at the final follow-up according to Odom's criteria was: Excellent 5 cases, Good 21 cases, Fair 14 cases and no Poor case. Only two pre-operative factors, age of onset and gross hand function score, showed statistical correlation with the post-operative outcome assessment by Logistic regression. ROC analysis showed that the area under the ROC curve of age of onset and gross hand function score were 0.790 and 0.793 respectively. The optimal predictive threshold was 15.5 years old and 5.5 points respectively.

Age of onset and gross hand function score were two pre-operative factors correlated with the post-operative outcome. These two factors could be used to predict the outcome of surgical treatment of Hirayama disease preoperatively.

To investigate the incidence of bone marrow edema in sacroiliac joint under examination of magnetic resonance imaging (MRI) in patients with axial spondyloarthropathy (SpA) in remission.

A total of 87 patients with axial SpA were recruited. Disease activity was assessed by calculation of BASDAI and ASDAScrp scores. All the SpA patients completed MRI scan of sacroiliac joint and bone marrow edema in sacroiliac joint was quantized by SPARCC scoring standard.

According to BASDAI standard (n=87), 60 patients (69.0%) were categorized as remission, of which 40 patients (66.7%) exhibited bone marrow edema in sacroiliac joint (SPARCC>0). 27 patients (31.0%) were categorized as activity, while 23 patients (85.2%) exhibited bone marrow edema in sacroiliac joint (SPARCC>0). According to ASDAScrp standard (n=75), 12 patients (16.0%) were classified as remission, of which 4 patients (33.3%) exhibited bone marrow edema in sacroiliac joint (SPARCC>0). 63 patients (31.0%) were categorized as activity, while 52 patients (82.5%) exhibited bone marrow edema in sacroiliac joint (SPARCC>0). SPARCC score positively correlated with BASDAI (r=0.271, P<0.05), ASDAScrp (r=0.291, P=0.011) and patient global assessment (r=0.414, P<0.01). All the patients were classified as non-regular treatment group, traditional drugs group, and biologics group based on the therapeutic conditions. Percentages of patients with SPARCC>0 in sacroiliac joint were also different among these groups (86.8%, 75.0%, 31.6%, χ²=21.483, P<0.01).

About 1/3 to 2/3 axial SpA patients in clinical remission represent bone marrow edema in sacroiliac joint under MRI examination, which indicates presence of subclinical inflammation in axial SpA with clinical remission. SpA patients treated with biologics could have better remission of radiographic inflammation on MRI.

To observe the expression of granulocyte colony-stimulating factor (G-CSF) in cervical cancer and to investigate its clinical significance.

A total of 53 cases of cervical cancer with a large number of granular cell infiltration were collected in the last ten years, and 57 cases of cervical cancer with no cell infiltration were selected as controls. The infiltration of neutrophils in cancer tissues was observed, and the expression of G-CSF in cancer tissue was detected by immunohistochemistry at the same time. And the relationship between the expression of G-CSF and clinical pathological significance in cervical cancer was analyzed. All the patients were followed up, and the effect of G-CSF on the prognosis of the patients was analyzed.

Expression of G-CSF was observed in 53 cases out of the 110 cases cervical cancer. Among them, 48 (90.6%) cases were squamous cell carcinoma, 5(9.4%) cases were adenocarcinoma. The expression of G-CSF was closely related to granulocyte infiltration, histological type, necrosis, high grading and regional lymph node metastasis (P<0.01), but not related to size of tumor (P>0.05). G-CSF positive cases were 33.676 and 78.495 times more dangerous than those cases that were negative in high grading and regional lymph node metastasis (P<0.01). The difference in survival between the positive and the negative was also significant (P<0.01).

Certain cervical cancer can produce G-CSF, and the most common in non-keratinizing squamous cell carcinoma. Cervical cancer tissue that excretes G-CSF tends to have low differentiation, obvious dysplasia, high degree of malignancy, extensive necrosis and granulocyte cell infiltration, and is often associated with lymph node metastasis, with low survival rate and poor prognosis.

To explore the clinical features and microsurgical treatment strategies of giant intracranial arteriovenous malformations (AVM).

A total of 15 cases of giant intracranial AVM treated with microsurgery were analyzed retrospectively. According to the Spetzler-Martin grade, there were 4 cases of grade Ⅳ, 11 cases of grade Ⅴ. Pre-operative endovascular embolizations were carried out in 3 AVMs.

All the included patients were confirmed as giant intracranial AVM by magnetic resonance angiography (MRA), digital subtraction angiography (DSA), 3-dimensional CT angiography (3D-CTA) before surgery. All the resected tissues were sent for pathological examination, and the diagnoses were confirmed as AVM. The average operation time of the 15 patients was 10.3 ±6.9 hours. After 1-3 months, all the patients were rechecked by DSA, the large vascular malformations in 12 cases were completely resected, 3 cases had a small amount of residual further treated with gamma knife treatment. Magnetic resonance imaging (MRI) and MRA examination indicated that the residual AVM was occluded after 12 months. Patients were followed up at 6, 12 and 24 months after operation, and assessed by Glasgow outcome scale (GOS) score: 13 cases good, 1 cases mild disability, 1 cases severe disability; the good rate was 86.6%, with no dead case.

Sufficiently preoperative preparation, appropriate operative methods and skills are necessary to treat giant intracranial arteriovenous malformation.

To investigate the pathological characteristic of gastrocnemius (GM) and quantitatively assess GM tissue stiffness in spinal cord injury (SCI) rat models; to explore the novel method in evaluation of GM stiffness.

A total of 54 SD male rats (weight 260-280 g) were allocated into normal control group (0 w) and model groups (2, 4, 8 and 12 w) in this study. Complete SCI (T10 level) was applied in model groups. At the above different time points, Modified Ashworth Scale (MAS) was used to assess the GM spasticity; Basso, Beattie, and Bresnahan Locomotor Rating Scale (BBB) was used to assess the movement ability of lower limb. GM stiffness was assessed with shear wave sonoelastography technology in these groups. All GM at right side of rats was further checked by pathological examinations (muscle weight, ATP staining, myosin heavy chain (MyHC) electrophoretic analysis) after sonoelastography imaging examinations.

After removing the overweight and underweight rat models which were alive, six rats were included in each group. There were some pathologic changes in GM in SCI rat models. Compared with normal control group, data from model groups showed ankle dorsiflexors MAS (1.5±0.8-0.8±0.7 score) was increased (P≤0.05), BBB scores of lower limb (3.2±1.0-7.2±1.3score) were decreased (P≤0.05). The GM elastic modulus was increased at dorsiflexion location in model group (25.1±2.4-37.4±5.5 kPa, P≤0.05); GM weights were decreased, ratio of type Ⅰ fibers was decreased and ratio of type Ⅱ fibers was increased in GM. Compared with normal control group, MyHC-Ⅰ was decreased, while MyHC-Ⅱ was increased according electrophoretic analysis.

Both pathological characteristic and muscle stiffness of GM change after SCI. Shear-wave sonoelastography technology can be used to assess the GM stiffness in SCI rat models.

To obtain the recombinant herpes simplex virus 1 (HSV-1) inserted p53 gene with homologous recombination technology and investigate the virus' replication ability and oncolytic propertyin vitro and in vivo.

A eukaryotic expression case with p53 gene was cloned into pKO5/BN. The pKO5/p53 was constructed and transfected to the E. coli with pHSV_ΔIR-BAC by electroporation. Then the recombinant pHSV_ΔIR-BAC/p53 was obtained and transfected into Vero cells. Recombinant virus (MH1004) was identified by Southern blot and Western blot. Then the virus' replication abilities in several human tumors cells were tested by plaque assay. A murine melanoma model was established by subcutaneous inoculation of B16 cells. A dosage of 2×10⁶ PFU (plaque forming unit) of MH1004, MH1001, HSV-1 wt or PBS was injected 3 times intratumorally in every 3 days. The tumor volume and survival rate were measured twice a week.

The results of Western blot showed that the p53 protein can be detected from the Vero cells infected by MH1004. The replication abilities of MH1004 and HSV-1 wt in the same tumor cell was insignificant (P>0.05). And MH1004's replication abilities in SK-N-SH and U251 was significantly higher than other cancer cells. The tumors volume of group HSV-1 wt, MH1001(HSV_ΔIR)and MH1004 were (6 180±751), (5 760±267) and (4 850±532) mm³ compared with PBS group (9 860±91) mm^3, the difference of reduction of tumors volume was significant (P< 0.01). And the tumors volume of MH1004 group was smaller than HSV-1 wt and MH1001 group, but without significant difference (P>0.05). And the survival rate of MH1004 treated mice (5/6) was greatly higher than PBS (3/6), HSV-1 wt (3/6) and MH1001 (3/6).

The replication abilities of MH1004 in neural tumor are very high and MH1004 can inhibit the growth of tumor so that prolong the survival of mice bearing murine melanoma.

To investigate the expression and significance of AKT/mTOR signaling pathway in natural degeneration in vitro model of rat endplate chondrocytes.

Rat endplate chondrocytes were isolated and cultured, and the natural degeneration in vitro model of rat endplate chondrocytes was established. The endplate chondrocytes were divided into blank control group (P2 cells), natural degeneration passage group (P5 cells), AKT/mTOR signaling pathway inhibitor group (P5 cells), AKT/mTOR signaling pathway agonist group (P5 cells). The endplate chondrocyte morphology changes were observed under inverted microscope; Toluidine blue staining was used to detect the expression changes of proteoglycans in endplate chondrocytes; Western blot was used to detect the expression changes of AKT and P-AKT; real-time polymerase chain reaction was used to detect the expression of type Ⅱ collagen, proteoglycan, SOX9 and the key gene of AKT/mTOR signaling pathway, mTOR gene.

With in vitro passage of rat endplate chondrocytes, phenotypes of rat endplate chondrocytes gradually reduced or even lost; the type Ⅱ collagen (P5/P2=0.28, P=0.042 7), proteoglycan (P5/P2=0.33, P=0.026 3), SOX9 (P5/P2=0.40, P=0.018 2) and mTOR (P5/P2=0.28, P=0.038 1) expression were significantly reduced in natural degeneration passage group; in AKT/mTOR signaling pathway inhibitor group: type Ⅱ collagen (P5/P2=0.19, P=0.034 7), proteoglycan (P5/P2=0.25, P=0.023), SOX9 (P5/P2=0.31, P=0.034 2) and mTOR (P5/P2=0.20, P=0.024 1) expression were decreased compared with natural passage group; in AKT/mTOR signaling pathway agonist group: type Ⅱ collagen (P5/P2=0.41, P=0.044 1), proteoglycan (P5/P2=0.53, P=0.015 1), SOX9 (P5/P2=0.61, P=0.019 7) and mTOR (P5/P2=0.41, P=0.038 1) expression were increased compared with natural passage group and inhibitor group.

AKT/mTOR signaling pathway may play an important role in the degenerative process of rat endplate chondrocytes in vitro, artificial control or intervention of AKT/mTOR signaling pathway may accelerate, inhibit or slow the degeneration of endplate cartilage of rats.

To investigate the effects of GABA_B receptor on cognitive impairment by using pilocarpine induced kindled rats model and also to check early gene (Arc/Arg3.1) expression.

Pilocarpine induced kindled rats were divided into four groups (Group normal, Baclofen, CGP and Kindled) randomly, and every group included 20 rats.We checked their cognitive impairment by using passive avoidance test and water maze test.The expression of GABA_B receptor (GB₁, GB₂) and Arc/Arg3.1 was tested by immunohistochemical staining, RT-PCR and Western blot.

Passive avoidance test showed four Group rats shuttle times were 6.8±0.6, 1.2±0.2, 5.4±0.5, 3.6±0.3, incubation period were 26.1±3.9, 152.2±12.9, 65.8±7.0, 91.2±9.1, and water maze test had the same trend, with values in epilepsy groups significantly lower than the normal group of rats, which meant cognitive dysfunction.The above results also showed Baclofen further inhibited the learning and memory ability of the rats and CGP35348 promoted the learning and memory ability.The results of the Arc/Arg3.1 and GB₁, GB₂ level detection showed that epilepsy groups had significantly higher expression levels of Arc/Arg3.1 and GB₁, GB₂ than the normal group.Comparison among epilepsy groups showed that Baclofen group expressed lower levels of Arc/Arg3.1 and expressed higher levels of GB₁, GB₂, however CGP35348 group expressed higher levels of Arc/Arg3.1 and expressed lower levels of GB₁, GB₂.

GABA_B receptor can affect the ability of spatial learning and memory of epileptic rats by regulating Arc/Arg3.1.

To explore the technique of hearing reconstruction in the cases of conductive hearing loss with malformed tympanic segment of facial nerve.

Data of 10 cases from July 2010 to March 2015 were collected.The status of tympanic segment of facial nerve, malformed ossicles and the reconstructed methods of ossicular chain were analyzed and discussed based on the embryo anatomy and surgical technique.

All facial nerves in 10 cases were exposed and drooping to stapes or cover the oval window.Three patients who had normal stapes, pushed by the exposed facial nerve, were reconstructed with partial ossicular replacement prostheses (PORP). Two patients who had footplate, with partial fixation, were reconstructed with total ossicular replacement prostheses (TORP). Three patients who had atresia of the oval window were implanted with Piston after being made hole in the atresia plate.Another two cases who had atresia of the oval window were implanted with TORP after promontory being drilled out.All cases had no injury of facial nerve and nervous hearing, and no tinnitus.Nine cases had conductive hearing improvement, except one with promontory drilled out.

Patients who had conductive hearing loss with malformed tympanic segment of facial nerve can be treated by the technique of hearing reconstruction.The fenestration technique in the bottom of the scala tympani of the basal turn provides us a new method for treating patients whose oval window was fully covered by malformed facial nerve.

A 55-year-old female was admitted to the hospital on 5 March 2007 due to persistent pain in the right lower abdomen for 3 months. Physical examination: body temperature 36.8 ℃, 20 breaths/min, 80 pulses/min, blood pressure 141/86 mmHg (1 mmHg =0.133 kPa). There is no cyanosis of the lips and no distension of the jugular veins. The appearance of the thorax was normal, and the breathing sounds of both lungs were clear. The heart rate was 80 beats/min, and the heart rhythm was uniform. Tenderness in the right lower abdomen, with a palpable mass about 3 cm ×4 cm in size. Past history: In December 2006, the patient underwent hysterectomy and right ovariectomy for uterine leiomyoma and right ovarian cyst.

A 30-year-old female was admitted to the hospital due to "involuntary motion of lips and limbs for 2 years, aggravated for more than 3 months". The patient had involuntary movement of lips and limbs without obvious inducement 2 years ago, which was obvious when he was awake and disappeared after falling asleep; Three months ago, the patient's symptoms worsened, he bit his lower lip, pushed the food out when eating, and had slurred speech with unstable walking. The local hospital diagnosed "dystonia? Obsessive-compulsive disorder?", and after treatment with "clonazepam" and "paroxetine", the improvement was poor, so he went to the Second Affiliated Hospital of Zhejiang University School of Medicine for treatment. Since the onset of the disease, the patient has lost about 10 kg of body weight. History of denial of toxic exposure. Parents are married by close relatives (cousins), and there is one brother who is healthy. Physical examination: emaciated body type, negative corneal K-F ring, thinning and ulceration of lower lip, partial defect, salivation (Figure 1), involuntary perioral movement, poor oral speech, still relevant answers, weakened bilateral pharyngeal reflex, reduced muscle tone of limbs, muscle strength grade 5, involuntary movement of limbs, stable and accurate finger-nose test, positive counterattack sign of both upper limbs, positive pull-back test, poor coordination during walking, weakened bilateral biceps tendon reflex, undrawn residual tendon reflex, and negative bilateral pathological signs.

A 35-year-old female began to have shortness of breath, cough and expectoration after activity in January 2013 (more than 7 months of pregnancy at this time), which was white foamy sputum without blood in sputum, and intermittent edema of the face and both lower limbs. Cesarean section was performed on March 23, 2013. The postoperative symptoms were not significantly relieved, and the cough was worse than before. On April 3, 2013, he was admitted to the Department of Cardiology of Xiangya Hospital of Central South University due to "shortness of breath for 3 months after activity". Physical examination: body temperature 36.4℃, heart rate 81 beats/min, blood pressure 110/68 mmHg (1 mm Hg =0.133 kPa), multiple needle-like bleeding spots on both arms, coarse breathing sounds in both lungs, a few wet rales, uniform heart rhythm and P2 hyperactivity. WBC 3.9×10⁹/L, red blood cells 3.86×10¹²/L, platelets 319×10⁹/L. Liver and kidney function was normal. Cardiac color ultrasound: cardiac function ejection fraction (EF) 33%, stroke volume (SV) 50 ml, cardiac output (CO) 3.40 L/min (Simpson). The whole heart was enlarged, the right heart chamber was more obvious, the pulmonary artery and its branches were obviously widened, and the inner diameter of the ascending aorta was normal. Color Doppler flow diagram (CDFI): aortic blood flow Vmax 0.69 m/s, pulmonary blood flow Vmax 0.49 m/s, blue regurgitation beam reaching the middle of the atrium during mitral and tricuspid systole, Vmax 2.47 and 2.85 m/s, respectively; The pulmonary systolic pressure was estimated to be approximately 42 mmHg based on the maximum tricuspid regurgitation velocity. Conclusion Whole heart enlargement, moderate mitral and tricuspid valve regurgitation, pulmonary hypertension (moderate), moderate decrease in left ventricular systolic function and normal diastolic function. The systolic, diastolic and mean arterial pressures of the main pulmonary arteries were 64, 33 and 47 mmHg, respectively. Right ventricular systolic, diastolic and mean arterial pressures were 65, 9 and 12 mmHg, respectively. Conclusion: Pulmonary artery pressure, right ventricular pressure, pulmonary arteriolar resistance and whole pulmonary resistance were increased. Comprehensive analysis showed that the clinical diagnosis was "perinatal cardiomyopathy". After about 1 week of treatment with nifedipine to reduce blood pressure, anti-heart failure and prevent thrombosis, the patient's symptoms did not improve significantly.

Acute coronary syndrome (ACS) is a common acute and severe cardiovascular disease. Previous studies suggest that the incidence of abnormal glucose metabolism after admission in ACS patients is at a high level, and suggest that admission hyperglycemia (AH) has an adverse effect on the prognosis of patients. However, there are still controversies regarding the related prognosis and treatment options. This article aims to review the study of ACS patients complicated with AH.

Pelvic organ prolapse (POP) is a common disease that seriously affects middle-aged and elderly women. The causes of its pathogenesis are complex, and genetic factors have been paid more and more attention in recent years. Based on the methods of genome-wide association study, linkage analysis and case-control candidate gene association study, especially for susceptible populations, to explore the influence pathways of genetic factors in POP induction, it has been found that collagen-related genes (COL1A1、COL3A1), elastin-related gene (LAMC1), extracellular matrix-related genes (LOX、MMPs、TIMPs), estrogen related genes (ER α、ER β) and other gene loci are associated with the occurrence of POP. It is now reviewed as follows.