Volume 96  ·  Issue 07  ·  2016

It is the purpose of clinical guidelines to standardize the clinical medical behavior of medical staff and provide them with information that keeps pace with the times and guides clinical work. The premise of individualized treatment or precision medicine is also to innovate and develop on the basis of the consensus of doctors. Therefore, the compilation of guidelines must be based on the principles of evidence-based medicine, evaluate the advantages and disadvantages of relevant diagnosis and treatment methods, form recommendations and guide clinical practice.

Alzheimer's disease (AD) is the most common senile dementia. It is a primary neurodegenerative disease that occurs in old age and pre-old age. Its clinical manifestations are continuous deterioration of memory and cognitive function, progressive decline of daily life ability, and various neurological and psychiatric symptoms and behavioral disorders. mild cognitive impairment (MCI) is considered to be a high-risk state before AD. With the prolongation of human life and the aging of the population, the prevalence of AD has also increased significantly: the latest WHO report shows that there were more than 35 million patients worldwide in 2015, and it is expected to double by 2030. By 2050, 115 million people will be sick worldwide^[1]。 The prevalence rate of AD among people aged 60-69 in China is 2.30%, 70-79 is 3.97%, and over 80 is 32.00%. In 2010, the number of AD patients in China reached 5.69 million, ranking first in the world^[2]。 The most prominent pathological features in the brain of AD patients are senile plaques and neuronal fibrous tangles. The main component of senile plaques is beta-amyloid peptide (A β), while neuronal fibrous tangles are composed of hyperphosphorylated tau protein in cells. The above-mentioned pathological changes mainly involve the internal temporal lobe in the early stage, which manifests as memory impairment. As the disease progresses, the neocortex of the brain is involved, and symptoms of dementia appear. In recent years, the occipital lobe involvement of the brain and the accompanying visual symptoms have been paid more and more attention.

Glioma refers to a tumor originating from glial cells, which is the most common primary intracranial tumor. WHO Central Nervous System Tumor Classification classifies glioma into WHO grades Ⅰ ~ Ⅳ, grades Ⅰ and Ⅱ are low-grade glioma, and grades Ⅲ and Ⅳ are high-grade glioma^[1]。 This guideline mainly deals with the diagnosis and treatment of low-grade glioma, high-grade glioma, cerebral gliomatosis and ependymoma.

In the United States and other developed countries, the incidence and mortality of cardiovascular disease has decreased significantly over the past 40 years. This is related to the effective control of cardiovascular risk factors, the improvement of treatment strategies, the application of non-invasive cardiovascular imaging, etc. In particular, cardiovascular CT imaging is gradually developing towards the direction of accurate diagnosis and fine stratification of risk degree of high-risk groups of cardiovascular diseases, which has replaced some traditional examination methods with greater risk or low diagnostic accuracy. The prevalence of cardiovascular diseases in China is on the rise. This inevitably leads to the increasing use of cardiovascular CT, and the resulting ionizing radiation damage becomes a major concern. Although there is currently no direct evidence that radiation damage by CT can lead to malignancy, even small doses of ionizing radiation may be carcinogenic risk based on the idea of linear non-threshold. Therefore, the principle of as low as reasonably achievable (ALARA), which requires adequate diagnostic image quality and diagnostic accuracy at the lowest possible radiation dose, is generally accepted^[1,2,3,4]。

To explore the characteristics of ecological executive function in school-aged children with idiopathic or probably symptomatic epilepsy and examine the effects of executive function on social adaptive function.

A total of 51 school-aged children with idiopathic or probably symptomatic epilepsy aged 5-12 years at our hospital and 37 normal ones of the same gender, age and educational level were included.The differences in ecological executive function and social adaptive function were compared between the two groups with the Behavior Rating Inventory of Executive Function (BRIEF) and Child Adaptive Behavior Scale, the Pearson's correlation test and multiple stepwise linear regression were used to explore the impact of executive function on social adaptive function.

The scores of school-aged children with idiopathic or probably symptomatic epilepsy in global executive composite (GEC), behavioral regulation index (BRI) and metacognition index (MI) of BRIEF ((62±12), (58±13) and (63±12), respectively) were significantly higher than those of the control group ((47±7), (44±6) and (48±8), respectively))(P<0.01). The scores of school-aged children with idiopathic or probably symptomatic epilepsy in adaptive behavior quotient (ADQ), independence, cognition, self-control ((86±22), (32±17), (49±14), (41±16), respectively) were significantly lower than those of the control group ((120±12), (59±14), (59±7) and (68±10), respectively))(P<0.01). Pearson's correlation test showed that the scores of BRIEF, such as GEC, BRI, MI, inhibition, emotional control, monitoring, initiation and working memory had significantly negative correlations with the score of ADQ, independence, self-control ((r=-0.313--0.741, P<0.05)). Also, GEC, inhibition, MI, initiation, working memory, plan, organization and monitoring had significantly negative correlations with the score of cognition ((r=-0.335--0.437, P<0.05)); Multiple stepwise linear regression analysis showed that BRI, inhibition and working memory were closely related with the social adaptive function of school-aged children with idiopathic or probably symptomatic epilepsy.

School-aged children with idiopathic or probably symptomatic epilepsy may have significantly ecological executive function impairment and social adaptive function reduction.The aspects of BRI, inhibition and working memory in ecological executive function are significantly related with social adaptive function in school-aged children with epilepsy.

To study apoptosis and expression of Caspase 3 and Caspase 4 in temporal lobe neurocytes of refractory human temporal lobe epilepsy (TLE).

The temporal tissue samples were obtained from 30 cases of refractory TLE (TLE group) and 10 cases of brain trauma (contrast group) between January 1993 and May 2008. The surgical specimens were paraffin-embedded samples from Department of Pathology of Fujian Medical University and Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University. S-P staining of immunohistochemistry was used to detect the expression of Caspase 3 and Caspase 4 in temporal lobe neurocytes of TLE group and contrast group. Their expression was then analyzed. The terminal deoxynucleoitidyl transferase-mediated dUTP nick end labeling (TUNEL) staining was performed to visualize and analyze the neurocytes' apoptosis of two groups.

The expression of Caspase 3 and Caspase 4 in neurocytes of TLE group were both higher than that of contrast group (t=12.905, P<0.01;t=11.880, P<0.01). The apoptotic index (AI) of neurocytes in TLE group also increased than that of contrast group (t=9.664, P<0.01).

Caspase 3 and Caspase 4 may mediate neurocytes apoptosis in temporal lobe tissue of refractory human TLE.

To explore the effects of posterior decompression and internal fixation for spinal metastases epidural spinal cord compression (MESCC) and analyze the related factors of postoperative ambulation function.

Clinical data of 67 cases with MESCC who received thoracic posterior decompression and internal fixation in our department from January 2006 to December 2014 was retrospectively analyzed.Information about patients' age, gender, pathological type of primary tumor, Karnofsky performance status (KPS) score, pre-operative and postoperative visual analogue scale, preoperative Frankel grade, pre-operative and postoperative imaging characteristics (number of thoracic vertebrae metastases, location, compression fractures of vertebral bodies), time of movement dysfunction and survival was collected.

At the end of the follow-up of 67 cases, 57 cases were dead, 10 cases were alive, and the median survival was 8.1 months (1.2-91.9 months).38 cases (67%) died within one year, 50 cases (88%) died within two years.Visual analogue scale of preoperative and postoperative dropped from (5.67±1.67) points to (2.11±1.39) points (P<0.001), 38 (53%) patients' Frankel grade improved at least one grade.Among the 34 cases who were unable to walk, 15 cases regained ability of ambulation after surgery. The patients with KPS scores greater than 80 points and/or had preoperative ambulation ability, tended to have better postoperative ambulatory function.

Posterior decompression and internal fixation for MESCC is effective, and can effectively relieve pain and spinal cord compression, improve neurological function and the quality of life.The ambulatory functional outcomes after surgery are dependent on KPS scores, the occurrence time of neurological dysfunction, preoperative ambulatory status.

To investigate the functional brain pain center and default mode network response to electro acupuncture stimulate in weizhong acupoints(BL40) and dachangshu acupoints(BL25).

During January to February 2015, volunteers were enrolled in this study from the staff and student interns of Gansu Province Traditional Chinese Medicine Hospital.A total of 20 healthy, right-handed subjects, male 9, female 11, age (23±3) years, participated in this study. Block design task functional magnetic resonance imaging(fMRI) 3.0 T was performed in all subjects by electro acupuncture stimulating at BL40 and BL25 from the same experienced acupuncturist.The needle connected electric acupuncture apparatus through tow long coaxial-cable.A block design with five 120 s blocks of rest time (OFF block, electric acupuncture turn off ) interspersed between five 60 s blocks of stimulation (ON block, electric acupuncture turn on) fMRI scan.Magnetic resonance data of brain function was collected and FSL(fMRI Software Library) software was used to analyze the data.

All subjects' data were analyzed except 2 cases whose head movement were more than 2 mm.Activated brain function regions by electro acupuncture stimulate included temporal lobe lateral sulcus, lobus insularis, thalamus, supramarginal gyrus, prefrontal medial frontal gyrus.Negative activated brain regions included middle frontal gyrus, parahippocampal gyrus, cingulate cortex abdominal segment, parietal cortex.The functional pain central and default mode network were changed when electro acupuncture stimulate in(BL40) and(BL25).

There are several brain activation regions and negative activated brain regions when administering electro acupuncture stimulation at BL40 and BL25.

To evaluate the efficacy of tigecycline for treatment of ventilator-associated pneumonia in critically ill elderly patients.

Data of critically ill elderly patients with ventilator-associated pneumonia treated with tigecycline in the intensive care unit was collected from June 2011 to March 2014 in this retrospective study, to evaluated the clinical efficacy of tigecycline.

A total of 79 patients (83.5% male) were included, the mean age was 84 years old (rang, 65 years to 100 years old). Acinetobacter baumannii (39.1%), Pseudomonas aeruginosa (35.0%) and Klebsiella pneumonia (23.8%) were the most common pathogens.All patients were treated with tigecycline, 54.4% combined with other antimicrobial agents, 35.4% treated with double dose of tigecycline, and the mean course of antibiotic treatment was 9 days (range, 2 days to 22 days). After treatment, clinical success were recorded in 44 patients (55.7%), clinical failure were recorded in 29 patients, clinical uncertainty were recorded in 6 patients.28 days after treatment, patients' overall mortality was 39.0%.The clinical success rates were associated with acute physiology and chronic health evaluation (APACHE) Ⅱ score less than 15 (the clinical success rates were 72.2% and 41.9% in patients with APACHE Ⅱ score<15 and APACHE Ⅱ score≥15, respectively;P=0.007); treated with double dose of tigecycline (71.4% vs 47.1%, P=0.037) or combination regimens were also had significant difference (67.4% vs 41.7%, P=0.022).

Treatment of tigecycline combined with other antimicrobial agents and double dose of tigecycline may both can improve clinical efficacy in critically ill elderly patients with ventilator-associated pneumonia.

To investigate efficacy and safety of artery chemoembolization combined with radiofrequency ablation for advanced non-small cell lung cancer.

A total of 138 cases of Sichuan Cancer Hospital of patients with advanced non-small cell lung cancer were retrospectively analyzed from January 2011 to November 2014.All cases were divided into three groups, 61 cases were treated by artery chemoembolization (ACB group), 43 cases were treated by artery chemoembolization combined with radiofrequency ablation (Joint group), 34 cases were treated by radiofrequency ablation (RFA group). Recent efficiency, overall survival time, adverse reactions and complications of three groups were analyzed. The risk factors related to survival time of 138 patients were analyzed.

The recent efficiency of ACB group, Joint group and RFA group were 73.8%(45/61), 93.0%(40/43), 85.3%(29/34), respectively, and the difference was statistically significant (χ²=18.499, P=0.005). 1, 2, 3-year survival rates of Joint group were 90.7%(39/43), 58.1%(25/43), 20.9%(9/43), respectively that were better than ACB group(57.4%(35/61), 24.6%(15/61), 11.5%(7/61)) and RFA group(58.8%(20/34), 32.4%(11/34), 11.8%(4/34)), (χ² value were respectively 8.242 and 4.934, P values were 0.004 and 0.026). Chemotherapy side effects and complications of ablation were of no significant difference (P>0.05). Chemotherapy side effects and complications of ablation were of no significant difference (P>0.05). The number of tumors, tumor size, TNM staging, eastern cooperative oncology group (ECOG) score were independent risk factors which impact on survival time for non-small cell lung cancer.The artery chemoembolization combined with radiofrequency ablation treatment can improve survival time of patients with advanced non-small cell lung cancer.

Artery chemoembolization combined with radiofrequency ablation is a safe, effective, minimally-invasive treatment for advanced non-small cell lung cancer.

To explore the atypical MRI findings of focal nodular hyperplasia (FNH) of the liver.

Retrospective analyses were conducted for 13 cases (10 males and 3 females) confirmed pathologically as FNH after surgery or biopsy with liver MRI examination from January 2012 to June 2015 in PLA General Hospital.

There were 22 focal lesions in 12 cases, and diffuse pattern in 1 case.In the 22 focal lesions, there were 3 lesions with fatty change, 1 lesion with hemorrhage, 7 lesions with pseudo-capsule, regarding to dynamic contrast-enhanced pattern: 12/22 lesions with gradually increasing enhancement, 3/22 lesions with rapid wash-in and wash-out, and 7/22 lesions with rapid wash-in and slow wash-out.The hepatocyte-specific agent examinations were performed in 20/22 lesions, and 20/20 lesions showed iso- to hyper-intensity to the liver parenchyma in the hepatocyte phase.There was 1 case (female) showing diffuse lesions with obvious fatty change, and all the lesions took up the hepatocyte-specific agent in hepatocyte phase.

The atypical focal nodular hyperplasia often occurs in middle age males and could demonstrate fatty change, hemorrhage, pseudo-capsule, various enhancement patterns.And when the FNH showed atypical routine MRI findings, the use of the hepatocyte-specific agent could facilitate the diagnosis.

To analyze the current status of intracranial aneurysms treated in neurovascular hybrid operating room.

In the neurovascular hybrid operating room of New Era Stroke Care & Research Center, the Second Artillery General Hospital PLA, from October 2013 to November 2015, 99 cases of intracranial aneurysms were managed by interventional treatment, open surgery, hybrid surgery or switched surgical procedures.

Patients with intracranial aneurysms treated in neurovascular hybrid operating room achieved good clinical outcome.

It is an ideal option to treat intracranial aneurysms in neurovascular hybrid operating room.

To investigate the peripheral nerve sheath tumors sonographic features.

It was a retrospective analysis of ultrasound images and clinical manifestations which were pathologically confirmed 31 cases of peripheral nerve sheath tumors in March 2011 to November 2014 from Xuanwu Hospital.

In 14 cases of 31 patients were with a clinical touch and pressure pain, 17 cases showed superficial painless mass. Ultrasound showed hypoechoic nodules 30 cases, with an average size of (2.9 ± 1.6) cm; encapsulated, border clearance, including 1 case of cystic part; color Doppler flow imaging ultrasound: no intralesional flow signals 21 patients (21/30 patients), a small amount of blood flow signals 9 cases (9/30 patients); 2 cases of multiple lesions. Another one case of preoperative ultrasound examination showed no echo, misdiagnosed as ganglion cyst.

Hypoechoic encapsulated, border clearance, little or no blood flow is the main basis of ultrasound diagnosis schwannoma, in some cases, there may be cystic ultrasound, a small number of multiple lesions.

To determine whether all-trans retinoic acid (ATRA) could improve iodine uptake via repressing transcriptional activity of β-catenin in thyroid cancer cells.

Three kinds of treatment models were firstly established with alcohol, ATRA, and transfection of β-catenin shRNA in undifferentiated human thyroid cancer cell line-SW1736.Then the expressions of sodium iodide symporter (NIS), β-catenin and its regulating factors, epithelial-mensechymal transition (EMT)-phenotype, invasion and metastasis associated proteins were further measured in above three cell models.After that, the influence of ATRA on the functional expression of NIS, iodine uptake potency, tumor growth curve and treatment effect inducing by radioactive iodine was comparatively analyzed in vitro and in vivo trials.

After treated with ATRA, transcriptional activity of β-catenin decreased by downregulating phosphorylation of β-catenin Ser45、Y654 and GSK-3β Ser9.Additionally, ATRA effectively upregulated the protein level of NIS, and reversed EMT phenotype in alcohol treated cells, with absence in epithelial expression of E-cadherin and cytokeratin 18, as well as abnormal expression of Vimentin, urinary plasminogen activator (uPA), uPAR and Fibronectin.Compared with alcohol-treated group, both in vitro proliferation and invasion potential of ATRA treated cells markedly decreased (all P<0.05), and iodine uptakein vitro increased about 3.5-folds (P=0.007). In ATRA-treated animal model, tumor growth potential and tumor mass were significantly inhibited by radio-iodine (¹³¹I) treatment (all P<0.05).

ATRA can increase functional expression of NIS via downregulating transcriptional activity of β-catenin and promote isotope sensitivity to radio-iodine in human undifferentiated thyroid cancer.

To explore the effect of the integrin αvβ3 inhibitor Cilengitide on the blood brain barrier (BBB) permeability, brain edema, neuronal cell apoptosis and the relation with the vascular endothelial growth factor (VEGF)expression in acute cerebral ischemia rats.

A rat focal cerebral ischemia/reperfusion model was established by middle cerebral artery occlusion.Rats with middle cerebral artery occlusion, in accordance with the random number table, were divided into four groups: (1) the rats in Cilengitide group A (n=30) were treated with Cilengitide at a dose of 100 μg/kg; (2) the rats in Cilengitide group B ( n=28) were treated with Cilengitide at a dose of 200 μg/kg; (3) the rats in sham group ( n=31), without inserting thread into middle cerebral artery, were treated with normal saline; (4) the rats in control group (n=27) were treated with normal saline.All rats were treated with Cilengitide or saline 1 hour after infarction, given reperfusion 2 hours after infarction and were sacrificed 22 hours after reperfusion.The brain-water content was measured by dry/wet weight method.The permeability of BBB was measured by quantifying Evans Blue.The infarction volume was measured by 2, 3, 5-tripheyl tetrazolium Chloride (TTC) staining.Expression level of VEGF, P-Flk, Cleaved-Caspase-3 was measured by immunohistochemistry and Western blot, respectively.The neuronal cell apoptosis was evaluated by terminal deoxynucleotidyl transferased UTP nick end labeling (TUNEL).

Compared with Control group, treatment groups with cilengitide at the dose of 100 μg/kg and 200 μg/kg reduced brain-water content [(80.8±1.1)% vs (84.8±1.4)%, (81.0±1.4)% vs (84.8±1.4)%, P<0.05], reduced exudation of Evans blue[(9.2±1.1) μg/g vs (12.2±0.8) μg/g, (8.6±0.6) μg/g vs (12.2±0.8) g/g,P<0.05], reduced infarction volume[(31.9±4.9) mm³ vs(43.0±2.2) mm³, (29.2±3.5) mm³ vs(43.0±2.2) mm³, P<0.05] , reduced neuronal cell apoptosis [(36±4)vs(69±6)、(35±3)vs (69±6),P<0.05]. Compared with sham group, Cilengitide group A and Cilengitide group B had lower brain-water content, permeability of BBB, infarction volume, expression level of VEGF, P-Flk, Cleaved-Caspase-3 and neuronal cell apoptosis (P<0.05). When Cilengitide group A was compared with Cilengitide group B, there were no significant differences in brain-water content, permeability of BBB, infarction volume, expression level of VEGF, P-Flk, Cleaved-Caspase-3 and neuronal cell apoptosis (P>0.05).

The integrin αvβ3 inhibitor Cilengitide improves outcomes in the MCAO model by preserving the blood-brain barrier, attenuating brain edema and inhibiting neuronal cell apoptosis, which may occur in a VEGF-and VEGF-receptor-dependent manner, with the same efficacy between Cilengitide 100 μg/kg and 200 μg/kg after 23 hours treatment.

To assess the status of the cardiovascular disease associated risk levels among hypertensive population of Han, Uygur and Kazakh ethnicities, in Xinjiang Uygur Autonornous Region, to guide hypertension prevention and treatment in different ethnicities.

Four stages random cluster sampling method was used, and all the data was collected from Xinjiang local residents aged over 18 between October 2007 and March 2010.

A total of 14 618 subjects completed this survey, in which 2 654 Han, 1 612 Uygur and 2034 Kazakh people diagnosed with hypertension was included in this research.Most of them were"grade 1 hypertension", and the percentage of grade 3 hypertension was Han (19.1%), Uygur (17.3%) and Kazakh (32.3%), respectively.Majority hypertensive people accompanied with 1 risk factor.The risk proportions of low, medium, high and very high in hypertension population of different ethnicities were Han (19.4%, 34.6%, 46.1%), Uygur (17.7%, 37.6%, 44.7%), Kazakh (12.5%, 38.0%, 49.4%) respectively.In Han, Uygur and Kazakh ethnicities, the percentage of high risk and very high risk was highest in hypertensive men aged over 60 years old.The percentages of hypertension awareness were 42.0%, 45.6%, 46.5% and percentages of medicine therapy were 29.6%, 23.4%, 25.2% for Han, Uygur and Kazakh ethnicities, respectively.

Hypertensive people among Han, Uygur and Kazakh ethnicities in Xinjiang are mainly under high risk and very high risk situation of cardiovascular disease, especially in men aged ≥60.The percentage of hypertension awareness and medicine therapy in high risk and very high risk population is the highest, while percentage of awareness in medium risk population is low.

To evaluate the effect of β-blockers in patients with septic shock.

PubMed, EMBASE, Cochrane central registration of controlled trials, CNKI and Wanfang Data were searched to identify relevant studies from inception to October 2015.Statistical analysis was performed using STATA 12.0.The random effects model was used due to wide clinical variability across the trials.

After application of the inclusion criteria, 7 trials with 392 patients were included, involving 3 randomized controlled trials (RCT) and 4 quasi-experiments.The results of the meta-analysis for the quasi-experiments showed that compared with baseline, heart rates (standardized mean difference (SMD)=-2.51, 95%CI: -4.32--0.70, P=0.007) and lactate levels (SMD=-0.34, 95%CI: -0.67--0.02, P=0.039) significantly decreased, while no significant differences were seen for mean arterial pressure (SMD=0.01, 95%CI: -0.42-0.44, P=0.969), cardiac index (SMD=-0.35, 95%CI: -1.15-0.44, P=0.385) or norepinephrine requirements (SMD=-0.06, 95%CI: -0.38-0.27, P=0.726) after 24-hour therapy. Among randomized controlled trials, β-blockers, compared with standard care, was associated with reductions in heart rates ( P<0.001) , 28-day mortality (RR=0.60, 95%CI: 0.48-0.75, P<0.001) and troponin I levels (P<0.001). While no differences were found between the two groups in other hemodynamic and cardiac function variables, such as mean arterial pressure, cardiac index or stroke volume index (P>0.05).

The currently available evidence indicates that the use of β-blockers is associated with a significant decrease in heart rate, troponin I levels and 28-day mortality in patients with septic shock, while mean arterial pressure, cardiac index and stroke volume index might remain unchanged.Large scale, muti-center RCTs need to be carried out to confirm the effects of β-blockers in patients with septic shock.

Finger tip dissection is a common hand injury. Finger tip replantation is the first choice for repair and reconstruction^[1,2,3,4]However, for some severed fingers with slender or seriously damaged fingertips and vascular sclerosis and degeneration in elderly patients without replantation conditions, how to repair them reasonably has always been a clinical problem. In this study, 15 cases of finger tip dissection injury were repaired with emergency V-Y advancing skin flap covering the phalanges and nail beds with nutrition reimplantation.

A 77-year-old female was admitted to the Department of Nephrology, Peking University First Hospital on October 28, 2014 due to "intermittent fever for 4 months, palpitations and shortness of breath after activity for 2 weeks". Four months ago, there was no obvious trigger for fever (untested, details unknown), occasionally cough, cough of white sticky sputum, and no abdominal pain. The routine test of peritoneal dialysate at Peking University First Hospital showed that the number of nucleated cells was 320×10⁶/L, multiple nuclear cells 0.80. The initial diagnosis was peritoneal dialysis-related peritonitis, and intraperitoneal injection of vancomycin (1 g/time, once every 5 days) + cefoperazone (1 g) /sulbactam (0.5 g), once/d; Oral fluconazole 150 mg once a day. The number of nucleated cells remained high [(110~450) ×10⁶/L], predominantly multinuclear cells (55%-60%), intermittently accompanied by moderate fever (38.3-38.9 ℃). High fever occurred 3 months ago, with the highest body temperature of 39.2 ℃. Multiple peritoneal dialysis routine examinations showed an increase in the number of nucleated cells (maximum 480×10⁶/L), mainly monocytes, accounting for 60%-90%. CT scan of abdominal cavity: abdominal pelvic effusion, peritoneal thickening lesions, increased fat density in the abdominal cavity, and enlarged lymph nodes in the abdominal cavity, considering the possibility of peritonitis. Positron emission computed tomography (PET-CT) showed multiple lymph nodes enlarged in right cervical area IV, hepatic hilar area, anterior abdominal aorta and left axilla, with a short diameter of 0.5~1.3 cm; The pelvic peritoneum is thickened in nodular and strip shape, and glucose metabolism is increased. Superficial lymph node ultrasound: multiple swollen lymph nodes in the left axilla, the larger one was 1.6 cm ×1.1 cm. Positive T-cell SPOT test (T-SPOT) for tuberculosis infection. Considering the high possibility of tuberculosis, experimental anti-tuberculosis therapy (isoniazid 200 mg, once a day + rifamentin 600 mg, once a week) was initiated 3 months ago (24 Jul 2014). The patient's body temperature gradually returned to normal, and the peritoneal dialysis fluid routine: the number of nucleated cells is 92×10⁶/L, mononuclear cells 43×10⁶/L. Two weeks ago, the patient had palpitations and shortness of breath after slight activity, which could be relieved after rest. There was no paroxysmal dyspnea at night, and he could lie down at night. There were no hematemesis and melena. Retest blood routine: white blood cells 2.94×10⁹/L, hemoglobin 102 g/L, platelets 118×10⁹/L; Blood biochemistry: alanine aminotransferase (ALT) 34 U/L, aspartate aminotransferase (AST) 109 U/L, albumin 30 g/L. Blood routine 1 week ago: white blood cells 2.7×10⁹/L, hemoglobin 91 g/L, platelets 140×10⁹/L, blood biochemistry: ALT 23 U/L, AST 71 U/L, albumin 28.2 g/L. Admitted for further diagnosis and treatment.

A 19-year-old male was admitted with "sensorimotor disorders of both lower limbs for 3 d". The patient experienced sudden severe abdominal pain 2 h after exercise, and then felt transient radiating pain from the abdomen to both lower limbs, followed by sensory motor disorder of both lower limbs, with the left lower limb as the most important, accompanied by urinary incontinence. The local hospital gave symptomatic and supportive treatment (the specific treatment is unknown), but the efficacy was not good after 3 days, so he went to our hospital. The patient had no low-grade fever, night sweats, back pain, sensorimotor disorders, abnormal urination and defecation, good diet and sleep, and no obvious weight change in the near future. Previous: Dark red patches were found on the left back after birth, which gradually enlarged with growth; Blood pressure was found to increase for 3 years, approximately 150/95 mmHg (1 mmHg =0.133 kPa), untreated; Denial of tuberculosis history and exposure history. Personal history and family history are not special. Physical examination: body temperature 36.7℃, heart rate 110 beats/min, breathing 28 beats/min, blood pressure 148/89 mmHg. A dark red patch of about 20 cm ×12 cm can be seen on the left lower back, with irregular shape and clear boundary, slightly fading when pressed, no mass palpable below, no tremor or vascular murmur (Figure 1)。 There was no obvious tenderness and percussion pain in the spine and paravertebral areas, and no radiation pain. Hypoesthesia below the chest 8 plane, perineum, sellar area and both lower limbs, left lower limb muscle strength grade 0, right lower limb muscle strength grade 4, knee reflex and ankle reflex were weakened; Bilateral pathological reflexes were not elicited. Laboratory tests: Blood routine, biochemistry, erythrocyte sedimentation rate, C-reactive protein, procalcitonin, tuberculin (PPD), tuberculosis antibody, tuberculosis specific antigen (T-SPOT), tumor marker (C-12), alkaline phosphatase and acid phosphatase tests showed no obvious abnormalities. Auxiliary examination: color Doppler ultrasound of skin and soft tissue: the left back was scanned with dark red patches as the center, and there was no obvious mass sound image. Chest radiograph: No obvious abnormalities were found. CT plain scan enhanced three-dimensional imaging: (1) Fat density focus in spinal canal at T4 level; (2) Soft tissue foci in spinal canal and left intervertebral foramen at T10 level, osteogenesis and bone destruction were observed in vertebral bodies and adnexal bones at T5, T8-10, and left 5th to 10th posterior ribs; (3) A large number of tortuous and thickened blood vessel shadows paravertebral, the thickened blood vessels merge with azygos veins, and vascular malformations. MRI plain scan enhanced: (1) flat T3, 4 vertebral level extramedullary lipoma; (2) T7-10 intramedullary, spinal canal, vertebral body and adnexal areas have tortuous blood vessel shadows, which are considered as the possibility of arteriovenous malformation. Digital subtraction angiography (DSA): Abnormal staining masses were seen inside and outside the spinal canal in the T7-T12 segments, and some spinal veins were thickened, suggesting a space-occupying lesion with rich blood supply (Figure 2，Figure 3，Figure 4)。 Diagnosis: Cobb syndrome. Treatment: After admission, the patient was instructed to stay in bed absolutely, given symptomatic treatment such as hormone, dehydration and nerve nutrition, actively controlled blood pressure, and underwent spinal cord function rehabilitation training. After 20 days, the patient's neurological symptoms disappeared and the spinal cord function returned to normal. One year later, he underwent spinal angiography in another hospital. During the operation, he abandoned the embolization treatment due to the difficulty of putting the microguide wire in place, so he underwent further surgical resection of the spinal cord malformed vascular mass. The postoperative effect was satisfactory, and there has been no recurrence so far.

The child was delivered by cesarean section in the obstetrics department of Wulian County People's Hospital, Rizhao City at 16: 45 on September 19, 2014 due to "premature rupture of membranes" at 38 weeks of pregnancy. She had a birth weight of 2.9 kg. She had dyspnea immediately after birth, positive three concave signs, obvious shortness of breath, and purple skin. She was immediately given oxygen, cleared the respiratory tract, and found a "cyst at the base of the tongue" during tracheal intubation, so she was transferred to the neonatology department of our hospital. Admission physical examination, resuscitation sac positive pressure ventilation, triple concave sign positive, tracheal intubation was replaced, under direct laryngoscope, a white sac about 1 cm ×2 cm in size at the base of the tongue was seen, compressing the epiglottis, shortness of breath was relieved after intubation, triple concave sign disappeared. Connecting ventilator, continuous pulse oxygen monitoring and blood gas analysis, preliminary diagnosis of tongue base cyst.

Nowadays, tissue engineering construction or regenerative medicine treatment based on single cells has failed to meet the requirements of tissue structure and physiological action simulation, tissue stability and viability maintenance. Especially in the construction of large tissues and tissues lacking nourishing blood vessels and the regeneration of ischemic necrotic tissues, the most urgent difficulty to be overcome is the establishment of good blood supply system. And well-organized blood supply nourishment is not only the key to the success of regenerative therapy^[1]It is also required that the blood vessels in them can possess diverse cellular components in and around the blood vessels under normal physiological conditions to maintain vascular function for a long time^[2]。 Based on the above facts, more and more researchers tend to combine multiple cells to meet the increasingly complex regenerative medicine treatment requirements. Among them, vascular endothelial cells are often used in combination with mesenchymal stem cells for the induction of regenerative tissue and tissue pre-vascularization. On the one hand, with the participation of endothelial cells, the formation of neovascular network means that the tissue has better blood supply nourishment and better regeneration survival; On the other hand, although endothelial cells are the most important functional cells of normal-sized blood vessels, the stability and maintenance of vascular physiological function cannot be separated from the existence of their intrinsic vascular mesenchymal stem cells.

In recent years, transcatheter arterial chemoembolization (TACE) has played an important role in the treatment of liver cancer. Novel embolic material-drug-loaded microspheres with the ability to sustain the release of anti-tumor drugs^[1], has attracted much clinical attention. This paper reviews the recent advances in the application of drug-loaded microspheres in the treatment of TACE in liver cancer.