Volume 96  ·  Issue 23  ·  2016

The incidence rate of adolescent idiopathic scoliosis (AIS) is 1% ~3% in people aged 1~16 years. Because of the large population base in China, a large number of patients need related surgical treatment every year^[1]。 Spinal orthopedic surgery is a riskier treatment for scoliosis. In the past 20 years, with the continuous improvement of spinal surgery in China, postoperative complications have been greatly reduced. However, even so, there are still many patients who have serious complications after surgery, and even die from time to time, which not only brings huge risks to patients and their families, but also seriously consumes valuable medical resources^[2]。 Effectively reducing postoperative complications, reasonably and effectively allocating health resources and reducing medical expenses are urgent topics for orthopedic surgeons and health management departments in China.

Cardiac resynchronization therapy (CRT) adds left ventricular pacing to the traditional dual-chamber pacing, thereby restoring the synchronized systolic function of the ventricles. This technique has been applied to the clinical treatment of patients with heart failure (HF) with ventricular dyssynchrony, and can significantly reduce the mortality and hospitalization rate and improve the prognosis of patients with cardiac function grades II, III and IV of the New York Heart Association (NYHA)^[1]。

To explore the rules of the anatomic morphology between vertebral artery tortuosity and transverse foramen.

From January 2012 to December 2015, 60 patients with vertebral artery tortuosity by means of analyzing the image data and basic clinic information as the observation group, and 50 patients randomly selected exclusive of vertebral artery tortuosity, absence of vertebral artery, vertebral artery aneurysm, cervical decomposition incomplete deformity and oral cavity prosthesis artifacts as the control group, the basic clinical information was collected; the transverse foramen area (TF) and vertebral artery cross-sectional area (VA) of the vertebral artery were measured in the observation group and the control group; internal diameter of vertebral artery tortuosity, length of vertebral artery were measured and; twisting coefficient (s)of the vertebral artery was calculated.Then the difference of the above-mentioned statistics was acquired.

The C4 TF (25.91±10.13) mm and C6 TF(31.93±17.91) mm of the affected segment of the observation group were significantly higher than those in the control group[(22.11±8.67) mm, (27.19±7.89) mm] (P<0.05); VA and TF were positively correlated.The average age[(68.25±12.03) years], blood pressure (45 cases)of the observation group and the proportion of the menopausal women (39 cases)were higher than those in the control group[(61.32±11.32) years, 23/22](P<0.05).

The area of transverse foramen of C4 and C6 could be affected by vertebral artery tortuosity. It might be related to the occurrence of bone degeneration around C6 and C4.The risk factors of the expansion of the transverse foramen might be advanced age, hypertension and menopausal women.

To observe the changes in pelvic balance after posterior reduction of balanced L5-S1 Ⅲ-grade isthmic spondylolisthesis in adults.

A total of 18 adult patients with balanced L5-S1 Ⅲ-grade isthmic spondylolisthesis were retrospectively studied after successful treatment by posterior decompression, reduction and L5-S1 interbody fusion in Department of Orthopedic Surgery, the First Affiliated Hospital of Soochow University from October 2009 to October 2014.L5-S1 of eight patients were fixed with pedical strews, while others were fixed upgrade to L4.Spino-pelvic parameters: slipping percentage (SP), spondy slip angle (SSA), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT) and lumbar lordosis (LL) were measured on standing lateral view radiograms.The changes in pelvic balance were analyzed after posterior reduction.

All the patients experienced significant changes in SP and SSA with (42.4%±8.3)% and (9.8±4.9)°improved significantly while no significant differences were recorded in PI, PT, SS and LL. PI, PT, SS and LL passed from an average(61.1±6.2)°, (16.2±4.5)°, (44.8±2.9)°, (51.3±9.3)°preoperatively to (61.4±6.1)°, (14.9±4.0)°, (46.5±3.0)°, (48.6±7.0)°respectively.According to K-means cluster analysis, pelvic balance improved postoperatively.No significant correlation was found for ΔPT, ΔSS with ΔSP, while ΔPT and ΔSS had a significant correlation with ΔSSA (correlation coefficient -0.77 and 0.82 respectively).

Posterior SSA reduction in adults with balanced L5-S1 Ⅲ-grade isthmic spondylolisthesis can improve the former pelvic balance.

To analyze risk factors of major complications after spinal deformity surgery.

From January 2011 to December 2014, 254 consecutive patients undergone spinal deformity surgery , 68 male and 186 female, average age 22.1(3-73) years, were divided into two groups based on if they had major complications after surgery.Univariate and multivariate analysis (Logistic regression) were used to identify the risk factors.

Among them, 29 patients had major complications after surgery.Univariate risk factors showed that medical history, scoliosis operation history, preoperative nerve injury, vertebral number of major curve, cobb of major curve, Kyphosis(>90°), time of operation, operative bleeding and osteotomy of group Ⅰ were higher or longer than those of group Ⅱ.Maximal voluntary ventilation (MVC) and orthopaedic rate of group Ⅰ were worse than those of group Ⅱ[(63.5%±23.9%)vs(76.7%±21.9%), (53%±23%) vs(68%±21%),P<0.05]. Logistic regression identified that preoperative nerve injury(OR=5.976), medical history>10 years (OR=4.095), MVC observed/predicted<50(OR=7.405), time of operation>5 h (OR=3.510), osteotomy(OR=3.472)were final risk factors for major complications.

Major complications after surgery to treat spinal deformity can be predicted through preoperative nerve injury, medical history, maximal voluntary ventilation observed/predicted, time of operation and osteotomy during the surgery.The patients with these risk factors need more preoperative care and postoperative care to reduce the occurrence of major complications.

To investigate the effect of bone mineral density(BMD) and fracture site of the vertebrae on low back pain in elderly patients with osteoporotic vertebral compression fractures.

From August 2011 to August 2013, a total of 107 senile patients with osteoporotic vertebral compression fractures underwent percutaneous vertebroplasty were followed up for more than 2 ( average 2.5) years in Department of orthopedics, Xuanwu Hospital, Capital Medical University. The incidence of low back pain after vertebroplasty were analyzed on visual analog scale (VAS), and the relationship between BMD, vertebral fracture site were investigated.

A total of 18 cases(16.8%)after vertebroplasty have significant low back pain. Along with BMD decreased [(-2.90±0.91) vs (-4.87±0.52)], the VAS of low back pain increasing, which showed statistical significance difference[(-3.12±0.91) vs (4.03±1.08), P<0.05]. The site of vertebral fracture was lower, the VAS was higher.

About 16.8% patients show obvious low back pain after vertebroplasty. BMD and Vertebral fracture site were important factors of low back pain in elderly patients with osteoporotic vertebral compression fractures after vertebroplasty.

To evaluate the efficacy of a growth-guidance growing rod in an established porcine scoliosis model via the Cobb angle correction and the continued spinal growth.

Immature pigs (age: 6 weeks old, weight: 6-8 kg) were instrumented and tethered using a three separate incisions fashion.After considerable scoliosis was induced, the pigs were randomly assigned to an experiment group (EG) and a sham group (SG). In EG, the growing rod was implanted and the pigs were euthanized 8 weeks postoperatively; while in SG, the whole instrumentations were only removed and the pigs were followed up over a 8-week period.Dorsoventral (DV) X-ray radiographs were taken prior to and immediately after the growing rod implanting surgery, and at 4-week intervals to assess the Cobb angle orrection and instrumentation positioning.The continued spinal growth and the rod sliding were also assessed from the radiographs.

Of the 16 pigs, one pig encountered infection during the inducement of the experimental scoliosis and thus was excluded from analysis.Of the remaining 15 pigs, all animals developed progressive, structural scoliosis.The 15 pigs were randomized into EG(n=10) and SG(n=5). Two pigs in EG encountered infection and were also excluded from analysis.Of the remaining 8 pigs in EG, no neurologic complications, implant failure or infection were observed.In EG, the Cobb angle of the scoliosis before the growing rod implanted was (52.1 ±14.1)° and it decreased to (25.4±15.2)° postoperatively.After 8 weeks, the Cobb angle was (20.2±11.4)°.In SG, the Cobb angle of the scoliosis after 8-week tethering period was (55.2±15.7)° and it decreased to (53.6±15.8)° after removal of the tethering.The curvature remained stable (51.2°) during the subsequent 8 weeks.During the 8-16th week, the spinal height increased 14.2 cm and radiographic analysis of the growing rod sliding revealed an average distraction of 39.8 mm in EG; while in SG, the increased spinal height was 14.9 cm.The difference of the increased spinal height between EG and SG was not significant (P=0.821).

The novel growing rod system can provide substantial correction of deformity, and additionally, allow for continually spinal growth without significant growing disturbance.

To evaluate the effect of standardized treatment on reactivity of the lower limb terminal microcirculation in patients with type 2 diabetes mellitus (T2DM) by high frequency ultrasound combined with warm bath.

A total of 66 patients with T2DM were collected from June 2014 to May 2015 in the Second Affiliated Hospital of Wenzhou Medical University.According to the vascular complications , the patients were divided into group A without complications (36 cases)and group B with complications (30 cases). Hemodynamic parameters such as peak systolic velocity(PSV), end-diastolic velocity(EDV) and resistance index(RI) of the right plantar digital artery on fibular side of the 1st toe were acquired through Doppler in all subjects.Then the above operation were performed repetitively on all subjects after the right foot was immersed in 40 ℃ warm water for 5 minutes.The change rates of PSV, EDV and RI were calculated after warm bath.All subjects were examined again after three months treatment .The growth rates of the change rate of PSV, EDV and RI were calculated after treatment.All parameters were analyzed.

The change rates of the parameters in group B before and after treatment were lower than those of group A, before treatment (0.108±0.077 vs 0.184±0.091, P=0.037, 0.184±0.101 vs 0.380±0.167, P=0.002, 0.007±0.004 vs 0.015±0.008, P=0.028 7), after treatment (0.155±0.111 vs 0.421±0.138, 0.287±0.108 vs 0.794±0.286, 0.012±0.008 vs 0.039±0.014, P=0.000); the post treatment growth rates of the change rates of the parameters in group B were all less than those of group A (0.414±0.303 vs 2.192±2.673, P=0.048, 0.660±0.406 vs 1.422±1.075, P=0.042, 0.633±0.830 vs 2.191±2.269, P=0.048). The change rates of the parameters in two groups after treatment were higher than those before treatment (all P<0.05).

Warm bath test can be used to detect change degree of hemodynamic parameters in patients with T2DM so as to evaluate reactivity of blood microcirculation, which has a certain clinical application value in treatment.

To explore the effects of three luteal phase supporting strategies on clinical outcomes of intrauterine insemination (IUI).

1 779 subjects who underwent IUI at the Center of Reproductive Medicine, Peking University Third Hospital from November 2014 to June 2015 were enrolled in this retrospectively study.According to the luteal phase supporting strategies, all the subjects were divided into three groups: subjects receiving Dydrogesterone were group A; subjects receiving oral micronized progesterone were group B; subjects receiving vaginal micronized progesterone were group C. The pregnancy outcomes, including clinical pregnancy rate, early miscarriage rate, biochemical pregnancy rate and ectopic pregnancy rate were compared in the three groups.

There was no significant difference in the three groups in constituent ratio, average IUI times, rate of the natural cycle, rate ofovulation cycle and dropout rate(P>0.05). Similarly, there was also no significant difference in pregnancy outcomes in all groups.Subsequent stratified analysis demonstrated that pregnancy outcomes in subjects of natural cycle and ovulation cycle still showed no significant difference(P>0.05).

Our study suggested that the effects of three luteal phase supporting strategies on clinical outcomes of IUI were similar.The medication in clinic should be individualized.

To determine the clinical value of cerebrovascular hemodynamics analysis (CVA) on cerebral microcirculation.

One hundred consecutive patients from neurological department of Peking University People's Hospital from April to October, 2015, with symptoms of dizziness, lightheadedness, headache etc., who were diagnosed with ischemic cerebrovascular disease with normal transcranial doppler (TCD) and abnormal CVA, were recruited in this study.Other medical conditions were excluded through clinic and imaging examinations among these patients.Patients were categorized into mild, moderate and severe subgroups based on the degrees of decreased blood flow velocity and/or volume, and received treatment accordingly.CVA parameters including the minimum flow velocity (Vmin), the minimum flow volume (Qmin), peripheral resistance (R), critical pressure (CCP) and dynamic resistance (CVR) etc.before and after treatment were compared statistically (t test).

Out of the 100 patients with abnormal CVA, 52 patients had bilateral changes and 48 patients had unilateral changes.The minimum flow velocity and the minimum flow volume anomalies were found in 100 and 92 cases, respectively.A total of 47, 32 and 21 patients had mild, moderate and severe abnormal changes, respectively.Out of the 63 patients who had follow-up CVA after treatment (drop-out 37 cases), there were 63 abnormal Vmin cases, 60 abnormal Qmin cases, 17 abnormal R cases, 18 abnormal CCP cases, 41 abnormal characteristic impedance (Zc) cases, 41 abnormal elastic wave velocity (Wv) cases, 23 abnormal vascular compliance (C) cases, all before treatment.After treatment, symptoms and Vmin synchronization improved in 61 cases (96.8%), Qmin improved in 58 cases (96.6%), R improved in 13 cases (76.5%), CCP improved in 10 cases (55.6%), Zc improved in 27 cases (65.8%), Wv improved in 25 cases (61.0%), C improved in 6 cases (26.1%). All improvements were statistically significant (P<0.05), with Vmin, Qmin, R and CCP showing most significant changes (P<0.000 1). The CVR treatment showed no significant before and after treatment (P>0.05).

CVA is an important method in assessing cerebral microcirculation perfusion, providing information on intracranial microvascular bed that cannot be detected by TCD.It is not only helpful for diagnosis, but also evaluable for monitoring clinical treatment of cerebral microcirculation disorder.CVA is also helpful in determining the location of cerebral circulation impairment by correlation with carotid ultrasound and TCD.

To compare the therapeutic effect of portal vein stenting and endovascular implantation of iodine-125 seeds strand followed by transcatheter arterial chemoembolization combined with or without sorafenib in patients for hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT).

A total of 53 patients with HCC complicated by MPVTT who received portal vein stenting and endovascular implantation of iodine-125 seeds strand followed by transcatheter arterial chemoembolization combined without (group A, n=38) or with (group B, n=15) sorafenib in Affiliated Yancheng Hospital of Southeast University Medical College during January 2010 and August 2015 were analyzed retropectively.Overal survival, progress free survival and procedure-related adverse event were compared between the two groups.

The technical success rate was 100% for placement of ¹²⁵I seeds strand and stent in the obstructed main portal vein.No serious procedure-related adverse events occurred. Median survival time of group A and B were 12.1 and 14.8 months, respectively (P=0.037). Additionally, Median progress free survival time of group A and B were 2.8 and 4.0 months, respectively (P=0.002).

Endovascular implantation of iodine-125 seeds strand and portal vein stenting followed by transcatheter arterial chemoembolization combined with sorafenib could improve the survival time, the progress free survival time of patients with HCC complicated by MPVTT.

To explore the clinicopathological characteristics and treatments of brain metastasis (BM) in patients with gynecologic carcinoma.

Twenty-three pathologically confirmed patients with gynecologic carcinoma who had brain metastasis between February 2008 and October 2012 were analyzed retrospectively.

The primary carcinoma was cervical cancer in 5 patients, endometrial carcinoma in 8 patients and ovarian cancer in 10 patients, which accounted for 1.81% (5/276), 2.10% (8/380) and 2.67% (10/374) of patient with the same diagnosis of the same period, respectively.Among them, 91.3% (21/23) patients had heterochronous BM.Single BM was documented in 52.2% (12/23) patients.Besides, 78.2% (18/23) BM located in cerebrum.At the time of BM, 91.3% (21/23) patients had symptoms of central nervous system, in which headache ranked the top (90.4%). Altogether, thirteen patients had extracranial metastasis, in which 9 of them had metastasis of the lung.The median post-brain-metastasis survival (mPBMS) for the recursive partitioning analysis (RPA) classes Ⅰ-Ⅲ was 54 months, 9 months and 1 month, respectively (P<0.01). None of surgery, radiotherapy or chemotherapy treatment was proven to have prognosis-improving ability either in single variant or multivariate analysis.However, in patients with extracranial metastasis, chemotherapy could significantly improve their mPBMS (P<0.05).

The incidence of brain metastasis in patients with cervical cancer, endometrial carcinoma, and ovarian cancer increased gradually.RPA was valuable for a prognostic assessment in gynecologic carcinoma patients with BM.Chemotherapy could significantly improve prognosis of gynecologic carcinoma patients with BM if extracranial metastasis was presented.

To investigate the relationship between the group B streptococcal (GBS) genital infection of the pregnant women and premature rupture of membrane (PROM).

Five hundred and eighty seven cases in our hospital maternity clinic or hospital delivery of pregnant women were enrolled from October 2014 to December 2014, including 189 cases of pregnant women with PROM as the observation group and 398 cases of pregnant women without PROM as a control group.GBS in their rectum and vagina secretion was separated and tested by using Group B Streptococcus Chromogenic Agar.

Fifty eight cases were detected GBS positive in all 587 pregnant women.The positive rate was 9.9%.In 189 cases of PROM, 37 cases were GBS positive and the positive rate was 19.6%.While in 398 cases of normal pregnant women, 21 cases were positive and the positive rate was 5.3%.The difference has statistically significant (P<0.01).

GBS infection may be a risk factor for the occurrence of PROM.Psychological counseling, health education and antibiotics should be applied to the GBS positive pregnant women as a preventive strategy.

To investigate the nodal properties and reorganization of whole-brain functional network in subjects with severe right-sided SNHL.

From June 2012 to June 2013, a total of 19 patients with severe right-sided SNHL were collected from Zhongda Hospital or the recruitment advertising along with 31 healthy controls.Based on the graph-theoretical analysis, the whole-brain functional networks were constructed using the BOLD-fMRI data of all subjects.Two sample two-tailed t-tests were used to investigate the differences between two groups in nodal metrics, such as node degree, node betweenness, node global efficiency and node local efficiency.All metrics were corrected by multiple comparisons.Partial correlation analysis was used to estimate the relationship between the significant metrics and the duration or severity of hearing loss.

The right-sided SNHL showed significantly increased betweenness centrality in left supramarginal gyrus and right fusiform.However, other nodal parameters showed no statistical difference.Besides, patients exhibited no significant association between the altered metrics and clinical variables.

Alterations of local topological properties may underlie cerebral cross-modal plastic reorganization in visual or speech-related regions in severe right-sided SNHL patients.

To analyze magnetic resonance images of the posterior cranial fossa tumors, and evaluate the texture characteristics of three kinds of children's posterior cranial fossa tumors by support vector machine (SVM).

From May 2008 to August 2015, a total of 76 patients with children's posterior cranial fossa tumors in First Affiliated Hospital of Zhengzhou University were retrospectively analyzed, texture analysis was performed on the three types of tumors.

The 5 texture parameters extracted from the gray level co-occurrence matrix had at least 3 parameters which had statistically significant difference between the two different classes of data sets (P<0.05). For all kinds of data sets, the variance parameters of gray value of ROI region had statistically significant differences.The accuracy rate of SVM test in the remarkable difference of the ependymomas and medulloblastomas, the ependymomas and astrocytomas and the medulloblastomas and astrocytomas was 86.15%±4.16%, 73.63%±5.82% and 74.32%±5.85%, respectively.

The analysis of texture features can provide more quantitative information which could provide a new thought and method for the differential diagnosis of tumors in the posterior cranial fossa.

To investigate the clinical efficacy of ventriculoperitoneal shunt treatment to patients with idiopathic intracranial hypertension.

The clinical data of 32 patients with idiopathic intracranial hypertension who were admitted to Henan Provincial People's Hospital from August 2011 to February 2014 were collected.The underlying diseases included occlusion of the superior sagittal sinus (2 cases) and occlusion of transverse sinus (2 cases), and all 4 cases had a history of chronic otitis media.Twenty eight cases, with a history of oral contraceptive drugs (2 cases) and unclear etiology (26 cases), had normal venous sinus confirmed by imaging examination.All of 32 patients underwent ventriculoperitoneal shunt.

The symptoms of 32 patients such as headache, nausea, and vomiting were relieved obviously after surgery.The symptom of visual impairment of 31 cases got better in varying degrees except that 1 case went blind before operation.Besides 2 cases of loss of follow-up, the remaining 30 cases were followed up for 2 years.Thirty cases had no perioperative infection.One case had infection 1 year after operation.No one had the shunt tube blockage.

Patients with idiopathic intracranial hypertension should be taken active surgical treatment when drug therapy fails and could obtain satisfactory clinical curative effect by accepting treatment of ventriculoperitoneal shunt.By intraoperative ultrasound guiding lateral ventricle puncture can be achieved accurately.

To investigate the effect of silent mating type information regulation 2 homolog 1 (SIRT1) deficiency on function of brown adipose tissue (BAT) in high-fat diet (HFD)-induced obese mice.

Male SIRT1 deficient heterozygous (SIRT1^{+ /-}) mice and their wild-type (WT) littermates were challenged with a HFD diet for 16 weeks to induce obesity model.Energy metabolic cages were used to measure oxygen consumption and heat production, and cold tolerance test was to evaluate the adaptive thermogenic function.With brown fat collected after the diet intervention, determination techniques were adopted included HE staining for morphologic changes, immunohistochemical staining and Western blotting for uncoupling protein 1 (UCP1) expression, quantitative real-time PCR for relative content of mitochondria DNA (mtDNA).

Compared to WT controls, SIRT1^{+ /-} mice displayed significant decreases in both oxygen consumption and heat production[(2 681±297) vs (3 017±313) ml·kg^-1·h^-1, (19.05±2.40) vs (21.15±2.49) kcal·kg^-1·h^-1, both P<0.05)], as well as an impairment in maintaining their body temperature during the cold challenge.HE staining revealed the accumulation of larger lipid droplets in BAT of SIRT1^{+ /-} mice, and both immunohistochemical staining and Western blotting indicated an obvious reduction in expression of UCP1 (P<0.05). Quantitative real-time PCR showed a significant decrease in the relative mtDNA content in BAT of SIRT1^{+ /-} mice (0.38±0.10 vs 1.00±0.40, P<0.05).

SIRT1 deficiency promotes BAT dysfunction, meaning that whitening in obese mice.

We aimed to assess trends in clinical characteristics, treatment, and outcomes for hospitalized patients undergoing percutaneous coronary intervention (PCI) in eastern urban China from 2001 to 2011.

We analyzed a Chinese eastern representative sample of hospital admissions for PCI identified in China PEACE-retrospective CathPCI study using a two-stage random sampling design and calculated the weighted data of clinical information in each year.

We included 3 308 admissions for PCI in 29 urban hospitals.Between 2001 and 2011, rates of hospitalizations for PCI increased by 15 fold.Compared with 2001, the patients undergoing PCI were more likely to be female, older than 70 years, and to have history of diabetes, hypertension, dyslipidemia and PCI in 2011.The proportion of trans radial PCIs was increased from 3.5% in 2001 to 72.6% in 2011 (Statistic=-28.95, P_trend<0.000 1); the proportion of drug eluting stents (DES) among all the implanted stents was increased from 18.2%in 2001 to 98.4% in 2011(Statistic=-40.82,P_trend<0.000 1), largely due to increased use of domestic DES.Less than 10% of medical records of patients undergoing primary PCI documented door time and balloon time.The median length of stay decreased from 13 days in 2001 to 10 days in 2011 (Statistic=-0.11,P_trend<0.001). In-hospital mortality did not change significantly, but both any bleeding (Statistic= 2.66,P_trend< 0.01) and access bleeding were decreased significantly (Statistic= 5.55,P_trend< 0.000 1).

During 2001 and 2011 in eastern urban China, there has been a rapid increase in the number and significant change in treatment patterns of PCI.Quality gaps are identified that represent opportunities to improve care.

To observe the variation of central hemodynamics and peripheral arterial stiffness in different ages and to investigate the parameters of differential effects in younger individuals (≤60y) and older individuals (>60y).

We conducted a population-based cross-sectional study in eight regions by random cluster sampling, from April to July 2014 in Beijing, China.Central hemodynamics and peripheral arterial stiffness parameters were determined in 861 healthy (372 male), normotensive individuals, aged 20 to 91(56±14) years.The main observed indexes were central systolic blood pressure (cSBP), arterial augmentation index (AI), augmentation pressure (AP), heart-ankle pulse wave velocity (haPWV) and brachial-ankle PWV (baPWV). Subjects were divided into six groups by 10 aged segment.Differences between groups and age tendency were observed.

The mean values of cSBP, AI, AP, haPWV and baPWV were (113±12) mmHg, (90±18)%, (-5±9) mmHg, (987±144) cm/s and (1 382±254) cm/s, respectively.cSBP, AI, AP, haPWV and baPWV increased with age (P<0.001). In average, cSBP, baPWV and haPWV increased 3 mmHg, 97 cm/s and 62 cm/s by additional 10 years, respectively.cSBP, AI and AP increased slowly after 60 years old, while haPWV and baPWV increased significantly with age (P<0.001). Stepwise regression analysis showed: cSBP was mainly relevant with mean arterial pressure(b=0.990, P<0.001), while baPWV and haPWV were relevant with age(b=8.858, 5.971; P<0.001). AI and AP were associated with height and rest heart rate (b=-0.676, -0.660 and b=-0.361, -0.341, P<0.001). Individuals were divided into two groups by age 60.The age-related changes in AI were significant in under 60-year-old; while the changes in baPWV were more prominent in over 60-year-old.However there was no significant difference in cSBP between two groups.

In healthy people, there are obvious differences of age tendency in central hemodynamics and peripheral arterial stiffness parameters.AI might be a good predictor of cardiovascular disease for early stage, especially for early coronary artery disease.

A 31-year-old male, a stomatologist, was admitted to our hospital on December 17, 2014 due to "acral enlargement for 10 years and aggravation in the past 2 years". The patient experienced progressive facial changes and progressive enlargement of hands and feet for more than 10 years. It was not until May 2013 that he noticed acrohypertrophic facial changes. Random growth hormone (GH)>50 μ g/L was checked, and magnetic resonance imaging (MRI) showed pituitary tumor (2.5 cm ×1.5 cm,Figure 1)。 In June 2013, he underwent transnasal sphenoidal pituitary tumor surgery in another hospital, and the pathology showed pituitary GH tumor. In September 2013 (3 months after surgery), MRI revealed residual pituitary GH tumor (Figure 2), randomized GH 8 μ g/L, gamma knife treatment (central dose: 40 Gy, peripheral dose: 20 Gy, isodose: 50%, number of targets: 20, therapeutic range: 95 mm ×115 mm ×100 mm) was performed immediately in an outside hospital. After that, the signs of acromegaly did not change significantly compared with the previous, and GH and insulin-like growth factor 1 (IGF-1) were not re-examined. In June 2014 (1 year after surgery and 9 months after gamma knife), he developed fatigue, drowsiness, trance, and memory loss. The symptoms gradually worsened, accompanied by visual field defect in the left eye. Randomized GH>50 μ g/L, MRI showed residual postoperative pituitary GH tumor (Figure 3), abnormal enhanced shadows appeared in the optic chiasm and hypothalamus, showing irregular wreath-like enhancement at the edge, and the center of the lesion was a non-enhanced necrotic area. MRI reexamination in August 2014 showed enlarged lesions in the hypothalamus (Figure 4), considering the possibility of radiation encephalopathy, given mannitol 250 ml plus dexamethasone 2.5 mg treatment, mental improvement, increased appetite. Discontinued in December 2014, the patient experienced fatigue, drowsiness, trance, and loss of appetite again; MRI reexamination of optic chiasma and hypothalamus still showed abnormal enhanced shadows (Figure 5)。 Admitted to our hospital for further diagnosis and treatment. Physical examination: cart admission, moderate dehydration, drowsiness, inappropriate answers; cognitive decline; Typical signs of acromegaly: slightly thicker eyebrow arch, slightly wider bridge of nose, thicker upper lip, thicker extremities of limbs and extremities.

A 67-year-old female came to the Department of Oral and Maxillofacial Surgery of the People's Liberation Army General Hospital in May 2015 mainly because of "lower lip hemangioma for 67 years, local repeated ulceration of the hemangioma for more than 1 year, and then presented as painless ulcer, gradually increasing in area and accompanied by multiple lymphadenopathy in the neck". When the patient was born, the hemangioma of the lower lip was found, which was slightly raised and dark in color. No treatment was performed. The tumor slowly increased, the lower lip gradually turned out, and the hemangioma of the lower lip swelled and became larger when he lowered his head. Since 1 year ago, the right lower lip was obviously swollen, repeatedly ulcerated, the size of soybean grains, and self-applied medicine, but no obvious improvement was seen. After that, the ulcerated surface suddenly increased, and it was found that the right submandibular area and submental area could palpate multiple hard masses, the size of jujube, so I came to our hospital for treatment. The patient was in good health, had no history of smoking or drinking, had no habit of drinking hot food and drinking, and had no history of special diseases in his family. Physical examination: Vital signs were stable, and no positive signs were found in heart, lung and abdomen. Specialist examination: The patient's lower lip was obviously swollen, the red lip and the skin of the lower lip were dark red, the lower lip was everted, the hemangioma extent was about 7 cm ×8 cm, the red lip surface on the right side of the lower lip was ulcerated, the size of the ulcer surface was about 3 cm ×4 cm, and the surface of the tumor was cauliflower-like (Figure 1), it can be seen that blood scab is covered, the mandibular teeth are exposed, the mouth opening degree and mouth opening type are basically normal, and swollen lymph nodes can be palpable in the right submandibular and submental areas, which are hard in texture, with poor mobility, adhesion to surrounding tissues and no tenderness.