Volume 96  ·  Issue 33  ·  2016

gastroesophageal varices (GOV) are a common complication in patients with cirrhotic portal hypertension, and are seen in approximately 50% of patients with cirrhosis. esophagogastric variceal bleeding (EVB) has the characteristics of dangerous disease and high mortality rate, and its clinical management is difficult. In order to standardize the prevention and treatment of GOV and EVB, the Hepatology Branch, the Gastroenterology Branch and the Digestive Endoscopy Branch of the Chinese Medical Association promulgated the Guidelines for the Prevention and Treatment of Esophagogastric Variceal Bleeding in Cirrhosis and Portal Hypertension in 2016.^[1], offering many new recommendations.

The study aimed to analyze the impact of concomitant administration of P2Y12 inhibitors and PPIs on ischemia events in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).

We retrospectively analyzed data from a international, multi-center registry between 2003 and 2014 in patients with ACS after PCI, grouped the cohort into patients receiving PPIs or no PPIs and assessed 1-year clinical endpoint (all-cause death/re-infarction). Meanwhile, we grouped the cohort into patients receiving clopidogrel or ticagrelor, and compared the impact of concomitant administration of PPIs and clopidogrel or ticagrelor on 1-year clinical endpoint.

Of 9 429 patients in the final cohort, 54.8% (n=5 165) was prescribed a PPI at discharge. Patients receiving a PPI were more likely to have comorbidities. No association was observed between PPI use and the clinical endpoint (HR 1.00, 95% CI 0.86-1.18). Meanwhile, no association was found between PPI use and the clinical endpoint in patients receiving either clopidogrel or ticagrelor. And the clinical endpoint in patients administrated of clopidogrel and PPIs had no difference with that of ticagrelor and PPIs.

In patients with ACS following PCI, increased risk of ischemia event was not found in the concomitant use of PPIs and P2Y12 inhibitors, and especially, compared with ticagrelor, clopidogrel was found no association with ischemia events when concomitant administrated with PPIs.

To analyze the features of needle electromyography (EMG) in patients with amyotrophic lateral sclerosis (ALS), and explore the correlation between EMG parameters of the tenth thoracic paraspinal muscle and disease duration, rate of disease progression, forced vital capacity (FVC) and revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R).

Standard EMG was recorded from unilateral sternocleidomastoid muscle and/or tongue muscles, upper and lower limbs muscles and the tenth thoracic paraspinal muscle in 112 patients with definite ALS between March 2012 and June 2013 in the Department of Neurology at Chinese PLA General Hospital. Parameters studies included spontaneous potentials, duration and amplitude of motor unit potentials (MUP), pattern of recruitment.

EMG revealed diffuse neurogenic changes in each case. Fibrillation potential or positive sharp waves were found in some muscles in all of patients, and both of them were found in most of the cases. Fasciculation potentials (FPs) were found in 8 patients and accompanied with fibrillation potential and positive sharp waves in 5 of them. Complex repetitive discharges (CRDs) were found in only 1 patient. Duration and amplitude of MUP was prolonged and increased in ALS patients, and the rate of high amplitude and decreased recruitment pattern were 35.71% and 72.32%, respectively. Logistic regression analysis revealed an association of the FVC loss with the drop of ALSFRS-R and peak amplitude of the tenth thoracic paraspinal muscle.

The abnormal spontaneous activity with high frequency are fibrillation potentials and/or positive sharp waves. However, FPs is observed in a small number of patients and CRDs is rarely seen in ALS. The ALSFRS-R and peak amplitude of thetenth thoracic paraspinal muscle may be of certain clinical value in estimating the severity of disease especially the respiratory dysfunction in ALS patients.

To provide evidence for early clinical diagnosis of multiple system atrophy(MSA)by studying the characteristics of sympathetic skin responses(SSR) in the patients with MSA.

A total of 47 MSA patients and 32 healthy individuals were enrolled as case group and normal control(NC) group, from in and out patients of Neurology Department of Navy General Hospital from July 2013 to August 2015. SSR was tested by Nicolet electromyography, the latency and abnormal and disappeared rate of SSR were compared.

The SSR latency of upper limbs and lower limbs in MSA group had statistical significance compared respectively with the NCgroup (upper limbs: SSR latency was(1 485±187)ms in MSA group, and(1 375±108)ms in NC group, P<0.05; lower limbs: SSR latency was(2 200±386)ms in MSA group, and(1 994±240)ms in NC group,P<0.05). Sex and age had no significant effect on the latency and the abnormal and disappeared rate of SSR in two groups (P>0.05). The upper and lower limb SSR latency in MSA patients with disease duration more than 2 years(SSR latency was (1 592±160)ms in upper limb and (2 268±254)ms in lower limb) were longer than those within 2 years(SSR latency was (1 453±184)ms in upper limb and (2 190±442)ms in lower limb), but only the upper limbs had significantly statistical differences (P<0.05). Both SSR abnormal rate and SSR disappeared rate in MSA patients whose disease duration were more than 2 years(SSR abnormal rate: 85.00%, SSR disappeared rate: 75.00%) were higher than those with shorter disease duration(SSR abnormal rate: 55.56%, SSR disappeared rate: 22.22%), and both were statistically significant (SSR abnormal rate:P<0.05, SSR disappeared rate:P<0.001). The upper and lower limb SSR latency of MSA-C subgroup had no statistical difference compared with MSA-P subgroup(P>0.05). The SSR abnormal rate in MSA-C subgroup(78.13%) was higher than that of MSA-P subgroup(46.76%), and were statistically significant (P<0.05). The SSR disappeared rate in MSA-C subgroup has no statistical difference compared with the MSA-P subgroup(P>0.05).

SSR is helpful to diagnose MSA. The latency and the abnormal and disappeared rate of SSR are significantly increased with the extension of MSA duration. The SSR abnormal rate in MSA-C patients is higher than that in MSA-P patients, and symmetrically abnormal SSR is more supporting the diagnosis of MSA.

To investigate the pathogenesis, clinical presentation, imaging features and prognosis of spontaneous intracranial hypotension.

Clinical manifestation and imaging changes of 12 patients with spontaneous intracranial hypotension were reported. They were followed up regularly. The clinical and neuroimaging characteristics were summarized.

All the 12 cases were adults, presenting with orthostatic headache. They all recovered with conservative therapy. Head MRI demonstrated cerebral lobe hemorrhage, subdural hematoma, pituitary hyperemia, subarachnoid hemorrhage, enhancement of the pachymeninges, sagging of the brain, etc.

Spontaneous intracranial hypotension is characterized by orthostatic headaches and is associated with compensatory changes following loss of CSF volume. The long-time prognosis is not bad.

To determine the treatment efficacy of systemic chemotherapy combined with sequential CT-guided radiofrequency ablation (chemo-RFA) in the management of nasopharyngeal carcinoma (NPC) with liver metastasis.

A total of 427 NPC patients diagnosed with liver metastasis at Sun Yat-sen University Cancer Center between January 2000 and December 2013 were enrolled. Of the patients, 340 cases were male, 87 cases were female, the median age was 45 years (range 18-80 years), all patients received systemic chemotherapy and part of them also received RFA treatment. Patients were evaluated for response every two cycles during systemic chemotherapy and then every three months until death. One-to-one matched pairs between chemo-RFA group with chemo-only group were generated using propensity score matching; survival analysis was further conducted.

Of all the enrolled patients, 56 patients (13.1%) received combined treatment, 371 patients (86.9%)received chemotherapy alone. After propensity score matching, 56 pairs of well-matched liver metastatic NPC patients were selected from different treatment groups. The 1-, 3-, 5- year overall survival (OS) rates for chemo-RFA group were 89.2%, 45.5% and 32.5% and chemo-only group were 77.1%, 27.5% and 4.8% respectively; the 1-, 3-, 5- year progression-free survival (PFS) rates for chemo-RFA group were 64.0%, 25.4% and 10.7% and chemo-only group were 44.1%, 5.5% and 5.5% respectively.The adjusted hazard ratio in OS and PFS of the choice for chemo-RFA approach to chemo-only was HR 0.43, 95% CI 0.25-0.73 and HR 0.44, 95% CI 0.28-0.71 respectively.

CT-guided RFA combined with chemotherapy approach could improve the survival rate for NPC patients with liver metastasis.

To analyze MRI findings of renal cell carcinoma associated with Xp11.2 translocation-TFE gene fusion(Xp11.2 RCC).

MR imaging features of eleven patients with pathologically-proved Xp11.2 RCC were retrospectively analyzed from December 2008 to December 2015. The following MRI features of the lesions were analyzed in the study: location, maximal diameter, signal intensity, hemorrhage, necrosis, cystic change, enhancement features and metastasis. The data was analyzed by using t test.

Four men and seven women (mean age, 35.2 years; age range, 15-49 years) were included. Tumors occurred in the right kidney in 5 cases and the left kidney in 6 cases. On T₁WI tumors showed heterogeneously hypo-intensity and iso-intensity, hyper-intensity in 10 cases, 1 cases, respectively. On T₂WI tumors showed heterogeneously slight hypo-intensity, heterogeneously slight hyper-intensity and hyper-intensity in 6 cases, 4 cases, 1 case, respectively. On DWI tumors showed hyper-intensity and heterogeneously slight hype-intensity in 2 cases, 9 cases, respectively. ADC value of the tumors were statistically significant lower than that of renal cortex(×10^-3mm²/s)(1.35±0.20 vs 2.09±0.11, P<0.05). Imaging findings were suggestive of hemorrhage(n=4) or necrosis (n=1) or cystic change (n=6) or lipid(n=1) in the tumors. On dynamic contrast-enhanced imaging, tumors showed lower signal intensity change (96%±93%, 110%±86% and 103%±46%, respectively) than did renal cortex (285%±109%, 254%±97% and 225%±90%, respectively) (P<0.05). Tumor capsule showed in 7 cases. Enlarged lymph node was found in renal hilum in one case.

MRI findings may show characteristic features of Xp11.2 RCC combined with patients′ age and assist in preoperative correct diagnosis.

To investigate the predictive value of early lactate area for mortality in elderly patients with septic shock.

From January 2012 to December 2013, a prospective study was conducted in the Department of Critical Care Medicine, Qilu Hospital of Shandong University. A total of 115 septic shock patients with age ≥65 years were included in the study. Serum lactate was measured every 6 hours, the lactate indicators, including early lactate area, APACHE Ⅱ score etc were recorded.

The overall 28-day mortality rate was 67.0%. The top three primary infection sources were lung, abdominal cavity and bloodstream. When compared to survivors, non-survivors had significantly elevated early lactate area and APACHE Ⅱ score and lowered lactate clearance[(27.4±7.6) vs ( 20.3±6.5)], they were significantly more likely to have undergone mechanical ventilation, renal replacement therapy and inotropic or vasopressor support for ≥3 d, and more frequently displayed signs of cardiovascular, respiratory, and renal and hepatic dysfunction (all P<0.05) .Receiver Operating Characteristic curves indicated the lactate area score displayed a strong predictive power for 28 day mortality as indicated by an AUC of 0.758 (P<0.01) and had significantly greater predictive power when compared to the initial lactate or lactate clearance (allP<0.05).

In geriatric patients with septic shock, the early lactate area is a useful predictor for early death and showed better predictive value than other lactate indicators.

To investigate the clinical efficacy and safety of temporary heart pacemaker for emergency treatment of patients with acute and severe cardiovascular diseases.

The clinical data of 147 patients with cardiac arrest or bradyarrhythmia from August 2007 to December 2015, was analyzed retrospectively in Department of internal and Emergency Medicine, People′s Hospital of Henan. Based on the rescue methods, all patients were divided into two groups: observation group (80 cases, among whom, 49 cases with cardiac arrest and 31 cases with bradyarrhythmia) and control group (67 cases, among whom 39 cases with cardiac arrest and 28 cases with bradyarrhythmia). Patients in observation group received temporary heart pacemaker, and patients in control group received traditional cardio-pulmonary resuscitation and drug treatment. The rate of rescue and complications were analyzed and compared in two groups.

The total rescue rate in observation group was 96.3%, which was significantly higher than that in control group (44.8 %) (P<0.05). Further analysis showed that the rescue rate of patients with cardiac arrest in observation group was significantly higher than that in control group (95.1% vs 45.1%) (P<0.05), and the rescue rate of patients with bradyarrhythmia in observation group was significantly higher than that in control group (97.4% vs 44.4%) (P<0.05). Complications were observed in 4 patients: pericardial effusion (1 case ), ventricular fibrillation (1 cases) and catheter dislocation (2 cases).

Temporary heart pacemaker was safe and effective in the treatment of patients with acute and severe cardiovascular diseases with improved rescue rate.

To investigate the relationship among the prenatal ultrasound, prognosis and chromosome results of fetal bowel dilatation. And in order to further improve the positive rate of prenatal chromosome examination operation, and reduce the risk of missed diagnosis.

Ninety fetuses who were diagnosed as fetal bowel dilatation by prenatal ultrasound from June 2013 to December 2015 in the Second hospital of Jilin University were enrolled. Chromosomes were examined by amniotic cavity puncture or umbilical cord blood puncture. The change of fetus′s bowel was monitored periodically by prenatal ultrasound. The normal bowel movement of newborns was a good prognosis. The abdominal X ray or barium contrast radiography was performed in the newborns who did not have normal bowel movement after delivery. Patients underwent surgery or conservative treatment after diagnosis. Fetal karyotype analysis of aborted fetus was carried out by amniotic cavity puncture and umbilical cord blood before induction of labor. Autopsy was performed after induced labor. Patients who were not continued examination in our hospital were followed up by telephone.

Among the 90 fetuses, there are 11 cases of duodenum dilatation, 38 cases of jejunum and ileum dilatation, 41 cases of colorectal dilatation. Ten cases of duodenum dilatation were confirmed by autopsy after induced labor, and one case was lost in follow-up. Chromosome examination revealed 3 cases of 21- three body syndrome, 1 case of 18- three body syndrome, 1 case of chromosomal translocation. In 38 cases of jejunum and ileum dilatation, bowel dilatation of 26 cases had decrease or no obvious increase with good prognosis. Six cases of induced labor, 3 cases of receive surgery after birth, 2 cases of postoperative survival, and 3 cases of loss of follow-up. Chromosome examination revealed 1 case of 21- three body syndrome and 1 case of chromosomal translocation. In 41 cases of colorectal dilatation, 29 cases had good prognosis. Five cases were aborted, 1 case of fetal death, 2 cases died within 1 month after birth, 2 cases received surgery after birth and survived after operation, and 2 cases of loss of follow-up.

Clinical prognosis and the associated risk of chromosome abnormalities in patients with fetal bowel dilatation are different in terms of its expansion location and extent of the different, which need to a specific analysis of specific situations.

To explore the application value of assisted laparoscopic ultrasound in myomectomy.

One hundred and fifty six patients who underwent myomectomy in Beijing Obstetrics and Gynecology Hospital from 2011 to 2013 were enrolled.The patients were randomly divided into laparoscopic ultrasound guided group (n=57), laparoscopic group (n=54) and open resection group (n=45). The patients were followed up to calculate the residue and recurrence rates of uterine fibroids by vaginal ultrasound at 6th month and 12th-18th month after the operation. The residual and recurrence rates of the three methods were calculated and compared.

The recurrence rate of laparoscopic ultrasound guided group wassignificantly lower than that of laparoscopic group and open resection group (P<0.01) and (P<0.01). The residual rate of laparoscopic ultrasound guided group was also lower than that of laparoscopic group(P<0.05). However, there was no difference between the residual rates of laparoscopic ultrasound guided group and open resection group (P>0.05). When compared with open resection group, no difference was found in the residual and recurrence rates of laparoscopic group. The number of myoma was proportional to the residual rate and the recurrence rate. When the number of the myoma was more than 10, most of the cases existed residue.

The application of assisted laparoscopic ultrasound in myomectomy couldreduce the residual and recurrence rate of uterine fibroids.

To investigate the molecular mechanism of low-dose X-ray irradiation on osteoblasts by detecting the gene expression profiles of osteoblasts radiated with 0.5 Gy X-ray.

Microarray analyses to value the changes of gene expression of MC3T3-E1 osteoblasts after 0.5 Gy X-ray irradiation were conducted.The end points included modulation of key markers, and pathway and gene ontology through transcriptomic profiling and bioinformatics analysis. Several major genes during osteoblasts differentiation were selected for Real-time PCR analysis.

1 412 differentially expressed transcripts were identified between the radiated group and control group. Among the identified genes, 559 transcripts were up-regulated and 853 transcripts were down-regulated after irradiation.Real-time PCR analysis indicated that the mRNA expressions of Bglap-rs1, Col1a2, Tgf-β1, Lrp5, Dvl1, Map4k5 were apparently higher than that of the controls (P<0.01), whereas the Id2 and Dkk1 expression decreased under the same condition(P<0.01). Western-blot analysis indicated TGF-β1 and Lrp-5 protein expression increased and Dkk1 expression decreased(P<0.05). Pathway analysis and gene ontology analysis revealed that focal adhesion, extracellular signaling, cytoskeletal protein binding, Wnt signal pathway, IκB /NF-κB signal pathway and growth factor receptors activities.

Low-dose X-ray radiation promoted osteoblasts differentiation in which focal adhesion, extracellular signaling, cytoskeletal protein binding, Wnt signal pathway, IκB /NF-κB signal pathway and growth factor activities might be involved.

To investigate the effects of testosterone (T) on inflammatory cytokines (IL-6, MCP-1) production, insulin sensitivity of adipocyte and changes of macrophage phenotypes in indirect co-culture of RAW264.7 macrophages and 3T3-L1 adipocytes.

3T3-L1 preadipocytes were induced to mature in Transwell lower chamber, and then co-cultured with RAW264.7 macrophages in the upper chambers for 72 hours. Testosterone 10 μmol/L was added into indirect co-culture for 24 h. ELISA was used to testing IL-6, MCP-1 concentrations in supernatant. Western blot was used to detecting the phosphorylation of NF kappa B, ERK1/2, and theexpression of CD16/32 and CD206. Glucose transport was assessed by[ ³H]2-deoxy glucose uptake in adipocytes.

Testosterone enhanced inflammatory cytokines (IL-6, MCP-1) production in indirect co-culture of 3T3-L1 adipocytes and RAW264.7 macrophages, promoted the activation of ERK1/2 and nuclear factor kappa B p65, and inhibited glucose uptake in adipocytes. Testosterone facilitated the production of pro-inflammatory M₁ macrophages. The above effects of testosterone can be completely reversed by PDTC, and can be partly reversed by PD98059 (70%-90%).

NF kappa B and ERK1/2 could be the key proteins for testosterone to promote the production of inflammatory factors, to lead to insulin resistance, and to make macrophages differentiate to pro-inflammatory phenotypes in co-culture of RAW264.7 macrophages and 3T3-L1 adipocytes.

To investigate the expression pattern of beta-amyloid (Aβ) in rats after focal cerebral cortex infarction, and to identify whether the Aβ expression in the ipsilateral thalamus was directly related to focal cerebral ischemia.

The distal middle cerebral artery occlusion (MCAO) was performed by electrocoagulation in rats. The rats were divided randomly into sham group (n=18) and MCAO group (n=30) . We used 2, 3, 5-triphenyltetrazolium chloride (TTC) staining and immunohistochemical staining to detect the location of cerebral infarction and Aβ expression, respectively.

TTC staining showed that the cerebral infarction was consistently restricted to the frontal and temporoparietal cortex. In the peri-infarct area of the MCAO group, Aβ expression began at day 2, reached the maximum level at day 7, and disappeared almost completely at day 28 after MCAO. The Aβ appeared as diffuse small dots, and was located in neurons and astrocytes at day 2 and day 28, respectively. Meanwhile, in the ipsilateral thalamus, Aβ expression began at day 3, increased markedly at day 7, and remained until day 28 after MCAO. The Aβ was located constantly in the extracellular region of the ipsilateral thalamus, and aggregated gradually from small dots to dense plaque-like deposits with the time of ischemia.

There are dynamic changes of Aβ expression in both the peri-infarct area and the ipsilateral thalamus following MCAO. The Aβ expression in the ipsilateral thalamus is not directly related to focal cerebral ischemia.

To establish a model of endometriosis in immunodeficient nude mice and compare the outcome of the model construction between two different techniques.

Eighteen nude mice were divided into 2 groups, with 9 mice in each group. All nude mice received a subcutaneous transplantation of endometrial fragments, followed by sutured the wounded skin (sutured group) or not (no-sutured group). Then the success rate of the model construction, inflammation of the wounds and the animal survival rate in the two groups were analyzed.

In no-sutured group, the survival rate of animal and the success rate of the model construction were 9/9 and 8/9 respectively, with 8/9 survival rate and 7/9 success rate in sutured group. No significant difference was found between the two groups. And no obvious inflammation was presented in the wounds for both groups.

It is an effective method to establish animal model of endometriosis by subcutaneous transplantation in nude mice. After transplantation, it does not affect the outcome of the survival rate of the animal and the success rate of the model construction whether we suture the wounded skin. Considering the shorter operation time, we found it′s a simpler and time saving method to establish endometriosis by subcutaneously transplanting endometrial fragments in nude mice with no skin-sutured. And this model is worth of promotion.

Case 1: A 44-year-old female was admitted to hospital for more than 1 year due to low back pain accompanied by frequent urination, urgency, painful urination and hematuria. Ultrasonic findings: The bladder is well filled, and the bladder walls around the bilateral ureteral openings are irregularly thickened and the surface is uneven. Ultrasound revealed changes around the vesicoureteral opening, considering inflammation or space occupation; Further examination is recommended. Cystoscopy showed dozens of follicles with a diameter of 0.4 to 0.5 cm scattered in the bladder triangle. Intraoperative pathological examination showed follicular cystitis.

A 39-year-old woman was admitted with the complaint of finding a posterior mediastinal mass for 10 days. CT of the chest and upper abdomen showed that the posterior mediastinum occupied space, considering the possibility of cyst, esophageal cyst or bronchial cyst was suspected (Figure 1)。 Further endoscopic ultrasound examination revealed a smooth spherical bulge in the esophagus 30-38 cm away from the incisors. The ultrasound probe was placed at the bulge and scanned, and a hypoechoic mass in the third and fourth layers of the local esophageal wall ultrasound structure was found. The ultrasound section size was 7.0 cm ×6.5 cm, adjacent to the aorta. Submucosal mass of the esophagus, consider: (1) stromal tumor, (2) cyst. Physical examination and laboratory tests showed no positive results. An artificial pneumothorax thoracoscopic exploration + thoracoscopic assisted posterior massive mediastinal mass resection was performed on 11 Jan 2016.

A 34-year-old female suffered from intermittent headache and dizziness for 5 years, which worsened with nausea in the last month. Physical examination: full moon face, buffalo back and centripetal obesity, skin congestion and ecchymosis immediately after minor trauma. Enhanced magnetic resonance imaging (MRI) of the pituitary gland showed that a circular hyposignal shadow was seen in the right part of the pituitary gland, with a size of about 0.7 cm ×0.5 cm, and the enhancement degree was lower than that of the normal parenchyma of the pituitary gland. Transnasal sphenoidal pituitary tumor resection was performed on 31 Mar 2016. The pathological diagnosis was an adrenocorticotropic hormone (ACTH) type pituitary adenoma. The surgical approach was transnasal sphenoidal pituitary tumor resection. The patient underwent routine potassium supplementation after operation, but had transient severe hypokalemia symptoms. The changes of serum potassium ion levels before and after surgery in patients are shown inFigure 1。

Gestational trophoblastic diseases (GTD) are a group of trophoblastic diseases derived from abnormal spreading capacity and invasive properties. Generally including 5 diseases: hydatidiform mole, erosive hydatidiform mole, choriocarcinoma (referred to as choriocarcinoma for short), placental trophoblastic tumor and epithelial trophoblastic tumor, the general incidence rate is 0.8%^[1]Hydatidiform mole is the most common disease. Except for hydatidiform mole, all other four diseases are malignant diseases, collectively referred to as gestational trophoblastic tumor (GTN). Doppler ultrasound is a non-invasive examination method that can accurately assess and measure blood flow. Doppler ultrasound includes: color Doppler, energy Doppler, and spectral Doppler. Color Doppler evaluates the direction of blood flow based on changes in frequency. The energy Doppler mechanism lies in amplitude variations and is therefore more sensitive to low flow rate blood flow, but does not provide flow direction information. Spectral Doppler can measure blood flow velocity and its related parameters by changing the waveform. The most commonly used Doppler indexes are: systolic-diastolic ratio (S/D), resistance index (RI) and pulsatility index (PI). Studies have found that ultrasound Doppler examination in patients with GTN can obtain the same results as pelvic arteriography, such as tumor size and tumor location, so ultrasound Doppler instead of arteriography is increasingly widely used and clinical^[2]。 The application of ultrasound in trophoblastic diseases is reviewed as follows.

In recent years, with the advancement of medical technology in intensive care units (ICUs), more and more critically ill patients have survived, but many patients are often accompanied by muscle weakness that lasts for months to years after discharge. This myasthenia acquired by critically ill patients during ICU hospitalization is called ICU-acquired weakness (ICUAW), and the most common causes are critical illness myopathy (CIM) and critical illness polyneuropathy (CIP), but both can also exist at the same time, which is called critical illness polyneuromyopathy (CIPNM).^[1,2]。 At present, it is considered that the incidence of CIM is at least 3 times higher than that of CIP, accounting for more than 50% of ICUAW^[1]。