Volume 96  ·  Issue 37  ·  2016

Dementia is a clinical syndrome characterized by cognitive impairment, and Alzheimer's disease (AD) is the most common cause of dementia, accounting for 60% to 80%. The prevalence rate of dementia in China is 7.2%, which is higher than the global average of 6.2%. The total number of dementia is 15 million, accounting for 1/4 of the world. Among them, AD exceeds 10 million, which is equal to the total number of dementia in developed countries in the world. The prevalence rate increases with age. The prevalence rate is 4% under 65 years old, 15% between 65 and 74 years old, 44% between 75 and 84 years old, and 58% over 85 years old. The prevention and treatment situation is very severe^[1]。

To study the impairments of cognitive function in first-episode schizophrenia and the potential effectiveness of risperidone and olanzapine monotherapy on first-episode schizophrenia.

A total of 57 first-episode schizophrenia and 30 healthy controls were assessed at baseline, and patients were assessed again after 8-week antipsychotics therapy.

The positive and negative symptom scale (PANSS) reductive ratio between the two groups was similar. At baseline, the performance of schizophrenia patients was significant poor than healthy controls in the four domains of cognitive function (P<0.05); after 8-week′s antipsychotics therapy, the performance of Trail Making Test (t=3.862, P<0.05) and Verbal Learning (t=-3.073, P<0.05) got significant improvements in patients with risperidone, while in group of patients with olanzapine, the performance of Trail Making Test (t=3.587, P<0.05) and working memory domain (t=-2.891, P<0.05) got significant improvements. Spearman correlation analyses suggested that dosage of risperidone was negatively correlated with the score-reducing rate of the performance of Trail Making Test of patients (r=-0.391, P=0.048).

The effects of the two psychotroptic drugs on clinical symptoms and cognitive functions are almost equal. Comprehensive cognitive impairment is found in first-episode schizophrenia, and risperidone and olanzapine could partially improve the performance of cognitive function as well as clinical symptoms. The higher the dosage of risperidone is, the less improvement the patients has in the speed of process domain.

To investigate whether or not the involvement degree of extensor and flexor muscles in patients with Kennedy′s Disease (KD) was different by measuring the diameter of biceps and triceps brachii muscles using Magnetic Resonance Imaging (MRI).

All the subjects were outpatients or hospitalized patients from Department of Neurology, the Third Hospital of Peking University, 2011-2015. Subjects included 30 KD patients and 30 amyotrophic lateral sclerosis (ALS) patients. The right upper arms of all subjects were examined by muscle MRI. The diameters of biceps and triceps brachii muscles were measured, then the ratios were calculated. Additionally, the forces of these muscles were recorded.

The ratio of diameters of biceps to triceps brachii muscles were 1.08±0.14 in KD patients and 0.99±0.15 in ALS patients. The difference was statistically significant (P<0.05). The ratio of forces of biceps to triceps were 1.17±0.12 in KD patients and 0.98±0.28 in ALS patients. The difference was statistically significant (P<0.01). In KD patients, the fatty infiltration was more serious in triceps than biceps. At the same time, in ALS patients, the fatty infiltration was similar in triceps and biceps.

The involvement degree of extensor and flexor muscles in KD patients is different.

To explore the clinical and perfusion weighted imaging (PWI) characteristics of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) in order to improve the early diagnosis rate.

Clinical and imaging data of 46 patients with final diagnosis of MELAS treated in Henan Province People′s Hospital from January 2012 to June 2016 were collected.

Patients presented with symptoms of epilepsy, hemiplegia, language disorders, and decreased visual acuity and so on. Diffusion-weighted imaging (DWI) of the lesion area showed a high signal, apparent diffusion coefficient (ADC) chart with the course of disease development can be a high signal, low signal, high and low signal. Vascular stenosis was not seen in all the patients by magnetic resonance angiography (MRA). PWI perfusion increased in acute phase and was normal or decreased in the chronic phase.

The clinical manifestations of MELAS patients are complex and various, and lack of specificity. Routine MRI examination is of great significance for the screening of the lesion, which has a characteristic performance and is helpful to improve the early diagnosis rate of the disease.

To evaluate the value of multi-parametric MRI (Mp-MRI) in the diagnosis and differential diagnosis of early prostate cancer(PCa) in the peripheral zone(PZ) and low T₂WI signal intensity of prostatitis.

A total of 40 patients with PZ early PCa and 37 with prostatitis of hypointense T₂WI signal in PZ were retrospectively analyzed, which were collected from the General Hospital of Ningxia Medical University from Janurary 2009 to June 2015, who underwent T₂WI, DWI, and DCE-MRI examination and all patients were confirmed by pathology. All the data was transferred to GE Advanced Workstation AW4.3, the indexes divided into cancerous and prostatitis regions were calculated by Functool2 of signal intensity-time(SI-T) curve and ADC value, to calcuate the time to minimum(T_max), the whole enhancment degree (SI_max). ROC cure was used to determine the cutoff value for PCa detection with the ADC value.

On T₂WI, 57.5% of PCa (23/40) showed focal nodular homogeneous low signal intensity, 70.3% of prostatitis(26/37) showed diffuse inhomogeneous low signal intensity. DCE-MRI, the distribution of curve types for malignant tumors was type Ⅰ 2.5%(1/40), typeⅡ32.5%(13/40) and type Ⅲ 65.0% (26/40). While the numbers for prostatitis was type Ⅰ 16.2%(6/37) , type Ⅱ 56.8% (21/37) and type Ⅲ 27.0% (10/37)respectively.The patterns of curve types in malignant lesions were different from benign lesions significantly(χ² =12.32, P<0.01). The mean values of T_max, SI_max in cancerous and prostatitis regions were (17.96±2.91)s, 1.76%±0.23% and (21.19±3.59)s, 1.53%±0.18%, respectively (t=5.37, 6.10; P<0.01). On DWI, The mean ADC values in cancerous and prostatitis regions were (0.95±0.13)×10^-3 mm²/s and (1.12±0.13)×10^-3 mm²/s, respectively (t=7.10, P<0.01). According to the ROC analysis, when the cutoff value was 1.01×10^-3 mm²/s, the early PCa of diagnostic sensitivity, specificity and accuracy was 79.1%, 72.7% and 76.1% respectively.

Combined with morphology and signal characteristics of conventional T₂WI, DWI and DCE-MRI improve the power of MR imaging in discriminating prostatitis from early PCa.

To evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with cryoablation in patients with unresectable large hepatocellular carcinoma (HCC).

A total of 122 patients with unresectable large HCC admitted to the First Affiliated Hospital of Sun Yat-sen University between November 2011 and July 2015 were retrospectively involved.The patients were divided into study group (58 patients who underwent TACE combined with cryoablation) and control group (64 patients who underwent TACE alone). Short-term effect of the initial treatment, long-term effect, prognostic factors for survival and adverse reactions were statistically analyzed.

There was no statistical difference in general information between two groups. The effective rates of the study and control group were 29.3% and 10.9% (P=0.011), and the control rates were 79.3% and 62.5% (P=0.042). The median survival time was 11.0 months (95% CI 7.4-14.6) for the study group and 5.0 months (95% CI 4.0-6.0) for the control group, the 6-, 12-, and 18-month overall survival rates for the study and control group were 84.5%, 49.5%, 26.8% and 48.1%, 17.8%, 11.1%, respectively (all P<0.01). On multivariate analysis, negative distant metastasis, Barcelona Clinic Liver Cancer B-stage, neutrophil-to-lymphocyte ratio ≤5, alpha fetoprotein<400 μg/L, combined treatment and effective initial treatment were independent protective factors for survival of patients with large HCC.

The prognosis of patients with unresectable large HCC is affected by multiple factors. In comparison with TACE alone, TACE combined with cryoablation has advantage in both short-term and long-term effect with low incidence of serious adverse reactions, it is an effective and safe treatment option for patients with unresectable large HCC.

To explore the influence of the labro-chondral complex (LLC) on the development of the acetabulum after close reduction in developmental dysplasia of the hip (DDH).

Sixty-one cases (72 hips) with DDH presented in Beijing Jishuitan Hospital were reviewed, all the patients were treated by closed reduction, arthrogram and Spica casting from March 2010 to December 2013. The anterior-posterior pelvic radiography was performed to evaluate the morphology of the labro-chondral complex and reduction of the hip. The cases were divided into Ⅰ, Ⅱ, Ⅲ, Ⅳ four groups according to the shape of the LLC initially, and when performed the secondary Spica cast after 3 months, these cases were divided into 0-0.4, 0.4-0.6, and >0.6, three groups based on the height difference ratio (HDR) of the LLC. The relationship between the shape and HDR of the LLC was analyzed. The AI and CE angle were used to evaluate development of the hip during the latest follow up. The impact of the shape and HDR of the LLC on the development of the acetabulum was explored as well.

The HDR was the least in the type Ⅰ hips, all cases were less than 0.6, the AI in this group was significantly lower than the others(24.33°±3.12°), and the CE angle was significantly higher in the type Ⅰ hips(15.22°±3.11°) during the latest follow up. The CE angle was significantly different among the three groups of HDR. The HDR was lower, the CE angle was higher. The AI in 0-0.4 group was significantly lower than the others(14.24°±3.10°).

The shape of the LLC is helpful to judge development of the acetabulum when closed reduction was performed in DDH. And the HDR in the secondary cast change could be used as a sensitive index to predict development of the hip.

To evaluate the mid-term clinical efficacy of plate and intramedullary nail for humeral shaft fracture.

In this retrospective study a total of 122 patients with humeral shaft fracture were divided into 2 groups according to surgery type from May 2010 to July 2012. There were 63 patients in plate group and 59 patients in intramedullary nail group. The factors related to the operation for each group were compared respectively. The clinical outcome was evaluated by the Neer scores, Myao scores and EuroQol 5 dimensions scores (EQ-5D). All the patients were followed up periodically in the next 3 years.

There were no significant differences between the two groups on hospital stay and time of returning to work (P>0.05). While the operation time, amount of intraoperative blood loss and complication rate were less in intramedullary nail group. The mean follow-up duration was (41.2±4.2) months in plate group and (42.1±4.7) months in intramedullary nail group respectively. At the last follow-up the postoperative Neer scores, Myao scores and EQ-5D scores showed no significant differences between the 2 groups[Neer: (93.8±6.1) vs(92.1±4.2); Myao: (94.9±2.9) vs(96.2±1.5),P>0.05]. There were no cases complicated with nonunion, delayed union, infection and deformity during the follow-up period.

The mid-term outcome of open reduction and internal fixation with plate and close reduction with intramedullary nail for humeral shaft fracture is satisfactory. Although both surgeries are safe and effective, they also have some defaults. The doctors should choose the right surgery carefully according to the actual situation of the patients.

To evaluate the clinical results of the patients with severe kyphosis and paraplegia in different spine segment due to tuberculosis of thoracic and lumbar had been treated by one stage posterior surgical procedure to debriment of lesion and titian mesh bone fusion with internal fixation by pedicle screw system.

From May 2008 to March 2014, there were total 30 patients with severe kyphosis and paraplegia in different spine segment due to tuberculosis of thoracic and lumbar in Department of Orthopaedics, the People′s Hospital of Xinjiang Uygur Autonoumy Region.The average age was 27 years, ranging from 11-65 years old, 21 male and 9 female.Tuberculosis lesion were located in differental spine segment: T_3-54 four cases, T_6-10 ten cases, T₁₁-L₂ twelve cases, L₃-L₅ four cases, two vertebral bodies were involved in 6 cases, three vertebralbodies were involved in 12 cases, and four vertebral bodies were involved in 10 cases.All patients were treated by one stage posterior surgical procedure to debriment of lesion and titian mesh bone fusion with internal fixation of pedicle screw system .There were investigated the period of bone grafting fusion, kyphosis deformity correction degree , ESR, CRP preoperatively and postoperatively were compared before and after operation, and neurological function recovery record postoperatively, and neurological function recovery record postoperatively.

In the final follew-up, all patients got solid fusion in a average of eight months.The kyphosis deformity was corrected from(77±12)°preoperatively to(9.7±1.6)°postoperatively, in a average of 57°, the result is significant(P<0.05). The value of ESR degraded from(64±44)mm/h preoperatively to(15±7)mm/h, through statistic analyzing, the change of ESR value between postoperative and preoperative is significant(P<0.05) .The value of CRP degraded from(72±40)mg/L preoperatively to(13±5)mg/L postoperatively, via statistic analyzing, the change of CRP value between postoperative and preoperative is significant(P<0.05). All Patients neurological function deficiency achieved complete recovery, the longest time being within 8 months.All patients were cured thoroughly and there was no seroius complication.

The one stage debriment of lesion and threaded fusion cage with internal fixation of vertebral pedicle surgical procedure, according to the extent of severe kyphosis and paraplegir due to tuberculosis of thoracic and lumbar vertebrae can achieve thoroughly debridement of tuberculosis, solid interbody fusion, good correction of deformity and forever stability of spine with posterior internal fixation, it get successfully rehablitation for neurological function and improve the life quality.

To investigate the clinical characteristics and treatment of pituitary adenomas of childhood and adolescence.

Thisarticle was a retrospective study of 140 pituitary adenomas of childhood and adolescence that was admitted into Peking Union Medical College Hospital from December 1987 to December 2014, whose clinical manifestations, hormone secretions, images, pathological types, surgical complications and follow-ups were studied.

A total of 58 (41.4%) males and 82 females (58.6%) were included, whose mean age was 12.5 years old (age range from 7 to 18). As for the type of tumors, ACTH adenoma, PRL adenoma, GH adenoma, non-functional adenoma and multiple-secreting adenoma accounted for 35.7%, 25.7%, 12.2%, 25.7% and 0.7%, respectively. Microadenoma accounted for 33.6% of total patients, while macroadenoma and giant adenoma accounted for 60.0% and 6.4% respectively. 19.3% of adenomas in our study wereinvasive. Transsphenoidal approach surgery was commonly used and accounted for 97.9% of cases in our study, 2 of which used intraoperative navigation assistance. Total resection was achieved in 93.6% of patients, and the rest achieved subtotal resection. 108 (77.1%) patients got full term follow-up until 1 year after surgery, and tumor recurred in 14 patients (13.0%).

ACTH-secreting adenoma is the most common pituitary adenoma in childhood and adolescence which need surgical treatment. Transsphenoidal approach surgery is the most commonly used surgical procedure. The recurrence rate is about 13%, and the patients need regular examination of pituitary hormones and image study to confirm the recurrence.

To analyze the prognosis of surviving monochorionic co-twin after single intrauterine fetal demise (sIUFD).

Retrospectively analyzed the twin pregnancy cases admitted in Peking University Third Hospital between Jan 2008 and Feb 2015. We recorded perinatal characteristics, neuroimage in co-twin, and followed up the neonatal outcome.

47 cases were found, including 45 cases of monochorionic diamniotic (MCDA) and 2 cases of monochorionic monoamniotic (MCMA). Median gestational age at sIUFD was 27 weeks.Median interval between sIUFD and birth was 3.3 weeks.Median gestational age at birth was 34.2 weeks.The causes of sIUFD were: MCMA (2/47, 4.3%), sIUGR (11/47, 23.4%), twin-twin transfusion syndrome (TTTS) (16/47, 34.0%) or TTTS complicated with sIUGR (3/47, 6.4%). In the sIUGR pregnancies, sIUFD occurred all in the growth-restricted fetus.In the TTTS pregnancies, sIUFD always occurred in donors (15/16, 93.8%). There were 41 (87.2%) live-born co-twins.Among the live births, fetal cranial ultrasound showed that 7 neonatus got intraventricular hemorrhage.There were 6 neonatus dead in first 28 days.All of the 35 survivors whose follow up from 12 to 70 months, responses were all received and nobody had cerebral palsy.

sIUFD always occurred in the growth-restricted fetus and the donor-twins. There was nobody had cerebral palsy in the survivors.

To investigate the effect of IFNα on doxorubicin-induced apoptosis in human osteosarcoma cells with its molecular mechanisms to provide evidences for improving the treatment of osteosarcoma.

Osteosacoma U2OS and MG63 cells were treated with IFNα and Doxorubicin, alone or in combination, for 72 h . Cytotoxicity was determined with MTT. Apoptosis was evaluated through fluorescence-activated cell sorting, Hoechst33258 staining and DNA ladder assay. The expression of p53, Bax, Bcl-2, Mdm2, p21, caspase-3 and PARP was determined with Western blot. siRNA interference was used to silence p53.

IFNα treatment for 72 h did not induce cytotoxicity but greatly enhanced doxorubicin-induced cytotoxicity and apoptosis in p53-wild U2OS cells but not p53-mutant MG63 cells. Compared with other groups, the combination of IFNα and doxorubicin induced more obvious apoptotic morphological changes and DNA ladder. IFNα did not alter the expression of the indicate genes. The expression of p53, Bax, Mdm2 and p21 was up-regulated by doxorubicin and further increased in response to combination. The expression of Bcl-2 was down-regulated by doxorubicin and further decreased in response to combination.There were no differences among groups in MG63 cells. The expression of p53 was effectively blocked by p53-siRNA in U2OS cells. The p53 silencing greatly reduced the cytotoxicity mediated by combination for 72 h, compared with non- and control-siRNA groups. The activation of caspase-3 and PARP mediated by combination was largely suppressed by p53 silence.

IFNα sensitizes human osteosarcoma cells to doxorubicin-induced apoptosis through p53-dependent pathway. The combination of IFNα and traditional chemotherapy can be used in osteosarcoma treatment.

To investigate the destructive effects of erythromycin on biofilm of MRSA and find the effect of erythromycin on QS related factors.

Tested the MBC of erythromycin on MRSA.Established the model of biofilm.Erythromycin was added into the medium when bacteria were inoculated for 24 h. Tested the biofilm and collected the supernatant or serum of rat at 6, 12, 24, 48, 72 h and 7 d after adding erythromycin to detect the concentration of autoinducing peptides (AIP).

The MBC of the erythromycin on standard strains of MRSA was 256 g/L.There is a decreasing tendency of biofilm in a short time after adding erythromycin or TSB and then gradually increase until to a steady state. Biofilm of experimental group(1.348, 1.236, 1.667)were significantly less than the control group(1.789, 1.712, 2.349, P<0.05)at 12, 24, 48 h. Adding erythromycin to the mature biofilm, there was a significant decrease of biofilm.Adding erythromycin within 3 hours after inoculating bacteria, there was no bacterial growth or biofilm formation. The development trend of AIP was similar with biofilm and AIP happened earlier than biofilm.With the intervention of erythromycin, AIP of experimental group(0.891 5, 0.853 9, 0.792 4)were significantly less than the control group(1.023 7, 1.061 6, 1.034 7,P<0.05)at 6, 24, 48 h.

Adding erythromycin timely before biofilm formation, then bacteria were killed effectively.Erythromycin was able to destroy biofilm. Biofilm was inhibited by AIP obviously.To some extent, erythromycin can inhibit the synthesis or secretion of AIP.

To investigate the survival impact of systematic retroperitoneal lymphadenectomy (SL) and unsystematic lymphadenectomy (USL) in patients with epithelial ovarian cancer.

Randomized control trial (RCT) and observational studies about the effects of SL and USL on patients with epithelial ovarian cancer were searched in major online databases including PubMed, Embase, Web of Science, and Cochrane Library. The literature search was performed up to January 2016. The results were analyzed using RevMan 5.0 software.

Totally 14 studies including 1 634 patients in SL group and 1 719 patients in USL group were enrolled. Three of the 14 studies were RCTs, and the other 11 were observational studies. Meta analysis showed that SL was a favorable factor for 5-year overall survival rate (5-OS) compared with USL[RR=0.89, 95% CI (0.81, 0.97), P=0.007]. However, the efficacy of SL on increased 5-OS could not be determined in all type of studies owing to the result of RCTs[RR=0.99, 95% CI (0.85, 1.15), P=0.90], whereas SL improved 5-OS of patients in observational studies[RR=0.84, 95% CI (0.76, 0.93), P=0.001]. Moreover, SL increased 5-OS in patients with early stage (FIGO Ⅰ-Ⅱ) disease comparing with USL[RR=0.78, 95% CI (0.61, 0.99), P=0.04], as well as it could improve 5-OS statistically in advanced stage (FIGO Ⅲ-Ⅳ) disease[RR=0.90, 95% CI (0.82, 0.99), P=0.03]. But analysis on patients with optimal debulking surgery showed that SL could not improve 5-OS of these patients, regardless of early stage[RR=0.71, 95% CI (0.43, 1.17), P=0.18]or advanced stage[RR=1.01, 95% CI (0.90, 1.14), P=0.86].

The impact of SL on the survival of patients with epithelial ovarian cancer is still extremely controversial, which requires more relevant RCTs. In patients with optimal debulking surgery, SL could hardly improve the survival.

The patient was a 36-year-old male, weighing 50 kg, classified as Class III by the American Association of Anesthesiologists (ASA), with a history of hepatitis B virus for more than 30 years. He was diagnosed with right liver cancer and tumor thrombosis of portal vein and inferior vena cava. CT of the upper abdomen showed that the liver occupied space, and the right posterior lobe of the liver was partially ruptured, accompanied by tumor thrombosis of portal vein, right hepatic vein and inferior vena cava; Transthoracic color Doppler ultrasound (TTE) showed a 3.5 cm ×3.7 cm embolus at the entrance of the inferior vena cava to the right atrium, and the blood flow from the inferior vena cava to the right heart was obviously blocked and accelerated, V_max=2.9 cm/s (Figure 1)。 Right hemihepatectomy with preservation of middle hepatic vein + removal of tumor thrombus of portal vein and inferior vena cava was proposed under general anesthesia. After entering the operating room, peripheral venous access was opened and routine monitoring was performed: blood pressure 135/75 mmHg (1 mmHg =0.133 kPa), heart rate 85 beats/min, SpO₂100%。 Left radial artery puncture and catheterization were performed under local anesthesia, and invasive arterial pressure was monitored. Anesthesia induction: intravenous midazolam 5 mg, propofol 60 mg, cis-atracurium 10 mg and sufentanil 50 μ g. After successful tracheal intubation, a transesophageal cardiac ultrasound (TEE) probe is placed into the esophagus. First, the probe is placed in the two-chamber cardiac section of the middle esophagus (ME) to confirm the location of the tumor thrombus, and the temporary filter implanted into the inferior vena cava through the superior vena cava is guided (FIG. 2A)。 Thereafter, the size of each chamber, wall thickness, opening and closing of each valve, and the presence or absence of tumor thrombus invasion were further evaluated by ME four-chamber heart section, left ventricular long axis section, aortic short axis section and right ventricular inflow-outflow tract section, and aortic long axis section (Figure 2B)。 Transesophageal cardiac ultrasound (TEE) was used to further track the inferior vena cava to the confluence of the hepatic vein on the basis of the two-chamber cardiac section. It was found that the inferior vena cava was slightly expanded, with a diameter of 2.4 cm, and obvious blood flow stasis in the hepatic vein and inferior vena cava was observed (Figure 2C)； The distance from the right hepatic vein flowing into the inferior vena cava to the embolus was measured to be about 6.0 cm, which provided a reference for the operator to remove the thrombe. After the evaluation, the probe returned to the two-chamber cardiac section to observe the position of tumor embolus and temporary filter in real time. During the operation, it was found that the tumor thrombus moved forward and backward with the operation, which was most obvious when the sickle ligament of the liver was incised, the superior hepatic segment of the inferior vena cava and the surrounding hepatic veins were exposed, and the right deltagonal ligament and coronary ligament were separated. When the operator dragged out the tumor thrombus through the inferior vena cava, ECG monitoring showed: sudden supraventricular tachycardia, heart rate up to 165 beats/min, blood pressure dropped to 57/35 mmHg, SpO₂Maintain 99% ~100%, immediately give phenylephrine 40 μ g, blood pressure gradually rise; TEE showed that the blood flow of inferior vena cava was unobstructed. Immediate follow-up of ME four-chamber cardiac section, right ventricular inflow-outflow section, and short axis section of ascending aorta showed no abnormalities in heart movement and blood flow in the main pulmonary artery and left and right pulmonary arteries. After 2 min, the patient's blood pressure returned to normal, the supraventricular tachycardia automatically changed to sinus rhythm, and the heart rate decreased to 75 beats/min. After that, the patient's hemodynamics was stable, and the temporary filter was pulled out after the operation. After the patient's breathing was stable, the tracheal tube was removed and sent to ICU.

A 65-year-old male was admitted to the hospital on December 15, 2015 due to chest tightness and shortness of breath after activity for more than 1 year, and edema of both lower limbs for 1 month. The patient denied a history of hypertension. Physical examination: A persistent systolic murmur was smelled in the second intercostal area at the left margin of the sternum, and depressed edema of both lower limbs. Serum cardiac troponin T (cTnT) 0.251 μ g/L. The electrocardiogram showed the features of acute anterior wall and anterior septal myocardial infarction. Bilateral coronary pulmonary fistula (CPF) revealed by cardiac ultrasound. Preoperative diagnosis: bilateral CPF. Intraoperative coronary angiography revealed bilateral CPF [anterior descending artery emitting 2 branches (FIG. 1A), 1 branch from the right coronary artery (FIG. 2A)], the maximum diameter of the left fistula was about 3 mm, and the right fistula was about 4 mm. Intraoperatively, the tube was embolized with mechanically detachable coils (Helix EV3 Axium 3D and 2D). Coronary angiography revealed complete closure of bilateral fistulas after operation (FIG. 1B，Figure 2B)。 There were no major surgical complications such as coil displacement and coronary artery occlusion. After operation, the patients were treated with oral aspirin antiplatelet therapy. The symptoms of the patients were relieved 3 days after operation. After 3 months after operation, cardiac ultrasound examination showed no abnormal blood flow in bilateral coronary arteries.

neuromyelitis optica spectrum disorders (NMOSD) is a central nervous system autoimmune disease associated with serum aquaporin-4 immunoglobulin G antibody (AQP4-IgG). Breakthrough research progress has been made in recent 10 years. As its understanding continues to grow, the International Neuromyelitis Optica (NMO) Diagnostic Group published a new International Consensus on Diagnostic Criteria for NMOSD in July 2015, referring to NMO and NMOSD collectively as NMOSD in view of further understanding of the disease.

The earthquake of magnitude 8.0 on the Richter scale occurred at 14: 28 on May 12th, 2008, with its epicenter in Wenchuan County, Sichuan Province. It is the earthquake with the highest magnitude, the largest damage intensity, the largest death toll and the most serious economic loss in China since the Tangshan earthquake in 1976. After a major natural disaster, material loss and physical pain will be rebuilt and recovered, but the psychological stress caused by the disaster will have a long-term impact on the experiencer of the disaster. After the Wenchuan earthquake, the first large-scale psychological assistance after disaster was carried out in China. Disaster psychology has attracted attention in the field of rescue and psychology, and has been paid attention by the society. This study summarizes the related research on disaster psychology after Wenchuan earthquake in China by consulting the existing literature. English documents were searched in PubMed, Web of Science and PsyCINFO, and the key searches were "Wenchuan Earthquake", "mental health", "Psychological reaction" and "stress". Chinese documents were searched in CNKI (China Academic Journals Network Publishing Database and Chinese Important Conference Papers Full Text Database), and the key searches were "Wenchuan Earthquake", "512 Earthquake", "mental health", "Psychological reaction" and "stress". After screening, 232 articles in English and 251 articles in Chinese were retrieved. Further to the literature combing and classification, selected post-traumatic stress disorder, post-traumatic growth, post-disaster group reflection, post-traumatic stress disorder treatment and other aspects to summarize and analyze.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytic disease. It was first reported by William Chester and Jakob Erdheim in 1930. About 600 cases have been reported worldwide^[1]There are also some reports in China^[2,3]。 The disease often occurs in the ages of 40 to 70, and it is slightly more common in males than females. The etiology and mechanism of occurrence are unknown. The latest research suggests that it may be caused by somatic mutation, which is related to immune dysregulation and inflammation^[4]。 The typical pathological manifestation is the abnormal deposition of foam-like lipid cells of CD68 (+), CD1 α (-), and S-100 (-) to form xanthogranuloma-like infiltration, often accompanied by fibrosis. Because its morphology and immunostaining characteristics are similar to juvenile xanthogranuloma (JXG), the International Association of Organizational Cells has included ECD in the JXG disease family. Recent studies have also suggested that ECD is a special type of JXG that does not mainly involve skin invasion^[5]。 ECD can occur at any site, often involving multiple systems and organs, most often involving bone, central nervous system, cardiovascular system, lung, retroperitoneal space, etc^[6]。 Clinical manifestations are diverse, lack of specificity and poor prognosis. The diagnosis depends on histopathological examination.

Endometrial cancer is a common malignant tumor of female reproductive system. Western countries are particularly frequent, while Asian countries are also seeing an increase in incidence^[1,2]。 Endometrial cancer mostly occurs in postmenopausal women, but about 20% of patients occur before menopause and 5% before age 40^[3,4,5,6,7]And there is a trend of increasing numbers of young patients. Most patients are diagnosed early in the period^[8]。 In<The 5-year survival rate in 40-year-old patients with endometrial cancer is about 93%^[7]。 In the FIGO staged surgery of the International Federation of Obstetrics and Gynecology, which has been performed for nearly 30 years, the whole uterus and double adnexes require routine removal. However, after removing the ovaries of young patients, there are many adverse effects on the patient's physiology and psychology^[8]And young patients have a strong desire to preserve their ovaries, so it is urgent for people to study and explore the feasibility of preserving the ovaries of young patients with endometrial cancer, and formulate solutions to guide clinical work.