Volume 96  ·  Issue 39  ·  2016

Although the diagnosis and treatment of craniocerebral trauma and the understanding of pathophysiological mechanisms have made great progress in the past 30 years, the overall incidence of craniocerebral trauma and the mortality and disability rate of severe craniocerebral trauma have not decreased further. For example, the mortality rate of severe craniocerebral trauma patients maintained at 36% ~42%, and the poor prognosis rate was 52% ~60%^[1]。 Multiple large-scale multicenter randomized controlled clinical studies (RCTs) and clinical translation of preclinical research results ended in failure. The guidelines for craniocerebral trauma have not been updated for 10 years, and there are signs that clinical research on craniocerebral trauma is stuck in a puzzle and lacks bright spots, forcing insightful people to reflect in order to seek new theoretical and technical breakthroughs.

In this study, we tested platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), and other indicators of coagulation function, and revealed their difference in patients with traumatic brain injury (TBI) between plain and plateau area. Base on the results, we may provide research basis for the therapy of TBI associated coagulopathy in different areas.

151 TBI patients from Tianjin Medical University General Hospital, and 74 from People's Hospital of Tibet Autonomous Region in the period from Dec 2013 to Dec 2015 were enrolled.Coagulation function, including PC, platelet distribution width (PDW), mean platelet volume (MPV), platelet - large cell ratio (P- LCR), PT, APTT, fibrinogen (FIB), and D- Dimer were tested within 8 h. The difference in patients with TBI between plain and plateau areas were compared and analyzed.

Compared with plain area, the PC of patients with TBI in plateau area is lower [(168±49)×10⁹/L vs (196±72)×10⁹/L, P<0.05], while PT and APTT were extended [(13.5±1.3) s vs (12.0±4.0) s, (38±4) s vs(27±6) s,P<0.01]. On the other hand, FIB increases [(3.1±1.2) g/L vs (2.6±1.0) g/L,P<0.01] and D-Dimer decreases [(3.1±3.3) μg/L vs (4.7±3.6) μg/L,P<0.01] in plateau area compared with plain area.

Due to the people of plateau area living in hypoxia state, the coagulation function is activated for a long time.Once TBI happens, the platelets and coagulation factors may be excessive consumption, resulting in hypocoagulable state and high risk of rebleeding, while the fibrinolysis system in patients with TBI of plateau area is not activated obviously.Therefore, it should give full consideration to these differences in the treatment of patients with TBI in plateau area, instead of directly copying the standard therapy of the people in plain area.The treatment recommendations should primarily supplement coagulation materials, and antifibrinolytics may unlikely have the therapy effect.

To investigate the application value of combination of ¹⁸F-FDG PET and ultrasound cardiogram in the assessment of patients with severe coronary heart diseases.

A total of 38 patients with severe coronary heart diseases who were admitted to Beijing Anzhen Hospital from January 2015 to November 2015 were enrolled.There were 32 men and 6 women in this study, and the mean age was 33-73(59±10)years.All patients underwent coronary angiography, PET myocardial metabolic imaging, and echocardiography to evaluate the degree of myocardial ischemia, percentage of infarcted myocardium, left ventricular ejection fraction (LVEF), and left ventricular end-diastolic dimension (LVEDD). On the basis of the clinical experience of Beijing Anzhen Hospital, the study allocated these 38 patients to a CABG group (n=20), who underwent CABG, and a non-CABG group treated by medical therapy alone (n=18).

A significantly smaller amount of abnormal myocardium was seen in the CABG group (28.9%±6.3% vs 43.3%±4.5%; P<0.01). The percentage of infarcted myocardium was significantly smaller in the CABG group (13.0%±4.1% vs 24.2%±5.5%) (P<0.01). LVEF was significantly greater (45.3%±3.8% vs 36.1%±6.3%,P<0.01) and LVEDD significantly smaller (54.2 mm±7.1 mm vs 65.1 mm±5.8 mm) in the CABG group (P=0.003). Percentage of abnormal myocardium was moderately negatively correlated with LVEF (r=-0.603, P=0.006). Percentage of infarcted myocardium was mildly negatively correlated with LVEF (r=-0.477, P=0.039). CABG was performed without complications.The LVEF of A1 group before and after operation were 45.3%±3.8% vs 51.6%±9.3%(P=0.043). The cardiac function of the patients was improved obviously after operation.All patients were followed for 1-10 months after discharge.The cure rate was 100%.

In patients with severe coronary heart diseases undergoing CABG, ¹⁸F-FDG PET myocardial metabolic imaging combined with echocardiography have great value, they can assist in preoperative evaluation.

To assess the association of the traditional risk factors of coronary artery disease(CAD) and degree of coronary artery plaque.

A total of 3 752 patients who had a suspicion of CAD from September 2011 to November 2012 at the First Hospital of China Medical University underwent the coronary artery computed tomography. The univariable and multivariable Logistic regression were employ to assess the association the traditional risk factors of CAD and degree of coronary artery plaque.

Age, diabetes, hypertension and smoking were the independent risk factor for significant stenosis, multivessel lesions and high coronary artery calcium score(all P <0.05), male was an independent risk factor for significant stenosis( P=0.039), however HDL-C was the independent protect factor(all P<0.05).

Age, diabetes, hypertension and smoking are the independent risk factor for degree of coronary artery plaque, HDL-C is the independent protect factor.Male is only an independent risk factor for significant stenosis.

To assess the value of different grading criteria of sacroiliac joint (SIJ) computed tomogrphy (CT) in ankylosing spondylitis (AS).

Patients who had received SIJ CT examinations from June 2012 to December 2015 were enrolled.The CT scans were read by one rheumatologist.The difference between patients with sacroiliitis or without sacroiliitis was compared.The 1984 revision of modified New York (mNY) criteria, the criteria established by Lee (Lee criteria) and the Innsbruck criteria were used to evaluate SIJs on CT in patients with sacroiliitis.

Totally 2 714 patients were enrolled in this study.Thereinto 509 patients including 324 male and 185 female were detected with SIJs abnormality.The proportions of SIJs graded 3 or 4 by these three criteria were 79.37%, 82.91% and 76.32%, respectively.The consistency of grading between mNY criteria and Lee criteria was good (k=0.767, P<0.01). The correlation between Innsbruck criteria and other two criteria were satisfactory (r=0.866 and 0.839, respectively). There were more SIJs graded 3 by Lee criteria (64.44%), comparing with mNY criteria (60.90%). Forty five SIJs graded 1-3 by mNY criteria were graded 0 by Lee criteria, indicating that the latter criteria may have a better specificity. When evaluating the severity of SIJs, Innsbruck criteria has a better discrimination capability and the proportions of SIJs graded Ⅱ (A) to Ⅳ (B) were 10.71%, 8.94%, 26.82%, 20.92%, 10.12%, respectively.

Lee criteria has a better diagnostic specificity with a reduction of difficulty in assessing procedure, while Innsbruck criteria is a more detailed grading system with a possibility to reflect the development of sacroiliitis.

To assess the imaging features of 43 patients diagnosed as clinically possible or probable Creutzfeldt-Jakob disease (CJD) for providing referential information and experience on applications of MRI in the clinical diagnosis and treatment of CJD.

All patients who were diagnosed with "suspected CJD" and hospitalized in Xuanwu Hospital from January 2013 to November 2015 were collected, and their clinical information and MRI imaging features were analyzed retrospectively.

Totally 62 patients with "suspected CJD" were rectruited in this study, and 43 of them were diagnosied as probable and possible CJD when they were discharged.The typical MRI feature of CJD patients was "cortical ribbon" sign in MR DWI sequences and/or high signal in cortex or bilateral basal ganglia.In all patients, the simple coritcal involvement was the highest(76.47%, 26/34), followed by the cortical cortex and basal ganglia(23.53%, 8/34). MRI positive group had more prominent extrapyramidal symptoms than MRI negative group (26/31 vs 9/12, P=0.015), but no statistical difference in clinic feature was found between the group with simple cortex affected and the group with both cortex and bilateral basal ganglia affected (P>0.05).

MRI images of patients with CJD have special characteristics and have corresponding changes when the patients are in different stages of disease. In combination with the clinical evaluation of disease progression, brain microscopic pathological changes of CJD patients can be assessed by regularly brain MRI examination.

To investigate the clinical features in 44 patients with acute disseminated encephalomyelitis (ADEM).

Consecutive ADEM patients admitted to Neurology Department of the Third Affiliated Hospital of Sun yat-sen University during August 2009 to July 2014 were enrolled.Clinical and laboratory data of the patients were reviewed and analyzed.

Forty-four patients with ADEM based on the 2012 criteria were recruited, including 23 male and 21 female; 9 children, 11 teenagers and 24 adults.There were 23 monophasic ADEM (23/44, 52%) and 21 multiphasic ADEM (21/44, 48%). Fourteen patients (31.8%) had definite incentive factors within 2 weeks preceding the disease onset.The commonest presenting symptoms were fever (20/44, 45%), mental disorder (18/44, 41%), disturbance of consciousness (17/44, 39%) and seizure (12/44, 27%). The average EDSS score was (4.3±1.3), and the average mRS score was (2.7±0.9). Abnormal autoimmune antibodies were detected in 10 patients.Two patients were positive for NMO-IgG, and three patients were positive for oligoclonal bands.On MRI scanning, small lesions were observed in 18 of 44 patients (18/44, 41%); large confluent white matter lesions in 10 patients (10/44, 23%); symmetric bithalamic involvement in 12 patients (12/44, 27%). Patients were mainly treated with intravenous corticosteroids (40/44, 90.9%) and immunoglobulin G ( 13/44, 29.5%) in acute phase.Regular follow-up performed in 29 patients (65.9%), and the average follow-up time was (4.2±2.3) year.A monophasic course was found in 10 patients, and multiphasic course in 19 patients.After (2.5±2.3) years, patients with multiphasic ADEM experienced their first clinical relapse, and the relapse frequency was (3.3±1.4). The average EDSS score was (3.9±2.2), and the mRS score was (2.2±1.3) in their latest relapse.In follow-up MRI for (5.3±1.9) years, lesions in 18 patients (62.1%) were partially ameliorated, while 6 patients (20.7%) persisted, and new lesions appeared in 5 patients (17.2%). For the 13 multiphasic patients with regular treatment, intravenous corticosteroids (13/13, 100.0%) and immunoglobulin G (7/13, 53.8%) were still important treatments in the acute phase, while oral steroids (12/13, 92.3%) plus immunosuppressants including azathioprine, tacrolimus, cyclosporine and rituximab were chosen in the remission phase.

ADEM is not uncommon in adults, presenting with multiphasic course, encephalopathy features and disseminated lesions on MRI.As it shows very heterogeneous characteristics, ADEM is best viewed as a "syndrome" rather than a specific disorder.

To investigate the condition of implementation of continuous renal replacement therapy (CRRT) in quality control center of critical care medicine.

Questionnaire mails were issued to all of the quality control respondents to survey the application of CRRT in June 2015 from Jiangsu quality control center of critical care medicine.

Among the 69 quality control respondents, 62 were equipped with CRRT devices, and in 58 of which patients were treated with CRRT. There were 195 doctors and 253 nurses in 62 quality control respondents attended CRRT training at or above the provincial level; the proportions of hospitals in southern, central and northern regions of Jiangsu were 63%, 79% and 86% respectively with trained doctors (more than 2), and 34%, 38% and 43% respectively with trained nurses (more than 3). The preferred material for CRRT filter were AN69 and acrylic, accounting for 48% and 45% respectively. The average life span was less than 12 h for 21% filters, 12-24 h for 34% filters, and more than 72 h for only 2% filters. Manual displacement liquids were currently mainly used in our province, accounting for 75%. Heparin is the most frequently used anticoagulants, accounting for 48%. Citrate and low molecular weight heparin used for anticoagulation accounted for 31% and 21% respectively. Bleeding was the most common clinical complication (43%) in patients with CRRT, followed by low temperature (22%). The average hospitalization expenses for patients with CRRT amounted to 69 643 yuan RMB per person, in which the cost for CRRT accounted for 19 525 yuan RMB per person.

The application of CRRT varies in filter materials, anticoagulants, replacement frequencies and dilution mode. Bleeding is the most common clinical complication in patients with CRRT. Besides, the proportion of trained doctors and nurses at the provincial level is still very low. It will be improved with intensive training and reasonable implementation for us to prolong the lifespan of the filters and reduce the cost for patients with CRRT.

To discuss the diagnosis and management for pyriform sinus fistula in children.

Eight cases of pyriform sinus fistula admitted in Guangzhou Women and Children's Medical Center from May 2013 to August 2015 were retrospectively analyzed. The median age at onset was 54 months (range from 11 months to 12 years). All 8 cases presented recurrent neck infection (typical of redness, swelling, heat and pain) and 2 accompanied with acute suppurative thyroiditis. The diagnosis was confirmed by the preoperative barium esophagography combined with neck computed tomography scan (plain scan, enhancement and reconstruction). All the patients underwent laryngeal endoscopic-assisted surgery.

Preoperative imaging findings identified seven left-side cases and one bilateral (the symptom only manifested on left side). All 8 cases underwent left fistulectomy. There was no esophageal injury nor nerve injury during the operation. Postoperatively, all cases recovered well without complications (such as sound hoarse and coughing) and reoccurrence within the follow-up period (range from 7 months to 34 months).

Preoperative barium esophagogram combined with neck computed tomography scan facilitates proper diagnosis and appropriate treatment. Laryngeal endoscopic-assisted technique at operation provides a better understanding of the anatomic relationship and the points where the fistulas penetrated into the pharynx, and essentially improves the operation outcome.

To investigate the effects and mechanisms of itraconazole on prostate cancer PC-3 cells proliferation.

The PC-3 cells were divided into four group: control group, itraconazole group, itraconazole+ CerS-1-shRNA group and itraconazole+ PDMP group.3-(4, 5-dimethyl-2-thiazolyl)-2, 5-diphenyl-2-H-tetrazolium bromide(MTT)assay was used to detect the growth of PC-3 cells.Apoptosis was detected by Annexin V-FITC /PI.The intracellular ceramide production was assayed by high performance liquid chromatography(HPLC). The expression of Bax, Bcl-2, cleaved-caspase3 and the expression and phosphorylation of Akt, mTORC1 were detected by Western blot.

After treatment with 0, 5, 10, 20 μmol/L itraconazole, apoptosis rate was 3.23%±1.32%, 5.87%±2.45%, 23.22%±5.29%, 48.57%±8.37%.The percentage content of ceramide was 100%, 109%±18%, 156%±12%, 197%±22%.Compared with the control group, there were statistically differences when the concentration of itraconazole were 10 and 20 μmol/L(all P<0.05). Western blot analysis showed that the Bax, cleaved-caspase 3 expression of itraconazole group and itraconazole+ PDMP group was significantly higher than control group, while Bcl-2 expression was significantly lower than the control; the Bax, cleaved-caspase 3 expression ofitraconazole+ CerS1-shRNA group was significantly lower than itraconazole group, while Bcl-2 expression was significantly higher than the itraconazole group.After 5, 10, 20 μmol/L itraconazole treatment, the expression of p-Akt and p-mTORC1 were significantly lower than the control group; the expression of p-Akt and p-mTORC1 in itraconazole+ CerS-1-shRNA group were significantly higher than itraconazole group.

Itraconazole induces apoptosis of PC-3 cell through increasing the intracellular ceramide content, which might relate to upregulation of cleavage-caspase 3 and Bax, downregulation of Bcl-2 and inactivation of Akt-mTORC signal pathway.

To investigate the influences of genomic DNA methylation upon neuroglobin sustained expression in oxygen- glucose deprivation model.

With A549 cell strain as the research object, the control group were cultivated in the complete medium containing 10 μmol/L of 5-azacytidine for 4 days, and the control group was cultivated in the complete medium for 4 days.Then carried out oxygen glucose deprivation treatment for 4 h.Detecting neuroglobin expression, DNA methyltransferase expression, cell inhibition ratio and DNA methylation level at different time points.

DNA methylation level of the experimental group declined apparently[6 h : (1.0±0.0) vs (2.1±0.3); 12 h: ( 0.9±0.0) vs (1.4±0.0); 24 h: (0.9±0.0) vs (2.6±0.2); 36 h: (0.9±0.0) vs (2.9±0.1)], neuroglobin expression of the experimental group continued and was obviously higher than that of the control group at the same time point[NGB-PCR: 6 h: (3.3±1.1) vs (0.4±0.1); 12 h: (3.2±0.8) vs (0.1±0.1); 24 h: (4.6±0.6) vs (0.2±0.0); 36 h : (5.1±0.3) vs (0.1±0.1)], while the Cell inhibition ratio of the experimental group was obviously lower than that of the control group at the same time point[(6 h: (10.4±0.5) vs (14.1±0.7); 12 h: (22.0±1.3) vs (35.1±0.5); 24 h: (25.7±1.0) vs (40.6±1.3); 36 h: (30.0±0.8) vs (44.4±0.7)], differences had statistical significance (P<0.05).mRNA expression of three methyltransferases of the experimental group was higher than that of the control group at different time points, where, DNMT1 and DNMT3B showed great differences (P<0.05), while differences in DNMT3A of two groups had no statistical significance (P>0.05).

In the OGD/R model of A549 cell strain, genomic DNA methylation resulted in unsustained expression of neuroglobin, but neuroglobin expression increased after demethylation inhibitor was used.

To systematically review the efficacy, side effects and case-fatality rate of levetiracetam (LEV) versus phenytoin (PHT) for seizure prophylaxis of brain injured patients.

Randomized controlled trials of high quality about LEV versus PHT in seizure prophylaxis of brain injured patients from 2000 to 2016 were collected according to the key word PHT, LEV, brain injury in PubMed, Medline, Ovid, Springer, CNKI, Wanfang data and so on. Valid data were extracted to conduct meta-analysis by RevMan 5.3 software according to inclusion and exclusion criteria.

A total of 13 English articles were finally included with 2 529 patients in total.Meta-analysis showed that no significant differences were observed in LEV versus PHT at preventing the occurrence of seizures (RR=0.88, 95%CI: 0.61-1.27). No superiority of either drug at preventing early seizures (RR=0.74, 95%CI: 0.42-1.27). As to the occurrence of late seizures, the differences of the two drugs were not statistically significant (RR=0.71, 95%CI: 0.43-1.20). Number of patients with side effect was not statistically significantly different between the two groups (RR=0.73, 95%CI: 0.48-1.11). But significant difference was found between LEV and PHT in discontinuation because of side effect (RR=0.11, 95%CI: 0.06-0.23); no significant differences were noted in the case-fatality rate of patients received pretreatment between the two drugs (RR=1.57, 95%CI: 0.92-2.67). There were no significant differences between the two groups in the length of stay (WMD=-1.03, 95%CI: -4.97-2.91).

LEV and PHT demonstrate equal efficacy in seizure prevention after brain injury. The differences are insignificant in the side effect, the case-fatality rate and the length of stay between LEV and PH treatment, but adverse drug reactions requiring change in therapy occur more in PHT. Phenytoin remains the first choice for seizure prevention after brain injury based on the existing evidence, while levetiracetam seems to be a favorable choice where there is risk of drug-drug interactions and drug toxicity. However, very few randomized controlled trials on this topic were found, and larger prospective trials are warranted.

A 43-year-old female was admitted to the hospital in July 2015 due to low back pain accompanied by pain and numbness in the right lower limb for 1 year. Physical examination showed L4 and L5 paravertebral percussion pain and hypoesthesia in the right lower limb. Lumbar magnetic resonance imaging (MRI) showed L4/5 mild disc herniation with right nerve root compression, and subsequent discography showed no significant abnormalities. Laboratory tests showed prolonged prothrombin time (16.9 s), prolonged activated partial thromboplastin time (55.0 s), and increased international normalized ratio (INR) (1.41). The patient had a history of obesity (weight 75 kg; height 155 cm; BMI 31.22 kg/m²) and a 10-year smoking history of 5 cigarettes/d. Two months ago, the patient went to the doctor due to numbness in both hands and weakness in both lower limbs. Cervical MRI showed C5/6 disc herniation with nerve compression, and then underwent C5/6 decompression, bone grafting, fusion and internal fixation under general anesthesia. Postoperative numbness in both hands and weakness in both lower limbs were improved compared with those before operation, and there was no obvious abnormality in reexamination and follow-up. The patient underwent L5 right vertebral fenestration nerve root exploration under general anesthesia lying prone, and the operation time was 20 min. During the operation, no obvious abnormalities of nerve roots were found after careful and repeated exploration, and the nerve roots and surrounding tissues were washed with dexamethasone injection. A negative pressure drainage tube was placed in the surgical field, and the incision was sutured layer by layer. No cerebrospinal fluid leakage occurred during operation. Circulation was stable during surgery. The results of intraoperative blood gas analysis showed no abnormalities such as hypoxia, hypercapnia or pH, electrolyte and blood glucose disorders. Intraoperative bleeding 80 ml. After recovery from anesthesia, the patient was conscious, cough sound was clear, and limb movement was normal. The patient experienced speech difficulties, accompanied by depressed mood and slight vomiting at 14 hours after operation. Neurological examination showed good hearing, understanding the meaning of words but difficulty pronouncing them. The muscle strength and activity of the limbs were normal, and there were no abnormalities such as facial skew. Ask a neurologist for consultation, first consider the patient with postoperative neurosis, but the patient's symptoms have not improved significantly after antidepressant treatment. On the 5th day after operation, MRI of the brain showed patchy abnormal signal shadows in part of the left frontoparietotemporal lobe, and other patchy abnormal signal shadows in the left hemioval area, lateral ventricular area, basal ganglia area and bilateral frontal lobes. Carotid CT angiography (CTA) showed stenosis of the right carotid artery. After another consultation by the neurology department, the patient was diagnosed with cerebral infarction complicated with motor aphasia. Subsequently, the patient received active therapies such as anticoagulation (aspirin oral 100 mg, once/d), lipid lowering (atorvastatin oral 10 mg, once/d), improvement of microcirculation, bed rest, etc. The patient's neurological symptoms were not further aggravated. On the 11th postoperative day, the patient was able to make monosyllabic voices, but it was still difficult to make polysyllabic voices. The patient was then transferred to a rehabilitation hospital for hyperbaric oxygen therapy. After 3 months of follow-up, the speech pronunciation was basically normal, but the speech speed was slow (Figure 1，Figure 2，Figure 3)。

A 48-year-old male from Tunchang County, Hainan Province, had a fever of 39.6℃ without obvious trigger 11 days ago, accompanied by headache, exacerbated by paroxysmal aggravation, touch pain in the right occipital region, especially when he had fever, and a 0.5 cm ×1.0 cm skin ulcer was seen on the lateral side of the left waist. He had type 2 diabetes for 5 years and had poor blood sugar control. He was admitted to the hospital on November 7, 2014. After admission, he selected broad-spectrum antibiotics meropenem every 8 h combined with ganciclovir every 12 h, and hydrocortisone for anti-inflammation. CT examination: On November 7, 2014, CT found a stripe-shaped, triangular-like low-density shadow in the superior sagittal sinus, and the density of some layers was slightly uneven (Figure 1A); On November 11, 2014, CT found that compared with the anterior film, the hypodensity of the superior sagittal sinus triangle became uniform and increased, showing a typical "Δ" sign, and a thin crescent-shaped hypodensity shadow was seen under the inner plate of the right occipital skull (FIG. 1B), a crescent-shaped low-density shadow was seen on the left side of the superior sagittal sinus, and a flaky low-density shadow was seen in the left parietal lobe (Figure 1C)。 Chemical examination: admission blood routine, white blood cells 18.95×10⁹/L, the percentage of blood neutrophils is 92%; Alanine aminotransferase 191 U/L and aspartate aminotransferase 67 U/L. Cerebrospinal fluid routine: microscopic examination of white blood cells 0~1/HP, white blood cell count 2×10⁶/L. Blood biochemistry: glucose 11.33 mmol/L, trace protein 1 129 ng/L, chlorine 111 mmol/L. Diagnosis and results: Blood culture and drug susceptibility on November 12, 2014 indicated Burkholderia pseudomallei and imipenem sensitivity, and cerebrospinal fluid culture on November 13, 2014 indicated Burkholderia pseudomallei. At 21: 00 on November 14, 2014, blood pressure and blood oxygen saturation decreased repeatedly, and the family gave up treatment after many rescues failed.

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by the persistence of antiphospholipid antibodies (aPL), with arteriovenous thrombosis and morbid pregnancy as the main clinical manifestations. aPL is a general term for a group of heterogeneous autoantibodies. The 2006 international APS consensus determined that aPL with diagnostic value includes lupus anticoagulants (LA), anticardiolipin antibodies (aCL) and anti-β 2-glycoprotein Ⅰ antibodies (anti-β 2gpⅠ)^[1]。 Thrombosis is the most important pathological feature of APS, but the mechanism of APL-induced thrombosis is still unclear. It has been shown that the occurrence of thrombosis in patients with APS is the result of the interaction of multiple factors. The main factors include: the conformational change of β 2gpⅠ, the activation of cellular components of vascular system (vascular endothelial cells, monocytes, platelets, neutrophils) by antigen-antibody complexes, the disorder of coagulation components (coagulation system, anticoagulation system, fibrinolysis system), and the participation of inflammatory mediators (complement, cytokines). In this paper, the recent research on the mechanism of APS thrombosis is reviewed.

Intervertebral Disc (IVD) is an important structure for maintaining spinal load and motor function. In addition to direct huge medical expenses, Intervertebral Disc degenerative disease also causes indirect economic losses^[1]。 In recent years, artificial intervertebral disc replacement, simple nucleus pulposus replacement and allogeneic intervertebral disc transplantation have emerged^[2,3]But the long-term effect is not satisfactory. Using tissue engineering to construct functionalized intervertebral disc provides new hope for the treatment of intervertebral disc diseases^[4,5,6,7]。 At present, the research on tissue engineering of intervertebral disc mainly focuses on the construction of scaffold materials, seed cells, intervertebral disc tissue, etc. However, compared with bone and cartilage tissue engineering research, the research on intervertebral disc degeneration and regeneration is relatively lagging behind.

In human tissues, hydrogen protons are mainly found in water and adipose tissues, and fat has a short T₁Values and T₂Value, at T₁and T₂The weighted graph showed a high signal, and the higher fat signal reduced the image contrast and T₁Enhancing the scanning effect, fat high signal also makes the motion artifacts such as respiration more obvious, in addition, it will also cause serious chemical shift artifacts on the water-lipid interface, thus reducing the image quality and lesion detection rate. Therefore, in clinical practice, suppression of fat signal is particularly important. By suppressing adipose tissue signal, image contrast can be increased, enhanced scanning effect can be improved, motion artifacts, chemical artifacts and other related artifacts can be reduced, and image quality can be improved^[1]。 At present, fat suppression techniques are mainly based on two mechanisms: (1) the longitudinal relaxation difference between fat and other tissues; (2) Chemical shift effect of fat and water. Traditional methods can be divided into inversion recovery method (STIR) and frequency selection method (SPIR and SPAIR), but these techniques cannot meet the clinical needs in the diagnosis and accurate quantification of diseases containing fat components^[2,3]。 With the development of Dixon technology, the above problems have been solved gradually. The basic principle, development and improvement of Dixon technology and its clinical application progress are reviewed in this paper.

intracranial major artery stenosis/occlusion (ICASO) is one of the most common causes of ischemic stroke worldwide^[1]。 The progress and popularization of non-invasive craniovascular assessment technology has made ICASO become a hot spot in research, especially in the aspects of risk factors and susceptibility genes. Moyamoya disease is a rare and special cerebrovascular disease. Studies have shown that the two are consistent in the distribution of race and vascular involvement. Therefore, there is a hypothesis that Moyamoya disease is a confounding factor with a high incidence of intracranial aortic stenosis/occlusion in Asians. However, it is sometimes difficult for clinicians to accurately identify whether ICASO originates from Moyamoya disease or is related to traditional atherosclerosis risk factors with current examination methods. The ring-finger protein 213 gene was produced by Kamada et al.^[2]Moyamoya disease susceptibility genes discovered by genome-wide association analysis. Recent studies have found that the ring finger protein 213 gene is not only a genetic susceptibility gene for Moyamoya disease in Asians, but also has a clear correlation with intracranial stenosis/occlusion of large arteries in non-diagnostic Moyamoya disease. Some people with positive gene mutations may progress to Moyamoya disease^[3]This suggests that some of the ICASOs that were not previously diagnosed as moyamoya disease may be moyamoya disease. These studies suggest that early identification of intracranial arterial atherosclerotic stenosis and early moyamoya disease by detecting ring finger protein 213 gene may guide the formulation of treatment plan. This paper summarizes and analyzes the recent research progress on the relationship between RF213 gene and Moyamoya disease and ICASO.