Volume 95  ·  Issue 45  ·  2015

To investigate the efficacy and safety of mycophenolate mofetil (MMF) in the treatment of connective tissue disease-related interstitial lung disease (CTD-ILD).

A total of 60 patients with CTD-ILD, confirmed by high resolution computer tomography (HRCT), were enrolled from five clinical centers from July 2010 to July 2014. In addition to the basic glucocorticoid treatment, patients received intravenous cyclophosphamide (Group A) or oral MMF (Group B) for one year. Pulmonary function was assessed at the 3, 6, 12 months. All adverse events were recorded and efficacy and safety were evaluated at the end of this trial.

Total 60 patients were enrolled, each group had 30 patients. 5 patients withdrew voluntarily from each group, 2 and 3 patients died in group A and B, respectively. Total 45 patients completed this trial. Neither lung function, HRCT nor adverse events had differences between the two groups or within group (P>0.05). When the analysis was done among patients with forced vital capacity (FVC) ≤75% and forced expiratory volume in one second (FEV1)%≤75%, there were significantly statistical differences in FVC and FEV1 at 6th month compared with prior treatment in group A (bothP<0.05). And there were significant increase in FVC and FEV1 at 12 months in group B (bothP<0.05). But there was no statistical difference between the two groups. For the patients with diffusion capacity for carbon monoxide (DLco)≤65%, there were significant increase in group A at 3, 6 and 12 months (P<0.01,P<0.05,P<0.05, respectively). but no significant increase was found in patients on MMF. And there was no difference between the two groups. No statistical difference existed in survival rate between these two groups (P>0.05).

MMF has comparative effect as cyclophosphamide in the remission or stability of lung function and HRCT manifestations of CTD-ILD patients. MMF is generally well-tolerated, but its efficacy in maintenance therapy and long-term safety remains to be clarified.

To evaluate the apparent diffusion coefficient (ADC) value in differential diagnosis of ankylosing spondylitis active lesions.

A total of 68 patients with AS involving hip joint who were diagnosed in Third Affiliated Hospital of Southern Medical University form March 2010 to December 2014 were evaluated by MRI. The ADC values of the hip joint lesions were measured and compared in 38 cases of ankylosing spondylitis active lesions (active group) and 30 cases of ankylosing spondylitis in stable period (stable group), all cases were confirmed by clinical diagnosis.

There are 238 lesions were detected demonstrating hyperintens in DWI and ADC picture. The mean ADC values of active group and stable group were(1.00±0.13)×10^-3 mm²/s and (0.65±0.12)×10^-3 mm²/s (t=-11.85, P=0.00). The correlation coefficient between ADC and BASDAI score is 0.831(P<0.01). ROC curve showed that the threshold ADC value differentiating active group and stable group was 0.81×10^-3 mm²/s, with a sensitivity of 94.7%and specificity of 90%.

The ADC value of hip joint lesion of AS patient can help to determine the nature of the ankylosing spondylitis.

To explore abnormal microstructural changes of white matter using diffusion tensor imaging (DTI) in patients with leukoaraiosis (LA), and to determine the association of such abnormalities of DTI parameters with cognitive function, especially executive function.

A total of 44 patients with LA and 36 healthy controls were recruited from the department of Neurology, Beijing Chaoyang Hospital, Capital Medical University between July 2010 and June 2011. The two groups were matched for age, sex, education, and vascular risk factors. All the subjects underwent the scans of conventional magnetic resonance imaging (MRI), DTI and neuropsychological assessment. The values of mean diffusivity (MD) and fractional anisotropy (FA) were measured within white matter lesions (WML) and normal appearing white matter (NAWM). Three regions of interest (ROIs) were located in the white matter of centrum semiovale, anterior periventricular white matter and posterior periventricular white matter. The relationships between the cognitive function and the abnormalities of DTI parameters were analyzed.

(1) Patients with LA performed significantly worse cognitive function, especially in the fields of executive function. The results of our study showed that patients with LA were associated with comprehensive cognitive function deficits, including mini mental state examination (MMSE) (24.4±3.2 vs 28.3±1.2), montreal cognitive assessment (MoCA) (21.2±3.4 vs 25.7±1.7), Stroop B (69.2±13.5 vs 43.3±5.0), Stroop C (141.2±42.6 vs 64.8±10.0), Stroop (C-B) (72.0±41.9 vs 21.5±9.4), trail making test (TMT)-A (73.4±15.4 vs 31.1±7.1), TMT-B (126.2±17.5 vs 81.4±5.7), digit symbol test (25.2±5.4 vs 36.7±5.1) (all P<0.05). (2) The values of FA were lower, and MD were higher in WML than NAWM and controls in all the three ROIs (P<0.05). The values of FA in NAWM located in centrum semiovale and posterior periventricular white matter were lower than controls (P<0.05). The values of MD in NAWM located in anterior periventricular white matter were higher than controls (P<0.05). (3) The values of FA of NAWM located in anterior periventricular correlated inversely with the Z scores of executive function (r=-0.311, P=0.04).

Patients with LA are related with significant cognitive impairment, especially in the domains of executive dysfunction. Microstructural integrity of both white matter lesions and NAWM is associated with executive function. The underlying executive dysfunction in LA may attribute to the damage of the prefrontal-subcortical circle.

To evaluate the value of different diagnosis criteria for predicting the prognosis of amyotrophic lateral sclerosis (ALS).

Between January 2011 and December 2012, all patients with a diagnosis of ALS referred to and assessed at Peking University Third Hospital (PUTH) were screened. Baseline demographic details and clinical data were collected from the patient's first visit to PUTH. According to the Airlie House and Awaji-shima criteria, the levels of diagnostic certainty were categorized. The follow-up period was 24 months. Receiver operating characteristic (ROC) curves were made to compare the efficiency of the two ALS-criteria.

According to the Airlie House and Awaji-shima criteria, there was no difference in the outcome event rate among the different levels of diagnostic certainty (P>0.05). Among the sub-group with diagnostic delay time <12 months, the outcome event rate of high diagnostic level patients was higher than that of low diagnostic level patients (χ²=43.283, P<0.05). For the non-bulbar onset patients whose diagnostic delay time was under 12 months, the areas under the ROC curves of the Airlie House to predict the prognosis of ALS was 0.603, which was significantly higher than the baseline area of 0.500 (P<0.05).

The Airlie House criteria can predict the prognosis of non-bulbar onset ALS whose diagnostic delay time were under 12 months.

To evaluate the value of MRI in preoperative evaluation of carotid body tumor.

A retrospective study was including 32 CBT of 28 patients of carotid body tumor with complete clinical, imaging and pathological data in our hospital. The MRI images of vascular adjacent length, no enhancement vascular wall, carotid displacement, wrapping angle and carotid stenosis were analyzed respectively in tumor resection group, tumor dissection and artery repair group, and tumor and artery resection group. The results were compared with surgery.

The indexes of vascular adjacent average length were (3.2±0.8), (3.4±0.7) and (3.8±1.0)cm, respectively.The indexes of vascular adjacent average length and vascular displacement, which all showed no significant difference between each operation group(P=0.577, 0.859). The indexes of no enhancement vascular wall, wrapping angle and carotid stenosis, which all showed significant difference between each operation group (all P<0.01). Compared with the surgical and pathological findings, with no enhancement vascular wall <2/3 circumference as the index of carotid artery repair or resection, the sensitivity, specificity and accuracy were 86.4%, 90%, 87.5% respectively. With wrapping angle >1/3 circumference as the index of carotid artery repair or resection, the sensitivity, specificity and accuracy were 86.4%, 90%, 87.5% respectively. With carotid stenosis as the index of carotid artery resection, the sensitivity, specificity and accuracy were 80%, 100%, 93.7% respectively.

The no enhancement vascular wall, wrapping angle and carotid stenosis have a correlation with carotid artery intervention.The no enhancement vascular wall<2/3 circumference, wrapping angle >1/3 circumference and carotid stenosis have a certain value in preoperative evaluation of carotid body tumor, although vascular adjacent average length and vascular displacement have limited value.

To compare pretreatment and intra-operative methotrexate (MTX) administration when combined with laproscopy in the treatment of salpingocyesis.

All 200 patients with salpingocyesis treated with laproscopy in Jiangwan Hospital from Jan, 2010 to Dec, 2014 were enrolled and divided into group A and B, 100 patients in each. In group A, the patients were administered with MTX 50 mg/kg by intramuscular injection 24-48 h before the surgery. In group B, the patients were administered with MTX 20 mg in 2 ml normal saline to the target tubal seromuscular layer after the ectopic pregnancies were removed. Then, the following characteristics would be compared between the groups including the medical condition during the operation, post-operative body temperature, serum β-human chorionic gonadotropin (β-HCG) reduction, the rate of refractory ectopic pregnancy and tubal patency.

The bleeding volume during the surgery (P<0.01) was significantly reduced and the operation duration (P<0.05) was significantly shortened in group A. The serum β-HCG level (P<0.05) was also significantly reduced 4 and 7 days after the surgery in group A. There was significantly difference on the rate of tubal patency (P<0.01) between the groups. There was no refractory ectopic pregnancy in either groups after the surgery. And there were no significant differences on the post-operative temperature, period of serum β-HCG moving to the normal level between the groups (P>0.05).

Both pretreatment and intra-operative MTX administration showed good efficacy. But the surgery duration shortening, bleeding decreasing during the operation and tubes retaining were seen in group A. For this reason, we believe pro-operative MTX administration would be better for the patients with childbearing requests.

To compare the effects of percutaneous vertebroplasty (PVP) versus conservative method of integrated Chinese and Western Medicine for pain relief and functional outcome in patients with painful osteoporotic vertebral fractures. New fractures and secondary adverse effects were also analyzed during a mid-long term follow-up period.

Patients were recruited to this prospective nonrandomized trial from a single hospital. Patients were aged 55 years or older, had vertebral compression fractures on spine radiograph (level of fracture at T6 or lower; bone oedema on MRI), with back pain for 6 weeks or less, and a visual analogue scale (VAS) score of 6 or more. Patients were nonrandomly assigned to PVP group or conservative treatment group according to their own desire. After 2 weeks, patients from the conservative group could change therapy to PVP. VAS for pain and Oswestry disability index (ODI) questionnaire scores were assessed before and 1 week, 1 month, 3, 6, 12, 24, 36, 48, and 60 months after the treatment. Other data included patients' baseline characteristics before the treatment, new fractures and secondary adverse effects were also recorded.

A total of 181 consecutive patients were nonrandomly allocated to receive PVP (n=103) or conservative treatment (n=78) between December 2009 and August 2013. Six patients transferred to PVP group after 2 weeks conservative therapy. Pain relief and functional outcomes were significantly better in PVP group than in conservative group, as determined by VAS scores (3.67-1.13 vs 7.38-2.39) and ODI scores (23.55-5.83 vs 36.10-13.88) at 1 week, 1 month, 3 and 6 months (all P< 0.01). Both VAS and ODI scores decreased in PVP group showed no statistical significance at 1 year when compared with conservative group (P>0.05). However, pain relief and functional outcomes were significantly better at most of the subsequent follow-up points. The patients with complete pain relief (VAS<1) were significantly better in PVP group than in conservative group (P< 0.01) at all of the follow-up points. There were 17 patients died (PVP group:n=8) and 31 cases occurred secondary vertebral fractures (PVP group: n=19) during the follow-up periods. No serious complications or adverse events were related to PVP technique.

PVP has immediate pain relief and functional improvement compared with conservative treatment. PVP should be considered as the treatment of first choice for symptomatic osteoporotic vertebral fractures. However, for patients with VAS < 5, conservative method of integrated Chinese and Western Medicine may perform well.

To evaluate the difference between RetroButton and Interference Screw in Anterior Cruciate Ligament (ACL) Reconstruction.

Ninety-seven patients with ACL rupture were treated by arthroscopic reconstruction with RetroButton and Interference Screw from June 2008 to December 2011. There were 54 males and 43 females with an average age of 27.5 years (range, 18-53 years). The preoperative magnetic resonance imaging (MRI) of all injured knees revealed the rupture of ACL. The average time from injury to surgery was 13.1 days (range, 6-20 days). All the patients were randomly divided into RetroButton group and Interference Screw group. And all the operations were performed under arthroscopy. Patients were instructed to walk with crutches and weight-bearing 4 weeks after operation. Walk without crutches was allowed 6 to 8 weeks after reconstruction and normal daily activities were gradually resumed.

The average follow-up was 54.6 months (range 48-60 months). No adverse biological reactions or infection ever occurred. There was no spontaneous rupture or laxity of graft. The average Lysholm knee score[(56.1±7.9) vs (93.1±6.1); (55.3±8.5)vs(93.2±5.7)], KT-1000 examination [(9.2±1.8)vs(2.1±1.4); (9.5±1.7)vs(2.1±1.5)], International Knee Documentation Committee (IKDC) subjective and objective score[(49.7±5.9)vs(91.7±5.0); (50.2±6.3)vs(91.0±6.1)] were improved significantly in both two groups (allP<0.01), and there was no significant difference between the two groups[(93.1±6.1) vs(93.2±5.7),P>0.05].

ACL reconstruction using RetroButton and Interference Screw are simple and effective, and can lead to good ligamentous stability and knee function. The two kinds of fixation methods have no significant difference in short and medium term effect. Long-term follow-up should be performed to confirm the durable stability of the knee.

To observe the effect of open reduction through anterior approach of the elbow and frame shape plate internal fixation in the treatment of coronoid process fracture of ulna.

From August 2011 to October 2014, 17 patients with coronoid process fracture of ulna were treated with open reduction through anterior approach of the elbow and internal fixation with frame shape plate. There were 12 males and 5 females with an average age of 36.4 years old. A"S"shape anterior incision of the elbow was used to expose the fracture. The soft tissue of the bone block was kept intact and the fracture was fixed with internal frame shape plate. The therapeutic effects were evaluated by hospital for special surgery (HSS) elbow score system.

All the patients were followed up for 8-26 months (average 14 months). The fractures clinically healed at an average time of 10 weeks (ranged from 9 to 11 weeks). There was no myositis ossificans happened. The patients' elbow joint function according to the HSS scores were 12 cases excellent (70.6%), good 4(23.5%) and moderate 1 (5.9%). The total excellent and good rate was 94.1%.

Open reduction through anterior approach of the elbow and internal fixation with frame shape plate is effective to reach anatomical reduction in the treatment of the coronoid process fracture of ulna, with little damage and strong fixation.

To explore the effects of posterolateral lumbar fusion (PLF) and posterior lumbar interbody fusion (PLIF) on the stability of postoperative unstable single lumbar segment and the biomechanical alterations of the adjacent segments.

A finite element model of L3-S1 segments with a single segmental degeneration at the L4-5 level was established, and the model of L4-5 segmental instability after posterior laminectomy and facetectomy was also established, in which laminar and interior 2/3 area of bilateral facet joints were resected. Physical loads were applied to the models and the changes of the range of motion (ROM) at L4-5 level in different models were recorded at the condition of flexion, extension, lateral bending and rotation. PLF and PLIF were performed on postoperative unstable model respectively, the changes of the ROM at L4-5 level, the ROM and the stress on the adjacent discs in different models were recorded.

Compared to the unstable model, the L4-5 segmental stability was restored after PLF or PLIF. The ROMs of L3-4 and L5-S1 levels were similar to the preoperative unstable model. The stress on adjacent discs (L3-4 and L5-S1) was increased significantly, and maximum stress distribution changed and concentrated in the anterior annulus fiber in the two fusion models. There was no significant difference of the maximum stress on adjacent discs between PLF and PLIF models [(1.056±0.061)mPa vs (1.070±0.075)mPa; (1.147±0.055)mPa vs (1.162±0.075)mPa, P>0.05].

Lumbar segmental stability after posterior laminectomy and facetectomy can be recovered by both PLF and PLIF. Both PLF and PLIF may increase the possibility of adjacent segment degeneration because of the augmentation of maximum stress on adjacent discs.

To investigate the protective effect of Rosuvastatin on myocardial cells in rats with acute myocardial infarction and its possible mechanism.

Rats were randomly assigned to four groups: Control group, Sham group, AMI and Rosuvastatin group. The levels of lactate dehydrogenase (LDH) and creatine jubase (CK), the vitality of superoxide dismutase (SOD) and the content of malondialdehyde (MDA) were detected by assay kits and the levels of C-reactive protein (CRP), tumor necrosis factor (TNF) alpha and interleukin (IL)-6 expression were detected by enzyme linked immunosorbent assay (ELISA). TTC/Evans blue staining was used to determine the relative myocardial infarction area, HE staining was used to detect pathologic changes and myocardial apoptosis was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL). What's more, Western blot was used to detect the protein expression of B-cell lymphoma-2 (Bcl-2), Bax, cleaved-Caspase-3, Rock1, Rock2, I-κB and NF-κBp65.

The model of acute myocardial infarction rats was established. Compared with Sham group, the myocardial pathological changes were more severe, and the apoptosis number, the production of inflammatory factors and oxidative damage were significantly increased in AMI group. Compared with AMI group, the relative area of infarction myocardium (43%±4% vs 31%±8%, P=0.004 3) was dramatically reduced, the levels of LDH (2 545.45±613.67 U/L vs 1 573.43±373.72 U/L, P=0.02) and CK (7.49±1.75 U/ml vs 4.42±1.28 U/ml, P=0.04) in serum were significantly lower (P<0.01), the myocardial pathological damage degree was relieved, the apoptosis number (41%±8% vs 23%±6%,P=0.014 7) was significantly decreased, the expression of Bax (1.17±0.10 vs 0.57±0.08, P=0.003) and cleaved-Caspase-3 (1.31±0.07 vs 0.70±0.01, P=0.004) were dramatically reduced, and the expression of Bcl-2 (0.19±0.01 vs 0.32±0.01, P=0.003) was enhanced in Rosuvastatin group. Furthermore, the production of inflammatory factors and oxidative damage were effectively alleviated (P<0.05), the protein expression of Rock1, Rock2 and NF-κBp65 were declined in Rosuvastatin group (P<0.01).

Rosuvastatin can effectively alleviate the cardiomyocyte apoptosis induced by acute ischemia, and its main mechanism may be the inhibition on RhoA/ROCK activation and the oxidative stress and inflammation reaction mediated by it.

To investigate the effect of icariin on myocardial hypoxia reoxygenation injury and the possible mechanism.

Neonatal Sprague-Dawley rat cardiomyocytes in primary culture were treated with different concentrations of icariin for 24 h prior to hypoxia/reoxygenation injury. Cardiomyocyte apoptosis was evaluated with Tunel staining. The expression levels of apoptosis proteins were detected by Western blotting. The nuclear translocation of p65 was evaluated by immunofluorescence. The p65 signaling pathway was also detected by Western blotting.

Myocardial apoptosis rate significantly increased after hypoxia/reoxygenation (control: 1.5%±0.1%; Model: 23.4%±1.3%, P<0.05). While icariin significantly reduced cardiomyocyte apoptosis induced by hypoxia/reoxygenation (1 μmol/L icariin: 7.2%±0.9%; 10 μmol/L icariin: 3.9%±0.8%, bothP<0.05). Western blot showed that the expression levels of pro-apoptotic protein, Bax, increased significantly (control: 0.19±0.05; Model: 0.41±0.03,P<0.05), while the expression of anti-apoptotic protein, B-Cell CLL/Lymphoma 2 (BCL-2), was significantly reduced (control: 0.15±0.02; Model: 0.03±0.01,P<0.05) after hypoxia/reoxygenation. Notably, icariin reduced the expression of Bax (1 μmol/L icariin: 0.29±0.01; 10 μmol/L icariin: 0.33±0.03, bothP<0.05) and increased expression of BCL-2 (1 μmol/L icariin: 0.10±0.03; 10 μmol/L icariin: 0.11±0.02, bothP<0.05). Immunofluorescence showed that NFκB-p65 nuclear translocation in cardiomyocytes was increased after hypoxia/reoxygenation (control: 3.6%±0.5%; Model: 89.5%±4.8%,P<0.05), while icariin reduced the nuclear translocation of p65 (1 μmol/L icariin: 32.6%±2.3%; 10 μmol/L icariin: 10.6%±1.0%, bothP<0.05). Moreover, icariin reduced the activation of p65 and phosphorylation of IKBα induced by hypoxia/reoxygenation in cardiomyocytes.

Icariin can protect cardiomyocytes against hypoxia reoxygenation injury, which may be via blocking p65 signaling pathway.

The patient, a 5-year-old male, was admitted to the hospital on 7-Mar-2015 due to headache for 8 d. The patient developed dull pain in the neck and posterior occipital area without obvious trigger 8 days ago, which attacked 3 to 4 times a day, lasted 2 to 3 minutes and then relieved spontaneously, accompanied by fatigue. Electroencephalogram and transcranial Doppler examination at the outpatient clinic before admission showed normal results. Coagulation function showed: prothrombin time<8.0 s (normal 12-14 s); Prothrombin time activity>200%; International standardized ratio (PT)<0.76； Fibrinogen 1.90 g/L. Magnetic resonance examination: plain MRI of the head showed space-occupying lesions of the fourth ventricle, 32 mm ×36 mm ×40 mm, showing a slightly longer T₁Slightly longer T₂Signal, dilatation of the supratentorial ventricular system; DWI (b =1 000 s/mm²) Diffusion was limited and showed high signal, and the medulla oblongata and bilateral cerebellar hemispheres were compressed and deformed. After injection of Gd-DTPA, the enhanced scan showed that the lesions were uneven and obviously enhanced, and patchy unenhanced low signal could be seen at the edges, which resembled "fist clenching sign" (Figure 1)； MRS scan showed that Lip peak appeared in the lesion area, NAA peak and NAA/Cr ratio decreased compared with contralateral normal brain tissue, and Cho/Cr ratio increased compared with normal brain tissue (Figure 2)。 Proposed diagnosis of ependymoma or medulloblastoma. Abdominal color Doppler ultrasound showed no obvious abnormalities in liver, pancreas, spleen, peritoneum, kidney, ureter and bladder. Preoperative coagulation function test showed prothrombin time 9.30 s; fibrinogen 1.66 g/L; Thrombin time 16.20 s. After correcting the coagulation time, the tumor of the fourth ventricle was resected. Intraoperative findings: the tumor was located and filled the fourth ventricle, gray-red, with abundant blood supply and irregular shape. The tumor had no complete envelope, no obvious boundary with the surrounding normal tissues, and there was a layer of arachnoid separation between the tumor and the floor of the fourth ventricle. Pathology: The gross specimens of tumor tissue were gray-red. Immunohistochemistry: CD (+) , Syn (–), NSE (–), S – 100 (–), CD (–), CD20 (+), Bcl – 2 (–), CD (+), Bcl – 6 (+), Ki – 67 (+ nearly 100%). Pathological diagnosis: (fourth ventricle) Burkitt lymphoma (panel G).

The patient was a 28-year-old male. He was admitted to the Department of Neurology, Xiangya Hospital, Central South University on December 25, 2013 due to "numbness and weakness of both lower limbs for 6 days and difficulty in urinating and defecating for 3 days". Previous: From November 18 to 30, 2013, he was hospitalized due to "severe pneumonia and type 1 respiratory failure". After receiving anti-infective treatment such as "moxifloxacin, cefoperazone, sulbactam and vancomycin", his condition improved and he was discharged. At the time of discharge, he still had a little cough and yellow phlegm. Physical examination: muscle strength of both lower limbs 5^–Grade, normal muscle tone of limbs; The middle and lower abdominal wall reflexes were attenuated, knee reflex and Achilles tendon reflex (+ + +), bilateral ankle clonus was positive, and left Papanicolaou sign was suspected positive; Deep and superficial hypoesthesia below T9; It was difficult to establish signs with closed eyes (+), and no abnormalities were found in the remaining NS examination. Auxiliary examinations: muscle enzyme, electrolyte, erythrocyte sedimentation rate (ESR), procalcitonin, five thyroid function tests, coagulation routine, C-reactive protein (CRP), rheumatic factor, rheumatoid factor, antinuclear antibody (ANA), antinuclear antibody profile (ANA profile), anti-centromeric antibody (ACA), anti-double-stranded DNA antibody (anti-dsDNA), anti-soluble antigen antibody (ENA), anti-neutrophil cytoplasmic antibody (ANCA), anti-nucleosome, virus complete set, syphilis antibody, anti-HIV antibody, tuberculosis antibody, tuberculin test, T cell spot detection, parasite, vitamin, carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), hematuria light chain, G test, GM test and sputum culture were no abnormalities; Blood routine lymphocytes 0.9 (10⁹/L), monocytes 10.1%; Total serum protein 53.9 g/L, albumin 38.1 g/L, globulin 15.8 g/L; Blood complement C3 788 mg/L, LgM 570 mg/L; CRP 5.2 mg/L. Lumbar puncture pressure 115 mmH₂O (1 mmH₂O =0.009 8 kPa), CSF routine, biochemistry, three major stains, cytology, CRP, rheumatic factor, rheumatoid factor, ESR, immune five items, syphilis antibody, tuberculosis antibody, anti-HIV antibody, C12 were not abnormal; No abnormal cells were observed. Abdominal color Doppler ultrasound showed no obvious abnormalities. Lung CT: 27 Dec 2013 (Figure 1): Diffuse spotty, ground glass-like density increased shadow in both lungs. Cranial MRI (Figure 2): Patchy T was seen on the edge of some lesions in bilateral frontoparietal occipital lobes₁Like low signal, T₂Like hyperintensity foci, the FLAIR sequence showed hyperintensity, and diffuse multiple spotty enhancement foci were seen in the parenchyma after enhancement. Thoracic cord MRI (Figure 3): C7 – T12 spinal cord was significantly swollen throughout the course, with multiple spotty T₁Like low signal, T₂Like high-signal foci, they are not uniformly enhanced after enhancement. Lumbosacral MRI: Stripe-shaped T can be seen in the spinal conus₁Slightly higher signal, T₂Slightly low signal focus, mild enhancement after enhancement.

executive function is the ability to flexibly integrate and cooperate different cognitive processes to achieve a specific goal. Impairment of executive function is common in patients with vascular cognitive impairment^[1]。 This review reviews the relevant literature on executive function and its localization of brain regions, aiming to provide theoretical basis for the diagnosis and treatment of vascular cognitive impairment and further research. Common classifications of executive functions are as follows: (1) Gioia, etc.^[2]Executive functions are considered to include components such as initiation, switching, planning, organization, self-monitoring, emotional control, and working memory, in addition to components of inhibition control. (2) Pennington and Ozonoff^[3]Executive function is considered to have three dimensions: working memory, inhibitory control and attention flexibility. (3) Collette and Van der Linden^[4]From the perspective of imaging, the executive function is divided into four dimensions: inhibition, transition, refresh and dual-task coordination. Considering the above classification methods, this paper reviews the executive function and its functional brain region localization from three aspects: working memory, selective attention/inhibition control and cognitive flexibility (Figure 1)。

Long-term bed braking can lead to serious complications in critically ill patients with mechanical ventilation, such as acquired weakness in intensive care unit (ICU), dysfunction of cardiac and circulatory system, metabolic and mental abnormalities, etc^[1,2,3]。 The above complication will not only prolong the time of mechanical ventilation and ICU stay^[4]It can even seriously impair the rehabilitation of the patient's body function^[5,6]。 In order to prevent the complication of long-term bed braking in patients with mechanical ventilation, early activity is the key measure of prevention. Clinical studies have confirmed that active early activity is a safe and effective strategy for disease prevention and rehabilitation in critically ill patients undergoing mechanical ventilation^{[7,8,9,10,11]}。

Germ cell tumors are named after histopathology. According to the World Health Organization (WHO) classification criteria, they can be divided into germ cell tumors (GGCT) and non-germ cell neoplastic germ cell tumors (NGGCT). NGGCT can be further divided into choriocarcinoma, teratoma, endodermal sinus tumor and embryonic carcinoma^[1]。 Intracranial germ cell tumors (icGCT), as one of the primary childhood brain tumors, tend to occur in pineal and sellar regions. Germ cell tumors in the sellar area are rarer in clinic, and it is difficult to distinguish them from other lesions in the sellar area because of their diverse imaging manifestations. Some types of tumors lack tumor markers, so they have become difficult in clinical diagnosis and treatment. Its clinical rarity also brings certain difficulties to the standardization of its diagnosis and treatment plan.