Volume 97  ·  Issue 01  ·  2017

With the continuous development of economy, the continuous improvement of people's living standards and the aging of the population, people's demand for health is increasing, and medical expenses are rising. According to the World Health Organization (WHO), the world's population over 60 years old reached 900 million by 2015, and it is expected to reach 2 billion by 2050. According to the data of the sixth national census released by the National Bureau of Statistics of China^[1]As of November 1, 2010, China's total population was 1.37 billion. Among them, approximately 182 million people aged 60 and above accounted for 13.26%, an increase of 2.93% over 2000; The population aged 65 and over is 122 million, accounting for 8.87%. The problem of population aging is very prominent. At present, China is the country with the largest absolute number of elderly people in the world. It is estimated that the elderly population over 60 years old in China will increase to 245 million by 2020 and about 440 million by 2050^[2]。 Population aging is one of the important factors in the change of the disease spectrum in China. The common diseases that affect the health of our people have changed from infectious diseases in the past to chronic non-infectious diseases now, mainly including cardiovascular and cerebrovascular diseases, diabetes, chronic obstructive pulmonary disease and malignant tumors. In 2013, the National Center for Cardiovascular Diseases released the report "China Cardiovascular Disease Report 2012", which pointed out that as of 2012, the number of cardiovascular diseases in China was 290 million, and one person died of cardiovascular diseases every 10 seconds. Among cardiovascular diseases, hypertension is the most common cause, and its patients have exceeded 250 million. Hypertension causes damage to target organs such as heart, brain and kidney, seriously endangering human health^[3,4,5]。 According to China's coronary heart disease policy model, the number of cardiovascular diseases (angina pectoris, myocardial infarction, sudden death from coronary heart disease and stroke) among people aged 35-84 in China will increase by more than 50% from 2010 to 2030^[4]。 China is now the largest diabetic country in the world, with 114 million diabetic patients, and has become the fastest growing region of diabetes in the world. At present, deaths caused by chronic diseases have accounted for 85% of the total deaths in China, and the burden of diseases caused by chronic diseases accounts for 70% of the total burden of diseases. They are the main reasons for people to become poor due to diseases and fight against poverty due to diseases. If they are not effectively controlled in time, they will bring serious social and economic problems^[2,6]It is also one of the reasons for the increase of doctor-patient contradictions and doctor-patient disputes^[7]。

To explore the abnormality of chromosomes of patients with lipoma tethered cord syndrome and the probable association between Copy Number Variations (CNV) and lipoma tethered cord syndrome.

By using the Agilent SurePrint G3 Human CGH 8×60K Microarray Kit, we performed genome-wide screening for CNV on 11 patients with lipoma tethered cord syndrome adopted by the Neurosurgery Department of Chinese PLA General Hospital and their healthy parents from March 2015 to May 2015. We analyze CNVs got by the kit against the gene databases. Unrelated confirmed polymorphisms contained in Database of Genomic Variants (DGV) were discarded. Database of Chromosomal Imbalance and Phenotype in Humans using Ensemble Resources (DECIPHER) helps us with similarity inquiry, and UCSC Genome Browser helps in identification of non-polymorphic CNV. Biological process, cellular component and molecular function enrichment of these genes were conducted to confirm the association between the CNV and lipoma tethered cord syndrome.

17 CNV were discovered by aCGH in 11 patients. Chr8: 39258894-39386158 and Chr15: 20481702-22509254 showed a high frequency of 5/11. Angelman syndrome and Prader-Wolli syndrome were found to be associated with the CNV of Chr15. Gene function enrichment analysis revealed that ADAM5P and ADAM3A contained in CNV obtained from patients with lipoma tethered cord syndrome was also associated with orofacial clefts.

CNV in Chr8 and Chr15 of patients with lipoma tethered cord syndrome had a higher frequency than that of common human. It revealed that there is probable association between these two pieces of CNV and lipoma tethered cord syndrome. To explorer related genes or CNV, focusing on certain type of NTDs may increase the research efficiency and get more accurate results.

To evaluate the clinical application value of diffusion tensor imaging (DTI) parameter in evaluating the prognosis of spinal cord injury in acute cervical spinal cord injury.

From October 2012 to December 2015, a total of 23 patients with acute cervical spinal cord injury were examined by routine MRI-T₂WI high signal DTI examination, according to the American Spinal Injury Association (ASIA) damage standard. One month later according to the functional outcome of the spinal cord, all patients were divided into non improvement group (group A) 4 cases (2 cases of ASIA-A, 2 cases of grade B) and improvement group (group B) 19 cases (13 cases of ASIA-C, 5 cases of grade D, 1 case of grade B), 15 cases of healthy volunteers as the normal group (group C ). The FA value, ADC and axial eigen value[λ_∥=λ1], radial eigen value[λ_⊥=(λ2+ λ3)/2]of before and after the treatment in group A and group B were compared by pairedt test respectively. Single factor analysis of variance (ANOVA) was used to analyze the differences of DTI among the group A, group B and group C, and LSD test was used to compare the differences among the groups.Before and after treatment, the DTI measurement area was consistent.Changes of nerve fiber bundles in group A and group B before and after treatment were displayed in DTT.

After the treatment , the FA value of group A decreased , ADC value and λ _⊥ value increased than that of before treatment(t=3.037, -4.183, -4.805, all P<0.05), λ_∥ value increased(t=-1.160, P>0.05). After the treatment , the FA value and ADC value of group B increased , λ_⊥ value decreased than that of before treatment(t=-3.344, -3.642, 4.694, all P<0.05), λ_∥ value increased(t=-0.596, P>0.05). After treatment, there were statistical differences in FA values, λ_⊥ value , ADC values and λ _∥ values among three groups (F=71.958, 70.432, 75.902, 22.521, all P<0.01).

The changes of FA value, λ _⊥ value are the two most sensitive indicators of acute cervical spinal cord injury of spinal cord function prognosis.It suggests the poor prognosis of spinal cord function when FA value decreases and λ _⊥ value continues to increase.DTT can visually display subtle changes in the nerve fiber bundle.

To explore the causes and countermeasure in recurrent bleeding following the selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage.

A total of 334 patients of severe renal hemorrhage associated with percutaneous nephrolithotomy (PCNL) from March 2011 to April 2015 were analyzed retrospectively.All the patients underwent super selective angiography and renal artery embolization.The causes of recurrent hemorrhage were analyzed and principles for diagnosis and embolization were studied.

The initial embolization was performed in 329 cases hospitalized in the First Affiliated Hospital of Guangzhou Medical University and 318 cases were successfully stopped bleeding with a hemostatic rate of 96.7 %(318/329). Of total 334 consecutive cases, there were 16 cases of recurrent renal hemorrhage, 11 cases were initially embolized in this hospital, and otherwise the other 5 cases were in other hospitals. Causes of recurrent hemorrhage were missed embolization of tiny pseudoaneurysm (n=12), and two cases of 12, the tiny pseudoaneurysm were feeding by accessory renal arteries, undetected arteriovenous fistula(n=2), recanalization of the embolized arteries (n=2).

The causes of recurrent bleeding fallowing the initial selective renal artery embolization treating post-percutaneous nephrolithotomy hemorrhage are varied, and missed embolization of tiny pseudoaneurysm is the major cause of unsuccessful initial renal artery embolization. To strengthen the understanding of tiny pseudoaneurysm is helpful to improve the success rate of hemostasis.

To confirm the incidence of the symptomatic venous thrombosis and evaluate the efficacy of early treatments in patients with symptomatic venous thrombosis after knee arthroscopic surgery.

From June 2010 to December 2015, 19 patients with symptomatic venous thrombosis hospitalized after knee arthroscopy were retrospectively analyzed by visual analogue scale (VAS) in Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.

The incidence of symptomatic venous thrombosis after knee arthroscopy in our hospital was about 1.27%.15 cases were completely followed up to the end point.The clinical symptoms of those patients were statistically relieved[(4.74±0.73)vs(1.89±0.66), (1.60±0.51), P<0.05)]; [(46.68±4.09) cm vs (45.00±4.07)cm,P>0.05; (46.68±4.09) cm, (43.73±4.04)cm,P<0.05)]; and in one month ultrasonic review, 5 cases were confirmed to get revascularization, while with 4 cases get partially response.No significance was found in symptomatic relief-revascularization correlation and background factors comparison.No pulmonary embolism were observed among those cases.

Although the incidence of symptomatic venous thrombosis after knee arthroscopy is relatively low, caution should still be needed to get early detection, diagnosis and intervention.The conventional conservative treatments can usually get a relatively good and safe clinical outcome.

To assess the cost of illness, the current medication treatment status and health service utilization of patients with knee osteoarthritis (OA).

From January 2014 to May 2015, 250 patients in Arthritis Clinic and Research Center, Peking University People′s Hospital were recruited and followed up for 12 months. There were four visits during the follow-up, i. e. baseline, 1, 6 and 12 month. Data on sociodemographic variables, direct cost of illness, medication utilization and health service utilization were obtained by the questionnaire for the analyses.

Two hundred and twelve participants had accomplished the 12-month follow-up. The direct cost of knee OA was (8 858±5 120) yuan per year , median number was 7 020 yuan. Medical-related cost was (7 184±4 890) yuan per year , median number was 5 420 yuan; comprising 81.1% of the direct cost, whereas the non-medical related cost was( 1 674±924) yuan(RMB) per year , median number (1 239) yuan, comprising 18.9% of the direct cost. The medication cost was (5 484±3 510) yuan , median number was 4 046 yuan, accounting for the largest proportion (76.3%) of the medical-related cost. As for the medication utilization, glucosamine was most commonly prescribed (64.8%), followed by the Chinese herbals (61.2%) and NSAIDs (48.8%). The average amount of the hospital-visit per year was (11.8±4.1). Most knee OA patients (68.8%) took the tertiary care hospital as their first choice when they consulted orthopedists or physicians for OA.

The direct cost of OA patients is considerable. OA patients may take medicine blindly and not follow the current guidelines. The prevention and treatment of OA needs to be further standardized in the future.

The aim of the current study was to investigate the predictive value of fragmented QRS wave ( fQRS) for the prognosis of patients with coronary heart disease (CHD).

A total of 714 consecutive patients with confirmed CHD were included from Department of Cardiology, General Hospital of PLA between January 2013 and January 2014, and were divided into fQRS group and non-fQRS group based on the presence of fQRS wave or not according to Electrocardiograph (ECG). The baseline, ECG characteristic value, the echocardiography results of the patients were compared between the two groups. Cardiac events were recorded in all patients during 12 months′ follow-up. Subgroup analysis was also conducted among patients with abnormal Q wave to investigate the association between fQRS and cardiovascular events.

A total of 673 patients completed the follow-up, with 533 in fQRS group and 140 in non-fQRS group. The P wave duration in the fQRS group was longer than non-fQRS group [(92±21) vs (82±23)ms, P<0.01]. The left ventricular ejection fraction (LVEF) value in the fQRS group was lower than non-fQRS group (42%±22% vs 49%±15%,P<0.01) according to echocardiography results. The subgroup analysis with abnormal Q wave showed that compared with non-fQRS group, the left ventricular ejection fraction (LVEF) value in the group of fQRS was lower (38%±21% vs 50%±7%,P<0.01). There was statistically significant in the mortality of patients within follow-up period between the two groups (P<0.05), and the survival time in fQRS group was shorter than the non-fQRS group [(28.3±3.4) vs (30.5±1.5)months,P<0.01].

FQRS presence in body surface ECG of CHD patients with abnormal Q wave is a sign for increased risk of cardiovascular events, which can serve as an indicator to identify CHD patients at high risk of death.

To investigate the clinical application and preliminary results of ¹²⁵I radioactive seeds brachytherapy in the comprehensive treatment of the pediatric soft tissue sarcoma in head and neck.

A total of 24 pediatric patients with soft tissue sarcoma in head and neck were treated at Peking University School of Stomatology from April 2012 to July 2015. The data was collected and analyzed through statistical methods, which included the pathological type, gender, age, tumor location, volume, treatment and the clinical results after the application of ¹²⁵I radioactive seeds brachytherapy.

Among the 24 patients, there were 18 patients of rhabdomyosarcoma, 2 Ewing′s sarcoma, 2 fibrosarcoma, 1 synovial sarcoma and 1 malignant fibrous histiocytoma. After a follow-up of 9-48 months, 1 case of temporal rhabdomyosarcoma was observed to have a progression to the the lateral cranial base at the time of 12 months, 2 cases realized local control and systemic progression, the rest were completely relieved, and there was no recurrence during the follow-up period.The Kaplan-Meier survival analysis showed that the 1-year and 3-year local control rate were both 94.1%, the 1-year and 3-year event-free survival rate were 87.4% and 77.7%.

The preliminary results indicate that ¹²⁵I radioactive seeds brachytherapy play a very important role in the improvement of the local control rate and survival quality of the pediatric soft tissue sarcoma patient in head and neck, and it′s a minimally invasive treatment with the advantage of accuracy andsmall side effects.

To explore the correlation among the pre-pregnant body mass index (BMI), gestational weight gain (GWG) and umbilical cord blood C peptide, and to investigate the influence of maternal weight management on the incidence of baby long-term metabolic syndrome.

During May to Aug.2015, 485 pregnant women in Zhejiang Taizhou first people′s hospital and Taizhou Huangyan maternal &child care service centre were selected in random and divided into four groups according to pre-pregnant BMI: low body mass, normal body mass, over body mass and obese group, and also divided into two groups for getting gestational diabetes mellitus (GDM) or not. According to the gestational weight gain (GWG), all the cases were divided into two groups: above the Institute Of Medicine (IMO) 2009 recommendations or not. According to the outcome, the GDM group which had received weight control treatment, was divided into successful treat group or not. At last, we tested the umbilical cord blood C peptide and birth weight of each newborn and compared the difference in all subgroups. The correlation between the umbilical cord blood C peptide and birth weight were analysed.

(1) In the pre-pregnant BMI groups, there were significant differences of incidence of GDM (P<0.05). But, there were no significant differences of incidence of GWG in four groups (P>0.05). (2) Newborn birth weight and the umbilical cord blood C peptide were positively correlated (r=0.673, P<0.05). (3) Umbilical cord blood C peptide showed the correlation in all subgroups for different pre-pregnant BMI, GDM or not, overweight or not (P<0.05), but only the GDM or not group had relation to newborn birth weight in all subgroups. (4) All groups showed correlations with neonatal umbilical cord blood C peptide, the GDM mostly (β=0.58), pre-pregnant BMI secondly (β: 0.36, 0.38) , and GWG weakly (β=0.17). (5) By stratification analysis, in GDM group, low body mass was negatively correlated with umbilical cord blood C peptide (P<0.05, β=-1.41); in non-GDM group, over body mass group and obsess group were positively correlated with umbilical cord blood C peptide (P<0.05, β=0.37, 0.46).

There was direct correlation between the pre-pregnant body mass index, the gestational weight gain and umbilical cord blood C peptide. Suitable maternal weight control especially pre-pregnant body mass index control will lower the baby long-term metabolic syndrome incidence.

To explore the computed tomography(CT) features of inflammatory myofibroblastic tumor(IMT) in different pathological types, and improve the diagnostic level of this disease.

The CT features of 29 cases pathologically confirmed IMTs were retrospectively reviewed along with a literature review to analyze the CT features and pathological correlations, and three kinds of pathological classification of IMT in patients with gender , shape, boundary and location were respectively analyzed by Chi-Square test.

The age ranges from 2 to 78 years.There were 7 cases of mucinous blood vessel type and 13 cases of spindle cell type and 9 cases of fiber type.Immunohistochemically, Vimentin (22/29) and SMA (28/29) were positive in all the cases, ALK (4/29) and CD-67(6/29) were partly positive expression, other markers such as S-100 were negative expression.The Chi-Square test showed that there were statistically differences in the gender of the patients.

The CT and clinical features differ according to pathological types of IMT. Its final diagnosis still needs to be combined with pathology and immunohistochemistry result. In all, CT has a role in assessing the extension of IMT and especially about the relationship with adjacent organs which can effectively direct the establishment of clinical treating scheme.

To analysis the value of susceptibility vessel sign (SVS) in susceptibility weighted imaging (SWI) in detecting thrombogenesis in middle cerebral artery (MCA) and its association with clinical prognosis.

From December 2014 to December 2015 in People′s Hospital of Zhengzhou University, we retrospectively examined clinical, imaging and experimental datafrom 104 consecutive patients with acute ischemic strokeand compared the consistency of detecting thrombus between SWI and magnetic resonance angiography (MRA) using Kappa analysis. Clot Burden Score (CBS) was used to analysis extent and scope of thrombus. The association between CBS and clinical prognosiswere analyzed by Spearman rank correlation.

Mean age was 60 years old of the 104 patients with acute cerebral infarction and female accounted for 32%. There were 39 patients (37.5%) with SVS positive in SWI and 32 patients (30.8%) with both SVS positive and MRA occlusion or severe stenosis. The consistency in predicting arterial thrombosis of occlusion or severe stenosis between MRA and SVS in SWI was statistically significant (Kappa=0.502, P<0.001). There were 6 cases with SVS positive and none stenosis in MRA, and all the clots in this 6 case were located in distal artery. CBS was significantly associated with 3-month outcome (Spearman ρ =-0.472;P<0.001).

SWI is superior to MRA for the detection of intracranial distal thrombus in patients with acute ischemic stroke of the MCA territory. Higher clot burden(lower CBS) could be an important clinical tool to estimate poor outcome in patients with acutecerebral infarction.

Insulin resistance (IR) is a common manifestation in patients with polycystic ovarian syndrome (PCOS). Both clinical observations and animal studies have demonstrated that IR could be induced by hyperandrogenemia, which is the charac-teristic of PCOS.Nevertheless, the mechanisms of IR in PCOS are still unclear especially at the molecular level.We conduct this study to ellucidate the effects of androgen on insulin sensitivity and chronic low-grade inflammation in adult C57BL/6 female mice.

Eleven adult female C57BL/6 mice aged 8 weeks weredaily injected with testosterone (1.0 mg/100 g body weight)which dissolved in sesame oil (experimental group T) for 16 weeks.Ten control mice were injected with sesame oil only (group Con). The changes of body weight and body fat content were detected.Intraperitoneal glucose tolerance tests (IGTT) were performed at 0, 2, 3 and 16 weeks treatment, blood from tail vein was taken to detect levels of glucose.Intraperitoneal insulin tolerance tests (ITT) were performed at 16 weeks treatment.Both groups were sacrificed after16 weeks treatment, and phosphorylation of GSK3βand InsR, two molecules of insulin signaling pathway, were detected by Western blot from adipose tissue.The phosphorylation of NF-κBp65, CD16/32, and CD206 were also detected in adipose tissues.ELISA was used totest the serum IL-6 and MCP-1.

(1) No obvious significance of body weight as well as body fat content was detected between both experimental groups (P>0.05); (2) 2 weeks treatment with testosterone induced the in-crease of fasting blood glucose and displayed obvious significance compared with group Con (P<0.05); (3) 3 weeks treatment with testosterone induced the increase of area under the curve (AUC) of the blood glucose following IGTT and displayed significance compared with group Con (P<0.05). And more obvious significance was detected at 16 weeks treat-ment (P<0.01); (4) 16 weeks treatment with testosterone induced the increase of AUC of the blood glucose following ITT(P<0.01); (5) the serum IL-6 and MCP-1 in testosterone treat-ment was higher than that in thecontrols (P<0.05). And 16 weeks treatment with testosterone decreased phosphorylation of GSK3β and InsR in C57BL/6 adipose tissues (P<0.05), in-creased phosphorylation of NF-κBp65.Testosteroneenhanced the expression of CD206, and decreased the expression of CD16/32.

Treatment with testosterone in adult fe-male mice can induce insulin resistance by blocking insulin signal transduction, without in-fluencing body weight and body fat content.Testosterone could activate the NF-κB to pro-mote the expression of IL-6 and MCP-1. And testosterone facilitated to promote macro-phage to M1-subtype transformation.

To investigate the the expression of subchondral bone of Indian hedgehog(Ihh) with early experimental osteoarthritis induced by mechanical stress.

The animals were equally divided into two groups: experimental group(E-group, n=15) and control group(S-group, n=15). The right knee joints of E-group underwent surgery, which involved in both medial collateral ligament (MCL) transaction and medial meniscectomy, while the control group was only carried out with a sham operation.The rats were killed at 1, 2 and 4 weeks postsurgery to obtain the right knee joints. Immunostaining and immunofluorescence double staining were performed to evaluate the expression of Ihh in subchondral bone, respectively.

The polynuclear giant cells in the subchondral bone of E-Group expressed Ihh in their cytoplasm 1 and 2 weeks post-surgery, except for 4 week, while those of S-Group appeared negative at all three time points postsurgery. There is statistically difference between the mean density of positive area of Ihh in sections of E-group and S-group both in 1 week (E-group: 0.351+ 0.086, S-group: 0.153±0.017, P<0.05) and 2 weeks (E-group: 0.303±0.026, S-group: 0.176±0.013,P<0.05), but without statistically difference in 4 weeks (E-group: 0.092±0.033, S-group: 0.136±0.014,P>0.05) post surgery. Trap positive giant cells in subchondral bone of E-group were also found Ihh positive, which indicated expression of Ihh in osteoclast .

Ihh maybe play an important role in pathogenesis of early experimental osteoarthritis.

To investigate the effects of water extract of salvia miltiorrhiza aganst renal injury on rats exposed to cadmium.

Twenty female Wistar rats were randomly divided into blank control group (8), 32 rats in model group, conventional breeding, the blank control group received intraperitoneal injection of saline 5 ml·kg^-1·d^-1, model group with 2.8 mg·kg^-1·d^-1 of cadmium chloride solution by intraperitoneal injection. After the success in modeling, the model group was divided into treatment group (salvia extract high dose 2.7 g·kg^-1·d^-1, low water extract of salvia a dose of 1.35 g·kg^-1·d^-1), negative control group, positive control group. After 4 weeks to experiment in the drug group, the water extract of salvia miltiorrhiza by intragastric administration, the positive control group using sodium selenite solution 0.05 mg·kg^-1·d^-1 gavage, negative control group, the control group was given the same physical volume of saline water gastric 2.7 ml·kg^-1·d^-1, respectively. Each group intervention for 10 weeks. At the end of the experiment, serum was collected at, were used to detect the serum oxide dismutase (SOD), malondialdehyde (MDA), serum total antioxidant capacity (T-AOC).

Danshen aqueous extract can make dye CD rats body weight growth faster, the serum SOD activity decreased significantly[(241.0±2.8) U/ml vs(219.6±4.6) U/ml, P<0.05], serum MDA increased greatly[(7.2±0.3) μmol/L vs(11.9±0.9) μmol/L,P<0.01], to enhance the serum total antioxidant capacity[(8.7±1.5) U/ml vs(4.6±2.0)U/ml,P<0.05].

Danshen aqueous extract has obvious antioxidant injury, in reducing swelling of renal tubular epithelial cells, improve renal function effect significantly.

A 68-year-old female, Han nationality, was admitted to Beijing Jishuitan Hospital on October 28, 2011 due to progressive osteoarthralgia and proteinuria for 2 years. Two years ago, there was no inducement to appear bilateral heel and low back pain when bearing weight, which could be relieved by rest. Examination in outside hospital: blood routine was normal; urine protein (+) (+ +); normal liver function; Creatinine was 106-125 μ mol/L, urea nitrogen was 5.5-6.2 mmol/L, blood calcium was normal, blood phosphorus was 0.63-0.69 mmol/L (normal value 0.81-1.65), and blood alkaline phosphatase (ALP) was 180-235 U/L. Considering "hepatitis B virus-associated nephritis (HBV-GN) is not excluded", renal biopsy was performed, and pathological examination showed that under light microscope, 27 glomeruli, 4 ischemic sclerosis, diffuse mild hyperplasia of mesangial cells and stroma in other glomeruli, granular degeneration of renal tubular epithelial cells, partial epithelial brush margin detachment, lumen dilation, small focal atrophy of tubules, small focal mononuclear lymphocyte infiltration of renal interstitium with fibrosis, diffuse thickening of small arterial wall, and partial lumen stenosis; Immunofluorescence showed that 8 glomeruli were negative for IgG, IgA, IgM, C3, C4, C1q, FRA and HBsAg. Combined with the patient's history of hypertension, the diagnosis: hypertensive renal damage. He was treated with blood pressure control and "piperazine ferulate tablets", but the patient's urine protein continued (+) (+ +), his heel and low back pain progressively worsened, and he could not walk. And bilateral ankle joint, groin area, lower chest wall and shoulder joint pain, accompanied by difficulty in turning over and getting up. No joint swelling. Three months ago, dual-energy bone mineral density performed in a foreign hospital showed the T value of the 1st to 4th lumbar vertebrae-2.8 SD and the T value of the left femoral neck-4.5 SD, and was diagnosed as primary osteoporosis. PET-CT showed increased local metabolism with bone defects in the frontal bone, right zygomatic arch and both inferior pubic branches near the right frontal sinus; Local metabolism of multiple ribs is slightly higher; Systemic bone marrow metabolism is generally slightly increased. Biopsy of bone tissue of right ilium was performed, and no tumor cells were found in pathological examination. One month ago, the other hospital considered bone metastasis of the tumor, and gave intravenous incadronate disodium 10 mg, but the symptoms were not relieved. He was admitted to Beijing Jishuitan Hospital for further diagnosis and treatment. Height becomes 6 cm shorter. There was no significant change in body mass. Previous medical history: 20 years of history of hypertension, treatment with oral amlodipine besylate tablets 5 mg/d, good blood pressure control. Has a history of chronic hepatitis B for 19 years and started oral adefovir dipivoxil 10 mg/d 5 years ago. History of menstrual marriage and childbirth: menarche at 12 years old, menopause at 48 years old. Pregnancy 2 and natural delivery 2. Family history is not special.

A 57-year-old female was admitted to the Department of Neurology of China-Japan Friendship Hospital on August 15, 2014 due to "asymptomatic pontinopathy for 1 week". The patient had repeated fever 5 months before admission, with the highest body temperature of 39.3 ℃, without chills and chills. Blood routine was tested: white blood cells 4.92×10⁹/L, red blood cells 3.37×10¹²/L, hemoglobin 95 g/L, local treatment with cefuroxime, ribavirin, ribavirin and other treatments did not improve, and ferrous sulfate treatment was intermittently given, and hemoglobin 88 g/L was re-examined later. One week ago, the cranial MRI of the outside hospital showed that the volume of the pons was slightly enlarged, and the internal sheet was seen.₁Long T₂Signal, diffusion-weighted image hyperintensity, multiple ischemic foci in bilateral cerebral hemispheres (Figure 1)。 The patient felt fatigued from the onset of the disease, without dizziness, headache, numbness and weakness of the limbs, etc., and lost 10 kg in weight. Past physical health, menopausal for 5 years, personal history, family history is not special. Physical examination: blood pressure 120/70 mmHg (1 mmHg =0.133 kPa), consciousness, anemic appearance, unpalpable swelling of superficial lymph nodes. No dry and wet rales were heard in both lungs, the heart rate was 90 beats/min, the heart rhythm was uniform, no pathological murmur was heard, the abdomen was soft, no tenderness, the liver and spleen were not palpable, and no positive signs were found in the neurological examination.

The 47-year-old female was admitted to hospital on January 13, 2016 with intermittent pain in the left kidney area for more than 1 year. The patient developed pain in the left kidney area after exertion more than 1 year ago, and CT in the outside hospital showed a huge mass in the left adrenal gland area.

The patient, 38 years old, was seen in the outpatient clinic of the First Hospital of Jilin University in February 2014 due to "weakness of both lower limbs for more than 10 years". His mother had no special pregnancy and childbirth. She was born prematurely. She couldn't raise her head at 3 months. She could sit upright with the support of 8 months. She could climb at the age of 1 and walk at the age of 2. She had weakness in both lower limbs 10 years ago, and she could still run and jump. She could walk on a flat road. She was easy to fall when climbing stairs and had a duck-walking gait. Since then, her symptoms have gradually worsened. She couldn't run and jump, so she could only walk slowly on a flat road. No history of epilepsy. Acceptable academic performance. His parents were not intimate married and denied family genetic history. Physical examination: The mind is clear and the language is clear, there are no abnormalities in the cranial nerve examination, the muscle strength of bilateral deltoid muscles, biceps brachii, and triceps brachii is grade IV, the muscle strength of iliopsoas muscles, quadriceps femoris, biceps femoris, and tibialis anterior muscles is grade III, the muscle tension of the limbs is low, the tendon reflex and pathological reflex are not drawn out, the sensory and mutaxial physical examination is not abnormal, and there is no joint contracture. Auxiliary examination: EMG suggested myogenic lesion. Head MRI: bilateral lateral paraventricular, parietal T₁Low signal, T₂High signal, FLAIR high signal (Figure 1)。 Muscle enzyme: Creatine kinase 665 U/L (25-200 U/L).

A 37-year-old female was admitted to the Chest Pain Center of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine in February 2016 due to "sudden chest pain for 2 h"; Past physical health, denied "hypertension, coronary heart disease, diabetes" medical history and family history. Two hours before admission, there was no obvious trigger for sudden retrosternal squeezing pain, and it radiated to the left shoulder. Self-administered "analgesic tablets" were ineffective, so I came to the hospital for treatment. Physical examination showed: heart rate 90 beats/min, blood pressure 95/60 mmHg (1 mmHg =0.133 kPa), coarse respiratory sounds in both lungs, no dry and wet rales, positive Kussmaul's sign, small heart boundary, and grade 2/6 diastolic murmur in the auscultation area of mitral valve. The admission electrocardiogram showed ST segment elevation in Ⅱ, Ⅲ and avF leads (Figure 1), bedside rapid troponin was qualitatively positive. Considering acute inferior wall and right ventricular myocardial infarction, emergency coronary angiography was performed. The results showed that the intima of the left main trunk, circumflex artery and anterior descending artery was smooth and no stenosis was observed. 100% occlusion far from the proximal right coronary artery (Figure 2)。 The contrast catheter was exchanged for a guide catheter (Judkins R 3.0) and a BMW guidewire was fed to successfully pass through the occlusion section; The aspiration catheter was sent to the distal segment of the lesion along the guide wire, and after repeated aspiration, a mass "thrombus" was extracted (Figure 3), and sent for pathological examination. Re-examination showed TIMI blood flow of right coronary artery grade 3, and no plaque burden was observed in the whole course of the blood vessel (Figure 4)。 The postoperative electrocardiogram of the patient showed that the ST segment of the inferior wall lead fell back to the normal level (Figure 5)。 Considering the age of the patient, it is considered that the possibility of coronary artery embolism is high. The coagulation function of the patient was normal, and the levels of anticardiolipin antibody, protein S and protein C were normal; There was no evidence of atrial fibrillation on post-ambulatory electrocardiogram, and echocardiogram showed a hypoechoic mass about 6.5 cm ×4.6 cm ×3.0 cm in size on the left atrial side of the interatrial septum, which was soft in texture and lobulated (Figure 6), and travel between the left atrium and the mitral valve orifice with the heart beat; Anterior mitral flow was mildly restricted during diastole with a flow velocity of 1.6 m/s. The pathological findings of intracoronary embolus in the patient were "myxoma". Combined with the ultrasound results, it was considered that the myocardial infarction was caused by the partial detachment and embolization of atrial myxoma into the right coronary artery. After the patient's condition stabilized, he was transferred to the cardiac surgery department for left atrial space-occupying resection (Figure 7), and the postoperative pathology confirmed that it was consistent with the components of intracoronary embolus (Figure 8)。 Final diagnosis: (1) atrial myxoma; (2) Cardiogenic embolism: acute right ventricular and inferior wall myocardial infarction.

Holter electrocardiogram is a commonly used clinical screening method for cardiovascular diseases. By recording the ECG signals of suspicious patients in their natural life state for more than 24 hours continuously, arrhythmia events and abnormal changes of ST segment that are not easy to detect by conventional electrocardiogram can be found, and important diagnostic evaluation basis can be obtained. In recent years, the clinical application technology of dynamic electrocardiogram has been continuously updated. Through the analysis of indicators such as sinus heart rate oscillation, T-wave electrical alternation, heart rate deceleration force, heart rate variability and ECG scatter plot, it provides more comprehensive and reliable data for the diagnosis and prognosis of related diseases. Among them, the progress in the primary screening of sleep apnea syndrome (OSAHS) by detecting heart rate variability and deriving breathing curve has received a lot of attention^{[1,2,3,4,5,6,7]}。