Volume 97  ·  Issue 03  ·  2017

In October 2016, Beijing Tiantan Hospital admitted one patient, male, 45 years old. Previous history of hypertension, diabetes and long-term smoking. This time, due to dizziness, blurred vision, dysphagia, and bilateral limb weakness, I went to the hospital for 3 hours. The physical examination, laboratory tests and imaging examination of the patient were completed in the shortest time in the emergency department, and he was considered eligible for intravenous thrombolysis. He was given intravenous recombinant tissue plasminogen activator (t-PA) treatment about 3 h 40 min after the onset of the disease. After the patient's symptoms improved transiently (about 15 min), they worsened again, mainly manifested by disturbance of consciousness and inability to be awakened. After re-evaluation, it was considered necessary to complete cerebral angiography, and endovascular treatment was given if necessary. Angiography showed an occlusion of the middle basilar artery, followed by thrombectomy, balloon dilatation and stenting. Immediate postoperative angiography showed that the anterior basilar artery blood flow recovered well, and the patient's consciousness disorder was alleviated. After operation, NCU was given routine sedation, blood pressure control, antithrombotic treatment, and vital signs, cerebral blood flow and imaging were monitored. On the seventh day after surgery, the patient again experienced aggravated disturbance of consciousness, showed deep coma, and shortness of breath required ventilator assistance. No intracranial hemorrhage was observed after emergency review head CT, and the basilar artery was occluded again after the second angiography. Despite efforts, the patient's clinical outcome was poor.

Epidemiological data show that stroke has become the second most common cause of death in the world, and it is the first cause of death in China^[1]。 Although stroke has received high attention, treatment options for patients with acute ischemic stroke, especially those with severe stenosis or occlusion of large intracranial vessels, are still stretched^[2]。 Five international multicenter RCT studies published in the New England Journal of Medicine in 2015 (MR CLEAN^[3], ESCAPE^[4], REVASCAT^[5], SWIFT PRIME^[6], EXTEND IA^[7]The results showed that the early endovascular treatment of acute ischemic stroke, represented by the new generation stent thrombectomy, was superior to the previous standard medical treatment, which provided new clinical evidence for the treatment strategy of this group of patients.

Hospice for the elderly refers to the hospice care institutions providing palliative and supportive all-round services to the elderly and their families, covering the medical, nursing, psychological and social fields, with the goal of improving the quality of end-of-life of the elderly. The research of hospice care abroad is very rich, but comparatively speaking, the research of hospice care in China is relatively weak, and most of them are carried out in nursing, medicine, psychology and other disciplines. The construction of end-of-life care for the elderly involves not only the fields of end-of-life such as oncology, gerontology and nursing, but also social work, sociology, psychology, demography and other social science fields, which is closely related to the national medical and health policy. How to integrate the above different fields with medical and health policies as a whole will be a big research challenge. Based on the existing development of hospice care in China, this paper puts forward the strategy of building the hospice care system of urban elderly people in China from the actual situation of the country, with the aim of providing reference for the construction of scientific hospice care system in China.

To evaluate the difference of metal metabolism, damage to structure and functional activity in brains between hepatic and cerebral type Wilson disease (WD).

Forty patients with WD, including 20 with cerebral type and 20 with hepatic type, and 20 age-matched healthy controls in the First Affiliated Hospital, Sun Yat-sen University between Jul 2013 and May 2016 were enrolled.All study subjects underwent diffusion tensor imaging (DTI), resting state functional MRI (rs-fMRI) and susceptibility weighted imaging (SWI) of the brain.Six regions of interest (ROIs) were chosen.The values of fractional anisotropy (FA), λ in ROIs were determined on DTI, FA and fiber volumes between ROIs were also determined on DTI.The values of amplitude of low frequency fluctuation (ALFF) and regional homogeneity (REHO) in ROIs were determined on rs-fMRI.The values of corrected phase (CP) were calculated on SWI.The copper and iron content were measured.The difference of imaging and metal metrics between cerebral type and hepatic type WD were evaluated.

DTI metrics differed between patients with the cerebral and hepatic types of WD.ALFF values in the caudate nucleus, and thalamus were lower (P=0.037, 0.040), and REHO values in the caudate nucleus were lower (P=0.029), in patients of cerebral type than in hepatic type patients.CP values of the right caudate nucleus and left putamen in cerebral type WD patients were lower than in hepatic type patients (P=0.020, 0.23). The serum iron content of hepatic type WD patients was higher than the normal (P=0.013), and the urine copper content was higher than the cerebral type patients (P=0.021).

Metal deposition and damage to the structure and functional activity in the brain may occur in hepatic type WD patients.The structural and functional activity damage of the brain in hepatic type is less severe than that in cerebral type patients, while the metal deposition is not significant different between hepatic and cerebral type.

To analyze the correlation between white matter integrity and spatial navigation impairment in patients with mild cognitive impairment (MCI).

A total of 27 MCI subjects and 24 healthy controls were enrolled from the Affiliated Drum Tower Hospital of Nanjing University Medical School from May 2015 to February 2016, who underwent 3.0 T MRI scan and 2D-computer version spatial navigation test.DTI preprocessing and tract-based spatial statistics (TBSS) were performed by PANDA.Two sample t-test and partial correlation coefficients were performed to investigate the correlation of white matter impairments and spatial navigation decline.

Relative to controls, MCI showed worse egocentric navigation (t=-2.202, P<0.05). Decreased FA in superior longitudinal fasciculus (leftt=2.95, right t=2.95, P<0.05), inferior longitudinal fasciculus and inferior fronto-occipital fasciculus (leftt=2.66, right t=2.96, P<0.05), corpus callosum (t=2.09, P<0.05), cingulum (leftt=2.76, right t=2.41, P<0.05), fornix (t=4.83, P<0.05), and corticospinal tract (leftt=2.33, right t=2.26, P<0.05), were found in the MCI subjects.The decreased FA value of superior longitudinal fasciculus (leftr=-0.354, right r=-0.347, P<0.05), inferior longitudinal fasciculus (leftr=-0.338, right r=-0.336, P<0.05), cingulum (leftr=-0.395, right r=-0.370, P<0.05), right corticospinal tract (r=-0.362, P<0.05) and fornix (r=-0.369, P<0.05) were correlated with increased ego average total error.Allo average total error were negative correlated with FA value of superior longitudinal fasciculus (leftr=-0.329, right r=-0.350, P<0.05), inferior longitudinal fasciculus (leftr=-0.349, right r=-0.378, P<0.05), splenium of corpus callosum (r=-0.364, P<0.05) and cingulum (leftr=-0.340, right r=-0.406, P<0.05).

This study implicated the potential white matter structural basis of spatial navigation impairment and will have an impact on the further study of the neurobiological mechanisms of human spatial navigation ability.

To explore the clinical characteristics and long-term outcomes of mechanically ventilated patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis.

In this observational study, patients with anti-NMDAR encephalitis were enrolled, who were admitted into Xuanwu Hospital of Capital Medical University from Jan 2012 to Jun 2015.All patients accepted tumor screening, symptomatic therapy, and immunotherapy.Outcomes were assessed by modified Rankin Scale (mRS) after immunotherapy every 6 months, and mRS 0-2 was defined as favorable outcome.The differences of clinical manifestations, auxiliary examinations, and outcomes between mechanical ventilation (MV) group and no MV group were analyzed.

Fifty-six patients (mean age 28±12 years, range 12 to 58 years) were enrolled, and 28 were male.MV group included 16 (28.6%) patients.Five female patients were diagnosed with ovarian teratoma.After 6 months, 50 patients (89.3%) had favorable outcomes, mortality was 0.The proportions of patients being female, with ovarian teratoma, conscious disturbance, dysautonomia, accepting plasmapheresis, immunodepressant treatment, admitted into neuro-critical care unit in MV group were significant higher than those in no MV group.The duration of illness prior to MV was 10-73 days (mean 33±19 days). The period of MV was 3-154 days (mean 46±41 days). There was no significant difference in the period of using MV among different outcome groups.After 6-48 months′ follow-up, 6 patients (10.7%) relapsed, with 1 patient in MV group (1/16, 6.3%), 5 patients in no MV group (5/40, 12.5%). The relapses and long-term outcomes were not significant different between MV group and no MV group.

The condition of mechanically ventilated patients with Anti-NMDAR encephalitis is severe, and the treatment is difficult. However, after active combined immunotherapy and life support, majority of these patients could get good long-term outcomes.

To observe the efficacy and safety of recombinant tissue-type plasminogen activator (rtPA) intravenous thrombolysis (IVT) in the treatment of acute cerebral infarction with hyperdense middle cerebral artery sign (HMCAS).

Acute cerebral infarction patients with HMCAS from July 2010 to November 2015 at the First Affiliated Hospital of Dalian Medical University were collected.These patients were divided into two groups depending on whether they received IVT or not.The Nation Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to evaluate early and long-time therapeutic effects.Efficacy and safety were compared between the two groups.

A total of 93 patients were eligible for the analysis, with 45 cases in IVT group and 48 cases in non-IVT group.As time went by, NIHSS score in IVT group showed significant downward trend than the non-IVT group.The rate of patients with good outcome in IVT group was higher than that in non-IVT group (P<0.05). The rate of hemorrhage transformation (HT) in IVT group and non-IVT group was 35.6% (16/45) and 10.4% (11/48), respectively, and the difference was statistically significant (P<0.05). While no statistically significant difference was found about the rate of symptomatic intracranial hemorrhage (sICH) (8.9% vs 2.1%,P>0.05) and mortality (33.3% vs 27.1%,P>0.05) between these two groups.Logistic regression analysis identified relativity between IVT treatment and good outcome (P<0.05), hemorrhage transformation (P<0.05), rather than mortality (P>0.05).

Intravenous thrombolysis with rt-PA is an effective and safe treatment for most acute ischemic stroke patients with HMCAS and can promote early neurologic improvement and significantly improve long-term functional prognosis.Although Ⅳ thrombolysis can increase the risk of overall HT, it does not add risk in sICH and mortality.

To explore the different effects of chronic treatment with glibenclamide and gliclazide on the warm-up phenomenon in diabetes patients with coronary artery disease.

A total of seventy-one patients with chronic stable angina and diabetes who were positive for exercise test and was proven that the stenosis degree was 70%-90% in at least one major branch through coronary angiogram were included into the study.They were divided into three groups, diet control group (DMD), glibenclamide group (DMG1) and gliclazide group (DMG2), according to the treatment of diabetes.All of the patients underwent two bicycle exercise tests (EX) at 15-minute interval.Parameters including ischaemic threshold (the rate-pressure product at 1-mm ST-segment depression, RPP), time to ischaemic (the time to 1 mm ST-segment depression, T-STD), the maximum ST-segment depression (STDmax) and exercise duration (ED) were recorded respectively.

In group DMD, T-STD and ED were prolonged [(360±83) s vs (409±80) s, P<0.001] and [(518±90) s vs (549±96) s,P=0.001], STDmax were shortened [(1.91±0.43) mm vs (1.60±0.36) mm, P<0.001], and RPP was increased [(180±27) beats·min^-1·mmHg·10² vs (195±28) beats·min^-1·mmHg·10², P<0.001] as the parameters during EX2 were compared with those during EX1. In group DMG1, there was no statistic difference in these indexes except that ED was prolonged [(458±70) s vs (472±66) s,P=0.045] when those of EX2 and EX1were compared. In the group DMG2, all the analyzed variables improved significantly during two sequential exercise tests as the results in the group DMD except that ischaemic threshold was not increased [(199±41) beats·min^-1·mmHg·10² vs (211±39) beats·min^-1·mmHg·10², P=0.071].

Warm-up phenomenon is abolished in diabetic patients with stable angina treated with glibenclamide, partially preserved in gliclazide-treated patients. and the KATP channel may be involved in those different effects. Gliclazide should be the safer choice for the patients with diabetes and chronic stable angina.

To explore the diagnostic value of multi b-value DWI (MB-DWI) in the identification of benign and malignant breast lesions.

From October 2013 to December 2015, a total of 54 cases from Ningbo Medical Center Lihuili Hospital (22 benign cases with a total of 24 lesions, 32 malignant cases with a total of 38 lesions) were examined with conventional MR scan, single b-value DWI, and multiple b-value DWI (0, 10, 20, 30, 50, 100, 200, 400, 800, 1 200, 2 000, 3 000 s/mm²). GE ADW4.5 workstation was used to calculate the value of standard apparent diffusion coefficient (ADC_standard), slow apparent diffusion coefficient(ADC_slow), fast apparent diffusion coefficient (ADC_fast) and fraction of ADC_fast(f_fast). Receiver operating characteristic (ROC)curve was performed to evaluate those MB-DWI parameters above.

The ADC_standard, ADC_slow and f_fast value of malignant group were (0.761±0.166)×10^-3 mm²/s, (0.593±0.144)×10^-3 mm²/s, 0.330±0.099 respectively, which were significantly lower than those of benign group (all P<0.01), while the ADC_fast value of malignant group was 4.379×10^-3 mm²/s, significantly higher than that of benign group(P<0.01). The area under curve (AUC) of f_fast and ADC_standard were 0.799, 0.786 respectively and there is no statistically significant difference.The AUC of ADC_slow, ADC_fast were 0.719, 0.727, which were statistically significant different from the value of f_fast or ADC_standard(all P<0.01).

All the parameters in MB-DWI can be used to distinguish benign from malignant breast lesions.The f_fast and ADC_standard value have higher diagnostic value in the identification of benign and malignant breast lesions.

To investigate the radiographic and clinical assessment for supracondylar humeral fractures resulted from sports in children.

The medical records of 166 patients with displaced supracondylar humerus fractures treated in Shengjing Hospital of China Medical University from January 2015 to December 2015 were reviewed.The etiology of 56 of 166 cases was relevant to the sports.Medical records of 56 of 166 patients were reviewed, incluidng gender, the mean age of patient at the time of surgery, the mean duration of injury, radiographic assessment based on the anteroposterior (AP) and lateral radiographs of the elbow, neurologic injury, the Mayo Elbow Performance Score (MEPS) and the criteria of Flynn.

There were 34 boys (34 elbows, 60.7% (34/56)) and 22 girls (22 elbows, 39.3% (22/56)), and 32 patients in left elbow (57.1% (32/56)) and 24 patients in right elbow(42.9% (24/56)). The etiology included football in 16 patients (28.6% (16/56)), basketball in 10 patients (17.9% (10/56)), skating in 10 patients (17.9% (10/56)), skiing in 8 patients (14.3% (8/56)), roller skating in 5 patients (8.8% (5/56)), kick scooter in 3 patients (5.3% (3/56)), riding horse in 2 patients (3.6% (2/56)) and horizontal bar in 2 patients (3.6% (2/56)). The mean age of 56 patients at the time of surgery was 9.5 years ( range from 6 to 13 years). The mean duration of injury was 2.2 days (range from 4 hours to 35 days). The AP and lateral radiographs of the elbow of all 56 patients (56 elbows) were performed, and three dimensional computed tomography(CT) were performed in 23 patients (23 elbows). There were 54 patients in extension type(96.4% (54/56)) and 2 cases in flexion type (3.6% (2/56)) of supracondylar humeral fractures. There were 20 patients (35.7% (20/56)) of Gartland type Ⅱ and 34 patients (60.7% (34/56)) of Gartland type Ⅲ in 54 patients of extension-type. Two cases of flexion type were both Gartland type Ⅱ (3.6% (2/56)). 33 patients (58.9% (33/56)) had posteromedial displacement of the distal fragment, 21 patients (37.5% (21/56)) had posterolateral displacement of the distal fragment, and 2 patients (3.6% (2/56)) had anterolateral displacement of the distal fragment. Three dimensional CT showed the "-" shape and apposite "V" shape in the anterio edge of proximal fragments in 21 patients (91.3% (21/23)) and 2 patients (8.7% (2/23)), respectively.CT showed Gartland type Ⅲ in 5 patients those AP and lateral radiographs of the elbows were Gartland type Ⅱ.The neurologic deficit of radial nerve injury in 2 patients (3.6% (2/56)) resulted from displaced distal fragment.Closed reduction and percutaneous pinning were performed in all 56 patients.The pin configuration included two or three parallel lateral pins in 46 patients (82.1% (46/56)) and two or three divergent lateral pins in 10 patients (17.9% (10/56)). Of the 56 patients, 7 patients were lost to follow-up, leaving a follow-up rate of 87.5% (49/56). The mean length of follow-up was 9.6 months (range from 4 to 14 months). There were no cases of Volkmann′s ischaemic contracture, or iatrogenic injury of nerve.There were 25 excellent (44.6% (25/56)), 19 good (33.9% (19/56)), 10 fair results (17.9% (10/56)) and 2 poor results (3.6% (2/56)); the rate of excellent and good outcome was 78.5% (44/56) according to the criteria of Flynn.There were 47 excellent (83.9% (47/56)), 4 good (7.1% (4/56)) and 4 fair results (7.1% (4/56)) and 1 poor result (1.9% (1/56)), and the rate of excellent and good outcome was 91.0% (51/56) according to the MEPS.

Sports is the common reason of supracondylar humeral fracture requiring surgical treatment in children.CT is valuable for the diagnosis of supracondylar humeral fracture.Good functional results in the short-term follow-up can be found after closed reduction and percutaneous lateral-entry pinning.

To observe the clinical effect of vacuum sealing drainage (VSD) technique and simple dressing change in the treatment of delayed severe infection after calcaneal fracture surgery.

From August 2008 to July 2015 , 73 patients with delayed severe infection were treated after calcaneal fractures 3 months in Department of Foot and Ankle, the Second Hospital of Tangshan City, according to the treatment methods are divided into vacuum sealing drainage group of 38 cases, 35 cases of simple dressing group.Two groups of patients after regular wound debridement debridement and sterilization after vacuum sealing drainage group received double wound VSD dressing group received postoperative dressing, two groups of patients with sensitive antibiotics for treatment.Two groups of patients according to the frequency of dressing change, wound healing time, bacterial clearance time and healing time were compared in stage Ⅱ during the perioperative period.

Vacuum sealing drainage group: dressing: 7 times, the wound healing time was 27 days, bacterial culture negative for 8 days, the healing time of 13.5 days of perioperative period; treatment group: 34 times the number of dressing, wound healing time was 44 days, bacterial culture negative for 18 days, the healing time of 17 days of surgery period. Two groups of data were compared with the median, after the rank sum test, the difference was statistically significant (Z values were -6.670, -5.529, -5.011, -3.227, P<0.05). The vacuum sealing drainage group compared with conventional dressing group significantly reduced the number of dressing, wound healing time, healing time was significantly shortened bacterial clearance time and perioperative period Ⅱ.

Double VSD is easy , safe and quick, short cure time, less pain, higher quality of late life advantages, compared with the traditional dressing treatment of calcaneal fractures of postoperative delayed severe infection, is a safe and effective method.

To investigate the effects of hypoxia condition and hypoxia-reoxygenation condition on the cell viability, apoptosis rate and gene expression of osteoblasts cultured in vitro.

The cranium osteoblasts from newborn Sprague Dawley rats within 48 hours were cultured and purified through tissue block method.The morphological changes of cells were evaluated by the Alizarin Red S staining and Alkaline phosphatase staining.The third-generation osteoblasts were cultured in normal condition for 36 hours (group A), in hypoxic condition for 24hours (group B), in hypoxic condition for 24hours thereafter reoxygenated for 12 hours (group D), in hypoxic condition for 36 hours (group C). The cell viability of osteoblasts was tested via MTT assay.The apoptosis rate of osteoblasts was tested by FCM (flow cytometry). Quantitative PCR and Western blot methods were used to determine Collagen type Ⅰ, Bone morphogenetic protein 2 (BMP-2), Runt-related transcription factor 2 (RUNX-2), Transforming growth factor-β1(TGF-β1) expression levels.

The cell viability of osteoblasts decreased, group A(99.1%±8.3%), group B(90.9%±9.4%), group C(79.9%±8.7%), group D(73.0%±8.2%), group D <group C <group B <group A ( F=37.886, P=0.000); the apoptosis rate of osteoblasts increased, group A(1.9%±1.3%), group B(16.3%±2.5%), group C(28.2%±4.2%), group D(33.5%±3.6%), group D >group C >group B >group A( F=26.198, P=0.000); the mRNA expressions of Col Ⅰ, BMP-2, RUNX-2, TGF-β1 decreased under hypoxia and hypoxia-reoxygenation condition, and group D< group C< group B< group A (F=13.082, P=0.006; F=7.088, P=0.017; F=6.857, P=0.038; F=51.368, P=0.000); the protein expressions of Col Ⅰ, BMP-2, RUNX-2, TGF-β1 decreased under hypoxia and hypoxia-reoxygenation condition, and group D< group C< group B< group A (F=8.114, P=0.013; F=28.935, P=0.000; F=9.857, P=0.007; F=46.541, P=0.000).

Hypoxia condition and hypoxia-reoxygenation condition decreased the cell viability, increase the apoptosis rate and suppress the expressions of associated genes.Hypoxia-reoxygenation condition aggravate the injure of osteoblasts preconditioning under hypoxia condition.

Cerebral amyloid angiopathy-associated inflammation (CAA-I) is a rare clinical manifestation of sporadic cerebral amyloid angiopathy (CAA), mainly manifested by cognitive decline, headache, behavioral changes, seizures, and localized neurological dysfunction. Brain MRI showed T₂WI or Flair single or multiple patchy or fused white matter hyperintensity. The diagnosis of this disease needs to rely on invasive biopsy pathology, which is rarely reported in China. However, with the deepening understanding of this disease, many scholars have suggested that brain biopsy should be avoided based on typical clinical and neuroimaging characteristics^[1,2,3]。 Because CAA-I responds well to immunosuppressive therapy, improving clinicians' understanding of the disease is of great significance to improve prognosis. In this study, the clinical data of 6 patients with CAA-I based on clinical and imaging diagnosis were retrospectively analyzed, and their clinical and neuroimaging characteristics were analyzed, so as to increase clinicians' understanding of this disease and reduce misdiagnoses and misdiagnoses.

The patient was a 50-year-old female. He was admitted to Tianshui 407 Hospital due to "limb weakness and pain for 5 days, aggravated for 12 hours". He had a history of asthma for 1 year and was rescued in our hospital on March 22, 2016 due to "severe asthma". The lung CT and blood routine data are shown inTable 1、Figure 1。 After discharge, salmeterol and ticasone aerosol were inhaled (discontinued due to disappearance of asthma-related symptoms) and montelukast was administered orally until 1 week before onset. There were no clear cardiovascular high risk factors.

Sepsis is a clinical syndrome of uncontrolled host response to infection and life-threatening organ dysfunction. It is an important cause of death in critical care medicine (ICU) patients^[1]。 Despite the deepening of knowledge of sepsis and the rapid improvement of medical technology in recent years, the mortality rate of sepsis in adults is still as high as 24% ~50%^[2]。 Studies have shown that patients with sepsis are often complicated by hypoalbuminemia, which can lead to further aggravation of the condition and increase the mortality rate. It is currently considered that serum albumin concentrations<30 g/L, can be diagnosed as hypoalbuminemia, and its incidence in severely ill patients is 30% to 50%, where the albumin concentration may be reduced more in septic patients. Numerous studies have confirmed that decreased serum albumin concentration is an independent predictor of prognosis in patients with sepsis and septic shock.

Glioma is a tumor of neuroepithelial origin and is the most common primary tumor of the central nervous system. According to the latest statistics from the central brain tumor registry of the United States (CBTRUS)^[1], gliomas account for approximately 27% of all CNS tumors and 80% of malignant primary CNS tumors. Gliomas are mostly invasive and invasive, and they are easy to relapse after operation, and the mortality rate is high. In order to understand the biological characteristics of tumors more comprehensively, magnetic resonance weighted imaging (PWI) technology is used to evaluate tumor perfusion and angiogenesis. PWI mainly includes arterial spin labeling (ASL), dynamic susceptibility contrast MRI (DSC-MRI) and dynamic contrast-enhanced MRI (DCE-MRI). ASL is not widely used in clinical practice because of its sensitivity to motion artifacts and low signal-to-noise ratio; However, DSC-MRI, which is widely used in clinic, will lead to extravasation of contrast agent when tumors destroy the blood-brain barrier (BBB), thus underestimating cerebral blood flow. DCE-MRI can quantitatively evaluate tissue microvascularization and its function, so as to reflect tissue vascular distribution, blood perfusion and other physiological information at the level of cellular molecular function. Theoretically more accurate than DSC-MRI. Therefore, the research of DCE-MRI in glioma has been paid more and more attention. This article reviews the basic principles of DCE-MRI and its application in glioma.

Fulminant myocarditis is the most critical type of viral myocarditis. Although its incidence rate only accounts for 4% ~5% of the total number of acute myocarditis, its condition is fierce and can rapidly progress to severe heart failure and cardiogenic shock in a short time after the onset, and the mortality rate can be as high as 80%. However, the pathological basis of fulminant myocarditis is myocardial interstitial edema accompanied by inflammatory cell infiltration and involvement of conduction system, while only part of myocardial fibers have vacuolar degeneration and small focal myolytic necrosis, and this histopathological change is self-limiting. Therefore, after timely diagnosis and treatment, a considerable number of patients can almost completely recover the myocardial structure and function without leaving any complications, and the long-term prognosis is better than non-fulminant myocarditis^[1]。 This article will review the diagnosis and treatment status and progress of fulminant myocarditis in recent years.

Endometriosis (abbreviated as endometriosis) and autoimmune thyroiditis (AITD) are common diseases in women of childbearing age and common complications in infertile women. In vitro fertilization-embryo transfer (IVF-ET) is an effective method for the treatment of infertility. Previous studies suggest that the incidence of AITD is increased in patients with endometriosis, and the incidence of endometriosis is also increased in patients with AITD, suggesting that the pathogenesis of the two diseases and the impact on female reproductive function may be closely related. The effects of endometriosis and autoimmune thyroiditis on female reproductive ability and their possible mechanisms are summarized as follows.