Volume 97  ·  Issue 07  ·  2017

With the improvement of the display ability of large-scale imaging examination equipment, the problem that the anatomical structure of head and neck is subtle and complicated and difficult to display has been largely solved, and various new technologies have been introduced into the diagnosis and differential diagnosis of head and neck diseases, which can also be better used to explore the etiology of head and neck diseases.

Multiple organ dysfunction syndrome (MODS) can affect almost all organs and systems of a patient, including the immune system. Immune dysfunction is not only an important component of MODS, but also immune inflammatory response disorders play a crucial role in the development of sepsis, acute respiratory distress syndrome, MODS and other critical diseases^[1]。 Studies have shown that systemic inflammatory hyperactivity and immune suppression often exist at the same time in patients with trauma and sepsis. Reflection on the failure of anti-inflammatory therapy in the treatment of sepsis and the deepening of understanding of immunosuppressive mechanisms and the proposal of persistent inflammation, immunosuppression and catabolic syndrome (PICS) make the necessity of exploring the relationship between immunity and inflammation in critical disease immune dysfunction more prominent. It has theoretical value and clinical significance for understanding the pathogenesis of immune dysfunction in critical illness and realizing precise immunomodulatory therapy under the guidance of immune function monitoring.

To evaluate the value of dynamic contrast-enhanced MR (DCE-MRI) and diffusion weighted MR (DWI) in differential diagnosis of inflammatory pseudotumor and lymphoma in the lacrimal gland.

In this retrospective study, a total of 24 cases of inflammatory pseudotumor and 22 cases of lymphoma in the lacrimal gland at Beijing Tongren Hospital confirmed by histological results were enrolled from January 2010 to January 2015.DCE-MRI and DWI were performed in these cases, and the type of time-signal intensity curve (time-intensity curve, TIC), the peak contrast index (CIpeak), maximum enhancement ratio (ERmax), washout ratio (WR) and ADC value were analyzed.Differences of these parameters between inflammatory pseudotumor and lymphoma in the lacrimal gland was evaluated by independent samples t test or Mann-Whitney U test.The receiver operating characteristic analysis was used to evaluate the utility of these parameters in discriminating the two diseases.

Type of TIC, CIpeak, WR, ERmax and ADC values were statistically different (all P<0.05) between the inflammatory pseudotumor and lymphoma in the lacrimal gland.ERmax, CIpeak and ADC values of inflammatory pseudotumor were greater than those of lymphoma, but the WR values of inflammatory pseudotumor was less than those of lymphoma.The area under the ROC of the CIpeak, WR, ERmax and ADC values was 0.68±0.08, 0.70±0.08, 0.70±0.08, 0.84±0.81 respectively.Using an ADC_{b=0, 1000} value of 1.005×10^-3 mm²/s as the diagnostic threshold, the sensitivity, specificity and accuracy to differentiate benign lesions from malignant lesions were 84.2%, 65.0% and 75.0% respectively.The diagnostic ability of DWI combined with DCE-MRI was superior to that of DCE-MRI(P=0.000) or DWI alone(P=0.008) with overall sensitivity, specificity and accuracy of 86.3%, 87.5% and 86.9%.

DCE-MRI and DWI may improve the diagnostic accuracy in differentiation of the inflammatory pseudotumors and lymphomas in the lacrimal gland, and play an important role in differentiation among them.

To quantitatively evaluate the early radiation injury of salivary glands in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiotherapy (IMRT).

Twenty patients with NPC between 2014 and 2015 from the Second Affiliated Hospital of Soochow University were retrospectively analyzed.All patients underwent an MRI scan before and after IMRT.The volumes, T₁WI, T₂WI signal intensity(SIs) and apparent diffusion coefficient (ADCs) of the parotid and submandibular glands were measured.The relative signal intensity (RSIs) of each salivary gland was calculated with cerebrospinal fluid as control.The quantitative parameters of salivary glands were compared before and after radiotherapy.

The volumes (cm³) and T₁WI RSIs of the parotid and submandibular glands (14.88±6.00, 5.21±1.76, 2.98±1.05, 1.88±0.42, respectively) were significantly lower than those before radiotherapy (22.26±8.26, 7.76±2.45, 3.58±1.02, 2.27±0.50, respectively) (t=9.921, 4.013, 10.126, 4.202, respectively, P=0.000 for all). The T₂WI RSIs and ADCs (×10^-3 mm²/s) of the parotid and submandibular glands (0.50 ± 0.08, 0.41±0.04, 1.31±0.19, 1.50±0.13, respectively) were significantly higher than those before radiotherapy (0.45±0.07, 0.33±0.05, 1.02±0.21, 1.23±0.13, respectively) (t=-4.846, -9.276, -9.957, -10.679, respectively, P=0.000 for all). The volumes of parotid and submandibular glands were correlated with ADCs (r=-0.512, P=0.000; r=-0.358, P=0.001; respectively). The volumes and ADCs of submandibular glands were correlated with T₁WI RSIs and T₂WI RSIs(P<0.05).

MRI can quantitatively evaluate the early changes of salivary glands after radiotherapy of nasopharyngeal carcinoma as a noninvasive method, and has high clinical application potential.

To discuss the value of RESOLVE for predicting early therapeutic effect of concourrent radiochemotherapy in advanced stage nasopharngeal carcinoma patients.

Sixty-eight patients with nasopharyngeal carcinoma were confirmed by pathology in Henan Cancer Hospital from June 2014 to January 2016.All patients underwent RESLOVE(b value=800 s/mm²) with a 3.0 T MRI scanner.The ADC value and the area of the tumor was measured before treatment and 2 weeks after treatment independently performed by two radiologists with 5 years experiences and the agreement evaluation was performed using ANOVA analysis.The correlation among pretreatment ADC value, pathology type, gender, tumor area and the tumor regression rate were analyzed using Spearman rank correlation test.The difference between pretreatment ADC value was compared in CR group and non-CR group by independent sample t test.ROC curve was drawn and the maximum Youden index value was the cutoff calculating the ADC value and predicting the sensitivity, specificity and area under the curve.

(1)The agreement between 2 radiologist was excellent. The ICC values of the ADC and the area of the tumor before treatment and the area of the tumor after treatment were 0.89, 0.92 and 0.95, respectively. (2)The pretreatment ADC values of the CR group and the non-CR group were (0.877±0.103)×10^-3 mm²/s and (0.779±0.078)×10^-3 mm²/s, respectively. There was statistical difference t value=2.874, P value=0.005.(3)ROC curve showed that the sensitivity and specificity of the pretreatment ADC value in predicting CR was 85.2% and 71.0%, with the cut-off value of 0.792×10^-3 mm²/s, and the area under curve was 0.778.(4)There was apparently correlation beween the pretreatment ADC value and the tumor regression rate(r=0.333, P=0.006). There was no correlation among pretreatment ADC value, pathology type, gender and tumor area (P>0.05).

There is important value using the pretreatment ADC value measured by RESOLVE for predicting the early effect of concurrent radiochemotherapy in advanced stage nasopharngeal carcinoma patients.

To quantify the extent and complexity of residual coronary stenosis following PCI by the residual SYNTAX score, and to evaluate its impact on adverse ischemic outcomes in acute coronary syndrome(ACS) patients.

From January 2013 to December 2013, a total of 1 414 consecutive moderate- and high-risk ACS patients who underwent any PCI with multi-vessel coronary artery disease were evaluated.Patients were stratified by rSS quartiles and their outcomes were compared.

The rSS was 4.8±6.7. 591 patients (41.8%) had rSS=0(CR), 233 patients (16.5%) had rSS>0 but ≤ 3, 296 patients (20.9%) had rSS>3 but ≤8 and 294 patients (20.8%) had rSS>8.Clinical risk factors were more frequent in patients with incomplete revascularization(IR) compared with complete revascularization(CR). The 2-year rates of all-caused death(1.2% vs 0.4%, 2.0%, 4.4%,P=0.003), cardiac death, revascularization and MACCE were significantly higher in high rSS group, compared to other groups.By multivariable analysis, rSS was a strong independent predictor of ischemic outcomes at 2-year, including all-cause mortality (HR=1.05, 95%CI 1.01-1.09, P=0.019), cardiac death, revascularization and MACCE.

The rSS is a strong independent predictor of all-caused death, cardiac death, revascularization and MACCE and has moderated predictive ability for those ischemic outcomes.

This study investigated the influence of asymptomatic hyperuricemia on the prognosis of patients who had undergone elective percutaneous coronary intervention (PCI).

A total of 3 452 consecutive patients , who had preoperative serum uric acid level record and were without gout, underwent elective PCIs between July 2009 and September 2011 were included in this study. Patients were divided into two groups based on their preoperative serum uric acid levels. The association between baseline serum uric acid levels and postoperative mortality was investigated through 1.5 years of follow up.

Of the 3 452 patients in the study population, 516 had elevated uric acid and 2 936 had normal uric acid.Patients in the elevated uric acid group were older, more frequently had prior history of hypertension, stroke, myocardial infarction and interventional procedure, less likely to have prior history of diabetes mellitus.Other significant differences included higher white blood cell, total cholesterol and triglyceride levels; lower left ventricular ejection fraction, estimated glomerular filtration rate and high density lipoprotein (HDL) levels, more companied by multivessel disease, more PCI lesions, lower complete revascularization rate.More patients with elevated uric acid level were treated with ACEI/ARB and diuretics at the time of hospital discharge.The results of a multivariate Cox regression analysis revealed that preoperative elevated uric acid was an independent predictive factor for mortality after adjustment for other factors (hazard ratio 3.252, 95% confidence interval 1.902-5.560, P<0.001).

Asymptomatic hyperuricemia is an independent predictive factor of mortality in patients undergoing elective PCI.

To investigate the maternal and neonatal outcomes after different intrapartum interventions for vaginal birth after cesarean (Vaginal Birth After Cesarean-section, VBAC).

One hundred and forty three cases in Beijing Obstetrics & Gynecology Hospital, Capital Medical University from January 2015 to November 2016 were selected retrospectively.The relationship between the intrapartum inventions such as induction style, oxytocin usage and spinal analgesia and the maternal and neonatal outcomes such as delivery way, labor time, postpartum hemorrhage and fetal distress were analyzed in pregnant women underwent VBAC.

(1) Maternal and neonatal outcomes: No maternal and newborn deaths occurred in the 143 cases of VBAC.One hundred and thirteen cases underwent vaginal delivery (79.0%) and 30 cases underwent operative vaginal delivery (21.0%). Twenty-four cases (16.8%) occurred postpartum hemorrhage, 32 cases (24.3%) fetal distress, and 2 (1.4%) asphyxia.(2) Intrapartum inventions: 123 cases (86.0%) were spontaneous onset of labor and 20 cases (14.0%) induction of labor.41 cases (30.6%) used oxytocin during labor to strengthen contractions, 37 cases (25.9%) underwent spinal analgesia.The operative vaginal delivery rate in the induction labor group was significantly higher than that in natural labor group (P<0.05). The duration of the first stage, second stage and total labor in the group using oxytocin were significantly longer than those in the group not using oxytocin (P<0.05). The rate of operative vaginal delivery in the group using oxytocin was significantly higher than that in the group not using oxytocin (P<0.05). The duration of the first stage, second stage and total labor in analgesia group were significantly longer than those in the group not using analgesia (P<0.05). The incidence of postpartum hemorrhage and operative vaginal delivery in analgesia group was significantly higher than those in the group not using analgesia (P<0.05).

Oxytocin may increase the rate of vaginal delivery in VBAC.Spinal analgesia and oxytocin may prolong the labor time and increase the incidence of postpartum hemorrhage in VBAC.

To investigate the clinical characteristics of ankylosing spondylitis (AS) combined Andersson lesion (AL).

The clinical data of patients who were diagnosed as AS combined AL at Sun Yat-sen Memorial Hospital between January 2012 and December 2015 were reviewed retrospectively.SPSS 20.0 software was used for statistical analysis.Data of normal distribution was expressed by ±s (standard deviation) and that of abnormal distribution by median and range.

Fourteen patients were enrolled. Ten were male, median age (IQR, similarly hereinafter) was 46 (29-53) years, disease duration was 120 (54-150) months, 7 has symptom increased in the beginning, 6 has nerve compression symptom, 7 has kyphosis, and 4 has spinous tenderness or percussion pain in physical examination.Eleven of AL occurred in the thoracolumbar junction.Erythrocyte sedimentation rate was 24 (15-44) mm/1 h, C-reactive protein was 10 (5-18) mg/L, and Serum amyloid A was 19 (5-31) mg/L.All the 14 patients were divided into 2 groups, aggravated group (n=7) and none aggravated group (n=7) according to the symptom.It was no statistic difference between them about all the above indicators.

Imageological diagnosis should be performed to identify Andersson lesion, while ankylosing spondylitis patients combined mechanical pain based on inflammatory back pain, or mainly with nerve compression symptom, tenderness or percussion pain, or spinous, even when inflammatory markers were normal.

To investigate the characteristics of superior petrosal vein (SPV) and its influence on the surgical field in microvascular decompression (MVD) for trigeminal neuralgia (TN), and to analyze the effect of the surgical treatment of SPV on the surgical approach, indication and prognosis.

The clinical data of 280 patients with trigeminal neuralgia between Jan. 2013 and Jun. 2016 were collected, including the trunks and the branches of SPV, intraoperative electrocoagulation status, the surgery outcome and complications.

The petrosal vein during the operation was fully preserved in 152 cases (54.29%). The SPV were completely sectioned in 25 cases (8.92%), while some branches of SPV were sectioned in 103 cases (36.79%). We found that SPV have 1 to 3 trunks, accounted for 67 cases (23.90%), 168 cases (60%), and 45 cases (16.10%), while the SPV with 1 to 4 branches accounted for 17 cases (6.07%), 112 cases (40%), 136 cases (48.57%), and 15 cases (5.36%). The SPV was identified as offending vessel in 17 cases (6.07%). One patient with cutoff SPV trunk encountered cerebellar infarction and recovered completely at 2 weeks after MVD by using intravenous medication.

MVD is the recommended treatment method for PTN, mostly SPV is unnecessary to be sectioned completely and small branches of SPV could be sacrificed. Very few patients may develop cerebellar infarction or hematoma.

To investigate the clinical value of acoustic radiation force impulse (ARFI)technique in predicting esophageal and gastric varices in patients with biliary atresia after Kasai portoenterostomy.

A total of 42 patients with biliary atresia after Kasai portoenterostomy were collected from September 2015 to May 2016 in Tianjin First Central Hospital.ARFI technique was used to measure the stiffness of liver and spleen, and 28 healthy children as control.According to the result of CT examination , patients with biliary atresia were divided into two groups , twenty-three patients with esophageal and gastric varices(A group) and nineteen patients without esophageal and gastric varices (B group), Comparing the difference of liver and spleen stiffness between the two groups.The ROC curve analysis was carried out to test the diagnostic power of effective parameter.

The ARFI value of liver (2.98±0.80) m/s and spleen (3.00±0.33) m/s of patients with biliary atresia was significantly higher than that of control group((1.10±0.16) m/s, (2.12±0.32) m/s), the differences had statistical significance (both P<0.01). Between group A and group B, the spleen ARFI value of group A(3.16±0.26) m/s was higher than group B(2.83±0.32) m/s, the difference had statistical significance (P<0.01), whereas there was no statistical difference of liver ARFI value between two group((2.93±0.65), (3.02±0.96) m/s)(P>0.05). The cut-off ARFI value of spleen to diagnose esophageal and gastric varices in biliary atresia was 3.02 m/s, and the biggest area under the ROC curve, sensitivity, and specificity were 0.81, 78.6% and 84.5%, respectively.

ARFI can be used as a noninvasive method to predict the presence of esophageal and gastric varices in patients with biliary atresia after Kasai portoenterostomy.

To establish and evaluate chronic stress model in New Zealand white rabbit with hyperlipidemia.

A total of 45 clearing grade male New Zealand white rabbits were divided into four groups with random number table method: control (CON), normal diet combined with chronic stress for 8 weeks (CON+ CS), high fat diet (HFD) and high fat diet for 4 weeks combined with chronic stress for 8 weeks (HFD+ CS). Both social stress and physical stress methods were adopted.One-way ANOVA was used for comparison among groups.

(1) Chronic stress model assessments: ①body weight, the weight gain of stress groups was significantly reduced; ②behavioral assessment, rabbits exposed to stress in CON+ CS and HFD+ CS group [54%±7%, 55%±5%] exhibited more inactivity behavior than CON and HFD group [27%±5.28%, 34%±6%,P<0.01,P<0.05]; ③serum indexes: after stress regime for 4 weeks, cortisol of HFD+ CS was higher than HFD group [(60±5) ng/ml vs (38±4) ng/ml,P=0.001]. After 8 weeks, the serum levels of hs-CRP and IL-6 also elevated. (2) The effect of hyperlipidemia on chronic stress: compared with CON+ CS, HFD+ CS group showed more inactivity behavior and rising levels of cortisol, hs-CRP and IL-6. (3) Blood lipids: chronic stress induced raised serum total cholesterol.

(1)Chronic stress model in rabbit with hyperlipidemia could be successfully established with 4-week high lipid feed followed by social stress combined with physical stress for 8 weeks.(2) Hyperlipidemia and chronic stress influences each other.

To estimate the immune response of HepG2/dendritic cell (DC) fusion cells vaccines against HepG2 cells in vitro.

Peripheral blood mononuclear cells (PBMCs) were isolated from healthy donors by Ficoll-Hypaque density-gradient centrifugation.Then DC were obtain from PBMCs by culturing in medium containing granulocyte macrophage colony-stimulating factor (GM-CSF) and interleukin-4 (IL-4) for 5 days.DC and HepG2 fusion cells were induced by polythyleneglycol (PEG). The fusion cells were examined under fluorescence microscope by labeling DCs and HepG2 with green and red fluorescein, respectively, and then the fusion rates were analyzed by flow cytometry.The capacity of fusion cells to secrete interleukin (IL)-12 and stimulate the proliferation of T lymphocyte was assessed by ELISA and Flow cytometry, respectively.ELISPOT was used to assess the interferon gamma (IFN-γ) produced by cytotoxicity T lymphocyte (CTL), and the specific killing ability of fusion cells induce-CTL targeting HepG2 was estimated.

The fusion rate of HepG2/DC was 54.5%, and the fusion cells expressed a higher levels of DC mature marker CD80 and costimulatory molecules CD83, CD86 and MHC-Ⅰ, MHC-Ⅱ molecules HLA-ABC and HLA-DR than those in immature DCs (P<0.01). HepG2/DC showed a greater capacity to secrete high level of IL-12 (P<0.05) and activate proliferation of lymphocytes in vitro, as compared with DCs alone and DCs mix HepG2 (P<0.01). The HepG2/DC -activated CTL generated higher IFN-γ level and had a specific killing ability against HepG2 cells at the effecter/target ratio 30∶1 (31.4%±2.4%) and 100∶1 (57.6%±7.3%) (P<0.01).

HepG2/DC fusion cells could efficiently stimulate T lymphocytes to generate specific CTL targeting HepG2 cells.It might be a promising strategy of immunotherapy for HCC.

To observe effect of interleukin(IL)-1β on the expression of signaling pathway of mammalian target of rapamycin(mTOR) of articular cartilage.

Articular cartilage of rats was isolated under sterile technique, cells were digested by type Ⅱ collagenase and trypsin and cultured in vitro, pre-culture the Ⅱ cells for three days, different concentrations of IL-1β were added for 24 hours.The cells were stained with toluidine blue and HE, to observe morphological changes of cells.RT-PCR was used to detect the mRNA expression of typeⅡcollagen gene, aggrecan gene, mTOR gene and P70S6K gene, Western blotting was used to detect the expression of protein related to mTOR.

With increasing concentrations of IL-1β, the phenotype of cells appeared polygon into a spindle, the mRNA expression of gene of type Ⅱ collagen (the control group: 0.821±0.014; 1 ng/ml: 0.614±0.014; 10 ng/ml: 0.549±0.009; 100 ng/ml: 0.520±0.008), aggrecan(0.867±0.005; 0.857±0.001; 0.554±0.008; 0.538±0.004) and mTOR(0.845±0.015; 0.785±0.009; 0.569±0.025; 0.518±0.014) reduced, but P70S6K(0.465±0.024; 0.566±0.022; 0.663±0.022; 0.896±0.015) increased by PCR .Expression of protein detected by Western blotting was similar to the trend of PCR.

mTOR signaling pathway may play an important role on the degeneration of articular cartilage, regulating mTOR signaling pathway may provides a new idea of delaying the degeneration process of cells.

To investigate the effects of low-frequency pulsed wave ultrasound on the shear properties of interface of the vancomycin -loaded acrylic bone cement-stem.

The interfaces of 1% vancomycin-loaded acrylic bone cement-stem specimences were successfully manufactured and randomly divided into three groups: the control group, 450 mW/cm² ultrasound group and 1 200 mW/cm² ultrasound group, each group consisted of eight samples.Two ultrasound groups were exposed to a local ultrasonic field for 7 d, then immersed in PBS for 23 d, and the control groups were immersed in PBS for 30 d. After curing in air for 24 h, the shear strength of the stem-cement interface was determined by push-out test.The specimens were then photographed using SEM and analysed using Image-Pro Plus 6.0 to determine the porosity at the stem-cement interface.

The mean shear strength of stem-cement interface additionally decreased by 9% (P>0.05) and 17% (P<0.05) in 450 mW/cm² ultrasound group and 1 200 mW/cm² group respectively comparing with the control group, but no significant difference was found between the two ultrasound groups.The porosity at the stem-cement interface additionally increased by 44% (P>0.05) and 110% (P<0.05) in 450 mW/cm² ultrasound group and 1 200 mW/cm² group respectively comparing with the control group, furthermore.The porosity in 1 200 mW/cm² ultrasound group increased by 46% (P<0.05) comparing with the 450 mW/cm² group. There are much more fluid penetration along the stem-cement interface in ultrasound group .

Low-frequency pulsed wave ultrasound signifiantly enhanced porosity and fluid penetration interface, and reduced the interface shear strength and initial stability.

The 53-year-old female was seen in the Third People's Hospital of Xuzhou City, Jiangsu Province in May 2013 due to upper abdominal discomfort for more than one month. Ultrasound found multiple slightly hypoechoic masses in the liver, the largest located 27 mm ×19 mm under the capsule of the left lobe. Upper abdominal CT showed multiple round low-density shadows in the liver parenchyma. The edge of the enhanced scan was slightly enhanced in the arterial phase, and the contrast medium was withdrawn in the venous phase. The lesion was low-density. The diagnostic opinion was that the liver occupied multiple mass, and metastatic lesions were considered. PET-CT examination revealed multiple intrahepatic low-density associates¹⁸Abnormally increased F-FDG metabolism, nodule in the posterior segment of the upper lobe of the right lung¹⁸F-FDG metabolism is slightly increased, and the above changes consider malignant lesions. Suspected thickening of gastric wall in prepyloric region¹⁸F-FDG metabolism is slightly increased, except malignant. To further confirm the diagnosis, he was referred to the Department of Gastroenterology, Affiliated Hospital of Xuzhou Medical University, Jiangsu Province. There were no abnormalities in hematuria, fecal routine, coagulation function, biochemistry and tumor indexes of the patient admitted to hospital. Upper abdominal magnetic resonance revealed multiple circular abnormal signal shadows in the liver, and the periphery was slightly shorter T₁Slightly longer T₂Signal shadow with a slightly longer T in the center₁Long T₂Signal shadow, some boundaries are not clear, diffusion-weighted imaging shows high signal, mild annular enhancement after enhancement, low central enhancement, and nodular enhancement locally. Chest CT revealed multiple nodules in the lungs with high suspicion of distant metastasis. Pathological biopsy under gastroscopy diagnosed as chronic inflammation of mucosa with acute inflammation,¹³C Breath test was positive, and gastric lesions were finally diagnosed as chronic pylori-positive active superficial gastritis, excluding gastric malignancy. Combined with imaging examination (Figure 1) characteristics, the possibility of hepatopulmonary metastatic tumor with unknown primary focus is not excluded. Ultrasound-guided (Philips IU-22, Netherlands) puncture biopsy of left lobe liver lesions revealed abnormal cells (FIG. 2A)。 The results of immunohistochemistry indicated that the epithelial cells were CD31 (+), CD34 (+), CK (individual +), CK19 (-), CK7 (-) and Vimentin (+). Tissue cells CD68 (+), CD163 (+). Ki-67 (2%) (Figure 2B,Figure 2C,Figure 2D)。 Combined with the results of imaging, histopathology and immunohistochemistry, the final diagnosis was liver epithelioid hemangioendothelioma with intrapulmonary metastasis. After communicating with patients and family members, they refused surgery and chose interventional treatment, so they were transferred to the Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University.

sudden cardiac death (SCD) refers to unpredictable deaths induced by cardiovascular diseases in a short time. Nearly 90% of them are sudden deaths of arrhythmia type, while very few are sudden deaths of circulatory failure type. Among them, ventricular fibrillation or ventricular tachycardia are the most common. Recent studies have shown that the electrical remodeling of cardiomyocytes is the electrical basis of cardiac arrhythmia. Mitochondrial oxidative stress may cause mitochondrial dysfunction and energy metabolism disorder in cardiomyocytes by altering ion channels, thus inducing electrical remodeling, causing arrhythmia and sudden cardiac death. Therefore, this paper reviews the progress of ion channel dysfunction caused by mitochondrial oxidative stress and the development of SCD.

Bisphosphonates have become the most commonly used first-line drugs in the clinical treatment of osteoporosis, which can significantly reduce the risk of osteoporotic fractures, reducing the incidence of spinal fractures by 40% ~70%, and the incidence of hip fractures by 40% ~50%. Commonly used bisphosphonate drugs in clinic include alendronate sodium, risedronate sodium, ibanphosphate sodium and zoledronic acid injection. Some adverse reactions may occur after using bisphosphonates, including gastrointestinal intolerance (nausea, vomiting, etc.), esophagitis, esophageal cancer, esophageal stenosis, jawbone osteonecrosis, arrhythmia, atrial fibrillation, atypical fracture, etc.^[1]。 Among them, atypical fractures have attracted attention in recent years, and are also the most controversial complications. They are defined as non-traumatic or low-traumatic fractures that occur in the subtrochanteric region of the femur or the femoral shaft^[2]。