Volume 97  ·  Issue 13  ·  2017

With the development of science and technology and the transformation of medical mode, the innovation of medical technology continuously changes the process of people's understanding of diseases. The transformation of medical technology can best reflect the characteristics of scientific progress in different times and leave a deep imprint of the times. The development of multi-omics represented by genomics today; Clinical application of molecular imaging combining molecular biology technology with modern imaging technology; Development and Innovation of Surgical Robot, Intraoperative Navigation and Minimally Invasive Surgical Technology; The application of medical big data analysis technology has made today's medicine more accurate and individualized from the diagnosis to treatment of diseases, from discovering the cause of diseases to predicting the outcome of diseases, and medicine has begun to enter the era of precision medicine from the era of traditional medicine. Brainstem glioma is the most complex and highly heterogeneous disease among brain tumors. Brainstem gliomas can occur in children and adults, who have completely different biological characteristics and outcomes. At present, it is still the tumor with the highest disability, mortality and recurrence rate among brain tumors^[1]。 Judging from the history of diagnosis and treatment of brainstem glioma for more than 100 years, the development of medicine in different eras affects its diagnosis and treatment process.

brainstem gliomas (BSG) are a group of gliomas originating in the midbrain, pons and medulla oblongata. Before the 1980s, BSG was considered a group of homogeneous diseases. At that time, the brainstem was still a restricted area for surgery, which resulted in a lack of adequate understanding of the pathological characteristics of BSG. In addition, the tumor itself was insensitive to radiotherapy and chemotherapy, so the overall prognosis of BSG was extremely poor^[1]。 In recent 30 years, with the continuous development of neuroimaging technology, molecular biology and tumor genomics, people have gradually recognized that BSG is a group of highly heterogeneous diseases. First, BSG as a whole has different molecular genetic properties from cerebral hemispheric gliomas; Secondly, in BSG, tumors in different age groups and different sites have different pathogenesis, growth characteristics and prognosis^{[2,3,4,5,6,7,8,9,10,11,12]}。 From the surgical point of view, although the surgical safety and resection degree of BSG have been significantly improved in recent 30 years with the development of microneurosurgical techniques, neuroimaging techniques, neuronavigation techniques and neuroelectrophysiology techniques, the brainstem is still the site with the highest surgical risk in the central nervous system. Moreover, the tumors in different parts and different growth patterns in the brainstem have their own characteristics in the selection of surgical plan, surgical complications and perioperative nursing. The heterogeneity and complexity of BSG itself determine that it needs multidisciplinary involvement for comprehensive treatment. At present, there are no multidisciplinary research and treatment teams around BSG in domestic medical units. In addition, geographical differences in medical technology have led to a still lack of unified understanding of BSG. Therefore, it is necessary to formulate an expert consensus on BSG standardized diagnosis and treatment for the reference and application of medical institutions and medical staff in clinical work.

To investigate the therapeutic effects of intravenous thrombolysis, intra-artery thrombolysis, mechanical thrombectomy on patients with acute vertebrobasilar occlusion.

Retrospective analysis of clinical data of patients with acute vertebrobasilar occlusion, admitted to Huai′an First People′s Hospital and Bingtuan Qishi Hospital from January 2014 to January 2016, was performed. According to different vascular recanalization, these patients were divided into intravenous thrombolysis group, intra-artery thrombolysis group and mechanical thrombectomy group. Clinical outcomes were compared among the three groups such as recanalization rates( modified thrombolysis in cerebral infarction[mTICI]≥2b), changes of NIHSS scores after 24 hours(scores decreased at least 4 points or complete resolution of symptoms), symptomatic cerebral hemorrhage rate(European Cooperative Acute Stroke Study Ⅱ standard) and modified Rankin scale(mRS) score improvement 3 months after treatment.

Among patients from mechanical thrombectomy group, the recanalization rate was 87.5%(28/32), 22 patients(68.8%)got good outcome according to the significant decrease of NIHSS scores, symptomatic intracranial hemorrhage occurred in 3 patient (9.4%), the rate of good prognosis(mRS≤2) at 3 months was 50.0% (16/32). In patients from intravenous thrombolysis group, the rate of recanalization was 34.8% (16/46), 12 patients(26.1%)got apparent decrease of NIHSS scores, symptomatic cerebral hemorrhage occurred in 14 patients(30.4%), the rate of good clinical outcome(mRS ≤2) at 3 months was 17.4%(8/46). Among patients from intra-arterial thrombolysis group, the recanalization rate was 53.3%(16/30), 12 patients(40.0%) got good outcome according to the significant decrease in NIHSS score, symptomatic intracranial hemorrhage occurred in 6 patients(20.0%), the rate of good prognosis(mRS≤2) at 3 months was 26.7%(8/30). The rate of complete recanalization and NIHSS score improvement at 24 hours were significantly higher in the mechanical thrombectomy group than the intravenous or intra-arterial thrombolysis group(χ²=21.324, P<0.001; χ²=14.162, P=0.001). The good outcome(mRS≤2) at 3 months was more frequent in the mechanical thrombectomy group than the intravenous or intra-arterial thrombolysis group (χ²=9.799, P=0.007). The differences of symptomatic intracranial hemorrhage rate among the three treatment groups were not statistically significant(χ²=5.035, P=0.081).

As compared with the intravenous or intra-arterial thrombolysis, the mechanical thrombectomy has better efficiency and safety in the treatment of acute vertebrobasilar occlusion.

To disclose the correlation between the femur bowing angle(FBA) and vulgas correction angle(VCA), anlysys its influence on the total knee arthroplasty and the lower limbs alignment.

From Janurary 2013 to December 2015, 699 patients who had received total knee arthroplasty(TKA)were collected in the Department of Joint Surgery, China-Japan Friendship. The FBA, VCA, offset of the proximal femur, the lengh of the femur, the neck shaft angle of the femur of the eligible cases from the long leg X-ray were measured.All the data were analysed for the following steps: the FBA′s mean value and characteristics of distributation of all the cases; the VCA′s mean value and characteristics of distributation of all the cases; correlations between the VCA and the other parameters; divide all the cases into four groups based on the value of FBA : group A(FBA<-3°, 29), group B(-3°≤FBA≤0°, 255), group C(0°<FBA≤3°, 480), group D(FBA>3°, 236)and then plan to cut the distal femur with 5° and 6°, respectively. The percent of ideal alignmental outcome′s percentage of every group were compared.

The mean Value of the FBA is -7.1--12.1(1.4±2.4)°; the mean Value of the VCA is 2.5--11.9(6.5±1.3)°. The correlation index between VCA and FBA, the neck shaft angle of the femur , offset of the hip joint, the lengh of the femur is 0.72, -0.26, 0.45 and -0.08, perspectively. The theoretical ideal alignment percentage of the 5 degree-valgus-bone cut and 6 degree-valgus-bone cut in every group is group A: 89.7% and 66.5%; group B: 93.7% and 95.7%; group C: 71.9% and 94.6%; group D: 21.2% and 50.8%, respectively.

The cases whose femur bowing angles are outliers are common in daily medical practice, so the vulgas correction angles need be ajusted for its significant correlation with FBA. 5 degree-valgus-bone cut or 6 degree-valgus-bone cut could not get the ideal alignment some times.

To assess the clinical results of the method of anatomic coracoclavicular ligament reconstruction for distal clavicle fractures.

From August 2013 to January 2015, the super image system was used to measure the CT data of 16 patients suffering distal clavicle fractures before operation in Department of Orthopaedics , the First Affiliated Hospital of Nanjing Medical Univerisity. The fractures′ morphological features and acromioclavicular dislocation degree were assessed. By referring to the data collected by the my research group on Chinese people′s coracoclavicular ligament, the injuries of the coracoclavicular ligament were estimated, which was then to verify the actual injuries detected during operation. Coracoclavicular ligament reconstruction was performed on patients and screws or suture anchors fixing small bone blocks was used as an adjuvant therapy. Clinical and radiological follow-up was at 1, 3, 6 and 12 months after the procedure. The clinical outcomes were assessed pre- and postoperatively with Constant Scores. Anteroposterior radiographs for the bilateral acromioclavicular joints were obtained immediately after surgery and every follow-up.To compare the reduction maintenance, coracoclavicular distances of the injured shoulders were measured in preoperative and postoperative standard radiographs.

All patients received satisfactory fracture and acromioclavicular joint reduction. The average follow-up period was (12.6±3.9) months (ranging from 6 to 22 months). Fractures healed six months after the operation. The coracoclavicular distances increased from (7.8±1.4)mm at one month follow-up to (7.9±1.2)mm at the final follow-up (P>0.05), which could be considered as no difference statistically. The constant score significantly increased from (49.1±4.4) at one month follow-up to (93.8±2.1) at the final evaluation (P<0.001). Obvious loss of acromioclavicular joint reduction was not observed after the operation. Coracoid process and calvicle fractures did not appear. Fractures healed well and shoulder joints also functioned well. Patients′ lives and work went back to normal.

Accompanied by ligament injuries, distal clavicle fractures is different from middle fractures. Coracoclavicular ligament injury is a major cause of the acromioclavicular joint instability, and the focus of the surgery. Therefore, the application of the double-bundle coracoclavicular ligament reconstruction is a feasible method to treat distal clavicle fractures, displaying satisfying clinical results.

To investigate the correlation and metabolic characteristics of the growth hormone (GH) and other bone metabolism related biochemical markers in pregnancy women serum.

Determination of GH, 25 hydroxy vitamin D(25(OH)D), osteocalcin n-terminal fragments (N-MID), total propeptide of type 1 procollagen (TP1NP) and alkaline phosphatase (ALP) levels in different gestation women serum, the experimental group involving 75 cases of early pregnancy women(11-14 weeks), 135 cases of pregnancy women(15-21 weeks), 62 cases of late pregnancy women(31-40 weeks) and 28 cases of postpartum women(1-3 days). All cases were selected from prenatal screening patients in hospital from February 2016 to February 2017. The control group involving 55 cases of physically healthy nulliparous. The indicators of GH, 25(OH)D, TPINP and N-MID were detected by electrochemiluminescence and ALP were detected by rate method. All data were processed by SPSS. Variance analysis and Pearson correlation analysis were employed.

Serum GH level in early pregnancy, pregnancy, late pregnancy and control group were (4.54±2.26), (9.04±3.23), (20.16±4.89), (0.55±0.49)μg/L, respectively. The difference was statistically significant (F=270.037, P<0.01). Serum GH in each group of pregnant women were more higher than those in control group (allP<0.01), and there was statistical difference in different gestational stages(allP<0.01). Serum 25 (OH)D expression in early pregnancy, pregnancy and late pregnancy were (25.60±14.48), (27.10±12.05), (25.45±9.85)nmol/L. Compared with the control group(39.93±14.88)nmol/L, the difference was statistically significant (allP<0.01). Serum TP1NP level in early pregnancy, pregnancy, late pregnancy and control group were (44.44±11.80), (48.41±20.87), (102.63±41.73), (54.73±24.07)μg/L, respectively. The difference was significantly significant (F=54.027, P<0.01) and TP1NP in late pregnancy group was obvious higher than in early pregnancy group, pregnancy group and control group apart(allP<0.01). Serum N-MID level in early pregnancy, pregnancy, late pregnancy and control group were (5.91±2.64), (7.45±2.27), (17.24±6.47), (18.52±6.95)μg/L, and the difference was significantly significant(F=55.699, P<0.01). N-MID in early and middle pregnancy group were apparent lower than that in late pregnancy and control group (allP<0.01). Serum ALP level in early pregnancy, pregnancy, late pregnancy and control group were (49.74±10.14), (77.76±26.90), (168.34±45.15), (52.81±10.33) U/L, and the difference was significantly significant(F=180.349, P<0.01). However, there was noticeable difference in ALP level between late pregnancy and other pregnant group(P<0.01 orP<0.05). The serum GH, TP1NP and N-MID in postpartum women (1-3 days) were (1.44±0.99), (73.41±34.27), (12.10±5.64) μg/L, respectively. Compare with late pregnancy groups, the difference was significantly significant(allP<0.01). The content of GH in serum of 272 cases pregnant women was positively correlated with the concentration of TP1NP, N-MID and ALP, the gestational age and body weight of pregnant women(r=0.509, 0.720, 0.862, 0.827, 0.324, all P<0.01). The content of TP1NP, N-MID and ALP were positively correlated with gestational age, respectively(r=0.603, 0.722, 0.901, all P<0.01). Moreover, TP1NP expression was positively correlated with N-MID (r=0.849, P<0.01), and there was no correlation between other indexes.

These findings have revealed that there are different metabolic character of the GH and bone metabolism related biochemical indexes during different pregnancy period. And there is a positive correlation between gestational age and the index of GH, N-MID, TP1NP, ALP, respectively. Finally, the bone metabolism is more active and Vitamin D deficiency is severe throughout pregnancy.

To analyze age-related change in cerebral matter tract, especially fractional anisotropy, based on automating fiber-tract quantification(AFQ).

A total of 64 years old normal persons and 43 young volunteers were enrolled respectively from the Affiliated Drum Tower Hospital of Nanjing University Medical School and community from January 2015 to June 2016.All of them underwent MRI scan, which included DTI and 3D T₁WI sequence .All cases were divided into 3 groups according to their ages, the young group 20-35 years old, the middle old group 60-75 years old, the old group 76-90 years old.AFQ was used to identify 20 major white matter tracts in brains of all subjects and make measurements at anatomically equivalent locations along their trajectories.

The FA change trend of each fiber was similar among three groups. The old and the middle old group had different FA value in both sides of inferior fronto-occipital fasciculus(left t=-2.73, right t=-6.12, P<0.05), thalamic radiation(leftt=-4.79, right t=-19.61, P<0.05), arcuate(leftt=10.53, right t=-2.72, P<0.05), callosum forceps(genut=-2.66, splenium t=28.64, P<0.05), cingulum(leftt=-4.53, right t=-2.22, P<0.05)and right corticospinal tract(t=3.10, P<0.05), among which each location of callosum forceps minor was different between the old group and the young group, and this area decreased in the middle group. The old group had different FA value in both sides of uncinate fasciculus(leftt=-4.52, right t=-4.53, P<0.05), left corticospinal tract(t=-2.19, P<0.05)and right inferior longitudinal fasciculus(t=11.12, P<0.05). Compared to the young group, there was no statistical difference in the FA of both superior longitudinal fasciculus and left inferior longitudinal fasciculus in the old and the middle old group.

AFQ has an impact on the further specific study of the age-related white matter tract.

To evaluate the feasibility and safety of robotic system in early ovarian cancer surgery.

The clinical data of 131 patients with early ovarian cancer undergoing surgical treatment from November 2014 to November 2015 were reviewed retrospectively. There were 27 cases of early ovarian cancer, of which 9 cases of robotic group, 10 cases of laparoscopic group, 8 cases of laparotomy group. Age, Body Mass Index (BMI), preoperative neoadjuvant chemotherapy, operating time, operating method, intraoperative blood loss, intraoperative and postoperative complications, pathological type, lymph node dissection, postoperative exhaust time and postoperative hospital stay of all the patients were analyzed.

In the robot group, the mean operating time was( 251.4±58.7) minutes, the intraoperative blood loss was (208.9±202.7) ml, and the number of the main abdominal and pelvic lymph nodes was 27.8±8.9. The mean postoperative hospital stay was (11.1±3.5) days, and the mean postoperative hospital stay was( 2.0±0.5) days. All the patients were followed up for 12-24 months. There was no differences were observed among the three groups for operating time, complications, the blood loss, the number of lymph nodes, the hospital stay and survival time (P≥0.05).

A robotic approach for the early ovarian cancer is feasible and effective. Compared with traditional laparoscopic surgery and laparotomy, there is no significant difference in operative effect and tumor-free survival. The robotic approach provides a new method for surgical treatment of early ovarian cancer.

To analysis the clinical features of cesarean scar pregnancy (CSP), to evaluate the therapeutic effect of various treatments, especially the feasibility and advantage of Methotrexate (MTX)-Uterine artery embolization (UAE)- Sonogrphy directed-In situs aspiration sequential therapy based on the pregnancy sac three-dimensional conformation analysis (3D-MESIA).

From January 2007 to December 2014, 99 subjects who were diagnosed as CSP in Chaoyang Hospital of Capital Medical University were studied retrospectively. According to different treatment, they were divided into six groups: 51 cases treated by 3D-MESIA (group A), 8 cases treated by systemic MTX injection (group B), 9 cases treated by uterine artery chemoembolization or uterine artery embolization combined with systemic MTX injection (group C), 10 cases treated by uterine curettage after systemic MTX injection (group D), 11 cases treated by uterine curettage after uterine artery embolization (group E), 10 cases treated by uterine curettage directly (group F). Each group according to the CSP classification can be divided into two subgroups: endogenous CSP and exogenous CSP. The intraoperative blood loss, operative time, β-hCG clearance time, lesion absorption time, hospitalization time, hospitalization expenses, the success rate were compared among the six groups and two subgroups.

(1) The operative time and blood loss of endogenous CSP had no significant difference in different operative methods (P>0.05). β-hCG clearance time and lesion absorption time of endogenous CSP in group B were significantly longer than the other five groups (P<0.05). (2) The intraoperative blood loss in group A and group E compared with group D and group F was decreased significantly (P<0.05). β-hCG clearance time and lesion absorption time of exogenous CSP in group A were significantly shorter than those in the other five groups (P<0.05). (3) The hospitalization time in group E and group F were obviously shorter than that in other groups (P<0.05). The hospitalization expense in group B and group F were obviously less than that in other groups (P<0.05). (4) The success rate of endogenous CSP in group F was the lowest, but the difference had no significant statistical significance (P>0.05). The success rate of exogenous CSP in group A and group E were obviously higher than that of the other four groups (P<0.05).

The treatment effect of MTX therapy alone or uterine artery embolization for CSP is poor. 3D-MESIA is safe and effective for endogenous CSP. It is easy to promote and can be used as the initial treatment of exogenous CSP. If it fails, the laparoscopic removal of lesions and scar repair could be the remedial measure.

To evaluate the clinical value of percutaneous AngioJet thrombectomy in treatment of acute symptomatic portal and superior mesenteric venous thrombosis venous thrombosis (PVMVT) .

From January 2014 to January 2016, a total of 8 patients in Nanjing First Hospital with PVMVT verified by color Doppler ultrasound and computed tomographic angiography (CTA) were analyzed retrospectively. Under ultrasound guidance , the branch of the right portal vein(PV) was punctured with a micropuncture set and a 4-F infusion catheter was advanced to the superior mesenteric vein(SMV). The venogram demonstrated the thrombosis in the PV/SMV and a 6-F AngioJet Xpeeedior catheter was advanced over the guidewire and positioned in the distal SMV. Percutaneous thrombectomy was performed after a mixture of 250 000 U of urokinase in 100 ml of normal saline for mechanical pulse spray of thrombus in all patients for approximately 15 minutes. 2 patients underwent PTA and stent implantation after the thrombectomy procedure, 1 of them and the others 6 patients received continuous transcatheter infusion of urokinase (500 000 U/d) for 24 or 48 hours until the thrombosis was completely dissolved confirmed by angiography at 24 and 48 hours.After procedure and the thrombolytic therapy was discontinued, removal of the infusion catheter and the sheath from the liver, the transhepatic tract was embolized with coils or gelfoam to reduce the risk of bleeding. The patency rate of PV /SMV was assessed by CTA at 1 and 6 months after the procedure. Patients were discharged with oral anticoagulation regimen for at least 6 months.The following criteria were used in evaluation of thrombolysis: grade Ⅰ<50% thrombus removal; grade Ⅱ 50%~90% thrombus removal, and grade Ⅲ>90% thrombus removal.

All 8 patients with PVMVT were treated by AngioJet thrombectomy. Angiography after the thrombectomy procedure showed complete thrombus removal (>90%) was in 3 cases, substantial thrombus removal (50%~90%) in 5 cases. Grade Ⅲ (complete) thrombolysis was achieved in 7 cases and grade Ⅱ (50%~90%) lysis in 1 case post thrombolytic therapy for 24 or 48 hours. 2 patients had underwent PTA and stent implantation. Large volume intraperitoneal hemorrhage was discovered in 1 patient after removal of the catheter and sheath from the liver. The patient restored stability after a blood transfusion.Venous patency was comfirmed in all 8 patients at 1 or 6 months after the treatment. There was no patient with major complications death related to the procedure.

Percutaneous AngioJet thrombectomy with adjunctive thrombolytic therapy is an effective and safe treatment modality in patients with acute symptomatic PVMVT.

To compare the dose distributions of postoperative plans with preoperative plans for seeds implantations of paravertebral/retroperitoneal tumors assisted by 3D printing guide template and CT guidance, explore the effects of the technology for seeds implantations in dosimetry level and provide data support for the optimization and standardization in seeds implantation.

Between December 2015 and July 2016, a total of 10 patients with paravertebral/retroperitoneal tumors (12 lesions) received 3D printing template assist radioactive seeds implantations in department of radiation oncology of Peking University Third Hospital, and included in the study. The diseases included cervical cancer, kidney cancer, abdominal stromal tumor, leiomyosarcoma of kidney, esophageal cancer and carcinoma of ureter. The prescribed doses was 110-150 Gy. All patients received preoperative planning design, individual template design and production, and the dose distribution of postoperative plan was compared with preoperative plan. Dose parameters including D₉₀, MPD, V₁₀₀, V_150,conformal index(CI), EI of target volume and D_2cc of organs at risk (spinal cord, aorta, kidney). Statistical software was SPSS 19.0 and statistical method was non-parameters Wilcoxon symbols test.

A total of 10 3D printing templates were designed and produced which were including 12 treatment areas.The mean D₉₀ of postoperative target area (GTV) was 131.1 (97.8-167.4 Gy) Gy. The actual seeds number of post operation increased by 3 to 12 in 5 cases (42.0%). The needle was well distributed. For postoperative plans, the mean D_90,MPD, V_100,V₁₅₀ was 131.1 Gy, 69.3 Gy, 90.2% and 65.2%, respectively, and which was 140.2 Gy, 65.6 Gy, 91.7% and 26.8%, respectively, in preoperative plans. This meant that the actual dose of target volume was slightly lower than preplanned dose, and the high dose area of target volume was larger than preplanned range, but there was no statistical difference in P value between the two groups except V₁₅₀(P=0.004). The actual dose conformity of target volume was worse than preplanned (CI was 0.58 and 0.62, respectively) and the difference was statistically significant(P=0.019). The actual dose of external target volume was higher than preplanned (EI was 55% and 45.9%, respectively) and the difference had no significance. For organs at risk, the actual mean D_2cc of spinal cord, aorta and kidney was 24.7, 54.4 and 29.7 Gy, respectively, which was higher than preplanned(20.6, 51.6 and 28.6 Gy, respectively), and there was no significant difference in two groups.

Most parameters of postoperative validations for 3D printing template assisted seeds implantation in paravertebral/retroperitoneal are closed to the expectations of preoperative plans which means the improvement of accuracy in treatment.

To establish a method for monitoring the surface blood flow in the heart of rats, and to clarify the relationship between the degree of myocardial infarction and the blood perfusion on the surface of the heart, so as to provide a new indicator for the identification of rat myocardial infarction model.

The rats were divided into control group (n=23) and model group (n=107), the rat hearts were scanned by the laser doppler perfusion imager before and after operation respectively, and the data was analyzed to acquire the rate of surface blood flow change of the heart. Myocardial infarction size of model group was detected by NBT. Model group were divided into three subgroups of mild myocardial infarction, moderate myocardial infarction and severe myocardial infarction according to the myocardial infarction size, and an analysis was made on the correlativity between rate of surface blood flow change of the heart and myocardial infarction size.

Myocardial infarction size was highly correlated to the rate of surface blood flow change of the heart in model group (r=0.849 6, P<0.000 1). There was no significant correlation between infarction size and heart blood flow in the mild myocardial infarction subgroup (r=-0.133 6, P>0.05), while the correlation in moderate myocardial infarction was significant (r=0.721 7, P<0.000 1), and the highest correlation was shown in severe myocardial infarction subgroup (r=0.910 2, P<0.000 1).

The heart surface blood flow has a close relationship with the myocardial infarction size in rat, so the change of heart blood perfusion can beused as an effective reference to establish and identify rat myocardial infarction model.

To explore a registry method for acute cardiovascular events in large-scale fields across China.

This study was based on a community-based Kazakh cohort, including 1 668 persons with complete baseline data, conducted in Altay, Xinjiang. Acute cardiovascular events included acute myocardial infarction(ICD-10: I21-I22), sudden cardiac death (I46.1), and incident stroke (I60-I64) that occurred during the period from Oct 1, 2012 to Jun 30, 2016. There were three stages, a hospital-based search for checking medical records of inpatients in all four local hospitals, a community-based supplementary registry, and an extra survey for reducing false negatives, to complete this registry. The incidence referred to all events within one year per 100 000 people and mortality rate was the number of fatal events within 28 days per 100 000 people. The incidence and mortality was standardized with the weights from distribution of age and gender in the Sixth National Census of China.

Forty two cases with 46 acute cardiovascular events including 7 acute myocardial infarctions, 3 sudden cardiac deaths, and 36 incident strokes were found. The ratio of events was 3.6∶1 for stroke and heart attacks and this ratio was 1.6∶1 for ischemic or hemorrhagic strokes. A total of 28(60.9%) events and 18(39.1%) events were collected in the hospitals and by community-based supplementary registry physicians, respectively. False negatives were not found at the last stage. The crude and standardized incidence rates were 742 and 926 per 100 000 people and the related mortality rates were 194 and 272 per 100 000 people, respectively.

Primary Care physicians are"net bottom" of a monitoring system which needs to combine preventive and clinical medicine with all kinds of governmental resources including health and social benefit.

Patient 1 (proband), male, 44 years old. In January 2010, the neck and tail of the pancreas were found due to physical examination. Follow-up until 2014. During this period, there was intermittent vomiting for 1 year, accompanied by slight abdominal distension, no radiating pain in the abdomen and back. Diabetes was found for 3 years, and insulin treatment was poorly controlled. Pancreatic surgery was performed in October 2014. Preoperative biochemical examination showed that pepsinogen I, pepsin I and gastrin-17 were elevated; Blood urea 12.6 mmol/L, creatinine 170 mmol/L, blood glucose 14.6 mmol/L, thyroid stimulating hormone TSH 4.32 uTU/L, thyroxine (T4) 103.9 nmol/L; CT plain scan (FIG. 1A) showed that a nodule of different sizes was found in the head and neck (left ↓) and tail (right ↓) of the pancreas, and the neck lesion showed a cystic necrotic area, and the tail lesion density was uniform, enhancing the arterial phase (FIG. 1B) The solid part of the cervical lesion was obviously enhanced, but the cystic necrosis area was not enhanced, and the tail lesion was uniformly enhanced, with a delayed period (Figure 1C) The degree of lesion enhancement was reduced, but it was still higher than that of normal pancreatic parenchyma. Magnetic resonance (MR) examination showed that the two lesions were at T₁WI (Figure 1D) showed a slightly lower signal, T₂WI (Figure 1E) showed a slightly high signal, and the necrotic cystic degeneration area in the neck lesion showed T₁Lower WI, T₂WI higher signal, diffusion imaging (b =800 s/mm²)(Figure 1F), the solid part of the tumor showed hyperintensity. The patient's plain thyroid CT scan in April 2014 revealed the posterior occupation of the left thyroid lobe, considering parathyroid adenoma (Figure 1G)。 April 2014 pituitary MRI T₂WI showed an enlarged pituitary gland, which was quasi-circular (Figure 1H), preoperative ultrasound showed hypoechoic nodules in the head of the pancreas with uneven internal signal echoes (Figure 1I)。 The patient underwent pancreatic surgery, and postoperative pathology confirmed a neuroendocrine tumor (stage G2) (Figure 1J)。

arrhythmogenic right ventricular cardiomyopathy (ARVC) is often characterized by malignant arrhythmias, heart failure and sudden cardiac death, with a prevalence of 1/5 000 to 1/2 000^[1], more common in men^[2],Autosomal dominant inheritance is present in 30% to 50% of patients^[3]。 Progressive apoptosis of cardiomyocytes and inflammatory myocardial injury are associated with genetic processes determined by gene mutations^[4]。 At present, 13 disease-causing genes related to ARVC have been found^[5]According to the different functions of encoded proteins, the genes causing ARVC are mainly divided into two categories: desmosome-related genes and non-desmosome-related genes. Among them, patients with positive desmosome gene mutations account for 40% to 60% of the total number of patients with gene mutations^[6]。 When the gene mutation of desmosomes occurs, the tolerance of cardiomyocytes to normal mechanical stress decreases, resulting in intercellular segregation, apoptosis, and eventually replacement by fibrous tissue. Therefore, desmosome gene mutation plays an important role in the occurrence and development of the disease. However, some non-desmosomal genes are also related to the pathogenesis of ARVC. The following discusses the mechanisms and characteristics of two main types of gene mutations.

Antiphospholipid antibody syndrome is a group of non-inflammatory autoimmune diseases with adverse pregnancy, repeated thrombosis and positive serum antiphospholipid antibody as clinical manifestations. It is also an important and treatable cause of recurrent abortion (RSA) patients. Based on clinical manifestations, pathological features and immunological studies, although its pathogenesis is not completely clear, a preliminary consensus has been formed. Low molecular weight heparin combined with aspirin anticoagulation is currently the first-line treatment plan for this disease. This review focuses on anticoagulation therapy, and expounds the pathogenesis, diagnostic criteria, anticoagulation regimen, pharmacological mechanism and drug safety of RSA associated with antiphospholipid antibody syndrome, aiming to provide reference for the research of standardized anticoagulation therapy and other diagnosis and treatment regimens of this disease.