Volume 97  ·  Issue 23  ·  2017

interventional medicine (interventional medicine) is a new clinical discipline developed from imaging medicine after the 1970s, and it is also one of the most dynamic and fastest developing disciplines in the current medical field. The concept of "interventional medicine" was formally put forward in 1996 at the "Chinese Interventional Medicine Development Strategy and Academic Symposium" organized by the State Science and Technology Commission, the Ministry of Health and the State Medical Administration^[1]。 In recent years, interventional medicine in China has developed rapidly, and the number of interventional specialists, difficult interventional technology projects, minimally invasive interventional diagnosis and treatment, and national scientific research projects have all increased rapidly^[2]。 However, like other emerging disciplines, the system construction of interventional disciplines and medical education is far from keeping up with the progress of interventional diagnosis and treatment. The vague development orientation of disciplines and the lack of independent talent training mechanism have seriously hindered the development of interventional disciplines, which has also led to huge differences in the development of interventional disciplines and uneven medical quality across China. The development of interventional medicine has experienced bumps. This article intends to briefly review the development course and current situation of interventional medicine, and discuss the current situation and future vision of interventional medicine in China.

To investigate the incidence and risk factors of Lymphocele infection and the optimal timing for drainage after pelvic lymphadenectomy.

This retrospective study was carried out on 397 patients who received a pelvic lymphadenectomy with or without a para-aortic lymphadenectomy between January 2009 and April 2016, due to endometrial cancer in General hospital of Tianjin medical university.A total of 76 patients developed lymphocele and 20 patients developed lymphocele infection.

(1)The incidence of lymphocele infection was 5.04% (20/397). Single factor analysis indicated diameter of lymphocele ≥5 cm and postoperative anemia were associated with lymphocele formation (P<0.001,P=0.023). Multiple factors Logistic analysis through the adjustment of the factors showed diameter of lymphocele ≥5 cm was the independent risk factors for lymphocyst infection (P<0.001). (2)The total treatment period of cases treated only with antibiotics tended to be shorter than that of cases treated with combined antibiotics and drainage (P=0.008). However, for severe cases which needed drainage, initiating the drainage by day 3 significantly shortened the total treatment period compared with cases started on or after day 4 (P=0.048).

To identify the risk factors of the lymphocele infection is useful to help reduce the incidence of them with effective measurement.When drainage is required in addition to antibiotics, the earlier the drainage is performed, the shorter the treatment period is.

To evaluate the efficacy of primary chemotherapy with single-agent methotrexate (MTX) for low-risk gestational trophoblastic neoplasia and to analysis the influenced factors.

We retrospectively reviewed 259 cases with low-risk gestational trophoblastic neoplasia whose primary chemotherapies were MTX 0.4 mg·kg^-1 (maximum 25 mg) daily for 5 days every other week. Patients′ data between January 2001 and June 2015 was collected and the relationships of different factors to outcomes of chemotherapy were also evaluated.

183 of the 259 patients (70.66%, 183/259) achieved complete primary remission and all patients achieved complete remission after salvage chemotherapy. Univariate analysis showed that FIGO score, serum level of HCG before treatment and interval months from previous pregnancy were significantly associated with outcome of chemotherapy (P=0.001, 0.018, 0.014 respectively). Logistic regression analysis showed that the FIGO score (OR=4.094) and antecedent pregnancy (OR=0.268) were two independent factors predictive for the outcome of chemotherapy.

Primary chemotherapy with single-agent MTX may still be one of the options for patients with low risk GTN. The FIGO score and antecedent pregnancy are two independent risk factors of outcome of single-agent MTX chemotherapy.

To summarize the classifications and optimize endovascular treatment of the dissecting aneurysms of the vertebral artery (DAVA).

The clinical information of 39 cases of DAVA treated with endovascular methods in our department between January 2007 and September 2016 were analyzed retrospectively.According to the location of the aneurysm in relation to the posterior inferior cerebellar artery (PICA), the aneurysms were classified into three types: type pre-PICA, located proximally to the PICA; type in-PICA, located at the PICA origin; and type post-PICA located distally to the PICA.According to the hemodynamics of the contralateral vertebral artery, the aneurysms were classified into two types: compensatory type: including well-developed contralateral vertebral arteries and a guaranteed posterior circulation blood supply following the occlusion of the ipsilateral vertebral artery; and non-compensatory type: including contralateral vertebral arteries that were hypoplastic and provided an inadequate posterior circulation blood supply following ipsilateral vertebral artery occlusion.The choices of reconstructive or destructive methods were made according to the above-mentioned classification, combined with the consideration of morphological features and onset styles.Reconstructive surgery included stent-assisted coil embolization and the placement of multiple overlapping stents (6 patients). Destructive surgery referred to coil embolization combined with proximal coil trapping of the dissected segment of the parent artery (CE+ PT).

A total of 16 patients were type pre-PICA, of which 9 patients were compensatory type and 7 were non-compensatory type.In compensatory type, 4 underwent coil embolization combined with proximal coil trapping of the dissected segment of the parent artery (CE+ PT) and 5 underwent stent-assisted coil embolization (stent/coils). In non-compensatory type, 6 underwent stent/coils and 1 underwent multiple overlapping stents placement (stents). Nine patients were type in-PICA, of which 5 patients were compensatory type and 4 were non-compensatory type. In compensatory type, all patients underwent stent/coils.In non-compensatory type, 2 underwent stent/coils and 2 underwent multiple overlapping stents placement (stents). Fourteen patients were type post-PICA, of which 8 patients were compensatory type and 6 were non-compensatory type.In compensatory type, 6 underwent CE+ PT, 1 underwent stent/coils and 1 underwent stents. In non-compensatory type, 4 underwent stent/coils and 2 underwent stents.Totally, there were 10 underwent CE+ PT, 23 underwent stent/coils and 6 underwent stents.The incidence of perioperative complications was 7.7% (3/39), and the death rate associated with these complications was 5.1% (2/39). Of the 36 patients followed with long-term repeated angiographic examinations, 28(77.8%) patients had complete occlusion.Clinical outcome evaluations were performed using the Modified Rankin Scale and resulted in the following scores: 0-2 for 36 patients, 3-6 for 3 patients.

The classifications based on location, hemodynamics, morphological features and onset styles of the DAVA is safe and effective for the choice of the endovascular methods.

Using optical coherence tomography (OCT) to analyze the morphological characteristics of lesions between early in-stent restenosis (E-ISR) and very late in-stent restenosis (VL-ISR) after drug-eluting stents (DES) implantation.

In 25 patients (DES) with ISR, OCT images were acquired before percutaneous coronary intervention (PCI), the morphological characteristics of E-ISR (<1 years,n=14) and VL-ISR (>3 years,n=11) were compared.The quantitative and qualitative analysis of the entire stent and the minimum lumen area (MLA) site were carried out respectively. OCT quantitative restenotic tissue analysis included the assessment of mean lumen area, mean stent area, mean neointimal area and mean neointimal burden.OCT qualitative restenotic tissue analysis included the assessment of tissue structure [homogeneous or heterogeneous intima (lipid-rich neoitima, thin-cap fibroatheroma (TCFA)-like intima)], presence of microvessels, intraluminal material (red thrombus, pale thrombus), disrupted intima with cavity and tissue prolapse and was performed at every 1-mm slice of the entire stent.

Compared with the E-ISR group, the proportion of cross-sections with heterogeneous intima in the entire stent was significantly higher in the VL-ISR group (60.57% vs 32.93%, P=0.005), and both peristent and intraintimal microvessels were more frequently observed in the VL-ISR group (P<0.05). In addition, lipid-rich neointima (72.7% vs 21.4%,P=0.017), TCFA-like intima (54.5% vs 7.1%, P=0.021), disrupted intima with visible cavity (63.6% vs 7.1%, P=0.007) and red thrombus (63.6% vs 7.1%, P=0.007) were observed more frequently in the VL-ISR group compared with E-ISR group for the entire stent.The heterogeneous intima was observed more frequently in the VL-ISR group (90.9% vs 35.7%, P=0.012) at the MLA sites.Intraintimal microvessels and disrupted intima with visible cavity were observed only in the VL-ISR group.

OCT imaging indicates that the morphological characteristics of restenosis lesions in VL-ISR are different from those in E-ISR.The atherosclerotic changes of neointima, such as lipid-rich neointima, disrupted intima with cavity and microvessels are more often observed in VL-ISR lesions after DES implantation compared with E-ISR.Progression of the atherosclerosis within neointima after DES implantation may be associated with VL-ISR.

To investigate the value of neutrophil to lymphocyte ratio (NLR) in predicting risk stratification and prognosis in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS).

A total of 227 NSTE-ACS patients after percutaneous coronary intervention (PCI) were collected from September 2012 to September 2014 in Beijing Anzhen Hospital.Groups: (1)According to NLR, the patients were divided into 3 groups: NLR<2.20 group; 2.2≤NLR<3.33 group; NLR≥3.33 group.(2)According to the global registry of acute coronary events (GRACE) score, the patients were divided into 3 groups: Low-risk group, Medium-risk group and High-risk group.(3)According to the occurrence of major adverse cardiac events (MACE), the patients were divided into 2 groups: MACE group and non MACE group.Receiver operator characteristic curve (ROC) was used to assess value of NLR for high risk NSTE-ACS patients.Then COX regression analysis was used to analyze correlation between NLR and MACE.

A total of 227 NSTE-ACS patients after PCI were collected and the ratio of MACE was 32.2% (73/227). The GRACE score and the incidence of MACE in NLR≥3.33 group were higher than those in 2.2≤NLR<3.33 group and NLR<2.20 group (allP<0.01). The level of NLR and the incidence of MACE in High-risk group were higher than those in Low-risk group and Medium-risk group (allP<0.05). The level of NLR and the GRACE score in MACE group were higher than those in non MACE group (allP<0.05). COX regression analysis indicated that NLR was independent risk factor for MACE occurrence in NSTE-ACS patients at 1 year after PCI (OR=1.214, 95%CI: 1.114-1.323, P=0.000).

The level of NLR has significant correlation with High-risk NSTE-ACS patients, and NLR is an independent risk factor for poor prognosis in patients with NSTE-ACS.

To explore the feasibility of enhanced recovery after surgery (ERAS) combined with mobile microendoscopic discectomy-transforaminal lumbar interbody fusion (MMED-TLIF) in the treatment of lumbar spondylolisthesis and its influence on postoperative rehabilitation.

From October 1 2014 to July 1 2016 , a cohort of 52 patients with lumbar spondylolisthesis who received the program of ERAS-MMED-TLIF were retrospectively reviewed in Department of Minimally Invasive Spine Surgery, Tianjin Hospital.The primary outcomes include the operation time, intraoperative blood loss, length of hospital stay, VAS score (low back pain and leg pain) and Oswestry Disability Index (ODI) at different follow-up time and complication.The height of intervertebral space and fusion rate were also recorded as radiographic indicators.

All cases had an average follow-up of 12 months. The mean operative time was (115±30) min with a mean blood loss of (100±35) ml.Compared with preoperative condition, VAS score of low back pain (6.3±3.3 vs 3.5±2.3, P<0.05), VAS score of leg pain (7.1 ± 4.2 vs 3.1 ± 2.6,P<0.05) and the ODI disability index score (43.5±9.6 vs 20.9±7.3,P<0.05) at the postoperative 24 h were decreased and the difference was statistically significant.The mean hospitalized time were (4.9±1.3) days with mean postoperative hospital stay (2.1±1.2) days.Fusion rate was 92.31% (48/52) at the last follow-up time.

ERAS combined with MMED-TLIF is feasible in the treatment of lumbar spondylolisthesis, which can significantly reduce intraoperative bleeding, shorten the total length of stay and postoperative hospital stay, improve postoperative pain and promote rapid rehabilitation of patients after operation without increasing the operation time and influencing the long-term effect, it can be applied in clinical practice.

To explore the CT findings of the Takayasu′s arteritis (TA)with pulmonary artery (PA) involvement and its clinical significance.

A total of 35 patients with TA involving the PA in Xijing Hospital from November 2007 to November 2016, 6 male cases, 29 female cases, the age was 15-52 (28±9) years old, were retrospectively collected and included in the study group (TA+ P group), meanwhile 40 patients with TA but not involving the pulmonary artery in this hospital from January 2015 to November 2016 were collected as control group, 5 male cases, 35 female cases, the age was 7-67 (28±12) years old.The clinical and laboratory data, the pulmonary artery and right heart measurement data of the two groups were compared by using t test, χ ² test , and rank sum test.The CT signs of pulmonary artery involvement in the TA+ P group were analyzed.

TA+ P group patients had shortness of breath, wheezing(54.3% vs 10.0%), cough(31.4% vs 12.5%)and palpitations(11.4% vs 0)mostly, and there were statistical difference between TA+ P group and TA group (all P<0.05), However, there was no difference between the two groups in the activity and duration of disease (allP>0.05). In TA+ P group, a total of 312 pulmonary artery segments were involved in 35 patients.The lumen stenosis of PA was more common(35 cases, 211 segments), followed by occlusion(14 cases, 94 segments), bilateral PA (23 cases, 217 segments) and multiple branches of PA involvement(34 cases, 311 segments) were more common.The PA systolic pressure, the diameter of main pulmonary artery, right atrium and right ventricular width of the TA+ P group patients were significantly higher than those of the TA group (allP<0.05).

There are some CT certain characteristics in TA pulmonary arterial involvement, and they are not related to the activity and duration of the disease.Most patients with PA involvement present pulmonary hypertension and a series of special clinical manifestations.

To investigate the perfusion characteristics of arterial spin labeling (ASL) in intracranial tumor and its application value in classification.

The clinical, pathological and imaging data of 44 patients with gliomas confirmed by pathology were analyzed retrospectively, including 9 low grade gliomas, 15 high grade gliomas, 11 cases of meningiomas, 6 cases of neurilemmoma, 3 cases of metastatic tumors.Conventional plain scan, 3D- ASL and MRI dynamic enhanced imaging (DSC-MRI) were performed.The mean maximal cerebral blood flow (CBF) of the solid component of tumor was obtained based on the region of interest.Immunohistochemical staining was performed in 24 patients with glioma.The differences of cerebral blood flow map (CBF) and relative cerebral blood flow (rCBF) in 44 patients with intracranial tumors were compared. The results of paired t test between the tumor area and the contralateral mirror area were measured by the two methods.

Taken the normal control-lateral grey matter(GM) as reference to normalize the CBF of tumor, three normalized tumor blood flow (nTBF) acquired by ASL showed statistical difference between low grade and high grade gliomas respectively (P<0.05). While taken the mirror region (M) and normal control-lateral white matter (WM) as reference to normalize the CBF of tumor, it showed no statistical difference (P>0.05). There was no 1p deletion in the cases of ASL perfusion in low-grade glioma group.In the case of 1p deletion in high grade glioma group, ASL was low perfusion, and there was no 1p deletion in the cases of ASL perfusion.

3D ASL can be used to identify high-grade and low-grade gliomas which has important reference value in the qualitative diagnosis of brain tumors and preoperative grading of gliomas.A separate use of 3D-ASL might cause over-or underestimation of tumor diagnosis, therefore a comprehensive analysis is needed.

To explore the curative effect of microsurgical treatment of cervical intra- and extra-spinal tumors.

The clinical data of 15 patients with cervical intra-and extra-spinal tumors in Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College from January 2013 to February 2017 were retrospectively analyzed. According to Shaw′s tumor stage: 6 cases in stage Ⅰ, 5 cases in stage Ⅱ, 3 cases in stage Ⅲ, and 1 case in stage Ⅳ. About the surgical methods: 9 cases were treated via posterior median semi-laminectomy approach, of which were internal fixation in 2 cases, and via posterior median approach spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty in 3 cases, other 3 cases were operated via anterior cervical approach, including internal fixation in 1 case. After the surgery, vertebral canal MRI was adopted to evaluate the tumor, and CT three-dimensional reconstruction or X-ray of the spine was used for assessing the stability of spinal column, and Frankel grading standard was employed to evaluate the recovery of spinal cord function.

The tumors were totally resected in the first stage with the help of a microscope. Histological types of the tumors included schwannoma in 14 cases, gangliocytoma in 1 case. There was no leakage of cerebrospinal fluid and infection of incisional wound after operations. After the surgery, Frankel grading standard was adopted to assess the recovery of the spinal cord function, and the results showed grade D in 4 patients and grade E in 11 patients. All patients were followed-up for 1 to 24 months with an average of 13 months without tumor recurrence and spinal instability.

Appropriate surgical approach should be selected to treat the cervical intra- and extra-spinal tumors, totally resection of the tumor could be achieved under the microscope, and the corresponding vertebral reconstruction and spinal fixation should be used to maintain spinal stability if necessary.

To explore the effect of BoTN-A on pathological characteristics of calf (GM) and motor function of ankle dorsiflexors in SCI model rats.

Thirty-six SD male rats (weight 260-280 g) were randomly allocated into normal control group and 12w-control group, NS-injection group and BT-injection group in this study.NS/BT-injection groups were divided into two subgroups separately (2w-NS, 2w-BT, 8w-NS, 8w-BT). No injection was applied in normal control group or 12w-control group.Saline/BoTN-A was injected in right GM in NS/BT-injection group at two different time points(2w, 8w). GM and Sol on right side of rats would be forwarded for pathologicalexaminations, such as muscle weight, myosin heavy chain (MyHC) electrophoretic analysisat the 12th week.

Compared with the other three groups, the muscle weights of GM and Sol in the BT-injection group significantly decreased.MyHC type ratioof GM and Sol on the right side in the BT-injection group also significantlychanged.According to subgroup comparisons, MyHC type ratio of GM and Sol on the injectedside in the 2w-BT subgroup was significant different from that of the 8w-BT subgroup.MyHC type ratios of GM on the non-injected side in the BT injection group also changed more than normal control group.The change of MyHC type ratio of non-injected GM was significantly higher in the 2 week-BT subgroup than that in the 8-week subgroup.

BoNT-A intervention resulted in pathological changes not only in the injected GM in SCI rats, but also in non-injected GM and non-injected Sol.The effects of earlier (2 weeks) BoTN-A intervention on pathologic characteristicsof GM and Sol were larger than that of later intervention.

To evaluate the effect of human placental extracts (HPE) on the protection from acute liver injury (ALI) induced by D-GalN and analyze the components of HPE.

(1)Fourty male mice were randomly divided into five groups (Blank, Model, MgIG, HPE and HPE+ MgIG) for the ALI model and treatments.The serum alanine aminotransferase (ALT) and aspartate transaminase (AST) were determined by biochemical assays.Nitric monoxide (NO), malondialdehyde (MDA), superoxide dismutase (SOD), total antioxidant capacity (T-AOC) in serum and hepatic tissue were detected by assay kits.The extent of liver damage was evaluated by histological examination.(2)Relative molecular mass of HPE was determined by SDS-PAGE.(3) Component identification was performed by using LCMS-TOF.(4)Selected functional molecules in HPE were detected by protein array.

(1) A lower level of NO and MDA and a higher SOD and T-AOC were observed in rats treated with HPE compared to the non-treated rats in an acute liver failure disease model.(2) The size of HPE was about 1 200-4 600 by electrophores.(3) 7 peaks of HPE were identified, including uracil, hypoxanthine, tyrosine, phenylalanine, tryptophan, xanthine and thymine.(4) Comparable high concentrations of TGF-β, IGF-1, IL-9, IL-29 and TNF-α of HPE were revealed by protein array.

(1) HPE protects rat from liver damage induced by D-GalN. (2) HPE contains Uracil, hypoxanthine, xanthine, thymine, and functional proteins as TGF-β, IGF-1, IL-9, IL-29 and TNF-α.

To investigate the important roles of Wnt signaling in the processes of 0.5Gy X-ray promoting osteoblast differentiation, and make clear the molecular mechanisms involved.

Flow cytometry was employed to detect the apoptosis after osteoblast exposure to 0.5 Gy X-ray radiation.The protein level of osteoblast differentiation markers, such as collagen Iα (Col1α), alkaline phosphatase (ALP), osteocalcin (OCN), were detected by Western-blot and ALP activity staining was performed. Real-time PCR and Western-blot were utilized to evaluate the variations of key factors in Wnt signaling pathways, while specific inhibitor of Wnt/β-Catenin, XAV939 was used to block the Wnt signaling.

Low-dose (0.5 Gy) X-ray induced significant decline in MC3T3-E1 osteoblast apoptosis at three days after radiation.The dynamic variations in the expression of osteoblast differentiation markers, including Col1α, ALP, OCN, were observed after 0.5 Gy X-ray irradiation by Western blot analysis.The protein levels of Col1α have a reduction temporarily at 4 days of radiation (34.5%±5.8%,t=9.912, P<0.001), then a significant increase is detected at 10 day after radiation (162.5%±6.5%,t=2.673, P<0.05). OCN levels dropped by 83% (t=3.968, P<0.01) at 4 day after 0.5 Gy X-ray radiation, and raised at 10 day (39.5%±4.1%,t=3.219, P<0.05) and 14 day (79.4%±7.5%,t=6.708, P<0.001), respectively. ALP levels increased at 7 day (79.7%±22.3%,t=6.257, P<0.001) and 10 day(128.3%±6.1%,t=4.340, P<0.01)after radiation. At the same time, 0.5 Gy X-ray radiation can activate Wnt/GSK-3/β-Catenin signaling.The mRNA levels of Wnt3a、LPR5 and TCF-4 increased by 1.7 fold (t=6.573, P<0.001), 1.1 fold (t=5.323, P<0.05) and 1.4 fold (t=3.054, P<0.05) at 7 day after radiation.In addition, p-GSK-3β level reduced by 42.1% (t=4.460, P<0.01), and active β-Catenin increased by 1.9 fold (t=3.528, P<0.05). However, the specific inhibitor of Wnt/β-Catenin, XAV939 completely abrogated Wnt/β-Catenin signaling and the increase in ALP expression and activity induced by 0.5 Gy X-ray radiation.

These results demonstrated that low dose X-ray radiation promoted osteoblast survival at early differentiation, and promoted differentiation at middle and late stage, in which Wnt signaling participated the regulation processes.

The patient was a 41-year-old male. One month ago, there was cough, sputum, white sputum, difficult to cough up, no fever, no hemoptysis, no chest tightness, shortness of breath and other discomfort without obvious inducement, and the symptoms did not improve after self-administration of anti-infective and phlegm-reducing drugs. Tuberculosis antibody IgG positive and IgM negative in other hospitals; Check the normal range of tumor markers; WBC 15.8×10⁹/L, neutrophils 84.9%. Related examinations after admission: chest CT (Figure 1): Multiple lymph nodes in the right hilum, mediastinum and right supraclavicle are enlarged, and malignant tumors and lymphomas need to be considered; Emphysema. PET/CT: The uptake of radioactivity in the right supraclavicular, mediastinal and right hilar area was significantly increased, and lymphoma was considered first. Fiberoptic bronchoscopy showed that the right middle bronchus was slightly narrowed, and the mucosa was swollen with a few granular changes. The pathological results of fiber brush showed normal columnar epithelial cells, and no obvious signs of malignant tumor cells were found. Laboratory tests: procalcitonin normal range; Tuberculosis antibody (-), TB infection T cell detection unreactive type, TB infection gamma interferon antigen A and B were in the normal range, eosinophilic count 420/μ L (50.0-300.0/μ L), preoperative immune negative. The patient's symptoms did not improve significantly during 5 days of empirical anti-infective treatment and symptomatic treatment such as cough relief and phlegm resolution, and the body temperature showed intermittent fever during the treatment, up to 39 ℃. After comprehensive consideration, tuberculosis and reactive lymph node enlargement were first ruled out, but lymphoma, hematological diseases and metastases could not be further identified for the time being, and specific infection could not be excluded. One week later, the reexamination of chest CT showed that the right hilar lymph nodes were slightly enlarged, but the mediastinum and right supraclavicular lymph nodes did not change significantly. Lymphocytes, neutrophils and multinucleated giant cells were found in the fine needle aspiration smear of the right supraclavicular lymph node, but no tumor cells were found. Right supraclavicular lymph node resection was performed. Histopathological report: granuloma was composed of a large number of multinucleated giant cells and a large number of chronic inflammatory cells. Some granuloma was necrotic, and spherical capsulated bacteria were seen in multinucleated giant cells. Both PSA and PASM were positive (Figure 3)。 The patient's body temperature returned to normal on the first day after lymph node resection; There was no further increase or fluctuation in body temperature. According to the pathological results, cryptococcal infection was diagnosed, and fluconazole 200 mg was given twice a day. The cough was significantly improved. After 2 months, reexamination of chest CT showed that the right supraclavicular and right hilar lymph nodes were no longer obvious, and the intramediastinal lymph nodes were significantly smaller than before (Figure 2)。

Infection has always been a topic in the Department of Critical Care Medicine (ICU), and sepsis induced by infection is one of the most common diseases in critically ill patients, which has attracted much attention because of its critical condition, high mortality rate and expensive medical expenses. Since the definition and diagnostic criteria of sepsis were put forward, it has gradually been widely accepted and applied in clinical practice. With the deepening of clinical practice and experimental research, clinicians' understanding of organ and cell dysfunction and pathophysiological mechanism in sepsis patients tends to be more perfect and mature, and the definition and diagnostic criteria of sepsis have been revised and updated several times. The latest sepsis is defined as a clinical syndrome in which the host is dysresponsive to infection and develops life-threatening organ dysfunction^[1]。 The new definition of sepsis emphasizes organ dysfunction caused by infection, reflecting a more complex pathophysiological state than in ordinary infected patients. Despite the continuous progress in the understanding and diagnosis and treatment of sepsis, sepsis still brings a huge burden to global medical and health care. A meta-analysis of 27 studies from developed countries showed that the annual incidence of sepsis in the past 10 years was 437/100,000, and the mortality rate was 17%; The annual incidence of severe sepsis is 270/100,000 and the mortality rate is 26%^[2]。 The liver is the largest detoxification organ in human body, which participates in the clearance of inflammatory factors or inflammatory products, and plays an important role in regulating metabolic disorders and maintaining the internal environment of the body. At the same time, the liver is one of the organs most commonly involved in sepsis. The pathogenesis of hepatic dysfunction in sepsis is complex and there is no uniform definition at present^[3]At the same time, due to the lack of reliable indicators, early hepatic dysfunction cannot be detected^[4]。

The implantation of human embryos into the endometrium is a complex sequence of procedures involving many biological mechanisms. The two major factors that affect successful implantation are the quality of the embryo and the receptivity of the endometrium to the embryo. Although the current assisted reproductive technology has made remarkable progress in the treatment of infertility, the application of new controlled superovulation technology, intelligent embryo culture system and ultrasound-guided embryo transfer technology has greatly improved the clinical pregnancy rate. In vitro fertilization and embryo transfer (IVF-ET), the success rate of in vitro fertilization and embryo implantation into the uterus can reach 90%, but the clinical pregnancy rate has not improved accordingly, and has been floating around 40%, and the birth rate is only about 30%^[1,2]。 At present, the important reason for limiting the success of IVF is still the failure of embryo implantation, which may come from the lack of synchronization between embryo and maternal endometrium^[3,4]That is, the endometrium lacks receptivity during the optimal implantation period of the embryo. Endometrial receptivity (ER) refers to the ability of the endometrium to accept the blastocyst and allow the blastocyst to induce a series of changes in the endometrial stroma, and finally implant the endometrium. The endometrium can accept the embryo to the maximum extent, and the time for the embryo to implant smoothly is called the "implantation window" (WOI). The embryo cannot be accepted for implantation too early or too late, that is, the implantation window is closed^[5]。 At present, it is generally believed that the opening time of the implant window is in the mid-luteal phase, and the optimal endometrial receptivity time occurs about 6~8 days after the peak of luteinizing hormone (LH)^[6,7]。 The research progress of endometrial receptivity assessment indexes and clinical application in recent years is reviewed as follows.

cervical spondylotic amyotrophy (CSA) is a special type of cervical spondylotic disease, which is based on the degeneration of the cervical spine, mainly manifested as upper limb muscle atrophy, mainly unilateral, usually without or with mild paresthesia and spinal cord lesions (mainly manifested as lower limb symptoms and abnormal gait)^[1]。 Brain et al^[2]Cervical spondylosis with upper limb muscle atrophy as the main manifestation was reported for the first time, Keegan^[3]It is considered that the selective injury of motor nerve root caused by osteophyte formation caused by cervical degeneration is the main factor of upper limb muscle atrophy in patients with cervical spondylosis, and the phenomenon of upper limb sensorimotor separation, also known as Keegan type cervical spondylosis, is proposed^[1]。 Sobue et al.^[4]The theory of segmental spinal myelopathy was put forward, and the cervical spondylosis characterized by upper limb muscle atrophy was named "amyotrophic cervical spondylosis".

Parkinson's disease (PD) is a common degenerative disease of the central nervous system in middle-aged and elderly people, and its clinical manifestations are divided into two main types of symptoms: dyskinesia and non-dyskinesia. The main symptoms of dyskinesia are tremor, hypomobility, rigidity, postural balance disorder, etc. Non-dyskinetic symptoms include depression, Parkinson's disease psychosis (PDPsy), dementia, sleep disorders, and the like. Compared with movement disorders, non-movement disorders are still lacking effective drug treatments, so they pose different burdens on patients and caregivers^[1]。 PDPsy is more common in intermediate and advanced PD patients, which not only increases the burden on caregivers, but also further reduces the quality of life of patients and increases the mortality rate^[1]； At the same time, most antipsychotics have dopaminergic receptor antagonism, which will aggravate the motor symptoms of patients, which brings difficulties to the treatment of PDPsy. In this paper, the research progress of PDPsy is reviewed.