Volume 97  ·  Issue 25  ·  2017

At present, the prevalence of hyperuricemia in China continues to increase, reaching 8.4% ~13.3%^[1,2], showing a younger trend. The kidney is an important organ of uric acid metabolism in human body. Hyperuricemia is one of the most common complications of chronic kidney disease (CKD). About 90% of patients with hyperuricemia and gout are caused by glomerular filtration and/or renal tubular secretion dysfunction. At the same time, hyperuricemia can aggravate the progression of kidney disease and the occurrence of cardiovascular and cerebrovascular complications, and is an independent risk factor for the occurrence and development of CKD, cardiovascular and cerebrovascular diseases and metabolic diseases. For every 60 μ mol/L (1 mg/dl) increase in blood uric acid, the risk of kidney disease increased by 7% to 11%^[3]14% increased risk of renal function deterioration^[4]。 Blood uric acid levels ≥420 μ mol/L (7.0 mg/dl) in men and ≥360 μ mol/L (6.0 mg/dl) in women increased the risk of developing end-stage kidney disease 4-fold and 9-fold, respectively^[5]。 With the decrease of glomerular filtration rate, the prevalence of hyperuricemia in CKD patients gradually increased, fluctuating from 40% to 70%^[6]； Patients with CKD stages 3 to 5 with hyperuricemia have a higher risk of rapid progression of kidney disease and renal replacement therapy. For every 60 μ mol/L (1 mg/dl) increase in blood uric acid level in patients with CKD stages 3 to 4, the risk of cardiovascular death increased by 16%, while the risk of all-cause death increased by 17%^[6,7]。 Therefore, strengthening and standardizing the diagnosis and treatment of renal disease hyperuricemia is of great significance for delaying the progression and complications of renal disease and improving the prognosis of patients.

With the increasing pressure of competition in modern society, mental pressure has become a new pathogen, and mental illness has become a major public health problem. Anxiety and depression are common among general hospital patients. Foreign studies have found that more than 50% of community medical patients have anxiety, depression or somatization symptoms^[1]The prevalence rate of patients attending general hospitals in China was 16.5% who met any diagnosis of anxiety disorder (anxiety disorder), depressive disorder (depression), anxiety and comorbidity of depression^[2]。 These psychological problems also exist in large numbers in rheumatology patients. In the past, we paid more attention to organic rheumatism that can be accompanied by anxiety and depression. At the same time, anxiety and depression can also cause functional rheumatism symptoms, such as chronic pain, fear of wind and cold, and tingling sensation, and many patients go to rheumatology department for medical treatment only because of such symptoms^[3]。 Because of the lack of awareness of anxiety and depression causing functional rheumatism symptoms in the past, such patients are often missed or misdiagnosed. Therefore, it is very important for rheumatologists to identify functional rheumatism symptoms. On this basis, we should also master the basic treatment methods for functional rheumatism symptoms, which will help to relieve the disease as soon as possible, enhance patients' confidence in diagnosis and treatment, and reduce the possibility of transferring to multiple subjects or even delaying the disease.

With the improvement of people's living standard and the change of lifestyle, the prevalence of hyperuricemia is increasing year by year, which has become an important public health problem in China. kidney disease is an important cause of hyperuricemia, and hyperuricemia is also one of the most common complications of chronic kidney disease (CKD). Hyperuricemia can aggravate the progression of kidney disease and the occurrence of cardiovascular and cerebrovascular complications, and is an independent risk factor for the occurrence and development of CKD, cardiovascular and cerebrovascular diseases and metabolic diseases. At present, there is still a lack of clinical practice guidelines for the diagnosis and treatment of renal disease hyperuricemia in China. To this end, we formulated the Practical Guidelines for the Diagnosis and Treatment of Hyperuricemia in Kidney Diseases in China (2017 Edition) around the epidemiology, pathogenesis, diagnosis, assessment and treatment of hyperuricemia in kidney diseases, so as to guide the more standardized clinical treatment of hyperuricemia in patients with kidney diseases.

To explore the expression of Annexin a1 (AnxA1) mRNA in peripheral blood mononuclear cells (PBMC) from Naïve rheumatoid arthritis (RA) patients and healthy controls and to investigate its influencing factors.

Thirty Naïve RA patients and 36 healthy controls were recruited from the First Affiliated Hospital of Harbin Medical University between May 2013 and January 2015.All RA patients were fulfilled the classification criteria of ACR in 1987.Clinical characteristics and laboratory indexes were collected.Real time polymerase chain reaction (RT-PCR) was used to measure AnxA1 and Foxp3 mRNA expression respectively.Serum TNF-α, IL-17 and IL-10 levels in each group was determined separately by enzyme linked immunosorbent assay (ELISA). Furthermore, correlations between the expression of AnxA1 mRNA and clinical characteristics, laboratory parameters, Foxp3 mRNA, serum IL-17, TNF-α, IL-10 level in Naïve RA patients were analyzed.

The expressions of AnxA1 mRNA in PBMC of Naïve RA patients were lower than that of healthy controls [0.12 (0.05-0.30) versus 1.66 (0.40-2.68), P<0.05]. The Foxp3 mRNA expressions in PBMC of Naïve RA patients were also lower than that of healthy controls [0.77 (0.39-1.89) versus 2.93 (2.65-3.49),P<0.05], while serum TNF-α, IL-17, and IL-10 levels of Naïve RA patients were higher than those of healthy controls (P<0.05). The expression of AnxA1 was positively associated with the expression of Foxp3 mRNA (r_s=0.513, P<0.05) and negatively associated with the serum IL-17 level (r_s=-0.381, P<0.05). But there were no correlations between expression of AnxA1 in PBMCs from Naïve RA patients with the TNF-α, IL-10 level, clinical characteristics (sex, age, disease duration and disease activity) and the laboratory indexes (RF, Anti-CCP antibody, ESR and CRP). The expression of Foxp3 mRNA and the serum IL-17 level was the independent influencing factor.

The reduced expression of AnxA1 may associate with the reduced expression of Foxp3 and the increased IL-17 level in Naïve RA patients.It suggested that AnxA1 may play a key role in immune regulation and anti-inflammatory process in the pathogenesis of RA.

To investigate the effect of transcatheter arterial chemoembolization(TACE)combined with thymosin alpha1(Tα1)on the autophagy of immune cells from advanced hepatocellular carcinoma.

A total of 30 patients with advanced liver cancer enrolled in Lishui Central Hospital from September 2015 to June 2016 were collected in this study. The average age of patients was 16-75(56±12) years. All patients were treated with TACE after enrolled in hospital in a week. Patients were divided into TACE group and TACE+ Tα1 treatment group(15 cases in each group). Patients in TACE group received a conventional treatment, without any immunotherapy, while the TACE+ Tα1 treatment group accepted TACE following a subcutaneously injection of 1.6 mg Tα1 twice a week for 4 weeks. Flow cytometry was used to detect the T cell subsets in two groups both before and after TACE treatment for 1, 4 weeks and at 3 months follow-up. Peripheral blood mononuclear cells (PBMC) were isolated by density gradient centrifugation. The expression of Beclin-1, LC3 protein and mRNA were detected by Western blot (WB) and PCR respectively.

There was no statistical difference of the percentage of CD3⁺ , CD4⁺ , CD8⁺ T cell subsets and Beclin-1, LC3 protein and mRNA expression between the two groups before TACE treatment (P>0.05). The percentage of CD3⁺ , CD4⁺ , CD8⁺ T cell subsets in TACE+ Tα1 group at 1 week post-TACE treatment (58.45%±16.34%, 38.33%±15.16%, 27.31%±12.54%), at 4 weeks post-TACE treatment (62.38%±18.62%, 43.19%±13.86%, 29.54%±10.33%) and 3 months follow-up (64.15%±13.76%, 41.28%±14.65%, 29.38%±15.65%) were statistically higher than those in TACE group at 1 week post-TACE treatment (53.71%±11.17%, 32.12%±10.53%, 24.45%±13.72%) at 4 weeks post-TACE treatment (52.12%±14.26%, 31.16%±15.43%, 23.39%±15.33%) and 3 months follow-up (54.28%±13.15%, 32.17%±14.98%, 24.34%±14.12%) (P<0.05). The Beclin-1, LC3 protein and mRNA expression in TACE+ Tα1 group at 1 week post-TACE treatment (protein: 0.57±0.08, 2.26±0.36, mRNA: 0.62±0.11, 2.69±0.27), at 4 weeks post-TACE treatment (protein: 0.66±0.09, 3.11±0.45, mRNA: 0.78±0.13, 3.43±0.61) were higher than those in TACE group at 1 week post-TACE treatment (protein: 0.45±0.16, 1.43±0.30, mRNA: 0.52±0.15, 1.15±0.37), at 4 weeks post-TACE treatment (protein: 0.51±0.13, 1.81±0.35, mRNA: 0.56±0.10, 1.98±0.41) (P<0.05). But there was no statistically significant difference in the expression of Beclin-1 and LC3 in two groups at 3 months follow-up (P>0.05).

TACE combined with Tα1 significantly increase the level of autophagy in the immune cells of patients with advanced primary hepatocellular carcinoma.

To evaluate and compare the efficacy between posterior fossa decompression without duraplasty (PFD) and posterior fossa decompression with duraplasty (PFDD) in the surgical management for adult Chiari Ⅰ malformation.

Fifty-seven patients suffered from Chiari malformation type Ⅰ were treated in Department of Neurosurgery, Henan Provincial People′s Hospital from August 2008 to October 2013. Twenty-three patients received posterior fossa decompression without duraplasty and the other 34 patients received posterior fossa decompression with duraplasty. The clinical results were retrospectively analyzed to compare the efficacy of two different surgical approaches.

There was no death or severe neurological dysfunction case in 57 patients of the two groups. Patients undergoing PFD had shorter length of hospital stay[(13.7±3.5) d vs (16.2±4.1) d, P<0.05]and surgical time[(98.7±22.1) min vs (132.3±39.6)min,P<0.05]. Cerebrospinal fluid-related complications and intracranial infection were more common in patients undergoing PFDD[(0/23, 0) vs (8/34, 23.5%),P<0.05]. Clinical improvement was comparable in two groups[(15/23, 65.2%) vs (26/34, 76.5%),P>0.05]at the one-year follow-up. The rate of syrinx regression in patients with Syringomyelia was higher in patients undergoing PFDD[(3/12, 25%) vs (17/22, 77.3%),P<0.05].

For adult patients with Chiari malformation type Ⅰ, PFD has the advantages of simple manipulation, short length of hospital stay and low incidence of cerebrospinal fluid-related complications and intracranial infection, compared with PFDD. It is comparable to PFDD in clinical improvement, but the effect of PFD is not as good as that of PFDD in the aspect of syrinx regression.

To discuss functional connectivity changes in the emotional network of patients with post-concussion syndrome (PCS) and their clinical significance by resting-state functional magnetic resonance imaging (rs-fMRI).

Twenty-seven patients with PCS were recruited from the Department of Neurosurgery of Anhui provincial hospital affiliated to Anhui medical university from October 2015 to April 2016, and 27 healthy subjects were recruited as the controls. The Hamilton Anxiety Scale (HAMA) and The Hamilton Depression Scale (HAMD) were used to evaluate the emotional state of two groups of subjects. All fMRI data were preprocessed after RS-fMRI scanning, the left and right amygdala were selected as region of interest (ROI) to make functional connectivity (FC) calculation with the whole brain and then the results were did statistical analysis in order to obtain the altered brain areas of amygdala and whole brain functional connectivity in the PCS patient, to understand the functional changes of emotional network.

HAMA and HAMD scores of PCS group and the health controls had significant statistical difference (HAMA: the PCS group 9.8±1.5, the health controls 4.5±1.2, P=0.044; HAMD: the PCS group 12±1.2, the health controls was 4.2±1.5, P=0.024). Compared with the health controls, the left amygdala in PCS patients showed decreased FC with left insula, left putamen, left anterior cingulate gyrus, left inferior orbital frontal gyrus, left medial superior frontal gyrus, bilateral superior temporal gyrus, left superior temporal pole, bilateral supramarginal gyrus et al, on the contrary with the increased FC with right superior orbital frontal gyrus, right middle frontal lobe, right orbital frontal lobe, right middle frontal gyrus. The right amygdala in PCS patients showed decreased FC with bilateral putamen, right inferior orbital frontal gyrus, left insula, bilateral precuneus, bilateral superior temporal pole, right superior temporal gyrus, right supramarginal gyrus et al. Similarly, it had the increased FC with the left middle occipital lobe and the left superior occipital lobe.

Abnormal emotional network function of PCS patients in resting state, which may be one of the reasons that lead to emotional and cognitive dysfunction in PCS patients.

To investigate the relativity between the distribution of deep medullary vein (DMV) in patients with middle cerebral artery stroke and clinical prognosis by using susceptibility-weighted imaging (SWI).

A total of 144 cases of middle cerebral artery stroke patients and 55 healthy volunteers were retrospectively analyzed from January 2015 to October 2015 in order to investigate the symmetrical characteristic and the classification of DMV, then 30 cases were followed up. Kappa test was used to consider the consistency of judging DMV symmetry and type data by two radiologists.

Kappa value in DMV symmetry and DMV type were 0.875 and 0.852. Chi-square test analysis revealed a statistically significant difference of DMV symmetry between healthy control and stroke group(χ²=31.046, P=0.000). There was correlation between DMV type and NIHSS score in stroke group (r_s=0.208, P=0.025). There was no statistically significant difference of DMV distribution in the different periods of stroke group (P=0.110). But there was statistically significant difference of DMV distribution between acute and chronic stroke (P=0.018). Among 30 follow-up cases, 18 cases with asymmetry DMV changed into symmetry after stroke therapy. In 8 cases with symmetry DMV, the diameter of DMV became smaller after treatment. In 4 cases, DMV had no changes.

DMV in patients of MCA stroke are mostly asymmetry distribution. DMV classification can be used as an imaging standard to predict the prognosis of stroke patients.

To investigate the safety and feasibility of the treatment of hemorrhoids by superselective arterial embolization.

The clinical data of 15 patients with grade Ⅱ to Ⅳ hemorrhoids were collected who were treated by superselective SRA embolization.According to the number and shape of SRA in the vicinity of the dentate line, chosed coils, PVA particles and gelfoam particles, ethanol and bletilla mixture of gelfoam particles for embolization.And intraoperative operations, postoperative complications, follow-up treatment results were observed.

The interventional procedures were successfully accomplished in all 15 cases.The operation time was (30±14) min, and the hospital stay was 1-7 (2.0±1.8) days after operation, and the patients recovered to normal life in 12 hours after the operation.Tenesmus (14/15), pain (5/15) and low fever (11/15) can alleviate without special treatment. All patients were follow up (19.0±2.6) months, bleeding symptoms were cured, there′s no serious complications.

The treatment of hemorrhoids by transcatheter superselective embolization of superior rectal artery is technically safe and feasible.

To investigate the effect of high mechanical stretch stress(HMS)on human nucleus pulposus cells and its regulatory mechanism.

The non-degenerated nucleus pulposus tissue (Pfirrmann<grade Ⅲ) removed from the patient′s surgery was harvested and the human nucleus pulposus cells were isolated and cultured. In the presence or absence of pretreatment with the NF-κB specific blocker Bay11-7082, the cultured human nucleus pulposus cells were loaded cyclic mechanical stretch stress(CMS) with different parameters using the Flexercell system.The cell culture medium was collected and the secretion of inflammatory cytokines was detected by Elisa. The nucleus pulposus cells loaded with cyclic mechanical stretch stress(CMS) was collected, the changes of NF-κB/P65 signal pathway were detected, The mRNA and protein levels′ expression changes were detected by RT-PCR and WB; after human nucleus pulposus cells were exposed to IL-1β, with or without Bay11-7082, the changes of P65 were detected by immunofluorescence.

Those mechanical stretch stress of high amplitude (9%, 19%), low frequency (0.01 Hz) and long duration (72 h) led to degeneration of human nucleus pulposus cells, while the mechanical stretch stress of low amplitude (3%), low frequency and long duration could not promote the degeneration process; the mechanical stretch stress of high amplitude(19%), low-frequency(0.01 Hz) could promote the release of inflammatory cytokines of human nucleus pulposus cells after 24 h duration; high-amplitude, low-frequency mechanical stretch stress could activate the NF-κB signaling pathway in human nucleus pulposus cells, Bay11-7082 could block the process; immunofluorescence showed that IL-1β could promote the phosphorylation of P65 in the cytoplasm of human nucleus pulposus cells and promote the entry of P65 into the cell nucleus process, Bay11-7082 could block those processes; Bay11-7082, the specific blocking agent of NF-κB signaling pathway, could block the degeneration process of human nucleus pulposus cells induced by high cyclic mechanical stretch stress(CMS) in a dose-dependent.

High cyclic mechanical stretch stress promotes human nucleus pulposus cells degeneration through NF-κB signaling pathway.

To illustrate the effect of subthalamic nucleus deep brain stimulation (STN-DBS)on cognitionand its underlying mechanisms in a rat model of Parkinson′s disease (PD).

Thirty healthy male Sprague-Dawley rats were randomly divided into 3 groups: control group (healthy rats, n=10), model group (PD rats, n=10), and stimulation group (PD rats receiving high frequency stimulation, n=10). The cognitive functionof rats was tested through Morris water maze and acetylcholine levels in cortex, hippocampus and striatum have been examined through ELISA.

During Morris water mazetest, spatial learning and memory of PD ratsdeteriorated compared with healthy ones, withlonger escape latency[on day 4, (38±14) s vs (20±4) s, P=0.047; on day 5, (32±13) s vs (16±8) s, P=0.032]and shorter time in the platform region[(10±6) s vs (19±5) s, P=0.023], which could be restored by STN-DBS. Similar results demonstrated that the expression of Ach in hippocampus[(1 473±233) s vs (1 950±344) s, P=0.039]and striatum[(1 661±271) s vs (2 240±290) s,P=0.007]was significantly lower in PD rats than those in healthy rats, and STN-DBS treatment reversed this decline to insignificant.

The rat model of PD suffer from a decline in cognition, and STN-DBS contributes to cognitive recovery, possibly due to regulating Ach levels in cognition-associated regions of the brain, includinghippocampus and striatum.

To discuss the curative effect and prognosis of cryoablation to high-risk and locally recurrent prostate cancer patients.

Cryoablation related publications and relevant references were searched for potential pertinent articles until March, 2016.Articles were selected according to the exclusion criteria, Stata ver.11 was used to perform the statistical analysis.

5-year biochemical disease-free survival of salvage ablation for prostate cancer was 45%(95% CI 0.43-0.47), in salvage radiotherapy of 45% (95% CI 0.44-0.47). The 5-year biochemical disease-free survival of high-risk prostate cancer cryoablation was 66%(95% CI 0.64-0.67). The result of high-risk prostate cancer radiotherapy and EBRT were respectively 61%(95% CI 0.60-0.63) and 54% (95% CI 0.52-0.56).

The five-year biochemical recurrence of salvage cryoablation is similar to salvage radiotherapy. For high-risk prostate cancer, cryoablation shows an advantage than traditional EBRT radiation.

Cerebral arteriovenous malformation (AVM) is a vascular disease that often occurs in young adults and often starts with hemorrhage and epilepsy^[1]。 In longitudinal fissure arteriovenous malformation, due to tortuous blood supply arteries, anterior cerebral, pericallosal arteries and marginal callosal arteries participate in blood supply, the risk of cumulative functional blood vessels by interventional embolization is greater, and the technical difficulty is also greater. Longitudinal fissure deformity is located deep in the longitudinal fissure, with limited surgical space and limited visual field. From January 2014 to January 2016, Beijing Chaoyang Hospital and Beijing Tiantan Hospital used different approaches combined with intraoperative real-time ultrasound to treat 6 cases of longitudinal fissure cerebral arteriovenous malformation. The results are reported below.

The patient was a 33-year-old female. There was severe headache with nausea and vomiting for more than 7 days without obvious trigger. The headache was persistent, and there was no limb movement and sensory impairment. He went to a local hospital and got better after giving "mannitol". He came to the First Affiliated Hospital of Zhengzhou University for further treatment. Physical examination: The patient is conscious, poor spirit, poor appetite and poor sleep. Magnetic resonance examination: the left frontotemporal tissue structure and signal were disordered, the local bone showed discontinuity, and a strip of long T was seen under the inner plate of the skull₁Long T₂Signals. The left temporoparietal lobe showed mass-like mixed isotes₁Long T₂Signal, locally visible patchy short T₁Signal (FIG. 1A，FIG. 1B), diffusion-weighted imaging (DWI) (b =1 000 s/m²) The diffusion part was limited and showed obvious high signal, and large patches of long T could be seen around it₁Long T₂In the edema zone, the left lateral ventricle and the third ventricle were narrowed and deviated to the right under compression, the midbrain showed compression changes, the left lateral fissure pool became shallow, and the midline structure of the brain deviated to the right. Patchy long T is visible in bilateral frontal lobes₂Signal shadow, black water image is high signal. After intravenous injection of Gd-DTPA, the left temporoparietal lobe lesions showed obvious irregular wreath-like enhancement, and the enhancement range was 4.1 cm ×3.9 cm ×4.2 cm (anterior-posterior diameter × left-right diameter × superior-inferior diameter) (FIGS. 1C ~ E), linear enhancement was seen adjacent to the dura mater. Preliminary diagnosis: oligodendroglioma. Surgical procedure and pathology: During the operation, the left temporal lobe and temporal pole were gray-white with edema. The temporal pole was removed below the lateral fissure, and there was a mass deep in the lateral fissure of the left temporal lobe. The tumor was cystic, tough in texture, with clear tumor border and abundant blood supply. The size of the removed tumor was 4 cm ×4 cm ×5 cm. Pathology: Microscopically, endothelial cells of different shapes and sizes can be seen to form irregular and mutually anastomotic vascular lumens, and the size and shape of the vascular lumens are also uneven, showing fissures or expanding into sinuses. Immunohistochemical staining: GFAP (Focus +), Oligo-2 (Focus +), S-100 (Focus +), EMA (−), Ki-67 (+20%), CD34 (Focus +), CD31 (+). Pathological diagnosis: angiosarcoma (Figure 2)。

At present, the surgical treatment of lumbar degenerative diseases includes traditional pedicle screw internal fixation and non-fusion interspinous process elastic fixation. Although spinal fusion is the gold standard of lumbar surgical treatment, its complications such as high incidence of adjacent segment degeneration have attracted extensive attention^[1]。 The interspinous process distractor is also not perfect, and problems such as high risk of spinous process fracture and loose implant have also appeared one after another. Aiming at the shortcomings of the existing schemes, a new type of interlaminar dynamic fixation device-Intraspine came into being. This paper summarizes the design concept, biomechanics and clinical research progress of IntraSPINE.

Parkinson's Disease (PD) is a neurological Disease whose incidence rate is second only to Alzheimer's Disease. According to statistics, the incidence rate of PD in the global population reaches 0.3%, while the prevalence rate in the elderly over 60 years old reaches 1%, and the incidence rate in the population over 80 years old reaches 3%^[1,2]。 Parkinson's disease mainly causes movement disorders such as resting tremor, myotonia, bradykinesia and abnormal posture and gait, accompanied by a large number of non-motor symptoms. The prevalence and incidence of Parkinson's disease increased exponentially with the increase of age. With the arrival of aging society, the increase of aging population led to the global prevalence of Parkinson's disease showing an obvious upward trend^[2,3]。 Chen et al.^[4]Studies have shown that patients with Parkinson's disease have a higher risk of falling, and 8 years of follow-up of patients with Parkinson's disease found that the incidence of hip fractures was as high as 10.4%. Meanwhile, Karadsheh et al.^[5]Studies have shown that Parkinson's disease is an independent risk factor for higher 5-year mortality and reoperation rates in patients with femoral neck fractures. Therefore, it is important to understand the risk factors of hip fracture in patients with Parkinson's disease and master the perioperative management.

The incidence of delirium in the Department of Critical Care Medicine (ICU) remains high, and the various complications caused by delirium and the increased mortality rate of patients should be paid enough attention by clinicians. Routine ICU delirium monitoring and prevention, early prevention, early detection and early treatment of ICU delirium can not only reduce the incidence of delirium and shorten the duration of delirium, but also effectively improve the clinical prognosis of patients and reduce the social and economic burden. The non-drug and drug-induced preventive measures of delirium in ICU are reviewed and the effective methods to predict delirium are prospected. By predicting the probability of delirium, early intervention measures can be carried out to reduce the incidence of delirium in ICU.