Volume 97  ·  Issue 27  ·  2017

To analysis the change of brain functional activity in the left and right peripheral facial paralysis by using resting-state functional magnetic resonance imaging (R-fMRI) of fraction amplitude of low frequency fluctuation(fALFF) measurement technique, and research the abnormal brain region with different side patients whether there are differences.

A total of 43 patients with peripheral facial paralysis patients (patient groups, divided into left / right two subgroups) and 21 healthy volunteers (control group) in this study.Resting-state fMRI were acquired for each volunteer and patient. The fALFF approach was used to compare the peripheral facial paralysis groups to healthy group.Functional analysis was performed with brain function analysis software REST and DPARSFA , and then analysis the difference of two groups of patients and control group in two sample t test.At the same time, the correlation analysis between fALFF parameters map of the left and right side of two groups of patients and corresponding facial nerve grading TFGS score.Ultimately obtain a statistically significant brain regions.

Compared to healthy group, the decreased fALFF areas in the left side facial paralysis were showed in the right superior temporal gyrus , the pole of the right temporal, right middle temporal gyrus, the left occipital gyrus, and left medial cingulate gyrus, left paracentral lobule, and the left supplementary motor area; while the increased brain regions have the right superior frontal gyrus, right middle frontal gyrus, the right precentral gyrus, bilateral inferior temporal gyrus and middle temporal gyrus.Compared to healthy group, the decreased fALFF areas in the right side facial paralysis were showed in the right inferior temporal gyrus and fusiform gyrus, the left inferior occipital gyrus, the left superior parietalgyrus, the left inferior parietalgyrus, left precuneus, left paracentral lobule, the left supplementary motor area; while the increased brain regions have the left Calcarine, right lingual gyrus, corpus callosum, right medial cingulum gyrus.In the left facial paralysis group TFGS score was positively correlated with brain regions have left middle frontal gyrus, left precuneus and left cuneus, while the negatively related brain area on the right lingual gyrus.In the right facial paralysis groups TFGS score was positively correlated with brain areas have right inferior temporal gyrus and middle temporal gyrus, left inferior parietalgyrus; while the negatively correlated brain area on the left superior temporal gyrus, the right medial frontal gyrus.

The left and right side facial paralysis patient′s mood and motor function integration mechanism may be different, and the patient′s emotional and psychological changes may be associated with disease severity.

To detect the serum resistin levels in patients with generalized myasthenia gravis (GMG) and evaluate the clinical values of resistin.

We detected the serum resistin levels in 58 patients with GMG and 58 healthy controls (HC) from January 2013 to December 2015 in Tianjin medical university general hospital.Then we analyzed the correlation of the serum resistin levels with the clinical features.

The serum resistin levels in patients with GMG, (8.26±4.27) ng/ml, was significantly higher than in HC, (4.12±1.36) ng/ml, (P<0.001). There was no statistical difference of the serum resistin levels between female or male patients with GMG (P=0.589). The serum resistin levels in patients with GMG was positively correlated with the quantitative MG score for disease severity (QMG) (r=0.446, P<0.001), but not correlated with age (r=0.168, P=0.206). The patients with higher resistin levels took higher risk of combining with thymoma (P=0.002), 56.5%, and these patients had higher QMG, 11(5) (P=0.001); and the ratio and QMG in the patients with lower resistin levels were 17.1%, 7(5), respectively.The GMG patients with thymoma (TGMG+ ) had remarkably higher serum resistin levels, (10.7±5.3) ng/ml (P=0.010) and the QMG score, 11(5) (P<0.001) than the GMG patients without thymoma (TGMG-) with (7.0±3.1) ng/ml and 8(5).

Resistin is probably associated with the severity of the disease of MG, and maybe a potential biomarker of MG combined with thymoma.

To explore the efficacy and tolerance of Memantine combined Reinhartdt And Sea Cucumber Capsule (R.S.C) on treating agitation in patients with moderate-severe Alzheimer disease (AD).

One hundred and fifty-eight moderate-sever AD patients from Sep.2013 to Sep.2014 in Zhejiang Provincial People′s Hospital were randomly divided into two groups: group of Memantine combined R. S.C and group of single Memantine. Then Mini-Mental Sate Examination (MMSE) and Neuropsychiatric Inventory (NPI) were used to evaluate cognition symptom, behavioral and psychological symptoms of dementia (BPSD) and agitation symptom at the baseline and the end of 24 weeks.The Treatment Emergent Symptom Scale (TESS) was used to assess adverse reaction and tolerance.At last, the data was analyzed by chi-square test, t-test and covariance test.

At the terminal of experience, the total NPI scores and agitation factor decreased markedly in both of the two groups (P<0.05). Among the patients who had agitation symptom at the baseline, the total NPI scores and agitation factor (18±5, 3.7±2.6) in group of Memantine combined R. S.C were notably lower than those in the group of single Memantine (21±6, 5.3±2.5) (P<0.05). The incidence of adverse reaction between the two groups had no significant difference (combined treatment group was 27.7%, single treatment group was 23.2%). One patient dropped out because of skin allergy, and most adverse reactions were tolerant.

Both two groups are effective in agitation and BPSD, and Memantine combined R. S.C is better than single treatment.R.S.C dose not aggravate adverse reaction and can be well tolerated.

To achieve definite diagnosis in a clinically diagnosed Charcot-Marie-Tooth disease (CMT) pedigree and broaden the mutational diversity of CMT-related mutations in Chinese Han population.

Patients clinically diagnosed with CMT were recruited from Department of Neurology, Chinese PLA General Hospital between December, 2012 to June, 2016. Clinical examination, laboratory tests, nerve conduction studies, and molecular and bioinformatics analyses were performed on a clinically diagnosed CMT pedigree.

In the pedigree, a GARS mutation (c.794C>T, p. S265F) was identified and CMT2D was diagnosed.

The newly identified GARS mutation has broaden the mutational diversity of CMT2D in Chinese Han population.

To investigate the relationship between ApoB/A1 ratio and the characteristics of tissue components of their left main coronary artery(LMCA)plaque.

A total of 98 patients with stable angina pectoris who received chronic statin treatment underwentpercutaneous coronary intervention in the People′s Hospital of Henan Province from June 2010 to June 2016 were included.We prospectively performed intravascular ultrasound virtualhistology (IVUS-VH) to their LMCA and evaluated the tissue characteristics, and the blood level of total cholesterol (TC) and low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C), triglyceride(TG), LDL-C/HDL-C ratio, ApoB, ApoA1, ApoB/A1 ratio were measured, then the association of the tissue characteristics with the aboved lipids values were analyzed.

According to the median value of their ApoB/A1ratios (0.80), they were divided into 2 groups [high ApoB/A1 ratio (>0.80) (n=49) and low ApoB/A1 ratio (≤0.80) (n=49)]. The patients with a high ApoB/A1 ratio had alarger fibrolipid volume and a smaller fibrous volume compared to patients with a low ApoB/A1 ratio ( 17.5%±1.2% vs 9.0%±1.0%, P=0.03 and 55.1%±2.1% vs 63.9%±1.8%, P<0.01). Using multivariate linear regression analysis after adjustment for the above-mentioned confounding factors, the ApoB/A1 ratio had a significantly positive correlation with fibrolipid volume (r=0.445, β=0.29, P=0.010)and had a negative correlation with fibrous volume (r=-0.567, β=-0.32, P=0.011), suggesting that the ApoB/A1 ratio was associated with the vulnerability of the LMCA plaque.

For the patients with stable angina pectoris and chronic treatment of statins, a high ApoB/A1 ratio is associated with a high percentage of fibrolipid volume and a low percentage of fibrous volume in LMCA lesions, suggesting that the ApoB/A1 ratios could predict the vulnerability of the LMCA plaque.

To explore the value of ultrahigh b-value DWI in diagnosis of prostate cancer.

From October 2015 to October 2016, a total of 84 cases from Affiliated Changshu Hospital of Soochow University(39 cases of prostate cancer with a total of 57 lesions, 45 cases of benign prostate hyperplasia) were examined with T₂WI, high b-value DWI (b=1 000 s/mm²) and ultrahigh b-value DWI (b=2 000 s/mm²) .Three image sets were rated respectively based on PI-RADS V2 by two radiologists and the scores were compared with biopsy results.The differences of the area under the ROC curve (AUC) among the three groups of each observer were compared by Z test.

The difference of AUC between ultrahigh b-value DWI and T₂WI in the diagnosis of peripheral and transitional zone cancer was statistically significant between the two observers (P=0.009 9, 0.008 2, 0.010 8 and 0.004 5 respectively), and there was no significant difference of AUC between ultrahigh b-value DWI and high b-value DWI in the diagnosis of peripheral and transitional zone cancer.The inter-reader agreement was found to be perfect for all lesions, peripheral zone lesions and transition zone lesions at ultrahigh b-value DWI (kappa values were 0.738, 0.709 and 0.768 respectively).

The diagnostic performance of ultrahigh b-value DWI is superior to high b-value DWI and T₂WI in both peripheral zone and transition zone cancers.

To evaluate the clinical value of ultrasonic elastography and ultrasonography comprehensive scoring method in the diagnosis of cervical lesions.

A total of 116 patients were selected from the Department of Gynecology of the first hospital affiliated with Central South University from March 2014 to September 2015.All of the lesions were preoperatively examined by Doppler Ultrasound and elastography.The elasticity score was determined by a 5-point scoring method. Calculation of the strain ratio was based on a comparison of the average strain measured in the lesion with the adjacent tissue of the same depth, size, and shape.All these ultrasonic parameters were quantified, added, and arrived at ultrasonography comprehensive scores.To use surgical pathology as the gold standard, the sensitivity, specificity, accuracy of Doppler Ultrasound, elasticity score and strain ratio methods and ultrasonography comprehensive scoring method were comparatively analyzed.

(1) The sensitivity, specificity, and accuracy of Doppler Ultrasound in diagnosing cervical lesions were 82.89% (63/76), 85.0% (34/40), and 83.62% (97/116), respectively.(2) The sensitivity, specificity, and accuracy of the elasticity score method were 77.63% (59/76), 82.5% (33/40), and 79.31% (92/116), respectively; the sensitivity, specificity, and accuracy of the strain ratio measure method were 84.21% (64/76), 87.5% (35/40), and 85.34% (99/116), respectively.(3) The sensitivity, specificity, and accuracy of ultrasonography comprehensive scoring method were 90.79% (69/76), 92.5% (37/40), and 91.38% (106/116), respectively.

(1) It was obvious that ultrasonic elastography had certain diagnostic value in cervical lesions. Strain ratio measurement can be more objective than elasticity score method.(2) The combined application of ultrasonography comprehensive scoring method, ultrasonic elastography and conventional sonography was more accurate than single parameter.

To explore the value of neuroendoscope and minimal-access in enhanced recovery after surgery of microvascular decompression (MVD) for treatment elderly patients with idiopathic trigeminal neuralgia (ITN).

The clinical data of 62 elderly patients with ITN who undergoing neuroendoscope-assisted minimal-access microvascular decompression were analyzed retrospectively, including operative data and follow-up results.

In 62 cases, the effective rate was 96.8%, with 88.7% complete cure and 8.1% little residual pain. Sixty successful cases were followed-up for an average of 61 months.Three cases recurred within 3 years after operation.Eight cases had complications after MVD.

There was no serious complications that could be ascribed to old age and the operative result was satisfactory compared with younger age cases.Endoscope and minimal-access can help shorten operation time, raise the effectiveness of MVD, reduce postoperative recurrence rate, and enhanced recovery after surgery for elderly patients.

To investigate the pathogenesis and management of the hydrocephalus in patients with systemic lupus erythematosus (SLE).

Eight cases of hospitalized lupus patients with hydrocephalus in Peking Union Medical College Hospital from Jan 1990 to Mar 2017 were analyzed retrospectively.We collected the patients′ medical records including medical history, CT and/or MRI images and analysis of cerebrospinal fluid via lumbar puncture in order to investigate the pathogenesis of the hydrocephalus in patients with SLE and summarize treatment experience.

All the 8 patients with SLE complicated with hydrocephalus were treated with steroids or immunosuppressive agents, and 5 cases were diagnosed with the central nervous system infection. Three cases received ventriculoperitoneal shunt, 5 cases received treatment of medicine.They all were followed up for 2-12 months, of which 3 cases were markedly effective, 1 case effective and 4 cases dead.

The pathogenesis of lupus combined with hydrocephalus may have a certain relationship with the central infection, should take effective anti-infection treatment.We recommend cerebrospinal fluid shunt surgery intervention.

To study the character of sinus pericranii in the adults and enhance the levels of the diagnosis and treatment of sinus pericranii.

The clinical data of 13 adult patients with sinuses pericranii undergoing surgery in Beijing Hospital from 1992 to 2016 were analyzed retrospectively, including clinical manifestations, imaging data, surgical results.

Each of the patients presented with a nonpulsatile and soft tissue mass in their heads.Their ages ranged from 18 to 48 years (mean, 26 years). The diagnosis of the sinus pericranii was made by the clinical manifestations combined with CT and/or MRI examinations.The sinus pericranii did not play the main role in the drainage of the cerebral vein blood.All the patients were cured.The follow up time was from 6 months to 20 years with no sinus pericranii recurrence in all the patients.

The analysis of the drainage pattern of sinus pericranii was necessary before surgery in order to get a safe and good operation.The curative effect of the surgery on the sinus pericranii in adult was reliable.

Thecurrent study is to explore the neuron-protective mechanism of neuregulin1β (NRG1β) in a rat model of middle cerebral artery occlusion/reperfusion (MCAO/R) through inhibiting the c-Jun phosphorylation.

After 24 h of MCAO/R (referring to Longa′s method), neurobehavioral function was measured by modified neurological severity score (mNSS) test; the cerebral infarction volume was detected by triphenyltetrazolium chloride (TTC) staining; the blood brain barrier (BBB) permeability was measured by Evans Blue (EB); the neuron morphology of brain tissue was observed by Nissl stain; the ultra-structures of the neurons were observed by transmission electron microscopy (TEM); the apoptotic neurons were counted by in situ cell death detection kit colocalized with NeuN; the expressions of phospho-c-Jun was determined by immunofluorescent labeling and Western blot analysis.

Compared with the sham-operation rats, the rats receiving MCAO/R showed increased mNSS (9.7±1.2), cerebral infarction volume (41.4±3.0)%, permeability of BBB, deformation of neurons, ischemia-induced apoptosis (0.63±0.04), and enhanced expression of phospho-c-Jun protein (0.90±0.07) (all P<0.05). Our data indicated that NRG1β attenuated neurologic deficits (6.4±0.9), decreased the cerebral infarction volume (10.4±0.5), reduced EB extravasation (1.55±0.13) and the deformation of neurons, protected the ultra-structure of neurons, blocked ischemia-induced apoptosis (0.23±0.02), through down-regulated phospho-c-Jun expression (0.40±0.03) in MCAO/R rats (P<0.05).

NRG1β exerts neuron-protective effects against ischemia reperfusion-induced injury in rats through inhibiting the c-Jun phosphorylation.

Constructed the recombinant HSV-1 deleted ICP47 and inserted human IL-12, and investigate the virus′ replication ability and oncolytic property in vitro and vivo.

The recombinant HSV-1 deleting ICP47 (MH1005) and then inserting human IL-12 (MH1006) were obtained with bacterial artificial chromosome technology.The replication ability and the efficiency of inhibiting tumor were detected in several nerve tumor cell lines infected with HSV-wt, MH1005 and MH1006 respectively.The murine tumor model was established by subcutaneous inoculation Neuro-2a cells on both sides of mice back respectively.A dosage of 2×10⁶ PFU of HSV-wt, MH1001(recombinant HSV-1 deleted IR), MH1005, MH1006 and Mock were injected 3 times intratumorally on one side of mice back in every 3 days, the tumor volume and survival rate of the mice were measured.

The replication abilities of MH1005, MH1006 and HSV-wt in 293FT cells were insignificant (P>0.05); the replication abilities of recombinant HSV-1 in G422 and Neuro-2a were higher than that in SK-N-SH; and the nerve tumor cells could be inhibited significantly by recombinant HSV-1.After 15 days of treatment, on the mouse backside with injection treatment, the tumor volumes of group HSV-wt (6 267±484), MH1001 (5 730±1 071), MH1005 (4 537±538)and MH1006 (4 150±476)mm³ were smaller than that of group Mock (6 957±722) mm³ significantly (all P<0.01); on the mouse backside without injection treatment, the tumor volumes of group MH1005 (5 952±607) and MH1006 (5 473±661) mm³ were smaller than those of HSV-wt (6 785±1 063), MH1001 (6 774±808) and Mock (6 957±190) mm³ significantly (all P<0.05); after 35 days of treatment, the mice survival rates of group MH1005 (100%) and MH1006 (100%) were higher than those of MH1001 (67%), HSV-wt (50%) and Mock (33%) significantly (allP<0.05).

MH1005 and MH1006 can infect nerve tumor cells and replicate at high level, the viruses not only kill tumor cells directly but also induce immunological rejection to tumor, and prolong the survival of mice bearing tumor.

To explore the effect of JWA on cisplatin sensitivity and its potential molecular mechanism in esophageal cancer.

The siRNA was used to inhibit the JWA expression, then cisplatin sensitivity and LC3 (autophagy related protein) expression levels were observed in TE1 cells.Further, the effect of autophagy inhibitor tamoxifen (3-MA) on above process was determined.Cisplatin sensitivity of 20 fresh esophageal cancer samples was evaluated by histoculture drug response assay (HDRA).

Silencing JWA gene increased the sensitivity of TE1 cells to cisplatin (P<0.05), and decreased the LC3-Ⅰ and LC3-Ⅱ proteins induced by cisplatin.Furthermore, combined with 3-MA increased the inhibition rate of cisplatin in JWA silencing group (P<0.05). Additionally, the inhibition rate of cisplatin on tissues with low JWA expression were higher than those with high expression (45.6% vs 25.6%,P=0.005).

JWA could influence the cisplatin sensitivity by regulating autophagy in esophageal cancer.

To determine whether suction drainage is safe and effective compared with no-drainage in total knee arthroplasty.

The literature search was based on PubMed, MEDLINE, EMBASE, Highwire, the Cochrane Library, CBM, CNKI, VIP and WFSD.The data were analysed using RevMan 5.3.Fourteen randomised controlled trials involving 1 009 knees were included in our analysis.

Suction drainage increases the rate and volume of blood transfusion.No-drainage group increases the rate of wound problems (OR=1.92, 95%CI 1.21-3.04, P<0.05). No significant difference was observed in the incidence of periprosthetic infection (OR=0.68, 95%CI 0.20-2.30, P=0.54), VAS (OR=-0.09, 95%CI -0.32-0.14, P=0.46) and the length of stay (OR=0.41, 95%CI -0.21-1.03; P=0.19) when the drainage group was compared with the no-drainage group (P>0.05).

No-drainage for easy total knee arthroplasty may be a better choice. However, orthopedic surgeon need to weigh the pros and cons of no-drainage in some complicated TKAs such as extra-articular deformity .

The patient, a 20-year-old male, unmarried, student, was seen on July 6, 2016 with "progressive enlargement of the end of the fingers and toes and the knee, ankle and wrist joints for 19 years". The patient's family members felt that the ends of the patient's fingers and toes were swollen and pestle-shaped since childhood (since the patient was 1 year old), and there was no joint swelling, deformity and mobility impairment at that time; Since then, the patient's fingers and toe ends showed progressive enlargement, and gradually showed progressive enlargement of knee joints, ankle joints and wrist joints, accompanied by inflexible movements. He had visited other hospitals many times and was considered "Kaschin-Beck disease" without special treatment. In the past 3 years, I felt that my left and right cheeks were asymmetric, my forehead increased progressively, and my facial skin was rough, which was not treated. In the past 3 months, I felt that bilateral knee, ankle and wrist joints were swollen and movement impaired more obviously than before, accompanied by local tenderness, which was aggravated when going up and down stairs, walking fast and running. Now I came to our hospital for further diagnosis and treatment, and was admitted to the hospital with "pachydermal periosteal disease". Full-term natural birth, height and weight were not measured at birth. He has been slightly taller than his peers since childhood. Unmarried and childless. There were no abnormalities in the family history, and the parents were not intimate married. Physical examination: blood pressure 119/76 mmHg (1 mmHg =0.133 kPa), height 174 cm and weight 51 kg. The forehead skin is thickened, the facial skin is rough, the hair is thick, the hair is hard, and the distribution is normal. The ends of the limbs are enlarged, showing pestle-shaped fingers and toes, the joints of both knees and wrists are enlarged, the joints of both ankles are enlarged with tenderness, and the movement is limited, and the muscle strength and tone of the limbs are normal (Figure 1)。 Laboratory tests: Plasma sedimentation rate was 45 mm/h and C-reactive protein (CRP) was 24.4 mg/L. The levels of growth hormone, corticotropic hormone (ACTH) rhythm, cortisol rhythm, thyroid function and parathyroid hormone were normal. No abnormalities were observed except estradiol (107 ng/L). Rheumatoid factor, anti-O antibody and anti-cyclic citrulline peptide antibody were normal. X-rays showed that the periosteum of bilateral distal tibia and fibula and bilateral proximal radius was thickened and rough, the bone density was loose, and the trabecular bone was sparse (Figure 2)。 The genetic test results showed that the patient's hydroxyprost gene (HPGD) had two heterozygous mutations: (1) the first base sequence changed from adenine to guanine, and the corresponding amino acid mutated from methionine to valine (c.1A>G; P.M1V); (2) Homozygous deletion of cytosine and thymine at 310 and 311 base sequences occurred (c.310-311 CT). These two mutation sites were from the mother and the father, respectively: the mother carried the c.1A>G (P.M1V) mutation and the father carried the c.310_311CT, but both phenotypes were normal (Figure 3)。 The initial diagnosis was as follows: (1) Thick skin and thick periosteum syndrome (complete type); (2) Osteoporosis. During hospitalization, the patient was given "diclofenac sodium 50 mg twice daily; calcium carbonate D3 600 mg twice daily; alfacalcidol 0.25 μ g twice daily; ranitidine hydrochloride 0.15 g twice daily". The swelling and inflexibility of the joints were improved, and local tenderness was relieved. The above-mentioned drug treatment was continued outside the hospital, and the patient was followed up 3 or 6 months after discharge. The flexibility of joint movement was acceptable, and no joint swelling and pain occurred again.

The patient was a 25-year-old female. One month ago, there was no obvious trigger for intermittent chest tightness and palpitation, which was paroxysmal, mostly after activity, and could be relieved after rest. Not accompanied by nausea, vomiting, syncope, etc. during attack. No history of hypertension or heart disease. The electrocardiogram in the local hospital showed atrial fibrillation, and no special treatment was performed. In order to seek further treatment, he came to our hospital, and the outpatient clinic was admitted to the cardiology department with "atrial fibrillation". The heart rate was 108 beats/min, the rhythm was absolutely irregular, the intensity of heart sounds varied, no murmur was heard in the auscultation area of each valve, and there was no pericardial friction sound. Imaging examination: Ultrasound findings: A medium and low echo mass with a size of 43 mm ×40 mm can be accessed between the junction of the left and right atrial apices and in front of the descending aorta, with clear boundaries and uneven internal echoes (Figure 1)。 CT showed a massive soft tissue density shadow below the left atrium of the posterior mediastinum, about 56 mm ×46 mm ×35 mm (Figure 2), moderate enhancement after enhancement, uneven density, and no swollen lymph nodes were seen in the mediastinum and under the axilla. MRI showed a space-occupying lesion in the posterior inferior of the left atrium (anterior to the spine), at T₁WI is isosignaled (Figure 3), T₂WI showed a heterogeneous slightly high signal shadow (Figure 4), the boundary is still clear, the size is about 45 mm ×41 mm ×33 mm, and the adjacent left and right atrium are compressed. Enhancement showed that the first perfusion of the posterior and inferior lesion of the left atrium showed the entry of contrast medium, and delayed enhancement showed that the parenchyma of the lesion showed a strip-like mild enhancement (Figure 5)。 Imaging diagnostic opinion: benign space-occupying lesion of the mediastinum. Surgery and pathology: Thoracoscopic right thoracic cavity exploration was performed. There were no adhesions in the right thoracic cavity and no pleural effusion during the operation. A mass with a diameter of 40 mm ×40 mm ×50 mm was seen in the posterior mediastinal pericardium, which was hard in texture, closely related to the left atrium, and the boundary was unclear. He was transferred to the cardiac surgery department and underwent posterior mediastinal space-occupying resection. Intraoperative results showed that there was no pericardial adhesion, and the mediastinal space was located below the right inferior pulmonary vein, the left posterior of the inferior vena cava and the left atrium. The size is 30 mm ×40 mm ×50 mm, and the occupied outer envelope is complete, elastic and soft. Pathological examination: macroscopic observation: a piece of gray-red gray-yellow tissue, 60 mm ×30 mm ×35 mm in size, gray-red gray-yellow soft cut surface, intact envelope. Microscopically: pericardial spindle cell tumor (Figure 6), consistent with perivascular epithelioid cell tumor (PEComa). Immunohistochemistry: CK (-), S-100 (-), Collagen-IV (-), Nestin (-), EMA (-), CD57 (-), GFAP (-), CgA (-), CD56 (+), HMB45 (+), CD34 (vascular +), PR (-), Ki-67 (1% +), Desmin (+), TFE-3 (-), MelanA (-), Myogenin (-), MyoD1 (-), Caldesmon (+), SMA (+), SOX (-), MSA (+).

Low back pain caused by intervertebral disc degeneration (IVDD) is the most common spinal disorder^[1]。 Studies have stated that low back pain caused by IVDD affects about 80% of the global population^[2]It is also one of the main reasons for the limited labor capacity of people aged 20~50^[3]。 In the United States, up to $500 billion is spent annually on low back pain^[4]。 With the arrival of global population aging, the incidence of IVDD is increasing, which seriously affects people's work and daily life, and is a serious socio-economic problem^[5]。 The occurrence of IVDD is a complex process including many factors (such as aging, overweight, trauma, smoking, diabetes, genetic factors, etc.)^[6]The mechanism of its degeneration is still unclear^[7]。 Studies have shown that acidic environment has a certain effect on intervertebral disk degeneration^[8]。 Intervertebral disc cells are very sensitive to changes in the acidic environment of extracellular matrix. In certain acidic environment, the synthesis rate of extracellular matrix decreases and the degradation rate increases^[9]If you are in this environment for a long time, the disc cells will die^[10]。 The research progress on how intervertebral disc cells sense the changes of extracellular acidic environment and thus discal degeneration is reviewed below.

Intrauterine adhesion (IUA), also known AS Asherman syndrome (AS), is a common endometrial damage disease. In the last 30 years, the incidence of intrauterine adhesions has increased year by year, which has attracted more and more attention. Its clinical manifestations are amenorrhea or thin menstruation, infertility, repeated miscarriage and other pregnancy complications. Although intrauterine adhesion separation and hormone therapy have achieved certain curative effects, the overall therapeutic effect is not good. Stem cells have shown good clinical application because of their potential of multidirectional differentiation and self-renewal. Numerous studies have shown that mesenchymal stem cells can be used for the repair of endometrial damage. The research progress of various mesenchymal stem cells on endometrial damage repair in intrauterine adhesions and the advantages and disadvantages of clinical application are reviewed as follows.