Volume 97  ·  Issue 29  ·  2017

Critical blood purification is a concept both familiar and unfamiliar. Blood purification is often used in the rescue of critically ill patients, but so far, there is no comprehensive and systematic explanation of the concept of critically ill blood purification. After years of theoretical development and clinical practice, severe blood purification has developed into not only a technology, but a scientific system with distinctive characteristics in basic theory, clinical application principles and methods, and treatment implementation rules.

To investigate the prognostic value of modified lung ultrasound aeration loss score(mLUS) in shock patients in intensive care unit(ICU).

This was a prospective study.Shock patients who were admitted to ICU from April 2016 to August 2016 were eligible; 90 consecutive shock patients were enrolled.Chest ultrasound examination were done within the first 6 hours after included. The mLUS and other ultrasound variables were recorded as well as the clinical data and the outcome. Data has been analyzed, and a bivariate logistic regression model was established to identify the correlation between mLUS on admission and the ICU mortality.

The mean APACHE Ⅱ score, lactate, mLUS were significantly increased in non-survivors while the PaO₂/FiO₂ was decreased in these patients(P=0.048, 0.000, 0.048, 0.000, 0.004). The univariate analysis revealed that the above variables were significantly related to ICU mortality.The multivariate analysis demonstrated that mLUS are the independent risk factors of ICU mortality as well as the lactate(P=0.045, 0.006; AUC=0.733, 0.793, respectively).

Modified lung ultrasound aeration loss score can predict the outcome of shock patients in ICU.

To review the clinical aspects and pathogenesis of postpartum hemorrhage (PPH) and investigate the optimal protocols for intervention.

From February 2009 to December 2015, data of normal labour and casearean birth women admitted to intensive care unit (ICU) in our hospital because of hematobilia were selected. 95 patients were divided into three groups (e. g ≥500-1 000 ml, ≥1 000-1 500 ml, ≥1 500-2 500 ml and ≥2 500 ml group) according to the bleeding volume. A retrospective analysis was performed to study the pathogenesis of PPH, organ function, surgical intervention and clinical prognosis on hemorrhage.

The data comprised 20 504 women over the 6-year period. 95 (0.463%) of which resulted in PPH and were admitted to ICU. 9 of these patients with PPH unsurvived. The value of creatinine and urea nitrogen, the score of APACHE Ⅱ and the possibility of multiple organ dysfunction syndromethe (MODS) increased with the amount of bleeding (P<0.05). For patients with PPH caused by injury of birth canal and/or placenta factors, there was significant difference among three groups on amount of bleeding (P<0.05). For patients with surgical intervention such as vaginal packing, interventional treatment and exploratory laparotomy conducted in 6 hours, the volume of transfusion was(759±114) ml. The volume of transfusion was (2 000±829) ml and (4 999±1 699) ml in 6 to 12 hours intervention group and in greater than 12 hours intervention group, respectively. The volume of transfusion significant increased over intervention time. There was a statistically significant difference in all groups (P<0.05).

Classified treatment should be conducted according the classification on the amount of bleeding. Patients with severe PPH and/or tendency of organ failure should be admitted to ICU. Measures for maintenance of the function of organs are necessary, while appropriate surgical intervention is also needed based on the cooperation between ICU and obstetrical department, and the cure rate could be improved.

To evaluate the efficacy of endotracheal tube for drug injection in postoperative ICU patients.

A total of 60 ICU patients who were given mechanical ventilation after surgical treatment were enrolled in this study from January 2015 to August 2016 at our hospital. All the patients were divided into the observation group (30 cases) and the control group (30 cases). In the observation group, the patients were treated with the endotracheal tube for surface anesthesia by injecting 2% lidocaine into the trachea, and patients in the control group were treated with saline instead of lidocaine. Patients′ tolerance to endotracheal tube, cardiovascular system adverse reactions, the frequency and dosage of sedative and analgesic drug within 12 h mechanical ventilation post operation were analyzed and compared between the two groups.

The occurrence rate of cough, hypertension and tachycardia in the observation group were(0.6±0.3), (0.8±0.3)and(1.3±0.6), respectively, which were significantly lower than the control group (5.9±2.1), (6.0±1.9)and(4.9±1.8), the differences were statistically significant (P<0.05). In addition, the frequency of sedative drug was (0.8±0.3), with a dosage of midazolam(1.2±0.3)mg. While in the control group, the frequency of sedative drugs was (5.1±1.9), with a dosage of midazolam (9.9±3.2) mg. The frequency and dosage of sedative drug administration in the observation group were significantly lower than those in the control group, the difference was significant difference (P<0.05).

The use of endotracheal tube for drug injection can improve the tolerance of ICU patients to endotracheal tube, reduce the dosage of sedative drugs, and reduce the adverse cardiovascular reactions.

To investigate the discharge outcome of external ventricular drainage(EVD) and conservative treatment in patients with severe intraventricular hemorrhage (SeIVH).

From January 2011 to December 2016, patients with SeIVH admitted to the General Hospital of the PLA Rocket Force and the Army General Hospital received EVD treatment and were classified as the treatment group. According to intraventricular hemorrhage volume and age, patients received conservative treatment were pair matched and classified as control group. Then we compared the clinical outcome of moderate disability or less degree of discharge (mRS ≤3) and death incidence (mRS 6) between two groups.

A total of 361 patients with IVH were treated during these six years. Among them, 75 cases were chosen as treatment group. Another 75 cases were pair matched as control group from 286 cases. At the time of admission, the ventricular hemorrhage volume of two groups were (55.8±22.7) ml and (53.7±23.3) ml (P=0.569) respectively. Cerebral hemorrhage volume were (23.6±5.3) ml and (24.0±5.4) ml (P=0.631). And the median Glasgow coma score (GCS) were 4[IQR(3, 7)] and 5[IQR(4, 7)](P=0.131). At the discharge time, there were 16% (12/75) patients scored mRS≤3 in treatment group, while 2.7% (2/75) in control group (P<0.005). The absolute risk reduction (ARR) was 13.3%, and the number needed to treat (NNT) was 7.5. The mortality rate of treatment group was 13.3% (10/75), much lower than that of the control group 41.1% (31/75,P<0.001). ARR was 27.8% and NNT was 3.6.

Although the prognosis of SeIVH was poor, compared with conservative treatment, EVD treatment significantly improved the outcome of these patients. Randomized controlled trials are needed to validate the efficacy of EVD.

To evaluate the feasibility of detecting index of microcirculatory resistance (IMR) and the relationship between IMR and left ventricular (LV) systolic function after acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI).

The patients with first AMI received primary PCI in Peking University Third Hospital were enrolled from January 2014 to March 2016. IMR were measured immediately after PCI by using pressure/temperature wire. The relationship between IMR and left ventricular ejection fraction (LVEF) assessed by echocardiography at first day and 6 months after admission was evaluated.

Twenty-eight patients with anterior wall AMI were enrolled, with an average age (56±13) years. The success rate of IMR detection was 100%. The mean IMR was (33±18 )mmHg·s. There was no complication related to intravenous adenosine triphosphate (ATP) (140 μg· kg ^-1· min^-1). The IMR was negatively correlated with TIMI blood flow grade after primary PCI (r=-0.386, P=0.043), and positively correlated with female gender, CK peak value and TnT peak value (r=0.430, P=0.022; r=0.431, P=0.025; r=0.434, P=0.024). After 6 months of follow-up, no adverse cardiovascular events (including cardiac death, nonfatal myocardial infarction, malignant arrhythmia, unplanned revascularization, hospitalization for unstable angina pectoris and severe heart failure requiring hospitalization) occurred. LVEF increased significantly compared with the first day after PCI (0.54±0.08 vs 0.47±0.06, P=0.001), and IMR was negatively correlated with LVEF after 6 months (r=-0.477, P=0.014). Multivariable linear regression analysis showed that CK peak and IMR were predictors of LVEF after six months ( β=-0.595, t=-3.814, P=0.01; β=-0.352, t=-2.26, P=0.036).

Immediate detection of IMR in patients with anterior wall AMI after PCI is safe and feasible. The immediate IMR after PCI reflects the extent of myocardial necrosis and myocardial perfusion, and is a predictor of LVEF at 6 months after PCI.

To explore the differential between the value of dynamic contrast-enhanced MRI quantitative pharmacokinetic parameters and relative pharmacokinetic quantitative parameters in breast lesions.

Retrospective analysis of 255 patients(262 breast lesions) who was obtained by clinical palpation , ultrasound or full-field digital mammography , and then all lessions were pathologically confirmed in Zhongda Hospital, Southeast University from May 2012 to May 2016. A 3.0 T MRI scanner was used to obtain the quantitative MR pharmacokinetic parameters: volume transfer constant (K^trans), exchange rate constant (k_ep)and extravascular extracellular volume fraction (V_e). And measured the quantitative pharmacokinetic parameters of normal glands tissues which on the same side of the same level of the lesions; and then calculated the value of relative pharmacokinetic parameters: rK^rans、rk_ep and rV_e.To explore the diagnostic value of two pharmacokinetic parameters in differential diagnosis of benign and malignant breast lesions using receiver operating curves and model of logistic regression.

(1)There were significant differences between benign lesions and malignant lesions in K^trans and k_ep (t=15.489, 15.022, respectively, P<0.05), there were no significant differences between benign lesions and malignant lesions in V_e(t=-2.346, P>0.05). The areas under the ROC curve(AUC)of K^trans, k_ep and V_e between malignant and benign lesions were 0.933, 0.948 and 0.387, the sensitivity of K^trans, k_ep and V_e were 77.1%, 85.0%, 51.0% , and the specificity of K^trans, k_ep and V_e were 96.3%, 93.6%, 60.8% for the differential diagnosis of breast lesions if taken the maximum Youden’s index as cut-off. (2)There were significant differences between benign lesions and malignant lesions in rK^trans, rk_ep and rV_e (t=14.177, 11.726, 2.477, respectively, P<0.05). The AUC of rK^trans, rk_ep and rV_e between malignant and benign lesions were 0.963, 0.903 and 0.575, the sensitivity of rK^trans, rk_ep and rV_e were 85.6%, 71.9%, 52.9% , and the specificity of rK^trans, rk_ep and rV_e were 94.5%, 92.7%, 60.6% for the differential diagnosis of breast lesions.(3)There was no significant difference in the area under the ROC curve between the predictive probability of quantitative pharmacokinetic parameters and the prediction probability of relative quantitative pharmacokinetic parameters(Z=0.867, P=0.195).

There was no significant difference between the quantitative parameter values (K^trans, k_ep) and the relative quantitative parameter values (rK^trans, rk_ep) in diagnosis of breast lesions, which were important parameters in differential diagnosis of benign and malignant breast lesions.

To explore the MRI features of the lateral collateral ligament injuries of the ankle and determine the value MRI in diagnosing the ligament injuries of the ankle.

The study was reviewed and approved by an institutional review board of hospital. Retrospective analysised 10 healthy volunteers and 26 ankle injury cases underwent surgery since January 2013 to September 2016, the MR imaging findings of patients were compared with volunteers′ and operative documents, to analysis the MRI feature of the ligament injuries of the ankle.

The normal anterior talofibular ligament and posterior talofibular ligament can be manifest in 3-4 layers of MRI, and can be fully displayed in 1 layer. The normal calcaneofibular ligament can be manifest in 3 layers of MRI, but can not be fully displayed in 1 layer. 26 cases of lateral ligament injury (including 1 case of ATFL injury, 1 case of CFL injury, 3 cases of ATFL conjunction with CFL injury, 3 cases of ATFL conjunction with CFL and PTFL injury) manifested the heterogeneous signal of the T₁-weighted image, the ligament disruption, the increased signal intensity on fat-suppression PD-weighted image , the surrounding soft tissue edema and bone marrow edema.

MR imaging is an accurate method for evaluation of the ligament injuries of the ankle, and it is a useful tool for diagnosis and treatment.

To compare the post-implant target volumes and dosimetric evaluation with pre-plan, the gross tumor volume(GTV) by CT image fusion-based and the manual delineation of target volume in CT guided radioactive seeds implantation.

A total of 10 patients treated under CT-guidance ¹²⁵I seed implantation during March 2016 to April 2016 were analyzed in Peking University Third Hospital.All patients underwent pre-operative CT simulation, pre-operative planning, implantation seeds, CT scanning after seed implantation and dosimetric evaluation of GTV.In every patient, post-implant target volumes were delineated by both two methods, and were divided into two groups. Group 1: image fusion pre-implantation simulation and post-operative CT image, then the contours of GTV were automatically performed by brachytherapy treatment planning system; Group 2: the contouring of the GTV on post-operative CT image were performed manually by three senior radiation oncologists independently. The average of three data was sets. Statistical analyses were performed using SPSS software, version 3.2.0. The paired t-test was used to compare the target volumes and D₉₀ parameters in two modality.

In Group 1, average volume of GTV in post-operation group was 12-167(73±56) cm³. D₉₀ was 101-153 (142±19)Gy. In Group 2, they were 14-186(80±58)cm³ and 96-146(122±16) Gy respectively. In both target volumes and D₉₀, there was no statistical difference between pre-operation and post-operation in Group 1.The D₉₀ was slightly lower than that of pre-plan group, but there was no statistical difference (P=0.142); in Group 2, between pre-operation and post-operation group, there was a significant statistical difference in the GTV (P=0.002). The difference of D₉₀ was similarly (P<0.01).

The method of delineation of post-implant GTV through fusion pre-implantation simulation and post-operative CT scan images, the contours of GTV are automatically performed by brachytherapy treatment planning system appears to have improved more accuracy, reproducibility and convenience than manual delineation of target volume by maximum reduce the interference from artificial factor and metal artifacts. Further work and more cases are required in the future.

To investigate the feasibility and diagnostic value of preoperative transthoracic echocardiography guided three dimensional printing model (TTE Guided 3DPM) on the assessment of structural heart disease (SHD).

From February 2016 to October 2016, 44 patients underwent cardiac surgery in Tianjin Chest Hospital, forty-four patients were assessed preoperatively using TTE Guided 3DPM, including 25 males and 19 females, aged 3-75 years, with an average of (44±22) years. compared to conventional three dimensional transthoracic echocardiography (3D-TTE), and took direct intraoperative findings as "Golden Standard" simultaneously. There are twelve patients with SHD, including four cases with mitral prolapse, two cases with partial endocardial cushion defect, two cases with secondary atrial septal defect, two cases with rheumatic mitral stenosis, one case with tetralogy of Fallot, one case with ventricular septal defect (VSD), thirty-two patients without SHD were designed as negative control.

The sensitivity and specificity of TTE Guided 3DPM were greater than or equal to 3D-TTE, P value of McNemar test of 3D-TTE was greater than 0.05, the difference was not statistically significant, kappa=0.745, P<0.01, indicated that the results of 3DTTE and the gold standard were generally consistent.P value of McNemar test of TTE Guided 3DPM was greater than 0.05, the difference was not statistically significant, kappa=0.955, P<0.01, indicated that the results of TTE Guided 3DPM and gold standards were consistent. Compared with 3D-TTE and TTE Guided 3DPM,P value was greater than 0.05, the difference was not statistically significant, kappa=0.879, P<0.01, indicated that the results of 3D-TTE and TTE Guided 3DPM were consistent. TTE Guided 3DPM displayed the three-dimensional structure of SHD cardiac lesions clearly, which were consistent with intraoperative findings.

TTE Guided 3DPM provides essential information for the preoperative evaluation and decision of SHD.

To analyze the clinical characteristics and efficacy of extranodal Rosai-Dorfman disease in head and neck.

Clinical and pathological features and follow-up of patients who were diagnosed as RDD at Beijing Tongren Hospital of Capital Medical University between May 2008 and November 2016 were analyzed retrospectively.

There were a total of 20 extranodal RDD patients in head and neck including 14 females and 6 males, aged from 27 to 86 years (mean 52.5 years). Nose (14 cases) and throat (5 cases) were most commonly involved organs and 5 patients had 2 or more organs involved. Diagnosis depends on biopsy. Histopathologically, the lesions of RDD were characterized by the presence of large histiocytes with emperipolesis. The large sinus histiocytes were positive for S-100 and CD68 protein staining. Diagnostic Errors in 13 patients and operations in all patients were happened. More than 1 operation was performed in 9 recurrence patients. Eight patients were treated by Glucocorticoids and immunosuppressive agents. All the patients were alive until Feb 2017.

Extranodal RDD in head and neck is known as a rare benign idiopathic proliferative disease. Nose is the most common site involved, and recurrence easily. It is diagnosis depending on histopathological report. Operation is first choice in diagnosis and treatment now. Glucocorticoids and immunosuppressive agents are effective in recurrence patients.

To investigate the impact and value of multimodal navigation and intraoperative magnetic resonance imaging (iMRI) on the biopsy of intracranial lesions.

From February, 2009 to December, 2016, this study enrolled 156 patients, who underwent multimodal navigation and iMRI-guided brain biopsy in the Neurosurgery Department of PLA General Hospital. Metabolic information was used for biopsy target selection. Intraoperative guidance helped biopsy trajectory avoid the eloquent structures. iMRI was performed to prove the biopsy accuracy and to revise the incorrect biopsy. Diagnostic rate, perioperative neurological status, surgical parameter, and surgical outcome were recorded.

The first iMRI helped to revise 7 (4.5%) incorrect biopsy sites, and final iMRI confirmed biopsy accuracy in all cases. Postoperative diagnostic rate was 96.8% (151/156). No statistical difference was found between postoperative and preoperative neurological statuses, despite 86 (55.1%) lesions were adjacent to eloquent areas. Additionally, iMRI detected 6 (3.8%) intraoperative hematomas that were treated immediately.

Brian biopsy with iMRI and multimodal navigation is a safe, accurate and efficient biopsy modality. This technique may help increase the biopsy accuracy with low morbidity and mortality.

To explore the safety and efficiency of lateral supraorbital (LSO) approach for the ruptured anterior circulation aneurysm.

The clinical data of 23 patients with grade Ⅰ-Ⅲ ruptured anterior circulation aneurysm via LSO at the Second Hospital of Shandong University from February 2016 to December 2016 were retrospectively analyzed. The clinical data included their clinical manifestations, radiological finding, microsurgical techniques and follow-up results.

All patients were diagnosed as anterior circulation aneurysm by preoperative CT angiography (CTA) or Digital Subtraction Angiography (DSA). They all accepted aneurysm clipping via LSO. The operations carried out smoothly, with no operation related complications. They were followed up for 2 to 12 months, and the Glasgow outcome scales (GOS) were 5 in 18 patients (78.3%), 4 in 2 patients (8.7%), 3 in 2 patients (8.7%), and 1 in 1 patient (4.3%).

LSO could provide adequate exposure for the anterior circulation aneurysm, so the clipping could be carried out safely and effectively. LSO is a simple and minimally invasive surgical approach, and when it is used by the skilled master of pterion approach, its advantage could be fully played.

To investigate the feature of repetitive nerve stimulation (RNS) in patients with amyotrophic lateral sclerosis (ALS) and correlation between RNS and clinical features and electromyography (EMG) findings of the corresponding muscle.

Needle EMG and RNS were performed in 53 patients with ALS, who were recruited into Department of Neurology of Chinese PLA general hospital during April to December in 2016. Decrement of the compond muscle action potential (CMAP) in response to RNS of different nerves and stimulus frequencies was compared. The effects of gender, age of onset, disease duration, region of onset, ALS functional rating scale-revised (ALSFRS-R) and rate of disease progression (ΔFS) on the decrement were analyzed.

49.1% of patients with ALS had decremental responses to low frequency RNS (LF-RNS) in accessory nerve, which was lower in ulnar nerve (4.3%) and common peroneal nerve (2.6%). Decremental responses of accessory nerve at 3 Hz were observed in 49.1% of patients with ALS, more frequent than 30.2% at 1 Hz. None of the patients had increased responses to high frequency RNS. Patients with upper-limb-onset, longer disease duration and lower ALSFRS-R tended to have more frequent decrement of CMAP in response to RNS. The decrement with LF-RNS of accessory nerve was in concert with neurogenic damage of sternocleidomastoid muscle with needle EMG (r=0.365, P=0.007). There were 3 patients who had decremental responses to LF-RNS in accessory nerve without clinical involvement and neurogenic damage of sternocleidomastoid muscle.

There is significant decrement of CMAP in response to LF-RNS of accessory nerve in patients with ALS, which may reveal neuromuscular junction (NMJ) impairment. It may indicated a dying-back pattern of disease progression which derived from motor neuron terminal or NMJ to neuronal soma that some patients with ALS have decremental responses in RNS without clinical involvement and neurogenic damage of sternocleidomastoid muscle.

To analyze the clinical characteristics of neuromyelitis optica spectrum disorders (NMOSD) associated with syringomyelia (SML).

The clinical manifestations, laboratory parameters and imaging findings of 7 patients with NMOSD associated with SML during June 2008 to August 2016 from The Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed.

Six patients were female and 1 was male, with ages ranging from 27-67 years, the course of the disease was 3-12 years, recurrence was 2-7 times, all the patients were cerebrospinal fluid oligoclonal bands (CSF OCB) negative, 5 patients were positive for aquaporin-4-antibody/NMO-IgG. Sensory and motor dysfunction, bowel or bladder dysfunction were the common clinical manifestation, and pain was a significant symptom. Syringomyelia was predominantly located in C4-T10, cavity length 2-6 mm, diameter 0.8-3.6 mm; 5 had lobes involvement and 6 had long segmental spinal cord involvement.

NMOSD associated with SML had a high frequency of occurrence in female, with the clinical characteristics of limb pain, easy progression, high recurrence rate and disability rate. The anti AQP4 antibody were commonly seen in these patients. Syringomyelia was predominantly located in the lower cervical and upper thoracic spinal cord, the lobar and longitudinally extensive transverse myelitis were frequently found in patients with NMOSD associated with SML.

A 59-year-old male was admitted to Henan Provincial People's Hospital on November 14, 2016 with a sudden headache for 17 days as the main complaint. The admission mRS score was 1, mainly showing memory loss and slightly less speech. Cranial CT scan and head and neck vascular CTA on October 29, 2016 showed vascular malformation of left frontoparietotemporal lobe and insular hematoma (Figure 1)。 On November 7, 2016, the DSA of a foreign hospital confirmed the existence of AVM. The blood supply artery supplied blood from the left Heubner returning artery and multiple branches of the left middle cerebral artery. The malformation was single-drained into the superior sagittal sinus through the frontal cortical vein (Figure 2), Spetzler-Martin Class IV. There was no previous history of hypertension, with mean arterial pressure around 90 mmHg (1 mmHg =0.133 kPa) and systolic blood pressure around 120 mmHg. On November 16, 2016, CT reexamination showed that the hematoma was not completely absorbed and accompanied by a large low density area. Considering the edema zone, after 1 week of dehydration treatment, CT reexamination showed that the hematoma was not completely absorbed and the low density area was not significantly reduced (Figure 3)。 After a multidisciplinary consultation, embolization from the venous route was recommended for the treatment of arteriovenous malformations. Cerebral arteriovenous malformation embolization was performed under general anesthesia on 23 November 2016 after obtaining the consent of the patient, his family and the hospital ethics committee. A 6F sheath was placed on the right femoral artery, and a Sonic embolization catheter (Balt Extrusion, France) was attempted to enter the thicker supply artery with a Navien guide catheter (Medtronic, USA) and a Traxcess microwire (Microvention, USA).FIG. 4A) after failure into a small supply artery (FIG. 4B)。 Then, ultrasound-guided right internal jugular vein puncture was performed and 6F sheath was inserted in reverse direction, and Sonic embolization catheter was introduced from the venous end into the malformed nest with the cooperation of Navien guide catheter and Traxcess microwire (Figure 4C), an Echelon embolization catheter (Medtronic, USA) was introduced into the drainage vein near the deformity nest (Figure 4D)。 A malformed supply artery was first occluded from the arterial end along a Sonic catheter using a non-adhesive embolic agent ONXY-18 glue (Microvention, USA)Figure 4E)。 The patient's mean arterial pressure was then reduced and maintained at 50-55 mmHg, and then a 5 mm ×15 cm Axium coil was introduced from the venous end along the Echelon embolization catheter to loosely pack the draining vein (Figure 4F), and finally the malformed nest was embolized with ONXY-18 glue from the venous end along the Sonic catheter (Figure 4G), during which the embolism was intermittently verified from the end of the artery until the deformity nest completely disappeared (Figure 4HAndFIG. 4I)。 Immediately after operation, DYNA-CT showed a high-density band around the low-density band (Figure 4J)。 After operation, he was transferred to the neurological care unit, where the mean arterial pressure was maintained at 50-60 mmHg, and the systolic blood pressure was lower than 100 mmHg, and adjuvant dehydration and glucocorticoid treatment. On November 22, 2016, a physical examination occasionally showed nominal aphasia. Before Yu Tong surgery, CT reexamination showed abnormal high-density areas (FIG. 5A)。 Upon discharge on Nov. 30, 2016, CT revealed that abnormal high density areas still existed (FIG. 5B), the change was not obvious compared with the previous, the patient's mRS score was 1, and the symptoms were not aggravated.

reflex epilepsy is clinically rare, accounting for about 5% of all epilepsy patients^[1]It refers to epilepsy triggered by repeated, fixed and clear perceptual or cognitive stimulation. It is mostly caused by various sensory stimuli such as vision, hearing, smell, taste, somatic sensation, visceral sensation and mental stimulation. Idiopathic or symptomatic epilepsy can occur, and the former is more common^[2,3]。 As a special class of epilepsy^[3]This paper summarizes the predisposing factors, clinical manifestations and pathophysiology of reflex epilepsy, so as to improve the accuracy of its diagnosis clinically.

For a long time, in rheumatoid arthritis (RA), B cells are commonly considered to be one of the pathogenic cells that produce high-affinity, specific autoantibodies and induce T cell activation^[1]。 In recent years, a class of B cells with immunomodulatory function has received more and more attention in the etiology of RA. Regulatory B cells are a kind of B cells that play negative regulatory functions and maintain immune tolerance of the body. Among them, B cells that secrete interleukin-10 (IL-10) are the most concerned regulatory B cells at present^[2]which inhibits the production of proinflammatory cytokines by secretion of IL-10 and promotes the differentiation of regulatory T cells (Treg)^[3], play the negative immune regulatory function, so some scholars call them regulatory B cells (Breg), B10 or B cells that secrete IL-10. However, so far, the naming has not been unified. In this article, these cells are temporarily called regulatory B cells. The study confirmed that regulatory B cells were altered in both number and function in RA^[4,5], in a collagen-induced arthritis (CIA) model, adoptive transfer of regulatory B cells can alleviate arthritis in mice^[6]。 Therefore, regulatory B cells may play an important role in the development of RA. Therefore, a deep understanding of regulatory B cells will not only help to further clarify the pathogenesis of RA, but also open up new ideas for seeking new strategies for RA treatment. The research progress of regulatory B and its in RA is summarized as follows.

Starting the emergency system (EMS) to take immediate pre-hospital and in-hospital emergency measures for patients with acute coronary syndrome (ACS). Shortening the total myocardial ischemia time and saving the dying myocardium are the most important clinical measures.

Three-dimensional images can be quickly converted into real models, which can be applied to preoperative diagnosis, simulated surgery, intraoperative navigation, and customized implants, so as to optimize preoperative design, improve surgical accuracy and reduce postoperative complications. This paper reviews the clinical application status of 3D digital printing technology in trauma and orthopedics, anatomical model printing, surgical instrument design and internal implant customization.