Volume 97  ·  Issue 35  ·  2017

subtalar instability (STI) is caused by abnormal bone structure and/or ligament injury around the joint, with pain in the tarsal sinus area as the main manifestation. Simple STI is rare and often occurs at the same time as ankle instability. About 1/4 of patients with chronic ankle instability are complicated by STI, so STI is often misdiagnosed as chronic ankle instability. At the same time, because there are many controversies about the pathogenesis of STI, the diagnosis and treatment of STI are challenging and deserve high attention.

Ankle osteoarthritis can cause pain, dysfunction, and even disability, resulting in socioeconomic losses and increased medical expenses. As our country enters an aging society, the number of patients with ankle osteoarthritis is increasing year by year. The incidence of ankle osteoarthritis accounts for 13% of systemic osteoarthritis^[1]In Asians, the vast majority of ankle osteoarthritis is varus due to tibial plateau varus and lifestyle habits.

Hallux valgus is one of the most common lesions of forefoot, and its incidence is increasing in recent years. The treatment of hallux valgus is extremely challenging^[1,2,3,4]。 There are nearly 200 kinds of surgical methods for treating hallux valgus at home and abroad, and each method has its own advantages^{[5,6,7,8,9,10,11,12,13,14]}Most have been eliminated at present. One question before us is how to choose an individualized surgical protocol that is suitable for the patient^[15,16]To avoid the occurrence of complications and obtain satisfactory curative effect.

To compare the clinical outcome of removal of calcaneal posterior-superior prominence and that of calcaneal closing-wedge osteotomy for Haglund syndrome.

From February 2009 to July 2014, 36 patients with Haglund syndrome were included.They were divided into two groups, and each group included 18 patients and underwent removal of calcaneal posterior-superior prominence and calcaneal closing-wedge osteotomy respectively.They were evaluated preoperatively and after 6 , 12 months and 24 months postoperatively by American Orthopedic Foot & Ankle Society (AOFAS) score, VAS score, VISA-A questionnaire and Maryland Foot Score.Fowler-Philip angle and calcaneal posterior slope of the two groups were compared preoperatively and after 6 months.All data were analysis utilizing SPSS 18.0.

At six months of follow-up, the weight-bearing lateral X-rays reveals that removal of calcaneal posterior-superior prominence did not change Fowler-Philip angle and calcaneal posterior slope and calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope significantly[from preoperation (56.5±5.4)°, (120.0±1.3)°to postoperation (48.4±4.6)°, (109.0±5.3)°]. At six months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were worse in the wedge calcaneal osteotomy group.At twelve months of follow-up, no significant difference (P>0.05)was found between the two groups in terms of VAS score, and Maryland Foot Score, while the AOFAS score, and VISA-A questionnaire in the wedge calcaneal osteotomy group were better than those of posterior-superior prominence removal group.At twenty-four months of follow-up, the AOFAS score, VAS score, VISA-A questionnaire and Maryland Foot Score were better in the wedge calcaneal osteotomy group (P<0.05).

Both the two surgical methods are effective for Haglund syndrome.Calcaneal closing-wedge osteotomy decreased Fowler-Philip angle and calcaneal posterior slope of calcaneus and its clinical outcome appears better than that removal of calcaneal posterior-superior prominence.

To analyze the clinical effects of simple hallux valgus surgery for transfer metatarsalgia.

From September 2011 to November, a total of 21 patients(30 feets)with transfer metatarsalgia of hallux valgus and underwent the simple hallux valgus surgery without lateral metatarsal shortening osteotomy In Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, were enrolled in the study.The hallux valgus angle (HVA), intermetatarsal angle (IMA) , AOFAS scale and analogue score (VAS) were measured pre-operation and a half year, one year, two years after operation.The data were measured repeatedly and analyzed with analysis of variance.

The mean preoperative HVA changed [(39.6±9.7), (14.2±7.9), (14.8±7.9), (13.2±6.5)°] at 6 months, 1 year and 2 years follow-up; the mean IMA decreased [(13.8±4.0), (4.5±4.3), (5.8±3.9), (5.4±4.9)°] at 6 months, 1 year and 2 years follow-up(allP<0.001).63.5% of metatarsalgia cases improved, and 73.1% of painful callosities disappeared postoperatively.All the patients do not require further surgeries. The mean AOFAS for hallux , AOFAS for lesser toes and VAS were improved from 58.96 to 95.42, from 84.38 to 92.04 and from 7.5 to 1.3, respectively. All the results are statistically significant(P<0.001).

These results suggest that a simple osteotomy of the first metatarsal provides excellent outcomes with a low rate of complications when compared with the combining lateral metatarsal shortening osteotomy.

To evaluate the efficiency of modified Ottawa Ankle Rules (OAR) for the differential diagnosis of fractures in acute foot and ankle injuries.

From October 2016 to December 2016, 272cases (135 males and 137 females) of foot and ankle injury in emergency department of Tianjin Hospital were prospective enrolled in the study.The median age was 27.5 years (7-87); left limb 155, right 117 cases; injury time ranged from 0.3 to 24 h (median 4 h). Conventional and modified OAR was applied on physical examination, subsequently radiography performed to determine the occurrence of fractures.The efficiency of the two methods were compared and analyzed.

Fractures were found in 100 cases (36.8%), 49 cases of ankle and 51 cases of foot fractures.With the imaging results as the standard, the sensitivity for conventional and modified OAR were 93.0% and 100%, specificity were 9.9% and 8.7%, the positive predictive value were 37.5% and 38.9%, the negative predictive value were 70.8% and 100%, the accuracy were 40.4% and 42.3%, missed diagnosis rate were 7% and 0% respectively.The sensitivity, positive likelihood ratio, positive predictive value, negative predictive value, accuracy, negative likelihood ratio and missed diagnosis ratio were better than in modified OAR compared with Conventional OAR, while the specificity was slightly lower compared to Conventional OAR.The Kappa value of modified OAR was 0.065 (P>0.05), which is better than conventional OAR.Conventional OAR can reduce 6.3% (17/272) X-ray and modified OAR decline 5.5% (15/272).

Modified OAR significantly reduces the rate of missed diagnosis of foot fractures, but its specificity is poor. Ultrasound can be assisted to improve the specificity and reduce the number of unnecessary X-rays.

To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of complex fracture and dislocation of foot with severe soft tissue injury.

From March 2012 to January 2015, a retrospective analysis of 108 cases of the foot closed complex fracture dislocation with severe soft tissue injury in Department of Foot and Ankle, the Second Hospital of Tangshan City, Tangshan.Injury mechanisms included press and crush injury, traffic accident.According to the operation the cases were divided into the VSD group (56 cases) and the control group (52 cases). The injury foot swelling after treated by open reduction and internal fixation or fusion joint fracture and dislocation. VSD technique was used to cover the wound and wound in group VSD. The wound was sutured, the sterile dressing was covered and the dressing was changed regularly in the control group.

Preoperative hospitalization time: 16 days in group VSD, 28 days in the control group; the total hospitalization time: 33 days in group VSD, 53 days in the control group; wound healing: 29 cases in VSD group, 12 cases in the control group; prolonged healing after dressing: 16 cases in VSD group, 13 cases in the control group; after skin grafting healing: 9 cases in VSD group, 17 cases in the control group; healed after flap transposition: 2 cases in VSD group and 10 cases in thecontrol group.The difference of the data of the two groups was statistically significant, P<0.05.Maryland foot score: 55-98 (average: 88.8, median: 91.5) points in VSD group, 38-97 (average: 84.85, median: 91) points in control group, compared with median by rank sum test,Z value: -2.755, the difference was statistically significant, P< 0.05.The late recovery effect rating: 39 casesexcellent, good 12 cases, can be 5 cases, no poor in VSD group, excellent 29 cases, good 8 cases, can be 11 cases, poor 4 cases in the the control group, the difference was statistically significant,P<0.05.

VSD can shorten the preoperative waiting time and total hospitalization time, improve the wound healing rate directly, reduce the skin grafting and flap transfer replacement rate, reduce the secondary injury, increased fracture risk reduction and internal fixation, reduce joint fusion rate in the treatment of foot closed complex fracture and dislocation with severe soft tissue injury.

To explore the changes of brain activities in traffic accident survivors with acute stress response (ASR) within a week by using complex networks analysis method based on graph-theory, and to find out the alteration of topological properties in structural brain network.

From January, 2013 to February, 2016, twenty traffic accidents survivors with acute stress disorders (Acute Stress Disorder Interview, ASDI>3)and twenty healthy controls underwent the 3T diffusion tensor imaging (DTI) magnetic resonance imaging scan in Nanjing General Hospital.The graph-theory analysis method was used to compare the structural brain network properties and nodal features between ASR survivors and controls.Statistical analyses were also performed by including anxiety and depression as covariates to evaluate their effect.In additional, Pearson correlation was performed between abnormal parametric values and clinical indices.

(1) The brain structural networks had small-world properties in both groups; (2) while compared with healthy controls, patients with ASR showed increased weighted connectivity strength (Si, 1.36±0.47 vs 0.92±0.38, P=0.008) and nodal betweenness centrality (BCi, 20±15 vs 7±6, P=0.002) in left triangular part of inferior frontal (IFG triang_L), increased Si in orbital part of inferior frontal gyrus (1.10±0.31 vs 0.77±0.30, P=0.004) and obviously decreased Si in left caudate (0.75±0.24 vs 1.04±0.35, P=0.004); (3) furthermore, the inclusion of anxiety and depression as covariates abolished nodal parameters differences in IFG triang_L, left caudate, thalamus and inferior temporal gyrus.

The brain structure network in ASR patients has small world properties.But nodal parameters change obviously in some nodes compared with healthy controls and mainly locate in prefrontal lobe and striatum. High levels of anxiety and depression in ASR patients may partly account for these alterations.

To investigate the pregnancy outcomes in systemic lupus erythematosus (SLE) patients with planning pregnancy.And to evaluate the value of fetal umbilical artery Doppler.

A total of 130 SLE patients with planning pregnancy were prospectively recruited from January 2013 to January 2017 at the First Affiliated Hospital of Sun Yat-sen University.

Thirty eight (29.2%) patients had active lupus, 30 with mild activity, 5 with moderate activity and 3 with severe activity.Active disease in the first, second and third trimesters occurred in 6, 11 and 21 cases respectively.Lupus nephritis (76.3%) and hematological system involvement (39.5%) were the most common manifestation.Seven cases had pre-eclampsia during pregnancy.One or more adverse outcomes occurred in 40 patients, including 28 with premature, 12 with pregnancy loss, 9 with intrauterine growth restriction, and 8 with fetal distress.All of the pulsatility index, resistance index and S/D value of patients with adverse outcomes were higher than that of patients without adverse outcomes (P<0.05).

In SLE patients with planning pregnancy, disease flares were infrequent, and outcomes were favorable. Fetal umbilical artery Doppler can be used as a noninvasive monitoring method for SLE patients at late pregnancy.

To explore the clinical value of CT lymphography (CT-LG) on the localization and evaluation of sentinel lymph node (SLN) in patients with early-stage breast cancer.

Thirty-six patients with early-stage breast cancer were enrolled in this study from September 2014 to June 2016 in the First Hospital of Zhengzhou University.The diagnoses were confirmed by puncture or local surgical pathology with negative clinical palpation of axillary lymph nodes, and sentinel lymph node biopsy (SLNB) was planned.The patients received CT-LG examination.The first one or several lymph nodes along the lymph duct draining from the injection site to axilla was/were defined as SLN(s), and the results were compared with the SLNB.Wilcoxon signed ranks test was used to compare the number of SLN detected by CT-LG and SLNB; according to the pathologic results, Student t test or chi-square test was used to compare the differences of the positive SLNs with negative ones.

SLNs were successfully identified in all 36 patients, 32 cases (88.9%) had high-quality images (with both SLN and lymphatic vessel visible); 36 SLNs were located by CT-guided wire with a success rate of 100%.A total of 88 SLNs were identified by CT-LG in 36 patients, and 102 SLNs were obtained by SLNB (Z=-2.646, P=0.008). The long-short diameter ratio (L/S) of SLN obtained by SLNB was significantly smaller than that of CT-LG (1.7±0.3 vs 1.9±0.4, t=2.880, P=0.004). Compared with pathology, CT-LG showed 21 positive SLNs and 67 negative SLNs, and the short diameter of positive SLNs was bigger than that of negative ones[(5.9±2.1) vs (4.8±1.8) mm, t=2.235, P=0.028]. Of 67 negative SLNs, 61(91.04%) appeared homogenously contrast agent filling, and 13(61.90%) of the 21 positive SLNs were found filling defect changes, and the differences in filling defect changes between positive and negative SLNs were statistically significant (χ²=26.479, P<0.001).

CT-LG can accurately locate the SLN for early-stage breast cancer, and both the short diameter and filling defect changes can help evaluate the status of SLN.

To evaluate the value of CT in the risk assessment of thyroid benign nodules (BN) and malignant nodules (MN).

The CT signs of 461 pieces of MN in 447 cases and 548 pieces of BN in 484 cases were retrospectively analyzed, the diagnoses were confirmed by histology, including nodular morphology, cookie bite sign, microcalcification, enhanced range narrow/blurred, cystic changes and enhanced.The signs of CT were analyzed by univariate and multivariate regression analysis.The positive CT signs were calculated to assess sensitivity and specificity in the diagnosis of BN and MN.

Univariate and multivariate analysis showed that irregular nodular morphology (χ²=509.263, P<0.001,OR=5.297), cookie bite sign (χ²=504.619, P<0.001,OR=3.467), microcalcification (χ²=97.793, P<0.001,OR=1.730), enhanced range reduction/blur (χ²=361.967, P<0.001,OR=5.729) were more common in MN.Cysts changes (χ²=223.208, P<0.001,OR=7.537) and enhancement signs (χ²=65.983, P<0.001,OR=10.782) were more common in BN.The sensitivity and specificity of irregular nodular morphology in the diagnosis of MN were 80.5% and 90%, those in cookie bite sign were 74.2% and 94.3%, microcalcification were 35.6% and 90.1%, enhanced range reduction/blur were 80.7% and 79.4%.The sensitivity and specificity of capsule-based and high-enhanced BN diagnosis were 42.2% and 98.1%, 19.0% and 97.4%, respectively.

Irregular shape, cookie bite sign, microcalcification and enhanced range of narrowing/blur are significant CT signs in the assessment of MN, and cystic changes and enhancement are significant CT signs in the evaluation of BN.The diagnostic efficiency of various CT signs varies greatly, and combination of multiple CT signs can improve the diagnostic efficiency.

To investigate the clinical features, diagnosis and treatment of antibody mediated paraneoplastic neurological syndrome associated with thymoma.

From 2012 to 2017, the paraneoplastic antibody and neuron antibody were tested from both blood and cerebrospinal fluid (CSF) in consecutive patients clinically suspected with neurological paraneoplastic syndromes/unknown encephalitis in Peking Union Medical College Hospital.The clinical data, lab results, electrophysiological examinations, imaging features, treatment and clinical prognosis were collected.In this study, the patients who met the diagnostic criteria of both thymoma and neurological paraneoplastic syndrome were retrospectively analyzed.The functional severity was assessed by modified Rankin score(mRS).

Six patients (4 female and 2 male) were included for the analysis.Of them, 4 patients presented with limbic encephalitis, 1 with peripheral neuropathy accompanying with myasthenia gravis and 1 with spinal and cerebella degeneration.Three patients were in severe condition (mRS=5). Positive α-amino-3-hydroxy-5-methyl-4-iso xazolepropionic acid receptor, antibody (AMPAR) was identified in 3 patients(2 in blood and CSF, 1 in blood), CV2 plus acetylcholine receptor antibody (ACH-Ab) positive in blood was seen in 1 patient and positive N-methyl-D-aspartate receptor (NMDAR) in blood and CSF in 1 patient. Brain MRI showed abnormalities in 2 patients.The CT scan revealed thymoma in all 6 patients.All patients received intravenous immunogloblin (IVIG) and/or glucocorticoid immediately after diagnosis.Furthermore, thymectomy was performed in 5 patients. All the patients were remarkably improved with mRS 0-1 at discharge.Five patients were clinical stable within follow-up of 1-2.5 years.However, one patient who refused thymectomy experienced several clinical recurrencs.

Antibodies mediated paraneoplastic neurological syndrome/autoimmune encephalitis can occur in patients with thymoma with typical characteristics. The correlated antibody test and chest CT might be important in patients clinically suspected with neurological paraneoplastic syndrome or encephalitis with unknown reason. Surgical thymectomy combining with active immunological treatment may play a role in the favorable prognosis, even in those clinical severe patients.

To evaluate the application and influence factors of the Functional Assessment of Chronic Illness Therapy (FACIT-Fatigue) scale in patients with systemic lupus erythematosus (SLE).

SF-36 questionnaires were used to estimate the health-related quality of life (HRQOL) of SLE patients in Chinese Han population.FACIT-Fatigue scale was applied to measure fatigue.Disease activity was determined by SLE disease activity index (SLEDAI), meanwhile demographic parameters such as gender, disease duration, etc. were recorded.

A total of 223 patients with SLE were enrolled in the survey.FACIT-Fatigue scale was negatively correlated with SF-36 (P<0.05). FACIT-Fatigue scale of patients with SLE were correlated with education, erythrocyte sedimentation rate (ESR), C3, and SLEDAI score (P<0.05). The degree of bodily pain, the status of mental health and the amount of complement C3 were the independent factors of FACIT-Fatigue (P<0.1).

FACIT-Fatigue scale is related to disease activity, quality of life, age and ESR in patients with SLE.There fore, reduce the disease activity and improve the quality of life of SLE patients may be helpful to reduce the fatigue of patients with SLE.

To summarize the clinic experience of preventing cerebral ischemic events during perioperative period in patients which concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases.

The clinical materials of 31 consecutive patients with concomitant unruptured intracranial aneurysms and ischemic cerebrovascular diseases from April 2010 to April 2014 were retrospectively reviewed.A total of 35 aneurysms were detected, and all of them were unruptured aneurysms.Among them, 17 cases were located on the ipsilateral side of artery stenosis or occlusion, and 18 cases were detected in the contralateral side. Minimal invasive surgical approaches such as small pterional approach and lateral sub-frontal approach were adopted.The better management of perioperative blood pressure was performed. Intraoperative electroencephalogram and somatosensory evoked potential monitoring, indocyanine green video angiography and/or microvascular Doppler ultrasonography were regularly used to guarantee the safety of the surgery. The follow-up by digital subtraction angiography or computed tomography angiography were made.

All of 35 aneurysms were clipped. Major infarction occurred in one patient with posterior communicating artery aneurysm concomitant with common cervical carotid artery stenosis.Large bone flap was resected and dural-matter were got enlarged to tolerate the edema period.Paralysis and aphasia accompanied at discharge.Minor infarction in posterior limb of internal capsule occurred in one patient.Twenty-nine patients were favorable with Glasgow Outcome Scale (GOS) score 5 at discharge, one patient with minor neurological defect (GOS 4), and one patient with severe neurological defect (GOS 3). The follow-up period was 6 to 40 months.Four patients were lost.The modified Rankin scale (MRS) of last follow-up were 0-1 in 25 patients, 2 in one patient and 3 in one patient.Third months after operation, 3 cases were performed carotid artery stenosis, 1 patients were performed carotid endarterectomy.

Reinforcing the management of perioperative blood pressure, adjusting the perioperative blood coagulation function, and combine application of intraoperative monitoring technology can effectively prevent the occurrence of cerebral ischemia.

Chronic migraine (CM) is a complex, severely disabling neurological disorder with monthly headache episodes ≥15 days and lasting more than 3 months. The execution criteria are at least 5 migraines without aura per month and headache ≥8 days per month. The typical progression pattern of chronic migraine is that the incidence frequency increases with time, the incidence rate of the population is 1% ~3%, the cure rate of clinical treatment is low, and there is a high hospitalization rate and migraine-related disability, which causes a great burden to the patient's family and society. Studies have confirmed that botulinum toxin has some efficacy in chronic migraine that is ineffective in traditional treatment. Aydinlar et al.The Journal of Headache and PainA published article [J Headache Pain, 2017, 18 (1): 23] aimed to evaluate the therapeutic effect, negative emotions, and sleep quality after botulinum toxin injection in the treatment of chronic migraine. The study included 190 patients [mean age (39.3±10.2) years, 87.9% female] at the initial visit (baseline level, first visit) and 4 subsequent follow-up visits at 12 weeks (second follow-up), 24 weeks (third follow-up), 36 weeks (fourth follow-up), and 48 weeks (fifth follow-up) after botulinum toxin injection. PAQI (Pittsburgh Sleep Quality Index), headache frequency and severity, number of analgesics used, migraine disability rating scale (MIDAS), depression, anxiety, stress scale (DASS-21) were evaluated at each visit, and the four follow-up visits were compared with baseline levels. The results showed that from the baseline level to the 5th follow-up, all indicators decreased, and the mean headache frequency decreased from 19.5 to 8.4 (P=0.002), headache severity decreased from 8.1 to 6.1 (P=0.017), the analgesic drug use dose decreased from 26.9 to 10.4 (P=0.023) and the MIDAS score decreased from 67.3 to 18.5 (P<0.001)。 There were no significant changes in PSOI and DASS-21 scores throughout the study. It was concluded that the outcome of migraine was significantly improved after botulinum toxin injection, which was manifested in the frequency and severity of migraine, the number of analgesics used, and the MIDAS score. While there was no significant improvement in overall sleep quality and in prevalent negative mood states, patients without negative mood at baseline levels showed improved sleep quality throughout the study.

To investigate the interventional effect of Dan-fang capsule on liver fibrosis in rats.

Sixty one-week aged male healthy SD rats [weight (180±20) g] were randomly divided into normal control group (group A), hepatic fibrosis model group (group B), Fu-Fang-Bie-Jia-Ruan-Gan tablet group (group C), Dan-fang capsule groups at high, middle and low dose group (group D, E, F, respectively). Except for the normal control group, hepatic fibrosis was induced in other groups by intraperitoneal injection of porcine serum.Simultaneously, rats in Dan-fang capsule groups were administered by gavage with Dan-fang capsule at doses of 4.32, 2.16, 0.54 g/kg, respectively.Rats in Fu-Fang-Bie-Jia-Ruan-Gan tablet group were orally administered by gavage with Fu-Fang-Bie-Jia-Ruan-Gan tablet (0.54 g/kg) every day and the normal control group received saline alone.All rats were killed at the end of the 12th week. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and PⅢnp clia (PⅢNP) were measured in the groups.Pathology changes of hepatic tissue were evaluated by hematoxylin-eosin (HE) and Masson staining.The proteinic expressions of alpha-smooth muscle actin (α-SMA), collagen-Ⅰ (COL-Ⅰ) and collagen-Ⅲ (COL-Ⅲ) were observed with the method of immunohistochemistry.Analysis of variance was applied when data were compared among groups.

Compared with those in the group A, the levels of ALT, AST and PⅢNP in serum and the expressions of α-SMA, COL-Ⅰ and COL-Ⅲ in liver tissues were significantly higher in group B [(68.3±3.4) vs (51.5±6.3) U/L, (205±52) vs (135±24) U/L, (3.1±1.4) vs (1.6±0.6) μg/L and 0.35±0.02 vs 0.13±0.02, 0.37±0.02 vs 0.13±0.02, 0.43±0.13 vs 0.13±0.01, t=17.020, 71.053, 1.552, 0.214, 0.241, 0.292, all P<0.01], and the degree of liver fibrosis significantly increased in group B than that in group A. Compared with those in group B, the levels of ALT, AST, PⅢNP and the expressions of α-SMA, COL-Ⅰ, COL-Ⅲ were all significantly lower in group D, E and F (t=-58.232--0.104, all P<0.01). The degree of liver fibrosis significantly reduced in group D, E and F than that in group B (Z=3.82, 3.76, 3.90, all P<0.05).

Dan-fang capsule has certain preventive effect on liver fibrosis that caused by porcine serum in rats.

Skull base tumor is located in the deep intracranial layer, closely related to brainstem and intracranial nerves, and it is difficult to treat, with more and more serious postoperative complications^[1,2,3]。 Patients with skull base tumors tend to have a higher risk of lower extremity venous thrombosis after operation due to long operation time and many postoperative complications, and lower extremity venous thrombosis can be disabled if not treated in time. In severe cases, pulmonary embolism and other serious consequences can be caused by thrombus detachment^[4]It is one of the main causes of perioperative death, so the prevention of lower extremity venous thrombosis is very important^[1]。 The anti-thrombotic pressure pump improves the venous blood circulation of the lower limb by assisting circulation, and provides dynamic continuous pressure gradient for the lower limb veins of patients, thereby preventing the occurrence of venous thrombosis of the lower limb^[5]。 From March 2016 to March 2017, the Department of Neurosurgery of Beijing Tiantan Hospital used antithrombotic pressure pump to prevent venous thrombosis of lower limbs in patients with skull base tumors, with satisfactory results, which are reported as follows.

A 62-year-old male with low back pain was admitted to hospital for more than 1 month, and the specialist examination was negative.

The patient was a 47-year-old woman with abdominal distension for 1 year. She had a lower abdominal mass for 2 months. She occasionally had lower abdominal pain, which was tolerable. At the same time, she had a sense of anal distension and no other discomfort. She has not been treated since she became ill. Recently, abdominal distension has been worsened than before, with chest tightness, defecation and urination difficulty. B-ultrasound of Nancheng People's Hospital: anterior uterus, about 6.1 cm ×5.0 cm ×7.5 cm in size, clear outline, normal shape, uneven muscle layer echo, multiple hypoechoic nodules were detected in the basal layer, the larger one was about 1.4 cm ×1.1 cm, the endometrium was centered, IUD echoes were seen in the uterine cavity, bilateral ovaries were not detected, and heterogeneous echoic masses of about 26 cm ×22 cm ×10 cm were detected in the abdominal and pelvic cavities, located behind and above the uterus, with clear boundaries and irregular shape. The upper edge reached below the xiphoid process, and irregular anechoic areas were visible inside. Color Doppler (CDFI): a strip of blood flow signal can be seen in the right lower abdomen and a liquid dark area about 3.3 cm deep; Ultrasound showed: uterine fibroids, abdominopelvic heterogeneous echo mass, ascites. On April 8, 2016, the gynecological outpatient clinic of Shanxian Central Hospital was admitted to the hospital. Since the onset of the disease, the patient has regular menstruation, with a cycle of 25 to 26 days and 3 to 4 days of menstruation. Gynecological examination: the vulva developed normally, the vagina was unobstructed, the cervix could not be seen, a solid mass was touched in the pelvic cavity to 2 transverse fingers on the umbilicus, the mobility was poor, there was no tenderness, and the uterus and bilateral appendages could not be touched clearly; Tumor markers: AFP, CEA, CA199, CA125 and CA150 were all negative; Preliminary clinical diagnosis: (1) pelvic mass; (2) Uterine fibroids. On April 12, 2016, transabdominal exploration showed that the uterus was normal in size and there was no abnormality in the appearance of bilateral appendages. A mass about 26 cm ×20 cm ×15 cm in size was seen at the cervix behind the uterus, reaching up to the lower side of the xiphoid process, and reaching the base of the broad ligament on the left and right. It was cystic and solid with poor mobility. The peritoneum of the posterior lobe of the broad ligament and the uterorectal lacunae were opened, and the tumor capsule was incised with electrosurgical knife. The tumor ran along the pericervical vein, showing red lobules, and the lobules were different in size, the largest was about 13 cm ×13 cm ×12 cm, and the smaller was about 3 cm ×2 cm ×2 cm, all of which were connected to the uterine serosa. It was highly suspected of malignant tumor, and hysterectomy and bilateral salpingectomy were performed (Figure 1，Figure 2)。 Intraoperative rapid freezing results: lobular segmented smooth muscle tumor of uterine body with edema and mucinous degeneration, which was excluded from malignant transformation after routine extraction; Abdominal irrigation fluid exfoliation cytology was negative; Immunohistochemical marker: Ki-67 positive index<1% SMA (3+) Desmin (3+) CD10 (-), Results of routine pathological examination: Leiomyoma with edema and degeneration at the junction of cervix and body.

small fiber neuropathy (SFN) refers to peripheral neuropathy involving mainly thin-myelinated A-delta fibers and/or unmyelinated class C fibers, while large fibers are not or rarely involved^[1]。 SFN is mainly presented as sensory symptoms. Autonomic dysfunction may also occur^[1,2]。 Physical examination of the nervous system can show that the distal limb acupuncture sensation, temperature sensation decreased or hyperalgesia occurred, and the deep sensation, muscle strength and tendon reflex were generally normal.

Extracranial carotid atherosclerotic stenosis is one of the important causes of ischemic stroke, and more than 20% of ischemic strokes are caused by extracranial carotid atherosclerotic stenosis^[1]。 carotid endarterectomy is the best treatment for carotid stenosis. In recent years, carotid artery stenting (CAS) has attracted much attention in the treatment of extracranial carotid atherosclerotic stenosis because of its minimally invasive, safe and effective advantages. The results of multiple clinical randomized controlled trials have successively confirmed that there is no significant difference in the occurrence of long-term composite endpoint events between the two, and they have the same efficacy in long-term stroke prevention of carotid artery stenosis^[2,3,4,5]However, there were significantly more adverse events such as minor stroke in the perioperative period of CAS than CEA in subgroup analysis. Perioperative low hemodynamic changes (bradycardia, decreased blood pressure) in CAS are the most common complications^[6]It is also an important cause of perioperative cardiovascular and cerebrovascular adverse events^[7]。 This article mainly summarizes the mechanism, risk factors and prognostic risks of HD after CAS.