Volume 97  ·  Issue 39  ·  2017

From 1980s to now, transcranial Doppler ultrasound (TCD) has been used in the field of neurological diseases for nearly 40 years. In 2003, a German TCD expert believed: TCD is facing "death"! Because there are too many examinations such as CT angiography (CTA), magnetic resonance angiography (MRA) and digital subtraction angiography (DSA) can visualize intracranial and extracranial vascular lesions more intuitively. More than ten years have passed, and now it seems that TCD has not only not "died", but has glowed with vitality in many fields. In China, more and more neurologists and surgeons are learning to use TCD. The advantages of TCD, such as portability, cheapness, easy diagnosis of severe patients at bedside, and easy dynamic observation of disease evolution, are not found by other imaging methods. However, due to historical reasons, there are many cases of TCD abuse, and the clinical wrong TCD operation and its report make many clinicians question the value of TCD. Based on this, we organized experts in related fields to write this operating specification, hoping to have the effect of "breaking" to "establishing".

Generalized neurosonology includes transcranial Doppler, transcranial color Doppler ultrasound, cervical vascular ultrasound, transcranial parenchymal ultrasound, peripheral nerve ultrasound and muscle ultrasound^{[1,2,3,4,5,6]}。 The diagnostic value of neuroultrasound for clinical work depends largely on the technical and knowledge background of the operator. In order to facilitate the work of the majority of neuroultrasound medical staff, the Neuroultrasound Professional Committee of Neurologist Branch of Chinese Medical Doctors Association and the Neuroimaging Collaborative Group of Neurology Branch of Chinese Medical Association have written this operating specification for standardized training of neuroultrasound physicians at all levels.

To investigate the clinical characteristics and prognosis in patients with stroke after percutaneous coronary intervention (PCI).

From January 2013 to December 2013, 10 724 consecutive patients undergoing PCI including acute coronary syndrome and stable angina pectoris were enrolled.A two years′ follow up was conducted among these patients to investigate the clinical characteristics and prognosis of patients with stroke and of those without. A comparison was done between the two groups.

One hundred and forty-five patients had stroke (1.4%) during the follow-up period after PCI, including 124 cases with ischemic stroke (1.2%), out of whom 4 (3.2%) patients died; 21 cases with hemorrhagic stroke, out of whom 9 patients (42.9%) died.There was more female, and more patients with risks factors, hypertension, previous myocardial infarction, previous stroke, etc. in the patients with stroke.During the 2-year follow-up, patients with stroke experienced higher incidence of all-cause mortality (9% vs 1.1%, P<0.000 1). There were no significant differences in the incidences of cardiac death, myocardial infarction, revascularization, stent thrombosis and major adverse cardiovascular event rates between the two groups.COX regression analysis showed that stroke after PCI was associated with the increased mortality (HR=8.387, 95%CI: 4.725-14.855, P<0.000 1). Meanwhile, after propensity score matched analyses (129 pairs), the trend was not changed, and stroke was still an independent risk factor of all-cause mortality (HR=6.737, 95%CI: 1.52-29.85, P=0.012).

The patients underwent PCI, who had stroke later, had more clinical risk factors, and more serious degree of atherosclerosis.The incidence of stroke is an independent risk factor for all-cause mortality in patients with coronary heart disease after PCI.

To investigate the changes of resting brain function with time in patients with type 2 diabetes mellitus (T2DM) by using regional homogeneity (ReHo) with resting-state functional magnetic resonance imaging (rs-fMRI).

Multidimensional cognitive function tests and rs-fMRI scans were performed in 21 T2DM patients and 12 healthy controls in 2012 and 2015 respectively.The differences in clinical variables and the ReHo values before and after were measured by paired sample t test, and the correlation between the change of ReHo value and the change of clinical variables was measured by Pearson correlation analysis based on voxel.

The delayed score (14±6) of the T2DM patients in 2015 was significantly lower than that in 2012 (18±6) (t=-2.88, P=0.009); while the value of ReHo in the bilateral occipital lobe and right middle frontal gyrus was significantly lower than that in 2012 (P<0.01, Alphasim correction). And the decreased ReHo value in the left occipital lobe was significantly correlated with the change of complex figure test (CFT) delay score and the trail making test-B (TMT-B)(r=0.52, -0.46, both P<0.05). No significant change in cognitive function tests in the healthy control group was found between the two years, ReHo value in right cuneus decreased significantly (P<0.01, Alphasim correction), but it increased significantly in superior frontal gyrus (P<0.01, Alphasim correction) in 2015.No significant correlation between the changes of the ReHo values in the right cuneus and right superior frontal gyrus and the changes of cognitive function scores was found in the healthy controls.

The visual memory is significantly declined in T2DM patients within 3 years.The reduced neural activity areas in T2DM patients are in the bilateral occipitai lobes and the right middle frontal lobe. Decreased neural activity in the left occipital area is related to visual impairment, information processing speed and attention drops.

To study the effects of simulating leg length inequality on the spine and pelvic posture in standing and walking states and to explore their compensatory laws.

From January to April, a total of 44 healthy volunteers were rasterstereographically examined for spine and pelvis in Institute of Digitized Medicine, Wenzhou Medical University and Department of Orthopaedics, First Affiliated Hospital of Wenzhou Medical University.Volunteers wore uniform shoes, and single 5 mm thick insoles were customized.The simulating leg length inequalities (5-30 mm) were artificially created by increasing insole height.The parameters of 3D body surface parameters and 4D dynamic parameters of the pelvic and spine were measured and statistically analyzed in standing and walking states.

In the static standing state, with the increase of the difference of both lower extremities, coronal plane pelvic tilt and sagittal plane pelvic torsion also increased[the maximum value about (10.6±4.3) mm and (3.3±3.5)°], as well as the frontal deviation of the spine [the maximum value about (11.1±17.9) mm]. But the pelvic rotation, vertebral surface rotation angle (rms) and spine sagittal plane deviation were no obvious changes.In the walking state, with the difference between lower extremities increased, the maximum angles of vertebral surface rotation to the left and right and pelvic rotation to the left and right were no obvious changes, but (coronal) spinal maximum offset distance to left and right increased [the maximum value about (9.8±5.1), (10.4±6.9) mm].

The effect of the leg length discrepancy on the pelvic coronal plane and the sagittal plane changes are obvious, but little effect has on the pelvic cross section.The pelvis is compensated by the increase of the inclination of the coronal plane and the sagittal angle at first order.Similarly, the effect on the coronal plane of the spine is more markedly, but the changes of sagittal and cross-section of the spine is less affected, the spine is mainly compensated by the coronal plane bending at second order.

To identify the clinical features of mononucleosis caused by co-infection of Epstein-Barr virus (EBV) and cytomegalovirus (CMV) in adult patients.

A total of 103 inpatients with mononucleosis in Peking University Third Hospital from May 2013 to May 2016 were collected as the study subjects.The patients were divided into three groups according to the responsible pathogens: 33 patients infected with EBV and CMV, 53 infected with EBV alone and 17 infected with CMV alone.Furthermore, a case-control study was employed to retrospectively compare the clinical characteristics and prognosis with χ ^2,t or rank tests.

The incidences of sore throat, pharynx congestion, tonsil enlargement, tonsil membrane, lymphadenectasis in co-infected patients were statistically lower than those in EBV-infected patients(χ²=19.202-25.492, all P<0.05), and were equivalent to those in CMV-infected patients(χ²=0.078-4.381, all P>0.05). The levels of alkaline phosphatase, glutamyl transferase, lactic dehydrogenase, white blood cell count and atypical lymphocyte in co-infected patients were statistically lower than those in EBV-infected patients(t/U=3.471-104.629, all P<0.05), and were similar to those in CMV-infected patients(t/U=0.447-24.330, all P>0.05). The levels of alanine aminotransferase and total bilirubin in co-infected patients were equivalent to those in the other two groups(U=1.695, 6.371, both P>0.05). The duration of fever in co-infected patients[(18±9) d] was between EBV alone [(15±7) d] and CMV alone [(21±7) d]infected patients.

Co-infection of EBV and CMV is not uncommon.The clinic manifestation of co-infection is more like CMV infection. Liver injury and duration of fever shows no aggravation.

To evaluate and explore the mechanism of the effect of hypertonic pre-injection on postoperative delirium in the aged.

From June 2016 to February 2017, participants scheduled hip arthroplasty surgery were randomly divided into four groups: Group 1 (H1) 30 patients pre-injected 4 ml/kg hypertonic solution were proceeded general anesthesia; Group 2 (H2) 30 patients pre-injected 4 ml/kg hypertonic solution were proceeded spinal canal anesthesia; Group 3 (C1) 30 patients pre-injected 4 ml/kg isotonic saline were proceeded general anesthesia; Group 4 (C2) 30 patients pre-injected 4 ml/kg isotonic saline were proceeded spinal canal anesthesia in Department of Anesthesiology, Third Hospital of Hebei Medical University.All these patients were operated after anesthesia.To avoid electrolyte disorder, the level of Na⁺ , Ca²⁺ , K⁺ in the artery blood was analyzed.Peripheral venous blood was extracted to detect the concentration of inflammatory factors IL-1β, IL-6, IL-10, TNF-α and nerve injury factor S100β.In order to evaluate the relationship of these inflammatory fators with monocyte, we used flow cytometry to detect the number of mononuclear in peripheral venous blood.After operation 1 to 3 days, all these patients were assessed cognitive function by Nu-DESC.

Electrolytes fluctuationed in the normal range in four groups at different time points.Compared with before infusion, IL-6, IL-1β and TNF-α of four groups were significantly increased in postoperative.Compared with group H(H1 or H2), IL-1β, IL-6 and TNF-α were increased and IL-10 was decreased in group C(C1 or C2) after the surgery.S100β of group C(C1 and C2) was higher than before infusion.No significant changes were found in the cotykines mentioned above between group H1 and H2. The expression of monocytes CD14⁺ CD16⁺ /CD14^{+ +} was decreased and the incidence of postoperative delirium was lower in group H than group C(13.3%, 10.0% vs 33.3%, 36.7%, P<0.05).

Hypertonic saline can improve postoperative delirium of the aged and the mechanism may be related to the inhibition of monocyte cells secreting inflammatory factors.

To investigate the expression of miR-30a-5p in cartilage of osteoarthritis patients, and to explore its mechanism of chondrocyte apoptosis.

From May 2015 to December 2016, tissue specimen of 289 patients with osteoarthritis was collected in Department of Orthopedics, Changzhou traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine.The expression of miR-30a-5p and protein kinase B(Akt) mRNA in cartilage of different patients was detected by qPCR.The apoptosis of chondrocytes was detected by Tunel method.The expression of related proteins in tissues and cells was detected by immunoblotting, and apoptosis and cell cycle were detected by flow cytometry.

The expression of miR-30a-5p in OA patients was significantly higher than control patients (P<0.05), but Aktwas positively related[(3.64±0.95)vs(1.03±0.31),P<0.05]. The expression of miR-30a-5p in cartilage of OA patients was negatively correlated with Akt mRNA expression (r=0.729 3, P<0.001), but it had a positive correlation with the apoptotic rate (r=0.847 5, P<0.001). miR-30a-5p targets negative regulation of Akt gene expression in SW1353 cells, and the expression of p-Akt, IkB-α, p-IkB-α, p65, p-p65 and mTOR and p-mTOR were significantly down-regulated by miR-30a-5p (P<0.05). Compared with normal SW1353 cells, the apoptosis rate of SW1353 cells which was transfected with miR-30a-5p-mimics increased by 9.65 times, G0/G1 phase cells increased by 1.37 times, S phase cells decreased by 60.94%, G2/M phase cells decreased 19.53%.

miR-30a-5p is highly expressed in cartilage of osteoarthritis patients, and its high expression can block chondrocytes in G0/G1 phase by targeting Akt gene, and induce apoptosis of chondrocytes.

To investigate whether the short-term relief of spasm (within 7 days) after microvascular decompression (MVD) for hemifacial spasm (HFS) can be used as a prognostic factor of long-term outcome (>6 months).

The clinical characteristics and follow-up data (completely recorded) of 159 patients who had HFS and underwent microvascular decompression surgery in the first Affiliated Hospital of Fujian Medical University from August 2008 to May 2016 were analyzed retrospectively. The collected data focus on symptom relief in a time course: immediately after MVD, 7 days after MVD and the last follow-up (>6 months) by using Cohen-Albert grading.

In a total of 159 patients underwent MVD were followed up for more than 6 months.Compared to persist spasm group within 7 days after MVD, the cure rate was significantly higher in the spasm symptom relief group within 7 days after MVD (P<0.05). The cure rate of MVD (y) and the number of days within 7 days of relief (x) were highly relevant, y=-0.707x²+ 9.724x+ 67.442 (P<0.05). By using univariate Logistic regression analysis, we found that the prognostic factors of long-term curative effect were the symptom scale immediately after MVD and the average symptom scale in the 7 days after MVD (P<0.001). The incidence of delayed cure was 41.5%(66/159).

In the 7 days after MVD, at least 1 day of symptom remission can predict the cure of HFS.

To study the clinical characteristics of Parkinson′s disease (PD) patients with restless legs syndrome (RLS).

Ninety-nine PD patients and eighty-nine control group were included into this study and assessed for RLS by the question 6 of the non-motor symptoms questionnaire (NMSquest). The PD patients were divided into the RLS group and non RLS group, according to their answers to the NMSquest.The severity of motor symptoms, anxiety, depression and quality of life were evaluated according Unified Parkinson Disease Rating Scale (UPDRS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Parkinson′ s Disease Quality Of Life Questionnaire(PDQ-39), respectively.

(1)18.2%(18/81)of the PD patients experienced RLS, the incidence was significantly higher than the general population (P<0.001). (2) The RLS patients were more often women (66.7% vs 33.3%,P=0.033 ). (3) The UPDRS-Ⅱ score(20±7, P=0.008), UPDRS-Ⅲ score(43±14, P=0.015), BDI score(23±13, P=0.002), BAI score(18±8, P=0.012), PDQ-39 score(75±26, P=0.000)in RLS group were significantly higher compared with non RLS group. (4) RLS showed no association with the course of the disease, the age, the PD onset age and levodopa dose equivalents.

RLS more likely appears in PD patients, especially in women. The PD patients with RLS commonly suffer from serious motor symptom, low quality of life, anxiety and depression.

To investigate the effect of carotid artery stenting(CAS) on cognitive function and brain function based on changes of a battery of neuropsychological tests and magnetic resonance imaging.

Thirty-three patients were included with 17 in the stent-placement group and 16 in the control group (receiving medical treatment), among whom, the unilateral or bilateral severe internal carotid artery stenosis was confirmed by cerebral vascular angiography in the department of Interventional Radiology and Vascular Surgery of Zhongda Hospital Southeast University from June 2015 to September 2016.Neuropsychological tests and rest-state blood oxygenation level dependent fMRI were performed at the baseline and six months follow-up.The baseline characteristics and follow-up changes were compared in each group.

The overall cognitive function of the stent-placement group was statistically significantly improved (P<0.05) compared with control group, mainly in the executive function, memory, attention and other aspects.The value of amplitude of low-frequency fluctuation(ALFF) showed statistically significant increase (P<0.05, Alphasim correction) in left prefrontal cortex (t=5.861 3, P<0.05), the somatosensory association cortex in left superior parietal lobe(t=5.601 2, P<0.05) and bilateral motor cortical area in posterior frontal lobe (t=5.288 5, P<0.05). The ALFF showed statistically significant decrease (P<0.05, Alphasim correction) in left retrosplenial cingulate cortex(t=-5.590 4, P<0.05), left insular cortex (t=-6.340 8, P<0.05), right insular cortex (t=-8.129 9, P<0.05) and left dorsal anterior cingulate cortex (t=-5.584 8, P<0.05). There was no statistically significant difference (P>0.05, Alphasim correction)between baseline and follow-up results in control group.Besides, the ALFF changes of the left insular cortex (r=-0.591, P=0.033) and bilateral motor cortical area (r=-0.659, P=0.014) were negatively correlated with auditory verb learning test (AVLT) score changes.The ALFF change of bilateral motor cortical area was negatively correlated with the AVLT-delay score change (r=-0.588, P=0.034). And the ALFF change on right insular cortex and the frontal assessment battery (FAB) score change was positively correlated (r=0.638, P=0.025).

The overall cognitive function of patients with carotid artery stenosis significantly improve after CAS compared with medical treatment.The change of ALFF value in related brain area is also statistically significant.ALFF Change most in area of Default Mode Network may suggest a mechanism of postoperative neurological recovery in patients with carotid artery stenosis.

To analyze the effect of oral contraceptives on dysmenorrhea in patients with endometriosis.

We designed dysmenorrhea and chronic pelvic pain questionnaire.From February 2014 to February 2016 in the Gynecological Department of Peking University Third Hospital, patients suffered dysmenorrhea with or without endometriosis or adenomyosis were included.According to their own willingness, patients were divided into the research group and the control group.The research group periodically took oral contraceptives (Diane-35 or Yasmin), while the control group received no treatment.They were followed-up about dysmenorrhea every six months, and the total follow-up time was one and a half year.

The dysmenorrhea VAS scores of patients in research group after taking oral contraceptives for six or twelve months were significantly lower than that in baseline (VAS 4 vs 5 vs 7). The dysmenorrhea VAS scores increased after quitting medication, but remained still lower than baseline (VAS 6.5 vs 7). However, the dysmenorrhea VAS scores of patients in control group remained unchanged (VAS 6 vs 6). Patients who took pills for more than one year experienced the same severity of dysmenorrhea after six months′ or one year′s medication (VAS 2 vs 2), and they suffered slowly aggravating recurrent dysmenorrhea, while those who quitted after six months′ medication suffered quickly recurrent dysmenorrhea.The relieving rate of dysmenorrhea in research group was significantly higher than that in control group (79.7% vs 8.2%), and the relieving rate in patients with severe pain was significantly higher than that with mild or moderate pain (87.0% vs 66.6 % vs 77.1%). The relieving rate in patients without lesions was significantly higher than patients with adenomyosis (92.6% vs 59.1%).

Endometriosis is a progressing disease. Longterm medication of oral contraceptives can relieve the dysmenorrhea pain.The extent of pain relief was not connected with the length of medication.Dysmenorrhea recurred after quitting medication, and the longer of medication, the slower pain recurred.Patients without lesions experienced higher pain relieving rate than those with adenomyosis.

Pregnant woman 37 years old due to menopause 31^＋2Weeks, dyspnea and decreased fetal movement for 1 week, and was admitted to the Department of Obstetrics of Zhongnan Hospital of Wuhan University on May 16, 2016. I occasionally feel holding my breath in the first trimester, cough after catching a cold 1 week ago, blood in sputum, and dyspnea, accompanied by decreased fetal movement. The treatment with "penicillin" in the local hospital did not improve, and the outpatient color ultrasound showed an increase in pulmonary artery systolic blood pressure. One natural birth in 2001 and one ectopic pregnancy in 2009. In June 2015, my menstrual flow began to increase, lasting for 8~10 days, so the intrauterine ring was removed, and the pregnancy was obtained after the ring was removed. Suffered from "tuberculosis" in 2014. Physical examination at admission: blood pressure 130/89 mmHg (1 mmHg =0.133 kPa), oxygen saturation 85%-95%, heart rate 120 beats/min, breathing 20 beats/min, fine wet rales audible in the left lower lung, harmonic heart rhythm, and gestational bulge in the abdomen. Specialist examination: uterine height 26 cm, abdominal circumference 92 cm, buttock presentation, floating, fetal heart rate 150 beats/min. Blood routine at admission: white blood cells 12.18×10⁹/L [Reference range (3.5-9.5) ×10⁹/L, same below], red blood cells 3.27×10¹²/L [(3.8-5.1) ×10¹²/L], hemoglobin 94.00 g/L (115-150 g/L), platelets 203×10⁹/L [(125-350) ×10⁹/L], neutrophils 86.00% (40%-70%); Detection of liver, kidney and blood glucose: alanine aminotransferase (ALT) 42 U/L, aspartate aminotransferase (AST) 68 U/L (13-35 U/L), total bilirubin (TBIL) 12.9 μ mol/L, albumin 31.2 g/L (40-55 g/L); glucose 4.03 mmol/L; Urea nitrogen 3.29 mmol/L. Fetal heart electronic monitoring (NST) is shown as a sine wave. Obstetric B-ultrasound showed fetal weight of 1 424+ / -208 g; The amniotic fluid index was 11.9 cm, and the peak end-systolic (S) /end-diastolic (D) blood flow velocity of the umbilical artery was 1.71, suggesting a single live fetus in breech position in late pregnancy. Admission diagnosis: pregnancy 2 delivery 1 pregnancy 31^＋2Weekly expectant delivery; Fetal distress; Breech position; The cause of dyspnea to be investigated: pulmonary embolism? Tuberculosis? Lung infection?; Pulmonary hypertension; Moderate anemia.

The patient was a 54-year-old female. He was admitted to the hospital on May 1, 2012 due to ultrasound revealing a right thyroid nodule for 1 month. Previous 2-year history of radiotherapy for nasopharyngeal carcinoma. Admission physical examination: A hard mass about 2.0 cm ×1.8 cm in size could be accessed on the right thyroid gland, and several hard lymph nodes could be accessed on the right neck, the larger one was about 2.0 cm ×2.0 cm, and the remainder was negative. Laboratory tests were all normal. CT of head and neck showed: (1) post-radiotherapy of nasopharyngeal carcinoma; (2) Right cervical lymph nodes were swollen. Ultrasound examination showed: (1) A hypoechoic nodule about 2.1cm ×1.6cm ×1.8cm in size was seen at the lower pole of the right thyroid gland, with clear boundary and uneven internal echo (Figure 1)； (2) Several hypoechoic nodules were seen in the right neck and front of the neck, about 2.5 cm ×1.5 cm ×2.1 cm in size, with clear boundaries and uneven internal echoes (Figure 2)。 Ultrasound revealed "right thyroid nodule, nature to be determined; right cervical and anterior cervical lymph node enlargement, metastatic cancer?". "Total thyroidectomy + right paratracheal lymph node biopsy" was performed on 11 May 2012 under general anesthesia + cervical plexus anesthesia. Intraoperative findings: A mass of 2.0 cm ×1.8 cm was accessible to the right thyroid gland, which was hard in texture, with poor boundary and poor mobility. An enlarged lymph node of 2.0 cm ×2.0 cm was seen in front of the trachea, which was hard in texture and poor mobility. The mass adhered to the lymph node and invaded the esophagus. The left thyroid gland did not reach the mass. Intraoperative frozen pathology suggests that: (1) poorly differentiated right thyroid carcinoma with large necrosis, combined with clinical, nasopharyngeal carcinoma metastasis cannot be excluded; (2) The right anterior cervical lymph node was cancerous tissue under the microscope. Postoperative immunohistochemical staining showed that keratin antibody (34BE12) focal area (+), cytokeratin 5/6 (CK5/6) focal area (+), cytokeratin 7 (CK7) (-), cytokeratin AE1/AE3 (+), Epstein-Barr virus encoded RNAs (EBER) (-), Epstein-Barr virus (EBV) (-), tumor suppressor gene P63 (+), thyroglobulin (TG) (-), and thyroid transcription factor 1 (+) were weak. Pathological diagnosis: right thyroid nodule, consistent with metastasis of nasopharyngeal non-keratinizing squamous cell carcinoma (undifferentiated type), and right anterior cervical lymph node as cancerous tissue. After 4 years of follow-up, he was alive and had no recurrence or metastasis.

Because of its high morbidity, disability and mortality, stroke has become the first cause of death in China. Carotid atherosclerotic stenosis is one of the main causes of ischemic stroke, and more than 20% of ischemic strokes are caused by carotid atherosclerotic stenosis^[1]。 Atherosclerosis often progresses statically over many years until symptoms appear. The first clinical symptom is usually a transient ischemic attack or stroke^[2]。 At present, the risk assessment and treatment modalities of patients with asymptomatic carotid stenosis (ACS) are still controversial. This paper summarizes the research progress of ACS in recent years.

Ovarian mucinous tumors are a rare subtype of ovarian epithelial tumors with unique biological characteristics. Among them, mucinous adenocarcinoma accounts for 2% ~4% of ovarian epithelial carcinomas, and borderline mucinous adenoma accounts for 30% ~50% of borderline ovarian tumors^[1,2]。 At present, the etiology of mucinous adenocarcinoma is still unclear. Because the ovary does not have normal mucinous epithelial components in anatomical structure, mucinous metaplasia of epithelial cells in the ovarian cortex is also very rare^[2,3]Based on the above, the glandular epithelium of ovarian mucinous tumors is similar to gastrointestinal epithelial cells in pathological morphology, although the overall prognosis of ovarian mucinous tumors is good, the overall survival rate of borderline tumors can reach 100%^[4]The 5-year disease-free survival rate of mucinous adenocarcinoma can reach 80% ~90%^[5,6]However, considering that ovarian mucinous tumors may originate from the appendix or other digestive organs, once considered as ovarian mucinous tumors, the source of gastrointestinal tumors, especially the source of colon, should be excluded first, and preventive appendicectomy should be required. However, the clear relationship between mucinous ovarian tumor and appendix tumor in etiology and metastasis rate has not been confirmed, and the necessity of appendectomy in the treatment of ovarian myxoma is still controversial.