Volume 98  ·  Issue 07  ·  2018

Advances in science and technology have made neurosurgery more and more minimally invasive, and perioperative bleeding at the surgical site or non-surgical site caused by various reasons increases surgical trauma, reduces surgical treatment effect, impairs patient's postoperative recovery, and increases medical costs. The literature shows that perioperative hemorrhage can lead to increased intracranial pressure and cerebral edema, which can lead to cerebral hernia and central respiratory and circulatory failure, endangering the patient's life; Perioperative bleeding can extend hospital stay by an average of 9 days and increase medical costs by an average of $17,000^[1,2]。 Active prevention of perioperative hemorrhage can reduce surgical blood transfusion^[3]Shorten surgery and hospital stay^[4,5], reduce the risk of rebleeding and secondary surgery, significantly improve the clinical prognosis of patients, and improve the efficiency of the use of medical resources^[6]。

Perioperative hemorrhage in neurosurgery mainly refers to hemorrhage or rebleeding at the surgical site caused by various reasons. In severe cases, it can lead to increased intracranial pressure, cerebral edema, and even clinical crises such as central respiratory and circulatory failure and cerebral hernia, endangering the life of patients. The Neurosurgery Branch of Chinese Medical Association organized and compiled the Expert Consensus on Prevention and Treatment of Perioperative Bleeding in Neurosurgery in 2010, which has improved the prevention and treatment level of perioperative bleeding in neurosurgery in China to a certain extent. However, in recent years, there have been new developments in the clinical practice of neurosurgery. First of all, the disease spectrum of patients or their own conditions have changed. Many elderly people and patients with cardiovascular diseases are using anticoagulants for a long time. More attention should be paid to hemostasis during the perioperative period. Secondly, the development of new technologies has brought new problems, and many operations are faced with the problem of anticoagulation and hemostasis, which has caused great trouble to neurosurgeons; Third, new hemostatic materials are constantly emerging. From the earliest gelatin sponge and regenerated oxidized cellulose to the current fluid gelatin fibrin adhesive (also known as bio-protein glue), the hemostatic effect is getting better and better. Under the above background, in order to respond to the new situations and problems in recent years in time, the Neurosurgery Branch of Chinese Medical Association invited well-known experts from neurosurgery, hematology and anesthesiology in China to revise the 2010 edition of the Expert Consensus on Prevention and Treatment of Perioperative Bleeding in Neurosurgery, and then wrote the Expert Consensus on Prevention and Treatment of Perioperative Bleeding in Neurosurgery (2018) (hereinafter referred to as the Consensus), in order to guide neurosurgeons to rationally select techniques and hemostatic materials, effectively and standardizedly prevent and treat intraoperative and perioperative bleeding, and improve the surgical effect.

To evaluate the prognostic value of Global Registry of Acute Coronary Events(GRACE) discharge score for long-term out-of-hospital death in acute coronary syndrome (ACS) after drug-eluting stents (DES) and with Dual-antiplatelet Therapy (DAPT).

Our study was a prospective, observational, single center (Fuwai Hospital of China) study.A total of 6 431consecutive ACS patients underwent percutaneous coronary intervention(PCI)between January 2013 and December 2013 were involved.The primary endpoint was all-cause death and second endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) as a composite of all-cause death, myocardial infarction, revascularization, stent thrombosis or stroke.

Finally, 5 867 ACS patients who were received DES with DAPT and had no in-hospital event included in this study, and 59 (1.01%) death and 608 (10.36%) MACCE were reported during 2-year follow-up after discharge.GRACE score was significantly higher among death patients than those survivalpatients (94± 28 vs 78± 24, P<0.001). According to risk stratification of GRACE discharge score, as compared to the low-risk group, death risk in high-risk group was 6.73 times (HR=6.73, 95%CI 3.53-12.84; P<0.001) higher, but could not distinguish between the moderate and low risk group (HR=1.61, 95%CI 0.88-2.95; P=0.124). The GRACE score showed predictive value in ACS patients after DESand with DAPT (area under the receiver operating characteristic curve (AUROC)=0.661; 95%CI 0.586-0.736, P<0.001). In subgroup analysis, GRACE score also showed predictive value both in unstable angina pectoris (UAP)(AUROC=0.660, 95%CI 0.576-0.744; P<0.001) and acute myocardial infarction(AMI)subgroup (AUROC=0.748, 95%CI 0.631-0.864; P=0.001).

GRACE discharge score shows prognostic value for long-term out-of-hospital death in ACS patients undergoing PCI with DES and DAPT, and demonstrates good risk stratification of high and low-risk of death.

To explore the differences of one year death and stroke recurrence between ischemic stroke patients with intracranial atherosclerotic stenosis or occlusion of anterior circulation and those of posterior circulation.

All the patients were from the Chinese Intracranial Atherosclerosis Study (CICAS), between October 2007 and June 2009; patients with extracranial stenosis or occlusion, patients without acute infarction by diffusion weighted image, and patients with intracranial atherosclerosis of both anterior and posterior circulation were excluded.All the enrolled patients were divided into three groups: no significant intracranial atherosclerosis group (n=964), anterior circulation intracranial atherosclerosis group (n=440), posterior circulation intracranial atherosclerosis group (n=233). One year outcome was evaluated by any cause of death and stroke recurrence.

Of the 1 637 patients, 30 cases were died and 58 cases had stroke recurrence within one year.Compared with : no significant intracranial atherosclerosis group, adjusted hazard ratio (95% confidence interval) of one-year death for anterior and posterior circulation intracranial atherosclerosis group were 1.349 (0.311-5.851), 4.542 (1.227-16.813), respectively.Adjusted hazard ratio (95% confidence interval) of one year stroke recurrence were 1.663 (0.620-4.460) and 2.464 (0.935-6.493), respectively.

Ischemic stroke patients with intracranial atherosclerosis of posterior circulation has higher risk of one year death. One year stroke recurrence risk for patients with intracranial atherosclerosis of anterior and posterior circulation needs to be further evaluated.

To investigate the prognostic significance of central venous-arterial carbon dioxide tension to arterial-venous oxygen content ratio (Pcv-aCO₂/Ca-cvO₂) combined with lactate clearance rate (LCR) as early resuscitation goals of septic shock.

One hundred and forty-five septic shock patients admitted to Second Department of Critical Care Medicine of Lanzhou University Second Hospital from March 2013 to May 2017 were enrolled in this study.All septic shock patients received an initial resuscitation therapy according to early goal-directed therapy.The arterial and central venous blood gases were measured simultaneously at baseline (T0) and 6 hours after resuscitation (T6). Pcv-aCO₂/Ca-cvO₂ and LCR were calculated.Patients were classified into four groups according to Pcv-aCO₂/Ca-cvO₂ and LCR at T6: group A, Pcv-aCO₂/Ca-cvO₂>1.8 and LCR<30%; group B, Pcv-aCO₂/Ca-cvO₂>1.8 and LCR≥30%; group C, Pcv-aCO₂/Ca-cvO₂≤1.8 and LCR<30%; group D, Pcv-aCO₂/Ca-cvO₂≤1.8 and LCR≥30%.General demographics, hemodynamic parameters, oxygen metabolism parameters, acute physiology and chronic health evaluation (APACHE Ⅱ) scores, sequential organ failure assessment (SOFA) scores, length of intensive care unit (ICU) stay, and 28-day mortality rate were compared among the 4 groups.A Kaplan-Meier curve showed the survival probabilities at day 28 using a log-rank test for multiple comparisons.Parameters were introduced into a Cox′s proportional hazards regression model to analyze the prediction of 28-day mortality.Receiver operating characteristics (ROC) curves were constructed to evaluate the ability of Pcv-aCO₂/Ca-cvO₂, LCR, Pcv-aCO₂/Ca-cvO₂ combined with LCR at T6 to predict 28-day mortality.

Compared with patients in group A, patients from group D had the lower APACHE Ⅱ and SOFA score at day 3 (t=-2.909, -3.630, both P<0.05), shorter ICU stay (t=-2.575, P=0.011), and lower mortality rate at day 28 (χ²=3.124, P=0.011). Survival curves up to day 28, illustrated by Kaplan-Meier method, showed that group A had the shortest median survival time (χ²=10.332, P=0.016), difference between group A and group D was statistically significant (χ²=8.304, P=0.004). The Cox regression analysis revealed that Pcv-aCO₂/Ca-cvO₂ (RR=3.888, 95%CI: 2.443-6.189, P<0.001) and LCR (RR=0.073, 95%CI: 0.008-0.640, P=0.018) at T6 were independent predictors of 28-day mortality.The area under ROC curve for Pcv-aCO₂/Ca-cvO₂ combined with LCR (0.919, 95%CI: 0.862-0.958) was significantly greater than whether Pcv-aCO₂/Ca-cvO₂ (0.862, 95%CI: 0.795-0.914) or LCR (0.820, 95%CI: 0.748-0.879) alone (Z=2.032, 2.364, both P<0.05).

Combination of Pcv-aCO₂/Ca-cvO₂ and LCR is better than single parameter to predict the risk of adverse outcomes of septic shock patients, and may provide useful information for assessing the adequacy of resuscitation at early stage of septic shock.

To investigate the changes of CD71⁺ nucleated erythrocyte apoptosis, cytochrome C (Cyt-C) and mitochondrial membrane potential (MMP) in bone marrow of chronic mountain sickness (CMS).

14 patients with CMS and 15 patients with simple old fracture were divided into CMS group and control group, respectively.Bone marrow mononuclear cells (BMMNC) were separated, marked with CD71 monoclonal antibody and stained with Annexin V-FITC/PI.Then the apoptotic index of CD71⁺ nucleated erythrocytes was determined by flow cytometry.CD71⁺ nucleated erythrocytes were sorted out by magnetic column separation, and Cyt-C mRNA was detected by RT-qPCR, MMP was detected by JC-1 staining flow cytometry.

The apoptotic index of CD71⁺ nucleated erythrocytes was (1.9±1.4)% in the CMS group, and was (3.2±1.5)% in the control group, with significant difference between the two groups (P<0.05). The expression of Cyt-C mRNA was (0.72±0.14) in the CMS group, and was (1.00±0.15) in the control group, with significant difference between the two groups (P<0.01). The MMP was (5.0±2.2) in the CMS group, and was (3.3±0.9) in the control group, with significant difference between the two groups (P<0.05). The apoptotic index of CD71⁺ nucleated erythrocytes was negatively correlated with hemoglobin in CMS group (r=-0.569, P=0.034). But there was no significant correlation among apoptosis index, MMP and Cyt-C mRNA.

The apoptosis index of CD71⁺ nucleated erythrocytes decreased in CMS patients, which was negatively correlated with the level of hemoglobin, indicating that the decline of apoptosis index of CD71⁺ nucleated erythrocytes may be related to the accumulation of red blood cells in CMS.The MMP increased and Cyt-C mRNA expression decreased in CD71⁺ nucleated erythrocytes of CMS patients, which suggests that the change of mitochondrial pathway of apoptosis might be involved in the down-regulation of CD71⁺ nucleated erythrocytes apoptosis in CMS patients.But there was no significant correlation among CD71⁺ nucleated erythrocyte apoptosis index, MMP and Cyt-C mRNA levels, which indicates that the mechanism of CD71⁺ nucleated erythrocytes apoptosis is complex in CMS.

To investigate the clinical effect of enhanced recovery after surgery (ERAS) in unilateral total knee arthroplasty (TKA).

Retrospective analysis of 98 patients received unilateral TKA from September 2015 to September 2016 in the Orthopaedic Departmentof Affiliated Hospital of Logistics University of Chinese People′s Armed Police Forces.Of the patients, 52 cases were treated by traditional operation (routine group) and the other 46 cases were treated with ERAS concept (ERAS group). The following data were gathered and statistically analyzed between the groups: gender, age, body mass index, preoperative hemoglobin, preoperative visual analogue scale (VAS) score, postoperative visible blood loss, postoperative hemoglobin at 24 hour after operation, blood transfusion rate, postoperative VAS score, length of hospital stay, the satisfaction rate, preoperative and 1 and 6 months postoperative evaluation with hospital for special surgery knee score (HSS), postoperative range of motion (ROM) of knees after 2 weeks, 1 month and 6 months of surgery, incidence rate of complications after surgery.Data between groups were analyzed with one-factor analysis of variance or chi-square test.

There was no significant difference in preoperative data between two groups.Postoperative visible blood loss of ERAS group was significantly lower than that in routine group[(224±59) vs (361±70) ml, t=4.723, P<0.01]; postoperative hemoglobin after 24 hours in ERAS group was significantly higher than that in routine group[(109±8) vs (96±10) g/L,t=-3.297, P=0.004]; blood transfusion rate of ERAS group was significantly lower than that in routine group[6.5 %(3/46) vs 46.2%(24/52), χ ²=19.207, P<0.01]; the 12-hour and 48-hour postoperative VAS scores in ERAS groups were both significantly lower than those in routine group (t=3.708, 3.894, both P<0.05); length of hospital stay in ERAS group was significantly shorter than that in routine group[(6.8±1.2) vs (13.1±2.6) d,t=6.924, P<0.01]; HSS scores of ERAS groups at 1 month and 6 months after surgery were both significantly higher than those in routine group (t=-3.677, -3.594, both P<0.05); knees ROM in ERAS group at 2 weeks and 1 month after surgery were both significantly higher than those in routine group (t=-4.628, -4.442, both P<0.05); the rate of postoperative nausea vomiting in ERAS group was significantly lower than that in routine group[13.0%(6/46) vs 48.1%(25/52), χ²=13.852, P=0.002]. VAS score at 1 month after surgery, knees ROM at 6 months after surgery and the satisfaction rate were all comparable between the two groups (t=0.412, -1.026, χ ²=3.695, all P>0.05).

Condition of patients treated by unilateral TKA under ERAS model improves effectively during perioperative period when compared with routine treatment, patients have earlier rehabilitation and better experience in hospital and operation.

To explore the surgical technique and curative effect of microsurgical resection of large anterior skull base meningioma via unilateral subfrontal and interhemispheric approach.

The clinical data of 14 patients with large anterior skull base meningioma who received surgical treatment in the Department of neurosurgery in First Affiliated Hospital of Bengbu Medical College from April 2015 to September 2017 were analysed retrospectively.Of 9 cases were olfactory groove meningioma and 5 cases were tuberculum sellae meningioma.The microsurgical resection approach of all the patients was the unilateral subfrontal combined with interhemispheric approach.

According to the Simpson classification of meningioma resection, 13 cases(92.8%) were Simpson grade Ⅰand Ⅱ, 1 case was grade Ⅲ.The clinical symptoms were improved in 12 cases (85.7%), and no improvement in 2 cases.Fourteen patients had postoperative complications in 2 cases (14.2%), and all of them were no cerebrospinal fluid leakage and death.

Microsurgical removal of large anterior skull base meningioma through unilateral frontal and interhemispheric approach is safe and effective, providing a new way for surgical treatment of large anterior skull base meningioma. It had a positive significance for the prognosis of patients.

To investigate the effect and mechanism of Kruppel-like factor 2 (KLF2) on the migration of human liver sinusoidal endothelial cells (LSEC).

Cultured human LSEC were infected with different lenti-viruses to overexpress or suppress KLF2 expression (LV5-KLF2 and LV3-shKLF2, respectively), the infection efficacies were examined by real-time PCR and Western blot analysis.Transwell migration assay was used to investigate the role of KLF2 on the migration of LSEC.The mRNA and protein expression of vascular endothelial growth factor receptor-2 (VEGFR-2) were detected by real-time PCR and Western blot analysis, respectively.The expression and phosphorylation of Src, P38 MAPK, and P44/42 MAPK were detected by Western blot.

The up-regulation of KLF2 expression dramatically inhibited migration of treated LSEC, compared with LV5-NC and WT control cells, fewer LV5-KLF2 cells migrated to the lower side of the filter after 12 h [ (35.6±1.4), (71.3±2.4) and (69.3±1.6), P<0.001 for all comparisons]. In contrast, the down-regulation of KLF2 expression promoted the migration of LSEC, more LV3-KLF2 cells migrated to the lower side of the filter compared with the LV3-NC and WT control cells [(189.5±5.4), (83.4±2.5) and (82.2±3.4),P<0.001 for all comparisons]. Furthermore, up-regulation of KLF2 reduced the mRNA and protein expression level of VEGFR2, while down-regulation of KLF2 significantly increased its expression in LSEC.Additionally, up-regulation of KLF2 inhibited the phosphorylation of Src, P38 MAPK, and P44/42 MAPK pathway in LSEC, whereas down-regulation of KLF2 promoted the phosphorylation of those signaling pathway proteins.

KLF2 may inhibit the migration of human LSEC through the Src/ MAPK signaling pathway.

To determine the therapic effects of rutaecarpine in dextran sodium sulfate (DSS)induced experimental colitis and explore whether the protective role of rutaecarpine is related to the synthesis and release of CGRP.

Fifty female BABL/c strain mice were randomly divided into untreated model control group and DSS-exposed groups.DSS-exposed groups were given administration of 5% DSS for 7 days and respectively treated with vehicle, rutacarpine(30 mg/kg, 100 mg/kg) , prednisone by intragastric administration from day 8 to day 14.The disease activity index (DAI) scores, the histological scores, the mRNA and protein concentrations of CGRP in colonic tissues were measured.

On day 7, the DAI scores of the DSS-exposed groups[vehicle group (8.9±0.9), low-dose Rut group(8.9±0.6), high-dose Rut group(8.2±0.8), prednisone group(8.7±1.6)] were much higher, compared with the untreated model control group(0±0)(P<0.01). The DAI scores on day 14 of the vehicle, rutaecarpine or prednisone treated groups were respectively markedly lower than on day 7(3.2±0.6, 0.9±0.6, 3.1±0.7 vs 8.9±0.6, 8.2±0.8, 8.7±1.6,P<0.05). The DAI score of mice treated with high-dose rutaecarpine was significantly lower, compared with those treated with low-dose rutaecarpine and prednisone.Compared to the untreated model control group, the histological scores in other four groups significantly increased.Comparisons of values among the post-treatment groups had statistical significance (0.2±0.4 vs 6.9±0.9, 4.5±0.9, 2.8±0.8, 5.7±0.7,P<0.01), while the high-dose rutaecarpine group presented the lowest score.The colonic mucosal CGRP mRNA and CGRP protein expressions in groups receiving vehicle, low-dose rutaecarpine and prednisone were significantly reduced than those in the untreated model control group(0.32±0.03 vs 0.15±0.02, 0.18±0.01, 0.22±0.01,P<0.01). The CGRP mRNA and CGRP protein expressions in the untreated model control group was similar to those in the DSS+ high-dose rutaecarpine group with no statistic significance between them(0.32±0.03 vs 0.31±0.02,P>0.05). Pearson correlation analysis between CGRP mRNA levels, CGRP immunohistochemisty levels and DAI, histological scores showed a statistically negative relationship respectively(r=-0.797, -0.819, -0.863, -0.845, all P<0.01).

Rutaecarpine can ameliorate the DAI scores and histological scores of ulcerative colitis in mice.Rutaecarpine can upregulate the expressions of CGRP mRNA and CGRP protein.Correlation between CGRP mRNA, CGRP protein levels and DAI scores, histological scores respectively showed a statistically negative relationship.

To investigate the effect of prenatal administration of tetrandrine on the expression of Kruppel-like factors 5 (KLF5) and Survivin in the lung of congenital diaphragmatic hernia (CDH) rat model.

This experiment took simple random group method, 11 pregnant SD rats were randomly divided into three groups: normal control group (group NC, 3), model control group (group MC, 4), model+ tetrandrine group (group MT, 4). The rats in group MC and MT were given gavage administration with 125 mg nitrofen to induce CDH and the rats in group MT were administered with 30 mg/kg tetrandrine for three days (gestational age of 18.5, 19.5 and 20.5 d). All fetuses were delivered by caesarian section at the gestational age of 21.5 d to observe the formation of diaphragmatic hernia in 3 groups and to record the ratio of lung weight and body weight (Lw/Bw). The maturity situation of fetal lung tissue was evaluated by hematoxylin-eosin staining (HE staining). The expression of KLF5 and Survivin were detected by immune-histochemical staining and quantitatively analyzed by Western blotting methods.Single factor analysis of variance was taken among 3 groups to compare means of variables and the chi-square test was used to compare the difference of birth defect rates.

There was significant difference in CDH incidence between group MC [56.1%(37/66)] and MT[50.0%(28/56)](χ²=122.00, P<0.05). There was no significant difference in Lw/Bw among the three groups (F=0.985, P=0.376). The HE staining showed that pulmonary vascular-related and pulmonary alveolar-related developmental indexes in group MC were lower than those in the group NC, and those in the group MT were between the two groups.In addition, immunohistochemical staining showed that the average optical density (AOD) of KLF5 in group NC, MC, MT was 0.194 8±0.007 4, 0.212 1±0.004 9 and 0.192 7±0.001 9, respectively (F=14.53, P=0.002); and AOD of Survivin was 0.185 2±0.008 7, 0.209 2±0.003 6 and 0.192 8±0.007 5, respectively (F=12.31, P=0.003). The expression level of Survivin was positively correlated with that of KLF5 (r=0.993, P=0.039). Western blotting revealed that there were remarkable difference in the protein expression of KLF5 and Survivin among the three groups (F=4.29, 10.13, both P<0.05).

Prenatal gavage of tetrandrine to CDH rats induced by nitrofen promotes the development of fetal lung parenchyma and vascellum, and reduces the expression level of KLF5 and Survivin protein in fetal lung, which may be the mechanism of tetrandrine in improving lung hypoplasia of CDH.

To describe trends in diet consulting at discharge for patients with acute myocardial infarction (AMI) in China from 2001—2011.

A representative sample of patients in China admitted to hospital for AMI was created from a two-stage sampling approach; profiles for patients with AMI were retrospectively abstracted through their medical records.The study described the overall trends in diet consulting for patients with AMI in China, the rates of diet consulting among patients with hypertension, diabetes, and hyperlipidemia, and the variation in diet consulting across different regions.

We sampled 162 hospitals and included 16 100 patients with AMI in total.The weighted rates of diet consulting at AMI discharge in China was 16.5%, 28.8%, and 40.8% in 2001, 2006 and 2011, respectively (P for trend <0.001). The rates and trends among patients with hypertension, diabetes, and hyperlipidemia were similar to those among all patients with AMI (hypertension: 16.4%, 31.4%, and 41.1% in 2001, 2006 and 2011, respectively; diabetes: 18.2%, 32.2%, and 42.8%; hyperlipidemia: 18.6%, 31.4%, and 41.5%; all P for trend <0.001). The rates has not changed much for those in central rural region over the decade (19.2%, 19.4%, and 22.8% in 2001, 2006 and 2011, respectively; P for trend=0.09); meanwhile, the rates of diet consulting in other four regions increased over years (all P for trend<0.001).

From 2001 to 2011, the rates of diet consulting at discharge for patients with AMI has increased in China; however, there are still substantial rooms for improvement, especially for central rural region.Dietitian could work with clinician and be involved in diet consulting for AMI at discharge in order to improve prognosis for patients with AMI.

A 71-year-old female was admitted to the hospital due to "upper abdominal fullness, acid reflux for half a month, aggravated with vomiting for 3 days". Admission examination: urinary amylase: 621 U/L; Carcinoembryonic antigen: 10.20 μ g/L; Occult blood test (vomit): + + +. The patient underwent modified radical mastectomy for invasive ductal carcinoma of the right and left breast in 2006 and 2009, respectively, and routine chemotherapy after operation, and recovered well. Oral acoustic contrast medium ultrasonography (Figure 1): Diffuse thickening of the gastric wall, obvious gastric antrum, weakened peristalsis, accompanied by retention of gastric content, considering gastric malignant tumor. Gastroscopy (Figure 2): The stomach body, stomach corner and stomach wall are stiff, the stomach cavity is narrowed, it cannot expand after inflation, the mucosa is congested and edematous, and some of them are nodular. Consider leather stomach. Tissue biopsy (Figure 3): Chronic inflammation (active) of the mucosa (of the stomach body), Helicobacter pylori (HP)(－)。 Abdominal CT (Figure 4): Diffuse symmetrical thickening of the gastric wall, irregular shape, especially in the gastric antrum, stenosis of the gastric antrum cavity, obvious enhancement after enhancement, unclear mucosal line, clear surrounding fat space, swollen lymph nodes on the small curved side of the stomach, consider invasive gastric cancer or gastric lymphoma. Four days later, a gastroscopic biopsy was performed, but no tumor cells were found.

A 59-year-old male patient suffered from frequent urination and urgency with poor urination for more than 3 years. His symptoms worsened 3 months ago, and he developed urinary retention 2 weeks ago. He was placed with a catheter in the local hospital and came to our hospital on November 3, 2014 for further treatment. MRI findings on admission: prostate volume increased, anteroposterior diameter × left and right diameter × upper and lower diameter was 32 mm ×42 mm ×62 mm, the shape was irregular, the central gland partially protruded into the bladder and the boundary with the peripheral zone was poor, the bilateral peripheral zone was asymmetric, the right peripheral zone was smaller, the left peripheral zone was thicker, and its T₂Weighted image (T₂WI) Signal underuniformity (Figure 1,Figure 2,Figure 3), diffusion-weighted imaging (DWI) (b =1 000 s/m²No significant diffusion restriction was observed on) (Figure 4), no significant decrease was observed on the apparent dispersion coefficient (ADC) plot. There was no obvious abnormality in the morphological signals of bilateral seminal vesicles. The bladder wall is thickened, and multiple protrusions can be seen. Enhancement scan after intravenous injection of gadolinium diethylenetriamine pentaacetate (Gd-DTPA) showed heterogeneous enhancement in the central zone of the prostate, and mild enhancement in the peripheral zone in the delayed phase, which was lower than that in the central gland (Figure 5)。 Diagnosis: prostatic hyperplasia. During the operation, obvious hyperplasia of the middle lobe of the prostate was observed, which protruded into the bladder and occluded the urethral opening. The prostatic capsule was incised at 3 points and deducted by the finger cleft method. Pathological examination revealed spindle cell tumor, considering leiomyoma (Figure 6)。 immunohistochemistry (Figure 7,Figure 8,Figure 9): Desmin moiety (+), smooth muscle actin (SMA) (+), S-100 (-), Bcl-2 (-), CD34 (+), anaplastic lymphoma kinase (ALK) (-), Ki-67 (~5% +).

In the past two decades, image-guided microwave ablation technology has made great progress in clinical treatment of tumors. With the development of microwave ablation instruments and treatment options, microwave ablation technology has been applied in many medical institutions in China in the past decade to treat small liver cancer and even large liver cancer>5 cm and other solid tumors, and more than 530 hospitals have used this technology. Internationally, the countries that apply microwave ablation are mainly the United States, Italy, Germany and Japan. Multicenter studies of microwave ablation in the treatment of liver cancer have been reported at home and abroad, with the largest patient sample size and the most comprehensive survival and prognosis data reported in China. This article summarizes the application of microwave ablation in the treatment of many kinds of tumors, and reports it as follows.

Metabolic syndrome (MS) is a group of clinical syndromes with central obesity, hyperglycemia (diabetes or impaired glucose regulation), dyslipidemia and hypertension as its main characteristics, and insulin resistance as the common pathophysiological basis. With the development of society and economy, the change of living standard and lifestyle, the incidence of MS has obviously increased in recent years, and it has become one of the public health problems that seriously threaten human health. The pathogenesis of MS has not been fully elucidated. In recent years, it has been gradually discovered that besides genetic factors and lifestyle, intestinal flora plays an important role in the pathogenesis of MS.