Volume 98  ·  Issue 11  ·  2018

pelvic organ prolapse (POP) is a common disease that affects the quality of life of middle-aged and elderly women, and it is the main disease that needs to be solved in urogynecology and pelvic floor reconstruction surgery, a new subspecialty of obstetrics and gynecology. With the deepening of clinical anatomy research and the rapid development of medical biomaterials, pelvic organ bulge can be regarded as a special hernia. Drawing on the successful experience of surgical hernia repair and the rapid development of artificial synthetic grafts in recent ten years, synthetic mesh implantation has become a new surgical method of POP, namely transvaginal mesh (TVM).

osteoporotic vertebral compression fracture (OVCF) is one of the common and serious complications of osteoporosis (OP). In the treatment of OVCF, we should not only pay attention to the treatment of fracture, but also not neglect the treatment of OP, the primary disease of fracture. OP is a systemic skeletal disease characterized by low bone mass, decreased bone strength, destruction of bone microstructure, increased bone fragility and easy fracture. This definition includes bone mineral density (BMD) and bone mass. bone mass includes bone turnover (high energy and low energy), bone accumulative injury and bone mineralization in addition to the quality of bone microstructure. Once OVCF is clearly diagnosed, OP health education for patients should be carried out immediately, OP-related examinations should be improved, and a standardized and individualized long-term anti-OP treatment plan should be formulated. While relieving the patient's pain, resuming the patient's daily activities, improving the patient's quality of life, improving the patient's BMD and reducing the risk of re-fracture^[1,2]。

percutaneous kyphoplasty (PKP) has been widely used in the minimally invasive treatment of osteoporotic vertebral compression fracture (OVCF) worldwide, and has achieved remarkable clinical results^[1,2,3]。 As of December 2016, a total of 1,443 hospitals in China reported about 73,992 cases of PKP surgery in 330 journals^[4]。 The technique injects bone cement into the fractured vertebrae body after percutaneous puncture and balloon expansion under image guidance, so that the diseased vertebrae is immediately strengthened and stabilized, its weight-bearing function is restored, the pain of the patient is quickly relieved, the quality of life is obviously improved, and the technique is widely recognized by doctors and patients^[5,6,7]。 Although the efficacy of PKP surgery is satisfactory, the high risk of PKP surgery cannot be ignored. Complications such as bone cement leakage and pulmonary artery embolism can not only cause spinal cord nerve injury, paralysis, and even life-threatening^[8]。 There are still related problems to be solved in preoperative diagnosis, intraoperative puncture, reduction, perfusion and postoperative management. Therefore, clinicians should pay attention to the standardized operation of PKP surgery, master the treatment strategies of common problems in the application of PKP surgery, reduce the incidence of surgical complications and improve the surgical efficacy.

To develop the Chinese version of the fecal incontinence quality of life (FIQL) questionnaire, and to validate them in Chinese population.

Our study included 52 cases recruiting from outpatients diagnosed with fecal incontinence in Peking Union Medical College Hospital, fecal incontinence in Beijing City nursing homes for the elderly, and patients received perineal repair surgeries who suffered from perineal laceration and laceration in in Peking Union Medical College Hospital from October 2013 to 2016 December.The Original English Fecal Incontinence Quality of Life scale questionnaires were translated into Chinese and they were linguistically validated following the Cross-cultural adaptation of health-related quality of life measures.The reliability and validity of the Chinese version of FIQL questionnaires in Chinese population were evaluated.

Fifty-two patients completed the FIQL and the SF-12 questionnaires, as well as Cleveland Clinic Incontinence Score.The Cronbach′s alpha of FIQL was 0.949, test-retest reliability ICC was 0.437-0.866. FIQL scores were positively correlated with SF-12 (Spearman correlation coefficient was 0.588, P<0.01) and negatively correlated with Cleveland Clinic Incontinence Score (Spearman correlation coefficient was -0.617,P<0.01). Factor analysis showed that there were 6 common factors in FIQL.

Chinese version of FIQL have high reliability and validity in Chinese population, there fore it is suitable for clinic and research.

To investigate the risk factors for multiparous pelvic floor muscles injury during 6-8 weeks after delivery.

From June 2015 to April 2017, 1917 women (1 523 primigravidas and 294 multiparas) were accepted postpartum pelvic floor function screening during 6-8 weeks after delivery in Beijing Hospital.Pelvic examination and pelvic floor muscle strength testing were carried out in these women.All the data were analyzed with multivariate logistic regression method to explore the related factors for postpartum pelvic floor muscle injury.

The incidence of muscle strength grades less than third grade was 63.60 % (type Ⅰ muscle fiber) and 24.83 % (type Ⅱ muscle fiber). Multivariate analysis showed that time interval, between two deliveries, less than 3 years (OR=2.16, 95%CI 1.21-3.86), and maternal BMI<18.5 (OR=3.04, 95%CI 1.10-9.30) and BMI≥28 (OR=3.04, 95%CI 1.10-9.30) before pregnancy were risk factors for postpartum injury of type Ⅰ muscle fiber. Gestational age more than 40 weeks increased the risk of damaging type Ⅱ muscle fiber (OR=2.79, 95%CI 1.156-6.76). Compared with cesarean section, vaginal delivery significantly increased the risk of injury of type Ⅰ and Ⅱ pelvic floor muscle fibers (P<0.05).

The incidence of multiparous pelvic floor muscle injury was high in early postpartum period.Several factors are related to the pelvic floor muscle injury.Pelvic floor rehabilitation in early postpartum and maternal education may be helpful to reduce the radio of injury.

To probe the effect of multiple pregnancy on pelvic floor function of pregnant women, Pelvic floor ultrasonography was performed on the 42 day postpartum women.And the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were measured.

Collect 200 cases 42 day postpartum women who visited the second hospital of Jilin University from July 2015 to June 2017, of which 100 cases of primipara belong to group A, 100 cases of multiple pregnancy belong to group B, and 100 cases without maternal at the same age belong to the control group, ultrasound measurement of the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were measured.t test were proformed respectively between the three groups, P<0.05 was considered statistically significant difference.

In the control group, the bladder neck mobility is (2.59±0.51) cm , the bladder neck mobility in A group is (2.99±0.69) cm, the bladder neck mobility in B group is (3.36±0.71) cm; the bladder and urethral posterior angle in the control group is (112.56±13.61)°, the bladder and urethral posterior angle in the control group after Valsalva action angle is(135.37±12.17)°, the bladder and urethral posterior angle in A group is(119.26±15.80)°, the bladder and urethral posterior angle in group A after Valsalva action is(141.79±12.08)°, the bladder and urethral posterior angle in B group is(123.62±16.20)°, the bladder and urethral posterior angle in group B after Valsalva action is (148.92±13.60)°; the pelvic diaphragmatic hiatus area in the control group is (13.35±2.86) cm^2, the pelvic diaphragmatic hiatus area in the control group after Valsalva action is(15.28±3.15) cm^2, the pelvic diaphragmatic hiatus area in A group is(17.52±3.19) cm^2, the pelvic diaphragmatic hiatus area in A group ater Valsalva action is (18.06±5.13_the pelvic diaphragmatic hiatus area) cm^2, the pelvic diaphragmatic hiatus area in B group is (18.26±4.18) cm^2, the pelvic diaphragmatic hiatus area in B group after Valsalva action is (20.3±3.53) cm².In group A, group B and the control group, the measured value of the bladder neck mobility, bladder and urethral posterior angle and pelvic diaphragmatic hiatus area were examined by t test, and P<0.05, which means the difference was statistically significant.

Pregnancy can affect the function of female pelvic floor, and the effect of parturient is more significant than that of the primipara.

To investigate the long-term prognosis of coronary artery disease with atrial fibrillation (AF) after percutaneous coronary intervention (PCI).

A total of 10 724 patients with PCI were enrolled in 2013, and 2-year clinical outcomes in patients with AF (AF group) and without AF (non-AF group) were compared.

A total of 113 patients were with AF (1.1%), and 8 out of them were on triple antithrombotic therapy (9.5%), and AF group patients were with more complications. The 2-year follow-up results showed that the all-cause mortality in AF group was significantly higher than that in non-AF group (9.7% vs 1.1%; P<0.001). The incidence of cardiac death, stent thrombosis and stroke was also significantly higher in patients with AF. The incidence of major adverse cardiac and cerebrovascular events (MACCE) was also significantly higher in AF group compared with non-AF group (17.7% vs 8.8%;P<0.001), whereas the incidence of revascularization was significantly lower in the AF group than in the non-AF group (2.7% vs 8.7%;P=0.023). The incidence of myocardial infarction and bleeding had no significant difference between the two groups, and the adverse events between the two groups had no significant difference after propensity score (PS) either.

The 2-year clinical follow-up of single-center, large-sample PCI patients shows poor prognosis in patients with AF compared with the non-AF patients. But there is no difference in the prognosis between the two groups after PS, however, this conclusion still needs to be confirmed by randomized controlled studies.

To determine the relative percentage of skeletal muscle mass (SMM) in elderly patients with coronary heart disease, analyse the relationship between percentage of SMM and cardiorespiratory fitness (CRF), predict exercise capacity and cardiac reserve.

Patients aged 65 years and over after PCI, receiving cardiopulmonary exercise testing (CPET) during February 2014 to December 2016 in Department of Cardiology at Peking University Third Hospital were enrolled.All patients′ basic data, percentage of SMM and CPET related parameters, including peak oxygen uptake (VO₂peak), oxygen pulse (VO₂/HR), oxygen uptake efficiency slope (OUES) and other cardiorespiratory endurance indicators were collected, to do correlation analysis.

There were 402 patients enrolled, with average age (71±5) years, including 283 cases of male (70.40%) and 119 cases of female patients (29.60%). There were 62 patients with acute myocardial infarction (15.42%), 113 patients with old myocardial infarction (28.11%), and 227 patients diagnosed with angina pectoris (56.47%). The percentage of SMM was correlated to CRF.The percentage of SMM[97.00 (92.05, 102.10)%] and VO₂/HR (r=0.231, P<0.001) and OUES (r=0.264, P<0.001) were positively correlated.Body mass index was negatively correlated with VO₂peak(r=-0.162, P=0.001). Visceral fat area (VFA) was also negatively correlated with VO₂peak(r=-0.126, P=0.016). Multiple linear regression analysis showed that Body mass index and VFA were negatively correlated with VO₂peak (r=-0.204, P=0.014; r=-0.031, P=0.013). The percentage of SMM was positively independently correlated with OUES(r=11.020, P<0.001).

Muscle content is positively correlated with exercise capacity of patients.The percentage of skeletal muscle mass determines the core index of cardiorespiratory fitness, such as the slope of oxygen pulse and oxygen uptake efficiency.These indexes can be used as an important criterion for predicting and guiding rehabilitation exercise in patients with coronary heart disease.

To establish a three-dimensional (3D) finite element (FE) model of the whole cervical spinal cord (WSCS) and explore the biomechanical behaviors of cervical spinal cord injury related to different bone fragment impact velocities by FE analysis.

A 3D FE model of WCSC was established based on the morphologic data of each segment of the human cervical cord. The reconstruction structures, which included the dura mater, the cerebrospinal fluid, the gray and white matter in the C₂ to C₇ cervical vertebrae, were validated.On the validated WCSC model, three kinds of pellets with same mass (7 g) but different impact areas (314, 157 and 78.5 mm²) were created to represent the bone fragments.These were positioned in the middle of the spinal cord to impact at various initial velocities.The maximum of von Mises stress and the reduction of the cross-sectional area (CSA) of the spinal cord were measured from each impact.

The compression of WCSC (percentage) and the time to reach maximum compression were similar with the results reported in literatures, indicating the validity of the model.Regardless of the impact areas of the pellet, the maximum of von Mises stress and the reduction of CSA of the spinal cord increased with the increased velocity.The maximum of von Mises stress was 5.0-7.0 kPa at a pellet velocity of 1.5 m/s, and the reduction of CSA was 9.3%-12.3%.At a velocity of 3.5 m/s, the maximum of von Mises stress was 42-54 kPa and the reduction of CSA was over 30%.The stress of the spinal cord significantly increased when pellet velocity exceeded 3.5 m/s, and the fastest increase was recorded at 4.5 m/s.The von Mises stress of the spinal cord ranged between 240 and 320 kPa at a velocity of 6.0 m/s, and CSA decreased by more than 50%.

The 3D FE model of WSCS could provide more insights on the biomechanical mechanisms of spinal cord injury through various bone fragment impacts in burst fracture.When the impact velocity of the bone fragment exceeds 3.5 m/s, the maximum stress significantly increases and the reduction of CSA of the spinal cord is over 30%, and this could possibly lead to the contusion injury of the spinal cord.

To observe the effects of sural nerve nutrition vessels-supported flap for reconstruction of distal lower leg and ankle soft tissue defects.

From June 2014 to June 2017, 37 patients with calf distal and ankle soft tissue defect were repaired with sural nerve nutrition vessels-supported flap, of them 12 cases with calf distal soft tissue defect wounds and 25 cases with ankle soft tissue defect wounds.The scope of flaps was 9 cm×4 cm to 18 cm×9 cm, anti-infection, anti-freezing and dressing treatments were carried out after operation.The results of two-point discrimination among reexamination were recorded.

All the flaps survived without ulcer and effusion, only 1 flap for reconstruction of medial malleolus swelled and deactivated at the beginning while it recovered with proper dressings.During the follow-up periods, all the flaps kept favorable feelings, aspects and functions, and the two-point discrimination was 5 to 15 mm [averaged (11.2±1.7) mm].

Sural nerve nutrition vessels-supported flap brings significant effects with excellent safety and reliability in repairing calf and ankle soft tissue defects.

To investigate the expressions and clinicopathologic significance of Id2 and NF-κB/P65 in gastric cancer.

Immunohistochemistry was used to detect Id2 and NF-κB/P65 expressions in gastric cancer tissues of 336 cases and paraneoplastic normal mucosa tissues of 60 cases.The expressions of Id2 and NF-κB/P65 in gastric cancer were significantly higher than those in normal mucosa tissues (χ²=44.631, P<0.001; χ²=34.650, P<0.001).

The positive expression rates of Id2 and NF-κB/P65 were 71.4% (240/336) and 56.3% (189/336) in cancer tissues, and 26.7%(16/60) and 15.0%(9/60)in normal tissues, respectively.Id2 and NF-κB/P65 were all related to tumor size, differentiation degree, infiltrative depth, lymphatic invasion, distant metastasis and clinical TNM stage (P<0.05). The 5-year survival rate of the patients with Id2 or NF-κB/P65 expression was lower than that of patients with negative Id2 or NF-κB/P65 expression (χ²=52.329, P<0.001; χ²=20.525, P<0.001). Id2 expression in gastric cancer was positively correlated with the NF-κB/P65 expression (r=0.292, P<0.001). And the NF-κB/P65 expression in the Id2 positive group is significantly higher than that in the group with negative Id2 (χ²=28.681, P<0.001). The final multivariate Cox regression model indicated that Id2 expression was an independent prognostic factor for overall survival after operation (HR=2.327, 95%CI 1.622-3.337, P<0.001).

Id2 and NF-κB/P65 may synergistically promote the generation and evolution of gastric cancer, and their co-detection can be of great importance for clinical assessment of tumor biological behavior and prognosis in patients with gastric cancer.

Using microarray technology, to research characteristic circRNA and miRNA expression profile of acute myocardial infarction (AMI), and then explore the role of these circRNA and miRNA in gene regulation. The aim is to explore the mechanism of development of AMI.

The patients hospitalized in the Cardiovascular Research Center of the First Affiliated Hospital of Xinxiang Medical University between November 2016 and January 2017 were included and divided into control group and AMI group according to diagnostic criteria. We collected their whole blood and extracted the total RNA, and the expression profiles of circRNA and microRNA genes in peripheral blood of AMI were analyzed by gene chip. We predicted circRNA which was possible to combine with miRNA, and drew a network diagram, and the differentially expressed circRNA was analyzed by GO and Pathway.

There was difference in circRNA expression profile between the control group and the AMI group. The results showed: (1) a total of 1 670 circRNA had differential expressions, and in the analysis of miRNA expression, 13 miRNA had differential expressions (P<0.05, fc≥2); (2) multiple circRNAs-miRNAs were involved in the occurrence of AMI; (3) the analysis of GO and Pathway for differentially expressed circRNAs showed that many pathways, disease and function participated in it.

CircRNA, as an important post transcriptional regulator, is closely related to the development of AMI with miRNA.

To investigate the effect of α7nAChR mediated cholinergic anti-inflammatory pathway on inhibition of atrial fibrillation by low-level vagus nerve stimulation(LL-VNS).

Eighteen beagles were randomized into control group (n=6), LL-VNS group (n=6) and methyllycaconitine (MLA) + LL-VNS group (n=6). All the beagles were subjected to rapid atrial pacing at 800 beats/min for 6 hours.And the effective refractory period (ERP) of atriums and pulmonary veins and induced atrial fibrillation (AF) were measured hourly during non-pacing.After cessation of pacing for 3 hours, the beagles in control group were injected with saline into four ganglionated plexis (GPs), the beagles in LL-VNS group were given LL-VNS and saline injected into four GPs, and the beagles in MLA+ LL-VNS group were injected with MLA into four GPs combined with LL-VNS.And the levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and acetylcholine (ACh) in the plasma at baseline condition, 3 h and 6 h were measured.At the end of this experiment, atrial tissues were collected to examine the levels of TNF-α, IL-6, ACh, NF-κBp65 and STAT3 proteins.

During the right atrium pacing for the first 3 hours, the ERPs were gradually decreased while AF inducibility were gradually increased in all groups. At the end of this experiment, compared with the control group and MLA+ LL-VNS group, the ERPs in LL-VNS group were increased, and the induced times and duration of AF were significantly decreased. The levels of TNF-α and IL-6 in plasma were all significantly decreased in LL-VNS group and MLA+ LL-VNS group when compared with the control group(pg/ml) [IL-6: (101±6) vs (119±7),P<0.05; (102±5) vs (119±7),P<0.05; TNF-α: (17.8±1.7) vs (22.1±2.0),P<0.05; (17.9±2.2) vs (22.1±2.0),P<0.05]. And the levels of ACh were higher than in the control group(μg/ml)[(151±13) vs (123±10),P<0.05; (145±5) vs (123±10),P<0.05]. After cessation of pacing for 6 hours, compared with the control groupand MLA+ LL-VNS group, the tissue levels of TNF-α and IL-6 were significantly decreased in LL-VNS group (P<0.05). The concentrations of NF-κBp65 proteins in atrial tissues were lower in the LL-VNS group (P<0.05), and the levels of STAT3 proteins in those tissues were higher in the LL-VNS group than in thein the two other groups (P<0.05).

LL-VNS could inhibit the atrial electrical remodeling and atrial fibrillation induction; cholinergic anti-inflammatory pathway mediated by α7nAChR may be the important mechanism in vagal nerve regulated AF.

To study the cytotoxicity of Robo1-CAR-NK92 cells against U87-MG and SH-SY5Y cells, to explore the effects of IL-15, IL-21 and dexamethasone on the proliferation, survival and cytotoxicity of Robo1-CAR-NK92 cells and to optimize the culture protocol.

Robo1-CAR-NK92 cells were constructed by lentivirus transfection.The Robo1 car positive cells were sorted, expanded and detected by flow cytometry.The levels of Robo1 expression in SH-SY5Y and U87-MG cells were examined by flow cytometry.The cytotoxicity of Robo1-CAR-NK92 or NK92 cells against target cells was tested by CCK-8 and live cell imaging. The levels of cytokines in the supernatant of cultured cells during the cytotoxicity assay were quantified by the multiplex bead-array assay.NK92 and Robo1-CAR-NK92 cells (4×10⁴/ml) were treated with 25 ng/ml of IL-15, 25 ng/ml of IL-21 and/or 50 nmol/L dexamethasone for 3 days and were stained with trypan blue to acquire the viable cell numbers and survival rates.

Robo1-CAR-NK92 cells were constructed and tested 98.89% positive after sorting and expansion. While 88.14% of U87-MG cells were Robo1 positive, there were 99.75% of Robo1 positive SH-SY5Y cells.The specific lysis of Robo1-CAR-NK92 cells against target cells was significantly higher than that of NK92 cells (P<0.05). Robo1-CAR-NK92 cells obviously secreted more cytokines including IL-6, IL-10, TNF-α and IFN-γ than parental NK92 cells during cytotoxic activity against U87-MG cells (P<0.05). IL-15 significantly increased the proliferation and survival of Robo1-CAR-NK92 cells, but IL-21 played the opposite role.Remarkably, IL-21 and IL-15+ IL-21 enhanced the cytotoxicity of NK92 and Robo1-CAR-NK92 cells.The combination of dexamethasone and interleukins dramatically promoted the proliferation and survival but obviously impaired the cytotoxicity of NK92 and Robo1-CAR-NK92 cells (except that IL+ 15 and dexamethasone have no effect on the cytotoxicity of Robo1-CAR-NK92 cells).

Compared to parental NK92 cells, Robo1-CAR-NK92 cells exhibited more potent targeted killing against glioma and neuroblastoma cells.Collectively, treatment of IL-15 and dexamethasone was the optimized protocol for culture of Robo1 CAR NK cells during our experimental time.

A 46-year-old male was admitted to the Department of Gastrointestinal Surgery of Bethune First Hospital of Jilin University for "abdominal distension and abdominal pain accompanied by stopping defecation and exhaustion for 6 days". Abdominal distension and poor exhaust and defecation occurred 6 days before admission, which improved after conservative treatment; The symptoms aggravated after eating 5 days ago, and he was admitted to hospital for further diagnosis and treatment. Previous medical history: Two years ago, he was in remission after conservative treatment in a local hospital for intestinal obstruction. There was no history of abdominal trauma or surgery. Physical examination: The abdomen was slightly swollen, no gastrointestinal pattern and peristaltic wave were seen, no abdominal wall varicose veins were seen, and abdominal breathing was not limited. There is no tenderness, rebound pain and muscle tension in the whole abdomen. Unpalpable mass in the whole abdomen, unpalpable subcostal liver and spleen, unpalpable gallbladder, negative Murphy's sign. The mobile voicing was negative, and no bowel sounds were heard during auscultation. No sound of air passing through water or vibrating water was heard. No obvious abnormalities were found in digital anal examination. Whole abdominal multi-slice CT plain scan + three-phase enhancement (abdominal group) abdominal cavity small intestine dilatation, gas accumulation, see liquid gas plane, walk to the right pelvic small intestine lumen narrow, intestinal wall thickened, edge rough, enhancement scan uniform enhancement, adjacent small intestine intestine tubes close to each other, local mesenteric twist; Pelvic fluid shadow (Figure 1)。 Imaging diagnosis: small intestinal obstruction, the obstruction site is located on the right side of the pelvic cavity, and the local intestinal wall is thickened. After admission, there was no improvement after 1 week of conservative treatment such as fasting, fluid rehydration, enema, and gastrointestinal decompression. Exploratory laparotomy was performed. During the operation, about 200 ml of pale yellow ascites in the abdominal cavity was found, and extensive membranous adhesion between the small intestine and the abdominal wall under the incision and between the small intestine was found. No obvious nodules, calcification, and clear space-occupying lesions were found. After carefully releasing the adhesion between the small intestine and the abdominal wall, an incision protective sleeve was placed. The stenosis of the small intestine at 50 cm 100 cm away from the ileocecal region was further explored, and the adhesion formed a mass that could not be released. The proximal intestinal tube was dilated and the distal end was empty. It was judged that this was the obstruction site. Intraoperatively, "acute adhesive intestinal obstruction (abdominal cocoon?)" was diagnosed, and adhesion release, partial resection of the small intestine, intestinal anastomosis, intestinal obstruction catheter placement, and intestinal arrangement were decided. The operation went smoothly, and he returned to the ward after operation, and was given fasting water and fluid rehydration. Immunohistochemical results: Vimentin (+), β-chain protein (nuclear +), SMA (+) (Figure 2)。 Postoperative pathological report: spindle cell tumor-like hyperplasia was observed in local serous layer and mesentery, which was consistent with aggressive fibromatosis combined with morphology and immunohistochemistry (Figure 3)。 Two weeks after surgery, the patient's abdominal distension was significantly relieved, his exhaust and defecation were smooth, he did not complain of discomfort after eating liquid food, and he was discharged with an intestinal obstruction catheter. Four weeks after operation, the patient ate normally, exhausted and defecated normally, and the intestinal obstruction catheter was removed. The patient was followed up for 3 months without recurrence.

fecal incontinence (FI) refers to the involuntary discharge of liquid or solid feces at least twice within 4 weeks (Rome IV diagnostic criteria)^[1]。 According to the nature of fecal incontinence, it can be divided into sensory incontinence and motor incontinence (also known as urgency incontinence). This disease belongs to female pelvic floor dysfunction disease (PFD) together with urinary incontinence, pelvic organ prolapse and sexual dysfunction.

Autophagy and apoptosis are active or stress metabolic processes widely existing in eukaryotes, and are one of the key factors to maintain the dynamic balance between biosynthesis and catabolism of intracellular proteins. The disruption of the balance will cause tumor cell growth and cell death, so autophagy and apoptosis, two kinds of programmed cell death (PCD), play an important role in maintaining cell survival and development^[1]。 In mammalian cells, a series of autophagy-related proteins (ATGS) such as ATG4, ATG5, Beclin-1 (yeast ATG6 homologue) and ATG12 are involved in the molecular regulatory network of autophagy and apoptosis^{[2,3,4,5,6,7]}。 In this paper, the research progress of autophagy-related protein ATG5 regulating autophagy and apoptosis was reviewed, which laid a foundation for further research on the molecular mechanism of ATG5 regulating autophagy and apoptosis.

autoimmune encephalitis (AE) refers to the abnormal immune response of the body to the antigenic components of neurons, resulting in local or extensive central nervous system (CNS) lesions. With the development of neuroimmunological research and the advancement of autoantibody serological examination methods, since the discovery of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in 2007, new autoantibodies against neuronal cell surface or synaptic proteins have been continuously discovered, which has deepened people's understanding of autoimmune encephalitis. 2014 Sabater et al.^[1]Eight patients with sleep disorders as a prominent feature were found, who shared a common antibody acting on neuronal surface antigens-anti-Iglon5 antibody. Unlike previous autoimmune encephalitis, the disease was of chronic progressive course, characterized by abnormal sleep and sleep apnea. Genetic testing found HLA-DRB1*1001 and HLA-DQB1*0501 alleles, and serum or cerebrospinal fluid (CSF) IgLON5 antibody positivity. Because the disease is rare, clinicians don't know enough about it, and it is easy to neglect the detection of IgLON5 antibody, which is misdiagnosed as neurodegenerative disease. This article discusses the pathogenesis, clinical characteristics, diagnosis, differential diagnosis, treatment and prognosis of anti-Iglon5 antibody-related encephalopathy.