Volume 98  ·  Issue 13  ·  2018

Dementia is a clinical syndrome with cognitive dysfunction and decreased ability to do daily activities as the main manifestations, and mild cognitive impairment is an intermediate stage between normal aging and dementia. China's epidemiological survey shows that the total prevalence of dementia among people aged 65 and above is 5.14% ~7.3%^[1]The prevalence of mild cognitive impairment was as high as 20.8%^[2]。 According to this calculation, there are about 8 million patients with dementia and about 24 million patients with mild cognitive impairment among the elderly in China, which pose a huge challenge to China's social and economic development. However, the number and level of memory clinics and dementia specialists in general hospitals in China are far from meeting the needs of the rapid increase of dementia patients in the aging society^[3]。

Hyperuricemia is an abnormal increase in blood uric acid levels due to abnormal purine metabolism in the body. When the concentration of uric acid in the body exceeds its solubility, uric acid is easily precipitated to form urate crystals, which are deposited in the joints and surrounding tissues, causing gouty arthritis. Acute attack of gout is a typical acute inflammatory reaction, mainly manifested by redness, swelling, heat, pain and functional limitation of the affected joint and its surrounding tissues. In addition to gouty arthritis, increased blood uric acid is also closely related to diabetes, metabolic syndrome, hypertension, coronary heart disease and heart failure. Therefore, in addition to the acute inflammatory response during an acute gout attack, the process of uric acid metabolism is also involved in the chronic inflammatory response in a variety of diseases.

dementia is a syndrome that centers on acquired cognitive impairment and leads to a significant decrease in the ability of daily living, learning, working and social interaction. Patients' cognitive impairment involves memory, learning, orientation, understanding, judgment, calculation, language, visual-spatial function, analysis and problem-solving abilities, and is often accompanied by mental, behavioral and personality abnormalities at a certain stage of the disease course. Dementia is described as a "neurocognitive disorder" in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V) of the American College of Psychiatry. World Health Organization's International Classification of Diseases, 10th Edition (the International Statistical Classification of Diseases and Related Health Problems 10th Revision, ICD-10) The diagnosis of dementia needs to be confirmed by medical history inquiry and neuropsychological examination to confirm mental decline.

The diagnosis of Alzheimer's disease (AD) has made great progress in the past three decades. In terms of diagnosis, new standards are continuously introduced, which greatly improve the accuracy of diagnosis. However, the treatment is still based on improving symptoms, preventing the further development of dementia, maintaining residual brain function, and reducing complications.

To observe the correlation between the different ultrasonic manifestations of gouty arthritis and the indexes of bone destruction (Dickkopf-1, RANKL), in order to further explore the role of musculoskeletal ultrasonography in the diagnosis and monitoring of gouty arthritis.

160 cases of gouty arthritis from clinic of the Department of Rheumatology of Peking University People′s Hospital between July 2016 and June 2017 were recruited in this study. These patients were examined by musculoskeletal ultrasonography (bilateral first metatarsophalangeal joints, bilateral ankle joints and bilateral knee joints). Grouping was based on ultrasound features of joints. Group A showed no aggregate .Group B showed aggregate and double contour signs. Group C showed tophus and bone erosion. Serum concentrations of Dickkopf-1 and RANKL were measured. The correlations of Dickkopf-1 or RANKL and clinical/laboratory parameters were analyzed.

(1)There was a significant difference in Dickkopf-1 concentration between the three groups(P<0.001). And the group C[(1 722.2±482.7)ng/L]was higher than the group B[(1 309.3±496.4)ng/L](t=4.418, P<0.001), and the group B was higher than group A[(807.9±373.8)ng/L](t=6.137, P<0.001). (2)There was a significant difference in RANKL concentration between the three groups (P<0.001). And the group C[(0.78±0.47)ng/L]was higher than the group B[(0.35±0.29)ng/L](t=5.456, P<0.001), and the group B was higher than group A[(0.10±0.09)ng/L](t=6.923, P<0.001). (3)The level of Dickkopf-1 was associated with the disease duration(r=0.430, P<0.001), and the level of RANKL was associated with the disease duration(r=0.359, P<0.001).

Aggregates, double contour signs, tophus and bone erosion can be observed in the ultrasonic examination of gouty arthritis. And the longer the duration of the disease, the more likely the extent of bone destruction is. Joint ultrasound can be the first imaging examination for the extent of joint involvement in gouty arthritis. And the longer the duration of the disease, the more likely the extent of bone destruction is. Musculoskeletal ultrasonography can be the preferred imaging method for detecting the extent of joint involvement in gouty arthritis.

to investigate the clinical characteristics and disease activity in ankylosing spondylitis (AS) patients with hyperuricemia.

Laboratory tests, magnetic resonance imaging, disease activity and functional index of AS patients from Fudan University Zhongshan Hospital were collected. T test, square test were applied to investigate the difference between AS patients with hyperuricemia and AS patients with normal serum uric acid in clinical characteristics and disease activity in AS patients.

Among all the AS patients, 23.4% (22/94) patients accompanied with hyperuricemia. AS patients accompanied with hyperuricemia showed significant younger age (28.9±7.9 vs 35.8±11.1, P=0.002); higher serum alanine aminotransferase (33.6±23.6 vs 19.8±12.4, P=0.014), aspartate aminotransferase (23.8±8.7 vs 18.6±9.6, P=0.025) and creatinine (78.4±12.5 vs 69.8±13.3, P=0.009), lower Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) (11.2±8.8 vs 17.9±12.0, P=0.027) and Bath Ankylosing Spondylitis Functional Index (BASFI) (0.7±0.9 vs 1.8±2.2, P=0.002) compared with AS patients whose serum uric acid level is normal.

AS Patients with younger age, impaired hepatic and renal funtion and lower scores in BASDAI and BASFI tend to accompany with hyperuricemia.

To investigate the prevalence of hyperuricemia and the distribution of serum uric acid in young students.

Determination of 14 214 cases of freshmen, 3 072 cases of the graduate and 6 804 cases of school staff in 2015-2016 from one University of Beijing with uric acid (UA) enzymatic method, hyperuricemia criteria for male UA >420 μmol/L, female UA >357 μmol/L, were grouped according to age. From freshmen in 2016 randomly selected 1 782 cases men and 1 175 cases women through the questionnaire to investigate the prevalence of gout.

The prevalence of hyperuricemia in male and female freshmen were 34.47% (1 958/5 681) and 11.64% (993/8 533) respectively. The prevalence of hyperuricemia in male and female graduates were 32.73% (381/1 164) and 10.06% (192/1 908) respectively. In the same period, the prevalence of hyperuricemia was 14.42% (480/2 844) among male workers and 9.92% (393/3 960) among female workers. The blood uric acid level was analyzed among the freshmen in 2015-2016 and the graduates in 2015, most freshmen were 420-480 μmol/L in males and 357-480 μmol/L in females. The prevalence of gout was 0.34% (6/1 782) in males and 0.26% (3/1 175) in females respectively (which had at least one attack of the first metatarsophalangeal joint and non-traumatic articular pain and swelling of the knee). In addition, there was no significant difference in the prevalence of hyperuricemia in coastal and inland areas ( P>0.05). There was significant difference in the proportion of BMI in male and female newborns with hyperuricemia (P<0.05).

The young men of high uric acid hematic disease prevalence showed a trend of increased significantly, male and female serum UA value most in mild-to-moderate elevated levels, and a lower incidence of gout. Compared with the general population, BMI of the freshmen with hyperuricemia increased significantly.

To observe the expression of fibroblast growth factor 23 (FGF23) and FGFR4 in patients with atrial fibrillation (AF) and its relationship with atrial fibrosis.

Fifty-one patients with rheumatic heart disease undergoing cardiac surgery at the Second Affiliated Hospital of Nanchang University from October 2016 to April 2017 were divided into two groups according to whether they were complicated with atrial fibrillation: 39 patients with persistent AF(AF group), and 12 patients with sinus rhythm (SR group). The right atrial appendage was cut out during cardiac surgery. The expression of FGF23 and FGFR4 mRNA was detected by quantitative real-time PCR. The expression of FGFR4 protein was detected by Western blot. Atrial structure was evaluated by echocardiography. Masson staining was used to evaluate the degree of atrial fibrosis. The expression of FGF23 and FGFR4 was compared between the two groups.Additionally, the relationship between FGF23 and FGFR4 expression and atrial fibrosis was evaluated.

AF group had significantly higher right and left atrial diameter than SR group((40.1±1.6 )mm vs (34.1±1.5)mm, (52.4±2.9)mm vs (41.3±2.4)mm, all P<0.05) . There were no statistically significant differences in age, gender, ejection fraction between the two groups. The expression of FGF23 and FGFR4 mRNA in AF group were significantly higher than those in SR group (1.93±0.32 vs 0.93±0.14, 1.89±0.17 vs 0.91±0.11, bothP<0.05). Compared with the SR group, the protein expression of FGFR4 in the AF group was significantly higher(1.76±0.21 vs 0.84±0.12). In AF group, there was no correlation between FGF23 mRNA and atrial diameter (r=0.274 (left atrial), r=0.238 (right atrium), both P>0.05). Meanwhile, FGFR4 mRNA and protein expression had no correlation with atrial diameter either. There was positive correlation between FGF23 mRNA and atrial collagen volume fraction in AF group (r=0.42, P<0.05). The expression of FGFR4 mRNA and protein were positively correlated with the atrial collagen volume fraction (r=0.573, r=0.478, all P<0.05).

The expression of FGF23 and FGFR4 in atrial fibrillation patients is increased, which is positively correlated with atrial fibrosis, suggesting that FGF23/FGFR4 pathway may play an important role in atrial fibrillation by promoting atrial fibrosis.

To investigate the clinical value of stereo-electroencephalography guided radiofrequency thermos-coagulation (RFTC) in drug resistant temporal epilepsy.

The clinical data of 12 patients with refractory temporal epilepsy who underwent implantation of SEEG electrodes and radiofrequency thermos-coagulation from July 2016 to November 2017 were analysed retrospectively.

The mean follow-up time was 6.4±4.6 months after thermos-coagulation, and 10.2±3.5 months after resection. Engel Ⅰa was observed in 9 cases, with Ⅱa, Ⅲa and Ⅳa 1 cases respectively. Nine patients experienced a ≥50% decrease of seizure frequency after RFTC (R+ , 75%), of whom one had got a sustained seizure free for 15 months and the other with decrease of seizure frequency by over 90% for 14 months. There was a statistical significance in seizure frequency between pre- and post-thermo-coagulation (P=0.008). Ten cases underwent open surgery following SEEG-guided RFTC, of them 8 cases got seizure free. RFTC was effective in 6 of 8 cases. In our group, all patients have not suffered from any neurologic and cognitive deficiency, and even several patients have some improvements on memory quotient.

Although it is less effective than resective surgery, SEEG-guided RFTC can be a relatively safe, effective treatment because of its precision and minimal invasion for patients with complex drug resistant temporal epilepsy, especially for impossible any cortical resection. In addition, its effect may be a predictor of outcome after conventional cortectomy.

To analyze the biomechanics changes of lumbar spine caused by foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy using the finite element method.

Three healthy adult males (aged 35.6 to 42.3 years) without spinal diseases were enrolled in this study and 3D-CT scans were carried out to obtain the parameters of lumbar spine. Mimics software was applied to build a 3D finite element model of lumbar spine. Graded resections (1/4, 2/4, 3/4 and 4/4) of the left superior articular process of L₅ were done via percutaneous transforaminal endoscopic lumbar discectomy. Then, the pressure of the L_4/5 right facets, the pressure of the L_4/5 intervertebral disc and the motion of lumbar spine were recorded after simulating the normal flexion and extension, lateral flexion and rotation of the lumbar spine model during different resections. The data were compared among groups with analysis of variance.

Comparing with the normal group, after 1/4 resection of the left superior articular process of L₅, the pressure of the L_4/5 right facets showed significant differences during left lateral flexion and rotation of lumbar spine (q=8.823, 8.248, both P<0.05); and the pressure of L_4/5 intervertebral disc also changed significantly during extension and right rotation of lumbar spine (q=6.918, 6.438, both P<0.05); the motion of lumbar spine showed obvious differences during right lateral flexion and rotation (q=6.845, 7.772, 13.58, all P<0.05). Comparing with the normal group, after 2/4 resection of the left superior articular process of L₅, the pressure of the L_4/5 right facets presented significant differences during all conditions (q=5.670-17.830, all P<0.05); the pressure of L_4/5 intervertebral disc changed significantly during flexion, extension, lateral flexion and right rotation (q=5.260, 17.150, 5.727, 8.890, 15.660, all P<0.05); the motion of lumbar spine also existed differences during extension, lateral flexion and rotation (q=9.106, 5.431, 12.060, 11.160, 17.260, all P<0.05). However, after 3/4 resections, the pressure of the L_4/5 right facets, the pressure of the L_4/5 intervertebral disc and the motion of lumbar spine presented differences during all conditions when compared with those in normal group (q=6.303-25.48, all P<0.05). After 4/4 resections, the pressure of the L_4/5 right facets and the pressure of the L_4/5 intervertebral disc and the motion of lumbar spine showed significant differences during all conditions when compared with those in normal group (q=8.065-45.70, all P<0.05).

The biomechanics and the stability of lumbar spine changed partly after 1/4 resection of the superior articular process and obviously after more than 2/4 is resected. The superior articular process should be paid more attention during foraminotomy via percutaneous transforaminal endoscopic lumbar discectomy.

To observe the effect of sepsis single-disease manage system on the improvement of sepsis treatment and the value in predicting mortality in patients with sepsis.

A retrospective study was conducted. Patients with sepsis admitted to the Department of Surgical Intensive Care Unit of Sun Yat-Sen University First Affiliated Hospital from September 22, 2013 to May 5, 2015 were enrolled in this study. Sepsis single-disease manage system (Rui Xin clinical data manage system, China data, China) was used to monitor 25 clinical quality parameters, consisting of timeliness, normalization and outcome parameters. Based on whether these quality parameters could be completed or not, the clinical practice was evaluated by the system. The unachieved quality parameter was defined as suspicious parameters, and these suspicious parameters were used to predict mortality of patients with receiver operating characteristic curve (ROC).

A total of 1 220 patients with sepsis were enrolled, included 805 males and 415 females. The mean age was (59±17) years, and acute physiology and chronic health evaluation (APACHE Ⅱ) scores was 19±8. The area under ROC curve of total suspicious numbers for predicting 28-day mortality was 0.70; when the suspicious parameters number was more than 6, the sensitivity was 68.0% and the specificity was 61.0% for predicting 28-day mortality. In addition, the area under ROC curve of outcome suspicious number for predicting 28-day mortality was 0.89; when the suspicious outcome parameters numbers was more than 1, the sensitivity was 88.0% and the specificity was 78.0% for predicting 28-day mortality. Moreover, the area under ROC curve of total suspicious number for predicting 90-day mortality was 0.73; when the total suspicious parameters number was more than 7, the sensitivity was 60.0% and the specificity was 74.0% for predicting 90-day mortality. Finally, the area under ROC curve of outcome suspicious numbers for predicting 90-day mortality was 0.92; when suspicious outcome parameters numbers was more than 1, the sensitivity was 88.0% and the specificity was 81.0% for predicting 90-day mortality.

The single center study suggests that this sepsis single-disease manage system could be used to monitor the completion of clinical practice for intensivist in managing sepsis, and the number of quality parameters failed to complete could be used to predict the mortality of the patients.

To quantitatively evaluate the quality of advanced modeled iterative reconstruction (ADMIRE) combined with 70 kVp and linear blending images in low dose dual energy (70 kVp/sn150 kVp) pulmonary angiography.

A total of 74 cases with normal BMI underwent dual-source CT dual-energy pulmonary angiography with small amount of contrast medium (30 ml) from 2015 to 2017 from the First Affiliated Hospital of Zhengzhou University were randomly assigned to protocol Ⅰ(100 kVp/sn140 kVp) or protocol Ⅱ(70 kVp/sn150 kVp). 70 kVp+ ADMIRE (group 1), linear blending+ ADMIRE (group 2), 100 kVp+ SAFIRE (group 3) images were obtained. CT value and noise standard deviation (SD) of pulmonary arteries were measured in pulmonary trunk artery, left pulmonary artery and left superior pulmonary artery, then SNR and CNR were calculated. Radiation dose parameters (CTDIvol, DLP) were recorded.

CT values of pulmonary artery of group 1 were significantly higher than those in group 2 and 3 (both P<0.05). In group 2, SD value of pulmonary artery was lower than that of group 1 and 3(bothP<0.05). SD value of pulmonary trunk and left pulmonary artery in group 1 was higher than that in group 3 (P<0.05), SD value of left superior pulmonary artery had no significant difference between group 1 and group 3 (P>0.05). SNR and CNR value in group 1 and group 2 had no statistical difference, but they were both higher than that in group 3 (bothP<0.05). The effective dose of protocolⅠwas 46% lower than protocol Ⅱ.

ADMIRE combined with 70 kVp and linear blending images are better than SAFIRE combined with 100 kVp images, and radiation dose is reduced.70 kVp/sn150 kVp with small amount of contrast medium (30 ml) is a feasible dual energy pulmonary artery scanning protocol.

To explore the effect of anterior circulation transient ischemic attack (TIA) on early neurological deterioration (END) in patients with ipsilateral ischemic stroke and its mechanism.

(1) One hundred and thirteen patients with ipsilateral ischemic stroke and 36 healthy volunteers (healthy control group) in Neurology Department of Tianjin Medical University General Hospital from November 2014 to July 2015 were recruited into this study. According to whether got TIA before ischemic stroke, patients were divided into simple ischemic stroke group (CI group, n=87) and TIA-CI group (n=26). Their END, NIHSS score, 3-month mRS score, infarct size, serum hs-CRP and other risk factors were compared. (2) The peripheral blood mononuclear cells (PBMCs) were extracted from peripheral blood of TIA-CI group and CI group at 24 h, the 3 th day, the 7 th day and 12th day after ischemic stroke onset. At the same time, PBMCs of control group were collected. Western blot was carried out to evaluate the expression of nuclear factor-κB (NF-κB). Immunofluorescence was used to detect the cytoplasmic-to-nuclear shuttling of NF-κB.

(1) The incidence of END, NIHSS score at discharge, 3-month mRS score and serum hs-CRP level were significantly lower whereas the infarct size was significantly smaller of TIA-CI group than CI group (11.5% vs 31.0%, 1.9±2.3 vs 3.3±3.7, 0.9±0.8 vs 1.8±1.8, 1.1(0.3, 2.5) cm³ vs 2.4(0.5, 22.8) cm^3, (2.5±3.2) mg/L vs (6.2±3.2) mg/L, all P<0.05) . hs-CRP was positively correlated with END (r=0.311, P<0.05). (2) Expression of NF-κB: ① Compared with control group, the NF-κB expression increased first and then decreased in both of the two patient groups, and it decreased earlier in TIA-CI group than CI group.②In each time point, NF-κB expression of TIA-CI group was lower than CI group(t=1.754, P<0.05;t=1.858, P<0.05;t=0.609, P<0.05;t=0.519, P<0.05). (3) Activity of NF-κB: Most of NF-κB were inactivation and located in cytoplasm of control group. NF-κB of TIA-CI group and CI group was activated and translocated from cytoplasm into nuclear at the 24 h and 3 th day after ischemic stroke. At the 7 th day and 12th day, the accumulation of NF-κB in nuclear decreased and most of them located in cytoplasm in TIA-CI group, whereas most of NF-κB still located in nuclear in CI group. The activated station of NF-κB lasted shorter in TIA-CI group than CI group.

TIA can reduce the incidence of END in patients of ipsilateral ischemic stroke. Its protective effect may relate with the inhibition of inflammation which induced by NF-κB.

To investigate the influence of intravenous thrombolysis on prognosis of acute ischemic stroke in patients with moderate to severe leukoaraiosis and to analyze influencing factors of the clinical prognosis.

We consecutively included acute ischemic stroke patients with middle cerebral artery occlusion (n=101) from Department of Neurology or Emergency, and patients were divided into two groups according to whether on intravenous thrombolysis therapy (IVT) or not. The Fugl-Meyer scale score (FMS) was used to assess motor function outcome and the National Institutes of Health Stroke Scale (NIHSS) score was used to assess neurologic function. Clinical data were obtained and compared between the two groups. Patients were followed up for 90 days, the primary clinical endpoint events included stroke recurrence and death, and the key secondary endpoint events included other vascular events after IVT. Multivariate linear regression analysis was used to analyze the relevant factors influencing the motor function 90 days later.

Among the 101 enrolled patients, 37 (36.6%) were classified as IVT group and 64 (63.4%) as no IVT group. In IVT group, hemorrhagic transformation and symptomatic intracranial hemorrhage were observed in 32.4% (12/37) and 13.5% (5/37) of the patients, which were higher than those in the no IVT group (9.4% (6/64) and 1.6% (1/64) , respectively) (χ²=8.511, P=0.004; χ ²=5.993, P=0.014). And there was no significant difference between the two groups in NIHSS score and FMS score at any time point. In addition, there was no significant increase in 90-day FMS score in the two groups compared with the FMS score on admission (83±9 vs 80±12; 86±8 vs 80±10). After followed up for 90 days, the primary clinical endpoints were obtained in 32 patients (32/101; 31.9%), including 18 cases of stroke recurrence (18/101; 17.8%) and 14 cases of death (14/101; 13.9%). No significant difference was found in primary clinical endpoints between the two groups. Multivariate linear regression analysis revealed that symptomatic intracranial hemorrhage (t=-2.318; P=0.023), baseline NIHSS score (t=-4.263; P=0.000), recurrent stroke (t=-9.114; P=0.000) and hemorrhage transformation (t=-2.121; P=0.037) were risk factors of poor 90-day motor function recovery, but not application of intravenous thrombolysis therapy (t=0.328; P=0.744).

Acute ischemic stroke patients with moderate to severe LA have higher risk of hemorrhagic transformation and symptomatic intracranial hemorrhage after intravenous thrombolysis. However, there is no association of intravenous thrombolysis therapy with motor function recovery.

The linear no threshold (LNT) model in the field of radiation protection was proposed by Hermann Muller (1946 Nobel Prize in Physiology or Medicine), and has been used by countries around the world to formulate radiation safety guidelines, regulations and policies. The theory is that there is no safe level of radiation in the world, and ionizing radiation can induce cancer no matter how small the dose. Therefore, although 95% of medical radiographic images (X-ray, CT, PET) involved radiation doses below 20 mSv [author's note: to avoid confusion for readers, the radiation dose unit of different studies is unified as "mSv" (millisieverts). The average background radiation of the Earth is 2 to 3 mSv per year], according to the LNT model, these radiations still induce cancer, forming the iatrogenic cancer risk theory. However, the gene mutation rate caused by LNT model in the range of low-dose ionizing radiation is not supported by scientific data, and only extrapolated from the gene mutation rate caused by high-dose radiation. In addition, many studies on the biological effects of low-dose ionizing radiation have been published in recent years, which makes more and more people question the correctness of LNT model applied to low-dose ionizing radiation range, including the field of medical radiography.

autophagy is a basic metabolic process for cells to maintain their homeostasis, which is crucial for the removal of proteins, organelles and other substances that need to be degraded in healthy cells and the reuse of useful components. Dysfunctional autophagy is related to a series of diseases such as tumors, neurodegenerative diseases, cardiovascular diseases, blood diseases, endocrine and autoimmune diseases. Recent studies have shown that autophagy is involved in the development of lymphocytes and plays an important role in maintaining immune system homeostasis and function. Rheumatism refers to a group of diseases that mainly involve bones, joints and soft tissues. It is closely related to the autoimmune system and can cause joint inflammation and damage to various tissues and organs. A deeper understanding of the regulatory role of autophagy will deepen the understanding of the pathogenesis of rheumatism and provide new therapeutic targets. In this paper, the mechanism of autophagy, the relationship between autophagy and immune system, and its relationship with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoarthritis and other common rheumatic diseases are reviewed as follows.

painful diabetic peripheral neuropathy (pDPN or painful diabetic neuropathy, PDN) is a typical peripheral neuropathic pain in diabetic peripheral neuropathy (DPN) characterized by pain symptoms. With the exploration of diabetic peripheral neuropathy and pain related fields, pDPN has gradually been recognized by the medical science community from basic research to clinical practice. From 2008 to 2013, the international community published a series of related diagnosis and treatment guidelines^[1,2,3,4]And expert consensus^[5]In the field of physician continuing education and patient management, it provides clinical management norms for this disease. In 2012, the Neurology Branch of Chinese Medical Association published the "Consensus on Diagnosis and Treatment of Painful Peripheral Neuropathy", which introduced the characteristics, diagnosis process and treatment recommendations of pDPN as a typical type of painful peripheral neuropathy^[6]。 At present, the relevant data of relevant specialists in China on pDPN disease and their cognition of diagnosis and treatment are unknown. We summarize the relevant data surveys of specialists and patients' cognition of diseases or diagnosis and treatment in Europe, America and other Asian countries in recent years, in order to attract everyone's attention to pDPN disease and further promote the standardized diagnosis and treatment of pDPN.

Artificial joint replacement is the main method to reconstruct joint function. periprosthetic joint infection (PJI) is a serious complication after prosthetic replacement, which will seriously affect the prognosis^[1]It brings a huge economic and psychological burden to patients, and will improve the postoperative mortality rate of patients. The diagnostic criteria of PJI proposed by the American Musculoskeletal Infection Association (MSIS) in 2011 have been internationally recognized^[2]However, in clinical practice, some patients with PJI do not fully meet the MSIS criteria, and comprehensive evaluation by clinical workers is required. This article reviews the progress of PJI diagnosis and its influencing factors.