Volume 98  ·  Issue 17  ·  2018

Brain tumors occur in the human brain, and the brain is the most important organ in the human body. It is in charge of basic life activities such as respiration and heartbeat, nervous functions such as language and motor, and emotional psychology and advanced cognitive functions. Brain tumors mainly occur in young and middle-aged people. Because of the "three highs" characteristics of high surgical mortality, high disability rate and high postoperative recurrence rate, it has become one of the most harmful diseases to human health.

Intraoperative neuroelectrophysiological monitoring (IONM) refers to the technique of applying various neuroelectrophysiological techniques to monitor the functional integrity of the nervous system at risk during surgery. IONM has become an indispensable means to monitor nerve function in real time, reduce nerve damage and improve surgical quality. Nowadays, intraoperative neuroelectrophysiological monitoring needs to use a variety of monitoring methods, which requires the cooperation of surgeons, anesthesiologists and neuroelectrophysiological monitoring doctors to achieve the purpose of neurological function protection. Therefore, standardized operation is needed to ensure the completion of monitoring purpose. Therefore, the Expert Committee on Neuroelectrophysiological Monitoring of Neurosurgery Branch of Chinese Medical Doctors Association organized the writing of "Chinese Intraoperative Electrophysiological Monitoring Standards for Neurosurgery (2017 Edition)".

mild cognitive impairment (MCI) refers to the progressive decline of memory or other cognitive functions, but does not affect the ability to live daily, and does not meet the diagnostic criteria for dementia^[1]。 The diagnostic criteria of MCI were first proposed by Petersen et al. in 1999, and the criteria have been widely recognized and applied. However, this criterion is too limited in the diagnosis of MCI, mainly in the diagnosis of amnestic MCI. In 2003, the international working group revised the diagnostic criteria of MCI, which is also the widely used diagnostic criteria of MCI at present. The criterion classifies MCI into four subtypes, namely, single cognitive domain amnestic MCI, multi-cognitive domain amnestic MCI, single cognitive domain non-amnestic MCI, and multi-cognitive domain non-amnestic MCI^[2]。 In addition, the standard also explains the etiology of MCI more comprehensively, such as Alzheimer's disease, cerebral small vessel disease, Lewy body disease, frontotemporal degeneration and other slow-onset dementia types before the clinical symptoms reach dementia, mild pathological changes can cause MCI. Brain trauma, encephalitis, nutritional deficiency, etc. can lead to long-lasting MCI. Although the 2011 standards of the National Institute on Aging (NIA), the 2011 standards of the Alzheimer's Association (ADA), and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of 2013 have been updated for MCI caused by Alzheimer's disease and the diagnostic criteria for MCI, the basic contents are consistent with the 2003 diagnostic criteria for MCI^[3]。

To explore the clinical and teaching application value of virtual reality technology in preoperative planning and intraoperative guide of glioma located in central sulcus region.

Ten patients with glioma in the central sulcus region were proposed to surgical treatment. The neuro-imaging data, including CT, CTA, DSA, MRI, fMRI were input to 3dgo sczhry workstation for image fusion and 3D reconstruction. Spatial relationships between the lesions and the surrounding structures on the virtual reality image were obtained. These images were applied to the operative approach design, operation process simulation, intraoperative auxiliary decision and the training of specialist physician.

Intraoperative founding of 10 patients were highly consistent with preoperative simulation with virtual reality technology. Preoperative 3D reconstruction virtual reality images improved the feasibility of operation planning and operation accuracy. This technology had not only shown the advantages for neurological function protection and lesion resection during surgery, but also improved the training efficiency and effectiveness of dedicated physician by turning the abstract comprehension to virtual reality.

Image fusion and 3D reconstruction based virtual reality technology in glioma resection is helpful for formulating the operation plan, improving the operation safety, increasing the total resection rate, and facilitating the teaching and training of the specialist physician.

To investigate the effect of the second-stage transcranial and transsphenoidal approach for giant pituitary tumors.

A retrospective review of 21 patients, who had undergone the transcranial surgery and then transsphenoidal surgery for giant pituitary adenomas from 2012 to 2015 in the neurosurgery department of West China Hospital, was performed. Visual findings, endocrine presentation, complications, and tumor types were collected. All data were based on clinical feature, MRI, and follow-up.

Among the 21 cases, gross total resection of tumor was achieved in 7 of all patients, subtotal in 11, and partial in 3. No intracranial hemorrhage or death occurred postoperatively. Postoperative infectionoccurred in one patient and cerebrospinal fluid leakage occurred in 3 patients. Four patients recovered after treatment.

According to the clinical feature and MRI, it is safe and effective to choose the transcranial surgery and then transsphenoidal surgery for specific giant pituitary adenomas, which can improve treatment effects and reduce postoperative complications.

To study the value of neuroendoscopy assisted microneurosurgery technique in the treatment of posterior cranial fossa lesion.

Clinical data of 36 patients with posterior fossa lesions who accepted neuroendoscopy assisted microneurosurgery (NEAM group) in the department of neurosurgery of the First Affiliated Hospital of Chongqing Medical University, from January 2014 to December 2016, were retrospectively enrolled. A total of 113 cases diagnosed with the same lesions and accepted conventional microneurosurgery (non-NEAM group) in the same period were analyzed as control group. The total tumor resection rate, postoperative leakage of cerebrospinal fluid, intracranial infection, operating time and the recovery of facial nerve function were compared between the two groups.

Ninety-three patients with acoustic neuroma were analyzed, which were divided into non-NEAM group 78 cases (removed posterior lip of internal auditory canal in different degrees) and NEAM group 15 cases (not removed posterior lip of internal auditory canal). The total tumor resection rate and postoperative facial nerve function had no significant statistical differences between two groups. The operating time of NEAM group was longer than that of non-NEAM group (P=0.048, P<0.05), but the rate of leakage of cerebrospinal fluid and intracranial infection did not increase. Twenty-seven cases were diagnosed with cerebellopontine angle cholesteatoma. These cases were divided into two groups, 17 cases in non-NEAM group and 10 cases in NEAM group. NEAM group have higher total tumor resection rate (P=0.014, P<0.05), better short-term postoperative facial nerve function (P=0.039, P<0.05), and longer operating time (P=0.015, P<0.05), compared with non-NEAM group. No significant statistical differences were observed on long-term postoperative facial nerve function and postoperative complications. Of the 16 cases diagnosed tentorial meningioma, 10 cases were in non-NEAM group and 6 cases in NEAM group. Six cases in non-NEAM group and 4 cases in NEAM group were total removal. For the mean operating time, non-NEAM group was (6.6±1.0) hours and NEAM group was (7.1±0.7) hours. Thirteen cases were with fourth ventricular cholesteatoma, which all were totally resected, and 8 cases were in non-NEAM group and 5 cases in NEAM group. For non-NEAM group, 5 cases dissected cerebellar vermis and the mean operating time is (6.0±0.7) hours. However, NEAM group all did not dissect cerebellar vermis and the mean operating time is (6.4±0.4) hours.

Neuroendoscopy assisted microneurosurgery for cranial fossa lesions was benefit to totally resect tumor and reduce unnecessary injury. It needed longer operating time, but not increase postoperative intracranial infection.

To investigate the effectiveness and clinical significance of dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas.

From January 2011 to December 2016, a cohort of 28 patients with medial tentorial meningiomas were treated by microneurosurgery at the First Affiliated Hospital of Chongqing Medical University. Patients who treated intraoperatively with dynamic retraction surgery from January 2014 to December 2016 were assigned into dynamic retraction group, and those with fixed retractors intraoperatively from January 2011 to December 2013 were assigned into retractor group. The surgical approaches tailored in our patients were based on predominant direction of tumor extension. The extent of tumor resection was scored according to the Simpson′s classification scale. Comparisons of tumor size, operation time, hospitalization time, retraction-related injury, tumor Simpson resection grade and Karnofsky Performance Scale(KPS) score six months after surgery were also made between two groups.

A total of 12 patients(retractor group) were treated with the use of self-retaining brain retractors intraoperatively and dynamic retraction surgical procedure was performed intraoperatively in 16 patients(dynamic retraction group). The difference between two groups with regard to sex, age, tumor size, operation time and tumor Simpson resection grade was not statistically significant(all P>0.05). The mean duration of hospital time was shorter in the dynamic retraction group than that in the retractor group(18.3 d±1.8 d vs 20.2 d±1.3 d,P=0.004). The dynamic retraction group had lower incidence of retraction-related injury compared with the retractor group(1/16 vs 6/12), P=0.022]. The dynamic retraction group had better neurological recovery rate with KPS >80 evaluated six months after surgery compared with the retractor group(14/16 vs 5/12, P=0.017).

Dynamic retraction microneurosurgery for the treatment of medial tentorial meningiomas is feasible, which can obviate or reduce the amount of brain retraction needed, and may be of help in lowering the risk of postoperative neurological deficits and complications and leading to reduced hospitalization cost and improved surgical outcomes.

To investigate the polymorphism of BIN1 and ApoE genes in amnestic mild cognitive impairment (aMCI) patients in Tujia minority area of Enshi, Hubei.

A total of 107 patients with aMCI (aMCI group) and 150 healthy people (healthy control group) during the same period were included between December 2016 and October 2017 in Affiliated Minda Hospital of Hubei University for Nationalities, who were all the Tujia nationality. Three single nucleotide polymorphic site of BIN1 gene rs744373, rs7561528, rs6733839, and two single nucleotide polymorphic site of ApoE gene rs429358, rs7412, and Genotyping and sub-genotyping of ApoE genes were tested using ligase detection reaction technique(LDR), and gene polymorphisms of BIN1 and ApoE were analyzed with Logistic regression analysis.

The basic information was not statistically significan different between healthy control group and aMCI group (P>0.05); there were no statistically significant in genotype distribution among the 3 SNPs of BIN1 gene(rs744373, rs7561528, rs6733839) and between the 2 SNPs of ApoE gene(rs429358, rs7412) and its allelic profile (P>0.05), which conformed to Hardy-Weinberg balance; BIN1 gene rs744373 polymorphic site allele C was the risk factor of aMCI (OR 2.33, 95% CI 1.09-4.98, P=0.029), especially BIN1 gene rs744373 polymorphic site recessive model CC/CT+ TT increased the risk of aMCI disease (OR 2.29, 95% CI 1.15-4.59, P=0.019). The difference in genotype distribution of ApoE sub-genotype ε2/2, ε2/3, ε2/4, ε3/3, ε3/4, ε4/4 and allele ε2, ε3, ε4 genes between two groups were significantly different ( P<0.05), Carrying ApoEε2 may be a protective factor for aMCI (OR 0.46, 95% CI 0.22-0.96, P=0.039) and carrying ApoE ε4 may be a risk factor for aMCI ( OR 2.13, 95% CI 1.18-3.83, P=0.012).

The incidence of aMCI in Tujia region of Enshi may be related to the rs744373 polymorphic site of BIN1 gene, ApoEε2 is the protective factor and ApoEε4 is the risk factor for aMCI in Tujia region of Enshi, but it still needs to be further verified by a large sample population.

To explore the clinical value of magnetic resonance diffusion tensor imaging (DTI) combined with 3D pseudo continuous arterial spin labeling (3D-pcASL) perfusion imaging in differential diagnosis of hyper-acute and acute ischemic cerebral infarction.

A total of 42 patients with confirmed unilateral ischemic cerebral infarction from February 2015 to October 2017 of Affiliated Yancheng Hospital of Southeast University Medical College were collected. DTI and 3D-pcASL images of hyper-acute (14 patients, group A) and acute (28 patients, group B) ischemic cerebral infarction were retrospectively analyzed. The slice with the biggest lesion on diffusion weighted imaging (DWI) was selected to measure the infarction area (S_DWI) and abnormal cerebral blood flow (CBF) perfusion area (S_CBF). Regions of interest (ROIs) were set on the infarction core (IC) area, mismatch area of S_CBF and S_DWI (MACD), and their corresponding contralateral regions. The values of CBF, average diffusion coefficient (DC_avg), and fractional anisotropy (FA) parameter images in these ROIs in patients with both S_CBF>S_DWI and lower perfusion in the IC were recorded. The relative values of each infarction lesion to its corresponding contralateral region (rCBF, rFA, and rDC_avg) were calculated. Differences of each parameter value between the IC, MACD and their corresponding contralateral regions and of the relative values between group A and group B were investigated.

The CBF and DC_avg values in the IC and the CBF value in the MACD were lower than that of their corresponding contralateral regions in both groups (P<0.05). The DC_avg in the MACD in group A patients and the FA in the IC in group B patients were lower than that in their corresponding contralateral regions (P<0.05). Compared to group A patients, group B patients showed decreased rFA, rDC_avg in the IC and rFA in the MACD, and increased rDC_avg and rCBF in the MACD (P<0.05). Receiver operating characteristics (ROC) curve analysis indicated that the best diagnosis cut off values of the rFA and rDC_avg values in the IC and the rCBF, rFA, and rDC_avg values in the MACD were 0.890 and 0.541 and 1.139, 0.902 and 0.455, respectively, for identifying two groups.

The changes of the CBF, FA, and DC_avg values and their relative values can be applied to differentially diagnose patients with hyper-acute and acute cerebral infarction, which could provide the basis for selecting more reasonable treatment protocols.

To evaluate the safety and effectiveness of application of LVIS stent-assisted coiling endovascular procedures in cerebral aneurysms .

The clinical data of 41 patients with intracranial aneurysms , which were performed in LVIS stent-assisted coiling endovascular therapies from June 2015 to October 2017 in The First Affiliated Hospital of Bengbu Medical College were analyzed retrospectively. 13 patients were unruptured and 28 patients were ruptured. Immediate angiography outcomes and follow-up angiography outcomes were assessed by DSA. Clinical outcomes were evaluated by modified Rankin Scale (mRS).

The LVIS stents were successfully delivered in 39 cases, however there were 2 cases in which the LVIS stents did not fully open.The technical success rate was 95.1%(39/41). There were 2 cases had complications during perioperation, the rate of complications was 4.9%(2/41). One was thrombus formation in operation, there was no nerve function defect.The other was infarction three days after operation and which had mild function defect(mRS grade 2). Raymond grade 1 was 31 cases, Grade 2 was 2 cases , grade 3 was 8 cases, the effective embolism rate was 80.5%(33/41). Mean follow up time was 14.4 months, 32 cases were cured, the cure rate was 78.0%(32/41), 2 cases were reappeared, the recurrence rate was 4.9%(2/41). mRS grade 0 was 16 cases, grade 2 was 24 cases , grade 2 was 1 case , the cure rate of clinical symptom is 100%.

LVIS stent-assisted coiling is safe and effective in the treatment of cerebral aneurysms.

To explore the effect of hyperuricemia on prognosis in patients with heart failure of coronary heart disease (CHD) after revascularization.

A single-center retrospective study of all subjects who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) as revascularization for CHD at Beijing Anzhen Hospital, Capital Medical University, between January 2005 and December 2014 was performed.Patients were divided into two groups by with or without hyperuricemia.The average follow-up was 1 818 d.

The Logistic regression analysis revealed that hyperuricemia was independent risk factors of readmission of heart failure(P=0.018, OR=1.499, 95%CI 1.071-2.098). The Cox regression analysis revealed that hyperuricemia was independent risk factor of all-cause mortality(P=0.002, RR=1.520, 95%CI 1.166-1.982), cardiovascular (CV) mortality(P=0.001, RR=1.811, 95%CI 1.279-2.566), heart failure mortality(P=0.006, RR=2.151, 95%CI 1.247-3.711).

There is negative correlation between level of uric acid and left ventricular ejection fraction (LVEF). The patients with heart failure of coronary heart disease complicated with hyperuricemia have high risk of readmission of heart failure, all-cause mortality, CV mortality andheart failure mortality than patients with normal uric acid level. Hyperuricemia is an independent risk factor for patients with heart failure of coronary heart disease after revascularization.

To evaluate the location, extent of viable myocardial of chronic total coronary occlusions(CTO)lesions by ¹⁸F-FDG PET myocardial metabolism imaging and then compare with coronary collateral circulation(CCC) to evaluate the prognostic evaluation in patients with CTO lesions.

A total of Sixty consecutive patients with CTO lesions referred for viability assessment from April 2016 to April 2017 in Department of Cardiology, Beijing Anzhen Hospital were included in the study. These patients underwent ^99mTc-sestamibi ECG-gated SPECT rest myocardial perfusion imaging and ECG-gated ¹⁸F-FDG PET/CT myocardial metabolic imaging, as well as coronary arteriography were recruited in this study. LV functional parameters(EDV, ESV, and LVEF) were analyzed by QGS software. The extent of CCC to the area of CTO related artery was graded as poorly, or well developed collaterals, assessed by Rentrop classification. All patients were followed up for a median of 17 months(range 12-20 months) and evaluated the changes of NYHA. Then the prognostic value of ¹⁸F-FDG PET myocardial metabolism imaging and CCC in patients with CTO lesions were analyzed and evaluated.

As the standard evaluation of NYHA in patients with CTO lesions after 12-20 months, fifty-three patients were assigned in this study. According to the changes of NYHA, the patients were divided into no progress group and progress group. There were no statistically difference in age, gender, high risk of CTO lesion and drugs in two groups, but there were significant statistical differences in myocardial parameters. LVEF was significantly increased in patients with CTO lesion in no progress group(42.3%±17.2% vs 22.2%±10.4%, P<0.01). The EDV and ESV in no progress group were significantly smaller than patients in progress group.The sensitivity(95.2% vs 75.7%) and specificity(62.8% vs 38.1%) of¹⁸F-FDG PET myocardial metabolism imaging was much better than CCC in the evaluation of prognosis in patients with CTO lesion.

¹⁸F-FDG PET myocardial metabolism imaging has important role in the prognosis of patient with CTO lesions when compared with CCC.

To investigate the diagnostic value of RESOLVE DWI in the evaluation of benign and malignant epithelial tumors of parotid gland.

A total of 106 patients in the First Affiliated Hospital of Zhengzhou University with epithelial tumors of parotid gland confirmed by pathology from July 2015 to October 2017 were retrospectively analyzed. All patients underwent preoperative routine MRI and RESOLVE DWI, the ADC average values were calculated, t test were used to compare the ADC values of benign and malignant epithelial tumors of parotid gland. Diagnostic performance of ADC value was compared using receiver operating characteristic (ROC)curves.

All lesions were solitary, including 69 benign epithelial tumors and 37 malignant epithelial tumors. The mean ADC values of pleomorphic adenoma and basal cell adenoma, adenolymphoma and malignant epithelial tumors were (1.47±0.16)×10^-3 mm²/s, (0.83±0.19)×10^-3 mm²/s and(1.14±0.14)×10^-3 mm²/s, the mean ADC value of adenolymphoma lower than the rest of the two groups, there were statistically significant differences among them (P<0.05). Using 0.94×10^-3 mm²/s≤ADC value≤1.28×10^-3mm²/s as the critical value for diagnosing malignant epithelial tumors of parotid gland and comparing with pathological results, the result obtained had a sensitivity of 81.1%, specificity of 88.9%. ADC value had high correlations compared with pathological results, kappa value was 0.600.

RESOLVE DWI can be applied in differential diagnosis between benign and malignant epithelial tumors of parotid gland.

To explore the expression and distribution of programmed death receptor 1 (PD-1) and T-cell immunoglobulin mucin 3 (TIM-3) in breast cancer microenvironment and analyze the their correlation with the clinicopathological features.

The specimens of tumor tissue and adjacent tissues from 30 patients with infiltrative breast cancer who were diagnosed as breast cancer from June 2016 to May 2017 in The First Hospital of Jiaxing were collected, and the specimen were divided into two parts along the center. After embedding and cryosectioning, the expression and distribution of PD-1 and TIM-3 protein in tumor tissues were observed by immunofluorescence staining. Another part of the specimen was cut and digested, and non-continuous density gradient centrifugation was used to extract tumor-infiltrating lymphocytes (TILs), real-time quantitative PCR (qRT-PCR) was used to detect the mRNA expression of PD-1 and TIM-3 in TILs. Meanwhile, the protein expression was determined by Western blotting. The relationship between the expression of PD-1 and TIM-3 and pathological parameters of breast cancer was analyzed with correlation analysis.

Immunofluorescence results showed that more PD-1 and TIM-3 positive cells were observed in the tumor tissues compared with the tumor-adjacent tissues. The qRT-PCR showed that the expression of PD-1 and TIM-3 mRNA in TILs were both significantly higher than those in paracancerous tissues (3.09±0.38 vs 1.26±0.23, 3.42±0.31 vs 1.57±0.29, t=4.16, 4.37, both P<0.05). At the protein level, the expression of PD-1 and TIM-3 in tumor tissue lymphocytes(0.66±0.08, 0.80±0.11) was significantly higher than those in cancerous tissues(0.10±0.01, 0.26±0.02) (t=6.79, 4.57, both P<0.05). There were significant differences in the expression of PD-1, TIM-3 mRNA in the TILs between the different tumor histological grades, tumor sizes, lymph node metastasis (t=2.22-2.99, all P<0.05). Correlation analysis showed that there was a significant positive correlation between the expression of PD-1 and TIM-3 in tumor tissues (r=0.616, P<0.01).

In the breast cancer microenvironment, PD-1, TIM-3-mediated signaling pathway plays an important role in the occurrence and development of breast cancer, it provides a new basis for the combination therapy of breast cancer.

To evaluate the long-term efficacy of cervical artificial disc replacement for patients with cervical disc herniation and degenerative cervical canal stenosis.

Total of sixty-eight patients underwent single-level Bryan artificial disc replacement in Beijing Jishuitan Hospital from December 2003 to December 2007 with a minimum 10-year follow-up were retrospectively analyzed. There were 43 males and 25 females with a mean age of (46±8) years. According to preoperative CT and MRI, the patients were divided into two groups: 27 patients in cervical disc herniation group and 41 patients in degenerative cervical canal stenosis group. The evaluation indexes before surgery and at last follow-up were compared between two groups. The clinical indexes included Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) and Odom′s grade; and the radiological indexes included the global and segmental range of motion (ROM), Cobb′s angle at operated level. The continuous variable data were analyzed by independent sample t test.

In cervical disc herniation group, the improvement rate of JOA score was 83%±22%, NDI% decreased by 14%±9%, and Odom′s grade was excellent in 17 patients, good in 10 patients. In degenerative cervical canal stenosis group, the improvement rate of JOA was 68%±34%, NDI% decreased by 11%±7%, and Odom′s grade was excellent in 19 patients, good in 18 patients, fair in 4 patients. The segmental ROM was 10°±4° and 7°±6° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t=2.284, P=0.026). The global ROM was 50°±9° and 44°±14° in cervical disc herniation and degenerative cervical canal stenosis group at last follow-up (t=2.112, P=0.038).

Cervical artificial disc replacement has a favorable long-term efficacy in treating cervical degenerative diseases. The postoperative global and segmental ROM in patients with cervical disc herniation are better than those in patients with degenerative cervical canal stenosis.

A 76-year-old female was admitted to the hospital on June 18, 2017 due to pain and bleeding in both lower limbs due to being run over by a bus for 1 h. 1 h before admission, both lower limbs were crushed by the wheels of a bus, with pain and wound bleeding, with a bleeding volume of about 800 ml, no coma, mild irritability, nausea and vomiting after injury, no obvious dyspnea, abdominal pain and distension. The patient had a history of hypertension and diabetes for more than 10 years, and took medication on his own. The details were unknown, and other medical histories were denied. Physical examination: body temperature 36.2 ℃, breathing 22 times/min, pulse 92 times/min, blood pressure 90/60 mmHg (1 mmHg =0.133 kPa), painful face, pale complexion, irritability, and relevant answers. Extensive compression and avulsion of the skin and soft tissue of the left calf and dorsum of the left foot, exposure of the Achilles tendon, metatarsal bone and phalanges, obvious contusion of the Achilles tendon, fragmentation of the base of the metatarsal bone, active bleeding of the wound, fragmentation of the skin and soft tissue of the 1 to 5 toes of the left foot, phalanges, accessible bone friction of the left foot and left lateral ankle, poor movement of the left ankle, limited movement of each toe of the left foot, no blood supply at the periphery and poor sensation; Extensive avulsion of skin and soft tissue from 10 cm above the right knee to the right ankle, exposure of tibia and Achilles tendon, contusion of Achilles tendon, active bleeding of wound, residual sediment and dirt from open wound, exposure of gastrocnemius muscle and lower segment of tibia and fibula, fracture end of middle and lower segment of fibula, fracture of right lateral malleolus, absence of blood supply to the avulsed skin, tenderness of the affected limb, abrasive sensation of middle segment of right fibula and lateral malleolus, poor movement of right ankle and toes of right foot, poor blood supply at the periphery of right foot, and dull sensation. Admission diagnosis: multiple large-area severe skin and soft tissue avulsion injuries such as right knee, both calves and both feet; Achilles tendon contusion and avulsion injury; Five toes of the left foot were damaged and large area of skin defect on the dorsum of the foot was injured; Open comminuted fracture of left lateral malleolus; Fracture of left fifth metatarsal; Fracture of left cuboid bone; 1~5 toe damage of left foot; Open fracture of right medial malleolus with bone defect; fracture of middle right fibula; Partial avulsion and exposure of the Achilles tendon of both ankles; Diabetes; Hypertensive disease.

Brodie's abscess, also known as chronic localized osteomyelitis, is a low-toxicity infectious lesion of bone. It is more common in children and adolescents in the onset population. The clinical symptoms are mild, the specificity is not high, the imaging findings are sometimes atypical, and it is easy to be confused with other bone diseases, resulting in missed diagnosis and misdiagnosis^[1]。 Because the blood flow in the metaphysis is slow and bacteria are easier to deposit, Brodie abscess mostly involves the metaphysis, but the epiphyseal plate has a barrier function, and the cases of Brodie abscess involving the epiphyseal plate are rare. A case of Brodie's abscess involving epiphyseal plate admitted to our department in 2016 is reported as follows.

transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation therapy technique, which is widely used in the clinical treatment and scientific research of neuropsychiatric diseases including pain, Parkinson's disease, epilepsy, tinnitus, depressive disorder, schizophrenia, addiction and so on because of its advantages of non-invasive, safe, low cost and simple operation^[1]。 This article reviews and reviews the recent research progress of tDCS in the treatment of depressive disorders.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multiple organ system damage. Pulmonary arterial hypertension (PAH) is one of the serious comorbidities of SLE patients, and its incidence is 0.5% ~43%^[1,2]And it is more common in Asian people. The mortality rate of SLE patients has decreased sharply in the past 50 years, but the risk of death in patients with systemic lupus erythematosus-associated pulmonary hypertension (SLE-PAH) is still significantly higher than that in patients without PAH. The 5-year survival rates of both patients are 68% and 94.8%, respectively^[3,4]。 In recent years, the research on pulmonary hypertension associated with connective tissue disease (CTD-PAH) has attracted more and more attention from domestic and foreign researchers, especially the research on SLE-PAH has received more and more attention. With the deepening of basic research such as molecular biology and immunology, diagnostic techniques such as right heart floating catheter examination and therapeutic drugs, the basic and clinical research of SLE-PAH have made rapid progress. This article mainly reviews the latest research progress of SLE-PAH in terms of pathogenesis and treatment strategies as follows.

As one of the common malignant tumors, colorectal cancer seriously affects the quality of life of human beings, and liver metastasis is one of the important factors that affect the prognosis of colorectal cancer patients, and its early diagnosis and treatment are the key factors that determine the prognosis of patients. Therefore, how to use imaging methods to detect the lesion as early as possible and carry out appropriate clinical treatment is a common problem that imaging examination and clinical work need to face. At present, the available imaging methods for patients with liver metastasis of colorectal cancer include CT, magnetic resonance (MR), ultrasound, PET and PET-CT/MRI, which has not been popularized yet. These methods have their own advantages and disadvantages in qualitative diagnosis, treatment choice and prognosis evaluation. How to closely combine them with clinical treatment and learn from their strengths to achieve accurate diagnosis and treatment of diseases is the issue that this article should focus on.