Volume 98  ·  Issue 21  ·  2018

With the coming of the age of aging, cardiovascular and cerebrovascular diseases have gradually become an important factor affecting human health. On the one hand, in order to avoid ischemic cerebrovascular disease, anticoagulation and antiplatelet therapy have become standard clinical treatments; At the same time, with the progress of vascular interventional technology for cardiovascular and cerebrovascular diseases, the number of antithrombotic drugs matched with interventional therapy (stent technology, etc.) has increased significantly. Anticoagulation, thrombolysis and antiplatelet therapy became necessary adjuvant therapies. When intracranial hemorrhage is associated with the application of antithrombotic drugs, it will bring many problems to clinical work, and poor treatment will affect the life of patients. The coagulation function of antithrombotic therapy may have the possibility of progressive hemorrhage, which directly affects the prognosis of patients. How to properly deal with these patients according to the needs of the disease has become a key problem faced by clinical practice.

Neurosurgery often involves external drainage, including external cavity drainage, external ventricular drainage (EVD) and external lumbar cistern drainage (LD). At present, some elective neurosurgical procedures have chosen not to place external cavity drainage^[1]However, in emergency surgery such as brain trauma and cerebral hemorrhage, the operative cavity or subgaleal aponeurosis external drainage is often used. EVD and LD have both therapeutic and monitoring roles. Among them, the average EVD in the United States alone is more than 40,000 times a year^[2]It is also very common in our country. However, LD is a technique mastered by almost all primary neurosurgery departments, and its use is greater. Since there is no consensus or guideline on the related techniques of neurosurgical external drainage in China, it is necessary to standardize and manage it.

neuromyelitis optica (NMO) is a group of inflammatory demyelinating diseases of the central nervous system that mainly involve the optic nerve and spinal cord. In 2004, Lennon discovered an NMO-specific marker, aquaporin 4 antibody (AQP4-IgG). In 2007, Wingerchuk expanded the definition of NMO to neuromyelitis optica spectrum disorders (NMOSD). In 2015, the NMO International Collaboration Group greatly updated the concept and diagnostic criteria of NMOSD, and divided it into AQP4-IgG positive or negative NMOSD. In recent years, myelin oligodendrocyte glycoprotein (MOG) antibody, glial fibrillary acidic protein (GFAP) antibody, aquaporin 1 antibody (AQP1-IgG) antibody have been found in the negative NMOSD group^[1,2]Isopositive related subtypes have aroused the attention of clinicians. A variety of new immunosuppressants under development provide patients with more treatment options. Clinicians should update their understanding of NMOSD in time, grasp its research progress, and achieve the purpose of scientific diagnosis and treatment.

In the age of aging society, more and more patients suffer from cardiovascular and cerebrovascular diseases such as myocardial infarction, cerebral infarction, atrial fibrillation and heart valve disease. At the same time, due to the extensive development of modern interventional technology, antithrombotic drug therapy has become a routine clinical treatment method. The prognosis of patients with intracranial hemorrhage in the course of antithrombotic drugs is worse than that of patients with intracranial hemorrhage alone, and the mortality and disability rate are higher^[1,2]。

External cerebrospinal fluid drainage is one of the most commonly used therapeutic techniques in neurosurgery. It specifically refers to the continuous drainage of cerebrospinal fluid in the ventricle or lumbar cistern to the external closed system, including external ventricular drainage (EVD) and external lumbar cistern drainage (LD). Its main purpose is to drain bloody or contaminated cerebrospinal fluid externally to the cranium, and it is sometimes used to monitor and control intracranial pressure and inject drugs through the drainage tube. On average, there are more than 40,000 EVDs in the United States a year^[1]However, there is no statistical data in China at present, but EVD and LD are also widely used in neurosurgery in China.

rapidly progressive dementia (RPD) is a class of rapidly progressing dementia syndrome, which refers to the rapid progression of dementia symptoms within weeks to months. The etiology is mainly non-neurodegenerative diseases, including infection, autoimmune, vascular, poisoning, metabolic, tumor, etc. Neurodegenerative diseases usually show a chronic progressive course, and very few may also show an acute, progressive or fluctuating course, often occurring due to infection, internal environmental disorders and other inducements. There are many etiologies and complex clinical manifestations of RPD, and different etiologies can correspond to completely different curative effects and prognosis. A few causes are treatable and have a good prognosis, most causes are partially treatable, and some rare causes are highly lethal. For example, rapidly progressing dementia caused by some infections/autoimmunity is reversible and curable, while patients with Creutzfeldt-Jakob disease progress rapidly once the disease develops, and the course of the disease is usually about half a year. Therefore, recognizing this dementia syndrome can help us clarify the cause, guide the treatment and prognosis.

Memory clinic is a new medical mode of specialized disease management. It is patient-centered, integrating clinical, neuropsychological, imaging and molecular biology diagnostic technology, drug and non-drug treatment and other medical resources, and standardizing the diagnosis and treatment process and level of cognitive impairment diseases. It is of great significance for early diagnosis, early treatment and prevention of dementia^[1]。

To analyze the clinical presentations of neuromyelitis optica spectrum disorders (NMOSD) with ultra-longitudinally extensive transverse myelitis (uLETM), in order to improve the diagnostic accuracy of this disorder.

Twenty-two uLETM patients was recruited and retrospectively analyzed for general clinical characteristics, laboratory tests and MRI characteristics, as well as therapeutic.

(1)The Male-to-female ratio was 1∶6. The median onset age was 31 years old. The duration from the first relapse to the onset was 5.5 months. (2)The positive rate of serum water channel aquaporin-4 antibody (AQP4-Ab) in the acute phase was 86.4%. The positive rate of cerebrospinal fluid (CSF) AQP4-Ab in the acute phase was 69.2%. The positive rate of autoimmune antibodies was 72.7%. There was a remarkable difference (Z=-12.632, P=0.000) in serum AQP4-Ab titer levels between with the acute and remission period (median titer of 1∶244.78 to 1∶139.63). There was a remarkable difference (Z=-20.161, P=0.000) in geometric mean of serum AQP4-Ab titer levels between with CSF AQP4-Ab positive (1∶289.8) and negative (1∶36.2). (3)63.6% of the uLETM patients had 10-15 contiguous segments, 31.8% had 16-19 contiguous segments and 4.5% had whole spinal cord affected. 72.7% of the lesions of uLETM were sliver. The detection rate of optic nerve lesion by MRI was 63.6% and brain sliver lesions was seen in 63.6% of the patients.(4) All patients improved after treatment with high-dose glucocorticoids (GCs) in the acute phase. 15 cases treated with long-term oral administration of low-dose GCs in remission stage of NMOSD. 6 cases treated with mycophenolate mofetil. 1 case treated with intravenous immunoglobulins.

NMOSD with uLETM is predominantly seen in young woman. The high risk period of relapse is 5.5 months after the onset. A high portion of NMOSD patients with uLETM have serum and CSF AQP4-Ab in acute phase. The therapy of GCs is recommended in acute phase. Combination of GCs with immunosuppressant can achieve stable and satisfactory effect in remission period of NMOSD.

To evaluate the efficacy and safety of mycophenolate mofetil (MMF) in neuromyelitis optica spectrum disorder (NMOSD).

From September 2014 to February 2017, NMOSD patients with seropositive aquaporin4-IgG was enrolled through a multicenter, prospective study, and the annual recurrence rate (ARR), Expanded Disability Status Scale (EDSS) and MMF-related side effects before and after MMF treatment were compared.

Ninety patients were enrolled in the study. After being treated for a median of 12 months (1-30 months), the median ARR decreased from 1.1 pre-MMF to 0 post-MMF (P<0.001), and the median EDSS score decreased from 4.0 pre-MMF to 3.0 post-MMF (P<0.001). The EDSS score reduced significantly after 90 days′ treatment (P<0.05). The main adverse events included the deranged liver enzymes (19%, 17/90), respiratory infection (11%, 10/90), urinary tract infection (6%, 5/90), varicella-zoster infection (6%, 5/90), anemia (6%, 5/90), leucopenia (6%, 5/90), diarrhea (2%, 2/90), hair loss (1%, 1/90); 11% (10/90) patients experienced severe adverse events, and 6% (5/90) patients discontinued MMF.

MMF could significantly reduce the ARR and EDSS score of NMOSD. However, awareness on side effects should be raised.

To study the clinical features of late-onset neuromyelitis optica spectrum disorders(LONMOSD).

Twenty-eight patients with LONMOSD and fifty-one patients with early-onset neuromyelitis optica spectrum disorders(EONMOSD) hospitalized in Navy General Hospital from January 2014 to May 2017 were enrolled and were followed up by telephone or outpatient visiting. The clinical manifestations, laboratory examinations and imaging features of the two groups were compared.

(1)The average age of onset in group LONMOSD was(59±6) years old, and 24 cases were female(85.7%). (2) The history of prodromal infection in LONMOSD patients was less reported than that in group EONMOSD(14.3 vs 37.3%, P<0.05), but concomitant diseases were more common in LONMOSD patients(53.6% vs 3.9%,P<0.05). (3) In group of LONMOSD, the patients with transverse myelitis(TM )as the first symptom were less than that of EONMOSD group (39.3% vs 64.7%,P<0.05). (4) There was no significant difference in EDSS score either in acute or remission stage, laboratory and imaging findings between the two groups.

Patients with LONMOSD have less history of prodromal infection, and those with TM as the first symptom are less than EONMOSD patients.

To analyze the clinical and immunological characteristics of acute severe bilateral optic neuritis, and to explore the predictive factors of vision outcome and relapse so as to save visual function and avoid or alleviate vision disability.

Forty-eight inpatients confirmed with acute severe bilateral optic neuritis from January 2013 to June 2015 were included and followed up. The clinical features, immunological findings, optic nerve imaging, visual function outcome and predictors of relapse were statistically analyzed.

Acute severe bilateral optic neuritis accounted for 7.3% of the total number of optic neuritis in the same period. There were 35 cases (72.9%) with monophasic course, and 13 cases (27.1%) with recurrence or other central nervous system involvement during the follow-up period; 11 (22.9%) in 48 patients with positive AQP4-IgG; AQP4-IgG-positive patients had a higher recurrence rate (P<0.001) and poorer visual function prognosis (P=0.034) than antibody-negative patients; the baseline visual acuity (P=0.004), early treatment response (P=0.012) and number of involved optic nerve segments (P=0.016) were associated with end point visual function. Positive AQP4-IgG(OR 13.486, 95% CI 1.971-16.263)and combining with other autoimmune antibodies (OR 5.591, 95% CI 1.502-15.621)were independently associated with relapse.

Acute severe bilateral optic neuritis is not unusual and may cause blindness or visual disability. The positive rate of AQP4-IgG and the recurrence rate of the disease are low in our study. The necessity for long-term immunotherapy requires individual consideration. The baseline visual acuity, involved segment number of optic nerve and response to early treatment are associated with prognosis of visual function. Patients with AQP4-IgG positive and other autoimmune antibodies are easy to relapse. Whether the antibody-negative bilateral optic neuritis is a heterogeneous disease and the relationship with classic NMO or NMOSD deserve further research.

To analyze the feasibility, perioperative complications and early outcomes of minimally invasive small incision in direct anterior approach total hip arthroplasty in lateral decubitus position.

From January 2015 to January 2017, 212 patients (228 hips) received minimally invasive small incision (approximately 8 cm in length) direct anterior approach total hip arthroplasty in modified lateral decubitus position and approach. Sixteen cases underwent bilateral hip arthroplasty separately. All procedures were performed by the same surgeon in the Department of Orthopedics, the First Affiliated Hospital of University of Science and Technology of China, Anhui Provincial Hospital. Twenty-eight patients (28 hips) were set as the complicated case group. The rest 184 patients (200 hips) had no previous hip surgeries, severe deformity and limited motion of the hip, were set as the standard group, and were divided into the first 100 cases group and the second 100 cases group in sequence. The difference between the standard group and complicated case group were analyzed. Also we compared the difference between the first 100 cases and the second 100 cases. Perioperative complications, postoperative function and radiological evaluation were recorded and statistically analyzed. The t test was applied to compare the data between groups.

All the patients were followed-up for 13 to 25 months[(18±5) months]. Intraoperative complications and postoperative complications happened in 9 and 34 patients respectively. The anterior dislocation occurred in 2 cases. The standard group showed significant superior outcomes when compared with complicated case group in the surgical time[(42±19) vs (67±16) min, t=-2.628, P=0.027], blood loss[(222±94) vs (579±120) ml, t=-8.371, P=0.000], postoperative Harris hip score[90±5 vs 83±7, t=2.390, P=0.024]and the rate of surgical complication (15.0% vs 46.4%, χ ²=15.854, P=0.000). The complication rate tended to decrease in the second 100 cases when compared with that in the first 100 cases (11.0% vs 19.0%, χ ²=3.922, P=0.037). Meanwhile, the second 100 cases showed significant excellent outcomes when compared with the first 100 cases in the mean surgical time[(34±15) vs (48±10) min, t=4.217, P=0.002]and blood loss[(182±52) vs (254±40) ml, t=2.889, P=0.018].

It suggests that there is a learning curve with the minimally invasive small incision direct anterior approach total hip arthroplasty in lateral decubitus position. The risk of intraoperative femoral fractures is slightly high, especially for cases with osteoporosis, stiffness and limited range of movement. Surgeons in early learning curve period should grasp the surgical indications and master the technical points.

To evaluate the influence of carpentry of Bryan disc, including artificial disc coverage ratio and shell angular, on long-term efficacy and complications cervical artificial disc replacement.

To retrospectively analyze the clinical data of 86 patients who underwent Bryan disc replacement in Beijing Jishuitan Hospital between 2003 and 2007 (including 101 operated segments). All the patients were followed-up for more than 10 years. Mean age of the patients was (53±9) years, including 51 males and 35 females, and 71 patients underwent single-level and 15 patients underwent two-level artificial disc replacement. Artificial disc coverage ratio and shell angular were measured on postoperative natural X-ray. According to the perfectness of carpentry including 2 parameters (postoperative shell kyphosis and artificial disc coverage ratio smaller than 95%), operated levels were divided into 2 groups: 43 levels in the optimal group and 58 levels in the suboptimal group. Radiographic indexes were evaluated preoperatively and at the last follow-up, included the segmental range of motion(ROM), segmental COBB′s angle, the occurrence of segmental mobility lost, segmental kyphosis and the high grade paravertebral ossification(PO). Clinical indexes including Japanese Orthopaedic Association (JOA) score, neck disability index (NDI) and Odom′s criteria were evaluated preoperatively and at the last follow-up. The improvement of JOA score, NDI% decline and the satisfaction rate of Odom′s criteria were calculated too. The continuous data were analyzed by independent sample t test. The grading data were analyzed by Mann-Whitney test.

The mean age of the optimal group was (52±7) years, including 23 males and 14 females; the mean age of the suboptimal group was (54±10) years, including 28 males and 21 females.The baseline data of two groups were comparable. There were significant differences in the segmental ROM, the segmental COBB′s angle, the occurrence of segmental mobility lost, segmental kyphosis and the high grade PO between the two groups at the last follow-up (t=5.608, 3.812, χ ²=15.097, 18.334, 27.141, all P<0.05). The improvement rate of JOA score was 69%±39% and 66%±44%, the NDI% decline was 14%±8% and 11%±8%, the satisfaction rate of Odom′s criteria was 97.3% and 83.7% in optimal group and suboptimal group, respectively; there was no significant difference in the up-mentioned indexes between the two groups(t=0.307, 1.483, Z=0.989, all P>0.05).

The carpentry of prosthesis will influence the occurrence of segmental mobility lost, segmental kyphosis, and high grade PO with cervical artificial disc replacement in the long run. It is suggested that the artificial disc coverage smaller than 95% and the shell kyphosis should be avoided.

To analyze the preoperative axial plane and the surgical outcomes of the Lenke type 1A patients with adolescent idiopathic scoliosis (AIS) whose coronal curve type was matched but thoracic kyphosis (TK) was different.

This study retrospectively reviewed a series of Lenke type 1A female AIS patients who underwent corrective surgery in the Department of Spine Surgery of Nanjing Drum Tower Hospital from May to August 2017. After matched with the Cobb angle of the main thoracic curve, the apical vertebral, the vertebra number included in the curve, the lumber modifier in the Lenke classification and Risser sign, 12 pairs of AIS patients, whose coronal curve was matched but thoracic kyphosis was different, were included in this study. The patients were divided into normal TK group and thoracic hypokyphosis group. EOS whole-body images were taken preoperatively and reconstructed by three-dimensional reconstruction. The whole spine anteroposterior X-ray was taken at 3 weeks after surgery. The radiographic parameters were measured on the preoperative and postoperative two-dimensional X-ray images: coronal Cobb angle, TK, lumbar lordosis (LL), pelvic incidence (PI) and pelvic tilt (PT). The vertebra rotation was obtained on the EOS three-dimensional reconstructed image, and the average vertebral rotation of the major thoracic curve (MTR), the average vertebral rotation of the proximal thoracic curve (PTR) and the average vertebral rotation of the lumbar curve (LR) were calculated. The paired sample t test was used to compare the difference of preoperative and postoperative radiographic parameters between the groups.

A total of 24 patients (12 pairs) were included in this study with an average age of (13.7±2.9) years. The preoperative Cobb angle was similar in the two groups (53.8°±10.2° vs 51.0°±11.1°, t=0.27, P=0.81). The average preoperative TK of the normal TK groups was 28.2°±6.1°, while that of the thoracic hypokyphosis group was 11.2°±5.6°(t=7.68, P<0.01). The MTR in the normal TK group was significantly smaller than that in the thoracic hypokyphosis group (10.2° vs 12.7°,t=-3.74, P<0.01), and there was a significant correlation between TK and MTR (r=0.30, P=0.03). As for the lumbar curve rotation, the LR of the normal TK group was significantly smaller than that in the thoracic hypokyphosis group (t=-2.65, P=0.002), but the absolute value of the two groups was similar (t=-0.33, P=0.31). The lumbar Cobb angle correction rate was significantly greater in patients with thoracic and lumbar curve rotating in the same direction than that in the opposite direction (81.1% vs 61.9%, t=4.24, P=0.005).

It indicated that when the coronal deformity is matched, the MTR of the patients with thoracic hypokyphosis is significantly larger than that in the patients with normal thoracic kyphosis. The direction of the thoracic and lumbar curve rotation is required to be well concerned in the preoperative surgical planning.

To explore the significance of multi-parameter semiquantitative Alberta Stroke Program Early CT Score (ASPECTS) in detecting core infarction in acute ischemic stroke (AIS) patients.

Twenty-one consecutive AIS patients from Beijing Hospital were retrospectively reviewed in this study from August 2016 to August 2017. All the patients presented within 6 hours since symptom onset.All the patients underwent one-stop dynamic whole brain 4D CTA-CTP scan before treatments (intravenous thrombolysis, mechanical thrombectomy, or other endovascular recanalization). MRI scan was performed in all patients 3 to 7 days after initial administration. Multi-parameter ASPECTS was calculated on the affected hemisphere regarding noncontrast CT (NCCT) map, cerebral blood flow (CBF) map, cerebral blood volume (CBV) map, mean transit time (MTT) map and MRI-DWI map by subtracting 1 point from 10 for any abnormalities visually detected. The evaluative consistency and diagnostic efficiency were analyzed by Pearson's χ ² test, kappa identity test, and Kendall′s coefficient of concordance using IBM SPSS statistics 22.0 software.

Compared with DWI-ASPECTS or follow-up NCCT-ASPECTS, CBV-ASPECTS had the best performance on both the kappa identity test (kappa coefficient κ=0.74)and Kendall's coefficient of concordance (τ=0.70). All the values of sensitivity (77.8%), specificity (95.5%), positive likelihood ratio (17.27) and AUC(0.87)were the highest in CBV-ASPECTS, followed by dMTT-ASPECTS. Meanwhile, the misdiagnosis rate (4.5%), missed diagnosis rate (22.2%) and negative likelihood ratio were the lowest in CBV-ASPECTS, followed by dMTT-ASPECTS. dMTT-ASPECTS had the same specificity(95.5%) as CBV-ASPECTS did and it could reveal the infarction in the areas where CBV map showed normal. NCCT-ASPECTS had the lowest sensitivity (64.7%) and highest missed diagnosis rate (35.3%). The misdiagnosis rate of CBF-ASPECTS was the highest (25.2%) and AUC was the lowest (0.76).

Multi-parameter semiquantitative ASPECTS may predict the infarction accurately in AIS patients. Compared with the single parameter of NCCT-ASPECTS, this new method may have better detectability and diagnostic performance.

To analyze the potential clinical relevance of inhibitory immune checkpoint genes, including PD1, PD-L1, CTLA4, LAG3 and TIM3 in esophageal squamous cell carcinoma (ESCC).

Expression were extracted from mRNA microarray data from 119 paired ESCC and adjacent normal tissues, which were collected from National Cancer Center/Chinese Academy of Medical Sciences between December 2005 and December 2007.Differential expression analyses and survival analyses were then performed to identify potential clinical relevance using R software.

Expression of PD-L1, CTLA4, LAG3 and TIM3 were significantly upregulated in ESCC tissues compared with adjacent normal tissues (P<0.05). CTLA4 was significantly correlated with tumor location and age (P<0.05). PD1 and LAG3 were significantly associated with overall survival and were favorable prognostic factors in ESCC.

Inhibitory immune checkpoint genes are commonly overexpressed in ESCC and are significantly associated with patients overall survival.These results provide important references in the application of immune checkpoints therapy in ESCC.

To evaluate the value of ¹⁸F-FDG PET/CT in predicting long-term survival of esophageal squamous cell carcinoma(ESCC) before initial treatment.

A total of 167 ESCC patients were retrospectively analyzed who underwent surgery between January 2010 and December 2014 in prospective database of Peking University Cancer Hospital Thoracic Surgery Department One, all cases were included according to inclusion and exclusion criteria.The relationship between SUVmax of the primary tumor and patients′ age, gender, tumor location, tumor differentiation, tumor regression grade as well as long term survival were compared.

The median follow-up time of the 167 cases was 46.9 months(ranging from 30.5 to 86.2 months), with 1 year and 3 years postoperatively being 95.1% and 68.4%, respectively.The SUVmax of the tumor was positively correlated with cT(P<0.01), cN(P=0.033), cTNM(P=0.002) and pTNM(P=0.003)of the tumor.Patients with SUVmax ≤6 obtained a survival significantly better compared with patients with SUVmax>6, the 3 years OS were 83.4 % vs 65.6% (P=0.02) , and DFS were 82.4% vs 55.4%(P=0.006), respectively.The multivariate regression analysis demonstrated that the SUVmax>6 before treatment was the independent prognostic factor for OS (HR=3, 95%CI 1.050-8.568) and DFS (HR=3.971, 95% CI 1.408-11.200) of the ESCC patients.

The higher the ¹⁸F-FDG PET/CT SUVmax of the ESCC primary tumor, the poorer survival of the patients. Therefore, SUVmax could be used as an indicator to predict long term survival of the ESCC patients before treatment.

To explore the entrance and suture method of umbilical incision in gynecological laparoscopy.

A total of 204 cases of gynecologic laparoscopy in our hospital from 2013 to 2016 were reviewed respectively. All the cases used two kinds of approach of umbilical incision: intra-umbilical incision and peri-umbilical incision (longitudinal/transverse oblique/arc incision according to the bellybutton natural skin folds) and two methods of suture: the suture of "U" and the suture of the whole subcutaneous tissue. Two groups were randomly assigned based on the entrance and suture method with each group 102 cases. The peri-operative outcomes were compared, including intra-operative and postoperative bleeding, postoperative incision fat liquefaction and infection, incision pain, incision appearance satisfaction and incision healing satisfaction.

The difference was statistically significant in the intra-operative and postoperative bleeding between two groups of intra-umbilical incision and peri-umbilical incision (P<0.05). There was statistically significant difference in postoperative incision fat liquefaction, infection and incision pain between two groups of the suture of "U" and the suture of the whole subcutaneous tissue (P<0.05). The incision appearance satisfaction showed no difference (P>0.05), but the difference was statistically significant (P<0.05) in the incision healing satisfaction between two groups.

The peri-umbilical incision (longitudinal/transverse oblique/arc incision according to the bellybutton natural skin folds) and suture of the whole subcutaneous tissue can be the feasible modified methods with high practicability and security, good cosmetic result. It should be promoted in gynecologic laparoscopy.

miRNAs (microRNAs) are a group of non-coding RNAs composed of 20-25 nucleotides. They were first discovered in Caenorhabditis elegans and later confirmed to be ubiquitous in animals and plants. By specifically binding to the non-coding sequence at the 3' end of the target gene, miRNAs can guide the RNA-induced silencing complex (RISC) to promote the degradation of the target gene or inhibit the translation process and ultimately inhibit the expression of the target gene^[1]。 Typically, miRNAs are generated by processing a single-stranded RNA precursor (pre-miRNA) having a hairpin structure of 70 to 90 bases by Dicer enzyme. miRNAs are evolutionarily conserved and are expressed only at specific tissue and developmental stages in multicellular eukaryotes such as animals, plants, and fungi^[2]。 Several studies have reported that miRNAs participate in and regulate the occurrence and development of myocardial remodeling. Abnormal expression of miRNA may directly or indirectly affect the structure, metabolism and function of the heart. For example, miR-101a can inhibit the proliferation, differentiation, migration and collagen production of cardiac fibroblasts by inhibiting TGF β receptor I (TGF β R I) and its downstream molecules^[3]。 After myocardial infarction, upregulated miR-34a in myocardial tissue can induce myocardial fibrosis by targeted activation of Smad4^[4]。 As an enriched miRNA in the heart, the regulatory function of miR-22 on hypertrophy, collagen production, autophagy and the expression of genes and proteins related to energy metabolism in myocardial remodeling has been gradually revealed. In this paper, the role of miR-22 in myocardial remodeling in recent years and the future research direction will be discussed.

Cognitive impairment is a disease characterized by cognitive decline, which can involve multiple cognitive domains. Severe cognitive impairment is called dementia^[1]。 Cognitive impairment/dementia has a high prevalence in the elderly, and patients with advanced disease cannot take care of themselves, which places a heavy burden on patients, families and society. Due to the limited effect, expensive price and adverse reactions of drug treatment, the breakthrough of non-drug treatment is urgently needed.

Rheumatoid arthritis (RA) is an autoimmune disease with high disability rate characterized by chronic synovitis, bone destruction and loss of joint function. The pathogenesis is still unclear. Current studies suggest that the incidence of RA is affected by both genetic and environmental factors, and the genetic effect of RA is only 60%^[1]。 About 10 in the human intestine¹⁴Bacteria are 10 times the number of somatic cells, with more than 1,000 species, and the number of genes encoded by them is more than 100 times that of the body's own genes. They directly participate in various biological activities such as nutrient absorption, fat metabolism, energy supply and immune regulation^[2]。 More and more studies have shown that intestinal flora is closely related to the pathogenesis of RA. The research progress on the role of intestinal flora in the pathogenesis of RA in recent years is summarized as follows.

Approximately 45,000 unicondylar joint replacements (UKA) and 600,000 total knee replacements (TKA) are required annually in the United States to treat end-stage degenerative arthritis^[1]。 At present, despite great progress in the design of implants, surgical tools, and postoperative rehabilitation of knee replacements, about 20% of patients still have unsatisfactory results^[2]。 Prosthesis position and soft tissue balance are critical to the success of TKA. Alignment deviation can cause a number of problems such as eccentric loading, instability, patellofemoral joint problems, wear, and aseptic loosening of the prosthesis^[3,4]。 During TKA, cutting error types were up to 4 in the coronal plane and up to 11 in the sagittal plane^[5]。 In this case, it is particularly important to accurately plan how to restore the force line of the knee before surgery and perform surgical operations according to the plan to improve patient function, prolong the life of the prosthesis and reduce pain. Therefore, recent developments in TKA have focused on improving surgical techniques to accurately determine mechanical axes, properly place osteotomy guides, and perform osteotomies. The goal of several computer-assisted surgical systems currently being developed is to control these factors more accurately and reliably, thereby improving clinical outcomes. Before the advent of robotic systems, computer-aided surgical systems mainly included surgical navigation systems and patient-personalized surgical instruments and prostheses. Although the use of navigation reduces the occurrence of mechanical axis abnormalities, the actual osteotomy still relies on hand tools, which may affect the accuracy of the osteotomy^[6]。 Meta-analysis failed to show a clear expected advantage in clinical outcomes using computer navigation^[7,8]。 Therefore, similar to computer navigation, TKA intraoperative robot-assisted technology developed by various manufacturers, surgeons and engineers, aimed at controlling surgical variables and improving the accuracy of surgical steps, may enable patients to recover faster and better.