Volume 98  ·  Issue 23  ·  2018

Cone-beam CT (CBCT) was introduced into stomatology in the middle and late 1990s and has been continuously improved, which has brought about great changes in oral and maxillofacial imaging. CBCT uses a flat panel detector for imaging, with a spatial resolution of up to 0.07 mm, and is a truly isotropic imaging, which provides a reliable imaging basis for stomatologists to diagnose clinical malocclusion, formulate and adjust orthodontic protocols, etc. Because CBCT has the dual advantages of high spatial resolution and low radiation dose, its clinical application should not be limited to stomatology, but should be further expanded to other areas where fine structures need to be displayed, such as the temporal bone.

In recent years, radioactive seed implantation has been applied in the treatment of patients with malignant tumors in various forms and has achieved certain curative effects^[1,2,3,4]。 The target area of tumor and the actual exposure dose of the endangered organ are the direct factors affecting the efficacy and complications. The report of the American Society of Medical Physicists Working Group No. 137 (AAPM TG-137), the American Brachytherapy Association and several European organizations stipulate that the application of three-dimensional treatment planning system (TPS) to CT images after prostate cancer radioactive seed implantation is the gold standard for evaluating the quality of seed implantation and the actual exposure dose^[5]。 At present, only prostate cancer has clear guidelines in the field of radioactive particle therapy, but it is still controversial about when to perform the verification plan after surgery, and the verification plan time is different in different units^[6,7]。 In order to avoid the effect of puncture edema, most scholars believe that dose verification at 1 month after operation is more accurate^[8,9]。 Most tumors in other sites rely on the subjective experience of physicians to evaluate the validated dose parameters on the same day or 1 week after surgery. The accuracy of dosimetric parameters, as factors directly related to prognosis, depends on the accurate verification of TPS. The use of TPS for peripheral dose verification is affected by many factors such as the shape, size, particle position and activity of the target area. Because the target area and the spatial position of prostate cancer particles have little change after seed implantation, the verification plan immediately after operation or one month after operation can be used as the actual absorbed dose. However, for tumors in other parts, the actual irradiation dose of target area and surrounding endangered organs changes constantly after seed implantation, and the verification plan immediately after operation or one month after operation alone is not enough to accurately evaluate the changes of actual dosimetric parameters of target area and endangered organs^[10]。 Dose validation time is the key factor affecting dosimetric parameters. Regular dose validation with TPS after seed implantation is helpful to fully evaluate the influence of activity and volume changes on dosimetric parameters of target areas and endangered organs, understand the influence of dynamic dose changes on curative effect and complications, and is beneficial to the formulation of prescription dose and endangered organ limit. At the same time, it provides a basis for formulating specifications for tumor seed implantation in other sites.

deep venous thrombosis (DVT) is a disease caused by abnormal blood coagulation in the deep veins of the lower limbs. Due to the obstruction of blood return, the patient has swelling, pain and dysfunction of the lower limbs, and the thrombus shedding can cause pulmonary embolism (PE), resulting in gas exchange disorder, pulmonary hypertension, right ventricular dysfunction, and dyspnea, shock and even death in severe cases. DVT and PE are collectively known as venous thromboembolism (VTE)^[1,2]。 Because the incidence of PE after DVT is high, or the embolus of PE is mostly derived from DVT, DVT and PE can be regarded as different stages or processes of VTE. If DVT is not effectively treated in the acute phase, the thrombosis is organized, and venous insufficiency is often left behind, which is called postthrombosis syndrome (PTS)^[3,4]； If PE is not dissolved in time, it can affect pulmonary artery blood flow and lead to chronic thromboembolic pulmonary hypertension (CTEPH).

Biopsy has been used in the diagnosis of thoracic diseases for more than 100 years. According to different sampling methods, chest tumor biopsy can be divided into trans-bronchoscopic biopsy, percutaneous puncture biopsy, trans-thoracoscopic biopsy and open thoracic biopsy. percutaneous transthoracic needle biopsy (PTNB) is a biopsy operation guided by imaging equipment. With the continuous update of imaging technology and equipment, the clinical application scope of percutaneous biopsy is constantly expanding, from the earliest pathological diagnosis to tissue subtype classification and genetic diagnosis, and the clinical demand is increasing day by day. At the same time, it is particularly important to improve the understanding of percutaneous puncture chest tumor biopsy, standardize its operation flow and strengthen perioperative management. As early as 2003, the British Thoracic Society (BTS) issued guidelines for percutaneous lung biopsy (hereinafter referred to as "BTS guidelines")^[1]In 2016, the Respiratory Disease Branch of the Chinese Medical Association and the China Lung Cancer Prevention and Treatment Alliance organized and released the "Chinese Expert Consensus on Issues Related to Small Sample Sampling of Lung Cancer"^[2]In this paper, the common key questions in the clinical practice of percutaneous lung biopsy were classified and answered. At present, there is no Chinese expert consensus on percutaneous biopsy of chest tumors, which systematically standardizes and guides the clinical practice of percutaneous biopsy of chest tumors. Accordingly, the Cancer Interventional Committee of China Anti-Cancer Association initiated the formulation of the Chinese expert consensus on percutaneous biopsy of chest tumors, updated the evidence on the basis of fully learning from the BTS Guidelines and the Chinese expert consensus on issues related to small sample collection of lung cancer, and gathered the opinions of multidisciplinary experts, finally forming the Chinese expert consensus on percutaneous biopsy of chest tumors suitable for China's national conditions.

To evaluate the image clarity of cone-beam computed tomography (CBCT) in displaying facial nerve canal and to investigate the feasibility of CBCT to display facial nerve canal and whether there are some advantages compared with MSCT.

Eight cadaveric heads were scanned using CBCT and MSCT and images of 16 temporal bones of each scanner were obtained.The imaging clarity of facial nerve canal of the two scanners was scored.Wilcoxon test was used to assess the difference of the two methods.P<0.05 was considered statistically significant. The defects of the wall of facial nerve canal were also observed in the images of both scanners.

Sixteen structures of facial nerve canal were evaluated, including the wall of labyrinthine segment, the anterior, medial, lateral, superior, inferior wall of the first genu, the lateral, inferior wall of the anterior part of tympanic segment, the lateral, inferior wall of the posterior part of tympanic segment, the medial and superior wall of tympanic segment, the lateral, inferior, superior, medial wall of the second genu and the wall of mastoid segment.The clarity of thirteen structures showed no differences between the two scanners (P>0.05). The clarity of three structures showed significant differences between CBCT and MSCT (P<0.05), which included the superior wall of the first genu, the posterior part of the lateral wall and the anterior part of the inferior wall of tympanic segment, and the scores of CBCT were higher than MSCT.The most frequent region of defect was in the anterior part of inferior wall of tympanic segment (14/16), followed by the inferior wall of labyrinthine segment (9/16) and the superior wall of tympanic segment (6/16).

Compared with MSCT, CBCT could also gain quite good imaging clarity for displaying facial nerve canal. The display effect of some fine structures, such as the lateral wall of tympanic segment, is better in the images of CBCT than in those of MSCT.

To compare the effective radiation dose levels of cone-beam computed tomography (CBCT) with those of multi-slice computed tomography (MSCT) when scanning for the temporal bone.

The absorbed doses of CBCT and MSCT scanners were detected using thermoluminescent dosimeters (TLDs) that were placed in a head and neck phantom and a RGD-3D dose reader.Then the effective doses were calculated and expressed according to the International Commission on Radiation Protection (ICRP) 2007 guidelines.

Three-dimensional images about temporal bone can obtained by both CBCT and MSCT scanners in this study.The effective dose value of CBCT scanning for bilateral and unilateral temporal bone was 164.1 μSv (bone marrow: 32.1 μSv; thyroid gland: 10.6 μSv; salivary glands: 31.0 μSv), and 98.1 μSv (bone marrow: 17.4 μSv; thyroid gland: 6.2 μSv; salivary glands: 16.1 μSv), respectively.The dose of MSCT scanning for bilateral temporal bone was 714.6 μSv (bone marrow: 95.1 μSv; thyroid gland: 127.8 μSv; salivary glands: 135.7 μSv).

When scanning for the temporal regions, the dose levels for CBCT are lower than those for MSCT.Dose levels reduction for CBCT could be obtained when smaller regions were scanned.

To compare the difference of measuring the length of styloid process between spiral CT with high resolution and cone-beam CT(CBCT).

Five specimens (including 5 pairs of styloid processes) were selected randomly from the Anatomy Laboratory of Otolaryngology Department, all the specimens underwent spiral CT with high resolution and cone-beam CT retrospectively.With the original DICOM data, the styloid processes were shown in one plate by multiple plate reconstruction technique, and later the length of styloid processes of each specimen were measured separately by software NNT Viewer (to CBCT) or Osrix (to spiral CT with high resolution).

The length of styloid processes measured by CBCT and spiral CT was (26.8±5.5) mm and (27.1±5.4) mm respectively, and there was no statistical difference between the two groups.

In respect of measuring the length of styloid process, the CBCT has the same value in clinical practice comparing to spiral CT with high resolution.

To observe the clinical characteristics of thoracolumbar vertebral fracture cascade, analyze the relationship between the baseline fractures and the subsequent fractures and compare the distribution differences of subsequent fractures following vertebral augmentation or non-operation.

From July 2012 to August 2016, 1 363 patients admitted to the First Affiliated Hospital of Soochow University with vertebral augmentation for the treatment of vertebral fractures were retrospectively analyzed.There were 190 cases of vertebral fracture cascade, 160 females and 30 males, with an average age of (74±9) years.The location and sequence of all vertebral fractures were recorded.The relationships between the baseline and the subsequent fractures were analyzed.According to different treatment on the baseline vertebral fractures, 190 cases were divided into vertebral augmentation group and non-operation group.The distribution differences of the subsequent fractures following vertebral augmentation and non-operation were compared with chi-square test.

Vertebral fracture cascade mainly located in the thoracolumbar spine T₁₁-L₂ with an incidence of 52.0%.According to the direction of fracture development, the fracture cascade could be divided into up, down, centrifugation and concentration, and the incidence was 39.8%, 39.2%, 8.4% and 12.6%, respectively.The closer the vertebral body to the baseline fractures, the subsequent fractures incidence was higher.For distance with zero, one, two, three and four vertebrae, the incidence of subsequent vertebral fractures was 36.5%, 26.2%, 15.2%, 11.5% and 3.7%, respectively.A linear relationship was found between the subsequent fractures and the baseline fractures with a correlation coefficient of 0.90.The distribution difference of subsequent fractures between vertebral augmentation and non-operation group was not significant (χ²=17.16, P>0.05).

The main directions of vertebral fracture cascade is up or down spiral development.The closer the vertebral body to the baseline fractures, the subsequent fractures incidence is higher.Vertebral augmentation doesn′t affect the distribution of subsequent fractures.

To evaluated the efficacy of additional immunoadsorption therapy (2 times) besides infliximab (IFX) ondisease remission in patients with severe rheumatoid arthritis (RA).

90 patients with serve RA were included in this study.There were 43 patients in the control group who were treated with IFX 3 mg/kg+ methotrexate (MTX) therapy, and other 47 patients were experimental group, who were previous given 2 times additional immunoadsorption therapy before IFX 3 mg/kg+ MTX therapy.IFX 3 mg/kg was infused at weeks 0, 2, 6, 14, 22 and 30.Age, sex ration, mean disease duration and core index of disease activity in two treatment groups were collected at weeks 0, 2, 6 and 30 weeks to compare the efficacy and safety of combined immunosorbent therapy in the treatment of severe RA.

The baseline age, sex ration and core indexes of disease activity were comparable between the two treatment groups (P>0.05). After treatment, the core indexes of disease activity of all patients decreased significantly compared with their baseline levels (P<0.05) and the difference of sustainable maintenance to 30 weeks (P<0.05). After 2 and 6 weeks of treatment, patients′ ACR20 remission rates of the experimental group were 46.81% and 68.08%, significantly higher than the control group; after 30 weeks of treatment, patients′ ACR20 remission rates of the experimental group was more than 90%, while the number was 79.07% in the control group.At the same time DAS28-ESR clinical remission and low disease activity also reached 72.34% in the experimental group, higher than the control group(P<0.05).

Additional immunoadsorption therapy can rapid relive the disease activity of serve RA patients, and the remission rate of 30W was significantly higher than only IFX treatment.

To investigate the expressions and significances of SDF-1 and its receptor CXCR-4 in endometriosis.

50 hysteromyoma patients treated at Beijing Tongren Hospital, Capital Medical University between 1^st January 2016 and 31^st December 2017 were divided into control group, that is, non-endometriosis group, while another 50 endometriosis patients were divided into experimental group.The endometrial tissues, endometriosis lesions, and peritoneal fluid samples of hysteromyoma patients were collected by operation.RT-PCR, ELISA and immunohistochemistry were adopted to detect the expressions of SDF-1 and CXCR-4 in the two groups.Cell count was used to analyze the roles of SDF-1 and CXCR4 in the mitosis and proliferation of endometrial stromal cells.

The mean value of SDF-1 and CXCR-4 expressions in ascites or peritoneal fluid of endometriosis patients were (2.56±0.33) mg/L and (4.47±0.32) mg/L, respectively. The mean concentrations in ascites or peritoneal fluid in hysteromyoma patients were (1.39±0.36) mg/L and (3.16±0.32) mg/L, respectively.The expressions of SDF-1 and CXCR-4 in ascites or peritoneal fluid of endometriosis patients were both significantly higher than those of patients in non-endometriosis group (P<0.05). SDF-1 and CXCR-4 were expressed in both endometriosis lesions and the glandular epithelial cells and mesenchymal cells of normal endometrial tissue.Positive staining sites were located in the cytoplasm.A value was used to calculate and analyze the expression of immune staining.The mean A value of SDF-1 and CXCR-4 in endometriosis group were 0.21±0.13 and 0.21±0.13, respectively, and the mean A value in normal endometrial tissues were 0.15±0.13 and 0.14±0.13, respectively.The expressions of these two in endometrial tissues were significantly higher than that in normal endometrial tissues, and the differences were statistically significant (P<0.05). The expression of CXCR-4 mRNA was abundant in the mesenchymal cells of endometriosis cultured in vitro.SDF-1 promoted the mitosis and proliferation of endometrial stromal cells culturedin vitro in a dose-dependent manner.The neutralizing antibody against CXCR-4 was obviously inhibited.

The high expressions of SDF-1 and CXCR-4 in endometriosis as well as SDF-1 through its specific receptor CXCR-4 promoted the mitosis and proliferation of endometrial stromal cells, suggesting that SDF-1 and CXCR-4 played important roles in the pathogenesis of endometriosis.

To research the application of lateral supraorbital (LOS) approach for resecting sellar tumors.

Clinical symptoms of 20 patients with surgery via LOS approach were analyzed retrospectively.According to the neuroradiological findings and the improvement of symptoms, and some score scale, the efficacy and safety of LOS were assessed for removing sellar tumors.There were tuberculum sellae meningioma (n=11), craniopharyngioma (n=4), epidermoid cysts (n=4) and pituitary adenoma (n=1).

Complete resection was achieved in seventeen patients(85%). The mean operating time was 144.0±54 minutes and the mean intraoperative blood loss was 96.5±51.1 ml.Four patients had post-operative fever, four had endocrine disorders, and one had seizure.No other complications were noted.Fifteen patients had visual function impairment before operation, seven of which were improved while one was aggravated after surgery.The median Karnofsky score (3-46 mon) was 95(0-100) and the Glasgow outcome scale (GOS) at follow-up (3-46 mon) was 4.7(0-5). In general, the outcomes were improved in 18 patients and the mortality was 2.

The resection of tumors at sellar region via lateral supraorbital approach is effecient, simple and minimally invasive, which can make the removal of the tumors reliably and safely.It is worthy to be popularized clinically.

To investigate the practicability of occipital tangent angle in assisting posterior occipital condylar screw placement and to verify the safety and accuracy of self-made screw placement device for auxiliary screw.

Occipito-cervical region specimens of 12 adult corpses were selected and scanned by thin-cut CT examination.The three-dimensional reconstruction of occipital and atlas was simulated for each specimen, and 3-matic software was used to measure the setting parameters, including occipital tangent angle, head obliquity, internal inclination angle, length of the screw and the distance from the inferior margin of hypoglossal canal to the screw axis.Using the self-designed occipital condylar screw placement device, combined with occipital tangent angle, internal inclination angle and insertion point, the posterior occipital condylar screw specimen was inserted with nails with assisting tool.The occipito-cervical region was reconstructed and scanned by thin-cut CT examination again after the operation to measuring the parameters of screw placement after actual screwing.The paired t test was used to compare the parameters of screw placement before and after operation.

Pre-operative three dimensional reconstruction of occipital condyle screw showed that the head obliquity was 5.3°±0.9°, the tangent angle was 14.9°±3.7°, the internal inclination angle was 28.1°±5.9°, and the length of screw insertion was (21.4±1.7) mm respectively; the distance from the inferior margin of hypoglossal canal to the screw axis was (4.74±0.36) mm.There was no significant difference in the parameters of analogue nailing between the left and right occipital condyles before the operation (t=-1.32, -0.48, 0.10, 0.23, 0.09, all P>0.05). The occipital condylar screw was safely implanted with screw placement device.The screw was located in the ideal nail insertion channel after operation by CT scan evaluation, without any injury to the hypoglossal canal, the atlanto-occipital articular surface and other structure.After the operation, the actual nailing parameters were measured: the head inclination angle was 5.2°±0.7°, the tangent angle was 15.1°±3.2°, the internal inclination angle was 28.2°±4.2°, the length of screw insertion was (21.5±1.7) mm, the distance from the inferior margin of hypoglossal canal to the screw axis was (4.54±0.29) mm.There was no significant difference between the left and right side in the actual screw placement parameters (t=-0.77, 0.82, 0.56, 0.22, 0.21, all P>0.05). It was found that there was no significant differences in the head obliquity, the occipital tangent angle, the internal inclination angle, length of screw entry, and the distance from the inferior margin of hypoglossal canal to the screw axis before and after the operation (t=0.56, -0.47, -0.18, -0.70, 1.89, all P>0.05).

The occipital tangent angle can be measured directly in the process of posterior occipital condyle screw insertion to guide occipital condylar screw insertion, and the self-made occipital condylar screw placement device can effectively combine the three parameters: occipital tangent angle, head inclination angle and insertion point, which can improve the safety of posterior occipital condylar screw insertion.

To study the effect of N-acetyl-L-cysteine (NAC) on vascular heterogeneity in microcirculation dysfunction caused by endotoxemia and its mechanism.

Eighteen Japanese big ear rabbits were divided into three groups: Control group, Lipopolysaccharides (LPS) group and LPS+ NAC group.A dose of 2 mg/kg LPS was injected to set up endotoxemia rabbit models.Rabbits in the LPS+ NAC group were infused with NAC at a dose of 350 mg/kg, and the same amount of normal saline were infected intravenously to the rabbits in the Control and LPS group.Macrocirculation parameters (central venous pressure, mean arterial pressure and cardiac output) and microcirculation parameters (microvascular flow index and flow heterogeneity index) in all the groups were recorded at 0 and 2 h. Artery and vein S-nitrosohemoglobin were detected at 2 h. Variables were compared by one-way analysis of variance.Dunnett-t3 was used for comparisons between two groups.

Microvascular flow index in Control group and LPS+ NAC group at 2 h were much higher than that in LPS group (2.82±0.09 vs 1.11±0.16, P<0.001; 1.60±0.17 vs 1.11±0.16,P<0.001), and flow heterogeneity index in Control group and LPS+ NAC group at 2 h were significantly lower than that in LPS group (0.16±0.06 vs 1.16±0.33,P<0.001; 0.80±0.12 vs 1.16±0.33,P=0.035). The arterial-venous difference of S-nitrosohemoglobin content in Control group and LPS+ NAC group were higher than LPS group [(41±6) vs (27±5) nmol/L, P=0.002; (36±5) vs (27±5) nmol/L, P=0.010].

In endotoxemia rabbits, NAC can improve the microcirculation dysfunction, especially vascular heterogeneity. It indicated that NAC could improve the ability of S-nitrosohemoglobin-mediated nitric oxide release from red blood cells.

To investigate the effect of CD1d molecules on the surface of CD4⁺ T cells on the progression of experimental autoimmune encephalomyelitis (experimental, allergic, encephalomyelitis, EAE) mouse models.

EAE model of C57BL/6 mice was established, Splenic cells were isolated at different stages of the progression of the disease.The proportion of CD1d⁺ cells on the surface of activated and non activated CD4⁺ T cells was detected by flow cytometry.

The proportion of CD1d⁺ cells in the control group (normal group and complete Freund′s adjuvant (CFA) group), in the peak and recovery period of disease in the EAE group were compared.The proportion of CD1d⁺ cells in the control group was (8.98 ±0.36)%, and the proportion of CD1d⁺ cells in the peak and recovery period of disease in the EAE group were respectively (2.14±0.15)% and (13.80±0.84)%.The differences were statistically significant difference (P<0.05).

The trend of the proportion of CD4⁺ T cells expressing CD1d molecules during the course of EAE pathogenesis is verified, which lays a foundation for further study on the interaction between CD4⁺ T cells and NKT cells in the progression of EAE models.

We are aiming at conducting a meta-analysis of the literature to elucidate the efficacy and safety of anti-hypertension therapy in acute stage of ischemic stroke (AIS).

Researches on the efficacy and safety of anti-hypertension therapy published on PubMed before 1st September 2017 were independently retrieved by two authors.Clinical benign prognosis and death measured as modified Rankin Scale (mRS) ≤2 and mRS=6 were taken as primary indicators of efficacy and safety, respectively.A meta-analysis of included randomized controlled trials (RCTs) was performed by RevMan 5.3 software, with funnel plot evaluating the publication bias.A systemic literature review was also made to illustrate the management of blood pressure in AIS.

Altogether 13 papers were included in the meta-analysis, among which 12 researches (including 7 596 versus 7 503 cases in the treatment and control group, respectively) based meta-analysis showed that anti-hypertensive therapy initiated within 72 h in AIS did not increase the rate of clinical benign prognosis (OR=1.01, 95%CI 0.94-1.08, P=0.79), and 11 studies (including 7 503 versus 7 369 cases in the treatment and control group, respectively) based analysis suggested there was no significant difference in mortality between the two groups (OR=1.03, 95%CI 0.92-1.15, P=0.59). No significant publication bias for the included studies was showed in the funnel plots.

Despite a relative safe profile of anti-hypertensive therapy for AIS, the overall therapeutic efficacy was not improved.The efficacy of anti-hypertensive therapy may be associated with the status of recanalization of blood vessels, further researches are needed to validate the efficacy of anti-hypertension therapy in certain subgroups of IS.

A 42-year-old male underwent aortic and mitral valve replacement in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine in 1997 due to rheumatic valvular heart disease, and was followed up regularly. On July 22, 2013, the patient went to the doctor for "waist soreness and swelling for more than 8 months with fever for 2 weeks". No obvious abnormalities were found on cardiac ultrasound, and CT showed: psoas major abscess (FIG. 1A), thoracolumbar vertebral body (T₁₁-L₁) destroy (FIG. 1B)。 Puncture and drainage were performed, and histopathology showed "granulomatous inflammation, excluding tuberculosis". The result of drainage culture was: Mycobacterium. Lumbar tuberculosis with psoas major abscess was diagnosed, and quadruple anti-tuberculosis treatment was started on August 7, 2013. The specific regimen was: isoniazid 0.3 g oral once daily + rifampicin 0.45 g oral once daily + pyrazinamide 0.5 g oral 3 times daily + ethambutol 0.75 g oral once daily. On September 4, 2013, he was re-admitted due to fever. Physical examination showed that his body temperature was 38.3 ℃, his heart rate was 100 beats/min, his breathing was 20 beats/min, and his blood pressure was 105/61 mmHg (1 mmHg =0.133 kPa). Laboratory test: white blood cell count 5.7×10⁹/L, red blood cell count 2.83×10¹²/L, hemoglobin 73 g/L, platelet count 194×10⁹/L, neutrophil percentage 69.1%, high-sensitivity C-reactive protein 149.4 mg/L, procalcitonin 0.1 μ g/L. Cardiac ultrasound showed: 15.3 mm ×11.6 mm moderate echo at the root of chordae tendineae in P1/P2 area of mitral prosthetic valve, and neoplasm was considered (Figure 2)。 Multiple negative routine blood cultures, combined with medical history and clinical manifestations, clinical diagnosis: "infectious endocarditis, Mycobacterium tuberculosis". The anti-tuberculosis treatment of the quadruple regimen was continued, and the anti-tuberculosis treatment was ended in July 2014. The CT reexamination on August 6, 2014 showed that the psoas major abscess was absorbed (FIG. 3A), vertebral bone destruction and healing (FIG. 3B)。 After regular follow-up, reexamination of cardiac ultrasound showed: endocardial neoplasms, smaller than before (FIG. 4A，FIG. 4B)。 Consider fibrotic tissue left after tuberculosis cure. Follow-up until August 2017, the patient was re-admitted due to "1 d ago fever with persistent palpitation". Physical examination: body temperature 36.4℃, heart rate 169 beats/min, breathing 24 beats/min, blood pressure 109/87 mmHg, white blood cell count 9.5×10⁹/L, neutrophil percentage 71.1%, platelet count 185×10⁹/L, NT proBNP 4 044 ng/L, high-sensitivity C-reactive protein 43.8 mg/L, procalcitonin 0.3 μ g/L, cardiac ultrasound showed: mitral paravalvular leakage and old vegetation. Chest CT: The old lesions of thoracic vertebra were similar to those before. Following cardiac surgical evaluation, mitral valve replacement (mechanical valve) was performed on August 7, 2017, considering mitral valve leaflet noose, and postoperative neoplasm pathology suggested scar fibrosis (Figure 5), and was discharged after postoperative rehabilitation. The patient was followed up all the time after the operation. The patient's general condition was stable. Reexamination of cardiac ultrasound showed changes after mitral valve replacement and good valve function.

In China, lung cancer is the tumor with the first incidence and mortality in men, and the second incidence and first mortality in women^[1]。 In recent decades, significant progress has been made in all aspects of lung cancer diagnosis and treatment, including screening, diagnostic tests, surgery, radiotherapy and chemotherapy. Surgery is still the preferred treatment for non-small cell lung cancer (NSCLC), and only patients who undergo radical surgery have hope of cure. However, cruelly, only about 20% of patients with early-middle-stage lung cancer have access to surgery; If these patients do not receive follow-up adjuvant treatment, the 5-year survival rate is disappointing. How to prolong the disease free survival (DFS) and overall survival (OS) of these patients has always been an important direction of clinical research. Here, we present a review of systemic adjuvant therapy after radical NSCLC surgery.

X-ray computed tomography (CT) plays an irreplaceable role in medical imaging, safety inspection, industrial non-destructive testing and other fields^[1]。 With the development of hardware equipment, algorithm and computer technology, CT system is becoming more and more mature, and the evaluation indexes such as image quality, reconstruction speed and radiation dose have been significantly improved.

Perinatal cardiomyopathy (PPCM) refers to idiopathic heart failure that occurs between the last month of pregnancy and 5 months after delivery, is characterized by cardiomyopathy as the basic feature, and does not meet other known heart failure diagnoses^[1]。 The mortality rate of untreated PPCM is between 9% and 50%. Early diagnosis and standardized treatment of PPCM can significantly reduce the mortality rate^[2]。 This article mainly describes the recent progress in the diagnosis and treatment of PPCM in recent years.

The risk of venous thromboembolism (VTE) is significantly increased in pregnant and puerperial women due to their special physiological changes, such as hypercoagulability, venous stasis, vascular endothelial injury and other factors. The incidence of VTE in pregnant women is 1:500, which is 4-5 times higher than that in non-pregnant women^[1,2]。 VTE is one of the leading causes of maternal mortality in developed countries^[3]The World Health Organization reports that 14.8% of maternal deaths are caused by thromboembolic diseases^[4]。 Excluding thrombosis-related gene mutation factors, the risk of developing VTE in Asian population is the same as in western countries^[5]Therefore, the Society of Obstetrics and Gynecology of developed countries such as the United Kingdom and the United States and the Working Group of the Asian Venous Thrombosis Forum have proposed to attach great importance to venous thrombotic diseases in pregnancy and puerperium, and suggest that all women of childbearing age should be assessed before, during and after pregnancy, and corresponding preventive measures should be taken for those at risk of thrombosis^[6]。 Combined with the latest foreign guidelines and research progress at home and abroad, this paper reviews the risk assessment and prevention of pregnancy thromboembolic diseases, so as to strengthen the screening, prevention and management of pregnancy-related VTE, reduce the risk of thrombosis and embolism, and improve pregnancy outcome.