Volume 98  ·  Issue 25  ·  2018

adult degenerative scoliosis (ADS) is defined as a new onset of scoliosis after bone maturation and is a common complex degenerative disease of the spine. ADS often leads to lower back pain, trunk imbalance and lower limb nerve damage due to spinal instability and spinal stenosis, which seriously affects the quality of life of patients. Traditional open decompression orthopedic internal fixation is the main surgical treatment for ADS. In recent years, the rapid development of minimally invasive spinal surgery technique has been tried by doctors at home and abroad. Can minimally invasive techniques have some value in the treatment of ADS? Can it meet the therapeutic needs of decompression, stabilization, correction and fusion of ADS treatment, while reducing the occurrence of complications? How should we rationally view the role played by minimally invasive surgery in the treatment of ADS? This article will expound the focus issues of minimally invasive surgery for ADS with evidence-based medicine.

With the advent of aging society, the incidence of spinal degenerative diseases is increasing year by year, and the most serious imaging manifestation of spinal degeneration is degenerative scoliosis (DS). Therefore, the clinical research on DS is also showing a blowout in recent years. For the treatment of DS, there are currently two schools of clinical treatment, one is open surgery and the other is minimally invasive surgery. Open surgery emphasizes thorough correction of the deformed spine on the basis of decompression and restoration of the normal sequence between vertebral bodies (including coronal and sagittal sequences); Minimally invasive surgery, on the other hand, tends to start with symptoms, and use minimally invasive means to deal with the responsible intervertebral space that causes patients' low back pain and lower extremity radiation pain, so as to help patients improve their pain symptoms. With the development of minimally invasive technology, it also has certain orthopedic ability. These two surgical methods have obvious advantages and disadvantages, and there are certain differences in indications, but they have a common goal, which is to help patients reestablish good trunk balance.

degenerative scoliosis (DS) is a three-dimensional deformity of the spine caused by aging degeneration, accompanied by chronic low back pain and neurological symptoms^[1,2]。 If the symptoms persist and conservative treatment is ineffective, surgical treatment is required. Traditional open surgery such as osteotomy and intervertebral fusion can significantly improve the clinical symptoms and quality of life of patients^[3,4]。 However, open surgery also has the problem of high hemorrhage, potential nerve damage, high incidence of serious complications such as pulmonary embolism^[5,6]。 In order to reduce tissue damage, bleeding and complications, minimally invasive surgery (MIS) came into being to treat DS. The surgical approaches of MIS to treat DS include anterior approach (MIS-ALIF), posterior approach (MIS-TLIF, MIS-PLIF) and lateral approach (XLIF, OLIF)^{[7,8,9,10,11]}。 Recently, anterior column reconstruction (ACR) MIS technique with anterior longitudinal ligament release, intervertebral discectomy and implantation of lordosis intervertebral cage through lateral approach of psoas major has become increasingly mature, which can effectively restore lumbar lordosis and sagittal balance in some patients with DS, and reduce the use of three-column osteotomy^[12]。 However, there are many complications in the treatment of DS with MIS, such as the complications related to the approach (anterior complications such as macrovascular, peritoneal and abdominal organ injury; posterior complications such as paravertebral muscle injury and nerve root injury; and lateral complications such as lumbar plexus injury^[9,10,11])。 In addition, if the indications are not properly grasped, complications such as insufficient correction (especially sagittal plane) and pseudoarthrosis may occur. Therefore, it is of great significance to strictly grasp the indications of MIS in the treatment of DS to reduce the risk of complications. When choosing MIS or open surgery for DS, imaging parameters, clinical manifestations and general conditions of patients should be considered comprehensively.

To evaluate the efficacy of restoring the balance in the coronal and sagittal planes and to evaluate clinical outcomes in the treatment of severe adult degenerative scoliosis patients using staged lateral lumbar interbody fusion (LLIF) and percutaneous transpedicle screw fixation (pTSF).

A retrospective analysis was made on 13 patients with severe adult degenerative scoliosis treated with staged surgery in Ruijin Hospital between May, 2014 and July, 2015. The operation data were collected, including operation time, estimated blood loss, and complications. Preoperative and postoperative standing anteroposterior and lateral lumbar radiographs were obtained by EOS image system in all patients for measurement of sagittal and coronal plane alignment. All patients were available for at least 24 months of following-up (18-32 months). Paired sample t test was used to compare the parameters of each group pre- and post-operation.

All of the 13 patients received LLIF with staged transpedicle screw fixation. Mean operation time was (231±48) minutes and (155±33) minutes for two-stage surgery. Mean blood loss was (253±80) ml during one-stage LLIF surgery and (326±99) ml during two-stage pTSF surgery. The interval between two surgical procedures was from 7 to 42 days (mean 14 days). In the coronal plane, the mean Cobb angle of curves was 43.1°±7.3° preoperatively, and it was 11.4°±4.0°after one-stage LLIF (t=10.16, P<0.001) and 5.5°±1.9° after two-stage pTSF (t=6.14, P<0.001). In the sagittal plane, lumbar lordosis (LL) changed after each procedure was as follows: LLIF from 16.8°±8.4° to 30.1°±6.8° (t=5.21, P<0.001) and PSF to 37.1°±4.0° (t=5.04, P<0.001). Sagittal vertical axis (SVA) was reduced from (10.5±2.4) cm to (5.3±2.1) cm after one-stage LLIF (t=8.52, P<0.001) and to (3.1±1.5) cm after two-stage pTSF (t=5.51, P<0.001). In the spino-pelvic parameter, pelvic incidence(PI)-LL mismatch decreased from 33.6°±9.6° to 17.8°±4.5° (t=5.31, P<0.001) after LLIF and to 9.9°±3.7° after pTSF (t=4.68, P<0.001). The visual analogue scale (VAS) of low back pain and leg pain and the Oswestry dability Index (ODI) improved significantly at the last follow-up (t=10.42, 8.94, 19.20, all P<0.01).

LLIF significantly improves segmental and coronal plane alignment in patients with degenerative lumbar scoliosis, and these patients can be effectively corrected by staged minimally invasive surgery.

To compare the operation time, estimated blood loss, clinical outcome and correction of lumbar lordosis between oblique lateral interbody fusion (OLIF) and transforaminal lumbar interbody fusion (TLIF) in patients with degenerative lumbar diseases.

Seventy-three patients who underwent OLIF or TLIF surgery from January 2016 to December 2017 in Sir Run Run Shaw Hospital Zhejiang University were analyzed in this retrospective case-control study. The patients included 31 males and 42 females, with a mean age of 65.8 years (range, 36-88 years). Of the patients, there were 9 cases of calcified disc herniation, 34 cases of spinal stenosis, 17 cases of degenerative spondylolithesis, 12 cases of degenerative scoliosis and 1 case of isthmic spondylolithesis. According to the type of surgery, patients were divided into OLIF group (34 cases) and TLIF group (39 cases). The operation time, estimated blood loss and transfusion were recorded, pre-and post-operative visual analogue scale (VAS) for back pain and Oswestry Disability Index (ODI) were evaluated, and pre- and post-operative lumbar lordosis (LL) and fused segment lordosis (FSL) were measured. Student t test were used in comparison between groups.

Ten (29.4%) patients in OLIF group and all 39 (100%) patients in TLIF group were supplemented with posterior instrumentation (χ²=41.013, P<0.05). The average operation time and estimated blood loss was significantly lower in OLIF group than in those in TLIF group[(163±68) vs (233±79) min, (116±148) vs (434±201) ml,t=4.019, 6.964, both P<0.05]. There was no significant differences in decreases value in VAS and ODI after surgery between the two groups (t=1.716, 0.522, both P>0.05). The correction of LL was 4.0°±10.0° in the OLIF group and 4.2°±6.1° in the TLIF group; the correction of FSL was 4.1°±7.0° in the OLIF group and 5.2°±4.6° in the TLIF group, with no significant differences between the two groups too (t=0.139, 0.805, both P>0.05). The correction of LL was significantly higher in OLIF group with posterior instrumentation than that in TLIF group (9.9°±11.1° vs 4.2°±6.1°,t=2.180, P<0.05).

Both OLIF and TLIF can restore LL to some extent, but OLIF has obvious advantages in the operation time and blood loss during surgery. When supplemented with posterior instrumentation, OLIF can achieve better correction of LL than TLIF.

To investigate the surgical outcome of minimally invasive surgery(MIS) for severe degenerative lumbar scoliosis(DLS) and put forward a two-stage MIS surgical strategy.

Prospective study of MISDEF Ⅲ DLS patients from June 2016 to August 2017 in the Second Affiliated Hospital of Zhejiang University was carried out, excluding the patients whose apex vertebrae of scoliosis was above L_1/2 level or whose facet joint got spontaneous fusion. Fifty-three patients were included in this study for staging evaluation and MIS surgical treatment. Information was recorded, including gender, age, body mass index, follow-up period, pelvic incidence (PI), blood loss, operation time, visual analogue pain score (VAS), Oswestry disability index (ODI), complications in the perioperative period and follow-up period, and also the radiographic parameters such as scoliosis Cobb angle, the mismatch between pelvic incidence and lumbar lordosis (PI-LL), sagittalvertical axis (SVA), coronal balance (CB) before and after each stage of surgery or latest follow-up. The paired-samples t test was used to analyze the effectiveness of staging surgery.

Fifty-three patients (18 males and 35 females) were included in this study. All patients had completed clinical and the follow-up records, with an average follow-up period of 11.52 months (6-20 months). A total of 168 segments fusions were performed with CLIF, 113 segments were performed with anterior column realignment (ACR), the average correct angle was 15.6°±6.3°(7°-28°) in sagittal plane each level. After the stage Ⅰ surgery, lumbar scoliosis cobb had been corrected for 55.35%, after the stage Ⅱ surgery, rate of correction was 75.6%. PI-LL had been matched (-32.8°±14.9° to -2.5°±9.4°), SVA was changed from 5.7 cm to 0.6 cm, the stage Ⅰ rate of correction was 80.3 and stage Ⅱ was 88.8%, pelvic tilt (PT), lumbar lordosis (LL) and CB had been restored; 13 (24.5%) patients were performed paraspinal approach transforaminal decompression. The posterior minimally invasive fixation indexes: 11(20.8%) patients were performed paraspinal approach transforaminal multi-segment transforaminal osteotomy (TFO) and internal fixation; 36(67.92%) cases were performed paraspinal approach transforaminal multi-segment fixation; 6(11.33%) patients were treated with percutaneous pedicle screw fixation. The average fixed segments was 7.4±1.4 in each patient. The blood loss of stage Ⅰ and stage Ⅱ operation was (157±71) ml, (343±224)ml, respectively. The operation time was (214±60) min, (190±54)min respectively in the two stage operations. The low back pain and leg pain VAS score and ODI improved after the stage Ⅰ and Ⅱ surgery (t=17.948, 10.099, 14.619, all P<0.001).

MIS for the severe degenerative lumbar scoliosis can achieve good clinical outcome and deformity correction. The two-stage protocol has the advantages of less complications and is well-tolerated.

To characterize the brain functional changes of amyotrophic lateral sclerosis (ALS) patients with various levels of cognitive impairment as measured by resting-state functional MRI (RS-fMRI).

From September 2013 to March 2017, a total of 55 patients diagnosed with ALS in Peking Union Medical College Hospital and 20 healthy controls (HCs) were included in this study, and all participants underwent neuropsychological assessments and diffusion tensor imaging scans. According to their cognitive performance, ALS patients were further subclassified into ALS with normal cognition (ALS-Cn, n=27), those with cognitive impairment (ALS-Ci, n=17) and ALS-FTD (n=11). Comparisons of fractional amplitude of low frequency fluctuation (fALFF) value and regional homogeneity (ReHo) value were conducted among the 4 subgroups.

The fALFF showed significant differences in bilateral frontal lobe, left temporal lobe and cingulate gyrus, (P<0.001, uncorrected) and the ReHo showed significant differences in left frontal lobe, right temporal lobe and left cingulate gyrus (P<0.001, FDR corrected). The differences mainly stemmed from that patients with ALS-FTD showed decreased fALFF and ReHo in these areas when compared to the other three groups, especially in relation to HCs, mainly locating in left prefrontal lobe and anterior cingulate cortex. The whole-brain comparisons of fALFF and ReHo between ALS-Ci, ALS-Cn and HCs revealed no significant difference (P<0.001, uncorrected).

Hypoactivities are detected in extramotor areas in patients with ALS-FTD. RS-fMRI is helpful in investigating the pathophysiologic mechanism of cognitive impairment in ALS.

To investigate the efficacy of endoscopic neurosurgery combined with intraventricular lavage for pyogenic ventriculitis.

A retrospective analysis of 45 patients with pyogenic ventriculitis in six hospitals which included Beijing Shijitan Hospital and Peking Union Medical College Hospital from 2001 to 2017. Twenty-four patients (non-endoscopic group) were treated with external ventricular drainage combined with intraventricular antibiotics administration from 2001 to 2009. Twenty-one patients (endoscopic group) was treated by endoscopic neurosurgery combined with intraventricular antibiotics lavage from 2010 to 2017. The drainage time, mortality, and modified Rankin score (mRS) after 6 months of follow-up were compared between the two groups.

Drainage time: (20±6) days in the endoscopic group, and (42±10) days in the non-endoscopic group. There was a significant difference between the two groups (P<0.001). Days in hospital: (29±7) days in the endoscopic group, and (51±11) days in the non-endoscopic group. There were significant differences between the two groups (P<0.001). Mortality: 8 patients (33.3%) died in the non-endoscopy group, and 1 patient (4.76%) died in the endoscopy group. There was a significant difference between the two groups (P=0.017). After 6 months of follow-up, patients of mRS≤3 were 14 cases (66.67%) in the endoscopy group, and 7 cases (29.17%) in the non-endoscopic group. There was a significant difference between the two groups (P=0.001).

Endoscopic neurosurgery combined with intraventricular antibiotics saline lavage for pyogenic ventriculitis is an effective assessment and treatment method, and it is worth further promotion and application.

To analyze the prognosis and untoward effect in recurrent refractory trigeminal neuralgia (RRTN) patients who underwent repeat Gamma Knife Radiosurgery treatment (GKRS) retrospectively, and to summarize the experience of repeat Gamma Knife Radiosurgery treatment of recurrent refractory trigeminal neuralgia.

RRTN patients who treated with repeat GKRS during 1998.8.1 to 2014.10.1 in Gamma Knife treatment Center of the Fifth Affiliated Hospital of Zhengzhou University were involved. The factors influencing long-term prognosis and facial numbness adverse reactions were statistically analyzed.

Therapeutic dose was an independent factor that influence long-term prognosis of RRTN patients. Therapeutic dose was a dangerous factor that influence long-term facial numbness. Interval time between twice GKRS treatment was a favorable factor for facial numbness. Long-term prognosis of repeat GKRS treatment was positively correlated with therapeutic dose. Untoward effect of facial numbness after repeat GKRS treatment was positively correlated with therapeutic dose and negatively correlated with interval time between twice GKRS treatment.

Repeat GKRS for RRTN patients is safe and effective, but personalized treatment plan should be given according to the patient′s own condition.

To evaluate the efficacy and related issues for cervical ripening by double-balloon catheter with and without oxytocin.

The prospective non-randomly control research was conducted from March 2015 to June 2017 in Yuquan Hospital of Tsinghua University. The primipara with induced labor indications and balloon placement conditions were divided into two groups. Seventy-eight cases were in the balloon with oxytocin group, in which oxytocin was used if there were no contraction 1 hour after balloon placement. Meanwhile, 220 cases were in the single balloon group. Before and after balloon placement, the changes of cervical Bishop Scores and delivery outcome were compared between the groups.

The effective rate of cervical ripening in the balloon with oxytocin group was higher than that in the balloon group[92.3% (72/78) vs 82.7% (182/220), P<0.05], the proportion of parturiency within 12 hours was as well[15.4% (12/78) vs 7.3% (16/220),P<0.05]. The effective rate of cervical Bishop score 4-5 points was further improved in the balloon with oxytocin group[95.7%(66/69) vs 85.1% (165/194),P<0.05]. Taken out balloon, the cervical Bishop scores (8.1±1.1) points in the balloon with oxytocin group were higher than (6.5±1.2) points in the balloon group (P<0.05). For the maternal without parturiency in the balloon with oxytocin group, the cervical Bishop score reduced from (7.7±0.9) points to (6.6±0.6) points after removal balloon for 12 hours (P<0.05). The cesarean section proportion for intrauterine infection in the balloon with oxytocin group was higher than that of the balloon group (P<0.05), but the placental pathological diagnosis proportion was no significant difference (P>0.05). In the two groups, the cesarean section rate, the first labor stage, the episiotomy rate, the postpartum hemorrhage rate, neonatal weight, the neonatal asphyxia and referral rate showed no significant differences (P>0.05, respectively).

The double-balloon catheter with oxytocin can further improve the efficiency of patients with cervical Bishop score 4-5 points for cervical ripening , and increase the chance of labor in 12 hours.

To establish the ischemia reperfusion injury model in rat after lung transplantation(LT) and explore the expression of high mobility group box 1 protein(HMGB1) after intravenous injection with bone marrow mesenchymal stem cells(MSCs).

Forty healthy 8-10 weeks male SD rats were randomly divided into four groups including the sham-operated group, ischemia-reperfusion (IR), Saline-IR and MSC-IR group. The sham-operated rats were only conducted thoracotomy without lung transplantation and the rest groups were respectively conducted with the left LT, left LT followed by 1 ml saline and left LT followed by 1 ml MSCs (1.0×10⁷/ml). Four groups of rats were killed at 24 h after reperfusion. The blood and left lung tissue were collected. Oxygenation index(OI) and the ratio of wet/dry in four groups were detected and histological sections stained with hematoxylin and eosin (HE) were made. HMGB1 levels in serum were detected with ELISA. Real-time PCR and Western blot were performed to detect the expression of HMGB1 in mRNA and protein levels.

The OI in four groups were respectively 383±15, 174±24, 170±30 and 217±21.OI in IR and Saline-IR group decreased compared with the sham-operated group , all P<0.01. The OI increased after injection with MSCs compared with IR group,P<0.01. The histological images showed the marked inflammatory infiltrates and interalveolar septal thickening in IR group. Treatment with MSCs reduced inflammatory injury.The ratio of wet/dry in IR group and Saline-IR group increased compared with the sham-operated group((5.38±0.19), (5.24±0.15) vs (4.16±0.12), allP<0.05). Ratio in MSC-IR group decreased compared with the IR group (4.47±0.14) vs (5.38±0.19),P<0.05. ELISA results showed that HMGB1 level increased significantly in IR group (287±37)ng/ml, Saline-IR group (260±24)ng/ml and MSC-IR group (101±14)ng/ml when compared with the sham-operated group (41±5) ng/ml. The serum HMGB1 level in IR group was positively correlated with the OI (r=0.759, P<0.05) and wet/dry ratio (r=0.725, P<0.05). RT-PCR showed that HMGB1 mRNA level in sham-operated group was the lowest and increased significantly in IR group, while decreased significantly in MSC-IR group compared with IR group and Saline-IR group(P<0.01). The results of HMGB1 expression at protein level by Western blot were consistent with the mRNA level.

Lung transplantation can induce the expression of HMGB1 but HMGB1 level of lung tissue decreased significantly after the treatment with MSCs, which indicated that MSCs might play an important role in protecting transplanted lung via HMGB1.

Exploring the modulation of periphery and central serotonin (5-hydroxytrytamine, 5-HT) and 5-HT_2A receptor (5-HT_2AR) in mice with heart failure during the process of heart failure and after treatment.

Thirty mice were allocated into three groups randomly including normal group (NG), heart failure group (HFG) and treatment group (TG) (n=10). Mice in the NG were sacrificed after evaluating left ventricular ejection fraction (EF) with echocardiogram. Mice in HFG and TG experienced myocardial infarction surgery to achieve EF≤30%, HFG was treated with saline and TG with Ginkgo biloba pills (GBP), once a day for 4 weeks, then EF was assessed again before sacrifice. Cardiac muscle tissue fibrosis was observed and the severity of fibrosis was assessed by semiquantitative method. All the indexes including BNP, serum 5-HT, 5-HT and 5-HT_2AR in platelet and brain were detected. The data were analyzed by SPSS 19.0.

EF: EF in HFG and TG were much lower than that in NG (P<0.05), TG was much higher than HFG (P<0.05). BNP: BNP in HFG and TG were much higher than that in NG (P<0.05), TG was significantly lower than HFG (P<0.05). HFG showed ventricular remodeling, increased myocardial fibrosis; while myocardial fibrosis decreased in TG. 5-HT in serum: serum 5-HT in HFG was much higher than NG (212±29 ng/L vs 146±5 ng/L,P<0.05), TG was much lower than HFG (163±8 ng/L vs 212±29 ng/L,P<0.05). 5-HT in platelet: platelet 5-HT in HFG was much lower than NG (165±22 ng/L vs 193±19 ng/L,P<0.05), platelet 5-HT in TC was higher than HFG and NG (224±27 ng/L vs 193±19 ng/L, 165±22 ng/L,P<0.05). 5-HT_2AR in platelet: platelet 5-HT_2AR in HFG was much lower than NG (P<0.05), TG was much higher than NG and HFG (P<0.05). 5-HT in cortex: cortex 5-HT in HFG and TG were much higher than NG (253±4 ng/L, 231±31 ng/L vs 179±9 ng/L,P<0.05), TG was a little lower than HFG (231±31 ng/L vs 253±4 ng/L,P>0.05). 5-HT_2AR in cortex: cortex 5-HT_2AR in HFG and TG were much higher than NG (P<0.05), TG was much lower than HFG (P<0.05). 5-HT in hippocampus: hippocampus 5-HT in HFG was much higher than NG (250±7 ng/L vs 179±5 ng/L,P<0.05), TG was much lower than HFG (164±6 ng/L vs 250±7 ng/L,P<0.05). 5-HT_2AR in hippocampus: hippocampus 5-HT in both HFG and TG were much higher than NG (P<0.05), there was no significant difference between TG and HFG (P>0.05).

Significant changes of 5-HT and 5-HT_2AR are found in heart failure mice during the process of heart failure and after treatment, indicating the potential value of 5-HT modulation in the diagnose and treatment of heart failure.

To assess the safety of olanzapine, risperidone and quetiapine drugs in dementia patients with behavioral and psychological symptoms.

The EMBASE, Cochrane Controlled Trials Register and the Cochrane Database of Systematic Reviews, Medline, CNKI, Wang Fang were systematically searched for eligible randomized controlled trials of olanzapine, risperidone and quetiapine drugs therapy in patients with psychotic symptoms of dementia before February 2016. Two reviewers independently assessed the quality of the trials and extracted information. All the data was analyzed with meta analysis and software of the Revman5.3 provided by Cochrane network.

Overall, 16 relevant RCTs with 1 727 participants were identified (olanzapine group: 672; quetiapine group: 395; risperidone group: 660). (1)Olanzapine group had higher incidence of somnolence than risperidone group (OR=1.49, 95% CI [-1.01-2.21], P=0.05), while for the dizziness, agitation, accidental injury, weight gain, abnormal gait, weakness, sleep disorders, extrapyramidal symptoms, there were no significant difference. (2) Risperidone had higher incidence of extrapyramidal symptoms than quetiapine group (OR=0.11, 95% CI [0.04-0.27], P=0.64), the incidence of somnolence was lower than quetiapine group (OR=0.03, 95% CI [1.06-3.51], P=0.03), while for accidental injury, dizziness, fatigue, insomnia, constipation, there were no significant difference. (3) Olanzapine group had higher incidence of extrapyramidal symptoms than quetiapine group (OR=11.10, 95% CI [3.35-36.75], P<0.000 1), while for somnolence, sleep disturbances, constipation, agitation, weight gain, dizziness, there was no significant difference. (4) The subgroup analysis showed that in the Chinese population, compared with the population in Europe and America, risperidone group had higher incidence of agitation, sleep disorders than olanzapine (agitation: [OR= 0.26, 95% CI [0.08-0.82]; sleep disorders: OR= 0.31, 95% CI [0.10-0.99]), olanzapine group had higher incidence of weight gain than quetiapine (OR=6.8, 95% CI [2.00-23.14]).

Among olanzapine, risperidone and quetiapine, risperidone has lowest incidence of somnolence, quetiapine has lowest incidence of extrapyramidal symptoms. In the Chinese population, compared with the population in Europe and America, risperidone group has higher incidence of agitation, sleep disorders than olanzapine, and olanzapine group has higher incidence of weight gain than quetiapine.

Parkinson's disease (PD) and Alzheimer's disease (AD) are common degenerative diseases of the central nervous system with unknown etiology. Studies have shown that excessive iron accumulation in the body will induce oxidative stress, produce free radicals, damage mitochondrial electron transport system, intracellular electrolyte imbalance, enhance protease action, enhance membrane lipid peroxidation, and finally lead to cell death, PD, AD and other neurodegenerative diseases^[1,2,3]。 Therefore, it is speculated that iron-related genes may play an important role in PD and AD diseases. At present, the pathogenic genes are mainly believed to be transferrin (Tf) G258S (G/A) and transferrin receptor (TfR) S82G (A/G) polymorphism^[4,5]。 Therefore, we conducted a study of these two gene loci with the aim of exploring the causative genes of PD.

A 70-year-old male was admitted to the hospital on February 1, 2017 due to "abdominal distension with swelling of both lower limbs for 20 d". The local hospital examined abdominal enhanced CT: the left, middle and right veins of the liver were unclear, and the inferior vena cava was slender: considering the possibility of Budd-Chiari syndrome, it was transferred to our hospital. Has a history of drinking Tu Panax notoginseng medicinal wine in the past, and has no history of viral hepatitis. Physical examination: skin, sclera yellowing, abdominal swelling, abdominal wall without varicose veins, mild tenderness and rebound pain in the whole abdomen. Mobility voiced (+). Both lower limbs were edema without ulcer and pigmentation. Auxiliary examination: blood routine: white blood cells 4.9×10⁹/L, neutrophil ratio 70.5%, platelet 121×10⁹/L, hemoglobin 140 g/L; Liver function: alanine aminotransferase (ALT) 67 U/L, glutamate aminotransferase (AST) 107 U/L, glutamyl transpeptidase (GGT) 83 U/L, alkaline phosphatase (ALP) 132 U/L, prealbumin 0.11 g/L, albumin 28.3 g/L, total bilirubin 50.8 μ mol/L, direct bilirubin 29.7 μ mol/L; Coagulation function: prothrombin time 16.2 s, fibrinogen 1.226 g/L; Tumor markers: CA125 782.4 U/ml, alpha-fetoprotein normal. Fluid withdrawn from abdominal puncture, pale yellow and transparent, albumin 0.12×10⁹/L, Levanta test (−), total protein 19.5 g/L, albumin 9.9 g/L. No malignant tumor cells were found in ascites exfoliated cells. MRA: The inferior vena cava and hepatic veins are unclear and poorly enhanced, with signs of hepatic congestion and massive ascites. Color Doppler ultrasound: three hepatic veins flow to the heart, inferior vena cava compression sonography, the main portal vein trunk width is about 1.2 cm; Ascites (depth approximately 8.4 cm). Gastroscopy: esophageal varices, chronic gastritis with erosion, duodenitis.

A 47-year-old female patient visited the gynecological clinic of Zunyi Medical College Affiliated Hospital on September 27, 2017 due to "discomfort on the right side of the vulva". Physical examination: No abnormalities in heart, lung and abdomen. There was no enlargement of superficial lymph nodes throughout the body. Gynecological examination: there is no congestion, edema, ulcer and vegetation of the vulva, no abnormality in elasticity and color of the skin of the vulva, slightly swollen in the lower right side of the labia majora, no redness, swelling, fever, low skin temperature when touched, swelling and pain, no fluctuating feeling, deep position, close to the anus, fixed, unclear boundary, tough texture, no abnormality in the remaining vulva. The vagina is smooth, a little discharge, no odor, the cervix is smooth in appearance, and the uterus and double appendages are not palpable. Follow up the medical history, complain of discomfort on the right side of the labia majora 20^＋In 2000, a mass of about 5 mm was perceived in this area, which was not treated. In the past 20 days, I felt that the tumor mass increased rapidly, distended and painful, but there were no chills and high fever, no low fever and night sweats, no abdominal pain, and no increased vaginal discharge. Denial of history of tuberculosis and exposure to tuberculosis patients. History of vulvar surgery denied. Vaginal B-ultrasound showed no abnormalities in the double uterine appendages, and a cystic mass with a size of about 1.7 cm ×1.0 cm was seen below the right labia majora, with a clear boundary and no obvious blood flow signal. Laboratory tests: HBsAg (+), HBeAb (+), HBcAb (+); Blood routine, coagulation function, liver and kidney function, human immunodeficiency virus antibody + Treponema pallidum antibody qualitative test were all normal, and T-spot test (T-spot.TB) of Mycobacterium tuberculosis infection was negative. No abnormalities were found on plain chest radiograph and electrocardiogram. Considering the right Bartholin cyst, Bartholin cyst stomy was performed in the gynecological clinic of Zunyi Medical College Affiliated Hospital (Figure 1), the swollen part of the right labia majora was incised, and no liquid was seen to flow out. The swollen part was solid tissue, tough in texture, fixed, and the boundary was not clear. The tissue was removed as much as possible, and it was seen as yellow fat-like tissue (Figure 2), sent for pathological examination, routine suture incision site. The pathological diagnosis showed that the deep soft tissue of the right labia majora showed acute and chronic non-specific inflammation with granulomatous hyperplasia (Figure 3)。 The patient refused to undergo immunohistochemical examination. After 2 months, the follow-up examination showed that the incision on the right side of the labia majora healed well and there was no abnormality in the vulva.

Adult degenerative scoliosis (ADS) often causes pain, numbness and walking disorders in the lower back and lower limbs of patients, and the incidence rate in the elderly population is as high as 35.5% ~68%^[1,2]。 Although open surgery can achieve better clinical efficacy for ADS which is not effectively treated by conservative treatment, it is traumatic and has a high incidence of postoperative complications^[3]。 In order to reduce surgical trauma, minimally invasive surgery has been gradually applied to the treatment of ADS in recent years. Minimally invasive spinal surgery has less trauma, can effectively reduce surgical complications and improve surgical safety. This article will review the decompression effect, fixed orthopedic ability, fusion effect and trunk balance recovery ability of minimally invasive treatment of ADS, and evaluate the value of minimally invasive surgery in the treatment of ADS.

Annular enhanced liver lesion refers to the appearance of annular enhanced shadows around the lesion after CT/MR enhanced scan, which can be thick or thin, smooth or rough. This type of disease is generally divided into two categories: non-neoplastic and neoplastic. Non-neoplastic lesions such as liver abscess and liver tuberculosis. Neoplastic lesions such as benign hepatic hemangioma, hepatitis pseudotumor, or malignant hepatocellular carcinoma, intrahepatic cholangiocarcinoma, metastases. The treatment plan and prognosis of these two types of diseases are quite different, so it is necessary to make correct diagnosis and reasonable differential diagnosis. This article reviews the progress of imaging research and diagnostic value of hepatic annular enhancement lesions.

Glioma is the most common intracranial malignant tumor, accounting for about 50% of primary intracranial tumors^[1]。 Most gliomas show invasive growth, and the boundary with the surrounding normal brain tissue is unclear, so it is difficult to completely remove the tumor by surgery. Although some progress has been made in the treatment of glioma, the average survival cycle of glioblastoma patients is only 14.6 months because the pathogenesis of glioma has not been fully elucidated^[2]。 Therefore, the study of glioma is crucial for improving the efficacy of glioma and prolonging the survival cycle of patients. Establishing an ideal animal model is the key to study the pathogenesis of glioma and develop new therapeutic methods. An ideal glioma animal model should have the following characteristics: (1) the origin of tumor cells in the animal model is similar to that of human glioma cells; (2) have similar genetic characteristics and cell heterogeneity to human glioma; (3) It has similar biological and pathological characteristics as human glioma, such as invasive growth, neovascularization, changes in blood-brain barrier permeability and easy recurrence; (4) the tumor model responds to treatment similarly to human glioma; (5) The tumor model has high reproducibility^[3]。 Brain gliomas were classified into inducible, transplantable and transgenic animal models. Among them, transgenotype is the hottest and fastest advancing glioma animal model.