Volume 98  ·  Issue 31  ·  2018

Magnetic resonance imaging (MRI) technology has the advantages of good tissue and spatial resolution and no radiation, and its value in clinical and scientific research of the central nervous system (CNS) has been unanimously recognized by the industry. MRI research of central nervous system covers many fields such as tumors, cerebrovascular diseases, neurodegenerative diseases and aging, demyelinating diseases, epilepsy, cognitive and mental diseases, etc. At the same time, new technologies and methods of MRI, whether in scientific research or clinical application, are often the first to be tried in the nervous system, developed and matured in all systems of the whole body. Therefore, being familiar with and understanding the progress and existing problems of MRI of nervous system will help us to better use various new MRI technologies.

To investigate the diagnostic performance of whole-tumor volume analysis of mono-exponential and intravoxel incoherent motion (IVIM)parameters in the preoperative grading of hepatocellular carcinoma (HCC).

A total of 106 patients who undewent parital hepatectomy were prospectively enrolled and underwent with routine MR and IVIM examination.112 HCCs were confirmed by the surgical pathology.The original images of IVIM were imported into the GE AW 4.6 workstation.Two independent radiologist who were blinded to the histopathological results analyzed the data.Freehand ROI was used to cover the whole tumor volume, ADC, ADC_slow, ADC_fast and f was calculated.Intra-class correlation coefficient (ICC) was used to evaluate the inter-observer agreement, One-way ANOVA and Kruskal-Wallis sign rank test were used to evaluate the difference of these parameters in grading HCC, Spearman correlation analysis was used to determine the correlation between these parameters and histologic grade, receiver operating characteristics (ROC) curves were performed to evaluate the diagnostic performance.

ICC value of ADC, ADC_slow, ADC_fast and f were 0.948, 0.966, 0.901 and 0.940, respectively.Statistical significances were obtained from the ADC_slow(R1: χ ²=74.403, P<0.001; R2:F=44.973, P<0.001) and ADC (R1: χ²=52.987, P<0.001; R2:F=30.851, P<0.001) in grading HCC.Between the multiple-comparison in grading HCC, the ADC_slow and ADC (except for E-S 3 and 4, R1: P=0.134; R2: P=0.069) also demonstrated a statistical significant difference (all P<0.05). Area under curve (AUC) value of two radiologists for ADC_slow were 0.905 and 0.917, for ADC were 0.831 and 0.829, a negative correlation was obtained from the ADC and ADC_slow (all P<0.05).

Mono-exponential and intravoxel incoherent motion (IVIM) model can be used to evaluate the pathological differentiated grade of HCC, ADC and ADC_slow value entailed the highest diagnostic performance.

To explore the changes of cerebral white matter in the hyperacute period (<24 h) patients with mild traumatic brain injury (mTBI) by diffusion kurtosis imaging(DKI) technique.

A total of 52 patients with mTBI were included in this study, collected in Emergency Department of Affiliated Hospital of Hangzhou Normal University from May 2016 to June 2017. Twenty-one healthy controls were recruited at the mean time(gender, age and years of education were matched with the patients). DKI data were acquired with 3.0 T scanners.The FSL software was used to preprocess the DKI data, and the white matter abnormalities were detected by tract-based spatial statistics (TBSS).

There were no statistical differences in gender, age and years of education between mTBI patients and healthy controls (P=0.427, P=0.235, P=0.165). The values of MK of the body of corpus callosum (BCC), the genu of corpus callosum (GCC), the splenium of corpus callosum (SCC), the bilateral anterior limb of interbal capsule (ALIP), the right posterior limb of internal capsule (PLIC_R), the bilateral anterior corona radiate (ACR), the bilateral posterior corona radiate (PCR), the bilateral superior corona radiate (SCR), the left inferior fronto-occipital fasciculus (IFOF_L)and the bilateral superior longitudinal fasciculus (SLF) were lower in mTBI patients((1.095±0.080), (1.130±0.066), (1.160±0.080), (1.135±0.077), (1.108±0.076), (1.203±0.069), (1.073±0.056), (1.052±0.055), (1.170±0.055), (1.149±0.050), (1.028±0.056), (1.051±0.059), (0.868±0.060), (1.194±0.048), (1.183±0.054) mm²/s) than those in healthy controls((1.153±0.054), (1.184±0.057), (1.215±0.068), (1.181±0.053), (1.163±0.062), (1.258±0.041), (1.115±0.037), (1.096±0.049), (1.210±0.040), (1.190±0.049), (1.063±0.042), (1.087±0.057), (0.913±0.063), (1.236±0.047), (1.214±0.038) mm²/s)(P<0.01). However, there were no statistical differences in fractional anisotropy (FA) between groups (P>0.01).

DKI technology is more sensitive in detecting cerebral white matter abnormalities in patients with hyperacute mTBI which routine MRI findings was normal.

To investigate the alterations of the volumes and 3D shapes of fifteen subcortical nucleus in patients with post-stroke depression (PSD) and to explore the pathogenesis regularity and mechanism of early PSD.

From 2015 to 2017, a total of 28 patients with PSD and 18 stroke patients without depression (PSND), 13 patients with depression (De) and 11 cases of healthy volunteers (NC) were enrolled to perform 3.0 T high resolution MRI.Computer automatic segmentation and vertex analysis were used to segment and measure the volume of bilateral nucleus accumbens, caudate nucleus, putamen, globus pallidus, thalamus, hippocampus, mygdale and brainstem.

The volume of bilateral nucleus accumbens and bilateral thalamus, left pallidum were different among groups with statistical difference (P<0.05). The nucleus volume of the PSD group was (415±128) mm³ (L-Nac)/(303±90) mm³ (R-Nac), (7 590±867) mm³ (L-Th)/(7 459±905) mm³ (R-Th), (1 675±328) mm³ (L-Pa), which was smaller than that of PSND group (433±100) mm³ /(307±88) mm³, (7 999±961) mm³ /(7 753± 955) mm³, (1 790±286) mm³ and other groups.The nuclei with significantly statistical differences between inter-group were found in following: between PSD group and NC group, right accumbens and bilateral thalamus (P<0.01); between PSD group and De group, right accumbens and right thalamus (P<0.001), left accumbens, left pallidum and left thalamus (P<0.01); between PSND group and NC group, right accumbens (P<0.05); between PSND group and De group, right accumbens (P<0.001), left accumbens and right thalamus (P<0.05). Significant differences in morphology changes of nuclei (P<0.05) byF test mainly located on the top and tail of right accumbens, the anterior and middle body of right caudate nucleus, the most part of bilateral thalamus, the ventromedial body of bilateral hippocampus, the anterior and body of left caudate nucleus, especially in left thalamus.

PSD has abnormal volume and morphological structure of subcortical nuclei, which supports the role of subcortical structures changes in the pathophysiology and pathogenesis of early PSD.

To explore whether cephalic artery peak velocity variation during passive leg raising (ΔVpeak_CA-PLR) could effectively predict fluid responsiveness in mechanically ventilated severe sepsis patients with spontaneous breathing.

Total of 38 patients on mechanical ventilation with spontaneous breathing admitted to the Fourth Departments of Intensive Care Unit (ICU) of Fujian Provincial Hospital from January to December in 2017 were enrolled.The patients were diagnosed with severe sepsis or sepsis shock.The peak velocity in cephalic artery (Vpeak_CA) during PLR was measured by bedside portable ultrasonic, and then ΔVpeak _CA-PLR was calculated.All patients received volume expansion (VE) test and the changes of stroke volume during VE test (ΔSV-VE) were measured.Patients were classified as responsive group or non-responsive group according to the ΔSV-VE increased ≥15% or not after VE test.Furthermore, the sensitivity and specificity of ΔVpeak_CA-PLR for predicting fluid responsiveness were evaluated by receiver operating characteristic (ROC) curve.The comparisons between groups were performed with Student′s unpaired two-tailed t test, and Pearson′s test was used for the correlation analysis.

Among the patients, 22 cases responded to VE test and the rest 16 cases did not.There were no significantly differences in age, gender, body mass index, infection site, sepsis-related organ failure assessment score, acute physiology and chronic health evaluation Ⅱ score, ventilator parameters and dose of vasoactive agent between the two groups.The ΔVpeak _CA-PLR in responsive group was markedly higher than that in non-responsive group (15.7%±4.2% vs 6.9%±4.3%, t=6.240, P<0.05), and the ΔVpeak_CA-PLR in the responsive group was positively related to the ΔSV-VE ( r=0.723, P<0.05). Furthermore, the area of ΔVpeak_CA-PLR under ROC curve was 0.912.The sensitivity and specificity of ΔVpeak _CA-PLR≥12.2% to predict fluid responsiveness in the patients with sepsis were 81.8% and 87.5%, respectively.

ΔVpeak_CA-PLR measured by bedside portable ultrasonic can predict the fluid responsiveness in mechanically ventilated severe sepsis patients with spontaneous breathing, and it can be used to guide further fluid resuscitation.

To explore the therapeutic effect of burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis for ischemic moyamoya disease of adults.

The burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was performed on 21 adults with ischemic moyamoya disease since January 2013 in the second hospital of Shandong university.All of the patients were followed up for 3 months to 3 years.Digital subtraction angiogram (DSA) reexamination was performed and the cerebral MR perfusion imaging (PWI) was used to observe the perfusion of cerebral ischemic area before and after operation quantificationally, and the KPS scores before and after the surgery were analysed by the statistics.The clinical symptoms of the 21 patients gradually improved after the operation, there was statistical significance by paired t test of the KPS scores (P<0.001).

19 patients were reexamined by DSA and PWI.The DSA results revealed there was apparent neovascularization in 65 burr-holes of total 72 holes , mainly came from the middle meningeal artery and superficial artery, and there was neovascularization in 33 burr-holes of total 35 holes whose arachnoid was completed, there was no statistical significance by χ ² test (P>0.05). The revascularization of the ischemic cerebral tissue was obtained through the PWI.The postoperative complications included 1 case of subdural hematoma, 3 cases of postoperative temporary neurological deficits.

The burr-hole operation combined with dural inversion and temporalis-periosteal synangiosis was effective, the MR perfusion imaging could assessment the effect exactly, there was no significant difference of neovascularization whether or not opening the arachnoid.

To investigate the effect of Ventriculoperitoneal shunt (VPS)in adult patients with idiopathic normal pressure hydrocephalus (iNPH).

The patients with idiopathic normal pressure hydrocephalus were reviewed, who were admitted into the Peking union medical college hospital from October 2010 to October 2016.The patients treated via VPS were retrospectively analyzed by collecting the data including clinic features, iNPH score and imaging data.

33 patients were included in the group.3 months after operation, the iNPH scores were significantly decreased (3.0±1.0 vs 6.0±2.5, P<0.01), and there were no difference among 3 month, 6 month and 12 month post operation.The Evans index and the width of the three ventricles were also significantly decreased.1 patient suffered from subdural hematoma and no other complications such as infection, obstruction or death occurred.

VPS is an effective treatment approach of iNPH and multidisciplinary team is the key in diagnosis.

To analyze the biomechanical stability of four kinds of internal fixation for the type Ⅰ Hangman fracture, type Ⅱ odontoid fracture and the C_2/3 disc injury by finite element (FE) analysis.

Thin-section spiral computed tomography (0.5 mm) was performed on C₁ to C₃ region of cervical vertebra in healthy male volunteers.A three-dimensional hexahedral FE model of upper cervical spine was established by software (Mimics, GEOMAGICS, Pro/E and Ansys). Then the weakening of the strength of grid was performed to simulate the FE model of the type Ⅰ Hangman fracture, type Ⅱ odontoid fracture and the C_2/3 disc injury (FE/Fracture), the four internal fixation models: anterior cervical plate+ odontoid screw+ cage (FE/ACP+ OS+ cage), affixing rods from pedicle screws in C₂ to lateral mass screws in C₃+ odontoid screw + cage (FE/C₂PS+ C₃LMS+ OS+ cage), affixing rods from pedicle screws in C₁ to pedicle screws in C₂ and lateral mass screws in C₃ (FE/C₁PS+ C₂PS+ C₃LMS), anterior odontoid screw plate fixation system (FE/AOSP) were simulated on the FE/Fracture model.Flexion, extension, lateral bending and axial rotation were imposed on the FE/Intact, FE/Fracture and the four fixation models respectively.

The intact model of upper cervical spine (C₁-C₃) was established successfully, consisting of 259 641 nodes and 403 674 units.There was no significant difference among the FE/ACP+ OS+ cage, the FE/ C₂PS+ C₃LMS+ OS+ cage and the FE/AOSP of ROMC_1/2.During flexion, extension, left axial rotation and right axial rotation of ROMC₂-C₃, the FE/AOSP decreased 70.7%, 74.4%, 38.9%, 41.1% respectively compared with the FE/C₁PS+ C₂PS+ C₃LMS.The ROMC₂-C₃ during flexion, extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation in the FE/AOSP decreased for 82.2%, 82.8%, 73.2%, 64.8%, 72.2%, 81.5% respectively when compared with those in FE/ACP+ OS+ cage.The ROMC₂-C₃ during flexion, extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation in the FE/AOSP decreased 88.2%, 81.2%, 47.6%, 41.2%, 38.9%, 39.0% respectively when compared with those in FE/C₂PS+ C₃LMS+ OS+ cage.The stress concentrated on the connection between plate and screw in the FE/ACP+ OS+ cage, the FE/C₂PS+ C₃LMS+ OS+ cage and the FE/C₁PS+ C₂PS+ C₃LMS, while it distributed evenly in the FE/AOSP.

Anterior odontoid screw plate fixation system can be used to treat the type Ⅰ Hangman fracture, type Ⅱ odontoid fracture, and the C_2/3 disc injury and can reserve the function of atlanto-axial joint.

To investigate the clinical features of patients involved with both malignant tumors and neuromyelitis optica spectrum disorders (NMOSD).

The clinical data of 473 patients with NMOSD admitted into the Third Affiliated Hospital of Sun Yat-sen University and the Department of Neurology, Affiliated Hospital of Guizhou Medical University from June 2012 to March 2017 were retrospectively analyzed. Eleven NMOSD patients complicated with malignant tumors were screened out (3 with breast cancer, 2 with cervical cancer, 2 with rectal cancer, 2 with leukemia, 1 with nasopharyngeal carcinoma, 1 with thyroid cancer). Fifty patients without NMOSD were included as controls.

Most of the NMOSD patients were complicated by low-moderately differentiated squamous cell carcinoma/adenocarcinoma, mainly seen in breast, reproductive system, digestive system and hematological system. In terms of sex ratio and autoantibodies, the NMOSD patients with and without malignant tumors showed no significant difference. However, comparing to the patients without malignant tumor, the ones with malignant tumor showed a tendency of lower rate of initial brain symptoms and relapse rate, while with older onset age, higher initial EDSS score, protein content in cerebrospinal fluid (CSF), higher rates of initial symptom resulted from the focus of posterior region of the medulla and of significant image focus. Of the 8 NMOSD patients who diagnosed as malignant tumors in our hospital, 2 with breast cancer and 1 with cervical cancer had a good prognosis (follow-up EDSS score <3). All the 3 patients received aggressive surgery and chemotherapy treatment. However, the other 5 patients had poor prognosis (follow-up EDSS score ≥3 points). All the 11 patients received anti-tumor therapy, 4 patients had first NMOSD attack after anti-tumor treatment and no relapse. Only one case from the remaining 7 patients had relapse; Among the 9 patients received immunosuppressive therapy, 7 patients had no relapse, and 8 cases maintained stable; while, among all the 9 patients received immunosuppressive agents and anti-tumor therapy, only one case had relapse.

There are some differences in the clinical features between the NMOSD patients with malignant tumors and the NMOSD patients without malignant tumors. Immunosuppressive therapy can improve the prognosis of patients with NMOSD and tumor, without increasing the risk of malignant tumor. The pathological type, staging and antitumor therapy may influence the prognosis of NMOSD. NMOSD patients with malignant tumor could be treated with anti-tumor and immunosuppressive agents if needed.

To examine clinical, neuroimaging and genetic features of two Chinese families with fatal familial insomnia (FFI).

The clinical data, including case history, physical examination, biochemical analysis of blood and neuroimaging of two pedigrees with FFI who admitted to the Navy General Hospital in 2014 and 2017 were collected. The D178N prion protein (PRNP) mutation were determined by DNA sequencing among the proband and family members.

There were 6 patients in 2 families, 5 male and 1 female. The onset age of disease in family 1 was 47 and 60 years old respectively, and 46, 58, 58, 60 years old respectively in family 2. In terms of disease course, patients in family 1 had a rapid disease course and died half year after onset while patients in family 2 had a relatively slow disease course and survived more than 1 year after onset.The induced factors of the patients in the family 1 were fright, followed by abnormal behaviors and sleep disorders accompanied by autonomic nervous dysfunction; the clinical features of the pedigree 2 were memory loss, decreased sleep and motor disorder without obvious inducement, and the autonomic nervous dysfunction was not significant. The neuroimaging examination of 2 probands showed a mild atrophy of the whole brain and no ribbon sign. The electroencephalography (EEG) did not show typical triphasic waves. Both cases had a positive cerebrospinal fluid (CSF) 14-3-3 protein and PrP D178N /Met-129 mutation.All patients were given traditional sedatives or anti-anxiety and depression drugs which were with poor efficacy.

The major clinical manifestations of FFI are sleep disorders accompanied by mental disorders. The clinical manifestations are similar among different individuals within one family, however, there is obvious clinical variability among different families. The neuroimaging examination shows a mild atrophy of the whole brain and no ribbon sign. There are no typical triphasic waves in EEG. Positive CSF 14-3-3 protein and PrP D178N /Met-129 mutation are common in FFI. Traditional sedatives or anti-anxiety and depression drugs may have poor efficacy.

To compare the clinical effects of stent-assisted embolization and surgical clipping in the treatment of middle cerebral artery bifurcation wide-necked aneurysms.

From July 2014 to March 2017, the clinical and imaging data of 45 patients with Hunt-Hess 0-Ⅲ grade middle cerebral artery bifurcation wide-necked aneurysms were divided into stent-assisted embolization group (20 patients from PLA Rocktet Army Hospital) and surgical clipping group (25 patients from Peking University International Hospital). The total occlusion rates of aneurysm, operation-related adverse events, clinical outcomes, and results of follow-up imaging from the two groups were compared.

The total occlusion rates in the stent-assisted embolization group and surgical clipping group were 90.0% (18/20) and 92.0% (23/25), respectively, and the difference was not statistically significant (P=0.815). The favorable six-month postoperative outcomes defined as the modified Rankin Scale ≤2 were 94.7% (18/19) in the stent-assisted embolization group and 91.3% (21/23) in the surgical clipping group (P=0.667). Fewer patients experienced the operation-related adverse events in the stent-assisted embolization group (15.0%, 3/20), as compared to that of the surgical clipping group (24.0%, 6/25), but the difference were not significant (P=0.453). After 2-24 months (median 7 months) of the operation, the follow-up imaging indicated that in the stent-assisted embolization group, 2 out of the 19 patients had residual or recurrent aneurysms.While in the surgical clipping group, residual or recurrent aneurysms were identified in 2 out of the 23 patients 2-14 months (median 3 months) after the surgery; the frequency was not statistically different between the two groups (P=0.841).

Stent assisted embolization is a safe and effective treatment for the low grade middle cerebral artery bifurcation wide-necked aneurysms.

To detect the expression of lncRNA RAB11B-AS1 in osteosarcoma and investigate its role in osteosarcoma cells proliferation and the responsible mechanisms.

Osteosarcoma and corresponding adjacent normal tissues were collected from 24 patients subjected to operations from October 2015 to October 2017 in the Third Affiliated Hospital of Southern Medical University.RAB11B-AS1 expression was detected in osteosarcoma specimens by quantitative real-time polymerase chain reaction (qRT-PCR). Lentiviral vectors that stably over-expressing RAB11B-AS1 were constructed and transfected into U2OS osteosarcoma cell line.The effect of RAB11B-AS1 on osteosarcoma cell proliferation and apoptosis was investigated by cell counting kit (CCK-8) assay and flow cytometry.U2OS osteosarcoma xenograft model of nude mice was established to observe the effect of RAB11B-AS1 on xenograft growth in mice, and the role of RAB11B-AS1 in proliferation and apoptosis of osteosarcoma cells was investigated by immunohistochemistry and TUNEL staining of osteosarcoma slices.The relationship between RAB11B-AS1 and RAB11B was explored using luciferase reporter assay.The data were compared with t test between the two groups.

Expression of RAB11B-AS1 was significantly down-regulated in osteosarcoma (0.010±0.015) versus their paired non-neoplastic tissues (0.022±0.030) (t=2.117, P=0.045). Up-regulation of RAB11B-AS1 resulted in decreased proliferative rate of U2OS cells (F=15.659, P<0.001). The ratios of cells in G0-G1 phase, S phase, G2-M phase were 62.6%±6.3%, 21.4%±2.2%, 16.3%±1.6% respectively in RAB11B-AS1 up-regulated group versus 59.4%±5.9%, 25.9%±2.6%, 15.5%±1.1% respectively in control group, and cell ratio in G0-G1 and S phase were increased significantly by RAB11B-AS1 up-regulation (t=17.124, 17.321, both P<0.05). Apoptosis rate was significantly elevated in RAB11B-AS1 over-expressed cells (12.7%±1.3%) when compared with that in control (10.3%±1.0%)(t=17.321, P=0.003). Mice transplanted with osteosarcoma cells that overexpressed RAB11B-AS1 exhibited lower growth rate of tumor (F=8.798, P=0.009). Mechanistically, RAB11B-AS1 expression correlated negatively with RAB11B expression (r=-0.356, P=0.044).

lncRNA RAB11B-AS1 expression is down-regulated significantly in osteosarcoma tissues.RAB11B-AS1 may suppress the progression of osteosarcoma via down-regulating RAB11B.

Studies show that the prevalence rate of Parkinson's disease among people over 65 years old in China is 1,700/100,000, and the incidence rate gradually increases with the increase of the overall age of the population^[1]。 Depression is common in Parkinson's disease^[2,3]The incidence rate of non-motor symptoms is 40% ~50%, which seriously affects the daily function, emotional state and disease prognosis of patients, reduces the quality of life of patients and increases the burden of caregivers. However, because the clinical symptoms of Parkinson's depression are relatively hidden and difficult to identify and diagnose, they have not received enough attention from researchers; In addition, most current studies focus on its causes and pathogenesis^[4]Rare studies on interventable influencing factors of depression in Parkinson's disease. In view of this, the purpose of this study is to understand the depression level of patients with Parkinson's disease in Dalian, analyze its influencing factors, and reduce their depression and improve their prognosis by adjusting the intervening factors.

TCS as a non-invasive, radiation-free and easy-to-operate inspection method^[1]It has gradually become one of the important tools to assist in the diagnosis of PD. Previous studies have evaluated the relationship between SN strong echoes and clinical features. Most studies support that SN strong echoes can maintain a relatively stable state for a long time, independent of disease course and disease progression^[2]； There is also a combination of cranial MRI and PET imaging tests, which confirms the correlation between strong echo and disease severity^[3]However, the current research evidence is insufficient, and there are few related studies using TCS for follow-up. Therefore, in order to clarify the relationship between SN strong echo and disease progression, we performed TCS examination and clinical characteristics evaluation in PD patients, and performed dynamic follow-up observation to analyze the correlation between SN strong echo changes with S/M as the main reference index and clinical symptom progression.

A 61-year-old female developed right upper abdominal pain for 10 days without obvious trigger. Ultrasound in a local hospital showed multiple liver occupation. She was admitted to Sino-Japanese Friendship Hospital of Jilin University for further treatment. After admission, all indexes of liver function and tumor markers such as alpha-fetoprotein (AFP) were normal in the laboratory. Conventional ultrasound showed that the left and right lobes of the liver were enlarged, the caudate lobe was not large, full in shape, rounded and blunt in edge, and the parenchyma echoed was uneven. The patchy echoic areas were diffusely distributed in the liver, without obvious boundaries, showing map-like changes, and no definite localized mass was found. The portal vein and intrahepatic branches are not wide, the blood flow is full, the flow rate is 12 cm/s, the three hepatic veins are not wide, compressed and slightly narrow, the flow rate is not fast (excluding Budd-Chiari syndrome), the gallbladder wall is not thick, the spleen is not large, and there is no ascites. It was suggested that the liver was enlarged and showed diffuse damaging changes (Figure 1，Figure 2)。 CT and enhanced scans showed uneven density of liver parenchyma, diffuse patchy low density shadows, patchy abnormal enhancement shadows in portal and delayed phases, and no obvious enhancement in arterial phases. It suggests heterogeneous fatty liver and diffuse intrahepatic changes. After that, the patient came to the ultrasound department for contrast enhancement, which showed that the hepatic parenchyma showed uneven enhancement in the arterial phase, portal phase and delayed phase, and multiple low-enhancement areas were visible. Combined with the changes of conventional ultrasound, the possibility of hepatic sinusoidal obstruction sydrome (HSOS) was considered (Figure 3，Figure 4)。 Ultrasound-guided liver tissue biopsy was performed. Under microscope, the hepatic sinus was highly dilated, some sinus endothelial cells were degenerated, and hepatocytes were atrophied. No definite malignant tumor was found in histology, and the pathology considered hepatic sinus obstruction syndrome. After effective treatment, the clinical symptoms disappeared and the patient was allowed to be discharged.

Rheumatoid arthritis (RA) is a systemic chronic inflammation characterized by synovial inflammation and progressive destruction of articular cartilage and bone. Immune imbalance of helper T cells 17 (Th17 cells) and regulatory T cells (Treg cells) is involved in the pathogenesis of RA: Th17 cells can produce inflammatory factors such as interleukin (IL) -17, which lead to synovial inflammation, articular cartilage and bone destruction; The function of Treg cells mainly lies in maintaining autoimmune tolerance and negatively regulating inflammatory factors to prevent the occurrence of chronic inflammation^[1]。 The study found a decrease in the number or dysfunction of Treg cells and a relative increase in Th17 cells in peripheral blood and target organs (synovium) in RA patients. In the field of oncology, in addition to IL-2 as an earlier anti-tumor drug, IL-15 as a member of the IL-2 family has also begun to become a new anti-tumor drug^[2,3]。 Similarly, in the field of autoimmune diseases, IL-15 and-2 have previously been considered to be pro-inflammatory factors^[4,5]Recent studies have found that low-dose IL-2 can promote Treg cell proliferation in RA patients^[6], inhibiting the proliferation and differentiation of Th17 cells, which is beneficial to controlling inflammation-mediated joint destruction^[7]。 Moreover, various regulatory pathways of IL-15 on Th17 cells and Treg cells have been gradually explored. When IL-2 is deficient, IL-15 can also increase the number of Treg, and may inhibit Th17 cell proliferation and IL-17 secretion, thereby alleviating the inflammatory response. In this article, the recent research progress on the effect of IL-15 on Th17 and Treg cells in RA is reviewed below.

Epilepsy is a common neurological disorder, which is characterized by repeated hypersynchronous firing activity of neurons without obvious trigger^[1]。 Drug therapy is still the first choice, but more than one third of epilepsy patients cannot effectively control seizures with existing antiepileptic drugs, thus developing drug-refractory epilepsy^[2]。 focal cortical dysplasia (FCD) is the most important pathological type of epileptogenic tissue in patients with drug-refractory epilepsy^[3]It is also considered to be one of the main causes of drug-refractory epilepsy^[4,5,6,7]。 Therefore, exploring the neuroelectrophysiological mechanism of FCD-induced epilepsy is extremely important for developing novel therapeutic strategies for refractory epilepsy caused by FCD.

Metastasis-associated in colon cancer 1 (MACC1) is a gene of Stein et al.^[1]Differentially expressed genes discovered in 2009 through a genome-wide search of primary and metastatic colon cancer, which can promote colorectal cancer metastasis, hence the name. Compared with normal tissues (colon mucosa, liver) or adenomas, the expression of MACC1 was significantly upregulated in malignant tissues (colon cancer at all stages and liver and lung metastases). In recent years, many literatures have reported about the abnormally high expression of MACC1 in various cancers and its potential application value in cancer occurrence, development and prognosis. This article reviews the results of the current research progress of MACC1 in cancer.