Volume 98 ·  Issue 37 ·  2018

The incidence of cardiovascular, cerebral and peripheral vascular diseases in China is increasing year by year, and even in recent years, it has shown a younger trend. Many people without obvious clinical symptoms or young people who have not been diagnosed with cardiovascular and cerebrovascular diseases also have adverse cardiovascular events and even sudden death. Faced with the severe situation of cardiovascular and cerebrovascular diseases, all walks of life in China have gradually shifted from focusing on disease treatment to focusing on disease prevention, disease rehabilitation and whole life cycle management. At present, it is known that the main pathophysiological mechanism of heart, brain, kidney and other tissues and organs lesions is arteriosclerosis, atherosclerosis, stenosis and occlusion of their supply vessels, resulting in damage to vascular structure and function, which in turn leads to the occurrence of adverse vascular events, such as coronary heart disease, stroke, peripheral arterial occlusive disease and even sudden death^[1,2]。 At present, there are many clinical studies related to blood vessels abroad, while most of the domestic research on blood vessels is basic, and there is a lack of large sample and high-quality clinical research data in the field of blood vessels. China has formulated the first guidelines in the field of vascular detection since 2006 (the second edition will be updated in 2011)^[3,4]However, at present, the early comprehensive evaluation system of vascular lesions needs to be improved to improve its clinical practicality, operability and generalizability. Although interventional therapy has become a direct and rapid method to relieve arterial lumen blockage caused by atherosclerotic stenosis, in the face of the increasing number of patients with vascular diseases worldwide, preclinical detection and intensive intervention and reversal of vascular diseases are the only way to ultimately reduce the incidence of clinical cardiovascular events.

According to the "China Cardiovascular Disease Report 2017", the number of cardiovascular diseases in China is 290 million, including 13 million stroke, 11 million coronary heart disease, 4.5 million heart failure and 270 million hypertension^[1],The burden of cardiovascular diseases in China is increasing day by day, which has become a major public health problem. It is urgent to prevent and treat cardiovascular diseases.

To investigate the gray matter(GM) volume and the change of GM volume after antipsychotic treatment for 8 weeks in first-episode drug-naive adolescents with schizophrenia.

T1-weighted brain MRIs were obtained on a 3T scanner in 35 controls and 35 subjects with adolescents schizophrenia who were admitted to the Second Affiliated Hospital of Xinxiang Medical College from April 2015 to June 2016 and not given antipsychotic medication, the schizophrenia patients received second scan after 8 weeks of antipsychotic treatment. Positive and negative syndrome scale (PANSS) assessments were performed in patients pre- and post-treatment; voxel-based morphometry (VBM) was used to analyze changes of GM volume and the correlation between the baseline GM volume and the PANSS scores was further analyzed.

GM volumes in the left frontal gyrus (MIN(x, y, z): -13.5, 36, 46.5), left superior parietal lobule (MIN(x, y, z): -52.5, -42, 52.5), left inferior parietal lobule (MIN(x, y, z): -31.5, -45, 69) and left central anterior (MIN(x, y, z): 9, 21, 61.5) were significantly smaller than those in the normal control group (t=-4.384 0, -4.556 2, -6.430 9, -4.313 9 respectively, P<0.001); after treatment for 8 weeks PANSS scores were significantly lower than those of baseline (P<0.001), however, there was no significant difference in regional GM volume between the pre-and post-treatment (P>0.05) and no significant correlation was found between GM volume and PANSS scores.

There are local GM volume reductions in subjects with adolescents schizophrenia and these regions may be independent to mental symptoms of patients.

To investigate the clinical features and risk factors for poor prognosis in patients with intracranial Acinetobacter baumannii infection.

Retrospective analysis of data of patients who were hospitalized in the First Affiliated Hospital of AnHui Medical University between January 2011 and December 2017, and whose cerebral spinal fluid samples were positive for Acinetobacter baumannii and who were clinically demonstrated as intracranial infection during hospitalization was performed. Risk factors for poor prognosis were analyzed using single factor analysis and logistic regression analysis.

A total of 50 patients were included, with poor prognosis rate of 58% (29/50).92% of patients had history of craniotomy or operation of site adjacent to brain.Major type of intracranial infection was purulent meningitis.Fever rate was 100%.Multidrug resistant Acinetobacter baumannii accounted for 89.01%. Sensitivity to meropenem was only 9.09%.Shock, multi-drug resistant bacteria and no intrathecal injection were risk factors for poor prognosis of patient.Multi-factor logistic regression analysis showed "no intrathecal injection" was independent risk factor for poor prognosis of patients with intracranial Acinetobacter baumannii infection.

Acinetobacter baumannii that induced intracranial infection is mostly highly drug-resistant bacterium, with high risk of post-infection poor prognosis.Clinically, it is essential to take proper peri-operative measures and early identify occurrence of intracranial infection.Reasonable application of anti-infection drug and external ventricle drainage, especially intrathecal injection of aminoglycosides, can be promoted as a kind of safe and effective means.

To explore the feasibility of cone beam computed tomography (CBCT) in quantitatively assessing singular nerve canal and to propose a method to locate singular nerve canal in CBCT imaging.

Eight cadaveric heads were scanned using CBCT and images of 16 temporal bones were obtained.The diameters of three points of singular nerve canal were measured which included the internal auditory canal aperture, the central turning area, and the aperture of ampulla of the posterior semicircular canal.The length of singular canal was measured.The distances from the three points to the inner edge of round window were measured.The best oblique axial plane to display the whole course of singular canal was adjusted and the angle between this plane and the lateral semicircular canal was measured.Two independent sample t-test was used to compare the left and right measurements.

The mean diameters of the three points were(0.98±0.51), (0.36±0.05) and(0.38±0.06) mm respectively.The mean length of singular nerve canal was(4.16±0.87) mm.The mean angle was 19.1°±10.2°.2D and 3D location graphs of singular nerve canal were made with the distance between the three points on singular nerve canal and the medial end of the round window.There was no significant statistical difference between left and right side in all the measurement (all P>0.05).

CBCT can clearly display the whole course of singular nerve canal.Measurement can be done on CBCT images, and the specific location of singular nerve canal can be determined, which are important for surgery.

To investigate the outcomes and associated factors for adverse pregnancy outcomes (APO) in pregnant patients with lupus nephritis (LN).

The clinical data of 139 LN pregnant patients from from 2009 to 2017 in the First Affiliated Hospital of Sun Yat-sen University were analyzed retrospectively.

Totally, 105 LN were diagnosed before pregnancy and 34 were newly diagnosed during pregnancy. One or more APO occurred in 71.2% of patients with LN and 40 (28.8%) were without any APO. Thirty-six (25.9%) of pregnancies resulted in fetal loss. A total of 54 pregnancies were preterm birth with 20 at gestational age <34 weeks, 13 were intrauterine growth retardation (IUGR), 3 were fetal distress, and 8 were neonatal lupus, pregnancy induced hypertension occurred in 18 cases, of which, 2 cases were gestational hypertension and 16 were preeclampsia. There was no eclampsia occurred.In multivariate analysis, predictors of APO included active lupus during pregnancy ( OR=8.9, 95%CI: 3.7-21.7, P<0.001), rash (OR=7.3, 95%CI: 2.2-24.5, P=0.001), cylindruria (OR=5.3, 95%CI: 1.6-17.0, P=0.005) and antiphospholipid syndrome (OR=11.4, 95%CI: 1.5-88.3, P=0.02) were risk factors for pregnancy loss. Variables that were independently predictive of preterm birth included anticardiolipin antibody positive (OR=8.8, 95%CI: 1.5-51.5, P=0.02) and active lupus during pregnancy (OR=7.9, 95%CI: 2.3-24.5, P=0.001).

Pregnancies in LN are still at high risk of APO in terms of pregnancy loss and preterm birth. Stable disease can help to reduce the risk of APO.

Using the method of the ultrasound and the noninvasive DNA to find the relationship between the choroid plexus cyst and the aneuploidy, and to provide the meaningful data for prenatal consultant.

A total of 112 cases, that the gestational age were between 13 and 20 weeks, which were diagnosed with choroid plexus cyst in the Department of Gynecology and Obstetrics of the Second Hospital of Jilin University from January. 2016 to July. 2017 were tested by ultrasonography. They all accepted the noninvasive DNA. At the same time, a total of 100 normal fetuses were randomly involved in the control group by the combination of gestational age and the age of the pregnant woman, all of them had taken the non-invasive DNA examination and followed up until the birth. Those fetuses who combined with other malformations were induced labor in the two groups. If the results of noninvasive DNA indicated the high-risk, invasive examination for karyotype analysis were recommended. If the results were aneuploidy, they chose induced labor. The rest cases followed up until the birth.

Five cases of the 112 fetuses in the case group were found with obvious malformation (3 of them were found in the early trimester, 2 of them were found in the middle trimester). The numbers of high risk results of noninvasive DNA were 7, and 5 of them underwent the invasive karyotype analysis. When the aneuploidy had diagnosed definitely, induced labor had been taken. One case was found to be the aneuploidy in the control group, and took the induced labor. One case was diagnosed as right side aortic arch by ultrasound in the control group, with a good prognosis. The other cases were followed up until the birth with a good prognosis.

(1)In the early trimester, the fetus with choroid plexus cyst has an increasing risk of aneuploidy. (2)When the maximum diameter of choroid plexus cyst is less than 1 cm and the cyst was single, most of them could disappear in the middle trimester, it has no effect on the fetus. (3)Noninvasive DNA test has a high accuracy, which can improve the positive rate of invasive examination.

To explore the roll and function of hydroxymethylglutaryl-CoA synthase 2 (HMGCS2) in the development and progression of human esophageal squamous cell carcimoma(ESCC).

Using immunohistochemistry, the expression of HMGCS2 was determined in 150 primary ESCC patients from July 2002 to December 2005 in the People′s Hospital of Linzhou City, Henan Province. And HMGCS2 over-expression ESCC cell lines were established to verify HMGCS2 gene function.

In 150 cases of ESCCs, the expression rate of HMGCS2 was 58% (87/150), which was lower than 72% (108/150) in paired normal tissues, the difference was statistically significant (P=0.013). HMGCS2 down-regulated expression was associated with tumor cell differentiation (P=0.022), pT status (P=0.036), pN status (P=0.017) and TNM stage(P=0.012). The 5-years disease-specific survival (DSS) in down HMGCS2 expression group (14 months) was poorer than those in normal expression group (20 months; P=0.002). In addition, multivariate Cox regression analysis showed that HMGCS2 expression (Wald=7.136, P=0.008) was an independent risk factor for DSS. Furthermore, functional studies demonstrated that HMGCS2 gene could suppress the tumorigenic ability of ESCC cells (OD: 0.79±0.04 vs 1.25±0.68; P=0.01), the formation of colone (number of colones: 30±10 vs 189±15, P=0.002), and cell motility (number of cells: 27±14 vs 222±40, P=0.009).

HMGCS2 can inhibit the proliferation and migration of ESCC cells, and could be an important candidate tumor suppressor gene for ESCC.

To explore the effects of ankle arthroscopy technique in treating the tarsal tunnel syndrome.

From May 2014 to May 2016, the ankle arthroscopy technique was used for surgical treatment of tarsal tunnel syndrome in the Department of Hand and Foot Microsurgery in Xuzhou Central Hospital. Twenty-two patients with 24 feet with tarsal tunnel syndrome were hospitalized for treatment, with 10 left feet and 14 right feet, aged 26-57 years. The disease duration ranged from 4 to 15 months (mean 8.3 months). The dual-portals ankle arthroscopic neurolysis and fiber membrane resection were performed. The Pfeiffer scoring system was used to evaluate the post-operative outcomes.

Primarily healing of the wound was achieved in all the patients. No postoperative infection was found during the follow-up. The postoperative hospitalization time was 2 to 5 days (mean 3.7 days). All patients were followed up for 12 to 24 months. At the final follow-up, all the patients had significant improvement in numbness and pain. According to the Pfeiffer scoring system, the results were excellent in 16 feet, good in 8 feet, with an excellent and good rate of 100%.

The ankle arthroscopic neurolysis is a safe and easy treatment option for the tarsal tunnel syndrome and provides satisfactory results.

To investigate the effects of intraoperative hemodynamic instability on postoperative complications of laparoscopic surgery for pheochromocytoma.

It was a retrospective cohort study. According to inclusion/exclusion criteria, adult patients underwent laparoscopic surgery for pheochromocytoma from January 2005 to December 2017 in Peking University First Hospital were enrolled in this study. Eligible patients were divided into two groups by evidence of postoperative complications to find out the effects of intraoperative hemodynamic instability and its′ effects on other prognostic indices. The normally distributed continuous variables were compared between two groups by Student′s t test, Mann-Whitney U test were used for the comparison for non-normally distributed continuous variables and χ ² test for categorical variables.

A total of 198 patients were finally enrolled in this study, including 87 males and 111 females with an average age of (47±15) years. Postoperative complications occurred in 17 patients with an incidence of 8.6%, and intraoperative hemodynamic instability occurred in 45 patients (22.7%). It was found that history of stroke[odds ratio (OR)=13.387, 95% confidence interval (CI): 2.284-78.460, P=0.004], intraoperative hemodynamic instability (OR=3.351, 95%CI: 1.119-10.039, P=0.031) and intraoperative positive fluid balance (for each additional 100 ml) (OR=1.087, 95%CI: 1.031-1.146, P=0.002)were the independent risk factors of postoperative complications of laparoscopic surgery for pheochromocytoma. Furthermore, more postoperative complications, higher rate of admitting to ICU and longer hospital stay was found in patients with hemodynamic instability.

Intraoperative hemodynamic instability is an independent risk factor for postoperative complications of laparoscopic surgery in patients with pheochromocytoma, and it associates with more postoperative complications and higher rate of admitting to ICU.

To investigate the difference of invasive and noninvasive blood pressure in systolic, diastolic and mean blood pressure (SBP, DBP and MAP) levels in critically ill patients.

A total of 197 critically ill patients were enrolled in the intensive care unit of Peking Union Medical College Hospital in this prospective observative study. There were 113 males and 84 females with a mean age of (59±17) years. With Pearson correlation and Bland-Altman analysis, the difference and agreement of invasive and noninvasive blood pressure in SBP, DBP and MAP levels were investigated.

Invasive blood pressure monitoring was significantly correlated with noninvasive blood pressure (the correlation coefficients of SBP, DBP and MAP was 0.908, 0.861 and 0.888, respectively, all P<0.001). The mean bias and 95% confidence interval (CI) in SBP_invasive-SBP_noninvasive, DBP_invasive-DBP_noninvasive, MAP_invasive-MAP_noninvasive respectively was as following: SBP (14.5±11.9) mmHg (-8.8-37.8 mmHg); DBP (1.0±7.2) mmHg(-13.2-15.2 mmHg); MAP (10.5±8.3) mmHg (-5.9-26.8 mmHg). Moreover, there was a significant positive correlation between the bias of SBP_invasive-SBP_noninvasive and the value of SBP; when the SBP_invasive≥143 mmHg was used to predict a value of bias≥20 mmHg, the sensitivity was 72.4% and specificity was 81.3%, and the area under the receiver operating characteristic curve was 0.808 (95% CI: 0.745-0.870).

There is a good agreement between invasive and noninvasive blood pressure in critically ill patients, the bias of invasive-noninvasive blood pressure measurement is positively correlated to the value of blood pressure.

To evaluate the value of minimum ADC(ADC_min)and mean ADC(ADC_mean), lesion to spinal cord signal intensity ratio (LSR) in diagnosis of metastatic hilar and mediastinal lymph nodes in patients with lung cancer.

A total of 34 patients (89 lymph nodes) pathologically diagnosed as lung cancer were enrolled into this study who were examined in the Second Affiliated Hospital of Nantong University from January 2016 to June 2017. All patients underwent MRI scan 1 week before surgery or endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The short-axis diameter, ADC_mean and ADC_min of lymph nodes were measured and recorded respectively by two radiologists.The signal intensity of lymph nodes and spinal cord was also measured on DWI images (b=800 s/mm²). According to pathological findings, all lymph nodes were divided into metastasis group (58 lymph nodes) and non-metastasis group(31 lymph nodes). An independent sample t-test was used to compare the differences between the two groups of short-axis diameter, LSR, ADC_mean and ADC_min between two groups.The diagnostic performance of short-axis diameter, LSR, ADC_mean and ADC_min was analyzed by ROC curves.

There were significant differences in short-axis diameter, ADC_mean, ADC_min and LSR values between two groups (all P<0.01). The short-axis diameter and LSR of the metastatic group were higher than that in non-metastasis group, while ADC_mean and ADC_min in metastatic group were lower than that in non-metastasis group.The ROC curve analysis showed that ADC_mean, ADC_min and LSR achieved excellent but comparable diagnostic performance with an AUC of 0.977, 0.972 and 0.941, respectively (P<0.05). While the short-axis diameter of lymph nodes demonstrated poor diagnosis performance with an AUC of 0.798 (P<0.05). The thresholds of short-axis diameter, ADC_mean, ADC_min and LSR were 9.86 mm, 1.88×10^-3 mm²/s, 1.57×10^-3 mm²/s and 0.80, respectively.Sensitivity, specificity, positive predictive value, negative predictive value and accuracy for ADC_mean were 96.6%, 90.3%, 94.9%, 93.3% and 94.4%, respectively, and those for ADC_min were 98.3%, 90.3%, 95.0%, 96.6% and 94.4%, respectively, those for LSR were 91.4%, 90.3%, 94.6%, 84.8% and 89.9%, respectively, while those for short-axis diameter were 79.3%, 71.0%, 83.6%, 64.7% and 76.4%, respectively.There were significant differences in the area under the ROC curve between short-axis diameter and LSR, short-axis diameter and ADC_mean, short-axis diameter and ADC_min (P<0.05). But there was no significant difference in the area under ROC curve between LSR and ADC_mean, LSR and ADC_min, ADC_mean and ADC_min (P>0.05).

LSR, ADC_min and ADC_mean are the reliable parameters for the differentiation of metastatic and non-metastatic lymph nodes in lung cancer patients, and have good performance.

To investigate the effect of lipid factor CTRP9 on myocardial remodeling induced by isoproterenol in mice.

Male C57BL/6J mice were randomly assigned to four groups (n=10 per group), then mice were administered 5 mg/kg ISO q12h for 12 days by daily subcutaneous injection to induce myocardial remodeling model. Mice also received subcutaneous injection of CTRP9 (200 μg·kg ^-1·d^-1) for 12days. Echocardiography was performed to compare the ventricular wall thickness and cardiac function. Heart weight/body weight (HW/BW), lung weight/body weight (LW/BW), heart weight/tibia length (HW/TL) and cross-sectional area of cardiomyocytes were compared between groups. The cardiac hypertrophic markers and fibrotic markers were also compared by RT-PCR between the two groups. Molecular protein changes were evaluated by Western blot.

CTRP9 was down-regulated in model group. The LVEDd (4.00 mm vs 4.67 mm), LVEDs (2.60 mm vs 3.12 mm) in mode group were both higher than control group while the LVEF (73% vs 55%) and FS (39% vs 21%) were reduced in mode group. Compared with the control group, the HW/BW, LW/BW, HW/TL and cross-sectional area of cardiomyocytes were much higher in mode group (P<0.05). The transcription level of hypertrophic markers (ANP, BNP, β-MHC) were elevated. Left ventricular collagen volume was increased as well as the transcription level of fibrosis markers collagen Ⅰ, collagen Ⅲ and a-SMA. Western blot results indicated that CTRP9 increased nNOS and eNOS derived NO production but not iNOS expression.

CTRP9 could protect against ISO induced myocardial remodeling by increasing nNOS and eNOS derived NO production.

The patient was a 55-year-old male. He was admitted to the Second Affiliated Hospital of Fujian Medical University on June 28, 2012 due to fever, dry cough for 7 days and right limb weakness for 1 day. Fever appeared 7 days before admission, body temperature 39 ℃, with dry cough and dizziness, which still fluctuated between 37 and 38.6 ℃ after intravenous antibiotics (unknown) in the local clinic. Cranial CT was performed in our hospital 4 days ago (Figure 1) showed that the sulcus was slightly widened and untreated. When I woke up 1 day ago, I felt numbness and weakness in my right limb, and my speech was vague. It gradually worsened to the point that he could not walk and had difficulty expressing himself. CT of the head in the outside hospital showed "left frontotemporal parietal lobe infarction" (no film was taken). No treatment was made and he was referred to our hospital. He previously denied "sinusitis, mastoiditis, otitis media and odontitis", denied the history of traumatic surgery, did not measure blood pressure, and was addicted to tobacco and alcohol for 25 years. Physical examination at admission: body temperature 38 ℃, pulse 104 beats/min, breathing 20 beats/min, blood pressure 153/92 mmHg (1 mmHg =0.133 kPa), coarse breathing sounds in both lungs, no rales, and no abnormalities in the heart and abdomen. Specialty situation: clear consciousness. Motor aphasia. The right nasolabial fold is shallow, and the tongue is extended to the right. Muscle strength: Right upper limb grade 0, right lower limb grade 3, right limb muscle tone is low. Hypoalgesia in right hemisphere. Soft neck, negative Klinefelter sign. Residual nervous system examination showed no abnormalities. Emergency blood routine: white blood cells 13.8×10⁹/L (↑), neutrophils 84.7% (↑), red blood cells 4.85×10¹²/L, platelets 477×10⁹/L (↑); The complete set of emergency biochemistry and coagulation was normal; Head CT scan + angiography (CTA) showed left frontotemporal parietal lobe infarction, no abnormalities in paranasal sinuses and mastoid area, and multiple branches of left middle cerebral artery occlusion (FIG. 2A,Figure 2B,Figure 2C)； Proposed diagnosis of "(1) cerebral infarction; (2) hypertension? (3) upper respiratory tract infection?" to improve circulation, anti-platelet, lipid-lowering, anti-inflammatory (ceftriaxone + azithromycin), dehydration and other treatments.

A 55-year-old male came to the hospital for more than 10 days with no obvious inducement of skin and sclera yellowing with skin pruritus. Admission examination: Laboratory tests indicated that serum enzymatic bilirubin was increased, and carcinoembryonic antigen (CEA) and carbohydrate antigen 724 (CA72-4) cytokeratin 19 fragment Cyfra21-1 were increased. Ultrasound examination showed that the bile duct in the right lobe of the liver was not dilated; The small bile ducts of the left lobe were all dilated, with poor internal sound transmission, and the left hepatic duct was dilated, with a wider internal diameter of 1.0 cm, and a strip-shaped weak echo with a visible range of 4.2 cm ×0.8 cm, with clear boundaries and no obvious blood flow signal. The common bile duct was dilated, with a wider internal diameter of 1.4 cm, and a weak echo of 2.5 cm ×1.2 cm was seen in the hilar segment, without obvious blood flow signal (Figure 1,Figure 2)。 Suggested obstructive left lobe intrahepatic bile duct, common bile duct dilatation: left hepatic duct and common bile duct hilar weak echo suggested further examination: occupying space? Cholestasis? Magnetic resonance (MR) and magnetic resonance cholangiopancreatography (MRCP) showed dilation of intrahepatic bile duct, left hepatic duct and common hepatic duct in the left lobe of the liver, and congenital bile duct cyst to be excluded (Figure 3，Figure 4)。 After symptomatic treatment, clinical symptoms were relieved, and laboratory indicators dropped back.

The patient was a 76-year-old female. He was admitted to the hospital on October 7, 2017 with neck pain and stiffness accompanied by fever for 3 days without obvious inducement. The neck pain was intermittent, the visual analogue scale (VAS) of neck pain was 7 points, the body temperature was 37.7~38.8 ℃, there was no pain and numbness in the limbs, no walking instability, and the defecation was normal. No previous history of gout or rheumatoid arthritis. Admission physical examination: cervical spine rotation was obviously limited, neck muscles were stiff, and no obvious signs of nerve or spinal cord injury were found. Laboratory test: white blood cells 11.2×10⁹/L (4 to 10×10⁹/L), erythrocyte sedimentation rate 35.4 mm/1 h (0-20 mm/1 h), high-sensitivity C-reactive protein 14.7 mg/L (0-6 mg/L), rheumatoid factor and procalcitonin were normal. Cervical CT scan showed arcuate calcification of the transverse ligament of the atlas posterior to the odontoid process (FIG. 1A) and vertical linear calcification (FIG. 1B)。 According to the patient's medical history, physical signs and auxiliary examinations, odontoid plus coronary syndrome (CDS) can be basically diagnosed. After admission, lornoxicam 8 mg intravenously was administered twice daily, and the starting amount of dexamethasone 10 mg intravenously was administered once daily, which was changed to 5 mg/d after 3 days. After continuous treatment for 5 days, the patient's symptoms were significantly relieved at admission, and the leukocytes, erythrocyte sedimentation rate and high-sensitivity C-reactive protein all returned to normal after re-examination. After six months of follow-up, no neck pain with fever appeared.

Cementless total hip arthroplasty (THA) has emerged as the best option for end-stage hip disease in young active patients^[1,2]。 Despite the great success of cementless THA, with technological advances in prosthesis design, fixation interface and friction interface, there are still problems such as dislocation, unequal length of both lower limbs, aseptic loosening, intraoperative fractures, proximal femoral stress occlusion and persistent thigh pain, prosthesis impingement and other complications^{[3,4,5,6,7,8]}。 Precise prosthesis matching and positioning is essential to enhance prosthesis-bone matching^[9]。 Manual operation may cause intraoperative femoral fracture, the size of femoral stem is too small, and the femoral prosthesis is not well inclined forward, which may lead to poor prosthesis matching. Therefore, in order to improve the 20-year survival rate after THA to>95%, the accuracy in hip reconstruction needs to be maximized. This led to the development of computer-assisted orthopedic surgery (CAOS). Introduction of robotics in hip replacement with the aim of improving preoperative planning, optimizing implant selection and size, and increasing the accuracy of prosthesis positioning. Because of its high accuracy and high stability, this system has been used more and more in the field of joint surgery.

Epilepsy is a chronic neurological disease caused by abnormal and synchronized discharge of neurons in the brain. Due to the influence of irregular and repeated seizures, patients' psychological, cognitive function, mental and emotional problems are caused. The epidemiology of epilepsy patients showed that the incidence of comorbid depression ranged from 8% to 48%, with a mean of 29% and a median of 32%, which was much higher than that of the general population and other patients with chronic diseases^[1]。 Comorbid depression may aggravate the frequency of epileptic seizures, reduce the quality of life of patients, and affect the prognosis. Patients with epilepsy with a history of depression had a 2.2-fold higher risk of developing drug-resistant or refractory epilepsy than those without a history of depression, and the former had a higher probability of failure of surgical treatment^[2]。 Therefore, understanding the pathogenesis of comorbid depression in epilepsy, early recognition and appropriate treatment of comorbid depression have important clinical significance for improving the prognosis of epilepsy patients.