Volume 98 ·  Issue 39 ·  2018

Esophageal cancer is one of the eight common cancers in the world, and it is extremely difficult to cure^[1]。 The median time of postoperative recurrence was only 12 months, and more than 40% of them had local or regional recurrence. There was no uniform standard for retreatment after recurrence, and the median survival time was only 3~7 months^[2,3,4]。 According to the results of three-field lymph node dissection, the metastasis of cervical lymph node can reach about 20%^[5,6,7]。 The retreatment of cervical lymph node metastasis of esophageal cancer is difficult, and the overall response rate is only 34%^[3]。 Two-course radiotherapy for local recurrence of esophageal cancer after radiotherapy is difficult to achieve the expected dose due to the restriction of the tolerated dose of local normal tissue, and the probability of injury of normal tissue will increase when receiving the second course of radiotherapy^[8]Therefore, the second course of radiotherapy should be cautious. Lin et al.^[9]Application¹²⁵The 2-year local control rate and survival time were 26% and 10.5% in patients with recurrent esophageal cancer with cervical metastatic lymph nodes treated with radioactive seed implantation. 31.6% of patients had no recurrence within 12 months. It is suggested that radioactive seed implantation may be an effective treatment for local lymph node metastasis recurrence. However, the anatomical structure of the neck is complicated, the position of the target area is variable, and the peripheral blood vessels and nerves are abundant. It is difficult to puncture when seed implantation by conventional methods, and it is easy to damage blood vessels and other dangerous organs. In addition, because there is no standard surgical procedure, most doctors still use freehand experience implantation, resulting in inconsistent preoperative and postoperative doses, unrepeatable doses, uncontrollable doses, and difficult to popularize. How to implant cervical lymph nodes accurately has become an urgent problem to be solved. In recent years, the application of 3D printing templates has solved the problems of accurate puncture position and accurate particle dose for radioactive particle implantation^[10,11]。 Cervical lymph nodes are relatively fixed with peripheral blood vessels and nerves and other endangered organs, and their positions are superficial. The patient's position can be accurately placed as required, which is a good indication for 3D printing template-guided radioactive particle implantation. The 3D template is designed individually according to the CT images of the target area and endangered organs, and contains the anatomical position information and dosimetry information of the patient, which can effectively avoid puncture injury, improve the consistency of dose parameters before and after operation, and is simple, safe and repeatable. In order to improve the level of multidisciplinary comprehensive treatment of cervical lymph node metastasis of esophageal cancer and better standardize¹²⁵I Radioactive seed implantation for the treatment of cervical metastatic lymph nodes of esophageal cancer. Radioactive seed implantation branch of Hebei Medical Physicians Association organized multidisciplinary experts to discuss and write this article, so as to provide reference for clinical practice.

The global burden of disease study shows that hypertension has become the first contributor to disability-adjusted life years (DALY) in China, contributing 24.6% to all-cause deaths^[1,2]； Premature death years lost (YLL) caused by hypertension accounted for 64.5% and 72.8% of cardiovascular diseases and cerebrovascular diseases respectively, ranking first among all cardiovascular and cerebrovascular disease risk factors^[2]。 The proposal of the "Healthy China 2030" strategy provides basic guidelines for the prevention and control of hypertension in China, and in order to better play the guiding role of health policies in the prevention and control of hypertension, this paper systematically reviews the policies related to hypertension prevention and control issued since the launch of a new round of medical and health system reform in 2009, and puts forward relevant suggestions.

According to statistics, in 2013, the age-standardized prevalence of stroke in China was 11,14.8 per 100,000 people, and the age-standardized incidence rate was 246.8 per 100,000 people, which is the first cause of death in China^[1]Of which ischemic stroke accounts for 70% to 80%^[2,3]。 Therefore, the treatment ability of acute ischemic stroke (AIS) is the touchstone to test the treatment efficiency of stroke. In recent years, AIS treatment has developed rapidly, and rapid blood flow reconstruction is the core of the treatment, including recombinant tissue plasminogen activator (rt-PA), urokinase intravenous thrombolysis and mechanical thrombectomy. Patients with AIS received intravenous thrombolysis in a time-dependent manner, and the faster the thrombolysis, the better the effect^[4]； For patients with ischemic stroke onset 4.5 h, patients should be strictly screened according to the indications and contraindications, and intravenous rt-PA or urokinase thrombolytic therapy should be given as soon as possible; For patients with onset time longer than 4.5 h and onset within 6 h, patients can be strictly selected to consider intravenous urokinase thrombolysis^[5]。 The American Heart Association (AHA) recommends that patients with acute large vessel occlusion (AIS-LVO) receive endovascular therapy after intravenous thrombolysis, which is also time-sensitive^[6]。 However, in the real world, the treatment efficiency of AIS patients in China is not ideal, and the situation is grim. Relevant studies show that only 21.5% of AIS patients in China can reach emergency department within 3 hours of onset^[7], and pre-hospital delay is one of the important reasons why AIS patients cannot arrive at medical institutions where thrombolytic therapy can be performed within the time window^[8]。 The treatment of stroke can be divided into three stages: onset-call for help, call for help-go to hospital, and go to hospital-treatment^[9]While pre-hospital first aid covers the first two stages. In order to further improve the overall level of pre-hospital emergency treatment for stroke and standardize the work of pre-hospital emergency treatment, we compiled this "Guidelines for Diagnosis and Treatment of Pre-hospital Emergency Treatment for Stroke" with reference to successful experiences at home and abroad, combined with China's national conditions and the current situation of stroke treatment.

At present, pancreatic cancer has become the third leading cause of cancer death in developed countries such as Europe and America^[1]The mortality rate of pancreatic cancer in China is rising. Statistics from China Cancer Center in November 2017 show that pancreatic cancer has become the sixth leading cause of death for male cancer patients and the seventh leading cause of death for female cancer patients in China. The difficult factors in the treatment of pancreatic cancer are: (1) pancreatic cancer is aggressive, developing rapidly, and its early symptoms are hidden. Most patients have metastasized when they see a doctor, and the opportunity of radical surgical resection is lost; (2) Pancreatic cancer can surround important vascular structures such as superior mesenteric artery, vein and celiac trunk artery at the early stage of growth. Even if there is no metastasis, 30% ~40% of patients can no longer undergo radical resection at the time of diagnosis^[1,2,3]； (3) Only 5% ~12% of patients can undergo surgical resection treatment^[2]However, due to the large surgical trauma and many complications, it is difficult for patients to accept it, and because the tumor grows invasively, it is difficult to completely remove it after surgery, and it is easy to relapse after surgery, so the survival time of the patient is not significantly prolonged; (4) The efficacy of chemotherapy alone is not satisfactory. In the past, gemcitabine combined with albumin paclitaxel chemotherapy regimen was mostly used for the treatment of pancreatic cancer that cannot be surgically resected. In recent years, FOLFIRINOX regimen has been gradually used clinically to treat pancreatic cancer. Although the effect is improved compared with before, the efficacy is still not significant; (5) Although the commonly used radiotherapy methods such as conformal intensity modulated radiotherapy and cyberknife have obvious therapeutic advantages over traditional radiotherapy, the control of pancreatic cancer is still not ideal^[4]； (6)¹²⁵I Radioactive seed implantation has achieved certain clinical efficacy in the treatment of pancreatic cancer, but sometimes it is accompanied by complications such as pancreatic leakage, bleeding and radiation enteritis; (7) The temperature-based physical ablation techniques such as radiofrequency ablation, microwave ablation and argon-helium knife are "non-selective" in the destruction of tissue structure, and the ablation lesion is easy to damage the surrounding important tissue structure and easily cause serious complications^[5,6,7]Therefore, it is difficult to popularize and apply.

To explore the MRI characteristics of injuries of scapholunate ligament (SLL), and provide imaging basis for the early diagnosis and treatment of the injuries.

A total of 20 healthy volunteers without wrist injuries and 30 patients who complained dorsoradial-sided wrist pain and were highly suspected as the injury of SLL underwent the wrist magnetic resonance examination and X-ray examination in Beijing Jishuitan Hospital from January 2013 to September 2017.All subjects underwent anterior and lateral radiographs of the wrist joint and examination on coronal T₁WI scan and PD-FS on 3 planes respectively in a prone position.Then the MRI characteristics of 20 healthy volunteers and 30 patients with SLL injuries that confirmed by operation were analyzed.According to the comparative analysis of normal anatomy and Geissler grades, the injuries were graded and MRI features of different types of injuries were analyzed.At last, imaging findings were compared with surgical results.

Twenty healthy volunteers without injuries showed mainly in low signal intensity on T₁WI and PD-FS images.According to Geissler grades, there were 11 GradeⅠ injuries (5 had triangular fibrocartilage complex (TFCC) and SLL injuries and 1 had fracture of scaphoid and SLL injuries simultaneously), 8 GradeⅡ injuries (2 had TFCC and SLL injuries, 1 had TFCC, lunotriquetral ligament (LTL) and SLL injuries and 1 had distal radius fracture, TFCC and SLL injuries simultaneously), 7 Grade Ⅲ injuries (3 had TFCC and SLL injuries, 2 had fracture of scaphoid and SLL injuries and 1 had TFCC, LTL and SLL injuries simultaneously) and 4 Grade Ⅳ injuries (2 had TFCC and SLL injuries and 1 had fracture of scaphoid and SLL injuries simultaneously) among 30 patients.A tear can be confidently diagnosed when the ligament segment was absent or there was a fluidfilled discontinuity.A tear that involves 1 or 2 of the 3 segments (volar, proximal, or dorsal) of either the SLL was considered a partial tear, whereas a tear of all 3 segments was a complete tear.

MRI can demonstrate the anatomy of interosseous ligaments accurately, evaluate and make the general grades of injuries.It is of significance for the early diagnosis and treatment protocols of the interosseous ligaments injuries.

To investigate the diagnostic value of low dose of dual-source CT venography examination for DVT (deep venous thrombosis).

A total of 60 patients from Nanjing First Hospital with suspected DVT underwent indirect low dose CTV examination and treatment of DSA from January to December, 2017, and recording the radiation dose for CTV.DSA as the gold standard, calculate the sensitivity, specificity of CTV, kappa consistency test was used to exam the results of CTV and DSA.McNemar test was used to check statistical difference between two examinations.

A total of 60 patients, 780 blood vessels took CTV examinations, 326 were positive; 420 blood vessels took DSA examinations, 332 were positive.DSA as the gold standard, the sensitivity, specificity, of DVT detection by CTV were 96.2% and 92.6%, kappa=0.860, P<0.05, and the result ofMcNemar test was P=0.263.

Low dose of dual-source indirect CTV examination for DVT can not only reduce radiation dose for the patients, but also has a high clinical value in the diagnosis of DVT.

To evaluate the value of apparent diffusion coefficient (ADC) histogram in neonatal brain alteration with congenital heart disease (CHD).

MRIs of 60 neonates with CHD confirmed by echocardiography were retrospectively analyzed in Children′s Hospital of Nanjing Medical University from January 2012 to December 2016.Twenty-two MRIs of neonates with mild pneumonia or scalp hematoma who were suspicious of brain disease but normal MRI findings were enrolled as normal control.MRIcron and ImgJ softwares were used to acquire ADC histogram.The correlation between the gestational age and ADC histogram values were calculated respectively.Then t-test was used to analyze the differences of the histogram values and the diagnostic efficacy of different parameters was analyzed using the receiver operating characteristic curve.

The ADC values were significantly correlated with the gestational age (P<0.05). The 70th-90th ADC, skewness, kurtosis and variance were statistically significant (P<0.05). The area under the curve of the 90th ADC value was the largest at 0.698.

The ADC histogram can quantify and objectively provide more diffusion information of brain tissue. It is a rapid and feasible quantitative method to identify brain changes in neonates with CHD.

To investigate the safety and efficacy of transarterial chemoembolization (TACE) using bleomycin for the treatment of medium-advanced hepatocellular carcinoma (HCC).

Between December 2015 and December 2017, a total of 160 patients from the Chinese PLA General Hospital with moderate-advanced HCC whose diagnoses were confirmed by pathology or clinical imaging and were in accord with the Barcelona Clinic Liver Cancer (BCLC) staging criteria were prospectively analyzed.All patients had shown persistent viable tumor or tumor progression after at least 2 sessions of TACE.All patients included 135 males and 25 females , age 35-74 (57±8)years, were randomly divided into two groups, the treatment group: TACE procedures consisted of bleomycin+ pirarubicin+ oxaliplatin+ fluorouracil, the control group: pirarubicin+ oxaliplatin+ fluorouracil, and according to modified RECIST criteria the tumor response was evaluated once every 4-6 weeks, survival analysis was performed, overall survival and progression free survival were evaluated.the adverse events were recorded.

Response rate of the treatment group was 27.5%(22/80), the median progression free survival(mPFS)was 5.8 months, and the median overall survival (mOS) was 8.1 months.Response rate of the control group was 7.5%(6/80), mPFS of 2.9 months, and mOS of 4 months.The differences in mPFS and in mOS between the two groups were statistically significant (P=0.009, 0.002 respectively), and no serious adverse occurred.

It is suggested that transarterial chemoembolization with bleomycin is safe and effective for medium-advenced HCC.

To investigate the mRNA genomics changes and significance of important ion channel proteins in patients with atrial fibrillation (AF), to reveal the mechanism of electrical remodeling in AF.

Ninety patients with AF were chosen to receive the radiofrequency ablation (AF-RFA), 90 healthy subjects were included as the normal control group.The coronary sinus blood and peripheral venous blood were taken from each AF patient during the operation of AF-RFA.The genome-wide mRNA expression profile was analyzed with mRNA microarray chip, and the mRNA expression difference results for the major ion channel gene was further validated using Real-time PCR test.

The expression of twelve ion channel protein mRNA increased ≥2.0-fold, expression of 10 mRNA decreased ≥2.0-fold, among which K⁺ channel gene KCNE4, KCND2, KCNN4 declined obviously, KCNA5 dropped 11.54-fold (P< 0.01); KCNS3, KCNS1, KCNG1, KCNG7 and Ca^{+ +} channel gene CACNA2D3 increased significantly.Compared with autologous peripheral blood, 12 mRNAs of ion channel protein in coronary sinus blood of AF patients was differentially expressed ≥2.0-fold.Compared with control group in peripheral blood, 7 ion channel protein mRNA expression differences was ≥2.0-fold, and the KCNA5 gene expression was down by 8.13-fold.RT-PCR confirmed that the trend and extent of differential expression were consistent with the chip results.The results of myocardial tissue RT-PCR showed that CACNA1C, KCNC3, KCNG1 and KCNK7 mRNA were up-regulated in AF (P<0.05), and other ion channel mRNA expressions were down-regulated (P<0.05). KCNA5 was down-regulated most obvious.

The down-regulation of KCNA5 gene expression in AF patients is most obvious, and more potassium ion channel expression differences are also significant, so that the potassium ion channel reconstruction may play a dominant or much more important role in AF electrical remodeling.

To evaluate the surgical technique and outcomes of uteri retrieval from brain-dead multi-organ donors.This study is a preclinical research of human living uterine transplantation.

From May, 2015 to May, 2017, four uteri retrieval procedures, characterized with radical hysterectomy and uterine vascular pedicles dissection, were performed in multi-organ brain-dead donors.The uterus was the third authorized organ after the kidney and liver retrieval procedures in the first two cases.The uterine pedicles included the uterus, ovaries, fallopian tubes, the upper one-third of the vagina and internal iliac vessels or external iliac vessels.The perfusion of the uterus was conducted after the retrieval for evaluating the availability, followed by histopathological examination of the uterine issues per 30 minutes.

Since the uterine vein was quite difficult to identify and dissect in the first two case, which result in the rupture of triple uterine veins.Therefore, the uterine venous vessels including uterine vein connected with internal iliac vein and internal iliac arteries were selected as vascular grafts and dissected successfully in the last two cases, which could be perfused with the mixture of 4 ℃ heparinized physiological saline through each artery because of shortening the surgical time and arranging the uterine procurement as the first authorized organ procedure.Mean (SD) operative time was 152.5±39.0 min (115-215 min, n=4).

Our preliminary experience indicated that the uterus could be retrieved from the brain-dead multi-organ donors and transplanted to the recipient.The attempt of skeletonizing the uterine veins should be replaced by dissection of internal iliac vein.

To discuss the diagnosis and treatment strategy of traumatic optic nerve neuropathy (TON) combined with carotid artery injury.

Retrospective analyses were performed 397 cases of TON at Neurosurgery department of Beijing Tongren Hospital, Capital Medical University (CMU), from January 2016 to December 2017.The clinical experience was concluded.

9 cases of Traumatic Pseudo Aneurysm (TPA) and 16 cases of Traumatic Carotid Artery-Cavernous Sinus Fistula (TCCF) were found.7 cases of TPA were treated by covered stent, the other 2 cases were treated by detachable balloons.11 cases of TCCF were treated by detachable balloons, and 5 cases of fistulas were found spontaneously closed by DSA after 1-3 months.There was no disability rate and mortality in this study.

TON combined with carotid artery injury was a critical situation, and sometime without obvious symptoms and sign, which was easily miss diagnosed.It should be with more concern in diagnosing and treating in such cases, to avoid disability rate and mortality.

To evaluate the cortical bone characteristics in the medial column of proximal humerus.

A total of one hundred and three healthy adults who underwent shoulder computed tomography scanning in Tianjing Hospital were included in this study.The subjects were divided into three groups according to the age: group A (20-39 years), group B (40-59 years), and group C (>60 years). Cortical bone mapping (CBM) was used to analyze ordinary clinical CT scans using Stradwin 5.2 software.Colors thickness maps were created for each proximal humerus.The region of interest (ROI) 1-6 were set at three levels of the lateral and medial column of proximal humerus.Cortical thickness (CTh), cortical mass surface density (CMSD), and endocortical trabecular bone mineral density (ECTD) were assessed in the three slices in proximal metaphysis.The impact of age, gender to the cortical bone indices of medial column of proximal humerus were investigated with relative analysis.Cortical indices of the lateral and medial column were compared with independent samplest test.

In ROI 2 and 3, men had higher cortical bone values than women, and significant differences in ECTD and CMSD were found in ROI 2, 3 and ROI 2 (t=2.100, 2.238, 2.530, all P<0.05). The lineal regression analysis showed that all cortical indices in ROI 1-3 decreased significantly with age for both women and men (r²=0.042-0.248, all P<0.05). In group A-C, the medial columns had higher CTh and CMSD values than lateral sides in plane 1, although significant differences were found only in group A (t=3.696, 3.749, both P<0.05). The highest CTh, CMSD and ECTD of the medial compact bone was detected in ROI 1, followed by ROI 2 and 3 in group A (F=5.867, 6.776, 19.062, all P<0.05). The medial columns had approximately equivalent cortica indices values in ROI 1-3 in group B and C.

It indicated that significant regional variation in all cortical parameters exists in the medial column of proximal humerus, and the indices are influenced by gender and age.

To evaluate the outcome of the deep component augmentation and superficial component repairing and syndesmosis screw fixation in treating ankle fracture associated with deltoid ligament injury and syndesmosis diastasis.

From January 2014 to December 2017, 16 patients with ankle fracture combined with deltoid ligament injury and syndesmosis diastasis were treated with the deep component augmentation and superficial component repairing in Beijing Jishuitan Hospital.Of the patients, 13 were males and 3 were females, with an average age of (38±10) years (21-57 years). Nine cases were athletic injuries, 4 cases were daily-life injuries and 3 cases were traffic injuries.According to the Weber classification, 6 cases were type B, 10 cases were type C. According to the Lauge-Hansen classification, 6 cases were supination external rotation Ⅳ injury, 9 cases were pronation external rotation Ⅳ injury, 1 case was pronation abduction Ⅲ injury.The surgical treatment method was rigid fixation of the lateral malleolus and deep deltoid ligament augamentation instead of syndesmosis screw fixation.The effect of the surgical method was observed.

The average follow up was (24±12) months (6-40 months). The mean degree of dorsiflexion was 17.8°±6.8° (5°-30°), with 3.8°±6.0° (0°-15°) less than that in normal side, the mean degree of plantar flexion was 46.9°±7.9°, with 1.9°±3.9° (0°-10°) less than that in normal side.The mean Philips and Schwartz score was 96.8±5.1 (82-100), the American Orthopaedic Foot and Ankle Society (AOFAS) Score was 97.4±4.6 (84-100).

In the treatment of ankle fracture associated with deltoid ligament injury and syndesmosis diastasis, the deep component augmentation and superficial component repairing and proper rehabilitation can benefit the functional recovery.

To analyze the clinical characteristics of primary Sjögren′s syndrome (pSS) with venous system thrombosis (VT), and to improve the understanding of the disease.

The clinical and laboratory characteristics of 16 cases of pSS with VT were analyzed retrospectively.

Among 16 cases, 12 cases was women, 2 case was men, age between 45 and 71.There were 14 cases of lower extremity VT, 2 case of jugular vein thrombosis.Twelve patients admitted with dry symptoms and 4 patients with pulmonary symptoms.Antiphospholipid antibodies were negative.The positive cases of anti-SSA 52 000 and anti-SSA 60 000 were 12 cases respectively.Sixteen cases had interstitial lung diseases.

pSS are potential VT high risk, especially in patients with interstitial lung disease and anti-SSA positive.We should improve the VT vigilance of pSS patients.

To evaluate the safety of resuscitation with hydroxyethyl starch 130/0.4 during the early stage of hemorrhagic shock.

Total of 120 healthy male SD rats of 2 to 3 months of age were selected as the study sample (weighed from 250 to 290 g), all the rats were numbered by staining.After that, the rats were divided into 12 groups by using random number table method: sham group (S group), no liquid resuscitation group (NF group), lactated Ringer′s resuscitation group (LR group), HES resuscitation group (HES group). At the same time, the LR and HES resuscitation groups were divided into five subgroups with a concentration of 7.5, 15, 30, 60 and 90 ml·kg^-1·h^-1, respectively.The model of uncontrollable hemorrhagic shock was created by the method of exsanguination plus tail-cuffing.Fluid resuscitation was started 30 minutes after the exsanguination and continued for 60 min after transfusion for 15 min.The observation was continued for 330 min.At the end of observation, all rats were sacrificed and blood was collected from the rats to determine the thromboelastograms and the maximum amplitude and related parameters, as well as platelet counts, blood urea nitrogen, creatinine, urinary and renal injury molecules, and neutrophil gelatinase-associated apolipoprotein levels.Rat lung tissue specimens were collected and wet weights of the right lung and dry weights after drying were measured.The data were compared by using one-way analysis of variance (ANOVA), LSD-t test or Dunnett-t test.

ANOVA analysis showed that there was no significant difference in mean artery pressure (MAP) values between groups at the beginning of fluid resuscitation (F=0.934, P=0.245). At the end of fluid resuscitation, the MAP of HES90 group was (40±9) mmHg, which was lower than that in other groups.Compared with other groups, the HES90 group had higher blood loss and blood transfusion rate.There was no significant differences in platelet counts between the HES group and the LR group at 330 min (t=0.987, P>0.05), but the maximal amplitude (MA) of the thrombelastogram (TEG) was lower in the HES90 group than that in the S group (t=2.354, P<0.05). No significant difference was detected in blood urea nitrogen and serum creatinine levels between the HES, LR group and the S group (t=1.098, 0.895, both P>0.05). The total amount of urinary kidney injury molecule 1 (Kim-1) in the HES90 and NF groups increased, neutrophil gelatinase-associated apolipoprotein (NGAL) concentration and urinary NGAL levels were significantly higher than those in other groups, and the difference were statistically significant (t=3.532-11.209, all P<0.05).

Small to moderate doses of HES130/0.4 during hemorrhagic shock is more effective and safer than the same dose of LR.

Since the implementation of the "comprehensive two-child" policy in China in 2015, the number of rebirths of older women has increased. Elderly pregnant women refer to pregnant women whose delivery age is ≥35 years. The proportion of elderly pregnant women in China has increased from 10.1% in 2011 to 19.9% in the first half of 2016^[1]。 Will older pregnant women increase adverse perinatal pregnancy outcomes compared with non-older pregnant women? Therefore, this study retrospectively analyzed the clinical data and pregnancy outcomes of 3 138 elderly pregnant women to explore the influence of advanced age on perinatal pregnancy outcomes.

Cardiogenic shock is the first cause of death in hospitalized patients with acute myocardial infarction^[1]。 Foreign research data show that although early reperfusion therapy and active drug therapy have been widely used in clinical practice, the prognosis of patients with cardiogenic shock has been greatly improved, but the hospitalization mortality rate remains at a high level^[2,3,4]。 There are few investigations on the clinical status of cardiogenic shock after myocardial infarction in China. This study retrospectively collected the data of patients with acute myocardial infarction combined with cardiogenic shock who attended Fuwai Hospital of Chinese Academy of Medical Sciences for emergency coronary angiography during 7 years from January 1, 2010 to December 31, 2016, and analyzed the changes of incidence, clinical complications, treatment measures and hospitalization mortality of cardiogenic shock, aiming to reveal the clinical characteristics, prognosis and changing trends of acute myocardial infarction combined with cardiogenic shock.

Weber first proposed two-point resolution (2-PD) in 1835, defining it as the minimum distance between two points that can be felt^[1]。 At present, the normal value standards of 2-PD used in China are all quoted from foreign research data, but there are few relevant studies in China. No normal values of 2-PD in the feet and lower limbs have been reported previously. We use Mayo Hospital's Aronson et al.^[2]Reported test methods for static 2-PD. The 2-PD of 128 healthy adults were investigated in order to obtain the normal range of 2-PD in China.

Case 1 was a 49-year-old male. In July 2013, he was admitted to Zaozhuang Municipal Hospital of Shandong Province for more than 10 years due to enlarged deformity of both fingers and skin ulcers. More than 10 years ago, the patient developed swelling of the metacarpophalangeal joints, proximal and distal interphalangeal joints of both hands without obvious reason, without obvious joint pain, and gradually developed enlarged deformity of both fingers, accompanied by finger ulcer, blackening of the ends of the knuckles, spontaneous necrosis and detachment of some knuckles, pus discharge, and non-union, so he underwent terminal knucklectomy in a local hospital. Postoperatively, both hands were still progressively enlarged, accompanied by repeated skin ulcers on both hands (Figure 1)。 X-ray plain films of both hands showed multiple falangeal defects and deformities in both hands, and bone destructive lesions in the falangeal bone of the left index finger. Cervical MRI showed syringomyelia at the upper margin of C2~ T4. MRI of the brain and thoracolumbar cord showed: cerebellar subtonsillar hernia, C1~ T2 vertebral level syringomyelia (Figure 2)。

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by abnormal production of autoantibodies due to excessive activation of B cells and imbalance of T lymphocytes. It causes multiple organ and system damage through immune complex deposition and lymphocyte infiltration. There are two new types of helper T cells (Th) localized in the lymphoid germinal center: follicular helper T cells (Tfh) and follicular regulatory T cells (Tfr). Tfh-Tfr balance plays a crucial role in the formation of lymphocyte germinal center, abnormal B cell activation and autoantibody production in SLE, and is closely related to the involvement of target organs such as disease activity and lupus nephritis. The latest research progress of Tfh-Tfr immune balance in SLE is reviewed below.

Heart failure is a manifestation of the development of various heart diseases to the end stage, and is the main cause of cardiovascular death^[1]Cardiac remodeling is an important pathogenesis of heart failure, and the central link of cardiac remodeling is cardiac hypertrophy^[2]。 Myocardial hypertrophy is an adaptive change of myocardial tissue to adapt to hemodynamic overload, aiming at reducing ventricular wall tension and oxygen consumption, so as to maintain normal systolic function and cardiac output. Under the continuous stimulation of various pathological factors such as ischemia and pressure overload, myocardial fibrosis is aggravated, microcirculation is damaged, which leads to tissue hypoxia, myocardial cell death, decompensation of myocardial hypertrophy, and finally deteriorates to heart failure^[3]。 Pathological myocardial hypertrophy is a kind of ventricular remodeling and cardiac insufficiency caused by hypertension, coronary heart disease and valvular heart disease. It is an independent risk factor of heart failure and an important predictor of cardiovascular morbidity and mortality^[4]Therefore, clarifying the specific pathogenesis of pathological myocardial hypertrophy is the key to the prevention and treatment of heart failure and cardiovascular diseases.

immunoglobulin G4 related disease (IgG4-RD) was first proposed in 2003^[1]The main feature is multi-organ IgG4+ cell infiltration. In recent years, with the further understanding of IgG4-RD, it has been found that the disease can involve the nervous system, that is, IgG4-related nervous system diseases. The etiology of this disease is unknown, which may be related to genetic factors. The clinical manifestations lack specificity, and the diagnosis is difficult. IgG4-related neurological diseases can involve pituitary gland, dura mater, brain parenchyma, intracranial blood vessels and other sites. This article reviews the clinical manifestations, auxiliary examinations, diagnosis, differential diagnosis and treatment of IgG4-related neurological diseases, so as to improve clinicians' understanding of the disease.