Volume 98 ·  Issue 41 ·  2018

Guillain-Barré syndrome (GBS) is the most common cause of acute delayed paralysis worldwide^[1]。 GBS is somewhat self-limiting, but despite the application of immunotherapy, 25% of patients progress to severe respiratory insufficiency, 20% of patients have persistent severe disability, and approximately 5% of patients die^[2]。 On the one hand, the current diagnostic standards commonly used internationally are too strict and over-reliance on laboratory tests, resulting in delays in diagnosis and initiation of treatment for some patients^[3]。 On the other hand, non-individualized treatment plan is also the main reason for poor prognosis of some patients^[4]。 Therefore, it is necessary to correctly understand the misunderstanding of diagnosis and treatment of GBS.

Critical thinking is a form of thinking based on sufficient rationality and objective facts to conduct theoretical evaluation and objective evaluation. It is not swayed by emotional and unfounded opinions, words and deeds. Criticizing an opinion is not the same as criticizing the person who holds it. In recent years, various clinical expert consensus and clinical diagnosis and treatment guidelines have sprung up like mushrooms after a rain. There are numerous and countless, covering almost all kinds of diseases, which have a quite positive effect on standardizing clinical behavior and improving the level of diagnosis and treatment of diseases. However, these consensus or guidelines are only the experience summary of a few experts, and are often formulated on the basis of the commonality of diseases, without considering the particularity and complexity of diseases. If it is not correctly understood and practiced, it may lead to misdiagnosis and mistreatment, which may bring harm to patients. The humble opinion on the clinical expert consensus and guidelines is discussed below.

To introduce a robot-assisted modified method of sacroiliac screw path planning in order to reduce the incidence of screw misplacement.

The study involved 13 patients suffering from posterior pelvic injuries treated by percutaneous sacroiliac screw in Yantai Shan Hospital from August 2016 to May 2018. The patients included 9 males and 4 females, aged from 18 to 70 years (mean age 46.2 years). Causes of injury were traffic accidents (n=7), crushing injury (n=4) and fall from height (n=2). According to AO classification, 8 cases were classified with type B fractures (3 with type B1 and 5 with type B2), and 5 cases with type C fractures (2 with type C1, 1 with type C2, 2 with type C3). All the patients were treated by robot-assisted percutaneous sacroiliac screws (AO cannulated screws with a diameter of 7.3 mm) with an improved method of screw path planning. The screw placement time, blood loss, postoperative neurological, vascular and visceral function etc were observed. X-ray and CT were checked in the follow-up after the operation. Visual analogue scale (VAS) score was used to assess the pain degree of patients one week after the surgery.

All the sacroiliac screws were successfully implanted once with the robot-assisted improved method of screw path planning. The mean placement time of single screw was 15.9 min and the mean blood loss for single screw placement was less than 1 ml. No clinical manifestations of injuries of blood vessels, internal organs and lumbosacral nerve was found after the operation. The postoperative X-ray films and CT showed that none of the sacroiliac screws wore out the sacral body or the sacral wing′s frontal cortex. Also, it was found that none of the sacroiliac screws strayed into the sacral canal and the intervertebral space. The mean VAS score decreased from preoperative 6.9 (4-10) to postoperative 1.8(0-3).

The robot-assisted improved method of screw path planning contributes to safe and accurate sacroiliac screw placement.

To evaluate the predictive value of thumb ossification composite index (TOCI) for growth potential in female adolescent idiopathic scoliosis (AIS) patients and to analyze its correlation with several other indicators of growth potential.

A retrospective review was conducted on 45 girls with AIS who underwent standard bracing treatment between October 2006 and August 2013 in Nanjing Drum Tower Hospital. All patients were regularly followed up with an interval of 3-6 months until brace weaning. At each visit, the following data were collected and recorded: chronologic age, stage of menses, standing height, Cobb angle of main curve, TOCI score, digital skeletal age (DSA) score and radius, ulna and small bones (RUS) score. The height velocity (HV) at each visit were calculated. The correlations analysis between TOCI and other indicators including DSA scores and RUS scores were studied.

The average age at initial visit was (10.9±1.3) years. The mean age of menarche was (12.6±1.3) years. The mean peak height velocity (PHV) was (7.5±1.5) cm/year and the mean age of PHV was (12.0±0.9) years. A total of 71.8% AIS girls attained their PHV at TOCI 5. The Spearman correlation analysis showed that TOCI was highly correlated with the DSA and RUS scores (r=0.95 and 0.96, both P<0.001). Chi-square test showed that TOCI 5 accurately predicted the occurrence of PHV (Cramer V=0.531,P=0.007).

The TOCI 5 indicates high HV and high growth potential in AIS patients with bracing treatment. TOCI can thus serve as a good indicator for growth potential in braced AIS girls.

To analysis of fetal ultrasound soft index positive cases during 16-18 weeks of pregnancy, and to explore the relationship with chromosomal abnormalities in order to increase the positive rate of invasive prenatal diagnosis and reduce the rate of missed diagnosis.

A total of 569 cases which were diagnosed with positive soft markers in the department of gynecology and obstetrics of the Second Hospital of Jilin University from Jan.2016 to Jan.2017 were studied by ultrasonography. Twenty-five cases were lost in follow-up and finally 544 cases were included as group A. Those fetuses who combined with other malformations were induced labor. Non-invasive DNA examination was recommended for continued pregnant women, and those pregnant women whose results were high risk underwent the amniotic cavity puncture. When the fetal aneuploidy was confirmed, they chose induced labor. We followed the rest of those patients until postnatal half year. Randomly selected 544 cases during 16-18 weeks of pregnancy without obvious abnormalities into group B, followed up to half a year after birth.

In group A, 7 of the 544 cases were combined with other severe malformation in the beginning, among the remaining 537 patients, 273 of them received non-invasive DNA examination. Ten cases were high risk results, all of them underwent the amniotic cavity puncture with the result of chromosome abnormality, and they chose induced labor. Six cases were found other malformation in the second trimester who chose induced labor, and the rest 521 cases followed until the fetuses was born after half year had a favorable prognosis. In group B, 1 cases of severe deformities and 1 cases of haploid fetuses were found in 544 fetuses. The incidence of haploid fetus in group A and group B were 1.8% and 0.2%, respectively, with statistically significant (P<0.05). The incidence of severe malformation in group A and group B were 2.3% and 0.2%, respectively, with statistically significant (P<0.05).

During 16-18 weeks of pregnancy, sonographic markers may indicate an increased risk in fetal chromosomal abnormalities. The risk of serious malformation was increased in the fetuses with ultrasonic soft marker positive, but there was no specificity.

To investigate the clinical manifestations of an early-onset Alzheimer′s family and the novel mutation sites of PSEN1 gene.

Clinical data was collected from 30 members of a family with early onset Alzheimer′s disease from Neurology Department of Henan Province People′s Hospital in 2016, and high-throughput sequencing and sanger sequencing were used to detect and further validate the PSEN1 gene mutation. At the same time, 100 unrelated healthy people were selected as controls.

A total of 3 members of the family carried PSEN1 (p.F105L mutation). The clinical symptoms or imaging of the three people were consistent with the diagnosis of Alzheimer′s disease.

The p. F105L mutation of the PSEN1 gene has been found in the Chinese population, which may be involved in the pathogenesis of this familial Alzheimer′s disease.

To compare the ability and visibility of cone-beam CT and MSCT in showing vestibular aqueduct.

An experimental anatomical study which from June 2017 to August 2017 was performed on 76 temporal bones from 38 human cadavers with unknown clinical history. They all underwent CBCT and MSCT and all images were unified and standardized. The standard position was oblique sagital reconstruction.The length of the vestibular aqueduct, the midpoint and the external aperture width were measured on the standard position. The internal aperture, isthmus and proximal portion of the vestibular aqueduct on the images of the two kinds of equipment were evaluated. The measurement results of the two devices and image quality of the vestibular aqueduct were compared.

There was no significant statistical difference between the results of the measurement of CBCT and MSCT(P>0.05). In CBCT images, the total display rate of internal aperture was 77.6%(59/76), and the clearly display rate was 81.4%(48/59). The total display rate of the proximal portion of vestibular aqueduct was 57.0%(45/79), and the clearly display rate was 60.0%(27/45). The total display rate of isthmus of vestibular aqueduct was 59.2%(45/76), and the clearly display rate was 60.0%(27/45). In MSCT images, the total display rate of was 46.1%(35/76), and the clearly display rate was 60.0%(21/35). The total display rate of 5 of the proximal portion of vestibular aqueduct was 56.6%(43/76), the clearly display rate was 46.5%(20/43). The total display rate of isthmus of vestibular aqueduct was 68.4%(52/76), and the clear display rate 36.5%(19/52). There was significant statistical difference between the CBCT and the MSCT (P<0.05) in displaying of internal aperture of vestibular aqueduct.

Compared with MSCT, the image of vestibular aqueduct obtained by CBCT can meet the diagnostic requirements and CBCT have better visibility in showing some subtle structures of vestibular aqueduct than MSCT.

To investigate the correlation between tumorous cellular density (TCD) and apparent diffusion coefficient (ADC) of 3.0 T magnetic resonance diffusion weighted imaging (DWI) in local advanced lung cancer.

From January 2015 to December 2017, a total of 59 patients with locally advanced lung cancer confirmed by pathology in Shaoxing People′s Hospital who underwent DWI by 3.0 T magnetic resonance imaging were included.The ADC and TCD values of tumor were measured. The difference and correlation between ADC value and TCD in lung cancer were analyzed.

Among 59 lung cancer cases who were examined with DWI, 45 cases of TCD were obtained. Statistical analysis showed that the ADC value of small cell lung cancer (SCLC) was significantly higher than that of squamous cell carcinoma (P=0.011)and adenocarcinoma (P=0.004). TCD of small cell carcinoma was significantly higher than that of squamous cell carcinoma (P=0.007) and adenocarcinoma (P<0.01). There was no statistical difference in ADC value and TCD between squamous cell carcinoma and adenocarcinoma (allP>0.05). There was negative correlation between the ADC value and TCD in lung cancer (P=0.001, r=-0.534).

DWI is not only beneficial to distinguish SCLC from squamous cell carcinoma and adenocarcinoma, but also can indirectly reflect the tumorous cellular density.It can provide a basis for monitoring the therapeutic effect of clinical lung cancer.

To measure the activity of ¹²⁵I seed and compare the dose difference of ten patients treated with seed implantation in pre-plan with actual seed activity and calibrate activity.

The activity of 100 seeds from company A and B was measured with a well-type ionization chamber 1 day before operation and named group A and B. The activity of two groups was compared and the error between actual and calibrate activity (22.2 MBq, group C) was calculated. Ten patients implanted with ¹²⁵I seeds from November 1 st to 30 th, 2017, solstice 30 were selected in Hebei General Hospital. Firstly, pre-plans were designed with 22.2 MBq, prescribed dose were 100-140 Gy. The dose parameters of 90% volume absorbed dose (D₉₀), 150% volume fraction (V₁₅₀) and 100% volume fraction (V₁₀₀) were calculated. Then changed 22.2 MBq to actual activity of group A and B, calculated the dose parameters above again. Then dose parameters of D₉₀, V₁₅₀, V₁₀₀ in group C were compared with those in group A and B respectively.

The actual activity 1 day before the operation was(22.6±0.7)and(23.9±0.9)MBq in group A and B respectively. Compared with 22.2 MBq, the difference was statistically significant(t=5.7, P<0.05 andt=19.2, P<0.05), and the activity error of group B was greater than 5%. The D₉₀ of group A, B and C were (124.3±9.7) , (131.2±10.2) and (121.9±9.5) Gy respectively.The V₁₅₀ were 58.4%±9.4%, 63.7%±8.9% and 56.5%±9.2% respectively. The V₁₀₀ were 88.9%±5.0%, 92.0%±4.1%, 88.1%±5.2% respectively.The difference of D₉₀ between calibrate activity(group C) and actual activity(group A and B) were statistically significant (t=40.2, P<0.05 andt=40.3, P<0.05). The difference of V₁₅₀ between group C and group A and B were statistically significant (t=7.5, P<0.05 andt=24.7, P<0.05). The difference of V₁₀₀ between group C and group A and B were statistically significant (t=6.6, P<0.05 andt=7.3, P<0.05).

There is difference between the actual activity and calibration activity. The difference affects the dose parameters in pre-plan.The seed activity should be measured before operation strictly and the pre-plan should be designed with the actual activity.

A variety of interstitial cells in tumor microenvironment (TME) based on glioma stem cells(GSC) have the function to promote malignant progression of tumors, but whether these interstitial cells have already undergone malignant transformation and their related molecular characteristics are still poorly understood.

Human SU3-RFP glioma stem cells (GSC) stably transfected with red fluorescent protein (RFP) and interstitial cells from enhanced green fluorescent protein (EGFP) transgenic nude mice were co-cultured in vitro. SU3-RFP cells were also inoculated in different tissues of EGFP-Balb/c nude mice. Immortal EGFP⁺ cells were monocloned either from co-culture cells in vitro, or from their xenografts in vivo. These immortal EGFP⁺ cells were confirmed to bear characteristics of tumor cell via chromosomal analysis and tumorigenicity assay. Related molecular phenotypes of these cells were further detected through RT-PCR, flow cytometry and immunochemistry(IHC) techniques.

(1) Two EGFP⁺ cell lines were obtained in vitro, and 5 EGFP⁺ cell lines were obtained in vivo tumorigenic experiments. Seven EGFP⁺ cell lines all have characteristics of self-renewal, heteroploid of chromosomes and 100% tumorigenicity. (2) Cell surface marker analysis showed cell origin of these cell lines were macrophages (tMΦ1 and tMΦ2 ), dendritic cells (tDC1 and tDC2), fibroblasts (tFB), oligodendrocytes (tOG) and BMSC cells (tBMSC), respectively. (3)All of these seven cell lines co-expressed Sca-1 and c-myc, and have Sox-2 or Nanog expression also, which suggest that they may bear molecular characteristics of mesenchymal stem cells or pluripotent stem cells.

(1) Tumor stromal cells in TME have undergone malignant transformation, which is related to the tissue remodeling of TME by GSCs, and not limit to the specific type of their parasitic tissues. (2) Tumor cells originated from GSC and tumor interstitial cells, respectively, are two major types of tumor cells with different origins in glioma parenchyma, can not be simply regarded as tumor heterogeneity, transformed interstitial cells of TME may have the potential to serve as new targets for target diagnosis and therapy.

To investigate the effects of calcineurin gene silencing on the remodeling of transient outward potassium current (Ito) ionic channel and action potential duration (APD) in phenylephrine (PE)-induced hypertrophic ventricular myocytes from neonatal rats.

The ventricular myocytes of 1-day-old Sprague-Dawley rats were isolated and cultured for 48 h. RNA interference mediated by adenovirus carrying short hairpin RNA was used to knock down the gene which encodes the beta subtype of calcineurin A subunit (CnAβ) and the cells were divided into 4 groups as Ad-null group, Ad-null+ PE group, Ad-CnAβshRNA1(A1) group and A1+ PE group, and then cultured for 48 h. The gene expression of Kv4.2 was assayed by real-time reverse transcriptase-polymerase chain reaction. The protein expressions of CnAβ and Kv4.2 were assayed by Western blot test. Whole cell patch clamp technique was used to record Ito and action potential.

Treatment of the neonatal rat ventricular myocytes with PE induced the cell hypertrophy, up-regulated the protein expression of CnAβ, attenuated the gene and protein expressions of Kv4.2 and the Ito current density, and prolonged APD. Silencing of CnAβ in the neonatal rat ventricular myocytes using Ad-CnAβshRNA1 inhibited the aforementioned ability of PE significantly.

CnAβ gene silencing inhibits the remodeling of transient outward potassium current ionic channel and change of APD in PE-induced hypertrophic ventricular myocytes from neonatal rats.

To investigate the dosimetric distribution characteristics of ¹²⁵I seed stents with different seed spacing, diameter and length, as well as different ¹²⁵I seed activity. The dosimetry table of ¹²⁵I seed esophageal stent was derived to provide dosimetry for its clinical application.

The self-expanding coated esophagus stent was designed to carry radioactive ¹²⁵I seeds with different length, diameter and seed spacing. A cylindrical organic glass model (Thickness 0.8 cm, diameter 20 cm, height 20 cm) was fixed vertically to a cylindrical organic glass containing a solid paraffin (analytical pure) solution. After paraffin cooling and solidification, CT scan was used to transmit image information to TPS. With the center of the bracket as a dot, the cumulative dose at a distance of 1.5, 2.0, 2.5, 3.0, 3.5, 4.0, 5.0, 6.0 and 8.0 cm away from the dot was simulated respectively in 0° and 9° direction.

The radial cumulative dose with the seed spacing which was 1.0 and 1.5 cm were different by 4.8%, 5.8%, 7.2%, 8.0%, 8.6% and 13.3% respectively under the exposure of 18.5, 22.2, 25.9, 29.6, 33.3 and 37.0 MBq. When the seed spacing was the same as the length of the stent, the radial cumulative dose with the stent which diameter was 1.3, 2.0, 2.4 cm were different by 4.9% vs 3.4%, 4.7% vs 3.8%, 5.4% vs 6.6%, 4.5% vs 5.3%, 4.7% vs 4.8%, 4.8% vs 5.4% respectively under the exposure of 18.5, 22.2, 25.9, 29.6, 33.3 and 37.0 MBq. When the seed spacing was the same as the diameter of the stent, the radial cumulative dose with the stent which length was 8, 12, 16 cm were different by 1.9% vs 1.2%, 1.7% vs 0.8%, 1.6% vs 1.3%, 1.9% vs 1.5%, 1.7% vs 1.8%, 1.6% vs 1.3% respectively under the exposure of 18.5, 22.2, 25.9, 29.6, 33.3 and 37.0 MBq.

The radial cumulative dose of the ¹²⁵I seed stent is positively correlated with the activity of the radioactive seeds, Which means the dose rate of a certain point of the ¹²⁵I seed stent increase with the increase of the activity of the radioactive seeds. The stent of the ¹²⁵I radioactive seeds is negatively correlated with the distance, the dose rate of the ¹²⁵I seed stents decrease rapidly with the increase of distance.

To investigate whether long non-coding RNA (lncRNA) growth arrest-specific transcript 5 (GAS5)/microRNA-200c-3p/angiotensin converting enzyme 2(ACE2) involved in the regulation of the apoptosis of human lung epithelial cell A549 in acute respiratory distress syndrome (ARDS).

ARDS rat models were established and were divided into control, ARDS, ARDS+ pcDNA and ARDS+ pcDNA-GAS5 groups. Six hours after the establishment of ARDS rat model, arterial blood and lung tissues of the rats from the four groups were collected. The changes of partial pressure of oxygen (PO₂) and partial pressure of CO₂ (PCO₂) were analyzed and the expression of GAS5 in lung tissue was observed in these groups. Then, A549 cells were divided into control, lipopolysaccharide (LPS), LPS+ pcDNA, LPS+ pcDNA-GAS5, LPS+ pcDNA-GAS5+ pre-NC, LPS+ pcDNA-GAS5+ miR-200c-3p mimic groups. Quantitative real-time PCR (qRT-PCR) was conducted to measure lncRNA GAS5, ACE2 and miR-200c-3p levels. RNA immunoprecipitation and RNA pull-down assay were used to detect the combination between GAS5 and miR-200c-3p. Western blotting was used to detect the protein level of ACE2. Flow cytometry was used to observe the apoptosis of A549 cells in those groups. The data between groups were compared by t test.

In ARDS rat model, PO₂ value was significantly increased in ARDS+ pcDNA-GAS5 group than that in ARDS+ pcDNA group[(81.5±3.3) vs (57.5±5.1) mmHg, t=4.850, P<0.05], and PCO₂ value was significantly decreased in ARDS+ pcDNA-GAS5 group than that in ARDS+ pcDNA group[(50.6±1.9) vs (64.0±1.9) mmHg, t=5.940, P<0.05]. LncRNA GAS5 level in A549 cells of LPS group decreased significantly than that in control group (0.43±0.01 vs 1.01±0.01,t=0.242, P<0.05). Compared with LPS+ pcDNA group, ACE2 expression increased significantly in LPS+ pcDNA-GAS5 group (0.85±0.04 vs 0.34±0.02,t=1.800, P<0.05). Compared with LPS+ pcDNA-GAS5+ pre-NC group, ACE2 expression decreased significantly in LPS+ pcDNA-GAS5+ miR-200c-3p mimic group (0.62±0.01 vs 0.84±0.02,t=9.440, P<0.05). Compared with control group, the percentage of A549 cell apoptosis promoted significantly in LPS group (25.90±0.61 vs 7.90±0.22,t=0.257, P<0.05). Compared with LPS+ pcDNA group, the percentage of A549 cell apoptosis suppressed significantly in LPS+ pcDNA-GAS5 group (10.50±0.37 vs 26.37±0.45,t=1.760, P<0.05). Compared with LPS+ pcDNA-GAS5+ pre-NC group, the percentage of A549 apoptosis promoted significantly in LPS+ pcDNA-GAS5+ miR-200c-3p mimic group (19.07±0.56 vs 10.87±0.26,t=0.643, P<0.05).

In ARDS, down-regulation of lncRNA GAS5 decreases ACE2 expression through increasing miR-200c-3p to promote the apoptosis of A549 cells, thus to promote the progression of ARDS.

To describe the spatial distribution characteristics of the HIV prevalence among pregnant women in mainland China in 2016, providing scientific evidence for the prevention of mother-to-child transmission of HIV.

Data on pregnant women and those living with HIV in 2016 for all counties in mainland China is from the National Maternal & Child Health Statistics dataset. To obtain robust estimates, 2 964 counties were merged into 344 cities. Spatial autocorrelation analysis and trend analysis were performed based on the city-level dataset to detailedly describe the characteristics of the spatial distribution.

A total of 14 879 082 pregnant women were included in the analysis, among whom 5 051 were diagnosed to be infected with HIV, giving an overall prevalence of 34.0 per 100 000 pregnant women. The prevalence was higher in the south than in the north, and decreased from the west (93.5/100 000) to the east(8.6/100 000 ), more specifically, the prevalence in the West region was 11 times as high as that in the East region(χ_trend²=68.61, P<0.01). Stratified analysis by provinces showed that there were 6 provinces whose prevalence was >50.0 per 100 000, and they (Yunnan, Xinjiang, Sichuan, Guangxi, Guizhou and Chongqing) were all located in the West Region; pregnant women in these provinces accounted for 21% of all pregnant women, but the HIV cases accounted for 76% of all cases diagnosed in mainland China. Stratified analysis by cities showed that there were 30 cities whose prevalence was >100.0 per 100 000, and 28 of these cities were also located in the western provinces above. Furthermore, the global Moran′sI (0.5, P<0.01) indeed indicated a strong clustered distribution across mainland China; 2 hot spots were observed in the Midwest of Xinjiang, and Yunnan and its bordering areas (Sichuan, Guizhou, Guangxi and Chongqing), while 1 cold spot in the central and east China. The HIV prevalence in the hot spots (183.6/100 000) was 23 times as much as that in the cold spot (8.1/100 000).

The overall HIV prevalence for pregnant women who lived in mainland China in 2016 (34.0/100 000) ranked at low-level worldwide, but varied markedly across the whole country with 2 high-prevalence-clustered areas: the Midwest of Xinjiang Uygur Autonomous Region, and Yunnan province along with its bordering areas, indicating comprehensive intervention strategies especially targeted to the areas with high HIV prevalence should be developed.

To investigate the relationship between the polymorphism of Uridine diphosphate glucuronosyltransferases (UGT)1A4 142T>G (*3, L48V, rs 2011425)and serum concentration of lamotrigine(LTG) in Chinese epileptic patients.

Databases including Cochrane Library, PubMed, Embase, CNKI, VIP and Wanfang were searched for the studies on the relationship of the polymorphisms of UGT1A4 142T>G with concentration of LTG (from the establishment a database to December 1, 2017). Meta-analysis was performed by RevMan 5.3.

We pooled data from 6 literatures, including 903 Chinese epileptic patients. Meta-analysis: In terms of the effect of UGT1A4 142T>G polymorphism on the serum concentration/dose ratio(CDR)of LTG, there was no significant difference between the wild-type(TT genotype)group and mutant-type (TG+ GG genotype) group (MD=-0.08, 95% CI (-0.40-0.23)). Further subgroup analysis was performed on LTG monotherapy or valproic acid(VPA)co-administration. For patients treated with LTG as monotherapy, difference was not statistically significant between the 2 groups(MD=0.16, 95% CI(-0.25-0.57)). But in children treated with VPA co-administration, difference was statistically significant between the 2 groups (MD=-0.50, 95% CI(-0.75--0.26)).

UGT1A4 142T>G polymorphism has an effect on LTG concentration only with VPA co-administration in Chinese epileptic pediatric patients and those children with wild-type (TT genotype) have a tendency to have a lower serum concentration of lamotrigine.

Cervical disc replacement is a common surgical method for cervical disc herniation and disc degeneration in spine surgery in recent years. The choice of indication, surgical technique, product design, patient's physical condition and other factors are the reasons for the loosening of the prosthesis^[1]。 This paper reports a case of progressive prosthesis loosening 2 years after surgery, and analyzes the causes of loosening.

A 52-year-old male patient. The main cause was "sudden numbness and weakness of the right upper limb for 1 d, aggravated with episodic convulsions for 20 h", and he was admitted to the hospital on June 30, 2016. The patient developed numbness in his right upper limb after waking up from a nap at 3 pm on June 29, 2016. His self-measured blood pressure was 140/100 mmHg (1 mmHg =0.133 kPa). He went to the Shennei emergency department of Beijing Hospital. Physical examination showed no positive signs. Cranial CT was performed (Figure 1) showed that the density of the local gyrus of the left parietal lobe was increased, and the sulcus gyrus was slightly swollen. He was discharged from hospital after being treated with oral aspirin anti-polymerization, statin lipid-lowering drugs and intravenous drip drugs to improve circulation. On the way out of the hospital, there was a sudden aggravation of numbness in the right hemibody, accompanied by weakness in the right limb, followed by a generalized seizure, which lasted about 5 minutes and then stopped. After the patient regained consciousness, he felt a headache on the left side and was sent to the emergency department of our hospital. Considering acute cerebrovascular disease and secondary epilepsy, he was given anti-epileptic treatment by intravenous pumping of sodium valproate, and there was no recurrent epilepsy. Review head MRI on 30-Jun-2016 (Figure 2) shows: a large hemorrhagic focus in the left frontoparietal lobe, the nature of which is to be determined, and the possibility of infarction with hemorrhage is high. The patient felt that the weakness of the right limb was aggravated compared with the previous day with poor speech, and was admitted to the neurology ward for further diagnosis and treatment. Past History: Physical Fitness; Smoking and drinking for more than 30 years, smoking 3~4 cigarettes/d and drinking 100~150 g/d.

A 23-year-old male developed painless full-course macroscopic hematuria for 4 d after activity, without blood clots and lumbar pain, which relieved spontaneously. Relevant examinations at the local hospital indicated that the right kidney occupied space, and the patient was admitted to Sino-Japanese Friendship Hospital of Jilin University for further definite diagnosis and treatment. After admission, routine physical examination and specialist physical examination showed no abnormal findings. Conventional ultrasound showed that the size of the right kidney was normal, and a mixed echo mass with a size of 10.9 cm ×5.5 cm ×7.4 cm and mainly hyperechoic was seen in the middle and lower renal parenchyma, with clear boundaries, envelopes and regular shape. There were many small liquefaction foci scattered in the middle and lower kidney, and the sound transmission of the liquefaction foci was poor. In addition, a large number of punctate calcifications were scattered in the middle and lower kidney parenchyma. No obvious blood flow signal was observed in different sections of the mass (Figure 1，Figure 2)。 Mild hydrops under compression of the renal pelvis, separated 1.0 cm. It is suggested that the right kidney is focal lesion, the nature of which is to be determined. Preoperative plain and enhanced CT scans showed that the middle and lower part of the right kidney showed massive shadows of abnormal density with unclear boundaries, the size was 6.4 cm ×5.9 cm ×8.5 cm. The enhanced scans showed obvious uneven enhancement of the lesions in the cortical and parenchymal phases, and the enhancement degree was slightly reduced in the excretion phase, and the lesions were slightly calcified. It suggests that the middle and lower part of the right kidney occupies space, and it is more likely to consider clear cell carcinoma. In summary, clinicians considered it to be a neoplastic lesion and performed radical right nephrectomy. After operation, the right kidney of the surgical specimen was dissected, and a tumor was found in the right kidney, with a size of 9.0 cm ×8.0 cm ×8.0 cm. The section was yellow and white, accompanied by necrosis, which seemed to have pseudocapsule. The samples were sent to pathology, and the pathological diagnosis showed focal necrosis, interstitial fibrosis, scattered sand-like calcification and inflammatory cell infiltration in the cancer tissue. Combined with the histological morphology and immunolabeling results, it was consistent with XP11.2 translocation/TFE3 gene fusion-related renal carcinoma (referred to as XP11.2 translocation renal carcinoma). The patient recovered well and was allowed to be discharged.

RecentLancetAs mentioned in the published global burden of disease, cardiovascular diseases and tumors accounted for the first and third leading causes of death in the world in 2016, respectively^[1]。 In the United States, the overall cancer mortality rate has declined since the early 1990s. The latest statistics released by the National Cancer Institute in April 2018 show that the cancer mortality rate continues to decline: from 2006 to 2015, the mortality rate of male and female cancer patients decreased by 1.8% and 1.4% each year, respectively. With the decline of mortality, the base of the population suffering from cancer increases, and it is not uncommon for cancer patients to have coronary heart disease (CHD). A study that included 6 439 women with breast cancer^[2]It was found that 45.8% of the patients were complicated with cardiovascular disease, including myocardial infarction (MI), CHD, and congestive heart failure (CHF). There are some common risk factors for tumors and CHD, such as age, smoking and obesity^[3]。 Antitumor therapy such as chemotherapy and radiotherapy may lead to vascular endothelial damage, coronary artery spasm, arterial thrombosis, etc. These factors will increase the risk of CHD in cancer patients^[4]。 When these patients treat CHD, if they choose percutaneous coronary stenting (PCI), they need to weigh the risk of thrombosis and bleeding in the subsequent treatment of tumors; If you choose coronary artery bypass grafting (CABG), you need to consider the sequence between GABG and tumor resection and the advantages and disadvantages of cardiopulmonary bypass (ECC).