Volume 99 ·  Issue 15 ·  2019

In recent years, image-guided ablation of adrenal tumors has the advantages of less trauma, high safety and precise curative effect, and is increasing in the local treatment of adrenal tumors. However, ablation of adrenal tumors also has certain complication risks, especially the adrenal gland as an endocrine organ. The occurrence of hypertensive crisis during ablation is one of the most serious complications in clinic.

Adrenal tumors include primary and metastatic tumors. Primary adrenal tumors mostly occur in adrenal cortex or medulla cells, but may also occur in other adrenal tissues, such as schwannoma, neurofibroma, lipoma, leiomyoma, etc., but are rare^{[1,2,3,4,5,6]}。 At the same time, the adrenal gland is also one of the most common sites of metastasis of various malignant tumors. According to the presence or absence of endocrine function, it can be divided into non-functional adrenal tumor and functional adrenal tumor^{[7,8,9,10,11]}。

Spinal degenerative nerve root pain is a disease in which nerve roots are invaded by external factors and damaged, resulting in pain as the main manifestation in the innervation area of spinal nerves. Clinically, neck, waist, back and extremity pain are the most common. According to statistics, the incidence of cervical spondylosis is about 3.8% ~17.6%, and about 67% of adults suffer from low back pain, of which about 56% of patients have radicular pain or sciatica. The etiology of spinal degenerative nerve root pain is mainly caused by mechanical factors (such as compression, deformity, etc.) and chemical factors (including aseptic and immune inflammation) to stimulate the spinal nerve roots. Common diseases include: disc herniation, spinal stenosis, hypertrophy of facet joints and uncinate joints, ligamentum flavum hypertrophy, etc. Spinal nerve root pain includes a large class of chronic spinal degenerative diseases. Correct understanding and understanding of the mechanism, clinical characteristics and disease classification of spinal nerve root pain is beneficial to the clinical diagnosis and treatment of spinal nerve root pain.

China has entered an aging society. Senile osteoporosis is an age-related bone metabolism disease, and its incidence increases significantly with age^[1,2]。 In 2016, the prevalence of osteoporosis among the elderly over 60 in China was as high as 36%, of which 23% were men and 49% were women^[1]。 Common spinal diseases in the elderly, such as lumbar spinal stenosis, degenerative lumbar spondylolisthesis, degenerative scoliosis, spinal fracture, etc. are often combined with osteoporosis, and the problems such as screw loosening, extraction and bone graft non-fusion caused by osteoporosis bring great challenges to clinicians^[3,4,5]。 There is no relevant consensus in China on spinal internal fixation surgery for patients with osteoporosis. Therefore, China Health Promotion Foundation organized domestic experts in the fields of spinal surgery and osteoporosis to formulate this consensus for clinical reference through questionnaire surveys and multiple rounds of expert meetings.

To evaluate the tumor burden reducing efficacy and safety of transcatheter arterial embolization (TAE) combined with octreotide LAR on neuroendocrine tumor liver metastasis (NETLM).

Twenty-nine NETLM patients treated in the First Affiliated Hospital of Sun Yat-sen University from October 2014 to August 2018 were retrospectively recruited, including 12 males and 17 females. The mean age was 25-69(50±11) years. All patients were histologically proved as well-differentiated NET liver metastasis. Seventeen patients underwent combined treatment of TAE plus octreotide LAR (combined group) and 12 patients treated with only octreotide LAR (control group). Response of hepatic lesions were assessed according to RECIST 1.1. Objective response rates (ORR) of two groups were compared and analyzed. Safety and tolerance to TAE were also evaluated.

There were 13 PR and 4 SD in combined group, but only 1 PR and 9 PD in the control group. The ORR between the two groups were significantly different (13/17 vs 1/12, P<0.01).The main complication post TAE was post embolization syndrome, including abdominal pain (12/17), vomiting (6/17), fever (4/17), elevated transaminase (8/17) and bilirubinemia (3/17). Tumor lysis syndrome was observed in one patient.

Compared to administration of octreotide LAR, TAE combined with octreotide LAR can effectively reduce tumor burden in patients with NETLM. TAE is safe and well-tolerated.

To evaluate the therapeutic effect and prognosis of preoperative transcatheter arterial chemoembolization (TACE), transcatheter arterial chemoembolization (TAIC), preoperative intravenous chemotherapy for children with advanced stage nephroblastoma.

From January 2007 to December 2018, according to different treatment protocols before surgery, children with nephroblastoma were divided into 3 groups, which were TACE group (44 cases), TAIC group (7 cases) and intravenous chemotherapy group (9 cases) in Children′s Hospital, Zhejiang University School of Medicine. The imaging examination, treatment safety and long-term efficacy of these three groups before and after treatment were compared. Observed indicators include tumor debulking rate, envelope integrity rate, necrosis rate, postoperative adverse reactions and follow-up.

Tumor debulking rate: tumor of TACE group decreased 46.5%, TAIC group shrinked 28.3%, and intravenous chemotherapy group reduced by 23.3%, the difference of tumor shrinkage between TACE group and intravenous chemotherapy group was statistically significant (P<0.05). Tumor necrosis rate: necrotic area in TACE group was about 46.0%-95.4%, average 75.1%±12.5%, while in intravenous chemotherapy group was 65.8%±8.7%, the difference was statistically significant (P<0.01). The tumor membrane integrity rate of these three groups were 86.4%(38/44),5/7 and 6/9 respectively, and difference between TACE group and intravenous chemotherapy group was significant (P<0.05). Patients who had myelosuppression each was 5 in TACE group (5/44), 4 in TAIC group (4/7), and 8 in intravenous chemotherapy group (8/9), and there were significant differences. Follow-up time and tumor-free survival rate in each group were respectively 20 to 92 months (median time 64 months) and 95% in TACE group, 12 to 69 months (median time 30 months) and 43.0% in TAIC group, and 16 to 72 months (median 28 months) and 56.0% in intravenous chemotherapy group.

Preoperative TACE can lead to tumor shrinkage and necrosis more obviously, systemic adverse reactions are small, also the tumor complete resection rate is higher and the operation is safer.The survival rate can be effectively improved and more suitable for clinical treatment.

To investigate the feasibility and safety of magnetic resonance guided focused ultrasound surgery (MRgFUS) ablation treatment for uterine fibroids and adenomyosis.

From February 2017 to July 2018, a total of 61 women in Foshan Hospital of Traditional Chinese Medicine with uterine fibroids or adenomyosis (36 cases of fibroids and 25 cases of adenomyosis) were included for treatment of MRgFUS, mean age was 27-48 (39±5) years. The treatment status, treatment effect and complications were recorded, and the differences between myoma and adenomyosis were compared.

Thirty-two (88.9%) patients of fibroid group and twenty-one (84.0%) patients of adenomyosis group were completed MRgFUS treatment respectively (P>0.05). The spot energy of adenomyosis group was 1 039-5 698(2 852±991) J, which was higher than 600-6 466(2 485±1 137) J of fibroid group (P<0.01). There was no significant statistical difference in mean temperature of spot and ablation time between the two groups (P>0.05).The non-perfusion volume ratio (NPVR) of the fibroid and adenomyosis group was 54%-99%(84%±15%) and 60%-98%(82%±12%) and there was no significant statistical difference (P>0.05), but the ablation efficiencies of adenomyosis group was less than fibroid group (0.8-4.3(2.1±0.9) cm³/min vs 1.3-7.8(3.6±1.5)cm³/min, P<0.01).The incidence of complications of adenomyosis group was 47.6%(10/21), it was higher than fibroid group 18.8%(6/32) (P<0.05).

MRgFUS is a non-invasive, safe and effective treatment for both uterine fibroids and adenomyosis. Compared with uterine fibroids, MRgFUS treatment of adenomyosis has some disadvantages such as higher energy, lower ablation efficiency and more adverse reactions, and further optimization is needed.

To explore the relationship between apolipoprotein E (ApoE) gene polymorphism and hydrogen proton magnetic resonance spectroscopy (¹H-MRS) in patients with Alzheimer′s disease (AD) and amnestic mild cognitive impairment(aMCI).

The cognitive function of 35 AD patients (AD group), 35 aMCI patients (aMCI group) and 36 normal controls (NC group) were evaluated by neuropsychological scales, including Mini-mental State Examination (MMSE) and Cambridge Cognitive Examination-Chinese version (CAMCOG-C). The genotypes of ApoE were analyzed by high-resolution melting assay. Brain regional metabolites were measured via ¹H-MRS technique with the regions of interest (ROIs) located in the left frontal lobe and left hippocampus.

The CAMCOG-C (NC group 94.00 (8.50);aMCI group 86.00(8.00);AD group 61.00(18.0)) and MMSE (NC group 29.00 (2.00);aMCI group 26.00(2.00);AD group 13.00(9.5)) scores in AD and aMCI group were significantly lower in comparison with that in NC group (P<0.05). There was multi-domain cognitive impairment both in AD and aMCI. The CAMCOG-C (ε4 carriers 76.00(28.00);no-ε4 carriers 89.00 (17.00)) and MMSE (ε4 carriers 23.00(16.00);no-ε4 carriers (27.00 (6.00))scores in ε4 carriers were significantly lower than those in no-ε4 carriers (P<0.05). The AD and aMCI groups showed decreased NAA/Cr ratio in the left hippocampus as well as elevated Cho/Cr ratio and MI/Cr in the left frontal lobe compared to the NC group (P<0.05). This change was even more pronounced in AD group when compared to aMCI group. The NAA/Cr ratio and Cho/Cr ratio in the left hippocampus in ε4 carriers were lower, the MI/Cr ratio in left frontal lobe in ε4 carriers was higher ( P<0.05).

ApoE gene polymorphism affects the alteration of ¹H-MRS in AD and aMCI patients. The combination of ApoE gene polymorphism and ¹H-MRS may be more useful to differentiate and diagnose AD and aMCI early.

To establish a method for detecting multi-segmental motor nerve conduction of axillary nerve using magnetic stimulation technique, and to preliminarily discuss its clinical application value.

From April 2017 to February 2018, 80 healthy volunteers, 40 male and 40 female, were included and divided into five groups according to age and gender (groupⅠwere <35 years old; groupⅡwere 35-44 years old; group Ⅲ were 45-54 years old; groups Ⅳ were 55-64 years old; groups Ⅴ aged 65-74). Axillary nerve recording electrodes were placed in the deltoid muscle belly, reference electrode was placed in the deltoid muscle check point. Using the magnetic stimulation coil, stimulation was released at spots which were, respectively, 2 fingers from the lateral side of subscapular fossa, 2 fingers from the lateral side of infraclavicular fossae, and Erb′s point. The latency, amplitude, detection distance (stimulation to recording electrode) were recorded at each spot, and the height and arm length were also measured.

The detection rate of axillary nerve waveform in healthy volunteers was 97.2%. There were no statistically significant differences in latency and amplitude in the different sides, gender (P>0.05).The latency corresponding to different detection distances was compared, and the difference was statistically significant (P<0.05).Height and arm length in different age groups were significantly increased in groupsⅠ, Ⅱ and Ⅲ compared with groups Ⅳ and Ⅴ, with statistical significance (P<0.05). When compared among different age groups, the latency and amplitude of group Ⅳand Ⅴ (more than 55 years old and over) were significantly prolonged and decreased, with statistically significant differences (P<0.05).

The method of detecting multi-segmental magnetic stimulation of axillary nerve is stable and the result is reliable, which makes the evaluation of the proximal nerve of upper limbs be possible. However, the biological effects of age on nerve conduction should be carefully considered.

To evaluate the prognosis of visual function and the impact of surgery in pediatric patients with sellar mass lesions, as evidenced by diffusion tensor imaging (DTI) and visual evoked potentials.

Twenty patients with sellar mass lesions were included in the study. DTI and visual evoked potentials were obtained before and after surgery. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated for both optic nerves. DTI parameters and visual evoked potential amplitudes were compared for all patients to assess the correlation between DTI parameters and visual function.

The 20 patients were divided into two groups according the relationship between the lesions and the optic chiasm. The FA values increased significantly after operation, while the ADC values decreased (P<0.05). And the average amplitude of visual evoked potentials after operation was significantly higher than before operation (P<0.05).

DTI assessments of the affected sides, with the resulting FA and ADC values, may help to estimate the visual improvement produced by surgical therapy in the early postoperative period. Surgical removal can improve visual function dramatically.

To investigate the in vivo kinematics of the lumbar degenerative spondylolysis (LDS) in senile patients.

From March to October in 2014, nine L_4-5 LDS patients [mean age (74±9) years] and nine healthy volunteers [mean age, (54±4) years] were recruited. Combined fluoroscopy and CT scanning technique were used to obtain the three dimension kinematic data of the vertebral anatomical structures (vertebral body anterior margin, vertebral body posterior margin, facet joints and spinous process) in various postures (supine, standing, flexion and extension) under physical loads, and to compare the stability of different anatomical structures. The L_4-5 segmental disc angle was also measured in different postures. Paired-samples t test was applied to compare the displacement differences between the two groups.

During flexion-extension motion, all anatomical structures of the LDS group were slightly larger than those in normal group, but the statistical difference was not obvious (all P>0.05). For normal group, in anterior-posterior and cranial-caudal direction, sub-movement analysis showed that the anterior vertebral body margin at the flexion range of motion [(-1.07±0.84) mm, (-1.27±1.01) mm] were larger than the extension range of motion [(0.66±1.38) mm, (0.63±0.99) mm] (t=3.21, 4.03, both P<0.05). Whereas for LDS group, in anterior-posterior and cranial-caudal direction, sub-movement analysis showed that the anterior vertebral body margin at the extension range of motion [(1.46±1.26) mm, (1.17±0.54) mm] were significantly greater than the flexion range of motion [(-0.43±0.47) mm, (-0.45±1.24) mm] (t=4.22, 3.59, both P<0.05). The disc angles of the LDS group were all smaller than those in normal group, but the statistical difference was not obvious (all P>0.05). However, the disc angles were significantly different under different postures, the flexion were both the smallest in the normal group and LDS group.

The senile LDS patients may not necessarily have instability, stability may also occur in these patients. Increasing extension range of motion is one of the kinematic characteristics in senile patients with LDS. The intervertebral stability should be taken into account, but if instability develops, surgical procedure should be suggested for elderly patients with LDS.

Currently, the commonly used screening methods for Lynch syndrome in patients with endometrial cancer (EC) are clinical diagnostic criteria and immunohistochemical testing. Our study compared the accuracy of the two methods in this prospective cohort study.

Mismatch repair (MMR) protein was detected by immunohistochemical in the pathological tissues of newly diagnosed EC patients in Peking Union Medical College Hospital, during December 2015 and June 2018. Lynch syndrome related mutation gene was detected in patients with MMR protein deficiency. At the same time, all the patients were evaluated by the clinical diagnostic criteria (Amsterdam Criteria Ⅱ and the revised Bethesda criteria).

A total of 121 newly diagnosed EC patients were enrolled in this study, and 41 cases (33.9%) were MMR protein deficient. All of them received Lynch syndrome related mutation gene detection, and 7 cases were finally diagnosed with Lynch syndrome. Only 6 cases of Lynch syndrome, however, were diagnosed by the clinical diagnostic criteria, with 1 case misdiagnosed and 2 cases missed diagnosed.

The incidence of Lynch syndrome in endometrial cancer patients is 5.8%. And the clinical diagnostic criteria for Lynch syndrome in patients with EC will result in miss diagnosis and misdiagnosis.

To investigate the feasibility of detecting circulating tumor cells based on capture of heteroploid chromosome cells in peripheral blood of glioma patients.

A total of 88 patients who were considered to suffer from gliomas and 10 healthy volunteers were enrolled in this study during January 2016 to December 2016 at Beijing Tiantan Hospital, from whom 6 ml preoperative blood was collected. Subtraction enrichment (SE)-immunostaining FISH (iFISH) was applied to capture the heteroploid chromosome 8 cells in those samples. Meanwhile, centromere probe 8(CEP-8)-FISH was used to identify aneuploid cells in 10 tumors and 10 brain tissues.

Numerous heteroploid chromosome 8 cells were observed in tumors whereas negative result was present in brain tissues (P<0.01). CTC was successfully detected in 90.9% glioma patients, in contrast, only one healthy volunteer was shown with a heteroploid chromosome 8 cell (P<0.01). Glial fibrillary acidic protein was not exhibited in the overwhelming majority of CTC (96.1%). High grade glioma (HGG) without IDH mutation possessed much more CTC than low grade (12.0 vs 2.2), P<0.01. Furthermore, multiploidy (≥5 copies) CTC accounted for a much significant percentage in HGG, either in tumors originating from oligodendrocyte or astrocyte (75.9% vs 56.0%), P<0.01; 62.7% vs 51.7%, P=0.016, respectively).

CTC could be identified and enumerated in glioma by detecting aneuploidy cells in blood. The number and multiploidy proportion of CTC may be correlative with tumor grade and molecular characteristics.

Carotid stenosis or carotid plaque detachment may lead to stroke, which can lead to death in severe cases, while milder symptoms also have different degrees of sequelae. Carotid endarterectomy (CEA) has saved countless patients with carotid stenosis since its application, and has also been improved into many surgical methods. However, for different degrees of single and double carotid stenosis, there are still no standardized standards and clear guidelines for clinical workers in the choice of surgical methods and surgical timing, but the surgical strategy directly affects the prognosis of patients. Relying on the rich clinical practice experience of the center, this paper summarizes what treatment options to choose for different conditions and types of carotid artery stenosis.

Osteoarthritis (OA) is the most common degenerative bone and joint disease. Due to the lack of anatomical characteristics of vascular nerve distribution and a single chondrocyte structure of cartilage, its self-repair ability is insufficient. In recent years, studies have shown that the articular cartilage of healthy adults and patients with OA contains a group of cartilage precursor stem cells (CSPCs), which are involved in maintaining cartilage tissue homeostasis, and express stem cell-related surface markers, which have the ability of clone formation and multilineage differentiation, and are regarded as one of the important seed cells for cartilage repair. The research progress of CSPCs is reviewed in order to provide more theoretical information for CSPCs as a potential seed cell for OA cell therapy.

Migraine is a common neurovascular disease with a higher incidence in women than men. It runs throughout a woman's life and has different characteristics at different periods. Estrogen plays an important role in the development of migraine. Migraine is associated with cardiovascular and cerebrovascular diseases. This article summarizes the characteristics of migraine in women, aiming to better understand migraine in this particular population of women and provide assistance for treatment.