2015年 · 第95卷第13期

Spinal surgery requires extensive manipulation of bone tissue around nerve vessels. In the past, spinal surgeons often used bone knives, bone-biting forceps, curettes, annular saws and other instruments to treat spinal bones. However, because the spinal bone tissue is irregular and adjacent to important neurovascular tissues, the operation is difficult and dangerous. Using the above tools is easy to cause important structural damage and tissue trauma due to the great vibration impact on bone tissue. With the increasing demand for the precision and safety of spinal surgery, grinding drill is gradually used more and more widely in spinal surgery. As a characteristic tool of contemporary spinal surgery, grinding drills bring greater kinetic energy, faster speed and more delicate operation to surgery. Micro-drill grinding technology is widely used in spinal surgery, which greatly increases the safety of surgery and reduces tissue trauma. In the 21st century, a lot of research has been carried out in ultrasonic grinding, and different ultrasonic grinding drills have appeared. Because of the selectivity of ultrasonic grinding drills to tissue grinding, the surgical safety has been increased, and it is considered to be an ideal tool to replace traditional surgical instruments^[1]。

A 67-year-old female was admitted to Peking Union Medical College Hospital on May 24, 2011 due to sudden retrosternal persistent crushing pain for 2 h. Electrocardiogram: Sinus rhythm, pathological Q wave formation in V8-V9 leads, no ST segment and T wave dynamic changes were observed. Serum creatine kinase 194 U/L, creatine kinase isoenzyme-MB 18.2 μ g/L, troponin I 2.59 μ g/L. "Non-ST segment elevation myocardial infarction" was diagnosed, and the symptoms were relieved by intravenous injection of nitroglycerin and antiplatelet and anticoagulant therapy. Past history: Diagnosis of "hypertension" for 20 years; Diagnosis of "dyslipidemia" for 10 years; Diagnosis of "ischemic stroke" for 10 years; Diagnosis of "left breast cancer" for 7 years, radical left breast cancer surgery; After the diagnosis of "coronary atherosclerotic heart disease" for 4 years, one rapamycin-eluting stent was implanted in each of the anterior descending artery and the posterior descending artery. Physical examination: blood pressure 135/77 mmHg (1 mmHg =0.133 kPa), heart rate 65 beats/min, body mass index 27.4 kg/m²There were no other positive findings.

A 32-year-old female developed right lumbar pain after climbing stairs more than a month ago, which was persistent dull pain without obvious reflex pain, and the pain resolved spontaneously. Physical examination showed soft abdomen, no tenderness, rebound pain, no muscle guard, no abnormal mass, and negative Murphy's sign. The kidney area was flat and symmetrical, without obvious percussion pain, no vascular murmur, and no tenderness in the bilateral ureteral pathway. Routine urine examination on admission: urine specific gravity: 1.015, urine leukocyte esterase: 2+, urine occult blood: 1+, turbidity: turbidity, 25 red blood cells/μ L, 120 white blood cells/μ L, and 708 bacteria/μ L. MRI examination of upper abdomen showed that a type of round abnormal signal focus was seen in the right adrenal region, T₁WI showed high signal, mixed with patchy flocculate low signal (FIG. 1A), T₂WI – SPAIR showed high signal, mixed with patchy flocculate low signal (FIG. 1B), DWI shows high/low/equal confounding signals (Figure 1C), a fusiform T was seen on the right edge of the lesion₁WI low, T₂WI – SPAIR high, DWI slightly high signal foci; Enhanced scan showed that the cyst wall and septum of the right adrenal area were linear enhancement, but no enhancement was observed in it (Figure 1D), the boundary of the lesion was clear, the size was about 75 mm ×77 mm ×85 mm, the right adrenal gland was unclear, and the adjacent liver, hepatic hilar structure, kidney and inferior vena cava showed compressed migration changes, and the boundary with the lesion was clear. MRI diagnosis of teratoma in the right adrenal region is possible. CT examination of the upper abdomen showed a type of round low-density mass in the right adrenal region, with relatively uniform density on plain scan, and linear separation. The CT value of the fusiform low-density area at the separated right lateral edge was 7-49 HU, with an average CT value of about 23 HU, and the CT value of the round low-density area at the separated left lateral edge was-21-62 HU, with an average CT value of 23 HU, and scattered spotty calcification was also seen (FIG. 2A)； The enhanced scan showed linear enhancement of the cyst wall and septum of the right adrenal region, and no obvious enhancement was observed in it (Figure 2B、Figure 2C、Figure 2D), with clear edges and a size of 75 mm ×80 mm ×90 mm. CT diagnosis of cystic lesions in the right adrenal region is possible. Gross pathology showed cystic lesions of the right adrenal gland, soft and round, with thick cyst wall, hemorrhagic focus and close adhesion to the adrenal gland and surrounding tissues. Pathological diagnosis: right adrenal angioma with hemorrhage and organization (Figure 3)。

A 63-year-old male was admitted to the hospital on 16 April 2014 mainly due to "unresponsiveness with memory loss for 2 weeks". At about 18: 00 pm 12 days before admission, sudden unresponsiveness, dull expression, inability to find their own bed and toilet, memory loss, inability to correctly answer questions and distinguish the surrounding environment, accompanied by dizziness and headache, which lasted for 1 h and improved; Six days before admission, the patient was unresponsive again, unconscious, unclear speech, did not know the door of the home, could not identify the surrounding environment, could not find the door of the toilet, walked unsteadily, and fell; After that, the patient gradually developed increased sleep, sleepiness, less speech and less movement, reduced communication with family members, inability to answer questions correctly, and occasionally incontinence. The outpatient head CT showed "right caudate nucleus head lacunar infarction" and was admitted to the hospital. Previous diabetes for 12 years, silicosis for more than 1 month. He has worked in a cement factory for more than 40 years and smoked for more than 40 years, about 10 cigarettes/d. His father has died of gastric cancer, and his mother has died of cerebral hemorrhage. Physical examination: The mind is clear, the questions can be answered, the answers to the questions are not relevant, the bilateral pathological signs are positive, and the other obvious positive signs are not seen. Medical examination showed no obvious abnormalities in heart, lung and abdomen, and no enlargement of lymph nodes in the whole body.

A 49-year-old male, physical examination found that the left occipital region occupied space for more than 3 years, and the lesion was found to be enlarged for more than 1 month. The patient found that the left occipital region occupied space during the physical examination on January 4, 2011. Because the occupied space was small and there was no discomfort, no operation was performed, and he was told to follow-up visit. On November 15, 2011, the lesion was found to be slightly enlarged during the re-examination of MR. After the enhancement, the lesion was significantly enhanced with meningeal tail sign. Meningioma was diagnosed, but no operation was still performed. In recent months, I experienced left occipital discomfort and occasional headache. There were no abnormal manifestations in my scalp and appearance during physical examination. On April 30, 2014, MR was re-examined and the occupied space of the left occipital region was significantly increased. On June 5, 2014, I went to Haikou People's Hospital. Imaging findings: CT on January 4, 2011: Nodular slightly high-density shadow convex into the brain in the left occipital region (FIG. 1A), adjacent to bone resorption destruction (FIG. 1B)； 15-Nov-2011 MR: Left Occipital Nodular Iso-T₁Long T₂Signal, obvious enhancement after enhancement, and meningeal tail sign, adjacent bone destruction (Figure 1C、Figure D、Figure 1E)； 30-Apr-2014 MR: The lesion was significantly enlarged (Figure 1F～Figure 1G)。 On June 9, 2014, the left occipital craniotomy was performed under general anesthesia for tumor resection: during the operation, the tumor was dark red on the convex dura of the left occipital region, the host bone was destroyed, and the occipital lobe was obviously compressed and migrated. Pathological examination: Microscopically, intracellular cavernous angiomatous hyperplasia (FIG. 2A), with bleeding, destruction of the host bone, and new trabecular bone can be seen. Immunohistochemistry: vascular endothelial cells CD31, CD34 (Figure 2B), CD56, Syn and Vimentin (Figure 2C) positive, CgA, CK, CD31, CD34, S-100, SMA, CD138, CD20, desmin, CD79a, CD99 and LCA were all negative, and about 5% of Ki-67 positive cells. Pathological diagnosis: cavernous hemangioma of the skull (left occipital region).

Angiopoietin-like protein family (Angptls) is a new family of secreted glycoproteins discovered in recent years, and its members are Angptls 1~7. As a new family of secreted glycoproteins, the role of Angptls in metabolism and angiogenesis has been widely paid attention to. Among them, there is substantial evidence that ANGPTL3 and ANGPTL4 play an important role in regulating plasma triglyceride levels, including in vivo and in vitro studies in mice and humans^[1,2,3,4]。 In humans, genome-wide association studies have also demonstrated the association of ANGPTL3 and ANGPTL4 with circulating lipid metabolism^[5,6]and the loss of functional mutations in ANGPTL3 in humans may be responsible for low plasma triglyceride levels^[7,8]。 In mice, the effects of ANGPTL3 and ANGPTL4 genes are consistent, that is, both overexpression and deletion of the corresponding genes can increase and decrease the levels of triglycerides in serum, respectively^[9,10]。 Recently, three research groups independently identified and confirmed a new vascular lipid regulator, which was named Lipasin/RIFL/ANGPTL8^[11,12,13]And found that it is a new member of the Angptls family, namely ANGPTL8, and a recent article published in the journal CELL found that this new angiopoietin family member (named betatrophin) can significantly and specifically stimulate the proliferation of β cells in mouse models, which has attracted great attention. In this paper, we will review the related research of this new regulator of glucose and lipid metabolism, in order to better clarify its important role in the regulation of glucose and lipid metabolism, which we collectively call betatrophin here.