2017年 · 第97卷第03期

In October 2016, Beijing Tiantan Hospital admitted one patient, male, 45 years old. Previous history of hypertension, diabetes and long-term smoking. This time, due to dizziness, blurred vision, dysphagia, and bilateral limb weakness, I went to the hospital for 3 hours. The physical examination, laboratory tests and imaging examination of the patient were completed in the shortest time in the emergency department, and he was considered eligible for intravenous thrombolysis. He was given intravenous recombinant tissue plasminogen activator (t-PA) treatment about 3 h 40 min after the onset of the disease. After the patient's symptoms improved transiently (about 15 min), they worsened again, mainly manifested by disturbance of consciousness and inability to be awakened. After re-evaluation, it was considered necessary to complete cerebral angiography, and endovascular treatment was given if necessary. Angiography showed an occlusion of the middle basilar artery, followed by thrombectomy, balloon dilatation and stenting. Immediate postoperative angiography showed that the anterior basilar artery blood flow recovered well, and the patient's consciousness disorder was alleviated. After operation, NCU was given routine sedation, blood pressure control, antithrombotic treatment, and vital signs, cerebral blood flow and imaging were monitored. On the seventh day after surgery, the patient again experienced aggravated disturbance of consciousness, showed deep coma, and shortness of breath required ventilator assistance. No intracranial hemorrhage was observed after emergency review head CT, and the basilar artery was occluded again after the second angiography. Despite efforts, the patient's clinical outcome was poor.

Epidemiological data show that stroke has become the second most common cause of death in the world, and it is the first cause of death in China^[1]。 Although stroke has received high attention, treatment options for patients with acute ischemic stroke, especially those with severe stenosis or occlusion of large intracranial vessels, are still stretched^[2]。 Five international multicenter RCT studies published in the New England Journal of Medicine in 2015 (MR CLEAN^[3], ESCAPE^[4], REVASCAT^[5], SWIFT PRIME^[6], EXTEND IA^[7]The results showed that the early endovascular treatment of acute ischemic stroke, represented by the new generation stent thrombectomy, was superior to the previous standard medical treatment, which provided new clinical evidence for the treatment strategy of this group of patients.

Hospice for the elderly refers to the hospice care institutions providing palliative and supportive all-round services to the elderly and their families, covering the medical, nursing, psychological and social fields, with the goal of improving the quality of end-of-life of the elderly. The research of hospice care abroad is very rich, but comparatively speaking, the research of hospice care in China is relatively weak, and most of them are carried out in nursing, medicine, psychology and other disciplines. The construction of end-of-life care for the elderly involves not only the fields of end-of-life such as oncology, gerontology and nursing, but also social work, sociology, psychology, demography and other social science fields, which is closely related to the national medical and health policy. How to integrate the above different fields with medical and health policies as a whole will be a big research challenge. Based on the existing development of hospice care in China, this paper puts forward the strategy of building the hospice care system of urban elderly people in China from the actual situation of the country, with the aim of providing reference for the construction of scientific hospice care system in China.

Cerebral amyloid angiopathy-associated inflammation (CAA-I) is a rare clinical manifestation of sporadic cerebral amyloid angiopathy (CAA), mainly manifested by cognitive decline, headache, behavioral changes, seizures, and localized neurological dysfunction. Brain MRI showed T₂WI or Flair single or multiple patchy or fused white matter hyperintensity. The diagnosis of this disease needs to rely on invasive biopsy pathology, which is rarely reported in China. However, with the deepening understanding of this disease, many scholars have suggested that brain biopsy should be avoided based on typical clinical and neuroimaging characteristics^[1,2,3]。 Because CAA-I responds well to immunosuppressive therapy, improving clinicians' understanding of the disease is of great significance to improve prognosis. In this study, the clinical data of 6 patients with CAA-I based on clinical and imaging diagnosis were retrospectively analyzed, and their clinical and neuroimaging characteristics were analyzed, so as to increase clinicians' understanding of this disease and reduce misdiagnoses and misdiagnoses.

The patient was a 50-year-old female. He was admitted to Tianshui 407 Hospital due to "limb weakness and pain for 5 days, aggravated for 12 hours". He had a history of asthma for 1 year and was rescued in our hospital on March 22, 2016 due to "severe asthma". The lung CT and blood routine data are shown inTable 1、Figure 1。 After discharge, salmeterol and ticasone aerosol were inhaled (discontinued due to disappearance of asthma-related symptoms) and montelukast was administered orally until 1 week before onset. There were no clear cardiovascular high risk factors.

Sepsis is a clinical syndrome of uncontrolled host response to infection and life-threatening organ dysfunction. It is an important cause of death in critical care medicine (ICU) patients^[1]。 Despite the deepening of knowledge of sepsis and the rapid improvement of medical technology in recent years, the mortality rate of sepsis in adults is still as high as 24% ~50%^[2]。 Studies have shown that patients with sepsis are often complicated by hypoalbuminemia, which can lead to further aggravation of the condition and increase the mortality rate. It is currently considered that serum albumin concentrations<30 g/L, can be diagnosed as hypoalbuminemia, and its incidence in severely ill patients is 30% to 50%, where the albumin concentration may be reduced more in septic patients. Numerous studies have confirmed that decreased serum albumin concentration is an independent predictor of prognosis in patients with sepsis and septic shock.

Glioma is a tumor of neuroepithelial origin and is the most common primary tumor of the central nervous system. According to the latest statistics from the central brain tumor registry of the United States (CBTRUS)^[1], gliomas account for approximately 27% of all CNS tumors and 80% of malignant primary CNS tumors. Gliomas are mostly invasive and invasive, and they are easy to relapse after operation, and the mortality rate is high. In order to understand the biological characteristics of tumors more comprehensively, magnetic resonance weighted imaging (PWI) technology is used to evaluate tumor perfusion and angiogenesis. PWI mainly includes arterial spin labeling (ASL), dynamic susceptibility contrast MRI (DSC-MRI) and dynamic contrast-enhanced MRI (DCE-MRI). ASL is not widely used in clinical practice because of its sensitivity to motion artifacts and low signal-to-noise ratio; However, DSC-MRI, which is widely used in clinic, will lead to extravasation of contrast agent when tumors destroy the blood-brain barrier (BBB), thus underestimating cerebral blood flow. DCE-MRI can quantitatively evaluate tissue microvascularization and its function, so as to reflect tissue vascular distribution, blood perfusion and other physiological information at the level of cellular molecular function. Theoretically more accurate than DSC-MRI. Therefore, the research of DCE-MRI in glioma has been paid more and more attention. This article reviews the basic principles of DCE-MRI and its application in glioma.

Fulminant myocarditis is the most critical type of viral myocarditis. Although its incidence rate only accounts for 4% ~5% of the total number of acute myocarditis, its condition is fierce and can rapidly progress to severe heart failure and cardiogenic shock in a short time after the onset, and the mortality rate can be as high as 80%. However, the pathological basis of fulminant myocarditis is myocardial interstitial edema accompanied by inflammatory cell infiltration and involvement of conduction system, while only part of myocardial fibers have vacuolar degeneration and small focal myolytic necrosis, and this histopathological change is self-limiting. Therefore, after timely diagnosis and treatment, a considerable number of patients can almost completely recover the myocardial structure and function without leaving any complications, and the long-term prognosis is better than non-fulminant myocarditis^[1]。 This article will review the diagnosis and treatment status and progress of fulminant myocarditis in recent years.

Endometriosis (abbreviated as endometriosis) and autoimmune thyroiditis (AITD) are common diseases in women of childbearing age and common complications in infertile women. In vitro fertilization-embryo transfer (IVF-ET) is an effective method for the treatment of infertility. Previous studies suggest that the incidence of AITD is increased in patients with endometriosis, and the incidence of endometriosis is also increased in patients with AITD, suggesting that the pathogenesis of the two diseases and the impact on female reproductive function may be closely related. The effects of endometriosis and autoimmune thyroiditis on female reproductive ability and their possible mechanisms are summarized as follows.