2018年 · 第98卷第17期

Brain tumors occur in the human brain, and the brain is the most important organ in the human body. It is in charge of basic life activities such as respiration and heartbeat, nervous functions such as language and motor, and emotional psychology and advanced cognitive functions. Brain tumors mainly occur in young and middle-aged people. Because of the "three highs" characteristics of high surgical mortality, high disability rate and high postoperative recurrence rate, it has become one of the most harmful diseases to human health.

Intraoperative neuroelectrophysiological monitoring (IONM) refers to the technique of applying various neuroelectrophysiological techniques to monitor the functional integrity of the nervous system at risk during surgery. IONM has become an indispensable means to monitor nerve function in real time, reduce nerve damage and improve surgical quality. Nowadays, intraoperative neuroelectrophysiological monitoring needs to use a variety of monitoring methods, which requires the cooperation of surgeons, anesthesiologists and neuroelectrophysiological monitoring doctors to achieve the purpose of neurological function protection. Therefore, standardized operation is needed to ensure the completion of monitoring purpose. Therefore, the Expert Committee on Neuroelectrophysiological Monitoring of Neurosurgery Branch of Chinese Medical Doctors Association organized the writing of "Chinese Intraoperative Electrophysiological Monitoring Standards for Neurosurgery (2017 Edition)".

mild cognitive impairment (MCI) refers to the progressive decline of memory or other cognitive functions, but does not affect the ability to live daily, and does not meet the diagnostic criteria for dementia^[1]。 The diagnostic criteria of MCI were first proposed by Petersen et al. in 1999, and the criteria have been widely recognized and applied. However, this criterion is too limited in the diagnosis of MCI, mainly in the diagnosis of amnestic MCI. In 2003, the international working group revised the diagnostic criteria of MCI, which is also the widely used diagnostic criteria of MCI at present. The criterion classifies MCI into four subtypes, namely, single cognitive domain amnestic MCI, multi-cognitive domain amnestic MCI, single cognitive domain non-amnestic MCI, and multi-cognitive domain non-amnestic MCI^[2]。 In addition, the standard also explains the etiology of MCI more comprehensively, such as Alzheimer's disease, cerebral small vessel disease, Lewy body disease, frontotemporal degeneration and other slow-onset dementia types before the clinical symptoms reach dementia, mild pathological changes can cause MCI. Brain trauma, encephalitis, nutritional deficiency, etc. can lead to long-lasting MCI. Although the 2011 standards of the National Institute on Aging (NIA), the 2011 standards of the Alzheimer's Association (ADA), and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of 2013 have been updated for MCI caused by Alzheimer's disease and the diagnostic criteria for MCI, the basic contents are consistent with the 2003 diagnostic criteria for MCI^[3]。

A 76-year-old female was admitted to the hospital on June 18, 2017 due to pain and bleeding in both lower limbs due to being run over by a bus for 1 h. 1 h before admission, both lower limbs were crushed by the wheels of a bus, with pain and wound bleeding, with a bleeding volume of about 800 ml, no coma, mild irritability, nausea and vomiting after injury, no obvious dyspnea, abdominal pain and distension. The patient had a history of hypertension and diabetes for more than 10 years, and took medication on his own. The details were unknown, and other medical histories were denied. Physical examination: body temperature 36.2 ℃, breathing 22 times/min, pulse 92 times/min, blood pressure 90/60 mmHg (1 mmHg =0.133 kPa), painful face, pale complexion, irritability, and relevant answers. Extensive compression and avulsion of the skin and soft tissue of the left calf and dorsum of the left foot, exposure of the Achilles tendon, metatarsal bone and phalanges, obvious contusion of the Achilles tendon, fragmentation of the base of the metatarsal bone, active bleeding of the wound, fragmentation of the skin and soft tissue of the 1 to 5 toes of the left foot, phalanges, accessible bone friction of the left foot and left lateral ankle, poor movement of the left ankle, limited movement of each toe of the left foot, no blood supply at the periphery and poor sensation; Extensive avulsion of skin and soft tissue from 10 cm above the right knee to the right ankle, exposure of tibia and Achilles tendon, contusion of Achilles tendon, active bleeding of wound, residual sediment and dirt from open wound, exposure of gastrocnemius muscle and lower segment of tibia and fibula, fracture end of middle and lower segment of fibula, fracture of right lateral malleolus, absence of blood supply to the avulsed skin, tenderness of the affected limb, abrasive sensation of middle segment of right fibula and lateral malleolus, poor movement of right ankle and toes of right foot, poor blood supply at the periphery of right foot, and dull sensation. Admission diagnosis: multiple large-area severe skin and soft tissue avulsion injuries such as right knee, both calves and both feet; Achilles tendon contusion and avulsion injury; Five toes of the left foot were damaged and large area of skin defect on the dorsum of the foot was injured; Open comminuted fracture of left lateral malleolus; Fracture of left fifth metatarsal; Fracture of left cuboid bone; 1~5 toe damage of left foot; Open fracture of right medial malleolus with bone defect; fracture of middle right fibula; Partial avulsion and exposure of the Achilles tendon of both ankles; Diabetes; Hypertensive disease.

Brodie's abscess, also known as chronic localized osteomyelitis, is a low-toxicity infectious lesion of bone. It is more common in children and adolescents in the onset population. The clinical symptoms are mild, the specificity is not high, the imaging findings are sometimes atypical, and it is easy to be confused with other bone diseases, resulting in missed diagnosis and misdiagnosis^[1]。 Because the blood flow in the metaphysis is slow and bacteria are easier to deposit, Brodie abscess mostly involves the metaphysis, but the epiphyseal plate has a barrier function, and the cases of Brodie abscess involving the epiphyseal plate are rare. A case of Brodie's abscess involving epiphyseal plate admitted to our department in 2016 is reported as follows.

transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation therapy technique, which is widely used in the clinical treatment and scientific research of neuropsychiatric diseases including pain, Parkinson's disease, epilepsy, tinnitus, depressive disorder, schizophrenia, addiction and so on because of its advantages of non-invasive, safe, low cost and simple operation^[1]。 This article reviews and reviews the recent research progress of tDCS in the treatment of depressive disorders.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with multiple organ system damage. Pulmonary arterial hypertension (PAH) is one of the serious comorbidities of SLE patients, and its incidence is 0.5% ~43%^[1,2]And it is more common in Asian people. The mortality rate of SLE patients has decreased sharply in the past 50 years, but the risk of death in patients with systemic lupus erythematosus-associated pulmonary hypertension (SLE-PAH) is still significantly higher than that in patients without PAH. The 5-year survival rates of both patients are 68% and 94.8%, respectively^[3,4]。 In recent years, the research on pulmonary hypertension associated with connective tissue disease (CTD-PAH) has attracted more and more attention from domestic and foreign researchers, especially the research on SLE-PAH has received more and more attention. With the deepening of basic research such as molecular biology and immunology, diagnostic techniques such as right heart floating catheter examination and therapeutic drugs, the basic and clinical research of SLE-PAH have made rapid progress. This article mainly reviews the latest research progress of SLE-PAH in terms of pathogenesis and treatment strategies as follows.

As one of the common malignant tumors, colorectal cancer seriously affects the quality of life of human beings, and liver metastasis is one of the important factors that affect the prognosis of colorectal cancer patients, and its early diagnosis and treatment are the key factors that determine the prognosis of patients. Therefore, how to use imaging methods to detect the lesion as early as possible and carry out appropriate clinical treatment is a common problem that imaging examination and clinical work need to face. At present, the available imaging methods for patients with liver metastasis of colorectal cancer include CT, magnetic resonance (MR), ultrasound, PET and PET-CT/MRI, which has not been popularized yet. These methods have their own advantages and disadvantages in qualitative diagnosis, treatment choice and prognosis evaluation. How to closely combine them with clinical treatment and learn from their strengths to achieve accurate diagnosis and treatment of diseases is the issue that this article should focus on.