2018年 · 第98卷第21期

With the coming of the age of aging, cardiovascular and cerebrovascular diseases have gradually become an important factor affecting human health. On the one hand, in order to avoid ischemic cerebrovascular disease, anticoagulation and antiplatelet therapy have become standard clinical treatments; At the same time, with the progress of vascular interventional technology for cardiovascular and cerebrovascular diseases, the number of antithrombotic drugs matched with interventional therapy (stent technology, etc.) has increased significantly. Anticoagulation, thrombolysis and antiplatelet therapy became necessary adjuvant therapies. When intracranial hemorrhage is associated with the application of antithrombotic drugs, it will bring many problems to clinical work, and poor treatment will affect the life of patients. The coagulation function of antithrombotic therapy may have the possibility of progressive hemorrhage, which directly affects the prognosis of patients. How to properly deal with these patients according to the needs of the disease has become a key problem faced by clinical practice.

Neurosurgery often involves external drainage, including external cavity drainage, external ventricular drainage (EVD) and external lumbar cistern drainage (LD). At present, some elective neurosurgical procedures have chosen not to place external cavity drainage^[1]However, in emergency surgery such as brain trauma and cerebral hemorrhage, the operative cavity or subgaleal aponeurosis external drainage is often used. EVD and LD have both therapeutic and monitoring roles. Among them, the average EVD in the United States alone is more than 40,000 times a year^[2]It is also very common in our country. However, LD is a technique mastered by almost all primary neurosurgery departments, and its use is greater. Since there is no consensus or guideline on the related techniques of neurosurgical external drainage in China, it is necessary to standardize and manage it.

neuromyelitis optica (NMO) is a group of inflammatory demyelinating diseases of the central nervous system that mainly involve the optic nerve and spinal cord. In 2004, Lennon discovered an NMO-specific marker, aquaporin 4 antibody (AQP4-IgG). In 2007, Wingerchuk expanded the definition of NMO to neuromyelitis optica spectrum disorders (NMOSD). In 2015, the NMO International Collaboration Group greatly updated the concept and diagnostic criteria of NMOSD, and divided it into AQP4-IgG positive or negative NMOSD. In recent years, myelin oligodendrocyte glycoprotein (MOG) antibody, glial fibrillary acidic protein (GFAP) antibody, aquaporin 1 antibody (AQP1-IgG) antibody have been found in the negative NMOSD group^[1,2]Isopositive related subtypes have aroused the attention of clinicians. A variety of new immunosuppressants under development provide patients with more treatment options. Clinicians should update their understanding of NMOSD in time, grasp its research progress, and achieve the purpose of scientific diagnosis and treatment.

In the age of aging society, more and more patients suffer from cardiovascular and cerebrovascular diseases such as myocardial infarction, cerebral infarction, atrial fibrillation and heart valve disease. At the same time, due to the extensive development of modern interventional technology, antithrombotic drug therapy has become a routine clinical treatment method. The prognosis of patients with intracranial hemorrhage in the course of antithrombotic drugs is worse than that of patients with intracranial hemorrhage alone, and the mortality and disability rate are higher^[1,2]。

External cerebrospinal fluid drainage is one of the most commonly used therapeutic techniques in neurosurgery. It specifically refers to the continuous drainage of cerebrospinal fluid in the ventricle or lumbar cistern to the external closed system, including external ventricular drainage (EVD) and external lumbar cistern drainage (LD). Its main purpose is to drain bloody or contaminated cerebrospinal fluid externally to the cranium, and it is sometimes used to monitor and control intracranial pressure and inject drugs through the drainage tube. On average, there are more than 40,000 EVDs in the United States a year^[1]However, there is no statistical data in China at present, but EVD and LD are also widely used in neurosurgery in China.

rapidly progressive dementia (RPD) is a class of rapidly progressing dementia syndrome, which refers to the rapid progression of dementia symptoms within weeks to months. The etiology is mainly non-neurodegenerative diseases, including infection, autoimmune, vascular, poisoning, metabolic, tumor, etc. Neurodegenerative diseases usually show a chronic progressive course, and very few may also show an acute, progressive or fluctuating course, often occurring due to infection, internal environmental disorders and other inducements. There are many etiologies and complex clinical manifestations of RPD, and different etiologies can correspond to completely different curative effects and prognosis. A few causes are treatable and have a good prognosis, most causes are partially treatable, and some rare causes are highly lethal. For example, rapidly progressing dementia caused by some infections/autoimmunity is reversible and curable, while patients with Creutzfeldt-Jakob disease progress rapidly once the disease develops, and the course of the disease is usually about half a year. Therefore, recognizing this dementia syndrome can help us clarify the cause, guide the treatment and prognosis.

Memory clinic is a new medical mode of specialized disease management. It is patient-centered, integrating clinical, neuropsychological, imaging and molecular biology diagnostic technology, drug and non-drug treatment and other medical resources, and standardizing the diagnosis and treatment process and level of cognitive impairment diseases. It is of great significance for early diagnosis, early treatment and prevention of dementia^[1]。

miRNAs (microRNAs) are a group of non-coding RNAs composed of 20-25 nucleotides. They were first discovered in Caenorhabditis elegans and later confirmed to be ubiquitous in animals and plants. By specifically binding to the non-coding sequence at the 3' end of the target gene, miRNAs can guide the RNA-induced silencing complex (RISC) to promote the degradation of the target gene or inhibit the translation process and ultimately inhibit the expression of the target gene^[1]。 Typically, miRNAs are generated by processing a single-stranded RNA precursor (pre-miRNA) having a hairpin structure of 70 to 90 bases by Dicer enzyme. miRNAs are evolutionarily conserved and are expressed only at specific tissue and developmental stages in multicellular eukaryotes such as animals, plants, and fungi^[2]。 Several studies have reported that miRNAs participate in and regulate the occurrence and development of myocardial remodeling. Abnormal expression of miRNA may directly or indirectly affect the structure, metabolism and function of the heart. For example, miR-101a can inhibit the proliferation, differentiation, migration and collagen production of cardiac fibroblasts by inhibiting TGF β receptor I (TGF β R I) and its downstream molecules^[3]。 After myocardial infarction, upregulated miR-34a in myocardial tissue can induce myocardial fibrosis by targeted activation of Smad4^[4]。 As an enriched miRNA in the heart, the regulatory function of miR-22 on hypertrophy, collagen production, autophagy and the expression of genes and proteins related to energy metabolism in myocardial remodeling has been gradually revealed. In this paper, the role of miR-22 in myocardial remodeling in recent years and the future research direction will be discussed.

Cognitive impairment is a disease characterized by cognitive decline, which can involve multiple cognitive domains. Severe cognitive impairment is called dementia^[1]。 Cognitive impairment/dementia has a high prevalence in the elderly, and patients with advanced disease cannot take care of themselves, which places a heavy burden on patients, families and society. Due to the limited effect, expensive price and adverse reactions of drug treatment, the breakthrough of non-drug treatment is urgently needed.

Rheumatoid arthritis (RA) is an autoimmune disease with high disability rate characterized by chronic synovitis, bone destruction and loss of joint function. The pathogenesis is still unclear. Current studies suggest that the incidence of RA is affected by both genetic and environmental factors, and the genetic effect of RA is only 60%^[1]。 About 10 in the human intestine¹⁴Bacteria are 10 times the number of somatic cells, with more than 1,000 species, and the number of genes encoded by them is more than 100 times that of the body's own genes. They directly participate in various biological activities such as nutrient absorption, fat metabolism, energy supply and immune regulation^[2]。 More and more studies have shown that intestinal flora is closely related to the pathogenesis of RA. The research progress on the role of intestinal flora in the pathogenesis of RA in recent years is summarized as follows.

Approximately 45,000 unicondylar joint replacements (UKA) and 600,000 total knee replacements (TKA) are required annually in the United States to treat end-stage degenerative arthritis^[1]。 At present, despite great progress in the design of implants, surgical tools, and postoperative rehabilitation of knee replacements, about 20% of patients still have unsatisfactory results^[2]。 Prosthesis position and soft tissue balance are critical to the success of TKA. Alignment deviation can cause a number of problems such as eccentric loading, instability, patellofemoral joint problems, wear, and aseptic loosening of the prosthesis^[3,4]。 During TKA, cutting error types were up to 4 in the coronal plane and up to 11 in the sagittal plane^[5]。 In this case, it is particularly important to accurately plan how to restore the force line of the knee before surgery and perform surgical operations according to the plan to improve patient function, prolong the life of the prosthesis and reduce pain. Therefore, recent developments in TKA have focused on improving surgical techniques to accurately determine mechanical axes, properly place osteotomy guides, and perform osteotomies. The goal of several computer-assisted surgical systems currently being developed is to control these factors more accurately and reliably, thereby improving clinical outcomes. Before the advent of robotic systems, computer-aided surgical systems mainly included surgical navigation systems and patient-personalized surgical instruments and prostheses. Although the use of navigation reduces the occurrence of mechanical axis abnormalities, the actual osteotomy still relies on hand tools, which may affect the accuracy of the osteotomy^[6]。 Meta-analysis failed to show a clear expected advantage in clinical outcomes using computer navigation^[7,8]。 Therefore, similar to computer navigation, TKA intraoperative robot-assisted technology developed by various manufacturers, surgeons and engineers, aimed at controlling surgical variables and improving the accuracy of surgical steps, may enable patients to recover faster and better.