2018年 · 第98卷第25期

adult degenerative scoliosis (ADS) is defined as a new onset of scoliosis after bone maturation and is a common complex degenerative disease of the spine. ADS often leads to lower back pain, trunk imbalance and lower limb nerve damage due to spinal instability and spinal stenosis, which seriously affects the quality of life of patients. Traditional open decompression orthopedic internal fixation is the main surgical treatment for ADS. In recent years, the rapid development of minimally invasive spinal surgery technique has been tried by doctors at home and abroad. Can minimally invasive techniques have some value in the treatment of ADS? Can it meet the therapeutic needs of decompression, stabilization, correction and fusion of ADS treatment, while reducing the occurrence of complications? How should we rationally view the role played by minimally invasive surgery in the treatment of ADS? This article will expound the focus issues of minimally invasive surgery for ADS with evidence-based medicine.

With the advent of aging society, the incidence of spinal degenerative diseases is increasing year by year, and the most serious imaging manifestation of spinal degeneration is degenerative scoliosis (DS). Therefore, the clinical research on DS is also showing a blowout in recent years. For the treatment of DS, there are currently two schools of clinical treatment, one is open surgery and the other is minimally invasive surgery. Open surgery emphasizes thorough correction of the deformed spine on the basis of decompression and restoration of the normal sequence between vertebral bodies (including coronal and sagittal sequences); Minimally invasive surgery, on the other hand, tends to start with symptoms, and use minimally invasive means to deal with the responsible intervertebral space that causes patients' low back pain and lower extremity radiation pain, so as to help patients improve their pain symptoms. With the development of minimally invasive technology, it also has certain orthopedic ability. These two surgical methods have obvious advantages and disadvantages, and there are certain differences in indications, but they have a common goal, which is to help patients reestablish good trunk balance.

degenerative scoliosis (DS) is a three-dimensional deformity of the spine caused by aging degeneration, accompanied by chronic low back pain and neurological symptoms^[1,2]。 If the symptoms persist and conservative treatment is ineffective, surgical treatment is required. Traditional open surgery such as osteotomy and intervertebral fusion can significantly improve the clinical symptoms and quality of life of patients^[3,4]。 However, open surgery also has the problem of high hemorrhage, potential nerve damage, high incidence of serious complications such as pulmonary embolism^[5,6]。 In order to reduce tissue damage, bleeding and complications, minimally invasive surgery (MIS) came into being to treat DS. The surgical approaches of MIS to treat DS include anterior approach (MIS-ALIF), posterior approach (MIS-TLIF, MIS-PLIF) and lateral approach (XLIF, OLIF)^{[7,8,9,10,11]}。 Recently, anterior column reconstruction (ACR) MIS technique with anterior longitudinal ligament release, intervertebral discectomy and implantation of lordosis intervertebral cage through lateral approach of psoas major has become increasingly mature, which can effectively restore lumbar lordosis and sagittal balance in some patients with DS, and reduce the use of three-column osteotomy^[12]。 However, there are many complications in the treatment of DS with MIS, such as the complications related to the approach (anterior complications such as macrovascular, peritoneal and abdominal organ injury; posterior complications such as paravertebral muscle injury and nerve root injury; and lateral complications such as lumbar plexus injury^[9,10,11])。 In addition, if the indications are not properly grasped, complications such as insufficient correction (especially sagittal plane) and pseudoarthrosis may occur. Therefore, it is of great significance to strictly grasp the indications of MIS in the treatment of DS to reduce the risk of complications. When choosing MIS or open surgery for DS, imaging parameters, clinical manifestations and general conditions of patients should be considered comprehensively.

Parkinson's disease (PD) and Alzheimer's disease (AD) are common degenerative diseases of the central nervous system with unknown etiology. Studies have shown that excessive iron accumulation in the body will induce oxidative stress, produce free radicals, damage mitochondrial electron transport system, intracellular electrolyte imbalance, enhance protease action, enhance membrane lipid peroxidation, and finally lead to cell death, PD, AD and other neurodegenerative diseases^[1,2,3]。 Therefore, it is speculated that iron-related genes may play an important role in PD and AD diseases. At present, the pathogenic genes are mainly believed to be transferrin (Tf) G258S (G/A) and transferrin receptor (TfR) S82G (A/G) polymorphism^[4,5]。 Therefore, we conducted a study of these two gene loci with the aim of exploring the causative genes of PD.

A 70-year-old male was admitted to the hospital on February 1, 2017 due to "abdominal distension with swelling of both lower limbs for 20 d". The local hospital examined abdominal enhanced CT: the left, middle and right veins of the liver were unclear, and the inferior vena cava was slender: considering the possibility of Budd-Chiari syndrome, it was transferred to our hospital. Has a history of drinking Tu Panax notoginseng medicinal wine in the past, and has no history of viral hepatitis. Physical examination: skin, sclera yellowing, abdominal swelling, abdominal wall without varicose veins, mild tenderness and rebound pain in the whole abdomen. Mobility voiced (+). Both lower limbs were edema without ulcer and pigmentation. Auxiliary examination: blood routine: white blood cells 4.9×10⁹/L, neutrophil ratio 70.5%, platelet 121×10⁹/L, hemoglobin 140 g/L; Liver function: alanine aminotransferase (ALT) 67 U/L, glutamate aminotransferase (AST) 107 U/L, glutamyl transpeptidase (GGT) 83 U/L, alkaline phosphatase (ALP) 132 U/L, prealbumin 0.11 g/L, albumin 28.3 g/L, total bilirubin 50.8 μ mol/L, direct bilirubin 29.7 μ mol/L; Coagulation function: prothrombin time 16.2 s, fibrinogen 1.226 g/L; Tumor markers: CA125 782.4 U/ml, alpha-fetoprotein normal. Fluid withdrawn from abdominal puncture, pale yellow and transparent, albumin 0.12×10⁹/L, Levanta test (−), total protein 19.5 g/L, albumin 9.9 g/L. No malignant tumor cells were found in ascites exfoliated cells. MRA: The inferior vena cava and hepatic veins are unclear and poorly enhanced, with signs of hepatic congestion and massive ascites. Color Doppler ultrasound: three hepatic veins flow to the heart, inferior vena cava compression sonography, the main portal vein trunk width is about 1.2 cm; Ascites (depth approximately 8.4 cm). Gastroscopy: esophageal varices, chronic gastritis with erosion, duodenitis.

A 47-year-old female patient visited the gynecological clinic of Zunyi Medical College Affiliated Hospital on September 27, 2017 due to "discomfort on the right side of the vulva". Physical examination: No abnormalities in heart, lung and abdomen. There was no enlargement of superficial lymph nodes throughout the body. Gynecological examination: there is no congestion, edema, ulcer and vegetation of the vulva, no abnormality in elasticity and color of the skin of the vulva, slightly swollen in the lower right side of the labia majora, no redness, swelling, fever, low skin temperature when touched, swelling and pain, no fluctuating feeling, deep position, close to the anus, fixed, unclear boundary, tough texture, no abnormality in the remaining vulva. The vagina is smooth, a little discharge, no odor, the cervix is smooth in appearance, and the uterus and double appendages are not palpable. Follow up the medical history, complain of discomfort on the right side of the labia majora 20^＋In 2000, a mass of about 5 mm was perceived in this area, which was not treated. In the past 20 days, I felt that the tumor mass increased rapidly, distended and painful, but there were no chills and high fever, no low fever and night sweats, no abdominal pain, and no increased vaginal discharge. Denial of history of tuberculosis and exposure to tuberculosis patients. History of vulvar surgery denied. Vaginal B-ultrasound showed no abnormalities in the double uterine appendages, and a cystic mass with a size of about 1.7 cm ×1.0 cm was seen below the right labia majora, with a clear boundary and no obvious blood flow signal. Laboratory tests: HBsAg (+), HBeAb (+), HBcAb (+); Blood routine, coagulation function, liver and kidney function, human immunodeficiency virus antibody + Treponema pallidum antibody qualitative test were all normal, and T-spot test (T-spot.TB) of Mycobacterium tuberculosis infection was negative. No abnormalities were found on plain chest radiograph and electrocardiogram. Considering the right Bartholin cyst, Bartholin cyst stomy was performed in the gynecological clinic of Zunyi Medical College Affiliated Hospital (Figure 1), the swollen part of the right labia majora was incised, and no liquid was seen to flow out. The swollen part was solid tissue, tough in texture, fixed, and the boundary was not clear. The tissue was removed as much as possible, and it was seen as yellow fat-like tissue (Figure 2), sent for pathological examination, routine suture incision site. The pathological diagnosis showed that the deep soft tissue of the right labia majora showed acute and chronic non-specific inflammation with granulomatous hyperplasia (Figure 3)。 The patient refused to undergo immunohistochemical examination. After 2 months, the follow-up examination showed that the incision on the right side of the labia majora healed well and there was no abnormality in the vulva.

Adult degenerative scoliosis (ADS) often causes pain, numbness and walking disorders in the lower back and lower limbs of patients, and the incidence rate in the elderly population is as high as 35.5% ~68%^[1,2]。 Although open surgery can achieve better clinical efficacy for ADS which is not effectively treated by conservative treatment, it is traumatic and has a high incidence of postoperative complications^[3]。 In order to reduce surgical trauma, minimally invasive surgery has been gradually applied to the treatment of ADS in recent years. Minimally invasive spinal surgery has less trauma, can effectively reduce surgical complications and improve surgical safety. This article will review the decompression effect, fixed orthopedic ability, fusion effect and trunk balance recovery ability of minimally invasive treatment of ADS, and evaluate the value of minimally invasive surgery in the treatment of ADS.

Annular enhanced liver lesion refers to the appearance of annular enhanced shadows around the lesion after CT/MR enhanced scan, which can be thick or thin, smooth or rough. This type of disease is generally divided into two categories: non-neoplastic and neoplastic. Non-neoplastic lesions such as liver abscess and liver tuberculosis. Neoplastic lesions such as benign hepatic hemangioma, hepatitis pseudotumor, or malignant hepatocellular carcinoma, intrahepatic cholangiocarcinoma, metastases. The treatment plan and prognosis of these two types of diseases are quite different, so it is necessary to make correct diagnosis and reasonable differential diagnosis. This article reviews the progress of imaging research and diagnostic value of hepatic annular enhancement lesions.

Glioma is the most common intracranial malignant tumor, accounting for about 50% of primary intracranial tumors^[1]。 Most gliomas show invasive growth, and the boundary with the surrounding normal brain tissue is unclear, so it is difficult to completely remove the tumor by surgery. Although some progress has been made in the treatment of glioma, the average survival cycle of glioblastoma patients is only 14.6 months because the pathogenesis of glioma has not been fully elucidated^[2]。 Therefore, the study of glioma is crucial for improving the efficacy of glioma and prolonging the survival cycle of patients. Establishing an ideal animal model is the key to study the pathogenesis of glioma and develop new therapeutic methods. An ideal glioma animal model should have the following characteristics: (1) the origin of tumor cells in the animal model is similar to that of human glioma cells; (2) have similar genetic characteristics and cell heterogeneity to human glioma; (3) It has similar biological and pathological characteristics as human glioma, such as invasive growth, neovascularization, changes in blood-brain barrier permeability and easy recurrence; (4) the tumor model responds to treatment similarly to human glioma; (5) The tumor model has high reproducibility^[3]。 Brain gliomas were classified into inducible, transplantable and transgenic animal models. Among them, transgenotype is the hottest and fastest advancing glioma animal model.