BACKGROUND:Diffusion conditions of bone cement in vertebral fracture line may be one of the main factors affecting the therapeutic effect of percutaneous vertebroplasty, but there are less related studies. OBJECTIVE:To study the effect of diffusion conditions of bone cement in vertebral fracture line on the therapeutic outcomes of percutaneous vertebroplasty. METHODS: CR and MRI data of 77 patients with T1-L2 osteoporotic vertebral compression fractures, 28 males and 49 females, aged 55-86 years, undergoing percutaneous vertebroplasty were analyzed. Al the patients were divided into test group (n=53, bone cement diffused wel in the vertebral fracture line) and control group (n=24, bone cement dispersion was unsatisfactory). Visual analogue scale, Oswestry disability index and Cobb angle change in the two groups were measured and compared before and after operation. RESULTS AND CONCLUSION:There was no difference in the visual analogue scale score, Oswestry disability index and Cobb angle between the two groups before operation, but these parameters were al improved significantly in the two groups after 2 days and 6 months of operation (P< 0.05). The visual analogue scale score and Oswestry disability index were significantly lower in the test group than the control group at 2 days after operation (P < 0.05), but there was no difference between the two groups at 6 months after operation. The Cobb angle and vertebral colapse rate became lower in the test group than the control group at 6 months after operation (P < 0.05), but there was no difference in the re-fracture rate between the two groups. These findings indicate that poor bone cement dispersion in the fracture line can affect the relief of short-term pain and dysfunction and it can increase the possibility of long-term secondary vertebral colapse.

Objective To explore the relationship between immunohistochemistry of LN,FN,p53 and TIMES in human brain glioma(BG). Methods Transmission electronic microscope(TEM) and immunohistochemistry were used to investigate the morphological characteristics of micrangiums in BG and the expression of LN,FN,p53 in BG and intracranial metastatic tumors. Results 1.It was found that base laminas beneath endothelial cell with locally or extensively thickened were intact and continuous in BG.The increasing thickness of BM was consistent with the staining of LN and FN and related to p53 immunostaining.BM of p53-protein positive cases grew thicker than that of p53-protein negative ones.2.Micrangiums BM in all BG were positive for LN and FN.The more malignant the BG was,the stronger the LN and FN staining became and the thicker the blood vessel walls grew(P0.05).Conclusion One of the reasons that BMs in TIMES in BG thicken may be the over expression of LN and FN of brain micrangium endothelial cells.Also,the influence of p53 on TIMES is associated with the functional state of endothelial cells.Micrangiums endothelial cells may be play a role in regulating TIMES.

BACKGROUND:Whether there is a necessary connection or internal patterns between the amount of bone cement-recovery of vertebral height-clinical efficacy has no evidence-based medicine findings in the treatment of osteoporotic vertebral compression fractures using percutaneous vertebroplasty with high-viscosity bone cement injection.
OBJECTIVE: To observe the change of vertebral height in the elderly with osteoporotic vertebral compression fractures after percutaneous vertebroplasty with high-viscosity bone cement injection.
METHODS:A total of 110 elderly patients with osteoporotic vertebral compression fractures (139 vertebrae) were admitted at the Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region from January 2011 to December 2012. Al the patients received percutaneous vertebroplasty by the same group of surgeons. Bone cement at drawing stage was injected into the fractured vertebra. During the 12-month folow-up, visual analogue scale, Barthel index and vertebral height restoration were observed as evaluation indexes.
RESULTS AND CONCLUSION:The surgical treatment was done successfuly in the 110 patients (139 vertebrae). The amount of bone cement per vertebra was 3-6 mL, with a mean of 3.5 mL. At 12 months after surgery, the visual analog scale scores were decreased from 7.9 to 1.8, Barthel index was increased from 40.25 to 82.21, both of which were improved significantly (P < 0.05). After surgery, the vertebral heights at the anterior and middle parts were increased by (81.25±9.26)% and (78.22±10.65)%, respectively, and there was significant differences before ant at 24 hours, 3 months and 12 months after surgery (P < 0.05). During the folow-up, there were five vertebrae with bone cement leakage, but no clinical symptoms occurred, and no nerve injury or pulmonary embolism happened. These findings indicate that percutaneous vertebroplasty with high-viscosity bone cement injection can effectively relieve pain, restore the vertebral height, reduce the incidence of complications and shorten the recovery time in patients with osteoporotic vertebral compression fractures.

Objective To investigate the correlation between Hcy and blood lipid level and its diagnostic value in patients with cerebral infarction.Methods 218 patients with cerebral infarction were divided into the cerebral infarction group and no cercbral infarction group,based on the diagnosis results of head CT or MRI,and 60 healthy individuals were used as the control group.The levels of serum TC,TG,HDL-c,LDL-c and serum Hcy were determined in each group.The level of serum Hcy was used as a diagnostic-test and the criterion of cerebral infarction which was diagnosed by using head CT or MRI was used as a gold standard.Meanwhile,the sensibility,specificity,predictive value and likelihood ratio of Hcy were measured in patients with and without cerebral infarction.Results Levels of TC and Hcywere significantly elevated (P ＜ 0.01),but HDL-c level was significantly decreased in patients with and without cerebral infarction compared with the healthy people (P ＜ 0.05).Hcy level was shown negatively correlated with HDL-c (r =-0.144,P ＜ 0.05).The sensibility and specificity of Hcy in both two groups of patients with and without cerebral infarction were 42.20％ and 54.13％,the positive predictive value and negative predictive value of Hcy were 47.92％ and 48.36％,the positive likelihood ratio and negative likelihood ratio of Hcy were 0.92 and 1.07,respectively.Conclusion Hcy and blood lipid have definite correlation,but Hcy has low diagnostic value for cerebral infarction and may not be used as a biological marker for the cerebral infarction diagnosis.

Objective To investigate the neuroimaging and pathological features of epithelioid glioblastoma (EGBM) to improve the diagnosis.Methods The clinical and pathological features of 4 E-GBM cases were analyzed retrospectively.Results E-GBMs occurred predominantly in young adults.MRI examination showed irregular solidcystic lesion with heterogeneous or ring enhancement in 4 cases.Histological examination revealed uniform population of epithelioid or rhabdoid cells with prominent nucleoli and mitotic activity as well as geographic necrosis..Immunohistochemical staining showed various positive signals of Vimentin and S-100 protein in 4 cases,positive signal of BRAF (VE1) in 3 cases and focal positive signal of GFAP in 1 case.However,IDH-1 was negative and 1p/19q codeletion was lack.All patients were followed-up for 2-6 months.One patient had tumor recurrence 3 months and one patient died of disease 6 months after surgical excision.Conclusion E-GBM has a poor outcome and is closely associated with pleomorphic xanthoastrocytoma.MRI and epithelioid histological features are very important for the differential diagnosis.

Objective:To analyze the antibody level of phospholipase A2 receptor (PLA2R) in Chinese patients with primary membrane nephropathy (PMN) and its correlation with clinical indicators, and to explore more suitable cut-off value for Chinese patients.Methods:All hospitalized patients with renal biopsy at Peking University People's Hospital from January to August 2018 were retrospectively reviewed. According to the primary disease, patients were divided into PMN group (including patients with idiopathic membranous nephropathy and atypical membranous nephropathy of unknown cause) and control group (other pathological types, including secondary membranous nephropathy patients). Their clinical and pathological characteristics were analyzed, and the level of serum PLA2R antibodies was detected using the method of enzyme-linked immunosorbent assay (ELISA). Spearman correlation was used to analyze the correlation between PMN patients' blood anti-PLA2R antibody level and clinical indicators. The risk factors of PMN were analyzed by logistic regression model, and the optimal cut-off value of PMN was analyzed by ROC curve.Results:A total of 354 patients were included in this study, including 114 patients in PMN group and 240 patients in control group. The age of PMN group was (51.7±14.1) years old and the ratio of male to female was 2.2∶1. The median concentration of PLA2R antibody in PMN group was 16.87 RU/ml [inter-quartile range ( IQR) 1.88-57.26], which was significantly higher than that in control group (1.43 RU/ml, IQR 1.20-1.62, P<0.001). In PMN group, the concentration of anti-PLA2R antibody was correlated with the 24-hour urine protein ration ( r=0.278, P=0.003) and urine erythrocyte ( r=0.190, P=0.043), but not with serum albumin ( r=-0.149, P=0.114) and serum creatinine ( r=0.136, P=0.149). The ROC curve showed that the sensitivity of distinguishing PMN from other diseases was 69.3% (95% CI 60.3%-77.0%), the specificity was 92.9%(95% CI 89.0%-95.5%), and the area under the curve was 0.859(95% CI 0.813-0.905) when the cut-off value was set as 2.28 RU/ml, which was significantly better than the cut-off value of 20.00 RU/ml (the sensitivity/specificity was 46.5%/97.5%) and 14.00 RU/ml (the sensitivity/specificity was 53.5%/97.1%). Conclusions:PLA2R antibody is one of the main pathogenic antibodies of PMN. In China, it is recommended to lower its cut-off value to 2.28 RU/ml, which can improve the sensitivity of distinguishing PMN from other pathological types without reducing specificity.

Blue rubber bleb nevus syndrome (BRBNS) is a rare disease, which is characterized by multiple hemangiomas of the skin and gastrointestinal tract. We once treated a case with intussusception requiring surgery. The purpose of this article is to improve our understanding of this disease.

In recent years, the clinical experts consensuses or guidelines of ankylosing spondylitis (AS)/spondyloarthritis (SpA) have been constantly updated, but to better understand and practice, patient self-participation management is one of the key points to improve the level of diagnosis and treatment. Through questionnaire survey of these patients, we screened out the most concerned issues, and established the AS/SpA patient practice guideline working group with multidisciplinary physicians and patients. Fifteen opinions, as the AS/SpA patient practice guidelines, are proposed in accordance with the relevant principles of the "WHO guidelines development manual" , and with the international normative process.

Screening and evaluating the diseases responding specifically to traditional Chinese medicine （TCM） will help to highlight the advantages of TCM treatment， and the evaluation method should be standardized with consideration to the unique characteristics of the diseases. The incidence of Sjögren's Syndrome （SS） is increasing year by year， while the pathogenesis of this disease remains unclear. Modern therapies for this disease include biological agents and immunosuppressants， which generally have unsatisfactory efficacy. The TCM treatment of SS focuses on the harmony of the physical and mental health. The Rheumatology Branch of the China Association of Chinese Medicine organizes experts in TCM， Western medicine， and evidence-based medicine to form working groups. Delphi method and bibliometric method were used for analysis， and SS was selected as a disease responding specifically to TCM. Furthermore， the evaluation system was established for this disease， and the consensus regarding this disease was reached after seminar discussion. This paper summarized the whole process of the evaluation of the advantages of TCM treatment of SS. First， because TCM atomization is widely used in clinical practice and enriches TCM administration methods， this therapy is included after other non-drug therapies were taken as characteristic therapies. Second， the evaluation indicators of therapeutic effect should be determined with consideration to international acceptance and the current research status. Third， the expression method should be accurate， standardized， and objective， highlight the natural advantages of TCM， and avoid arbitrary extension. This paper provides a reference for clinicians to explore other diseases responding specifically to TCM.