Surgical relevance of diagnostic imaging techniques in pretherapeutic staging of carcinoma of the esophagus, stomach, colon and rectum

Summary. The increasing spectrum of therapeutic options for tumors of the gastrointestinal tract has resulted in a refinement of the pretherapeutic diagnostic strategies. The diagnostic approach in surgical institutions that are focused on primary surgical resection will therefore be much less sophisticated than in institutions who propose a selective therapeutic approach based on the pretherapeutic tumor stage and prognostic parameters. Pretherapeutic assessment of the depth of tumor infiltration, i. e. the T-category, is essential because most further diagnostic and therapeutic decisions are based on this information. This can today be achieved with a high degree of accuracy by endoscopy and endoscopic ultrasonography. Early T-stages (T1–2) are usually an indication for primary surgical resection and, after exclusion of distant metastases, no further diagnostic studies are required. In patients with locally advanced esophageal, gastric or rectum tumors (T3–4) multimodal therapeutic concepts should be considered. This usually requires additional diagnostic studies. None of the available diagnostic imaging modalities today allows satisfactory pretherapeutic assessment of lymph node metastases. The assumed nodular status should therefore currently not influence therapeutic decisions. Essential is, however, the assessment of distant metastases, since the documentation of distant tumor spread will change the therapeutic approach to a palliative situation. Detailed histologic and molecular-biologic assessment of tumor characteristics is growing in importance. This not only provides therapeutically relevant information regarding tumor grading, but opens the door towards a modern molecular diagnostic approach. It can be expected that in the near future a vast amount of relevant prognostic information can be obtained from endoscopic tumor biopsies, which may soon alter our therapeutic concepts.      

硬膜外镇痛联合应用乙酰氨基酚在剖宫产术后的镇痛效果

目的：比较对乙酰氨基酚联合自控硬膜外镇痛的多模式术后镇痛与单纯自控硬膜外镇痛用于剖宫产产妇术后镇痛效果。方法：200名行剖宫产的产妇随机分为实验组（S组）和对照组（C组）,S组产妇在术前15min静脉注射对乙酰氨基酚1g,C组产妇在术前15min静脉注射安慰剂（生理盐水）。两组产妇均采用腰硬联合麻醉方案,缝合切口时启动自控硬膜外镇痛泵。术前、术后即刻、术后1天、术后2天观察疼痛强度和血清IL-6、IL -10水平;记录新生儿出生Apgar评分、术后阿片类药物使用量及术后不良反应、产妇满意度和对母乳喂养的影响程度。结果：术后1天疼痛评分S组显著低于C组。术后即刻、术后1天S组IL-6表达水平低于C组,而该时点S组IL-10表达水平高于C组（P＜0.05）。两组间不良反应、新生儿出生Apgar评分、产妇满意度和母乳喂养情况无统计学差异（P＞0.05）。结论：剖宫产术前静脉注射对乙酰氨基酚联合自控硬膜外镇痛比单独应用自控硬膜外镇痛能够为产妇提供更好的术后疼痛管理。     

Feeling what you hear: auditory signals can modulate tactile tap perception

We tested whether auditory sequences of beeps can modulate the tactile perception of sequences of taps (two to four taps per sequence) delivered to the index fingertip. In the first experiment, the auditory and tactile sequences were presented simultaneously. The number of beeps delivered in the auditory sequence were either the same as, less than, or more than the number of taps of the simultaneously presented tactile sequence. Though task-irrelevant (subjects were instructed to focus on the tactile stimuli), the auditory stimuli systematically modulated subjects tactile perception; in other words subjects responses depended significantly on the number of delivered beeps. Such modulation only occurred when the auditory and tactile stimuli were similar enough. In the second experiment, we tested whether the automatic auditory-tactile integration depends on simultaneity or whether a bias can be evoked when the auditory and tactile sequence are presented in temporal asynchrony. Audition significantly modulated tactile perception when the stimuli were presented simultaneously but this effect gradually disappeared when a temporal asynchrony was introduced between auditory and tactile stimuli. These results show that when provided with auditory and tactile sensory signals that are likely to be generated by the same stimulus, the central nervous system (CNS) tends to automatically integrate these signals.     

Spatial relation of the acetylcholinesterase-rich domain to the visual topography in the feline superior colliculus

Summary The superior colliculus (SC) of the cat shows a prominent compartmentalized organization at the level of its intermediate layers. The mosaic of these compartments is apparent in the pattern of acetylcholinesterase (AChE) staining. Patches of high AChE-activity are sharply set off from surrounding areas in the caudal SC while they are less distinct anteriorly. The rostral part lacks such obvious compartments. Thus, a structural reorganization apparently cuts across the topographical representations spread out in the SC. In order to test if this compartmental gradient relates to the topographic maps of the colliculus, retinotopic landmarks were visualized in the superficial layers by labeling the retinotectal pathway. In the SC ipsilateral to the eye injected with horseradish peroxidase (HRP) a paucity of labeling indicated the zone representing the ipsilateral visual half-field. Serial reconstructions of collicular sections, cut longitudinally or tangentially, revealed that the non-compartmentalized part of the intermediate layers corresponds to the representation of the ipsilateral visual half-field in the layers above, while an intricate mosaic array of compartments prevail in tectal zones related to the representation of the contralateral visual half-field.     

2021年ACOG关于产后阶梯式多模式药物镇痛的建议及要点解读

产后疼痛是困扰产妇的常见问题,如治疗不当可能会导致阿片类药物滥用、产后抑郁和疼痛长期存在等不良后果。因此,美国妇产科医师学会（American College of Obstetricians and Gynecologists,ACOG）于2021年9月提出了针对产后疼痛的临床共识,专门对产后疼痛的一般管理、阴道分娩、剖宫产术后、母乳喂养时及出院后疼痛的处置给出了治疗建议与指导,强调了阶梯式多模式药物镇痛方法与个体化用药原则。推荐临床用药可遵循“非阿片类镇痛药（如对乙酰氨基酚和非甾体抗炎药）—弱阿片类药物—强阿片类药物（必要时）”阶梯式给药原则,并可合理联合用药。对此进行简要介绍与要点解读。     

Esofaguectomía «tubeless»: menos es más

The esophageal cancer surgery is a complex procedure with elevated rates of both morbidity and mortality, which is why, in order to achieve adequate results, it should be performed in high volume centers, where complete multidisciplinary support is available and recent clinical guidelines are applied. We describe the initial experience and the technique of “tubeless” esophagectomy where esophageal resection and mediastinal lymphadenectomy are performed and no drains nor tubes of any kind are placed, with the aim to decrease the level of surgical aggression, enhance the postoperative comfort and accelerate the patient?s recovery.     

HBV相关肝硬化结节的多模态超声诊断价值

目的采用多模态超声对HBV相关肝硬化背景内结节进行评估并分类。方法选取2013年10月~2016年10月于浙江中医药大学附属杭州市西溪医院就诊的HBV相关性肝硬化患者200例,其中病理诊断为增生结节(RN)者51例,不典型增生结节(DN)者57例,其中低级别不典型增生结节(LGDN)27例,高级别不典型增生结节(HGDN)30例,肝细胞肝癌(HCC)为17例,均行多模态二维超声、彩色多普勒、超声造影检查,对比不同病理类型的结节多模态超声特征性表现,进一步将肝硬化背景肝内结节分为Ⅰ、Ⅱ、Ⅲ、Ⅳ4类。采用χ~2检验比较不同大小、超声造影不同增强模式肝硬化背景肝内DN及HCC检出率的差异。结果直径2.0~3.0 cm结节25个,均为HCC与DN;直径1.0~2.0 cm结节94个,4个为HCC,24个为HGDN;直径1.0 cm结节6个,全部为RN;不同大小肝硬化背景肝内结节HCC与DN检出率差异有统计学意义(P0.05)。RN结节主要以"等进等出"增强模式为主,LGDN主要以"慢进等出"增强模式为主,HGDN及HCC主要以"快进快出"增强模式为主,不同组间不同的增强模式差异有统计学意义(P0.05);而HCC与HGDN在造影剂进入时间、达峰时间、流出时间上差异有统计学意义(P0.05),Ⅲ类、Ⅳ类结节在DN及HCC检出率上差异有统计学意义(P0.05)。结论多模态超声对于HBV相关肝硬化肝内结节进行评估、分类,对于HGDN及HCC早期诊断有一定帮助。