Central venous pressure and pulmonary artery pressure monitoring

Stroke volume is a key determinate of cardiac output. It is affected by the preload, contractility and afterload of the myocardium. It is possible to gain insight into the right and left ventricular preload following the insertion of a central venous catheter and pulmonary artery catheter to measure central venous pressure and pulmonary capillary wedge pressure, respectively. Abnormal measurements can indicate a pathophysiological state and guide management.     

基于SEER数据库的原发性中枢神经系统淋巴瘤不同治疗方法的疗效分析

目的探讨原发性中枢神经系统淋巴瘤(PCNSL)患者的预后因素及不同治疗方法的临床效果。方法回顾性分析1975年1月至2016年12月美国SEER数据库中4812例PCNSL患者的临床资料。其中男性2831例,女性1981例,男女比例为1.4∶1.0;发病年龄<60岁者2236例(46.47%),60~<75岁者1718例(35.70%),≥75岁者858例(17.83%);幕上肿瘤2417例(50.23%),幕下肿瘤299例(6.21%),脑内多发肿瘤554例(11.51%),其他或未指明部位的脑部肿瘤1542例(32.04%);弥漫大B细胞淋巴瘤(DLBCL)3513例(73.00%),非DLBCL 234例(4.86%),其他或未指明类型的淋巴瘤1065例(22.13%);治疗方式为单独活检的2010例(41.77%),单独部分切除61例(1.27%),单独完全切除54例(1.12%),活检+化疗2384例(49.54%),部分切除+化疗159例(3.30%),完全切除+化疗144例(2.99%)。采用单因素及多因素Cox回归模型分析影响患者总体生存的预后因素;采用Fine-Gray检验与竞争风险模型研究影响患者肿瘤特异性生存的预后因素;生存分析采用Kaplan-Meier法,并通过Log-rank进行比较。结果单因素及多因素Cox风险回归模型分析结果显示,影响PCNSL患者总体生存的独立预后因素包括年龄、种族、婚姻状态、肿瘤部位、病理学亚型、手术、化疗、合并其他恶性肿瘤、合并HIV感染等。Fine-Gray检验与竞争风险模型分析结果显示,影响患者肿瘤特异生存的独立预后因素包括年龄、种族、婚姻状态、肿瘤部位、病理学亚型、手术方式、化疗、合并其他恶性肿瘤、合并HIV感染,而性别与放疗均与肿瘤特异生存无明显相关性。与活检相比,PCNSL患者可能从手术切除中获益(部分切除:HR=0.805,95%CI:0.656~0.989,P=0.04;完全切除:HR=0.521,95%CI:0.414~0.656,P<0.01)。Kaplan-Meier生存分析结果显示,活检+化疗组中位生存时间为28个月(95%CI:24.497~31.503),单独活检组为2个月(95%CI:1.756~2.244),单独部分切除组为2个月(95%CI:1.410~2.590),单独完全切除组为19个月(95%CI:0~39.311),部分切除+化疗组为67个月(95%CI:46.187~87.813),完全切除+化疗组为84个月(95%CI:57.448~110.552),使用不同治疗方法的患者的中位生存时间的差异有统计学意义(P<0.01)。结论手术切除可能改善部分PCNSL患者的预后。化疗可能使肿瘤完全切除或部分切除患者的肿瘤特异生存时间延长。     

腹腔镜肝切除术中控制性低中心静脉压技术实施要点与意外处理

控制性低中心静脉压（CLCVP）技术的合理实施,可减少腹腔镜肝切除术中出血、提供清晰手术视野、促进病损精准切除、实现病人术后加速康复,因此,近年来在临床上逐渐得到广泛应用。然而,这项技术有一定难度,若实施不当可能导致病人器官功能受损;因此,对麻醉医生的临床能力提出了较高要求。CLCVP技术的合理实施,首先应严格掌握其适应证、禁忌证;其次需在完善的“麻醉镇痛、镇静和抗应激”基础上进行限制性补液,同时辅以输注心血管活性药物、调节手术体位、优化通气等治疗措施;最后应确保过程中病人循环功能稳定、重要器官灌注正常。CLCVP技术实施过程中可能发生CO2气栓、低氧血症、酸中毒和以急性肾功能损伤为代表的器官功能损害等意外事件,影响手术进行和病人预后。因此,围手术期应对可能的并发症进行积极预防、动态管理、及时处理。麻醉科医师在掌握上述实施要点和意外防治方法的前提下,通过不断实践、合理运用CLCVP技术,可为腹腔镜肝切除术提供良好手术条件,协助术者微创、精准切除肝脏病损,同时保障病人安全、促进快速康复。     

Uterine physiology

The role of the uterus is to nurture the fetus until delivery. It is composed of the fundus, body and cervix. Functionally, the uterus is largely under hormonal control and undergoes significant change throughout pregnancy. At parturition a shift in the balance of hormones causes cervical remodelling and uterine contraction, leading to ejection of the fetus. A number of medicines impact uterine function and can be used to both induce or prevent labour.     

Concomitant dysregulation of androgen secretion and dysfunction of adipose tissue induced insulin resistance

Hyperandrogenism and hyperinsulinemia have resulted from dysfunction of the theca cell of the ovary and adipose tissue and each one potentiates the other in patients with androgen excess disorders e.g., polycystic ovary disease and idiopathic hirsutism. Possible external and/or internal triggers can produce such cellular dysfunction. There is evidence that sodium valproate acts as a trigger of cellular dysfunction and produces both hyperinsulinemia and hyperandrogenism. Therefore, the elimination of these triggers can help the patients to recover from hyperinsulinemia, insulin resistance and hyperandrogenism.     

The effect of vitamin A deficiency during pregnancy on anorectal malformations

Objective

The aim of this study was to study the effect of vitamin A deficiency (VAD) on the embryological development of anorectal malformations (ARMs) and the enteric nervous system.

Materials and Methods

Female Sprague-Dawley rats were divided into 3 groups: VAD group, normal group (negative control), and ethylene thiourea (ETU) group (positive control) with a normal diet. On day 20 of pregnancy, cesarean section was performed on all rats. The incidence of ARMs in the fetal rats and Protein gene product 9.5 (PGP9.5) and S-100 protein expression by immunohistochemistry were determined.

Results

The incidence of ARMs in VAD and ETU groups was 64.8% (59/91) and 45.9% (61/133), respectively (P > .05). Anorectal malformations were not found in the normal group. Protein gene product 9.5 and S-100 protein expression in the non-ARM rectums of the VAD group was lower than the ETU (P = .0156 vs P = .0105) and normal groups (P = .0091 vs P = .0024). There was no significant difference in PGP9.5 and S-100 protein expression between ETU and normal groups. In the ARM rectums, PGP9.5 and S-100 protein expression in the VAD group was lower than the ETU group (P < .0001). Protein gene product 9.5 and S-100 protein expression was also lower in ARM than non-ARM rectums in the VAD and ETU groups (P < .0001, P = .0203, and P = .0122, respectively).

Conclusion

Vitamin A deficiency during pregnancy may result in the embryological development of ARMs. Enteric nervous system development may be related to ARMs.     

Rosai-Dorfman disease mimicking meningiomatosis: a case report

Rosai-Dorfman disease (RDD), also known as sinus histocytosis with massive lymphadenopathy, is a rare idiopathic histioproliferative disease affecting the lymph nodes. Although extranodal involvement has been reported in diverse sites, central nervous system manifestations, particularly in the absence of nodal disease with clinical and radiological findings suggestive of meningioma, are extremely rare. Histopathology and immunohistochemistry are essential for a positive diagnosis. We report a case of RDD in a patient presenting multiple meningeal nodules with a review of the literature and discussion of differential diagnosis.     

发热的神经通路

发热是在宿主中枢神经协调下的对周身感染的适应性反应。近期对发热产生机制（尤其足导致发热的神经解剖通路）的研究取得了很大进展。在本文中,我们简要陈述目前对中枢神经对周边感染的监测机制的认识,以及E2类前列腺素及其受体在发热中的作用：着重阐述了发热产生的神经通路,尤其是这一通路与E2类前列腺素受体在中枢神经内的相互分布关系。最后,我们展示了一个发热产生的神经化学模型,并指出未来研究工作的方向。     

Urinary dysfunction and autonomic control in amyloid neuropathy

Abstract Uro-neurological assessment was performed in four patients with small-fiber neuropathy due to amyloidosis (2 transthyretin-type/2 immunoglobulin light-chain-type). Voiding difficulties were due to detrusor weakness and impaired bladder sensation. In two patients cholinesterase inhibition treatment caused urge incontinence, indicating detrusor denervation supersensitivity. The underlying mechanisms of urinary dysfunction seem to involve postganglionic cholinergic and afferent somatic nerves.