Sepsis

Sepsis is a clinical syndrome that requires prompt recognition and control in order to optimize clinical outcomes in patients. It is very relevant to surgical practice, as it can affect perioperative patients and those recovering on surgical wards. A working knowledge of sepsis is essential to any medical or surgical practitioner, and here we cover the topic with relevance to surgery and the MRCS examination.     

The Potential Role of Monocyte Chemoattractant Protein-1 for Major Depressive Disorder

The immune hypothesis of major depressive disorder (MDD) fits well with the supposed interaction between genetic and environmental factors in disorders with a complicated etiopathogenesis. It has been suggested that infectious diseases are associated with MDD in that cytokines may play a critical role as a key modulator in the transition between infection and the development of MDD. It has been also suggested that antidepressants have immunomodulatory effects on some cytokines and cytokine receptors, although the exact mechanism has not yet been fully elucidated. Among cytokines, monocyte chemoattractant protein-1 (MCP-1) is especially well known and has attracted considerable interest owing to its immunomodulatory functions. MCP-1 is expressed in highly regionalized neuronal areas in the brain, leading to kind of modulation of neuronal activity and neuroendocrine functions commonly seen in patients with MDD. Additionally, it is involved in the control of other cytokines that have been consistently proposed as associated with the development of MDD. It also has a possible role in the neurodegenerative process of a number of central nervous system (CNS) diseases. Hence, this paper draws from the perspective of immunology to offer several suggestions about the role of MPC-1 in the development of MDD.     

Neuropathies douloureuses et atteinte des petites fibres

It is customary to consider that a purely sensory and painful neuropathy accompanied by normal electroneuromyographic examination may be or must be a small fiber neuropathy. This leads to perform specific tests, such as measuring the intra-epidermal nerve fiber density on skin biopsy or neurophysiological tests, such as evoked potentials to noxious stimuli (laser) or quantification of thermal sensory thresholds. However, these tests are only sensitive to the loss of small fibers (A-delta and C), which does not reflect the mechanisms responsible for peripheral neuropathic pain. Selective loss of small sensory fibers inherently generates a sensory deficit that does not necessarily present a painful character. Also, assigning the cause of a painful neuropathy to a small fiber neuropathy has no pathophysiological sense, although there are indirect links between these two conditions. In fact, it is not possible to explain univocally peripheral neuropathic pain, which reflects complex and diverse mechanisms, involving different types of nerve fibers. In this context, the clinical and laboratory approach must be improved to better understand the underlying mechanisms. It is imperative to interpret the data provided by laboratory tests and to correlate these data to the clinical signs and symptoms presented by the patients. Thus, one must go beyond many a priori and misinterpretations that unfortunately exist in this area at present and are not based on any solid pathophysiological basis.     

脑小血管病病理生理机制研究进展

脑小血管病（cerebral small vessel disease,CSVD）是由于不同原因的脑小血管或微小血管发 生病理改变后导致的疾病,是临床上引起血管性认知功能障碍（vascular cognitive impairment,VCI）的 重要病因。充分认识CSVD的发生、发展,将为预防VCI提供可能。本文从脑小血管病的病理生理机制 的研究进展进行综述,以期为临床实践提供思路。     

The neurobiology of body dysmorphic disorder: A systematic review and theoretical model

There has been an increase in neuroimaging research in body dysmorphic disorder (BDD), yet little is known about the underlying neurobiological basis of the disorder. We aimed to provide a systematic overview of the literature on the neurobiology of BDD. Two reviewers undertook a search of three electronic research databases: PubMed, PsycINFO, and Google Scholar. The search consisted of synonyms commonly associated with BDD and methods to evaluate brain structure, function, and network organisation. Out of an initial yield of 175 articles, 19 fulfilled inclusion criteria and were reviewed. We identified differences in brain activity, structure, and connectivity in BDD participants in frontostriatal, limbic, and visual system regions when compared to healthy control and other clinical groups. We put forth a neurobiological model of BDD pathophysiology that involves wide-spread disorganisation in neural networks involved in cognitive control and the interpretation of visual and emotional information. This review considers how this model might aid in the development of future research and understanding of BDD.     

Mild parkinsonian features in dystonia: Literature review,mechanisms and clinical perspectives

Dystonia is a hyperkinetic movement disorder that can be highly stigmatizing and disabling. Substantial evidence from animal models, neuropathological, neurophysiological, neuroimaging and clinical studies emphasizes the role of dopaminergic dysfunction in the pathophysiology of dystonia, illustrating possible pathophysiological overlap with parkinsonism. Furthermore, basal ganglia dysfunction has been implicated in the pathogenesis of dystonia, and is well established to underlie the manifestations of Parkinson's disease. Clinically, parkinsonian features are a key characteristic of some combined dystonias, including dopa-responsive dystonia, and Parkinson's disease often presents with dystonia. Moreover, many treatments effective in Parkinson's disease, both medical and surgical, also offer some benefit in dystonia. Therefore, mild parkinsonian features might logically accompany idiopathic and inherited isolated dystonias. However, as the current literature is particularly scant, the present review aimed to investigate mild parkinsonism in idiopathic and inherited dystonia. We found limited evidence alluding to the presence of mildly reduced arm-swing, increased tone, and non-decremental bradykinesia in adult-onset focal dystonia. Tremor, with postures, action and rest, also occurs commonly in idiopathic isolated dystonia, and can simulate Parkinson's disease tremor and be a cause of ‘scans without evidence of dopaminergic deficit’. Parkinsonian features in monogenic isolated dystonias have been less well investigated, despite the potential benefit of correlating pathophysiological and clinical findings. The recognition and improved clinical characterization of parkinsonian features in idiopathic and inherited isolated dystonia extends the clinical spectrum of motor features in dystonia, which may help avoid incorrect diagnosis and inform therapeutic research.     

以问题为基础的学习在病理生理学教学中的应用

目的： 与传统的教学方法进行比较，探讨在本科生病理生理学教学中开展以问题为基础的学习（PBL）的必要性，并进一步探索在我国开展PBL教学的可能方法和途径。 方法： 在大学三年级本科生中抽取1个大班作为试验班，其余3个大班作为对照班，在试验班中采用全程PBL教学，将病理生理学教材内容重新整合并划分为6个单元，分别由3位指导教师承担不同单元的教学。每个单元相互独立，但又相互联系、交叉，均以1-2个病历为主要内容，每个病历中均隐藏着所涉及的学习要点的全部内容，学生通过小班讨论、自学、小组讨论、大班讨论以及教师总结等几个环节，归纳、总结出该单元的学习要点，以备进一步学习。在课程结束之后，在学生中进行问卷调查，同时采用PBL教学试验班和对照班期末考试考同一份卷的方法比较PBL教学和传统教学方式的主要差别。 结果： 采用PBL教学方式能够更好地调动学生的学习积极性，启发学生自主学习，并且在提高学生分析问题和解决问题的能力方面相对于传统的教学方式具有明显的优势。     

慢加急性肝衰竭病因及其病理生理机制研究进展

慢加急性肝衰竭(acute-on-chronic liver failure,ACLF)是国内最常见的肝衰竭类型,其临床表现复杂,病死率极高.ACLF的病理生理学改变目前尚不明确,深入了解ACLF的病理生理学改变有助于临床治疗工作的改善.近年来ACLF的病理生理学研究取得了一定的成就.本文就ACLF的概念、病因及其病理生理学改变作一综述.     

Prevalence and pathophysiology of early dumping in patients after primary Roux-en-Y gastric bypass during a mixed-meal tolerance test

Background

Early dumping is a poorly defined and incompletely understood complication after Roux-en-Y gastric (RYGB).