2018年·第98卷第45期

In 2018, the Neurocritical Care Collaboration Group of the Neurology Branch of the Chinese Medical Association and the Neurocritical Care Professional Committee of the Neurologist Branch of the Chinese Medical Doctor Association launched the "Chinese Expert Consensus on Monitoring and Treatment of Intracranial Hypertension"^[1]。 The purpose of the launch is to keep pace with the times and change the unchanging intracranial pressure monitoring and treatment mode; Optimizing the imperfect intracranial pressure monitoring and treatment plan; Make more neurologists, emergency physicians and critical care physicians have clear goals, appropriate measures and perfect.

Today, sepsis is still one of the most important fatal diseases in critically ill patients. Every year, there are about 31 million confirmed cases worldwide, and its in-hospital mortality rate is as high as 30%. The definition of sepsis has been updated three times. In 2016, the American Society of Critical Care Medicine and the European Society of Critical Care proposed the latest definition of sepsis, that is, life-threatening multiple organ dysfunction caused by the host response to infection-induced dysfunction. Accordingly, the diagnosis of sepsis must have three elements: first, there is infection; Second, the host response to infection is dysregulated; Third, abnormal responses lead to multiple organ dysfunction. It can be seen that the pathogenesis of sepsis includes the imbalance of body response including immune dysfunction: from extensive activation to excessive inflammation, and finally into a systemic suppression state, that is, from "controllable" to "out of control" and finally to "failure" evolution process. Correspondingly, the prevention and treatment of sepsis involves many measures: actively treating the primary disease, effectively controlling infection, protecting and maintaining important organ functions, immune regulation, etc. Although anti-infective treatment, intensive care and organ protection measures have significantly reduced the in-hospital mortality of sepsis patients, the improvement of their long-term prognosis is still a difficult problem; Immunomodulation may be an effective way to benefit sepsis patients in the long term. autophagy is an inherent metabolic and adaptive regulatory mechanism of eukaryotic cells, and its effects in the immune system have been the focus of recent attention. Many observations have shown that autophagy in sepsis has protective effects on the immune, respiratory, circulatory, digestive and coagulation systems of the body, and is one of the important targets of immunomodulation strategies, which is expected to open up a new way for the prevention and treatment of sepsis.

Alzheimer's disease (AD), commonly known as Alzheimer's disease, is a neurodegenerative disease that seriously endangers the physical and mental health of the elderly. With the progress of population aging in China, the incidence of this disease is increasing year by year. According to statistics, the prevalence of AD among the elderly over 65 years old in China is 3.21%^[1]It has become one of the main diseases that seriously endanger the health of the elderly and affect the sustainable development of society. Therefore, it is very urgent and important to explore the pathogenesis of this disease and seek possible prevention and treatment means and measures.

Increased intracranial pressure (ICP) can cause serious adverse consequences, and is common in brain diseases such as craniocerebral trauma, intracranial infection, cerebrovascular disease and brain tumor. The neurocritical care unit (NCU) treated most patients with acute severe brain injury, refractory intracranial hypertension (ICP>20 mmHg, 1 mmHg =0.133 kPa), and the proportion of standard treatment failed accounted for about 20%^[1]The mortality rate is as high as 80% ~100%^[2]。 Therefore, accurately monitoring the changes of intracranial pressure, reasonably confirming the intervention boundary value of intracranial pressure, and effectively controlling intracranial pressure become the key to reduce the mortality rate and improve the prognosis of neurological function. To this end, the Neurocritical Care Collaboration Group of Neurology Branch of Chinese Medical Association and the Neurocritical Care Professional Committee of Neurologist Branch of Chinese Medical Doctors Association launched the Chinese Expert Consensus on Monitoring and Treatment of Intracranial Pressure Increase.

knee osteoarthritis (KOA) is a chronic degenerative bone and joint disease. The prevalence of symptomatic KOA among middle-aged and elderly people in China is 8.1%^[1]And there is a rising trend. The disease seriously affects the quality of life of patients and has a certain disability rate, which causes a huge burden on society and economy. Traditional Chinese and Western medicine have their own advantages in the diagnosis and treatment of KOA. In order to clarify the role of integrated Chinese and Western medicine in the diagnosis and treatment of KOA and improve the diagnosis and treatment level of integrated Chinese and Western medicine, the Professional Committee of Orthopaedics and Traumatology of Chinese Society of Integrated Chinese and Western Medicine organized experts to formulate this guide after many discussions according to the latest progress in the diagnosis and treatment of KOA in recent years, with reference to domestic and foreign guidelines and the latest evidence-based medical evidence, combined with clinical experience. This guide is for academic guidance only, and should be implemented in conjunction with the specific circumstances of patients and medical treatment. Refer to the relevant product instructions before taking various preventive and therapeutic measures.

Image-guided percutaneous biopsy is a common method for sampling small samples of pulmonary lesions, and it is of great value in the diagnosis of pulmonary diseases. At present, clinical imaging guidance methods include conventional computed-tomography (CT) guidance, CT fluoroscopy guidance, C-arm CT guidance, ultrasound guidance, fluoroscopy guidance, conventional magnetic resonance imaging (MRI) guidance, magnetic resonance fluoroscopy guidance, etc. Each of the above guidance methods has its own advantages and disadvantages, among which conventional CT guidance is the most widely used^{[1,2,3,4,5,6,7,8,9,10,11]}。 In recent years, high-field magnetic resonance imaging has been gradually applied to the imaging diagnosis of lung lesions and guided percutaneous biopsy. This technique has the advantages of good soft tissue resolution, vascular emptying effect, multi-parameter and multi-sequence imaging, functional imaging, arbitrary plane imaging, allowing flexible needle insertion path design and no ionizing radiation, but also has the disadvantages of low spatial resolution and long imaging time^{[12,13,14,15,16,17,18,19,20,21]}。 High Field Intensity MRI Guided Puncture Biopsy of Pulmonary Lesions with High Diagnostic Accuracy and Low Probability of Complications^[21,22]This technique, as a guiding means without ionizing radiation and with good soft tissue resolution, can play an important role in percutaneous puncture biopsy of lung lesions.

Initial CD4^＋T cells can differentiate into different helper T cell subsets according to the action of different transcription factors and cytokines. CD4^＋CD25^＋CD127^{dim/ -}Regulatory T cells (Tregs) highly express the transcription factor FoxP3, which inhibits the immune response mainly through the secretion of interleukin (IL) -10 and IL-35; Th17 cells express retinoic acid-associated solitary nuclear receptor γ T (still rare, ROR γ T), which can secrete IL-17 and IL-22 to promote inflammatory response^[1]。 Tregs and Th17 cell imbalance in patients with coronary heart disease^[2], Notch signaling pathway in hepatitis C^[3]immune thrombocytopenia^[4]Asthma, etc.^[5]It can regulate the imbalance of Tregs and Th17 cells in disease, but the study of this regulatory effect in coronary heart disease is rare. Therefore, we observed the effect of Notch signaling pathway on the proportion and function of Tregs and Th17 cells in patients with coronary heart disease, aiming to explore the role of this regulatory process in coronary heart disease.

Total artificial knee arthroplasty (TKA) relieves pain, joint deformities and improves quality of life caused by end-stage knee osteoarthritis (KOA). The surgical technique and perioperative management of TKA have become mature^[1,2]The artificial knee joint prosthesis is also increasingly improved in terms of material science and prosthesis design. In terms of the service life of the prosthesis, 90% to 95% of patients can use it for more than 20 years^[3,4]Thus, it is called one of the most successful procedures in orthopedic orthopedics. However, although the surgical technique of TKA has become more mature and standardized, as well as good perioperative management and postoperative rehabilitation guidance, a considerable number of patients have not achieved postoperative satisfaction^[5]And even reported dissatisfaction rate of 28.3%^[6]。 Among them, some patients failed to achieve the purpose of relieving pain, improving function and improving quality of life after surgery, and some patients had unknown reasons. The study found that this may be related to the psychological state of patients^[7]。 This article mainly summarizes the relationship between psychological state and satisfaction during perioperative period of TKA and the research status of psychological intervention, and discusses the influence of psychological factors on the postoperative effect of TKA, so as to enhance the emphasis of orthopedic surgeons on the psychological state of patients and improve the postoperative satisfaction of patients.

Glioma is the most common and aggressive primary malignant tumor in the central nervous system. It has the characteristics of high recurrence rate, short survival time and poor effect of conventional treatment. The classical theory suggests that the high heterogeneity of glioma cells is highly correlated with the malignant characteristics of the tumor^[1]。 The immune system also plays an important role in different stages of tumor development. It was found that the changes of glucose metabolism in tumor environment are highly correlated with the occurrence and progression of tumor. Global metabolic analysis has confirmed that the metabolic remodeling of tumor cells can promote the progression of glioma, and metabolic changes play an important role in immune regulation^[2]。 Application of metabolic-related node inhibitors can eliminate tumor-mediated immunosuppression and significantly improve the clinical prognosis of patients^[3]。 The correlation between glioma metabolic remodeling and tumor immunosuppression is reviewed as follows.