2014年 · 第94卷第23期

Refractory hypertension usually refers to lifestyle adjustments based on the use of optimal doses of three different classes of antihypertensive drugs including diuretics, but blood pressure still fails to reach the standard^[1]。 Estimates of the prevalence of patients with truly refractory hypertension based on the above criteria vary greatly among different populations. Overall, 5% to 10% of hypertensive patients receiving standardized treatment meet the defining criteria of refractory hypertension. So far, the treatment of refractory hypertension has focused on antihypertensive drugs blocking various mechanisms that may lead to increased blood pressure, including the use of low-dose spironolactone as a fourth-line treatment. However, these measures are still difficult to solve some refractory hypertension. In recent years, percutaneous catheter-based renal denervation (RDN) has brought new promise to patients with refractory hypertension. The basic principle is to release energy through the radiofrequency catheter inserted into the renal artery, and selectively destroy the renal sympathetic nerve fibers of the adventitia through the intima and media of the renal artery, thus reducing the activity of renal sympathetic nerves and blocking the excessive excitation of sympathetic nerves in maintaining hypertension, especially refractory hypertension. A proof-of-principle study (Symplicity HTN-1)^[2]and a subsequent randomized efficacy study (Symplicity HTN-2)^[3]and meta-analyses^[4]It indicated that percutaneous catheter-based renal denervation had a significant effect of reducing blood pressure in the clinic. Since the publication of the results of the Symplicity HTN-2 trial, the news media, the medical community, medical device manufacturers and the majority of hypertensive patients are full of expectations for the future of this technology.

The differences in valgus were related to age, gender, shoe-wearing habits, genetics and other factors. It can occur at any age, and the incidence rate increases with the increase of age. The incidence of female is much higher than that of male, and the ratio of male to female can reach 1:40^[1]And often associated with lateral, especially metastatic ostealgia of the 2nd and 3rd metatarsal heads. The main clinical manifestations were deformity and pain of the forefoot, pain under the lateral metatarsal head with corpus callosum formation, which was aggravated when walking.Because of its complexity, valgus makes it impossible to have a single surgical approach to treat allThere are many surgical methods for valgus deformity. According to the literature reports, there are more than 130 kinds^[2]。 We summarized the past experience, referred to various surgical methods at home and abroad, combined with actual clinical work, selected modified Scarf osteotomy combined with lateral metatarsal head shortening osteotomyPatients with valgus combined with metastatic bone pain of the 2nd and 3rd metatarsal heads.

angiocentric glioma (AG) is a benign solid brain tumor associated with refractory epilepsy discovered in recent years. It was included in the WHO classification of neurological tumors in 2007 and specifically described^[1]。 This disease is rare, and epilepsy is mostly the first and main symptom in clinic, and most drugs are difficult to control. Through Pubmed database search, there are 65 cases of AG described in detail in foreign literature at present, while less than 10 cases have been reported in China. The clinical, imaging features and pathological manifestations of AG are reviewed systematically in order to improve the awareness and attention of relevant doctors and avoid misdiagnosis or misdiagnosis.

The mortality rate of acute respiratory distress syndrome (ARDS) is still above 41%^[1]。 The damage of pulmonary capillary endothelium plays an important role in the development of ARDS. Therefore, maintaining the structure and function of endothelial cells is the key to the treatment of ARDS. Endothelial cell surface polysaccharide coating layer (EGL) is a highly hydrated membrane structure covering the surface of vascular endothelial cells formed by interconnecting various macromolecular substances. Polysaccharide coating Because it is a "sugar coating" on the surface of vascular endothelial cells, Bennet^[2]It is named "polysaccharide coating". It was found that polysaccharide coating plays an important role in maintaining the structure and function of vascular endothelial cells, regulating capillary permeability, and participating in systemic inflammatory response^[3,4]。 Polysaccharide coating is the first protective layer of vascular endothelial cells, and maintaining the intact performance of polysaccharide coating reduces the occurrence of ARDS and prevents its further progression. This provides another new target and new direction for the treatment of ARDS.

Case 1, a 25-year-old female, was admitted to the hospital due to "confused speech for more than half a month, accompanied by fever for 3 days". The patient had intermittent speech confusion, abnormal behavior and insomnia half a month ago. He had visited a psychiatric hospital and was considered "schizophrenia". He was treated with risperidone for 1 week. After the symptoms did not improve, he stopped taking the drug on his own. Three days before admission, there was disturbance of consciousness and increased body temperature, up to 39.2 ℃, and there was no cough, sputum, nausea and vomiting. Physical examination on admission: confusion, mutism, pupils of equal size, sensitivity to light. Sign of meningeal irritation was positive, muscle tone of limbs increased, tendon hyperreflex, involuntary tremor, and the pathological sign was not drawn out. Auxiliary examination: white blood cells 16.96×10⁹/L, serum potassium 3.6 mmol/L, serum sodium 157.0 mmol/L, blood chloride 119.0 mmol/L, mild abnormal liver and kidney function, urine and stool routine, ten items of immunity, twelve items of antinuclear antibody and tumor, blood Torch series, etc. No abnormalities were found. Cerebrospinal fluid pressure, routine and biochemistry were normal, and cranial MRI showed patchy slightly long T in the corpus callosum pressure area₁, T₂Signal and FLAIR High Signal (Figure 1), EEG mild-moderate abnormalities. Consider viral encephalitis, after active salt restriction, antiviral and symptomatic rehydration treatment. After 1 week, the patient's consciousness gradually became clear, the body temperature was normal, the meningeal irritation sign was negative, and the blood white blood cells were 6.83×10 after re-examination⁹/L, blood sodium 134.5 mmol/L, blood chloride 97.4 mmol/L, EEG normal. After 2 weeks, his condition was stable and he could get out of bed. Because the patient had always had delusions of persecution, he was transferred to a psychiatric hospital for treatment. One month later, the MRI lesions of the head disappeared after re-examination in another hospital.