2015年 · 第95卷第25期

Treatment is actually a process of intervention according to the condition. The intervention itself can not only have a therapeutic effect on the disease, but also lead to re-injury to the body. In order to highlight the therapeutic effect and reduce the re-injury effect in the intervention process, the intervention must be strictly limited. The accuracy of intervention is mainly determined by the direction, extent and timing of intervention. The treatment of severe cases is often characterized by complicated and concentrated clinical manifestations, hidden intervention sites, drastic intervention degree and rapid changes in disease conditions, which leads to almost strict requirements for severe treatment. The clinical application of hemodynamics can provide a complete interpretation of the precise treatment of severe cases. Severe hemodynamic therapy is a goal-oriented quantitative treatment process based on hemodynamic theory and according to the real-time state and response of the body. Clinical hemodynamics takes the characteristics and regularity of blood and its components in the body as the starting point, and realizes the monitoring of severe cases by discovering and analyzing the mechanism of disease and finding the changes of disease in real time. Through the quantitative grasp of disease changes, the analysis of intervention responsiveness and the regulation of intervention methods, the treatment of severe cases is realized. In severe hemodynamic therapy, the direction of treatment is determined by purpose indicators, and the degree of treatment is defined by target indicators, so as to achieve strict control of the whole intervention process. At the same time, through the real-time judgment of the disease condition, each step in the treatment process is as close to the actual needs of the body as possible. In recent years, the development of hemodynamic theory and clinical operation technology has further enhanced the clinical necessity and feasibility of severe hemodynamic treatment. In the foreseeable time, ten areas of development should be of concern.

The patient was a 57-year-old male. Radiation pain in the left lower limb for more than 4 years, which has aggravated in the last 4 months and was admitted to Beijing Hospital. More than 4 years ago, the patient had left lower limb pain without obvious trigger, and the pain had no obvious temporal change, and there was no obvious way to relieve it. Physical examination: the ankle reflex of the left leg is weaker than that of the right leg, the pain in the tibial side of the left leg is more sensitive than that in the fibular side, spinous process tenderness (+), paravertebral percussion pain (+), Babinski (-), Chaddock (-). On March 12, 2010, CT (plain scan plus enhancement) in an outside hospital considered the possibility of left psoas major schwannoma. On April 26, 2010, plain MRI scan in Beijing Hospital showed the left side nodule of the lumbar 2 vertebral body.₁The nodules on WI and lipid pressure images showed high and low signal (FIG. 1A，FIG. 1B), T₂High and low mixed signals were shown on WI and lipid pressure images, and patchy hyperintensity shadows were seen in the surrounding soft tissues (FIG. 2A，Figure 2B), with non-uniform mild enhancement after enhancement scan (FIG. 3A，FIG. 3B), the edges are underfinished. Surgical findings: The space between the multifidus muscle and the longissimus pectoralis muscle was separated, and the lumbar 2 transverse processes were disconnected and drawn laterally, revealing the tumor capsule, which was gray-white, tough in texture, with clear boundaries, and abundant tumor bleeding. Pathological findings: (L2 paravertebral space occupied) there was hemorrhage and a large amount of hemosiderin deposition, and a large number of plasma cells and lymphocytes were seen locally (FIG. 4A，FIG. 4B)。 Pathological diagnosis: epithelioid hemangioendothelioma. Immunohistochemistry: VM (+ +), S-100 (-), Desmin (-), CD34 (+), Bcl-2 (-), ALK (-), Ki-67 (1% +), Actin Ping (+).

With the continuous improvement of arthroscopic instruments and the gradual proficiency of doctors' operation techniques, arthroscopic repair of rotator cuff injury has been widely used. Although arthroscopic repair of rotator cuff injury significantly reduces pain and improves shoulder function, previous studies have shown that the postoperative rotator cuff re-tearing rate is still around 11% to 29%^[1,2]。 Therefore, how to reduce the postoperative re-tear rate is still a serious problem faced by sports injury doctors. Platelet-rich plasma (PRP) has attracted the attention of many researchers because it contains a large number of growth factors that promote tissue repair, including platelet-like growth factor (PDGF), transforming growth factor (TGF), fibroblast growth factor (FGF), vascular endothelial growth factor (VEGF) and epithelial growth factor (EGF). According to the different preparation methods of PRP and the content of white blood cells and fibrin, PRP can be divided into many types. At present, the more accepted Dohan classification method^[3,4]PRP was divided into the following four categories: pure PRP (pure P-PRP), leukocyte-rich platelet plasma (L-PRP), pure platelet-rich fibrin (P-PRF) and leukocyte-rich platelet fibrin (L-PRF). PRP has been widely used in damage repair of various tissues^[5,6,7]。 Theoretically, PRP can promote the repair of rotator cuff injury. In recent years, a lot of researches have been carried out in the world on PRP repair of rotator cuff injury. Now, the latest basic, clinical and evidence-based medical evidence of PRP repair of rotator cuff injury in recent years are reviewed.

cerebral amyloid angiopathy (CAA) is a neurodegenerative disease characterized by the deposition of amyloid β (A β) in intracranial microvessels. In recent years, some studies have found that some patients with intracranial vascular A β deposition also have vascular inflammation, which is now commonly called cerebral amyloid angiopathy related inflammation (CAA-I). CAA-Ⅰ often manifests as acute or subacute cognitive decline, headache, epilepsy or focal neurological deficit, and responds well to immunosuppressive therapy^[1]At present, it is rarely reported in China. This article focuses on a systematic review of clinical manifestations, pathological characteristics, diagnosis and treatment of CAA-Ⅰ, aiming at improving clinicians' understanding of CAA-Ⅰ and reducing misdiagnosis or misdiagnosis.

relaxin is a polypeptide hormone that can relax pelvic ligaments originally extracted from pig serum by Hisaw et al., hence the name "relaxin". Relaxin plays an important role in human reproductive system and non-reproductive system. As a reproductive hormone, relaxin promotes endometrial decidualization in early pregnancy, assists embryo implantation and placental growth; Dilate peripheral blood vessels in the middle and late trimester of pregnancy, improve placental blood flow supply, and inhibit the contraction of uterine muscles during pregnancy to facilitate the maintenance of pregnancy; Relaxation of pelvic connective tissue at term pregnancy to facilitate delivery. Relaxin also works on other systems in the body. The physiological role of relaxin in the reproductive system and its relationship with disease are reviewed as follows.

With the improvement of medical technology, electrosurgical equipment, laser knife, ultrasonic scalpel and other tools are widely used in surgery, which makes modern medical work more convenient and effective, and also brings new health risk factors to medical staff, and surgical smoke is one of them. Operating room smoke refers to gaseous substances generated during surgery, also known as aerosols, burning smoke, diathermic plumes, etc. It is the destruction, ablation, and decomposition of tissue causing its fine particles to suspend in the air when using electrosurgical equipment (ESU), laser knife, high-frequency electrosurgical knife, or ultrasonic scalpel^[1]。 It is an air pollutant, and medical staff are exposed to harmful smoke for a long time due to work reasons, which is a serious threat to their health. According to the Occupational Safety and Health Administration (OSHA), up to 500,000 healthcare workers in the United States are exposed to operating room smoke each year, including surgeons, anesthesiologists, nurses and other staff. In order to improve the awareness of the hazards of surgical smoke and strengthen the protection against it, we investigated the situation of the awareness of surgical smoke and put forward suggestions for protection.