2015年 · 第95卷第39期

Albumin is the most important protein for maintaining colloid osmotic pressure in plasma^[1]。 As a carrier for transporting a variety of endogenous and exogenous components, albumin also has anti-oxidant, anti-inflammatory and buffering acid-base balance disorders properties^[2,3]。 The choice between crystalline solution (e.g. saline) or plasma albumin for fluid resuscitation in critically ill patients has long been debated^[4,5,6]。 It is believed that supplementing albumin to the normal range for patients with hypoalbuminemia is the correct treatment, just as they need to eat to satisfy their hunger when they are hungry. But there are also opposing views that dispute this.

A 21-year-old female was admitted to Drum Tower Hospital affiliated to Nanjing University School of Medicine for more than 7 months due to physical examination of left ovarian mass. In July 2014, the patient detected a slightly stronger echoic mass in the left adnexal area, with a size of 68 mm ×50 mm ×19 mm, and considered the possibility of teratoma. Blood CA125 and other tumor markers were normal. Past menstrual rules. Physical examination: Flat and soft abdomen without tenderness, rebound pain and muscle tension, sign of ascites (–). Gynecological examination: vulva unmarried, uterus median, normal size. No obvious abnormalities were observed in the right adnexal area; A 6 cm ×5 cm mass was palpable in the left adnexal area with good mobility and no tenderness. Preoperative diagnosis: The nature of left ovarian mass is to be investigated. The patient underwent laparoscopic ovarian mass excision under general anesthesia on 4 February 2015. There were no abnormalities in uterus, right ovary and bilateral fallopian tubes during the operation; The left adnexal area was cystically enlarged (6 cm ×5 cm ×5 cm), the surface was smooth and blue-purple, and the cyst adhered to the surrounding membrane. After resection, it was sent to pathology for examination, and the postoperative recovery was good. Gross examination: A pile of gray-red broken tissue, with a total size of 6 cm ×6 cm ×3 cm, with dark red-gray-white cut surface, and some areas showed sponge-like and honeycomb-like changes. Under the microscope: the mass submitted for examination is composed of large pieces of differentiated and mature dilated thin-walled blood vessels, with lumens of varying sizes and anastomosis with each other (Figure 1), part of the lumen is filled with red blood cells, and thrombi can be seen, and some areas of the lumen can see a few abnormal spindle cells and collagenization of the tube wall. The inner wall of the lumen was covered with a single layer of flat endothelial cells, and the cells had no atypia (Figure 2)。 A small amount of ovarian tissue was seen in the tissue submitted for examination. Pathological diagnosis: The vascular structure showed tumor-like hyperplasia in the intraoperative rapid frozen section, and the cells had no obvious atypia, suggesting that there was no clear malignant basis, so the patient only underwent mass resection. The postoperative pathological diagnosis was: ovarian cavernous hemangioma with partial tumor degeneration and collagenization. Immunohistochemistry: Lumen endothelial cells expressed CD31 (+) (Figure 3), CD34 (+) (Figure 4), CR (-), CK (-), D2-40 (-), inhibin α (-), Desmin (-), Actin (-), Ki-67 about 1% (+).

The rise of 3D printing (three-dimensional printing) technology has brought great impact and changes to traditional manufacturing, medical, cultural and creative industries, aerospace and other industries. Among them, the research of 3D printing technology in the medical field is even more eye-catching, which has set off the development upsurge of 3D printing technology in this field at home and abroad^[1]。 Neurosurgery is one of the most challenging departments in the medical field. Because of the complex anatomical structure, fine functions and complex diseases of the nervous system, it brings great challenges and difficulties to neurosurgeons, and also brings great hidden dangers to medical safety. In recent years, 3D printing technology has made rapid development in the field of neurosurgery. The research status and application prospects of 3D printing technology in the field of neurosurgery are summarized as follows.

Severe burn, trauma and major surgical stress can easily induce sepsis, and further development can lead to septic shock and multiple organ dysfunction syndrome (MODS), which is one of the most important causes of death in clinical burn, trauma and critical patients^[1]。 Although early fluid resuscitation, anti-infective therapy, nutritional metabolism and vital organ-assisted supportive therapy have made great progress, the mortality rate of sepsis has remained high because the exact etiology and pathogenesis of sepsis are still unclear. In recent years, trypsin inhibitors represented by ulinastatin (UTI) have been widely used in the clinical treatment of sepsis, and their efficacy has gradually been affirmed. Previous studies on UTI mainly focused on inhibiting protease hydrolysis, oxidative stress and anti-inflammatory aspects, but these data do not fully explain its effect in the clinical treatment of sepsis. Therefore, it is of great significance to analyze and discuss the exact role and intervention mechanism of UTI in cytoprotection in critical state for further understanding the pathogenesis of sepsis and the development of targeted drugs.