2016年 · 第96卷第37期

Dementia is a clinical syndrome characterized by cognitive impairment, and Alzheimer's disease (AD) is the most common cause of dementia, accounting for 60% to 80%. The prevalence rate of dementia in China is 7.2%, which is higher than the global average of 6.2%. The total number of dementia is 15 million, accounting for 1/4 of the world. Among them, AD exceeds 10 million, which is equal to the total number of dementia in developed countries in the world. The prevalence rate increases with age. The prevalence rate is 4% under 65 years old, 15% between 65 and 74 years old, 44% between 75 and 84 years old, and 58% over 85 years old. The prevention and treatment situation is very severe^[1]。

A 65-year-old male was admitted to the hospital on December 15, 2015 due to chest tightness and shortness of breath after activity for more than 1 year, and edema of both lower limbs for 1 month. The patient denied a history of hypertension. Physical examination: A persistent systolic murmur was smelled in the second intercostal area at the left margin of the sternum, and depressed edema of both lower limbs. Serum cardiac troponin T (cTnT) 0.251 μ g/L. The electrocardiogram showed the features of acute anterior wall and anterior septal myocardial infarction. Bilateral coronary pulmonary fistula (CPF) revealed by cardiac ultrasound. Preoperative diagnosis: bilateral CPF. Intraoperative coronary angiography revealed bilateral CPF [anterior descending artery emitting 2 branches (FIG. 1A), 1 branch from the right coronary artery (FIG. 2A)], the maximum diameter of the left fistula was about 3 mm, and the right fistula was about 4 mm. Intraoperatively, the tube was embolized with mechanically detachable coils (Helix EV3 Axium 3D and 2D). Coronary angiography revealed complete closure of bilateral fistulas after operation (FIG. 1B，Figure 2B)。 There were no major surgical complications such as coil displacement and coronary artery occlusion. After operation, the patients were treated with oral aspirin antiplatelet therapy. The symptoms of the patients were relieved 3 days after operation. After 3 months after operation, cardiac ultrasound examination showed no abnormal blood flow in bilateral coronary arteries.

The patient was a 36-year-old male, weighing 50 kg, classified as Class III by the American Association of Anesthesiologists (ASA), with a history of hepatitis B virus for more than 30 years. He was diagnosed with right liver cancer and tumor thrombosis of portal vein and inferior vena cava. CT of the upper abdomen showed that the liver occupied space, and the right posterior lobe of the liver was partially ruptured, accompanied by tumor thrombosis of portal vein, right hepatic vein and inferior vena cava; Transthoracic color Doppler ultrasound (TTE) showed a 3.5 cm ×3.7 cm embolus at the entrance of the inferior vena cava to the right atrium, and the blood flow from the inferior vena cava to the right heart was obviously blocked and accelerated, V_max=2.9 cm/s (Figure 1)。 Right hemihepatectomy with preservation of middle hepatic vein + removal of tumor thrombus of portal vein and inferior vena cava was proposed under general anesthesia. After entering the operating room, peripheral venous access was opened and routine monitoring was performed: blood pressure 135/75 mmHg (1 mmHg =0.133 kPa), heart rate 85 beats/min, SpO₂100%。 Left radial artery puncture and catheterization were performed under local anesthesia, and invasive arterial pressure was monitored. Anesthesia induction: intravenous midazolam 5 mg, propofol 60 mg, cis-atracurium 10 mg and sufentanil 50 μ g. After successful tracheal intubation, a transesophageal cardiac ultrasound (TEE) probe is placed into the esophagus. First, the probe is placed in the two-chamber cardiac section of the middle esophagus (ME) to confirm the location of the tumor thrombus, and the temporary filter implanted into the inferior vena cava through the superior vena cava is guided (FIG. 2A)。 Thereafter, the size of each chamber, wall thickness, opening and closing of each valve, and the presence or absence of tumor thrombus invasion were further evaluated by ME four-chamber heart section, left ventricular long axis section, aortic short axis section and right ventricular inflow-outflow tract section, and aortic long axis section (Figure 2B)。 Transesophageal cardiac ultrasound (TEE) was used to further track the inferior vena cava to the confluence of the hepatic vein on the basis of the two-chamber cardiac section. It was found that the inferior vena cava was slightly expanded, with a diameter of 2.4 cm, and obvious blood flow stasis in the hepatic vein and inferior vena cava was observed (Figure 2C)； The distance from the right hepatic vein flowing into the inferior vena cava to the embolus was measured to be about 6.0 cm, which provided a reference for the operator to remove the thrombe. After the evaluation, the probe returned to the two-chamber cardiac section to observe the position of tumor embolus and temporary filter in real time. During the operation, it was found that the tumor thrombus moved forward and backward with the operation, which was most obvious when the sickle ligament of the liver was incised, the superior hepatic segment of the inferior vena cava and the surrounding hepatic veins were exposed, and the right deltagonal ligament and coronary ligament were separated. When the operator dragged out the tumor thrombus through the inferior vena cava, ECG monitoring showed: sudden supraventricular tachycardia, heart rate up to 165 beats/min, blood pressure dropped to 57/35 mmHg, SpO₂Maintain 99% ~100%, immediately give phenylephrine 40 μ g, blood pressure gradually rise; TEE showed that the blood flow of inferior vena cava was unobstructed. Immediate follow-up of ME four-chamber cardiac section, right ventricular inflow-outflow section, and short axis section of ascending aorta showed no abnormalities in heart movement and blood flow in the main pulmonary artery and left and right pulmonary arteries. After 2 min, the patient's blood pressure returned to normal, the supraventricular tachycardia automatically changed to sinus rhythm, and the heart rate decreased to 75 beats/min. After that, the patient's hemodynamics was stable, and the temporary filter was pulled out after the operation. After the patient's breathing was stable, the tracheal tube was removed and sent to ICU.

neuromyelitis optica spectrum disorders (NMOSD) is a central nervous system autoimmune disease associated with serum aquaporin-4 immunoglobulin G antibody (AQP4-IgG). Breakthrough research progress has been made in recent 10 years. As its understanding continues to grow, the International Neuromyelitis Optica (NMO) Diagnostic Group published a new International Consensus on Diagnostic Criteria for NMOSD in July 2015, referring to NMO and NMOSD collectively as NMOSD in view of further understanding of the disease.

Endometrial cancer is a common malignant tumor of female reproductive system. Western countries are particularly frequent, while Asian countries are also seeing an increase in incidence^[1,2]。 Endometrial cancer mostly occurs in postmenopausal women, but about 20% of patients occur before menopause and 5% before age 40^[3,4,5,6,7]And there is a trend of increasing numbers of young patients. Most patients are diagnosed early in the period^[8]。 In<The 5-year survival rate in 40-year-old patients with endometrial cancer is about 93%^[7]。 In the FIGO staged surgery of the International Federation of Obstetrics and Gynecology, which has been performed for nearly 30 years, the whole uterus and double adnexes require routine removal. However, after removing the ovaries of young patients, there are many adverse effects on the patient's physiology and psychology^[8]And young patients have a strong desire to preserve their ovaries, so it is urgent for people to study and explore the feasibility of preserving the ovaries of young patients with endometrial cancer, and formulate solutions to guide clinical work.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytic disease. It was first reported by William Chester and Jakob Erdheim in 1930. About 600 cases have been reported worldwide^[1]There are also some reports in China^[2,3]。 The disease often occurs in the ages of 40 to 70, and it is slightly more common in males than females. The etiology and mechanism of occurrence are unknown. The latest research suggests that it may be caused by somatic mutation, which is related to immune dysregulation and inflammation^[4]。 The typical pathological manifestation is the abnormal deposition of foam-like lipid cells of CD68 (+), CD1 α (-), and S-100 (-) to form xanthogranuloma-like infiltration, often accompanied by fibrosis. Because its morphology and immunostaining characteristics are similar to juvenile xanthogranuloma (JXG), the International Association of Organizational Cells has included ECD in the JXG disease family. Recent studies have also suggested that ECD is a special type of JXG that does not mainly involve skin invasion^[5]。 ECD can occur at any site, often involving multiple systems and organs, most often involving bone, central nervous system, cardiovascular system, lung, retroperitoneal space, etc^[6]。 Clinical manifestations are diverse, lack of specificity and poor prognosis. The diagnosis depends on histopathological examination.

The earthquake of magnitude 8.0 on the Richter scale occurred at 14: 28 on May 12th, 2008, with its epicenter in Wenchuan County, Sichuan Province. It is the earthquake with the highest magnitude, the largest damage intensity, the largest death toll and the most serious economic loss in China since the Tangshan earthquake in 1976. After a major natural disaster, material loss and physical pain will be rebuilt and recovered, but the psychological stress caused by the disaster will have a long-term impact on the experiencer of the disaster. After the Wenchuan earthquake, the first large-scale psychological assistance after disaster was carried out in China. Disaster psychology has attracted attention in the field of rescue and psychology, and has been paid attention by the society. This study summarizes the related research on disaster psychology after Wenchuan earthquake in China by consulting the existing literature. English documents were searched in PubMed, Web of Science and PsyCINFO, and the key searches were "Wenchuan Earthquake", "mental health", "Psychological reaction" and "stress". Chinese documents were searched in CNKI (China Academic Journals Network Publishing Database and Chinese Important Conference Papers Full Text Database), and the key searches were "Wenchuan Earthquake", "512 Earthquake", "mental health", "Psychological reaction" and "stress". After screening, 232 articles in English and 251 articles in Chinese were retrieved. Further to the literature combing and classification, selected post-traumatic stress disorder, post-traumatic growth, post-disaster group reflection, post-traumatic stress disorder treatment and other aspects to summarize and analyze.