2018年·第98卷第38期

Hepatic hydatidosis is a zoonotic parasitic disease. There are two main types, one is cystic hydatidosis (CE) caused by larval infection of Echinococcus granulosus; The other is alveolar hydatidosis (AE) caused by larval infection of Echinococcus multilocularis. The World Health Organization (WHO) believes that hydatidosis is a seriously neglected disease, which seriously endangers human health and safety^[1,2]。 The incidence rate of hepatic alveolar hydatidosis is 4% ~10%^[2,3]However, alveolar hepatic hydatidosis is asymptomatic in the early stage, and most of it belongs to the middle and late stages when it is discovered, and its harm to the body is much higher than that of cystic hydatidosis. Surgical operation is the main treatment, but for most advanced patients, the operation is difficult, and the radical surgical resection rate is not high. In recent years, with the improvement of surgical technology, the concept of precise liver surgery, and the development of three-dimensional (3D) medical imaging technology, the rate of radical hepatectomy has reached more than 50%^[4]。 Radical resection refers to the complete resection of the lesion. The extent of resection requires normal liver tissue more than 1~2 cm beyond the edge of the lesion, so as to eliminate the "infiltration zone" with active proliferation of the lesion and ensure the structural integrity and functional compensation of the remaining liver^[5]。 PNM staging with reference to WHO, PIVM typing with XJHCRI^[6,7]Combined with our team's experience in the treatment of alveolar hepatic echinococcosis, the concept and strategy of radical surgical treatment of alveolar hepatic echinococcosis are discussed as follows.

Malignant hyperthermia (MH) is a familial myopathy that is an abnormal hypermetabolic state of skeletal muscle triggered mainly by volatile inhaled anesthetics and depolarizing muscle relaxant-succinylcholine. Once the disease occurs in MH susceptible patients, the disease progresses rapidly, manifesting as systemic muscle spasm, sharp and sustained increase in body temperature, rapid increase in oxygen consumption, CO₂In the absence of specific therapeutic drugs, general clinical cooling and therapeutic measures are difficult to control the progression of the disease, and the patient may eventually die due to multiple organ failure^[1,2,3,4,5]。

With the transformation of the modern medical model, pain management has become one of the important health problems. And in rapid recovery surgery, multimodal analgesia is considered an indispensable link^[1]。 Single drug analgesia cannot fully meet the clinical needs. Compound opioid analgesics, composed of acetaminophen/ibuprofen and weak/strong opioid analgesics in a fixed ratio, are widely used in clinical practice, and are important drugs for the treatment of acute, chronic, moderate and severe pain such as nociceptive pain, neuropathic pain and cancer pain. Compared with single prescription, compound opioid analgesics have the advantages of synergistic analgesic effect, less adverse reactions, convenient acquisition and good medication compliance, and are widely recommended by experts at home and abroad^[2,3,4]。 However, there are still potential safety risks in clinical application^[5]And there is little evidence-based medical evidence on the clinical application of compound opioids at home and abroad, which cannot provide effective guidance on the clinical application of compound opioid analgesics. In order to standardize the clinical application of compound opioid analgesics, the pain branch of Chinese Medical Association organized domestic pain experts to write this consensus.

Percutaneous foramen ovale puncture of trigeminal semilunar radiofrequency thermocoagulation is one of the classical methods for the treatment of primary trigeminal neuralgia^[1,2]However, it is difficult to achieve highly selective branch treatment of the trigeminal nerve, and the non-responsible branch is often damaged. In addition, the semilunar ganglion of the trigeminal nerve is deep in the middle cranial fossa, and the radiofrequency puncture needle enters the cranium to repeatedly find the responsible branch, which increases the risk of intracranial hematoma and infection caused by damage to brain tissue or intracranial blood vessels. Therefore, our research group developed a high-selective percutaneous round hole radiofrequency technique for the treatment of trigeminal branch II pain without intracranial penetration^[3]In combination with the radiofrequency of supraorbital foramen and foramen ovale, extracranial non-semilunar radiofrequency treatment of trigeminal neuralgia is realized^[4]However, in clinical application, it has been found that when extracranial non-semilunar foramen ovale radiofrequency is performed on patients with pain in the mandibular branch of the trigeminal nerve, if the foramen ovale on the affected side is large (width>6 mm), a small branch of the mandibular nerve will often be incompletely damaged, leaving residual pain^[5]。 Therefore, this study attempted to use extracranial non-semilunar foramen ovale bipolar radiofrequency in patients with pain in the mandibular branch of the trigeminal nerve of the great foramen ovale, and achieved good results, which are reported below.

Hemophagocytic syndrome (HPS), also known as hemophagocytic lymphohistiocytosis (HLH), is caused by inherited or acquired cytotoxic T lymphocytes (CTL) and natural killer (NK) cells, which cannot effectively remove antigen stimulation and produce a highly activated but ineffective immune response. The body releases a large number of cytokines, forming a cytokine storm, thus causing multiple organ and tissue damage^[1]。 The disease progresses rapidly, the course of the disease is dangerous, and the mortality rate is high. Because the disease is relatively rare, with complex etiology and diverse clinical manifestations, early diagnosis is difficult. This study retrospectively analyzed the clinical data of children with HLH, summarized their clinical manifestations, laboratory characteristics, treatment and outcome, and analyzed the related factors affecting prognosis.

The patient, a 17-year-old Tibetan, was admitted to the Department of Nephrology, People's Hospital of Tibet Autonomous Region on November 20, 2017 mainly due to "edema of face and limbs for 1 week". The patient developed facial edema without obvious trigger 1 week ago, mainly in the morning, and then gradually expanded to the limbs, showing symmetrical depressed edema. No low back pain, hematuria, hair loss, oral ulcer, joint pain and other discomfort. Then he went to the outpatient clinic of our hospital. Urine routine: protein + +, occult blood- +, red blood cells-; Blood routine: hemoglobin 104 g/L, platelets 60.40×10⁹/L, further hospitalization. Past history: There is a history of repeated photosensitivity for 1 year, and it can be improved after symptomatic treatment with sunscreen.

A 33-year-old female, hotel manager, was admitted to the hospital on 6 June 2016 due to "episodic headache for 6 years and daily headache for 3 months". The initial episodic frontotemporal unilateral headache, mostly located on the right side, lasted 6-24 h each time, about 2 times/month. Headache is moderate or severe, accompanied by fatigue, photophobia, phonophobia, nausea in severe cases, and rarely vomiting. Cold, mental stimulation, menstrual induction. In the past 4 years, the intensity and frequency of headache have increased, and the intensity of headache during menstruation is the strongest, reaching VAS 9 points. I have been sent to the emergency department for medical treatment many times. In the past 2 years, the scope of headaches has gradually expanded: including one-sided headache in the right occipital region-right headache with left frontotemporal headache-including total headache in both occipital regions. In the past 6 months, the headache was more than 15 d/month, and many measures such as pericranial injection of botulinum toxin A (BTXA) were ineffective. I have had total headache every day for 3 months, the heaviest in the right occipital region. Severe decline in the ability to live daily, incapacity to work, unemployment. Have suicidal tendencies. There were no positive signs in the nervous system, the cranial MRI was normal, and the cervical MRI showed C3-7 intervertebral disc bulge.

A male child, 6 months and 11 days, was admitted to the hospital due to the discovery that his motor development was 2 months behind and his eyes were turned down for 20 days. Physical examination: clear consciousness, poor mental response, backward development, inability to raise the head, large head, head circumference 47.5 cm, scalp varicose veins. The anterior fontanel is swollen and has high tension. Both eyeballs can chase objects, and the sunset sign is positive. Both pupils are large and equal round, with a diameter of 2 mm. They are sensitive to light, can move the limbs, do not cooperate with muscle strength examination, high muscle tone, bilateral biceps and triceps reflexes, knee tendon reflexes, negative Pap sign and negative meningeal irritation sign. CT and MRI of the head showed severe ventricular dilatation and obvious periventricular edema (Figure 1，Figure 2)。 Cervical and thoracic MRI, three-dimensional CT of chest and spine: cystic occupation of the right side of the spine at the level of cervical 6 to thoracic 5 vertebrae, considering myelomeningocele (protruding into the thoracic cavity), cervical and thoracic bone development deformity, ventral spina bifida (Figure 3，Figure 4，Figure 5，Figure 6)。 Diagnosis: Severe hydrocephalus, cervical myelomeningocele, cervical ventral spina bifida, cervical and thoracic developmental malformations. The ventricular-peritoneal shunt was performed under general anesthesia after examination, and drugs such as hemostasis and nerve nourishment were given postoperatively. Postoperative reexamination of the head CT showed that the dilatation of the ventricular system was reduced, the shadow of periventricular low-density edema recovered, and the sulcus was more obvious than before (Figure 7)。 Reexamination of chest CT showed that the cystic space occupied by the right side of the original spine was significantly smaller than before (Figure 8)； After 1.5 months follow-up, CT of the head showed no aggravation of ventricular dilatation and resolution of periventricular edema (Figure 9)。 Reexamination of chest CT showed that the cystic space occupied by the right side of the spine was further reduced compared with the previous one (Figure 10)。 The child's condition recovered smoothly, and the next step is transthoracic myelomeningocele resection and repair.

Isolated celiac trunk dissection (ICAD) refers to blood entering the media layer through the rupture of the intima of the celiac trunk, resulting in tearing and peeling of the media of the celiac trunk to form a false cavity. The false cavity may or may not be accompanied by thrombosis, and the false cavity without thrombosis often expands in a tumor-like manner to form a dissected aneurysm^[1]。 ICAD is generally considered to be a rare vascular disease in clinical practice, but with the widespread application of multi-slice spiral CT (MSCT), the reports of ICAD are increasing year by year^[2,3,4,5]。 ICAD is at risk of distal organ ischemia, necrosis, gastrointestinal bleeding, retroperitoneal hematoma, and patients with dissecting aneurysm formation are at risk of dissecting aneurysm rupture^[5,6,7,8]。 Although reports of ICAD are increasing year by year^[9]However, so far, there is still no diagnosis and treatment specification for ICAD^[2]。 This article reviews the progress in the diagnosis and treatment of ICAD.

Myelodysplastic syndrome (MDS) is characterized by abnormal myeloid cell differentiation and development, which is characterized by ineffective hematopoiesis, refractory cytopenia, hematopoietic failure, and high risk of conversion to acute myeloid leukemia (AML)^[1]。 50% ~80% of MDS patients have iron overload. Iron overload leads to structural damage and dysfunction of important organs, damages bone marrow hematopoiesis, and promotes the conversion of high-risk MDS to AML. Iron chelation therapy (ICT) improves hematological parameters, reduces transfusion dependence and prolongs survival^[2]。 This article reviews iron overload in MDS and its effects on hematopoiesis, assessment of iron overload and new advances in ICT.

In recent years, the age structure of China's population has undergone tremendous changes, the aging of the population has been accelerating, and the proportion of the elderly population has increased rapidly. Therefore, it is necessary to pay enough attention to the health status of the elderly. Frailty is an important geriatric syndrome. The prevalence of frailty is about 7% in people aged 65 and over, and 25% to 40% in people aged 80 and over^[1]。 Numerous studies have shown that frailty increases the risk of adverse outcomes such as falls, accidental disability, hospitalization and death in older adults^[2]。 chronic kidney disease (CKD), as one of the common and high-incidence diseases in the elderly, is closely related to weakness. Therefore, on the basis of elaborating the definition, evaluation methods and pathogenesis of frailty, this paper reviews the prevalence of frailty in CKD patients and its influence on the prognosis of CKD patients and the corresponding clinical intervention studies.

Dry eye is a multifactorial disease of the ocular surface, characterized by loss of tear film homeostasis, accompanied by ocular surface symptoms. Its pathogenesis includes tear film instability, tear hyperosmolarity, ocular surface inflammation and injury, and neurosensory abnormalities^[1]。 17% to 34% of Asians are affected by dry eyes^[2]The factors causing dry eye are complex and diverse, among which the change of estrogen level is one of the important causes of dry eye. A large number of studies have shown that estrogen can act on estrogen receptors widely distributed in various tissues of the ocular surface, such as lacrimal gland, meibomian gland, conjunctiva and cornea^[3], regulating related gene expression through the estrogen response element pathway and binding to transcription factors such as nuclear factor-κ B, thereby affecting cell biological processes, molecular functions, and cellular components^[4]It leads to changes in the quality and quantity of tears and the stability of tear film, and participates in the occurrence and development of dry eye. However, some scholars believe that estrogen has no relationship with dry eye.