胎儿大脑中动脉血流监测在产科中的应用

胎儿大脑中动脉（MCA）血流频谱反映了其心血管对缺氧或血流再分布的早期适应,其测量要求标准化、规范化,是近年来胎儿血流动力学临床应用研究的热点之一。国内外近期出现了一些大样本的回顾性及前瞻性临床研究,对MCA评估指标、参考值范围以及临床各疾病中运用的截断值进行了报道。文章结合2021年版国际妇产科超声学会（ISUOG）胎儿多普勒血流频谱监测指南,对胎儿MCA血流频谱相关的高质量研究进行分析总结,为其临床规范化运用提供参考。     

发热并腹泻1 d 抽搐1次——牛奶蛋白过敏 模拟脓毒症临床分析

 第一阶段病历资料         患儿女,42 d。因“发热、腹泻1 d,抽搐1次”于2011-10-02就诊于天津市儿童医院。经急诊医生抗惊厥处理后于当晚转入儿童重症监护病房（PICU）。转入时查体：体温（肛表测试）36.8℃,呼吸20次/min,脉搏110次/min,血压80/50 mmHg（1 mmHg = 0.133 kPa）。营养状态中等,体重43 kg,精神反应弱,哭声弱,少泪,眼窝稍凹陷,皮肤弹性尚可,肢端温度稍低,末梢循环充盈时间正常。双肺呼吸音稍粗,心音有力,心率110次/min。腹平,未见肠型及蠕动波,腹壁软,肝脾无肿大,未触及包块。肠鸣音活跃,性质无异常。神经系统检查未见异常。门诊及入院实验室和影像学检查见表1。初步诊断：腹泻病（感染性）,脱水（轻-中度）,支气管炎,发热惊厥原因待查。入院10 h内治疗：予以抗生素和液体疗法（1/2张力葡萄糖盐水）,纠正脱水和电解质紊乱。经鼻管饲深度水解配方奶和水。入院第10小时,患儿突然出现口唇紫绀,意识不清,经皮血氧饱和度（SO2）逐渐下降至50% ~ 60%,心率逐渐减慢至80次/min。随即予以肾上腺素和呼吸中枢兴奋剂、气管内插管、呼吸机辅助呼吸［通气模式为间歇正压通气（IPPV）+ 呼气末正压（PEEP）2 cm,呼吸频率40次/min,吸气末峰压（PIP）20 cmH2O（1 cmH2O = 0.098 kPa）,吸呼比（I/E）1∶1.5,吸入氧浓度（FiO2）0.5］。SO2和心率逐渐恢复,血压80/50 mmHg。2 h后因肝脏增大和心率增快予以强心药地高辛。再次检测血液生化提示低钠血症     

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??Study on surgical anatomy and histology of mesopancreas WU Wen-guang*??GUAN Wen-bin??LIU Yong-chen??et al. *Department of General Surgery??Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine??Shanghai 200092??China
Corresponding author??LIU Ying-bin??E-mail??laoniulyb@163.com
Abstract Objective To investigate the surgical anatomical and histological data for the mesopancreas and mesopancreatic excision. Methods The anatomic structures of the peripancreatic space??the important vessels and the retroperitoneal structures of 5 cadaveric specimens between January and December 2016 in Basic Medicine Faculty of Shanghai Jiao Tong University were observed in the study. The structures of the vessels and retroperitoneum were histological studied. Results Posterior pancreatic space was an important anatomical plane of mesopancreatic excision. Celiac trunk and superior mesenteric artery were important anatomic landmarks of mesopancreatic excision. The No.16 lymph node was the extra anatomy structure of mesopancreas. There was a natural surgical space between the adventitia and sheath of the artery. There was a great deal of nerve and lymphatic vessel distribution on and outside the arterial sheath of the peripancreatic arteries. Conclusion Mesopancreas and mesopancreatic excision have the corresponding basis of surgical anatomy. Arterial sheaths dissection strategy for improving the dissection effect has certain anatomical basis.     

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??Case analysis of conversion therapy by laparoscopic HIPEC combined with intraperitoneal and systemic chemotherapy for gastric cancer peritoneal metastasis XUE Kan*??LI Zi-yu??LI Shuang-xi??et al. * Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing 100142, China
Corresponding author??LI Zi-yu??E-mail??ligregory@outlook.com
Abstract Objective To investigate the efficacy of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) combined intraperitoneal and systemic chemotherapy in gastric cancer patients with peritoneal metastasis. Methods A gastric cancer patient whose peritoneal cancer index was 39 during laparoscopic exploration was admitted at Peking University Cancer Hospital Gastrointestinal Center. The patient received laparoscopic HIPEC with docetaxel, followed by 6 courses of intraperitoneal and intravenous PTX??along with S-1 orally. Results CT scan showed distinct response during post-treatment evaluation. A second look by laparoscopy was suggested by MDT. No tumor cell was found in the lavage fluid through abdominocentesis and no metastasis can be seen by laparoscopic exploration. Then total gastrectomy plus D2 minus No.10 lymph node dissection was performed. The patient recovered smoothly after surgery. The pathology confirmed a ypT3N2M1, moderate to poor-differentiated adenocarcinoma, from gastric antrum to body. By September 2017, the patient was still in postoperative treatment. Conclusion Laparoscopic HIPEC combined with intraperitoneal and systemic chemotherapy showed effective interim results in gastric cancer peritoneal metastasis conversion therapy and is deserved for further researches.     

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??Protection of Oddi sphincter function and its significance in endoscopic sphincterotomy LU Xin-liang*??LIANG Ting-bo. *Department of Gastroenterology, the Second Affiliated Hospital, Zhejiang University School of Medicine; Key Laboratory of Pancreatic Diseases of Zhejiang Province, Hangzhou 310009, China.
Corresponding author: LIANG Ting-bo, E-mail:liangtingbo@
zju.edu.cn
Abstract The sphincter of Oddi is a neuromuscular structure located at the junction of the bile and pancreatic ducts with the duodenum. The primary functions of the sphincter of Oddi are to regulate the delivery of bile and pancreatic juice into the duodenum and to prevent the reflux of duodenal contents restrograde infection. EST damage the integrity of the Oddi sphincter, leading to sphincter relaxation or stenosis, causing partial or complete loss of the original physiological function of the Oddi sphincter. Therefore, surgeons should strictly control the indications of EST, retain the sphincter function as far as possible, so as to provide patients with more reasonable and standardized treatment strategy.     

罹患重度牙周病变磨牙采取微创拔牙和微翻瓣位点保存术后种植修复效果观察（附1例3年随访报告）

种植治疗因其临床长期效果稳定,逐渐成为牙列缺损或缺失后的常规修复方法,而充足的骨量和良好的软组织条件对种植治疗方案的实施至关重要。罹患重度牙周病变的磨牙不但在拔牙之前已经存在牙槽骨吸收,而且在拔牙窝愈合过程中所发生的不同程度牙槽骨吸收均会增加种植治疗的难度。文章完整展示了1例磨牙牙周-牙髓联合病变病例从病情分析、采取微创拔牙和微翻瓣技术在拔牙窝实施位点保存创造良好硬组织条件、按照标准化流程完成种植修复到追踪观察3年的具体实施过程,为评价此类病例微创拔牙和微翻瓣位点保存术后种植修复的长期效果提供了依据。     

大黄素-8-O-β-D-吡喃葡萄糖苷对牙龈卟啉单胞菌唾液酸酶活性及其毒力基因表达影响研究

目的    探讨大黄素-8-O-β-D-吡喃葡萄糖苷对牙龈卟啉单胞菌（P. gingivalis）唾液酸酶活性及其毒力基因表达的影响。方法    使用不同质量浓度的大黄素-8-O-β-D-吡喃葡萄糖苷（0.2、0.5、2、5、10 mg/mL）处理P. gingivalis W83（实验组）,用未加药物的P. gingivalis W83作对照（对照组）,采用荧光法检测大黄素-8-O-β-D-吡喃葡萄糖苷对P. gingivalis唾液酸酶活性的作用。5 mg/mL大黄素-8-O-β-D-吡喃葡萄糖苷作用于P. gingivalis W83,Real-time PCR法检测毒力基因fimA、fimR、fimS、kgp、rgpA和rgpB的表达情况。结果    大黄素-8-O-β-D-吡喃葡萄糖苷对P. gingivalis唾液酸酶活性产生了抑制作用,当其质量浓度为0.2、0.5、2、5、10 mg/mL时,对唾液酸酶活性的抑制率分别为11.4%、32.23%、40.21%、73.54%、84.31%。与对照组比较,实验组（5 mg/mL大黄素-8-O-β-D-吡喃葡萄糖苷处理）的fimA、fimR、fimS、kgp、rgpA和rgpB基因表达均下降,差异均有统计学意义（均P < 0.05）。结论    大黄素-8-O-β-D-吡喃葡萄糖苷可有效抑制P. gingivalis唾液酸酶活性,其抑制作用会降低细菌毒力基因表达,有望成为预防及治疗牙周炎的新型药物。     

基于锥形束CT对邻面接触区釉质厚度的测量与分析

目的    应用锥形束CT（cone beam computed tomography,CBCT）测量上下颌牙列邻面接触区釉质厚度及邻接点距离牙合面和釉牙骨质界的垂直高度,为临床邻面去釉提供参考数据。方法    选取2019年6—10月于吉林大学口腔医院医学影像科行CBCT检查患者50例,根据纳入标准选取符合测量条件的牙齿145颗,运用Invivo软件测量每颗牙齿邻面接触区的釉质厚度及邻接点距离牙合面和釉牙骨质界的垂直高度。结果    从切牙至第一磨牙邻面接触区釉质厚度有逐渐增大的趋势;大多数牙位的远中邻面接触区釉质厚度大于近中（P < 0.05）,仅有上颌第一前磨牙和下颌第一磨牙的近远中邻面接触区釉质厚度差异无统计学意义（P > 0.05）;上下颌左右侧同名牙邻面接触区釉质厚度差异无统计学意义（P > 0.05）;除上颌中切牙-侧切牙、上下颌侧切牙-尖牙邻面接触区外,其余相邻牙齿近远中邻面接触区釉质厚度相似,差异均无统计学意义（均P > 0.05）;上颌邻面接触区平均釉质厚度大于下颌,差异有统计学意义（P < 0.05）;上下颌近远中邻接点到牙合面的垂直距离均小于到釉牙骨质界的垂直距离（均P < 0.05）。结论    不同牙位近远中邻面接触区釉质厚度不同,邻接点距离牙合面和釉牙骨质界的垂直高度也不同,临床邻面去釉时不同牙位去釉量不能按照同一标准进行,应结合CBCT影像资料制定个体化治疗方案。     

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??Value of preoperative lymphoscintigraphy in sentinel lymph node biopsy of breast cancer SUN Xiao*, LIU Juan-juan, WANG Yong-sheng, et al. *Breast Cancer Center, Shandong Cancer Hospital, Jinan 250117, China
Correcponding author: WANG Yong-sheng, E-mail: wangysh2008@yahoo.com.cn
Abstract Objectives Background Although preoperative lymphoscintigraphy for sentinel lymph nodes biopsy (SLNB) in breast cancer patients is undergone commonly, its clinical significance remains controversial. Methods Firstly, a database containing 716 consecutive breast cancer patients who received preoperative lymphoscintigraphy before SLNB was retrospectively analyzed. Secondly, 565 consecutive breast cancer patients were prospectively randomized into groups with or without preoperative lymphoscintigraphy before SLNB. Results In the retrospective study, sentinel lymph nodes (SLNs) were well imaged by lymphoscintigraphy in 86.6% patients, and negative lymphoscintigraphy results were associated with axillary node metastases. Failure of identification of SLNs by isotope alone was associated with whether axillary hot spot was imaged by lymphoscintigram (P<0.001). There were no significant differences in the false negative rate (P=0.731) of SLNB by isotope alone, in the identification rate (P=0.174) and the false negative rate (P=0.947) of SLNB by combination of dye and isotope between patients who had axillary hot spot in lymphoscintigram and those who had not. In the prospective study, 290 patients were randomized into the group with preoperative lymphoscintigraphy (82.1% patients were well imaged by lymphoscintigraphy) and 275 patients without. There were no significant differences between two groups in the identification rate (P=0.757) and the false negative rate (P=1.00) of SLNB by isotope alone, also in the identification rate (P=1.00) and the false negative rate (P=1.00) of SLNB by combination of dye and isotope. Conclusion Preoperative lymphoscintigraphy could not improve the identification rate and reduce the false negative rate of SLNB in breast cancer patients, and it is not a prerequisite for SLNB.