【Abstract】Objective To summarize the effects of vasoactive mediators on local microvasculature in acute pancreatitis（AP）. Methods Literatures concerning metabolism, receptors, action mechanisms of vasoactive mediators and their effects in AP were reviewed. Results Bradykinin, endothelin, platelet activating factor and nitric oxide were important mediators in the development of microcirculatory disturbance in AP, however the results of experiments were inconsistent. Conclusion The roles which vasoactive mediators play in microcirculatory disturbance of AP are affected by many factors, and await further study.
ObjectiveTo summarize the clinical characteristics of epilepsy comorbid with tic disorders in children, and discuss its diagnosis, treatment and management. MethodsThe clinical data of 12 epileptic children comorbid with tic disorders treated in Wuhan children's Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology from December, 2018 to June, 2021 was collected retrospectively. The clinical characteristics, EEG, MRI, treatment, prognosis of epileptic children comorbid with tic disorders were analyzed and summarized. ResultsThere were 12 epileptic children comorbid with tic disorders in total, 11 males, 1 female, average (10.0±2.9) years old. The onset age of epilepsy was ranged from 0.6 to 11 years old, average (6.5±3.3) years old. The onset age of tic disorders ranged from 3.5 to 11 years old, average (7.2±2.0) years old. The epileptic seizure types included focal seisures (Focal, 8 cases), atypical absence seizures(AAS, 2 cases), myoclonic seizure (MS, 1 case), generalized tonic-clonic seisures (GTCS, 3 cases). The epileptic syndromes included benign epilepsy with centrotemporal spikes (BECT, 2 cases), Dravet syndrome (1 case), juvenile myoclonic epilepsy(JME, 1 case), temporal lobe epilepsy (TLE, 1 case).The average oral antiepileptic seizure drug was 1, including lamotrigine(LTG), valproic acid(VPA), oxcarbazepine(OXC), levetiracetam(LEV), topiramate(TPM) and Perampanel. The clinical course of tic disorders ranged from 0.5 to 3.0 years, average (1.5±0.9) years. The clinical types included provisional tic disorder (PTD, 4 cases), chronic tic disorder (CTD, 5 cases, all of which were motor tics) and Tourette syndrome (TS, 3 cases). The severity of tic disorders was mild up to the last follow-up. In addition to tic disorders, other comorbidities included attention deficit and hyperactivity disorder (ADHD, 2 cases), 1 children was mixed type, 1 children was hyperactive impulse dominated type, psychomotor development disorder(3 cases), enuresis (1 case) and emotional disorder (1 case). There were interictal epileptiform discharges in 12 children with EEG, including focal discharges(7 cases, 1 EEG showed that focal discharges originated from the right temporal region), multiple discharges (5 cases, 1 EEG showed that multiple discharges originated from the right centro-temporal region), and clinical seizures were monitored in 6 cases (3 cases of focal seizures, 2 cases of atypical absence seizures, and 1 case of myoclonic seizure). Magnetic resonance imaging (MRI) of head showed no obvious abnormalities. The follow-up time was ranged from 0.5 to 3.0 years. Up to the last follow-up (2022.01.01), 8 cases of epilepsy had been controlled and 4 cases of tic disorders were cured. The prognosis of epilepsy comorbid with tic disorders in most children was good. ConclusionsThe prognosis of epilepsy comorbid with tic disorders in most children is good, the types of epileptic seizures and epileptic syndromes are various. Prognosis of these chidren mainly depends on the control of epileptic seizures, the severity of tics and existence of other neuropsychiatric comorbidities. Therefore, drug treatment mainly focuses on controlling the epileptic seizures, and the impact of comorbidities on children can not be ignored. The clinical management needs regular follow-up, timely evaluation and corresponding interventions.
ObjectiveTo study the effect of hyperbaric oxygen combined with nimodipine in the treatment of cerebral dysfunction resulted from traumatic brain injury. MethodWe retrospectively collected and analyzed the data of 124 patients with cerebral dysfunction induced by traumatic brain injury, admitted to the Neurosurgery Department during February 2011 to February 2014. All the patients were divided into the traditional treatment group (n=45), the traditional treatment with hyperbaric oxygen group (HBO group, n=40) and the traditional treatment with nimodipine and hyperbaric oxygen group (integrated group, n=39). The differences among the three groups in neurological injury severity evaluated by National Institute of Health Stroke Scale and the cerebral blood flow were recorded and analyzed at three time points (before the treatment, 2 and 4 weeks after treatment). ResultsThere was no significant difference in neurological injury severity and cerebral blood flow among these three groups before treatment (P>0.05). Evaluated at 2 and 4 weeks after treatments, the neurological injury severity of HBO group and integrated group were significantly less than the traditional treatment group (P<0.05); the neurological severity score of integrated group was significantly lower than the HBO group (P<0.05); the cerebral blood flow of HBO group and integrated group were significantly higher than the traditional treatment group (P<0.05); and the cerebral blood flow of integrated group was significantly higher than the HBO group (P<0.05). ConclusionsThe combination therapy of hyperbaric oxygen combined with nimodipine is effective in the treatment of cerebral dysfunction induced by traumatic brain injury, because of its attenuation of neurological injury severity and increase of cerebral blood flow.
Objective To investigate the association between types of rapid eye movements during sleep and ICD-10 as a mothod for diagnosing depression. Methods Depression was diagnosed according to ICD-10 and changes of 9 variables of REM sleep in 120 psychiatric outpatients and inpatients by calculating the Kappa values. Results In 120 psychiatric patients, 52 depressive patients were diagnosed by using ICD-10, and 58 patients were diagnosed as depression according to decreased REM sleep latency and increased REM activity, REM intensity, REM density, and increasing amount of REM sleep. Kappa value was 0.73, Plt;0.05, which implied that these two diagnosing ways were significantly consistent. Conclusions Measuremen of REM sleep variable should be investigated further as a supplementary method for diagnosing depression.
目的探讨保留幽门的胰十二指肠切除术(PPPD)的手术适应证、捆绑式胰肠吻合术的特点及胃排空障碍的治疗。方法12例均行PPPD，消化道重建按Child法，胰肠吻合均采用捆绑式胰肠吻合。结果除1例术后第21天并发切口裂开、肺栓塞死亡外，其余11例均顺利出院，平均住院时间24 d，随访1年，1例术后8个月死亡，余均健在。结论PPPD是治疗胰头癌及壶腹周围癌的一种具有广阔应用前景的术式，捆绑式胰肠吻合有望作为胰肠吻合的标准术式。
Objective To explore the effect of preoperative hypothyroidism on postoperative cognition dysfunction (POCD) in elderly patients after on-pump cardiac surgery. Methods Patients who were no younger than 50 years and scheduled to have on-pump cardiac surgeries were selected in West China Hospital from March 2016 to December 2017. Based on hormone levels, patients were divided into two groups: a hypo group (hypothyroidism group, thyroid stimulating hormone (TSH) >4.2 mU/L or free triiodothyronine 3 (FT3) <3.60 pmol/L or FT4 <12.0 pmol/L) and an eu group (euthyroidism group, normal TSH, FT3 and FT4). The mini-mental state examination (MMSE) test and a battery of neuropsychological tests were used by a fixed researcher to assess cognitive function on 1 day before operation and 7 days after operation. Primer outcome was the incidence of POCD. Secondary outcomes were the incidence of cognitive degradation, scores or time cost in every aspect of cognitive function. Results No matter cognitive function was assessed by MMSE or a battery of neuropsychological tests, the incidence of POCD in the hypo group was higher than that of the eu group. The statistical significance existed when using MMSE (55.56% vs. 26.67%, P=0.014) but was absent when using a battery of neuropsychological tests (55.56% vs. 44.44%, P=0.361). The incidence of cognitive deterioration in the hypo group was higher than that in the eu group in verbal fluency test (48.15% vs. 20.00%, P=0.012). The cognitive deterioration incidence between the hypo group and the eu group was not statistically different in the other aspects of cognitive function. There was no statistical difference about scores or time cost between the hypo group and the eu group in all the aspects of cognitive function before surgery. After surgery, the scores between the hypo group and the eu group was statistically different in verbal fluency test (26.26±6.55 vs. 30.23±8.00, P=0.023) while was not statistically significant in other aspects of cognitive function. Conclusion The incidence of POCD is high in the elderly patients complicated with hypothyroidism after on-pump cardiac surgery and words reserve, fluency, and classification of cognitive function are significantly impacted by hypothyroidism over than other domains, which indicates hypothyroidism may have close relationship with POCD in this kind of patients.
ObjectiveTo investigate influencing factors of postoperative cognitive dysfunction (POCD) in elderly patients underwent laparoscopic surgery. MethodsThe elderly patients underwent laparoscopic surgery were collected in the Daye City People's Hospital and Yangxin County People's Hospital from September 14, 2014 to January 1, 2016 and the Traditional Chinese Medicine Hospital of Daye City from June 19, 2014 to January 1, 2016. Factors included in the registration of patients in general and a variety of influencing factors during perioperative period were recorded. The independent factors associated with POCD were analyzed by multivariate logistic regression analysis. ResultsThree hundred and seventy-eight elderly patients underwent laparoscopic surgery were included according to the inclusion and exclusion criteria, of which 43 patients with POCD and 335 patients without POCD within 3 days after laparoscopic surgery. The baseline data had no significant differences between the patients with POCD and without POCD. The cerebral infarction, preoperative fear, preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, operation time, low SpO2 during anesthesia induction, PaCO2 after pneumoperitoneum, postoperative patient controlled epidural analgesia (PCEA), postoperative VAS score on day 3 were associated with the POCD (P < 0.05). The results of logistic regression analysis showed that the preemptive analgesia, use of dexmedetomidine before laparoscopic surgery, general anesthesia combined with epidural anesthesia, and postoperative PCEA were the independent protective factors of the POCD (P < 0.05). The operation time and PaCO2 after pneumoperitoneum were the independent risk factors of the POCD (P < 0.05). ConclusionFor elderly patients underwent laparoscopic surgery, clinicians should be alert to occurrence of POCD according to the influence factors of it, and timely screen relevant scale so as to early diagnose and early intervent and effectively delay progress of patient's POCD.