2016年 · 第96卷第13期

With the rising trend of hypertensive patients in China every year, the incidence of aortic dissection, aortic aneurysm and other diseases caused by this is also increasing year by year. In addition, the incidence of connective tissue diseases such as Marfan syndrome in China is much higher than that in western countries, and the number of aortic diseases caused by this is also higher. Aortic disease is a group of serious life-threatening diseases. Because of its urgency, complexity and danger, the surgical treatment is not only technically difficult, but also has a high mortality and disability rate. The risk assessment before surgery seriously affects the surgical decision-making, survival and prognosis of patients.

CNS-related complications have always accompanied the development of cardiovascular surgery. The complications of the central nervous system mainly include brain complications and spinal cord complications, while the complications of the central nervous system in traditional cardiac surgery are mainly brain, while the complications of the spinal cord in macrovascular surgery, especially those involving the descending arch and thoracic aorta, are much higher than those in traditional cardiovascular surgery. The main complications related to spinal cord injury are paraplegia or lower limb paresis. The incidence of this complication in thoracotomy is 2.7% ~33%^[1,2,3]In the recent development of endovascular thoracic aorta repair (TEVAR), although it is less invasive than traditional surgery, the incidence of spinal cord injury also reaches 3% ~6%^[4,5,6]。 Once these complications occur, they will increase the mortality rate of patients or decrease the quality of life, causing a great economic burden on society and families.

From the perspective of discipline development, neuroscience is one of the important frontier fields in life science, which is highly valued by governments and society. Although the development of neuroscience has achieved brilliant achievements driven by science and technology, as President Barack Obama said, "People can identify galaxies and magnetic fields tens of thousands of light years away from the Earth, and can study particles smaller than atoms. However, with current technological capabilities, people still can't fully and profoundly reveal the mystery of their own brain." Neuroscience is a great challenge for contemporary natural science. The progress of science and technology, the cross-penetration and collaboration of multiple fields and disciplines are undoubtedly the key to tackle this challenge.

A 33-year-old female, G₁P₀The main reason was "menopause for 61 days, vaginal bleeding for 22 days, lower abdominal pain for 3 days, and syncope for one admission". The patient underwent ovulation induction artificial insemination in a hospital 47 days ago, and postoperative B-ultrasound showed that 3 eggs were discharged. The patient had a small amount of vaginal bleeding without obvious trigger 22 days ago, and B-ultrasound showed that fetal sac was visible in the uterus (Figure 1，Figure 2), blood human chorionic gonadotropin (HCG) 4 475 U/L, given intramuscular progesterone 20 mg for abortion protection. B-ultrasound was re-examined in the external hospital 9 days ago, which indicated that the embryo was stopped. Uterine curettage was performed in the external hospital 7 days ago, and villus tissue was seen during the operation. Postoperative review B-ultrasound: the endometrium was clear, and no abnormal mass was found in the left adnexal area (Figure 3，Figure 4)。 The patient experienced continuous aggravation of left lower abdominal pain without trigger 3 days ago, accompanied by anal distension, and fainting when going to the toilet. Emergency admission with blood pressure 100/70 mmHg (1 mmHg =0.133 kPa) and pulse 98 beats/min. Emergency blood HCG 756.51 U/L, hemoglobin 99 g/L; Hematocrit 30%. Emergency B-ultrasound showed that 5.5 cm heterogeneous mass could be seen in the left adnexal area, 1.7 cm diameter without echo could be detected in the center, and 0.7 cm diameter fetal bud-like structure could be seen inside, without obvious fetal heart beat; A 3.6 cm liquid dark area was visible in the left lower abdomen (Figure 5，Figure 6)。 0.8 ml of dark red non-coagulant blood was extracted from the posterior fornix puncture. Considering intraabdominal hemorrhage, ectopic pregnancy is highly likely. Urgent laparoscopic exploration. Intraoperative detection: the ampulla of the left fallopian tube was enlarged to form a 6.0 cm ×2.0 cm mass, and a blood clot was seen at the umbrella end, with active bleeding. When the mass was incised, aggravated tissue and blood clot were seen, which resembled villi, and the size of both ovaries was normal. Non-coagulation and blood clots in the pelvic cavity 1 600 ml. Postoperative pathology confirmed that the villus structure could be seen in the samples submitted for examination. The patient recovered well after postoperative follow-up.

Acute respiratory distress syndrome (ARDS) is a common clinical critical disease that seriously threatens the life of patients. It is urgent to explore the early and effective treatment of ARDS. The basic pathological damage of ARDS is the extensive damage of lung parenchyma cells, especially lung microvascular endothelial cells and alveolar epithelial cells^[1]But the self-repair ability of injured lung tissue is limited^[2]。 The methods to promote the early and effective repair of pulmonary microvascular endothelial cells and alveolar epithelial cells, and to realize the effective reconstruction of alveolar structure are the key and difficult points of current research. Exogenous mesenchymal stem cell (MSC) transplantation provides a new possible therapeutic approach for the repair of ARDS injured cells, but an important factor for the success of MSC transplantation is whether MSC can be homed in the corresponding tissues at the later stage of transplantation.

Sphingolipid is the main component of eukaryotic cell membrane. Ceramide-1-phosphate, sphingosine and sphingosine 1-phosphate (S1P) are important metabolites of sphingolipid. They are widely involved in and regulate many biological processes such as cell proliferation and apoptosis, cell migration, angiogenesis, immune response and inflammation. Recent studies have found that sphingolipid metabolites are involved in the development of rheumatoid arthritis (RA), inflammatory bowel disease, dermatomyositis and subacute cutaneous lupus erythematosus, and their signaling pathways may be potential targets for the treatment of autoimmune diseases^[1], suggesting the importance of focusing on the role of these metabolites in autoimmune diseases. The research progress of S1P in RA is summarized as follows.

obstructive sleep apnea syndrome (OSAS) is a clinical syndrome characterized by hypopnea and apnea caused by repeated partial or complete collapse of the respiratory tract during sleep, resulting in multiple system organ dysfunction, including hypertension, pulmonary hypertension, cardiovascular disease, glucose intolerance, sexual dysfunction, gastroesophageal reflux, and a series of neuropsychiatric^[1]and cerebrovascular diseases. Polysomnogram (PSG) surveillance is currently the best means to diagnose this disease. OSAS is characterized by repeated hypopnea and apnea during sleep, resulting in disordered sleep structure, increased nocturnal awakening times and micro-awakening index, and hypoxemia and hypercapnia. In recent years, the cognitive dysfunction caused by OSAS has been widely concerned by scholars at home and abroad^{[2,3,4,5,6,7,8]}The most common manifestations are executive function, learning and memory, and delayed recall function. This article reviews the research progress on the characteristics, mechanism, clinical evaluation and treatment of cognitive dysfunction in OSAS patients, so as to provide help for early clinical prevention and treatment.