2017年 · 第97卷第29期

Critical blood purification is a concept both familiar and unfamiliar. Blood purification is often used in the rescue of critically ill patients, but so far, there is no comprehensive and systematic explanation of the concept of critically ill blood purification. After years of theoretical development and clinical practice, severe blood purification has developed into not only a technology, but a scientific system with distinctive characteristics in basic theory, clinical application principles and methods, and treatment implementation rules.

A 59-year-old male was admitted to Henan Provincial People's Hospital on November 14, 2016 with a sudden headache for 17 days as the main complaint. The admission mRS score was 1, mainly showing memory loss and slightly less speech. Cranial CT scan and head and neck vascular CTA on October 29, 2016 showed vascular malformation of left frontoparietotemporal lobe and insular hematoma (Figure 1)。 On November 7, 2016, the DSA of a foreign hospital confirmed the existence of AVM. The blood supply artery supplied blood from the left Heubner returning artery and multiple branches of the left middle cerebral artery. The malformation was single-drained into the superior sagittal sinus through the frontal cortical vein (Figure 2), Spetzler-Martin Class IV. There was no previous history of hypertension, with mean arterial pressure around 90 mmHg (1 mmHg =0.133 kPa) and systolic blood pressure around 120 mmHg. On November 16, 2016, CT reexamination showed that the hematoma was not completely absorbed and accompanied by a large low density area. Considering the edema zone, after 1 week of dehydration treatment, CT reexamination showed that the hematoma was not completely absorbed and the low density area was not significantly reduced (Figure 3)。 After a multidisciplinary consultation, embolization from the venous route was recommended for the treatment of arteriovenous malformations. Cerebral arteriovenous malformation embolization was performed under general anesthesia on 23 November 2016 after obtaining the consent of the patient, his family and the hospital ethics committee. A 6F sheath was placed on the right femoral artery, and a Sonic embolization catheter (Balt Extrusion, France) was attempted to enter the thicker supply artery with a Navien guide catheter (Medtronic, USA) and a Traxcess microwire (Microvention, USA).FIG. 4A) after failure into a small supply artery (FIG. 4B)。 Then, ultrasound-guided right internal jugular vein puncture was performed and 6F sheath was inserted in reverse direction, and Sonic embolization catheter was introduced from the venous end into the malformed nest with the cooperation of Navien guide catheter and Traxcess microwire (Figure 4C), an Echelon embolization catheter (Medtronic, USA) was introduced into the drainage vein near the deformity nest (Figure 4D)。 A malformed supply artery was first occluded from the arterial end along a Sonic catheter using a non-adhesive embolic agent ONXY-18 glue (Microvention, USA)Figure 4E)。 The patient's mean arterial pressure was then reduced and maintained at 50-55 mmHg, and then a 5 mm ×15 cm Axium coil was introduced from the venous end along the Echelon embolization catheter to loosely pack the draining vein (Figure 4F), and finally the malformed nest was embolized with ONXY-18 glue from the venous end along the Sonic catheter (Figure 4G), during which the embolism was intermittently verified from the end of the artery until the deformity nest completely disappeared (Figure 4HAndFIG. 4I)。 Immediately after operation, DYNA-CT showed a high-density band around the low-density band (Figure 4J)。 After operation, he was transferred to the neurological care unit, where the mean arterial pressure was maintained at 50-60 mmHg, and the systolic blood pressure was lower than 100 mmHg, and adjuvant dehydration and glucocorticoid treatment. On November 22, 2016, a physical examination occasionally showed nominal aphasia. Before Yu Tong surgery, CT reexamination showed abnormal high-density areas (FIG. 5A)。 Upon discharge on Nov. 30, 2016, CT revealed that abnormal high density areas still existed (FIG. 5B), the change was not obvious compared with the previous, the patient's mRS score was 1, and the symptoms were not aggravated.

reflex epilepsy is clinically rare, accounting for about 5% of all epilepsy patients^[1]It refers to epilepsy triggered by repeated, fixed and clear perceptual or cognitive stimulation. It is mostly caused by various sensory stimuli such as vision, hearing, smell, taste, somatic sensation, visceral sensation and mental stimulation. Idiopathic or symptomatic epilepsy can occur, and the former is more common^[2,3]。 As a special class of epilepsy^[3]This paper summarizes the predisposing factors, clinical manifestations and pathophysiology of reflex epilepsy, so as to improve the accuracy of its diagnosis clinically.

For a long time, in rheumatoid arthritis (RA), B cells are commonly considered to be one of the pathogenic cells that produce high-affinity, specific autoantibodies and induce T cell activation^[1]。 In recent years, a class of B cells with immunomodulatory function has received more and more attention in the etiology of RA. Regulatory B cells are a kind of B cells that play negative regulatory functions and maintain immune tolerance of the body. Among them, B cells that secrete interleukin-10 (IL-10) are the most concerned regulatory B cells at present^[2]which inhibits the production of proinflammatory cytokines by secretion of IL-10 and promotes the differentiation of regulatory T cells (Treg)^[3], play the negative immune regulatory function, so some scholars call them regulatory B cells (Breg), B10 or B cells that secrete IL-10. However, so far, the naming has not been unified. In this article, these cells are temporarily called regulatory B cells. The study confirmed that regulatory B cells were altered in both number and function in RA^[4,5], in a collagen-induced arthritis (CIA) model, adoptive transfer of regulatory B cells can alleviate arthritis in mice^[6]。 Therefore, regulatory B cells may play an important role in the development of RA. Therefore, a deep understanding of regulatory B cells will not only help to further clarify the pathogenesis of RA, but also open up new ideas for seeking new strategies for RA treatment. The research progress of regulatory B and its in RA is summarized as follows.

Starting the emergency system (EMS) to take immediate pre-hospital and in-hospital emergency measures for patients with acute coronary syndrome (ACS). Shortening the total myocardial ischemia time and saving the dying myocardium are the most important clinical measures.

Three-dimensional images can be quickly converted into real models, which can be applied to preoperative diagnosis, simulated surgery, intraoperative navigation, and customized implants, so as to optimize preoperative design, improve surgical accuracy and reduce postoperative complications. This paper reviews the clinical application status of 3D digital printing technology in trauma and orthopedics, anatomical model printing, surgical instrument design and internal implant customization.