2018年 · 第98卷第40期

Having been engaged in anesthesia for many years, I often hear some different voices about the decision-making of geriatric orthopedic surgery. Because the combined diseases are not well controlled, "the risk is too great, the operation is suspended, and the preoperative preparation is further strengthened" (withdrawal), and there are also cases of "the earlier the operation, the better the patient's prognosis" and "the conditions have no conditions to create opportunities" (advancement). How should we make scientific decisions?

The widespread application of enhanced recovery after surgery (ERAS) can effectively improve surgical safety, shorten hospital stay and reduce medical expenses^[1]。 However, in clinical practice, despite standardized preoperative nutritional intervention to correct malnutrition according to the requirements of the guidelines, it is still difficult for these patients to reach the goals of ERAS. We can't help but ask why? With regard to these questions, I would like to talk about the following views for my fellow peers' reference.

The scapula is a triangular flat bone located behind the thorax, and the front and back are surrounded by muscles. Therefore, scapula fracture is not common. However, with the rapid development of transportation industry, the incidence of scapula fracture caused by high energy injury has increased significantly^[1]。 Patients with scapular fracture are associated with obvious displacement of the fracture end and various degrees of combined injuries, including rib fracture, clavicle fracture, hemopneumothorax, brain contusion, skull fracture, proximal injury of upper limb, spinal fracture and spinal cord injury. The mortality rate of scapular fracture is 10% ~15%, and the death causes are mostly lung infection and head injury^[2,3,4]。 Body fractures of scapula with obvious displacement or angular deformity need surgical treatment, and general anesthesia is mostly used clinically^[5]。 At present, there are no reports of simple nerve block for scapular fracture surgery at home and abroad. The clinical data and anesthesia management of two cases of scapular fracture undergoing open reduction and internal fixation with simple nerve block in our hospital are retrospectively analyzed as follows.

A 47-year-old female was admitted to Peking Union Medical College Hospital on January 4, 2018 due to "dry mouth and eyes for 7 years, increased nocturia for 3 months, fatigue and multiple bone pain throughout the body for 1 month". The patient began to have dry mouth, dry eyes and flaky tooth loss 7 years ago. In the past 7 years, the denture was gradually replaced, and photosensitivity gradually developed, which was not diagnosed and treated. In the past six months, I feel that the above symptoms have obviously aggravated, without tears, and I need to take water when I eat dry food. In the past 3 months, nocturia increased with polydipsia, 6-7 times/night, without urgency and painful urination. One month ago, there was fatigue, pain in both lower limbs, pain when moving the right hip joint, squat and stand up, and difficulty climbing stairs; At the same time, there was pain in the right hypochondrium, which was obvious when the position was changed, and the pain numerical score (NRS) score was 6 to 7 (0 to 10). In the past 1 week, the pain site was shifted to the right to the axillary line position. Visit our hospital for further diagnosis and treatment. The patient denied skin rash, oral and vulvar ulcers. Since the disease, there has been no obvious change in appetite, constipation in the past 3 months, defecation once in about 5 to 6 days, and weight loss of about 5 kg. Past history, personal history, marriage, childbirth, menstrual history, and family history are no different.

A 38-year-old female was admitted to the Department of Internal Medicine, Jinshan Campus, Fujian Provincial Hospital on September 26, 2017 due to proteinuria found in physical examination for 1 month. Physical examination 1 month ago found urine routine: protein + +, occult blood + + +, red blood cells 16/μ L; Blood routine: white blood cells 5.21×10⁹/L, hemoglobin 88 g/L, platelets 152×10⁹/L; Blood biochemistry: albumin 35.4 g/L, urea nitrogen 8.45 mmol/L, serum creatinine 139 μ mol/L, uric acid 557.2 μ mol/L. There were no edema, oliguria, low back pain, macroscopic hematuria, rash, joint pain and oral ulcer. No previous special medical history. Personal History: Resident in Singapore, Housewives, No toxic and chemical exposure history. Have 1 son. Diagnosis: proteinuria to be examined, moderate anemia.

Diabetes is one of the earliest described diseases, but people's perception of it is long and tortuous. As early as 1500 BC, a manuscript from Egypt has written accounts of similar clinical manifestations of diabetes. In his book, Aretaeus of Cappadocia, an ancient Greek physician in the 2nd century BC, described the symptoms of diabetic patients and proposed the term diabetes. In the late 18th century, the British scholar John Rolle added "mellitus" (that is, "derived from honey") after diabetes. In this way, an ancient disease was given a new name-diabetes mellitus^[1]。

Inflammatory complex is a protein complex composed of various proteins in cells, which mainly exists in the cytoplasm of myeloid cells such as monocytes and macrophages. Its concept was first developed by Martinon et al.^[1]Proposed in 2002. The inflammatory complex is one of the fundamental units of the structure and function of the innate immune system, which can recognize or sense pathogen/injury-related molecular patterns, activate interleukin (IL) 1 β and IL-18, and mediate a range of immune responses^[2]。 The biological behavior of multiple tumors is associated with activated inflammatory complexes. Overexpression and sustained activation of nucleotide-binding oligomerization domain-like receptor family thermoprotein domain protein 3 (NLRP3) inflammasomes in melanoma and brain malignant gliomas suggest continued tumor progression^[3]。 This paper reviews the role of inflammatory complex in hematological malignancies and its research progress.

Uterine arteriovenous malformation (UAVM) refers to abnormal communication between the branches of the uterine artery and the uterine venous plexus that does not occur through the capillary network. The typical clinical manifestation of UAVM is irregular and uncontrollable massive vaginal bleeding without obvious inducement. If not treated in time, it can be life-threatening in severe cases^[1]。 UAVM accounts for 1% to 2% of reproductive system hemorrhage-related diseases^[2]。 UAVM can be divided into two types: congenital and secondary. Congenital UAVM is extremely rare. Due to the abnormal development of the primitive vascular structure in the embryonic period, the primitive plexiform structure persists, thus forming various arteriovenous malformations of different numbers and sizes^[3,4]。

On August 3-4, 2018, the 13th National Clinical Forum on the Diagnosis and Treatment of Helicobacter Pylori and Digestive Diseases and the 2nd National Summit Forum on the Integration of Traditional Chinese and Western Medicine of Helicobacter Pylori and Gastrointestinal Ecology were held in Beijing. Professor Hu Fulian of Department of Gastroenterology, Peking University First Hospital served as the chairman of the conference, and Professor Wang Huahong served as the executive chairman. The core contents of the conference are: (1) the release and interpretation of the National Consensus on the Integrated Treatment of Helicobacter Pylori-Related Diseases and Syndromes with Traditional Chinese and Western Medicine; (2) Advances in new therapeutic pathways for Helicobacter pylori; (3) 2018 Helicobacter Pylori Youth Forum and Case Sharing.