2018年 · 第98卷第47期

Polysomnography is an examination technique that uses polysomnography to collect, record and analyze multiple sleep physiological parameters and pathological events continuously and simultaneously in sleep monitoring room. In recent years, the application of polysomnography technology in China is increasing day by day, and it has been carried out in different clinical departments of medical institutions at all levels, but its standardized application still faces challenges. In response to this, the Sleep Disorder Professional Committee of the Neurologist Branch of the Chinese Medical Association initiated and invited relevant experts together with the Sleep Disorder Professional Committee of the Chinese Sleep Research Association and the Sleep Disorder Group of the Neurology Branch of the Chinese Medical Association to launch the "Chinese Adult Polysomnography Technology Operation Specification and Clinical Application Expert Consensus"^[1]In order to further standardize the clinical application of polysomnography technology in China and promote the exchange and development of sleep medicine in China.

Talk to the patient and/or family members, inform them in detail about the necessity, expected efficacy, possible complications and risks during and after surgical procedures, obtain the consent of the patient (or) guardian, and sign the informed consent form for TACE treatment.

Qualitative diagnosis of intracranial lesions is the prerequisite for choosing treatment, and qualitative diagnosis mainly depends on pathological diagnosis, which is also the most direct and final diagnosis result. Although advanced imaging technology is of great significance in the diagnosis of intracranial lesions, there are still some lesions that cannot be diagnosed by imaging characteristics because of their atypical imaging manifestations, and pathological diagnosis can only be made by biopsy or surgery.

With the gradual improvement of the understanding of sleep diseases in modern medicine, sleep monitoring technology has been widely used in clinical departments such as neurology, respiratory department, otolaryngology department, stomatology department and psychiatry department. As an important tool in clinical and scientific research of sleep medicine, the value of polysomnography technology has been paid more and more attention. In order to further clarify the scope of clinical indications of polysomnography technology in China, standardize the operation process, and unify the diagnostic terminology and reporting form, the Sleep Disorder Professional Committee of Neurologist Branch of Chinese Medical Physicians Association initiated and together with the Sleep Disorder Professional Committee of China Sleep Research Association and the Sleep Disorder Group of Neurology Branch of Chinese Medical Association, invited relevant experts from the mainland and Hong Kong, China, to form the "Expert Committee on Operating Specifications and Clinical Application of Polysomnography Technology for Adults in China" for in-depth discussion. With appropriate reference to relevant foreign specifications, and on the basis of extensive solicitation of opinions, we jointly discussed and wrote the "Expert Consensus on Operating Specifications and Clinical Application of Polysomnography Technology for Adults in China".

Since 1992 Roviaro et al.^[1]It is reported that since the first complete laparoscopic anatomical lobectomy, video-assisted thoracoscopic surgery (VATS) has made a leap forward. The American Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) shows that the percentage of anatomical lung resections (lobectomy and segmentectomy) in VATS increased from 8% in 2003 to 30% in 2013^[2]。 Due to the "minimally invasive" characteristics of VATS, the trauma of traditional thoracotomy is greatly reduced, such as mild postoperative pain degree and quick relief, little impact on shoulder joint function, better protection of lung function, reduction of postoperative trauma factors, better protection of immune function, obvious improvement of patients' postoperative quality of life and rapid recovery^{[3,4,5,6,7,8,9,10,11,12]}。 Previously, the application of VATS lobectomy in the treatment of lung cancer has been controversial, but under the premise of strictly mastering the indications, it still reflects the great advantage of minimally invasive and becomes one of the important means of diagnosis and treatment of lung cancer^[13]。 With the continuous development of minimally invasive surgical techniques and instruments, the accumulation of surgical experience and the emergence of reports of good long-term survival rate of surgical patients, the surgical mode of lung cancer began to change. In 2006, the guidelines for lung cancer treatment issued by the National Comprehensive Cancer Network (NCCN) in the United States began to propose that VATS lobectomy is a feasible option for resectable lung cancer, and preliminarily clarified the position of VATS in the surgical treatment of lung cancer; The latest NCCN guidelines in 2018 clearly state that VATS is the recommended surgical method for resectable lung cancer^[14]。 At present, VATS lobectomy has basically become mature and widely recognized, and its surgical technique is gradually refined and improved day by day.

Delirium is an acute fluctuating brain dysfunction caused by many reasons, mainly manifested as cognitive impairment, sleep-wake cycle disturbance, mood change and psychomotor abnormalities^[1]。 According to the alertness and psychomotor characteristics of patients, delirium is divided into three types: low-activity, high-activity and mixed^[2]。 Senile delirium is a cerebral organic syndrome caused by various diseases in the elderly, mostly caused by surgery, infection, cerebrovascular disease, metabolic disorders, ventilator application and intensive care unit (ICU) environment^[3,4]。 After delirium, the mortality, hospital stay and cost of patients increased significantly, which affected the long-term cognitive function and quality of life of patients^[4,5]。 At present, there are no effective and safe interventions in the prevention and treatment of delirium, mainly because the pathogenesis of delirium is not clear. Current studies suggest that some serological substances change during the development of delirium, which may be predictive factors and therapeutic targets of delirium. This article mainly summarizes the literature and discusses the serological markers that may change during the development of delirium, so as to provide clues for exploring the mechanism and diagnosis and treatment of delirium in the future.

prostacyclin (PGI₂) is an important metabolite formed by cyclooxygenase (COX) pathway of arachidonic acid, and is one of the members of the prostaglandin family that regulates the vascular system to make it in dynamic equilibrium. PGI₂Can act on platelet precursors, endothelial cells, vascular smooth muscle cells (VSMCs), and megakaryocytes, thereby exerting their role in dilating blood vessels, inhibiting platelet aggregation, and proliferation and differentiation of vascular smooth muscle cells^[1,2]。 Clinical PGI₂The analogues can activate downstream signaling pathways by interacting with type I prostaglan membrane receptors (IP) and peroxisome proliferator-activated receptors (PPARs), exert pharmacological effects such as anti-platelet and vasodilating, and then achieve the effects of improving ischemic symptoms, protecting damaged blood vessels, delaying the progression of atherosclerosis and reducing thrombosis^[3]。 The purpose of this article is to analyze the pharmacological mechanism of prostacyclin and its analogues and discuss its application in arterial occlusive diseases.