简介：AbstractBackground:It is still unclear what the minimal infusion volume is to effectively predict fluid responsiveness. This study was designed to explore the minimal infusion volume to effectively predict fluid responsiveness in septic shock patients. Hemodynamic effects of fluid administration on arterial load were observed and added values of effective arterial elastance (Ea) in fluid resuscitation were assessed.Methods:Intensive care unit septic shock patients with indwelling pulmonary artery catheter (PAC) received five sequential intravenous boluses of 100 mL 4% gelatin. Cardiac output (CO) was measured with PAC before and after each bolus. Fluid responsiveness was defined as an increase in CO >10% after 500 mL fluid infusion.Results:Forty-seven patients were included and 35 (74.5%) patients were fluid responders. CO increasing >5.2% after a 200 mL fluid challenge (FC) provided an improved detection of fluid responsiveness, with a specificity of 80.0% and a sensitivity of 91.7%. The area under the ROC curve (AUC) was 0.93 (95% CI: 0.84-1.00, P < 0.001). Fluid administration induced a decrease in Ea from 2.23 (1.46-2.78) mmHg/mL to 1.83 (1.34-2.44) mmHg/mL (P = 0.002), especially for fluid responders in whom arterial pressure did not increase. Notably, the baseline Ea was able to detect the fluid responsiveness with an AUC of 0.74 (95% CI: 0.59-0.86, P < 0.001), whereas Ea failed to predict the pressure response to FC with an AUC of 0.50 (95% CI: 0.33-0.67, P = 0.086).Conclusion:In septic shock patients, a minimal volume of 200 mL 4% gelatin could reliably detect fluid responders. Fluid administration reduced Ea even when CO increased. The loss of arterial load might be the reason for patients who increased their CO without pressure responsiveness. Moreover, a high level of Ea before FC was able to predict fluid responsiveness rather than to detect the pressure responsiveness.Trial registration:ClinicalTrials.gov, NCT04515511

简介：AbstractEndoscopic drainage of pancreatic fluid collections (PFCs) with fewer complications and less trauma has gradually replaced surgery or percutaneous drainage to become the first-line treatment for PFCs. In recent years, the differential efficacy of various stent techniques to drain different types of PFCs has been controversial. This review summarizes the clinical applications of endoscopic ultrasound-guided stent placement for PFCs drainage.

简介：TherevisedAtlantaclassificationofacutepancreatitiswasadoptedbyinternationalconsensus,andisbasedonactuallocalandsystemicdeterminantsofdiseaseseverity.Thelocaldeterminantispancreaticnecrosis(sterileorinfected),andthesystemicdeterminantisorganfailure.Localcomplicationsofpancreatitiscanincludeacuteperi-pancreaticfluidcollection,acutenecroticcollection,pseudocystformation,andwalledoffnecrosis.Interventionalendoscopicultrasound(EUS)hasbeenincreasingutilizedinmanagingtheselocalcomplications.AfterperformingaPubMedsearch,theauthorsmanuallyappliedpre-definedinclusioncriteriaorafiltertoidentifypublicationsrelevanttoEUSandpancreaticcollections(PFCs).Theauthorsthenreviewedtheutility,efficacy,andrisksassociatedwithusingtherapeuticEUSandinvolvedEUSdevicesintreatingPFCs.Duetothedevelopmentandregulatoryapprovalofimprovedandnovelendoscopicdevicesspecificallydesignedfortransmuraldrainageoffluidandnecroticdebris(accessandpatencydevices),theauthorspredictcontinuingevolutioninthemanagementofPFCs.WebelievethatEUSwillbecomeanindispensablepartofproceduresusedtodiagnosePFCsandperformimage-guidedinterventions.AfterdrainingaPFC,theamountoftissuenecrosisisthemostimportantpredictorofasuccessfuloutcome.Hence,itseemslogicaltoclassifythesecollectionsbasedontheirpercentageofnecroticcomponentordebrispresentwhenviewedbyimagingmethodsorEUS.Finally,theauthorsproposeanalgorithmformanagingfluidcollectionsbasedontheirsize,location,associatedsymptoms,internalechogenicpatterns,andcontent.

简介：Osteocytesactasmechanosensorsinbone,whichcansendmechanicalsignalsdirectlytoosteoblaststhroughgapjunctions.However,underphysiologicalconditionsthenumberofgapjunctionsislimitedbecauseofthequantityvarianceofthetwokindsofcells.Inthisstudy,thepossibilityofindirectinteractionbetweenthesetwocellswasinvestigated.Anewflowchamperwasdesignedinwhichosteocytesandosteoblastswerecoculturedintwochampersseparately.OsteocyteswereexposedtofluidflowandthentheALPactivity,osteocalcinandosteopotinofosteoblastsweredetermined.TheresultsshowedthateitherALPactivityorproductionofosteocalcinandosteopotininosteoblaststhatwerecoculturedwithshearedosteocytesincreased,whichindicatedthatosteocytescouldregulateosteoblastsindirectlythroughsomesolublefactors.

简介：Objective:Theexpressionofvascularendothelialgrowthfactor(VEGF)iscorrelatedtotheinvasionandmetastasisoftumorcellsinmanyclinicalcarcinomas.Inthisstudy,wedetectedsolubleVEGFlevelsinascitesandperitonealfluidandexploreditsclinicalsignificance.Methods:Atotalof91sampleswerecollectedanddividedinto5experimentalgroups:petitonealfluidofpatientswithbenign(n=10)andmalignantdisease(n=14),cirrhoticascites(n=36),tuberculousascites(n=8)andmalignantascites(n=23).Usingasandwichenzyme-linkedimmunoadsorbentassay,theconcentrationofsolubleVEGFwasmeasuredinascites(n=67)andpetitonealfluid(n=24).Results:VEGFlevelsinmalignantasciteswere640.74(264.81pg/ml,significantlyhigherthanthoseincirrhoticascites,tuberculousascitesandperitonealfluidofpatientswithbenignandmalignantdisease(P<0.01,separately).However,thedifferenceofVEGFlevelsamongthelatter4groupshadnostatisticsignificance(P>0.05),separately).Furthermore,VEGFlevelsinmalignantascitesfrompatientswithovariancancerwerehigherthanthosewithgastricandcoloncancer(P<0.01,respectively),whiletherewasnosignificantdifferencebetweengastriccancerandcoloncancer(P>0.05).UsingVEGFlevelof118.96pg/mlasaminimumcutofflimit,thesensitivityandspecificityofVEGFofthisassaytodiagnosemalignantasciteswere91.3%and73.9%respectively.Conclusion:TheelevatedlevelsofVEGFmaybeusefulasanindexindifferentialdiagnosisofbenignandmalignantascites.ItappearsthatVEGFplaysanimportantroleinmalignantascitesformation.

简介：Acutepancreatitis(AP)isafrequentdiseasewithdegreesofincreasingseverityresponsibleforhighmorbidity.Despitecontinuousimprovementincare,mortalityremainssignificant.Becausehypovolemia,togetherwithmicrocirculatorydysfunctionleadtopooroutcome,fluidtherapyremainsacornerstoneofthesupportivetreatment.However,poorclinicalevidenceactuallysupporttheaggressivefluidtherapyrecommendedinrecentguidelinessinceavailabledataarecontroversial.Fluidmanagementremainsunclearandleadstocurrentheterogeneouspractice.DifferentstrategiesmayhelptoimprovefluidresuscitationinAP.Ononehand,integrationoffluidtherapyinaglobalhemodynamicresuscitationhasbeendemonstratedtoimproveoutcomeinsurgicalorsepticpatients.Tailoredfluidadministrationafterearlyidentificationofpatientswithhigh-riskofpooroutcomepresentinginadequatetissueoxygenationisamajorpartofthisstrategy.Ontheotherhand,newdecisionparametershavebeendevelopedrecentlytoimprovesafetyandefficiencyoffluidtherapyincriticallyillpatients.Inthisreview,weproposeapersonalizedstrategyintegratingthesenewconceptsintheearlyfluidmanagementofAP.ThisnewapproachpavesthewaytoawiderangeofclinicalstudiesinthefieldofAP.

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简介：BecauseofnoexactnameaboutobesityintraditionalChinesemedicine,clinicallytherehavenounifiedsyndrometypesaboutobesity.Thepresentpaperusestheoriginalsyndromedifferentiationofbodyfluidandselectsclassicalacupunctureandmoxibustionprescriptionstotreatobesity,whichisconducivetofurthersystematizingclassicalacupunctureandmoxibustionprescriptionsandprovidingsufficientbasisforclinicalpopularization.

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简介：AbstractBackground:Recent studies suggest that a healthy diet helps to prevent the development of Alzheimer disease (AD). This study aimed to investigate whether spicy food consumption is associated with cognition and cerebrospinal fluid (CSF) biomarkers of AD in the Chinese population.Methods:We enrolled 55 AD patients and 55 age- and gender-matched cognitively normal (CN) subjects in a case-control study, as well as a cohort of 131 participants without subjective cognitive decline (non-AD) in a cross-sectional study. Spicy food consumption was assessed using the Food Frequency Questionnaire (FFQ). Associations of FFQ scores with cognition and CSF biomarkers of AD were analyzed.Results:In the case-control study, spicy food consumption was lower in AD patients than that in CNs (4.0 [4.0-8.0] vs. 8.0 [4.5-10.0], P < 0.001); FFQ scores were positively associated with Mini-Mental Status Examination scores in the total sample (r = 0.218, P = 0.014). In the cross-sectional study, the association between spicy food consumption and cognition levels was verified in non-AD subjects (r = 0.264, P = 0.0023). Moreover, higher FFQ scores were significantly associated with higher β-Amyloid (1-42) (Aβ42) levels and lower phospho-tau/Aβ42 and total tau/Aβ42 ratios in the CSF of non-AD subjects (P < 0.05).Conclusion:Spicy food consumption is closely related to higher cognition levels and reversed AD biomarkers in the CSF, suggesting that a capsaicin-rich diet might have the potential to modify the cognitive status and cerebral pathologies associated with AD.

简介：AbstractObjective:To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.Methods:Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.Results:In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery.Conclusion:Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.

简介：开发shear变瘦代替血的非牛顿的液体在自从血是展出的shear变瘦nonNewtonian液体，设计的biomedicine的研究是合乎需要的粘滞、有弹性性质，并且通常在大体积不可得到。有不同集中和温度的水的Xanthan口香糖的rheological性质在现在的纸被学习。结果证明水的Xanthan口香糖是显示的非牛顿的液体显著砍变瘦行为并且是合适的血类似物液体。在之间有一种幂定律分发关系砍强调并且砍率，并且答案集中越高，它显示越多强烈砍变瘦行为。有解决方案温度减少或与解决方案集中的水的Xanthan口香糖增加的粘性值在线性增加。而且在37的温度，有0.4和0.6的集中的水的Xanthan口香糖在rheological性质最好匹配人的血。根据重新适合，与温度和concentrition改变的粘性表示被获得，并且Xanthan口香糖答案的稳定性被讨论。

简介：ObjectivePorencephaliccystpresentingwithotologicinvolvementisuncommon.Onlyafewcaseshavebeenreported.Wereportararecaseofcerebrospinalfluid(CSF)otorrheacausedbyamassiveporencephaliccystencompassingthelefttemporalandoccipitallobes.TheCSFleakwasrepairedsuccessfullyusingatransmastoidapproachwithfacia,abdomenfatandfibringluetosealtheosseousdefectsinthesinoduralangle.AreviewoftheliteratureconcerningporencephaliccystandCSFotorrheaisalsopresented.

简介：Invitrocellloadingexperimentsareusedtoinvestigatestimulationofstraintocellularproliferation.Astheflowingconditionsofculturefluidinloadingsystemshasbeenlittleknown,strictlypeoplecannotdetecttheinfluenceofstraintocellularproliferationexactlybecauseshearflowcanenhancecellproliferationeither.Basedontheworkingprincipleandcyclicloadingparameters,wesimplifyNavier-Stokesequationtodescribetheflowofculturefluidonsubstratesofuniaxialandequi-biaxialfiattensileloadingsystemsandfourpointbendingsystem.Withapproximatesolutions,thedistributionsofvelocityfieldandwallshearflowtocellsaregained.Resultsshow:shearflowsarezerointhemiddle(orfixedpointorline)ofsubstrateforallsystems,andtheygetlargerproportionallytodistancefrommiddleandsubstrateelongate;theshearflowonthesubstrateoffourpointbendingsystemismuchgreaterthanthoseofothers.Thisshearflowinfourpointbendingsystem,confirmedbyOwan,I.,etalwithOPNmRNAincreaseintheirexperiment,couldcausemoreinfluencetoosteoblast-likecellsthanthatcausedbystrain.WeestimatetheaveragemagnitudeofshearstressinOwan'sdevice,theresultsareconsistentwithotherexperimentaldataaboutshearflow.Inconclusionourstudymakesitpossibletodifferentiatetheinfluenceofstrainoncellularproliferationtothatofshearflowinloadingexperimentswiththedevicesmentionedabovequantitatively.

简介：AbstractObjective:To describe and assess the repair technique and perioperative management for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture via extradural anterior skull base approach.Methods:This was a retrospective review conducted at the Department of Neurosurgery of the Shanghai Tenth People's Hospital from January 2015 to April 2020. Patients with traumatic CSF rhinorrhea resulting from extensive anterior skull base fracture treated surgically via extended extradural anterior skull base approach were included in this study. The data of medical and radiological records, surgical approaches, repair techniques, peritoperative management, surgical outcome and postoperative follow-up were analyzed. Surgical repair techniques were tailored to the condition of associated injuries of the scalp, bony and dura injuries and associated intracranial lesions. Patients were followed up for the outcome of CSF leak and surgical complications. Data were presented as frequency and percent.Results:Thirty-five patients were included in this series. The patients’ mean age was 33 years (range 11-71 years). Eight patients were treated surgically within 2 weeks; while the other 27 patients, with prolonged or recurrent CSF rhinorrhea, received the repair surgery at 17 days to 10 years after the initial trauma. The mean overall length of follow-up was 23 months (range 3-65 months). All the patients suffered from frontobasal multiple fractures. The basic repair tenet was to achieve watertight seal of the dura. The frontal pericranial flap alone was used in 20 patients, combined with temporalis muscle and/or its facia in 10 patients. Free fascia lata graft was used instead in the rest 5 patients. No CSF leak was found in all the patients at discharge. There was no surgical mortality in this series. Bilateral anosmia was the most common complication. At follow-up, no recurrent CSF leak or meningitis occurred. No patients developed mucoceles, epidural abscess or osteomyelitis. One patient ultimately required ventriculoperitoneal shunt because of progressive hydrocephalus.Conclusion:Traumatic CSF rhinorrhea associated with extensive anterior skull base fractures often requires aggressive treatment via extended intracranial extradural approach. Vascularized tissue flaps are ideal grafts for cranial base reconstruction, either alone or in combination with temporalis muscle and its fascia—fascia lata sometimes can be opted as free autologous graft. The approach is usually reserved for patients with traumatic CSF rhinorrhea in complex frontobasal injuries.

简介：AIM:Toinvestigatewhethergenemethylationintheperitonealfluid(PF)predictsperitonealrecurrenceingastriccancerpatients.METHODS:ThegenemethylationofCHFR(checkpointwithforkheadandringfingerdomains),p16,RUNX3(runt-relatedtranscriptionfactor3),E-cadherin,hMLH1(mutLhomolog1),ABCG2(ATP-bindingcassette,sub-familyG,member2)andBNIP3(BCL2/adenovirusE1B19kDainteractingprotein3)wereanalyzedin80specimensofPFbyquantitativemethylation-specificpolymerasechainr...

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简介：人人都渴望有一副健壮的身体和青春靓丽的容颜，有的人甚至不惜花高昂的费用进美容院或购买一些强身、健体的保健用品。殊不知，在日常生活中，如果我们将一些普通的健美方法按月份或季节进行循序渐进的锻炼，竟也会收到意想不到的效果。

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