Tumor maligno de la vaina nerviosa periférica: reporte de un caso / Malignant peripheral nerve sheath tumor, a case report

Resumen El tumor maligno de la vaina nerviosa periférica (TMVNP) es un sarcoma de alto grado de malignidad. Es poco frecuente, agresivo y generalmente se localiza en tronco y miembros inferiores. Se presenta mayormente en pacientes con neurofibormatosis tipo 1, aunque no siempre se encuentra esta asociación. Este tumorcomparte características histológicas e inmunohistoquímicas con el melanoma, lo que puede dificultar el diagnóstico. Presentamos el caso de un paciente con TMVNP, en el cual los hallazgos histológicos iniciales condujeron a un diagnósticoerróneode melanoma.

Abstract Malignant peripheral nerve sheath tumor (MPNST) is a high-grade sarcoma. It is rare, aggressive and generally located on the trunk and lower limbs. It occurs in a high percentage of patients with neurofibormatosis type 1, although this association is not always found. This tumor shares histological and immunohistochemical characteristics with melanoma, which can make diagnosis difficult. We present the case of a patient with MPNST, in whom the initial histological findings led to an erroneous diagnosis of melanoma.

Application value of ultrasonic measurement of optic nerve sheath diameter and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococcal meningitis / 重庆医学

Objective To explore the application value of ultrasonic measurement of optic nerve sheath diameter(ONSD)and cerebral blood flow parameters in intracranial hypertension caused by AIDS cryptococ-cal meningitis.Methods A total of 27 patients with cryptococcal meningitis diagnosed by Chongqing Public Health Medical Center from February to July,2022 were included.All patients were examined with ultrasound measurement of ONSD and ultrasound measurement of cerebral blood flow of intracranial middle cerebral ar-tery(MCA),including peak systolic velocity(PSV),end diastolic velocity(EDV),peak systolic velocity/end diastolic velocity(S/D)and resistance index(RI),and then lumbar puncture was performed and intracranial pressure(ICP)was recorded.The ICP≥200 mmH2O was defined as the ICP increased group,ICP＜200 mmH2O was defined as the ICP normal group,and 17 AIDS patients without complications were selected as the control group.The baseline data,ONSD and MCA cerebral blood flow parameters of the three groups were compared,and the statistically significant indexes were correlated with ICP,and the receiver operating charac-teristic(ROC)curve of the subjects was drawn to analyze the diagnostic efficacy of ONSD value in predicting intracranial hypertension caused by AIDS cryptococcal meningitis.Results There were no significant differ-ences in gender,age,systolic blood pressure or diastolic blood pressure among the ICP increased group,the ICP normal group and the control group(P＞0.05).There were no significant differences in PSV,EDV,S/D and RI among the three groups of MCA(P＞0.05),but there was significant difference in ONSD among the three groups(P＜0.05).There was a positive correlation between ICP and ONSD in the patients with AIDS cryptococcal meningitis(P＜0.01,r=0.736).The ROC curve analysis showed that when the ONSD cutoff value was 3.965 mm,it predicted the highest efficacy of intracranial high pressure in the patients with AIDS cryptococcal meningitis.The area under the ROC curve was 0.90(95％CI:0.714-1.000,P=0.001),the sensitivity was 90％,and the specificity was 100％.Conclusion Ultrasonic measurement of ONSD can effec-tively predict ICP in patients with AIDS cryptococcal meningitis and guide clinical decompression measures in time,which is worthy of clinical application.

Value of ultrasonic measurement of the ratio of optic nerve sheath diameter to eyeball transverse diameter in the diagnosis and prognosis of intracranial hypertension in patients with craniocerebral trauma / 中国医师进修杂志

Objective:To investigate the value of ultrasonic measurement of the ratio of optic nerve sheath diameter (ONSD) to eyeball transverse diameter(ETD) in the diagnosis and prognosis of intracranial hypertension in patients with craniocerebral trauma.Methods:A total of 120 patients with craniocerebral trauma treated in the Xingtai General Hospital of North China Medical and Health Group from December 2021 to January 2023 were perspectively selected, and they were divided into normal intracranial pressure group (73 cases) and intracranial hypertension group (47 cases) according to the results of intracranial pressure measurements, and the intracranial hypertension group was divided into good prognosis group (20 cases) and poor prognosis group (27 cases) according to the follow-up prognosis. The efficacy of ONSD, ETD and ONSD/ETD in intracranial hypertension diagnosis and prognosis assessment were analyzed by receiver operating characteristic (ROC) curve. Kaplan-Meier method was used to evaluate the 6-month risk of adverse prognosis of patients, and the comparison was made by Log-rank test.Results:The levels of intracranial pressure, ONSD, ONSD/ETD in the normal intracranial pressure group were lower than those in the intracranial hypertension group: (130.73 ± 23.63) mmH 2O (1 mmH 2O = 0.009 8 kPa) vs. (270.11 ± 35.78) mmH 2O, (5.47 ± 0.29) mm vs. (5.78 ± 0.44) mm, 0.246 ± 0.018 vs. 0.263 ± 0.018, there were statistical differences ( P<0.05). The scores of Glasgow Coma Scale (GCS), intracranial pressure, ONSD, ONSD/ETD in the good prognosis group were lower than those in the poor prognosis group: (5.50 ± 1.24) scores vs. (6.41 ± 1.34) scores, (256.15 ± 30.23) mmH 2O vs. (280.44 ± 36.56) mmH 2O, (5.62 ± 0.40) mm vs. (5.90 ± 0.44) mm, 0.254 ± 0.014 vs. 0.270 ± 0.017, there were statistical differences ( P<0.05). ROC curve analysis results showed that the area under the curve (AUC) of ONSD and ONSD/ETD for diagnosing intracranial hypertension in patients with craniocerebral trauma were 0.718 and 0.765, respectively, and the critical values were 5.87 mm and 0.263, respectively. The AUC of ONSD and ONSD/ETD predicting prognosis of intracranial hypertension patients was 0.677 and 0.763, respectively, and the critical values were 5.90 mm and 0.267, respectively. Grouped by the threshold of ONSD/ETD for the prognosis of intracranial hypertension (0.267), the incidence of adverse prognosis in ONSD/ETD > 0.267 group was higher than that in the ONSD/ETD≤0.267 group, there was statistical difference ( P<0.05). Conclusions:ONSD/ETD can be used as an index for diagnosis and prognosis of intracranial hypertension.

Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks

SUMMARY OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Abstract Background: Positive end-expiratory pressure (PEEP) can overcome respiratory changes that occur during pneumoperitoneum application in laparoscopic procedures, but it can also increase intracranial pressure. We investigated PEEP vs. no PEEP application on ultrasound measurement of optic nerve sheath diameter (indirect measure of increased intracranial pressure) in laparoscopic cholecystectomy. Methods: Eighty ASA I-II patients aged between 18 and 60 years scheduled for elective laparoscopic cholecystectomy were included. The study was registered in the Australian New Zealand Clinical Trials (ACTRN12618000771257). Patients were randomly divided into either Group C (control, PEEP not applied), or Group P (PEEP applied at 10 cmH20). Optic nerve sheath diameter, hemodynamic, and respiratory parameters were recorded at six different time points. Ocular ultrasonography was used to measure optic nerve sheath diameter. Results: Peak pressure (PPeak) values were significantly higher in Group P after application of PEEP (p = 0.012). Mean respiratory rate was higher in Group C at all time points after application of pneumoperitoneum (p < 0.05). The mean values of optic nerve sheath diameters measured at all time points were similar between the groups (p > 0.05). The pulmonary dynamic compliance value was significantly higher in group P as long as PEEP was applied (p = 0.001). Conclusions: During laparoscopic cholecystectomy, application of 10 cmH2O PEEP did not induce a significant change in optic nerve sheath diameter (indirect indicator of intracranial pressure) compared to no PEEP application. It would appear that PEEP can be used safely to correct

Ecografía de nervio óptico para estimar hipertensión intracraneal en pacientes adultos con neurotrauma / Optic Nerve Ultrasound to Estimate Intracranial Hypertension in Adult Patients with Neurotrauma

Introducción: El neurotrauma es una condición que puede dar paso a una hipertensión intracraneana, situación que es muy grave. Los métodos diagnósticos de elección son los invasivos, aun así, los no invasivos y entre ellos la ecografía del nervio óptico, ofrecen muchísimas ventajas. Objetivo: Describir elementos esenciales de la ecografía de nervio óptico como método para diagnosticar hipertensión intracraneal en pacientes adultos con neurotrauma. Métodos: Se hizo una revisión de la literatura más reciente sin restricción lingüística o geográfica en las bases de datos PubMed y SciELO, se usaron términos afines al tema del artículo y se realizó una valoración crítica sobre la bibliografía consultada. Resultados: La literatura disponible sobre la ecografía del nervio óptico en la determinación de la hipertensión intracraneal es abundante y la mayoría apunta a sus beneficios como método no invasivo. La principal debilidad del mismo es que no es capaz de dar un valor exacto y esto se debe a que el valor normal del diámetro de la vaina del nervio óptico por cada persona puede variar significativamente. La proporción directa entre el diámetro de la vaina del nervio óptico y la presión intracraneal es un hecho que ningún autor intenta invalidar. Conclusiones: La ecografía del nervio óptico es un método seguro, accesible económicamente, no invasivo, fácil de usar y con un valor predictivo confiable para determinar la hipertensión intracraneal(AU)

Introduction: Neurotrauma is a condition that can lead to intracranial hypertension, which is a very serious situation. The diagnostic methods of choice are the invasive ones, even so, the non-invasive ones offer many advantages, the ultrasound of the optic nerve is among them. Objective: To describe essential elements of optic nerve ultrasound as a method to diagnose intracranial hypertension in adult patients with neurotrauma. Methods: A review of the most recent literature was made without linguistic or geographical restrictions in databases such as PubMed and SciELO, terms related to the theme of the manuscript were used. A critical assessment of the consulted bibliography was made. Results: The available literature on optic nerve ultrasound in the determination of intracranial hypertension is abundant and most points to the benefits as a non-invasive method. However, its main weakness lies in the fact that it is not capable of giving an exact value, due to the fact that the normal value of the diameter of the optic nerve sheath for each person can vary significantly. The direct relationship between optic nerve sheath diameter and intracranial pressure is a fact that no author attempts to invalidate. Conclusions: Optic nerve ultrasound is a safe, affordable, non-invasive, easy-to-use method with a reliable predictive value to determine intracranial hypertension(AU)

Hematoma espontáneo de la vaina de los rectos en paciente con COVID-19 y leucemia mieloide crónica. Reporte de un caso clínico y revisión de la literatura

Introducción: El hematoma de la vaina de los rectos es poco frecuente. En este reporte se presenta un caso clínico de este cuadro en un paciente con neumonía por COVID-19 y leucemia mieloide crónica, junto con una revisión de literatura. Caso Clínico: Paciente masculino de 55 años, hospitalizado por neumonía por COVID-19 y leucemia mieloide crónica, presenta taquicardia, hipotensión y aumento de volumen abdominal asimétrico. En la tomografía computarizada se evidencia un hematoma de la vaina de los rectos. Se realiza drenaje quirúrgico y control del sangrado. No presentó complicaciones postoperatorias ni necesidad de reoperación. Discusión: Las complicaciones hemorrágicas en pacientes con COVID-19 están poco descritas. El sangrado es una posible complicación en pacientes con leucemia mieloide crónica. Es relevante tener en cuenta el hematoma de la vaina de los rectos en pacientes con COVID-19 y/o leucemia mieloide crónica que presenten aumento de volumen abdominal, para un manejo precoz por un equipo multidisciplinario. Conclusión: La vigilancia activa y el alto índice de sospecha son clave para identificar posibles complicaciones hemorrágicas en pacientes con COVID-19 y/o leucemia mieloide crónica.

Introduction: Rectus sheath hematoma is a rare entity. This report presents a clinical case of a rectus sheath hematoma in a patient with COVID-19 pneumonia and chronic myeloid leukemia, along with a review of the literature. Case Report: A 55-year-old male patient, hospitalized for COVID-19 pneumonia and chronic myeloid leukemia, presents with tachycardia and hypotension. Computed tomography shows a rectus sheath hematoma. Surgical management was performed to control bleeding and drainage of the hematoma. There were no postoperative complications or need for reoperation. Discussion: Hemorrhagic complications in patients with COVID-19 are seldomly reported. Bleeding is a possible complication in patients with chronic myeloid leukemia. It is important to take into account rectus sheath hematoma in patients with COVID-19 and/or chronic myeloid leukemia who present with abdominal pain, for early management by a multidisciplinary team. Conclusion: Active surveillance and a high index of suspicion are key to identifying potential bleeding complications in patients with COVID-19 and/or chronic myeloid leukemia.

Time-dependent proregenerative effects of exogenous melatonin on the transected sciatic nerve / Efectos proregenerativos dependientes del tiempo de la melatonina exógena en el nervio ciático seccionado

SUMMARY: Microsurgical procedures are the treatment of choice of peripheral nerve injuries, but often fail to reach full functional recovery. Melatonin has neuroprotective actions and might be used as a possible proregenerative pharmacological support. Therefore, the aim of this study was to analyze the time-dependence of the neuroprotective effect of melatonin on the overall fascicular structures of both ends of the transected nerve. Sciatic nerve transection was performed in 34 adult male Wistar rats divided in four groups: two vehicle groups (N=7) treated intraperitoneally for 7 (V7) or 21 (V21) consecutive days with vehicle (5 % ethanol in Ringer solution) and two melatonin groups (N=10) administered intraperitoneally 30 mg/kg of melatonin for 7 (M7) or 21 (M21) consecutive days. At the end of the experiment, proximal stump neuroma and distal stump fibroma were excised and processed for qualitative and quantitative histological analysis. Intrafascicular neural structures were better preserved and the collagen deposition was reduced in the melatonin treated groups than in the vehicle groups. Myelin sheath regeneration observed through its thickness measurement was statistically significantly (p<0,05) more pronounced in the M21 (1,23±0,18 µm) vs. V21 group (0,98±0,13 µm). The mean volume density of the endoneurium was lower in both melatonin treated groups in comparison to the matching vehicle treated groups. Although not statistically different, the endoneural tube diameter was larger in both melatonin groups vs. vehicle groups, and the effect of melatonin was more pronounced after 21 days (24,97 % increase) vs. 7 days of melatonin treatment (18,8 % increase). Melatonin exerts a time-dependent proregenerative effect on nerve fibers in the proximal stump and an anti-scarring effect in both stumps.

Los procedimientos microquirúrgicos son el tratamiento de elección de las lesiones de los nervios periféricos, pero a menudo no logran una recuperación funcional completa. La melatonina tiene acciones neuroprotectoras y podría ser utilizada como un posible apoyo farmacológico proregenerativo. Por lo tanto, el objetivo de este estudio fue analizar la dependencia del tiempo del efecto neuroprotector de la melatonina sobre las estructuras fasciculares generales de ambos extremos del nervio seccionado. La sección del nervio ciático se realizó en 34 ratas Wistar macho adultas divididas en cuatro grupos: dos grupos de vehículo (N=7) tratados por vía intraperitoneal durante 7 (V7) o 21 (V21) días consecutivos con vehículo (5 % de etanol en solución Ringer) y dos grupos grupos de melatonina (N=10) a los que se les administró por vía intraperitoneal 30 mg/kg de melatonina durante 7 (M7) o 21 (M21) días consecutivos. Al final del experimento, se extirparon y procesaron el neuroma del muñón proximal y el fibroma del muñón distal del nervio para un análisis histológico cualitativo y cuantitativo. Las estructuras neurales intrafasciculares se conservaron mejor y el depósito de colágeno se redujo en los grupos tratados con melatonina respecto a los grupos con vehículo. La regeneración de la vaina de mielina observada a través de la medición de su espesor fue estadísticamente significativa (p<0,05) más pronunciada en el grupo M21 (1,23±0,18 µm) vs V21 (0,98±0,13 µm). La densidad de volumen media del endoneuro fue menor en ambos grupos tratados con melatonina en comparación con los grupos tratados con vehículo equivalente. Aunque no fue estadísticamente diferente, el diámetro del tubo endoneural fue mayor en ambos grupos de melatonina frente a los grupos de vehículo, y el efecto de la melatonina fue más pronunciado después de 21 días (aumento del 24,97 %) frente a los 7 días de tratamiento con melatonina (18,8 % de aumento). La melatonina ejerce un efecto proregenerativo dependiente del tiempo sobre las fibras nerviosas del muñón proximal y un efecto anticicatricial en ambos muñones.

Malignant peripheral nerve sheath tumor of tongue: a case report / 华西口腔医学杂志

Malignant peripheral nerve sheath tumor (MPNST) is a rare neurogenic malignant tumor. MPNST has aty-pical clinical symptoms and imaging presentations, difficult diagnosis, a high degree of malignancy, and poor prognosis. It usually occurs in the trunk, approximately 20% in the head and neck, and rarely in the mouth. This paper reports a case of MPNST of the tongue. A summary of the clinical features, diagnosis, and treatment of MPNST is presented in combination with a literature review to provide a reference for the diagnosis and treatment of this disease.

A retrospective study on retrograde Intra-renal Surgery with versus without the use of Ureteral Access Sheaths in patients with Nephrolithiasis

INTRODUCTION@#Placement of ureteral access sheath (UAS) prior to retrograde intra-renal surgery (RIRS) is done to provide easier re- entries, shorter operation time and better vision. However, some studies have associated the placement of UAS to increased morbidity and complications.@*OBJECTIVE@#The study aimed to compare outcomes of patients with nephrolithiasis who underwent RIRS with versus without placement of UAS.@*METHODS@#This is a retrospective cohort study among patients with nephrolithiasis who underwent RIRS with or without placement of UAS. The authors analyzed a total of 52 patients who underwent RIRS, 22 without, and 30 with UAS. Comparison of patients’ clinical profile, duration of post-operative hospital stay and the difference of their frequency were determined using Independent Sample T-test, Mann-Whitney U test and Fisher’s Exact test, respectively. STATA 15.0 was used for data analysis.@*RESULTS@#The two groups were similar in terms of clinical profile and operative outcomes. In terms of complications, there was one patient who had a failed surgery in the UAS group. Bleeding was reported in both groups. One-fourth of the patients had abdominal/bladder cramps and 13% had fever. Stone-free rate was 94% at 1 month and 92% at 3 months post-op. Readmission within 3 months was seen in four patients (8%) and retreatment was done on three patients (6%).@*CONCLUSION@#There is no significant difference in placing UAS or not prior to RIRS in terms of clinical profile and operative outcomes. Safety measures should be observed to prevent any bleeding and ureteral injuries during placement of UAS intra-operatively.

Enhancement of oligodendrocyte autophagy alleviates white matter injury and cognitive impairment induced by chronic cerebral hypoperfusion in rats

Cognitive impairment caused by chronic cerebral hypoperfusion (CCH) is associated with white matter injury (WMI), possibly through the alteration of autophagy. Here, the autophagy-lysosomal pathway (ALP) dysfunction in white matter (WM) and its relationship with cognitive impairment were investigated in rats subjected to two vessel occlusion (2VO). The results showed that cognitive impairment occurred by the 28th day after 2VO. Injury and autophagy activation of mature oligodendrocytes and neuronal axons sequentially occurred in WM by the 3rd day. By the 14th day, abnormal accumulation of autophagy substrate, lysosomal dysfunction, and the activation of mechanistic target of rapamycin (MTOR) pathway were observed in WM, paralleled with mature oligodendrocyte death. This indicates autophagy activation was followed by ALP dysfunction caused by autophagy inhibition or lysosomal dysfunction. To target the ALP dysfunction, enhanced autophagy by systemic rapamycin treatment or overexpression of Beclin1 (BECN1) in oligodendrocytes reduced mature oligodendrocyte death, and subsequently alleviated the WMI and cognitive impairment after CCH. These results reveal that early autophagy activation was followed by ALP dysfunction in WM after 2VO, which was associated with the aggravation of WMI and cognitive impairment. This study highlights that alleviating ALP dysfunction by enhancing oligodendrocyte autophagy has benefits for cognitive recovery after CCH.

Effect of Modified Shuyuwan on Hippocampal Myelin Sheath Injury in Vascular Dementia Rats Through Cx43/Glu/AMPAR Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the effect and mechanism of modified Shuyuwan （SYW） on hippocampal myelin sheath injury in vascular dementia （VD） model rats. MethodSixty male SD rats of SPF grade were randomly divided into sham operation group， model group， and high-， medium- and low-dose modified SYW groups， with 12 rats in each group. The VD model was induced by bilateral carotid artery ligation in rats of the groups except for those of the sham operation group. After modeling， rats were screened by the water maze test， followed by drug treatment by gavage. Specifically， rats in the modified SYW groups were treated with modified SYW at 10， 5， 2.5 g·kg-1·d-1， accordingly， and those in other groups were administered with the same amount of normal saline. After intragastric administration for 28 days， the spatial learning and memory abilities of rats were detected by the water maze test. The hippocampal neuron structure was observed by hematoxylin-eosin （HE） staining. The content of hippocampal tumor necrosis factor （TNF）-α， interleukin-6 （IL-6）， and glutamate （Glu） was observed by biochemical detection. The hippocampal expression of myelin basic protein （MBP）， astrocyte activation marker glial fibrillary acidic protein （GFAP）， and connexin 43 （Cx43） was detected by immunofluorescence detection. The myelin sheath structure in the hippocampus was observed by the electron microscope. The α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor （AMPAR） and Cx43 protein expression was detected by Western blot. ResultCompared with the sham operation group， the model group showed prolonged escape latency （P<0.01）， decreased times of crossing the original platform and percentage of target quadrant detention time （P<0.01）， disordered neuron structure in the hippocampal CA1 region， loose myelin sheath lamella with blurry edge， up-regulated expression levels of TNF-α， IL-6， and Glu in the hippocampal CA1 region， especially Glu （P<0.01）， reduced expression of AMPAR （P<0.01）， increased protein expression of p-AMPAR and Cx43 （P<0.01）， significantly dwindled protein expression of MBP in the myelin sheath， and enhanced fluorescence co-labeled by GFAP and Cx43. Compared with the model group， the modified SYW groups showed shortened escape latency （P<0.05）， increased times of crossing the original platform and percentage of target quadrant detention time （P<0.05）， closely arranged hippocampal neuron structure， denser myelin sheath lamella with clear edge， down-regulated expression levels of TNF-α， IL-6， and Glu in the hippocampal CA1 region， especially Glu （P<0.01）， up-regulated AMPAR （P<0.01）， reduced protein expression of p-AMPAR and Cx43， especially in the high-dose group （P<0.01）， significantly elevated protein expression of MBP in the myelin sheath， and weakened fluorescence co-labeled by GFAP and Cx43， especially in the high-dose group. ConclusionModified SYW can improve the learning and memory abilities of VD rats， and the mechanism may be related to the inhibition of Cx43 expression， reduction of the release of Glu， inhibition of AMPAR-mediated inflammatory response to reduce the production of astrocyte marker GFAP， and promotion of the expression of MBP protein to alleviate myelin injury.

Application of controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy in the treatment of renal calculi / 现代泌尿外科杂志

【Objective】 To compare the clinical application value of controllable negative pressure suction outer sheath and ordinary flexible endoscope outer sheath in flexible ureteroscopic lithotripsy with holmium laser in the treatment of renal calculi less than or equal to 2 cm in diameter. 【Methods】 A total of 85 patients with renal calculi were selected and randomly divided into negative pressure group (n=45) and ordinary group (n=40). The operation time, complications, infection indexes 2 h after operation, adverse reactions, treatment efficacy and stone-clearance rate were compared between the two groups. 【Results】 The sheath was successfully implanted and holmium laser lithotripsy was performed in both groups. The negative pressure group had significantly shorter operation time than the ordinary group [(43.3±4.9) min vs. (66.2±5.8) min, P0.05). The increase of infection indexes (procalcitonin and leukocyte) 2 h after operation were significantly lower in the negative pressure group than in the ordinary group (P<0.05). The efficacy in the negative pressure group was 91.11% (41/45) and the stone-clearance rate was 95.56% (43/45), which were significantly better than those in the ordinary group (72.50% (29/40) and 80% (32/40), respectively. The total incidence of adverse reactions such as renal colic, gross hematuria and ureteral stone street was higher in the ordinary group than in the negative pressure group (P<0.05). 【Conclusions】 Controllable negative pressure suction sheath in flexible ureteroscopic lithotripsy is more effective, as the circulation perfusion keeps the operation field clear, reduces the operation time and improves the stone-clearance rate, while the negative pressure suction lowers the pelvis pressure to prevent infectious urine from entering the blood.

Value of optic nerve sheath diameter and optical disk elevation measured by ultrasound in the diagnosis of intracranial hypertension in patients with cerebral venous sinus thrombosis / 中华超声影像学杂志

Objective:To investigate the diagnostic value of ultrasonic measurement of optic nerve sheath diameter (ONSD) and optical disk elevation (ODE) for intracranial hypertension in patients with cerebral venous sinus thrombosis(CVST).Methods:A total of 50 patients with CVST who underwent lumbar puncture and ONSD examination in the Department of Neurology and Emergency Department of Xuanwu Hospital, Capital Medical University from January 2021 to December 2021 were retrospectively enrolled. After lumbar puncture, the patient′s initial intracranial pressure was recorded. Normal ICP was defined as ICP between 80 and 200 mmH 2O, and increased ICP was defined as ICP>200 mmH 2O. Fifty patients with CVST were divided into normal ICP group (14 cases) and increased ICP group (36 cases). The differences of baseline data, ONSD and ODE between the two groups were compared, and the receiver operating characteristic (ROC) curve was generated. The area under the curve (AUC) and the diagnostic cut-off value of ONSD were analyzed. Spearman correlation analysis was used to analyze the correlation between ONSD, ODE, CVST involvement range scores and intracranial pressure. Results:①There were no significant differences in gender, age and body mass index between the normal ICP group and the increased ICP group (all P>0.05). ②The ONSD and ODE in the increased ICP group were higher than those in the normal ICP group, and the differences were statistically significant [(4.83±0.33)mm vs (4.21±0.21)mm, (0.67±0.44)mm vs (0.24±0.29)mm, all P<0.001]. Spearman correlation analysis showed that ONSD and ODE were positively correlated with intracranial pressure ( rs=0.74, 0.51, all P<0.001). ③The extent of CVST involvement in the intracranial hypertension group was higher than that in the normal intracranial pressure group, and the difference was statistically significant [5.0(3.0, 7.5) vs 2.5(2.0, 5.0), P=0.015]. Spearman correlation analysis showed that CVST involvement score was positively correlated with intracranial pressure ( rs=0.43, P<0.001). ④In the diagnosis of intracranial hypertension in patients with cerebral venous sinus thrombosis, the AUC of ONSD was 0.935, the best diagnostic threshold of ONSD was 4.5 mm, the sensitivity was 0.81, and the specificity was 0.93. Conclusions:ONSD and ODE measured by ultrasound are reliable imaging methods to identify intracranial hypertension in patients with CVST.

A comparative study of the effect of super thin flexible ureteroscope (F7.5) and other types of flexible ureteroscope on the control of intrapelvic pressure / 中华泌尿外科杂志

Objective:To compare the effect of F7.5 ureteroscope and other types of ureteroscope (F8.5, F9.0, F9.2, F9.6) in the control of intrapelvic pressure during operation.Methods:F7.5 super thin flexible ureteroscope and other 4 kinds of disposable flexible ureteroscopes (F8.5, F9.0, F9.2, F9.6) were combined with 3 kinds of ureteral guidance sheaths to form 15 endoscope-sheath combinations. The real outer diameter of each flexible ureteroscope was measured and the effective ratio of endoscope-sheath diameter was calculated. The real outer diameter of each soft mirror was measured and the effective sheath ratio was calculated. The irrigation during lithotripsy was simulated in a 3D printed kidney model, the irrigation pressure of 50-500 cmH 2O was set, and the stable intrapelvic pressure and flow rate were measured. The line chart was drawn and the relationship between intrapelvic pressure and irrigation pressure was analyzed by linear regression. The intrapelvic pressure between different endoscope-sheath combinations and different endoscope groups were compared respectively. Results:The ratio of endoscope-sheath diameter for all combinations ranges from 0.62 to 0.92, with 0.75, 0.68 and 0.62 for the F7.5 flexible ureteroscopes and F10/12, F11/13 and F12/14 sheath combinations respectively. Intrapelvic pressure and flow rate showed an approximately linear relationship with irrigation pressure in all groups. The F7.5 flexible scope with the F10/12, F11/13 and F12/14 sheaths all provided intrapelvic pressures below 40 cmH 2O. The F12/14 sheath-F7.5 scope combination produced the lowest intrapelvic pressure of 1.47 cmH 2O at 50 cmH 2O irrigation pressure and the highest flow rate of 74.24 ml/min at 500 cmH 2O irrigation pressure. When combined with the F10/12 sheath, only the F7.5 flexible scope was able to maintain a safe intrapelvic pressure of only 25.90 cmH 2O throughout. Analysis of the variability of intrapelvic pressure using the combination of instruments as the grouping variable suggested a significant overall difference( P<0.05). Analysis of the variability between groups using the different flexible scope as the grouping variable showed that the F7.5 scope group had significantly lower intrapelvic pressure compared to the other four groups( P<0.05). Conclusions:The F7.5 super thin flexible scope has the best intrapelvic pressure control of the five flexible scopes due to the significantly reduced ratio of endoscope-sheath diameter for the instrument combination and the ability to fit a thinner guide sheath while maintaining safe pelvic pressure.

Effect of combined fascial sheath suspension in treatment of blepharoptosis failure / 中华医学美学美容杂志

Objective:To analyze the failure causes and repair methods of conjoint fascial sheath (CFS) suspension in ptosis correction.Methods:From 2021 September to September 2022, 13 cases (5 males and 8 females, aged from 19 to 49 years with an average of 25 years) were collected, and there were 18 eyes of CFS suspension in the Department of Burn and Plastic Surgery Center, the 940th Hospital of the Joint Logistic Support Force of PLA with a failed ptosis surgeries, including levator palpebrae superioris muscle shortening, CFS suspension, and frontalis muscle suspension.Results:Among the 13 patients (18 eyes), the failure causes included a result of the unfamiliar anatomy of CFS, unstable suture fixation, dysplasia of CFS, and improper suture site, CFS suspension failed to correct ptosis. After following-up for 6 to 30 months after reconstructive surgery, 14 eyes were corrected satisfactorily, 2 eyes were relieved of ptosis, and 2 eyes had ptosis recured six months after restorative surgery and a frontalis muscle suspension was used in the recured cases with a satisfactory outcome.Conclusions:According to the patient′s eye condition, mastering the indications, be familiar with the local anatomy and accurate surgical procedures are the key to success.

Effects of intrathecal infusion chemotherapy on intracranial pressure in non-small cell lung cancer patients with leptomeningeal metastases by ultrasound measurement of optic nerve sheath diameter / 国际肿瘤学杂志

Objective:To evaluate the effects of intrathecal infusion chemotherapy on intracranial pressure (ICP) in non-small cell lung cancer (NSCLC) patients with leptomeningeal metastases (LM) by ultrasound measurement of the optic nerve beside the bed of optic nerve sheath diameter (ONSD) .Methods:A total of 31 NSCLC-LM patients who underwent intrathecal infusion chemotherapy at Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School from June 10, 2021 to December 25, 2022 were collected. The ONSD values were measured before and after the first lumbar puncture by bedside optic nerve ultrasound, and measured dynamically 30 min before intrathecal infusion chemotherapy (T0) , 30 min (T1) , 1 h (T2) , 2 h (T3) , 4 h (T4) , 6 h (T5) , and 24 h (T6) after intrathecal infusion chemotherapy. ICP ONSD was calculated, with differences between ICP LP and ICP ONSD, and differences between ONSD and ICP ONSD series at different time being compared separately. Mean arterial pressure (MAP) , heart rate, and headache score were assessed and compared respectively at T0, T1, T2, T3, T4, T5 and T6. Spearman analysis was used to evaluate the correlation between the response assessment in neuro-oncology (RANO) score and ICP. Results:Before the first lumbar puncture for cerebrospinal fluid drainage, ICP LP was (218.55±63.83) mmH 2O, left eye, right eye, and binocular eyes ICP ONSD were (217.28±57.17) mmH 2O, (223.64±51.13) mmH 2O, and (220.46±52.50) mmH 2O respectively, in NSCLC-LM patients, with no statistically significant difference ( F=0.77, P=0.463) . After first lumbar puncture for cerebrospinal fluid drainage, ICP LP was (214.68±58.01) mmH 2O, left eye, right eye, and binocular eyes ICP ONSD were (216.71±48.96) mmH 2O, (216.62±47.18) mmH 2O, and (216.67±47.86) mmH 2O respectively, with no statistically significant difference ( F=0.12, P=0.757) . At T0, T1, T2, T3, T4, T5, and T6, the MAP during intrathecal infusion chemotherapy was 89.80 (83.40, 93.67) mmHg, 95.00 (80.83, 99.37) mmHg, 91.86 (79.88, 100.14) mmHg, 90.15 (79.04, 100.55) mmHg, 105.14 (88.55, 114.74) mmHg, 98.96 (81.72, 111.81) mmHg, and 89.29 (85.45, 100.38) mmHg, with a statistically significant difference ( χ2=16.11, P=0.013) ; heart rates were 80.00 (75.00, 84.50) times/min, 80.00 (72.50, 87.50) times/min, 74.00 (66.00, 87.50) times/min, 82.00 (72.00, 90.00) times/min, 80.00 (70.50, 90.00) times/min, 77.00 (68.00, 91.00) times/min, 77.00 (71.50, 88.50) times/min, with no statistically significant difference ( χ2=2.18, P=0.902) ; headache scores were 2.00 (0.50, 3.00) score, 2.00 (1.00, 3.00) score, 2.00 (2.00, 3.00) score, 2.00 (1.00, 3.00) score, 2.00 (1.00, 2.00) score, 2.00 (1.00, 2.00) score, and 2.00 (0.00, 2.00) score, with no statistically significant difference ( χ2=11.64, P=0.071) . At T0, T1, T2, T3, T4, T5, and T6, left eye, right eye, and binocular ONSD were (5.85±0.64) mm, (5.72±0.68) mm, (7.11±1.11) mm, (6.42±0.78) mm, (5.69±0.63) mm, (5.61±0.64) mm, (5.65±0.88) mm, (5.85±0.12) mm, (5.89±0.12) mm, (6.93±0.20) mm, (6.40±0.14) mm, (5.71±0.12) mm, (5.66±0.12) mm, (5.33±0.14) mm, (5.85±0.64) mm, (5.81±0.64) mm, (7.02±1.03) mm, (6.41±0.75) mm, (5.70±0.63) mm, (5.64±0.63) mm, (5.49±0.76) mm, with statistically significant differences ( F=58.48, P<0.001; F=49.34, P<0.001; F=78.05, P<0.001) ; ICP ONSD were (222.81±56.81) mmH 2O, (211.89±60.29) mmH 2O, (335.12±98.32) mmH 2O, (274.17±68.87) mmH 2O, (208.77±56.12) mmH 2O, (201.75±56.79) mmH 2O, (205.59±78.36) mmH 2O, (223.26±58.33) mmH 2O, (227.08±61.68) mmH 2O, (319.36±101.10) mmH 2O, (272.33±69.61) mmH 2O, (211.21±57.73) mmH 2O, (206.51±57.22) mmH 2O, (177.22±68.98) mmH 2O, (223.03±57.24) mmH 2O, (219.49±57.24) mmH 2O, (327.24±91.56) mmH 2O, (273.25±67.04) mmH 2O, (209.99±56.26) mmH 2O, (204.13±56.29) mmH 2O, (191.40±67.95) mmH 2O, with statistically significant differences ( F=58.48, P<0.001; F=49.34, P<0.001; F=78.13, P<0.001) . The ONSD of the left eye, right eye, and binocular eyes and the corresponding ICP ONSD increased significantly at T2 compared with T0, T1, T3, T4, T5, and T6, with statistically significant differences (all P<0.05) . Pre- and post-treatment RANO scores were 4.00 (3.00, 7.00) score and 3.00 (2.00, 6.00) score respectively. Pre- and post-treatment RANO scores were positively correlated with ICP ONSD in the left eye ( r=0.55, P=0.001; r=0.60, P<0.001) , right eye ( r=0.54, P=0.001; r=0.46, P=0.009) and binocular eyes ICP ONSD ( r=0.45, P=0.010; r=0.37, P=0.043) . Conclusion:Intrathecal infusion chemotherapy for NSCLC-LM patients can cause a transient increase in ONSD and ICP, with the greatest effect at 1 hour after intrathecal infusion chemotherapy. RANO score is positively correlated with ICP ONSD before and after treatment, which can provide an important reference for evaluating the efficacy of intrathecal infusion chemotherapy.

Optic nerve sheath diameter for neurological prognosis in critically ill patients without primary brain injury / 中华急诊医学杂志

Objective:To explore the predictive value of bedside ultrasound monitoring of optic nerve sheath diameter (ONSD) for short-term neurological prognosis in critically ill patients without primary brain injury.Methods:An observational prospective study was conducted to enroll critically ill patients without primary brain injury admitted to the emergency intensive care unit (ICU) of Cangzhou Central Hospital from January 2021 to April 2022. The exclusion criteria were as follows: age < 18, combined ocular and optic nerve pathology or injuries, impaired consciousness due to prior neuropathy, primary brain injury, ICU stay < 3 days, death or loss of follow-up within 28 days. Bedside ultrasound measurements of ONSD were performed within 24 hours of ICU admission and on day 3 of ICU admission. The consciousness status was assessed daily during ICU hospitalization. If the Glasgow Coma Scale (GCS) is 15 and the confusion assessment method intensive care unit (CAM-ICU) is negative, the consciousness status will be defined as nonconsciousness disorder. While if the GCS score is less than 15 or the CAM-ICU is positive, the consciousness status will be defined as consciousness disorder. According to the status of consciousness at 28 days, patients were divided into a nonconscious disorder group and a conscious disorder group, and the difference in each index was compared between the two groups. Univariate and multivariate Cox regression were used to analyze the factors influencing 28-day neurological function prognosis, and a Kaplan?Meier survival curve was plotted to analyze the relationship between ONSD and 28-day neurological function prognosis.Results:Sixty-one critically ill patients without primary brain injury (48 in the nonconscious disorder group and 13 in the conscious disorder group) were recruited. Compared to patients in the unconscious disorder group, those in the conscious disorder group had lower GCS upon ICU admission [7(4, 8) vs. 8(6, 14), P<0.05], longer length of mechanical ventilation (MV) [28(15, 28) days vs. 10(4, 14) days, P<0.001], and longer length of ICU stay [28(28, 28) days vs. 12(7, 20) days, P<0.001]. Patients in the conscious disorder group had a higher ONSD within 24 hours of ICU admission [(5.75±0.53) mm vs. (5.45±0.60) mm, P=0.114] and a higher ONSD 3 days after ICU admission [(5.54±0.64) mm vs. (5.22±0.65) mm, P=0.124] than patients in the unconscious disorder group, but the differences were not statistically significant. Multivariate Cox regression analysis showed that use of MV, GCS upon ICU admission and ONSD on day 3 of ICU admission were independent risk factors. Kaplan?Meier survival analysis showed that patients with an ONSD < 5.30 mm on day 3 had a better 28-day neurological prognosis. Moreover, among the patients with ONSD within 24 hours ≥5.30 mm, the patients with ONSD decreased to < 5.30 mm on day 3 had significantly better 28-day neurological prognosis than those with ONSD ≥ 5.30 mm on day 3 ( P=0.042). Conclusions:ONSD within 24 hours of ICU admission, especially ONSD levels and changes in ONSD on day 3, had predictive value for the short-term neurological prognosis of critically ill patients without primary brain injury.

Effect of peroneal tendon sheath integrity on posterior foot movement during calcaneal fracture / 临床外科杂志

Objective In the patients with calcaneal fractures,the surgical method with intact peroneal tendon sheath was used to treat them,and compared with the traditional surgical method with dynamic retraction of the peroneal tendon,to analyze the influence of the surgical method on the posterior foot movement.Methods A retrospective analysis was made on 60 patients with calcaneal fracture admitted to the Department of Orthopaedics of our hospital from December 2016 to December 2020.The patients were divided into two groups according to the surgical method.The patients in the distraction group received the surgical treatment of traditional dynamic distraction of peroneal tendon(28 cases),and the patients in the preservation group received the surgical treatment of preserving the integrity of peroneal tendon sheath(32 cases).The outcome measures included perioperative indicators,Maryland score of foot function 12 months after surgery,AOFAS score of posterior foot and imaging indicators(Boler Angle and Gissane Angle)12 months after surgery.Results The surgical time(89.34±12.21 minutes)and hospitalization time(5.26±1.47 days)of the retention group were significantly better than those of the traction group[(124.22±11.56)min,(11.59±2.43)d](P＜0.05).At the last follow-up,the AOFAS score(70.56±3.62)and Maryland's excellent and good rate(87.5％)of patients in the retention group were better than those in the traction group(81.37±3.58,71.4％)(P＜0.05).The difference in imaging indicators between the two groups was relatively small(P＞0.05).Conclusion The surgical method of keeping the peroneal tendon sheath intact in the treatment of patients with calcaneal fracture has definite clinical effects,and can also effectively reduce the adverse effects of surgical trauma on posterior foot activity.