心脏超声在卵圆孔血流受限胎儿中的筛查分析

摘要 目的：分析与探讨心脏超声在卵圆孔血流受限胎儿中的筛查价值。方法：2019年1月-2020年9月在本院进行产前心脏超声筛查的孕妇58例,都给予常规超声与组织多普勒成像,记录影像学特征并判断诊断价值。结果：58例胎儿判断为卵圆孔处血流受限18例,占比31.0 %。受限组的卵圆孔大小、卵圆瓣长度、继发隔长度都少于未受限组(P<0.05)。受限组的D-FOC值低于未受限组(P<0.05),Vm-PV、Vm-FOC值高于未受限组(P<0.05)。受限组的左心室E、A、E''、A''值都低于未受限组(P<0.05)。结论：心脏超声作为检出胎儿心脏畸形的有效手段,可通过观察胎儿卵圆孔血流频谱与形态来鉴别诊断卵圆孔血流受限,是孕期诊断卵圆孔血流受限的最有效方法之一。     

Cohort study of multiple brain lesions in sport divers: role of a patent foramen ovale.

OBJECTIVE: To investigate the role of a patient foramen ovale in the pathogenesis of multiple brain lesions acquired by sport divers in the absence of reported decompression symptoms. DESIGN: Prospective double blind cohort study. SETTING: Diving clubs around Heidelberg and departments of neuroradiology and neurology. SUBJECTS: 87 sport divers with a minimum of 160 scuba dives (dives with self contained underwater breathing apparatus). MAIN OUTCOME MEASURES: Presence of multiple brain lesions visualised by cranial magnetic resonance imaging and presence and size of patent foramen ovale as documented by echocontrast transcranial Doppler ultrasonography. RESULTS: 25 subjects were found to have a right-to-left shunt, 13 with a patent foramen ovale of high haemodynamic relevance. A total of 41 brain lesions were detected in 11 divers. There were seven brain lesions in seven divers without a right-to-left shunt and 34 lesions in four divers with a right-to-left shunt. Multiple brain lesions occurred exclusively in three divers with a large patent foramen ovale (P = 0.004). CONCLUSIONS: Multiple brain lesions in sport divers were associated with presence of a large patent foramen ovale. This association suggests paradoxical gas embolism as the pathological mechanism. A patent foramen ovale of high haemodynamic relevance seems to be an important risk factor for developing multiple brain lesions in sport divers.     

Percutaneous closure of a patent foramen ovale after cryptogenic stroke

A patent foramen ovale is a common intracardiac finding that is located between the left and right atrium. It can cause right-to-left shunting and has a high prevalence in patients who suffer a cryptogenic stroke. Earlier trials did not show superiority of percutaneous patent foramen ovale closure with standard medical therapy over standard medical therapy alone in the treatment of cryptogenic stroke. Interestingly, several meta-analyses show positive results regarding closure, suggesting underpowering of the individual trials. Recently, two large prospective trials and one long-term follow-up study showed benefit of percutaneous closure over standard medical therapy in treatment of cryptogenic stroke. A larger right-to-left shunt or the presence of an atrial septal aneurysm were predictors for a recurrent event. Therefore, percutaneous patent foramen ovale closure after cryptogenic stroke should be recommended over antiplatelet therapy alone in patients younger than 55 years of age with a high-risk patent foramen ovale.     

The posterior border of the sphenoid greater wing and its phylogenetic usefulness in human evolution

The elucidation of patterns of cranial skeletal maturation and growth in fossil hominids is possible not only through dental studies but also by mapping different aspects of ossification in both extant African apes and humans. However, knowledge of normal skeletal development in large samples of extant great apes is flimsy. To remedy this situation, this paper offers an extensive survey and thorough discussion of the ossification of the posterior border of the sphenoid greater wing. Indeed, this area provides much information about basicranial skeletal maturation. We investigate three variants: the absence of the foramen spinosum and the position of both the foramen spinosum and the foramen ovale in relation to the sphenosquamosal suture. Providing original data about humans and 1,425 extant great ape skulls and using a sample of 64 fossil hominids, this study aimed to test whether different ossification patterns occurred during the course of human evolution. The incidence of three derived morphologies located on the posterior border of the sphenoid greater wing increases during human evolution at different geological periods. The evolutionary polarity of these three derived morphologies is assessed by outgroup comparison and ontogenetic methods. During human evolution, there is a clear trend for the foramen spinosum to be present and wholly located on the posterior area of the sphenoid greater wing. Moreover, in all the great ape species and in Australopithecus afarensis, the sphenosquamosal suture may split the foramen ovale. Inversely, the foramen ovale always lies wholly within the sphenoid greater wing in Australopithecus africanus, robust australopithecines, early Homo, H. erectus (and/or H. ergaster), and Homo sapiens. From ontogenetic studies in humans, we conclude that, during human evolution, the ossification of the posterior area of the sphenoid greater wing progressively surrounded the middle meningeal artery (passing through the foramen spinosum) and the small meningeal artery (passing through the foramen ovale). Am J Phys Anthropol 107:387–399, 1998. © 1998 Wiley-Liss, Inc.     

心脏磁共振在不明原因脑卒中病因筛查中的应用

目的探讨心脏磁共振成像技术在不明原因缺血性脑卒中患者病因筛查中的应用价值。方法选取2014年9月~2015年2月在我院诊治的不明原因缺血性脑卒中患者53例为研究对象,均行心脏MRI和经胸超声心动图检查,并对检查出卵圆孔未闭(PFO)的患者进行分析。结果 53例不明原因缺血性脑卒中患者中,心脏MRI检查诊断合并PFO为27例(50.94%),经胸超声动图(TTE)检查诊断合并PFO为7例(13.21%),差异有统计学意义(P0.001)。结论心脏MRI对PFO的检出率较高,可作为不明原因缺血性脑卒中患者病因筛查的有效手段。     

The crescent of foramina in Australopithecus afarensis and other early hominids

The crescent of foramina of the cerebral surface of the sphenoid bone (superior orbital fissure, foramen rotundum, foramen ovale, foramen spinosum) differs morphologically in the African great apes and modern humans. New discoveries of Australopithecus afarensis at Hadar, Ethiopia, draw attention to the similarity of the crescent, particularly the “foramen” shape of the superior orbital fissure and its close proximity to the foramen rotundum, in this species, the African apes, and many other primates. Australopithecus africanus also shows this primitive pattern, whereas “robust” australopiths and humans share a configuration in which a true, laterally extended superior orbital fissure intervenes between the greater and lesser wings of the sphenoid and a broad bridge of bone separates the fissure from the foramen rotundum. This shared morphology may be added to the list of putative “robust” australopith-Homo synapomorphies. © 1996 Wiley-Liss, Inc.     

Reexamination of the morphological evidence for the cohort Epitheria (Mammalia,Eutheria)

Novacek and co-workers recognized a monophyletic clade Epitheria, comprising all eutherians except edentates and the extinct palaeoryctoids, on the basis of two synapomorphies: a stirrupshaped stapes and a foramen ovale enclosed within the alisphenoid. To evaluate this phylogenetic hypothesis, we reexamined the distributions of stapedial morphologies and positions of the foramen ovale across Recent and extinct mammals and nonmammalian cynodonts. The states and distributions of the stapes and forament ovale characters used by Novacek and coworkers were modified by recognizing two stapedial characters (one relating to shape of the crura, the other to the nature of the foramen) and a single, multistate foramen ovale character (within, behind, and lateral to the alisphenoid). The taxon-character matrix used by Novacek (1989, 1992b), substituting our amended stapedial and foramen ovale characters and adding several previously unscored extinct taxa and three new characters, was subjected to a series of PAUP manipulations. Identified among the most parsimonious trees were three major topologies for the base of Eutheria: (1) a polytomy including an Edentata/Ungulata clade, (2) a polytomy with Edentata and Ungulata as separate clades, and (3) Edentata and (when included) Palaeoryctoidea as the successive outgroups to a monophyletic Epitheria. We conclude that topology 2 best reflects the current state of knowledge. An edentate/ungulate clade is supported by three characters (from the mastoid region and subarcuate fossa); however, other morphological studies require modification of the distributions of these characters in xenarthrans and bassal ungulates, thereby eliminating support for this clade. In nearly all manipulations, obtaining a monophyletic Epitheria required that one or two steps be added to the most parsimonious trees. When a monophyletic Epitheria was obtained, it was supported by a triangular stapes and, in some trees, the reappearance of a stapedial artery (lost earlier at the level of Recent therians) and a transpromontorial internal carotid artery. In the most parsimonious trees, a foramen ovale within the alisphenoid was an equivocal synapomorphy of Recent therians or cutherians, and a stapes with strongly convex crura (our state closest to the stirrup-shaped state of Novacek and co-workers) appeared independently within various eutherian lineages. The reduction or loss of the stapedial foramen was identified as an independent event in monotremes and within marsupials and various eutherian lineages.To whom correspondence should be addressed.     

右心声学造影联合血清cTnI、NT-proBNP对心源性脑梗死的预测价值

摘要 目的：探讨右心声学造影联合血清心肌肌钙蛋白I（cTnI）、N-末端脑利钠肽前体（NT-proBNP）对心源性脑梗死（CE）的预测价值。方法：选择2020年7月至2023年6月湖南中医药高等专科学校附属第一医院收治的急性脑梗死患者128例,根据是否发生CE分为CE组（n=31）和非CE组（n=97）。两组均行右心声学造影检查,检测两组血清cTnI、NT-proBNP水平,比较两组右心声学造影参数及血清cTnI、NT-proBNP水平。受试者工作特征（ROC）曲线分析右心声学造影联合血清cTnI、NT-proBNP对CE的预测价值。结果：右心声学造影显示CE组卵圆孔未闭阳性率、右向左分流分级（1级+2级+3级）构成比、卵圆孔长径均显著高于非CE组（P<0.05）。CE组卵圆孔未闭患者活动性房间隔构成比显著高于非CE组卵圆孔未闭患者（P<0.05）。CE组血清cTnI、NT-proBNP水平显著高于非CE组。ROC曲线分析结果显示,卵圆孔未闭、右向左分流分级1级+2级+3级、卵圆孔长径、活动性房间隔、cTnI、NT-proBNP对CE具有一定的预测价值,其中联合检验对CE的预测效能最高,曲线下面积（AUC）为0.867（0.812～0.928）。结论：右心声学造影联合血清cTnI、NT-proBNP检查可用于CE的预测。     

A Reexamination of Proposed Morphology-Based Synapomorphies for the Families of Dasyuromorphia (Marsupialia). I. Dasyuridae

The validity of eight morphological features previously advanced as synapomorphic for Dasyuridae is investigated in the light of new fossil and molecular data. Results indicate that one of these features (alisphenoid–periotic enclosure of the foramen ovale) is common to outgroups for Dasyuromorphia. Another feature (loss of intestinal cecum) is a likely synapomorphy for Dasyuromorphia. Two features (development of a hypoconulid notch, enlargement of stylar cusp D) may represent shared–derived characters within Dasyuromorphia but not at the family level for Dasyuridae (i.e., probably unite Dasyuridae–Thylacinidae). Another two features (loss of posterolateral palatine foramina, reduction of P₃) are also apomorphic within Dasyuromorphia but unite specialized clades within Dasyuridae. Only two previously treated features are probable synapomorphies for the family (enlargement of the alisphenoid tympanic wing and development of a distinct periotic hypotympanic sinus). An additional feature is identified as a dasyurid synapomorphy (presence of a distinct tubal foramen). Of all putative synapomorphies proposed to date, only the presence of a periotic hypotympanic sinus and tubal foramen are unique for Dasyuridae among dasyuromorphians. Results suggest considerable homoplasy for basicranial features within Dasyuromorphia. Independent acquisition for alisphenoid enclosure of the foramen ovale, development of secondary foramina ovale and loss of posterolateral palatal foramina has occurred in derived thylacinid and dasyurid clades. Convergence is also indicated for hypertrophy of the alisphenoid tympanic wing shown for dasyurids and myrmecobiids, and the development of a squamosal epitympanic sinus in Thylacinidae, Dasyuridae, and Myrmecobiidae. The finding of plesiomorphy for alisphenoid–periotic enclosure of the foramen ovale within Dasyuromorphia undermines the strongest morphology-based synapomorphy uniting a monophyletic Dasyuridae–Myrmecobiidae. Phylogenetic placement for some plesiomorphic fossil dasyuromorphians, known only from dental material, within Dasyuridae is currently untenable, with no dental synapomorphies uniting the family. The value of identifying morphoclines within clades known from robust phylogenetic data for consideration in character analysis is stressed, as is the importance of form–function and ontogenetic data.     

Foramen ovale electrodes: a new technique enabling presurgical evaluation of patients with mesiobasal temporal lobe seizures

A recently developed technique to record from the mesiobasal aspect of the temporal lobes by subdural electrodes inserted through the foramen ovale is described. Experience with this technique in 13 candidates for surgical epilepsy therapy is presented. Our results indicate that interictal epileptiform potentials as well as ictal discharges are reliably picked up by the foramen ovale electrode whenever nucleus amygdallae, hippocampus and parahippocampal gyrus show synchronous epileptic activity. The advantages of this technique are discussed.     

颅底孔在多层CT三维重建中的测量研究

探讨颅底MSCT三维重建图像效果及主要孔的正常值,采用多层螺旋CT(MSCT),对200名正常成人(男100名,女100名)进行颅脑扫描,利用电子计算机三维重建程序立体地显示颅底外面的卵圆孔、棘孔、颈动脉管外口、破裂孔、茎乳孔、枕骨大孔,并观察其形态和测出其内径及其性差。     

A Stereotaxic Apparatus for Injection of the Trigeminal Root and Ganglion

A stereotaxic apparatus was designed which would enable a needle to be passed easily through the foramen ovale with accuracy and with a minimum of radiological aid by one relatively unskilled in injection of the trigeminal ganglion. Successful penetration of the foramen was achieved in 39 of 46 injections on cadavers and in six injections on five patients. The substance injected was 5% phenol in glycerin. In one patient alcohol was used. The anesthesia produced was satisfactory in all except one patient. We feel that this apparatus will enable the trigeminal ganglion to be injected relatively easily in all patients except those with unusually shaped skulls.     

Precocial diving and patent foramen ovale in bearded seal (<Emphasis Type="Italic">Erignathus barbatus</Emphasis>) pups

In this study we used a Doppler ultrasonic device, in combination with a sonographic contrast medium, to test whether free-living bearded seal (Erignathus barbatus) pups have a closed (anatomically or functionally) foramen ovale. A total of 17 examinations were performed on 12 individual pups with a body mass range of 29-103 kg (0-21 days old). These examinations showed that young bearded seal pups dive with a patent foramen ovale (PFO), and that this structure starts to close, at least functionally, during the 2nd week of life. The wide range in the timing of closure (one animal 21 days old still had a PFO) indicates that a closed foramen ovale is not crucial for the diving that these seals perform at this age. The primary function of diving during the 1st week of life is to avoid surface predation and only moderate diving ability is sufficient to achieve this goal. However, some of the diving performed by bearded seal pups with a PFO would likely be sufficient to create intravenous bubble formation during breath-hold diving in humans. Special adaptations in the seals, such as collapsible lungs and diving with minimal lung air volume, probably prevent this from happening.     

Five cases of cyclical Cushing's syndrome.

Reported cases of cyclical Cushing''s syndrome are rare. Of 14 successive patients with Cushing''s syndrome nine collected sequential urine samples for the estimation of cortisol:creatinine ratio. Five had cyclical Cushing''s syndrome while two had considerable variation in urinary cortisol excretion without a cyclical pattern being established. Two of the five patients with a cyclical syndrome had paradoxical responses to dexamethasone. In only one patient with a cyclical pattern did the cortisol:creatinine ratio fall after treatment with bromocriptine or cyproheptadine, or both. The high incidence of the cyclical form of Cushing''s syndrome has important clinical implications. A high index of suspicion of the syndrome is required in patients with symptoms or signs of Cushing''s syndrome but with normal cortisol values, in patients with fluctuating cortisol values, and in patients with anomalous responses to dexamethasone. Because of possible variations in steroidogenesis the results of drug studies in Cushing''s syndrome must be interpreted cautiously.     

A quantum probability explanation for violations of ‘rational’ decision theory

Two experimental tasks in psychology, the two-stage gambling game and the Prisoner''s Dilemma game, show that people violate the sure thing principle of decision theory. These paradoxical findings have resisted explanation by classical decision theory for over a decade. A quantum probability model, based on a Hilbert space representation and Schrödinger''s equation, provides a simple and elegant explanation for this behaviour. The quantum model is compared with an equivalent Markov model and it is shown that the latter is unable to account for violations of the sure thing principle. Accordingly, it is argued that quantum probability provides a better framework for modelling human decision-making.     

Complications and mid-term outcome after percutaneous patent foramen ovale closure in patients with cryptogenic stroke

Background: Percutaneous patent foramen ovale (PFO) closure seems to reduce the risk of recurrent thromboembolism. We report the safety and efficacy of percutaneous PFO closure in our centre. Methods: All patients, >16 years of age, who underwent a percutaneous PFO closure in our centre were included. Reoccurrence of stroke, transient ischaemic attack (TIA) and peripheral thromboembolism were assessed. Periprocedural and midterm complications are reported. Results: Eighty-three consecutive patients (mean age 49±13 years) were included. Indications for PFO closure were cryptogenic stroke (59.0%), TIA (33.7%), peripheral embolism (2.4%) and other (4.8%). For PFO closure, a Cardioseal/Starflex device was used in 63 patients and an Amplatzer PFO occluder device in 20 patients. Stroke recurred in 1.2%, TIA in 3.6%, peripheral embolism in 0% during a mean follow-up of 1.9±1.2 years. Major periprocedural complications occurred in 1.2%. The mid-term complication rate was 2.4% and only consisted of minor complications. During follow-up, a residual right-to-left shunt was present in 5.7% of the patients. No significant difference in outcome, complications or residual shunting could be documented between the two device types. Conclusion: In our centre, the percutaneous closure of a PFO seems to be a safe and effective procedure to prevent recurrence of paradoxical thrombo-embolic events. (Neth Heart J 2008;16:332-6.)     

On the Comparison of Two Observed Frequencies

A significance measure essentially due to Liebermeister and dating back to 1877 may be preferable to Fisher's Exact Test, a conservative but commonly applied test when the sample sizes are small. We show that Liebermeister's measure is less conservative than Fisher's P‐value and just as easy to calculate, while retaining the important features of a significance measure. We also compare Liebermeister's measure with Lancaster's mid‐P, which has gained increasing acceptance as a replacement for Fisher's P‐value. Application is made to a recent striking medical study on appendicitis symptoms for which the Fisher test does not give significance.     

Respiratory oscillator entrainment by periodic vagal afferentes: An experimental test of a model

This communication compares the well known phenomenon of respiratory driving by the respiratory pump through the Breuer Hering reflex with a model (Segundo, 1979) of a neuronal pacemaker (i.e. regularly firing) interactions via IPSP's. The assumption involves a linear dependence (“delay function”) of the postsynaptic interval lengthening (or “delay”) produced by the IPSP's on the position (or “phase”) with respect to the preceding spike of the latter's arrival. Cats anesthetized and paralized with gallamine were artificially ventilated using a computer driven respirator. The pump period and the respiratory period (identified by the phrenic discharge) corresponded to the model's presynaptic pacemaker interval and to that of the post synaptic one, respectively. The delay of the respiratory period by an inflation was related linearly and in increasing manner to the latter's phase with respect to the inspiration onset. In the steady state, plots of average respiratory period versus pump period consisted in a succession of broad “paradoxical” segments with positive slopes 3, 2, 1, 1/2, 1/3 in which respiration was locked with the pump as predicted by the model. The locked condition were less easy to reach when F_{A CO 2}increased or when level of anaesthesia decreased. The limits of paradoxical segments were different when measured using pump periods that increased or using periods that decreased. There was therefore a hysteresis as if the delay function parameters changed, a behavior that was not part of the model that assumed fixed characteristics. These modifications were related to dependency of each cycle on the preceding one. The model proposed for simple neuronal pacemaker interactions can thus be applied satisfactorily to the drive of the complex respiratory neuronal oscillator by the respiratory pump through Breuer Hering reflex, providing nevertheless some additonal assumptions concerning respiratory cycle interdependency are introduced to account for the hysteresis phenomenon. The Breuer Hering reflex could be considered as the equivalent of IPSP acting on the central respiratory oscillator. F_{A CO 2}increase and anesthesia level decrease produced the same effect as the addition of noise to the model's presynaptic pacemaker, thus leading to the hypothesis that they act by adding noise (e.g., randomly distributed excitatory input) at the level of Breuer Hering reflex inhibition.     

Decrease in shunt volume in patients with cryptogenic stroke and patent foramen ovale

Background  

In patients with patent foramen ovale (PFO) there is evidence supporting the hypothesis of a change in right-to-left shunt (RLS) over time. Proven, this could have implications for the care of patients with PFO and a history of stroke. The following study addressed this hypothesis in a cohort of patients with stroke and PFO.