舒芬太尼、曲马多用于小儿鼾症手术苏醒期躁动的临床研究

目的：探究舒芬太尼与曲马多对用于小儿鼾症手术苏醒期躁动的作用与影响。方法：60例ASAI或II级扁桃体肥大或腺样体肥大的鼾症手术患儿,年龄6-14岁,无呼吸系统,循环系统等疾病,一般状态良好。随机分为舒芬太尼组（s组）和曲马多（T组）,每组各30例。常规监测各项生命体征。于手术结束前20分钟（min）,S组缓慢静脉输入0．15μg／kg舒芬太尼,T组静脉输入1．2mg／kg曲马多。观察各组的：平均动脉压 （MAP）、心率（HR）、血氧饱和度（SpO2）,进行各组的镇静评分（RSS）、躁动评分（RS）、镇痛评分（VRS）、意识状态评分（OAAS）。记录拔管前（T0）、拔管时（T1）、拔管后5min（T2）、拔管后10min（T3）、拔管后20min（T4）各时间点各参数的变化。记录各组的恶心呕吐、呼吸抑制、烦躁等的发生率。结果：SpO2各组间无显著差异。MAP,HR在各时间点的变化T组大于S组,P〈0．05,有显著差异。T组在RS,RSS,VRS评分与S组有显著差异,P〈0．05。结论：0．15μg／kg的舒芬太尼在小儿鼾症手术的苏醒期可以维持稳定的血流动力学,副作用小,镇痛效果良好,可以有效减少小儿苏醒期的躁动。     

正常中国人中枢运动系统传导时间的测定

本文应用高电压、低输出阻抗刺激器,经皮给予大脑皮层和脊髓电刺激(BSPES),同时在上肢鱼际(Thenar)和下肢胫骨前肌(Muscle tibialis anterior)上记录诱发肌肉动作电位,测定了64名正常健康中国人(男:46;女:18)的中枢运动系统传导时间。受试者年龄为20—67岁,身高为156—185cm。刺激大脑皮层出现反应的潜伏期与刺激脊髓出现反应的潜伏期之差为中枢运动传导时间(CMCT)。实验测得鱼际的 CMCT 为6.69±1.48ms;胫骨前肌的 CMCT 为12.90±1.59ms。经统计学处理证明,CMCT 与左右侧肢体、性别、年龄及身高无关。说明 CMCT 是无损伤测定与评价中枢运动系统功能的较精确的一种客观指标。本文根据所测数据,计算出脊髓内运动传导速度为71.34±10.89 m/s,与文献报道的锥体束传导速度50—70 m/s 相近。因此,CMCT 反映了锥体束的传导时间。     

Influence of spinal cord transection on the presence and axonal transport of CGRP-, chromogranin A-, VIP-, synapsin I-, and synaptophysin-like immunoreactivities in rat motor nerve

Using immunofluorescence and cytofluorimetric scanning (CFS), we investigated the short-term (1-7 days) influence of lower thoracic spinal cord transection on lumbar motor neurons. The content of calcitonin gene-related peptide- (CGRP) like immunoreactivity (LI), chromogranin A (Chr A) -LI, vasoactive intestinal polypeptide (VIP)-LI, Syn I-LI, and synaptophysin (p38)-LI in motor perikarya, and the anterograde and retrograde axonal transport of these substances in the sciatic nerve, were studied in nerve crush (6 h) experiments. During the week after transection, CGRP-LI in perikarya decreased, whereas Chr A-LI increased. VIP-LI, co-localized with Chr A-LI in motor perikarya, did not change after transection. The antero- and retrograde transport of CGRP-LI in the sciatic nerve, occurring in both motor and sensory axons, appeared unchanged in cytofluorimetric scanning (CFS) graphs, but the microscopical picture clearly showed that large motor axons had a decreased content of CGRP-LI at 3 and 7 days posttransection, whereas thinner axons were unchanged in fluorescence intensity. The anterograde transport of Chr A-LI, present in both motor and postganglionic adrenergic axons, was decreased 1 and 3 days after lesion, but returned to control by day 7. There was a marked decrease in anterograde transport of VIP-LI, present mainly in postganglionic sympathetic axons, at day 3, but at 7 days transport was normal. The amounts of transported p38, the synaptic vesicle marker, were in the normal range during the whole period. Syn I-LI accumulation anterogradely was somewhat decreased at 3 and 7 days posttransection, and at 1 day the retrograde accumulation was significantly increased. The results suggest that removal of supraspinal input to intact lower motor neurons causes alterations in metabolism and axonal transport of organelle-associated substances, partly probably related to the complex pattern of transmitter leakage from degenerating, descending nerve terminals. These alterations appear to take place also in postganglionic sympathetic neurons in the sciatic nerve, that originate in the lumbar sympathetic chain. © 1992 John Wiley & Sons, Inc.     

肥胖病人急性阑尾炎腹腔镜手术与开腹手术临床效果比较分析

目的分析对肥胖急性阑尾炎病人实施腹腔镜阑尾切除与开腹阑尾切除的临床治疗效果。方法回顾性分析我院2007年1月至2011年12月期间腹腔镜阑尾切除与开腹阑尾切除相关资料。结果实施腹腔镜阑尾切除手术病人的总体并发症发生率与致死率均较低,住院时间较短,住院费用较少,两种方法相比差异显著,具有统计学意义。结论对于肥胖病人实施腹腔镜阑尾切除手术比实施开腹阑尾切除手术更为安全可靠,疗效更好,不论阑尾炎是否穿孔,腹腔镜阑尾切除手术应作为首选方法。     

Transplants of Human Mesenchymal Stem Cells Improve Functional Recovery After Spinal Cord Injury in the Rat

Human mesenchymal stem cells (hMSCs) derived from adult bone marrow represent a potentially useful source of cells for cell replacement therapy after nervous tissue damage. They can be expanded in culture and reintroduced into patients as autografts or allografts with unique immunologic properties. The aim of the present study was to investigate (i) survival, migration, differentiation properties of hMSCs transplanted into non-immunosuppressed rats after spinal cord injury (SCI) and (ii) impact of hMSC transplantation on functional recovery. Seven days after SCI, rats received i.v. injection of hMSCs (2×10⁶ in 0.5 mL DMEM) isolated from adult healthy donors. Functional recovery was assessed by Basso–Beattie–Bresnahan (BBB) score weekly for 28 days. Our results showed gradual improvement of locomotor function in transplanted rats with statistically significant differences at 21 and 28 days. Immunocytochemical analysis using human nuclei (NUMA) and BrdU antibodies confirmed survival and migration of hMSCs into the injury site. Transplanted cells were found to infiltrate mainly into the ventrolateral white matter tracts, spreading also to adjacent segments located rostro-caudaly to the injury epicenter. In double-stained preparations, hMSCs were found to differentiate into oligodendrocytes (APC), but not into cells expressing neuronal markers (NeuN). Accumulation of GAP-43 regrowing axons within damaged white matter tracts after transplantation was observed. Our findings indicate that hMSCs may facilitate recovery from spinal cord injury by remyelinating spared white matter tracts and/or by enhancing axonal growth. In addition, low immunogenicity of hMSCs was confirmed by survival of donor cells without immunosuppressive treatment.     

脊髓外科手术术后精神障碍患者发病影响因素及抑制性神经递质水平、神经营养因子表达变化情况分析

摘要 目的：探讨与分析脊髓外科手术术后精神障碍患者发病影响因素及抑制性神经递质水平、神经营养因子表达变化情况。方法：选择2016年9月到2021年5月本院完成脊髓外科手术的患者83例作为研究对象,检测血清抑制性神经递质水平、神经营养因子（NTFs）表达水平。所有患者都给予抑郁自评量表（SDS）调查、执行功能行为评定量表成人版自评问卷（BRIEF-A）评分并进行相关性分析。结果：83例患者术后平均SDS评分为45.10±2.87分,判定为精神障碍23例（精神障碍组）,占比27.7 %。精神障碍组的性别、年龄、手术时间、术中出血量与非精神障碍组对比无差异（P>0.05）,精神障碍组的饮酒、术后清醒时间与非精神障碍组对比有差异（P<0.05）。精神障碍组的BRI自我控制、情感控制、转移、抑制等评分与MI任务启动、任务监督、工作记忆、计划、组织评分都高于非精神障碍组（P<0.05）。精神障碍组的血清NTFs含量低于非精神障碍组,血清HA与5-HT含量高于非精神障碍组（P<0.05）。在83例患者中,Pearson分析显示SDS评分与饮酒、术后清醒时间、血清NTFs、NA、5-HT含量都存在相关性（P<0.05）;二分类logistic逐步回归显示术后清醒时间、血清NTFs、NA、5-HT含量都为导致脊髓外科手术术后精神障碍患者发病的重要因素（P<0.05）。结论：脊髓外科手术术后精神障碍的发生较常见,可导致患者认知与执行功能降低,多伴随有抑制性神经递质水平表达上升与神经营养因子表达下降,血清NTFs、NE、5-HT含量都为导致精神障碍发病的重要因素。     

盐酸右美托咪定联合瑞芬太尼在骨科手术中的应用效果及对呼吸功能的影响

本研究考察了盐酸右美托咪定联合瑞芬太尼(观察组,n=68)和丙泊酚联合瑞芬太尼(对照组,n=68)在我院136例骨科手术患者中的应用效果,应用警觉/镇静观察评分(OAA/S)评价患者用药前(T0)、用药10 min后(T1)、用药20 min后(T2)、用药30 min后(T3)和清醒后(T4)的镇静效果,并比较了两组患者在不同时间点的呼吸频率(RR)、血氧饱和度(SpO2)、心率(HR)和平均动脉压(MAP)。研究结果显示,两组患者在T0、T1和T4时间点的OAA/S评分无统计学差异(p>0.05),观察组在T2和T3时间点的OAA/S评分明显小于对照组(p<0.05)。两组患者在T0、T1和T4时间点的RR无统计学差异(p>0.05),观察组在T2和T3时间点时的RR明显大于对照组(p<0.05)。观察组在T2时间点时的SpO2明显大于对照组(p<0.05)。两组患者的SpO2在其他时间段时无明显差异(p>0.05)。两组患者的HR和MAP均未表现出明显差异(p>0.05)。观察组的不良反应发生率为2.94%,明显高于对照组的11.76%(p=0.049)。本研究结论初步表明,与丙泊酚联合瑞芬太尼相比,盐酸右美托咪定联合瑞芬太尼在骨科手术中具有更好的镇静效果,可有效保障患者的呼吸功能,具有良好的血流动力学稳定性和安全性。     

The natural history of the helicoidal occlusal plane and its evolution in early Homo

In modern man the pitch of the occlusal plane may vary along the tooth-row. When anterior cheek-teeth show a plane sloping upward palatally, whilst that on posterior cheek-teeth slopes upward buccally, there results a twisted or helicoidal occlusal plane (Ackermann). Several hypotheses have been proposed for the structural basis of the helicoidal occlusal plane. Campbell's proposal ('25) has gained widest acceptance, namely that the helicoid results from anteroposterior differences in upper and lower alveolar arch width. In the early 1960s, while studying the Olduvai hominids assigned to Homo habilis, the author noted changing occlusal slopes along the tooth-row and a slight helicoid, although these featues had not been noted in other early hominids. Subsequently, Wallace showed a total absence of the helicoid from South African australopithecines, and its presence in Swartkrans Homo, SK 45 and SK 80. Recent studies confirm the presence of the helicoid in all available specimens of H. habilis, including Stw 53 found at Sterkfontein in 1976. Hence, this trait may distinguish between Australopithecus and early Homo. Measurements of the maxillary arch widths have shown that, whereas in Australopithecus arch widths increase to a maximum at M3, in early Homo maxillary arch widths are greatest at M2. The decline in posterior maxillary arch width is part of a general reduction of that region. Thus despite striking elongation of premolars and M1 in early Homo, M2 and M3 are mesiodistally abbreviated. It is hypothesized that the onset of posterior arch reduction, with the appearance of a helicoid, was a structural and functional concomitant of the transition from the presumed australopithecine ancestor to H. habilis.     

急性胰腺炎患者腹腔镜胆囊切除术的时机研究

目的：探讨急性胰腺炎胆囊切除术的有效性及时机。方法：分别对患有急性胰腺炎而进行腹腔镜胆囊切除的38例患者的临床信息进行了研究。结果：首先对38例病人进行了3-15天非手术的保守治疗,当临床症状和表征基本消失,血、尿中的淀粉酶接近正常水平时,进行胆囊切除。手术时间为30分钟到90分钟（平均时间60分钟）,手术中无转化和严重并发症症状发生。对这38例病人随访6到56周后无复发现象发生。结论：当临床症状和表征基本消失,血、尿中的淀粉酶接近正常水平时,急性胰腺炎胆囊切除术是有效且可行的。在中国患有急性胰腺炎的患者中,进行腹腔镜胆囊切除的占50％～70％。胆结石治疗取决于患者胰腺炎的严重性,及患者是否患有梗阻性黄疸。对于非梗阻性胰腺炎的患者,早期是否要进行明确的手术治疗尚无定论。我院患有急性胰腺炎的38例患者进行腹腔镜胆囊切除术（2004年2月到2009年4月之间）后取得了满意的效果。详情如下。     

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Objective: To provide evidence‐based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS). Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail. Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity‐related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well‐defined postsurgical diet progression. Discussion: Obesity‐related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short‐ and long‐term risks include: comprehensive medical screening; appropriate pre‐, peri‐, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long‐term nutrition education/counseling.