人工耳蜗颅中窝进路植入点

目的:探讨人工耳蜗植入颅中窝进路植入点的精确定位及其可行性。方法:成人整颅标本行植入点定位,并对相关测量项进行测定,然后确定植入点的精确定位;通过1例成人女性尸头标本行模拟手术,验证其可行性。结果:沿岩浅大神经延长线,在距面神经裂孔3.10 mm±0.88 mm处确定"O"点("O"点位于膝状神经节窝),再以"O"点为原点,确定与岩浅大神经夹角为97.85°±5.38°的面神经管迷路段内侧壁投影线,然后依据面神经管迷路段内侧壁投影线做距其1.58mm±0.41mm的平行线,后再做距岩浅大神经5.47 mm±0.95 mm的平行线,两平行线相交点即为植入点("Z"点)。植入点与面神经沟的距离仅为0.67mm±0.15mm,最小值甚至为0.00 mm,而面神经沟的下部即蜗神经管,并且蜗神经管比面神经沟更为凸前,在植入点开窗极易损伤蜗神经起始段。通过模拟手术验证,用以上植入点确定方法,行开窗,不能保证进入耳蜗底转上部,更不能保证准确进入前庭阶,并有损伤蜗神经的可能。结论:颅中窝进路人工耳蜗植入点选择,不能在不磨除颞骨岩面骨质的情况下行精确定位。手术时应以面神经裂孔为定位点,先确定岩浅大神经与面神经管迷路段内侧壁投影线,然后磨除距两者1.00 mm平行线夹角内区域的骨质,尽量轮廓出耳蜗底转上部,颜色呈蓝线时,靠蓝线后部行植入点定位开窗,这样既可以将电极准确植入耳蜗底转,又可以因不暴露岩浅大神经管内段和面神经迷路段,避免其损伤。     

颞骨岩部结构的定位解剖及临床意义

目的:为颅底手术中耳蜗的定位、岩尖的磨除范围提供解剖学方法。方法:在12个成人头颅标本上利用颅中窝入路暴露岩内面神经、耳蜗、颈内动脉等结构。观测岩内膝状神经节、颈内动脉(internalcarotidartery,ICA)的膝部、内耳道内侧缘、棘孔与耳蜗之间的解剖关系。结果:耳蜗位于面神经膝状神经节的前下方和岩内ICA膝部的后上方,耳蜗覆盖到ICA膝部的上方。ICA水平段与ICA膝部和内耳道内侧缘连线的夹角为67.1°±4.3°。结论:以棘孔和膝状神经节连线的中点、膝状神经节、内耳道内侧缘形成的三角定位耳蜗。在耳前—颞下窝斜坡手术入路中,在中颅底,过ICA膝部做与ICA水平段成67.1°±4.3°的夹角,在这个夹角内磨除岩尖骨质,不会损伤耳蜗、内耳道及其内容物。耳蜗基底圈至ICA膝部的距离为(0.302±0.016)cm。从前向后磨除岩尖骨质时,ICA膝部后方的骨质磨除不要超过(0.302±0.016)cm,否则会损伤耳蜗。     

儿童寰枢椎后路椎弓根螺钉固定的解剖与影像学研究

目的：探讨儿童寰枢椎后路置入直径为3．5mm的椎弓根螺钉的可行性。方法：（1）儿童脑死亡尸体标本10具，年龄6～8岁，测量寰椎椎弓根高度、宽度，寰椎侧块中部高度、宽度，椎动脉沟下方的寰椎后弓的宽度，椎动脉沟下方的寰椎后弓的外侧1／3、内侧1／3高度、枢椎椎弓根（横突孔）外缘、内缘高度，枢椎椎弓根（横突孔）上缘、中缘、下缘宽度；（2）对20例6～8儿童寰枢椎进行CT平扫，利用CT工作站测量寰枢椎横断面上寰椎椎弓根长度、宽度，枢椎椎弓根长度、宽度；寰枢椎椎弓根纵轴与正中矢状面的角度。结果：标本组寰椎椎弓根高度和宽度分别为（5．26±0．44）mm和（6．26±0．75）mm，寰椎椎动脉沟下方的寰椎后弓的外侧1／3高度为（4．07±0．24）mm，枢椎椎弓根外缘高度和内缘高度分别为（6．86±0．48）mm和（6．67±0．49）mm，上缘宽度、中缘宽度和下缘宽度分别为（6．63±0．61）mm、（5．41±0．39）mm、（3．71±0．30）mm。CT组寰椎高度为（5．47_＋0．34）mm、宽度为（6．63＋0．54）mm；枢椎高度为（6．59±0．51）mm、宽度为（5．13±0．42）mm；寰枢椎椎弓根纵轴与正中矢状面的角度分别为（9．60±1．32）°、（27．80±2．22）°。结论：6～8岁儿童寰枢椎椎弓根容纳直径为3.5mm的螺钉是可行的。     

《外科与放射解剖学》杂志文题摘要（2004年第26卷第2期）

1 Topographic relationship between the cochlea and the middle fossafloor:the anatomical basis for an alternative approach to the cochlcarturns S.Anagnostopoulou P.Diamantopoulou耳蜗与颅中窝底的局部解剖学关系:耳蜗管选择性入路的解剖学基础 自从耳蜗植入术被认为是治疗某种类型双侧深度听力减低的确切方法后,耳蜗得到了外科医生的极大关注。传统的入路是经由中耳到耳蜗管的。极少有文献报道有关耳蜗的选择性手术入路。由于有人提出可以由颅中窝底手术进入耳蜗,我们在58具人干性颅骨(116个颞骨)上专门研究了骨性耳蜗的上面至邻近的岩骨表浅结构的解剖学关系。以岩浅大神经沟和面神经孔作为标志点,显露耳蜗上面的结构。测量以下距离:a)颅中窝底到蜗管基底部表浅处.b)颅中窝底到耳蜗顶点;c)蜗管基底部表浅处到岩浅大神经沟;d)蜗管基底部表浅处中部至外侧的面神经管第一转弯处。我们的研究结果显示从颅中窝底至骨性耳蜗的手术入路是可行和可靠的。(26:82-85)     

大鼠肝、肾、胰器官簇移植的解剖基础研究

目的：为大鼠肝、肾、胰器官簇移植的开展提供解剖学基础。方法：35只大鼠显微镜下解剖观察肝肾、胰主要血管、胆管、胰管、输尿管的分布及其形态规律。结果：35只大鼠腹主动脉、肝上下腔静脉、肝下下腔静脉直径分别为（2．2±0．4）mm、（8．8±0．6）mm、（7．8±0．6）mm；肝、肾、胰血管细小（〈0．3mm．1．0±0．2mm，〈0．2mm）；肝动脉、胰腺血管有变异（分别为6／35、6／35）；采用腹主动脉、下腔静脉可以完成器官簇的移植手术。结论：肝、肾、胰器官簇移植在解剖学上比单一器官移植更简单，为大鼠肝、肾、胰器官簇移植手术模型建立提供了解剖学基础。     

颞骨岩部的临床应用解剖研究

目的 为经颞骨前岩部(petrous bone,PB)的颅底手术入路中,判断耳蜗位置和岩尖切除范围提供解剖学资料。方法 在12个成人头颅标本上,观测岩内面神经(facial nerve,FN)、耳蜗、颈内动脉(internal carotid artery,ICA)等结构之间的解剖关系。结果 耳蜗位于膝状神经节(geniculate ganglion,GG)的前下方和岩内ICA膝部的后上方,耳蜗覆盖到ICA膝部的上方。提出以棘孔和GG连线的中点、GG、内耳门内侧缘形成的三角定位耳蜗。ICA水平段与ICA膝部和内耳门内侧缘连线的夹角为67.1±4.3°,耳蜗基底圈至ICA膝部的距离为0.302±0.016cm。结论 在耳前-颞下窝斜坡手术入路中,在中颅底,过ICA膝部做与ICA水平段成67.1±4.3°的夹角,在这个夹角内切除岩尖骨质,不会损伤耳蜗。从前向后切除岩尖骨质时,ICA膝部后方的骨质切除不要超过为0.302±0.016cm,否则会损伤耳蜗。     

颈胸段脊柱前方手术入路的应用解剖

目的：为颈胸段脊柱（CTS）选择合理的手术入路提供解剖学依据。方法：在30具尸体标本上，观察胸骨颈静脉切迹（SJN）平面重要结构解剖及毗邻关系。结果：（1）70％的SJN水平向后对应的椎体水平为T2～T2/3。（2）70％的主动脉弓（AA）顶点位于T3椎体水平。63．33％的上腔静脉（SVC）起点位于T3椎体水平。AA顶点与SVC起点分别距椎体前正中线（PVM）的距离之间差异无统计学意义（P〉0.05）。头臂干和左颈总动脉分别与PVM的夹角α为（31．58±1.02）°和β为（16．55±0．46）°，两者之间差异有统计学意义（P〈0.05）。结论：熟悉胸骨颈静脉切迹、主动脉弓及其分支、和上腔静脉及其属支的相关解剖有助于在颈胸段脊柱前路手术中选择合理的手术入路。     

大三学生认知风格对情绪的影响

目的：探讨大三学生认知风格与情绪的关系。方法：使用认知方式图形测验、抑郁形容词检查表、状态焦虑问卷和诱导失败测验对选出的100名大三学生进行实验分组测查；场独立性组（男25人，女25人）和场依存性组（男25人、女25人）各50名。结果：（1）失败后，场独立组和场依存组抑郁和焦虑评分均高于失败前（抑郁：10．5±2．9／9．4±2．5，P=0．003；13．3±4．1／7．9±3．7，P〈0．001；焦虑：36．7±5．8／33．3±5．5，P〈0．001；43．9±8．9／37．9±9．6，P〈0．001）。（2）失败前，两组抑郁、焦虑得分差异均无显著性（P=0．193、0．125），但失败后，场依存组抑郁和焦虑评分均高于场独立组（抑郁：13．3±4．1／10．5±2．9，P=0．038；焦虑：43．9±8．9／36．7±5．8，P=0．014）。（3）认知风格与抑郁、焦虑呈中度负相关（r=-0．42、-0．58，P〈0．001）。结论：认知风格与状态情绪密切相关，但与特质情绪的关系还需进一步的研究探讨。     

小学生同伴接纳、教师接纳、学业成绩与心理健康的关系

目的：探讨同伴接纳、教师接纳、学业成绩与小学生心理健康的关系。方法：采用分层随机抽样的方法从福州市三所小学二、四、五年级的2200名学生中抽取445名学生，通过社会测量法和儿童行为量表来测量小学生心理健康状况，结合方差、相关等统计分析方法探讨这四者的关系。结果：小学男生Achebach儿童行为量表评分位于前3位的依次为：攻击性（8．45±6．05）、多动（4．82±3．51）、强迫性（4．56±4．18）。小学女生评分位于前3位的依次为：攻击性（7．79±6．03）、抑郁（5．05±4．20）、多动（4．69±3．67）；心理健康和同伴接纳、教师接纳、学业成绩之间呈负相关（r=-0．22、-0．26、-0．17，均P〈0．01）；不同同伴接纳、教师接纳和学业成绩水平小学生的心理健康存在显著的差异（F=11．610、11．34、6．147，P〈0．01）。进一步两两比较发现：高同伴接纳组的Achebach儿童行为量表总分低于中等接纳组和低接纳组[（25．3±17．2）vs．（30．7±21．7）、（42．4±22．2），P〈0．001]，中等接纳组得分低于低接纳组（P〈0．001）；低教师接纳组的Achebach儿童行为量表总分高于高接纳组和中等接纳组[（46．6±24．9）vs．（25．7±25．4）、（30．7±21．7），P〈0．001]，中等接纳组得分高于高接纳组（P〈0．001）；高成绩组的Achebach儿童行为量表总分低于中等成绩组和低成绩组[（25．3±17．9）vs．（31．1±21．9）、（38．4±22．0），P〈0．001]，中等成绩组低于低成绩组（P〈0．05）。结论：教师接纳程度低的学生心理健康水平也低。学业成绩好的学生同伴接纳水平和教师接纳水平也高。同伴接纳、教师接纳和学业成绩对小学生的心理健康会产生一定的影响。     

中学生内疚与羞耻差异的对比研究

目的：探讨中学生内疚与羞耻的关系。方法：采用自编内疚事件与羞耻事件问卷对1000名中学生进行调查，同时对24名做深度访谈。结果：（1）中学生自我报告内疚事件中体验的内疚程度大于羞耻程度（6．0±1．2／5．0±1．7，P〈0．001），羞耻事件中内疚程度小于羞耻程度（5．1±1．9／5．7±1．4，P〈0．001）；内疚在内疚事件里的评价高于在羞耻事件里的评价（6．0±1．2／5．1±1．9，P〈0．001），羞耻在羞耻事件里的评价高于在内疚事件里的评价（5．0±1．7／5．7±1．4，P〈0．001）；（2）在内疚事件中，除初一年级外，其余各年级体验到的内疚程度均高于羞耻程度（如，初二5．8±1．4／5．1±1．6，P〈0．001）；在羞耻事件中，除初一和初二年级外，其余各年级体验到的内疚程度均低于羞耻程度（如，初三4．7±2．0／5．6±1．3，P〈0．001）；（3）内疚事件和羞耻事件在发生场合、伤害对象、后悔与面子方面的发生频率均存在显著差异，如，内疚事件主要发生于私人化场合314（64．3％），羞耻事件主要发生于公开化场合329（65．9％）（χ^2=181．504，P〈0．001）；（4）中学生在内疚事件上的归因得分大于在羞耻事件上的归因得分（5．2±1．6／3．8±1．8，P=0．001）。结论：中学生内疚和羞耻总体上存在显著差异，同时存在一个由相同到分化的关键期，大致在初三年级；“公开化和私人化”假设以及“伤害自我与伤害他人”假设同样适合于中国中学生群体；存在“后悔与面子”假设；个体对内疚事件更倾向于内归因，对羞耻事件更倾向于外归因。     

Immunological aspects of implantation and implantation failure

The human endometrium contains a significant proportion of leukocytes (8-35% of all cells), the absolute numbers and proportions varying during both the menstrual cycle and early in pregnancy. T cells, macrophages and a population of phenotypically unusual large granular lymphocytes (LGL) are commonly present, although B cells are absent. Relative T cell numbers decrease significantly in first trimester decidua, and hence are unlikely to play an important role in maintenance of human pregnancy, but T cells could be important in implantation where their relative numbers are greater. In addition to producing cytokines, local tissue macrophages may provide an immediate antigen non-specific host defence to infection. Most attention has, nevertheless, focused on a role for LGL in implantation and maintenance of pregnancy since, at the time of implantation, LGL comprise 70-80% of the total endometrial leukocyte population. Although endometrial LGL have been shown to express natural killer (NK) cell-type cytotoxicity against classical NK cell targets, such cytotoxicity against trophoblast is induced only after activation by interleukin (IL)-2. Selective expression of the unusual class I human leukocyte antigen (HLA) molecule, HLA-G, by extravillous cytotrophoblast may assist in protecting invasive cytotrophoblast from potential maternal NK cell attack, probably via interactions with killer inhibitory receptor molecules on LGL. Many cytokines have been demonstrated to be expressed at the maternal-fetal interface although, currently, in mice only two (IL-11 and leukaemia inhibitory factor) appear to be absolutely essential for successful pregnancy outcome. Immune effector cells and cytokines may also play a role in human pregnancy pathologies, such as recurrent early pregnancy loss.     

Cytokines in implantation

The process of implantation in the human involves ‘invasion’of the maternal endometrium by the tro-phoblast surroundingthe developing blastocyst, in response to which there is a cellularreaction in the endometrium. The overall situation has somefeatures analogous to invasion by a tumour and some which aremore characteristic of an inflammatory response. In addition,and also in common with cancer and inflammation, there is arelease of biologically active molecules, including cytokines,at and around the implantation site. It is believed that thesecytokines may play an important role in the successful establishmentof the pregnancy; the evidence for this belief is examined inthis review.     

小鼠胚泡植入前、中、后子宫内膜nm23-M2动态表达

目的研究抑癌基因nm23-M2在小鼠胚泡植入前、中、后子宫内膜的动态表达。方法采用RT-PCR及免疫组织化学方法分别检测小鼠妊娠第2天（植入前）、第5天（植入中）、第7走（植入后）子宫内膜nm23-M2表达。结果RT-PER测得胚泡植入前、中、后子宫内膜中均存在nm23-M2的表达，但在妊娠第5天植入窗口期（植入中）nm23-M2 mRNA/β-actin mRNA的比值明显升高，与植入前和植入后相比较，具有显著差异（P〈0．01）。免疫组织化学分析显示妊娠第5天子宫内膜nm23-M2表达为强阳性，而植入前和植入后子宫内膜nm23-M2表达多为弱阳性。表明胚泡植入窗口期子宫内膜nm23-M2表达上调。结论nm23-M2可能参与了小鼠胚泡植入。     

小鼠胚泡植入前、中、后子宫内膜nm3-M2动态表达

目的研究抑癌基因nm23-M2在小鼠胚泡植入前、中、后子宫内膜的动态表达。方法采用RT-PCR及免疫组织化学方法分别检测小鼠妊娠第2天(植入前)、第5天(植入中)、第7天(植入后)子宫内膜nm23-M2表达。结果 RT-PcR测得胚泡植入前、中、后子宫内膜中均存在nm23-M2的表达,但在妊娠第5天植入窗口期(植入中)nm23 -M2 mRNA／β-actin mRNA的比值明显升高,与植入前和植入后相比较,具有显著差异(P<0．01)。免疫组织化学分析显示妊娠第5天子宫内膜nm23-M2表达为强阳性,而植入前和植入后子宫内膜nm23-M2表达多为弱阳性。表明胚泡植入窗口期子宫内膜nm23-M2表达上调。结论 nm23-M2可能参与了小鼠胚泡植入。     

Embryo implantation and GnRH antagonists: embryo implantation: the Rubicon for GnRH antagonists

When gonadotrophin-releasing hormone (GnRH) was discovered, the agonist and antagonist of GnRH were developed to control the release of FSH and LH by the gonadotrophs. More than 10 years of research were needed to develop a GnRH antagonist free of histamine release. Recent studies have shown that these GnRH antagonists are effective in preventing a rise in LH during ovarian stimulation in IVF. However, a decrease in ongoing pregnancies seems to suggest that implantation rates per transferred embryo are reduced in GnRH antagonist-stimulated cycles. In my opinion, these data highlight an area less well known to clinicians: the role of the GnRH antagonist at the cellular level in extrapituitary tissues. There are sufficient data in the literature suggesting that GnRH antagonist is an inhibitor of the cell cycle by decreasing the synthesis of growth factors. Given that, for folliculogenesis, blastomere formation and endometrium development, mitosis is everything; the interaction between the GnRH antagonist and the GnRH receptor (present in all these cells and tissues) may compromise the mitotic programme of these cells. This is the Rubicon for the GnRH antagonist: to demonstrate irrevocably that, at the minimal doses necessary to suppress LH release, it does not affect processes such as implantation, embryo development and folliculogenesis.     

Endometrial implantation window in infertility

The paper presents the results of biopsy and curettage specimens from 92 patients with infertility. Histological and immunohistological (steroid receptors, Ki67, P27, and cyclin E) methods and scanning electron microscopy have been used. The substantial immunohistochemical (IHC) changes found in the endometrial implantation window in infertility are associated with the spectrum of the detected pathology. No clear correlations between the expression of IHC markers and the concentrations of serum hormones, which are characteristic of the normal menstrual cycle, may suggest that there is an imbalance of steroid reception at the endometrial tissue level. The detection of proteins P27 and cyclin E in the cytoplasm of glandular and stromal cells reflects the deficient block of a cell cycle essential for an adequate implantation window. The detected features of the superficial endometrial ultrastructure may be an additional indicator of the adequacy of endometrial secretory maturation. The essential histological, immunohistochemical, and ultrastructural features of the endometrium in infertility give valuable information that complements the traditional clinical classifications. Evaluation of the endometrial morphofunctional state opens up fresh opportunities to ensure an individual approach when using the regimens of assisted reproductive technologies.     

A micromanometer for chronic implantation

A micromanometer has been developed for implantation into the ventricles of dogs to obtain high-fidelity recordings of the ventricular-pressure pulse wave. The device consists of a cylindrical epoxy-resin body to which is bonded a thin glass diaphragm, and which contains a linear variable differential transformer excited at 100 kHz. The overall diameter is 3·8 mm and the length is approximately 8·9 mm. A 2·5 mm-diameter p.v.c. tube is attached and carries the excitation and signal wires. A 100 kHz carrier amplifier is used with the device. The damped natural frequency of the manometer is typically 1·5 kHz, with a damping ratio of less than 0·1. The net response of the system is determined by theRC active filter of the carrier amplifier, and is uniform from 0 to 35 Hz. The device exhibits satisfactory linearity and hysteresis, and is free of movement artefact, but is sensitive to temperature and does exhibit a small degree of creep.