The Functional Organization of the Olivo-Cerebellar System as Examined by Multiple Purkinje Cell Recordings

Multiple recordings from Purkinje cells in the rat cerebellum allowed the mechanism responsible for the activation of rows of synchronous complex spikes to be investigated. By determining the spatial distribution of the climbing fibre reflex that follows electrical microstimulation of the cerebellar cortex, it was shown that the mechanism for the simultaneity of firing was the electrotonic interactions between neurons in the inferior olive (IO). The spatial organization of the complex spike activity was shown to be regulated by GABAergic inhibitory input into the IO, probably arising from the cerebellar nuclear neurons. The rostro-caudal organizion of the complex spike activity following physiological stimulation (tactile stimulation of the upper and lower lip) demonstrated the same spatial distribution of synchronous activity in the cerebellar cortex as did the spontaneous activity and this was also disrupted by GABA blockers. Finally, complex spike responses to physiological stimulation indicate that the IO is capable of gating sensory inputs in accordance with its intrinsic autorhythmicity and that strong peripheral stimuli reset the oscillatory properties of the IO. The functional implications of the synchronicity and of the temporo-spatial organizion of complex spikes in the cerebellar cortex are discussed in the context of motor coordination and timing.     

他汀给药时机对行rt-PA溶栓急性脑梗死患者神经功能损伤程度、实验室指标及并发症发生风险的影响

目的探讨他汀给药时机对行rt-PA急性脑梗死患者神经功能损伤程度、实验室指标及并发症发生风险的影响。方法选择行rt-PA急性脑梗死患者共130例,以随机数字表法分为A组(65例)和B组(65例);其中A组患者在rt-PA溶栓后给予他汀10 mg/d口服治疗,B组患者在rt-PA溶栓前给予他汀10 mg/d口服治疗;比较两组患者预后良好率、症状性颅内出血发生率,以及治疗前后NIHSS评分、Barthel指数评分、MMP-9、HMGB1、IL-17水平等。结果 B组患者预后良好率显著高于A组(P<0.05);B组患者治疗后NIHSS评分和Barthel指数评分均显著优于A组、治疗前(P<0.05);B组患者治疗后HMGB1、MMP-9及IL-17水平均显著低于A组及治疗前(P<0.05);两组患者症状性颅内出血发生率比较差异无统计学意义(P>0.05)。结论他汀溶栓前给药用于行rt-PA急性脑梗死患者,可有效降低患者神经功能损伤程度,提高其日常生活质量,下调HMGB1、MMP-9及IL-17水平,改善其临床预后,且未增加症状性颅内出血风险,优于溶栓后给药。     

重症急性胰腺炎各期经皮穿刺置管引流疗效

目的 探讨重症急性胰腺炎经皮穿刺置管引流治疗的时机及临床价值.方法 回顾性分析采用经皮穿刺(置管)引流术治疗的125例重症急性胰腺炎病例资料.所有患者在CT及床边B超引导下行经皮穿刺引流术.结果 首次穿刺引流时间距发病1~46(11.0±7.9)d,每例置管次数0~11次,平均3.2次,留置引流管时间0~128(27.1±16.6)d.共107例(107/125,85.6%)患者接受经皮穿刺(置管)引流或后期中转开腹手术治疗后康复,18例(18/125,14.4%)死亡.21例(21/117,17.9%)在行经皮穿刺置管引流后3~32(19.8±9.0) d接受开放手术治疗、16例(16/21,76.2%)最终获得治愈、5例(5/21,23.8%)死亡.穿刺置管引流总体有效率为70.9%(83/117),1周内为79.4%(27/34),1~2周为75.9%(22/29),2~4周为63.2%(24/38),4周后为62.5%(10/16);各阶段置管并发症发生例数分别为5、8、7、4(P=0.595);各阶段死亡例数为5(14.7%)、4(13.7%)、7(18.4%)、2(12.5%)(P=0.932).结论 在遵循指南的基础上,观察患者的临床表现、置管引流有效性等更为重要;早期穿刺置管引流的最终有效率较高,安全、不增加感染率,但差异无统计学意义;后期不排斥中转开放手术治疗,但指征需进一步探究.     

Timing of elective cesarean section and neonatal morbidity: a population-based study

Purpose: To assess the incidence of neonatal complications related to gestational age at elective cesarean section near term.

Methods: We used a population-based dataset to compare neonatal outcomes by gestational age in uncomplicated singleton pregnancies delivered by elective cesarean section ≥37 weeks.

Results: A total of 7364 mothers had an elective cesarean during 2002–2012; 343 (4.7%) at 37, 21?753 (3.8%) at 38, 3140 (2.6%) at 39, 1718 (23.3%) at 40 and 410 (5.6%) at ≥41 weeks. Infants born at a lower gestational age had a higher rate of Apgar scores?<7 (2%, 0.4%, 0.6%, 0,3%, 0.2% at 37, 38, 39, 40 and ≥41 week, p?=?0.013), hypoglycemia (1.5%, 1.0%, 0.8%, 0.4%, 0.5% at 37, 38, 39, 40 and ≥?41 week, p?=?0.012), hyperbilirubinemia (12.2%, 9.5%, 6.4%, 4.8%, 4.1% at 37, 38, 39, 40 and ≥?41 week, p?<?0.001), respiratory distress syndrome (5.5%, 2.2%, 1.6%, 0.5%, 0.7% at 37, 38, 39, 40 and?≥?41 week, p?<?0.001), and neonatal intensive care admissions (8.7%, 2.3%, 1.9%, 1.0%, 1.7% at 37, 38, 39, 40 and ≥?41 week, p?<?0.001).

Conclusions: Elective cesarean section at ≥?39 weeks gestation would significantly reduce neonatal complications.     

不同时机体外冲击波碎石术治疗双侧输尿管结石的效果对比

目的:研究不同时机体外冲击波碎石术治疗双侧输尿管结石的效果。方法:纳入2017年7月~2018年6月收治的78例双侧输尿管结石患者展开研究,按照碎石次数分为对照组和观察组各39例,对照组在接受两次体外冲击波碎石术后进行手术治疗,观察组在进行1次体外冲击波碎石术后进行手术治疗,将两组的临床疗效、肾功能、并发症发生情况进行比对。结果:观察组双侧输尿管结石患者的临床总有效率(92.31%)明显高于对照组,术后的BUN水平(5.22±1.17)mmol/L、Cr(111.62±10.69)μmol/L以及并发症发生率(10.26%)均明显低于对照组,差异具有统计学意义(P<0.05)。结论:双侧输尿管结石患者经1次体外冲击波碎石术后排石效果不理想尽早进行手术取石治疗的效果高于两次体外冲击波碎石术后进行手术治疗,可使肾功能损伤程度降低,安全性更高。     

眶内填充物治疗爆裂性眼眶壁骨折的临床疗效观察

目的探讨眶壁爆裂性骨折手术疗效及手术时机。方法采用眶壁修补术治疗76例眶壁爆裂性骨折患者。术后随访3mo～1a,观察患者复视、眼球突出度、眼球活动度及其并发症。结果①手术后对眼球内陷疗效的观察早期手术治愈率69%,好转率31%。晚期手术治愈率69%,好转率31%。在治疗眼球内陷的总有效率为100%。但早期手术与晚期手术患者有效率(包括治愈与好转)比较P>0.05无显著差异;②手术后对复视恢复的观察早期手术中有效率62%,好转率24%,无效率14%。晚期手术中有效率21%,好转率29%,无效率50%。早期手术与晚期手术总有效率(包括治愈及好转)比较P<0.01有极显著性差异;③术后并发症有1例患者在术后因眶压增高导致视力丧失。结论早期眶壁修补术是治疗眶壁爆裂性骨折的有效方法。     

Biological spacetime and the temporal integration of functional modules: a case study of dento-gnathic developmental timing.

For the individual, coordination between tooth and jaw development is important to proper food acquisition and ingestion later in life. Among and within species, variation in dental and gnathic size, shape, and, in the case of teeth, number, must be mutually accommodating and functionally compatible. For these reasons, the development and evolution of these two systems should be closely integrated. Furthermore, the timing of dental development correlates tightly with life history events such as weaning. This correlation hints at a central regulation of the developmental timing of multiple systems that have tandem effects on physiology and behaviour. Important work on embryonic oral development continues to tease apart the molecular mechanisms that pattern jaw identity and establish tooth morphology and position in the alveolar bone. Still very poorly understood is what underlies rates and periods of gene activity such that pre- and postnatal tooth and jaw development are coordinated. Recent literature suggests at least some level of autonomy between permanent tooth and mandibular ontogenetic timing. However, whether the timing of these various signaling pathways is directly regulated or is an outcome of the pathways themselves is untested. Here, we review what is currently known about the embryonic signaling pathways that regulate tooth and jaw development in the context of time rather than space, as has been traditional. We hypothesize that the timing of mandibular and dental development is not directly mediated by a common factor but is an indirect outcome of strong selection for coordinated molecular pathways and growth trajectories. The mandible and lower jaw dentition is a powerful model with which to investigate the mechanisms that facilitate morphological change-in this case, the development and evolution-of organs that are closely integrated in terms of function, space and time.     

Time is spine: What's over the horizon

The overarching theme in the early treatment of acute spinal cord injury (SCI) is to reduce the extent of secondary damage to facilitate early neurological and functional recovery. Although multiple studies have brought us innovative and potential new therapies to treat SCI, ameliorating neural damage remains a formidable challenge. Knowledge translation of clinical and basic research studies has shown that surgical intervention is a valuable treatment modality; however, the role, timing and optimal technique in surgery remains a topic of great controversy. While evidence to support the concept of ultra-early surgery for acute SCI continues to emerge, current protocols and international guidelines that encourage reducing time from trauma to surgery support the concept of “Time is Spine”. The present article provides a critical narrative review of the current best practice, with a particular focus on the timing of surgical intervention, which shapes our understanding of how time is of the essence in the management of acute SCI.     

Computing sleep deficiency

Sleep deficiency is a major public health concern. Since epidemiological studies play an important role in public health evaluations, this theoretical paper pursues answers to the question: ‘How can we compute sleep deficiency as informative measures of exposures or doses in observational research?’ Starting from the social jetlag concept and based on the chronodisruption rationale, we illustrate and discuss five approaches (one established and four untested, each with unique strengths and limitations) to quantify sleep deficiency by focusing on the timing and duration of sleep. Hitherto, social jetlag and chronodisruption rationale were neither explicitly proposed nor developed as assessments of sleep deficiency but, as we suggest, could potentially be utilized to this end. This first foray into computing sleep deficiency in epidemiological studies makes clear that laboratory, field and epidemiological collaboration is pre‐requisite to elucidating potential (co‐)causal roles of sleep deficiency in disease endpoints.