The superficial ulnar artery: incidence and calibre in 95 cadaveric specimens

The superficial ulnar artery (SUA) is an anatomical variation of the upper limb vasculature with a prevalence of 0.7-9.4% in the population. The importance of this variant is that it may be cannulated inadvertently by an unsuspecting physician, leading to possible ischemia of the hand. With the growing use of radial forearm flaps, the surgeon needs to be aware of its presence during surgery and be able to adapt the procedure accordingly. The aims of the study focus on the incidence and calibre of the SUA. Ninety-five cadaveric limbs were dissected and the calibre of the different arteries measured. Four SUAs (4.2%) were found, all in male cadavers. Two of these were from the same cadaver. Measurements of the calibre of the vessels showed that the SUA was smaller than the ulnar artery. Of the limbs dissected, 4.2% had an SUA, which is a similar prevalence to other studies in Western Europe. It is most commonly found in males, unilaterally and in the right upper limb. It is extremely rare to experience consequences from intra-arterial cannulation and the SUA may have more of a beneficial role in reconstructive fasciocutaneous forearm flaps.     

Contusive spinal cord injury evokes localized changes in NADPH-d activity but extensive changes in Fos-like immunoreactivity in the rat

The histological detection of nicotinamide adenine dinucleotide phosphate-diaphorase (NADPH-d), a marker for nitric oxide-producing cells, was used to evaluate ongoing changes in the neural biochemistry of the rat spinal cord 1 week following contusive spinal cord injury (SCI). In addition, the immunohistochemical detection of the immediate-early gene c-fos was used to identify basal patterns of neural activity at this time. The numbers and laminar locations of NADPH-d- and c-fos-positive cells were examined in spinal segments adjacent to the site of injury (T12-S3) as well as those distant from the injury (C3-C5) in both SCI and un-injured rats. Our data show that contusive SCI results in a significant reduction in NADPH-d labelling in the superficial dorsal horn, and a significant increase in NADPH-d expression in small bipolar neurons and large motoneurons in the ventral horn at the site of the injury. In spinal segments distant to the injury site (C3-C5), NADPH-d activity did not differ from that of uninjured controls. Furthermore, significant reductions in the levels of c-fos expression were observed in SCI rats, in spinal segments both at and distant to the site of injury for all spinal laminae. The only exception was a dramatic increase observed in the sacral parasympathetic nucleus. These data suggest that increased NADPH-d expression is related to conditions specific to the site of injury, whereas the changes in c-fos expression probably indicate more global changes in neuronal activity following SCI.     

柴夏芩姜汤治疗肝气犯胃兼脾胃湿热型慢性浅表性胃炎患者的效果

目的:观察柴夏芩姜汤治疗肝气犯胃兼脾胃湿热型慢性浅表性胃炎患者的效果。方法:选取60例慢性浅表性胃炎患者作为研究对象,采取随机数字表法分为对照组和观察组各30例。对照组采取常规西药治疗,观察组采取柴夏芩姜汤治疗,比较两组临床疗效、治疗前后胃肠疾病中医证候评分和不良反应发生率。结果:观察组治疗总有效率为100.00%(30/30),高于对照组的80.00%(24/30),差异有统计学意义(P<0.05);治疗后,观察组胃肠疾病中医证候评分低于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:柴夏芩姜汤治疗肝气犯胃兼脾胃湿热型慢性浅表性胃炎患者可提高治疗总有效率,降低中医证候评分,效果优于常规西药治疗。     

全身麻醉复合颈浅丛阻滞麻醉对甲状腺术后躁动和术中甲状腺素水平的影响

目的探讨全身麻醉复合颈浅丛阻滞麻醉对甲状腺术后躁动和术中甲状腺素水平的影响。 方法随机将行甲状腺手术患者84例均分为两组。对照组采用全身麻醉,观察组采用全身麻醉复合颈浅丛阻滞麻醉。比较两组麻醉诱导前(T0)、气管插管后1 min(T1)、切开皮肤时(T2)、手术开始后30 min(T3)、手术结束时(T4)患者的心率(HR)、平均动脉压(MAP)。测定血游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺素(T4)、三碘甲状腺原氨酸(T3)、促甲状腺激素(TSH)等水平。 结果观察组T2、T3、T4点MAP、HR明显低于对照组(P＜0.05)。观察组术后各时间点甲状腺素水平差异无显著性(P＞0.05);观察组T3、T4点FT3、T3、TSH水平均明显高于对照组(P＜0.05);观察组T2、T3、T4点FT4、T4水平均明显高于对照组(P＜0.05)。观察组术后3、6、12、24hVAS评分均明显低于对照组(P＜0.05)。观察组不良反应发生率显著低于对照组(χ²＝6.157,P＝0.017)。 结论全身麻醉复合颈浅丛阻滞麻醉下甲状腺术中甲状腺素水平比较稳定,且抑制术后躁动,具有较高的临床应用价值。     

Activity of deep and superficial pelvic floor muscles in women in response to different verbal instructions: a preliminary investigation using a novel electromyography electrode北大核心CSCD

INTRODUCTION Verbal instructions are used clinically to encourage activation of the pelvic floor muscles (PFM). Whether separate layers of PFM activate differently in response to instructions remains unknown. AIM To test the hypotheses that (i) instructions that aimed to bias activity of a specific muscle layer would increase activation of the targeted layer to a greater extent than the other layer,(ii) activity of individual PFM layers would differ between instructions, and (iii) PFM activity would be symmetrical for all instructions.     

Novel enriched pathways in superficial malignant peripheral nerve sheath tumours and spindle/desmoplastic melanomas

Superficial malignant peripheral nerve sheath tumour (MPNST) is a rare, soft tissue neoplasm that shares morphological features and some molecular events with spindle/desmoplastic melanoma (SDM). Herein, we sought to identify molecular targets for therapy by using targeted RNA/DNA sequencing and gene expression of key immunological players. DNA and RNA from formalin‐fixed paraffin‐embedded tissue were extracted and processed. Massive high‐throughput deep parallel sequencing was performed with the Oncomine comprehensive panel, enabling detection of relevant single‐nucleotide variants, copy number variations, gene fusions and indels for 143 unique genes on the Ion torrent sequencer for clinical trial research programmes. Gene expression analysis was carried out with a customized 770‐gene expression panel combining markers for 24 different immune cell types and 30 common cancer antigens, including key checkpoint blockade genes analysed with the Ncounter system. Fifty‐one patients (SDM, 16/11; MPNST, 24; male, n = 37; female, n = 16) had sufficient DNA and RNA for testing. NF1 deleterious mutations and/or deep/homozygous deletions were identified in 73% of MPNSTs and 67% of SDMs, with 50% of the mutations involving the RAS‐binding domain. Inactivating/deleterious mutations of TSC1/TSC2 were identified in 40% and 41% of MPNSTs and SDMs, respectively. Activating mutations affecting the EGFR‐like and the negative regulatory domains of NOTCH1 and KDR (VEGFR2) were identified in 45% and 40% of SDMs and in 30% and 8% of MPNSTs, respectively. Differential gene expression and gene clustering analysis showed significantly perturbed immune pathway components, including nuclear factor‐κB (NF‐κB), JAK–STAT, and CXCL12–CXCR4, and differentially expressed CD274 and CTLA4, in both SDM and MPNST. Angiogenesis (KDR and NOTCH1) and mammalian target of rapamycin complex (mTORC) pathways offer a rationale for anti‐angiogenic and selective mTORC inhibition as treatment strategies for MPNST and SDM. Cytokines and the JAK–STAT, TNF and NF‐κB axes were perturbed in both SDM and MPNST. These pathways have been targeted in haematological malignancies and present promising targets for these tumours. Copyright © 2017 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

浅静脉留置针穿刺中双止血带双交叉结扎法的临床研究

目的探讨浅静脉穿刺双止血带双交叉结扎法对浅静脉留置针穿刺止血带结扎成功率、静脉血管充盈度及静脉穿刺成功率的影响。方法将300例静脉血管充盈度差、在消化内科住院接受静脉输液的患者浅静脉穿刺时采用止血带单、双交叉结扎法进行对比研究,共穿刺600例次,平均每例穿刺2次。采用自身对照法,分单、双日组,双日组为实验组,单日组为对照组,实验组采用双止血带双交叉结扎法,对照组采用止血带单交叉结扎法。结果观察组止血带的一次结扎成功率、不同时间的静脉血管充盈度及静脉穿刺成功率明显高于对照组(P<0.05)。结论浅静脉留置针穿刺双止血带双交叉结扎法,能提高止血带一次结扎的成功率,改善静脉血管的充盈度,从而提高浅静脉留置针穿刺的成功率及护理的工作效率,为病人的治疗与抢救赢得时间。     

羊膜移植治疗难治性浅表性角膜溃疡的临床观察

目的：探讨羊膜移植在难治性浅表性角膜溃疡治疗中的可行性及治疗效果。方法：时32例经长期药物治疗效果不佳的难治性浅表性角膜溃疡患者采取病灶切除后羊膜覆盖术。结果：27眼于术后5d～2周感染得到控制，溃疡愈合，角膜不同程度恢复透明。随访3～12个月，27例患者原症状消失，角膜荧光素染色阴性，溃疡无复发。5例分别于术后1及2个月复发，经羊膜移植联合板层角膜移植术后治愈，视力均有不同程度提高。结论：人羊膜移植是一种简便有效的治疗难治性浅表性角膜溃疡的手术方法。     

恶性肿瘤患者浅静脉化疗时自我护理情况调查

目的 了解恶性肿瘤患者浅静脉化疗时自我护理状况。方法 采用自行设计的调查表，对100例恶性肿瘤患者浅静脉化疗时自我护理情况进行调查，包括治疗和护理的依从情况、对化疗药物知识了解情况、静脉血管的保护情况3方面。结果 恶性肿瘤患者化疗时依从性较好，对化疗药物知识了解较少，保护静脉血管知识掌握较差。结论 护士应加强患者化疗知识的健康教育，指导患者提高自我护理的能力。