不同麻醉方案在术中唤醒试验中的应用

相比体感诱发电位（SSEP）和运动诱发电位（MEP），手术唤醒试验具有简单、安全、可靠、无特殊设备要求的优点，因而在临床广泛应用于大脑皮质功能区手术及脊柱侧弯矫形手术。如何进行快速、安全、平稳的唤醒试验对麻醉医师术中管理水平提出了巨大的挑战。本文就不同麻醉方法和药物在唤醒试验中的应用及其对唤醒时间、苏醒质量的影响做一综述。     

缺血性卒中患者的睡眠障碍：病理生理学机制和治疗

睡眠障碍是缺血性卒中的一种常见并发症,如不及时诊断和治疗,可影响卒中的康复和复发。根据梗死部位的不同,睡眠障碍的表现形式多样。对于卒中后睡眠障碍的治疗,目前临床上多采取药物和物理治疗相结合的方法。近年来,随着多导睡眠监测技术的广泛应用,卒中后睡眠障碍已能得到明确和细致的诊断。针对卒中后睡眠障碍的治疗可明显改善患者的预后。     

Is Acromioplasty Ever Indicated During Rotator Cuff Repair?

Based on data from a national healthcare insurance carrier in the United States between 2010 and 2012, orthopedic surgeons performed an acromioplasty procedure on 73 to 76% of their arthroscopic rotator cuff repairs. This has remained a prevalent arthroscopic adjunct despite the controversies disputing the role and etiology of external impingement on symptomatic rotator cuff disease. Within the past decade, several randomized studies have demonstrated negligible benefits with acromioplasty performed alongside rotator cuff repair, with no significant differences in either patient-reported outcome scores or retear rates). Conversely, other authors have suggested higher rates of reoperation with rotator cuff repair alone. Critical shoulder angle, an objective measure of lateral acromion extension and glenoid inclination that is considered a gauge of external impingement, has demonstrated an association with rotator cuff tears; Despite this, patient-reported outcomes do not consistently correlate with critical shoulder angle or other variants in acromial morphology after arthroscopic full-thickness rotator cuff repair. Evidenced-based data is currently lacking to support routine use of acromioplasty in all cases of rotator cuff repair. However, the current available studies do present design flaws, namely statistical underpowering, particularly in type III acromion morphology; inadequate short-term follow-up; lack of imaging data to assess cuff healing; and insensitive outcome measures to capture the theorized benefits of subacromial decompression. Additionally, several relevant merits of acromioplasty have been reported, including decreased abrasive wear with prominent type III acromial morphology, release of natural growth factors to improve rotator cuff healing, and improved visualization during rotator cuff repair. Further evaluation is needed to determine the correct indications for acromioplasty in the setting of cuff repair. Current data would indicate that acromioplasty can be used safely at the discretion of the operating surgeon based on preoperative and intraoperative findings.     

Wake-related activity of tuberomammillary neurons in rats

Histaminergic neurons of the tuberomammillary nucleus (TMN) are hypothesized to promote wakefulness, but little is known about the activity of these cells during spontaneous behavior. We measured histaminergic neuron activity in the dorsomedial, ventrolateral, and caudal TMN at four different times using Fos and adenosine deaminase immunohistochemistry and recordings of sleep/wake behavior. Because circadian factors could influence neuronal activity, we then assessed TMN neuron activity in predominantly sleeping or awake animals, all killed at the same time of day. In both experiments, Fos expression in histaminergic neurons of all three TMN subnuclei was higher during periods of wakefulness. These results demonstrate that histaminergic neurons throughout the TMN are wake-active, and this activity is largely independent of the time of day.     

Pathobiologic study of pituitary tumors: report of 62 cases with a review of the recent literature

Advances in radioimmunoassay procedures, immunocytochemistry, neuroradiologic imaging, and the surgical and medical treatment of pituitary adenomas have led to reappraisal of their classification as well as refinements in the diagnostic approaches used by pathologists. Sixty-two pituitary adenomas are described, and recent advances in this field are reviewed. Most of the patients were adults, but one of the adrenocorticotropic hormone (ACTH)-producing adenomas occurred in an 11-month-old infant. Endocrine-inactive tumors (43.5 per cent) were less common than hormone-producing tumors (56.5 per cent). Local invasion was most common in the former group, followed by ACTH-producing and other hormone-producing tumors. Ultrastructural features correlated with hormonal levels in the growth hormone(GH)-secreting tumors but not in the prolactin(LTH)- or ACTH-producing tumors. The formation of 7-nm filaments in the cytoplasm of tumor cells, corresponding to Crooke's hyaline change on light microscopy, was characteristic of ACTH-producing tumors. Ultrastructural changes in the ACTH granules suggested that the filaments may be derived from the feedback action of cortisol. Prior to surgery, a Rathke's cleft cyst and a chordoma were mistaken for endocrine-inactive pituitary adenomas. In two additional cases ectopic ACTH-producing tumors of lung clinically mimicked pituitary adenoma. Conversely, one pituitary adenoma mimicked sphenoid wing meningioma. Clinical, hormonal, and radiologic data and immunocytochemical and electron microscopic studies are needed for accurate pathologic interpretation and classification of pituitary adenomas.     

Development of a porcine deep partial thickness burn model

Swine are the preferred animal models to study the effects of burns on dermal wound healing. Various studies have been published in which little emphasis was placed on minimizing burn variability and inconsistency. We developed a novel method to create deep partial thickness burns that are highly consistent.     

Relationship between sleep habits,anthropometric characteristics and lifestyle habits in adolescents with intellectual disabilities

The aim was to explore the relationship between sleep habits and overweight/obesity, physical activity and sedentary behaviours in French adolescents with intellectual disabilities. This observational study was conducted on 535 French adolescents with intellectual deficiency. Sleep habits were analyzed and related to anthropometric measures, physical activity and sedentary behaviours. The study was conducted using a self-administered questionnaire. Adolescents completed the questionnaire during an interview with the principle investigator. Sleep timing behaviour was classified into 4 sleep patterns: Early-bed/Early-rise, Early-bed/Late-rise, Late-bed/Late-rise, and Late-bed/Early-rise. Of 573 eligible participants, 125 were excluded because of missing data on age, weight or height. The number of participants identified in each of the four sleep patterns was as follows: Early-bed/Early-rise, N = 59 (15.4%), Early-bed/Late-rise, N = 164 (43%), Late-bed/Early-rise, N = 56 (15%), Late-bed/Late-rise N = 102 (27%). Adolescents who woke up early were more active than those from the late rise group (p < 0.001). The number of adolescents who are sedentary was higher in late rise vs. early rise subjects (p < 0.001). Subjects in the late-bed group were more likely overweight and obese (p < 0.05). Results suggest that sleep behaviour was associated with overweight/obesity, physical activity and sedentary behaviour in adolescents with intellectual deficiency. Sleep behaviours should be considered in planning health promotion strategies.     

Volume reduction of ventromedial prefrontal cortex in bipolar II patients with rapid cycling: a voxel-based morphometric study

Although rapid cycling (RC), a course specifier of bipolar I or II disorder, is particularly common among bipolar II patients compared with bipolar I patients, the pathophysiological lines of evidence regarding bipolar II with RC are still limited. In this preliminary study with a cross-sectional design, we examined the regional gray matter (GM) volume in 14 bipolar II patients with RC, 17 patients without RC and 84 healthy controls by whole-brain and region-of-interest (ROI) analysis methods, using magnetic resonance imaging with voxel-based morphometry. Whole-brain analysis in this study revealed that the bipolar II patients with RC showed GM volume reductions in the bilateral hemispheres of the medial orbital prefrontal cortex, ventromedial prefrontal cortex, anterior cingulate, insula and parahippocampus, in the left hemisphere of the inferior temporal cortex and cerebellum, and in the brainstem, compared with the healthy controls. Moreover, ROI analysis focusing on the ventral prefrontal cortex, i.e., Brodmann areas 10, 11 and 47, revealed that the bipolar II patients with RC showed GM volume reduction in the ventromedial prefrontal cortex, compared with the patients without RC. The findings of our pilot study suggest that the ventromedial prefrontal cortex is associated with the generation of RC in bipolar II disorder.     

无创通气对清醒状态慢性阻塞性肺疾病患者呼吸动力的影响

目的 探讨无创正压通气(NIPPV)对清醒状态慢性阻塞性肺疾病(COPD)患者呼吸动力的影响.方法 选择19例COPD急性加重期住院患者,治疗后病情稳定,通过食道-胃囊管法,检测气道开口压、食道压和胃内压,层流速仪测呼吸流速和容量改变.监测患者在清醒状态下自主呼吸及NIPPV时呼吸动力的变化.结果 ①对呼吸流速和肺通气的影响:吸气峰流速(PIF)、平均吸气流速(VT/Ti)、潮气量(VT)、分钟通气量(VE)在自主呼吸及NIPPV时,两组间变化差异无统计学意义.②对上气道阻力(Rua)和动态肺顺应性(CLdyn)的影响:自主呼吸时Rua(15.07±3.62)cm H2O·L-1·s-1、CLdyn(0.052±0.012)L/cm H2O,与自主呼吸比较,NIPPV时Rua减少6.91%(P＞0.05)、CLdyn增加44.23%(P＞0.05).③对呼吸肌肉活动和呼吸努力的影响:自主呼吸时跨膈压(Pdi)(19.85±4.00)cm H2O、食道负压(Pes)(-13.37±3.77)cm H2O,压力时间乘积(PTP)(287.79±95.14)cm H2O·s/min,与自主呼吸比较,NIPPV时Pdi下降61.96%(P＜0.001),Pes负压减少67.83%(P＜0.001),PTP下降58.80%(P＜0.01).结论 NIPPV对清醒状态COPD患者吸气流速、肺通气量及上气道阻力无明显影响;NIPPV有效的降低了呼吸肌肉活动,减少呼吸努力,改善呼吸肌疲劳.     

组合压气机中尾迹与势流同频/异频干涉的叠加特性

为揭示多级压气机中上下游叶轮对中间叶片叠加气动影响特性,阐述不同叠加干涉情况下下游叶轮进气角度变化,采用数值方法模拟了一级轴流和一级离心组成的组合压气机非定常流场。详细讨论了上游动叶尾迹和下游动叶势流对中间导流叶栅段气流非定常流动的异频和同频叠加干涉特性,依据计算结果,直观地展示了静叶通道中两种干涉间相互激励和抑制作用的位置和时间,与数学公式的推导结果相互印证。研究结果表明:当上下游动叶对中间静叶段异频干涉时,干涉的激励、抑制区域的轴向位置随时间发生变化；当上下游动叶对中间静叶干涉频率相同时,干涉的相互激励、抑制区域的轴向位置不随时间发生变化,但干涉的激励、抑制区域的轴向位置受时序位置影响。另外,上游动叶尾迹与下游离心叶轮势流的不同叠加情况,决定着下游离心叶轮进口相对气流角的大小及波动幅值。 