FDA：长效β受体激动剂需限制使用

适当使用时,LABAs利大于弊,可继续用于治疗哮喘。FDA建议仅用于哮喘控制药物如吸入性皮质激素不能有效缓解病情的患者。     

Use of microvascular free flaps in the reconstruction of the anterior and middle skull base

Different reconstruction techniques of the anterior and middle skull base as consequence of a defect after surgical treatment of neoplastic pathologies are described in the literature. The aim of the present study is to present our experience regarding the use of microvascular free flaps for reconstruction of the anterior or middle skull base after large defects caused by removal of malignant neoplasms. From 2000 to 2004, in the Department of Maxillo-Facial Surgery of the University of Rome "La Sapienza" and "Tor Vergata," 13 surgical procedures for reconstruction of anterior and middle skull base defects by free flaps were performed in 11 patients. Data on patient demographics, histopathology, location and size of defect, type of reconstruction, and postoperative complications were obtained from medical record charts. A safe soft tissue closure of the intracranial space was achieved in all patients. Defect repair was accomplished by revascularized transfer of rectus abdominis flaps in seven cases, latissimus dorsi muscle flaps in two patients, radial forearm flap in one case, and fibula flap in one case. There were two total flap losses; the secondary defect repair was accomplished in both cases by revascularized transfer of latissimus dorsi muscle flap. No donor site complications were observed in all the flaps. The mean operation time was 85 hours; patients were hospitalized for a mean period of 14 days. The method of choice for the reconstruction of anterior or middle skull base defect should be based upon careful evaluation of the single case and, particularly, the localization and entity of the residual defect. For defects that require large amounts of soft tissue, the latissimus dorsi free flap and the rectus abdominis free flap are the best appropriate choices for reconstructive procedures for anterior and middle skull base tumors.     

Scoliosis of the cranial base: radiological and mathematical analysis using finite elements system analysis (FESA) of a case.

INTRODUCTION AND PROPOSED STUDY: Numerous deforming syndromes of the craniofacial complex involve also the symmetry of the cranial base. This study considers a particular alteration, that of 'scoliosis', in which the line Nasion-Sella-Basion-Inion is not rectilinear but curved, due to a torsion of the cranial base in the horizontal plane. MATERIALS: Plagiocephaly was studied in one patient, which was probably caused by altered timing or mechanism of closure of the cranial sutures. METHODS: This study was carried out using CT images of the patient's craniofacial complex, using standard neuroradiological points. In order to study the forces that operated in the various complexes, a mathematical analysis was applied namely, a finite element system analysis (FESA). RESULTS: From this mathematical study, which has enabled us to evaluate the forces that operate in determining the deformity, it has been possible to locate two sites of force concentration. They were located at different levels and on opposite sides. CONCLUSION: This finding could explain why the middle and lower thirds of the face were also involved.     

To blink or not to blink: fine cognitive tuning of the defensive peripersonal space

The blink reflex elicited by the electrical stimulation of the median nerve at the wrist [hand blink reflex (HBR)] is a subcortical, defensive response that is enhanced when the stimulated hand is inside the peripersonal space of the face. Such enhancement results from a tonic, top-down modulation of the excitability of the brainstem interneurons mediating the HBR. Here we aim to (1) characterize the somatotopical specificity of this top-down modulation and investigate its dependence on (2) cognitive expectations and (3) the presence of objects protecting the face, in healthy humans. Experiment 1 showed that the somatotopical specificity of the HBR enhancement is partially homosegmental, i.e., it is greater for the HBR elicited by the stimulation of the hand near the face compared with the other hand, always kept far from the face. Experiment 2 showed that the HBR is enhanced only when participants expect to receive stimuli on the hand close to the face and is thus strongly dependent on cognitive expectations. Experiment 3 showed that the HBR enhancement by hand-face proximity is suppressed when a thin wooden screen is placed between the participants' face and their hand. Thus, the screen reduces the extension of the defensive peripersonal space, so that the hand is never inside the peripersonal space of the face, even in the "near" condition. Together, these findings indicate a fine somatotopical and cognitive tuning of the excitability of brainstem circuits subserving the HBR, whose strength is adjusted depending on the context in a purposeful manner.     

Migraine and depression: bidirectional co-morbidities?

Even if the bidirectional co-morbidity between migraine and depression has been supported by epidemiological and genetic studies, many aspects of this association have not been completely understood. This may be due to the heterogeneous character of migraine and depression as well as to their multifactorial pathogenesis. In this review, we have briefly reported the more recent findings published about the co-morbidity between migraine and depression by discussing the above reported issues and the relative clinical and therapeutic implications.