Overt and imagined singing of an Italian aria

Activation maps of 16 professional classical singers were evaluated during overt singing and imagined singing of an Italian aria utilizing a sparse sampling functional magnetic imaging (fMRI) technique. Overt singing involved bilateral primary and secondary sensorimotor and auditory cortices but also areas associated with speech and language production. Activation magnitude within the gyri of Heschl (A1) was comparable in both hemispheres. Subcortical motor areas (cerebellum, thalamus, medulla and basal ganglia) were active too. Areas associated with emotional processing showed slight (anterior cingulate cortex, anterior insula) activation. Cerebral activation sites during imagined singing were centered on fronto-parietal areas and involved primary and secondary sensorimotor areas in both hemispheres. Areas processing emotions showed intense activation (ACC and bilateral insula, hippocampus and anterior temporal poles, bilateral amygdala). Imagery showed no significant activation in A1. Overt minus imagined singing revealed increased activation in cortical (bilateral primary motor; M1) and subcortical (right cerebellar hemisphere, medulla) motor as well as in sensory areas (primary somatosensory cortex, bilateral A1). Imagined minus overt singing showed enhanced activity in the medial Brodmann's area 6, the ventrolateral and medial prefrontal cortex (PFC), the anterior cingulate cortex and the inferior parietal lobe. Additionally, Wernicke's area and Brocca's area and their homologues were increasingly active during imagery. We conclude that imagined and overt singing involves partly different brain systems in professional singers with more prefrontal and limbic activation and a larger network of higher order associative functions during imagery.     

胶原-壳聚糖复合材料的制备及生物安全性检测

目的:制备胶原-壳聚糖复合细胞载体,并对该载体进行系统的生物学性能检测。方法:实验于2003-07/2006-06在天津市医药科学研究所完成。将胶原溶液和壳聚糖溶液按照一定比例(9∶1)混匀,交联后真空冷冻干燥,制成胶原-壳聚糖复合载体,对该载体进行复合材料性状及理化性能检测。并采用急性全身毒性试验、皮内刺激试验、皮肤致敏试验、溶血试验、细胞毒性试验和致突变试验进行生物学性能检测。结果:①胶原-壳聚糖复合材料具有三维立体多孔结构,适合细胞的三维生长,能为新生组织提供良好的支架。②急性全身毒性试验、皮内刺激试验均阴性,致敏率仅为6.25%,细胞毒性为0级,无诱变能力。结论:从仿生学角度出发,制备出可生物降解的胶原-壳聚糖复合材料,经过系统的生物学评价发现,胶原-壳聚糖复合材料具有良好的生物安全性,对机体无毒,不致突变,对细胞有较强的亲和作用,利于细胞生长和分化。     

Hepatic arterial flow volume and reserve in patients with cirrhosis: use of intra-arterial Doppler and adenosine infusion

BACKGROUND & AIMS: In cirrhosis, liver blood flow becomes increasingly dependent on the hepatic artery. The aim of this study was to investigate hepatic arterial blood flow volume and resistance and hepatic arterial flow reserve in relation to liver function and systemic hemodynamic alterations in patients with cirrhosis. METHODS: In 38 patients with cirrhosis, liver function, cardiac output, and systemic vascular resistance were studied, and hepatic arterial blood flow velocity, flow volume, and pulsatility index at baseline and during intra-arterial administration of adenosine (2-40 microg. min-1. kg body wt-1) were assessed by angiography combined with intravascular Doppler flowmetry. RESULTS: Hepatic arterial flow velocity was 21 +/- 11, 31 +/- 17, and 41 +/- 27 cm/s; flow volume was 266 +/- 246, 342 +/- 289, and 417 +/- 220 mL/min; and pulsatility index was 2.2 +/- 0.7, 1.7 +/- 0.6, and 1.5 +/- 0.5 in Child-Pugh classes A, B, and C, respectively (differences not statistically significant). Adenosine-induced changes in these parameters were more marked in Child-Pugh class A (68 +/- 15 cm/s, 1246 +/- 486 mL/min, and -1.14 +/- 0.5) than in class C (45 +/- 23, P < 0.05; 704 +/- 492, P = 0.02; and -0.58 +/- 0.38, P < 0.05). Using analysis of variance, cardiac index, systemic vascular resistance, and ascites, but not Child-Pugh class, were related to baseline values and adenosine-induced changes. CONCLUSIONS: Adenosine is a potent dilator of the hepatic artery in humans. The data suggest that hepatic arterial blood flow and adenosine-dependent flow reserve in patients with cirrhosis are under systemic hemodynamic or neurohormonal control.     

三种移植物关节镜下重建膝关节前交叉韧带效果比较：2年随访

目的:采用自体骨-髌韧带、自体双股半腱肌腱半膜肌及同种异体跟腱移植重建膝关节前交叉韧带,比较不同移植物的临床疗效。方法:选择1998-06/2003-02中山大学附属第三医院骨科单纯前交叉韧带损伤后行关节镜下重建手术病例96例,患者均签署知情同意书。根据不同移植物分为3组:①自体骨-髌韧带组38例,应用自体中1/3骨-髌韧带-骨移植物。②自体双股半腱肌腱股薄肌腱组22例,应用自体双股半腱肌腱股薄肌腱。③同种异体跟腱组36例,应用同种异体跟腱。术后定期随访,对膝关节活动度、肌力恢复程度、Werner髌股痛评分(最差为0分,最高为55分)、Lysholm评分(0～100分,分数越高膝关节功能恢复越好)、国际膝关节文献委员会评分(按病情严重程度分类分为正常、接近正常、异常、严重异常4个等级)等进行对比观察。结果:①96例患者随访2年,无脱落。②全部患者无感染,未发生髌骨骨折。也未发现关节内粘连、下肢深静脉血栓形成和血管神经损伤等并发症。③膝关节活动度、肌力恢复情况、髌股痛评分:随访结束时3组差异均无显著性意义(P>0.05)。④Lysholm膝关节评分:随访结束时自体骨-髌韧带组由术前(68.2±6.3)分提高至(88.6±6.8)分,自体双股半腱肌腱股薄肌腱组由术前(66.5±6.5)分提高至(86.4±6.6)分,同种异体跟腱组由术前(68.2±6.3)分提高至(86.3±6.2)分,随访结束时各组评分均显著高于术前(P<0.05),3组比较差异无显著性意义(P>0.05)。⑤国际膝关节文献委员会评分(术后活动水平正常或接近正常):随访结束时自体骨-髌韧带组为87%,自体双股半腱肌腱股薄肌腱组为86%,同种异体跟腱组为89%,各组移植术后膝关节功能均有所改善,3组间差异无显著性意义(P>0.05)。结论:关节镜下采用自体骨-髌韧带、自体双股半腱肌腱股薄肌腱和同种异体跟腱移植重建前交叉韧带,均能明显改善膝关节运动功能,3种移植方法的临床疗效无明显差异,提示重建前交叉韧带的术后疗效与移植物种类的相关性不明显。     

Verteilungsplanung von Verletzten beim MANV oder Katastrophenfall

Relevant changes have occurred in disaster management in Germany due to legal alterations and the introduction of the diagnosis-related groups (DRG) system. This has resulted in a reduction in bed capacities and an increase in bed utilization. In addition to the preclinical deployment strategy the provisional aspects of disaster medicine with the problem of the emergency service/hospital interface will be described. A suggestion for a solution for optimization of patient allocation in mass disasters or catastrophes will be demonstrated with the catastrophe network of the German Society for Trauma Surgery (DGU).     

Erstversorgung von Frakturen und Luxationen

Musculoskeletal trauma is common in emergency medicine. Likely, patients are threatened by severe pain. Therefore analgesia, reduction, splinting and transport in a trauma center are simple and effective procedures, which have great impact on rehabilitation and quality of life. Most important in preclinical management of musculoskeletal injuries is the prevention of 2nd hits and further soft tissue damage. Severely injured or polytraumatized patients are threatened by hypovolemia coming along with shock. The ban of bleeding is the most important thing to do. After hemodynamic stabilization the patient has to be transferred in a trauma center. This article presents the basic terminology of traumatic injuries and classification of soft tissue damage and deals with all preclinically relevant procedures.     

Ciliary neurotrophic factor promotes survival of neonatal rat islets via the BCL-2 anti-apoptotic pathway

Ciliary neurotrophic factor (CNTF) belongs to the cytokine family and increases neuron differentiation and/or survival. Pancreatic islets are richly innervated and express receptors for nerve growth factors (NGFs) and may undergo neurotypic responses. CNTF is found in pancreatic islets and exerts paracrine effects in neighboring cells. The aim of this study was to investigate possible effects of CNTF on neonatal rat pancreatic islet differentiation and/or survival. For this purpose, we isolated pancreatic islets from neonatal rats (1-2 days old) by the collagenase method and cultured for 3 days in RPMI medium with (CNTF) or without (CTL) 1 nM CNTF. Thereafter, glucose-stimulated insulin secretion (RIA), general metabolism by (NAD(P)H production; MTS), glucose metabolism ((14)CO(2) production), gene (RT-PCR), protein expression (western blotting), caspase-3 activity (Asp-Glu-Val-Asp (DEVD)), and apoptosis (DNA fragmentation) were analyzed. Our results showed that CNTF-treated islets demonstrated reduced glucose-induced insulin secretion. CNTF treatment did not affect glucose metabolism, as well as the expression of mRNAs and proteins that are crucial for the secretory process. Conversely, CNTF significantly increased mRNA and protein levels related to cell survival, such as Cx36, PAX4, and BCL-2, reduced caspase-3 activity, and islet cells apoptosis, suggesting that CNTF does not affect islet cell differentiation and, instead, acts as a survival factor reducing apoptosis by increasing the expression of the anti-apoptotic BCL-2 protein and decreasing caspase-3 activity.