内镜下扩大经鼻蝶入路至斜坡区的解剖学研究

目的探索内镜下经扩大鼻蝶入路显露斜坡区的可行性,为切除斜坡区病变提供解剖学参考。方法在10例成人头部固定标本上,内镜下模拟扩大经鼻蝶手术入路显露斜坡区,观察有关显微解剖标志。结果扩大经鼻蝶内镜入路可磨除从鞍后到斜坡、枕骨大孔前缘的骨性结构;可显露斜坡区腹侧硬膜下的椎基底动脉及其分支、后交通动脉及其与大脑后动脉汇合处、动眼神经、脑干腹侧等结构。此入路的手术标志主要包括:蝶筛隐窝、蝶窦开口、视神经隆突、颈内动脉隆突与颈内动脉视神经隐窝、咽结节、枕骨大孔前缘。结论内镜下扩大经鼻蝶手术入路可充分显露鞍后-斜坡区的腹侧硬膜下结构,适用于此区病变的手术治疗。     

Value of high-definition imaging in neuroendoscopy

To compare the image quality of a standard definition （SD） three-chip camera with a new high-definition （HD） three-chip camera. In five neurosurgical interventions, an SD three-chip camera and an HD three-chip camera were used with the same endoscopic equipment. Both cameras were used while performing one endoscopic third ventriculostomy, one endoscope-assisted microvascular decompression, one endoscope-assisted removal of a vestibular schwannoma, and two endonasal pituitary surgeries. To provide comparable conditions, the outputs of both cameras were displayed on the same fiat screen and were recorded on hard disk with an appropriate workstation using a visually lossless codec.     

Mitogen‐activated protein kinase 2 regulates physiological and pathological bone turnover

The objective of this study was to investigate the role of the serine‐threonine kinase mitogen‐activated protein kinase 2 (MK2) in bone homeostasis. Primary bone cell cultures from MK2^+/+ and MK2^–/– mice were assessed for osteoclast and osteoblast differentiation, bone resorption, and gene expression. Bone architecture of MK2^+/+ and MK2^–/– mice was investigated by micro–computed tomography and histomorphometry. Ovariectomy was performed in MK2^+/+ and MK2^–/– mice to assess the role of MK2 in postmenopausal bone loss. Osteoclastogenesis, bone resorption, and osteoclast gene expression were significantly impaired in monocytes from MK2^–/– compared to MK2^+/+ mice. Mechanistically, loss of MK2 causes impaired DNA binding of c‐fos and nuclear factor of activated T cells cytoplasmic 1 (NFATc1) to tartrate‐resistant acid phosphatase (TRAP) and the calcitonin receptor gene promoter. In addition, MK2^–/– mice showed an age‐dependent increase in trabecular bone mass and cortical thickness, fewer osteoclasts, and lower markers of bone resorption than MK2^+/+ mice. Furthermore, MK2^–/– mice were protected from ovariectomy‐induced bone loss. Osteoblastogenesis and bone formation were unchanged in MK2^–/– mice, whereas osteoblast expression of osteoprotegerin (OPG) and serum levels of OPG were higher in MK2^–/– than in MK2^+/+ mice. Loss of MK2 effectively blocks bone resorption and prevents the development of postmenopausal bone loss. Small‐molecule inhibitors of MK2 could thus emerge as highly effective tools to block bone resorption and to treat postmenopausal bone loss. © 2013 American Society for Bone and Mineral Research.     

Lumbar agenesis with sacral sparing: a case report.

Caudal agenesis or caudal regression syndrome refers to a spectrum of malformations involving the lower spine, which can result in significant progressive or permanent neurologic defects. Caudal agenesis is frequently associated with other congenital anomalies of the axillary skeleton, hindgut and genitourinary systems. Described in this paper is a patient who presented with multiple clinical and radiographic findings consistent with caudal agenesis. This case is unique in that there is total absence of the lumbar vertebral column with an intact spinal cord and bony sacrum.     

精液分析现状：对《亚洲男性学杂志》出版的陆金春等所著的“中国118家实验室精液分析状况的调查”一文的评论

陆金春等^[1]所著的“中国118家实验室精液分析状况的调查”一文主要回顾了当前在中国采用的精液分析方法。调查使用的是作者自己设计的包括36个问题的“男科实验室精液分析调查表”。给145家精液实验室发放了调查表，收回118份答卷。调查表均由实验室专业技术人员填写。     

Snake bites by the jararacucu (Bothrops jararacussu): clinicopathological studies of 29 proven cases in Sao Paulo State, Brazil

The jararacucu, one of the most dreaded snakes of Brazil, southern Bolivia, Paraguay and northeastern Argentina, is a heavily-built pit viper which may grow to a length of 2.2 m. Up to 1000 mg (dry weight) of highly-lethal venom may be milked from its venom glands on a single occasion. It has accounted for 0.8% to 10% of series of snake bites in Sao Paulo State, Brazil. We examined 29 cases of proven jararacucu bites recruited over a 20-year period in two Sao Paulo hospitals. Severe signs of local and systemic envenoming, (local necrosis, shock, spontaneous systemic bleeding, renal failure) were seen only in patients bitten by snakes longer than 50 cm; bites by shorter specimens were more likely to cause incoagulable blood. Fourteen patients developed coagulopathy, six local necrosis (requiring amputation in one) and five local abscesses. Two became shocked and four developed renal failure. Three patients, aged 3, 11 and 65 years, died 18.75, 27.75 and 83 h after being bitten, with respiratory and circulatory failure despite large doses of specific antivenom and intensive-care- unit management. In two patients, autopsies revealed acute renal tubular necrosis, cerebral oedema, haemorrhagic rhabdomyolysis at the site of the bite and disseminated intravascular coagulation. In one survivor with chronic renal failure, renal biopsy showed bilateral cortical necrosis; the patient remains dependent on haemodialysis. Effects of polyspecific Bothrops antivenom were not impressive, and it has been suggested that anti-Bothrops and anti-Crotalus antivenoms should be given in combination.      

A review of prehospital care litigation in a large metropolitan EMS system

A retrospective review of all claims brought against a large, metropolitan emergency medical services (EMS) system related to paramedic-patient encounters during the 12-year period from 1976 through 1987 was undertaken to review and describe the incidence and types of malpractice claims. During this period, EMS units responded to approximately 2 million calls and transported more than 1 million patients. Sixty claims occurred during the incidence study period (1976 through 1985). The overall litigation rate was one lawsuit per 27,371 paramedic-patient encounters and one lawsuit per 17,995 patient transports. While the total number of runs and transports did not change significantly during the study period, the data indicate a trend of increasing claims filed against the prehospital care provider. To date, 26 cases (38%) have been settled with the majority involving either no monetary awards or nominal out-of-court settlements.