Primary afferent projections from the upper respiratory tract in the muskrat.

The central projections of the ethmoidal, glossopharyngeal, and superior laryngeal nerves were determined in the muskrat by use of the transganglionic transport of a mixture of horseradish peroxidase (HRP) and wheat germ agglutinin (WGA)-HRP. The ethmoidal nerve projected to discrete areas in all subdivisions of the ipsilateral trigeminal sensory complex. Reaction product was focused in ventromedial portions of the principal nucleus, subnucleus oralis, and subnucleus interpolaris. The subnucleus oralis also contained sparse reaction product in its dorsomedial part. Projections were dense to ventrolateral parts of laminae I and II of the rostral medullary dorsal horn, with sparser projections to lamina V. Label in laminae I and V extended into the cervical dorsal horn. A few labeled fibers were followed to the contralateral dorsal horn. The interstitial neuropil of the ventral paratrigeminal nucleus was densely labeled. Extratrigeminal primary afferent projections in ethmoidal nerve cases involved the K?lliker-Fuse nucleus and ventrolateral part of the parabrachial nucleus, the reticular formation surrounding the rostral ambiguous complex, and the dorsal reticular formation of the closed medulla. Retrograde labeling in the brain was observed in only the mesencephalic trigeminal nucleus in these cases. The cervical trunk of the glossopharyngeal and superior laryngeal nerves also projected to the trigeminal sensory complex, but almost exclusively to its caudal parts. These nerves terminated in the dorsal and ventral paratrigeminal nuclei as well as lamina I of the medullary and cervical dorsal horns. Lamina V received sparse projections. The glossopharyngeal and superior laryngeal nerves projected to the ipsilateral solitary complex at all levels extending from the caudal facial nucleus to the cervical spinal cord. At the level of the obex, these nerves projected densely to ipsilateral areas ventral and ventromedial to the solitary tract. Additional ipsilateral projections were observed along the dorsolateral border of the solitary complex. Near the obex and caudally, the commissural area was labeled bilaterally. Labeled fibers from the solitary tract projected into the caudal reticular formation bilaterally, especially when the cervical trunk of the glossopharyngeal nerve received tracer. Labeled fibers descending further in the solitary tract gradually shifted toward the base of the cervical dorsal horn. The labeled fibers left the solitary tract and entered the spinal trigeminal tract at these levels. Retrogradely labeled cells were observed in the ambiguous complex, especially rostrally, and in the rostral dorsal vagal nucleus after application of HRP and WGA-HRP to either the glossopharyngeal or superior laryngeal nerves. In glossopharyngeal nerve cases, retrogradely labeled neurons also were seen in the inferior salivatory nucleus.(ABSTRACT TRUNCATED AT 400 WORDS)     

不同孔径纳米羟基磷灰石人工骨修复兔桡骨缺损效果比较

目的:纳米级的羟基磷灰石材料与人体内组织成分更为相似,具有更佳的生物性能。评价不同孔径的多孔纳米羟基磷灰石人工骨的骨缺损修复能力,从而筛选出适合的孔径以达到骨传导功能与生物力学性能的良好统一。方法:实验于2005-10/2006-10在深圳市第二人民医院中心实验室完成。①实验材料:纳米羟基磷灰石人工骨以硝酸钙和磷酸二氢铵为原料,采用溶胶-絮凝法制备粉体,运用压力成型、木模成型和浸渍成型分别制得孔隙分布均匀的孔径分别为50～150μm、100～250μm和300～500μm的多孔纳米羟基磷灰石人工骨。②实验动物:雄性新西兰大白兔60只随机分为植入50～150μm孔径材料组、植入100～250μm孔径材料组、植入300～500μm孔径材料组、空白对照组,每组15只。实验过程中对动物处置符合动物伦理学要求。③实验方法:制备双侧桡骨骨缺损动物模型,然后用3种不同孔径的纳米羟基磷灰石人工骨材料植入骨缺损处进行修复,空白对照组不植入任何材料。④实验评估:术后4,8和12周分别行大体标本观察、X射线片观察、扫描电镜观察及生物力学测试,比较各组材料修复骨缺损的能力。结果:实验动物均进入结果分析。①X射线片检查结果:术后4周、8周、12周,植入100～250μm孔径材料组X射线评分高于植入50～150μm,300～500μm孔径材料组,差异有显著性意义(P<0.05)。②生物力学检测结果:术后4周、8周、12周,植入100～250μm孔径材料组生物力学强度高于植入50～150μm,300～500μm孔径材料组,差异有显著性意义(P<0.05)。③扫描电镜观察结果:植入100～250μm孔径材料组成骨效果明显优于植入50～150μm,300～500μm孔径材料组和空白对照组。结论:纳米羟基磷灰石人工骨具有良好的成骨能力,但其骨修复能力受孔径因素的影响,孔径100～250μm的纳米羟基磷灰石人工骨材料成骨能力较好。     

工程化视知觉感知学习系统治疗儿童弱视的效果评价

目的:传统治疗弱视的方法(如遮盖治疗,精细训练等)起效慢,疗效欠佳;视知觉感知学习系统作为一种针对性很强的儿童弱视治疗方法,其疗效需进一步观察。方法:①收集2006-09/2007-02于广西壮族自治区人民医院视光中心就诊的弱视儿童125例250眼,女73例,男52例,年龄(6±2)岁。患儿家长知情同意并签署知情同意书;实验经医院伦理委员会批准。②根据视功能检查结果,采用视知觉感知学习系统对弱视患儿进行针对性的治疗,如双眼视力相差两行以上,辅助遮盖优势眼治疗。1个月为1个疗程,每天训练2次,每次2个训练内容(程序),每个训练内容10min,40min/d,训练内容之间要求有10min左右的休息间隙。训练需在安静和黯淡环境下进行。每月定期复查双眼视力及其各项视功能的恢复情况,并根据复查结果继续原程序治疗或调整治疗程序。结果:弱视患儿125例均进入结果分析。①视力:视知觉感知学习系统治疗儿童弱视的总有效率为75.2%,视力提高行数从治疗第3个月起有大幅增加(P<0.05),最佳矫正视力由治疗前的0.60±0.23提高至治疗后的0.86±0.26,差异有显著性意义(P<0.05)。②治疗时间与疗效:疗效达到进步的平均时间为(2.82±1.30)个月,达到基本治愈为(2.87±1.40)个月。治疗3个月的患者视力疗效达进步率最高[98%(39/40)],治疗1个月的患者视力进步率最低[55%(31/56),P<0.05]。基本治愈率随治疗时间的增加递增,治疗4个月组基本治愈率最高[67%(31/46),P<0.05]。结论:视知觉感知学习系统治疗儿童弱视疗效快,达到有效的时间为治疗两三个月。     

颈动脉内中膜厚度与初诊2型糖尿病视网膜病变的关系

目的:研究发现,糖尿病视网膜病变和动脉粥样硬化终点事件相关。试验拟验证颈动脉内中膜厚度与初诊汉族2型糖尿病患者糖尿病视网膜病变相关危险因素的关系。方法:①试验对象:选择2006-06/2007-06本院住院的初诊2型糖尿病患者187例,男114例,女73例;平均年龄(51±14)岁;平均体质量指数(24.7±4.7)kg/m2。均符合1997年美国糖尿病协会的2型糖尿病诊断标准,排除既往已存在心血管疾病者。患者对治疗及试验均知情同意。根据眼底照相检查结果,将所有受检者分为糖尿病视网膜病变组及非糖尿病视网膜病变组进行统计分析。②试验方法及评估:所有患者询问一般情况,测量颈动脉内中膜厚度以及相关生化指标,对糖尿病视网膜病变相关因素进行单因素及多因素Logistic回归分析。结果:纳入2型糖尿病患者187例,均进入结果分析。单因素Logistic回归分析显示,高血压、糖尿病家族史、颈动脉内中膜厚度、尿白蛋白、低密度脂蛋白胆固醇与糖尿病视网膜病变发生呈显著正相关,多因素Logistic回归分析未见显效因素。结论:单因素回归分析中颈动脉内中膜厚度及其他4项指标与糖尿病视网膜病变相关,而多因素回归分析这些因素未进入主效基因模型。     

Severe road traffic injuries in Kenya, quality of care and access

Background

Road traffic injuries (RTI) are on increase in developing countries. Health care facilities are poorly equipped to provide the needed services.

Objective

Determine access and quality of care for RTI casualties in Kenya.

Design

Cross-sectional survey

Setting

53 large and medium size private, faith-based and public hospitals.

Participants

In-patient road traffic crash casualties and health personnel in the selected hospitals were interviewed on availability of emergency care and resources. Onsite verification of status was undertaken.

Results

Out of 310 RTI casualties interviewed, 72.3%, 15.6% and 12.2% were in public, faith-based and private hospitals, respectively. Peak age of the injured was 15–49 years. First aid was availed to 16.0% of casualties. Unknown persons transported 76.5% of the injured. Police and ambulance vehicles transported 6.1% and 1.4%, respectively. 51.9% reached health facilities within 30 minutes of crash and medical care provided to 66.2% within one hour. 40.8% of recipient facilities were adequately prepared for RTI emergencies.

Conclusions

Most RTI casualties were young and from poor backgrounds. Training of motorists and general public in first aid should be considered in RTI control initiatives. Availability of basic trauma care medical supplies in public health facilities was highly deficient.     

Pressor responses to nasal stimulation are unaltered after disrupting the CPA

Stimulation of either the caudal pressor area (CPA) in the most caudal ventrolateral medulla with glutamate, or the nasal mucosa with ammonia vapors, induces an increase in mean arterial blood pressure (MABP). In the present study, we determined if neurons in the CPA serve as a relay for the increase in MABP seen after nasal stimulation. Ammonia vapors stimulated the nasal mucosa of rats anesthetized with either urethane alone or ketamine/xylazine and urethane to induce an increase in MABP, a bradycardia, and an apnea. Bilateral injections (50 nl) of glycine (1 M) or muscimol (2 mM) were placed in the CPA and the nasal mucosa again stimulated. The increases in MABP, the bradycardia and the duration of apnea to nasal stimulation were unchanged after either injection. However, resting MABP and HR were decreased significantly after glycine injections and resting MABP and resting respiratory rate were decreased after muscimol injections. The increase in MABP seen with nasal stimulation also did not change after multiple bilateral injections (3x40 nl) of ibotenate (5 microg/microl) in the CPA, but the bradycardia was eliminated and the duration of apnea was significantly shorter. These results suggest that the increase in MABP induced by nasal stimulation is via routes that do not include neurons in the CPA.     

Aneurysm regression after endovascular aneurysm repair: what should we expect?

This study reviewed a large national core laboratory database for the Ancure (Guidant, Menlo Park, California) phase I and II trial of overall aneurysm sac regression after endovascular aneurysm repair. Data were reviewed for aneurysm size and endoleak in follow-up. Endoleak was recorded as well as maximum major and minor axis aortic diameters. Included were patients with baseline assessment within 3 months of implantation and at least 24 months of follow-up, and 444 were available for review. The mean baseline aortic diameter was 56.6 mm; mean follow-up was 48.7 months. Of these patients, 129 (29.5%) had aneurysm regression to less than 40 mm, 42 (9.5%) regressed to less than 35 mm, and 12 (2.7%) had complete aneurysm sac obliteration. Multivariate analysis demonstrated that baseline aneurysm size was the only predictor of aneurysm size regression. Significant sac regression is common after Ancure aneurysm repair and appears to be related primarily to initial aneurysm size.