Topographical relationship between urethral rhabdosphincter and rectourethralis muscle: A better understanding of the apical dissection and the posterior stitches in radical prostatectomy

Objectives:   To clarify the topographical relationship between the urethral rhabdosphincter and the rectourethralis muscle as these structures lying dorsally to membranous urethra are important factors to post-prostatectomy urinary continence.
Methods:   Pelvic floor specimens including prostate, bulbus penis, and anorectum, obtained from 15 male cadavers (ages at death 66 to 80 years), were examined with standard histologic and immunohistochemical techniques using semiserial sagittal and transverse sections.
Results:   The rectourethralis muscle was defined. It was found to be located at the interface between the levator ani muscle and rectum. It was not possible to histologically identify the fibromuscular node known as the perineal body. The urethral rhabdosphincter was found to be inserted into the rectourethralis muscle, which is composed of the smooth muscle fibers. Abundant nerves passed between the rectourethralis muscle and the levator ani, or through the rectourethralis muscle. The urethral rhabdosphincter was closely attached to the apical or ventral portion of the rectourethralis muscle. Morphologically, the membranous urethra was fixed to the rectourethralis muscle through the urethral rhabdosphincter.
Conclusions:   The rectourethralis muscle influences the stabilization of membranous urethra. The posterior stitches for the reconstruction of the dorsal musculofascial plate might injure the nerve fibers running along and through the rectourethralis muscle.     

重复经颅磁刺激对帕金森病患者双眼竞争平均切换时间的影响

目的 探讨对帕金森病病患者辅助运动区进行重复经颅磁刺激（rTMS）的感知觉变化。 方法 回顾性连续纳入2018 年4—10 月于安徽医科大学第一附属医院神经内科门诊就诊的12 例帕金 森病患者（6 例男性，6 例女性），采用rTMS 的持续性θ爆发式磁刺激序列，在导航下对辅助运动区进行 连续14 d 的rTMS 治疗，治疗前后分别测定患者未服药状态下的双眼竞争平均切换时间，并采用汉密尔 顿焦虑量表（HAMA）、汉密尔顿抑郁量表17 项（HAMD-17）、统一帕金森病评定量表中第Ⅲ部分运动症 状评定量表（UPDRS Ⅲ）进行评定。结果 受试者治疗前UPDRS Ⅲ评分为（29.25±12.02）分，治疗后评 分为（24.00±11.63）分明显低于治疗前，差异有统计学意义（t=2.644，P ＜ 0.05）。受试者治疗前HAMA、 HAMD-17 评分分别为（9.08±3.09）、（9.75±3.52）分，治疗后分别为（8.50±3.29）、（8.75±3.22）分，治疗前 后评分差异均无统计学意义（t值分别为1.074、1.225，均P＞ 0.05）。治疗前后受试者双眼竞争平均切换 时间为（5.50±1.47）、（4.06±1.21）s，治疗后的双眼竞争平均切换时间较治疗前明显缩短，差异有统计学 意义（t=3.743，P ＜ 0.05）。结论 rTMS 干预帕金森病患者辅助运动区可加快帕金森病患者双眼竞争的 切换，提高其感知觉水平。     

某公立医院2010年—2019年信访情况的分析与探讨

对某三甲公立医院2010年—2019年医院信访情况进行回顾性统计与分析.研究表明新时期医院信访工作呈现内容复杂化和多样化、投诉重点以服务质量和服务态度为主、不实投诉数量激增的变化趋势.建议从推进分级诊疗制度建设,树立服务意识,建立多渠道信访机制,强化闭环管理流程,重视网络舆情等五个方面优化医院信访工作.     

Auricular cartilage configuration: A histological study using late-stage human fetuses and adult cadavers

The auricular cartilage is considered to develop from a funnel-like arrangement of six embryonic hillocks. However, there is little information as to when and how the initial cartilage plate differentiates into the major three hollows or caves: the concha, the scapha and the triangular fossa. We examined semiserial histological sections from 42 human fetuses as well as from seven cadavers of elderly individuals. Tangential sections from adults suggested that three ring-like cartilages were combined to provide a single auricular cartilage and that the external auditory meatus was attached to the lowest ring or concha. All of the fetuses studied carried the three major hollows delineated by skin folds. These skin folds often contained a cartilage loop as a core in place of a thickening or tubercle. Conversely, some of the skin folds corresponded to a highly wavy cartilage plate without looping. According to whether the cartilage loop was present or absent in horizontal sections from 35 fetuses, we classified the cartilage morphology into four patterns, the most frequent of which was absence of the triangular fossa loop (27 fetuses), followed by absence of the scapha loop (11 fetuses). Each pattern was evenly distributed among small and large fetuses. This suggested that some form of cartilage correction or reconstruction was likely to occur after birth, especially at the triangular fossa and/or scapha. Infants appear to show significant region-specific variation in the postnatal growth of the auricular cartilages, especially at the triangular fossa and/or scapha.     

高血压患者体位性低血压的影响因素及综合护理干预

目的探讨高血压患者发生体位性低血压的影响因素并以此采取相应的综合护理措施进行个体化干预。方法分析了于2010~2012年间我院诊治的385例高血压患者发生体位性低血压的影响因素,对比了应用防低血压综合护理干预措施前后低血压相关事件(晕厥、跌倒)的发生情况。结果体位性低血压发生率为9.6%(37/385),主要的影响因素为高龄、α受体阻断剂、利尿剂和血压控制不佳。实施低血压综合护理干预后患者低血压相关的不良事件由人均4.6例次/年降至0.9例次/年,干预后发生率差异有统计学意义(P0.05)。结论高血压患者OH发生较为常见,需重视监测直立位血压。影响OH因素为高龄、α受体阻断剂、利尿剂及血压控制不良。综合性的防低血压措施可有效降低其不良事件,提高患者的生活质量。