Discovery of a new waveform for intraoperative monitoring of hemifacial spasms

Background

Surgeons often rely on intraoperative electrophysiological monitoring to determine whether decompression is sufficient during microvascular decompression surgery for hemifacial spasms. A new monitoring method is needed when an abnormal muscle response is occasionally not available or is unreliable. This study was an observational clinical trial exploring a new waveform recorded from the facial muscles while the offending artery wall was electrically stimulated.

Methods

Thirty-two patients with typical hemifacial spasm and 12 with trigeminal neuralgia as a control were included. The facial muscle response was recorded during microvascular decompression surgery while the offending artery wall was stimulated (2?mA?×?0.2?ms). The latency, amplitude, and effective refractory period were analyzed.

Results

A waveform was recorded from the facial muscles of patients with hemifacial spasm when the offending artery wall was stimulated and was named the “Z-L response.” The latency was 7.3?±?0.8?ms, the amplitude was 0.08?±?0.02?mV, and the effective refractory period was 3.5–4?ms. The Z-L response disappeared immediately after microvascular decompression. No waveform was recorded from the facial muscles of patients with trigeminal neuralgia while the anterior inferior cerebellar artery, which adheres to the facial nerve, was stimulated (2?mA?×?0.2?ms).

Conclusion

We found a new waveform for intraoperative monitoring of hemifacial spasm. The Z-L response was useful when the abnormal muscle response was absent before decompression or persisted after all vascular compressions were properly treated. Particularly, the Z-L response may help neurosurgeons determine the real culprit when multiple offending vessels exist.     

Construction and application of traditional Chinese medicine-oriented care model for stroke

目的 通过理论与临床相结合的研究方式构建中风病辨证施护模式,以提高护理效果和患者满意度.方法 将200例中风病患者按病区分为观察组104例和对照组96例.对照组采用中医常规护理方案;观察组构建中风病辨证施护模式,采用该模式对患者辩证分型施护.连续14d后评价效果.结果 观察组疗效、Barthel指数评价及患者满意度显著高于对照组,并发症发生率显著低于对照组(P<0.05,P<0.01).结论 中风病辩证施护模式应用于临床效果可靠,患者满意,可作为中医临床护理和研究的借鉴.     

CD44v6和组织蛋白酶D表达与食管癌预后的关系

目的　研究CD4 4v6和组织蛋白酶D(cathepsinD ,CD)表达与食管癌生物学行为的关系。方法　应用免疫组化法 ,检测 6 5例食管鳞状细胞癌组织中CD4 4v6和CD表达水平。结果　在食管癌中CD4 4v6和CD表达阳性率分别为 5 8.5 %和 6 4 .6 %。CD4 4v6和CD表达均与肿瘤分级、浸润、淋巴结转移和预后相关。结论　CD4 4v6和CD异常表达与食管癌的病理生物学行为密切相关 ,可作为是预测食管癌转移潜能和评估食管癌预后的客观指标     

Study on changes of partial pressure of brain tissue oxygen and brain temperature in acute phase of severe head injury during mild hypothermia therapy

Ahighdeathrateofseverebraininjurieshasattractedmuchattention .Mildhypothermiatherapyandmonitoringbrainoxygenmetabolismandcerebralbloodflowhavebeendoneinmanyhospitals.Wimaretal1elucidatedthevalueofmonitoringbrainoxygeninseverebraininjuries.Butthemechanismofmildhypothermiaremainsunclear .Zhang2 reportedthatmildhypothermiatherapycouldrecoverthebrainoxygentonormal.Gupta3 usedanesthesiacoolingandobservedduringmildhypothermiathebrainoxygenwasdecreased .Wehavetreated 116patientswithseverebraininjuri…     

Association of cardiovascular risk factors with pattern of lower limb atherosclerosis in 2659 patients undergoing angioplasty.

OBJECTIVES: Aim of this study is to correlate distribution pattern of lower limb atherosclerosis with cardiovascular risk factor profile of patients with peripheral arterial occlusive disease (PAD). PATIENTS AND METHODS: Analysis is based on a consecutive series of 2659 patients (1583 men, 1076 women, 70+/-11 years) with chronic PAD of atherosclerotic origin undergoing primary endovascular treatment of lower extremity arteries. Pattern of atherosclerosis was grouped into iliac (n=1166), femoropopliteal (n=2151) and infrageniculate (n=888) disease defined according to target lesions treated. A multivariable multinomial logistic regression analysis was performed to assess relation with age, gender and classical cardiovascular risk factors (diabetes mellitus, arterial hypertension, hypercholesterolemia, cigarette smoking) using femoropopliteal disease as reference. RESULTS: Iliac disease was associated with younger age (RRR 0.95 per year of age, 95%-CI 0.94-0.96, p<0.001), male gender (RRR 1.32, 95%-CI 1.09-1.59, p=0.004) and cigarette smoking (RRR 2.02, 95%-CI 1.68-2.42, p<0.001). Infrageniculate disease was associated with higher age (RRR 1.02, 95%-CI 1.01-1.02, p<0.001), male gender (RRR 1.23, 95%-CI 1.06-1.41, p=0.005) and diabetes mellitus (RRR 1.68, 95%-CI 1.47-1.92, p<0.001). Hypercholesterolemia was less prevalent in patients with lesions below the knee (RRR 0.82, 95%-CI 0.71-0.94, p=0.006), whereas no distinct pattern was apparent related to arterial hypertension. CONCLUSION: Clinical phenotype of peripheral atherosclerosis varies with prevalence of cardiovascular risk factors suggesting differences in mechanisms involved in iliac as compared with infrageniculate lesions. Identification of molecular mechanism might have influence on future therapeutic strategies in PAD patients.     

白细胞介素-6和白细胞介素-10在不同细菌性血流感染小鼠模型中的表达及意义

目的:探讨白细胞介素(IL)-6和IL-10在不同病原菌所致细菌性血流感染中的表达及其意义.方法:建立金黄色葡萄球菌、粪肠球菌、大肠杆菌和肺炎克雷伯菌ICR小鼠血流感染模型,以注射相应剂量磷酸盐缓冲液的小鼠作为对照组,采用Luminex液相悬浮芯片系统检测各实验组和PBS对照组感染后0.5、1、3、6、12、24和48h时IL-6和IL-10的含量.结果:细菌感染小鼠后0.5 h时,各实验组IL-6的含量与对照组相比均明显升高(P＜0.05).各实验组IL-10的水平与对照组相比,感染后0.5h均明显升高(P＜0.05).大肠杆菌组、肺炎克雷伯菌组IL-10的含量在感染后1h达最大值.金黄色葡萄球菌组感染后3h达到最大值,粪肠球菌组在感染后6h达到最大值,且大肠杆菌组和肺炎克雷伯菌组IL-6和IL-10含量升高的幅度明显高于金黄色葡萄球菌组和粪肠球菌组(P＜0.05).对照组小鼠血清中IL-6和IL-10的含量在此过程中无明显变化.结论:IL-6和IL-10的含量在4种细菌性血流感染模型早期均明显升高.大肠杆菌组、肺炎克雷伯菌组IL-6和IL-10的含量升高幅度明显高于金黄色葡萄球菌组和粪肠球菌组.联合运用IL-6和IL-10有可能用于区分革兰阳性或革兰阴性细菌感染.     

Metabonomic analysis of fatty acids in seminal plasma between healthy and asthenozoospermic men based on gas chromatography mass spectrometry

The mechanism of asthenozoospermia remains unclear. The knowledge of the metabolism of fatty acids in seminal plasma is important and meaningful for the pathological study of asthenozoospermia. We present an optimised assay of extraction and derivatisation followed by GC/MS to analyse metabolites, especially fatty acids, in seminal plasma from healthy and asthenozoospermic men. Eighty‐nine peaks including 17 kinds of fatty acids were analysed and identified in the chromatogram. The GC/MS data were analysed using t test, fold change and partial least squares discriminant analysis to explore the potential biomarkers of asthenozoospermia. Seven metabolites in asthenozoospermic group were found to be significantly different from those in the normal group (with p < .05, fold change >1.2 and variable importance for projection >1). Of which, high levels of oleic acid and palmitic acid in seminal plasma from asthenozoospermic men may indicate a membrane metabolism disorder in spermatozoa and the lack of valine in the asthenozoospermic group may contribute to poor sperm motility. The results may facilitate the understanding of the role of fatty acids and amino acids in asthenozoospermia and provide solid foundation for further pathological study of asthenozoospermia.     

Direct Anterior Approach for Total Hip Arthroplasty in the Lateral Decubitus Position: Our Experiences and Early Results

Background

The direct anterior approach (DAA) for total hip arthroplasty (THA) is typically performed in the supine position using a specially designed operating room table, which makes this approach more accessible to orthopedic surgeons. We attempted to perform this procedure in the lateral decubitus position on an ordinary operation table to avoid dependence on a special operating room table. There is an obvious absence of literature regarding this subject.

Unexplained Pain Post Total Knee Arthroplasty With an Oxford Knee Score ≥20 at 6 Months Predicts Good 2-Year Outcome

Background

Total knee arthroplasty (TKA) is an effective procedure for end-stage osteoarthritis of the knee. Some patients experience persistent unexplained pain post-TKA despite normal investigations. The purpose of this study is to identify which of these patients are likely to improve without any surgical intervention. We hypothesize that patients with unexplained persistent pain and a poor 6-month Oxford knee score (OKS) post-TKA can improve at 2 years.

S-ROM股骨假体在髋关节翻修中应用的临床研究

目的 :探讨在髋关节翻修中使用S-ROM股骨假体重建股骨的中期临床效果。方法:回顾性分析2008年1月至2016年1月在髋关节翻修术中应用S-ROM假体进行股骨重建的患者21例21髋,男5例,女16例;年龄29~73岁,平均48.33岁。股骨翻修原因:无菌性松动13例,假体周围感染占位器植入术后4例,粗隆下截骨处骨不连2例,反复脱位1例,外伤致大粗隆骨折1例。初次关节置换原因:先天性髋关节发育不良12例(其中CroweⅣ型9例),股骨颈骨折5例,股骨头坏死2例,感染致股骨近端畸形2例。Paprosky股骨缺损分型:Ⅱ型11例,Ⅲa型9例,Ⅲb型1例。比较患者术前及末次随访时Harris髋关节评分及疼痛评分、髋关节屈曲度,记录患者术后末次随访时主观满意度。结果:手术时间125~290 min,平均189 min。术中出血量200~2 000 ml,平均867 ml。随访时间12~97个月,平均53.14个月。疼痛评分由术前17.14±9.56提高至末次随访的41.71±2.03(t=11.42,P=0.00);功能评分由术前24.01±11.02提高至末次随访的49.95±5.38(t=9.73,P=0.00);Harris髋关节评分由术前41.15±14.81提高至末次随访的91.67±5.83(t=15.33,P=0.00)。髋关节屈曲度由术前(93.10±27.27)°提高至末次随访的(121.90±16.62)°(t=4.59,P=0.00)。患者平均主观满意度9.48分(10分制),其中14例完全满意。末次随访X线片显示21例均为骨长入,其他股骨柄无明显松动或下沉。股骨近端袖套有5例周围形成骨锚定征。股骨近端术中骨折5例,3例为小粗隆骨折,2例为大粗隆骨折。因股骨髓腔狭窄,为预防假体植入发生骨折,小粗隆预捆扎钢丝4例。1例因外伤导致股骨假体远端斜行骨折,行切开复位锁定钢板内固定。其他患者无神经损伤、关节脱位、感染及下肢深静脉血栓形成等并发症发生。结论:S-ROM假体在PaproskyⅡ、Ⅲ型股骨缺损的髋关节翻修术中取得令人满意的结果,特别对于CroweⅣ型先天性髋发育不良等股骨近端畸形的翻修患者可以获得良好初始稳定性,减少并发症,实现远期生物固定。