旋股外侧动脉内侧降支移植修复掌浅弓缺损

目的探讨应用旋股外侧动脉内侧降支移植修复掌浅弓缺损的可行性。方法通过对旋股外侧动脉内侧降支的应用解剖学研究,1999年5月-2004年2月,对8例手掌严重损伤致掌浅弓缺损的患者,切取上述血管移植重建掌浅动脉弓,血管切取长度为9～15cm。结果术后患者手指及移植皮瓣全部成活,手功能恢复满意,血管供区血液循环无影响,肌力正常。结论旋股外侧动脉内侧降支,与掌浅弓有十分相似的解剖学结构,且解剖位置恒定,切取方便。该血管最佳适应证是修复掌浅弓缺损和同时伴有皮肤软组织缺损。     

Enhancement of the Bulbocavernosus Reflex During Intraoperative Neurophysiological Monitoring through the Use of Double Train Stimulation: A Pilot Study

OBJECTIVE: Electrophysiological bulbocavernosus reflex (BCR) testing, during surgeries in which the constituent neural components are at risk, might supplement other low sacral (S2-4) stimulation/recording techniques. However, intraoperative BCR is not always reliably implemented. We proposed to analyze BCR signals in five surgical patients monitored with the novel application of double train stimulation (DTS) to determine if the potential could be enhanced. METHODS: We prospectively planned a regime of DTS BCR with a series of intertrain delays in five monitored patients at risk for low sacral neural injury. Patients were maintained with propofol, opiate infusion, and low inhalant anesthesia without muscle relaxant. Cutaneous sensory nerves of the penis (or clitoris) were stimulated using two consecutive pulse trains (DTS). Intertrain delays were 75, 100, 125, 150, 175, 200, and 250 ms. For BCR recording, uncoated paired wires were inserted into the external anal sphincter (EAS) bilaterally. For each trial, waveform amplitude, duration, and turn count measures for the first (single train) and second (double train) response were recorded. Percent increase/decrease of the second train response compared to the first train response was calculated. RESULTS: There was at least a 30% increase in measures of amplitude, turn count, and duration of the second train response in 22/28, 22/28, and 14/28 of the total trials respectively. There was an insufficient number of independent observations to determine statistical significance. CONCLUSIONS: Intraoperative BCR is currently obtained with some difficulty using pulse train stimulation. Our preliminary evidence has identified BCR waveform enhancement using DTS and suggests that the reliability of intraoperative BCR acquisition may be further improved by the addition of this technique. Our data are insufficient to define the best intertrain interval.     

The oncologic safety of left colectomy with modified complete mesocolic excision for distal transverse colon cancer: Comparison with descending colon cancer

BackgroundThe optimal surgical approach for distal transverse colon cancer has not been well established. This study aimed to evaluate the oncologic safety of left colectomy with a modified complete mesocolic excision for distal transverse colon cancer as compared with descending colon cancer.Material and methodsThis study involved 383 patients who underwent left colectomy with modified complete mesocolic excision for non-metastatic distal transverse and splenic flexure colon (transverse group, N = 110) and descending colon cancer (descending group, N = 237) from 3 institutions. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups.ResultsBaseline characteristics between the two groups were similar except for the length of the distal margin (transverse group = 11.0 cm vs descending group = 9.0 cm, p = 0.004). During a median follow-up of 47.0 months, RFS and OS were not different between the transverse and descending groups (5-year RFS: 82% vs 71%, p = 0.139; 5-year OS: 83% vs 79%, p = 0.416, respectively). In multivariable analysis, RFS and OS were not different between the two groups (transverse group vs. descending group: adjusted hazard ratio [aHR] = 1.557, 95% CI = 0.786–3.084, p = 0.204; aHR = 1.251, 95% CI = 0.530–2.952, p = 0.609).ConclusionThe oncologic outcomes of left colectomy with a modified complete mesocolic excision of distal transverse colon cancer were comparable to those of descending colon cancer. Left colectomy with a modified complete mesocolic excision can be an acceptable surgical treatment for distal transverse colon cancer.     

Reliability of single and paired‐pulse transcranial magnetic stimulation in the vastus lateralis muscle

Introduction: Transcranial magnetic stimulation (TMS) is an important tool to examine neurological pathologies, movement disorders, and central nervous system responses to exercise, fatigue, and training. The reliability has not been examined in a functional locomotor knee extensor muscle. Methods: Within‐ (n = 10) and between‐day (n = 16) reliability of single and paired‐paired pulse TMS was examined from the active vastus lateralis. Results: Motor evoked potential amplitude and cortical silent period duration showed good within‐ and between‐day reliability (intraclass correlation coefficient [ICC] ≥ 0.82). Short‐ and long‐interval intracortical inhibition (SICI and LICI, respectively) demonstrated good within‐day reliability (ICC ≥ 0.84). SICI had moderate to good between‐day reliability (ICC ≥ 0.67), but LICI was not repeatable (ICC = 0.47). Intracortical facilitation showed moderate to good within‐day reliability (ICC ≥ 0.73) but poor to moderate reliability between days (ICC ≥ 0.51). Conclusions: TMS can reliably assess cortical function in a knee extensor muscle. This may be useful to examine neurological disorders that affect locomotion. Muscle Nerve 52: 605–615, 2015     

A systematic review of multisensory cognitive–affective integration in schizophrenia

The etymology of schizophrenia implies poor functional integration of sensory, cognitive and affective processes. Multisensory integration (MSI) is a spontaneous perceptual–cognitive process by which relevant information from multiple sensory modalities is extracted to generate a holistic experience. Deficits in MSI may hinder prompt and appropriate behavioural responses in a complex and transient environment. Despite extensive investigation of sensory, cognitive and affective processing in patients with schizophrenia, little is known about how MSI is affected in the illness. We systemically searched the PubMed electronic database and reviewed twenty-nine behavioural and neuroimaging studies examining MSI in patients with schizophrenia. The available evidence indicates impaired MSI for non-emotional stimuli in schizophrenia, especially for linguistic information. There is also evidence for altered MSI for emotional stimuli, although findings are inconsistent and may be modality-specific. Brain functional alterations in the superior temporal cortex and inferior frontal cortex appear to underlie the deficits in both non-emotional and emotional MSI. The limitations of the experimental paradigms used and directions for future research are also discussed.     

Prepulse inhibition and facilitation of the postauricular reflex,a vestigial remnant of pinna startle

If the postauricular reflex (PAR) is to be used effectively in studies of emotion and attention, its sensitivity to basic modulatory effects such as prepulse inhibition and facilitation must be determined. Two experiments were carried out with healthy young adults to assess the effects of transient and sustained visual prestimuli on the pinna‐flexion response to trains of startle probes. In the first experiment, participants passively viewed a small white square. It was displayed from 1,000 ms prior to onset of a train of noise bursts until the end of that train. Relative to no‐prepulse control trials, PAR amplitude was inhibited, possibly due to the withdrawal of attentional resources from the auditory modality. In the second experiment, participants performed a visual oddball task in which irrelevant trains of startle probes followed most briefly displayed task stimuli (checkerboards). Prepulse inhibition was observed when a transient stimulus preceded the first probe at a lead time of 100 ms. Amplitude facilitation was observed at longer lead times. In addition to documenting the existence of prepulse inhibition and facilitation, the data suggest that the PAR is not elicited by visual stimuli, that temporal expectancy does not influence its amplitude or latency, and that this vestigial microreflex is resistant to habituation. Results are interpreted in light of a recent theory that the human PAR is a highly degraded pinna startle, in which the reflex arc no longer includes the startle center (nucleus reticularis pontis caudalis).     

70例牙源性下行性坏死性纵隔炎临床分析

目的: 分析牙源性下行性坏死性纵隔炎患者的临床特征,为诊断和治疗提供参考。 方法: 回顾分析2014年1月—2016年12月上海交通大学医学院附属第九人民医院收治的牙源性下行性坏死性纵隔炎患者,收集、分析患者的一般资料、感染来源、临床症状、实验室检查、细菌培养、治疗和预后。采用SPSS 22.0软件包对数据进行统计学分析。 结果: 本组70例患者中,男57例,女13例,平均年龄57.8±11.42岁。主要的发病来源为下颌前磨牙及第一、第二磨牙（38.6%）。根尖周炎是最常见的牙源性感染的病因。治疗包括抗生素和经颈部纵隔引流（63例）、胸廓切开术（7例）。死亡率为5.7%。影响牙源性下行性坏死性纵隔炎患者预后的危险因素为发生并发症（P<0.005）和严重脓毒症或败血性休克（P<0.002）。 结论: 成功治疗牙源性下行性坏死性纵隔炎的关键是对疑似症状的迅速诊断、快速CT扫描和彻底的纵隔引流。     

神经肌肉本体易化技术联合神经肌肉电刺激治疗脑卒中患者肩关节半脱位疗效观察

目的：观察神经肌肉本体易化技术（ proprioceptive neuromuscular facilitation ,PNF）技术联合神经肌肉电刺激对脑卒中后肩关节半脱位的治疗效果。方法将90例脑卒中后肩关节半脱位患者按随机数字表示分为治疗组和对照组各45例。2组患者均接受早期药物治疗、良肢位摆放及常规康复治疗,治疗组加用PNF技术联合神经肌肉电刺激。2组患者治疗前及治疗后均拍摄双肩关节X射线片并进行指诊,测定两侧肩峰至肱骨头的间距（ AHI）评价肩关节脱位恢复情况,采用Fugl-Meyer评定量表（ FMA）评价患者患侧上肢运动功能。结果2组患者在治疗1月后AHI评分及FMA评分均较治疗前改善,且治疗组较对照组改善更显著（ P＜0.05）。结论 PNF技术联合神经肌肉电刺激对脑卒中后肩关节半脱位及上肢运动功能改善效果显著,其疗效优于常规康复治疗。     

Attention effects on vicarious modulation of nociception and pain

The observation of others’ facial expressions of pain has been shown to facilitate the observer’s nociceptive responses and to increase pain perception. We investigated how this vicarious facilitation effect is modulated by directing the observer’s attention toward the meaning of pain expression or the facial movements. In separate trials, participants were instructed to assess the “intensity of the pain expression”(meaning) or to “discriminate the facial movements” in the upper vs lower part of the face shown in 1-second dynamic clips displaying mild, moderate, or strong pain expressions or a neutral control. In 50% of the trials, participants received a painful electrical stimulation to the sural nerve immediately after the presentation of the expression. Low-level nociceptive reactivity was measured with the RIII-response, and pain perception was assessed using pain ratings. Pain induced by the electrical stimulation increased after viewing stronger pain expressions in both tasks, but the RIII-response showed this vicarious facilitation effect only in the movement discrimination task at the strongest expression intensity. These findings are consistent with the notion that vicarious processes facilitate self-pain and may prime automatic nociceptive responses. However, this priming effect is influenced by top-down attentional processes. These results provide another case of dissociation between reflexive and perceptual processes, consistent with the involvement of partly separate brain networks in the regulation of cortical and lower-level nociceptive responses. Combined with previous results, these findings suggest that vicarious pain facilitation is an automatic process that may be diminished by top-down attentional processes directed at the meaning of the expression.