幕上高血压脑出血预后影响因素的多重线性回归分析

目的探讨影响幕上高血压脑出血（SICH）患者预后的相关因素,以指导临床治疗和评估预后。方法回顾性分析符合本研究纳入标准的幕上高血压脑出血324例完整病历。以一般资料、起病症状、入院查体、影像学资料、治疗方式、并发症等43项为自变量,以发病后1个月后功能独立性评定评分（functional independence measure,FIM）为因变量,建立多重线性回归模型,筛选出对预后有影响的因素,并比较各因素的影响大小。结果经统计学处理发现血肿体积、入院时收缩期血压、GCS评分、脑室是否积血、血肿体积扩大、是否并发肺部感染和应激性溃疡等7项对预后有显著性的影响。结论血肿体积、入院GCS评分和脑室是否积血对预后影响有重要意义,可作为SICH患者预后的关键性指标。     

脑出血后的病理改变与T淋巴细胞反应

目的:探讨脑出血血肿周围局部病理改变及细胞免疫机制。方法:用免疫组化方法及组织HE染色法观察20只大鼠尾壳核脑出血24 h,3天、7天血肿周围区域的组织病变及CD3 、CD8 T淋巴细胞的分布形式和表达时程。结果:①在脑出血后24 h血肿周围即可见明显血管源性水肿,大量炎性细胞浸润,以中性粒细胞为主,少量散在淋巴细胞、小胶质细胞、星形细胞、少突胶质细胞弥漫浸润;出血3天、7天以淋巴细胞、巨噬细胞浸润为主,小胶质细胞、星形细胞、少突胶质细胞增生明显,双侧半球皮层下和血管周围出现小胶质细胞结节;②出血灶周围CD3 和CD8 T淋巴细胞浸润在出血后24 h已可见,出血后3天组和出血后7天组,CD3 和CD8 阳性细胞数明显高于出血后24 h组。结论:①脑出血期以中性粒细胞反应为主,以后以淋巴细胞反应为主,胶质细胞反应在出血后24 h已发生,持续一周以上;②CD3 、CD8 阳性细胞的出现提示它们参与了出血后脑损伤的病理过程,在出血7天内, CD3 和CD8-阳性细胞反应呈增强趋势。     

"Hour-glass" shape of the uterus in the diagnosis and treatment of cervical pregnancy

This study attempts to point out the importance of the anatomo-clinical finding of an "hour-glass" shape to the uterus in the diagnosis and treatment of cervical pregnancy. From 1973 to 2001, four cases of cervical pregnancy were treated in the 2nd Obstetrical and Gynecological Clinic of the Aristotelion University of Salonica. The incidence was 1:13,111 pregnancies (4 cervical in 52,446 pregnancies). Three of the patients underwent bilateral ligation of the anterior trunk of the internal iliac artery using absorbable ligatures. The fourth patient (a 42-year-old), elected to have a hysterectomy. All patients were well and discharged from hospital on the seventh postoperative day. Two of the three patients treated by ligation of the anterior trunk of the internal iliac arteries subsequently had normal pregnancies and deliveries. We lost contact with the third patient. The finding of an "hour-glass" uterine shape was very helpful in the diagnosis of cervical pregnancy. The Aristotelion University of Salonica has found that treatment by ligation of the anterior trunk of the internal iliac arteries is effective, causes no complications, never ends in hysterectomy, and maintains the normal menstrual cycles and reproductive ability of the woman.     

A quantitative study of the brainstem cholinergic projections to the ventral part of the oral pontine reticular nucleus (REM sleep induction site) in the cat

The ventral part of the cat oral pontine reticular nucleus (vRPO) is the site in which microinjections of small dose and volume of cholinergic agonists produce long-lasting rapid eye movement sleep with short latency. The present study determined the precise location and proportions of the cholinergic brainstem neuronal population that projects to the vRPO using a double-labeling method that combines the neuronal tracer horseradish peroxidase–wheat germ agglutinin with choline acetyltransferase immunocytochemistry in cats. Our results show that 88.9% of the double-labeled neurons in the brainstem were located, noticeably bilaterally, in the cholinergic structures of the pontine tegmentum. These neurons occupied not only the pedunculopontine and laterodorsal tegmental nuclei, which have been described to project to other pontine tegmentum structures, but also the locus ceruleus complex principally the locus ceruleus and peri-, and the parabrachial nuclei. Most double-labeled neurons were found in the pedunculopontine tegmental nucleus and locus ceruleus complex and, much less abundantly, in the laterodorsal tegmental nucleus and the parabrachial nuclei. The proportions of these neurons among all choline acetyltransferase positive neurons within each structure were highest in the locus ceruleus complex, followed in descending order by the pedunculopontine and laterodorsal tegmental nuclei and then, the parabrachial nuclei. The remaining 11.1% of double-labeled neurons were found bilaterally in other cholinergic brainstem structures: around the oculomotor, facial and masticatory nuclei, the caudal pontine tegmentum and the praepositus hypoglossi nucleus. The disperse origins of the cholinergic neurons projecting to the vRPO, in addition to the abundant noncholinergic afferents to this nucleus may indicate that cholinergic stimulation is not the only or even the most decisive event in the generation of REM sleep.     

Adrenal pseudocysts: Evidence of their posthemorrhagic nature

Hemorrhagic adrenal pseudocysts are uncommon nonneoplastic lesions that have been reported as secondary to intraparenchymal hemorrhage or alternatively related to endothelial (vascular) cysts. Ultrastructural and immunohistochemical evidence in support of the latter has been presented, but the exact nature of hemorrhagic adrenal pseudocysts remains poorly defined. We evaluated six surgical specimens of hemorrhagic adrenal pseudocysts using immunohistochemical staining for CD31 and CD34, as well as conventional histochemistry. All six cases had hemorrhagic contents within a wall of variable thickness possessing focal areas of linear, disrupted elastin, and smooth muscle. Three cases demonstrated extensive thrombosis with organization, including papillary endothelial hyperplasia, simulating angiosarcoma. In these cases, CD31 and CD34 staining decorated areas of papillary endothelial hyperplasia as well as foci of the internal cyst lining, whereas the other cases were negative for both antibodies. Of interest is the history of FNA prior to surgical resection in three cases of hemorrhagic adrenal pseudocysts, two of which showed papillary endothelial hyperplasia. The presence of papillary endothelial hyperplasia and our immunohistochemical findings support, the conclusion that adrenal pseudocysts are posthemorrhagic and derive from vascular disruption. Furthermore, FNA or other interventional studies may be associated with papillary endothelial hyperplasia in hemorrhagic adrenal pseudocysts.     

全膝关节置换后不放置引流的相关管理策略

背景:近年来,随着全膝关节置换技术提升、手术时间缩短、术中及术后止血药的应用,其总失血量不断减少,术后引流量也逐渐减少,术后快速康复理论应运而生,引流管放置也再次成为骨科医生所热议的问题,越来越多的医生认为可以常规取消放置引流,引流似乎已可有可无。目的:旨在复习既往文献,对全膝关节置换后引流放置的相关问题归纳总结,提供围术期引流管理的相关经验。方法:检索中国知网、万方、维普、中国生物医学文献数据库等中文数据库,以及PubMed、The Cochrane Library、WebofScience、EMBASE、OVID等外文数据库,以"引流,膝关节置换术"及"totalknee arthroplasty,drainage"为检索词,检索自建库始至2020年2月为止所有与主题相关的文献,总结归纳全膝关节置换后不放置引流管围术期各方面需综合考虑的要素。结果与结论:①引流管的放置问题关乎全膝关节置换手术的最终结果,与术后出血、血肿、血栓、感染等并发症的发生关系密切;②目前全膝关节置换术后不推荐常规放置引流,但不意味着不需要管理,其实际上对临床医护在围术期各方面的管理提出更高的要求,包括但不限于术前适应证选择、手术操作、止血带使用、术中及术后药物使用、物理疗法的使用等。     

Forebrain and lower brainstem participation in facilitatory and inhibitory regulation of the display of lordosis in female rats

Neural transection of the dorsal extrahypothalamic descending afferents by means of an L-shaped Halász knife at the anterior commissure (anterior roof deafferentation. ARD) markedly potentiated the display of lordosis and soliciting behaviors. Bilateral lesions of the ventromedial hypothalamus (VMH) attenuated lordotic activity in the ARD sham females but not in the ARD females. In contrast, the lesions in the pontine central gray concurrently with ARD effectively inhibited the display of lordosis but not soliciting behaviors. These results suggest that the VMH may not be a primary focus of the dorsal extrahypothalamic inhibitory influence on lordosis. The influence of this inhibitory system seems to be dominant in regulating the expression of lordosis behavior, compared to that of the hypothalamic lordosis facilitating system. Furthermore, the dorsal extrahypothalamic inhibitors influence which could be removed by ARD must be modified by the neural mechanism in the lower brain stem in which the pontine central gray may be actively involved.     

A simple intra-operative maneuver to decrease a duodenal ulcer hemorrhage temporarily: description and anatomical bases

Intraoperative hemostatic suture to treat a bleeding duodenal ulcer is sometimes difficult when there is massive hemorrhage. The aims of this paper are: (1) to describe a practical and easy intraoperative procedure which quickly decreases a massively bleeding duodenal ulcer, allowing the surgeon to identify the bleeding site clearly and obtain definitive hemostasis by suturing the involved vessels with a low risk of common bile duct lesion; and (2) to study in cadavers the anatomical basis of this surgical procedure already successfully performed on patients. Fourteen patients with massive duodenal ulcer bleeding, after unsuccessful endoscopic hemostasis, were operated on and included in this study. After surgical anterior gastroduodenotomy, the surgeon introduced a finger in a downward and forward direction in the bursa omentalis vestibule through the omental foramen. This simple and quick procedure decreased hemorrhage by compressing the gastroduodenal artery against the first part of the posterior surface of the duodenum. Twenty-four fresh blocks of normal tissue were removed from cadavers and were injected with silicone rubber through the common hepatic artery. The distance between the gastroduodenal artery and the omental foramen was measured. With this maneuver the surgeon can clearly see the exact bleeding site and perform an adequate suture with a minor risk of common bile duct lesion.     

Perivascular Drainage of Amyloid-β Peptides from the Brain and Its Failure in Cerebral Amyloid Angiopathy and Alzheimer's Disease

Alzheimer's disease is the commonest dementia. One major characteristic of its pathology is accumulation of amyloid-β (Aβ) as insoluble deposits in brain parenchyma and in blood vessel walls [cerebral amyloid angiopathy (CAA)]. The distribution of Aβ deposits in the basement membranes of cerebral capillaries and arteries corresponds to the perivascular drainage pathways by which interstitial fluid (ISF) and solutes are eliminated from the brain—effectively the lymphatic drainage of the brain. Theoretical models suggest that vessel pulsations supply the motive force for perivascular drainage of ISF and solutes. As arteries stiffen with age, the amplitude of pulsations is reduced and insoluble Aβ is deposited in ISF drainage pathways as CAA, thus, further impeding the drainage of soluble Aβ. Failure of perivascular drainage of Aβ and deposition of Aβ in the walls of arteries has two major consequences: (i) intracerebral hemorrhage associated with rupture of Aβ-laden arteries in CAA; and (ii) Alzheimer's disease in which failure of elimination of ISF, Aβ and other soluble metabolites from the brain alters homeostasis and the neuronal environment resulting in cognitive decline and dementia. Therapeutic strategies that improve elimination of Aβ and other soluble metabolites from the brain may prevent cognitive decline in Alzheimer's disease.