经皮穴位电刺激辅助全麻对乳腺癌根治术中镇痛效应和血流动力学的影响

目的 观察经皮穴位电刺激（TEAS）辅助全麻下对乳腺癌根治术中镇痛效应和血流动力学的影响。方法 选取来自温州医科大学附属第一医院2019 年7 月～2020 年2 月全麻下行乳腺癌根治术患者80 例,按随机数字表法随机分成两组：TEAS 组和对照组,每组各40 例。TEAS 组在麻醉诱导前30 min 行TEAS（取穴为双侧合谷、内关、足三里、三阴交）,直至手术结束。对照组予相同位置贴电极片,不予电刺激处理。两组患者均采用常规诱导后置入喉罩全麻。记录两组术中各时间点的MAP、HR 和脑电双频谱值（BIS）、拔管时间、术中麻醉用药情况。结果 两组患者的一般情况和手术情况无差异。TEAS 组的拔管时间较对照组缩短,术中瑞芬太尼用量减少（P＜0.05）;TEAS 组在插管后即刻（T1）、插管后5 min（T2）、拔管后即刻（T6）、拔管后3 min（T7）的MAP 水平显著低于对照组（P＜0.05）,TEAS 组在插管后即刻（T1）、插管后5 min（T2）、拔管后即刻（T6）的HR 水平显著低于对照组（P＜0.05）;TEAS 组的T1 时刻BIS 值显著低于对照组（P＜0.05）。结论 经皮穴位电刺激辅助全麻可以增强乳腺癌根治术中镇痛效应,减轻术中应激反应。     

低频脉冲电刺激联合吞咽功能训练在脑卒中后吞咽障碍患者中的应用

目的 探讨低频脉冲电刺激联合吞咽功能训练在脑卒中后吞咽障碍患者中的应用。方法 选取2017 年6 月～2019 年2 月我院神经内科治疗的脑卒中后吞咽障碍患者92 例,随机分为联合组和单纯组,每组各46 例。单纯组患者予常规吞咽功能训练,联合组患者在单纯组常规吞咽功能训练的基础上加低频脉冲电刺激治疗,两组干预周期均为6 周。比较干预前后两组患者的吞咽功能评分及血氧饱和度,并评估临床效果。结果 治疗6 周后,两组藤氏评分、饮水试验评分和血氧饱和度均高于治疗前,且联合组均高于单纯组,差异有统计学意义（P＜0.05）;联合组总有效率（95.65%）显著高于单纯组（82.61%）,差异有统计学意义（P＜0.05）。结论 低频脉冲电刺激联合吞咽功能训练用于脑卒中后吞咽障碍患者的效果优于单纯吞咽功能训练,能改善患者的吞咽功能及血氧饱和度水平。     

心脏除颤器的质量检测实践

目的通过对心脏除颤器的质量检测,掌握心脏除颤器的性能状况,提高使用的安全性和有效性。方法以南京地区某三级甲等医院40台除颤器为研究对象,采用FLUKE专业的质控设备对心脏除颤器的外观、电气安全和性能参数进行检测。结果初次检测外观合格率为50%,电气安全合格率为85%,性能参数合格率为95%,不合格心脏除颤器经过相应处理后二次检测全部合格。结论加强心脏除颤器的质量检测关系重大,要制定合理的检测方案,积极推进除颤器使用人员的资质认证工作,使设备始终处于安全、有效的工作状态。     

Neural representations of ethologically relevant hand/mouth synergies in the human precentral gyrus

Complex motor responses are often thought to result from the combination of elemental movements represented at different neural sites. However, in monkeys, evidence indicates that some behaviors with critical ethological value, such as self-feeding, are represented as motor primitives in the precentral gyrus (PrG). In humans, such primitives have not yet been described. This could reflect well-known interspecies differences in the organization of sensorimotor regions (including PrG) or the difficulty of identifying complex neural representations in peroperative settings. To settle this alternative, we focused on the neural bases of hand/mouth synergies, a prominent example of human behavior with high ethological value. By recording motor- and somatosensory-evoked potentials in the PrG of patients undergoing brain surgery (2–60 y), we show that two complex nested neural representations can mediate hand/mouth actions within this structure: (i) a motor representation, resembling self-feeding, where electrical stimulation causes the closing hand to approach the opening mouth, and (ii) a motor–sensory representation, likely associated with perioral exploration, where cross-signal integration is accomplished at a cortical site that generates hand/arm actions while receiving mouth sensory inputs. The first finding extends to humans’ previous observations in monkeys. The second provides evidence that complex neural representations also exist for perioral exploration, a finely tuned skill requiring the combination of motor and sensory signals within a common control loop. These representations likely underlie the ability of human children and newborns to accurately produce coordinated hand/mouth movements, in an otherwise general context of motor immaturity.Since Penfield’s original work, it is commonly assumed that complex motor responses are produced by combining elemental movements that are independently represented at different neural sites (1). However, the generality of this model was recently challenged in nonhuman primates, where reaching, grasping, defensive, and hand/mouth movements have been found to be represented as complex motor primitives in independent circumscribed territories of the precentral gyrus (PrG) (2–4). To account for this observation, it was suggested that complex motor primitives have emerged during primate evolution to optimize the production of ethologically relevant behaviors (4). However, to date, direct evidence is lacking that such integrated representations of ethologically relevant movements also exist in humans. This may have two different origins.First, it could be that complex ethologically relevant representations exist in human PrG but have not yet been described, due to the difficulty of identifying neural representations associated with the expression of elaborate sensorimotor behaviors in peroperative contexts. With respect to this point, Penfield and other researchers have clearly reported complex multijoint motor responses following cortical stimulation (5–8), including concurrent movements of the hand and mouth (9). Nevertheless, these movements were not investigated systematically in several subjects, described in detail, or related to the existence of integrated neural representations for ethologically relevant behaviors. An obstacle to the investigation of these representations could have been the tendency to stop the stimulation following movement onset. This was explicitly acknowledged by Penfield in the following terms: “the stimulating electrode has frequently been removed at the first evidence of response, and thus the opportunity of producing more of the elaborate synergic responses may have been missed” (6).At a second level, it could be that the PrG does not contain functional representations of complex ethologically relevant behaviors in humans. This possibility is consistent with the existence of substantial dissimilarities in sensorimotor organization between human and nonhuman primates (10, 11). Interestingly, these dissimilarities are well documented for the precentral region mediating ethological synergies in monkeys. In this species, electrical stimulation in the rostral part of PrG evokes coordinated hand-to-mouth movements (12). These movements are part of the behavioral repertoire of the primate newborns (13), which is consistent with the observation that the rostral (phylogenetically oldest) part of PrG lacks cortico-motoneural cells and generates movements by recruiting the integrative mechanisms of the spinal cord through descending projections that are mature at birth (14). However, in human infants, the difficulty of evoking motor responses through electrical stimulation of the rostral PrG does not seem consistent with the existence of early mature descending projections (15, 16). Also, in adults, transcranial magnetic stimulation studies have suggested, in apparent contrast with monkey data, that late-maturing cortico-motoneural cells are present in the human rostral PrG (17, 18).The main aim of this study was to determine whether integrated neural representations of complex actions can be found in the human PrG. We investigated this possibility by studying the neural bases of hand/mouth synergies, a salient example of early and elaborate human behavior with high ethological value (19–21). To this end, motor and somatosensory mapping were combined in children and adult patients undergoing brain surgeries.     

Limiting glutamate transmission in a Vglut2-expressing subpopulation of the subthalamic nucleus is sufficient to cause hyperlocomotion

The subthalamic nucleus (STN) is a key area of the basal ganglia circuitry regulating movement. We identified a subpopulation of neurons within this structure that coexpresses Vglut2 and Pitx2, and by conditional targeting of this subpopulation we reduced Vglut2 expression levels in the STN by 40%, leaving Pitx2 expression intact. This reduction diminished, yet did not eliminate, glutamatergic transmission in the substantia nigra pars reticulata and entopeduncular nucleus, two major targets of the STN. The knockout mice displayed hyperlocomotion and decreased latency in the initiation of movement while preserving normal gait and balance. Spatial cognition, social function, and level of impulsive choice also remained undisturbed. Furthermore, these mice showed reduced dopamine transporter binding and slower dopamine clearance in vivo, suggesting that Vglut2-expressing cells in the STN regulate dopaminergic transmission. Our results demonstrate that altering the contribution of a limited population within the STN is sufficient to achieve results similar to STN lesions and high-frequency stimulation, but with fewer side effects.The subthalamic nucleus (STN) has long been a structure of interest for researchers and clinicians alike. There is ample evidence that high-frequency stimulation of the STN improves symptoms such as tremor, rigidity, and slowness of movement, so called bradykinesia, in patients with Parkinson disease (see ref. 1 for review), but the mechanism through which this is achieved is still unknown. Some studies suggest that electrical stimulation causes a hyperexcitation of this structure (2), whereas others find evidence that the opposite is true (3–5). Other possible interpretations include the activation of the zona incerta, a neighboring white-matter structure (6) or of fibers coming from the motor cortex (7). Bilateral lesions of the STN improve locomotion (8), a result that is consistent with the inactivation hypothesis. However, previous studies have also found cognitive side effects when using high-frequency stimulation of the STN (9), findings supported by lesion studies in experimental animals, which led to abnormalities in operant tasks involving attention and impulsivity (10, 11). The projections of the STN to other regions help explain the multiple roles of this structure: It sends projections to other targets in the basal ganglia, such as the internal segment of the globus pallidus [also termed the entopeduncular nucleus (EP) in rodents] and the substantia nigra pars reticulata (SNr) (12, 13). The STN is also part of a circuit that includes the prefrontal cortex and the nucleus accumbens (14). It is currently unknown, however, whether these different roles reflect a heterogeneous population of cells, characterized by distinct gene expression. If that is the case, it would allow direct control over each cell population, facilitating the investigation of their respective roles. In rodents, the STN is believed to be composed solely of glutamatergic neurons, characterized by expression of the subtype 2 Vesicular glutamate transporter (Vglut2), whereas the other two subtypes (Vglut1 and Vglut3) have not been detected (15, 16). Selective targeted deletion of Vglut2 expression in this nucleus would therefore provide a specific loss-of-function model that would bypass a common problem presented by traditional lesions with pharmacological agents, which have patterns of diffusion that likely affect surrounding structures (17). It is known, however, that Vglut2 is expressed in many other parts of the brain (18), and a complete knockout in the mouse is not viable (19, 20). There is also evidence that the promoter driving expression of the Paired-like homeodomain 2 (Pitx2) gene is strong in the mouse STN (21) but is also not specific to this structure and a full knockout of Pitx2 expression results in premature death (22). To achieve the desired level of specificity, using a conditional knockout technique previously used to eliminate glutamatergic transmission in other cell types (23), we crossed Pitx2-Cre and Vglut2-lox mice, producing Vglut2^{f/f;Pitx2-Cre} conditional knockout (cKO) mice in which Vglut2 expression in the STN was strongly reduced in comparison with expression levels in littermate control mice. To understand the physiological contribution of the selected subpopulation of STN cells, we characterized these cKO mice with regard to anatomical, electrophysiological, and molecular properties, as well as their performance in a range of behavioral tasks.     

花红颗粒联合阿莫西林克拉维酸钾治疗慢性盆腔炎的临床研究

目的探讨花红颗粒联合阿莫西林克拉维酸钾治疗慢性盆腔炎的临床效果和安全性。方法选取宣城市人民医院2017年4月—2018年6月接诊的慢性盆腔炎患者186例,随机分成对照组(93例)和治疗组(93例)。对照组患者口服阿莫西林克拉维酸钾片,2片/次,2次/d;治疗组患者在对照组基础上口服花红颗粒,1袋/次,3次/d。两组患者均连续治疗21 d。观察两组患者临床疗效,同时比较治疗前后两组患者盆腔炎性包块直径、盆腔积液深度、生活质量评分及症状积分、C-反应蛋白(hs-CRP)、粒细胞集落刺激因子(GM-CSF)和转化生长因子β1(TGF-β1)水平。结果经治疗,对照组和治疗组临床有效率分别为89.25%和97.85%,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者盆腔炎性包块直径、盆腔积液深度和症状积分均显著降低(P0.05),WHOQOL-100评分均显著升高(P0.05),且治疗组各指标比对照组改善更明显(P0.05)。治疗后,两组患者血清hs-CRP、GM-CSF水平均显著降低(P0.05),血清TGF-β1水平均显著升高(P0.05)且治疗组hs-CRP、GM-CSF和TGF-β1水平明显好于对照组(P0.05)。结论花红颗粒联合阿莫西林克拉维酸钾治疗慢性盆腔炎疗效显著,且能够显著改善患者的生活质量,安全性高。     

金鸡片联合左氧氟沙星治疗慢性盆腔炎的临床研究

目的探讨金鸡片联合左氧氟沙星片治疗慢性盆腔炎的临床疗效。方法选取2017年12月—2018年12月天津市宝坻区人民医院收治100例慢性盆腔炎患者为研究对象,随机分为对照组(48例)和治疗组(52例)。对照组患者口服左氧氟沙星片,100 mg/次,2次/d。治疗组患者在对照组治疗的基础上口服金鸡片,4片/次,3次/d。两组患者连续治疗14 d。观察两组的临床疗效,比较两组的临床症状消失时间、炎性因子水平、血清因子水平。结果治疗后,对照组和治疗组的总有效率分别为70.83%、88.46%,两组比较差异有统计学意义(P0.05)。治疗后,治疗组患者腰骶胀痛、下腹疼痛、带下异常的消失时间较对照组明显更短,两组比较差异有统计学意义(P0.05)。治疗后,两组患者C-反应蛋白(CRP)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);并且治疗后治疗组患者炎性因子水平均明显低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组患者前白蛋白水平显著升高,分泌型免疫球蛋白A、内皮素、血栓素水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05);并且治疗后治疗组患者血清因子水平均明显优于对照组,两组比较差异具有统计学意义(P0.05)。结论金鸡片联合左氧氟沙星片治疗慢性盆腔炎具有较好的临床疗效,能改善临床症状,降低患者炎性水平,具有一定的临床推广应用价值。