Responsiveness of the ANP providing system to volume load in conscious dogs

We examined in detail changes in arterial plasma ANP concentration in response to volume load in conscious dogs. In a 5-min volume load experiment, 18 ml/kg of isosmotic and isooncotic 3% Dextran 40 in saline was infused over a period of 5 min. Mean left atrial pressure (MLAP) increased transiently by 7.6±0.9 mm Hg. Plasma ANP level (P-ANP) did not significantly increase. Assayed P-ANP levels were corrected for hemodilution. Corrected P-ANP (C-ANP) significantly increased from 206±17 to 348±34 pg/ml. However, the level of C-ANP did not reach a steady state. No significant linear correlation was found between increases in MLAP and normalized C-ANP. In a 45-min volume load experiment, the elevated level of MLAP caused by the 5-min volume load was maintained for 40 min by supplemental infusion. C-ANP significantly increased from 196±18 pg/ml to 435±73 ng/ml. The level of C-ANP reached a steady state. A close linear correlation was observed between increases in MLAP and normalized C-ANP. However, the peak time of C-ANP lagged 10 min behind MLAP. These results indicate that it takes 10 min for P-ANP to reach a steady state in fully responding to a volume load, and that the long-term volume load is a prerequisite to the response of the ANP providing system.     

The role of a raphe serotonin system in the control of septal unit activity and hippocampal desynchronization.

The effects of electrical stimulation of the median raphe nucleus on neuronal discharges in the medial septal area and electrical activity of the hippocampus were examined in urethane-anaesthetized rats. Two cell populations in the medial septal area were differentiated on the basis of their spontaneous discharge pattern, response to median raphe nucleus stimulation and whether or not they were antidromically activated following hippocampal stimulation. Medial septal area cells classified as I-neurones discharge in an irregular pattern which was unrelated to hippocampal activity. In contrast, B-neurones discharge in either rhythmic bursts or in an irregular manner which were related to hippocampal ‘theta’ or ‘desynchronization’, respectively. Single pulse stimulation of the median raphe nucleus inhibited the spontaneous discharge of I-neurones but did not influence the firing of B-neurones or hippocampal activity. Repetitive stimulation of the median raphe nucleus resulted in a prolonged inhibition of I-neurones, a disruption of the bursting discharge of B-neurones, and desynchronization of the hippocampal ‘theta’. The effects of median raphe nucleus stimulation were blocked by pretreatment with parachlorophenylalanine suggesting that a serotonin-containing system originating in the median raphe nucleus may be involved in mediating these responses.     

Screening for coeliac disease as a possible maternal risk factor for neural tube defect

Coeliac disease is an important cause of malabsorption, particularly of folic acid, in adults. We investigated the possibility that it might be a maternal risk factor for neural tube defect (NTD)-associated pregnancy by screening affected mothers using serum endomysial antibody (EmA) which has high sensitivity and specificity for coeliac disease. One (1.6%) of 60 patients was EmA positive and had a diagnosis of coeliac disease confirmed by the finding of villous atrophy on jejunal biopsy. In conclusion, the majority of NTD-associated pregnancies are not associated with maternal coeliac disease and our study is additional evidence that abnormalities of folic acid metabolism rather than absorption are the most important risk factors for NTD. Further studies are needed to determine whether the coeliac disease prevalence among women with NTD-affected pregnancy is higher than that of the general population.     

自体骨膜游离移植修复关节软骨缺损进展

探讨自体骨膜游离移植修复关节软骨缺损的研究进展。从骨膜的解剖生理功能和骨膜再生软骨能力两方面进行分析,并阐述了关节内营养环境、关节活动、骨膜生发层不同朝向、年龄及手术技巧等因素对移植修复的影响。同时总结了该方法的临床应用状况、效果及存在的问题。实验及临床的研究证明自体骨膜游离移植是修复关节软骨缺损的重要手段,局部环境因素影响骨膜成软骨。     

Effect of Bmk venom microinjected into LS on electric activities of nociceptive neurons in Pf of rat

目的 :研究外侧隔核是否是蝎毒产生中枢镇痛作用的重要部分之一。方法 :用玻璃微电极记录束旁核的单位放电 ;通过不锈钢套管向外侧隔核内微量注射 0 .0 3%蝎毒。结果 :外侧隔核内微量注射0 .0 3%蝎毒可以明显地减弱束旁核内的痛兴奋神经元和痛抑制神经元对伤害性刺激的反应。结论 :外侧隔核是蝎毒产生中枢镇痛作用的重要部位之一。     

Left atrial appendage perforation with Watchman device implantation: Strategies for surgical repair

Percutaneous occlusion of the left atrial appendage is increasingly being used as an alternative for stroke prevention in patients with non‐valvular atrial fibrillation at high risk of complications from long term anticoagulation. We describe a case of left atrial appendage perforation during Watchman device implantation requiring emergency repair of the left atrium using sternotomy and cardiopulmonary bypass. Technical considerations for surgical decision making are discussed; in hemodynamically unstable patients as well as those at high risk for embolization.     

Migraine-like headaches associated with nickel allergy requiring removal of atrial septal defect closure device

There is a deficit of literature regarding the association between nickel allergy–induced symptoms and implanted devices. This report describes a case of nickel allergy causing debilitating migraine-like symptoms, failing to resolve with medical therapy, requiring surgical removal of the device and repair of the defect.     

Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap

ObjectiveTo report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow‐up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale.ResultsThe average body mass index (BMI) was 26.6 ± 1.7 kg/m² (range, 23.9 to 28.7 kg/m²). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm²). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm²). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second‐stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow‐up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article.ConclusionsThe free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically.