Blood supply of the olfactory nerve

Summary The authors report the results of a series of dissections and anatomic sections of the fronto-basal region of the brain and of the anterior cranial fossa in human cadavers. The constant presence of an arachnoidal cistern above the olfactory nerve was verified. The arachnoid separates from the pial membrane and forms a bridge with the ventral part of the olfactory bulb and tract, from the lateral edge of the olfactory sulcus to the medial edge of the gyrus rectus. The cistern is wide in its anterior portion, between the gyrus rectus and the olfactory bulb, and is reduced to a virtual slit in its posterior portion where the tract is lodged in the olfactory sulcus. The olfactory nerve can be separated without damaging fronto-basal arachnoidial adhesions over several centimeters. Dissection of this region after intravascular injection of colored media shows the constant presence of an artery destined to the olfactory bulb and tract. It originates either from the lateral surface of the anterior cerebral a. (segment A2), or from the medial fronto-basal a., and consistently provides terminal branches in front of the olfactory trigone in the medial olfactory sulcus. At their ventral extremity, the olfactory structures are therefore vascularised independently for several centimeters, from the lower face of the frontal lobe. The independent vascularisation of the olfactory nerve, the tenuous and easily detachable adhesions, and the actual presence of a true arachnoidal cistern all contribute to enabling surgical techniques which conserve olfactory function during anterior approaches.

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Vascularisation du nerf olfactif. Rapports méningés et applications chirurgicales

Résumé Les auteurs rapportent les résultats d'une série de dissections et de coupes de la région fronto-basale de l'encéphale et de la fosse crânienne antérieure sur sujets cadavériques. La présence constante d'une citerne arachnoïdienne au dessus du n. olfactif a été vérifiée. L'arachnoïde se sépare du feuillet pial et passe en pont à la partie ventrale du bulbe et du tractus olfactifs, du bord latéral du sillon olfactif au bord médial du gyrus rectus. La citerne est large dans sa portion antérieure, entre le gyrus rectus et le bulbe olfactif, se réduit à une fente virtuelle postérieure lorsque le tractus se loge dans le sillon olfactif. Le n. olfactif peut être séparé sans dommage des adhérences arachnoïdiennes fronto-basales sur quelques centimètres. La dissection de cette région, après injection intravasculaire de masses colorées montre, de façon originale, la présence constante d'une artère destinée au tractus et au bulbe olfactifs. Elle naît soit de la face latérale de l'a. cérébrale antérieure (segment A2), soit de l'a. fronto-basale médiale, pour donner ses branches terminales toujours en avant du trigone olfactif dans le sillon orbitaire médial. Sur quelques centimètres à leur extrémité ventrale, les structures olfactives ont donc une vascularisation indépendante de la face inférieure du lobe frontal. L'indépendance vasculaire du n. olfactif, des adhérences ténues, facilement détachables, et la réalité vérifiée d'une véritable citerne arachnoïdienne permettent d'imaginer des techniques conservatrices de la fonction olfactive utilisées dans plusieurs indications de la chirurgie de la fosse crânienne antérieure.

     

Blastocoele collapse by micropipetting prior to vitrification gives excellent survival and pregnancy outcomes for human day 5 and 6 expanded blastocysts

BACKGROUND: Manual puncture of the trophectoderm of human blastocysts with a needle before vitrification increases their survival rate, but the embryos take a long time to re-expand. This study examined whether causing human blastocysts to collapse by manual pipetting before vitrification would allow more rapid re-expansion and improve pregnancy rates. METHODS: After embryo transfer in IVF cycles, surplus embryos that developed to the expanded blastocyst stage were placed in cryoprotectant and then artificially shrunk by mechanical pipetting with a fine hand-drawn glass pipette slightly smaller in diameter than the blastocyst. The shrunken embryos were placed in a small volume of vitrification solution and plunged into liquid nitrogen on a cryotop. The blastocysts were thawed by warming and then dilution in 1 mol/l sucrose. RESULTS: Of 49 expanded vitrified blastocysts, 48 (98%) re-expanded within 3 h after warming. Following transfer (48 blastocysts in 28 cycles), 14 women (50%) became clinically pregnant, and the implantation rate was 33% (16/48). Eight healthy babies have been born in six deliveries, and the other eight pregnancies are ongoing. To date, there have been no spontaneous abortions. CONCLUSIONS: The results suggest that artificial shrinkage with pipetting is a simple and effective technique to assist successful cryopreservation of expanded blastocysts by vitrification.     

经下颌下咽后入路颅颈交界腹侧区手术的应用解剖

目的:为临床经下颌下咽后入路处理颅颈交界腹侧区病变提供解剖学基础。方法:对15例(30侧)带颈头颅标本模拟经下颌下咽后入路进行显微外科解剖,同时进行了有关的数据测量。结果:该入路浅层的重要结构均位于各自的筋膜层中,以这些结构为解剖学标志可鉴别各层并引导手术进行。咽结节是显露的上限,限制骨窗侧方显露范围的各重要结构的内缘距正中线的水平距离分别为寰枢外侧关节,左(7.78±1.03)mm,右(7.81±1.01)mm;寰枕关节,左(9.27±1.86)mm,右(9.22±1.69)mm;舌下神经管内口,左(12.76±2.77)mm,右(12.81±2.53)mm及椎动脉C2水平,左(18.36±2.27)mm,右(18.47±2.14)mm;C1水平左(25.35±2.31)mm,右(25.18±2.33)mm;穿硬膜处,左(12.69±2.42)mm,右(12.72±2.39)mm。结论:(1)经下颌下咽后入路解剖上大致可分为3个层次:浅层,深层和骨、韧带及硬膜层。(2)掌握每个层次的解剖特点及操作要点,有助于安全充分的显露和处理咽颅颈交界腹侧区病变。     

Ocular pharmacokinetic models of clonidine-3H hydrochloride

A single topical instillation of clonidine-³H HCl solution (0.2%) was administered to the rabbit eye (30 μl) in order to study the drug's ocular pharmacokinetics. Seven different tissues and plasma were excised and assayed for drug over 180min. By 45–60 min pseudoequilibrium is reached for the cornea, iris/ciliary body, and aqueous humor. Thereafter, drug levels in these tissues decline in parallel. The data are fit separately to a physiological model and a classical diffusion model for which seven ocular tissue compartments and a plasma reservoir are constructed for each model. Clearance terms and distribution equilibrium coefficients are determined from the tissue level data and used as parameters in fitting the mass balance differential equations representing the physiological model. The model parameters can also be fit to a 0.4% single dose. In a separate experiment, a topical infusion technique was designed to provide a constant rate input to the cornea until an apparent steady state was reached in aqueous humor at 55 min. Aqueous humor levels were assayed for clonidine over the infusion and postinfusion periods. The physiological model parameters are fit to the topical infusion data and show good agreement between the predicted and experimental data. The classical model is too complex to fit the data to integrated exponential equations primarily because the method of residuals is inadequate in determining a sufficient set of initial estimates. This is overcome by dividing the eight-compartment model into seven fragmental models, each representing one to five compartments. A stepwise procedure is developed in which initial estimates are obtained for each separate fragmental model and refined. The refined parameter values can then be used as initial estimates for the complex model. Differential equations for the complex model are fit simultaneously to tissue levels representing each compartment. By observation, the classical model fit the data more closely than the physiological model. Statistical moment theory is also applied to the topical infusion data to determine ocular pharmacokinetic parameters for clonidine. The calculated values are: corneal absorption rate constantk _a , 0.00139 min^?1; aqueous humor elimination rate constantk ₁₀ , 0.0658min^?1; mean residence timeMRT _d , 35.6 min; apparent steadystate volume of distributionV _ss, 0.530 ml; and ocular clearanceQ _e , 14.9 =μl/min. The fraction absorbed from the single instillation is estimated as 0.0163.     

Coconut Oil Supplementation Does Not Affect Blood Pressure Variability and Oxidative Stress: A Placebo-Controlled Clinical Study in Stage-1 Hypertensive Patients

Exploring an alternative to improve the clinical management of hypertension, we tested the hypothesis that food supplementation with coconut oil (EVCO), alone or combined with aerobic exercise training, could exert an antihypertensive effect (primary outcome) in patients with stage 1 hypertension. Forty-five hypertensive volunteers of both genders participated in a placebo-controlled clinical trial. The volunteers were submitted to 24-hour ambulatory blood pressure monitoring, analysis of blood pressure variability (BPV), measurement of serum malondialdehyde (MDA) and nutritional assessment. Results indicate that EVCO consumption had no adverse effects. The supplementation did not increase the caloric intake compared with placebo, and the dietary constituents were similar between groups, except for the saturated fats, especially lauric acid. The analysis of blood pressure indicated absence of antihypertensive effect of EVCO alone or combined with physical training. Furthermore, no effects on blood pressure variability and oxidative stress were observed in the supplemented hypertensive patients. Thus, despite the results observed in pre-clinical studies, the current clinical study did not provide evidence to support the use of coconut oil as an adjuvant in the management of hypertension in humans.     

医院档案管理工作基于新形势的开展途径分析

医院是为人类提供公共卫生服务的一个单位,其存在具有至关重要的影响意义,是人们医疗卫生事业的主要承担场所,医院所提供的公共卫生服务水平主要受到两个方面因素的影响,其一是医疗卫生发展水平,其二是人们生活水平;而这两种因素均受到人类社会经济发展水平的影响,由此可见,医院可以直接反映人类社会的发展水平,医院管理治疗会对其实际运行水平产生直接性影响,同时也侧面体现了我国公共卫生服务质量。因此,基于此种社会现实下,结合新形势要求,分析医院档案管理工作存在的弊端,并探讨创新途径具有至关重要的影响意义,这不仅是国家发展、社会发展的要求,同时也是医院实现可持续运行的根本条件,是当前医院刻不容缓需要解决的主要问题。     

经鼻蝶窦入路垂体瘤切除术后颅内感染病原学及其影响因素

目的探讨经鼻蝶窦入路垂体瘤切除术后并发颅内感染病原菌特征及影响因素。方法回顾性分析浙江省丽水市人民医院2014年1月-2019年2月500例经鼻蝶窦入路垂体瘤切除术患者临床资料,观察颅内感染发生情况,分析感染组感染病原菌分布情况及影响因素。结果500例经鼻蝶窦入路垂体瘤切除手术患者共有42例发生颅内感染,发生率为8.40%。年龄、肿瘤直径、手术时间、术中脑脊液漏、术后留置引流管是导致经鼻蝶窦入路垂体瘤切除术后颅内感染发生的独立危险因素;从42例感染患者脑脊液标本中共分离出51株病原菌,以凝固酶阴性葡萄球菌感染占比33.33%最高,其次为金黄色葡萄球菌、肺炎克雷伯菌、鲍氏不动杆菌;根据术后28 d患者临床结局,比较生存(n=493)和病死(n=7)患者,高龄、肿瘤直径较大、肿瘤具侵袭性、术后颅内感染患者的病死比例较高(P<0.05)。结论年龄、肿瘤直径、手术时间、术中脑脊液漏、术后留置引流管均是经鼻蝶窦入路垂体瘤切除术后颅内感染发生的影响因素,感染病原菌主要为凝固酶阴性葡萄球菌、金黄色葡萄球菌、鲍氏不动杆菌、肺炎克雷伯菌,术后颅内感染不利于患者预后。     

2021年ACOG关于产后阶梯式多模式药物镇痛的建议及要点解读

产后疼痛是困扰产妇的常见问题,如治疗不当可能会导致阿片类药物滥用、产后抑郁和疼痛长期存在等不良后果。因此,美国妇产科医师学会（American College of Obstetricians and Gynecologists,ACOG）于2021年9月提出了针对产后疼痛的临床共识,专门对产后疼痛的一般管理、阴道分娩、剖宫产术后、母乳喂养时及出院后疼痛的处置给出了治疗建议与指导,强调了阶梯式多模式药物镇痛方法与个体化用药原则。推荐临床用药可遵循“非阿片类镇痛药（如对乙酰氨基酚和非甾体抗炎药）—弱阿片类药物—强阿片类药物（必要时）”阶梯式给药原则,并可合理联合用药。对此进行简要介绍与要点解读。     

无胸壁缺损的心外胸骨旁小切口的可行性研究

目的研究以带蒂复合组织瓣修复胸骨旁小切口术后胸壁缺损的可行性。方法观察尸体前胸壁深层结构的血供 规律,测量胸骨外侧缘与胸廊内动脉之间的距离,并在此基础之上设计出以胸阔内动脉为蒂的肋软骨助间肌瓣。结果 前胸壁深层各结构均由胸廓内动脉及其分支供血,胸廊内动脉里胸骨外侧缘的距离为１ｃｍ左右。紧挨胸骨外侧缘切开 肋软骨,可以避免胸廓内动脉的损伤。以该动脉为帮,可以保证数种肋软骨肋间肌瓣有良好的血供。结论用以胸廊内动 脉为蒂的肋软骨助间肌瓣修复心脏外科术后的胸壁缺损具有良好的可行性。