Neurovascular bundle size measured on 3.0-T magnetic resonance imaging is associated with the recovery of erectile function after robot-assisted radical prostatectomy

Background and objective

Erectile dysfunction is one of the complications occurring after radical prostatectomy (RP), and recovery of erectile function is quantitatively related to the preservation of the neurovascular bundles (NVB).We evaluated the significance of NVB area on functional outcomes after RP.

脑白质损伤防治新标靶——神经血管单元

围生期脑白质损伤是导致早产儿神经系统发育受损甚至远期后遗症最常见的脑损伤形式.其发病机制复杂,目前尚缺乏有效的防治手段.近年来,神经血管单元作为神经系统结构和功能的整体,逐渐在神经科学领域引起关注.该文就脑白质中神经血管单元的组分及相互作用,脑白质损伤的病理生理、预防和治疗等方面的研究进展作一综述.     

The surgical anatomy of the dorsal carpal branch of the ulnar artery: basis for a neurovascular dorso-ulnar pedicled flap

Summary In order to design a neurovascular flap from the dorso-ulnar aspect of the midhand for pedicled transfer to adjacent or distant locations, the surgical anatomy of the dorsal carpal branch of the ulnar artery (DCBUA) was studied in 12 cadavers. The DCBUA was identified in all specimens. It originates from the ulnar artery 1.6 to 4.4 centimeters proximal to the ulnar styloid, passing deep to the flexor carpi ulnaris tendon, and spirals superficially to the extensor retinaculum around the ulnar border of the wrist. Its terminal branches supply an undetermined area of skin overlying the ulnar metacarpals and the ulnar hypothenar region, either by direct cutaneous supply (3/12 specimens) or by septo-cutaneous perforators (8/12 specimens). The DCBUA is closely related to the dorsal sensory branch of the ulnar nerve, with which it supplies a common neurovascular territory.

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Anatomie chirurgicale de la branche carpienne dorsale de l'artère ulnaire. Bases anatomiques d'un lambeau pédiculé neurovasculaire dorso-ulnaire

Résumé Afin de déterminer les limites d'un lambeau pédiculé à partir du versant dorso-ulnaire de la région métacarpienne, l'anatomie chirurgicale de la branche carpienne dorsale de l'artère ulnaire a été étudiée sur 12 cadavres. La branche carpienne dorsale de l'artère ulnaire (DCBUA en abrévviations anglaises), a été identifiée chez tous les spécimens. Elle naît de l'artère ulnaire à une distance variant de 1,6 à 4,4 cm au-dessus du processus styloïde, passe en arrière du tendon du fléchisseur ulnaire du carpe, et contourne superficiellement le bord ulnaire du poignet pour gagner le rétinaculum des extenseurs. Ses branches terminales vascularisent une aire cutanée encore mal définie, qui recouvre les métacarpiens ulnaires et la région hypothénarienne, soit par des branches cutanées directes (3 cas sur 12), soit par des perforantes septo-cutanées (8 cas sur 12). La DCBUA est en rapport étroit avec la branche sensitive dorsale du nerf ulnaire, avec laquelle elle assure la prise en charge d'un territoire neuro-vasculaire commun.

     

疏肝通络汤治疗血管神经性偏头痛70例

目的：观察疏肝通络汤治疗血管神经性偏头痛的疗效。方法：采用疏肝通络汤治疗偏头痛患者70例,疗程10天。结果：治愈31例,好转37例,无效2例,总有效率97．14％。结论：疏肝通络汤治疗血管神经性偏头痛疗效显著。     

电针对脑缺血大鼠神经血管单元及Wnt/β-catenin信号通路的影响

目的:观察电针对脑缺血大鼠神经血管单元主要标志蛋白——血管内皮生长因子(VEGF)、胶质纤维酸性蛋白(GFAP)、神经元核抗原(NeuN)和Wnt/β-catenin信号通路关键成分β-连环蛋白(β-catenin)、支架蛋白(Axin2)蛋白及mRNA表达的影响,探讨电针治疗缺血性脑卒中的机制。方法:将108只健康雄性SD大鼠随机分为对照组、模型组、电针组,每组36只,并按照术后7、14、21 d分为3个时相组,每组12只。电凝大鼠大脑中动脉建立永久性大脑中动脉闭塞(MCAO)模型。电针组大鼠予以电针刺激"百会""水沟"及双侧"三阴交""内关"(2 Hz/100 Hz,2~4 V,30 min)。第1次电针在造模后2 h内进行,此后每天上午电针1次,7 d为1个疗程,最多3个疗程。用Zea Longa评分法评价各组大鼠神经功能缺损情况;用磁共振影像系统检测各组大鼠脑梗死情况;分别用免疫组织化学法和荧光定量PCR法检测各组大鼠缺血区脑组织VEGF、GFAP、NeuN、β-catenin及Axin2蛋白和mRNA的表达。结果:与对照组比较,造模后模型组大鼠神经功能评分和脑梗死体积均明显升高(P<0.01);电针组在术后第7、14、21天神经功能评分和脑梗死体积均显著低于模型组(P<0.01)。与对照组比较,模型组各时点缺血脑组织中VEGF、GFAP、β-catenin蛋白和mRNA表达显著升高(P<0.01),NeuN、Axin2蛋白和mRNA表达显著降低(P<0.01)。与模型组比较,电针组各时点VEGF、GFAP、NeuN、β-catenin蛋白和mRNA表达显著增多(P<0.01),且随着时间延长,表达均逐渐增加,在第21天达到峰值;Axin2蛋白和mRNA表达明显下降(P<0.01)。结论:电针可以有效保护脑缺血大鼠神经血管单元,减少脑梗死体积,改善MCAO大鼠神经功能缺损症状,其机制可能与上调β-catenin及下调Axin2的表达,激活经典Wnt/β-catenin信号通路有关。     

面肌痉挛MVD入路与中血管神经复合体的解剖学研究

目的研究面肌痉挛微血管减压（MVD）经枕下外侧小脑绒球下方入路与桥小脑角（CPA）区中血管神经复合体的显微解剖学关系。方法应用15例经10％甲醛充分固定并灌有乳胶的国人成人头颅湿标本，经枕下外侧小脑绒球下方入路，在4～25倍手术显微镜下对CPA区中血管神经复合体逐层解剖，观察，测量及照相。同时，临床应用该入路治疗面肌痉挛9例。结果经枕下外侧小脑绒球下方入路可直接从尾侧方小脑绒球与舌咽神经之间的间隙显露面、听神经分离处，能够准确、安全、快捷到达CPA区相应的中血管神经复合体位置，充分暴露术野，达到完全减压效果。结论经枕下外侧小脑绒球下方入路是治疗面肌痉挛安全有效的方法，可以最大限度的减少术中损伤神经致术后颅神经麻痹等并发症。     

男性盆腔神经丛及神经血管束的应用解剖

目的认识盆丛、神经血管束（NVB）与周围组织器官的关系。方法对10例成人男性盆腔器官标本作盆丛、NVB大体解剖,1例43岁成人新鲜盆腔脏器作连续切片,观察盆丛、NVB与周围组织器官的关系。结果盆丛位于腹膜后、直肠的侧壁,呈网络状,精囊腺的后外侧,由盆丛发出的阴茎海绵体神经在前列腺后外侧走行,这些神经与前列腺被膜血管组成NVB。NVB的密度沿前列腺下行时逐渐变稀,在膜部尿道的外侧和后外侧分布于尿道旁的横纹肌中。结论明确盆丛、NVB位置以及与盆腔器官的毗邻关系,有助于术中有效鉴别和保护盆丛和NVB,达到保留性神经的盆腔、会阴部手术的目的。     

Tiger bite in captivity

Tiger bites are an uncommon but reported entity. We report a case of a 19-year-old girl who sustained multiple wounds on her left arm after attempting to feed a Siberian tiger at Dublin zoo. Exploration and debridement was carried out under general anesthesia. There was no neurovascular damage or tendon rupture. Most of the wounds were closed primarily. Three required split skin grafting. Manipulation under anesthetic and Kirschner wire fixation was required for a transverse fracture of the proximal phalanx of the left ring finger. The patient had an uneventful postoperative recovery. Reported cases of tiger attacks in Europe are rare. The typical pattern of injury, prevalence, and complications are discussed.     

ABCDE and ABCDEF care bundles: A systematic review of the implementation process in intensive care units

Background:The ABCDE (Awakening and Breathing Coordination of daily sedation and ventilator removal trials, Delirium monitoring and management, and Early mobility and exercise) and ABCDEF (Assessment, prevent and manage pain, Both spontaneous awakening and spontaneous breathing trials, Choice of analgesia and sedation, assess, prevent and manage Delirium, Early mobility and exercise, Family engagement) care bundles consist of small sets of evidence-based interventions and are part of the science behind Intensive Care Unit (ICU) liberation. This review sought to analyse the process of implementation of ABCDE and ABCDEF care bundles in ICUs, identifying barriers, facilitators and changes in perception and attitudes of healthcare professionals; and to estimate care bundle effectiveness and safety.Methods:We selected qualitative and quantitative studies addressing the implementation of ABCDE and ABCDEF bundles in the ICU, identified on MEDLINE, Embase, CINAHL, The Cochrane Library, Web of Science, Epistemonikos, PsycINFO, Virtual Health Library and Open Grey, without restriction on language or date of publication, up to June 2018. The outcomes measured were ICU and hospital length of stay; mechanical ventilation time; incidence and prevalence of delirium or coma; level of agitation and sedation; early mobilization; mortality in ICU and hospital; change in perception, attitude or behaviour of the stakeholders; and change in knowledge of health professionals. Two reviewers independently selected the studies, performed data extraction, and assessed risk of bias and methodological quality. A meta-analysis of random effects was performed.Results:Twenty studies were included, 13 of which had a predominantly qualitative and 7 a quantitative design (31,604 participants). The implementation strategies were categorized according to the taxonomy developed by the Cochrane Effective Practice and Organization of Care Group and eighty strategies were identified. The meta-analysis results showed that implementation of the bundles may reduce length of ICU stay, mechanical ventilation time, delirium, ICU and hospital mortality, and promoted early mobilization in critically-ill patients.Conclusions: This study can contribute to the planning and execution of the implementation process of ABCDE and ABCDEF care bundles in ICUs. However, the effectiveness and safety of these bundles need to be corroborated by further studies with greater methodological rigor.Protocol registration:PROSPERO CRD42019121307.