Long-term ST database: A reference for the development and evaluation of automated ischaemia detectors and for the study of the dynamics of myocardial ischaemia

The long-term ST database is the result of a multinational research effort. The goal was to develop a challenging and realistic research resource for development and evaluation of automated systems to detect transient ST segment changes in electrocardiograms and for supporting basic research into the mechanisms and dynamics of transient myocardial ischaemia. Twenty-four hour ambulatory ECG records were selected from routine clinical practice settings in the USA and Europe, between 1994 and 2000, on the basic of occurrence of ischaemic and non-ischaemic ST segment changes. Human expert annotators used newly developed annotation protocols and a specially developed interactive graphic editor tool (Semia) that supported paperless editing of annotations and facilitated international co-operation via the Internet. The database contains 86 two- and three-channel 24h annotated ambulatory records from 80 patients and is stored on DVD-ROMs. The database annotation files contain ST segment annotations of transient ischaemic (1155) and heart-rate related ST episodes and annotations of non-ischaemic ST segment events related to postural changes and conduction abnormalities. The database is intended to complement the European Society of Cardiology ST-T database and the MIT-BIH and AHA arrhythmia databases. It provides a comprehensive representation of ‘real-world’ data, with numerous examples of transient ischaemic and non-ischaemic ST segment changes, arrhythmias, conduction abnormalities, axis shifts, noise and artifacts.     

Arterial supply of the temporo-medial region of the brain significance for preoperative vascular occlusion testing

The mesiobasal limbic system is of particular significance in the surgical treatment of temporo-medial tumors and epilepsy. It consists of the uncus, amygdaloid body, hippocampus, dentate gyrus, subiculum, fasciolar gyrus and the parahippocampal gyrus. Knowledge of the vascular microanatomy is a key to the surgical treatment of pathologies in the region. The anterior choroidal artery was selectively injected in fresh brain specimens 50 specimens with a gelatinous ink mixture to demonstrate vascular territories in stereotactic brain slices, and 50 with a Biodur resin to obtain casts for microanatomical evaluation. The cast technique was also applied to 35 specimens injected into the posterior cerebral artery. The rostral third of the temporomedial region is mainly supplied by branches of the anterior choroidal artery. The occipital two thirds are supplied by hippocampal branches, the posteromedial choroidal artery and the inferior temporal branches of the posterior cerebral artery. Important vessel variations with significant implications for the preoperative Wada-test are presented     

国人胃后动脉及其临床意义

本文在查阅了资料后就胃后动脉以下几方面进行综述。1.胃后动脉的起源、出现率、类型;起源于脾动脉者最多,占78％;出现率为62％～88％;绝大部分为一支类型,占75.44～92％。2.外径、长度、毗邻;外径在1.53～3mm之间;长度为2.2～8.1cm;90％的与胃后静脉伴行。3.行径、供血区:在脾动脉上缘发出后,在网膜囊后壁腹膜外向上方走行,经胃膈韧带内最后进入贲门侧的胃底部,并供应该区的血液。     

Monosynaptic inputs from the nucleus tractus solitarii to the laryngeal motoneurons in the nucleus ambiguus of the rat

The cricothyroid (CT) and the posterior cricoarytenoid (PCA) muscles in the larynx are activated by the laryngeal motoneurons located within the nucleus ambiguus; these motoneurons receive the laryngeal sensory information from the nucleus tractus solitarii (NTS) during respiration and swallowing. We investigated whether the neurons in the NTS projected directly to the laryngeal motoneurons, and what is the synaptic organization of their nerve terminals on the laryngeal motoneurons using the electron microscope. When wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) was injected into the NTS after cholera toxin subunit B-conjugated HRP (CT-HRP) was injected into the CT muscle or the PCA muscle, the anterogradely WGA-HRP-labeled terminals from the NTS were found to directly contact the retrogradely CT-HRP-labeled dendrites and soma of both the CT and the PCA motoneurons. The labeled NTS terminals comprised about 4% of the axosomatic terminals in a section through the CT motoneurons, and about 9% on both the small (PCA-A) and the large (PCA-B) PCA motoneurons. The number of labeled axosomatic terminals containing round vesicles and making asymmetric synaptic contacts (Gray’s type I) was almost equal to that of the labeled terminals containing pleomorphic vesicles and making symmetric synaptic contacts (Gray’s type II) on the CT motoneurons. The labeled axosomatic terminals were mostly Gray’s type II on the PCA-A motoneurons, while the majority of them were Gray’s type I on the PCA-B motoneurons. These results indicate that the laryngeal CT and PCA motoneurons receive a few direct excitatory and inhibitory inputs from the neurons in the NTS. Accepted: 2 June 2000     

后路经皮内窥镜下颈椎椎间盘切除术的解剖学研究及临床意义

目的　探讨后路经皮内窥镜下颈椎椎间盘切除术的安全范围。 方法　选取20具成人颈椎标本，分别测量C3/C4至C6/C7各节段左右两侧V点与硬脊膜外侧距离、V点与椎动脉水平及垂直距离、小关节面宽度，并进行统计学比较。 结果　V点与硬脊膜外侧距离为：左（1.31±0.32）~（2.46±0.60） mm，右（1.29±0.35）~（2.75±0.45） mm，各节段间差别有统计学意义，同一水平左右差别无统计学意义；V点与椎动脉水平距离为：左（2.17±0.42）~（5.10±0.93） mm，右（1.99±0.39）~（5.00±0.71） mm，各节段间差别有统计学意义，同一水平左右差别无统计学意义；V点与椎动脉垂直距离为：左（11.05±1.06）~（13.47±1.12）mm，右（11.33±1.20）~（13.61±1.01）mm，同一水平左右侧差别有统计学意义，节段间比较C3/C4与C4 /C5无明显差异，其余节段间差别均有统计学意义；小关节面宽度为：左（10.79±0.93）~（12.66±0.88） mm，右（10.86±0.68）~（12.54±0.70）mm。 结论　后路经皮内窥镜下颈椎椎间盘切除术的安全范围宜控制在距V点内侧C₃/C₄至C₆/C₇各水平1.20~2.00 mm；磨除范围距V点外侧C₃/C₄至C₆/C₇各水平超过2.00~5.00 mm时可能到达椎动脉体表投影处，因此需注意此时的手术进入深度宜控制在：C₃/C₄~C₆/C₇各节段距V点11.00~14.00 mm。     

Projections of the temporo-parietal cortex on vestibular complex in the macaque monkey (Macaca fascicularis)

Summary Connections of the posterior parietal cortex (area 7) with the vestibular complex have been studied in 4 macaque monkeys by anterograde axonal transport methods. WGA-HRP and tritiated amino-acids have been injected in the posterior part of area 7 including the caudal end of the superior bank of superior temporal sulcus and the lateral sulcus. Labeled terminals were observed in the vestibular nuclei complex and distributed bilaterally with a greater ipsilateral contribution. Two main groups of area 7 efferences were found to project to vestibular complex: a) A first group terminates on vestibular nuclei (the inferior vestibular nucleus and the caudal part of the medial nucleus) mainly connected with cerebello-spinal system, b) A second group terminates on vestibular nuclei (the medial and the superior vestibular nuclei and the y group) mainly involved in vestibulo-ocular mechanisms. The prepositus hypoglossi nucleus has also been found to receive area 7 projections. It is concluded that the possible control played by area 7 on the vestibulo-ocular reflex might be exerted through these direct cortico-vestibular projections.     

Changes in extracellular potassium concentration in cat spinal cord in response to innocuous and noxious stimulation of legs with healthy and inflamed knee joints

Summary In 20 cats anaesthetized with alpha-chloralose and spinalized at the thoracolumbar junction we investigated the role of stimulation induced accumulation of extracellular potassium in the spinal cord in the processing of nociceptive discharges from the knee joint. For that we electrically stimulated the posterior articular nerve of the knee. We further performed innocuous and noxious stimulation of the knee and of other parts of the leg and studied the effect of an acute inflammation of the knee on [K⁺]₀ in the spinal cord. Innocuous stimulation of the skin (brushing or touching) and innocuous movements in the knee joint all induced rises in [K⁺]₀ which were maximal at recording depths of 1500 to 2200 m below the surface of the cord dorsum. Peak increases were 0.4 mM for touching the leg and 1.7 mM during rhythmic flexion/ extension of the knee joint. Noxious stimulation of the skin, the paw, the tendon and noxious movements of the knee joint also produced rises in [K⁺]₀, which were somewhat larger for the individual types of stimuli than those produced by innocuous intensities. Electrical stimulation of the posterior articular nerve induced rises in [K⁺]₀ by up to 0.6 mM. Stimulus intensities sufficient to activate unmyelinated group IV fibers were only slightly effective in raising [K⁺]₀ above the levels reached during stimulation of myelinated group II and III fibers. During development of an acute inflammation of the knee joint (induced by kaolin and carrageenan), increases in [K⁺]₀ and associated field potentials became larger by about 25%. We assume that this reflects an increase in neuronal responses. In conclusion, changes in [K⁺]₀ in the spinal cord are some-what larger during noxious stimulation than during innocuous stimulation. The absolute level reached depended more on the site and type of stimulation than on the actual stimulus intensity itself. Hence a critical role of spinal K⁺ accumulation for nociception is unlikely.     

The effect of transcranial magnetic stimulation on the latencies of vertical saccades

In this study, we investigated the effect of transcranial magnetic stimulation (TMS) over the right posterior parietal cortex (PPC) on the latency of two different types of visually-guided vertical saccades: reflexive saccades triggered by the sudden onset of a target, and saccades towards target locations known in advance. For this reason, we used two oculomotor tasks: a gap and a delay task, respectively. Nine normal subjects performed vertical saccades at ±7.5 and ±15°. TMS was applied at 80 and 100 ms after target onset in the gap task, and after fixation offset in the delay task. Without TMS, we confirmed a latency asymmetry in the gap task favouring upward saccades at the lower eccentricity (7.5°), and a latency symmetry in the delay task. TMS increased the latencies of all saccades in the delay task, when delivered at 100 ms. This effect was mostly pronounced for downward saccades at 7.5°. As a result, saccade latencies showed an asymmetry in this condition, similar to the one observed in the gap task without TMS. The gap task with TMS resulted in a variable latency distribution and no significant overall effect on saccade latency. Our results indicate that the right PPC is involved in the initiation of vertical saccades in the delay task, and that this involvement appears to be enhanced for downward saccades. A conclusion for the involvement of this area in the gap task could not be drawn from this study.     

旋后肩法处置肩难产对产妇分娩后盆底肌功能改善的临床研究

目的探讨旋后肩法用于肩难产产妇,对其产后盆底肌功能的改善作用。 方法选择2018年7月至2020年1月,在宁波市妇女儿童医院采用旋后肩法完成肩难产助产的28例产妇为研究对象,并纳入研究组。选取同期在本院分娩,采用耻骨联合上加压法完成肩难产助产的25例产妇纳入对照组。采用表面肌电图(sEMG),获取2组产妇分娩8周后盆底肌收缩运动肌电值。采用成组t检验,对2组产妇一般临床资料、盆底sEMG检测结果进行统计学分析。采用χ²检验,对2组产妇分娩巨大儿所占比例等进行统计学分析。本研究遵循的程序符合病例收集医院伦理委员会制定的伦理学标准,得到该委员会批准[审批文号：[2018]伦审字(28)号]。与所有受试者签署临床研究知情同意书。 结果①2组产妇身高、体重,分娩时人体质量指数(BMI)、孕龄、年龄等一般临床资料比较,差异均无统计学意义(P>0.05)。②2组产妇分娩新生儿的出生体重和巨大儿所占比例分别比较,差异亦均无统计学意义(P>0.05)。③研究组产妇前基线值、快肌收缩最大值、混合肌收缩最大值、混合肌收缩平均值、耐力肌收缩平均值、后基线值分别为(1.4±0.3) μV、(23.8±5.5) μV、(19.9±3.4) μV、(17.2±2.9) μV、(13.7±3.0) μV、(1.3±0.3) μV,均超过对照组的(1.3± 0.3) μV、(20.6±4.4) μV、(17.7±3.3) μV、(14.2±4.1) μV、(11.8±3.4) μV、(1.1±0.3) μV,并且差异均有统计学意义(P<0.05)。而2组产妇耐力肌收缩最大值比较,差异无统计学意义(P>0.05)。 结论旋后肩法用于肩难产产妇助产,较传统耻骨联合上加压法,可改善产妇产后短期内的盆底肌功能。     

三维节段脊柱内固定系统在脊柱矫形术中的应用

目的评价三维节段脊柱内固定系统在不同脊柱畸形中的应用效果.方法应用三维节段脊柱内固定系统CD、TSRH等治疗脊柱畸形26例,其中特发性侧凸19例,先天性侧凸2例,后凸畸形5例,均以后路矫形自体骨植骨融合.结果所有病例经6～27个月随访,平均10.4个月.侧凸冠状面畸形平均矫正率为61.4%;矢状面后凸术后平均32.5°;旋转畸形平均矫正Ⅰ度,顶椎最大偏距平均矫正率为65.1%;后凸畸形平均矫正率为59.2%.所有病例无脱钩、断棍、感染、骨折以及脊髓神经损伤.结论三维节段脊柱内固定系统不仅可以完成畸形的三维矫正,而且矫正可靠,稳定性高,术后可不用石膏固定.