面神经的角神经三维可视化研究

目的 通过三维可视化技术,验证前期解剖学研究结果,并为失神经支配手术提供一定的理论依据.方法 取自愿捐献的甲醛固定的成人尸头,切取内眦角内侧全层软组织长3 cm、宽1 cm,以皮肤表面2平行刀痕为定位线,连续横断石蜡切片,片厚10 μm,切片间距0.25 mm,共切取120张切片.采用HE组织化学染色,高分辨率扫描仪获取二维数码图像后进行三维重建.结果 ①真实再现了角神经的三维立体结构及角神经与内眦动静脉的三维立体行径,且重建结构不但能单独或搭配显示,并可从任意角度显示.②证实了角神经显微解剖学研究的正确性.③角神经毗邻关系的三维重建技术可以应用到临床.结论 基于组织学和计算机技术,可以三维重建角神经的毗邻关系,为角神经的失神经支配手术提供更加准确的可行性依据.     

长期迷走神经电刺激对肥胖鼠摄食和体重的影响

目的观察膈下迷走神经刺激(vagal nerves stimulation,VNS)对肥胖鼠摄食、体重、摄食神经肽的影响。方法将18只雄性营养性肥胖鼠(dietary induced obesity,DIO)随机分3组:对照组、假手术组、VNS组。VNS组大鼠体内植入自主研发的闭环芯片并高脂饲养90天,芯片电刺激膈下迷走神经;假手术组体内植入不工作的芯片;对照组不做手术。术后每天测量所有动物体重、日进食量。90天后处死所有动物,分离并称重双侧附睾脂肪垫。反转录PCR法(RT-PCR)半定量检测摄食神经肽:重组人刺鼠色蛋白相关蛋白(AgRP)、神经肽Y(NPY)、可卡因-苯丙胺调节转录因子编码的肽(CART)、阿片促黑色素原(POMC)的含量。结果 VNS组大鼠体重增加量[(124.3±15.5)g vs.(263.1±16.8)g,P=0.013],总摄食量[(1998.7±37.2)g vs.(3312.6±40.9)g,P=0.021]以及附睾脂肪垫重量[(15.9±2.3)g vs.(22.7±2.6)g,P=0.035]明显低于假手术组。VNS组大鼠下丘脑促摄食神经肽AgRP(P=0.027)、NPY的含量(P=0.019)低于假手术组,而抑制摄食的神经肽POMC高于假手术组(P=0.011)。结论 膈下迷走神经电刺激可显著减少大鼠摄食量,减轻体重。     

Anatomy of the salivary glands

The salivary glands comprise the parotid, the submandibular and the sublingual glands as well as small subsidiary glands scattered beneath the mucosa of the buccal cavity. The largest, the parotid, drains by its duct into the mouth at the level of the second upper molar tooth. It is traversed by the facial nerve, which may be invaded by a parotid carcinoma or damaged during parotid surgery. The submandibular gland has a superficial part, at the angle of the jaw, wedged between the mandible and the mylohyoid muscle. Its deep part projects deep to mylohyoid along the hyoglossus. Its duct opens alongside the fraenum of the tongue, where it is easily visible, and is crossed by the lingual nerve. The sublingual gland lies in the floor of the mouth into which it drains directly by a series of short ducts.     

Effects of stimulation site and stimulation parameters on bladder inhibition by electrical nerve stimulation

What's known on the subject? and What does the study add? Electrical stimulation of the dorsal nerve of the penis, the compound pudendal nerve and the S1 sacral nerve have been used clinically to treat the symptoms of overactive bladder, but the relative efficacy of the three locations was unclear and the optimal stimulation parameters across locations had not been determined. In the present paper we quantified the effects of acute electrical stimulation location, frequency and amplitude on isovolumetric reflex bladder contractions and maximum cystometric capacity in anaesthetized male cats. Our results could influence the selection of anatomical targets for clinical neuromodulation and how neuromodulation devices are programmed.

OBJECTIVE

• ? To quantify the effects of acute electrical stimulation frequency and amplitude at the dorsal nerve of the penis (DNP), pudendal nerve (PN) and S1 sacral nerve (S1) on isovolumetric reflex bladder contractions and maximum cystometric capacity in anaesthetized male cats.

MATERIALS AND METHODS

• ? Experiments were conducted in 14 adult male cats anaesthetized with α‐chloralose.
• ? The effects of stimulation on the pressure – time integral of reflex bladder contractions were evaluated using a randomized block design with the following factors randomized: stimulation intensity (0.8, 1, or 2× the threshold for evoking a reflex electromyogram response in the external anal sphincter [T]), frequency (2 Hz, 5 Hz, 7.5 Hz, 10 Hz, 15 Hz, 20 Hz, or 33 Hz) and location (PN, S1 or DNP).
• ? The effects of stimulation (with parameters that produced maximum inhibition of isovolumetric bladder contractions) on cystometric capacity were evaluated using a randomized block design, with the order of stimulation location randomized and control trials interleaved with stimulation trials.

RESULTS

• ? Inhibition of isovolumetric bladder contractions was significantly dependent on stimulation location, frequency, amplitude and the interactions between any two of these variables.
• ? Stimulation of the DNP, at 5 Hz, 7.5 Hz or 10 Hz, and at 2T caused greater reductions in normalized bladder contraction area than any other location, frequency or amplitude tested.
• ? Stimulation of the PN or S1 at 7.5 Hz or 10 Hz and 2T, or of the DNP at 5 Hz, 7.5 Hz or 10 Hz and 0.8T, 1T or 2T generated maximum inhibition of isovolumetric bladder contractions.
• ? Cystometric capacity was significantly larger with stimulation (10 Hz, 1T–2T) than control.
• ? There was no significant difference in cystometric capacity based upon stimulation location.

CONCLUSIONS

• ? There was no significant difference in the maximum degree to which the respective optimum parameters inhibited bladder contractions or increased cystometric capacity by location.
• ? The range of amplitudes and frequencies that caused maximum inhibition was larger for DNP stimulation than for PN or S1 stimulation.
• ? These findings have implications on the selection of anatomical target and device programming for clinical neuromodulation for treatment of the symptoms of overactive bladder.

     

Positive or Negative Ulnar Variance after Ulnar Shortening for Ulnar Impaction Syndrome: A Retrospective Study

Background

The goal of this study was to compare simple radiographic findings and clinical results according to residual ulnar variance following ulnar shortening for ulnar impaction syndrome.

Methods

Forty-five cases of ulnar impaction syndrome, which were treated with ulnar shortening from 2005 to 2008, were studied retrospectively. Group I included 13 cases with positive residual variance after ulnar shortening and group II included 32 cases with negative variance after shortening. The presence of a lunate cystic lesion both preoperatively and at final follow-up and assessments of wrist function based on the modified Mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, as well as the Chun and Palmer score were evaluated.

Results

A cystic lesion of the lunate was present in 4 cases preoperatively and the size decreased in 2 cases at final follow-up in group I, and in 10 and 5 cases, respectively, in group II. No statistical difference was observed between the groups. The modified Mayo wrist score, DASH score, as well as the Chun and Palmer score improved significantly in both groups. No significant differences were observed between the two groups in terms of the proportion of positive cystic lesions at final follow-up or the functional scores.

Conclusions

After ulnar shortening, the degree of radiological change in the cystic lunate lesions and clinical improvement did not differ significantly between the groups with unintended residual positive and negative variance after shortening.     

Posterior elbow release and humeral osteotomy for patients with arthrogryposis

Children with arthrogryposis often lack the ability to feed themselves, largely due to limited shoulder external rotation and elbow flexion. Patients who can achieve passive elbow flexion through a surgical release but who cannot externally rotate their shoulders are still unable to reach their mouths with their hands. Combining a posterior elbow capsular release with a simultaneous humeral osteotomy in these patients places the forearm and hand in a much better position for function with minimal additional surgical exposure.