肝细胞癌门静脉主干癌栓uPA和uPAR基因表达

目的：探讨uPA,uPAR基因表达和肝癌转移，肝细胞癌门静脉主干癌栓（Tumor thrombosid of the main trunk of the portal vein,PVTT)形成的关系。方法：采用原位杂交等技术检测uPA,uPAR表达。结果：癌栓（A1组）和其原发癌（A2组）uPA,uPAR mRNA阳性表达率均高于无转移肝癌（B组）（P均＜0．01），A1组表达强度均高于A2组（P＜0．01），A2组小血管内可见癌细胞群落，A1组多见，B组无此现象，A1组、A2组uPAR和uPA蛋白质阳性表达率均高于B组（P均＜0．01），A1组表达强度均高于A2组（P＜0．01），uPA,uPAR mRNA和其蛋白质表达存在良好相关性（P均＜0．01），结论：uPA,uPAR在肝癌的侵袭和转移中起重要作用。其过度表达是PVTT形成和肝癌转移的重要因素。     

脑卒中躯干肌旋转肌群电生理研究

目的：本实验利用表面肌电图收集躯干旋转肌群的肌电信号，加以处理分析，具体研究偏瘫患者腹内斜肌、背阔肌、腹外斜肌、腰竖脊肌、胸竖脊肌在躯干等轴旋转动作中的改变，揭示其改变的可能机制及临床意义。方法：重偏瘫患者10例，轻偏瘫患者8例，正常人7例，收集双侧腹内斜肌、背阔肌、腹外斜肌、腰竖脊肌、胸竖脊肌在放松坐位、左旋45°位、右旋45°的肌电信号。结果：对数据进行标准化处理后。背阔肌三组之间比较重偏瘫患者健侧肌肉向健侧旋转（GRG）与正常人之间有显著性差异（P〈0．05）。重偏瘫患者患侧肌肉向患侧旋转（BRB）有较正常人减少的倾向（P=0．229）。三组之间腹内斜肌比较重偏瘫患者与正常人的GRG、BRB有显著性差异（P〈0．05）。正常人、重偏瘫患者、轻偏瘫患者的双侧腹外斜肌、腰竖脊肌、胸竖脊肌的GRG、BRB等无明显差异。结论：正常人背阔肌及腹内斜肌在躯干向同侧旋转时表现出较大的主动性，腹外斜肌及胸大肌、腰竖脊肌及胸竖脊肌在旋转中未表现出方向上的主动性。与正常人比，重偏瘫患者双侧背阔肌及腹内斜肌肌电活动降低，且均未表现出方向上的主动性。轻偏瘫患者与正常人无明显差异。重偏瘫患者与轻偏瘫患者腹外斜肌、腰竖脊肌及胸竖脊肌在旋转中的表现与正常人无明显差异。     

Clarification of the Innervation of the Bladder,External Urethral Sphincter and Clitoris: A Neuronal Tracing Study in Female Mongrel Hound Dogs

Many studies examining the innervation of genitourinary structures focus on either afferent or efferent inputs, or on only one structure of the system. We aimed to clarify innervation of the bladder, external urethral sphincter (EUS) and clitoris. Retrograde dyes were injected into each end organ in female dogs. Spinal cord, mid‐bladder, and spinal, caudal mesenteric, sympathetic trunk and pelvic plexus ganglia were examined for retrograde dye‐labeled neurons. Neurons retrogradely labeled from the bladder were found primarily in L7‐S2 spinal ganglia, spinal cord lateral zona intermedia at S1‐S3 levels, caudal mesenteric ganglia, T11‐L2 and L6‐S2 sympathetic trunk ganglia, and pelvic plexus ganglia. The mid‐bladder wall contained many intramural ganglia neurons labeled anterogradely from the pelvic nerve, and intramural ganglia retrogradely labeled from dye labeling sites surrounding ureteral orifices. Neurons retrogradely labeled from the clitoris were found only in L7 and S1 spinal ganglia, L7‐S3 spinal cord lateral zona intermedia, and S1 sympathetic trunk ganglia, and caudal mesenteric ganglia. Neurons retrogradely labeled from the EUS were found in primarily at S1 and S2 spinal ganglia, spinal cord lamina IX at S1‐S3, caudal mesenteric ganglia, and S1‐S2 sympathetic trunk ganglia. Thus, direct inputs from the spinal cord to each end organ were identified, as well as multisynaptic circuits involving several ganglia, including intramural ganglia in the bladder wall. Knowledge of this complex circuitry of afferent and efferent inputs to genitourinary structures is necessary to understand and treat genitourinary dysfunction. Anat Rec, 2018. © 2018 Wiley Periodicals, Inc.     

老年人行走时躯干冠状面运动学变化对稳定性的影响及其与跌倒的关联性

目的:更好的理解老年人在行走时躯干冠状面的稳定性,及其与跌倒风险的联系。方法:12例健康老年人和12例健康年轻人在步行机上分别以1.0km/h、2.0km/h、3.0km/h、4.0km/h、5.0km/h 5个步速行走以观测他们的躯干运动。在确定步宽、步幅时间、局部动态稳定性和躯干冠状面运动幅度的同时,测量身体重心(centre of mass,Co M)投影到足部放置位置的距离(d Co M)和躯干运动与足跟着地时间的时序差别(d Time)。另外,测量髋最大外展肌力,受试者自述过去一年中跌倒次数。结果:老年人的髋外展肌力(1.0±0.05)N/kg比年轻人小,躯干局部动态稳定性降低,步宽(0.18±0.08)m增大,步幅(1.20±0.25)s减小,此外,老年人的d Co M(0.11±0.05)m比年轻人大,而d Time(0.42±0.13)s比年轻人短。老年人的髋外展肌力、步宽、步幅时间、d Co M、d Time均和跌倒次数相关联。结论:老年人在行走时步宽更大,步幅时间更短,而且d Co M也比年轻人大,这可能是为了稳定冠状面的平衡而采取的一种策略。老年人髋外展肌肌力降低,使d Time缩短,损害了冠状面的平衡,从而导致跌倒的发生。     

臂丛神经上干损伤的屈肘功能重建体会

目的:探讨臂丛神经上干根性撕脱伤后重建屈肘功能的方法。方法:对7例臂丛上干根性撕脱伤,术前EMG、MRI及全面的理学检查确诊后,或者通过术中神经探查及术中肌电检测确诊后,施行新的神经移位术:尺神经部分神经束移位至肌皮神经的肱二头肌肌支(经典的Oberlin手术),正中神经部分神经束移位至肌皮神经的肱肌肌支,施行双重移位,重建屈肘功能。术中运用电生理技术,增加手术的准确性和合理性,术后早期行理疗、功能锻炼及神经营养药物等综合措施。结果:经过术后6～28个月的随访,屈肘功能恢复满意。5例随访超过1年的患者,目标肌力均达M3以上,随访少于8个月的2例患者,目标肌力也达M1～2。结论:对臂丛上干根性撕脱伤确诊后,尺神经及正中神经部分神经束双重移位是重建屈肘功能有效的、合理的治疗方法,较之单一的尺神经部分束移位(即为传统的Oberlin术式),增加了屈肘功能的恢复效率。     

颈内动脉海绵窦段分支及应用解剖学研究

目的：观察颈内动脉海绵窦段（ICICA）分支及其对穿行海绵窦颅神经的血供,为减少术中神经血供损伤提供解剖基础。方法：解剖观测15例（30侧）成人头颅内ICICA分支及海绵窦内穿行颅神经的血供。结果：颈内动脉在海绵窦的主要分支有脑膜垂体干（垂体下（供应垂体后部）、小脑幕（供应脑膜顶及动眼神经和滑车神经近端）及脑膜背动脉（供应上斜坡的脑膜及展神经岩斜段））和外下干（上支（供应海绵窦顶、动眼神经及滑车神经近端）、前支（供应动眼神经、滑车神经、展神经及三叉神经眼支的海绵窦段远端）及后支（参与三叉神经节血供））。结论：ICICA主要供应海绵窦穿行颅神经的动脉为外下干和脑膜垂体干发出的小脑幕及脑膜背动脉。     

经肺动脉干切口行室间隔缺损修补术18例报告

目的对18例干下型室间隔缺损病例采用经肺动脉干切口行修补术的治疗总结。方法室间隔缺损补片修补18例。结果死亡1例,存活17例,效果满意,无残余瘘和新的主动脉瓣关闭不全发生。结论对干下型室间隔缺损采用经肺动脉干切口行补片修补效果较好。     

The third time is the charm--anastomosis between the celiac trunk and the left colic artery

An atypical case of abdominal vasculature, found in a 58-year-old woman is presented. The multidetector computed tomography angiogram revealed a large tortuous anastomotic vessel between the stem of the celiac trunk and the left colic artery, supplying branches for the left colon and pancreatic body and tail. We propose a simple embryological explanation for the development of this aberrant artery--the longitudinal ventral anastomosis, which connects the precursors of principal visceral arteries in a loop-like manner, loses its direct communication with the superior mesenteric artery but maintains its continuity above and below this level. This variation could pose a problem for radiological interpretation and affect surgical approaches to the aorta, left colon, and the pancreas.