FLAIR颅内椎动脉高信号在延髓梗塞诊断中的价值

目的:探讨低场强磁共振液体衰减反转恢复(fluid-attenuated inversion recovery,FLAIR)序列与其他序列搭配在延髓梗塞应用的临床价值,提高延髓梗塞的诊断水平。方法:搜集具有延髓梗塞及其后组颅神经损害为主要临床症状的MRI资料14例。采用西门子Concerto型0.2T磁共振,常规GRE-T1WI、T2WI、FLAIR和TOF-MRA检查,观察椎动脉闭塞的MRI征像。结果:8例(57.1%)FLAIR显示颅内椎动脉高信号,其中颅内椎动脉和基底动脉高信号3例。10例TOF-MRIA显示椎动脉严重狭窄或闭塞中有8例和FLAIR显示颅内椎动脉高信号一致。5例(35.7%)颅内椎动脉夹层,FLAIR均显示颅内椎动脉高信号。结论:FLAIR颅内椎动脉高信号并不意味着已经发生延髓梗塞,但有延髓梗塞的风险。FLAIR颅内椎动脉高信号是延髓梗塞的早期征像。     

Comparison of fentanyl-bupivacaine or midazolam-bupivacaine mixtures with plain bupivacaine for caudal anaesthesia in children

BACKGROUND: The aim of this study was to evaluate the intensity and effectiveness of 0.75 ml.kg-1 bupivacaine 0.25% with the addition of fentanyl or midazolam for caudal block in children undergoing inguinal herniorrhaphy. METHODS: Seventy-five children were allocated randomly to three groups to receive a caudal block with either 0.25% bupivacaine with fentanyl 1 microg.kg(-1) (group BF) or with midazolam 50 microg.kg(-1) (group BM) or bupivacaine alone (group B) after induction of anaesthesia. Haemodynamic parameters, degree of pain, additional analgesic requirements and side-effects were evaluated. RESULTS: The mean systolic arterial pressure at 10, 20, 30 min after caudal block was higher in group B compared with groups BF and BM. Mean intraoperative heart rate was lower in group BF than the other groups. Adequate analgesia was obtained in all patients (100%) in group BF, 23 patients (92%) in group BM and 21 patients (84%) in group B (P > 0.05). The time to recovery to an Aldrete score of 10 was significantly shorter in group B than group BM (P < 0.05). Although not significant, it was also shorter in group B than group BF. There was no difference in additional analgesic requirements between the groups in the first 24 h. Sedation score was higher in the midazolam group at 60 and 90 min postoperatively than the other groups. CONCLUSIONS: Caudal block with 0.75 ml.kg(-1) 0.25% bupivacaine and 50 microg.kg(-1) midazolam or 1 microg.kg(-1) fentanyl provides no further analgesic advantages to bupivacaine alone when administered immediately after induction of anaesthesia in children undergoing unilateral inguinal herniorrhaphy.     

国人延髓动脉的观察

本文观察了110例成人脑标本的延髓外部动脉;采用动脉X线造影法和透明法,在20例人脑标本上观察了延髓内部动脉的形态和供应。将延髓表面分为四区,供应各区的外部动脉可分为相应的4群。前正中群和前外侧群动脉主要来自脊髓前动脉,前正中群动脉供应舌下神经核、内侧丘系及部分锥体束等中缝两侧结构;前外侧群动脉供应大部分锥体束;外侧群动脉来自椎动脉、小脑下后动脉、基底动脉和小脑下前动脉,主要供应网状结构、脊髓丘脑束、三叉神经脊束及核、迷走神经背核等;后群动脉来自脊髓后动脉和小脑下后动脉,主要供应薄、楔束核等。本文还讨论了延髓外侧区的血液供应及“终动脉”等问题。     

Effect of oxidative stress in rostral ventrolateral medulla on sympathetic hyperactivity after traumatic brain injury

Sympathetic hyperactivity occurs in a subgroup of patients after traumatic brain injury (TBI). The rostral ventrolateral medulla (RVLM) is a key region for the activity of sympathetic nervous system. Oxidative stress in the RVLM is proved to be responsible for the increased level of sympathetic activity in animal models of hypertension and heart failure. In this study, we investigated whether oxidative stress in the RVLM contributed to the development of sympathetic hyperactivity after TBI in rats. Model of diffuse axonal injury was induced using Sprague‐Dawley rats, and level of mean arterial pressure (MAP) and plasma Norepinephrine (NE) was measured to evaluate the sympathetic activity. For the assessment of oxidative stress, expression of reactive oxygen species (ROS), malondialdehyde (MDA), and superoxide dismutase (SOD) in the RVLM was determined. Microinjection of Tempol into the RVLM was performed to determine the effect of oxidative stress on sympathetic hyperactivity. According to the results, TBI led to elevated MAP and plasma NE in rats. It also induced a significantly increased level of ROS, MDA production and decreased level of SOD in the RVLM. The sympathetic activity, ROS, and MDA in the RVLM decreased significantly after microinjection of Tempol. Therefore, the present results suggested that oxidative stress in the RVLM was involved in the development of sympathetic hyperactivity following TBI.     

Distinct patterns of neuronal inputs and outputs of the juxtaparaventricular and suprafornical regions of the lateral hypothalamic area in the male rat

We have analyzed at high resolution the neuroanatomical connections of the juxtaparaventricular region of the lateral hypothalamic area (LHAjp); as a control and in comparison to this, we also performed a preliminary analysis of a nearby LHA region that is dorsal to the fornix, namely the LHA suprafornical region (LHAs). The connections of these LHA regions were revealed with a coinjection tract-tracing technique involving a retrograde (cholera toxin B subunit) and anterograde (Phaseolus vulgaris leucoagglutinin) tracer. The LHAjp and LHAs together connect with almost every major division of the cerebrum and cerebrospinal trunk, but their connection profiles are markedly different and distinct. In simple terms, the connections of the LHAjp indicate a possible primary role in the modulation of defensive behavior; for the LHAs, a role in the modulation of ingestive behavior is suggested. However, the relation of the LHAjp and LHAs to potential modulation of these behaviors, as indicated by their neuroanatomical connections, appears to be highly integrative as it includes each of the major functional divisions of the nervous system that together determine behavior, i.e., cognitive, state, sensory, and motor. Furthermore, although a primary role is indicated for each region with respect to a particular mode of behavior, intermode modulation of behavior is also indicated. In summary, the extrinsic connections of the LHAjp and LHAs (so far as we have described them) suggest that these regions have a profoundly integrative role in which they may participate in the orchestrated modulation of elaborate behavioral repertoires.     

Glucose utilization,blood flow and capillary density in the ventrolateral medulla of the rat

A specific population of neurons in the ventrolateral medulla (VLM) acts as the main integration center for the regulation of the sympathetic outflow to the cardiovascular system. In order to investigate whether this nucleus can be distinguished from its surroundings in the reticular formation of the medulla with respect to functional and morphological variables, the present study investigates several of such variables in this area on a quantitative basis. Local medullary glucose utilization was measured by the 2-[¹⁴C]deoxyglucose method; local medullary blood flow was quantified using iodo[¹⁴C]-antipyrine, and the local density of perfused capillaries was calculated by counting the number of intravascular fluorescent spots in brain sections after i.v. infusion of a globulin-coupled fluorescent dye. The values obtained from the VLM were compared with the respective values found in a reference area of the same brain section (gigantocellular nucleus). The values for glucose utilization, blood flow and capillary density were significantly (P<0.05) higher in the VLM than in the reference area (gigantocellular nucleus). This difference was 44.7% for glucose utilization, 34.1% for blood flow and 19.7% for capillary density. These data support the hypothesis that neurons in the VLM are specifically well supplied for being directly regulated in their activity by the PCO₂ and pH in the arterial blood.     

针刺过程中有衣小泡的形成、形态特征及其数量变化的研究

针刺大鼠“人中”、“四白”穴使之产生明显镇痛效果后,再将针刺时间分别延长至1、2、4、6、8、10、12h,到预定时间立即将动物灌流杀死取材,采用定量电镜方法观察计数了三叉神经尾侧脊束核胶状质亚核内各种有衣小泡的数量、形态以及在不同针刺时间内数量的变化。结果发现:大单壁有衣小泡的形成与针刺时间无明显正比例关系;而双壁有衣小泡则显然与之不同,它不仅形态多样,数目也随针刺时间而改变。本文将观察到的双壁有衣小泡归纳为以下五种类型:1、尚未与相邻两终末质膜脱离的孤立存在者。2、游离于终末内孤立存在者。3、与终末质膜相连且融合而成簇存在者;4、游离于终末内融合成簇者;5、树突棘凸入另一轴突或树突内并与之共同形成的不典型的双壁有衣小泡簇。本研究还发现,在针刺过程中双壁有衣小泡在1～8h内的形成与时间成正比,即1h时开始增多,4h显著增多,8h达高峰;以后开始下降,10h已恢复到4h的水平,到12h恢复到针刺前的状态。对照组仅见少数孤立的双壁有衣小泡,其形成基本上不随时间而变化。本文认为双壁有衣小泡的形成,是较大单壁有衣小泡的形成更为有效地继大致密核心小泡非突触部位胞吐之后膜再循环的一条新途径。     

Thoracic caudal epidural catheter localization using ultrasound guidance

Caudal epidural catheters provide exceptional analgesia while avoiding or minimizing opioids. Historically, the catheter tip location (dermatomal level) was estimated or verified via epidurogram. According to the Pediatric Regional Anesthesia Database, the majority of caudal‐to‐thoracic epidural catheters are placed without imaging guidance or verification of the position of the catheter tip. Ponde et al demonstrated that catheter insertion depth was longer when using ultrasound guidance than when estimated by external measurement. We report a simple yet novel ultrasound approach for catheter localization.