Efferent projections of reuniens and rhomboid nuclei of the thalamus in the rat

The nucleus reuniens (RE) is the largest of the midline nuclei of the thalamus and exerts strong excitatory actions on the hippocampus and medial prefrontal cortex. Although RE projections to the hippocampus have been well documented, no study using modern tracers has examined the totality of RE projections. With the anterograde anatomical tracer Phaseolus vulgaris leuccoagglutinin, we examined the efferent projections of RE as well as those of the rhomboid nucleus (RH) located dorsal to RE. Control injections were made in the central medial nucleus (CEM) of the thalamus. We showed that the output of RE is almost entirely directed to the hippocampus and "limbic" cortical structures. Specifically, RE projects strongly to the medial frontal polar, anterior piriform, medial and ventral orbital, anterior cingulate, prelimbic, infralimbic, insular, perirhinal, and entorhinal cortices as well as to CA1, dorsal and ventral subiculum, and parasubiculum of the hippocampus. RH distributes more widely than RE, that is, to several RE targets but also significantly to regions of motor, somatosensory, posterior parietal, retrosplenial, temporal, and occipital cortices; to nucleus accumbens; and to the basolateral nucleus of amygdala. The ventral midline thalamus is positioned to exert significant control over fairly widespread regions of the cortex (limbic, sensory, motor), hippocampus, dorsal and ventral striatum, and basal nuclei of the amygdala, possibly to coordinate limbic and sensorimotor functions. We suggest that RE/RH may represent an important conduit in the exchange of information between subcortical-cortical and cortical-cortical limbic structures potentially involved in the selection of appropriate responses to specific and changing sets of environmental conditions.     

Activity of fin muscles and fin motoneurons during swimming motor pattern in the lamprey

Coordination of motoneuron activity is a fundamental prerequisite for the generation of functional locomotor patterns. We investigate the neural mechanisms that coordinate activity of motoneuron pools in the vertebrate spinal cord with differing phases of activity in the locomotor cycle in a simple motor system, the lamprey swimming network. In the region of dorsal fins the lamprey spinal cord contains two groups of motoneurons: the myotomal motoneurons that innervate the trunk muscles; and the fin motoneurons controlling muscle fibres of the dorsal fins. We investigated the activity of fin muscles during swimming in vivo and that of fin motoneurons during fictive swimming in vitro. During swimming in vivo with cycle periods of 4-8 Hz, fin muscle activity covered a broad portion of the cycle, with the peak of activity out-of-phase to the ipsilateral myotomal muscles. During fictive swimming evoked by N-methyl-d-aspartate in the isolated spinal cord, fin motoneurons expressed similar out-of-phase activity. The phase relationship of the synaptic drive to fin motoneurons was examined by recording their activity intracellular during fictive swimming. Three different forms of membrane potential oscillation with different time courses in the locomotor cycle could be distinguished. Sagittal lesions of the spinal cord in the segment where fin motoneurons are recorded and up to one segment rostral and caudal from it did not influence the out-of-phase activity pattern of the motoneurons. Our results indicate that coordination of fin motoneuron activity with the locomotor activity of myotomal motoneurons does not depend on intrasegmental contralateral premotor elements.     

Overactive bladder in Parkinson's disease: alteration of brainstem raphe detected by transcranial sonography

Urinary dysfunction is very common in idiopathic Parkinson's disease (PD) and manifests primarily with symptoms of overactive bladder (OAB). Affection of central serotonergic systems has been suggested to play a role in OAB. The objective of this study was to evaluate whether in PD patients with OAB symptoms a specific alteration of the brainstem raphe (BR), which contains serotonergic neurons, can be detected with transcranial sonography (TCS). Of 116 PD patients enrolled, 19 had PD-related OAB symptoms (OAB+) unlike remaining 97 patients (OAB−). Patients were examined by a sonographer blinded to the clinical data. Reduced echogenicity of BR was found in 12 (63%) OAB+ patients but only in 18 (19%) of 93 assessable OAB− patients (Mann–Whitney U -test, P  < 0.001). In OAB+ patients, lower raphe echogenicity score was associated with longer duration of OAB symptoms ( anova , P  = 0.033). Other TCS findings such as echogenicity of substantia nigra, thalami, lenticular and caudate nuclei, and widths of third and lateral ventricles did not differ between OAB+ and OAB− patients. TCS findings suggest a pathogenetic role of BR in OAB related to PD. Alterations may reflect disturbance of its central serotonergic system.     

Central fatigue in continuous and intermittent contractions of triceps brachii

Conflicting results have been found across studies concerning the effect of rest periods on the development of central fatigue during prolonged muscle activity. Thus, the aim of the present study was to assess differences in the development of central fatigue between continuous and intermittent elbow extension fatigue tasks in the same subjects. Force and electromyographic data were collected on eight healthy volunteers. The ability to maximally activate the triceps brachii muscle was assessed by delivering trains of electrical stimulation during maximal voluntary efforts. This was done before, during, and after three fatigue tasks involving a maximal contraction in elbow extension. One short-duration ( approximately 55-s) and two long-duration (3-min) fatigue tasks were performed by all subjects on separate sessions. One 3-min task was intermittent (5-s rests every 30 s) and the other was continuous. The main findings were that the development and extent of central fatigue were task-dependent, with a greater decrease in the ability to maximally activate triceps brachii observed for the 3-min continuous task. Also, the voluntary activation (VA) ratio was found to be a more sensitive index of central fatigue than the central activation ratio (CAR). These results suggest that, when assessing central fatigue in patients, conclusions may vary depending on the continuous/intermittent nature of the task performed and the estimate of voluntary activation used.     

Pancreatic solid serous cystadenoma treated by laparoscopy: Presentation of a new case report and review of the literature

Solid serous cystadenoma is an uncommon benign pancreatic tumor, with only, including this case, 21 cases published so far. It is often misdiagnosis with other malignant pancreatic tumors.Below we report a new case of a solid serous cystadenoma of the pancreas treated by laparoscopic distal pancreatectomy in 53-year-old female who presented with epigastric pain. Histological and immunohistochemical examination revealed a solid serous cystadenoma of the pancreas. Preoperative diagnosis of this subtype of serous cystadenoma is difficult, and, due to its benign nature, conservative resection of the tumor is the recommended treatment.After analyzing the literature, including this case from our department, we discuss clinical presentation, imaging characteristics and histopathological findings, considering in particular difficulties in preoperative diagnosis, feasibility of laparoscopic resection.     

Central quadriceps free tendon for anterior cruciate ligament reconstruction

Central quadriceps free tendon provides an outstanding autograft alternative for routine anterior cruciate ligament (ACL) reconstruction, allowing preservation of hamstring tendons and eliminating the morbidity of bone plug harvest from the patella. Correct graft harvest technique, proper tunnel/graft sizing, accurate fixation, and adherence to the methods described will permit excellent ACL reconstruction with low morbidity.     

Anatomic relationship between the internal jugular vein and the carotid artery in preschool children--an ultrasonographic study

Background:  Central venous cannulation in young children is technically difficult and may lead to potentially serious complications especially when performed blindly or using anatomical landmarks only.
Aim:  The aim of this study was to determine the anatomical relationship of the internal jugular vein (IJV) and the common carotid artery (CA) in preschool children using ultrasound.
Methods:  Forty five children aged 60 months and under were included prospectively and divided into three groups: group 1: <6 months, group 2: 7–18 months and group 3: 19–60 months. With the head in neutral position the location of the left and right IJV was noted as anterior (A), anterolateral (AL), lateral (L) or medial (M) in relation to the CA at the level of the cricoid cartilage. Depths of IJV and CA as well as time taken to locate the vessels were recorded.
Results:  The IJV was more commonly found in the AL position in all groups. The mean depth was 0.96 cm in group 1, 0.95 cm in group 2 and 3. Mean duration for localization of the vessels was 4.2 s in group 1, 4 s in group 2 and 4.3 s in group 3. The differences between the groups were not significant.
Conclusion:  This study demonstrates that the IJV cover the CA in the majority of young children. Depth of the IJV is rarely more than 1 cm deep to the skin. Ultrasound location of the IJV and CA is easy and does not necessarily delay the procedure. The findings of this study support the use of ultrasound guidance for CVC in children.     

Fibrin sheath removal from central venous catheters: an internal snare manoeuvre.

BACKGROUND: Dysfunction of haemodialysis catheters is most commonly due to a narrowing of the catheter lumen and/or formation of a fibrin sheath around the catheter tip. Reported methods for restoring patency of the catheter lumen include passage of a J-tipped guide wire, passage of a biopsy brush through the catheter, or infusion of a thrombolytic agent into the catheter. While these methods are often effective, they suffer from several limitations. We present a minimally invasive technique to remove thrombi and debris from within the lumen of a partially thrombosed haemodialysis catheter while simultaneously stripping the fibrous sheath. METHODS: A 0.089 cm nitinol wire is bent to create a loop, which is then inserted via the catheters. Upon exiting the lumen of the catheters, the nitinol wire forces a snare open, which disrupts the fibrin sheath and catches intraluminal thrombi and debris. The technique requires no anaesthesia or recovery time. RESULTS: Initial clinical success in our series was achieved in all patients (7/7) as evidenced by restoration of target flow rates on subsequent haemodialysis. None of the patients experienced any complications as a result of the procedure. The catheter 2-, 4-, and 6-week primary success rates were 100% (8/8), 100% (8/8), and 100% (8/8) respectively with a mean duration of 17.1 weeks (range 8-40 weeks). CONCLUSIONS: The internal snare technique is an effective, inexpensive and minimally invasive approach to restoring patency to failed central venous access catheters.     

卵巢浆液性囊腺癌术后双途径化疗的临床观察

目的 探讨Ⅱ期以上卵巢浆液性囊腺癌患者术后行腹腔持续灌注联合双途径化疗的临床疗效。方法 76例Ⅱ-Ⅳ期卵巢浆液性囊腺癌术后随机分为两组：联合组40例,腹腔持续灌注联合静脉双途径化疗6次;对照组36例,常规静脉化疗6次。两组化疗均采用PCH方案（顺铂＋环磷酰胺＋羟基喜树碱）,并均于术后21-28 d开始化疗。结果 联合组1,3年生存率分别为97.5%（39/40）和85.0%（34/40）,对照组分别为94.4%（34/36）和50.0%（18/36）。两组1年生存率无显著性差异（P〉0.05）,3年生存率有显著性差异（P〈0.05）。联合组和对照组Ⅱ度以上胃肠道反应发生率分别为27.5%（11/40）和77.8%（28/36）,有显著性差异（P〈0.01）。两组骨髓抑制差异无显著性（P〉0.05）。结论 双途径化疗可延长Ⅱ-Ⅳ期卵巢浆液性囊腺癌患者术后生存期,降低Ⅱ度以上胃肠道反应发生率。     

持续改进护理在预防恶性肿瘤患者化疗期间外周置入中心静脉导管感染的效果观察

目的观察持续改进护理在预防恶性肿瘤患者化疗期间外周置入中心静脉导管（PICC）感染的疗效。方法采用回顾性对照研究,选择2012年1月至2012年12月123例PICC置管化疗的恶性肿瘤患者作为对照组,选取2013年1月至2013年12月129例PICC置管化疗的恶性肿瘤患者为观察组,比较持续改进护理前后护理人员PICC相关知识及处理能力改进情况,同时比较两组患者PICC置管期间感染发生率。结果持续改进护理实施后,本院肿瘤科护士PICC理论知识及感染处理能力均有显著提高,实施后与实施前比较差异具有统计学意义（P均〈0．05）。对照组PICC感染发生率为13．82％,观察组PICC感染发牛率为3．83％,两组比较差异具有统计学意义（x^2=4．100,P〈0．05）。结论应用持续改进护理循环管理模式,有利于减少和消除护理不当导致的PICC相关感染,具有较好的防控作用,为恶性肿瘤患者化疗的顺利完成创造了必要的条件。