后腹腔镜上尿路手术体位的研究进展

综述后腹腔镜上尿路手术体位的应用、摆放的原则和其各自的优缺点,以及后腹腔镜上尿路手术体位的改良方法和进展状况、手术医生的术姿疲劳程度的相关因素分析,探讨后腹腔镜上尿路手术的适宜体位,以提高病人安全舒适度并减轻医生手术操作的疲劳度,提高工作效率和工作质量。     

Trautmann's triangle anatomy with application to posterior transpetrosal and other related skull base procedures

Trautmann's triangle (TT) faces the cerebellopontine angle and is exposed during posterior transpetrosal approaches. However, reports on the morphometric analysis of this structure are lacking in the literature. The goal was to better understand this important operative corridor. TT was exposed from an external approach (transmastoid) in ten cadavers (20 sides) and from an internal approach on 20 dry adult temporal bones. Measurements included calculation of the area of TT and the distance of the endolymphatic sac from the anterior border of the sigmoid sinus. The area range of TT was 45–210 mm² (mean 151 mm²; SD 37 mm²). Three types of triangles were identified based on area. Type I triangles had areas less than 75 mm², Type II areas were 75–149 mm², and Type III areas were 150 mm² and greater. These types were observed in 37.5%, 35%, and 27.5% of sides, respectively. The distance from the jugular bulb's anterior border to the posterior border of the posterior semicircular canal ranged from 6 to 11 mm (mean 8.5 mm). The endolymphatic sac was located in the inferior portion of TT and traveled anterior to the sigmoid sinus. The horizontal distance from the anterior edge of the sigmoid sinus to the posterior edge of the endolymphatic sac ranged from 0 to 13.5 mm (mean 9 mm). Additional anatomic knowledge regarding TT may improve neurosurgical procedures in this region by avoiding intrusion into the endolymphatic sac and sigmoid sinus. Clin. Anat. 27:994–998, 2014. © 2014 Wiley Periodicals, Inc.     

Somatosensory Thalamic Activity Modulation by Posterior Insular Stimulation: Cues to Clinical Application Based on Comparison of Frequencies in a Cat Model

BackgroundThe posterior insula (PI) has been proposed as a potential neurostimulation target for neuropathic pain relief as it represents a key-structure in pain processing. However, currently available data remain inconclusive as to efficient stimulation parameters.ObjectivesAs frequency was shown to be the most correlated parameter to pain relief, this study aims to evaluate the potential modulatory effects of low frequency (LF-IS, 50 Hz) and high-frequency (HF-IS, 150 Hz) posterior insular stimulation on the activity of somatosensory thalamic nuclei.Materials and MethodsEpidural bipolar electrodes were placed over the PI of healthy adult cats, and extracellular single-unit activities of nociceptive (NS), nonnociceptive (NN), and wide dynamic range (WDR) thalamic cells were recorded within the ventral posterolateral nucleus and the medial division of the thalamic posterior complex. Mean discharge frequency and burst firing mode were analyzed before and after either LF-IS or HF-IS.ResultsLF-IS showed a significant thalamic modulatory effects increasing the firing rate of NN cells (p ≤ 0.03) and decreasing the burst firing of NS cells (p ≤ 0.03), independently of the thalamic nucleus. Conversely, HF-IS did not induce any change in firing properties of the three recorded cell types.ConclusionThese data indicate that 50 Hz IS could be a better candidate to control neuropathic pain.     

Respiration phase‐locks to fast stimulus presentations: Implications for the interpretation of posterior midline “deactivations”

The posterior midline region (PMR)—considered a core of the default mode network—is deactivated during successful performance in different cognitive tasks. The extent of PMR‐deactivations is correlated with task‐demands and associated with successful performance in various cognitive domains. In the domain of episodic memory, functional MRI (fMRI) studies found that PMR‐deactivations reliably predict learning (successful encoding). Yet it is unclear what explains this relation. One intriguing possibility is that PMR‐deactivations are partially mediated by respiratory artifacts. There is evidence that the fMRI signal in PMR is particularly prone to respiratory artifacts, because of its large surrounding blood vessels. As respiratory fluctuations have been shown to track changes in attention, it is critical for the general interpretation of fMRI results to clarify the relation between respiratory fluctuations, cognitive performance, and fMRI signal. Here, we investigated this issue by measuring respiration during word encoding, together with a breath‐holding condition during fMRI‐scanning. Stimulus‐locked respiratory analyses showed that respiratory fluctuations predicted successful encoding via a respiratory phase‐locking mechanism. At the same time, the fMRI analyses showed that PMR‐deactivations associated with learning were reduced during breath‐holding and correlated with individual differences in the respiratory phase‐locking effect during normal breathing. A left frontal region—used as a control region—did not show these effects. These findings indicate that respiration is a critical factor in explaining the link between PMR‐deactivation and successful cognitive performance. Further research is necessary to demonstrate whether our findings are restricted to episodic memory encoding, or also extend to other cognitive domains. Hum Brain Mapp 35:4932–4943, 2014. © 2014     

前牙开(牙合)患者颞下颌关节间隙及髁突形态的锥形束CT评价

目的应用锥形束CT(cone-beam CT,CBCT)对前牙开(牙合)患者的颞下颌关节间隙及髁突形态进行测量分析,探讨前牙开(牙合)患者与正常覆(牙合)患者的颞下颌关节的差异。方法选取2014年6月至2020年8月于南京大学医学院附属口腔医院正畸科就诊的前牙开(牙合)患者54例(前牙(牙合)开组)和正常覆(牙合)患者54例(正常覆(牙合)组),对其拍摄的颌面部CBCT图像使用多平面重建技术重建颞下颌关节矢状位及冠状位图像。使用Ka-melchuk法测量颞下颌关节上、后、前间隙,根据髁突骨质情况将髁突形态分为正常型与异常型2类,对前牙开(牙合)组和正常覆(牙合)组进行关节间隙及髁突形态的统计学分析。将前牙开(牙合)组根据开(牙合)的程度分为3个亚组:(1)Ⅰ°开(牙合)组(开(牙合)距离<3 mm);(2)Ⅱ°开(牙合)组(3 mm≤开(牙合)距离≤5 mm);(3)Ⅲ°开(牙合)组(开(牙合)距离>5 mm),比较3个亚组间关节间隙的差异。结果前牙(牙合)开组与正常覆(牙合)组相比,颞下颌关节前、上间隙差异无统计学意义(P>0.05),颞下颌关节后间隙显著增宽(P<0.01);前牙开(牙合)组髁突骨质异常占52.8%,正常覆(牙合)组骨质异常占21.3%,两组间具有显著性差异(P<0.01)。与Ⅰ°和Ⅱ°前牙开(牙合)患者相比,Ⅲ°前牙开(牙合)患者髁突在关节窝内更靠前(P<0.05)。结论前牙开(牙合)患者的髁突在关节窝内位置更加靠前、髁突骨质异常比例较高。