术前准备时间对子宫肌瘤患者手术疗效的影响

目的探讨术前准备时间对子宫肌瘤患者手术疗效的影响。方法选择2010年2月-2012年2月于湖北省京山医院因子宫肌瘤行子宫切除患者200例为研究对象,分为研究组和对照组,每组各100例,研究组术前准备1d,对照组常规术前准备3d。比较两组患者手术时间、术中出血量,术后体温恢复时间、肛门排气时间、术后镇痛药使用、C反应蛋白（CRP）、白细胞计数、住院天数、住院费用及手术并发症情况。结果研究组手术时间为（76．43±28．12）min,术中出血量为（85．10±36．13）mL,对照组手术时间为（78．50±30．28）min,术中出血量为（87．24±38．12）mL,研究组与对照组比较,差异均无统计学意义（均P〉0．05）。研究组术后体温恢复时间为（32．72±4．27）h,肛门排气时间为（25．4±3．31）h,术后镇痛药物使用率为10．0％（10／100）,白细胞计数为（6．81±1．61）x10±L,CRP为（5．82±1．67）mg／L,对照组术后体温恢复时间为（40．16±5．73）h,肛门排气时间为（33．62±4．25）h,术后镇痛药物使用率为15．0％（15／100）,白细胞计数为（10．00±2．37）,CRP为（9．45±3．68）mg,L,研究组与对照组比较,差异均有统计学意义（均P〈0．05）。研究组无并发症发生,对照组出现1例腹部切口感染。研究组住院时间[（8．57±1．91）d]、住院费用[（3587．41±231．28）元1均低于对照组【（10．45±1．74）d、（3978．62±325．37）元】,差异均有统计学意义（均P〈0．05）。结论子宫肌瘤术前准备1d后进行手术,可缩短患者的住院时间,减少患者的住院费用,为子宫肌瘤患者最佳手术时机的选择提供瘤子宫全切围术期临床路径。     

Oscillatory phase coupling coordinates anatomically dispersed functional cell assemblies

Hebb proposed that neuronal cell assemblies are critical for effective perception, cognition, and action. However, evidence for brain mechanisms that coordinate multiple coactive assemblies remains lacking. Neuronal oscillations have been suggested as one possible mechanism for cell assembly coordination. Prior studies have shown that spike timing depends upon local field potential (LFP) phase proximal to the cell body, but few studies have examined the dependence of spiking on distal LFP phases in other brain areas far from the neuron or the influence of LFP–LFP phase coupling between distal areas on spiking. We investigated these interactions by recording LFPs and single-unit activity using multiple microelectrode arrays in several brain areas and then used a unique probabilistic multivariate phase distribution to model the dependence of spike timing on the full pattern of proximal LFP phases, distal LFP phases, and LFP–LFP phase coupling between electrodes. Here we show that spiking activity in single neurons and neuronal ensembles depends on dynamic patterns of oscillatory phase coupling between multiple brain areas, in addition to the effects of proximal LFP phase. Neurons that prefer similar patterns of phase coupling exhibit similar changes in spike rates, whereas neurons with different preferences show divergent responses, providing a basic mechanism to bind different neurons together into coordinated cell assemblies. Surprisingly, phase-coupling–based rate correlations are independent of interneuron distance. Phase-coupling preferences correlate with behavior and neural function and remain stable over multiple days. These findings suggest that neuronal oscillations enable selective and dynamic control of distributed functional cell assemblies.     

Season of Birth,Gender, and Social-Cultural Effects on Sleep Timing Preferences in Humans

Study Objective:

The present study aimed to analyze season of birth effects on preferred sleep-wake cycle timing as assessed by Morningness-Eveningness Questionnaire (MEQ).

Participants and Measurements:

The MEQ was administered to a sample of 5,720 university students (3,851 Italians and 1,869 Spaniards; 3,877 female and 1,843 male; mean age 22.23 ± 2.98 years).

Results:

Females preferred to go to bed significantly earlier and sleep longer than males, regardless of season of birth and nationality. Subjects born in spring and summer went to bed and reached midpoint of sleep later than subjects born in fall and winter. Nationality significantly affected all the sleep parameters considered except duration.

Conclusion:

Overall, the effect of the season of birth on sleep preference timing was significant but quantitatively small. We suggest an evolutionary context for the different contributions of genetic and environmental factors in modulating sleep-wake cycles in humans.

Citation:

Natale V; Adan A; Fabbri M. Season of birth, gender, and social-cultural effects on sleep timing preferences in humans. SLEEP 2009;32(3):423–426.     

Nonallelic transvection of multiple imprinted loci is organized by the H19 imprinting control region during germline development

Recent observations highlight that the mammalian genome extensively communicates with itself via long-range chromatin interactions. The causal link between such chromatin cross-talk and epigenetic states is, however, poorly understood. We identify here a network of physically juxtaposed regions from the entire genome with the common denominator of being genomically imprinted. Moreover, CTCF-binding sites within the H19 imprinting control region (ICR) not only determine the physical proximity among imprinted domains, but also transvect allele-specific epigenetic states, identified by replication timing patterns, to interacting, nonallelic imprinted regions during germline development. We conclude that one locus can directly or indirectly pleiotropically influence epigenetic states of multiple regions on other chromosomes with which it interacts.     

The effect of 2% CO2, 100% O2, theophylline and 15% O2 on ‘inspiratory drive’ and ‘effective’ timing in preterm infants

We studied 20 preterm infants (B.W. 1440 ± 80 g (S.E.); G.A. 33 ± 1 wk) to determine the effect of respiratory stimulants and depressants on respiratory output as measured by V_E = V_T · f and V_E = V_T/T_i · T_i/T_tot. These 20 infants were divided in four groups of five infants. Each group received a respiratory stimulant (2% CO₂, 100% O₂ or theophylline) or a respiratory depressant (15% O₂). V_T/T_i is mean inspiratory flow and represents a mechanic translation of neuronal output. T_i/T_tot is a dimensionless number and has been defined as effective timing. Each study consisted of 3–5 min while the infant breathed 21% O₂, followed by 5 min breathing 2% CO₂, 100% O₂ or 15% O₂. The effect of theophylline was assessed 48–72 h after the initial dose. The respiratory stimulants caused an increase in V_T with little or no change in f 15% O₂ produced a decrease in f primarily. According to the newer approach, 2% CO₂, 100% O₂ and theophylline produced an increase in ‘inspiratory drive’ with little or no change in ‘effective’ timing; 15% O ₂ decreased ‘effective’ timing primarily via an increase in T_e. These findings suggest that the paradoxical decrease in ventilation during hypoxia in preterm infants may not be solely dependent on the central depressant effects of O₂. At least in part, the mechanism may be due to a direct action of low O₂ on elements controlling expiratory time.     

Circadian aspects of serum prolactin and TSH lowering by bromocriptine in patients with prostatic hypertrophy

Bromocriptine mesylate lowers the serum concentration of prolactin and TSH in patients with prostatic hypertrophy as a function of drug administration time. The effect of a 2.5-mg dose in lowering these two hormones in presumably similar patients is statistically highly significant and relatively large at unusual test times (in the evening); at other, conventional test or administration times (early morning or midday), it is smaller, questionable, or not demonstrable with the dose and conditions used. Dosing without timing may lead to reduced effect or lack of effect, ambiguity and controversy, and lack of timing may account for the circumstance that an effect of bromocriptine upon TSH in human serum was not previously established. Rigorous assessment of the effect of bromocriptine mesylate upon circulating TSH and prolactin requires consideration of the entire spectrum of rhythms, ultradian and infradian as well as circannual. The circadian approach here analyzed represents a step toward that goal and indicates that the circadian frequency is a critical determinant of this response. Manipulation of TSH concentration in serum, in turn, is of interest in view of the demonstrated alteration of the circannual TSH rhythm in patients with prostatic cancer.     

Perioperative endocrine status and prognosis in early breast cancer

Although the relationship between breast cancer and hormones has been known for almost two centuries, it is only during the last 16 years that evidence suggesting the hormonal profile of the patient at the time of surgery can affect the outcome, came to light. A series of studies investigated the hypothesis that unopposed estrogen (observed during the follicular phase of the cycle) may adversely affect the overall and/or disease-free survival of women operated on at that time. The findings have been, at times, contradictory. The retrospective nature of the studies, poor recording of last menstrual period, small study size, and the possible effect of the timing of the diagnostic procedures (cytology or core biopsy) on the outcome may be responsible for the conflicting results. Despite this, more sophisticated studies based on pathological or hormonal observations/measurements, confirmed the relation of luteal phase surgery to better outcome. Estrogen-induced increased protease activity activates a cascade of proteolysis and allows the more discohesive tumor cells to gain access to the circulation. Moreover, disseminated cells might be able to proliferate easier because of several estrogen-dependent growth factors. Diminished immune function during the follicular phase, because of natural killer cell activity and mononuclear cell phagocytic activity down-regulation may also be implicated in the dissemination of viable tumor cells. Taken together these findings provide a framework for explaining the observation that luteal phase surgery can lead to an improved outcome. By altering the perioperative hormonal milieu it may be possible to reduce deaths from breast cancer in a simple and nontoxic manner.     

Early operation for the ruptured intracranial aneurysm

It has been commonly accepted that the intracranial direct surgery, especially of aneurysmal neck occlusion, is the most desirable treatment for the intracranial aneurysm. However its timing is still controversial. In this report, early operation for the ruptured intracranial aneurysm was advocated based on the analysis of cases, encountered until the end of December, 1970, in which direct operation was performed within 3 weeks from the last subarachnoid hemorrhage, with special reference to the causes of death. The most reliable clinical parameter in deciding the timing of intracranial direct surgery seems to be the course of patient's consciousness. Age, blood pressure, site of aneurysm, motor disturbance, cranial nerve disorder and preoperative vasospasm were less related to the surgical results. The meningeal irritation and frequency of the past subarachnoid hemorrhage were related to the surgical results to some extent only. Therefore direct operation should be performed for the ruptured intracranial aneurysm even within one week after the last attack, providing the patient is neither in a state of coma nor in a down hill course of consciousness.     

Timing of operation for ruptured cerebral aneurysm and long-term recovery of cognitive functions

Summary Advantages and disadvantages of early and late operation for ruptured cerebral aneurysm are controversially evaluated with regard to peri-operative operation outcome and long-term cognitive recovery.In this retrospective analysis 22 patients with early surgery (ES) within three days after subarachnoid haemorrhage (SAH) and 22 patients with late surgery (LS) at least 14 days after SAH were studied.Patients were pair-wise matched by degree of SAH, localisation of aneurysm and age at SAH. On average three years after SAH both groups were examined individually with a comprehensive neuropsychological test battery including tests of premorbid intelligence, concept formation, memory, visuomotor speed, aphasia screening, and mood. ES and LS patients were well comparable in terms of years of education and level of premorbid intelligence. There was a clear influence of patients age on fluid intelligence tests, indicating a general change-sensitivity of tests.No influence of degree of SAH and localisation of aneurysm could be detected. There were also no differences between ES and LS patients in neuropsychological tests sensitive to brain damage, suggesting that the decision for early or late surgery for ruptured cerebral aneurysm can be based upon surgical reasons at the time of the SAH.     

Level of consciousness and age as prognostic factors in aneurysmal SAH

Summary The prognostic value of the level of consciousness and the patient's age for the outcome of aneurysmal subarachnoid haemorrhage (SAH) is studied in 74 patients admitted on day (D)0 to D3 after aneurysm rupture.For the level of consciousness three groups of patients are compared: grade I+II (alert patients), grade III+IV (drowsy patients), and grade V (comatose patients). For the age, two groups are compared: patients aged under 50, and patients aged 50 and over. The timing of surgery was: D0–D3 51%, D4–D6 20%, D7 and later 18%, and No surgery 11%.The overall management results were: Good (satisfactory result) 43%, Fair (moderately disabled) 18%, Poor (severely disabled+vegetative survival) 19%, and Death 20%. The outcome was strongly related to the level of consciousness, the rates of Good result decreasing from 71% (grades I–II) to 14% (grades III–IV) and to zero (grade V), and the mortality rates increasing respectively from 5% to 14% and 61%.The relationship between outcome and age was less marked: 54% Good result under 50 and 30% over 50. Out of the Grade V group, 56% could be operated upon and 44% died before surgery. No patient from the other two groups died before surgery. The literature concerning the Grading Systems published so far and the various prognostic factors are discussed.