前锯肌平面阻滞和胸椎旁神经阻滞在胸腔镜手术中的麻醉效果及对疼痛因子的影响

目的 研究前锯肌平面阻滞与胸椎旁神经阻滞对胸腔镜手术患者的麻醉效果及对疼痛因子的影响。方法 选取2020年11月—2021年9月安徽省池州市人民医院60例接受胸腔镜手术治疗的患者作为研究对象,按照随机数字表法分为A组和B组,每组30例。两组患者术中均接受气管插管全身麻醉,麻醉诱导前,A组选择前锯肌平面阻滞,B组选择胸椎旁神经阻滞。比较两组患者的麻醉效果、阻滞操作时间、阻滞起效时间、阻滞持续时间、生命体征、术后镇痛泵按压次数、术后舒芬太尼使用量、疼痛因子、术后疼痛评分及术后不良反应发生率。结果 A组的麻醉优良率为96.67%,B组的麻醉优良率为93.33%,两组比较,差异无统计学意义（P>0.05）。两组患者的麻醉平面、阻滞起效时间比较,差异无统计学意义（P>0.05）;A组较B组阻滞操作时间缩短,阻滞持续时间延长。两组患者切皮前后收缩压、舒张压、心率差值比较,差异无统计学意义（P>0.05）。A组的术后48 h内镇痛泵按压次数、术后舒芬太尼使用量较B组减少（P <0.05）。两组患者手术前后血清PGE2、IL-6差值比较,差异有统计学意义（P <0.05）...     

Spontaneous arterial baroreflex control of the heart rate during head-down tilt in heat-stressed humans

The purpose of this study was to elucidate the effect of raised body temperature per se during acute heat stress on the spontaneous arterial baroreflex control of heart rate (f _c) in humans. To investigate whether unloading of cardiopulmonary baroreceptors during whole-body heating would alter the arterial baroreflex control of f _c, we controlled loading of the cardiopulmonary baroreceptors by head-down tilt (HDT) at angles of 5°, 10°, 15°, and 30° during heat stress produced by hot-water-perfused suits. The sensitivity of the arterial baroreceptor-cardiac reflex was calculated from the spontaneous changes in beat-to-beat arterial pressure and f _c. As an index of cardiopulmonary baroreceptor loading, the left atrial diameter (LAD) was measured by echocardiography. During whole-body heating, the LAD decreased with the rising body core temperature and increased with the HDT. The decreased LAD during heating almost recovered to the normothermic control level by 10° HDT. In the supine position, cardiac baroreflex sensitivity remained unchanged during heating. Arterial pressure, f _c and cardiac baroreflex sensitivity were not changed by HDT ranging from 5° to 30° during heating. These results suggest that cardiac baroreflex sensitivity remain unchanged during graded loading of the cardiopulmonary baroreceptors in heat-stressed humans. Also, we conclude that the sensitivity of the spontaneous arterial baroreflex controlling the f _c is not influenced by raised body temperature per se during acute heat stress. Electronic Publication     

Transcatheter arterial embolization of abnormal neovessels in a swine model of knee arthritis

BackgroundIn recent years, transcatheter arterial embolization (TAE) using imipenem/cilastatin (IPM/CS) has attracted attention as a treatment for relieving osteoarthritis (OA) pain. However, IPM/CS is not approved by Japanese medical insurance for use as an embolic material. Therefore, it is necessary to develop new embolic materials for TAE to relieve OA pain. The purpose of this study was to develop a swine model of knee arthritis and embolize abnormal neovessels (ANs) using two different embolic materials. We compared the embolic effects and tissue damage in knees.MethodsKnee arthritis was induced by intra-articular injection of papain into 12 knees in six female swine. The swine were divided into two groups of three swine each (six knees per group) for embolization of ANs in the knees with either IPM/CS or soluble gelatin sponge particles (SGSs). Three days after embolization, we compared the embolic effects using angiography and the tissue damage histopathologically.ResultsANs were observed in all 12 knees at 42 days after papain injection. The ANs disappeared and the patent arteries were recanalized 3 days after TAE in all 12 knees. Histopathological evaluation revealed synovitis changes, such as synovial thickening and inflammatory cell infiltration, in all 12 knees. There was no evidence of skin or muscle necrosis in either group. The appearance of ANs, recanalization of the parent arteries, and histopathological outcomes were not significantly different between the two groups.ConclusionSGSs were as safe as IPM/CS for TAE of ANs in this swine model of knee arthritis.     

尺神经深支,骨间前神经旋前方肌支的应用解剖

尺神经深支向近侧无损伤分离后,可超越旋前方肌上缘以上26.58mm,此时宽1.80mm、厚1.00mm,可与宽1.35mm、厚0.89mm的旋前方肌支缝合。     

线扫描直接数字化X线摄影原理与应用

目的 探讨线扫描直接数字化X线摄影的工作原理与实用价值。方法 以多丝正比室线扫描X线摄影系统为基础，分析线扫描直接数字化X线摄影的适用性。结果 线扫描成像技术克服了散射线造成的干扰，且探测灵敏度和精密度分辨率高。结论 线扫描成像技术适合于除了动态摄影以外的各种数字X线摄影，对我国常规X线摄影逐步实现数字化开辟了美好的前景。     

Biological effects of static magnetic fields on the microcirculatory blood flowin vivo: a preliminary report

There have been few studies of the effect of static magnetic fields on microcirculatory haemodynamics in vivo. The rat skinfold transparent chamber technique was used, which provides an excellent means of observing and quantifying direct in vivo microvascular haemodynamic responses to static magnetic fields up to 8 T. An intravital videomicroscope was used to measure the changes in blood flow before and after exposure to a magnetic field for 20 min in a horizontal type superconducting magnet with a bore 100 mm in diameter and 700 mm long. After exposure, microcirculatory blood flow showed an initial increase for about 5 min followed by a gradual decrease and a return to the control value. It is hypothesised that these changes represent rebound hyperaemia following reduced blood flow during exposure.     

A simple method for monitoring changes in cell height using fluorescent microbeads and an Ussing-type chamber for the inverted microscope

In this study, we report two developments for studies of ion transport in cultured epithelial cells. First, a convenient method is presented for measuring apparent cell height using fluorescent microbeads as high-contrast landmarks of the apical and basal cell surfaces. The apparent cell height is then used as an indicator to monitor the time course of changes in cell volume in response to osmotic perturbations. Second, an Ussing-type chamber design for the inverted fluorescence microscope is presented, which allows determination of transepithelial electrical properties. Using these two methods, we obtained simultaneous measurements of cell height and transepithelial electrical parameters for cultured renal (A6) epithelium. Cell height was measured by alternately focusing the microscope between microbeads marking the apical and basal surfaces. The distance between these two surfaces was measured electrically from the voltage output of a potentiometer that was mechanically coupled to the fine-focusing knob of the microscope. Following decreases in the bathing solution osmolality, the cell height and transepithelial Na⁺ transport rate (measured as short-circuit current, I _SC) increased. The increase in cell height preceded changes in I _SC by several minutes, suggesting a lack of direct linkage between changes in cell volume and transepithelial Na⁺ transport. Both the fluorescent microbead cell height method and the Ussing-type chamber can be used in conjunction with patch-clamp techniques, intracellular microelectrode impalements, or fluorescent probes of intracellular composition. Therefore, this system may be advantageous for studies of epithelial cell volume and channel regulation.     

Interactions between normal and tumoral tissues at the boundary of human anterior pituitary adenomas

We studied the boundary between adenoma and peritumoral anterior pituitary tissues in order to understand their mutual interactions during tumour progression. We selected 18 adenomas of different secretory type, grade and invasiveness in which fragments of peritumoral anterior pituitary were still attached to the adenoma. Immunohistochemistry was performed on serial sections with markers of the basement membranes (type IV collagen), the hormone-producing cells of the normal and neoplastic anterior pituitary, and the folliculo-stellate cells (S-100 protein). In passing from tumour to gland, localized areas of passive compression of the normal gland were seen in only 3 cases. In all the tumours, the boundary consisted partly or solely of a transitional zone characterized by the presence of enlarged cell-cords. Openings in the basement membrane of these enlarged cell-cords were seen in contact with the tumour tissue. Normal and neoplastic cells intermingled in the transitional zone. Normal residual cells could be seen in the central area of the tumour but no adenomatous cells were observed in the gland around the tumour. Folliculo-stellate cells were concentrated in the vicinity of the transition zone. These findings favour the existence of an active process of adenoma expansion within the normal parenchyma, without noticeable infiltration of tumour cells into surrounding gland.     

内耳门周结构对内镜下脑桥小脑三角区手术的影响

目的：研究内耳门周结构对颞骨径路内镜下处理脑桥小脑三角区病变手术的影响，为临床开展相应手术提供参考。方法：在20例40侧成人尸头上模拟颞骨径路内窥镜手术，观察小脑下前动脉及内耳门后唇的变异，了解其对内窥镜导入及其手术的影响。结果：内耳门后唇隆起超过面神经脑桥小脑角段1／3以上者占27．5％(11侧)。小脑下前动脉在Ⅶ、Ⅷ脑神经外侧成袢者占22．5％(9侧)。内耳门后唇隆起合并小脑下前动脉袢在Ⅶ、Ⅷ脑神经之外侧者占7．5％(3侧)。结论：当内耳门后唇隆起超过面神经脑桥小脑角段1／3或小脑下前动脉弓在Ⅶ、Ⅷ脑神经之前时将对内窥镜导入有阻碍，当两种情况合并存在时要将内窥镜导入脑桥小脑三角区相当困难，不宜采用此种手术方式。