集合不足型外斜视外直肌斜向后徙

目的　评价集合不足型外斜视外直肌斜向后徙的效果。方法　研究组 2 2例 ,对照组 8例 ,看近斜视角大于看远斜视角至少 15PD ,研究组 2 2例行外直肌斜向后徙术 ,对照组 8例行标准的外直肌后徙术。结果　研究组 18/2 2术后看近外斜度≤ 10PD ,2 2 /2 2术后看远外斜度≤ 10PD ,看近看远外斜角平均差值由术前 2 5± 8 11PD减少到术后 5 2 3± 4 0 3PD。对照组仅 3 /8术后看近外斜度≤10PD ,6/8术后看远外斜度≤ 10PD。结论　集合不足型外斜视外直肌斜向后徙术效果优于标准的外直肌后徙术。     

下直肌后徙加眼球筋膜囊头部复位术初步探讨

目的 探讨有效地防止下直肌后徙术后下睑退缩的手术方法。方法 37例下直肌后徙加CPH复位术病人，下直肌后徙4～6mm，中位数6mm。CPH缝合在新肌止端前浅层巩膜或肌肉断端上，手术前后采用三棱镜遮盖试验测量双眼分别注视时的斜视角，测定双眼下睑缘的位置关系。结果 术后双眼下睑缘位置关系无变化，术后无一例发生下睑退缩，15例随访1～20月，中位数6月，也未出现下睑退缩，多数病人眼位满意。结论 下直肌后徙加CPH复位术可以有效地防止下睑退缩。     

酒石酸罗格列酮对2型糖尿病患者颈动脉内膜中层厚度作用的分析

目的:探讨酒石酸罗格列酮(噻唑烷二酮类药物)抑制动脉粥样硬化的作用。方法:60例2型糖尿病患者服用罗格列酮4mg/d,观察期3个月。通过B型超声仪检测治疗前后颈动脉内膜中层厚度(IMT)及相关生化指标的变化。结果:患者服用罗格列酮3个月后,其IMT值(0.78±0.14)同治疗前(0.84±0.14)比较明显的降低(P<0.001),且IMT值与胰岛素抵抗指数(IAI)呈正相关(r=0.31,P<0.05)。结论:酒石酸罗格列酮可能通过降低胰岛素抵抗以及发挥抗炎抗细胞增殖作用,对2型糖尿病早期动脉粥样硬化病变具有一定的抑制作用。     

前臂内侧神经血管复合体岛状筋膜皮瓣的应用解剖

目的为前臂内侧神经血管复合体岛状筋膜皮瓣的应用提供解剖学基础。方法上肢标本18侧,显微剥离表皮组织,观察前臂内侧皮神经、贵要静脉及各自营养血管的起始、走行、分支、分布及与其它血管的吻合情况;新鲜整尸标本5具,动脉灌注显影剂,剥离体被组织于X光下摄影,分析皮动脉的分布及其与毗邻血管的关系。结果前臂内侧皮神经前支与贵要静脉伴行,两者周围分布着外径大于0.5 mm的营养动脉,平均3.4支,它们分别来自尺侧下副动脉、尺侧返动脉和尺动脉,营养动脉彼此吻合,形成动脉血管链。其中第一支位于肘横纹上21.25±6.33 mm,血管外径1.03±0.24 mm。结论可以在前臂内侧部切取神经血管复合体岛状筋膜皮瓣,供临床使用。     

Ontogeny of aromatase and tyrosine hydroxylase activity and of aromatase-immunoreactive cells in the preoptic area of male and female Japanese quail

The aromatization of testosterone into oestrogens plays a key role in the control of many behavioural and physiological aspects of reproduction. In the quail preoptic area (POA), aromatase activity and the number of aromatase-immunoreactive (ARO-ir) cells are sexually differentiated (males > females). This sex difference is implicated in the control of the sexually dimorphic behavioural response of quail to testosterone. We analysed the ontogenetic development of this sex difference by measuring aromatase activity and counting ARO-ir cells in the POA of males and females from day 1 post hatch to sexual maturity. We investigated in parallel another enzyme: tyrosine hydroxylase, the rate limiting step in catecholamine synthesis. Between hatching and 4 weeks of age, aromatase activity levels were low and equal in males and females. Aromatase activity then markedly increased in both sexes when subjects initiated their sexual maturation but this increase was more pronounced in males so that a marked difference in aromatase activity was present in 6 and 8 week-old subjects. Tyrosine hydroxylase activity progressively increased with age starting immediately after hatching and there was no abrupt modification in the slope of this increase when birds became sexually mature. No sex difference was detected in the activity of this enzyme. The number of ARO-ir cells in the POA progressively increased with age starting at hatching. No sex difference in ARO-ir cell numbers could be detected before subjects reached full sexual maturity. The analysis of the three-dimensional organization of ARO-ir cells in the POA revealed that, with increasing ages, ARO-ir cells acquire a progressively more lateral position: they are largely periventricular in young birds but they are found at higher density in the lateral part of the medial preoptic nucleus in adults. These data indicate that aromatase activity differentiates sexually when birds reach sexual maturity presumably under the activating effects of the increased testosterone levels in males. The number of ARO-ir cells, however, begins to increase in a non sexually differentiated manner before the rise in plasma testosterone in parallel with the increased tyrosine hydroxylase activity. Whether this temporal coincidence results from a general ontogenetic pattern or from more direct causal links remains to be established.     

伴有面转代偿头位的先天性下直肌麻痹临床特征与手术治疗

目的：描述伴有面转代偿头位的先天性单纯下直肌麻痹患者的临床表现,并分析其手术治疗效果。

方法：回顾性分析2014-05/2018-07伴有明显面转代偿头位的先天性下直肌麻痹患者,手术前后患者面转程度的变化借助骨科量角器来检查,垂直、水平斜视度变化通过三棱镜交替遮盖试验来测量,旋转斜视度变化通过眼底对眼球客观旋转状态评估。下直肌缩短术是主要治疗方案。

结果：在15例研究对象中,有13例行下直肌缩短术或者联合上直肌后徙术术后疗效好,下直肌运动不足明显改善,眼球运动协调,以面转为主的代偿头位消失,垂直、水平、旋转斜视得到矫正; 并得出：每缩短1 mm下直肌可矫正1.54±0.93°内旋斜视。而行下斜肌断腱术治疗的垂直斜视度小的患者,面转改善不理想,仍遗留眼球运动不协调。

结论：先天性单纯的下直肌麻痹以面转代偿头位为主,下直肌缩短术治疗效果好,轻度的过矫及欠矫不影响手术疗效。     

Age-dependent changes in the neural substrates of empathy in autism spectrum disorder

In typical development, empathic abilities continue to refine during adolescence and early adulthood. Children and adolescents with autism spectrum disorders (ASD) show deficits in empathy, whereas adults with ASD may have developed compensatory strategies. We aimed at comparing developmental trajectories in the neural mechanisms underlying empathy in individuals with ASD and typically developing control (TDC) subjects. Using an explicit empathizing paradigm and functional magnetic resonance imaging, 27 participants with ASD and 27 TDC aged 12–31 years were investigated. Participants were asked to empathize with emotional faces and to either infer the face’s emotional state (other-task) or to judge their own emotional response (self-task). Differential age-dependent changes were evident during the self-task in the right dorsolateral prefrontal cortex, right medial prefrontal cortex, right inferior parietal cortex, right anterior insula and occipital cortex. Age-dependent decreases in neural activation in TDC were paralleled by either increasing or unchanged age-dependent activation in ASD. These data suggest ASD-associated deviations in the developmental trajectories of self-related processing during empathizing. In TDC, age-dependent modulations of brain areas may reflect the ‘fine-tuning’ of cortical networks by reduction of task-unspecific brain activity. Increased age-related activation in individuals with ASD may indicate the development of compensatory mechanisms.     

Congenital dysplasia involving both medial and inferior recti: clinical features and surgical outcomes

AIM: To investigate the clinical features and surgical outcomes of congenital dysplasia involving both inferior recti (IR) and medial recti (MR) muscles. METHODS: A retrospective review was conducted including cases of simultaneous congenital dysplasia of IR and MR that were diagnosed and surgically treated at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China, from July 2009 to November 2019. Ocular motility, ocular alignment at distance (6 m) and near (33 cm) by prism alternating cover test and stereoacuity were assessed in all patients before and after surgery. RESULTS: A total of five patients (four males and one female; three with right eye and two with left eye congenital dysplasia) were included in this review. The patients ranged in age from 10 to 42y (21±13.4y). The main clinical findings were hypertropia and exotropia of the affected eye, along with motility limitations in adduction and depression. Lateral rectus (LR) recession/transposition combined with IR resection was performed in one case. Two scheduled surgeries were performed in four cases, with one involving superior rectus recession and IR resection and the others LR recession and MR resection. Mean±SD pre-surgical exotropia of 51.0±31.11 prism diopter (PD) and hypertropia of 29.20±7.12 PD in the primary position were decreased to 3.6±12.90 and 3.2±10.09 PD, respectively, at two years after surgery, with a success rate of 60% and an under-correction rate of 40%. CONCLUSION: The main clinical features associated with simultaneous MR/IR congenital dysplasia are hypertropia and exotropia of the affected eye along with motility limitations in adduction and depression. Scheduled two-stage surgeries achieved a success rate of 60%.     

Intraoperative lateral rectus electromyographic recordings optimized by deep intraorbital needle electrodes

ObjectiveWe demonstrate the advantages and safety of long, intraorbitally-placed needle electrodes, compared to standard-length subdermal electrodes, when recording lateral rectus electromyography (EMG) during intracranial surgeries.MethodsInsulated 25 mm and uninsulated 13 mm needle electrodes, aimed at the lateral rectus muscle, were placed in parallel during 10 intracranial surgeries, examining spontaneous and stimulation-induced EMG activities. Postoperative complications in these patients were reviewed, alongside additional patients who underwent long electrode placement in the lateral rectus.ResultsIn 40 stimulation-induced recordings from 10 patients, the 25 mm electrodes recorded 6- to 26-fold greater amplitude EMG waveforms than the 13 mm electrodes. The 13 mm electrodes detected greater unwanted volume conduction upon facial nerve stimulation, typically exceeding the amplitude of abducens nerve stimulation. Except for one case with lateral canthus ecchymosis, no clinical or radiographic complications occurred in 36 patients (41 lateral rectus muscles) following needle placement.ConclusionsIntramuscular recordings from long electrode in the lateral rectus offers more reliable EMG monitoring than 13 mm needles, with excellent discrimination between abducens and facial nerve stimulations, and without significant complications from needle placement.SignificanceLong intramuscular electrode within the orbit for lateral rectus EMG recording is practical and reliable for abducens nerve monitoring.     

Medial sural artery perforator flap aided by preoperative computed tomography angiography mapping for tongue reconstruction

The purpose of this paper is to present an innovative method for tongue reconstruction after cancer ablation using the medial sural artery perforator flap with the aid of preoperative computed tomography angiography (CTA) mapping. We describe the case of one patient treated with this technique and illustrate the anatomy of perforator vessels and the surgical techniques used in flap harvest. CTA was applied preoperatively to assess the number and location of medial sural artery perforators. The result obtained was both aesthetically and functionally satisfactory. The flap presented has the advantage of less donor site morbidity, and being thin, it is a suitable option for tongue reconstruction including that of a hemiglossectomy defect. CTA is an effective means of improving the safety of flap harvest.