Knowledge about sudden infant death syndrome prevention among postpartum women in Southern Brazil, 2019: a cross-sectional survey / Conocimiento sobre la prevención del síndrome de muerte súbita del lactante en puérperas del Sur de Brasil, 2019: un estudio transversal / Conhecimento sobre prevenção da síndrome da morte súbita do lactente entre puérperas no Sul do Brasil, 2019: um estudo transversal

ABSTRACT Objective To assess knowledge on sudden infant death syndrome (SIDS) prevention among postpartum women who received prenatal care in public and private services in Rio Grande, Rio Grande do Sul, Brazil, in 2019. Methods A cross-sectional study was conducted with postpartum women who gave birth in that municipality in 2019; the outcome was the indication of incorrect sleeping position (side/supine position) to prevent SIDS; the chi-square test was used to compare proportions between those who underwent prenatal care in public and private services. Results Among all 2,195 postpartum women, 67.7% (95%CI 65.7;69.6) were unaware of the position that prevents SIDS, 71.6% were public care service users; 77.8% of them feared choking/suffocation; 1.9% were informed about SIDS during prenatal care; doctors/nurses (70.5%) and grandmothers (65.1%) were influential regarding the baby's sleeping position. Conclusion Most postpartum women were unaware of the sleeping position that prevents SIDS, especially those receiving care in the public sector; in general, this subject is not discussed in prenatal care.

RESUMEN Objetivo Evaluar el conocimiento sobre la prevención del síndrome de muerte súbita del lactante (SMSL) entre puérperas que realizaron prenatal en servicios públicos y privados en Rio Grande, Rio Grande do Sul, Brasil, en 2019. Métodos Estudio transversal, con puérperas que dieron a luz en Rio Grande, en 2019; el resultado consistió en la indicación de posición incorrecta para dormir (lado/supino) para prevenir el SMSL; utilizando chi-cuadrado, se compararon las proporciones entre mujeres que recibieron atención prenatal en servicios públicos y privados. Resultados Entre las 2.195 puérperas, 67,7% (IC95% 65,7;69,6) desconocían como se previene el SMSL, estando el 71,6%, en la red pública; 77,8% temía asfixiarse/ahogarse; el 1,9% fue informado sobre el SMSL durante el prenatal; los médicos(as)/enfermeros(as) (70,5%) y los abuelos (65,1%) influyeron en la posición para dormir del bebé. Conclusión La mayoría de las puérperas desconocían la posición que previene el SMSL, especialmente en la red pública; en general, este tema no está cubierto en la atención prenatal.

RESUMO Objetivo Avaliar o conhecimento sobre prevenção da síndrome da morte súbita do lactente (SMSL) entre puérperas com pré-natal realizado nos serviços público e privado de Rio Grande, Rio Grande do Sul, Brasil, 2019. Métodos Estudo transversal, com puérperas do município; seu desfecho constituiuse da indicação de posição incorreta para dormir (decúbito lateral ou dorsal), visando prevenir a SMSL; utilizou-se o teste qui-quadrado para comparar proporções do desfecho e de exposição entre puérperas que realizaram pré-natal nos serviços público e privado. Resultados De 2.195 puérperas, 67,7% (IC95% 65,7;69,6), majoritariamente atendidas na rede pública (71,6%), desconheciam a posição preventiva da SMSL; 77,8% temiam engasgo/afogamento; 1,9% foram informadas sobre SMSL no pré-natal; médicos(as)/enfermeiros(as) (70,5%) e avós (65,1%) mostraram-se influentes na decisão sobre como posicionar o bebê adormecido. Conclusão A maioria das puérperas, especialmente as atendidas na rede pública, desconhecia a posição que previne SMSL; geralmente, o tema não é abordado no pré-natal.

Effects and Mechanisms of Electroacupuncture at Zhongwan （CV12） on Gastric Nociceptive Response Induced by Gastric Acid Stimulation in Rats / 中医杂志

ObjectiveTo observe the effects of electroacupuncture at Zhongwan （CV12） on gastric nociceptive response induced by gastric acid stimulation and explore the underlying mechanisms associated with nuclei of the medullary viscerosensory and visceral motor neurons. MethodsTwenty SD rats were given intragastric administration of 0.5 mol/L diluted hydrochloric acid （0.5 ml/100 g） to induce gastric nociceptive response induction. Eight rats were randomly selected to record the gastric slow wave （GSW） area under the curve， and extracellular discharge frequency of neurons in the nucleus of the solitary tract （NTS） and dorsal motor nucleus of the vagus nerve （DMV） before intragastric administration and at 1， 5， 10， 15， 20， 25， 30， 35， 40， 45， 50， 55， and 60 minutes after intragastric administration. The remaining 12 rats received electroacupuncture intervention at Zhongwan within 5 to 25 minutes after intragastric administration of diluted hydrochloric acid， with a duration of one minute. The GSW area under the curve and extracellular discharge frequency of NTS and DMV neurons were compared between the 1-minute intervals before and after electroacupuncture intervention. ResultsCompared to the baseline before intragastric administration， the area under the curve of GSW significantly increased at 1， 5， 10， 15， 20， and 25 minutes after intragastric administration， and the extracellular discharge frequency of excitatory neurons in the NTS （accounting for 90%， 57/63） significantly increased at 1， 5， 10， 15， 20， 25， 30， 35， and 40 minutes， both reaching peak values at 1 minute after intragastric administration （P＜0.01 or P＜0.05）. The extracellular discharge frequency of inhibitory neurons in the DMV （accounting for 91%， 20/22） showed a non-significant increase at 1 minute after intragastric administration （P＞0.05）， but significantly decreased at other timepoints （P＜0.05）. Compared to the baseline before electroacupuncture intervention， the GSW area under the curve and the extracellular discharge frequency of excitatory neurons in the NTS significantly decreased （P＜0.05）， while the extracellular discharge frequency of inhibitory neurons in the DMV showed no significant difference （P＞0.05）. ConclusionElectroacupuncture at Zhongwan can improve gastric nociceptive response induced by gastric acid stimulation， possibly by reducing the transmission of visceral sensation and decreasing the excitability of NTS neurons in the medulla.

Intervention effect of Tuina pressing and kneading the Huantiao (GB30) acupoint on NF-κB p65 protein at spinal cord dorsal horn in sciatica rats / 中国骨伤

OBJECTIVE@#To observe the analgesic effect of Tuina by pressing and kneading the Huantiao (GB30) acupoint on rats with chronic constriction injury (CCI) and to explore the analgesic mechanism of Tuina on sciatica rats.@*METHODS@#Thirty-two SPF male SD rats weighing 180 to 220 g were randomly divided into fore groups:blank group (without any treatment), sham group (only exposed without sciatic nerve ligating), model group (sciatic nerve ligating) and Tuina group (manual intervention after lsciatic nerve ligating). The CCI model was prepared by ligating the right sciatic nerve of the rats, on the third day of modeling, the rats in the Tuina group were given pressing and kneading the Huantiao (GB30) point for 14 days, and the changes of paw withdrawal threshold(PWT), paw withdrawal latency(PWL) were measured before and on the 1st, 3rd, 7th, 10th, 14th and 17th days after modeling. The changes of sciatic functional index(SFI) were measured before and on the 1st and 17th day after modeling. The morphological changes of the sciatic nerve were observed by hematoxylin-eosin(HE) staining;and the differences in NF-κB protein expression in the right dorsal horn of the spinal cord of rats were detected.@*RESULTS@#Following modeling, there was no significant difference in PWT, PWL and SFI between the blank group and the sham group (P>0.05), but the PWT, PWL and SFI of the model group and the Tuina group decreased significantly (P<0.01). After manual intervention, the pain threshold of rats in Tuina group increased. On the 8th day of manual intervention (the 10th day after modeling), PWT in Tuina group increased significantly compared with that in model group (P<0.01). On the 5th day of manual intervention (the 7th day after modeling), the PWL of the massage group was significantly higher than that of the model group (P<0.01). The pain threshold of rats in Tuina group continued to rise with the continuous manipulation intervention. After 14 days of manipulative intervention, the sciatic nerve function index of rats in the Tuina group increased significantly(P<0.01). Compared with the blank group and sham group, the myelinated nerve fibers of sciatic nerve in the model group were disordered and the density of axons and myelin sheath was uneven. Compared with the model group, the nerve fibers of rats in the Tuina group were gradually continuous and the axons and myelin sheath were more uniform than those in the model group. Compared with the blank group and sham group, the expression of NF-κB protein in the right spinal dorsal horn of the model group was significantly increased(P<0.01). Compared with the model group, the expression of NF-κB protein in the right spinal dorsal horn of rats in Tuina group decreased significantly(P<0.01).@*CONCLUSION@#Pressing and kneading the Huantiao (GB30) point restores nerve fiber alignment;and improves the PWT、PWL and SFI in the CCI model by decreasing NF-κB p65 protein expression in the spinal dorsal horn. There fore, Tuina demmstrates an analgesic effect and improves the gait of rats with sciatica.

The application of intraoperative neurophysiological monitoring in selective dorsal neurotomy for primary premature ejaculation: a prospective single-center study / 亚洲男科学杂志(英文版)

Selective dorsal neurotomy (SDN) is a surgical treatment for primary premature ejaculation (PE), but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed. We performed this study to explore the value of intraoperative neurophysiological monitoring (IONM) of the penile sensory-evoked potential (PSEP) for standard surgical procedures in SDN. One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group. The PSEP was monitored and compared between the two groups under both natural and general anesthesia (GA) states. In addition, patients in the PE group were randomly divided into the IONM group and the non-IONM group. During SDN surgery, PSEP parameters of the IONM group were recorded and analyzed. The differences in PE-related outcome measurements between the perioperative period and 3 months' postoperation were compared for the PE patients, and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared. The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states (P < 0.001). Three months after surgery, the significant effective rates in the IONM and non-IONM groups were 63.6% and 34.0%, respectively (P < 0.01), and the difference in complications between the two groups was significant (P < 0.05). IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.

Bilateral variation in the branching pattern of the subclavian artery: an unusual finding with clinical implications / Variação bilateral no padrão de ramificação da artéria subclávia: um achado incomum com implicações clínicas

Abstract The subclavian artery is a significant branch of the aortic arch. We present a rare case of a bilateral variation in the branching pattern of the subclavian artery, observed in an adult male cadaver aged 70 years. On both the sides of the neck, all the branches of the subclavian artery took their origin from its first part. There was a rare occurrence of a cervicodorsoscapular trunk, which gave rise to superficial cervical, suprascapular, and dorsal scapular arteries. The same branching pattern was observed on the left side of the neck, with the presence of another cervicodorsoscapular trunk. Thyrocervical trunk and transverse cervical artery were both absent from the cervical region bilaterally. The inferior thyroid artery was a direct branch from the subclavian artery. Knowledge regarding variations of the subclavian artery is very important as lateral cervical region arteries are important for flap harvesting in plastic and reconstruction surgery. Preoperative radiologic evaluation of pedicles might help in choosing the optimal flap design, prevent ischemic complications, and help to improve overall treatment outcomes.

Resumo A artéria subclávia é um ramo significativo do arco da aorta. Apresentamos um caso raro de variação bilateral do padrão de ramificação da artéria subclávia, observada em um cadáver adulto do sexo masculino de 70 anos. Em ambos os lados do pescoço, todos os ramos da artéria subclávia originavam-se de sua primeira parte. Houve rara ocorrência de tronco escapular cervical dorsal, que deu origem às artérias cervical superficial, supraescapular e escapular dorsal. O mesmo padrão de ramificação foi observado no lado esquerdo do pescoço, com a presença de tronco escapular cervical dorsal. O tronco tireocervical e a artéria cervical transversa estavam ausentes em ambas as regiões cervicais direita e esquerda. A artéria tireóidea inferior consistia em um ramo direto da artéria subclávia. O conhecimento das variações da artéria subclávia é fundamental, pois as artérias da região cervical lateral são importantes para a obtenção de retalhos em cirurgias plásticas e reconstrutivas. A avaliação radiológica pré-operatória dos pedículos pode ajudar na escolha do desenho ideal do retalho, prevenir complicações isquêmicas e ajudar a melhorar o resultado geral do tratamento.

Bloodletting at auricular dorsal vein combined with auricular point sticking for menstrual migraine of qi stagnation and blood stasis and its effect on serum levels of E2 and 5-HT / 中国针灸

OBJECTIVE@#To observe the clinical effect of bloodletting at auricular dorsal vein combined with auricular point sticking on menstrual migraine (MM) of qi stagnation and blood stasis, and explore its possible mechanism.@*METHODS@#A total of 102 cases of MM with qi stagnation and blood stasis were randomly divided into an observation group (51 cases, 3 cases dropped off) and a control group (51 cases, 2 cases dropped off). The patients in the observation group were treated with bloodletting at auricular dorsal vein combined with auricular point sticking. The bloodletting was performed at vein at upper 1/3 of the dorsalis near the ear helix; the auricular point sticking was performed at Pizhixia (AT4), Neifenmi (CO18), Jiaogan (AH6a), Nie (AT2), Zhen (AT3), Shenmen (TF4) and Yidan (CO11). The auricular points of both ears were alternate used. From 7 days before the onset of menstruation, bloodletting at auricular dorsal vein was given once every 7 days, 3 times were taken as a course of treatment, and 1 course of treatment was given; the auricular point sticking was given once every 3 days, and 6 times of treatment were given. The patients in the control group were treated with oral administration of flunarizine hydrochloride capsules. From 7 days before the onset of menstruation, flunarizine hydrochloride was given 2 capsules per time, once a day for 3 weeks. The menstrual headache index and visual analogue scale (VAS) score of the two groups were observed before treatment, one menstrual cycle into treatment and the first and the second menstrual cycle after treatment; the migraine-specific quality of life questionnaire (MSQ) score and the serum levels of estradiol (E2) and 5-hydroxytryptamine (5-HT) were compared before treatment and one menstrual cycle into treatment; the clinical efficacy was evaluated at one menstrual cycle into treatment.@*RESULTS@#Compared before treatment, the menstrual headache index and VAS scores were reduced at one menstrual cycle into treatment and the first and second menstrual cycle after treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). Compared before treatment, the MSQ scores and the serum levels of E2 and 5-HT in the two groups were increased at one menstrual cycle into treatment (P<0.05), and those in the observation group were higher than the control group (P<0.05). The total effective rate was 95.8% (46/48) in the observation group, which was higher than 73.5% (36/49) in the control group (P<0.05).@*CONCLUSION@#Bloodletting at auricular dorsal vein combined with auricular point sticking could relieve headache intensity, improve the quality of life in patients with MM of qi stagnation and blood stasis, which may be achieved by raising the serum levels of E2 and 5-HT to improve the level of hormone in the body.

Dorsal midbrain syndrome from thalamocapsuloganglionic hemorrhage: A case report

@#Dorsal midbrain syndrome (DMS) is a supranuclear palsy of vertical gaze characterized by conjugate upgaze palsy, light-near dissociation, convergence-retraction nystagmus, lid retraction, and skew deviation. Majority of cases are due to primary midbrain lesions such as strokes or neoplasms, or due to pineal gland tumors compressing the said area. Presented here is the case of a 57-year-old male who came in with a chief complaint of diplopia and the typical signs of DMS. Cranial tomography scan revealed a parenchymal hemorrhage at the left thalamocapsuloganglionic region, a rarely reported site of a primary lesion causing DMS. In this case, the syndrome may have been a consequence of the mass effects and perilesional edema associated with the thalamocapsuloganglionic hemorrhage, or may have been due to disruption of supranuclear inputs to the dorsal mibdrain. This case provides further evidence that DMS may arise from lesions without obvious involvement of the said region. This case also highlights the importance of a thorough physical examination to elicit the findings associated with DMS, and the need to correlate these with a keen analysis of diagnostic test results.

Analgesic Effect of Intrathecal 2R， 6R-HNK on Neuropathic Pain in Female Mice / 中山大学学报(医学科学版)

ObjectiveTo investigate the analgesic action and mechanism of intrathecal 2R， 6R-hydroxynorketamine （2R， 6R-HNK） on spared nerve injury （SNI）-induced chronic neuropathic pain （CNP） in female mice. MethodsSNI was used to establish acute and chronic CNP models in female mice. The mice were randomly divided into different groups with administration of vehicle， 2R， 6R-HNK or S-ketamine （10 mg/kg intraperitoneal injection/i.p. or 7， 21 μmol/L intrathecal injection/i.t.） at 3 weeks after or 30 min/1 d before operation （n = 3 - 7 mice/group）. The curative or preventive effect of 2R， 6R-HNK was evaluated by mechanical paw withdrawal threshold （PWT） and the analgesic efficiency. Finally， immunofluorescence and RT-PCR of dorsal root ganglion （DRG） and spinal dorsal horn （SDH） were used to explore the possible mechanisms. ResultsCompared with vehicle， intrathecal injection of 2R， 6R-HNK largely reversed SNI-induced bilateral mechanical allodynia in a delayed-and-dose-dependent way. Among them， 21 μmol/L 2R， 6R-HNK reached its maximum analgesic efficiency （75.32±7.69） % at 2 d. Pre-intrathecal delivery of 2R， 6R-HNK also delayed the development of bilateral mechanical hypersensitivity 2 - 3 d induced by SNI. Mechanically， 2R， 6R-HNK reversed not only the abnormal excitability of neurons in bilateral DRG and superficial SDH， but also the upregulation of calcitonin gene-related peptide （CGRP） and brain-derived nerve growth factor （BDNF） in DRG. ConclusionIntrathecal administration of 2R， 6R-HNK exerts an analgesic effect against CNP， probably via suppressing abnormal neuronal excitability in ascending pain pathway as well as down-regulating CGRP and BDNF expression in DRG neurons.

Remifentanil Down-regulates GIRK2 Expression in Rat Dorsal Root Ganglion and Spinal Dorsal Horn / 中山大学学报(医学科学版)

ObjectiveTo observe the changes in the expression and distribution of G protein-gated inwardly rectifying potassium channel subunit 2 （GIRK2） in the dorsal root ganglion （DRG） and spinal cord dorsal horn of rats with remifentanil-induced hyperalgesia. MethodsHyperalgesia was induced by intravenous infusion of remifentanil 4 μg/kg/min for 2 h in adult male SD rats. At 6th hour and on days 1， 3 and 5 following remifentanil treatment， we used immunofluorescence to examine the changes in the GIRK2 distribution and expression. Immunoblotting was used to detect GIRK2 expression of the total protein and membrane protein in DRG and spinal dorsal horn of rats. Behavioral testing was applied to evaluate the effect of intrathecal injection of GIRK2-specific agonist ML297 on thermal nociceptive threshold on day 1 after remifentanil infusion. Resultsmmunofluorescence results showed that GIRK2 was mainly co-localized with IB4-positive small neurons in DRG and nerve fibers in spinal dorsal horn. GIRK2 expression was significantly downregulated following remifentanil treatment. Immunoblotting results revealed that on day 1 following intravenous infusion of remifentanil， compared with those in the control group， GIRK2 expression levels of the total protein and membrane protein in DRG （0.47 ± 0.10 vs. 1.01 ± 0.17， P < 0.001； 0.47 ± 0.11 vs. 1.06 ± 0.12， P < 0.001） and spinal dorsal horn （0.52 ± 0.09 vs. 1.10 ± 0.08， P < 0.001； 0.54 ± 0.10 vs. 1.01 ± 0.13， P < 0.001） were all significantly decreased. The behavioral results showed that intrathecal ML297 effect on thermal withdrawal latency was significantly reduced following remifentanil treatment （P < 0.001）. ConclusionsRemifentanil might induce hyperalgesia via down-regulating GIRK2 expression in rat DRG and spinal cord dorsal horn.

Adjustable "paper clip" techniques suturing the dorsal vein complex in radical prostatectomy / 现代泌尿外科杂志

【Objective】 To investigate the efficacy of the adjustable "paper clip" techniques in the suture of dorsal vein complex (DVC) and retention of urethral function in robot-assisted laparoscopic radical prostatectomy (RALRP). 【Methods】 A total of 30 cases of prostate cancer treated with RALRP were enrolled, all of which used the adjustable "paper clip" techniques. During operation, the DVC was sewed with barbed suture, and then a reverse suture was made through two sides of the prostatic ligaments. A Hem-o-lock was used to fasten the suture, which would be flexible to control the degree of tightness for the ligature. Perioperative and follow-up data of urinary continence and symptoms were collected and analyzed. 【Results】 All operations were successful. The estimated blood loss was (123.3±80.7) mL, 53.6% patients recovered continence in 1 month, and the continence rate increased to 92.9% and 96.3% at month 3 and 6. 92.9 of patients had no risk of incontinence 3 months after surgery. 【Conclusion】 The adjustable "paper clip" techniques have advantages in reducing blood loss, maintaining clear surgical field, preserving urethral function, and improving urinary continence.

Analgesic Effect and Mechanism of Osteoking on Dorsal Root Ganglion Compression Model Rats / 中国实验方剂学杂志

ObjectiveTo investigate the analgesic effect and mechanism of Osteoking （OK） on nerve compression in lumbar disc herniation. MethodThe rat model of chronic compression of dorsal root ganglion （CCD） was established to simulate clinical lumbar disc herniation. The CCD rats were randomly divided into model group， low， medium， and high dose OK groups （1.31， 2.63， 5.25 mL·kg-1·d-1）， and pregabalin group （5 mg·kg-1）， with eight rats in each group. Another eight SD rats were taken as the blank group， and the same volume of normal saline was given by gavage. Behavioral tests， side effect evaluation， network analysis， Western blot， immunofluorescence， and antagonist application were used to explore the effect. ResultCompared with the blank group， the mechanical hyperalgesia threshold， thermal hyperalgesia threshold， and the expression of inflammatory factors in the spinal dorsal horn of the model group are significantly increased （P<0.01）， and the related indicators of the affected foot footprints are significantly down-regulated （P<0.01）. The expression of signal transducer and activator of transcription 3 （STAT3）， vascular endothelial growth factor A （VEGFA）， and phosphorylated extracellular regulated protein kinase （p-ERK） in microglia in the spinal dorsal horn is significantly increased in the model group （P<0.01）. Compared with the model group， low， medium， and high dose OK groups can increase the mechanical hyperalgesia and thermal hyperalgesia thresholds of CCD rats （P<0.05， P<0.01） in a dose-dependent manner， improve the gait of CCD rats （P<0.05， P<0.01）， and reduce the expression of inflammatory factors in the spinal dorsal horn （P<0.05， P<0.01）. The expression of STAT3， VEGFA， and p-ERK in the spinal dorsal horn microglia of CCD rats is significantly decreased （P<0.05， P<0.01）， and the acetic acid-induced nociceptive response in rats is effectively reduced （P<0.05， P<0.01）. In addition， there is no tolerance. The results of the body mass test， organ index， forced swimming， and rotation show that OK has no obvious toxic or side effects. Further antagonist experiments show that MRS1523 and RS127445 can reverse the transient analgesic effect of OK compared with the high dose OK group （P<0.01）. ConclusionOK has a good analgesic effect on the CCD model without obvious toxic side effects， and its mechanism may be related to the activation of ADORA3 and HTR2B and the inhibition of STAT3， VEGFA， p-ERK， and other elements in microglia.

Exploring the effect of Tuina on the dendritic structure of spinal cord dorsal horn in rats with lumbar disc herniation based on NR2B/PSD-95 pathway / 针灸推拿医学（英文版）

Objective: To investigate the analgesic mechanism of Tuina (Chinese therapeutic massage) by observing the effect of the N-methyl-D-aspartate receptor subunit 2B (NR2B)/postsynaptic density-95 (PSD-95) pathway on the dendritic structure of spinal cord dorsal horn in rats with lumbar disc herniation. Methods: Fifty Sprague-Dawley rats were randomly divided into a blank group, a model group, a Tuina group, a blocker agent group, and a blocker agent + Tuina group. The sciatic nerve chronic constriction injury (CCI) model was prepared by the sciatic nerve ligation method. From the 4th day after modeling, rats in the Tuina group and the blocker agent + Tuina group were subject to daily Tuina intervention, and those in the blocker agent group and the blocker agent + Tuina group were daily intrathecally injected with NR2B blocker agent (MK-801). The spontaneous pain score was used to observe the pain behavior of all rats. The expression levels of NR2B and downstream PSD-95 were measured by immunohistochemistry, and the dendritic structure changes were observed by Golgi staining for rat spinal cord dorsal horn after 14 d of continuous intervention. Results: Compared with the blank group, the degree of rat spontaneous pain after CCI was elevated in both the model and the Tuina groups (P<0.01) and was reduced in the Tuina group after the Tuina intervention compared with the model group (P<0.05). Compared with the model group, the rat spontaneous pain level after blocking NR2B was reduced in both the blocker agent group and the blocker agent + Tuina group (P<0.05). The NR2B and PSD-95 protein levels were significantly higher in the model group compared with the blank group (P<0.01); the total number of dendritic branches was increased (P<0.01), and the total dendritic length became longer (P<0.01) in the spinal cord dorsal horn. The rat NR2B and PSD-95 protein levels were significantly decreased in the Tuina group compared with the model group (P<0.01); the total dendritic branch number was reduced (P<0.01) and the total length was shortened (P<0.01) in the spinal cord dorsal horn. After blocking NR2B, the expression levels of NR2B and downstream PSD-95 protein were significantly lower in both the blocker agent group and the blocker agent + Tuina group compared to the model group (P<0.01). The total branch number was significantly reduced (P<0.01), and the total length was significantly shortened (P<0.01) of the dendrites in the spinal cord dorsal horn. Conclusion: Tuina may exert an analgesic effect by remodeling the dendritic structure in the spinal cord dorsal horn in rats with lumbar disc herniation, and its mechanism may be related to the inhibition of NR2B/PSD-95 signaling pathway.

Comparison of two types of flaps based on dorsal cutaneous branch of proper palmar digital artery for repair of wound of fingertip or finger-pulp / 中华显微外科杂志

Objective:To compare the clinical effectiveness of propeller flap and vascular chain flap based on dorsal cutaneous branch of proper palmar digital artery for repair of wounds of fingertip or finger-pulp.Methods:From April 2018 to May 2021, a total of 55 patients (55 fingers) with wounds of fingertip or finger-pulp in the 2nd-5th fingers were treated in emergency surgery in the Department of Hand Surgery, the Second Hospital of Tangshan. The patients were randomly divided into 2 groups by the method of drawing lots. The wounds of 29 patients (29 fingers) were repaired by propeller flaps based on dorsal cutaneous branch of proper palmar digital artery (propeller group) and that of 26 patients(26 fingers) were treated by vascular chain flaps based on dorsal cutaneous branch of proper palmar digital artery(vascular chain group). Survival of the flaps and the skin grafts at donor sites were observed between the 2 groups. The operation and follow-up time in both groups were recorded. Postoperative follow-up included outpatient clinic visits, telephone reviews and WeChat video-clips. At final follow-up, the static TPD of the flaps, patient satisfaction with the appearance of flaps and donor sites and the Range of motion(ROM) of the injured fingers were recorded. The measurement and count data of both groups were compared by independent sample t-test, χ2 tests or Fisher's exact test, respectively. P<0.05 was considered a statistically significant. Results:All the flaps and skin grafts survived primarily in both groups. The operation time in propeller group was 57.55 minutes±4.35 minutes. It was less than what in the vascular chain group (61.12 minutes±4.58 minutes) and with statistically significant difference( P<0.05). The follow-up period was 14.55 months±2.89 months in propeller group and 15.15 months±3.78 months in the vascular chain group. There was no significant difference between the 2 groups( P>0.05). At final follow-up, the static TPD and patient satisfaction with the appearance of flaps in propeller group were 6.55 mm±1.24 mm and 4.59±0.50, which were better than 7.46 mm±1.27 mm and 4.31±0.47 in the vascular chain group with a statistically significant difference( P<0.05). The patient satisfaction with the appearance of donor sites and ROM of the injured digital joints in propeller group were 4.45±0.57 and 190.86°±8.56°, while what in the vascular chain group were 4.35±0.56 and 185.96°±10.58°. There was no significant difference between the 2 groups( P>0.05). Conclusion:The propeller flap and vascular chain flap are both based on dorsal cutaneous branch of proper palmar digital artery and are both suitable for repair of wounds of fingertip or finger-pulp. Compared with the vascular chain flap, the propeller flap has the advantages in shorter operation time, better flap sensation and appearance.

Chimeric flap pedicled with superficial branch of superficial iliac circumflex artery in repair of soft tissue defects of dorsal hand and metacarpal bone / 中华显微外科杂志

Objective:To investigate the effect of chimeric flap pedicled with superficial branch of superficial iliac circumflex artery in repair of soft tissue defect of dorsal hand combined with metacarpal bone defect.Methods:From May 2015 to January 2022, 34 patients(28 males and 6 females) of soft tissue defects of dorsal hand with metacarpal bone defects were treated in the Department of Orthopedics of Yibin Third People's Hospital. The age of patients ranged from 22 to 51 years old, with an average age of 37 years old. The areas of soft tissue defects after debridement were 2.5 cm×5.0 cm-4.5 cm×9.0 cm, and the defects were all in dorsal hand and dorsal wrist. The lengths of metacarpal bone defect were 1.8-4.1 cm. All the patients had only single metacarpal bone defect, among which: 14 patients had defects in first metacarpal bone, 7 in second metacarpal bone, 4 in third metacarpal bone, 8 in fourth metacarpal bone and 1 in fifth metacarpal bone. All the patients were repaired by chimeric flap pedicled with superficial branch of superficial iliac circumflex artery. The size of flaps were 3.6 cm×5.4 cm-5.2 cm×9.5 cm. Anticoagulation, thermal preservation and plaster fixation were applied for 4-6 weeks after surgery. Postoperative follow-ups included regularly outpatient clinic visit, telephone or Wechat reviews. Follow-up items covered: the feeling and appearance of flaps in recipient sites, healing of the donor sites and recovery of hand functions.Results:All the 34 chimeric flaps survived. Regular follow-up lasted for 3 to 15(average, 10) months. All incisions in the donor sites of hip healed in stage I. TPD of the flaps was 5.1-7.3(mean, 6.4) mm. Appearance of flaps in the receiving area were satisfactory without swelling. Movement of wrists and metacarpophalangeal joints met the basic requirement of movement. The healing time of metacarpal defect was 2-3 months with an average of 2.8 months. Hand functions were evaluated at excellent in 6 patients and good in 28, according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Conclusion:The chimeric flap pedicled with superficial branch of superficial iliac circumflex artery is an ideal flap to repair the soft tissue defect in dorsal hand combined with metacarpal bone defect. It has advantages of less donor site damage, good blood supply of flap, simple surgical procedure, and one-stage repair of a combined soft tissue and metacarpal bone defects.

Effects of transcranial magnetic stimulation combined with radiofrequency ablation of dorsal root ganglia in the treatment of herpes zoster neuralgia / 中华物理医学与康复杂志

Objective:To observe the clinical efficacy of combining repeated transcranial magnetic stimulation (rTMS) with radiofrequency ablation (RF) of dorsal root ganglia in treating herpes zoster infection and neuralgia.Methods:Eighty-four individuals with a herpes zoster infection who had suffered from neuralgia for no more than 7 days were divided randomly into a control group, an rTMS group, an RF group, and an observation group, each of 21. All were treated with gabapentin, valciclovir and mecobalamin. The rTMS group received rTMS treatment, 5 days per week, for 2 consecutive weeks. The RF group received RF treatment of the dorsal root ganglia on the 15th day after enrollment, while the observation group received only the medication. Before the experiment as well as after 3, 7, 16, 30 and 60 days, all of the subjects self-assessed their discomfort using a pain visual analog scale (VAS). The Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Quality of Life Assessment Scale (QOL-SF36), and Pittsburgh Sleep Quality Index (PSQI) were also administered.Results:The average VAS, HAMA, HAMD, QOL-SF36, and PSQI scores of the observation group improved continuously and significantly during and after the treatment. Beyond 16 days all of those results were significantly better than the control group′s averages, and the observation group′s average VAS, HAMA and HAMD results were also significantly better than those of the rTMS group. The observation group′s average VAS, HAMA, HAMD and PSQI scores had improved significantly more than the RF group′s averages beyond 30 days.Conclusion:Combining rTMS and dorsal root ganglion RF can effectively alleviate the early pain symptoms of herpes zoster infection and neuralgia, relieve anxiety and depression, and significantly improve sleep and life quality. Such therapy is worthy of clinical promotion and application.

Analysis of left hepatolithiasis treated with cranial-dorsal approach laparoscopic anatomic left hemihepatectomy / 中华肝胆外科杂志

Objective:To study the safety and feasibility of anatomic left hemihepatectomy via cranial-dorsal approach in the treatment of left hepatolithiasis.Methods:Clinical data of 47 patients with left intrahepatic bile duct stones who underwent cranial-dorsal approach laparoscopic anatomic left hemihepatectomy in Hunan People's Hospital from October 2016 to June 2022 were retrospectively analyzed, including 15 males and 32 females, aged (56.45±1.37) years old. The operative time, intraoperative blood loss, postoperative liver function and complications were analyzed. Patients were followed up by telephone and outpatient review.Results:All 47 patients successfully underwent laparoscopic surgery without conversion. The median operative time was 260 (range, 160-440) min. The median intraoperative blood loss was 100 ml (range, 20-400 ml). The total bilirubin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were 15.7 (11.7, 21.9) μmol/L, 126.6 (91.7, 168.5) U/L, and 151.1 (98.0, 212.4) U/L on postoperative day (POD) 1, respectively, and decreased to 12.6 (9.6, 16.2) μmol/L, 97.9 (60.7, 156.9) U/L, 54.2 (40.0, 104.1) U/L on POD 3, respectively. The median postoperative hospital stay was 7 (range, 4-24) d. Postoperative abdominal effusion and infection occurred in one patient, and the complication rate was 2.1% (1/47). Postoperative CT review found residual stones in common bile duct in one patient [2.1% (1/47)]. No stone recurrence or death occurred during postoperative follow-up.Conclusion:Anatomic left hemihepatectomy via cranial-dorsal approach is a safe and feasible surgery for the treatment of left hepatolithiasis.

A circuit from dorsal hippocampal CA3 to parvafox nucleus mediates social novelty preference deficits induced by chronic social defeat stress / 中国药理学与毒理学杂志

OBJECTIVE The preference for social novelty is crucial to the social life of humans and rodents.However,the neural mechanisms underlying social novelty preference are poorly understood.Dorsal hippocampal CA3(dCA3)is an important brain area that responds to social defeat stress,and the neural circuitry of dCA3→lat-eral septum(LS)participates in the context-associated memory.Meanwhile,the parvafox nucleus(PFN)Foxb1+ neurons regulate the defensive reaction to life-threaten-ing situations.Therefore,we investigate a cell-specific cir-cuit of dCA3CaMKⅡα+→dorsal LSGABA+→PFNFoxb1+ in social novelty preference.METHODS Chronic social defeat stress(CSDS)and three-chamber social interaction test were performed in adult male C57BL/6J mice to detect social behaviors.Optogenetic and chemical-genetic experiments were conducted to regulate the circuit.RESULTS CSDS reduced the preference for social nov-elty in mice and the response of dCA3CaMKⅡα+ neurons dur-ing approach to an unfamiliar mouse was impaired by CSDS.Optogenetic inhibition of dCA3CaMKⅡα+→dLS pro-jection reduced the preference for the unfamiliar mouse versus a familiar mouse.Meanwhile,optogenetic activa-tion of dCA3CaMKⅡα+→dLS projection rescued the prefer-ence for social novelty of CSDS-treated mice.Manipula-tions dLSGABA+→PFN projection activation regulated the preference for social novelty in mice.Optogenetic activa-tion of PFNFoxb1+→lPAG projection reduced the prefer-ence for a familiar C57BL/6J mouse versus a novel object in control mice.CSDS decreased the excitability of dCA3CaMKⅡα+ neurons by up-regulation of Kir2.4(Kcnj14)expression.CONCLUSION Our present study suggest-ed that activation of a cell-specific circuit of dCA3CaMKⅡα+→dLSGABA+→PFNFoxb1+→lPAG reverses the deficits of social novelty preference in defeated mice,and inhibition of this circuit reduces the preference for social novelty.The cir-cuit that regulates the preference for social novelty deficits may provide a new information for the potential therapeu-tic targets for neuropsychiatric diseases.

Agenesia del páncreas dorsal: reporte de caso y revisión del tema / Agenesis of the dorsal pancreas: case report and topic review

Complete agenesis of the dorsal pancreas (ADP) is an exceedingly rare congenital anomaly, compatible with life. It may be asymptomatic and usually incidentally diagnosed. In symptomatic cases, the clinical manifestations vary from abdominal pain, pancreatitis and diabetes mellitus to exocrine insufficiency with steatorrhea. We present a case report of a 28 year old female with ADP, diagnosed incidentally during radiological evaluation for hyperglycemias in SARS COV2 concomitant affection. Magnetic resonance cholangiopancreatography confirmed the absence of, neck, body and tail of the pancreas. Knowing the pancreatic embryogenesis, the clinical presentation of their malformations and the main radiological characteristics is important for the proper diagnosis of these anomalies.

Asociación de colgajo dorsal ancho pediculado y libre para reconstrucción de grandes defectos de mama y tórax / Association of pedicled and free latissimus dorsi flap for reconstruction of large breast and thoracic defects

Introducción. Los tratamientos del cáncer de mama en estadios avanzados suelen ser tratamientos radicales. Ello implica la resección de grandes cantidades de tejido, a veces asociada a radioterapia o a procedimientos como quimioembolización intraarterial, lo que suele dar como resultado un gran defecto de cobertura cutánea que involucra no solo la mama sino también todo el hemitórax. Esto resulta un desafío para el cirujano plástico reconstructivo, ya que tiene que acudir a técnicas reconstructivas más complejas. En este trabajo proponemos, para estas pacientes, reconstrucción mamaria unilateral con la utilización de dos colgajos para cubrir el defecto completamente y así restaurar el tórax y la mama. Pacientes y métodos. Se realiza un estudio retrospectivo desde enero de 2017 a agosto de 2019. Se analizan 11 (once) pacientes con grandes defectos de cobertura cutánea. Diez pacientes reúnen la característica común de haber presentado cáncer de mama en estadio III, sometiéndose a cirugía radical + radioterapia. Una de las once presenta una necrosis extensa del hemitórax y la mama producto de una complicación de la quimioembolización intraarterial. Se realizó reconstrucción mamaria unilateral en dos tiempos con tejido autólogo mediante dos colgajos: colgajo dorsal ancho pediculado + colgajo dorsal ancho libre (6 casos). Una de ellas acude con el primer colgajo dorsal ancho pediculado realizado en otra institución; colgajo dorsal ancho pediculado + colgajo DIEP (3 casos); colgajo dorsal ancho pediculado + colgajo SGAP (1 caso), colgajo TRAM pediculado y colgajo dorsal ancho pediculado (1 caso). Resultados. Todos los colgajos sobrevivieron. El caso del paciente con colgajo TRAM fue derivado de otra institución con una vitalidad del 50%. Se presentó un caso de seroma en zona dadora de la espalda y una dehiscencia de herida en el mismo. El seguimiento promedio fue de 21,36 meses luego de la segunda instancia quirúrgica. Conclusiones. Los grandes defectos de tejidos blandos en el tórax anterior causados por resecciones extrarradicales de mama dejan defectos demasiado grandes para ser cubiertos por los colgajos de reconstrucción mamaria tradicionales. La reconstrucción mediante la asociación de un colgajo dorsal ancho pediculado y un colgajo dorsal ancho libre demostró ser una buena opción estética y funcional para poder resolver estos casos complejos que involucran no solo a la mama, sino también a la región torácica.

Large soft tissue defects in the anterior thorax cause by extraradical breast resections leave too large defects to be covered by traditional breast reconstruction flaps. Reconstruction by association of a pedicled latissimus dorsi flap and a free latissimus dorsi flap proved to be a good aesthetic and functional option, so much to be able to solve these complex cases that involve not only the breast as well also to the thoracic region.

Risco para lesões por posicionamento cirúrgico decorrentes da posição supina / Riesgo de lesiones de posicionamiento quirúrgicoderivadas de la posición supina / Risk for surgical position injuries arising from the supine position

Objetivo: relacionar o escore de risco de lesões por posicionamento cirúrgico decorrentes da posição supina com aspectos sociodemográficos, clínicos, cirúrgicos e ocorrência de complicações. Método: estudo observacional longitudinal realizado com 89 pacientes em decúbito dorsal. Aplicadas variáveis ​​sociodemográficas e clínicas e a Escala de Risco para Desenvolvimento de Lesões por Posicionamento Cirúrgico. Adotadas análises descritivas, bivariadas e de regressão logística, considerando-se um nível de significância de α=0,05. Resultados: a idade aumentou em 1,11 vezes (p<0,001) e a obesidade em 13,77 vezes (p=0,01) a chance de aumento do risco de lesões. A proporção de dor (34,1%) e lesão por pressão na região sacrococcígea (91,7%) destacou-se nos pacientes de maior risco (p=0,05). Conclusão: obesos e idosos apresentaram maior risco de lesões. Dor e ocorrência de lesão por pressão na região sacrococcígea foram as complicações predominantes nos pacientes de maior risco (AU)

Objective:to relate the risk score for injuries due to surgical positioning resulting from the supine position with sociodemographic, clinical, surgical aspects and the occurrence of complications. Method: longitudinal observational study carried out with 89 patientsin the supine position. Sociodemographic and clinical variables and the Risk Scale for the Development of Surgical Positioning Injuries were applied. Descriptive, bivariate and logistic regression analyzes were adopted, considering a significance level ofα=0.05. Results: age increased by 1.11 times (p<0.001) and obesity by 13.77 times (p=0.01) the chance of increased risk of injury. The proportion of pain (34.1%) and pressure injury in the sacrococcygeal region (91.7%) stood out in patients at higher risk(p=0.05). Conclusion:obese and elderly people had a higher risk of injury. Pain and occurrence of pressure injury in the sacrococcygeal region were the predominant complications in patients at higher risk (AU)

Objetivo:relacionar el puntaje de riesgo de lesiones por posicionamiento quirúrgico derivado de la posición supina con aspectos sociodemográficos, clínicos, quirúrgicos y la ocurrencia de complicaciones. Método:estudio observacional longitudinal realizado con 89 pacientes en decúbito supino. Se aplicaron variables sociodemográficas, clínicas y la Escala de Riesgo para el Desarrollo de Lesiones de Posicionamiento Quirúrgico. Fueron adoptados análisis descriptivos, bivariados y de regresión logística, considerando un nivel de significancia de α=0,05. Resultados:La edad aumentó en 1,11 veces (p<0,001) y la obesidad en 13,77 veces (p=0,01) la probabilidad de mayor riesgo de lesión. La proporción de dolor (34,1%) y lesión por presión en la región sacrococcígea (91,7%) sedestacó en los pacientes de mayor riesgo (p=0,05).Conclusión:Las personas obesas y ancianas tenían mayor riesgo de lesiones. El dolor y la aparición de lesión por presión en la región sacrococcígea fueron las complicaciones predominantes en los pacientes de mayor riesgo (AU)