Endoscopic anatomy of infraorbital/maxillary nerves in endoscopic transmaxillary approach / 中国神经精神疾病杂志

Objective To explore the localization and guidance value of infraorbital/maxillary nerve in endoscopic transmaxillary approach, and to provide anatomical data for clinical operation. Methods The eight adult cadaver heads were dissected by means of the endoscopic transmaxillary approach to expose the infraorbital/maxillary nerve, and relevant data were collected. Results In 8 cases, 16 maxillary nerves arose from the trigeminal ganglion of the trigeminal nerve and emerged from the foramen rotundum, transited to the infraorbital nerve at the infraorbital fissure, then traveled in the infraorbital canal and out of the infraorbital foramen. The infraorbital/maxillary nerve could be divided into four segments according to the foramen rotundum, infraorbital groove and infraorbital foramen: the terminal segment, the infraorbital nerve and its terminal branches to the face, distal to the infraorbital foramen; the orbitomaxillary segment and the orbitomaxillary segment of the infraorbital nerve within the infraorbital canal from the infraorbital foramen along the infraorbital groove (length 11.7 ±2.5 mm ), which was readily identified in the roof of the maxillary sinus in all specimens. The pterygopalatine segment, the pterygopalatine segment within the pterygopalatine fossa, which started at the infraorbital groove to the foramen rotundum (length 13.4±2.1 mm); The intracranial segment, the intracranial segment from the foramen rotundum to the trigeminal ganglion(length 15.2±3.9 mm). Conclusion The infraorbital nerve can serve as a anatomical landmark for endoscopic transmaxillary approach to get access to infratemporal fossa, pterygopalatine fossa, trigeminal ganglion and lateral wall of the cavernous sinus.

Neuroprotective effects of Ghrelin on traumatic brain injury in mice / 中华行为医学与脑科学杂志

Objective To investigate the neuroprotective effect of Ghrelin on traumatic brain injury (TBI) in mice.Methods TBI model of C57BL/6 mice was established by electronic cortical impact instrument (eCCI).According to the random figure table method,twenty-four mice were randomly divided into sham group(Sham group),TBI group and Ghrelin intervention group(Ghrelin group) with 8 mice in each group.The model of TBI was established in TBI group and Ghrelin group.The mice in Ghrelin group was injected intraperitoneally 0.5 g/kg before and 1 h after injury respectively.And the mice Sham group and TBI group were injected with the same amount of normal saline.The changes of cerebral blood perfusion (CBP)were monitored in real time by laser speckle contrast analysis(LSCI),the changes of neuroelectrophysiology were observed by monitoring motor evoked potential (MEP),and the status of neurological deficit was evaluated by modified neurological deficit score (mNSS).Results Compared with Sham group,the mice in TBI group had significantly lower cerebral blood perfusion(CBP) (t=-12.36,P＜0.01),longer latency and lower amplitude of motor evoked potential (MEP) (t=5.03,-11.55,all P＜0.01),and significantly higher mNSS scores (t=9.34,P＜0.01).However,compared with the TBI group,the cerebral blood perfusion(CBP) of Ghrelin group increased significantly at 12 h after TBI((196.87± 17.36) PU/mm2 vs (123.62±8.04)PU/mm2,t=10.45,P＜0.01),while the latency of MEP decreased((5.30±0.33) ms vs (6.80±0.97) ms,t =-5.01,P＜0.01),the amplitude of MEP increased ((2.21 ± 0.16) mV vs (1.27± 0.27) mV,t =9.65,P＜0.01).And compared with the TBI group,the neurological deficit score of Ghrelin group decreased significantly at 24 h after TBI((4.9±1.2) vs (8.4±2.6),t=-3.87,P＜0.01).Conclusion Ghrelin exhibits a significant neuroprotective role by increasing cerebral blood flow perfusion,reducing the degree of neurological deficit and promoting motor function recovery in TBI mice.

Neuroprotective effects of Ghrelin on traumatic brain injury in mice / 中华行为医学与脑科学杂志

Objective@#To investigate the neuroprotective effect of Ghrelin on traumatic brain injury (TBI) in mice.@*Methods@#TBI model of C57BL / 6 mice was established by electronic cortical impact instrument (eCCI). According to the random figure table method, twenty-four mice were randomly divided into sham group(Sham group), TBI group and Ghrelin intervention group(Ghrelin group) with 8 mice in each group. The model of TBI was established in TBI group and Ghrelin group.The mice in Ghrelin group was injected intraperitoneally 0.5 g/kg before and 1 h after injury respectively. And the mice Sham group and TBI group were injected with the same amount of normal saline. The changes of cerebral blood perfusion (CBP) were monitored in real time by laser speckle contrast analysis(LSCI), the changes of neuroelectrophysiology were observed by monitoring motor evoked potential (MEP), and the status of neurological deficit was evaluated by modified neurological deficit score (mNSS).@*Results@#Compared with Sham group, the mice in TBI group had significantly lower cerebral blood perfusion(CBP) (t=-12.36, P<0.01), longer latency and lower amplitude of motor evoked potential (MEP) (t=5.03, -11.55, all P<0.01), and significantly higher mNSS scores (t=9.34, P<0.01). However, compared with the TBI group, the cerebral blood perfusion(CBP) of Ghrelin group increased significantly at 12 h after TBI((196.87±17.36) PU/mm2 vs (123.62±8.04)PU/mm2, t=10.45, P<0.01), while the latency of MEP decreased((5.30±0.33)ms vs (6.80±0.97)ms, t=-5.01, P<0.01), the amplitude of MEP increased((2.21±0.16)mV vs (1.27±0.27)mV, t=9.65, P<0.01). And compared with the TBI group, the neurological deficit score of Ghrelin group decreased significantly at 24 h after TBI((4.9±1.2) vs (8.4±2.6), t=-3.87, P<0.01).@*Conclusion@#Ghrelin exhibits a significant neuroprotective role by increasing cerebral blood flow perfusion, reducing the degree of neurological deficit and promoting motor function recovery in TBI mice.

Role of susceptibility-weighted imaging and diffusion tensor imaging sequence of MRI in diagnosis and prognosis evaluation of diffuse axonal injury / 中华创伤杂志

Objective To evaluate the clinical application of SWI and DTI of MRI in the diagnosis and prognosis of diffuse axonal injury (DAI).Methods A retrospective case series study was conducted on the clinical data of 16 patients with DAI admitted from January 2015 to December 2017.There were nine males and seven females,aged (56.3 ± 4.1) years.According to Glasgow Coma Scale (GCS),there were seven patients with 3-8 points,eight with 9-12 points,and one with 13 points.All patients received head CT examination on admission and then received head MRI examination within one week to record the number of lesions on T1WI,T2WI,DWI,and SWI in CT and MRI examination.On the DTI sequence,five regions including the subcortical white matter,the corpus callosum,the thalamus,the cerebellum,and the brain stem were selected for measurement of the apparent diffusion coefficient (ADC) and partial fraction of anisotropy (FA) values.The Glasgow outcome scale (GOS) was evaluated 6 months after injury.The linear correlation between ADC,FA values,GCS,and GOS on admission and after 6 months were analyzed.Results The statistical analysis of CT,T1WI,T2WI,DWI and SWI in 16 patients showed that the detection rates of DAI lesions were 25.6％ (43/168),30.4％ (51/168),44.0％ (74/168),51.8％ (87/168),and 100％,respectively (P ＜0.01).The ADC values of the subcortical white matter,the corpus callosum,the thalamus,the cerebellum,and the brain stem were 0.830 ± 0.148,0.536 ± 0.169,0.838 ± 0.596,0.708 ± 0.157,and 0.713 ± 0.135,respectively,and FA values were 0.487 ± 0.103,0.142 ± 0.040,0.293 ± 0.089,0.212 ± 0.045,and 0.366 ± 0.797,respectively.The GCS on admission was (8.9 ± 3.3)points,and GOS was (4.2 ± 1.0)points six months after injury.The correlation analysis showed that the ADC value and FA value of subcortical white matter and cerebellum were not related to GCS and GOS (P ＞ 0.05).The correlation strength of ADC values in each region with the GCS score in descending order was the thalamus,the corpus callosum,and the brain stem (P ＜ 0.05 or 0.01);for ADC with the GOS score,it was the corpus callosum,the thalamus and the brain stem (P ＜0.05 or 0.01);for FA with GCS and GOS scores,it was thalamus,corpus callosum,and brainstem (P ＜ 0.05 or 0.01).Conclusion The SWI has better sensitivity to detect DAI lesions than CT and conventional MRI sequences.DTI can accurately,objectively and visually detect the integrity of cerebral white matter fibers.Both SWI and DTI can help make early diagnosis and evaluate the prognosis of DAI patients accurately.

Effect of Ghrelin on gastrointestinal motility after traumatic brain injury / 中华创伤杂志

Objective To investigate the effect of Ghrelin on gastrointestinal motility after traumatic brain injury (TBI).Methods A total of 72 adult male SD rats were randomly divided into sham operation group (n =8),TBI group (n =32) and Ghrelin group (n =32),according to the random number table.In the sham operation group,the scalp was sutured after craniotomy and sterilization,without any strike.In the TBI group,after intraperitoneal anesthesia,the skull was opened and the electric cortical contusion impactor was used to strike the center of bone window at the depth of 3 mm and the rate of 5 m/s.The duration of hitting the lowest point was 200 ms.In the Ghrelin group,20 μg/kg of Ghrelin was injected into the rat via the tail vein 30 minutes after injury.The modified neurologicalseverity score (mNSS),percentage of water content in feces and percentage of gastric contents in body weight at 6,24,48 and 72 hours after operation in each group were measured.The stomach,the small intestine 15 cm from ileocecal junction,ileocecal junction (about 3 cm in the proximal ileal loops,about 3 cm in the distal ileal loops,and 3 cm colon loops) were taken out to prepare the electron microscopy section and observe the microscopic changes of the gastrointestinal mucosa.Results The mNSS in the TBI and Ghrelin groups was higher than that in the sham operation group after 24,48 and 72 hours (P ＜0.01).The mNSS in the TBI group was higher than that in the Ghrelin group after 24,48 and 72 hours (P ＜0.01).In the sham operation group,the intestinal wall was pink.In the TBI group,gastric dilatation and thinner wall with pale or dark red color were seen,and small intestine cavity expansion with dark color and even congestion were observed.There was much mucus in the intestinal wall.The Ghrelin group improved obviously than the TBI group after 6 hours.Compared with the Ghrelin group,the percentage of fecal water content in the TBI group decreased significantly after 24 hours (P ＜ 0.05),and the decrease rate dropped with time.Obvious delayed gastric emptying occurred (P ＜ 0.05),and the percentage of gastric contents in body weight demonstrated downtrend.The changes of gastric mucosa were as follows:the chief cells in the gastric glands were observed 72 hours after TBI in the TBI group,and scattered short microvilli were seen in the cell surface.The cytoplasm protruded into the glandular cavity,and a large number of rough endoplasmic reticulum could be seen in the cytoplasm,with irregular arrangement.Medullary bodies could be seen inside the mitochondria which swelled locally.Abundant endocrine granules were seen in the cytoplasm.Mitochondria were scattered and swollen,and mitochondria cristae became shorter and fewer,which contained medullary bodies.The Ghrelin group improved obviously than TBI group after 72 hours in terms of gastric mucosa changes.With respect to cecum mucosa,in the TBI group 72 hours after TBI,severe edema of the cecum absorption epithelium,obvious dilation of the rough endoplasmic reticulum,expansion of the free water gap inside the cell,and local decrease of the microvilli at the top of the cell were observed.Abundant microvilli were seen in the cecum absorption epithelium and cell top.The connection complex composed of tight connections,intermediate connections,and bridging particle connections could be seen between cells.The Ghrelin group improved obviously than TBI group after 72 hours in terms of cecum mucosa changes.Conclusions Ghrelin can improve gastrointestinal motility and protect gastrointestinal mucosa in rats after TBI.

Microsurgical anatomic study of subtemporal approach using a minimal access / 中华显微外科杂志

Objective To investigate the surgical exposure of the subtemporal approach and explore clinical indications using a minimal-access.Methods Ten adult cadaveric heads fixed with formalin were used in this study.The holes with 3.0 cm × 2.5 cm of zygomatic arch vertically were operated on each head with subtemporal approach.During the anatomical procedures,measured the maximal exposure lengths of tentorial margin,posterior cerebral artery,and anterior border of brain stem,vertical distances between highest structure in the field of view and posterior clinoid process,the shortest distances form the zygomatic arch 1/3 to tentorial edge,sulcus lateralis mesencephali and anterior clinoid process; After tentorium of cerebellum was cut,measured the straight distance form the internal carotid artery to the optic nerve and form the posterior communicating artery to the tentorial edge.Results Oculomotor,trochlear nerve,tentorial edge,superior cerebllar artery.,P1-P2 segment of posterior cerebral artery,ventrolateral surface of mesencephalon and pon higher than root of trigeminal nerve,anterior and posterior clinoid process,posterior communicating artery and anterior choroidal artery,and superior portion of pituitary stalk could be observed via subtemporal approach using a minimal-access.Conclusion 1.The subtemporal approach using a minimal-access can protect the superficial temporal artery and the facial nerve branches especially in the process of the flap formation.It does little damage to the temporallis,reduces the invalid exposure of brain tissue,farthest lowers the damage to the scalp,skull and adjacent tissue ; 2.The subtemporal approach using a minimal-access can obtain the exposure rang.It can see the upper pons,petroclival region,tentorial notch area,ventrolateral brain stem.