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关键词： closed-loop feedback   ECAP   electrically evoked compound action potential   pain relief   programming   spinal cord stimulation  

摘要： Introduction The electrically evoked compound action potential (ECAP) is a measure of the response from a population of fibers to an electrical stimulus. ECAPs can be assessed during spinal cord stimulation (SCS) to elucidate the relationship between stimulation, electrophysiological response, and neuromodulation. This has consequences for the design and programming of SCS devices. Methods Sheep were implanted with linear epidural SCS leads. After a stimulating pulse, electrodes recorded ECAPs sequentially as they propagated orthodromically or antidromically. After filtering, amplification, and signal processing, ECAP amplitude and dispersion (width) was measured, and conduction velocity was calculated. Similar clinical data was also collected. A single-neuron computer model that simulated large-diameter sensory axons was used to explore and explain the observations. Results ECAPs, both animal and human, have a triphasic structure, with P1, N1, and P2 peaks. Conduction velocity in sheep was 109 ms(-1), which indicates that the underlying neural population includes fibers of up to 20 mu m in diameter. For travel in both directions, propagation distance was associated with decrease in amplitude and increase in dispersion. Importantly, characteristics of these changes shifted abruptly at various positions along the cord. Discussion ECAP dispersion increases with propagation distance due to the contribution of slow-conducting small-diameter fibers as the signal propagates away from the source. An analysis of the discontinuities in ECAP dispersion changes with propagation revealed that these are due to the termination of smaller-diameter, slower-conducting fibers at corresponding segmental levels. The implications regarding SCS lead placement, toward the goal of maximizing clinical benefit while minimizing side-effects, are discussed. Conflict of Interest John Parker is the founder and CEO of Saluda Medical and holds stock options. Milan Obradovic, Nastaran Hesam Shariat

关键词： 眼科学   人体解剖学  

ISBN: (纸本)9787533199913

摘要： 《钟世镇现代临床解剖学全集·眼科临床解剖学》分册第2版是在第1版的基础上修订编写的。全书共分八章，分别从眼的胚胎发育学、眼球的解剖、眼附属器的解剖、眼表结构与临床、眼眶及其毗邻的解剖关系、眼部的血液循环和眼的神经分布等介绍了眼部精细形态结构及其与眼科临床相关的知识，文字尽量简洁而全面，力图使读者得到系统、全面、真实而完整的眼科临床解剖学知识。

关键词： 血管外科学   人体解剖学  

ISBN: (纸本)9787572300035

摘要： 本书应用了数字解剖学、影像解剖学、临床解剖学的研究新进展介绍了重要血管的位置、毗邻关系、发育变异等；凸显了作者的特长及研究成果；介绍了颈部、纵隔、腹膜后筋膜间隙研究的最新进展；使用当今最先进的多层螺旋CT、高场强MRI、DSA成像设备及图像后处理技术获取血管的多平面断层图像和三维图像；重点围绕血管外科临床上的常见病、多发病这一轴线介绍了临床意义较大的血管解剖及临床应用，突出了临床医生日常使用的活体解剖学内容。

关键词： Lamprey   Cholecystokinin   GABA   Glutamate   Brain   Spinal cord  

摘要： Cholecystokinin (CCK) is a neuropeptide that modulates processes such as digestion, satiety, and anxiety. CCK-type peptides have been characterized in jawed vertebrates and invertebrates, but little is known about CCK-type signalling in the most ancient group of vertebrates, the agnathans. Here, we have cloned and sequenced a cDNA encoding a sea lamprey (Petromyzon marinus L.) CCK-type precursor (PmCCK), which contains a CCK-type octapeptide sequence (PmCCK-8) that is highly similar to gnathostome CCKs. Using mRNA in situ hybridization, the distribution of PmCCK-expressing neurons was mapped in the CNS of P. marinus. This revealed PmCCK-expressing neurons in the hypothalamus, posterior tubercle, prethalamus, nucleus of the medial longitudinal fasciculus, midbrain tegmentum, isthmus, rhombencephalic reticular formation, and the putative nucleus of the solitary tract. Some PmCCK-expressing neuronal populations were only observed in adults, revealing important differences with larvae. We generated an antiserum to PmCCK-8 to enable immunohistochemical analysis of CCK expression, which revealed that GABA or glutamate, but not serotonin, tyrosine hydroxylase or neuropeptide Y, is co-expressed in some PmCCK-8-immunoreactive (ir) neurons. Importantly, this is the first demonstration of co-localization of GABA and CCK in neurons of a non-mammalian vertebrate. We also characterized extensive cholecystokinergic fibre systems of the CNS, including innervation of habenular subnuclei. A conspicuous PmCCK-8-ir tract ascending in the lateral rhombencephalon selectively innervates a glutamatergic population in the dorsal isthmic grey. Interestingly, this tract is reminiscent of the secondary gustatory/visceral tract of teleosts. In conclusion, this study provides important new information on the evolution of the cholecystokinergic system in vertebrates.

关键词： Cannabis   dependence   neuroanatomy   magnetic resonance imaging   hippocampus   caudate   pituitary gland   cerebellum  

摘要： Objectives: We aimed to investigate whether severity of cannabis dependence is associated with the neuroanatomy of key brain regions of the stress and reward brain circuits. Methods: To examine dependence-specific regional brain alterations, we compared the volumes of regions relevant to reward and stress, between high-dependence cannabis users (CD+, n = 25), low-dependence cannabis users (CD-, n = 20) and controls (n = 37). Results: Compared to CD- and/or controls, the CD+ group had lower cerebellar white matter and hippocampal volumes, and deflation of the right hippocampus head and tail. Conclusion: These findings provide initial support for neuroadaptations involving stress and reward circuits that are specific to high-dependence cannabis users.

关键词： 耳鼻咽喉科学   外科学   解剖学   头部   颈  

ISBN: (纸本)9787572301414

摘要： 本书收录了耳鼻咽耳、鼻、鼻窦、咽、喉、气管、食管、颈部、颅底等各重要器官的解剖结构、毗邻关系、临床应用，以及常用手术入路的解剖要点和手术技巧。本书图文并茂，对解剖结构的讲解极为详细，融入了作者多年的临床解剖学经验，结合了中国人的解剖特点，可为临床手术医师，以及医学生和年轻医生提供重要参考。

关键词： 人体解剖学   中医学院   教材  

ISBN: (纸本)9787547846407

摘要： 本教材内容包括绪论、运动系统、消化系统、呼吸系统、泌尿系统、生殖系统、循环系统、内分泌系统、感觉器和神经系统，主要介绍了人体各系统的器官组成、位置、形态结构。按照“注重传承、整体优化、面向临床”的培养目标，强调基本理论、基本知识和基本技能的学习与训练；以科学严谨的治学态度，对教材体系进行科学设计，综合考虑学科的分化与交叉，注意各学科之间的有机衔接，确保理论体系完整、知识点阐述完备。编写力求做到内容精炼、文字表达准确、名词术语规范、重点突出、图文并茂，充分体现思想性、科学性、先进性、启发性、适用性的基本原则，便于学生学习和掌握。

关键词： neuroanatomy education   medical education   undergraduate education   neuroscience   teaching   learning   medical students   knowledge retention   students satisfaction  

摘要： Neuroanatomy has been deemed crucial for clinical neurosciences. It has been one of the most challenging parts of the anatomical curriculum and is one of the causes of "neurophobia," whose main implication is a negative influence on the choice of neurology in the near future. In the last decades, several educational strategies have been identified to improve the skills of students and to promote a deep learning. The aim of this study was to systematically review the literature to identify the most effective method/s to teach human neuroanatomy. The search was restricted to publications written in English language and to articles describing teaching tools in undergraduate medical courses from January 2006 through December 2017. The primary outcome was the observation of improvement of anatomical knowledge in undergraduate medical students. Secondary outcomes were the amelioration of long-term retention knowledge and the grade of satisfaction of students. Among 18 selected studies, 44.4% have used three-dimensional (3D) teaching tools, 16.6% near peer teaching tool, 5.55% flipped classroom tool, 5.55% applied neuroanatomy elective course, 5.55% equivalence-based instruction-rote learning, 5.55% mobile augmented reality, 5.55% inquiry-based clinical case, 5.55% cadaver dissection, and 5.55% Twitter. The high in-between study heterogeneity was the main issue to identify the most helpful teaching tool to improve neuroanatomical knowledge among medical students. Data from this study suggest that a combination of multiple pedagogical resources seems to be the more advantageous for teaching neuroanatomy.

关键词： 右半结肠   毗邻层面   应用解剖   右半结肠   血管   应用解剖  

摘要： 目的应用尸体解剖方法研究右半结肠毗邻的层面关系,为精准右半结肠膜解剖手术提供可靠的应用解剖学依据。方法对经福尔马林固定5具尸体(男性4具,女性1具)右半结肠毗邻层面进行解剖学观察。结果右半结肠与其周围的毗邻层面,形成了右Toldt's融合筋膜区、胰头十二指肠融合筋膜区、大网膜-横结肠融合筋膜区等三个区域。1.右Toldt's融合筋膜区:因回盲部、升结肠及其系膜筋膜背侧叶与原始后腹膜形成右Toldt's融合筋膜而来。右Toldt's融合筋膜区的头侧界为十二指肠环下缘,内侧界为肠系膜上动脉右缘,右侧与尾侧边界为回盲部、升结肠与后腹膜的愈着缘。在右Toldt's融合筋膜区背侧依次存在后腹膜延续层面(原始后腹膜)和泌尿生殖层2个层面,依次形成了右Toldt's融合筋膜间隙、肾前间隙和肾后间隙等三个间隙。2.胰头十二指肠融合筋膜区:因结肠肝曲及其系膜筋膜背侧叶与胰头十二指肠固有筋膜形成的融合筋膜而来。头侧界为胃大网膜在十二脂肠球部附着处,尾侧界为十二指肠环下缘,外侧界为十二指肠环外侧缘,内侧界为大网膜的右缘(其内标志为胃网膜右静脉)。胰头十二指肠融合筋膜区背侧依次为胰头十二指肠、后腹膜延续层面(原始后腹膜)和泌尿生殖层3个层面。依次形成了胰头十二指肠前间隙、胰头十二指肠后间隙、肾前间隙和肾后间隙等4个融合筋膜间隙。右Toldt's融合筋膜间隙向头侧延续,被胰头十二指肠层面分隔为胰头十二指肠前间隙与胰头十二指肠后间隙;胰十二指肠上前静脉起自胰头,跨越胰头十二指肠前间隙,汇入肠系膜平面的Henle干。3.大网膜-横结肠融合筋膜区:起自大网膜右缘,向左侧由大网膜与横结肠系膜筋膜前叶融合而形成的区域。由腹侧向背侧形成网膜囊、胰周间隙和胰后间隙3个间隙。大网膜第3层覆盖于胰体尾浅面,大网膜第4层包绕胰体尾和脾脏,该两层间为胰周间隙。大网膜第4层与横结肠系膜无血管区紧密融合,在胰腺下缘分离,其间与胰后间隙相通。结论在胚胎发育理论基础上,应用解剖学方法揭示右半结肠毗邻层面关系。1.本实验对右半结肠的空间毗邻关系进行了明确划分,依次为右Toldt's融合筋膜区、胰头十二指肠融合筋膜区、大网膜-横结肠融合筋膜区这3个区域;2.明确提出对胰头十二指肠融合筋膜区与大网膜-横结肠系膜融合区的分界,为大网膜的右缘,其内标志为胃网膜右静脉;3.从解剖学上证实了可分离的后腹膜延续层面,即Toldt’s融合筋膜可被解剖分离为升结肠背侧系膜筋膜与后腹膜延续层面;4.详细描述了泌尿生殖层在右半结肠后方的结构;5.在这些层面关系以及层面之间的融合筋膜间隙研究的基础上,我们提出了右半结肠手术两次系膜穿越的概念,即“回结肠系膜穿越”之外“横结肠系膜穿越”(微头侧入路)的入路方式,以结肠中动脉为解剖标志,纵行离断横结肠系膜,沿胰颈处向胰头部分离,分别从尾侧与头侧解剖确定Henle干,有助于安全有效控制Henle干,提高安全性,同时避免了联合入路的腹腔镜频繁场景转换,可以流畅、安全、高效地完成右半结肠根治性膜解剖手术。目的应用尸体解剖及手术视频回顾的方法,根据手术实际操作要求描述右半结肠血管的精确解剖结构,辨认和分析右半结肠血管的特点,从而为腹腔镜右半结肠根治性切除术提供血管解剖形态依据,减少因为误操作导致血管损伤的机率。方法对经福尔马林固定12具尸体及2018年1月至2019年3月陕西省人民医院普外一科接受腹腔镜右半结肠癌根治性切除术的28例手术录像,对右半结肠血管的走行、分布和变异情况进行解剖学观察。测量并统计尸体的Henle干长度、Henle干根部外径、Henle干与胰腺下缘的距离、结肠中动脉起始部至左右支分岔处距离等相关资料。结果1.由肠系膜上动脉发出的回结肠动脉发生率为100%;右结肠动脉发生率为47.5%;结肠中动脉发生率为95%。回结肠静脉发生率为97.5%;右结肠静脉发生率为67.5%;上右结肠静脉发生率为72.5%。2.回结肠动脉从背侧跨过肠系膜上静脉发生率57.5%,从腹侧跨过SMV为42.5%,右结肠动脉从腹侧跨过肠系膜上静脉发生率为100%。3.结肠中动脉起始部至左右支分岔处的距离:2.40±1.00cm(范围0.55～3.6 cm)。***干发生率为100%,未见Henle干缺如的病例。对Henle干将传统的分类方式结合器官来源重新分类,基于胰十二指肠上前静脉存在与否将Henle干分为胃结肠静脉干和胃胰结肠静脉干两种类型,基于结肠静脉将两种类型进一步细分为9型。其中最常见亚型是胃网膜右静脉+胰十二指肠上前静脉+上右结肠静脉,占30%,其次是胃网膜右静脉+胰十二指肠上前静脉+右结肠静脉,占20%。Henle干与肠系膜上静脉汇合点距胰腺下缘距离2.0±0.74 cm,其平均外径0.59cm。结论1.右结肠的主要分支回结肠动脉和结肠中动脉较为恒定,可作为

关键词： 智慧树   腾讯课堂   线上教学   翻转课堂   ARCS动机模型  

摘要： 新型冠状病毒肺炎疫情期间, 结合临床"5+3"一体化学生特点和课程内容, 在解剖学理论教学中运用智慧树与腾讯课堂构建了"课前—课中—课后"高效、精准、互动的线上翻转智慧课堂。将ARCS动机模型引入教学设计中, 助力翻转课堂的有效进行。课前通过智慧树发布教学资源, 学生进行自主学习;课中应用腾讯课堂直播教学, 针对性地讲解重难点内容, 答疑讨论;课后应用智慧树发布习题测试与作业。实践表明, 该模式的线上教学受到了学生们的广泛认可;有助于培养学习兴趣, 提高自主学习能力和分析问题解、决问题的能力;有助于实施多元化形成性考核;为疫情之后开展混合式教学奠定了基础。