导针钝头探通法辅助判断空心拉力螺钉置入深度在老年人股骨颈骨折闭合复位内固定术中的应用

目的 探讨导针钝头探通法辅助判断空心拉力螺钉置入深度在老年患者股骨颈骨折闭合复位内固定术中应用的效果。方法 回顾性研究。纳入2016年10月—2020年10月河北医科大学第三医院创伤急救老年骨科收治的老年股骨颈骨折患者16例,其中男3例、女13例,年龄65~89（70.1±4.8）岁。患者均为GardenⅡ型骨折。均行闭合复位空心拉力螺钉内固定手术治疗,术中均使用导针钝头探通法辅助判断空心拉力螺钉置入深度。术后即刻复查患侧髋关节CT及三维重建,观察骨折断端对位、对线情况,螺钉的置入位置,测量螺钉尖与股骨头软骨下骨的距离,评估导针钝头探通法辅助判断螺钉深度技术的效果及有效性。术后1年内定期随访,观察切口愈合情况、骨折愈合时间以及内固定断裂、骨折不愈合等并发症的发生情况。术后6个月采用Harris评分评定疗效。结果 16例患者均顺利完成手术治疗,手术时间为30~85（51.8±11.2） min,术中出血量为20~100（44.3±23.5） mL。16例患者共打入空心拉力螺钉49枚,术后即刻影像学检查显示,骨折断端对位、对线优良,螺钉的置入位置良好,螺钉钉尖与股骨头软骨下骨的距离为0.21~0.49 （0.38±0.11） cm;螺钉置入位置均有效,有效性为优（100%）。术后患者伤口均一期愈合,未发生感染、内固定失败。16例患者均获随访,随访时间6~16（9.1±3.3）个月。随访期间无螺钉断钉、退钉及股骨头塌陷、坏死等并发症发生,骨折愈合时间为3~6（4.1±1.0）个月。术后6个月采用Harris评分评定疗效,16例患者疗效均为优良。结论 在老年股骨颈骨折闭合复位内固定术中,使用导针钝头探通法辅助判断空心拉力螺钉置入深度,可将螺钉尖准确放置在股骨头软骨下骨下方0.5 cm范围内,有助于提高内固定稳定性、促进骨折断端良好愈合。     

中青年股骨颈骨折空心螺钉内固定术后股骨头坏死的相关因素分析

目的探讨中青年股骨颈骨折空心螺钉内固定术后股骨头坏死的影响因素,为股骨颈骨折术后股骨头坏死预防提供理论依据。方法选取2013年2月至2015年2月于我院行空心螺钉内固定术治疗的145例中青年股骨颈骨折患者,2015年3月至2017年3月电话或复诊随访,共24个月,统计发生股骨头坏死病例。将股骨头坏死患者设为观察组,未发生者设为对照组,调查2组患者性别、年龄、骨折Garden分型、Garden指数等基本情况,通过单因素与多因素logistic回归分析确定股骨颈骨折空心螺钉内固定术后股骨头坏死的独立危险因素。结果 145例患者均完成随访,发生股骨头坏死20例,发生率13. 79%,股骨头坏死平均时间(15. 76±3. 54)个月; 2组受伤至手术时间、骨折Garden分型、Garden指数、术后开始负重时间、是否取出内固定、骨折移位、性别差异具有统计学意义(P 0. 05);手术时间、年龄、受伤原因差异无统计学意义(P 0. 05);多因素logistic回归分析结果显示受伤至手术时间大于等于7 h[OR=1. 764,95%CI(0. 767~6. 565)]、骨折Garden分型Ⅲ、Ⅳ型[OR=2. 435,95%CI(1. 043~8. 665)]、负重时间小于3个月[OR=2. 043,95%CI(1. 022~5. 645)]、Garden指数Ⅲ、Ⅳ[OR=2. 231,95%CI(1. 116~5. 976)]、取出内固定[OR=1. 563,95%CI(0. 422~4. 643)]是中青年股骨颈骨折空心螺钉内固定术后股骨头坏死的独立危险因素。结论股骨颈骨折空心螺钉内固定术后股骨头坏死发生率较高,受伤至手术时间大于7 h、骨折Garden分型Ⅲ、Ⅳ型、术后开始负重时间小于3个月、Garden指数Ⅲ、Ⅳ以及取出内固定均会增加股骨头坏死风险。     

经踝后内侧入路Herbert螺钉内固定治疗距骨后突骨折22例

[摘要]目的 探讨经踝后内侧入路Herbert螺钉内固定治疗距骨后突骨折的临床疗效。方法 对2010年6月~2013年5月术治疗的22例距骨后突骨折患者的治疗效果进行总结分析。术前常规行三维CT扫描明确骨折类型及移位情况，采用经踝后内侧入路Herbert螺钉内固定，术后早期不负重功能锻炼。根据美国足踝外科协会（AOFAS）踝与后足评分标准进行功能评价。结果 22例患者距骨后突骨折均获满意复位，其中19例患者术后得到10~22个月随访，平均16.6个月，均达到骨性愈合。AOFAS评分58~92分，平均83.12分，其中优8例，良8例，可2例，差1例；优良率为84℅（16/19）。结论 经踝后内侧入路Herbert螺钉内固定治疗距骨后突骨折可有效恢复距骨解剖结构及关节面平整，结合早期不负重功能锻炼可获得较好的临床效果。     

单侧髋关节蛙式位透视在股骨颈骨折内固定手术中的应用及相关问题探讨

目的探讨股骨颈骨折闭合复位内固定手术中的透视体位及相关问题。方法对2004～2006年间收治的31例股骨颈骨折病人进行回顾性分析。结果28例患者行患髋蛙式位透视下闭合复位空心螺钉内固定手术；3例行人工关节置换术。28例病人获平均16．5个月（8～36个月）随访，X线片均示骨折解剖复位，螺钉空间位置良好，后期随访26例骨性愈合，l例骨折不愈合，l例发生股骨头缺血性坏死。结论患髋蛙式位透视下辅助复位可最大程度的复位；新鲜股骨颈骨折的首选治疗方法是骨折复位空心螺钉内固定术。     

“前向后”螺钉和“后向前”螺钉固定治疗Haraguchi Ⅰ型后踝骨折的疗效比较

目的 比较“前向后”螺钉和“后向前”螺钉固定治疗三踝骨折中的Haraguchi Ⅰ型后踝骨折的疗效。方法 回顾性分析2014年1月 ～ 2019年7月收治的83例伴有Haraguchi Ⅰ型后踝骨折的三踝骨折。其中,男33例,女50例;年龄18 ～ 77岁,平均47.5岁,均为单侧骨折,旋后外旋型Ⅳ度61例及旋前外旋型Ⅳ度22例; 后踝骨折块面积占比平均19.8%（15% ～ 32%）;其中38例采用间接复位由“前向后”螺钉内固定后踝骨折,45例采用后外侧入路直接复位螺钉内固定后踝骨折。比较两组手术时间、后踝骨折复位质量及临床功能疗效。结果 所有患者术后获得平均15.6个月随访（6 ～ 26个月）,骨折均获得愈合。“前向后”组手术时间明显少于“后向前”组（P<0.05）。在关节面复位影像学评价中,“前向后”组中优13例（34.2%）、良19例（50.0%）及差6例（15.8%）;“后向前”组中优26例（57.7%）、良16例（35.6%）及差3例（6.7%）,两组间差异有统计学意义（P<0.05）。末次随访AOFAS踝与后足评分：“前向后”组（83.05±7.85）分,“后向前”组（87.84±7.22）分,两组间差异有统计学意义（P<0.05）。结论 与“前向后”间接复位螺钉固定Haraguchi Ⅰ型后踝骨折相比,通过后外侧入路直接复位螺钉内固定可以获得更好的骨折复位质量及临床功能疗效。     

微创空心加压螺钉内固定治疗股骨颈骨折

目的 探讨应用微创空心加压螺钉内固定治疗老年股骨颈骨折的临床疗效.方法 自2000年4月～2004年4月对128例经微创空心螺钉内固定治疗老年股骨颈骨折的临床资料进行回顾性分析.结果 GardenⅠ型骨折17例,Ⅱ型86例,Ⅲ型25例.损伤至手术时间1～2W,手术时间平均60min,均未出现伤口感染,下肢深静脉血栓,肺栓塞或内固定物断裂现象,无死亡发生.均得到随访,时间16～48个月,平均30月.所有病例骨折愈合良好,5例（5/128,3.9%）术后股骨颈短缩移位,6例（6/128,4.6%）出现不同程度的股骨头坏死.术后Harris髋关节功能评分平均95.4分.结论 微创空心加压螺钉内固定治疗股骨颈骨折具有创伤小、方法简便、固定牢靠、可早期功能锻炼、并发症少的优点,是治疗GardenⅡ、Ⅲ型老年性股骨颈新鲜骨折的理想方法.     

髋关节外科脱位入路联合Herbert钉治疗股骨头骨折

目的探讨髋关节外科脱位入路联合Herbert钉治疗股骨头骨折的临床疗效。方法2015年1月~2018年9月采用髋关节外科脱位入路联合Herbert钉治疗股骨头骨折12例。其中,男9例,女3例;年龄23~48岁,平均33.5岁;左侧5例,右侧7例。骨折按Pipkin分型:2例Ⅰ型,3例Ⅱ型,2例Ⅲ型,5例Ⅳ型。去除髋臼内细碎的骨片,将较大的骨折块复位,用2~4枚Herbert钉固定骨块,钉尾埋于股骨头软骨下。末次随访时按照Tompson-Epstein评价系统评价关节功能。结果本组患者均获得6~33个月的随访,平均14.5个月。所有患者术后髋关节无明显疼痛,骨折愈合时间平均4.5个月。2例出现异位骨化,2例出现股骨头坏死,髋关节活动轻度受限。结论采用髋关节外科脱位入路治疗伴或不伴髋臼骨折的股骨头骨折是一种相对安全的手术方式,术中可减少对股骨头血供的破坏,可全方位观察到股骨头骨折的渗血情况,Herbert钉固定股骨头骨折加压牢固,骨折愈合时间短,患者可获得更好的预后。     

空心钉辅助内侧支撑钢板治疗Pauwels Ⅲ型股骨颈骨折的临床疗效观察

[摘要]目的 探讨空心钉辅助内侧支撑钢板治疗Pauwels Ⅲ型股骨颈骨折的临床疗效。方法 回顾性分析昆山市中医医院2013年5月至2017年5月收治的70例Pauwels Ⅲ型股骨颈骨折患者,平均随访（62.5±12.9）个月,其中44例患者接受3枚空心钉辅助内侧支撑钢板治疗（A组）,26例患者采用单纯3枚空心螺钉治疗（B组）。记录并比较两组手术时间、术中出血量、输血率、骨折愈合时间、髋关节功能评分（Harris评分）、术后并发症（内固定失败、骨折不愈合及股骨头坏死）。结果 A组手术时间（85.45±17.16） min长于B组（71.56±15.20）min（P<0.05）,A组术中出血量（240.17±22.65） mL多于B组（136.34±20.18）mL（P<0.05）,但两组输血率比较差异无统计学意义。A组骨折愈合时间为（17.60±3.48）周,B组骨折愈合时间为（20.92±4.04）周,A组骨折愈合时间小于B组,差异有统计学意义（P<0.05）。术后6个月Harris评分A组（88.09±3.56）分,高于B组的（72.35±4.88）分（P<0.05）。A组无内固定失败,B组发生内固定失败3例,失败率两组差异有统计学意义（P<0.05）。A组1例发生骨不连,B组4例发生骨不连,两组差异有统计学意义（P<0.05）。A组股骨头坏死2例,B组股骨头坏死5例,差异有统计学意义（P<0.05）。结论 对于Pauwels III型股骨颈骨折,空心钉辅助内侧支撑钢板治疗相对单纯3枚空心钉治疗髋关节功能更佳,术后并发症率更低,降低了股骨头坏死发生率及内固定失败率。     

肘前入路Herbert螺钉内固定修复肱骨小头骨折:骨折复位及愈合的评价

背景:对于肱骨小头骨折的治疗临床上已经达成初步的共识,就是对有移位的骨折采用切开复位内固定治疗。但是对于选用何种入路以及采用何种内固定物才能达到最佳的固定效果目前尚存争论。目的:探讨经肘前入路Herbert螺钉置入内固定对有移位的肱骨小头骨折的修复效果。方法:选择武汉科技大学附属普仁医院骨科2008年8月至2012年5月收治的有移位的肱骨小头骨折患者12例,均采用经肘前入路Herbert螺钉置入内固定治疗。按Bryan-Morrey分型:Ⅰ型8例,Ⅱ型3例,Ⅲ型1例。观察患者内固定后骨折愈合、肘关节功能恢复及相关并发症发生情况。结果与结论:经过2年随访,12例骨折均达临床愈合,按Mayo肘关节功能评分,优10例,良2例。绝大多数患者肘关节功能恢复正常,无内固定后相关并发症发生。提示经肘前入路Herbert螺钉置入内固定修复有移位的肱骨小头骨折效果满意,内固定后肘关节功能恢复良好,存在明显的优势。     

比较踝关节骨折后踝螺钉不同进钉方向固定疗效

目的 比较踝关节骨折后侧入路后踝螺钉不同进钉方向的固定疗效。 方法 选取漂浮体位下后外侧入路对后踝骨折分别采用不同进钉方向螺钉固定患者48例,男性20例,女性28例,年龄（51.88 ± 7.90）岁,左踝20例,右踝28例,依据Lauge-Hansen踝关节骨折分型：旋后外旋型Ⅳ度36例,旋前外旋型Ⅳ度12例。后踝均采用螺钉固定,前向后固定组22例,后向前固定组26例,对比两组手术时间、骨折愈合时间及并发症情况,末次随访采用AOFAS评分进行临床疗效评价。 结果 两组病例均获随访,随访时间10~20个月,平均（13.0±3.5）个月,均Ⅰ期愈合,无切口感染、血管神经损伤等并发症,手术时间、骨折愈合时间、AOFAS评分均未见统计学差异,P>0.05。 结论 后外侧入路固定后踝骨折疗效较好,螺钉不同进钉方向具有相似的临床固定结果,手术医生可凭经验选择合适的方法。     

Schizophrenia in a North Swedish geographical isolate, 1900–1977. Epidemiology, genetics and biochemistry

Over 200 schizophrenic patients belonging to three major and interrelated pedigree complexes have been investigated over the past 30 years in a North Swedish geographically isolated population, presently numbering about 6,000. An intensive investigation of a number of biochemical correlates and genetic markers in a few selected families belonging to one of the major pedigrees has indicated new strategies for the current research program.
Schizophrenia, as defined operationally, is significantly associated with decreased activities of two enzymes (1) blood platelet monoamine oxidase, (2) plasma dopamine-β-hydroxylase, and (3) with the genetic marker Gc² (group specific antigen). Both enzymes are subject to genetic variation. A positive score for linkage between schizophrenia and low plasma DBH activity has been calculated, but, so far, available data are insufficient for discrimination between linkage and partial contribution of genetically controlled low plasma DBH to the pathogenesis of the disease. Alternatively, both mechanisms could be involved.
As a model for continued research, schizophrenia is explained as based on a double dominant-recessive genotype (Aabb), representing a vulnerability which in about 50 % of cases develops into clinical schizophrenia. It is suggested that the dominant mutation (A) operates on or affects MAO activity, and that the recessive genotype (bb) is instrumental in low variates of DBH activity and very likely such variates within the normal range of physiological variation. Moreover, it is suggested that the combined effects of MAO- and DBH-reduced efficiency on the metabolism of e.g. dopamine could be an essential pathogenic mechanism for the schizophrenic illness which is segregating in this population.     

The dominant diseases of modernized societies as omega-3 essential fatty acid deficiency syndrome: Substrate beriberi

About 1900, modern food selection and processing caused widespread $\text{epidemics}$ of the B vitamin deficiency diseases of beriberi and pellagra which, for genetic reasons, often expressed as different diseases ranging from bowel and heart disease to dermatoses and psychoses. But the B vitamins merely help convert essential fatty acids (EFA) into the prostaglandin (PG) tissue regulators and it now turns out that, through hydrogenation, milling and selection of w3-poor southern foods, we have also been systematically depleting, by as much as 90%, a newly discovered trace Nordic EFA (w3) of special importance to primates and sole precursor of the PG3(4) series, even as a concurrent fiber deficiency increases body demand for EFA. Since substrate EFA is processed by many B vitamin catalysts, an EFA deficiency will mimic a $\text{panh}$ypovitaminosis B, i.e., a mixture of $\text{substrate}$ beriberi and $\text{substrate}$ pellagra resembling vitamin beriberi and pellagra but exhibiting as even more diverse $\text{endemic}$ disease. This would consitute a second stage of the Modern Malnutrition and explain why some workers now hold the dominant diseases of modermized societies to be new, nutritionally based, pellagraform yet lipid-related and to range, once again, from heart disease to psychosis. It is an assumption that our dominant diseases are unrelated to each other or are merely revealed by our diagnostic acumen and therapeutic success; and that hydrogenating millions of tons of food oils annually, to destroy the rancidity producing w3-EFA, is safe for $\text{primates}$. Extensive beriberiform disease is reported here in 32 typical cases taken from medical practice which responds strikingly to linseed oil supplements (60% w3-EFA) in confirmation of identical results in Capuchins.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

'Very sore nights and days': the child's experience of illness in early modern England, c.1580-1720

Sick children were ubiquitous in early modern England, and yet they have received very little attention from historians. Taking the elusive perspective of the child, this article explores the physical, emotional, and spiritual experience of illness in England between approximately 1580 and 1720. What was it like being ill and suffering pain? How did the young respond emotionally to the anticipation of death? It is argued that children’s experiences were characterised by profound ambivalence: illness could be terrifying and distressing, but also a source of emotional and spiritual fulfilment and joy. This interpretation challenges the common assumption amongst medical historians that the experiences of early modern patients were utterly miserable. It also sheds light on children’s emotional feelings for their parents, a subject often overlooked in the historiography of childhood. The primary sources used in this article include diaries, autobiographies, letters, the biographies of pious children, printed possession cases, doctors’ casebooks, and theological treatises concerning the afterlife.     

Guidelines for the Validation and Use of Immunoassays for Determination of Introduced Proteins in Biotechnology Enhanced Crops and Derived Food Ingredients

Recent advancements in agricultural biotechnology have created a need for analytical techniques to determine introduced proteins in crops enhanced through modern biotechnology techniques. These proteins are expressed in plant tissues and may be present in food ingredients. Immunoassays are ideally suited for protein detection and may be used as both quantitative and threshold methods. Microplate ELISA and lateral flow devices are two of the most commonly used immunoassay formats for agricultural biotechnology applications. This paper provides general background information and a discussion of criteria for the validation and application of immunochemical methods to the analysis of proteins introduced into plants and food ingredients using biotechnology methods. It is the result of a collaborative effort of members of the Analytical Environmental Immunochemical Consortium. This collaborative effort represents the combined expertise of several organizations to reach consensus on establishing guidelines for the validation and use of immunoassays. Further, the paper offers developers and users a consistent approach to adopting the technology as well as aid in producing accurate and meaningful results.     

Ultracryotomy: development and application (with examples from the yeast cytology) (author's transl)

The preparation steps usually necessary for obtaining ultrathin frozen sections of biological material (chemical prefixation, enclosing, cryoprotective treatment, freezing, sectioning, and post-staining the sections for transmission electron microscopy) are submitted to a critical analysis. The application of cryo-ultramicrotomy, in particularly for cytochemical purposes, is reviewed. Fundamental considerations of chemical prefixation and poststaining are supported by examples from yeast cytology. Furthermore, the efficiency of the cryo-ultramicrotomy (electron optical resolution of ultrastructural details) is demonstrated on yeast cells and protoplasts.     

Hypo- und Hypermagnesämie aus kardiologischer Sicht

Zusammenfassung Eine Reihe pathologischer Zustände bedingen Magnesiummangel. Zustände mit Hypermagnesämie sind ebenfalls bekannt, doch wesentlich seltener. Für den Kardiologen beachtenswert ist, daß unter Therapie mit bestimmten Diuretica bei Herzinsuffizienz, bei Herzinfarkt, Kardiomyopathie, Digitalisintoxikation und bestimmten Herzrhythmusstörungen Hypomagnesämie beobachtet wurde. Leider kann in der klinischen Routine nur ein extracelluläres Magnesiumdefizit durch Serumbestimmungen gemessen werden; über Magnesiummangel einzelner Organe kann nichts ausgesagt werden. Hinweise für Magnesiummangel geben aber neben der Messung des Serumspiegels Anamnese, klinischer Befund, bestimmte EKG-Veränderungen wie auch evtl. Hypokalämie, ein Zustand, bei dem sich oft — besonders bei Aldosteronismus — parallele Veränderungen zeigten.Tierexperimente deuten darauf hin, daß infarktähnliche Läsionen unter Magnesiummangel entstehen, doch ob Herzinfarkt beim Menschen durch Magnesiummangel ausgelöst werden kann, ist noch ungeklärt. In Leichenherzen zeigte sich im Infarktgebiet neben Calciumakkumulation signifikanter Magnesiumverlust, wobei unklar blieb, ob sich Ursache oder Folge des Infarktes widerspiegelten. Falls ein ursächlicher Zusammenhang besteht, ist er im Myokardstoffwechsel selbst zu suchen, wie bei der Alkoholkardiomyopathie, wo myokardialer Magnesiummangel zumindest als pathogenetischer Teilfaktor anerkannt wird. Andererseits versucht man aber auch Beziehungen zwischen Atherosklerose, Blutgerinnung und Hypomagnesämie herzustellen, in der Meinung, daß Magnesiummangel auch über den coronaren Pathomechanismus des Herzinfarktes wirken könnte. Sicher scheint, daß gewisse EKG-Veränderungen und Herzrhythmusstörungen durch einen irritierten Magnesiumhaushalt bedingt sein können, da sie bei Gabe bzw. Entzug von Magnesium verschwinden. Daß Magnesiummangel die Glykosidtoleranz verringert, wird tierexperimentell bestätigt. Unter Hypomagnesämie bewirkt Acetylstrophanthidin eher und länger Rhythmusstörungen als ohne, außerdem lassen diese sich durch Magnesiumgaben eliminieren. Da in gewissen Fällen spontane und digitalisinduzierte Herzrythmusstörungen durch Magnesiuminjektionen beseitigt wurden, scheint Magnesium als Therapeuticum angebracht. Einsatz verschiedener Magnesiumsalze bei Angina pectoris, degenerativen Herzerkrankungen und Herzinsuffizienz ohne geprüften und offensichtlich gestörten Magnesiumhaushalt ist fragwürdig, weil keine eindeutigen klinischen Erfolgsbeweise vorliegen. Immerhin mag es aber larvierte, durch Serumbestimmungen nicht erfaßbare Mangelzustände geben. Allgemein erscheint es aus kardiologischer Sicht ratsam, den Magnesiumhaushalt zu überwachen und in entsprechenden Fällen auszugleichen, um möglichen Myokardläsionen oder fatalen Herzrhythmusstörungen entgegenzuwirken.     

HLA in North Colombia Chimila Amerindians

HLA-A,-B,-C,-DRB1 and -DQB1 alleles have been studied in Chimila Amerindians from Sabana de San Angel (North Colombian Coast) by using high resolution molecular typing. A frequent extended haplotype was found:HLA-A*24:02-B*51:10-C*15:02-BRB1*04:07-DQB1*03:02 (28.7%) which has also been described in Amerinndian Mayos Mexican population (Mexico, California Gulf, Pacific Ocean). Other haplotypes had already been found in Amerindians from Mexico (Pacific and Atlantic Coast), Peru (highlands and Amazon Basin), Bolivia and North USA. A geographic pattern according to HLA allele or haplotype frequencies is lacking in Amerindians, as already known. Also, five new extended haplotypes were found in Chimila Amerindians. Their HLA-A*24:02 high frequencies characteristic is shared with aboriginal populations of Taiwan; also, HLA-C*01:02 high frequencies are found in New Zealand Maoris, New Caledonians and Kimberly Aborigines from Australia. Finally, this study may show a model of evolutionary factors acting and rising one HLA allele frequency (-A*24:02), but not in others that belong to the same or different HLA loci.     

The case for allele‐specific recognition by the TCR

There is a sharp difference in how one views TCR structure–function–behaviour dependent on whether its recognition of major histocompatibility complex‐encoded restriction elements (R) is germline selected or somatically generated. The generally accepted or Standard model is built on the assumption that recognition of R is by the V regions of the αβ TCR, which is not driven by allele specificity, whereas the competing model posits that recognition of R is allele‐specific. The establishing of allele‐specific recognition of R by the TCR would rule out the Standard model and clear the road to a consideration of a competing construct, the Tritope model. Here, the case for allele‐specific recognition (germline selected) is detailed making it obvious that the Standard model is untenable.