人工半肩关节置换和钢板置入修复老年复杂肱骨近端骨折:肩关节功能比较

背景:老年肱骨近端粉碎性骨折的修复方法临床尚存在争议。目的:对比人工半肩关节置换与肱骨近端锁定钢板置入内固定修复老年肱骨近端复杂骨折的肩关节功能恢复情况。方法:回顾性分析2012年10月至2014年10月收治的老年肱骨近端复杂骨折患者22例,12例行人工半肩关节置换,10例行肱骨近端锁定钢板置入内固定。所有患者均进行治疗后随访,随访期内复查X射线片,并通过Neer评分评估肩关节功能恢复情况。结果与结论:末次随访,人工半肩关节置换组未见假体松动及肱骨头缺血坏死,Neer评分(81±5)分;肱骨近端锁定钢板内固定组内固定松动4例,肱骨头缺血坏死3例,Neer评分(69±5)分,组间差异有显著性意义(P0.05)。在修复过程中,人工半肩关节置换组的平均手术时间低于肱骨近端锁定钢板内固定组,出血量前者高于后者,但组间差异无显著性意义(P0.05)。提示肱骨近端锁定钢板置入内固定与人工半肩关节置换均为肱骨近端复杂骨折有效的修复手段,但人工半肩关节置换可更早的进行功能锻炼,肩关节恢复也较好。     

肱骨近端锁定钢板治疗肱骨近端4部分骨折

背景：以往对肱骨近端4部分骨折患者行切开复位内固定时常使用非锁定的解剖钢板,难以获得稳定的固定,固定后并发骨折再移位及肱骨头坏死的概率相对较高。 目的：观察肱骨近端锁定钢板治疗肱骨近端4部分骨折的临床疗效。 方法：肱骨近端4部分骨折的患者72例,其中无肱骨头脱位40例,肱骨头脱位32例,均给予切开复位、肱骨近端锁定钢板锁定系统固定,固定后3周内给予肩关节制动,之后逐渐开始功能锻炼。定期随访,通过Neer评分评价肩关节的功能。 结果与结论：末次随访3,6,9,12,18,≥24个月的患者数分别为6,13,31,9,8,5例。末次随访≥9个月的53例,骨折愈合率达98%(52/53),Neer评分中级以上达85%(45/53),肱骨头坏死率6%(3/53)。X射线检查显示3例均为固定前肱骨头脱位患者,肩峰撞击综合症发生率9%(5/53),无内固定松动、螺钉断裂。固定前肱骨头脱位固定后肱骨头坏死和Neer评分与固定前无肱骨头脱位比较差异无显著性意义。说明肱骨近端锁定钢板治疗肱骨近端4部分骨折利于骨折块复位,固定牢靠,固定后肩关节功能恢复良好,并发症较少。     

长型肱骨近端锁定钢板治疗肱骨近端并肱骨干骨折

背景：国内外均有文献报道证实长型肱骨近端内固定锁定钢板用于治疗肱骨近端骨折疗效显著。 目的：总结应用长型肱骨近端内固定锁定钢板手术治疗肱骨近端合并肱骨干骨折的临床疗效。 方法：纳入应用长型肱骨近端内固定锁定钢板治疗肱骨近端合并肱骨干骨折患者16例。其中男7例,女9例,年龄45-83岁,平均71岁。肱骨近端Neer分型,2部分骨折5例,3部分骨折8例,4部分骨折3例;肱骨干骨折AO分型A1型5例,B1型6例,B2型2例,C1型2例,C3型1例。内固定后肩关节功能采用Constant-Murley肩关节评分标准对患者两侧肩关节进行评分,同时计算评分百分比并作相应评价。肘关节采用改良HSS评分标准评估。 结果与结论：16例患者均获随访,随访时间12-24个月,平均14.9个月。所有患者骨折均愈合,时间8-17周,平均12.1周。2例患者出现伤口脂肪液化,换药后均愈合。1例患者治疗后出现桡神经麻痹症状,1例患者出现肩峰撞击综合征,治疗后好转。无内固定松动、螺钉切割及肱骨头缺血坏死等并发症发生。治疗后12个月按Constant-Murley评分标准为65-90分,平均76.87分。与健侧百分比为71.4%-93.8%,平均83.41%。优良15例,满意1例。改良HSS肘关节评分优13例,良3例,优良率100%。说明长型PHILOS钢板治疗肱骨近端合并肱骨干骨折固定可靠,并发症少,疗效满意。     

锁定钢板治疗肱骨近端骨折的临床疗效分析

[摘要] 目的 探讨肱骨近端锁定钢板治疗肱骨近端骨折的临床疗效。方法 2010年2月~2013年8月应用肱骨近端锁定钢板（locking proximal humeral plate, LPHP）治疗肱骨近端骨折73例，其中男性32例，女性41例，年龄39~78岁，平均（61.2±10.4）岁。根据Neer分型，二部分骨折22例，三部分骨折43例，四部分骨折8例。结果 73例患者65例获得随访，随访时间6~25月，平均14.5月，最终均骨性愈合，平均愈合时间约5.5月。根据肩关节Neer功能评分标准评定：优（>90分）35例；良（80~89分）24例；可4例，差（＜70分）2例。优良率达90.8%。随访中未发现伤口感染、螺钉松动及肱骨头坏死等并发症。结论 LPHP设计合理，用于治疗肱骨近端骨折具有固定牢靠，并发症少，可早期进行功能锻炼等优点，疗效肯定、满意。     

第3代multiloc髓内针、普通弯型髓内针与肱骨近端锁定钢板治疗复杂肱骨近端骨折的比较北大核心

背景:对于较为复杂的肱骨近端骨折,临床中多采取植入物内固定治疗,关于何种固定方式更有优势目前仍无定论。目的:比较第3代multiloc髓内针、普通弯型肱骨髓内针与肱骨近端锁定钢板治疗复杂肱骨近端骨折(Neer 3、4部分)的效果。方法:选择2018年8月至2022年3月在镇江瑞康医院接受治疗且进行术后随访的复杂肱骨近端骨折(Neer3、4部分)患者38例,男20例,女18例,年龄57-74岁,其中13例接受第3代multiloc髓内针内固定治疗,12例接受普通弯型髓内针内固定治疗,13例接受肱骨近端锁定钢板内固定治疗。术后随访观察3组骨折愈合时间、目测类比评分、Constant-Murley肩关节评分、上肢功能障碍DASH评分与影像学检查结果。结果与结论:(1)38例患者均获得术后随访,随访时间12-18个月,3组间术后7 d的目测类比评分比较差异无显著性意义(P> 0.05),3组间骨折愈合时间比较差异无显著性意义(P> 0.05);(2)3组间术后1,3,6,12个月的患肩前屈上举、外旋、内旋、外展角度比较,差异均无显著性意义(P> 0.05);影像学检查结果显示,multiloc髓内针组术后3,6,12个月的肱骨颈干角大于普通弯型髓内针组、锁定钢板组(P <0.05),术后3,6,12个月的肱骨头内翻角、肱骨头高度丢失小于普通弯型髓内针组、锁定钢板组(P <0.05);(3)multiloc髓内针组术后1,3,6,12个月的Constant-Murley肩关节评分高于普通弯型髓内针组、锁定钢板组(P <0.05),术后1,3,6,12个月的上肢功能障碍DASH评分低于普通弯型髓内针组、锁定钢板组(P <0.05);(4)结果表明,对于复杂肱骨近端骨折(Neer 3、4部分),第3代multiloc髓内针具有显著抗压缩、抗内翻及维持颈干角度的固定优势,并具有肩关节功能恢复快等特点。     

肱骨近端锁定钢板与三叶草钢板治疗老年肱骨近端骨折的疗效分析

目的 比较肱骨近端锁定钢板与三叶草钢板治疗肱骨近端骨折的疗效.方法 2009年1月至2011年12月肱骨近端骨折老年患者50例,其中使用肱骨近端锁定钢板治疗27例(锁定钢板组),三叶草钢板治疗23例(三叶草钢板组),术后随访1个月至1.5年,观察骨折愈合、肩关节活动功能、手术切口疼痛以及手术并发症等情况,Neer肩关节评分系统评估其疗效.结果 2组手术时间、术中出血比较,P ＜0.05,差异有统计学意义.Neer肩关节评分:术后1个月、3个月,2组的评分比较,P＜0.05,差异有统计学意义;术后1年,2组评分比较,P＞0.05,差异无统计学意义.结论 肱骨近端锁定钢板与三叶草钢板治疗老年肱骨近端骨折临床疗效均满意,但是三叶草钢板与骨面的接触面积更大,肱骨头缺血坏死发生几率高些,肱骨近端锁定钢板更具功能锻炼早、并发症少、功能恢复好优势.     

新型骨水泥强化螺钉结合锁定钢板内固定与人工肱骨头置换治疗肱骨近端骨质疏松性骨折的比较

文题释义： 骨水泥强化螺钉技术：骨质疏松是中老年常见的代谢性疾病,常导致内固定松动而致内固定失败。而骨水泥强化螺钉技术是预防螺钉松动的有效办法,主要用于骨质疏松性骨折。肱骨近端骨水泥强化螺钉技术是通过空心螺钉通道将骨水泥注入肱骨头松质骨中,使螺钉及骨质有良好的整合作用、防止螺钉松动,同时对疏松的骨质起到支撑作用,防止肱骨头塌陷。 肱骨近端骨折：是指大结节基底部以上部位的骨折,包括外科颈;Neer 和Codman 将肱骨近端分成4个基本解剖结构：大结节、小结节、肱骨干、肱骨头,大小结节间的结节间沟是肱骨近端骨折复位的标志性结构。约87%的患者骨折发生于低能量损伤,可能和骨质疏松相关。肱骨近端骨折是目前第三常见的骨质疏松性骨折,同时肱骨近端骨质疏松性骨折是临床治疗的一个难点。 背景：为解决骨质疏松骨折行内固定可能出现的螺钉切出、松动、把持力不足等并发症,目前一种新的骨水泥强化螺钉技术结合PHILOS锁定钢板被用于治疗肱骨近端骨质疏松性骨折,但国内应用该技术治疗肱骨近端骨质疏松性骨折的临床疗效鲜见报道。 目的：比较新型骨水泥强化螺钉技术结合锁定钢板内固定与人工肱骨头置换治疗肱骨近端骨质疏松性骨折的临床疗效。 方法：选择2017年2月至2019年3月贵州省人民医院收治的肱骨近端骨质疏松性骨折患者22例,其中男8例,女14例,年龄68-88岁,其中10例行骨折切开复位新型骨水泥强化螺钉技术结合锁定钢板内固定治疗(内固定组),另12例行人工肱骨头置换治疗(肱骨头置换组)。比较两组手术时间、术中出血量、术中及术后并发症;术后6个月进行肩关节目测类比评分及肩关节Constant评分等。术后所有患者均给予抗骨质疏松治疗。试验获得贵州省人民医院伦理委员会批准,批准号：2017(02)号。 结果与结论：①22例患者均获得随访,随访时间6-15个月,平均(9.0±1.6)个月;②两组术中未出现骨水泥毒性反应、栓塞等并发症;内固定组术后1例出现肩关节僵硬,两组术后未出现切口感染、异位性骨化、骨折延迟愈合及不愈合,未出现螺钉拔出及切割等不良反应;③内固定组手术时间及术中出血量少于肱骨头置换组(P < 0.05);④两组术后6个月的目测类比评分与肩关节Constant评分优良率比较差异均无显著性意义(P > 0.05);⑤结果表明,新型骨水泥强化螺钉技术结合锁定钢板内固定治疗肱骨近端骨质疏松性骨折可获得与人工肱骨头置换相近的临床疗效,是部分可能需行肩关节置换患者选择内固定治疗的一种治疗方法补充。 ORCID: 0000-0002-8139-1175(佘荣峰) 中国组织工程研究杂志出版内容重点：人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程     

肱骨头置换治疗肱骨近端粉碎性骨折与锁定钢板治疗的对比

背景:NeerⅢ型、Ⅳ型肱骨近端骨折是较难处理的骨折类型,一直争议较多。目的:比较肱骨近端骨折采用肱骨头置换治疗与锁定钢板治疗的效果。方法:对2004-06/2006-08收治的26例有完整随访资料的应用肱骨头置换治疗肱骨近端粉碎性骨折患者的疗效进行回顾性分析,26例患者采用人工肱骨头置换治疗。以文献检索的锁定钢板治疗方法及常规内固定方法,选折治疗对象相似、疗效评价标准相同的研究作为对照。按Neer评分标准比较3种方法的治疗效果及并发症发生情况。结果与结论:26例全部随访,随访时间为11～36个月,平均24个月。按Neer评分标准优11例,满意13例,不满意2例。与文献报道采用锁定钢板组比较差异无显著性意义(P0.05),但疗效优于常规内固定组P0.05)。并发症:肱骨头置换组疼痛2例;锁定钢板组肱骨头坏死6例,疼痛3例;常规手术组感染1例,肩峰撞击4例,肱骨头坏死6例,疼痛6例。结果提示,在严格掌握手术适应证的前提下,人工肱骨头置换能减轻患者的疼痛、恢复肩关节的功能和稳定性。     

肱骨近端锁定钢板治疗中老年肱骨近端骨折体会

目的 探讨用肱骨近端锁定钢板治疗肱骨近端有移位骨折的疗效.方法 对肱骨近端骨折有移位的32例患者,进行 Neer分类,二,三部分骨折和四部分骨折行肱骨近端锁定钢板内固定.结果 内固定术后所有骨折均愈合,无畸形.愈合时间为8～12周,平均10周.所有病例均无感染、神经、血管损伤等并发症发生.结论 对肱骨近端骨折采用手术治疗可取得较为满意的效果.Neer二部分骨折、多数三部分骨折及一些四部分骨折可采用肱骨近端锁定钢板内固定.     

肱骨近端锁定钢板置入结合Osteoset人工骨治疗肱骨近端骨折随访：22例

背景：螺钉、克氏针张力带钢丝、髓内钉、三叶草钢板等置入内固定肱骨近端骨折的疗效欠佳,常出现螺钉固定不牢或松动等现象,影响肱骨头血运与肩关节外展功能。 目的：观察肱骨近端锁定钢板置入内固定结合Osteoset人工骨植入治疗肱骨近端骨折的临床效果。 方法：应用肱骨近端锁定钢板置入内固定结合Osteoset人工骨植入治疗22例肱骨近端骨折病例。 结果与结论：所有病例随访12~24个月均骨性愈合,根据Neer疗效评分标准,优13例,良7例,可2例,差0例,优良率为91%;治疗后X射线显示所有肱骨近端骨折及肩关节脱位均获得了满意复位。说明肱骨近端锁定钢板置入内固定结合Osteoset人工骨植入治疗肱骨近端骨折疗效肯定。     

Renal dysplasia and asplenia in two sibs

A family is reported in which two sibs, one male and the other female, both died within 24 hours of birth with enlarged polycystic kidneys. Postmortem histology in the second child showed gross renal dysplasia. In both children the pancreas was enlarged, nodular and cystic but the liver appeared macroscopically normal. In the second child, histological examination confirmed pancreatic fibrosis with cystic dilation of ducts, but showed portal fibrosis with bile duct proliferation in the liver.
This combination of findings is very reminiscent of those in a girl and her brother reported by Ivemark et al. (1959). The children reported here also showed absence or hypoplasia of the spleen, cardiac anomalies and other features of the Ivemark syndrome (Ivemark 1955), a quite different, usually sporadic, congenital disorder. It is suggested that the children described here have a distinct lethal congenital disorder, probably inherited in an autosomal recessive manner.     

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.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

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.     

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.     

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.     

Environmental risk factors and their role in the management of atopic dermatitis

Introduction: The etiology of atopic dermatitis (AD) is multifactorial with interaction between genetics, immune and environmental factors.

Areas covered: We review the role of prenatal exposures, irritants and pruritogens, pathogens, climate factors, including temperature, humidity, ultraviolet radiation, outdoor and indoor air pollutants, tobacco smoke exposure, water hardness, urban vs. rural living, diet, breastfeeding, probiotics and prebiotics on AD.

Expert commentary: The increased global prevalence of AD cannot be attributed to genetics alone, suggesting that evolving environmental exposures may trigger and/or flare disease in predisposed individuals. There is a complex interplay between different environmental factors, including individual use of personal care products and exposure to climate, pollution, food and other exogenous factors. Understanding these complex risk factors is crucial to developing targeted interventions to prevent the disease in millions. Moreover, patients require counseling on optimal regimens for minimization of exposure to irritants and pruritogens and other harmful exposures.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

'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.