指背腱膜滑动与近侧指间关节屈曲关系及临床意义

目的:探讨指背腱膜滑动距离与近侧指间关节(PIP)屈曲关系,为临床修复提供解剖学基础。方法:男性成人新鲜尸体标本10侧30指(示、中、环指各10指),切除手指皮肤,不破坏腱鞘、屈肌支持带、伸肌支持带、内在肌及外在肌,使肌腱保持正常的生理状态,分别测量各指中央束(CS)、侧束(LB)在PIP屈曲45°和90°时的滑动距离。结果:当PIP屈曲45°时,CS滑动距离为(2.7±0.4)mm,LB滑动距离为(2.8±0.6)mm;当PIP屈曲90°时,CS滑动距离为(4.3±0.7)mm,LB滑动距离为(4.8±0.6)mm。结论:指背腱膜滑动距离减少,严重影响手指的屈曲功能。对于指背腱膜的新鲜性损伤应予以精确修复;对于陈旧性损伤的修复应确保指背腱膜的正常滑动范围。     

Evidence for the involvement of HLA-DR antigens in restricted cytotoxicity by fetal calf serum-specific human T cells

Fetal calf serum (FCS) generated at least two distinct populations of human cytotoxic cells in vitro. One population expressed natural killer (NK) cell-like activity and lysed K562 and HSB-2 targets more effectively than autologous or allogeneic lymphoblastoid cell lines (LCLs). The other population contained FCS-specific cytotoxic T cells which preferentially lysed the autologous LCLs and showed minimal lysis of K562. E-rosette separation and cold target competition experiments clearly established that NK cells were not involved in the self-reactive lysis. Moreover, the lytic activity of the E-rosetted T cells was reduced by up to 95% when autologous target cells were grown in human AB serum rather than FCS, showing that FCS-associated determinants on targets were essential in the cytolytic phase. Autologous LCLs grown in FCS were also considerably stronger competitors than human serum-grown LCLs. The consistent self-preferred lysis suggested that HLA antigen-related restriction was involved, but the patterns of lysis did not implicate HLA-A or B antigens, and monoclonal antibody (W6/32) to an A, B, and C monomorphic determinant failed to block FCS-specific lysis. In contrast, monoclonal antibody (DA.2) to a monomorphic determinant of DR effectively blocked FCS-specific lysis. Cytotoxicity tests with a small panel of DR-typed donors indicated that strong cross-reactions were invariably associated with sharing of DR antigens, particularly DR2, and to a lesser but significant extent DR7. Although DR antigen sharing did not always result in lysis of allogeneic targets, the overall evidence strongly suggests that FCS-specific T-cell cytotoxicity in humans is restricted by products encoded by or associated with the DR genes.     

Understanding the financial impact of a diagnosis of young onset dementia on individuals and families in the United Kingdom: Results of an online survey

Although literature on postdiagnostic support for people affected by young onset dementia acknowledges financial concerns, this topic has remained underresearched. The aim of this study was to explore the financial impact of a diagnosis of young onset dementia on individuals and families. An online survey, comprising binary yes/no, multiple-response and open-ended questions, was codesigned with people living with young onset dementia. The survey was promoted via networks and online platforms. Data were collected from August to October 2019. Survey respondents across the United Kingdom (n = 55) who had received a diagnosis of young onset dementia were aged between 45 and 64, were at different stages of dementia and had been diagnosed with thirteen different types of dementia. Of the 55 respondents, 71% (n = 39) had received assistance from family members when completing the survey. The main financial impact of a diagnosis of young onset dementia resulted from premature loss of income and reduced and often deferred pension entitlements. In some cases, care-costs became unaffordable. Lack of clarity of processes and procedures around needs assessments, carers' assessments and financial assessments by different organisations resulted in some families having to ask for legal advice and, in some cases, involved lengthy appeal processes. Future research needs to involve Adult Social Care and Third Sector organisations to help codesign and test financial management interventions to support people affected by this progressive health condition.     

EGF刺激下PIP2水解的数学模型

为了研究表皮生长因子刺激下细胞膜上磷脂酰肌醇二磷酸水解的动力学特性,我们根据质量作用定律和准稳态近似原则建立数学模型,模拟磷脂酰肌醇二磷酸的代谢;建立了磷脂酰肌醇二磷酸和表皮生长因子受体间浓度关系的微分方程,讨论了各个参数对磷脂酰肌醇二磷酸浓度变化趋势的影响。这个数学模型描述了磷脂酰肌醇二磷酸代谢的生物学特性以及关键信号分子间的浓度依赖关系。     

Suzuki's pins and rubber traction for fractures of the base of the middle phalanx

Abstract

Basal fractures of the middle phalanx are uncommon, but difficult to treat. We have reviewed our first 20 patients using the Suzuki pins and rubber traction who were treated during an 8.5 year period (June 1998–December 2006) and 18 who were reviewed after 49 (range 17–116) months. All injuries were closed fractures of the base of the middle phalanx. Ten patients had a fracture of the volar lip and dorsal subluxation of the phalanx, one had a fracture of the dorsal lip, and seven had comminuted pilon fractures. Median operating time was 33 (18–255) minutes. Thick “vessel loops” were often used for traction, and active movement before the traction was removed after 38 (8–46) days was disappointing. There were two superficial infections and one deep. One proximal interphalangeal (PIP) joint had been treated by arthrodesis and another amputated before review. On a visual analogue scale (VAS) from 0 (best) to 10 (worst), patients at review reported discomfort when wearing the traction as 5.5 (0–10), pain as 0 (0–6), and finger function as 3 (0–6). The median Quick-DASH score (100 = worst) was 2 (0–48) and grip strength 97 (75–118) % of the other hand. Median extension, flexion, and total range of movement of the PIP joint in 16 fingers were -9°, 83°, and 72°, respectively. Our results are no more than adequate. They might have been better if the force of traction had been less by using rubber bands instead of vessel loops, if postoperative follow-up had been more frequent allowing for correction of traction when necessary, and if traction had been discontinued earlier.     

Effectiveness of Conservative,Surgical, and Postsurgical Interventions for Trigger Finger,Dupuytren Disease,and De Quervain Disease: A Systematic Review

Objectives

To provide an evidence-based overview of the effectiveness of conservative and (post)surgical interventions for trigger finger, Dupuytren disease, and De Quervain disease.

Localization of PIP5Kγ selectively in proprioceptive peripheral fields and also in sensory ganglionic satellite cells as well as neuronal cell membranes and their central terminals

Based on a previous study by others reporting that PIP5Kγ (phosphatidylinositol 4-phosphate 5-kinase γ) and its product, phosphatidylinositol 4,5 bisphosphate (PIP₂), are involved in the regulation of nociception, the present immunohistochemical study examined the localization of PIP5Kγ-immunoreactivity in dorsal root ganglia (DRG) and their peripheral and central terminal fields. PIP5Kγ-immunoreactivity was localized for the first time in the muscle spindles, in which it was found in I-bands of polar regions of intrafusal muscle fibers and also in sensory nerve terminals abutting on equatorial regions of the muscle fibers. This finding indicates the involvement of PIP5Kγ in the proprioception and suggests somehow complicated mechanisms of its involvement because of its heterogeneous localization in intra-I-band structures. In DRG, on the other hand, PIP5Kγ-immunoreactivity was shown to be localized heterogeneously, but not evenly, over apposed plasma membranes of both neurons and ganglionic satellite cells in immune electron microscopy. In addition, no peripheral nerve terminals of DRG showing its distinct immunoreactivity were found in most peripheral fields of nociception and any other sensory perception except for the proprioception through muscle spindles. In contrast, numerous central terminals of DRG in the spinal posterior horn were immunoreactive for it. This finding leads us to consider the possibility that the regulation by PIP5Kγ of nociception is dominantly exerted in DRG and sensory neural tracts central, rather than peripheral, to DRG.     

Arthrodesis of proximal inter-phalangeal joint for hammertoe: intramedullary device options

Background

Proximal inter-phalangeal (PIP) joint arthrodesis today represents the standard treatment for structured hammertoes; however, recently, a lot of new intramedullary devices for the fixation of this arthrodesis have been introduced. The purpose of this work is to look at the currently available devices and to perform a review of the present literature.

Materials and methods

A literature search of PubMed/Medline and Google Scholar databases, considering works published up until September 2014 and using the keywords: hammertoe, arthrodesis, PIP joint, fusion, intramedullary devices, and K-wire, was performed. The published papers were included in the present study only if they met the following inclusion criteria: English articles, arthrodesis of PIP joints for hammertoes with new generation intramedullary devices, series with n > 10. Studies using absorbable pins or screws that are considered as another kind of fixation that involved more than one articulation, as well as comments, letters to the editor, or newsletters were excluded.

Results

Nine publications were included. Of the patients’ reports, 93–100 % were good or excellent concerning satisfaction. Radiological arthrodesis was achieved in 60.5–100 % of cases. Three of the publications compared the new devices with the K-wire. Of these three articles, two employed the traditional technique and one the buried technique. The AOFAS score, evaluated in three publications, showed a delta of 19, 45 and 58 points. Major complications, which required a secondary surgical revision, were between 0 and 8.6 %. The complications of the K-wire and the new devices were similar; also the reoperation rate was close to equal (maximal difference 2 %). On the other hand, these kinds of devices definitely have a higher price, compared to the K-wire.

Conclusion

The use of these new devices provides good results; however, their high price is currently a problem. For this reason, cost-benefit studies seem to be necessary to justify their use as standard treatment.

Level of evidence

Level III systematic review.