同种异体软骨听骨赝复物与羟基磷灰石听骨赝复物修复听骨链损伤的比较

背景:以往多采用同种异体软骨听骨赝复物作为听骨链重建的材料,近年来羟基磷灰石听骨赝复物已广泛地应用于鼓室成形术的临床工作中。而目前有关两种听骨赝复物在鼓室成形术、听骨链重建中的临床疗效比较尚无相关报道。目的:比较两种听骨赝复物的临床疗效,旨在探求更适宜临床推广应用的听骨赝复物。方法:将进行鼓室成形、听骨链重建术的慢性中耳炎患者60例分为同种异体软骨听骨赝复物组和羟基磷灰石听骨赝复物组,两组在术前、术后进行纯音听力测试,以语言频率区(0.5,1.0,2.0kHz)听阈气导平均值及气骨导差平均值统计,取最后一次(至少6个月以后)复查听力结果作为组间对比指标之一。同时记录两组病例移植鼓膜愈合情况,即移植鼓膜良好上皮化的时间,两组听骨赝复物的脱出率。结果与结论:在相同病变类型、相同术式患者中,同种异体软骨听骨赝复物与羟基磷灰石听骨赝复物植入后听力恢复水平方面差异不显著(P0.05),术后移植鼓膜愈合情况方面差异不显著(P0.05)。在相同病变类型、相同术式的术后赝复物脱出率均为0。提示同种异体软骨听骨赝复物与羟基磷灰石听骨赝复物在慢性中耳炎患者行鼓室成形、听骨链重建术中的临床疗效相似。     

中耳畸形对圆窗激振听力补偿性能影响的数值分析

目的研究中耳畸形对圆窗激振性能的影响,为圆窗激振式人工中耳的优化提供理论支持。方法构建包含两腔不对称的非螺旋耳蜗的人耳有限元模型,并与实验数据进行对比,验证模型的可靠性。基于该模型,通过改变相应组织的材料属性,分别模拟听骨链固定、听骨链融合、听小骨缺损3种中耳畸形对圆窗激振性能的影响。结果中耳畸形主要影响圆窗激振式人工中耳的低频性能,听骨链固定和听骨链融合对圆窗激振起恶化效果。镫骨固定对圆窗激振补偿性能的影响最大,恶化量高达47.93 dB;听小骨缺损可提高圆窗激振的性能,最大改善量为6.24 dB。结论中耳畸形对圆窗激振的低频性能有影响,临床植入圆窗激振式人工中耳时需要针对性地提高其作动器的输出量。     

细菌生物膜对置换钛质听骨赝复物听力恢复的影响

目的 探讨生物膜不同成长时期对部分钛质听骨赝复物结构动力行为的影响,为临床治疗分泌性中耳炎等疾病提供理论依据。方法 基于人体正常右耳的CT扫描图像,结合自编程序,重建人耳三维有限元模型,对其进行声音传导动力分析,并与实验数据对比。采用频率响应方法对耳结构模型进行计算,同时分析不同生长时期的细菌生物膜生长在人工钛质听骨上对声音传导的影响。结果 模拟得到鼓膜凸和镫骨底板振幅与实验数据吻合,验证了模型的正确性。生物膜的存在会使患者听力在低频段有0~1.6 dB的损伤;生物膜沿部分听骨赝复物径向生长会使患者听力在中高频阶段有0~12 dB的损伤,尤其是在8 kHz时,听力损伤高达11.2 dB。结论 细菌生物膜对患者听力有影响,在低频段会使患者听力损失,在高频段听力有增加。细菌生物膜在人工听骨上的径向生长会降低听力,影响人工假体对听力恢复正常的工效。     

先天性外耳道狭窄和闭锁患者卵圆窗、圆窗的空间方位特点及其临床意义

目的：研究先天性外耳道狭窄、外耳道闭锁患者卵圆窗和圆窗的空间方位特点,探讨其临床意义。方法： 将先天性外耳道狭窄、先天性外耳道闭锁患者和正常人的CT数据三维重建后,计算圆窗龛口平面、圆窗膜平面、 卵圆窗平面、圆窗龛中轴线的空间方位。结果：圆窗膜与法兰克福平面的夹角在外耳道狭窄组（42.43°±25.58°） 小于正常组（66.72°±45.18°）。圆窗膜与矢状面的夹角在外耳道狭窄组（74.70°±17.94°） 小于正常组 （91.62°±21.36°）。圆窗膜与冠状面的夹角在外耳道狭窄组（72.14°±20.10°）和外耳道闭锁组（71.38°±27.59°） 均小于正常组（92.39°±29.36°）。卵圆窗与冠状面的夹角在外耳道狭窄组（103.38°±20.52°）大于外耳道闭锁组 （88.43°±20.14°）和正常组（82.40°±17.25°）。圆窗龛中轴线与矢状面的夹角在外耳道闭锁组（25.38°±7.63°） 大于正常组（17.14°±7.50°）。结论：在先天性外耳道狭窄患者圆窗膜后半部分向外下方倾斜,卵圆窗后半部分 向内下方倾斜。在外耳道闭锁患者,圆窗龛整体向前倾斜。本研究可为经卵圆窗区和圆窗区手术提供解剖学基础, 以避免损伤面神经、圆窗膜和椭圆囊等内耳重要结构。     

基于基底膜响应的圆窗激振性能评估偏差研究

目的研究采用传统基底膜位移评价标准评估圆窗激振式人工中耳听力补偿性能的准确性,为圆窗激振式人工中耳的性能评估提供理论基础。方法基于耳蜗几何结构的实验数据,建立耳蜗感声微观有限元模型,通过对比内听毛细胞、外听毛细胞、盖膜等部位位移响应的实验测量值,验证模型的可靠性。基于该模型,对比分析正向激振、圆窗激振下的基底膜位移与内听毛细胞静纤毛剪切位移;以内听毛细胞静纤毛剪切位移作为感声标准,研究圆窗激振时采用传统人工中耳基底膜评价标准的等效声压级偏差。结果在所研究耳蜗微段对应的5 k Hz特征频率处,相同幅值的声压作用下,圆窗激振的基底膜位移和内听毛细胞静纤毛剪切位移均小于正向激振的对应值。结论正向激振下的内听毛细胞更兴奋,感声效果更强。同时,采用正向激振的基底膜位移评价方法评估圆窗激振的听力补偿效果,会高估圆窗激振的听力补偿性能;但偏差较小,是一种相对可靠的评价方法。     

中耳炎病变对圆窗激振听力补偿影响的数值分析

为了研究中耳炎引起的鼓膜病变和听小骨腐蚀对圆窗激振式人工中耳听力补偿的影响,利用计算机断层扫描(CT)技术和逆向成型技术建立了包含耳蜗不对称结构的人耳有限元模型,并与相关实验数据对比,验证模型的可靠性。基于该模型,通过改变相应的组织结构,分别模拟中耳炎引起的鼓膜病变和听小骨腐蚀,并对比相应的基底膜特征频率处的位移响应,来研究中耳炎病变对圆窗激振听力补偿效果的影响。结果表明:鼓膜增厚和鼓膜硬化主要恶化圆窗激振低频段的听力补偿效果;鼓膜穿孔和未导致听骨链脱离的听小骨腐蚀,对圆窗激振的影响较小;不同于前述病变类型的影响,听小骨腐蚀导致听骨链脱离时,将提高圆窗激振低频段的听力补偿性能。因此,设计圆窗激振作动器时,应综合考虑中耳炎病变对其听力补偿性能的影响,特别是鼓膜增厚及硬化对其低频段性能的恶化,适当增大其低频段的输出增益,确保其术后的实际听力补偿性能。     

仿真材料的赝复法修复耳郭部分缺损

背景：耳郭畸形的治疗方法包括义耳赝复、肋软骨植入、Madpor支架植入及骨合种植等,但利弊各异,效果上各有优劣。 目的：采用仿真材料的赝复法治疗部分耳郭缺损患者,并评估其赝复效果。 方法：选用部分耳郭缺损的小耳畸形患者2例,根据耳郭缺损的情况,以双组份室温固化硅橡胶制作出赝复体,借助医用黏合剂固定赝复体至缺损部位。分别在不同光线、距离和环境下评估赝复效果以及患者自身满意度。 结果与结论：纳入的2例部分耳郭缺损患者经赝复法治疗后其耳郭可达到良好视觉效果。赝复法治疗部分缺损的小耳畸形患者,方法简单无需手术,可重复性好,易于维护。自然光线下,室外赝复物肉眼分辨距离低于1.5 m时,患者表现出较高满意度。     

人工耳蜗四年经验小结

一、引言 1957年已经提出了用人工耳蜗使全聋病人重新听到声音的想法,当时DjournO等人第一次把电极植入到听神经附近,并且通过电刺激这些神经使其诱发出类似于噪声的感觉。在正常的耳朵中,传来的声波引起鼓膜的振动。这个振动通过中耳内的三个小骨传导到卵圆窗膜,并且激发耳蜗内的外淋巴液的运动。耳蜗包括三个充满液体的阶,根据传来的声音的频率,内耳的液体在沿着耳蜗长度的特定部位、呈现出最大的运动。克氏器     

可摘局部义齿上颌赝复体设计及其生物力学评价

对单侧上颌缺损的腭部封闭式和阻塞式赝复体进行几何仿真,并对这两种重建方法分别进行卡环和附着体固位方式设计,并对重建的生物力学效果进行了对比研究。模拟加载肌肉约束和力边界条件,分析四种不同上颌赝复体的应力分布,综合考虑义齿、基托、牙面板、阻塞器、卡环和附着体结构等强度问题,以及余留牙和赝复体的应力大小和分布趋势。根据应力结果,优化设计,为赝复体的临床成功作出生物力学的评价。分析结果表明:整个赝复体修复上颌结构各部分应力都在强度允许范围内,余留天然牙和牙槽骨上应力分布合理,赝复体有效传导力。阻塞器式赝复体材料属性与牙槽骨比较接近或略低于骨,填充了缺损侧上颌空腔,增大了与上颌的接触面积,使应力有效传导,在结构上较上腭封闭赝复体更为合理。四种赝复体天然牙应力和位移值比较表明,附着体固位阻塞器赝复体避免了天然牙应力集中,对义齿赝复体的固位和动力支持都非常有利。     

人耳蜗基底膜模型的动力特性有限元数值模拟

目的采用有限元模拟,建立人耳蜗基底膜模型,研究耳蜗结构的动力响应。方法应用有限元方法,利用大型有限分析软件ANSYS求解基底膜简化模型的模态。结果 得到了模型上不同部位产生最大振幅时对应的振动频率。结论 频率不同时,行波传播的远近和最大行波的出现部位不同。振动频率愈低,最大行波振幅出现的部位愈靠近基底膜顶部;相反地,高频率声音引起的基底膜振动,只局限于卵圆窗附近。从一个新的角度验证了行波理论。     

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.     

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.     

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.     

'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.     

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.     

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.     

The universal muscular chamber. A basic unit of the genitourinary, cardiovascular, gastro-intestinal, skeletal, cutaneous, respiratory and other systems, endocameral hypertension; and spasm, the key to their idiopathic diseases and arthropathies

Starting with the integument, we see many organs are contractile sacs or multiples thereof, which tubes or bags constitute the major part of the entire body. Recognition of this basic unit and its characteristics sheds new light, individually and collectively, on many disorders previously considered unrelated. Muscular tears and perforations develop in the walls of these chambers, being no way peculiar to those organs, wherein, hydrochloric acid occurs. So, it is not necessary to explain the absence of excessive acid from patients who exhibit holes in the gastric, uterine, aortic, duodenal, rectal, pulmonary, retina, and other walls. Muscle, not acid is the great common factor relating idiopathic disorders in the gastrointestinal tract to each other and to similar diseases in other systems. When the units are linked together, the lesions tend to appear as arthropathies, i.e. at the joints. Rephrasing common-place observations, frees us from conventional, conceptual cul-de-sacs. An observation is only as good as its interpretation, so all possibilities must be considered, otherwise, we will remain blinded by our misconceptions.     

Der Einfluß von Nahrungsmitteln und Rauchen auf die klinisch-chemische Diagnostik von Phäochromozytom,Neuroblastom und Karzinoid-Syndrom

Zusammenfassung Der Einfluß von verschiedenen Nahrungsmitteln auf Methoden zur Bestimmung von Adrenalin (AD), Noradrenalin (NA), Vanillinmandelsäure (VMS), Metanephrinen (MN), Homovanillinsäure (HVS) und 5-Hydroxyindolessigsäure (5-HIE) im 24 h-Harn zur Diagnose des Phäochromozytoms bzw. Karzinoid-Syndroms wurde untersucht. Die in die Untersuchung einbezogenen Nahrungsmittel waren: Tee, Kaffee, Mandeln, Ananas, Käse, Walnüsse, Vanillepudding, Bananen, Tomaten und Milchschokolade. Außerdem wurde der Einfluß des Zigarettenrauchens auf die Bestimmung von AD, NA, VMS und MN untersucht.Walnüsse führten zu einer starken Erhöhung der 5-HIE-Ausscheidung. Bananen erhöhten die Ausscheidung von AD, NA, VMS, MN und 5-HIE. Kaffee und Ananas bewirkten eine geringe Zunahme der MN-Werte. Rauchen von 20–30 Zigaretten/Tag beeinflußte keine der vier Variablen.Wenn die beschriebenen Methoden benutzt werden, sollte lediglich auf den Verzehr von Bananen und Walnüssen vor und während der Harnsammelperioden verzichtet werden, da die oberen Normgrenzen im Harn überschritten werden könnten. Ein Verzicht auf Kaffee und Ananas in normalen Mengen ist nicht erforderlich. Es besteht kein Anlaß, weiterhin die bisherigen umfangreichen Restriktionen der übrigen Nahrungsmittel beizubehalten.