拇收肌腱弓处尺神经卡压征的应用解剖

目的 :为拇收肌腱弓处的尺神经卡压征机理和治疗提供解剖学基础。方法 :解剖 2 0个 ( 4 0侧 )成人尸体标本手的拇收肌腱弓 ,对拇收肌起始部的纤维弓状结构进行观察、测量 ,对观测结果进行统计学处理。结果 :40侧中 3 7.5 % ( 15侧 )存在纤维弓状结构 ;其中呈膜性的 (A型 )占 73 .3 % ( 11侧 ) ;呈索带状(B型 )占 2 6.6% ( 4侧 )。肌纤维弓状结构长平均 3 .7± 0 .6mm。结论 :部分人手存在拇收肌起始部的纤维腱弓 ,形成神经血管腔隙 ,腔隙内压增高可导致尺神经终末运动支嵌压征。治疗是在第 3掌骨基底部切开腱弓减压。     

Clinical aspects of muscle imbalance in the hand due to ulnar nerve lesions

Summary This study deals with the anatomical and clinical bases of the thumb-index finger grip, emphazising not only its general importance, but also its ergonomie role. A classification according to the different functions of two muscular groups (extrinsic and intrinsic), with special reference to muscular imbalance due to ulnar nerve lesions is proposed.After some general considerations on the function of the hand practical conclusions are drawn.

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Aspects cliniques du déséquilibre musculaire de la main après lésion du nerf cubitalEssai de classification de la préhension pouce-index

Résumé Cette étude rapporte les bases anatomocliniques de la préhension pouce-index, insistant, non seulement sur ses aspects généraux, mais aussi, sur son rôle ergonomique. Une classification permettant d'apprécier les différentes fonctions des deux groupes musculaires (intrinsèques et extrinsèques), insistant surtout sur le déséquilibre musculaire après lésion du nerf cubital, est proposée. Après des considérations générales sur l'importance de la main, des conclusions pratiques sont tirées.

     

Fine structural differences in “fast” and “slow” muscle fibers of the crab

The muscle fibers in the accessory flexor muscle of the crab were examined with the electron microscope. The limiting membrane of the muscle fiber invaginates at many points to form an internal extrafibrillar membranous system between the muscle fibrils. Two types of muscle fiber were found. In one, the fibrils are well separated from each other by an extensive membranous system, the sarcomere lengths are short, and the filaments in the A band are thick. This muscle fiber is the same as the fast fiber previously found physiologically. The other type of muscle fiber has large fibrils poorly separated by a relatively scant system of internal membranes. It has relatively long sarcomeres and comparatively thin filaments in the A band. This type of fiber is the same as the slow fibers described physiologically. Fibers intermediate in type are also found. Nerve terminals with typical synaptic vesicles occur and appear similar on both types of muscle fiber under the electron microscope. Membrane thickenings of nerve ending and muscle fiber also occur at the terminals on both types of muscle fiber. The nerve terminals on the fast fiber are much more easily found and hence more numerous than on the slow fiber. A comparison is made between the invertebrate and vertebrate fast and slow fibers, and some physiological implications of these findings are discussed.     

Metabolic responses in feline “red” and “white” skeletal muscle to shock and ischemia

In order to investigate possible differences in the reaction to hypoxic conditions between “red” and “white” skeletal muscle, cats were subjected to a 2 h period of either hemorrhagic shock or hind limb tourniquet ischemia, and the hypoxia induced changes were studied in the soleus and lateral gastrocnemius muscles. Muscle biopsies were analysed for ATP, CP, glucose, G 6–P and lactate. Using microelectrodes, the resting membrane potential was repeatedly measured. Both experimental models resulted in increased tissue lactate levels and a successive decrease in the membrane potential of both muscles studied. No reduction of the high energy phosphagen content (ATP+CP) occurred in any of the muscles during shock. The tourniquet ischemia resulted in a 40% reduction of the ATP+CP content in the soleus muscle, whereas in the gastrocnemius muscle no significant reduction occurred. A significant correlation was found between the tissue lactate content and the membrane potential under both conditions and in both muscles studied. It is concluded that “red” muscles are more susceptible to metabolic derangement than “white” muscles during total ischemia, whereas during hypovolemia “red” muscles appear to be protected from early hypoxic damage, probably due to a redistribution of skeletal muscle blood flow.     

From the “little brain” gastrointestinal infection to the “big brain” neuroinflammation: A proposed fast axonal transport pathway involved in multiple sclerosis

The human central nervous system (CNS) is targeted by different pathogens which, apart from pathogens’ intranasal inoculation or trafficking into the brain through infected blood cells, may use a distinct pathway to bypass the blood–brain barrier by using the gastrointestinal tract (GIT) retrograde axonal transport through sensory or motor fibres. The recent findings regarding the enteric nervous system (often called the “little brain”) similarities with CNS and GIT axonal transport of infections resulting in CNS neuroinflammation are mainly reviewed in this article. We herein propose that the GIT is the vulnerable area through which pathogens (such as Helicobacter pylori) may influence the brain and induce multiple sclerosis pathologies, mainly via the fast axonal transport by the afferent neurones connecting the GIT to brain.     

Waiting for a diagnosis in Rubinstein–Taybi: The journey from “ignorance is bliss” to the value of “a label”

The journey to receiving a diagnosis for rare genetic disease can be long and emotionally impactful. This study describes parental experiences of receiving their child's diagnosis of Rubinstein–Taybi syndrome (RTS), a rare genetic condition characterized by growth and developmental delay together with dysmorphic features. Parents from the RTS Australia support group participated in qualitative, semi‐structured phone interviews, which were transcribed verbatim and thematically analyzed. Questions focused on psychosocial challenges and benefits pre and post‐diagnosis. Ten mothers and three fathers participated, with the mean age of diagnosis being 8 months. Parents reported positive psychological effects from a slight delay in diagnosis, and negative effects from an extended diagnostic delay, suggesting the ideal time for a parent to receive a diagnosis lies in the post attachment stage, prior to the development of significant parental concerns. This stage would vary depending on condition severity. Parents desired a diagnosis to reduce uncertainty; however, uncertainty remained post diagnosis, and shifted its focus from broadly encompassing etiology and prognosis, to specifically focusing on concerns regarding severity within the spectrum. Perceived benefits of a diagnosis mainly centered on the provision of a label. Parents articulated that a label increased social acceptance, enhanced coping, promoted communication, and improved access to medical, financial, and support services. This study provides insights into the experience of families prior to and following receipt of a diagnosis. It also highlights the possibility of an optimal time window to receive a diagnosis; in which bonding is maximized and parental distress is minimized.     

Linear Polyethyleneimine: Optimized Synthesis and Characterization – On the Way to “Pharmagrade” Batches

The synthesis of linear polyethyleneimine (LPEI) by acidic hydrolysis of poly(2‐ethyl‐2‐oxazoline) is studied and optimized to reach the highest degree of hydrolysis within the shortest time range using a microwave synthesizer. In addition, the purification procedure is significantly improved; the fast batch processing combined with an excellent control of the actual heating time represents a well‐suited alternative to the conventional synthesis on the way to “pharmagrade” PEI. The developed protocol for the preparation of methyl and proton‐initiated LPEIs shows a high reproducibility, and the identity and purity of the LPEIs is proven by means of ¹H NMR and IR spectroscopy as well as MALDI‐TOF‐ and ESI‐Q‐TOF‐MS.

     

Cardiovascular Control in the Milan Strain of Spontaneously Hypertensive Rat (MHS) at “Rest” and during Acute Mental “Stress”

The cardiovascular responses to acute mental “stress” were compared in the Milan strain of spontaneously hypertensive rats (MHS) and in normotensive control rats (NR). Blood pressure and heart rate were followed in pairs of awake MHS and NR, while defence reactions were provoked by alerting stimuli (noise, vibration). No differences were noted between the two groups in response to “stress” although resting heart rate in MHS was lower than in NR. Administration of atropine or propranolol to MHS and NR showed the MHS to have a higher resting vagal tone and lower sympathetic tone than the NR. Subsequent (at least two weeks later) hemodynamic investigation, under nembutal anesthesia, showed no difference in cardiac output between MHS and NR but a higher stroke volume, presumably related to the lower heart rate in MHS. Thus, total peripheral resistance was increased in MHS as was the ratio left ventricular weight/body weight, and in good proportion to the blood pressure rise. Thus MHS differ substantially in both their responses to “stress” and also hemodynamically from the Okamoto strain of spontaneously hypertensive rat (SHR), being the so far most studied and best known model of essential hypertension in man. In MHS the hypertension is more of a systolic type and is of primarily renal origin. As such, MHS provide another model for investigating the polygenic nature of hypertension in man.     

Significance of the diagnostic categories “atypical” and “suspicious for malignancy” in the cytologic diagnosis of solid pancreatic masses

Endoscopic ultrasound guided (EUS) fine‐needle aspiration (FNA) investigation of solid pancreatic lesions has been shown to have good sensitivity and specificity. Many lesions can be definitely classified as benign or malignant but some can only be cytologically classified as “atypical” or “suspicious for malignancy”. Risk for malignancy in these indeterminate categories has not been well categorized. The cytology records of four University Medical centers were searched for all EUS guided FNAs of solid pancreatic lesions. All cases with a diagnosis of “atypical”, or “suspicious for malignancy” were selected for analysis when histologic biopsy or over 18 months clinical follow‐up was available. Two hundred and ninety‐two cases with a diagnosis of “atypical” or “suspicious for malignancy” and adequate follow‐up were obtained from the combined data of the four institutions. The percentage malignant for the categories “atypical” and “suspicious for malignancy” were 79.2 and 96.3%, respectively. If the category “atypical” was classified as benign and “suspicious for malignancy” was classified as malignant, the resulting positive predictive value was 96.3 (95% CI: 92.6–98.5) and the negative predictive value 20.8 (95% CI: 13.4–30.0). The categories of “atypical” and “suspicious for malignancy” stratify risk for malignancy in a fashion, which may aid in patient counseling and selection of follow‐up protocols. Classification of “suspicious for malignancy” as malignant optimizes diagnostic sensitivity and specificity. Diagn. Cytopathol. 2014;42:292–296. © 2014 Wiley Periodicals, Inc.     

Prospective memory in HIV infection: Is “remembering to remember” a unique predictor of self-reported medication management?

Optimal adherence to antiretroviral medications is critical to the effective long-term management of HIV infection. Although prospective memory (ProM; i.e., “remembering to remember”) has long been theorized to play an important role in medication adherence, no prior studies have evaluated whether HIV-associated ProM impairment possesses unique predictive value in this regard. Results from this study demonstrate a robust association between ProM impairment and self-reported medication management in 87 HIV-infected persons currently prescribed antiretroviral medications. Specifically, more frequent ProM complaints and performance deficits on both laboratory and semi-naturalistic ProM tasks were all independently related to poorer self-reported medication management. A series of hierarchical regression analyses revealed that HIV-associated ProM impairment accounted for a significant amount of variance in self-reported medication management beyond that which was explained by other factors known to predict nonadherence, including mood disorders, psychosocial variables, environmental structure, and deficits on a traditional battery of neuropsychological tests. Overall, these findings support the hypothesis that ProM captures a unique and largely untapped aspect of cognition that is germane to optimal medication adherence. The potential benefits of individualized remediation strategies that are informed by conceptual models of ProM and specifically target medication adherence warrant further exploration.     

Epidemiology of congenital hydrocephalus in Utah, 1940–1979: Report of an iatrogenically related “epidemic”

As part of an epidemiological study of congenital hydrocephalus in Utah, we focused on the effect of ascertainment sources and temporal variability to further delineate the causes of this relatively common, handicapping birth defect. The incidence and distribution of 934 reported cases diagnosed prior to age 6 months, and born to Utah residents from 1940 to 1979, were analyzed. Data were ascertained by examination of multiple sources, e.g., 982,066 birth, 11,161 fetal death, and 248,208 death certificates, and selected hospital and clinic records. Of the 934 reported cases, 700 met our selection criteria for congenital hydrocephalus, which results in a crude incidence of 0.70 per 1,000 live and stillbirths. Seventy-one cases (10.1%) had additional, multiple congenital anomalies. The male/female sex ratios of the 619 cases of isolated congenital hydrocephalus (occurring as a single entity or in the absence of other reported or known birth defects) and those with multiple congenital anomalies (71 cases) were virtually identical, being 1.45 and 1.48, respectively. A significant 85% increase in the rate of reported cases was observed for the period 1966 to 1970. However, examination of patients' records from 1966 to 1975 in the hospital responsible for almost all of this increase suggests that this was an iatrogenically related “epidemic” caused by several factors: the introduction and possible misinterpretation of pneumoencephalograms (PEG) in the diagnosis of hydrocephalus (PEG was replaced by CAT scanning in the early 1970s), inappropriate diagnosis, and incorrect recording of age at time of diagnosis. © 1994 Wiley-Liss, Inc.     

Rapid accumulation and axonal transport of “cholinergic vesicles” in rat sciatic nerve,studied by immunohistochemistry

Amino acid uptake, protein synthesis and progesterone production were studied in rat granulosa cells, isolated from follicles of different stages of development. The amino acid uptake in granulosa cells from prepubertal rats was rapid with a distribution ratio above 1 within 10 min. No significant effects of gonadotrophins were observed on this parameter. The acute influence of exogenous LH and FSH or dibutyryl cyclic AMP (dbcAMP) on incorporation of ³H-leucine or ³H-phenylalanine was investigated as a measure of the rate of protein synthesis. In most experiments progesterone production was determined concomitantly. Both FSH (10μg/ml or 100 /μg/100 g b. wt.) and dbcAMP (1 mM) stimulated (1.6-1.8 fold) the incorporation of leucine into granulosa cell proteins from prepubertal rats while LH was without effect. Progesterone production in these granulosa cells was very low and neither the gonadotrophins nor dbcAMP were stimulatory. Similarly designed experiments were performed on granulosa cells isolated from preovulatory rat follicles. It was then found that both FSH (10 μg/ml or 100 μg/199 g bwt.) and dbcAMP (1 and 5 mM) as well as LH (10 μg/ml or 100 μg/100 g bwt.) significantly (1.2-2 fold) stimulated protein synthesis. Furthermore, basal progesterone production was higher and was markedly stimulated (3–6 fold) by all three substances tested. The observations that the protein synthesis in immature granulosa cells is increased by exposure to FSH and dbcAMP while progesterone production is not, whereas both these parameters are stimulated with FSH, LH and dbcAMP in the preovulatory granulosa cells suggest that there might be certain differences in the nature of the proteins synthesized by immature and preovulatory granulosa cells.     

Is Spontaneous Resorption in the DBA/2-Mated CBA/J Mouse due to a Defect in “Seed” or in “Soil”?

PROBLEM: Recurrent spontaneous resorption in DBA/2-mated CBA/J mice has been attributed to damage by NK-lineage cells and TNF-α beginning several days after implantation. However, some recent data have suggested CBA/J female mice have a high proportion of preimplantation embryo abnormalities resulting in defective in vitro implantation and impaired trophoblast outgrowth. Could spontaneous abortion be due to a defective embryo (“seed”) rather than a hostile post-implantation uterine lining (“soil”). METHOD: Mated CBA/J females were manipulated so as to have high spontaneous abortion rates and a high percent abnormal embryos, or low resorption rates and a low percent abnormal embryos. Embryos from low aborting females were transferred into high aborting female recipients that were pseudopregnant, and vice versa. RESULTS: Abnormal embryos from females with high abortion rates implanted in low aborting females and did not show any greater tendency to resorb than normally developed embryos in these recipients. By contrast, normal embryos to some extent and abnormal embryos to a much greater extent, gave a high abortion rate when the recipient female was a high aborter. CONCLUSION: Properties of the “soil” into which embryos implant determines the likelihood of success or failure (abortion). Abnormal pre-implantation embryos can be “rescued” by “good soil”; “sick soil” damages both normal and abnormal embryos. Defining the cellular and molecular mechanisms may be useful in understanding basic mechanisms leading to aborting and nonaborting pregnancy.