男性尿道膜部括约肌支配神经的应用解剖

目的:为根治性膀胱前列腺切除手术中保护尿道控尿神经提供解剖学依据。方法:对15例成年男性尸体盆腔标本进行解剖,观察支配尿道膜部括约肌神经的组成、形态及毗邻关系。结果:尿道膜部括约肌接受下腹下丛和阴部神经盆内盆外分支支配,其中盆神经起源于下腹下丛远端盆内脏神经分支,沿肛提肌表面到达尿道膜部5点和7点位;40%的标本中阴部神经存在盆内分支,此分支自阴部管内的阴部神经主干穿肛提肌进入盆内,与盆神经一起支配尿道膜部括约肌,其进入尿道膜部的位置距离前列腺尖部(5.3±1.8)mm。在53.3%的标本中阴茎背神经发出分支到达尿道膜部,此分支进入尿道膜部的位置距离前列腺尖部(4.2±1.1)mm。结论:根治性膀胱前列腺切除术中对控尿神经的保护是多方面的,术中对精囊和前列腺尖部的操作最易损伤控尿神经。     

男性盆腔内脏神经的解剖学研究及其临床意义

男性盆腔内脏神经与盆筋膜及盆内脏器的毗邻关系复杂,且个体形态学差异大,临床上涉及肛肠外科、泌尿外科、男科等多个学科,应用甚广。近年来,对内脏神经的术中保护越来越受到重视。男性盆腔内脏神经主要包括上腹下丛、腹下神经、下腹下丛(即盆丛)、盆内脏神经、膀胱丛、前列腺丛、直肠丛及其分支等。现已证明盆腔内脏神经的损伤会给患者的排便、排尿及阴茎勃起等造成功能障碍。熟悉男性盆腔内脏神经及其分支的形态特点及其与周围结构的关系,能降低手术并发症,提高患者术后生活质量。     

男性盆丛神经的观察及其临床意义

目的：直肠癌扩大根治术是提高术后生存率，减少癌细胞转移的重要术式，但其术后排尿和性功能障碍并发症较多，其原因是术中损伤了盆丛神经。本文对盆丛的研究可为改进直肠癌扩大根治术，降低并发症，提高生存质量，提供解剖学资料。方法：用３０侧男性盆腔标本，通过冰醋酸松解剥离方法，对盆丛的起源、组成和分支分布进行了详细观测。结果：盆丛长径为４１．６±７．３ｍｍ，宽径２９．８±８．５ｍｍ。盆丛又继续形成直肠丛、膀胱丛和前列腺丛，三个次级丛参与管理排尿功能和性功能。结论：手术中如能对盆丛及其次级丛神经加以保护，免受或减少损伤，可防止或减少术后并发症的发生。     

盆腔内筋膜的解剖结构及神经走形：避免修复中的损伤

背景：盆腔内走行着大量支配泌尿生殖等系统脏器的神经,包括内脏神经和脊神经两种,每一种均由运动神经和感觉神经两种成分组成。其中内脏神经的核心为盆丛。1982年,Heald提出的全直肠系膜切除已经成为直肠癌诊疗的“金标准”。但术中极易损伤神经,导致术后出现尿潴留、性功能障碍等并发症。目的：综述前人的研究,以明确盆腔内筋膜的解剖结构和神经走形。方法：以“splanchnic nerves,superior hypogastric plexus,pelvic plexus,pelvic splanchnic nerve,total mesorectal excision(TME),clinical anatomy”为关键词,检索2000年1月至2015年1月PubMed数据库中关于盆腔内神经及相关脊神经的走形和成分、盆腔内神经节及相关脏器反射等研究,以盆腔内的神经为主。结果与结论：盆腔内的主要内脏神经丛为：①上腹下丛：主体位于由左、右髂总动脉和骶岬围成的髂间三角内,左髂总静脉和第5腰椎前面。②盆丛：腹下神经、盆内脏神经、骶内脏神经在直肠侧面的后下方1/3处汇合形成神经丛,也称下腹下丛,位于输尿管后下方、膀胱及精囊腺的背侧。由内脏神经丛发出的神经包含交感神经、副交感神经及感觉神经3种成分,走行分布在盆腔各脏器表面,支配其运动与感觉功能。明确的盆腔内筋膜的解剖结构和神经走形是全直肠系膜切除成功的关键,可在手术中最大程度避免神经损伤,提高患者预后及生活质量。中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

人海绵体神经的应用解剖及临床意义

海绵体神经起源于盆神经丛的次级神经丛-前列腺丛,含有交感神经纤维和副交感神经纤维两种成分。该神经与尿道血管形成神经血管束,沿前列腺两侧向远端走形,穿尿生殖膈后,发出分支进入海绵体,或与阴茎背神经交通,最后管理阴茎勃起组织。在盆内手术如膀胱、前列腺的根治性手术和全直肠系膜切除术后因海绵体神经损伤而导致患者术后勃起功能障碍时有发生。熟悉海绵体神经及其分支的走行特点及其与周围结构的关系,能降低手术并发症。在海绵体神经损伤后的重建方面也取得了一定的成果。     

全直肠系膜切除相关盆自主神经的解剖学观察

目的：阐述全直肠系膜切除术相关盆自主神经的局部解剖学特点，探讨盆自主神经保留的部位和对策。方法：对20具男性盆腔固定标本进行解剖观察。结果：腹主动脉丛远离肠系膜下动脉起点；上腹下丛贴近骶岬表面；腹下神经部分毗邻输尿管；盆内脏神经伴行直肠中动脉外侧部；下腹下丛位于直肠系膜后外侧；其直肠侧支走行于直肠侧韧带内，直肠前支向前穿过Denonvilliers筋膜后叶；勃起神经位于Denonvilliers筋膜前叶外侧部。结论：盆自主神经保留的部位是：离断肠系膜下血管时的腹主动脉丛左干，直肠后分离时的上腹下丛和腹下神经，直肠侧面分离时的下腹下丛和盆内脏神经，直肠前分离时的勃起神经。共同原则是：在直肠后间隙中贴近直肠系膜操作；直视下操作；避免过度牵引直肠系膜。     

骨盆手术防止股外侧皮神经损伤的应用解剖学

目的:为骨盆手术防止股外侧皮神经盆内段损伤提供解剖学基础。方法:在25具成人防腐标本上解剖观察股外侧皮神经的起源、行程及分支,测量神经出盆点与髂前上棘中心点的距离。结果:①股外侧皮神经出盆点位置的解剖变异较大,根据神经出盆点与髂前上棘的关系可分为四种类型。②股外侧皮神经72％从腹股沟韧带深面穿出,28％穿行于腹股沟韧带中。穿出点距髂前上棘的距离为(1.02±0.88)cm。③股外侧皮神经穿过腹股沟韧带并被阔筋膜包裹,形成了股外侧皮神经的远侧固定点。结论:(1)腹股沟韧带及阔筋膜对股外侧皮神经的固定作用是骨盆手术损伤股外侧皮神经的解剖学因素。(2)术中神经预防性松解是避免医源性神经损伤的关键。     

盆部内脏神经血管的解剖特点及临床应用

目的:探讨经腹腔镜行全直肠系膜切除术中盆部内脏神经和血管的保护.方法:解剖32具成人躯干标本(女15、男17)和31侧成人男性骨盆矢状标本,结合腹腔镜手术,观测有关的盆腔血管神经的形态及定位.结果:(1)骶中静脉大多1支,61%偏左,骶外侧静脉53%为两支,骶前静脉丛在骶曲处密集粗大,骶椎椎前穿通静脉在第4、5骶椎前方形成静脉窦,且与骨膜结合紧密.(2)盆从位于距直肠外侧约1.1cm和距直肠膀胱陷凹上外测约4.7cm处的骨盆侧壁.左右腹下神经分别于骶骨岬上下1.0～2.0 cm的范围内分出,其夹角约95.9°.上腹下丛位于腹主动脉分叉周围至骶骨岬下2 cm之间.(3)腹腔镜下骶前间隙主要由少量的疏松结缔组织填允容易分离,解剖层面清晰.结论:手术中应找准解剖层面,根据血管神经的定位以神经为导向进行分离,可避免损伤盆部的内脏神经及骶前静脉丛.     

阴茎海绵体神经丛的应用解剖学观察

目的探讨常规手术入路修复尿道对阴茎海绵体神经丛损伤的解剖学基础。方法通过解剖成人男尸标本15具,观察阴茎海绵体神经丛走行及其分支与周围血管神经组织的毗邻关系;通过解剖新鲜成人男尸3具,模拟不同手术入路修复尿道,探讨降低阴茎海绵体神经损伤的术式。结果阴茎海绵体神经与尿道膜部和尿道前列腺部关系密切,神经呈网束状经过尿生殖膈,其宽度(12.11±2.32)mm。结论经耻骨联合和经会阴途径来重建尿道,都有损伤阴茎海绵体神经丛的可能,需紧贴中线的操作才最大限度降低损伤。     

直肠癌全直肠系膜切除术中易损伤神经的定位及应用

目的 :探讨直肠癌全系膜切除术中容易损伤的有关内脏神经丛及分支的定位。方法 :在成人男性骨盆矢状标本及男性躯干标本上解剖观测有关内脏神经丛及分支的形态及位置。结果 :上腹下丛位于腹主动脉分叉至骶骨岬下约 2cm的范围内 ;左右腹下神经的夹角约为 95 .9° ;两侧神经的投影点分别位于骶骨岬中点至左右坐骨大切迹下缘 (近坐骨棘 )内侧一横指处 ;盆丛上、下端的投影点分别位于直肠膀胱陷凹上外侧约 4.71cm和 2 .98cm的盆壁 ,盆丛内侧缘距直肠外侧约 1 .1 1cm处。结论 :手术中应根据神经的定位分离或保护各神经丛及分支 ,就能最大限度的避免损伤神经 ,防止术后性功能及排尿功能障碍。     

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.