髌骨沟的应用解剖

目的　为全膝关节成形术重建下肢正确力线提供解剖学基础。方法　在 40根干性股骨标本上用金属丝标记解剖轴、机械轴、髁上轴、经髁轴和髌骨沟全长 ,拍摄正位、侧位和轴位X线片 ,观测髌骨沟的弧长和弧度 ,髌骨沟与 4条基本轴线的角度。结果　髌骨沟的弧长和弧度变化幅度分别为 (2 0 .6± 1.8) (18.6～ 2 4.5 )mm和 115 .4°± 5 .6°(10 8.6°～ 118.4°) ;髌骨沟和股骨的 4条基本轴线的关系变化极大 ,变化范围在 10 .0°～ 16 .5°,髌骨沟最接近垂直干经上髁轴线。结论　在设计全膝人工关节股骨假体部分时 ,可参考髁上轴来确定髌骨沟的位置 ,使髌股关节能最大限度的匹配 ,减少术后并发症     

安装假体时股骨旋转定位轴线及相关角度的解剖学特征

背景:人工全膝关节置换过程中股骨假体旋转定位良好是置换成功的关键之一,与置换后关节功能密切相关。股骨髁各项解剖参数也非常重要,熟悉其各项数据能够合理截骨以及选择轴线,避免假体安装位置不佳导致全膝关节置换后关节功能障碍。目的:通过对股骨髁标本的解剖结构进行观察,测量股骨髁标本解剖参数及定位轴线之间的角度。方法:固定架固定共40例股骨骨性标本,观察内上髁及外上髁形态变化,测量股骨髁解剖参数,包括长度、宽度等;应用定位导向器于内外上髁之间穿克氏针固定,垂直股骨后髁轴截骨后以万能角度量角器测量股骨4条轴线——手术髁上轴、临床髁上轴、后髁轴、AP轴之间的相关角度关系。结果与结论:内上髁凹陷出现比例较低,约占所有标本比例总数的25%;股骨髁的高度与西方人相比差别不大,宽度与西方人相比差别较大。提示股骨髁宽度与西方人群差别较大,手术操作应充分注意;股骨髁内上髁凹陷出现比例不高,故参照髁上轴的后髁角定位只适用于部分人群;而AP轴较易定位,两条轴线与后髁轴线之间成角数值稳定,变异性较小,证实AP轴可做为股骨假体旋转定位的可靠标记。     

带血管蒂髌骨移位修复膝关节面缺损的应用解剖

目的：为带血管蒂髌骨移位修复股骨髁和胫骨髁关节面缺损提供解剖学基础。方法：用34侧经动脉红色乳胶灌注的下肢标本，经解剖和铸型研究髌骨的血供。观测30块髌骨和胫骨内外侧髁上关节面的形态和面积。结果：供应髌骨的各支动脉先在髌骨周围吻合成髌周动脉环，再由该环发支进入髌骨。参与形成髌周动脉环的主要动脉有膝上外动脉、膝下外动脉、膝降动脉髌上支、膝降动脉髌下支和膝下内动脉。髌骨关节面与股骨内外侧髁关节面、胫骨内外侧髁上关节面形态大小相似。结论：带血管蒂髌骨可以移位至股骨内外侧髁、或胫骨内外侧髁，利用髌骨的关节面修复股骨髁或胫骨髁关节面缺损，以期最大限度保留膝关节的功能。     

人体膝关节股骨后髁角度的MRI测量

背景：全膝关节置换过程中股骨假体旋转力线良好非常重要,研究显示后髁角度是确定力线的重要依据,后髁角度为股骨后髁轴与股骨手术髁上轴之间角度,MRI测量可清晰显示后髁软骨、外上髁突起及内上髁凹陷,从而保证测量数据的准确。 目的：测量保定北部地区人群中膝关节后髁角度,为临床实施全膝关节置换过程中确定股骨假体旋转力线提供影像学依据。 方法：应用核磁共振机对入选中青年人群膝关节进行扫描,取膝关节伸直中立位,扫描平面垂直于膝关节机械轴,选择T1像上最佳膝关节轴位平面,由两名观察者独自分析图像,通过Bravo viewer 6.0影像软件观察股骨内上髁存在率,画出股骨髁上轴线及后髁线并测量两条轴线之间角度,即股骨后髁角度。 结果与结论：入选人群男性股骨后髁角度为(2.73±1.28)°,女性股骨后髁角度为(2.35±1.37)°,不同性别间差异无显著性意义。提示MRI测量股骨后髁角具有较大优越性,人工全膝关节置换过程中髁上轴线变异性较小,可参照后髁角度定位安装股骨假体,避免膝关节置换后并发症发生。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;组织工程全文链接：     

股骨颈前倾角与扭转角的区别

股骨颈前倾角与扭转角是两个不同的解剖学概念。在人类学、诊断学和治疗股骨上端疾病等方面都有一定的参考价值。但目前国内文献资料都把二者混为一谈。为此，我们在大量临床观察的基础上，从解剖学、几何学和临床应用角度阐述了二者的主要区别，以资参考。１　股骨颈前倾角和扭转角是两个完全不同的解剖学概念１．１　股骨颈前倾角的定义所谓前倾角即人体某部位轴线与人体冠状面的夹角。股骨颈前倾角就是股骨颈轴线与股骨髁额状面（即人体冠状面）所成的夹角。但有些文献认为：股骨颈前倾角是股骨头颈轴线与股骨下端两髁间投影连线的夹角［…     

膝外翻畸形全膝关节置换的假体匹配:三维模型数字化测量与分析

背景:膝外翻畸形常需人工全膝关节置换来矫形,人工全膝关节置换选用假体与膝关节相匹配程度明显影响置换后长期效果。目前国内使用率较高的仍然是依据西方人数据设计的假体系统,应用于国人往往达不到最好匹配。目的:探讨股骨髁及胫骨平台的解剖形态学异常,为膝外翻畸形的全膝关节置换提供解剖学数据。方法:对41例(53膝)成人膝外翻畸形进行CT扫描,图像导入Mimics 10.01软件建立数字化三维模型,测量相关解剖参数,分析其分布规律与相关关系。将膝关节相关参数与单膝畸形患者的健侧正常膝(对照组29膝)进行比较。结果与结论:膝外翻畸形X射线片显示股胫角为(15.4±5.1)°,冠状面上测量股骨解剖轴与股骨远端关节面的外侧夹角(76.6±1.2)°减小,胫骨解剖轴与胫骨近端关节面的内侧夹角(95.8±0.5)°增大。CT显示通髁线与股骨髁远端关节面切线的夹角(6.5±1.3)°增大、通髁线与股骨髁后方关节面切线的夹角通髁线与股骨髁后方关节面切线的夹角(5.2±1.2)°增大。以上测量指标与对照组比较,差异有显著性意义(P0.05)。提示在膝外翻畸形全膝关节置换中,应注意股骨髁和胫骨平台的解剖学异常。     

股骨远端解剖形态性别差异与假体形态设计的关系

目的：通过三维螺旋CT重建正常人膝关节，测量股骨远端相关解剖参数，探讨男女性股骨远端的解剖特点对于关节表面假体形态的不同要求。方法：80侧正常成人膝关节，男性、女性各40侧，年龄18～72岁，行三维螺旋CT扫描，在GE Advantage workstation工作站上进行0．625mm层厚重建，测量股骨经上髁轴线宽度、内外侧髁高度、髁间高度及内外侧滑车前突距离，行模拟截骨后，测量各截骨面高度，比较各测量值性别问的差异。结果：男女性髁间高度、经上髁轴线宽度、外侧髁高度及内侧髁高度均有显著性差异（P〈0．001），男性各值均大于女性。股骨远端横径与纵径的比值亦为男性大于女性（P〈0．001），男性股骨内、外侧滑车前突距离均大于女性，均值差分别为1．2mm和0．7mm，均有显著性差异（P〈0．001）。结论：男女性之间股骨髁形态存在一定差别，股骨远端关节面假体形态的设计应该性别差异化，使假体与截骨面更好的吻合。以提高全膝关节置换术的手术效果。     

股外侧肌腱与股骨外侧髁接触的解剖学观察及其临床意义

目的：探讨髌骨半脱位致髌骨外侧软骨面压力过高的形态学因素。方法：对５０侧膝关节标本股外侧肌腱内面及其与股骨外侧髁的接触进行了解剖学观察。结果：股外侧肌腱内面呈椭圆形或圆形光滑面。其周围有滑膜皱襞附着，其长２．１±０．９（１．０～５．４）ｃｍ，宽１．３±０．４（０．７～２．４）ｃｍ，与髌上囊以皱襞相隔。在屈曲９０°时与股骨外侧髁边缘相接触，接触处为光滑的骨软骨结构约１．０ｃｍ×０．８ｃｍ大小。摸拟髌骨半脱位时，整个股四头肌腱外移，股外侧肌腱内面与股骨外侧髁不能接触。结论：①在正常情况下股外侧肌腱内面与股骨外侧髁存在着接触，这可能是缓解髌骨外侧关节软骨面压力的正常接触；②当髌骨半脱位时，该接触减小或消失，可能是髌骨半脱位时外侧面压力增高的原因之一     

颞下颌关节的断层影像解剖学研究

目的：为颞下颌关节疾病的诊疗提供解剖学基础。方法：选用成人尸体头颈部标本15例，分别制成冠状、矢状、横断层标本。在经颞下颌关节层面上，观察颞下颌关节及其周围结构的解剖学关系，用游标卡尺测量关节盘的厚度。结果：冠状、矢状和横断层解剖可分别显示颞下颌关节的位置、毗邻关系及结构特点，冠状解剖可确定关节盘的位置，矢状解剖有利于关节脱位的诊断。关节盘最厚处4．02mm，最薄处1．32mm。结论：颞下颌关节的断层影像解剖对颞下颌关节疾病的影像诊断和内窥镜治疗具有重要的指导作用。     

股骨远端旋转力线中的测量及其临床意义

目的:通过测量股骨外科上髁轴线、股骨前后轴线及其股骨后髁轴线之间的夹角,探讨全膝关节置换术中定位股骨假体旋转力线的方法。方法:75侧正常成人股骨标本,性别、年龄不详,数码相机拍摄股骨远端轴位片并输入个人电脑,在Photoshop7.0.1软件中测量股骨外科上髁轴线与股骨后髁轴线之间的夹角(股骨后髁角,PCA)及前后轴线的垂线与股骨后髁轴线的夹角(APA),行配对资料的t检验,比较两角度的差异。结果:PCA均值3.67°±1.62°(0.75°～5.90°),与西方人数据及国人影像学测量数据接近;APA均值3.50°±1.40°(1.34°～5.65°),与PCA差异无统计学意义(t=0.949,P=0.359),此两个角度均有较大的变异性。结论:术中仅通过测量PCL进行旋转力线的定位可能导致截骨不准确,通过PCL、APL进行双重定位可以提高手术操作精度。     

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.