成人颞骨骨迷路的解剖学研究及其临床意义

目的:对成人颞骨骨迷路进行解剖观察和测量,为临床提供解剖学基础。方法:制作26侧成人颞骨骨迷路标本进行观察和测量。结果:(1)半规管长度以后半规管最长,前半规管次之,外半规管最短。(2)半规管横断面呈椭圆形,其弓顶处管腔纵径大于横径。(3)壶腹端、单脚端、总脚端均近似圆形。后、前、外半规管壶腹端的纵径分别为:1.94mm,1.95mm,1.92mm。外半规管单脚端纵径为1.20mm,前、后半规管总脚端纵径为1.60mm。(4)三个半规管弓除外半规管弓在同一平面上外,前、后半规管弓均不在同一平面上,而呈不同程度的扭曲。(5)同侧三半规管之间并非相互垂直。(6)26侧中前半规管位于弓状隆突下的有16侧(61.54％),余10侧(38.46％)与弓状隆突不相重叠。结论:本研究结果为骨迷路结构研究增添了新的内容,为临床内耳手术的开展提供解削学基础和参考数据。     

国人内耳骨半规管的形态学观测

目的　为人类学及临床应用提供解剖学资料。方法　采用内耳铸型法制作内耳骨迷路标本 30例 (6 0侧 ) ,对骨半规管的跨度、高度、内径、弧长、各骨半规管间的顶点间距及总骨脚的长度进行观测 ,所得数据用SAS 6 12软件进行分析。结果　 6 0侧内耳硅胶铸型标本骨半规管显示为半环形小管。前骨半规管的跨度为 (4 91± 0 70 )mm ,高度为 (5 4 94 - 0 5 7)mm ,内径为 (1 784 - 0 2 3)mm ,弧长为 (18 344 - 1 95 )mm ;后骨半规管的跨度为 (2 784 - 0 5 2 )mm ,高度为 (6 184 - 0 6 3)mm ,内径为 (1 86 4 - 0 2 8)mm ,弧长为 (2 0 18 ± 1 93)mm ;外骨半规管的跨度为 (4 30 4 - 0 4 5 )mm ,高度为 (4 0 6± 0 5 2 )mm ,内径为 (2 0 94 - 0 2 4 )mm ,弧长为 (11 80± 1 5 2 )mm ;总骨脚的长度为 (4 984 - 0 4 9)mm。各骨半规管的顶点间距分别是前 -外骨半规管为 (8 0 6 4 - 0 77)mm ,前-后骨半规管为 (9 95 4 - 0 96 )mm ,外 -后骨半规管为 (5 4 6 4 - 0 75 )mm。左右两侧差异无显著性。结论　 3个骨半规管的大小、形态各异     

正常成人内耳系统液体容积的磁共振测量与分析

目的 探讨磁共振三维水成像技术在内耳液体容积测量中的应用价值.方法 30例正常成人志愿者均采用GE1.5T磁共振机、8通道头部相控阵线圈,行内耳内听道水成像序列扫描(三维真稳态进动快速成像序列),所采集信号传送至工作站AW4.2进行多平面重建和容积重建,测量耳蜗、前庭-半规管和内听道容积,初步建立其正常值范围,并分别比较耳别、性别及年龄段间有无差异.结果 30例(60耳)正常志愿者的耳蜗、前庭-半规管和内听道容积分别为(101.2±11.1)mm3、(151.5±19.9)mm3和(220.1±58.7) mm3;正常值范围分别为(79.4～123.0)mm3、(112.5～190.5)mm3和(105.0～335.2)mm3;变异系数分别为0.11、0.13和0.27.内耳系统液体容积在耳别、性别及年龄段间差异均无统计学意义(P＞0.05).结论磁共振三维水成像技术可用于活体内耳系统液体容积的测量,为临床上内耳腔道结构的评估及内耳畸形的分类、分型提供影像解剖学依据.     

15例成年国人内耳膜迷路及内耳道MRI最大密度投影三维重建图像的解剖学研究

目的研究成年国人内耳膜迷路及内耳道最大密度投影(MIP)三维重建图像,观测内耳主要结构磁共振成像(MRI)的正常解剖测量值,为临床耳显微外科及神经外科手术提供解剖学依据。方法选用15名健康志愿者,使用GE-signal 1．5T超导型核磁共振机,环行耳颞部线圈,三维快速自旋回波序列(3D／FSE／T2W1)(水成像)及脂肪抑制技术,对两侧耳部同时进行扫描。原始扫描图像行MIP三维重建,多角度旋转对内耳主要结构进行解剖学观测。所得数据用SPSS10．0软件进行统计学分析。结果MIP三维重建能满意显示两侧内耳膜迷路及内耳道的解剖结构,其中3个膜半规管、椭圆囊、球囊、蜗管及内耳道呈高信号。测量结果内耳主要结构均无显著的侧别差异。结论临床MIP三维重建能直观、立体地显示内耳膜迷路及内耳道的结构,为成年国人内耳主要结构MRI正常解剖测量值的确立提供了一定的基础资料。     

枕下乙状窦后入路内听道后壁磨除的显微解剖

目的 观测经枕下乙状窦后入路手术路径中,显微镜下磨除内听道后壁所涉及的重要解剖结构及相关解剖学参数,以指导术中安全磨除内听道后壁。方法 模拟枕下乙状窦后入路,对6具(12侧)国人湿性头颅标本显微镜下行磨除内听道后壁,以内听道内口后缘中点(P点)作为参照点,分别测量P点至弓状隐窝、后半规管、共脚、内听道底、前庭导水管外口、颈静脉孔的最短距离,对这些结构拍照记录,所得测量结果行统计学处理。结果 以内听道后壁作为参照平面,测得内听道干与后壁平面所呈夹角为47.3°±17.2°。以P点作为参照点,测得P点至弓状隐窝的最短距离(4.10±0.60)mm,P点至后半规管最短距离(7.39±0.44)mm,P点至共脚的最短距离(8.09±0.47)mm,P点至内听道底距离(9.08±0.59)mm,P点至前庭导水管外口(10.44±0.73)mm,P点至颈静脉孔最短距离(7.35±1.09)mm。结论 枕下乙状窦后入路磨除内听道后壁,其磨除长度不应超过7 mm,可减少半规管及共脚的损伤概率。熟悉磨除内听道后壁过程中容易损伤的结构,可避免损伤半规管、颈静脉球、前庭导水管外口及内淋巴囊等重要解剖结构。     

CT与磁共振图像融合技术对显示正常内耳结构的应用价值

目的 探讨内耳CT与磁共振成像(MRI)图像融合的可行性以及融合图像对正常内耳结构的显示能力.方法 对20例(40耳)双侧内耳及内听道形态正常的感音神经性耳聋患者行多层螺旋CT(MSCT)和MRI扫描,并应用西门子图像融合软件将CT与MRI图像进行配准、融合,然后半定量评价融合图像对正常内耳和内听道结构的显示能力.结果 CT与MRI融合可有9种融合模式,在不同融合模式的图像中CT不反相+MRI反相对骨迷路显示最清晰;CT反相+MRI不反相、CT反相+MRI伪彩对膜迷路显示最清晰、立体感强;CT不反相+MRI反相、CT与MRI均反相对面神经、听神经及蜗神经显示最清晰、最直观、立体感最强;CT不反相+MRI反相、CT反相+MRI不反相、CT伪彩+MRI反相对蜗孔处蜗神经显示最好.结论 CT与MRI图像可以进行精确配准和融合,不同模式融合图像对内耳不同结构的显示清晰度不同.     

磁共振3D-CISS与CT高分辨率成像在电子耳蜗植入前的应用

目的利用中、内耳高分辨C计算机X线断层照相术(computed tomography,CT)扫描及磁共振(magnetic resonance imaging,MRI)高分辨3D-CISS序列成像对拟行人工耳蜗植入术的患者作术前检查,分析、比较两种方法的临床价值。方法选择30例拟行电子耳蜗植入的感音性耳聋患者。行中内耳CT高分辨放大扫描,层厚1mm,层间隔1mm,放大倍数2。磁共振高分辨率三维稳态干扰序列(three dimensional constructive inference insteady state,3D-CISS)扫描(TR12.30ms,TE5.9ms),翻转角70°,层厚0.7mm,无间隔扫描,最大信号强度投影(maximum intensity projection,MIP)内耳重建。比较两种方法提供的信息。结果CT可观察中耳内耳、骨性结构;MRI可显示内耳膜迷路情况及内听道的神经。结论将中、内耳螺旋CT高分辨成像与磁共振高分辨3D-CISS序列其联合应用可为人工耳蜗植入提供更精确可靠的术前信息。     

微创内固定技术治疗锁骨骨折的基础研究

目的:根据锁骨形态特点,探讨微创内固定技术治疗锁骨骨折的手术入路。方法:成人锁骨标本60个,防腐成人尸体(8具)的肩关节标本16个。测量锁骨长度、锁骨最窄处直径、锥状结节处入钉点区域及该部位入钉在锁骨内的固定长度。结果:锁骨长度为(144.34±6.48)mm;最窄处直径为(9.40±1.92)mm。锁骨锥状结节至肩锁关节内侧进针范围为(32.86±5.18)mm;该范围内最近及最外穿刺点打入的克氏针均可通过锁骨前弧最凸点,穿行长度最短为(74.28±1.16)mm,最长为(98.86±2.16)mm。肩关节标本解剖显示,锁骨外侧端与肩胛冈形成向内侧开放的角度,锥状结节以远部分比相应的肩胛冈高(8.24±0.62)mm。左、右侧锁骨测量结果经t检验两侧无显著性差异(P>0.05)。结论:锁骨锥状结节处可作为微创手术入路及入钉点区域,该部位入钉可在锁骨内穿行足够的固定长度。     

基于磁共振数据的三维半规管建模空间方向测量

目的测量半规管相互夹角和空间方向。方法对16例磁共振3D-CISS序列内耳检查影像,分割半规管结构建立三维模型,生成3D PDF文件,在各半规管取3点坐标,通过数学方法对同侧和双侧的半规管相互夹角以及各半规管和水平面的夹角进行计算。结果左右后半规管夹角为98.49°±12.07°,可以推测后半规管和矢状面的夹角为49.25°±6.04°。左右水平半规管夹角为171.58°±3.78°;左侧后半规管和右侧前半规管夹角为165.56°±5.78°,右侧后半规管和左侧前半规管夹角为164.74°±6.46°,左侧水平半规管和水平面夹角为19.43°±3.02°,右侧水平半规管和水平面夹角22.11°±4.12°。结论左右共同平面对半规管近乎平行,后半规管和矢状面的夹角大于45°,两侧半规管总脚分叉点和眼球下缘平面更加接近水平面。     

成人内听道底相关结构的多层螺旋CT解剖学观察

目的：应用64层MSCT观测成人内听道底及其相关的解剖结构,为临床应用提供影像解剖学依据。方法筛选2011年4—12月广东省人民医院采用64层MSCT扫描的乳突气化良好、无中耳或内耳病变且无眩晕等平衡功能障碍症状的40例共80耳成人CT资料进行回顾性分析。在MSCT图像上观测：横嵴,横嵴至前庭内侧骨壁的距离（ D1),面神经管迷路段、上前庭神经管、下前庭神经管和后壶腹神经管（单管)各管的长度、宽径,以及后壶腹神经管的内听道开口（单孔)至前庭内侧骨壁的距离（D2)。结果80耳的横嵴、面神经管迷路段、上前庭神经管、下前庭神经管和后壶腹神经管、单孔在横断位、冠状位及矢状位均能显示。其中横嵴局部解剖位置清晰、稳定,位于内听道底的中部,内侧缘自前内向后外走行,D1为（1．56±0．55)mm（0．55~2．67 mm)。面神经管迷路段长度（2．60±0．34)mm（1．54~3．27 mm),宽径（0．91±0．23)mm（0．50~1．58 mm);上前庭神经管长度（3．39±0．52) mm（2．50~5．06 mm),宽径（1．03±0．19)mm（0．74~1．62 mm);下前庭神经管长度（1．35±0．27) mm（0．74~2．17 mm),宽径（1．34±0．25)mm（0．85~2．34 mm);后壶腹神经管长度（3．88±0．84) mm （2．58~6．00 mm),宽径（0．63± 0．12) mm （0．42~0．98 mm)。 D2为（2．50±0．72)mm（1．37~5．01 mm)。结论64层螺旋CT能较好地显示位于内听道底的横嵴以及面神经管迷路段、前庭上神经、前庭下神经、后壶腹神经各骨管和单孔的走行及形态特征,为内耳疾病的诊断、鉴别诊断及术前评估提供有参考价值的信息。     

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.     

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.     

What will studies of Fulani individuals naturally exposed to malaria teach us about protective immunity to malaria?

There are an estimated over 200 million yearly cases of malaria worldwide. Despite concerted international effort to combat the disease, it still causes approximately half a million deaths every year, the majority of which are young children with Plasmodium falciparum infection in sub-Saharan Africa. Successes are largely attributed to malaria prevention strategies, such as insecticide-treated mosquito nets and indoor spraying, as well as improved access to existing treatments. One important hurdle to new approaches for the treatment and prevention of malaria is our limited understanding of the biology of Plasmodium infection and its complex interaction with the immune system of its human host. Therefore, the elimination of malaria in Africa not only relies on existing tools to reduce malaria burden, but also requires fundamental research to develop innovative approaches. Here, we summarize our discoveries from investigations of ethnic groups of West Africa who have different susceptibility to malaria.     

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.     

The universal muscular chain reaction,muscle spasm,Torsions, ruptures and extravasations. Chameleons of pathology and some manifestations of simple muscular disorders

Most bodily functions require the coordinated actions of complementary and supplementary paired muscle groups. Where this essential muscular cooperation is lacking, hollow organs may burst and others become literally screwed up, giving rise to many similar spastic diseases such as Torticollis, Twisted ovarian cyst, Torsion of the Testis, Volvulus of the intestines, Varicose Veins, Megacolon, Aortamegaly, Scoliosis, Erb's Palsy, Peyronie's Disease, Main-en-Griffe, Undescended Foot (Pes Cavus), Talipes, Strabismus. Spasm is “panenepidemic” and unclassified examples of Torsion Dystonia and Dyskinesia really are as common as debt and taxes.     

Class II HLA in Georgia Caucasus Tbilisi Georgians and their Mediterranean ancestry: The Usko Mediterranean languages

Georgia (or Sakartvelo in its own language) is a South Caucasus Mts. country with its easternmost part is enigmatically named Iberia, like the Iberian Peninsula, which may refer to rivers “Kura” and “Ebro” or their valleys respectively. Most of their inhabitants speak Georgian which is included within Dene-Caucasian group and Usko-Mediterranean subgroup of languages. The latter includes Basque, Berber, ancient Iberian-Tartessian, Etruscan, Hittite, Minoan Lineal A and others. In the present paper, HLA class II -DRB1 and -DQB1 alleles has been studied and extended haplotypes calculated. Most frequent haplotypes are also of Mediterranean origin (i. e.: (A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*51)-DRB1*13:01-DQB1*06:03, or (A*24-B*35)-DRB1*01:01-DQB1*05:01) and DA genetic distances show that closest world populations to Georgians are Mediterraneans. Georgians also show common extended haplotypes ((A*02-B*51)-DRB1*11:01-DQB1*03:01, (A*02-B*13)-DRB1*07:01-DQB1*02:01 and (A*03-B*35)-DRB1*11:01-DQB1*03:01) with Svan people, a secluded population in North Georgia mountains. We can conclude that Georgians belong to a very old Mediterranean substratum according to both linguistics (Usko Mediterranean languages) and HLA genetics.     

'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.     

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.