掌浅弓和掌深弓变异1例

<正>手部血液供应主要是由桡动脉和尺动脉的终支相互吻合形成的掌浅弓和掌深弓,及它们所发出的分支支配。但是掌浅弓和掌深弓的类型多变,尤其是掌浅弓,大体可分为完全弓和不完全弓~([1～5])。作者在制作一成人男性标本时,发现其左侧手掌为不完全掌浅弓,并且桡动脉走行分支异常,为积累解剖学资料,报道如下:该标本的尺动脉末端未与其他血管吻合,而是单独形成不完全掌浅弓,营养手掌尺侧半。尺动脉起始外径3.02 mm,     

桡动脉掌浅支粗大合并分支异常一例

双侧掌浅支粗大合并行程异常及分支变异者比较少见。作者在解剖一例成年男尸时发现双侧桡动脉掌浅支粗大合并行程异常同时伴有分支变异。 左侧桡动脉的掌浅支自桡骨茎突上方0.85cm处发出(见附图)。发支后的桡动脉干外径为2.00mm。掌浅支起始部外径1.92mm,该支贴鱼际肌表面的筋膜下行达手掌与尺动脉终支吻合成掌浅弓。掌浅弓属桡尺动脉型,位置正常,弓之最细处外径为1.58mm。掌浅弓在拇短屈肌下缘发出一长为0.50cm,外径为1.54mm的短支,即拇主要动脉。该动脉随即分为两支:一支为拇指桡掌侧动脉,走行于拇指掌面的桡侧缘;另一支是拇指尺掌侧动脉和示指桡掌侧动脉的共干支,继行2.00cm后,于拇收肌下缘处即分为上述两支。分别至拇、示指掌面的相对缘。另外。桡侧两条指掌侧总动脉共干发自掌浅弓。     

左手动脉异常一例报道

正常分布于手的动脉来源于尺、桡动脉的分支:桡动脉发出掌浅支与尺动脉的终末支吻合形成掌浅弓,掌浅弓发出小指掌侧动脉和三条指掌侧总动脉,指掌侧总动脉分别发出两条指掌侧固有动脉,分布于2~5指相对缘;桡动脉穿第一掌骨间隙处发出拇主要动脉(其分三支分布于拇指两侧和示指桡侧     

掌浅弓变异1例

掌浅弓的形态多变 ,作者在解剖一成年男性标本时 ,见其右侧掌浅弓形态特殊 ,报道如下。成年男性尸体 ,防腐固定后 ,经股动脉灌注红色乳胶。在其右上肢 ,桡动脉于近桡骨茎突处发出掌浅支后转至手背。掌浅支沿拇短屈肌内侧份浅面前行 ,发出分支与正中神经返支进入鱼际肌并供应支配之。本干继续行向远、尺侧 ,在掌腱膜深面、指屈肌腱及蚓状肌的浅面与尺动脉终支吻合而成特殊形态的掌浅弓。此掌浅弓之形式与现行教科书及相关专著所述类型有明显不同 (附图 )。 1.该动脉弓由桡动脉掌浅支与尺动脉终支吻合而成 ,有近侧、远侧两个弓 ,且弓的两端相…     

桡动脉掌浅支及掌浅弓变异1例

<正>桡动脉在桡骨茎突水平发出掌浅支,经舟骨结节尺缘穿鱼际肌实质或沿其表面下行至手掌中远端与尺动脉吻合形成掌浅弓,弓的凸侧发出指总动脉[1]至各手指。作者在临床手术中发现一桡动脉掌浅支变异,报道如下。,患者,女性,42岁,右手拇指开放性损伤致皮肤缺损,拟行桡动脉掌浅支皮瓣修复,术中见桡动脉于桡骨茎突水平尺侧发出掌浅支直径为1.1mm,有两伴行静脉,直径约0.7mm、0.8mm,行向舟骨结节远侧缘,穿拇短展肌实质深部约1mm,于肌肉内向远尺侧走行,行程1.5 cm即拐向尺侧与尺动脉分支吻合,在手掌根部形成弓状血管吻合,血管弓动脉,,     

手掌侧浅层动脉的观察

本文观察了181例(成人73,儿童108)手掌侧浅层动脉。掌浅弓类型:尺动脉型(36.5％)、桡尺动脉型(50.8％)、正中尺动脉型(10.5％)、桡正中尺动脉型(2.2％)。前二者具有非常显著的年龄差异,成人尺动脉型为儿童的2倍以上,桡尺动脉型则反之。作者认为主要是由于大鱼际处受压所致。男性尺动脉型多于女性,也可能是该原因。掌浅弓的分支可为2～6支,其中4支者占53.0％、5支者占30.9％;按分支的排列形式,有并列型(61.3％)、共干型(26.0％)、间隔型(8.3％)和混合型(4.4％)。共干多出现在尺侧分支,而间隔多出现在桡侧大鱼际处。我们认为,后者可能也与该处易受压有关。掌浅弓分支在手指的分布率,从尺侧向桡侧递减。     

桡动脉掌浅支变异1例

桡动脉在其转向手背时发出掌浅支 ,通常穿鱼际肌实质或沿其表面下行 ,与尺动脉吻合形成掌浅弓。作者在解剖一具成年男尸时发现其左手桡动脉掌浅支变异 ,此类变异较少见 ,现报道如下。桡动脉平豌豆骨上方 2 .9ｃｍ处发出掌浅支 ,直径为 1.34ｍｍ ;穿拇短展肌实质 ,行程 1.1ｃｍ ,后穿出行于皮下 ,该支未与尺动脉吻合 ,距豌豆骨 6 .5ｃｍ处分两终末支 (附图 ) ,其中一支营养拇指桡侧半 ,直径 0 .8ｍｍ ;另一支在距分支 1.9ｃｍ处与拇主要动脉吻合后发出示指桡掌侧动脉 ,直径为 0 .5 6ｍｍ。附图　桡动脉掌浅支变异桡动脉掌浅支变异1例@马新伟$…     

拇、示指动脉的分型及其临床意义

目的：对拇指、示指的血供来源进行分型，为手外科提供解剖学基础。方法：在78例手部动脉铸型标本上观察拇指、示指主要动脉的来源。结果：根据拇指、示指血液供应的主要来源将其分为3型：Ⅰ型（拇主要动脉型）主要由拇主要动脉分支营养拇指、示指。根据示指桡掌侧固有动脉的来源，又将其分为3个亚型（掌浅弓型、掌深弓型、掌浅、深弓型），掌浅弓型：示指桡掌侧固有动脉从掌浅弓发出，占总数的52．56％（41例，左22例，右19例）；掌深弓型：示指桡掌侧固有动脉从掌深弓发出，占总数的30．77％（24例，左8例，右16例）；掌浅、深弓型：示指桡掌侧固有动脉由掌浅弓和掌深弓共同发出，占总数的5．13％（4例，左3例，右1例）。Ⅱ型（桡动脉掌浅支型）主要由桡动脉掌浅支分支营养拇指、示指，占总数的8．97％（7例，左5例，右2例）。Ⅲ型（指掌侧总动脉型）主要由指掌侧总动脉分支营养拇指、示指，占总数的2．56％（2例，右2例）。结论：根据拇指、示指血液供应来源不同分为拇主要动脉型、桡动脉掌浅支型和指掌侧总动脉型。其中拇主要动脉型又分为掌浅弓型、掌深弓型和掌浅、深弓型三种亚型。     

掌浅弓、掌深弓多处变异1例

<正>在制作一成人左上肢血管神经标本时,发现其掌浅弓、掌深弓异常,并有多处手掌动脉呈现Z型异常扭曲,现报道如下。该标本桡动脉在桡腕关节处未发出掌浅支,而是以单干转至手背,在桡骨茎突下入鼻咽窝发出变异的拇主要动脉,终支构成掌深弓。变异的拇主要动脉穿拇收肌后在其浅面发出拇指桡侧固有动脉,其外径为1.16 mm。分支后外径为1.44     

国人掌浅弓类型及其顶点的表面投影

一、观察400侧(成人200,儿童200)国人掌浅弓的解剖资料,根据直接由浅部入掌的各动脉来源、组合以及发育配布的状况,而分为四种基本类型,其中桡尺动脉型占总侧数47.25±2.50％,尺动脉型占46.25±2.49％,正中尺动脉型占6.00±1.19％,桡正中尺动脉型占0.50±0.35％。二、按照上述各类型中掌浅部动脉的吻接分离状况,发现其中呈弓形吻合者占总侧数81.25％,非弓形吻合者(即本文所谓借线形细支连接者)占6.75％,其余完全独立或互相分离者占12％。三、调查上述国人资料的指掌侧动脉的起源情况,其结果由浅弓分支构成小指尺掌侧动脉者为96.25％,构成各指掌侧总动脉者均在96％以上,构成食指桡掌侧动脉者为39％,分支供给拇指尺侧和桡侧者各为31％及12.75％。概言之,尺侧3(1/2)指主要由浅弓分支参予供给,桡侧1(1/2)指则大部分为深弓分支供给。四、讨论了各类型及各指掌侧动脉起源等问题的种族差别情况,并分析不同作者研究国人资料的结果,根据t值测验,证明戴蘅茹文献中尺动脉型弓和桡尺动脉型弓的出现率并无显著差异,故认为戴氏所谓国人掌浅弓中,尺动脉型弓占最多数,而应列为正常型的肯定性结论,尚有值得进一步探讨的必要。五、选取各型掌浅弓中成弓形吻合者114侧(成人14,儿童100),作为浅弓顶点表面投影定位的研究。结果得出顶点的自然分布境界,基本局限在掌正中线中点桡侧0.6厘米,尺侧0.5厘米,远侧0.45厘米,近侧0.35厘米所形成的长方形范围之内,并有89.96％的顶点集中在以中点为圆心,以0.35厘米为半径所绘成的圆内。尚未发现一例顶点平及头线或超出其远侧。除据此与国外书刊中不同说法对照讨论外,并分析我们所得结果基本适于代表我国成人和儿童的概况,谅可供作国人标准的参考。     

Pain and Effusion and Quadriceps Activation and Strength

Context:

Quadriceps dysfunction is a common consequence of knee joint injury and disease, yet its causes remain elusive.

Objective:

To determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion affect the magnitude of quadriceps dysfunction.

Design:

Crossover study.

Setting:

University research laboratory.

Patients or Other Participants:

Fourteen (8 men, 6 women; age = 23.6 ± 4.8 years, height = 170.3 ± 9.16 cm, mass = 72.9 ± 11.84 kg) healthy volunteers.

Intervention(s):

All participants were tested under 4 randomized conditions: normal knee, effused knee, painful knee, and effused and painful knee.

Main Outcome Measure(s):

Quadriceps strength (Nm/kg) and activation (central activation ratio) were assessed after each condition was induced.

Results:

Quadriceps strength and activation were highest under the normal knee condition and differed from the 3 experimental knee conditions (P < .05). No differences were noted among the 3 experimental knee conditions for either variable (P > .05).

Conclusions:

Both pain and effusion led to quadriceps dysfunction, but the interaction of the 2 stimuli did not increase the magnitude of the strength or activation deficits. Therefore, pain and effusion can be considered equally potent in eliciting quadriceps inhibition. Given that pain and effusion accompany numerous knee conditions, the prevalence of quadriceps dysfunction is likely high.Key Words: arthrogenic muscle inhibition, central activation failure, voluntary activation, muscles

Key Points

• Knee pain and effusion resulted in arthrogenic muscle inhibition and weakness of the quadriceps.
• The simultaneous presence of pain and effusion did not increase the magnitude of quadriceps dysfunction.
• To reduce arthrogenic muscle inhibition and improve muscle strength, clinicians should employ interventions that target removing both pain and effusion.

Quadriceps weakness is a common consequence of traumatic knee joint injury^1,2 and chronic degenerative knee joint conditions.^3,4 Arthrogenic muscle inhibition (AMI), a neurologic decline in muscle activation, results in quadriceps weakness and hinders rehabilitation by preventing gains in strength.⁵ The inability to reverse AMI and restore muscle function can lead to decreased physical abilities,⁶ biomechanical deficits,⁷ and possibly reinjury.⁵ Furthermore, researchers^8,9 have suggested that quadriceps weakness resulting from AMI may place patients at risk for developing osteoarthritis in the knee. In light of the substantial influence of quadriceps AMI on these clinically relevant outcomes, we need to improve our understanding of the factors that contribute to this neurologic decline in muscle activity so efforts to target and reverse it can be implemented and gains in strength can be achieved more easily.Joint injury and disease are accompanied by numerous sequelae (ie, pain, swelling, tissue damage, inflammation), so ascertaining which one ultimately leads to neurologic muscle dysfunction is difficult. Whereas a joint effusion can result in AMI,^10–12 the effects of pain are less understood despite many clinicians attributing AMI to pain. Using techniques that introduce knee pain without accompanying injury may provide insights into the role of pain in eliciting AMI.The degree of knee joint damage may play a role in the quantity of AMI that manifests. Hurley et al^13,14 demonstrated that quadriceps AMI, measured using an interpolated-twitch technique, was greater in patients with extensive traumatic knee injury (eg, fractured tibial plateau, ruptured medial collateral ligament, and medial meniscectomy) than patients with isolated joint trauma (ie, isolated anterior cruciate ligament [ACL] rupture). Similarly, patients with more knee joint symptoms (ie, greater number of symptoms and increased severity of symptoms) may present with greater magnitudes of quadriceps inhibition. Recently, investigators¹⁵ have suggested that patients with more pain display less quadriceps strength, supporting this tenet. Given that effusion and pain often present simultaneously with joint injuries and diseases, such as ACL injury and osteoarthritis, examining both the isolated and cumulative effects of these sequelae appears warranted to determine if they influence the magnitude of muscle inhibition.Experimental joint-effusion and pain models are safe and effective experimental methods that allow for the isolated examination of their effects on muscle function. The effusion model, whereby sterile saline is injected directly into the knee joint capsule,⁷ produces a clinically relevant magnitude of the joint effusion that may be present with traumatic injury. Effusion is thought to activate group II afferents responding to stretch or pressure,^16–18 which in turn may facilitate group Ib interneurons and result in quadriceps AMI.⁵ The pain model involves injecting hypertonic saline into the infrapatellar fat pad to produce anteromedial knee pain similar to that described in patients with patellofemoral pain syndrome.¹⁹ Pain is considered to initiate AMI through activation of group III and IV afferents that act as nocioceptors to signal damage or potential damage to joint structures.^16–18 The firing of these afferents then may lead to facilitation of group Ib interneurons, the flexion reflex, or the gamma loop, ultimately resulting in quadriceps inhibition.²⁰ Thus, these models allow us to create symptoms that are associated with knee injury and have the added benefit of providing a way to examine their effects in isolation.Therefore, the purpose of our study was to determine the effects of pain on quadriceps strength and activation and to learn if simultaneous pain and knee joint effusion would affect the magnitude of quadriceps dysfunction. We hypothesized that pain alone would result in quadriceps inhibition and that the magnitude of inhibition would be greater when effusion and pain were present simultaneously.     

即早基因c-fos与脑血管病及学习记忆

即早基因c-fos是广泛存在于原核细胞和真核细胞的高度保守基因.在正常情况下,c-fos基因参与细胞生长、分化、信息传递、学习和记忆等生理过程,而在病理情况下c-fos基因表达及调控变化与多种疾病的发生和发展有关.C-fos在中枢神经系统的某些部位可有基础水平的表达,但表达很低,当受到如脑缺血、脑出血、痫性发作、应激等刺激后,其在数十分钟内做出反应,在对外界刺激-转录耦联的信忠传递过程中起着核内第三信使的重要作用.     

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.