脑神经海绵窦段的显微解剖及其临床应用

目的　为海绵窦 (cavernoussinus,CS)直接手术提供解剖学基础。方法　在手术显微镜下对 15例 (30侧 )成人头颅标本CS内脑神经位置、行径以及与颈内动脉CS段的毗邻关系进行观测。结果　①动眼神经入窦点在前床突尖后方 (4 5 7± 1 0 5 )mm ,与滑车神经、眼神经垂直距离分别为 (2 2 0± 0 6 7)mm和 (4 37± 1 35 )mm。②滑车神经入窦点与眼神经垂直距离为 (5 5 2± 1 0 6 )mm。滑车神经CS段行程形状可分为三型。③颈内动脉后曲顶高出眼神经和展神经上缘分别为 (5 5 2± 1 84)mm和 (6 6 0± 1 94)mm。④经前床窦尖外侧或外下方时 ,动眼神经、滑车神经及眼神经与前床突尖垂直距离分别为 (1 85±0 75 )mm、(5 30± 1 0 4)mm和 (6 6 1± 1 6 3)mm。结论　掌握脑神经CS段的显微解剖对CS的直接手术具有重要意义。     

床突间隙及其周围结构的显微解剖

目的：为经床突间隙(CS)入路手术提供显微解剖学基础。方法：在手术显微镜下观测干燥颅骨标本和头颅湿标本CS及其周围结构。结果：前床突(ACP)基部宽度约9．27mm，厚度约4．89mm；Dolenc三角的三边长度分别约为6．02mm，10．27mm和10．00mm；23．3％的ACP气化，与后组鼻窦相通；颈内动脉(ICA)床突段长度约2．87mm；ICA近环外侧距动眼神经约2．55mm。结论：(1)磨除ACP须局限在Dolenc三角内；(2)ACP气化增加了相关手术的危险性；(3)在ICA近环与动眼神经之间切开海绵窦上壁较安全；(4)通过CS可显露ICA床突段。     

脑神经海绵窦段的应用解剖

目的 :为海绵窦手术避免脑神经损伤提供解剖学依据。方法 :对 17例成年头部标本的海绵窦内脑神经的位置、走行、毗邻进行解剖学观察。结果 :动眼神经入窦点在后床突的前外侧 7.8± 2 .1mm ,在颈内动脉床突上段后方 5 .0± 2 .0mm处。滑车神经窦内段长度为 10 .1± 3 .9mm ,其走行可分为窦内直行、中份凸向眼神经、“S”型双弯曲、前 1/2段凸向眼神经 4种类型。眼神经在窦内的长度为 15 .8±6.2mm。展神经在窦内为单干者占 5 2 .9% ( 18侧 ) ;2干者占 2 9.4% ( 10侧 ) ;3干者占 17.7% ( 6侧 )。结论 :滑车神经的走行变化较大 ,经Pakinson三角行海绵窦手术时 ,应注意保护滑车神经。切开海绵窦上壁分离窦腔时 ,应注意保护经上壁入窦的动眼神经。     

海绵窦上壁的应用解剖学研究

目的为经海绵窦(CS)上壁的手术提供解剖学资料。方法解剖观测15例(30侧)成人头颅标本CS上壁的解剖三角、脑膜及相关结构。结果①CS上壁为不规则的四边形,可分出3个解剖三角:颈动脉三角、动眼神经三角及前内侧三角;②动眼神经门的长径为(5.67±0.87)mm,短径为(1.09±0.35)mm;动眼神经鞘膜袋前深(4.69±1.31)mm,后深(6.50±1.58)mm;③上壁的脑膜结构有镰状韧带、前岩床皱襞、后岩床皱襞、床突间韧带,颈动脉床突韧带、颈动脉穴及颈动脉领、动眼神经鞘膜袋、远环及近环等,膜结构在前床突(ACP)尖形成复杂的膜复合体。结论CS上壁的解剖三角可作为CS的手术入路,其脑膜结构对于手术也具有重要意义。     

床突间隙显微外科解剖及概念的探讨

目的为经床突间隙(CS)进行海绵窦、鞍内、颈内动脉及眼动脉等病变的直接手术提供解剖依据,进一步澄清CS的概念.方法用22例成人头颅标本,在手术显微镜下从翼点和额下入路对前床突及周围结构进行直接解剖、观察和测量.结果CS是磨除前床突后留下的一楔形空间,其顶边宽(2.39±0.18)mm(0.64～4.10 mm),底边宽(5.34±0.16)mm(2 .66～7.00 mm),上内侧边长(7.67±0.33)mm(4.02～14.32 mm),下内侧边长(11.21±0.4 9)mm(4.24～17.06 mm),下侧边长(10.00±0.32)mm(5.6～14.26 mm),底高(7.87±0.35) mm(5.12～16.38 mm),尖端空间完全被颈内动脉(ICA)床突段所占据.ICA的远硬膜环和近硬膜环都不完整,动脉壁外常有海绵窦静脉丛,术中剥离ICA床突段可引起静脉丛出血.结论ICA床突段血管壁外有海绵窦静脉丛,它是海绵窦内结构,所以手术松解ICA床突段最好只剥离其内侧缘的ICA 穴,并为术中暴露CS后的空间大小提供了客观指标.     

海绵窦区三角解剖及面积的临床应用

目的　观察海绵窦区各脑神经相互关系及其变异,测量各海绵窦三角的面积,为临床经海绵窦显微外科手术提供解剖学依据。 方法　对12例成人尸头标本的海绵窦区域进行显微解剖和观测,并对海绵窦各三角的面积进行测算。 结果　在海绵窦区的三角中,分别选取、观测床突三角、动眼神经三角、滑车上三角、滑车下三角、前内侧三角、前外侧三角、后内侧三角、后外侧三角并分别测量其面积为77.75、82.73、45.00、83.40、66.38、51.28、121.65、161.67 mm2。 结论　海绵窦区三角是神经外科颅底手术入路必经区域,是手术中可参考的操作范围,因部分神经、骨性结构变异,可导致部分三角面积缩小而影响手术操作。测量各三角面积的数据,在临床工作实践中,可作为手术入路选择的参考,并为虚拟现实技术实践提供数据支持。     

滑车神经的应用解剖研究

目的 :为颅底和眶内手术提供滑车神经的解剖依据和补充国人滑车神经的体质学资料。材料与方法 :在 2 1例 (4 2侧 )正常成年人头颅标本上 ,观测滑车神经的走行及各段长度和外径。结果 :滑车神经连脑处位于下丘的外下方 ,离中线 4 5± 0 .6mm ;穿小脑幕处在后床突后外方 1 3 .7± 3 .8mm ;在海绵窦外侧壁 ,与动眼神经相距 4.5±2 .1mm ,与眼神经相距 4 2± 1 .4mm。测得滑车神经颅段、幕潜行段、海绵窦段、眶上裂段和眶段的长度及各段中部的宽度和厚度。结论 :在颅底和眶内手术时 ,应重视该神经的解剖位置并加以保护。     

海绵窦三角的显微解剖

30侧经颈内动脉灌注红色乳胶的成人颅底标本,在手术显微镜(目镜10×有测微器)下解剖和观测。海绵窦外侧壁下份内有Parkinson三角,我们还观察到其上方另有一个三角,由动眼神经、滑车神经和小脑幕游离缘的后份形成。海绵窦顶亦呈三角。确定了这三个三角的界限。研究了动眼神经、动眼神经与滑车神经的交点、滑车神经与眼神经的交点在窦壁上的表面投影。观察了通过各个三角内的颈内动脉各段及其分支。从而明确了窦壁内结构与窦内结构的毗邻关系,为找寻海绵窦内诸结构入路,和临床应用提供参考。     

动眼神经的应用解剖学

目的 :为颅底区手术提供与动眼神经相关的应用解剖学和补充国人体质学资料。材料和方法 :选用正常成人头颅标本 2 1例 (4 2侧 ) ,测量动眼神经的颅段、海绵窦段和眶上裂段的长度和外径 ,观测该神经在海绵窦内与周围结构的毗邻关系。结果 :动眼神经在后床突前外方 6.0± 1 .6mm处入海绵窦 ;在窦的中部 ,位于滑车神经内侧4.5± 2 .1mm。动眼神经在眶上裂内已分成上、下二支的占 86% ,在眶内分支的为 1 4%。结论 :在枕骨斜坡区、海绵窦上缘和蝶骨小翼外下方手术时 ,应特别注意辨认和保护动眼神经。     

鼻内镜下扩大经鼻蝶入路海绵窦内侧壁的应用解剖学

目的:研究扩大经鼻蝶入路海绵窦内侧壁的形态结构特征,为术中处理侵及海绵窦内侧壁的病变,提供解剖学资料。方法:成人福尔马林固定尸头标本15例,模拟扩大经鼻蝶手术入路,由浅入深地解剖观测了海绵窦内侧壁及其毗邻关系。结果:双侧颈内动脉前曲段、床突段和下水平段内侧缘之间的最小间距分别为(21.60±3.83)mm、(11.07±2.05)mm和(11.93±3.469)mm,垂体上下径、左右径分别为(7.57±1.11)mm和(12.43±2.12)mm,垂体与颈内动脉下水平段之间的关系有压迹型、紧邻型和分离型3种,分别占40%、30%和30%。结论:鼻内镜下扩大经鼻蝶入路是处理海绵窦内侧壁病变的良好手术方式,术者需熟悉扩大经鼻蝶入路海绵窦内侧壁在内镜下的解剖特点。     

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.     

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.     

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.     

'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.     

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.     

The case for allele‐specific recognition by the TCR

There is a sharp difference in how one views TCR structure–function–behaviour dependent on whether its recognition of major histocompatibility complex‐encoded restriction elements (R) is germline selected or somatically generated. The generally accepted or Standard model is built on the assumption that recognition of R is by the V regions of the αβ TCR, which is not driven by allele specificity, whereas the competing model posits that recognition of R is allele‐specific. The establishing of allele‐specific recognition of R by the TCR would rule out the Standard model and clear the road to a consideration of a competing construct, the Tritope model. Here, the case for allele‐specific recognition (germline selected) is detailed making it obvious that the Standard model is untenable.