空心加压螺钉张力带治疗髌骨骨折

2007年3月～2010年10月,我科采用切开复位空心螺钉张力带内固定技术治疗44例髌骨骨折患者,疗效满意。1材料与方法1.1病例资料本组44例,男18例,女26例,年龄21～68岁。均为移位明     

Switching Tinnitus-On: Maps and source localization of spontaneous EEG

ObjectiveTo identify the spectrotemporal changes and sources in patients that could “turn on” tinnitus with multichannel electroencephalography (EEG) system.MethodsMultichannel EEG was recorded from six patients during the Tinnitus-On and Tinnitus-Off states. The EEG power spectrum and eLORETA-based sources were measured.ResultsThere was a global increase in delta and theta during Tinnitus-On plus large changes in alpha 1 and alpha 2. During the Tinnitus-On state, many new sources in delta, theta, alpha 1 and gamma bands emerged in the opposite hemisphere in the inferior temporal gyrus (Brodmann area, BA 20), middle temporal gyrus (BA 21), lateral perirhinal cortex (BA 36), ventral entorhinal cortex (BA 28) and anterior pole of the temporal gyrus (BA 38).ConclusionsThe emergence of new delta, theta and gamma band sources in the inferior temporal gyrus (BA 20), middle temporal gyrus (BA 21) and lateral perirhinal cortex (BA 36) plus the appearance of new delta and theta sources in the ventral entorhinal cortex (BA28) and anterior pole of the temporal lobe (BA 38) may comprise a network capable of evoking the phantom sound of tinnitus by simultaneously engaging brain regions involved in memory, sound recognition, and distress which together contribute to tinnitus severity.SignificanceThe sudden appearance of new sources of activity in the opposite hemisphere within the inferior temporal gyrus, middle temporal gyrus and perirhinal cortex may initiate the perception of tinnitus perception.     

Individual EEG Alpha Activity Analysis for Enhancement Neurofeedback Efficiency: Two Case Studies

The hypothesis was tested of whether neurofeedback training applied in order to increase or decrease power of individual EEG frequency ranges is more efficient than neurofeedback training of standard EEG frequency ranges. The sessions of decreasing the theta/beta ratio and reinforcing alpha neurofeedback training were carried out on two outpatients with attention deficit disorder (a schoolboy) and functional pain contraction (a professional musician). The neurofeedback utilizing standard EEG frequency ranges (theta 4-8, alpha 8-12, beta 13-18) was inefficient and even resulted in aggravation of symptoms in both cases. The individualized neurofeedback that utilized individual frequency ranges resulted in substantial clinical improvement.     

Quality Assurance of Commercial Insulin Formulations: Novel Assay Using Infrared Spectroscopy

Background:For insulins in commercial formulations, degradation can be observed within the certified shelf life when not stored at recommended conditions. Elevated temperatures and exposure to shear forces can cause changes in the secondary structure of the hormone, leading to a decrease in pharmaceutical potency. International pharmacopoeia recommendations for insulin quality monitoring assays mainly rely on liquid chromatography methods. These methods are unable to distinguish between active and inactive forms, both of which may exist in pharmaceutical insulins exposed to stress conditions.Method:Infrared attenuated total reflection spectroscopy has been used for the analysis of insulin dry film preparations using affordable instrumentation. This method can be applied to either formulated insulin specimens or pure insulins obtained by ultrafiltration. Such samples have been stored under different temperatures (0°C, 20°C, and 37°C), and degradation processes have been monitored up to a period of a few months.Results:By analyzing specific shifts of absorption bands in the infrared spectra, which are sensitive to the protein secondary structure, even small structural changes in the hormone become evident. Another option is amide I band deconvolution into individual bands, which can be attributed to secondary structure subunits that are part of the insulin tertiary structure.Conclusion:A novel and innovative method based on infrared attenuated total reflection spectroscopy of insulin dry films is a promising analytical tool for quantifying the degree of insulin degradation, as it provides information on indicating a decrease in biological potency. The established methods for insulin potency assays require animal testing or clamp experiments on people with diabetes.     

Impairment of semantic memory after basal forebrain and fornix lesion

Semantic memory impairment is classically associated with lesion of the anterior temporal lobe. We report the case of a patient with severe semantic knowledge impairment and anterograde amnesia after bilateral ischemic lesion of the fornix and of the basal forebrain following surgical clipping of an aneurysm of the anterior communicating artery. Fluorodeoxyglucose positron emission tomography (FDG-PET) showed a temporal hypometabolism. Severe semantic impairment is a rare complication after rupture of an anterior communicating artery aneurysm and may result from disconnection of the temporal lobe.     

An autoradiographic study of neurotensin receptors in the human hypothalamus

The aim of the present investigation was to determine a detailed mapping of neurotensin (NT) in the human hypothalamus, the brain region involved in neuroendocrine control. For this, we investigated the presence and the distribution of neurotensin binding sites in the human hypothalamus, using an in vitro quantitative autoradiography technique and the selective radioligand monoiodo-Tyr3-neurotensin (2000 Ci/mM). This study was performed on nine adult human postmortem hypothalami. We first determined the biochemical kinetics of the binding and found that binding affinity constants were of high affinity and do not differ significantly between all cases investigated. Our analysis of the autoradiographic distribution shows that NT binding sites are widely distributed throughout the rostrocaudal extent of the hypothalamus. However, the distribution of NT binding sites is not homogenous and regional variations exist. In general, the highest densities are mainly present in the anterior hypothalamic level, particularly in the preoptic region and the anterior boarding limit (i.e. the diagonal band of Broca). Important NT binding site densities are also present at the mediobasal hypothalamic level, particularly in the paraventricular, parafornical and dorsomedial nuclei. At the posterior level, relatively moderate densities could be observed in the mammillary complex subdivisions, apart from the supramammillary nucleus and the posterior hypothalamic area. In conclusion, the present study demonstrates the occurrence of high concentrations of NT binding sites in various structures in many regions in the human adult hypothalamus, involved in the control of neuroendocrine and/or neurovegetative functions.     

Nuclear organization of cholinergic,catecholaminergic, serotonergic and orexinergic systems in the brain of the Tasmanian devil (Sarcophilus harrisii)

This study investigated the nuclear organization of four immunohistochemically identifiable neural systems (cholinergic, catecholaminergic, serotonergic and orexinergic) within the brains of three male Tasmanian devils (Sarcophilus harrisii), which had a mean brain mass of 11.6 g. We found that the nuclei generally observed for these systems in other mammalian brains were present in the brain of the Tasmanian devil. Despite this, specific differences in the nuclear organization of the cholinergic, catecholaminergic and serotonergic systems appear to carry a phylogenetic signal. In the cholinergic system, only the dorsal hypothalamic cholinergic nucleus could be observed, while an extra dorsal subdivision of the laterodorsal tegmental nucleus and cholinergic neurons within the gelatinous layer of the caudal spinal trigeminal nucleus were observed. Within the catecholaminergic system the A4 nucleus of the locus coeruleus complex was absent, as was the caudal ventrolateral serotonergic group of the serotonergic system. The organization of the orexinergic system was similar to that seen in many mammals previously studied. Overall, while showing strong similarities to the organization of these systems in other mammals, the specific differences observed in the Tasmanian devil reveal either order specific, or class specific, features of these systems. Further studies will reveal the extent of change in the nuclear organization of these systems in marsupials and how these potential changes may affect functionality.     

Average chest wall thickness at two anatomic locations in trauma patients

Background

Needle thoracostomy is the emergent treatment for tension pneumothorax. This procedure is commonly done using a 4.5 cm catheter, and the optimal site for chest wall puncture is controversial. We hypothesize that needle thoracostomy cannot be performed using this catheter length irrespective of the site chosen in either gender.

Methods

A retrospective review of all chest computed tomography (CT) scans obtained on trauma patients from January 1, 2011 to December 31, 2011 was performed. Patients aged 18 and 80 years were included and patients whose chest wall thickness exceeded the boundary of the images acquired were excluded. Chest wall thickness was measured at the 2nd intercostal (ICS), midclavicular line (MCL) and the 5th ICS, anterior axillary line (AAL). Injury severity score (ISS), chest wall thickness, and body mass index (BMI) were analyzed.

Results

201 patients were included, 54% male. Average (SD) BMI was 26 (7) kg/m². The average chest wall thickness in the overall cohort was 4.08 (1.4) cm at the 2nd ICS/MCL and 4.55 (1.7) cm at the 5th ICS/AAL. 29% of the overall cohort (27 male and 32 female) had a chest wall thickness greater than 4.5 cm at the 2nd ICS/MCL and 45% (54 male and 36 female) had a chest wall thickness greater than 4.5 cm at the 5th ICS/AAL. There was no significant interaction between gender and chest wall thickness at either site. BMI was positively associated with chest wall thickness at both the 2nd and 5th ICS/AAL.

Conclusion

A 4.5 cm catheter is inadequate for needle thoracostomy in most patients regardless of puncture site or gender.     

Subluxation of the Extensor Carpi Ulnaris Tendon Associated with the Extensor Digitorum Tendon Subluxation of the Long Finger

A twenty-year-old male visited our clinic with wrist and long finger metacarpophalangeal (MP) joint pain. Dynamic ultrasonography revealed sagittal band (SB) ulnar subluxation and extensor carpi ulnaris (ECU) volar subluxation. Magnetic resonance imaging showed longitudinal splitting and dislocation of the volar half slip of the ECU tendon. The redundant radial SB was augmented and ECU sheath was advanced to the periosteum using suture anchors. He was able to perform his previous activities at the last follow-up. We encountered a case of "simulateous" ECU dislocation with extensor tendon subluxation of the long finger at the MP joint. Therefore, we report this case with a review of the relevant literature.     

可吸收锚钉联合8字减张带治疗髌骨下极粉碎性骨折

背景：髌骨下极粉碎性骨折具有骨折块小、修复髌腱起点困难等特点,临床如何处理粉碎性骨折块及重建髌韧带功能是亟待解决的问题。目的：探讨可吸收锚钉联合8字减张带治疗髌骨下极粉碎性骨折的方法和临床疗效。方法：2007年8月至2012年12月收治26例髌骨下极粉碎性骨折患者,男15例,女11例;年龄19~65岁,平均42.5岁。患侧髌骨下极粉碎性骨折严重,均无法用克氏针及拉力螺钉固定,术中切除粉碎性骨折块,两枚可吸收带线锚钉依次垂直于髌骨下极,沿骨横截面中轴三等分点拧入,Kessler法缝合髌腱起点,膝关节屈曲90°位8字钢丝减张带固定。结果：术后切口均Ⅰ期愈合,无一例发生并发症。26例中24例获得随访,随访时间为6个月~5年,平均15.6个月。末次随访时,患者疼痛视觉模拟评分（VAS）为（1.0±0.3）分,患侧膝关节活动度（ROM）与健侧比较无统计学差异（P〉0.05）,患侧Lysholm评分优18例、良4例、可1例、差1例,优良率为91.6%。结论：可吸收锚钉联合8字减张带是治疗髌骨下极粉碎性骨折的有效方法,具有并发症少、术后恢复快等优点。