缺血性股骨头坏死患者血清透明质酸及层粘连蛋白的研究

为探讨细胞外间质主要成分透明质酸（ＨＡ）与层粘连蛋白（ＬＮ）在缺血性股骨头坏死（ＩＮＦＨ）中的生理病理过程及临床价值，采用放射免疫分析法对４５例不同病因的ＩＮＦＨ患者进行了血清ＨＡ与ＬＮ的定量分析，并与３０例正常人对照。结果显示，ＩＮＦＨ患者血清ＨＡ含量极显著地高于对照组（ｔ＝３－２９；Ｐ＜０－０１）。尤以激素性ＩＮＦＮ增高最为显著（ｔ＝３－６２；Ｐ＜０－０１）。ＩＮＦＨ患者ＬＮ含量亦明显高于对照组（ｔ＝２－８４；Ｐ＜０－０１）。同时，ＨＡ与ＬＮ含量增高与病程发展密切相关。故定量检测ＨＡ与ＬＮ可作为ＩＮＦＨ早期诊断及判断预后的良好指标     

Excitation-contraction coupling in femoral arterial smooth muscle in response to noradrenalin

Bulletin of Experimental Biology and Medicine -     

肩胛骨前后联合入路治疗陈旧性浮肩损伤（附6例报告）

目的：探讨肩胛骨前后联合入路治疗陈旧性浮肩损伤的临床疗效。方法：采用肩胛骨前后联合入路对6例陈旧性浮肩损伤进行手术治疗。结果：根据Herscovici功能评估标准，其中优1例，良2例，可3例，无血管神经副损伤。结论：采用肩胛骨前后联合入路处理陈旧性浮肩损伤，术野显露清楚，易于操作与复位固定，可以有效地避开血管神经，安全可靠。     

Source of the slippage in the universal joints of the Hoffmann external fixator

An investigation was conducted to determine what improvements in the resistance to slippage could be obtained in selected interfaces (rod/clip torsional, cheek/bowl and cheek/clip) of the Hoffmann external fixator. The modification involved changing the standard wing-nut clamp for a bolt with a thread of 7 mm and a 1 mm pitch and placing an FAG 28–303 thrust-bearing (needle roller and cage assembly) between the bolt and the cheek. The results showed a significant improvement in the slippage values of all interfaces; increases of approximately six times were obtained at all torque values of the wing-nut clamp or fastener tested. Such improvements would markedly increase the reliability of external fixation systems and thus reduce the incidence of loss-of-reduction of fracture due to slippage of the universal joint.     

The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains

The anterior talofibular ligament is the most commonly injured ligament in the ankle. Despite considerable interest in the clinical outcome of treatment protocols, we do not know whether the distinctive pattern of localization of the injuries relates to regional differences in the structure and molecular composition of the ligament. To address this issue, ligaments were examined by histology and immunohistochemistry. Differences in the structure of its two attachments (i.e. entheses) were evaluated with quantitative, morphometric techniques, and regional differences in the distribution of collagens, glycosaminoglycans and proteoglycans were determined qualitatively by immunolabelling. Morphometric analyses showed that bone density was less at the fibular attachment, but that enthesis fibrocartilage was more prominent. Immunohistochemistry revealed the presence of a fibrocartilage (containing type II collagen and aggrecan) at the site where the ligament wraps around the lateral talar articular cartilage in a plantarflexed and inverted foot: the fibrocartilage is regarded as an adaptation to resisting compression. We propose that avulsion fractures are less common at the talar end of the ligament because (1) bone density is greater here than at the fibular enthesis, and (2) stress is dissipated away from the talar enthesis by the 'wrap-around' fibrocartilaginous character of the ligament near the talar articular facet.     

豚鼠脊髓运动神经元分支至股神经和腰背肌的研究——逆行荧光双标记法

应用碘化丙院-双苯甲亚胺配伍逆行荧光双标记技术对豚鼠脊髓运动神经元分支至股神经和腰背肌作了研究.结果发现股神经的运动纤维来源于同侧L1～5脊髓前角内侧核运动神经元和L4～5脊髓前角外侧核运动神经元;腰背肌的运动纤维来源于同侧相应节段脊髓前角内侧核运动神经元.在L3～5脊髓前角内侧核运动神经元中,有碘化丙啶-双苯甲亚胺荧光双标记运动神经元,占内侧核全部标记运动神经元的18.8‰.结果提示脊髓前角运动神经元具有分支分布至腰背肌和股神经的现象.     

Forelimb reflexes modulated by tonic neck positions in cats

The modulation of monosynaptic forelimb reflexes by tonic neck positions was investigated in cats with the head fixed.Lateral flexion of the body in a horizontal plane markedly facilitates reflexes of the deep radial nerve (DR) in the ipsilateral forelimb, while the antagonistic ulnar nerve (ULN) reflexes are strongly inhibited. Opposite effects are seen after contralateral body movement.Dorsiflexion of the body clearly increases DR-reflexes and exerts a reciprocal although more pronounced inhibition on ULN reflexes. Opposite effects appear after ventriflexion.The reflex modulation starts with head-body displacements of approximately 5° and increases with increasing angles. Furthermore reflex modulation does not depend on the intact cerebrum and cerebellum. The comparison of forelimb and hindlimb reflexes shows a decrease of the neck influences along the spinal cord.Supported by Sonderforschungsbereich Hirnforschung und Sinnes-physiology (SFB 70) der Deutschen Forschungsgemeinschaft (DFG).Essential parts of this paper will be submitted by A. F. as a thesis to the Faculty of Medicine, Freiburg/Breisgau, Germany.     

Participation of Ia reciprocal inhibitory neurons in the spinal circuitry of the tonic neck reflex

Summary As part of our studies of the spinal circuitry of the tonic neck reflex, we have recorded extracellularly from Ia reciprocal inhibitory neurons of the decerebrate, labyrinthectomized cat. The activity of a majority of neurons driven by stimulation of the quadriceps nerve was modulated by sinusoidal rotation of the neck; such modulation was much less frequent in the case of neurons driven by stimulation of nerves to more distal muscles. The results suggest that some of the inhibition which is part of the tonic neck reflex is mediated by Ia reciprocal inhibitory neurons, but that other pathways must also play an important role.     

Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture

ObjectivesTo evaluate a machine learning model designed to predict mortality for Medicare beneficiaries aged >65 years treated for hip fracture in Inpatient Rehabilitation Facilities (IRFs).DesignRetrospective design/cohort analysis of Centers for Medicare & Medicaid Services Inpatient Rehabilitation Facility–Patient Assessment Instrument data.Setting and ParticipantsA total of 17,140 persons admitted to Medicare-certified IRFs in 2015 following hospitalization for hip fracture.MeasuresPatient characteristics include sociodemographic (age, gender, race, and social support) and clinical factors (functional status at admission, chronic conditions) and IRF length of stay. Outcomes were 30-day and 1-year all-cause mortality. We trained and evaluated 2 classification models, logistic regression and a multilayer perceptron (MLP), to predict the probability of 30-day and 1-year mortality and evaluated the calibration, discrimination, and precision of the models.ResultsFor 30-day mortality, MLP performed well [acc = 0.74, area under the receiver operating characteristic curve (AUROC) = 0.76, avg prec = 0.10, slope = 1.14] as did logistic regression (acc = 0.78, AUROC = 0.76, avg prec = 0.09, slope = 1.20). For 1-year mortality, the performances were similar for both MLP (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.96) and logistic regression (acc = 0.68, AUROC = 0.75, avg prec = 0.32, slope = 0.95).Conclusion and ImplicationsA scoring system based on logistic regression may be more feasible to run in current electronic medical records. But MLP models may reduce cognitive burden and increase ability to calibrate to local data, yielding clinical specificity in mortality prediction so that palliative care resources may be allocated more effectively.