BACKGROUND & AIMS: UNLABELLED:To identify the galanin-immunoreactive neurons projecting to the posterior lobe of the pituitary in the rat hypothalamus, a retrograde tracer (complex of wheat germ agglutinin-enzymatically inactive horseradish peroxidase-colloidal gold) was injected into the posterior lobe of the pituitary. Sections of the hypothalamus were treated with a combination of silver enhancement of retrogradely transported tracer and immunohistochemistry of galanin. Of the total number of hypothalamic cells doubly labeled with retrograde tracing and galanin-immunostaining, 56-60% were found in the supraoptic nucleus, 18-23% in the retrochiasmatic nucleus, 8-10% in the lateral magnocellular portion of the paraventricular nucleus. The ratio of (number of doubly labeled cells/number of galanin-immunoreactive cells) in each of the above regions was similar to the ratio of (number of retrogradely labeled cells/number of Nissl-stained cells) in the supraoptic nucleus. Of all retrogradely labeled cells in the hypothalamus, 51-56% also contained galaninlike immunoreactivity. IN CONCLUSION:(1) galanin-immunoreactive fibers in the posterior lobe of the pituitary originate mainly in the supraoptic nucleus, retrochiasmatic nucleus, and lateral magnocellular portion of the paraventricular nucleus, (2) most of galanin-immunoreactive cells in these regions project to the posterior lobe of the pituitary, and (3) about half the neurons constituting the hypothalamo-neurohypophyseal system contain galaninlike immunoreactivity.

背景与目标：

BACKGROUND & AIMS: STUDY DESIGN:Case report of pedicle screw fixation in an infant with nonaccidental spine trauma. OBJECTIVE:To ensure awareness of nonaccidental pediatric spine trauma and describe a safe and effective method of treating a complex problem of thoracolumbar fracture-dislocation in an infant. SUMMARY OF BACKGROUND DATA:Nonaccidental pediatric spine trauma is rare, accounting for <1% of abuse. No previous cases of pedicle screw fixation have been described in a patient younger than 1 year of age. Prior treatment of this clinical entity has been treated with casts or wire-fixation. METHODS:An 8-month-old boy had a nonaccidental (also known as child abuse) traumatic T12-L1 fracture-dislocation. This was subsequently surgically corrected with posterior spinal fusion and instrumentation with pedicle screws. RESULTS:After surgery, the patient is doing well with no adverse effects from surgery. CONCLUSIONS:Although child abuse is a rare cause of spinal trauma, clinicians should do a full skeletal survey to ensure no other injuries are overlooked. Pedicle screw fixation can be used in infants with unstable traumatic spinal injuries, allowing earlier rehabilitation and return to normal activity level.

背景与目标：

BACKGROUND & AIMS: :A case of acute subdural haematoma of the posterior fossa in an alive adult secondary to anticoagulant therapy is described. The clinical presentation and the final decision of conservative management are discussed and the literature is reviewed.

背景与目标： : 描述了一例继发于抗凝治疗的存活成年人的后颅窝急性硬膜下血肿。讨论了保守治疗的临床表现和最终决定，并回顾了文献。

BACKGROUND & AIMS: :Fractures of the posterior wall are the most common of the acetabular fractures. The aim of this study was to assess the medium-term results of reconstruction of comminuted posterior wall fractures of the acetabulum by using the buttress technique. This is a retrospective review conducted at a level 1 trauma centre. Thirty-two patients (25 men, 7 women, mean age 41 years, range 14-80 years) with comminuted posterior wall fracture of the acetabulum underwent reconstruction of the posterior wall during the period of July 1998 to February 2004. The average follow-up was 43 months (range 24-70 months). Clinical evaluation was based on modified Merle d'Aubigne and Postel scoring. Radiographic evaluation was according to criteria developed by Matta. The postoperative reduction was graded as anatomical in 28 patients (88%) and imperfect in 4 patients (12%). The clinical outcome was excellent in 11 (34% ), very good in 9 (28%), good in 4 (12%), fair in 3 (9%) and poor in 5 (15%). Radiological grading at the final follow-up was excellent 12 (37%), good 11 (34%), fair 4 (12%) and poor 5 (15%). Reconstruction of comminuted posterior wall acetabular fractures by buttress technique can be expected to produce good results. It can provide a stable fixation of the posterior wall amenable to early range of motion and weight bearing.

背景与目标： : 后壁骨折是髋臼骨折中最常见的。这项研究的目的是评估使用支撑技术重建髋臼粉碎性后壁骨折的中期结果。这是在一级创伤中心进行的回顾性审查。在1998年7月至2004年2月期间，对32例髋臼粉碎性后壁骨折患者 (男性25例，女性7例，平均年龄41岁，范围14-80岁) 进行了后壁重建。平均随访43个月 (24-70个月)。临床评估基于改良的Merle d'Aubigne和Postel评分。射线照相评估是根据Matta制定的标准进行的。术后复位分为解剖型28例 (88% 例)，不完美的4例 (12% 例)。临床结果优11例 (34% 例)，好9例 (28% 例)，好4例 (12% 例)，好3例 (9% 例)，差5例 (15% 例)。最终随访的放射学分级为优秀12 (37%)，良好11 (34%)，一般4 (12%) 和较差5 (15%)。通过支撑技术重建粉碎性后壁髋臼骨折有望产生良好的效果。它可以提供稳定的后壁固定，适合早期的运动范围和承重。

BACKGROUND & AIMS: BACKGROUND:Posterior reversible encephalopathy syndrome may occur frequently and be underrecognized in children and young adults admitted to a pediatric critical care unit. METHODS:Patients <21 years of age with the diagnosis of posterior reversible encephalopathy syndrome were reviewed in this retrospective cohort study conducted over a 30-month period. RESULTS:There were 2588 admissions to pediatric critical care unit, 226 neurology service consultations, and 10 patients diagnosed with posterior reversible encephalopathy syndrome (incidence of 1 in 259 pediatric critical care unit admissions, 0.4%). The majority of posterior reversible encephalopathy syndrome patients (9/10) presented with generalized tonic and or clonic seizures. Apart from hypertension and cytotoxic medication use, anemia, a previously unreported risk factor, was found in all 10 (100%) patients with posterior reversible encephalopathy syndrome. One-year follow up available in eight patients showed no residual neurological deficits attributable to posterior reversible encephalopathy syndrome with significant resolution of white matter signal abnormalities on neuroimaging. CONCLUSION:Our case cohort includes an estimation of incidence of posterior reversible encephalopathy syndrome in children and young adults with 1-year follow-up and anemia as a potential previously unreported risk factor.

背景与目标：

BACKGROUND & AIMS: :Separation of the vitreous and posterior hyaloid membrane (PHM) or posterior vitreous detachment (PVD) typically occurs between the ages of 45 and 65 years in the general population, but may occur earlier in myopic or otherwise predisposed individuals. Age-related synergetic changes occurring within the cortical and central gel must be distinguished from the PHM, which envelopes it. This study reports on the correlation between 'true' PVD seen clinically by the physician using dynamic examination, high-power slit-lamp biomicroscopy, and oblique illumination with some of its histological, immunohistochemical, and ultrastructural features post-mortem. The presence of the Weiss ring does not necessarily indicate total clean separation of PHM, nor does its absence confirm that the PHM remains attached, since it may be destroyed during the process of separation. Immediately prior to PVD with the vitreous gel attached, the PHM must, by definition, form part of the inner limiting membrane. The detached PHM frequently exhibits basement membrane (BM) and its indigenous laminocytes stain focally for GFAP and type IV collagen. The PHM is distinct from and much thicker than the BM of Müller cells alone and the factors that initiate or limit separation of the PHM require greater study, particularly the role of laminocyte proliferation and migration.

背景与目标： : 在一般人群中，玻璃体和后玻璃体膜 (PHM) 或玻璃体后脱离 (PVD) 的分离通常发生在45至65岁之间，但在近视或其他易患个体中可能更早发生。皮质和中央凝胶内发生的与年龄有关的协同变化必须与包裹它的PHM区分开。这项研究报告了医师使用动态检查，大功率裂隙灯生物显微镜和斜视照明及其某些组织学，免疫组织化学和死后超微结构特征在临床上所见的 “真实” PVD之间的相关性。Weiss环的存在不一定表示PHM的完全干净分离，也不一定表明PHM的缺失仍然存在，因为它可能在分离过程中被破坏。在附着玻璃体凝胶的PVD之前，根据定义，PHM必须形成内部限制膜的一部分。分离的PHM经常表现出基底膜 (BM)，其本地层细胞染色局部为GFAP和IV型胶原蛋白。PHM与单独的m ü ller细胞的BM不同且厚得多，启动或限制PHM分离的因素需要更多的研究，尤其是层细胞增殖和迁移的作用。

BACKGROUND & AIMS: :The rat auditory cortex is divided anatomically into several areas, but little is known about the functional differences in information processing between these areas. To determine the filter properties of rat posterior auditory field (PAF) neurons, we compared neurophysiological responses to simple tones, frequency modulated (FM) sweeps, and amplitude modulated noise and tones with responses of primary auditory cortex (A1) neurons. PAF neurons have excitatory receptive fields that are on average 65% broader than A1 neurons. The broader receptive fields of PAF neurons result in responses to narrow and broadband inputs that are stronger than A1. In contrast to A1, we found little evidence for an orderly topographic gradient in PAF based on frequency. These neurons exhibit latencies that are twice as long as A1. In response to modulated tones and noise, PAF neurons adapt to repeated stimuli at significantly slower rates. Unlike A1, neurons in PAF rarely exhibit facilitation to rapidly repeated sounds. Neurons in PAF do not exhibit strong selectivity for rate or direction of narrowband one octave FM sweeps. These results indicate that PAF, like nonprimary visual fields, processes sensory information on larger spectral and longer temporal scales than primary cortex.

背景与目标： : 大鼠听觉皮层在解剖学上分为几个区域，但对这些区域之间信息处理的功能差异知之甚少。为了确定大鼠后听觉场 (PAF) 神经元的过滤特性，我们比较了对简单音调，调频 (FM) 扫描以及调幅噪声和音调与初级听觉皮层 (A1) 神经元反应的神经生理反应。PAF神经元具有平均比A1神经元宽65% 的兴奋性感受野。PAF神经元的较宽的感受野导致对比a1强的窄和宽带输入的响应。与A1相反，我们几乎没有证据表明PAF中基于频率的有序地形梯度。这些神经元表现出的潜伏期是a1的两倍。响应调制的音调和噪声，PAF神经元以明显较慢的速度适应重复刺激。与A1不同，PAF中的神经元很少对快速重复的声音表现出促进作用。PAF中的神经元对窄带一个倍频FM扫描的速率或方向没有很强的选择性。这些结果表明，与非主要视野一样，PAF在比主要皮层更大的光谱和更长的时间尺度上处理感觉信息。

BACKGROUND & AIMS: :To investigate if the surface modification of intraocular lens (IOL) is efficient in the prevention of posterior capsular opacification (PCO), the acrylic surface of intraocular lens (Acrysof) was polymerized with polyethylene glycol (PEG-IOL). The human lens epithelial cells (1 x 10(4) cells/mL) were inoculated on PEG grafted or unmodified acrylic lenses for the control. The adherent cells on each IOL surface were trypsinized and counted. The every PEG-IOL was implanted in 20 New Zealand rabbits after removal of crystalline lens. The formations of PCO were checked serially through retroilluminated digital photography, and the severity scores were calculated using POCOman. The cell adherence patterns on each IOL were examined by scanning electron microscopy. As a result, the mean number of adherent cells of PEG-IOL (3.2+/-1.1 x 10(3)) tended to be smaller than that of the acrylic controls (3.6+/-1.9 x 10(3)) without a statistical significance (p=0.73). However, the mean severity of PCO formation in PEG-IOL was significantly lower than that in the control during the third to sixth weeks after surgery. Scanning electron microscopy revealed that the more patch-like cells were found firmly attached to the IOL surface in control than in the PEG-IOL. Conclusively, PEG polymerization to the acrylic IOL would possibly lessen the formation of PCO after cataract removal.

背景与目标： : 为了研究人工晶状体 (IOL) 的表面改性是否能有效预防后囊混浊 (PCO)，人工晶状体 (Acrysof) 的丙烯酸表面与聚乙二醇 (PEG-IOL) 聚合。将人晶状体上皮细胞 (1x10(4) 细胞/mL) 接种在PEG移植或未修饰的丙烯酸镜片上，以进行对照。对每个IOL表面的贴壁细胞进行胰蛋白酶处理并计数。去除晶状体后，将每只PEG-IOL植入20只新西兰兔子中。通过逆光数码摄影连续检查PCO的形成，并使用pocomanan计算严重程度评分。通过扫描电子显微镜检查每个IOL上的细胞粘附模式。结果，PEG-IOL的贴壁细胞的平均数目 (3.2 +/-1.1 × 10(3)) 趋向于小于丙烯酸对照的数目 (3.6 +/-1.9 × 10(3))，没有统计学意义 (p = 0.73)。然而，在术后第三至第六周，PEG-IOL中PCO形成的平均严重程度显着低于对照组。扫描电子显微镜显示，与PEG-IOL相比，对照中发现更多的斑块状细胞牢固地附着在IOL表面。最终，聚乙二醇聚合到丙烯酸IOL可能会减少白内障摘除后PCO的形成。

BACKGROUND & AIMS: :Extranodal presentation in non-Hodgkin's lymphoma (NHL) is uncommon, and the mandible is very rarely involved. Primary NHL of the mandible, for the most part, has intermediate or high malignancy and has a much greater incidence of local recurrence compared with other sites of involvement. A 48-year-old Japanese man with NHL of the mandible received radiotherapy, followed by high-dose chemotherapy supported with peripheral blood stem cell transplantation (PBSCT). High-dose cyclophosphamide, Adriamycin, and vincristine were used for pretransplant conditioning. He achieved complete remission and has survived in continuous complete remission for more than 72 months to date. Marrow-ablative chemotherapy facilitated by PBSCT is thought to be useful as part of the primary therapy for patients with NHL who have poorer prognoses.

背景与目标： : 非霍奇金淋巴瘤 (NHL) 的结外表现并不常见，下颌骨很少涉及。与其他受累部位相比，下颌骨的原发性NHL大部分具有中等或高度恶性，并且局部复发的发生率更高。一名48岁的日本下颌骨NHL男子接受了放疗，随后接受了大剂量化疗，并伴有外周血干细胞移植 (PBSCT)。大剂量环磷酰胺，阿霉素和长春新碱用于移植前调理。迄今为止，他获得了完全缓解，并且在连续完全缓解中存活了72个月以上。PBSCT促进的骨髓消融化疗被认为是对预后较差的NHL患者的主要治疗的一部分。

BACKGROUND & AIMS: BACKGROUND:Idiopathic chronic anal fissure is believed to be a consequence of a traumatic acute anodermal tear followed by recurrent inflammation and poor healing due to relative tissue ischaemia secondary to internal sphincter spasm. This pilot trial compared the efficacy of a novel manufactured ano-coccygeal support attached to a standard toilet seat (Colorec) to the standard procedure of lateral internal sphincterotomy (LIS) for chronic anal fissure. METHODS:Fifty-three patients with confirmed chronic anal fissures were enrolled and assigned, based on their preference, to the test group and the control group. Each patient was reviewed after therapy, and follow-up was scheduled at 4, 6 and 8 weeks and at 6 months. RESULTS:The fissure healing rate was 100% in both groups. There were no statistically significant differences between the test group (n = 30, median age 42 years; range 20-71 years) and the control group (n = 22, median age 38 years; range 23-60 years) with regards to resolution of rectal bleeding at defaecation after 4 weeks (86.6 vs. 72.7%, p = 0.698), and by week 6, bleeding had resolved in 100% of patients in both groups. There was no statistically significant difference between the test group and the control group with regards to pain scores at 4, 6 and 8 weeks (4.30 ± 0.79, 2.03 ± 0.80, 0.43 ± 0.50 vs. 3.50 ± 0.74, 1.68 ± 0.56, 0.50 ± 0.51, p = 0.054) and to time until complete healing of fissures (5.60 ± 1.52 weeks vs. 5.91 ± 1.57 weeks, p = 0.479). After continuous use of the ano-coccygeal support over 6 months, no patients in the test group had recurrent fissures. No complications were observed during the trial. CONCLUSIONS:Results of both methods were comparable and demonstrated that the ano-coccygeal support is at least as effective as LIS, without any short-term complications. Larger and randomised trials on the use of ano-coccygeal support for chronic anal fissures are awaited.

背景与目标：

BACKGROUND & AIMS: We studied the roles of Notch, Delta, and Serrate in vertebrate epithelial appendage morphogenesis using feather as a model and found the following. (1) C-Notch-1, C-Delta-1, and C-Serrate-1 are not expressed at the early placode stage and are therefore not involved in the determination of bud versus interbud compartments. (2) From symmetric short buds to asymmetric long buds, C-Delta-1 and C-Serrate-1 are expressed in the posterior bud mesenchyme in a nested fashion, while C-Notch-1 is expressed as a stripe perpendicular to the anterior-posterior (A-P) axis and positioned posterior to the midpoint. (3) Epithelial-mesenchymal recombination with rotation led to the disappearance of these genes followed by their reappearance with new positions appearing to predict their new morphological orientation. (4) Conditions leading to branched buds (e.g., recombination of later buds) show polarized staining patterns before branching occurs. (5) Conditions leading to symmetrical round buds (e.g., treated with the protein kinase A agonist forskolin) suppress expression of all three genes. These results lead us to hypothesize that Notch, Delta, and Serrate are involved in establishing the A-P asymmetry of feather buds.

背景与目标： 我们以羽毛为模型研究了Notch，Delta和Serrate在脊椎动物上皮附件形态发生中的作用，发现以下内容。(1) C-Notch-1，C-Delta-1和C-Serrate-1在早期阶段不表达，因此不参与芽间隔室的确定。(2) 从对称的短芽到不对称的长芽，C-Delta-1和C-Serrate-1以嵌套方式在后芽间充质中表达，而C-Notch-1表示为垂直于前后 (a-P) 轴并位于后的条纹中点。(3) 旋转使上皮-间充质重组导致这些基因消失，然后以新的位置重新出现，以预测其新的形态方向。(4) 导致分支芽的条件 (例如，后期芽的重组) 在分支发生之前显示出极化染色模式。(5) 导致对称圆芽的条件 (例如，用蛋白激酶A激动剂forskolin处理) 抑制所有三个基因的表达。这些结果使我们假设缺口，三角洲和锯齿参与建立羽毛芽的A-P不对称性。

BACKGROUND & AIMS: We report the case of a 5-year-old girl with an enlarging suboccipital mass, a posttraumatic intraosseous arachnoid cyst. Diagnostic work-up revealed that the lesion consisted of an intradiploic arachnoid cyst and an extra-axial occipital pouch that communicated by way of an osseous and dural defect. Surgical repair was undertaken with good results. A search of the current literature has shown only seven previous reports of leptomeningeal cysts situated at the occipital bones, most of them the result of an antecedent skull fracture. A pathogenetic hypothesis is presented comparing the growth of arachnoid intraosseous cysts and the development of meningocencephaloceles.

背景与目标： 我们报告了一个5岁女孩的情况，该女孩的枕下肿块扩大，创伤性骨内蛛网膜囊肿。诊断性检查显示，病变由一个内蛛网膜囊肿和一个通过骨和硬脑膜缺损连通的轴外枕袋组成。进行了手术修复，效果良好。对当前文献的搜索显示，以前只有七个关于枕骨处的软脑膜囊肿的报道，其中大多数是先前颅骨骨折的结果。提出了一种致病假说，比较了蛛网膜骨内囊肿的生长和脑膜脑膜的发展。

BACKGROUND & AIMS: :The aim of the study was to analyze the long-term outcome (>20 years) after treatment of posterior fossa medulloblastoma (MB) in childhood. We analyzed data from patients treated for posterior fossa MB between 1974 (introduction of the first international treatment protocol in Norway) and 1987 (when use of radiotherapy was abandoned in children under 4 years of age). Out of 47 children, 24 survived >20 years. At the time of analysis, 16 patients (median age 41 years, range 32-52) were alive (median follow-up 34 years, range 30-42), while 8 patients died 22-41 years (median 31 years) after primary treatment: one late death (after 22 years) was due to tumor recurrence whilst other 7 deaths (after 23 to 41 years) were related to the detrimental effects of the treatment (secondary tumors, stroke, severe epilepsy and depression). Observed 20- and 30-year survival rates were 51% and 44%, respectively. Despite successful treatment of MB in childhood and satisfactory tumor control during the first 20 years following primary treatment, our data indicates that even long-term survivors may die from tumor recurrence. However, the main factors causing late mortality and morbidity in long-term survivors seem to be the complications related to radiotherapy given in childhood.

背景与目标： : 该研究的目的是分析儿童期后颅窝髓母细胞瘤 (MB) 治疗后的长期结果 (>20年)。我们分析了接受后颅窝MB 1974年 (在挪威引入了第一个国际治疗方案) 和1987 (在4岁以下儿童中放弃放疗时) 治疗的患者的数据。在47名儿童中，有24名存活了20年以上。在分析时，16例患者 (中位年龄41岁，范围32-52) 存活 (中位随访34年，范围30-42)，而8例患者在初次治疗后死亡22-41年 (中位31年): 1例晚期死亡 (22年后) 是由于肿瘤复发，而其他7例死亡 (23至41年后) 与治疗的有害影响 (继发性肿瘤，中风，严重癫痫和抑郁症) 有关。观察到的20年和30年生存率分别为51% 和44%。尽管在儿童时期成功治疗了MB，并且在初次治疗后的前20年中肿瘤控制令人满意，但我们的数据表明，即使是长期幸存者也可能死于肿瘤复发。然而，导致长期幸存者晚期死亡率和发病率的主要因素似乎是与儿童时期放疗有关的并发症。

BACKGROUND & AIMS: OBJECTIVE:The characteristics of typical posterior canal-benign paroxysmal positional vertigo-canalolithiasis (P-BPPV-Can) are well known. We found 10 patients with a new variant of P-BPPV-Can: Reverse (Rev)-P-BPPV-Can. The characteristics and pathophysiology of Rev-P-BPPV-Can are discussed. METHODS:For 4 years and 9 months, 10 patients with Rev-P-BPPV-Can (9 women and 1 man; mean age: 73 years) visited our clinic. Within the same period, 268 patients with unilateral typical P-BPPV-Can were treated. During the Dix-Hallpike and Epley maneuvers, nystagmus was recorded using an infrared charge-coupled device camera mounted on a pair of spectacles. RESULTS:The patients exhibited entirely opposite direction of nystagmus from typical P-BPPV-Can in both the Dix-Hallpike head position and upright sitting position. The patients had typical characteristics of nystagmus due to canalolithiasis, such as latency, duration of <1 min, linear-torsional nystagmus, and fatigability. Rev-P-BPPV-Can appeared after the Epley maneuver for typical P-BPPV-Can; in other patients, Rev-P-BPPV-Can changed to typical P-BPPV-Can. The affected sides of Rev-P-BPPV-Can were decided by those of typical P-BPPV-Can. CONCLUSION:Canalolithiasis in the non-ampullary distal portion of the posterior semicircular canal may be a potential pathophysiology of Rev-P-BPPV-Can. The Epley maneuver has little effect for treating Rev-P-BPPV-Can, but spontaneous transition to typical P-BPPV-Can or spontaneous recovery is expected.

背景与目标：

BACKGROUND & AIMS: UNLABELLED:It is unclear whether using artificial cages increases fusion rates compared with use of bone chips alone in posterior lumbar interbody fusion for patients with lumbar spondylolisthesis. We hypothesized artificial cages for posterior lumbar interbody fusion would provide better clinical and radiographic outcomes than bone chips alone. We assumed solid fusion would provide good clinical outcomes. We clinically and radiographically followed 34 patients with spondylolisthesis having posterior lumbar interbody fusion with mixed autogenous and allogeneic bone chips alone and 42 patients having posterior lumbar interbody fusion with implantation of artificial cages packed with morselized bone graft. Patients with the artificial cage had better functional improvement in the Oswestry disability index than those with bone chips alone, whereas pain score, patient satisfaction, and fusion rate were similar in the two groups. Postoperative disc height ratio, slip ratio, and segmental lordosis all decreased at final followup in the patients with bone chips alone but remained unchanged in the artificial cage group. The functional outcome correlated with radiographic fusion status. We conclude artificial cages provide better functional outcomes and radiographic improvement than bone chips alone in posterior lumbar interbody fusion for lumbar spondylolisthesis, although both techniques achieved comparable fusion rates. LEVEL OF EVIDENCE:Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

背景与目标：