Quantitative evaluation of the major determinants of human gait

Accurate knowledge of the isolated contributions of joint movements to the three-dimensional displacement of the center of mass (COM) is fundamental for understanding the kinematics of normal walking and for improving the treatment of gait disabilities. Saunders et al. (1953) identified six kinematic mechanisms to explain the efficient progression of the whole-body COM in the sagittal, transverse, and coronal planes. These mechanisms, referred to as the major determinants of gait, were pelvic rotation, pelvic list, stance knee flexion, foot and knee mechanisms, and hip adduction. The aim of the present study was to quantitatively assess the contribution of each major gait determinant to the anteroposterior, vertical, and mediolateral displacements of the COM over one gait cycle. The contribution of each gait determinant was found by applying the concept of an ‘influence coefficient’, wherein the partial derivative of the COM displacement with respect to a prescribed determinant was calculated. The analysis was based on three-dimensional measurements of joint angular displacements obtained from 23 healthy young adults walking at slow, normal and fast speeds. We found that hip flexion, stance knee flexion, and ankle-foot interaction (comprised of ankle plantarflexion, toe flexion and the displacement of the center of pressure) are the major determinants of the displacements of the COM in the sagittal plane, while hip adduction and pelvic list contribute most significantly to the mediolateral displacement of the COM in the coronal plane. Pelvic rotation and pelvic list contribute little to the vertical displacement of the COM at all walking speeds. Pelvic tilt, hip rotation, subtalar inversion, and back extension, abduction and rotation make negligible contributions to the displacements of the COM in all three anatomical planes.     

Electromyography of pelvic floor muscles

Pelvic floor muscles (PFM) are intimately involved in function of lower urinary tract, the anorectum and sexual functions, therefore their neural control transcends the primarily important somatic innervation of striated muscle, as they are directly involved in “visceral activity”. Neural control of pelvic organs is affected by a unique co-ordination of somatic and autonomic motor nervous systems. Visceral and somatic sensory fibres supply sensory information from pelvic organs; their input influences through central integrative mechanisms also pelvic floor muscle activity. Anatomically, somatic afferent and efferent nerves of the sacral cord segments, reflexly integrated at the spinal cord and brainstem level, conduct neural control of PFM. The inputs from several higher centres influence the complex reflex control and are decisive for voluntary control, and for socially adapted behaviour related to excretory functions.     

Allometric growth of the trunk leads to the rostral shift of the pelvic fin in teleost fishes

The pelvic fin position among teleost fishes has shifted rostrally during evolution, resulting in diversification of both behavior and habitat. We explored the developmental basis for the rostral shift in pelvic fin position in teleost fishes using zebrafish (abdominal pelvic fins) and Nile tilapia (thoracic pelvic fins). Cell fate mapping experiments revealed that changes in the distribution of lateral plate mesodermal cells accompany the trunk-tail protrusion. Presumptive pelvic fin cells are originally located at the body wall adjacent to the anterior limit of hoxc10a expression in the spinal cord, and their position shifts rostrally as the trunk grows. We then showed that the differences in pelvic fin position between zebrafish and Nile tilapia were not due to changes in expression or function of gdf11. We also found that hox-independent motoneurons located above the pelvic fins innervate into the pelvic musculature. Our results suggest that there is a common mechanism among teleosts and tetrapods that controls paired appendage positioning via gdf11, but in teleost fishes the position of prospective pelvic fin cells on the yolk surface shifts as the trunk grows. In addition, teleost motoneurons, which lack lateral motor columns, innervate the pelvic fins in a manner independent of the rostral-caudal patterns of hox expression in the spinal cord.     

SLK三联疗法联合硬膜外分娩镇痛对初产妇盆底功能及围产结局影响的相关研究

摘要 目的：探究SLK三联疗法联合硬膜外分娩镇痛对初产妇盆底功能及围产结局影响。方法：选取2022年1月-2022年12月在江阴市人民医院及其集团内医院产检并分娩单胎孕妇200人，依据随机数字表法随机分为对照组、SLK三联疗法组、硬膜外分娩镇痛、联合组，每组50例。对照组采用常规训练，SLK三联疗法组采用Sopfrology分娩训练、Lamaze呼吸训练和Kegel训练联合训练，硬膜外分娩镇痛组采用病人自控硬膜外镇痛，联合组在SLK三联疗法的基础上进行硬膜外分娩镇痛。采用超声诊断仪检测盆底功能指标（2）采用神经肌肉刺激生物反馈治疗仪检测盆底肌电生理指标，记录并比较各组产前发热率、助产率、产后出血率、剖宫产率、产程和Apgar 评分。结果：硬膜外镇痛组与对照组相比，盆底超声检查△y、α、β、γ各参数差异无统计学意义（P>0.05）；SLK组和联合组盆底超声检查△y、α、β、γ各参数均显著低于对照组，差异具有统计学意义（P<0.05）；但SLK组和联合组上述各指标差异无统计学意义（P>0.05）。SLK组和联合组I类和II类肌纤维肌力、I类和Ⅱ类肌纤维疲劳度均显著优于对照组，差异具有统计学意义（P<0.05）；但SLK组和联合组上述各指标差异无统计学意义（P>0.05）。SLK组、硬膜外镇痛组和联合组产后出血率和剖宫产率显著低于对照组，差异具有统计学意义（P<0.05），硬膜外镇痛组第一产程和第二产程显著高于对照组，差异具有统计学意义（P<0.05），SLK组第一产程和第二产程显著低于对照组，联合组第一产程和第二产程显著低于硬膜外镇痛组，SLK组和联合组Apgar 评分显著高于对照组。结论：SLK三联疗法联合硬膜外分娩镇痛能够有效改善初产妇盆底功能和围产结局，弥补单独硬膜外分娩镇痛的不足，值得临床推广。     

Prospective evaluation of the setup errors and its impact on safety margin for cervical cancer pelvic conformal radiotherapy

AimThe primary objective was to assess set-up errors (SE) and secondary objective was to determine optimal safety margin (SM)BackgroundTo evaluate the SE and its impact on the SM utilizing electronic portal imaging (EPI) for pelvic conformal radiotherapy.Material and methods20 cervical cancer patients were enrolled in this prospective study. Supine position with ankle and knee rest was used during CT simulation. The contouring was done using consensus guideline for intact uterus. 50 Gy in 25 fractions were delivered at the isocenter with ≥95% PTV coverage. Two orthogonal (Anterior and Lateral) digitally reconstructed radiograph (DRR) was constructed as a reference image. The pair of orthogonal [Anterior-Posterior and Right Lateral] single exposure EPIs during radiation was taken. The reference DRR and EPIs were compared for shifts, and SE was calculated in the X-axis, Y-axis, and Z-axis directions.Results320 images (40 DRRs and 280 EPIs) were assessed. The systematic error in the Z-axis (AP EPI), X-axis (AP EPI), and Y-axis (Lat EPI) ranged from -12.0 to 11.8 mm, -10.3 to 7.5 mm, and -8.50 to 9.70 mm, while the random error ranged from 1.60 to 6.15 mm, 0.59 to 4.93 mm, and 1.02 to –4.35 mm. The SM computed were 7.07, 6.36, and 7.79 mm in the Y-axis, X-axis, and Z-axis by Van Herk’s equation, and 6.0, 5.51, and 6.74 mm by Stroom’s equation.ConclusionThe computed SE helps defining SM, and it may differ between institutions. In our study, the calculated SM was approximately 8 mm in the Z-axis, 7 mm in X and Y axis for pelvic conformal radiotherapy.     

激光显微切割技术用于子宫内膜异位组织DNA的提取及其完整性分析

目的：探索一套激光显微切割（LCM）分离子宫内膜异位症腺体细胞后提取微量DNA并进行完整性分析的操作流程。方法：分别对20例石蜡标本及20例冰冻标本进行LCM,收集切割后的腺体细胞;2组标本各取10例提取微量DNA,检测DNA浓度并通过PCR扩增进行验证;余20例标本分别进行全基因组扩增,检测产物浓度并利用8种常见管家基因作为引物通过PCR扩增进行验证,对比分析其结果。结果：石蜡标本与冰冻标本在LCM获取腺体细胞及提取微量DNA两个环节中均可获得满意效果;但经全基因组扩增后,石蜡标本无法保留完整DNA信息。结论：LCM获取子宫内膜异位症腺体细胞提取微量DNA是一种操作简单、结果稳定的方法,可作为日后子宫内膜异位症基因组研究的常规方法;冰冻切片相对石蜡切片,更能保留完整的DNA信息。     

PID患者宫颈及盆腔病原体培养结果的对比分析

目的 (1)了解慢性盆腔炎患者宫颈局部分泌物及盆腔病原体培养结果的一致性;(2)了解盆腔炎患者盆腔与宫颈病原微生物感染的情况。方法对2009年12月至2010年3月因慢性盆腔炎住院患者,将其宫颈局部分泌物进行病原体培养,后经腹腔镜将其盆腔积液或盆腔冲洗液进行病原体培养,将培养结果进行对比。结果 (1)慢性盆腔炎患者盆腔与宫颈分泌物病原微生物培养有中度一致性,Kappa=0.494,Z<0.05,差异有统计学意义;(2)PID患者中,UU检出率高,在宫颈局部及盆腔积液或冲洗液中的检出率分别为46.07%和27.45%;CT的检出率也较高,在宫颈局部及盆腔积液或冲洗液的检出率分别为19.60%和17.64%。结论慢性盆腔炎患者中严格按照操作行宫颈局部分泌物培养对盆腔炎用药有一定的指导意义,盆腔及宫颈局部UU感染率明显高于其他STD病原体。     

全子宫切除术后盆腔肿块的发生因素调查分析

目的:调查与探讨全子宫切除术后患者出现盆腔肿块的发生因素。方法:2017年9月至2019年3月选择在北部战区总医院(本院)进行择期全子宫切除术的女性患者178例,所有患者都给予全子宫切除术,患者取膀胱截石位,选用连续硬膜外麻醉或静脉复合麻醉,宫颈扩张棒扩张宫颈口,切除病灶部位。记录所有患者的一般资料(包括疾病类型、孕次、产次、年龄、体重指数等)与围手术期指标(包括手术时间、术中出血量、术后排气时间、术后住院时间),以及术后并发症发生情况;在术后6个月进行经阴道超声观察,判断患者术后盆腔肿块发生情况并进行调查分析。结果:术后随访6个月,178例患者中发生盆腔肿块14例,发生率为7.9%。发生其他并发症17例,其中切口感染4例,淋巴囊肿6例,尿潴留5例,下肢静脉血栓2例。在178例患者中,不同手术时间、术中出血量、孕次、产次、年龄、疾病类型患者的盆部肿发生率对比差异有统计学意义(P<0.05)。以单因素分析中有统计学意义的指标作为自变量,以盆腔肿块作为因变量,Logistic回归分析显示手术时间、孕次、产次、疾病类型等为导致盆腔肿块发生的主要因素(P<0.05)。结论:女性全子宫切除术后患者盆腔肿块比较常见,手术时间、孕次、产次、疾病类型等为导致盆腔肿块发生的主要因素。     

硬膜外麻醉无痛分娩、剖宫产和自然分娩对盆底组织功能的影响

摘要 目的：比较不同的分娩方法（自然分娩、无痛分娩、剖宫产）对产妇盆底组织功能的影响。方法：选择2019年10月～2020年11月在我院进行分娩的80例产妇,其中,自然分娩组15例,无痛分娩组26例、剖宫产组39例。记录自然分娩组和无痛分娩组第一、第二产程的疼痛程度和第一、第二产程所需时间,巨大儿、新生儿黄疸、低体重儿和新生儿窒息等母婴结局,Apgar评分、产时出血量和胎儿体重;且检查产妇的盆底肌力,记录自然分娩组、无痛分娩组、剖宫产组的尿失禁发生率。结果：无痛分娩组的第一、第二产程的视觉模拟评分法（Visual analog scales,VAS）评分和第一、第二产程所需时间明显低于自然分娩组(P<0.05);自然分娩组和无痛分娩组的巨大儿、新生儿黄疸、低体重儿和新生儿窒息率无明显差异(P>0.05);自然分娩组和无痛分娩组的Apgar评分、产时出血量和胎儿体重无明显差异(P>0.05);无痛分娩组的盆底肌力明显高于自然分娩组(P<0.05),剖宫产组的盆底肌力明显高于无痛分娩组(P<0.05);三组尿失禁的发生率对比差异无统计学意义(P>0.05)。结论：无痛分娩不但能减轻分娩疼痛程度,还能减轻对盆底组织功能的损伤,值得进行推广。     

Recepteur d'origine nantais contributes to the development of endometriosis via promoting epithelial-mesenchymal transition of a endometrial epithelial cells

Endometriosis is a benign, chronic inflammatory disease that commonly occurs in reproductive-aged women. Epithelial - mesenchymal transition (EMT) of endometrial epithelial cells plays an important role in the development of endometriosis. Recepteur d'origine nantais (RON), a receptor tyrosine kinase, has been reported to promote EMT and progression in tumours. However, whether and how RON mediates the EMT and endometriosis development is not known. Here, we found that RON activation could improve the migratory and invasive capabilities, change cellular morphologies, and decrease expression of E-cadherin and increase expression of N-cadherin in endometrial epithelial cells. Inhibition or knockdown of RON expression suppressed the migration and invasion of endometrial epithelial cells. Our studies also indicated that RON played its part in endometrial epithelial cells through protein kinase B (Akt) and mitogen-activated protein kinase (MAPK) pathways. Treatment with a RON inhibitor could decrease the number of ectopic lesions in a mouse model of endometriosis and mediate expression of EMT markers in endometriotic lesions. These data suggest that RON contributed to endometriosis development by promoting EMT of endometrial epithelial cells. Therefore, RON may be a new therapeutic target for endometriosis.