经鼻内镜手术进展

颅底手术正随着经鼻内镜手术的发展而发生着转变。经鼻内镜手术最初开发于鼻窦手术,但其适应症已逐渐扩大到其它领域,可以用于治疗大量的疾病。经鼻内镜手术的主要优点是：它利用天然的孔道来处理大量的颅内、鼻窦病变,避免了皮肤切口、面部骨瓣切口、脑回缩等直接开颅所不可避免的后遗症。与传统的神经外科手术相比,发病率和死亡率下降,并间接减少了住院时间和管理成本。本文就经鼻内镜手术的进展进行综述。在综述中阐述了经鼻内镜手术的适应症和基本原则,以及显露、特别是重建技术的进展,这些进展要求在可接受的并发症前提下达到更广泛的切除;讨论了经鼻内镜手术的局限性,尤其是,虽然这种手术往往是“微创”,但它并不是完全没有并发症;展望了经鼻内镜手术的适应症会不断拓宽,并发症会越来越少的美好未来。     

经鼻内镜手术进展

颅底手术正随着经鼻内镜手术的发展而发生着转变。经鼻内镜手术最初开发于鼻窦手术,但其适应症已逐渐扩大到其它领域,可以用于治疗大量的疾病。经鼻内镜手术的主要优点是:它利用天然的孔道来处理大量的颅内、鼻窦病变,避免了皮肤切口、面部骨瓣切口、脑回缩等直接开颅所不可避免的后遗症。与传统的神经外科手术相比,发病率和死亡率下降,并间接减少了住院时间和管理成本。本文就经鼻内镜手术的进展进行综述。在综述中阐述了经鼻内镜手术的适应症和基本原则,以及显露、特别是重建技术的进展,这些进展要求在可接受的并发症前提下达到更广泛的切除;讨论了经鼻内镜手术的局限性,尤其是,虽然这种手术往往是"微创",但它并不是完全没有并发症;展望了经鼻内镜手术的适应症会不断拓宽,并发症会越来越少的美好未来。     

Cranial trepanation in two skulls of early medieval Italy

Cranial trepanation is a practice known since prehistory in various, often geographically distant populations. In this work are presented two early medieval trepaned skulls. The first skull comes from Canosa in Apulia (6th-7th c. AD; according to radiocarbon dating), the second is from Ticineto Alessandrino (5th-8th c. AD). The skull of Canosa shows a single perforation on the bregmatic quadrant of the right parietal, whereas the Ticineto skull presents three lesions of different shapes and sizes. Two perforations are on the left parietal and the other is on the right parietal. The lesions of the Ticineto skull can be referred to a therapeutic operation following a trauma, with survival of the individual. In the Canosa skull the absence of a healing reaction suggests a pathological process, without survival of the subject. Moreover, a particular ritual practice cannot be excluded (i.e. a post-mortem trepanation).     

Patterns of violence‐related skull trauma in neolithic southern scandinavia

This article examines evidence for violence as reflected in skull injuries in 378 individuals from Neolithic Denmark and Sweden (3,900–1,700 BC). It is the first large‐scale crossregional study of skull trauma in southern Scandinavia, documenting skeletal evidence of violence at a population level. We also investigate the widely assumed hypothesis that Neolithic violence is male‐dominated and results in primarily male injuries and fatalities. Considering crude prevalence and prevalence for individual bones of the skull allows for a more comprehensive understanding of interpersonal violence in the region, which is characterized by endemic levels of mostly nonlethal violence that affected both men and women. Crude prevalence for skull trauma reaches 9.4% in the Swedish and 16.9% in the Danish sample, whereas element‐based prevalence varies between 6.2% for the right frontal and 0.6% for the left maxilla, with higher figures in the Danish sample. Significantly more males are affected by healed injuries but perimortem injuries affect males and females equally. These results suggest habitual male involvement in nonfatal violence but similar risks for both sexes for sustaining fatal injuries. In the Danish sample, a bias toward front and left‐side injuries and right‐side injuries in females support this scenario of differential involvement in habitual interpersonal violence, suggesting gendered differences in active engagement in conflict. It highlights the importance of large‐scale studies for investigating the scale and context of violence in early agricultural societies, and the existence of varied regional patterns for overall injury prevalence as well as gendered differences in violence‐related injuries. Am J Phys Anthropol, 2013. © 2012 Wiley Periodicals, Inc.     

Determinants of poor outcome after laceration and surgical incision repair

The most important outcomes after repair of traumatic lacerations and surgical incisions are their long-term cosmetic appearance and development of infection. However, few studies have attempted to identify patient and wound characteristics associated with increased infection rates and suboptimal scar appearance. The authors determined patient and wound characteristics associated with wound infection or suboptimal appearance after laceration or incision repair. A secondary analysis of data collected from a multicenter randomized clinical trial comparing the outcome of lacerations and incisions closed with tissue adhesive or standard closure methods conducted at 10 clinical inpatient and outpatient sites was performed. The presence of infection and scar appearance were prospectively determined using validated outcomes. Univariate and multivariate analyses were performed to identify patient and wound characteristics associated with poor wound outcome (wound infection at 5 to 10 days or suboptimal appearance at 3 months). Eight hundred fourteen patients with 924 wounds (383 lacerations, 541 incisions) were enrolled. Mean age was 32 years and 47 percent were female. Characteristics associated with suboptimal cosmetic appearance on multivariate analysis were presence of associated tissue trauma [odds ratio (OR), 3.9; 95 percent confidence interval (CI), 1.4 to 10.7], use of electrocautery (OR, 3.4; 95 percent CI, 1.8 to 6.5), incomplete wound edge apposition (OR, 2.9; 95 percent CI, 1.7 to 5.0); extremity location (OR, 2.1; 95 percent CI, 1.2 to 3.7), and wound width (OR, 1.08; 95 percent CI, 1.01 to 1.14). Characteristics associated with wound infection on univariate analysis included associated tissue trauma (8.7 percent versus 1.2 percent, p = 0.04) and incomplete wound apposition (6.6 percent versus 0.5 percent). Suboptimal appearance was more common in infected wounds (relative risk, 3.2; 95 percent CI, 1.8 to 5.6). Suboptimal wound appearance is increased with extremity wounds, wide wounds, incompletely apposed wounds, associated tissue trauma, use of electrocautery, and infection. Type of closure device and use of deep sutures had no effect on infection rates or cosmetic appearance.     

术中神经电生理监测在颅底外科中的应用进展

临床颅底外科手术中充满各种风险,特别是有对神经系统结构造成损伤的潜在风险。有些损伤无法通过直接观察来判断,因此术中电生理监测(intraoperative neuroelectrophysiological monitoring,IONM)是神经外科手术医生术中实时监测和评估神经功能的重要手段。国外上世纪80年代就将其应用于颅底肿瘤手术中,但直至目前我国相关应用仍未普及。术中神经电生理监测是运用各种电生理技术,实时监测术中处于有损伤风险的神经系统功能的完整性,并提示手术医生及时终止风险性操作,有针对性的采取有效干预措施消除或减小神经损伤、改善患者预后的一门技术。近年来,颅底外科进展迅速,并向多学科协作和减少创伤的方向发展,术中神经电生理监测已经迅速发展为降低颅底手术中神经损伤发生率的重要辅助手段。     

An adaptive-remeshing framework to predict impact-induced skull fracture in infants

Biomechanics and Modeling in Mechanobiology - Infant skull fractures are common in both accidental and abusive head trauma, but identifying the cause of injury may be challenging without adequate...     

内蒙古中部新发现的始施氏貘(哺乳纲,奇蹄目)头骨材料(英文)

记述了产自内蒙古呼和勃尔和剖面阿山头组的始施氏貘(Schlosseria magister)幼年头骨、头骨碎片及产自额尔登敖包底白层的S.magister成年头骨。幼年头骨在脊齿貘科属首次描述,成年头骨材料也是目前S.magister中首次描述。幼年头骨主要特征如下:头骨细长,脑颅部略有扩张,有眶后突,眶后收缩明显,矢状脊轻微发育;鼻切迹浅,位于前臼齿列之前,由前颌骨和鼻骨构成;眼眶大,眶前缘位于M1后部上方,眶下孔位于DP3-4之上;基蝶骨向后向中央逐渐加厚,末端隆起;翼蝶骨很大,从腹面看向后向背侧扩展,末端形成三角形的翼蝶骨突,覆盖在卵圆孔上;岩骨岬部表面有内颈动脉及其分支留下的3条沟痕;最内侧的为内颈动脉内侧沟,沿着岬部弯曲前行至最前部;镫骨动脉沟短小,横跨在圆窗前腹侧;岬动脉沟最长,起始于卵圆窗前内侧,沿岬部向前延伸;弓形下窝所在位置平滑,无凹陷。S.magister乳颊齿主要特征如下:DP2冠面大致呈三角形,前窄后宽,前缘较尖,长明显大于宽;外脊上仅有一个中央主尖前尖,一个非常不明显的小棱(可能为雏形的原脊)紧贴在前尖后舌侧壁上;前、后附尖不明显。DP3冠面呈梯形,与DP2相比明显增大,亚臼齿化,前附尖和后附尖略大,原、后脊明显。前尖大,后尖尚未分离;原尖很弱,几乎无法辨认,原脊低且不发育;次尖大而钝,比原尖更靠舌侧,后脊比原脊略发育,中部具小的后小尖;后脊在次尖处拐向后唇侧,使得磨蚀面呈V形。DP4冠面近方形,完全臼齿化,后尖已从外脊上分化出来,比前尖稍小,向舌侧倾斜,后尖肋明显;舌侧尖、脊发育完好,原尖和次尖大而钝,原脊、后脊近乎平行,比DP3的更高更长;两条脊分别在原尖和后尖处拐向后唇侧方,形成V形的磨蚀面。S.magister在由幼年向成年转变的过程中,主要变化趋势如下:1)吻部特征不同,主要表现为鼻切迹的位置、形态以及与之相关的前颌骨、上颌骨形态的差异。幼年头骨的鼻切迹位于前臼齿列之前,由前颌骨和鼻骨组成;成年头骨的鼻切迹后缩至M1-2之上,由鼻骨和上颌骨组成,并且因鼻切迹后缩造成鼻骨不与前颌骨接触。幼年和成年个体上颌骨的整体形态,眶前窝、眶下孔的位置和形态都差异显著。2)与咀嚼功能相关的结构改变。幼年个体的矢状脊微弱,而成年个体的则高且突起,暗示了后者具有相对强大的颞肌,以适应咀嚼功能。对比发现,S.magister与Lophialetes expeditus成年头骨在大小、整体形态和一些具有分类意义的特征上(如鼻骨和泪骨、前颌骨的接触方式,眶后突、关节后突、下颌关节窝的形状,矢状脊的高度等)非常接近。参照童永生、雷奕振(1984)对脊齿貘类头骨的划分方法,将Schlosseria magister的头骨与L.expeditus的划为一组,同时纠正了原有划分方案中存在的问题。     

Evolution of skull shape in carnivores 2. Additional modern carnivores

Fifteen functionally significant aspects of skull morphology were measured on skulls of 36 additional species of carnivores to complete a survey of skull shape in modern fissiped (land) carnivores that includes most of the living genera. The measurements were transformed to dimensionless variables based on the residuals from allometric equations, and were analysed singly and in a 10 variable principal components analysis. An initial study of 62 species of viverrids, canids, mustelids and felids had shown those families to be distinguished from each other by the functionally significant measurements. However, among the additional 36 species, some procyonids, ursids and mustelids display a range of diversity of skull morphology that overlaps that of the other families and diminishes the potential value of the measurements as taxonomic characters. Intraspecific variation is presented for 12 species, and is low enough to allow use of some features as species level diagnostic characters. The lack of correlation between diet and functionally significant aspects of skull morphology among omnivorous carnivores, and the absence of certain skull shapes among carnivores are discussed.     

周口店直立人头骨创伤与人工切割痕迹辨析

自20世纪40年代魏敦瑞提出北京猿人（周口店直立人）可能存在“暴力争斗”和“同类残食”的观点之后,引发了一些学者和科普大众对北京猿人是否为“食人族”的争论。由于原始化石标本在第二次世界大战期间丢失,本文以保存下来的周口店（ZKD）直立人头骨原始模型和素描图为研究材料,对魏敦瑞提出的具有创伤和人工切割痕迹的5件标本（ZKD II、ZKD VI、ZKD X、ZKD XI和ZKD XII）进行辨析。结果显示：1）ZKD X、ZKD XI、ZKD XII这3件标本的头盖部,有7处可以确定为生前遭受非致死性撞击导致的局部创伤;2）ZKD VI头盖骨残片周边的及中央区域的断痕,为个体生前遭受致死性的暴力打击导致;3）ZKD II和ZKD VI顶骨位置疑似人工切割痕迹的沟槽实际上是动物啃咬或自然因素导致的,北京猿人“同类残食”的观点在本文研究中没有得到证实。北京猿人头骨的创伤痕迹都位于头盖部,以顶骨居多,其次为额骨,符合人群之间暴力冲突产生创伤的位置。     

Bioarchaeological investigation of ancient Maya violence and warfare in inland northwest Yucatan,Mexico

This study investigates evidence of changes and continuities in ancient Maya violence and warfare in inland northwest Yucatan, Mexico from the Middle Preclassic (600–300 BC) to the Postclassic (AD 1050–1542) through bioarchaeological analysis of cranial and projectile trauma. It is hypothesized that the frequency of violence increases before the Classic Maya collapse and remains high during the Postclassic period. It is also hypothesized that the flat, open terrain was conducive to warfare and resulted in higher trauma frequencies than in other parts of the Maya area. Results show that the frequency of cranial trauma decreases before the Classic collapse and increases in the Postclassic, partially matching the expected chronological trends. The frequency of cranial trauma does not differ significantly from other Maya regions but the pattern does: for all periods, males have more healed injuries than females and they are concentrated on the left side of the anterior of the skull. Some injuries appear to be from small points hafted in wooden clubs. In addition, projectile trauma is evident in a scapula with an embedded arrowhead tip, the first such case reported in a Maya skeleton. Overall, these results suggest greater reliance on open combat and less on raids in this region compared with other parts of the Maya area, possibly due to the flat, open terrain, though the identification of perimortem trauma in both women and men indicates surprise raids on settlements were also practiced. Am J Phys Anthropol 154:140–151, 2014. © 2014 Wiley Periodicals, Inc.     

Craniometrical variability and developmental stability. Two useful tools for assessing the population viability of Eurasian otter (Lutra lutra) populations in Europe.

Morphometrical univariate analyses of otter skulls collected over the past hundred years in European countries from presumed healthy populations were compared with skulls from presumed endangered populations. The average degree of sexual dimorphism of die European populations was found to be directly correlated to die skull size of die male otters. Fluctuating asymmetry (FA) in metric skull traits was analysed as an estimator of developmental stability. There was evidence for increased FA in different traits over time in some of the presumed endangered populations, and for a reduction in size of skull traits. In contrast, the healthy populations did not show any significant changes in the same traits during the same period. The reduced sexual dimorphism of the endangered populations is suggested to be a product of relaxed sexual selection and deteriorated habitat conditions. Environmental and genetic forces that may have shaped these patterns are discussed.     

The skull ofvelociraptor mongoliensis,a small cretaceous theropod dinosaur from Mongolia

The skull of the small theropod dinosaurVelociraptor mongoliensis is described in detail, using the holotype from the Djadokhta Formation (Campanian) of Mongolia. A reconstruction of the skull is attempted.Velociraptor is closely related toDeinonychus andDromaeosaurus; however, it is distinguished from all other dromaeosaurids described by its relatively long, low skull and a depressed muzzle. The affinities ofVelociraptor are discussed and the taxonomic status of all other previously described East Asian dromaeosaurids is examined.     

A new approach to mammalian cranial analysis, illustrated by examples of prosimian primates

Latex endocranial casts, which may be made without damaging the skull, reveal much of the information provided by a hemisected skull. Examination of drawings of endocasts superimposed on skulls may provide insight into the biological significance of skull and brain morphology. The high degree of cranial flexion and the globose brain shape of Daubentonia appear to be related to the functional demands of its gnawing mechanism. The broad frontal lobes of indriids are correlated with orbital orientation; differences in frontal lobe sulcal pattern suggest greater elaboration of the motor filed for the hand in indriids than in lemurids. Several features of lorisid cranial anatomy are discussed. It is suggested that, as a first approximation, increased splanchnocranial declination in small prosimians results from the necessity of accommodating relatively large eyes in a skull with a relatively small splanchnocranium.     

Trauma in the preceramic coastal populations of northern Chile: violence or occupational hazards?

One hundred and forty-four Chinchorro skeletons, stored at the Museo Arqueol?ogico San Miguel de Azapa in Arica, Chile, were examined to test the following alternative hypotheses concerning skeletal trauma: either observed trauma was a consequence of interpersonal violence, or was the result of work-related accidents. Trauma found in subadults was rare, with 1.8% (1/55) contrasted with 30% (27/89) in the adult population. The location of most adult trauma was the skull with 24.6% (17/69), followed by the upper extremities with 8. 7% (7/80), the trunk with 2.9% (2/68), and the lower extremities with the least trauma at 1.1% (1/89). Skull trauma corresponded to well-healed, semicircular fractures, with males being three times more affected than females at 34.2% (13/38) and 12.9% (4/31), respectively. Most fractures were nonlethal, appearing to have been caused by impacts from stones, suggesting interpersonal violence rather than accidents. This study indicates that the egalitarian, maritime, hunter-gatherer Chinchorro culture (circa 4000 years B.P.) may not have lived as peacefully as once thought.     

A novel structure-specific endonuclease activity associated with polypyrimidine-tract binding (PTB) related protein from rat testis

Nucleases are involved in the processing of various intermediates generated during crucial DNA metabolic processes such as replication, repair, and recombination and also during maturation of RNA precursors. An endonuclease, degrading specifically single-stranded circular DNA, was identified earlier in rat testis nuclear extract while purifying a strand-transfer activity. We are now reporting the purification of this endonuclease, which is a monomeric 42 kDa protein, from rat testis to near-homogeneity. In addition to degrading single-stranded circular DNA, it nicks supercoiled plasmid DNA to generate relaxed DNA and does not act on linear single-stranded or double-stranded DNA. It also makes specific incisions at the single-strand/duplex junction of pseudo-Y, 3'- and 5'-overhangs and 3'- and 5'-flap structures. Other structures such as mismatch, insertion loop, and Holliday junction are not substrates for the testis endonuclease. In contrast to FEN1, the testis endonuclease makes asymmetric incisions on both strands of the branched structures, and free single-stranded ends are not necessary for the structure-specific incisions. Neither 5'-3' nor 3'-5' exonuclease activity is associated with the testis endonuclease. The amino acid sequences of tryptic peptides of the 42 kDa endonuclease show near-identity to polypyrimidine-tract binding protein (PTB) that is involved in the regulation of splicing of eukaryotic mRNA. The significance of the results on the association of structure-specific endonucleae activities with PTB-related protein is discussed.     

The cranial morphology of Greererpeton burkemorani Romer (Amphibia: Temnospondyli)

The skull of Greererpeton burkemorani Romer, a temnospondyl amphibian from the Upper Mississippian at Greer, West Virginia is described. A detailed account of the stapes of a Mississippian amphibian is given for the first time and its function is discussed. It is suggested that the stapes formed the principal element of support for the back of the braincase and resisted potential dislocation of the otico-occipital region from the skull roof during contraction of the hypaxial musculature.
Greererpeton is included in the Colosteidae and an amended diagnosis of the family is given. Erpetosaurus differs from Colosteus, Greererpeton and Pholidogaster in the pattern of bones in the skull roof and palate, the dentition and the otic region and, consequently, it is removed from the Colosteidae. The Temnospondyli are considered to be a monophyletic group characterized by the development of a connection between the dorsal portion of the occipital arch, the exoccipital bones, and the skull roof. The loxommatids are removed from the Temnospondyli as they retain the plesiomorphic condition of braincase attachment which relies exclusively on derivatives of the auditory capsules.
On the basis of similarities in the structure of the braincase, palate and manus it is suggested that microsaurs are the collateral descendants (sister group) of temnospondyls. This relationship may account for the large number of similarities in the three living groups of Amphibia: Anura are generally believed to have descended from temnospondyls, while the Urodela and Apoda are often considered to have descended from microsaurs. These systematic conclusions endorse the recent suggestions that neither the Lepospondyli nor the Labyrinthodontia are natural groups, and both terms should be abandoned.     

Fellow travellers: emergent properties of collective cell migration

Cells can migrate individually or collectively. Collective movement is common during normal development and is also a characteristic of some cancers. This review discusses recent insights into features that are unique to collective cell migration, as well as properties that emerge from these features. The first feature is that cells of the collective affect each other through adhesion, force‐dependent and signalling interactions. The second feature is that cells of the collective differ from one another: leaders from followers, tip from stalk and front from back. These are dynamic differences that are important for directional movement. Last, an unexpected property is discussed: epithelial cells can rotate persistently in constrained spaces.     

Broken noses for the gods: ritual battles in the Atacama Desert during the Tiwanaku period

The sample consists of 226 skulls from the Atacame?o cemetery of Coyo Oriente (639-910 AD), associated with the Tiwanaku period. The authors analyzed signs of acute trauma typically associated with violence, and the results were 12% of men and 9.9% of women displaying any type of lesion related to violence. In males, concentration of these non-lethal lesions in the nasal region (10.4%) as opposed to a random distribution over the entire skull (1.6%), suggests that the blows were struck during rituals. The cultural context of this period, with a strong ideological influence from Tiwanaku, supports the ritual hypothesis, since both the ethnographic as well as archeological records point to the existence of non-lethal violent bleeding with ritual beating to the face. Such rituals persist to this day among certain Andean populations. Among women, the most plausible hypothesis for the lesions (3.9% in the skull, 4.9% in the nasal bones, and 0.9% in the face) is domestic conflicts, since they show a random distribution. Previous studies with other Atacame?o samples had indicated the same results for women.