Metacarpophalangeal length changes in humans during adulthood: a longitudinal study.

Total lengths of the 19 diaphyseal hand bones were measured from standardized radiographs of healthy American whites as young adults (ca. 21 years) and again at ca. 55 years of age. The four hand-bone rows exhibit distinctive length changes: Distal and middle phalanges continue to increase significantly in length, proximal phalanges constitute a transition zone of little change, and metacarpals uniformly decrease in length. Clear-cut sex differences are noteworthy: Males change more (lose more in some bone rows, gain more in others) than females. Progressive elongation was greatest in the distal phalanges where apposition around the distal aspect ("tufting") is not constrained by a joint or epiphysis. Loss of bone length in the metacarpals by subchondral resorption is consistent with documented reductions in activity levels and grip strength with age, as well as diminished joint spaces which alter loading of the joints.     

Applications of radiodermatography to human and primate studies

Using 325-mesh tantalum powder as a contrast medium, it is possible to take high-resolution “radiodermatographs” of man and infra-human primates that combine the advantages of postero-anterior hand radiographs and conventional paper palm-and-finger prints. The radiodermatographs are particularly useful in relating creases, triradii and fingertip ridge patterns to differences in the proportions of the carpals, metacarpals and phalanges.     

Comparative and functional morphology of hominoid fingers.

Comparisons of hominoid metacarpals and phalanges reveal differences, many of which are closely linked to locomotor hand postures. The African apes display features of the metacarpals and phalanges which distinguish them from the other Hominoidea. These features are most evident in digits III and IV. The orangutan hand is demonstrably less well adapted to knuckle-walking and is distinctive in its adaptation to power and hook grasping of vertical and horizontal supports, respectively. Orangutan fingers possess a "double-locking" mechanism (Napier, '60), and a slight ulnad shift in the axis of the hand which results in lengthened phalanges of ray IV. Hylobatid apes are more like orangutans in their finger morphology than any of the other Hominoidea, but exhibit unique features of their own. These include elongate phalanges of fingers II-V. Human metacarpals II-V form two sets composed of II-III, and IV-V. The heads of both metacarpals II and III are characterized by axial torsion. This reflects the enhanced manipulatory role of the third finger in humans. Human distal phalanges are unique in the development of pronounced apical tufts. Multivariate analysis of metacarpal III and proximal III yields variables that array the extant apes along an arboreal-terrestrial axis, from hylobatid apes to male gorillas. The positions of taxa on this discriminant concur with observations on the locomotion of free-ranging apes.     

Notches in the non-epiphyseal ends of the metacarpals and phalanges in children of four South African populations

The incidence of notches in the non-epiphyseal ends of the shafts of the metacarpals and phalanges was determined from radiographs of the left hand of 1,303 Pretoria school-children aged 6 to 11 years. The group included White, Negro, Coloured and Indian children. The notches represent vestiges of supernumerary epiphyses or pseudo-epiphyses. Notching of one or more of the metacarpals or phalanges was found in 88.9% of White children, 77.1% of Negro children, 84.3% of Coloured children and 78.8% of Indian children. Notches were most common in metacarpal I followed in declining order of frequency by metacarpal II, metacarpal V, middle phalanx V and proximal phalanx I. Notches were rare in other sites. The mean number of notches per subject was significantly higher in males than in females in all four population groups. However, the sex differences appear to be due mainly to earlier obliteration of notches in females. The findings in White children suggest that there is no significant relationship between metacarpal and phalangeal notching and skeletal maturation rate. Notches are significantly more common in Pretoria Whites than in relatively poorly nourished Pretoria Negro children. It is concluded that the occurrence of notches is a normal phenomenon accompanying the ossification of the hand skeleton and that notching is related neither to retardation in skeletal development nor to undernutrition.     

Ontogenetic and anatomic variation in mineralization of the wing skeleton of the Mexican free-tailed bat, Tadarida brasiliensis

We examined patterns of variation in the mineral content of the wing skeleton of the Mexican free-tailed bat, Tadarida brasiliensis. We ashed humeri, radii, metacarpals II-V, and phalanges of digit III, and quantified mineralization differences among elements at specific ages, and ontogenetically for each element. The most mineralized elements are the humerus and the radius, followed by the metacarpals, of which the third and fifth are the most mineralized. The proximal and middle phalanges of the third digit exhibit the lowest mineral content, and the distal phalanges have no mineral content according to our ashing protocol. Histological examination shows a thin (< 10 μm) shell of unmineralized osteoid surrounding a cartilaginous core in distal phalanges. Mineral content of each bone increases linearly with age during post-natal development, but there are differences in the rate and extent of this increase among the different elements.
The mineralizaton differences we observed parallel substantially different bone loading patterns found in different parts of the wing in other studies. The humerus and radius are subjected to large torsional loads during flight, while the metacarpals and phalanges experience dorsoventral bending. The high mineral content of the humerus and radius and the low mineral content of the metacarpals and phalanges may resist torsion proximally and promote bending distally. Furthermore, the decrease in mineral content along the wing's proximodistal axis decreases bone mass disproportionately at the wing tips, where the energetic cost of accelerating and decelerating limb mass is greatest.     

Digit effects produced by prenatal exposure to antiepileptic drugs

The hypothesis tested was that digit anomalies among individuals exposed in utero to antiepileptic drugs (AED) are best identified by a systematic search, including radiographs and dermatoglyphics, rather than relying only on visual inspection. A systematic search was made for five types of digit abnormalities in 46 AED-exposed individuals ages 5-29 years in comparison with controls: visible anomalies, size of fingernails, dermal ridge patterns, length of metacarpals and phalanges, and qualitative changes in the distal phalanges. Among the AED-exposed, nail size was not decreased. However, there was a 10.8% frequency of digit anomalies, a 12% frequency of three or more arch patterns, and significant shortening and qualitative changes in the distal phalanges, all of which are consistent with the fetal effects of AED. Among the 42 individuals who underwent all evaluations, 14.3% had two or more of these abnormalities, most of which would not be identified by clinical inspection. This frequency is much higher in these AED-exposed individuals than in the general population. Radiographs in 13 individuals over a period of several years showed that the changes in the phalanges and metacarpals persisted.     

A resampling approach and implications for estimating the phalangeal index from unassociated hand bones in fossil primates

Primate fossil assemblages often have metacarpals and phalanges from which functional/behavioral interpretations may be inferred. For example, intrinsic hand proportions can indicate hand function and substrate use. But, estimates of intrinsic hand proportions from unassociated hand elements can be imperfect due to digit misattribution. Although isolated metacarpals can be identified to a specific digit, phalanges are difficult to assign to a specific ray. We used a resampling approach to evaluate how estimates of intrinsic hand proportions are affected by such uncertainty. First, the phalangeal index—intermediate phalanx length plus proximal phalanx length divided by metacarpal length—for the third digit was calculated for associated specimens of terrestrial, semiterrestrial, and arboreal taxa. We then used resampling procedures to generate distributions of “composite digits” based on resampled ratios in which phalanges from the second, fourth, and fifth rays, and from different individuals, were chosen randomly. Results confirm that the phalangeal index for associated third digits significantly discriminates groups. We also found that resampled ratios had significantly lower means, indicating that using composite digits is prone to systematic underestimation. Resampled ratios also generated distributions with greater variance around the means that obscured distinctions between groups, although significant differences between the most arboreal and terrestrial taxa are maintained. We conclude that using unassociated phalanges to calculate a phalangeal index is prone to sampling bias. Nevertheless, a resampling approach has the potential to inform estimates of hand proportions for fossil taxa, provided that the comparative sample is constrained to mimic the fossil composition. Am J Phys Anthropol 151:280–289, 2013. © 2013 Wiley Periodicals, Inc.     

北京某三甲医院预约挂号对患者候诊时间的影响分析

目的 分析预约挂号是否缩短门诊患者的等候时间。方法抽取医院某一周全部患者挂号记录49 147条,通过秩和检验方法,分析预约挂号与非预约挂号患者的候诊时间的差异,比较不同预约方式对患者候诊时间是否存在影响。结果 预约挂号平均候诊时间为50分钟,非预约挂号患者平均候诊时间为111分钟,不同预约方式的患者候诊时间存在统计学上的差异。结论 预约挂号能够有效缩短门诊患者的候诊时间,其中复诊预约患者候诊时间最短,应鼓励患者预约就诊,复诊患者应鼓励进行复诊预约。     

Male advancement in prenatal hand development

Male advancement in the developing hand was evidenced by 66 grossly and microscopically normal embryos in the 15–75 mm crown-rump range. Male advancement was particularly pronounced in the younger (15–30 mm) embryos, both in the proximal hand region including the round bones of the wrist and in the distal hand region, comprising the metacarpals and phalanges. Thirty-four additional embryos, abnormal in implantation or development or representing spontaneous abortion similarly evidenced male advancement in the early hand skeleton.     

Correlations between rates of epiphyseal and diaphyseal elongation in the short bones of the hand

Serial annual radiographs of the hand have been used to analyze the rates of elongation of the epiphyses and diaphyses of the metacarpals and phalanges in children at ages from 3 to 13 years. The rates of elongation for many corresponding ephiphyses and diaphyses (i.e., of the same bone) are negatively correlated but to an extent that is not statistically significant for any particular bone. This tendency toward negative correlations is found for most of these bones although the correlation coefficients for most of the metacarpals are positive in each sex. Within rays, the correlation indices between the rates of elongation for corresponding epiphyses and diaphyses (i.e., of the same bone) have larger negative or smaller positive values than for those between either adjacent and non-corresponding or non-adjacent and non-corresponding epiphyses and diaphyses (i.e., not of the same bone but of either adjacent or non-adjacent bones). The communality indices for the ratio between the rates of epiphyseal and diaphyseal elongation in particular bones are more highly correlated in the girls than in the boys and within the rows than within the rays. Some implications of the tendency to negative correlations between the rates of elongation of corresponding epiphyses and diaphyses have been discussed.     

A variant of Cenani-Lenz type syndactyly

Cenani-Lenz syndrome is a form of complete syndactyly resembling the spoon hand in Apert syndrome. It is often associated with disorganization of phalanges, the fusion of metacarpals and mesomelic shortness of the arm. We describe an additional case of Cenani-Lenz type of syndactylism in a 16 month-old girl who also has rib and vertebral abnormalities and mixed type hearing loss, that have not been seen before in a single patient.     

Stereoradiogrammetric technique for estimating alignment of the joints in the hand and wrist

A method and apparatus for quantitative measurement of the alignment and motion of the joints of the hand in three dimensions has been developed using stereoradiogrammetric principles. Alignment in planes of flexion-extension and radial-ulnar deviation can be determined to within 2.5°; rotation about the long axis of the metacarpals or phalanges is more difficult to determine, and can be measured to within 7°. Stereo views subtending angles in the range of 40° were found to optimize the total system accuracy.     

Tubular hand bone growth during the latter half of the prenatal period: an allometric analysis

The growth of the 19 tubular hand bones from fetal months 5 to 9 was studied by the allometric method. The hand bones were carefully dissected under a low power stereoscopic microscope. The length and breadth of all bones was found to be monophasic in relation to crown-rump length. In general, maximum bone and ossified shaft lengths in the same row group demonstrate similar allometric coefficients. The specific growth rate of ossified shaft length for all fetal hand bones is greater than the growth rate of maximum length. The highest allometric coefficients for both maximum length and ossified shaft length were obtained from the middle phalanges. The shape of the metacarpals and distal phalanges becomes thinner, while the other bones become thicker or maintain their length-breadth ratio. The relative growth pattern of the first proximal phalanx differed from the middle phalangeal group of the other digits. This suggests that current nomenclatures for the three bones of the pollex is appropriate.     

不同麻醉方式对骨科手术患者血流动力学、术后精神状态及认知功能的影响

目的:探讨不同麻醉方式对骨科手术患者血流动力学、术后精神状态及认知功能的影响。方法:选取2016年1月～2018年12月期间我院收治的89例骨科手术患者,根据数字表法将患者随机分为对照组(n=44)和研究组(n=45),对照组给予全身麻醉,研究组给予硬膜外麻醉,比较两组患者围术期指标情况,比较两组患者不同时间点血流动力学、术后精神状态及术后认知功能障碍(POCD)发生率。结果:两组患者术中麻醉时间、术中出血量比较,差异无统计学意义(P0.05);研究组麻醉药物使用量少于对照组,苏醒时间、语言恢复时间短于对照组(P0.05)。两组患者麻醉后术前(T2)时间点平均动脉压(MAP)、心率(HR)均较麻醉前(T1)时间点降低,两组患者手术30 min(T3)、手术结束时(T4)时间点MAP、HR均较T2时间点升高(P0.05),但两组患者T1～T4时间点MAP、HR比较,差异无统计学意义(P0.05)。对照组术后6 h(T5)～术后72 h(T8)时间点、研究组T5～术后24 h(T7)时间点MMSE评分低于T1时间点(P0.05),而研究组T8时间点MMSE评分与T1时间点比较,差异无统计学意义(P0.05);研究组T7、T8时间点MMSE评分高于对照组(P0.05)。研究组T5、术后12 h(T6)时间点POCD发生率均低于对照组(P0.05),两组T7、T8时间点POCD发生率比较,差异无统计学意义(P0.05)。结论:两种麻醉方式均可对骨科手术患者血流动力学、术后精神状态造成一定影响,但硬膜外麻醉对术后精神状态的影响程度相对更轻,同时还可降低POCD发生率,改善围术期部分指标。     

3D数字打印技术在重度脊柱侧弯中的临床分析研究

目的:评估和比较3D数字打印技术在重度脊柱侧弯患者手术中的临床疗效及安全性。方法:按照已经设定的纳入及排除标准,对2017年1月至2019年1月诊断为重度脊柱侧弯并在我科行手术治疗的22名患者进行前瞻性分析。根据是否采用3D打印技术辅助,将其通过随机数字表分为3D辅助组(实验组)与对照组。实验组(共11例)通过Minics软件进行3D模拟设计及打印,术中进行技术辅助。对照组(11例)则通过常规的徒手置钉办法进行手术。通过CT比较两组患者的置钉准确性,并比较两组患者的其他影像学检查和相关手术指标,包括:手术时间,输血量,透视次数等。结果:本研究纳入的患者(22例)均得到至少6个月的完整随访。两组患者在术前的影像学测评,Cobb角,年龄、性别构成等指标的比较中未见显著统计学差异(P>0.05)。实验组CT评价置钉准确率为83.6%(0级及1级),对照组的置钉准确率为72.3%。两组比较有统计学差异(P<0.05)。实验组在手术时间,术中输血量及透视次数等手术指标的比较中均显著优于对照组(P<0.05)。实验组的入院后待手术时间显著高于对照组(P<0.05)。实验组在术后3天的VAS指标显著优于对照组(P<0.05),但在术后6月的比较中无显著性差异(P>0.05)。两组患者的ODI指数较术前均有显著改善(P<0.05),且两组间无显著性差异(P>0.05)。两组患者均未出现严重并发症(P>0.05)。结论:与常规的徒手置钉相比,针对重度脊柱侧弯患者,3D数字打印辅助技术能够显著的提高置钉的准确性,减少手术时间和术中输血量,大幅度减少透视危害,且降低操作难度,值得临床进一步推广使用。     

Pattern profile analysis of hominid and chimpanzee hand bones

In a study designed to complement morphological research on hominid hand bones, length and width measurements of the thumb, index, and middle rays were obtained from radiographs of modern human hands. These rays are primary in precision-gripping postures and are therefore the ones most relevant for investigating evolutionary changes in fine manipulation. Pattern profile analysis allows individuals or samples to be plotted against a reference sample in standard deviation units, or Z-scores. It provides an indication of how different measurements are from modern human averages, while taking into consideration the degree of variation present within modern human samples. A pattern profile for chimpanzees is clearly distinct from humans but quite similar to that of a bonobo, demonstrating the promise of pattern analysis. Partial pattern profiles of several of the more complete early hominid bones from Hadar, Swartkrans, and Olduvai (O.H. 7) are presented and compared. Hadar bones are long and wide at midshaft relative to articular widths; both body-size effects and functional differences are likely. Thumb distal phalanges from Swartkrans and Olduvai both have relatively small base widths, but they differ in other proportions. Two first metacarpals from Swartkrans show distinct patterns. The profiles of La Ferrassie I and Shanidar IV show the characteristically large Neanderthal distal phalanges. Profiles of Skhūl IV and P?edmost III are alike in some regions with reference to modern North American white males, though they are less similar overall than are those of the two Neanderthals. © 1995 Wiley-Liss, Inc.     

Fluctuating asymmetry and morphometric variation of hand bones

The major aim of this study was to test three hypotheses: 1) more complex traits of the hand are less prone to developmental insults and therefore show lower fluctuating asymmetry (FA) as compared with simple traits; 2) the manifestation of FA correlates with the variability of the trait (i.e., CV); and 3) FA is an organ-wide property, and therefore a concordance exists between the FA measures of different traits in hand bones. Seventy-two bilateral measurements of hand bones, were made from plain-film radiographs of 365 cadavers. A complex trait was considered as the total length of the three phalanges of a finger and their contiguous metacarpals. Simple traits were considered to be the lengths of individual bone that made up the complex trait. The following results were obtained: 1) on the average simple traits, composing the complex trait, show much higher FA than the corresponding complex trait, but this result is expected if there is no correlation (or low correlation) between FA of simple traits within the complex trait, due to random direction of right-left differences; 2) strong and highly significant correlation was observed between FA and CV of studied traits, regardless of sex and age of individuals; and 3) the majority of FA measurements of hand bones showed no correlation. However, correlations between some sets of FA traits were highly significant. They were interpreted, although not specifically tested, as the result of a tight relationship between traits related not only developmentally but also by active performance of the same function. Am J Phys Anthropol 107:125–136, 1998. © 1998 Wiley-Liss, Inc.     

The case against HIV antibody testing of refugees and immigrants.

Computers are now widely used in medical practice for accounting and secretarial tasks. However, it has been much more difficult to use computers in more physician-related activities of daily practice. I investigated the Desqview multitasking system on a 386 computer as a solution to this problem. Physician-directed tasks of management of patient charts, retrieval of reference information, word processing, appointment scheduling and office organization were each managed by separate programs. Desqview allowed instantaneous switching back and forth between the various programs. I compared the time and cost savings and the need for physician input between Desqview 386, a 386 computer alone and an older, XT computer. Desqview significantly simplified the use of computer programs for medical information management and minimized the necessity for physician intervention. The time saved was 15 minutes per day; the costs saved were estimated to be $5000 annually.     

The Operative Treatment of Scapula Fractures: An Analysis of 10,097 Patients

BackgroundThe indications for operative treatment of scapula fractures have been debated over the past decade. Our purpose was to determine 1) the incidence and trends in the operative treatment of scapula fractures, 2) the incidence of conversion from operative fixation to total or hemi-shoulder arthroplasty (THSA) and 3) rates of associated injuries in scapula fractures. We hypothesized that the operative treatment of scapula fractures is increasing over time and that scapula fractures treated with open reduction and internal fixation (ORIF) would have increased risk for conversion to THSA.MethodsThe Humana Inc. administrative claims database was queried from 2008 to 2015. Patients with any scapular fracture, ORIF of scapula fracture, total or hemi-shoulder arthroplasty, and associated injuries were identified by ICD-9 and CPT codes. Analysis was performed for 1) all patients with a scapula fracture undergoing operative fixation (i.e. ORIF and THSA), 2) all scapular fractures treated with ORIF with subsequent conversion to ipsilateral THSA, and 3) all associated injuries.ResultsThere were 10,097 scapula fractures (28.4% glenoid, 48% female). 60% occurred in patients 65 years and older. There were 198 (1.96%) fractures (70% glenoid) treated with ORIF. There were 287 (2.84%) fractures (45% glenoid) treated with THSA (76% total shoulder). The rate of ORIF of scapular fractures did not significantly increase (RR=0.87, p=0.58). There was a significant increase in THSA as primary treatment of scapula fractures in 2015 compared to 2007 (RR=0.43, p=0.0016). Conversion from ORIF to THSA was 12.6% (25/198). Scapula fractures treated with ORIF were at significant risk for conversion to THSA (RR=4.77, p<0.0001). Associated injuries occurred in nearly 50% of scapula fractures—other fractures, lung contusion and pneumothorax/hemothorax ranking the highest, accounting for 37%, 14.5% and 8.3% of all associated injuries, respectively.ConclusionThe incidence of operative treatment of scapula fractures was 1.96% and 2.84% for ORIF and THSA, respectively. Scapular fractures previously treated with ORIF were at significant risk for conversion to THSA. Although ORIF in scapular fractures did not significantly increase over time, both THSA and overall (ORIF+THSA) operative treatment of scapula fractures increased significantly. Level of Evidence: IV     

短指/趾的分子遗传学研究进展

短指/趾(Brachydactyly, BD)是指(趾)骨和/或掌(跖)骨短小、缺失或融合导致的手/足先天畸形, 是一组以骨发育障碍为特征的肢体畸形疾病。BD可单独出现, 也可作为综合征的一种体征, 还可伴随其他的手/足畸形如并指/趾、多指/趾、短缺畸形和指/趾骨关节融合出现。绝大多数单纯型BD呈常染色体显性遗传, 存在表现度不同和外显不全。大多数单纯型BD和一些综合征型BD的致病基因缺陷已经被鉴定。BMP (Bone morphogenetic protein)通路参与正常指/趾发育, 且已知的BD致病基因直接或间接参与该通路。文章综述了BD分子遗传学研究方面的新进展, 将有助于BD致病机制的研究和基因诊疗的开展。