Calculation of impingement-free combined cup and stem alignments based on the patient-specific pelvic tilt

Proper cup alignment is crucial in total hip arthroplasty for reducing impingement risks, dislocations and wear. The Lewinnek “safe zone” is often used in clinical routine. This safe zone does not consider functional aspects and dislocation can occur even when the cup is oriented within the safe zone. Functional safe zones based on the hip range of motion (ROM) were introduced but are not commonly used in clinical routine. The reason might be that these methods are time-consuming due to complex simulations. A relatively fast method based on analytical mathematical formulas was proposed, but it is difficult to consider arbitrary motion. This work introduces an efficient algorithm for calculating a patient-specific target zone based on the target ROM which can consider any set of motions. The method is based on matrix transformations and trigonometric formulas. The resulting target zone which contains all impingement-free cup orientations is dependent on the patient-specific pelvic tilt, the 3D angular neck and stem orientation within the femur, and the technical prosthesis ROM. This method could be integrated into computer-assisted preoperative planning and intra-operative navigation tools. As pelvic tilt and stem orientation influence the optimal cup orientation they need to be acquired from the patient to derive a patient-specific ROM-based target zone.     

盆腔结缔组织炎大鼠模型的层黏连蛋白表达

目的建立混合菌液致SD大鼠盆腔结缔组织炎模型,研究大鼠盆腔黏连组织的病理学改变与层黏连蛋白表达。方法用注射器将细菌混悬液0．5mL,注人大鼠盆腔,并结合子宫穿孔手术,建立SD大鼠盆腔结缔组织炎模型。采用Philips分级评分法对大鼠盆腔黏连程度分级评分,切取黏连组织,用多聚甲醛固定,进行病理检测,并采用免疫组化法测定层黏连蛋白表达情况。结果模型组大鼠盆腔黏连Philips分级评分以Ⅲ级为主,与正常对照组比较差异极显著。HE染色镜检模型组可见大量炎细胞浸润,脓肿形成,伴有多少不等的纤维组织增生。免疫组化染色镜检模型组可见层黏连蛋白高表达,纤维结缔组织增生程度越高,层黏连蛋白表达越多。结论盆腔注射混合菌液并结合子宫穿孔手术,可作为建立大鼠盆腔结缔组织炎模型的方法。层黏连蛋白在盆腔结缔组织炎发病中起重要作用,参与整个炎症过程并维持盆腔黏连组织纤维化,可作为判断盆腔结缔组织炎的炎症和纤维化程度的参考指标。     

Anatomy of the renal pelvis in the hamster.

The hamster renal pelvis has been studied by means of low-power light microscopy, scanning electron microscopy and morphometric analyses. The results of this study are highly suggestive that the contact of pelvic urine with the other medulla as well as with the inner medulla may be an important aspect of final urine formation. The outer medulla constituted nearly 50% of the total pelvic surface area, with the inner stripe of the outer medulla more than twice the pelvic surface area of the outer stripe of the outer medulla. The large outer medullary pelvic surface area was accounted for by the elaboration of the upper pelvic walls into peripelvic columns, opercula ("secondary pyramids"), fornices and secondary pouches. A thin simple-squamous to low cuboidal pelvic epithelium separated pelvic urine from outer medullary parenchyma. The inner medulla which constituted about one quarter of the total pelvic surface area was covered by a cuboidal to columnar pelvic epithelium which appeared morphologically similar to the papillary collecting duct epithelium. Tubules and capillaries of the inner medulla did not appear as closely juxtaposed to the pelvic epithelium as did those of the outer medulla. Cortical tissue comprised only 11.7% of the total pelvic surface area and was covered by transitional epithelium similar to that of ureter and bladder. The previously reported impermeability of this epithelium suggests that pelvic urine contact with the cortex is unimportant in final urine formation. The rich layer of smooth muscle under the transitional epithelium probably functions to move urine into and out of the pelvis during pelvic peristalsis, which has been observed in vivo.     

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。     

Lower limb postures resembling sitting and standing alter lumbar angles along the passive stiffness curve

In vivo lumbar passive stiffness is often used to assess time-dependent changes in lumbar tissues and to define the neutral zone. We tested the hypothesis that flexing the hips would alter tension in hip and spine musculature, leading to a more extended passive stiffness curve (i.e., right-shifted), without changes in lumbar stiffness. Twenty participants underwent side-lying passive testing with the lower limbs positioned in Stand, Kneel, and Sit representative postures. Moment-angle curves were constructed from the lumbar angles and the moment at L4/5 and partitioned into three zones. Partially supporting our hypothesis, lumbar stiffness within the low and transition stiffness zones was similar between the Stand and Sit. Contrary to our hypothesis, lumbar angles were significantly larger in the Sit compared to the Stand and Kneel postures at the first and second breakpoints, with average differences of 9.3° or 27.2% of passive range of motion (%PassRoM) in flexion and 5.6° or 16.6 %PassRoM in extension. Increased flexion in the Sit may be linked to increased posterior pelvic tilt and associated lower lumbar vertebrae flexion. Investigators must ensure consistent pelvis and hip positioning when measuring lumbar stiffness. Additionally, the adaptability of the neutral zone to pelvis posture, particularly between standing and sitting, should be considered in ergonomic applications.     

Severe Pelvic Obliquity Affects Femoral Offset in Patients with Total Hip Arthroplasty but Not Leg-Length Inequality

Leg-length inequality is an extensively studied complication of total hip arthroplasty in normal patients. However, few studies have focused on the pelvic obliquity of coronal pelvic malrotation. We hypothesized that pelvic obliquity with a fixed abduction/adduction contracture deformity of the hip may intraoperatively affect the release of soft tissues, ultimately resulting in a leg-length inequality. This study also investigated whether the femoral and vertical offsets of total hip arthroplasty were correlated with pelvic obliquity. This prospective study divided 98 patients into six groups based on the inclination of pelvic obliquity before total hip arthroplasty. Leg-length inequality, variation of pelvic obliquity, offset, and vertical offset were measured after total hip arthroplasty. Leg-length inequality and vertical offset were not significantly different among groups, whereas the variation of pelvic obliquity was significantly higher in type IIC pelvic obliquity than in other groups. Type IC pelvic obliquity had a significantly shorter offset than did the other groups, which may have been an important factor leading to type IC pelvic obliquity. Pelvic obliquity exhibited no significant effect on leg-length inequality in patients with total hip arthroplasty. A shorter offset may be caused by the higher tension of the abductor in the operated hip, which may result in the formation of type IC pelvic obliquity. Releasing the abductor contracture and restoring femoral offset are important for increasing hip stability and maintaining pelvic balance following total hip arthroplasty.     

基于CTA的在体女性盆腔静脉血管网数字化三维模型构建的方法及意义

目的:探讨利用CTA原始数据集构建在体女性盆腔静脉血管网数字化三维模型的方法及意义。方法:基于双源CTA技术,获取1例宫颈癌患者的Dicom 3.0原始二维断层图像数据集。利用Mimics 10.01软件分别对骨盆、盆腔动脉血管网以及盆腔静脉血管网进行三维重建并配准融合。结果:构建的盆腔静脉血管网数字化三维模型可以清楚地显示下腔静脉、髂总静脉、髂外静脉、髂内静脉及其初级属支,以及双侧卵巢静脉等。与重建的骨盆、盆腔动脉血管网配准融合后,各支静脉血管的解剖走形及引流区域变得更加清晰明确。结论:基于CTA的计算机三维重建技术是一种研究女性盆腔静脉血管网的好方法,具有较大的运用价值。     

Informativeness of angiography in trophoblastic tumors of the uterus

A study was made of the resolving power of general and selective pelvic angiography with regard to specified diagnosis of trophoblastic tumors of the uterus. The informative value of general pelvic angiography was estimated by the results of angiomorphological correlations in 81 operated patients. The significance of selective pelvic angiography performed in 152 women was based on comparison of its results with those of pharmacoangiography supplemented by hysterography in 86 patients. The correctness of diagnosis in 26 of them was confirmed by operative findings. Analysis of the investigations has shown that general pelvic angiography allowed the detection of a tumor, its size and site in the uterus in 48% of the patients only. Selective pelvic angiography combined with pharmacoangiography was shown to be a method extending the diagnostic potentialities of pelvic angiography. In the authors' experience, it permitted obtaining a direct contrast image of a trophoblastic tumor or excluding its presence in the uterus of 85% of the examinees.     

The effect of boundary condition on the biomechanics of a human pelvic joint under an axial compressive load: a three-dimensional finite element model

The finite element (FE) model of the pelvic joint is helpful for clinical diagnosis and treatment of pelvic injuries. However, the effect of an FE model boundary condition on the biomechanical behavior of a pelvic joint has not been well studied. The objective of this study was to study the effect of boundary condition on the pelvic biomechanics predictions. A 3D FE model of a pelvis using subject-specific estimates of intact bone structures, main ligaments and bone material anisotropy by computed tomography (CT) gray value was developed and validated by bone surface strains obtained from rosette strain gauges in an in vitro pelvic experiment. Then three FE pelvic models were constructed to analyze the effect of boundary condition, corresponding to an intact pelvic joint, a pelvic joint without sacroiliac ligaments and a pelvic joint without proximal femurs, respectively. Vertical load was applied to the same pelvis with a fixed prosthetic femoral stem and the same load was simulated in the FE model. A strong correlation coefficient (R(2)=0.9657) was calculated, which indicated a strong correlation between the FE analysis and experimental results. The effect of boundary condition changes on the biomechanical response depended on the anatomical location and structure of the pelvic joint. It was found that acetabulum fixed in all directions with the femur removed can increase the stress distribution on the acetabular inner plate (approximately double the original values) and decrease that on the superior of pubis (from 7 MPa to 0.6 MPa). Taking sacrum and ilium as a whole, instead of sacroiliac and iliolumber ligaments, can influence the stress distribution on ilium and pubis bone vastly. These findings suggest pelvic biomechanics is very dependent on the boundary condition in the FE model.     

Organ cross talk modulates pelvic pain

Interstitial cystitis (IC) is a chronic bladder inflammatory disease of unknown etiology that is often regarded as a neurogenic cystitis. IC is associated with urothelial lesions, voiding dysfunction, and pain in the pelvic/perineal area, and diet can exacerbate IC symptoms. In this study, we used a murine neurogenic cystitis model to investigate the development of pelvic pain behavior. Neurogenic cystitis was induced by the injection of Bartha's strain of pseudorabies virus (PRV) into the abductor caudalis dorsalis tail base muscle of female C57BL/6J mice. Infectious PRV virions were isolated only from the spinal cord, confirming the centrally mediated nature of this neurogenic cystitis model. Pelvic pain was assessed using von Frey filament stimulation to the pelvic region, and mice infected with PRV developed progressive pelvic pain. Pelvic pain was alleviated by 2% lidocaine instillation into either the bladder or the colon but not following lidocaine instillation into the uterus. The bladders of PRV-infected mice showed markers of inflammation and increased vascular permeability compared with controls. In contrast, colon histology was normal and vascular permeability was unchanged, suggesting that development of pelvic pain was due only to bladder inflammation. Bladder-induced pelvic pain was also exacerbated by colonic administration of a subthreshold dose of capsaicin. These data indicate organ cross talk in pelvic pain and modulation of pain responses by visceral inputs distinct from the inflamed site. Furthermore, these data suggest a mechanism by which dietary modification benefits pelvic pain symptoms.     

经利用网片的前盆底重建术治疗重度盆腔器官脱垂的临床疗效

目的:探讨经利用网片的前盆底重建术治疗重度盆腔器官脱垂的临床效果。方法:选取2013年1月-2015年3月我院妇科收治的以前中盆腔联合缺陷为主的盆底障碍性疾病患者39例(POP-Q分度III-IV度)。实施经阴道Avaulta前盆腔重建术,24例切除子宫,9例保留子宫,其中6例因中盆腔重度脱垂联合行阴道残端骶棘韧带固定术,2例合并尿失禁同时行经尿道无张力悬吊术。术后随访12-25月,根据盆腔脏器脱垂评分(POP-Q)测量及PFIQ-7评分进行客观评价及主观感受评价进行中短期的临床效果分析。结果:39例患者手术过程顺利,术后无严重并发症,POP-Q评分均较术前显著降低,客观疗效理想。术后阴道前壁及子宫、阴道穹窿脱垂等症状显著改善;到目前为止无一例复发。结论:经阴道前盆腔重建术治疗前盆腔重度盆腔脱垂为主以及合并尿失禁等复杂情况的并发症少,治愈率高,复发率低,临床效果好。     

Activation of renal mechanosensitive neurons involves bradykinin, protein kinase C, PGE(2), and substance P

Increased renal pelvic pressure or bradykinin increases afferent renal nerve activity (ARNA) via PGE(2)-induced release of substance P. Protein kinase C (PKC) activation increases ARNA, and PKC inhibition blocks the ARNA response to bradykinin. We now examined whether bradykinin mediates the ARNA response to increased renal pelvic pressure by activating PKC. In anesthetized rats, the ARNA responses to increased renal pelvic pressure were blocked by renal pelvic perfusion with the bradykinin B(2)-receptor antagonist HOE 140 and the PKC inhibitor calphostin C by 76 +/- 8% (P < 0.02) and 81 +/- 5% (P < 0.01), respectively. Renal pelvic perfusion with 4beta-phorbol 12,13-dibutyrate (PDBu) to activate PKC increased ARNA 27 +/- 4% and renal pelvic release of PGE(2) from 500 +/- 59 to 1, 113 +/- 183 pg/min and substance P from 10 +/- 2 to 30 +/- 2 pg/min (all P < 0.01). Indomethacin abolished the increases in substance P release and ARNA. The PDBu-mediated increase in ARNA was also abolished by the substance P-receptor antagonist RP 67580. We conclude that bradykinin contributes to the activation of renal pelvic mechanosensitive neurons by activating PKC. PKC increases ARNA via a PGE(2)-induced release of substance P.     

太行山猕猴髋骨变量研究初报

本文对22例（♂11,♀11）成年太行山地区猕猴髋骨有关变量进行测量,通过有关变量单因素方差分析、R型聚类和回归分析,结果表明：太行山猕猴的髋骨变量有较明显的自身特征,髋骨有关变量在雌雄之间有明显差异。     

实时三维盆底超声对产后压力性尿失禁患者疗效评估作用及与尿动力学的相关性分析

摘要 目的：探讨实时三维盆底超声对产后压力性尿失禁（SUI）患者疗效评估作用及与尿动力学的相关性。方法：选择2020年4月至2022年12月石家庄市人民医院收治的139例产后SUI患者,均接受盆底生物反馈电刺激联合盆底肌锻炼治疗。治疗前后分别进行实时三维盆底超声检查和尿动力学检查。比较治疗前后实时三维盆底超声参数、尿动力学指标差异。Pearson法分析实时三维盆底超声参数与尿动力学指标的相关性。结果：实时三维盆底超声图像特征显示：治疗前盆膈裂孔内的结构疏松,回声变弱,盆腔器官结缔组织疏松,间隙增宽,盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较大;治疗后盆膈裂孔两侧耻骨直肠肌对称,耻骨内脏肌呈带状高回声,盆膈裂孔面积、尿道旋转角、膀胱尿道后角以及膀胱颈移动度较治疗前降低。产后SUI患者治疗后静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度均较治疗前降低（P＜0.05）,腹压漏尿点压、最大逼尿肌压力均较治疗前增加（P＜0.05）。产后SUI患者静息状态和Valsalva状态下盆膈裂孔面积、尿道旋转角、膀胱尿道后角、膀胱颈移动度与最大逼尿肌压力、腹压漏尿点压呈负相关（P＜0.05）,与最大膀胱容量和残余尿量无关（P＞0.05）。结论：产后SUI患者经盆底生物反馈电刺激联合盆底肌锻炼治疗后实时三维盆底超声参数较治疗前降低,与尿动力学改善有关。临床可通过实时三维盆底超声检查,对产后SUI患者进行临床疗效评价,以指导临床治疗。     

Interacting evolutionary constraints in pelvic reduction of threespine sticklebacks, Gasterosteus aculeatus (Pisces, Gasterosteidae)

The pelvic girdle of Gasterosteus aculeatus is normally a complex and robust structure that varies moderately among and within populations, but in several populations it occurs as a vestigial series. Based on 14 Recent and fossil populations from North America and Scotland, three general patterns of intrapopulation variation of vestigial pelvic structures can be recognized. In most cases of pelvic reduction, the size and complexity of the pelvic girdle are reduced mostly by progressive truncation of distal structures, but two patterns of distal truncation occur. Paedomorphosis appears to play a role in all cases of pelvic reduction, but in a fossil assemblage and one extant population it accounts for most of the structural simplification.
Pelvic reduction in populations of Gasterosteus depends on an interaction between natural selection, which appears to determine whether or not pelvic reduction occurs, and phylogenetic constraint (especially developmental constraint), which strongly influences the form of pelvic vestiges. The empirical difficulty of discriminating between phylogenetic constraint and effects of natural selection, and the potential for phylogenetic constraint to produce homoplasy are discussed. Pelvic reduction apparently has been a recurrent phenomenon in Gasterosteus since at least the early Pliocene, but it has not resulted in evolution of a separate lineage of 'pelvicless' sticklebacks because such populations are restricted to lakes, which are ephemeral over evolutionary time. Rapid phyletic pelvic reduction coupled with selective extinction of populations with vestigial pelvic structures has resulted in phylogenetic stasis.     

EVOLUTION OF PELVIC REDUCTION IN THREESPINE STICKLEBACK FISH: A TEST OF COMPETING HYPOTHESES

Reimchen hypothesized that pelvic reduction in threespine stickleback is favored by an absence of piscivorous fishes and the resulting increase in predation by insects, but Giles hypothesized that the predation regime is unimportant and that a low dissolved calcium concentration favors evolution of pelvic reduction. Substantial pelvic reduction in threespine stickleback sampled from 179 lakes around Cook Inlet, Alaska is strongly associated both with an absence of predatory fishes and a low calcium concentration. However, the association of pelvic reduction with low calcium concentration appears to be contingent on the absence of predatory fishes. These results emphasize the importance of interactions between seemingly unrelated environmental variables for selection of a single trait. However, these results also conflict with some observations elsewhere and do not rule out the possibility that other environmental factors are important for selection for pelvic reduction in threespine stickleback.     

Androgen regulation of the motor copulatory pattern in the male New Zealand white rabbit

The effect of castration and testosterone propionate (TP) treatment on the motor copulatory pattern was studied by an accelerometric technique in five sexually experienced New Zealand white male rabbits. This technique permits the oscillographic recording of thrusting frequency, rhythmicity, and amplitude of the pelvic movements occurring during copulation. Castration resulted in a marked decrease in sexual activity in all rabbits. Mounting, including occasional intromissions, was retained by four of the rabbits for periods ranging from 2 to 15 weeks. Castration did not affect mount duration, but decreased strength and frequency of pelvic thrusting. Diminution in the frequency of pelvic thrusting was mainly due to intercalation of pauses within the mounting trains. The change in the rhythm of pelvic thrusting was related to the failure of most mounts performed by castrated rabbits to stimulate lordosis in the female. Testosterone propionate (TP, 10 mg daily for 15 days) restored mounting activity and increased strength and frequency of pelvic thrusting in all rabbits. It is concluded that TP, besides stimulating sexual motivation, regulates the vigor and rhythm of pelvic movements during copulation in the rabbit.     

盆底肌肉康复训练联合盆底重建术对女性盆底功能障碍性疾病患者炎症反应及应激反应的影响

目的:观察盆底肌肉康复训练联合盆底重建术治疗女性盆底功能障碍性疾病(PFD)的疗效及对炎症反应及应激反应的影响。方法:选择2019年1月~2021年1月期间我院收治的PFD患者200例,按乱数表法分为对照组(100例)和研究组(100例)。对照组患者接受盆底重建术治疗,研究组患者接受盆底肌肉康复训练联合盆底重建术治疗。观察两组治疗后的疗效及术后并发症发生情况,对比两组相关量表评分、炎症反应及应激反应指标。结果:研究组治疗后盆底功能影响问卷简表(PFIQ-7)、盆底不适调查表简表(PFDI-20)评分低于对照组(P<0.05)。研究组治疗后盆底Ⅰ类肌纤维肌电压、盆底Ⅱ类肌纤维肌电压高于对照组(P<0.05)。研究组治疗后白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)低于对照组(P<0.05)。研究组治疗后皮质醇(COR)、去甲肾上腺素(NE)、前列腺素E2(PGE2)低于对照组(P<0.05)。研究组术后并发症发生率低于对照组(P<0.05)。结论:盆底肌肉康复训练联合盆底重建术治疗PFD,可促进盆底功能恢复,减轻机体炎症反应及应激反应,降低术后并发症发生率。