简介：ItiswellknownthatsplinesmoothingestimatorrelatestotheBayesianestimateunderpartiallyinformativenormalprior.Inthispaper,wederivetheconditionsfortheproprietyoftheposteriorinthenonparametricmixedefectsmodelunderthisclassofpartiallyinformativenormalpriorforfxedefectwithinversegammapriorsonthevariancecomponentsandhierarchicalpriorsforcovariancematrixofrandomefect,thenweexploretheGibbssamplingprocedure.

简介：Traumatichematomaofposteriorfossa(THPF)isaspecialkindofcraniocerebralinjurywithitsowncharacteristicsinclinicalmanifestations,diagnosisandtreatment.Ingeneral,theprognosisofTHPFispoor.Withoutearlydiagnosisandprompttreatment,theoutcomewouldbeverypoor,withhighoccurrenceofmorbidityandmortality.Sincetheavailabilityofcomputedtomography(CT)in1983,wehavereceivedandsuccessfullytreated44patientswithTHPFuntilNovember2000.

简介：AIM:Toinvestigatetheeffectsofanewopeningpatterninneodymium:yttrium-aluminum-garnet(Nd:YAG)laserposteriorcapsulotomyonvisualfunction.METHODS:Thistechniquewasconductedalongacircularpattern.Theenergyrangedbetween0.8and1.2mJ/pulsewasconsumedandmeantotalenergylevelswere74±21mJ(mean±standarddeviation:SD,from40to167)andlasershotsaimedat150μmawaybehindadatumpointandwentalonganimaginarylinewhichextends0.5mminsidefromopticmarginandintothecircularenblocpattern.Vitreousstandswereattachedwithfragmentandthentheywerecutoffbythelaseraftercircularapplication.Thecircularfragmentwascompletelyseparatedfromvitreous,andthenthisfragmentwasquicklysunkinintravitrealspace.RESULTS:Thefollow-upperiodrangesfromatleastaweekto40mo,making15.8moonaverage.Theproceduraloutcomeshowed96%(74eyesoutofthe77eyes)enhancementinpatients’visualacuity.Cystoidmacularedemaorretinaldetachmentwasnotobservedinanyofthepatientsduringfollow-upperiods.CONCLUSION:Thisnewtechniqueisexpectedtoimprovetheweaknessesthattheconventionalprocedureshavebyaddingtheprocesstocutoffvitreousstandsattachedwiththefragmentbythelasertothecircularapplication.

简介：作者报导了支撑了臀部的无法缩减的postero侧面的创伤的脱臼与的一个27岁的人的案例胶囊并且labral陷阱。起始的X光显示出仅仅小acetabular碎片。在在一般麻醉下面与肌肉麻痹减少臀部的二次尝试失败了以后，病人被立即的开的减小通过一条postero侧面的途径对待。臀部的外科的探索表明小osteochondral碎片属于上唇和囊的一大片，堵塞髋臼。大腿骨的头与扭扣孔效果在撕的囊上交叉。这些元素被减轻，骨头碎片与2公里螺丝钉被修理，囊被修理。在10年的后续，功能的结果与100个点的一个哈里斯分数和坏死或骨关节炎的没有迹象是优秀的。作者建议这不平常的损害的文学评论。

简介：与ipsilateral联系的臀部的创伤的以后的脱臼代替了大腿骨的颈骨折是稀罕损害。而且，如此的病人的管理唤起考虑主要代替或保存大腿骨的头的强壮的看法。我们与如此的损害介绍了年轻成年人的一个盒子。他被操作在之上与大腿骨的颈的脱臼和固定的减小，在cancellous的帮助下的骨折拧紧。二年以后，破裂联合起来，病人是无征状的。我们进一步为如此的破裂建议了损害的机制并且在发展中的世界的变化损伤情形讨论了管理。

简介：AbstractPurpose:Combined anterior and posterior ring (APR) fixation is classically performed in Tile B2 and C1 injuries to achieve superior biomechanical stability. However, the posterior ring (PR) is the main weight bearing portion that is responsible for weight transmission from the upper parts of the body to the lower limbs through the sacrum and the linea terminalis. It is hypothesized that isolated PR fixation can achieve comparable radiological and clinical outcomes to APR fixation. Therefore, we conducted this study to compare the two fixation principles in managing Tile B2 and C1 injuries.Methods:Our study included 20 patients with Tile B2 injuries and 20 patients with Tile C1 injuries. This study was a randomized control single-blinded study via computerized random numbers with a 1:1 allocation by using random block method. The study was performed at a level one trauma center. A total of 40 patients with Tile B2 and C1 injuries underwent combined APR or isolated PR fixation (Group A and B, respectively). Matta & Tornetta radiological principles and Majeed pelvic scoring system were used for the assessment of primary outcomes and postoperative complications. Secondary outcomes included operative time, amount of blood loss, intraoperative assessment of reduction, need of another operation, length of hospital stay, ability to weight bear postoperatively and pain control metrics. We used student t-test to compare the difference in means between two groups, and Chi-square test to compare proportions between two qualitative parameters. We set the confidence interval to 95% and the margin of error accepted to 5%. So, p ≤ 0.05 was considered statistically significant.Results:The mean follow-up duration was 18 months. The operative time (mean difference 0.575 h) and the intraoperative blood loss (mean difference 97.5 mL) were lower in Group B. Also, despite the higher frequency of rami displacement before union in the same group, there were no significant differences in terms of radiological outcome (excellent outcome with OR = 2.357), clinical outcome (excellent outcome with OR = 2.852) and postoperative complications assessment (OR = 1.556) at last follow-up.Conclusion:The authors concluded that isolated PR fixation could favorably manage Tile B2 and C1 pelvic ring injuries with Nakatani zone II pubic rami fractures and intact inguinal ligament. Its final radiological and clinical outcomes and postoperative complications were comparable to combined APR fixation, but with less morbidity (shorter operation time, lower amount of blood, and no records of postoperative wound infection).

简介：AbstractPurpose:To analyze the curative effect and technical points of a modified posteromedial approach in the treatment of Klammer III posterior Pilon fracture.Methods:A retrospective analysis of patients with Klammer III posterior Pilon fractures were conducted in our department from January 2018 to December 2019. Before the surgery, the patients were fully relieved of swelling and pain, and a comprehensive examination was carried out. The posteromedial approach exposed the posterior and medial fracture block of the distal tibia. According to the fracture of external malleolus, it is determined whether to combine a lateral incision and protect tendons and vascular nerves by a retractor, and then perform a fracture reduction and internal fixation. Postoperatively, the patients were treated with analgesia, detumescence, anticoagulation and rehabilitation exercise. The American orthopaedic foot and ankle society (AOFAS) score and visual analogue score were recorded at regular follow-up after surgery. A t-test was used for the comparison of the preoperative and final AOFAS score.Results:There were 7 male and 13 female (n = 20) included in the study, aged 22 to 88 years (average age 54.2 years). The injury mechanisms were falling from a height (n = 7), traffic accident (n = 6), walking injury (n = 2) and heavy injury (n = 5). The postoperative follow-up duration was 12—24 months (mean 16.95 months). The AOFAS score of the 20 patients before and after surgery were compared. The preoperative AOFAS score was 38.90 ± 3.91, and the final AOFAS score was 80.55 ± 4.20, (p < 0.001). The mean final visual analogue scores at rest, active and weight-bearing walking were 0.30, 0.85 and 1.70, respectively. One patient reported poor postoperative wound healing and required a return to hospital for debridement and anti-infection treatment.Conclusion:In the treatment of Klammer III posterior Pilon fractures, the modified posteromedial approach can fully expose the fracture block and the collapsed articular surface of the medial malleolus, achieve good reduction and internal fixation with limited injury of the tendon and vascular nerves, and have a better prognosis.

简介：AbstractObjective:To describe the procedure and results of an adapted closure and reconstruction technique for translabyrinthine surgery that focuses on identifying and managing potential pathways for CSF egress to the middle ear and Eustachian tube.Methods:Retrospective review of a cohort of translabyrinthine acoustic neuroma cases that were reconstructed using this technique.Results:In addition to meticulous packing of potential conduits using soft tissue, hydroxyapatite cement is used to seal opened air cell tracts prior to obliteration of the mastoid defect using adipose tissue. Early results of a small patient cohort using this technique are encouraging and there were no wound infections. There was a single case of CSF rhinorrhea associated with incomplete sealing of opened petrous apex cells, with no recurrence after appropriate implementation of the described protocol during revision surgery.Conclusion:Proactive management of potential conduits of CSF egress including opened air cell tracts has a high likelihood of reducing rates of rhinorrhea and need for revision surgery after the translabyrinthine approach to the posterior fossa.

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简介：AbstractPosterior placenta accreta spectrum (PAS) disorders are infrequent but potentially associated with significant maternal mortality and morbidity, especially if not diagnosed prenatally. Analysis of published literature is problematic since most experiences included only a few cases. Knowledge of the risk factors associated with posterior PAS is crucial to identifying mothers at higher risk and ask for high sensitivity studies. Ultrasound has poor diagnostic accuracy in detecting posterior PAS, while magnetic resonance imaging better delineates the posterior uterine wall. In comparison, prenatal imaging’s diagnostic performance in detecting posterior PAS is significantly lower than anterior placenta invasion. Management of posterior PAS depends on several factors, including maternal hemodynamic status, available resources, clinical presentation, and invasion severity. For accreta or increta cases, a compression suture is habitually enough to perform hemostasis. Nevertheless, organ involvement habitually requires a multidisciplinary team with the assistant of a general or coloproctology surgeon. The present article aims to update the risk factors, prenatal diagnosis, and surgical management of pregnancies complicated by posterior PAS.

简介：TheposteriorgutoftheDrosophilaembryo,consistingofhindgutandMalpighiantubules,providesasimple,well-definedsystemwhereitispossibletouseageneticapproachtodefinecomponentsessentialforepithelialmorphogenesis.WereviewheretheadvantagesofDrosophilaasamodelgeneticorganism,themorphogenesisoftheepithelialstructuresoftheposteriorgut,andwhatisknownaboutthegeneticrequirementstoformthesestructures.Inoverview,primordiaarepatternedbyexpressionofhierarchiesoftranscriptionfactors;thisleadstolocalizedexpressionofcellsignalingmolecules,andfinally,totheleastunderstoodstep:modulationofcelladhesionandcellshape.Wedescribeapproachestoidentifyadditionalgenesthatarerequiredformorphogenesisofthesesimpleepithelia,particularlythosethatmightplayastructuralrolebyaffectingcelladhesionandcellshape.

简介：AbstractBackground:The optimal surgical approach for four-level cervical spondylotic myelopathy remains controversial. The purpose of this study was to compare clinical and radiological outcomes and complications between the anterior and posterior approaches for four-level cervical spondylotic myelopathy.Methods:A total of 19 patients underwent anterior decompression and fusion and 25 patients underwent posterior laminoplasty and instrumentation in this study. Perioperative information, intraoperative blood loss, clinical and radiological outcomes, and complications were recorded. Japanese Orthopedic Association (JOA) score, 36-item short form survey (SF-36) score and cervical alignment were assessed.Results:There were no significant differences in JOA scores between the anterior and posterior group preoperatively (11.6 ± 1.6 vs. 12.1 ± 1.5), immediately postoperatively (14.4 ± 1.1 vs. 13.8 ± 1.3), or at the last follow-up (14.6 ± 1.0 vs. 14.2 ± 1.1) (P > 0.05). The JOA scores significantly improved immediately postoperatively and at the last follow-up in both groups compared with their preoperative values. The recovery rate was significantly higher in the anterior group both immediately postoperatively and at the last follow-up. The SF-36 score was significantly higher in the anterior group at the last follow-up compared with the preoperative value (69.4 vs. 61.7). Imaging revealed that there was no significant difference in the Cobb angle at C2-C7 between the two groups preoperatively (-2.0° ± 7.3° vs. -1.4° ± 7.5°). The Cobb angle significantly improved immediately postoperatively (12.3° ± 4.2° vs. 9.2° ± 3.6°) and at the last follow-up (12.4° ± 3.5° vs. 9.0° ± 2.6°) in both groups compared with their preoperative values (P = 0.00). Three patients had temporary dysphagia in the anterior group and four patients had persistent axial symptoms in the posterior group.Conclusions:Both the anterior and posterior approaches were effective in treating four-level cervical spondylotic myelopathy in terms of neurological clinical outcomes and radiological features. However, the JOA score recovery rate and SF-36 score in the anterior group were significantly higher. Persistent axial pain could be a major concern when undertaking the posterior approach.

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简介：AbstractPurpose:Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm.Methods:Both PubMed and Scopus Databases were systematically searched for the terms "posterior shoulder fracture-dislocation" or "posterior glenohumeral fracture-dislocation" or "posterior glenoid fracture-dislocation" for articles written in English and published in the last decade.Results:A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively.Conclusion:The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.

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简介：选择腰椎间盘突出症后凸型患者96例，随机分为观察组50例和对照组46例，观察组采用针剌牵引推拿综合治疗，对照组仅用针刺治疗，对患者治疗后进行疗效评定。治疗组和对照组治疗后的疗效有显著差异(P<0．05)。综合治疗腰椎间盘突出症后凸型疗效确切，方法简便，具有一定的临床指导意义。

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简介：AIM:Tocomparetheanteriorandposteriorcornealparametersbeforeandaftercollagencross-linkingtherapyforkeratoconus.METHODS:Collagencross-linkingwasperformedin31eyesof31keratoconuspatients(meanage30.6±8.9y).Priortotreatmentandanaverage7moaftertherapy,ScheimpfluganalysiswasperformedusingPentacamHR.Inadditiontocornealthicknessassessments,cornealradius,elevation,andaberrometricmeasurementswereperformedbothonanteriorandposteriorcornealsurfaces.Dataobtainedbeforeandaftersurgerywerestatisticallyanalyzed.RESULTS:Intermsofhorizontalandverticalcornealradius,andcentralcornealthicknessnodeviationswereobservedanaverage7moafteroperation.Cornealhigherorderaberrationshowednodifferenceneitheronanteriornoronposteriorcornealsurfaces.Duringfollow-upperiod,nosignificantdeviationwasdetectedregardingelevationvaluesobtainedbymeasurementinmmunitsbetweenthe3.0-8.0mm-zones.CONCLUSION:Cornealstabilizationcouldbeobservedintermsofanteriorandposteriorcornealsurfaces,elevationandhigherorderaberrationvalues7moaftercollagencross-linkingtherapyforkeratoconus.

简介：客观：为了介绍posteromedial，从胫骨为以后的十字形的系带(打印机控制语言)的多骨的撕裂的减小和附件通过gastrocnemius的中间的头的中间的边阶来临。方法：通过posteromedial的起作用的减小和内部固定从1998年2月在我们的部门gastrocnemius走近到2000年3月的有PCL的胫骨的附件经历了的avulsed的十一个病人。皮切口被颠倒沿着gastrocnemius和以后的囊的中间的头的中间的边阶塑造L被把暴露中间的边阶和侧面的收回，避免腿弯部的神经与血管的结构的损坏。在那以后，以后的囊垂直地有点中间地被把到以后的intercondylarsulcus并且就在手指触诊放的以后的中间的胫骨的著名上。当时，PCL和它的胫骨的附件是容易温和的。在推迟的盒子中，打印机控制语言外设释放是必要的克服系带收回并且为最佳的减小并且多骨的愈合使破裂床清醒。最后，一或二个可被细菌破坏的螺丝钉被用来修理avulsed骨头片断和30°屈曲膝灰浆在创伤被关上以后，演员组固定定期被使用。评估包括了X光检查，以后下垂符号和以后的抽屉与相反地侧面的方面相比测试。因为伴随物损害，对低手足的功能的评价不是可得到的。结果：在PCL的胫骨的附件avulsed损害的修理使用的gastrocnemius的Theposteromedial途径能提供清楚的解剖暴露的利益，很少血损失(20ml平均)，对任何结构的分开或附件的没有需要。病人被跟随在上面为一般水准上的11个月(从6个月到2年)。它证明多骨的愈合在推迟的损害的情况下在新鲜损害和7-9星期的情况下在4-6星期以内被完成。六从8fresh盒子出现了完全否定以后下垂符号或以后的抽屉测试但是为1-2公里的2有的额外的松弛。在3个推迟的盒子中，为3-4公里的额外的松弛与thecontralateral膝相比被介绍。结论；gastrocnemius的pos

简介：AIMTo在一年后续上分析并且比较五个不同变量(1wk，1，3，6并且12mo)：线性测密度术珍视的前面的囊(交流)，和以后的囊(PC)区域测密度术值，交流和PC，和交流洞在femtosecond以后的区域减小比率帮助激光的奔流surgery.METHODSThis是未来的比较级学习。71个病人经历了femtosecond在2014年6月和2015年12月之间的单个眼睛上的帮助激光的奔流外科。5.0公里直径激光帮助了前面的capsulotomy在所有眼睛上被执行。在每外科以后的评估，交流opacificaction(ACO)和密度铺平的PCopacification(PCO)被OculusPentacam?HR使用区域和线性测密度术方法。数字图象与一个裂缝灯Topcon摄影照相机和IMAGEnet?被捕获5软件。数字图象上的交流洞区域用Sketchandcalc区域计算器被测量并且变换成减小比率levels.RESULTSUsing皮尔森关联系数(PCC)，我们没发现关联(r=-0.091，P=0.46)在在ACO的进化之间的第12个月评价，区域测密度术珍视，PCO区域测密度术珍视看作了独立变量。我们没发现关联，用PCC(r=-0.096，P=0.43)在ACO线性测密度术价值和PCO的进化之间，线性测密度术珍视在第12月访问，作为独立变量两个都工作。交流线性测密度术层次和交流区域测密度术层次继续从第六强烈成长到第12个月。交流空缺区域减小比率的价值的分析(1wk，1，3，6，12mo)揭示了连续考试的价值之间的统计上重要的差别，但是变化的大小减少了。在在六和12之间监视月的最后的时期，变化的大小是结果显示出的low.CONCLUSIONOur当capsulorhexis区域减小比率铺平时，ACO测密度术从第六珍视到第12个月的Scheimpflug的猛烈增加显示了可观的减少。我们没发现在ACO区域和PCO区域和线性测密度术价值之间的关联，在第12月考试，作为独立变量工作。