The formation of pantropical intercontinental disjunction(PID)in plants has generally been attributed to vicariance,boreotropical migration,and long-distance dispersal.However,this pattern has primarily been examined ...The formation of pantropical intercontinental disjunction(PID)in plants has generally been attributed to vicariance,boreotropical migration,and long-distance dispersal.However,this pattern has primarily been examined in herbs,shrubs,and trees,and less commonly studied in interlayer plant taxa.Here we examined evolutionary processes that resulted in the PID of a pantropical woody liana,Uncaria(Rubiaceae).We first constructed a comprehensive phylogeny by employing 73 plastid protein-coding sequences from 29 accessions of Uncaria(including 16 newly sequenced)from different continents.We then inferred divergence time,history and ecological niche evolution of this genus.Our results showed that Uncaria consisted of four well-supported clades that belonged to two geographically distinct lineages:the Asia-Oceania lineage and the Afro-Neotropical lineage.Biogeographic reconstruction showed this genus likely originated in Asia during the early Miocene(ca.19.03 Ma)and the Middle Miocene Climatic Optimum may have triggered the early diversification of Uncaria.Due to its recent origin and small seeds with long wings,wind or water-mediated long-distance dispersal may have contributed to the distribution of Uncaria in tropical Oceania(via stepping-stone dispersal)and tropical Africa and America(by transoceanic dispersal).Our findings also indicate that diversification of Uncaria was primarily driven by ecological niche divergence,particularly climatic factors.Our study emphasizes the dual role of climatic niche divergence and long-distance dispersal in shaping the PID of Uncaria,providing references for many other extant lineages with similar distributions.展开更多
Diastasis of the symphysis pubis is a rare postpartum complication. We report two cases of symphysis diastasis after dystocic delivery, in two patients who presented in the postpartum period with functional impotence,...Diastasis of the symphysis pubis is a rare postpartum complication. We report two cases of symphysis diastasis after dystocic delivery, in two patients who presented in the postpartum period with functional impotence, pubalgia and acute urine retention. A frontal radiograph of the pelvis confirmed the diagnosis, showing a symphyseal separation of 12 mm and 18 mm. In our case, management was mainly medical, with a favorable clinical outcome.展开更多
The present paper reviews advances in the study of two major intercontinental disjunct biogeographic patterns： （i） between Eurasian and western North American deserts with the Mediterranean climate （the Madrean- T...The present paper reviews advances in the study of two major intercontinental disjunct biogeographic patterns： （i） between Eurasian and western North American deserts with the Mediterranean climate （the Madrean- Tethyan disjunctions）; and （ii） between the temperate regions of North and South America （the amphitropical disjunctions）. Both disjunct patterns have multiple times of origin. The amphitropical disjunctions have largely resulted from long-distance dispersal, primarily from the Miocene to the Holocene, with available data indicating that most lineages dispersed from North to South America. Results of recent studies on the Mediterranean disjuncts between the deserts of Eurasia and western North America support the multiple modes of origin and are mostly consistent with hypotheses of long-distance dispersal and the North Atlantic migration. Axelrod＇s Madrean-Tethyan hypothesis, which implies vicariance between the two regions in the early Tertiary, has been favored by a few studies. The Beringian migration corridor for semiarid taxa is also supported in some cases.展开更多
Toxicodendron is a genus in the Rhus complex of Anacardiaceae with a disjunct distribution between eastern Asia and North America, extending to southeastern Asia and the neotropics. Nuclear （internal transcribed spac...Toxicodendron is a genus in the Rhus complex of Anacardiaceae with a disjunct distribution between eastern Asia and North America, extending to southeastern Asia and the neotropics. Nuclear （internal transcribed spacer, external transcribed spacer, and NIA-i3） and chloroplast （ndhF and trnL-F） sequences were used to construct phylogenetic relationships of Toxicodendron. Phylogenetic analysis of these data strongly support Toxieodendron as a monophyletic group distinct from other genera of the Rhus complex, and the phylogeny does not fully corroborate classification at the sectional level. Two temperate disjunct lineages were detected, one from section Toxicodendron and the other between the eastern North American Toxicodendron vernix and the eastern Asian Toxicodendron vernieifluum. Their divergence times were estimated to be 13.46 （7.95-19.42） and 7.53 （2.76-12.86） mya, respectively. The disjunction between section Griffithii （taxa from warm temperate to tropical Asia） and Toxieodendron striatum （from the neotropics） was supported and their divergence time was estimated to be 20.84 （11.1 6-30.52） mya in the early Miocene. Our biogeographic results and the paleontological data support the Bering land bridge as the most likely route to explain the temperate disjunctions, yet the tropical disjunction in Toxicodendron seems to be best explained by the North Atlantic land bridge hypothesis.展开更多
BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy.As it is a rare pathology(ranging fr...BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy.As it is a rare pathology(ranging from 1 in 300 to 1 in 30000 pregnancies),no gold standard treatment has been defined.CASE SUMMARY This study examines two cases,a 27-year-old woman(gravida 1,para 1)and a 32-year-old woman(gravida 2,para 2),who presented to the clinic after uneventful vaginal deliveries.A normal pregnancy with no complications was observed in both patients.Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion.Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended.Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations.The symptoms decreased after treatment.Posttreatment magnetic resonance imaging(MRI)in the first case showed a reduction in symphyseal separation with no signs of osteitis.Three years later the symptoms recurred;MRI examination showed no further symphyseal widening or signs of osteitis.A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery.In the second case,pain recurred when the patient conceived for the second time.This time no benefit following conservative treatment was observed.Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy,thus surgical treatment was chosen and internal pubic synthesis was performed.CONCLUSION Overall,surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.展开更多
The disjunct distribution of plants between eastern Asia(EA) and North America(NA) is one of the most well-known biogeographic patterns. However, the formation and historical process of this pattern have been long deb...The disjunct distribution of plants between eastern Asia(EA) and North America(NA) is one of the most well-known biogeographic patterns. However, the formation and historical process of this pattern have been long debated. Chamaecyparis is a good model to test previous hypotheses about the formation of this disjunct pattern as it contains six species disjunctly distributed in EA, western North America(WNA)and eastern North America(ENA). In this study, we applied ecological niche models to test the formation of the disjunct pattern of Chamaecyparis. The model calibrated with the EA species was able to predict the distribution of eastern NA species well, but not the western NA species. Furthermore, the eastern Asian species were shown to have higher niche overlap with the eastern North American species. The EA species were also shown to share more similar habitats with ENA species than with WNA species in the genus. Chamaecyparis species in WNA experienced a significant niche shift compared with congeneric species. Chamaecyparis had a low number of suitable regions in Europe and the middle and western NA during the Last Glacial Maximum(LGM) period, and became extinct in the former region whereas it retains residual distribution in the latter. The extirpations in western NA and Europe in response to the late Neogene and Quaternary climatic cooling and the more similar habitats between ENA and EA ultimately shaped the current intercontinental disjunct distribution of Chamaecyparis. Both current hypotheses may be also jointly applied to explain more eastern Asian and eastern North American disjunctions observed today.展开更多
The genus Thuja is ideal for investigating the genetic basis of the East Asia-North America disjunction.The biogeographical background of the genus is debatable and an adaptive strategy is lacking.Through the analysis...The genus Thuja is ideal for investigating the genetic basis of the East Asia-North America disjunction.The biogeographical background of the genus is debatable and an adaptive strategy is lacking.Through the analysis and mining of comparative transcriptomes,species differentiation and positively selected genes(PSGs)were identified to provide information for understanding the environmental adaptation strategies of the genus Thuja.De novo assembly yielded 44,397-74,252 unigenes of the five Thuja species with contig N50length ranging from 1,559 to 1,724 bp.Annotations revealed a similar distribution of functional categories among them.Based on the phylogenetic trees constructed using the transcriptome data,T.sutchuenensis was divided first,followed by T.plicata and T.occidentalis.The final differentiation of T.koraiensis and T.standishii formed a clade.Enrichment analysis indicated that the PSGs of the North American Thuja species were involved in plant hormone signal transduction and carbon fixation of photosynthetic organisms pathways.The PSGs of East Asian Thuja were related to phenolic,alkaloid,and terpenoid synthesis,important stress-resistant genes and could increase plant resistance to external environmental stresses.This study discovered numerous aroma synthetic-related PSGs including terpene synthase(TPS)genes and lipid phosphate phosphatase 2(LPP2),associated with the synthetic aroma of T.sutchuenensis.Physiological indicators,such as the contents of soluble sugars,total chlorophyll,total phenolics,and total flavonoids were determined,which are consistent with the PSGs enrichment pathways associated with adaptive strategies in the five Thuja species.The results of this study provide an important basis for future studies on conservation genetics.展开更多
The research proposes a surgical technique for patients with chronic pubic symphysis diastasis and bladder herniation by means of a pelvic reconstruction technique. Three patients were treated initially in other hospi...The research proposes a surgical technique for patients with chronic pubic symphysis diastasis and bladder herniation by means of a pelvic reconstruction technique. Three patients were treated initially in other hospitals and referred to us. All presented with pubic symphysis diastasis greater than 7 cm and bladder herniation. Two patients were initially treated with external fixation, and in one patient, the symphysis diastasis had been completely neglected. All cases presented good evolution with the proposed technique, which is described in details in the paper.展开更多
Background: Pubic symphysis diastasis (PSD) is an uncommon complication of labor and delivery. Common risk factors of PSD include precipitous labor, rapid second stage of labor, intense uterine contractions, prior pel...Background: Pubic symphysis diastasis (PSD) is an uncommon complication of labor and delivery. Common risk factors of PSD include precipitous labor, rapid second stage of labor, intense uterine contractions, prior pelvic pathology, multiparity and macrosomia. Diagnosis is made clinically and confirmed by imaging. Management of PSD depends on the severity of symptoms and degree of symphysis separation. Standard therapy is conservative, but surgery may be needed in severe cases. Case Report: A 25-year-old female at term pregnancy presented in active labor and had a rapid second stage of labor without intravenous oxytocin or an epidural. She was subsequently diagnosed with severe PSD with a 5.5 cm separation. Her management included a pelvic binder, pain management, physical therapy, and serial imaging to monitor improvement. Discussion: In severe cases, surgery can be avoided in favor of conservative measures for the management of PSD. Multidisciplinary involvement with orthopedic surgery, radiology, physical therapy, and anesthesiology can play a vital role in optimal management. PSD may recur in future deliveries, but this does not preclude vaginal birth.展开更多
Symphyseal dissection results from high-energy trauma and usually occurs in poly trauma context. The treatment is only orthopedic in our department. The aim of this work was to study the current therapeutic aspects ma...Symphyseal dissection results from high-energy trauma and usually occurs in poly trauma context. The treatment is only orthopedic in our department. The aim of this work was to study the current therapeutic aspects management of the disjunction of the pubic symphysis in the department of ortho-traumatology of CHU Gabriel Touré of Bamako MALI. This was a prospective and analytical study;from 1 July 2021 to 30 June 2022, within 15 patients classified according to Young and Burgess, with a functional evaluation according to Majeed and a minimum follow-up of 4 months. We report symphyseal disconnections accounted for 20.83% of the traumas of the pelvic ring, and 1.84% of patients hospitalized for fracture in the department during the period of the study. We noted a predominance of gender male in 87% of cases with a ratio of 2.75 and the average age in our series was 32 years, with extremes ranging from 18 to 63 and a SD of 13.96. The most common etiologies are APR with 66.7% and traditional mine slide cases with 20%, and the anteroposterior compression mechanism is most frequently encountered at 73.3%. The APCI types: 20%, APCII: 40% and VC: 20% of the Young and Burgess classification are the most found. The treatment of these patients was surgical in 53% cases by locked screw plate. The surgical approach of Pfannenstiel was preferred to the ilio-inguinal of Judet. Non-surgical treatment by trans-osseous traction and the wearing of a pelvic belt was recommended for cases of stable disjunction or severe associated lesions. The average length of stay is 17.27 days with extremes of 5 and 34 days. The functional assessment according to Majeed allowed us to classify 73.3% of patients’ cases as excellent, showing a good socio-professional reintegration. Symphyseal disjunction is a rare pathology but of serious functional consequences, regardless of the therapeutic method good management allows to minimize these functional sequelae.展开更多
After experiencing racism in Canada, where multiculturalism emphasized ethnic differences and fixed identities rather than allowing for cultural interaction and hybridity, the author, B. Mukherjee, moves to the USA wh...After experiencing racism in Canada, where multiculturalism emphasized ethnic differences and fixed identities rather than allowing for cultural interaction and hybridity, the author, B. Mukherjee, moves to the USA whose biculturalism favors cultural interactions and fluid identities. Here she experiences the transformative powers of cultural interactions and frees herself and her work from the static power of cultural disjunction. Her personal experience highlights the need of immigrant characters to connect to the mainstream and not to be isolated from it The paper explores the problem of cultural adaptability and integration as experienced by Dimple, the main character in Mukherjee＇s novel Wife （1975）. Based upon contemporary research on cultural and social identity formation, the paper analyses Dimple＇s inner struggle of identity in the context of her immigrant status, and it relates her ultimately tragic response to loneliness and alienation resulting in cultural disjunction, non-adaptability, and non-assimilation.展开更多
基金funded equally by grants from the National Natural Science Foundation of China(32322006 and 32100187)the Second Tibetan Plateau Scientific Expedition and Research(STEP)program(2024QZKK0200)+5 种基金by the Key Projects of the Joint Fund of the National Natural Science Foundation of China(U23A20149)the Key R&D Program of Yunnan Province(202103AF140005 and 202101BC070002)the Yunnan Provincial Science and Technology Talent and Platform Plan(202305AM070005)the Key Specialized Research and Development Breakthrough Program in Henan Province(232102110237)the Natural Science Foundation of Henan Province(242300421572)the Strategic Biological Resources Capacity Building Project of Chinese Academy of Sciences(KFJ-BRP-017-08).
文摘The formation of pantropical intercontinental disjunction(PID)in plants has generally been attributed to vicariance,boreotropical migration,and long-distance dispersal.However,this pattern has primarily been examined in herbs,shrubs,and trees,and less commonly studied in interlayer plant taxa.Here we examined evolutionary processes that resulted in the PID of a pantropical woody liana,Uncaria(Rubiaceae).We first constructed a comprehensive phylogeny by employing 73 plastid protein-coding sequences from 29 accessions of Uncaria(including 16 newly sequenced)from different continents.We then inferred divergence time,history and ecological niche evolution of this genus.Our results showed that Uncaria consisted of four well-supported clades that belonged to two geographically distinct lineages:the Asia-Oceania lineage and the Afro-Neotropical lineage.Biogeographic reconstruction showed this genus likely originated in Asia during the early Miocene(ca.19.03 Ma)and the Middle Miocene Climatic Optimum may have triggered the early diversification of Uncaria.Due to its recent origin and small seeds with long wings,wind or water-mediated long-distance dispersal may have contributed to the distribution of Uncaria in tropical Oceania(via stepping-stone dispersal)and tropical Africa and America(by transoceanic dispersal).Our findings also indicate that diversification of Uncaria was primarily driven by ecological niche divergence,particularly climatic factors.Our study emphasizes the dual role of climatic niche divergence and long-distance dispersal in shaping the PID of Uncaria,providing references for many other extant lineages with similar distributions.
文摘Diastasis of the symphysis pubis is a rare postpartum complication. We report two cases of symphysis diastasis after dystocic delivery, in two patients who presented in the postpartum period with functional impotence, pubalgia and acute urine retention. A frontal radiograph of the pelvis confirmed the diagnosis, showing a symphyseal separation of 12 mm and 18 mm. In our case, management was mainly medical, with a favorable clinical outcome.
基金supported,in part,by grants from the National Science Foundation (DEB 045573 to Michael DILLON and Jun WENand DEB 0743474 to Steve MANCHESTER and Jun WEN)support for S. ICKERT-BOND from the National Museum of Natural History,the Smithsonian Institution
文摘The present paper reviews advances in the study of two major intercontinental disjunct biogeographic patterns： （i） between Eurasian and western North American deserts with the Mediterranean climate （the Madrean- Tethyan disjunctions）; and （ii） between the temperate regions of North and South America （the amphitropical disjunctions）. Both disjunct patterns have multiple times of origin. The amphitropical disjunctions have largely resulted from long-distance dispersal, primarily from the Miocene to the Holocene, with available data indicating that most lineages dispersed from North to South America. Results of recent studies on the Mediterranean disjuncts between the deserts of Eurasia and western North America support the multiple modes of origin and are mostly consistent with hypotheses of long-distance dispersal and the North Atlantic migration. Axelrod＇s Madrean-Tethyan hypothesis, which implies vicariance between the two regions in the early Tertiary, has been favored by a few studies. The Beringian migration corridor for semiarid taxa is also supported in some cases.
基金supported bygrants from the National Basic Research Program of China (973 Program,grant no. 2007CB411601)the National Natural Science Foundation of China (grant nos.30625004 and 40771073 to H. Sun)+2 种基金the Yunnan Natural Science Foundation (grant no. 2008CC013)the John D. and Catherine T. MacArthur Foundation (to J.Wen)supported by the Laboratory of Analytical Biology of the National Museum of Natural History,Smithsonian Institution,Washington DC,USA
文摘Toxicodendron is a genus in the Rhus complex of Anacardiaceae with a disjunct distribution between eastern Asia and North America, extending to southeastern Asia and the neotropics. Nuclear （internal transcribed spacer, external transcribed spacer, and NIA-i3） and chloroplast （ndhF and trnL-F） sequences were used to construct phylogenetic relationships of Toxicodendron. Phylogenetic analysis of these data strongly support Toxieodendron as a monophyletic group distinct from other genera of the Rhus complex, and the phylogeny does not fully corroborate classification at the sectional level. Two temperate disjunct lineages were detected, one from section Toxicodendron and the other between the eastern North American Toxicodendron vernix and the eastern Asian Toxicodendron vernieifluum. Their divergence times were estimated to be 13.46 （7.95-19.42） and 7.53 （2.76-12.86） mya, respectively. The disjunction between section Griffithii （taxa from warm temperate to tropical Asia） and Toxieodendron striatum （from the neotropics） was supported and their divergence time was estimated to be 20.84 （11.1 6-30.52） mya in the early Miocene. Our biogeographic results and the paleontological data support the Bering land bridge as the most likely route to explain the temperate disjunctions, yet the tropical disjunction in Toxicodendron seems to be best explained by the North Atlantic land bridge hypothesis.
文摘BACKGROUND Widening of the pubic joint of more than 10 mm is diagnostic and defined as pubic symphysis diastasis and is considered a complication of vaginal childbirth or pregnancy.As it is a rare pathology(ranging from 1 in 300 to 1 in 30000 pregnancies),no gold standard treatment has been defined.CASE SUMMARY This study examines two cases,a 27-year-old woman(gravida 1,para 1)and a 32-year-old woman(gravida 2,para 2),who presented to the clinic after uneventful vaginal deliveries.A normal pregnancy with no complications was observed in both patients.Severe pain in the pubic region occurred after labour and was accompanied by complicated locomotion.Pubic symphysis diastasis was confirmed radiologically and bed rest with lateral decubitus positioning was recommended.Oral non-steroidal antiinflammatory drugs were administered to relieve pain exacerbations.The symptoms decreased after treatment.Posttreatment magnetic resonance imaging(MRI)in the first case showed a reduction in symphyseal separation with no signs of osteitis.Three years later the symptoms recurred;MRI examination showed no further symphyseal widening or signs of osteitis.A relapse of symphyseal separation was diagnosed and conservative treatment was re-administered resulting in successful recovery.In the second case,pain recurred when the patient conceived for the second time.This time no benefit following conservative treatment was observed.Persistent pain and complicated locomotion led to scoliotic deformation of the lumbar part of the spine and leg length discrepancy,thus surgical treatment was chosen and internal pubic synthesis was performed.CONCLUSION Overall,surgical treatment resulting from insufficient conservative treatment showed a high risk of postoperative complications following the treatment of postpartum pubic symphysis diastasis.
基金funded by grants from the Ministry of Science and Technology of China, Basic Research Project(No. 2013FY112600)the Talent Project of Yunnan Province(No. 2011CI042)
文摘The disjunct distribution of plants between eastern Asia(EA) and North America(NA) is one of the most well-known biogeographic patterns. However, the formation and historical process of this pattern have been long debated. Chamaecyparis is a good model to test previous hypotheses about the formation of this disjunct pattern as it contains six species disjunctly distributed in EA, western North America(WNA)and eastern North America(ENA). In this study, we applied ecological niche models to test the formation of the disjunct pattern of Chamaecyparis. The model calibrated with the EA species was able to predict the distribution of eastern NA species well, but not the western NA species. Furthermore, the eastern Asian species were shown to have higher niche overlap with the eastern North American species. The EA species were also shown to share more similar habitats with ENA species than with WNA species in the genus. Chamaecyparis species in WNA experienced a significant niche shift compared with congeneric species. Chamaecyparis had a low number of suitable regions in Europe and the middle and western NA during the Last Glacial Maximum(LGM) period, and became extinct in the former region whereas it retains residual distribution in the latter. The extirpations in western NA and Europe in response to the late Neogene and Quaternary climatic cooling and the more similar habitats between ENA and EA ultimately shaped the current intercontinental disjunct distribution of Chamaecyparis. Both current hypotheses may be also jointly applied to explain more eastern Asian and eastern North American disjunctions observed today.
基金supported by the National Natural Science Foundation of China(31870664)the 948 Program of National Forestry and Grassland Administration(2013-4-47)the National Key Research and Development Program of China(2022YFD2200103)。
文摘The genus Thuja is ideal for investigating the genetic basis of the East Asia-North America disjunction.The biogeographical background of the genus is debatable and an adaptive strategy is lacking.Through the analysis and mining of comparative transcriptomes,species differentiation and positively selected genes(PSGs)were identified to provide information for understanding the environmental adaptation strategies of the genus Thuja.De novo assembly yielded 44,397-74,252 unigenes of the five Thuja species with contig N50length ranging from 1,559 to 1,724 bp.Annotations revealed a similar distribution of functional categories among them.Based on the phylogenetic trees constructed using the transcriptome data,T.sutchuenensis was divided first,followed by T.plicata and T.occidentalis.The final differentiation of T.koraiensis and T.standishii formed a clade.Enrichment analysis indicated that the PSGs of the North American Thuja species were involved in plant hormone signal transduction and carbon fixation of photosynthetic organisms pathways.The PSGs of East Asian Thuja were related to phenolic,alkaloid,and terpenoid synthesis,important stress-resistant genes and could increase plant resistance to external environmental stresses.This study discovered numerous aroma synthetic-related PSGs including terpene synthase(TPS)genes and lipid phosphate phosphatase 2(LPP2),associated with the synthetic aroma of T.sutchuenensis.Physiological indicators,such as the contents of soluble sugars,total chlorophyll,total phenolics,and total flavonoids were determined,which are consistent with the PSGs enrichment pathways associated with adaptive strategies in the five Thuja species.The results of this study provide an important basis for future studies on conservation genetics.
文摘The research proposes a surgical technique for patients with chronic pubic symphysis diastasis and bladder herniation by means of a pelvic reconstruction technique. Three patients were treated initially in other hospitals and referred to us. All presented with pubic symphysis diastasis greater than 7 cm and bladder herniation. Two patients were initially treated with external fixation, and in one patient, the symphysis diastasis had been completely neglected. All cases presented good evolution with the proposed technique, which is described in details in the paper.
文摘Background: Pubic symphysis diastasis (PSD) is an uncommon complication of labor and delivery. Common risk factors of PSD include precipitous labor, rapid second stage of labor, intense uterine contractions, prior pelvic pathology, multiparity and macrosomia. Diagnosis is made clinically and confirmed by imaging. Management of PSD depends on the severity of symptoms and degree of symphysis separation. Standard therapy is conservative, but surgery may be needed in severe cases. Case Report: A 25-year-old female at term pregnancy presented in active labor and had a rapid second stage of labor without intravenous oxytocin or an epidural. She was subsequently diagnosed with severe PSD with a 5.5 cm separation. Her management included a pelvic binder, pain management, physical therapy, and serial imaging to monitor improvement. Discussion: In severe cases, surgery can be avoided in favor of conservative measures for the management of PSD. Multidisciplinary involvement with orthopedic surgery, radiology, physical therapy, and anesthesiology can play a vital role in optimal management. PSD may recur in future deliveries, but this does not preclude vaginal birth.
文摘Symphyseal dissection results from high-energy trauma and usually occurs in poly trauma context. The treatment is only orthopedic in our department. The aim of this work was to study the current therapeutic aspects management of the disjunction of the pubic symphysis in the department of ortho-traumatology of CHU Gabriel Touré of Bamako MALI. This was a prospective and analytical study;from 1 July 2021 to 30 June 2022, within 15 patients classified according to Young and Burgess, with a functional evaluation according to Majeed and a minimum follow-up of 4 months. We report symphyseal disconnections accounted for 20.83% of the traumas of the pelvic ring, and 1.84% of patients hospitalized for fracture in the department during the period of the study. We noted a predominance of gender male in 87% of cases with a ratio of 2.75 and the average age in our series was 32 years, with extremes ranging from 18 to 63 and a SD of 13.96. The most common etiologies are APR with 66.7% and traditional mine slide cases with 20%, and the anteroposterior compression mechanism is most frequently encountered at 73.3%. The APCI types: 20%, APCII: 40% and VC: 20% of the Young and Burgess classification are the most found. The treatment of these patients was surgical in 53% cases by locked screw plate. The surgical approach of Pfannenstiel was preferred to the ilio-inguinal of Judet. Non-surgical treatment by trans-osseous traction and the wearing of a pelvic belt was recommended for cases of stable disjunction or severe associated lesions. The average length of stay is 17.27 days with extremes of 5 and 34 days. The functional assessment according to Majeed allowed us to classify 73.3% of patients’ cases as excellent, showing a good socio-professional reintegration. Symphyseal disjunction is a rare pathology but of serious functional consequences, regardless of the therapeutic method good management allows to minimize these functional sequelae.
文摘After experiencing racism in Canada, where multiculturalism emphasized ethnic differences and fixed identities rather than allowing for cultural interaction and hybridity, the author, B. Mukherjee, moves to the USA whose biculturalism favors cultural interactions and fluid identities. Here she experiences the transformative powers of cultural interactions and frees herself and her work from the static power of cultural disjunction. Her personal experience highlights the need of immigrant characters to connect to the mainstream and not to be isolated from it The paper explores the problem of cultural adaptability and integration as experienced by Dimple, the main character in Mukherjee＇s novel Wife （1975）. Based upon contemporary research on cultural and social identity formation, the paper analyses Dimple＇s inner struggle of identity in the context of her immigrant status, and it relates her ultimately tragic response to loneliness and alienation resulting in cultural disjunction, non-adaptability, and non-assimilation.
