A cross-correlation of WMAP and ROSAT

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Almgren and Chriss(VWAP)

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桡骨远端骨折文献2

Open reduction and internal ﬁxation compared to closed reduction and external ﬁxation in distal radial fracturesA randomized study of 50 patientsAntonio Abramo 1, Philippe Kopylov 1, Mats Geijer 2, and Magnus Tägil 11Hand Unit, Department of Orthopedics, Clinical Sciences, Lund University; 2Department of Radiology, Lund University Hospital, SwedenCorrespondence: tony.abramo@med.lu.seSubmitted 08-04-22. Accepted 09-02-22Open Access - This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the source is credited.DOI 10.3109/17453670903171875Background and purpose In unstable distal radial fractures thatare impossible to reduce or to maintain in reduced position, thetreatment of choice is operation. The type of operation and thechoice of implant, however, is a matter of discussion. Our aim wasto investigate whether open reduction and internal ﬁxation wouldproduce a better result than traditional external ﬁxation.Methods 50 patients with an unstab le or comminute distalradius fracture were randomized to either closed reduction andb ridging external ﬁxation, or open reduction and internal ﬁxa-tion using the TriMed system. The primary outcome parameterwas grip strength, but the patients were followed for 1 year withob jective clinical assessment, sub jective outcome using DASH,and radiographic examination.Results At 1 year postoperatively, grip strength was 90% (SD16) of the uninjured side in the internal ﬁxation group and 78%(17) in the external ﬁxation group. Pronation/supination was 150°(15) in the internal ﬁxation group and 136° (20) in the externalﬁxation group at 1 year. There were no differences in DASHscores or in radiographic parameters. 5 patients in the externalﬁxation group were reoperated due to malunion, as compared to1 in the internal ﬁxation group. 7 other cases were classiﬁed asradiographic malunion: 5 in the external ﬁxation group and 2 inthe internal ﬁxation group.Interpretation Internal ﬁxation gave b etter grip strengthand a better range of motion at 1 year, and tended to have lessmalunions than external ﬁxation. No difference could be foundregarding subjective outcome.N Distal radial fractures account for about one-sixth of the frac-tures seen in the emergency room, with an annual incidenceof 26 per 10,000 inhabitants in Sweden (Brogren et al. 2007).Non-operative treatment using plaster cast is chosen in non-displaced fractures and in displaced, but reducible fractures (Handoll and Madhok 2003a). The subject of our study is: fractures that are primarily impossible to reduce or impossible to retain in an acceptable position. These fractures are often considered necessary to operate. The type of operation and the choice of implant is still, however, a matter of discussion; a Cochran report has stated that “randomized trials do not provide robust evidence for most of the decisions necessary in the management of these fractures” (Handoll and Madhok 2003b).At our department, 2 types of surgical interventions have been used over the last decade for the treatment of distal radius fractures. The TriMed fragment-speciﬁc system (Schnall et al. 2006), is used preferably in younger patients whereas external ﬁxation has been used more in older patients, but is still an acceptable option in all age groups. The present randomized study was conducted to compare closed reduction combined with external ﬁxation—which has been or still is the standard operation in many hospitals—to the more complex and more technically demanding open reduction and internal ﬁxation. Our aim was to determine whether a more accurate reduction could be achieved and retained during healing, and whether the outcome—both objective and subjective—could be improved by internal fragment-speciﬁc ﬁxation methods, compared to external ﬁxation. The study allowed the best possible opera-tion performed either openly or closed—thus allowing for additional pins, bone substitute, or graft if deemed necessary. As primary outcome, we chose grip strength at 7 weeks and 12 months postoperatively and as secondary outcome we chosethe DASH score at the same 2 time points.Patients and methods Patients At our department, all patients with a distal radial fracture areyears old were considered to be less osteoporotic. The aim was to recruit at least 24 patients (4 blocks) in each age group and the sealed envelopes were opened on the day of surgery, immediately before the operation. Randomization would stop when 4 blocks (24 patients) in each group had been random-ized. 26 patients were randomized to the O treatment and 24 to the C treament. Evaluation All patients were followed for 1 year with visits at 2, 5, and 7 weeks and 3, 6, and 12 months postoperatively. The grip strength at 7 weeks and at 12 months was chosen as the pri-mary outcome and the DASH score at the same time points was chosen as the secondary outcome. Reoperations for either a malunion or a redislocation of the fracture were considered to be endpoints and patients were excluded thereafter. Com-plications were registered by a hand surgeon at each visit. Complications were divided into (1) major complications, deﬁned as those that were expected to have an effect on the ﬁnal outcome, (2) moderate complications, deﬁned as those that were not expected to have an effect on the ﬁnal outcome but would need further interventions, and (3) minor compli-cations, deﬁned as temporary and self-healing. Grip strength (JAMAR), range of motion (goniometer), and sensibility in all ﬁngers (Weber 2PD) were recorded by a physiotherapist at all visits. Lateral and AP radiographs were taken at injury, directly postoperatively, at 2 and 5 weeks, and at 3, 6, and 12 months postoperatively. All radiographs were classiﬁed by a radiologist (MG) according to the Frykman and AO classiﬁ-cations. The radiographic result after healing was evaluated according to the same criteria as used for the deﬁnition of the primary instability (Table 1). Subjective outcome was evalu-ated using the DASH score, which is a self-administered ques-tionnaire developed by the AAOS and the Institute for Work and Health in Canada (Hudak et al. 1996). The questionnaire consists of 30 questions evaluating physical activities, severity of symptoms, and the effect of the injury on social activities. A score is calculated and converted to a scale from 0 to 100 with a score of 100 expressing the largest degree of disability. A Swedish version was used, which has been validated for gen-eral use in upper extremity disorders (Atroshi et al. 2000). At inclusion, the patients were asked to ﬁll out the DASH ques-tionnaire relating to their pre-injury status and then again at 7 weeks, 3 months, and 1 year postoperatively. One patient in the O group moved to another part of the country and declined further visits after 7 weeks, when she was back to work and with full function. 1 patient in the O group failed to return the DASH form at 7 weeks, and another in the same group failed to return the form at 3 months. 1 patient in the O group failed to appear at the physical examination at 6 months. 2 patients in the C group failed to appear at the 12-month visit, but returned their completed DASH forms.treated according to a treatment protocol (Abramo et al. 2008).Non-displaced fractures are treated in a plaster cast for 4–5weeks. Displaced fractures are reduced and casted. If the frac-ture after reduction is unstable or even impossible to primarilyreduce (for deﬁnitions, see Table 1), surgical treatment is sug-gested to the patient. Patients with fractures in the AO groupsA1–3 and C1–3 were eligible for the study. These patientswere invited to participate in a randomized study comparingopen and closed treatment. The study was approved by thelocal ethics committee (no. Lu 45/02).Between May 2002 and December 2005, 50 patients (36women) with a mean age of 48 (20–65) years with unstablefractures fulﬁlled the inclusion criteria (Table 1). Most patientswith a distal radius fracture were older than 65 years and werenot eligible for the study. Patients with a redislocated frac-ture were also not eligible for the study. Thus, only youngerpatients with an unstable fracture who were in need of anacute operation were recruited, thus explaining the relativelylong recruitment time.The patients gave their written and informed consent, andwere included and randomized to either open reduction andinternal ﬁxation (O), or closed reduction and external ﬁxation(C). 38 patients considered themselves to be healthy, 5 hadcardiovascular diseases such as hypertension or atrial ﬁbrilla-tion, 1 had diabetes mellitus, 1 had epilepsy, 1 had hypothy-roidism, 1 had well-controlled depressive problems, and 3 hadasthma.RandomizationRandomization was prepared in blocks of 6 containing equalnumbers of C and O patients, and the patients were stratiﬁedinto 2 age groups. The older group was considered to be moreosteoporotic and consisted of men of 60 years of age andabove, and women of 50 years of age and above. The youngergroup of women less than 50 years old and men less than 60 Table 1. The inclusion and exclusion criteria for the studyOperative techniqueThe patients were operated by 1 of 4 senior hand surgeons.The participating surgeons agreed to aim for the best possiblestabilization in each patient with each technique, including theuse of additional K-wires, bone graft, or bone substitute. Thefragment-speciﬁc wrist ﬁxation system TriMed (Konrath andBahler 2002) was used for internal ﬁxation. The system con-sists of a combination of pins, plates, and screws (Figure 1).V olar ﬁxed-angle plates were not available at the start of thestudy and were not used.Open reduction and internal ﬁxation (O). Ordinarily, 2 inci-sions were made through the ﬁrst and fourth extensor com-ter active mobilization was started under the supervision of aphysiotherapist.Closed reducti on and external ﬁxati on (C). The externalﬁxator used for the ﬁrst 20 patients was the Hoffman type-1 bridging external ﬁxator (Stryker, Hopkinton, MA), whichwas changed to the Radio Lucent Wrist Fixator (OrthoﬁxSrl, Bussolengo, Italy) by the start of 2005 and used in thelast 4 patients. Pins were inserted into the second metacarpaland into the radius proximally to the fracture. Clamps wereattached to the pins and the fracture was reduced and ﬁxatedwith a steel rod between the clamps (Figure 2). In comminutedfractures with a bone defect and when additional stability wasdesired, K-wires were inserted percutaneously. A bone graftsubstitute (Norian SRS), also inserted percutaneously, wasused at the surgeons’ discretion (2 patients). The ﬁxator wasusually removed after 5–6 weeks and thereafter active mobili-zation was started under the supervision of a physiotherapist.There was no restriction regarding pronation or supinationduring the ﬁxation time in either of the groups.Statistics Based on the results of a previous study comparing external ﬁxation with closed treatment using a bone substitute (Kopylov et al. 1999), grip strength was chosen as the primary outcome and a power analysis was performed. 20 patients were needed in each group to show a 10% difference in grip strength with a power of 85% in a two-sided test at the 5% signiﬁcance level. Fisher’s exact test was used for categorized outcomes and Mann-Whitney U test for ordinal outcomes. Student’s t-test was used for continuous data such as radiographic measure-ments. Spearman correlation coefﬁcient was used to calculate correlations between objective and radiographic parameters. SPSS software version 14.0 was used. Bonferroni correction was used for repeated measures of objective parameters at 7 weeks and at 12 months of follow-up.Figure 1. AP and lateral radiographs in two cases of distal radial fracture operated with the TriMed system. A. This patient was operated using a radial pin-plate and a volar buttress pin. Additionalstability was achieved using Norian SRS bone substitute. B. In intraarticular fractures with an ulnar fragment, an ulnar pin-plate could be combined with the radial pin-plate.Figure 2. AP and lateral radiographs of a patient operated using closedreduction and external ﬁxation.partments. The fracture was reducedand 2 pins were introduced at the tipof the radial styloid, obliquely andin a proximal direction—leaving theradial cortex ulnarly and proximally.A stabilizing pin-plate was threadedonto the styloid pins and the platewas secured to the radial side of theradius by 3–5 screws. Through thedorsal incision, a buttress pin and/oran ulnar pin-plate was introducedfor dorsal stability. At the surgeon’sdiscretion, Norian SRS (Kopylov2001) (Synthes GmbH, Switzerland) was used in the void to add stabil-ity (2 patients). Postoperatively, the patients were treated with a forearmplaster cast for 2 weeks and thereaf-statistically signiﬁcant difference was still found between the O and C groups both regarding the primary outcome param-eter grip strength (90% and 78%, respectively) (p = 0.03) and also forearm rotation (149° and 136°, respectively) (p = 0.03). In both groups, range of movement in extension/ﬂexion was 121° and in radial/ulnar deviation it was 60°.Subjective outcome (Figure 3)The secondary outcome parameter, mean DASH score, was 3 (0–45) before the injury (Table 4) as reported by the patients. 41/48 had a score of 1 or less before injury. 3 patients had a pre-injury DASH score higher than 20, 2 of them due to CMC1 osteoarthritis, and 1 due to shoulder impingement. The results of the postoperative DASH questionnaires showed noROM in extension–flexion ROM in pronation–supination605040302010ROM in radial–ulnar deviation Grip strength (%)Results Age, sex, injured side, type of work, category of fracture, radiographic ﬁndings, and type of injury were equally distributed between the groups (Tables 2 and 3; see supple-mentary data). Most patients had intraarticular fractures, either in the radiocarpal joint or in the distal radio-ulnar joint or both, and only 8 patients had extraarticular fractures. There were 4 AO type-A fractures in eachgroup, and 20 type-C fractures in theC group and 22 in the O group.The operations were performed ata mean time of 3.6 (1–9) days afterinjury. In 7 patients in the C group,the fracture was augmented withK-wires. Norian SRS was used in 2patients in each group. Postopera-tively, the patients in the open groupwere treated in a forearm plaster castfor 14 (6–20) days, and the patientsin the closed group wore the ﬁxatorfor 36 (33–41) days. There were noperoperative complications.Objective outcome (Figure 3)At 7 weeks postoperatively, the pri-mary outcome parameter, mean grip strength, was signiﬁcantly higher in the O group than in the C group (47% of the uninjured side and 34% of the uninjured side, respectively) (p =0.01). Also, the mean range of motion in forearm rotation was signiﬁcantly greater in the O group than in the C group (129° and 104°, respectively) (p = 0.006). No statistically signiﬁ-cant differences were found regard-ing extension/ﬂexion (88° and 74°, respectively) (p = 0.09) or radial/ulnar deviation (48° and 41°) (p = 0.2) at the early follow-up. At the ﬁnal follow-up 1 year postoperatively, astatistically signiﬁcant differences between the groups at any time after surgery (i.e. 7 weeks, 3 months, or 1 year postopera-tively). The DASH scores for the extraarticular fractures were better than the intraarticular scores 3 months postoperatively (median 6.8 vs.17; p = 0.01), but no statistically signiﬁcant difference was found at 1 year.Complications50 postoperative complications occurred in 34 patients (Table 5). 1 patient in the O group had a postoperative swelling of the hand and ﬁngers, which led to hospitalization for 2 days. Another patient in the same group had a small, incomplete longitudinal fracture proximal to the initial fracture. This was left untreated, and it healed without complications. 2 patients—both in the external ﬁxation (C) group—had early dislocation of the fracture, resulting in both radial compres-sion and angulation requiring surgical correction. 1 patient was reoperated after 2 weeks and the other was reoperated 6 months postoperatively at another hospital. These 2 patients were then excluded from the study analyses.Most complications in both groups were minor, such as transient carpal tunnel syndrome (CTS) not requiring surgery, skin adhesions, tendonitis not requiring surgery, transient radial neurapraxia, excessive postoperative pain, and super-ﬁcial infections not requiring antibiotics. The most common minor complication in the O group was radial nerve symp-toms, due to the surgical approach through the ﬁrst extensor compartment for the radial pin-plate. In all cases but 1, the nerve symptoms were transient and had resolved at the ﬁnal follow-up at 1 year. 1 patient had the plate removed.Moderate complications requiring secondary interventions but not affecting the ﬁnal outcome were equally common in both groups. Major complications, which may inﬂuence the ﬁnal outcome, such as malunions requiring additional surgery, splinting, or reﬂex sympathetic dystrophy, were more common in the C group (Table 5). In the symptomatic malunions lead-ing to a secondary procedure, 1 patient in the C group had a radiocarpal intraarticular malunion and 5 others had extraar-ticular malunions with shortening and/or angulation of the radius. 5 of these patients were operated with a radial oste-otomy, 2 of them also with ulnar shortening. 1 patient in the C group was reoperated with the TriMed, 2 weeks after the primary operation. In addition to the malunions requiring cor-rective osteotomy, there were 7 other cases of radiographic malunion not in need of further surgery but with an incongru-ence in either the distal radioulnar joint or in the radiocarpal joint. These malunions are described below in the radiography section. The total number of malunions—those requiring cor-rective osteotomy and/or radiographic malunions—was 10 in the C group and 3 in the O group.Sick leavePatients with moderate-to-heavy manual work had more days at home from work in the C group than in the O group (Table 6). For patients with desk work, there was no statistically sig-niﬁcant difference.Table 5. Complications by group and severityTable 4. Pre- and postoperative DASH scoresRadiologyThe fracture types, as classiﬁed by the Frykman and by the AO classiﬁcation, were symmetrically distributed between the groups (Table 3; see supplementary data). As 8 patients in the C group and 10 in the O group underwent closed reduction at the ER prior to the ﬁrst radiograph, preoperative radiographic measurements could not be done. There were no differences between the groups in mean postoperative radial inclination, dorsal angulation, radial compression, and incongruence in the radiocarpal and the distal radioulnar joint at any time post-operatively (Table 7; see supplementary data). In addition to the 6 malunions requiring corrective osteotomy, there were 7 cases of radiographic loss of correction, 5 in the C group and 2 in the O group. In the C group, 2 cases had intraarticular malunions with intraarticular steps of 2.2 mm and 2.4 mm, 2 cases had ulnar variances of 4.3 mm and 7.9 mm, and 1 case had both a dorsal angulation of 21˚ and an ulnar variance of 4.3 mm. 2 radiographic malunions were seen in the O group, 1 with an articular step of 3.3 mm and 1 with an ulnar variance of 6 mm.DiscussionIn contrast to many other fractures, there are have been a number of randomized studies on treatment of distal radial fractures. However, no clear conclusions can be drawn from meta-analyses of all randomized radial fracture studies as sum-marized in the Cochrane report (Handoll and Madhok 2003b) where 48 randomized trials and 25 different treatment options were compared in 3,371 patients. Also, in a major meta-analy-sis (Margaliot et al. 2005) of 46 non-randomized studies with either external or internal ﬁxation in 1,519 patients, no clear conclusion could be drawn. Finally, in addition to the lack of consensus regarding the older established methods, no random-ized or high-quality prospective non-randomized studies have been carried out yet for the newest concepts. We believe that these new concepts, such as the TriMed system used in the pres-ent study or the increasingly popular volar angle-stable plates, improve the treatment of unstable distal radial fractures.To our knowledge, 4 randomized studies have compared open reduction and internal ﬁxation to closed or indirect reduction. In a recent study by Leung et al. (2008), a better result was found for internal ﬁxation with AO plates either dorsally or volarly compared to bridging external ﬁxation with augmentation with Kirschner wires at the surgeon’s dis-cretion. The other 3 studies have reported either an absence of signiﬁcant differences or a better functional outcome for external ﬁxation (Kapoor et al. 2000, Grewal et al. 2005, Kreder et al. 2005). Grewal and co-workers (2005) also found a higher complication rate for internal ﬁxation with a dorsal plate than for external ﬁxation. Kapoor and co-workers (2000) concluded that open reduction and internal ﬁxation provide the best articular anatomy in highly comminuted fractures, although the best outcome was achieved with the external ﬁx-ator. Grewal et al. (2005) compared internal ﬁxation using the dorsal Pi-plate with mini-open reduction and external ﬁxation, and found a higher complication rate for the Pi-plate. A better grip strength was found in the mini-open group but there were no signiﬁcant differences in ROM or DASH. Kreder et al. (2005) randomized 179 patients between either a mini-open indirect reduction and K-wires/screws or a full arthrotomy with internal ﬁxation. A better result was found for the indirect group, but a high rate of crossovers from the indirect group to the open group at the time of surgery was reported and many patients were lost to follow-up.Higher rates of infection and hardware failure have been reported in patients treated with external ﬁxation and higher rates of tendon complications with internal ﬁxation (Margaliot et al. 2005). Thus, in the literature as well as in our study, the patterns of complications differ between the methods and might help the orthopedic surgeon to decide whether to use external or internal ﬁxation. We found a high rate of complica-tions, but most were minor and transient. In the external ﬁxa-tion group, the rate of major complications such as redisloca-tion requiring reoperation or complex regional pain syndrome was higher. Other studies have reported complication rates of 20% and 85% with external ﬁxation (Anderson et al. 2004, Capo et al. 2006), most complications being minor.The malunion rate is an important outcome variable when evaluating different surgical treatments, and should be included in the overall decision. In our study, 5 cases in the external ﬁx-ation group and 1 case in the internal ﬁxation group had loss of reduction and malunions requiring further surgery. 5 otherpatients in the C group and 2 in the O group had radiographic Table 6. Days away from workmalunion only. The malunion rate found by McQueen (1998),comparing non-bridging external ﬁxation to bridging external ﬁxation, was similar to ours: 14 in the 30 patients treated with bridging external ﬁxator.Regarding grip strength, which was the primary outcome in the power analysis, the group that was operated with internal ﬁxation had a better result, maybe less surprising, at 7 weeks, but more important also at 12 months. Also, regarding fore-arm rotation, the results were better in the internal ﬁxation (O) group at all follow-up visits. The absolute values of grip strength and range of motion in the present study were similar to those in other studies, both in the C group (McQueen et al. 1996, Harley et al. 2004, Wright et al. 2005, Atroshi et al. 2006) and in the O group, and in the latter case both compar-ing to the TriMed system (Benson et al. 2006, Schnall et al. 2006) or to the latest ﬁxation trends of angle-stable volar plat-ing (Musgrave and Idler 2005, Wright et al. 2005).There may be different explanations for the increased range of motion and grip strength in the internal ﬁxation group after 1 year of follow-up. The fractures in the O group might be better aligned at surgery and/or a better reduction may be maintained during the healing, leading to a better congruency of the joint. In the O group rehabilitation starts 3 weeks earlier, which could explain the early difference between the groups, both regarding range of motion and grip strength, as found in previous studies (Kopylov et al. 1999). However, in the pres-ent study, this effect persisted throughout the whole of the ﬁrst year. Also, regarding the subjective outcome there was a ten-dency for there to be a better outcome in the O group.The median DASH values in our series (9 in the O group and 14 in the C group) are similar to the results in other studies reporting DASH scores, around 16 for the volar plate (Mus-grave and Idler 2005, Wright et al. 2005), between 9 and 17 for the TriMed system (Konrath and Bahler 2002, Benson et al. 2006, Gerostathopoulos et al. 2007), and between 7 and 17 for external ﬁxation (McQueen et al. 1996, Harley et al. 2004, Wright et al. 2005, Atroshi et al. 2006). This subjective outcome in both groups must be considered favorable, bearing in mind that in our study internal and external ﬁxation was compared in the most unstable distal radial fractures.In this group of patients with primarily unstable fractures, there is no acceptable alternative to surgery. The two methods we compared will both give a good result with good DASH values, good grip strength, and good range of motion after a year. Overall, considering the subjective and objective results as well as the rate of major complications and the sick-leave, we believe that internal ﬁxation gives a superior result and in our opinion it would be the method of choice; however, results for the external ﬁxator are still acceptable. Which method to use to internally stabilize the fracture is still a matter for dis-cussion and should be the subject of future randomized stud-ies. With smaller and smaller differences between the 2 meth-ods, better and more sensitive subjective outcome instruments will be required if the number of patients needed to show a difference is to be kept within reasonable numbers.AA: project set-up, planning, collection and interpretation of data, statistics, and writing of the manuscript. PK: project set-up, planning, and revision of the manuscript. MG: data collection and revision of the manuscript. MT: proj-ect set-up, planning, and revision of the manuscript.We thank physiotherapist Kerstin Runnquist for excellent assistance in follow-up of the patients and Ewa Persson for excellent secretarial assistance.The project was supported by Region Skåne, Lund University Hospital, the Swedish Medical Research Council (project 09509), the Alfred Österlund Foundation, the Greta and J ohan Kock Foundation, the Maggie Stephens Foundation, the Thure Carlsson Foundation, and the Faculty of Medicine at Lund University.Supplementary dataTables 2, 3 and 7 can be found at our website , iden-tiﬁcation number 2771/09.Abramo A, Kopylov P, Tägil M. Evaluation of a treatment protocol in distal radius fractures. A prospective study in 581 patients using DASH as out-come. Acta Orthop. 2008; 79 (3): 376-85.Anderson J T, Lucas G L, Buhr B R. Complications of treating distal radius fractures with external ﬁxation: a community experience. Iowa Orthop J 2004; 24: 53-9.Atroshi I, Gummesson C, Andersson B, Dahlgren E, Johansson A. The dis-abilities of the arm, shoulder and hand (DASH) outcome questionnaire: reliability and validity of the Swedish version evaluated in 176 patients. Acta Orthop Scand 2000; 71 (6): 613-8.Atroshi I, Brogren E, Larsson G U, Kloow J, Hofer M, Berggren A M. Wrist-bridging versus non-bridging external ﬁxation for displaced distal radius fractures: a randomized assessor-blind clinical trial of 38 patients followed for 1 year. Acta Orthop 2006; 77 (3): 445-53.Benson L S, Minihane K P, Stern L D, Eller E, Seshadri R. The outcome of intra-articular distal radius fractures treated with fragment-speciﬁc ﬁxa-tion. J Hand Surg (Am) 2006; 31 (8): 1333-9.Brogren E, Petranek M, Atroshi I. Incidence and characteristics of distal radius fractures in a southern Swedish region. BMC Musculoskelet Disord 2007; 8: 48.Capo J T, Swan K G, Jr., Tan V. External ﬁxation techniques for distal radius fractures. Clin Orthop 2006; (445): 30-41.Gerostathopoulos N, Kalliakmanis A, Fandridis E, Georgoulis S. Trimed ﬁxa-tion system for displaced fractures of the distal radius. J Trauma 2007; 62 (4): 913-8.Grewal R, Perey B, Wilmink M, Stothers K. A randomized prospective study on the treatment of intra-articular distal radius fractures: open reduction and internal ﬁxation with dorsal plating versus mini open reduction, per-cutaneous ﬁxation, and external ﬁxation. J Hand Surg (Am) 2005; 30 (4): 764-72.Handoll H H, Madhok R. Conservative interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev 2003a; (2): CD000314. Handoll H H, Madhok R. Surgical interventions for treating distal radial frac-tures in adults. Cochrane Database Syst Rev 2003b; (3): CD003209. Harley B J, Scharfenberger A, Beaupre L A, Jomha N, Weber D W. Augmented external ﬁxation versus percutaneous pinning and casting for unstable frac-tures of the distal radius--a prospective randomized trial. J Hand Surg (Am) 2004; 29 (5): 815-24.Hudak P L, Amadio P C, Bombardier C. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. The Upper Extremity Collaborative Group (UECG). Am J Ind Med 1996; 29 (6): 602-8.。

散发性大肠癌脆性组氨酸三联体基因与错配修复基因蛋白表达关系的研究

D i g e s t i v e D i s e a s e a n dE n d o s c o p y 中国消化内镜散发性大肠癌脆性组氨酸三联体基因与错配修复基因蛋白表达关系的研究白文元苏艳欣穆华（河北医科大学第二医院消化内科,石家庄，050000）【摘要】目的探讨散发性大肠癌（Spor a di c C ol or ect al C ar ci nom a，SCC）组织中脆性组氨酸三联体基因（Fr agi l eH i s t i di ne T r i ad，FH I T）与错配修复基因（hum a n D N A M i sm a t c h R e pai r gene，hM M R）蛋白的表达之间有无相关性，以进一步研究大肠癌的发病机制。

方法采用免疫组织化学的方法，检测了50例散发性大肠癌组织中的FH I T、hM LH1、hM SH2蛋白表达。

结果（1）所有正常/非瘤组织中FH I T、hM LH1和hM SH2蛋白均为阳性表达。

（2）FH I T蛋白表达的缺失癌在高、中和低分化癌中分别为3/10、11/29和9/11，低分化癌中FH I T表达的缺失癌与高、中分化癌比较，差异有显著性（P<0.01）。

FH I T蛋白低表达癌在不同D uke’s分期癌中的分布为A和B期癌中总共为12/36，D uke’s C期癌中为11/14。

已伴淋巴结转移的C期癌与未转移组的A和B期癌比较，差异有显著性（P<0.01）。

（3）散发性大肠癌中主要发生突变的错配修复基因是hM LH1。

hM L H1和（或）hM SH2蛋白低表达癌在高、中和低分化癌中分别为2/10、6/29和7/11，低分化癌中hM LH1或hM S H2蛋白表达的缺失与高、中分化癌比较，差异有显著性（P<0.05）。

h M LH1和（或）hM SH2蛋白低表达癌在左侧和右侧大肠癌组织中分别为8/38和7/12，hM SH2蛋白低表达癌多分布在右侧大肠癌。

生理学报第59卷作者索引

生理学报第59卷作者索引AJONUMA Louis-Chukwuemeka (见陈小章等) (495)Alan Watson (见Giovanni E. Mann等) (117)BLEICH Markus, SHAN Qi-Xian：上皮细胞K+通道的生理学意义与临床应用：跨上皮细胞转运的驱动力生成和K+循环 (英文) (443)BOMPADRE Silvia G., HWANG Tzyh-Chang：囊性纤维化跨膜电导调节体：ATP结合和水解门控Cl-通道(英文) (431)CAPLAN Michael J. (见ZHANG Li等) (505)Daniel C. Sigg (见萧永福等) (562)David JR Foster (见徐　民等) (42)David N. Sheppard (见李红宇等) (416)Giovanni E. Mann, Jörg Niehueser-Saran, Alan Watson, Ling Gao, Tetsuro Ishii, Patricia de Winter, Richard C. M. Siow：内皮细胞和平滑肌细胞氧化应激时Nrf2/ARE信号通路对抗氧化基因表达的调控：与动脉粥样硬化和先兆子痫的关系(英文) (117)HWANG Tzyh-Chang (见BOMPADRE Silvia G.等) (431)ISHIGURO Hiroshi, STEWARD Martin, NARUSE Satoru：胰管细胞H C O3-分泌：囊性纤维化跨膜电导调节体和SLC26转运体 (英文) (465)Jeff W. Lichtman (见Ju Lu等) (683)Joachim B. Grammer (见蔡　芳等) (27)Jörg Niehueser-Saran (见Giovanni E. Mann等) (117)Ju Lu, Jeff W. Lichtman：神经肌肉接头研究世纪回顾 (英文) (683)Ling Gao (见Giovanni E. Mann等) (117)MAENO Emi (见SHIMIZU Takahiro等) (512)NARUSE Satoru (见ISHIGURO Hiroshi等) (465)OKADA Yasunobu (见SHIMIZU Takahiro等) (512)Patricia de Winter (见Giovanni E. Mann等) (117)Philip H. -S. Jen (见栾瑞红等) (805)Prem KUMAR：颈动脉体对化学信号的换能作用(英文)... (128)QUINTON Paul M.：囊性纤维化：太多NaCl，太少HCO3-(英文) (397)Richard C. M. Siow (见Giovanni E. Mann等) (117)Sebnem Tuncdemir (见陈功等) (697)SHAN Qi-Xian (见BLEICH Markus等) (443)SHIMIZU Takahiro, MAENO Emi, OKADA Yasunobu：持续性细胞皱缩在人上皮细胞凋亡过程中的必要性 (英文).. (512)STEWARD Martin (见ISHIGURO Hiroshi等) (465)Tetsuro Ishii (见Giovanni E. Mann等) (117)ZHANG Li, CAPLAN Michael J.：极化上皮细胞中转运蛋白的分选 (英文) (505)二　画丁银元 (见李妙龄等) (858)三　画习瑾昆, 金元哲, 崔勋, 徐哲龙：心肌再灌注损伤保护的机制和策略 (英文) (553)于晓江 (见臧伟进等) (593)于海玲, 安　英, 姜海英, 金清华, 金元哲：单侧迷路破坏后大鼠前庭神经内侧核区氨基酸含量的变化 (英文) (71)马　妍 (见黄心璇等) (571)马　蓓 (见张琰敏等) (103)马　燕 (见朱　敏等) (197)马　鑫 (见吴恩惠等) (227)马元怡, 孔淑珍, 杨黎江, 孟金兰, 吕乐春, 何敏：大鼠黑质多巴胺能神经元的二型性 (753)马克涛 (见范　平等) (331)马季骅, 罗岸涛, 王伟平, 张培华：细胞外pH值降低可增强豚鼠心室肌细胞持续性钠电流 (233)马原野 (见杨　光等) (305)马朝林 (见金新春等) (739)马慧娟 (见高　宇等) (363)四　画井　然 (见秦　岭等) (351)孔淑珍 (见马元怡等) (753)文　文 (见张琰敏等) (103)文赛兰 (见秦　岭等) (351)毛节明 (见何　榕等) (1)王　东 (见鲁文果等) (51)王　佐 (见危当恒等) (831)王　芳 (见李建莎等) (204)王　昕 (见张　浩等) (660)王　勇 (见余剑平等) (814)王　宪 (见何　榕等) (1)王　宪 (见戴　晶等) (585)王　爽 (见张巧俊等) (183)王　喆 (见周文良等) (487)王　越 (见张晓芸等) (278)王　越, 张晓芸, 李　韶, 张　健, 赵　杰, 张万琴：蝎毒耐热蛋白对大鼠急性分离海马神经元兴奋性的影响 (英文).. 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(601)张　曦 (见黄　维等) (865)《生理学报》第59卷　作者索引884生理学报Acta Physiologica Sinica, December 25, 2007, 59(6): 881-895张万琴 (见王　越等) (87)张万琴 (见张晓芸等) (278)张文杰 (见高　宇等) (363)张文德 (见杨　光等) (305)张世庆 (见李恩中等) (345)张巧俊, 高　蕊, 刘　健, 刘娅萍, 王　爽：帕金森病大鼠中缝背核5-羟色胺能神经元电活动的变化 (英文) (183)张幼怡 (见徐　明等) (175)张永健 (见师晨霞等) (19)张立藩 (见高　放等) (821)张全江 (见刘海涛等) (651)张志琴 (见范　平等) (331)张苏明 (见鲁文果等) (51)张奇兰 (见杨文星等) (325)张季平 (见杨文伟等) (784)张学明 (见李恩中等) (345)张昆茹 (见刘海涛等) (651)张珍祥 (见白　晶等) (311)张珍祥 (见赵建平等) (157)张珍祥 (见赵建平等) (319)张珍祥 (见谢　敏等) (94)张振英, 刘秀华, 郭晓笋, 刘凤英：钙网蛋白参与缺血后处理减轻大鼠骨骼肌缺血/再灌注损伤 (643)张晓芸 (见王　越等) (87)张晓芸, 王　越, 张　健, 王靖宇, 赵　杰, 张万琴, 李　韶：蝎毒耐热蛋白对大鼠海马神经元钠通道的抑制作用...... 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(454)袁　芳 (见周利彬等) (840)袁　斌 (见李　杨等) (777)贾　宁 (见李　晖等) (299)郭　宁 (见黄　维等) (865)郭　治 (见赵建平等) (157)郭　治 (见赵建平等) (319)郭书梅 (见周利彬等) (840)郭文仪 (见刘海涛等) (651)郭晓笋 (见张振英等) (643)郭梅梅, 黄明慧, 王春晖, 唐承薇：猕猴发育过程中肠肝组织血管活性肠肽及其受体的变化 (163)高　宇, 宋光耀, 马慧娟, 张文杰, 周　宇：长期高饱和、高不饱和脂肪酸饮食诱导胰岛素抵抗大鼠肾动脉舒张和收缩功能的变化 (英文) (363)高　放, 张立藩, 黄威权, 孙　岚：慢性阻断血管紧张素II 1型受体不能完全防止模拟失重大鼠血管的适应性结构变化 (821)高　原, 罗　蕾, 刘　红：大鼠单根近端肾小管Na+-K+-ATPase活性测定方法的改进 (英文) (382)高　峰 (见刘海涛等) (651)高　莉, 沈金宝, 孙　捷, 单保恩：雷氏大疣蛛毒液对人肝癌HepG2细胞p21基因表达的影响 (英文) (58)高　蕊 (见张巧俊等) (183)高上凯 (见陈小默等) (851)高文元 (见张琰敏等) (103)高东明 (见林凡凯等) (79)高青华 (见汤　浩等) (534)十一　画崔　芳 (见张　浩等) (660)崔　勋 (见习瑾昆等) (553)崔香丽, 陈还珍, 吴博威：氨甲酰胆碱通过M2胆碱能受体对大鼠心肌细胞发挥正性肌力作用 (英文) (667)崔桂英 (见汤　浩等) (534)崔慧林, 乔健天：溶血磷脂酸对离体培养的大鼠胚胎神经干细胞向神经胶质细胞分化的影响 (英文) (759)887《生理学报》第59卷　作者索引曹　宇 (见汤　浩等) (534)曹　倩, 魏灵荣, 鲁玲玲, 赵春礼, 赵焕英, 杨　慧：星形胶质细胞通过谷胱甘肽保护MN9D细胞抵抗鱼藤酮所致氧化应激 (英文) (253)梁　晖 (见王宝利等) (169)萧永福, Daniel C. Sigg：用生物学方法重建心脏起搏点的研究进展 (英文) (562)黄　欣 (见赵　彤等) (273)黄　维, 黄宏平, 穆　玉, 张　磊, 金　木, 吕　靖, 古靓丽, 修　云, 张　勃, 郭　宁, 刘　涛, 孙　蕾, 宋美英, 张　曦,阮怀珍, 周　专：中枢神经系统去甲肾上腺素分泌的实时检测 (865)黄心璇, 马　妍, 郑永添, 黄德明：雌激素的心脏保护作用——与β1-肾上腺素受体的相互作用及其信号通路 (英文) (571)黄宏平 (见黄　维等) (865)黄明慧 (见郭梅梅等) (163)黄威权 (见高　放等) (821)黄娅林 (见贺　明等) (796)黄新莉 (见羡晓辉等) (357)黄德明 (见黄心璇等) (571)龚永生, 范小芳, 吴小脉, 胡良冈, 唐朝枢, 庞永政, 齐永芬：Intermedin/adrenomedullin 2及其受体在慢性低氧性肺动脉高压大鼠右心室的表达变化 (210)十二　画彭聿平 (见林树新等) (150)彭丽花 (见秦晓群等) (454)曾木圣 (见贺玉香等) (524)曾因明 (见李敬远等) (13)曾晓荣 (见李妙龄等) (858)曾晓荣 (见蔡　芳等) (27)焦　博 (见李　辉等) (369)程　俊 (见蔡　芳等) (27)程　祺 (见晏　妮等) (240)程明亮 (见杨　勤等) (190)羡晓辉, 黄新莉, 周晓红, 张景琨, 凌亦凌：硫化氢与内毒素血症大鼠心肌损伤的关系 (357)董　芳 (见师晨霞等) (19)蒋建利, 唐　娟：CD147相互作用蛋白及其细胞生物学功能(英文) (517)谢　敏 (见白晶等) (311)谢　敏, 刘先胜, 徐永健, 张珍祥, 白　晶, 倪　望, 陈士新：细胞外信号调节激酶1/2信号通路在慢性哮喘模型大鼠支气管平滑肌细胞迁移功能变化中的调控作用 (94)谢汝佳 (见杨　勤等) (190)韩　冰 (见杨　勤等) (190)韩启德 (见徐　明等) (175)韩雪飞 (见邢　莹等) (267)鲁文果, 陈　红, 王　东, 黎逢光, 张苏明：小鼠胚胎干细胞移植入成体大鼠脑内的区域特异性存活与分化 (英文).... (51)鲁玲玲 (见曹　倩等) (253)鲁景艳 (见李恩中等) (345)十三　画甄国华 (见赵建平等) (319)路　军 (见任新瑜等) (339)鄢文海 (见邢　莹等) (267)阙海萍, 李　欣, 李　松, 刘少君：低浓度神经生长因子存在下GPI-1046刺激鸡胚神经节突起生长 (英文) (791)雷　琦, 闫剑群, 施京红, 杨雪娟, 陈　坷：味觉刺激引起大鼠臂旁核神经元抑制性反应 (英文) (260)雷　霆 (见李　董等) (35)靳　冰 (见赵　彤等) (273)十四　画熊　原 (见周文良等) (487)熊　哲 (见林凡凯等) (79)熊　雷 (见吴恩惠等) (227)臧伟进, 孙　蕾, 于晓江：腺苷和乙酰胆碱后适应诱导的心肌保护作用 (英文) (593)蔡　芳, 李鹏云, 杨　艳, 刘智飞, 李妙龄, 周　文, 裴　杰, 程俊, 兰　欢, Joachim B. Grammer, 曾晓荣：猪冠状动脉平滑肌细胞的自发瞬时外向电流的特性 (英文) (27)蔡　青 (见李　晖等) (299)蔡志伟 (见李红宇等) (416)蔡莉蓉 (见李玉珍等) (221)裴　杰 (见李妙龄等) (858)裴　杰 (见蔡　芳等) (27)谭宇蓉 (见秦晓群等) (454)十五　画樊志刚 (见邢　莹等) (267)樊俊蝶 (见吴恩惠等) (227)黎逢光 (见鲁文果等) (51)十六　画穆　玉 (见黄　维等) (865)十七　画戴　晶, 王　宪：同型半胱氨酸在心血管疾病中的免疫调节作用 (英文) (585)戴晨琳 (见王宝利等) (169)鞠　敏 (见李红宇等) (416)魏义明, 许盈, 俞昌喜：褪黑素对吗啡戒断小鼠下丘脑弓状核和中脑导水管周围灰质中β-内啡肽含量的影响..(765)魏灵荣 (见曹　倩等) (253)十八　画瞿智玲 (见任新瑜等) (339)。

The Contemporary Theory of Metaphor

The Contemporary Theory of MetaphorGeorge Lakoff(c) Copyright George Lakoff, 1992To Appear in Ortony, Andrew (ed.) Metaphor and Thought (2nd edition), Cambridge University Press.Do not go gentle into that good night. -Dylan ThomasDeath is the mother of beauty . . . -Wallace Stevens, Sunday Morning IntroductionThese famous lines by Thomas and Stevens are examples of what classical theorists, at least since Aristotle, have referred to as metaphor: instances of novel poetic language in which words like mother,go, and night are not used in their normal everyday senses. In classical theories of language, metaphor was seen as a matter of language not thought. Metaphorical expressions were assumed to be mutually exclusive with the realm of ordinary everyday language: everyday language had no metaphor, and metaphor used mechanisms outside the realm of everyday conventional language. The classical theory was taken so much for granted over the centuries that many people didn’t realize that it was just a theory. The theory was not merely taken to be true, but came to be taken as definitional. The word metaphor was defined as a novel or poetic linguistic expression where one or more words for a concept are used outside of its normal conventional meaning to express a similar concept. But such issues are not matters for definitions; they are empirical questions. As a cognitive scientist and a linguist, one asks: What are the generalizations governing the linguistic expressions re ferred to classically as poetic metaphors? When this question is answered rigorously, the classical theory turns out to be false. The generalizations governing poetic metaphorical expressions are not in language, but in thought: They are general map pings across conceptual domains. Moreover, these general princi ples which take the form of conceptual mappings, apply not just to novel poetic expressions, but to much of ordinary everyday language. In short, the locus of metaphor is not in language at all, but in the way we conceptualize one mental domain in terms of another. The general theory of metaphor is given by characterizing such cross-domain mappings. And in the process, everyday abstract concepts like time, states, change, causation, and pur pose also turn out to be metaphorical. The result is that metaphor (that is, cross-domain mapping) is absolutely central to ordinary natural language semantics, and that the study of literary metaphor is an extension of the study of everyday metaphor. Everyday metaphor is characterized by a huge system of thousands of cross-domain mappings, and this system is made use of in novel metaphor. Because of these empirical results, the word metaphor has come to be used differently in contemporary metaphor research. The word metaphor has come to mean a cross-domain mapping in the conceptual system. The term metaphorical expression refers to a linguisticexpression (a word, phrase, or sentence) that is the surface realization of such a cross-domain mapping (this is what the word metaphor referred to in the old theory). I will adopt the contemporary usage throughout this chapter. Experimental results demonstrating the cognitive reali ty of the extensive system of metaphorical mappings are discussed by Gibbs (this volume). Mark Turner’s 1987 book, Death is the mother of beauty, whose title comes from Stevens’great line, demonstrates in detail how that line uses the ordinary system of everyday mappings. For further examples of how literary metaphor makes use of the ordinary metaphor system, see More Than Cool Reason: A Field Guide to Poetic Metaphor, by Lakoff and Turner (1989) and Reading Minds: The Study of English in the Age of Cognitive Science, by Turner (1991). Since the everyday metaphor system is central to the understanding of poetic metaphor, we will begin with the everyday system and then turn to poetic examples.Homage To ReddyThe contemporary theory that metaphor is primarily conceptual, conventional, and part of the ordinary system of thought and language can be traced to Michael Reddy’s (this volume) now classic paper, The Conduit Metaphor,which first appeared in the first edition of this collection. Reddy did far more in that paper than he modestly suggested. With a single, thoroughly analyzed example, he allowed us to see, albeit in a restricted domain, that ordinary everyday English is largely metaphorical, dispelling once and for all the traditional view that metaphor is primarily in the realm of poetic or figurative language. Reddy showed, for a single very significant case, that the locus of metaphor is thought, not language, that metaphor is a major and indispensable part of our ordinary, conventional way of conceptualizing the world, and that our everyday behavior reflects our metaphorical understanding of experience. Though other theorists had noticed some of these characteristics of metaphor, Reddy was the first to demonstrate it by rigorous linguistic analysis, stating generalizations over voluminous examples. Reddy’s chapter on how we conceptualize the concept of communication by metaphor gave us a tiny glimpse of an enormous system of conceptual metaphor. Since its appearance, an entire branch of linguis tics and cognitive science has developed to study systems of metaphorical thought that we use to reason, that we base our actions on, and that underlie a great deal of the structure of language. The bulk of the chapters in this book were written before the development of the contemporary field of metaphor research. My chapter will therefore contradict much that appears in the others, many of which make certain assumptions that were widely taken for granted in 1977. A major assumption that is challenged by contemporary research is the traditional division between literal and figurative language, with metaphor as a kind of figurative language. This entails, by definition, that: What is literal is not metaphorical. In fact, the word literal has traditionally been used with one or more of a set of assumptions that have since proved to be false:Traditional false assumptions•All everyday conventional language is literal, and none is metaphorical.•All subject matter can be comprehended literally, without metaphor.•Only literal language can be contingently true or false.•All definitions given in the lexicon of a language are literal, not metaphorical.•The concepts used in the grammar of a language are all literal; none are metaphorical.The big difference between the contemporary theory and views of metaphor prior to Reddy’s work lies in this set of assumptions. The reason for the difference is that, in the intervening years, a huge system of everyday, convention al, conceptual metaphors has been discovered. It is a system of metaphor that structures our everyday conceptual system, including most abstract concepts, and that lies behind much of everyday language. The discovery of this enormous metaphor system has destroyed the traditional literal-figurative distinction, since the term literal,as used in defining the traditional distinction, carries with it all those false assumptions. A major difference between the contemporary theory and the classical one is based on the old literal-figurative distinction. Given that distinction, one might think that one arrives at a metaphorical interpretation of a sentence by starting with the literal meaning and applying some algorithmic process to it (see Searle, this volume). Though there do exist cases where something like this happens, this is not in general how metaphor works, as we shall see shortly.What is not metaphoricalAlthough the old literal-metaphorical distinction was based on assumptions that have proved to be false, one can make a different sort of literal-metaphorical distinction: those concepts that are not comprehended via conceptual metaphor might be called literal. Thus, while I will argue that a great many common concepts like causation and purpose are metaphorical, there is nonetheless an extensive range of nonmetaphorical concepts. Thus, a sentence like The balloon went up is not metaphorical, nor is the old philosopher’s favorite The cat is on the mat.But as soon as one gets away from concrete physical experience and starting talking about abstractions or emotions, metaphorical understanding is the norm.The Contemporary Theory: Some ExamplesLet us now turn to some examples that are illustrative of contemporary metaphor research. They will mostly come from the domain of everyday conventional metaphor, since that has been the main focus of the research. I will turn to the discussion of poetic metaphor only after I have discussed the conventional system, since knowledge of the conventional system is needed to make sense of most of the poetic cases. The evidence for the existence of a system of conventional conceptual metaphors is of five types: -Generalizations governing polysemy, that is, the use of words with a number of related meanings.-Generalizations governing inference patterns, that is, cases where a pattern of inferences from one conceptual domain is used in another domain.-Generalizations governing novel metaphorical language (see, Lakoff & Turner, 1989).-Generalizations governing patterns of semantic change (see, Sweetser, 1990).-Psycholinguistic experiments (see, Gibbs, 1990, this volume).We will primarily be discussing the first three of these sources of evidence, since they are the most robust.Conceptual MetaphorImagine a love relationship described as follows: Our relationship has hit a dead-end street.Here love is being conceptualized as a journey, with the implication that the relationship is stalled, that the lovers cannot keep going the way they’ve been going, that they must turn back, or abandon the relationship altogether. This is not an isolated case. English has many everyday expressions that are based on a conceptualization of love as a journey, and they are used not just for talking about love, but for reasoning about it as well. Some are necessarily about love; others can be understood that way: Look how far we’ve come. It’s been a long, bumpy road. We can’t turn back now. We’re at a crossroads. We may have to go our separate ways. The relationship isn’t going anywhere. We’re spinning our wheels. Our relationship is off the track. The marriage is on the rocks. We may have to bail out of this relationship. These are ordinary, everyday English expressions. They are not poetic, nor are they necessarily used for special rhetorical effect. Those like Look how far we’ve come, which aren’t necessarily about love, can readily be understood as being about love. As a linguist and a cognitive scientist, I ask two commonplace questions:•Is there a general principle governing how these linguistic expressions about journeys are used to characterize love?•Is there a general principle governing how our patterns of inference about journeys are used to reason about love when expressions such as these are used?The answer to both is yes. Indeed, there is a single general principle that answers both questions. But it is a general principle that is neither part of the grammar of English, nor the English lexicon. Rather, it is part of the conceptual system underlying English: It is a principle for under standing the domain of love in terms of the domain of journeys. The principle can be stated informally as a metaphorical scenario: The lovers are travelers on a journey together, with their common life goals seen as destinations to be reached. The relationship is their vehicle, and it allows them to pursue those common goals together. The relationship is seen as fulfilling its purpose as long as it allows them to make progress toward their common goals. The journey isn’t easy. There are impediments, and there are places (crossroads) where a decision has to be made about which direction to go in and whether to keep traveling together. The metaphor involves understanding one domain of experience, love, in terms of a very different domain of experience, journeys. More technically, the metaphor can be understood as a mapping (in the mathematical sense) from a source domain (in this case, journeys) to a target domain (in this case, love). The mapping is tightly structured. There are ontological correspondences, according to which entities in the domain of love (e.g., the lovers, their common goals, their difficulties, the love relationship, etc.) correspond systematically to entities in the domain of a journey (the travelers, the vehicle, des tinations, etc.). To make it easier to remember what mappings there are in the conceptual system, Johnson and I (lakoff and Johnson, 1980) adopted a strategy for naming such mappings, using mnemonics which suggest the mapping. Mnemonic names typically (though not always) have the form: TARGET-DOMAIN IS SOURCE-DOMAIN, or alternatively, TARGET-DOMAIN AS SOURCE-DOMAIN. In this case, the name of the mapping is LOVE IS A JOURNEY. When I speak of the LOVE IS A JOURNEY metaphor, I am using a mnemonic for a set of ontological correspondences that characterize a map ping, namely:THE LOVE-AS-JOURNEY MAPPING-The lovers correspond to travelers.-The love relationship corresponds to the vehicle.-The lovers’ common goals correspond to their common destinations on the journey.-Difficulties in the relationship correspond to impediments to travel.It is a common mistake to confuse the name of the mapping, LOVE IS A JOURNEY, for the mapping itself. The mapping is the set of correspondences. Thus, whenever I refer to a metaphor by a mnemonic like LOVE IS A JOURNEY, I will be referring to such a set of correspondences. If mappings are confused with names of mappings, another misunderstanding can arise. Names of mappings commonly have a propositional form, for example, LOVE IS A JOURNEY. But the mappings themselves are not propositions. If mappings are confused with names for mappings, one might mistakenly think that, in this theory, metaphors are propositional. They are, of course, anything but that: metaphors are mappings, that is, sets of conceptual correspondences. The LOVE-AS-JOURNEY mapping is a set of ontological correspondences that characterize epistemic correspondences by mapping knowledge about journeys onto knowledge about love. Such correspondences permit us to reason about love using the knowledge we use to reason about journeys. Let us take an example. Consider the expression, We’re stuck, said by one lover to another about their relationship. How is this expression about travel to be understood as being about their relationship? We’re stuck can be used of travel, and when it is, it evokes knowledge about travel. The exact knowledge may vary from person to person, but here is a typical example of the kind of knowledge evoked. The capitalized expressions represent entities n the ontology of travel, that is, in the source domain of the LOVE IS A JOURNEY mapping given above. Two TRAVELLERS are in a VEHICLE, TRAVELING WITH COMMON DESTINATIONS. The VEHICLE encounters some IMPEDIMENT and gets stuck, that is, makes it nonfunctional. If they do nothing, they will not REACH THEIR DESTINATIONS. There are a limited number of alternatives for action:•They can try to get it moving again, either by fixing it or get ting it past the IMPEDIMENT that stopped it.•They can remain in the nonfunctional VEHICLE and give up on REACHING THEIR DESTINATIONS.•They can abandon the VEHICLE.•The alternative of remaining in the nonfunctional VEHICLE takes the least effort, but does not satisfy the desire to REACH THEIR DESTINATIONS.The ontological correspondences that constitute the LOVE IS A JOURNEY metaphor map the ontology of travel onto the ontology of love. In doing so, they map this scenario about travel onto a corresponding love scenario in which the corresponding alternatives for action are seen. Here is the corresponding love scenario that results from applying the correspondences to this knowledge structure. The target domain entities that are mapped by the correspondences are capitalized:Two LOVERS are in a LOVE RELATIONSHIP, PURSUING COMMON LIFE GOALS. The RELATIONSHIP encounters some DIFFICULTY, which makes it nonfunctional. If they do nothing, they will not be able to ACHIEVE THEIR LIFE GOALS. There are a limited number of alternatives for action:•They can try to get it moving again, either by fixing it or getting it past the DIFFICULTY.•They can remain in the nonfunctional RELATIONSHIP, and give up onACHIEVING THEIR LIFE GOALS.•They can abandon the RELATIONSHIP.The alternative of remaining in the nonfunctional RELATIONSHIP takes the least effort, but does not satisfy the desire to ACHIEVE LIFE GOALS. This is an example of an inference pattern that is mapped from one domain to another. It is via such mappings that we apply knowledge about travel to love relationships.Metaphors are not mere wordsWhat constitutes the LOVE-AS-JOURNEY metaphor is not any particular word or expression. It is the ontological mapping across conceptual domains, from the source domain of journeys to the target domain of love. The metaphor is not just a matter of language, but of thought and reason. The language is secondary. The mapping is primary, in that it sanctions the use of source domain language and inference patterns for target domain concepts. The mapping is conventional, that is, it is a fixed part of our conceptual system, one of our conventional ways of conceptualizing love relationships. This view of metaphor is thoroughly at odds with the view that metaphors are just linguistic expressions. If metaphors were merely linguistic expressions, we would expect different linguistic expressions to be different metaphors. Thus, "We’ve hit a dead-end street" would constitute one metaphor. "We can’t turn back now" would constitute another, entirely different metaphor. "Their marriage is on the rocks" would involve still a different metaphor. And so on for dozens of examples. Yet we don’t seem to have dozens of different metaphors here. We have one metaphor, in which love is conceptualized as a journey. The mapping tells us precisely how love is being conceptualized as a journey. And this unified way of conceptualizing love metaphorically is realized in many different linguistic expressions. It should be noted that contemporary metaphor theorists commonly use the term metaphor to refer to the conceptual mapping, and the term metaphorical expression to refer to an individual linguistic expression (like dead-end street) that is sanctioned by a mapping. We have adopted this terminology for the following reason: Metaphor, as a phenomenon, involves both conceptual mappings and individual linguistic expressions. It is important to keep them distinct. Since it is the mappings that are primary and that state the generalizations that are our principal concern, we have reserved the term metaphor for the mappings, rather than for the linguistic expressions. In the literature of the field, small capitals like LOVE IS A JOURNEY are used as mnemonics to name mappings. Thus, when we refer to the LOVE IS A JOURNEY metaphor, we are refering to the set of correspondences discussed above. The English sentence Love is a journey, on the other hand, is a metaphorical expression that is understood via that set of correspondences.GeneralizationsThe LOVE IS A JOURNEY metaphor is a conceptual mapping that characterizes a generalization of two kinds:•Polysemy generalization: A generalization over related senses of linguistic expressions, e.g., dead-end street, crossroads, stuck, spinning one’s wheels, not going anywhere, and so on.•Inferential generalization: A generalization over inferences across different conceptual domains.That is, the existence of the mapping provides a general answer to two questions: -Why are words for travel used to describe love relationships? -Why are inference patterns used to reason about travel also used to reason about love relationships. Correspondingly, from the perspective of the linguistic analyst, the existence of such cross-domain pairings of words and of inference patterns provides evidence for the existence of such mappings. Novel extensions of conventional metaphorsThe fact that the LOVE IS A JOURNEY mapping is a fixed part of our conceptual system explains why new and imaginative uses of the mapping can be understood instantly, given the ontological correspondences and other knowledge about journeys. Take the song lyric, We’re driving in the fast lane on the freeway of love. The traveling knowledge called upon is this: When you drive in the fast lane, you go a long way in a short time and it can be exciting and dangerous. The general metaphorical mapping maps this knowledge about driving into knowledge about love relationships. The danger may be to the vehicle (the relationship may not last) or the passengers (the lovers may be hurt, emotionally). The excitement of the love-journey is sexual. Our understanding of the song lyric is a consequence of the pre-existing metaphorical correspondences of the LOVE-AS-JOURNEY metaphor. The song lyric is instantly comprehensible to speakers of English because those metaphorical correspondences are already part of our conceptual system. The LOVE-AS-JOURNEY metaphor and Reddy’s Conduit Metaphor were the two examples that first convinced me that metaphor was not a figure of speech, but a mode of thought, defined by a systematic mapping from a source to a target domain. What convinced me were the three characteristics of metaphor that I have just discussed: The systematicity in the linguistic correspondences. The use of metaphor to govern reasoning and behavior based on that reasoning. The possibility for understanding novel extensions in terms of the conventional correspondences.MotivationEach conventional metaphor, that is, each mapping, is a fixed pattern of conceptual correspondences across conceptual domains. As such, each mapping defines an open-ended class of potential correspondences across inference patterns. When activated, a mapping may apply to a novel source domain knowledge structure and characterize a corresponding target domain knowledge structure. Mappings should not be thought of as processes, or as algorithms that mechanically take source domain inputs and produce target domain outputs. Each mapping should be seen instead as a fixed pattern of onotological correspondences across domains that may, or may not, be applied to a source domain knowledge structure or a source domain lexical item. Thus, lexical items that are conventional in the source domain are not always conventional in the target domain. Instead, each source domain lexical item may or may not make use of the static mapping pattern. If it does, it has an extended lexicalized sense in the target domain, where that sense is characterized by the mapping. If not, the source domain lexical item will not have a conventional sense in the target domain, but may still be actively mapped in the case of novel metaphor. Thus, the words freeway and fast lane are not conventionally used of love, but the knowledge structures associated with them are mapped by the LOVE IS A JOURNEY metaphor in the case of We’re driving in the fast lane on the freeway of love. Imageable IdiomsMany of the metaphorical expressions discussed in the literature on conventional metaphor are idioms. On classical views, idioms have arbitrary meanings. But withincognitive linguistics, the possibility exists that they are not arbitrary, but rather motivated. That is, they do arise automatically by productive rules, but they fit one or more patterns present in the conceptual system. Let us look a little more closely at idioms. An idiom like spinning one’s wheels comes with a conventional mental image, that of the wheels of a car stuck in some substance-either in mud, sand, snow, or on ice, so that the car cannot move when the motor is engaged and the wheels turn. Part of our knowledge about that image is that a lot of energy is being used up (in spinning the wheels) without any progress being made, that the situation will not readily change of its own accord, that it will take a lot of effort on the part of the occupants to get the vehicle moving again --and that may not even be possible. The love-as-journey metaphor applies to this knowledge about the image. It maps this knowledge onto knowledge about love relationships: A lot of energy is being spent without any progress toward fulfilling common goals, the situation will not change of its own accord, it will take a lot of effort on the part of the lovers to make more progress, and so on. In short, when idioms that have associated conventional images, it is common for an independently-motivated conceptual metaphor to map that knowledge from the source to the target domain. For a survey of experiments verifying the existence of such images and such mappings, see Gibbs 1990 and this volume. Mappings are at the superordinate levelIn the LOVE IS A JOURNEY mapping, a love relationship corresponds to a vehicle. A vehicle is a superordinate category that includes such basic-level categories as car, train, boat, and plane. Indeed, the examples of vehicles are typically drawn from this range of basic level categories: car ( long bumpy road, spinning our wheels), train (off the track), boat (on the rocks, foundering), plane (just taking off, bailing out). This is not an accident: in general, we have found that mappings are at the superordinate rather than the basic level. Thus, we do not find fully general submappings like A LOVE RELATIONSHIP IS A CAR; when we find a love relationship conceptualized as a car, we also tend to find it conceptualized as a boat, a train, a plane, etc. It is the superordinate category VEHICLE not the basic level category CAR that is in the general mapping. It should be no surprise that the generalization is at the superordinate level, while the special cases are at the basic level. After all, the basic level is the level of rich mental images and rich knowledge structure. (For a discussion of the properties of basic-level categories, see Lakoff, 1987, pp. 31-50.) A mapping at the superordinate level maximizes the possibilities for mapping rich conceptual structure in the source domain onto the target domain, since it permits many basic-level instances, each of which is information rich. Thus, a prediction is made about conventional mappings: the categories mapped will tend to be at the superordinate rather than basic level. Thus, one tends not to find mappings like A LOVE RELATIONSHIP IS A CAR or A LOVE RELATIONSHIP IS A BOAT. Instead, one tends to find both basic-level cases (e.g., both cars and boats), which indicates that the generalization is one level higher, at the superordinate level of the vehicle. In the hundreds of cases of conventional mappings studied so far, this prediction has been borne out: it is superordinate categories that are used in mappings.Basic Semantic Concepts That Are MetaphoricalMost people are not too surprised to discover that emotional concepts like love and anger are understood metaphorically. What is more interesting, and I think more exciting, is the realization that many of the most basic concepts in our conceptual systems are alsocomprehended normally via metaphor-concepts like time, quantity, state, change, action, cause, purpose, means, modality and even the concept of a category. These are concepts that enter normally into the grammars of languages, and if they are indeed metaphorical in nature, then metaphor becomes central to grammar. What I would like to suggest is that the same kinds of considerations that lead to our acceptance of the LOVE-AS-JOURNEY metaphor lead inevitably to the conclusion that such basic concepts are often, and perhaps always, understood via metaphor.CategoriesClassical categories are understood metaphorically in terms of bounded regions, or ‘containers.’ Thus, something can be in or out of a category, it can be put into a category or removed from a category, etc. The logic of classical categories is the logic of containers (see figure 1). If X is in container A and container A is in container B, then X is in container B. This is true not by virtue of any logical deduction, but by virtue of the topological properties of containers. Under the CLASSICAL CATEGORIES ARE CONTAINERS metaphor, the logical properties of categories are inherited from the logical properties of containers. One of the principal logical properties of classical categories is that the classical syllogism holds for them. The classical syllogism, Socrates is a man. All men are mortal. Therefore, Socrates is mortal. is of the form: If X is in category A and category A is in category B, then X is in category B. Thus, the logical properties of classical categories can be seen as following from the topological properties of containers plus the metaphorical mapping from containers to categories. As long as the topological properties of containers are preserved by the mapping, this result will be true. In other words, there is a generalization to be stated here. The language of containers applies to classical categories and the logic of containers is true of classical categories. A single metaphorical mapping ought to characterize both the linguistic and logical generalizations at once. This can be done provided that the topological properties of containers are preserved in the mapping. The joint linguistic-and-inferential relation between containers and classical categories is not an isolated case. Let us take another example.Quantity and Linear ScalesThe concept of quantities involves at least two metaphors. The first is the well-known MORE IS UP, LESS IS DOWN metaphor as shown by a myriad of expressions like Prices rose, Stocks skyrocketed, The market plummeted, and so on. A second is that LINEAR SCALES ARE PATHS. We can see this in expressions like: John is far more intelligent than Bill. John’s intelligence goes way beyond Bill’s. John is way ahead of Bill in intelligence. The metaphor maps the starting point of the path onto the bottom of the scale and maps distance traveled onto quantity in general. What is particularly interesting is that the logic of paths maps onto the logic of linear scales. (See figure 2.) Path inference: If you are going from A to C, and you are now at in intermediate point B, then you have been at all points between A and B and not at any points between B and C. Example: If you are going from San Francisco to N.Y. along route 80, and you are now at Chicago, then you have been to Denver but not to Pittsburgh. Linear scale inference: If you have exactly $50 in your bank account, then you have $40, $30, and so on, but not $60, $70, or any larger amount. The form of these inferences is the same. The path inference is a consequence of the cognitive topology of paths. It will be true of any path image-schema. Again, there is a linguistic-and-inferential generalization to be stated. It would be stated by the metaphor LINEAR SCALES ARE PATHS, provided that metaphors in general preserve the cognitive topology (that is, the image-schematic structure) of the source。

科马克·麦卡锡《路》中的梦境叙事

World Literature Studies 世界文学研究, 2023, 11(5), 375-379Published Online October 2023 in Hans. https:///journal/wlshttps:///10.12677/wls.2023.115065科马克·麦卡锡《路》中的梦境叙事王妍扬州大学外国语学院，江苏扬州收稿日期：2023年8月28日；录用日期：2023年10月10日；发布日期：2023年10月19日摘要作为一种独到的文学创作技巧，梦境叙事在美国当代作家科马克·麦卡锡著名的末世题材小说《路》中占据重要地位。

小说中的十三处梦碎片大体可分为怀旧梦、想象梦、变异梦三个类别，梦中出现的“怪物”“蛇”“妻子”等重要意象蕴含深刻的象征意义，不仅揭示了人物内心世界，还开拓了小说叙事格局，亦凸显了小说“末世救赎”之主题。

关键词《路》，梦境叙事，科马克·麦卡锡，意象On the Dream Narrative in CormacMcCarthy’s The RoadYan WangCollege of Foreign Languages, Yangzhou University, Yangzhou JiangsuReceived: Aug. 28th, 2023; accepted: Oct. 10th, 2023; published: Oct. 19th, 2023AbstractAs a unique literary creation skill, dream narrative occupies an important position in the Ameri-can contemporary writer Cormac McCarthy’s apocalyptic novel The Road. The thirteen dreams in the novel can be divided into three categories: nostalgic dreams, imaginary dreams, and mutated dreams. The important images appearing in the dreams including “monsters” “snakes” and “wife”carry profound symbolic meaning, which not only provides insights into characters’ mind, but also opens up the narrative pattern of the novel, and highlights the “apocalyptic redemption” them of the novel.王妍KeywordsThe Road, Dream Narrative, Cormac McCarthy, ImageCopyright © 2023 by author(s) and Hans Publishers Inc.This work is licensed under the Creative Commons Attribution International License (CC BY 4.0)./licenses/by/4.0/1. 引言《路》是美国作家科马克·麦卡锡著名的末世题材小说，讲述了在一片死寂的末日寒冬，一对父子沿着某条模糊的“长路”执着向南，寻找更为温暖的避难所。

ATOXGeneralanglèsfromMonica-中英文

2020/3/29
黄曲霉毒素
该族中大约有20种毒素 (平面结构) 在食物中经常被发现的毒素仅有 B1, B2, G1 和 G2 由曲霉菌属产生 (黄曲霉, 寄生曲霉与 A. nominus)
在重要的商品化食物原料中时有发现，例如谷物，坚果，香料，无花果以及干果等
在中等极性溶液中自由溶解， (e.g. 氯仿,甲醇), 在水中的溶解度为 0.02 g/L （疏水性）致癌: 黄曲霉毒素 B1: 是致癌物质之一，
许多政府均定期对其进行监察
2020/3/29
ZEARALENONE
Phenolic resorcyclic acid lactone (planar structure) Produced by Fusarium species (F.culmorum, F. graminearum and F. crookwellense) Occur in cereals, and tend to develop particulary during cool, wet growin seasons Dissolve in water to extent of 0.02 g per litre (hydrophobic) Zearalenone is a naturally occuring estrogen: negative effect on reproductive system: hyperestrogenism, particulary in
POSTHARVEST
Temperature & moisture control Antifungal agents DECONTAMINATION
ADSORBENTS based DECONTAMINATION STRATEGY: CLAY MINERALS and others

论弗罗斯特《摘苹果之后》中的死亡隐喻

论弗罗斯特《摘苹果之后》中的死亡隐喻发布时间：2022-07-21T08:53:03.876Z 来源：《时代教育》2022年5期作者：刘沛婷[导读] 乔治·莱考夫和马克?约翰逊于《我们赖以生存的隐喻》一书中指出隐喻不仅仅是一种修辞手法，更是一种思维方式刘沛婷湖南师范大学，湖南长沙 410006摘要：乔治·莱考夫和马克?约翰逊于《我们赖以生存的隐喻》一书中指出隐喻不仅仅是一种修辞手法，更是一种思维方式，在人们的日常语言和活动中无所不在。

诗歌是高度隐喻化的体裁，本文就将以弗罗斯特的短诗——《摘苹果之后》为例，通过挖掘诗歌中的结构隐喻、方位隐喻和本体隐喻，深刻剖析弗罗斯特的死亡观建构，为该诗的解读提供新的维度，也有助于丰富该理论的应用范畴。

关键词:《摘苹果之后》；结构隐喻；方位隐喻；本体隐喻；死亡On death metaphors in Frost’s “After Apple-Picking”Peiting LiuHunan Normal University, Hunan Changsha 410006Abstract: George Lakoff and Mark Johnson put forward in their book Metaphors We Live By that metaphor is not only a figure of speech but a way of thinking, pervasive in everyday language and action. Since poetry is highly metaphorical, this thesis is to explore how Robert Lee Frost construct his insight of death through structural metaphors, orientational metaphors as well as ontological metaphors in his short poem “After Apple-Picking”, with the hope to provide a new dimension for the interpretation of the poem and to expand the application scope of the theory. Key words: “After Apple-Picking”; structural metaphors; orientational metaphors; ontological metaphors; death 1.IntroductionLakoff and Johnson in their monograph Metaphors We Live Вy, point out that metaphor not only can be understood from the figurative perspective, but is the thinking way.[1] Ungerer and Schmid hold that conceptual metaphor, as a cognitive instrument, is not just a stylistically dramatic way of expressing thoughts by means of literary language, but a way of thinking.[2] K?vecses has put that conceptual metaphor is defined as understanding one conceptual domain in terms of another conceptual domain.[3] On the basis of the cognitive approach to the understanding of conceptual metaphor, it can be divided into structural metaphor, orientational metaphor and ontological metaphor. The development of conceptual metaphor theory has brought advance to Linguistics, Anthology, Literature and so on.Robert Lee Frost commands an important place in any list of outstanding poets in the twentieth century. His poem “After Apple-picking” is written in the first person. The speaker is an orchard worker who has picked apples long and hard but is now on the verge of being overwhelmed by fatigue and the depth of the experience. On the edge of falling sleep, he remembers not only the ripe apples successfully picked but also those that fell and were considered damaged and had to be sent to the cider mill. He knows that his sleep will be troubled by the failures more than by the successes. He is not sure about the nature of the sleep he is about to drop into—whether it will be ordinary sleep, more like a hibernation, or more like death.The entire poem is a kind of extended metaphor, in which the activity of harvesting apples represents people’ life and the speaker’s falling asleep suggests human death.As a classical literary work, the study of this poem mostly focuses on its rhythm and writing devices. The analysis of multiple themes and symbols has always been the research hotspot of literature works. Li Yingxue discussed the fuzziness of the meaning of poetry from the perspective of deconstruction, and there are many scholars who explore metaphors in Frost’s other poems.[4] Few people applied it to analyze “After Apple-Picking”. Therefore, this paper is to discuss how Frost structures his thoughts on death metaphorically by describing a laborer’s picking apples. The first three chapters of this thesis illustrate Frost’s views of death through the construction of structural metaphors, orientational metaphors and ontological metaphors in “After Apple-Picking” respectively. At last it is followed by a logical conclusion of this thesis.2.Structural MetaphorsIn structural metaphor, one greatly structured and explicitly delineated concept is applied to structure another. As Lakoff and Johnson point out that one domain of conceptual metaphor is metaphorically structured in light of another. Structural metaphor allows its source domain to offer a comparatively rich knowledge structure for the target domain, that is to say, the cognitive function of structural metaphor is to enable audiences to understand the target domain by the structure of the source domain. The poem “After Apple-Picking” include two key conceptual metaphors: DEATH IS SLEEP and PEOPLE ARE PLANTS.2.1 DEATH IS SLEEPFrost chooses a laborer who is overtired with apple-picking and falls asleep to reflect his insight of death. Hence the poem can be understood as a mapping from a source domain (sleep) to a target domain (death). The mapping is tightly structured. There are ontological correspondences. The dead correspond to those who have a sound sleep. The retrospection before death corresponds to the unconscious state near sleep. The darkness corresponds to the night. The cease of life corresponds to the stillness and motionlessness of sleep. As Lakoff puts it, “people use a concrete source domain to describe an abstract target domain.”[5] Death is an abstract concept, which can be understood vividly through the concept of sleep. The word “sleep”has been repeated five times. “Winter sleep” suggests the emotion of being decayed, forlorn and silent triggered by death because winter, in the metaphoric meanings, has strong associations with death.[6] Another euphemistic expression of death is “long sleep”, which is indicative of its permanence. “Human sleep” is the most evident reflection of conceptualization of death as sleep, showing that human death is what Frost has discussed. In the light of sleep, Frost’s “After Apple-Picking” is no longer a lyrical poem of a worker’s experience on the orchard farm and fatigue aftera day’s labor, but a profound thought on life and death through an extended conceptual metaphor of death as sleep.2.2 PEOPLE ARE PLANTSBoth man and tree are living beings that go through birth and wither, and the achievements of man are kin to the fruits of plants. “Apples I didn’t pick upon some bough” correspond to those unfilled dreams while apples that “struck the earth/ No matter if not bruised or spilled with stubble”correspond to people’s failed pursuits. The scent of apples refers to delight and satisfaction brought by success. In Frost’s poem, the act of apple-picking is a metaphor for the fruits the speaker has achieved in life.[7] It is universally acknowledged that success is what people desire and is something enjoyable. However, the speaker is overtired of the great harvest and wished to rest, which illustrates that the speaker has been bored with worldly sense of accomplishment and hopes to simple have a dream and a “long sleep”. Due to the sweet smell of the apple, the narrator actually falls asleep after fatigue and he enters into “long sleep”(death) with a sense of emptiness resulted from the excessive fruits he has gathered. The speaker’s experience reveals the poet’s meditation on life that it is futile people achieve a great deal of success but eventually own nothing after death. Therefore, the poet don’t ponder on human sleep for no reason but he penetrates the meaninglessness of long tough life struggles.The two root metaphors are carefully chosen to reflect Frost’s philosophy on death. This also confirms the cognitive value of metaphor, that is, vehicles(such as sleep) are usually well known to readers, and their features and structures will be mapped to relatively unfamiliar things when they interact with tenor (such as death) to help readers understand the characteristics and structures of ontology. The characteristics of sleep are mapped to the characteristics of death. Frost’ poem “After Apple-Picking” is not only a pastoral work of rural world in orchard farm but also a thought-provoking poem on death. The end of labor leaves the speaker with a sense of completion and fulfillment yet finds him blocked from success by winter’s approach and physical weariness. The futility that what people achieved as a result resembles fallen apples of no worth leads to fatigue and wish to seek relief in sleep, that is death. Therefore, this seemingly idyllic poem is in fact the ultimate exploration of human destiny through the metaphors of death as sleep and people as plants.3.Orientational MetaphorsOrientational metaphors do not structure one concept in terms of another but instead organize a whole system of concepts with respect to one another.[1] Most of them have to do with spatial orientation: up-down, in-out, front-back, on-off, deep-shallow, central-peripheral. These spatial orientations arise from the fact that we have bodies of the sort we have and that they function as they do in our physical environment. As Lakoff points out that CONSCIOUS IS UP; UNCONSCIOUS IS DOWN. HEALTH SND LIFE ARE UP; SICKNESS AND DEATH ARE DOWN. This poem employs spatial antagonism to construct death metaphor. “The Apple-Picking” involves a development from consciousness to unconsciousness. At the very beginning, the farmer is sober enough on the long two-pointed ladder sticking toward heaven. The spacial position is rather high. After the speaker has been done with apple-picking, rest is badly needed after the arduous labour. He is drowsed off and no longer in his conscious state. Frost adopts simple past tense from line8 to line17, serving as a beginning of the speaker’s dream. In the half unconsciousness of the farmer, the autumn evening bursting with the aroma of the apples has for a moment changed into a winter morning with hoary glass. In farmer’s dream, things “melted”, “fall and break”, which suggests a downward trend. Finally both woodchuck and the farmer fall asleep on the ground. The perspective of the whole poem shifts from heaven to earth, that is from top to bottom, revealing the opposition of space. A pane of glass divides the world into two parts: reality and dream. The transition from reality to dream is the manifestation of change of the speaker’s consciousness. The higher position represents reality and consciousness while the lower dream and unconsciousnessWhat’s more, the positional contrast reveals the opposition of life and death. In the first line of “After Apple-Picking”, the ladder occupies a central position in the whole picture of the poem, acting as a bridge between heaven and earth, life and death. The imagery of heaven and apples evokes the garden of Eden. The act of ascending the ladder symbolized a re-approach to heaven and eternal life while the movement down the ladder symbolizes the descent from heaven to earth, also from life to death[4]. According to Bible, picking apples is considered as corruption and degradation. As baskets of apples fall down and are spiked, they become worthless. This is true of human beings. After the farmer has finished apple-picking, fatigue and emptiness has wrapped him. His vigorous life reaches a pause, which actually means the farmer’s death. Most of fundamental concepts are organized in terms of one or more spatialization metaphors. In Frost’s “After Apple-Picking”, the poet shows the transition from consciousness to unconsciousness as well as from life to death in virtue of the binary opposition of space. The physical basis of such division is that humans sleep and die lying down and stand up when they are awaken. Therefore, the antagonism of life and death is constructed through the opposition of up and down positions, which contributes to the further construction of the root metaphors.4.Ontological MetaphorsOntological metaphor helps us understand those abstract entities through conceptualizing them as these entities and substances which are related to human’s experience. As Lakoff and Johnson point out: “our experience of physical objects and substances provides a further basis for understanding.” Ontological metaphor could be classified into three types, which are entity and substance metaphor, container metaphor and personification.Firstly, an invisible abstract concept, in entity and substance metaphor, is considered as a visible concrete object. Human being expresses abstract concepts as these entities and substances which are related to human’s experience. Death is an abstract concept, which can be understood thanks to another common concept—sleep. The dark and bleak state of death is implied by night in winter. The poet also tries to clarify the hibernation of hamsters and the long sleep of human beings: one is short seasonal rest and the other is an eternal stop of motion. In this way, the characteristics of death are no longer vague. The first root metaphor of death as sleep receives deeper and more detailed illustrations. Similarly, human achievements becomes a measurable entity like apples in “ After Apple-Picking”. Through these well-known common things, the original abstract concept can be elucidated. The essence of metaphor lies in the comparison between two entities.Secondly, container metaphor is a kind of ontological metaphor in which an invisible abstract concept is regarded as a container which has a surface owning scope and range with an in-out orientation. In Frost’s poem, the farmer’s dream and sleep is a container, where he can see “magnified apples”, feel “the pressure of ladder-round”. The farmer’s falling into dreams shows the motion from one space to another space. The state of farmer can be classified into “in sleep” and “out of sleep”, which symbolize death and life respectively.Lastly, personification specifies the physical object as being a man, which can make people to comprehend these different physical objects in light of human characteristics, motivations and activities. In Frost’s poem, apple “struck the earth” and long sleep can “come on” are all personification. They are extensions of ontological metaphors and that they allow us to make sense of phenomena in the world on the basis of our own goals. It is carefully chosen to endow this poem a dynamic effect so that the theme of this poem can be effectively conveyed. All in all, the understanding of a poetic metaphor is a cognitive process.[8] Ontological metaphor makes us understand abstract concepts by use of concrete concepts. The poet uses sleep to explain death, making the abstract concept simplified and concrete. In the poem, the dream not only reflects the structural metaphor, but also reflects the container metaphor. It forms a contrast between “in dream” and “out of dream” so as to further strengthen the difference between life and death. Apple has bruises, and Death actively does come in. These anthropomorphic expressions embody the metaphorical nature of language and the symbolic nature of death. As a result, metaphor of death in this poem has been justified.5.ConclusionThe exploration of the relationship between Frost’s view of death and Lakoff’s cognitive metaphors will undoubtedly help readers to guard against deceptive surface meanings when interpreting and appreciating Frost’s poems, and to explore the profound life philosophy reflected in his poems through metaphorical thinking and active participation.Through dividing metaphors in Frost’s “After Apple-Picking” according to Lakoff’s classification, the way of constructing poem’s theme is evidently revealed. At the first glance, it seems to be a lyrical poem, but it actually a poem of death after further analysis. Frost implicitly depicts life actions as apple picking activities, apples are symbols of human achievements, and death is similar to long sleep, which are structural metaphors, through which the characteristics of abstract concept death can be easily understood. Moreover, the orientational metaphors constitute to the body of this poem. The up-down spatial position divides the farmer’s state into consciousness and unconsciousness, also a reflection of human’s state of life and death. The contrast between in-out categories reflects the whole poem’s structure: it shifts from reality to dream. Since the farmer’s dream is explained as a container, the state of dreaming metaphorically stands for death. Therefore the whole poem is based on structural metaphors of death is sleep and people are plants, which are illustrated with orientational metaphors and ontological metaphors.However, the thesis still has some limitations due to the author’s slim analysis. It can be better with more logical illustrations and evidences. But it is no doubt that the thesis provides a new perspective of discussing Frost’s poem. It expands the application scope of Lakoff’s conceptual metaphor and enriches its practice, and produces referential meaning to literature appreciation. References[1]Lakoff, G & M. Johnson. Metaphors We Live By[M]. Chicago: The University of Chicago Press.1980.[2]Ungerer, F & H. J. Schmid. An Introduction to Cognitive Linguistics.[M]. Beijing: Foreign Language Teaching and Research Press. 2008.[3]K?vecses, Z. Metaphor: A practical introduction[M]. New York: Oxford University Press.2002.[4]李应雪. 一个解构批评的范本——析罗伯特·弗洛斯特诗歌《摘苹果之后》意义的模糊性[J]. 宁夏大学学报(人文社会科学版), 2007(04): 78-81.[5]Lakoff, G. The Invariance Hypothesis: is abstract reason based on image-schemas?[J]. Cognitive Linguistics, 1990(01): 39-47.[6]Huo, Lirong. Comments on “After Apple-Picking”[J]. Overseas English, 2012(01): 196-197.[7]赵志宇. 罗伯特·弗洛斯特的《摘罢苹果》[J]. 文学语言学研究, 2007(02):70-71.[8]胡壮麟. 诗性隐喻[J]. 山东外语教学, 2001(03): 3-8.。

精品医学课件--腕关节损伤(英文)

– Primary vascular supply enters distal pole and runs retrograde to the proximal scaphoid
– The more proximal the fracture, the more likely are healing complications.
Intercarpal Ligaments
• The proximal and distal carpal rows are attached by capsular ligaments on each side of the lunocapitate joint.
• Injury to these ligaments leads to abnormal motion between the two rows, and nondissociative wrist instability patterns.
• Injury to the scapholunate or lunotriquetral ligaments leads to asynchronous motion of the lunate and leads to dissociative carpal instability patterns.
• Lunate dislocation • FCR tendon rupture • Radial styloid fracture • Trapezium fracture • deQuervain’s disease • CMC (basal) joint arthrosis
Imaging
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• Physical Exam • Imaging

艾米·洛威尔经典诗歌：TheCross-Roads

艾米·洛威尔经典诗歌：The Cross-Roads艾米·洛威尔，美国诗人，她的第一部诗集是《多彩玻璃顶》。

1913年她在实验性的意象派运动中脱颖而出，并继埃兹拉·庞德之后而成为该运动的领袖人物。

她运用“自由韵律散文”和自由诗的形式进行创作，被称为“无韵之韵”。

下面店铺为大家带来艾米·洛威尔经典诗歌：The Cross-Roads，欢迎大家阅读!A bullet through his heart at dawn. Onthe table a letter signedwith a woman's name. A wind that goes howlinground the house,and weeping as in shame. Cold November dawnpeeping throughthe windows,cold dawn creeping over the floor, creeping up hiscold legs, creeping over his cold body, creeping across his coldface.A glaze of thin yellow sunlight on the staring eyes. Windhowlingthrough bent branches. A wind which never dies down. Howling,wailing.The gazing eyes glitter in the sunlight. The lids arefrozen openand the eyes glitter.The thudding of a pick on hard earth. A spade grindingand crunching.Overhead, branches writhing, winding, interlacing, unwinding, scattering;tortured twinings, tossings, creakings. Wind flingingbranches apart,drawing them together, whispering and whining among them. Awaning,lobsided moon cutting through black clouds. A streamof pebbles and earthand the empty spade gleams clear in the moonlight, then is rammedagaininto the black earth. Tramping of feet. Menand horses.Squeaking of wheels."Whoa! Ready, Jim?""All ready."Something falls, settles, is still. Suicideshave no coffin."Give us the stake, Jim. Now."Pound! Pound!"He'll never walk. Nailed to the ground."An ash stick pierces his heart, if it buds theroots will hold him.He is a part of the earth now, clay to clay. Overheadthe branches sway,and writhe, and twist in the wind. He'll never walk witha bulletin his heart, and an ash stick nailing him to the cold, black ground.Six months he lay still. Six months. And thewater welled up in his body,and soft blue spots chequered it. He lay still, for theash stickheld him in place. Six months! Then her facecame out of a mist of green.Pink and white and frail like Dresden china, lilies-of-the-valleyat her breast, puce-coloured silk sheening about her. Under the younggreen leaves, the horse at a foot-pace, the high yellow wheels ofthe chaisescarcely turning, her face, rippling like grain a-blowing,under her puce-coloured bonnet; and burning beside her, flamingwithinhis correct blue coat and brass buttons, is someone. What has dimmed the sun?The horse steps on a rolling stone; a wind in the branches makesa moan.The little leaves tremble and shake, turn and quake, over and over,tearing their stems. There is a shower of young leaves,and a sudden-sprung gale wails in the trees.The yellow-wheeled chaise is rocking -- rocking,and all the branchesare knocking -- knocking. The sun in the sky is a flat,red plate,the branches creak and grate. She screams and cowers,for the green foliageis a lowering wave surging to smother her. But she seesnothing.The stake holds firm. The body writhes, the body squirms.The blue spots widen, the flesh tears, but the stake wears well in the deep, black ground. It holds the body in the still,black ground.Two years! The body has been in the ground twoyears. Itis worn away;it is clay to clay. Where the heart moulders, agreenishdust, the stakeis thrust. Late August it is, and night; a nightflauntinglyjewelledwith stars, a night of shooting stars and loud insectnoises.Down the road to Tilbury, silence -- and the slow flapping of largeleaves.Down the road to Sutton, silence -- and the darkness of heavy-foliagedtrees.Down the road to Wayfleet, silence -- and the whirring scrape ofinsectsin the branches. Down the road to Edgarstown, silence-- and stars likestepping-stones in a pathway overhead. It is very quietat the cross-roads,and the sign-board points the way down the four roads, endlesslypointsthe way where nobody wishes to go.A horse is galloping, galloping up from Sutton. Shakingthe wide,still leaves as he goes under them. Striking sparks withhis iron shoes;silencing the katydids. Dr. Morgan riding to a child-birthover Tilbury way;riding to deliver a woman of her first-born son. Oneo'clock fromWayfleet bell tower, what a shower of shooting stars! Anda breezeall of a sudden, jarring the big leaves and making them jerk upand down.Dr. Morgan's hat is blown from his head, the horse swerves, andcurves awayfrom the sign-post. An oath -- spurs -- a blurring ofgrey mist.A quick left twist, and the gelding is snorting and racingdown the Tilbury road with the wind dropping away behind him.The stake has wrenched, the stake has started,the body, flesh from flesh,has parted. But the bones hold tight, socket and ball,and clamping them downin the hard, black ground is the stake, wedged through ribs andspine.The bones may twist, and heave, and twine, but the stake holds themstillin line. The breeze goes down, and the round stars shine,for the stakeholds the fleshless bones in line.Twenty years now! Twenty long years! The bodyhas powdered itself away;it is clay to clay. It is brown earth mingled with brownearth. Only flakybones remain, lain together so long they fit, although not one boneis knitto another. The stake is there too, rotted through, butupright still,and still piercing down between ribs and spine in a straight line.Yellow stillness is on the cross-roads, yellowstillness is on the trees.The leaves hang drooping, wan. The four roads point fouryellow ways,saffron and gamboge ribbons to the gaze. A little swirlof dustblows up Tilbury road, the wind which fans it has not strength todo more;it ceases, and the dust settles down. A little whirlof windcomes up Tilbury road. It brings a sound of wheels andfeet.The wind reels a moment and faints to nothing under the sign-post.Wind again, wheels and feet louder. Wind again -- again-- again.A drop of rain, flat into the dust. Drop! -- Drop! Thickheavy raindrops,and a shrieking wind bending the great trees and wrenching off theirleaves.Under the black sky, bowed and dripping with rain,up Tilbury road,comes the procession. A funeral procession, bound forthe graveyardat Wayfleet. Feet and wheels -- feet and wheels. Andamong themone who is carried.The bones in the deep, still earth shiver and pull. Thereis a quiverthrough the rotted stake. Then stake and bones fall together in a little puffing of dust.Like meshes of linked steel the rain shuts downbehind the procession,now well along the Wayfleet road.He wavers like smoke in the buffeting wind. Hisfingers blow out like smoke,his head ripples in the gale. Under the sign-post, inthe pouring rain,he stands, and watches another quavering figure drifting downthe Wayfleet road. Then swiftly he streams after it. Itflickersamong the trees. He licks out and winds about them. Over, under,blown, contorted. Spindrift after spindrift; smoke followingsmoke.There is a wailing through the trees, a wailing of fear,and after it laughter -- laughter -- laughter, skirling up to the black sky.Lightning jags over the funeral procession. A heavy clapof thunder.Then darkness and rain, and the sound of feet and wheels.艾米·洛威尔经典诗歌：The Cross-Roads 将本文的Word文档下载到电脑，方便收藏和打印推荐度：点击下载文档文档为doc格式。

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a r X i v :a s t r o -p h /0309106v 1 3 S e p 2003A cross-correlation of WMAP and ROSATJ.M.Diego 1,J.Silk 1,W.Sliwa 21University of Oxford,Denys Wilkinson Building,1Keble Road,OX13RHOxford,United Kingdom2Nicolas Copernicus Astronomical Centre,Bartycka 18,00-716Warsaw,Poland1IntroductionThe recent release of the WMAP data (Bennett et al.2003)has opened a new window for studies of large-scale structure based on the well known Sunyaev-Zel’dovich eﬀect (SZ eﬀect)(Sunyaev &Zel’dovich,1972).The SZ eﬀect shifts the spectrum of the CMB photons to higher frequencies.This shift is redshift-independent and proportional to the product of the electron column density with the average temperature along the line of sight.The electron tempera-ture and optical depth due to Thomson scattering are particularly high inside galaxy clusters.Thus,the SZ eﬀect is a good tracer of clusters,even for those at high redshift.Around galaxy clusters,a diﬀuse,possibly ﬁlamentary,dis-tribution of hot gas is believed to be present.These ﬁlaments have not been deﬁnitively detected due to their low contrast compared with the background(either CMB or X-ray backgrounds).The same electrons which cause the SZ eﬀect will also emit X-rays by bremsstrahlung emission.Therefore,one ex-pects the SZ eﬀect and the X-ray emission of galaxy clusters andﬁlaments to be spatially correlated.Since the X-ray background and the CMB are not cor-related(except at very large scales where there could be a correlation due to the integrated Sachs-Wolfe eﬀect(Boughn et al.1998)),the cross-correlation of an X-ray map with the CMB should enhance the signal of clusters andﬁl-aments with respect to the background.This fact motivates the present study. We will be interested in studying the cross-correlation SZ⊗XR(where⊗stands for cross-correlation).We need to deﬁne a statistical object to quantify this correlation.We will use the power spectrum of the SZ⊗XR map as such an object.We will also use the so-called cross-power spectrum(cross-correlation of the Fourier modes).There are several advantages to using the power spectrum and cross-power spectrum over other statistical objects.First, they contain useful information at diﬀerent scales.For instance the0mode accounts for the correlation coeﬃcient of the two maps.Higher modes will contain information about theﬂuctuations at smaller scales.The modelling of the power spectrum is also easier and it can easily account for the uncertainties in the assumptions made in the model.The power spectrum will also tell us something about the contribution of clusters andﬁlaments to the CMB power spectrum.Previous papers have claimed an excess in the CMB power spectrum (Mason et al.2003;Bond et al.2002).It is not yet clear whether this excess could be caused by the SZ eﬀect signal or just be inadequately subtracted residuals(compact sources or residual noise).An independent estimation of the SZ eﬀect power spectrum would help to clarify this point.The reader can ﬁnd all the details of this work on Diego et al.(2003)2The cross-correlation WMAP⊗ROSATWMAP data consists of5all-sky maps atﬁve diﬀerent frequencies(23Ghz <ν<94Ghz).At low frequencies,these maps show strong galactic emission (synchrotron and free-free).The highest frequency maps(41-94Ghz)are the cleanest in terms of galactic contaminants and will be the most interesting for our purpose.We will focus on one basic linear combination of the WMAP data,the diﬀerenced Q−W bands of the1◦smoothed version of the origi-nal data.This diﬀerencing completely removes the main contaminant in this work,the CMB,leaving a residual dominated by galactic and extragalactic foregrounds as well asﬁltered instrumental noise.On the other hand,the ROSAT All-Sky Survey data(RASS,see Snowden et al.1997)is presented in a set of bands(≈0.1−2keV).Low energy bands are highly contaminated by local emission(local bubble and Milky Way galaxy)Fig.1.Power spectrum of(Q-W)WMAP times ROSAT-R6.The thin solid lines are the predicted signals for models withσ8=0.8(A),σ8=0.9(B)andσ8=1.0(C). while high energy bands show an important contribution from extragalactic AGN’s.The optimal band for our purposes will be the band R6(≈0.9-1.3 keV).This band is the best in terms of instrumental response,background contamination and cluster vs AGN emission.The ROSAT maps have been cleaned from the most prominent point sources(sources above the threshold 0.02cts/s in the R5+R6band).However,we should note that for the above threshold,the survey source catalogue was incomplete and there are still some (very hard)point sources present in the maps of the diﬀuse X-ray background. We also have to note that during the point source subtraction process several compact clusters were removed from the data.This fact may introduce a sys-tematic error in our conclusions which will be discussed later.In order to maximise the extragalactic signal,we restrict our analysis to regions outside the galactic plane.In particular,we will consider only a clean portion of the sky above b=40◦and70◦<ℓ<250◦which will also exclude the contribution from the north-galactic spur.This optimal area of the sky covers ≈9%of the sky.We also have to remove a few bright point sources in the ROSAT maps which were not originally removed.Some of these sources will produce a correlation signal if we do not remove them.One of these bright sources(MRK0421) was already identiﬁed in a previous work as a source of correlation between ROSAT and COBE maps(Kneissl et al.1997).The power spectrum of W MAP⊗ROSAT(power spectrum of the product of the maps in real space)is shown inﬁgure1.At large scales(small multipoles) the product maps contains more power that at small scales(large l’s).This is mostly due to the smoothing process of WMAP maps(1◦)which suppresses power at small scales.We should also mention that,contrary to what happens in the cross-power spectrum,the power spectrum of the product maps doesFig.2.Cross-power spectrum(dotted line)compared with the modelsσ8=0.8 (A),σ8=0.9(B)andσ8=1.0(C).not have to be0if there is no correlation between the maps.This fact makes more diﬃcult the identiﬁcation of a correlation between two maps.In order to identify possible correlations we have to rotate one of the maps.Then,if there is a spatial correlation between the maps,the power spectrum will be smaller after rotating one of the maps.When we do that for several rotation angles we observe that the power spectrum does not change.This means that there is not a signiﬁcant correlation between the maps.When we look at the cross-power spectrum,we do not observe any signiﬁcant correlation either.The cross-power spectrum oscillates around0as expected for two maps which are not correlated.The cross-power spectrum is the k-ring average of the product of the Fourier modes of the two maps.If the maps are not correlated this average must be0.Although we do not detect any signal neither with the power spectrum of the product maps nor the cross-power spectrum,we can still use this fact to set some constraints on the model.Inﬁgures1and2we compare the measured power and cross-power with three diﬀerent models where we change the parameterσ8(Ωm isﬁxed to0.3).This simple comparison tell us that models with lowσ8are favoured by the observed lack of correlation between the two data sets.High values ofσ8can be accommodated if the SZ eﬀect is signiﬁcantly contaminated by point sources(embedded in the clusters)so the net distortion in the CMB is smaller than if the cluster signal is just pure SZ eﬀect(point sources contribute as positive signals while the SZ eﬀect is negative at the frequencies considered in this work).High values ofσ8can also be compatible with the data if the fraction of clusters removed in the point source subtraction process in ROSAT data contribute signiﬁcantly to the power spectrum and cross-power spectrum.We have estimated this possible source in systematic error in the worst-scenario case in which all the clustersFig.3.Current estimates of the CMB power spectrum compared with predicted SZ eﬀect power spectrum(R-J)for the previous models A,B,and C The top solid line is a rebinning(10bins)of the original WMAP CMB power spectrum.The symbols are current estimates by CBI and ACBAR(error bars have been omitted except in the last two points).The last three symbols atℓ≈3000are the estimated power spectrum at highℓby CBI(top),ACBAR(middle)and the expected CMB power spectrum for a standard model(bottom star).above the0.02cts/s point source removal threshold have been subtracted.In this case the theoretical power spectrum shown inﬁgures1and2should be smaller by a factor≈3.Taking this reduction in power into account,models withσ8=0.9could be marginally consistent with the lack of correlation but models withσ8=1.0still seem diﬃcult to reconcile.3conclusionsWe do notﬁnd any signiﬁcant correlation between WMAP and ROSAT.This lack of correlation can be due to contamination of the SZ eﬀect by point sources,a signiﬁcant reduction in the cluster signal due to erroneously sub-tracted clusters during the point source subtraction process in ROSAT data, the possibility that we live in a universe with a low normalisation of the power spectrumσ8or a combination of the previous factors.We found that diﬀerent assumptions about the model lead to diﬀerentﬁts to the data.In particular,high values ofσ8seem to be diﬃcult to reconcile with the absence of signiﬁcant correlation.This absence of signiﬁcant correlation could also be used to rule out the pos-sibility that the excess in ACBAR and CBI is due to SZ eﬀect.We illustrate this point inﬁgure3where we compare the power spectrum of the SZ eﬀect for the models A,B,and C with the recent estimate of the CMB power spectrum by WMAP(solid line)and with estimates from ACBAR(Kuo et al.2003)and CBI(Mason et al.2003).From this plot we could conclude that the fact that we do not observe a corre-lation between WMAP and ROSAT implies that the SZ eﬀect power spectrum should not contribute signiﬁcantly to any of these experiments.Unfortunately, the quality of the data does not allow us to make such a severe aﬃrmation. An updated version of this work made with the four year CMB data from WMAP and a new version of the soft X-ray diﬀuse background maps(with no cluster subtraction)could certainly help to answer this question.4AcknowledgementsThis research has been supported by a Marie Curie Fellowship of the European Community programme Improving the Human Research Potential and Socio-Economic knowledge under contract number HPMF-CT-2000-00967. References[1]Bennet et al.2003,ApJ accepted,astro-ph/0302207[2]Bond J.R.,et al.2002,ApJ submitted.astro-ph/0205386.[3]Boughn et al.1998,Boughn S.P.,Crittenden R.G.,Turok N.,1998,New Astronomy,vol3,no5,p.275.[4]Diego J.M.,Silk J.W.Sliwa,2003,MNRAS accepted.astro-ph/0302268[5]Kneissl R.,Egger R.,Hasinger G.,Soltan A.M.,Tr¨u mper J.,1997,A&A, 320,685.[6]Kuo et al.2003,ApJ submitted.astro-ph/0212289.[7]Mason et al.2003,ApJ,591,540.[8]Snowden S.L.,Egger R.,Freyberg M.J.,McCammon D.,Plucinsky P.P., Sanders W.T.,Schmitt,J.H.M.M.,Truemper J.,Voges W.1997,ApJ,485, 125.[9]Sunyaev R.A.,Zel’dovich Ya,B.,1972,A&A,20,189.。