Anterior Superior Spine Research Articles

Muscular Strategies for Correcting the Pelvic Position to Improve Posture-An Exploratory Study.

The correction of postural weaknesses through the better positioning of the pelvis is an important approach in sports therapy and physiotherapy. The pelvic position in the sagittal plane is largely dependent on the muscular balance of the ventral and dorsal muscle groups. The aim of this exploratory study was to examine whether healthy persons use similar muscular activation patterns to correct their pelvic position or whether there are different motor strategies. The following muscles were recorded in 41 persons using surface electromyography (EMG): M. trapezius pars ascendens, M. erector spinae pars lumbalis, M. gluteus maximus, M. biceps femoris, M. rectus abdominis, and M. obliquus externus. The participants performed 10 voluntary pelvic movements (retroversion of the pelvis). The anterior pelvic tilt was measured videographically via marker points on the anterior and posterior superior iliac spine. The EMG data were further processed and normalized to the maximum voluntary contraction. A linear regression analysis was conducted to assess the relationship between changes in the pelvic tilt and muscle activities. Subsequently, a Ward clustering analysis was applied to detect potential muscle activation patterns. The differences between the clusters and the pelvic tilt were examined using ANOVA. Cluster analysis revealed the presence of four clusters with different muscle activation patterns in which the abdominal muscles and dorsal muscle groups were differently involved. However, the gluteus maximus muscle was involved in every activation pattern. It also had the strongest correlation with the changes in pelvic tilt. Different individual muscle patterns are used by different persons to correct pelvic posture, with the gluteus maximus muscle apparently playing the most important role. This can be important for therapy, as different muscle strategies should be trained depending on the individually preferred motor patterns.

Assessment of the sacroiliac joint with computed tomography motion analysis: a diagnostic study of 12 patients.

Pain in the sacroiliac joint may be caused by abnormal joint motion. Diagnosis is mainly based on clinical tests. The aims of this study were to examine whether low-dose computed tomography with provocation of the hip could detect sacroiliac joint motion, and to study whether provocation of the hip results in greater sacroiliac joint motion in the ipsilateral than in the contralateral sacroiliac joint. 12 patients with sacroiliac joint pain were examined with low-dose computed tomography scans of the sacroiliac joint, one with the hips in the neutral position, and one each in provocation with the left or the right hip in a figure-of-4 position. Accuracy was tested by comparing internal rotation of the sacrum with internal rotation in the sacroiliac joint. Motion in the sacroiliac joint was assessed by comparing the position of each of the ilia with the reference, the sacrum. Data is shown as mean with 95% confidence interval (CI). We observed greater motion in the sacroiliac joint than internally in the sacrum, i.e., 0.57° (CI 0.43-0.71) vs. 0.20° (CI 0.11-0.28). The motion of the geometric center of the moving object for the sacroiliac joint was larger on the provoked side; mean difference 0.17 mm (CI 0.01-0.33), P = 0.04. Corresponding figures for rotation were mean difference 0.19° (CI 0.10-0.28), P < 0.001. Compared with the sacrum, the largest motion was seen at the anterior superior iliac spine; mean difference 0.38 mm (CI 0.10-0.66), P = 0.001. Provocation in the figure-of-4 position of the hip results in sacroiliac joint motion measurable with computed tomography motion analysis. Provocation of the hip induces larger motion on the ipsilateral than on the contralateral sacroiliac joint.

Exploring 3D Pelvis Orientation: A Cross-Sectional Study in Athletes Engaged in Activities with and without Impact Loading and Non-Athletes.

Female athletes subjected to various types of impact loading, especially over a long period of time, may experience changes in their pelvic orientation, which may affect their sport performance and increase the likelihood of injury. The aim of the present study was to determine whether female athletes involved in high-impact loading sports (HILS), odd-impact loading sports (OILS), and repetitive non-impact loading sports (NILS) demonstrate changes in pelvis orientation compared to non-athletes (NATH). Pelvic orientation was determined using Euler/Cardan angles, calculated from the coordinates of the right, and left anterior superior iliac spines and pubic symphysis via a novel method. Two-way ANOVA tests showed significant differences between groups for pelvis position in the frontal plane (p < 0.05), with HILS and OILS demonstrating greater pelvic obliquity compared to NILS athletes and NATH. Significant main effects were also obtained for directions within the sagittal plane (p < 0.001). Significant within-group differences were observed in sagittal pelvic position among female athletes engaged in NILS (p < 0.01) and non-athletes (NATH) (p < 0.05), with a greater anterior pelvic tilt compared to posterior. Our findings suggest that pelvis orientation in female athletes across sports is influenced by sport-specific impact loads, potentially affecting performance and injury occurrence.

Anatomic feasibility study of a sartorius myocutaneous flap with a distally based pedicle and proximal skin paddle

IntroductionWe conducted an anatomic feasibility study of a sartorius myocutaneous flap with a distally based pedicle and proximal skin paddle to cover soft tissue defects of the knee region. HypothesisA recent anatomic study by Mojalla showed that the sartorius muscle had 2 distinct pedicles, making it possible to isolate this muscle on its distal pedicle and harvest it with a skin paddle. Materials and methodsThis anatomic study was conducted on 10 lower limbs. The 2 criteria assessed were (1) the viability of our proximal skin paddle and (2) the arc of rotation and coverage obtained with this myocutaneous flap. ResultsWe identified 7 proximal skin paddles after the injection of India ink into the distal pedicle of the sartorius muscle. In all cases, the arc of rotation of the flap allowed coverage of the knee region. The mean distance between the inferior edge of the skin paddle and the proximal border of the patella (DBAP) was measured at 13cm, and the mean distance between the superior edge of the flap paddle and the anterior superior iliac spine (DASIS) at 16cm. The average skin paddle size was 14 by 7cm. DiscussionOur anatomic study demonstrated the feasibility of our sartorius flap with a distally based pedicle and proximal skin paddle. This technique may be a viable alternative when using gastrocnemius flaps is not feasible, or the surgeon lacks the microsurgical skills to perform free flaps. Level of evidenceIV; descriptive anatomic study.

Osteochondromas Gone Pelvic: A Case Report of Concurrent Tibial Osteoblastoma and incidental detection of multiple pelvic Osteochondromas on bone scan.

In a unique clinical presentation, a 20-year-old female with a known left distal Tibial Osteoblastoma (previously treated via curettage) developed pain and weight-bearing difficulties in her left lower limb six months later. Subsequently bone scan revealed a unprecedented clinical presentation: residual activity in the treated Osteoblastoma alongside additional foci of increased tracer uptake on skeletal scintigraphy, localized to the bilateral anterior superior and inferior iliac spines. Subsequent radiographs confirmed sessile bony outgrowths in these locations, consistent with multiple pelvic Osteochondromas (an uncommon variant). Notably, these Osteochondromas lacked associated radiolucencies or cortical destruction. Further MRI confirmed the Osteochondroma diagnosis. Interestingly, the patient declined surgical intervention for the asymptomatic Osteochondromas, prioritizing ongoing treatment for the primary Osteoblastoma. This case highlights the rare co-occurrence of these distinct tumor types in an uncommon usual pelvic location, emphasizing the importance of patient centered treatment approach based on patient preferences and clinical context.

Alternative Models for Pelvic Marker Occlusion in Cycling.

Bike fitting aims to optimize riders' positions to improve their performance and reduce the risk of injury. To calculate joint angles, the location of the joint centers of the lower limbs needs to be identified. However, one of the greatest difficulties is the location of the hip joint center due to the frequent occlusion of the anterior superior iliac spine markers. Therefore, the objective of this study was to validate a biomechanical model adapted to cycling (modified pelvic model, MPM), based on the traditional pelvic model (TPM) with an additional lateral technical marker placed on the iliac crests. MPM was also compared with a widely used model in cycling, trochanter model (TM). Thirty-one recreational cyclists pedaled on a roller bike while the movement was captured with a 7-camera VICON system. The position of the hip joint center and knee angle were calculated and compared with the TPM continuously (along 10 pedaling cycles) and discreetly at 90° and 180° crank positions. No significant differences were found in the position of the hip joint center or in the knee flexion/extension angle between the TPM and the MPM. However, there are differences between TPM and TM (variations between 4.1° and 6.9° in favor of the TM at 90° and 180°; P < .001). Bland-Altman graphs comparing the models show an average difference or bias close to 0° (limits of agreement [0.2 to -8.5]) between TPM and MPM in both lower limbs and a mean difference of between -4° and -7° (limits of agreement [-0.6 to -13.2]) when comparing TPM and TM. Given the results, the new cycling pelvic model has proven to be valid compared with the TPM when performing bike fitting studies, with the advantage that the occluded markers are avoided. Despite its simplicity, the TM presents measurement errors that may be relevant when making diagnoses, which makes its usefulness questionable.

Anatomical features of venous and arterial corona mortis in fresh cadavers in the Turkish population and anatomical landmarks to be used during surgical procedures

Objectives: The aim of this study is to determine the topographic position of the corona mortis on fresh cadavers and also to determine anatomical landmarks that will facilitate surgeons to consider to this structure during operations by clarifying the relationship of the corona mortis with the surrounding anatomical structures. Methods: A total of 50 autopsy cases of 31 men and 19 women, all examined within 24 hours post-mortem, were evaluated bilaterally for the presence of corona mortis. When identified, the vascular characteristics (arterial/venous) of the corona mortis were documented. The topographic position of the corona mortis was determined by measuring the distances to the pubic symphysis, promontory, obturator nerve and anterior superior iliac spine. The study also investigated whether some anthropometric measurements affect these distances. Results: Out of the 100 hemipelves examined, corona mortis were observed in 50 cases. Among these, 34% were arterial (n=17), and 66% were venous (n=33). Anastomoses were identified in the hemipelves of 22 women and 28 men, with no significant gender difference (p&gt;0.05). The average distances to anatomical landmarks were as follows: 5.43 cm to the pubic symphysis, 1.77 cm to the obturator nerve, 9.87 cm to the promontory, and 10.56 cm to the anterior superior iliac spine. Conclusion: Corona mortis poses a significant risk in surgical procedures. Knowing the vascular anatomy of the pelvis is vital for gynecological, urological and orthopedic interventions, while investigating deaths caused by pelvic trauma is important for forensic practice. This anatomical study contributes to a better understanding of the complex and intricate pelvic structure.

Variability of anterolateral thigh flap perforator locations - clinical implications.

&lt;b&gt;&lt;br&gt;Introduction:&lt;/b&gt; The anterolateral thigh flap is an example of a free flap widely applied for reconstruction of tissues within various areas of the body.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Aim:&lt;/b&gt; The aim of the study was to determine the most common locations of the ALT flap perforators in men and women as well as to clarify any potential differences in the location of the vessel in male vs. female subjects.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Material and method:&lt;/b&gt; In years 2021-2022, a study was conducted at the Plastic, Reconstructive, and Aesthetic Surgery Clinic in a group of 90 volunteers (45 women and 45 men, a total of 180 lower extremities) to determine the location of the anterolateral thigh flap perforator against the flap surface using a portable Doppler probe.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Results:&lt;/b&gt; Variable locations were revealed for the anterolateral thigh flap perforator within the study. In women, the perforator is located more distally from the anterior superior iliac spine, most frequently within the inferolateral quadrant, while being located closer to the anterior superior iliac spine, and most frequently within the superolateral quadrant, in men. No perforator was found in 3.3% of the examined limbs. No statistically significant differences were observed between the course of the perforators within the left and right lower limbs in individual patients.&lt;/br&gt; &lt;b&gt;&lt;br&gt;Conclusions:&lt;/b&gt; The location of the ALT flap perforator is subject to sexual dimorphism, which facilitates the investigation area being narrowed down to the well-defined locations of its most frequent occurrence when planning anterolateral thigh flap reconstructive procedures.&lt;/br&gt.

Premier Highland dancer sports injuries

Objective: The objective of this paper is to document sports injuries in premier Highland dancers. Highland dance originated in Scotland and is a relatively unknown sport to physiatrists and sports physicians. It is not the same as Irish dance performed in tap shoes but has some similarities to ballet with regard to the turnout of the leg in the first position. Methods: An Institutional Review Board approved, prospective, telephone survey was conducted to document demographics, area, type, and age of injury in premier Highland dancers. Results: A total of 22 premier Highland dancers met the inclusion criteria for the study. In the hip region, injuries included apophysitis at the anterior superior iliac spine. In the knee region, knee effusions, shin splints, and hairline stress fractures of the tibia were reported. In addition, less common injuries in sports, such as tibialis anterior strain and plantaris tendon partial rupture, were noted. In the ankle/foot region, sprains and tears of anterior tibiofibular, calcaneofibular, posterior talofibular ankle ligaments, and plantar fasciitis were observed, as well as fractured metatarsals in the foot and degenerative arthritis. Conclusion: Injuries resulting from improper alignment in “turnout” (external rotation at the hip) and overuse syndromes from intense and long hours of training to reach national and international competitive premier level were observed. Uncommon injuries, such as tibialis anterior strain and plantaris tendon partial rupture, were also noted that were unique to the jumping and heel/toe maneuvers performed in this sport.

The Anatomical Course of the Femoral Nerve with Regard to the Direct Anterior Approach for Total Hip Arthroplasty

BackgroundFemoral nerve (FN) injury is noted as a serious neurological complication following total hip arthroplasty performed via a direct anterior approach (DAA). Therefore, we aimed to clarify the anatomical course of the FN around the acetabular rim and in relation to retractor placement during DAA. MethodsAccording to standard protocol, a DAA for total hip arthroplasty was performed on 69 hemipelves from formalin-preserved full-body donors. The surgery was halted after retractor placement at the anterior part of the acetabulum. Then dissection was performed to expose the FN and the iliopsoas muscle. Various measurements were taken using a reference line from the anterior superior iliac spine to the acetabulum’s center. A total of 6 measurement points, one every 30° from 0° to 150° along the reference line were used to determine the association between the FN and the retractor tip (RT) and the anterior acetabular rim. ResultsThe mean distance from the RT to the FN was 22.5 millimeters (mm). The distance from the FN to the anterior acetabular rim decreased from 0 to 90°, where it was 18.8 mm, before increasing again to 27.3 mm at 150°. ConclusionsIn our cadaveric study, the FN was within 11 to 36 mm of the RT. Second, we found the FN to be closest to the anterior acetabular rim at 90° and 120°. Accordingly, special care should be taken during retractor placement, and if possible, placement at 90° and 120° avoided.

Pregnancy with Peripheral Arteriovenous Malformation

22 years old primigravida with 37 weeks singleton gestation was admitted with profuse bleeding from swelling over left anterior superior iliac spine region. Ultrasound findings suggested a high flow vascular malformation with feeder from left common femoral artery. Bleeding was managed conservatively with pressure bandage. Delivery was uneventful. Live female baby of 2.045 kg was delivered by spontaneous vaginal delivery at 38 weeks. After 4 weeks of delivery vascular malformation was confirmed with angiography and treated successfully with endovascular embolization of the major arterial feeder. In periodic follow up until 6 months, no further complication was reported by the patient.

Digit ratio and the femoral circumflex artery perforator: A sex-dependent association between the vascular system of the thigh and prenatal sex hormones?

BackgroundThe anterolateral thigh flap (ALTF) is a type of free flap which is commonly used in reconstructive surgery procedures and is based on the perforator from femoral circumflex artery. Some authors found that the location of the perforator differs between sexes. ObjectiveTo verify the influence of prenatal sex hormones (as measured by 2D:4D) on the morphology of the perforator of the descending branch of the femoral circumflex artery. Methods88 participants (43 women) of a mean age of 28.5 years (SD 8.1 years) had the following measurements performed: height and weight; right and left-hand 2nd and 4th fingers' lengths; and distance from anterior superior iliac spine to the perforator from descending branch of lateral femoral circumflex artery related to the thigh length (right and left) (AP ratio). ResultsRight 2D:4D and Dr-l (right minus left 2D:4D) were dimorphic, similarly to AP ratio (right and left), which in women was significantly higher than in men. A significant correlation was found between right and left 2D:4D and location of the perforator of the left thigh in men. The higher right and left 2D:4D (more feminine) the higher the left AP ratio (more feminine). ConclusionOur findings suggest that the location of perforator of femoral circumflex artery may be influenced by prenatal sex steroids such that low prenatal testosterone and high prenatal oestrogen are correlated to high AP (lower branching of the artery).

Variations of the Femoral Artery Position in Relation to Femoral Vein and Mid-inguinal Point: A Cadaveric Study

Introduction: Femoral artery is one of the major arteries in human body. It is more preference for catheterization in some medical procedures. This study was designed to identify anatomical variations of the femoral artery position, in relation to femoral vein and mid-inguinal point of human cadavers. Methods: Dissection was performed on 22 cadavers. The associations were analyzed using Fisher’s Exact test and correlation test. Results: There was superolateral positioning detected. Distal traversing was only observed on the left thigh. Bivariate analysis showed that there was a significant association of distance from anterior superior iliac spine (ASIS) to femoral artery between the right and left thigh. However, there was no significant association of distance from mid-inguinal point (MIP) to femoral artery between the right and left thigh, position of femoral artery to MIP between the right and left thigh and distance of traversing point between the right and left thigh. Conclusion: This study showed that distance from ASIS to mid-point of femoral artery was significantly associated with the left-right sided of cadavers, while distance from MIP to femoral artery, position of femoral artery to MIP and distance of traversing point were not significantly associated with the left-right sided of cadavers. These informations may help in diagnostic cardiac catheterization procedures and coronary interventions.

Safe surgical corridor for iliosacral screw placement in unstable pelvic fractures: a computed-tomography-guided validation study of the “triangulation method”

BackgroundThe percutaneous iliosacral screw technique represents a global standard fixation method for unstable fractures of the posterior pelvic ring. However, the inaccurate positioning of iliosacral screws is associated with a significant risk of severe intra-operative complications. Therefore, this study aimed to investigate the relationship between the skin entry point of the transverse iliosacral screw of the first sacral vertebral body and the anterior superior iliac spine and the greater trochanter of the femur using computed-tomography-guided validation.MethodsOverall, 91 consecutive patients admitted to a tertiary referral center in China for posterior pelvic ring fixation via the “triangulation method” using computed-tomography-guided validation between January 1, 2020, and December 31, 2020, were included in this retrospective observational cohort study. Modeling and simulated iliosacral screw placement were performed using the Mimics software. The distance between the three points of interest was measured, and their relationship in a rectangular coordinate system was determined. Patients were categorized according to gender, body mass index, and femoral rotation angle to investigate the factors affecting the positional relationship between the three points.ResultsAn equilateral triangular relationship was observed between the positioning points of the transverse iliosacral screw, anterior iliac spine, and greater trochanter. Additionally, 95% of the entry points were within a circle radius centered 12 mm at the apex of an equilateral triangle comprising the anterior superior iliac spine and the greater trochanter as the base. The entry point in the femoral external rotation was more dorsal than that in the internal femoral rotation. Furthermore, the entry point in females was more rostral than that in males, and the entry point in overweight patients was more dorsal than that in normal-weight patients.ConclusionsThe skin entry point of the percutaneous iliosacral screw can be located by drawing an equilateral triangle from the anterior superior iliac spine and the greater trochanter as the base to the dorsum end of the patient’s head. In summary, this retrospective cohort study validated the safety and efficacy of the “triangulation methods” for percutaneous fixation of unstable posterior pelvic ring injuries.

Comparison of Pelvic Landmarks for Leg Length Discrepancy Measurement With Robotic Arm-Assisted Total Hip Arthroplasty

BackgroundLeg length discrepancy (LLD) is a common complication after total hip arthroplasty (THA) leading to significant morbidity and dissatisfaction for patients. A popular system for robotic arm-assisted THA utilizes preoperative computed tomography (CT) scans for surgical planning. Accurate measurement of leg length is crucial for restoring appropriate patient anatomy during the procedure. This study investigates the interobserver and interlandmark reliability of 3 different pelvic landmarks for measuring preoperative LLD. MethodsWe compiled preoperative pelvic CT scans from 99 robotic arm-assisted THAs for osteoarthritis. Radiologic leg length measurement was performed using the robotic arm-assisted THA application by 2 orthopaedic residents using reference lines bisecting the following pelvic landmarks: the anterior superior iliac spines, acetabular teardrops, and most inferior aspect of the ischial rami. ResultsOn multivariate analysis, there was no significant difference found (P value = .924) for leg length measurement based on the 3 different pelvic anatomical landmarks. Leg length measurements showed interobserver reliability with significant Pearson correlation coefficients (r = 1.0, 0.94, 0.96, respectively) and nonsignificant differences in LLD means between subjects on paired sample (P value = .158, .085, 0.125, respectively) as well as between landmarks on pairwise comparison. ConclusionsThe 3 pelvic landmarks used in this study can be used interchangeably with the lesser trochanter as the femoral reference point to evaluate preoperative LLD on pelvic CT in patients undergoing robotic-arm assisted THA. This study is the first of its kind to evaluate the interobserver and interlandmark reliability of anatomical landmarks on pelvic CT scans and suggests interchangeability of 3 pelvic landmarks for comparing leg length differences.

Step-cut osteotomy of the anterior superior iliac spine for increased visualisation in the Levine approach for Bernese periacetabular osteotomy surgery.

Hip dysplasia can lead to pain and dysfunction in the young adult. Acetabular undercoverage leads to abnormal joint loading and results in joint degeneration, accelerating need for arthroplasty in this patient population. Conceptually, treatment focuses on increasing acetabular coverage in the form of periacetabular osteotomy. The procedure can be performed through the iliofemoral approach, and performing an anterior superior iliac spine (ASIS) osteotomy can enhance the visualisation in this approach. Several techniques have been described for ASIS osteotomy. The purpose this study was to report on step-cut technique for ASIS osteotomy during the Bernese periacetabular osteotomy procedure to enhance visualisation when utilising the iliofemoral approach. This step-cut technique enhances stability at the osteotomy site, and minimises soft tissue dissection to reduce pain and assists with maintaining a stable fixation construct postoperatively. There were no nonunions and minimal morbidity to the lateral femoral cutaneous nerve injury in cohort of 86 patients while utilising this technique. We recommend using this step-cut ostetomy of the ASIS during Bernese periactetabular osteotomy for benefit of increasing exposure while maintaining a low complication profile.

Non-invasive assessment of sacroiliac joint and lumbar spine positioning in different unilateral sitting postures

ABSTRACT Background Sacroiliac joint (SIJ) motion has been documented using invasive and noninvasive kinematic techniques. No study has explored SIJ angular positions in functional postures using noninvasive techniques. The purpose of this study was to quantify SIJ positioning among different seated postures in a healthy population. Methods Twelve female and 11 male healthy young participants participated. Left and right anterior and posterior superior iliac spines were manually digitized during standing, neutral sitting and four different seated postures. Rigid bodies recorded the kinematics of the lumbar spine. Angles calculated included transverse sacroiliac angle, innominate sagittal angle, sacral tilt, lumbar flexion-extension, lumbar lateral bend and lumbar axial twist. Findings The observed range of angular positions was approximately 3 to 4 degrees across the SIJ-related angles. The main effect of seated posture was observed for all angles measured. The main effect of sex was observed for all angles except lumbar lateral bending. Females consistently experienced more posterior sacral tilt than males. Interaction effects between sex and posture were only observed at the right-transverse sacroiliac angle and sacral tilt. Previous sitting posture affected the subsequent neutral sitting posture for the right-transverse sacroiliac angle and lumbar spine angle. Interpretation SIJ angular position differences among the seated postures were similar in magnitude to motions previously reported in participants undergoing prone passive hip abduction and external rotation. Sex differences, including greater sacral posterior tilt observed in females, likely reflect underlying morphological and physiological differences. Future studies should explore SIJ positioning during functional tasks in pathological populations to help elucidate the underlying causes of SIJ pain and inform treatment strategies.

A retrospective CT based comparative analysis of available screw pathways to determine optimal iliac screw trajectory

&lt;b&gt;Introduction:&lt;/b&gt; The lumbo-sacral stabilization using iliac screw is gaining popularity in such cases of long multi segment lumbar constructs. Iliac screws help to achieve strong spinopelvic fixation, augments and protects sacral screws. However, there is a great variability found in literature for iliac screw fixation in terms of trajectory, screw length and screw diameter. Also, to the best of our knowledge, there is lacunae in current literature regarding the optimal pathway, screw length and screw diameter in the Indian population. Hence, we planned the study with the aim to analyze the available screw pathways to determine optimal iliac screw trajectory, screw length and diameter for the Indian population.&lt;br /&gt; &lt;b&gt;Material and methods:&lt;/b&gt; This was a tertiary center-based retrospective study. One hundred pelvic CT scans of patients in 18-70 years age, who underwent abdominal CT on Siemens 256-slice dual source CT scanner for various indications were evaluated. Subsequently, 4 iliac screw trajectories were assessed by connecting the points given below using double oblique reformats on which the lengths and narrowest zones of these trajectories were measured. Path A: Posterior Superior Iliac Spine (PSIS) to Anterior Superior Iliac Spine (AIIS); Path B: point between PSIS and posterior inferior iliac spine (PIIS) to Anterior Inferior iliac spine&amp;nbsp; (AIIS); Path C: iliac crest intersection point (CLIC) point to Upper acetabulum; Path D: CLIC point to acetabular center.&lt;br /&gt; [p1]&amp;nbsp;&lt;b&gt;[a2]&amp;nbsp;Results:&lt;/b&gt; Statistically significant difference was found in the lengths of various pathways. Path A (PSIS to AIIS) was found to be the longest (mean 13 cm). The second longest path in our study was path C (CLIC point to Upper acetabulum). The narrowest widths of each path were not found to have any statistically significant difference.&lt;br /&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Iliac screw fixation is of paramount importance for lumbosacral stabilization. Of the studied paths, trajectory from posterior-superior iliac spine to Antero-inferior iliac spine has the longest passage length and is the most optimal path for the Indian population. In case additional screws are required, the trajectory from CLIC point to Upper acetabulum provides the second largest screw passage.

Bikini-line Hiatal Hernia Repair (BLHHR) During Sleeve Gastrectomy

BackgroundTo preserve the aesthetic benefits achieved with Bikini line sleeve gastrectomy (BLSG), we have devised a novel approach for simultaneous hiatal hernia repair (HHR), known as bikini-line hiatal hernia repair (BLHHR). This manuscript presents our initial experience with BLHHR and assesses its feasibility and outcomes.MethodsA prospective preliminary study was conducted on patients who underwent BLHHR between September 2020 and October 2022. Patient demographics, preoperative assessments, operative details, postoperative outcomes, and aesthetic evaluations were recorded. Feasibility and safety were assessed.ResultsAmong 891 BLSG patients, 89 (9.9%) underwent BLHHR. The mean distances between the xiphoid process and the umbilicus, symphysis pubis, and anterior superior iliac spine (ASIS) were 28.8 ± 2.2, 33.9 ± 3.1, and 31.2 ± 1.8 cm, respectively. Optimal visualization and accessibility of the gastroesophageal junction (GEJ) were achieved without compromising HHR repair or sleeve gastrectomy. The mean operative time was 76.5 ± 11 min, longer than the 58 ± 10 min required for BLSG alone. Patient scar satisfaction ranged from 87.5 to 97.9%, and the mean pain score was 2.9 ± 0.8. No major complications were reported. At 6 months, %EWL (percentage of excess weight loss) was 53.3 ± 13.7%, GERD (gastroesophageal reflux disease) remission was achieved in 62.8% of patients and comorbidities were improved.ConclusionBLHHR was potentially feasible and safe. Outcomes related to patient scar satisfaction, weight loss, improvement of associated comorbidities, and GERD symptoms were not compromised. The aesthetic benefits achieved by BLSG were maintained.Graphical

Impact of PRaG Therapy on Peripheral Immune Cells of Subcutaneous Tumor Peritoneal Metastasis Model of Colon Cancer

Immune cells in peripheral blood may be closely related to the efficacy of immune checkpoint inhibitors. T cells originally present in tumors may have limited antitumor effects, and T cells that respond to immune checkpoint inhibitors may be derived from peripheral blood. Therefore, in this study, subcutaneous tumor peritoneal metastasis model of colon cancer was constructed to reveal the changes of T cells and their subsets (CD4+T cells, CD8+T cells, CD226+T cells), MDSCs and their subsets (G-MDSCs, M-MDSCs) in peripheral blood of mice after PRaG therapy. A total of 90 male Balb/c mice aged 6-8 weeks were divided into five groups: control group, PD-1 inhibitor group, radiation group, radiation + PD-1 inhibitor group, and radiation + PD-1 inhibitor +GM-CSF (PRaG therapy) group. The subcutaneous tumor peritoneal metastasis model of colon cancer was constructed. 3×105 CT26.WT cells was inoculated subcutaneously at the right thigh root, and 5 days later, 1×105 CT26.WT cells was inoculated on the left side at the junction of the anterior superior iliac spine and the midabdominal line. The subcutaneous tumor was selected for radiotherapy of 8 Gy×3. GM-CSF (100ng, i.p.) was given on the 1st day and PD-1 inhibitor (0.25mg/kg, i.p.) was given on the 2nd day after radiotherapy with one cycle every 3 days. On day 22, the peripheral blood of mice was collected. The proportion of immune cells was detected by flow cytometry. Compared with other groups, PRaG therapy decreased the proportion of CD4+T cells and increased the proportion of CD8+T cells. Moreover, PRaG therapy increased the proportion of CD226+CD4+T cells and CD226+CD8+T cells. Finally, PRaG therapy increased the proportion of M-MDSCs and decreased the proportion of G-MDSCs. PRaG therapy can improve the immune microenvironment of peripheral blood of subcutaneous tumor peritoneal metastasis model of colon cancer in mice.