Forearm Research Articles

Detection of skin thickness and echo density in healthy adults by using high-frequency ultrasound

Objective To measure the thickness and echo density of the skin at multiple sites of healthy adults by using high-frequency ultrasound. Methods A total of 50 healthy volunteers were enrolled from Department of Dermatology and Venereology, China-Japan Friendship Hospital between June and December in 2018, including 33 females and 17 males aged 22-69 years. The thickness and echo density of the epidermis, dermis and epidermis-dermis layer were detected by using high-frequency ultrasound at 12 sites, including the forehead, cheek, chest, abdomen, and the inner and outer sides of the upper arm, forearm, thigh and leg. The means of two groups were compared by using t test, and means of several groups were compared by using one-way analysis of variation. Results High-frequency skin ultrasound images differed among different anatomical sites. There were significant differences in the thickness and echo density of the epidermis, dermis and epidermis-dermis layer among the 12 sites (P < 0.05) . The epidermis was thickest at the inner side of the thigh (160.68 μm ± 25.71 μm) , the dermis was thickest at the cheek (1 828.78 μm ± 399.10 μm) , and the epidermis-dermis layer was thickest at the cheek (1 943.48 μm ± 402.4 μm) . The echo density of the epidermis, dermis and epidermis-dermis layer was highest at the inner side of the leg (152.27 ± 21.56) , forearm (52.71 ± 15.57) and forearm (62.56 ± 15.76) respectively. The thickness of the epidermis, dermis and epidermis-dermis layer at the forehead, cheek and the inner side of the forearm was significantly higher in male volunteers than in female volunteers (P ≤ 0.05 or < 0.01) , while the echo density of the dermis and epidermis-dermis layer at the forehead, cheek and the outer side of the leg was significantly lower in male volunteers than in female volunteers (P < 0.05 or 0.01) . Conclusion Differences exist in skin thickness and echo density among different anato mical sites and between male and female healthy adults. Key words: Ultrasonography; Epidermis; Dermis; Skin thickness; Skin echo density

Application of fusion site osteotomy combined with ulna and radius osteotomy for the treatment of congenital proximal radioulnar synostosis

Objective To explore the clinical features and surgical treatment of congenital proximal radioulnar synostosis. Methods From May 2014 to May 2017, 9 cases of congenital proximal radioulnar synostosis were treated in our hospital. By preoperative X-ray examination, forearm shape, forearm rotation function, elbow flexion and extension function, the fusion and development of radial head, ulna and radius were observed and classified. The operations including fusion site osteotomy, ulna osteotomy, radius osteotomy, interosseous membrane release and circular ligament reconstruction were performed. Results Nine patients performed operation on 14 sides were follow-up for 3 to 38 months with an average of 17 months. No re-synostosis occurred, and the shape and rotation function of the forearm were improved. The elbow function was evaluated by Mayo score, and the results were excellent in 7 sides, good in 5 sides and fair in 2 sides. Conclusion Congenital proximal radioulnar synostosis seriously affects the quality of life of children, and the fusion site osteotomy combined with ulna and radius osteotomy can achieve good treatment outcomes. Key words: Congenital abnormalities; Surgical procedures, operative; Proximal radioulnar synostosis; Osteotomy

Combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery for the reconstruction of large area tissue defects of upper limbs

Objective To explore the feasibility and clinical efficacy of combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery for the reconstruction of large area tissue defects of upper limbs. Methods From January 2014 to June 2018, 22 patients with large area skin and soft tissue defects of upper extremities were treated with bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery. The donor site was closed directly. The wound involved upper arm, forearm, hand and elbow stump. The area of defect ranged from 16 cm×13 cm to 40 cm×15 cm. Results Twenty-one cases (95.45%) of the combined flaps survived completely. One case had partial necrosis of the distal part of the flap, which was healed by second-stage skin grafting. The donor sites of the flaps were closed directly and achieved primary healing without complications. The follow-up period ranged from 3 to 38 months with an average of 20 months. All the cases had good wound healing and limb functional recovery. Conclusion The combined transplantation of bilateral perforator flaps based on the descending branch of lateral circumflex femoral artery is an effective method for repairing large skin and soft tissue defects of upper extremities. The operation is simple, the perforator vessel is reliable and the flaps can be cut in large area with less damage to donor site. Key words: Upper extremity; Surgical flaps; Descending branch of lateral circumflex femoral artery; Upper extremity reconstruction

Design and analysis of demolition robot arm based on finite element method

As a novel robot which mainly engages in the demolition and transformation of various concrete buildings, the demolition robot has developed rapidly in recent years. The impact force is mainly produced by the breaking hammer installed in the front end of the arm. As the most important part of a demolition robot, the boom arm is mainly composed of four parts including a supporting arm, a main arm, a fore arm, and a breaking hammer system. In this article, a mechanical model of the boom arm is established, and the finite element analysis obtaining the first four-order natural frequencies and modes is carried out in ANSYS Workbench. The results reveal that the resonation can be easily stimulated when a hydraulic breaking hammer is at the second-order frequency. The mounting block of the hydraulic breaking hammer, the hinge parts of the supporting arm, and the main arm are easily deformed or damaged in the Y direction by analyzing the deformation in three directions of the second-order mode. After the structure optimization, the vibration characteristics of the two parts are significantly enhanced, which provides a theoretical basis for optimizing the prototype and gives a reference in the experimental modes.

Headless double-threaded compression screws plus microplate for capitellar fracture of Ring typeII

Objective To investigate the clinical effects of headless double-threaded compression screws plus microplate for treatment of capitellar fracture of Ring type Ⅱ. Methods In the period from March 2015 to February 2018, 12 capitellar fractures of Ring type Ⅱ were treated at Department of Upper limb Orthopedics, Zhengzhou Orthopaedics Hospital. There were 8 men and 4 women, aged from 25 to 57 years (average, 35.4 years). There were 5 left and 7 right fractures. The fractures were exposed and reduced through the posterolateral elbow approach in 6 patients and through the lateral elbow approach in the other 6 ones. Fixation of all the fractures was conducted with headless double-threaded compression screws plus microplate. At the final follow-up, the elbow function was evaluated by the Mayo elbow performance score and the severity of traumatic arthritis by the Broberg & Morrey imaging criteria. Results All the patients were followed up for 9 to 36 months (average, 23 months). The fracture healing time ranged from 9 to 12 weeks (average, 10.6 weeks). The final follow-ups revealed fine stability of the affected elbow joint in all the patients, and no loss of reduction, loosening or breakage of internal fixators or ischemic necrosis in any case. At the final follow-ups, the elbow inflection angles ranged from 90° to 130° (average, 114.3°), the elbow extension angles from 0° to 20° (average, 12.4°), the forearm pronation angles from 50° to 85° (average, 70.5°) and the forearm supination angles from 45° to 80° (average, 64.3°). The Mayo elbow performance scores at the final follow-up averaged 93.2 points (from 85 to 100 points), yielding 8 excellent and 4 good cases. According to the Broberg & Morrey imaging criteria, 10 patients showed no regressive change and 2 patients change by one grade. Conclusions A proper surgical approach should be chosen according to the preoperative imaging findings. The fracture of articular surface can be firmly fixated by head-less double-threaded compression screws and the integrity of the distal lateral column of the humerus can be restored with a microplate to achieve a strong biomechanical fixation. Fine clinical outcomes can be obtained by early functional exercise. Key words: Elbow joint; Bone fixation, internal; Capitellar fracture; Headless double-threaded screws; Microplate

LIMB SALVAGE IN RECURRENT GIANT CELL TUMOUR PROXIMAL END RADIUS

An 18years old male patient had undergone surgery for a giant cell tumour upper end of the right radius in Jan 2007. The tumour recurred within two months. Patient took alternative methods of treatment including indigenous medicines for the condition; all these failed and the patient was advised an above elbow amputation. By Sep 2008 the tumour had grown to a 14”x11”x11” swelling in the forearm extending to the distal arm with neurovascular involvement. A total resection of the tumour was done; vascular continuity of the brachial to the ulnar artery was done with a vein graft to salvage the limb. In 2012 tendon transfer was done to restore function to the wrist. Now there is no recurrence of the tumour and the patient has a fully functional limb.

Anatomical study on the attachment location of forearm interosseous membrane ligament

Objective To elucidate the composition and precise attachment location of the forearm interosseous membrane ligament complex. Methods Thirty-two adult cadaveric forearm specimens were dissected to identify all ligaments of the interosseous membrane, measure the distance between the attachment site and the radius styloid process or the tip of the ulna head, and express the attachment location of the ligament by the percentage of the length to the length of the whole ulna and radius. Results The forearm interosseous membrane consists of five ligament components: central ligament, accessory ligament, distal oblique tract, proximal oblique cord and dorsal accessory oblique cord. The distal and proximal positions of the radius origin of the central ligament were 55% and 66% of the total radius length, respectively, and 30% and 42% of the total ulna length. The central points of the radius and ulna attachment location were 38% of the radius and 24% of the ulna for the accessory ligament, 10% of the radius and 16% of the ulna for the distal oblique tract, 78% of the radius and 82% of the ulna for the proximal oblique cord, and 63% of the radius and 65% of the ulna for the dorsal accessory oblique cord. Conclusion This study elucidates the precise attachment location of all the typical forearm interosseous membrane ligaments. This information is very useful for the biomechanical study of the interosseous membrane ligaments and the appropriate transplantation location of the interosseous membrane reconstruction surgery. Key words: Forearm; Anatomy; Interosseous membrane; Ligaments; Attachment location

Minimally invasive treatment of double forearm fractures in children with elastic intramedullary nails

Objective To investigate the clinical efficacy and surgical techniques of elastic intramedullary nail in the treatment of double forearm fractures in children. Methods From March 2014 to July 2017, 12 children with double forearm fractures were treated with titanium elastic intramedullary nails. The elastic intramedullary nails were inserted from the distal radius and proximal ulna, and the affected limb was fixed with plaster over elbow and wrist for 4 to 6 weeks. When X-ray showed that the callus was well formed, the plaster was removed for functional exercise. The elastic intramedullary nails were removed after fracture healing. Results The closed reduction of radius and ulnar was performed in 7 and 8 cases respectively. The open reduction of radius and ulnar was performed in 5 and 4 cases respectively. The average length of incision at nail entry point was (1.17±0.17) cm. The average length of incision for open reduction was (1.54±0.29) cm. The operation time was (1.71±0.63) hours. The average amount of bleeding during operation was (12.92±7.53) ml. The postoperative follow-up period was 8 to 48 months, with an average of (23.58±11.42) months. The duration of bone healing was 3 to 8 weeks with an average of (4.92±1.38) weeks. The pronation angle of forearm was (83.75±6.44)°, and the supination angle was (85.83±5.15)°. The flexion and extension activities of elbow and wrist joints were similar to those of the healthy side. No complications such as nonunion, malunion, epiphyseal injury and needle tail irritation symptoms occurred in all the cases. Conclusion The application of titanium intramedullary nail is effective and minimally invasive in the treatment of double forearm fractures in children. Key words: Child; Forearm; Fractures,bone; Intramedullary nails

Carpal tunnel syndrome caused by nontuberculosis mycobacteria infection

Objective To investigate the clinical features, differential diagnosis and treatment of carpal tunnel syndrome caused by nontuberculosis mycobacteria (NTM) infection. Methods Seven patients with carpal tunnel syndrome caused by NTM infection were retrospectively analyzed from June 2014 to June 2017. Carpal tunnel incision and median nerve release were performed. Synovial dysplasia was found during the operation. Samples were sent for culture and pathological examination of common bacteria, fungi and mycobacterium. The inducing factors, clinical features, differential diagnosis, culture results, treatment process and follow-up prognosis were analyzed. Results There were 3 cases with definite inducement (history of stabbing wounds such as fish and shrimp), and the other 4 cases had no definite inducement. All the patients had hand anesthesia and pain in different degrees, which manifested as acute pain in 4 cases. There were 4 cases with obvious signs of infection and 3 cases without signs of redness and swelling. Bacterial culture results: mycobacterium marinum infection in 5 cases, mycobacterium fortuitum in 1 case, mycobacterium lentiflavum in 1 case. EMG showed that median nerve carpal tunnel was compressed moderately in 5 cases and severely in 2 cases. 4 patients had a history of taking anti-mycobacterium drugs before operation. 4 cases underwent thorough debridement of the carpal tunnel, forearm and affected fingers, and 3 cases underwent median nerve release and local debridement through carpal tunnel incision. The symptoms of nerve compression, especially pain, were relieved in all the patients after the operation. 6 patients recovered after 2 to 3 months of anti-mycobacterium treatment, and 1 patient who underwent limited incision relapsed 2 months after the operation, and recovered after reoperation. Postoperative hand function recovered well in 6 cases and slightly limited in 1 case. Conclusion Carpal tunnel syndrome caused by NTM infection may be similar to idiopathic carpal tunnel syndrome, which needs to be differentiated carefully. If there is no obvious manifestation of infection, acute pain that cannot be alleviated may indicate infection. Surgery is suitable for patients with obvious symptoms of nerve entrapment that cannot be alleviated by conservative treatment. Antimycobacterium drugs are needed for 2 to 3 months after the operation. Key words: Carpal tunnel syndrome; Retrospective studies; Nontuberculosis mycobacterium; Clinical feature

Research progress in complications following elastic intramedullary nail treatment for long bone fracture of extremities in children

The elastic stable intramedullary nailing (ESIN) technique is widely accepted by pediatric orthopedic surgeons for the following advantages: being minimally invasive, non-destructive on epiphyseal function, easy, rapid postoperative recovery, allowing early functional exercise and having low complication rate. It has become the mainstream technique for the treatment of long bone fractures in children. Although the concept of minimally invasive surgery for children with long bone fractures is constantly evolving and the surgical technique is becoming more and more mature, there are still some complications after ESIN operation, such as tendon and iatrogenic nerve injury, soft tissue irritation and infection, poor alignment after fracture or re-shift, delayed union and non-union, leg-length discrepancy, rotation and angular deformity, osteofascial compartment syndrome, and other clinical problems. These complications often occur due to the negligence of important biological principles, obvious technical errors and the negligence of the characteristics of local anatomy. The authors review the problems of ESIN technique in the treatment of humeral fractures, radius and ulna fractures, femoral fractures and tibial fractures of children, seeking to avoid the complications as much as possible and giving full play to the minimally invasive advantages of ESIN. Key words: Fracture fixation, intramedullary; Child; Postoperative complications; Elastic stable intramedullary nailing

CCurative effectivenss of canulated screw fixation combined with artificial bone grafting for adult humeral capitulum-trochlear fracture

Objective To study the medium-term results of canulated screw fixation combined with artificial bone support for adult humeral capitulum-trochlear fracture. Methods We chose 16 patients including 3 males and 13 females who had humeral capitulum-trochlear fracture during Mar. 2010 to June 2015 from Department of Orthopedics, the First Affiliate Hospital of Zhengzhou University, and the fracture was typed by AO, Dubberley and Bryan-Morrey classifications. Their age varied from 24 to 69 years old, with an average year of 47.6 years old. The causes of injury were as follows: 3 cases of walking fall, 7 casesof electric bicycle fall, 3 cases during sports, 2 casesof car accident and 1 case of high fall. It took 4 to 11 days from injury to surgery, with an average days of 7.5. With open reduction and cannulated screws fixation, and artificial bone grafting to support subchondral bone when necessary as our treatment modality, all of them started functional exercise two weeks after surgery. We recorded and analyzed the last follow-up symptoms: range of motion, pain score, Mayo elbow score, avascular necrosis, traumatic arthritis and heterotopic ossification. Results Sixteen patients were successfully followed up. The average follow-up time was 34.9 months (24 to 47 months). At the last follow-up, all the fractures were healed, and there were 7 patients with no elbow joint pain, 8 with mild pain, 1 with moderate pain, and no severe pain. The average degree of flexion reached 124° (105°-150°), extension 30.1° (0°-70°), flexion and extension 93.9° 35°-150°). The average forearm pronation reached 72° (60°-85°), and supination 82.8° (75°-90°). All of the patients had no elbow instability, avascular necrosis and internal fixation failure, but had traumatic arthritis to varying degrees. Four of them had different degrees of heterotopic ossification. As for the Mayo elbow performance index, the average score was 85 (55 to 100), among which, 7 cases were excellent, 6 cases were good, 2 cases were middle, and 1 case was poor. Conclusion Though humeral capitulum-trochlear fracture has low incidence, it can cause harmful consequences like ankylosis of elbow and traumatic arthritis. Local artificial bone grafting can provide good bone substance for internal fixation when compression and crushing happen to fracture end. Most patients can get excellent prognosis through active surgical treatment and rehabilitation. Key words: Humeral capitulum fracture; Trochlear fracture; Internal fixation; Artificial bone grafting

Decreased Bone Mineral Density in Forearm vs Loaded Skeletal Sites in Professional Ballet Dancers.

To compare the differences in bone mineral density (BMD) at loaded and non-loaded skeletal sites in professional ballet dancers. We hypothesized that in both male and female elite ballet dancers, a significant difference in BMD will be observed between impact and non-impact sites. 44 elite ballet dancers, 22 men (age 26.4±5.9 yrs) and 22 women (age 24.9±5.3 yrs), were examined. BMD measurements were performed using dual-energy x-ray absorptiometry at three skeletal sites-forearm (FA), lumbar spine (LS), and femoral neck (FN)-and analyzed using t-tests, ANOVA, and linear regression models. Information about career duration, training volume, health habits, and menstrual disorders (women) was collected. Z-scores for LS and FN were significantly higher in men than in women. However, Z-scores for FA were similar in men and women and fell below the expected range for age (<-2.0), and they were significantly lower than those for LS and FN. With longer career duration, a trend was observed towards lower Z-scores for FN in men and towards higher Z-scores for FA in women. In ballet dancers, FA mineralization is extremely low compared to loaded skeletal sites. Male dancers may have lowered forearm BMD despite the absence of risk factors present in female dancers (menstrual disorders). Professional ballet dancers may be at risk of local osteopenia due to the "local non-impact" characteristics of ballet dance, and use of the 33% distal radius region for the accurate assessment of bone mineral status should be investigated further in this population.

The application of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation

Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation. Methods From January, 2013 to October, 2017, 29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair. Fifteen cases treated with multiple end-to-side anastomosis on flap arteries, and 2-3 arteries were anastomosed, with the average of 2.13. Nine cases were treated with venous multiple end-to-side anastomosis, and 2-4 veins were anastomosed, with the average of 3.11. Five cases treated with arterial and venous multiple end-to-side anastomosis, and 4-6 vessels were anastomosed, with the average of 5.20. Distribution of wounds: 10 cases with hands and wrists wounded, 15 cases with forearms and elbow joints wounded, and 4 cases with lower legs and feet wounded. The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm, and the flap area was 6 cm×15 cm-12 cm×29 cm. Postoperative followed-up was performed every 3-6 months to review flap survival. Results All flaps of 29 cases survived. Venous congestion occurred in 2 flaps within 48 h after the operation, among which, 1 was overcomed after released the dressing and sutures, and the other underwent surgical exploration. The venous end-to-side anastomotic stomas were unobstructed, and hematoma was formed. After the hematoma compression was removed, circulation was recovered and the flap survived. With followed-up for 6 months to 2.5 years, both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder. Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable. Key words: Anterolateral thigh perforator flaps; Vascular anastomosis; End-to-side anastomosis; Repair; Microsurgical technique

Wiedemann-Steiner syndrome caused by novel mutation of KMT2A gene: one case report and literature review

Objective To analyze the clinical and biochemical, as well as genetic characteristics of a patient with Wiedemann-Steiner syndrome (WDSTS). Methods The clinical data of a patient with WDSTS were collected. The patient was treated with recombinant human growth hormone (rhGH) combined with gonadotrophine-releasing hormone agonist (GnRHa). Blood samples of the patient and her parents were taken for whole-Exome Sequencing (WES). Relevant literatures about KMT2A mutations were reviewed. Results The 5-year old girl presented with growth retardation, with height 100 cm (-2.4 SD), torpid reaction, and facial anomalies including low hairline, thick eyebrow and hair, hypertelorism, a wide nasal bridge. She had small and puffy hands and feet, excessive hair around back of neck, bilateral forearm and lower limbs. Her GH peak level was 26.6 ng/ml during GH stimulation test. She was re-examined at the age of 10.4 years, with severe short stature (120 cm/-3.58 SD) and a Tanner stage 2 of breast development. Her bone age was found to be approximately 11.4 years. Height increased from 120 cm at the age of 10.4 years to 147.3 cm after rhGH treatment combined with GnRHa for 2.5 years. rhGH therapy alone continued for 1.1 years and a height of 150 cm was reached at the age of 14.9 years, with bone age 14 years. Gene sequencing revealed a de novo frameshift mutation (c.10051delA, p. Thr3351Leufs*17) of exon 27 in KMT2A gene of the patient, but without any mutation in her parents. Through a literature review, seventy-one patients with WDSTS (including present case) presented with intellectual disability(70/71), facial anomalies (70/71), short stature (50/71), and hypertrichosis(39/71). Conclusion Patients presented with short stature, typical facial dysmorphism, intellectual disability, and hypertrichosis should be considered for WDSTS. The mutation p. Thr3351Leufs*17 in the KMT2A gene detected in our patient is a novel mutation. This is so far the first report of WDSTS patient who was successfully treated with a combination of GH and GnRHa at the onset of puberty to improve her adult height. Key words: Wiedemann-Steiner syndrome; KMT2A gene; Short stature; Hypertrichosis; Therapy

Diagnostic value of high resolution B-mode and doppler sonography for imaging of hand and finger joints in RA

High-resolution sonography enables a detailed assessment of intra-articular and extra-articular soft tissue abnormalities of joints affected by rheumatoid arthritis (RA). B-mode sonography and power Doppler should be interpreted together with findings of clinical examinations and conventional radiography. In patients with RA, the wrists, the metacarpophalangeal joints, and the proximal interphalangeal joints can be involved and thus should be assessed with ultrasound in B-mode and power Doppler application, using a standardised technique. This examination can be time-consuming and for this reason multiple publications recommend to limit the examination to the most commonly involved joints such as the second and third MCP and PIP and the radiocarpal and radioulnar joints. The severity of acute synovitis correlates with the increased vascularity. With power/colour Doppler the inflammation is documented on a 3-point scale score which is suitable for follow-up examinations. Radiographs remain the baseline imaging modality for assessment of erosions but these are also easily detected by sonography. Sonography detects 20% more abnormalities than does radiography, and sonography has the potential to provide simple grading of disease activity. Thus, together with blood tests, sonography is excellent for monitoring the disease activity in RA and is considered as an extended diagnostic arm for clinical decisions. Learning objectives: 1. Understand the pathogenesis in RA that results in erosions and synovitis. 2. To be familiar with the sonographic findings and scoring systems. 3. Differentiation of osteoarthritis from RA.

Squamous Cell Carcinoma Secondary to a Verrucous Carcinoma of Tongue and Redial Fore Arm Free Flap as a Reconstructive Option: A Case Report

Squamous Cell Carcinoma Secondary to a Verrucous Carcinoma of Tongue and Redial Fore Arm Free Flap as a Reconstructive Option: A Case Report

휠체어 농구 투 핸드 3점 슛 동작 시 성공과 실패에 따른 운동학적 비교분석

The purpose of this study is to comparatively analyze the kinematic variables such as how long it takes in each phase, the CM(center of mass) displacement, CM velocity and body segment angles for when a three point shoot by wheelchair basketball players succeed or fail. The conclusion based on the experiment results are as follows.BR First, there was no significant difference in the time it took for each phase of a three point shoot whether it was a success or failure. Second, there were no significant differences in the upper arm segmentation, fore arm segmentation, hand segmentation, the ball was left and right of position, horizontal of position and vertical of position whether the three point shoot was a success or failure. However, the mean of the position in the front and back of the hand segmentation showed a higher position change in the second phase in cases of failure. As for the change in position from left to right, the mean value saw no change in the second phase in cases of success, but success cases saw a higher change in position in the third phase.BR Third, there was no significant differences in the upper arm segmentation, fore arm segmentation or the velocity of the ball whether it was a success or failure, but the mean value for a success case was faster in the third phase. Fourth, there were no significant differences in the shoulder joints, elbow joints, wrist joints or projection angle whether it was a success or a failure, but the mean value of the projection angle in the success case was lower.

In vivo assessment and prediction of topical bioavailability of iodiconazole, a new triazole antifungal agent

Objective To assess the in vivo cutaneous bioavailability of iodiconazole in a topical formulation. Methods Iodiconazole cream was topically administrated to the ventral forearms of 10 healthy volunteers for 1 hour, and the excess formulation was removed. The stratum corneum (SC) at the application sites was tape-stripped immediately or at different time points, quantified gravimetrically, and extracted for analysis. Together with concomitant transepidermal water loss (TEWL) measurement, SC drug concentration-depth profiles were reproducibly determined and fitted mathematically to obtain the SC-vehicle partition coefficient (K) and a first-order rate constant (D/L2) related to iodiconazole diffusivity. The main pharmacokinetic parameters were calculated by Drug and Statistics software. With these parameters, the uptake of iodiconazole of time into SC was assessed. The variation of iodiconazole concentrations in stratum corneum post-removal of the formulation was also investigated. Results The mean values of K and D/L2 of 10 healthy volunteers were (0.13 ± 0.07) and (0.15 ± 0.08) /hour, respectively. The classic lag-time for diffusion (Tlag) across the SC varied from 0.52 hours to 2.28 hours. The mean value of time to reach steady-state transport (Tss) was (3.74 ± 1.69) hours. The mean values of the elimination half-life (t1/2) and the elimination rate constant (Kel) of 10 healthy volunteers were (8.47 ± 5.36) hours and (0.11 ± 0.05) /hour, respectively. Conclusions After topical application, iodiconaole penetrated into the SC rapidly and maintained a high concentration at the target site. The results of this study can provide reliable evidences for the clinical medication and the design of following phase Ⅱ study for iodiconazole. Key words: Dermatopharmacokinetics; Bioavailability; Tape stripping; Stratum corneum; Skin absorption; Iodiconazole

Clinical analysis and surgical treatment of focal epilepsy arising from posteriolateral temporal cortex

Objective To analyze the clinical manifestation and post-operative seizure outcome in patients with epilepsy originating from posteriolateral temporal cortex. Methods A retrospective study was conducted on the clinical data of 10 patients with epilepsy originating from posteriolateral temporal cortex who underwent surgical treatment at Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University from March 2015 to December 2017. Presurgical evaluation data were analyzed in detail. All patients received lesionectomy and seizure outcome was obtained during clinical visit or with telephone. Results Ten patients (male: 4) were included in the analysis. The mean age of seizure onset was 14.0±7.6 years old and the mean surgery age was 18.8±6.0 years, with mean disease duration of 5.1±3.3 years. MRI images were positive in all patients. Four patients presented with automatism, including oropharyngeal automatism and bilateral forearm automatism, which was observed in the early phase of seizure. Ictal version (n=6) was another typical seizure semiology and occurred in the early phase of seizure. Ipsilateral version was reported in 4 cases. Two patients had seizures occasionally within one month after surgery and relieved at 3-month follow-up. With the mean follow-up time of 18.6±5.3 months, all patients were seizure free (ILAE level 1). Conclusions Ictal version and automatism frequently occur in patients with epilepsy arising from posteriolateral temporal cortex. Thus, epilepsy arising from posteriolateral temporal cortex should be considered according to seizure semiology, electrophysiology and medical imaging information. Lesionectomy appear to be effective in seizure control. Key words: Epilepsy; Disease attributes; Neurosurgical procedures; Posteriolateral temporal cortex

Label-free thermoacoustic imaging of human blood vessels in vivo

Here, we demonstrate that thermoacoustic imaging (TAI) is able to image human blood vessels in vivo without the use of any contrast agent. By optimizing the polarization direction of the antenna used, the microwave energy deposition in blood vessels is significantly enhanced, allowing the in vivo acquisition of thermoacoustic vascular images. Specifically, the fore arms of two adult male volunteers were imaged, and the blood vessels 5.5 mm below the skin in the forearm were recovered by TAI in both cross- and sagittal sections. Ultrasound imaging was used to cross-validate the images of blood vessels thermoacoustically imaged. The results obtained suggest that TAI may have the potential to become a new tool for examining vascular diseases.