Internal Muscle Research Articles

Revisiting the four Hexapoda classes: Protura as the sister group to all other hexapods

Insects represent the most diverse animal group, yet previous phylogenetic analyses based on morphological and molecular data have failed to agree on the evolutionary relationships of early insects and their six-legged relatives (together constituting the clade Hexapoda). In particular, the phylogenetic positions of the three early-diverging hexapod lineages-the coneheads (Protura), springtails (Collembola), and two-pronged bristletails (Diplura)-have been debated for over a century, with alternative topologies implying drastically different scenarios of the evolution of the insect body plan and hexapod terrestrialization. We addressed this issue by sampling all hexapod orders and experimenting with a broad range of across-site compositional heterogeneous models designed to tackle ancient divergences. Our analyses support Protura as the earliest-diverging hexapod lineage ("Protura-sister") and Collembola as a sister group to Diplura, a clade corresponding to the original composition of Entognatha, and characterized by the shared possession of internal muscles in the antennal flagellum. The previously recognized 'Elliplura' hypothesis is recovered only under the site-homogeneous substitution models with partial supermatrices. Our cross-validation analysis shows that the site-heterogeneous CAT-GTR model, which recovers "Protura-sister," fits significantly better than homogeneous models. Furthermore, the morphologically unusual Protura are also supported as the earliest-diverging hexapod lineage by other lines of evidence, such as mitogenomes, comparative embryology, and sperm morphology, which produced results similar to those in this study. Our backbone phylogeny of hexapods will facilitate the exploration of the underpinnings of hexapod terrestrialization and megadiversity.

A Comparison of Skeletal Muscle Diffusion Tensor Imaging Tractography Seeding Methods.

The internal arrangement of a muscle's fibers with respect to its mechanical line of action (muscle architecture) is a major determinant of muscle function. Muscle architecture can be quantified using diffusion tensor magnetic resonance imaging-based tractography, which propagates streamlines from a set of seed points by integrating vectors that represent the direction of greatest water diffusion (and by inference, the local fiber orientation). Previous work has demonstrated that tractography outcomes are sensitive to the method for defining seed points, but this sensitivity has not been fully examined. To do so, we developed a realistic simulated muscle architecture and implemented four novel methods for tract seeding: seeding along the muscle-aponeurosis boundary with an updated procedure for rounding seed points prior to lookup in the muscle boundary mask and diffusion tensor matrix (APO-3); voxel-based seeding throughout the muscle volume at a user-specified spatial frequency (VXL-1); voxel-based seeding throughout the muscle volume at a variable spatial frequency (VXL-2), and seeding near external and internal muscle boundaries (VXL-3). We then implemented these methods in an example human dataset. The updated aponeurosis seeding procedures allow more accurate and robust tract propagation from seed points. The voxel-based seeding methods had quantification outcomes that closely matched the updated aponeurosis seeding method. Further, the voxel-based methods can accelerate the overall workflow and may be beneficial in high throughput analysis of multi-muscle datasets. Continued evaluation of these methods in a wider range of muscle architectures is warranted.

Pelvic floor imaging in women with hemorrhoidal disease: An anatomical feasibility study

ObjectiveTo compare pelvic floor muscle and organ structures in women with and without hemorrhoidal disease (HD) using magnetic resonance imaging (MRI). Material and methodsPelvic MRI measurements and computer-based medical records of women diagnosed with HD between January 2018 and March 2021 were analyzed. Parameters including pubococcygeal distance, puborectal distance, posterior anorectal angle, obturator internus muscle area, presence of levator ani muscle defect, genital hiatus length, vaginal length, uterocervical angle, cervix-upper vagina angle, and cervix-middle vagina angle were evaluated. The control group consisted of women without HD, matched for age and body mass index. ResultsPuborectal hiatus distance was higher in the HD group (59.2 ​± ​8.7 ​mm vs. 55.5 ​± ​7.1 ​mm, p ​= ​0.03). Similarly, the distance to the M line was greater in the HD group (18.3 ​± ​4.8 ​mm vs. 16 ​± ​4.6 ​mm, p ​= ​0.04). Obturator internus muscle area was found to be lower in the HD group compared to the non-HD group (1721 ​± ​291.4 ​mm2 vs. 1897.5 ​± ​352.5 ​mm2, p ​= ​0.02). Additionally, the presence of unilateral levator ani muscle defect was higher in HD patients (p ​= ​0.03). There was a negative correlation between birthweight and obturator internus muscle area (r ​= ​−0.388, p ​= ​0.02), and a positive correlation with M line distance (r ​= ​0.344, p ​= ​0.04). ConclusionLevator ani muscle defects and obturator internus muscle area, indicators of pelvic floor dysfunction, are more common in patients with hemorrhoidal disease.

Robot-Assisted Exploration of the Alcock Canal: A Novel Surgical Technique

ObjectiveTo demonstrate a safe and reproducible surgical approach to the Alcock canal with a full decompression of the pudendal nerve. SettingPudendal neuralgia, a condition causing debilitating pelvic pain, is traditionally managed through a trans-gluteal incision.1-2 This surgical approach offers limited visualization and ability for nerve decompression.3 With the current technique, a full exposure and decompression of the pudendal nerve was achieved. ParticipantsA 44-year-old para 2 with symptoms of left pudendal neuralgia. InterventionsA 44-year-old para 2 presented with burning vaginal pain radiating to the left groin that was aggravated with sitting. She underwent a robotic-assisted left sacrospinous ligament transection and fasciotomy of the obturator internus muscle for suspected pudendal neuralgia. The surgery was performed with three robotic ports using the daVinci® Xi robotic system. ConclusionWith the enhanced access to the pudendal nerve provided by the novel surgical technique demonstrated in this study, a more comprehensive nerve decompression can be performed. This technique was successfully applied to a patient with pudendal neuralgia. There were no immediate intra-operative or post-operative complications. In short-term follow-up, the patient had significant relief of preoperative symptoms. While all surgical procedures for pudendal neuralgia have a risk of pudendal nerve and vessel injury,4 the presented technique has the potential to limit these risks by providing an enhanced view of the relevant anatomy. Future adaptation and refinement of this technique may contribute to the advancement of the surgical management of pudendal neuralgia.

Sexual function in women with endometriosis and pelvic floor myofascial pain syndrome.

To evaluate and compare the sexual function and pelvic floor muscles (PFM) function of women with endometriosis and chronic pelvic pain (CPP) with and without Myofascial Pelvic Pain Syndrome (MPPS). Cross-sectional study conducted between January 2018 and December 2020. Women with deep endometriosis underwent assessments for trigger points (TP) and PFM function using the PERFECT scale. Electromyographic activity (EMG) and sexual function through Female Sexual Function Index (FSFI) were assessed. Statistical analyses included chi-square and Mann-Whitney tests. There were 46 women. 47% had increased muscle tone and 67% related TP in levator ani muscle (LAM). Weakness in PFM, with P≤2 was noted in 82% and P≥3 in only 17%. Incomplete relaxation of PFM presented in 30%. EMG results were resting 6.0, maximal voluntary isometric contraction (MVIC) 61.9 and Endurance 14.2; FSFI mean total score 24.7. We observed an association between increased muscle tone (P<.001), difficulty in relaxation (P=.019), and lower Endurance on EMG (P=.04) in women with TP in LAM. Participants with TP presented lower total FSFI score (P=.02). TP in the right OIM presented increased muscle tone (P=.01). TP in the left OIM presented lower values to function of PFM by PERFECT (P=.005), and in MVIC (P=.03) on EMG. Trigger points (TP) in pelvic floor muscles (PFM) and obturator internus muscle (OIM) correlates with poorer PFM and sexual function, particularly in left OIM TP cases. Endometriosis and chronic pelvic pain raise muscle tone, weaken muscles, hinder relaxation, elevate resting electrical activity, lower maximum voluntary isometric contraction, and reduce PFM endurance.

The short external rotator muscles of the hip: a cadaveric study on 18 specimens with clinical implications.

The short external rotator muscles (SERMs) of the hip are composed of six postural muscles that constitute a single functional unit that is aligned to coapt the articular surfaces of the hip joint, providing dynamic stability. This study aims to provide a morphometric evaluation of this unit that could benefice clinical practice. In particular, the implication of the morphology and direction of the hip triceps tendon when performing a posterolateral approach for total hip arthroplasty. A total of 18 cadaveric hips were dissected rigorously. Variations of the origin, course and insertion of all SERMs were recorded and quantified. Measurements were conducted for the following parameters: total muscle lengths, intra-muscular and extra-muscular tendon lengths, muscle sagittal and frontal angles, and femoral neck length. Correlation was searched for between total muscle length and femoral neck length. Results were as follows: (a) the obturator internus and externus muscles insert quasi perpendicularly on the proximal femur, (b) both gemelli take distal insertion onto the tendon of the obturator internus to form the hip triceps tendon, (c) morphometric data of the studied parameters was reported, and (d) moderate to high correlation with femoral neck length was found for all muscles but the quadratus femoris. Our results showed that the direction of the hip triceps tendon is always orthogonal to the proximal femur in the frontal plane. Such anatomical reference could be used when performing total hip arthroplasty with the posterolateral approach. Future research is needed to assess whether the easy identification and re-insertion of the hip triceps could reduce leg length discrepancy and offset.

Psoas force recruitment in full-body musculoskeletal movement simulations is restored with a geometrically informed cost function weighting

Simulations of musculoskeletal models are useful for estimating internal muscle and joint forces. However, predicted forces rely on optimization and modeling formulations. Geometric detail is important to predict muscle forces, and greater geometric complexity is required for muscles that have broad attachments or span many joints, as in the torso. However, the extent to which optimized muscle force recruitment is sensitive to these geometry choices is unclear. We developed level, uphill and downhill sloped walking simulations using a standard (uniformly weighted, “fatigue-like”) cost function with lower limb and full-body musculoskeletal models to evaluate hip muscle recruitment with different geometric representations of the psoas muscle under walking conditions with varying hip moment demands. We also tested a novel cost function formulation where muscle activations were weighted according to the modeled geometric detail in the full-body model. Total psoas force was less and iliacus, rectus femoris, and other hip flexors’ force was greater when psoas was modeled with greater geometric detail compared to other hip muscles for all slopes. The proposed weighting scheme restored hip muscle force recruitment without sacrificing detailed psoas geometry. In addition, we found that lumbar, but not hip, joint contact forces were influenced by psoas force recruitment. Our results demonstrate that static optimization dependent simulations using models comprised of muscles with different amounts of geometric detail bias force recruitment toward muscles with less geometric detail. Muscle activation weighting that accounts for differences in geometric complexity across muscles corrects for this recruitment bias.

The associations of physical parameters with the Closed Kinetic Chain Upper Extremity Stability Test, the Upper Quarter Y Balance Test, and the Upper Limb Rotation Test in professional overhead athletes

ObjectiveTo investigate the associations of glenohumeral internal (IR) and external rotation (ER), horizontal adduction (HA), and thoracic spine rotation ranges of motion (ROM), isometric muscle strength of the shoulder rotators, and trunk muscle endurance with the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST), the Upper Quarter Y Balance Test (YBT-UQ), and the Upper Limb Rotation Test (ULRT) in overhead athletes. DesignCross-sectional study. SettingsLaboratory. ParticipantsOne hundred twenty-one athletes were enrolled. Main outcome measuresIndependent variables were: IR, ER, HA, and thoracic spine rotation ROMs, isometric muscle strength of glenohumeral IR and ER muscles, and trunk muscle endurance. Dependent variables were: CKCUEST, YBT-UQ, ULRT. ResultsIR ROM of the nondominant side was associated with the CKCUEST, the YBT-UQ, and the ULRT. IR muscle strength of the dominant side was associated with the CKCUEST and the ULRT. Trunk flexor and lateral endurance of the dominant side were associated with the CKCUEST and the YBT-UQ, respectively. ConclusionsMany of the physical parameters influencing scores on the CKCUEST and the YBT-UQ are different. Common parameters influence the CKCUEST and ULRT scores, yet more parameters influence the CKCUEST score. We suggest the combined use of the CKCUEST and the YBT-UQ in overhead athletes.

Clinical Outcomes of Bipolar Hemiarthroplasty with a Conjoined Tendon-Preserving Posterior Approach for Femoral Neck Fractures.

Background and Objectives: The conventional posterior approach in the lateral decubitus position is widely used for femoral neck fractures in femoral hemiarthroplasty. Postoperative dislocation is the major problem with this approach. The conjoined tendon-preserving posterior (CPP) approach is a less invasive surgical approach than the conventional posterior approach to the hip, maintains posterior stability, and preserves short external rotators and joint capsules. However, the mention was required to avoid muscle damage and whether muscle damage affects postoperative dislocation or not. The current study aimed to evaluate the clinical results of the CPP approach in hemiarthroplasty for femoral neck fractures and identify muscle damage risk factors. Materials and Methods: This study was a retrospective cohort study and included 170 hips in 168 patients. The mean age at the operation was 81.2 years. The preservation rate of the internal obturator muscle and gemellus inferior muscle and factors related to intraoperative short rotator muscle injury were investigated retrospectively. The postoperative complications and the relation between muscle damage and postoperative dislocation were investigated. Results: In the four hips (2.3%) with the obturator internus muscle damage, thirty-eight hips (22.4%) with gemellus inferior muscle damage were detected; in the muscle-damaged cases, the high body mass index (BMI) was significantly higher. The complication occurred in four hips (2.3%), including postoperative posterior dislocation in one hip without muscle damage (0.6%). Postoperative infection occurred in one hip (0.6%), and peroneal or sciatic nerve paralysis was suspected in two hips (1.1%). Conclusions: Compared to the conventional posterior approach in previous reports, the CPP approach reduces postoperative dislocation. A higher BMI is a risk factor for muscle damage, and the gemellus inferior muscle damage has no effect on postoperative dislocation. The CPP approach for BHA appeared to be an effective treatment method.

In Vivo Osteo-organoid Approach for Harvesting Therapeutic Hematopoietic Stem/Progenitor Cells.

Hematopoietic stem cell transplantation (HSCT) requires a sufficient number of therapeutic hematopoietic stem/progenitor cells (HSPCs). To identify an adequate source of HSPCs, we developed an in vivo osteo-organoid by implanting scaffolds loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2) into an internal muscle pouch near the femur in mice. After 12 weeks of implantation, we retrieved the in vivo osteo-organoids and conducted flow cytometry analysis on HPSCs, revealing a significant presence of HSPC subsets within the in vivo osteo-organoids. We then established a sublethal model of hematopoietic/immune system injury in mice through radiation and performed hematopoietic stem cell transplantation (HSCT) by injecting the extracted osteo-organoid-derived cells into the peripheral blood of radiated mice. The effect of hematopoietic recovery was evaluated through hematological, peripheral blood chimerism, and solid organ chimerism analyses. The results confirmed that in vivo osteo-organoid-derived cells can rapidly and efficiently reconstruct damaged peripheral and solid immune organs in irradiated mice. This approach holds potential as an alternative source of HSPCs for HSCT, offering benefits to a larger number of patients.

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Diagnosis and management of complications following pelvic organ prolapse surgery using a synthetic mesh: French national guidelines for clinical practice

Primary Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma of the Prostate: MRI and FDG-PET Imaging Findings

Background: Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the prostate is a rare condition, and there is no report on magnetic resonance imaging (MRI) and its relationship with fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET). Objectives: The purpose of this article is to present the MRI and FDG-PET imaging findings of primary MALT lymphoma of the prostate and discuss the imaging findings’ importance in the diagnosis and management. Case summaries: A 73-year-old male patient underwent a prostate biopsy for lower urinary tract symptoms and an elevated serum prostate-specific antigen level. Histopathologic and immunohistochemical findings were consistent with MALT lymphoma. As the tumor was confined to the prostate and adjacent tissues and no lymph node metastases were detected on PET-CT, the diagnosis was primary MALT lymphoma of the prostate. The tumor of the transitional zone infiltrated along the obturator internus muscle and into the pubic bone, the levator ani muscle was almost intact on MRI. Conclusion: The absence of lymph node metastasis or gross muscle destruction but a high degree of invasiveness into surrounding tissues is an important imaging finding in the diagnosis of primary MALT lymphoma of the prostate. Keywords: Differential Diagnosis; MRI; Prostate Neoplasms

ENHANCING ORTHODONTIC TREATMENT FOR PATIENTS WITH SWALLOWING AND SPEECH DISORDERS

Introduction. At the modern level, disorders of the functions of the tongue are considered by scientists in close relationship with the condition of the cranio-mandibular structures, posturological changes and various general somatic disorders of the human body.&#x0D; The purpose of this study was to improve the effectiveness of orthodontic treatment outcomes for patients with disorders of tongue functions based on data obtained from the systematic review of revelant literature and own clinical experience.&#x0D; Materials and Methods. The research involved an analysis of contemporary national and international literature spanning from 2000 to the present. Additionally, the study summarized the clinical experience gained from examining and treating 1024 patients with swallowing and speech disorders over the past 8 years.&#x0D; Results. The "Algorithm for investigating the state and position of the tongue during swallowing and speech functions" has been formulated. This algorithm encompasses stages of clinical and paraclinical analysis, evaluating factors such as the tongue position, the condition of supra- and sublingual spaces, pharyngeal airways, hyoid bone position, as well as using techniques such as photopalatography, electropalatography, and electromyography. The corrective method we offer for addressing improper tongue positioning during swallowing and speech involves enhancing the patient's overall somatic condition through recommendations for a healthy diet, an active lifestyle, and specific myogymnastics. It further focuses on normalizing the myodynamic balance between the external and internal muscle circles of the dento-jaw area. Controlled myogymnastics for the tongue is facilitated using a specially designed device.&#x0D; Conclusion. The developed algorithm for studying the condition and position of the tongue during swallowing and speech functions, along with the proposed corrective method, promises to enhance the effectiveness of diagnosing malocclusion associated with or caused by tongue function disorders. This approach contributes to the objectification of results in orthodontic treatment.

A cadaveric case study of the fibulo calcaneus internus muscle as a rare accessory muscle of calf region

The fibulocalcaneus (peroneocalcaneus) Internus (FCI) muscle which is also called as Peroneo calcaneus Internus (PCI) muscle (of MacAlister) is a rare variation of calf muscle with a low prevalence of &amp;#60;1%-3% in cadaveric dissection and imaging studies. The FCI arises from the posterior-medial aspect of the distal 1/3 of the fibula, descends posterior and lateral to the flexor hallucis longus (FHL) muscle. It than traverses the tarsal tunnel inferior to the sustentaculum tali of the Calcaneus, and get inserted into the plantar surface of the calcaneus. However, controversy exists concerning the exact location of the insertion site of FCI muscle. Recently the insertion of the FCI muscle has been described as distal to the coronoid fossa, a small depression between the anterior tuberosity and the anterior apex of the sustentaculum tali of the calcaneus. However, chronological descriptions described the FCI as inserting into either the sustentaculum tali itself or a small tubercle on the medical surface of the calcaneus distal to the sustentaculum tali. During routine dissection for under graduate students, about 56-year old Indian male, a Fibulocalcaneus (peroneocalcaneus) Internus (FCI) muscle was identified, which originated from the posterior medial surface of distal third of the fibula and tendon merges with 2 slip of flexor digitorum longus and get inserted on base of distal phalanx of second toe. Knowledge of the FCI muscle is important due its involvement with various ankle pathologies, including predisposing individuals to tarsal tunnel syndrome, FHL tenosynovitis, and posterior ankle impingement and pain. The FCI muscle is one of the least common muscular variants associated with the ankle joint, and it has been implicated in posterior ankle pain and impingement. This muscle is often confused with the flexor digitorum accessorius longus (FDAL) muscle. Additionally, this study describes ways to differentiate between the FCI and FDAL muscles in the lower leg. Radiologists and clinicians should be aware of this anomalous muscle when considering various diagnoses, interpreting radiographs, and pursuing surgical involvement to reduce symptoms of posterior ankle region.

Location of Local Recurrences Post-Prostatectomy Detected by 18F-DCPFyL and Implications for Salvage Radiotherapy Target Volumes.

The use of prostate-specific membrane antigen (PSMA) PET scans have improved detection of recurrent prostate cancer for biochemical failure post-prostatectomy. The primary aim of this study is to assess the location of local recurrences for PSMA PET positive disease post-prostatectomy relative to anatomical landmarks and to inform salvage radiotherapy contouring guidelines. This is a retrospective study of patients who underwent a staging PSMA PET-CT scan with 18F-DCFPyL tracer. Eligible patients included men with biochemical recurrence (PSA >0.2ng/mL) post-prostatectomy for prostate adenocarcinoma. PSMA positive local disease (GTV) was marked on the CT scan of the PSMA PET/CT, using the PSMA PET scan fused as the secondary dataset. Reference structures were contoured to compare the positional relationship to the GTV local recurrence. Centroids of each GTV position were measured to the closest border of the reference structures and distance measured. Forty-five patients had a local recurrence on PSMA PET, 28/45 with prostate bed recurrence and 17/45 with seminal vesicle bed recurrence. The median age was 72.7 years, median pre-treatment PSA 0.515 ng/ml (0.2-11.1), pT2 in 37.8% and pT3 in 62.2, ISUP G2-3 was 66.7%, ISUP 4-5 29.6%, 67% ECE, 15.4% SV involvement and 40% positive margin. For prostate bed recurrences, 93.6% of GTVs were within 15mm from the inferior border of pubic symphysis (median 3.3mm [-9.8-15.4]), 83.9% within 10mm from the VUA (median 3.3mm [-17.4-15.9]), and 80.6% were greater than 10mm from the most superior slice of the penile bulb (median 16.4mm [1-29.5]). Laterally, 83.9% of recurrences were within 10mm of midline and 41.9% within 5mm (median 3.3mm [-13.56-11.59]) and all were contained within levator, 35.5% within 5mm (median 7.7 [1-22.6]) of the medial muscle border. 29.0% were within 5mm from the anterior edge of the rectal wall (median -7mm [-32.3-0.5]). Seminal vesicle bed recurrences were within 17.5mm of upper border of pubic symphysis for 88.9% of patients (median -4.69mm[-30.8to18.2]), 100% were more than 7.5mm inferiorly from the vas deferens (median-22.1mm[-32.7to-7.7]). Laterally, 100% recurrences were more than 7.5mm medial from obturator internus (median 5.37mm [-23.1to37.8]), and 88.9% were more than 10mm from midline (median 23.1mm [2.0-36.6]). The 18F-DCFPyL PSMA PET local recurrences can provide detailed localization of prostate bed and seminal vesicle recurrences. Our data can inform contouring guidelines for salvage radiotherapy to the prostate bed, particularly when using anatomical landmarks to define cranio-caudal extent of target volumes. For target volume laterally, the medial wall of levator ani would encompass all prostate bed recurrences, and no seminal vesicles recurrences were seen at the medial border of the obturator internus muscle.

Division of neuromuscular compartments and localization of the center of the intramuscular nerve-dense region in pelvic wall muscles based on Sihler's staining.

The innervation of the pelvic wall muscles is not very clear. This study aimed to reveal the division of neuromuscular compartments and localize the surface position and depth of the center of the intramuscular nerve-dense region (CINDR) of the pelvic wall muscles based on Sihler's staining. Twenty-four adult cadavers were used. To localize the CINDR of the pelvic wall muscles, horizontal (H) and longitudinal (L) reference lines were drawn, and Sihler's staining was used to reveal the intramuscular nerve distribution. The CINDR projection points (P and P' points) behind and in front of the body surface, the positions of the P points projected onto the H and L lines (PH and PL points), and the depth of CINDR were determined by spiral computed tomography scanning. The piriformis and obturator internus muscles can be divided into two and three neuromuscular compartments, respectively. The PH of CINDR of the piriformis muscle was located at 22.61 ± 2.66% of the H line, the PL was at 28.53 ± 6.08% of the L line, and the puncture depth of the piriformis muscle was at 24.64 ± 2.16% of the PP' line. The PH of CINDR of the obturator internus muscle was at 16.49 ± 1.20% of the H line, the PL was at 10.94 ± 1.09% of its L line, and the puncture depth was 6.26 ± 0.38cm. These findings may guide the design of the compartmentalized transplantation of the pelvic wall muscles and improve the target localization efficiency and efficacy for injecting botulinum toxin A to treat pelvic wall muscle spasm.

Management of Perineal Epidermoid Cyst in a 20-year-old Female

Epidermoid cysts are cutaneous or subcutaneous masses caused by the implantation of epidermal elements into the dermis. This case report presented an epidermal cyst of the perineum clinically mimicking endometriosis in a female patient. A 20-year-old virgo female patient was admitted to our clinic with complaints of severe pain, especially in the right leg, and postmenstrual bleeding for three years. In the transrectal ultrasound, a 54*39 mm cystic lesion with dense internal echo was detected in the medial neighborhood of the pelvic floor right obturator internus muscle. Since the cystic lesion detected in the contrast-enhanced pelvic MRI was evaluated as an epidermoid cyst and no significant endometrioma or endometriosis focus was detected, an operation was planned. Surgical excision should be performed not only for symptom relief and diagnosis but also to exclude rare malignancy. However, it is vital to master the pelvic and perineal anatomy along with careful surgery.

Motor control similarity between speakers saying "a souk" using inverse atlas tongue modeling.

Finite element models (FEM) of the tongue have facilitated speech studies through analysis of internal muscle forces indirectly derived from imaging data. In this work, we build a uniform hexahedral FEM of a tongue atlas constructed from magnetic resonance imaging data of a healthy population. The FEM is driven by inverse internal tongue tissue kinematics of speakers temporally aligned and deformed into the same atlas space, while performing the speech task "a souk" allowing muscle activation predictions. This work aims to investigate the commonalities in tongue motor strategies in the articulation of "a souk" predicted by the inverse tongue atlas model. Our findings report variability among five speakers for estimated muscle activations with a similarity index using a dynamic time warp function. Two speakers show similarity index > 0.9 and two others < 0.7 with respect to a reference speaker for most tongue muscles. The relative motion tracking error of the model is less than 2% which is promising for speech study applications.

Intramuscular neural distribution of the obturator internus muscle regarding injective treatment.

The obturator internus muscle is frequently targeted for injective treatments such as botulinum toxin injections in the management of pain syndromes. However, there are controversies over injective method delivering injection to the muscle. A method called modified Sihler's method was used to stain the OI muscle in 16 specimens to reveal the intramuscular neural distribution of the muscle. The greatest intramuscular neural distribution was located on the 2/10-4/10 of the muscle in the medial edge of the obturator foramen (0/0) to the greater trochanter of the femur (10/10). The result suggests that botulinum neurotoxin should be delivered in the intrapelvic portion of the obturator internus muscle. As most of the extrapelvic portion of the obturator muscle is composed of a tendinous portion, it should be considered unsuitable as an injection site by medical professionals.

Could Electromyographic and Pressure Related Signals Identify Differences in Abdominal Activity and Postural Control between Women with and without C-Section?

Scars interfere with the motor system; however, the influence of c-section scars has not been described yet. The aim of this study is to relate the presence of abdominal scars from a caesarean section with changes in postural control-stability and orientation and abdominal and lumbar neuromuscular control in the orthostatic position. Cross-sectional analytical observational study comparing healthy primiparous women with caesarean delivery (n = 9) and physiologic delivery (n = 12) who have delivered more than one year before. The relative electromyographic activity of the rectus abdominis, transverse abdominis/oblique internus and lumbar multifidus muscles, antagonist co-activation, the ellipse area, amplitude, displacement, velocity, standard deviation, and spectral power of the centre of pressure, and thoracic and lumbar curvatures, were evaluated in the standing position in both groups, through an electromyographic system, a pressure platform and spinal mouse system. In the "caesarean delivery" group, scar mobility was evaluated using a modified adheremeter. Significant differences in CoP medial-lateral velocity and mean velocity were observed between groups (p < 0.050), while no significant differences were in the level of muscle activity, antagonist co-activation, and thoracic and lumbar curvatures (p > 0.05). The information provided by the pressure signal seems to identify postural impairments in women with c-sections.