Maximum Cross-sectional Area Research Articles

Sleep Is Compromised in -12° Head Down Tilt Position.

Recent studies are elucidating the interrelation between sleep, cranial perfusion, and cerebrospinal fluid (CSF) circulation. Head down tilt (HDT) as a simulation of microgravity reduces cranial perfusion. Therefore, our aim was to assess whether HDT is affecting sleep (clinicaltrials.gov; identifier NCT 02976168). 11 male subjects were recruited for a cross-over designed study. Each subject participated in two campaigns each comprising 3 days and 2 nights. Intervention started on the second campaign day and consisted of maintenance of horizontal position or −12° HDT for 21 h. Ultrasound measurements were performed before, at the beginning and the end of intervention. Polysomnographic measurements were assessed in the second night which was either spent in horizontal posture or at −12° HDT. Endpoints were sleep efficiency, sleep onset latency, number of sleep state changes and arousals, percentages of N3, REM, light sleep stages and subjective sleep parameters. N3 and REM sleep reduced by 25.6 and 19.1 min, respectively (P = 0.002, g = -0.898; P = 0.035, g = -0.634) during −12° HDT. Light sleep (N1/2) increased by 33.0 min at −12° HDT (P = 0.002, g = 1.078). On a scale from 1 to 9 subjective sleep quality deteriorated by 1.3 points during −12° HDT (P = 0.047, g = -0.968). Ultrasonic measurement of the venous system showed a significant increase of the minimum (P = 0.009, P < 0.001) and maximum (P = 0.004, P = 0.002) cross-sectional area of the internal jugular vein at −12° HDT. The minimum cross-sectional area of the external jugular vein differed significantly between conditions over time (P = 0.001) whereas frontal skin tissue thickness was not significantly different between conditions (P = 0.077, P = 0.811). Data suggests venous congestion at −12° HDT. Since subjects felt comfortable with lying in −12° HDT under our experimental conditions, this posture only moderately deteriorates sleep. Obviously, the human body can almost compensate the several fold effects of gravity in HDT posture like an affected CSF circulation, airway obstruction, unusual patterns of propioception and effects on the cardiovascular system.

Diagnosis and treatment of kidney stones complicated with emphysema pyelonephritis (report of 8 cases)

Objective To discusse the diagnosis and treatment of kidney stones with emphysema pyelonephritis. Methods The clinical data of 8 patients with kidney stones complicated with emphysema pyelonephritis diagnosed in our hospital from January 2015 to October 2018 were retrospectively analyzed. There were 5 males and 3 females. The average age was 50 years old. The clinical manifestations including chills fever in 6 cases, low back pain in 5 cases, nausea and vomiting in 3 cases. Six patients had diabetes, one had thalassemia, and two had contralateral kidney stones. The maximum cross-sectional area of stones was 737.6 mm2. Among the 8 cases, there were 7 cases which number of white blood cells and procalcitonin were higher than normal reference value. 4 cases of hemoglobin <110 g/L, 2 cases of platelet count <125×109/L. The patient was cultured with urine and/or blood and drainage fluid. 5 cases were Escherichia coli, 2 cases were infected with Proteus mirabilis, and 1 case was infected with Pseudomonas aeruginosa. According to the CT findings of emphysematous pyelonephritis reported in the literature, it was divided into type Ⅰ-Ⅳ: There were 2 cases of type Ⅰ, 2 cases of type Ⅱ, 3 cases of type Ⅲ, and 1 case of type Ⅳ. Results 4 cases of type Ⅰ and type Ⅱ patients, 2 cases without SIRS were given positive medical treatment to control infection then performed PCNL. 2 cases with SIRS, first treated with percutaneous nephrolithotomy and active medical, after control infection the PCNL was performed. None of the 4 patients were treated with ICU and recovered well after surgery. Three patients with type Ⅲ and one patient with type Ⅳ were complicated with SIRS. Two of them underwent percutaneous nephrolithotomy in the emergency department. They were transferred to the ICU after surgery. After the infection and general condition improved, PCNL was performed. The postoperative recovery was satisfied. One patient percutaneous nephrolithotomy, due to poor drainage, secondary percutaneous nephrolithotomy, large intrachannel, low pressure perfusion in the operation of partial obstruction of renal pelvis stones, dredge obstruction, after ICU control infection PCNL was performed, postoperative recovery was good. One patient with type Ⅲ also had poor peritoneal drainage for the first time. Secondary percutaneous nephrolithotomy was performed. After the infection was controlled by ICU, PCNL was performed to remove the stones. However, because the patient had contralateral kidney stones and thalassemia, an epileptic-like reaction occurred during the anti-infection with imipenem, and a serious infection occurred again after the operation, and eventually the patient died. Conclusions Patients with type Ⅰ and Ⅱemphysematous pyelonephritis with renal calculi treated with conservative medical treatment alone or combined with percutaneous renal puncture drainage with SIRS can achieve better therapeutic effects after PCNL surgery. Type Ⅲ, Ⅳ emphysema pyelonephritis with renal calculus patients need to be actively anti-infective accompany with percutaneous renal puncture drainage. When the stone leads to multiple renal pelvic obstruction, large channels, low-pressure perfusion can be used to crush stones, dredge obstruction. PCNL was performed after infection control. Key words: Emphysema pyelonephritis; Kidney calculi; Infection; Treatment

Neuromuscular ultrasound in ulnar neuropathy at the elbow: correlation with electrodiagnostic studies

IntroductionUlnar nerve entrapment is the second most common entrapment neuropathy in the upper limb after carpal tunnel syndrome, and, if left untreated, it may lead to significant functional impairment and disability.ObjectiveThe aim of this study was to perform clinical, electrodiagnostic (EDX), and neuromuscular ultrasound assessment for patients with ulnar neuropathy at the elbow, to determine the possible roles of neuromuscular ultrasound in the localization of the neuropathy, in the detection of its possible etiologies and in the determination of its severity.Patients and methodsA sample of 15 (22 elbows) patients was recruited and subjected to full medical history, neurological assessment, EDX studies, and neuromuscular ultrasound examination. Ten (20 elbows) age-matched and sex-matched healthy volunteers were also recruited and served as a control group.ResultsThis study revealed significantly enlarged ulnar nerve cross-sectional area (CSA) at the ulnar groove and below the elbow and supracondylar sites in patients compared with the control group. receiver-operating characteristic curve analysis revealed high diagnostic accuracy of the absolute CSA at the ulnar groove, and below the elbow and supracondylar sites, with an area under the curve of 0.8, 0.8, and 0.9, respectively, and the cutoff values were >9, >8, and >8, respectively. The area under the curve for the ‘maximum CSA/midforearm CSA ratio’ was 0.9, with a cutoff value of more than 1.3.ConclusionOur study data suggest that neuromuscular ultrasound (NMUS) examination may play a potentially important role in the assessment of ulnar neuropathy at the elbow. It can localize the lesion and disease severity, and it can differentiate between patients and controls, given its high diagnostic ability. Abnormalities in ultrasonographic features of ulnar nerve entrapment with regard to CSA and ratio between ‘maximum CSA and midforearm CSA’ at the elbow was correlated with EDX findings.

Quadriceps Recovery After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Versus Patellar Tendon Autografts.

Background:Quadriceps tendon (QT) autografts are being increasingly used for anterior cruciate ligament reconstruction (ACLR). A paucity of studies exist that compare QT autografts with alternative graft options. Additionally, concerns exist regarding quadriceps recovery after graft harvest insult to the quadriceps muscle-tendon unit.Purpose/Hypothesis:The purpose of this study was to compare quadriceps recovery and functional outcomes in patients with QT versus bone–patellar tendon–bone (BPTB) autografts. The hypothesis was that those with QT autografts would demonstrate superior outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:Active patients with a history of primary, unilateral ACLR with soft tissue QT or BPTB autografts participated. Quadriceps recovery was quantified using variables of strength, muscle size, and activation. Knee extensor isometric and isokinetic strength was measured bilaterally with an isokinetic dynamometer and normalized to body weight. Quadriceps activation was measured with the superimposed burst technique. The maximal cross-sectional area of each quadriceps muscle was measured bilaterally using magnetic resonance imaging. Assessors of muscle size were blinded to the graft type and side of ACLR. Functional tests included hop tests and step length symmetry during walking, measured via spatiotemporal gait analysis. Self-reported function was determined with the International Knee Documentation Committee (IKDC) questionnaire. Neuromuscular and functional outcomes were expressed as limb symmetry indices (LSIs: [surgical limb/nonsurgical limb]*100%). Wilcoxon rank-sum tests were used to compare the LSIs and IKDC scores between groups.Results:There were 30 study participants (19 male, 11 female; median age, 22 years [range, 14-41 years]; median time since surgery, 8 months [range, 6-23 months]), with 15 patients in each group. There were no significant between-group differences in demographic variables or outcomes. LSIs were not significantly different between the QT versus BPTB group, respectively: knee extensor isokinetic strength at 60 deg/s (median, 70 [range, 41-120] vs 68 [range, 37-83]; P = .285), activation (median, 95 [range, 85-111] vs 92 [range, 82-105]; P = .148), cross-sectional area of the vastus medialis (median, 79 [range, 62-104] vs 77 [range, 62-95]; P = .425), single-leg hop test (median, 88 [range, 35-114] vs 77 [range, 49-100]; P = .156), and step length symmetry (median, 99 [range, 93-104] vs 98 [range, 92-103]; P = .653). The median IKDC scores between the QT and BPTB groups were also not significantly different: 82 (range, 67-94) versus 83 (range, 54-94); respectively (P = .683).Conclusion:Patients with QT autografts demonstrated similar short-term quadriceps recovery and postsurgical outcomes compared with patients with BPTB autografts.

Development of a Non-invasive Methodology for the Assessment of Muscle Fibre Composition.

The percentage area of fast twitch fibres of a muscle is a major determinant of muscle mechanical power and, thus, an important biomarker for the evaluation of training processes. However, the invasive character of the assessment (muscle biopsy) limits the wide application of the biomarker in the training praxis. Our purpose was to develop a non-invasive method for the assessment of fast twitch fibre content in human soleus muscle. From a theoretical point of view, the maximum muscle mechanical power depends on the fibre composition, the muscle volume and muscle specific tension. Therefore, we hypothesised that the percentage area of type II fibres would show a correlation with the maximum muscle mechanical power normalised to muscle volume and specific muscle contractile strength (i.e., plantar flexion moment divided by muscle cross-sectional area). In 20 male adults, the percentage area of type II fibres, volume and maximum cross-sectional area of the soleus muscle as well as the maximum plantar flexion moment and the maximum mechanical power were measured using muscle biopsies, magnetic resonance imaging and dynamometry. The maximum mechanical power normalised to muscle volume and specific muscle contractile strength provided a significant relationship (r = 0.654, p = 0.002) with the percentage area of type II fibres. Although the proposed assessment parameter cannot fully replace histological measurements, the predictive power of 43% can provide a relevant contribution to performance diagnostics in the training praxis.

Optimal Ultrasonographic Measurements for Diagnosing Carpal Tunnel Syndrome in Patients With Diabetic Sensorimotor Polyneuropathy: A Case-Control Study.

ObjectiveTo investigate the optimal sonographic method for diagnosing carpal tunnel syndrome (CTS) in patients with diabetic sensorimotor polyneuropathy (DSP).MethodsA total of 190 participants were divided into four groups based on DSP history and electrodiagnostic results of CTS. The absolute parameters were measured at baseline and the relative values were calculated: maximal cross-sectional area (CSA) of the median nerve throughout the carpal tunnel (Mmax), median nerve CSA at the forearm level (Mf), ulnar nerve CSA at the pisiform level (Upi), difference between Mmax and Mf (∆MM), and difference between Mmax and Upi (∆MU). Then, the optimal ultrasonographic parameters for diagnosing CTS, according to the presence of DSP, using absolute and relative cutoff values were analyzed.ResultsMedian and ulnar nerve CSAs were significantly larger in the DSP group than in the control group. In the DSP participants, the mean Mmax, ∆MM, and ∆MU values were significantly larger in patients with both DSP and CTS than in patients with DSP only. The Mmax thresholds of 9.5 mm2 in the control group and 11.5 mm2 in the DSP group showed the greatest sensitivity and specificity for diagnosing CTS. The ∆MM thresholds of 2.5 mm2 and ∆MU thresholds of 4.5 mm2 had the greatest sensitivity and specificity in both the DSP and control groups.ConclusionMeasurement of Mmax, ∆MM and ∆MU is an optimal ultrasonographic evaluation method for diagnosing CTS in patients with DSP.

Tenosynovial fluid as an indication of early posterior tibial tendon dysfunction in patients with normal tendon appearance

Our primary aim was to quantify the posterior tibial tendon (PTT) sheath fluid volume in individuals with the clinical diagnosis of stage 1 posterior tibial tendon dysfunction (PTTD) and no MRI-detectable intra-substance tendon pathology and compare them with patients with other causes of medial ankle pain, also without MRI-detectable intra-substance PTT pathology and with normal controls. We also wanted to determine if there is a fluid measurement that correlates with the clinical diagnosis of PTTD. A total of 326 individuals with medial ankle pain and no intra-substance PTT pathology were studied. Group 1 included 48 patients with a clinical diagnosis of stage 1 PTT dysfunction, group 2 comprised 278 patients with other causes of medial ankle pain, and a third control group consisted of 56 patients without any medial ankle pain. MRI-based geometric measurements included PTT fluid volume, maximum cross-sectional fluid area, and fluid width. Fluid measurements were compared between groups and measurement reliability was tested. Group 1 showed greater PTT fluid volume, area, and width compared with groups 2 (other causes of medial ankle pain) and 3 (asymptomatic controls) (all p values < 0.001). A 9-mm threshold maximum fluid width was associated with PTTD (sensitivity 84%, specificity 85%). Measurements were reliable (all p values < 0.03) among three observers blinded to the gold standard. Patients with stage 1 PTT dysfunction displayed greater volumes of tendon-sheath fluid than those with other causes of medial ankle pain and compared with asymptomatic controls. A threshold maximum fluid width greater than or equal to 9mm distinguishes those with PTTD. An association between tendon sheath fluid distension and the clinical diagnosis of stage 1 posterior tibial tendon disease in the setting of no MRI-detectable intra-substance tendon pathology may allow for differentiation of medial ankle pain from other sources and may allow for early intervention aimed at preventing progressive PTTD. The level of evidence was prognostic (level III).

Anatomy of the Surrounding Tissue of the Eustachian Tube in Patulous Eustachian Tube: 3 Tesla Magnetic Resonance Imaging Approach.

To clarify the possible pathological conditions of cartilaginous portion of the Eustachian tube (ET) and its surrounding tissues. Retrospective review. Twenty-five normal subjects (control group) and 25 patients with patulous ET (patulous group). We reconstructed cross-sectional 3 Tesla magnetic resonance (MR) images using the multiplanar reconstruction (MPR) technique. Cross-section area widths that were measured included the following: 1) inferior head of lateral pterygoid muscle (PM); 2) pterygoid venous plexus (PVP); 3) medial soft tissues of ET, including ET cartilage; and 4) maximum cross-sectional area of high intensity surrounding the medial ET lumen. A statistically significant difference was found in the thickness of the inferior head of the lateral PM between male and female; it was thicker in the male participants. Ostmann's fatty tissue (OF) was significantly smaller in the patulous ET group. Smaller size of the surrounding tissues of the ET, viz., the OF, may contribute to the pathogenesis of patulous ET.

The Modified Bushen Antai Recipe Upregulates Estrogen and Progesterone Receptors at the Maternal-Fetal Interface in Pregnant Rats with Mifepristone-Induced Pregnancy Loss.

Background The modified Bushen Antai recipe (BSAT) is a centuries-old traditional Chinese medicine that we use in our center as a therapy against pregnancy loss. Our study aimed to explore the potential benefit and mechanism of BSAT in pregnant rats with mifepristone-induced pregnancy loss. Materials and Methods The signature compounds of the eight BSAT ingredients were analyzed by high-performance liquid chromatography (HPLC). The BSAT group (n = 8) was treated daily with 6.3 ml/kg BSAT from gestation day (D) 0.5 to 10.5 and once with 1.25 mg/kg mifepristone on D 10.5. Normal saline replaced BSAT in the model group (n = 8), and both BSAT and mifepristone in the control group (n = 8). Morphological and histological analyses were performed on D 13.5. Results BSAT contains eight medicinal ingredients including Cuscuta chinensis and Dipsacus asperoides. The HPLC analysis detected the signature compounds of seven medicinal ingredients in the extract. Embryo resorption rate in the BSAT group was significantly lower than that in the model group, although the number of surviving embryos was similar between the two groups. Hematoxylin and eosin (HE) staining suggested that the maximum cross-sectional area of the placenta and the area ratio of the placental labyrinth in the BSAT group were higher than those in the model group. Immunohistochemical (IHC) staining indicated that the expression of ki67, estrogen receptor alpha (ERα), and progesterone receptor (PR) in the placental labyrinth of the BSAT group was higher than that of the model group. Furthermore, the protein levels of ERα, PR, phospho-Akt/Akt, and phospho-Erk1/2/Erk1/2 in the BSAT group were higher than those in the control group. The mRNA levels of ERα and PR in the BSAT group were higher than those in the control group. Conclusions BSAT may induce estrogen and progesterone receptors by phosphorylation via the classic Akt and Erk1/2 signaling pathways in the maternal-fetal interface of pregnant rats, thereby reducing the pregnancy loss rate and improving the live birth rate.

Screening of clinical indicators for evaluation of incarcerated stone before operation

Objective To investigate the clinical indicators which could be used to differentiate incarcerated stones from unincarcerated stones by comparing clinical characteristics of patients. Methods 96 patients who were diagnosed as ureteral stones treated by ureteroscopic lithotripsy (URSL) from June 2017 to November 2017 were selected in the study. Clinical characteristics of patients were collected. The total study consisted of 62 male and 34 female patients. The patients’ age ranged from 24 to 78 years old and average age was (54.5±12.7) years old. There were 35 patients were diagnosed as ureteral stones with hypertension, 9 patients with diabetes, 85 patients with hydronephrosis, respectively. The number of patients, whose stone located in upper ureters, middle ureters and lower ureters were 49, 19, 28, respectively. The average of maximum stone diameter, maximum cross-sectional area of the stone, stone volume, hounsfield units of stone and maximum ureteral wall thickness (UWTmax) at the stone site were(7.75±2.68)mm, (36.12±24.43)mm2, (304.06±303.39)mm3, (755.75±318.05) HU, and (3.18±1.13)mm, respectively. Percussion tenderness over kidney region were positive in 11 cases, weak positive in 64 cases and negative in 21 cases, respectively. Stone-free rate after operation were 93.8%. Patients were divided into two groups, incarcerated or unincarcerated, and statistical differences between clinical characteristics of the two groups were analyzed by univariate analysis. The differences were further compared by multivariate logistic regression analysis to find independent predictors of impacted stones. The ROC curve was used to find the optimal UWTmax for diagnosis of impacted stone. The accuracy of this value was evaluated and patients were grouped by this value to compare the differences between groups. Results The operation and follow-up were successfully performed in all patients. Univariate analysis showed there were no statistical significance differences in gender[(24 males and 16 females)vs. (38 males and 18 females)], age [(53.4±12.3) years vs.(48.7±12.7) years], previous history of diabetes (4 cases vs. 5 cases) and stone location[(19 upper stones, 9 middle stones, 12 lower stones) vs. (30 upper stones, 10 middle stones, 16 lower stones)], between the two groups(P>0.05). Among the clinical characteristics of patients in incarcerated and unincarcerated groups, UWTmax were (4.15±0.94)mm and (2.58±0.76)mm, previous history of hypertension were 20 cases and 15 cases, ipsilateral URSL history were 14 cases and 10 cases, hounsfield units of stone were (847.66±282.39)HU and (698.65±325.50) HU, hydronephrosis were 40 cases and 50 cases, maximum stone diameter were (8.67±2.28)mm and (7.17±2.75)mm, maximum cross-sectional area of the stone were (43.83±23.65)mm2 and (31.14±23.64)mm2, stone volume were (386.20±296.60)mm3 and (253.04±296.29)mm3, percussion tenderness over kidney region were positive in 8 cases(20.0%), weak positive in 27 cases, negative in 5 cases and positive in 3 cases, weak positive in 37 cases, negative in 16 cases, respectively. The difference was statistically significant(P<0.05). Multivariate logistic regression analysis showed UWTmax (OR=10.40, P<0.001) at the stone site was significantly correlated with impacted ureteral stones and it was an independent predictor of impacted stones. ROC curve analysis showed that the optimal cut-off value of UWTmax was 3.26 mm. The sensitivity of the value to predict impacted stone is 82.5% and the specificity is 87.5%. Depending on the cut off value of 3.26 mm, cases were divided into two groups, 40 cases were in high UWTmax(≥3.26 mm)group and 56 cases were in low UWTmax(<3.26 mm)group. Higher UWTmax was accompanied with a higher incidence of ureteral edema[77.5%(31/40) vs. 32.1%(18/56)], polyps[30.0%(12/40)vs. 7.1%(4/56)], strictures[37.5%(15/40)vs. 12.5%(7/56)] and a lower stone-free rate[87.5%(35/40)vs. 98.2%(55/56)]. The difference was statistically significant(P<0.05). Conclusions UWTmax can be used to differentiate impacted stones from unimpacted stones before surgery. The patients with Higher UWTmax(≥3.26 mm) was accompanied with a higher incidence of stone impacted, ureteral edema, polyps, and strictures, and a lower rate of stone clearance. Key words: Ureteral wall thickness; Ureteral calculi; Impacted stone

A study of superior oblique muscle changes in superior oblique palsy using magnetic resonance imaging

Objective: To observe the magnetic resonance imaging(MRI) changes of superior oblique muscle and to study the relationship between changes and clinical signs in superior oblique muscle palsy. Methods: Cross-sectional study. Data was collected from January 2014 to January 2016 in Tianjin Eye Hospital. Twenty-three(30 eyes) patients who were diagnosed with superior oblique palsy included 15 patients with congenital superior oblique palsy [9 males and 6 females aged (32±13) years (range, 12-53 years)] and 8 cases with acquired superior oblique palsy [3 males and 5 females aged (36±15) years(range, 17-62 years)]. Twenty normal volunteers [11 males and 9 females aged (35±13) years (range, 15-60 years)] were also observed. Coronal MRI was used to detect superior oblique muscle morphological changes, as well as the maximum cross-sectional area and volume changes. The relationship between the morphological changes and vertical deviation and cyclotorsion in the primary gaze was analyzed. Rank sum test, t-test and Person correlation analysis were used for statistical analysis. Results: Two morphological changes were obtained using MRI in superior oblique muscle palsy, including round (19 eyes) and oval changes (11 eyes). The maximum cross-sectional area in eyes with the palsied superior oblique muscle [round, (10.38±1.76) mm(2); oval, (11.16±2.02) mm(2)] was significantly smaller than fellow eyes [(14.16±1.88) mm(2); Z=6.208, 5.178, both P<0.001] and eyes with normal superior oblique muscle [(15.40±1.71) mm(2); Z=8.215, 6.330, both P<0.001], and the volume changes [round, (104.92±13.36) mm(3); oval, (110.43±16.11) mm(3)] were also significantly different from fellow eyes [(254.57±20.15) mm(3); Z=7.511, 5.396, both P<0.001] and eyes with normal superior oblique muscle [(258.04±16.36) mm(3); Z=10.040, 6.936, both P<0.001]. There was no significant difference in vertical deviation between round and oval superior oblique muscle palsies (P>0.05). The cyclotorsion effect of the round change in superior oblique muscle palsy was significantly less than that of the oval change (5.47°±1.05° vs. 7.36°±0.97°, t=3.083, P=0.005). The correlation of the volume changes with vertical deviation angle in the primary gaze was not significantly different (round and oval, both P<0.05), but there was a correlation between the morphological changes and cyclotorsion strabismus (r=0.631, P=0.004; r=0.801, P=0.003). Conclusions: In the patients with superior oblique palsy, MRI scans shows that the maximum cross-sectional area decreased and the volume was smaller, which indicated superior oblique muscle atrophy. Deformation of superior oblique muscle do not significantly affect the vertical deviation, but is in correlation with cyclodeviation. (Chin J Ophthalmol, 2019, 55:20-24).

Measurement of the cross-sectional area of the hamstring muscles during initial and stretch positions with gravity magnetic resonance imaging.

[Purpose] We aimed to investigate the change rate in the cross-sectional area of each hamstring component to evaluate muscle extensibility and to contribute to the studies on hamstring strain prevention. [Participants and Methods] Fifteen healthy young males volunteered to participate in this study. They performed a knee extension test. For the measurements, we used multi-posture magnetic resonance imaging (gravity magnetic resonance imaging), the open shape of which allows performing body scanning in various positions. We measured the maximum cross-sectional area of the hamstring during the initial and stretch positions from the obtained images. Then, for each muscle, we calculated the maximum cross-sectional area change rate relative to the initial position. [Results] For all hamstring muscles, the maximum cross-sectional area during stretching was significantly smaller than that in the initial position. The maximum cross-sectional area change rate of the semimembranosus was significantly smaller than that of the other 3 muscles (there were no significant differences among these 3 muscles). [Conclusion] The results suggest that the semimembranosus has higher resistance to morphological change than the other muscles, which could be an important limiting factor for the extensibility of the hamstring muscle group.

Endogenous automatic nerve discharge promotes nerve repair: an optimized animal model.

Exogenous electrical nerve stimulation has been reported to promote nerve regeneration. Our previous study has suggested that endogenous automatic nerve discharge of the phrenic nerve and intercostal nerve has a positive effect on nerve regeneration at 1 month postoperatively, but a negative effect at 2 months postoperatively, which may be caused by scar compression. In this study, we designed four different rat models to avoid the negative effect from scar compression. The control group received musculocutaneous nerve cut and repair. The other three groups were subjected to side-to-side transfer of either the phrenic (phrenic nerve group), intercostal (intercostal nerve group) or thoracodorsal nerves (thoracic dorsal nerve group), with sural nerve autograft distal to the anastomosis site. Musculocutaneous nerve regeneration was assessed by electrophysiology of the musculocutaneous nerve, muscle tension, muscle wet weight, maximum cross-sectional area of biceps, and myelinated fiber numbers of the proximal and distal ends of the anastomosis site of the musculocutaneous nerve and the middle of the nerve graft. At 1 month postoperatively, compound muscle action potential amplitude of the biceps in the phrenic nerve group and the intercostal nerve group was statistically higher than that in the control group. The myelinated nerve fiber numbers in the distal end of the musculocutaneous nerve and nerve graft anastomosis in the phrenic nerve and the intercostal nerve groups were statistically higher than those in the control and thoracic dorsal nerve groups. The neural degeneration rate in the middle of the nerve graft in the thoracic dorsal nerve group was statistically higher than that in the phrenic nerve and the intercostal nerve groups. At 2 and 3 months postoperatively, no significant difference was detected between the groups in all the assessments. These findings confirm that the phrenic nerve and intercostal nerve have a positive effect on nerve regeneration at the early stage of recovery. This study established an optimized animal model in which suturing the nerve graft to the distal site of the musculocutaneous nerve anastomosis prevented the inhibition of recovery from scar compression.

Influence of thiophene spacer and auxiliary acceptor on the optical properties of 4-(Diethylamino)-2-hydroxybenzaldehyde based D-π-A-π-D Colorants with N-alkyl donors: Experimental, DFT and Z-scan study

We report here design and synthesis of four new D-π-A-π-D type dyes (4 and 5) with triphenylamine/N-ethyl carbazole as fixed rotor/donor and N, N-diethyl amine as a secondary donor having dicyanovinylene as a common acceptor. The Influence of π-linker (thiophene) along with an auxillary cyano group on the nonlinear and linear optical properties is investigated. Molecules with thiophene spacer (4b and 5b) exhibit progressive variation in their absorption and emission profiles reflecting the effect of π-linker, compared to those devoid of thiophene spacer (4a and 5a). The dyes display solvent dependent emission [e.g. 4b (toluene = 689 nm) and 5b (DMSO = 795 nm)] suggesting a more polarized photo-excited state arising as a result of enhanced intramolecular charge transfer in the excited state. The solvatochromic nature is supportive of a general solvent effect, which is confirmed by solvent polarity plots (Weller’s and Rettig’s plot). The trends in the optical properties were also validated by time dependent density functional theory computations which further reveals charge transfer (from secondary donor to acceptor) for the long wavelength absorption. Dye with the highest charge transfer dipole moment relatively has the maximum two-photon absorption cross-section area (4b = 246–399 GM) which was established using theoretical two-level model. Non-linear optical properties were investigated using solvatochromic two-level model and computationally using global and range separated hybrid functionals. The dyes show high first-order hyperpolarizability (β0) in the range of 191–1162 × 10−30 e.s.u. and second-order hyperpolarizability (γ0) in the range of 491–6,704 × 10−36 e.s.u. Z-scan results show 4a (3.79 × 10−13 e.s.u.) possesses a higher value of third order nonlinear susceptibility in DMSO. Thus, the dyes can be considered as promising candidates for NLO application in material science.

Assessment of Maximum Cross-Sectional Area and Volume of the Canine Biceps Brachii – Brachialis Muscles

Abstract The biceps brachii - brachialis muscles has attachment on the medial coronoid process (MCP) and proximal radius. It is considered that medial coronoid disease (MCD) can be caused by biceps brachii – brachialis muscle generated force to MCP. Computed tomography data from 31 dogs were analysed. The aim of this study was to compare biceps brachii – brachialis muscle volume and maximum cross-sectional area (mCSA) between clinically normal dogs to dogs with a MCD. Results showed that in dogs with MCD, biceps brachii - brachialis muscle volume and mCSA is smaller than in clinically normal dogs and therefore the generated muscle force cannot be considered as the main or accompanying cause of a MCD.

Aortic stiffness in aortic stenosis assessed by cardiovascular MRI: a comparison between bicuspid and tricuspid valves

ObjectivesTo compare aortic size and stiffness parameters on MRI between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with aortic stenosis (AS).MethodsMRI was performed in 174 patients with asymptomatic moderate-severe AS (mean AVAI 0.57 ± 0.14 cm2/m2) and 23 controls on 3T scanners. Valve morphology was available/analysable in 169 patients: 63 BAV (41 type-I, 22 type-II) and 106 TAV. Aortic cross-sectional areas were measured at the level of the pulmonary artery bifurcation. The ascending and descending aorta (AA, DA) distensibility, and pulse wave velocity (PWV) around the aortic arch were calculated.ResultsThe AA and DA areas were lower in the controls, with no difference in DA distensibility or PWV, but slightly lower AA distensibility than in the patient group. With increasing age, there was a decrease in distensibility and an increase in PWV. After correcting for age, the AA maximum cross-sectional area was higher in bicuspid vs. tricuspid patients (12.97 [11.10, 15.59] vs. 10.06 [8.57, 12.04] cm2, p < 0.001), but there were no significant differences in AA distensibility (p = 0.099), DA distensibility (p = 0.498) or PWV (p = 0.235). Patients with BAV type-II valves demonstrated a significantly higher AA distensibility and lower PWV compared to type-I, despite a trend towards higher AA area.ConclusionsIn patients with significant AS, BAV patients do not have increased aortic stiffness compared to those with TAV despite increased ascending aortic dimensions. Those with type-II BAV have less aortic stiffness despite greater dimensions. These results demonstrate a dissociation between aortic dilatation and stiffness and suggest that altered flow patterns may play a role.Key Points• Both cellular abnormalities secondary to genetic differences and abnormal flow patterns have been implicated in the pathophysiology of aortic dilatation and increased vascular complications associated with bicuspid aortic valves (BAV).• We demonstrate an increased ascending aortic size in patients with BAV and moderate to severe AS compared to TAV and controls, but no difference in aortic stiffness parameters, therefore suggesting a dissociation between dilatation and stiffness.• Sub-group analysis showed greater aortic size but lower stiffness parameters in those with BAV type-II AS compared to BAV type-I.

Comparative study of dual energy CT iodine imaging and standardized concentrations before and after chemoradiotherapy for esophageal cancer

BackgroundTo compare dual energy CT iodine imaging and standardized iodine concentration before and after chemoradiotherapy (CRT) for esophageal cancer and evaluate the efficacy of CRT for EC by examining DECT iodine maps and standard CT values.MethodsThe clinical data of 45 patients confirmed by pathology with newly diagnosed esophageal cancer who underwent concurrent CRT from February 2012 to January 2017 in our department of radiology were collected. All patients underwent dual-source dual-energy CT (DECT) before and after CRT. Normalized iodine concentration (NIC) and normalized CT (NCT) corresponding to the overall cancer lesion and its maximum cross-sectional area were observed and compared. Additionally, 30 healthy individuals were compared as control group. After treatment, the patients were divided into two groups according to RECIST1.1: treatment effective group and ineffective group.ResultsThere were 33 patients (CR 9, PR 24) in the effective group and 12 patients (SD 12, PD 0) in the ineffective group. There was no significant difference in the NIC-A, NIC-V, NCT-A and NCT-A indexes between the effective group (B group) and the ineffective group (C group) before treatment (P > 0.05). After the treatment, the above-mentioned indexes in the effective group of patients were significantly lower than before treatment, and compared with the ineffective group, the NIC-A, NIC-V, NCT-A and NCT-V values of the effective group were significantly lower than those of ineffective group (P < 0.05). After treatment, the NIC-V and NCT-V in the ineffective group were lower than before treatment, and the difference was statistically significant (P < 0.05). However, their NIC-A and NCT-A were not statistically different from those before treatment (P > 0.05).ConclusionUsing DECT iodine map, the changes of NIC and NIC before and after CRT in patients with esophageal cancer can evaluate the effect of CRT, and does not increase the radiation dose, so it is suitable for clinical use.

Fluid dynamic assessment of tracheal flow in infants with congenital tracheal stenosis before and after surgery.

Tracheal flow in infants with congenital tracheal stenosis (CTS) was numerically investigated using subject-specific airway models before and after reconstructive surgery. We quantified tracheal flow based on airway resistance during inhalation, and compared it between controls and patients before and after surgery. The airway resistance in each subject was assessed using geometrical parameters of the trachea: the minimum cross-sectional area Amin, the minimum cross-sectional area normalized by the standard deviation of the cross-sectional area Amin/σA, the area ratio of the minimum and maximum cross-sectional area Amin/Amax, and ratio of the normalized standard deviation of cross-sectional area to the mean cross-sectional area σA/Amean. Our numerical results demonstrated that such geometrical parameters could be used to assess the severity of CTS. Since subjects can be more clearly categorized as controls and most preoperative patients in terms of the airway resistance, a simulation using subject-specific airway models can lead us to a precise understanding of tracheal flow, and also provide knowledge about therapeutic decision. Our numerical results also demonstrated that significant surgical expansion of cross-sectional area did not help recover tracheal flow because of expansion loss. These results will be helpful not only when making therapeutic decisions about surgery but also when assessing quality of life in postoperative patients. Graphical abstract.

Histopathological changes in the infrapatellar fat pad in an experimental rabbit model of early patellofemoral osteoarthritis

BackgroundThe purpose of this study was to characterise the histopathological changes in the infrapatellar fat pad (IPFP) in the early stage of patellofemoral osteoarthritis (PFOA). MethodsSixty-four New Zealand white rabbits were randomly divided into experimental (n = 24), sham (n = 16), and control groups (n = 24). In the experimental group, denoted as the patellar ligament uneven shortening group (US group), the patellar ligament (PL) was folded eight millimetres and sutured. After eight weeks, all animals were euthanised, and magnetic resonance imaging (MRI) evaluation, wet IPFP weight measurement, and histopathological and immunohistochemistry analysis were performed to analyse the histopathological changes in the IPFPs. ResultsThe maximum cross-sectional area (CSA) of the IPFPs in the sagittal position of MRI in the control group, sham group, and US group were 45.50 ± 7.19 mm2, 45.88 ± 6.60 mm2 (vs. control group, P = 0.907), and 53.83 ± 8.24 mm2 (vs. control group, P = 0.015; vs. sham group, P = 0.035), respectively. The MRI intensity of the IPFPs in the control group, sham group, and US group were 115.53 ± 28.85, 108.53 ± 26.73 (vs. control group, P = 0.589), and 154.52 ± 18.48 (vs. control group, P = 0.002; vs. sham group, P = 0.002), respectively. The wet weight of the IPFPs in the control group, sham group, and US group were 0.32 ± 0.05 g, 0.32 ± 0.04 g (vs. control group, P = 0.895), and 0.38 ± 0.06 g (vs. control group, P = 0.017; vs. sham group, P = 0.033), respectively. The Osteoarthritis Research Society International (OARSI) scores of the IPFPs in the US group were 6.00 ± 1.91, which was higher than the scores of 2.50 ± 2.02 (P < 0.001) in the control group and of 2.75 ± 1.67 (P = 0.001) in the sham group. ConclusionsThe histopathological changes of the IPFPs as determined via MRI and microscopic structure appeared to occur much earlier than cartilage damage in PFOA. Furthermore, detecting and treating the IPFP changes may offer aid in the diagnosis and treatment of PFOA.

Investigation on the measurement sites of the cross-sectional areas of the gluteus maximus and gluteus medius.

To verify the relationship between muscle volume and muscular strength of different cross-sectional areas (CSAs) of the gluteus maximus and medius, and to clarify the effective evaluation index. Twenty healthy adults were enrolled in this cross-sectional study. Magnetic resonance images were evaluated, and CSAs of the gluteus maximus and medius were calculated. Calculation sites were the peak CSA, lowest end of the sacroiliac joint CSA, and just above the femoral head CSA. Muscle volume and muscular strength were measured. The correlation between muscular CSA, muscle volume, and muscular strength was verified using Pearson's correlation coefficient (p < 0.05). One-way analysis of variance and the Tukey-Kramer test were used to verify differences in each CSA (p < 0.05). A significantly positive correlation was found between muscular CSA, muscle volume, and muscular strength of both muscles (p < 0.05). For the gluteus maximus, the muscular CSA calculated just above the femoral head showed a significantly larger value than that calculated at the lowest end of the sacroiliac joint (p < 0.05). For the gluteus medius, the peak CSA and muscular CSA calculated at the lowest end of the sacroiliac joint were significantly larger than that calculated just above the femoral head (p < 0.05). The maximum CSA of the gluteus maximus was found just above the femoral head and that of the gluteus medius was near the lowest end of the sacroiliac joint; hence, CSAs should be calculated at these sites. The CSA reflected muscle volume and strength.