Morphometric assessment of tibial nerve and its branches around the ankle.

It is essential to understand the considerable variations in bifurcation patterns of the tibial nerve (TN) and its peripheral nerves at the level of the tarsal tunnel to prevent iatrogenic nerve injury during surgical nerve release or nerve block. A total of 16 ankles of 8 human cadavers were dissected to investigate the branching patterns of the TN, using 2 imaginary lines passing through the tip of the medial malleolus (MM) as reference lines. Bifurcation patterns and detailed information on the relative locations of the medial plantar, lateral plantar, medial calcaneal, and inferior calcaneal nerves to the reference lines were recorded. The most common bifurcation pattern was Type 1 in 12 ankles (75%), followed by Type 2 in 2 ankles (13%). One medial calcaneal nerve (MCN) was seen in 11 (69%) specimens and 2 MCN branches were seen in 5 (31%) specimen. 88% of the MCN branches bifurcated from the TN, whereas 6% originated from both TN and lateral plantar nerve (LPN). At the level of the tip of the MM, 2 of 7 parameters showed statistically significant difference between both sexes (P < .05). There was a statistically significant difference between left and right ankles in 2 of 7 measurements (P < .05). Further morphometric analysis of the width, distance, and angle between the TN branches and the tip of MM showed a highly variable nature of the location of the peripheral nerve branches.

Electrodiagnostic Findings Using Radial Motor Segmental Conduction Study and Inching Test in Patients with Radial Neuropathy.

OBJECTIVE: The aim of this study was to characterize the electrodiagnostic findings of radial neuropathy using motor segmental conduction study (RMSCS), and to determine the utility of subsequent inching test in precise lesion localization. DESIGN: Twenty-three patients with radial neuropathy were evaluated using RMSCS with three-point stimulation. The pathomechanism of the lesions according to the RMSCS was classified into three groups: conduction block (CB), mixed lesion (combination of CB and axonal degeneration), and axonal degeneration. Inching test was performed in patients with CB to localize the lesion site, and needle EMG identified the most proximal radial nerve-innervated muscles affected. RESULTS: Out of twenty-three cases, the RMSCS demonstrated probable partial CB in 10, mixed lesions in 2, and axonal degeneration in 10. One case could not be categorized with RMSCS alone. As determined by RMSCS and inching test, the most common cause of CB was compression, while the most common cause of axonal degeneration was iatrogenic. In the CB group, the lesion locations identified by RMSCS and inching test were consistent with needle EMG localization. CONCLUSION: The combined RMSCS and inching test technique can precisely localize radial motor nerve injuries and provide detailed information on electrodiagnostic characteristics of radial mononeuropathy.

Clinical, Electrophysiological, and Sonographic Findings in Patients With Nerve Injury After Vessel Puncture.

BACKGROUND AND PURPOSE: This study aimed to describe the clinical, electrophysiological, and ultrasonographic findings of patients with nerve injury after vessel puncture. METHODS: Data on ten patients (three males and seven females) with nerve injury after vessel puncture were reviewed. Demographic and clinical data were analyzed retrospectively. Bilateral electrophysiological studies were performed based on clinical findings. Ultrasonographic examinations were performed on both the affected and unaffected sides of the injured nerve. RESULTS: The nerves of nine patients were injured following vein puncture, and injury occurred following arterial sampling in one patient. Seven patients had superficial radial sensory nerve injury: five medial, one lateral, and one at both branches. One patient had injury to the dorsal ulnar cutaneous nerve, one to the lateral antebrachial cutaneous nerve, and one to the median nerve. Nerve conduction studies produced abnormal findings in 80% of patients, whereas ultrasonographic examinations produced abnormal findings in all of the patients. Spearman's coefficient for the correlation between the amplitude ratio and nerve cross-sectional area ratio was not significant, at -0.127 (95% confidence interval=-0.701 to 0.546, p=0.721). CONCLUSIONS: Ultrasonography supported by electrodiagnosis was found to be a useful method for identifying the lesion location and structural abnormalities of vessel-puncture-related neuropathy.

Ultrasonographic Evaluation of the Optimal Needle Position in the Supinator Muscle.

BACKGROUND AND PURPOSE: Investigating the supinator muscle (SUP) is important for diagnosing radial neuropathy or cervical radiculopathy in needle electromyography (EMG). However, different authors have proposed several locations for needle EMG placement in the SUP. This study aimed to determine the optimal needle insertion position for examining the SUP via needle EMG under ultrasonographic guidance. METHODS: This study included 16 male (32 upper limbs) and 15 females (30 upper limbs). In the supine position, the line connecting the midpoint of the dorsal wrist to the upper margin of the radial head (RH) (RH_WRIST line) was measured while the forearm was pronated. Under ultrasonographic guidance, the thickness of the SUP was measured at 1-cm intervals from the RH to 4 cm along the RH_WRIST line. Moreover, the horizontal distance (HD) from the RH_WRIST line to the posterior interosseous nerve (PIN) and the distance from the RH to the point where the RH_WRIST line and the PIN intersected (VD_PIN_CROSS) were measured. RESULTS: VD_PIN_CROSS was 51.25±7.0 mm (mean±SD). The muscle was the thickest at 3 cm (5.6±0.8 mm) and 4 cm (5.4±1.0 mm) from the RH. The distances from the PIN to these points were 14.1±3.9 mm and 9.0±4.3 mm, respectively. CONCLUSIONS: Our findings suggest that the optimal needle placement is at 3 cm from the RH.

A Cadaveric Study of a Safe and Accurate Electromyographic Needle Approach to the Rhomboid Major.

OBJECTIVE: This study aimed to investigate a safe and accurate electromyographic needle insertion site of the rhomboid major (RM) muscle using cadaver dissection. DESIGN: Dissection of the trapezius and rhomboid major muscles around the scapula was performed in 18 scapulae from nine fresh cadavers. The point (point A) at which the lateral margin of the lower trapezius muscle crossed the medial border of the scapula and the distal insertion point (point DI) of the rhomboid major muscle to the medial scapula were determined. The midpoint (point M) between points A and DI was also determined. The distance from the inferior angle of the scapula to each point was measured. RESULTS: The length of the medial scapula was 12.9 ± 1.2 cm from the root of the scapular spine to the inferior angle of the scapula. Points A, DI, and M were located at a mean distance of 8.4 ± 0.7, 1.8 ± 0.4, and 5.1 ± 0.5 cm proximal to the inferior angle of the scapula, respectively. CONCLUSIONS: Needle electromyographic examination of the rhomboid major muscle can be performed safely and accurately using the lower part of the rhomboid major muscle, as investigated in this anatomical study.

Optimal placement for needle electromyography of the supinator muscle: Cadaveric studies.

INTRODUCTION/AIMS: The existing methods for needle electromyography are confusing as to which is the safest and most effective. Our aim was to identify the optimal and safest needle electromyographic insertion site in the supinator muscle. METHODS: We performed a two-step cadaveric dissection of the supinator muscle and related neurovascular structures. The study was performed using 18 upper limbs of 9 fresh adult cadavers (step 1) and 14 upper limbs of 7 fresh adult cadavers (step 2). In step 1, an imaginary line connecting the radial head (RH) and midpoint of the dorsal wrist (RW line) was drawn, and the distance from the RH to the point where the RW line and posterior interosseous nerve (PIN) intersect (L_CROSS) was measured on the RW line. In step 2, the needle was inserted 30 mm distal to the RH according to the results of step 1. After injection with India ink, dissection was performed to measure the distance between the needle insertion site and PIN (L_CROSS_Inj) on the RW line. RESULTS: The median L_CROSS was 51.4 (35.5-65.6) mm. Needle insertion spared the PIN in all cases during step 2, and the needle was inserted into the supinator muscle in all cases. The median L_CROSS_Inj was 27.4 (13.2-39.8) mm. DISCUSSION: A safe and accurate needle insertion site for the supinator muscle is approximately 30 to 40 mm distal to the RH along the RW line.

A cadaveric study for the volar needle approach to the pronator quadratus using the palmaris longus tendon landmark.

INTRODUCTION: Our aim in this work was to determine the safety and accuracy of the volar approach to the pronator quadratus (PQ) through cadaver dissection. METHODS: Twenty upper limbs from 10 fresh cadavers were investigated. At the level 3 cm proximal to the ulnar styloid process (USP), a needle was inserted just medial to the palmaris longus (PL) tendon. Distances of the median nerve (MN) and ulnar artery (UA) from the needle insertion point (IP) were measured using ultrasonography and cadaver dissection. RESULTS: The PQ was located at a depth of 10.8-19.9 mm from the skin and had a median thickness of 9.1 mm, measured 3 cm proximal to the USP. The median distances of the MN and UA from the IP were 7.6 and 13.4 mm, respectively. DISCUSSION: A needle insertion for the volar approach to the PQ was safe at 3 cm proximal to the USP, just medial to the PL tendon.

Optimal Placement of Needle Electromyography in Extensor Indicis: A Cadaveric Study.

OBJECTIVE: To identify the center of extensor indicis (EI) muscle through cadaver dissection and compare the accuracy of different techniques for needle electromyography (EMG) electrode insertion. METHODS: Eighteen upper limbs of 10 adult cadavers were dissected. The center of trigonal EI muscle was defined as the point where the three medians of the triangle intersect. Three different needle electrode insertion techniques were introduced: M1, 2.5 cm above the lower border of ulnar styloid process (USP), lateral aspect of the ulna; M2, 2 finger breadths (FB) proximal to USP, lateral aspect of the ulna; and M3, distal fourth of the forearm, lateral aspect of the ulna. The distance from USP to the center (X) parallel to the line between radial head to USP, and from medial border of ulna to the center (Y) were measured. The distances between 3 different points (M1- M3) and the center were measured (marked as D1, D2, and D3, respectively). RESULTS: The median value of X was 48.3 mm and that of Y was 7.2 mm. The median values of D1, D2 and D3 were 23.3 mm, 13.3 mm and 9.0 mm, respectively. CONCLUSION: The center of EI muscle is located approximately 4.8 cm proximal to USP level and 7.2 mm lateral to the medial border of the ulna. Among the three methods, the technique placing the needle electrode at distal fourth of the forearm and lateral to the radial side of the ulna bone (M3) is the most accurate and closest to the center of the EI muscle.

Cell cloning-on-the-spot by using an attachable silicone cylinder.

Cell cloning is a laboratory routine to isolate and keep particular properties of cultured cells. Transfected or other genetically modified cells can be selected by the traditional microbiological cloning. In addition, common laboratory cell lines are prone to genotypic drift during their continual culture, so that supplementary cloning steps are often required to maintain correct lineage phenotypes. Here, we designed a silicone-made attachable cloning cylinder, which facilitated an easy and bona fide cloning of interested cells. This silicone cylinder was easy to make, showed competent stickiness to laboratory plastics including culture dishes, and hence enabled secure isolation and culture for days of selected single cells, especially, on the spots of preceding cell-plating dishes under microscopic examination of visible cellular phenotypes. We tested the silicone cylinder in the monoclonal subcloning from a heterogeneous population of a breast cancer cell line, MDA-MB-231, and readily established independent MDA-MB-231 subclones showing different sublineage phenotypes.

Scaffold-Free Coculture Spheroids of Human Colonic Adenocarcinoma Cells and Normal Colonic Fibroblasts Promote Tumorigenicity in Nude Mice.

The aim of this study was to form a scaffold-free coculture spheroid model of colonic adenocarcinoma cells (CACs) and normal colonic fibroblasts (NCFs) and to use the spheroids to investigate the role of NCFs in the tumorigenicity of CACs in nude mice. We analysed three-dimensional (3D) scaffold-free coculture spheroids of CACs and NCFs. CAC Matrigel invasion assays and tumorigenicity assays in nude mice were performed to examine the effect of NCFs on CAC invasive behaviour and tumorigenicity in 3D spheroids. We investigated the expression pattern of fibroblast activation protein-α (FAP-α) by immunohistochemical staining. CAC monocultures did not form densely-packed 3D spheroids, whereas cocultured CACs and NCFs formed 3D spheroids. The 3D coculture spheroids seeded on a Matrigel extracellular matrix showed higher CAC invasiveness compared to CACs alone or CACs and NCFs in suspension. 3D spheroids injected into nude mice generated more and faster-growing tumors compared to CACs alone or mixed suspensions consisting of CACs and NCFs. FAP-α was expressed in NCFs-CACs cocultures and xenograft tumors, whereas monocultures of NCFs or CACs were negative for FAP-α expression. Our findings provide evidence that the interaction between CACs and NCFs is essential for the tumorigenicity of cancer cells as well as for tumor propagation.

Characterization of the cytokine profile of platelet rich plasma (PRP) and PRP-induced cell proliferation and migration: Upregulation of matrix metalloproteinase-1 and -9 in HaCaT cells.

BACKGROUND: The underlying rationale of platelet rich plasma (PRP) therapy is that an injection of concentrated PRP at the site of injury may promote tissue repair via cytokine release from platelets. The molecular mechanisms of PRP therapy in the skin wound healing process are not well understood at present, and would benefit from clarification. METHODS: PRP was stimulated with angonists for 5 min, and cytokine profile analysis was performed. To investigate the wound healing activity of PRP, cell proliferation and migration analyses were performed in skin cells. The effects of PRP were analyzed on the expression and activity of matrix metalloproteinase (MMP)-1, -2, -9, and the activation of transcription factors. RESULTS: Thrombin was found to be a strong stimulator of PRP activation to release growth factors and chemokines. PRP induced cell proliferation and migration in HUVECs, HaCaT cells, and HDFs, as well as MMP-1and MMP-9 expression in HaCaT cells, but PRP did not have a significant effect on the expression or activity of MMPs in HDFs. The transcription factors, including signal transducer and activator of transcription-3 (STAT-3) were found to be phosphorylated following PRP treatment in HaCaT cells. CONCLUSION: In this study, we have identified the cytokine profile of activated PRP after agonist stimulation. We have shown that PRP plays an active role in promoting the proliferation and migration of skin cells via the regulation of MMPs, and this may be applicable to the future development of PRP therapeutics to enhance skin wound healing.