Topographical anatomy of the anterior cervical approach for c2-3 level.

PURPOSE: To develop a clinically relevant anterior cervical approach (ACA) to the C2-3 level. METHODS: Frequently encountered nerves [hypoglossal (HyN), internal (ISLN) and external superior laryngeal nerves (ESLN)] and vessels [lingual (LiA), superior laryngeal (SLA) and superior thyroid arteries (STA)] in the field of high ACA and the anatomic spatial markers [submandibular gland (SMG); sling for digastrics muscle (SDG); hyoid bone (HyB), and thyroid cartilage (ThC)] were evaluated using 18 fresh cadavers. The vertical distance of each structure at the carotid sheath and larynx and each disc for cervical level were measured from the suprasternal notch. RESULTS: The cervical levels of SDG, SMG and HyB were mostly C3 and that of ThC was C5. The vertical locations of HyN and LiA were not significantly different and the levels corresponded to C2. The levels for ISLN and ESLN were C3 at carotid and C4 and C5 at larynx sides, respectively. The vertical locations of ISLN and HyN were significantly different at carotid (p = 0.001) and larynx (p < 0.001) sides. The vertical locations and cervical levels of SLA and STA at carotid and larynx sides were not significantly different with those of ISLN and ESLN, respectively. The HyN traversed C2 with accompanying LiA. The ISLN passed C3 and C4 from carotid to larynx sides and accompanied SLA. CONCLUSIONS: The C2-3 level can be exposed through the space between the HyN and the ISLN by retracting the LiA superiorly, the SLA inferiorly, the HyB medially, and the carotid sheath laterally.

The significance of tibial and common peroneal nerves in nerve blocks.

PURPOSE: The aim of this study was to elucidate the anatomical location of tibial nerve (TN) and common peroneal nerve (CPN) in the popliteal crease for specific nerve block. METHODS: Fifty fresh specimens from 27 adult Korean cadavers (16 males and 11 females, age 35-87 years) were investigated. Five of the 27 cadavers were used to determine the depths of nerves in cross-section. RESULTS: Tibial nerve was located 50 % from the most lateral point of the popliteal crease and 1.4-cm deep to the surface. In 20 % of the 50 specimens, the medial sural cutaneous nerve branched out below or at the popliteal crease, whereas the CPN was located at 26 % from the most lateral point of the popliteal crease and 0.7-cm deep from the surface. Furthermore, in 6 % of specimens the lateral sural cutaneous nerve branched out below or at the popliteal crease. CONCLUSION: The results concerning the location of the TN and CPN at the popliteal crease offer a good guide to optimal nerve block.

Intramuscular distribution of the phrenic nerve in human diaphragm as shown by Sihler staining.

INTRODUCTION: Intramuscular innervation of the human diaphragm has not been well described. The goal of this study was to elucidate the detailed intramuscular distribution of the phrenic nerve in the human diaphragm. METHODS: Fifteen human diaphragms were visualized using modified Sihler staining, and the detailed intramuscular phrenic nerve distribution was photographed and recorded. RESULTS: Three types of primary phrenic nerve branches were noted. Each type of primary branch innervated a confined muscular subvolume of the diaphragm, and the intramuscular branches in each subvolume anastomosed largely with one another and formed a characteristic "net" of nerve branches. A few small nerve filaments were seen entering the peripheral diaphragm. The directions and locations of nerve branches innervating the hiatal diaphragm were not symmetrical between sides. CONCLUSION: These findings may offer useful information for anatomists, physiologists, and clinicians.

Effective zone of botulinum toxin a injections in hallux claw toe syndrome: an anatomical study.

INTRODUCTION: The aim of this study was to determine the anatomical location of the motor points of the flexor hallucis longus (FHL) and brevis (FHB) muscles for an effective motor point block. METHODS: Twenty cadavers were used for this study. For the FHL, we identified the line between the medial and lateral epicondyle of the femur and the line joining the prominent point on the surface of the medial malleolus of the tibia and the lateral malleolus of the fibula. For the FHB, we identified the line between the middle-lowest point of the great toe and the middle-lowest point of the sole of the foot. RESULTS: The dense area of the motor points was located at 40-70% for the FHL and 50-70% for the FHB. CONCLUSION: An injection area of 50-60% on the reference line for the FHL and FHB is suggested.

Arterial anatomy of the gracilis muscle as determined by latex injection and glycerin transparency.

The gracilis muscle is widely used in reconstructive surgery, either as a pedicled flap or as a free microsurgical flap. The aim of this study was to demonstrate in detail the arterial anatomy of the gracilis muscle, particularly its intramuscular artery distribution, by using a method involving red latex injection and glycerin transparency, which makes muscle tissues quite transparent and allows direct visualization of the arterial anatomy. Twenty-four specimens of gracilis muscle were harvested after injecting 12 cadavers with red latex. The different patterns of blood supply of the gracilis muscle were counted. A complete arterial system formed by anastomoses of intramuscular arterial branches was observed in each specimen. The existence of several arterial branches at the proximal origin of each muscle was observed. The results of this study provide reconstructive surgeons with useful information regarding gracilis muscle flap design.

CircRNA_0078767 promotes osteosarcoma progression by increasing CDK14 expression through sponging microRNA-330-3p.

Circular RNA (circRNA)-associated competing endogenous RNA (ceRNA) mechanism have emerged as critical mechanism in cancer initiation and progression. However, the roles of the circRNA-microRNA (miRNA)-messenger RNA ceRNA network in osteosarcoma are still not fully characterized. In this study, therefore, circ_0078767-related ceRNA mechanism in osteosarcoma was studied. Bioinformatics tools primarily identified differentially expressed circRNAs and their downstream miRNAs in osteosarcoma, implying the potential interaction between circ_0078767, miR-330-3p, and cyclin-dependent kinase 14 (CDK14) in this malignancy, which were further verified by means of RNA immunoprecipitation, RNA pull-down, and dual-luciferase reporter gene assays. Aberrant abundance of circ_0078767 was found in both osteosarcoma tissues and cells, relating to dismal prognosis in patients with osteosarcoma. Functionally, circ0078767 strengthened the proliferation, invasiveness, and migration of osteosarcoma cells, which could be neutralized by miR-330-3p. Additionally, miR-330-3p targeted and decreased CDK14 expression whereby motivating the malignant phenotypes of osteosarcoma cells. Through in vivo experiments, we further confirmed that circ_0078767 targeted miR-330-3p to upregulate CDK14, whereby strengthening the in vivo tumorigenic and metastatic ability of osteosarcoma cells. Circ_0078767 promotes the occurrence and development of osteosarcoma by upregulating CDK14 in a miR-330-3p-dependent manner.

Location of the motor entry point and intramuscular motor point of the tibialis posterior muscle: for effective motor point block.

The aim of this study was to elucidate the anatomical location of the motor entry point (MEP) and intramuscular motor point (IMP) of the tibialis posterior muscle for effective motor point block. Thirty-six fresh specimens from 20 adult Korean cadavers (11 males and 9 females) were investigated. The reference line between the most proximal-medial articular margin of the tibia (MPM) at the level of the knee joint and the most distal point of the malleolus of the tibia (MDM) on the surface were identified. The mean length of the reference line was 326.5 ± 27.1 mm. There were 82.5% of the total number of MEPs located at 10-30% and 67.9% of the total IMPs were 10-40% from the MPM. The safety zone for botulinum toxin (BTX) injections on the medial approach was 10-40% from the MPM. In addition, insertion of the needle to a depth of 3.5 cm from the surface of the skin was effective. These results may assist in determining more accurate localization of injection sites.

Anatomic localization of motor entry point of superficial peroneal nerve to peroneus longus and brevis muscles.

This study examined the anatomic location of the motor entry point (MEP) and branching point at the proximal and distal points of the tendon of the peroneal muscle by visual observation. Forty-three fresh legs of 25 adult bodies which had been donated to science were investigated in this study. The mean length of the reference line between the most proximal point of the head of the fibula (PHF) and the most distal point of the malleolus of the fibula (DMF) was 33.4 ± 2.5 cm. The MEPs of the peroneus longus (PL) and peroneus brevis (PB) gathered from 20 to 40% (7.0-13.0 cm) and 40 to 60%, respectively. The branching point where the nerve was divided to innervate the PL and PB was 10% and 28% from the PHF, respectively. These anatomic results suggest appropriate areas where to inject phenol or other agents for a MEP block in the case of a spastic lower extremity as well as guidelines for an electromyography conduction test.

Effective and direct control of neural TTS prosody by removing interactions between different attributes.

End-to-end TTS advancement has shown that synthesized speech prosody can be controlled by conditioning the decoder with speech prosody attribute labels. However, to annotate quantitatively the prosody patterns of a large set of training data is both time consuming and expensive. To use unannotated data, variational autoencoder (VAE) has been proposed to model individual prosody attribute as a random variable in the latent space. The VAE is an unsupervised approach and the corresponding latent variables are in general correlated with each other. For more effective and direct control of speech prosody along each attribute dimension, it is highly desirable to disentangle the correlated latent variables. Additionally, being able to interpret the disentangled attributes as speech perceptual cues is useful for designing more efficient prosody control of TTS. In this paper, we propose two attribute separation schemes: (1) using 3 separate VAEs to model the real-valued, different prosodic features, i.e., F0, energy and duration; (2) minimizing mutual information between different prosody attributes to remove their mutual correlations, for facilitating more direct prosody control. Experimental results confirm that the two proposed schemes can indeed make individual prosody attributes more interpretable and direct TTS prosody control more effective. The improvements are measured objectively by F0 Frame Error (FFE) and subjectively with MOS and A/B comparison listening tests, respectively. The scatter diagrams of t-SNE also demonstrate the correlations between prosody attributes, which are well disentangled by minimizing their mutual information. Synthesized TTS samples can be found at https://xiaochunan.github.io/prosody/index.html.

LINC01278 is Highly Expressed in Osteosarcoma and Participates in the Development of Tumors by Mediating the miR-134-5p/KRAS Axis.

PURPOSE: There is increasing evidence that non-coding RNAs (ncRNAs), including long non-coding RNAs (lncRNAs) and microRNAs (miRNAs), produce a critical regulatory effect on osteosarcoma (OS). LINC01278, as a newly discovered lncRNA, is found to be highly expressed in OS, but its related mechanism remains unclear. This research, therefore, is designed to study the mechanism of LINC01278 in OS and to find potential targets for clinical use. METHODS: qRT-PCR was applied to determine the relative expression of LINC01278 and analyze its diagnostic value in OS. CCK-8, Transwell and flow cytometry were utilized for the determination of cell proliferation, migration/invasion, and apoptosis. RIP and RNA pull-down experiments were used to verify the targeted binding effect of miR-134-5p and LINC01278. The relationship between miR-134-5p and LINC01278 or KRAS was analyzed using dual luciferase reporter gene. The effects of LINC01278 on tumor growth in nude mice was analyzed by in vivo experiment. RESULTS: qRT-PCR showed that LINC01278 increased in OS tissues and serum, indicating poor prognosis. In addition, LINC01278 was also of high value for OS diagnosis. Functional experiments showed that LINC01278 inhibited KRAS-mediated OS cell proliferation and metastasis through miR-134-5p. Finally, the results of an in vivo animal model indicated that LINC01278 promoted OS growth. CONCLUSION: LINC01278 is expressed highly in OS, and patients with high LINC01278 expression have poor prognosis. Moreover, LINC01278 can suppress the proliferation and apoptosis of OS cells through mediating miR-134-5p/KRAS axis, which is expected to become a potential therapeutic target for OS.

Localization of motor entry points and terminal intramuscular nerve endings of the musculocutaneous nerve to biceps and brachialis muscles.

To determine the 3D location of the intramuscular motor nerve endings of the biceps brachii and brachialis, we identified from 56 fresh cadaveric arms the regions where the intramuscular branches were most densely located in relation to a reference line connecting the medial epicondyle of humerus and the coracoid process. For the biceps, these points were most densely distributed at a length from 64.6 to 70.3% point of the reference line with the coracoid process as starting point, at a width of 21.6-32.6 mm lateral to the reference line. For the brachialis muscle, these points were located at a length of 75.4% point and width of 27.1-35.4 mm lateral to the reference line. At these points, the biceps was located at a depth of the upper two-third portion and the brachialis at the lower one-third portion of the upper arm, from skin to humeral bone.

Demonstration of intramuscular artery and nerve distribution in the same whole mount gracilis muscle by different colors / Demostración de la distribución intramuscular de la arteria y nervio del músculo grácil mediante diferentes colores

The goal of this study was to describe the intramuscular artery and nerve distribution in detail by different colors in the same whole mount gracilis muscle. Red latex injection into the external iliac artery was performed on 14 fresh human cadavers. Two weeks later, 28 gracilis muscles were harvested from the cadavers and during this course the number of the arterial pedicle of each specimen was counted. Then, the muscle specimens were fixed in 10 % formalin 4 weeks for fixation and Sihler's staining procedures was performed on each muscle specimens. After all of the procedures, the gracilis muscle appeared almost transparent, and the extra- and intramuscular artery and nerve branches, even the terminals, were clearly demonstrated in red and dark blue separately. Two of the 28 specimens were supplied by a single main arterial pedicle alone, 14 specimens by a main arterial pedicle and an accessory pedicle, 8 specimens by a main pedicle and 2 accessory pedicles, while 4 specimens by a main arterial pedicle and 3 accessory pedicles. Although the number of the arterial pedicles was inconsistent, the intramuscular artery branches anastomosed with each other and formed a whole arterial system in all specimens. The nerve innervating the gracilis muscle divided into two or three major branches, which directed distally and innervated the distal two thirds of the muscle, while running longitudinally and parallel to the muscle fibers. We found the innervation pattern was remarkably consistent from specimen to specimen. This study provided very detailed and useful information for anatomists, physiologists and reconstructive surgeons. Furthermore, we here also provided a new method to demonstrate the intramuscular artery and nerve distribution in the same whole mount muscle by different colors for other researchers to refer to.

El objetivo de este estudio fue describir en detalle la distribución intramuscular de la arteria y el nervio del músculo grácil por diferentes colores en un solo montaje. Se realizó inyección de látex rojo en la arteria ilíaca externa en 14 cadáveres humanos frescos. Dos semanas más tarde se retiraron 28 músculos grácil de los cadáveres y se realizó un conteo del número de pedículos arteriales de cada muestra. Las muestras de músculo se fijaron en formalina al 10 % durante 4 semanas para los procedimientos de tinción de Sihler. Al término de todos los procedimientos, el músculo grácil parecía casi transparente, y las ramas extra e intramusculares de las arterias y los nervios, incluso los terminales, se observaron en azul y rojo oscuro por separado. Dos de los 28 especímenes presentaron por pedículo arterial principal único, 14 muestras un pedículo arterial principal y un pedículo accesorio, 8 de las muestras un pedículo principal y dos pedículos accesorios, mientras que 4 muestras un pedículo arterial principal y tres pedículos accesorios. Aunque el número de los pedículos arteriales era inconsistente, las ramas de la arteria intramuscular se anastomosaban entre sí y formaban un sistema arterial conjunto en todos los especímenes. El nervio que inerva el músculo grácil se encontró dividido en dos o tres ramos principales, dirigidos distalmente e inervaron los dos tercios distales del músculo, mientras que otro discurre longitudinalmente y en paralelo a las fibras musculares. Encontramos que el patrón de inervación fue notablemente consistente de un espécimen a otro. Este estudio proporciona información muy detallada y útil para los anatomistas, fisiólogos y cirujanos. Además, también se proporcionó un método innovador para demostrar la distribución intramuscular de la arteria y el nervio en un mismo músculo, entero, y con diferentes colores.