International Recommendations to Manage Poststroke Equinovarus Foot Deformity Validated by a Panel of Experts Using Delphi.

OBJECTIVE: To establish international recommendations for the management of spastic equinovarus foot deformity. DESIGN: Delphi method. SETTING: International study. PARTICIPANTS: A total of 24 international experts (N=24) in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, geriatricians, orthopedic surgeons, neurosurgeons, plastic surgeons). INTERVENTIONS: Experts answered 3 rounds of questions related to important aspects of diagnosis, assessment, and treatment of spastic equinovarus foot deformity. MAIN OUTCOME MEASURES: A consensus was established when at least 80% of experts agreed on a statement RESULTS: A total of 52 items reached consensus. Experts recommend assessing effect of the deformity on functional activities before treatment. Before treatment, it is crucial to differentiate spastic muscle overactivity from soft tissue contractures, identify which muscles are involved in the deformity, and evaluate the activity of antagonist muscles. Motor nerve blocks, 2-dimensional video analysis, and radiologic examinations are often required to complement a clinical examination. The treatment of equinovarus foot depends on the correctability of the deformity and the patient's ability to stand or walk. The preoperative assessment should include an interdisciplinary consultation that must finalize a formal agreement between physicians and the patient, which will define personalized attainable goals before surgery. CONCLUSION: The establishment of guidelines on managing equinovarus foot will help physicians and surgeons, specialists, and nonspecialists to diagnoses and assess the deformity and direct patients to a network of experts to optimize patient functional recovery and improve their autonomy.

Anatomy of the axillary arch: from its incidence in human to an embryologic and a phylogenetic explanation of its origins.

INTRODUCTION: Typically, the axillary arch is defined as a fleshy slip running from latissimus dorsi to the anterior aspect of the humerus. Phylogeny seems to give the most relevant and plausible explanation of this anatomical variant as a remnant of the panniculus carnosus. However, authors are not unanimous about its origin. We report herein the incidence of axillary arch in a series of 40 human female dissections and present an embryologic and a comparative study in three domestic mammals. MATERIALS AND METHODS: Forty formalin-preserved Caucasian human female cadavers, one rat (Rattus norvegicus), one rabbit (Oryctolagus cuniculus) and one pig (Sus scrofa domesticus) cadavers were dissected bilaterally. A comparative, analytical and a descriptive studies of serial human embryological sections were carried out. RESULTS: We found an incidence of axillary arch of 2.5% (n = 1 subject of 40) in Humans. We found a panniculus carnosus inserted on the anterior aspect of the humerus only in the rat and the rabbit but not in the pig. The development of the latissimus dorsi takes place between Carnegie stage 16-23, but the embryological study failed to explain the genesis of the axillary arch variation. However, comparative anatomy argues in favour of a panniculus carnosus origin of the axillary arch. CONCLUSIONS: With an incidence of 2.5% of cases, the axillary arch is a relatively frequent variant that should be known by clinician and especially surgeons. Moreover, while embryology seems to fail to explain the genesis of this variation, comparative study gives additional arguments which suggest a possible origin from the panniculus carnosus.

Patellofemoral design enhancements reduce long-term complications of postero-stabilized total knee arthroplasty.

PURPOSE: Few studies investigated whether trochlear and patellar design enhancements improve long-term outcomes of total knee arthroplasty (TKA). This study aimed to compare the long-term survival and complication rates of two consecutive generations of the same TKA system with identical tibiofemoral geometry, but different patellofemoral designs. METHODS: The authors retrieved the records of 93 patients (104 knees) operated with the HLS II system and 116 patients (122 knees) operated with HLS Evolution system. Patients were evaluated preoperatively and at a minimum of 10 years noting all complications. Kaplan-Meier (KM) survival was compared for two endpoints: (1) revision of all components and (2) revision of any component. RESULTS: From the HLS II series, the incidence of revision of all components was 6.4%, and of any component was 9.8%. From the HLS Evolution series, the incidence of revision of all components was 4.1%, and of any component was 5.1%. Comparing the survival at equivalent follow-up of 14 years, considering revision of all components, the HLS II had higher survival than the HLS Evolution (98.9% vs 95.9%), while considering revision of any component, the HLS II had lower survival than the HLS Evolution (93.0% vs 94.9%). The differences in survival of the two implants were not significant, neither at equivalent follow-up of 14 years (n.s.), nor at maximum follow-up of each cohort (n.s.). The complication rate was higher for the HLS II series compared to the HLS Evolution (28% vs 12%, p = 0.009), but patellofemoral complications were not more frequent (8% vs 6%, n.s.). CONCLUSIONS: Though the differences in survival of the two implants were not significant, conflicting findings are observed due to partial revisions for patellar fractures (5 in the HLS II series and 1 in the HLS Evolution series) which could be related to patellofemoral design enhancements. This study highlights the importance of patello-femoral geometry, which is often overlooked in TKA. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Anatomical variations of the subscapular pedicle and its terminal branches: an anatomical study and a reappraisal in the light of current surgical approaches.

PURPOSE: While anatomical variations of the subscapular vessels are frequently encountered during axillary dissection, little is found in the literature. The aim of this cadaveric study was to define arterial and venous anatomical variations and frequencies of the subscapular vascular pedicle and its terminal/afferent vessels in women. METHODS: We performed 80 dissections of the axillary region on forty female formalin-embalmed cadavers. Each anatomical arrangement was photographed and recorded on a scheme before analysis. RESULTS: We propose a new classification of the subscapular pedicle variations. We observed three types of subscapular arterial variation. The type Ia was the most frequent arrangement (71% of our dissections), the type Ib was observed in 11% and the type II in 18% of cases. We observed four types of subscapular venous variation. The type Ia was observed in 63% of cases, the type Ib in 14%, the type II in 14% and the type III in 10% of cases. CONCLUSIONS: This knowledge of the anatomical variation arrangement and frequencies of the subscapular vascular pedicle will assist the surgeon when dissecting the axillary region for malignant or reconstructive procedures.

Ligaments injuries check-up and assessment of their healing potential in simple posterolateral elbow dislocation: about 25 cases.

INTRODUCTION: Elbow dislocation can lead to instability and stiffness of the elbow. The main goal of this study was to list the initial elbow ligaments injuries caused by simple posterolateral elbow dislocations. The secondary goals were to assess ligament healing 2 months after the initial dislocation, to research a correlation between ligaments injuries and clinical course, and to search for predictive factors of instability. PATIENTS AND METHODS: Patients who had simple posterolateral elbow dislocation for the first time between January 2015 and May 2016 were included. Each patient had an MRI scan of their traumatised elbow on the day of the dislocation and then again 2 months later. The assessment was performed thanks to a clinical examination and calculation of functional recovery scores. The Mann-Whitney U test was used to research a correlation between the healing of ligaments injuries and clinical course. RESULTS: Twenty-five patients were included in the study. The initial MRI scans showed 70% and 54% ligament rupture, respectively, for the anterior band (ant MCL) and the posterior band (post MCL) of the medial collateral ligament (MCL), as well as 79% for the ulnar (ULCL) and 50% for the radial (RLCL) lateral collateral ligaments. The healing rate 2 months after dislocation was fairly low from 18% for the ULCL up to 41% for the anterior band of the MCL. No correlation was found between the ligament healing noticeable on MRI scans and clinical course. No elbow instability was diagnosed during the 4-month follow-up. CONCLUSION: Elbow dislocation is particularly damaging for ligaments. There is no predominance on medial or lateral ligament for rupture. The low healing rate 2 months after the initial dislocation could be explained by performing a follow-up MRI scan too early.

Trapezius perforator flaps: anatomical basis using 58 dissections.

INTRODUCTION: The trapezius muscle is a good option for soft tissue defects in the cervical and thoracic regions. However, pedicled flaps raised from perforators in the trapezius are rare. Through a series of cadaver dissections, the authors aim to map the perforating arteries in the trapezius muscle. MATERIALS AND METHODS: Dissection of 58 anatomical regions in 32 cadavers was carried out. The perforating arteries of the trapezius were inventoried based on their location, dimensions and frequency using the scapular spine and spinous process line as landmarks. RESULTS: In 78% of cases, the main perforators of the trapezius were located along two vertical lines parallel to the spinous process line, 5-6 cm on either side of it, between the scapular spine laterally, the tip of the scapula caudally and the superior margin of the trapezius cranially. On each side of the spinous process line, we found an average of 16 perforators (range 5-27) with an average diameter of 0.6 mm (range 0.1-2.6 mm). CONCLUSION: Our study shows that surgeons can use fixed landmarks when developing trapezius perforator flaps.

Experimental determination of the elbow's center of rotation using the VICON™ optoelectronic motion capture system.

PURPOSE: Knowledge of elbow kinematics is essential to better understand this joint. There is currently no reliable dynamic method to accurately study the elbow joint in a non-invasive manner. The goal of this study was to implement an accurate protocol to study in vivo elbow kinematics using a VICON™ optoelectronic motion analysis system. MéTHODS: The elbow's centers of rotation (CR) were calculated for 10 anatomical specimens. The effect of skin movement was determined by comparing measurements taken using skin surface markers and bone-fixed markers. The validated protocol was then used in 30 healthy subjects who underwent passive elbow joint movements. RESULTS: The elbow's CR was found to be distal (7 ± 14 mm), lateral (4 ± 9 mm) and anterior (4 ± 10 mm) to the medial epicondyle in vitro. Mean CR values for anatomical specimens did not differ whether calculated using the skin-based or bone-fixed markers. CONCLUSION: This study has validated a dynamic, non-invasive, and accurate method for locating the elbow's center of rotation. This preliminary study thus found a different center of rotation of the one in the middle of the trochlea previously thought. This could lead us to reflect on the designs of our prostheses to reduce the mechanical stresses and the risk of loosening.

Comparative morphometry of the antebrachial and crural interosseous membranes: preliminary study for the use of the crural interosseous membrane in the surgical repair of the antebrachial interosseous membrane tears.

INTRODUCTION: Traumatic tears of the antebrachial interosseous membrane (AIOM) on its whole length are difficult to treat, particularly in the Essex-Lopresti syndrome. The number of ligamentoplasty techniques described in the literature witnesses the difficulty of its reconstruction and the absence of reliable and satisfying procedure. The aim of this study was to explore a new way of treatment, which consists in replacing the AIOM by the crural interosseous membrane (CIOM), harvested from the same patient. MATERIALS AND METHODS: A morphometric study of the AIOM and CIOM has been conducted on both sides of 15 formalin preserved corpses (i.e. 30 AIOM and 30 CIOM). Studied data were: length of forearms and legs, length and width (at different locations) of the membranes, in situ and after harvesting, and orientation of their fibers. The thickness of membrane was also measured but only after harvesting. RESULTS: Concerning the AIOM, the mean length was 13.3 cm in situ and 12.8 cm after harvesting. Its width was maximal at the union of middle and distal thirds with an average value of 1.7 cm in situ and 1.45 cm after harvesting. Mean thickness was 1 mm. Anterior fibers were oblique distally and medially (20.5° ± 0.95°), and posterior fibers were oblique distally and laterally (40° ± 3.4°). Concerning the CIOM, the mean length was 24.75 cm in situ and 23.9 cm after harvesting. Its width was maximal at the union of proximal and middle thirds with an average value of 2.3 cm in situ and 1.85 cm after harvesting. Mean thickness was 0.5 mm. Obliquity of its fibers was reverse of that of the AIOM: the anterior fibers were quite oblique distally and laterally (13° ± 2.6°), and the posterior fibers oblique were oblique distally and medially (24.2° ± 2.48°). DISCUSSION: From these results, one may conclude that the largest length and width of the CIOM allow its use as substitute for the injured AIOM. The orientation of its fibers should necessitate either its reversal while using the same side or the use of the CIOM of the opposite side; its relative sharpness could signify that its biomechanical properties could be worse. A biomechanical study is necessary to evaluate how this new way of replacing the AIOM could resist to the strains imposed on the forearm.

The supinator muscle: anatomical bases for deep branch of the radial nerve entrapment.

PURPOSE: Our goals were to carry out an anatomical description of the internal architecture of the supinator muscle in order to describe potentially compressive structures for the deep branch of the radial nerve (DBRN) and to establish reference landmarks for the surgical treatment of radial tunnel syndrome. METHODS: Thirty upper limbs were dissected. The pennation angle of proximal and distal arcades of the supinator to the radial shaft axis was measured. Possible compressive structures of both superficial and deep heads of supinator were recorded. Proximal and distal arcades of the superficial layer of the supinator were classified according to their fiber content as tendinous, musculo-tendinous, muscular or membranous. The distances of superficial layer of the supinator muscle to the humeroradial joint line and lateral epicondyle were measured. RESULTS: Pennation angle was 33.6° (±4.2°) for the superficial layer and 50.2° (±6.6°) for the deep layer. The difference was statistically significant (p < 0.0001). The proximal arcade was purely tendinous in 20 cases (66.7 %). The distal arcade was mainly tendinous or musculo-tendinous (70 %). The average distance between the lateral epicondyle and the proximal arcade was 41.6 mm. We did not find any other potentially compressive structure within DBRN course between both layers. CONCLUSION: Our anatomical results about pennation angle could be used as a basis for a thorough functional study about the supinator. Both proximal and distal arcades appeared as the two zones ables to compress the DBRN. Their localization should help the surgeon for the DBRN neurolysis.

A survey on the potential contribution of Reunion Island dye plant species diversity to the market demand for bioactive plant-based dyes and pigments.

BACKGROUND: Proven toxicity and environmental burdens caused by artificial dyes have motivated dyeing industries to turn to natural alternatives. Plant-based dyestuffs are an interesting group of alternative crops. Reunion Island located in the Indian Ocean is the only European region in the southern hemisphere. It has a great number of assets to find new molecules in the abundant plant biodiversity. However, the dye-producing plants diversity in this island had not been documented to date. METHODOLOGY: The assessment of the Reunion Island's plant biodiversity through the "PLANTIN" project allowed us to establish here the first ethnobotanical inventory of plants growing on Reunion Island which may have promising properties as a new alternative source of dyes or colorants for the industries. First, an ethnobotanical survey focused on the uses of plants traditionally used in dyeing was conducted on local stakeholders. Then, the importance of different criteria (e.g., endemicity, accessibility and cultivability, plant organs used for the extraction, industrial interests of the species, etc.) has been considered to establish a classification method of the species, to finally select the most interesting plants which have been further harvested and investigated for their coloring property and dyeing application on natural fibers. RESULTS: The results showed that local people have accumulated traditional knowledge of dyeing plants, but that this approach had been discontinued in Reunion. The uses of 194 plant species potentially rich in dyes or pigments, belonging to 72 different families, with diverse botanical status (endemic, native, introduced or alien-invasive species) have been recorded. Then, 43 species were harvested and their coloring property were investigated. It demonstrated that dyes extracted from promising species, e.g., Terminalia bentzoe, Weinmannia tinctoria, Thespesia populnea, Erythroxylum laurifolium, Morinda citrifolia, Leea guinensis, Ochrosia borbonica, Danais fragrans, Terminalia cattapa, Casuarina equisetifolia, and Coccoloba uvifera, amongst others, could be used as new textile dyes. Their efficacy in the wool and cotton dyeing has been successfully demonstrated here. CONCLUSION: These plant-based dyestuffs showed promising coloring properties with different shades that could meet industrial application requirement. It's an area that could promote local cultural inheritance, create opportunity for business and farmers, and that can make a significant contribution to preserving endangered native species by supporting reforestation schemes. Additional researches are in progress to evaluate the safety of these plant-based colored extracts, their chemical composition and biological activities.

Venous system mapping of the digits and the hand: An anatomical study and potential surgical applications.

Background: Venous anatomy of the digits and the hand is poorly reported in the literature compared to arterial anatomy. While knowledge of the venous anatomy is crucial to ensure safe skin incisions, skin flap design, or blood return restoration for digital replantations, data in anatomical and clinical textbooks are rather limited. The purpose of this anatomical study was to describe the venous anatomy of the digits and the hand. Method: Our series reports descriptive results from 10 non-embalmed hand dissections from 5 different corpses. Hands were previously co-injected by arteries followed by veins with a different colored latex before being dissected under optical magnification (x4). Each anatomical specimen was photographed before being analyzed. Results: Each injection revealed both arterial and venous vascular systems. Latex injections were a useful technique to show the dorsal, volar superficial, and deep venous system. There was a constant and reliable topographic vascular anatomy of the superficial venous system of the digits and hand. However, we could not observe a high density of dorsal superficial venous valves as previously reported. Conclusion: The knowledge of the arrangement of the venous system of the digits and the hand should help the surgeon when performing surgical procedures in the hand. The surgeon should take into consideration this venous anatomy when performing skin incisions, skin flaps, or replantation procedures which would preserve the normal venous physiology as much as possible.

Relevance of a novel external dynamic distraction device for treating back pain.

Low back pain is a common, expensive, and disabling condition in industrialized countries. There is still no consensus for its ideal management. Believing in the beneficial effect of traction, we developed a novel external dynamic distraction device. The purpose of this work was to demonstrate that external distraction allows limiting the pressure exerted in standing-up position on the lower intervertebral discs. Numerical and cadaveric studies were used as complementary approaches. Firstly, we implemented the device into a numerical model of a validated musculoskeletal software (Anybody Modeling System) and we calculated the lower disc pressure while traction forces were applied. Secondly, we performed an anatomical study using a non-formalin preserved cadaver placed in a sitting position. A pressure sensor was placed in the lower discs under fluoroscopic control through a Jamshidi needle. The intradiscal pressure was then measured continuously at rest while applying a traction force of 200 N. Both numerical and cadaveric studies demonstrated a decrease in intradiscal pressures after applying a traction force with the external device. Using the numerical model, we showed that tensile forces below 500 N in total were sufficient. The application of higher forces seems useless and potentially deleterious. External dynamic distraction device is able to significantly decrease the intradiscal pressure in a sitting or standing position. However, the therapeutic effects need to be proven using clinical studies.

New anatomic considerations on the levator labii superioris related with the nasal ala.

The levator labii superioris (LLS) muscle is well known as one of the upper-lip elevators; however, there have been few reports about the anatomic description of the LLS. Especially, the shape of the LLS and its relationship with the nasal ala were not clearly shown in the literature. The aim of this study was to clarify and describe the morphology and topography of the LLS and the anatomic variations to understand the function of the LLS related with the nasal ala. The LLS was examined in 102 specimens of embalmed Korean and French adult cadavers. The LLS was classified into 3 categories according to its shape and attachment: rectangular (83%), fan (10%), or trapezoid (7%) type. The medial fibers of the LLS were attached to the deep surface of the alar facial crease and were mainly intermingled with the alar part of the nasalis. Some of the deeper muscle fibers of the LLS extended to the vestibular skin of the nasal lobule. These new anatomic findings in the current study could be useful information for understanding the function of the LLS and the various surgical procedures of the perinasal region.

Anatomical bases of the free posterior brachial fascial flap.

PURPOSE: Fascias can be used for reconstruction of gliding surfaces of upper and lower extremities or when thin, pliable coverage is required. Free large and well-vascularised fascial flaps are not very many and harvesting is seldom onto upper limb. The aim of this work was to study blood supply of the posterior brachial fascia in order to define the anatomical bases of a new free fascial flap. METHODS: Our study included dissection on 18 anatomic specimens from 10 cadavers. Measures of the flap and blood supply were studied. Histological study was performed to analyse vessels location and measures into flap thickness. RESULTS: The posterior brachial fascia was thin, with a broad surface area and easily separable from the subcutaneous and muscular plane. Its average surface size is 115-mm length and 54-mm width. It was richly vascularised by two major pedicles: the cutaneous posterior brachial pedicule and the fascial branch of the superior ulnar collateral artery. Satellite venous elements were always present. A rich vascular network exists within the thickness of the fascia. Surgical procedure of flap harvesting is described. CONCLUSION: Harvesting of the flap can be carried out by a posteromedial approach into upper limb, without significant donor-site morbidity. This flap is adapted to cover and reconstruct gliding tendinous surfaces onto hand or fingers.

Adrenal gland hypertrophy in a case of homolateral renal agenesis: case report with special emphasis on adrenal blood supply.

Hypertrophic suprarenal gland is an anomaly which can lead to serious complications during adrenalectomy under endoscopy because of abnormal veins of the retroperitoneum. The authors report a rare dissection of a male which presented with this anomaly in a case of homolateral renal agenesis, highlighting this left pseudorenal vein. No abnormality of the genital tract was found. The anatomic features, associated syndromes, implications for endoscopic surgery are outlined and embryologic considerations and discussed.

Arthroscopic resection of wrist ganglia: About 30 cases.

INTRODUCTION: The synovial wrist ganglion is a particularly common pathology of which the first "complication" is recidivism. The main objective of our study was to determine the rate of recurrence of this pathology in a series of arthroscopic patients. The secondary objective was to assess patient satisfaction well after the operation. MATERIAL AND METHODS: Our study was observational and retrospective and involved 30 patients (17 dorsal and 13 palmar cases) aged 41 years on average. The patients underwent an arthroscopic procedure for a palmar or dorsal ganglion of the wrist between March 2007 and April 2013. The data were collected by re-reading the files and conducting telephone interviews. Each patient answered a questionnaire about the operation, after-treatment, and their satisfaction well after the surgery. At the end of the interview, we calculated the Patient Rated Wrist Evaluation (PRWE) score. RESULTS: The mean follow-up was 4.6 years. A recurrence was noted in 4 (13%) cases, at an average delay of 9 months (6 months-1 year). There were only 2 patients (6.7%) that experienced the complication of complex regional pain syndrome type 1. Twenty-eight (93%) patients experienced improvement in postoperative pain. For 27 (90%) patients, firm-handed activities could be practised without limitation. The average time to resumption of activities of daily living was 27.1 days (1-240 days), resumption of firm-handed activities was 56 days (15-360 days), and return to work was 47.5 days (1-360 days). The mean PRWE score was 6.9/50 (0-34) for pain and 1.38/50 (0-8) for function. CONCLUSION: The 13% recurrence rate is on the average of what is observed in the literature. Later satisfaction with the intervention is very good, and complications remain rare.Studies tend to show a lower rate of complications and recurrence following arthroscopic treatment, but to date, no randomized comparative series between the two methods has yet revealed any significant difference in these two points. A study of this type on a large scale could make it possible to highlight one of these treatment approaches.

Tibialis posterior transfer for foot drop due to central causes: Long-term hindfoot alignment.

BACKGROUND: Tibialis posterior transfer (TPT) is the treatment most widely used to palliate foot drop due to dorsiflexor palsy. TPT has been extensively studied in patients with peripheral neurological causes of foot drop. In contrast, data are scarce on central foot drop, in which TPT is often blamed for causing flattening of the arches. The primary objective of this study was to assess the impact on foot alignment of TPT in patients with central foot drop. The secondary objective was to determine whether TPT combined with other surgical procedures improved gait. HYPOTHESIS: TTP can induce flattening of the medial arch of the foot. PATIENTS AND METHODS: We retrospectively identified 13 patients managed with TPT (1 foot per patient). Mean follow-up was 65 months (range, 12-108 months). The causes were stroke (n=5), head injury (n=3), spinal cord injury (n=2), cervical spondylotic myelopathy (n=1), cerebral palsy (n=1), and a brain tumour (n=1). The clinical assessment focused chiefly on forefoot alignment and footprint parameters. The following variables were collected from weight-bearing radiographs: Djian-Annonier angle, Méary-Toméno angle, lateral arch angle, and calcaneal pitch angle in the sagittal plane; talo-metatarsal angle in the transverse plane; and rearfoot valgus angle in the coronal plane. RESULTS: Of the 13 feet, 6 had normal footprint parameters and 7 pes cavus. There were no cases of flatfoot. Pronation deformities and supination deformities were each found in 2 patients. Comparing the radiographic parameters between the two feet in each patient identified differences only for the lateral arch angle and calcaneal pitch angle, which indicated pes cavus on the operated side (operated side: 142.7° [range, 136°-156°], p=0.041; and 24° [range, 14°-33°], p=0.028, respectively). DISCUSSION: In contrast to the working hypothesis, we found no evidence of progression to valgus flatfoot after TPT transfer performed to treat central foot drop. LEVEL OF EVIDENCE: IV, retrospective study with no control group.

Preclinical Assessment of Leptin Transport into the Cerebrospinal Fluid in Diet-Induced Obese Minipigs.

OBJECTIVE: A minipig model was employed to explore the changes in endogenous leptin transport into the central nervous system and in hypothalamic sensitivity to exogenous leptin when individuals are placed on high-fat diet (HFD) compared with standard diet. METHODS: Serum and cerebrospinal fluid (CSF) leptin concentrations during 10 weeks of HFD versus standard diet and exogenous leptin-induced STAT3 phosphorylation in the hypothalamus of minipigs were assessed, and the hypothalamic leptin-sensitive cells were characterized by immunofluorescence. RESULTS: The efficiency of the passage of endogenous blood-borne leptin into the CSF (measured as the log [CSF:serum leptin ratio]) decreased over time in minipigs fed a HFD (ß = -0.04 ± 0.005 per kilogram of weight gain in HFD; P < 0.0001), while it remained stable in minipigs fed a standard diet. However, the ability of peripherally administered leptin to activate its receptor in hypothalamic neurons was preserved in obese minipigs at 10 weeks of HFD. CONCLUSIONS: Together, these data are consistent with the existence of an early-onset tranport deficiency for endogenous circulating leptin into the brain in individuals developing obesity, preceding the acquisition of hypothalamic leptin resistance. Although additional studies are required to identify the underlying mechanisms, our study paves the way for the development of new preclinical pharmacological models targeting the restoration of the shuttling of peripheral leptin into the central nervous system to manage obesity.

Three dimensional model of the female perineum and pelvic floor muscles.

OBJECTIVE: The anatomy of the perineum and the pelvic diaphragm of woman is complex. A numerical complete three-dimensional (3D) model of every muscle of the woman pelvis doesn't exist. The pathophysiology of genital prolapse is still debated. Knowledge of anatomy is essential to better understand its mechanisms. The aim of this research was to build a complete three-dimensional model of the female perineum and pelvic floor muscles. STUDY DESIGN: To model the pelvic muscles we reconstructed them in three dimensions from tracing a magnetic resonance imaging (MRI) of a female pelvis from a cadaver. RESULTS: We obtained a complete anatomical model of the muscles of the perineum and pelvic floor. Each muscle was built thanks to the MRI. CONCLUSION: We obtained the first complete anatomical model of the perineal muscles and pelvic diaphragm. It could be a good educational and simulation tool for better understanding normal and pathological pelvic mobility.

Mandibular subcondylar fracture accessibility with transparotid approach by rhytidectomy and modified Risdon approach: An anatomical comparative study.

PURPOSE: The purpose of our anatomical study was to compare the accessibility of the area at the level of the neck of the condyle and the condylar head by two different approaches: the modified Risdon approach and a transparotid approach by rhytidectomy (TPAR). METHODS: An anatomical study was performed on 12 heads of cadavers preserved with a solution rich in glycerin and ethanol, but very low in formalin. A modified Risdon approach and a TPAR were each performed on a hemiface of the same head. The bone surface was rendered digitally accessible on an anatomical diagram using Image J software. The software was used to determine a concordance score between the area of accessibility and the area of interest necessary for osteosynthesis of a high subcondylar fracture. This score was presented as a numerical scale from 0 to 100. We measured the total number of pixels in our area of interest and assigned it a score of 100. We then compared the area of accessibility with the area of interest necessary for osteosynthesis of a high subcondylar fracture. RESULTS: Using the modified Risdon approach, an average score of 55.88 (SD = 18.96) was found, or 55.88% of the accessible area of interest. Using TPAR, we found a score of 91.05 (SD = 7.95) or 91.05% of the accessible area of interest. This difference in score between the two techniques was significantly different (p < 0.001), taking into account intra-hemiface and intra-individual correlation. CONCLUSION: TPAR seems to be more effective in treating high condylar process fractures of the mandible.