[Herbal textural research, morphologic characteristics and DNA barcoding of botanical origins of Alismatis Rhizoma].

Alismatis Rhizoma(Zexie) is a commonly used traditional Chinese medicine, and it is separated into "Chuan Zexie"(Sichuan and Hubei provinces), "Jian Zexie"(Fujian and Jiangxi provinces) and "Guang Zexie"(Guangxi province) according to different producing areas. Alisma plantago-aquatica and A. orientale were listed as the original plants of Alismatis Rhizoma in different editions of Chinese Pharmacopoeia(Ch.P), respectively. The botanical origins of Alismatis Rhizoma caused much controversy during a period of time. This study aimed to define the botanical origins of Alismatis Rhizoma from different producing areas, and supply scientific evidence for Ch. P 2020 edition. In this paper, we summarized the descriptions of original plants and producing areas of Alismatis Rhizoma in ancient literatures. Flowers and fruits of original plants of Alismatis Rhizoma were collected from different typical areas, and compared with the morphological description of two species from Alisma genus in the Flora of China. Thirty-nine batches of leaves from 8 different areas were identified using DNA barcoding technology. The results showed that original plants of Alismatis Rhizoma from different areas could be distinguished from each other based on morphological characteristics and molecular characteristics. Then, "Jian Zexie" was identified as A. orientale, while "Chuan Zexie" and "Guang Zexie" were identified as A. plantago-aquatica. In conclusion, combining with herbal textural research, morphologic characteristics, DNA barcoding technology and market situation, this paper recommended that the botanical sources of Alismatis Rhizoma could be revised as Alisma orientale(Sam.) Juzep. and Alisma plantago-aquatica Linn. in the Ch. P 2020 edition.

Monitoring Morphologic Changes in Male Rowers Using Limited Portable Echocardiography Performed by a Frontline Physician.

Athletes' hearts have been studied for adaptive changes in response to exercise. Physiologic changes are normal responses to intense athletic training regimens, whereas pathologic changes predispose athletes to sudden cardiac death. The two alterations overlap in clinical presentation. Research continues to investigate the upper limits of cardiac remodeling to aid clinical decision making. Studying normal changes that occur in response to exercise will advance physicians' understanding of physiologic responses to exercise and potentially improve clinical distinction. To expand this body of knowledge, we present an observational case series that describes morphologic changes in athlete's hearts concurrent with performance measurements.

Intra- and Intergrader Agreement for Detection of OCT Angiographic Characteristics Associated With Type 3 Neovascularization.

Purpose: To examine the intra- and intergrader agreement on morphologic characteristics of type 3 neovascularization on optical coherence tomography angiography (OCT-A). Methods: OCT-A images of 22 eyes from 21 patients with a new-onset, treatment-naive type 3 neovascularization were included in this cross-sectional retrospective agreement study. Each image was graded three times by two independent medical retina specialists to assess intra- and intergrader agreement. The graders scored the presence or absence of the following vascular and structural features: intraretinal neovascularization (IRN), subretinal neovascularization, sub-retinal pigment epithelium (RPE) neovascularization (SRPEN), retinal choroidal anastomosis (RCA), intraretinal cysts, subretinal fluid, and pigment epithelial detachment. Agreement was analyzed for each feature using Gwet's AC1, к statistics, and percentage of agreement. Results: The best agreement (AC1) was found for intraretinal neovascularization (withingrader1: 0.94; withingrader2: 0.93 and between: 1.00) and intraretinal cysts (withingrader1, 1.00; withingrader2, 0.97 and between, 1.00). The poorest intragrader agreements were observed for SRPEN (withingrader1, 0.54 and withingrader2, 0.36) and RCA (withingrader1, 0.45 and withingrader2, 0.52), and the poorest intergrader agreement was found for SRPEN, RCA, and pigment epithelial detachment (0.18, 0.37, and 0.15, respectively). Conclusions: Although the agreement values were high for intraretinal features, considerable grader variability was found for the vascular and structural features in the deeper retina or under the RPE. Clinicians should be careful to base therapeutic decisions on qualitative OCT-A assessment, because even well-trained specialists show a considerable grader variation in their subjective evaluation. Translational Relevance: The clinical value of OCT-A imaging largely depends on the agreement of subjective evaluations by ophthalmologists.

Basic morphological characteristics of coracoid grafts obtained by open and arthroscopic Latarjet techniques: A comparative study.

BACKGROUND: A knowledge of the anthropometric characteristics of the coracoid graft (CG) that can be obtained by the open and arthroscopic Latarjet techniques may be beneficial in the preoperative planning and intraoperative decision making for coracoid osteotomy and transfer. We have not found any study that compared the morphology of the CG that can be obtained from open and arthroscopic Latarjet techniques. The purpose of this study was to verify if the basic anthropometric characteristics of CGs are equivalent. HYPOTHESIS: We hypothesize that the basic anthropometric characteristics of the CGs are similar. METHODS: Twenty fresh-frozen human paired cadaveric shoulder specimens that had been randomly distributed in two groups of 10 specimens each were used. Two surgeons, each with experience in performing the open and arthroscopic Latarjet technique, performed these procedures in each of the respective groups (OG, open group; AG, arthroscopic group). A CT scan was performed. Using the volume rendering technique, a metric analysis of the volume, area and length of the CG were performed, evaluated and statistically analysed. RESULTS: There were no significant differences in length (p=0.162) (mean length, 22.6mm for OG and 23.6mm for AG). There were significant differences in the volume (p=0.031) and area (p=0.007) of the CG, being lower in the OG (mean volume, 2.8 cm3 for OG and 3.6 cm3 for AG; mean area, 9.9 cm2 for OG and 12.8 cm2 for AG). No significant differences were observed by sex or laterality. CONCLUSION: The mean lengths of the CGs that were obtained by each technique are equivalent. However, the areas and volumes of the grafts are different, being lower in the open surgery. These differences have not been an impediment to perform the technique. Our results corroborates that consolidation is more related to the preparation and placement than to the anthropometric characteristics of the CG. No significant differences were observed by sex or laterality. LEVEL OF EVIDENCE: Basic Science.

MRI morphologic and clinicopathologic characteristics for predicting outcomes in patients with locally advanced rectal cancer.

PURPOSE: The aim of this study was to investigate the value of MRI morphologic and clinicopathologic factors for predicting 3-year disease-free survival (DFS) in patients with locally advanced rectal cancer (LARC). METHOD: In this retrospective study, pre- and post-neoadjuvant chemoradiotherapy (nCRT) MRI morphologic (e.g., pre-nCRT MRI-detected extramural venous invasion) and clinicopathologic variabilities (e.g., pathological complete response) were evaluated in all patients. Three-year DFS was estimated using Kaplan-Meier product-limit method, and Cox proportional hazards models were used to determine associations between morphologic or clinicopathologic variabilities and survival outcomes. RESULTS: A total of 115 patients (39 females and 76 males; median age, 54 years; age range, 28-82 years) with LARC treated with nCRT were enrolled. With a median follow-up of 48.0 months, the 3-year DFS was 79.0% for all patients. During follow-up, 18 patients died, 28 patients experienced relapse (26 distant, one local, and one both), and 69 patients were censored. MRI-detected extramural venous invasion (mrEMVI) was the only significantly independent factor of long-term survival, while HR was 2.308 (95% CI 1.151-4.629, P = 0.018) on univariate and 2.495 (95% CI 1.243-5.012, P = 0.010) on multivariate analysis. The 3-year cumulative survival rate in patients with mrEMVI negativity compared with positivity were 86.6% versus 65.0% (P = 0.015), respectively. CONCLUSION: In conclusion, pre-nCRT mrEMVI status was the independent significant risk factor for long-term outcomes in LARC patients treated with nCRT, while the other morphologic and clinicopathologic characteristics were not related to the patient survival.

Three-dimensional digitizing and anatomic study of lumbar vertebral canal and pedicle in children.

INTRODUCTION: Spinal pedicle screw internal fixation has been widely used in adult spine injury fixation. Due to being in a period of continuous growth and development, the spine of children at different ages shows different characteristics from adults in terms of anatomy, physiological function, and biomechanics. Furthermore, because the pedicle of children is small, has large anatomic variation, and has complex adjacent relationships, the surgical risk is extremely high. How to improve the screwing accuracy is the key to the success of children's pedicle internal fixation. Therefore, applying the concept of digitized and individualized screwing will be of great significance to children's pedicle screwing. AIM: To investigate the morphologies, development patterns, and aging characteristics of the lumbar vertebral pedicle (LVP) in children aged 6-11 years, and to provide a theoretical basis for screw implantation and related biomechanical studies. MATERIAL AND METHODS: A total of 60 children aged 6-11 years were selected for the intergroup measurement and statistical analysis of their lumbar diameter, pedicle diameter, screw canal length (SCL), etc. RESULTS: Generally, the vertebral foramen diameter (ID), sagittal diameter (SD), pedicle width (PW), and SCL as well as the pedicle height (PH) exhibited an increasing trend with age and increasing vertebral sequence among children aged 6-11 years. CONCLUSIONS: By observing the LVP in children using 3D digital reconstruction technology, the morphology of the spinal canal and pedicles at different lumbar segments showed obvious development patterns, and the best treatment protocol should be selected according to the LVP characteristics in clinical applications.

MR-guided attenuation map for prostate PET-MRI: an intensity and morphologic-based segmentation approach for generating a five-class attenuation map in pelvic region.

PURPOSE: Prostate imaging is one of the major application of hybrid PET/MRI systems. Inaccurate attenuation maps (µ-maps) derived by direct segmentation (SEG) in which the cortical bone is ignored and the volume of the air in cavities is underestimated is the main challenge of commercial PET/MRI systems for the quantitative analysis of the pelvic region. The present study considered the cortical bone and air cavity along with soft tissue, fat, and background air in the µ-map of the pelvic region using a method based on SEG. The proposed method uses a dedicated imaging technique that increases the contrast between regions and a hybrid segmentation method to classify MR images based on intensity and morphologic characteristics of tissues, such as symmetry and similarity of bony structures. PROCEDURES: Ten healthy volunteers underwent MRI and ultra-low dose CT imaging. The dedicated MR imaging technique uses the short echo time (STE) based on the conventional sequencing implemented on a clinical 1.5T MRI scanner. The generation of a µ-map comprises the following steps: (1) bias field correction; (2) hybrid segmentation (HSEG), including segmenting images into clusters of cortical bone-air, soft tissue, and fat using spatial fuzzy c-means (SFCM), and separation of cortical bone and internal air cavities using morphologic characteristics; (3) the active contour approach for the separation of background air; and (4) the generation of a five-class µ-map for cortical bone, internal air cavity, soft tissue, fat tissue, and background air. Validation was done by comparison with segmented CT images. RESULTS: The Dice and sensitivity metrics of cortical bone structures and internal air cavities were 72 ± 11 and 66 ± 13 and 73 ± 10 and 68 ± 20 %, respectively. High correlation was observed between CT and HSEG-based µ-maps (R 2 > 0.99) and the corresponding sinograms (R 2 > 0.98). CONCLUSIONS: Currently, pelvis µ-maps provided by the current PET/MRI systems and the ultra-short echo time and atlas-based methods tend to be inaccurate. The proposed method acceptably generated a five-class µ-map using only one image.

Influence of Glenoid Defect Size and Bone Fragment Size on the Clinical Outcome After Arthroscopic Bankart Repair in Male Collision/Contact Athletes.

BACKGROUND: The usefulness of arthroscopic Bankart repair for collision/contact athletes has varied in previous reports. PURPOSE: To investigate the influence of glenoid rim morphologic characteristics on the clinical outcome after arthroscopic Bankart repair without additional reinforcement procedures in male collision/contact athletes, including athletes with a large glenoid defect. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Eighty-six athletes (93 shoulders) followed for a minimum of 2 years were retrospectively investigated. The sports were rugby (36 shoulders), American football (29 shoulders), and other collision/contact sports (28 shoulders). Preoperative glenoid defect size, bone fragment size, and bone union after bony Bankart repair were investigated regarding factors influencing postoperative recurrence. Postoperative changes in glenoid defect size and bone fragment size were investigated as well as their influence on the clinical outcome. RESULTS: Postoperative recurrence of instability was noted in 22 shoulders (23.7%). The recurrence rate was 33.3% in rugby, 17.2% in American football, and 17.9% in other collision/contact sports. The recurrence rate was only 7.1% in 28 shoulders without a preoperative glenoid defect, but it increased to 43.8% in 16 shoulders that did not have a bone fragment even though there was a preoperative glenoid defect. Additionally, the recurrence rate was 7.7% in 26 shoulders with bone union after arthroscopic bony Bankart repair but rose to 45% in 20 shoulders without bone union. In the shoulders with bone union, the mean bone fragment size increased from 8.2% preoperatively to 15.2% postoperatively, while the mean glenoid defect size decreased from 18.0% to 2.8%, respectively. The recurrence rate was 8.3% in shoulders with a final glenoid defect 5% or less versus 38.1% in shoulders with a defect greater than 5%. While the recurrence rate was low among athletes other than rugby players with a final defect of 10% or less, it was low in only the rugby players with a defect of 0%. CONCLUSION: In male collision/contact athletes, while the overall clinical outcome was unsatisfactory, a favorable outcome was achieved in athletes without a preoperative glenoid defect and athletes with bone union. The glenoid defect decreased in size postoperatively due to remodeling of the united bone fragment, and the recurrence rate was low when the final glenoid defect size was 5% or less.

Radiographic Morphologic Characteristics of Bunionette Deformity.

BACKGROUND: Bunionette deformity is characterized as head hypertrophy, lateral bowing, or splaying of the fifth metatarsal, or a combination of these deformities. Most previous studies have focused on the fourth and fifth metatarsals; few have analyzed the radiographic morphologic characteristics of the entire foot. The morphologic characteristics of the entire foot in cases of symptomatic bunionette deformity were analyzed with a radiographic image-mapping system. METHODS: The system was used for the morphologic analysis of 112 feet with symptomatic deformity and 123 asymptomatic control feet. The mapping system includes 2-dimensional coordinates. We compared morphologies of both groups on the basis of simple models prepared from x and y coordinates of each reference point, calculated by using the mapping system and various angle measurements. We set cutoff values and categorized cases according to Fallat's system. We evaluated the characteristics of each type and a new deformity type (type V) wherein no measurement exceeded the cutoff values. RESULTS: The heads of the third, fourth, and fifth metatarsals were more laterally displaced, and the angles between the metatarsal axes were larger in the deformity group. Comparison of deformity types showed that the morphology of the fifth metatarsal might be only one cause of deformity. The intermetatarsal angles between the second and third metatarsals and between the third and fourth metatarsals were larger in deformity type II and type V feet than in control feet. Additionally, the intermetatarsal angles between the third and fourth metatarsals and between the fourth and fifth metatarsals were larger in deformity type III and type IV feet than in control feet. CONCLUSION: We believe it is necessary to not only focus on the fourth and fifth metatarsals, but also assess the morphologic characteristics of the entire foot in patients with a bunionette, including splaying of all the metatarsals and the forefoot width, when planning surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Labral morphologic characteristics in patients with symptomatic acetabular dysplasia.

BACKGROUND: The morphologic characteristics of the labrum in patients with symptomatic acetabular dysplasia have been described to some extent in smaller retrospective series, but the need remains to further define these disease characteristics and their importance as a diagnostic feature of hip instability. PURPOSE: To (1) characterize the morphologic characteristics of the labrum in patients with symptomatic acetabular dysplasia and (2) test the relationships between specific labral variants, severity of dysplasia, and duration of symptoms. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Thirteen surgeons from 10 centers enrolled patients undergoing periacetabular osteotomy (PAO) for symptomatic acetabular dysplasia from 2008 to 2014. Patient demographics, presenting characteristics, preoperative radiographic data, operative data, and intraoperative findings were prospectively collected and retrospectively reviewed. RESULTS: A total of 942 patients (972 hips) met the initial inclusion criteria, with a mean age of 25.2 years (range, 9-51 years; 84% female, 16% male). In addition to having PAO, 52.6% of hips had an anterior arthrotomy and 19.8% had a hip arthroscopy either to perform an osteochondroplasty of the femoral head-neck junction or to address labral pathologic changes. Of these 553 hips in which the labrum was visualized, labral morphologic status was graded as hypertrophic in 50%, normal in 45%, hypoplastic in 4%, and ossified in less than 1%. Decreased lateral center-edge angle and anterior center-edge angle and increased acetabular inclination were associated with labral hypertrophy, but chronicity of symptoms was not. Of the 553 hips, 64% had tears of the labrum, with the majority being degenerative-type tears. CONCLUSION: Labral pathologic changes are common in patients with symptomatic acetabular dysplasia. Labral hypertrophy, however, is not a universal finding, particularly in hips with mild dysplasia, and therefore should not be considered a reliable diagnostic criterion for instability.

Water workout application effects on the body composition and motor abilities of 13-year-old female adolescents / Efectos de la aplicación de entrenamiento acuático sobre la composición corporal y las habilidades motoras de adolescentes mujeres de 13 años de edad

The aim of this research was to determine the water workout application effects on anthropometric characteristics, body composition and motor abilities of 13-year-old female adolescents. The research was conducted on the sample of 154 female adolescents from south-eastern Serbia, divided into experimental group (n= 82) and control group (n= 72). In the area of anthropometry, the following components were measured: body height, body mass, body mass index (BMI) and five skinfolds. In the area of body composition, the percentage of body fat and total muscle mass was measured. According to the Eurofit Manual, the standard tests recommended for testing school children were conducted, measuring the following variables in the motor area: plate tapping, sit-andreach, standing broad jump, sit-ups in 30 seconds, bent-arm hang test, agility run 10 x 5 m, and 20 m shuttle-run. The three-times-a-week water training programme lasting for eight weeks was the experimental factor. ANOVA results indicate the statistically significant differences between the experimental and control groups in body mass, BMI, skin biceps brachi, skin suprailiaca, skin medicalf, skin triceps brachi and body composition variables (p<0.01). There were statistically significant differences between the experimental and control groups (p< 0.01) in variables pertaining to the plate tapping, standing broad jump, sit-ups in 30 seconds, 20 m shuttle-run, and sitand- reach and agility run 10 x 5 m (p< 0.05). Based on the obtained results, we can conclude that the water training programme affected the reduction of body composition, improvement of cardiorespiratory endurance, muscular force, muscular endurance and mobility in 13-year-old female adolescents. The given water training programme would be the means for obesity prevention in adolescents, which can be useful for the improvement of youth health and quality of life.

El objetivo de esta investigación fue determinar los efectos de la aplicación de entrenamiento acuático en las características antropométricas, la composición corporal y las habilidades motoras de mujeres de 13 años. La investigación se realizó en una muestra de 154 mujeres adolescentes del sudeste de Serbia, divididas en dos grupos, experimental (n = 82) y control (n = 72). En el área de la antropometría, se midieron los siguientes componentes: Altura corporal, masa corporal, índice de masa corporal (IMC) y cinco pliegues cutáneos. En el área de composición corporal, se midió el porcentaje de grasa corporal y la masa muscular total. Según el Manual de Eurofit, se llevaron a cabo las pruebas estándar recomendadas para evaluar a escolares, midiendo las siguientes variables en el área motora: golpear las placas, sentado y alcance, salto de pie, sentadillas en 30 segundos, prueba de colgar el brazo doblado, agilidad de 10 x 5 m, y 20 m de carrera de lanzadera. El programa experimental de entrenamiento en agua tres veces por semana durante ocho semanas fue el factor experimental. Los resultados de ANOVA indican las diferencias estadísticamente significativas entre los grupos experimental y de control en masa corporal, IMC, pliegue braquio cutáneo, piel suprailiaca, tríceps y variables de composición corporal (p<0,01). Hubo diferencias estadísticamente significativas entre los grupos experimental y control (p<0,01) en las variables relacionadas con el golpe de placas, el salto de pie, las sentadillas en 30 segundos, la carrera de lanzadera de 20 m y la carrera de sentarse y alcanzar, y agilidad 10 x 5 m (p<0,05). En base a los resultados obtenidos, podemos concluir que el programa de entrenamiento acuático provocó una reducción de la composición corporal, el mejoramiento de la resistencia cardiorrespiratoria, la fuerza muscular, la resistencia muscular y la movilidad en mujeres de 13 años. El programa de entrenamiento realizado en agua, sería el medio para la prevención de la obesidad en adolescentes, que puede ser útil para mejorar la salud y la calidad de vida de los jóvenes.