Anatomical consideration of ultrasonography-guided intraoral injection for temporal tendinitis.

Temporal tendinitis is characterized by acute inflammation often resulting from mechanical stress, such as repetitive jaw movements associated with jaw opening and closing and teeth clenching. Treatment for temporal tendinitis typically involves the administration of local anesthetic or corticosteroid injections. However, the complex anatomical structure of the coronoid process, to which the temporalis tendon attaches, located deep within the zygomatic arch, poses challenges for accurate injections. In this study, we aimed to establish guidelines for the safe and effective treatment of temporal tendinitis by using intraoral ultrasonography (US) to identify the anatomical structures surrounding the temporalis tendon and coronoid process. US was performed using an intraoral transducer on 58 volunteers without temporomandibular joint disease. The procedure involved placing the transducer below the occlusal plane of the maxillary second molar. Measurements were taken for the horizontal distance from the anterior border of the coronoid process, observed at the midpoint (MP) of the US images, and the depth of the coronoid process and temporalis muscle from the oral mucosa. The anterior border of the coronoid process was visualized on all US images and classified into three observed patterns at the MP: type A (anterior to the MP, 56.2%), type B (at the MP, 16.1%), and type C (posterior to the MP, 27.7%). The temporalis muscle was located at a mean depth of 3.12 ± 0.68 mm from the oral mucosa. The maxillary second molar is an intraoral landmark for visualizing the anterior border of the coronoid process. The new location information obtained using intraoral US could help identify the safest and most effective injection sites for the treatment of temporal tendinitis.

Expression, Purification, and Characterization of Plasmodium vivax Lactate Dehydrogenase from Bacteria without Codon Optimization.

Plasmodium vivax is the most widespread cause of malaria, especially in subtropical and temperate regions such as Asia-Pacific and America. P. vivax lactate dehydrogenase (PvLDH), an essential enzyme in the glycolytic pathway, is required for the development and reproduction of the parasite. Thus, LDH from these parasites has garnered attention as a diagnostic biomarker for malaria and as a potential molecular target for developing antimalarial drugs. In this study, we prepared a transformed Escherichia coli strain for the overexpression of PvLDH without codon optimization. We introduced this recombinant plasmid DNA prepared by insertion of the PvLDH gene in the pET-21a(+) expression vector, into the Rosetta(DE3), an E. coli strain suitable for eukaryotic protein expression. The time, temperature, and inducer concentration for PvLDH expression from this E. coli Rosetta(DE3), containing the original PvLDH gene, were optimized. We obtained PvLDH with a 31.0 mg/L yield and high purity (>95%) from this Rosetta(DE3) strain. The purified protein was characterized structurally and functionally. The PvLDH expressed and purified from transformed bacteria without codon optimization was successfully demonstrated to exhibit its potential tetramer structure and enzyme activity. These findings are expected to provide valuable insights for research on infectious diseases, metabolism, diagnostics, and therapeutics for malaria caused by P. vivax.

Anatomical analysis of the intramuscular distribution patterns of the levator scapulae and the clinical implications for pain management.

PURPOSE: The present study aimed to demonstrate the intramuscular nerve distribution of the levator scapulae muscle that is responsible for pain and to use this anatomic data to propose possible injection sites. METHODS: Twenty levator scapulae muscles were dissected from 16 Korean embalmed cadavers. The intramuscular nerve distribution of the levator scapulae muscle was identified by whole-mount nerve staining to preserve and stain the nerve fibers without damage. RESULTS: The posterior ramus of spinal nerves C3, C4, and C5 innervated the levator scapulae muscles. When the origin and insertion of the muscle were set to 0% and 100%, respectively, most of the intramuscular nerve terminals were located between 30 and 70%. This area may correspond to the cricoid cartilage of the sixth cervical vertebra. CONCLUSION: Most intramuscular nerve terminals can be found in the middle and distal portions of the levator scapulae muscle. Our findings improve our understanding of the intramuscular nerve distribution of the levator scapulae muscle and will aid in pain management in clinical practice.

A standardized protocol for needle placement in the infraspinatus muscle: an anatomical perspective.

PURPOSE: This study aimed to evaluate the morphology of the three parts of the infraspinatus muscle based on surface landmarks for precise and effective access, and to propose the most effective fine-wire electrode insertion technique and sites. METHODS: Fifteen Asian fresh cadavers were used. We investigated the probability of the presence of the superior, middle, and inferior parts in each infraspinatus muscle based on surface landmarks. Based on the positional characteristics of the muscle, we determined the needle insertion method and confirmed its effectiveness by dissection. RESULTS: The superior part was mostly observed near the spine of the scapula. The middle part was broadly observed within the infraspinous fossa. The inferior part showed variable location within the infraspinous fossa. The injection accuracy of the superior, middle, and inferior parts in the infraspinatus muscle was 95.8%, 100%, and 91.7%, respectively. Targeting the superior and middle parts for injection of the infraspinatus muscle is relatively more straightforward than targeting the inferior part. Targeting the inferior part of the infraspinatus muscle in this study was more challenging than targeting the superior and middle parts. CONCLUSION: Needling for electromyography should be performed with special care to avoid unintended muscle parts, which could lead to inaccurate data acquisition and affect the conclusions about muscle function.

Three-dimensional topography of facial soft tissues for the safer and effective threading procedures.

INTRODUCTION: To reduce complications caused by the procedure, the target layer for thread lifting should be the superficial fat or superficial musculoaponeurotic system of the face. The aim of this study was to establish the thicknesses of the facial skin and superficial fat using a 3D scanning system to provide basic clinical data for thread lifting. MATERIAL AND METHODS: Thirty fixed Korean and Thai cadavers (male: 17, female: 13) were used. The depths of the skin and superficial fat were measured using a three dimensional (3D) structured-light scanner. Facial images of both undissected and removed skin and superficial fat were taken with the 3D scanner. The paths from the temple and the front of the tragus to the infraorbital, perioral, cheek, and mental areas were displayed on the 3D image. The thickness along the path was measured by calculating the difference between the undissected and dissected 3D images. RESULTS: The means and standard deviations of thicknesses of the skin and superficial fat were 2.1 ± 0.4 mm and 5.2 ± 1.9 mm in the 11 pathways. The facial skin became thicker going toward the lower aspect of the face from temple to infraorbtial and perioral regions. The thickness of the superficial fat around the marionette line showed the biggest change. CONCLUSIONS: The present findings indicate that a 3D scanning system can yield crucial anatomical information about the thickness of the facial skin and superficial fat for use in various minimally invasive clinical procedures including thread lifting.

Clinical anatomy considerations on the muscular and vascular components of the midface by ultrasonographic imaging.

The first signs of face aging appear in the midface, so procedures such as botulinum toxin and filler injections are performed there. However, no guidelines based on clinical anatomy describing the muscular and vascular components in vivo have been published. The aim of this research was to describe the depths of the midface muscles and the locations of vessels using ultrasonographic (US) imaging. US was applied at 12 landmarks on the midface in 88 volunteers (49 males and 39 females; 19-36 years) to detect sex differences in the depths of muscles and the locations of the vessels. The depths of the orbicularis oculi (OOc), levator labii superioris alaeque nasi (LLSAN), and zygomaticus minor (Zmi) differed significantly with sex at P7 (p = 0.001) and P8 (p = 0.017), P1 (p = 0.028), and P4 (p = 0.035), respectively. The facial artery, facial vein, angular artery, angular vein, and perforator vessels were found at P9, P2 and P10, P1, P1 and P5, and P8, P11 and P12, respectively. The findings indicate that the depths of the OOc, LLSAN, and Zmi muscles differ between the sexes and that the vessels appear at specific landmarks. This information could help in developing anatomical guidelines for several procedures.

Three-Dimensional Evaluation of the Depressor Anguli Oris and Depressor Labii Inferioris for Botulinum Toxin Injections.

BACKGROUND: Botulinum toxin type A (BoNT-A) injection administered at an inappropriate site or depth can produce an unwanted change in facial animation because the depressor anguli oris (DAO) and depressor labii inferioris (DLI) muscles are partially overlapped. Therefore, simple BoNT-A injection guidelines, based on 3-dimensional (3D) facial anatomic references and landmarks, would be very useful. OBJECTIVES: The aim of this study was to establish novel BoNT-A injection guidelines that include the soft tissue thickness at the lower perioral region. Data were acquired with a 3D scanning system combined with dissections in order to obtain accurate injection sites and depths for the DAO and DLI. METHODS: 3D scans of the facial skin, superficial fat, and facial muscle surface were performed in 45 embalmed cadavers. The thicknesses of the skin and subcutaneous layer were calculated automatically from superimposed images at each of 5 reference points (P) in the perioral region. RESULTS: In every case (100%), P3 and P5 were located in the DLI and DAO areas, respectively (45/45). Therefore, we defined P3 as the "DLI point" and P5 as the "DAO point." The soft tissue thicknesses at the DLI and DAO points were 6.4 [1.7] mm and 6.7 [1.8] mm, respectively. CONCLUSIONS: The P3 and P5 described in this study are effective guidelines that only target the DLI and DAO. Clinicians, specifically, can easily use facial landmarks, such as the cheilion and pupil, to assign the DLI and DAO points without any measurement or palpation of the modiolus.

Three-Dimensional Territory and Depth of the Corrugator Supercilii: Application to Botulinum Neurotoxin Injection.

This study aimed to determine the three-dimensional (3D) territory and depth of the corrugator supercilii muscle (CSM) using a 3D structured-light scanner. Thirty-two hemifaces from Korean and Thai embalmed cadavers were used in this study, and 35 healthy young Korean subjects also participated. A 3D analysis of the CSM territory and depth was performed using a structured-light 3D scanner. The most frequently observed locations of the CSM identified in the cadaver were confirmed in healthy young subjects using a real-time two-dimensional B-mode ultrasonography system. The CSM was present in all of the cadavers and healthy young subjects at the intersection point between the vertical line passing through the medial canthus and the horizontal line passing through the glabella (Point #6). The CSM was located on the medial side of the lateral limbus in most cases. The most-medial and most-lateral origin points were at depths of 5.7 ± 1.4 mm (mean ± SD) and 6.6 ± 1.4 mm, respectively; the corresponding depths of the insertion points were 5.4 ± 1.4 mm and 5.6 ± 2.1 mm, respectively. The origin and insertion points of the CSM were at similar depths. The injection depth should be around 4 mm for botulinum neurotoxin (BoNT) injections into the CSM. Point #6 could be regarded as an effective target point for managing the glabellar frown line and preventing palpebral ptosis when injecting BoNT into the CSM. Clin. Anat., 33:795-803, 2020. © 2019 Wiley Periodicals, Inc.

Hippocampal activation of 5-HT1B receptors and BDNF production by vagus nerve stimulation in rats under chronic restraint stress.

A growing body of evidence shows that the electrical stimulation of the vagus nerve can improve mental illness including depression. Here, we investigated whether the vagus nerve stimulation (VNS) is involved in regulating the responsiveness of hippocampal neurons in rats under chronic restraint stress (CRS). c-Fos protein signals were detected 2 hr after VNS in 5-HT1A receptor-positive neurons in the dorsal raphe nucleus (DRN) as well as in the nucleus tractus solitarius (NTS). Chronic VNS was performed on a daily basis for 2 weeks using an implanted microelectrode in rats that had undergone CRS for 2 weeks. We found that the levels of both 5-HT1B receptors and phospho-Erk1/2 were decreased in parallel in the hippocampal neurons of CRS animals and then increased to the baseline levels by chronic VNS. Hippocampal induction of 5-HT1B receptors and phospho-Erk1/2 by VNS was diminished after the injection of 5,7-dihydroxytryptamine (5,7-DHT), a neurotoxin of serotonergic neurons, into the DRN. Hippocampal production of brain-derived neurotrophic factor (BDNF) was also upregulated by VNS, but the treatment of 5,7-DHT abrogated the effects of VNS on BDNF induction. VNS in CRS animals improved the behavioral scores in forced swimming test (FST) compared to sham-stimulated control. Our results suggest that VNS-mediated serotonergic input via 5-HT1B receptors into the hippocampal neurons may activate BDNF pathway and improve depressive-like behaviors in CRS animals.

Regional thickness of facial skin and superficial fat: Application to the minimally invasive procedures.

Various recently introduced minimally invasive treatment modalities are now widely used for enhancing the aging face. In a special, filler is used to increase the volume of tissue, and so understanding the regional thickness and distribution of the facial superficial fat is essential for optimizing minimally invasive procedures. The aim of this study was to establish the overall facial skin and superficial fat thicknesses using a three-dimensional (3D) scanning system. From 53 adult Korean and Thai embalmed adult cadavers, the undissected and serially-dissected facial specimens were scanned and reconstructed. The facial skin and superficial fat thicknesses on seven facial regions were calculated from the superimposed images. The facial skin tended to become thicker in the order of the radix and dorsum, and the temple, supraorbital, forehead, perioral, cheek, and infraorbital areas. The skin was thinnest at radix and dorsum (1.51 ± 0.55 mm), and thickest in infraorbital region (1.97 ± 0.84 mm). The facial superficial fat thickness tended to increase in the order of the radix and dorsum, supraorbital, forehead, temple, cheek, infraorbital, and perioral regions. The superficial fat was thinnest at the radix and dorsum (1.61 ± 1.07 mm), and thickest in the perioral region (5.14 ± 3.31 mm). The facial superficial fat thickness tended to increase in the order of the radix and dorsum, supraorbital, forehead, temple, cheek, infraorbital, and perioral regions. The present findings indicate that 3D scanning system can yield crucial anatomical information about depths of the facial skin and superficial fat layers for utilization in various clinical procedures. Clin. Anat. 32:1008-1018, 2019. © 2019 Wiley Periodicals, Inc.

Ultrasonography of the internal architecture of the superficial part of the masseter muscle in vivo.

It is unclear whether the deep inferior tendon (DIT) is equally present in vivo, and little anatomical information is available regarding the existence and morphology of the DIT in healthy young subjects. The aim of this study was to characterize the DIT of the masseter muscle in healthy young subjects using ultrasonography and to compare the morphology of this tendon with previously reported data for healthy young subjects in order to provide the most-effective injection methods for botulinum neurotoxin treatments of masseteric hypertrophy. This study investigated two fresh cadavers and 30 healthy subjects. Ultrasonography scanning in both longitudinal and transverse directions was applied to the masseter muscle. The DIT within the superficial part of the masseter was observed in both the fresh cadavers and the living subjects. The posterior region of the masseter muscle was compartmentalized (entirely covered) by the DIT in 26.7% of the specimens. The superficial part of the masseter muscle was divided by the DIT transversely and longitudinally into the superficial and deep muscle bellies in 35% and 38.3% of the specimens, respectively. The present findings suggest applying a DIT-based injection technique under guidance by ultrasonography prior to treating masseteric hypertrophy. Clin. Anat. 32:446-452, 2019. © 2019 Wiley Periodicals, Inc.

Correlation between Cycling Power and Muscle Thickness in Cyclists.

The aim of this study was to determine the correlation between muscle thickness (MT) and cycling power in varsity cyclists using ultrasonography (US) and to identify any differences in MT between short- and long-distance cyclists. Twelve cyclists participated in this study. Real-time two-dimensional B-mode US was used to measure the MT in the anterior thigh, anterior lower leg, and trunk, especially in the abdominal and lumbar regions. A cycle ergometer was used to measure cycling power parameters such as maximum anaerobic power (over 5 s), mean anaerobic power (over 30 s), and aerobic power (over 3 min). This study was approved by the Ethics Committee of Korea National Sports University. There was a significant relationship between the MT and cycling power for the rectus femoris (RF) and vastus lateralis (VL) in the thigh, the rectus abdominis (RA) in the abdominal region, and the erector spinae (ES) in the lower back. The MT values of the RF, VL, and ES were strongly associated with the maximum and mean anaerobic power. There were significant differences between short- and long-distance cyclists in the MT of the RF in the thigh, the RA, the external abdominal oblique, the internal abdominal oblique, and the transverse abdominis muscle in the abdomen. We suggest that training programs attempting to improve cycling performance focus on improving the VL and ES via resistance weight or cycle training and also the core muscles for short-distance cyclists. Clin. Anat. 31:899-906, 2018. © 2018 Wiley Periodicals, Inc.

Positional relationship between the pectoralis major and external abdominal oblique muscles for consideration during dual-plane breast augmentation.

During dual plane breast augmentation (DPBA), the costal origin of the pectoralis major (the PM) should be cut to ensure appropriate coverage and positioning of an implant. However, surgeons sometimes make inappropriate planar incisions and insufficient muscular incisions because the external abdominal oblique (the EAO) muscle partially overlaps the lateral portion of the PM. The goal of this study was to clarify the positional relationship between the PM and EAO with the aim of improving the accuracy of implant and muscular incisions during DPBA. Forty sides of 20 embalmed and fresh cadavers were dissected. The midline and midclavicular line (MCL) were used as reference lines for measurements. We clarified the overlapping patterns between the PM and EAO, and measured the distances from the MCL to the borders of those two muscles. The costal part of the PM originated from the 5th (25%), 6th (70%), or 7th rib (5%), respectively. The distances from the MCL to the lateral border of the PM at the 4th, 5th, and 6th ribs were 49.8 mm, 30.5 mm, and 6.3 mm, respectively. In 90% of the specimens, the PM and the EAO overlapped near the MCL. The width of the overlapping portion between the PM and EAO was about 25 mm. This study is one of the first to suggest an innovative approach for explaining the positional relationships between the PM and EAO. Our findings can be useful for surgeons attempting to produce optimal outcomes in DPBA, especially in procedures that involve patients of different races. Clin. Anat. 31:339-346, 2018. © 2018 Wiley Periodicals, Inc.

Classification of unusual insertion of the pectoralis minor muscle.

PURPOSE: The pectoralis minor muscle (PMi) generally originates from the third, fourth, and fifth ribs and inserts on the medial and superior margins of the anterior portion of the coracoid process. Variations in the shape and attachment point of the PMi could cause discomfort in the shoulders. The aim of this study was to observe the types of morphological insertion patterns and attachment sites of the PMi. METHODS: Seventy-four sides of fresh, embalmed Korean (42 sides; mean age 78 years) and Thai (32 sides; mean age 78 years) cadavers were dissected to analyze the morphological insertion types and attachment sites of the PMi. RESULTS: Unusual insertion patterns were evident in about 23% of the samples. When the portion of the PMi tendon ran over the coracoid process, the most common attachment site was the glenohumeral joint capsule. We also confirmed the attachment of the PMi to the clavicle. Costal attachments of the PMi that extend from the second rib to the fourth rib were observed frequently as well. CONCLUSIONS: Unusual insertion patterns of the PMi are common. Some authors consider that tendon attachment to the joint capsule can cause shoulder pain. In addition, the PMi tendon could be utilized in acromioclavicular joint reconstruction. Surgeons need to be aware of the possibility of a PMi variant being found during surgery even when this is not visible in magnetic resonance or ultrasound imaging.

DNA damage-induced apoptosis suppressor (DDIAS), a novel target of NFATc1, is associated with cisplatin resistance in lung cancer.

In a previous study, we reported that DNA damage induced apoptosis suppressor (DDIAS; hNoxin), a human homolog of mouse Noxin, functions as an anti-apoptotic protein in response to DNA repair. Here we reveal that DDIAS is a target gene of nuclear factor of activated T cells 2 (NFATc1) and is associated with cisplatin resistance in lung cancer cells. In the DDIAS promoter analysis, we found that NFATc1 activated the transcription of DDIAS through binding to NFAT consensus sequences in the DDIAS promoter. In addition, tissue array immunostaining revealed a correlation between DDIAS and NFATc1 expression in human lung tumors. NFATc1 knockdown or treatment with the NFAT inhibitor cyclosporine A induced apoptosis and led to growth inhibition of lung cancer cells, indicating the functional relevance of both the proteins. In contrast, DDIAS overexpression overcame this NFATc1 knockdown-induced growth inhibition, supporting the cancer-specific role of DDIAS as a target gene of NFATc1. NFATc1 or DDIAS inhibition clearly enhanced apoptosis induced by cisplatin in NCI-H1703 and A549 cells. Conversely, DDIAS overexpression rescued NCI-H1703 cells from cisplatin-mediated cell death and caspase-3/7 activation. These results suggest that NFATc1-induced DDIAS expression contributes to cisplatin resistance, and targeting DDIAS or NFATc1 impairs the mechanism regulating cisplatin resistance in lung cancer cells. Taken together, DDIAS is a target of NFATc1 and is associated with cisplatin resistance in lung cancer cells.

Validity and reliability of a structured-light 3D scanner and an ultrasound imaging system for measurements of facial skin thickness.

Three-dimensional (3 D)-scanning-based morphological studies of the face are commonly included in various clinical procedures. This study evaluated validity and reliability of a 3 D scanning system by comparing the ultrasound (US) imaging system versus the direct measurement of facial skin. The facial skin thickness at 19 landmarks was measured using the three different methods in 10 embalmed adult Korean cadavers. Skin thickness was first measured using the ultrasound device, then 3 D scanning of the facial skin surface was performed. After the skin on the left half of face was gently dissected, deviating slightly right of the midline, to separate it from the subcutaneous layer, and the harvested facial skin's thickness was measured directly using neck calipers. The dissected specimen was then scanned again, then the scanned images of undissected and dissected faces were superimposed using Morpheus Plastic Solution (version 3.0) software. Finally, the facial skin thickness was calculated from the superimposed images. The ICC value for the correlations between the 3 D scanning system and direct measurement showed excellent reliability (0.849, 95% confidence interval = 0.799-0.887). Bland-Altman analysis showed a good level of agreement between the 3 D scanning system and direct measurement (bias = 0.49 ± 0.49 mm, mean±SD). These results demonstrate that the 3 D scanning system precisely reflects structural changes before and after skin dissection. Therefore, an in-depth morphological study using this 3 D scanning system could provide depth data about the main anatomical structures of face, thereby providing crucial anatomical knowledge for utilization in various clinical applications. Clin. Anat. 30:878-886, 2017. © 2017 Wiley Periodicals, Inc.

Transglutaminase 2 exacerbates α-synuclein toxicity in mice and yeast.

α-Synuclein is a key pathogenic protein that aggregates in hallmark lesions in Parkinson's disease and other α-synucleinopathies. Prior in vitro studies demonstrated that it is a substrate for cross-linking by transglutaminase 2 (TG2) into higher-order species. Here we investigated whether this increased aggregation occurs in vivo and whether TG2 exacerbates α-synuclein toxicity in Mus musculus and Saccharomyces cerevisiae. Compared with α-synuclein transgenic (Syn(Tg)) mice, animals double transgenic for human α-synuclein and TG2 (TG2(Tg)/Syn(Tg)) manifested greater high-molecular-weight insoluble species of α-synuclein in brain lysates and developed α-synuclein aggregates in the synaptic vesicle fraction. In addition, larger proteinase K-resistant aggregates developed, along with increased thioflavin-S-positive amyloid fibrils. This correlated with an exaggerated neuroinflammatory response, as seen with more astrocytes and microglia. Further neuronal damage was suggested by greater morphological disruption of nerve fibers and a trend toward decreased c-Fos immunoreactive neurons. Finally, the performance of TG2(Tg)/Syn(Tg) animals on motor behavioral tasks was worse relative to Syn(Tg) mice. Greater toxicity of α-synuclein was also demonstrated in yeast cells coexpressing TG2. Our findings demonstrate that TG2 promotes the aggregation of α-synuclein in vivo and that this is associated with aggravated toxicity of α-synuclein and its downstream neuropathologic consequences.

DJ-1 induces thioredoxin 1 expression through the Nrf2 pathway.

DJ-1, which is linked to recessively inherited Parkinson's disease when mutated, is a multi-functional protein with anti-oxidant and transcription regulatory activities. However, the mechanism(s) through which DJ-1 and the genes it regulates provide neuroprotection is not fully understood. Here, we show that wild-type DJ-1 induces the expression of thioredoxin 1 (Trx1), a protein disulfide oxidoreductase, whereas pathogenic mutant isoforms L166P and M26I cannot. Conversely, DJ-1 knockdown in SH-SY5Y cells and DJ-1 knockout in mice result in significant decrease in Trx1 protein and mRNA expression levels. The importance of Trx1 in the cytoprotective function of DJ-1 is confirmed using a pharmacological inhibitor of Trx reductase, 1-chloro-2,4-dinitrobenzene, and Trx1 siRNA. Both approaches result in partial loss of DJ-1-mediated protection. Additionally, knockdown of Trx1 significantly abrogates DJ-1-dependent, hydrogen peroxide-induced activation of the pro-survival factor AKT. Promoter analysis of the human Trx1 gene identified an antioxidant response element (ARE) that is required for DJ-1-dependent induction of Trx1 expression. The transcription factor Nuclear factor erythroid-2 related factor 2 (Nrf2), which is a critical inducer of ARE-mediated expression, is regulated by DJ-1. Overexpression of DJ-1 results in increased Nrf2 protein levels, promotes its translocation into the nucleus and enhances its recruitment onto the ARE site in the Trx1 promoter. Further, Nrf2 knockdown abolishes DJ-1-mediated Trx1 induction and cytoprotection against hydrogen peroxide, indicating the critical role of Nrf2 in carrying out the protective functions of DJ-1 against oxidative stress. These findings provide a new mechanism to support the antioxidant function of DJ-1 by increasing Trx1 expression via Nrf2-mediated transcriptional induction.

Age and gender are important considerations in choosing the sniffing position for laryngoscopic view.

AIMS: The sniffing position is considered to be the standard position for direct laryngoscopic viewing. This crossover study evaluated age and gender as variables in comparing the benefits of the sniffing position over simple head extension for laryngeal view during direct laryngoscopy. METHODS: Laryngoscopy with a curved blade was performed on 200 anesthetized adults (100 males, 100 females) presenting for routine elective surgery. Glottic visualization was assessed by using the percentage of glottic opening (POGO) score in both simple extension and sniffing positions without the aid of the assistant or external laryngeal manipulation. Each gender group was divided into a younger group (< 50 years) and an older group (≥ 50 years). POGO scores were compared between both positions within each group. RESULTS: Mean (SD) POGO scores increased significantly only in younger male patients from 43% (39%) in the head extension position to 76% (30%) in the sniffing position. CONCLUSION: The sniffing position seems to be advantageous for getting a better laryngeal view during laryngoscopy for tracheal intubation in adult male patients less than 50 years old.

A practical guide to botulinum neurotoxin treatment of teres major muscle in shoulder spasticity: Intramuscular neural distribution of teres major muscle in cadaver model.

BACKGROUND: Botulinum neurotoxin treatment typically focuses on the teres major muscle as a primary target for addressing shoulder spasticity. The muscle is located deep within a large muscle group and optimal injection locations have not been identified. OBJECTIVE: To identify the preferred location for administering botulinum toxin injections in the teres major muscle. METHODS: Teres major specimens were removed from 18 cadaveric models and stained with Sihler's method to reveal the neural distribution within the muscle. The muscles were systematically divided into equal lengths from origin to insertion. The neural density in each section was evaluated to determine the location that would be likely to increase effectiveness of the injection. RESULTS: The greatest density of intramuscular nerve endings was located in the middle 20% of the muscle. The tendinous portion was observed at the ends of the muscle. CONCLUSIONS: The results suggest that botulinum neurotoxin should be delivered in the middle 20% of the teres major muscle.