Physical strength, body composition, and G-test results of air force cadets based on nutrition knowledge differences.

The Gravitational Acceleration Test (G-test) is a demanding, and sophisticated high-intensity physical activity, greatly influenced by individual body composition and physical strength. This study analyzed the general nutrition knowledge questionnaire (GNKQ) responses of Air Force cadets to identify the relationship between nutrition knowledge, body composition, physical activity, physical strength, and gravity-induced loss of consciousness. Based on the G-test results, 105 fourth-year Air Force cadets were divided into two groups: GP (G-test pass group) and GF (G-test fail group). The analysis items were GNKQ responses, body composition, and physical strength analysis, based on which independent sample t-tests , and logistic regression analysis were conducted. Physical activity according to the G-test results was statistically higher in the GP compared to the GF (vigorous activity reps/week, p = 0.017; mins/day, p = 0.011). The GP Group showed a statistically high GNKQ score compared to the GF Group: Overall (p = 0.003), Section 1 (p < 0.001), and Section 2 (p = 0.002). Based on this study, it can be deduced that analyzing the effect G-test through continuous research over the next years and applying them to physical training will have a greater impact on the cadets' increased physical strength and their success on the G-test.

Novel Ultrasound-guided Injection Method for Thoracic Outlet Syndrome Based on Anatomical Features: A Cadaveric Study.

BACKGROUND: Despite the positive effect of botulinum neurotoxin (BoNT) injections in thoracic outlet syndrome (TOS) treatment, there is insufficient anatomical evidence of its use in the anterior scalene (AS) and middle scalene (MS) muscles. OBJECTIVES: This study aimed to provide safer and more effective guidelines for the injection of botulinum neurotoxin into scalene muscles for the treatment of thoracic outlet syndrome. STUDY DESIGN: The study was based on an anatomical study and ultrasound studies. SETTING: This study was conducted at the Division in Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institute, BK21 FOUR Project, Yonsei University College of Dentistry (Seoul, Republic of Korea. METHODS: Ten living volunteers underwent ultrasonography, and the depths of the anterior scalene (AS) and middle scalene (MS) muscles were calculated from the skin surface. In cadaveric specimens, fifteen AS and 13 MS muscles were stained using the Sihler staining procedure; the neural arborization pattern was identified, and localized dense portions were investigated. RESULTS: The mean depth of the AS was 9.19 ± 1.56 mm, and that of the MS was 11.64 ± 2.73 mm at 1.5 cm above the clavicle. At 3 cm above the clavicle, the AS and MS were clearly located 8.12 ± 1.90 mm and 10.99 ± 2.52 mm deep, respectively. The nerve ending points were highest in the lower three-quarters of the AS (11/15 cases) and MS muscles (8/13 cases), followed by the lower quarter (AS muscle, 4/15 cases; MS muscle, 3/13 cases). LIMITATIONS: There are many difficulties for clinics to directly perform ultrasound-guided injections in clinical practice. However, results of this study can be used as basic data. CONCLUSION: According to anatomical features, the appropriate location for botulinum neurotoxin injection in the AS and MS muscles for the treatment of TOS is the lower portion of the scalene muscles. Therefore, it is recommended to inject at a depth of approximately 8 mm for AS and 11 mm for MS at a point 3 cm above the clavicle.

The Deep Temporal Arteries: Anatomical Study with Application to Augmentations Procedures of the Temple.

The aim of this study was to determine the anatomical features of the deep temporal arteries (DTAs) and thereby provide clinical information for the temple augmentation procedure. Forty-two adult hemifaces from 15 Korean and 6 Thai cadavers (12 males, 9 females; mean age at death, 79.6 years) with no history of trauma or surgical procedure on the temple area were used for anatomical study. A detailed dissection was performed to identify the locations of the anterior and posterior deep temporal arteries (ADTA and PDTA) with reference to the vertical plane passing through the zygomatic tubercle. Fifty-eight healthy Korean participants (31 males and 27 females; mean age, 24.7 years) were included in the ultrasonographic study. The distance from the bone to the DTAs was measured at the level of the zygomatic tubercle (HZt ) and the eyebrow (HEb ). The DTAs were not found within 7.2-12.6 mm posterior to the zygomatic tubercle; instead, the locations varied widely at the HEb . The distances between the bone and the ADTA were 1.7 ± 1.2 mm (mean ± SD) and 1.3 ± 0.8 mm, and those between the bone and the PDTA were 2.1 ± 1.2 mm and 2.0 ± 1.4 mm at HZt and HEb , respectively. Our findings indicate that at HZt , the area 1 cm posterior to the zygomatic tubercle may be a safe area for deep temple augmentation procedures. However, because the distribution patterns of the DTAs at HEb and depth of the DTAs are variable, additional care is required to minimize the risks of the procedure.

Guidance to trigger point injection for treating myofascial pain syndrome: Intramuscular neural distribution of the quadratus lumborum.

Postural habits and repetitive motion contribute toward the progress of myofascial pain by affecting overload on specific muscles, the quadratus lumborum (QL) muscle being the most frequently involved. The therapy of myofascial pain syndrome includes the release of myofascial pain syndrome using injective agents such as botulinum neurotoxin, lidocaine, steroids, and normal saline. However, an optimal injection point has not been established for the QL muscle. This study aimed to propose an optimal injection point for this muscle by studying its intramuscular neural distribution using the whole mount staining method. A modified Sihler's procedure was completed on 15 QL muscles to visualize the intramuscular arborization areas in terms of the inferior border of the 12th rib, the transverse processes of L1-L4, and the iliac crest. The intramuscular neural distribution of the QL had the densely arborized areas in the three lateral portions of L3-L4 and L4-L5 and the medial portion between L4 and L5.

Functional relationship between the anatomical structures of the calf and athletic ability.

Calf muscle plays an important function in driving the movement of stepping on the ground and moving forward when walking or running. The Achilles tendon has been reported to be closely related to the elasticity of tendons to absorb shock and rebound and convert energy into propulsion. We wanted to determine the effect and correlation of the anatomical structure of the calf region on function. Measurements of anatomical structures were conducted with 51 volunteers using ultrasonography, and exercise capacity tests were conducted to measure anaerobic power, elasticity, and flexibility. The mean power and length of the calf (LoC), muscle thickness (MT), and fascicle angle (FA) of the medial head of gastrocnemius (p < 0.001) showed the strongest positive correlation among the variables of anatomical structures. MT of the Gastrocnemius and LoC Gastrocnemius were also correlated with peak power. In the anatomical structure variables, the FA of the lateral head of gastrocnemius, length and width of the Achilles tendon, and part of the athletic ability, the standing long jump test and sitting trunk flexion test, were not significantly correlated. Based on these results, it can be concluded that the height and degree of development of the calf muscles are structures that affect the exercise of anaerobic power. Hence, it can be used as a predictor of athletic ability. Furthermore, the trainer can predict athletic ability according to the characteristics of the event by first understanding the athlete's physical condition.

Correlation between muscle architecture and anaerobic power in athletes involved in different sports.

Athletes cultivate highly developed muscles based on their sport category, creating a body shape that matches the characteristics of that sports category. We tested the significance of the correlation between muscle development characteristics and anaerobic power in athletes to build a database for each category. Fifty-eight college athletes participated in this study. To assess muscle characteristics, muscle thickness (MT) and fascicle angle (FA) were measured by ultrasonography (US) in lower limb. Furthermore, anaerobic power was measured with the Wingate test. Analysis of the correlation between muscle structure and anaerobic power revealed significant differences between the sports categories, except for the MT of the medial head of gastrocnemius (Gm), lateral head of gastrocnemius, and FA of Gm. A significant difference was observed for all parameters, except for the arrival time to peak power in the anaerobic power items; in particular, a high degree of correlation in mean power/kg and peak power/kg was observed. A similar tendency was observed in the correlation between muscle structure and anaerobic power in most sports categories, but certain muscle characteristic factors were prominent in each sport. Based on these, it is possible to contribute to predicting and promoting athletic performance.

Effective botulinum neurotoxin injection in treating iliopsoas spasticity.

INTRODUCTION: To detect ideal locations for botulinum toxin (BoNT) injection by exploring the intramuscular nerve arborization of the psoas major and iliacus muscles. METHOD: A modified Sihler's method was performed on the psoas major and iliacus muscles (16 specimens each). Intramuscular nerve arborization was recorded according to the most prominent point of the anterior superior iliac spine (ASIS), the posterior superior iliac spine (PSIS), the lesser trochanter (LT), and the transverse process of the 12th thoracic vertebra. RESULTS: Intramuscular nerve arborization of the psoas major muscle was the largest from 1/5 to 3/5 the distance from the transverse process of the 12th thoracic vertebra to the PSIS, and the tendinous portion of the muscle occupied from 3/5 to 5/5 this distance. In terms of the plane of the ASIS, the PSIS, and the LT, the arborization of the iliacus muscle was the largest from 1/5 to 3/5 the horizontal distance and 0 to 1/3, the distance longitudinally, and from 1/5 to 2/5, the horizontal distance and 1/3 to 2/3, the longitudinal distance. DISCUSSION: These results suggest that an injection of BoNT to the psoas major and iliacus muscle should be applied in specific areas. Additionally, the posterior approach is an ideal method for targeting only the psoas major because the injection point is above the PSIS. However, when treating both the psoas major and iliacus muscles, the proximal anterior approach is an ideal method according to the arborization patterns.

Ultrasonography Analysis of Vessels Around the Forehead Midline.

BACKGROUND: Filler injection into the glabella is well known to be a highly dangerous procedure due to the high risk of embolism and intravascular injection. Although it is conventional practice to insert the cannula into the middle of the forehead to perform injections into the glabella or radix, vascular structures can be observed in this region during anatomic dissection procedures. OBJECTIVES: The aim of this study was to characterize the blood vessels around the forehead midline in order to provide crucial anatomic information for ensuring the safety of noninvasive procedures involving the forehead and glabella. METHODS: Ultrasonography image scanning was performed at the following 4 points on the forehead midline: trichion (P1), metopion (P2), halfway point between metopion and glabella (P3), and glabella (P4). The courses and locations of vessels were identified and classified according to their proximity to the forehead midline. RESULTS: Vessels coursing within 0.75 cm either side of the forehead midline were found in 34% to 50% of individuals. Arteries running near the forehead midline tended to be dominant on the right side of the forehead except in the P4 area. About half of the individuals had vessels in the P4 area, of which 96.7% were veins. CONCLUSIONS: The present results indicate that there are superficial vessels running close to the midline of the forehead. This anatomic information can explain the higher incidence of vascular complications during conventional aesthetic procedures. To ensure safety, the cannula entry point or needle puncture point for glabella augmentation should be reconsidered.

Guidelines for botulinum neurotoxin injections in piriformis syndrome.

BACKGROUND: The piriformis muscle is normally involved in piriformis syndrome and can be treated with botulinum neurotoxin using several different injection methods. However, definitive injection guidelines for the muscle have not been reported previously. AIMS: This study aimed to determine the ideal area for injections based on the intramuscular nerve distribution as obtained using a modified Sihler's staining technique. MATERIALS AND METHODS: A modified Sihler's method was applied to the piriformis muscle in 15 specimens. The intramuscular arborization areas were identified based on two anatomical landmarks: (a) the lateral border of the sacrum bone and (b) the greater trochanter. RESULTS: The nerve entry point for both piriformis muscles was found in the area between the lateral border of the sacrum and one-fifth of the distance toward the greater trochanter. The intramuscular nerve distribution for the piriformis muscle had the largest arborization patterns between one-fifth and two-fifths of the distance from the sacrum to the greater trochanter. The piriformis muscle was tendinous from two-fifths of the distance to the greater trochanter. DISCUSSION: This study has yielded suggested optimal injection locations for the piriformis muscle relative to external anatomical landmarks. CONCLUSION: Clinicians can use these guidelines to ensure the effectiveness of not only botulinum neurotoxin injections but also other agents such as steroids, anesthetics, and normal saline. These guidelines will also help to avoid adverse outcomes of injection treatments.

Anatomical Considerations When Treating Compensatory Hypertrophy of the Upper Part of the Masseter after Long-Term Botulinum Neurotoxin Type A Injections.

The masseter is the most targeted muscle when treating hypertrophy to produce a smooth face shape. Compensatory hypertrophy is a well known clinical sequela that occurs in botulinum neurotoxin (BoNT) treatments and is limited to the lower part of the masseter. Based on the masseteric hypertrophy procedure, which targets a confined area, we predicted the possibility of compensatory hypertrophy occurring in the upper part of the masseter. If the patient complains about an unexpected result, additional injections must be performed, but the involved anatomical structures have not been revealed yet. The aim of this study was to identify the morphological patterns of the masseter. Deep tendons were observed in most specimens of the upper part of the masseter and mostly appeared in a continuous pattern (69.7%). The superficial and deep tendons could be classified into a simply connected form and forms surrounding part of the muscle. In 45.5% of cases there were tendon capsules that completely enclosed the muscle, which can interfere with how the injected toxin spreads. Interdigitation patterns in which the tendons could be identified independently between the muscles were present in 9.1% of cases. The present findings provide anatomical knowledge for use when injecting BoNT into the masseter.

Positional relationship of superior and inferior labial artery by ultrasonography image analysis for safe lip augmentation procedures.

The aim of this study was to use ultrasonography to determine the locations and distributions of the superior labial artery (SLA) and the inferior labial artery (ILA) relative to the vermilion border (VB). Sixty healthy Korean volunteers (35 males, 25 females; age, 21-36 years) were investigated using ultrasonography. The participants had not received any noninvasive treatment or surgical procedure in the facial regions during the previous 6 months. Based on the VB, the overall thicknesses of the upper and lower lips were 9.4 ± 0.4 mm (mean ± SD) and 10.9 ± 0.7 mm, respectively. In most cases, the labial arteries were located in the wet mucosal layer on both the upper (35-57%) and lower lips (28-55%), respectively. In the upper lip, the SLA was in the intramuscular layer in 20-45% of cases, making it the second most common type. At some of the measuring points, the SLA was observed more often in the intramuscular layer than in the wet mucosal layer. In the lower lip, the ILA was also located in the dry mucosa (5-27%). The dry-wet mucosal junction is unclear in the lip area, and the ILA was commonly observed at the dry-wet mucosal junction. The arterial depth was 5.3 ± 0.3 mm in the upper lip and 4.2 ± 0.4 mm in the lower lip. The SLA and ILA are evenly distributed over all parts of the oral mucosa. Injection procedures for lip augmentation should therefore use very superficial approaches. Clin. Anat. 33:158-164, 2020. © 2019 Wiley Periodicals, Inc.

Effective botulinum toxin injection guide for treatment of cervical dystonia.

The aim of this study was to elucidate the distribution of the accessory nerve within the sternocleidomastoid muscle (SCM) to aid identifying the optimum sites for botulinum neurotoxin (BoNT) injections and applying chemical neurolysis. Thirty SCM specimens from 15 Korean cadavers were used in this study. Sihler's staining was applied to 10 of the SCM specimens. Transverse lines were drawn in 20 sections to divide the SCM into 10 divisions vertically, and a vertical line was drawn into the medial and lateral halves from the mastoid process to the sternoclavicular joint. The most densely innervated areas were 5/10-6/10 and 6/10-7/10 along the lateral and medial parts of the muscle, respectively. We suggest injecting BoNT in the medial region 6/10-7/10 along the SCM prior to injecting in the lateral region 5/10-6/10 along the muscle to ensure safe and effective treatment. Clin. Anat. 33:192-198, 2020. © 2019 Wiley Periodicals, Inc.

Sonographic Analysis of the Upper Labial Orbicularis Oris and Its Clinical Implications.

BACKGROUND: Purse string lips, which include the vertical wrinkles over the lips, are frequently observed in aged individuals. Botulinum toxin and fillers are routinely injected into these areas to remove the wrinkles; however, the anatomy of the orbicularis oris muscle (OOr) near the vermilion border area has not been well defined. OBJECTIVES: The aim of this study was therefore to identify any morphological differences of the upper OOr via sonographic imaging. METHODS: The upper lip muscles as observed utilizing an ultrasound device were divided into 2 muscles (pars peripheralis and pars marginalis) that were subsequently divided into a further 2 types (Type I and Type II) associated with the development of the pars marginalis. Type II was further divided into Type IIa and Type IIb depending on whether the muscle fibers were well developed and connected. RESULTS: On the midline of the lip, Type I, in which the pars marginalis was rarely observed and only appeared in traces, was observed in 20.0% of the volunteers. Type IIa, in which the pars marginalis was well-developed and appeared continuous, was observed in 42.9% of the volunteers. Type IIb, in which the pars marginalis was observed but appeared discontinuous, was observed in 37.1% of the volunteers. CONCLUSIONS: The shapes of the upper pars marginalis of the OOr varied markedly between volunteers. Type classification of the OOr based on its shape and the lip appearance serves as a reliable source of reference information to be utilized when injecting botulinum toxin into the upper lip.

Ultrasonographic and Three-Dimensional Analyses at the Glabella and Radix of the Nose for Botulinum Neurotoxin Injection Procedures into the Procerus Muscle.

Botulinum neurotoxin (BoNT) injections are widely used for facial rejuvenation procedures, and the procerus muscle is a major target in cases of glabellar transverse lines or rhytids. Although there have been many cadaveric studies of the procerus, its depth and thickness have not been investigated thoroughly. The aim of this study was to measure the depth and thickness of the procerus and identify the location of the intercanthal vein using ultrasonographic (US) imaging and the three-dimensional scanning method, which is needed to know to avoid side effects during BoNT injections. The morphology of the procerus was classified into two types based on the US images obtained at the glabella. The procerus was located deeper below the skin surface at the glabella than the sellion (3.8 ± 0.7 mm versus 2.7 ± 0.6 mm). The width of the procerus in US images increased from the sellion (10.9 ± 0.2 mm) to the glabella (14.5 ± 4.6 mm), whereas its thickness decreased (from 1.6 ± 0.6 mm to 1.1 ± 0.5 mm). The intercanthal vein was located 5.1 ± 4.0 mm superior to the sellion and 3.0 ± 0.6 mm below the skin's surface. The present findings provide anatomical knowledge as well as the reference location information for use when injecting BoNT into the procerus.

Locational Relationship between the Lateral Border of the Frontalis Muscle and the Superior Temporal Line.

BACKGROUND: The frontalis is a representative target muscle for botulinum neurotoxin type A injections aimed at treating horizontal wrinkles in the forehead region. However, a lack of information regarding the shape and thickness of the frontalis may lead to unexpected side effects. METHODS: This study dissected hemifaces of 44 embalmed Korean and Thai cadavers and performed ultrasound examinations on 20 Korean volunteers. Two anatomical types were identified: (1) the lateral portion of the frontalis covered the superior temporal line in type I, and (2) the lateral border of the frontalis and the superior temporal line almost coincided in type II. A horizontal line was drawn laterally from the midpoint between the metopion and the glabella, and landmarks F1, F2, and F3 were defined as points where this horizontal reference line intersected with vertical lines from the midpoint of the pupil, the lateral canthus, and the lateral orbital rim, respectively. RESULTS: Type I was more common than type II [84 percent (37 of 44) versus 16 percent (seven of 44)]. When the lateral border of the frontalis ran along the border, there were no cases in which the superior temporal line was not visible. The mean minimum distance in type I was 10.53 mm. The muscle thicknesses at F1, F2, and F3 were 1.80 ± 0.44 mm (mean ± SD), 1.61 ± 0.37 mm, and 0.11 ± 0.04 mm, respectively. CONCLUSIONS: This study yielded data on the location and thickness of the lateral border of the frontalis. An anatomical study-based, ultrasound-guided injection technique can achieve reliable results when noninvasive treatment is applied to the forehead area.

Topographic Anatomy of the Infraorbital Artery and Its Clinical Implications for Nasolabial Fold Augmentation.

BACKGROUND: Understanding the topography of the blood vessels distributed around the nasolabial fold region is essential for ensuring the safety of dermal filler injections into the nasolabial fold. The purpose of this study was to provide anatomical information on the infraorbital artery distribution and its relationship with the facial artery for use in clinical procedures involving filler injection during nasolabial fold augmentation. METHODS: The infraorbital artery was investigated in the nasolabial fold region divided into zones I to XII based on clock-hour meridians centered on the infraorbital foramen. The running layers of the infraorbital artery and infraorbital nerve were also compared in the infraorbital foramen. Changes in the infraorbital artery were observed according to vascular dominance of the facial artery. RESULTS: The infraorbital artery was divided into three main branches, palpebral, nasal, and labial infraorbital artery branches in 34.7, 100, and 100 percent of the specimens, respectively; with these branches of palpebral, nasal, and labial infraorbital artery observed most commonly in zones I, V, and VI, respectively. Analysis of the bilateral facial artery topography revealed that its vascular dominance was observed in 19.4 percent. The infraorbital artery was thicker and had a wider distribution on the nondominant side of the facial artery, whereas the nasal infraorbital nerve anastomosed with the facial artery in the lateral nasal region in 57.1 percent. CONCLUSION: Investigating and verifying the vascular structure regarding its interactions with the facial artery and infraorbital artery will provide critical information to physicians performing facial surgery and cosmetic procedures.

The inflammasome and danger molecule signaling: at the crossroads of inflammation and pathogen persistence in the oral cavity.

Inflammasomes are an oligomeric assembly of multiprotein complexes that activate the caspase-1-dependent maturation and the subsequent secretion of inflammatory interleukin-1beta and interleukin-18 cytokines in response to a 'danger signal' in vertebrates. The assessment of their significance continues to grow rapidly as the complex biology of various chronic inflammatory conditions is better dissected. Increasing evidence strongly links inflammasomes and host-derived small 'danger molecule ATP' signaling with the modulation of the host immune response by microbial colonizers as well as with potential altering of the microbiome structure and intermicrobial interactions in the host. All of these factors eventually lead to the destructive chronic inflammatory disease state. In the oral cavity, a highly dynamic and multifaceted interplay takes place between the signaling of endogenous danger molecules and colonizing microbes on the mucosal surfaces. This interaction may redirect the local microenvironment to favor the conversion of the resident microbiome toward pathogenicity. This review outlines the major components of the known inflammasome complexes/mechanisms and highlights their regulation, in particular, by oral microorganisms, in relation to periodontal disease pathology. Better characterization of the cellular and molecular biology of the inflammasome will probably identify important potential therapeutic targets for the treatment and prevention of periodontal disease, as well as for other debilitating chronic diseases.