Investigation of preinguinal approach for removal of urachal abscess in three Japanese black cattle older than 18 months of age.

This study investigated the diagnostic and surgical management of urachal abscessation involving the urinary bladder in three cattle aged >18 months. While the abdominal floor or paralumbar fossa are typically considered for accessing the urachus and bladder in calves and heifers, the distance is too great to perform the procedure under direct vision in adult cows. Therefore, a novel preinguinal approach was used for access in cows with urachal abscesses after 18 months. Access was successfully achieved in all the three cows through a preinguinal incision to the urachal abscess at the apex of the bladder. However, in cases wherein the abscess and adhesions are severe, removal may be challenging or may necessitate a combined median or paramedian approach.

Fundamental research for dose control during supine dental panoramic radiography.

OBJECTIVE: This study aimed to control radiation doses when using a portable supine dental panoramic radiography system by measured the scattered doses. METHOD: The study used LPX7007 (Asahi Roentgen) for the panoramic radiography system. The subjects comprised a cylinder phantom (QualitA) and a RANDO Phantom (Alderson). The semiconductor dosimeter was an X2 survey sensor (RaySafe). The phantom was set at a height of 1 m from the floor, and the sensor was set at 1 m from the floor at the genital level and 1.5 m at the lens level. Measurements were taken at 30°intervals clockwise from 0°at distances of 0.5 m and 1 m in radius around the phantom. The occupational exposure range was defined as 0 ± 30° and the public exposure range was defined as the occupational exposure range and 30° to 150° and 210° to 330° as the public exposure range. RESULT: The highest doses were observed in the 120° and 240° directions, and the lowest in 0° ± 30° range. The lowest limit number of images taken in the occupational exposure range was 130 images at a distance of 0.5 m, 452 images at 1 m at the lens level for the cylinder phantom, and 320 images at 0.5 m and 1098 images at 1 m for the RANDO Phantom. In the public exposure range at the genital level, there was one image at 0.5 m and six images at 1 m for the cylinder phantom, and two images at 0.5 m and eight images at 1 m for the RANDO Phantom. CONCLUSION: We found that radiation exposure can be reduced by keeping a distance from the subject, avoiding working at 120° and 240° and staying within 0° ± 30° behind the panoramic radiography system.

Stray radiation dose reduction using a backscatter shield and a rectangular collimator for a handheld intraoral X-ray unit.

The objective of this study was to study the dose reduction effect on occupational exposure of operators and public exposure other than operators when a backscatter shield and a rectangular collimator are used in conjunction with a handheld intraoral X-ray unit. The occupational exposure was reduced to 40% when the backscatter shield was attached to the cone-tip, to 13% when the rectangular collimator was attached and to 7.7% when the backscatter shield and rectangular collimator were used together. On the other hand, the public exposure was reduced to 20% when the rectangular collimator was attached, but the backscatter shield was not effective in reducing the public exposure. Attaching a backscatter shield is effective in reducing the occupational exposure, and a rectangular aperture is effective in reducing the occupational exposure, as well as the public exposure.

Relationships among hip instability, iliofemoral ligament, and pain in patients with developmental dysplasia of the hip.

BACKGROUND: To evaluate the relationships among hip instability, pain, and morphology of the iliofemoral ligament (ILFL) in patients with developmental dysplasia of the hip (DDH) using ultrasonography (US). METHODS: We reviewed 86 patients (109 hips) with DDH (Group D), 40 patients (46 hips) with borderline hip dysplasia (BDDH) (Group B) and 20 patients (23 hips) without hip pain and bony abnormality (control group). Group D was classified into three subgroups-the severe (group SP), moderate (group MP), and none/mild (group NMP) hip pain groups-using the visual analogue scale (VAS). For evaluating hip instability and ILFL morphology, the distance between the anterior edge of the anterior inferior iliac spine (AIIS) and the horizontal line to the femoral head, and ILFL thickness were measured using US. The difference between the distance in the neutral position and Patrick position was calculated and defined as the femoral head translation distance (FTD). RESULTS: FTD and ILFL thickness in group D were significantly larger than those in the control group and group B (P < 0.05). There was a significant positive correlation between FTD and ILFL thickness in three groups (r = 0.57, P < 0.05; r = 0.55, P < 0.05; r = 0.62, P < 0.05, respectively). FTD and ILFL thickness in group SP were significantly larger than those in group NMP (P < 0.05). FTD and ILFL thickness in group D had significantly negative correlations with the lateral center edge (r = -0.54, P < 0.05; r = -0.40, P < 0.05, respectively) and vertical-center-anterior angle (r = -0.51, P < 0.05; r = -0.43, P < 0.05, respectively). CONCLUSIONS: Acetabular bony deficiency, especially in the anterior and lateral region can result in antero-posterior hip instability, leading to thickened ILFL and hip pain, even in patients with BDDH. These findings may facilitate our understanding and treatment of patients with DDH. When hip instability is suspected, hip US examination may help confirm the diagnosis and assist in providing objective clinical diagnostic evidence.

Effect of cranium structure on dose distribution during intraoral radiography.

OBJECTIVES: This study aimed to evaluate, the effect of the cranium structure on dose distribution by measuring the dose using the RANDO phantom for safe use of an X-ray unit during personal identification work at a large-scale disaster site. METHODS: As the subject, the head and neck of the RANDO Phantom (Alderson) containing a dry skull composed of a tissue-equivalent substance and having a shape similar to that of a living body were studied. With the body in the supine position, the air doses per second of irradiation time were measured for a total of six sections of the anterior, premolar, and molar teeth (molar on the left side) at a tube voltage of 60 kV and tube current of 10 mA during maxilla and mandible intraoral radiography. RESULTS: The region having the highest exposure dose was the main X-ray direction in both the mandible and maxilla. Conversely, the dose tended to be low in the range from the temporal region to the occipital region on both sides of the horizontal plane, from the frontal region to the occipital region of the sagittal plane, and in the parietal region of the frontal plane. CONCLUSIONS: It would be preferable to examine from the top of the body where the dose tends to decrease for all imaging sites.

Preoperative T2 mapping MRI of articular cartilage values predicts postoperative osteoarthritis progression following rotational acetabular osteotomy.

AIMS: Rotational acetabular osteotomy (RAO) has been reported to be effective in improving symptoms and preventing osteoarthritis (OA) progression in patients with mild to severe develomental dysplasia of the hip (DDH). However, some patients develop secondary OA even when the preoperative joint space is normal; determining who will progress to OA is difficult. We evaluated whether the preoperative cartilage condition may predict OA progression following surgery using T2 mapping MRI. METHODS: We reviewed 61 hips with early-stage OA in 61 patients who underwent RAO for DDH. They underwent preoperative and five-year postoperative radiological analysis of the hip. Those with a joint space narrowing of more than 1 mm were considered to have 'OA progression'. Preoperative assessment of articular cartilage was also performed using 3T MRI with the T2 mapping technique. The region of interest was defined as the weightbearing portion of the acetabulum and femoral head. RESULTS: There were 16 patients with postoperative OA progression. The T2 values of the centre to the anterolateral region of the acetabulum and femoral head in the OA progression cases were significantly higher than those in patients without OA progression. The preoperative T2 values in those regions were positively correlated with the narrowed joint space width. The receiver operating characteristic analysis revealed that the T2 value of the central portion in the acetabulum provided excellent discrimination, with OA progression patients having an area under the curve of 0.858. Furthermore, logistic regression analysis showed T2 values of the centre to the acetabulum's anterolateral portion as independent predictors of subsequent OA progression (p < 0.001). CONCLUSION: This was the first study to evaluate the relationship between intra-articular degeneration using T2 mapping MRI and postoperative OA progression. Our findings suggest that preoperative T2 values of the hip can be better prognostic factors for OA progression than radiological measures following RAO. Cite this article: Bone Joint J 2021;103-B(9):1472-1478.

Three-dimensional analysis of the cortical contact state of short and conventional stems in different stem positions in total hip arthroplasty.

BACKGROUND: Despite the increasing use of short cementless stems in total hip arthroplasty, their potential benefits have yet to be confirmed. We evaluated the cortical contact state of short and conventional stems in different femoral canal types and stem positions using a CT-based 3-dimensional templating software. METHODS: We reviewed 153 hips in 153 patients, grouped according to femoral canal type-normal (68), champagne-flute (41), and stove-pipe canal (44). We investigated the influence of stem position on the contact state by evaluating three situations of stem anteversion (original anteversion, +5°anteverted, and +5°retroverted), three stem positions, neutral +2°extended, and +2°flexed positions using Taperloc Complete MicroplastyⓇ stem. FINDINGS: The contact values of all zones between both stems in all canal types exhibited no significant differences. The values in zones 1, 2, 6, and 7 of both stems in 5° retroverted and anteverted, 2° extended and flexed positions were not significantly different compared to those of the neutral position. However, the values in zones 3, 4, and 5 of both stems were significantly greater compared to those of the neutral position in 2° extended and flexed positions; these values were also significantly larger in all canal types for the conventional stem. INTERPRETATION: We demonstrated that the short and conventional stems can achieve the same proximal cortical contact in any femoral canal, regardless of the stem position. However, extended and flexed stem positions increase the distal contact, especially in conventional stems. Furthermore, the distal contact increases for the retroverted stem insertions.

Comparison of air dose and operator exposure from portable X-ray units.

This study was aimed at investigating and comparing exposure dose of workers and the surrounding workers. In addition, worker's exposure was also measure about lens and finger. Four intraoral portable X-ray units were evaluated. The stray radiations were measured using Pitman 37D and ionization chamber (Pitman). MyDosemini (ALOKA) was used for measurement of the finger exposure dose. Without the shield became high in anterior 0.5 m. Comparing the air dose for the four models used in this study showed a high tendency for the two NOMAD models. And using the shields, the images could be taken 4.6 times of the baseline at a maximum and 3.6 times on average. The finger radiation exposure dose was low with both of the NOMAD models, with no significant difference found. By setting the baseline value without a shield, finger radiation exposure when using a shield was lower than the detection limit for the D3000, and was reduced by approximately 94-96% for other three models. All models can photograph around 100 bodies, so it is considered that it is not necessary to switch out the operator considering the operation limit. But even if it does not reach the operation limit, the stochastic effects of radiation exposure can be increased as well as the deterministic effects of the operation limit. The operator and the surrounding workers seek to protect themselves. It is important to perform exposure management that takes into account the stochastic effects to the operator and the surrounding workers.

Factors affecting impingement and dislocation after total hip arthroplasty - Computer simulation analysis.

BACKGROUND: Studies on the causes and factors affecting dislocation after total hip arthroplasty have revealed conflicting results. The purpose of this study was to evaluate the factors affecting impingement and dislocation after total hip arthroplasty, using a 3-dimensional dynamic motion analysis. METHODS: The CT data of 53 patients (53 hips: anterior dislocation; 11 cases, and posterior dislocation; 42 cases) who experienced hip dislocation after total hip arthroplasty with posterior approach, and 120 control patients (120 hips) without dislocation were analyzed. Parameters related to implant alignment, offset and leg length were evaluated. The impingement type was also analyzed using a software. FINDINGS: Considering implant settings affecting dislocation, patients at risk for posterior dislocation had decreased stem anteversion, combined anteversion, femoral offset, and leg length. Nevertheless, patients at risk for anterior dislocation had only lower leg length, and these patients may also be at risk for a higher incidence of recurrent dislocation. Bony impingement occurred in almost half of the cases with posterior dislocation, while implant impingement was associated with anterior dislocation. Importantly, anterior dislocation was not as common as posterior dislocation even in cases with occurrence of posterior impingement. INTERPRETATION: Bony impingement substantially affects dislocation even in the situation where the implant position and alignment are determined by the so-called "safe zone", especially on the anterior side, while implant impingement affects anterior dislocation. The restoration of anterior offset (i.e., prescribed by the stem anteversion and femoral offset) and combined anteversion is critical for avoidance of posterior dislocation after total hip arthroplasty.

Reduction of operator exposure by rectangular collimation in portable intraoral radiography.

Portable intraoral X-ray units are frequently used for home-visit dental treatment and personal dental identification. Therefore, the reduction of operator exposure is crucial. Rectangular collimation is effective at reducing patient exposure and operator exposure; however, its effects are not known. We investigated the reduction of operator exposure through rectangular collimation by measuring the backscattered dose in relation to the operator exposure dose. Using a portable intraoral X-ray unit, a head phantom for CT dose measurement as the object, a dosimeter, and stainless-steel rectangular collimator, a 1-cm ambient dose equivalent was measured in intervals of 15° in horizontal and vertical planes with the radii of 50 and 100 cm. The backscattered dose decreased to approximately one-third when a rectangular collimator was attached to the cone tip. This may have been due to the reduction of the volume of scattered X-rays generated in the phantom by rectangular collimation. We clarified that rectangular collimation is effective at reducing the operator exposure and is useful for protecting the operators of portable intraoral X-ray units during home-visit dental treatment and personal dental identification.

Intra-articular pathology affects outcomes after joint preserving surgery for osteonecrosis of the femoral head.

PURPOSE: Currently, knowledge regarding the intra-articular pathology and its relationship to outcomes after joint-preserving surgery in patients with osteonecrosis of the femoral head (ONFH) is lacking. The purposes were to evaluate the intra-articular pathology and its relationship with outcomes of joint-preserving surgery in ONFH. METHODS: We reviewed 41 hips with ONFH in 41 patients (27 women; mean age, 34.9 years old) who underwent intertrochanteric curved varus osteotomy. Radiographic evaluations were based on pre-operative imaging studies, including radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). Intra-articular pathology was evaluated by arthroscopic inspection of the femoral head, labrum, and acetabular cartilage during surgery. In addition, we performed radiographic measurements of the hip, including the collapse of the femoral head and minimal joint space width at three  years post-operatively and at final follow-up. RESULTS: Arthroscopy revealed damage to the acetabular cartilage and labrum in 22 (54%) and 13 patients (32%), respectively. However, these lesions could be detected on imaging in only 13 (32%) and ten patients (24%), respectively. The change in joint space width after surgery was significantly higher in patients with cartilage degeneration and labral injury (P = 0.02, P = 0.02). Logistic regression analysis for subsequent progression of osteoarthritis showed an association with degenerative changes of articular cartilage and the labral tear as independent predictors (P = 0.001, P = 0.03). CONCLUSIONS: Our data demonstrate the presence of labral and acetabular cartilage lesions in ONFH patients, while images do not reveal the full extent of the tissue damage. These intra-articular pathologies can be associated with the outcomes after joint-preserving surgery.

Effect of transtrochanteric rotational osteotomy on impingement and contact state of a femoral implant in conversion total hip arthroplasty - Retrospective simulation study.

BACKGROUND: The transtrochanteric rotational osteotomy is a common osteotomy for osteonecrosis of the femoral head, although the results of conversion total hip arthroplasty after the osteotomy are controversial. We evaluated how deformities in the proximal femur after the osteotomy affect hip impingement and the contact state of the stem in total hip arthroplasty. METHODS: We retrospectively reviewed 35 hips (24 men) that had undergone the transtrochanteric rotational osteotomy for osteonecrosis of the femoral head (TRO-group) and compared them with 31 contralateral, unoperated hips (Primary group). The distance between the anterior and posterior greater trochanter at the cutting point of the femur, defined as the greater trochanter width and the contact area of the femoral implant surface with cortical bone were measured by CT-based three-dimensional templating software. We also calculated the hip range of motion in conversion total hip arthroplasty and analyzed the correlations between the greater trochanter width and the range of motion. FINDINGS: The number of bony-impingement cases was significantly greater, and the range of motion in flexion, internal rotation and external rotation was significantly less in TRO-group. There was a significant negative correlation between the greater trochanter width and range of motion of internal rotation. There were no significant differences between two groups in percentages of femoral-implant contact area. INTERPRETATIONS: The femoral implant fixation appears to be satisfactorily fixed in all zones in conversion total hip arthroplasty. However, the greater attention should be paid to minimizing bony impingement, especially on the anterior side, in conversion total hip arthroplasty.

Age estimation based on the volume change in the maxillary premolar crown using micro CT.

Age is often estimated using teeth because numerous external and internal changes appear due to aging. The purpose of this study was to investigate an age estimation method based on the volume ratio of the internal structure of the crown. 61 maxillary first premolars and 50 maxillary second premolars from subjects aged 20-79 years old were used. Micro CT, which can be used to analyze teeth in a non-destructive manner with high sensitivity, was employed in the present study. In consideration of individual differences among subjects, the volume ratio was calculated for the following four items: The pulp chamber was calculated separately based on the presence of enamel.In order to estimate age, regression analysis was conducted with the actual age as the dependent variable and each volume ratio as the independent variable. As a result, the highest correlation was found with PVR (E-) for each measurement item. Therefore, the regression equation using the volume change of the maxillary premolar crown as an index was as follows: Age = -12.43 × 4: PVR (E-) + 69.85. Age = -12.94 × 5: PVR (E-) + 72.54.

Fetal anatomy of the upper pharyngeal muscles with special reference to the nerve supply: is it an enteric plexus or simply an intramuscular nerve?

We examined pharyngeal nerve courses in paraffin-embedded sagittal sections from 10 human fetuses, at 25-35 weeks of gestation, by using S100 protein immunohistochemical analysis. After diverging from the glossopharyngeal and vagus nerves at the level of the hyoid bone, the pharyngeal nerves entered the constrictor pharyngis medius muscle, then turned upward and ran superiorly and medially through the constrictor pharyngis superior muscle, to reach either the levator veli palatini muscle or the palatopharyngeus muscle. None of the nerves showed a tendency to run along the posterior surface of the pharyngeal muscles. Therefore, the pharyngeal nerve plexus in adults may become established by exposure of the fetal intramuscular nerves to the posterior aspect of the pharyngeal wall because of muscle degeneration and the subsequent rearrangement of the topographical relationship between the muscles that occurs after birth.

Expression of myostatin and follistatin in Mdx mice, an animal model for muscular dystrophy.

Follistatin is a functional antagonist of several members of the TGF-beta family of secreted signaling factors, including myostatin, the most powerful inhibitor of muscle growth characterized to date. Myostatin inhibition offers a novel therapeutic strategy for muscular dystrophy by restoring skeletal muscle mass and suppressing the progression of muscle degeneration. To assess the potential benefits of follistatin in treating muscle degenerative diseases, we examined the expression of myostatin and follistatin in Mdx mice, a model for Duchenne muscular dystrophy, and in B10 mice as a control. Our results demonstrated a temporary and coincident expression of follistatin and myostatin in both mouse strains, but this expression was significantly higher in Mdx mice than in B10 mice. The maximum expression of follistatin and myostatin in the presence of restoring necrotic muscle was detected 4 weeks after birth in Mdx mice. Interestingly, during the stage of complete regeneration, the absence of myostatin and follistatin proteins and a marked decrease in the expression of both genes were observed 9 weeks after birth in both mouse strains. These findings suggest that follistatin not only blocks myostatin but also allows other activators to function in muscle development, emphasizing that follistatin could be a very potent molecule in combating muscle loss during dystrophies and muscle ageing, disuse, or denervation.

Three-dimensional analysis of the internal structure of the mandibular condyle in dentulous and edentulous jaws using micro-CT.

This study clarifies the internal structure of the mandibular condyle in dentulous and edentulous jaws; three-dimensional observation and morphological measurements were performed using micro-CT. The materials used in this study were 14 mandibular condyles each removed from the dentulous and edentulous cadavers. Internal structures of the mandibular condyle were morphologically analyzed in three anatomical planes. Additionally, morphometrical observations of the trabecular bone structure at five regions of interest and cortical bone thickness were performed. The mandibular condyle of dentulous jaws consisted predominantly of regularly aligned plate-shaped trabeculae. Conversely, edentulous jaws were predominantly irregularly aligned narrow rod-shaped trabeculae. The results of morphometrical analysis showed that trabecular separation (Tb.Sp) in the central region of the mandibular condyle most closely reflected the difference between dentulous and edentulous jaws. These results suggest that, in edentulous jaws, reduced masticatory function due to tooth loss affects the internal structures of mandibular condyle.

Increased expression of decorin during the regeneration stage of mdx mouse.

Satellite cells exist in postnatal muscle tissue and constitute the main source of muscle precursor cells for growth and repair. These cells carry out important roles for skeletal muscle formation postnatally during growth of muscle mass as well as damage-induced regenerative processes. Muscle regeneration supports muscle function in aging and has a role in the functional impairment caused by progressive neuromuscular diseases. Major substances controlling this process are growth factors and extracellular matrix. Myostatin, a member of TGF-beta family, was mainly expressed in muscle tissue. Decorin, a member of the small leucine-rich proteoglycan gene family, is composed of a core protein and a dermatan/chondroitin sulfate chain. Recent studies have shown that decorin enhanced the proliferation and differentiation of myogenic cells by suppressing myostatin activity. Thus, decorin appears to be a new molecule in the myostatin signaling pathway and a promising target for treatment of progressive neuromuscular diseases. Therefore, in this study, we examined the localization of decorin as well as myostatin in a muscular dystrophy model in mdx mice and B10 Scott Snells mice as a control to elucidate the differences between decorin and myostatin messages as well as protein distribution. This study revealed increased expression of decorin protein as well as mRNA at the regenerative stage of mdx mice compared to early stages, while only weak expression of decorin was detected in the control mice. Our study contributes to identifying the relationship between decorin and myostatin as well as the development of a therapeutic strategy for progressive neuromuscular diseases.

Three-dimensional bone microstructures of the mandibular angle using micro-CT and finite element analysis: relationship between partially impacted mandibular third molars and angle fractures.

The mandibular angle is one of the areas of the mandible that are prone to bone fractures, and the presence of an impacted third molar has been found to be associated with increased risk of angle fractures. The factors involved in bone fractures are the amount and direction of load, and the biomechanical and anatomical properties of bone. In the present study, micro-focused X-ray computed tomography was performed to observe and analyze the three-dimensional (3D) bone microstructure of the mandibular angle, and finite element analysis was conducted to examine the relationship between angle fractures and the presence or absence of mandibular third molars. 3D bone microstructure showed no marked difference between mandibles with and without third molars. Finite element analysis showed that, in the mandible with a third molar, stress was concentrated around the root apex of the third molar, and was transmitted in a direction matching the clinical findings of angle fractures. The results obtained in this study suggest that the presence of an impacted third molar changes the concentration and transmission of stress in the mandible, thus increasing the risk of an angle fracture.