Exploring flatfeet morphology in children aged 6-12 years: relationships with body mass and body height through footprints and three-dimensional measurements.

The aim of the study was to determine the relationship between flatfoot morphology and body mass and height in children aged 6-12 years. A total of 6471 Chinese children (mean age 9.0 ± 1.9 years, 41% female) were assessed for foot morphometry, body height, and body mass index. Foot morphology, including foot length, width, girth, arch height, hallux valgus angle, and rearfoot valgus angle, was measured using a 3D laser scanner. Flatfoot evaluations were conducted using the Sztriter-Godunov index (KY) from footprints. All measurements were analyzed by age and sex using the mean values of the left and right sides. Comparisons were performed between flatfoot groups, between body mass index (BMI) groups, and between body height groups. The study revealed a significant decrease in the incidence of bipedal flatfoot with age (p < 0.001), whereas the prevalence of obesity remained consistent (p > 0.05). Bipedal flatfoot was associated with distinct morphological changes, including lower arches, reduced instep height, diminished ankle heights and a greater rearfoot valgus angle (p < 0.05). When comparing the BMI groups, overweight children had larger and thicker feet (p < 0.05), but no differences were found in arch height and ankle height (p > 0.05). When comparing the body height groups, short-statured children had a shorter feet girth, shorter arches, and shorter ankle height (p < 0.05), but no differences were found in the rearfoot valgus angle (p > 0.05). CONCLUSION: The main characteristics of flat feet include lower arches and instep heights and ankle heights but higher rearfoot valgus angles. In general, overweight children's feet do not have the common features of flat feet. In contrast, short children had similar features of flatfoot except for rearfoot valgus. Assessment of posture, such as rearfoot valgus, can be critical in identifying children with flat feet. WHAT IS KNOWN: • The morphology of children's feet is associated with body growth, but the relationship between flatfeet and body mass and height remains controversial. WHAT IS NEW: • Three-dimensional foot measurement shows that body mass is generally not associated with flatfeet, while short children have lower arches but no rearfoot valgus.

A Retrospective Study of the Effect of Spinopelvic Parameters on Fatty Infiltration in Paraspinal Muscles in Patients With Lumbar Spondylolisthesis.

OBJECTIVE: The effect on fat infiltration (FI) of paraspinal muscles in degenerative lumbar spinal diseases has been demonstrated except for spinopelvic parameters. The present study is to identify the effect of spinopelvic parameters on FI of paraspinal muscle (PSM) and psoas major muscle (PMM) in patients with degenerative lumbar spondylolisthesis. METHODS: A single-center, retrospective cross-sectional study of 160 patients with degenerative lumbar spondylolisthesis (DLS) and lumbar stenosis (LSS) who had lateral full-spine x-ray and lumbar spine magnetic resonance imaging was conducted. PSM and PMM FIs were defined as the ratio of fat to its muscle cross-sectional area. The FIs were compared among patients with different pelvic tilt (PT) and pelvic incidence (PI), respectively. RESULTS: The PSM FI correlated significantly with pelvic parameters in DLS patients, but not in LSS patients. The PSM FI in pelvic retroversion (PT > 25°) was 0.54 ± 0.13, which was significantly higher in DLS patients than in normal pelvis (0.41 ± 0.14) and pelvic anteversion (PT < 5°) (0.34 ± 0.12). The PSM FI of DLS patients with large PI ( > 60°) was 0.50 ± 0.13, which was higher than those with small ( < 45°) and normal PI (0.37 ± 0.11 and 0.36 ± 0.13). However, the PSM FI of LSS patients didn't change significantly with PT or PI. Moreover, the PMM FI was about 0.10-0.15, which was significantly lower than the PSM FI, and changed with PT and PI in a similar way of PSM FI with much less in magnitude. CONCLUSION: FI of the PSMs increased with greater pelvic retroversion or larger pelvic incidence in DLS patients, but not in LSS patients.

Identification of the length and location of the A1 pulley combining palpation technique with palm landmarks: a cadaveric study.

Through anatomical morphology, to accumulate the relevant parameters of the A1 pulley of each adult finger. A total of 100 fingers were selected, dissected layer by layer, and the A1 pulley and neurovascular of each finger were observed. Measure the length of the A1 pulley, the distance between the needle knife insertion point and the proximal edge of A1 pulley, and the nerves and blood vessels on both sides. (1) The length of A1 pulleys of each finger is 6.18 ± 0.33 mm, 6.58 ± 0.73 mm, 5.98 ± 0.67 mm, 5.36 ± 1.08 mm, 5.63 ± 1.09 mm. (2) The distances between the needle knife entry point of each finger and the volar proper nerve of the ulnar finger are 7.00 ± 1.55 mm, 8.29 ± 1.46 mm, 5.10 ± 0.25 mm, 5.30 ± 0.24 mm, 0 mm; the distances from the volar proper nerve of the radial finger are 9.08 ± 0.87 mm, 4.70 ± 1.10 mm, 7.03 ± 0.72 mm, 6.81 ± 0.22 mm, 7.81 ± 0.57 mm. (3) The distances between the needle knife entry point of each finger and the proper volar artery of the ulnar finger are 10.40 ± 0.75 mm, 8.89 ± 0.53 mm, 6.35 ± 0.44 mm, 7.26 ± 0.16 mm, 0 mm, respectively; The distances from the volar proper artery of the radial finger are 8.75 ± 1.07 mm, 6.10 ± 0.35 mm, 11.44 ± 0.41 mm, 8.19 ± 0.60 mm, 9.78 ± 0.68 mm, respectively. The landmarks of the needle entry points are located at the position corresponding to the highest point of the metacarpal heads, except the tail finger. From the needle knife entry point to distal, cut the proximal edge of the A1 pulley longitudinally along the midline until the patient can flex autonomously, and pay attention to the distance between the two sides of 3.60-11.85 mm neurovascular bundle.

Sustentaculum tali in Chinese population: anatomy and clinical significance.

BACKGROUND: Previous studies lacked adequate quantitative data on sustentaculum tali (ST), especially in Chinese population. The aims of this study are to explore the quantitative morphology of ST in dried bone specimens, and to discuss its implications related to ST screw fixation, talar articular facet variation, as well as subtalar coalitions. METHODS: A total of 965 dried intact calcanei from Chinese adult donors were evaluated. All linear parameters were measured by two observers with a digital sliding vernier caliper. RESULTS: Most parts of ST body can accommodate a commonly-used 4-mm-diameter screw, but the minimum height of anterior ST is only 4.02 mm. The shapes of the STs are slightly affected by left-right, subtalar facet, but the subtalar coalition may potentially increase the sizes of STs. The incidence of tarsal coalition is 14.09%. Among the osseous connection, there are 58.8% of type A articular surface and 76.5% of middle and posterior talar facet (MTF and PTF) involvement. ROC curve shows that subtalar coalition will be detected when ST length is greater than 16.815 mm. CONCLUSIONS: Theoretically, all the STs can accommodate 4 mm diameter screw, but a 3.5 mm diameter screw is recommended to be placed in the middle or posterior of the small ST for safety. The shapes of the STs are greatly influenced by the subtalar coalition, while they are less affected by left-right, subtalar facet. The osseous connection is common in type A articular surface and always involved in the MTF and PTF. The cut-off value of the length of STs was confirmed as 16.815 mm for predicting subtalar coalition.

Morphometric study of percutaneous A1 pulley of thumb release.

Through anatomy, microscope, histopathology, and simulating needle knife operation on specimens, to accumulate the relevant parameters of the A1 pulley of thumb, and to provide an anatomical evidence for the needle knife therapy of stenosing flexor tenosynovitis. A total of 20 fingers were selected from 20 intact adult upper limb specimens, a small amount of emerald green waterproof dye was injected from the needle insertion point, dissected layer by layer, and the A1 pulley and neurovascular bundle were observed. Observe the loosening of the thumb A1 pulley after 5 and 10 times of simulated needle knife cutting on the specimen; observe the relationship between the needle knife entry point and the A1 pulley under the thumb extension and abduction, and the thumb extension neutral position respectively; further observe the histological characteristics, and the relationship between needle entry point and A1 pulley by microscope. ① In general observation, the A1 pulleys of each finger were transverse fibers perpendicular to the flexor tendon, tough in texture, connected with synovial fibers at the proximal end. It is difficult to distinguish, and connected with oblique fibers at the distal end. ② The release rate of the thumb A1 pulley after 5 and 10 times of simulated needle knife cutting on the specimen were (40.46 ± 2.22)% and (63.52 ± 4.49)%, respectively. ③ In the neutral position of the thumb straightening, the needle entry point is 3.06 ± 0.14 mm from the proximal side of the proximal edge of the A1 pulley, which overlaps with the needle entry point where the thumb is straight and abducted. ④ Observed under a microscope, the A1 pulley is a dense transverse fiber with a pale yellow dense connective tissue, both ends are continuous with the synovial fibers. It is thin and translucent, and loose connective tissue. The A1 pulley is a dense transverse fiber with a pale yellow dense connective tissue. The anatomical key points of the needle knife therapy lie in the extended and abducted position of the thumb. Currently, it is believed that cutting the proximal edge of the A1 pulley is sufficient, and there is no need to cut the entire A1 pulley.

Anatomical parameters of sustentaculum Tali screw placement in the Asian population: A retrospective radio-anatomical study.

Purpose: This study aimed to determine the anatomical parameters of successful Sustentaculum Tali (ST) screw placement in the Asian population. Method: CT scans of unilateral feet of 110 participants were reviewed, retrospectively. The 3 D reconstruction of the calcaneus and morphometric measurements were performed by Mimics Research 19.0 and 3-Matic Research 11.0. Finally, six cadaveric feet were used for verification of the accuracy of the measurements. Results: We discovered a method to help place ST screw successfully: (1) The entry point located at the middle section of the lateral wall of posterior talar articular surface (PTAS), and the perpendicular distance from the entry point to the lateral edge of PTAS (PDEL) was 10.78 mm, (2) Screw was perpendicular to the z-axis, 66.98° to the y-axis (the longitudinal axis of the foot), (3) The length of the ST screw should be approximately 44.74 mm in male and 41.14 mm in female, and (4) The diameter of the ST screw should be approximately 4.0 mm in male and 3.5 mm in female. With this new method, all screws in six cadaveric feet were placed successfully into the middle of ST. Conclusions: In this study, we discovered a general approach to safely place ST screws in the Asian population, which may potentially help surgeons improve their success rate in surgical practice.

[Problems of acupoint injection therapy].

There are a large number of clinical reports that acupoint injection therapy is effective, but there are still some basic problems that have not been effectively resolved, such as the type, dosage, concentration and compatibility of acupoint injection drugs. This article analyzes and discusses the problems of acupoint injection therapy in five aspects: the effect of acupoint injection on local tissues, the study of mechanism, the best treatment plan and advantages, and the similarities and differences with local injection therapy.

Morphological Characteristics of the Spinous Process of Axis: Clinical Implications for Cervical Spine Manipulation.

OBJECTIVE: The purpose of this study was to evaluate the osseous variation of the axis spinous process as it may relate to palpation by clinicians. METHODS: Morphologies of the bifid spinous process in the intact dry axis of 121 Chinese adult were investigated and classified. The angular deflection of the spinous processes, the bifid spinous processes (the bifid portions of the spinous processes), and the length of the bifid spinous processes were observed and measured. RESULTS: The bifid spinous process morphologies were classified into 4 types: inverted-V shape (n = 49), inverted-U shape (n = 50), M shape (n = 18), and nonbifid spinous processes (n = 4). The direction of the spinous processes and bifid spinous processes were consistent because they depended on each other's direction of deviation. When the correlation between angular deflection of spinous processes and bifid spinous processes was analyzed, the right deviations of spinous process specimens (29 cases) showed that angular deflections of spinous processes were equal to bifid spinous processes and there was no statistically significant difference seen between them (t = 0.286, P > .05), whereas in the left deviations of spinous process specimens (49 cases), the angular deflection of spinous processes were not equal in length, but bigger than the bifid spinous processes, which was statistically significant (t = -3.079, P = .003 < .05). CONCLUSION: The anatomical structure of the spinous processes and the bifid spinous processes vary from one another, but they exhibit some regularity. In clinical spinal manipulation practice, the anatomical characteristic of the axis should be taken into account during cervical static palpation, diagnostic imaging, and treatment.

[Effect of warm acupuncture on pathological morphology and pain-induced inflammatory mediators in rats with myofascial pain trigger].

OBJECTIVE: Based on the establishment of a rat model of trigger point, this study was to intervene with warm acupuncture, and to evaluate the effect on pathological morphology and pain-induced inflammation of the rat model by microscopic pathology and microdialysis. METHODS: Sixty-four SD rats were randomly divided into group A (blank control), group B (model control) and group C (model and intervention control). Groups A and B were divided into 3 groups (A0, A1, A2 and B0, B1, B2), the group C was divided into 2 groups (C1 and C2). The MTrPs model was established in both groups B and C, warm acupuncture intervention were given to the C1 group for 7 days and the C2 group for 15 days. Rats were sacrificed in batches. MTrPs were locally sampled and stained with hematoxylin-eosin after the preparation. The pathological changes were observed under light microscopy. The iocal interleukin-1ß and prostaglandin E2 were detected by microdialysis technique. RESULTS: Microscopically, the muscle fibers of the model were arranged disorderly, broken, twisted, local fibrosis, contracture thickening and so on; macrophage and other inflammatory cell invasion in local area and a large area of adhesion occurred on the contracture nodule, the pathological state of local muscle fibers was significantly improved after warm needle intervention, local microvascular formation and maturation, local muscle fiber repair. After successful modeling, the amount of interleukin-1ß and prostaglandin E2 in group B0 was significantly higher than that in group A0 before warm needle intervention (P<0.01). After warming intervention for 7 days, there was no significant difference in the amount of interleukin-1ß and prostaglandin E2 between group C1 and group B1 (P>0.05). Group C1 and B1 were significantly higher than group A1 (P<0.01); warm needle intervention for 15 days, the amount of interleukin-1ß and prostaglandin E2 in group C2 were lower than those in group B2 (P<0.05), but those in group C2 and B2 were significantly higher than group A2 (P<0.01), and the amount of interleukin-1ß and prostaglandin E2 in group C2 was lower than group C1 (P<0.05). CONCLUSIONS: The modeling method of exercise combined hitting used in this study was proved to be effective by histopathology; warm acupuncture can improve the pathological and inflammatory state of local muscle fiber in myofascial pain trigger of rat, promote local microvascular formation and maturation, and help the trigger point local muscle fiber repair.

A Finite Element Analysis of Stress Distribution and Disk Displacement in Response to Lumbar Rotation Manipulation in the Sitting and Side-Lying Positions.

OBJECTIVE: This study aimed to investigate stress distribution and disk displacement in healthy and degenerated intervertebral disks during simulated lumbar rotation manipulation (LRM) in the sitting and side-lying positions. METHODS: Three-dimensional (3D) finite element models of healthy, mildly degenerated and moderately degenerated L4/5 spinal units were reconstructed. Lumbar rotation manipulation in the sitting and side-lying positions were simulated, and alterations in stress distribution and disk displacement in the lumbar disks were observed. RESULTS: The application of LRM in the sitting or side-lying position resulted in a similar stress distribution in healthy, mildly degenerated, and moderately degenerated disks. Stress was concentrated at the anterior right side of the annulus. In all disks, intradiskal pressure (IDP) and maximum von Mises stress were higher during LRM in the sitting position than during LRM in the side-lying position. During these manipulations, Intradiskal pressure and stress in the annulus of moderately degenerated disks were higher than in mildly degenerated disks. Displacement was most obvious in healthy disks. CONCLUSIONS: Mildly and moderately degenerated lumbar disks were subject to higher stress during LRM in the sitting position than during LRM in the side-lying position. Intradiskal pressure and the maximum von Mises stress in the annulus of moderately degenerated disks increased, suggesting the need for caution when treating patients with moderately compromised disks. Although our results are in accordance with previously published data, they are simulated and preliminary and do not necessarily replicate the clinical condition.

[Effect of electroacupuncture on proprioception in cynomolgus monkeys after unilateral anterior cruciate ligament injury].

OBJECTIVE: To study the effect of electroacupuncture on proprioception in cynomolgus monkeys after unilateral anterior cruciate ligament (ACL) injury. METHODS: Twenty-seven cynomolgus monkeys were randomized equally into 3 groups, namely unilateral ACL injury with electroacupuncture group, unilateral ACL injury model group and blank control group. One week after modeling, the monkeys in electroacupuncture group were treated daily for 12 weeks with electroacupuncture at the acupoints Wei Yang, Yin Gu, Xi Yangguan and Qu Quan. At 4, 8, and 12 weeks during the treatment, the changes in the somatosensory evoked potentials (SEPs) and motor nerve conduction velocity (MCV) of the nerves of the ACL were examined with neural electrophysiological method; the changes in the morphology and the total and variable number of the proprioceptors in the ACL were observed with gold chloride staining. RESULTS; In the mokeys in the model group, the incubation period of the SEPs and MCV on the injured side of the knee were significantly extended and the amplitudes were decreased with the passage of time (P<0.05). Intervention with electroacupuncture significantly reduced the incubation period and increased the amplitudes of the SEPs and MCV (P<0.05). The total number of the proprioceptors in the ACL was significantly decreased and the variable number of the proprioceptors in ACL was increased with time in the monkeys in the model group (P<0.05); electroacupuncture intervention obviously slowed the reduction rate of total number of the proprioceptors (P<0.05) but without affecting the variable number of the proprioceptors (P>0.05). CoONCLUSION: ACL injury causes attenuation of the proprioception on the injury side, and electroacupuncture intervention can produce a positive effect on the proprioception in cynomolgus monkeys.

[Effect of pushing manipulation on Qiaogong acupoint on hemodynamics in cynomolgus monkeys with mild carotid atherosclerotic plaques].

OBJECTIVE: To explore the hemodynamic changes in cynomolgus monkeys with mild carotid atherosclerotic (CAS) plaques after therapy with pushing manipulation on Qiaogong acupoint (MPQ). METHODS: Nine cynomolgus monkeys were equally randomized into MPQ group, mild CAS model group and blank control group. Mild CAS models were established in the monkeys in MPQ and model groups, and the monkeys in MPQ group received treatment with MPQ intervention after the modeling. The conditions of the carotid artery and the hemodynamic changes in the 3 groups were evaluated after the treatment. RESULTS: Formation of CAS plaques was detected in monkeys in both MPQ and model groups. The vascular cross?sectional area, plaque cross?sectional area and stenosis rate of the plaques in the two groups all differed significantly from those in the blank control group (P<0.05), but these parameters were similar between MPQ group and the model group (P>0.05). Compared with those in the blank control group, the hemodynamic parameters showed significant changes in MPQ and the model groups (P<0.05) but remained similar between the latter two groups (P>0.05). CONCLUSION: CAS plaques can cause changes in hemodynamic parameters. Short?term therapy with MPQ does not affect the stability of the plaques or cause adverse effects on hemodynamics in cynomolgus monkeys with mild CAS plaques.

[Experimentation of the relationship between medial or lateral patellar stabilizer and patellofemoral stabilization].

OBJECTIVE: To study the contribution of medial or lateral stabilizer to the stability of the patella, to explore the function and effect of releasing the LPR clinically and to provide a biomechanical basis for the clinical treatment of patellar instability(PI). METHODS: The quadriceps femoris of 6 fresh human cadaver knees were loaded to simulate a normal condition of muscle strength. First the loading force was measured and recorded, which subluxated the patella with the different degrees of knee flexion. Intervention 1:released the medial patellar retinaculum(MPR) to simulate pathologic conditions, then repeated the above manipulates and recorded the loading force. Intervention 2:released the LPR furthermore to simulate clinical surgical treatment, then repeated the above manipulates and recorded the loading force. RESULTS: After releasing the MPR, the loading force which subluxated the patella were decreased obviously, and there were significant differences between the two groups(P<0.05). The above loading force was further decreased after the further release of LPR, but the difference was not significant(P>0.05). CONCLUSIONS: MPR plays an important role in maintaining the stability of the patella and in the normal trajectory of the patellofemoral joint. The attention should be paid to the repair or reconstruction of the MPR in the treatment for patella recurrent lateral dislocation subluxation. Releasing the LPR is not a best choice.

Celastrol inhibits prostaglandin E2-induced proliferation and osteogenic differentiation of fibroblasts isolated from ankylosing spondylitis hip tissues in vitro.

BACKGROUND: Heterotopic ossification on the enthesis, which develops after subsequent inflammation, is one of the most distinctive features in ankylosing spondylitis (AS). Prostaglandin E2 (PGE-2) serves as a key mediator of inflammation and bone remodeling in AS. Celastrol, a well-known Chinese medicinal herb isolated from Tripterygium wilfordii, is widely used in treating inflammatory diseases, including AS. It has been proven that it can inhibit lipopolysac-charide-induced expression of various inflammation mediators, such as PGE-2. However, the mechanism by which celastrol inhibits inflammation-induced bone forming in AS is unclear. OBJECTIVE: To investigate whether celastrol could inhibit isolated AS fibroblast osteogenesis induced by PGE-2. METHODS: Hip synovial tissues were obtained from six AS patients undergoing total hip replacement in our hospital. Fibroblasts were isolated, primarily cultured, and then treated with PGE-2 for osteogenic induction. Different doses of celastrol and indometacin were added to observe their effects on osteogenic differentiation. Cell proliferation, osteogenic markers, alizarin red staining as well as the activity of alkaline phosphatase were examined in our study. RESULTS: Celastrol significantly inhibits cell proliferation of isolated AS fibroblasts and in vitro osteogenic differentiation compared with control groups in a time- and dose-dependent manner. CONCLUSION: Our results demonstrated that celastrol could inhibit isolated AS fibroblast proliferation and in vitro osteogenic differentiation. The interaction of PI3K/AKT signaling and Wnt protein may be involved in the process. Further studies should be performed in vivo and animal models to identify the potential effect of celastrol on the bone metabolism of AS patients.

Downregulation of dickkopf-1 enhances the proliferation and osteogenic potential of fibroblasts isolated from ankylosing spondylitis patients via the Wnt/ß-catenin signaling pathway in vitro.

BACKGROUND: Heterotopic ossification of the entheses is one of the most distinctive features in ankylosing spondylitis (AS). Fibroblasts are potential target cells for heterotopic ossification. The Wnt/ß-catenin pathway and its inhibitor dickkopf-1 (DKK-1) regulate bone formation. DKK-1 expression in human AS tissues has not been documented. OBJECTIVE: The purpose of the current study was to investigate the expression of DKK-1 in AS tissues and to elucidate its role in fibroblasts proliferation and osteogenesis in AS. METHODS: DKK-1 expression was assessed by western blotting, real time-polymerase chain reaction (RT-PCR), and immunohistochemistry analysis of hip synovial tissues obtained from AS and control patients. Fibroblasts were isolated, cultured, and transfected with lentiviral vectors for overexpressing human DKK-1 or an shRNA for silencing DKK-1. MTS [(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl) 2-(4-sulfophenyl)-2H-tetrazolium] and a 5-ethynyl-2'-deoxyuridine (EdU) incorporation assay were used to detect AS fibroblasts proliferation after transfection. The expression levels of ß-catenin, phosphorylated ß-catenin, c-Myc, cyclin D1, and the osteogenesis markers alkaline phosphatase (ALP), osteocalcin (OCN), and Runt-related transcription factor 2 (Runx2) were then examined by western blot analysis. Alizarin red staining (ARS) was also used to observe biomineralization activity. RESULTS: DKK-1 was downregulated in hip synovial tissues from AS patients compared to that observed in controls. AS fibroblasts exhibited excessive proliferation, a higher growth rate, and a decreased apoptotic rate. EdU assay demonstrated that DKK-1 suppressed the growth of AS fibroblasts. Downregulation of DKK-1 decreased the phosphorylation of ß-catenin and upregulated the expression of ß-catenin, c-Myc, cyclin D1, and osteogenesis markers. Overexpression of DKK-1 had the opposite effect, resulting in the inhibition of the Wnt/ß-catenin pathway. ARS showed an increase in biomineralization activity after the inhibition of DKK-1. CONCLUSIONS: AS fibroblasts are characterized by an imbalance between proliferation and apoptosis. DKK-1 may play a role in switching to new bone formation in AS progression.

Classification and Morphological Parameters of the Scapular Spine: Implications for Surgery.

Incidence of scapular spine (SS) fractures as a result of complications of reverse total shoulder arthroplasty is relatively high leading to inferior clinical outcomes and an increased risk of revision and dislocation. Fractures of SS because of trauma, including the acromion, constitute 6% to 23% of scapula fractures. The purpose of this study was to classify the SS and present specific geometrical parameters according to osteologic features. A total of 319 intact dry scapulae were collected and classified based on morphological characteristics and shape of the SS. Nine bony landmarks were also chosen and described for their relevance to regions of interest for scapular fixation. Five specific types of SS were noted and the most prevalent groups were Type 1 (Fusiform shape) (47.17%) and Type 5 (Horizontal S-shape) (19.18%). Overall, Types 3, 4, and 1 showed thicker landmark values compared to Type 5, with Type 2 having smaller values. Our classification into 5 distinct types allowed appreciation of the anatomical variance of SSs. The contours of Types 5 and 1 presented a more complex morphology and may lead to a worse surgical approach due to a fracture. As Types 2 and 5 were much thinner than the other types, these may be more susceptible to fractures.

Ligament, nerve, and blood vessel anatomy of the lateral zone of the lumbar intervertebral foramina.

PURPOSE: To provide an anatomical basis for intrusive treatment using an approach through the lateral zones of the lumbar intervertebral foramina (LIF), especially for acupotomology lysis, percutaneous transforaminal endoscopy, and lumbar nerve root block. METHODS: Blood vessels, ligaments, nerves, and adjacent structures of ten cadavers were exposed through the L1-2 to L5-S1 intervertebral foramina and examined. RESULTS: The lateral zones of the LIF were almost filled by ligaments, nerves, and blood vessels, which were separated into compartments by superior/inferior transforaminal ligaments and corporotransverse superior/inferior ligaments. Two zones relatively lacking in blood vessels and nerves (triangular working zones) were found beside the lamina of the vertebral arch and on the root of the transverse processus. Both the ascending lumbar vein and branches of the intervetebral vein were observed in 12 Kambin's triangles, and in only seven Kambin's triangles were without any veins. CONCLUSIONS: Nerves and blood vessels are fixed and protected by transforaminal ligaments and/or corporotransverse ligaments. It is necessary to distinguish the ligaments from nerves using transforaminal endoscopy so that the ligaments can be cut without damaging nerves. Care needs to be taken in intrusive operations because of the veins running through Kambin's triangle. We recommend injecting into the lamina of the vertebral arch and the midpoint between the adjacent roots of the transverse processus when administering nerve root block. Blind percutaneous incision and acupotomology lysis is dangerous in the lateral zones of the LIF, as they are filled with nerves and blood vessels.

A cadaveric study on sacroiliac joint injection.

The scope of this study was to explore the possibility as well as the feasibility of sacroiliac joint injection following simple X-ray clip location. For the cadaveric study, 10 fixed sacroiliac joint (SIJ) sectional specimens, 4 dried cadaveric pelvises and 21 embalmed adult cadaveric pelvises were dissected, followed by an injection of contrast agent into the joint. The irrigation of the agent was observed through CT scanning. For the radiologic study, 188 CT scans of ankylosing spondylitis patients (143 male, 45 female) were collected from 2010 to 2012, in Nanfang Hospital. What was measured was (1) Distance between the posterior midline and sagittal synovium; (2) Length of the sagittal synovium; (3) Distance between the midpoint of the sagittal synovium and posterior superior iliac spine; and (4) Distance between the superficial skin vertical to the sagittal synovium point were measured. For the practice-based study: 20 patients (17 males and 3 females) with early ankylosing spondylitis, from Nanfang Hospital affiliated with Southern Medical University were recruited, and sacroiliac joint unguided injections were done on the basis of the cadaveric and radiologic study. Only the inferior 1/3(rd) portion parallel to the posterior midline could be injected into since the superior 2/3(rd) portion were filled with interosseous ligaments. Thirteen of the 20 patients received successful injections as identified by CT scan using the contrast agent. Sacroiliac joint injection following simple X-ray clip location is possible and feasible if the operation is performed by trained physicians familiar with the sacroiliac joint and its surrounding anatomic structures.

New iridium dopants forg white phosphorescent devices: enhancement of efficiency and color stability by an energy-harvesting layer.

A new light blue complex (fmoppy)2Ir(tfpypz) [bis(4'-fluoro-6'-methoxylphenyl pyridinato)-iridium(III)-3-(trifluoromethyl)-5-(pyridin-2-yl)-1,2,4-triazolate] and a new orange complex (dpiq)2Ir(acac) [bis(3,4-diphenylisoquinoline)-iridium(III)-acetylacetonate] were synthesized. These two complexes were used as the dopants for the fabrication of two-element white phosphorescent devices. Via the introduction of a thin energy-harvesting layer (EHL) to harvest the extra energy and exciton from the emission zone, highly efficient two-element white devices with excellent color stability were created. One of the best devices shows yellow-white color emission with an extremely high external quantum efficiency (EQE) of 21.5% and a current efficiency of 68.8 cd/A. The other device gave a pure white emission with an external quantum efficiency of 19.2% and a current efficiency of 53.2 cd/A. At a high brightness of 1000 cd/m(2), the EQE still remains as high as 18.9 and 17.2%. With a brightness of 1000-10000 cd/m(2), the CIE coordinates of these two devices shift by only (0.02, ≤0.01). The white phosphorescent devices with the EHL showed much higher efficiency and better color stability than the one without the EHL.

[Relationship between fracture risk evaluated by FRAX tool and spinal curvature].

OBJECTIVE: To investigate the relationship between the risk of osteoporotic fracture in old people and the spinal morphology. METHODS: From June 2010 to January 2011, 107 old people's BMD of femoral neck were measured by Dual energy X-ray. A questionnaire survey on fracture risk factors of the 107 aged and data collection were adopted. Among the aged,41 were male and 66 were female,ranging in age from 48 to 82 years old,with an averaged of (67 +/- 6) years old. The fracture risk assessment tools (FRAX) recommended by WHO were adopted. A risk assessment on osteoporotic fracture in old people was done,followed with the calculation of the probability of the hip fracture and the main bone fractures (spine,hip,forearm or shoulder fractures) in ten years. The angles of spine vertebra, spine curvature in the upright positions of the old people were measured by using Spinalmouse. The correlation analysis along with curve fitting analysis between the probability of fracture risk and included angles of spine vertebra, spine curvature were done. RESULTS: The probability of osteoporotic fracture had a positive relation with thoracic vertebra T7 and T8, thoracic spine curvature,lumbar curvature and incline angle in upright position (P < 0.05). CONCLUSION: The old people's morphological characteristics of spine have the ability to reflect the risk level o osteoporotic fracture.