An Anatomically Complicated Living Donor Kidney Transplantation from Hepatitis B Surface Antigen-Positive Donor to Negative Recipient With Size Discrepancy.

The deficiency of organ donors remains a barrier to kidney transplantation. Living donor kidney transplantation (LDKT) can overcome graft shortage, resulting in better outcomes. Many efforts are being made to expand the donor pool, such as hepatitis B surface antigen (HBsAg)-positive donors to negative recipients and anatomically complicated donor kidneys with size discrepancies. We report a case in which we overcame various problems in LDKT. The recipient was a 56-year-old, 106-kg, HBsAg negative male with diabetic nephropathy. The donor was a 63-year-old female, 56-kg, hepatitis B virus (HBV) carrier with dual renal arteries. Preoperative antiviral medication was provided to the donor for negative conversion of HBV-DNA. The recipient was given HBV vaccination (antihepatitis B antibody: 2.25-36.16 mIU/mL). Anti-HBV immunoglobulin was intraoperatively administered to prevent transmission. The donor and recipient had an absolute weight difference (50 kg). In addition, the donor's kidney had a main and an accessory artery in the upper pole, which were anastomosed to the recipient's right external iliac and inferior epigastric artery, respectively. Follow-up serum creatinine levels decreased. Doppler ultrasonography showed good vascular flow within the reference range of the resistive index. The recipient's follow-up HBV-DNA titer was negative with antiviral medication. We successfully performed LDKT from an HBV-positive donor to a negative recipient by perioperative antiviral treatment and overcame a significant size discrepancy and anatomic challenges by preserving even a small portion of the kidney graft.

Core-Shell Perovskite Quantum Dots for Highly Selective Room-Temperature Spin Light-Emitting Diodes.

Circularly polarized light (CPL) is a crucial light source with a wide variety of potential applications such as magnetic recording, and 3D display. Here, core-shell heterostructured perovskite quantum dots (QDs) for room-temperature spin-polarized light-emitting diodes (spin-LEDs) are developed. Specifically, a 2D chiral perovskite shell is deposited onto the achiral 3D inorganic perovskite (CsPbBr3 ) core. Owing to the chiral-induced spin selectivity effect, the spin state of the injected charge carriers is biased when they are transmitted through the 2D chiral shell. The spin-controlled carriers then radiatively recombine inside the CsPbBr3 emissive core, resulting in CPL emission. It is demonstrated that the (R)- and (S)-1-(2-(naphthyl)ethylamine) (R-/S-NEA) 2D chiral cations enhance the spin polarization degree due to their strong chiroptical properties. Systematical defect analyses confirm that 2D chiral cations (i.e., R-/S-NEA) successfully passivate halide vacancies at the surface of the CsPbBr3 QDs, thereby attaining a high photoluminescence quantum yield of 78%. Moreover, the spin-LEDs prepared with core-shell QDs achieve a maximum external quantum efficiency of 5.47% and circularly polarized electroluminescence with a polarization degree (PCP-EL ) of 12% at room temperature. Finally, various patterns fabricated by inkjet printing the core-shell QDs emit strong CPL, highlighting their potential as an emitter for next-generation displays.

The Protective Effects of Eicosapentaenoic Acid for Stress-induced Accelerated Senescence in Vascular Endothelial Cells.

Background: Eicosapentaenoic acid (EPA) is an omega-3 fatty acid that protects against cardiovascular diseases in patients with hypertriglyceridemia and may have pleotropic effects beyond lowering triglycerides. Many degenerative diseases, such as atherosclerosis and diabetes, are related to cellular senescence as a pathophysiological mechanism. We aimed to examine whether EPA could protect vascular endothelial cells under stress conditions against stress-induced accelerated senescence (SIAS). Methods: Cultured human umbilical vein endothelial cells (HUVECs) were exposed to H2O2 as oxidative stress and a high glucose concentration with palmitate as a glucolipotoxic condition. Changes in cell viability, apoptosis, lactate dehydrogenase release, and cell cycle analysis were measured by cell counting kit-8 assay, annexin V/ propidium iodide staining, and enzyme-linked immunosorbent assay, respectively. EPA was applied in stress conditions. The degree of senescence was measured by senescence-associated beta-galactosidase staining and p16 staining using immunofluorescence. Apoptosis and cellular senescence-related proteins were measured by Western blotting. Results: Cultured HUVECs under oxidative and glucolipotoxic stresses revealed accelerated senescence and increased apoptosis. These changes were markedly reversed by EPA administration, and the expressions of apoptosis and cellular senescence-related proteins were reversed by EPA treatment. Conclusion: EPA effectively protects HUVECs against SIAS, which may be one of its pleotrophic effects.

The Effect of Porosity on the Thermal Conductivity of Highly Thermally Conductive Adhesives for Advanced Semiconductor Packages.

This study suggests promising candidates as highly thermally conductive adhesives for advanced semiconductor packaging processes such as flip chip ball grid array (fcBGA), flip chip chip scale package (fcCSP), and package on package (PoP). To achieve an extremely high thermal conductivity (TC) of thermally conductive adhesives of around 10 Wm-1K-1, several technical methods have been tried. However, there are few ways to achieve such a high TC value except by using spherical aluminum nitride (AlN) and 99.99% purified aluminum oxide (Al2O3) fillers. Herein, by adapting highly sophisticated blending and dispersion techniques with spherical AlN fillers, the highest TC of 9.83 Wm-1K-1 was achieved. However, there were big differences between theoretically calculated TCs that were based on the conventional Bruggeman asymmetric model and experimentally measured TCs due to the presence of voids or pores in the composites. To narrow the gaps between these two TC values, this study also suggests a new experimental model that contains the porosity effect on the effective TC of composites in high filler loading ranges over 80 vol%, which modifies the conventional Bruggeman asymmetric model.

Normal Distal Tibiofibular Syndesmosis Assessment Using Postmortem Computed Tomography (PMCT).

BACKGROUND: Distal tibiofibular syndesmotic injuries, often misdiagnosed, can lead to substantial morbidity. This study utilized postmortem computed tomography (PMCT) to define normal syndesmotic relationships in 131 subjects. METHODS: Three parameters were measured: fibular rotation (FR), sagittal translation (ST), and incisura depth (ID). RESULTS: Interobserver reliability was excellent for FR and ID but moderate for ST. Anatomical variability was wide, with FR ranging from -0.4° to 16.6°, ST from 0.33 mm to 3.49 mm, and ID from 1.89 mm to 6.05 mm. Side-to-side variability within subjects was minimal. Gender-specific differences were observed in ST, possibly due to size variations, highlighting the need for gender-specific diagnostic criteria. CONCLUSIONS: Although establishing universal reference values is challenging, using contralateral ankles for comparison can enhance diagnostic accuracy in syndesmotic injuries. This study, the first of its kind, offers valuable insights into normal distal tibiofibular syndesmotic relationships based on PMCT data. Future validation studies in patients with syndesmotic injuries can further improve diagnostic accuracy.

Estimating Adult Stature Using Metatarsal Length in the Korean Population: A Cadaveric Study.

This study aims to propose a regression equation for estimating stature in the Korean population using metatarsal bones from cadavers and to validate the appropriateness of the Korean-specific equation by comparing it to equations from other populations. A total of 81 adult formalin-fixed cadavers (51 males and 30 females) were evaluated. The first and second metatarsal bones' physiological and maximal lengths were measured, and the cadaveric stature of the subjects was determined as the distance from the vertex to the plantar face of the heel. In all measurements, the correlation coefficient between real stature and metatarsal length was statistically significant (p < 0.001). Additionally, both sexes showed a correlation between stature and metatarsal bone length. For unknown sex, M1 (first metatarsal maximal length) showed the strongest association between stature and metatarsal length. The following is the appropriate regression equation: 1172.4913 + 7.3275M1 (R = 0.703). The current equation demonstrated a statistically significant appropriateness for the Korean population when compared to equations for other populations (p < 0.001). In conclusion, we proposed a Korean-specific regression equation for estimating stature using metatarsal length, and this formula may be more appropriate and useful in forensic science for the Korean population.

Design of EM Sensor for Non-Contact Detection of Defective Wire Harness in Conveyor System.

For a non-contact detection of defective wire harness in conveyor system, a new method using the electromagnetic (EM) sensor is proposed in this paper. A dual-feed and multi array microstrip patch antenna operating at 5.8 GHz is utilized to design the EM sensor. When the wire harness is located above patch antenna, the equivalent circuit of each patch antenna and wire harness can be modeled as shunt resistor, capacitor, and inductor. Moreover, a capacitive coupling between the patch antenna and the wire harness is generated. Next, the shunt resistor of wire harness increases due to the defect of the wire so that the reflection coefficient of the patch antenna is lower than that of the wire without defect; thus, the defect of wire harness can be detected by magnitude of reflection coefficient at resonant frequency. The performances of the designed EM sensor are verified and compared by the equivalent circuit modeling, full-wave simulation, and measurement.

Energetic Contributions Including Gender Differences and Metabolic Flexibility in the General Population and Athletes.

Metabolic flexibility includes the ability to perform fat and carbohydrate oxidation, as well as oxidative capacity, which is associated with mitochondrial function, energetic contributions, and physical health and performance. During a session of graded incremental exercise testing (GIET), we investigated metabolic flexibility, the contributions of three energy systems, and performances of individuals with different metabolic characteristics. Fifteen general population (GP; n = 15, male n = 7, female n = 8) and 15 national-level half-marathon and triathlon athletes (A; n = 15, male n = 7, female n = 8) participated in this study. During GIET, heart rate (HR), oxygen uptake (V˙O2mean and V˙CO2mean), metabolic equivalents (METs) in V˙O2mean, and blood glucose and lactate concentrations (La-) were measured. Furthermore, jogging/running speeds (S) at specific La-, fat and carbohydrate oxidations (FATox and CHOox), and energetic contributions (oxidative; WOxi, glycolytic; WGly, and phosphagen; WPCr) were calculated. The percentages of HRmax, relative V˙O2mean, V˙CO2mean, and METs in V˙O2mean were all lower in A than they were in GP. FATox values were lower in GP than in A, while CHOox and La- were higher in GP than in A. Negative correlations between La- and FATox were also observed in both groups. Contributions of WOxi, WGly, and WPCr were higher in GP than in A during GIET. Moreover, values of WGly, and WPCr were significantly lower and higher, respectively, in male GP than in female GP. Furthermore, S at specific La- were higher in A than in GP. It is suggested that an individualized low-intensity recovery exercise program be established, to achieve increased metabolic flexibility and oxidative capacity (aerobic base), such as public health improvements and a greater volume of higher exercise intensities; this is the type of exercise that elite athletes worldwide mostly perform during their training period and progression. This may prevent cardiac/metabolic diseases in GP.

Design of an Intermediate Die for the Multi-Pass Shape Drawing Process.

The multi-pass shape drawing process is mainly used in metal forming processes to manufacture long components with constant arbitrary cross-sectional shapes along their lengths. The cross-roller guide is a typical component that is manufactured by a multi-pass shape drawing process. The cross-roller guide is mostly used in optical measurement equipment where high-precision movement is required. Therefore, the dimensional accuracy of the cross-roller guide is very important since it can influence precision linear motion. However, the unfilled defects can occur in a case where the product has a complex cross-sectional shape. In this study, a new design method for an intermediate die is suggested by using an equal-radial-velocity variation method in order to reduce the unfilled defects. The proposed design method can reduce the unfilled defects by minimizing the radial velocity variation in the deformation zone of the drawing die. The intermediate die was designed by geometrical information of the final product without prior finite element (FE) analysis. The suggested method was applied to design the multi-pass shape drawing process for manufacturing the cross-roller guide. FE analysis was performed to validate the effectiveness of the proposed method in comparison to the conventional design method that uses equipotential lines in the multi-pass shape drawing process. Finally, a shape drawing experiment was performed to compare the target shape and the FE analysis with the experimental data.

Anatomical Characteristics of Extensor Hallucis Longus Tendon Variations and Its Clinical Implications: A Korean Cadaveric Study.

The purpose of this study is to ascertain the morphological characteristics of the extensor hallucis longus (EHL) tendon variation using larger-scale dissection of Korean cadavers and to classify the types of variation along with incidence. A total of 158 feet from adult formalin-fixed cadavers (50 males, 29 females) were dissected. The morphological characteristics and measurements of the EHL tendon variants were evaluated. Three types of the EHL tendon variation were classified, wherein the most common type was Type 2 (106 feet, 67.1%), Type 3 (3 feet, 1.9%) was the rarest type, and Type 1 without accessory tendon was found in 49 feet (31.0%). Type 2K (11 feet, 7%) and Type 3K (1 foot, 0.6%) were described as new subtypes. The present study suggests morphological characteristics of the EHL tendon variation in Korean populations and high morphological variability of the EHL tendon along with the possibility of differences according to race or ethnicity and gender. Furthermore, a newly updated classification complemented by new subtypes of variation will help foot and ankle surgeons in diagnosis and surgical planning with hallux problems.

Anatomical Classification for Plantaris Tendon Insertion and Its Clinical Implications: A Cadaveric Study.

The purposes of this study were to ascertain the morphological characteristics of a plantaris tendon (PT) insertion using a larger-scale dissection of Korean cadavers and to classify the types of PT insertion related to the calcaneal tendon (CT). A total of 108 feet from adult formalin-fixed cadavers (34 males, 20 females) were dissected. The morphological characteristics and measurements of the PT insertion were evaluated. Five types of PT insertion were classified, wherein the most common type was Type 1 (39 feet, 63.1%). Type 2 and Type 3 were similar, with 16 feet (14.8%) and 15 feet (13.9%), respectively. Type 4 (6 feet, 5.6%) was the rarest type, and Type 5 had 25 feet (23.1%). The case of an absent PT was noted in 7 feet (6.5%). In the proximal portion, the tendon had a thick and narrow shape, became thin and wide in the middle portion, and then changed to thick and narrow again just before the insertion into the calcaneal tuberosity. This study confirmed the five types according to the location of the PT and the area of its insertion-related CT. The morphology of the PT insertion may be anatomically likely to influence the occurrence of tendinopathy in the CT.

Real-World Analysis of Rapid-Acting Insulin Analog Use and Its Blood Glucose Lowering Effect in Patients with Type 2 Diabetes Mellitus: Results from PASSION Disease Registry in Korea.

Purpose: Although rapid-acting insulins (RAIs) are used frequently in Korean clinical settings, evidence on their use is limited. This study explores the pattern and clinical effectiveness of the use of RAIs in Korean patients with type 2 diabetes mellitus (T2DM). Patients and Methods: This non-interventional, observational study enrolled patients (aged >18 years) with T2DM who were prescribed RAIs. The pattern of use and effectiveness of RAI analogs were evaluated over 6 months. Results: A total of 299/451 patients were analyzed. Approximately 90% (n/N=270/299) of the patients received insulin glulisine, which significantly reduced their levels of glycated hemoglobin (HbA1c: n=270, mean± standard deviation [SD]; -1.16±6.02%, p=0.0017), fasting plasma glucose (n=40; mean±SD: -54.9±90.89 mg/dl, p=0.0005), and post prandial blood glucose (n=35, mean±SD: -89.46± 105.68 mg/dl, p<0.0001) at 6 months, with a corresponding increase in body weight (BW) (n=197, mean±SD:1.45±3.64 kg, p<0.0001). At 6 months, more patients receiving an intensive regimen (basal insulin+≥2 RAI injections/day) had HbA1c <7% than those receiving a non-intensive regimen (basal insulin+1 RAI injection/day) (20.69% vs 7.46%; p=0.0333); the corresponding reduction in HbA1c was also higher in patients receiving the intensive regimen (p<0.0001). About one-fourth patients (n/N=22/95) were switched to the intensive regimen (from 1 to ≥2 RAI injections/day), and only 4.41% (n/N=9/204) of the patients were switched to 1 RAI injection/day. The patients receiving the intensive regimen showed higher levels of HbA1c reductions (mean±SD: -1.27±1.96%) compared with the maintenance group-1 RAI injection/day (mean±SD: -0.72±1.66%) (p=0.0459), without a significant increase in BW and body mass index. Conclusion: The insulin glulisine intensification regimen showed glycemic target achievement and can be considered a therapeutic tool in the management of T2DM patients.

A double-blind, Randomized controlled trial on glucose-lowering EFfects and safety of adding 0.25 or 0.5 mg lobeglitazone in type 2 diabetes patients with INadequate control on metformin and dipeptidyl peptidase-4 inhibitor therapy: REFIND study.

AIMS: To compare the efficacy and safety of adding low-dose lobeglitazone (0.25 mg/day) or standard-dose lobeglitazone (0.5 mg/day) to patients with type 2 diabetes mellitus (T2DM) with inadequate glucose control on metformin and dipeptidyl peptidase (DPP4) inhibitor therapy. MATERIALS AND METHODS: In this phase 4, multicentre, double-blind, randomized controlled, non-inferiority trial, patients with T2DM insufficiently controlled by metformin and DPP4 inhibitor combination therapy were randomized to receive either low-dose or standard-dose lobeglitazone. The primary endpoint was non-inferiority of low-dose lobeglitazone in terms of glycaemic control, expressed as the difference in mean glycated haemoglobin levels at week 24 relative to baseline values and compared with standard-dose lobeglitazone, using 0.5% non-inferiority margin. RESULTS: At week 24, the mean glycated haemoglobin levels were 6.87 ± 0.54% and 6.68 ± 0.46% in low-dose and standard-dose lobeglitazone groups, respectively (p = .031). The between-group difference was 0.18% (95% confidence interval 0.017-0.345), showing non-inferiority of the low-dose lobeglitazone. Mean body weight changes were significantly greater in the standard-dose group (1.36 ± 2.23 kg) than in the low-dose group (0.50 ± 1.85 kg) at week 24. The changes in HOMA-IR, lipid profile and liver enzyme levels showed no significant difference between the groups. Overall treatment-emergent adverse events (including weight gain, oedema and hypoglycaemia) occurred more frequently in the standard-dose group. CONCLUSIONS: Adding low-dose lobeglitazone to metformin and DPP4 inhibitor combination resulted in a non-inferior glucose-lowering outcome and fewer adverse events compared with standard-dose lobeglitazone. Therefore, low-dose lobeglitazone might be one option for individualized strategy in patients with T2DM.

Physiological Profiling and Energy System Contributions During Simulated Epée Matches in Elite Fencers.

PURPOSE: The aim of this study was to investigate physiological responses and energetic contributions during simulated epée matches in elite fencers. METHODS: Ten elite male fencers participated in simulated epée (direct elimination) matches. Simulated epée matches included 3 bouts of 3 minutes each with 1-minute rests between bouts. During these sessions, physiological variables such as mean and peak heart rate, peak and mean oxygen uptake (VO2peak and VO2mean), metabolic equivalents of task in VO2peak and VO2mean, and blood lactate concentrations (peak lactate concentration and delta blood lactate concentration) were measured. Furthermore, energetic contributions (oxidative [WOxi], glycolytic, and phosphagen) and time-motion variables were estimated. RESULTS: Values of peak heart rate, mean heart rate, and WOxi (in percentages) were significantly higher in the second and third bouts compared with the first. VO2peak and metabolic equivalents of task in VO2peak were significantly higher in the first bout compared with the third bout. Values of delta blood lactate concentration and glycolytic contribution (in kilojoules and percentages) were significantly lower in the second and third bouts compared with the first. VO2mean and metabolic equivalents of task in VO2mean were significantly higher in the second bout compared with the third bout. Furthermore, WOxi (in kilojoules and percentage) was significantly higher in all bouts compared with phosphagen and glycolytic contributions. Low positive and negative correlations were seen between WOxi, VO2mean, sum of attacks and defense times, and the sum of time without attacks and defenses. CONCLUSIONS: Direct-elimination epée matches consist of high-intensity intermittent exercise, and the oxidative contribution is 80% to 90%. Improving aerobic conditioning may support high-intensity intermittent actions during entire epée matches in elite fencers.

Korean-english Bilingual Children's Stress Cue Sensitivity and its Relationship with Reading in English.

Lexical stress plays a critical role in multisyllabic word reading in English. However, assignment of English lexical stress, which is neither fixed nor marked in writing, can pose significant challenges for English learners and has not been well-understood. The present study aims to fill the research gap by studying sensitivity to lexical stress cues and its contribution to their word reading performance among young English-language learners whose first language is Korean. The fundamental differences in prosodic systems between Korean and English provide theoretical significance of studying how bilingual children having no lexical stress in their first language process English lexical stress. This study focuses on two major cues to English lexical stress: morphological and orthographic cues. Findings revealed that the participants are sensitive to the two stress cues, with better performance with orthographic cues to stress assignment. However, no statistically significant correlations were found among variables on stress cue sensitivity with those on reading.

A clinical study of 288 patients with anterior cerebral artery infarction.

OBJECTIVE: Acute ischemic stroke in the territory of anterior cerebral artery (ACA) is uncommon. Therefore, large population studies evaluating ACA infarction are scarce. We sought to evaluate epidemiological and etiological characteristics of ACA infarction compared to other territorial infarctions. METHODS: We analyzed a prospectively collected stroke registry of all acute ischemic stroke patients for 19 years at two tertiary hospitals. We included patients with acute ischemic stroke caused by large vessel stenosis or occlusion including ACA, middle cerebral artery (MCA), posterior cerebral artery (PCA), and vertebrobasilar artery (VBA). RESULTS: A total of 4171 patients were enrolled. Patients with ACA infarction (N = 288) were significantly older with more females than those with MCA, PCA, or VBA infarction. There were more patients with history of prior ischemic stroke in the ACA infarction group than in other groups. The etiology of the ACA infarction was similar to those of the MCA, PCA and also the total population (66.7-71.8% of LAA and 17.9-20.9% of CE). When patients had prior ischemic stroke history, ACA infarction was more likely to be caused by LAA than MCA or PCA infarction (OR = 6.2, 95% CI 2.0-19.2, p = 0.002 and OR = 4.0, 95% CI 1.1-14.6, p = 0.038, respectively). CONCLUSIONS: Patients with ACA infarction had significantly more prior ischemic stroke than those with MCA, PCA, or VBA infarction. The etiology of ACA infarction in patients with prior ischemic stroke showed significantly more LAA than that of MCA or PCA infarction.

Exploring Risk and Protective Factors for Cyberbullying and Their Interplay: Evidence from a Sample of South Korean College Students.

This study explored risk and protective factors for cyberbullying perpetration and examined whether they independently and interactively predicted cyberbullying perpetration. Based on key propositions of micro-level theories of crime and delinquency, we adopted two risk factors, cyberbullying victimization and association with cyberbullying peers, and two protective factors, morality and self-control. Using a sample of South Korean college students (N = 244; 112 women (45.9%), 132 men (54.1%); Mean (age) = 22), we found that the two risk factors were positively associated with cyberbullying perpetration, while only one of the two protective factors, which is morality, had a negative relationship with cyberbullying perpetration. In addition, the two protective factors partially buffered the effects of both risk factors on cyberbullying perpetration. The implications and limitations of these findings were also discussed.

Pleiotropic Benefits of DPP-4 Inhibitors Beyond Glycemic Control.

Dipeptidyl peptidase (DPP)-4 inhibitors are oral anti-diabetic medications that block the activity of the ubiquitous enzyme DPP-4. Inhibition of this enzyme increases the level of circulating active glucagon-like peptide (GLP)-1 secreted from L-cells in the small intestine. GLP-1 increases the glucose level, dependent on insulin secretion from pancreatic ß-cells; it also decreases the abnormally increased level of glucagon, eventually decreasing the blood glucose level in patients with type 2 diabetes. DPP-4 is involved in many physiological processes other than the degradation of GLP-1. Therefore, the inhibition of DPP-4 may have numerous effects beyond glucose control. In this article, we review the pleiotropic effects of DPP-4 inhibitors beyond glucose control, including their strong beneficial effects on the stress induced accelerated senescence of vascular cells, and the possible clinical implications of these effects.

Adult Stature Estimation from Radiographic Metatarsal Length in a Contemporary Korean Population.

The ability to estimate stature can be important in the identification of skeletal remains. This study aims to develop a Korean-specific equation predicting stature using radiographic measurements in the contemporary Korean population. 200 healthy Korean adults, including 102 males and 98 females, were randomly selected (age, range 20-86 years). The first and second metatarsals of the foot were measured by a standing X-ray using a digital medical image viewer. The result showed a statistically significant correlation between metatarsal length and stature in Korean populations (male, R = 0.46, p < 0.001; female, R = 0.454, p < 0.001). Values of correlation coefficients (R) of the equations were 0.431 to 0.477. Compared to equations derived from other races, the Korean-specific equation showed significantly lower error values for estimating the actual height of Koreans through cross-validation. In conclusion, this study is the first to propose a Korean-specific regression formula for estimating stature using metatarsal length and a verified formula for precise application to the Korean population. However, given the relatively low correlation coefficient, the stature estimation formula derived from this study can be utilized when other bones that allow more accurate stature estimation are not available.

A New Anatomical Classification for Tibialis Posterior Tendon Insertion and Its Clinical Implications: A Cadaveric Study.

The variations in the tibialis posterior tendon (TPT) could not be defined by previous classification; thus, this study used a larger-scale cadaver with the aim to classify the types of TPT insertion based on the combination of the number and location of TPT insertions. A total of 118 feet from adult formalin-fixed cadavers were dissected (68 males, 50 females). The morphological characteristics and measurements of TPT insertion were evaluated. Four types of TPT insertions were classified, wherein the most common type was type 4 (quadruple insertions, 78 feet, 66.1%), which was divided into four new subtypes that were not defined in the previous classification. The second most common type was type 3 (triple insertions, 25 feet, 21.2%) with three subtypes, including the new subtype. Type 2 was found in 13 feet (11%), and the rarest type was type 1 (2 feet, 1.7%), wherein the main tendon was only attached to the navicular bone and the medial cuneiform bone. We suggest high morphological variability of the TPT in relation to the insertion location, along with the possibility of significant differences according to race and gender. Moreover, this classification will help clinicians understand adult flatfoot deformity-related posterior tibial tendon dysfunction (PTTD).