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OBJECTIVE: This study evaluates the amplitude of the anatomical-mechanical angle (AMA-angle) using 4 measuring methods of the tibial distal anatomical axes (DAA) previously described, comparing the literature results to determine if there are significant differences in patients with cranial cruciate ligament (CrCL) rupture. ANIMALS: This study was comprised of 30 tibiae (29 dogs), including 1 bilateral case. METHODS: A retrospective study was selected for this research. DAA measurements were performed on all surgically confirmed cases of canine CrCL rupture at Hospital Veterinário de Especialidades Bruselas from 2019 to 2022. Four different published methods (identified by surname of the corresponding author of the original publication) were compared. Tibial measurements were made using Veterinary Preoperative Orthopedic Planning Pro software (https://vpoppro. com/) on mediolateral radiographic projections obtained from a digital database. RESULTS: The mean (range) in the DAA method conducted by Hulse obtained a AMA-angle of 5.4° (3.3 to 8.1°), 3.0° (0 to 5.8°) for Osmond et al, 3.2° (0.9 to 6°) for Miles, and 5.9° (2.4 to 8.8°) for Tudury. Differences among the means of the AMA-angle of the authors methods were found with a statistical difference (P < .05), except between Osmond and Miles. The mean AMA-angle with the Osmond method concurred with previous study results that determined the magnitude using the same measurement method of DAA in patients with CrCL rupture. CLINICAL RELEVANCE: The AMA-angle magnitude has been associated with higher sensitivity and specificity for predicting the development of CrCL rupture compared to other anatomical factors evaluated; therefore, future comparisons with different methods of measurement of the DAA between healthy and affected patients are recommended to determine whether any of them can increase the percentage value as a predictive factor for the occurrence of this condition. [ABSTRACT FROM AUTHOR]

Background: Adjustable shunt valves that have been developed for managing hydrocephalus rely on intrinsically magnetic components; thus, artifacts with these valves on magnetic resonance imaging (MRI) are inevitable. No studies on valve-induced artifacts in lumboperitoneal shunt (LPS) surgery have been published. Therefore, this study aimed to evaluate valve-induced artifacts in LPS. Methods: We retrospectively reviewed all MRIs obtained between January 2023 and June 2023 in patients with an implanted Codman CERTAS Plus adjustable shunt valve (Integra Life Sciences, Princeton, New Jersey, USA). The valve was placed < 1 cm subcutaneously on the paravertebral spinal muscle of the back, with its long axis perpendicular to the body axis. The scans were performed using a Toshiba Medical Systems 1.5 Tesla scanner. The in-plane artifact sizes were assessed as the maximum distance of the artifact from the expected region of the back. Results: All spinal structures or spinal cords can be recognized, even with valve-induced artifacts. The median maximum valve-induced artifact distance on T1-weighted axial imaging was 25.63 mm (mean, 25.98 mm; range, 22.24-30.94 mm). The median maximum valve-induced artifact distance on T2-weighted axial imaging was 25.56 mm (mean, 26.27 mm; range, 21.83-29.53 mm). Conclusion: LPS surgery with adjustable valve implantation on paravertebral muscles did not cause valve-induced artifacts in the spine and spinal cord. We considered that LPS could simplify the postoperative care of these patients. [ABSTRACT FROM AUTHOR]

Purpose: No study has investigated intermammillary relationships using neuroimaging modalities. This study aimed to explore them using magnetic resonance imaging (MRI). Materials and methods: We enrolled 72 patients who underwent conventional MRI examinations, followed by constructive interference steady-state sequence in the coronal plane. The intermammillary distances (IMDs) were measured at the uppermost level of the intermammillary gap (IMDupp) and the lowest level (IMDlow) of the mammillary bodies (MBs). Results: MBs with varying morphologies were consistently delineated. The appearance of both MBs could be classified into four patterns based on the size and relative levels, with the symmetrical type being the most common. Intermammillary relationships exhibited five patterns. In 69%, the IMDupp was discernible and measured 0.7 ± 0.4 mm, while it was not discernible in 31% due to the presence of intermammillary connection and adhesion. The age distribution did not differ between populations with and without discernible IMDupp. The IMDlow was measured 4.4 ± 0.9 mm. Although the IMDlow was not significantly different between both sexes; it was longer in subjects in their 70s. Conclusions: Intermammillary relationships show variable morphologies with gaps formed between both MBs. The IMDlow may become more evident in association with age-related increase in the width of the third ventricle and atrophy of the MBs. [ABSTRACT FROM AUTHOR]

This comprehensive review explores the mechanical and anatomical axis approaches in total knee replacement (TKR) surgery, addressing the ongoing debate within the orthopedic community. Emphasizing the significance of TKR in alleviating knee-related disorders, this review underscores the pivotal role of accurate alignment in achieving optimal surgical outcomes. The purpose is to navigate the divide between the well-established mechanical axis approach, focusing on a straight-line alignment, and the anatomical axis approach, aligning with natural knee landmarks. The analysis delves into the advantages, disadvantages, and clinical implications of each approach, offering a nuanced perspective on their efficacy. The conclusion emphasizes a patient-centric approach, recommending the adoption of hybrid strategies and the incorporation of emerging technologies for enhanced precision. The future of TKR aligns with personalized medicine, leveraging advancements in computer-assisted navigation, robotics, and patient-specific implants. Ongoing professional development and interdisciplinary collaboration are crucial for surgeons, and as the field evolves, innovations in artificial intelligence, imaging, and 3D printing are expected to shape the trajectory of TKR alignment approaches., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Suneja et al.)

Abstract Background The anatomical axis of the femur is crucial for determining the correct alignment in corrective osteotomies of the knee, total knee arthroplasty (TKA), and retrograde and antegrade femoral intramedullary nailing (IMN). The aim of this study was to propose the concept of different anatomical axes for the proximal and distal parts of the femur; compare these axes in normally aligned subjects and also to propose the clinical application of these axes. Methods In this cross-sectional study, the horizontal distances between the anatomical axis of the proximal and distal halves of the femur and the center of the intercondylar notch were measured in 100 normally aligned femurs using standard full length alignment view X-rays. Results The average age was 34.44 ± 11.14 years. The average distance from the proximal anatomical axis to the center of the intercondylar notch was 6.68 ± 5.23 mm. The proximal anatomical axis of femur passed lateral to the center of the intercondylar notch in 12 cases (12%), medial in 84 cases (84%) and exactly central in 4 cases (4%). The average distance from the distal anatomical axis to the center of the intercondylar notch was 3.63 ± 2.09 mm. The distal anatomical axis of the femur passed medially to the center of the intercondylar notch in 82 cases (82%) and exactly central in 18 cases (18%). There was a significant difference between the anatomical axis of the proximal and distal parts of the femur in reference to the center of intercondylar notch (P value

Purpose: Higher revision rates were shown in varus- or valgus-positioned tibias in unicompartmental knee arthroplasty (UKA), but more than 15% of UKA prostheses are implanted with more than 5° of varus or valgus. This study aimed to analyze the wear rate in UKA when implanting the tibial component in either varus or valgus position versus a neutral placement at 90° to the tibial anatomical axis. The study hypothesized that a 5° varus or valgus positioning of the tibial plateau will generate less wear compared to a neutral alignment.Methods: Wear was experimentally analyzed on a medial anatomical fixed-bearing unicompartmental knee prosthesis (Univation, Aesculap, Germany) in vitro with a customized, four-station, servohydraulic knee wear simulator, reproducing the walking cycle. The forces, loading and range of motion were applied as specified in the ISO 14243-1:2002, 5 million cycles were analyzed. The tibial components of the medial prostheses were inserted in a neutral position, with 5° varus, and 5° valgus (n = 3, each group).Results: The wear rate decreased significantly with a 5° varus positioning (6.30 ± 1.38 mg/million cycles) and a 5° valgus positioning (4.96 ± 2.47 mg/million cycles) compared to the neutral position (12.16 ± 1.26 mg/million cycles) (p < 0.01 for the varus and the valgus position). The wear area on the inlay was slightly reduced in the varus and valgus group.Conclusion: A varus or valgus "malpositioning" up to 5° will not lead to an increased wear. Wear was even less because of the reduced articulating contact area between the inlay and the femur. A slight varus positioning of the tibial component (parallel to the anatomical joint line) positioning can be advocated from a point of wear.Level Of Evidence: Experimental study. [ABSTRACT FROM AUTHOR]

Understanding the morphological features characterising a normal femoral head and acetabular cavity is critical for a more comprehensive and updated definition of hip anatomy. Based on anatomical observations, MacConaill introduced the notion that spheroidal articular surfaces are better represented by ovoidal shapes, in comparison with the still well-established spherical shape. This work tests MacConaill's classification by using a surface-fitting framework to assess the goodness-of-fit regarding the largest assortment of sphere-like shapes presented in a single study (i.e. a total of 10 different shapes: sphere, rotational conchoids, rotational ellipsoid, ellipsoid, superellipsoid, Barr's superellipsoid, tapered ellipsoid, Barr's tapered superellipsoid, ovoid, superovoid). Anatomical data of the femoral head and acetabular cavity were obtained from computed tomography scans of a gender-balanced, asymptomatic 15 population of 30 adult subjects. The framework involved image segmentation with active contour methods, mesh smoothing and decimation, and surface fitting to point clouds was performed with genetic algorithms. The statistical analysis of the surface-fitting errors revealed the superior approximation of non-spherical shapes: superovoids provided the best fit for each femoral head and acetabular cavity, whereas spheres presented the worst fitting values. We also addressed gender variability in bony 20 hip geometry as sphericity, ellipticity, conicity and squareness were measured. [ABSTRACT FROM AUTHOR]

Background: The glenoid version of the shoulder joint correlates with the stability of the glenohumeral joint and the clinical results of total shoulder arthroplasty. We sought to analyze and compare the glenoid version measured by traditional axial two-dimensional (2D) computed tomography (CT) and three-dimensional (3D) reconstructed images at different levels. Methods: A total of 30 cases, including 15 male and 15 female patients, who underwent 3D shoulder CT imaging was randomly selected and matched by sex consecutively at one hospital. The angular difference between the scapular body axis and 2D CT slice axis was measured. The glenoid version was assessed at three levels (midpoint, upper one-third, and center of the lower circle of the glenoid) using Friedman's method in the axial plane with 2D CT images and at the same level of three different transverse planes using a 3D reconstructed image. Results: The mean difference between the scapular body axis on the 3D reconstructed image and the 2D CT slice axis was 38.4°. At the level of the midpoint of the glenoid, the measurements were 1.7°±4.9° on the 2D CT images and -1.8°±4.1° in the 3D reconstructed image. At the level of the center of the lower circle, the measurements were 2.7°±5.2° on the 2D CT images and -0.5°±4.8° in the 3D reconstructed image. A statistically significant difference was found between the 2D CT and 3D reconstructed images at all three levels. Conclusions: The glenoid version is measured differently between axial 2D CT and 3D reconstructed images at three levels. Use of 3D reconstructed imaging can provide a more accurate glenoid version profile relative to 2D CT. The glenoid version is measured differently at different levels. [ABSTRACT FROM AUTHOR]

BACKGROUND: Total knee arthroplasty is often used to treat knee joint diseases. The intraoperative osteotomy mainly measures osteotomy and gap balance technology, which can ensure the stability of prosthesis implantation and improve the prognosis by reasonable osteotomy. OBJECTIVE: To statistically analyze the clinical efficacy of the osteotomy and gap balance technique in patients undergoing total knee arthroplasty. METHODS: Data of 76 cases of primary osteoarthritis from May 2015 to October 2016 were collected. The patients were divided into control and trial groups (n=38/group). The control group used the measurement osteotomy technique, and the trial group used the gap balance technique to compare the surgical indexes and prognostic effects at 1 year postoperatively. RESULTS AND CONCLUSION: The femoral distal osteotomy and thickness of polyethylene liner in the trial group were significantly higher than those in the control group at postoperative 3 days (P < 0.05). Compared with the control group, the knee joint stability and knee flexion 90° femoral angle were improved better in the trial group (P < 0.05). The excellent and good rate of the lower limb strength and the anatomical axis of the lower leg in the control and trial groups was 47% and 61%, respectively (P > 0.05). There was no case of loosening of the prosthesis in the two groups during the follow-up, and there were no significant differences in other complications (P > 0.05). After 1 year of follow-up, the Visual Analogue Scale and Western Ontario and McMaster Universities Osteoarthritis Index pain scores in the trial group were significantly decreased, and the Knee Society Score function was significantly improved (P < 0.05). These results imply that the gap balance technique used in total knee arthroplasty, can significantly improve the clinical symptoms and prognosis. [ABSTRACT FROM AUTHOR]

Purpose: For coronal alignment in total knee arthroplasty (TKA) most surgeons use the patient's individual hip-knee shaft (HKS) angle (angle between the anatomical axis and the mechanical axis of the femur). The major problem of the sole use of HKS angle is that the individual patient's distal femoral asymmetry is not considered. The purpose of this study was to determine the variability of the HKS angle, the mechanical femoral angle (FMA) and to evaluate whether or not one of the two angles is more important for TKA alignment strategy. It was the hypothesis that HKS and FMA are not directly related to each other and hence HKS should not be considered as guide for coronal alignment.Methods: Prospectively collected CT data of 1480 consecutive patients who underwent 3D reconstructed CT scans before TKA was used for this retrospective registry study [882 women and 598 men, mean age ± standard deviation 71 ± 9 years (34-99 years)]. The CT protocol was modified according to the Imperial Knee Protocol, which is a lowdose CT protocol that includes high-resolution 0.75-mm slices of the knee and 3-mm slices of the hip and ankle joints. All measurements were done using Symbios® 3D knee preoperative planning's software (Symbios, Yverdon les Bains, Switzerland). The HKS, FMA and hip-knee-ankle (HKA) angles were measured. Angles measured were displayed as mean, standard deviation (SD) and range. In addition, the angles were shown as percentages after categorization. The HKS was categorized between 3° and 9° in 1° increments. The FMA was categorized between 83.5° and 98.5° in 3° increments. The HKA was categorized between 12.5° varus 5.5° valgus in 3° increments. Pearson correlations were used to investigate correlation of HKS and FMA (p < 0.05).Results: The HKS angle was not constant at 7° but averaged 6°, and ranged from 2.5° to 9°. The FMA angle was on average 93° but varied more than 20°, ranging from 75° (varus) to 104° (valgus). The mean HKA ± SD was - 3.4° ± 5.7° (range - 23.0° to 15.0°). The mean HKSSD was 5.6° ± 0.9° (range 2.5°-8.8°). The mean FMASD was 92.6° ± 2.8° (range 75.2°-103.5°). The Pearson correlations of all measured angles are presented in Table 1. HKS significantly correlated negatively with HKA and FMA (p < 0.001). FMA and HKA were strongly correlated with each other (p < 0.0001). Considering the HKS angle as a constant angle can induce a deviation of up to 5° with respect to an orthogonal distal femoral cutting objective. The great variability of the FMA angle implies that the FMA seems more relevant than the HKS angle to define the strategy of realignment of the lower limb. However, then patient specific instrumentation has to be used to precisely transfer the planning to the surgical technique. Having the aim of a more personalized TKA alignment in mind the individual constitutional knee phenotype should be taken into account. [ABSTRACT FROM AUTHOR]

Digeneans use oral and ventral suckers for attachment, locomotion, and feeding. The structure of these organs is rarely described in detail. I used fluorescent actin staining and confocal laser scanning microscopy to describe musculature arrangement in the oral sucker of eight digenean species (all Plagiorchiida). Scanning electron microscopy and light microscopy of histological sections were used for a general morphological description of the sucker structure. The musculature of the oral sucker is independent from the body wall and the internal muscles. The arrangement of the muscles within the oral sucker is complex; it includes up to 14 groups. Layers of transverse and meridional muscle fibers line the outer surface beneath tunica propria. Transverse muscle bands, meridional fibers, anterolateral groups, and circular or semicircular fibers of the sphincter are present at the rim of the oral sucker. Circular and longitudinal muscle fibers are found beneath the tegument of the buccal cavity. The bulk of the sucker consists of radial muscle bundles, but it also contains chordal muscle bundles, diagonal fibers, and wide lateral muscle bands. Based on the results, I propose that three features determine the complexity of musculature arrangement in the oral sucker: (1) bilateral symmetry of the sucker, (2) incongruity of the main body axis and the own axis of the sucker, and (3) regionalization of the sucker surface. The origin and functioning of the oral sucker are discussed. [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract An organizer is defined as a group of cells that secrete specific factors and can change the fate of adjacent cells and instruct a specific pattern. Spemann and Mangold were the first to use the term, when in 1938 they discovered that the dorsal blastopore lip of a salamander embryo induced a secondary axis after transplantation. Since then, several such regions have been identified in the embryos of many animal species. However, little is known about the presence of organizers at the adult stage, although some organizing activity must be required during regenerative processes to pattern the new tissue. In this study we review the current knowledge on planarians, flatworms that can regenerate any lost body parts, including their heads, within a few days. We will summarize the current data that made it possible to identify planarian anterior and posterior tips as regenerative organizers. We will present the current knowledge about the molecular networks that define each organizer, and we will discuss the presence of organizers in planarians during normal homeostasis. We will propose some unanswered questions concerning both planarian regeneration and regenerative medicine, and examine future research prospects in this field. [ABSTRACT FROM AUTHOR]

Abstract Biologists have long marveled at the ability of planarian flatworms to regenerate any parts of their bodies in just a little over a week. While great progress has been made in deciphering the mechanisms by which new tissue is formed at sites of amputation, we know relatively little about the complementary remodeling response that occurs in uninjured tissues to restore anatomical scale and proportion. This review explores the mysterious biology of this process, first described in hydra by the father of experimental zoology, Abraham Trembley, and later termed 'morphallaxis' by the father of experimental genetics, Thomas Hunt Morgan. The perceptive work of these early pioneers, together with recent studies using modern tools, has revealed some of the key features of regenerative tissue remodeling, including repatterning of the body axes, reproportioning of organs like the brain and gut, and a major increase in the rate of cell death. Yet a mechanistic solution to this longstanding problem in the field will require further study by the next generation of planarian researchers. [ABSTRACT FROM AUTHOR]

Purpose: During total knee arthroplasty, few rotating reference axes can be reliably used after tibial resection. We speculated that a line that passes through the lateral edge of the posterior cruciate ligament (PCL) at its tibial attachment after resection and the most prominent point of the tibial tubercle [after-tibial resection (ATR) line] will provide a good reference axis. In this study, we aimed to evaluate the association between ATR and Akagi’s lines. Materials and methods: In this case–control simulation study, we retrospectively evaluated 38 patients with varus knee and 28 patients with valgus knee. We defined the reference cutting plane as 10 mm distal from the lateral articular surface of the tibia in varus group and as 7 mm distal from the medial articular surface in the valgus group. We measured angles between Akagi’s line and the ATR line (ATR line angle) as well as between Akagi’s line and 1/3 Akagi’s line (1/3 Akagi’s line angle), which passes through the midpoint of PCL and the medial third of the patellar tendon. We used paired t-tests to determine the significance of differences between these angles, with p < 0.05 indicating statistical significance. Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi’s line angle and ATR line angle were analyzed by two surgeons. Results: We found that 1/3 Akagi’s line angle was 10.2° ± 1.3° in the varus group and 10.9° ± 1.3° in the valgus group (p = 0.017). The ATR line was positioned externally compared with Akagi’s line in all patients. Mean ATR line angles at 0°, 3° and 7° posterior slopes were 6.1° ± 1.9°, 5.8° ± 2.0° and 6.0° ± 1.7° in the varus group and 6.3° ± 2.3°, 6.2° ± 2.3° and 5.4° ± 2.1° in the valgus group, respectively. There were no significant differences in the ATR line angle between the varus and valgus groups. (p = 0.34–0.67) Intra- and interclass correlation coefficients for the reproducibility of 1/3 Akagi’s line angle were 0.936 and 0.986 and those for the reproducibility of ATR line angle were 0.811 and 0.839. Conclusions: The ATR line was positioned between Akagi’s line and 1/3 Akagi’s line in all patients and was a valid option for evaluating rotational tibial alignment after tibial resection. [ABSTRACT FROM AUTHOR]

Highlights • Anatomical features may define positive strategies for water acquisition and storage. • The degree of methyl-esterification of pectins in bromeliad leaves, at different positions along the rosette, can maximize water storage. • The water storage tissue has higher plasticity index than other leaf tissues at different positions along the rosette. • Cell elongation and elasticity depend on the maintenance of HGAs with high methyl-esterified in water storage tissue. Abstract In tank-dependent bromeliads, leaves may exhibit anatomical and functional differences along the apical and basal regions, or according to the different positions in the rosette. Thus, the apical region of the leaf may invest in photosynthetic tissues, while the basal one invests in structures for water and nutrient storage. We suppose here, that differences among the tissue functions are strongly related to anatomical traits, especially the degree of methyl-esterification of pectins in the cell walls, at different positions along the rosette. Thus, the aims of this study were to quantify anatomical variations and describe the pectin composition of the cell wall, along the Aechmea distichantha Lem. rosette, to assess how the different tissues varied. We found that the water storage tissue showed higher variation between the apex and the base of the leaves than the other tissues, with higher expansion between the fourth leaf in development and the outer leaf in the rosette. Moreover, its cells were intensely labeled for epitopes of high methyl-esterified HGs, recognize by JIM7 antibody. The presence of pectin with high methyl-esterified groups in water storage tissue provides greater cell wall elasticity. The chlorenchyma showed the lowest Relative Distance Plasticity Index values, and its development in A. distichantha seems to occur early, in a very young leaf and inside the rosette tank. [ABSTRACT FROM AUTHOR]

Objective: Fetoscopy for closure of open neural tube defects (NTD) remains controversial, as the use of patches or single-layer closure is not considered to meet the standards of good neurosurgical reconstruction. In this study, we describe a fetoscopic two-layer (myofascial and skin) closure technique for the treatment of NTD in five patients and report the preliminary anatomical outcome at birth.Methods: From February to September 2017, five pregnant women with a fetus with a NTD, including three cases of myelomeningocele and two cases of myelocele, were operated on using a fetoscopic two-layer closure technique. In this technique, with the uterus exteriorized and using three 10-Fr ports, the placode is dissected from the surrounding tissue and detethered, removing the cystic tissue. The skin is undermined by blunt dissection and the defect is sutured to the midline in two layers (myofascial and skin) using a running 4/0 resorbable barbed suture.Results: Median gestational age at the procedure was 24 + 3 (range, 23 + 5 to 27 + 3) weeks. Surgery was successful in all cases, without any intraoperative complications. Median time in surgery was 180 (range, 140-180) min and median time for fetoscopy was 105 (range, 65-120) min. In terms of obstetric complications, three cases of premature rupture of membranes and one case of chorioamnionitis were recorded. Median gestational age at delivery was 34 + 1 (range, 25 + 4 to 37 + 2) weeks and two patients delivered vaginally. The closed defect was watertight with good quality tissue in all cases.Conclusion: Fetoscopic two-layer closure of NTD may improve the quality of the tissue covering the defect, diminishing the need for postnatal surgical revision, and preserving the well-documented beneficial effects of prenatal closure on the neural tissue and hindbrain herniation. However, this technique may not be appropriate for those cases with wide diastasis of the myofascial layer or with a low quantity of available tissue. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The vertebrate body forms by continuous generation of new tissue from progenitors at the posterior end of the embryo. The study of these axial progenitors has proved challenging in vivo largely due to the lack of unique molecular markers to identify them. Here, we elucidate the expression pattern of the transcription factor Nkx1-2 in the mouse embryo and show that it identifies axial progenitors throughout body axis elongation, including neuromesodermal progenitors and early neural and mesodermal progenitors. We create a tamoxifen-inducible Nkx1-2CreERT2 transgenic mouse and exploit the conditional nature of this line to uncover the lineage contributions of Nkx1-2-expressing cells at specific stages. We show that early Nkx1-2- expressing epiblast cells contribute to all three germ layers, mostly neuroectoderm and mesoderm, excluding notochord. Our data are consistent with the presence of some selfrenewing axial progenitors that continue to generate neural and mesoderm tissues from the tail bud. This study identifies Nkx1-2-expressing cells as the source of most trunk and tail tissues in the mouse and provides a useful tool to genetically label and manipulate axial progenitors in vivo. [ABSTRACT FROM AUTHOR]

Purpose and Hypothesis: Patient-specific instrumentation (PSI) uses 3D preoperative imaging to produce individualized cutting blocks specific to patients' anatomy and according to the preoperative plan with the aim to reduce the number of mechanical leg alignment (MLA) outliers, to improve implant positioning and to decrease surgery time. The primary purpose of this study was to investigate the efficacy of a specific PSI in comparison with standard instrumentation (SI) in reducing the number of MLA outliers. It was hypothesized that the number of MLA outliers would be significantly lower in the PSI group.Methods: A multicenter randomized controlled trial was implemented. There were 59 patients in the PSI group and 66 in the SI group. The absolute number of outliers outside the ± 3° target neutral MLA was compared between the groups with a Chi-square test. As secondary outcomes, the Knee Society Score (KSS) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were compared between the groups preoperatively and at 90-day follow-up.Results: There were 15 (26.3%) MLA outliers in the PSI group and 8 (12.3%) in the SI group. The number of outliers was not independent from the group ( X2 (1) = 3.8, p = 0.04; Relative risk = 1.5). Preoperatively, there were no significant differences between the groups when comparing their KSS and KOOS sub-scores. At 90 days postoperatively, the patients in the SI group showed better KOOS-Quality of Life (KOSS-QOL) in comparison with the PSI group (p < 0.0001).Conclusion: The use of PSI did not significantly reduce the number of MLA outliers in comparison with SI. There were no differences when comparing the achieved mean MLA of both groups.Level Of Evidence: Level I, prospective randomized controlled trial. [ABSTRACT FROM AUTHOR]

Purpose: The orientation and distance from the shaft of the femur and tibia to the articular surface centre is important for performing total knee arthroplasty (TKA) with cementless stems. It is important to understand anatomic differences between races to match the tibial and femoral shaft axis to the knee articular surface. Thus, the purpose of this study was to compare knee morphology between Caucasian and East Asian individuals to determine the optimal placement of tibial and femoral stems.Methods: A retrospective study was conducted on a matched cohort of 50 East Asians (21F, 29M) and 50 Caucasians (21F, 29M) by age and gender. CT scans were obtained in healthy volunteers using < 2-mm slices. The distance from the proximal tibial diaphysis axis to the tibial plateau centre and the distance from the distal femoral diaphysis axis to the centre of distal femoral articular surface were measured separately. Tibial measurements were taken using Akagi's anteroposterior (AP) axis and the widest mediolateral (ML) diameter, and femoral measurements were based on Whiteside's line and the surgical epicondylar axis.Results: The ML distance between the tibial shaft centre and Akagi's line was significantly higher for Asians (9.9 ± 2.7 mm, Caucasians 7.7 ± 3.1 mm, p < 0.001). The distance between the femoral shaft centre and Whiteside's line was lower, although not significantly different (Asians 1.9 ± 1.0 mm, Caucasians 2.2 ± 1.1 mm, n.s.). However, there were no differences in the AP dimension for the femur or tibia comparing Asians to Caucasians in both tibial side (Asians 10.6 ± 3.3 mm vs. Caucasians 10.9 ± 4.0 mm) and femoral side (Asians 18.1 ± 1.7 mm vs. Caucasians 17.5 ± 1.6 mm).Conclusion: East Asian individuals have more offset in the ML dimension for the tibia. This finding is clinical relevant, as this dimensional difference should be taken into consideration when designing primary and revision TKA stemmed tibial implants for East Asian individuals.Level Of Evidence: Case-control study, Level III. [ABSTRACT FROM AUTHOR]

Purpose: High tibial osteotomy (HTO) has gained more importance in the treatment of cartilage damage or osteoarthritis of the medial compartment with concurrent varus deformity. Concerning the extent of axis correction, various different views exist. The aim of this study was to evaluate the effect of the size of axis correction on functional outcome in patients undergoing a valgus HTO.Methods: From 2005 to 2013, 156 patients with an underlying varus deformity and cartilage damages or unicompartimental osteoarthritis of the medial compartment were treated by HTO. Retrospectively patients were allocated into three different groups according to the degree of axis correction. For this purpose, three adjacent areas, respectively, comprising 5% of the tibial plateau were defined. Limits of those areas were set as follows: with the medial border representing the 0% point and the lateral border representing the 100 point, the three areas were separated according to their limiting intersection points (group A 50-55%, group B 55-60%, group C > 60%). For comparison of the functional outcomes, standardized measures and scores were used (pre-OP: VAS, Lysholm; post-OP: VAS, Lysholm, KOOS). Analysis of the pre- and post-operatively recorded X-rays was effected by means of a planning software (mediCAD, Hectec GmbH, Germany), and statistical analysis was carried out using SPSS Statistics 21.0 (IBM Corp., Armonk, USA). A p value of 0.05 was considered statistically significant.Results: Thirty-nine patients were allocated to group A, 50 patients to group B and 67 to group C. Pre-operatively, patients in each group were of a homogenous constitution. In the groups A-C, HTO proved to reduce the VAS score and to increase the Lysholm score (p < 0.001). Regarding outcome parameters, group A showed significantly better results in terms of increased Lysholm (p = 0.049) and KOOS pain score (p = 0.043). In patients treated by HTO and ACI implantation for medial compartment lesions, the best results were achieved in group A which was of statistical significance in comparison of the Lysholm (p = 0.006) and VAS score (p = 0.045) of groups A and C. In this subgroup, the size of the post-operative valgus angle significantly correlated with the final VAS score (PC 0.364; p = 0.013), final Lysholm score (PC - 0.390; p = 0.007) and KOOS4 (PC - 0.356; p = 0.014).Conclusion: HTO for varus deformity in patients with concomitant cartilage damage or osteoarthritis of the medial compartment is a reliable treatment option with satisfying functional outcome. Precise pre-operative planning regarding individual factors in each patient is mandatory; a pathology-based extent of correction leads to a favourable clinical outcome and to a significant reduction in pain.Level Of Evidence: Retrospective cohort study, Level III. [ABSTRACT FROM AUTHOR]

Purpose: This study was set up to identify the native trochlear geometry and define its relationship with the rotational landmarks of the distal femur.Methods: The rotational landmarks of the distal femur were analysed on CT-scans of 281 patients with end-stage knee osteoarthritis.Results: The anterior trochlear line (ATL) was on average 4.3° (SD 3.3°) internally rotated relative to the surgical transepicondylar axis (sTEA). The ATL was on average 2.1° (SD 3.0°) internally rotated relative to the posterior condylar line (PCL). The relationship between the ATL and the sTEA was statistically different in the different coronal alignment groups (p = 0.004): 3.9° (SD 3.0°) in varus knees, 4.0° (SD 2.9°) in neutral knees and 5.4° (SD 3.8°) in valgus knees. The lateralisation of the trochlea, represented by the distance between the perpendicular to PCL and the perpendicular to the posterior parallel line to the sTEA, was on average 2.2 mm (SD 1.8 mm).Conclusion: The ATL was on average 4.3° (SD 3.3°) internally rotated relative to the sTEA and 2.1° (SD 3.0°) internally rotated relative to the PCL. The ATL is more externally orientated in varus knees and more internally rotated in valgus knees. The trochlear groove is lateralised by only 2.2 mm when the femoral component is externally rotated.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Purpose: Patient-specific instruments (PSIs) are already in relatively common use, and their post-operative radiographic results are equal to those for total knee arthroplasty (TKA) with conventional instrumentation. PSI use requires a preoperative MRI scan, CT scan, or a combination of MRI and a long-leg standing radiograph. However, there is no consensus as to which of these modalities, MRI or CT, is the preferred imaging modality when performing TKA with PSIs.Methods: This systematic literature review and meta-analysis studied the differences in alignment outliers between CT- and MRI-based PSI for TKA. A search of the Cochrane Database of Systematic Reviews, MEDLINE/PubMed and Embase was conducted, without restriction on date of publication. Only level I evidence studies written in English that included TKA with the use of MRI- and CT-based PSI were selected. A meta-analysis was then performed of the rate of outliers in the biomechanical axis and individual femoral and tibial component alignment. Where considerable heterogeneity among studies was present or the data did not provide sufficient information for performing the meta-analysis, a qualitative synthesis was undertaken.Results: Twelve randomized controlled trials, studying 841 knees, were eligible for data extraction and meta-analysis. MRI-based PSI resulted in a significantly lower proportion of coronal plane outliers with regard to the lateral femoral component (OR 0.52, 95% CI 0.30-0.89, P = 0.02), without significant heterogeneity (n.s.). There were no significant differences regarding the biomechanical axis or frontal femoral and individual tibial component alignment.Conclusion: This systematic review and meta-analysis demonstrate that alignment with MRI-based PSI is at least as good as, if not better than, that with CT-based PSI. To prevent for malalignment, MRI should be the imaging modality of choice when performing TKA surgery with PSI.Level Of Evidence: I. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the orientations of the surgical epicondylar axis (SEA) of varus and non-varus knees in the coronal plane.Methods: One-hundred and sixty-two knees from 81 Chinese patients undergoing total knee arthroplasty (TKA) were retrospectively investigated. The angle between the medial side of the femoral mechanical axis and the SEA (MA-SEA), as well as the physiological valgus angle, was measured in the coronal plane using three-dimensional reconstruction. The joint line angle (JLA) and hip-knee-ankle angle (HKAA) were measured in long-leg weight-bearing radiographs. The mean of each parameter was compared between the varus (HKAA < 177.0°) and the non-varus knees (HKAA ≥ 177.0°) using an independent t test. Linear regression was used to assess the correlation between MA-SEA with JLA and HKAA.Results: A total of 42 non-varus knees (6 valgus and 36 neutral knees) and 98 varus knees were measured, as 22 knees were abandoned due to unrecognizable bony landmarks. The mean MA-SEA and JLA were significantly larger in non-varus knees (both, p < 0.01). The mean physiological valgus angle was 5.9 ± 1.0° for Chinese TKA patients and was significantly larger in varus knees (p < 0.01). There was a strong positive correlation between the MA-SEA and JLA (R 2 = 0.35, p < 0.05).Conclusions: There were significant differences in the orientation of the SEA between varus and non-varus knees, which was strongly correlated with the orientation of the femoral joint line. These findings will enhance the current knowledge of knee anatomy and should prove useful for coronal alignment in TKA.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]

Palpation of the seventh cervical vertebra (C7) is important for the diagnosis and treatment of neck and chest conditions. However, the spinous process of C7 (C7-SP) displays an anatomical deviation among individuals. The present study aimed to clarify anatomic characteristics of C7-SP by using a three-dimensional (3D) computed tomographic (CT) reconstruction technique. A total of 245 subjects meeting the selection criteria were examined. After CT scanning, the images were reconstructed in 3D. All subjects were grouped according to their deviation of C7-SP: Deviating to the right (DR group), deviating to the left (DL group) and no deviation (ND group). Three distances and three angles were recorded on C7-SP. The vertical distances between the borders of the left and right transverse processes and the tip of the SP, were termed DLTS and DRTS, respectively. The length of the SP was also determined. The angle of the SP deviation was referred to as ∠α, the angle between the SP axis and the line crossing the tips of the transverse processes was referred to as ∠β and the angle between the vertebral body axis and the SP axis was referred to as ∠γ. Among the three groups, differences in ∠α and ∠β were statistically significant (P<0.05). Furthermore, the DLTS was significantly different between the DL and ND groups (P<0.05). In addition, a significant difference in the DRTS was identified between the DR and ND groups (P<0.05). 3D CT reconstruction was reliable for studying anatomic characteristics of C7-SP. Based on this, patients may be preliminarily grouped according to the deviation of their C7-SP and the measurement of the C7-SP may guide clinical diagnoses and treatments. [ABSTRACT FROM AUTHOR]

Attaining molecular and morphological axial polarity during gastrulation is a fundamental early requirement for normal development of the embryo. In mammals, the first morphological sign of the anterior–posterior axis appears anteriorly in the form of the anterior marginal crescent (or anterior visceral endoderm) while in the avian the first such sign is the Koller’s sickle at the posterior pole of the embryonic disc. Despite this inverse mode of axis formation many genes and molecular pathways involved in various steps of this process seem to be evolutionarily conserved amongst amniotes, the nodal gene being a well-known example with its functional involvement prior and during gastrulation. The pitx2 gene, however, is a new candidate described in the chick as an early marker for anterior–posterior polarity and as a regulator of axis formation including twinning. To find out whether pitx2 has retained its inductive and early marker function during the evolution of mammals this study analyses pitx2 and nodal expression at parallel stages during formation of the anterior–posterior polarity in the early rabbit embryo using whole-mount in situ hybridization and serial light-microscopical sections. At a late pre-gastrulation stage a localized reduction of nodal expression presages the position of the anterior pole of the embryonic disc and thus serves as the earliest molecular marker of anterior–posterior polarity known so far. Pitx2 is expressed in a polarized manner in the anterior marginal crescent and in the posterior half of the embryonic disc during further development. In the anterior segment of the posterior pitx2 expression domain, the anterior streak domain (ASD) is defined by nodal expression as a hypothetical progenitor region of the anterior half of the primitive streak. The expression patterns of both genes thus serve as signs of a conserved involvement in early axis formation in amniotes and, possibly, in twinning in mammals as well. [ABSTRACT FROM AUTHOR]

Background: Total knee arthroplasty (TKA) is the surgical treatment for osteoarthritis knee. Results of treatment are measured by clinical outcome and by longevity of the implant. The coronal plane axis of the tibial implant and the mechanical axis alignment of the leg are factors affecting outcome of the surgery. Mechanical axis malalignment results in early loosening, limited function, and reduced survivorship. Objective: To determine if good tibial alignment correlates with mechanical axis alignment and clinical outcome. Materials and Methods: This was a retrospective cohort study of 62 TKA patients. All TKAs were done by a single surgeon. The surgical protocol included the use of computer-assisted surgery and antibiotic cementing of the posterior cruciate-retaining knee without resurfacing of the patella. Preoperative, postoperative clinical outcome, WOMAC score, and KSS was record. One year postoperative x-rays (tibia implant alignment, mechanical axis alignment) and clinical outcomes (WOMAC score, KSS) were record. The patients were classified as good tibial alignment (Group A) if the tibia implant alignment was +2° of the tibia axis (neutral) and outlier tibial alignment (group B) if the tibia implant alignment was more than 92° or less than 88°. Clinical outcomes and the mechanical axis of good tibial alignment and outlier tibial alignment patients were compared. The good tibial alignment group was subdivided into neutral mechanical alignment (Group Al) if the mechanical axis alignment was +3° and outlier mechanical alignment (group A2) if the mechanical axis was less than 177° or more than 183°. WOMAC score and KSS were compared between the good tibial alignment and neutral mechanical alignment group (Group A l) and the good tibial alignment and outlier mechanical alignment group (Group A2). Results: The good tibial alignment group had significantly better postoperative mechanical alignment than the outlier tibial alignment group (p = 0.003). There was no statistically significant difference in WOMAC score (p = 0.18) between the groups, but the good tibial alignment group had significantly higher (better) KSS scores (p = 0.04). Between the good tibial alignment with neutral mechanical alignment group and the good tibial alignment with outlier mechanical alignment group, there was no statistically significant difference in clinical outcome with either WOMAC score or KSS. Conclusion: Tibia implant alignment in the coronal plane is one factor that affects postoperative mechanical axis alignment. If the tibial implant alignment is within +2° of neutral (90°), then the mechanical axis will be better aligned, although clinical outcome may not be improved. Clinical outcome was not correlated with tibial implant alignment within +2° of neutral with mechanical axis alignment deviation of less than 3° and tibial implant alignment within +2° of neutral but with alignment deviation greater than 3°. [ABSTRACT FROM AUTHOR]

Background: The anatomical axis of the femur is crucial for determining the correct alignment in corrective osteotomies of the knee, total knee arthroplasty (TKA), and retrograde and antegrade femoral intramedullary nailing (IMN). The aim of this study was to propose the concept of different anatomical axes for the proximal and distal parts of the femur; compare these axes in normally aligned subjects and also to propose the clinical application of these axes. Methods: In this cross-sectional study, the horizontal distances between the anatomical axis of the proximal and distal halves of the femur and the center of the intercondylar notch were measured in 100 normally aligned femurs using standard full length alignment view X-rays. Results: The average age was 34.44 ± 11.14 years. The average distance from the proximal anatomical axis to the center of the intercondylar notch was 6.68 ± 5.23 mm. The proximal anatomical axis of femur passed lateral to the center of the intercondylar notch in 12 cases (12%), medial in 84 cases (84%) and exactly central in 4 cases (4%). The average distance from the distal anatomical axis to the center of the intercondylar notch was 3.63 ± 2.09 mm. The distal anatomical axis of the femur passed medially to the center of the intercondylar notch in 82 cases (82%) and exactly central in 18 cases (18%). There was a significant difference between the anatomical axis of the proximal and distal parts of the femur in reference to the center of intercondylar notch (P value < 0.05), supporting the hypothesis that anatomical axes of the proximal and distal halves of the femur are different in the coronal plane. Conclusions: While surgeons are aware that the anatomical axis of the distal part of the femur is different than the anatomical axis of the proximal part in patients with femoral deformities, we have shown that these axes are also different in the normally aligned healthy people due to the anatomy of the femur in coronal plane. Also the normal ranges provided here can be used as a reference for the alignment guide entry point in TKA and antegrade and retrograde intramedullary femoral nailing. [ABSTRACT FROM AUTHOR]

Few studies compare sampling protocol effect on sweat composition. Here we evaluate the impact of sweat stimulation mode and site of collection on lipid mediator composition. Sweat from healthy males ( n = 7) was collected weekly for three weeks from the volar forearm following either pilocarpine iontophoresis or exercise, and from the forearm, back and thigh following pilocarpine iontophoresis only. Sweat content of over 150 lipid mediators were measured by liquid chromatography-tandem mass spectrometry. Seventy lipid mediators were routinely detected, including prostanoids, alcohols, diols, epoxides, ketones, nitrolipids, N-acylethanolamides, monoacylglycerols, and ceramides. Detected lipid mediators appeared unaffected by sampling site, though the forearm was the most consistent source of sweat. Pilocarpine-induced sweat showed increased concentrations of most detected compounds. Moreover, lipid mediator concentrations and profiles were temporally stable over the study duration. Sweat therefore appears to be a consistent and anatomically-stable source of lipid mediators, but care must be taken in comparing results obtained from different stimulation techniques. [ABSTRACT FROM AUTHOR]

Background: Defining the optimal cutting plane for derotational osteotomy at the distal femur for correction of torsion in cases of patellofemoral instability is still challenging. This preliminary study investigates changes of frontal alignment by a simplified trigonometrical model and demonstrates a surgical guidance technique with the use of femur cadavers. The hypothesis was that regardless of midshaft bowing, a cutting plane perpendicular to the virtual anatomic shaft axis avoids unintended valgus malalignment due to derotation.Methods: A novel mathematical model, called the Pillar-Crane-Model, was developed to forecast changes on frontal alignment of the femur when a perpendicular cutting plane to the virtual anatomical shaft was chosen. As proof of concept, eight different torsion angles were assessed on two human cadaver femora (left and right). A single cut distal femoral osteotomy perpendicular to the virtual anatomical shaft was performed. Frontal plane alignment (mLDFA, aLDFA, AMA) was radiographically analyzed before and after rotation by 0°, 10°, 20°, and 30°. Measurements were compared to the model.Results: The trigonometrical equation from the Pillar-Crane-Model provides mathematical proof that slight changes into varus occur, seen by an increase in AMA and mLDFA, when the cutting plane is perpendicular to the virtual anatomical shaft axis. A table with standardized values is provided. Exemplarily, the specimens showed a mean increase of AMA from 4.8° to 6.3° and mLDFA from 85.2° to 86.7 after derotation by 30°. Throughout the derotation procedure, aLDFA remained at 80.4° ± 0.4°SD.Conclusions: With the use of this model for surgical guidance and anatomic reference, unintended valgus changes on frontal malalignment can be avoided. When the cutting plane is considered to be perpendicular to the virtual anatomical shaft from a frontal and lateral view, a slight increase of mLDFA results when a derotational osteotomy of the distal femur is performed. [ABSTRACT FROM AUTHOR]

Body axis formation during embryogenesis results from asymmetric localization of maternal factors in the egg. Shortly before the first cleavage in ascidian eggs, cell polarity along the anteroposterior (A-P) axis is established and the cytoplasmic domain (myoplasm) relocates from the vegetal to the posterior region in a microtubule-dependent manner. Through immunostaining, tubulin accumulation during this reorganization is observable on the myoplasm cortex. However, more detailed morphological features of microtubules remain relatively unknown. In this study, we invented a new reagent that improves the immunostaining of cortical microtubules and successfully visualized a parallel array of thick microtubules. During reorganization, they covered nearly the entire myoplasm cortical region, beneath the posterior-vegetal cortex. We designated this microtubule array as CAMP (cortical array of microtubules in posterior vegetal region). During the late phase of reorganization, CAMP shrank and the myoplasm formed a crescent-like cytoplasmic domain. When the CAMP formation was inhibited by sodium azide, myoplasmic reorganization and A-P axis formation were both abolished, suggesting that CAMP is important for these two processes. [ABSTRACT FROM AUTHOR]

We show the vertebrate anterior –posterior axis is made by time space translation (TST). 1/ TST of Hox temporal to spatial collinearity makes the trunk part of the axis. 2/TST continues into the head. 3/ TST is mediated by collinear Hox‐Hox interactions. 4/ ‘Decision points’ involving signalling pathways separate axial domains. [ABSTRACT FROM AUTHOR]

In order to adapt behavior to a potentially body damaging threat, it is crucial to coordinate the perception of the location of the threat in external space and that of the location of the potential damage on the body surface. Such ability presupposes interactions between nociceptive stimuli and visual stimuli occurring close to the body. We hypothesized that these interactions would rely on multisensory representations of each limb itself, extending its boundaries slightly into external space, with less influence of the global representation of the body as a whole. In most studies investigating such representations, spatial organization of the somatic and extra-somatic stimuli is made according to an egocentric frame of reference centered on the main axes of the participant’s whole body (e.g. the trunk), dissociating the left vs. the right side of space. Here, the contribution of such a body-centered frame was minimized, by placing participants’ hands in front of them along their anteroposterior body axis, one at a proximal, the other at a distal location. They performed a temporal order judgment task on pairs of visual stimuli, one delivered close to each hand. Visual stimuli were preceded by nociceptive stimuli applied either on one hand, or on both hands simultaneously (control condition). Results showed that, as compared to the control condition, participants’ judgements were biased in favor of the visual stimuli the closest to the stimulated hand, irrespective of their distance from the trunk. This finding supports the idea that the mechanisms underlying nociceptive-visual interactions are based on spatial representations that primarily use the stimulated limb rather than the whole body as a coordinate system. [ABSTRACT FROM AUTHOR]

Homeobox (HOX) genes are conserved transcription factors which determine the anterior-posterior body axis patterning. HOXD8 is a member of HOX genes deregulated in several tumors such as lung carcinoma, neuroblastoma, glioma and colorectal cancer (CRC) in a context-dependent manner. In CRC, HOXD8 is downregulated in cancer tissues and metastatic foci as compared to normal tissues. Whether HOXD8 acts as a tumor suppressor of malignant progression and metastasis is still unclear. Also, the underlying mechanism of its function including the downstream targets is totally unknown. Here, we clarified the lower expression of HOXD8 in clinical colorectal cancer vs . normal colon tissues. Also, we showed that stable expression of HOXD8 in colorectal cancer cells significantly reduced the cell proliferation, anchorage-independent growth and invasion. Further, using The Cancer Genome Atlas (TCGA), we identified the genes associated with HOXD8 in order to demonstrate its function as a suppressor or a promoter of colorectal carcinoma. Among inversely related genes, apoptotic inhibitors like STK38 kinase and MYC were shown to be negatively associated with HOXD8. We demonstrated the ability of HOXD8 to upregulate executioner caspases 6 & 7 and cleaved PARP, thus inducing the apoptotic events in colorectal cancer cells. [ABSTRACT FROM AUTHOR]

The purpose of this prospective, radiographic, descriptive study was to compare measurements of tibial anatomical-mechanical axis angle (AMA-angle), tibial plateau angle (TPA), relative tibial tuberosity width (rTTW) and Z-angle from mediolateral radiographs of the tibia between two canine breeds (72 dogs) not predisposed to cranial cruciate ligament rupture (CCLR) and those from a consecutive series of 185 large dogs and 17 West Highland white terriers (WHWT) diagnosed with unilateral, surgically confirmed CCLR. Correlations among these measurements were determined, and levels of inter- and intra-observer variability among and within three observers for each measurement were established using Kendall's coefficient of concordance. Breed had a significant effect on AMA-angle. The median AMA-angle of the subject population of large dogs affected by CCLR was 2.80° (range 1.09°–5.21°); for the WHWT, it was 6.34° (range 5.68°–8.88°); and for the clinically normal dogs, it was 0.74° (range 0.00°–5.40°). In the CCLR group, AMA-angle and TPA were strongly correlated ( r = 0.745; p < 0.0001). A receiver operating characteristic (ROC) curve analysis showed that an AMA-angle higher than 1.87° had a sensitivity of 0.941 (95% confidence interval [CI]: 0.898–0.966) and a specificity of 0.965 (95% CI: 0.919–0.987) for predicting CCLR and was more accurate than TPA, rTTW and Z-angle at predicting CCLR ( p < 0.0001). Good inter- and intra-observer agreement was found for all measurements. The highly significant difference in AMA-angle found between clinically normal dogs and dogs with CCL injury suggests that AMA-angle magnitude may be a clinically relevant predisposing factor for the development of canine CCLR. [ABSTRACT FROM AUTHOR]

Today there is continuous development of wearable devices in various fields such as sportswear, orthotics and personal gadgets, among others. The design of these devices involves the human body as a support environment. Based on this premise, the development of wearable devices requires an improved understanding of the skin strain field of the body segment during human motion. This paper presents a methodology based on a three dimensional digital image correlation (3D-DIC) system to measure the skin strain field and to estimate anatomical lines with minimum deformation as design criteria for the aforementioned wearable devices. The errors of displacement and strain measurement related to 3-D reconstruction and out-of-plane motion are investigated and the results are acceptable in the case of large deformation. This approach can be an effective tool to improve the design of wearable devices in the clinical orthopaedics and ergonomics fields, where comfort plays a key role in supporting the rehabilitation process. [ABSTRACT FROM AUTHOR]

Objectives Tilt perception is part of the perception of spatial orientation. It is determined not only by the allocentric gravity axis, but also by a second allocentric axis induced by visual information as well as by the egocentric body (head) axis induced by somatosensory information. The aim of this study was to quantify roll-tilt perception using the subjective visual vertical (SVV) and the newly developed subjective postural head vertical (SPHV) and to investigate the visual effects on both during static roll-tilt. Study Design Basic science Methods Nine male volunteers participated in this study. A flight simulator was used to create several roll-tilt environments that were then combined with visual information. SVV and SPHV were evaluated in healthy participants during static roll-tilt. Results The SVV evaluation revealed significant differences between the dark condition (control) and other visual conditions with respect to some of the body roll-tilt environments, and between a body roll-tilt of 0° and ≥ 20°. The SPHV evaluation revealed a significant difference between the dark condition and the visual condition that was always roll-tilted 20° to the right of the body axis. However, there were no significant differences in SPHV error between a body roll-tilt of 0° and other tilt angles for every visual condition, unlike SVV error. Conclusions Our data indicate that human susceptibility to spatial disorientation is dependent on roll-tilt angle and visual information. They also suggest that the SPHV is not affected by roll-tilt angle, and thus differs from SVV. Level of Evidence NA [ABSTRACT FROM AUTHOR]

Body axis elongation by convergent extension is a conserved developmental process found in all metazoans. Drosophila embryonic germ-band extension is an important morphogenetic process during embryogenesis, by which the length of the germ-band is more than doubled along the anterior-posterior axis. This lengthening is achieved by typical convergent extension, i.e. narrowing the lateral epidermis along the dorsal-ventral axis and simultaneous extension along the anterior-posterior axis. Germ-band extension is largely driven by cell intercalation, whose directionality is determined by the planar polarity of the tissue and ultimately by the anterior-posterior patterning system. In addition, extrinsic tensile forces originating from the invaginating endoderm induce cell shape changes, which transiently contribute to germ-band extension. Here, we review recent progress in understanding of the role of mechanical forces in germ-band extension. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to measure the angle ( Interneural angle, INA) between intracranial segments of optic nerves (ISON), and to look for any relation between it and the relative anteroposterior location (RAPL) of the optic chiasm (OC)-viz. prefixed, normofixed and postfixed. Methods: The sample comprised of 100 autopsy specimens from South Indian population. INA was measured using software-aided processing of digital photographs. Length of the ISON was measured on each side using Vernier calipers. RAPL of the OC was noted during dissection. These were analysed with statistical methods. Results: RAPL of OC was found to be prefixed in 24 %, normofixed in 65 % and postfixed in 11 %. The INA had an overall mean of 69.9° (SD 9.29°). ANOVA confirmed statistically significant difference in INA among different groups; the corresponding mean value for the group was as follows: 79.61° (prefixed), 68.10° (normofixed) and 59.48° (postfixed). ROC curve was plotted for the use of various 'cut off' values of INA to 'diagnose' prefixed OC; an INA ≥71.4° was seen to diagnostically correlate with prefixed OC with 83.3 % sensitivity and 75 % specificity. Conclusions: The INA is wider when OC is prefixed, intermediate when normofixed and narrowed when postfixed. This observation throws light on the possibility of using INA as a marker of RAPL of OC. As INA can be measured in axial MRI sections, it can be used in differentiation of the cases with prefixed OC from others during pre-operative work up for pituitary surgeries and to identify individuals 'at risk' during subfrontal approach for pituitary lesions. [ABSTRACT FROM AUTHOR]

Purposes: The detailed understanding of the anatomy and timing of ossification centers is indispensable in both determining the fetal stage and maturity and for detecting congenital disorders. This study was performed to quantitatively examine the odontoid and body ossification centers in the axis with respect to their linear, planar and volumetric parameters. Methods: Using the methods of CT, digital image analysis and statistics, the size of the odontoid and body ossification centers in the axis in 55 spontaneously aborted human fetuses aged 17-30 weeks was studied. Results: With no sex difference, the best fit growth dynamics for odontoid and body ossification centers of the axis were, respectively, as follows: for transverse diameter y = −10.752 + 4.276 × ln(age) ± 0.335 and y = −10.578 + 4.265 × ln(age) ± 0.338, for sagittal diameter y = −4.329 + 2.010 × ln(age) ± 0.182 and y = −3.934 + 1.930 × ln(age) ± 0.182, for cross-sectional area y = −7.102 + 0.520 × age ± 0.724 and y = −7.002 + 0.521 × age ± 0.726, and for volume y = −37.021 + 14.014 × ln(age) ± 1.091 and y = −37.425 + 14.197 × ln(age) ± 1.109. Conclusions: With no sex differences, the odontoid and body ossification centers of the axis grow logarithmically in transverse and sagittal diameters, and in volume, while proportionately in cross-sectional area. Our specific-age reference data for the odontoid and body ossification centers of the axis may be relevant for determining the fetal stage and maturity and for in utero three-dimensional sonographic detecting segmentation anomalies of the axis. [ABSTRACT FROM AUTHOR]

Vascular plants have an open body plan and continuously generate new axes of growth, such as shoot or root branches. Apical-to-basal transport of the hormone auxin is a hallmark of every axis, and the resulting pattern of auxin distribution affects plant development across scales, from overall architecture to cellular differentiation. How the first axis is initiated in the early embryo is a long-standing question. While our knowledge is still sparse, some of the key players of axialization have emerged, and recent work points to specific models for connecting cellular polarity to the asymmetric division of the zygote and domain specific gene expression to the organization of basipetal auxin flux. [ABSTRACT FROM AUTHOR]

Introduction: Spinal column represents a strong and flexible body axis. It is consisted of vertebrae which are connected by the intervertebral disk and solid fibrous joints. Aim of the Study: To ascertain whether or not and to what extent foraminotomy affects the final outcome of lumbar herniated disc surgery. Patients and Methods: This retrospective study analyzed 71 patients who were operated at the Clinic of Neurosurgery in Banja Luka, in the period from 2009 to 2016. Extirpation of disc was performed in 41 respondents, while in 30 patients, a nerve root was further alleviated, along with the extirpation of disc. All patients were operated under the same conditions. Results: There was no statistically significant difference in the age of women and men who underwent classical discectomy and foraminotomy. There was a statistically significant difference in the disc protrusion and extrusion in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was no statistically significant difference in diagnosis in respondents who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was statistically significant difference in the severity of pain in patients who underwent conventional discectomy and those who underwent foraminotomy, along with conventional discectomy. There was a statistically significant difference in clinical recovery, where the findings were in favor of the respondents who underwent foraminotomy, compared to the respondents who did not. Discussion: The treatment of this syndrome is complex, multidisciplinary and with problematic success, and in cases when the operation is performed, the results are not as good as in the primary operation. Conclusion: The results of this study show that the patients who underwent foraminotomy during the operation of prolapsed lumbar disc have a clinically better result. [ABSTRACT FROM AUTHOR]

Mammalian Host-Cell Factor 1 (HCF-1), a transcriptional co-regulator, plays important roles during the cell-division cycle in cell culture, embryogenesis as well as adult tissue. In mice, HCF-1 is encoded by the X-chromosome-linked Hcfc1 gene. Induced Hcfc1 cKO/+ heterozygosity with a conditional knockout (cKO) allele in the epiblast of female embryos leads to a mixture of HCF-1-positive and -deficient cells owing to random X-chromosome inactivation. These embryos survive owing to the replacement of all HCF-1-deficient cells by HCF-1-positive cells during E5.5 to E8.5 of development. In contrast, complete epiblast-specific loss of HCF-1 in male embryos, Hcfc1 epiKO/Y , leads to embryonic lethality. Here, we characterize this lethality. We show that male epiblast-specific loss of Hcfc1 leads to a developmental arrest at E6.5 with a rapid progressive cell-cycle exit and an associated failure of anterior visceral endoderm migration and primitive streak formation. Subsequently, gastrulation does not take place. We note that the pattern of Hcfc1 epiKO/Y lethality displays many similarities to loss of β-catenin function. These results reveal essential new roles for HCF-1 in early embryonic cell proliferation and development. [ABSTRACT FROM AUTHOR]