Wide Riparian Zones Inhibited Trace Element Loss in Mining Wastelands by Reducing Surface Runoff and Trace Elements in Sediment

The diffusion of trace elements in mining wastelands has attracted widespread attention in recent years. Vegetation restoration is an effective measure for controlling the surface migration of trace elements. However, there is no field evidence of the effective riparian zone width in mining wastelands. Three widths (5 m, 7.5 m, and 10 m) of Rhododendron simsii/Lolium perenne L. riparian zones were constructed in lead-zinc mining wastelands to investigate the loss of soil, cadmium (Cd), copper (Cu), arsenic (As), lead (Pb), and zinc (Zn). Asbestos tiles were used to cut off connections between adjacent plots to avoid hydrological interference. Plastic pipes and containers were used to collect runoff water. Results showed that more than 90% of trace elements were lost in sediment during low coverage and heavy rainfall periods. Compared with the 5 m riparian zone, the total trace element loss was reduced by 69-85% during the whole observation period in the 10 m riparian zone and by 86-99% during heavy rain periods in the 10 m riparian zone, which was due to reduction in runoff and concentrations of sediment and trace elements in the 10 m riparian zone. Indirect negative effects of riparian zone width on trace element loss through runoff and sediment concentration were found. These results indicated that the wide riparian zone promoted water infiltration, filtered soil particles, and reduced soil erosion and trace element loss. Riparian zones can be used as environmental management measures after mining areas are closed to reduce the spread of environmental risks in mining wastelands, although the long-term effects remain to be determined.

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

BACKGROUND

Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD.

PURPOSE/HYPOTHESIS

The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 3.

METHODS

A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia).

RESULTS

The LPD group demonstrated reduced medial patellar width (Δ = -3.6 mm; P < .001) and medial facet length (Δ = -3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = -3.2 mm; P = .009), decreased patellar volume (Δ = -0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%.

CONCLUSION

The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.

Neurophysiological correlates of tactile width discrimination in humans

Introduction

Tactile information processing requires the integration of sensory, motor, and cognitive information. Width discrimination has been extensively studied in rodents, but not in humans.

Methods

Here, we describe Electroencephalography (EEG) signals in humans performing a tactile width discrimination task. The first goal of this study was to describe changes in neural activity occurring during the discrimination and the response periods. The second goal was to relate specific changes in neural activity to the performance in the task.

Results

Comparison of changes in power between two different periods of the task, corresponding to the discrimination of the tactile stimulus and the motor response, revealed the engagement of an asymmetrical network associated with fronto-temporo-parieto-occipital electrodes and across multiple frequency bands. Analysis of ratios of higher [Ratio 1: (0.5-20 Hz)/(0.5-45 Hz)] or lower frequencies [Ratio 2: (0.5-4.5 Hz)/(0.5-9 Hz)], during the discrimination period revealed that activity recorded from frontal-parietal electrodes was correlated to tactile width discrimination performance between-subjects, independently of task difficulty. Meanwhile, the dynamics in parieto-occipital electrodes were correlated to the changes in performance within-subjects (i.e., between the first and the second blocks) independently of task difficulty. In addition, analysis of information transfer, using Granger causality, further demonstrated that improvements in performance between blocks were characterized by an overall reduction in information transfer to the ipsilateral parietal electrode (P4) and an increase in information transfer to the contralateral parietal electrode (P3).

Discussion

The main finding of this study is that fronto-parietal electrodes encoded between-subjects' performances while parieto-occipital electrodes encoded within-subjects' performances, supporting the notion that tactile width discrimination processing is associated with a complex asymmetrical network involving fronto-parieto-occipital electrodes.

Short-Term and Long-Term Outcomes of Fetal Ventriculomegaly beyond Gestational 37 Weeks: A Retrospective Cohort Study

Birth defects have brought about major public health problems, and studying the clinical outcomes of the most common prenatal central nervous system abnormality, namely, fetal ventriculomegaly (VM), is helpful for improving reproductive health and fertility quality. This is a retrospective cohort study from 2011 to 2020 in the West China Second University Hospital, Sichuan University, aiming to evaluate the short-term and long-term outcomes of VM over 37 weeks' gestation to exclude the influence of preterm birth. The study analyzed data from 401 term pregnancies, with 179 VM and 222 controls. From the short-term outcomes, the rate of the neonatal intensive care unit (NICU) admission under the VM group (10.06%) was comparatively higher than the control (0.45%), but Apgar scores between both groups at 1 min, 5 min and 10 min were not significantly different. From the long-term outcomes, there were more infants with abnormal neurodevelopment under the VM group than control (14.53% vs. 2.25%, p < 0.001). In addition, NICU admission (p = 0.006), peak width of lateral ventricles (p = 0.030) and postnatal cranial ultrasound suggestive with VM (p = 0.002) were related to infants' long-term outcomes. NICU admission during the perinatal period was an independent risk factor for the adverse long-term outcomes (OR = 3.561, 95% CI 1.029-12.320, p = 0.045). In conclusion, VM impairs short-term and long-term outcomes of term infants. Short-term outcome, especially NICU admission, could predict their adverse long-term outcomes.

Experimental Investigation on the Anode Flow Field Design for an Air-Cooled Open-Cathode Proton Exchange Membrane Fuel Cell

A flow channel structure design plays a significant role in an open-cathode proton exchange membrane fuel cell. The cell performance is sensitive to the structural parameters of the flow field, which mainly affects the heat and mass transfer between membrane electrode assembly and channel. This paper presents theoretical and experimental studies to investigate the impacts of anode flow field parameters (numbers of the serpentine channels, depths, and widths of the anode channel) on cell performance and temperature characteristics. The result indicates that the number of anode serpentine channels adjusts the pressure and flow rate of hydrogen in the anode flow channel effectively. The depth and width of the channel change the pressure, flow rate, and mass transfer capacity of hydrogen, especially under the high current density. There appears the best depth to achieve optimum cell performance. The velocity and concentration of hydrogen have important influences on the mass transfer which agrees with the anode channel structure design and performance changes based on the field synergy principle. This research has great significance for further understanding the relationship between anode flow field design and fuel cell performance in the open-cathode proton exchange membrane fuel cell stack.

Diagnosis and Management of Giant Esophageal Fibrovascular Polyp With Hypopharyngeal Pedicle

Background: Fibrovascular polyps (FVPs) with hypopharyngeal pedicles (hFVPs) are the rare intraluminal benign tumours of the upper aerodigestive tract, and their accurate diagnosis and optimal management are challenging. Purpose: The present retrospective study attempted to explore the optimal diagnosis and treatment of hFVPs. Research Design: The clinical records of 2 patients with giant, irregularly shaped hFVPs, who underwent several failed surgical procedures after inaccurate diagnosis, were reviewed. Finally, the patients were correctly diagnosed and successfully treated at Capital Medical University Beijing Friendship Hospital in different years, 2018 and 2020. Results: Case 1 was of a 43-year-old woman with 2 months of progressive dysphagia. Gastroenterologists overlooked the origin of her FVP, and decided to sever its narrowest point in the oesophagus through endoscopy. However, upon unsuccessful removal of the mass, a gastrotomy procedure was performed to extract the mass 7 days later. Symptoms recurred 3 months after the treatment, and a fibreoptic laryngoscopy confirmed hFVP in the patient at our department. A transcervical approach was used to sever the hypopharyngeal pedicle, achieve haemostasis and remove the oesophageal tumour. No recurrence was detected during the 2-year follow-up period after the treatment. Case 2 was of a 32-year-old man with dysphagia who had previously undergone transthoracic and transcervical oesophagotomy procedures within a gap of 3 months for the removal of FVP causing dysphagia. The hypopharyngeal pedicle was not diagnosed in the patient. The symptoms of dysphagia recurred 4 years after the treatment, and a fibreoptic laryngoscope confirmed hFVP at our department. The tumour was removed successfully through the transcervical approach. No recurrence was detected during the 6-months follow-up after surgery. Conclusion: In conclusion, the transcervical approach is suitable for achieving haemostasis and removing giant, irregularly shaped hFVPs.

Morphometric Magnetic Resonance Imaging Evaluation of Cervical Spinal Canal and Cord in Normal Small-Breed Dogs

Cervical spinal disease is one of the most common neurological disorders in small-breed dogs. Magnetic resonance imaging (MRI) is a common test for dogs with cervical spinal diseases. However, there is no information on cervical spinal canal and cord using MRI in normal small-breed dogs. Therefore, this study aimed to perform analyses to establish morphologic MRI reference ranges of the cervical spinal canal and cord in normal small-breed dogs. Cervical MRI examinations were taken in 20 client-owned small dogs. The height, width, and cross-sectional area (CSA) of the spinal canal and cord were measured on sagittal and transverse T2-weighted images at each vertebral body level and each intervertebral disk level from C1-C2 to C7 (a total of 12 levels). The height ratio, the width ratio, and the CSA ratio were calculated. The height, width, and CSA of the spinal canal and cord increased as the dog's weight increased (p < 0.01), except for that at C1-C2. However, there was no correlation between the body weight and height ratio and the width ratio and CSA ratio at all levels, except for that at C1-C2. Also, there was a negative correlation between the body weight and CSA ratio at C1-C2. There were no statistical differences for the CSA of the spinal canal, the CSA of the spinal cord, and the CSA ratio between nearby levels, except for that at C1-C2. There was no statistical difference between measurements at each same level of the sagittal and transverse images. The results of this study may provide basic and morphometric information for diagnosing and researching cervical spinal diseases in small-breed dogs.

Dimensional determinants for the carcinogenic potency of elongate amphibole particles

CONTEXT

Carcinogenic properties of particulates depend, among other factors, on dimensional characteristics that affect their ability to reach sensitive tissue, to be removed or retained, and to interact with the cells.

OBJECTIVE

To model mesothelioma and lung cancer potency of amphibole particles based on their dimensional characteristics and mineral habit (asbestiform vs. nonasbestiform) utilizing epidemiological data and detailed size information.

METHODS

The datasets from recently created depository of dimensional information of elongate mineral particles were used to correlate mesothelioma and lung cancer potency with the fraction of particles in a specific size range and the ratio of length and width in different powers. In addition, the cancer potency factors were estimated and compared for 30 asbestiform, 15 nonasbestiform, and 10 mixed datasets.

RESULTS

For particles longer than 5 µm, the highest correlation with mesothelioma potency was achieved for width <0.22 µm, and with lung cancer <0.28 µm. The statistical power of the correlation was observed to lose significance at a maximum width of 0.6-0.7 µm. Mesothelioma potency correlated with length in the power of 1.9 divided by width in the power of 2.97, lung cancer potency with length in the power of 0.4 divided by width in the power of 1.17. The predicted cancer potencies of asbestiform, nonasbestiform, and mixed categories were significantly different.

CONCLUSION

While additional studies in this direction are warranted, this paper should serve as an additional confirmation for the role of fiber dimensions in the carcinogenicity of amphibole elongate mineral particles (EMPs).

Analysis of Age and Gender-Related Changes in Gingival Width in Patients of Known Population: A Cross-sectional Study

Aims:

The present study was conducted for analyzing age and gender-related alterations in gingival width (GW) in patients of known population.

Materials and Methods:

Two hundred and ten healthy participants were enrolled in the present research. All the participants were divided into the following study groups with seventy participants in each group based on their age: adolescents, young adults, and older adults. All the participants were recalled and oral and periodontal examination was carried out using mouth mirror, probe, and explorer. Lidocaine spray was used for anesthetizing the anterior gingival region. A probe was used for assessing the width of the gingiva, in which and rubber stopper was fitted. In all the six maxillary anterior and mandibular anterior teeth, the width and thickness of the attached gingivae were assessed. All the measurements were recorded and analyzed.

Results:

Mean width of the attached gingiva in the maxillary arch in adolescents, young adults, and older adults were found to be 2.51 mm, 2.93 mm, and 3.92 mm, respectively. Mean width of the attached gingiva in the mandibular arch in adolescents, young adults, and older adults were found to be 1.76 mm, 2.39 mm, and 3.19 mm, respectively. Significant results were observed while comparing the GW among participants divided on the basis of age group. Nonsignificant results were observed while comparing the GW among participants divided on the basis of gender.

Conclusion:

There is a significant enhancement of GW with the advancement of age in both the maxillary arch and mandibular arch.

Is thoracic facet joint arthritis over-reported? It's time to review CT grading parameters - An analytical cross-sectional study

Background:

In the absence of any exclusive classification for dorsal FJA, there is a lot of confusion while labelling grade 1 FJA in thoracic spine based on decreased FJ space.

Purpose:

The purpose of this study was to know the facet joint space measurements in thoracic spine of asymptomatic and symptomatic participants and to comment whether the lower cut-off of 2 mm used in lumbar FJA classification can be safely applied in thoracic spine too.

Materials and Methods:

This cross-sectional study was done from December 1, 2018 to November 30, 2019. Patients above 18 years of age in this study who underwent CT thorax for causes unrelated to dorsal spinal pain were included. IBM SPSS Statistics v 26 was used for statistical analysis.

Results:

We measured and analysed 1512 thoracic facet joints in 63 patients (30 females and 33 males) in both axial and sagittal plane on CT scan. Mean age of the entire sample was 59.19 ± 15.19 years, ranging from 33 to 97 years and a standard error of mean 1.365 years. Overall mean thoracic facet joint space was measured to be 1.270 mm ± 0.3416 mm, ranging from 0 to 3.1 mm and a standard error of mean 0.0088 mm and a variance of 0.117 mm. The median was 1.300 mm while mode was 1.1 mm.

Conclusion:

The popular lumbar FJA classification by Weishupt et al. cannot be applied in its present form in thoracic spine, without the modification in parameters of grade 1 FJA. The lower cut-off of normal thoracic facet joint space probably lies around 1 mm.

Designing a floor plan using aircraft seat comfort knowledge by aircraft interior experts

BACKGROUND:

Recent research indicated that an 18^′′ ×30^′′ aircraft seat resulted in nearly the same level of comfort as a 17^′′ ×34^′′ seat. However, it took less space in the floor plan.

OBJECTIVES:

This study explores seat layouts preferred by experts regarding different criteria. Those results of the experts are later compared to layouts produced by computational algorithms to evaluate the advantages of each method.

METHODS:

Eighty-eight experts in the field of aircraft interior were invited to make a floor plan of a part of a Boeing 777 aircraft where comfort was one of the main goals. Participants worked in groups of 3 and are given the freedom to design a section of the cabin between economy and first-class (5.87 m wide and 3.7 m long), where besides these two types of seats, an old business-class size seat of 20^′′ ×36^′′ was introduced as well for more flexibilities in design. Computational algorithms were also applied with the same inputs and constraints to generate layouts as a comparison.

RESULTS:

In total, 29 floor-plans were made, and these plans were analysed to compare against the complexity of the operations, the number of passengers on board, the revenue of the airline, and the width of the aisle. Results showed that 14 groups opted for the economy seats, while the rest utilized a hybrid setup where the business class seats were used in the configuration. These results are compared to the 126 computerized layouts generated.

CONCLUSIONS:

Among all layouts designed by experts, a combination of 28 18^′′ ×30^′′ seats and 20 17^′′ ×34^′′ seats had the highest potential revenue of US$21,984. This floor plan fits the regulations with an aisle width of 0.93 m. The computerized layout had a better outcome in maximizing profit of US$22,416 with 32 18^′′ ×30^′′ seats and 16 20^′′ ×36^′′ seats. However, the comfort of such results was to be explored as some seats were rotated 90 degrees.

Radiographic Methods Are as Accurate as Magnetic Resonance Imaging for Graft Sizing Before Lateral Meniscal Transplantation

BACKGROUND

Accurate allograft matching is deemed critical for meniscal transplantation; thus, precise measurements are essential to correctly calculate meniscal size. Several methods for meniscal sizing have been described, but there remains a discussion on which is the most accurate for the lateral meniscus.

PURPOSE

To compare the accuracy of radiographic, anthropometric, and magnetic resonance imaging (MRI) methods of determining width and length of the lateral meniscus with actual dimensions after anatomic dissection.

STUDY DESIGN

Controlled laboratory study.

METHODS

Ten fresh-frozen human cadaveric knees without any evidence of meniscal or ligamentous injury were primarily imaged using radiography and MRI and subsequently underwent dissection to assess the anatomic size of each meniscus. Four methods were used to predict the size of the lateral menisci: anthropometric, radiographic (Pollard and Yoon), and MRI. Absolute differences in length and width between actual and predicted sizes were determined.

RESULTS

The anatomic lateral meniscal width and length were 33.01 ± 4.25 mm (mean ± SD; range, 24.84-40.18 mm) and 31.41 ± 5.06 mm (range, 25.2-40.05 mm), respectively. Regarding width, the anthropometric method demonstrated an absolute difference from anatomic measurement significantly greater when compared with the Pollard technique and MRI (P = .002). Regarding length, the Pollard method presented an absolute difference significantly greater than all other techniques (P = .003). In terms of the ability to measure width and length, MRI accurately predicted meniscal size within 10% of the anatomic size in 65% of measurements, the Yoon method in 54%, and the Pollard method in 20% (P = .01). Radiographs tended to overestimate the true size of the lateral meniscus, while the anthropometric technique overestimated width in all specimens.

CONCLUSION

This study demonstrated that MRI and the Yoon radiographic method are comparable in terms of accuracy for graft sizing before lateral meniscal transplantation. While MRI is useful, a contralateral MRI is required, which makes the Yoon radiographic method recommended given the ease and cost advantage. The original Pollard technique and the anthropometric method are not recommended.

CLINICAL RELEVANCE

Over- and undersizing of meniscal transplants has been implicated in graft failure. Therefore, increasing the reliability of preoperative meniscal measurements is deemed important for the success of meniscal allograft transplantation.

Influence of maxillary lateral incisor width ratio on perception of smile esthetics among orthodontists and laypersons

OBJECTIVE

This study aimed to analyze the impact of different maxillary lateral incisor width ratios on the perception of smile esthetics among orthodontists and laypersons.

METHODS

A smile photograph of a male subject showing the lips and gingival margins was selected. The smile was standardized for maxillary central incisor width proportions and ideally perceived smile esthetics. The maxillary lateral incisor width was symmetrically modified in increments of ratios of the central incisor from a ratio of 4:10 to a ratio of 8:10. The images were analyzed by 283 laypersons and 83 orthodontists who ranked the level of attractiveness using a visual analog scale.

RESULTS

There were significant differences between the esthetic perception of the five different width ratios, and between the orthodontists and laypersons in their evaluations of esthetics (P < 0.0004). There were no significant differences in esthetic evaluations between genders.

CONCLUSIONS

For orthodontists, the most attractive width ratio was 5.7:10, while the highest ranked ratio among laypersons was 8:10, although laypersons ranked all ratios very similarly. Both groups ranked the width ratio of 4:10 the lowest. Orthodontists were more critical in their assessment of esthetics.

CLINICAL SIGNIFICANCE

To what proportions or protocol should a peg-shaped maxillary lateral incisor or missing lateral, that is, to be replaced with an implant/crown be restored? This is an important clinical question that is often encountered by the orthodontist and the restoring dentist. The literature suggests that orthodontists and laypeople have different perceptions of smile esthetics, and it is important to have patient centered goals when treatment planning. Further research is necessary to identify the width ratio of which the lateral incisor is perceived to be esthetic as well as the ideal ratio to consider when restoring lateral incisors. This research assessed and compared the perception that orthodontists and laypeople have on smile esthetics regarding different width ratios of lateral incisors.

Olfactory Cleft Measurements and COVID-19-Related Anosmia

Objective

This study aimed to investigate the differences in olfactory cleft (OC) morphology in coronavirus disease 2019 (COVID-19) anosmia compared to control subjects and postviral anosmia related to infection other than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Study Design

Prospective.

Setting

This study comprises 91 cases, including 24 cases with anosmia due to SARS-CoV-2, 38 patients with olfactory dysfunction (OD) due to viral infection other than SARS-CoV-2, and a control group of 29 normosmic cases.

Methods

All cases had paranasal sinus computed tomography (CT), and cases with OD had magnetic resonance imaging (MRI) dedicated to the olfactory nerve. The OC width and volumes were measured on CT, and T2-weighted signal intensity (SI), olfactory bulb volumes, and olfactory sulcus depths were assessed on MRI.

Results

This study showed 3 major findings: the right and left OC widths were significantly wider in anosmic patients due to SARS-CoV-2 (group 1) or OD due to non–SARS-CoV-2 viral infection (group 2) when compared to healthy controls. OC volumes were significantly higher in group 1 or 2 than in healthy controls, and T2 SI of OC area was higher in groups 1 and 2 than in healthy controls. There was no significant difference in olfactory bulb volumes and olfactory sulcus depths on MRI among groups 1 and 2.

Conclusion

In this study, patients with COVID-19 anosmia had higher OC widths and volumes compared to control subjects. In addition, there was higher T2 SI of the olfactory bulb in COVID-19 anosmia compared to control subjects, suggesting underlying inflammatory changes. There was a significant negative correlation between these morphological findings and threshold discrimination identification scores.

Level of Evidence

Level 4.

Plantar Pressure Measurements and Geometric Analysis of Patients With and Without Morton's Neuroma

BACKGROUND

The purpose of this research was to see if there were any differences in peak pressure, contact time, pressure-time integrals, and geometric variables such as forefoot width, foot length, coefficient of spreading, and arch index between subjects with Morton's neuroma (MN) and control subjects.

METHODS

Dynamic peak plantar pressure, contact time, pressure-time integral, and geometric data were extracted using the EMED-X platform in 52 subjects with MN and 31 control subjects. Differences in peak pressure, contact time, pressure-time integral, and geometric data between participants with and those without MN were determined using independent-samples t tests. There were no significant differences in age, weight, height, and body mass index between patients with MN and control subjects.

RESULTS

There were no significant differences in the peak pressures of all masked areas and pressure-time integrals under metatarsal 2 to 4 heads between patients with MN and control subjects. In addition, no significant differences were observed between patients with MN and control subjects in geometric measurements of forefoot length, width, coefficient of spreading, foot progression angle, and arch index.

CONCLUSION

No relationship was found in this study between peak pressure, contact time, and pressure-time integral under the metatarsal heads, forefoot width, foot length, coefficient of spreading, and foot progression angle in a symptomatic MN group compared with a control group. The need to perform osteotomies to treat MN not associated with other lesser metatarsal phalangeal joint pathologies is questionable.

LEVEL OF EVIDENCE

Level III, Case-Control Study.

The changing paradigm of resection margins in sarcoma resection

Soft tissue sarcomas (STS) are a heterogeneous group of rare mesenchymal tumors that account for approximately 1% of all adult malignancies. They can arise throughout the body due to their mesenchymal origin, although 60% of all STS occur in the extremities. Locally advanced STS can lead to significant functional morbidity and tend to local recurrences despite surgical resection. About 30% of all STS patients develop distant metastases with a median overall survival of less than 15 months. The treatment of choice in patients with localized disease is still surgical resection with negative margins. However, there has been a paradigm shift in the last few decades. Large retrospective analyses could not establish a strong association between radical resections and improved local control or survival. Previous radical concepts in STS surgery have been gradually replaced by more moderate approaches with function- and limb-sparing resections combined with radiotherapy. Here, the margin status appears to be of prognostic significance. However, several large retrospective analyses have presented inconsistent results, questioning the independent prognostic impact of surgical margins. This article reviews the literature critically, focusing on the changing role of surgical margins in STS surgery.

Which Are the Most Reliable Methods of Predicting the Meniscal Size for Transplantation?

BACKGROUND

Although the size of the meniscal allograft is crucial during meniscal transplantation, the accuracy of meniscal measurement methods is still under debate. A number of methods based on radiographic and magnetic resonance imaging (MRI) data as well as on anthropometric data have been proposed, but their reproducibility and reliability are still unclear.

PURPOSE

To compare meniscal length and width as measured by different techniques (anthropometric and plain radiographic) to establish which of these 2 methods is more reliable and cost-effective for determining the meniscal size in comparison to MRI.

STUDY DESIGN

Cohort study (diagnosis); Level of evidence, 2.

METHODS

The MRI scans and plain radiographic films of 22 patients (44 knees) from a single institution were studied. The width and length of the medial and lateral menisci were measured using specific techniques. Data on sex, age, body weight, and height were used to develop a regression formula for meniscal measurements (comparing both imaging methods) to establish meniscal dimensions. Data validation was achieved using the Pearson correlation, the intraclass correlation coefficient, and the Wilcoxon nonparametric test for all variables, with a significance level established at 95%. Accuracy was established as a 10% measure discrepancy from the gold standard (MRI) and was considered an average between the right and left knees.

RESULTS

No statistically significant difference was observed between the right and left knees on radiographic and MRI measurements. The Pollard technique of radiographic measurement overestimated the width of the lateral meniscus when compared with anthropometric measurements (P < .001), considering MRI as the gold standard. The same was observed for MRI measurements of the length of the lateral meniscus in which not only anthropometric but also plain radiographic measurements using the Yoon technique were significantly smaller than those values found with the Pollard technique (P < .001). The anthropometric method underestimated the width and length of the medial meniscus with an accuracy of 68.2% and 63.6%, respectively. The radiographic method was comparable with MRI in establishing all medial meniscal measurements with an accuracy of 93.2% for length and 77.3% for width.

CONCLUSION

Some viable alternatives to MRI have been suggested. For the lateral meniscus, anthropometric data are an alternative for width, and the Yoon method can be used to assess length. For the medial meniscus, the Pollard method is considered a satisfactory alternative. This study emphasized the importance of measuring the width and length of the meniscus independently during preoperative sizing for a meniscal allograft transplantation procedure. Using MRI as a gold standard, the study also proposed other less costly and satisfactory methods of obtaining such measurements.

An arthroscopic evaluation of the anatomical "critical zone"

BACKGROUND

The "critical zone", a region of speculated vascularity, is situated approximately 10 mm proximal to the insertion of the supraspinatus tendon. Despite its obvious role as an anatomical landmark demarcator, its patho-anatomic nature has been identified as the source of rotator cuff pathology. Although many studies have attempted to evaluate the vascularity of this region, the architecture regarding the exact length, width and shape of the critical zone, remains unreported. This study aimed to determine the shape and morphometry of the "critical zone" arthroscopically.

MATERIALS AND METHODS

The sample series, which was comprised of 38 cases (n = 38) specific to pathological types, employed an anatomical investigation of the critical zone during routine real-time arthroscopy. Demographic representation: i) sex: 19 males, 19 females; ii) age range: 18-76 years; iii) race: white (n = 29), Indian (n = 7) and coloured (n = 2).

RESULTS

The incidence of shape and the mean lengths and widths of the critical zone were determined in accordance with the relevant demographic factors and patient history. Although the cresenteric shape was predominant, hemispheric and sail-shaped critical zones were also identified. The lengths and widths of the critical zone appeared markedly increased in male individuals. While the increase in age may account for the increased incidence of rotator cuff degeneration due to poor end-vascular supply, the additional factors of height and weight presented as major determinants of the increase in size of the critical zone.

CONCLUSIONS

In addition, the comparisons of length and width with each other and shape yielded levels of significant difference, therefore indicating a directly proportional relationship between the length and width of the critical zone. This detailed understanding of the critical zone may prove beneficial for the success of post-operative rotator cuff healing.

Quantitative Anatomy of the Trapezius Muscle in the Human Fetus

BACKGROUND

The trapezius muscle consists of three parts that are capable of functioning independently. Its superior part together with the levator scapulae and rhomboids elevate the shoulder, the middle part retracts the scapula, while the inferior part lowers the shoulder.

OBJECTIVES

The present study aimed to supplement numerical data and to provide growth dynamics of the trapezius in the human fetus.

MATERIAL AND METHODS

Using methods of anatomical dissection, digital image analysis (NIS Elements AR 3.0), and statistics (Student's t-test, regression analysis), we measured the length, the width and the surface area of the trapezius in 30 fetuses of both sexes (13™ k,17™ … ) aged 13-19 weeks.

RESULTS

Neither sex nor laterality differences were found. All the studied parameters of the trapezius increased proportionately with age. The linear functions were computed as follows: y = -103.288 + 10.514 × age (r = 0.957) for total length of the trapezius muscle, y = -67.439 + 6.689 × age (r = 0.856) for length of its descending part, y = -8.493 + 1.033 × age (r = 0.53) for length of its transverse part, y = -27.545 + 2.802 × age (r = 0.791) for length of its ascending part, y = -19.970 + 2.505 × age (r = 0.875) for width of the trapezius muscle, and y = -2670.458 + 212.029 × age (r = 0.915) for its surface area.

CONCLUSIONS

Neither sex nor laterality differences exist in the numerical data of the trapezius muscle in the human fetus. The descending part of trapezius is the longest, while its transverse part is the shortest. The growth dynamics of the fetal trapezius muscle follows proportionately.

Ultrasound Imaging in Postpartum Women With Diastasis Recti: Intrarater Between-Session Reliability

STUDY DESIGN

Clinimetrics.

OBJECTIVES

To investigate the intrarater between-session reliability of inter-rectus distance (IRD) measurement using ultrasound imaging in postpartum women with diastasis recti.

BACKGROUND

Diastasis recti, a separation of the rectus abdominis muscles at the linea alba, occurs as a result of pregnancy and is characterized by increased IRD. The measurement of IRD in this population is of interest to determine changes in diastasis recti severity over time, or in response to treatment. Ultrasound imaging has been proposed as a useful tool to measure IRD in women with diastasis recti; however, the consistency of IRD measurement in this population using ultrasound imaging has, to our knowledge, never been investigated.

METHODS

Ultrasound imaging was used to measure IRD in 20 women with diastasis recti on 2 different occasions. On each testing occasion, images were acquired at 4 locations along the linea alba while participants remained relaxed and while they performed a head lift to activate the rectus abdominis muscles. Reliability statistics included intraclass correlation coefficients, Bland-Altman analyses, minimum clinically important difference, and standard error of the measurement.

RESULTS

Between-session reliability of IRD measurement was high, particularly when measuring IRD at or above the umbilicus, as indicated by intraclass correlation coefficients greater than 0.90 and low standard error of the measurement and minimum clinically important difference values (below 0.17 cm and 0.46 cm, respectively). Reliability coefficients were poorer when measuring IRD below the umbilicus.

CONCLUSION

When performed by an experienced investigator, ultrasound imaging is a reliable tool by which to measure IRD in postpartum women who have diastasis recti.

Measurement standards for human metacarpals

Standards for measuring the metacarpals are absent from commonly used osteometric guides. Perhaps the closest to a set of standard measurements in common use today are those proposed by Scheuer and Elkington (Scheuer and Elkington: J Forensic Sci 38 (1993) 769-788) for forensic sex assessment. They include caliper measurements of interarticular length, base and head width, base and head height, and maximum midshaft diameter. Over the last decade, a new set of measurements that encompass similar dimensions to those used by Scheuer and Elkington, but which are taken with a mini-osteometric board (MOB) have been developed by the lead author. Use of the MOB avoids the need to manipulate both the bone and calipers in three-dimensional space and causes less strain on the hands. However, the question of intra- and interobserver accuracy has not been adequately addressed for either set of measurements. The purpose of this study was to test both the Scheuer/Elkington and MOB measurements on 20 hands from 10 anatomical skeletons for intra- and inter-observer accuracy. The study found that 92% of the MOB measures had a lower intraobserver error, and 88% had a lower interobserver error than did the caliper measurements. It also found that the maximum midshaft diameter measurement used by Scheuer and Elkington is more repeatable than a mediolateral diameter. Overall, 88% of the 25 MOB measurements had median intraobserver error rates of under 1.5%, compared with 60% of the caliper measurements. Furthermore, the MOB measurements as a set were taken 10 to 12% faster than the caliper measurements.

Morphological Characteristics of the Repaired Labrum According to Glenoid Location and Its Clinical Relevance After Arthroscopic Bankart Repair: Postoperative Evaluation With Computed Tomography Arthrography

BACKGROUND

There have been no studies on the postoperative morphological characteristics of the restored labrum at different glenoid locations and its clinical relevance after arthroscopic Bankart repair with suture anchors.

PURPOSE

To analyze the morphological characteristics of the restored labrum at different locations of the glenoid and their relevance to clinical outcomes as well as affecting factors and to trace the inserted suture anchors after arthroscopic Bankart repair using computed tomography arthrography (CTA).

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

A total of 46 patients (mean age, 26.5 ± 6.8 years) who underwent arthroscopic Bankart repair with absorbable suture anchors were enrolled in this study. Patients underwent CTA preoperatively and 6 months postoperatively as well as functional outcome evaluation preoperatively and at the last follow-up (>24 months) with the Rowe score and visual analog scale for pain. Labral height and width were measured on conventional axial CTA images at the 3-, 4-, and 5-o'clock positions twice by 2 raters. The postoperative measurements were also compared with those of the healthy anterior labrum, acquired from the same CTA examination of 32 consecutive patients (mean age, 26.5 ± 8.5 years) with superior labral lesions in the same study period. The postoperative difference in the measurements and between clock positions, and the relationship between the measurements and the clinical factors and functional outcomes, were evaluated. In addition, the locations of all suture anchors were traced on each CTA image, and outcomes according to the locations of the most inferior suture anchors were assessed.

RESULTS

The interobserver and intraobserver reliabilities of measurements at each location were excellent (Pearson correlation coefficient = 0.773-0.988). Of the 46 patients, 2 (4.35%) had redislocations after surgery. Postoperative labral height and width were significantly increased at all locations (all P < .001) up to a level similar to the healthy anterior labrum, with significantly larger values at the inferior location compared with the superior location (all P < .05). Patients who had a greater frequency of dislocations before surgery showed a lower postoperative labral height at the 5-o'clock position (P = .012), and this correlated with postoperative instability and poor functional outcomes by the Rowe score (P = .036). In most patients (41/46; 89.1%), the tips of the lowest suture anchors perforated the far cortex, and these anchors were mostly located below the 5-o'clock position (32/41; 78.0%). However, perforation of the far cortex did not affect functional outcomes.

CONCLUSION

Surgeons should be cautious of restoring labral height at the inferior glenoid location for successful arthroscopic Bankart repair. In addition, attention should be given to inserting the lowest suture anchor regardless of clinical significance.

MicroRNA-101 inhibits human hepatocellular carcinoma progression through EZH2 downregulation and increased cytostatic drug sensitivity

BACKGROUND & AIMS

Oncogene polycomb group protein enhancer of zeste homolog 2 (EZH2) has been proposed to be a target gene of putative tumor suppressor microRNA-101 (miR-101). The aim of our study was to investigate the functional role of both miR-101 and EZH2 in human hepatocellular carcinoma (HCC).

METHODS

MiR-101 and EZH2 expressions were evaluated in tumor tissues of 99 HCC patients and 7 liver cancer cell lines by real-time PCR. Luciferase reporter assay was employed to validate whether EZH2 represents a target gene of miR-101. The effect of miR-101 on HCC growth as well as programmed cell death was studied in vitro and in vivo.

RESULTS

MiR-101 expression was significantly downregulated in most of HCC tissues and all cell lines, whereas EZH2 was significantly overexpressed in most of HCC tissues and all cell lines. There was a negative correlation between expression levels of miR-101 and EZH2. Luciferase assay results confirmed EZH2 as a direct target gene of miR-101, which negatively regulates EZH2 expression in HCC. Ectopic overexpression of miR-101 dramatically repressed proliferation, invasion, colony formation as well as cell cycle progression in vitro and suppressed tumorigenicity in vivo. Furthermore, miR-101 inhibited autophagy and synergized with either doxorubicin or fluorouracil to induce apoptosis in tumor cells.

CONCLUSION

Tumor suppressor miR-101 represses HCC progression through directly targeting EZH2 oncogene and sensitizes liver cancer cells to chemotherapeutic treatment. Our findings provide significant insights into molecular mechanisms of hepatocarcinogenesis and may have clinical relevance for the development of novel targeted therapies for HCC.

Wnt signaling regulates homeostasis of the periodontal ligament

BACKGROUND AND OBJECTIVE

In health, the periodontal ligament maintains a constant width throughout an organism's lifetime. The molecular signals responsible for maintaining homeostatic control over the periodontal ligament are unknown. The purpose of this study was to investigate the role of Wnt signaling in this process by removing an essential chaperone protein, Wntless (Wls), from odontoblasts and cementoblasts, and observing the effects of Wnt depletion on cells of the periodontal complex.

MATERIAL AND METHODS

The Wnt responsive status of the periodontal complex was assessed using two strains of Wnt reporter mice: Axin2(LacZ/+) and Lgr5(LacZ/+) . The function of this endogenous Wnt signal was evaluated by conditionally eliminating the Wntless (Wls) gene using an osteocalcin Cre driver. The resulting OCN-Cre;Wls (fl/fl) mice were examined using micro-computed tomography and histology, immunohistochemical analyses for osteopontin, Runx2 and fibromodulin, in-situ hybridization for osterix and alkaline phosphatase activity.

RESULTS

The adult periodontal ligament is Wnt responsive. Elimination of Wnt signaling in the periodontal complex of OCN-Cre;Wls(fl/fl) mice resulted in a wider periodontal ligament space. This pathologically increased periodontal width is caused by a reduction in the expression of osteogenic genes and proteins, which results in thinner alveolar bone. A concomitant increase in fibrous tissue occupying the periodontal space was observed, along with a disruption in the orientation of the periodontal ligament.

CONCLUSION

The periodontal ligament is a Wnt-dependent tissue. Cells in the periodontal complex are Wnt responsive, and eliminating an essential component of the Wnt signaling network leads to a pathological widening of the periodontal ligament space. Osteogenic stimuli are reduced, and a disorganized fibrillary matrix results from the depletion of Wnt signaling. Collectively, these data underscore the importance of Wnt signaling in homeostasis of the periodontal ligament.

Narrowing carpal arch width to increase cross-sectional area of carpal tunnel--a cadaveric study

BACKGROUND

Carpal tunnel morphology plays an essential role in the etiology and treatment of carpal tunnel syndrome. The purpose of this study was to observe the morphological changes of the carpal tunnel as a result of carpal arch width narrowing. It was hypothesized that carpal arch width narrowing would result in increased height and area of the carpal arch.

METHODS

The carpal arch width of eight cadaveric hands was narrowed by a custom apparatus and cross-sectional ultrasound images were acquired. The carpal arch height and area were quantified as the carpal arch width was narrowed. Correlation and regression analyses were performed for the carpal arch height and area with respect to the carpal arch width.

FINDINGS

The carpal tunnel became more convex as the carpal arch width was narrowed. The initial carpal arch width, height, and area were 25.7 (SD1.9) mm, 4.1 (SD0.6) mm, and 68.5 (SD14.0) mm(2), respectively. The carpal arch height and area negatively correlated with the carpal arch width, with correlation coefficients of -0.974 (SD0.018) and -0.925 (SD0.034), respectively. Linear regression analyses showed a 1mm narrowing of the carpal arch width resulted in proportional increases of 0.40 (SD0.14) mm in the carpal arch height and 4.0 (SD2.2) mm(2) in the carpal arch area.

INTERPRETATION

This study demonstrates that carpal arch width narrowing leads to increased carpal arch height and area, a potential mechanism to reduce the mechanical insult to the median nerve and relieve symptoms associated with carpal tunnel syndrome.

Influence of equine conformation on rider oscillation and evaluation of horses for therapeutic riding

To obtain basic knowledge about selecting horses for therapeutic riding, the influence of equine conformation on rider oscillation and relationships between these factors and the evaluation on horses as the therapeutic riding were studied. Thirty-five riding horses were used. Equine conformation was estimated by 24 indices. Rider oscillation was measured by an accelerometer fixed at the rider's waist. The spatial position of the oscillation was estimated by a double integration of the acceleration. Horses were evaluated for therapeutic riding by a Riding for the Disabled Association instructor as a rider. Evaluations were on a scale of 1 to 5, with 5 being the highest score for 27 items. Horses were classified into 4 groups: the short and narrow (SN), short and wide (SW), tall and narrow (TN), and tall and wide (TW). The frequencies of rider oscillation both at walk and trot were higher (P<0.01), and the vertical (P<0.01) and longitudinal (P<0.05) amplitudes at trot were smaller, on short horses than on tall horses. The vertical amplitude at walk was smaller (P<0.05) and the lateral amplitude at trot was larger (P<0.01) on wide horses than on narrow horses. Short horses could be used for the rider who requires side walkers. Wide horses could be used for relieving muscular tension and for the rider who could not maintain good balance on the horse. Short and wide horses should be suitable for therapeutic riding.