Investigation of a low cost method to quantify cosmetic defect

For many patients, the motivation in seeking treatment is the improvement of their appearance rather than to correct an underlying skeletal deformity, so cosmetic concerns and the psychosocial impacts of adolescent idiopathic scoliosis are important factors in the clinical decision-making process. In the current environment of evidence based medicine there is a growing need to quantify back surface shape and general body asymmetry with the objective of producing an agreed scoring to be used in developing treatment plans and assessing outcomes but to date many clinics continue to rely on qualitative or expensive methods to describe cosmetic deformity. In November 2010, Microsoft® Corporation launched the low cost Kinect™ camera with 18 million units sold (as at January 2012) throughout the world. The device incorporates proprietary light coding technology that reconstructs the three dimensional location of an estimated 50,000 projected points illuminating objects within its field of view in approximately 1/30th of a second. The aim of the research was to investigate the capabilities of a low cost, reliable and inherently safe apparatus based on Kinect depth sensing and video technology to simultaneously acquire back surface shape and the locations of bony landmarks with the goal of providing data to describe cosmetic defect. Work has been completed using both the apparatus and a commercially available optical motion capture system (Vicon Motion Systems, Oxford, U.K.) to acquire data from a test object representing an unaffected human torso. Results were obtained to compare tri-dimensional bony landmark reconstruction accuracy and combined with analyses of point cloud data to describe back shape. Early indications are that the proposed apparatus has potential to be a clinically useful tool.

Heteropagus twinning on back -- a case report

Heteropagus twins, also called parasitic twins, are malformation of the foetus where the development of one twin is incomplete. They are attached most commonly to the lower chest and upper abdomen. We report a case of heteropagus twin, where the parasite possessed well-formed limb as well as blind ending intestine. It was attached to the back of the host by a broad pedicle. We take this opportunity to classify areas of confusion prevailing regarding twinning, foetus in foetu, teratoma and caudal duplication.

Nuclear localization of ataxin-3 is required for the manifestation of symptoms in SCA3: in vivo evidence

Spinocerebellar ataxia type 3 (SCA3) is an autosomal dominantly inherited neurodegenerative disorder caused by the expansion of a CAG repeat in the MJD1 gene resulting in an expanded polyglutamine repeat in the ataxin-3 protein. To study the course of the disease, we generated transgenic mice for SCA3 using full-length ataxin-3 constructs containing 15, 70, or 148 CAG repeats, respectively. Control mice (15 CAGs) were phenotypically normal and had no neuropathological findings. However, mice transgenic for ataxin-3 with expanded polyglutamine repeats were severely affected by a strong neurological phenotype with tremor, behavioral deficits, strongly reduced motor and exploratory activity, a hunchback, and premature death at 3 to 6 months of age. Neuropathological examination by immunohistochemical staining revealed ubiquitin- and ataxin-3-positive intranuclear inclusion bodies in a multitude of neurons. Directing ataxin-3 with 148 CAGs to the nucleus revealed an even more pronounced phenotype with more inclusions and earlier death, whereas mice transgenic with the same construct but attached to a nuclear export signal developed a milder phenotype with less inclusions. These studies indicate that nuclear localization of ataxin-3 is required for the manifestation of symptoms in SCA3 in vivo.

Quantifier variables of the back surface deformity obtained with a noninvasive structured light method: evaluation of their usefulness in idiopathic scoliosis diagnosis

New noninvasive techniques, amongst them structured light methods, have been applied to study rachis deformities, providing a way to evaluate external back deformities in the three planes of space. These methods are aimed at reducing the number of radiographic examinations necessary to diagnose and follow-up patients with scoliosis. By projecting a grid over the patient's back, the corresponding software for image treatment provides a topography of the back in a color or gray scale. Visual inspection of back topographic images using this method immediately provides information about back deformity, but it is important to determine quantifier variables of the deformity to establish diagnostic criteria. In this paper, two topographic variables [deformity in the axial plane index (DAPI) and posterior trunk symmetry index (POTSI)] that quantify deformity in two different planes are analyzed. Although other authors have reported the POTSI variable, the DAPI variable proposed in this paper is innovative. The upper normality limit of these variables in a nonpathological group was determined. These two variables have different and complementary diagnostic characteristics, therefore we devised a combined diagnostic criterion: cases with normal DAPI and POTSI (DAPI < or = 3.9% and POTSI < or = 27.5%) were diagnosed as nonpathologic, but cases with high DAPI or POTSI were diagnosed as pathologic. When we used this criterion to analyze all the cases in the sample (56 nonpathologic and 30 with idiopathic scoliosis), we obtained 76.6% sensitivity, 91% specificity, and a positive predictive value of 82%. The interobserver, intraobserver, and interassay variability were studied by determining the variation coefficient. There was good correlation between topographic variables (DAPI and POTSI) and clinical variables (Cobb's angle and vertebral rotation angle).

Back injuries and pain in adolescents attending a ski high school

This study compared overuse injuries, small abnormalities, and pain alone in different types of skiing and activity levels. Subjects were 45 ski high school athletes aged 15-19 years. We found the back and knees significantly more prone to activity-related injuries and pain than other body regions. Thirty subjects (67%) had low back pain on the first examination, and 17 had pain caused by overuse of the back. This was more frequent among active, young competitive boys in the cross-country skiing group, with mature height less than 99%, than among noncompetitive boys in the same group or among the alpine skiers. Neck pain was reported only by girls. Eight subjects had low back pain related to small abnormalities. The subjects were given counseling about training and physiotherapy. The 1-year follow-up found a significant reduction in back pain due to overuse injuries (from 17 to 3 subjects) and indistinct neck pain (from 10 to 2) but no reduction in pain in those with small abnormalities in the low back. Low back pain was common in young athletes, particularly in cross-country skiers. Excessively rapid progression of training and faulty technique increased back pain complaints from 36% when entering the school to 67% at the first examination. A proper evaluation and treatment of overuse injuries and accurate counseling of training types, volume, and progression reduced the low back pain problems to 29% of subjects 1 year later in spite of a maintained high activity level. A minimum entrance requirement to conditioning seems mandatory for students attending a ski high school.

Determinants in the morphogenesis of muscle tendon insertions

The factors that normally determine the location and insertion of a muscle were explored in human experiments of nature with early problems in morphogenesis. Monozygotic conjoined twins for whom there could be no genetic determinants for muscle attachments at the sites of juncture served as one model; these attachments had to follow general principles of morphogenesis. A second type of problem involved absence of bone that presumably antedated muscle and tendon development (e.g., genetically determined radial aplasia). A third category included mechanical alteration of early limb position that may have occurred prior to the development of muscle attachments (e.g., early amnion rupture sequence). The dissection findings from all three types imply a general hierachy of muscle tendon attachments. Tendons appear to attach preferentially to bone. In the absence of the bone to which they would normally attach, they will attach to the next closest bone. If no such bone is available, tendons may attach to other tendons; and if no tendons is available, occasionally they will attach to the fascia of another muscle. If there is no connective tissue attachment site, there will be no muscle, implying a need for function in the development and preservation of muscle.

[Ectopic mammary gland on the back]

A supernumerary, fully developed mammary gland between both shoulder blades above the vertebral column was discovered in a 32-year-old woman when it caused symptoms. It was removed by operation. Histological examination revealed fibrous mastopathy. The only abnormal radiological feature was a spina bifida of T6 at the site of the ectopic breast.

Congenital malformations of the lower back in childhood

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