Comparison of C2-3 Pedicle Screw Fixation With C2 Spinous Muscle Complex and Iliac Bone Graft for Instable Hangman Fracture

Purpose: To compare the effect between C2 spinous muscle complex graft and iliac bone graft in C2-3 pedicle screw fixation for instable Hangman fracture. Using axial spinous muscle complex instead of iliac bone for instable Hangman fracture can decrease neck pain, bone donor site complication, and operation time.Method: The outcomes of C2-3 pedicle screw fixation with C2 spinous muscle complex were compared with iliac bone graft in 18 and 21 patients with instable Hangman fracture. The mean age was 49.1 ± 15.8 years in the complex group and 55.3 ± 12.2 years in the Iliac group, and the mean time to surgery of the patients was 3.3 ± 0.6 days in the complex group and 3.6 ± 0.9 days in the iliac group. Outcome measures including operation time, blood loss, visual analog scale (VAS) for pain, Japanese orthopedic association score (JOA), American spine injure association classification (ASIA), and bone fusion time were collected from medical records. In addition, the postoperative complications were also recorded.Results: There were significant differences in operation time and interoperative blood loss between the two groups (P < 0.01). Also a significant difference was found in VAS score and JOA score between the two groups (P = 0.0012 and P < 0.001, respectively) at 1-month follow-up, whereas, no significant difference was found at other visit time. In the final visit, all patients showed good bone fusion, and two patients shows incision edema and exudation in the iliac group.Conclusion: C2-3 pedicle screw fixation with C2 spinous muscle complex graft maybe a feasible and safe procedure for instable Hangman fracture.

Muscle Actuators, Not Springs, Drive Maximal Effort Human Locomotor Performance

The current investigation examined muscle-tendon unit kinematics and kinetics in human participants asked to perform a hopping task for maximal performance with variational preceding milieu. Twenty-four participants were allocated post-data collection into those participants with an average hop height of higher (HH) or lower (LH) than 0.1 m. Participants were placed on a customized sled at a 20º angle while standing on a force plate. Participants used their dominant ankle for all testing and their knee was immobilized and thus all movement involved only the ankle joint and corresponding propulsive unit (triceps surae muscle complex). Participants were asked to perform a maximal effort during a single dynamic countermovement hop (CMH) and drop hops from 10 cm (DH10) and 50 cm (DH50). Three-dimensional motion analysis was performed by utilizing an infrared camera VICON motion analysis system and a corresponding force plate. An ultrasound probe was placed on the triceps surae muscle complex for muscle fascicle imaging. HH hopped significantly higher in all hopping tasks in comparison to LH. In addition, the HH group concentric ankle work was significantly higher in comparison to LH during all of the hopping tasks. Active muscle work was significantly higher in HH in comparison to LH as well. Tendon work was not significantly different between HH and LH. Active muscle work was significantly correlated with hopping height (r = 0.97) across both groups and hopping tasks and contributed more than 50% of the total work. The data indicates that humans primarily use a motor-driven system and thus it is concluded that muscle actuators and not springs maximize performance in hopping locomotor tasks in humans.

Image-guided confirmation of a precision pull-through procedure during laparoscopically assisted anorectoplasty in an open MRI operating theater: first application in an infantile case with anorectal malformation

Background Image-guided surgery with an open magnetic resonance imaging (MRI) system is applied for brain tumors in the neurosurgery field, but has rarely been reported in pediatric surgery. We report our initial experience of intraoperative confirmation of precision rectal pull-through during laparoscopically assisted anorectoplasty (LAARP) in an open MRI operating theater for pediatric patients with anorectal malformation (ARM). Case presentation A 3.0 kg term male neonate was delivered with anorectal malformation. An invertogram revealed the intermediate type. Transverse colostomy was made on the left upper abdomen. The recto-bulbar urethral fistula (RBUF) was diagnosed by a distal colostogram and voiding cystourethrogram. LAARP was planned at 6 months of age. Because this was the first procedure in which the pediatric abdomen had been scanned in an open MRI operating theater in our institution, we scanned his pelvic floor under sedation 3 weeks before the operation using the open MRI system in our operation room. We performed the operation with 4 trocars. The peritoneal reflection was carefully incised and the rectum was dissected. The RBUF was resected. The center of the muscle complex was detected at the perineal skin with an electrical nerve stimulator, and a 7-mm longitudinal skin incision was made on the perineal lesion for anoplasty. The muscle complex and the pubo-rectal sling were confirmed laparoscopically using a 3.5-mm bipolar forceps connected to the electrical nerve stimulator. Anoplasty was performed between the rectal stump and perineal skin. After anoplasty, the patient was scanned with open MRI under general anesthesia. We attached the quadrature-detection (QD) head coil around the patient’s pelvis and inserted him in the gantry. A 0.45-T open MRI clearly revealed that the pulled through rectum was located in the center of the muscle complex on T2-weighted images. The postoperative course was uneventful. Oral intake was started on post-operative day 1. Postoperative dynamic urography showed no complication (e.g., leakage or residual fistula). Conclusions We successfully performed LAARP for ARM, with intraoperative confirmation of precision rectal pull-through in an open MRI operating theater. Further cases are required to evaluate the application of open MRI systems in pediatric surgery.

Modified Levator Muscle Complex Suspension on Treating Pediatric Blepharoptosis with Poor Bell’s Phenomenon

Purpose: To evaluate the surgical outcomes of pediatric congenital blepharoptosis with poor Bell’s phenomenon (BP) treated with modified levator muscle complex suspension.Methods: Forty-two pediatric congenital blepharoptosis patients with poor BP were treated with modified levator muscle complex suspension, and their major surgical outcomes such as marginal reflex distance1 (MRD1), palpebral fissure height (PFH), and postoperative lagophthalmos were retrospectively reviewed. Results: The mean follow-up was 10.28±9.89 months (range: 3-32 Months). Surgical success was achieved in 54 (87.1%) of 62 eyelids at the final visit, including excellent results in 46 (74.2%) eyelids, good results in 8 (12.9%) eyelids, and poor results in 8 (12.9%) eyelids, respectively. The postoperative PFH of affected eyes (7.97±1.47 mm) was significantly improved compared with that before surgery (3.58±1.31 mm). The mean MRD1 was improved from -1.48±1.36 mm before surgery to 2.94±1.46 mm after surgery. The postoperative MRD1 was ≥ 3 mm in 46 eyelids and < 3 mm in 16 eyelids. The mean lagophthalmos was 1.42±1.20 mm 3 months after surgery. All of the patients presented complete blink postoperatively. Postoperative complications were rarely observed during follow-up. No patient had exposure keratitis, but blepharoptosis recurred in 6 patients (8 eyelids). All patients had satisfactory eyelid symmetry and contour. No complications were observed until the last visit.Conclusions: The modified method results complete blink, mild and quick recovery of lagophthalmos, flexible eyelid motility, stable ocular surface, and it is simple to perform with few complications and a low recurrence rate at 12.9%, which is worth to wide application on poor bell’s phenomenon blepharoptosis.

THE ORAL SUCKER OF SOME GASTROINTESTINAL TREMATODES: HISTOLOGICAL AND HISTOCHEMICAL RESEARCH

We conducted histological and histochemical studies of the oral sucker of gastrointestinal trematodes of the family Paramphistomatidae, Fischoeder, 1901 living in the rumen of ruminants, namely, Liorchis scotiae, Paramphistomum cervi and Paramphistomum ichikawai. The oral sucker of paramphistomes and the Liorchis scotiae trematode is a complex muscular organ modified into a pharynx-sucker, the muscle complex of which is formed from longitudinal, circular and radial muscle fibers. In the thick pharynx wall, we found secretory cells, single neurosecretory cells and many desmoblastic cells of connective tissue. Histochemical stains showed intense staining with alcian blue, toluidine blue, bromophenol blue and a positive periodic acid Schiff reaction, which indicates the presence of glycosaminoglycans, total proteins and glycoproteins. Due to this structure, the pharynx sucker of gastrointestinal trematodes is involved in capturing food and evacuating its undigested residues from the helminth's body to the outside. In addition, the substances produced by secretory cells of the pharynx carry out a partial chemical treatment of the food consumed by the parasite and protect the parasite from substances that are metabolites of the host tissues and waste products of symbionts and commensals that inhabit the rumen of ruminants. Thus, trophic adaptation of the parasite in its ecological niche, the rumen of polygastric mammals, is ensured.

Electromyographic analysis of transversus abdominis/internal oblique muscles during the execution of pelvic patterns of proprioceptive neuromuscular facilitation

Objective: To evaluate the electromyographic response of the transversus abdominis/internal oblique muscles (TrA/IO) during the execution of the four pelvic patterns of proprioceptive neuromuscular facilitation (PNF). Methods: Cross-sectional study. Were evaluated 21 women aged 18-38 years. The right TrA/IO complex, ipsilateral to the execution of a PNF combination of isotonics technique was monitored by surface electromyography. Three repetitions were performed with two-minute intervals between them in the four PNF pelvic patterns: anterior elevation, posterior depression, anterior depression, and posterior elevation. For the analysis of the electromyographic signal, a period of 500ms adjusted to the central value was extracted and the Root Mean Square amplitude was analyzed. Descriptive statistics and ANOVA test was used with a 95% confidence interval. Results: There was a higher TrA/IO activity in the concentric phase in the anterior elevation pattern (36.2 ± 32.3%) when compared to previous depression (19.5 μV ± 12.9), posterior elevation (16.1 μV ± 8.7), posterior depression 14.6μV ± 5.9). In addition, in the antero-elevation there is greater activation of the TrA/IO muscle complex when compared to the other patterns (p <0.01). Conclusion: The higher EMG response of the TrA/IO found in the anterior elevation pattern reveals its usefulness for clinical use.

Pelvic Floor Muscles Contribution in Surgical Outcome of Children with High-type Anorectal Malformations

As a consequence of high-type anorectal malformations (ARMs) pathogenesis, the pelvic floor muscles remain severely underdeveloped or hypoplastic, the rectal pouch is located at the level or above the puborectalis sling, and the bowel terminates outside the sphincter muscle complex support. For children with high-type ARMs the ultimate objective of therapy is mainly to grow up having bowel continence function that is compatible with a good quality of life, and the final prognosis depends significantly on the grade of development of pelvic floor muscles and the successful entering of the anorectum fully within the support of the external anal sphincter due to intraoperative conservation of the puborectalis sling. Pelvic magnetic resonance imaging (MRI) has recently become the preferred imaging study for prediction of functional outcomes, since it can define the anatomy and evaluate the development of the sphincteric muscles before and after surgical correction. Based on recent literature and our clinical experience, we will discuss the relevance of pelvic floor muscles MRI to the clinical outcome of children with high type ARMs.

Prolonged oral coenzyme Q10-β-cyclodextrin supplementation increases skeletal muscle complex I+III activity in young Thoroughbreds

Coenzyme Q10 (CoQ10) is an essential component of the mitochondrial electron transport chain (ETC). Decreased skeletal muscle CoQ10 content may result in decreased ETC activity and energy production. This study tested the hypotheses that supplementation with oral CoQ10 will increase plasma CoQ10 concentrations and that prolonged supplementation will increase skeletal muscle CoQ10 content in young, healthy untrained Thoroughbreds. Nineteen Thoroughbreds (27.5±9.7 months old; 11 males, eight females) from one farm and maintained on a grass pasture with one grain meal per day were supplemented daily with 1.5 mg/kg body weight of an oral CoQ10-β-cyclodextrin inclusion complex. Whole-blood and skeletal muscle biopsies were collected before (T0) and after (T1) nine weeks of supplementation. Plasma CoQ10 concentrations were determined via high-performance liquid chromatography. Skeletal muscle mitochondrial ETC combined complex I+III enzyme activity (indirect measurement of CoQ10 content) was assessed spectrophotometrically and normalised to mitochondrial abundance. Horses accepted supplementation with no adverse effects. Plasma CoQ10 concentration increased in all horses following supplementation, with mean plasma CoQ10 concentration significantly increasing from T0 to T1 (0.13±0.02 vs 0.25±0.03 μg/ml; mean difference 0.12±0.03; P=0.004). However, variability in absorbance resulted in a 58% response rate (i.e. doubling of T1 above T0 values). The mean skeletal muscle complex I+III activity significantly increased from T0 to T1 (0.36±0.04 vs 0.59±0.05 pmol/min/mg of muscle, mean difference 0.23±0.05; P=0.0004), although T1 values for three out of 19 horses decreased on average by 23% below T0 values. In conclusion, oral supplementation with CoQ10 in the diet of young, healthy untrained Thoroughbreds increased mean plasma CoQ10 concentration by 99% with prolonged daily supplementation increasing mean skeletal muscle complex I+III activity by 65%. Additional research is warranted investigating training and exercise effects on skeletal muscle CoQ10 content in CoQ10 supplemented and un-supplemented Thoroughbreds.