Patterns of lingual split and lateral bone cut end and their associations with neurosensory disturbance after bilateral sagittal split osteotomy

The purpose of this study was to characterize the patterns of lingual split and lateral bone cut end (LBCE) after bilateral sagittal split osteotomy (BSSO) in patients and identify their associations with postoperative neurosensory disturbance. This retrospective cohort study recruited 273 patients with skeletal malocclusion who received BSSO. The postoperative cone beam computed tomography data were reconstructed to three-dimensionally view the patterns of lingual split and LBCE. Associations between lingual split and LBCE and their effects on neurosensory disturbance in the lower lip and chin were determined. Six types of lingual split and three types of LBCE were defined based on three-dimensional images. Type I lingual split as a vertical fracture line to the inferior mandibular border was the most common (40.29%). Inferior LBCE was the most prevalent, followed by lingual and buccal types. Significant associations among lingual split, LBCE and skeletal deformities were found (P < 0.05). However, patterns of lingual split and LBCE were not associated with the incidence of neurosensory disturbance. Patterns of lingual split after BSSO significantly associated with types of LBCE and dentomaxillofacial deformities, but not with postoperative neurosensory disturbance.     

Hamstring origin–anatomy,angle of origin and its possible clinical implications

IntroductionThe posterior compartment of the thigh is composed of three major muscles collectively known as the hamstring muscles. These consist of the biceps femoris short and long head, semimembranosus and semitendinosus. Excluding the short head of biceps femoris, the hamstrings contribute to the movement of the hip and the knee joints as they span across both joints. Our hypothesis is that the nature of the conjoint tendon -ischial angle predisposes to an increased risk of tearing in this hamstring component. We therefore aim to look at the anatomy of the hamstring origin at the ischial tuberosity and spatial relationship between the long head of biceps, semitendinosus and semimembranosus in the form of vector angles.Material and methods100 consecutive pelvic MRIs in patients under the age of 40 years were reviewed by musculoskeletal radiology fellow and a consultant musculoskeletal radiologist with more than 10 years’ experience in musculoskeletal radiology and measured the angle of origin of conjoined tendon and semimembranosus at its ischial origin. P value using a paired t-test was less than 0.0001 confirming that the difference in the vector angle of the different hamstring components was statistically significant.ResultsThe median angle of origin of conjoined tendon was 12° and for semimembranosus was 6°. Applying the concept of Newton’s second law to the angles calculated we demonstrated that an increase of 9% force applied to the conjoint tendon origin when compared to the semimembranosus tendon.ConclusionWe hypothesis that the difference in the angle of origin of the components of hamstrings might be one of the reasons for the difference in the incidence and patterns of the injuries of the various muscles of the hamstrings.     

顾锡镇教授从脾肾论治肌萎缩侧索硬化症经验

肌萎缩侧索硬化症是一种病因不清的致死性神经系统罕见病，临床表现为进行性加重的肌无力、肌肉萎缩及延髓麻痹，最终累及呼吸肌致呼吸衰竭而死亡。顾锡镇教授从脾肾论治，运用健脾补肾法治疗该病在延缓疾病进展与改善生活质量方面取得了一定疗效。文章总结了顾教授辨治肌萎缩侧索硬化症的临床经验，并例举1个典型医案加以佐证。     

Nucleus–cytoplasm cross-talk in the aging brain

Aging is a primary risk factor for fatal neurodegenerative disorders, yet the mechanisms underlying physiological healthy aging and pathological aging, and how these mechanisms can divert one scenario to the other, are not completely understood. In recent years, reports indicate that alterations in nucleocytoplasmic transport may be a hallmark of both healthy and pathological aging. In this review, I summarize recent evidence supporting this information, specifically focusing on the association between the nucleocytoplasmic transport and aging of the brain, indicating both common and case-specific mechanisms and their interplay, and pointing out alterations of these mechanisms as regulatory “switches” for the fate of the aging brain. Importantly, some of these alterations are intervenable druggable targets, paving the way to a future pharmacotherapeutic intervention.     

Small fiber neuropathy in unexpected clinical settings: a review

Small fiber neuropathy (SFN) is being recognized with increasing frequency in neuromuscular practice due to improved diagnostic techniques. Although there are some common etiologies, up to one-third of cases are considered idiopathic. In recent years, several disorders have unexpectedly been reported in association with SFN, on clinical grounds and complementary investigations, including quantitative sensory testing, intraepidermal nerve fiber density and confocal corneal microscopy. Knowledge of these disorders is important in clinical practice as increased awareness enables prompt diagnosis of SFN in these settings and early optimal therapeutic management of affected patients. Furthermore, these new developments may lead to a better understanding of the pathophysiologic mechanisms underlying SFN in these different disorders as well as, in some cases, an expanded spectrum of affected organs and systems. This article reviews these reported associations, their possible pathophysiologic bases, and the potential resulting management implications.     

Post-contrast 3D T1-weighted TSE MR sequences (SPACE,CUBE, VISTA/BRAINVIEW,isoFSE, 3D MVOX): Technical aspects and clinical applications

Post-contrast three-dimensional T1-weighted imaging of the brain is widely used for a broad range of vascular, inflammatory or tumoral diseases. The variable flip angle 3D TSE sequence is now available from several manufacturers (CUBE, General Electric; SPACE, Siemens; VISTA/BRAINVIEW, Philips; isoFSE, Itachi; 3D MVOX, Canon). Compared to gradient-echo (GRE) techniques, 3D TSE offers the advantages of useful image contrasts and reduction of artifacts from static field inhomogeneity. However, the respective role of 3D TSE and GRE MR sequences remains to be elucidated, particularly in the setting of post-contrast imaging. The purpose of this review was (1) to describe the technical aspects of 3D TSE sequences, (2) to illustrate the main clinical applications of the post-contrast 3D T1-w TSE sequence through clinical cases, (3) to discuss the respective role of post-contrast 3D TSE and GRE imaging in the field of neuroimaging.