The Origin of the Variations of the Hyoid Apparatus in Human

Currently, theories based on acquired calcification of the stylohyoid ligament are believed to be a pathogenesis of syndromes associated with the hyoid apparatus (HA) and its variations. We studied the development of the HA from Reichert´s cartilage using serial sections of 25 human embryos and 45 fetuses. We ensured a fact that, at the initial stage, the HA appeared as two independent cartilage segments, that is, the cranial or styloid segment and the caudal or hyoid segment of Reichert's cartilage, those are connected by a mesenchymal structure. However, between 8 and 10 weeks of development, the mesenchymal connection was lost. We hypothesize that this disconnection is likely to be one of the major factors to make a descent of the hyoid bone in evolution. The stylohyoid ligament was not observed. The variations of the HA, should be considered variations of the development of Reicherts cartilage. If these variations are maintained in the adult, are likely to explain a major symptom associated with Eagle's syndrome. Anat Rec, 298:1395–1407, 2015. © 2015 Wiley Periodicals, Inc.     

Hyoid Bone Development: An Assessment Of Optimal CT Scanner Parameters and Three‐Dimensional Volume Rendering Techniques

The hyoid bone anchors and supports the vocal tract. Its complex shape is best studied in three dimensions, but it is difficult to capture on computed tomography (CT) images and three‐dimensional volume renderings. The goal of this study was to determine the optimal CT scanning and rendering parameters to accurately measure the growth and developmental anatomy of the hyoid and to determine whether it is feasible and necessary to use these parameters in the measurement of hyoids from in vivo CT scans. Direct linear and volumetric measurements of skeletonized hyoid bone specimens were compared with corresponding CT images to determine the most accurate scanning parameters and three‐dimensional rendering techniques. A pilot study was undertaken using in vivo scans from a retrospective CT database to determine feasibility of quantifying hyoid growth. Scanning parameters and rendering technique affected accuracy of measurements. Most linear CT measurements were within 10% of direct measurements; however, volume was overestimated when CT scans were acquired with a slice thickness greater than 1.25 mm. Slice‐by‐slice thresholding of hyoid images decreased volume overestimation. The pilot study revealed that the linear measurements tested correlate with age. A fine‐tuned rendering approach applied to small slice thickness CT scans produces the most accurate measurements of hyoid bones. However, linear measurements can be accurately assessed from in vivo CT scans at a larger slice thickness. Such findings imply that investigation into the growth and development of the hyoid bone, and the vocal tract as a whole, can now be performed using these techniques. Anat Rec, 298:1408–1415, 2015. © 2015 Wiley Periodicals, Inc.     

舌骨大角尖端周围血管神经的解剖学研究

目的为临床颈部手术以舌骨大角尖端(THB)为标志定位周围血管神经提供解剖学资料。方法在21例防腐罐注红色乳胶的成人头颈部标本上显露THB及其周围结构(颈总动脉分叉,甲状腺上动脉、舌动脉、舌下神经、喉上神经),通过THB做互相垂直的水平线和垂直线,测量相关结构与此两线间的距离。结果颈总动脉分叉点A位于THB后方8.5±2.3 mm,下方12.8±4.8 mm;甲状腺上动脉起点B位于THB后方4.6±2.2 mm,下方12.8±4.2 mm;舌动脉起点C位于THB后方4.1±2.5 mm,上方0.2±3.8 mm;其弓形最高点D位于THB前方0.2±2.1 mm,上方7.5±2.6 mm;舌下神经与垂直轴交点E位于THB上方5.1±1.6 mm;喉上神经内支与两轴的交点F、G分别距THB后方7.9±2.5 mm,下方6.5±2.0 mm。结论以THB为标志定位其周围血管神经有利于临床医生处理颈部的手术。     

舌骨形态学与显微结构的观测

目的通过对22例标本舌骨进行形态学观测及micro-CT扫描,了解其内部骨小梁的结构特点,为舌骨发育情况的判断及临床诊疗提供理论依据。方法肉眼观测22例完整舌骨骨性标本舌骨体与舌骨大角的连接方式,观察舌骨小角的出现率,利用micro-CT对舌骨进行扫描,以观测其内部骨小梁的结构特点并进行重建。结果舌骨以完整连接型为主,占59.09%,单侧分离型占36.36%,双侧分离型占4.55%;舌骨小角的出现率为31.8%;micro-CT扫描可清晰显示舌骨各部分的显微结构,内部骨小梁的分布主要集中于舌骨体两端和舌骨大角前端处,即舌骨体与舌骨大角连接处,并且不论是完整连接型还是单侧分离型,其连接处均存在骨化中心,可见连接处有明显骨化愈合。结论舌骨并不是一个完整的整体结构,根据发育过程可分为完整型、单侧分离型和双侧分离型;micro-CT扫描可以很好地显示舌骨内部骨小梁的结构特点及分布规律,为舌骨的后期研究提供了理论依据。     

Dynamic evaluation of swallowing in pediatric patients with dysphagia: The Brazilian perspective

Dynamic Evaluation of Swallowing (DES) is an exam which provides invaluable information on the swallowing function. This review describes the requirements, protocols and processes for DES in regions of Brazil. Dysphagia is a swallowing abnormality, in one or more swallowing phases, with risk and/or occurrence of aspiration, damage regarding nutrition and/or hydration and possible need of nonoral feeding methods. DES is performed in an armored room, using fluoroscopy, with the patient in lateral and anteroposterior views, in an orthostatic position. Different consistencies and volumes are tested, depending on the patient's age, complaint and clinical conditions. Its main objective is to determine if the patient can safely eat orally, is able to meet his basic nutritional and hydration needs, or if alternative means of feeding are necessary. It allows anatomical observation of structures, and the dynamics of swallowing during oral, pharyngeal and esophageal phases, in real time. The DES is used worldwide for pediatric patients, from newborns to adolescents, for a complete assessment. In Brazil, the exam is the state of the art in the functional evaluation of swallowing, however it is only available to a fraction of the population, mostly in the largest, and economically developed cities, and usually restricted to major health centers and teaching hospitals. Implementing DES in healthcare units requires radiological equipment, infrastructure standards, availability and training of personnel, as well as specialized physicians, and speech-language pathologists. For these reasons, our services face daily challenges while managing long scheduling waiting lists.     

Redescription of the Hyoid Apparatus and Associated Musculature in the Extant Coelacanth Latimeria chalumnae: Functional Implications for Feeding

The coelacanth Latimeria is the only extant vertebrate in which the neurocranium is divided into an anterior and a posterior portion which articulate by means of an intracranial joint. This articulation is thought to allow an elevation of the snout up to 20‐degree angle, which is supposed to enhance mouth gape and velocity, in turn allowing for a powerful suction. Several functional models have been proposed to explain the skull movement in Latimeria, but they disagree on the mechanisms responsible for mandibular depression and intracranial elevation, and more precisely on the role and mobility of the hyoid apparatus during these processes. We here show that the m. coracomandibularis spans ventrally to the palate‐mandible joint, and is likely involved in mandibular depression. The hyoid apparatus is sheathed by several layers of ligaments, rendering extensive movements of the hyoid bones in the anteroposterior direction unlikely. Together with the manipulation of the 3D virtual model of the skull, these observations suggest that the hyoid arch is less mobile than previously proposed, and that the movements proposed in previous models are unlikely. In the light of our new observations, we suggest that the mechanisms proposed for explaining the intracranial elevation are incomplete. Moreover, we suggest that the extensive movements of the hyoid arch elements, which were thought to accompany intracranial elevation, are unlikely. In the absence of intracranial elevation, we propose that the movements of the hyoid mainly take place in the transverse plane, allowing the lateral expansion of the orobranchial chamber. Anat Rec, 298:579–601, 2015. © 2014 Wiley Periodicals, Inc.     

基于超声背散射信号分析松质骨中的声阻抗

采用背散射法,研究用声阻抗评价松质骨状况.对松质骨中的超声散射特性进行了分析和讨论,并将分析结果和Faran理论模型进行比较分析;最后对理论和实验所得的牛胫骨、人离体跟骨和人在体跟骨松质骨中的声阻抗分布进行了分析讨论.结果表明松质骨中的声阻抗随入射频率的增加而非线性的增加,理论和实验结果是一致的.当患有骨质疏松时,松质骨密度将减小,因此,与健康松质骨中的声阻抗相比,患骨质疏松松质骨中的声阻抗较小.     

骨移植体及骨移植替代物在体内的血管化

探讨了骨移植体及骨移植替代物在体内血管化的机理、意义及过程,以更好地促进骨缺损移植修复的效果.通过对近期有关文献所作相关研究的综述,总结出各类骨移植体及骨移植替代物体内血管化的特点及影响因素.骨移植体及骨移植替代物体内血管化过程是移植手段能够奏效的重要保障.组织工程化人工骨作为一种日益重要的骨移植替代物,进一步提高其在体内的血管化进程,是更好发挥其生命活力的关键.     

Ultrasonography for guidance of amniocentesis in genetic counseling

The value of preliminary ultrasonography as a guide for amniocentesis in the early second trimester of pregnancy was prospectively evaluated. One hundred and fifty patients were alternately assigned to a control group or to an ultrasound group who underwent examination with a real-time scanner immediately prior to amniocentesis. All amniotic fluid samples were assessed as to the presence of blood by: (1) visual observation during the amniocentesis; (2) appearance of the centrifugate; and (3) microscopic analysis. Ultrasonography did not reduce the failure rate, the incidence of multiple needle insertions, or the proportion of amniotic fluid samples containing blood.     

Pain Palliation in Patients with Bone Metastases Using Magnetic Resonance-Guided Focused Ultrasound with Conformal Bone System: A Preliminary Report

PurposeWe evaluated the safety and effectiveness of the Magnetic Resonance-guided Focused Ultrasound (MRgFUS) with the ExAblate Conformal Bone System for the palliation of painful bone metastases.ResultsAll patients showed significant pain relief within 2 weeks. Two patients experienced complete pain reduction that lasted for 1 year. Two other patients showed pain relief measured as VAS scores of 2 and 4 on their last follow-up. Although the remaining patient had experienced significant pain relief in two lesions, the VAS score re-increased on his last follow-up. The size of the enhancing soft tissue mass in metastatic lesions decreased, and new bone formation was seen on follow-up images. Although adverse events were not serious, non-specific leg pain and second degree skin burn were noted.ConclusionMRgFUS was demonstrated to be effective palliative treatment within 2 weeks in selected patients with painful bone metastases.     

基于自适应网格技术方法的牙齿移动骨改建过程模拟

目的 建立一种可以高效模拟正畸牙槽骨重建的方法。 方法 建立单颗门牙和磨牙的完整牙及牙周模型,模拟位移控制和力控制加载远中平移,基于外部重建理论和牙周膜应变理论,实现基于利用 ABAQUS 子程序UMESHMOTION 结合自适应网格技术(ALE),模拟牙槽骨重建过程。 结果 位移控制能够将初始远中位移加载量50 μm 通过骨重建算法实现,达到远中移动牙槽骨重建位移量 50 μm;力控制模式在施加 1 N 初始远中方向力并考虑最终衰减到 50% 初始力水平情况下,单、双根牙最终位移量分别为 67. 5、23. 77 μm。 两种模式均实现骨重建后牙周膜上绝对值最大主应力恢复到 0 应力水平,牙周膜达到新的力学平衡。 该算法可以在很短时间内很好模拟单、双根牙槽骨的重建过程。 控制成骨和破骨速率比为 7 ∶5时,单次迭代位移移动量控制在 0. 1 μm 能够得到稳定的重建过程。 结论 本方法首次实现了双根牙槽骨重建模拟,在位移和衰减力控制下均可以很好模拟牙槽骨重建的过程,为无托槽和有托槽正畸力系的设计提供有效工具。     

大鼠心脏移植急性排斥反应模型的超声表现

目的评价大鼠心脏移植急性排斥反应模型的超声表现。方法建立大鼠心脏同系移植与同种异体移植模型。以14 MHz高频探头对手术后第1、3、6天移植心脏行超声心动图检查,于乳头肌水平左室短轴切面测量左室舒张末期内径（LVDd）、左室壁厚度（LVT）、室壁增厚率（LVTR）及左室射血分数（LVEF）,并比较同系移植与同种异体移植间差异。结果同系移植组移植心无急性排斥反应发生;同种移植组术后第3天的移植心病理分级为I～II级;移植后第6天的病理分级为III～IV级。同系移植组中,术后第1、3、6天动态观察各超声指标无明显变化（P〉0.05）。同时段两组间比较,LVDd无显著差异（P〉0.05）;术后第6天,同种异体移植组LVEF明显低于同系移植组（P〈0.05）;术后第3、6天,同种异体移植组LVT明显高于同系移植组（P〈0.01）,而LVTR则明显较低（P〈0.01）。结论高频超声检查可动态显示大鼠心脏移植的解剖形态、结构及功能的改变,判断不同程度急性排斥反应的发生,LVT和LVTR可作为其评价的敏感指标。