Dear Editor,The importance of the medial entorhinal cortex(MEC)for memory and spatial navigation has been shown repeatedly in many species,including mice and humans[1,2].It is,therefore,not surprising that the connect...Dear Editor,The importance of the medial entorhinal cortex(MEC)for memory and spatial navigation has been shown repeatedly in many species,including mice and humans[1,2].It is,therefore,not surprising that the connectivity of this structure has been studied extensively over the past century,mainly using a range of anterograde and retrograde anatomical tracers[3].展开更多
The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial ...The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella.Despite this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion.The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial.This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.展开更多
BACKGROUND Multiple sclerosis(MS)is known to affect many sensory systems,yet most auditory research in MS has focused on the afferent pathways,with relatively few studies examining efferent function.The brainstem is a...BACKGROUND Multiple sclerosis(MS)is known to affect many sensory systems,yet most auditory research in MS has focused on the afferent pathways,with relatively few studies examining efferent function.The brainstem is a common site for MS plaques,and the medial olivocochlear(MOC)system is located in the superior olivary complex(SOC)of the brainstem.The cochlear nuclei are also involved in the MOC reflex arc.Additionally,the temporal cortex can modulate the SOC and cochlear nucleus,so lesions in the brainstem or temporal cortex may affect the MOC reflex in MS.AIM To investigate efferent auditory system activity in patients with multiple sclerosis via the MOC reflex.METHODS The study included 50 patients with MS and 50 healthy controls.Patients with MS were divided into three subgroups according to cranial magnetic resonance imaging findings:Patients with brainstem lesions(Group 1,n=20);patients with temporal cortex lesions without brainstem involvement(Group 2,n=20);and patients without any lesions in the brainstem or temporal cortex(Group 3,n=10).Tympanometry,acoustic stapedial reflex thresholds,pure-tone audiometry,and transientevoked otoacoustic emission(TEOAE)tests(with and without contralateral noise)were performed for all participants.RESULTS There was no significant difference in pure-tone hearing thresholds or baseline TEOAE amplitudes between the MS and control groups,indicating normal cochlear function in patients with MS;however,MOC reflex suppression was significantly reduced in patients with MS compared to controls(P=0.021).In particular,Group 1(MS with brainstem lesions)showed the lowest mean suppression values,which was significantly lower than that of Group 2 and the control group(P=0.002).By contrast,Group 2 and Group 3 did not significantly differ from controls.Additionally,patients with MS exhibited a sex difference in MOC function:Male patients had significantly lower suppression compared to female patients both within Group 1 and in the MS group as a whole.CONCLUSION The findings indicate that the efferent auditory system(specifically the MOC reflex)is affected by MS.MOC reflex activity was most significantly decreased in patients with MS with brainstem lesions,while temporal cortex lesions alone did not appear to notably impair the MOC reflex.Diminished MOC activity may underlie various auditory difficulties in patients with MS(e.g.,hearing in noise),and loss of efferent suppression could contribute to symptoms such as hyperacusis or tinnitus in this population.Further studies are needed to better understand the relationship between MOC dysfunction and auditory symptoms in MS,as well as the potential diagnostic value of MOC testing in MS.展开更多
Anxiety disorder is a major symptom of autism spectrum disorder(ASD)with a comorbidity rate of~40%.However,the neural mechanisms of the emergence of anxiety in ASD remain unclear.In our study,we found that hyperactivi...Anxiety disorder is a major symptom of autism spectrum disorder(ASD)with a comorbidity rate of~40%.However,the neural mechanisms of the emergence of anxiety in ASD remain unclear.In our study,we found that hyperactivity of basolateral amygdala(BLA)pyramidal neurons(PNs)in Shank3 InsG3680 knock-in(InsG3680+/+)mice is involved in the development of anxiety.Electrophysiological results also showed increased excitatory input and decreased inhibitory input in BLA PNs.Chemogenetic inhibition of the excitability of PNs in the BLA rescued the anxiety phenotype of InsG3680+/+mice.Further study found that the diminished control of the BLA by medial prefrontal cortex(mPFC)and optogenetic activation of the mPFC-BLA pathway also had a rescue effect,which increased the feedforward inhibition of the BLA.Taken together,our results suggest that hyperactivity of the BLA and alteration of the mPFC-BLA circuitry are involved in anxiety in InsG3680+/+mice.展开更多
BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical...BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.展开更多
Fear memory is crucial for survival and adaptation in complex and dynamically changing environments that enables individuals to avoid or escape from potentially dangerous situations.However,excessive fear memories can...Fear memory is crucial for survival and adaptation in complex and dynamically changing environments that enables individuals to avoid or escape from potentially dangerous situations.However,excessive fear memories can significantly contribute to emotional disabilities and mental disorders,including panic disorder,phobias,social anxiety disorder,and post-traumatic stress disorder(PTSD).展开更多
BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The...BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The combination of Yokoyama surgery and medial rectus muscle recession has been proposed as an advanced technique addresses both myopia-induced globe displacement and muscular imbalance offering potential advantages over conventional strabismus surgery in this population.AIM To investigate the effects of the modified Yokoyama surgery coupled with medial rectus muscle recession in restoring ocular motility and correcting esotropia among athletes with high myopia and fixed esotropia.METHODS A retrospective study analyzed 30 highly myopia athletes(57 eyes)with fixed esotropia treated at our hospital from January 2022 to April 2024.The participants were allocated into two groups based on the surgical method:The traditional group(n=15,29 eyes)received conventional strabismus surgery,and the combined group(n=15,28 eyes)underwent modified Yokoyama surgery in combination with medial rectus muscle recession.Eye movement improvement,esotropia alleviation,and complications were compared preoperatively and at 1,3,and 6 months post-treatment.RESULTS Both surgical groups exhibited similar baseline scores(traditional:-4.04±0.38 vs combined:-4.12±0.45,P>0.05),showing severe preoperative limitations in ocular motility.Following the intervention,the combined group achieved significantly better outcomes at both 1 month(combined:-2.25±0.28 vs traditional:-2.67±0.32)and 3 months(combined:-1.48±0.28 vs traditional:-1.76±0.43),with statistically significant improvements(P<0.05).However,by 6 months,no significant difference was observed between the two groups(combined:-0.93±0.13;traditional:-1.03±0.18;P>0.05).Prior to treatment,all patients in both groups exhibited a compensatory head posture(CHP).Following treatment,the incidence of CHP decreased to 6.67%in the combined group and 20.00%in the traditional group,both reductions being significant compared to pretreatment levels(P<0.05).Nevertheless,the difference in CHP incidence between the two groups after treatment was not significant(P>0.05).The rates of improvement in esotropia showed an increasing trend in both groups at 1 month(46.43%vs 34.48%),3 months(78.57%vs 51.728%),and 6 months(100.00%vs 89.66%)post-treatment.Notably,the combined group had a significantly higher improvement rate than the traditional group at the 3-month follow-up(P<0.05).No significant difference was observed in the esotropia improvement rates between the two groups at 1 and 6 months post-treatment(P>0.05).The combined group experienced slightly lower but not significant(combined group:0.00%vs traditional:3.45%)as opposed to the traditional group(3.45%;P>0.05).CONCLUSION The combination of modified Yokoyama surgery and medial rectus muscle recession provides effective and safe approach to improving in eye movement and esotropia in athletes with high myopia and fixed esotropia,offering reliable clinical benefits.展开更多
Tibetan singing bowls emit low-frequency sounds and produce perceptible harmonic tones and vibrations through manual tapping.The sounds the singing bowls produce have been shown to enhance relaxation and reduce anxiet...Tibetan singing bowls emit low-frequency sounds and produce perceptible harmonic tones and vibrations through manual tapping.The sounds the singing bowls produce have been shown to enhance relaxation and reduce anxiety.However,the underlying mechanism remains unclear.In this study,we used chronic restraint stress or sleep deprivation to establish mouse models of anxiety that exhibit anxiety-like behaviors.We then supplied treatment with singing bowls in a bottomless cage placed on the top of a cushion.We found that unlike in humans,the combination of harmonic tones and vibrations did not improve anxietylike behaviors in mice,while individual vibration components did.Additionally,the vibration of singing bowls increased the level of N-methyl-D-aspartate receptor 1 in the somatosensory cortex and prefrontal cortex of the mice,decreased the level ofγ-aminobutyric acid A(GABA)receptorα1 subtype,reduced the level of CaMKII in the prefrontal cortex,and increased the number of GABAergic interneurons.At the same time,electrophysiological tests showed that the vibration of singing bowls significantly reduced the abnormal low-frequency gamma oscillation peak frequency in the medial prefrontal cortex caused by stress restraint pressure and sleep deprivation.Results from this study indicate that the vibration of singing bowls can alleviate anxiety-like behaviors by reducing abnormal molecular and electrophysiological events in somatosensory and medial prefrontal cortex.展开更多
Sleep deprivation has been shown to exacerbate pain sensitivity and may contribute to the onset of chronic pain,yet the precise neural mechanisms underlying this association remain elusive.In our study,we explored the...Sleep deprivation has been shown to exacerbate pain sensitivity and may contribute to the onset of chronic pain,yet the precise neural mechanisms underlying this association remain elusive.In our study,we explored the contribution of cholinergic neurons within the medial habenula(MHb)to hyperalgesia induced by sleep deprivation in rats.Our findings indicate that the activity of MHb cholinergic neurons diminishes during sleep deprivation and that chemogenetic stimulation of these neurons can mitigate the results.Interestingly,we did not find a direct response of MHb cholinergic neurons to pain stimulation.Further investigation identified the interpeduncular nucleus(IPN)and the paraventricular nucleus of the thalamus(PVT)as key players in the pro-nociceptive effect of sleep deprivation.Stimulating the pathways connecting the MHb to the IPN and PVT alleviated the hyperalgesia.These results underscore the important role of MHb cholinergic neurons in modulating pain sensitivity linked to sleep deprivation,highlighting potential neural targets for mitigating sleep deprivation-induced hyperalgesia.展开更多
Glucose is the primary fuel source of the brain,and therefore glucose levels need to be tightly regulated and maintained within a small physiological range.Certainly,the body necessitates a stable supply of energy mai...Glucose is the primary fuel source of the brain,and therefore glucose levels need to be tightly regulated and maintained within a small physiological range.Certainly,the body necessitates a stable supply of energy mainly provided by glucose for various bodily functions.High or low blood glucose levels would impair the physiological functions of various organs of the body.展开更多
Nicotine addiction is a concern worldwide.Most mechanistic investigations are on nicotine substance dependence properties based on its pharmacological effects.However,no effective therapeutic treatment has been establ...Nicotine addiction is a concern worldwide.Most mechanistic investigations are on nicotine substance dependence properties based on its pharmacological effects.However,no effective therapeutic treatment has been established.Nicotine addiction is reinforced by environments or habits.We demonstrate the neurobiological basis of the behavioural aspect of nicotine addiction.We utilized the conditioned place preference to establish nicotine-associated behavioural preferences(NABP)in rats.Brain-wide neuroimaging analysis revealed that the medial prefrontal cortex(mPFC)was activated and contributed to NABP.Chemogenetic manipulation ofµ-opioid receptor positive(MOR+)neurons in the mPFC or the excitatory outflow to the nucleus accumbens shell(NAcShell)modulated the NABP.Electrophysiological recording confirmed that the MOR+neurons directly regulate the mPFC-NAcShell circuit via GABAA receptors.Thus,the MOR+neurons in the mPFC modulate the formation of behavioural aspects of nicotine addiction via direct excitatory innervation to the NAcShell,which may provide new insight for the development of effective therapeutic strategies.展开更多
1|SUMMARY Metastatic renal cell carcinoma(RCC)lesions in the foot are a rare entity and uncommon finding in a series of foot radiographs ordered to investigate foot pain.We report the case of a 72 year old male who ex...1|SUMMARY Metastatic renal cell carcinoma(RCC)lesions in the foot are a rare entity and uncommon finding in a series of foot radiographs ordered to investigate foot pain.We report the case of a 72 year old male who experienced left foot pain for a year,before developing intermittent haematuria and right flank pain,and subsequently being found to have right RCC with an osseous metastatic lesion in the left medial cuneiform.展开更多
Objective The ventral part of the medial prefrontal cortex（mPFC）plays an important role in initiation and control of voluntary movement,mood and cognition.However,after the degeneration of the nigrostriatal pathway,...Objective The ventral part of the medial prefrontal cortex（mPFC）plays an important role in initiation and control of voluntary movement,mood and cognition.However,after the degeneration of the nigrostriatal pathway,the neuronal activity of the ventral mPFC and the role of serotonin1A（5-hydroxytryptamine,5-HT1A）receptors in the firing of the neurons are still unknown.The present study is to investigate the change of neuronal activity in the ventral mPFC and the effect of systemic administration of the selective 5-HT1Areceptor antagonist WAY-100635 on the activity of the neurons in normal and 6-hydroxydopamine（6-OHDA）-lesioned rats.Methods Single unit responses were recorded extracellularly with glass microelectrodes from ventral mPFC neurons in normal rats and 6-OHDA unilaterally lesiond rats in vivo.Results 6-OHDA lesion of the substantia nigra pars compacta（SNc）significantly increased the firing rate with no change in the firing pattern of neurons of the ventral mPFC in rats.Systemic administration of WAY-100635（0.1 mg/kg,i.v.）did not change the mean firing rate and firing pattern of ventral mPFC neurons in normal rats.In contrast,WAY-100635 signifi- cantly decreased the mean firing rate of the neurons in rats with 6-OHDA lesion of the SNc.Conclusion These data suggest that the degeneration of the nigrostriatal pathway results in an increase of neuronal activity of ventral mPFC and dysfunction of 5-HT1Areceptor.展开更多
BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the p...BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter,this ligament is critical in maintaining joint stability.There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.AIM To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.METHODS By May 8,2022,four electronic databases were searched:Medline(PubMed),Scopus,Web of Science,and Google Scholar.General keywords such as"patellar instability,""patellar dislocation,""MPFL,""medial patellofemoral ligament,""MPTL,"and"medial patellotibial ligament"were co-searched to increase the sensitivity of the search.RESULTS The pooled effects of combined MPFL and MPTL reconstruction for Kujala score(12-mo followup)and Kujala score(24-mo follow-up)were positive and incremental,according to the findings of this meta-analysis.The mean difference between the Cincinnati scores was also positive,but not statistically significant.The combination of the two surgeries reduces pain.According to cumulative meta-analysis,the trend of pain reduction in various studies is declining over time.CONCLUSION The combined MPFL and MPTL reconstruction has good clinical results in knee function and,in addition to providing good control to maintain patellofemoral joint balance,the patient's pain level decreases over time,making it a valid surgical method for patella stabilization.展开更多
Background: In the treatment of infantile and accommodative esotopia medial rectus (MR) recession combined posterior fixation suture (Faden operation) can be used. But, there is very limited literature on effect of oc...Background: In the treatment of infantile and accommodative esotopia medial rectus (MR) recession combined posterior fixation suture (Faden operation) can be used. But, there is very limited literature on effect of ocular parameters (axial length, medial rectus width and the distance of medial rectus insertion to limbus) to this operation. Objective: To evaluate effects of ocular parameters on medial rectus Faden operations with recession for esotropia. Material and Methods: In this retrospective study, 38 patients (57 eyes) who underwent Faden operation with unilateral or bilateral recession (4 - 4.5 mm) on medial rectus were divided into three groups according to axial length, medial rectus width and the distance of medial rectus insertion to limbus. Preoperative and postoperative deviations compared. Results: 11 cases were infantile esotropia, 46 cases were acquired esotropia. Female/male rate was 19/19. The mean preoperative amount of esotropia at near was 49.95 ± 17.36 prism diopters (PD) and postoperative 1 week 11.77 ± 11.14 PD, 1 month 12.02 ± 11.52 PD and 6 months 9.46 ± 10.19 PD. The mean preoperative amount of esotropia at distance was 38.84 ± 19.03 PD and postoperative 1 week 7.25 ± 11.29 PD, 1 month 6.54 ± 10.52 PD and 6 months 4.40 ± 9.08 PD. Due to axial length, in shorter eyes, the decrease in mean post-operative deviation was statistically significant. Due to medial rectus width and the distance of medial rectus insertion, there was no statistically significant difference. Conclusions: Axial length has an effect on medial rectus Faden operations with recession but medial rectus width and medial rectus insertion distance from limbus do not.展开更多
Patel ar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the...Patel ar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament(MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed:(1) incorrect surgical indication or inappropriate surgical technique/patient selection;(2) a technical error; and(3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.展开更多
People with schizophrenia exhibit impaired social cognitive functions, particularly emotion regulation. Abnormal activations of the ventral medial prefrontal cortex （vMPFC） during emotional tasks have been demonstra...People with schizophrenia exhibit impaired social cognitive functions, particularly emotion regulation. Abnormal activations of the ventral medial prefrontal cortex （vMPFC） during emotional tasks have been demonstrated in schizophrenia, suggesting its important role in emotion processing in patients. We used the resting-state functional connectivity approach, setting a functionally relevant region, the vMPFC, as a seed region to examine the intrinsic functional interactions and communication between the vMPFC and other brain regions in schizophrenic patients. We found hypo-connectivity between the vMPFC and the medial frontal cortex, right middle temporal lobe （MTL）, right hippocampus, parahippocampal cortex （PHC） and amygdala. Further, there was a decreased strength of the negative connectivity （or anticorrelation） between the vMPFC and the bilateral dorsal lateral prefrontal cortex （DLPFC） and pre-supplementary motor areas. Among these connectivity alterations, reduced vMPFC-DLPFC connectivity was positively correlated with positive symptoms on the Positive and Negative Syndrome Scale, while vMPFC-right MTL/PHC/amygdala functional connectivity was positively correlated with the performance of emotional regulation in patients. These findings imply that communication and coordination throughout the brain networks are disrupted in schizophrenia. The emotional correlates of vMPFC connectivity suggest a role of the hypo-connectivity between these regions in the neuropathology of abnormal social cognition in chronic schizophrenia.展开更多
Objective Working memory is a key cognitive function in which the prefrontal cortex plays a crucial role. This study aimed to show the firing patterns of a neuronal population in the prefrontal cortex of the rat in a ...Objective Working memory is a key cognitive function in which the prefrontal cortex plays a crucial role. This study aimed to show the firing patterns of a neuronal population in the prefrontal cortex of the rat in a working memory task and to explore how a neuronal ensemble encodes a working memory event. Methods Sprague-Dawley rats were trained in a Y-maze until they reached an 80% correct rate in a working memory task. Then a 16-channel microelectrode array was implanted in the prefrontal cortex. After recovery, neuronal population activity was recorded during the task, using the Cerebus data-acquisition system. Spatio-temporal trains of action potentials were obtained from the original neuronal population signals. Results During the Y-maze working memory task, some neurons showed significantly in- creased firing rates and evident neuronal ensemble activity. Moreover, the anticipatory activity was associated with the delayed alternate choice of the upcoming movement. In correct trials, the averaged pre-event firing rate （10.86 ± 1.82 spikes/ bin） was higher than the post-event rate （8.17 ± 1.15 spikes/bin） （P 〈0.05）. However, in incorrect trials, the rates did not differ. Conclusion The results indicate that the anticipatory activity of a neuronal ensemble in the prefrontal cortex may play a role in encoding working memory events.展开更多
Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial a...Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.展开更多
The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament(MUCL)], posterior(PB), and transverse ligamen...The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament(MUCL)], posterior(PB), and transverse ligament, is commonly injured in overhead throwing athletes. Attenuation or rupture of the ligament results in valgus instability with variable clinical presentations. The AB or MUCL is the strongest component of the ligamentous complex and the primary restraint to valgus stress. It is also composed of two separate bands(anterior and posterior) that provide reciprocal function with the anterior band tight in extension, and the posterior band tight in flexion. In individuals who fail co-mprehensive non-operative treatment, surgical repair or reconstruction of the MUCL is commonly required to restore elbow function and stability. A comprehensive understanding of the anatomy and biomechanical properties of the MUCL is imperative to optimize reconstructive efforts, and to enhance clinical and radiographic outcomes. Our understanding of the native anatomy and biomechanics of the MUCL has evolved over time. The precise locations of the origin and insertion footprint centers guide surgeons in proper graft placement with relation to bony anatomic landmarks. In recent studies, the ulnar insertion of the MUCL is described as larger than previously thought, with the center of the footprint at varying distances relative to the ulnar ridge, joint line, or sublime tubercle. The purpose of this review is to consolidate and summarize the existing literature regarding the native anatomy, biomechanical, and clinical significance of the entire medial ulnar collateral ligament complex, including the MUCL(AB), PB, and transverse ligament.展开更多
文摘Dear Editor,The importance of the medial entorhinal cortex(MEC)for memory and spatial navigation has been shown repeatedly in many species,including mice and humans[1,2].It is,therefore,not surprising that the connectivity of this structure has been studied extensively over the past century,mainly using a range of anterograde and retrograde anatomical tracers[3].
文摘The surgical approach for patellar instability usually refers to reconstruction of the medial patellofemoral ligament associated with an osteotomy of the tibial tuberosity or a trochleoplasty when required.The medial patellotibial ligament and the medial patellomeniscal ligament are secondary stabilizers of the patella.Despite this,both the medial patellotibial and patellofemoral ligaments aid in patellar rotation and tilt when the knee is flexed beyond 45°.The medial patellotibial ligament plays a particularly important role in the final stages of stretching in extension and between 40 degrees to 90 degrees of flexion.The clinical relevance and surgical indications for medial patellotibial ligament reconstruction associated with medial patellofemoral ligament reconstruction are still controversial.This editorial explores the surgical indications and clinical results for medial patellotibial ligament reconstruction to improve readers’understanding of this technique,especially because reported clinical outcomes have remained sparse.
文摘BACKGROUND Multiple sclerosis(MS)is known to affect many sensory systems,yet most auditory research in MS has focused on the afferent pathways,with relatively few studies examining efferent function.The brainstem is a common site for MS plaques,and the medial olivocochlear(MOC)system is located in the superior olivary complex(SOC)of the brainstem.The cochlear nuclei are also involved in the MOC reflex arc.Additionally,the temporal cortex can modulate the SOC and cochlear nucleus,so lesions in the brainstem or temporal cortex may affect the MOC reflex in MS.AIM To investigate efferent auditory system activity in patients with multiple sclerosis via the MOC reflex.METHODS The study included 50 patients with MS and 50 healthy controls.Patients with MS were divided into three subgroups according to cranial magnetic resonance imaging findings:Patients with brainstem lesions(Group 1,n=20);patients with temporal cortex lesions without brainstem involvement(Group 2,n=20);and patients without any lesions in the brainstem or temporal cortex(Group 3,n=10).Tympanometry,acoustic stapedial reflex thresholds,pure-tone audiometry,and transientevoked otoacoustic emission(TEOAE)tests(with and without contralateral noise)were performed for all participants.RESULTS There was no significant difference in pure-tone hearing thresholds or baseline TEOAE amplitudes between the MS and control groups,indicating normal cochlear function in patients with MS;however,MOC reflex suppression was significantly reduced in patients with MS compared to controls(P=0.021).In particular,Group 1(MS with brainstem lesions)showed the lowest mean suppression values,which was significantly lower than that of Group 2 and the control group(P=0.002).By contrast,Group 2 and Group 3 did not significantly differ from controls.Additionally,patients with MS exhibited a sex difference in MOC function:Male patients had significantly lower suppression compared to female patients both within Group 1 and in the MS group as a whole.CONCLUSION The findings indicate that the efferent auditory system(specifically the MOC reflex)is affected by MS.MOC reflex activity was most significantly decreased in patients with MS with brainstem lesions,while temporal cortex lesions alone did not appear to notably impair the MOC reflex.Diminished MOC activity may underlie various auditory difficulties in patients with MS(e.g.,hearing in noise),and loss of efferent suppression could contribute to symptoms such as hyperacusis or tinnitus in this population.Further studies are needed to better understand the relationship between MOC dysfunction and auditory symptoms in MS,as well as the potential diagnostic value of MOC testing in MS.
基金supported by grants from the National Natural Science Foundation of China(31970902,U22A20306,and 3192010300)the Municipal Administration of Hospitals Incubating Program(PZ2023009)+1 种基金the Key-Area R&D Program of Guangdong Province(2019B030335001)the Autism Research Special Fund of Zhejiang Foundation for Disabled Persons(2022003).
文摘Anxiety disorder is a major symptom of autism spectrum disorder(ASD)with a comorbidity rate of~40%.However,the neural mechanisms of the emergence of anxiety in ASD remain unclear.In our study,we found that hyperactivity of basolateral amygdala(BLA)pyramidal neurons(PNs)in Shank3 InsG3680 knock-in(InsG3680+/+)mice is involved in the development of anxiety.Electrophysiological results also showed increased excitatory input and decreased inhibitory input in BLA PNs.Chemogenetic inhibition of the excitability of PNs in the BLA rescued the anxiety phenotype of InsG3680+/+mice.Further study found that the diminished control of the BLA by medial prefrontal cortex(mPFC)and optogenetic activation of the mPFC-BLA pathway also had a rescue effect,which increased the feedforward inhibition of the BLA.Taken together,our results suggest that hyperactivity of the BLA and alteration of the mPFC-BLA circuitry are involved in anxiety in InsG3680+/+mice.
文摘BACKGROUND In intertrochanteric fractures,the positive medial cortex support reduction is considered to provide a non-anatomical buttress that helps in controlled collapse.AIM To analyze the concept of medial cortical reduction(MCR)and its clinical and radiological association in geriatric intertrochanteric femur fractures.METHODS Geriatric patients who presented with AO/OTA 31A1 and 31A2 femur fractures and treated with proximal femoral nailing between July 2021 and June 2023 were include in this prospective cohort study.Based on the degree of MCR,they were divided into positive,neutral,or negative MCR groups.The demographic baseline characteristics,postoperative radiographic femoral neck-shaft angle and neck length were analyzed at 6,12 and 24 weeks post-surgery.Functional outcomes such as modified Harris Hip Score(HHS)and time to full-weight bearing were also analyzed.RESULTS 47 patients(Male:Famale 35:12)with mean age of 65.8±4.2 years were included in this study.Twenty-two cases had neutral support,nine had negative support,and sixteen had positive support in the medial cortex postoperatively.Baseline characteristics of the three groups were comparable.No significant differences were found in the femur neck length and femur neck-shaft angle changes post-surgery between the groups.The modified HHS was not found to be significant between the groups(P=0.883)as that of the time to full weight bearing(P=0.789).CONCLUSION The type of reduction achieved based on medial cortical alignment does not affect the femur neck length shortening or varus collapse.Future randomized controlled trials are needed to validate the findings noted in the study.
文摘Fear memory is crucial for survival and adaptation in complex and dynamically changing environments that enables individuals to avoid or escape from potentially dangerous situations.However,excessive fear memories can significantly contribute to emotional disabilities and mental disorders,including panic disorder,phobias,social anxiety disorder,and post-traumatic stress disorder(PTSD).
文摘BACKGROUND Fixed esotropia in high myopia,characterized by irreversible inward ocular deviation and abduction limitation,presents unique therapeutic challenges for athletes requiring precise binocular coordination.The combination of Yokoyama surgery and medial rectus muscle recession has been proposed as an advanced technique addresses both myopia-induced globe displacement and muscular imbalance offering potential advantages over conventional strabismus surgery in this population.AIM To investigate the effects of the modified Yokoyama surgery coupled with medial rectus muscle recession in restoring ocular motility and correcting esotropia among athletes with high myopia and fixed esotropia.METHODS A retrospective study analyzed 30 highly myopia athletes(57 eyes)with fixed esotropia treated at our hospital from January 2022 to April 2024.The participants were allocated into two groups based on the surgical method:The traditional group(n=15,29 eyes)received conventional strabismus surgery,and the combined group(n=15,28 eyes)underwent modified Yokoyama surgery in combination with medial rectus muscle recession.Eye movement improvement,esotropia alleviation,and complications were compared preoperatively and at 1,3,and 6 months post-treatment.RESULTS Both surgical groups exhibited similar baseline scores(traditional:-4.04±0.38 vs combined:-4.12±0.45,P>0.05),showing severe preoperative limitations in ocular motility.Following the intervention,the combined group achieved significantly better outcomes at both 1 month(combined:-2.25±0.28 vs traditional:-2.67±0.32)and 3 months(combined:-1.48±0.28 vs traditional:-1.76±0.43),with statistically significant improvements(P<0.05).However,by 6 months,no significant difference was observed between the two groups(combined:-0.93±0.13;traditional:-1.03±0.18;P>0.05).Prior to treatment,all patients in both groups exhibited a compensatory head posture(CHP).Following treatment,the incidence of CHP decreased to 6.67%in the combined group and 20.00%in the traditional group,both reductions being significant compared to pretreatment levels(P<0.05).Nevertheless,the difference in CHP incidence between the two groups after treatment was not significant(P>0.05).The rates of improvement in esotropia showed an increasing trend in both groups at 1 month(46.43%vs 34.48%),3 months(78.57%vs 51.728%),and 6 months(100.00%vs 89.66%)post-treatment.Notably,the combined group had a significantly higher improvement rate than the traditional group at the 3-month follow-up(P<0.05).No significant difference was observed in the esotropia improvement rates between the two groups at 1 and 6 months post-treatment(P>0.05).The combined group experienced slightly lower but not significant(combined group:0.00%vs traditional:3.45%)as opposed to the traditional group(3.45%;P>0.05).CONCLUSION The combination of modified Yokoyama surgery and medial rectus muscle recession provides effective and safe approach to improving in eye movement and esotropia in athletes with high myopia and fixed esotropia,offering reliable clinical benefits.
基金supported by the National Natural Science Foundation of ChinaNos.32170950(to LY),31970915(to LY),31871170(to CL)+4 种基金the Natural Science Foundation of Guangdong Province for Major Cultivation ProjectNo.2018B030336001(to LY)the Natural Science Foundation of Guangdong Province,Nos.2021A1515010804(to CL),2023A1515010899(to CL)the Guangdong Grant‘Key Technologies for Treatment of Brain Disorders’No.2018B030332001(to CL)。
文摘Tibetan singing bowls emit low-frequency sounds and produce perceptible harmonic tones and vibrations through manual tapping.The sounds the singing bowls produce have been shown to enhance relaxation and reduce anxiety.However,the underlying mechanism remains unclear.In this study,we used chronic restraint stress or sleep deprivation to establish mouse models of anxiety that exhibit anxiety-like behaviors.We then supplied treatment with singing bowls in a bottomless cage placed on the top of a cushion.We found that unlike in humans,the combination of harmonic tones and vibrations did not improve anxietylike behaviors in mice,while individual vibration components did.Additionally,the vibration of singing bowls increased the level of N-methyl-D-aspartate receptor 1 in the somatosensory cortex and prefrontal cortex of the mice,decreased the level ofγ-aminobutyric acid A(GABA)receptorα1 subtype,reduced the level of CaMKII in the prefrontal cortex,and increased the number of GABAergic interneurons.At the same time,electrophysiological tests showed that the vibration of singing bowls significantly reduced the abnormal low-frequency gamma oscillation peak frequency in the medial prefrontal cortex caused by stress restraint pressure and sleep deprivation.Results from this study indicate that the vibration of singing bowls can alleviate anxiety-like behaviors by reducing abnormal molecular and electrophysiological events in somatosensory and medial prefrontal cortex.
基金supported by grants from the Ministry of Science and Technology of China(2021ZD0203204)the National Natural Science Foundation of China(32030052 and 31530028).
文摘Sleep deprivation has been shown to exacerbate pain sensitivity and may contribute to the onset of chronic pain,yet the precise neural mechanisms underlying this association remain elusive.In our study,we explored the contribution of cholinergic neurons within the medial habenula(MHb)to hyperalgesia induced by sleep deprivation in rats.Our findings indicate that the activity of MHb cholinergic neurons diminishes during sleep deprivation and that chemogenetic stimulation of these neurons can mitigate the results.Interestingly,we did not find a direct response of MHb cholinergic neurons to pain stimulation.Further investigation identified the interpeduncular nucleus(IPN)and the paraventricular nucleus of the thalamus(PVT)as key players in the pro-nociceptive effect of sleep deprivation.Stimulating the pathways connecting the MHb to the IPN and PVT alleviated the hyperalgesia.These results underscore the important role of MHb cholinergic neurons in modulating pain sensitivity linked to sleep deprivation,highlighting potential neural targets for mitigating sleep deprivation-induced hyperalgesia.
基金supported by grants from the NIH(P01DK113954,R01DK115761,R01DK117281,R01DK125480 and R01DK120858 to YXR01DK129548 to YH)+1 种基金USDA/CRIS(51000-064-01S to YX)Postdoctoral Fellowship(2020AHA000POST000204188)to LT。
文摘Glucose is the primary fuel source of the brain,and therefore glucose levels need to be tightly regulated and maintained within a small physiological range.Certainly,the body necessitates a stable supply of energy mainly provided by glucose for various bodily functions.High or low blood glucose levels would impair the physiological functions of various organs of the body.
基金supported by JSPS KAKENHI(24659574,26112003,and 15K14328),and JP 16H06276(AdAMS).
文摘Nicotine addiction is a concern worldwide.Most mechanistic investigations are on nicotine substance dependence properties based on its pharmacological effects.However,no effective therapeutic treatment has been established.Nicotine addiction is reinforced by environments or habits.We demonstrate the neurobiological basis of the behavioural aspect of nicotine addiction.We utilized the conditioned place preference to establish nicotine-associated behavioural preferences(NABP)in rats.Brain-wide neuroimaging analysis revealed that the medial prefrontal cortex(mPFC)was activated and contributed to NABP.Chemogenetic manipulation ofµ-opioid receptor positive(MOR+)neurons in the mPFC or the excitatory outflow to the nucleus accumbens shell(NAcShell)modulated the NABP.Electrophysiological recording confirmed that the MOR+neurons directly regulate the mPFC-NAcShell circuit via GABAA receptors.Thus,the MOR+neurons in the mPFC modulate the formation of behavioural aspects of nicotine addiction via direct excitatory innervation to the NAcShell,which may provide new insight for the development of effective therapeutic strategies.
文摘1|SUMMARY Metastatic renal cell carcinoma(RCC)lesions in the foot are a rare entity and uncommon finding in a series of foot radiographs ordered to investigate foot pain.We report the case of a 72 year old male who experienced left foot pain for a year,before developing intermittent haematuria and right flank pain,and subsequently being found to have right RCC with an osseous metastatic lesion in the left medial cuneiform.
基金the National Natural Science Foundation of China（No.30370464） ；the Science and Technological Program of Shaanxi Province,China（No.2005K13-G6）
文摘Objective The ventral part of the medial prefrontal cortex（mPFC）plays an important role in initiation and control of voluntary movement,mood and cognition.However,after the degeneration of the nigrostriatal pathway,the neuronal activity of the ventral mPFC and the role of serotonin1A（5-hydroxytryptamine,5-HT1A）receptors in the firing of the neurons are still unknown.The present study is to investigate the change of neuronal activity in the ventral mPFC and the effect of systemic administration of the selective 5-HT1Areceptor antagonist WAY-100635 on the activity of the neurons in normal and 6-hydroxydopamine（6-OHDA）-lesioned rats.Methods Single unit responses were recorded extracellularly with glass microelectrodes from ventral mPFC neurons in normal rats and 6-OHDA unilaterally lesiond rats in vivo.Results 6-OHDA lesion of the substantia nigra pars compacta（SNc）significantly increased the firing rate with no change in the firing pattern of neurons of the ventral mPFC in rats.Systemic administration of WAY-100635（0.1 mg/kg,i.v.）did not change the mean firing rate and firing pattern of ventral mPFC neurons in normal rats.In contrast,WAY-100635 signifi- cantly decreased the mean firing rate of the neurons in rats with 6-OHDA lesion of the SNc.Conclusion These data suggest that the degeneration of the nigrostriatal pathway results in an increase of neuronal activity of ventral mPFC and dysfunction of 5-HT1Areceptor.
文摘BACKGROUND The medial patellofemoral ligament(MPFL),along with the medial patellotibial ligament(MPTL)and medial patellomeniscal ligament,aid in the stabilization of the patellofemoral joint.Although the MPFL is the primary stabilizer and the MPTL is a secondary limiter,this ligament is critical in maintaining joint stability.There have been few studies on the combined MPFL and MPTL reconstruction and its benefits.AIM To look into the outcomes of combined MPFL and MPTL reconstruction in frequent patellar instability.METHODS By May 8,2022,four electronic databases were searched:Medline(PubMed),Scopus,Web of Science,and Google Scholar.General keywords such as"patellar instability,""patellar dislocation,""MPFL,""medial patellofemoral ligament,""MPTL,"and"medial patellotibial ligament"were co-searched to increase the sensitivity of the search.RESULTS The pooled effects of combined MPFL and MPTL reconstruction for Kujala score(12-mo followup)and Kujala score(24-mo follow-up)were positive and incremental,according to the findings of this meta-analysis.The mean difference between the Cincinnati scores was also positive,but not statistically significant.The combination of the two surgeries reduces pain.According to cumulative meta-analysis,the trend of pain reduction in various studies is declining over time.CONCLUSION The combined MPFL and MPTL reconstruction has good clinical results in knee function and,in addition to providing good control to maintain patellofemoral joint balance,the patient's pain level decreases over time,making it a valid surgical method for patella stabilization.
文摘Background: In the treatment of infantile and accommodative esotopia medial rectus (MR) recession combined posterior fixation suture (Faden operation) can be used. But, there is very limited literature on effect of ocular parameters (axial length, medial rectus width and the distance of medial rectus insertion to limbus) to this operation. Objective: To evaluate effects of ocular parameters on medial rectus Faden operations with recession for esotropia. Material and Methods: In this retrospective study, 38 patients (57 eyes) who underwent Faden operation with unilateral or bilateral recession (4 - 4.5 mm) on medial rectus were divided into three groups according to axial length, medial rectus width and the distance of medial rectus insertion to limbus. Preoperative and postoperative deviations compared. Results: 11 cases were infantile esotropia, 46 cases were acquired esotropia. Female/male rate was 19/19. The mean preoperative amount of esotropia at near was 49.95 ± 17.36 prism diopters (PD) and postoperative 1 week 11.77 ± 11.14 PD, 1 month 12.02 ± 11.52 PD and 6 months 9.46 ± 10.19 PD. The mean preoperative amount of esotropia at distance was 38.84 ± 19.03 PD and postoperative 1 week 7.25 ± 11.29 PD, 1 month 6.54 ± 10.52 PD and 6 months 4.40 ± 9.08 PD. Due to axial length, in shorter eyes, the decrease in mean post-operative deviation was statistically significant. Due to medial rectus width and the distance of medial rectus insertion, there was no statistically significant difference. Conclusions: Axial length has an effect on medial rectus Faden operations with recession but medial rectus width and medial rectus insertion distance from limbus do not.
文摘Patel ar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament(MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed:(1) incorrect surgical indication or inappropriate surgical technique/patient selection;(2) a technical error; and(3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.
基金supported by grants from the Beijing Municipal Science & Technology Commission(D0906001040191,D101107047810005,D101100050010051)the Beijing Natural Science Foundation(7102086)+3 种基金the Fund for Capital Medical Development and Research(2007-3059)the National Natural Science Foundation of China(81171409)Startup Foundation for Distinguished Research Professors of the Institute for Psychology(Y0CX492S03)Fund for Outstanding Talents in Beijing(2012D003034000003)
文摘People with schizophrenia exhibit impaired social cognitive functions, particularly emotion regulation. Abnormal activations of the ventral medial prefrontal cortex （vMPFC） during emotional tasks have been demonstrated in schizophrenia, suggesting its important role in emotion processing in patients. We used the resting-state functional connectivity approach, setting a functionally relevant region, the vMPFC, as a seed region to examine the intrinsic functional interactions and communication between the vMPFC and other brain regions in schizophrenic patients. We found hypo-connectivity between the vMPFC and the medial frontal cortex, right middle temporal lobe （MTL）, right hippocampus, parahippocampal cortex （PHC） and amygdala. Further, there was a decreased strength of the negative connectivity （or anticorrelation） between the vMPFC and the bilateral dorsal lateral prefrontal cortex （DLPFC） and pre-supplementary motor areas. Among these connectivity alterations, reduced vMPFC-DLPFC connectivity was positively correlated with positive symptoms on the Positive and Negative Syndrome Scale, while vMPFC-right MTL/PHC/amygdala functional connectivity was positively correlated with the performance of emotional regulation in patients. These findings imply that communication and coordination throughout the brain networks are disrupted in schizophrenia. The emotional correlates of vMPFC connectivity suggest a role of the hypo-connectivity between these regions in the neuropathology of abnormal social cognition in chronic schizophrenia.
基金supported by the National Natural Science Foundation of China(61074131,91132722)the Doctoral Fund of the Ministry of Education of China(20101202110007)
文摘Objective Working memory is a key cognitive function in which the prefrontal cortex plays a crucial role. This study aimed to show the firing patterns of a neuronal population in the prefrontal cortex of the rat in a working memory task and to explore how a neuronal ensemble encodes a working memory event. Methods Sprague-Dawley rats were trained in a Y-maze until they reached an 80% correct rate in a working memory task. Then a 16-channel microelectrode array was implanted in the prefrontal cortex. After recovery, neuronal population activity was recorded during the task, using the Cerebus data-acquisition system. Spatio-temporal trains of action potentials were obtained from the original neuronal population signals. Results During the Y-maze working memory task, some neurons showed significantly in- creased firing rates and evident neuronal ensemble activity. Moreover, the anticipatory activity was associated with the delayed alternate choice of the upcoming movement. In correct trials, the averaged pre-event firing rate （10.86 ± 1.82 spikes/ bin） was higher than the post-event rate （8.17 ± 1.15 spikes/bin） （P 〈0.05）. However, in incorrect trials, the rates did not differ. Conclusion The results indicate that the anticipatory activity of a neuronal ensemble in the prefrontal cortex may play a role in encoding working memory events.
文摘Medial tibial stress syndrome(MTSS) is a debilitating overuse injury of the tibia sustained by individuals whoperform recurrent impact exercise such as athletes and military recruits. Characterised by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, in most cases it is also an injury involving underlying cortical bone microtrauma, although it is not clear if the soft tissue or cortical bone reaction occurs first. Nuclear bone scans and magnetic resonance imaging(MRI) can both be used for the diagnosis of MTSS, but the patient's history and clinical symptoms need to be considered in conjunction with the imaging findings for a correct interpretation of the results, as both imaging modalities have demonstrated positive findings in the absence of injury. However, MRI is rapidly becoming the preferred imaging modality for the diagnosis of bone stress injuries. It can also be used for the early diagnosis of MTSS, as the developing periosteal oedema can be identified. Retrospective studies have demonstrated that MTSS patients have lower bone mineral density(BMD) at the injury site than exercising controls, and preliminary data indicates the BMD is lower in MTSS subjects than tibial stress fracture(TSF) subjects. The values of a number of tibial geometric parameters such as cross-sectional area and section modulus are also lower in MTSS subjects than exercising controls, but not as low as the values in TSF subjects. Thus, the balance between BMD and cortical bone geometry may predict an individual's likelihood of developing MTSS. However, prospective longitudinal studies are needed to determine how these factors alter during the development of the injury and to find the detailed structural cause, which is still unknown. Finite element analysis has recently been used to examine the mechanisms involved in tibial stress injuries and offer a promising future tool to understand the mechanisms involved in MTSS. Contemporary accurate diagnosis of either MTSS or a TSF includes a thorough clinical examination to identify signs of bone stress injury and to exclude other pathologies. This should be followed by an MRI study of the whole tibia. The cause of the injury should be established and addressed in order tofacilitate healing and prevent future re-occurrence.
文摘The medial ulnar collateral ligament complex of the elbow, which is comprised of the anterior bundle [AB, more formally referred to as the medial ulnar collateral ligament(MUCL)], posterior(PB), and transverse ligament, is commonly injured in overhead throwing athletes. Attenuation or rupture of the ligament results in valgus instability with variable clinical presentations. The AB or MUCL is the strongest component of the ligamentous complex and the primary restraint to valgus stress. It is also composed of two separate bands(anterior and posterior) that provide reciprocal function with the anterior band tight in extension, and the posterior band tight in flexion. In individuals who fail co-mprehensive non-operative treatment, surgical repair or reconstruction of the MUCL is commonly required to restore elbow function and stability. A comprehensive understanding of the anatomy and biomechanical properties of the MUCL is imperative to optimize reconstructive efforts, and to enhance clinical and radiographic outcomes. Our understanding of the native anatomy and biomechanics of the MUCL has evolved over time. The precise locations of the origin and insertion footprint centers guide surgeons in proper graft placement with relation to bony anatomic landmarks. In recent studies, the ulnar insertion of the MUCL is described as larger than previously thought, with the center of the footprint at varying distances relative to the ulnar ridge, joint line, or sublime tubercle. The purpose of this review is to consolidate and summarize the existing literature regarding the native anatomy, biomechanical, and clinical significance of the entire medial ulnar collateral ligament complex, including the MUCL(AB), PB, and transverse ligament.
