Kinematic measurement of the lumbar spine and pelvis in the normal population

Spinal and pelvis motion has been studied by a variety of different methods, the majority of which have a number of limitations. The present study investigated motion characteristics of the lumbar spine and pelvis using a three-dimensional optoelectronic system. The aim of our study was to determine kinematic parameters of spine and pelvis during trunk flexion, extension and lateral bending in normal, healthy subjects. Kinematic motion analysis was performed on 63 asymptomatic volunteers for four different trunk motions. This study has shown that the pelvis range of motion is affected by the gender Contribution of pelvic movement to trunk flexion was 50%, while pelvic angle was significantly higher in women. During lateral bending female subjects had statistically significant higher values of vertebral arc with respect to male subjects. During extension the contribution of pelvic movement was 45%. There was no significant difference found in total angle, pelvic angle and vertebral arc.     

Effects of fatigue on lower limb,pelvis and trunk kinematics and muscle activation: Gender differences

Background: Muscle fatigue is associated with biomechanical changes that may lead to anterior cruciate ligament (ACL) injuries. Alterations in trunk and pelvis kinematics may also be involved in ACL injury. Although some studies have compared the effects of muscle fatigue on lower limb kinematics between men and women, little is known about its effects on pelvis and trunk kinematics. The aim of the study was to compare the effects of fatigue on lower limb, pelvis and trunk kinematics and muscle activation between men and women during landing. Methods: The participants included forty healthy subjects. We performed kinematic analysis of the trunk, pelvis, hip and knee and muscle activation analysis of the gluteal muscles, vastus lateralis and biceps femoris, during a single-leg landing before and after fatigue. Results: Men had greater trunk flexion than women after fatigue. After fatigue, a decrease in peak knee flexion and an increase in Gmax and BF activation were observed. Conclusion: The increase in the trunk flexion can decrease the anterior tibiofemoral shear force resulted from the lower knee flexion angle, thereby decreasing the stress on the ACL.     

Transformation of the kidney pelvis and the major and minor calices during their development

The investigation has been performed in 28 series of histological sections of human embryos and prefetuses (4-20 weeks of the intrauterine development) and in 17 fetal corpses by means of certain histological methods, preparation of graphic reconstructive models, microscopy and fine preparation. The structural form of the definitive organ renal pelvis is demonstrated to depend on the ramification type of the metanephric duct derivatives. This is stipulated by interinductive processes of the ureteral sprout and metanephrogenic tissue. Quantitative and qualitative characteristics of the diverticulum ramification of the mesonephric duct during embryonic period of the prenatal ontogenesis predetermine the number of the calyces renalis majors and minors in the metanephros.     

Calcitonin gene-related peptide (CGRP)-immunoreactive nerve plexuses in the renal pelvis and ureter of rats

Summary The distribution of calcitonin gene-related peptide-immunoreactive nerve fibers in the renal pelvis and ureter was examined by immunohistochemistry using whole-mount preparations and cryostat sections. The patterns of innervation were contrasted between the pelvis and ureter; the immunoreactive nerve fibers in the pelvis ran parallel to the long axis of each of the circular and longitudinal muscle layers, causing a lattice-like appearance of the nerve fibers. In the ureter, the immunoreactive fibers were accumulated in the subepithelial region and the longitudinal muscle. In both the pelvis and ureter, a portion of the nerve fibers of smaller caliber showed a swollen or beaded structure; they were located in the musculature and beneath the epithelium extending for considerable distances. Ligation of the ureter caused a marked decrease in the immunoreactive nerves in the pelvis and the proximal portion of the ureter, suggesting that the axonal flow in the calcitonin gene-related peptide-containing neurons of the ureter runs towards the pelvis.     

Axial pelvis range of motion affects thorax-pelvis timing during gait

During gait, patients with pelvic girdle pain and low back pain demonstrate an altered phase relationship between axial thorax and pelvis rotations (thorax-pelvis relative phase). This could be the result of an increase in axial pelvis range of motion (ROM) which has been observed in these patients as well. To establish this relationship, we investigated if altered axial pelvis ROM during gait affects thorax-pelvis relative phase in 12 healthy subjects. These subjects walked on a treadmill and received real-time feedback on axial pelvis rotations. Subjects were asked to (1) walk normal, and walk with (2) decreased and (3) increased pelvis ROM. Gait speed and stride frequency were matched between trials. Subjects were able to increase pelvis ROM to a large extent, but the reduction in pelvis ROM was relatively small. Walking with large pelvis ROM resulted in a change in thorax-pelvis relative phase similar to that in pelvic girdle pain and low back pain. A forward dynamic model was used to predict the effect of manipulation of pelvis ROM on timing of thorax rotations independent of apparent axial trunk stiffness and arm swing amplitude (which can both affect thorax-pelvis relative phase). The model predicted a similar, even larger, effect of large axial pelvis ROM on thorax-pelvis relative phase, as observed experimentally. We conclude that walking with actively increased ROM of axial pelvis rotations in healthy subjects is associated with a shift in thorax-pelvis relative phase, similar to observations in patients with pelvic girdle pain and low back pain.     

The pelvis in the bipedalism of primates

The pelvis in the “Normalstellung” tends in man to tilt backwards. In primates, the pelvis shows a marked tendency to tilt into quadruped posture. In both the bodyweight intensifies those tendencies. Consequently, assuming erect posture and maintaining bipedal balance encounter, in primates, constant resistance from pelvis and bodyweight. In gibbons and ponginae loss of the tail, lengthening of the sacrum and broadening of the ilium combined with a pronounced development of the sacro-tuberous ligament furnish the gluteal muscles with a more powerful reflectory moment on pelvis and body. Moreover, the development of a short head of the femoral bicipital muscle, made the hip-joint to a greater degree independent of the knee-joint. Thus, maintenance of bipedal balance is better developed in gibbons and ponginae than in monkeys. In man broadening of the sacrum altered the position of the acetabulum. Together with ensuing changes of the ilium and the ischium this brought about in the pelvis a balance relationship so that the bodyweight not only causes no resistance to standing upright but even facilitates it. The essence of bipedalism, however, is not only the capacity to rise upright and to stand, but also to walk, that is, to keep the body balanced in the frontal plane on one leg. It is the ventralwards broadening of the ilium, and the sidewards bend of its middle segment, that allow, the strongest part of, the gluteus medius (and minimus) to produce a powerful abducent moment on the pelvis. The lack of a corresponding osteomuscular structure in monkeys as well as in gibbon and ponginae compels these primates to move faster and run straddle-legged, in a more or less forward-bending posture. Lastly it is found that in gibbons and ponginae, not only is the ilium markedly broadened laterally, but also that its sacral part is turned completely sidewards. This indicates that bipedalism in man has developed along quite other lines than in gibbons and ponginae.     

Abdominal muscle activation changes if the purpose is to control pelvis motion or thorax motion

The aim of this study was to compare trunk muscular recruitment and lumbar spine kinematics when motion was constrained to either the thorax or the pelvis. Nine healthy women performed four upright standing planar movements (rotations, anterior–posterior translations, medial–lateral translations, and horizontal circles) while constraining pelvis motion and moving the thorax or moving the pelvis while minimizing thorax motion, and four isometric trunk exercises (conventional curl-up, reverse curl-up, cross curl-up, and reverse cross curl-up). Surface EMG (upper and lower rectus abdominis, lateral and medial aspects of external oblique, internal oblique, and latissimus dorsi) and 3D lumbar displacements were recorded. Pelvis movements produced higher EMG amplitudes of the oblique abdominals than thorax motions in most trials, and larger lumbar displacements in the medial–lateral translations and horizontal circles. Conversely, thorax movements produced larger rotational lumbar displacement than pelvis motions during rotations and higher EMG amplitudes for latissimus dorsi during rotations and anterior–posterior translations and for lower rectus abdominis during the crossed curl-ups. Thus, different neuromuscular compartments appear when the objective changes from pelvis to thorax motion. This would suggest that both movement patterns should be considered when planning spine stabilization programs, to optimize exercises for the movement and muscle activations desired.     

Genotoxicity assessment in patients with thalassemia minor

Thalassemia is an inherited blood disorder that affects both genders and results in reduced synthesis of hemoglobin, and thus causing anemia. Previous studies have shown that the severe form of this disease, thalassemia major, is associated with genotoxicity. This includes increases in the level of sister chromatid exchange (SCEs), chromosomal aberrations (CAs) and micronuclei. In this study, we assessed genotoxicity in the lymphocytes of thalassemia minor subjects using sister chromatid exchange (SCE) and chromosomal aberration (CA) assays. In addition, we investigated the level of oxidative DNA damage by measuring 8-hydroxy-2'-deoxyguanosine (8OHdG) biomarker in urine samples. Eighteen thalassemia minor subjects and eighteen matched normal healthy controls were volunteered in the study. In addition, seven thalassemia major patients were recruited as positive controls. The results showed increases in the frequency of SCEs (P<0.05) in thalassemia minor compared to healthy controls. However, no difference in CAs frequency was detected between thalassemia minor and controls (P>0.05). Both SECs and CAs in thalassemia major patients were significantly higher compared to other groups (P<0.05). Regarding urine 8OHdG levels, the result showed a slight increase in thalassemia minor compared to healthy controls but the difference was not significant (P>0.05). In conclusion, our results showed that thalassemia minor is associated with genotoxicity to blood lymphocytes as indicated by SCEs assay.     

The effects of major and minor trauma on lymphocyte kinetics in mice.

The effects of major and minor trauma on the circulating white blood cell populations of C57BL mice were followed. The results showed that not only major trauma (nephrectomy) but minor injury and stress (e.g. injection, bleeding) triggered a highly significant fall (50-70%) in the number of lymphocytes circulating in the blood. The fall was a gradual one, with the maximal drop 2 h after the operation or handling procedure. Major trauma resulted in a fall in both B and T lymphocytes. Minor trauma produced a fall in B lymphocytes only. A 3-4 fold increase in circulating polymorph numbers also accompanied major trauma, but no increase was observed after minor trauma. The blood picture returned to normal generally within 24 h of both minor and major trauma. Repetition of the trauma stimulus after recovery led to a renewed trauma response. Bilateral adrenalectomy abolished the lymphocyte response to major and minor trauma and decreased the polymorph response to major trauma by more than 50%, indicating that stress hormones played a role in these changes. Studies with 51chromium-labelled lymphocytes, transferred into traumatized and adrenalectomized animals, suggested that decreased entry of lymphocytes into the blood (rather than increased exit from the blood into the tissues, or cell death) was the most likely mechanism of the lymphopenia following trauma.     

3D reconstruction of the pelvis from bi-planar radiography

3D personalized models are more and more requested for clinical and biomechanical studies. Techniques based on bi-planar X-rays present the advantage of a low radiation dose for the patient. However, up to now, such techniques have shown limited accuracy in the case of pelvis reconstruction. This study proposes and validates a method providing accurate 3D personalized model of the pelvis from bi-planar X-rays. The algorithm is based on the fast computation of an initial solution followed by local deformations based on 2D anatomical points and contours that are digitized in both radiographs. Results were close to CT-scan reconstructions (mean difference 1.6 mm and differences under 4.3 mm for 95% of the points). Moreover, 3D morphometry of the pelvis could be obtained with an accuracy of 5%. This technique provides 3D patient specific model with a low radiation dose.     

The multifactor pelvis: An alternative to the adaptationist approach of the obstetrical dilemma

The obstetrical dilemma describes the competing demands that a bipedally adapted pelvis and a large-brained neonate place on human childbirth and is the predominant model within which hypotheses about the evolution of the pelvis are framed. I argue the obstetrical dilemma follows the adaptationist program outlined by Gould and Lewontin in 1979 and should be replaced with a new model, the multifactor pelvis. This change will allow thorough consideration of nonadaptive explanations for the evolution of the human pelvis and avoid negative social impacts from considering human childbirth inherently dangerous. First, the atomization of the pelvis into discrete traits is discussed, after which current evidence for both adaptive and nonadaptive hypotheses is evaluated, including childbirth, locomotion, shared genetics with other traits under selection, evolutionary history, genetic drift, and environmental and epigenetic influences on the pelvis.     

Movement of the human pelvis and displacement of related anatomical landmarks on the body surface

Anatomical landmarks on the body surface can be measured with high accuracy by using rasterstereography and surface curvature analysis. The present study shows that the lumbar dimples can be localized with a statistical error of about 1 mm. It is generally assumed that the dimples are in close relation to the pelvis (in particular to the PSISs) and may thus be taken as indicators for pelvis movements. By introducing an artificial pelvis tilt of up to +/- 10 degrees this relation was examined. In fact, a nearly perfect correlation (r approximately equal to 0.99) between landmark and pelvis movements was observed. Asymmetries of pelvis motion due to scoliotic deformity were not observed. There was, however, a systematic lag of the dimple movements, resulting in a displacement of the dimples of up to +/- 1.5 mm relative to the pelvis (for +/- 10 degrees pelvis tilt). Either a soft tissue effect or a torsion of the pelvis may be responsible for this behaviour. The theory of pelvis torsion is confirmed by the fact that the orientation of the back surface at the locus of the dimples reveals a corresponding torsion of similar magnitude and sign. A torsion angle of about +/- 1.5 degrees in either sacro-iliac joint is sufficient to explain the observed dimple lag and the surface torsion. An independent measurement (e.g. using roentgenphotogrammetry) would be desirable to further validate this theory. According to our measurements the dimples of the PSISs cannot be taken as exact indicators for orientation and movement of the pelvis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Benign mixed epithelial stromal tumor of the renal pelvis with exophytic growth: case report

Background

Mixed epithelial and stromal tumor (MEST) is a distinctive benign composite neoplasm of the kidney predominantly seen in females mostly in the perimenopausal period. Although these tumors are known to arise from renal pelvis, our case was distinct in that it had no intrapelvic component growing in exophytic fashion.

Case report

A 35 year old female patient presented to us with vague abdominal pain. She had undergone excision of bilateral ovarian cystic masses for cystic teratoma twelve years earlier. A computed tomography scan of abdomen and pelvis showed a 9 × 7 cm uniformly solid mass with poor contrast enhancement situated in the inferomedial aspect of the left kidney. On exploration, the mass was arising from the inferior and anterior aspect of left renal pelvis, and was attached to it with a narrow pedicle. There was no adherence or attachment to the renal parenchyma. The mass was excised preserving the kidney. Microscopically, the tumor was composed of large collagenized areas containing bundles of spindle cells and several 'microcysts' lined by cuboidal epithelium suggestive of a benign mixed epithelial stromal tumor.

Discussion

Mixed epithelial tumors usually present in perimenopausal women as a partially cystic mass. Tumors are composed of irregular mixtures of cystic and solid areas, glands with variable complexity and distribution and the stromal component is characterized by a spindle cell proliferation. Commonly, it arises from the renal parenchyma and pelvis and nephrectomy is advocated to manage these tumors.

Conclusion

MEST is a distinctive benign tumor of the kidney that should be distinguished from other renal neoplasms. MEST arising from the renal pelvis and growing exophytically is a rare entity. The overall prognosis is favorable.

     

Thorax and pelvis kinematics during the downswing of male and female skilled golfers

Thorax and pelvis motion during the golf swing have most frequently been described for male golfers at discrete points during the swing, such as top of backswing (TBS) and ball contact (BC). Less is known about the continual motion and coordination of the thorax and pelvis throughout the downswing for either male or female golfers. The purpose of this study was to present detailed 3D kinematic profiles of thorax and pelvis motion during the downswing, and to determine if differences in kinematics exist between male and female skilled golfers. Thorax and pelvis data were collected from 19 male (26±7 years) and 19 female (25±7 years) skilled golfers (handicap ≤4) using an optical motion analysis system. 3D segment position, orientation and angular velocity were calculated, along with phase plane trajectories and thorax–pelvis separation angles. At BC males had greater pelvis posterior tilt, greater pelvis and thorax lateral tilt to the right, and less pelvis and thorax axial rotation to the left compared to females. Males achieved greater peak thorax and pelvis angular velocity, and angular velocity at BC, in the anterior–posterior and lateral tilt directions. Phase plane trajectories revealed that males and females had similar thorax lateral tilt and anterior–posterior tilt angular velocity–displacement relationships at TBS, yet by BC males had greater tilt angles and velocities compared to females. Collectively, the results suggest that male and female skilled golfers have different kinematics for thorax and pelvis motion, predominantly for lateral and anterior–posterior tilt. What might be considered optimal swing characteristics for male golfers should not be generalized to female golfers.     

Anemia,differentiating between thalassemia minor and iron deficiency

Many of the conditions noted in examination of the blood of patients with thalassemia minor are much like those observed in patients with iron deficiency anemia. A study was made of similarities and contrasts between blood and bone marrow features in both conditions for purposes of differential diagnosis. A salient distinction is that bone marrow hemosiderin is present in normal amount in patients with thalassemia minor, but not in those with iron deficiency anemia. If therapy with iron does not restore hemoglobin values to normal, thalassemia minor is strongly suspect. Even in the latter disease, however, there may be small fluctuations in hemoglobin values, particularly in pregnancy. One must be alert to this possibility lest a slight, fleeting increase in hemoglobin be mistakenly ascribed to iron therapy.     

Suppressor T cell recognition of major and minor histocompatibility alloantigens: selected suppression of MHC-directed responses by minor alloantigen Ts

The induction of suppression by i.v. administered alloantigens in the murine host was analyzed as a model of the possible effects of blood transfusion on transplant survival. The results indicated that suppressor T cells (Ts) specific for minor histocompatibility alloantigens could be readily induced by the i.v. presentation of minor alloantigen-disparate spleen cells. In contrast, similar priming with cells differing solely at the H-2 major histocompatibility complex stimulated only positive T cell immunity, with no evidence of suppression. The induction of H-2 directed Ts activity could be accomplished only by i.v. priming with major plus minor incompatible donor cells, suggesting that suppressor cell recognition of minor alloantigens may have facilitated the generation of Ts against H-2-encoded major transplantation antigens. A role for minor histocompatibility antigens in the regulation of H-2-specific immunity at the effector level was also indicated. Ts induced by i.v. pretreatment with minor antigen-disparate donor cells not only suppressed the delayed-type hypersensitivity (DTH) response to the relevant minor alloantigens, but also inhibited DTH against unrelated H-2 alloantigens introduced during subsequent intradermal immunization. Suppression of H-2-directed T cell reactivity was specific in that the presence of the Ts-inducing minor alloantigens was also required and occurred only when the minor and unrelated major alloantigens were presented within the same inoculum, if not on the same cell surface. The capacity of Lyt-2+Ts or Ts-derived suppressive factors specific for one set of cell surface molecules to modulate responses to an unrelated group of surface antigens does not appear to represent a general phenomenon, because similar suppression of immunity to unrelated tumor-specific transplantation antigens by minor-specific Ts was not observed. These results are discussed with respect to the possible mechanism of H-2-directed suppression and the role of the I region in Ts recognition of antigen.     

Sex differences in the growth of the human bony pelvis

The study of individual patterns of longitudinal growth of the bony pelvic complex reveals the following findings concerning the sex differences in the growth of the bony pelvis. (1) The patterns of growth show the same individual variability and male-female overlap as the adult configuration of pelves. (2) The sex differences in the adult bony pelvis cannot be attributed to the differential response of one bone to sex hormone. (3) Sex differences develop from complicated variations in rates and direction of growth of local areas of the pelvic complex. (4) The superior functional division of the bony pelvis shows only one notable sex difference — the sexual dimorphism of the directional growth of the anterior one-half of the iliac crest. (5) The inferior functional division of the bony pelvis shows numerous local areas of sexually dimorphic growth, but the major sex differences result from the greater lateral migration of the ischia. (6) Of the regions showing definite sexual dimorphism in growth, the pelvic inlet and sciatic notch are the more variable because of their dependency on two separate anatomical systems for their final adult morphological configuration. The subpubic angle and length of the superior pubic ramus are directly associated with only one anatomical system, the enlargement of the pelvic cavity, thus, they show less variability and more definitive sex difference.     

A biomechanical model on muscle forces in the transfer of spinal load to the pelvis and legs.

Based on musculoskeletal anatomy of the lower back, abdominal wall, pelvis and upper legs, a biomechanical model has been developed on forces in the load transfer through the pelvis. The aim of this model is to obtain a tool for analyzing the relations between forces in muscles, ligaments and joints in the transfer of gravitational and external load from the upper body via the sacroiliac joints to the legs in normal situations and pathology. The study of the relation between muscle coordination patterns and forces in pelvic structures, in particular the sacroiliac joints, is relevant for a better understanding of the aetiology of low back pain and pelvic pain. The model comprises 94 muscle parts, 6 ligaments and 6 joints. It enables the calculation of forces in pelvic structures in various postures. The calculations are based on a linear/non-linear optimization scheme. To gain a better understanding of the function of individual muscles and ligaments, deviant properties of these structures can be preset. The model is validated by comparing calculations with EMG data from the literature. For agonistic muscles, good agreement is found between model calculations and EMG data. Antagonistic muscle activity is underestimated by the model. Imposed activity of modelled antagonistic muscles has a minor effect on the mutual proportions of agonistic muscle activities. Simulation of asymmetric muscle weakness shows higher activity of especially abdominal muscles.     

Exfoliative cytology of a primary adenocarcinoma of the renal pelvis. A case report

The cytologic features of a primary adenocarcinoma of the renal pelvis in a 64-year-old woman are reported. Cytologic examination of voided urine revealed an ordinary papillary pattern, characterized by clumping of cells with nuclear overlapping, eccentric position of nuclei and cytoplasmic vacuolization due to mucus production. Leukocytes and micro-organisms were also present. Multiple lesions of papillary adenocarcinoma were subsequently found in the right renal pelvis and ureter. The histogenesis of the primary adenocarcinoma seemed to be closely related to columnar-cell metaplasia of lining of the renal pelvis of this patient, who had previously been treated for tuberculosis of the urinary bladder.     

Subject-specific finite element model of the pelvis: development, validation and sensitivity studies

A better understanding of the three-dimensional mechanics of the pelvis, at the patient-specific level, may lead to improved treatment modalities. Although finite element (FE) models of the pelvis have been developed, validation by direct comparison with subject-specific strains has not been performed, and previous models used simplifying assumptions regarding geometry and material properties. The objectives of this study were to develop and validate a realistic FE model of the pelvis using subject-specific estimates of bone geometry, location-dependent cortical thickness and trabecular bone elastic modulus, and to assess the sensitivity of FE strain predictions to assumptions regarding cortical bone thickness as well as bone and cartilage material properties. A FE model of a cadaveric pelvis was created using subject-specific computed tomography image data. Acetabular loading was applied to the same pelvis using a prosthetic femoral stem in a fashion that could be easily duplicated in the computational model. Cortical bone strains were monitored with rosette strain gauges in ten locations on the left hemipelvis. FE strain predictions were compared directly with experimental results for validation. Overall, baseline FE predictions were strongly correlated with experimental results (r2=0.824), with a best-fit line that was not statistically different than the line y=x (experimental strains = FE predicted strains). Changes to cortical bone thickness and elastic modulus had the largest effect on cortical bone strains. The FE model was less sensitive to changes in all other parameters. The methods developed and validated in this study will be useful for creating and analyzing patient-specific FE models to better understand the biomechanics of the pelvis.