Effect of the intra-abdominal pressure and the center of segmental body mass on the lumbar spine mechanics - a computational parametric study

Determination of physiological loads in human lumbar spine is critical for understanding the mechanisms of lumbar diseases and for designing surgical treatments. Computational models have been used widely to estimate the physiological loads of the spine during simulated functional activities. However, various assumptions on physiological factors such as the intra-abdominal pressure (IAP), centers of mass (COMs) of the upper body and lumbar segments, and vertebral centers of rotation (CORs) have been made in modeling techniques. Systematic knowledge of how these assumptions will affect the predicted spinal biomechanics is important for improving the simulation accuracy. In this paper, we developed a 3D subject-specific numerical model of the lumbosacral spine including T12 and 90 muscles. The effects of the IAP magnitude and COMs locations on the COR of each motion segment and on the joint/muscle forces were investigated using a global convergence optimization procedure when the subject was in a weight bearing standing position. The data indicated that the line connecting the CORs showed a smaller curvature than the lordosis of the lumbar spine in standing posture when the IAP was 0?kPa and the COMs were 10?mm anterior to the geometric center of the T12 vertebra. Increasing the IAP from 0 kPa to 10 kPa shifted the location of CORs toward the posterior direction (from 1.4?±?8.9 mm anterior to intervertebral disc (IVD) centers to 40.5?±?3.1 mm posterior to the IVD centers) and reduced the average joint force (from 0.78?±?0.11 Body weight (BW) to 0.31?±?0.07 BW) and overall muscle force (from 349.3?±?57.7 N to 221.5?±?84.2 N). Anterior movement of the COMs from -30 mm to 70 mm relative to the geometric center of T12 vertebra caused an anterior shift of the CORs (from 25.1?±?8.3 mm posterior to IVD centers to 7.8?±?6.2 mm anterior to IVD centers) and increases of average joint forces (from 0.78?±?0.1 BW to 0.93?±?0.1 BW) and muscle force (from 348.9?±?47.7 N to 452.9?±?58.6 N). Therefore, it is important to consider the IAP and correct COMs in order to accurately simulate human spine biomechanics. The method and results of this study could be useful for designing prevention strategies of spinal injuries and recurrences, and for enhancing rehabilitation efficiency.     

In-vivo motion characteristics of lumbar vertebrae in sagittal and transverse planes

Lumbar vertebrae are complicated in structure and function. The purpose of this study was to investigate the in-vivo motion characteristics of different portions of the lumbar vertebrae during functional activities. Motion of L2, L3 and L4 was reproduced using a combined dual fluoroscopic and MR imaging technique during flexion–extension and left–right twisting of the trunk. The ranges of motion (ROM) of the proximal vertebra with respect to the distal one at 3 representative locations: the center of the vertebral body, the center of the spinal canal and the tip of the spinous process were measured. Centers of rotation (COR) of the vertebrae were then determined by calculation of the points of zero motion in 2D sagittal and transverse planes. During flexion–extension, the center of the vertebral body moved less than 0.6 mm, while the tip of the spinous process moved less than 7.5 mm in the sagittal plane. The CORs of both L23 (L2 with respect to L3) and L34 were located inside the vertebral body, at a distance about one-third the length of the vertebral body from the posterior edge. During left–right twisting, the center of the vertebral body moved less than 1.0 mm, while the tip of the spinous process moved less than 1.6 mm in the transverse plane. The CORs of both L23 and L34 were located approximately 30 mm anterior to the front edge of the vertebral body. The results of this study may be used to define the ideal locations for surgical placement of the disc prosthesis, thus help improve the prosthesis design and surgical treatment of various pathological conditions.     

菱臼齿兽((犭亚)目、哺乳纲)耳区的骨骼结构

本文详细描述了菱臼齿兽耳区各个部分的基本结构;并指出了耳区结构与某些啮齿类的相似性,以及中耳鼓泡组成成份与戈壁(犭亚)兽(Anagale gobiensis)的区别。     

Functional interactions of the inferior frontal cortex during the processing of words and word-like stimuli

The hypothesis that ventral/anterior left inferior frontal gyrus (LIFG) subserves semantic processing and dorsal/posterior LIFG subserves phonological processing was tested by determining the pattern of functional connectivity of these regions with regions in left occipital and temporal cortex during the processing of words and word-like stimuli. In accordance with the hypothesis, we found strong functional connectivity between activity in ventral LIFG and activity in occipital and temporal cortex only for words, and strong functional connectivity between activity in dorsal LIFG and activity in occipital and temporal cortex for words, pseudowords, and letter strings, but not for false font strings. These results demonstrate a task-dependent functional fractionation of the LIFG in terms of its functional links with posterior brain areas.     

Morphological aspects and biomechanical properties of the vertebroaxial joint (C2-C3).

The C2-C3 intervertebral joint must be regarded as a transitional area situated between the upper cervical spine where most rotation of the neck and little flexion and extension occur and the lower cervical spaces where chiefly motion in the sagittal plane and also somewhat rotation take place. Under normal circumstances the range of flexion-extension reaches 11 degrees, slighter than below (19.5 degrees at C5-C6); on the opposite, the range of rotation attains 7 degrees; less than above but much more than below (0 degrees at C5-C6). The motion in the sagittal and coronal planes is relatively poor because of the location of Penning's motor-axis of C2 which runs far from the vertebral body and the lowness of the intervertebral disc. However, the rotation of C2 with respect to C3 is fair by the peculiar inclination of the articular facets which slope sagittally but also coronally and trace a sphere whereupon C2 may move around its motor-centre in any plane. When C2-C3 is surgically fixed by bone graft, the lack of motion is completed by a "compensatory movement" in the upper cervical spaces and especially at the atlantooccipital joint for flexion-extension. In the same way, C2-C3 may improve its mobility especially in the sagittal plane when the inferior partner is blocked by surgical or arthritic fusion.     

A clinical and anatomical study of the location of the mental foramen in adult Chinese mandibles

One hundred mandibles of adult Chinese cadavers of both sexes without missing teeth, alveolar bone resorption and malposition of teeth were studied. The anatomical location of each mandibular mental foramen was measured by using a combination of three previous methods. Our results showed that the location of the mental foramen below the apex of the lower second premolar (relation IV: 58.98%) was the most common. On average, the distance between the most anterior portion of the anterior border of the mental foramen and the mandibular symphysis was 28.06 mm, between the most anterior portion of the anterior border of the mental foramen and the posterior border of the ramus 74.14 mm, between the inferior border of the mental foramen and the lower border of the mandibular body 14.70 mm, between the superior border of the mental foramen and the bottom of the lower second premolar socket 2.50 mm. The distance across the mental foramen between the alveolar crest and the lower border of the mandibular body was 30.29 mm. Our results were compared with those of other investigators. The significance of identifying the anatomical location of the mental foramen in dental practice is discussed.     

Functional analysis of the rabbit temporomandibular joint using dynamic biplane imaging

The dynamic function of the rabbit temporomandibular joint (TMJ) was analyzed through non-invasive, three-dimensional skeletal kinematics, providing essential knowledge for understanding normal joint motion. The objective of this study was to evaluate and determine repeatable measurements of rabbit TMJ kinematics. Maximal distances, as well as paths were traced and analyzed for the incisors and for the condyle–fossa relationship. From one rabbit to another, the rotations and translations of both the incisors and the condyle relative to the fossa contained multiple clear, repeatable patterns. The slope of the superior/inferior incisor distance with respect to the rotation about the transverse axis was repeatable to 0.14 mm/deg and the right/left incisor distance with respect to the rotation about the vertical axis was repeatable to 0.03 mm/deg. The slope of the superior/inferior condylar translation with respect to the rotational movement about the transverse axis showed a consistent relationship to within 0.05 mm/deg. The maximal translations of the incisors and condyles were also consistent within and between rabbits. With an understanding of the normal mechanics of the TMJ, kinematics can be used to compare and understand TMJ injury and degeneration models.     

Increased resorptive activity and accompanying morphological alterations in osteoclasts derived from the oim/oim mouse model of osteogenesis imperfecta

The current study addresses whether alterations in osteoclasts (OCs) derived from oim/oim mice, an established model of moderate-to-severe OI, are present. Bone marrow cells from oim/oim and wildtype (+/+) mice were cultured on bone slices in the presence of MCSF and RANKL and evaluated at days 0, 1, 2, 4, and 7. OCs were identified by tartrate-resistant acid phosphatase (TRAP) staining, and bone slice resorption pits were analyzed by reflection microscopy. Flow cytometry was used to examine CD51 (integrin alphaV) and CD61 (integrin beta3) markers. Confocal microscopy was used to assess changes in OC morphology and resorption. There was no difference between the OC precursors of the two genotypes in expression of CD51 and CD61 markers. At day 2, the bone slices seeded with oim/oim cells had a greater percentage of mononuclear cells associated with resorption pits compared to +/+ bone slices. At day 4, the diameter and area of oim/oim OCs were larger compared to the +/+ OCs, and the number of nuclei per OC was also greater for the oim/oim group. At day 7, the oim/oim OCs contained more F-actin rings compared to the +/+ OCs, and the number of OCs in the oim/oim group was greater compared to the +/+ group. The resorbed area of bone slices for the oim/oim group was also greater compared to the +/+ group at day 7. In conclusion, oim/oim mononuclear resorbing cells and OCs showed cellular changes and greater resorptive activity compared to +/+ cells, features that likely contribute to dysregulated bone remodeling in OI.     

The course of the inferior alveolar nerve in the normal human mandibular ramus and in patients presenting for cosmetic reduction of the mandibular angles

This study was undertaken to quantify the path of the inferior alveolar nerve in the normal human mandible and in the mandibles of patients presenting for cosmetic reduction of the mandibular angles. The goals were: (1) to provide normative information that would assist the surgeon in avoiding injury to the nerve during surgery; (2) to characterize gender differences in the normal population; and (3) to compare the course of the nerve in the normal population to its course in a group of patients who presented with a complaint of "square face." The study was based upon the computerized tomographic scans of 10 normal patients (six men, four women) and 8 patients (all women) complaining of "square face." Using AnalyzePC 2.5 imaging software, the mandibles were segmented and the position of the nerve was recorded within its osseous canal in the mandibular ramus on each axial slice in which it was identifiable. Distances were calculated between the nerve and the anterior, posterior, lateral, and medial cortices. The positions of the lateral ramus prominence and the lowest point on the sigmoid notch were also recorded. The position of the mental foramen was recorded in relation to the nearest tooth, and the three-dimensional surface distances from the foramen to the alveolar bone, the inferior border of the mandible, and the mandibular symphysis were determined. The distances from the entrance of the nerve into the mandible to the lateral ramus prominence and the lowest point on the sigmoid notch were calculated. Summary statistics were obtained, comparing differences in gender. The nerve was identifiable in each ramus over a mean distance of 12.7 mm. On average, the lateral ramus prominence was 0.3 mm higher on the caudad-cephalad axis than the point at which the nerve entered the bone, whereas the location of the lowest point on the sigmoid notch was 16.6 mm above the nerve. The average distances from the nerve to the anterior, posterior, medial, and lateral cortices were 11.6, 12.1, 1.8, and 4.7 mm, respectively. Gender differences were significant for all of these except the medial cortex to nerve distance. On average, the mental foramen exited the body of the mandible immediately below the second premolar and the average surface distances from the foramen to the symphysis, the most cephalad alveolar bone, and the inferior border of the body were 30.9, 14.2, and 19.3 mm, respectively. With regard to the patients presenting for mandibular angle reduction, there were a few statistically significant but small scalar differences from normal controls.     

颧根与侧颅底重要结构的解剖学测量

目的：通过测量颧根与侧颅底各重要结构间的距离关系,为临床侧颅底外科手术治疗提供定位参考。方法：取成人颅骨标本50例（去颅盖标本8例,整颅42例）100侧,用游标卡尺、圆规和直尺测量颧根与侧颅底重要结构的距离。结果：实验测得左右侧颧根与外耳门前缘中点、乳突尖、茎突、翼突外侧板根部、舌下神经管外口、茎乳孔、颈静脉孔外缘、颈动脉管外口后缘、棘孔、卵圆孔、破裂孔的距离分别为22.30±2.84mm和22.02±3.27mm、40.37±3.21mm和40.56±3.54mm、32.53±2.78mm和32.92±2.68mm、35.13±3.14mm和35.19±2.74mm、49.29±2.88mm和48.98±2.87mm、32.92±2.44mm和33.05±2.61mm、35.15±2.86mm和34.68±3.13mm、33.17±2.78mm和33.17±2.72mm、28.83±2.62mm和28.68±2.63mm、31.15±2.76mm和31.49±2.73mm、43.67±3.32mm和44.15±3.02mm,左右侧数据无差异（P〉0.05）。结论：颧根可以作为侧颅底外科手术的定位标志,为直视条件下经颞下等入路的侧颅底外科手术提供解剖学依据。     

Tumor necrosis factor stimulates osteoclastogenesis from human bone marrow cells under hypoxic conditions

Bone homeostasis is maintained by the balance between osteoblastic bone formation and osteoclastic bone resorption. In this study, we used human bone marrow cells (BMCs) to investigate the role of hypoxic exposure on human osteoclast (OC) formation in the presence of tumor necrosis factor (TNF). Exposing the BMCs to 3%, 5%, or 10% O₂ in the presence of receptor activator of NF-κB ligand (RANKL) and macrophage colony-stimulating factor (M-CSF) generated tartrate-resistant acid phosphatase (TRAP)-positive multinuclear cells, consistent with OCs. The addition of TNF under hypoxic conditions generated significantly greater numbers of mature OCs with more nuclei than OCs generated under normoxic conditions. Longer initial hypoxic exposure increased the number of OC precursor cells and facilitated the differentiation of OC precursor cells into multinucleated OCs. Quantitative RT-PCR analysis revealed that RANKL and TNFR1 were expressed at higher levels in non-OC cells from BMCs under hypoxic conditions than under normoxic conditions. Furthermore, to confirm the involvement of TNF-induced signaling, we examined the effects of blocking antibodies against TNFR1 and TNFR2 on OC formation under hypoxic conditions. The TNFR1 antibody was observed to significantly suppress OC formation. These results suggest that hypoxic exposure plays an important role in TNF-induced osteoclastogenesis from human BMCs.     

Gender and the active smoking and high-sensitivity C-reactive protein relation in late adolescence

C-reactive protein (CRP), smoking, and oral contraceptive (OC) use are associated with CVD risk in adults. This study examines the effect of smoking on high-sensitivity CRP (hs-CRP) levels, and the interactive effects of sex and OC use on this relationship in an adolescent cohort. A total of 1,050 adolescents (mean age 17 ± 0.25 years) from the Western Australian Pregnancy Cohort (Raine) Study had anthropometric, lifestyle, and metabolic measures recorded. The association between smoking status and log-transformed hs-CRP was analyzed using multivariable Tobit linear regression models, with adjustment for adiposity, lifestyle, and early-life confounders. A three-level variable (girls not using OCs, girls using OCs, and boys) was employed to assess the interactive effects of sex, OC use, and smoking. Smoking associated with higher hs-CRP levels in girls not using OCs (b = 0.571; P = 0.001), but not in girls using OCs (b = −0.117; P = 0.598) or in boys (b = 0.183; P = 0.2). OC use in nonsmoking girls was the strongest factor associated with higher hs-CRP levels (b = 1.189; P < 0.001). This study has demonstrated a more robust effect of smoking on hs-CRP levels in girls not using OCs compared with boys. The findings may explain why CVD risk conferred by smoking is higher in women than in men.     

Regulation of Hepatic Drug Transporter Activity and Expression by Organochlorine Pesticides

Organochlorine (OC) pesticides constitute a major class of persistent and toxic organic pollutants, known to modulate drug‐detoxifying enzymes. In the present study, OCs were demonstrated to also alter the activity and expression of human hepatic drug transporters. Activity of the sinusoidal influx transporter OCT1 (organic cation transporter 1) was thus inhibited by endosulfan, chlordane, heptachlor, lindane, and dieldrine, but not by dichlorodiphenyltrichloroethane isomers, whereas those of the canalicular efflux pumps MRP2 (multidrug resistance‐associated protein 2) and BCRP (breast cancer resistance protein) were blocked by endosulfan, chlordane, heptachlor, and chlordecone; this latter OC additionally inhibited the multidrug resistance gene 1 (MDR1)/P‐glycoprotein (P‐gp) activity. OCs, except endosulfan, were next found to induce MDR1/P‐gp and MRP2 mRNA expressions in hepatoma HepaRG cells; some of them also upregulated BCRP. By contrast, expression of sinusoidal transporters was not impaired (organic anion‐transporting polypeptide (OATP) 1B1 and OATP2B1) or was downregulated (sodium taurocholate co‐transporting polypeptide (NTCP) and OCT1). Such regulations of drug transporter activity and expression, depending on the respective nature of OCs and transporters, may contribute to the toxicity of OC pesticides.     

Lower blepharoplasty using bony anatomical landmarks to identify and avoid injury to the inferior oblique muscle

In the resection of redundant orbital fat during lower blepharoplasty, selective excision is performed from the medial, central, and lateral compartments. During transcutaneous blepharoplasty, the inferior oblique muscle is susceptible to injury because of its intimate association between the medial and central compartments. When performing a transconjunctival approach, the inferior oblique muscle is even more susceptible to injury because it lies in the direct path of dissection for fat pad exposure. Injury to the inferior oblique muscle can result in symptoms ranging from transient diplopia to a more debilitating permanent strabismus. Fresh cadaver heads were used to identify bony anatomical landmarks that would help to more accurately define the origin and body of the inferior oblique muscle. The orbital rim, infraorbital foramen, and supraorbital notch were chosen as guideline landmarks. The origin of the inferior oblique muscle was designated with respect to the above structures, and the muscle course was delineated. The inferior oblique muscle originates on the orbital floor, 5.14 +/- 1.21 mm posterior to the inferior orbital rim, on a line extending from the infraorbital foramen to 10 +/- 0.9 mm inferior to the supraorbital notch along the supramedial orbital rim. The muscle belly extends from this origin to its insertion into the posterolateral globe in an oblique direction toward the lateral canthal area. Identification of the orbital rim, infraorbital foramen, and supraorbital notch more accurately localizes the origin and course of the inferior oblique muscle, which may facilitate fat resection during lower blepharoplasty by preventing morbidity associated with inferior oblique muscle injury.     

The death receptor DR5 is involved in TRAIL-mediated human osteoclast apoptosis

The number and activity of osteoclasts (OCs) are critical for maintaining normal bone turnover. The number is determined by the rates of cell differentiation and death. TNF-related apoptosis-inducing ligand (TRAIL), a member of the TNF superfamily, induces apoptosis by interacting with its death receptors, (DR4, DR5). However, its activity can be modulated by two decoy receptors, (DcR1 and DcR2). In this paper we show that TRAIL treatment causes reduced OC viability as well as an increased apoptotic OC number. Loss of nuclei integrity and derangement of the actin microfilament were also induced by TRAIL in OCs. Moreover, we demonstrated the expression of all TRAIL receptors in both precursors and differentiated OCs, and the upregulation of DR5 during OC differentiation. Interestingly, DcR2 was upregulated in the early stage of osteoclastogenesis and downregulated at the end of the differentiation process. We showed that DR5, upregulated by TRAIL, could be the mediator of TRAIL-induced OC apoptosis, since the addition of anti-DR5 neutralizing antibodies restores the OC viability previously reduced by TRAIL. Furthermore, the intracellular pathway induced by TRAIL in OCs involves caspase-8 and Bid activation. In conclusion, our data highlight an important role for the TRAIL/TRAIL receptor system in the regulation of OC apoptosis.     

M-CSF potently augments RANKL-induced resorption activation in mature human osteoclasts

Macrophage-CSF (M-CSF) is critical for osteoclast (OC) differentiation and is reported to enhance mature OC survival and motility. However, its role in the regulation of bone resorption, the main function of OCs, has not been well characterised. To address this we analysed short-term cultures of fully differentiated OCs derived from human colony forming unit-granulocyte macrophages (CFU-GM). When cultured on dentine, OC survival was enhanced by M-CSF but more effectively by receptor activator of NFκB ligand (RANKL). Resorption was entirely dependent on the presence of RANKL. Co-treatment with M-CSF augmented RANKL-induced resorption in a concentration-dependent manner with a (200-300%) stimulation at 25 ng/mL, an effect observed within 4-6 h. M-CSF co-treatment also increased number of resorption pits and F-actin sealing zones, but not the number of OCs or pit size, indicating stimulation of the proportion of OCs activated. M-CSF facilitated RANKL-induced activation of c-fos and extracellular signal-regulated kinase (ERK) 1/2 phosphorylation, but not NFκB nor nuclear factor of activated T-cells, cytoplasmic-1 (NFATc1). The mitogen-activated protein kinase kinase (MEK) 1 inhibitor PD98059 partially blocked augmentation of resorption by M-CSF. Our results reveal a previously unidentified role of M-CSF as a potent stimulator of mature OC resorbing activity, possibly mediated via ERK upstream of c-fos.     

IL‐1α and IL‐1β have different effects on formation and activity of large osteoclasts

Interleukin 1 (IL‐1) is a proinflammatory cytokine upregulated in conditions such as rheumatoid arthritis and periodontal disease. Both isoforms, IL‐1α and IL‐1β, have been shown to activate osteoclasts (OCs), the cells responsible for resorbing bone. Inflammatory conditions are also characterized by increased bone loss and by the presence of large OCs (10+ nuclei). We and others have previously shown that large OCs are more likely to be resorbing compared to small OCs (2–5 nuclei). Moreover, large OCs express higher levels of the IL‐1 activating receptor IL‐1RI, integrins αv and β3, RANK, and TNFR1, while small OCs have higher levels of the decoy receptor IL‐1RII. We hypothesized that IL‐1 would have different effects on large and small OCs due to these distinct receptor expression patterns. To test this hypothesis, RAW 264.7 cells were differentiated into populations of small and large OCs and treated with IL‐1α or IL‐1β (1 and 10 ng/ml). In the presence of sRANKL, both IL‐1α and IL‐1β increased total OC number and resorptive activity of large OCs. IL‐1α stimulated formation of large OCs and increased the number of resorption pits, while IL‐1β changed the morphology of large OCs and integrin‐β3 phosphorylation. No effects were seen in small OCs in response to either IL‐1 isoform. These results demonstrate that IL‐1 predominantly affects large OCs. The dissimilarity of responses to IL‐1α and IL‐1β suggests that these isoforms activate different signaling pathways within the two OC populations. J. Cell. Biochem. 109: 975–982, 2010. © 2010 Wiley‐Liss, Inc.     

Middle Pleistocene human remains from the Bau de l'Aubesier

Excavations in later Middle Pleistocene levels at the Bau de l'Aubesier, Vaucluse, France yielded a maxillary molar (M(1) or M(2); Aubesier 10) and a partial mandible from the left C(1) alveolus to the right condylar base lacking the coronoid process (Aubesier 11). Dentally they are similar to other later Middle Pleistocene Europeans in dental dimensions and variable taurodontism (Aubesier 10 but not Aubesier 11). The small Aubesier 11 mandible exhibits a retreating symphyseal profile with a minimal tuber symphyseos, an anterior marginal tubercle at P(4)/M(1), the mental foramen at P(4)/M(1)-M(1), a modest retromolar space, no lingular bridging of the mandibular foramen, an enlarged superior medial pterygoid tubercle, a modest lateral condylar tubercle, and a mandibular notch crest that intersects the middle third of the condylar margin. All of these features fall within the ranges of variation of later Middle Pleistocene Neandertal lineage humans, and some are characteristic of Middle Pleistocene human mandibles in general. In addition, Aubesier 11 exhibits pervasive ante mortem alveolar resorption with apical abscesses, alveolar bone destruction, universal labial/buccal bone loss, ante mortem tooth loss (for > or =81.8% of preserved alveoli), a lingual alveolar fenestration, and two broken root apices with masticatory attrition. These lesions indicate significantly impaired masticatory function, the oldest specimen currently known with such a reduced degree of dental function but one of several Middle Pleistocene human remains with indications of serious abnormalities.     

Ontogeny of the partial secondary wall of the otoccipital region of the endocranium in prehatching Alligator mississippiensis (Archosauria, Crocodylia)

The ontogeny of the posterior otic and anterior occipital portions of the neural endocranium of prehatching Alligator mississippiensis was investigated by reconstruction from sectioned material. In Stage 6 of this species, in which the endochondral ossification of the otoccipital region of the neural endocranium is only in its very early stage, two bony outgrowths-laminae-are present at the external wall of the posterior portion of the neural endocranium. The anterior lamina arises from the external surface of the basal plate at the level of the posterior margin of the subcapsular process; the posterior lamina arises from the external surface of that portion of the pila occipitalis that forms the posteroventral wall of the metotic fissure. During ontogeny, both laminae lying in the anteroposterior sequence ossify in membrane, fuse together, grow laterodorsally, and fuse with the lateral wall of the lateral semicircular canal and the crista parotica. This lamina forms a new, secondary wall enclosing the posterior section of the otic capsule and contains the large external jugular foramen (or foramen vagi) in its basal portion. The laminae, designated lamina juxtaotica anterior and posterior (lamina juxtaotica when fused together), have not been recorded previously in crocodylians and are absent in all other Recent reptiles. From the functional point of view, the juxtaotic lamina 1) forms the margins of the external jugular foramen, and 2) forms the floor of the posterior section of the Eustachian tube. In birds, the structure called the metotic cartilage, which arises in ontogeny as an independent element, has a similar position as the juxtaotic lamina. However, the two structures differ in their developmental origins and their relation to the Eustachian tube and the ramus hyomandibularis of the facialis nerve. Moreover, there is no external jugular foramen in birds.     

枕下远外侧入路研究进展

下斜坡、枕大孔前缘、颈静脉孔区及脑干腹侧的病变,一直以来这些区域的手术难度高,风险极大。由于周围毗邻解剖关系复杂,对于神经外科医生是一个巨大的挑战,枕下远外侧入路是到达上述区域比较理想的入路之一,它包括:1)沿颅颈交界区后外侧面分离肌肉,充分暴露C1横突和枕下三角;2)今早在寰椎后弓上方和或寰椎和枢椎动脉;3)行枕下颅骨切除术或枕下开颅术,并切除至少半个寰椎后弓。这一入路提供了以下三个入路的通道:经髁入路的方向经过枕髁或寰枕关节和邻近的髁部;髁上入路的方向经过枕髁上方的区域;髁旁入路的方向经过枕髁外侧区域。它的路径短,适合于颅颈交界区域的多种病变,可以较早地辨认与保护椎动脉,并可以根据手术的具体要求选择磨除枕髁的多少以及周围的骨性结构,以期达到良好的术野。