In vivo determination of the Achilles tendon moment arm in three-dimensions

Two-dimensional methods have been applied to determine the Achilles tendon moment arm in previous studies, although the talocrural joint rotates in three-dimension. The purpose of this study was to develop a method for determining the Achilles tendon moment arm in three-dimensions (3DMA). A series of sagittal ankle images were obtained at ankle positions of -20°, -10° (dorsiflexed position), 0° (neutral position), +10°, +20°, and +30° (plantarflexed position). The talocrural joint axis was determined as the finite helical axis of the ankle joint over 20° of displacement, and the 3DMA was determined as the shortest distance from the talocrural joint axis to the line of action of the Achilles tendon force. The corresponding 2DMA was determined with the center of rotation method using the images captured on the sagittal plane passing through the mid-point of the medio-lateral width of the tibia. The 3DMA ranged from 35 to 41 mm across various ankle positions and was, on average, 11 mm smaller than 2DMA. The difference between the two measures was attributable primarily to the deviations of the talocrural joint axis from the anatomical medio-lateral direction. The deviations on the coronal plane (21.4±20.7°) and on the transverse planes (14.8±22.6°) accounted for the errors of 1.3 mm and 3.0 mm, respectively. In addition, selecting either a medially or laterally misaligned sagittal-plane image for determining the 2DMA gave rise to error by 3.5 mm. The remaining difference was accounted for by the random measurement error.     

In vivo moment arm calculations at the ankle using magnetic resonance imaging (MRI)

In vivo moment arm lengths for the Achilles tendon and tibialis anterior (TA) were determined in 10 adult male subjects. Moment arms were measured as the perpendicular distance between the joint center of rotation (CR) and the center of the muscle's tendon on a series of sagittal plane magnetic resonance images. The first set of calculations used a fixed CR and the second a moving CR. The position of the CR was determined using a modification of the graphical method of Reuleaux. For both moving and fixed CR conditions, moment arms increased by approximately 20% for the Achilles tendon and decreased by approximately 30% for the TA when the ankle moved from maximum dorsiflexion to maximum plantarflexion. Moment arms averaged 3.1% greater for the Achilles tendon and 2.5% greater for the TA when calculated using a fixed CR. These data suggest that the averaged moment arm lengths for the Achilles tendon and the TA were relatively unaffected by the use of a fixed vs moving CR.     

In vivo moment arm lengths for hip extensor muscles at different angles of hip flexion

Moment arm lengths of three hip extensor muscles, the gluteus maximus, the hamstrings and the adductor magnus, were determined at hip flexion angles from 0 degrees to 90 degrees by combining data from ten autopsy specimens and from twenty patients, the latter examined by computed tomography. A straight-line muscle model for muscle force was used for the hamstrings and adductor magnus, and for the gluteus maximus a two-segment straight-line muscle force model was used. With the joint in its anatomical position the moment arm of the gluteus maximus to the bilateral motion axis averaged 79 mm, for the hamstrings 61 mm and for the adductor magnus 15 mm. The moment arm of gluteus maximus decreased with increasing hip flexion angle. The hamstrings showed an increase in moment arm length up to an average of 35 degrees hip flexion and then a decrease with increasing hip flexion angle. The corresponding figures for the adductor magnus moment arm showed an increase up to 75 degrees and then a decrease. Statistical analysis revealed significant differences in moment arm length between men and women.     

In vivo measurement-based estimations of the moment arm in the human tibialis anterior muscle-tendon unit

The aim of this study was to estimate the moment arm of human tibialis anterior (TA) muscle-tendon unit at rest and during isometric dorsiflexion maximum voluntary contraction (MVC) from in vivo sagittal-plane magnetic resonance (MR) and ultrasound scans. Two methods were employed, both of them based on the assumption that the ankle joint complex and TA muscle-tendon unit operate in the sagittal plane. Using method A, moment arms were obtained from MR scans of the foot by measuring the perpendicular distance between a moving centre of rotation in the talo-crural joint and the TA tendon action line. Using method B, moment arms were calculated from the ratio of TA tendon displacement, which was estimated from a planimetric muscle model using pennation angles and muscle thickness measured by ultrasonography, to the tibial rotation around the talus, which was measured from the foot MR scans. Using either of the two methods at rest, the estimated TA moment arm decreased from approximately 4.5 to approximately 2.9 cm in the transition from dorsiflexion to plantarflexion. Using method A, moment arms during MVC were larger by 0.9-1.5 cm (33-44%, P < 0.01) than the respective resting estimations. In contrast, no difference (P > 0.05) was found between the resting and MVC moment arm estimations of method B. Limitations in the oversimplified musculoskeletal model used raise questions for the validity of both method estimations.     

In vivo measurements of moment arm lengths of three elbow flexors at rest and during isometric contractions

The purpose of this study was to determine in vivo moment arm lengths (MAs) of three elbow flexors at rest and during low- and relatively high-intensity contractions, and to examine the contraction intensity dependence of MAs at different joint positions. At 50°, 80° and 110° of elbow flexion, MAs of the biceps brachii, brachialis and brachioradialis were measured in 10 young men using sagittal images of the right arm obtained by magnetic resonance imaging, at rest and during 20% and 60% of isometric maximal voluntary elbow flexion. In most conditions, MAs increased with isometric contractions, which is presumably due to the contraction-induced thickening of the muscles. This phenomenon was especially evident in the flexed elbow positions. The influence of the contraction intensities on the increases in MAs varied across the muscles. These results suggest that in vivo measurements of each elbow flexor MA during contractions are essential to properly examine the effects on the interrelationships between elbow flexion torque and individual muscle forces.     

B-mode ultrasonography of the bull testicle

The scrotum and testicles from 20 bulls aged 6 mo to 10 yr were obtained from a slaughterhouse and ultrasonically scanned to determine the normal echographic anatomy Ultrasonically, the normal bull testicle was homogeneous and moderately echogenic. The mediastinum testis was a linear structure in the center of the testicle and was slightly more echogenic than the parenchyma. The head and tail of the epididymis were easily identified on all testicles, but the epididymal body and ductus deferens were difficult to identify consistently. Ultrasound scanning of the testicles may prove to be a valuable noninvasive diagnostic technique for evaluating testicular diseases in bulls.     

In vivo changes in the human patellar tendon moment arm length with different modes and intensities of muscle contraction

The purpose of this study was to examine the effect of different muscle contraction modes and intensities on patellar tendon moment arm length (d(PT)). Five men performed isokinetic concentric, eccentric and passive knee extensions at an angular velocity of 60 deg/s and six men performed gradually increasing to maximum effort isometric muscle contractions at 90( composite function) and 20( composite function) of knee flexion. During the tests, lateral X-ray fluoroscopy imaging was used to scan the knee joint. The d(PT) differences between the passive state and the isokinetic concentric and extension were quantified at 15( composite function) intervals of knee joint flexion angle. Furthermore, the changes of the d(PT) as a function of the isometric muscle contraction intensities were determined during the isometric knee extension at 90( composite function) and 20( composite function) of knee joint flexion. Muscle contraction-induced changes in knee joint flexion angle during the isometric muscle contraction were also taken into account for the d(PT) measurements. During the two isometric knee extensions, d(PT) increased from rest to maximum voluntary muscle contraction (MVC) by 14-15%. However, when changes in knee joint flexion angle induced by the muscle contraction were taken into account, d(PT) during MVC increased by 6-26% compared with rest. Moreover, d(PT) increased during concentric and eccentric knee extension by 3-15%, depending on knee flexion angle, compared with passive knee extension. These findings have important implications for estimating musculoskeletal loads using modelling under static and dynamic conditions.     

Mechanical properties in the human gastric antrum using B-mode ultrasonography and antral distension

The aims of this study were to investigate gastric antral geometry and stress-strain properties by using transabdominal ultrasound scanning during volume-controlled distensions in the human gastric antrum. Seven healthy volunteers underwent stepwise inflation of a bag located in the antrum with volumes up to 60 ml. The stretch ratio and Cauchy stress and strain were calculated from measurements of pressure, diameter, and wall thickness. A second distension series was conducted in three volunteers during administration of the anticholinergic drug butylscopolamine. Analysis of stretch ratios demonstrated positive strain in the circumferential direction, negative strain in the radial direction, and no strain in the longitudinal direction. The stress-strain relation was exponential and did not differ without or with the administration of butylscopolamine. The wall stress was decomposed into its active and passive components. The well-known length-tension diagram from in vitro studies of smooth muscle strips was reproduced. The maximum active tension appeared at a volume of 50 ml, corresponding to a stretch ratio of 1.5. We conclude that the method provides measures of antral biomechanical wall properties and can be used to reproduce the muscle length-tension diagram in humans.     

The 3D patellar tendon moment arm: quantified in vivo during volitional activity

The patellar tendon moment arm is a critical quantity in that it defines the quadriceps ability to generate a moment on the tibia. Thus, the primary purpose of this study was to establish the first in vivo three-dimensional measures of the patellar tendon moment arm, measured non-invasively and in vivo during dynamic activity in a large normative population (n=34) using a dynamic MRI technique (fast-PC MRI). The magnitude of the moment arm was defined as the shortest distance between the finite helical axis and the patellar tendon line of action. Using these data, the hypothesis that the patellar tendon moment arm is independent of gender was tested. In general, the moment arm increased from 20 to 50 mm during knee extension. There were significant differences (P<0.05) in the moment arm between gender, but these differences were eliminated when the moment arm was scaled by the femoral epicondylar width. This study took a large step forward towards the ultimate goal of defining how pathology may alter joint dynamics through alteration in moment arms by establishing the first in vivo normative data base for the patellar tendon moment arm using non-invasive measures during volitional activity in a relatively large population (n=34). The fact that the scaled moment arm was independent of gender may lend insights into impairments that tend to be gender specific, such as patellar maltracking. The next steps will be to quantify the patellar tendon moment arm in populations with specific pathologies.     

Mechanosensory properties in the human gastric antrum evaluated using B-mode ultrasonography during volume-controlled antral distension

The aims of this study were to evaluate gastric antral mechanical behavior and distension-induced sensorimotor responses in the human gastric antrum using transabdominal ultrasound scanning. Ten healthy volunteers underwent volume-controlled ramp inflation of a bag located in the antrum with volumes up to 125 ml. The active and passive circumferential tensions and stresses were calculated from measurements of pressure, diameter, and wall thickness before and during the administration of the anticholinergic drug butylscopolamine. The bag distensions elicited contractions in the antrum and sensory responses below the pain threshold. Butylscopolamine abolished the contractions and significantly reduced the sensory response. The length-tension diagram known from in vitro studies of smooth muscle strips could be reproduced as tension-volume diagrams in the human gastric antrum. The number of induced contractions and the contraction pressure amplitude (afterload) showed a parabolic behavior as function of the distension volume (preload), with maximum approximately at 70 ml. At the sensation threshold, the luminal circumference showed the lowest variation coefficient (13-25%), whereas the variation coefficient was more than 100% for the pressure, tensions, and stresses. We conclude that the muscle length-tension diagram and typical preload-afterload curves ad modem the Frank-Starling cardiac law can be obtained in the human gastric antrum. The sensory responses were most closely associated with the luminal circumference, indicating that the sensation during antral distension depends on deformation rather than on tension.     

In vivo determination of organellar pH using a universal wavelength-based confocal microscopy approach

Many essential cellular processes are affected by transmembrane H(+) gradients and intracellular pH (pHi). The research of such metabolic events calls for a non-invasive method to monitor pHi within individual subcellular compartments. We present a novel confocal microscopy approach for the determination of organellar pHi in living cells expressing pH-dependent ratiometric fluorescent proteins. Unlike conventional intensity-based fluorometry, our method relies on emission wavelength scans at single-organelle resolution to produce wavelength-based pH estimates both accurate and robust to low-signal artifacts. Analyses of Ato1p-pHluorin and Ato1p-mCherry yeast cells revealed previously unreported wavelength shifts in pHluorin emission which, together with ratiometric mCherry, allowed for high-precision quantification of actual physiological pH values and evidenced dynamic pHi changes throughout the different stages of yeast colony development. Additionally, comparative pH quantification of Ato1p-pHluorin and Met17p-pHluorin cells implied the existence of a significant pHi gradient between peripheral and internal cytoplasm of cells from colonies occurring in the ammonia-producing alkali developmental phase. Results represent a step forward in the study of pHi regulation and subcellular metabolic functions beyond the scope of this study.     

In vivo fascicle length measurements via B-mode ultrasound imaging with single vs dual transducer arrangements

Ultrasonography is a useful technique to study muscle contractions in vivo, however larger muscles like vastus lateralis may be difficult to visualise with smaller, commonly used transducers. Fascicle length is often estimated using linear trigonometry to extrapolate fascicle length to regions where the fascicle is not visible. However, this approach has not been compared to measurements made with a larger field of view for dynamic muscle contractions. Here we compared two different single-transducer extrapolation methods to measure VL muscle fascicle length to a direct measurement made using two synchronised, in-series transducers. The first method used pennation angle and muscle thickness to extrapolate fascicle length outside the image (extrapolate method). The second method determined fascicle length based on the extrapolated intercept between a fascicle and the aponeurosis (intercept method). Nine participants performed maximal effort, isometric, knee extension contractions on a dynamometer at 10° increments from 50 to 100° of knee flexion. Fascicle length and torque were simultaneously recorded for offline analysis. The dual transducer method showed similar patterns of fascicle length change (overall mean coefficient of multiple correlation was 0.76 and 0.71 compared to extrapolate and intercept methods respectively), but reached different absolute lengths during the contractions. This had the effect of producing force–length curves of the same shape, but each curve was shifted in terms of absolute length. We concluded that dual transducers are beneficial for studies that examine absolute fascicle lengths, whereas either of the single transducer methods may produce similar results for normalised length changes, and repeated measures experimental designs.     

B超检测颈动脉粥样硬化与脑梗死相关性的研究

目的:探讨颈动脉粥样硬化变化与脑梗死的关系.方法:选择我院2007年4月～2009年脑梗死患者103例作为观察组,同时选择本院同期住院非脑梗死患者51例作为对照组,彩色多普勒超声仪检测显示颈部动脉:经总动脉远端:颈内动脉起始部和颈动脉分叉处,观察血管解剖形态内膜情况有无斑块形成以及斑块的形态大小性质及管腔是否狭窄狭窄程度.结果:①两组患者内膜增厚发生率比较,差异无统计学意义,P＞0.05;两组患者斑块形成发生率相比,差异有统计学意义,P＜0.05;②斑块发生在颈总动脉膨大部,占43.8%;发生在颈总动脉主干,占30.1%;发生在颈内动脉起始部13.6%;发生在颈内动脉主干,占6.8%;发生在椎动脉,占5.4%;③观察组和对照组在轻度狭窄发生率、中度狭窄发生率、重度狭窄发生率比较,差异有统计学意义,P＜0.05.结论:颈动脉粥样硬化在一定程度上能够反映脑动脉粥样硬化的情况,与脑梗死的关系密切,是预测脑梗死风险的重要指标,早期发现颈动脉粥样硬化对预防脑梗死的发生有着重要意义.     

In vivo assessment of muscle fascicle length by extended field-of-view ultrasonography

The present study examined the reliability and validity of in vivo vastus lateralis (VL) fascicle length (L(f)) assessment by extended field-of-view ultrasonography (EFOV US). Intraexperimenter and intersession reliability of EFOV US were tested. Further, L(f) measured from EFOV US images were compared to L(f) measured from static US images (6-cm FOV) where out-of-field fascicle portions were trigonometrically estimated (linear extrapolation). Finally, spatial accuracy of the EFOV technique was assessed by comparing L(f) measured on swine VL by EFOV US to actual measurements from digital photographs. The difference between repeated VL L(f) measurements by the same experimenter was 2.1 ± 1.7% with an intraclass correlation (ICC) of 0.99 [95% confidence interval (CI) = 0.95-1.00]. In terms of intersession reliability, no difference (P = 0.48) was observed between L(f) measured on two different occasions, with ICC = 0.95 (CI = 0.80-0.99). The average absolute difference between L(f) measured by EFOV US and using linear extrapolation was 12.6 ± 8.1% [ICC = 0.76 (CI = -0.20-0.94)]; EFOV L(f) was always longer than extrapolated L(f). The relative error of measurement between L(f) measured by EFOV US and by dissective assessment (digital photographs) in isolated swine VL was 0.84% ± 2.6% with an ICC of 0.99 (CI = 0.94-1.00). These results show that EFOV US is a reliable and valid method for the measurement of long muscle fascicle in vivo. Thus EFOV US analysis was proven more accurate for the assessment of skeletal muscle fascicle length than conventional extrapolation methods.     

In vivo site-directed mutagenesis using oligonucleotides

Functional characterization of the genes of higher eukaryotes has been aided by their expression in model organisms and by analyzing site-specific changes in homologous genes in model systems such as the yeast Saccharomyces cerevisiae. Modifying sequences in yeast or other organisms such that no heterologous material is retained requires in vitro mutagenesis together with subcloning. PCR-based procedures that do not involve cloning are inefficient or require multistep reactions that increase the risk of additional mutations. An alternative approach, demonstrated in yeast, relies on transformation with an oligonucleotide, but the method is restricted to the generation of mutants with a selectable phenotype. Oligonucleotides, when combined with gap repair, have also been used to modify plasmids in yeast; however, this approach is limited by restriction-site availability. We have developed a mutagenesis approach in yeast based on transformation by unpurified oligonucleotides that allows the rapid creation of site-specific DNA mutations in vivo. A two-step, cloning-free process, referred to as delitto perfetto, generates products having only the desired mutation, such as a single or multiple base change, an insertion, a small or a large deletion, or even random mutations. The system provides for multiple rounds of mutation in a window up to 200 base pairs. The process is RAD52 dependent, is not constrained by the distribution of naturally occurring restriction sites, and requires minimal DNA sequencing. Because yeast is commonly used for random and selective cloning of genomic DNA from higher eukaryotes such as yeast artificial chromosomes, the delitto perfetto strategy also provides an efficient way to create precise changes in mammalian or other DNA sequences.     

In vivo determination of cell cycle kinetics of non-Hodgkin's lymphomas using iododeoxyuridine and bromodeoxyuridine.

Using sequential infusions of two S-phase-specific drugs, iododeoxyuridine and bromodeoxyuridine, we have developed an in vivo method for determining the labeling index (LI), the S-phase duration (Ts), and total cell cycle times (Tc) of non-Hodgkin's lymphomas. In nine non-Hodgkin's lymphomas studied, the LI ranged from 1.5% in a follicular small cleaved-cell lymphoma to 29.6% in a diffuse large-cell lymphoma. The Ts ranged from 16 hr in a large-cell lymphoma (immunoblastic type) to 117 hr in a follicular small cleaved-cell lymphoma. The Tc varied from 69 hr in a large-cell lymphoma (immunoblastic type) to over 1000 hr in all low-grade lymphomas studied. Immunohistochemical methods using anti-BrdU antibodies were used to detect cell incorporation of the two S-phase-specific drugs. In this manner, cell cycle times could be calculated while the architecture of the tumor specimen was preserved. Difficulties in using this methodology, specifically in the calculation of the growth fraction and total cell cycle times, are pointed out. This in vivo method does, however, allow for Ts calculations independent of growth fraction considerations. Correlations of cell cycle data with various biological and clinical factors await further patient follow-up.     

Reconstruction of shoulder function using a reflected long head biceps: a moment arm study

A tendon transfer technique is proposed for the reconstruction of the paralyzed shoulders secondary to brachial plexus injury. This innovative technique does not require bone-to-bone or tendon to-bone fixation, and attempts to overcome other clinical limitations such as those due to insufficient length of donor muscle. The approach is referred to as the reflected long head biceps (RLHB) technique. The long head of biceps tendons is utilized as a bridging tendon graft. Two surgical alternatives, namely the through-deltoid (TD) pathway and the sub-deltoid (SD) pathway, were studied. The moment arms of the transferred tendons were assessed and reported. The TD technique yielded a larger moment than the SD technique. In the plane 30 degrees anterior to the scapular plane, the average moment arms were 3.8cm TD and 3.0cm SD at zero elevation. Such differences tended to further widen with increasing elevation. At 80 degrees elevation, the moment arms became 3.2cm TD and 1.2cm SD. The results supported the clinical feasibility of this RLHB tendon transfer approach.     

The human patellar tendon moment arm assessed in vivo using dual-energy X-ray absorptiometry

Accurate assessment of muscle–tendon forces in vivo requires knowledge of the muscle–tendon moment arm. Dual-energy X-ray absorptiometry (DXA) can produce 2D images suitable for visualising both tendon and bone, thereby potentially allowing the moment arm to be measured but there is currently no validated DXA method for this purpose. The aims of this study were (i) to compare in vivo measurements of the patellar tendon moment arm (d_PT) assessed from 2D DXA and magnetic resonance (MR) images and (ii) to compare the reliability of the two methods. Twelve healthy adults (mean±SD: 31.4±9.5 yr; 174.0±9.5 cm; 76.2±16.6 kg) underwent two DXA and two MR scans of the fully extended knee at rest. The tibiofemoral contact point (TFCP) was used as the centre of joint rotation in both techniques, and the d_PT was defined as the perpendicular distance from the patellar tendon axis to the TFCP. The d_PT was consistently longer when assessed via DXA compared to MRI (+3.79±1.25 mm or +9.78±3.31%; P<0.001). The test–retest reliability of the DXA [CV=2.13%; ICC=0.94; ratio limits of agreement (RLA)=1.01 (?/÷1.07)] and MR [(CV=2.27%; ICC=0.96; RLA=1.00 (?/÷1.07)] methods was very high and comparable between techniques. Moreover, the RLA between the mean DXA and MRI d_PT values [1.097 (?/÷1.061)] demonstrated very strong agreement between the two methods. In conclusion, highly reproducible d_PT measurements can be determined from DXA imaging with the knee fully extended at rest. This has implications for the calculation of patellar tendon forces in vivo where MR equipment is not available.     

肝炎肝硬化和酒精性肝硬化的B超表现比较

目的比较肝炎肝硬化和酒精性肝硬化的B超表现,为临床工作提供参考。方法收集2007年1月1日至2008年12月31日入住温州医学院附属第三医院肝硬化患者的B超资料,回顾性分析比较其B超表现特点。结果酒精性肝硬化患者肝脏肿大的比例高于肝炎肝硬化患者,差异有统计学意义(P0.001),但二者肝脏缩小比例差异无统计学意义。酒精性肝硬化患者肝脏表面光滑的比例较高而呈锯齿状的比例较低,与肝炎肝硬化患者比较差异均有统计学意义(P=0.015和P=0.027)。酒精性肝硬化患者肝内明显可见结节的比例低于肝炎肝硬化患者,二者差异有统计学意义(P=0.009)。门静脉宽度比较2组均数差异无统计学意义(P=0.581)。结论与肝炎肝硬化患者比较,酒精性肝硬化患者肝右叶斜径增大的比例较高,表面较光滑而较少出现锯齿状,发现粗大不规则结节的比例较低,而门静脉内径二者无差异。     

Application of B-mode ultrasonography in the assessment of the dog penis

With the purpose to characterize the ultrasonographic features of the dog penis, 20 healthy dogs aged from 2 to 11 years old were used. Ultrasonography was performed using a 5-9MHz linear probe and a Philips HD3 scanner. Ultrasonograms were obtained at the penile body (pre- and post-scrotal sections) and at both the bulbus glandis and the pars longa glandis, with the dog placed in dorsal recumbency. The typical anatomy of the dog penis is easily demonstrated in ultrasonographic images, as revealed in this study. On ultrasonograms taken at the body level, the two corpora cavernosa showed a homogeneous, hypoechoic structure; ventrally, the corpus spongiosum appears as a slightly hyperechoic structure surrounding the urethra. In glans ultrasonograms, the most typical feature is the os penis, observed as a strong hyperechoic structure, whose acoustic shadow impairs the screening of adjacent tissues. Lining on its concavity, the corpus spongiosum is observed as a slightly hyperechoic tissue around the urethra. An ovoid, regularly hypoechoic tissue corresponding to the erectile tissue of the pars longa, surrounds these structures. The bulbus glandis is visualized as a regular hypoechoic structure with small anechoic areas, corresponding to sinusoidal spaces. The albuginea is evidenced as a well-defined, hyperechoic external layer. The preputial cavity appears as a thin anechoic layer surrounding the albuginea. The results of this study demonstrate that ultrasonographic assessment of the dog penis is easily performed and accurate enough for penile examination. Furthermore, ultrasonography of the dog penis can become an interesting diagnostic tool to explore in the canine practice, during breeding soundness evaluation and also whenever penile exposition is impossible to achieve.