Chinese Journal of Clinical Anatomy

The microsurgical anatomy and transplantation of nailbed flap supplied by fibular branch of first dorsal digital artery of the great toe

Chinese Journal of Clinical Anatomy. 2019, 37(6): 609-613. doi:10.13418/j.issn.1001-165x.2019.06.001

Abstract ( 913 )

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Objective　To provide anatomic basis for the clinical design of the pedicle flap of the fibular branch of first dorsal digital artery.　Methods　Fifteen fresh foot specimens （The left side was 6 cases, the right side was 9 cases, 11 males and 4 females）were used for red latex infusion. The origins, flowing patterns, distribution patterns and characteristics of the fibular branch of first dorsal digital artery of the great toe were analyzed.　Results　The fibular branch of first dorsal digital artery of the great toe was found. According to the origin, it was divided into 3 types: Type I. The fibular branch of first dorsal digital artery of the great toe was released from the inside of the first dorsal metatarsal artery for 9 cases which was accounting for 60.00 %, with the initial diameter ( 1.21±0.34. ) mm; Type II, The fibular branch of first dorsal digital artery in the proximal phalanx was originated from the lateral of the plantar artery on fibular side of great toe for 3 cases,which was accounting for 20.00 %, with the initial diameter (1.13 ± 0.26) mm; Type III, The fibular branch of first dorsal digital artery was distributed by the first dorsal metatarsal artery and the plantar artery on fibular side of great toe in the proximal phalanx for 3 cases which was accounting for 20.00 %. According to the branch thickness, the type III can be divided into three subtypes: Type IIIa, 1 case,The branch of the first dorsal metatarsal artery was preponderance, accounting for 6.67%, the diameter of the branch of the first dorsal metatarsal artery at starting point was 0.82 mm, and the diameter of the branch of the plantar artery on fibular side of great toe at the starting point was 0.53 mm. Type IIIb, 1 case The branch of the plantar artery on fibular side of great toe was preponderance, accounting for 6.67. %, the diameter of the branch of the first dorsal metatarsal artery at starting point was 0.51 mm, the diameter of the branch of the plantar artery on fibular side of great toe at the starting point was 0.71 mm; Type IIIc, 1 case the branch of the first dorsal metatarsal artery and the branch of the plantar artery on fibular side of great toe were isometrically (generally contracted), accounting for 6.67%, the diameter of the branch of the first dorsal metatarsal artery at starting point was 0.41mm, and the diameter of the branch of the plantar artery on fibular side of great toe at the starting point was 0.43mm. All types of the fibular branch of first dorsal digital artery extended into the nail bed, and there were skin branches to nourish the upper nail and the temporal side.　Conclusions　The pedicle flap of the fibular branch of first dorsal digital artery is easy to be transplant and repair the nail bed defect. This procedure has the advantages of reliable blood supply, no sacrifice of main blood vessels, safe cutting, and nutritional nerves.

Anatomical study on the insertion of flexor digitorum profundus tendon and extensor tendon

ZHANG Lei, HUO Yong-xin, DU Xiao-jian, ZHANG Wen-long, ZUO Yu-ming, WANG Yue-guang, ZHANG Jun-shan

Chinese Journal of Clinical Anatomy. 2019, 37(6): 614-618.

Abstract ( 3142 )

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Objective　To study the differences of the volar and dorsal insertion of flexor digitorum profundus tendon and extensor tendon in the base of the distal phalanx and provide anatomical base for possible mechanism of Seymour fracture. 　Methods　10 hand specimens were collected from the anatomical laboratory of the hospital, including 3 left hand cases and 7 right hand cases, all of which were male patients，aged 24~58 years old. All 2~5 fingers were 10 fingers respectively, and all fingers had no history of traumatic surgery or deformity. The flexor digitorum profundus tendon and extensor tendon of each finger were cut apart from the level of the volar and dorsal interphalangeal joint and separated at the level of the distal interphalangeal joint. The distances from the insertion of flexor digitorum profundus tendon and extensor tendon to the volar and dorsal articular surfaces of the distal phalanx were recorded, and the insertion levels of the flexor digitorum profundus tendon and the extensor tendon at the volar and dorsal phalanx were compared.　Results　The distances from the articular surface to the proximal insertion point of the flexor digitorum profundus tendon for each finger were as follows: the index fingers (2.19±0.27) mm, the middle fingers (2.50±0.14) mm, the ring fingers (2.23±0.16) mm, and the little fingers (1.83±0.19) mm. The distances from the proximal extensor tendon insertion point to the articular surface for each finger were as follows: the index fingers (0.12±0.02) mm, the middle fingers (0.18±0.02) mm, the ring fingers (0.12±0.05) mm, and the little fingers (0.06±0.01) mm. The differences of each finger were statistically significant (P<0.05). The distances from the middle point of the insertion of the flexor digitorum profundus tendon to the articular surface for each finger were as follows: the index fingers (3.73±0.45) mm, the middle fingers (4.33±0.45) mm, the ring fingers (3.53±0.46) mm, and the little fingers (3.16±0.41) mm. The distances from the middle point of the insertion of the extensor tendon to the articular surface for each finger were as follows: the index fingers (1.77±0.06) mm, the middle fingers (1.76±0.20) mm, the ring fingers (1.77±0.06) mm, and the little fingers (1.47±0.10) mm. The differences of each finger were statistically significant (P<0.05).　Conclusions　The insertion point of the extensor tendon at the base of the terminal phalanx is much closer to the articular surface than that of the flexor digitorum profundus tendon, which provides anatomical basis for the mechanism of Seymour fracture.

The anatomical study of location and application of lateral retinacular nerve in the diagnosis and treatment of lateral knee pain

ZHANG Zhong-jun, JIANG Xiao-dong

Chinese Journal of Clinical Anatomy. 2019, 37(6): 619-622. doi:10.13418/j.issn.1001-165x.2019.06.003

Abstract ( 698 )

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Objective　To observe and measure the lateral retinacular nerve (LRN) in order to facilitate diagnostic and therapeutic nerve block and treatment for anterolateral knee pain.　Methods　Total 34 lower limbs had been dissected from 17 normal adult specimens. The exact location and main branches of the sciatic nerve (SN) were observed by specimen dissection. The posterior branch of the knee, superior lateral genicular nerve (SLGN) was dissected. Its first branch LRN was determined by tracing to the end. The first measurement point was the position from LRN branch of SLGN to the lateral tibiofemoral knee line. The second measurement point was the position from LRN branch of SLGN to the top of the external epicondyle of femur.　Results　The average distance of the first measuring point was (55.00±3.22) mm. The average distance of the second measuring point was (26.00±2.42) mm. There was gender differences. In which, the average distance of the first measurement point in male was (57.00±3.64) mm, and the average distance of the second measurement point in male was (27.00±2.72) mm. The average distance of the two measurement points in female was (51.00±1.14) mm, (23.00±0.54) mm, respectively. The evaluation of the two measurement points showed that, the probability of the first measurement point locating in knee joint was 100%, while the probability of the second measurement point locating in knee joint was 67%.　Conclusions The study provides two dependable landmarks and a description of the path of the LRN making it possible to target the lateral retinacular nerve to diagnose and alleviate lateral knee pain.

Imaging measurement and clinical significance of posterior marginal osteophyte of cervical vertebral intervertebral space

CHEN Jia-cheng, YUAN Feng, XU Fei-hu, LU Wei-qiang

Chinese Journal of Clinical Anatomy. 2019, 37(6): 623-626. doi: 10.13418/j.issn.1001-165x.2019.06.004

Abstract ( 545 )

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Objective To study the clinical value of cervical osteophytes in posterior margin of intervertebral space by imaging measurement. Methods 88 patients with cervical spondylosis, among which of 36 males and 52 females, were selected from September 2016 to December 2017. X-ray of cervical spine was taken, the system imaging of PACS was consulted before operation. The posterior edge osteophytes of cervical spine were divided into upper and lower parts (Aupper, Alower, Bupper, Blower) based on the tangent line of upper and lower endplate of the vertebral body respectively (Line a, Line b). The area of osteophytes of each part were measured by Auto CAD 2014 software. The ratio of the area of osteophytes of upper and lower parts and the total area of osteophytes of the same side (Aall, Ball) were calculated (Mean±SD). Results The posterior margin osteophytes were classified into four types. Type I accounted for 61.36% of the measured data, type II 5.68% type III 10.22%, and type IV 22.72%. Posterior marginal osteophytes of cervical intervertebral space were mainly located in C5/6, accounting for 43.18% of all segments. There was no statistical significance in gender of different segments. The percentage of osteophytes above the line-a of the lower edge of the upper vertebral body was 32.94%. The ratio of the area of Aupper osteophytes to the total area of Aall osteophytes was (41.18±15.45) %. The percentage of osteophytes below the line-b of the upper edge of the lower vertebral body was 28.40%. The ratio of Blower osteophyte area to total Ball osteophyte area was (54.69±22.49) %. Conclusions By analyzing the imaging types of osteophytes in posterior margin of cervical vertebra before operation, planning the treatment of osteophytes in posterior margin during operation, decompression-fusion of discectomy can obtain better effect in reducing pressure of spinal cord.

Measurement of anatomical parameters of cervical zero-incision interbody fusion cage

ZHANG Li-ren, LIU Jia-ming, LIU Zhi-li, ZHANG Zhi-hong

Chinese Journal of Clinical Anatomy. 2019, 37(6): 627-632. doi:10.13418/j.issn.1001-165x.2019.06.005

Abstract ( 1058 )

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Objective　To provide a theoretical reference for designing the cervical anterior cervical zero-incision interbody fusion cage by measuring the anatomical parameters of the cervical intervertebral space of normal adults.　Methods　200 healthy volunteers were included into doing X-ray, the following parameters were measured on X-ray of the cervical spine neutral lateral radiographs: leading edge, midpoint, posterior margin height of the C2/C3 to C6/C7 intervertebral space, transverse diameter of the intervertebral space, sagittal diameter of the intervertebral space, best angle and depth of the screw nail insertion, angle of the intervertebral disc. The mean and standard deviation of each anatomical parameter were calculated separately.　Results　The 100 male volunteers’ average age was 31.21 years old, while the 100 female was 31.05 years old. Parameters of the male group were as follows: the transverse diameter of intervertebral space was (19.88±1.06) mm, the sagittal diameter was (19.42±1.59) mm, the leading edge height was (5.57±0.74) mm, and the midpoint height was (7.24±0.98) mm, the height of the trailing edge was (4.11 ±0.27) mm, the optimal depth of the upper screw insertion was (33.54±1.14) mm, the optimal depth of the lower screw insertion was (24.35±1.53) mm. The optimal angle of the upper screw insertion was (41.10±2.86)°, the optimal angle of the lower screw insertion was (47.13±3.17)°, the angle of the intervertebral disc was (4.94±1.36)°. Parameters of the female group were as follows: the transverse diameter of the intervertebral space was (18.29±0.89) mm, the sagittal diameter was (13.76±1.41) mm, the leading edge height (5.12±0.64) mm, and the midpoint height (6.68±0.67) mm, the height of the trailing edge (3.20±0.25) mm, the optimum depth of the upper screw insertion was (25.18±1.75) mm, the optimal depth of the lower screw insertion was (21.83±1.66) mm, the optimal angle for the upper screw nail insertion was (41.66±2.70)°, the optimal angle for lower screw insertion was (47.03±2.43)°, the angle of intervertebral disc was (4.80±1.38)°. There were no significant differences in the above parameters between male and female groups (P>0.05). There were statistical differences in the heights of the anterior, middle and posterior margins of the intervertebral space at the same segment, which were characterized as follows: the height of the trailing edge < the height of the leading edge < the height of the midpoint (P<0.05).　Conclusions　We can get the data of adults for designing the cervical anterior cervical zero-incision interbody fusion cage by anatomical measurement of normal cervical vertebra X-ray

Kinesiology analysis of distal radioulnar joint rotation by utilizing magnetic resonance imaging

YUAN Jian-xiang, PENG Guo-yi, LIU Yong-jian, ZHENG Han-yi, KE-Qi, FANG Ting-song

Chinese Journal of Clinical Anatomy. 2019, 37(6): 633-637. doi:10.13418/j.issn.1001-165x.2019.06.006

Abstract ( 481 )

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Objective　To analyze the normal distal radioulnar joint (DRUJ) rotation by utilizing the magnetic resonance imaging on axial imaging.　Methods　Axial magnetic resonance images at the bilateral DRUJ of 30 healthy volunteers (15 males, 15 females) were examined in seven rotational positions: maximum supination, 60 ° supination, 30 ° supination, neutral, 30 ° pronation, 60 ° pronation and maximum pronation. A line (AB) was drawn from the volar margin (A) and dorsal margin (B) of the sigmoid notch. The center of the ulnar head (C) was mrked using the workstation tools. A line (AD) perpendicular to this line (AB) was drawn to the center of the ulnar head (C). The point across the AB line was regarded as D. The AD/AB ratio was calculated, which was defined as the radioulnar ratio (RUR). A straight line at the apex of the dorsal edge of the ulnar head (E) and the ulnar styloid process (F) was drawn, and the palmar angle (radioulnar angle, RUA) at which straight line EF intersects straight line AB was measured. The measurement and calculation of average value were completed independently by two radiologists then the credibility of the method was evaluated.　Results　The RUR values of maximum supination, 60 ° supination, 30 ° supination, neutral, 30 °pronation, 60 °pronation and maximum pronation were (0.29±0.05), (0.36±0.06), (0.42±0.07), (0.49±0.05), (0.53±0.06), (0.56±0.06), (0.61±0.07) respectively, then the RUA were (38.41±3.71)°, (48.74±5.54)°, (63.31±4.98)°, (105.56±5.63)°, (138.68±6.04)°, (162.45±6.00)°, (178.46±2.09°) respectively. RUR was positively correlated with RUA and there were statistical difference between them (r=0.97，P<0.05). With the increasing of RUA, the RUR also increased during the process of wrists joints rotation from maximum supination to maximum pronation. The intraclass correlation coefficient (ICC) of RUR and RUA ranged from 0.83 to 0.96 under the above different positions.　Conclusions　By establishing the normal range of RUR of DRUJ at different rotation angles, more data could be provided for the diagnose of the instability of distal radioulnar joint.

Effects on inflammatory imbalance and pathological changes of liver and lung of cordycepin combined with glutamine in LPS-induced sepsis rats

FAN Xiao-guang, PENG Jin, HONG Shu-kun, HU Guo-xin, LIU Jian, ZHANG Zhi-kun, ZHAO Li-shu, WANG Heng, YANG Guang-hu, QIAO Lu-jun

Chinese Journal of Clinical Anatomy. 2019, 37(6): 638-643. doi:10.13418/j.issn.1001-165x.2019.06.007

Abstract ( 380 )

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Objective To study the effects on inflammatory imbalance and pathological changes of liver and lung of cordycepin (Cop) combined with glutamine (Gln) in sepsis rats induced by lipopolysaccharide (LPS) and its possible mechanism. Methods Rats were randomly divided into five groups according to body weight: a control group, a model group (LPS group), a LPS+Cop group, a LPS+Gln group and a LPS+Cop+Gln group. The sepsis rat model was established by intraperitoneal injection of LPS (5 mg/kg). The levels of inflammatory factors IL-6, TNF-α, IL-1β and IL-10 in peripheral blood were detected by ELISA. The pathological damage of liver and lung tissue were observed by HE staining. The apoptosis rate of liver and lung tissue were detected by TUNEL staining. The expression of Caspase-3 and the phosphorylation of NF-κB p65 in liver and lung tissue were detected by Western blot. Results In the LPS+Cop group, LPS+Gln group and LPS+Cop+Gln group, reversal of high expressions of LPS-induced pro-inflammatory factors (IL-6, TNF-α, IL-1β) and low expression of anti-inflammatory factors (IL-10) could be observed (P<0.05). Also, alleviation of pathological damage, inhibition of apoptosis (P<0.05), reduction of high expression of apoptotic protein Caspase-3 (P<0.05) and down-regulation the phosphorylation level of NF-κB p65 (P<0.05) were observed. Conclusions Cordycepin combined with glutamine can effectively improve inflammation imbalance and pathological changes of liver and lung in LPS-induced sepsis rats.

Eucommia chlorogenic acid enhances the radiosensitivity of retinoblastoma cell line HXO-Rb44 via PI3K/AKT/Nrf-2 pathway

LIU Ming, WANG Jun , LI Li, CHENG Zhong-xia

Chinese Journal of Clinical Anatomy. 2019, 37(6): 644-649. doi:10.13418/j.issn.1001-165x.2019.06.008

Abstract ( 457 )

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Objective　To investigate the enhancement of eucommia chlorogenic acid(CGA) on the radiosensitivity of retinoblastoma cell line HXO-Rb44 by regulating PI3K/AKT/Nrf-2 pathway. 　Methods HXO-Rb44 cells were treated with different concentrations of CGA, then IC10 was detected as CGA concentration in subsequent experiments. Cells were divided into 4 groups: a Ctrl group, a Radio group, a CGA group and a Radio+CGA group. Radio group was disposed with 4 MV X-rays for 24 h, CGA group was processed with CGA for 24 h, and Radio+CGA group was disposed with 4 MV X-rays for 24 h after CGA treatment for 24 h. Flow cytometry was used to detect the cell cycle and cell apoptosis. The protein expressions of Ki67, NAD (P) H quinone oxidoreductase I (NQO1), cleaved-caspase-3 (cl-caspase-3), thioredoxin reductase-1 (TrxR1), activated phosphatidylinositol 3-kinase (PI3K), protein kinase B (AKT), p-AKT and nuclear factor-erythroid 2-related factor 2 (Nrf2) were determined by Western blot. Furthermore, PI3K activator 740Y-P was added to detect, the cell cycle, cell apoptosis, cell proliferation and apoptosis associated protein expressions, expressions of proteins in PI3K/AKT/Nrf2 pathway. Results With the increasing concentrations of CGA, the relative survival rates of cells were decreased, and the drug toxicity was concentration-dependent. The IC10 value was 81.59 μmol/L. Compared with Ctrl group, the cell population in G2/M period was significantly increased, and the cell apoptosis rates were increased in Radio group and CGA group (P<0.01). Compared with Radio group, the cell population in G2/M period and cell apoptosis rates were increased further in Radio+CGA group. Meanwhile, compared with Ctrl group, the protein expressions of Ki67, NQO1, TrxR1, p-PI3K, Nrf2 and p-AKT/AKT ratios in other groups were decreased significantly (P<0.01), and the combined effect of Radiation and CGA further reduced the above indicators in Radio+CGA group. Furthermore, PI3K activator could reverse the effects of radiation treatment on cell cycle, cell proliferation, cell apoptosis and PI3K/AKT/Nrf2 pathway. CGA could restore the changes of the above indicators caused by radiation (P<0.01). Conclusions CGA can enhance the radiosensitivity of retinoblastoma cell line HXO-Rb44, and the protective effect of CGA may be related to its inhibition of PI3K/AKT/Nrf2 pathway.

Effects of morroniside on the vascular dementia rats

ZHAO Xiu-ru, YU Jing, WANG Yan

Chinese Journal of Clinical Anatomy. 2019, 37(6): 650-655. doi:10.13418/j.issn.1001-165x.2019.06.009

Abstract ( 463 )

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Objective To study the effect and mechanism of morroniside(Mor) on the vascular dementia(VD) model rats.　Methods　VD model rats were randomly divided into sham operation group (Sham group), model group (VD group), VD+Mor (25, 50 and 100 mg) groups. Rats were intragastric administration Mor once a day for 28 days. The spatial learning and memory ability were measured by Morris water maze. Histopathological changes of brain issue, apoptosis rate of hippocampus were detected by HE and TUNEL staining respectively. The serum levels of SOD, MDA and LDH were measured by ELISA, the protein expression of Bax/Bcl-2, cytochrome C, caspase-9, caspase-3 and p53 in hippocampus were measured by Western Blot.　Results　Morroniside improved the learning and memory ability of VD rats in a dose-dependent manner, inhibited the histopathological changes of brain tissue; decreased the apoptosis rate, increased the serum level of SOD, reduced the content of MDA and LDH, and inhibited the protein expression of Bax/Bcl-2 ratio, cytochrome c, caspase-9, caspase-3 and p53.　Conclusions　Morroniside improves the memory ability and pathological changes of VD rats, reduces the apoptotic rate and free radical level of brain tissue, and inhibits the protein expression of mitochondrial apoptotic pathway, thus playing a therapeutic role in VD rats.

Cyclic tension force-mediated BMP9 regulates osteogenic differentiation of human periodontal ligament fibroblasts via PI3K/AKT signaling pathway

ZHANG Chao, HU Jing, ZHANG Jun-yi, WEI Ke-yuan, SUN Hai-bao, HUANG Ke-qiang

Chinese Journal of Clinical Anatomy. 2019, 37(6): 656-661. doi:10.13418/j.issn.1001-165x.2019.06.010

Abstract ( 406 )

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Objective　To investigate whether bone morphogenetic proteins 9 (BMP9) can activate PI3K/AKT signaling pathway to regulate osteogenic differentiation of human periodontal ligament fibroblasts (hPDLFs) under cyclic tension force.　Methods　The cultured in vitro hPDLFS were loaded with sine wave, deformation rate 10%, frequency 0.5 Hz periodic tension by FlexCell system. Distribution and changes of cytoskeletal protein expression were observed by immunofluorescence method. Changes of mRNA expression of RUNX2, OCN, OPN and OSX were observed by qPCR. Cytoskeletal protein OCN, OPN expressions and changes of AKT, P-AKT, OCN, OPN after adding P13K signal inhibitor LY294002 were detected by Western blot.　Results　Compared with control group, there were a significant increase of the expression of cytoskeletion-associated protein, up-regulation of the expression of osteogenic markers in 6 h and 12 h groups (P<0.05). The trend of mRNA expression was consistent with the result of protein detection.　Conclusions　Cyclic tension force-mediated BMP9 can regulate osteogenic differentiation of hPDLFs through PI3K/AKT signaling pathway.

Effects of sennoside B on growth and invasion of A549 cells and tumorigenesis of nude mice by inhibiting the phosphorylation of STAT3 and ERK1/2

WANG Jun-jie, DUAN Ren-hui, LIU Ling

Chinese Journal of Clinical Anatomy. 2019, 37(6): 662-667.

Abstract ( 336 )

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Objective　To investigate the effects and mechanisms of sennoside B on the growth, invasion of A549 cells and tumorigenesis of nude mice.　Methods　A549 non-small cell lung cancer cells were treated with sennoside B at doses of 0, 5, 10 and 20 μM respectively. The cells were divided into four groups randomly according to the dose and then the follow-up experiment was proceeded. Brdu staining was used to detect the cell proliferation of each group, and Hoechst staining was used to detect apoptosis. Cell migration was detected by scratch test. Cell invasion was detected by Transwell assay. Protein expression levels of Ki67, PCNA, cl-caspase-3, cl-caspase-9, VEGF, N-cadherin and E-cadherin, as well as phosphorylation of STAT3 and ERK1/2 were detected by western blotting. Tumor-bearing mice model was established and the weight of tumor was tested. The expression of Ki67 and VEGF were detected by immunohistochemistry.　Results　Compared with the Control group, the result showed that the Brdu positive cells number, the invasion cells number in each sennoside B dosage group were significantly reduced（P<0.05）, the apoptosis rate increased significantly（P<0.05）, the rate of cells scratches healing（P<0.05）, the protein levels of ki67, PCNA and VEGF, N-cadherin decreased obviously（P<0.05）, the protein levels of cl-caspase-3, cl-caspase-9, E-cadherin increased significantly（P<0.05）, phosphorylation levels of STAT3 and ERK1/2 were significantly reduced （P<0.05）, and the weight of tumor and the expression levels of Ki67 and VEGF were decreased in tumor-bearing mice model（P<0.05）.　Conclusions　Sennoside B inhibits the phosphorylation of STAT3 and ERK1/2 and the growth of A549 cells.

Protection effects and the mechanism on renal tissue in rats with diabetie nephropathy through inhibiting miR-200c expression

LIU Xin-lei, SONG Wei-min, GAO Zhi-qiang, CHEN Fu-lian

Chinese Journal of Clinical Anatomy. 2019, 37(6): 668-672. doi:10.13418/j.issn.1001-165x.2019.06.012

Abstract ( 526 )

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Objective　To explore the protection on the kidneys of streptozotocin (STZ)-induced diabetic nephropathy (DN) SD rats, and the related mechanism, by abating miR-200C.　Methods　The DN SD rat model was constructed through high-glucose and high-fat diet combined with intraperitoneal injection of STZ. Thirty successfully constructed DN model rats were randomly divided into a model group and an observation group, with 15 rats in each group. Additionally, 15 normal healthy SD rats were collected as the control group. After successful modeling, rats in observation group were given a tail vein injection of antagomir-200c (30 mg/kg) every 7 days, while those in model group and control group were given a tail vein injection of equivalent amounts of normal saline. Eight weeks later, the serum creatinine (Cr), blood urea nitrogen (BUN), and 24 h urine protein quantitation (UPQ) level in rats were detected. Meanwhile, miR-200c expression in renal tissues was detected through real-time fluorescence quantitative PCR (qRT-PCR). Histopathological changes in kidneys were observed through HE staining. Reactive oxygen species (ROS) and malondialdehyde (MDA) levels in renal tissues were detected using the ROS and MDA detection kits. In addition, the protein levels of transforming growth factor-β1 (TGF-β1) and fibronectin in renal tissues were also detected through Western blot. Results Compared with the control group, miR-200c expression in renal tissues, serum BUN and Cr levels, 24 h UPQ, renal interstitial injury score, ROS and MDA levels, as well as TGF-β1 and fibronectin protein expression in the model group were all markedly elevated (P＜0.05). Compared with the model group, the above indicators in the observation group were all markedly reduced (P＜0.05). Conclusions miR-200c expression in the renal tissues of STZ-induced DN rats is up-regulated, and abation of miR-200c can partly protect the kidneys of DN rats, which may be related to the reduction of oxidative stress in kidney tissue and the inhibition of TGF-β1 signaling pathway.

Dynamic analysis on distribution of intracranial pressure and herniation risk in patients with traumatic brain injury

LI Na, LIU Yin, XIONG Kun, BIN Shi-zhen

Chinese Journal of Clinical Anatomy. 2019, 37(6): 673-679. doi:10.13418/j.issn.1001-165x.2019.06.013

Abstract ( 292 )

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Objective　Finite element (FE) simulation models of two patients with moderate traumatic brain injury who developed hematoma were established according to the patients CT images and the data of intracranial pressure. The effect of intracranial pressure (ICP) caused by hematoma after brain injury was analyzed.　Methods　The finite element simulation models of adult head and molecular dynamics method were used to analyze the relationship between hematoma swelling and increasing of intracranial pressure, to extract and fold the hematoma. The CT images and intracranial pressure values were used to add dilatometry curves, to get the brain tissue pressure distribution map and brain tissue strain map, to calculate the difference of brain tissue pressure on areas which brain herniation happened. 　Results　The pressure values, the clinical mid-line shift displacements of the simulation models were in good fitness with the ventricular probe pressure of clinical patients and the mid-line of CT images, the error rates against the clinical data were 4% and 2% for the two patients. The simulation indicated that, in coronal views of the left temporo-occipital lobe, there was no substantial pressure difference between each side of the gyrus cinguli below the falx, with values of 1400 Pa and 1320 Pa respectively. However, the pressure in the temporal lobe above the tentorium was larger than that in the lobulus quadrangularis cerebelli, with values of 2504 Pa and 1360 Pa respectively. In sagittal views of the left temporo-occipital lobe, there was no substantial pressure difference between the anterior cerebellar lobe and posterior ambient cistern. There was bigger effective strain of tentorium cerebelli of left hematoma patients than that of right side patients.　Conclusions　We conclude that a hematoma in the fronto-temporal and basal ganglia regions of left side patients is most likely to cause anterior transtentorial herniation. The pressure caused by hematoma of right side is replaced by the strain of tentorium cerebelli, thus reducing the herniation risk. This research can make a better understanding of distribution of intracranial pressure caused by hematoma effect on motivation of brain injury, can also provide dynamic reference for injured prognosis.

3D reconstruction of sophisticated eardrum-ossicular chain model and the harmonic response analysis calculated by finite element method

HU Li-da, TIAN Guang-yong, XU Piao, LIN Qiong-ping

Chinese Journal of Clinical Anatomy. 2019, 37(6): 680-685. doi:10.13418/j.issn.1001-165x.2019.06.014

Abstract ( 494 )

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Objective　To verify the reliability of the sophisticated eardrum-ossicular chain model and provide theoretical basis and reference for the follow-up experiments by using finite element method to analyze the harmonic response.　Methods　A sophisticated eardrum-ossicular chain model by multi-software synthesized was established, by using Micro-CT and finite element method to obtain the fault data (screw pitch:0.24mm, total cross sectional image: 464 slices). The fault data were compared with the data which obtained from the temporal bone specimen scanned by laser doppler.　Results　The amplitudes of the tympanic membrane data collection points were 0.022, 0.031 and 0.0041 microns at frequency of 100Hz, 800Hz, 8000Hz respectively, and the amplitudes of the stapes plate data collection points were 0.011, 0.015 and 0.000069 microns respectively. The result of the models’ harmonic response was consistent with the result of laser doppler.　Conclusions　We can rebuild effectively a sophisticated eardrum-ossicular chain by establishing the model, we can use this model to analyze physiological function and pathologic change of the ossicular chain.

Propensity score matching study of correlation between anatomical parameters of knee joint and non-contact anterior cruciate ligament (ACL) injury

HE Min, JIA Zhi-he, LIU Shui-hong, WEN Yi-ying, GAO Zhi-zeng

Chinese Journal of Clinical Anatomy. 2019, 37(6): 686-690. doi:10.13418/j.issn.1001-165x.2019.06.015

Abstract ( 403 )

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Objective　To study the correlation between the anatomical parameters of knee joint and non-contact anterior cruciate ligament injury by propensity score matching.　Methods　Unilateral non-contact ACL injury patients (Nc-ACL group) who were treated in our hospital from July 2013 to July 2018 were selected. The control group was the patients who having knee joint injuries examined by MRI, but no abnormal anatomical structure of bone and soft tissue. The Nc-ACL group and the control group went propensity score matching in terms of age, gender, height and weight. Anatomical parameters of knee joint were measured on MIR: notch width index (NWI), notch shape index (NSI), lateral tibial plateau slope (LTS), medial tibial plateau slope (MTS), patellar tendon-tibial shaft angle (PTTSA).　Results　Total of 136 cases (136 knees) were enrolled in Nc-ACL group. In the control group, 358 cases (358 knees) were enrolled. The Nc-ACL group and the control group went propensity score matching in terms of age, gender, height and weight. The matching was completed with the method of same size ratio non-substituted nearest neighbor. The two groups were enrolled respectively into 68 cases (68 knees). NWI with statistical difference in Nc-ACL group was lower than that in control group (P<0.05). LTS, MT and PTTSA with statistical difference in Nc-ACL group were higher than those in control group (P<0.05). The NWI of male/female subgroup with statistical difference in Nc-ACL group was lower than that of male/female subgroup in control group (P<0.05). LTS, MT and PTTSA of male/female subgroup with statistical difference in Nc-ACL group were higher than those of male/female subgroup in control group (P<0.05). There was no statistical difference in the parameters of NWI, NSI, LTS, MT and PTTSA between male and female (P>0.05). The best truncation value of NWI was 0.261, sensitivity 64.94%, specificity 77.14%; LTS 9.11, sensitivity 89.66%, specificity 57.86%; MTS 8.84, sensitivity 70.11%, specificity 65.71%; PTTSA was 26.58, sensitivity 83.91%, specificity was 69.29%.　Conclusions　The abnormalities of NWI, MTS, LTS and PTTSA may be closely related to non-contact ACL injury. However, this conclusion needs more samples to be confirmed.

Development and preliminary evaluation of the calcaneal sustentaculum tali director using the method of positioning from the medial of the calcaneus

LIU Jin-wei, ZHU Zhao-hui, ZHANG Zeng-fang, LIU De-heng, YANG Bin, ZHENG Liang-xiao, CHEN Dong-liang, SONG Xiao-feng, LIU Peng, SAI Jia-ming, DING Zi-hai

Chinese Journal of Clinical Anatomy. 2019, 37(6): 691-696. doi:10.13418/j.issn.1001-165x.2019.06.016

Abstract ( 631 )

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Objective To evaluate the feasibility and accuracy of the guide needle inserted through the calcaneal sustentaculum tali by locating from inside, while putting the screw from the outside. Methods The L-shaped extended incision was simulated to expose the lateral calcaneal structure and subtalar joints on 10 adult cadaveric specimens (20 sides). The self-designed calcaneal sustentaculum tali director was adopted. First, placed the "positioning needle" from the inside into the subtalar joint, made the “positioning hole” of the “inner arm” entangled the positioning needle, then placed and adjusted the "inner arm of the director" so that the latter "guiding channel" was located in the center of the sustentaculum tali, installed “the lateral arm” to fix “the handle”. Then, a "guide needle" was inserted to the calcaneal from inside to outside via the"guide channel", after C-arm fluoroscopy clarifiing the ideal position of the "guide needle", drilled with a hollow hole from the outside along the "guide needle", then screwed in the appropriate hollow pressure screw. Finally, the specimens were scanned under spiral CT and the accuracy of the insertion screw was evaluated using CT images. Collecting relevant data during the process to evaluate the function of the director. Results The guide needles of all the specimens were located in the sustentaculum tali, 65% of them were located in the center, 25% below and 10% behind. On the inside, 75% of the guide needles passed through the posterior tibia tendon, 15% lied between the posterior tibia tendon and the flexor digitorum longus tendon, and 10% passes through the upper 1/3 of the flexor digitorum longus tendon. On the outside, the distance between the needle outlet point of the guide needle and the calcaneocuboid joint was (38.03±5.60) mm, the distance from the posterior articular surface was (15.01±3.38) mm, the average length of screw was (44.80±3.59) mm. In the CT scan image, all the screws were located in the sustentaculum tali, two cases penetrated the upper bony cortex, no cases showed that screw pierced the inferior and anterior of the sustentaculum tali or lower bony cortex. Conclusions The guidance of the self-designed director which adopted the "medial-oriented method" can improve the accuracy of sustentaculum tali screw placement and reduce the complications such as screw entry into the joint and calcaneal medial cortex.

Clinical application of TKA surgery assisted by 3D printing osteotomy guide plate in Hexi Corridor

NIU Ming, MA Ju-rong, WU Xu-nian, WANG Tong, CAI Jing-wei, WANG Xu-bo

Chinese Journal of Clinical Anatomy. 2019, 37(6): 697-704. doi:10.13418/j.issn.1001-165x.2019.06.017

Abstract ( 679 )

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Objective　To compare the differences of clinical efficacy between 3D printing technology surgical method and conventional surgical method in total knee arthroplasty (TKA), and to investigate the application of 3D printing osteotomy technique assisted TKA in the treatment of knee arthropathy.　Methods　From October 2015 to June 2018, 136 knees of 120 patients with TKA were randomly divided into two groups, a 3D group and a conventional group. The 60 patients in the 3D group (70 knees) used 3D printing osteotomy guide plate to assist the TKA operation. The 60 patients (66 knees) in the conventional group adopted the traditional TKA method over the same period. There were no significant differences in age, gender and knee society score grade among two groups before operation (P>0.05). Operation time, the actual distal femur and the osteotomy data of proximal tibia during operation were recorded. The mechanical femur tibia angle (MFTA), the sagittal tibia plateau caster angle (STCA) of two groups after operation were measured by X-ray and were analyzed statistically, and the knee society score (KSS) was recorded and compared between the two groups at the end of the follow-ups. 　Results　All patients were followed up for 9~32 months, no infection, prosthesis loosening or motion was observed in two groups. No significant differences in the distal femur and the osteotomy data of proximal tibia were found between the planned value in 3D group and the actual value in the operation (P＞0.05). There were statistical significances in operation time, MFTA value and STCA value between 3D group and conventional group (P<0.05). The 3D group had better clinical and functional grade in KSS than the conventional group during the last follow-ups. and there were statistical significances (P＜0.05).　Conclusion　The 3D printing technique can simplify the operation procedure, improve the surgical accuracy and the clinical efficacy, making it worthy of further promotion.

Clinical application and effect of microsurgery through eyebrow arch for the treatment of craniopharyngioma

DENG Zhao-jian, JIANG Qi-jun, GAN Zheng-kai

Chinese Journal of Clinical Anatomy. 2019, 37(6): 704-707. doi:10.13418/j.issn.1001-165x.2019.06.018

Abstract ( 633 )

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Objective To analyze the clinical effect and advantages of microsurgery of eyebrow arch for the treatment of patients with craniopharyngioma. Methods From March 2016 to March 2018, 20 patients with craniopharyngiomas who underwent microsurgical resection of eyebrow arch in our hospital were selected as the observation group; from January 2015 to February 2016, 15 patients with craniopharyngiomas who were treated with traditional coronary intervention in our hospital were selected as the control group. Clinical indicators, the integrity of tumor resection, clinical improvement, and complications were analyzed in both groups. Results The operation time, hospitalization time and length of surgical incision in the observation group were shorter than those in the control group, and the cost of treatment and the numbers of blood transfusion were less than those of the control group, the satisfaction degree of the field exposure was 95.00 %, which was statistically higher than the control group (66.67 %), P＜0.05. There was no statistical difference in the total resection rate of craniopharyngioma between the two groups. After 3 months of follow-up, the clinical manifestations of headache and endocrine symptoms in the observation group were better than those in the control group (P<0.05), while the olfactory disturbance, visual loss, and polyuria symptoms were not statistically different. The complication rate of the observation group was 20.00 %, which was lower than that of the control group (66.67 %), P<0.05. Conclusions The microscopic technique through the eyebrow arch can be used to minimally treat craniopharyngioma, which is worth promoting, because it can obtain a good surgical field of view, less damage to the brain tissue, shorter operation time and shorter hospital stay. The cost of treatment and the number of blood transfusions are also small. The headache and endocrine symptoms are significantly improved. The incidence of complications is low.

Short-term fixation of two teeth hook plate for treating avulsion fracture in adolescents with no-closed epiphysis

YIN Qu-dong, GU San-jun, HAN Xiao-fei, RUI Yong-jun, WU Yong-wei, ZHOU Zi-hong

Chinese Journal of Clinical Anatomy. 2019, 37(6): 708-711. doi:10.13418/j.issn.1001-165x.2019.06.019

Abstract ( 522 )

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Objective　To explore the effect of short-term fixation of two teeth hook plate on avulsion fracture in adolescents with no-closed epiphysis. 　Methods 　From January 2012 to November 2016, 22 cases of fresh avulsion fracture in adolescents with no-closed epiphysis were treated with short-term fixation of two teeth hook plate, of which were 13 males and 9 females, whose age ranged between 10 ~ 15 years old, with a mean of 13.0 years old. For the Salter-Harris type: type I in 8 cases, type II in 10 cases, type III in 3 cases and type IV in one case. For location of fracture type: ulna olecranon in 6 cases, humeral medial epicondyle in 4 cases, humeral lateral epicondyle in 4 cases, humeral greater tuberosity in 2 cases, lateral malleolus in 4 cases and medial malleolus in 2 cases. Early postoperative rehabilitation were all taken. After the fracture healed, the internal fixator was removed timely. All patients were followed up for 12 to 28 months (averaging 18.2 months). The functionary recovery of limb was evaluated based on the upper limb function score (DASH) and Kaikkonen’s ankle injury score respectively.　Results　The incisions healed by first intention. No vascular or nerve injury and infection, no loosening or broken of internal fixator were observed. All the avulsion fractures were smoothly healed without fracture displacement and delayed healing. During the last follow-up, the good rate of functional recovery was 100%, there were no instability of joint, no skeletal dysplasia and no traumatic arthritis.　Conclusions　Short-term fixation of two teeth hook plate has no secondary, iatrogenic injury to the epiphysis or epiphyseal plate, which is indicated for avulsion fracture in adolescents with no-closed epiphysis, but over compression and long-time fixation should be avoided.

The clinicopathological features and prognosis of 15 cases with primary extragastrointestinal stromal tumors and literature reviews

HU Wei-xian, HUANG Cheng-zhi, ZHAO Liang, YAO Xue-qing

Chinese Journal of Clinical Anatomy. 2019, 37(6): 712-717. doi:10.13418/j.issn.1001-165x.2019.06.020

Abstract ( 400 )

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Objective To investigate the clinical and pathological features of primary extragastrointestinal stromal tumors (EGISTs) and analyze the potential prognostic factors. Methods　The EGISTs patients admitted to Guangdong Provincial People's Hospital from January 2006 to August 2017 were analyzed. All cases underwent surgical resection of the tumor and further pathological diagnosis. All patients were followed up.　Results　A total of 15 patients who were pathologically confirmed as EGISTs were collected in 11 years. Among the 15 patients, 11 were male and 4 were female, with the average median age of onset was 45 years (33~70 years). In the clinical manifestations, the most initial symptoms were abdominal mass. As for tumor location, retroperitoneum (4 cases), mesocolon (4 cases), small intestinal mesentery (3 cases), pelvic cavity (1 case), left pleural cavity (1 case), pancreatic capsule (1 case), and lesser omentum (1 case) were observed. The median follow-up time was 53 months on average (ranged 1~102 months). Immunohistochemical report showed that CD117 of 14 cases positive expression(14/15), CD34 of 10 cases positive (10/15), DOG-1 of 6 cases positive (6/8). 7 patients received gene detection, while 2 cases found c-KIT gene exon 9 mutation, 2 cases c-KIT gene exon 11 mutation, 1 cases PDGFRa gene exon 12 mutation, 2 cases without any c-KIT gene or PDGFRa gene mutation. According the standard of reformative National Institutes of Health to classify the risk, five high-risk patients received R0 postoperative adjuvant imatinib therapy (average survival time was 67 months), while eight high-risk patients did not receive adjuvant therapy (average survival time was 36.58 months). Eight patients had appeared recurrence metastasis during follow-up, and eight patients had occurred tumor-related death. Conclusions Extragastrointestinalstromal tumors, whose most common symptom is abdominal mass, have low incidence and poor prognosis. The pathological features of EGISTs are similar to those of gastrointestinal stromal tumors (GISTs). R0 resection is the crucial treatment, and adjuvant imatinib therapy is beneficial to improve prognosis and prevent recurrence metastasis.

Analysis of upper and lower limbs muscle strength in 87 patients with chronic obstructive pulmonary disease by using isokinetic testing

BAI Li-ming, ZHANG Lei, ZHANG Ming-sheng

Chinese Journal of Clinical Anatomy. 2019, 37(6): 718-720. doi:10.13418/j.issn.1001-165x.2019.06.021

Abstract ( 317 )

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Objective　To analyze the muscle strength of upper and lower limbs in patients with chronic obstructive pulmonary disease (COPD) by using isokinetic testing.　Methods　The flexors and extensors of the elbow and knee in 87 patients with COPD (experimental group, mild 17, moderate 44, severe 26) and those in 34 healthy subjects (control group) were assessed by using isokinetic testing. The flexion and extension muscle peak torque (PT) of elbow and knee at angular velocity 60°/s and 180°/s were recorded respectively. The fatigue index of lower limb flexor and extensor muscles was also calculated respectively. Results　The muscle PT of elbow flexion and extension in experimental group were (20.56±7.54) Nm and (22.61±9.26) Nm respectively, the muscle PT of knee flexion and extension in experimental group were (35.78±16.99) Nm and (71.86±27.98) Nm respectively, which were lower than those of in the control group (P<0.05). The fatigue index of lower limb flexor and extensor muscles in experimental group was lower than that of in the control group (P<0.05).　Conclusions　Isokinetic muscle testing can be used as a method to analyze the changes of peripheral muscle strength in patients with COPD.

One case of very rarely anterolateral thigh free flap with oblique branch repair the foot defect

LIU Zu-an, MA Liang-hua, LI Han-hua, ZHENG Shao-yi , LAI Wen

Chinese Journal of Clinical Anatomy. 2019, 37(6): 721-723. doi:10.13418/j.issn.1001-165x.2019.06.022

Abstract ( 310 )

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