Expression of the endocannabinoid receptors in human fascial tissue.

open7noCannabinoid receptors have been localized in the central and peripheral nervous system as well as on cells of the immune system, but recent studies on animal tissue gave evidence for the presence of cannabinoid receptors in different types of tissues. Their presence was supposed also in myofascial tissue, suggesting that the endocannabinoid system may help resolve myofascial trigger points and relieve symptoms of fibromyalgia. However, until now the expression of CBI (cannabinoid receptor I) and CB2 (cannabinoid receptor 2) in fasciae has not yet been established. Small samples of fascia were collected from volunteers patients during orthopedic surgery. For each sample were done a cell isolation, immunohistochemical investigation (CB1 and CB2 antibodies) and real time RT-PCR to detect the expression of CB1 and CB2. Both cannabinoid receptors are expressed in human fascia and in human fascial fibroblasts culture cells. although to a lesser extent than the control gene. We can assume that the expression of mRNA and protein of CBI and CB2 receptors in fascial tissue are concentrated into the fibroblasts This is the first demonstration that the fibroblasts of the muscular fasciae express CBI and CB2. The presence of these receptors could help to provide a description of cannabinoid receptors distribution and to better explain the role of fasciae as pain generator and the efficacy of some fascial treatments. Indeed the endocannabinoid receptors of fascial fibroblasts can contribute to modulate the fascial fibrosis and inflammation.noneopenFede, C; Albertin, G; Petrelli, L; Sfriso, Mm; Biz, C; De Caro, R; Stecco, CFede, C; Albertin, Giovanna; Petrelli, Lucia; Sfriso, MARIA MARTINA; Biz, Carlo; DE CARO, Raffaele; Stecco, Carl

Hallux valgus and fusion of the middle phalange of V ray

Hallux valgus (HV) is a foot deformity commonly seen in medical practice, often accompanied by significant functional disability and foot pain. Its prevalence in the adult population is in 23% in adults (18-65 years) and 35.7% in elderly people (over 65 years) and is higher in females (30% compared to males 13%). The anatomical variation of the lateral rays has been ascribed to the process of involution of the feet and of its functions and actions. The intermediate phalanges of the V ray can be fused or also reduced in volume. The aim of the study was to evaluate a possible association between HV and anatomical variation of V ray. The standard radiographs of 100 patients (M 21, F 79, mean age 53y) with clinical diagnosis of HV were analysed. The HV angle was 29.84 (range 16.9 - 62,5), the 1-2 intermetatarsal angle was 10.92 (range 6.93-16.63) and the hallux interphalangeal angle was 10.55 (range 1,8 – 35.3). In 98% of cases there was the presence of fusion of the phalanges. A series of 100 consecutive patients (M 25, F 75, mean age 48y) were also analysed and basing on the review of the standard radiographs the fusion of the middle phalange was found in 42% of cases. There are conflicting notions about aetiology of HV as well. Occupation, shoe wear, genetic predisposition, and pes planus have been implicated. Our study show a strong association between the HV and fusion of the middle phalange. The presence of an anatomical variation of the V ray could modify the biodynamic of the walk and consequently influence the development and progression of the HV

Anatomical study and clinical implication of perivascular fascia of the radial artery

The characteristics of the fascial tissue that surround a vascular bundle are rarely described in any anatomical textbook and often neglected in the histological description of a vascular structure. The ability of a vascular structure to adapt to any body movement, to maintain its calibre against external pressure preserving its functional role is guarantee by this perivascular fascia. Wrist ganglions are the most common masses localized on the dorsal and volar aspect of the wrist. The herniation of the synovial sac or a split in the synovial epithelium of the volar wrist joint produce a ganglion that is able to distort and compress the radial artery. Authors present the case of 24 years old man with a mucinous cyst originated from the volar wrist joint that was grown inside the vascular fascia of the radial artery and extended up to the middle portion of the forearm. Clinical sintomatology of pain and tenderness was justify by the temporary partial decrease of the arterial lumen and occlusion of the satellite veins. To better understand the clinical relevance of these fascial tissue a microscopical study of serial sections of the radial artery in 20 cadaveric upper limbs was performed (EE, Azan-Mallory, Weigert). The mean area of the perivascular fascia was 13596,3 mm, the mean minimum and maximum thickness of this area was 73 and 389 micron. The mean thickness of the fibrous tissue of the perivascular fascia was 26,21 micron. During the raising of a forearm pedicled radial artery flap or during the surgical excision of volar wrist ganglions the surgeon has to mobilize the radial artery thanks to the integrity of its perivascular fascia. The fascia surrounding the radial artery and satellite veins represented a inestensive sleeve that compelled the mucinous cyst to grow flattened proximally until its complete erniation and superficial radial nerve dislocation in the middle of the forearm. Other clinical implications of the alteration of the radial perivascular fascia are described

Evaluation of fascial manipulation in carpal tunnel syndrome: A pilot randomized clinical trial

peer reviewed[No abstract available

A fuzzy feature fusion method for auto-segmentation of gliomas with multi-modality diffusion and perfusion magnetic resonance images in radiotherapy

The difusion and perfusion magnetic resonance (MR) images can provide functional information about tumour and enable more sensitive detection of the tumour extent. We aimed to develop a fuzzy feature fusion method for auto-segmentation of gliomas in radiotherapy planning using multi-parametric functional MR images including apparent difusion coefcient (ADC), fractional anisotropy (FA) and relative cerebral blood volume (rCBV). For each functional modality, one histogram-based fuzzy model was created to transform image volume into a fuzzy feature space. Based on the fuzzy fusion result of the three fuzzy feature spaces, regions with high possibility belonging to tumour were generated automatically. The auto-segmentations of tumour in structural MR images were added in fnal autosegmented gross tumour volume (GTV). For evaluation, one radiation oncologist delineated GTVs for nine patients with all modalities. Comparisons between manually delineated and auto-segmented GTVs showed that, the mean volume diference was 8.69% (±5.62%); the mean Dice’s similarity coefcient (DSC) was 0.88 (±0.02); the mean sensitivity and specifcity of auto-segmentation was 0.87 (±0.04) and 0.98 (±0.01) respectively. High accuracy and efciency can be achieved with the new method, which shows potential of utilizing functional multi-parametric MR images for target defnition in precision radiation treatment planning for patients with gliomas

3D-MRI rendering of the anatomical structures related to acupuncture points of the Dai mai, Yin qiao mai and Yang qiao mai meridians within the context of the WOMED concept of lateral tension: implications for musculoskeletal disease

BACKGROUND: A conceptual model of lateral muscular tension in patients presenting thyroid associated ophthalmopathy (TAO) has been recently described. Clinical improvement has been achieved by using acupuncture on points belonging to the so-called extraordinary meridians. The aim of this study was to characterize the anatomical structures related to these acupuncture points by means of 3D MRI image rendering relying on external markers. METHODS: The investigation was carried out the index case patient of the lateral tension model. A licensed medical acupuncture practitioner located the following acupuncture points: 1) Yin qiao mai meridian (medial ankle): Kidney 3, Kidney 6, the plantar Kidney 6 (Nan jing description); 2) Yang qiao mai meridian (lateral ankle): Bladder 62, Bladder 59, Bladder 61, and the plantar Bladder 62 (Nan jing description); 3) Dai mai meridian (wait): Liver 13, Gall bladder 26, Gall bladder 27, Gall bladder 28, and Gall bladder 29. The points were marked by taping a nitro-glycerin capsule on the skin. Imaging was done on a Siemens Magnetom Avanto MR scanner using an array head and body coil. Mainly T1-weighted imaging sequences, as routinely used for patient exams, were used to obtain multi-slice images. The image data were rendered in 3D modus using dedicated software (Leonardo, Siemens). RESULTS: Points of the Dai mai meridian – at the level of the waist – corresponded to the obliquus externus abdominis and the obliquus internus abdominis. Points of the Yin qiao mai meridian – at the medial side of the ankle – corresponded to tendinous structures of the flexor digitorum longus as well as to muscular structures of the abductor hallucis on the foot sole. Points of the Yang qiao mai meridian – at the lateral side of the ankle – corresponded to tendinous structures of the peroneus brevis, the peroneous longus, and the lateral surface of the calcaneus and close to the foot sole to the abductor digiti minimi. CONCLUSION: This non-invasive MRI investigation has revealed the anatomical relations of acupuncture points belonging to 3 of the so-called extraordinary meridians. We conclude that the clinically developed "WOMED concept of lateral tension" is related to tendino-muscular structures

Pediatric primary intramedullary spinal cord glioblastoma

Spinal cord tumors in pediatric patients are rare, representing less than 1% of all central nervous system tumors. Two cases of pediatric primary intramedullary spinal cord glioblastoma at ages 14 and 8 years are reported. Both patients presented with rapid onset paraparesis and quadraparesis. Magnetic resonance imaging in both showed heterogeneously enhancing solitary mass lesions localized to lower cervical and upper thoracic spinal cord parenchyma. Histopathologic diagnosis was glioblastoma. Case #1 had a small cell component (primitive neuroectodermal tumor-like areas), higher Ki67, and p53 labeling indices, and a relatively stable karyotype with only minimal single copy losses involving regions: Chr8;pter-30480019, Chr16;pter-29754532, Chr16;56160245–88668979, and Chr19;32848902-qter on retrospective comparative genomic hybridization using formalin-fixed, paraffin-embedded samples. Case #2 had relatively bland histomorphology and negligible p53 immunoreactivity. Both underwent multimodal therapy including gross total resection, postoperative radiation and chemotherapy. However, there was no significant improvement in neurological deficits, and overall survival in both cases was 14 months.This report highlights the broad histological spectrum and poor overall survival despite multi modality therapy. The finding of relatively unique genotypic abnormalities resembling pediatric embryonal tumors in one case may highlight the value of genome-wide profiling in development of effective therapy. The differences in management with intracranial and low-grade spinal cord gliomas and current management issues are discussed

Efficacy and safety of extracranial vein angioplasty in multiple sclerosis: A randomized clinical trial

Importance: Chronic cerebrospinal venous insufficiency (CCSVI) is characterized by restricted venous outflow from the brain and spinal cord. Whether this condition is associated with multiple sclerosis (MS) and whether venous percutaneous transluminal angioplasty (PTA) is beneficial in persons with MS and CCSVI is controversial. Objective: To determine the efficacy and safety of venous PTA in patients with MS and CCSVI. Design, Setting, and Participants: We analyzed 177 patients with relapsing-remitting MS; 62 were ineligible, including 47 (26.6%) who did not have CCSVI on color Doppler ultrasonography screening. A total of 115 patients were recruited in the study timeframe. All patients underwent a randomized, double-blind, sham-controlled, parallel-group trial in 6MS centers in Italy. The trial began in August 2012 and concluded in March 2016; data were analyzed from April 2016 to September 2016. The analysis was intention to treat. Interventions: Patients were randomly allocated (2:1) to either venous PTA or catheter venography without venous angioplasty (sham). Main Outcomes and Measures: Two primary end pointswere assessed at 12 months: (1) a composite functional measure (ie, walking control, balance, manual dexterity, postvoid residual urine volume, and visual acuity) and (2) a measure of new combined brain lesions on magnetic resonance imaging, including the proportion of lesion-free patients. Combined lesions included T1 gadolinium-enhancing lesions plus new or enlarged T2 lesions. Results: Of the included 115 patients with relapsing-remitting MS, 76 were allocated to the PTA group (45 female [59%]; mean [SD] age, 40.0 [10.3] years) and 39 to the sham group (29 female [74%]; mean [SD] age, 37.5 [10.6] years); 112 (97.4%) completed follow-up. No serious adverse events occurred. Flow restoration was achieved in 38 of 71 patients (54%) in the PTA group. The functional composite measure did not differ between the PTA and sham groups (41.7%vs 48.7%; odds ratio, 0.75; 95%CI, 0.34-1.68; P = .49). The mean (SD) number of combined lesions on magnetic resonance imaging at 6 to 12 months were 0.47 (1.19) in the PTA group vs 1.27 (2.65) in the sham group (mean ratio, 0.37; 95%CI, 0.15-0.91; P = .03: adjusted P = .09) and were 1.40 (4.21) in the PTA group vs 1.95 (3.73) in the sham group at 0 to 12 months (mean ratio, 0.72; 95%CI, 0.32-1.63; P = .45; adjusted P = .45). At follow-up after 6 to 12 months, 58 of 70 patients (83%) in the PTA group and 22 of 33 (67%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 2.64; 95%CI, 1.11-6.28; P = .03; adjusted P = .09). At 0 to 12 months, 46 of 73 patients (63.0%) in the PTA group and 18 of 37 (49%) in the sham group were free of new lesions on magnetic resonance imaging (odds ratio, 1.80; 95%CI, 0.81-4.01; P = .15; adjusted P = .30). Conclusion and Relevance: Venous PTA has proven to be a safe but largely ineffective technique; the treatment cannot be recommended in patients with MS