Anatomical study of the bone morphology of the anterior talofibular ligament attachment / 대한해부학회지

Anterior talofibular ligament (ATFL) injuries are the most common cause of ankle sprains. To ensure anatomically accurate surgery and ultrasound imaging of the ATFL, anatomical knowledge of the bony landmarks around the ATFL attachment to the distal fibula is required. The purpose of the present study was to anatomically investigate the ATFL attachment to the fibula with respect to bone morphology and attachment structures. First, we analyzed 36 feet using microcomputed tomography. After excluding 9 feet for deformities, the remaining 27 feet were used for chemically debrided bone analysis and macroscopic and histological observations. Ten feet of living specimens were observed using ultrasonography.We found that a bony ridge was present at the boundary between the attachments of the ATFL and calcaneofibular ligament (CFL) to the fibula. These two attachments could be distinguished based on a difference in fiber orientation. Histologically, the ATFL was attached to the anterodistal part of the fibula via fibrocartilage anterior to the bony ridge indicating the border with the CFL attachment. Using ultrasonography in living specimens, the bony ridge and hyperechoic fibrillar pattern of the ATFL could be visualized. We established that the bony ridge corresponded to the posterior margin of the ATFL attachment itself. The ridge was obvious, and the superior fibers of the ATFL have directly attached anteriorly to it. This bony ridge could become a valuable and easy-to-use landmark for ultrasound imaging of the ATFL attachment if combined with the identification of the fibrillar pattern of the ATFL.

The malaris muscle concept reconsidered / 대한해부학회지

The malaris muscle has long been described as one of the facial muscles. Numerous studies have attempted to define and examine the malaris muscle owing to its clinical implications related to the facial aesthetic concept. In the anatomical context, however, the concept of the malaris muscle remains ambiguous. This review article proposes a reconsideration of the malaris muscle. The article focuses on the anatomical concept of the malaris muscle from previous studies to the current studies as well as the conceptual changes in the malaris muscle. To improve understanding of the role of the malaris muscle in the facial aesthetic aspects, here the article reviews the role of the malaris muscle in facial aging appearance and discusses the practical clinical applications surrounding this aging gradation.

Team–Based Learning at the Duke–NUS Graduate Medical School Singapore / 医学教育

1)We visited the Duke–NUS Graduate Medical School Singapore to learn the administration and management of, and the theory behind, team–based learning (TBL), a candidate educational method to replace the problem–based learning tutorial.<br>2)TBL motivates students to prepare for and engage in discussion. The grading of performance in TBL, certain characteristics of assignments, and the use of peer evaluation all promote individual and group accountability for learning.<br>3)To obtain the maximum overall benefit from TBL and to exploit group dynamics for effective learning, well–designed assignments are the key.

Anatomical study on the positional relationship between the meridians/acupuncture points and their surrounding structures-On the meridian/acupuncture points on the posterior aspect of the lower limb- / 全日本鍼灸学会雑誌

[Objective]More accurate data on the positional relationship between the acupuncture points belonging to the bladder meridian on the posterior aspect of the lower limb and their surrounding structures are discussed to get the effective methods for acupuncture.<BR>[Methods]Detailed dissections on the surrounding anatomical structures of the acupuncture points were performed on three cadavers of the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.<BR>[Results] 1. BL36 (Chengfu (Chinese), Shofu (Japanese)) and BL37 (Yinmen, Inmon) were situated medial to the posterior femoral cutaneous nerve and the sciatic nerve.<BR> 2. BL38 (Fuxi, Fugeki) and BL39 (Weiyang, Iyo) were situated on or near the common peroneal nerve along the media border of the biceps femoris tendon.<BR> 3. BL40 (Weizhong, Ichu), BL55 (Heyang, Goyo), BL56 (Chengjin, Shokin), BL57 (Chengshan, Shozan), BL58 (Feiyang, Hiyo), BL59 (Fuyang, Fuyo), BL60 (Kunlun, Konron), BL61 (Pucan, Bokushin) and BL62 (Shenmai, Shinmyaku) were situated along the medial sural cutaneous nerve, sural nerve and small saphenous vein.<BR> 4. BL40, BL55, BL56, BL57 were situated along the tibial nerve, the popliteal and posterior tibial arteries deep to the soleus.<BR>[Conclusion] 1. The posterior femoral cutaneous nerve and the sciatic nerve tend to run laterally to BL36 and BL37, so it is necessary to apply the acupunctural treatment lateral to BL36 and BL37 to stimulate these two nerves.<BR> 2. The sural nerve and small saphenous vein gradually tend to approach the acupuncture points toward the distal part of the posterior aspect of the leg.<BR> 3. BL40, BL55, BL56 and BL57 are shown as the acupuncture stimulation points to the tibial nerve passing the deep part of the posterior aspect of the leg.

Anatomical study on the positional relationship between the meridians/acupuncture points and their surrounding structures-Relationship between the composition of the pelvic plexus and hachiryoketsu- / 全日本鍼灸学会雑誌

[Objective]More accurate data of the relationship between the composition and distribution of the pelvic plexus and hachiryoketsu is discussed to get an effective acupuncture method.<BR>[Methods]Detailed dissections were performed under a stereomicroscope in five cadavers belonging to the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.<BR>[Results]1. The pelvic plexus is composed of the sympathetic hypogastric nerve and sacral splanchnic nerve, and the parasympathetic pelvic splanchnic nerve.<BR>(1) The hypogastric nerve arises from the superior hypogastric plexus contributing constantly to the second and third lumbar splanchnic nerves, and enters the postero-superior horn of the pelvic plexus. The sacral splanchnic nerves arise from the third and fourth lumbar gangalia and enter the postero-inferior horn of the pelvic plexus.<BR>(2) The pelvic splanchnic nerves mainly arise from the most ventral layer of the ventral primary of the third and fourth sacral nerves, and enter the postero-inferior horn of the pelvic plexus. These nerves tend to compose the common trunk with the pudendal nerve and the nerve to the levator ani. <BR> 2. The visceral branches of the pelvic plexus do not originate and distribute equally, but tend to divide into I-IV groups. Especially, group III is considered important clinically as these nerves are related to sexual and voiding functions.<BR>[Conclusion] 1. BL33(Zhongliao, Churyo) and BL34 (Xialiao, Geryo) are suggested to have an effect on the function of the intrapelvic organs as these acupuncture points can stimulate the pelvic splanchnic nerves directly rather than BL31 (Shangliao, Joryo) and BL32 (Ciliao, Jiryo).<BR> 2. The point of the needle into the hachiryoketsu reaches the side of the rectum, so treating with a needle to the median direction should be avoided or paid attention to.

Anatomical study on the positional relationship between the meridians/acupuncture points and their surrounding structures-On the surrounding structures of Zhibian (BL54) and the acupuncture stimulation points to the sciatic nerve- / 全日本鍼灸学会雑誌

[Objective]More accurate anatomical data is discussed to reveal the surrounding structures of the new and former BL54 (Zhibian, Chippen) according to the positional modification of acupuncture points by WHO (2006), and also to demonstrate the acupuncture stimulation points to the sciatic nerve as effective methods for acupuncture treatment of the pain in the lower back.<BR>[Methods]Detailed dissections were performed on the surrounding structures of the acupuncture points of the bladder meridian at the gluteal region and the posterior aspect of the thigh in three cadavers at the Unit of Clinical Anatomy, Graduate School, Tokyo Medical and Dental University.<BR>[Results] 1. The new BL54 (WHO, 2006) was situated at or near the infrapiriform foramen, with the posterior femoral cutaneous nerve, inferior gulteal nerve and vessels and sciatic nerve passing through.<BR> 2. The former BL54 was situated at or near the suprapiriform foramen with the inferior gulteal nerve and vessels passing through.<BR> 3. The acupuncture stimulation points to the sciatic nerve at the gluteal region and the posterior aspect of the thigh were as follows;(1) the initial portion of the sciatic nerve, (2) the infrapiriform foramen (new BL54, WHO), (3) the lateral one third point of the line connecting the sacrococcygeal junction and the greater trochanter, (4) the midpont of the line connecting the ischial tuberosity and the greater trochanter, (5) the point about 1 cm lateral to BL36 (Chengfu, Shofu), (6) the medial half portion of the biceps femoris muscle lateral to BL37 (Yinmen, Inmon).<BR>[Conclusion] 1. The new and former BL54 are situated near the main nerves and vessels of the gluteal region and the posterior aspect of the thigh, so are considered as effective points for the acupunctural treatment.<BR> 2. The six positions are showed as the acupuncture stimulation points to the sciatic nerve in the gluteal region and the posterior aspect of the thigh.