The effective zone of botulinum toxin A injections in the sternocleidomastoid muscle.

PURPOSE: The aim of this study was to document the anatomical landmarks of the motor entry point (MEP) and the intramuscular motor point (IMP) of the sternocleidomastoid (SCM) muscle for effective botulinum toxin injections. MATERIALS AND METHODS: Thirty-five specimens from 20 adults bodies donated to science were investigated. The reference points were the mastoid process and the most medial point of the clavicle. RESULTS: The mean length of the reference line was 165.2 ± 12.8 mm. 97.0% of the total number of MEP in this study were located at 20-40 and 85.0% of the total number of the IMP was located at 20-70% from the mastoid process. The intersection with the great auricular nerve was located at 22%, it was 45% for the transverse cervical nerve and 28% for the external jugular vein. CONCLUSIONS: In clinical practice, the mass in patients with torticollis or cervical dystonia might be formed at the lower part or upper part of the SCM muscle. For a mass in the upper portion of the SCM muscle, the injection area using alcohol, phenol or botulinum toxin was determined to be 20-40%. However, to inject the area at 20-40%, ultrasound guidance is recommended because of the cervical cutaneous nerves and veins. For a mass in the lower portion of the SCM muscle, the injection area of botulinum toxin was 50-70%. These areas can be used with botulinum toxin injections or other agents for motor point blocking in patients with torticollis or cervical dystonia.

Anatomical localization of submandibular gland for botulinum toxin injection.

The aim of this study was to document the anatomical landmarks of the submandibular gland (SMG) for a botulinum toxin injection. Thirty-four SMGs from 20 cadavers were examined. The mean length of a reference line between the angle of the mandible and the gnathion was 94.8 ± 5.9 mm, the proximal and distal point of the SMG from the angle of the mandible was 10.6% (11.5 ± 3.5 mm) and 41.8% (40.9 ± 5.2 mm), respectively. The facial artery came out of the SMG at 11.6% (14.6 ± 3.4 mm) and the position of the intersection of the facial artery with the inferior border of the mandible was located at 24.4% (28.0 ± 5.5 mm) from the angle of the mandible. The shape of the SMG was generally triangular or irregular round on the anatomical position. The mean superior-inferior diameter, anterior-posterior diameter and medial-lateral diameter of the gland was 28.8 ± 4.1, 30.0 ± 6.1 and 15.1 ± 3.5 mm, respectively. The safety zone for the injection was 20-35% from the mandible angle on the inferior view and 1.5 cm below the inferior line of the mandible on the lateral view. In addition, the needle should be inserted to a depth of 2.0 cm from the skin surface on the inferior view. These results may assist in determining a accurate localization of injection sites for the SMG, particularly for injections without ultrasound guidance.

Interaction between the alpha-T catenin gene (VR22) and APOE in Alzheimer's disease.

BACKGROUND: APOE is the only gene that has been consistently replicated as a risk factor for late onset Alzheimer's disease. Several recent studies have identified linkage to chromosome 10 for both risk and age of onset, suggesting that this region harbours genes that influence the development of the disease. A recent study reported association between single nucleotide polymorphisms (SNPs) in the VR22 gene (CTNNA3) on chromosome 10 and plasma levels of Abeta42, an endophenotype related to Alzheimer's disease. OBJECTIVE: To assess whether polymorphisms in the VR22 gene are associated with Alzheimer's disease in a large sample of Alzheimer's disease families and an independent set of unrelated cases and controls. RESULTS: Several SNPs showed association in either the family based or case-control analyses (p<0.05). The most consistent findings were with SNP6, for which there was significant evidence of association in both the families and the unrelated cases and controls. Furthermore, there was evidence of significant interaction between APOE-4 and two of the VR22 SNPs, with the strongest evidence of association being concentrated in individuals carrying APOE-4. CONCLUSIONS: This study suggests that VR22 or a nearby gene influences susceptibility to Alzheimer's disease, and the effect is dependent on APOE status.

Gender, ethnicity, and acculturation in intergenerational conflict of Asian American college students.

This study examined differences in patterns of intergenerational conflict according to gender, ethnicity, and acculturation level of Asian American college students. A survey containing a measure of acculturation and intergenerational conflict was completed by 342 participants. A 2 (gender) x 5 (ethnicity) x 3 (acculturation) multivariate analysis of variance for the 3 subscales of the Intergenerational Conflict Inventory revealed significant F values for all 3 main effects, but none for the interactions. On the subscale of Dating and Marriage, male students reported less conflict than female students, and Japanese Americans reported less conflict than Chinese, Filipino, Korean, and Southeast Asian Americans. On the subscale of Family Expectations, Japanese Americans also reported less conflict than Koreans and Southeast Asians. On both of these and a 3rd subscale of Education and Career, the acculturated group reported lower conflict than both the low-acculturated and bicultural groups. The implications of these findings for research and practice are discussed.