Gene expression regulation of the effect of shading on chlorophyll content in Fuding White Tea (Camellia sinensis L.).

Shading is an important practical method to improve the quality of green tea. Previous research of our group found that because the biosynthesis and distribution of theanine in tea plants were affected by down regulation of gene encoding amino acid permeases, theanine content in tea leaves which grown under shading condition was significantly higher than those under natural light. In this study, our group analyzed the changes of tea leaf area, free amino acid content and photosynthetic parameters under natural light and shading conditions, to ensure that moderate shading did not reduce but improve the quality of tea. Transcriptome sequencing and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were conducted to reveal the expression levels of genes related to chlorophyll content and chlorophyll a/b ratio under natural light and shading conditions. Experimental results revealed the presence of the following differentially expressed genes (DEGs) in the porphyrin and chlorophyll metabolism pathway of tea under natural light and shading conditions: the up regulation of CPOX expression may lead to an increase in the accumulation of raw materials of chlorophyll synthesis, while the down regulation of SGR expression may lead to a decrease in chlorophyll degradation. The combined effect of these two genes may lead to an increase in the total chlorophyll content of tea. The down regulation of NOL expression may lead to the obstruction of chlorophyll b transform to chlorophyll a, that is, the decrease of the chlorophyll a/b ratio. This study investigated the molecular mechanism of chlorophyll content and component alteration in Fuding white tea under natural light and shading conditions, and elucidated the effects of different light intensities on the porphyrin and chlorophyll metabolism pathway of tea. Thus provided deep understanding of chlorophyll regulation under shading condition in tea cultivation, which could contribute to high-quality matcha production.

Complex causal association between genetically predicted 731 immunocyte phenotype and osteonecrosis: A bidirectional Two-sample mendelian randomization analysis.

PURPOSE: Previous studies have explored the role of immune cells on osteonecrosis. This Mendelian randomization (MR) study further assessed 731 immunocyte phenotypes on osteonecrosis whether a causal relationship exists and provides some evidence of causality. METHODS: The 731 immunocyte phenotypes and osteonecrosis data used in this study were obtained from their respective genome-wide association studies (GWAS). We used inverse variable weighting (IVW) as the primary analysis method. In addition, we simultaneously employed multiple analytical methods, including MR-Egger, weighted mode, simple mode, and weighted median, to strengthen the final results. Finally, sensitivity analyses were conducted to verify the stability and feasibility of the data. RESULTS: The results of the IVW method of MR analysis showed that 8 immunocyte phenotypes were positively associated with osteonecrosis (P<0.05, OR > 1); 18 immunocyte phenotypes were negatively associated with osteonecrosis (P<0.05, OR<1), none of which were heterogeneous or horizontally pleiotropic (P > 0.05) or reverse causality. In addition to this, in reverse MR, osteonecrosis was positively associated with 10 additional immunocyte phenotypes (P<0.05, OR > 1) and negatively associated with 14 immunocyte phenotypes (P<0.05, OR<1). And none of them had heterogeneity and horizontal pleiotropy (P > 0.05) or reverse causality. CONCLUSIONS: We demonstrated a complex causal relationship between multiple immune phenotypes and osteonecrosis through a comprehensive two-way two-sample MR analysis, highlighting the complex pattern of interactions between the immune system and osteonecrosis.

Evaluations of the diagnostic performance of ZOOMit diffusion-weighted imaging and conventional diffusion-weighted imaging for breast lesions.

Background: Diffusion-weighted imaging (DWI) is valuable in the screening, diagnosis, and grading of breast lesions. However, conventional DWI (C-DWI) is prone to chemical shift and distortion. ZOOMit DWI (Z-DWI), as an advanced magnetic resonance imaging (MRI) technique, applies two spatially selective parallel excitation pulses to focus sampling in the hope of obtaining more valuable information. This study aimed to evaluate and compare the image quality and feasibility of Z-DWI with those of C-DWI in breast lesions. Methods: The study included 51 patients with breast lesions who underwent breast MRI from May 2021 to February 2022. All patients received Z-DWI and C-DWI sequences, with b values selected as 50 and 800 s/mm2 (Z-DWIb50, Z-DWIb800, C-DWIb50, and C-DWIb800). Apparent diffusion coefficient (ADC) values based on Z-DWI and C-DWI were calculated. For qualitative analysis, four image quality parameters were selected and assessed on a 4-point Likert scale (1 = poor and 4 = excellent). For quantitative analysis, ADC, relative ADC (rADC), signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and tumor-to-parenchymal contrast (TPC) values were selected for comparison. Results: Z-DWI had higher scores compared to C-DWI in terms of lesion conspicuity, anatomical details, distortion and artifacts, and overall image quality (P<0.05). Meanwhile, the agreement between the two readers was reasonably good [intraclass correlation coefficient (ICC) range, 0.360-0.881]. The SNR of Z-DWIb800 was better than that of C-DWIb800 (P<0.001). The Z-DWI ADC and rADC values of breast lesions were statistically significantly lower than those of C-DWI (mean ADC: P<0.001; rADC; P=0.005). Conclusions: Z-DWI sequences were shown to have superior image quality. The ADC map of Z-DWI is more conducive to the imaging evaluation of breast lesions.

An Assessment of the Pathological Classification and Postoperative Outcome of Focal Cortical Dysplasia by Simultaneous Hybrid PET/MRI.

OBJECTIVES: The purpose of this research was to investigate whether MRI and Simultaneous Hybrid PET/MRI images were consistent in the histological classification of patients with focal cortical dysplasia. Additionally, this research aimed to evaluate the postoperative outcomes with the MRI and Simultaneous Hybrid PET/MRI images of focal cortical dysplasia. METHODS: A total of 69 cases in this research were evaluated preoperatively for drug-resistant seizures, and then surgical resection procedures of the epileptogenic foci were performed. The postoperative result was histopathologically confirmed as focal cortical dysplasia, and patients then underwent PET and MRI imaging within one month of the seizure. In this study, head MRI was performed using a 3.0 T magnetic resonance scanner (Philips) to obtain 3D T1WI images. The Siemens Biograph 16 scanner was used for a routine scanning of the head to obtain PET images. BrainLAB's iPlan software was used to fuse 3D T1 images with PET images to obtain PET/MRI images. RESULTS: Focal cortical dysplasia was divided into three types according to ILAE: three patients were classified as type I, twenty-five patients as type II, and forty-one patients as type III. Patients age of onset under 18 and age of operation over 18 had a longer duration (p = 0.036, p = 0.021). MRI had a high lesion detection sensitivity of type III focal cortical dysplasia (p = 0.003). Simultaneous Hybrid PET/MRI showed high sensitivity in detecting type II and III focal cortical dysplasia lesions (p = 0.037). The lesions in Simultaneous Hybrid PET/MRI-positive focal cortical dysplasia patients were mostly located in the temporal and multilobar (p = 0.005, 0.040). CONCLUSION: Simultaneous Hybrid PET/MRI has a high accuracy in detecting the classification of focal cortical dysplasia. The results of this study indicate that patients with focal cortical dysplasia with positive Simultaneous Hybrid PET/MRI have better postoperative prognoses.

Value of contrast-enhanced magnetic resonance imaging-T2WI-based radiomic features in distinguishing lung adenocarcinoma from lung squamous cell carcinoma with solid components >8 mm.

Background: Radiomics is one of the research frontiers in the field of imaging and has excellent diagnostic performance. However, there is a lack of magnetic resonance imaging (MRI)-based omics studies on identifying pathological subtypes of lung cancer. Here we explored the value of the contrast-enhanced MRI-T2-weighted imaging (T2WI)-based radiomic analysis in distinguishing adenocarcinoma (Ade) from squamous cell carcinoma (Squ) with solid components >8 mm. Methods: A retrospective analysis was performed of a total of 71 lung cancer patients who undergoing contrast-enhanced MRI and computed tomography (CT) before treatment, and the nodules had solid components ≥8 mm in our center from January 2020 to September 2021. All enrolled patients were divided into Squ and Ade groups according to the pathological results. In addition, the two groups were randomly divided into training set and validation set in a ratio of about 7:3. Radiomics software was used to extract the relevant radiomic features. The least absolute shrinkage and selection operator (Lasso) was used to screen radiomic features that were most relevant to lung cancer subtypes, thus calculating the radiomic scores (Rad-score) and constructing the radiomic models. Multivariate logistic regression was used to combine relevant clinical features with Rad-score to form combined model nomograms. The receiver operating characteristic (ROC) curves. the area under the ROC curve (AUC), the decision curve analysis (DCA) and the DeLong's test were used to evaluate the clinical application potentials. Results: The sensitivity and specificity of the clinical model based on smoking was 75.0% and 93.8%. The AUC of the constructed magnetic resonance (MR)-Rad model for differentiating the pathological subtypes of lung cancer was 0.8651 in the validation sets. The AUC of the CT-Rad model in the validation set were 0.9286. The combined model constructed by combining clinical features and Rad-score had AUC of 0.8016, for identifying the 2 pathological subtypes of lung cancer in the validation set. There was no significant difference in diagnostic performance between MR-Rad model and CT-Rad model (P>0.05). Conclusions: The MR-Rad model has a diagnostic performance similar to that of CT-Rad model, while the diagnostic performance of the combined mode was better than the single MR model.

Three-dimensional reconstruction with dual-source computed tomography for evaluating graft deformation and bone tunnel position following reconstruction of the anterior cruciate ligament.

OBJECTIVE: Considering the limitations of MRI and X-ray and few studies on the use of dual-source computed tomography (DSCT) in anterior cruciate ligament (ACL) reconstruction are limited, this study explored the clinical application of DSCT for three-dimensional reconstruction of graft deformation and bone tunnel position images following ACL reconstruction. METHODS: The data of 123 patients who underwent single-bundle ACL reconstruction under arthroscopy from January 2017 to October 2021 were retrieved. Two weeks after surgery, DSCT was used to assess graft deformation and tunnel widening. Based on the positions of ACL graft deformation and bone tunnel, the patients were divided into a collision group (n = 35), posterior group (n = 37) and satisfactory group (n = 51). The groups were compared in terms of the relative position of the central point of the femoral tunnel (FX, FY) and tibial tunnel (TX, TY), the straight-line distances of the grafts (L), the sagittal plane angle (∠α), and the coronal plane angle (∠ß) between the two bone tunnels. RESULTS: Tx, Ty, ∠α and âˆ ß were significantly different among the three groups, while no difference in Fx, Fy and L were observed. Tx, Ty and ∠α were identified as independent risk factors for collisions between the graft and intercondylar notch. Ty and ∠α were independent risk factors for posterior deviation of tibial tunnel position. CONCLUSION: DSCT demonstrated promising clinical applicability to evaluate graft deformation and bone tunnel position after reconstruction of ACL and could guide preoperative positioning and postoperative evaluation.

Distinguishing T1-2 and T3a tumors of rectal cancer with texture analysis and functional MRI parameters.

PURPOSE We aimed to investigate whether the texture analysis and functional magnetic resonance imaging (fMRI) could differentiate rectal cancer pathological stages T1-2 (pT1-2) and T3a (pT3a). METHODS Eighty-two rectal adenocarcinoma patients at stage pT1-2 and pT3a received T2 and fMRI examination before surgery. The latter included apparent diffusion coefficient (ADC) sequence, dynamic contrast enhancement (DCE) MRI, and intravoxel incoherent motion (IVIM) diffusion weighted imaging. Patients were grouped into early stage (pT1-2) and advanced stage (pT3a). The MRI accuracy in diagnosing rectal cancer before surgery was calculated. The differences in clinicopathological variables, quantitative parameters including ADC values, IVIM parameters (perfusion fraction [f], true diffusion coefficient [D], and pseudo- diffusion coefficient [D*]), DCE MRI parameters (transfer constant [Ktrans], reflux constant [Kep], and extravascular extracellular fractional volume [Ve]), and texture features were compared between the groups. Receiver operating characteristic (ROC) curves of texture features and fMRI parameters were generated to distinguish pT1-2 and pT3a tumors. The multivariate analysis was used to develop a predictive model and to find independent risk factors. Hosmer-Lemeshow test was used to see the fitness of the model. DeLong test was applied to compare the ROC curves of different features. Correlation of texture features and fMRI parameters with stage were calculated using r (Spearman's rank correlation coefficient). RESULTS The preoperative accuracy in differentiating pT1-2 from pT3a rectal cancer using MRI was 74.39%. Kep, Ve, and ADC showed significant differences between the groups. Kep and ADC showed negative correlation with stage. Ve correlated positively with stage. Twenty-five texture features from T2 images showed significant differences between groups, and S(0,2)SumOfSqs and WavEnLH_s_2 among these showed better performance, showing negative correlation with stage. The area under the curve (AUC) values of S(0,2)SumOfSqs, WavEnLH_s_2, ADC, Kep, and Ve were 0.721, 0.699, 0.690, 0.666, and 0.653, respectively. The multivariate analysis showed that S(0,2) SumOfSqs, WavEnLH_s_2, and ADC are risk factors for advanced tumors, and the logistic model built by Kep, Ve, S(0,2)SumOfSqs, WavEnLH_s_2, and ADC has the AUC, sensitivity, and specificity of 0.833, 88.5%, and 73.3%, respectively. ROC curve of the model showed statistical significance between S(0,2)SumOfSqs, ADC, Kep, and Ve. The P value of the Hosmer-Lemeshow test was 0.65. CONCLUSION S(0,2)SumOfSqs, WavEnLH_s_2, and ADC are risk factors for advanced rectal cancer, and the model built by Kep, Ve, S(0,2)SumOfSqs, WavEnLH_s_2, and ADC has better performance than using a single method. The application of above combinations could be beneficial to patients' accurate and individualized treatments.

BRITTLE CULM17, a Novel Allele of TAC4, Affects the Mechanical Properties of Rice Plants.

Lodging resistance of rice (Oryza sativa L.) has always been a hot issue in agricultural production. A brittle stem mutant, osbc17, was identified by screening an EMS (Ethylmethane sulfonate) mutant library established in our laboratory. The stem segments and leaves of the mutant were obviously brittle and fragile, with low mechanical strength. Examination of paraffin sections of flag leaf and internode samples indicated that the number of cell layers in mechanical tissue of the mutant was decreased compared with the wild type, Pingtangheinuo, and scanning electron microscopy revealed that the mechanical tissue cell walls of the mutant were thinner. Lignin contents of the internodes of mature-stage rice were significantly lower in the mutant than in the wild type. By the MutMap method, we found candidate gene OsBC17, which was located on rice chromosome 2 and had a 2433 bp long coding sequence encoding a protein sequence of 810 amino acid residues with unknown function. According to LC-MS/MS analysis of intermediate products of the lignin synthesis pathway, the accumulation of caffeyl alcohol in the osbc17 mutant was significantly higher than in Pingtangheinuo. Caffeyl alcohol can be polymerized to the catechyl lignin monomer by laccase ChLAC8; however, ChLAC8 and OsBC17 are not homologous proteins, which suggests that the osbc17 gene is involved in this process by regulating laccase expression.

Native T1-mapping and diffusion-weighted imaging (DWI) can be used to identify lung cancer pathological types and their correlation with Ki-67 expression.

Background: This study aimed to explore the value of native T1-mapping and diffusion-weighted imaging (DWI) in differentiating the pathological types and degree of tumor differentiation of lung cancer and their correlation with Ki-67 protein expression. Methods: A total of 78 consecutive lung cancer patients who received chest magnetic resonance imaging (MRI) scans between May 2020 and June 2021 were enrolled in this study. Two radiologists independently analyzed the apparent diffusion coefficient (ADC) and T1 values for each lesion. The intraclass correlation coefficient (ICC) and Bland-Altman plots were generated to assess interobserver agreement of the T1 and ADC mean values in lesions. The difference in ADC and T1 values among different pathological types, as well as between high- and low-differentiated lung cancers were analyzed, and diagnostic efficacy was evaluated by receiver operating characteristic (ROC) curve analysis. The correlation between ADC value, T1 value, and Ki-67 protein expression index was determined. Results: The ADC and T1 values showed excellent interobserver agreement (ICC 0.820, 0.942, respectively). There was a significant difference in ADC values between small cell carcinoma and squamous carcinoma (P<0.05), and between small cell carcinoma and adenocarcinoma (P<0.05), but not between squamous carcinoma and adenocarcinoma (P>0.05). A significant difference in T1 values was observed between small cell carcinoma (P<0.05) and adenocarcinoma, and between squamous carcinoma (P<0.05) and adenocarcinoma, but not between squamous carcinoma and small cell carcinoma (P>0.05). There were statistically significant differences in ADC and T1 values between the moderately and highly differentiated group and the poorly differentiated group (P<0.05). ROC curve analysis showed that the T1 combined with ADC value had high diagnostic value for the degree of differentiation of the tumor [area under the curve (AUC) =0.912]. Pearson correlation analysis showed a significant positive correlation between T1 value and Ki-67 index (r=0.66, P<0.001) and a significant negative correlation between ADC value and Ki-67 index (r=-0.45, P<0.01). Conclusions: T1 and ADC values can be used to distinguish the pathological type and differentiation degree of lung cancer.

The effects of cognitive load and encoding modality on prospective memory.

Successful execution of an intention as planned is necessary for people's normal life. However, people sometimes even forget intentions that they consider as very important. Hence, the issues that whether prospective memory performance can be improved under high cognitive load tasks are worth discussing. In this study, we used a 2 (cognitive load: high or standard) × 2 (encoding modality: verbal or enactment encoding) mixed design to explore the effects of encoding modality and cognitive load of ongoing tasks on prospective memory. The results showed that the prospective memory performance under high cognitive load condition was significantly worse than that under standard cognitive load condition for verbal encoding condition. However, for enactment encoding condition, enactment encoding enhanced the performance and abolished the difference between high and low cognitive load effects on prospective memory. Strategic issues of prospective memory will be discussed.

A correlative study of iron metabolism based on q-Dixon MRI in benign prostatic hyperplasia and prostate cancer.

Clinical staging, Gleason score, and prostate-specific antigen (PSA) have been accepted as factors for evaluating the prognosis of prostate cancer (PCa). With the in-depth study of iron metabolism and the development of multiparametric magnetic resonance imaging technology, we used q-Dixon magnetic resonance imaging (MRI) to measure the iron content of the PCa patients' lesions, and used enzyme-linked immunosorbent assay (ELISA) to measure the iron metabolism indicators in the patients' serum samples, combined with the patients' postoperative clinical data for analysis. We found that the serum indexes were correlated with the T2 star values, International Society of Urological Pathology (ISUP) grade, and pathological classification in PCa patients (all P < 0.001) but not in benign prostatic hyperplasia (BPH) patients (all P > 0.05). The utilization of q-Dixon-based MRI and serum indexes allows the noninvasive measurement of iron content in prostate lesions and the assessment of differential iron metabolism between PCa and BPH, which may be helpful for evaluating the prognosis of PCa.

Translating words into actions in working memory: The role of spatial-motoric coding.

Research from a working memory perspective on the encoding and temporary maintenance of sequential instructions has established a consistent advantage for enacted over verbal recall. This is thought to reflect action planning for anticipated movements at the response phase. We describe five experiments investigating this, comparing verbal and enacted recall of a series of action-object pairings under different potentially disruptive concurrent task conditions, all requiring repetitive movements. A general advantage for enacted recall was observed across experiments, together with a tendency for concurrent action to impair sequence memory performance. The enacted recall advantage was reduced by concurrent action for both fine and gross concurrent movement with the degree of disruption influenced by both the complexity and the familiarity of the movement. The results are discussed in terms of an output buffer store of limited capacity capable of holding motoric plans for anticipated action.

Teacher's Emotional Support and Math Performance: The Chain Mediating Effect of Academic Self-Efficacy and Math Behavioral Engagement.

Positive teacher-student interaction can exert a positive influence on student engagement and math performance. As an important part of teacher-student interaction, emotional support of a teacher plays an indispensable role in the math performance of junior middle school and elementary school students. This study aimed to explore the effects of teacher's emotional support on math performance, and examine the mediating role of academic self-efficacy and math behavioral engagement. A total of 1,294 students in grades 3-5 and 7-8 from 14 junior middle and primary schools in China took part in the web-based survey. Results showed the following: (1) academic self-efficacy mediated the relationship between teacher's emotional support and math performance of Chinese primary and middle school boys and girls; math behavioral engagement mediated the relationship between teacher's emotional support and math performance of Chinese primary and middle school boys and girls; (2) The relationship between teacher's emotional support and math performance of Chinese junior middle school boys and girls was mediated by the chain of academic self-efficacy and math behavioral engagement.

Memory for actions in Chinese children with developmental dyslexia.

Around 5-10% of school children in China suffer from reading disabilities. Previous studies have shown that children with developmental dyslexia have deficits in encoding and retrieval information. Moreover, many studies have provided evidence that performing actions can promote the encoding and retrieval of memory compared to verbal tasks. Therefore, we expected that performing actions can improve the memory performance of children with developmental dyslexia. However, memory for actions of children with developmental dyslexia has not been sufficiently explored. The present study used a 2 (group: dyslexic or typical) × 2 (type of encoding: subject-performed task or verbal task) between-subjects design to examine whether subject-performed task could enhance the memory performance of children with developmental dyslexia. The results revealed that performing actions not only improves the memory performance of the typical group but also of the dyslexic group. We suggest that performing actions can improve the level of self-involvement during encoding and enhance item accessibility during retrieval of memory of children with dyslexia, thus compensating for the memory reduction caused by the deficits of rehearsal and retrieval strategies of children with dyslexia.

The output monitoring of performed actions: What can we learn from "recall-recognition" performance?

Memories of simple action phrases are retained better following subject-performed tasks (SPT) than verbal tasks (VT), and this superior memory performance of SPT over VT is referred to as the SPT effect. Although research has been conducted on the SPT effect for more than 30 years, how well participants recognize whether they recalled the items successfully and the relationship between item-specific processing encoding and automatic retrieval have not been addressed. The present study used a 2 (instruction: with or without pleasantness rating) × 2 (type of encoding: SPT or VT) between-subject design and applied a "recall-recognition" paradigm to explore the above issues. For the "recall-recognition" performance, the SPT (and the VT with the pleasantness-rating task) produce very poor recognition of the correct recall of the last items (recency effect) and still poorer recognition of the middle items relative to VT alone, indicating that the retrieval process of these items in SPT needs less intention, effort, or monitoring, happens instantly, and involves a more non-obvious memory trace than that in VT alone. This was taken as support for the idea that an emphasis on item-specific information leads to automatic retrieval and thus poor awareness of the prior correct recall. We suggest that the SPT effect can be explained from the perspective of both encoding and retrieval.

The Role of Item-Specific Information for the Retrieval Awareness of Performed Actions.

Research on action memory has been pursued for more than 30 years, but it is still unclear what drives the recollection process of performed actions. In this study, we used the remember/know paradigm and designed two experiments to examine the relation between item-specific processing and retrieval awareness of subject-performed tasks (SPT). The results showed that SPT allows remember responses in remember-know judgments more easily; that is, SPT can enhance the frequency of recalling re-collective experience. Item-specific processing can improve the memory performance and the proportion of remember judgments of verbal tasks (VT), but it does not improve the memory performance and proportion of remember judgments of SPT, indicating that SPT can enhance item-specific processing, which leads to more remember responses in judgment. The relation between item-specific processing and retrieval awareness of SPT is also discussed.

Directed forgetting of negative performed actions is difficult: A behavioural study.

Strong evidence suggests that both performing actions and emotional stimuli can enhance memory by capturing attention. However, the synergetic effect of the two factors on directed forgetting has not been assessed. In this study, we used an item-method directed forgetting paradigm to examine the forgetting of emotional materials depending on whether actions were performed. The results showed that action performance influenced the directed forgetting of emotional words. Specifically, when actions were performed there was a directed forgetting effect for neutral and positive words but not for negative words. In comparison, for verbal tasks, directed forgetting was observed for all words. The elaborative encoding prior to the remember/forget instructions and the influence of negative emotion on attentional inhibition after the presentation of the instructions together suggest that it is more difficult to intentionally forget negative performed actions.

Anatomic assessment of femoral tunnel by transtibial drilling technique in double-bundle anterior cruciate ligament reconstruction: an in vivo study.

OBJECTIVE: To evaluate the anatomy of femoral tunnels created by simulated transtibial technique in double-bundle anterior cruciate ligament (ACL) reconstruction. METHODS: Two tibial tunnels, anteromedial (AM) and posterolateral (PL), were drilled 45?and 55?to tibial plateau respectively. On the femoral side, the AM and PL tunnels were drilled through anteriomedial portal. After the four tunnels were established, the shaft of a reamer was introduced into the joint through tibial tunnel and reached against the lateral wall of intercondylar notch. The position that the reamer shaft can reach was marked and recorded. RESULTS: Neither femoral AM nor PL tunnel opening can be fully or partially reached by the reamer shaft through the tibial AM tunnel in all cases. The evaluation through the tibial PL tunnel showed that only in 8 of 50 cases (16%) the femoral AM tunnel opening and in 4 cases (8%) the PL opening can be fully reached. On the other hand, in 12 cases (24%) the femoral AM tunnel opening and in 10 cases (20%) the PL opening can be partially reached by the shafts through the tibial PL tunnel. CONCLUSION: The result strongly suggests that transtibial technique is not well competent for femoral tunnel drilling in anatomic double-bundle ACL reconstruction as we have hypothesized.