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The manner of innervation of the obturator internus, superior and inferior gemelli, and the quadratus femoris in humans (101 pelvic halves) and in rhesus monkeys (Macaca mulatta: 8 pelvic halves) were investigated. In most specimens, the inferior gemellus originated from the lateral surface of the ischial tuberosity and also from the medial surface (intrapelvic origin) just beneath the obturator internus and was covered by the falciform process of the sacrotuberous ligament. The superior gemellus was frequently innervated by the nerve to the obturator internus and the nerve to the quadratus femoris (60.4%), and the inferior gemellus was innervated by the obturator internus nerve in two specimens. The quadratus femoris nerve originated from more cranial segments than the obturator internus nerve, however these nerves had various communication patterns inside and outside the muscles. According to the intramuscular nerve distribution, in some specimens the branches to the superior gemellus from the quadratus femoris nerve extended to the inferior gemellus, and the branches to the inferior gemellus were distributed to the obturator internus. The present findings revealed that the positional relationships among the branches to the obturator internus and gemelli muscles are relatively constant, although the branching patterns and innervation patterns were varied. The various patterns and routes are considered to reflect the variability of the differentiation patterns of the anlage of the muscles. A possible schematic model of the positional relationships between the muscles and the nerves is Key words: obturator internus; quadratus femoris; gemelli muscles; innervation; sacral plexus; human gross anatomy; comparative morphologyThe obturator internus, quadratus femoris and gemelli are deep muscles of the hip joint. Several comparative anatomical studies have described the quadratus femoris (Cunningham, 1881;Wilson, 1888;Bardeen, 1907), however, few reports introduce the details of the obturator internus and gemelli muscles. Gräfenberg (1904) and Bardeen (1907) proposed that these muscles are derived from a common muscle anlage, and the obturator internus shifts to the intrapelvic space to cover the obturator foramen. Kikuchi (1987b) described that the superior gemellus is supplied not only by the nerve to the obturator internus (obturator internus nerve) but also by the nerve to the quadratus femoris (quadratus femoris nerve), and thus he proposed that the superior gemellus has two different origins. Recently, however, Shinohara (1995) proposed that the obturator internus and the two gemelli

This study was designed to determine seasonal changes in cytokines, soluble CD23 and specific IgE in the serum of patients with seasonal allergic rhinitis, and the effect of immunotherapy on these seasonal changes. Fifty-four patients with seasonal allergic rhinitis caused by Japanese cedar pollens were divided into a medication group and an immunotherapy group. The patients of the medication group were treated with nonsedating antihistamines alone during the pollen season. The patients of the immunotherapy group had been treated for variable periods (mean, 5.0 Ϯ 3.2 years) with immunotherapy using Japanese cedar pollen antigens. Serum samples were collected before and during the pollen season from each patient, to determine specific IgE, interleukin-4 (IL-4), interferon-g (IFN-g) and soluble CD23 levels in serum. A significant increase in specific IgE and IL-4 and a significant decrease in IFN-g were observed during the pollen season in the medication group. In contrast, in the immunotherapy group, none of specific IgE, IL-4 and IFN-g was significantly changed following natural exposure to pollens. However, these effects were not significant in patients undergoing immunotherapy for 3 or fewer years. Seasonal rates of increase in specific IgE and IL-4 differed significantly between good responders and poor responders to immunotherapy, but seasonal rates of decrease in IFN-g did not. A seasonal rate of increase in soluble CD23 was significantly correlated with a seasonal rate of increase in specific IgE, in both the medication and the immunotherapy groups. The seasonal rate of increase in soluble CD23 was significantly smaller in the good responders than in the poor responders to immunotherapy. In conclusion, pollen immunotherapy reduces the seasonal increase in specific IgE, IL-4 and soluble CD23 in serum, and in addition switches the seasonal preferential activation of Th-2 cells to reciprocal activation of Th-1 cells with treatment over several years. It is likely that the mechanisms responsible for the clinically beneficial effects of immunotherapy principally involve the modulation of Th-2 rather than Th-1 cytokines.

In order to comprehend more completely the morphology of the nerves to the piriformis, it is necessary to obtain a detailed understanding of the relationship of the origin and the course of these nerves from the dorsal division of the sacral plexus, with reference to the superior and inferior gluteal nerves. Twelve of seven human pelvic halves were carefully dissected in order to examine the origins of the nerves from the dorsal division of the sacral plexus. Six of these pelvic halves were further dissected under a stereomicroscope to examine the nerves to the piriformis.1. The origin of the superior gluteal nerve was more proximal and dorsal in the sacral plexus than that of the inferior gluteal nerve.2. The superior gluteal nerve consisted of a thick cranial part and a thin caudal part; the former continued as the inferior branch of the nerve, and the latter, the superior branch. The cranial and caudal parts crossed before reaching the glutei medius and minimus.3. The nerves to the piriformis arose from three main nerves from the dorsal division of the sacral plexus: 1) the caudalmost root of the superior gluteal nerve, 2) the caudal roots of the inferior gluteal nerve and 3) the common peroneal nerve. Considering the stratificational relationship among the main nerves from the dorsal division of the sacral plexus, the piriformis appears to be composed of parts from different muscle layers. o

BackgroundMutations in CDH23 are responsible for Usher syndrome 1D and recessive non-syndromic hearing loss. In this study, we revealed the prevalence of CDH23 mutations among patients with specific clinical characteristics.MethodsAfter excluding patients with GJB2 mutations and mitochondrial m.1555A > G and m.3243A > G mutations, subjects for CDH23 mutation analysis were selected according to the following criteria: 1) Sporadic or recessively inherited hearing loss 2) bilateral non-syndromic congenital hearing loss, 3) no cochlear malformation, 4) a poorer hearing level at high frequencies than at low frequencies, and 5) severe or profound hearing loss at higher frequencies.ResultsSeventy-two subjects were selected from 621 consecutive probands who did not have environmental causes for their hearing loss. After direct sequencing, 13 of the 72 probands (18.1%) had homozygous or compound heterozygous CDH23 mutations. In total, we identified 16 CDH23 mutations, including five novel mutations. The 16 mutations included 12 missense, two frameshift, and two splice-site mutations.ConclusionsThese results revealed that CDH23 mutations are highly prevalent in patients with congenital high-frequency sporadic or recessively inherited hearing loss and that the mutation spectrum was diverse, indicating that patients with these clinical features merit genetic analysis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13023-015-0276-z) contains supplementary material, which is available to authorized users.