Coexistence of the suprascapular notch and the suprascapular foramen—a rare anatomical variation and a new hypothesis on its formation based on anatomical and radiological studies

The suprascapular notch is the most common site of suprascapular nerve entrapment, which can manifest in disability and pain of the upper limb. Here, we present three cases of a very rare anatomical variation in the suprascapular region: the coexistence of the suprascapular notch and the suprascapular foramen. The variation was found during radiological and anatomical investigations. The suprascapular foramen was situated inferior to the suprascapular notch. A bony bridge lay between them, likely created by an ossified anterior coracoscapular ligament (ACSL). This anatomical variation probably increased the risk of suprascapular nerve entrapment by nerve irritation of the bony margins during passsage through the foramen and by a lack of the elasticity that the ACSL normally demonstrates. Also, a bony bridge passing through the middle part of the suprascapular notch reduces the space available for nerve passage (bony bridge decreases the space by about 36.5–38.6 %). One patient who underwent the radiological study had typical symptoms of suprascapular nerve entrapment. Based on his medical history and the presence of this rare variation of the suprascapular notch at the suprascapular region we suspect this neuropathy.     

Effect of glucocorticoids on indomethacin-induced gastric ulcer in the adult male albino rat – histological,morphometric and electron microscopy study

Introduction

Indomethacin is a non steroidal anti-inflammatory drug (NSAID) which is capable of producing injury to gastric mucosa. To prevent of NSAID-induced gastropathy, it is important to evaluate the risk factors. One of them is steroid. The aim is to study time dependent effects of glucocorticoids (GC) on indomethacin induced gastric ulcer.

Material and methods

Forty-nine albino rats were used. They were divided into control and experimental groups. The experimental group was subgroup I (rats were given indomethacin and were sacrificed 1 day after drug intake), subgroup II (rats were given indomethacin + dexamethasone and were sacrificed 1 day after drug intake), subgroup III (rats were given indomethacin + dexamethasone and were sacrificed 3 days after drug intake) and subgroup IV (rats were given indomethacin + dexamethasone and were sacrificed 7 days day after drug intake). Histological, scanning electron microscopy and morphometric studies were used.

Results

Indomethacin induced gastric ulceration with shredding of the superficial epithelial cells. The fundic glands were dilated in the subgroups II, III, IV. The surface epithelial cells were shredded and the ulcer sizes were big in subgroup IV. All subgroups exhibited abnormal surface epithelial cells within the gastric ulcer area.

Conclusions

Indomethacin is capable of producing injury to gastrointestinal mucosa. With prolonged use of GC the surface epithelial cells became more affected and the ulcer sizes became bigger. Concomitant use of both medications will delay the healing of the indomethacin induced gastric ulcer and induce more gastric complication.     

Are high lumbar punctures safe? A magnetic resonance imaging morphometric study of the conus medullaris

A high lumbar puncture (LP) at L2–L3 or above is often necessary to consider on technical grounds, but complications of conus medullaris (CM) damage during high LP are potentially concerning. We hypothesized that a high LP might be safer than previously thought by accounting for movements of the CM upon patient positional changes. We retrospectively reviewed standard normal supine lumbar spine magnetic resonance imaging of 58 patients and used electronic calipers on axial images at the T12–L1, L1–L2, and L2–L3 disc levels to measure the transverse diameter of the CM relative to the size of the dorsal thecal sac space (DTSS) through which a spinal needle could be inserted. On 142 axial images, the means for CM diameters were 8.2, 6.0, and 2.9 mm at the three levels, respectively. We then used known literature mean CM displacement values in the legs flexed and unflexed lateral decubitus position (LDP) to factor in CM shifts to the dependent side. We found that at all three levels, the likely positional shift of the CM would be too small and insufficient to displace the entire CM out of the DTSS. However, if needle placement could be confined to the midsagittal plane, an LP in the unflexed LDP would theoretically be entirely safe at both L1–L2 and L2–L3, and almost so at L2–L3 in the legs flexed LDP. Thus, high LPs at L1–L2 and L2–L3 are in theory likely safer than considered previously, more so in the legs unflexed than in the flexed LDP. Clin. Anat. 32:618–629, 2019. © 2019 Wiley Periodicals, Inc.     

Intracholecystic papillary-tubular neoplasms of the gallbladder – A clinicopathological study of 36 cases

Intracholecystic papillary-tubular neoplasms (ICPNs) account for <0.5% of all cholecystectomies. There is a lack of significant published data from the Indian subcontinent on ICPN to the best of our knowledge. The objective of the current study was to describe the clinicopathological features of ICPN of gallbladder from the departmental archives during a 5.5-year period. We also aimed to classify them into various histological subtypes and to correlate the clinicopathological parameters of ICPN with invasive adenocarcinoma.This study included 36 cases diagnosed over a period of 5.5 years (2013–2018). Clinical, radiological and histopathological data were analyzed in detail.The incidence of ICPN was 0.8%. The mean age of patients was 45.7 years with a female to male ratio of 1.3:1. Biliary phenotype was associated with invasion (p ≤0.001). Papillary pattern was present in 15 cases (41.6%) and was associated with invasion (p ≤0.001). High grade dysplasia was seen in 34 cases (94.4%), of which invasion was seen in 18 cases (50%). One case in our study also had synchronous common bile duct carcinoma. Majority (92%) of the patients were alive and well at the end of available follow-up (mean of 7 months and 25 days).ICPNs are mass forming neoplasms of the gallbladder with a slight female predominance. Biliary phenotype has an aggressive course, often associated with an invasive adenocarcinoma component. Papillary configuration of the lesion is significantly associated with an invasive component. Diligent follow-up of these lesions is warranted as they can be associated with other malignancies of the biliary system.     

Stem potentialities of the human iris – An in situ immunohistochemical study

According to recent findings multiple human tissues harbor stem cells which, in turn, have different levels of stemness. We performed an immunohistochemical study on paraffin-embedded samples to test if the in situ stromal cells of the iris of the human eye (EI) have immune stem/progenitor phenotypes. Eviscerated post-traumatic eyes from eight patients were studied. These irises were found to contain fibroblastoid stromal cells with a CD34+/CD45+/CD105+/CD117+/DOG1+/PDGFR-α+/vimentin+/nestin−/collagen III− phenotype. These were assumed to be possible stem/progenitor cells involved in physiological processes of iridial stromal maintenance. All the vascular endothelia were CD34+/CD105+/vimentin+. Newly formed nestin+ endothelia were also found; this finding was supported by evidence of filopodia-projecting CD34+ endothelial tip cells, which demonstrated active processes of sprouting angiogenesis. The phenotype of the stromal cells also suggests a role of the circulating fibrocytes in iridial regenerative processes.     

Revisiting peri-implant soft tissue – histopathological study of the peri-implant soft tissue

Peri-implant soft tissues are essential for osseointegration. The peri-implant mucosa may lack vascular supply, and histological observation, even without plaque, shows the presence of inflammatory cells. The objectives of this study were to assess the histopathological changes of the epithelium and connective tissue around the implant. Twenty patients of both genders were studied. Twelve weeks after implant placement, fragments of peri-implant gingival sulcus were harvested and processed for light microscopy. Group I (10): without clinical inflammatory signs (control); Group II (10): with clinical inflammatory signs. Histopathological parameters were analyzed and classified in 3 grades: mild, moderate or severe (grade 1, 2 or 3). Control group showed only slight changes, grade 1. In group II we found edema with moderate to severe cellular and nuclear changes. There are more women than men with all grades of inflammation. All patients with moderate edema are male and all patients with severe edema are female. A significant association (p=0.007) exists between these two variables. Significant differences were found when comparing the degree of inflammation with nuclear alterations (p=0.001) and the same results when comparing the degree of edema and nuclear changes (p<0.001). This study demonstrates that clinical examination can be used, with a small margin of error, to monitor and control the state of the peri-implant mucosa. In clinics the predisposition of female patients to greater degree of edema and inflammation should be accounted for.     

Do variants of the intercondylar notch predispose children to the injury of the anterior cruciate ligament?

Differences in knee development result in morphological variations observed among individuals. Some of them predispose to significant knee injuries. Although the anatomical risk factors are well established in adults, there is still a need for further research in this area in the group of children. This work aims to determine the morphological variations of the intercondylar notch of the femur predisposing to anterior cruciate ligament (ACL) injuries in the pediatric population. Magnetic resonance imaging (MRI) scans of the knee were retrospectively analyzed in 74 patients aged 4–18 years. Examinations were performed due to pain complaints after trauma. The completely torn ACL was found in 35 patients. The diagnosis was confirmed intraoperatively. The remaining patients, with no signs of injuries, were qualified as a reference group. The intercondylar notch width was evaluated by calculating the Notch Width Index. Additionally, the morphology of the intercondylar eminence was assessed. Finally, a statistical analysis of the obtained data was performed.Patients with a torn ACL had a narrower intercondylar notch (a lower Notch Width Index, P = 0.0007) as well as a broader and more sharply ended intercondylar eminence (P = 0.0267 and 0.0188, respectively). The narrowed intercondylar notch, expressed by the low Notch Width Index, and the increased size of the intercondylar eminence were identified as the risk factors for the ACL rupture in children. Clin. Anat. 32:706–709, 2019. © 2019 Wiley Periodicals, Inc.     

Illustrating ontogenetic change in the dentition of the Nile monitor lizard,Varanus niloticus: a case study in the application of geometric morphometric methods for the quantification of shape–size heterodonty

Many recent attempts have been made to quantify heterodonty in non-mammalian vertebrates, but the majority of these are limited to Euclidian measurements. One taxon frequently investigated is Varanus niloticus, the Nile monitor. Juveniles possess elongate, pointed teeth (caniniform) along the entirety of the dental arcade, whereas adults develop large, bulbous distal teeth (molariform). The purpose of this study was to present a geometric morphometric method to quantify V. niloticus heterodonty through ontogeny that may be applied to other non-mammalian taxa. Data were collected from the entire tooth row of 19 dry skull specimens. A semilandmark analysis was conducted on the outline of the photographed teeth, and size and shape were derived. Width was also measured with calipers. From these measures, sample ranges and allometric functions were created using multivariate statistical analyses for each tooth position separately, as well as overall measures of heterodonty for each specimen based on morphological disparity. The results confirm and expand upon previous studies, showing measurable shape–size heterodonty in the species with significant differences at each tooth position. Tooth size increases with body size at most positions, and the allometric coefficient increases at more distal positions. Width shows a dramatic increase at the distal positions with ontogeny, often displaying pronounced positive allometry. Dental shape varied in two noticeable ways, with the first composing the vast majority of shape variance: (i) caniniformy vs. molariformy and (ii) mesially leaning, ‘rounded’ apices vs. distally leaning, ‘pointed’ apices. The latter was twice as influential in the mandible, a consequence of host bone shape. Mesial teeth show no significant shape change with growth, whereas distal teeth change significantly due primarily to an increase in molariformy. Overall, heterodonty increases with body size concerning both tooth size and shape, but shape heterodonty changes in the mandible are much less pronounced. Although it is unclear to what degree V. niloticus specializes in hard prey items (durophagy), previous studies of varanid feeding behavior, along with research on analogous durophagous vertebrates, indicate a division of labor along the tooth row in adults, due to a possible transition to at least a partial durophagous niche. The geometric morphometric method proposed here, although not without its own limitations, may be ideal for use with a number of dental morphotypes in the future.     

Determinants of abstract acceptance for the Digestive Diseases Week – a cross sectional study

Background

The Digestive Diseases Week (DDW) is the major meeting for presentation of research in gastroenterology. The acceptance of an abstract for presentation at this meeting is the most important determinant of subsequent full publication. We wished to examine the determinants of abstract acceptance for this meeting.

Methods

A cross-sectional study was performed, based on abstracts submitted to the DDW. All 17,205 abstracts submitted from 1992 to 1995 were reviewed for acceptance, country of origin and research type (controlled clinical trials (CCT), other clinical research (OCR), basic science (BSS)). A random sub-sample (n = 1,000) was further evaluated for formal abstract quality, statistical significance of study results and sample size.

Results

326 CCT, 455 OCR and 219 BSS abstracts were evaluated in detail. Abstracts from N/W Europe (OR 0.4, 95% CI 0.3–0.6), S/E Europe (OR 0.4, 95% CI 0.2–0.6) and non-Western countries (OR 0.3, 95% CI 0.2–0.5) were less likely to be accepted than North-American contributions when controlling for research type. In addition, the OR for the acceptance for studies with negative results as compared to those with positive results was 0.4 (95% CI 0.3–0.7). A high abstract quality score was also weakly associated with acceptance rates (OR 1.4, 95% CI 1.0–2.0).

Conclusions

North-American contributions and reports with statistically positive results have higher acceptance rates at the AGA. Formal abstract quality was also predictive for acceptance.

     

Secular trends in cranial chord variables: a study of changes in sexual dimorphism of the North Indian population during 1954–2011

Abstract

Background: Sex estimation of fragmentary remains is a critical problem which is further aggravated by the changing pattern of sexual dimorphism due to temporal/secular changes. Previously cranial chord variables were examined only to deduce cranial abnormalities and hominin evolution. In forensic anthropological literature to date, no studies have examined the importance of cranial chord variables in sex determination and neither have secular changes been reported in those measurements to date.

Aim: The present study aims to examine the sexual dimorphism and temporal changes in chord measurements in the Indian population and to provide updated sex discriminant formulae.

Subjects and methods: A total of 483 (contemporary: n?=?158; sub-recent: n?=?325) adult crania (18–70?years) from two temporally distinct North Indian populations were included in the study. Seven chord variables were measured and data were subjected to discriminant function analysis using SPSS 16.00.

Results: Analysis of the data using the t-test demonstrated significant sexual and population variations over time. Univariate discriminant analysis revealed the glabella-bregma chord as the best variable in both populations (78.5 and 74.5% accuracy in the contemporary and sub-recent populations, respectively). Using multivariate analysis classification accuracy reached 86.1% in the contemporary sample.

Conclusion: It is concluded that Indian crania are going through secular changes as the contemporary population has larger chord dimensions than their predecessors and chord variables can be applied for sex estimation in the Indian population.     

Changes in length of the plantar aponeurosis during the stance phase of gait – An in vivo dynamic fluoroscopic study

In locomotion, ligaments and muscles have been recognized to support the arch of the foot. However, it remains unclear to what extent the passive and active structures of the lower extremity support the longitudinal arch of the foot during walking. In this study, the mechanical function of the plantar aponeurosis (PA) is investigated by elongation measurements in vivo during the stance phase of gait, in combination with measurements of the mechanical properties of the PA in vitro.Fluoroscopy was used to measure the dynamic changes in PA length and the angular motion of the metatarsophalangeal joint of the first ray, measured during the stance phase (StPh) in 11 feet. Simultaneously, ground forces were measured. Additionally, four cadaver feet delivered topographic information relating to the PA, and three autopsy specimens of PA served to determine the in vitro mechanical properties of PA.The present study revealed a non-significant peak average PA shortening of 0.48% at about 32.5% StPh, followed by a significant average peak elongation of 3.6% at 77.5% StPh. This average peak elongation of 3.6% corresponds to a force of 292 N, as estimated by mechanical testing of the autopsy PA specimens. Considering the maximum peak elongation measured in one volunteer of 4.8% at 76% StPh, a peak PA load of 488 N might be expected. Hence, with an average body weight of 751 N, as allocated to the 11 investigated feet, this maximum peak force would correspond to about 0.65 × body weight.As far as we are aware, this is the first report on a dynamic fluoroscopic study of the PA in gait with an appreciable number of feet (11 feet).In conclusion, muscles contribute to support of the longitudinal arch of the foot and can possibly relax the PA during gait. The ‘windlass effect’ for support of the arch in this context is therefore questionable.     

Physical activity evaluation in Yugoslav Study of the Precursors of Atherosclerosis in School Children – YUSAD study

Introduction

It is observed that there is a lack of physical activity and exercise in children, stressing higher prevalence of childhood obesity. The purpose of the study was to evaluate duration of physical activity in a child population and correlation of dynamics in physical activity during 5 years of follow-up in the same population.

Material and methods

We evaluated 3243 school children from 12 regional centres across Serbia. The first examination was done when the children were 10 years old (baseline group), while the second examination was done on the same population when children were 15 years old. Physical activity was classified as recreational activity after school. We analysed 3 groups regarding physical activity: a group of children who were physically active less than 1 hour per day (group I), a second group active from 1 hour to < 3 hours per day (group II), and a third group active ≥ 3 hours per day (group III).

Results

In our study we have found on examination that the majority of children were physically active between 1 and 3 hours per day. Our results indicate that there is significant movement from groups I and III toward group II on the second examination regarding the proportion in the baseline group. There is a significant increase in the number of children in group I as they get older.

Conclusions

School children in Serbia are physically active predominantly between 1 and 3 hours per day at the age between 10 and 15 years.     

Growth and sexual dimorphism of the hyoid bone and its relationship to the mandible from birth to 19 years: A three-dimensional computed tomography study

The hyoid bone and the hyomandibular complex subserve the functions of respiration, deglutition, and speech. This study quantified the growth of the hyoid bone and the hyomandibular relationships in males and females from birth to 19 years. Using 97 computed tomography (CT) scans, from a previous study (Kelly et al., 2017) on mandibular growth from 49 individuals (16 with longitudinal scans), landmarks were placed on 3D CT models and used to calculate four distance, and three angular measurements. A general increase in growth trend was observed in hyoid bone linear measurements—length, width, and depth—as well as relational mandible-to-hyoid distance, throughout the developmental ages examined in both males and females, with most variables having larger measurements for females up to age 10 years. A general decrease in all three angular measurements was observed in both males and females up to approximately age 12 years, at which time male angular measurements gradually increased with significant sexual dimorphism emerging after age 15 years. As expected, postpubertal males had greater hyoid angle than females; they also had greater hyoid angle of inclination than mandible body inclination (with inclination relative to the anterior–posterior nasal plane), likely related to hyo-laryngeal descent. This study contributes to normative data on hyoid bone and hyomandibular relational growth in typically developing individuals and provides a baseline against which structural and functional influences on anatomic growth may be examined by clinical disciplines that address the aerodigestive and speech functions, as well as the fields of anatomy, forensics, and anthropology.     

Disfranchisement,expulsion and persecution of pathologists in the Third Reich – A sociodemographic study

This sociodemographic study focuses on the disenfranchisement, expulsion and persecution of pathologists in the Third Reich – a group that has, until now, received little systematic attention in scholarly research. The paper attempts to determine the number of pathologists who suffered persecution, the characteristics they shared, and the effects the repression had on their lives – both in the period from 1933 to 1945 and in the post-war period.The study is based on primary sources from numerous archives as well as on a systematic re-analysis of published secondary literature on the history of Nazi medicine. A total of 89 disenfranchised pathologists were identified and have been included. The vast majority of these pathologists (90%) were persecuted due to their Jewish ancestry or their relation to Jews. A good two-thirds of these pathologists were employed at a university until their disenfranchisement.For two-thirds of these pathologists (n = 62; 70%), documentation of emigration was found. Twenty-four pathologists remained in their home country; of these, five died in concentration camps and two others committed suicide.The preferred country for direct immigration was the United States (n = 19), followed by Great Britain (n = 13). Most of these pathologists were able to establish themselves professionally in their destination country, and little inclination to return to Germany after 1945 was shown. The reasons for this were a lack of career options in their home country, the lack of a welcoming culture among colleagues and universities, and the stigmatizing experiences of individual pathologists had during academic appointments and reparations proceedings in Germany. However, especially in recent decades and in part posthumously, these pathologists are being granted honorary, intangible recognition in Germany and Austria. Even though this recognition can no longer provide tangible reparations, it is nevertheless a sign of a gradual change in consciousness.     

Prevalence of childhood asthma,rhinitis, and eczema in the Ternopil region of Ukraine – results of BUPAS study

PurposeThe aim of the study was to estimate the prevalence of allergic diseases and symptoms in children of the Ternopil Region (Ukraine) and to explore their familial and environmental correlates.Material/MethodsA cross-sectional study based on parental answers to a respiratory questionnaire based on ISAAC that included 4871 urban and rural children aged 6–14 years. Association of physician-made diagnoses and symptoms with environmental factors was examined by means of multivariate logistic regression.ResultsIncreased risk of asthma (1.7%) was associated with urban residence (OR=1.8; p=0.04) and high parental education (OR=1.8; p=0.02); spastic bronchitis (6.2%) with parental allergy (OR=1.3; p=0.03); atopic eczema (6.2%) with younger age (OR=1.3; p=0.03), high parental education (OR=1.3; p=0.03), parental allergy (OR=1.4; p=0.02), tobacco smoke at home (OR=0.7; p=0.01) and household density (OR=0.6; p=0.001); diagnosis of unspecified allergic sensitization (11.8%) was related to high parental education (OR=1.2; p=0.03), parental employment (OR=0.8; p=0.02) and pets at home (OR=1.2; p=0.06). Symptoms of chest wheezing (11.5%) were related to tobacco smoke at home (OR=0.8; p=0.06). Attacks of dyspnea (7.3%) were related to parental allergy (OR=1.4; p=0.007), and type of heating (OR=1.7; p=0.04). Hay fever symptoms (5.7%) were related to younger age (OR=1.3; p=0,01) and urban residence (OR=2.0; p<0.0001).ConclusionsExcept for asthma the prevalence of allergic diseases and symptoms as well as their correlates in children of Ternopil are similar to other estimates obtained in Eastern Europe. Low prevalence of asthma and relatively frequent occurrence of spastic bronchitis may suggest substantial underdiagnosis of childhood asthma.     

Megasome biogenesis in Leishmania amazonensis : a morphometric and cytochemical study

Megasomes are large lysosomes found in the amastigote stage of Leishmania species belonging to the mexicana complex. The biogenesis of megasomes was investigated by transmission electron microscopy during the transformation of promastigotes into the amastigote form of L. amazonensis maintained in axenic cultures. Mainly small vacuoles with low electron density were found in the promastigote and early intermediate forms. Morphometrical analysis showed an increase in the volume density of these structures during the transformation process. Cysteine proteinase was localized in this structure by immunocytochemical assay. Membrane-bounded structures filled with electron-dense material were also found in significant amounts from the 2nd day on. These structures were relatively abundant, both in axenic and lesion-derived amastigotes, but not in stable long-term axenic amastigote culture. A three-dimensional reconstruction of lesion-derived amastigotes and axenic amastigotes of L. amazonensis demonstrated that megasomes comprise almost 5% of the total cell volume. In addition, the development of other organelles was examined during the transformation process. Received: 18 May 2000 / Accepted: 31 August 2000