Anatomical variations of the superior thyroid artery: A systematic review.

BACKGROUND: The superior thyroid artery (STA) is one of the main arteries that provide blood supply to the thyroid gland. It has a plethora of anatomical variations, and knowledge of its anatomy is necessary in procedures in this area. The aim of this review is to summarize and describe human studies (cadaveric and angiographic) that investigate the anatomical variations related to the STA. MATERIAL AND METHODS: A systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. A literature search in PubMed, and Embase databases was carried out. Original studies that investigated the origin of the STA and reported data on the variant arterial anatomy were considered, including only cadaveric and angiographic studies. RESULTS: A total of 34 studies (4048 heminecks in total; heminecks in each study: min: 25-max: 1280) were finally included. All studies provide details about sex [men/women ratio median (IQR): 2(1-5)] but none about age and 10 (29%) about nationality. STA morphological characteristics described in the included studies are origin, length, number of branches, distance from the carotid bifurcation and the vessel's diameter. CONCLUSIONS: The STA's anatomical features are subject to a non-negligible degree of variability. Our results should improve the awareness of anatomical variations of the STA, and eventually have an impact on the interventions regarding the visceral compartment of the neck in clinical practice.

Anatomical variations of human vertebral and basilar arteries: A current review of the literature.

The vertebral artery originates from the subclavian artery and is divided into four segments (V1-V4). In its intracranial segment (V4), the two vertebral arteries join to form the basilar artery, an unpaired medium-sized artery. However, apart from this typical description, several anatomical variations may occur in the human body. Although in some cases such variations may be asymptomatic, they may be also associated with several pathological conditions, neurological complications, surgical complications, and increased risk of developing vascular diseases. Therefore, it is crucial to obtain sufficient information on the anatomy and variants of both arteries to prevent such complications and ensure the safe completion of surgical and radiological treatments. For this reason, we reviewed studies published up to January 2022 concerning the reported variations of the vertebral artery and basilar artery regarding their origin, course, length, and diameter. We believe that the thorough presentation of these variations would help surgeons worldwide during their daily clinical and surgical practice.

Case series and a systematic review concerning the level of the aortic bifurcation.

BACKGROUND: The aim of this study is to present the level of aortic bifurcation in a sample of Greek origin (case series) and to perform an up-to-date systematic review in the existing literature. MATERIALS AND METHODS: Seventy-six formalin-fixed adult cadavers were dissected and studied in order to research the level of aortic bifurcation. Additionally, PubMed and Google Scholar databases were searched for eligible articles concerning the level of aortic bifurcation for the period up to February 2020. RESULTS: The mean level of aortic bifurcation according to our case series was the lower third of the L4 vertebral body (21/76, 27.6%). The level of aortic bifurcation ranged between the lower third of the L3 vertebral body and the lower third of the L5 body. No statistically significant correlation was found between the two sexes. The systematic review of the literature revealed 31 articles which were considered eligible and a total number of 3537 specimens were retracted. According to the recorded findings the most common mean level of aortic bifurcation was the body of L4 vertebra (1495/3537 cases, 42.2%), while the range of aortic bifurcation was described to occur from upper third of L3 vertebrae to the upper third of the S1 vertebrae in the 52.8% of the cases (1866/3537). CONCLUSIONS: The mean level of AA corresponds to the body of L4 and presents a great range (form L3U to S1U). Knowledge of the mean level of aortic bifurcation and its probable ranges is of great significance for interventional radiologists and especially vascular surgeons that deal with aneurism proximal to the aortic bifurcation.

Pterional variable topography and morphology. An anatomical study and its clinical significance.

BACKGROUND: Pterion is the junction of the frontal, parietal, greater wing of the sphenoid and the squamous part of the temporal bone. The sphenoparietal, frontotemporal, stellate and epipteric pteria were described. The current study determines pterion topography, morphology (variant types' frequency) and morphometry, as well as epipteric bones presence in dried skulls. Gender impact is underlined as well. MATERIALS AND METHODS: Ninety Greek adult dried skulls were observed. The distances in between pterion and the zygomatic arch midpoint and in between pterion and the frontozygomatic suture were measured. RESULTS: The sphenoparietal pterion was the commonest (58.3%), following by the stellate (25%), epipteric (15.5%) and by the frontotemporal pterion (1.1%). Twenty-eight (15.5%) skulls had epipteric bones, further categorised as quadrisutural (35.7%), trisutural (57.1%), bisutural and multiple (3.57%). The mean distances between pterion and the midpoint of zygomatic arch were 4.13 ± 0.45 cm on the right and 4.09 ± 0.47 cm on the left side and between pterion and the frontozygomatic suture were 3.47 ± 0.61 cm on the right and 3.52 ± 0.65 cm on the left side. Both distances were symmetrical. Male skulls showed slightly higher values on the left side for the distance (pterion-midpoint of zygomatic arch). CONCLUSIONS: Pterion is a commonly used neurosurgical landmark and thus in depth knowledge of the pteric area and its variants could be valuable. Recognition of the possible variability in pterion location, morphology and morphometry, as well as possible occurrence of epipteric bones may render pterional craniotomy safer among different population groups.

Anatomical study of the common iliac arteries.

BACKGROUND: The common iliac arteries (CIA) are the two terminal branches of the abdominal aorta which supply the pelvis and the lower extremities. The present study aims to examine the morphometric features of the CIA in a cadaveric sample and possible correlations between lengths. MATERIALS AND METHODS: Seventy-six formalin fixed cadavers of Greek origin were dissected in the Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens. In each cadaver dissected, the abdominal aorta and the CIA were identified and their lengths were measured. Also the torso length was measured and the height of each cadaver. All the statistical analysis was done by SPSS 15.0. RESULTS: The mean length of the left CIA was 6.12 cm (SD: ± 1.791, SE: 0.205) and that of the right one was 6.03 cm (SD: ± 1.607, SE: 0.184). The lengths of the CIA differed between the sexes, but no statistically significant difference was observed. Statistically significant differences regarding the torso lengths and body heights were found between the sexes, as well as a statistically strong correlation between the lengths of the left and right CIA in the cadavers dissected. CONCLUSIONS: The knowledge of the anatomy and morphology of the CIA is ofgreat clinical significance, given that abnormal course, length or branching pattern of these vessels are not uncommon and their clinical impact may be great. Mostly interventional radiologists and vascular surgeons should be aware of this knowledge.

Anatomical variation of a trifid (trifurcation) lateral root origin of the median nerve.

Anatomic variations of the brachial plexus are common. Awareness of these variations is of paramount importance in clinical practice mainly in achieving best results in minimal invasive or surgical procedures. The aim of our study was to depict a case of a trifid lateral root origin of the medial nerve. This anatomical variation in the brachial plexus was encountered after dissection in upper extremities in a 90-year-old male cadaver.

17ß-Estradiol/N-acetylcysteine interaction enhances the neuroprotective effect on dopaminergic neurons in the weaver model of dopamine deficiency.

The weaver mouse, is a phenocopy of Parkinson's disease (PD) in which dopaminergic neurons degenerate gradually during development, reaching at P21 a neurodegeneration of 55%. Thus, the weaver mouse constitutes an appropriate in vivo PD model for investigating the effect of neuroprotective agents. In the present study, long-term treatment (from P1 to P21) with 17ß-estradiol (17ß-estradiol) significantly protected the dopaminergic neurons in the substantia nigra (SN) of weaver mouse by 54%, as was detected by immunohistochemical experiments, using the specific antibody against tyrosine hydroxylase (TH). This dopaminergic neuroprotection is in line with our biochemical results showing that 17ß-estradiol treatment significantly decreased the high lipid peroxidation levels seen in the SN of weaver mouse, indicating high oxidative stress. Interestingly, co-administration of 17ß-estradiol with N-acetylcysteine (NAC, precursor molecule of glutathione (GSH)) further significantly increased the survival of dopaminergic neurons in the SN (by 85%), with a parallel further decrease of lipid peroxidation to normal levels. Our results show the in vivo neuroprotective effect of 17ß-estradiol, which is strongly enhanced by co administration of NAC, indicating a strong synergistic effect of the two drugs. Furthermore, the main mechanism underlying this neuroprotective action seems to be the reversal of the oxidative stress shown by the high peroxidation levels. These results could be of clinical relevance since both drugs are already used separately in the clinic, 17ß-estradiol for treatment of PD and NAC as a mucolytic agent and for the treatment of several disorders.

Donor transmission intestinal carcinoma after kidney transplantation: case report.

Tumor transmission is a rare complication of organ transplantation. Despite several improvements in excluding donor malignant disease, there continue to be reports of unknown tumors in the donors. The risk of having a donor with an undetected malignancy ranges between 1.3% and 2%. The cases of two kidney transplant recipients who had intestinal carcinoma transmitted from the same deceased donor are described. The clinical presentation, previous data, and management options are discussed. As a result of the increase in the overall donor pool, using extended criteria donors, donors of extreme ages, donors with prolonged intensive care admission, and donors who may potentially transmit disease to their recipients, the risk of tumor transmission and also infections should be considered.

Applying waste management scenarios in the Peloponnese Region in Greece: a critical analysis in the frame of life cycle assessment.

The aim of this paper is to apply life cycle assessment in the waste management sector, in order to compare the environmental performance of different waste management methods. The methods that are studied are: landfilling, aerobic and anaerobic biological treatment, incineration and recycling, focusing on mass and energy balances and the environmental performance of each applied scenario. The Peloponnese Region in Greece was selected as a case for the application of this methodology and more specifically its largest municipalities, where a significant amount of waste is presented. The conducted LCA study proves the necessity of the adoption of an integrated waste management system and indicates its principal objectives by measuring environmental impacts. Thermal scenario contributes significant to the mitigation on the Greenhouse Gases. On the other hand, separation at source and recycling practices provides significant benefits to the abiotic depletion impact.

Single center experience with elective surgical patients as living kidney donors.

PURPOSE: To report a single center experience with elective surgical patients as living kidney donors. METHODS: We retrospectively analyzed a prospective database of 458 living kidney donors from September 2005 to May 2011. Fifteen (3.2%) of them were elective surgical patients simultaneously undergoing living donor nephrectomy. We reviewed age, gender, operative time, intraoperative blood transfusion, intra- and postoperative complications, as well as length of hospital stay. Recipients were evaluated for delayed graft function. Four hundred forty-three patients undergoing living donor nephrectomy alone composed the control group. RESULTS: Among the elective surgical patients group, the mean (range) operative time was 155 (90 to 310) minutes and mean (range) length of hospital stay was 3 (2 to 9) days. One (6.7%) recipient displayed delayed graft function. Among the regular living kidney donors group, the mean (range) operative time was 100 (70 to 150) minutes, mean (range) length of hospital stay was 3 (2 to 5) days, and delayed graft function was observed in 5.6% of recipients. Only operative time (P = .03) was significantly different between the groups. CONCLUSIONS: Elective surgical patients are potential donors who may be treated at the same time as the living donor nephrectomy.

Modelling of a downdraft gasifier fed by agricultural residues.

A non-stoichiometric model for a downdraft gasifier was developed in order to simulate the overall gasification process. Mass and energy balances of the gasifier were calculated and the composition of produced syngas was predicted. The capacity of the modeled gasifier was assumed to be 0.5 MW, with an Equivalence Ratio (EQ) of 0.45. The model incorporates the chemical reactions and species involved, while it starts by selecting all species containing C, H, and O, or any other dominant elements. Olive wood, miscanthus and cardoon were tested in the formulated model for a temperature range of 800-1200°C, in order to examine the syngas composition and the moisture impact on the supplied fuel. Model results were then used in order to design an olive wood gasification reactor.

Cardiovascular risk factors and not disease activity, severity or therapy associate with renal dysfunction in patients with rheumatoid arthritis.

OBJECTIVES: The present study aimed to evaluate the prevalence and associations of renal dysfunction in patients with rheumatoid arthritis (RA). It specifically addressed the hypotheses that renal dysfunction in these patients may associate with the presence of insulin resistance, dyslipidaemia, uric acid levels and/or current levels of systemic inflammation. METHODS: Renal function was assessed by estimated glomerular filtration rate (GFR) using the modification of diet in renal disease equation in 400 consecutive RA patients for this cross-sectional, single-centre study. Risk factors for renal dysfunction were recorded/measured in all participants. Correlations between GFR and other variables were analysed by Pearson or Spearman test as appropriate. Linear regression was used to test the independence of the associations between GFR and other variables. RESULTS: In this RA patient cohort, 67.75% of patients had a reduced GFR of less than 90 ml/minute per 1.73 m(2) and 12.75% had a GFR of less than 60 ml/minute per 1.73 m(2). Multivariable analysis revealed significant associations between GFR and age (beta = -0.370, p<0.001), female sex (beta = -0.181, p=0.002), total cholesterol (beta = -0.112, p=0.022), serum uric acid (SUA) (beta = -0.425, p<0.001) and the presence of extra-articular disease, apart from sicca and/or nodules (beta = -0.084, p=0.040). CONCLUSIONS: Renal dysfunction in RA is quite common and associates with classic cardiovascular risk factors such as advanced age and dyslipidaemia, levels of SUA and the presence of extra-articular disease. Renal dysfunction was not related to other RA-related factors including disease activity and duration, disability and past or present use of nephrotoxic medications.

Marginalised social groups in contemporary weee management within social enterprises investments: A study in Greece.

This paper deals with the creation of appropriate conditions aimed at developing social services for reuse and recycling of waste electrical and electronic equipment (WEEE), by the inclusion of handicapped and Roma people in the workforce. Application areas for the project are the Hellenic (Greek) regions of Thessaly and North Aegean, where these groups suffer from professional and social exclusion. The efforts to reduce unemployment in the two aforementioned groups, together with the efforts to implement related Greek and European legislation for sustainable WEEE management, are examined here. Furthermore, networking and cooperation at local, regional and central levels between small enterprises, entrepreneurships and local authorities are examined, so that these social enterprises and their corresponding investments may support the development of the Greek alternative WEEE recycling system.

Developing a holistic strategy for integrated waste management within municipal planning: challenges, policies, solutions and perspectives for Hellenic municipalities in the zero-waste, low-cost direction.

The present position paper addresses contemporary waste management options, weaknesses and opportunities faced by Hellenic local authorities. It focuses on state-of-the-art, tested as well as innovative, environmental management tools on a municipal scale and identifies a range of different collaboration schemes between local authorities and related service providers. Currently, a policy implementation gap is still experienced among Hellenic local authorities; it appears that administration at the local level is inadequate to manage and implement many of the general policies proposed; identify, collect, monitor and assess relevant data; and safeguard efficient and effective implementation of MSWM practices in the framework of integrated environmental management as well. This shortfall is partly due to the decentralisation of waste management issues to local authorities without a parallel substantial budgetary and capacity support, thus resulting in local activity remaining often disoriented and isolated from national strategies, therefore yielding significant planning and implementation problems and delays against pressing issues at hand as well as loss or poor use of available funds. This paper develops a systemic approach for MSWM at both the household and the non-household level, summarizes state-of-the-art available tools and compiles a set of guidelines for developing waste management master plans at the municipal level. It aims to provide a framework in the MSWM field for municipalities in Greece as well as other countries facing similar problems under often comparable socioeconomic settings.

Multifocal renal allograft biopsy: impact on therapeutic decisions.

OBJECTIVE: There are no data to support the suggestion that samples removed from one segment of the transplanted kidney are representative of the whole graft. The aim of this study was to compare the histological differences between biopsies obtained from different portions of the renal allograft and their impact on treatment recommendations. PATIENTS AND METHODS: Two hundred percutaneous biopsies were performed on kidney allografts and samples were collected from the upper and lower poles (100 kidneys). All samples were randomized and blindly reviewed. We obtained the discordance rates between the poles for the grading of acute rejection and for the diagnosis of nephrotoxicity due to immunosuppression. We also checked if the differences found were sufficient to call for different clinical recommendations. These values were compared with the intrapathologist variation rates. RESULTS: In 70 kidneys adequate sampling was obtained from both poles. The diagnosis of acute rejection were made in 17. The discordance rate between the upper and lower poles was 82.3% (kappa = 0.34), higher than the intrapathologist variation (P = .002). Nephrotoxicity was found in 14 kidneys. The discordance rate between the upper and lower poles was 28.6% (kappa = 0.88), with no difference compared with the intrapathologist variation. In 14 of the 70 kidneys (25.7%), discordances between poles had impact on clinical recommendations, most of these cases due to different gradings of acute rejection (78%). This number was higher than the intrapathologist variation (P = .04). CONCLUSIONS: The histopathological changes in the kidney allograft are not always homogeneous. This heterogeneity may affect the therapeutic recommendations.

Increased expression of CD154 (CD40L) on stimulated T-cells from patients with psoriatic arthritis.

OBJECTIVES: CD40L is a costimulatory molecule and an early activation marker of T-lymphocytes. Based on the hypothesis that activated T-cells may play a role in the pathogenesis of psoriatic arthritis (PsA), we evaluated the level of CD40L expression on T-cells from patients with PsA. METHODS: We analysed 12 patients with PsA, six patients with rheumatoid arthritis (RA) and four healthy volunteers. T-cell surface expression of CD40L was evaluated using two-colour flow cytometry in (i) the resting state and (ii) following stimulation with phorbol myristate acetate/ionomycin, with or without ciclosporin (CsA)-mediated inhibition. RESULTS: Expression of CD40L was significantly increased on activated T-cells from patients with PsA, particularly those with active disease, when compared with normal individuals and patients with RA (mean percentages of CD3+ CD40L+ cells: 23.74, 11.59 and 9.57% for patients with active PsA, patients with RA and healthy volunteers, respectively). CsA-mediated inhibition of CD40L induction was equally effective in all study groups. CONCLUSION: CD40L is overexpressed on T-cells from patients with active PsA. This may indicate a role for CD40L in PsA pathogenesis. Larger-scale studies are warranted to address these issues.

Vitrification of lead-rich solid ashes from incineration of hazardous industrial wastes.

Lead-rich solid industrial wastes were vitrified by the addition of glass formers in various concentrations, to produce non-toxic vitreous stabilized products that can be freely disposed or used as construction materials. Toxicity of both the as-received industrial solid waste and the stabilized products was determined using standard leaching test procedures. The chemically stable vitreous products were subjected to thermal annealing in order to investigate the extent of crystal separation that could occur during cooling of large pieces of glass. Leaching tests were repeated to investigate the relation between annealing process and chemical stability. X-ray, scanning and transmission electron microscopy techniques were employed to identify the microstructure of stabilized products before and after thermal treatment. Relation between synthesis and processing, chemical stability and microstructure was investigated.

Comparison of palpation-guided and ultrasound-guided biopsies in transplanted kidneys.

UNLABELLED: Biopsy is the gold standard for the diagnosis of conditions affecting the function of renal allografts. Obtaining representative tissue in biopsies is critical but these procedures are associated with up to 9% of complications and 20% of inadequate material. Although ultrasound guidance allows perfect control of depth and location of the graft, there is controversy regarding the cost-benefit of its use and reports of unsuitable material in ultrasound-guided biopsies are still high. PURPOSE: To compare ultrasound with the palpation method to guide biopsies in order to see if there is any difference between both methods and which one is better. PATIENTS AND METHODS: The casuistic consisted of 82 renal transplant patients (32 female and 50 male patients, age ranging between 5 and 64 yr; m=31.2 yr) randomized into two groups: GI, palpation-guided; GII, ultrasound-guided. Fifty-six biopsies were performed in GI and 66 in GII. RESULTS: Number of glomeruli, arcuate, and interlobar arteries and arterioles were compared in the two groups and were 503 (m=10) vs. 801 (m=12.9), 24 (m=0.5) vs. 38 (m=0.6), 104 (m=2.1) vs. 154 (m=2.5), and 174 (m=3.5) vs. 264 (4.3), respectively (p<0.05). Inadequate material for analysis in GI and GII was 7.1 and 7.6%, respectively (p=0.72). CONCLUSIONS: Although ultrasound guidance improves the number of glomeruli, arcuate, and interlobar arteries, as well as arterioles, compared with palpation-guided biopsies, there is no difference in the rate of adequate material between the two methods.