Morphology of the greater palatine foramen: a clinical point of view.

PURPOSE: Anatomical characteristics of the greater palatine foramen (GPF) are essential during the greater palatine nerve block application to anesthetize maxillary teeth, gums, midface, and nasal cavities. The position of GPF is usually described in relation to adjacent anatomical structures. This investigation aims to examine the morphometric relationships of GPF and closely determine its position. METHODS: The study included 87 skulls (174 foramina). They were photographed in a horizontal position with bases facing up. The digital data were processed in the ImageJ 1.53n software. RESULTS: The average distance of the GPF from the median palatine suture was 15.94 mm. In relation to the posterior border of the bony palate, the distance was 2.05 mm. Statistical significance was found in comparing the angle between the GPF, incisive fossa, and the median palatine suture between the sides of the skulls (p = 0.02). Comparing tested parameters between males and females showed significant differences in GPF-MPS (p = 0.003) and GPF-pb (p = 0.012), with lower values in females. The most significant percentage of skulls (77.01%) had the GPF located at the level of the third molar. The most significant number of bony palates had one lesser opening (60.91%) on the left side. CONCLUSION: GPF is located at the level of the maxillary third molar in most of the examined palates. Knowledge of the anatomical position of the greater palatine foramen and its variations is the basis for successfully implementing anesthesia and various surgical interventions.

Effectiveness of the Reverse Sural Flap in Covering Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis.

Background: The reverse sural fasciocutaneous flap (RSFCF) has been used with success to cover noncomplicated foot and ankle soft tissue defects. However, there are some controversies when it is used in patients having chronic diabetic foot ulcers. This aim of this meta-analysis was to evaluate the efficacy of RSFCF in covering diabetic foot and ankle ulcers. Methods: A systematic review was undertaken from MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Only diabetic foot and ankle ulcers were accepted for inclusion and all study designs were included. Proximally based flaps, nondiabetic ulcers, and assisted negative pressure therapy were excluded. Suitability for inclusion was assessed by 2 reviewers. The random-effect estimate was reported for the set outcomes whenever high heterogeneity was present. Metaregression analysis was performed to identify independent risk factors for failure. Results: The search identified 33 relevant studies comprising 187 patients and flap interventions; all but 1 were case-series. The weighted outcomes were as follows: (1) the flap healing rate was 93.3% while 6.6% resulted in total necrosis, (2) the rate of partial flap necrosis was 12%, (3) venous congestion was reported in 6.6% of cases, (4) the infection rate was 8.3%, and (5) the donor site morbidity was 4.6%. No association was found between pedicle width or presence of a subcutaneous pedicle tunnel and the primary outcome of total loss. Conclusions: This review demonstrated excellent results of the flap when covering complicated or large diabetic foot and ankle ulcers. When compared to those published in the literature, our results found RSFCF to be relatively less successful in diabetic wounds than in trauma patients but more successful than in those having associated osteomyelitis and those who were treated with random local flaps.

Historique: Le lambeau fascio-cutané sural inversé (LFCSI) a couvert avec succès des anomalies non compliquées des tissus mous du pied et de la cheville. Cependant, une controverse sévit quant à son utilisation chez les patients ayant des ulcères du pied causés par un diabète chronique. La présente méta-analyse visait à évaluer l'efficacité du LFCSI sur des ulcères du pied et de la cheville causés par un diabète. Méthodologie: Les chercheurs ont réalisé une analyse systématique dans MEDLINE, EMBASE, Web of Science, Bibliothèque Cochrane et Google Scholar. Ils n'ont inclus que les ulcères du pied et de la cheville causés par le diabète, mais accepté toutes les méthodologies d'étude. Ils ont exclu les lambeaux proximaux, les ulcères non diabétiques et la thérapie assistée par pression négative. Deux examinateurs ont évalué la pertinence de l'inclusion. Ils ont précisé l'évaluation à effets aléatoires des résultats cliniques observés dès qu'une forte hétérogénéité était constatée. La méta-analyse de régression a permis d'établir les facteurs de risque d'échec. Résultats: La recherche a permis d'extraire 33 études pertinentes incluant 187 patients et interventions par lambeaux, toutes étant des séries de cas, sauf une. Les résultats pondérés s'établissaient comme suit: a) taux de guérison des lambeaux de 93,3%, et 6,6% de nécrose totale, b) taux de nécrose partielle du lambeau de 12%, c) congestion veineuse dans 6,6% des cas, d) taux d'infection de 8,3% et e) atteinte au siège du donneur de 4,6%. Aucune association n'a été constatée entre la largeur du pédicule ou la présence d'un tunnel pédiculaire sous-cutané et le résultat primaire de perte totale du lambeau. Conclusions: La présente analyse a démontré d'excellents résultats du lambeau pour couvrir des ulcères étendus et complexes du pied et de la cheville causés par le diabète. Par rapport aux résultats figurant dans les publications, les LFCSI étaient relativement moins efficaces pour les plaies causées par le diabète que par un traumatisme, mais plus efficaces que celles également associées à l'ostéomyélite ou que les lambeaux locaux aléatoires.

Morphometric analysis of the patterns of calcaneal facets for the talus in Serbian population.

Literature describes different patterns of calcaneal facets for the talus in terms of whether some calcaneal facets are connected or separated from each other or completely absent. The aim of this study was to establish the patterns of calcaneal facets for the talus, to calculate their total area, and to analyse the data with respect to gender. The study involved 59 calcanei which were photographed. The patterns of calcaneal facets noted in this study were compared with the patterns from the literature. ImageJ program was used to measure different parameters on calcanei. The pattern 1 was the most commonly found in the study sample (45.76%), then the pattern 2 (40.68%), and finally the pattern 3 (13.56%). That order of frequencies is the same in both sexes. The patterns 1 and 2 have a larger contact surface for the talus in comparison to the pattern 3. Male bones have a larger contact surface for the talus than female bones. The sum of the pattern 1 and pattern 3 frequencies was high. Knowing the frequency of different patterns of calcaneal facets for the talus in a certain population is important for orthopaedic surgeons when performing foot osteotomy.

Morphological and morphometric analysis of the external aperture of the carotid canal in Serbian population / Análisis morfológico y morfométrico de la apertura externa del canal carotídeo en la población Serbia

The carotid canal is located in the petrous part of the temporal bone and transmits the internal carotid artery along with the venous and sympathetic nerve plexus. The shape, location and dimensions of the carotid canal are clinically very important especially in cases of skull base surgery. The aim of this study was to investigate the morphological and morphometric parameters of the external aperture of the carotid canal in Serbian population. The study included 24 dry adult skulls and 36 dry adult temporal bones. Diameters and distances of the external aperture of the carotid canal from various important landmarks of the skull base were measured. The shape of the external carotid canal aperture was also noted. Digital data were processed in the ImageJ software. The average length of the external aperture of the carotid canal in all investigated specimens (skulls and temporal bones) on the right and left sides was 7.31±1.01 mm and 7.71±1.06 mm, respectively. The average width of the external aperture of the carotid canal on the right side was 5.82±0.78 mm while on the left side was 6.20±1.04 mm. The frequency of different shapes of the external aperture of the carotid canal was as follows: round in 45 (53.57 %), oval in 25 (29.76 %), and the rarest was almond shape noted in 13 (15.47 %) cases. There were no statistically significant differences in all measured parameters between genders and body sides. The only statistical significance was found in females between right and left side in relation with length (AP diameter) of the external aperture of the carotid canal. The results of this study will be useful for neurosurgeons to improve different surgical approaches to the petrous part of the internal carotid artery and prevent its complications.

El conducto carotídeo se encuentra en la parte petrosa del hueso temporal y da paso a la arteria carótida interna junto con el plexo nervioso venoso y simpático. La forma, ubicación y dimensiones del canal carotídeo son clínicamente muy importantes, especialmente en casos de cirugía de la base del cráneo. El objetivo de este estudio fue investigar los parámetros morfológicos y morfométricos de la apertura externa del canal carotídeo en la población serbia. El estudio incluyó 24 cráneos adultoss y 36 huesos temporales adultos secos. Se midieron los diámetros y distancias de la apertura externa desde varios puntos de referencia de la base del cráneo. También se observó la forma de la apertura del canal carotídeo externo. Los datos digitales se procesaron con Software ImageJ. La longitud promedio de la apertura en todos los especímenes investigados (cráneos y huesos temporales) en los lados derecho e izquierdo fue de 7,31 ± 1,01 mm y 7,71 ± 1,06 mm, respectivamente. El ancho promedio de la apertura en el lado derecho fue de 5,82 ± 0,78 mm mientras que en el lado izquierdo fue de 6,20 ± 1,04 mm. La frecuencia de las diferentes formas de la abertura externa fue la siguiente: redonda en 45 (53,57 %), ovalada en 25 (29,76 %), y la más rara fue la forma de almendra observada en 13 (15,47 %) casos. No hubo diferencias estadísticamente significativas en todos los parámetros medidos entre sexos y lados del cuerpo. La única estadística significativa se encontró en las mujeres entre el lado derecho e izquierdo en relación con la longitud (diámetro AP) de la apertura externa del conducto carotídeo. Los resultados de este estudio serán útiles para un mejor enfoque quirúrgico de los neurocirujanos en la parte petrosa de la arteria carótida interna, y advertir posibles complicaciones.

What Do We Find Attractive about the Face?: Survey Study with Application to Aesthetic Surgery.

The appearance of the face is one of the most important factors influencing our perception of beauty. However, few studies have attempted to quantitate what one perceives as beauty. Therefore, this study was conducted with the goal of providing physicians with anatomical data that demonstrate which facial traits most influence our perception of one's attractiveness. In the first phase of the study, faces of 60 participants (30 males and 30 females) were photographed. Next, the photographs were shown to another group of 120 study members (60 males and 60 females), who evaluated the facial features using a Visual Analogue Scale. The highest rated facial parts were then measured using the ImageJ program. In men, the most attractive parts of the face were Type 1:2 lips, a Type IV nose of medium width, blue eyes, brown hair, and a very narrow face. Among females, the most attractive parts of the face were Type 2:1 lips, Type III and V noses of medium width, dark brown eyes, blonde hair, and a narrow face. This is the first study in which the most aesthetically important facial parts have been comprehensively examined. The results obtained in our study show a higher degree of representativeness compared to other studies due to a different methodological approach and can be used as an aesthetic guide and can help in the planning of aesthetic surgery such as lip augmentation and rhinoplasty. Clin. Anat. 33:214-222, 2020. © 2019 Wiley Periodicals, Inc.

Survival prediction in patients with cutaneous melanoma by tumour lymphangiogenesis.

Objectives: Melanoma induces lymphangiogenesis by secreting lymphangiogenic growth factors. The aim of this study was to examine the role of tumour lymphangiogenesis in survival of patients with cutaneous melanoma. Methods: Immunostaining of one hundred melanoma specimens was done with lymphatic-specific antibody D2-40. The quantification of tumour lymphangiogenesis - lymphatic vessel density (LVD) and lymphatic vessel area (LVA) - was calculated by computer-assisted morphometric analysis. Results: High intratumoural LVD, high peritumoural LVD, male gender, greater tumour thickness and Clark level IV/V were significantly associated with shorter disease-free survival (p= 0.001, p= 0.004, p= 0.004, p= 0.000 and p= 0.008, respectively) and melanoma-specific survival (p= 0.002, p= 0.002, p= 0.001, p= 0.000 and p= 0.017, respectively), while the trunk melanoma site was significantly associated only with shorter disease-free survival (p= 0.033). No significant association of LVA with survival was found. At multivariate analysis, peritumoural LVD [hazard ratio (HR) = 2.143, 95% confidence interval (CI) 1.097-4.189, p= 0.026)] and melanoma thickness (HR = 1.276, 95%CI 1.106-1.473, p= 0.001) were independent predictors of disease-free survival, while intratumoural LVD (HR = 3.446, 95%CI 1.465-8.109, p= 0.005), peritumoural LVD (HR = 2.742, 95%CI 1.313-5.725, p= 0.007) and gender (HR = 2.880, 95%CI 1.304-6.362, p= 0.009) were independent predictors of melanoma-specific survival. Conclusion: Тhis study shows that LVD enables better prediction of survival than melanoma thickness and other clinical-pathological parameters. Intratumoural LVD is the most significant predictor of melanoma-specific survival, while only peritumoural LVD has a significant impact on both, a disease-free survival and a melanoma-specific survival.

Variations and morphometrics of palmaris longus in fetuses: a meta-analysis of cadaveric studies.

The palmaris longus muscle, and its tendon, is one of the most variable muscles in humans. Though it has been extensively researched in the adult population, its variations and development in the fetal period were rarely investigated. The aim of this meta-analysis is to conduct an evidence synthesis on PL variations and the prevalence of its agenesis during intrauterine development. Seven studies met the inclusion criteria comprising 497 fetuses and 1027 fetal limbs. The true and crude weighted prevalence rates were of 81.2% and 77%, respectively. The bilateral and unilateral prevalence estimates were of 62.2% and 15%, respectively. No significant differences were found for side-based and gender-based prevalence values. There were significant frequency differences between the studied populations (p < 0.0001).The Japanese population had the highest prevalence, the Turkish had the lowest and the European value was in between. Out of 494 studied muscles, 67 (13.5%) variations were noted. The weighted proportions of the commonest morphological variations were as follows: (a) bifid tendon in 10 (2%) cases, (b) inverted PL muscle in 9 (1.9%), muscle duplication in 6 (1.36%), and digastric muscle in 25 (5.1%). Prevalence values of the fetal PL were similar to those reported in adults; however, variations seem to be higher than in older populations. The true, crude, and ancestry-based prevalence presence rates of PL in fetuses were found to be similar to those of the adult population.

Morphometric analysis and surgical adequacy of palmaris longus as a tendon graft. A systematic review of cadaveric studies.

INTRODUCTION: The tendon of the palmaris longus is commonly used as a tendon graft in many reconstructive surgeries. Easy to access and at proximity to the hand, the palmaris longus tendon is considered as the optimal tendon source for hand reconstructive surgery. However, and besides its inconsistency, the size of the palmaris longus tendon is reported to show variability. The aim of this study is to look for the surgical adequacy of the palmaris longus tendon by conducting a quantitative synthesis on its length and width in human populations and its correlation with the forearm length. METHODS: Twenty-four studies met the inclusion criteria including 1761 cadaveric limbs. RESULTS: The results were as following: (a) the mean palmaris longus tendon length was of 13.9 ± 2.6 cm, (b) the mean ratio palmaris longus tendon length/forearm length was of 0.545 ± 0.06, (c) the weighted correlation value was of 0.686, and (d) the mean palmaris longus tendon width was of 4.0 ± 1.7 mm. Only five studies reported a palmaris longus tendon length of more than 15 cm. The palmaris longus tendon length was shown to vary between ancestries; the Japanese had the shortest while Malaysian the longest palmaris longus tendons. All studies but one reported a palmaris longus tendon mean width of more than 3 mm where the minimal mean palmaris longus tendon width was of 2.5 mm. CONCLUSION: While the requested length depends on the recipient site and/or type of reconstructive surgery, the palmaris longus tendon often met the required diameter for grafting. Our review demonstrated that while palmaris longus length varies between ancestries, its width is often adequate for grafting. In addition, the forearm length could be a good predictor of palmaris longus tendon length; such correlation could assist surgeons when planning to use palmaris longus tendon as a graft source.

Prevalence of the palmaris longus and its impact on grip strength in elite gymnasts and non-athletes / Prevalencia del músculo palmar largo y el impacto en la fuerza de agarre en gimnastas de elite y no atletas

In elite athletes, the palmaris longus (PL) presence has a potential contribution to hand strength, smaller reaction time, better shooting speed and power. The aim of this study was to investigate the prevalence of PL in elite competitive artistic gymnasts and its impact on grip strength compared to a control group of moderately active non-athletes. This prospective study included 370 subjects divided in two groups (170 elite artistic gymnasts and 200 moderately active non-athletes, students of medicine). The study consisted of two clinical sets of examination: a search for the clinical presence of PL was initially conducted followed by the assessment of maximal grip strength. Standard and six additional tests were performed to confirm PL tendon absence. Maximal grip strength was measured bilaterally with an electronic hand dynamometer. Bilateral absence was more common than unilateral, predominately noted on left side in both study groups. Unilateral PL absence was correlated to decreased grip strength in students, while the opposite was found in gymnasts. The mean value of grip strength in some age groups was higher on the side where the PL was absent. The results of our study show that the presence of the PL doesn`t affect the hand grip strength in gymnasts. Due to the low incidence of unilateral PL absence, further large-sampled research is warranted to assess PL contribution to hand grip strength and to other hand functions that could be of significant importance for athletes and non-athletes.

La presencia del músculo palmar largo (MPL) en atletas de élite tiene el potencial de aportar mayor fuerza a la mano, un tiempo de reacción menor, mejor velocidad de tiro y potencia. El objetivo de este estudio fue investigar la prevalencia de MPL en las gimnastas artísticas competitivas de élite y su impacto en la fuerza de agarre en comparación con un grupo control de no atletas moderadamente activos. El estudio incluyó 370 sujetos divididos en dos grupos (170 gimnastas artísticas de élite y 200 no atletas moderadamente activos, estudiantes de medicina). El estudio consistió en dos series clínicas de examen: inicialmente se realizó una búsqueda de la presencia clínica de MPL, seguido de la evaluación de la fuerza máxima de agarre. Se realizaron pruebas estándar y seis pruebas adicionales para confirmar la ausencia del tendón del MPL. La máxima fuerza de agarre se midió bilateralmente con un dinamómetro de mano electrónico. La ausencia bilateral fue más común que unilateral, predominantemente observada en el lado izquierdo en ambos grupos de estudio. La ausencia unilateral de MPL se correlacionó con una menor fuerza de agarre en los estudiantes, mientras que en gimnastas se encontró lo contrario. El valor medio de la fuerza de agarre en algunos grupos de edad fue mayor en el lado donde el MPL estaba ausente. Los resultados de nuestro estudio muestran que la presencia de MPL no afecta la fuerza de agarre de la mano en gimnastas. Debido a la baja incidencia de ausencia unilateral de MPL, se justifica una investigación adicional de gran tamaño para evaluar la contribución de MPL a la fuerza de agarre de la mano y otras funciones de la mano que podrían ser de gran importancia para los atletas y no atletas.

Prevalence of the Linburg-Comstock variation through clinical evaluation.

INTRODUCTION: Linburg-Comstock variation, the tendinous interconnection between flexor pollicis longus and flexor digitorum profundus, is known to have a wide frequency range. Its prevalence is reported with a range of 13-66%. The aim of the study was to assess this variation in general population and to correlate it with gender and side. MATERIAL AND METHODS: This prospective study included 215 subjects (82 males and 133 females). Two clinical tests were conducted to diagnose the variation and to detect any related symptomatology. The primary outcome was set to be the prevalence of Linburg-Comstock variation. Secondary outcomes were defined as gender-based prevalence, side-based prevalence, and Linburg-Comstock variation prevalence association with gender and side. RESULTS: Linburg-Comstock variation was clinically diagnosed in 130 (60.47%) participants. Unilateral and bilateral prevalence were of 17.21% and 43.26%, respectively, yielding a statistically significant difference. Right-sided and left-sided presence were calculated at 7.44% and 9.77%. Bilateral prevalence was statistically more common in females. Right-sided variation was found to be more frequent in males while left-sided variation was more prevalent in females. The index finger was the most commonly involved with prevalence of 91.03%. Symmetry was noted in 67.74% of subjects. CONCLUSION: The results of our study demonstrated a relatively high prevalence of the Linburg-Comstock variation in Serbian population. We noted a few unusual cases and this finding point to the existence of the broader spectrum of Linburg-Comstock variation, and complexity of the flexor apparatus of the hand, so, further investigations about this topic are needed to improve our knowledge. Due to the possibility of false-positive result during clinical testing we suggest to use expanded clinical method.

Prevalence of third coronary artery: variation or constant coronary artery? / Prevalencia de la tercera arteria coronaria: ¿variación o arteria coronaria constante?

Third coronary artery or supernumerary coronary artery is a direct branch from right aortic sinus and it supplies pulmonary conus and upper part of right ventricle. Third coronary artery is an important bridge for collateral circulation between right and left coronary system. The aim of this study was to determine the number of arteries that origin from right aortic sinus, their frequency and position. The study included 55 adult human hearts collected from Department of Anatomy. The hearts were morphologically studied by gross dissection for the prevalence and topographical anatomy of supernumerary coronary arteries. Out of 55 hearts, 26 (47.3 %) had one right coronary artery, 23 (41.8 %) had two right coronary arteries, and 6 (10.9 %) had three coronary arteries. The supernumerary arteries arises from the right aortic sinus. Right supernumerary coronary arteries may be present in about 52.7 % of the Serbian population. Interpretation of signs and symptoms of coronary occlusion should therefore consider possible contribution of this blood vessels.

La tercera arteria coronaria o arteria coronaria supernumeraria es una rama directa del seno aórtico derecho y su ministra el cono pulmonar y la parte superior del ventrículo derecho. La tercera arteria coronaria es importante para la circulación colateral entre el sistema coronario derecho e izquierdo. El objetivo de este estudio fue determinar el número de arterias de origen del seno aórtico derecho, su frecuencia y posición. El estudio incluyó 55 corazones humanos adultos pertenecientes al Departamento de Anatomía. Los corazones se estudiaron morfológicamente mediante disección macroscópica para determinar la prevalencia y la anatomía topográfica de las arterias coronarias supernumerarias. De 55 corazones, 26 (47,3 %) tenían una arteria coronaria derecha, 23 (41,8 %) tenían dos arterias coronarias derechas, y 6 (10,9 %) tenían tres arterias coronarias. Las arterias supernumerarias surgen del seno aórtico derecho. Las arterias coronarias supernumerarias derechas pueden estar presentes en aproximadamente el 52,7 % de la población serbia. La interpretación de los signos y síntomas de la oclusión coronaria debería considerar la posible contribución de estos vasos sanguíneos.

Application of algometry in patients with cervical and lumbar radiculopathy.

BACKGROUND: Algometry, as a highly sensitive method, provides an objective insight into the degree of pain, while the use of questionnaires can estimate the patient's psychological status in a simple way. OBJECTIVE: This study was conducted in order to measure the pressure pain threshold in patients with cervical and lumbar radiculopathy and to find a possible association of pain with the anxiety and depression. METHODS: The study examined 60 hospitalized patients with cervical radiculopathy and 60 patients with lumbar radiculopathy before starting and after finishing kinesitherapy. The research was conducted using the digital algometry device and Hospital Anxiety and Depression Scale. RESULTS: There was no statistically significant difference in algometric values between the patients with cervical radiculopathy and the patients with lumbar radiculopathy. The program of rehabilitation did not lead to significant improvement in the level of pain. Females have a lower pressure pain threshold than males. Psychological factors greatly affect the pain. CONCLUSIONS: The applied methods will provide the implementation of appropriate therapy and would achieve better verification of the results in a rehabilitation program. Radiculopathy in conservative therapy should be treated in cervical-thoracic and lumbar region together. Rehabilitation period for patients with radiculopathy have to be longer.

Explosive muscle power assessment in elite athletes using wingate anaerobic test / Avaliação da força muscular explosiva em atletas de elite usando o teste anaeróbico de wingate / Evaluación de la fuerza muscular explosiva en atletas de élite usando la prueba anaeróbica de wingate

ABSTRACT Introduction: Maximal effort physiological tests provide information about the current functional capacity of athletes. Objective: The aim of this study was to evaluate anaerobic performance parameters in elite athletes and to compare them in terms of the specific demands of each sport. We also created and applied the new software which enables us to quantify a new parameter -explosive muscle power (EP), a major component in sports requiring explosive bursts of movement lasting from a few seconds to 1 or 2 minutes. This new parameter reflects the velocity of energy transformation from intramuscular ATP and high-energy phosphates into mechanical power. Methods: All Wingate test parameters (standard parameters) - anaerobic power (AP), anaerobic capacity (AC), and explosive power (EP) as the new parameter were recorded in 104 subjects: 30 non-athletes and 74 athletes divided into different groups depending on their sport specialty (20 rowers, 28 wrestlers and 26 soccer players). Results: Anaerobic power (AP), anaerobic capacity (AC) and explosive power (EP) were significantly higher in the group of athletes compared to non-athletes. Among athletes, significant differences were observed in some parameters according to the type of activities they are involved in. The highest values were recorded in the group of wrestlers (AP=836W; AC=16.6kJ; EP=139W/s). The values of AP (absolute values) and EP (absolute and relative values) were significantly higher in wrestlers than in soccer players and rowers, but there was no significant difference in AC among these groups. The EP variable had a distribution similar to AP. Conclusions: Alongside anaerobic power and anaerobic capacity, the assessment of explosive power may complement the anaerobic profile of athletes. Experts in the field of sports medicine and exercise physiology could find these results useful in improving test variables, which are more important for specific sports, and for evaluating and monitoring training progress. Level of Evidence I; Diagnostic studies - Investigating a diagnostic test.

RESUMO Introdução: Os testes fisiológicos de esforço máximo fornecem informações sobre a capacidade funcional atual dos atletas. Objetivo: O objetivo deste estudo foi avaliar os parâmetros de desempenho anaeróbico em atletas de elite e compará-los em relação às demandas específicas de cada esporte. Além disso, criamos e aplicamos o novo software que possibilita a quantificação de um novo parâmetro - força muscular explosiva (FE), um componente importante em esportes que requerem explosões de movimento que duram de alguns segundos a 1 ou 2 minutos. Este novo parâmetro reflete a velocidade de transformação de energia a partir de ATP e fosfatos de alta energia intramusculares em potência mecânica. Métodos: Todos os parâmetros de teste de Wingate (parâmetros padrão) - potência anaeróbica (PA), capacidade anaeróbica (CA) e força explosiva (FE) como um novo parâmetro foram registrados em 104 indivíduos: 30 não atletas e 74 atletas divididos em diferentes grupos, dependendo da sua especialidade esportiva (20 remadores, 28 lutadores e 26 jogadores de futebol). Resultados: A potência anaeróbica (PA), a capacidade anaeróbica (CA) e a força explosiva (FE) foram significativamente maiores no grupo de atletas em comparação com não atletas. Entre os atletas, diferenças significativas foram observadas em alguns parâmetros, de acordo com o tipo de atividades nas quais eles estão envolvidos. Os valores mais altos foram registrados no grupo de lutadores (PA = 836 W, CA = 16,6 kJ, FE = 139 W/s). Os valores de PA (valores absolutos) e FE (valores absolutos e relativos) foram significativamente maiores em lutadores do que em jogadores de futebol e remadores, mas não houve diferenças significativas na CA entre esses grupos. A variável FE mostrou uma distribuição similar à da PA. Conclusões: Juntamente com o poder anaeróbico e a capacidade anaeróbica, a avaliação da força explosiva pode complementar o perfil anaeróbico dos atletas. Especialistas no campo da medicina esportiva e da fisiologia do exercício poderiam achar esses resultados úteis para melhorar as variáveis de teste que são mais importantes para esportes específicos e para avaliar e monitorar o progresso do treinamento. Nível de Evidência I; Estudo diagnóstico - Investigação de um exame para diagnóstico.

RESUMEN Introducción: Las pruebas fisiológicas de esfuerzo máximo proporcionan información sobre la capacidad funcional actual de los atletas. Objetivo: El objetivo de este estudio fue evaluar los parámetros de rendimiento anaeróbico en atletas de élite y compararlos en relación con las demandas específicas de cada deporte. Además, creamos y aplicamos el nuevo software que permite la cuantificación de un nuevo parámetro - fuerza muscular explosiva (FE), un componente grande en deportes que requieren explosiones de movimiento que duran de unos segundos a 1 o 2 minutos. Este nuevo parámetro refleja la velocidad de transformación de energía a partir de ATP y fosfatos de alta energía intramusculares en potencia mecánica. Métodos: Todos los parámetros de prueba de Wingate (parámetros estándar) - potencia anaeróbica (PA), capacidad anaeróbica (CA) y fuerza explosiva (FE) como un nuevo parámetro fueron registrados en 104 sujetos: 30 no atletas y 74 atletas divididos en diferentes grupos dependiendo de su especialidad deportiva (20 remeros, 28 luchadores y 26 jugadores de fútbol). Resultados: La potencia anaeróbica (PA), la capacidad anaeróbica (CA) y la fuerza explosiva (FE) fueron significativamente mayores en el grupo de atletas en comparación con los no atletas. Entre los atletas, se observaron diferencias significativas en algunos parámetros según el tipo de actividades en las que están involucrados. Los valores más altos fueron registrados en el grupo de luchadores (PA =836 W; CA = 16,6 kJ; FE=139 W/s). Los valores de PA (valores absolutos) y FE (valores absolutos y relativos) fueron significativamente mayores en luchadores que en jugadores de fútbol y remeros, pero no hubo diferencias significativas en CA entre estos grupos. La variable FE mostró una distribución similar a la de la PA. Conclusiones: Junto con la potencia anaeróbica y la capacidad anaeróbica, la evaluación de la fuerza explosiva puede complementar el perfil anaeróbico de los atletas. Los expertos en el campo de la medicina deportiva y la fisiología del ejercicio podrían encontrar estos resultados útiles para mejorar las variables de prueba que son más importantes para deportes específicos y para evaluar y monitorear el progreso del entrenamiento. Nivel de Evidencia I; Estudio diagnóstico - Investigación de un examen para diagnóstico.

Linburg-Comstock variation and syndrome. A meta-analysis.

INTRODUCTION: Linburg-Comstock variation often connecting the flexor pollicis longus and flexor digitorum profundus of the index finger at a different level with significant discrepancy between clinical and cadaveric frequencies reported in the literature. Although this variation is quite prevalent, it is yet frequently unrecognized. The aim of this meta-analysis is to generate more accurate weighted frequency values of the Linburg-Comstock variation and to look for possible association with ethnicity, laterality, gender and side. METHODS: A systematic literature search identified 14 studies, including 4132 forearms/hands, which met the inclusion criteria. RESULTS: While no significant difference was found for laterality, we found significantly higher Linburg-Comstock variation rate in females compared to males. Turkish population demonstrated a significantly higher crude frequency when compared to Europeans (22.2 vs. 15.2%). Hispanic population showed the highest crude frequency (34.5%), whereas the African ancestry showed the least one (8.8%). CONCLUSIONS: Linburg-Comstock variation could cause career-threatening disabilities and could complicate some hand injuries as well. This review invites future researchers to use a single nomenclature; the term "Linburg-Comstock variation" is to be used when no symptoms are present, and the term "Linburg-Comstock syndrome" in cases where the variation is symptomatic.

PALMARIS LONGUS ABSENT IN ONE IDENTICAL TWIN: A CASE REPORT.

- Palmaris longus is a very variable muscle in the human body, but it is often used as an applicable tendon graft. We report on differences between one pair of identical twins regarding the existence of the palmaris longus, which were detected accidentally during examination of the presence/absence of this muscle in Caucasian population. In one of the twins, the palmaris longus was present at both forearms, while the other twin was lacking this muscle at both forearms. On search of the available literature, we found no articles about distinctions in the presence or absence of the palmaris longus in twins.

Lymphatic vessel density and VEGF-C expression as independent predictors of melanoma metastases.

INTRODUCTION: In many patients, the clinical behaviour of cutaneous melanoma is very difficult to predict by traditional histologic and clinical parameters. This study aimed to examine the role of quantitative parameters of tumour lymphangiogenesis and vascular endothelial growth factor (VEGF)-C in predicting metastatic risk in patients with cutaneous melanoma. METHODS: One hundred melanoma specimens were stained with lymphatic-specific antibody D2-40 and with anti-VEGF-C antibody. Quantitative parameters of lymphangiogenesis-lymphatic vessel density (LVD) and lymphatic vessel area (LVA)-were determined by computer-assisted morphometric analysis. Moderate or strong staining was assessed as a positive expression of VEGF-C in tumour cells. RESULTS: Univariate analysis revealed that intratumoural LVD, peritumoural LVD, VEGF-C expression in tumour cells, melanoma thickness, Clark level, ulceration, gender and histologic type were significant predictors of lymph node metastasis (p = 0.000, p = 0.000, p = 0.000, p = 0.000, p = 0.005, p = 0.005, p = 0.011 and p = 0.027, respectively). No significant association of intratumoural and peritumoural LVA with metastases was found. In multivariate analysis, independent predictors of metastatic risks were melanoma thickness [odds ratio OR = 1.655, 95% confidence interval (CI) 1.102-2.484, p = 0.015], intratumoural LVD (OR = 1.086, 95% CI 1.027-1.148, p = 0.004), peritumoural LVD (OR = 1.050, 95% CI 1.008-1.094, p = 0.020) and a positive VEGF-C expression in tumour cells (OR = 20.337, 95% CI 2.579-160.350, p = 0.004). CONCLUSIONS: This study identified intratumoural and peritumoural LVD and the VEGF-C expression in tumour cells as more significant predictors of metastatic risk than melanoma thickness, ulceration and other clinical-pathological parameters.

Lymphatic invasion and the Shields index in predicting melanoma metastases.

INTRODUCTION: Findings of the prognostic significance of lymphatic invasion are contradictory. To determine an as efficient cutaneous melanoma metastasis predictor as possible, Shields et al. created a new prognostic index. This study aimed to examine whether the lymphatic invasion analysis and the Shields index calculation can be used in predicting lymph node status in patients with cutaneous melanoma. METHODS: Lymphatic invasion of 100 melanoma specimens was detected by dual immunohistochemistry staining for the lymphatic endothelial marker D2-40 and melanoma cell S-100 protein. The Shields index was calculated as a logarithm by multiplying the melanoma thickness, square of peritumoural lymphatic vessel density and the number "2" for the present lymphatic invasion. RESULTS: No statistically significant difference was observed between lymph node metastatic and nonmetastatic melanomas regarding the lymphatic invasion. Metastatic melanomas showed a significantly higher Shields index value than nonmetastatic melanomas (p = 0.00). Area under the receiver operator characteristic (ROC) curve (AUC) proved that the Shields index (AUC = 0.86, 95% confidence interval (CI) 0.79-0.93, p = 0.00) was the most accurate predictor of lymph node status, followed by the melanoma thickness (AUC = 0.76, 95% CI 0.67-0.86, p = 0.00) and American Joint Committee on Cancer (AJCC) staging (AUC = 0.75, 95% CI 0.66-0.85, p = 0.00), while lymphatic invasion was not successful in predicting (AUC = 0.56, 95% CI 0.45-0.67, p = 0.31). The Shields index achieved 81.3% sensitivity and 75% specificity (cut-off mean value). CONCLUSIONS: Our findings show that D2-40/S-100 immunohistochemical analysis of lymphatic invasion cannot be used for predicting the lymph node status, while the Shields index calculation predicts disease outcome more accurately than the melanoma thickness and AJCC staging.

The Fibularis (Peroneus) Tertius Muscle in Humans: A Meta-Analysis of Anatomical Studies with Clinical and Evolutionary Implications.

Being considered an exclusive human structure for a long time, fibularis tertius (FT) is believed to have a secondary function of foot dorsiflexion and eversion. This study is an attempt to approach the issue from an anatomical perspective. A systematic literature search identified 35 studies (7601 legs) which met the inclusion criteria. The weighted results of FT presence were as follows: an "adult cadaveric" frequency of 93.2% and a clinical frequency of 80%. The most common FT origin and insertion sites were the distal half of fibula and the base of the 5th metatarsal, respectively. In 95% of cases, an accessory fibular muscle was detected when FT was lacking. We demonstrated that the discrepancy found between the adult cadaveric and clinical frequency values would point out a probable bias in interpreting previous kinesiological results. On an evolutionary level, comparative anatomy demonstrated a very low FT prevalence among monkeys while reaching a frequency of 30% in gorillas, the only non-human apes having an almost exclusive terrestrial locomotion. The consistent prevalence among humans and the presence of similar functional muscles when it is missing would support an essential role of FT during the phylogenetic development of the erect bipedal posture and probably during gait.

Patterns of the superficial veins of the cubital fossa: A meta-analysis.

Background The aim of this systematic review is to quantitatively synthesize evidence on the prevalence of superficial vein patterns in the cubital region. Method A systematic literature search was conducted through a number of electronic databases. We identified 27 studies, including 9924 arms, which met the inclusion criteria. Results Meta-analysis showed that "N" shaped arrangement type was the commonest pattern (≈44-60%) followed by "M" shaped arrangement (≈20-25%). The prevalence of "M" type and "M"-like type was significantly higher in males, whereas females showed a significant predominance of "I" or "O" type. No significant differences in various pattern types were found for laterality. The frequency of "M" type is significantly lesser in Indian and Japanese populations, but they have significantly higher frequency of "N" type. In Malay population, "I" or "O" type was significantly higher, while the brachial CV was poorly developed or missing significantly in Indian population. Conclusion This evidence-based clinical anatomy review contributes to our anatomical knowledge regarding the true prevalence of pattern types of the superficial veins in cubital region in humans and, subsequently, might help in performing safer venous access and more direct approaches to these veins, especially under emergency conditions.

The value of P300 event related potentials in the assessment of cognitive function in subclinical hypothyroidism.

BACKGROUND: Mild hypothyroidism (thyroid stimulating hormone [TSH] less than 10 mIU/L) induces reversible cognitive dysfunction, which can be evaluated by event related potentials (ERP). So far, only little is known about the impact of subclinical hypothyroidism on ERP as electrophysiological markers of cognitive activity. The aim of this study was to follow-up P300 latencies and amplitudes in patients with subclinical hypothyroidism and to evaluate the influence of thyroxine treatment which led to the normalization of TSH level in serum. METHODS: We recorded the P300 wave using an auditory oddball paradigm in 60 patients (mean age 51.1±6.2 years, range 40-62 years), with subclinical hypothyroidism (normal mean value of FT4, with elevated TSH levels) at baseline, after 3 months, after 6 months and in 30 healthy control subjects. 30 patients treated six months with L-thyroxine until the normalization of TSH and 30 patients received placebo. RESULTS: The P300 latencies in patients with subclinical hypothyroidism were significantly longer, and the P300 amplitudes were significantly smaller than those of the control group. In the thyroxine treated patients P300 latency continuously decreased over the observation period with a significant difference after 6 months compared to baseline (P<0.01). The amplitude P300 showed no significant changes over time. CONCLUSIONS: Our results show the importance of P300 event related potentials in the detection of cognitive changes in patients with hypothyroidism. The P300 latency stands out as a marker for cognitive function recovery during treatment with thyroxine.