Linear B Mycenaean Greek and medical nomenclature.

This brief report is intended to call attention to the fact that we use some very old terms in our daily medical speaking that were in use about 3500 years ago and were probably uttered as early as the late Bronze Age by Achilles, Agamennon and the other Homeric heroes outside the walls of Troy.

The fundamental contribution of James Maxwell Ross Cormack (1909-1975) in suggesting the term "apoptosis".

This study highlights the historical contribution of Professor James Cormack by providing a Greek term that describes the process of programmed cell death. In 1972 the ancient Greek word "apoptosis" first appeared in the scientific literature. This short manuscript will examine the actual meaning of the term and its historical and phylological background. The word "apoptosis" contains a variety of semantic nuances that are perfectly suited to describe such a complex set of biological events as programmed cell death.

A mandibular bone defect of uncertain significance: report of a paleopathological case.

Anatomical variations of the mandibular canal as well as the presence of accessory canals and foramina are common findings in the human mandible. Here, we present a previously unreported type of anatomical variation, consisting of a large full-thickness bone defect of the right mandibular ramus, observed in a young male unearthed from a mediaeval cemetery located in North-Eastern Italy. The defect was located very close to, yet not directly connected with, the mandibular canal. Awareness of the existence of deviations from the anatomical norm such as that we describe here is strategic to avoid diagnostic misinterpretations, minimise technical hitches, and prevent clinical complications during invasive procedures in the region of the mandible.

A Novel Protocol for Planning and Navigation in Craniofacial Surgery: A Preclinical Surgical Study.

PURPOSE: In modern craniofacial surgery, the accuracy of osteotomies plays a central role in surgical technique. To reach a higher level of accuracy, many centers use virtual presurgical planning. In the past decade, some surgeons also have applied navigational approaches to craniofacial procedures. In this work, a novel protocol for surgical planning and intraoperative navigation is described and validated in a preclinical setting to determine its accuracy in guiding osteotomies. MATERIALS AND METHODS: This study was based on planning a set of osteotomies using 3-dimensional models of computed tomographic images of human skulls. The planned osteotomies were reproduced on real skulls using an optical infrared navigation system. Positions of the performed osteotomies and planned osteotomies were compared. Results were described as the mean positional error and as a Lin concordance coefficient. The Bland-Altman interval of agreement also was defined to assess a range that could include 95% of possible errors. RESULTS: The mean error was 0.044 mm (95% confidence interval [CI], -0.128 to +0.216), the Lin concordance interval was 0.999 (95% CI, 0.999-1.000), and the Bland-Altman limit of agreement ranged from -1.500 to +1.589 mm. CONCLUSIONS: These results show a submillimetric mean error and a very narrow interval of agreement, providing preclinical validation of this new protocol and suggesting that it could be applied in a clinical setting.

Congenital axis dysmorphism in a medieval skeleton : secunda a vertendo epistropheus .

PURPOSE: We describe here the axis dysmorphism that we observed in the skeletal remains of a human child dug up from a fifteenth century cemetery located in north-eastern Italy. This bone defect is discussed in the light of pertinent literature. METHODS: We performed macroscopical examination and CT scan analysis of the axis. RESULTS: Axis structure was remarkably asymmetric. Whilst the left half exhibited normal morphology, the right one was smaller than normal, and its lateral articular surface showed horizontal orientation. In addition, the odontoid process appeared leftward deviated and displayed a supplementary articular-like facet situated on the right side of its surface. CONCLUSIONS: These findings suggest a diagnosis of unilateral irregular segmentation of atlas and axis, a rare dysmorphism dependent upon disturbances of notochordal development in early embryonic life. Likewise other malformations of the craniovertebral junction, this axis defect may alter the delicate mechanisms of upper neck movements and cause a complex series of clinical symptoms. This is an emblematic case whereby human skeletal remains may provide valuable information on the anatomical defects of craniovertebral junction.

A keyhole-shaped sternal defect in an ancient human skeleton.

We observed a sternal foramen contiguous with a small sternal cleft in a human skeleton coming from North-Eastern Italy and dating back to between the sixteenth and seventeenth century AD. Both of these types of anomalies result from a defective midline fusion of the developing sternum. Sternal foramen is a relatively common bony defect that usually comes to light as an incidental finding. Sternal cleft is a rarer morphological anomaly that can have a wide spectrum of clinical manifestations and outcomes, depending on the extent of the bony defect as well as on the presence and severity of other abnormalities. The coexistence of a sternal foramen and a sternal cleft has very rarely been described in the literature. We report here one such unusual association and discuss its potential practical implications. In most cases, sternal foramina and small sternal clefts are clinically uneventful; yet, lack of awareness about the existence of these subtle anatomical variations can sometimes lead to misinterpretation of radiological and pathological findings or make sternal biopsy and acupuncture unsafe.

The craniovertebral junction, between osseous variants and abnormalities: insight from a paleo-osteological study.

The bony components of the craniovertebral junction (CVJ) have been investigated in 172 skeletons, dug up from several archaeological sites, to define the frequency of developmental dysmorphisms, and to acquire qualitative and quantitative data about their morphology. A review of the pertinent literature is also presented. Twenty-five individuals (14.5%) exhibited at least one dysmorphism, which ranged from a condition of simple variant to a true malformation. Four individuals presented two or more anomalies at the same time (2.3% of the whole sample, 16% of the affected individuals). The most frequently observed abnormalities were: (i) the presence of a complete bony bridge in the atlas, forming a canal surrounding the vertebral artery (arcuate foramen, supertransverse foramen, and the simultaneous occurrence of arcuate foramen and supertransverse foramen); (ii) the presence of basilar processes. Basilar processes displayed a great variety in shape and dimension. They also differed with respect to their relationship with atlas and axis. The less frequently detected anomalies were: (i) complete absence of the posterior arch of C1, (ii) fusion of C2 and C3, and (iii) irregular segmentation of C2. A broad array of structural defects has been described at the CVJ. They may occur either isolated or as part of complex multisystem syndromes. Although harmless in many cases, they can notwithstanding cause severe, even life-threatening complications. When unrecognized, they may generate trouble during surgery. Hence, accurate knowledge of CVJ arrangement, including its multifarious variations, is a critical issue for radiologists, clinicians, surgeons, and chiropractors.

Two paleopathological cases suggestive of paralabral cysts of the shoulder.

OBJECTIVE: To undertake differential diagnosis of scapular bone defects found in two medieval skeletons buried in different necropoles of Friuli Venezia Giulia (Italy) and to evaluate the clinical significance of paralabral cysts in the context of shoulder pathology. MATERIALS: Individual JoT36 is an adult male exhumed from a necropolis belonging to a rural agricultural settlement dated to the 10th to 11th century A.D. Individual CIVT58 is an adult male from a Langobard necropolis dated to 630-670 A.D. METHODS: Macroscopic examination of the skeletons was performed using standard osteological methods and review of pertinent clinical literature to assist differential diagnosis. RESULTS: Between the glenoid cavity and the spinoglenoid notch of the right scapula of JoT36 there is a multilocular circular defect adjacent to the glenoid rim. On the neck of the left scapula of CIVT58, immediately above the spinoglenoid notch, there is a unilocular circular depression. In both cases, the cortical bone appears smooth without any evidence of erosion or sclerosis. CONCLUSIONS: Skeletal findings and historical/archaeological contexts of both cases are compatible with the diagnosis of paralabral cysts. SIGNIFICANCE: Paralabral cysts are relatively frequently observed in clinical settings but very few examples have been documented in paleopathological literature. This study seeks to improve recognition and interpretation of this pathology in historical/archaeological contexts. LIMITATIONS: Findings from a case report can neither generate epidemiological information nor be generalized. SUGGESTIONS FOR FURTHER RESEARCH: Identification of new cases may add valuable information about lifestyles and related shoulder pathologies in ancient times.

The Cerebral Cortex and the Songs of Homer: When Neuroscience Meets History and Literature.

In this article we reconsider Homer's poetry in the light of modern achievements in neuroscience. This perspective offers some clues for examining specific patterns of brain functioning. Homer's epics, for instance, painted a synthetic picture of the human body, emphasizing some parts and neglecting others. This led to the formation of a body schema reminiscent of a homunculus, which we call the "Homeric homunculus." Both poems were largely the product of centuries of oral tradition, in which the prodigious memory of courtly rhapsodists was essential to the performance of the epics. The underlying cognitive functions required a close interplay of memory and language skills, supported by the musical and rhythmic cadence of Homeric verse.

Bilateral arcuate foramen associated with partial defect of the posterior arch of the atlas in a medieval skeleton: case report and review of the literature. Looking backward to go forward.

PURPOSE: We observed a complex atlas (C1) dysmorphism in a human medieval skeleton dug up from the sixth to the seventh century necropolis located in the north-eastern Italy. We analyzed such a dysmorphism in the light of pertinent literature and discussed the functional and clinical implications related to this type of C1 structural malformation. METHODS: Macroscopical and CT-SCAN examinations of the atlas were carried out. RESULTS: Bone findings consisted of partial aplasia of the posterior arch of the C1 accompanied by a bilateral arcuate foramen. In addition, the spinous processes of C7 and T1 were found to be bifid. CONCLUSIONS: Although such abnormalities are supposed to be clinically inconspicuous, yet they may become challenging or even dangerous in the context of trauma. They may even complicate specific diagnostic or surgical procedures. In addition, they may cause a great number of symptoms, ranging from headache and neck pain to loss of postural muscle tone and consciousness, due to the close and complex relationship of bone structures with nerves, blood vessels, muscles, and ligaments. As a result, radiologists, clinicians, surgeons, and chiropractors should consider in their clinical reasoning the possibility that atlas dysmorphisms may occur.

Facial Muscle Activity Patterns in Clarinet Players: A Key to Understanding Facial Muscle Physiology and Dysfunction in Musicians.

OBJECTIVES: Facial muscle activity is crucial to controlling musical performance in wind instrument playing. Facial muscle dysfunctions are common in wind instrument players, dramatically affecting their professional musical activity and potentially leading to disabling symptoms.The aim of this pilot study on a cohort of healthy clarinetists was to use surface electromyography to identify the facial muscle activity patterns involved in stabilizing the mouthpiece, controlling emission and articulation during musical tasks in physiological conditions, also comparing muscle activity between less and more experienced clarinetists (students vs postgraduates/professionals). METHODS: Surface electromyographic measures of the sternocleidomastoid, masseter, mentalis, mylohyoid and buccinator muscles were obtained from eight healthy clarinet players (four students and four postgraduates/professionals) performing two standardized musical tasks. RESULTS: Overall, mean IEMG activity was significantly lower for the sternocleidomastoid than for the other muscles (P = .000), and for the mouthpiece-stabilizing muscles (masseter and mentalis) than for those directly involved in controlling emission and articulation (buccinator and mylohyoid muscles) (P = .000).Regardless of the musical task, the mean IEMG values were significantly higher in the students for the masseter (P = .0007), buccinator (P = .0001) and mylohyoid (0.000), while they were significantly higher in the postgraduates/professionals for the mentalis (P = .000). No significant differences emerged between the two groups for the sternocleidomastoid (P = .207). CONCLUSIONS: These preliminary data reflect a significantly higher overall facial muscle activity in the less-experienced group, potentially resulting in an overload, whereas the more expert players had more optimized muscle activity patterns.

Ultrastructural evidence of a vesicle-mediated mode of cell degranulation in chicken chromaffin cells during the late phase of embryonic development.

In the present investigation, we attempted to determine whether ultrastructural features indicative of a vesicle-mediated mode of cell secretion were detectable in chick chromaffin cells during embryo development. The adrenal anlagen of domestic fowls were examined at embryonic days (E) 12, 15, 19 and 21 by electron microscopy quantitative analysis. Morphometric evaluation revealed a series of granule and cytoplasmic changes highly specific for piecemeal degranulation (PMD), a secretory process based on vesicular transport of cargoes from within granules for extracellular release. At E19 and E21 we found a significant peak in the percentage of granules exhibiting changes indicative of progressive release of secretory materials, i.e. granules with lucent areas in their cores, reduced electron density, disassembled matrices, residual cores and membrane empty containers. A dramatic raise in the density of 30-80-nm-diameter, membrane-bound, electron-dense and electron-lucent vesicles--which were located either next to granules or close to the plasma membrane--was recognizable at E19, that is, during the prehatching phase. The cytoplasmic burst of dense and clear vesicles was paralleled by the appearance of chromaffin granules showing outpouches or protrusions of their profiles ('budding features'). These ultrastructural data are indicative of an augmented vesicle-mediated transport of chromaffin granule products for extracellular release in chick embryo chromaffin cells during the prehatching stage. In conclusion, this study provides new data on the fine structure of chromaffin cell organelles during organ development and suggests that PMD may be part of an adrenomedullary secretory response that occurs towards the end of chicken embryogenesis. From an evolutionary point of view, this study lends support to the concept that PMD is a secretory mechanism highly conserved throughout vertebrate classes.

Unusual case of occipital vertebra in a medieval skeleton.

The craniovertebral junction (CVJ) is a transitional region of the spine that exhibits extensive structural variability. Developmental defects include a vast array of anatomical anomalies that result from remnants of the proatlas and are grouped under the term 'occipital vertebra'. The purpose of the present paper is to describe the case of a medieval skeleton, which was found to display a previously unreported manifestation of occipital vertebra. It consisted of two large basilar processes that articulated with the anterior arch of the atlas. In addition, the left process exhibited a supplementary contact zone with the dens of the axis. These structural defects were associated with an accessory canal situated posterior to the right hypoglossal canal.

"The quiet necrosis": An early medieval case of multifocal juvenile osteochondritis dissecans of the knee.

BACKGROUND: osteochondritis dissecans (OCD) is an ancient disease with few well-described cases in paleopathological records. Here, we report a very rare case of OCD on both lateral femoral condyles and on the lateral condyle of the right tibia in an early medieval human skeleton. METHODS: macroscopic examination of the bone vestiges of a young male unearthed from a 6th-8th Lombard cemetery in the northeast Italy was perform. RESULTS: We observed a circular crater-like depression with well-defined smooth margins and exposure of the trabecular bone on both lateral femoral condyles and in the lateral condyle of the right tibia. The left tibia was fragmented and the lateral condyle was lacking. Findings are consistent with the diagnosis of multifocal juvenile osteochondritis dissecans of the knee. CONCLUSION: Research in past and modern skeletal remains can contribute to define the nature and distribution of OCD.

Of flesh and blood I am made - The anatomical study of the recently unveiled wooden Christ of Donatello in Santa Maria dei Servi, in Padua.

ABSTRACT: The wooden Crucifix of the Santa Maria dei Servi Church in Padua was recently attributed to the great sculptor Donatello. This crucifix recently underwent a demanding restoration. In the context of a multidisciplinary study of this sculpture, several analyses were carried out (Digital Rx, 3D scanning, CT scanning and micro-stratigraphic analysis) and the anatomical study was performed. Donatello sculpted the anatomy of this Christ realistically reproducing the human body, emphasizing some particulars, with less attention to details in the regions of the body hidden by the Crux. A swelling is well appreciable just below the lateral portion of the inguinal ligament, on the right thigh. It is a six cm wide bulge and it could be the consequence of the beating suffered by Christ before the crucifixion.

Low back pain and FokI (rs2228570) polymorphism of vitamin D receptor in athletes.

BACKGROUND: Low back pain (LBP) is common in athletes. LBP can be detrimental to athletic performance and health. Factors predisposing to LBP in athletes remain elusive and require further studies. We investigated whether carriage of a specific genotype and/or allele of vitamin D receptor gene (VDR) FokI polymorphism (rs2228570) was a risk factor for LBP in athletes of different sports disciplines. METHODS: This genotype/phenotype association case-control study included 60 Italian athletes (25 females and 35 males; mean age 33.9 ± 13.3 years; body-mass-index 23.5 ± 3.5 kg/m2) of which 16.7% were swimmers, 11.7% soccer players, 11.7% volleyball players, 10.0% rugby players and other disciplines. VDR-FokI polymorphism was measured by PCR-RFLP in 24 athletes with LBP and 36 athletes without LBP episodes. Absence or presence of the FokI restriction site was denoted "F" and "f", respectively. Other risk factors were evaluated by a questionnaire. RESULTS: The homozygous FF genotype was found in 58.3% (14/24) of athletes with LBP versus 27.8% (10/36) of athletes without LBP, adjusted OR = 5.78, 95% CI 1.41-23.8, P = 0.015. The F allele was a 2-fold risk factor to develop LBP, adjusted OR = 2.55, 95% CI 1.02-6.43, P = 0.046, while f allele was protective. Exposure to vehicle vibrations ≥2 h daily, and family history of lumbar spine pathology were significant risk factors for LBP with OR = 3.54, and OR = 9.21, respectively. CONCLUSIONS: This is the first study in which an association between VDR-FokI polymorphism and LBP in athletes was found. Further research is needed to extend our results, and to clarify the biochemical pathways associated with how vitamin D modulates LBP in athletes. The VDR-FokI polymorphism should be considered when developing genetic focused studies of precision medicine on health in athletes.

The phylogenetic profile of mast cells.

Mast cells (MCs) are tissue-based immune cells that participate to both innate and adaptive immunities as well as to tissue-remodelling processes. Their evolutionary history appears as a fascinating process, whose outline we can only partly reconstruct according to current remnant evidence. MCs have been identified in all vertebrate classes, and a cell population with the overall characteristics of higher vertebrate MCs is identifiable even in the most evolutionarily advanced fish species. In invertebrates, cells related to vertebrate MCs have been recognized in ascidians, a class of urochordates which appeared approximately 500 million years ago. These comprise the granular hemocyte with intermediate characteristics of basophils and MCs and the "test cell" (see below). Both types of cells contain histamine and heparin, and provide defensive functions. The test cell releases tryptase after stimulation with compound 48/80. A leukocyte ancestor operating in the context of a primitive local innate immunity probably represents the MC phylogenetic progenitor. This cell was likely involved in phagocytic and killing activity against pathogens and operated as a general inducer of inflammation. This early type of defensive cell possibly expressed concomitant tissue-reparative functions. With the advent of recombinase activating gene (RAG)-mediated adaptive immunity in the Cambrian era, some 550 million years ago, and the emergence of early vertebrates, MC progenitors differentiated towards a more complex cellular entity. Early MCs probably appeared in the last common ancestor we shared with hagfish, lamprey, and sharks about 450-500 million years ago.

Normal anatomy and anatomic variants of vascular foramens in the cervical vertebrae: a paleo-osteological study and review of the literature.

We investigated 923 cervical vertebrae belonging to late-antiquity and medieval skeletal remains and assessed the qualitative and quantitative structural characteristics of transverse foramens (TF) and additional vascular canals. We also reviewed the pertinent literature. Double TF were chiefly observed in C6 (with a right/left side prevalence of 35.7 and 44.4%, respectively) and C5 vertebrae (23.6 and 23.9%, right/left side, respectively), while unclosed TF were mainly documented in C1 vertebrae (8.4%). Retrotransverse canal and retrotransverse groove were present in 8.5 and 17.8%, respectively, of C1 vertebrae examined, while arcuate foramens and supertransverse foramens were found in 7.3 and 3.7% of specimens, respectively. TF diameter decreased from C6 to C2 vertebrae, being smallest in C7 and greatest in C1 vertebrae, with no left/right significant difference. There was a significant correlation between TF diameter and stature, but only on the right side. The mean area of the arcuate foramen was lower than the mean area of the ipsilateral TF (24.5 ± 5.7 vs 28.5 ± 7.7 mm(2), respectively; p = 0.048), possibly causing compression of the vertebral artery within the arcuate foramen. The study of human vertebrae excavated from archaeological sites is a simple and effective way to analyze the morphology and quantitative anatomy of vascular foramens.

Decreased hypothalamus volumes in generalized anxiety disorder but not in panic disorder.

BACKGROUND: The hypothalamus is a brain structure involved in the neuroendocrine aspect of stress and anxiety. Evidence suggests that generalized anxiety disorder (GAD) and panic disorder (PD) might be accompanied by dysfunction of the hypothalamus-pituitary-adrenal axis (HPA), but so far structural alterations were not studied. We investigated hypothalamic volumes in patients with either GAD or PD and in healthy controls. METHODS: Twelve GAD patients, 11 PD patients and 21 healthy controls underwent a 1.5T MRI scan. Hypothalamus volumes were manually traced by a rater blind to subjects' identity. General linear model for repeated measures (GLM-RM) was used to compare groups on hypothalamic volumes, controlling for total intracranial volume, age and sex. RESULTS: The hypothalamus volume was significantly reduced (p=0.04) in GAD patients, with significant reductions in both the left (p=0.02) and right side (p=0.04). Patients with PD did not differ significantly (p=0.73). Anxiety scores were inversely correlated with hypothalamic volumes. LIMITATIONS: The small sample size could reduce the generalizability of the results while the lack of stress hormone measurements renders functional assessment of the hypothalamus-pituitary-adrenal axis not feasible. CONCLUSIONS: The present study showed decreased hypothalamic volumes in GAD patients but not in those with PD. Future longitudinal studies should combine volumetric data with measurements of stress hormones to better elucidate the role of the HPA axis in GAD.