Are There Any Differences in the Healing Capacity between the Medial Collateral Ligament's (MCL) Proximal and Distal Parts in the Human Knee? Quantitative and Immunohistochemical Analysis of CD34, α-Smooth Muscle Actin (α-SMA), and Vascular Endothelial Growth Factor (VEGF) Expression Regarding the Epiligament (EL) Theory.

The human knee is a complex joint that comprises several ligaments, including the medial collateral ligament (MCL). The MCL provides stability to the knee and helps prevent its excessive inward movement. The MCL also has a thin layer of connective tissue known as the epiligament (EL), which adheres to the ligament. This unique feature has drawn attention in the field of ligament healing research, as it may have implications for the recovery process of MCL injuries. According to the EL theory, ligament regeneration relies heavily on the provision of cells, blood vessels, and molecules. The present study sought to compare the expression of vascular endothelial growth factor (VEGF), CD34, and α-smooth muscle actin (α-SMA) in healthy knees' proximal and distal MCL segments to better understand how these proteins affect ligament healing. By improving the EL theory, the current results could lead to more effective treatments for ligament injury. To conduct the present analysis, monoclonal antibodies were used against CD34, α-SMA, and VEGF to examine samples from 12 fresh knee joints' midsubstance MCLs. We identified a higher cell density in the EL than in the ligament connective tissue, with higher cell counts in the distal than in the proximal EL part. CD34 immunostaining was weak or absent in blood vessels and the EL, while α-SMA immunostaining was strongest in smooth muscle cells and the EL superficial layer. VEGF expression was mainly in the blood vessels' tunica media. The distal part showed more SMA-positive microscopy fields and higher cell density than the proximal part (4735 vs. 2680 cells/mm2). Our study identified CD34, α-SMA, and VEGF expression in the MCL EL, highlighting their critical role in ligament healing. Differences in α-SMA expression and cell numbers between the ligament's proximal and distal parts may explain different healing capacities, supporting the validity of the EL theory in ligament recovery.

A bilateral four-headed brachialis muscle with a variant innervation: a cadaveric report with possible clinical implications.

PURPOSE: Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a bilateral four-headed brachialis muscle (BM) with aberrant innervation. Emphasis on the embryological background and possible clinical significance are also provided. METHODS: Classical upper limb dissection was performed on an 84-year-old donated male cadaver. The cadaver was donated to the Anatomy Department of the National and Kapodistrian University of Athens. RESULTS: On the left upper limb, the four-headed BM was supplied by the musculocutaneous and the median nerves after their interconnection. On the right upper limb, the four-headed BM received its innervation from the median nerve due to the musculocutaneous nerve absence. A bilateral muscular tunnel for the radial nerve passage was identified, between the BM accessory heads and the brachioradialis muscle. CONCLUSION: BM has clinical significance, due to its proximity to important neurovascular structures and frequent surgeries at the humerus. Hence, knowledge of these variants should keep orthopedic surgeons alert when intervening in this area. Further dissection studies with a standardized protocol are needed to elucidate the prevalence of BM aberrations and concomitant variants.

What is the axillary arch (of Langer)?

We read with great interest the article by Weninger et al. (2023) on the presence of the axillary arch (AA) (of Langer) found during anatomical dissections-"Axillary arch (of Langer): A large-scale dissection and simulation study based on unembalmed cadavers of body donors." The authors performed their study using 400 axillae from 200 unembalmed cadavers; they identified this variant muscle in 27 axillae of 18 cadavers. Weninger et al. (2023) described the muscular AA in 15 cases; AA was composed of connective tissue in six cases, and AA comprised muscular and connective tissue in six cadavers. Moreover, these authors indicated that after passive abduction and lateral rotation of the arm, 17 arches (63%) came into contact with the neurovascular axillary bundle, which is of clinical importance. In our opinion, this is the most precise and detailed AA muscle study in the literature, illustrated with excellent photographs and schemes. Such studies expand the existing data in the literature and are of real help to clinicians. However, we want to present our modest comments about the title of the article and would like to pose the question, "What is the axillary arch (of Langer)?" Weninger et al. (2023) stated that connective or muscular tissue crossing the axilla is termed the AA (of Langer). This structure splits from the latissimus dorsi muscle, crosses the axilla, and joins the anterior part of the upper limb. The first detailed description of this variation was published in 1846 by Karl Langer Ritter von Edenberg (Langer, 1846). Nowadays, a significant number of articles term all muscular and fibromuscular connections between the latissimus dorsi muscle and the anterior part of the upper limb as "Langers AA" (Markou et al., 2023; Sang et al., 2019; Scrimgeour et al., 2020; Taterra et al., 2019). What Langer described in his work "Zur anatomie des musculus latissimus dorsi" was a fibrous thickening of the medial edge of the axillary fascia between the borders of the pectoralis major and the latissimus dorsi muscles, a structure he termed "Achselbogen." In a sequel of this article, Langer investigated muscular fibers inserting at or encircling the connective tissue "Achselbogen" (Langer, 1846). Therefore, in our opinion, in the study of Weninger et al. (2023), the term AA (of Langer) should only be used to describe the cases presenting solely with a connective tissue "arch" or these comprised of both, muscular and connective tissue. Weninger et al. (2023) noted that muscle fibers could not be excluded in these cases. Of course, to answer this question accurately, a histological study of these cases would be necessary.

Squamous Cell Carcinoma of the Thumb: A Case Report.

Squamous cell carcinoma (SCC) is the most common tumor of the hand with a high tendency for local recurrence and a low rate of metastasis. Herein, we present an interesting case of SCC of the thumb of the right hand in a 68-year-old patient with one recurrence, treated with surgical excision and following radiotherapy. Five years postoperative, there are no clinical and imaging data for local recurrence, as well as the presence of metastases. We also make a brief review of the current literature on this neoplasia.

The enigmatic os supratrochleare anterius: from rarity to recognition in elbow pathology-case report and review of literature.

Accessory bones around the elbow are scarce, with a reported mean incidence rate of 0.77%. The rarest one is the os supratrochleare anterius, with only a handful of documented cases in the literature. Despite their scarcity, various types of ossicles have been documented, posing diagnostic challenges and potential misinterpretation on X-rays. Herein, we report a case of an accidentally found os supratrochleare anterius in a 43-year-old pig farmer presenting with symptoms of tennis elbow. After conservative treatment with nonsteroidal anti-inflammatory drugs and physiotherapy, he made a full recovery within 2 weeks. This report emphasizes the rarity of the ossupra trochleare anterius, the importance of accurate diagnosis, and the need for continued research and awareness of this anatomical variation.

Normative Data of Handgrip Strength in Macedonian Children and Adolescents According to Chronological and Biological Age / Datos Normativos de la Fuerza de Prensión Manual en Niños y Adolescentes Macedonios Según la Edad Cronológica y Biológica

SUMMARY: The handgrip strength is used as a means of individual's health prediction during life. It is used as an indicator of the nutrition status, bone fragility, presence of sarcopenia and it correlates with certain diseases and clinical complications. The research goal was to analyze the results of the hand dynamometry test, based on the chronological and biological age, and to offer normative and referent standards about children and adolescents from the Republic of North Macedonia. The study was conducted on a sample of 4031 respondents of both sexes at the age 6-14 years. In order to achieve the research goals, the measured characteristics were of the weight, height, sitting height and handgrip strength. The body mass index and biological maturity values (APHV) were obtained by using formulas. On the basis of the obtained results, it can be concluded that statistically significant differences in handgrip strength are established between the boys and girls of all age categories. Also, statistically significant differences between boys and girls are established in the hand dynamometry test of all APHV levels. In general, the use of the APHV allows a better categorization of the performance of the studied children and adolescents. With boys, the correlation between the chronological age and test was 68 %, and with girls - 77 %. The normative referent standards of the hand dynamometry test are presented in percentiles for both sexes. Thye hand dynamometry test's results during childhood and adolescence should be analyzed and interpret on the basis of biological age, and not on the chronological age. These tools can help specialists who work with children and adolescents in ethnic and epidemiological context.

La fuerza de prensión se utiliza como medio para predecir la salud del individuo durante la vida. Se utiliza como indicador del estado nutricional, fragilidad ósea, presencia de sarcopenia y se correlaciona con determinadas enfermedades y complicaciones clínicas. El objetivo de la investigación fue analizar los resultados de la prueba de dinamometría manual, con base en la edad cronológica y biológica, y ofrecer estándares normativos y referentes sobre niños y adolescentes de la República de Macedonia del Norte. El estudio se realizó en una muestra de 4031 encuestados de ambos sexos con edades comprendidas entre 6 y 14 años. Para lograr los objetivos de la investigación, las características medidas fueron el peso, la altura, la altura al sentarse y la fuerza de prensión. El índice de masa corporal y los valores de madurez biológica (APHV) se obtuvieron mediante fórmulas. Sobre la base de los resultados obtenidos, se puede concluir que se establecen diferencias estadísticamente significativas en la fuerza de prensión manual entre niños y niñas de todas las categorías de edad. Asimismo, se establecen diferencias estadísticamente significativas entre niños y niñas en la prueba de dinamometría manual de todos los niveles APHV. En general, el uso del APHV permite una mejor categorización del desempeño de los niños y adolescentes estudiados. En los niños, la correlación entre la edad cronológica y la prueba fue del 68 %, y en las niñas, del 77 %. Los estándares normativos referentes de la prueba de dinamometría manual se presentan en percentiles para ambos sexos. Los resultados de la prueba de dinamometría manual durante la infancia y la adolescencia deben analizarse e interpretarse en función de la edad biológica y no de la edad cronológica. Estas herramientas pueden ayudar a los especialistas que trabajan con niños y adolescentes en un contexto étnico y epidemiológico.

The tendon of the fibularis brevis muscle - Systematic overview and new classification system.

The fibularis brevis muscle belongs to the lateral compartment of the leg. It originates from the lower two-thirds of the lateral surface of the fibula bone and it also is attached to the anterior intermuscular septum. Its insertion is normally located on the tuberosity at the base of the fifth metatarsal bone, on its lateral side. However, distal attachment of this muscle is morphologically variable. Different variations have been identified and some classification systems have been created for both adults and foetuses. Based on various literature references, we have created a new classification system and compared the frequency of each type. The main aim of this review is to present morphological variations of the fibularis brevis tendon with their clinical significance, especially in autografting in case of surgical treatment of fibularis brevis tendon rupture. The clinical aspect of this pathology and some medical cases will also be presented.

Do the Differences in the Epiligament of the Proximal and Distal Parts of the Anterior Cruciate Ligament Explain Their Different Healing Capacities? Quantitative and Immunohistochemical Analysis of CD34 and α-SMA Expression in Relation to the Epiligament Theory.

The aim of this study was to assess the epiligament theory by determining the normal epiligament morphology of the proximal and distal parts of the anterior cruciate ligament in humans and analyzing the differences between them and the midportion of the ligament in terms of cell numbers and expression of CD34 and α-SMA. Samples were obtained from the anterior cruciate ligaments of 12 fresh knee joints. Monoclonal antibodies against CD34 and α-SMA were used for immunohistochemistry. Photomicrographs were analyzed using ImageJ software, version 1.53f. The cell density was higher in the epiligament than in the ligament connective tissue. Cell counts were higher in the proximal and distal thirds than in the midsubstance of the epiligament. CD34 was expressed similarly in the proximal and distal thirds, although it seemed slightly more pronounced in the distal third. α-SMA expression was more robust in the proximal than the distal part. The results revealed that CD34 and α-SMA are expressed in the human epiligament. The differences between the numbers of cells in the proximal and distal parts of the epiligament and the expression of CD34 and α-SMA enhance epiligament theory. Future investigations into improving the quality of ligament healing should not overlook the epiligament theory.

The coracobrachialis muscle: typical morphology, accessory forms, and the issues with terminology.

The coracobrachialis muscle (CB) represents one of the anterior arm compartment muscles. It has been defined by classic anatomy textbooks and old papers, as a muscle of one belly arising from the coracoid process tip and partially from the tendon of the biceps brachii short head, and inserted into the humeral shaft, above the bone's midpoint. However, recent cadaveric studies have confirmed that in the majority of cases, the CB is a two-headed muscle consisting of a superficial and a deep head. This finding has caused confusion regarding the terminology of CB's morphology. Typical CB morphology, according to recent data should not be considered the muscle of one belly, but the two-headed muscle. In particular, the musculocutaneous nerve's (MCN) course plays an important role in defining the CB morphological characteristics. If the MCN courses medially to the CB, with no signs of penetration after dissection, it can be concluded, that the CB is composed of one head; otherwise, if the muscle is composed of two or more heads, the MCN will courses between the CB bellies. In conclusion, it is of paramount importance to adopt common-universal terminology. Hence, considering recent findings, if the CB origin and/or the insertion differs from the typical anatomy, an "atypical CB" is the proper definition of the muscle, while if this "atypical CB" coexists with a typical CB, the terminology "accessory CB" may be used.

Physical Exercise-Induced DNA Methylation in Disease-Related Genes in Healthy Adults-A Systematic Review With Bioinformatic Analysis.

ABSTRACT: Vasileva, F, Hristovski, R, Font-Lladó, R, Georgiev, G, Sacot, A, López-Ros, V, Calleja-González, J, Barretina-Ginesta, J, López-Bermejo, A, and Prats-Puig, A. Physical exercise-induced DNA methylation in disease-related genes in healthy adults-A systematic review with bioinformatic analysis. J Strength Cond Res 38(2): 384-393, 2024-This study aimed to systematically review the existing literature regarding physical exercise (PE) and DNA methylation (DNAm) in healthy adults. Specific goals were to (a) identify differently methylated genes (DMGs) after PE intervention, their imprinting status, chromosome and genomic location, function, and related diseases; and (b) to screen for core genes and identify methylation changes of the core genes that can be modified by PE intervention. Our search identified 2,869 articles from which 8 were finally included. We identified 1851 DMGs ( p < 0.05) after PE intervention, although 45 of them were imprinted. Aerobic exercise (AE) seems to induce more DNA hypermethylation rather than hypomethylation, whereas anaerobic exercise (AN) seems to induce more DNA hypomethylation rather than hypermethylation. Aerobic exercise induced highest % of methylation changes on chromosome 6, whereas AN and mixed type (MT) on chromosome 1. Mixed type induced higher % of methylation changes close to transcription start site in comparison to AE and AN. After PE intervention, DMGs were mainly involved in fat metabolism, cell growth, and neuronal differentiation, whereas diseases regulated by those genes were mainly chronic diseases (metabolic, cardiovascular, neurodegenerative). Finally, 19 core genes were identified among DMGs, all related to protein metabolism. In conclusion, our findings may shed some light on the mechanisms explaining PE-induced health benefits such as the potential role that PE-induced DNAm may have in disease prevention and disease treatment.

First body fat reference curves for Macedonian children and adolescents: the MAKFIT study.

INTRODUCTION: childhood obesity is a worldwide chief health problem. Along with body mass index, body fat percentile values can also be used to predict future cardiovascular and metabolic health risks. OBJECTIVE: the study's aim is to define the percentile values and curves about the fat tissue percentage through which the childhood and adolescent overweight/obesity in the Republic of North Macedonia will be diagnosed. METHODS: the research was conducted on a sample of 15,075 children and adolescents aged six to 14 years (7,627 boys and 7,448 girls). Body fat percentage was established by bioelectrical impedance. The LMS method was used in percentile values and curves' construction. RESULTS: the boys' 50th percentile curve shows that the body fat percentage average value has a slight growth from seven to ten years of age, but after their 10th it begins to drop continuously until the age of 14 years. At the same time, the girls' body fat percentage average value increases continuously from six to 14 years of age. CONCLUSION: since body mass index cannot always establish body fat content, the direct assessment of body fat by bioelectrical impedance would be of great advantage for pediatric and clinical decisions. Therefore, the study provides referent percentile norms for the body fat percentage of healthy Macedonian children and adolescents. For this purpose, a practical and clinically applicable method was used. The obtained referent percentile norms can be useful in assessing overweight and obesity in Macedonian children and adolescents.

The Influence of Personal Evaluation and Social Support on Career Expectations of College Students.

This study aimed to investigate the factors influencing career expectations, determine the influence of college students' personal ability on personal evaluation in the process of gaining employment, and further explore the impact of personal evaluation and social support on career expectations. This study used a random sampling method to administer questionnaires to final-year undergraduates majoring in the liberal arts, science, art, and sports at two Chinese universities. Career expectations were positively correlated with satisfaction. The preferred employer for graduates is a school. In selecting a career, college students believed that exerting their talents was most important. Personal evaluations had a significant effect on self-development in career expectations. The level of social support had a significant effect on prestige and welfare stability in career expectations.

Characteristics of Pre-Lens Tear Film Behavior in Eyes Wearing Delefilcon A Silicone Hydrogel Water Gradient Contact Lenses.

The pre-lens tear film (PLTF) over (i) delefilcon A silicone hydrogel water gradient (WG; 33-80% from core to surface) contact lenses (CLs) (SHWG-CLs) and (ii) subjects' own non-WG soft CLs (SCLs) (SO-SCLs) was studied in 30 eyes of 30 subjects to assess the hypothesized PLTF stabilization over SHWG-CLs. In both eyes, delefilcon A SHWG-CLs (DAILIES TOTAL1®; Alcon, Fort Worth, TX, USA) or SO-SCLs were worn. After 15 min of wearing each lens, the tear meniscus radius (TMR, mm), lipid-layer interference grade (IG) and spread grade (SG), and non-invasive breakup time (NIBUT, seconds) were evaluated and compared between the SHWG-CLs and the SO-SCLs. The comparison between the SHWG-CL and SO-SCL groups (SHWG-CL and SO-SCL, mean ± SD) revealed that TMRs temporarily decreased and reached a plateau value after 15 min (0.21 ± 0.06; 0.21 ± 0.06) compared to the value prior to CL insertion (0.24 ± 0.08; 0.25 ± 0.08), with no significant difference between the two groups. The NIBUT, IG, and SG values after 15 min of wearing the CLs were (9.7 ± 3.7; 4.7 ± 4.2), (1.0 ± 0.2; 1.8 ± 1.0), and (1.1 ± 0.4; 1.9 ± 1.5), respectively, and all values were significantly better in the SHWG-CL group (p < 0.0001, p = 0.0039, and p < 0.0001, respectively). We found that compared to the SO-SCLs, the maintenance of the PLTF on the SHWG-CLs was supported by the thicker and more stable PLTF.

Effect of non-invasive spinal cord stimulation in unmedicated adults with major depressive disorder: a pilot randomized controlled trial and induced current flow pattern.

Converging theoretical frameworks suggest a role and a therapeutic potential for spinal interoceptive pathways in major depressive disorder (MDD). Here, we aimed to evaluate the antidepressant effects and tolerability of transcutaneous spinal direct current stimulation (tsDCS) in MDD. This was a double-blind, randomized, sham-controlled, parallel group, pilot clinical trial in unmedicated adults with moderate MDD. Twenty participants were randomly allocated (1:1 ratio) to receive "active" 2.5 mA or "sham" anodal tsDCS sessions with a thoracic (anode; T10)/right shoulder (cathode) electrode montage 3 times/week for 8 weeks. Change in depression severity (MADRS) scores (prespecified primary outcome) and secondary clinical outcomes were analyzed with ANOVA models. An E-Field model was generated using the active tsDCS parameters. Compared to sham (n = 9), the active tsDCS group (n = 10) showed a greater baseline to endpoint decrease in MADRS score with a large effect size (-14.6 ± 2.5 vs. -21.7 ± 2.3, p = 0.040, d = 0.86). Additionally, compared to sham, active tsDCS induced a greater decrease in MADRS "reported sadness" item (-1.8 ± 0.4 vs. -3.2 ± 0.4, p = 0.012), and a greater cumulative decrease in pre/post tsDCS session diastolic blood pressure change from baseline to endpoint (group difference: 7.9 ± 3.7 mmHg, p = 0.039). Statistical trends in the same direction were observed for MADRS "pessimistic thoughts" item and week-8 CGI-I scores. No group differences were observed in adverse events (AEs) and no serious AEs occurred. The current flow simulation showed electric field at strength within the neuromodulation range (max. ~0.45 V/m) reaching the thoracic spinal gray matter. The results from this pilot study suggest that tsDCS is feasible, well-tolerated, and shows therapeutic potential in MDD. This work also provides the initial framework for the cautious exploration of non-invasive spinal cord neuromodulation in the context of mental health research and therapeutics. The underlying mechanisms warrant further investigation. Clinicaltrials.gov registration: NCT03433339 URL: https://clinicaltrials.gov/ct2/show/NCT03433339 .

Cardio-Physiological and Anthropometric Profile of Elite International Handball Players from Top Ranking Macedonian Teams / Perfil Cardiofisiológico y Antropométrico de Jugadores Internacionales de Balonmano de Élite de Equipos Macedonios de Primer Nivel

SUMMARY: Monitoring of body composition and cardiophysiological parameters are main part of the general health status of handball players and significant indicators of their physical fitness. The assessment of body components, especially skeletal muscle mass and body fat mass are important because of their influence on sport performance. The aim of this study is to determine the body composition and cardiophysiological characteristics of elite handball players from Republic of North Macedonia. 27 male HB players from two top ranking teams from RNM were tested ergometrically with Bruce protocol for determination of maximal oxygen consumption; body analysis was made with bioelectrical impedance analyzer, InBody 720. Anthropometric parameters were as follows: mean height was 190.4±7.8 cm and weight 96.3±15.5 kg, skeletal muscle mass (SMM)=47.11±6.69 kg; BMI=26.38±3.1; BF%=15.04±6.01 and WHR=0.9±1.8. The result of ergometrical test produce mean VO2 max=43.92 ml/kg/min which is 100.46 % of reference value. The body composition of elite international handball players from the top handball teams in Republic of North Macedonia showed similar body components as other European handball players. The obesity diagnose parameters were negatively associated with exercise time and maximal oxygen consumption.

El seguimiento de la composición corporal y los parámetros cardiofisiológicos son una parte principal del estado de salud general de los jugadores de balonmano y son indicadores importantes de su condición física. La evaluación de los componentes corporales, especialmente la masa muscular esquelética y la masa grasa corporal, son importantes debido a su influencia en el rendimiento deportivo. El objetivo de este estudio fue determinar la composición corporal y las características cardiofisiológicas de jugadores de balonmano de élite de la República de Macedonia del Norte. Se evaluaron 27 jugadores masculinos de HB de dos equipos de primer nivel de RNM ergométricamente con el protocolo de Bruce para determinar el consumo máximo de oxígeno; el análisis corporal se realizó con el analizador de impedancia bioeléctrica InBody 720. Los parámetros antropométricos fueron los siguientes: talla media 190,4±7,8 cm y peso 96,3±15,5 kg, masa músculo esquelética (SMM)=47,11±6,69 kg; IMC=26,38±3,1; %GC=15,04±6,01 y RCC=0,9±1,8. El resultado de la prueba ergométrica produce un VO2 máximo medio = 43,92 ml/kg/ min, que es el 100,46 % del valor de referencia. La composición corporal de los jugadores de balonmano internacionales de élite de los mejores equipos de balonmano de la República de Macedonia del Norte mostró componentes corporales similares a los de otros jugadores de balonmano europeos. Los parámetros diagnósticos de obesidad se asociaron negativamente con el tiempo de ejercicio y el consumo máximo de oxígeno.

Congenital, Acquired, and Trauma-Related Risk Factors for Thoracic Outlet Syndrome-Review of the Literature.

Thoracic outlet syndrome is a group of disorders that affect the upper extremity and neck, resulting in compression of the neurovascular bundle that exits the thoracic outlet. Depending on the type of compressed structure, the arterial, venous, and neurogenic forms of TOS are distinguished. In some populations, e.g., in certain groups of athletes, some sources report incidence rates as high as about 80 cases per 1000 people, while in the general population, it is equal to 2-4 per 1000. Although the pathogenesis of this condition appears relatively simple, there are a very large number of overlapping risk factors that drive such a high incidence in certain risk groups. Undoubtedly, a thorough knowledge of them and their etiology is essential to estimate the risk of TOS or make a quick and accurate diagnosis.

New parasitoid (Hymenoptera, Chalcidoidea) records of bark beetles (Coleoptera, Curculionidae, Scolytinae) in pine plantations in Bulgaria.

Background: In 2020 and 2021, chalcidoid parasitoids (Hymenoptera, Chalcidoidea) of bark beetles in pine (Pinus spp.) plantations were studied in Bulgaria. Samples (cuttings of stems and branches) of pine trees infested by bark beetles were collected from seven plantations of Pinussylvestris and P.nigra in Bulgaria. From each sampling plot, five cuttings were collected and placed in photoeclectors in laboratory conditions (18-22ºC). Emerged bark beetles and parasitoids were regularly gathered and fixed in ethanol. New information: Six parasitoid species - Dinotiscuscolon, Metacolusazureus, M.unifasciatus, Rhopalicusquadratus, R.tutela (Chalcidoidea: Pteromalidae) and Heydeniapretiosa (Chalcidoidea, Heydeniidae) were reared from five bark beetle hosts (Ipsacuminatus, Pityogenesbistridentatus, Pityophthoruspityographus, Tomicuspiniperda and T.minor). Amongst them, three species (H.pretiosa, M.azureus and R.quadratus) are recorded as new for Bulgarian fauna.

A Bilateral Symmetric Accessory Coracobrachialis Muscle Combined With an Interconnection of the Musculocutaneous Nerve With the Median Nerve.

This report describes a bilateral symmetric accessory coracobrachialis muscle variant coexisting with a unilateral interconnection of the musculocutaneous nerve and the median nerve. An 80-year-old female cadaver was dissected. The bilateral coracobrachialis muscle variant consisted of three heads: two superficial heads and one deep head. One superficial head arose from the tip of the coracoid process, while the other originated from the short head tendon of the biceps brachii. The deep head of the coracobrachialis muscle emerged from the base of the coracoid process. The musculocutaneous nerve bilaterally coursed between the superficial and deep heads. On the right side, the three-headed coracobrachialis muscle coexisted with an ipsilateral interconnection of the musculocutaneous nerve and the median nerve, located at the lower third of the arm. While the presence of a unilateral three-headed coracobrachialis muscle is not rare (with a prevalence range of 0-22.2%), as well as the distal interconnection between the musculocutaneous nerve and the median nerve at the lower third of the arm (with a prevalence range of 1.8-53.6%), the coexistence of the current bilateral three-headed coracobrachialis muscle variant with the distal interconnection of the musculocutaneous and median nerves is quite unusual. A similar report underscores the finding of the bilateral coracobrachialis muscle variant.

A Rare Variation of the Levator Scapulae Muscle: A Case Report and Review of Literature.

Muscle variations in the posterior neck region are mainly categorized as variations in the origin and insertion of the muscles and the presence of accessory slips or rudimentary muscles. The levator scapulae muscle is a variable muscle with several different types of variations described throughout the literature. Herein, we report a rare unilateral case of an accessory slip from the levator scapulae. Aberrant muscle slip originates from the distal one-third of the levator scapulae. Then, it passes upwards and outwards above a vascular bundle containing a superficial branch of the transverse cervical artery and vein. The deviant muscle slip inserts onto the superior nuchal line. Muscle variations in the neck's posterior region and the levator scapulae's variations, as per se, have the utmost clinical significance since they might be mistaken for tumor mass. Moreover, such variations might be deceptive during surgical procedures in the region. Therefore, detailed knowledge of such complex muscular variations in the posterior region of the neck is paramount for surgeons and radiologists alike.

Symptomatic Bilateral Talonavicular Coalition in a Seven-Year-Old Boy.

Congenital talonavicular coalition is less frequent than the talocalcaneal or the calcaneonavicular and accounts for around 1% of all tarsal coalitions. Commonly, patients are asymptomatic and rarely need surgical treatment. Herein, we present a case of bilateral symptomatic talonavicular coalition in a seven-year-old boy who underwent surgery with full relief of symptoms. We also review the literature and discuss this pathological condition in detail.