Interthalamic adhesion and Alzheimer’s: Preliminary study

OBJECTIVE: Identifying the prevalence and dimensions of the Interthalamic Adhesion (ITA) in corpses from the “Serviço de Verificação de Óbitos da Capital - USP”, considering factors as age, sex, weight, height, and diagnosis of Alzheimer’s disease (AD). METHODS: Fifty-seven corpses (31M/26F) were included in the study. The mean age was 66.2 (varying between 15 and 91). The analysis of the ITA was made after the encephalon’s removal from its cavity, which occurred by the transversal section of the skullcap, and, next, an axial incision in the inferior limit of the pons to separate the encephalon from the spinal cord. Fifty-four encephalons were submitted to medial sagittal incisions, two encephalons were submitted to axial cuts and one to a coronal section. Quantitative data were compared by the Student’s T Test, and qualitative data by the Chi-squared test. The Age vs Area analysis was made by linear regression. RESULTS: the prevalence of the ITA was 79%, not having differences in prevalence between sexes (p=0.68). Advanced ages presented lower areas in sagittal sections (p= 0.02). It does not appear to have a significant alteration in prevalence of the ITA and transversal section aerea in patients with AD. DISCUSSION: Unlike previous studies which observed higher prevalence and size of the ITA in females, differences in this parameters were not obtained in this study. Evidence of correlation between AD and lower sagittal section of the ITA, even without statistic significance, points to the need of further studies.OBJETIVO: Descrever dimensões e prevalência da Aderência Intertalâmica (AI) em cadáveres do Serviço de Verificação de Óbitos da Capital - USP, considerando idade, sexo, peso, altura e histórico pessoal de doença de Alzheimer (DA). MÉTODOS: Cinquenta e sete cadáveres (31H/26M) foram incluídos no estudo, com média de idade de 66,2 anos (variando entre 15 e 91 anos). A análise da AI foi feita após secção transversal da calota craniana e incisão axial no limite inferior do tronco encefálico seguida de retirada do encéfalo de sua cavidade. Cinquenta e quatro encéfalos foram submetidos a incisão sagital mediana, dois encéfalos foram submetidos a cortes axiais, e um encéfalo a secção coronal. Dados quantitativos foram comparadas pelo teste t de student, e dados qualitativos pelo teste de Qui Quadrado. A análise idade vs área foi feita por regressão linear. RESULTADOS: A prevalência de AI foi de 79%, não havendo diferença significativa entre os sexos (p=0,68).  Observou-se associação entre menores áreas de secção sagital e idades mais avançadas (p=0,02). Não houve diferença significativa na prevalência de AI nem na área de secção transversal em pacientes com DA. DISCUSSÃO: Ao contrário de estudos prévios, que associaram maior prevalência e tamanho de AI com sexo feminino, isso não foi observado em nossa casuística. Apesar de não ser estatisticamente significativa nota-se uma diferença importante nas áreas médias de secção sagital dos grupos com e sem DA, o que aponta para a necessidade de estudos subsequentes com amostras maiores

Avaliação discente é importante ferramenta no aperfeiçoamento dos cursos de anatomia clínica

Background: Medical knowledge and students’ demands are under continuous changes and learning process must adapt accordingly. We retrospectively analyzed students’ evaluation of three different approaches employed in our course of Clinical Anatomy in the last decade. Methods: The University of São Paulo Medical School has a systematic evaluation of each discipline where students grade 38 different topics ranging to physical conditions to the quality of the classes. In this study, different methods to teach Clinical Anatomy to 2nd and 3rd year students of Medicine were confronted to the students’ evaluations, comparing the general appreciation of the course in different teaching approaches. We analyzed the changes in the Anatomy course from 1994 to the present and their impact based on the students´ evaluations. Results: Significant improvement in general evaluation was observed when the course changed from Problem Based Learning technique to a more formal approach with theoretical classes given by specialists, most of them invited from other Clinical Departments of the University. A still better evaluation was obtained as the practical demonstrations focused aspects showed in theoretical classes, which were given mostly by specialists trained in Anatomy. Discussion: Students' evaluation allows course coordinators to redirect objectives and teaching methods to adjust the course format as needed. Performance in final exams may also be analyzed together so effectiveness of the teaching method can be measured along with students’ satisfaction. Conclusion: Continuous feedback from students is essential to course coordinators to adequate strategies to face the modern challenges in the teaching/learning process and obtain the best results in courses of Clinical Anatomy.Introdução: O conhecimento médico e a demanda docente estão em constante e progressiva mudança e os processos pedagógicos devem ser adaptados conforme as necessidades para prover o máximo rendimento. Analisamos retrospectivamente a avaliação discente de três métodos diferentes utilizados no curso de Anatomia Clínica da FMUSP na última década. Métodos: A Faculdade de Medicina da Universidade de São Paulo oferece avaliação sistemática de cada Disciplina, com avaliação dos estudantes de 38 diferentes aspectos relacionados ao curso, de estrutura física até a qualidade das aulas. Neste estudo, métodos diferentes de ensino de Anatomia Clínica para os alunos de 2o e 3o anos de Medicina foram confrontados com as avaliações discentes ao final do curso. Foram analisadas as mudanças pedagógicas no curso desde 1994 até o presente e seu impacto baseado na avaliação dos estudantes. Resultados: Observou-se melhora significativa na avaliação geral quando o curso foi mudado da técnica de Aprendizagem Baseada em Problemas para uma abordagem mais formal, com aulas teóricas dadas por especialistas, em sua maioria convidada de outras Disciplinas da Faculdade. Uma avaliação ainda mais positiva ocorreu quando os aspectos práticos focaram aspectos demonstrados em aulas teóricas, na sua maioria dada por especialistas com formação em Anatomia. Discussão: A avaliação dos estudantes permite aos coordenadores do curso redirecionar os objetivos e os métodos pedagógicos para ajustar o formato do curso como necessário. As notas finais também podem ser analisadas conjuntamente para que a efetividade do método empregado possa ser avaliada em conjunto com a avaliação discente. Conclusão: A contínua avaliação dos estudantes é essencial para que os coordenadores dos cursos possam adequar suas estratégias para enfrentar os desafios atuais dos processos pedagógicos e obter os melhores resultados nos cursos de Anatomia Clínica

Sternalis Muscle: A Case Report and Literature Review

Introduction and Objective: The sternal muscle is a rare anatomical variation found in the anterior chest wall. This study's objective was to make a narrative review of the anatomical and epidemiological aspects of the sternal muscle, as well as to present its finding in one of this group’s dissections. Materials and Methods: This study consisted of a literature review using Pubmed and LILACS platforms. Articles were analyzed regarding incidence, laterality, action, innervation, and vascularization of the sternal muscle. We also present a case report based  on a cadaveric dissection of the Hospital das Clínicas, Faculty of Medicine, University of São Paulo (HCFMUSP). Results: Our review included 22 articles. The anatomical variation incidence ranged from 1.96% to 5.55%, with a higher predominance of a bilateral presentation. The action of the sternal muscle is predominantly accessory and there are divergences in the literature regarding its innervation and vascularization. Our case reports the finding of a unilateral sternal muscle in the left paramedian line inserted in both sternocleidomastoid muscles, in a female patient. Conclusion: The sternal muscle has a small incidence in the population and it is usually bilateral. The anatomical knowledge of this muscle is important to prevent it from being confused with other structures commonly found in the chest and cervical region.  Significance/Implication: The importance of sternal muscle importance cannot be overlooked due to possible misinterpretations in imaging and its possible influence on mastectomies. Wider case series are necessary for a better definition of its irrigation and innervation

Hormônio da paratireoide: um preditor precoce da hipocalcemia sintomática após a tireoidectomia total

OBJECTIVE: The purpose of this study was to evaluate if the measurement of peri-operative parathyroid hormone (PTH) is able to identify patients with increased risk of developing symptoms of hypocalcemia. SUBJECTS AND METHODS: Forty patients who underwent total thyroidectomy were studied prospectively. Ionized serum calcium and PTH were measured after induction of anesthesia, one hour (PTH1) and one day after surgery (PTH24). Patients were evaluated for symptoms of hypocalcemia and treated with calcium and vitamin D supplementation as necessary. RESULTS: Symptomatic hypocalcemia developed in 16 patients. Symptomatic patients had significant lower PTH1 and greater drops in PTH levels. The selection of 12.1 ng/L as PTH1 level cutoff level divided patients with and without symptoms with 93.7% sensitivity and 91.6% specificity. The selection of 73.5% as the cutoff value for PTH decrease resulted in 91.6% sensitivity and 87.5% specificity. CONCLUSION: PTH1 levels and the drop in PTH levels are reliable predictors of developing symptomatic hypocalcemia after total thyroidectomy.OBJETIVO: O objetivo deste estudo é avaliar se a medida perioperatória do hormônio da paratireoide (PTH) pode identificar os pacientes com maior risco de desenvolver sintomas de hipocalcemia. SUJEITOS E MÉTODOS: Foram estudados quarenta pacientes submetidos à tireodiectomia total. A medida do cálcio sérico e do PTH foi feita após a indução anestésica, uma hora (PTH1) e um dia após a cirurgia. Os pacientes foram avaliados quanto à presença de sintomas de hipocalcemia e tratados com suplementação de cálcio e vitamina D quando necessário. RESULTADOS: Dezesseis pacientes apresentaram sintomas de hipocalcemia. Os pacientes sintomáticos apresentaram PTH1 significantemente menor e queda no PTH significativamente maior. Usando o valor de 12,1 ng/L como corte, conseguimos distinguir pacientes com e sem sintomas de hipocalcemia com sensibilidade de 93,7% e especificidade de 91,6%. Utilizando como corte a queda de 73,5% no valor do PTH, temos sensibilidade de 91,6% e especificidade de 87,5%. CONCLUSÃO: O PTH1 e a queda no PTH são bons preditores de hipocalcemia no pós-operatório de tireoidectomia totalUniversidade Federal de São Paulo (UNIFESP)UNIFESPUNIFESPSciEL

Corona Mortis: A Systematic Review of Literature

Our systematic review evaluates surgically relevant information about corona mortis (CM), such as anatomical structure, size, laterality, incidence, and anthropometric correlations. This study aimed to provide data about anastomosis in an attempt to avoid iatrogenic damage during surgery. Articles were searched online using the descriptor ‘‘Corona Mortis’’ in PubMed, Biblioteca Virtual em Sau´ de (BVS) (Literatura Latino-Americana e do Caribe em Sau´ de [LILACS], MEDLINE, indice bibliografico espan˜ ol en ciencias de la salud [IBECS]), and SciELO database. The time range was set between 1995 and 2020. The articles were selected according to their titles and later the abstracts’ relation to our research purpose. All the selected articles were read entirely. A manual search based of the references cited in these articles was also conducted to identify other articles or books of interest. Forty references fulfilled the criteria for this review. The mean incidence of CM was 63% (the majority venous) among 3,107 hemipelvises. The incidence of bilateral CM was lower than that of unilateral variations based on the analysis of 831 pelvises. The mean caliber of the anastomosis was 2.8 mm among 1,608 hemipelvises. There is no consensus concerning the anthropometric influences in CM. Finally, we concluded that CM is not an unusual anatomical variation and that we must not underestimate the risk of encountering the anastomosis during surgery. Anatomical knowledge of CM is, therefore, essential in preventing accidents for surgeons who approach the inguinal and retropubic regions

Extensive gunshot wound to the face: a case report

Facial fractures caused by gunshots are a major challenge for oral and maxillofacial surgeons. Underdeveloped countries present a higher rate of homicides committed by gunshots than developed countries. This case report presents a 25 year-old male victim of a gunshot wound to the mandible, evolving into a complex fracture. The fracture was treated using rigid internal fixation. After 18 months of follow-up, the patient presents good facial appearance and masticatory activity. The gunshot caused the permanent paralysis of the right mandibular branch of the facial nerve. We managed to preserve the involved teeth and mandibular integrity, with complete bone healing. Despite the late infection following plate fixation, healing occurred without further complications, indicating that blood supply was maintained.As fraturas faciais causadas por arma de fogo são um grande desafio para o cirurgião oral e maxilofacial. Os países subdesenvolvidos apresentam uma taxa maior de homicídios cometidos por arma de fogo do que os países desenvolvidos. Este relato de caso apresenta um paciente do sexo masculino, 25 anos, vítima de ferimento por arma de fogo na mandíbula, evoluindo para fratura complexa. A fratura foi tratada com fixação interna rígida. Após 18 meses de seguimento, o paciente apresenta boa aparência facial e atividade mastigatória. O tiro causou paralisia permanente do ramo mandibular direito do nervo facial. Conseguimos preservar os dentes envolvidos e a integridade mandibular, com cicatrização óssea completa. Apesar da infecção tardia após a fixação da placa, a cicatrização ocorreu sem complicações adicionais, indicando que o suprimento de sangue foi mantido

Gene expression profiling of papillary thyroid carcinoma identifies transcripts correlated with BRAF mutational status and lymph node metastasis

Purpose: To identify papillary thyroid carcinoma (PTC)-associated transcripts, we compared the gene expression profiles of three Serial Analysis of Gene Expression libraries generated from thyroid tumors and a normal thyroid tissue.Experimental Design: Selected transcripts were validated in a panel of 57 thyroid tumors using quantitative PCR (qPCR). An independent set of 71 paraffin-embedded sections was used for validation using immunohistochemical analysis. To determine if PTC-associated gene expression could predict lymph node involvement, a separate cohort of 130 primary PTC (54 metastatic and 76 nonmetastatic) was investigated. the BRAF(V600E) mutational status was compared with qPCR data to identify genes that might be regulated by abnormal BRAF/MEK/extracellular signal-regulated kinase signaling.Results: We identified and validated new PTC-associated transcripts. Three genes (CST6, CXCL14, and DHRS3) are strongly associated with PTC. Immunohistochemical analysis of CXCL14 confirmed the qPCR data and showed protein expression in PTC epithelial cells. We also observed that CST6, CXCL14, DHRS3, and SPP1 were associated with PTC lymph node metastasis, with CST6, CXCL14, and SPP1 being positively correlated with metastasis and DHRS3 being negatively correlated. Finally, we found a strong correlation between CST6 and CXCL14 expression and BRAF(V600E) mutational status, suggesting that these genes may be induced subsequently to BRAF activation and therefore may be downstream in the BRAF/MEK/extracellular signal-regulated kinase signaling pathway.Conclusion: CST6, CXCL14, DHRS3, and SPP1 may play a role in PTC pathogenesis and progression and are possible molecular targets for FTC therapy.Universidade Federal de São Paulo, Genet Bases Thyroid Tumor Lab, Div Genet, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Div Endocrinol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Div Head & Neck Surg, BR-04039032 São Paulo, BrazilUniv São Paulo, Sch Med, Dept Surg, São Paulo, BrazilJohns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21205 USAUniversidade Federal de São Paulo, Genet Bases Thyroid Tumor Lab, Div Genet, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Div Endocrinol, BR-04039032 São Paulo, BrazilUniversidade Federal de São Paulo, Div Head & Neck Surg, BR-04039032 São Paulo, BrazilWeb of Scienc

An Anatomical Basis for the Myofascial Trigger Points of the Abductor Hallucis Muscle

Myofascial pain syndrome is characterized by pain and a limited range of joint motion caused by muscle contracture related to motor-end-plate dysfunction and the presence of myofascial trigger points (MTrPs). It is the most frequent cause of musculoskeletal pain, with a worldwide prevalence varying between 13.7% and 47%. Of the patients with myofascial pain syndrome, approximately 17% have pain in the medial hindfoot area. The abductor hallucis muscle is located in the medial, posterior region of the foot and is related to painful plantar syndromes. The objective of this study was to describe the distribution of the medial plantar nerve and their anatomical relationship with MTrPs found in the literature. Thirty abductor hallucis muscles were dissected from 15 human cadavers (8 males and 7 females). The muscles were measured, and the distribution data of the medial plantar nerve branches in each quadrant were recorded. For statistical analysis, we used generalized estimation equations with a Poisson distribution and a log logarithm function followed by Bonferroni multiple comparisons of the means. The data are expressed as the mean ± standard deviation. The level of significance was adjusted to 5% (p<0.05). A high concentration of nerve branches was observed in the first quadrant (Q1) of the abductor hallucis muscle, which is the same area in which the MTrPs are described. The topography of the entry points of the branches of the medial plantar nerve to the abductor hallucis muscle correlates with the topography of the muscular trigger points. The anatomical structure of the MTrPs may be useful for a better understanding of the pathophysiology of myofascial disorders and provide a basis for surgical and clinical treatments