The variable origin of the lateral circumflex femoral artery: a meta-analysis and proposal for a new classification system

The lateral circumflex femoral artery (LCFA) is responsible for vascularisation of the head and neck of the femur, greater trochanter, vastus lateralis and the knee. The origin of the LCFA has been reported to vary significantly throughout the literature, with numerous branching patterns described and variable distances to the mid-inguinal point reported. The aim of this study was to determine the estimated population prevalence and pooled means of these anatomical characteristics, and review their associated clinical relevance. A search of the major electronic databases was performed to identify all articles reporting data on the origin of the lateral circumflex femoral artery and its distance to the mid-inguinal point. Additionally, an extensive search of the references of all relevant articles was performed. All data on origin, branching, and distance to mid-inguinal point was extracted and pooled into a meta-analysis. A total of 26 articles (n = 3731 lower limbs) were included in the meta-analysis. Lateral circumflex femoral artery most commonly originates from the deep femoral artery with a pooled prevalence of 76.1% (95% confidence interval 69.4–79.3). The deep femoral artery-derived lateral circumflex femoral artery was found to originate with a mean pooled distance of 51.06 mm (95% confidence interval 44.61–57.51 mm) from the mid-inguinal point. Subgroup analysis of both gender and limb side data were consistent with these findings. Due to variability in the lateral circumflex femoral artery’s origin and distance to mid-inguinal point, anatomical knowledge is crucial for clinicians to avoid iatrogenic injuries when performing procedures in the femoral region, and thus radiographic assessment prior to surgery is recommended. Lastly, we propose a new classification system for origin of the lateral circumflex femoral arter

Protrusion of the carotid canal into the sphenoid sinuses: evaluation before endonasal endoscopic sinus surgery

Background: Many reports have previously indicated the vast number of anatomical variations of the sphenoid sinuses, e.g. presence of the recesses. Notwithstanding, there are a few crucial neurovascular structures directly neighbouring with the sinuses. The following research aimed to evaluate frequency prevalence of the carotid canal’s protrusion into the sphenoid sinuses in adult population.Materials and methods: Computed tomography (CT) scans of the paranasal sinuses of 296 patients (147 females, 149 males) were analysed in this retrospective study. The patients did not present any pathology in the sinuses. Spiral CT scanner Siemens Somatom Sensation 16 was used in the standard procedure in the option Siemens CARE Dose 4D.Results: Protrusion of the carotid canal was found in the majority of the patients — 55.74%, more frequently in males (65.1% of the patients) than in females (46.26% of the patients). The said variant — regardless of gender — was noted more often bilaterally (41.55% of the cases: 29.93% females, 53.02% males) than unilaterally (14.19% of the cases: 16.33% females, 12.08% males). In the unilateral type (regardless of gender), the protrusion was more common for the left sphenoid sinus — 10.81% of the patients (12.24% females, 9.4% males) than for the right — 3.38% of the patients (4.08% females, 2.68% males).Conclusions: Complicated structure of the paranasal sinuses, derived from the high prevalence of their anatomical variations, may perplex routine surgical interventions. Henceforth, referral for a CT scan is imperative in order to abate the risks associated with an invasive procedure in the said region

A novel, pan-PDE inhibitor exerts anti-fibrotic effects in human lung fibroblasts via inhibition of TGF-β\beta signaling and activation of cAMP/PKA signaling

Phosphodiesterase (PDE) inhibitors are currently a widespread and extensively studied group of anti-inflammatory and anti-fibrotic compounds which may find use in the treatment of numerous lung diseases, including asthma and chronic obstructive pulmonary disease. Several PDE inhibitors are currently in clinical development, and some of them, e.g., roflumilast, are already recommended for clinical use. Due to numerous reports indicating that elevated intracellular cAMP levels may contribute to the alleviation of inflammation and airway fibrosis, new and effective PDE inhibitors are constantly being sought. Recently, a group of 7,8-disubstituted purine-2,6-dione derivatives, representing a novel and prominent pan-PDE inhibitors has been synthesized. Some of them were reported to modulate transient receptor potential ankyrin 1 (TRPA1) ion channels as well. In this study, we investigated the effect of selected derivatives (832-a pan-PDE inhibitor, 869-a TRPA1 modulator, and 145-a pan-PDE inhibitor and a weak TRPA1 modulator) on cellular responses related to airway remodeling using MRC-5 human lung fibroblasts. Compound 145 exerted the most considerable effect in limiting fibroblast to myofibroblasts transition (FMT) as well as proliferation, migration, and contraction. The effect of this compound appeared to depend mainly on its strong PDE inhibitory properties, and not on its effects on TRPA1 modulation. The strong anti-remodeling effects of 145 required activation of the cAMP/protein kinase A (PKA)/cAMP response element-binding protein (CREB) pathway leading to inhibition of transforming growth factor type β1 (TGF-β1) and Smad-dependent signaling in MRC-5 cells. These data suggest that the TGF-β pathway is a major target for PDE inhibitors leading to inhibitory effects on cell responses involved in airway remodeling. These potent, pan-PDE inhibitors from the group of 7,8-disubstituted purine-2,6-dione derivatives, thus represent promising anti-remodeling drug candidates for further research

Correlation of morphological and radiological characteristics of degenerative disc disease in lumbar spine: a cadaveric study

Background: Intervertebral disc (IVD) degeneration plays a crucial role in the pathophysiology of low back pain. Several grading systems have been developed for both morphological and radiological assessment. The aim of this study was to assess the morphological and radiological characteristics of IVD degeneration and validate popular radiological Pfirrmann scale against morphological Thompson grading system. Material and methods: Full spinal columns (vertebrae L1-S1 and IVD between them) were harvested from cadavers through an anterior dissection. MRI scans of all samples were conducted. Then, all vertebral columns were cut in the midsagittal plane and assessed morphologically. Results: A total of 100 lumbar spine columns (446 IVDs) were included in the analysis of the degeneration grade. Morphologic Thompson scale graded the majority of discs as grade 2 and 3 (44.2% and 32.1%, respectively), followed by grade 4 (16.8%), grade 1 (5.8%) and grade 5 (1.1%). The Radiologic Pfirrmann grading system classified 44.2% of discs as grade 2, 32.1% as grade 3, 16.8% as grade 4, 5.8% as grade 1 and 1.1% as grade 5. The analysis on the effect of age on degeneration revealed significant, although moderate, positive correlation with both scales. Analysis of the agreement between scales showed weighted Cohen’s kappa equal to 0.61 (p<0.001). Most of the disagreement occurred due to a 1 grade difference (91.5%), whereas only 8.5% due to a 2 grade difference. Conclusions: With the increase of the prevalence of intervertebral disc disease in the population, reliable grading systems of IVD degeneration are crucial for spine surgeons in their clinical assessment. While overall there is agreement between both grading systems, clinicians should remain careful when using Pfirmann scale as the grades tend to deviate from the morphological assessment

Current concepts on the morphology of popliteus tendon and its clinical implications

In this review we described the anatomy and biomechanics of popliteus muscle and its tendon. Furthermore, we combined the anatomy with clinics and discussed a wide spectrum of disorders regarding the popliteus and its musculotendinous complex. There are three main anatomical regions of the popliteus musculotendinous complex: the proximal origin, the mid-portion, the distal part on the tibia. The unique localisation and various origins of the tendon, connected with structures such as fibular head, Wrisberg, Humphrey and posterior cruciate ligament, lateral meniscus, medial collateral ligament, give an implication to diagnosis and treatment. Popliteus dysfunction is often overlooked, that is the reason why diagnosis and treatment of its injuries is mostly insufficient. Repetitive or acute direct varus forces, when the tibia is in external rotation, and knee hyperextension or flexion with forced external rotation of the tibia, are the main mechanisms of trauma. Popliteus injuries mainly affect the athletic population and lead to severe activity limitations. Chronic disorders of the popliteus tendon, less known, are often described as tendinopathy and are frequently seen in runners. Their symptoms can mimic the lateral meniscal tears. On the other hand, high-energy traumatic injuries of the popliteus tendon often accompany complex, multi ligamentous injuries seen in competitive sports. We also presented the implication of popliteus tendon in knee arthroplasty, due to its particular exposition to iatrogenic trauma during surgery. The issues such as proper tibial component location and well-designed cut systems are crucial to avoid the popliteus impingement and preserve its structure

A three-headed piriformis muscle: an anatomical case study and narrative review of literature

Introduction: The piriformis muscle (PM) is found in the gluteal region, exiting the pelvis through the greater sciatic foramen and dividing it into the suprapiriform and infrapiriform foramina. The piriformis works as part of the hip external rotator muscle group, and is responsible for rotation of the femur upon hip extension and abduction of the femur during flexion of the hip joint. The aim of the present report is to describe a very rare case of the primary three-headed piriformis muscle. To the best knowledge of the authors, the said variant has not yet been described in the existing literature. Case report: The 71-year-old male formalin-fixed cadaver was subjected to routine dissection. After careful removal of the connecting tissue, three separate, primary heads of the PM were identified. The lower head of the PM arose from the middle part of the sacral bone; 87.56 mm long and 9.73 mm wide. The medial head was attached to the internal part of the posterior inferior iliac spine; 121.6 mm long and 20.97 mm wide. The upper head was attached to the external part of the posterior inferior iliac spine; 78.89 mm long and 23.94 mm wide. All heads converged into a common tendon which inserted onto the greater trochanter. Conclusions: The clinical importance of this work comes down to the fact that the aberrant PM may be the reason behind the piriformis syndrome and its associated symptoms. Moreover, knowledge regarding the variant anatomy of the PM is of immense importance to, e.g., anesthesiologists performing CT- or ultrasound-guided SN injection for local anesthesia, radiologists interpreting imaging studies, and surgeons, especially during posterior approaches to the hip and pelvis

Upper limit on the photon fraction in highest-energy cosmic rays from AGASA data

A new method to derive an upper limit on photon primaries from small data sets of air showers is developed which accounts for shower properties varying with the primary energy and arrival direction. Applying this method to the highest-energy showers recorded by the AGASA experiment, an upper limit on the photon fraction of 51% (67%) at a confidence level of 90% (95%) for primary energies above 1.25 * 10^20 eV is set. This new limit on the photon fraction above the GZK cutoff energy constrains the Z-burst model of the origin of highest-energy cosmic rays.Comment: 4 pages, 3 figures. Analysis extended to account for primary energy resolution; conclusions unchanged. Accepted by Phys. Rev. Let

Calibration of the Logarithmic-Periodic Dipole Antenna (LPDA) Radio Stations at the Pierre Auger Observatory using an Octocopter

An in-situ calibration of a logarithmic periodic dipole antenna with a frequency coverage of 30 MHz to 80 MHz is performed. Such antennas are part of a radio station system used for detection of cosmic ray induced air showers at the Engineering Radio Array of the Pierre Auger Observatory, the so-called Auger Engineering Radio Array (AERA). The directional and frequency characteristics of the broadband antenna are investigated using a remotely piloted aircraft (RPA) carrying a small transmitting antenna. The antenna sensitivity is described by the vector effective length relating the measured voltage with the electric-field components perpendicular to the incoming signal direction. The horizontal and meridional components are determined with an overall uncertainty of 7.4^{+0.9}_{-0.3} % and 10.3^{+2.8}_{-1.7} % respectively. The measurement is used to correct a simulated response of the frequency and directional response of the antenna. In addition, the influence of the ground conductivity and permittivity on the antenna response is simulated. Both have a negligible influence given the ground conditions measured at the detector site. The overall uncertainties of the vector effective length components result in an uncertainty of 8.8^{+2.1}_{-1.3} % in the square root of the energy fluence for incoming signal directions with zenith angles smaller than 60{\deg}.Comment: Published version. Updated online abstract only. Manuscript is unchanged with respect to v2. 39 pages, 15 figures, 2 table