Vertebral artery variations revised: origin, course, branches and embryonic development

Background: The vertebral artery originates from the subclavian artery and is divided into four segments. The aim of this study is to investigate the anatomical variations in the course and branches of the vertebral artery. Materials and methods: A research was performed via PubMed database, using the terms: “variations of vertebral artery AND cadaveric study”, “variations of vertebral artery AND cadavers” and “anomalies of vertebral artery AND cadavers”. Results: A total of 24 articles met the inclusion criteria, 13 of them referring to variations of the origin of the vertebral artery, 9 to variations of the course and 3 to variations of its branches. On a total sample of 1192 cadavers of different populations, origin of the left vertebral artery directly from the aortic arch was observed at 6.7%. In addition, among 311 cadavers, 17.4% were found with partially or fully ossified foramen of the atlas for the passage of the vertebral artery, while the bibliographic review also showed variants at the exit site of the artery from the transverse foramen of the axis. Conclusions: Despite the fact that variations of both the course and the branches of vertebral artery are in most cases asymptomatic, good knowledge of anatomy and its variants is of particular importance for the prevention of vascular complications during surgical and radiological procedures in the cervix area

Impairment of gut microbial biotin metabolism and host biotin status in severe obesity: effect of biotin and prebiotic supplementation on improved metabolism

Objectives Gut microbiota is a key component in obesity and type 2 diabetes, yet mechanisms and metabolites central to this interaction remain unclear. We examined the human gut microbiome\u27s functional composition in healthy metabolic state and the most severe states of obesity and type 2 diabetes within the MetaCardis cohort. We focused on the role of B vitamins and B7/B8 biotin for regulation of host metabolic state, as these vitamins influence both microbial function and host metabolism and inflammation. Design We performed metagenomic analyses in 1545 subjects from the MetaCardis cohorts and different murine experiments, including germ-free and antibiotic treated animals, faecal microbiota transfer, bariatric surgery and supplementation with biotin and prebiotics in mice. Results Severe obesity is associated with an absolute deficiency in bacterial biotin producers and transporters, whose abundances correlate with host metabolic and inflammatory phenotypes. We found suboptimal circulating biotin levels in severe obesity and altered expression of biotin-associated genes in human adipose tissue. In mice, the absence or depletion of gut microbiota by antibiotics confirmed the microbial contribution to host biotin levels. Bariatric surgery, which improves metabolism and inflammation, associates with increased bacterial biotin producers and improved host systemic biotin in humans and mice. Finally, supplementing high-fat diet-fed mice with fructo-oligosaccharides and biotin improves not only the microbiome diversity, but also the potential of bacterial production of biotin and B vitamins, while limiting weight gain and glycaemic deterioration. Conclusion Strategies combining biotin and prebiotic supplementation could help prevent the deterioration of metabolic states in severe obesity

The role of surgical masks during the COVID-19 pandemic. A mini-review

Introduction-The coronavirus disease 2019 (COVID-19) is considered to be highly contagious and restriction of transmission requires the utilization of protective equipment like surgical masks from both healthcare workers and public. The aim of this review is to investigate the role of surgical masks during the COVID-19 pandemic. Materials and Methods – A literature research was conducted via PubMed to detect articles featuring the potential protective role of surgical masks when they were worn by healthcare workers or by the general public. Results – Among 114 articles, only 31 met the inclusion criteria. Thirteen additional articles provided useful information according to the aim of this review. Existing literature supports the positive effect of surgical masks on COVID-19 contamination. Debate on the efficacy of surgical masks compared with other forms of facial protective devices exists. There seems to be a tendency to favor the use of particulate-filtering facepiece respirators in healthcare professionals who face higher risk of infection. However, surgical masks primarily and cloth masks secondarily seem to be adequate means of protection for the general public and for healthcare workers during procedures where respiratory droplets are not generated. Rational use of surgical masks is imperative; however, reuse after decontamination is not ideal. Conclusions – For optimum protection from COVID-19, the use of surgical masks should be combined with other infection control measures like hand hygiene and social distancing, since the level of their effectiveness is still being investigated. Shortage of surgical masks should be prevented; therefore, rational use plays a crucial role in this direction. © 2020 by Begell House, Inc

Three-dimensional (3d) printing in orthopedics education

Three-dimensional (3D) printing is a newly established concept in orthopedics compared with other in-dustries. Surgical applications of 3D printing and tissue engineering have been investigated since the early 2000s, almost two decades after Charles Hull had patented the first device currently in use for additive manufacturing, also known as rapid prototyping or more commonly 3D printing, and whose initial formal appellation was stereolithography (SLA). Despite technological progress, substantial principles have largely remained unaltered. Training directly on patients and on cadavers is considered the “gold standard” for learning and developing suitable surgical qualifications. However, restrictions concerning patient safety, ethical dilemmas, lack of availability, etc., have to be taken into account. Thus, 3D representations can be utilized as an educational tool both for patients to improve their understanding of their condition and also medical students, residents, and surgeons to comprehend complex anatomical structures and practice their surgical maneuvers to be prepared and more confident in theater. © 2020 by Begell House, Inc

Vertebral artery variations revised: Origin, course, branches and embryonic development

Background: The vertebral artery originates from the subclavian artery and is divided into four segments. The aim of this study is to investigate the anatomical variations in the course and branches of the vertebral artery. Materials and methods: A research was performed via PubMed database, using the terms: "variations of vertebral artery AND cadaveric study", "variations of vertebral artery AND cadavers"and "anomalies of vertebral artery AND cadavers". Results: A total of 24 articles met the inclusion criteria, 13 of them referring to variations of the origin of the vertebral artery, 9 to variations of the course and 3 to variations of its branches. On a total sample of 1192 cadavers of different populations, origin of the left vertebral artery directly from the aortic arch was observed at 6.7%. In addition, among 311 cadavers, 17.4% were found with partially or fully ossified foramen of the atlas for the passage of the vertebral artery, while the bibliographic review also showed variants at the exit site of the artery from the transverse foramen of the axis. Conclusions: Despite the fact that variations of both the course and the branches of vertebral artery are in most cases asymptomatic, good knowledge of anatomy and its variants is of particular importance for the prevention of vascular complications during surgical and radiological procedures in the cervix area. © 2021 Via Medica

The role of medical students during COVID-19 era. A review

Background and aim of the work: Since December 2019, the world has been facing the coronavirus disease 2019 (COVID-19) pandemic. Medical students could not remain uninvolved. Our aim is to investigate the impact of COVID-19 on their mental health, and to evaluate their awareness and aptitude for contributing to the fight against COVID-19. Methods: An in-depth search of the literature was performed in Pubmed database, for studies investigating the preferred source of information about COVID-19, the knowledge on virus transmission, COVID-19 clinical symptoms and preventive measures against its spread, and the impact of COVID-19 on mental health among medical students. Their potential roles during the COVID-19 pandemic were also investigated. Results: Twenty studies were included. The majority of medical students prefer social media to acquire knowledge about COVID-19. They are adequately informed about COVID-19 transmission and symptoms, as well as preventive measures against COVID-19, although wear-ing a face-mask is not so popular among them. Their mental health is affected, mainly expressed as a fear of infection. Possible alternative roles of students during pandemic may be providing information to the public and tracing contacts of infected people. Conclusions: Medical students have an adequate level of knowledge upon COVID-19 and implement proper strategies to prevent its spread. Further training is essential to im-prove some aspects in this field. Despite the negative impact of COVID-19 on their mental health, they could assist healthcare systems under appropriate precautions. (www.actabiomedica.it). © Mattioli 1885