Unilateral psoas minor: a case report

Introduction:The posterior abdominal wall is a complex region of human anatomy. It is formed by the lumbar vertebrae, pelvic girdle and the five main posterior abdominal muscles - the iliacus, psoas major, quadratus lumborum, the diaphragm, their associated fascia and the variable psoas minor and tertius muscles. The psoas muscle group is comprised of the long fusiform muscles - major, minor and tertius, with only the psoas major muscle being an obligatory muscle present in all individuals. The psoas muscle group however are extremely variable and have differences not only in their structure and morphology, but also in their innervation. The psoas minor is an extremely variable inconstant muscle, a prime example for a vestigial structure in the human body.Case report:During a standard posterior abdominal wall dissection of an adult female cadaver a unilateral right-sided psoas minor muscle was established, with a complete absence of the same muscle on the contralateral left side. The unilateral right-sided psoas minor muscle was located superficially and laterally to the psoas major muscle, it was fusiform in shape and its body measured 96 mm in length and 16mm in circumference.Conclusion:The psoas muscle group is one of the most variable muscle groups in the human body. It could be bilaterally - located on both sides of the vertebral column on the anterior surface of psoas major muscle. Our case is representative of one of the not so common variations of the psoas minor muscle with muscle morphology extremely representative of this type of unilateral variation

Does a Ketogenic Diet Influence Patients with Alzheimer`s Disease?

Introduction:The ketogenic diet(KD) is a low-carb, high-fat diet, which forces the body to burn fatty acids instead of glucose for ATP synthesis. This metabolism of ketone bodies (kb) is activated during fasting and when glucose levels are diminished. Ketone bodies are another essential source of energy for the organism and their delivery is vital especially to the central nervous system and to the muscular tissue of the heart. The ketogenic diet is used in different kinds of neurodegenerative diseases such as Alzheimer`s disease.Materials and Methods: Our study is based on a literature survey (PubMed). We used the following keywords: ketogenic diet, Alzheimer`s disease, ketone bodies metabolism, KD`s effect on neuronal degeneration, memory.Results: Alzheimer`s disease (AD) is a progressive neurological disease, which affects multiple brain functions, including memory, ability to learn new things, thinking, language function and behavior. Studies show that neuronal excitability is enhanced in patients with Alzheimer`s disease. The pathological processes of AD involve neuronal degeneration with accumulation of abnormal cellular products such as brillary plaques and tangles. However, there is evidence that points to alterations in the function of the extant neural circuits and mitochondrial homeostasis. Studies show numerous experiments with transgenic AD mice and AD patients on a KD that reveal improvement in mitochondrial function and reduced expression of amyloid precursor protein and β-amyloid. sResearches also show that by altering energy metabolism with the KD, rates of degeneration of certain neural structures and functions might be slowed down, due to the fact that ketone bodies have a neuroprotective effect against the toxicity of β-amyloid plaques.Conclusions:The results from this literature research suggest that the ketogenic diet may be used as an effective treatment approach towards Alzheimer`s disease through a variety of metabolism-induced mechanisms that can reduce the causes of the disease

Does Ghrelin Affect Memory?

Introduction: Ghrelin (Ghr) is an acylated 28-amino acid  peptide initially related to the regulation of food intake, body weight, adiposity and glucose metabolism. However, Ghr-ergic neurons were also detected in the central nervous system (CNS) - in the hypothalamic arcuate, paraventricular and supraoptic nucleus and the ependimal layer of the third ventricle.There are two forms of ghrelin: acylated, the receptor of which is a growth hormone secretagogue receptor (GHSR1a), and des - acyl Ghr, the receptor of which has not been identified yet.Materials and Methods: Our study is based on a literature survey (PubMed) using the following  keywords: ghrelin, neurodegenerative diseases, memory, synaptophysin.Results: As previously reported, Ghr participates in the regulation of some high brain functions such as sleep-wakefulness, learning and memory formation. Animal studies show that acyl-Ghr has a stimulating effect on neuronal activity and synaptic plasticity, including changes in synapse morphology and number. Ghr increases dendritic spine formation and synaptogenesis, as well as earlier onset of neuronal activity and generation of mature network activity patterns. The synaptogenic effect is demonstrated by the increased levels of the presynaptic marker synaptophysin. Additionally, Ghr is beneficial for the recovery of memory, mood and cognitive dysfunction after stroke or traumatic brain injury. On the other hand, chronic neurodegenerative disorders such as Alzheimer`s, Parkinson`s and Huntington`s disease are characterized by synaptic and neuronal loss in motor, sensory or cognitive systems, leading to cognitive and motor decline. Furthermore, it has been found that there is a strong correlation between metabolic changes and neurodegenaration.Conclusions: The results from this literature researches suggest that acyl-ghrelin could be used as a potential new pharmaceutical approach to the neurodegenerative disorders

Psoas minor - a cadaveric study

Introduction: The psoas muscle group is part of the posterior abdominal wall and is comprised of long muscles - major, minor and tertius. Out of those, only the psoas major muscle is an obligatory muscle present in all individuals. The psoas minor originates as vertical fascicles inserted on the bod­ies of the last thoracic and first lumbar vertebrae inserting into the iliopectineal eminence. The mus­cle`s actions are bending of the lumbar spine in a limited fashion. The aim of the study is to establish the frequency of the muscle in the Bulgarian population.Materials and Methods: This study was carried out in the Department of Anatomy and Cell Biology, Medical University - Varna `Prof. Dr. Paraskev Stoyanov`, Varna, Bulgaria, in November, 2017 on a total of 10 cadavers. The length, width and circumference of the muscle`s body were measured. The collected data was interpreted in a descriptive manner.Results: The psoas minor muscle was present in six out of ten cadavers (60%). Out of those six cadav­ers, the muscle was bilateral in three, left-side unilateral in one and right-side unilateral in two ca­davers. The average length of the muscle was 19.66cm (minimum 14.4cm - maximum 21.7cm), average width was 1.73cm (minimum 1.0cm - 3.2cm maximum) and average circumference was 3.48cm (min­imum 1.7cm - maximum 5.6cm). Male to female ratio of cadavers with a psoas minor muscle was 1:1.Conclusions: The frequency of the muscle`s variations considering its presence in the Bulgarian pop­ulation (60%) is higher when compared to its presence in the Indian population (36.67%), virtually identical to the Brazilian population (59%) and lower than that reported in United States of Ameri­ca (65.6%). The morphometric analyses between the different populations showed a shorter psoas mi­nor in the Bulgarian population

Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes

BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo