Quantitative anatomy of the growing supraspinatus muscle in the human fetus

The supraspinatus muscle, one of the four rotator cuff muscles, initiates abduction of the arm, simultaneously stretching the articular capsule at the glenohumeral joint, and also contributes to exorotation of the arm. In the present study we aimed to evaluate the age-specific normative values for morphometric parameters of the supraspinatus muscle in human fetuses at varying ages and to elaborate their growth models. Using anatomical dissection, digital  image analysis (NIS Elements AR 3.0) and statistics (Student’s t-test, regression analysis), the length, width, circumference and projection surface area of the supraspinatus muscle were measured in 34 human fetuses of both sexes (16♂, 18♀) aged 18–30 weeks of gestation. Neither sex nor laterality differences were found in numerical data of the supraspinatus muscle. In the supraspinatus muscle its length and projection surface area increased logarithmically, while its width and circumference grew proportionately to gestational age. The following growth models of the supraspinatus muscle were established: y = –71.382 + 30.972 × ln(Age) ± 0.565 for length, y = –2.988 + 0.386 × Age ± 0.168 for greatest width (perpendicular to superior angle of scapula), y = –1.899 + 0.240 × Age ± 0.078 for width perpendicular to the scapular notch, y = –19.7016 + 3.381 × Age ± 2.036 for circumference, and y = –721.769 + 266.141 × ln(Age) ± 6.170 for projection surface area. The supraspinatus muscle reveals neither sex nor laterality differences in its size. The supraspinatus muscle grows logarithmically with reference to its length and projection surface area, and proportionately with respect to its width and circumference

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Quantitative anatomy of the primary ossification center of the squamous part of temporal bone in the human fetus.

Detailed numerical data about the development of primary ossification centers in human fetuses may influence both better evaluation and early detection of skeletal dysplasias, which are associated with delayed development and mineralization of ossification centers. To the best of our knowledge, this is the first report in the medical literature to morphometrically analyze the primary ossification center of the squamous part of temporal bone in human fetuses based on computed tomography imaging. The present study offers a precise quantitative foundation for ossification of the squamous part of temporal bone that may contribute to enhanced prenatal care and improved outcomes for fetuses with inherited cranial defects and skeletodysplasias. The examinations were carried out on 37 human fetuses of both sexes (16 males and 21 females) aged 18-30 weeks of gestation, which had been preserved in 10% neutral formalin solution. Using CT, digital image analysis software, 3D reconstruction and statistical methods, the size of the primary ossification center of the squamous part of temporal bone was evaluated. With neither sex nor laterality differences, the best-fit growth patterns for the primary ossification center of the squamous part of temporal bone was modelled by the linear function: y = -0.7270 + 0.7682 × age ± 1.256 for its vertical diameter, and the four-degree polynomial functions: y = 5.434 + 0.000019 × (age)4 ± 1.617 for its sagittal diameter, y = -4.086 + 0.00029 × (age)4 ± 2.230 for its projection surface area and y = -25.213 + 0.0004 × (age)4 ± 3.563 for its volume. The CT-based numerical data and growth patterns of the primary ossification center of the squamous part of temporal bone may serve as age-specific normative intervals of relevance for gynecologists, obstetricians, pediatricians and radiologists during screening ultrasound scans of fetuses. Our findings for the growing primary ossification center of the squamous part of temporal bone may be conducive in daily clinical practice, while ultrasonically monitoring normal fetal growth and screening for inherited cranial faults and skeletodysplasias

Quantitative anatomy of the fused ossification center of the occipital squama in the human fetus.

CT-based quantitative analysis of any ossification center in the cranium has not previously been carried out due to the limited availability of human fetal material. Detailed morphometric data on the development of ossification centers in the human fetus may be useful in the early detection of congenital defects. Ossification disorders in the cranium are associated with either a delayed development of ossification centers or their mineralization. These aberrations may result in the formation of accessory skull bones that differ in shape and size, and the incidence of which may be misdiagnosed as, e.g., skull fractures. The study material comprised 37 human fetuses of both sexes (16♂, 21♀) aged 18-30 weeks. Using CT, digital image analysis software, 3D reconstruction and statistical methods, the linear, planar and spatial dimensions of the occipital squama ossification center were measured. The morphometric characteristics of the fused ossification center of the occipital squama show no right-left differences. In relation to gestational age, the ossification center of the occipital squama grows linearly in its right and left vertical diameters, logarithmically in its transverse diameters of both the interparietal and supraoccipital parts and projection surface area, and according to a quadratic function in its volume. The obtained numerical findings of the occipital squama ossification center may be considered age-specific references of relevance in both the estimation of gestational age and the diagnostic process of congenital defects

Dry needling as one of the methods of eliminating myofascial trigger points

Dry needling is one of the methods used to treat myofascial pain syndrome. The treatment involves the use of disposable acupuncture needles but dry needling and acupuncture are not the same. In most cases, the treatment includes myofascial trigger point puncturing. The desired effect to be achieved during the procedure is eliciting a local muscle contraction. The most common response after treatment is pain in the needled area

Morphometric study of the bilateral middle cerebral arteries in patients with a unilateral aneurysm

Background: The middle cerebral artery (MCA) supplies a major part of the brain and is of considerable clinical importance as a common location of intracranial aneurysms. The aim of the present study was to analyze the bilateral MCAs in patients with unilateral aneurysms. Material and methods: Images of computed tomography angiography of 45 patients were analyzed. The morphometric parameters of MCA were measured. The measured parameters of the normal MCAs were compared with MCAs containing aneurysms located in the main trunk division. Results: No significant differences in the length of trunk and angles between the middle and anterior cerebral arteries were found between the non-affected and aneurysmatic MCAs. Concerning arteries with aneurysms, more branches originating from the main trunk division were found more frequently. The coexistence of the more frequent trifurcation of the MCA and an aneurysm constitutes evidence of greater anatomical variability of this arterial area in cases with a concomitant vascular malformation. Conclusions: This finding is consistent with literature data, showing the relationship between aneurysms and arterial variability and the fact that aneurysms are most often located at arterial divisions

Morphometric study of the diaphragmatic surface of the liver in the human fetus.

This study aimed to examine age-specific reference intervals and growth dynamics of the best fit for liver dimensions on the diaphragmatic surface of the fetal liver. The research material consisted of 69 human fetuses of both sexes (32♂, 37♀) aged 18-30 weeks. Using methods of anatomical dissection, digital image analysis and statistics, a total of 10 measurements and 2 calculations were performed. No statistical significant differences between sexes were found (p>0.05). The parameters studied displayed growth models that followed natural logarithmic functions. The mean value of the transverse-to-vertical diameter ratio of the liver throughout the analyzed period was 0.71±0.11. The isthmic ratio decreased significantly from 0.81±0.12 in the 18-19th week to 0.62±0.06 in the 26-27th week, and then increased to 0.68±0.11 in the 28-30th week of fetal life (p<0.01). The morphometric parameters of the diaphragmatic surface of the liver present age-specific reference data. No sex differences are found. The transverse-to-vertical diameter ratio supports a proportionate growth of the fetal liver. Quantitative anatomy of the growing liver may be of relevance in both the ultrasound monitoring of the fetal development and the early detection of liver anomalies