Anatomia

The distinctive long neck of the giraffe (Giraffa camelopardalis) entails functional difficulties brought about by the extended distance between the heart and the head. Blood must be circulated over 2 m from the heart to the brain against gravitational force. The natural movement of the head to ground level would result in a large volume of blood moving toward the brain with the force of gravity. Large blood volumes also rush to the brain during bulls’ fighting (necking), rendering the giraffe susceptible to possible brain damage. The natural movement of the head from ground level to fully erect would result in blood moving away from the brain with gravitational force. The lack of blood perfusing the brain can cause fainting. The giraffe, however, suffers neither brain damage nor fainting. What adaptations do giraffes have to counteract these challenges? The aim of this study was to investigate the functionality of the rostral epidural rete mirabile situated just beneath the brain and its possible contribution to successful circulation in long-necked giraffes. The unique rostral epidural rete mirabile structure significantly contributes to counteract physiological challenges. Turns and bends characterize this structural arterial meshwork and subsequently an increased artery length through which blood flow must proceed before entrance into the brain, exerting resistance to blood racing to the brain when the head is lowered to the ground. The brain is supplied mainly by the maxillary artery through the carotid rete, with a rudimentary basilar artery not contributing to the brain’s blood supply. The resistance to blood flow due to the structure and position of the rostral epidural rete mirabile when the head is in the upright position is counteracted by the unique carotid-vertebral anastomosis allowing immediate cerebral blood supply. The rostral epidural rete mirabile structure in giraffes is an essential feature balancing physiological difficulties arising due to the extensive heart-to-head distance and might fulfill the same function in other long-necked artiodactyls. Full article

The objective of this paper was to describe the anatomy of the stifle joint (Articulatio genus) of the pampas deer (Ozotoceros bezoarticus, Linnaeus, 1758) by dissection and imaging studies. Twenty-six pelvic limbs were used for gross dissection, and four stifle regions from two animals were used for radiography and magnetic resonance imaging (MRI). The stifle joint of the pampas deer comprised the femoropatellar joint (joint between the distal part of the femur and the patella), and the femorotibial joint joined the femoral condyles to the proximal extremity of the tibia. The general anatomy of the stifle joint, including the overall morphology of the joint with its bones, complementary parts, means of attachment, and anatomical relationships, was like that of other ruminant species of similar size. Imaging techniques such as MRI allow adequate visualization of most components of the stifle joint. Full article

While relatively uncommon, a duplication of the inferior vena cava is moderately well-discussed in the literature. This anatomical variation was noted in a 69-year-old white female donor. This variation is typically asymptomatic; however, it can be associated with complications, such as confusion with a mediastinal mass, increased risk for thromboembolism, and hemorrhage during surgery. It is also associated with a handful of comorbidities, including, but not limited to, congenital renal anomalies such as horseshoe kidney or fused crossed kidney. Research supports that the variation of a duplicated IVC (DIVC) can be due to a failure of the left supracardinal vein to regress during embryonic development. Full article

Forearm extensor muscle variations can be diverse and, in some instances, rare. During a routine anatomical dissection of human cadaveric donors during the 2021 first-year medical gross anatomy course and 2021 graduate nursing advanced anatomy course at the Uniformed Services University of the Health Sciences, bilateral agenesis of the extensor carpi ulnaris muscle was noted in one 70-year-old white male donor. This variation is described as extremely rare in the literature. The presence of an extensor indicis et digiti medii tendon, a variant of the extensor indicis tendon, appeared to be evident in post-dissection photographs on the left hand. The presence of a duplicated extensor indicis proprious tendon appears to be evident on the right hand. However, further inspection of this region was impeded as the body was sent for cremation prior to the variation being identified. The presence of various juncturae tendinum was also noted bilaterally. Reported prevalence of extensor indicis muscle variants ranges from 0.75% to 13%, depending on the specific type or grouping of variations observed. Knowledge of variations in the extensor compartment of the forearm and wrist is crucial for orthopedic surgeons and specialists. Alteration of surgical approaches may be necessary if such a variation is present. Such variations can be options for grafts, resulting in minimal functional change to the grafted area due to the continued existence of other muscles performing similar functions. Knowledge of such variations, and alternative, synonymous names for them, is also important for anatomy instructors, who may need to assist students in identifying these rare variations during anatomical dissection. Full article

Background: Fundamental knowledge of the anatomy and physiology of the inner ear is necessary to understand otologic diseases and therapeutic strategies. Aim: Evaluate the inter- and intraindividual variability of the modiolar position in relation to vestibular landmarks and cranial morphology on computed tomography scans (CT scan). Methods: Thirty CT scans of normal temporal bones (25 adults, 5 children) were analyzed after multiplanar reconstruction (MPR). The measurements for each ear included the angle of each semicircular canal (SCC) made by a line passing through the chosen plane and a line passing between the apex and the ampulla of the SCC studied and the angle of the modiolus in the transverse and sagittal planes. Results: Intraindividual asymmetries with a moderate to good right/left correlation were observed for the lateral SCC in the transverse plane, posterior SCC in the frontal plane, and the superior SCC in the sagittal plane and for the modiolus in the transverse plane. Conclusions: An anatomical variability in the cochlea, independent of other surrounding anatomical elements, seems to exist, but the SCCs seem to remain symmetrical. Significance: The orientation of the modiolus is an important knowledge to acquire during presurgical planning prior to transmodiolar auditory nerve implantation. Full article

Conventional anatomical models and cadaveric specimens can be time-consuming and resource intensive for any anatomical institute. In recent years, there has been a push for more flexible and varied approaches to teaching, including problem-based and computer-aided learning, which includes web-based anatomical models or the use of three-dimensional visualization technology. With advances in hardware, autostereoscopic (AS) 3D screens have become more affordable, portable, and accessible to individuals, not just institutes. At King’s College London (KCL), we developed the Virtual Anatomy and Histology (VAH) platform—an online resource which focuses on perspective volumetric 3D viewing of medical scan data and 3D models to facilitate the online teaching and learning of anatomy. This paper presents the features of VAH and details a study that was conducted in 2022, to evaluate the VAH 3D AS viewer configured with The Looking Glass Portrait (TLG) (Looking Glass, New York, NY, USA) 8-inch AS display. We tested the hypothesis that using an AS display can improve spatial understanding of cardiovascular anatomy. A cardiovascular 3D textured model was used from our gallery to carry out a spatial test. Twenty current healthcare students at King’s participated in the study and completed a structured questionnaire. Results showed that 47.6% and 52.4% of participants agreed and strongly agreed, respectively, that identifying anatomical structures was easier in 3D compared to 2D. Qualitative feedback was positive as most students found King’s VAH and TLG display “useful for people who need help with spatial understanding” and that “it was a good tool to test your anatomical knowledge”. In conclusion, based on the quantitative results and feedback, we are optimistic that King’s VAH and portable AS displays can be beneficial in anatomy education. With the increasing availability of such systems and competitive pricing, this technology is likely to have a significant impact in education in coming years. Full article

A morphological study of the skeletal specimen of Canis lupus L. from an archeological dig of Agnano (Pisa) (Fauna Laboratory, Department of Archaeological Sciences, University of Pisa, Italy) that is chronologically placed in the Wurm period (last glaciation) was done to perform an anatomical comparison between this wild ancestor and osteological specimens of Canis familiaris L. present in the Veterinary Anatomy Museum (University of Pisa). Marked morphological differences in the splanchnocranium (nasal bone, zygomatic arch and orbital angle), neurocranium (sagittal crest) and temporomandibular joint (due to different developments of the masticatory muscles) are highlighted on the wolf specimen compared to those in the domestic dog specimens present in Museum. The appendicular skeletal bones of the wolf show anatomical features similar to those of dog bone specimens, confirming their belonging to the same family (Canidae). This result confirms that domestication has almost exclusively affected the anatomical features of the skull that have changed due to the difference in dietary approach between wolves and dogs. Full article

The Locomotor System Anatomy (LSA) course, placed in the first semester of the first year of the new Master’s degree in Medicine and Surgery High Technology (MSHT) at the Sapienza University of Rome, was integrated with surgical and bioengineering content. This study investigated the educational value and the students’ perceptions of the effectiveness of these two types of integration, comparing surgical integration (SI) with engineering integration (EI). Anatomy knowledge and students’ opinions attending the LSA course in MSHT degree (n = 30) were compared with those of students (n = 32) attending another medical and surgery course not comprising EI. Data show that students in the MSHT course like in-depth SI much more than in-depth EI. However, those who like in-depth SI also like in-depth EI. Significant differences were in anatomy knowledge between the two groups in the three sections of the test. There was no significant correlation between the three test scores and the levels of liking, while there was a significant correlation between students liking SI and those liking EI. A statistically significant correlation was also found in students who correctly responded to questions on the head and trunk, with students responding correctly to questions on the upper limbs. This study will be important in optimizing the deepening of SI and EI in the LSA course. Full article

The cerebellum is an encephalic region classically known for its central role in the control of movement, although recent research has revealed its involvement in other cognitive and affective tasks. Several different pathologies are known to affect this structure, causing a wide range of behavioral and gait impairments. Intriguingly, although the neurodegenerative factors affect all Purkinje cells of the cerebellum uniformly, certain neurodegeneration patterns can be distinguished, in which some Purkinje cells persist longer than other cell types. Specifically, there is a cerebellar region, lobe X, which is more resistant to different types of neurodegeneration, regardless of the injury. Degeneration patterns of the cerebellum have been described in several models, but this review goes further, as it aims at describing a phenomenon not so described: the resistance of the lobe X to neurodegeneration. For this purpose, the main models of cerebellar degeneration will be reviewed and a common origin for the lobe X resistance will be sought. Full article

Human brain atlases are tools to gather, present, use, and discover knowledge about the human brain. The developments in brain atlases parallel the advances in neuroanatomy. The brain atlas evolution has been from hand-drawn cortical maps to print atlases to digital platforms which, thanks to tremendous advancements in acquisition techniques and computing, has enabled progress in neuroanatomy from gross (macro) to meso-, micro-, and nano-neuroanatomy. Advances in neuroanatomy have been feasible because of introducing new modalities, from the initial cadaveric dissections, morphology, light microscopy imaging and neuroelectrophysiology to non-invasive in vivo imaging, connectivity, electron microscopy imaging, genomics, proteomics, transcriptomics, and epigenomics. Presently, large and long-term brain projects along with big data drive the development in micro- and nano-neuroanatomy. The goal of this work is to address the relationship between neuroanatomy and human brain atlases and, particularly, the impact of these atlases on the understanding, presentation, and advancement of neuroanatomy. To better illustrate this relationship, a brief outline on the evolution of the human brain atlas concept, creation of brain atlases, atlas-based applications, and future brain-related developments is also presented. In conclusion, human brain atlases are excellent means to represent, present, disseminate, and support neuroanatomy. Full article

This study evaluates ultra-low-dose computed tomography (ULDCT) protocols concerning the detectability of pulmonary nodules. The influence of tube current settings, kernels, strength levels of third-generation iterative reconstruction algorithms, and pitch was investigated. A chest phantom with artificial spherical nodules of different densities and diameters was examined with a third-generation dual-source CT. Scanning and post-processing protocols, tube current levels, and ultra-high and non-high pitch modes were applied. Images were reconstructed with filtered back-projection (FBP) or advanced model-based iterative reconstruction (ADMIRE) algorithms. Sharp (Bl57) or medium-soft (Br36) convolution kernels were applied. The reading was performed by an experienced and an inexperienced reader. The highest observer sensitivity was found using a non-high pitch protocol at tube currents of 120 mAs and 90 mAs with the sharp kernel and iterative reconstruction level of 5. Non-high pitch protocols showed better detectability of solid nodules. Combinations with the medium-soft kernel achieved slightly higher observer sensitivity than with the sharp kernel. False positives (FP) occurred more often for subsolid nodules, at a tube current level of 120 mAs, and with the sharp kernel. A tube current level of 90 mAs combined with the highest iterative reconstruction level achieved the highest accuracy in lung nodule detection regardless of size, density, and reader experience. Full article

Flaminio Rota was a 16th century anatomist and medical figure at the University of Bologna. He was highly praised, despite his poor scientific production. As a matter of fact, Rota competed with scientific activities in different anatomical arguments, but he did not publish any important research. Nevertheless, we know the principal results of his scientific activity because indirect information can be found in other publications, where some of his studies were emphasized by his contemporary colleagues. Henning Witte even mentioned Rota as a very famous Italian medical figure, together with Galilei and Santorio. On the other hand, Rota was a highly esteemed teacher. The best evidence of his recognition is well-documented in the Palace of Archiginnasio in Bologna, where Rota’s teaching activity was praised with six memorial epigraphs. In the south-eastern outskirts of Bologna, there is an 18th century villa, including a more ancient annex, that belonged to Rota. At this location, the upper parts of the walls and the ceiling are decorated with a pictorial cycle illustrating medical scenes. In this paper, we theorize regarding his scientific thinking by analyzing the pictorial cycle he commissioned. Full article

Neuroblastoma-like schwannoma is known as a rare unusual variant of schwannoma with difficulties of differential diagnosis with neuroblastoma, Ewing sarcoma/peripheral neuroectodermal tumor and other cutaneous small round cell tumors. Herein, we describe a neuroblastoma-like schwannoma that was presented as a painless lesion on the dorsal side of the left hand in a 39-year-old woman. Composed collagen fibers in the central core of rosettes and diffuse expression of S100 protein in the tumor cells found in the biopsy specimens confirmed the Schwann cell origin of the tumor. Full article

Background: The flexor digitorum brevis tendon to the fifth digit is frequently absent, and this absence is typically an incidental discovery during dissection or surgical studies. This study aimed to assess the frequency of a missing flexor digitorum brevis tendon in a Hispanic population for the first time, the association between the absence of the flexor digitorum brevis tendon, variables such as sex and ethnicity, and the functional implications of an absent tendon. Methods: Our sample consists of 30 cadavers whose feet were dissected and examined for the presence or absence of the digiti minimi tendon. Results: We found no significant relationship between the presence or absence of the tendon to sex or ethnicity. However, due to a lack of significant effects on human ambulation from the absence of this tendon, and the ability of adjacent muscles to adapt to its absence, the absence of this tendon might become increasingly prevalent over time. Conclusions: Knowledge of the frequency of flexor digitorum brevis variations concerning the demographic characteristics of patients would be of clinical importance for tendon repair, tendon transfer to correct deformities such as claw toe or hammer toe, or soft tissue reconstruction in foot surgery. Full article

Detailed knowledge about the normal anatomy and its variations is a necessity in good clinical and surgical practice. The case we are reporting here shows a rare configuration origin of the superior thyroid, lingual and facial arteries arising directly from a pentafurcated common carotid artery. A fresh frozen latex-infiltrated cadaver was dissected. The superior thyroid artery, the lingual artery and the facial artery were found to be directly detached from the common carotid artery as terminations of the five terminal rami variations. The current classifications of anatomical variants are discussed in detail in relation to this case. Full article

In this paper, we want to refute the notion that the microbiota should be considered an organ, given that an organ comprises tissue of similar or different embryological origin, while the microbiota is a pool of different microbial species originating individually from single replications and not from a common ancestral cellular element. Hence, we would like to propose a new morphological interpretation of its nature, based on the comprehensive context in which these microbes live: a muco-microbiotic layer of hollow organs, such as the airways and the bowel. The above concept should represent not only a new terminological annotation but also a more accurate portrayal of the physiology and pathophysiology of these organs. Indeed, a better understanding of the biological nature of this part of the human body can help scientists develop more specific experimental protocols, potentially leading to the establishment of better therapeutic strategies. Full article

The distal radius, one of the frequent sites of upper extremity fractures, includes unique anatomy referred to as the volar rim. Few studies have addressed its interindividual differences. Additionally, implants for osteosynthesis must match the anatomical structures to prevent soft tissue invasion, but no implants have focused on that so far. In this study, three-dimensional surface models were created from CT images of 101 cases. Analysis of the distal radius, including the volar rim anatomy, was performed to design plates to minimize the discrepancy between the bone anatomy and the implant. The results showed that there were considerable interindividual differences in the morphology of the distal radius, particularly in the degree of palmar protrusion of the volar rim. A moderate correlation between the width of the distal radius and the shape of the volar rim was demonstrated. Considering that variations in plate width are available for treatment of normal distal radius fractures and that the shape of the volar rim changes in correlation with the width of the bone, we infer that simply adding volar rim shape information to the current variations should suffice in preventing complications. We conclude that individualized design according to the shape of the volar rim is unnecessary in fracture surgery. Full article

The objectives of this study were to identify and correlate orofacial anatomy discrepancies as biometric data and the impact of its rehabilitation as an educational, forensic approach to human identification. An observational and retrospective cohort study was performed on cephalography and photographic exams of a clinical database. The clinical reports were randomly selected according to inclusion and exclusion criteria, reviewed, and interpreted according to the anatomical features. The anatomic features analyzed for human identification compare pre- and post-medical intervention data. The challenging anatomical area was the lower one-third of the face. In an extreme forensic condition, identification should consider the medical history for a positive and accurate conclusion. Full article