Emergency treatment of pelvic ring injuries: state of the art.

High energy pelvic injuries sustain significant mortality rates, due to acute exsanguination and severe associated injuries. Managing the hemodynamically unstable trauma patient with a bleeding pelvic fracture still forms a major challenge in acute trauma care. Various approaches have been applied through the last decades. At present the concept of Damage Control Resuscitation (DCR) is universally accepted and applied in major trauma centers internationally. DCR combines hemostatic blood transfusions to restore blood volume and physiologic stability, reduced crystalloid fluid administration, permissive hypotension, and immediate hemorrhage control by operative or angiographic means. Different detailed algorithms and orders of hemostatic procedures exist, without clear consensus or guidelines, depending on local traditions and institutional setups. Fracture reduction and immediate stabilization with a binder constitute the basis for angiography and embolization (AE) or pelvic packing (PP) in the hemodynamically unstable patient. AE is time consuming and may not be available 24/7, whereas PP offers a quick and technically easy procedure well suited for the patient in extremis. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has also been described as a valuable adjunct in hemostatic non-responders, but merely constitute a bridge to surgical or angiographic hemostasis and its definitive role in DCR is not yet clearly established. A swift algorithmic approach to the hemodynamically unstable pelvic injury patient is required to achieve optimum results. The present paper summarizes the available literature on the acute management of the bleeding pelvic trauma patient, with emphasis on initial assessment and damage control resuscitation including surgical and angiographic hemostatic procedures. Furthermore, initial treatment of open fractures and associated injuries to the nervous and genitourinary system is outlined.

Impact of High-Fat Diet and Exercise on Bone and Bile Acid Metabolism in Rats.

Bile acids help facilitate intestinal lipid absorption and have endocrine activity in glucose, lipid and bone metabolism. Obesity and exercise influence bile acid metabolism and have opposite effects in bone. This study investigates if regular exercise helps mitigate the adverse effects of obesity on bone, potentially by reversing alterations in bile acid metabolism. Four-month-old female Sprague Dawley rats either received a high-fat diet (HFD) or a chow-based standard diet (lean controls). During the 10-month study period, half of the animals performed 30 min of running at moderate speed on five consecutive days followed by two days of rest. The other half was kept inactive (inactive controls). At the study's end, bone quality was assessed by microcomputed tomography and biomechanical testing. Bile acids were measured in serum and stool. HFD feeding was related to reduced trabecular (-33%, p = 1.14 × 10-7) and cortical (-21%, p = 2.9 × 10-8) bone mass and lowered femoral stiffness (12-41%, p = 0.005). Furthermore, the HFD decreased total bile acids in serum (-37%, p = 1.0 × 10-6) but increased bile acids in stool (+2-fold, p = 7.3 × 10-9). These quantitative effects were accompanied by changes in the relative abundance of individual bile acids. The concentration of serum bile acids correlated positively with all cortical bone parameters (r = 0.593-0.708), whilst stool levels showed inverse correlations at the cortical (r = -0.651--0.805) and trabecular level (r = -0.656--0.750). Exercise improved some trabecular and cortical bone quality parameters (+11-31%, p = 0.043 to 0.001) in lean controls but failed to revert the bone loss related to the HFD. Similarly, changes in bile acid metabolism were not mitigated by exercise. Prolonged HFD consumption induced quantitative and qualitative alterations in bile acid metabolism, accompanied by bone loss. Tight correlations between bile acids and structural indices of bone quality support further functional analyses on the potential role of bile acids in bone metabolism. Regular moderate exercise improved trabecular and cortical bone quality in lean controls but failed in mitigating the effects related to the HFD in bone and bile acid metabolism.

Course and Relation of the Facial Vessels-An Anatomical Study.

Background and Objectives: Facial vascular anatomy plays a pivotal role in both physiological context and in surgical intervention. While data exist on the individual course of the facial artery and vein, to date, the spatial relationship of the vasculature has been ill studied. The aim of this study was to assess the course of facial arteries, veins and branches one relative to another. Materials and Methods: In a total of 90 halved viscerocrania, the facial vessels were injected with colored latex. Dissection was carried out, the relation of the facial vessels was studied, and the distance at the lower margin of the mandible was measured. Furthermore, branches including the labial and angular vessels were assessed. Results: At the base of the mandible, the facial artery was located anterior to the facial vein in all cases at a mean distance of 6.2 mm (range 0-15 mm), with three cases of both vessels adjacent. An angular vein was present in all cases, while an angular artery was only present in 34.4% of cases. Conclusions: The main trunk of the facial artery and vein yields a rather independent course, with the facial artery always located anterior to the vein, while their branches, especially the labial vessels, demonstrate a closer relationship.

Shape or size matters? Towards standard reporting of tensile testing parameters for human soft tissues: systematic review and finite element analysis.

Material properties of soft-tissue samples are often derived through uniaxial tensile testing. For engineering materials, testing parameters (e.g., sample geometries and clamping conditions) are described by international standards; for biological tissues, such standards do not exist. To investigate what testing parameters have been reported for tensile testing of human soft-tissue samples, a systematic review of the literature was performed using PRISMA guidelines. Soft tissues are described as anisotropic and/or hyperelastic. Thus, we explored how the retrieved parameters compared against standards for engineering materials of similar characteristics. All research articles published in English, with an Abstract, and before 1 January 2023 were retrieved from databases of PubMed, Web of Science, and BASE. After screening of articles based on search terms and exclusion criteria, a total 1,096 articles were assessed for eligibility, from which 361 studies were retrieved and included in this review. We found that a non-tapered shape is most common (209 of 361), followed by a tapered sample shape (92 of 361). However, clamping conditions varied and were underreported (156 of 361). As a preliminary attempt to explore how the retrieved parameters might influence the stress distribution under tensile loading, a pilot study was performed using finite element analysis (FEA) and constitutive modeling for a clamped sample of little or no fiber dispersion. The preliminary FE simulation results might suggest the hypothesis that different sample geometries could have a profound influence on the stress-distribution under tensile loading. However, no conclusions can be drawn from these simulations, and future studies should involve exploring different sample geometries under different computational models and sample parameters (such as fiber dispersion and clamping effects). Taken together, reporting and choice of testing parameters remain as challenges, and as such, recommendations towards standard reporting of uniaxial tensile testing parameters for human soft tissues are proposed.

Terminological discrepancies and novelties in the histological description of the female genital system: proposed amendments for clinical-translational anatomy.

Histological terminology of the female genital organs is currently a part of the internationally accepted nomenclature Terminologia Histologica (TH), the latest edition of which dates back to 2008. Many new discoveries have been documented within 16 years since then, and many discrepancies have been found. This paper aims to revise the terminology from clinical and educational perspectives comprehensively. The authors thoroughly searched the current edition of "Terminologia Histologica: International Terms for Human Cytology and Histology," focusing on missing and controversial terms in the chapter Female genital system. The authors identified six controversial and ambiguous terms and four missing important histological terms. The authors also discussed the addition of less used eponymic terms in the histological description of female genital organs like Hamperl cells, Popescu cells, Kroemer lacunae, Balbiani bodies, Call-Exner bodies, membrane of Slavianski, nabothian cysts, or anogenital sweat glands of van der Putte. We expect the second and revised edition of the TH to be published soon and hope that the Federative International Program on Anatomical Terminology will approve and incorporate all these propositions and suggestions. We also strongly recommend using the official internationally accepted Latin and English histological nomenclature-the TH, either in oral or written form, both in theoretical and clinical medicine.

Evaluating the stability of external fixators following pelvic injury: A systematic review of biomechanical testing methods.

INTRODUCTION: This systematic review aims to identify previously used techniques in biomechanics to assess pelvic instability following pelvic injury, focusing on external fixation constructs. METHODS: A systematic literature search was conducted to include biomechanical studies and to exclude clinical trials. RESULTS: Of an initial 4666 studies found, 38 met the inclusion criteria. 84% of the included studies were retrieved from PubMed, Scopus, and Web of Science. The studies analysed 106 postmortem specimens, 154 synthetic bones, and 103 computational models. Most specimens were male (97% synthetic, 70% postmortem specimens). Both the type of injury and the classification system employed varied across studies. About 82% of the injuries assessed were of type C. Two different fixators were tested for FFPII and type A injury, five for type B injury, and fifteen for type C injury. Large variability was observed for external fixation constructs concerning device type and configuration, pin size, and geometry. Biomechanical studies deployed various methods to assess injury displacement, deformation, stiffness, and motion. Thereby, loading protocols differed and inconsistent definitions of failure were determined. Measurement techniques applied in biomechanical test setups included strain gauges, force transducers, and motion tracking techniques. DISCUSSION AND CONCLUSION: An ideal fixation method should be safe, stable, non-obstructive, and have low complication rates. Although biomechanical testing should ensure that the load applied during testing is representative of a physiological load, a high degree of variability was found in the current literature in both the loading and measurement equipment. The lack of a standardised test design for fixation constructs in pelvic injuries across the studies challenges comparisons between them. When interpreting the results of biomechanical studies, it seems crucial to consider the limitations in cross-study comparability, with implications on their applicability to the clinical setting.

Measuring the global mechanical properties of the human thorax: Costo-vertebral articulation.

Biomechanical simulation of the human thorax, e.g. for 3D-printed rib implant optimisation, requires an accurate knowledge of the associated articulation and tissue stiffness. The present study is focusing on determining the stiffness of the costo-vertebral articulations. Specimens of rib segments including the adjacent thoracic vertebrae and ligaments were obtained from two human post-mortem bodies at four different rib levels. The rib samples were loaded with a tensile force in the local longitudinal, sagittal and transverse direction and the resulting displacement was continuously measured. The moment-angle response of the rib articulations was also determined by applying a load at the rib end in the cranial - caudal direction and measuring the resulting displacement. The torsional load response of the costo-vertebral articulations at an applied moment between -0.1 Nm and 0.1 Nm corresponded to a median range of motion of 13.2° (6.4° to 20.9°). An almost uniform stiffness was measured in all tensile loading directions. The median displacement at the defined force of 28 N was 1.41 mm in the longitudinal, 1.55 mm in the sagittal, and 1.08 mm in the transverse direction. The measured moment-angle response of the costo-vertebral articulation is in line with the data from literature. On the contrary, larger displacements in longitudinal, sagittal and transverse directions were measured compared to the values found in literature.

Experimental characterization of motion resistance of the sacroiliac joint.

BACKGROUND: The human sacroiliac joint (SIJ) in vivo is exposed to compressive and shearing stress environment, given the joint lines are almost parallel to the direction of gravity. The SIJ supports efficient bipedal walking. Unexpected or unphysiological, repeated impacts are believed to cause joint misalignment and result in SIJ pain. In the anterior compartment of the SIJ being synovial, the articular surface presents fine irregularities, potentially restricting the motion of the joints. OBJECTIVE: To clarify how the SIJ articular surface affects the resistance of the motion under physiological loading. METHODS: SIJ surface models were created based on computed tomography data of three patients and subsequently 3D printed. Shear resistance was measured in four directions and three combined positions using a customized setup. In addition, repositionability of SIJs was investigated by unloading a shear force. RESULTS: Shear resistance of the SIJ was the highest in the inferior direction. It changed depending on the direction of the shear and the alignment position of the articular surface. CONCLUSION: SIJ articular surface morphology is likely designed to accommodate upright bipedal walking. Joint misalignment may in consequence increase the risk of subluxation.

On a potential morpho-mechanical link between the gluteus maximus muscle and pelvic floor tissues.

Stress urinary incontinence presents a condition not only found in female elderlies, but also in young athletes participating in high-impact sports such as volleyball or trampolining. Repeated jumps appear to be a predisposing factor. Yet the pathophysiology remains incompletely elucidated to date; especially with regard to the influence of the surrounding buttock tissues including gluteus maximus. The present study assessed the morpho-mechanical link between gluteus maximus and the pelvic floor female bodies. 25 pelves obtained from Thiel embalmed females were studied in a supine position. Strands of tissues connecting gluteus maximus with the pelvic floor obtained from 20 sides were assessed mechanically. Plastinates were evaluated to verify the dissection findings. In total, 49 hemipelves were included for data acquisition. The fascia of gluteus maximus yielded connections to the subcutaneous tissues, the fascia of the external anal sphincter and that of obturator internus and to the fascia of the urogenital diaphragm. The connection between gluteus maximus and the urogenital diaphragm withstood an average force of 23.6 ± 17.3 N. Cramér φ analyses demonstrated that the connections of the fasciae connecting gluteus maximus with its surroundings were consistent in the horizontal and sagittal planes, respectively. In conclusion, gluteus maximus is morphologically densely linked to the pelvic floor via strands of connective tissues investing the adjacent muscles. Though gluteus maximus has also been reported to facilitate urinary continence, the here presented morpho-mechanical link suggests that it may also have the potential to contribute to urinary stress incontinence. Future research combining clinical imaging with in-situ testing may help substantiate the potential influence from a clinical perspective.

Fat quantification in the sacroiliac joint syndesmosis: a new semi-automatic volumetric approach.

Fat is physiologically embedded within the interosseous ligaments in the posterior part of the sacroiliac joint (PSIJ). This composite of fat and ligaments is hypothesized to serve a shock-absorbing, stabilizing function for the sacroiliac joint and the lumbopelvic transition region. Using a novel Python-based software (VolSEQ), total PSIJ volume and fat volume were computed semi-automatically. Differences within the cohort and the viability of the program for the quantification of fat in routine computed tomography (CT) scans were assessed. In 37 CT scans of heathy individuals, the PSIJ were first manually segmented as a region of interest in OSIRIX. Within VolSEQ, 'fat' Hounsfield units (- 150 to - 50 HU) are selected and the DICOM file of the patient scan and associated region of interest file from OSIRIX were imported and the pixel sub volumes were then automatically computed. Volume comparisons were made between sexes, sides and ages (≤ 30, 31-64 and > 65 years). PSIJ volumes in both software (VolSeq vs. OSIRIX) were non-different (both 9.7 ± 2.8cm3; p = 0.9). Total PSIJ volume (p = 0.3) and fat volume (p = 0.7) between sexes were non-different. A significant difference in total PSIJ volume between sexes (p < 0.01) but not in fat volume (p = 0.3) was found only in the ≥ 65 years cohort. Fat volume within the PSIJ remains unchanged throughout life. PSIJ volume is sex-dependent after 65 years. VolSEQ is a viable and user-friendly method for sub-volume quantification of tissues in CT.

The Course and Variation of the Facial Vein in the Face-Known and Unknown Facts: An Anatomical Study.

Background and Objectives: The facial vein is the main collector of venous blood from the face. It plays an important role in physiological as well as pathological context. However, to date, only limited data on the course and tributaries of the facial vein are present in contemporary literature. The aim of this study was to provide detail on the course and the tributaries of the facial vein. Materials and Methods: In 96 sides of 53 body donors, latex was injected into the facial vein. Dissection was carried out and the facial vein and its tributaries (angular vein, ophthalmic vein, nasal veins, labial veins, palpebral veins, buccal and masseteric veins) were assessed. Results: The facial vein presented a textbook-like course in all cases and crossed the margin of the mandible anterior to the masseter in 6.8% of cases, while being located deep to the zygomaticus major muscle in all cases and deep to the zygomaticus minor in 94.6% of cases. Conclusions: This work offers detailed information on the course of the facial vein in relation to neighboring structures, which shows a relatively consistent pattern, as well as on its tributaries, which show a high variability.

Morpho-mechanical mapping of human dura mater microstructure.

The human dura mater is known to impact vastly traumatic brain injury mechanopathology. In spite of this involvement, dura mater is typically neglected in computational and physical human head models. The lack of location-dependent microstructural and related mechanical data of dura mater may be considered a rationale behind this simplification. The anisotropic nature of dura mater under various loading conditions so far remains unelucidated. Furthermore, principal collagen fiber orientation is yet to be quantified for a morpho-mechanically-informed material model on the dura mater. This study aims to assess how location-dependent mechanical anisotropy is linked to principal collagen fiber orientation. Uniaxial extension tests were performed in a heated tissue bath for 60 samples from six individuals and correlated to the three-dimensional collagen structure in four individuals using second-harmonic generation (SHG) imaging. Failure stress and stretch at failure, elastic modulus, and a microstructurally motivated material model were integrated to examine local differences in dura mater morpho-mechanics. The quantitative observation of collagen fiber orientation and dispersion confirmed that collagen is highly aligned in the human dura mater and that both fiber orientation and dispersion differ depending on the location investigated. This observation provides a possible explanation for the previously observed isotropic mechanical behavior, as the main collagen fiber direction is not oriented along the anterior-posterior or medial-lateral direction at most of the mapped locations. Additionally, these site-dependent structural properties have implications for the mechanical load response and therefore potentially for the regional functions dura mater has to fulfill. The here chosen non-symmetrical fiber dispersion material model fits the data well and provides a comprehensive parameter base for further studies and future finite element models. STATEMENT OF SIGNIFICANCE: The human dura mater greatly affects traumatic brain injury mechanisms, but it is often ignored in computational and physical head models. This is because there is a lack of detailed microstructural and mechanical data specific to the dura mater. Its anisotropic nature and collagen fiber orientation have not been fully understood, hindering the development of an accurate material model. Hence, this study combines morphological data on collagen fiber orientation and dispersion at multiple locations of human cranial dura mater, and links microstructure to location-specific load-displacement behavior. It provides microstructurally informed mechanical information towards realistic head models for predicting location-dependent tissue behavior and failure for assessing brain injury and graft material development.

Microstructural analysis on the innervation of the anterior, medial, and lateral human hip capsule: Preliminary evidence on its neuromechanical contribution.

OBJECTIVE: Capsular repair aims to minimize damage to the hip joint capsular complex (HJCC) and subsequent dislocation risk following total hip arthroplasty (THA). Numerous explanations for its success have been advocated, including neuromuscular feedback loops originating from within the intact HJCC. This research investigates the hypothesis that the HJCC contributes to hip joint stability by analyzing HJCC innervation. METHOD: Twenty-nine samples from the anterior, medial, and lateral aspects of the midportion HJCC of 29 individuals were investigated stereologically and immunohistochemically to identify encapsulated mechanoreceptors according to a modified Freeman and Wyke classification, totaling 11,745 sections. Consecutive slices were observed to determine the nerve course within the HJCC. RESULTS: Few encapsulated mechanoreceptors were found in the HJCC subregions and overlying tissues across the cohort studied. Of regions studied, no significant regional differences in the density of mechanoreceptors were found. No significant difference in mechanoreceptor density was found between sides (left, 10.2×10-4/mm3, 4.0×10-4 - 19.0×10-4/mm3; right 12.9×10-4/mm3, 5.0×10-4 - 22.0×10-4/mm3; mean, 95% confidence intervals) sexes (female 10.4×10-4/mm3, 4.0×10-4 - 18.0×10-4/mm3; male 11.6×10-4/mm3, 5.0×10-4 - 20.0×10-4/mm3; mean, 95% confidence intervals), nor in correlation with age demographics. Myelinated nerves coursed consistently within the HJCC in various orientations. CONCLUSION: Sparse mechanoreceptor density suggests that the HJCC contributes to a limited extent to hip joint stabilization. HJCC nerve terminals may potentially contribute to neuromuscular feedback loops with associated muscles to mediate joint stability in tandem with the active and passive components of the joint.

Does surgical reconstruction of the distal oblique bundle (DOB) provide similar stability as the intact bundle or Adams procedure? A systematic review.

INTRODUCTION: The aim of this review was to summarize the available evidence for biomechanical stability following surgical DOB reconstruction, and to determine whether distal radioulnar joint (DRUJ) stability with a reconstructed DOB was similar to the native intact condition or that after the Adams procedure. MATERIAL AND METHODS: A systematic literature search according to the PRISMA guidelines was performed using the databases PubMed and Embase. The following search algorithm was used: ("DOB" OR "Distal Oblique Bundle") AND "Reconstruction". Biomechanical or human cadaveric studies that measured stability of the DRUJ after reconstruction of the DOB were included. RESULTS: Four articles were included in the final analysis. DOB incidence was reported to be between 50% and 70%. Two studies observed no differences between the intact situation and the reconstructed DOB, respectively the Adams procedure. A further author group found no signs of major instability after the Adams reconstruction or after DOB reconstruction, except for decreased stability during supination in the DOB sample. In another study, similar results could be shown for the Adams and DOB reconstruction groups; however, the DOB sample showed decreased dorsal translation of the radius during forearm supination. CONCLUSION: In conclusion, DOB reconstruction was proven to stabilize the DRUJ adequately. Moreover, the reconstructed DOB showed the same stability as the native DOB, except for one study, in which stability following reconstruction was reduced during supination. No significant difference between the DOB and the Adams reconstruction could be observed.

Sample size considerations in soft tissue biomechanics.

Biomechanical experiments help link tissue morphology with load-deformation characteristics. A tissue-dependent minimum sample number is indispensable to obtain accurate material properties. Stress-strain properties were retrieved from human dura mater and scalp skin, exemplifying two distinct soft tissues. Minimum sample sizes necessary for a stable estimation of material properties were obtained in a simulation study. One-thousand random samples were sequentially drawn for calculating the point at which a majority of the estimators settled within a corridor of stability at given tolerance levels around a 'complete' reference for the mean, median and coefficient of variation. Stable estimations of means and medians can be achieved below sample sizes of 30 at a ± 20%-tolerance within 80%-conformity for scalp skin and dura. Lower tolerance levels or higher conformity dramatically increase the required sample size. Conformity was barely ever reached for the coefficient of variation. The parameter type appears decisive for achieving conformity. STATEMENT OF SIGNIFICANCE: Biomechanical trials utilizing human tissues are needed to obtain material properties for surgical repair, tissue engineering and modeling purposes. Linking tissue mechanics with morphology helps elucidate form-function relationships, the 'morpho-mechanical link'. For material properties to be accurate, it is vital to examine a minimum number of samples. This number may vary between tissues, and the effects of intrinsic tissue characteristics on data accuracy are unclear to date. This study used data obtained from human dura and skin to compute minimum sample sizes required for estimating material properties at a stable level. It was shown that stable estimations are possible at a ± 20%-tolerance within 80%-conformity below sample sizes of 30. Higher accuracy warrants much higher sample sizes for most material properties.

Undergraduate medical student perceptions and learning outcomes related to anatomy training using Thiel- and ethanol-glycerin-embalmed tissues.

Anatomical dissection is known to serve as an integral tool in teaching gross anatomy, including postgraduate training. A variety of embalming techniques exist, resulting in different haptic and optical tissue properties. This study aimed to objectify learning outcomes and medical student perceptions related to the use of two widely used embalming techniques, namely Thiel and ethanol-glycerin embalming. Between 2020 and 2022, first- and second-year medical students enrolled in the course on topographic anatomy participated in this study. Objective structured practical examinations were carried out for the head, neck, thorax, abdomen, pelvis, and extremity regions following regional dissection just before the oral examinations began. Six to ten numbered tags were marked in prosections of each region in Thiel- and ethanol-glycerin-embalmed specimens. Following the examinations, the students were surveyed regarding the suitability of the two embalming techniques with respect to preservation, colorfastness, tissue pliability, and the suitability in preparing for their anatomy examinations. Consistently higher scores were achieved for the thoracic and abdominal regions in ethanol-glycerin-embalmed specimens when compared to Thiel. No benefit was found for Thiel-embalmed upper or lower extremities. Tissues embalmed with ethanol-glycerin were rated higher for preservation and suitability to achieve the learning objectives, tissue pliability was rated higher for Thiel-embalmed tissues. Ethanol-glycerin embalming appears to offer certain advantages for undergraduate students in recognizing visceral structures, which may align with students' ideas on tissue suitability for their learning. Consequently, the benefits reported for Thiel embalming for postgraduate study unlikely reflect its suitability for novices.

The chemicals between us-First results of the cluster analyses on anatomy embalming procedures in the German-speaking countries.

Hands-on courses utilizing preserved human tissues for educational training offer an important pathway to acquire basic anatomical knowledge. Owing to the reevaluation of formaldehyde limits by the European Commission, a joint approach was chosen by the German-speaking anatomies in Europe (Germany, Austria, Switzerland) to find commonalities among embalming protocols and infrastructure. A survey comprising 537 items was circulated to all anatomies in German-speaking Europe. Clusters were established for "ethanol"-, formaldehyde-based ("FA"), and "other" embalming procedures, depending on the chemicals considered the most relevant for each protocol. The logistical framework, volumes of chemicals, and infrastructure were found to be highly diverse between the groups and protocols. Formaldehyde quantities deployed per annum were three-fold higher in the "FA" (223 L/a) compared to the "ethanol" (71.0 L/a) group, but not for "other" (97.8 L/a), though the volumes injected per body were similar. "FA" was strongly related to table-borne air ventilation and total fixative volumes ≤1000 L. "Ethanol" was strongly related to total fixative volumes >1000 L, ceiling- and floor-borne air ventilation, and explosion-proof facilities. Air ventilation was found to be installed symmetrically in the mortuary and dissection facilities. Certain predictors exist for the interplay between the embalming used in a given infrastructure and technical measures. The here-established cluster analysis may serve as decision supportive tool when considering altering embalming protocols or establishing joint protocols between institutions, following a best practice approach to cater toward best-suited tissue characteristics for educational purposes, while simultaneously addressing future demands on exposure limits.

Comparison between the parietal foramina observed in samples of African and European population groups / Comparación entre los forámenes parietales observados en muestras de grupos de población africanos y europeos

SUMMARY: Parietal foramina of the human skull act as a passageway for emissary veins, connecting the superior sagittal sinus to the veins of the scalp. This passageway can lead to the spread of infection from the scalp to the dural venous sinuses, but may also assist in relieving intracranial pressure. However, variation in the prevalence of parietal foramina has been noted among population groups. This observational and descriptive study aimed to determine the incidence, size and location of parietal foramina by using osteological specimens of 252 African skulls from the Sefako Makgatho Health Sciences University, South Africa and 95 European skulls from the University of Leipzig, Germany. Parietal foramina were significantly more common in the African sample (61.9 %) compared to the European sample (55.8 %). Moreover, the Central European sample displayed more unilateral foramina (29.5 %), while the African sample exhibited more bilateral foramina (40.8 %). The diameter of the parietal foramen average 1.98 mm and 1.88 mm for the European and African samples, respectively. In this study, a median foramen on the sagittal suture was observed in 14 of the overall skull caps (4 %). This study demonstrated that parietal foramina are more prevalent than anticipated in both population groups. Findings of this study, indicating an increased prevalence, and the subsequent possibility of more emissary veins encountered, can be used to improve the understanding of the variations in the prevalence and clinical implications of the parietal foramen among various population groups located world-wide.

Los forámenes parietales del cráneo humano actúan como una vía para las venas emisarias, conectando el seno sagital superior con las venas del cuero cabelludo. Este pasaje puede conducir a la propagación de infecciones desde el epicráneo (calva) hasta los senos venosos durales, pero también puede ayudar a aliviar la presión intracraneal. Sin embargo, se ha observado una variación en la prevalencia de los forámenes parietales entre los grupos de población. Este estudio observacional y descriptivo tuvo como objetivo determinar la incidencia, el tamaño y la ubicación de los forámenes parietales mediante el uso de muestras osteológicas de 252 cráneos africanos de la Universidad de Ciencias de la Salud Sefako Makgatho, Sudáfrica, y 95 cráneos europeos de la Universidad de Leipzig, Alemania. Los forámenes parietales fueron significativamente más comunes en la muestra africana (61,9 %) en comparación con la muestra europea (55,8 %). Además, la muestra centroeuropea mostró más forámenes unilaterales (29,5 %), mientras que la muestra africana mostró más forámenes bilaterales (40,8 %). El diámetro del foramen parietal promedió 1,98 mm y 1,88 mm para las muestras europeas y africanas, respectivamente. En este estudio, se observó un foramen medio en la sutura sagital en 14 de los cráneos en general (4 %). El estudio demostró que los forámenes parietales son más frecuentes de lo previsto en ambos grupos de población. Los hallazgos de este estudio, que indican una mayor prevalencia y la subsiguiente posibilidad de que se encuentren más venas emisarias, pueden ser útiles para mejorar la comprensión de las variaciones en la prevalencia y las implicaciones clínicas del foramen parietal entre varios grupos de población ubicados en el mundo.

New Insights into the Communications of the Facial Vein with the Dural Venous Sinuses.

Background and Objectives: Anastomoses of the extracranial and intracranial venous system have been described in the literature. The presence of such anastomoses may facilitate a possible spread of infection into the dural venous sinuses. However, the frequency and relevance of such anastomoses is highly debated. The aim of this study was to quantify frequencies of anastomoses between the facial vein and the dural venous sinuses. Materials and Methods: In 32 sides of 16 specimens, latex was injected into the facial vein. Dissection was carried out to follow and described these anastomoses, yielding the presence of latex in the intracranial venous system. Results: In 97% of cases, a dispersal of latex into the cavernous sinus as well as anastomoses was observed. A further dispersal of latex into other dural venous sinuses was found at rates ranging between 34% (transverse sinus)-88% (superior petrosal sinus), respectively. Conclusions: The presence of anastomoses between the extracranial and intracranial venous system in a majority of cases needs to be considered when dealing with pathologies as well as procedures in the facial region.