Prevalence and Variations of the Median Artery: A Pilot Study in a Sample of Lithuanian Cadavers.

Objective This pilot project aimed to assess the prevalence and variations of the median artery (MA) on a small scale in preparation for a large-scale study investigating MA in Lithuanian cadavers. Methods Eight formalin-fixed adult female cadavers were used in this study. Dissection was performed to allow for the observation of MA presence, type, origin, termination, and relations with other structures. The gathered data was analyzed, and a literature search was performed to compare the findings. Results MA was found in 10 of the 16 upper limbs examined; therefore, the incidence of MA in the present study was 62.5%. Of the 10 MAs found, six (60%) were of the antebrachial type (a-MA), and four (40%) were palmar (p-MA). Thus, the prevalence of a-MA and p-MA in the upper limbs examined was 37.5% (N = 6/16) and 25% (N = 4/16), respectively. Among the six cadavers that were found to possess MA, it was identified bilaterally in four (66.7%) and unilaterally in two (33.3%). The associations between the antimere and the presence of MA or MA-type were not statistically significant. MA most commonly originated from the common interosseous artery (50%, N = 5/10), followed by the ulnar artery (UA) (40%, N = 4/10), and the anterior interosseous artery (10%, N = 1/10). Two (33.3%) of the six a-MAs terminated in the mid-forearm, while four (66.7%) a-MAs ended in the distal forearm. Meanwhile, three (75%) of the four p-MAs terminated by joining the UA, while one (25%) terminated as the first common palmar digital artery. In the forearm, nine (90%) of the 10 MAs traveled anteriorly to the anterior interosseous nerve (AIN), and only one (10%) traveled posteriorly to the AIN. Additionally, one (10%) of the 10 MAs was found to pierce the median nerve. Conclusions Our findings confirm the variability in MA characteristics reported by previous studies. The high incidence of MA discovered in our sample calls attention to the importance of being aware of MA in a clinical setting, as this would allow for a timely and accurate response to a potential pathology associated with this structure.

Pilot Cadaveric Study of Anatomical Variations of the Median Nerve at the Wrist in the Lithuanian Population.

INTRODUCTION:  Carpal tunnel syndrome (CTS) is known as one of the most common neurological disorders in the human body. Nowadays, the prevalence in the general population ranges between 1% and 5%. Due to its high prevalence and increasing incidence of carpal tunnel surgery, the anatomical variations of the median nerve at the wrist are important to know to avoid iatrogenic injury of the nerve. PURPOSE: The objective of this study was to evaluate the anatomical variation of the median nerve at the level of the wrist in the Lithuanian population with a focus on its thenar motor branch based on the classifications of Lanz. MATERIAL AND METHODS: A cadaveric study was performed, and 30 wrists of 15 adult Lithuanian cadavers ranging from 70 to 89 years of age were dissected and examined. Eight female and seven male cadavers were included in the study. Any anatomical finding was documented, and the results were compared with the classification of Lanz as well as with the data found in the literature. RESULTS: All hands showed different patterns in comparison to the standard anatomical variation Lanz type 0. The most common result was dedicated to Lanz group 4A. Nineteen out of 30 hands (63%, p<0.01) had an accessory branch proximal to the carpal tunnel, while one of these hands showed a third thenar motor branch. Five hands (16%) were dedicated to Lanz group 2 with an accessory branch distal to the carpal tunnel. One hand (3%) showed a variation close to Lanz group 2, but in this case, the thenar motor branch had its origin under the flexor retinaculum instead of proximal to it. Two hands each (6%) were classified by Lanz groups 1B and 3A. Additionally, one variation showed a pattern of a combination of Lanz types 3A and 3B. The bifid median nerve had a connecting branch in between which started distal to the flexor retinaculum. Two anatomical variations (6%) were not described by the classification of Lanz.

Anatomical Variations of Superior Sagittal Sinus and Tributary Bridging Veins: A Cadaveric Study.

Background and objective Injuries to the parasagittal cerebrovenous structures may lead to devastating complications. Being aware of the inherent anatomical heterogeneity in the region might lower the rate of undesirable outcomes. In this study, our goal was to characterize the superior sagittal sinus (SSS) positioning in relation to the midline and depict tributary bridging veins (BVs) distribution over the lateral surface of the cerebral hemispheres. Methods We performed anatomical dissections of the brain in 10 cadaveric specimens (five females and five males; median age: 52 years, range: 44-74 years). Measurements (in mm) of the SSS width and deviation of its lateral margin from the midline were obtained along the entire length of the structure at six craniometric points [at mid-distance between Nasion and Bregma (½ N-B); at Bregma (B); in the middle of the Bregma-Lambda segment (½ B-L); at Lambda (L); halfway between Lambda and Inion (½ L-I); and at Inion (I)]. The count, diameter, and lateral insertion points of the draining BVs were also documented in three segments [Nasion-Bregma (N-B), Bregma-Lambda (B-L), and Lambda-Inion (L-I)]. Results The width of the SSS increased progressively along the direction of the blood flow (p<0.01). There was an SSS lateral deviation bias to the right, but the comparison failed to reach the significance level (p=0.12). The maximal lateralization of the SSS in the pre-Lambdal interval was 13.1 mm on the right side and 11.7 mm on the left side. These values increased up to 19.8 mm and 15.1 mm in the torcular area on the right and left sides, respectively. A total of 191 BVs were identified (a mean of 19.1 ± 2.5 per individual). The L-I segment showed a lower number of BVs as compared to its N-B and B-L counterparts (mean: 0.9 ± 0.6 vs. 8 ± 1.8 and 10.2 ± 2, respectively, p<0.01). Along the entire span of the SSS, the average diameter of the BVs was larger on the right side (mean: 1.4 ± 0.9 mm vs. 1.1 ± 0.8 mm on the left, p<0.01). The average lateralization of BVs dural entry points was lower on the left side in the B-L segment (mean: 5.6 ± 6.4 mm vs. 8.8 ± 6.7 mm on the right, p<0.01). There was a statistically significant trend of decreasing BVs lateralization with each consecutive SSS segment (mean: 10.9 ± 7.4 mm in the N-B segment, 7.3 ± 6.7 mm in B-L, and 1.6 ± 1.2 mm in L-I, p<0.01). The maximal lateral deviation of BVs insertion points was 33.6 mm in N-B, 30 mm in B-L, and 4.1 mm in L-I portions of the SSS. Conclusions In most cases, the SSS deviated laterally from the midline, up to 13 mm in the pre-Lambdal segment and up to 20 mm in the torcular area. Right-sided BVs were of larger average diameters. The lateral insertion points of BVs decreased along the rostrocaudal span of the SSS.

Associations between depression, height and body mass index in adolescent and adult population of Penza city and oblast, Russia.

The aim of this study was to investigate the possible associations between depression, height and body mass index (BMI) in the adolescent and adult population of Penza city and oblast, Russia. The study included 554 adults aged 16-89 years. The presence and severity of depression was evaluated using Beck's Depression Inventory (BDI-II). The participants self-reported their height (cm) and weight (kg) and these were used to calculate their BMI (kg/m2). Significant correlations were obtained between depression and short stature in young men, depression and short stature in participants with normal BMI and depression and age in overweight participants. Young women aged 16-23 years, and older men aged 60-89 years, presented the highest and very similar depression scores with no statistically significant difference between them. Special attention should be paid in Russia to these groups due to their higher risk of depressive disorders.

Changes in the prevalence of thinness among children in Vilnius, Lithuania: a comparison of two longitudinal data sets of children born in 1990 and 1996.

The aim of this study was to calculate and compare the prevalence of thinness in children born in 1990 and in 1996 in Vilnius, Lithuania. The study was longitudinal as the data used for calculation were obtained by measuring every child's height and weight at least once per year from birth to the age of 17. The measurements were transcribed from the children's personal health records from the same outpatient clinic. The prevalence of overall thinness and grade 1 thinness in children that were born in 1996 was considerably lower compared to the children that were born in 1990. The prevalence of grade 1 thinness comprised the majority of all thinness cases in girls and boys alike. In conjunction with another study (Suchomlinov et al. 2016), which assessed the same children and discovered an increase in the prevalence of overweight and obesity, a clear trend of a decrease in the prevalence of thinness and normal BMI, while an increase in the prevalence of overweight and obesity in children born in 1996 compared to 1990, emerged.

Variations in Facial Nerve Branches and Anatomical Landmarks for Its Trunk Identification: A Pilot Cadaveric Study in the Lithuanian Population.

Objective The purpose of this study was to evaluate facial nerve (FN) branching variations based on Davis and Kopuz classifications in the Lithuanian population and measure the shortest distance from the facial nerve trunk (FNT) to its anatomical landmarks. Methods Twenty-two hemifaces of 11 cadavers were dissected. The preauricular skin cut was made and extended behind the ear lobe and along the inferior border of the mandible. The skin with subcutaneous tissue and superficial fascia were separated and medially retracted, and the parotid gland was dissected anterogradely. The FNT and its furcation type and branching pattern were disclosed and noted based on Davis and Kopuz classifications. Further, the shortest distance from the FNT to the anatomical landmarks of the tragal pointer (TP), the angle of mandible (AM), and the tip of mastoid process (TMP) was measured. Results The prevalence of branching patterns did not differ significantly compared to Davis classification. Based on Kopuz, type IVA pattern was the most common in six cases (27%). Eighteen (82%) trunks split as bifurcations and two (9%) trifurcations, while two (9%) had separate double trunks. The shortest distance (mm) from the FNT to the TP is 9.30 ± 0.93, AM 36.45 ± 4.14, and TMP 12.52 ± 2.30. Conclusion The prevalence of FN variations in the Lithuanian population is similar to Davis classification. The AM and TMP are consistent superficial bony landmarks for trunk identification, while the distance from the TP highly varies among studies. Surgeons should be aware of double FNT during parotidectomy, which is described in Kopuz classification.

Height SDS Changes (ΔhSDS) in Healthy Children from Birth to 18 Years, with Correction Factors for Measurement Intervals of Less than One Year.

BACKGROUND: Growth is volatile and non-linear. Assessing the instantaneous speed of growth (momentary height velocity) depends on the precision and the number of measurements and the duration of the observation period. Measurements at short intervals reflect both the non-linearity of growth and the technical error of measurements (TEM). MATERIAL: We reanalyzed longitudinal measurements of body length at age 0, 3 months, 6 months, 9 months, 12 months, 18 months, and 24 months, from 1879 healthy infants (956 girls, 923 boys) from France (180 girls, 173 boys), Vilnius, Lithuania (507 girls, 507 boys), Lublin, Poland (67 girls, 56 boys), Zürich, Switzerland (94 girls, 102 boys) and Spain (108 girls, 95 boys); and longitudinal measurements of annual body height from age 2 to 18 years from 1528 healthy children and adolescents (774 girls, 754 boys) from France (41 girls, 47 boys), Vilnius, Lithuania (23 girls, 27 boys), Lublin, Poland (70 girls, 58 boys), Zürich, Switzerland (111 girls, 120 boys), Spain (94 girls, 74 boys), the Czech Republic (65 girls, 69 boys), Hungary (316 girls, 320 boys), and Berkeley, USA (54 girls, 39 boys). RESULTS: We calculated age - and sex-specific mean values for height and SD for height separately for each country. In addition, we defined the instantaneous speed of growth by the difference of two measures of hSDS Formulas References A1 , or in the case of multiple measurements, by the slope of the linear regression (ßhSDS(t)). Based on the longitudinal measurements of body length, we present reference values for annual growth velocity given in the form of SD of annual hSDS changes (ΔhSDS), from birth to maturity. Correction factors are added for validating measurements obtained at intervals of less than one year. The correction factors depend on number of measurements, and duration of the observation period.

Individual variability in height tracking in infancy: comparison of two longitudinal data sets of children born in 1990 and 1996 in Vilnius, Lithuania.

ABSTRACT: The aim of this study was to investigate variability of individual trajectories for height in two different birth cohorts of Lithuanian infants. Data were derived from the personal health records of 781 (399 boys and 382 girls) and 263 (139 boys and 124 girls) children born in 1990 and 1996 (respectively) in the city of Vilnius in Lithuania. The height of each child at birth, at one year and two years of age was investigated. The analysis of growth tracking was performed tracing the main centiles for height (3, 10, 25, 50, 75, 90 and 97). According to increase of height along the main centiles, five types of growth curves were possible. The average number of changed centile tracks for height for girls born in 1990, girls born in 1996 and boys born in 1996 was 2.05 ± 1.12, 2.02 ± 1.25 and 2.03 ± 1.06, respectively. However, the average number of changed centile tracks for height for boys born in 1990 was 1.74 ± 1.16, which differed significantly (p < 0.001) from the average number of changed centile tracks for height for girls born in 1990 and 1996, and boys born in 1996. Statistically significant differences (p < 0.001) were obtained between the incidences of the stable type of growth curve: the boys born in 1996 have presented the aforementioned type of growth curve much rarer compared to both the girls born in the same year and the boys born in 1990.

Increasing prevalence of overweight and obesity among children in Vilnius, Lithuania: comparison of two longitudinal data sets of children born in 1990 and 1996.

SUMMARY: The aim of this study was to assess changes in prevalence of overweight and obesity among children born in 1996 and 1990 in Vilnius city. The results were based on comparison of two longitudinal data sets (N = 624 and N = 389) collected from the personal health records of children born in 1996 and 1990 respectively. No statistically significant differences in final height and BMI were established between children born in 1990 and 1996; however, both boys and girls born in 1996 appeared to be higher and heavier at different ages compared to their peers born in 1990. After controlling for tempo, the differences in height between the two cohorts have become insignificant for girls, with exceptions at the age of 3 and 10 years; for boys, the differences between the cohorts have remained significant, however at a slightly lower level. More children born in 1996 tended to be overweight and obese. In six years, the prevalence of overweight in Vilnius children has more than doubled; the prevalence of obesity has increased up to five times in some age groups.

The absence of physiological neonatal weight loss on the 1st-5th day is associated with decreased later physical indices.

AIM: To investigate associations between physiological neonatal weight loss on the 1st-5th day and physical indices from birth up to the age of 17 years. METHODS: Data were derived from the personal health records of healthy, full-term and breastfed children born in Vilnius in 1990 and 1996. Five hundred and thirty children (289 boys and 241 girls) who left a maternity unit on the 1st-5th day after birth were included in the analysis. RESULTS: Infants left the maternity unit on day 4.62 ± 2.33. On the day of leaving a maternity unit, infants lost 105.06 ± 130.48 g (2.85 ± 3.65%) of birth weight. Girls who did not lose or gained weight after birth had already weighed less at birth (3163 ± 547 and 3490 ± 403 g, respectively, p < 0.01) and remained lighter up to the age of 17 years (54.3 ± 8.7 and 60.8 ± 10.1 kg at the age of 17 years respectively, p < 0.001). Girls who did not lose or gained weight after birth were also shorter than those who lost weight (164.3 ± 5.7 and 168.6 ± 5.4 cm at the age of 17 years, respectively, p < 0.001). CONCLUSION: Girls who did not lose or gained weight immediately after birth tended to remain shorter and lighter during childhood and adolescence. Only a few statistically significant differences were obtained in boys.

FACTORS ASSOCIATED WITH CHILDREN'S HEIGHT AND BODY MASS INDEX IN LITHUANIA, 1990-2008.

The aim of the study was to reveal the ethnic and socioeconomic factors associated with height and body mass index (BMI) of children during the period of political and social transition in Lithuania in 1990-2008. Data were derived from the personal health records of 1491 children (762 boys and 729 girls) born in 1990 in Vilnius city and region. Height and BMI from birth up to the age of 18 years were investigated. Children were divided into groups according to their ethnicity, place of residence, father's and mother's occupation and birth order. Height and BMI were compared between the groups; a Bonferroni correction was applied. A multiple linear regression model was used to measure the effects of the independent variables on height and BMI. Girls living in Vilnius city were significantly taller in later life at the ages of 8 and 11 years. Sons of mothers employed as office workers appeared to be significantly taller at the ages of 7, 12, 14 and 15 years compared with the sons of labourers. First-born girls were taller at the age of 7 years than later-born girls of the same age (124.48±5.11 cm and 122.92±5.14 cm, respectively, p<0.001). Later-born children of both sexes had higher BMIs at birth compared with first-borns; however, first-born girls had higher BMIs at the age of 11 years compared with their later-born peers (17.78±2.87 kg/m² and 16.79±2.14 kg/m² respectively, p<0.001). In the multiple linear regression model, the five tested independent variables explained only up to 18% of total variability. Boys were more sensitive to ethnic and socioeconomic factors: ethnicity appeared to be a significant predictor of boys' height at the age of 5 years (p<0.001), while birth order (p<0.001) predicted boys' BMI at birth. In general, ethnicity, place of residence, father's and mother's occupation and birth order were not associated with children's height and BMI in most age groups.

Variability in growth tracking is associated with body mass index at 17 years of age.

AIM: Variability in individual growth tracking and its association with body mass index (BMI) in later life remains insufficiently explored. Our aim was to investigate growth tracking variabilities from birth up to the end of growth at 17 years of age and their relationship to BMI. METHODS: Data were obtained from the personal health records of 1492 healthy children - 762 boys and 730 girls - who were born full term in 1990 in the city and surrounding villages of Vilnius in Lithuania. The analysis of growth tracking was performed using two methods: tracing the main percentiles and the changes in standard deviation scores for height and BMI. RESULTS: Most of the boys and girls changed one growth track for height and BMI. However, girls from birth to two years of age and 11-17 years of age were the most likely to change two growth tracks for the growth indices. Children who were underweight at 17 years of age changed significantly more BMI tracks during the first two years of life (2.19 ± 1.21) than overweight and obese 17-year-olds (1.75 ± 1.14). CONCLUSION: This study of 1492 healthy children at 17 years of age showed that great individual variability in the growth tracking of body mass index in early life was associated with being underweight at 17 years of age.

"Proceedings of the 22nd Aschauer Soiree on Growth and Health Screening", held at Altenhof, Germany, November 15th, 2014.

Twenty-five scientists met at Aschauhof, Altenhof, Germany, to discuss various aspects of the complex network of modern health screening, focusing on current scientific topics including medical sciences, human biology, and mathematics; on problems in implementing these results at the practical level of physicians, nurses, technicians, and engineers; and the level of administrative and political decisions. Whereas major scientific advancements have been published in the understanding and the bio-statistical evaluation of anthropometric screening parameters such as serial measurements of height and weight for preventive medical check-ups, BMI screening and surveillance in schools, etc., the implementation of these advancements into current health screening concepts, strategies and decision-making is poor. Fear of discrimination, misperception of body image, behavioural responses and political concerns, meanwhile dominate and negatively interfere with the implementation of recent scientific results into public health screening concepts and practices.

The relationship between birth weight, adiposity rebound and overweight at the age of 17 years (results of the Lithuanian longitudinal growth study, 1990 - 2008).

The purpose of this study was to investigate the relationship between overweight and obesity at the age of 17 years with a birth weight and time of an adiposity rebound. The results were based on data (N = 1535) collected from the personal health records of children born in 1990 in Vilnius city and region. The further growth of newborns with normal (3000 - 3999 g), suboptimal (2500 - 2999 g) and large (≥ 4000 g) birth weight was analyzed. Statistically significant results (p < 0.05) were obtained in girls: at the age of 17, the BMI of suboptimal, normal and large birth weight females was 19.87 ± 2.23 kg/m², 20.98 ± 2.78 kg/m² and 22.20 ± 3.52 kg/m² respectively. We also found that children with large birth weight had the highest risk to become overweight or obese later in their life. Both boys and girls overweight at the age of 17 had an earlier adiposity rebound (at the age of 5 years) in comparison with non-overweight children (their adiposity rebound had happened at the age of 6 - 7 years). However, the majority of children with an early adiposity rebound did not become overweight on the subsequent age period at once - it might happen later, already at the adolescence. Thus it is very important to carefully screen the growth of preschool children and start preventive measures against the overweight and obesity as early as possible.