Anatomy and computed tomography of the nasal cavity, nasal conchae, and paranasal sinuses of the endangered Patagonian huemul deer (Hippocamelus bisulcus).

This study explores for the first time the shape, volume, and configuration of nasal cavity structures of the endangered Patagonian huemul deer via computed tomography (CT). Three-dimensional (3D) reconstructions derived from data sets obtained from five Patagonian huemul deer skulls were analyzed. Using semiautomatic segmentation, 3D models were created of all the sinus compartments and nasal conchae. Volumetric measurements were taken of seven sinus compartments. The Patagonian huemul deer has a wide, large nasal cavity, with an osseous nasal aperture typical of cervids and a choana with characteristics that differentiate it from the pudu and roe deer. It also has six nasal meatuses and three nasal conchae, with the ventral nasal concha having the greatest volume and surface, which given its extension ensures a greater ability to humidify and heat the air. Further analysis showed the complex system of paranasal sinuses to be characterized by a rostroventral and interconnected group, where communication with the nasal cavity is common through the nasomaxillary opening, and a caudodorsal group that communicates with the nasal cavity through openings in the nasal meatuses. Our study of the endangered Patagonian huemul deer documents an intricate, and in some nasal cavity structures, unique morphological construction which may predispose it to higher rates of sinonasal afflictions due largely to its nasal complex anatomy, thus affecting its high cultural value.

Point-of-care hemoglobin A1c margin of error alters resident management of Type 2 diabetes when near glycemic target.

AIMS: Point-of-care (POC) HbA1c is frequently used as a surrogate for serum HbA1c. We aimed to determine if resident management of type 2 diabetes changed after accounting for the + 0.5% margin of error associated with POC HbA1c devices. METHODS: Residents were surveyed in an outpatient clinic regarding two of their patients with type 2 diabetes for which they had obtained a POC HbA1c. For one patient, the resident was asked if management would change if the POC HbA1c were 0.5% higher (called the positive case), and for another if management would change if POC HbA1c were 0.5% lower (negative case). RESULTS: Twelve of 58 (21%) cases had a change in management. Of the 27 cases where POC HbA1c was near the glycemic target (defined as POC HbA1c ≥6.0% and <8.0%), 11 (41%) resulted in a change in management while one (3%) of the 31 cases outside that interval had a change in management. CONCLUSION: POC HbA1c testing is well-suited for patients with poorly controlled type 2 diabetes while serum HbA1c testing may be more appropriate when near a patient's personalized HbA1c target since small changes in HbA1c can lead to differences in medical management.

Complex motion of Greenland Ice Sheet outlet glaciers with basal temperate ice.

Uncertainty associated with ice sheet motion plagues sea level rise predictions. Much of this uncertainty arises from imperfect representations of physical processes including basal slip and internal ice deformation, with ice sheet models largely incapable of reproducing borehole-based observations. Here, we model isolated three-dimensional domains from fast-moving (Sermeq Kujalleq/Store Glacier) and slow-moving (Isunnguata Sermia) ice sheet settings in Greenland. By incorporating realistic geostatistically simulated topography, we show that a spatially highly variable layer of temperate ice (much softer ice at the pressure-melting point) forms naturally in both settings, alongside ice motion patterns which diverge substantially from those obtained using smoothly varying BedMachine topography. Temperate ice is vertically extensive (>100 meters) in deep troughs but thins notably (<5 meters) over bedrock highs, with basal slip rates reaching >90 or <5% of surface velocity dependent on topography and temperate layer thickness. Developing parameterizations of the net effect of this complex motion can improve the realism of predictive ice sheet models.

Skull anatomy of the endangered Patagonian huemul deer(Hippocamelus bisulcus).

Studies of the normal skull anatomy of the Patagonian Huemul deer are scarce. Currently, the findings of bone lesions in the skull associated with metabolic imbalances are frequent in the literature. The objective of this study was to provide anatomical and morphometric data of the cranium and facies including a morphofunctional interpretation as a reference for clinical, ecomorphological and educational purposes. Five skulls were described, measured, scanned and digitally reconstructed. The presence of a caudal projection of the vomer bone, the absence of the facial tubercle and thin bones forming the cranial cavity were observed. Linear measurements allowed the skull to be classified as dolichocephalic, hyperlepten and ultra-dolichocranial. In conclusion, the Patagonian Huemul has a long head, an extremely long skull and a very narrow face. The thickness of the bones that made up the walls of the cranial cavity suggests chronic metabolic imbalances in response to mineral deficiency. The anatomical and morphometric data obtained in this study strongly emphasizes the relevance of considering the implementation of such management policies that aim at promoting an optimal nutritional context.

Ascites as the Presenting Sign of Systemic Lupus Erythematosus.

Although systemic lupus erythematosus (SLE) can manifest differently in each patient, ascites is a rare first sign. The diagnosis of SLE can be easily missed when the initial presentation is uncommon. A 39-year-old male presented with painless abdominal fullness and was found to have ascites, thrombocytopenia, and anemia. He was initially diagnosed with Evan's syndrome and treated with prednisone. Upon follow-up, he had worsening thrombocytopenia and was found to have a positive antinuclear antibody, anti-double-stranded DNA antibody, and low complement levels consistent with SLE. He was treated with methylprednisolone, intravenous immunoglobulin, and mycophenolate mofetil with improvement.

Enteroviral Meningoencephalitis as a Complication of Rituximab Therapy for Rheumatoid Arthritis.

Enteroviral meningoencephalitis is a rare complication of rituximab therapy that has been described in the treatment of hematologic malignancies. We report the first case of enteroviral meningoencephalitis in a patient receiving rituximab for the treatment of rheumatoid arthritis. A 37-year-old female treated with rituximab for severe rheumatoid arthritis presented with fever, headache, confusion, and tremor. Magnetic resonance imaging (MRI) of the brain was unrevealing. Cerebrospinal fluid showed a lymphocytic pleocytosis and multiplex polymerase chain reaction (PCR) was positive for enterovirus. She was treated with intravenous immunoglobulin (IVIG) for five days and had significant improvement in symptoms. Rituximab is an anti-CD20 monoclonal antibody that induces B-cell depletion and possible hypogammaglobulinemia, putting patients at increased risk for viral infections. We present this case to highlight that patients on rituximab, regardless of the indication for use, are susceptible to severe complications of otherwise typically self-limited viral infections. Furthermore, we describe the potential use of IVIG in treating these patients.

Surface osteosarcoma: Predictors of outcomes.

BACKGROUND AND OBJECTIVES: The subtypes of surface osteosarcomas include well-differentiated, low-grade parosteal osteosarcoma (POS), intermediate-grade periosteal osteosarcoma (PerOS), high-grade surface osteosarcoma (HGSO), and high-grade, dedifferentiated POS (dPOS). We aimed to determine disease progression, defined as local recurrence and metastatic disease, and overall (OS) and disease-specific survival (DSS). We identify outcome predictive factors and report functional results. METHODS: This retrospective study evaluated patients with primary surface osteosarcoma at our hospital from 1992 to 2019. Fifty-one patients had a median follow-up of 6.1 years (range: 0.1-25.2). Histologic subtypes included 32 POS, 11 PerOS, 4 HGSO, and 3 dPOS. Bone and soft tissue margins were classified using the American Joint Committee on Cancer residual tumor classification (Rx = Not evaluable; R0 = negative margin; R1 = microscopic positive margin; and R2 = macroscopic positive margin) and the modified R classification (mRx = not evaluable; mR0 = negative margin >1 mm; mR1 = negative margin ≤1 mm; mR1-dir: Positive microscopic margin locally; mR2a: Positive macroscopic margin locally; mR2b: positive macroscopic margin distally; and mR2C: positive macroscopic margin locally and distally). Forty-one patients had functional outcomes. RESULTS: Three POS patients developed recurrence: two had R0 margins and one an intralesional resection. Five patients developed lung metastases (POS: 3, dPOS: 2). Four patients died. The only significant disease progression predictor was age. OS at 10 years was 97%. 48 patients had negative bone margins (R0 or mR0 and mR1) and 47 patients had negative soft-tissue margins (R0 or mR0 and mR1). The average MSTS score was 88.43 (range: 34.29-100). CONCLUSIONS: We advocate surgery for POS and believe R0 (mR0 and mR1 resections) or planned R1 (mR1-dir) to preserve function are acceptable. We favor chemotherapy and surgery for PerOS, though a chemotherapeutic response is highly variable. High-grade tumors are the most infrequent subtype, but HGSO and dPOS seem to portend a poorer prognosis. Good function can be obtained.

Morphometric, anatomic and radiographic study of bone of the pelvic limb of endangered Patagonian huemul deer (Hippocamelus bisulcus) / Estudio morfométrico, anatómico y radiográfico de los huesos del miembro pélvico del huemul patagónico en peligro de extinción (Hippocamelus bisulcus)

Currently, the Patagonian huemul (Hippocamelus bisulcus) is endangered. Anatomical studies focused on understanding the anatomy of the deer most threatened by extinction in South America is a challenge for anatomists, veterinarians and biologists. Research carried out for its conservation has focused mainly on its ecology and pathology, leaving gaps in anatomical knowledge, which is basic and important for a comprehensive understanding of this species. Gross anatomy and radiography of the skeleton of the pelvic limb was performed in three adult Patagonian huemul. Bone specimens of three skeletally mature Patagonian huemul deer were used for gross osteological and radiographic studies. This study was conducted to reveal the morphometric and morphological features of the ossa membri pelvini of the Patagonian huemul. The main findings suggest the presence of powerful extensor muscles in the coxofemoral, femorotibial and tarsal joints, useful during walking, jogging and propulsion in deer. In general, the MNF of Patagonian huemul differ in position with respect to domestic ungulates. In addition, the presence of a notch or obturator canal was observed, with variability in morphology and development among the specimens.

Actualmente, el Huemul Patagónico (Hippocamelus bisulcus) está en peligro de extinción. Los estudios morfológicos centrados en comprender su anatomía han sido un desafío para morfólogos, veterinarios y biólogos. Investigaciones enfocadas en su conservación, se han centrado principalmente en su ecología, patología y en la descripción de sus principales agentes infecciosos, dejando vacíos en el conocimiento anatómico básico, y por ende, su comprensión morfofisiológica. El objetivo de este estudio fue describir la anatomía, morfometría y radiología macroscópica normal y detallada del ossa membri pelvini en tres especímenes de Huemul Patagónico, incluida una interpretación funcional como referencia para uso clínico y conservacionista, investigación biomédica y fines de enseñanza. Los principales hallazgos sugieren la presencia de potentes músculos extensores en las articulaciones coxofemoral, femorotibial y tarsal, útiles durante la marcha, el trote y la propulsión en los ciervos. En general, los forámenes nutricios principales del Huemul patagónico difieren en posición con respecto a los ungulados domésticos. Además, se observó la presencia de una muesca o canal obturador, con variabilidad morfológica y de desarrollo entre los especímenes.

Anatomy, Morphometry and Radiography in the thoracic limb bones of the Patagonian Huemul Deer (Hippocamelus bisulcus).

The aim of this study was to provide morphometric, anatomic and radiographic data of the thoracic limb bones of the Patagonian Huemul (Hippocamelus bisulcus) including a functional interpretation of this, as a reference for clinical use, biomedical research and teaching purposes. Currently, the Patagonian huemul deer is in danger of becoming extinct due to multiple causes. Research carried out for its conservation has focused mainly on its ecology and pathology, leaving gaps in biological knowledge, which is basic and important for its comprehension. This study was conducted to reveal the gross osteology and radiology features of the thoracic limb bones of the Patagonian huemul deer. The osteological findings suggest the presence of powerful flexor muscles in the scapulohumeral and elbow joints, useful to cushion the jumps. Also, the principal nutrient foramen of Patagonian huemul differs in position with respect to domestic ungulates, which may be important to consider during surgical procedures. Finally, the radiographic data can provide new information about the tissue loading conditions in Patagonian huemul, so that this new knowledge can be of great importance for a better understanding of mechanically induced or adaptive changes in bone produced by habitat or other ecological phenomena.

Percepción de los estudiantes de anatomía humana frente a un método de enseñanza y aprendizaje basado en la construcción de un modelo de pelvis / Perception of human anatomy students facing a learning and teaching methodology based on the construction of a pelvis model

RESUMEN: Este estudio describe la percepción de estudiantes de anatomía humana frente a la actividad de construcción de modelos tridimensionales (3-D) a escala de pelvis. Pocos estudios evalúan la percepción de los estudiantes frente a una actividad de enseñanza y aprendizaje con modelos 3-D. La actividad se aplicó a un curso de anatomía humana de la carrera de obstetricia y puericultura a los cuales se les entregó modelos de estructuras óseas de la zona pélvica a escala real para que incorporaran las estructuras anatómicas (ligamentos, músculos, vascularización e inervación), finalizando la actividad se les entregó un cuestionario de percepción. 60 estudiantes realizaron la actividad de construcción de modelo anatómico 3-D y además completaron el cuestionario. Se reportaron niveles mayores al 93 % de estudiantes que sintieron motivación, creen que fue un facilitador del aprendizaje y que la actividad fue bien planificada. Entre los aspectos negativos se registraron: el tiempo de trabajo y los costos involucrados. Dada la positiva percepción de los estudiantes frente a las actividades de construcción de modelos anatómicos, se considera que es una metodología adecuada dentro de los procesos de enseñanza y aprendizaje de la anatomía humana.

SUMMARY: In this study, the perception of human anatomy students faced with constructing a three-dimensional (3-D) pelvis model (to scale) was studied. Few studies evaluate the perception of students facing learning and teaching methodologies with 3-D models. The activity was performed with students from a human anatomy course as part of the obstetrics degree, in which models of pelvic zone bone structures (to scale) were supplied in order to incorporate the anatomic structures (ligaments, muscles, vascularization and innervation). Once the activity was finished, a perception questionnaire was taken. 60 students participated in the activity of constructing the 3-D anatomical model and also completed the questionnaire. It was found that over 93 % of the students felt motivated, believed the activity facilitated learning and also that the activity was well planned. Some of the negative factors that were reported included time taken and the associated costs. Due to the positive perception of the students involved in the activity of constructing anatomical models, this is considered to be a suitable methodology for use during the process of teaching and learning about human anatomy.

Computer-assisted learning in anatomy at the international medical school in Debrecen, Hungary: a preliminary report.

The University of Debrecen's Faculty of Medicine has an international, multilingual student population with anatomy courses taught in English to all but Hungarian students. An elective computer-assisted gross anatomy course, the Computer Human Anatomy (CHA), has been taught in English at the Anatomy Department since 2008. This course focuses on an introduction to anatomical digital images along with clinical cases. This low-budget course has a large visual component using images from magnetic resonance imaging and computer axial tomogram scans, ultrasound clinical studies, and readily available anatomy software that presents topics which run in parallel to the university's core anatomy curriculum. From the combined computer images and CHA lecture information, students are asked to solve computer-based clinical anatomy problems in the CHA computer laboratory. A statistical comparison was undertaken of core anatomy oral examination performances of English program first-year medical students who took the elective CHA course and those who did not in the three academic years 2007-2008, 2008-2009, and 2009-2010. The results of this study indicate that the CHA-enrolled students improved their performance on required anatomy core curriculum oral examinations (P < 0.001), suggesting that computer-assisted learning may play an active role in anatomy curriculum improvement. These preliminary results have prompted ongoing evaluation of what specific aspects of CHA are valuable and which students benefit from computer-assisted learning in a multilingual and diverse cultural environment.