A rare combined variation of left renal vasculature in a human cadaver: embryological basis and clinical significance.

Classically, a single renal artery supplies, and a single renal vein drains each kidney. The morphology and variations in the renal vascular structures are of great importance when performing any type of renal surgery. The present case describes a rare combination of renal vasculature variation in a formalin-fixed, Chinese male cadaver. In this case, the left kidney is drained by a main renal vein (MRV) and an inferior renal vein (IRV), the latter might be the remnant of the left dorsal renal vein during the embryonic period. Two sets of renal arteries are present in this case, possibly due to persistent mesonephric arteries during embryonic development. Describing such anatomical variations is not only of academic interest but also important to help radiologists with the correct interpretation of image examinations and for surgeons to be prepared in advance.

Bradykinin B1 receptor antagonist protects against cold stress-induced erectile dysfunction in rats.

Background: Erectile dysfunction (ED) demonstrates seasonal variation with higher rates in winter, and we hypothesize that endothelial damage in erectile tissue caused by bradykinin receptor B1 (B1R) might be detrimental to this change. Aim: To find out direct correlations between cold stress and ED, through which to further investigate the functional roles of B1R in erectile tissue and to elucidate the therapeutic roles of the B1R antagonist in a cold stress-induced ED rat model. Methods: Cold stress rat models are established through long-term intermittent exposure to low temperature. After their erectile function was assessed, ED rats were treated with the B1R antagonist through intraperitoneal injection. Penile tissues were obtained at the end of the experiment after measurement of intracavernosal pressure/mean arterial pressure (ICP/MAP); the location and distribution of cytokine expression were determined by immunohistochemistry; cytokine levels and NOS and CD31 expression were detected by Western blotting; and collagen fibers and smooth muscles were observed through Masson staining. Outcomes: Cold stress impairs erectile function, and the B1R antagonist protects against it. Results: We observed decreased erection frequency, prolonged erection latency time, decreased ICP/MAP, overexpression of B1R, increased expression of cytokines on cavernous sinus endothelium, and increased levels of collagen fibers/smooth muscles on erectile tissue in response to cold stress. Also, NOS and CD31 expression was downregulated. B1R antagonist treatment shows enhanced erectile function through increased erection frequency, shortened erection latency time, and increased ICP/MAP. Also, it reduces collagen fibers/smooth muscles, TNF-α, TGF-ß1, and IL-6 and upregulates the expression of nNOS and CD31. Clinical Translation: Our findings cast new light on the correlations between cold stress and erectile function and potential new applications of existing B1R antagonist drugs in the field of ED. Strengths and Limitations: Our data support that cold stress impairs erectile function. B1R-mediated, cytokine-induced corpus cavernosum fibrosis and endothelial damage might be the main reason behind it, and B1R inhibition protects against fibrosis and endothelial damage. Other ways of B1R antagonist blocking methods in different types of ED still need to be investigated. Conclusion: Long-term intermittent cold stress impairs erectile function, and B1R-mediated, cytokine-induced corpus cavernosum fibrosis and endothelial damage might be the main reason behind it. B1R inhibition also protects against fibrosis and endothelial damage. Our data support the hypothesis that cold stress impairs erectile function and that B1R blockade ameliorates the symptoms of ED, possibly by reversing fibrosis and endothelial damage in erectile tissue.

Variant formation and branching pattern of superficial palmar arch in a human cadaver: a case report.

Superficial palmar arch (SPA) is a dominant vascular structure in the palmar region that provides a major blood supply to fingers. Present case describes a rare formation and branching pattern of SPA in a formalin fixed cadaveric left hand. In this case, SPA was formed by the anastomoses between radial artery (RA) and the superficial brachioulnar artery (SBUA), which is defined as an ulnar artery with a high origin in the arm. More interestingly, unlike classic literature, SPA sends out six branches instead of four, and the principle artery of thumb arises directly from SPA instead of RA. The aforementioned variations have rarely been reported in previous literature and demonstrate important clinical significance for accidental intra-arterial injections, errors in blood pressure readings, as well as orthopedic, plastic and vascular surgeries of the upper limbs.

iTRAQ-based identification of differentially expressed proteins in ED rat model induced by cold stress combined with environmental oestrogen.

We aim to identify serum biomarkers and key proteins of erectile dysfunction (ED) induced by cold stress combined with environmental oestrogen through iTRAQ combined with LC-MS/MS. ED rat model was established by using oestrogen-like feed and cold stimulation. Differentially expressed proteins in serum were screened and analysed with iTRAQ combined with LC-MS/MS and IPA bioanalysis platform. We found that 35 proteins were differentially expressed in the ED group, including 31 upregulated and four downregulated proteins. The molecular functions of differential proteins mainly involved the activation of endopeptidase inhibitor and regulator. The main pathways involved were the FXR/RXR activation signalling pathway and the acute phase response signalling pathway. Furthermore, three protein markers related to ED were obtained, namely C-reactive protein (CRP), T-kininogen 1 and apolipoprotein Protein H (APOH). ELISA results showed that compared with the control group, proteins of HPX, TTR, APOH, RBP4, CRP and ORM1 were significantly upregulated, but ANGPT1 protein was significantly downregulated in the serum of the ED group (p < 0.05). Conclusively, the candidate serum markers for ED induced by cold stress combined with environmental hormones were obtained. Our results indicate that inflammation and vascular endothelial function changes may play a key role in the occurrence and development of ED.

A new holistic assessment system and its impacts on student performance in regional anatomy / Un nuevo sistema de evaluación holística y sus impactos en el rendimiento de los estudiantes en anatomía regional

Summative and formative assessments are two overlapping complementary ways of assessing student progress in regional anatomy teaching and learning. Our present study was designed to create a new holistic assessment system that embraces both summative and formative assessments, and evaluate its impacts on student performance of regional anatomy. A collection of five formative assessment tests were designed and introduced into the teaching process of regional anatomy, and their performances were combined with scores of the summative assessment taken at the end of the semester to form the holistic assessment. And an anonymous survey was conducted to gather student perceptions regarding the assessments. We found, compared to summative assessment scores, students' overall average points are higher by 4.67 points (P<0.05) and 9.23 points (P<0.01) when evaluated by the holistic and formative assessment; formative assessment scores are positively correlated to summative assessment scores, and the Pearson correlation is 0.624. Questionaire investigation showed 57.65 % of the students wishes to be assessed by the holistic assessmen, and 97.9 % of the students think that the holistic assessment can promote the frequency of student-teacher communication, which helps them form the right learning attitude and improve the performance. The results indicated that holistic assessment is a more reflective and practical approach of evaluating student performance in regional anatomy teaching, which can increase studentteacher communication and enhance the self-directed learning among students.

Las evaluaciones sumativas y formativas son dos formas complementarias superpuestas de evaluar el progreso de los estudiantes en la enseñanza y el aprendizaje de la anatomía regional. El presente estudio fue diseñado para crear un sistema nuevo de evaluación integral que abarque tanto las evaluaciones sumativas como las formativas, y evalúe sus impactos en el rendimiento de los estudiantes de la anatomía regional. Se diseñó e introdujo una colección de cinco pruebas de evaluación formativa en el proceso de enseñanza de la anatomía regional, y sus desempeños se combinaron con los puntajes de la evaluación sumativa tomada al final del semestre para formar la evaluación holística. Además, se realizó una encuesta anónima para recopilar las percepciones de los estudiantes con respecto a las evaluaciones. Encontramos que, en comparación con los puntajes de la evaluación sumativa, los puntos promedio generales de los estudiantes son más altos en 4,67 puntos (P <0,05) y 9,23 puntos (P <0,01) cuando se evalúan mediante la evaluación holística y formativa; los puntajes de las evaluaciones formativas se correlacionan positivamente con los puntajes de las evaluaciones sumativas, y la correlación de Pearson es 0,624. La investigación del cuestionario mostró que el 57,65 % de los estudiantes desea ser evaluado por los evaluadores holísticos, y el 97,9 % de los estudiantes piensa que la evaluación holística puede promover la frecuencia de la comunicación entre estudiantes y maestros, útil para formar una actitud correcta de aprendizaje y mejorar el rendimiento. Los resultados indicaron que la evaluación holística es un enfoque más reflexivo y práctico para evaluar el desempeño de los estudiantes en la enseñanza de anatomía regional, lo que puede aumentar la comunicación entre estudiantes y maestros y mejorar el aprendizaje autodirigido entre los estudiantes.

A rare variation of the hemiazygos vein draining into the persistent left superior vena cava.

During an educational dissection of a 72-year-old Chinese male cadaver, the hemiazygos vein (HAV) coursing the left side that drains into the persistent left superior vena cava was observed. The HAV was formed at the junction of the 9th to 11th right posterior intercostal veins, right subcostal vein, 5th to 11th left posterior intercostal veins, and left subcostal vein; it then ascended posteriorly to the thoracic aorta. After collecting the accessory hemiazygos vein, it crossed over the aorta and the pedicle of the left lung via the hemiazygos arch, then converged with a communicative branch (vein of Marshall) that emerged from the left brachiocephalic vein to form the persistent left superior vena cava and entered the pericardium at the level of the sixth thoracic vertebra. Upon opening the pericardium of our cadaver, the persistent left superior vena cava was found to drain directly into the significantly dilated coronary sinus at the level of the eighth thoracic vertebra. The azygos vein was formed by the union of the first to eighth right posterior intercostal veins and appeared to be finer and shorter than the HAV. The persistent left superior vena cava might be the result of incomplete degeneration of the left posterior cardinal vein. Knowledge of such variations could be of great value to surgeons placing peripherally inserted central catheters because incorrect placement of the azygos venous system can be detrimental to the patient. In addition, during heart surgery, awareness of such variations may prevent major complications, such as hemorrhage or damage to vascular structures, and possibly also provide new insights and perspectives to cardiovascular surgeries.