Correlating quadriceps patellar tendon angle and lateral patellar tilt angle in patients with irregular alignment: a cross-sectional study with retrospective data

Background

The newly defined angle, quadriceps-patella angle (QPA), reflects the combined force transmitted to the patella by the quadriceps muscles and patellar tendon. An increase in QPA may correlate with an increased force on the patella, which is significant in diagnosing patellofemoral instability and pain syndrome. In our study, we examined how various angles and pathologies vary depending on lateral patellar tilt angle (LPTA). QPA and patellar malalignment was investigated. Thus, the importance of understanding patellar malalignment and the research gap.

Methods

Three hundred and fifty patients who underwent knee magnetic resonance imaging (MRI) examinations were included. The cross-sectional study conducted retrospectively between the years of 2018-2020 in a tertiary care outpatient clinic. Shapiro-Wilk normality, Chi-square, Mann-Whitney-U, Spearman correlation and receiver operating characteristic (ROC) curve analysis, statistical tests used for analysis. The patellar tendon length, patellar height, tibial tubercle-trochlear groove distance (TT-TG), patella angle, trochlear sulcus angle, trochlear groove depth (TGD), medial trochlea length (MT), lateral trochlea length (LT), medial trochlear/lateral trochlear length ratio (MT/LT), LPTA, patella-patellar tendon angle (PPTA), QPA, Insall-Salvati index (ISI), medial trochlear inclination (MTI), lateral trochlear inclination (LTI) were among these measurements. In addition, we aim to reveal whether there is a significant relationship between two important angles LPTA and QPA. Whether there is a significant increase in the development of chondromalacia for the patient group with LPTA >5°. We examined how the frequency of chondromalacia changes in the patient group with LPTA >5°.

Results

Two hundred and seventy seven patients included in the study and many measurements were performed on MRI. Fad-pad edema was found to be significantly higher in the group with LPTA <5° (P=0.046). TT-TG distance was significantly higher, TGD and MT were significantly lower in patients with higher LPTA (P=0.001, P=0.002 and P=0.017, respectively). A low level of significant positive correlation was found between QPA and patellar tendon length. There is no significant difference between QPA and PPTA angles between the groups with LPTA <5° and >5° (P=0.503, P=0.188). In the ROC analysis performed to determine the cut-off value, the LPTA value ≤14.2° which significantly predicted the presence of fad-pad edema, had the highest sensitivity and specificity [sensitivity: 76.71%, specificity: 39.90%, area under the curve (AUC): 0.588, P=0.024].

Conclusions

QPA is independent from many angles of the knee and does not change significantly. As the patellar tendon length increases, QPA angle also increases. In patients with abnormal LPTA, the frequency of TT-TG distance and chondromalacia increased, while TGD and MT decreased. Patients with a low LPTA can be more carefully examined for chondromalacia and fad-pad edema in clinical and MRI examination.

Association Between Foramen Rotundum and Trigeminal Neuralgia in the Saudi Population: A Radiological Study

The trigeminal nerve is responsible for transmitting sensory information from the face, nasal and mouth cavities, and most of the scalp. Trigeminal neuralgia (TN) is a chronic facial pain disorder characterized by spontaneous paroxysmal pain throughout the distribution of the trigeminal nerve. This study investigated the morphological and morphometric variations of the foramen rotundum (FR) and its association with TN through a retrospective radiological analysis. A cohort of 97 participants from King Fahad University Hospital, Saudi Arabia, comprising 57 TN patients and 40 controls, underwent head CT scans for measurement and analysis. The study revealed significant differences in the FR morphology between TN patients and controls, particularly noting narrower FR measurements among TN individuals, especially in females. The right side demonstrated narrower FR dimensions, potentially correlating with the predominant side of pain in TN patients. While the presence of bony spurs was absent in all participants, variations in FR shape, size, and spatial positioning were observed and compared across genders and groups. These findings provide crucial insights into the potential anatomical factors contributing to TN, emphasizing the importance of understanding FR variations in clinical assessment and management of TN cases. Further research focusing on FR morphology and its clinical implications is recommended to enhance understanding and aid medical professionals in addressing TN-related concerns.

A very rare case of the accessory palmaris longus muscle and clinical significance

The palmaris longus muscle is located in the forearm region. It morphological variability was noted during standard anatomical dissection of the upper limb. The muscle was characterized by a normal course, i.e. originating from the medial humeral epicondyle and inserting to the palmaris aponeurosis, but a small additional tendon attached to the flexor retinaculum was observed in its distal part. An accessory palmaris longus muscle was also observed nearby. Interestingly, this accessory muscle was reversed, and the first part was not muscular, but tendinous, represented by two tendons originating from the common muscular mass attached to the medial epicondyle of the humerus; these later connected together, creating one muscle belly distally attached to the flexor retinaculum. This additional structure was innervated by a neural branch from the median nerve and the ulnar artery was responsible for blood supply. The course of the median nerve is also clinically important, because before entering the carpal tunnel, it was located directly under the accessory palmaris longus muscle. In turn, the ulnar artery passed through a special hole created by the flexor digiti minimi brevis and flexor retinaculum, before passing under the palmaris brevis muscle.

Morphological variability of the pectoralis major muscle in human fetuses

BACKGROUND

The pectoralis major muscle is located in the anterior chest wall. In most cases, it is divided into clavicular, sternal (sternocostal) and abdominal heads. The aim of this study is to demonstrate and classify the morphological variability of the pectoralis major muscles in human fetuses.

MATERIAL AND METHODS

Classical anatomical dissection was performed on 35 human fetuses aged 18-38 weeks of gestation at death were examined. (17 female, and 18 male, 70 sides; fixed in 10% formalin solution). The fetuses were obtained from spontaneous abortion after informed consent of both parents and through deliberate donation to the Medical University anatomy program. Upon dissection, the following morphological features were assessed: the morphology of the pectoralis major, the possible occurrence of accessory heads, the possible absence of some head, and morphometric measurements of each head of the pectoralis major muscle.

RESULTS

Five types of morphology (based on number of bellies) were observed in the fetuses. Type I was characterized by a single claviculosternal belly (10% of all samples). Type II comprised the clavicular and sternal heads (37.1%). Type III comprised three clavicular, sternal and abdominal heads (31.4%). Type IV (17.2%) was characterized by four muscle bellies and was divided into four subtypes. Type V (4.3%), was represented by five parts, and was divided into two subtypes.

CONCLUSIONS

Due to its embryological development, the PM demonstrates great variability in the numbers of its parts. The most common type was the PM with two bellies, in line with previous studies which also distinguished only clavicular and sternal heads.

Variations of the popliteal artery: a review

The popliteal artery is located in the popliteal fossa. In addition to its other branches, it divides into two terminal branches, the anterior and posterior tibial arteries, which are subject to numerous morphological variations. The purpose of this review is to compile several authors' classifications of the patterns of terminal branching of the popliteal artery among adults and to describe the division among foetuses, as described in the current literature. Pathologies of the popliteal artery such as popliteal artery aneurysm and popliteal artery entrapment syndrome and methods for treating them, like open surgery and endovascular interventions are also discussed. Awareness of the morphological variations of the popliteal artery is important for radiologists and surgeons as it allows the risk of complications during surgery to be reduced.

A case of atypical vivax malaria with a global review of reports on myriads of morpho-variations in parasitized red blood cells

Plasmodium vivax, one of the major species associated with human malaria, continues to be a major public health problem in many parts of the world. Numerous studies related to vivax malaria have described quantitative haematological findings (level of haemoglobin, thrombocytopaenia, haematocrit values), but diverse morphological changes of parasite forms within infected red blood cells (iRBCs) have been mentioned only in few studies. Here we report a case of a 13-year-old boy who presented with fever, significant low platelet counts and hypovolaemia that created a diagnostic dilemma. Detection of microgametocytes by microscopic examinations, further confirmed by multiplex nested PCR assays and response to anti-malarials, helped to make the diagnosis. We present an atypical case of vivax malaria with a review of morpho-variations of iRBCs and have summarized the characteristics that aid in creating increased awareness among laboratory health professionals and public health workers.

Morphological variations and morphometry details of the foramen ovale in the Saudi population: a retrospective radiological study

The foramen ovale is one of the essential foramina in the middle cranial fossa, more precisely, in the superior surface of the greater wing of the sphenoid bone. It has essential surgical and diagnostic significance since it serves as a surgical landmark, and crucial neurovascular vessels such as the mandibular nerve and accessory meningeal artery pass through it. Therefore, understanding the morphological and morphometric variations of the foramen ovale is essential for accurately identifying, diagnosing, and managing related pathologies. The study aimed to evaluate the morphological variations and morphometric details of the foramen ovale in the Saudi population. A radiological study was conducted to observe the measurements and the shapes of the foramen ovale in the skull with its anatomical variants. Retrospective data was collected from the Department of Radiology, King Fahad University Hospital, Saudi Arabia. The sample consisted of 100 human skulls from computed tomography scans, including 50 males and 50 females. The values for the mean length, width, and distance from the midline on the right side were 6.462 mm ± 1.681 mm, 4.897 ± 1.0631 mm, and 2.4565 ± 0.51275 mm, and 6.451 ± 1.6691 mm, 4.812 ± 1.0848 mm and 2.4290 ± 0.60039 mm for the left side, respectively. The foramen shape was oval in the majority (47%), followed by round shape (31%) with no bony outgrowths such as spur in the studied foramina. Furthermore, the morphometric variation between males and females was statistically insignificant (p-value>0.05). The observed variation of foramen ovale in this study has significant anatomical and clinical applications for various diagnostic and surgical procedures.

Two variant muscles in the gluteal region

The short lateral rotators of the thigh found in the gluteal region can have morphological variations. During anatomical dissection of a right lower limb, two variant structures were found in this region. The first of these accessory muscles originated from the external surface of the ramus of the ischium. Distally, it was fused with the gemellus inferior muscle. The second structure comprised tendinous and muscular parts. The proximal part originated from the external part of the ischiopubic ramus. It inserted on the trochanteric fossa. Both structures were innervated by small branches of the obturator nerve. The blood supply was via branches of the inferior gluteal artery. There was also a connection between the quadratus femoris and the superior part of the adductor magnus. These morphological variants could be clinically important.

Clinical significance of morphological variations of the inferior phrenic arteries

The rapid development of sciences such as genetics and molecular biology offers hope that better therapeutic methods can be developed and diagnosis and treatment made more effective. However, we must not forget that the basis for understanding the complex mechanisms of diseases and associated symptoms is knowledge of the relevant location and correlation among organs. In the present study, we focus on the clinical significance of the inferior phrenic artery. The diaphragm is a muscular structure that separates the abdominal and chest cavities. Thanks to this position, the inferior phrenic artery is much more significant than formerly assumed. A rich network of collaterals makes this vessel important in the development of neoplasms and metastases. Knowledge of anatomical variants of the inferior phrenic artery is also crucial for radiological procedures such as embolisation. The main aim of this study is to review the involvement of the inferior phrenic artery in physiological and pathophysiological processes. This work has value for all practicing doctors, especially radiologists and surgeons.

Construction of a high-density mutant population of Chinese cabbage facilitates the genetic dissection of agronomic traits

Chinese cabbage (Brassica rapa ssp. pekinensis) is an economically important vegetable crop throughout the world, especially in Asia. High-quality genome sequences are available for Chinese cabbage, but gene functional studies remain challenging. To promote functional genomic studies of Chinese cabbage, we generated an ethyl methane sulfonate (EMS) mutant population of ∼8000 M₂ plants using the double haploid inbred line A03 as the parent. The genome of A03 was sequenced and used as a reference for high-throughput functional characterization of gene mutations at the whole-genome level. A total of 300 M₂ to M₅ EMS mutants were phenotypically screened and then sequenced, revealing 750 629 SNPs and 46 272 InDel mutations that cover 98.27% of all predicted genes in the A03 genome. A forward-genetics approach was successfully used to identify two genes with chloroplast-related functions that are responsible for the yellow leaf mutant trait. A reverse-genetics approach was also used to identify associations between mutations in five genes of the glucosinolate biosynthetic pathway and variations in glucosinolate content of the mutant plants. In addition, we built the Chinese cabbage EMS mutation database (CCEMD, www.bioinformaticslab.cn/EMSmutation/home) to increase the usability of this mutant population resource. In summary, we performed large-scale screening of a heading Chinese cabbage EMS mutant collection at the phenotypic and genotypic levels, which will facilitate gene mining of Chinese cabbage and might also be useful for the study of other Brassica crops.

Six-headed coracobrachialis muscle

The coracobrachialis muscle is the smallest muscle of the anterior compartment of the arm. It is responsible for flexion and abduction in the glenohumeral joint. The coracobrachialis muscle is morphologically variable both, in its insertion and origin. Moreover, some additional heads or structures may also occur. The present report describes a six-headed coracobrachialis muscle originated as a common junction with the the short head of the biceps brachii muscle from the coracoid process. All of these heads insert into the medial surface of the humeral shaft. It is important to note that the musculocutaneous nerve was piercing the fourth belly. Other heads were innervated by branches from the musculocutaneous nerve. Knowledge of the morphological variability of this muscle is essential not only for anatomists but for clinicians as well.

Assessment of the incidence of accessory hepatic arteries: literature review

Modern medicine is developing towards application of endovascular techniques such as trans-arterial hepatic chemoembolization. They displace classic open procedures. However, their correct planning and performance depend on the knowledge pre-operative detection of hepatic arterial anatomical variations. The main abnormality that may generate complications during radiological and surgical procedures is occurrence of an accessory hepatic artery. In the present study we propose our own classification of the variability observed in the vessels based on cases reported in the literature. It analyzes more types of variations as compared to previous trials. A great advantage of this study is also a description of different pathological and frequently life-threatening conditions associated with hepatic arteries. This study is of value to medical practitioners, e.g. surgeons.

Sternal human variability and population affinity: Frequency of discrete traits and their relationship with sex and age

Sternal morphological variations differ among populations and are influenced by the interaction between inheritance, development, and environment. There are currently no studies that include all variability from a morphogenesis approach following a homogeneous definition. The aims of this study were (a) to develop a standardized method for the anatomical study of the sternum; (b) to analyze the prevalence of the morphological variations and their relationship between sex and age; (c) to compare the results with other populations. The sterna of 155 skeletons from a Spanish population were studied. The age at the time of death was 17 to 97 years. We analyzed two metric and 22 sternal morphological variations described in the literature and designed an illustrated atlas. The atlas was validated using the intraclass correlation coefficient (ICC). A descriptive statistical analysis was conducted to measure the prevalence and relationship between sex and age. To analyze the interpopulation variability, we compared our results with those from other authors. The atlas with definitions and reference images improves the observation and detection of all morphological variations of the sternum (ICC = 0.90). The dependence between the morphological traits and sex was significant for the variations in the sternal angle, the number of esternebra, and the development of the xiphoid process. No significant differences were found between age group and morphological traits. The expression of the sternal morphological variation and sex are population-specific. The results will help standardize future studies and provide valuable information on the variability of the sternal morphological variation.

The complete chloroplast genome of Campanula takesimana Nakai from Dokdo Island in Korea (Campanulaceae)

Completed chloroplast genome of Campanula takesimana Nakai isolated from Dokdo island in Korea is 169,719 bp long (GC ratio is 38.8%) and has four subregions: 102,381 bp of large single-copy (37.8%) and 7,750 bp of small single-copy (32.6%) regions are separated by 29,794 bp of inverted repeat (41.3%) regions including 131 genes (87 protein-coding genes, eight rRNAs, and 36 tRNAs). Phylogenetic analyses suggested that C. takesimana from Dokdo Island form a clade with C. takesimana from Ulleungdo Island and that chloroplast genomes of the two accessions are diverged.

The spider mites of the genus Eutetranychus Banks (Acari, Trombidiformes, Tetranychidae) from Saudi Arabia: two new species, a re-description, and a key to the world species

Two new species of the genus Eutetranychus Banks are described and illustrated based on adult females and males, E.spinosus sp. n. from Indigoferaspinosa Forssk (Leguminosae), E.neotransversus sp. n. from Juniperusprocera Hochst. ex Endl. (Cupressaceae), and E.palmatus Attiah, 1967 is redescribed from Washingtoniarobusta H. Wendl. (Arecaceae). Additionally, the intraspecific morphological variations within E.orientalis populations, collected from 28 various host plants and 80 different localities from six regions of Saudi Arabia from 2009 to 2017, are discussed and presented. The genus Eutetranychus is divided into two species groups based on the presence of one seta (orientalis group) or two setae (banksi group) on coxa II. In addition, seven Eutetranychus species are suggested as synonyms of E.orientalis (Klein, 1936) and E.papayensis Iqbal & Ali, 2008 is considered as species inquirenda. A key to all known species of the genus Eutetranychus is provided.

First Report of Entomopathogenic Nematode Steinernema Feltiae (Rhabditida: Steinernematidae) from Croatia

A survey of entomopathogenic nematodes was conducted in Croatia between 2016 and 2017. The steinernematids were recovered in two out of 100 soil samples from agricultural land characterized as loamy soils with acidic reaction. Molecular and morphological identification was used to distinguish the nematodes. The isolates were identified as two different strains conspecific with Steinernema feltiae. The variations in morphometrical characteristics of infective juveniles (IJs) and males were observed among Croatian strains and with the original description. The analysis of ITS region revealed the greatest similarity of Croatian strains with Slovenian B30 and English A2 strains, which together comprised a monophyletic group in evolutionary analysis. This is the first record of steinernematids, namely S. feltiae in Croatia.

Alterations and Interchange of Morphometric Characters in Different Life Cycle Stages with Reference to Genomic Variations of Anopheles subpictus (Diptera; Culicidae) Sibling Species Complex in Sri Lanka

The species complex of the mosquito Anopheles subpictus is designated by the sibling species A⁻D, depending on morphological characters of life cycle stages and variations in polytene chromosomes. However, morphological aberrations in the life cycle stages make the identification of sibling species uncertain and imprecise. The objective of the present study is to determine the suitability of morphological variations of sibling species and their genomic variations to identify the sibling species status of an An. subpictus population in Sri Lanka. Life cycle stages of larvae, pupal exuviae, and adults were examined for previously reported distinctive morphological features. Five nuclear and mitochondrial genome regions, including the Internal transcribed spacer 2 (ITS2) region, D3 region, white gene, cytochrome c oxidase I (COI), and Cytochrome b (Cyt-b), were sequenced and analyzed for variations. The eggs changed their distinct sibling morphological characters during metamorphosis (89.33%). The larvae, pupal exuviae, and adult stages showed deviation from their sibling characters by 26.10%, 19.71%, and 15.87%, respectively. However, all the species from the analysis shared two distinct sequence types for all regions, regardless of the morphological variations. In conclusion, the An. subpictus sibling species complex in Sri Lanka is not identifiable using morphological characters due to variations, and the genomic variations are independent from the morphological variations.

Morphological variations of the mandibular canal in digital panoramic radiographs: a retrospective study in a Chilean population

BACKGROUND

Morphological variations of the mandibular canal (MC) have been described in literature, so the clinician must be able to recognise them and adapt their treatment accordingly. The aim of this study was to determine the prevalence of morphological variations of the MC using digital panoramic radiographs (DPR) of Chilean patients.

MATERIALS AND METHODS

A retrospective study in which 1400 DPR were analysed to identify cases of bifid, trifid and retromolar MC. The radiographs were analysed independently by two examiners who had previously been trained by a specialist in oral and maxillofacial radiology. Inclusion and exclusion criteria were applied to reach a final sample.

RESULTS

Nine hundred and twenty-five radiographs were included (599 female, 326 male; mean age 36.1 ± 15.54 years). The prevalence of bifid MC was 11% (n = 102), with no significant differences by sex (p = 0.069). Proportion of bifid MC was higher among younger patients (p = 0.038). Prevalence of morphologi- cal variations of type 1 bifid MC was 7.4% (n = 69), type 2 was 2.3% (n = 23), type 3 was 0% (n = 0) and type 4 was 1.1% (n = 10). Prevalence of retromolar canal was 0.9% (n = 8), with no significant differences by sex (p = 0.893) or age (p = 0.371); of these, 2 (0.2%) cases were forward type and 6 (0.6%) cases were retromolar type. No cases of trifid MC were found.

CONCLUSIONS

Digital panoramic radiographs are useful for detecting morphological variations of the MC; we were able to identify three types of bifid MC as well as retromolar canals. Proper identification of these variations by an easily accessible examination is important for avoiding possible complications in clinical-surgical practice.

Phenotypic differentiation of the Solidago virgaurea complex along an elevational gradient: Insights from a common garden experiment and population genetics

Plant species distributed along wide elevational or latitudinal gradients show phenotypic variation due to their heterogeneous habitats. This study investigated whether phenotypic variation in populations of the Solidago virgaurea complex along an elevational gradient is caused by genetic differentiation. A common garden experiment was based on seeds collected from nine populations of the S. virgaurea complex growing at elevations from 1,597 m to 2,779 m a.s.l. on Mt. Norikura in central Japan. Population genetic analyses with microsatellite markers were used to infer the genetic structure and levels of gene flow between populations. Leaf mass per area was lower, while leaf nitrogen and chlorophyll concentrations were greater for higher elevations at which seeds were originally collected. For reproductive traits, plants derived from higher elevations had larger flower heads on shorter stems and flowering started earlier. These elevational changes in morphology were consistent with the clines in the field, indicating that phenotypic variation along the elevational gradient would have been caused by genetic differentiation. However, population genetic analysis using 16 microsatellite loci suggested an extremely low level of genetic differentiation of neutral genes among the nine populations. Analysis of molecular variance also indicated that most genetic variation was partitioned into individuals within a population, and the genetic differentiation among the populations was not significant. This study suggests that genome regions responsible for adaptive traits may differ among the populations despite the existence of gene flow and that phenotypic variation of the S. virgaurea complex along the elevational gradient is maintained by strong selection pressure.