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Voice production has been an area of interest in science since ancient times, and although advancing research has improved our understanding of the anatomy and function of the larynx, there is still little general consensus on these two topics. This review aims to outline the main developments in this field and highlight the areas where further research is needed. The most important hypotheses are presented and discussed highlighting the four main lines of research in the anatomy of the human larynx and their most important findings: (1) the arrangement of the muscle fibers of the thyroarytenoid muscle is not parallel to the vocal folds in the internal part (vocalis muscle), leading to altered properties during contraction; (2) the histological structure of the human vocal cords differs from other striated muscles; (3) there is a specialized type of heavy myosin chains in the larynx; and (4) the neuromuscular system of the larynx has specific structures that form the basis of an intrinsic laryngeal nervous system. These approaches are discussed in the context of current physiological models of vocal fold vibration, and new avenues of investigation are proposed., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Introduction: The purpose of this study was to characterize the morphological variations in the quadratus femoris muscle (QF) and to create an anatomical classification that could be used in the planning of surgical procedures in this area, radiological imaging, and rehabilitation., Materials and Methods: Ninety-two lower limbs from 46 cadavers, fixed in 10 % formalin solution, were examined., Results: The QF muscle was present in all specimens. According to morphology, the QF muscle was classified into three types. The most common type was Type I, characterized by one muscular belly (78.3 %), while the second most common type was Type II, characterized by two bellies, was observed in 17.4 % of cases. The rarest type was Type III. It was characterized by three bellies and was found in 4.3 % of the cases., Conclusions: The current classification system on quadratus femoris morphological variability is novel. Morphological variants may contribute to clinical issues, such as the ischiofemoral impingement syndrome, that could arise from type I quadratus femoris. Hence, the current study may be applicated to planning surgical procedures, imaging, and rehabilitation., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests. Financial Disclosure: Friedrich Paulsen receives royalties from Elsevier for the 24th Ed. of the anatomy atlas “Sobotta” and the ‘Sobotta Textbook of Anatomy’ 2nd Ed, (Copyright © 2024 Elsevier GmbH. All rights reserved.)

The ocular system is in constant interaction with the environment and with numerous pathogens. The ATP-binding cassette (ABC) transporters represent one of the largest groups among the transmembrane proteins. Their relevance has been demonstrated for their defense function against biotic and abiotic stress factors, for metabolic processes in tumors and for their importance in the development of resistance to drugs. The aim of this study was to analyze which ABC transporters are expressed at the ocular surface and in the human lacrimal apparatus. Using RT-PCR, all ABC transporters known to date in humans were examined in tissue samples from human cornea, conjunctiva, meibomian glands and lacrimal glands. The RT-PCR analyses revealed the presence of all ABC transporters in the samples examined, although the results for some of the 48 transporters known in human and analyzed were different in the various tissues. The present results provide information on the expression of ABC transporters at the mRNA level on the ocular surface and in the lacrimal system. Their detection forms the basis for follow-up studies at the protein level, which will provide more information about their physiological significance at the ocular surface and in the lacrimal system and which may explain pathological effects such as drug resistance., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Benedikt Kleinsasser reports financial support was provided by Sicca Forschungsförderung of the professional Association of German Ophthalmologists. Martin Schicht reports financial support was provided by Sicca Forschungsförderung of the professional Association of German Ophthalmologists. Martin Schicht reports financial support was provided by Ernst und Berta Grimmke Stiftung. Martin Schicht reports financial support was provided by Ernst Muck Stiftung. Friedrich Paulsen reports financial support was provided by German Research Foundation. Friedrich Paulsen is Editor-in-Chief of the Annals of Anatomy If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Background: The pectoralis minor muscle is located in the anterior thoracic wall. Typically, is constituted by a single belly originating from the 3rd to the 5th rib and inserted into the coracoid process near the origins of the biceps brachii shorth head and of the coracobrachialis muscle. The current study, on human fetuses, aims to detect all morphological muscle variants and to create a new classification system., Material and Methods: Classical dissection of the thoracic wall and the upper limb was bilaterally performed on 25 (13 male and 12 female) human formalin-fixed fetuses aged 18-38 weeks of gestation. The spontaneously aborted fetuses were donated after parental consent to the Medical University anatomy program. The pectoralis minor muscle's morphology, the number of the muscle's bellies, their origins, and insertions, as well as the morphometric details of each belly of the pectoralis minor, were assessed., Results: The pectoralis minor was bilaterally found in all fetuses (50 cases). Three types of muscle were identified based on the number of muscle bellies. In type, I (typical anatomy), were classified the cases with a single belly (in 66%). This type was divided into two subtypes (Ia and Ib). In the subtype Ia, the single belly had a typical course, and in Ib, a proximal attachment was characterized by two small bellies connecting together and creating one muscular mass. In type II, two bellies (24%), and in type III, three bellies (10%) were identified., Conclusions: Pectoralis minor is morphologically variable in the number of its bellies, its course, its origins, its insertions, and the location of its proximal attachments. The most common type (typical anatomy) was the type I represented by one belly. Other identified variants in the number of bellies by the present study may be hypothetically a result of prematurely terminated embryogenesis., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

The fibularis brevis muscle belongs to the lateral compartment of the leg. It originates from the lower two-thirds of the lateral surface of the fibula bone and it also is attached to the anterior intermuscular septum. Its insertion is normally located on the tuberosity at the base of the fifth metatarsal bone, on its lateral side. However, distal attachment of this muscle is morphologically variable. Different variations have been identified and some classification systems have been created for both adults and foetuses. Based on various literature references, we have created a new classification system and compared the frequency of each type. The main aim of this review is to present morphological variations of the fibularis brevis tendon with their clinical significance, especially in autografting in case of surgical treatment of fibularis brevis tendon rupture. The clinical aspect of this pathology and some medical cases will also be presented., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Purpose: To evaluate the feasibility of studying the vascular supply of the orbital and palpebral lobes of the human lacrimal gland using micro-computed tomography (micro-CT) and microscopic dissection., Methods: The lacrimal gland artery of a fresh parasagittalized cadaver head (male, aged 76 years) was infused with a lead oxide-latex mixture near the occipital pole of the gland. The entire lacrimal gland was imaged using micro-CT and 3D cinematic rendering (CR) and then dissected under a surgical microscope., Results: Micro-CT and CR images showed well-demarcated internal vascular branches of the lacrimal artery and their distribution within the orbital and palpebral lobes. The entire course of the artery and its branches could be visualized by CR and microscopic dissection, with the former showing better spatial orientation and finer branching. The main artery runs along the free edge of the aponeurosis of the levator palpebrae superior muscle and lies in the isthmus portion of the gland (between the orbital and palpebral lobes). The branches of the main lacrimal artery include one branch to the orbital adipose tissue just before entering the gland, two branches to the orbital lobe (medial and lateral), and two branches to the palpebral lobe (medial and lateral). The main artery terminates as palpebral and orbital lobe branches in the lateral half of the lacrimal gland., Conclusion: Latex and contrast-enhanced micro-CT is very well suited to visualize the vascular anatomy of the lacrimal artery within the gland. A large number of lacrimal gland examinations using the method presented here are required to demonstrate and understand the variability of the vascular anatomy of the human lacrimal gland., Competing Interests: Declaration of Competing Interest None of the authors have nothing to disclose and have no conflicting interests., (Copyright © 2024 Elsevier GmbH. All rights reserved.)

Background: In 2008, members of the TEPARG provided first insights into the legal and ethical framework governing body donation in Europe. In 2012, a first update followed. This paper is now the second update on this topic and tries to extend the available information to many more European countries., Methods: For this second update, we have asked authors from all European countries to contribute their national perspectives. By this enquiry, we got many contributions compiled in this paper. When we did not get a personal contribution, one of us (EB) searched the internet for relevant information., Results: Perspectives on the legal and ethical framework governing body donation in Europe., Conclusions: We still see that a clear and rigorous legal framework is still unavailable in several countries. We found national regulations in 18 out of 39 countries; two others have at least federal laws. Several countries accept not only donated bodies but also utilise unclaimed bodies. These findings can guide policymakers in reviewing and updating existing laws and regulations related to body donation and anatomical studies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Introduction: The morphological variability of the fibularis brevis tendon in adults is well known. However, studies on its classification in the human fetus do not exist. The aim of this study was to provide the first comprehensive classification of the fibularis brevis tendon based on its insertion in human fetuses. The second aim of the study is to evaluate the prevalence of fibularis digiti quinti., Material and Methods: Forty-three spontaneously aborted human fetuses were studied (21 male, 22 female, 86 lower limbs). All were from a Central European population), aged 18-38 weeks of gestation at the time of death., Results: Three main types of fibularis brevis tendon were distinguished. The most common was Type I (77%), characterized by a single distal attachment. The tendon was attached to the tuberosity at the base of the fifth metatarsal, on the lateral side. The second most common was Type II (19%) - a bifurcated distal attachment. The main tendon was attached to the tuberosity at the base of the fifth metatarsal on the lateral side. Based on the attachment site of the accessory tendon, four subtypes were determined: Type IIA - the accessory tendon attached to the dorsal surface of the base of the fifth metatarsal. At the side of attachment, the fibularis brevis tendon was connected with a portion of the fibularis tertius tendon. Type IIB - the accessory tendon attached to the proximal part of the shaft of the fifth metatarsal. Type IIC - the accessory tendon was attached to the fascia covering the fourth interosseous space. Type IID - the accessory tendon was fused with fibularis longus tendon. Type III is the rarest (4%) - triple branched distal attachment. The main tendon was attached to the tuberosity at the base of the fifth metatarsal. The first accessory tendon was attached to the proximal part of the shaft of the fifth metatarsal, and the second accessory tendon was attached to the fascia covering the fourth interosseous space. The fibularis digiti quinti was present in 24 feet (28%) of the 86 lower limbs dissected., Conclusion: The fibularis brevis is characterized by high morphological variability. The proposed classification consists of three main Types (I-III), with Type II divided into subtypes (A-D). The fibularis digiti quinti is not closely related to the type of fibularis brevis tendon., Competing Interests: Declaration of Competing interest The authors declare that they have no competing interests. Financial Disclosure: Friedrich Paulsen receives royalties from Elsevier for the 24th Ed. of the anatomy atlas “Sobotta” and the ‘Sobotta Textbook of Anatomy’ 2nd Ed., (Copyright © 2023 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Background: Mental health problems are common in medical professionals and their development already starts at the undergraduate level. Studies on medical students can replicate higher prevalence for depression and burnout in this group, but they normally compare semester cohorts in an anonymized, cross-sectional approach and without a preventive perspective., Methods: We surveyed medical students at the beginning and end of their medical curriculum and collected data on burnout, depressivity, work related experience and salutogenesis parameters with validated self-administered questionnaires. Most remarkably we obtained the data from the same 58 individuals after 5.5 years, representing data of the highest quality in order to compare the mental health status at the beginning and the end of our students´ medical curriculum., Results: Our results not only show a severe exacerbation of physical, mental and emotional burnout in the participants at the end of their studies. The students also do not seem to have sufficient personal (resilience) or social resources (e.g. experience of social support) for coping with their mental health problems around the time of their graduation., Conclusions: Our participants reflect a development of mental health during their medical studies at university that is paving the way to the devastating prevalence of mental disorders and suicide in health professionals. From our results we derive an urgent need to integrate self-care and active coping in the learning goals of medical curricula., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier GmbH.)

Background: The tarsometatarsal 1 arthrodesis is an adequate treatment for moderate to severe hallux valgus deformity and instability of the first ray. Plantar plating arthrodesis has been shown to provide better mechanical stability and fewer postoperative complications than screw fixation or medial plating. The medio-plantar plate is a new plate design for Lapidus arthrodesis. It could combine the biomechanical advantages of the plantar plate and the anatomical overview of a medial plate. However, the implanted material can cause irritation of the tibialis anterior, which in some cases may require removal of the material. The purpose of this study was to examine the possibility of tendon irritation following medio-plantar first tarsometatarsal joint arthrodesis using cadaveric specimens., Methods: The study involved the simulated surgical procedure of medio-plantar plate arthrodesis on 30 lower extremities. After the plates were fixed, a thorough examination of the feet was conducted to assess any tendon irritation and to determine a recommendation for placement of the medio-plantar plate based on the Olewnik classification., Results: Irritation of the tibialis anterior tendon components with the medio-plantar plate depends mainly on the anatomic norm variant, classified according to Olewnik et al. A medio-plantar plate is particularly recommended in TA tendon Olewnik type 3 and type 5. The positioning of a medio-plantar plate in Olewnik type 1 and type 2 tendons depends on the anatomic fit of the medio-plantar plate and the bony configuration of the TMT 1 joint. A large portion of the TA tendon must be detached, so a different plate design may be preferred in these patients., Conclusions: TMT 1 arthrodesis with medio-plantar plating of the first tarsometatarsal joint should be performed considering the anatomic TA tendon variations., Level of Evidence: Level V, Expert Opinion includes Case Reports and Technique Tips., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

The lunate foveola is often the starting point of a cystic swelling called a "ganglion". To make the anatomy of this region more relevant to the needs of clinicians and more accessible to students, we propose to introduce the term lunate foveola (Foveola lunata) on the dorsal side of the wrist just distal to the os lunatum. The easily located foveola will help in the examination of the wrist to more easily understand the anatomy of the wrist and facilitate the examination of patients with wrist injuries when an injury to the lunate (Os lunatum) is suspected., Competing Interests: Declaration of Competing Interest We declare no conflict of interest., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Background: Compression of the ulnar nerve at the elbow within the cubital tunnel is related to the anatomical structures and is generally believed to be caused by Osborne's ligament (also known as the cubital retinaculum). However, in rare cases an anatomical variation of the developmental peculiarity of a remaining anconeus epitrochlearis muscle may be responsible for the disease., Methods: We present a series of five cases in which an anconeus epitrochlearis muscle was found as the cause of illness., Results: All patients presented with typical symptoms of numbness and tingling in the hand and ulnar fingers, and recurring pain as well as weakness of the ulnar innervated muscles. With neurophysiologically confirmed diminished nerve conduction velocity and unsuccessful conservative treatment, surgical decompression revealed an anconeus epitrochlearis muscle as the reason of compression. Full symptom relief was achieved immediately after the procedure in all cases., Conclusions: This article strives to call attention to this entity when diagnosing ulnar nerve compression. Myectomy and medial epicondylectomy is the preferred treatment option in such cases., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

The valves of the lacrimal drainage system are an enigma with a rich eponymous history. The unidirectional flow of tears along with the ultrastructural demonstration of distinctive mucosal folds on the luminal surface has rekindled an interest in them. The first in vivo direct demonstration of the valve of Rosenmüller and its functions has laid to rest some of the controversies of its existence and that of the valve of Huschke. The dynamic assessment of the valve of Rosenmüller has shown a well-defined functional role in the facilitation of unidirectional tear flow. The present mini review describes the embryological aspects, brief overview of the eponymous valves, techniques for their identification along with recent structural and functional aspects of the valve of Rosenmüller., Competing Interests: Declaration of Competing Interest None for any of the authors., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Purpose: The ligamentum mucosum is a ligamentous structure within the synovial layer of the knee joint capsule. It usually arises from the infrapatellar fat pad and is inserted into the intercondylar notch of the femur. In recent years, more attention has been paid to this structure because of its clinical significance. Despite the growing attention, the complex morphology of the ligamentum mucosum has led to many misunderstandings among the scientists and clinicians. Therefore, the main objective of this study was to characterize the morphology of the ligamentum mucosum and its attachment points, classify it, and evaluate its prevalence., Methods: Classical anatomical dissection was performed on 70 lower limbs of human fetuses fixed in 10% formalin solution. Morphology was carefully assessed, and morphometric measurements were performed. The types revealed were classified., Results: The ligamentum mucosum was present in 100% of all 70 specimens examined. Two types were detected. Type I (65.71%) - "cord-like". This type was the most common and is characterized by a single longitudinal ligament. The proximal attachment of the ligamentum mucosum was located in the middle of the infrapatellar fat, and the distal attachment was at the tip of the intercondylar notch. Type II (34.29%) - "vertical septum". This type is less common, but its morphology is much more complex compared to type I. It is wider and thicker than type I. Proximally, it is attached to the infrapatellar fat pad and distally through the entire intercondylar notch down to the anterior surface of the anterior cruciate ligament. It divides the joint cavity into medial and lateral sides., Conclusion: The ligamentum mucosum exhibits high morphologic variability, and the view that it is a vestigial remnant of the embryologic development of the knee should be reconsidered. We have proposed an anatomical classification of its types in human fetuses, which is a valuable addition to existing knowledge and will hopefully change the approach of clinicians and scientists., Competing Interests: Competing interests The authors declare that they have no competing interests. Financial Disclosure: Friedrich Paulsen receives royalties from Elsevier for the 24th Ed. of the anatomy atlas “Sobotta” and the ‘Sobotta Textbook of Anatomy’ 2nd Ed., (Copyright © 2022. Published by Elsevier GmbH.)

Objective: Urea constitutes a physiological and presumably well-regulated constituent of tear fluid. Its lacrimal concentration is significantly decreased in dry eye disease. Urea homeostasis within the tear fluid may also depend on the expression of urea transporters. The present study reports on the expression patterns of urea transporter A (UT-A) in the cells and tissues of the ocular surface and the lacrimal glands., Methods: UT-A immunohistochemistry was performed on 5 µm paraffin sections of paraformaldehyde-fixed human, porcine, and murine corneas, eyelids, and lacrimal glands (n = 5 each)., Results: UT-A immunostaining was largely comparable in all three species. UT-A signals were detected in the corneal epithelium and endothelium, in the conjunctival epithelium, in the acinar cells and excretory ducts of the lacrimal gland, Meibomian gland, and in the glands of Moll and Zeis. The Meibomian glands and the glands of Zeis exhibited a marked UT-A-positive staining in the basal cells of the alveolar epithelia and in the ductal epithelia., Conclusion: UT-A shows comparable expression patterns to UT-B (previous study) at the ocular surface and in the lacrimal glands, as determined by immunohistochemistry. The presence of both urea transporters in the lacrimal functional unit suggests that they are essential for the normal function of the lacrimal system and the integrity of the tear film. Potential alterations in urea transporter expression might be associated with the significant reduction of urea found in the tear fluid of dry eye patients. They may thus play an important role in the pathogenesis of dry eye disease., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

Objective: Urea is a component of tear fluid showing a significantly decreased concentration in dry eye disease. The urea content of tear fluid may depend on urea transporters. The purpose of this study was to examine the expression of urea transporter B (UT-B) at the ocular surface and in the lacrimal glands., Methods: UT-B protein and mRNA expression was investigated in human, porcine, and murine samples. Immunohistochemical staining for UT-B was performed on paraffin sections of human, porcine, and murine corneas, eyelids, and lacrimal glands (n = 5 each). Reverse transcriptase polymerase chain reaction was conducted to detect UT-B mRNA in human and murine cornea, conjunctiva, Meibomian gland, and lacrimal gland (n = 5 each)., Results: UT-B protein expression was comparable in all three species. It was found in the corneal epithelium and endothelium, in the conjunctival epithelium, in the end pieces and excretory ducts of the lacrimal gland, Meibomian gland, and in the glands of Moll and Zeis. The glands of Zeis and the Meibomian glands showed intense UT-B signals in the basal layers of the alveolar epithelia and in the cells of the ductal epithelia. UT-B mRNA was detected in all samples analyzed., Conclusion: UT-B is expressed by the cells and tissues of the ocular surface and in the lacrimal glands. Potential changes in urea transporter expression might have implications for the pathogenesis of dry eye disease. Since comparable results were obtained for all species investigated, the presented findings may open the door for DED-relevant experimentation on porcine and murine model systems., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

Background: A profound understanding of the evolution and anatomy of the viscero- and neurocranium is quintessentially important for orthodontists. This particularly alludes to structures, which are directly targeted by orthodontic therapy such as the maxilla and the mid-palatal suture. The anatomy of the mid-palatal suture of toothed individuals is well described, whereas little is known about sutures' morphological changes after tooth loss. Therefore, the aim of this study was to evaluate the edentulous mid-palatal suture by means of histologic and histomorphometric analysis., Methods: Ten mid-palatal sutures of edentulous donors as well as six age- and sex matched dentulous controls were examined. For the histological and histomorphometric analysis (sutural width, obliteration, vascularization and interdigitation) conventional staining protocols (HE, Movat-Pentachrome, Sirius Red) and immunofluorescence (vWF, TRAP) were performed. Histomorphometric analysis was carried out using NIS-elements imaging software., Results: When compared to dentulous controls, the edentulous investigation group showed a decreased vascularization and sutural width as well as an increased sutural obliteration. Notably, a high variability and inhomogeneity within regard the histomorphometric parameters was seen in edentulous samples., Conclusions: The mid-palatal suture of edentulous individuals showed significant morphological differences compared to individuals with toothed jaws. The loss of teeth and thereby functional loading seems to have a considerable impact on sutures' morphology., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

Background: In the medical literature several classifications of the pelvis according to its shape can be found. The most common classification distinguishes four general pelvis types: gynecoid, android, anthropoid and platypelloid. Natural childbirth may be significantly prolonged, difficult or even impossible if the pelvis shape is not in proportion to the size of the fetus. The objectives of our study were to calculate major diameters and conjugate diameters of the female bony pelvic ring and to determine the major pelvic types according to their shape. Based on the parameters obtained, we aimed to establish a relationship between some pelvic types and difficult childbirth., Methods: The study was prospective in design and included 54 female subjects of various ages who had been referred for computed tomography of the pelvis, as part of the diagnosis of an underlying condition. In each patient, five most important parameters in two planes were measured and the pelvic type was determined by using the brim index and a special formula for android type. All measurements were performed using the Vue PACS v 12.1.6.1005 program. The description of the pelvic inlet was used to confirm all pelvic types. Data on previous births were taken from the questionnaire filled out by the subjects during the radiological examination., Results: Gynecoid pelvic type was the most common in our sample (28 pelvises - 52%), followed by platypelloid type (11 pelvises - 20%), anthropoid type (8 pelvises - 15%) and finally android type (7 pelvises - 13%). There was a statistically significant difference in the diameter bispinous length (p < 0.05) between the platypelloid and anthropoid pelvic types. Pathological degree of stenosis was present in seven pelvises (the first degree in six pelvises and the second degree in one pelvis). The frequency of cesarean section was 31.82% and this technique was most frequently used in the subjects with a gynecoid pelvic type. The duration of natural labor ranged from 4 to 18 h. There was no statistically significant difference in the duration of labor between subjects with different pelvic types., Conclusions: Gynecoid pelvic type was present in more than half of our subjects. Although this type is considered ideal for labor, we have not established that it has a great influence on whether the labor will be performed naturally or by cesarean section, neither that it significantly affects the length of birth. The gross narrowing of the pelvic ring is present in non-gynecoid pelvic types. The data obtained will certainly be useful to the obstetrician when planning the labor and considering all the factors that may affect the course of birth., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier GmbH. All rights reserved.)

Background: The purpose of this study was to characterize the morphology of the fibularis tertius (FT) in human fetuses, and to provide a classification based on its modes of origin in human fetuses., Methods: The material comprised 100extremities from 50 spontaneously aborted human fetuses (19 male, 31 female, 100 lowerlimbs in total), aged 18-38 weeks of gestation. These were dissected and the presence or absence of the FT muscle as well as the type of its proximal attachment were determined, and the FT was measured morphometrically., Results: The FT was present in 50% of fetuses. Four types of FT muscle origin were identified. The most common was Type 2, characterized by an origin on the middle third of the fibula and the intermuscular septum. Three other types were observed: Type 1 with an origin located on proximal third of the fibula and to the intermuscular septum, Type 3 characterized by an absent muscle belly, and an independent tendon originating from the that of the extensor digitorum longus, and Type 4 with an origin located on the distal third of the fibula and the intermuscular septum., Conclusions: The fibularis tertius demonstrates high morphological variability, with the most common origin located on third of the fibula and to the intermuscular septum., Competing Interests: Competing interest The authors declare that they have no competing interests. Financial Disclosure: Friedrich Paulsen receives royalties from Elsevier for the 24th Ed. of the anatomy atlas “Sobotta” and the ‘Sobotta Textbook of Anatomy’ 2nd Ed., (Copyright © 2022. Published by Elsevier GmbH.)

Background: Observing the microwear patterns of the dental crowns enamel surface can provide information on the ingredients and structure of the food consumed, but also on eating habits and lifestyle. Major role in reconstructing the diet and lifestyle of past populations is played by the analysis of alkaline earth metals, such as strontium, barium, zinc and calcium. Ba and Sr are indicators of the consumption of vegetables, plants (cereals and legumes) and marine organisms. This study aims to assess dietary diversity and identify its components based on microscopic techniques and chemical analyses of material from early modern archaeological sites in Wrocław, Poland., Methods: The material consisted of 36 permanent molars and the intrasternal parts of 122 first ribs, collected from 6 Wroclaw early modern cemeteries. Tooth microwear was evaluated on Scanning electron microscopy images, with Microwear 4.02 software. Bone chemical composition (Ca, P, Ba, Sr content) was evaluated with mass spectrometry., Results: Most lines were present on the teeth from St. Mary Magdalene Cemetery, with the lowest average number of lines observed on the teeth from St. Barbara Cemetery. The Ca/P ratios calculated for different sites formed two clusters that allows to distinguish two groups of archaeological sites with different bone preservation status. Number of differences in Ba/Sr, Sr/Ca, Ba/Ca ratios was found between disctinct archaeological sites. A number of correlations were found between the concentration of the chemical elements, but no statistically significant correlation was found between the microwear characteristics and the proportion of the elements studied. Some strong correlations were found between microwear features and the Ca/P ratio., Conclusions: the different values of Sr/Ca, Ba/Ca and Ba/Sr ratios indicate different diets in the different communities. The data obtained indicate a mixed diet, with a relatively high proportion of animal products throughout Wrocław. Conclusions should be treated with caution due to secondary diagenesis. The lack of interdependence between microwear and chemical composition characteristics suggests that the two methods should be considered complementary and not overlapping, as they provide different insights into the diets of past populations. The comparison of microwear between different sites should always take into account secondary diagenesis and the burial environment, as these influence the characteristics of microwear., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background: Traditionally, dynamic and functional anatomy, in particular the dynamic anatomy of the neck, is studied on cadaveric material. However, the development of in vivo visualization technologies and in silico modeling has made it possible to expand these possibilities. Despite significant progress in the study of dynamic and functional anatomy of the neck by means of in silico methods, the issues of validating the developed models and taking into account the pronounced nonlinearity of soft tissues as well as local anisotropy remain open. The aim of this study was to develop a virtual dynamic anatomical model of the human neck and reproduce the dynamic processes in the cervical spine from this model using the finite element method., Materials and Methods: Reverse engineering was used to generate a dynamic anatomical model of the neck from CT data (both male, 24 and 22 years old). Two segments of the cervical spine (C3-C5, C2-T1) were isolated from the resulting model for finite element analysis. Finite element mesh generation and contact interactions were performed using the HyperMesh software (Altair Engineering Inc, Troy, Michigan, USA). The anisotropic hyperelastic Holzapfel-Gasser-Ogden model was used to describe the material behavior of the fibrous rings of the disc. Material modeling and finite element analysis were performed using Abaqus CAE 6.14 software (Simulia, Johnston, Rhode Island, USA)., Results: A technique for creating a virtual dynamic anatomical model of the neck was elaborated and implemented. The model includes 79 major anatomical structures of the neck segmented from radiological data. A finite element analysis of the cervical spine was performed. The results of finite element analysis of the C3-C5 segment under axial load were compared with in vitro data. The proposed model shows nonlinear deformation of the disc under static loading; the model predicted displacement values agree well with the experimental ones. The displacement of the С3-С5 central vertebra with an axial load of 800 N reaches a value of 0.65 mm. For the segment C2-T1, data on intradiscal pressure, stress plots and displacements during flexion were obtained. The maximum stress value of 10.036 MPa is observed in the C3-C4 disc., Conclusion: Simulation results using the proposed methodology are in good agreement with experimental data. The generated biomechanical models allow describing dynamic phenomena in the cervical spine and obtaining a wide range of quantitative properties of anatomical objects, which are otherwise inaccessible to classical methods for studying dynamic and functional anatomy., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

The attitudes of medical students towards the clinical importance of neuroanatomy have been little studied. Because it has been reported that medical students find neuroanatomy difficult and can have 'neurophobia', here we test the hypothesis that early-stage medical students across Europe have a low regard for neuroanatomy's clinical relevance. The work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG), with just over 1500 students from 12 European medical schools providing responses to a survey (52% response rate) that assessed their attitudes using Thurstone and Chave methodologies. Regardless of the university surveyed, and of the teaching methods employed for neuroanatomy, our findings were not consistent with our hypothesis. However, the students had a less favourable opinion of neuroanatomy's importance compared to gross anatomy; although their attitudes were more positive than previously reported for histology and embryology. The extent to which neuroanatomy plays a significant role in the early years of medical education is moot. Nevertheless, we conclude that in addition to newly recruited medical students being informed of the subject's role in a healthcare profession, we advocate the use of modern imaging technologies to enhance student understanding and motivation and cognisance of the core syllabus for the subject being developed by the International Federation of Associations of Anatomists (IFAA)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Introduction: The morphological variability of the fibularis longus tendon (FLT) in adults is well understood. However, no comprehensive classification exists in human fetuses. The goal of this study was to prepare the first comprehensive classification of the fibularis longus tendon based on its insertion in human fetuses., Material and Methods: Forty-seven spontaneously-aborted human fetuses were examined: 38 male, 56 female, a total of 94 lower limbs (Central European population). Age ranged from18-38 weeks of gestation at death., Results: The classification comprised three types of FLT. The most common type was Type I (49%), characterized by the single distal attachment. This type was divided into two subtypes (A-B): A - the tendon inserts to the lateral tubercle of the base of the 1st metatarsal bone, B - the tendon inserts to the head of the 1st metatarsal bone. The second most type was Type II, characterized by a bifurcated distal attachment (24.5%). This type was divided into three subtypes (A-C): A - the main tendon inserts to the lateral tubercle of the base of the 1st metatarsal bone and the accessory band inserts to the medial cuneiform bone; B - the strong, main tendon inserts to both the base of the 1st metatarsal bone and medial cuneiform bone, including the first metatarsal-cuneiform joint, and the accessory bands inserts to the fourth interosseus dorsalis muscle; C - the main tendon inserts to the lateral tubercle of the base of the 1st metatarsal bone and the accessory band inserts to the first interosseus dorsalis muscle. The rarest type was Type III, characterized by a trifurcated distal attachment: the main tendon inserts to the lateral tubercle of the base of the 1st metatarsal bone and the first accessory band inserts to the medial cuneiform bone and the second accessory bands inserts to the first interosseus dorsalis muscle. The anterior frenular ligament was observed in 16% of all cases, and posterior frenular ligament in 6.4%., Conclusion: The FLT displays high morphological variability. The proposed classification consists of three main types, with Type I and Type II divided into sub-types; it also provides additional data regarding its accessory tendon bands., Competing Interests: Competing interests The authors declare that they have no competing interests. Financial Disclosure: Friedrich Paulsen receives royalties from Elsevier for the 24th Ed. of the anatomy atlas “Sobotta” and the ‘Sobotta Textbook of Anatomy’ 2nd Ed., (Copyright © 2021 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Background: In invasive examinations of the colon, e.g. colonoscopy, the tortuosity of the colon is a crucial factor for successful completion of the procedure. If adjacent segments of the colon bend at acute angles (under 90°), endoscopy may become difficult and troublesome., Methods: We retrospectively enroled 227 individuals (96 female, 131 male) who underwent abdominopelvic computed tomography examination. For inclusion, subjects were required to have a negative history for colonic disease and abdominopelvic surgery. We measured the angle between the descending colon and the proximal part of the sigmoid (in degrees). In addition, the position of the descending-sigmoid flexure was assessed in relation to the left anterior superior iliac spine, the median plane, and anterior aspect of the 5th lumbar vertebra (in mm). The study protocol was reviewed and approved by the local ethics committee., Results: We visualised the descending-sigmoid flexure in all 227 subjects. In one third of cases, the flexure formed an angle smaller than/or 90°. In females, this landmark (mean ± standard deviation) was located 30.2 ± 8.4 mm from the left anterior superior iliac spine, 88.6 ± 14.2 mm from the median plane, and 115.4 ± 21.4 mm from the anterior aspect of the 5th lumbar vertebra. In males, the dimensions were: 32.1 ± 12.8 mm, 97.6 ± 15.8 mm, and 123.9 ± 22.9 mm, respectively. This landmark distance remained constant from the left anterior superior iliac spine regardless of subject age, height and weight. The other measured distances were related to age, height, weight or BMI., Conclusions: The descending-sigmoid flexure is an important landmark in large intestine morphology situated approximately width of two fingers (3 cm) from the left anterior superior iliac spine and one hand width (9-10 cm) from the median plane. In approximately one third of the subjects, the flexure formed an angle of less than/or 90°, which can cause a problem during colonoscopy., Competing Interests: Conflict of interest statement We declare no conflict of interest., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Objectives: Research involving the nose reveals important information regarding the morphology and physiology of the epithelium and its molecular response to agents. The role of nasal epithelial cells and other cell subsets within the nasal epithelium play an interesting translational split between experimental and clinical research studying respiratory disorders or pathogen reactions. With an additional technical manuscript including a detailed description of important technical aspects, tips, tricks, and nuances for a successful culturing of primary, human nasal epithelial cells (NAEPCs), we here aim to improve the process of communication between experimentalists and physicians, supporting the purpose of a fruitful work for future translational projects., Methods: Based on previous work on various complex culture models of subject-derived NAEPCs, this additional manuscript harmonizes previously published facts combined with own experiences for a trouble-free implementation in laboratories., Results: A well-designed experimental question is essential prior to the establishment of different NAEPCs culture models. The correct method of cell extraction from the nasal cavity is essential and represent an important basis for successful culture work. Prior enzymatic processing of biopsy specimens, cell culture materials, collagenization procedure, culture conditions, and choice of culture medium are some important practical notes that increase the quality of the culture. Moreover, protocols on imaging techniques including histologic and electron microscopy must be adapted for NAEPC culture. Adapted flow cytometric protocols and transepithelial electrical resistance measurements can add valuable information., Outlook: A successful culturing of NAEPCs can provide an important basis for genetic studies and the implementation of omics-science, which is increasingly receiving broad attention in the scientific community. The common aim of in vitro 'mini-noses' will be a breakthrough in laboratories aiming to perform research under in vivo conditions. Here, organoid models are interesting models presenting a basis for translational studies., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background: In addition to traditional craniometric techniques, computer craniometry has been used in recent decades, including stereometric methods, which make it possible to determine the microanatomical spatial relationships and dimensional features of various structures of the skull, in particular the thickness of the inert palate of the maxilla., Aim: Determination of the gender-specific variability of the thickness of the bony palate at the age of 18-20 years using CT., Material and Methods: The material of the pilot study were 40 computed tomograms of young males and females aged 18-20 years. The method of computer craniometry was used to measure the thickness of the bony palate in sagittal projection taking into account the gender. A graphic raster map was created to identify the palatal areas, then analyze their thickness and determine the safe zones for the mini dental implants., Results: In young males and females (18-20 years) the thickness of the bony palate decreases at different levels from front to back and from the median suture to the alveolar process. The greatest thickness of the bony palate corresponds to its anterior third and reliably predominates in young males at all levels compared to young females. In the middle and posterior third palate, the averages do not show gender differences and their variation is insignificant., Conclusions: The greatest thickness of the bony palate can be used as the most favorable zone for the fixation of orthodontic mini dental implants. The variability in the thickness of the bony palate should be considered when selecting the most optimal zones and depth of mini-implant placement., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background: Wound healing disorders characterised by impaired or delayed reepithelialisation are a serious medical problem. In the present study, we show that gold-based blood serum therapy is a suitable therapeutic approach and shows a supportive effect in wound closure of human corneal epithelial cells (HCE) in primary in vitro experiments., Methods: For this purpose, blood from healthy individuals was incubated without (S.Ctrl) or with gold-microparticles (S.Therapy) for 24 h. Prior to human epithelial cell stimulation (HCE), the gold particles were removed and the serum was diluted in DMEM (10 % or 30 %). Both groups of serum were compared after injury. HCE were cultured and injured (corneal in vitro wound model) and then stimulated with S.Ctrl or S., Results: Treatment with serum from a gold-based serum therapy (S.Therapy) shows a supportive effect on wound healing in HCE cells in vitro. In addition, gold therapy supports the secretion of important cytokines normally associated with ocular surface wound healing (IL-1β, IL-6, TNF-α and TGF-β) in HCE cells., Conclusions: Therapy with gold-based blood serum significantly promotes the secretion and expression of cytokines and growth factors in HCE cells in vitro. Further preclinical experiments are necessary to demonstrate the influence of this therapy on HCE cells for possible clinical application on the human ocular surface and to prove its function also in poorly healing corneal lesions., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background: Test anxiety is a common phenomenon at universities with the potential to impair academic performance and student well-being. This study was conducted to investigate prevalence, characteristics, and development of the test anxiety categories "emotionality", "worry", "interference", and "lack of confidence" among first year medical students., Methods: Overall, 625 freshman medical students were enrolled. They were recruited from the participants of a first semester anatomy course. The participants were assessed four times with a validated psychological test anxiety questionnaire (Prüfungsangstfragebogen, PAF). The first assessment was conducted at the commencement of the first semester. All further assessments were performed two days prior to each of three mandatory oral anatomy tests in the course of one half year. Prevalence rates as well as mean global and subscale scores of the test anxiety dimensions "emotionality", "worry", "interference" and "lack of confidence" were determined and compared between assessments., Results: Approximately 50% of the study participants showed pronounced test anxiety in at least one dimension over the observation period. Only about 10% were considered test anxiety-positive according to the global PAF scale. Worry showed the highest (up to 48%) and interference the lowest (≈5%) prevalence rates. Emotionality had a stable prevalence of approximately 17%, whereas lack of confidence showed a rising trend over the observation period from 15.2% up to 24.0%., Conclusion: Test anxiety is substantially more prevalent among medical students as commonly reported and deserves more detailed, dimension-specific exploration in future. Especially worry and lack of confidence give reason for concern, demanding further investigation., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Purpose: Although the plantaris muscle is vestigial in humans, it is far too important to remain omitted. The aim of this study is to provide a comprehensive review of the existing literature focused on plantaris muscle clinical value, grafting usefulness and its morphological variations. Hopefully this study will be of great use for every medical practitioner due to its clarity and conciseness despite such broaden scope of this article., Material and Methods: The article is written based on 100 studies published since 1868 until 2020. During careful selection process 12 papers were dismissed due to their insufficient sample size, wrong methods used or results that were previously discovered., Results: Many aspects concerning the plantaris muscle are already well examined, summarized and described. However this study has shown how much we still do not know and which fields require further investigations., Conclusion: The anatomical variations of plantaris muscle morphology may cause mid-portion Achilles tendinopathy, tennis leg syndrome or increase the risk of failure while harvesting the tendons., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Background: Ultrasound is a routine procedure performed during pregnancy to monitor the status of the human fetus, including the development of the digestive tract. The aim of this publication was to determine the shape of the fetal sigmoid colon mesentery during the first and second trimester of pregnancy by means of ultrasound., Methods: The study was performed in 45 pregnant women (age: 36.4 years on average, range 25-45) during a routine ultrasound examination. The fetuses were between 12 and 22 weeks of pregnancy. The shape of the fetal sigmoid colon mesentery was analyzed., Results: We visualized the triangular shape of the mesentery in all 45 cases. A prevalence of scalene or isosceles acute triangles was found in both trimesters. At the 12-13 weeks we observed 5 different forms of mesenteric triangles - the scalene or isosceles acute triangles appeared at 33.3% and 28.6%, respectively. The obtuse scalene was present in 23.8 %. In the 2nd trimester (20-22 weeks) 4 types were found, among them 37.5 % acute scalene and 33.3 % acute isosceles., Conclusions: The fetal sigmoid colon mesentery can be visualized from the 12th week of pregnancy. The triangular shape of the sigmoid colon mesentery is easy to follow during routine ultrasound examinations., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Purpose: To evaluate the density and distribution of conjunctival goblet cells in mice without clinical evidence of ocular surface diseases., Methods: Immediately after euthanasia of C57BL/6 wild-type mice, the eyes including eyelids were removed and fixed in paraformaldehyde. Entire eyeballs and eyelids were cut in series along the sagittal axis from nasal to temporal on a microtome and then stained with Periodic Acid-Schiff acid to visualize the goblet cells. At each section stained in this way, the conjunctival goblet cells of the entire upper and lower lid conjunctiva were counted by light microscopy. Additional (transmission electron microscopy) (TEM)-Analysis on ultrathin sections was performed to evaluate morphological differences., Results: The total number of conjunctival goblet cells differs markedly between individual animals. Categorisation into upper eyelid (UL) and lower eyelid (LL) and into regions (nasal, middle, temporal) revealed a significant increase of goblet cells from nasal to temporal in the UL and a significant decrease in the LL., Conclusion: The distribution of conjunctival goblet cells in mice differs considerably from humans and between individual animals. Therefore, precise selection of sampling and methods are needed to obtain comparable data. We recommend to use the middle region of the conjunctiva of UL/LL for goblet cell studies in mice. These findings are of particular interest for dry eye mouse models as well as pharmacological studies on mice with influence on their goblet cells., (Copyright © 2021 Elsevier GmbH. All rights reserved.)

Aim of the present study was to identify the nerve structures of meibomian glands in humans, rats and mice into sympathetic, parasympathetic and sensory parts as well as their topographical relation with regard to the gland architecture. The upper and lower eyelids of humans, rats and mice were examined by means of immunohistochemistry and indirect immunofluorescence. Specimen were investigated with antibodies against vesicular acetylcholine transporter (VAChT), tyrosine hydroxylase (TH), nitric oxide synthase (NOS), and calcitonin gene-related peptide (CGRP). For overview and general identification of the nervous structures, protein gene product 9.5 (PGP 9.5) was used. PGP-immunoreactive nerve fibers were detectable in the interstitium of the meibomian glands, especially in the neighborhood to the basement membrane of the acini. The axons were positive for CGRP, VAChT, TH and NOS. In addition, the fluorescence labeling also revealed isolated nerve endings surrounding the duct system of the glands, especially along the main duct and in adjacent blood vessels. The density of the innervation of the meibomian glands and the detection of various neuropeptides suggest an influence of the nervous system on the function of the glands. To what extent these may play a role in the modulation of glandular function and the pathogenesis of dry eye disease, or perhaps even represent a possible therapeutic approach, needs further investigation., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

The research aims were to find out further intraosseous mandible organization indications and to structure it systematically., Material and Methods: in our research 400 mandibles were used: for the intraosseous examinations in total 300 mandibles of persons aged 20-65 were used. For all corpses cephalic index was measured. Segmentation of the mandibles were made by Jigley saw between medial root of the first molar at one side and central and second incisor of the opposite one. After that segments were stained with Schiff's reagent with following preparation. Dry preparations (n = 100) were used in exploration of mental foramen macroanatomy., Results: mental foramen cavity depth was divided into three types: low, n = 33 (depth 269 ± 081 mm), medium, n = 36 (depth 358 ± 092 mm) and deep, n = 31 (depth 417 ± 036 mm); transverse size of the cavity is 3109 ± 041 mm and longitudinal size is 397 ± 055 mm. According to the mandible anterior intraosseous organization research it is possible to make a mental nerve intraosseous canal types systematization: semi-oval; straight; s-shaped type, formed by two opposite and transient bends. The S-shaped type (49%) is more common in persons with a dolichocephalic skull type, especially (57.55%) in mesocephalic type and semi-oval (66.36%) in brachycephalic type., Conclusion: nerve in the eponymous mental foramen, (which we would like to call a cavity), is branched into two large branches: the extraosseous branch, which innervates the soft tissues (such as Rr. mentales, Rr. labiales and Rr. gingivales), and the intraosseous branch, which runs from the mental foramen to the symphysis, from the latter branch to the first premolar, to the canine and to the incisors., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Introduction: The soleus muscle (SM) is located in the superficial posterior compartment of the leg, together with the gastrocnemius muscle (GM) and plantaris muscle. There is little information on the morphological variability (pennation) of the SM. The aim of the study is to characterize the variations in the morphology of the pennation of the SM and to create the first accurate classification., Material and Methods: Eighty lower limbs (40 left, and 40 right) fixed in 10% formalin solution were examined. The morphology of the central tendon, medial and lateral aponeuroses was evaluated, together with the pennation angle., Results: In all cases, the soleus muscle was present. Four types could be distinguished based on muscle fibre morphology. In order of frequency: Type 1 - bipennate (43.75%); Type 4 - non-pennate (36.25%); Type 2 - unipennate (15%); Type 3 - multipennate (5%). No significant difference in type distribution was observed with regard to body side (p=0.9018) or gender (p=0.0844)., Conclusion: The soleus muscle is characterized by high morphological variability. Based on the pennation angle, four types (1-4) of soleus muscle are distinguishable., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Transient receptor potential (TRP) channels are cation channels with ubiquitous expression. Various TRP channels are functionally active at the ocular surface and are involved in tear secretion and multiple inflammatory processes. So far, the impact of TRP channels regarding the development of the lacrimal gland (LG) is unclear. While investigating TRP channels in the LG, the TRPM3 channel presented itself as a promising candidate to play a role in the development and functioning of the LG. Therefore, Trpm3 expression was analyzed in different embryonic and postembryonic LGs. Thus, gene expression of TRPM channels including Trpm2, Trpm3, Trpm4 and Trpm6 was analyzed by quantitative RT-PCR in murine LGs at different developmental stages. Localization of TRPM3 in LGs was examined by immunohistochemistry. Primary LG epithelial cells (LGEC) and mesenchymal cells (MC) from newborn mice were cultured (either separately or collectively) for three days, and Trpm3 expression was analyzed in LGEC and MC. As a result, gene expression of Trpm2, Trpm4 and Trpm6 showed no significant difference in LGs in the different stages of development. However, Trpm3 gene expression was significantly higher in the embryonic stage than in the postnatal stage with the peak at E18. Postnatal, Trpm3 expression significantly decreased up to 28-fold until two years of age. Immunohistochemistry for TRPM3 revealed apical membranous expression in the excretory ducts, as well as in the acini of up to P7 old mice. Trpm3 expression in LGEC were significantly higher than that of MC. Our results indicate that Trpm3 expression in murine LG is age-dependent and peaks at age E18. Its expression is localized in the apical membrane of the glandular epithelium. However, its functional role still requires additional study in the LG., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Background: The classical anatomical representation of the lingual relief of the mental region of the mandible reflects the presence of geniohyoid as well as genioglossus attachment areas, which are divided into two or single areas. The International Anatomical Terminology (contains references to the presence of upper and lower spinae mentales, but the terminology does not reflect the content of these structures. The aim of this study was to examine and classify the lingual canals of the mental region., Materials and Methods: Using a Sirona ORTHOPHOS XG 3D tomograph (isotropic voxel size 0.1 in high-resolution mode) and KaVo 3D eXam cone beam computed tomography, the mental region of the mandible was analyzed in 561 patients aged 18-75 years with regard to bone density and the occurrence of a canal opening on the lingual side of the mandible. In order to visualize the mental spine area, another 50 mandibles were analyzed, divided into two groups of 25 mandibels each: 25 native and 25 dry preparations., Results: By prevalence the following channel types were classified: in 33% type I (narrow); in 32% type II (double) and of these in 17.5% (convergent) and type IIb in 14.5% a type IIb subtype (non-convergent); in 14% type III (wide); in 12% type IV (hook-shaped) and in 9% type V (diverging channel), identifying three combined components: the system of channels of the superior and inferior mental spine, and the transversal intraosseous canal of the mental region of the mandible., Conclusions: Our anatomical and radiological approach allowed us to suggest a new classification of intraosseous organization of the anterior part of the human mandible. As a result of studying X-ray anatomical and anatomical-topographical, constitutional-based, structural features of the mandible, intraosseous structures of the anterior mandible were clarified and classified, which solve not only terminological disputes, but also are important clinical guidelines for bone surgery, prosthetics, traumatology, endodontic treatment, dental implantation and local anesthesia., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Purpose: The plantaris muscle is a morphologically variable structure with regard to both its origin and insertion, and the course of the tendon. We here determined the pattern of branching and distribution of intramuscular nerves of the plantaris muscle to determine its usability for autologous transplantation. No information exists on the innervation of the plantaris muscle using Sihler's staining technique, and hence its intramuscular nerves. The main purpose of the work is to determine the pattern of branching and distribution of the intramuscular nerves of the plantaris muscle. Is the plantaris muscle a good transplant candidate?, Materials and Methods: Eighty lower limbs from cadavers (40 left, 40 right, 40 male, 40 female, age range 41-94 years) were fixed in 10% formalin solution and examined macroscopically as well as morphometrically with regard to the innervation pattern of the respective plantaris muscle. Afterwards Sihler's staining was used in all 80 plantaris muscles to identify the exact distribution of the muscular branch originating from the main nerve trunk in the muscle belly., Results: Two patterns of branching and nerve distribution could be intensified in the plantaris muscle: Type I, with a single pattern entire up to the muscle and then divided into superior and inferior intramuscular branches.; type II with a double innervation pattern (superior and inferior). The superior and inferior pattern were not connected to each other., Conclusion: The plantaris muscle reveals variability with two different innervation patterns. Type II is ideally suited for autologous transplantation. New classifications of innervation are desirable for individual muscles rather than a generalized approach., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Purpose: To provide a systematic review of the literature on the ultrastructural findings of the lacrimal drainage system in healthy state and in few of the disorders studied so far., Methods: The authors performed a PubMed search of all articles published with reference to electron microscopic features of the lacrimal drainage pathways. Data captured include demographics, study techniques, scanning or transmission electron microscopic features, presumed or confirmed interpretations and their implications. Specific emphasis was laid on addressing the lacunae and potential directions for future research., Results: Ultrastructural studies have led to better understanding of the lacrimal drainage anatomy-physiology correlations. Cellular interactions between fibroblasts and lymphocytes could form a basis for pathogenesis of punctal stenosis. Ultrastructural characterization of peri-lacrimal cavernous bodies and changes in primary acquired nasolacrimal duct obstruction (PANDO) led to them being partly implicated in its etiopathogenesis. Electron microscopic characterization of the dacryolith core promises insights into their evolution. Ultrastructural tissue effects of mitomycin-C during a DCR surgery has provided potential evidence of its role in cases with high-risk of failure. Lacrimal stent biofilms are common but their clinical implications are currently uncertain., Conclusion: Ultrastructural exploration of lacrimal drainage system so far has been limited and sparsely explored. The list of unexplored areas is exhaustive. There is a need for the lacrimal Clinician-Scientist to make themselves familiar with techniques and interpretation of electron microscopy to advance the ultrastructural frontier of this science., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

The human large intestine in the living adult has a total length of about 1300 mm, ranging from 1100 to 2108 mm. The development of the gut continues after birth, up to the age 4-5. The large intestine ascends at the beginning in the right abdominal quadrant, then it traverses the abdominal cavity, and finally it descends to the anus. The left and right colic flexures are the basic flexions between the transverse, ascending and descending colon, respectively. Additionally, there are secondary bendings between intestinal segments. The angles between the neighbouring parts can vary between examined subjects. Most of the angulations can be found in the transverse (range 2-9) and sigmoid colon (range 1-9), making them the most troublesome parts to pass with a colonoscope. Colonoscopy (usually performed in the left lateral or supine position) is one of the most important examination of the large intestine mucus membrane. During this procedure the endoscope is passed through the colon into the cecum or terminal ilium. The individual anatomical features (tortuosity, supernumerary loops and elongation) may slow down or interfere with the progress of the scope. We summarize current knowledge on the human large intestine from the fetal period to adulthood and carve out some aspects that are currently less known to colonoscopists., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Purpose: To provide a systematic review of the literature on the disorders and management of the lacrimal drainage system (LDS) in few of the species of the animal kingdom., Methods: The authors performed a PubMed search of all articles that were published in English with specific reference to lacrimal drainage disorders in animals. Data captured include demographics, presentations, investigation, diagnoses and management modalities. Emphasis was also on anatomical differences, evolutionary perspectives and addressing the lacunae and potential directions for future research., Results: The lacrimal drainage system is a terrestrial adaptation in vertebrates. Evolutionary development of the LDS is closely linked to the Harderian gland and the vomeronasal organ. Variable differences in the clinical presentations and management of lacrimal drainage disorders (LDD) are noted in comparison to humans. These are secondary to unique structural and pathophysiological differences. Uniformity in usage and reporting of disease terminologies is required. Diagnostic challenges in clinical examination can be met with the development of customized lacrimal instruments. Contrast dacryocystorhinography is a very useful investigation in the diagnosis of LDD. Multiple bypass procedures like conjunctivorhinostomy, conjunctivobuccostomy and conjunctivomaxillosinosotomy have been described for nasolacrimal duct obstruction (NLDO). Advances of endoscopy and radiological techniques are paralleled by minimally invasive lacrimal interventions. The search for an ideal animal model for human LDS is far from over and the choice of the animal needs to be customized based on the research objectives., Conclusion: The lacrimal drainage system is an ancestral feature in tetrapod vertebrates and it is present, in some form or another, in most descendant species. The lacrimal drainage system has evolved considerably, adapting to the needs of the species. It is essential to understand the lacrimal drainage disorders of domestic animals so that the animal and human lacrimal sciences contribute more meaningfully to each other., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Purpose: To provide a review and an update on dacryocystography (DCG) and its relevance in the current era., Methods: The authors performed a PubMed search of all articles published in English on DCG, digital subtraction-DCG (DS-DCG), computed tomographic DCG (CT-DCG) and magnetic resonance-DCG (MR-DCG). Data analyzed include the indications, techniques, interpretations, complication and limitations., Results: Dacryocystography has been used for illustrating the morphological and functional aspects of the lacrimal drainage system (LDS). Subtraction DCG provides the precise location of the alterations and acceptably delineates stenosis or an obstruction. Transit time for contrast into the nose varies widely across the studies. Low osmolality iodinated contrast media are tolerated well for DS-DCG and CT-DCG. However, normal saline either mixed with lidocaine or alone provided similar image quality as obtained with gadolinium for MR-DCG. CT-DCG provides useful information in complex orbitofacial trauma and lacrimal tumors. MR-DCG allows better 3D visualization of the LDS and dynamic functional evaluation. Sensitivity of CT-DCG and MR-DCG are mostly similar in identifying an LDS obstruction., Conclusion: Various forms of DCGs can provide additional information to evaluate patients with maxillo-facial trauma, functional epiphora, suspected lacrimal sac diverticula, partial nasolacrimal duct obstruction, and lacrimal drainage tumors. Canaliculi and the membranous part of the nasolacrimal duct are not yet visualized in detail and further focused studies with advanced techniques are required., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Purpose: Benzalkonium chloride is the most widely used preservative in ophthalmic topical solutions. The aim of this study was to investigate the influence of BAC as a single substance or as a component of several commercially available ophthalmic solutions on meibomian gland epithelial cells in vitro., Materials and Methods: An immortalized human meibomian gland epithelial cell line (HMGEC) was used and cells were cultured in the absence or presence of fetal bovine serum to assess cell morphology, cell proliferation, cell viability (MTS assay) and impedance sensing (ECIS) after stimulation with BAC. Further, the viability of HMGECs stimulated with BAC-containing and BAC-free bimatoprost, travoprost and latanoprost was evaluated using the MTS assay. Real-time PCR analysis for hyperkeratinization associated genes (cornulin, involucrin) was performed., Results: In the absence of serum, the proliferation rate of HMGECs decreased starting with 0.1μg/ml BAC. At concentrations of 50μg/ml BAC and higher, cell viability was reduced after 10min exposure with a corresponding change in cell morphology. Toxicity of BAC-containing ophthalmic solutions was greater than that of BAC alone, whereas BAC-free alternative products did not significantly influence cell viability. Confluence, cell-cell contacts and serum-containing medium appeared to facilitate HMGECs survival. Expression rate of involucrin and cornulin declined after exposure to preserved bimatoprost and BAC., Conclusions: BAC showed cytotoxic effects on HMGECs starting with a concentration of 0.1μg/ml. The combination of BAC and prostaglandin-analogs might have a synergistic effect which results in higher toxicity than BAC alone. Unpreserved eye drops and eye drops preserved with Polyquaternium-1 are less damaging to HMGECs., (Copyright © 2019 Elsevier GmbH. All rights reserved.)

Normally, the inferior root of Ansa cervicalis passes around the internal jugular vein and runs in an anterior direction to meet the superior root ventral to the common carotid artery. However, anatomical variants of the Ansa cervicalis are as yet not well investigated and understood. To close this gap the present study was undertaken. The Ansa cervicalis was examined in 54 human formalin-fixed cadavers and preparations of the head and neck by conventional dissection. In 66% of the specimens the Ansa cervicalis displayed the typical course that was classified as "internal type" (located medial to the internal jugular vein inside the carotid sheath). The remaining 34% pertained to the "external type" of the Ansa cervicalis (lateral to the internal jugular vein). The distance of the Ansa cervicalis relative to the superior margin of the thyroid cartilage was measured in every specimen. The external type Ansa cervicalis was located significantly lower than the internal type relative to the superior margin of thyroid cartilage. Regarding its location relative to the internal jugular vein four variants of combinations of the external and internal types of Ansa cervicalis on the right and left sides were distinguished. Based on their distance from the superior margin of the thyroid cartilage three types of Ansa cervicalis were defined., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

The practice of human and veterinary medicine is based on the science of anatomy and dissection courses are still irreplaceable in the teaching of anatomy. Embalming is required to preserve body donors, for which process formaldehyde (FA) is the most frequently used and well characterized biocidal substance. Since January 2016, a new occupational exposure limit (OEL) for FA of 0.37mg/m 3 issued by the European Committee on Hazardous Substances is obligatory since FA has been classified as a human 1B carcinogen. The anatomical institutes in the German-speaking region are called upon to consolidate efforts to reduce use of FA in anatomical curricula and body donations. As a result, the Anatomische Gesellschaft (AG) has formed a "Working Group for Reduction of Formaldehyde Exposure in Dissection Courses" tasked with discussion and recommendation of measures to reduce FA. Based on the assessment of the Working Group, the AG has issued an official opinion to the effect that, at this point in time, embalming of body donors without FA completely is not feasible. Therefore, a combination of approaches are to be used to reduce FA exposure, including technical and structural (architectural) adaptations, modification of protocols for fixation and preservation as well as organizational measures. One structural measure considered unavoidable is the integration of air supply and exhaust of individual dissecting tables into the ventilation system of the anatomy building. To embalm human body donors, intra-arterial perfusion fixation with up to 4% FA and a total fluid volume of 150mL/kg body weight will suffice. For animals where body weights and biology of bodies vary widely (i.e. special needs of fixation for ruminants, large animals as horses) perfusion fixation with up to 4% FA and a quantity of fixative solution of 10-15% of the body weight may be required. Preservation of body donors in storage (immersion) can be done with 40% ethanol or in a full bath preservation containing up to 2% FA. Corpse humidification in the dissecting room is possible with 2% phenoxyethanol, in each case without FA. In veterinary anatomy, microbiological burden is often higher and therefore might lead to a need of FA in long-time storage. Compliance with the current OEL in all institutes would appear to be feasible in combination with various organizational measures., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

In order to get admission to study medicine at a German university, the most important criterion is the proof of an excellent final college prep school examination (Abitur) in order to get an adequate study place without time loss. For the purpose of a suitable selection for admission of candidates, however, the best qualified and suitable applicants should be found to be distributed to the limited available university places for medicine. The final examination mark alone can represent such a suitability - if at all - only to a very limited extent. In order to figure out which skills and competences characterize a potential medical student and after studies a well-practicing and resilient later physician, we sought for initial steps to apply competence profiling as a predictor matching suitable prerequisites to a subsequent successful outcome. In order to meet these demands, we founded a project called ComMedMent at the Friedrich Alexander University of Erlangen-Nürnberg (FAU), where we defined competences for successfully becoming a medical expert while studying the medical curriculum. Here we present a comprehensive catalogue of 16 standards and meaningful key competencies for potentially successful medical students at the FAU. In collaboration with the Center for Competence Balancing - CeKom SÜD - (Pforzheim; Germany) and a local competence team comprising institute management, lecturers and students of different educational backgrounds, a target profile for the "ideally equipped students and later successful practitioners" was established. The identification of a site-specific and/or general requirement profile for medical students could open up new perspectives for the selection process and show the opportunities for helping students along the path to becoming medical experts., (Copyright © 2018 Elsevier GmbH. All rights reserved.)