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In the classical description of normal liver anatomy, the umbilical fissure is a long, narrow groove that receives the ligamentum teres hepatis. The pons hepatis is an anatomic variant, where the umbilical fissure is converted into a tunnel by an overlying bridge of liver parenchyma. We carried out a study to evaluate the existing variations of the umbilical fissure in a Caribbean population. We observed all consecutive autopsies performed at a facility in Jamaica and selected cadavers with a pons hepatis for detailed study. A pons hepatis was considered present when the umbilical fissure was covered by hepatic parenchyma. We recognized two variants: an open-type (incomplete) pons hepatis in which the umbilical fissure was incompletely covered by parenchyma ≤ 2 cm in length and a closed type (complete) pons hepatis in which the umbilical fissure was covered by a parenchymal bridge > 2 cm and thus converted into a tunnel. We measured the length (distance from transverse fissure to anterior margin of the parenchymatous bridge), width (extension across the umbilical fissure in a coronal plane) and thickness (distance from the visceral surface to the hepatic surface measured at the mid-point of the parenchymal bridge in a sagittal plane) of each pons hepatis. A systematic literature review was also performed to retrieve data from relevant studies. The raw data from these retrieved studies was used to calculate the global point prevalence of pons hepatis and compared the prevalence in our population. Of 66 autopsies observed, a pons hepatis was present in 27 (40.9%) cadavers. There were 15 complete variants, with a mean length of 34.66 mm, mean width of 16.98 mm and mean thickness of 10.98 mm. There were 12 incomplete variants, with a mean length of 17.02 mm, width of 17.03 mm and thickness of 9.56 mm. The global point prevalence of the pons hepatis (190/5515) was calculated to be or 3.45% of the global population. We have proposed a classification of the pons hepatis that is reproducible and clinically relevant. This allowed us to identify a high prevalence of pons hepatis (41%) in this Afro-Caribbean population that is significantly greater than the global prevalence (3.45%; P

Background In the classic descriptions of the human liver, the umbilical fissure (UF) is a long, narrow groove on the visceral surface that receives the ligamentum teres hepatis. In this study, we document the UF variations encountered in a series of cadaveric dissections. Methods We reported UF variations using the following classification: Type I refers to "normal" anatomy where there is a long, narrow groove. In type II, the UF was covered by a fibrotic band devoid of hepatic parenchyma. In type III variants, an extension of hepatic parenchyma partially covered but did not obliterate the UF. In type IV variants, the hepatic parenchyma formed a bridge over the UF, completely obliterating the groove. After institutional review board approval, we observed all consecutive cadaveric dissections over five years and recorded the characteristics and dimensions of each UF and its immediate relations. Results There were 69 cadavers, and variant UFs were present in 38 (55.1%) cadavers: type II (1.5%), type III (20.3%), and type IV (33.3%). Conclusions In this Jamaican population, only 44.9% of persons had conventional "normal" anatomy and 55.1% had UF variants. These variants are clinically significant, as they lead to misinterpretation of patient imaging and can hinder operative procedures on the liver.

Background Variations in the anatomy of hepatic veins are of interest to transplant surgeons, interventional radiologists, and other medical practitioners who treat liver diseases. The drainage patterns of the right hepatic veins (RHVs) are particularly relevant to transplantation services. Aim The aim was to identify variations of the patterns of venous drainage from the right side of the liver. To the best of our knowledge, there have been no reports on RHV variations in in a Caribbean population. Methods Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral center. Venous outflow patterns were observed and RHV variants were described as: (1) Tributaries of the RHV; (2) Variations at the hepatocaval junction (HCJ); and (3) Accessory RHVs. Results A total of 118 scans met the inclusion criteria. Only 39% of the scans found conventional anatomy of the main hepatic veins. Accessory RHVs were present 49.2% and included a well-defined inferior RHV draining segment VI (45%) and a middle RHV (4%). At the HCJ, 83 of the 118 (70.3%) had a superior RHV that received no tributaries within 1 cm of the junction (Nakamura and Tsuzuki type I). In 35 individuals (29.7%) there was a short superior RHV with at least one variant tributary. According to the Nakamura and Tsuzuki classification, there were 24 type II variants (20.3%), six type III variants (5.1%) and, five type IV variants (4.2%). Conclusion There was significant variation in RHV patterns in this population, each with important relevance to liver surgery. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.

BACKGROUND In the classic descriptions of the human liver, the common hepatic duct forms at the confluence of left and right hepatic ducts. Many authors have documented variations in the intra-hepatic ductal system, but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations. AIM To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography (MRC) in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean. Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders. METHODS This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean. We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1, 2017 to March 31, 2019. Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang's classification. A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant. The variants in our population were compared to the global population. RESULTS There were 152 MRCs evaluated in this study in 86 males and 66 females. There were 109 (71.7%) persons with "classic" biliary anatomy (type A1) and variants were present in 43 (28.3%) persons. There was no statistical relationship between the presence of anatomic variants and gender or ethnicity. We encountered the following variants: 29 (19.1%) type A2, 7 (4.6%) type A3, 6 (3.95%) type A4, 0 type A5 and a single variant (quadrification) that did not fit the classification system. Compared to the global prevalence, our population had a significantly greater occurrence of A1 anatomy (71.7% vs 62.6%; P = 0.0227) and A2 trifurcations (19.1% vs 11.5%; P = 0.0069), but a significantly lower incidence of A3 variants (4.61% vs 11.5%; P = 0.0047). CONCLUSION There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics. Specifically, persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.

Hepatic surface grooves (HSGs) are prominent depressions on the antero-superior surface of the liver. We sought to document the prevalence of HSGs in an Eastern Caribbean population. We observed all consecutive autopsies performed at a facility in Trinidad and Tobago and recorded the presence, number, location, width, length and depth of any HSG identified. Each liver was then sectioned to document intra-parenchymal abnormalities. Sixty Autopsies were observed. There were HSGs in 9 (15%) cadavers (5 females and 4 males), at an average age of 66 years (range 48–83, Median 64, SD ± 10.4). The HSGs were located on the diaphragmatic surface of the right hemi-liver in 8 (89%) cadavers, left medial section in 4 (44%), left lateral section in 3 (33%) and coursing along Cantlie’s plane in 3 (33%) cadavers. Eight (89%) cadavers with HSGs had other associated anomalies: accessory inferior grooves (5), parenchymal nutmeg changes (5), abnormal caudate morphology (4), hyperplastic left hemi-liver (3), lingular process (2), bi-lobar gallbladder (1) and/or abnormal ligamentous attachments (1). Approximately 15% of unselected Afro-Caribbean persons in this Eastern Caribbean population have HSGs. Every attempt should be made to identify HSGs on pre-operative imaging because they can alert the hepatobiliary surgeon to: (1) associated anatomic anomalies in 89% of cases, (2) associated hepatic congestion in 56% of persons, (3) increased risk of bleeding during liver resections and (4) increased technical complexity of liver resections. The association between HSGs, cardiovascular complications, hepatic congestion and nutmeg liver prompted us to propose a new aetiologic mechanism for HSG formation, involving localized hyperplasia at growth zones due to upregulation of beta-catenin levels.

AIM To evaluate the variations in venous drainage from the left liver. MATERIALS AND METHODS A retrospective evaluation was performed of all consecutive abdominal computed tomography (CT) examinations at a tertiary referral facility between 1 January and 30 June 2018. Osirix (Pixmeo SARL, Bernex, Switzerland) was used to examine the major hepatic veins and their tributaries in each scan. The classification of variants as proposed by Nakamura and Tsuzuki was used to describe the findings. The following information was collected: ramification pattern, number, length and diameter of middle (MHV) and left (LHV) hepatic vein tributaries. Two researchers collected data independently, and the average measurements were used as the final dimensions. RESULTS Of 102 examinations evaluated, only 27 demonstrated the conventional venous drainage patterns. The LHV and MHV combined to form a common trunk that emptied into the inferior vena cava (IVC) in 75 (73.5%) cases. The common trunk had a mean length of 8.89 mm and mean diameter of 20.18 mm. Other patterns included Nakamura and Tsuzuki type I (27.5%), type II (29.4%) and type III variants (16.7%). In addition, 4.9% of patients had absent superior middle veins and 80% had supernumerary short hepatic veins (4%). CONCLUSION Only 26.5% of patients in this population had conventional venous drainage from the left liver. Surgeons and radiologists in hepatobiliary practice should be aware of these variants in order to minimise morbidity when performing invasive procedures.

Classic descriptions of the visceral surface of the human liver only define three fissures: transverse, sagittal and umbilical fissures. Any additional fissures that are present on the visceral surface of the liver are considered variant inferior hepatic fissures (IHFs). This study was carried out to document the prevalence of IHFs in the Eastern Caribbean. Knowledge of these variants is important to clinicians who treat liver disorders in persons of the Caribbean diaspora. In this study, two independent researchers observed all consecutive autopsies performed at the facility over a period of 10 weeks. They examined the visceral surface of the unfixed liver in situ. Any specimen with variant IHFs was selected for detailed study. We documented the relation of the variant IHFs to nearby viscera and then explanted the livers using a standardized technique. The following details were recorded for each liver: number, location, depth, length, and width of IHFs. All measurements were checked independently by two researchers and the average measurement was used as the final dimension. Each liver was then sectioned in 1 cm sagittal slices to document the relationship of intraparenchymal structures. We observed 60 consecutive autopsies in unselected cadavers. Variant IHFs were present in 21 (35%) cadavers at a mean age of 68.25 years (range: 61 - 83; median 64.5; standard deviation (SD) ± 8.45). The variants included a deep fissure in the coronal plane between segments V and VI in 19 (31.7%) cadavers (related to the right branch of the portal vein in 63.2% of cases), a well-defined segment VI fissure running in a sagittal plane in four (6.7%) cadavers, a well-defined fissure incompletely separating the caudate process from the caudate lobe proper in five (8.3%) cadavers, a consistent fissure that arose from the left side of the transverse fissure and coursed between segments II and III in three (5%) cadavers, and a deep coronal fissure dividing the quadrate to form an accessory quadrate lobe in one (1.7%) cadaver. Almost one in three unselected persons in this population have anatomically variant fissures on the visceral surface of the liver. The variants include Rouvière’s sulci (31.7%), caudate notches (8.3%), segment VI fissures (6.7%), left medial segment fissures (5%), and quadrate fissures (1.7%). The clinical relevance of these variants is discussed. Any clinician treating liver diseases in persons of Caribbean extract should be aware of their presence.

Chilaiditi’s syndrome describes a symptomatic patient with radiographic findings of interposed colon between the diaphragm and right lobe of liver. It may mimic a pneumoperitoneum on plain radiographs. We present a case in which Chilaiditis’ syndrome was entertained, delaying a decision for laparotomy. This case reinforces the diagnostic difficulty associated with Chilaiditi’s syndrome, and it increases awareness of an uncommon variation in the liver surface anatomy.

There have been no previous reports on hepatic surface grooves in an Afro-Caribbean population. This information is important to optimize radiology and hepatobiliary surgical services in the region.Two investigators independently observed 69 cadaveric dissections performed over five years at the University of the West Indies. Variations in surface anatomy were described.In this Caribbean population the majority of patients had conventional hepatic surface anatomy (88%). However, we found a greater incidence of hepatic surface grooves (12%) than reported in international literature.Abnormal surface anatomy is present in 12% persons in this population. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.

Background and aim Zinc deficiency due to low intake or unavailability by bioactive compounds may lead to morphological changes in the intestines resulting in disruptions in gut function. This study aims to assess effects of phytic acid on gut morphology of rats. Methods Diets supplemented with sweet potato phytate extract were fed to Wistar rats in zinc-deficient and zinc-sufficient states for 4 weeks. Similar test animals also had diets supplemented with the commercially available sodium phytate salt (IP6) for comparison. At the end of the feeding period, body weights, feed intake and markers of intestinal function were assessed. Results Acute zinc deficiency adversely affected the glycocalyx, goblet and Paneth cells within the small intestine. This may eventually lead to compromisation of the gut's immune system and further reductions in its metabolic and absorptive capacity. This was further aggravated by sweet potato phytate extract consumption. IP6 supplementation on the other hand, increased surface amplification in the jejunum resulting in increased gut transit time and more efficient absorption of nutrients. Conclusions To minimize compromisation of the gut's immune, absorptive and metabolic functions, adequate zinc supplementation is necessary especially if foods rich in phytates are included in the diet. Supplementation of the diet with IP6 seems to offset some of these effects with maximum benefits observed if the diet is properly supplemented with essential minerals.

Pumpkin (Cucurbita species) seed oil (PSO) is a rich source of phytoestrogens and the aim of this study was to examine the effect of PSO supplementation on the total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), triglycerides, high density lipoprotein cholesterol (HDL-C), systolic and diastolic blood pressure in non-ovariectomized and ovariectomized Sprague-Dawley rats. Female rats weighing 220-300 g were divided into non-ovariectomized rats for supplementation with corn oil (control CO; n = 6) or PSO (control PSO; n = 5) and ovariectomized rats for supplementation with corn oil (OVX/CO; n = 6) or PSO (OVX/PSO; n = 5) for 5 days per week for 12 weeks (corn oil 40 mg/kg or PSO 40 mg/kg given orally). Systolic and diastolic blood pressures were measured weekly. Blood was collected at the end of the period for plasma lipid assays. Control PSO had lower TC, LDL-C, triglycerides and higher HDL-C than the control CO. The OVX/CO had higher TC, LDL-C, triglycerides and lower HDL-C than the control CO and these changes were prevented in the OVX/PSO rats. PSO supplementation also resulted in lower systolic and diastolic blood pressures in both non-ovariectomized and ovariectomized rats. It is concluded that PSO supplementation can prevent changes in plasma lipids and blood pressure associated with inadequate oestrogen availability.

Research aimed at investigating sexual behavior and assessing intervention to improve sexual and reproductive health among young adults in Jamaica has increased in recent decades. This study was carried out to assess both positive and negative sexual outcomes e.g. sexual activity and sexual satisfaction related to sexual behavior such as multiple partners and the use or non-use of condoms among young adults. As part of the Reproductive Health Survey, data on the socio-demographic characteristics, sexual activity and behavior were assessed using a 56-item questionnaire on 213 randomly selected young adults from the 14 parishes in Jamaica attending two major public hospitals. The majority of the respondents had their first sexual experience when they were 15-18 years old. Among the men, the majority achieved full sexual satisfaction (100.0%) and had sex daily (49.6%). The majority of women were unable to achieve full sexual satisfaction (69.3%, χ2 =138.85, p< 0.05) yet had sexual intercourse more than once per week (76.1%, χ2 = 58.05, p< 0.05). The majority of respondents had 2-3 sexual partners (51.2%), used condoms (56.7%) and ranked highest among those with sexually transmitted infections (85.9%). Comprehensive behavioural interventions should target these young adults who are engaged in high sexual risk behaviors.

Objective This study evaluated the ability of 0.8% neem leaf extract (NLE) to treat diabetes mellitus by assessing its effects on blood glucose, insulin levels and islet morphology in streptozotocin (STZ)-induced diabetic Sprague-Dawley rats. Methods Diabetes was induced in two to three-day old rat pups by STZ intraperitoneally (60 mg/kg), followed by a further 40 mg/kg dose 12-23 weeks later. The diabetic treated (DT) rats received 0.8% w/v NLE in tap water while diabetic control (DC) and normal control (NC) rats received water ad libitum. Body weight, water and chow consumption, and blood glucose were evaluated weekly. Blood and pancreas were collected at the end of the study to evaluate serum insulin and islet histology, respectively. Results Neem leaf extract (0.8%) improved weight gain and beta cell regeneration but did not reduce blood glucose. Serum insulin increased slightly in the treated group and three-fold in the DC group (p < 0.05). Conclusion The results suggest that NLE has beta cell regenerating potential.

One of the most vital tasks of a forensic anthropologist is sex determination utilizing the available bone. The need for methods to estimate sex from cranial fragments is manifested when only a part of the skull is brought for human identification. The foramen magnum is an important feature of the base of the cranium. In this present study, the morphometric measurements taken on foramen magnum from a well-preserved collection of dry Jamaican skulls were analysed using standard osteometric techniques. The focus of this research was to determine the utility of the foramen magnum as a seminal factor of sex determination in Jamaican crania. A literature search revealed that there was no data available on the morphology and morphometry of the Foramen magnum in Jamaican Skulls, skulls of the Caribbean nor African-Based Diaspora. Twenty human adult cadaver dry skulls of known sex which were available, were randomly selected from the collection of the Anatomy Section Section of the Department of Basic Medical Sci...

In this study, the effect of yam steroidal sapogenin extract on intestinal morphology in streptozotocin-induced diabetic rats was examined. Diabetic male Wistar rats (n = 32) were fed diets supplemented with 1% bitter yam steroidal sapogenin extract or commercial diosgenin for three weeks. The effect on intestinal morphology was assessed. The induction of diabetes significantly increased villus length and crypt depth compared to the normal group. Supplementation of the diet with sapogenin extract or commercial diosgenin significantly increased villus width compared to the diabetic controls. The dietary supplements also significantly decreased crypt depth towards that of the normal controls. This study shows that the feeding of bitter yam steroidal sapogenin extract to diabetic rats may result in alterations in the intestinal morphology.

Summary Activity directed isolation studies of the ethanol extract of Bontia daphnoides L (Myoporaceae) leaves and stems led to the isolation of epingaione, a sesquiterpene furan. This compound was previously described by Chinnock et al. (1987) from the same plant. The compound showed growth regulatory activities on gravid adult female Boophilus microplus Canestrini (the southern cattle tick). The dose required for inhibiting the hatching of B. microplus eggs by 50% (Fid50)was 0.4±0.06 mg/g of the tick body weight. The Fid50 dose inhibited the sequestration of protein into eggs oviposited by 80%. These eggs were non-agglutinated and wrinkled. Histological examination of ovarian sections from the treated ticks revealed significant degeneration of funicle cells and reduction in yolk content.

Introduction The commonest variation to the classic anatomic description of renal arterial supply is the presence of accessory renal arteries. The incidence varies widely according to ethnicity. There is no data on the prevalence of these anomalies in persons of Caribbean ethnicity. Methods All CT scans done over two years from July 1, 2010 to June 30, 2012 were retrospectively evaluated. The anatomy of the renal arterial supply was reported from these studies and the anatomy of accessory renal arteries was documented. Results There were 302 CT scans evaluated and accessory renal arteries were present in 109/302 (36.1%) CT scans, 95% confidence interval 30.6%, 41.4%. There were 71/309 (23.5%) patients with accessory arteries on the left and 54/309 (17.9%) had them on the right (p 0.087). Of these, 16 (14.7%) patients had bilateral accessory renal arteries present. The most common origin for the accessory arteries was the abdominal aorta in 108 (99.1%) cases and in 1 case the accessory artery arose from the coeliac trunk. There were 80 left sided accessory renal arteries: 17 (21.3%) upper polar and 27 (33.8%) lower polar arteries. Of 62 right sided accessory arteries, 14 (22.6%) were upper polar and 26 (42%) were lower polar arteries. Conclusion This is the first population-based report of anatomic anomalies in renal arterial supply in a Caribbean population. These are important findings that may affect vascular and urologic procedures on persons of Caribbean ethnicity.

In the classic description of hepatic arterial supply, the common hepatic artery originates from the coeliac trunk. However, there are numerous variations to this classic pattern. We report a rare variant pattern of hepatic arterial supply and discuss the clinical significance of this variation.

The first inhabitants of Jamaica are now generally referred to as Tainos. It is likely that they arrived in the island after about 650 AD and were extinct by the end of the 16th century. In 1968, during the exploration of a small cave in Bull Savannah, St. Elizabeth parish, Dr. James Lee found two skulls, teeth, bones, and pottery. The aim of this work is to interpret in a biocultural perspective the one cranium with pathological lesions, such as caries sicca. This adult individual had an artificially modified cranium, a cultural practice common among Tainos, which was studied macroscopically and by radiological and computerized tomography. The radiocarbon dates, obtained by AMS, point to the 10th–11th centuries AD and the stable isotopes analysis revealed either the ingestion of a mixed C3/C4 plant diet or an extensive intake of marine resources, the former being more likely. This is the first cranium to be found in Jamaica with evidence of Pre-Columbian treponematosis, most probably syphilis, which has also been demonstrated in a few cases elsewhere in the Caribbean region. This finding agrees with the ethnohistorical narrative, according to which syphilis existed among the native population, who used plant extracts to treat the disease. This paper contributes to our knowledge about the Tainos and the history of treponematosis in the Americas.

Aim To evaluate the spectrum of hepatic arterial variants in unselected patients undergoing computed tomography (CT) of the abdomen at the main regional referral centre in the northern Anglophone Caribbean. Materials and methods Two radiologists independently reviewed 309 CT angiographic studies performed over 2 years between 1 July 2010 and 30 June 2012 at a regional hepatobiliary referral centre for the Northern Caribbean. The anatomical variations were described according to a conventional classification proposed by Michels et al. Results In this Caribbean population, the majority of patients had conventional Michels' type 1 vascular anatomy (63.4%). However, a statistically significantly greater incidence of Michels' type 2 variations (20.4%) were found than that reported in the international literature and a lower incidence of type 3 (5.2%), type 6 (0.6%), and type 9 (0) patterns than previously reported. One case with variations not previously described in this classification was also encountered. Conclusion Although 63.4% of persons in a Caribbean population have conventional vascular anatomy, the distribution of anatomical variants is quite different to that seen in North American and European centres. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity and mortality during invasive procedures.

The Joint Architecture Standard (JAS) program at Sandia National Laboratories requires the use of a reliable data delivery protocol over SpaceWire. The National Aeronautics and Space Administration at the Goddard Spaceflight Center in Greenbelt, Maryland, developed and specified a reliable protocol for its Geostationary Operational Environment Satellite known as GOES-R Reliable Data Delivery Protocol (GRDDP). The JAS program implemented and tested GRDDP and then suggested a number of modifications to the original specification to meet its program specific requirements. This document details the full RDDP specification as modified for JAS. The JAS Reliable Data Delivery Protocol uses the lower-level SpaceWire data link layer to provide reliable packet delivery services to one or more higher-level host application processes. This document specifies the functional requirements for JRDDP but does not specify the interfaces to the lower- or higher-level processes, which may be implementation-dependent.

Ethyl acetate soluble extracts from the leaves of the breadfruit Artocarpus altilis exerted a weak, negative chronotropic effect (p

Neutrophil and platelet counts were significantly lowered (p