High prevalence of sternal foramina in indigenous Bolivians compared to Midwest Americans and indigenous North Americans (sternal foramina in indigenous Bolivians).

Abstract: Sternal foraminas are developmental defects of the sternum. The incidence of sternal foramen is about 4.5% of population. They can be found usually coincidentally by radiological or postmortem examinations. In this case report, I represent an 84 years old woman with pulmonary contusion after blunt trauma who has double hole in her sternum detected by radiological examinations. Introduction: The sternum is a flat shape bone which is located in the middle of anterior thorax. It has three parts including manubrium, body and xiphoid cartilage [1]. Embryological development of sternum starts from sternal bars of ventrolateral body wall untiLthe mid-line and bar fusion finishes with the formation of xiphoid [2]. Sternal foramen (or perforated sternum) is a developmental defect and a result of the incomplete fusion of the sternal bar in the middle. The rate of sternal foramen is 4.5% (range 4.3-6.7%) of the population and usually located on inferior sternal body. Also it can be located on xiphoid part. Case Report: An 84 year old woman was admitted to thoracic surgery department with chest pain caused by thoracic blunt trauma. Diffuse pulmonary contusion and two sternal foraminas as a measurement of 7.5 mm at upper and 5 mm at lower detected by Thorax CT scan and 3D reconstruction (Figures 1-3). Pulmonary rehabilitation and analgesia therapy applied. The patient got discharged after 4 days. Discussion: Variation and anomalies of sternum is common. These malformations and anomalies are detected coincidentally by radiological examinations and postmortem. Any failure in the embryogenic process causes sternal anomalies, such as fissures or foramen. The incidence of sternal foramen evaluated as 4.3% - 6.6%-6.7% in different studies [3-5]. Others reported that developmental variations of sternum includes branched xiphoid process, V shaped bifurcation, sternum bifidum, synchondrosis sternii (incomplete ossification of the sternum), anomalies in the shape of the sternum (wedge shaped or asymmetrical bone), sternum gallinaceum and sternal foramen. Cooper detected sternal foramina in 6.7% in autopsy population that were usually solitary and located in the body of the sternum. They also detected a foramen in the manubrium. Also Moore detected 6.6% sternal foramina in an autopsy population. Yekeler evaluated the frequency of sternal foramens by MDCT in 4.5% of 1000 patient. The size of sternal foramina ranged between 2 and 16 mm in these case series [3-5] and in our case the upper foramen was 7.5 mm and lower was 5 mm. They were both located in the body of sternum. Patients with sternal foramen have the risk of spontaneous pneumothorax or pericardium tamponade during sternal biopsy or acupuncture [6]. As conclusion sternal foramen is the most common variation of sternum and mostly symptomless. It has to be kept in mind because of the serious complications after sternum biopsy and acupuncture.

Sternal foramina represent developmental defects in the sternum, which occur due to incomplete fusion of the sternal ossification centers. Sternal foramina have been correlated with several clinical implications and constitute a subject of interest for the forensic practice. The aim of this study is to define their incidence in Greek population. The presence of midline foramen was studied in 60 dried, adult sterna derived from the Anatomy Department of Medical School of Aristotle University of Thessaloniki. Measurements were made with a 0.01-mm accuracy caliber and photographic documentation was obtained. Additionally, computed tomography scanning of the sterna was performed. Sternal foramina were found in 11 subjects, resulting in an incidence of 18.3% over the total population. In 27.3% of the subjects with sternal foramen, a single sternal foramen was observed in the body of the sternum, while in 45.5% of the sterna presenting sternal foramina, multiple xiphoidal foramina were noticed. In two specimens, association of xiphoidal foramina with sternal cleft was documented. Sternal foramina are variant quite common in the population, with distinct imaging pattern and awareness of their existence is important for the physician.

The sternum is a crucial component of the thoracic cage. Its articulations and divisions play an important role in providing structural support to the thoracic cage and facilitating movements. The body of the sternum originates from four mesenchymal bars known as sternebrae, Incomplete fusion of the sternebrae or failure of fusion can lead to the development of a sternal foramen. The clinical significance of a sternal foramen lies in the potential risks associated with medical procedures such as acupuncture or sternal puncture for bone marrow biopsy. A study was conducted on 100 sterna at K. J. Somaiya Medical College to find out the presence of sternal foramen, to study their site, size and shape and to discuss its clinical Implications. 20% of the specimens were found to possess a sternal foramen. The vertical to transverse diameter of these foramina were in the range of 4.4 – 6.9mm. Most of the foramen were found to be at the level of 3 and 4 costal notches followed by Xiphoid process. The study also observed the variations in the shape of the manubrium and the body of the sternum and the variations of the Xiphoid process. Failure to recognize the presence of sternal foramina can pose serious risks during medical procedures, potentially leading to damage to the pericardium and heart. Therefore, it is essential for healthcare practitioners to be aware of these variations and consider obtaining X-ray or CT scans to assess sternum morphology before performing invasive procedures. The study emphasizes the importance of comprehensive anatomical knowledge and careful clinical assessment when dealing with the sternum and underscores the need for precautionary measures to prevent complications associated with sternal foramina.

We observed a sternal foramen contiguous with a small sternal cleft in a human skeleton coming from North-Eastern Italy and dating back to between the sixteenth and seventeenth century AD. Both of these types of anomalies result from a defective midline fusion of the developing sternum. Sternal foramen is a relatively common bony defect that usually comes to light as an incidental finding. Sternal cleft is a rarer morphological anomaly that can have a wide spectrum of clinical manifestations and outcomes, depending on the extent of the bony defect as well as on the presence and severity of other abnormalities. The coexistence of a sternal foramen and a sternal cleft has very rarely been described in the literature. We report here one such unusual association and discuss its potential practical implications. In most cases, sternal foramina and small sternal clefts are clinically uneventful; yet, lack of awareness about the existence of these subtle anatomical variations can sometimes lead to misinterpretation of radiological and pathological findings or make sternal biopsy and acupuncture unsafe.

The sternal foramen (SF) constitutes a specific anatomic defect in sternum, indicating an impaired fusion of ossificated segments, which occurs either in an anatomical part of the sternum or in sternal joints. The aim of this article is to provide baseline statistical data about the variations of the SF, to present a short review of the relevant literature and to compare results with other studies and populations. We review relevant literature, and we present data obtai-ned from skeletal samples of known population and sex. A total of 35 well-preserved dried sterna from the prefecture of Eastern Macedonia and Thrace, Greece, were selected: 20 men and 15 women with a mean age of 55 ± 6 years old. Measurements were made with a sliding calliper and photographic documentation. The incidence of the SF in the 35 dried specimens was 14.2%, 4 men (20% of male sample) and 1 woman (6.6% of female sample) and 80% of sternal foramina were observed in male individuals. The SF was found in the sternum body (2 cases, 40% of foramina), in xiphoid process (2 cases, 40% of foramina) and in sternoxiphoidal junction (1 case, 20% of foramina). All of the sterna presented 1 single visible SF. Two anatomically unique cases were identified throughout these 5 sterna, both belonging in male subjects. The SF constitutes a relatively common variation with great radiological, clinical, and forensic significance. Presence of a SF with irregular bony margins complicates considerably radiological differential diagnosis. Awareness of this important anatomic variation is fundamental for clinicians and autopsy pathologists, in order to avoid severe fatal complications and elucidate the exact cause of death, respectively.

A sternal foramen (SF), which arises from the incomplete fusion of the cartilaginous neonatal sternum, is a relatively common anatomical variation found in 2.5% to 13.8 % of all individuals. SFs are usually located at the lower third of the sternal body and their average diameter is 6.5 mm. An SF is subclinical; however, its close proximity to the thoracic organs, i.e., the heart and lungs, entails a risk of serious complications from blinded sternal interventions. Moreover, its presence can lead to misinterpretation of radiological and postmortem findings. The SF is ignored by many physicians and non-physician healthcare providers who must understand its clinical significance in order to optimize patient care. Our aim in this review is to highlight the potential clinical consequences for SF patients, discuss recommendations for performing sternal procedures safely when this anatomical variation is present, and preclude radiological and pathological misinterpretations so that patient care can be improved.

Due to inadvertent cardiac or great vessel injury, sternal foramina may pose as a great hazard during sternal puncture. They can also be misinterpreted as osteolytic lesions in cross-sectional imaging of the sternum. The distribution of these variations differs between populations, but data from Brazilians are scarcely reported. Therefore, this study aimed to verify the frequency of midline sternal foramen and double-ended xiphoid process, as developmental variations, in order to avoid fatal complications following sternal puncture of sternal acupuncture treatment. A total of 114 chest computed tomograms were evaluated. The frequency of midline sternal foramen in a complication risk bearing feature is of approximately 10.5%. The double-ended xiphoid process was present in 17.5%. We conclude that sternal acupuncture should be planned in the region of corpus-previous CT should be done to rule out this variation. Furthermore, we strongly recommend the acupuncture technique which prescribes a safe superficial-oblique approach to the sternum.

Anatomical variations of the sternal angle and anomalies of the sternum are unique happenings of major clinical significance. It is known that misplaced sternal angles may lead to inaccurate counting of ribs and create challenges with intercostal nerve blocks and needle thoracostomies. Sternal foramina may pose a great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury. These sternal variations and anomalies are rarely reported among Africans. The aim of this study was to determine the anatomical variations of the sternal angle and anomalies of the sternum among adult dry human sterna at the Galloway osteological collection, Makerere University, Uganda. This was a descriptive cross sectional study in which quantitative and qualitative data were collected. The study examined 85 adult human sterna at the Department of Anatomy, Makerere University. Univariate and bivariate analyses were done using SPSS 21.0 for Windows. Over 40% (36/85) of the specimens had variations in size, location and fusion of the sternal angle. There was no significant difference in the mean size of the sternal angle in males at 163.4 ± 6.7o compared with 165.0 ± 6.4o in females (p = 0.481). Of the 85 specimens examined, only 21 (24.7%) had a xiphoid process. The most frequent sternal anomalies were bifid xiphoid process 42.9% (9/21) and sternal foramen 12.9% (11/85). Sternal variations and anomalies are prevalent in the Galloway osteological collection and there is need for increased awareness of these findings as they may determine the accuracy of clinical and other procedures in the thoracic region.

In our study, we aimed to determine the topographic analysis of sternal foramen cases incidentally detected in patients underwent thoracic computed tomography. Patients aged 18 and over who were admitted to the thoracic surgery outpatient clinic for various reasons and underwent thoracic computed tomography (CT) between January 1, 2018 and January 1, 2019 were evaluated retrospectively. Thoracic CT scans of all patients with sternal foramen were evaluated by applying 3D bone configuration to evaluate foramina in the sternum and ribs. The data obtained were analyzed statistically by SPSS (Statistical Package for Social Sciences Version 21.0). Nine hundred and twelve patients were evaluated and sternal foramen prevalence was found to be 8.44% in our study. Of the 68 patients included in the study, 48 were male and 20 were female. The sternal foramen was localized in the corpus in 66.2% of the patients, whereas it was localized in xiphoid in 33.8%. Nine patients had scoliosis deformity and three patients had foramen in the rib. Sternal foramen is a more common defect than thought, and should be kept in mind in clinical practice to prevent complications.

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Abstract. We describe an assimilation system for atmospheric methane (CH4), CarbonTracker-CH4, and demonstrate the diagnostic value of global or zonally averaged CH4 abundances for evaluating the results. We show that CarbonTracker-CH4 is able to simulate the observed zonal average mole fractions and capture inter-annual variability in emissions quite well at high northern latitudes (53–90° N). In contrast, CarbonTracker-CH4 is less successful in the tropics where there are few observations and therefore misses significant variability and is more influenced by prior flux estimates. CarbonTracker-CH4 estimates of total fluxes at high northern latitudes are about 81 ± 7 Tg CH4 yr−1, about 12 Tg CH4 yr−1 (13%) lower than prior estimates, a result that is consistent with other atmospheric inversions. Emissions from European wetlands are decreased by 30%, a result consistent with previous work by Bergamaschi et al. (2005); however, unlike their results, emissions from wetlands in boreal Eurasia are increased relative to the prior estimate. Although CarbonTracker-CH4 does not estimate an increasing trend in emissions from high northern latitudes for 2000 through 2010, significant inter-annual variability in high northern latitude fluxes is recovered. Exceptionally warm growing season temperatures in the Arctic occurred in 2007, a year that was also anonymously wet. Estimated emissions from natural sources were greater than the decadal average by 4.4 ± 3.8 Tg CH4 yr−1 in 2007. CarbonTracker-CH4 estimates for temperate latitudes are only slightly increased over prior estimates, but about 10 Tg CH4 yr−1 is redistributed from Asia to North America. This difference exceeds the estimated uncertainty for North America (±3.5 Tg CH4 yr−1). We used time invariant prior flux estimates, so for the period from 2000 to 2006, when the growth rate of global atmospheric CH4 was very small, the assimilation does not produce increases in natural or anthropogenic emissions in contrast to bottom-up emission data sets. After 2006, when atmospheric CH4 began its recent increases, CarbonTracker-CH4 allocates some of the increases to anthropogenic emissions at temperate latitudes, and some to tropical wetland emissions. For temperate North America the prior flux increases by about 4 Tg CH4 yr−1 during winter when biogenic emissions are small. Examination of the residuals at some North American observation sites suggests that increased gas and oil exploration may play a role since sites near fossil fuel production are particularly hard for the inversion to fit and the prior flux estimates at these sites are apparently lower and lower over time than what the atmospheric measurements imply. The tropics are not currently well resolved by CarbonTracker-CH4 due to sparse observational coverage and a short assimilation window. However, there is a small uncertainty reduction and posterior emissions are about 18% higher than prior estimates. Most of this increase is allocated to tropical South America rather than being distributed among the global tropics. Our estimates for this source region are about 32 ± 4 Tg CH4 yr−1, in good agreement with the analysis of Melack et al. (2004) who obtained 29 Tg CH4 yr−1 for the most productive region, the Amazon Basin.

Cancer has become the second leading cause of death worldwide (Ferlay et al. 2008). Almost 13 million persons are diagnosed each year with cancer, and 7.6 million die (Ferlay et al. 2010). Today more than half of all cancers and 63% of cancer deaths occur in low- and middle-income countries (LMICs), a burden that is expected to grow in future years as the “Western lifestyle” spreads and the number of persons in LMICs who live to old age continues to increase (Ferlay et al. 2010). Toxic exposures in the environment, including workplace exposures, are responsible for a substantial percentage of all cancers (Danaei et al. 2005 Christiani 2011). Precise apportionment is not possible because of gaps in the exposure data, interactions between environmental and lifestyle carcinogens, and differences from country to country in exposure patterns (Pruss-Ustun and Corvalan 2006). However, credible estimates from the World Health Organization (WHO 2009) and the Internation Agency for Research on Cancer (IARC; Straif 2008) suggest that the fraction of global cancer currently attributable to toxic environmental exposures is between 7% and 19%. Asbestos, silica, arsenic, and radon are among the most common environmental carcinogens. All are considered proven causes of human cancer by IARC (El Ghissassi et al. 2009; Straif et al. 2009). Exposures to all remain widespread and are especially intense and uncontrolled in LMICs. Asbestos, for example, continues to be produced and used in quantities of nearly 2 million tons per year (U.S. Geological Survey 2011). While its use in Western Europe, the United States, and Canada has virtually ceased, export to the developing world is aggressively marketed and steadily increasing (Allen and Kazan-Allen 2008). For example, between 2000 and 2007, India’s consumption of asbestos is reported to have doubled (Burki 2010). Many cancers caused by environmental and occupational exposures can be prevented (Christiani 2011). Primary prevention—environmental interventions that halt the exposures that cause cancer—is the single most effective strategy. Primary prevention reduces cancer incidence, and it saves lives and billions of dollars. Successful examples include reductions in lung cancer and mesothelioma following bans on asbestos, reductions in bladder cancer after elimination of aniline dyes, reductions in leukemia following imposition of controls on benzene, and termination of hepatic angiosarcoma in chemical workers following introduction of closed-circuit technology for vinyl chloride polymerization (Christiani 2011). Despite their proven feasibility and cost-effectiveness, efforts to prevent environmental cancers have lagged. In contrast to vigorous and well-coordinated global efforts to prevent cancers caused by tobacco (WHO 2003), much more needs to be done in environmental cancer control and to further develop strategies for prevention of environmental causes of cancer (WHO 2008). To address these gaps and to develop a new global policy framework for environmental cancer, the WHO convened an international conference on “Environmental and Occupational Determinants of Cancer: Interventions for Primary Prevention” in Asturias, Spain, on 17–18 March 2011. The conference produced the “Asturias Declaration” (WHO International Conference on Environmental and Occupational Determinants of Cancer: Interventions for Primary Prevention 2011), which recommends that primary prevention of environmental and occupational cancers be an integral component of global cancer control. Specific recommendations of the declaration include the following: The WHO should develop a global framework for control of environmental and occupational carcinogens that concentrates on the exposures identified by IARC as proven or probable causes of human cancer (IARC 2011). The WHO should develop measurable indicators of carcinogen exposure and cancer burden to guide cancer surveillance worldwide. All countries need to adopt and enforce legislation and regulations to protect their populations, especially the most vulnerable (pregnant women, fetuses, infants, children, and workers) against environmental and occupational cancers. All countries need to develop communication campaigns tailored to local needs to educate their populations about environmental causes of cancer and prevention strategies. Corporations should comply with all rules and regulations for prevention of environmental and occupational cancers and adhere to the same standards in all countries—developed and developing—in which they and their subsidiaries operate. Conference participants agreed that successful prevention of environmental cancer will require partnerships among countries and collaborations of public health authorities with ministries of environment, labor, finance, and trade. In addition, independent, publicly funded research on environmental and occupational causes of cancer is an essential prerequisite to prevention (Tomatis 1995). The recommendations made by the participants in the “Asturias Declaration” complement and reinforce cancer control strategies focused on individual behaviors and medical practice. They will contribute to prevention of diseases beyond cancer and therefore synergize with the United Nations (UN) global agenda for control of noncommunicable diseases that is to be discussed at the UN General Assembly in September 2011 (UN General Assembly 2010). These recommendations will also prevent recurrence of such tragedies as the global asbestos epidemic, which now claims > 100,000 lives each year.

BackgroundSternal foramina are congenital anomalies arising from incomplete fusion of sternal ossification centers. They are often clinically silent but can pose risks during sternal procedures because of their proximity to critical mediastinal structures. Large-scale postmortem computed tomography (CT) studies of their prevalence in Japanese populations are limited, and their developmental origins remain elusive. We aimed to investigate the development, prevalence, and anatomical characteristics of sternal foramina in a large Japanese cohort using postmortem CT.MethodsWe retrospectively reviewed postmortem CT scans from 1503 adults (1021 males, 482 females; age range: 20–96 years) and 92 pediatric cases (age range: 0–8 years). In adults, we assessed prevalence, sex distribution, location, diameter, and adjacent structures. In pediatrics, ossification patterns of the third and fourth sternebral segments were evaluated to explore developmental contributions to foramen formation.ResultsSternal foramina were present in 3.7% of adults. They were more frequent in males (4.3%) than in females (2.5%), although the difference was insignificant. Most foramina were located at the level of the fifth costal notch and overlaid the pericardium or lung in 72% of evaluable cases. The median diameter was 4.5 mm. In pediatric cases, 11 (12%) exhibited lower-sternebral ossification-center patterns that could form sternal foramina, supporting a developmental origin. An estimated 31% of these patterns may persist into adulthood with unfused segments.ConclusionSternal foramina occurred in 3.7% of adults and were often situated over vital structures, posing procedural risks. Among pediatrics, ossification patterns that may impede fusion—defined as horizontal two-center or ≥ 3 center configurations—were present in 12%, and approximately 31% of these patterns appear to persist into adulthood as sternal foramina. These findings support a developmental basis for sternal foramina and emphasize the importance of recognizing them during imaging and procedural planning.

Reviewed by: Modernity and Its Other: The Encounter with North American Indians in the Eighteenth Century by Robert Woods Sayre Bryan C. Rindfleisch Robert Woods Sayre, Modernity and Its Other: The Encounter with North American Indians in the Eighteenth Century. (Lincoln: University of Nebraska Press, 2017). Pp. 468. $34.98 paper. Robert Woods Sayre demonstrates how Euro-Americans observed the profound socio-economic transformations to British North America during the late eighteenth century—or the transition to "modernity"—and the role that the Native Peoples of North America played, involuntarily, in that process. First published in French in 2008, this book features well-known eighteenth-century authors like William Bartram, St. John de Crévecoeur, Philip Freneau, Jonathan Carver, and John Lawson, in addition to lesser known individuals such as Moreau de Saint-Mery and Alexander Mackenzie, who illustrate how Euro-Americans wrestled with the onset of a commercial world, and utilized the Indigenous Peoples of North America as either a reflection or a commentary of that process. It is through these authors that Sayre imagines a "decisive historical moment" in which the "modernity" of British North America "clashed radically with the 'premodern' Native American cultures with which it was in close contact," a "watershed…in a process of evolution toward capitalism and modernity" (4). By the turn of the nineteenth century, though, with the emergence of a market economy in the United States, this Indigenous parallel to Euro-American "modernity" faded into the romanticism of the "Noble Savage" stereotype and was replaced with the triumphal narratives of American progress that were embodied in the writings of George Catlin. Altogether, Sayre finds that the transition to a capitalist modern world—in the Weberian sense of the word—occurred at this critical juncture in the late eighteenth century, and proved intimately connected to, and inherently in tension with, the Native Peoples of North America. Sayre's book is divided into two parts: the "View of Modernity" by Euro-American authors during the eighteenth century, and their "Views of the Other," or "Travels in Indian Territory." In part one, Sayre compares and contrasts the writings of Crévecoeur, Freneau, and Saint-Mery to pinpoint the "onset of modernity in the English colonies through the eyes" of both famous and obscure writers. From the Letters from an American Farmer and The Rising Glory of America, to [End Page 141] Saint-Mery's little known treatises, Sayre uses such texts to demonstrate capitalist mentalities—or the primacy of a "profit motive"—and commercial structures throughout British North America, which deviated from the agrarian foundations of the colonies (88). When Native Peoples were mentioned, which was rather infrequently by these authors, they were a tool to critique the new "modernity" (75). One of the most intriguing insights by Sayre is his analysis of Crévecoeur's "Distresses of a Frontier Man," in which the narrator contemplates "escaping his predicament [when faced with "modernity"] by going to live in an Indian village where he is known and feels sure to be welcomed," thereby inverting Indigenous Americans as a source of comfort, nostalgia, and identity for the frontiersman (53). In part two, Sayre uses the writings of French and English authors—beginning with the Baron de Lahontan and Francois Xavier de Charlevoix, followed by Lawson and Carver, then Bartram, and lastly the fur traders Mackenzie and Jean-Baptiste Trudeau—to better explore how Euro-American writers understood their interactions with the Native Peoples of North America within that transition to modernity in the eighteenth century. These authors' observations varied from the expected, such as by defining Indigenous Peoples as premodern (complete with the value judgments that reflected the authors' predispositions to modernity), to the unexpected, such as Bartram's "passionate identification with the Other…[who] expresses a romantic revolt against the modernity that he was convinced had drawn away from the authentically human" (234). This conflagration of modernity and Other reveals what Sayre calls a "radical paradox" exhibited by all of his Euro-American authors: a "unanimity of praise" for Indigenous Peoples and cultures (and in some cases their moral and cultural superiority), but at the same time equating those peoples and cultures as antithetical to modernity...

List of Illustrations Preface A Note on Classification, Terminology, and Spelling Acknowledgements 1. Situating the Indigenous Peoples of North America 2. Studying the Indigenous Peoples of North America through the Lens of Anthropology 3. Comprehending North American Archaeology 4. Studying Population, Languages, and Cultures in North America as they were at AD 1500 5. Overview of Traditional Lifeways 6. Understanding the Colonial Experience 7. Contemporary Conditions, Nation-building, and Anthropology Epilogue: Final Comments Appendices: 1. The United Nations Declaration on the Rights of Indigenous Peoples 2. Excerpts from the Code of Ethics of the American Anthropological Association (2009) 3. Excerpts from the Native American Graves Protection and Repatriation Act (1990) 4. Excerpts from the Royal Proclamation of 1763 5. Apology for Residential Schools 6. Apology to the Native Peoples of the United States 7. Studying Indigenous Peoples of North America Glossary Bibliography Index