Clinical Anatomy Research Articles

Terminologica Anatomica2: are we working toward achieving a unified consensus based anatomical terminology?

This paper focuses on the authors perspectives of the terminology developed by the Gross and Clinical Anatomy Working Group for Terminologica Anatomica2. Terminologica Anatomica2 represents a great deal of work by the Gross and Clinical Anatomy Working Group of the Federative International Program for Anatomical Terminology. Listing ofsynonyms and eponymscan be of great utility in terms of historical translation. However, the initial goal of achieving an international standard for anatomical terminology derived through a scholarly, consensus based process has been lost in Terminologica Anatomica2 as it provides a variety of choices that can be used to name a particular structure, in contrast to Terminologica Anatomica1 where preferred terminology is explicitly stated.

Morphology and Morphometry of the Anterior Clinoid Process in a Select South African Population

Background: Clinoid space is revealed when the anterior clinoid process (ACP) is removed, and it makes anterior vertical segment of the internal carotid artery (ICA) visible. Also, the presence of Carotico-clinoid foramen (CCF) makes the ICA from the cavernous sinus emerges through it and endangers the artery during anterior clinoidectomy which necessitates understanding the variable dimensions of ACP. Aim and Objectives: This study intended to investigate the morphology and morphometry of the ACP and to document the prevalence of the CCF in a select group of the South African population. Materials and Methods: The study was carried out on a total of 32 open crania (n=64 ACP) obtained from the University of KwaZulu-Natal, Nelson Mandela School of Medicine, Discipline of Clinical Anatomy using digital vernier caliper to measure the dimensions of the ACP. Results: The mean length, basal width, and thickness of the ACP on the right were10.18±1.34mm, 10.27±0.73mm, and 5.81±0.80mm and the left side was 10.89±0.94mm, 11.63±0.90mm, and 4.78±0.64mm respectively. The left ACP was significantly longer, wider, and thinner than the right ACP. Type I (short and broad) ACP was the most prevalent type, occurring in 53.13% of the studied population. Out of the 32 skulls studied, the CCF was observed in 6 (18.75%) cases. Five out of the six skulls (83.33%) had a bilateral complete CCF, and 1 (16.67%) had a unilaterally incomplete CCF. Conclusion: The ACP in our setting differs from other populations in terms of type, dimensions, and prevalence of the CCF and these should be considered when interpreting skull base radiographs and planning anterior clinoidectomy.

Impact of bias field correction on 0.35 T pelvic MR images: evaluation on generative adversarial network-based OARs' auto-segmentation and visual grading assessment.

Magnetic resonance imaging (MRI)-guided radiotherapy enables adaptive treatment plans based on daily anatomical changes and accurate organ visualization. However, the bias field artifact can compromise image quality, affecting diagnostic accuracy and quantitative analyses. This study aims to assess the impact of bias field correction on 0.35 T pelvis MRIs by evaluating clinical anatomy visualization and generative adversarial network (GAN) auto-segmentation performance. 3D simulation MRIs from 60 prostate cancer patients treated on MR-Linac (0.35 T) were collected and preprocessed with the N4ITK algorithm for bias field correction. A 3D GAN architecture was trained, validated, and tested on 40, 10, and 10 patients, respectively, to auto-segment the organs at risk (OARs) rectum and bladder. The GAN was trained and evaluated either with the original or the bias-corrected MRIs. The Dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (HD95th) were computed for the segmented volumes of each patient. The Wilcoxon signed-rank test assessed the statistical difference of the metrics within OARs, both with and without bias field correction. Five radiation oncologists blindly scored 22 randomly chosen patients in terms of overall image quality and visibility of boundaries (prostate, rectum, bladder, seminal vesicles) of the original and bias-corrected MRIs. Bennett's S score and Fleiss' kappa were used to assess the pairwise interrater agreement and the interrater agreement among all the observers, respectively. In the test set, the GAN trained and evaluated on original and bias-corrected MRIs showed DSC/HD95th of 0.92/5.63mm and 0.92/5.91mm for the bladder and 0.84/10.61mm and 0.83/9.71mm for the rectum. No statistical differences in the distribution of the evaluation metrics were found neither for the bladder (DSC: p = 0.07; HD95th: p = 0.35) nor for the rectum (DSC: p = 0.32; HD95th: p = 0.63). From the clinical visual grading assessment, the bias-corrected MRI resulted mostly in either no change or an improvement of the image quality and visualization of the organs' boundaries compared with the original MRI. The bias field correction did not improve the anatomy visualization from a clinical point of view and the OARs' auto-segmentation outputs generated by the GAN.

The anterior saphenous vein. Part 2. Anatomic considerations in normal and refluxing patients. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum, and the International Union of Phlebology

BackgroundThe term Anterior Accessory of the Great Saphenous Vein suggests this is a branch tributary vein despite this vessel’s anatomic features of a truncal vein. A multisocietal group suggested to designate this the anterior saphenous vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs. MethodsThe clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities. ResultsThe ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature. ConclusionsThe ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein.

The Anterior Saphenous Vein. Part 2. Anatomic considerations in normal and refluxing patients. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology.

The term Anterior Accessory of the Great Saphenous Vein suggest this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A multisocietal group suggested to designate this the Anterior Saphenous Vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs. The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities. The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature. The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein.

Venous valves of the azygos arch: A cadaveric study

PurposeThe existence of valves in the azygos vein are not discussed in depth in the current body of literature. Although the clinical relevance of the valves in these veins are not well understood, these valves may have implications in diagnostic imaging where their appearance on imaging studies can impact interpretation. This study aims to use cadaveric dissections to determine the anatomic prevalence and morphology of valves in the arch of the azygos vein in comparison to current data reported from clinical imaging studies and anatomy textbooks. MethodsApproval of this research study on human cadaveric specimen was sought from the St. George's University Institutional Review Board (IRB) and was deemed exempt from full review (IRB – 16015). This research project involved 47 azygos veins dissected from human cadaveric donor specimen. Azygos veins were harvested from the level of the diaphragm to the inflow into the superior vena cava for gross inspection of valve presence and morphology. The data collected was recorded and sorted by sex, valve presence, number and morphology and valve location. Chi square analysis was performed to assess possible relationships in valve findings based on sex. A brief search of the literature using the keywords “azygos vein” and “valves” was conducted to see the current understanding of azygos valve prevalence. ResultsOf the donor specimen, 53.2% (25 of 47) were male and 46.8% (22 of 47) were female. Of the 47 cadavers that were dissected, 89.3% (42 of 47) were found to have valves in the azygos vein, while 10.6% (5 of 47) were found to have none. The azygos vein contained mostly one valve along its length, mainly located in the arch. The valves were unicuspid (8.5%; 4 of 47), bicuspid (70.2%; 33 of 47) or tricuspid (10.64%; 5 of 47). Dividing the arch of the azygos into quartiles, valves were found most commonly in the third quartile of the distance from the opening of the right superior intercostal vein into the azygos vein to the superior vena cava. Four cadavers had multiple valves, each with varying valve morphology. The length of the cusp of the bicuspid valve ranged from 10 mm to 12 mm. ConclusionThis study shows that the azygos vein contains valves, predominantly within the arch at a prevalence of 89.3%. The presence and variability in morphology of valves in the azygos vein and its potential implications for contrast appearance on imaging studies is clinically important. Radiologists should have a working knowledge of the different appearances of azygos arch valves to minimize the risks of confusing normal variations with thoracic pathology. Though not commonly described in anatomy texts, the findings of this research not only add more detail to the historical cadaveric study information on azygos vein valves, but also shows that the prevalence of azygos arch valves surpasses the numbers reported in clinical studies. As such, it provides support for the inclusion of azygos arch valves in anatomical textbooks and in the teaching of image interpretation.

Clinical anatomy of the popliteal artery and its implications in total knee arthroplasty: a systematic review and meta-analysis.

The popliteal artery (PA) is a lower extremity arterial vessel, a continuation of the superficial femoral artery. PA may be injured in the majority of total knee arthroplasty (TKA), as well as arthroscopic surgeries which may lead to acute ischemic injury. Our objective was analyzing morphometry of PA in relation to other structures both in flexion and extension of the knee, highlighting discrepancies in the PA's location in varying positions. Literature was reviewed in regards to morphological qualities, prevalence rates, and variants of PA were pooled. Five cadaveric and 14 radiological studies were included, totalling 1473 lower limbs. We found that PA, when nearing bone, was more predictable and fixed as seen in axial plane one and two centimeters distal to joint line at 0 degrees flexion. The distance between PA and posterior tibial cortex was estimated at 3.3 mm with 95% confidence interval (CI) 2.6-4.1 and 7.8 mm (95% CI 5.1-10.5) respectively. Once PA passed over and nearing the joint it had larger discrepancies with distance comparing the knee in 0 vs 90 degree flexion. Due to rise of TKA, arthroscopic surgeries and connected vascular complications PA has been investigated more frequently, and while majority of publications describes relationships between vessels of popliteal area and specific landmarks conducted with knee in extension, our study also implemented data regarding knee flexion thus encompassing the problem in a more dynamic manner. We believe this provides superior data for identification of PA, especially during knee surgery.

Teaching clinical anatomy to medical students by flipped classroom.

Background We aimed to introduce the flipped classroom approach for teaching clinical anatomy and to assess its perception and feasibility among medical undergraduate students. Methods Our study included 151 MBBS students of the first professional. We took written informed consent after the study was approved by the Ethics Committee. Selected topics of clinical anatomy were taught using the flipped classroom (FCR) method. It involved pre-class, in-class and post-class activities. In pre-class activity, pre-reading material was given to the students 1 week before the class. An assignment was given 2 days before the class in the form of solving multiple- choice questions, drawing well-labelled diagrams, etc. In- class activity included a pre-test followed by a discussion of the topic in the form of problem-based questions in the class on the principle of Think-Pair-Share. Post-class activity included summarization of the topic by students in the form of a group activity followed by a feedback session. Feedback was collected using a pre-validated feedback questionnaire on Google forms. Data collected were analysed using SPSS 21.0 and Microsoft office 2010. The response to close-ended questions was expressed as percentage. Open-ended questions were analysed by grouping of qualitative responses. Results We found FCR to be a feasible, interesting and necessary pedagogical tool for medical education. Most students (95%) agreed that FCR is a useful technique for better understanding of clinical anatomy. They learnt better from FCR than other teaching methods and their in-depth understanding of the topic improved with FCR. Conclusion FCR is an established teaching-learning tool but it needs to be implemented in undergraduate teaching of clinical anatomy for better understanding of the topics. Didactic lectures do not touch upon clinical correlations in a case-based manner, which can be easily discussed in FCR.

Anthropometric Study Via Digital X-Rays of the Obturator Foramen in Surgical Treatment of Urine Incontinence in the South-Western Adult Female Population of Iran

Background: The trans-obturator tape (TOT) procedure is an efficient treatment option that provides support for the urethra in cases of stress urinary incontinence (SUI). Objectives: This research aimed to ascertain the accuracy of anthropometric parameters of the female pubic arch and the obturator foramen (OF) and their application in clinical anatomy. Methods: In this cross-sectional observational research conducted from October 2021 to September 2022, the morphometric characteristics of the pubic arch and the OF were measured on digital pelvic radiographs of 500 adult women from southwestern Iran. They were grouped into three age categories, namely, 18 - 34, 35 - 50, and more than 50 years old, and compared within and between the groups. Results: Significant differences were observed in computed parameter indices of the OF and pubic arch based on age. Parameters such as inter-obturator foramina distance, pubic symphysis length, pubic ramus width, and length increased significantly with age (P ≤ 0.05). Additionally, as women's ages increased, their subpubic angle decreased significantly (P = 0.001). However, other parameters, such as the OF area and the anterior urogenital triangle area, did not show a significant increase with age (P ≥ 0.05). These findings indicate that anatomical pelvic measurements change significantly with age in women. Conclusions: The present study revealed a wide range of variant bony pelvic anatomy in southwestern Iranian adult women, distinct from norms in other groups. Our findings could be utilized in surgical approaches and the production of trans-obturator kits by companies.

Anatomical review of internal jugular vein cannulation.

The internal jugular veins (IJV) are the primary venous outflow channels of the head and neck. The IJV is of clinical interest since it is often used for central venous access. This literature aims at presenting an overview of the anatomical variations, morphometrics based on various imaging modalities, cadaveric and surgical findings, and the clinical anatomy of IJV cannulation. Additionally, the anatomical basis of complications, techniques to avoid complications, and cannulation in special instances are also included in the review. The review was performed by a detailed literature search and review of relevant articles. A total of 141 articles were included and organized into anatomical variations, morphometrics, and clinical anatomy of IJV cannulation. The IJV is next to important structures such as the arteries, nerve plexus, and pleura, which puts them at risk of injury during cannulation. Anatomical variations such as duplications, fenestrations, agenesis, tributaries, and valves, may lead to an increased failure rate and complications during the procedure, if unnoticed. The morphometrics of IJV, such as the cross-sectional area, diameter, and distance from the skin-to-cavo-atrial junction may assist in choosing the appropriate cannulation techniques and hence reduce the incidence of complications. Age, gender, and side-related differences explained variations in the IJV-common carotid artery relationship, cross-sectional area, and diameter. Accurate knowledge of anatomical variations in special considerations such as paediatrics and obesity may help prevent complications and facilitate successful cannulation.

Surgical tooth extraction in cats and dogs. Part 2: dental extraction techniques

Background: Considering over 80 per cent of canine and feline patients over the age of three years have dental disease (Kortegaard and others 2008), dental extractions are undoubtedly some of the most commonly performed surgeries in first‐opinion practice. Yet, general knowledge and confidence with regards to these procedures is often lacking, resulting in veterinary dentistry having an undeserved reputation for being difficult and unrewarding. However, with the correct knowledge, a basic set of instruments and proper techniques it can quickly become a much more straightforward and immensely rewarding task.Aim of the article: This two‐part series provides readers with the tools needed to perform extractions successfully. Part one, published in the previous issue of In Practice, reviewed clinical anatomy, dental instrumentation and the basic principles of exodontics, while this article will focus on extraction techniques.

Klinik Anatomi Eğitimi Verilen Anesteziyoloji ve Reanimasyon Anabilim Dalı Araştırma Görevlilerinin Eğitim Hakkındaki Görüşlerinin Değerlendirilmesi: Bir Üniversite Örneği

Introduction: Anatomy is considered one of the cornerstones of medical education. In-depth understanding of anatomy is essential, especially for safe clinical practice in surgical disciplines. This study aimed to evaluate the feedback of research assistants in the department of anesthesiology and reanimation, who received clinical anatomy education.
 Methods: Clinical anatomy education was provided for research assistants at different levels in the department of anesthesiology and reanimation, with two hours per week, and the education was completed within one month. The 5-point Likert scale questionnaire consisting of 18 questions was administered to research assistants to gather their opinions about education. Participants were asked to rate the questions on a scale from 1 to 5. Additionally, data such as age, gender, duration of clinical experience, experience with neuroaxial or peripheral nerve blocks, and participation in regional anesthesia courses were recorded.
 Results: A total of 40 participants, including 15 (37.5%) males and 25 (62.5%) females, with an average age of 29.67 ± 3.94 years, were included in the study. Nearly all participants in our study reported that integrated clinical anatomy education is necessary. The majority mentioned that anatomy education would contribute to airway management and regional anesthesia applications. The participation rate in regional anesthesia courses before education was 17.5%. There was no significant difference in average questionnaire scores between those who participated in regional anesthesia courses and those who did not (p=0.06).
 Conclusion: In the process of anesthesiology and reanimation specialization training, we believe that incorporating clinical anatomy education would enhance the quality of specialization education, thereby improving safety and effectiveness in clinical applications.

The Clinical Anatomy Fellowship: Revolutionizing curricular experiences for faculty and students.

Fellows completing the Clinical Anatomy Fellowship at Kansas City University assist Anatomy faculty in the Gross Anatomy laboratory, complete robust research projects, and support other departments. The program's positive impact on participants has been reported; however, the impact on individuals interfacing with Fellows has not been investigated. A follow-up, survey-based (Likert scale, multiple-choice, open-ended) study was conducted to evaluate faculty, staff, and student perceptions of the program. Ninety-five percent of surveyed faculty and staff (n = 22) perceived the Fellows as beneficial to students, faculty, and the university (p < 0.05) by acting as role models (95%) and mentors (90%), contributing to educational processes (90%), and reducing faculty work burden (81%) (p < 0.05). Student responses (n = 95) were also positive: 97% perceived interactions with Fellows as beneficial (p < 0.05). A passion for Anatomy (mean, 4.6; p < 0.05) and the opportunity to increase competitiveness for residency (mean, 4.5; p < 0.05) were the most important factors driving interest in the Fellowship (Cronbach's alpha, 0.766). In contrast, diverting a year from the school's curriculum (mean, 4.4; p < 0.05) and delaying clinical experiences (mean, 4.3; p < 0.05) were the most important deterrents (Cronbach's alpha, 0.505). Additionally, the financial investment required by the program is lower than that associated with hiring full-time faculty. Analysis comparing employment of Fellows versus associate-level faculty identified annual net savings of $370,000. Not only does the Fellowship augment faculty and student experiences at the university, but it also allows for substantial cost savings. Collectively, these data are evidence for other health professional institutions to consider adopting a similar program.

The clinical anatomy of the atrioventricular conduction axis.

It is axiomatic that the chances of achieving accurate capture of the conduction axis and its fascicles will be optimized by equally accurate knowledge of the relationship of the components to the recognizable cardiac landmarks, and we find it surprising that acknowledged experts should continue to use drawings that fall short in terms of anatomical accuracy. The accuracy achieved by Sunao Tawara (1906) in showing the location of the atrioventricular conduction axis is little short of astounding. Our purpose in bringing this to current attention is to question the need of the experts to have produced such inaccurate representations, since the findings of Tawara have been extensively endorsed in very recent years. The recent studies do no more than point to the amazing accuracy of the initial account of Tawara. At the same time, we draw attention to the findings described in the middle of the 20th century by Ivan Mahaim (1947). These observations have tended to be ignored in recent accounts. They are, perhaps, of equal significance to those seeking specifically to pace the left fascicles of the branching atrioventricular bundle.

History of the hip joint pectineofoveal fold.

Although Josias Weitbrecht described the retinacula of the hip joint in his 1742 Syndesmologia, the anatomist Cesare Amantini of Perugia specifically studied the medial retinacula he referred to as the pectineofoveal fold in a late 19th-century monograph. This particular synovial fold stretches from the lesser trochanter to the osteocartilaginous junction of the femoral head along a virtual line connecting the lesser trochanter and the fovea for the ligament of the head. Although mentioned by some anatomists and radiologists, and despite its possible involvement in specific hip joint pathologies (fractures, impingements), it is surprising that Amantini's pectineofoveal fold remains ignored by most anatomy and clinical anatomy books. This study aims to verify if Cesare Amantini effectively drew attention to this synovial fold for the first time and coined the term "pectineofoveal fold," as well as determine whether most classical textbooks (i.e., published from 1890 to 2017) acknowledge the discovery and include it in the description of the hip joint. A possible evolutionary link between this synovial fold and the ambiens and pectineus muscles exists and should be discussed.

Moving Beyond the Near-Peer Teaching Model with the Rutgers New Jersey Medical School Teaching Assistant Program.

Medical students will become educators teaching peers, healthcare students, patients, and families. At Rutgers New Jersey Medical School, the "Teaching Assistants in Medical Education" program provides fourth-year medical students with the skills and experiences needed to prepare them as medical educators. The program goes beyond the near peer teaching model to support student development in curricular design, assessment, and communication skills through a Clinical Skills or Anatomy track. Investment in the development of medical students as future educators will yield immediate and long-term rewards.

A combined radiomics and anatomical features model enhances MRI-based recognition of symptomatic nerves in primary trigeminal neuralgia.

The diagnosis of primary trigeminal neuralgia (PTN) in radiology lacks the gold standard and largely depends on the identification of neurovascular compression (NVC) using magnetic resonance imaging (MRI) water imaging sequences. However, relying on this imaging sign alone often fails to accurately distinguish the symptomatic side of the nerve from asymptomatic nerves, and may even lead to incorrect diagnoses. Therefore, it is essential to develop a more effective diagnostic tool to aid radiologists in the diagnosis of TN. This study aims to establish a radiomics-based machine learning model integrating multi-region of interest (multiple-ROI) MRI and anatomical data, to improve the accuracy in differentiating symptomatic from asymptomatic nerves in PTN. A retrospective analysis of MRI data and clinical anatomical data was conducted on 140 patients with clinically confirmed PTN. Symptomatic nerves of TN patients were defined as the positive group, while asymptomatic nerves served as the negative group. The ipsilateral Meckel's cavity (MC) was included in both groups. Through dimensionality reduction analysis, four radiomics features were selected from the MC and 24 radiomics features were selected from the trigeminal cisternal segment. Thirteen anatomical features relevant to TN were identified from the literature, and analyzed using univariate logistic regression and multivariate logistic regression. Four features were confirmed as independent risk factors for TN. Logistic regression (LR) models were constructed for radiomics model and clinical anatomy, and a combined model was developed by integrating the radiomics score (Rad-Score) with the clinical anatomy model. The models' performance was evaluated using receiver operating characteristic curve (ROC) curves, calibration curves, and decision curve analysis (DCA). The four independent clinical anatomical factors identified were: degree of neurovascular compression, site of neurovascular compression site, thickness of the trigeminal nerve root, and trigeminal pons angle (TPA). The final combined model, incorporating radiomics and clinical anatomy, achieved an area under the curve (AUC) of 0.91/0.90 (95% CI: 0.87-0.95/0.81-0.96) and an accuracy of approximately 82% in recognizing symptomatic and normal nerves. The combined radiomics and anatomical model provides superior recognition efficiency for the symptomatic nerves in PTN, offering valuable support for radiologists in diagnosing TN.

Surgical tooth extraction in cats and dogs. Part 1: basics of dental extractions

Background: Dental extractions in their various forms (collectively known as exodontics) are exceedingly common treatments in first‐opinion practice. Despite being something even the most seasoned colleagues often dread performing, it is a skill all veterinary surgeons, including new graduates, are expected to be confident in. However, veterinary dentistry is commonly undertaught in universities and so many of us end up being taught these skills in practice by our colleagues, who, in most cases, haven't had a significant level of formal training themselves and feel less than positive about the task. Therefore, it is no wonder that many vets begin to sweat at the idea of a geriatric cat with tooth resorption that's been booked in for extractions just before evening consultations. Fortunately, with but a small amount of knowledge and a modicum of practice, dental extractions can quickly become hugely rewarding and potentially transformative for patient welfare.Aim of the article: The intention of this two‐part series is to provide readers with the comprehensive knowledge needed to successfully perform dental extractions. This first part focuses on clinical anatomy, dental instrumentation and the basic principles of extractions. Part two, to be published in a subsequent issue, will focus on closed and open extractions, from initial flap design to closure.

Comparison of Blood Biomarkers in Systemic Blood and Varicose Veins: A Cross-sectional Study

Introduction: Varicose Veins (VV) are enlarged, convoluted, and elongated veins that primarily affect the superficial veins in the lower limbs and are one of the most prevalent indications of vascular diseases. The reasons for elevated venous pressure are understood, but the inflammatory cytokines that initiate the ultimate pathways of tissue destruction and are in charge of the clinical characteristics of Chronic Venous Insufficiency (CVI) are yet unknown. Although inflammation plays a crucial role in the process of tissue apoptosis, it also plays a crucial role in tissue repair and regeneration. Aim: To investigate changes in blood markers of varicose vein inflammation and endothelial damage and compare them with systemic markers in VV patients and conclude that they are increased in VV blood. Materials and Methods: The comparative cross-sectional study was conducted in the Department of Biochemistry on 70 patients with primary VV who were scheduled for Outpatient Sclerotherapy at Nootan Medical College and Research Centre, Sankalcahnd Patel Vidyadham in Visnagar, Gujarat, India from April 2021 to June 2023. Chronic lower extremity Venous Disease (CVD) was categorised using the Clinical Aetiology Anatomy Pathophysiology (CEAP) classification method. Blood samples were obtained above the knee from the tortuous and dilated varicose tributaries of the great saphenous vein (local) and from the antecubital (systemic) vein by standard venipuncture. Erythrocytes, leukocytes, platelets, haemoglobin, and haematocrit were determined using an automatic haematology analyser. D-dimer and High sensitivity C-reactive Protein (hsCRP) were determined by an immune turbidimetric assay. IL-6 and von Willebrand factor (vWF) were measured by Enzyme Linked Immunosorbent Assay (ELISA) using commercially available kits according to the manufacturers’ instructions. An Independent samples t-test was used to compare group difference, and p-value ≤0.05 were considered significant in all two-sided statistical tests. Results: Basic haematologic test results {systemic versus (vs) varicose blood samples} were comparable. In VV, the following parameters were significantly increased compared to systemic blood: Haemoglobin (12.85±1.81 g/dL vs. 15.82±1.57 g/ dL, p&lt;0.001), hsCRP (1.34±1.01 mg/L vs. 3.78±1.67 mg/L, p&lt;0.001), IL-6 (2.65±1.07 pg/mL vs. 4.17±1.51 pg/mL, p&lt;0.001), vWF (90.73±16.72% vs. 127.30±19.92, p&lt;0.001). D-dimer was also substantially higher in samples extracted from leg VV than in systemic blood (105.87±17.72 ng/mL vs. 85.61±18.18 ng/mL, p&lt;0.001). Conclusion: Blood from VV has shown a higher level of several inflammatory markers and signs of endothelial dysfunction. This is most likely the result of worsening venous pressure and dilated, convoluted superficial veins that restrict blood flow. The procoagulant qualities of the local blood and damage to the venous wall, leading to a chronic inflammatory response, may accelerate the disease’s progression and thrombotic consequences.

Comparative Analysis of Angiographic Parameters and Percutaneous Coronary Intervention Outcomes in Diverse Populations in Türkiye.

Due to the conflict in Syria since 2011, more than 3.5 million Syrian citizens reside in Türkiye. Because Syrian patients were underrepresented in previous studies on percutaneous coronary intervention (PCI) outcomes, we aimed to analyze the severity of coronary artery disease and in-hospital outcomes of PCI in this population. We retrospectively analyzed 142 Syrian patients who underwent PCI at our center between June 2020 and October 2022 and compared the data with that of age- and sex-matched Turkish patients (n = 271) who also underwent PCI. We assessed comorbidities, coronary anatomy features, procedural complications, and in-hospital cardiovascular outcomes (Major Adverse Cardiac and Cerebrovascular Events, MACCE). The mean age of the study population was 57 ± 12 years, with 15% being female. Clinical indication and coronary anatomy features did not differ between the groups. However, the Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score was higher in Syrian patients compared to Turkish patients (16 [11-22] vs. 12 [8-20]; P < 0.001). Complex PCI rates, in-hospital bleeding and contrast nephropathy were similar in both groups. MACCE was comparable between Syrian and Turkish patients (13 [4.8%] vs. 13 [9.2%], P = 0.083). Comparable MACCE rates were observed in both ethnic groups undergoing PCI, despite a higher SYNTAX score in Syrian patients. Future research should investigate whether similar in-hospital MACCE rates are observed in other regions of Türkiye and whether long-term cardiovascular outcomes differ between Turkish and Syrian patients.