Nutrient Artery Research Articles

The Effects of Interleukin‐1 Receptor Antagonism on Micro‐ and Macrovascular Function in Young and Old Fischer‐344 Rats

BACKGROUNDInterleukin‐1 (IL‐1) is a pro‐inflammatory cytokine that plays a role in systemic and local inflammatory responses, inhibiting vascular contractility and inducing vascular dysfunction. Interleukin‐1 receptor antagonists (IL‐1RA) block IL‐1 signaling by binding to the IL‐1 receptor. Thus, IL‐1RA may have protective effects on vascular function during bone healing. We sought to determine the influence of IL‐1RA on vasodilator capacity of the femoral principal nutrient artery (i.e., PNA) following a bone defect. Additionally, we sought to determine the influence of IL‐1RA administration on macrovascular function (i.e., aortic stiffness).METHODSYoung (6 months) and old (24 months) male Fischer‐344 rats were randomly assigned to 1) young control (YC, n=7–8), young interleukin‐1 receptor antagonism (Y_IL‐1RA, n=5–7), old control (OC, n=5–6), and old interleukin‐1 receptor antagonism (O_IL‐1RA, n=5–10). Under anesthesia (2.0% isoflurane to O2 balance), rats underwent surgery to create a small bone defect in the right femur. During recovery, the control and IL‐1RA groups received PBS (100 μl/day, i.p.) or IL‐1RA (3 μg/kg, i.p.), respectively, 3 days/week for 3 weeks. To assess arterial stiffness in the aorta, pulse wave velocity (PWV; cm/sec) was measured prior to the surgery and before sacrifice. At sacrifice, right femoral PNAs were isolated and cannulated to assess endothelium‐dependent (acetylcholine [ACh]: 10−9 – 10−4 M) and endothelium‐independent (DEA NONOate [DEA]: 10−10 – 10−4 M) vasodilation. A One‐Way ANOVA and Repeated Measures ANOVAs were performed. Alpha was set a priori at p<0.05 and tendencies (p<0.10) are reported.RESULTSBody mass was higher (p<0.05) in the old (OC, 401±15 g and O_IL‐1RA, 410±10 g) vs. young (YC, 351±6 g and Y_IL‐1RA, 354±9 g) rats, but did not differ between the age‐matched groups. The maximal diameters of the PNA did not differ among groups (YC, 209±17 μm; Y_IL‐1RA, 209±15 μm; OC, 212±8 μm; O_IL‐1RA, 238±11 μm). IL‐1RA administration had no effect on endothelium‐dependent vasodilation of the femoral PNA, however, there was a tendency (p=0.056) for reduction in O_IL‐1RA vs. YC. Endothelium‐independent vasodilation was augmented (p<0.05) in OC vs. all other groups and was impaired (p<0.05) in O_IL‐1RA vs. OC. PWV was higher (p<0.05) in the old (OC, 478±10 cm/sec and O_IL‐1RA, 452±8 cm/sec) vs. young (YC, 396±10 cm/sec and Y_IL‐1RA, 369±10 cm/sec) groups, indicating greater aortic stiffness. In addition, there were tendencies for reduced aortic stiffness by 6.8% and 5.5% in Y_IL‐1RA (p=0.061) and O_IL‐1RA (p=0.056), respectively, vs. their age‐matched controls.CONCLUSIONS1) IL‐1RA treatment reduced endothelium‐independent vasodilation of the femoral PNA (i.e., the microvasculature) in old animals. 2) Aortic stiffness was augmented as a function of advanced age. 3) 3‐weeks of IL‐1RA treatment tended to reduce stiffness in the macrovasculature of both young and old rats.Support or Funding InformationGrant Support: American Heart Association: 16IRG27550003

Study of the Anatomical Variations in the Nutrient Foramina of Fibula

Background: The main blood supply to a growing bone is through its nutrient artery. It enters the bone through nutrient foramina (NF). Fibula is commonly used as a bone graft. The anatomical location of NF on fibula is valuable during surgeries. Objective: Topographic assessment of nutrient foramina on human fibulae. Study Design: Cross Sectional Observational Study. Settings: Anatomy Department, Postgraduate Medical Institute, Lahore Pakistan. Duration: 4 months (from 1-12-2018 to 31-3-2019). Methodology: 100 fibulae were obtained from the bone bank of anatomy department, Postgraduate Medical Institute, Lahore. The number of NF and their position on the fibular shaft were observed. Results: Single foramen was observed in 90 (90%) fibulae, 4 (4%) had two foramina, while 6 (6%) had no NF. 86 (93%) foramina were seen on the middle third of the bone. 47 (50%) NF were present on the posterior aspect. 2 (2%) foramina were on the proximal third and 4 (4%) were on the distal third of the fibulae. Conclusion: The posterior aspect and the middle third of the bony shaft bore most of the nutrient foramina.

Neural regulation of the contractility of nutrient artery in the guinea pig tibia.

Nutrient arteries provide the endosteal blood supply to maintain bone remodelling and energy metabolism. Here, we investigated the distribution and function of perivascular nerves in regulating the contractility of the tibial nutrient artery. Changes in artery diameter were measured using a video tracking system, while the perivascular innervation was investigated using fluorescence immunohistochemistry. Nerve-evoked phasic constrictions of nutrient arteries were suppressed by phentolamine (1μM), an α-adrenoceptor antagonist, guanethidine (10μM), a blocker of sympathetic transmission, or fluoxetine (10μM), a serotonin (5-hydroxytryptamine, 5-HT) reuptake inhibitor. In arteries pretreated with guanethidine, residual nerve-evoked constrictions were abolished by a high concentration of propranolol (10μM) that is known to inhibit 5-HT receptors, or ketanserin (100nM), a 5-HT2 receptor antagonist, but not SB207216 (1μM), an antagonist of 5-HT3 and 5-HT4 receptors. Bath-applied 5-HT (100nM) induced arterial constriction that was suppressed by propranolol (10μM) or ketanserin (100nM). Nerve-evoked arterial constrictions were enhanced by spantide (1μM), a substance P (SP) receptor antagonist, or L-nitro arginine (L-NA; 100μM), an inhibitor of nitric oxide synthase (NOS). Immunohistochemistry revealed 5-HT-positive nerves running along the arteries that are distinct from perivascular sympathetic or substance P-positive primary afferent nerves. For the first time, functional serotonergic nerves are identified in the tibial nutrient artery of the guinea pig. Thus, it appears that tibial nutrient arterial calibre is regulated by the balance between sympathetic and serotonergic vasoconstrictor nerves and vasodilator afferent nerves that release substance P-stimulating endothelial nitric oxide (NO) release.

Reverse neurocutaneous vs propeller perforator flaps in diabetic foot reconstruction

Introduction Reverse neurocutaneous and propeller perforator flaps are both used to reconstruct diabetic distal lower limb defects. Our study aims to compare outcomes between these two groups of flaps with an emphasis on indications and complication rates.Method A retrospective analysis was conducted, reviewing data from 54 diabetic patients who underwent reconstruction of acute or chronic wounds of the foot and ankle between 2005-2018. Thirty-four patients (Group A) had a reverse neurocutaneous flap (NCF): nineteen sural and fifteen lateral supramalleolar flaps. Twenty patients (Group B) had a propeller flap (PF) based on peroneal (n = 13) or posterior tibial artery perforators (n = 7). All patients had a preoperative Doppler examination to identify the nutrient artery of the flap. In both groups, we recorded patients’ demographics, characteristics of the defect, postoperative complications and time to heal. Follow-up ranged from 6 to 59 months. Student's t-test and chi-squared test were used for statistical analysis.Results Mean patients’ age was 59.1 and 50.8 years for Group A and B, respectively. Defects were located at the Achilles zone (n = 16), posterior heel (n = 14), foot dorsum (n = 9), lateral and medial malleolar areas (n = 8), anterior ankle (n = 5) and lateral foot (n = 2). Mean size of the defect was 42.8 cm2 in Group A and 23 cm2 in Group B. Uneventful healing was recorded in 20/34 neurocutaneous flaps and in 12/20 propeller flaps; complications included two complete flap losses (one NCF, one PF), seventeen distal flap necroses (10 NCFs, 7 PFs), fifteen delayed wound healing events over the donor or recipient site (12 NCFs, 3 PFs). Secondary surgeries were required in 15 NCF and 8 PF patients. Mean healing time was 48.1 and 40.7 days for Group A and B, respectively. All patients, except one NCF case, which resulted in leg amputation, returned to previous levels of ambulation.Conclusion Reverse neurocutaneous and propeller flaps may provide stable reconstruction of diabetic lower limb defects; neurocutaneous flaps are specially indicated for larger and more distally located defects, although they might be associated with longer healing time and additional revision surgeries. Propeller flaps were more frequently used in younger patients for smaller and more proximally located defects.

Congenital fibular dystrophisms conform to embryonic arterial dysgenesis.

The congenital short limb (CSL) with fibular deficiency has traditionally been graded by plain radiography. The most popular orthopedic classification sorts the fibular dysmorphologies into three radiographic groupings: IA (thinned), IB (proximally truncated), or II (absent). In contrast, the soft tissues have been relatively neglected. Since bone formation of the fibula progresses from the anlage, a scaffolding cartilage mold intermediate, cartilage transformation to bone is dependent upon timely embryonic arterial invasion. Absences of the requisite arteries predicate specific skeletal dysmorphologies. The usual arterial supply of the fibula is comprised primarily of the anterior tibialis artery (ATA), which uniquely supplies the proximal portion of the fibula, and also joins the peroneal artery (PA) in supplying the mid to distal fibular shaft. Combinations of the two nutrient arteries allow four potential variations of fibular vascular supply, among which the ATA and PA conjoin to supply the normal fibula and variably supply the three dysmorphic fibular models. The IA and IB deformities conform, respectively, to the absences of the PA and the ATA. Combined ATA and PA absences present in the radiographically "absent" fibula. Thus, each of the four fibular (dys)morphologies conforms to a specific embryonic pattern of arterial development. The term "dystrophism" most accurately characterizes such malformed long bones.

MORPHOLOGICAL AND MORPHOMETRIC STUDY OF NUTRIENT FORAMINA OF FEMUR IN SOUTH INDIAN POPULATION

MORPHOLOGICAL AND MORPHOMETRIC STUDY OF NUTRIENT FORAMINA OF FEMUR IN SOUTH INDIAN POPULATION

Three-dimensional topography of scapular nutrient foramina

PurposeThe aim of this study is to describe the number and location of the nutrient foramina in human scapulae which can minimize blood loss during surgery.Methods30 cadaveric scapulae were macerated to denude the skeletal tissue. The nutrient foramina of 0.51 mm and larger were identified and labeled by adhering glass beads. CT scans of these scapulae were segmented resulting in a surface model of each scapula and the location of the labeled nutrient foramina. All scapulae were scaled to the same size projecting the nutrient foramina onto one representative scapular model.ResultsAverage number of nutrient foramina per scapula was 5.3 (0–10). The most common location was in the supraspinous fossa (29.7%). On the costal surface of the scapula, most nutrient foramina were found directly inferior to the suprascapular notch. On the posterior surface, the nutrient foramina were identified under the spine of the scapula in a somewhat similar fashion as those on the costal surface. Nutrient foramina were least present in the peri-glenoid area.ConclusionNinety percent of scapulae have more than one nutrient foramen. They are located in specific areas, on both the posterior and costal surface.

Microsurgical treatment of cervical spinal hemangioblastoma

BackgroundHemangioblastoma is a rare intracranial vascular tumor, mostly found in the cerebellum. Cervical spinal hemangioblastoma (CSHB) has rarely been reported, and microsurgical treatment even less. ObjectiveTo present our experience with CSHB and conduct a literature review, in order to provide a systematic approach to diagnosis and microsurgical treatment. MethodsThe study included 11 patients with CSHB treated by total tumor resection from January 2005 to December 2015. We analyzed clinical and radiological data, surgical outcome, and pathological examination results. ResultsAll patients were treated by total tumor resection. All preoperative nerve root pain resolved completely. Four patients had associated numbness, which improved in 2 and persisted in 2. All patients were in good postoperative health. There were no recurrences during follow-up of 6–48 months. ConclusionPreoperative magnetic resonance imaging (MRI) and computed tomography angiography (CTA) can be used for diagnosis of CSHB. Finding and blocking the nutrient arteries during surgery is necessary reduce bleeding. Total tumor resection requires accurately identifying and separating the proliferative area around the tumor.

Reconstruction of Femur Length Using Epiphyseal and Diaphyseal Diameters in Contemporary Egyptian Sample, with Application to Ancient Egyptians.

Inferences in bioarchaeology and forensic contexts require mathematical stature estimation using long bone lengths. This study aimed to identify predictors of femur length (FL) from epiphyseal and diaphyseal width measurements that are not bound to assumptions of sex or laterality. To compute linear regression models, both standard and new measurements around the diaphyseal dominant nutrient foramina (NF) were collected on modern femora (n = 64) from the unidentified skeletal collection housed at Alexandria University. Four equations were then validated on an ancient Egyptian sample (n = 73) from the Goldman Osteometric Data Set to evaluate the effect of sex subdivision on the accuracy of FL and indirect stature estimations using Raxter's formulas. Most of models reflected significant positive association (r > 0.60) between width variables and FL. Oddly, the distance from the proximal end to the NF correlated weakly with FL (r = 0.34). The stepwise selected equations preferred measurements around NF to midshaft, with the anteroposterior diameter included in the proximal fragment model (r = 0.77), and circumference in diaphyseal fragment model (r = 0.62). Tested equations performed consistently on the ancient Egyptian sample. Measurements from the femoral proximal fragment are more reliable predictors than those from the distal fragment, with the exception of femur neck diameter. However, distal epicondylar breadth is a better predictor of FL in females than in males. Indirect stature estimation showed a reasonable degree of accuracy in both sexes. These models can be applied successfully in contemporary and ancient Egyptian fragmentary remains; however, due to larger size of femora from the Old Kingdom sample, they would be most applicable to individuals from later dynasties.

Study of nutrient foramina in fibula: its applied importance

The external opening of the nutrient canal is usually referred to as the nutrient foramen. The term 'Nutrient' itself describes the role of nutrient foramina in the nutrition and overall growth of the bones. The diaphyseal nutrient artery is the primary source of blood to entire osteal tissue and bone marrow of a long bone, especially during its active growth period and the early stages of ossification. Therefore, they play a very significant role in the healing of fractures and prevention of avascular bone necrosis. Every nutrient foramen has a particular position in each bone and fibula is of no exception. However, the number and location of nutrient foramina may very sometimes. In bone graft and vascularised surgery, the fibula is commonly used. Therefore, an understanding of the position and number of nutrient foramina in fibula is essential. Moreover, fibula flap is the most widely accepted flaps used in the mandibular reconstruction surgery, especially in the malignancy of oral and oropharyngeal regions. This review paper outlines the anatomical variation of the nutrient foramen of the fibula and its applied importance in clinical practice.

Location and number of nutrient foramina in human long bones of a Sri Lankan sample

Location and number of nutrient foramina in human long bones of a Sri Lankan sample

Nutrient foramen of clavicle an anatomical and a topographic study

Nutrient foramen of clavicle an anatomical and a topographic study - IJCAP- Print ISSN No: - 2394-2118 Online ISSN No:- 2394-2126 Article DOI No:- 10.18231/j.ijcap.2019.099, Indian Journal of Clinical Anatomy and Physiology-Indian J Clin Anat Physiol

Variations of Nutrient Foramen of Femur and its Clinical Implications

Introduction: Nutrient foramen is the largest opening on the shaft of the femur that conveys nutrient artery into the marrow cavity. Knowledge on locations of nutrient foramina is essential during surgical procedures as well as to rule out if the fracture line passes through the foramina. The purpose of the study was to determine the number and position of nutrient foramina in relation to length and topography of the femur. Methods: The study model was descriptive, cross-sectional study that included 151 femurs (71 right and 80 left side). The total number, location, and direction of nutrient foramina were investigated. Total length of femur and distance of foramen from the proximal end was measured with the 500mm 20" Digital Vernier Nib Jaw Caliper Metric/ Imperial Machine-DRO and finally Foraminal Index was calculated. Results: The analysis revealed 119(78.81%) of the femurs with single nutrient foramen, 31(20.52%) with double and 1(0.67%) with triple nutrient foramina. Foraminal Index II was found in 74(86.05%) on right side and 90(91.84%) on left side. The most common location of nutrient foramen was the medial lip of linea aspera (n= 77, 41.85%). All of the foramina were directed towards the proximal end. Conclusion: The present study has reported the majority of nutrient foramina located in the middle third of femur along the linea aspera. Thus, linea aspera should not be stripped off during surgical procedures to avoid damage to the nutrient arteries.

What about limb long bone nutrient canal(s)? – a 3D investigation in mammals

The nutrient arteries, located in the long bone diaphysis, are the major blood supply to long bones, especially during the early phases of growth and ossification. Their intersection with the central axis of the medullary area corresponds to the ossification center, and their opening on the outer bone surface to the nutrient foramen. Nutrient arteries/foramen have essentially been analyzed in humans, and only to a much lesser extent in a few mammals. Some studies have taken measurements of the nutrient foramen; others have investigated the shape and orientation of the nutrient canals, although only partially. No studies have analyzed the nutrient canal in three dimensions inside the bone and the relationships between nutrient foramen, nutrient canal, growth, and physiology require further investigation. The current study proposes to investigate in three dimensions the shape of the nutrient canal in stylopod bones of various mammals. Qualitative and quantitative parameters are defined to discuss the diversity in, for example, morphology, orientation, and diameter encountered, resorting to two different datasets to maximize differences within mammals and then analyze variation within morphologically and phylogenetically closer taxa. This study highlights a strong intraspecific variation for various parameters, with limited biological signal, but also shows trends. It notably provides evidence that canals are generally more numerous and relatively thinner in less elongated bones. Moreover, it shows that the growth center is located distally in the humerus and proximally in the femur, and that the canals are essentially oriented towards the faster growing end, so that the nutrient foramen does not indicate the location of the growth center. This result seems general in mammals but cannot be generalized outside of Mammalia. Further analyses of the features of nutrient arteries in reptiles are required to make comparisons with the trends observed in mammals.

Total cross-sectional area of the femoral neck nutrient foramina measured to assess arterial vascular beds in the femoral head

BackgroundA detailed understanding of the blood supply to the femoral head is required to plan the surgery in the femoral neck and head area. However, information about the blood vessel networks in the femoral head is inadequate.MethodsThe surface of the femoral neck of 100 dry cadaveric adult femur specimens was scanned using a 3D scanner. The scanning distance was 200 mm, precision 0.01 mm, and measuring point 0.04 mm. The images were acquired at a resolution of 1,310,000 pixels. Digital imaging data were recorded from the femoral neck surface. The diameters of the nutrient foramina of the superior, inferior and anterior retinacular arteries, and the ligamentum teres arteries were determined and divided into five groups.ResultsThe mean cumulative cross-sectional area of the nutrient foramina was as follows: canals of the superior, inferior, anterior, and ligamentum retinacular arteries were 15.59 mm2, 3.63 mm2, 4.32 mm2, and 1.58 mm2, respectively. Next, we analyzed the canals of the superior, inferior, anterior and ligamentum retinacular arteries, respectively, via 3D scanner. We found that the canals of the superior retinacular arteries appear to supply more blood to the femoral head than the canals of the other three types of arteries.ConclusionsOur results demonstrated that surgeries of the femoral neck and femoral head will be improved with prior 3D scanning and lead to better outcomes in surgeries involving the hip area.

Morphometric Study of the Nutrient Foramina of Human Femora and its Surgical Significance

Morphometric Study of the Nutrient Foramina of Human Femora and its Surgical Significance

Using nutrient foramina to differentiate human from non-human long bone fragments in bioarchaeology and forensic anthropology

Long bone shaft fragments can be found isolated in archaeological and forensic contexts, such as in mass fatality incidents. When diagnostic morphological landmarks are not visible, the assessment of a human or non-human origin of a bone fragment can be challenging. Further methods need to be developed. In long bones, the presence of a nutrient foramen on fragments that do not show any diagnostic landmarks can make the assessment of the origin of the bone still possible. In this paper, human long bones were compared to those of the following species: chicken (Gallus gallus domesticus), duck (Cairina moschata), sheep (Ovis aries), pig (Sus scrofa domesticus), and deer (fallow deer, Dama dama, and roe deer, Capreolus capreolus). Macroscopic evaluation of location, direction and appearance, and micro-CT scanning in order to measure angle and shape of canal entrance, were applied in this study to differentiate human from non-human nutrient foramina on long bone shafts. Observations regarding the location and direction of nutrient foramina were proven to be different between human and non-human bones; however, these two features might not be exploitable in cases of highly fragmented bones. The foramina appearance was the most reliable for the origin identification, although the shape of the canal entrance and its angle at the cortical bone, obtained from micro-CT scans, were also useful parameters. For a correct identification of a fragment, one parameter may not be enough and it is advisable to employ as many features as possible. This research demonstrates that nutrient foramina have potential as a reliable bone feature for the distinction between human and non-human fragmented and incomplete long bones.

An Anatomical Study of the Tibia in the North Indian Population

Introduction The human tibia is a complex anatomical unit and the knowledge of its morphometric values is important in Forensic, Anatomic and Radiological cases in order to identify unknown bodies and stature. Objective It was to analyze the tibia, its morphometry, side difference and to investigate the position of nutrient foramina in tibia. Methods In this study, 60 adult human tibias (30 right and 30 left) were obtained from the Department of Anatomy SMSR SHARDA UNIVERSITY. In the study a total of two parameters i.e. Cross Section Index in the middle and Cnemicus Index of the bones were obtained and evaluated by using two instruments- a Measuring Tape and a Vernier Calipers. All the bones were dry and showed normal anatomical features. Results The mean Cross Section Index in the middle was calculated as 80.42 ± 11.33 on the right side and 78.15± 12.78 on the left side; and the Cnemicus index was 78.40 ± 13.19 on the right side and 70.84 ± 11.38 on the left side Conclusion The two parameters in the North Indian population were compared with other populations. The values were found to be almost comparable however there were subtle differences between different populations. The position of nutrient foramen was also assessed. This knowledge will thus help further researchers and orthopedic surgeons in various procedures like joint replacement therapy, fracture repair, bone grafts and vascularized bone microsurgery as well as in medico‐legal cases.

Nutrient Foramen of Fibula in Relation to Distal end, Potential Implications for Vascularised Done Graft Surgery

Background Free vascularised fibular bone grafting has gained popularity in various Orthopaedic and Oral & maxillofacial reconstructive surgeries. The objective of the present study was to identify the morphology and topography of nutrient foramina of fibula and to determine the foraminal index (FI) of the fibula using a more surgeon friendly bony landmark. Methods The study comprised examination of 100 fibulae specimens. Each bone was divided into 03 parts and topographical analysis was performed on each section. The nutrient foramina were identified macroscopically using size 24-gauge needle. Modified Hughes formula was used to calculate the foraminal index using distance of foramen (DF) from distal end which is easier to palpate in living human beings, total length of fibula (TL); and the formula was DF/TL x100. Results With respect to fibulae, 98% had single foramen and foramen was absent in 2%. The mean foraminal index (FI) was 56% for fibulae using modified Hughes’ formula. The majority of the fibulae showed nutrient foramen in the middle 3rd in relation to distal end of fibula. Conclusion The study provides information on the morphology of nutrient foramina in relation to easily palpable landmark on living human beings, which can provide guidance to surgeon while performing microvascular bone transfer procedures.

Variation in number and position of nutrient foramen of clavicle – A morphological study in western Rajasthan

Introduction: The clavicle is a modified long bone. It is the most important bone for transmission of weight from upper limb to the axial skeleton. It supports the shoulder so that the arm can swing clearly away from the trunk. Materials and Methods: The study included 102 adult clavicles 52 right sides and 52 left side which were obtained from the department of the Anatomy Dr. S.N. Medical College Jodhpur. The age and sex of the clavicles were not determined. All the bones were grossly observed for the number, location and direction of the nutrient foramina. The data were collected and morphologically analysed. Results: In our Present study Nutrient foramina were present in 50 clavicles (Right) and 44 clavicles (left). Out of which single foramina in 41 clavicles (Right) and 36 clavicles (Left), double foramina in 9 clavicles (Right) and 6 clavicles (left) and three foramina in 2 clavicles (Left). Absence of nutrient foramina were found in 2 clavicles (Right) and 8 clavicles (Left). Maximum number was present in the medial 2/3 and on the posterior surface of 46 bones (Right) and 34 Bones (Left). All foramina were directed towards the acromial end. Conclusion: The knowledge of nutrient foramina in clavicles is important for surgical procedures such as bone grafting and in microsurgical vascularized bone transplantation. Keywords: Nutrient foramina, Clavicle, Bone graft.