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ABSTRACT: Fascia has traditionally been thought of as a passive structure that envelops muscles, and the term "fascia" was misused and confusing. However, it is now evident that fascia is a dynamic tissue with complex vasculature and innervation. A definition of fascia as an integral tissue has been provided here, highlighting the main features of the superficial and deep fasciae. Wide anatomic variations and site-specific differences in fascial structure are described, coupled with results of our extensive investigations of fascial anatomy. This will enable surgeons to make better decisions on selecting the appropriate fascia in the construction of fascial flaps. The use of the superficial or deep fasciae in the creation of a fascial flap cannot be selected at random, but must be guided by the anatomical features of the different types of fasciae. In particular, we suggest the use of the superficial fascia, such as the parascapular fascio-cutaneous free flap or any cutaneous flap, when a well-vascularized elastic flap, with the capacity to adhere to underlying tissues, is required, and a fascio-cutaneous flap formed by aponeurotic fascia to resurface any tendon or joints exposures. Moreover, the aponeurotic fascia, such as the fascia lata, can be used as a surgical patch if the plastic surgeon requires strong resistance to stress and/or the capacity to glide freely. Finally, the epimysial fascia, such as in the latissimus dorsi flap, can be used with success when used together with the underlying muscles. Clearly, extensive clinical experience and judgment are necessary for assessment of their potential use.
Anatomia Clinica 12/2012; · 0.93 Impact Factor
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ABSTRACT: PURPOSE: To identify the site of incision with the lowest risk of injury of the superior gluteal neurovascular pedicle in the total hip arthroplasty with Hardinge's direct lateral approach. METHODS: Eight fresh donated bodies were dissected and the branches of the superior gluteal nerve (SGN) and superior gluteal artery (SGA) were dissected. The distance between the SGA and the apex of greater trochanter (GT) was also evaluated in vivo in 29 patients by CT angiography. RESULTS: We observed 12 spray pattern and 4 transverse neural trunk pattern of the SGN. In all cases the nerve runs inferiorly to the artery, with a mean distance of 0.5 cm. At the CT angiography the average distance between the main branch of SGA and the GT was 5.2 cm, indicating a mean distance of 4.7 cm from the SGN to the GT. Terminal branches of SGA are found until 2.7 cm from GT. CONCLUSIONS: This study analyzed the relationships between superior gluteal neurovascular pedicle and the GT in vivo (considering also the muscular tone), showing that during direct lateral access a safe area of 4.7 cm exists from the GT to the SGN and of 3.5 cm to its lower rami.
Anatomia Clinica 09/2012; · 0.93 Impact Factor
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ABSTRACT: The University of Padua is one of the most ancient in the world, being founded in 1222, and the most important anatomists of the XVI, XVII, and XVIII centuries studied and taught here. Probably, the first professor of anatomy and surgery was Bruno da Longobucco (c. 1200-c. 1286), who had previously studied at the Salerno School of Medicine. While professor in Padua, Andreas Vesalius (1514-1564) published De Humani Corporis Fabrica (1543), which is considered as the birth of the modern anatomy. Following professors were Realdo Colombo (c. 1516-1559), Gabriel Fallopius (1523-1562), Hieronymus Fabricius ab Aquapendente (1533-1619), Iulius Casserius (1552-1616), Johann Wesling (1598-1649), and Johann Georg Wirsung (1589-1643). Many other foreign scholars studied in the University of Padua, such as Thomas Linacre (c. 1460-1524), the founder of the Royal College of Physicians, Werner Rolfinck (1599-1673), and Olof Rudbeck (1630-1702), who created anatomical theatres in Germany and Sweden, respectively, on the basis of the Paduan model. The anatomy of the XVII century characteristically widened the scope of its enquiry to function, as in the Exercitatio Anatomica De Motu Cordis et Sanguinis in Animalibus (1628) by William Harvey (1578-1657). Further evolution was then given by the anatomy in the XVIII century, which tried to correlate alterations of structure with clinical symptoms. The most important anatomist of this century is Giovanni Battista Morgagni (1682-1771), whose masterpiece De Sedibus et Causis Morborum per Anatomen Indagatis (1761) is a landmark contribution that is viewed as the beginning of modern pathologic anatomy. This year falls the 300th anniversary of Morgagni's inaugural lecture on medical education, Nova Institutionum Medicarum Idea (1712), which is still relevant in its effort to stress the importance of a deep knowledge of all the preclinical and clinical aspects of medical science.
The Anatomical Record Advances in Integrative Anatomy and Evolutionary Biology 06/2012; 295(6):902-16. · 1.47 Impact Factor
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ABSTRACT: The aim of the present study is to provide a review of cytochemical, clinical and experimental data indicating disruption of perinatal carotid body maturation as one of the possible mechanisms underlying SIDS pathogenesis. SIDS victims have been reported to show alterations in respiratory regulation which may partly be ascribed to peripheral arterial chemoreceptors. Carotid body findings in SIDS victims, although not entirely confirmed by other authors, have included reductions in glomic tissue volume and cytoplamic granules of type I cells, changes in cytological composition (higher percentages of progenitor and type II cells) and increases in dopamine and noradrenaline contents. Prematurity and environmental factors, such as exposure to tobacco smoke, substances of abuse, hyperoxia and continuous or intermittent hypoxia, increase the risk of SIDS and are known to affect carotid body functional and structural maturation adversely, supporting a role for peripheral arterial chemoreceptors in SIDS.
Respiratory Physiology & Neurobiology 05/2012; · 2.24 Impact Factor
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ABSTRACT: Quality management improvement has become a recent focus of attention in medical education. The program for the donation of bodies and body parts (Body Donation Program) at the University of Padova has recently been subjected to a global quality management standard, the ISO 9001:2008 certification. The aim of the present work is to show how the above standard is useful in enhancing the efficiency of body donation procedures and the quality and output of medical education. The program is managed by means of the following interlinked procedures: the collection of body donations, death certificates, data, and body parts from living donors; the transportation and identification of cadavers; the management of bodies, body parts, equipment, instruments, purchasing of necessary materials, and setting up anatomical training sessions; the management of preventive and corrective actions; the management of documents and registration; the management of internal and external quality audits; and the review of outcomes and improvement planning. Monitoring indicators are identified in the numbers of donors and of donated body parts per year, education sessions, and satisfaction of learners and donors, as evaluated by questionnaires. The process management approach, the integrated involvement of medical, technical, and administrative staff in defining procedures, and the application of monitoring indicators allow quality improvement in all aspects of the Body Donation Program. Anat Sci Educ. © 2012 American Association of Anatomists.
Anatomical Sciences Education 05/2012; 5(5):264-72. · 2.98 Impact Factor
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ABSTRACT: A randomized controlled trial was performed to compare the short-term effectiveness of botulinum toxin injections and physiatric treatment provided by means of Fascial Manipulation techniques in the management of myofascial pain of jaw muscles. Thirty patients with a Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis of myofascial pain were randomized to receive either single-session botulinum toxin injections (Group A) or multiple-session Fascial Manipulation (Group B). Maximum pain levels (VAS ratings) and jaw range of motion in millimeters (maximum mouth opening, protrusion, right and left laterotrusion) were assessed at baseline, at the end of treatment, and at a three-month follow-up. Both treatment protocols provided significant improvement over time for pain symptoms. The two treatments seem to be almost equally effective, Fascial Manipulation being slightly superior to reduce subjective pain perception, and botulinum toxin injections being slightly superior to increase jaw range of motion. Differences between the two treatment protocols as to changes in the outcome parameters at the three-months follow-up were not relevant clinically. Findings from the present investigation are in line with literature data supporting the effectiveness of a wide spectrum of conservative treatment approaches to myofascial pain of the jaw muscles. Future studies on larger samples over a longer follow-up span are needed on the way to identify tailored treatment strategies.
Cranio: the journal of craniomandibular practice 04/2012; 30(2):95-102. · 0.66 Impact Factor
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ABSTRACT: Spexin is a recently identified peptide which is expressed in many different endocrine and nervous tissues. Due to the absence of data regarding spexin expression in the carotid body, the first aim of the present study was to investigate, through immunohistochemistry and Real-Time PCR, the expression and distribution of spexin in the rat and human carotid body. Moreover, the carotid body is known to undergo various structural and functional modifications in response to hyperoxic stimuli during the first postnatal period. Thus, we also evaluated if hyperoxia during the first postnatal weeks may produce changes in the spexin expression. Materials consisted of carotid bodies obtained at autopsy from five human adult subjects and sampled from 10 six-weeks old Sprague-Dawley rats. Five rats were maintained in normoxia for the first six postnatal weeks; five rats were exposed to 60% hyperoxia for 2 weeks and then maintained in normoxia for other 4 weeks. Diffuse anti-spexin immunoreactivity was found in type I cells of both humans and rats. No spexin immunoreactivity was visible in the type II cells. Hyperoxia exposure during the first 2 weeks of postnatal life caused a reduction of volume in the carotid body still apparent after 4 weeks of normoxia. Using real-time PCR, spexin expression was 6-7 times higher in hyperoxia-exposed rats than in normoxia-exposed ones. The expression of spexin in type I cells suggests a possible modulator role in peripheral chemoreception. Moreover, the ascertained role of spexin in the regulation of cell proliferation in other tissues (e.g., adrenal gland cortex) suggests a possible role of spexin also in the hyperoxia-induced plasticity of the carotid body.
Advances in experimental medicine and biology 01/2012; 758:207-13. · 1.09 Impact Factor
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ABSTRACT: The pectoral nerves (PNs) may be selectively injured through various traumatic mechanisms such as direct trauma, hypertrophic muscle compression, and iatrogenic injuries (breast surgery and axillary node dissection, pectoralis major muscle transfers). The PN may be surgically recovered through nerve transfers. They may also be used as donors to the musculocutaneous, axillary, long thoracic, and spinal accessory nerves and for reinnervation of myocutaneous free flaps. Thus, in this article, we reviewed the surgical anatomy of PN. A meta-analysis of the available literature showed that the lateral pectoral nerve (LPN) arises most frequently with two branches from the anterior divisions of the upper and middle trunks (33.8%) or as a single root from the lateral cord (23.4%). The medial pectoral nerve (MPN) usually arises from the medial cord (49.3%), anterior division of the lower trunk (43.8%), or lower trunk (4.7%). The two PN are usually connected immediately distal to the thoracoacromial artery by the so-called ansa pectoralis. The MPN may also show communications with the intercostobrachial nerve. In 50%–100% of cases, it may pass, at least with some branches, through the pectoralis minor muscle. The LPN supplies the upper portions of the pectoralis major muscle; the MPN innervates the lower parts of the pectoralis major and the pectoralis minor muscle. Among the accessory muscles of the pectoral girdle, the LPN may also innervate the tensor semivaginae articulationis humero-scapularis, pectoralis minimus, sternoclavicularis, axillary arch, sternalis, and infraclavicularis muscles; the MPN may innervate the pectoralis quartus, chondrofascialis, axillary arch, chondroepitrochlearis, and sternalis muscles. Clin. Anat. 25:559–575, 2012. © 2011 Wiley Periodicals, Inc.
Clinical Anatomy 11/2011; 25(5):559 - 575. · 1.29 Impact Factor
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ABSTRACT: The layers of loose connective tissue within deep fasciae were studied with particular emphasis on the histochemical distribution of hyaluronan (HA). Samples of deep fascia together with the underlying muscles were taken from neck, abdomen and thigh from three fresh non-embalmed cadavers. Samples were stained with hematoxylin-eosin, Azan-Mallory, Alcian blue and a biotinylated HA-binding protein specific for HA. An ultrasound study was also performed on 22 voluntary subjects to analyze the thickness of these deep fasciae and their sublayers. The deep fascia presented a layer of HA between fascia and the muscle and within the loose connective tissue that divided different fibrous sublayers of the deep fascia. A layer of fibroblast-like cells that stained prominently with Alcian blue stain was observed. It was postulated that these are cells specialized for the biosynthesis of the HA-rich matrix. These cells we have termed "fasciacytes", and may represent a new class of cells not previously recognized. The ultrasound study highlighted a mean thickness of 1.88 mm of the fascia lata, 1.68 mm of the rectus sheath, and 1.73 mm of the sternocleidomastoid fascia. The HA within the deep fascia facilitates the free sliding of two adjacent fibrous fascial layers, thus promoting the normal function associated with the deep fascia. If the HA assumes a more packed conformation, or more generally, if the loose connective tissue inside the fascia alters its density, the behavior of the entire deep fascia and the underlying muscle would be compromised. This, we predict, may be the basis of the common phenomenon known as "myofascial pain."
Anatomia Clinica 10/2011; 33(10):891-6. · 0.93 Impact Factor
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ABSTRACT: Current undergraduate medical curricula provides relatively little time for cadaver dissection. The Department of Human Anatomy and Physiology at the University of Padova has organized a pilot project with the University Hospital for the donation of body parts that are surgically removed for therapeutic purposes and destined under Italian law for destruction. The aim of the project is to improve residents' practical training skills. A survey over the last two years has shown that about 60 body parts were available each year. These included 13 upper limbs or their parts (i.e., forearm with hand, hand, and fingers) and 47 lower limbs or their parts (i.e., legs with feet, feet, or toes). The residents explained the aim of the project to potential donors, and, if patients were willing to donate, their informed consent was obtained. The residents were present in the operating theater during the surgical procedure. In the post-operative phase, the same residents performed dissections on the body part(s), following a teaching schedule prepared by a clinical anatomist, who also assisted residents during their studies. Residents also acted as tutors for undergraduate medical students who attended these dissections. The underlying pathology for which the body part was removed was examined, and surgical procedures were practiced on the body part itself. Our project provided an opportunity for a close relationship between anatomists and surgeons, reinforcing core knowledge of anatomy by appreciation of its clinical importance. The active involvement of residents as learners and as teachers in the various steps of this project improved their knowledge of surgical techniques and helped to establish a sense of ethical responsibility and respect for the human body. This approach involves study of anatomical structures from new perspectives and leads to improved surgical practice.
Anatomical Sciences Education 05/2011; 4(3):151-6. · 2.98 Impact Factor
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ABSTRACT: Medical Gross Anatomy lecture at the University of Padova, Italy. Gross Anatomy at the University of Padova is taught utilizing both traditional and technological resources, which are integrated with practical laboratory exercises (mainly on plastic models and plastinated specimens) as well as radiological anatomy. In this issue of ASE, Dr. Veronica Macchi and her colleagues from the Department of Human Anatomy and Physiology at the University of Padova discuss an innovative pilot project with their University Hospital in which they obtain body parts removed from patients during surgical procedures and utilize them for gross anatomy education. The cover photograph shows one of the co-authors of this paper, Professor Raffaele De Caro and his students, performing dissection of the distal forearm and hand in the anatomy lecture theater at the University of Padova.
Anatomical Sciences Education 05/2011; 4(3). · 2.98 Impact Factor
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ABSTRACT: Leptin is known to play a role in the modulation of metabolism and control of breathing acting mainly on central nervous structures, although additional actions on peripheral arterial chemoreceptors have also been suggested in the literature. We therefore examined by means of immunohistochemistry the expression of leptin and leptin receptors in the carotid bodies of rats and humans. Leptin expression and relative expression of leptin receptor isoforms were also studied in rats by real-time PCR. No leptin or leptin receptor immunoreactivities were visible in the type II cells of either series. In rat carotid bodies, diffuse positive stainings for leptin and leptin receptors (both with antibody recognizing all receptor isoforms and antibody specific for Ob-Rb) were observed in type I cells. In human carotid bodies, the mean percentage (±standard error) of leptin immunoreactive type I cells was 39.4%±5.1% and the percentages of leptin receptor immunoreactive type I cells were 57.3%±3.9% with antibody recognizing all receptor isoforms and 33.3%±4.2% with antibody specific for isoform Ob-Rb. Double immunofluorescences with anti-tyrosine hydroxylase (type I cell marker) and anti-glial fibrillary acidic protein (type II cell markers) confirmed the selective location of leptin and Ob-Rb in type I cells. Real-time PCR showed the expression of leptin and Ob-Ra, Ob-Rb, Ob-Rc and Ob-Rf isoform mRNA in the rat carotid body, levels of expression being Ob-Rf>Ob-Rc>Ob-Ra>Ob-Rb. Ob-Re mRNA was not detected. The above findings suggest a role of circulating or locally produced leptin in the regulation of chemoreceptor discharge and/or metabolic sensing function, by means of direct action on type I cells.
Brain research 02/2011; 1385:56-67. · 2.46 Impact Factor
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ABSTRACT: Recent studies reveal the role of the ankle retinacula in proprioception and functional stability of the ankle, but there is no clear evidence of their role in the outcomes of ankle sprain. 25 patients with outcomes of ankle sprain were evaluated by MRI to analyze possible damage to the ankle retinacula. Patients with damage were subdivided into two groups: group A comprised cases with ankle retinacula damage only, and group B those also with anterior talofibular ligament rupture or bone marrow edema. Both groups were examined by VAS, CRTA and static posturography and underwent three treatments of deep connective tissue massage (Fascial Manipulation technique). All evaluations were repeated after the end of treatment and at 1, 3 and 6 months. At MRI, alteration of at least one of the ankle retinacula was evident in 21 subjects, and a further lesion was also identified in 7 subjects. After treatment, VAS and CRTA evaluations showed a statistically significant decrease in values with respect to those before treatment (p < 0.0001). There were also significant improvements (p < 0.05) in stabilometric platform results. No significant difference was found between groups A and B. The initial benefit was generally maintained at follow-up. The alteration of retinacula at MRI clearly corresponds to the proprioceptive damage revealed by static posturography and clinical examination. Treatment focused on the retinacula may improve clinical outcomes and stabilometric data.
Anatomia Clinica 02/2011; 33(10):881-90. · 0.93 Impact Factor
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ABSTRACT: In recent times new surgical approaches have been developed, in which subcutaneous tissue is the primary object, such as flaps and fat removal techniques, but different descriptions and abundance of terminology persist in Literature about this tissue.
In order to investigate the structure of abdominal subcutaneous tissue, macroscopic and microscopic analyses of its layers were performed in 10 fresh cadavers. Results were compared with in vivo CT images of the abdomen of 10 subjects.
The subcutaneous tissue of the abdomen comprises three layers: a superficial adipose layer (SAT), a membranous layer, and a deep adipose layer (DAT). The SAT presented fibrous septa that defined polygonal-oval lobes of fat cells with a mean circularity factor of 0.856 ± 0.113. The membranous layer is a continuous fibrous membrane rich in elastic fibers with a mean thickness of 847.4 ± 295 μm. In the DAT the fibrous septa were predominantly obliquely-horizontally oriented, defining large, flat, polygonal lobes of fat cells (circularity factor: mean 0.473 ± 0.07). The CT scans confirm these findings, showing a variation of the thickness of the SAT, DAT and membranous layer according with the subjects and with the regions.
The distinction of SAT and DAT and their anatomic differences are key elements in modern approaches to liposuction. The membranous layer appears to be also a dissection plane which merits further attention. According with the revision of Literature, the Authors propose that the term "superficial fascia" should only be used as a synonym for the membranous layer.
Anatomia Clinica 01/2011; 33(10):835-42. · 0.93 Impact Factor
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ABSTRACT: The extradural space is currently investigated through fluoroscopy and ultrasound for surgical approach, whereas magnetic resonance imaging has been used to provide detailed information. The aim of the present paper is to describe the radiologic anatomy of the sacral canal through a review of its appearance in the different radiologic techniques. CT is able to visualise also the sacrum and the content of the sacral canal, triangular in shape in the transverse images, being able to establish the measurement of the transverse area of the dural sac and of the canal diameter. On the sagittal CT scans, the sacrococcygeal membrane appears as a hypodense structure, between the posterior end of the sacral vertebra and the posterior tip of the coccyx. In magnetic resonance imaging, on T2-sagittal plane images, the sacral canal appears hyperintense, due to the presence of the liquor. The dural sac appears as a hypointense band and its termination as hypointense cul de sac in the context of the hyperintensity of the sacral canal. The sacrococcygeal membrane appears as a hypointense band between the posterior end of the sacral vertebra and the posterior tip of the coccyx. On ultrasound imaging, in the transverse sonographic view, two hyperechoic reversed U-shaped structures correspond to the two bony prominences of sacral cornua, between which there were two hyperechoic band-like structures. The band-like structure on top is the sacrococcygeal ligament. The band-like structure at the bottom is the dorsal surface of the sacrum. The sacral hiatus corresponds to the hypoechoic region observed between the two hyperechoic band-like structures.
Acta neurochirurgica. Supplement 01/2011; 108:5-8.
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ABSTRACT: This paper examines the main characteristics of the human fascial system, considered in its three-dimensional continuity. To better understand the anatomy of the human fascial system, a simple diagram of the subcutaneous tissue must be borne in mind. From the skin to the deepest plane, we find the superficial fascia, dividing the subcutaneous tissue into two fibroadipose layers, superficial and deep, and the deep fascia, which envelops all the muscles of the body, showing different characteristics according to region. Under the deep fascia is the epimysium, occurring in the limbs and some regions of the trunk. Skin ligaments connect the superficial fascia to the skin and to the deep fascia, forming a three-dimensional network among the fat lobules. The typical features of the superficial and deep fasciae and their relationships to nerves, vessels and muscles are reported here, highlighting the possible role of the deep fascia in proprioception and peripheral motor coordination. The main features of the fasciae with imaging techniques are also discussed. This knowledge may contribute to clinicians' understanding of the myofascial system and the role which the deep fasciae may play in musculoskeletal dysfunctions.
Italian journal of anatomy and embryology = Archivio italiano di anatomia ed embriologia 01/2011; 116(3):127-38.
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ABSTRACT: Traumatic and iatrogenic injuries of the axillary nerve (AN) are frequent in clinical practice; nevertheless, its anatomy and its relationships with the transdeltoid approaches to the shoulder are not well documented.
Anatomic study was performed on 16 shoulders of unembalmed cadavers. A proximal humeral internal locking system (PHILOS) plate was placed to simulate the osteosynthesis of a fracture of humeral surgical neck. The relationships between the plate and the nerve were evaluated. Selective dissection of all the nerve branches inside the deltoid muscle was performed.
The mean distance between the point where the AN entered into the deltoid muscle and the humeral head was 5.0 cm, and it was 6.8 cm from the acromion. The mean distance between the origins of the anterior and posterior branches of the axillary nerve was 5.4 cm. The mean diameter of the AN was 0.57 cm, the anterior branch diameter was 0.40 cm, of posterior branch diameter was 0.33 cm, and the teres minor branch diameter was 0.24 cm. The application of the PHILOS plate demonstrated that in 100% of cases, the 2 distal holes of the plate of those dedicated to the humeral head coincided with the passage of AN.
The different patterns of nerve branches inside the deltoid muscle show that the "safe zone" during transdeltoid approaches is the anterior region of the deltoid muscle for a maximum of 6.7 cm from the acromion. In addition, the insertion of the 2 distal screws of those dedicated to humeral head of the plate should be avoided.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 12/2010; 19(8):1166-74. · 1.93 Impact Factor
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ABSTRACT: Spexin is a highly conserved peptide which was recently identified through the bioinformatics approach. Immunohistochemical analysis of its expression has not yet been performed. Thus, in this study, we examined spexin location in a wide range of rat organs by both RT-PCR and IHC. RT-PCR identified spexin mRNA in all tissues examined. Spexin immunoreaction was mainly cytoplasmic. Spexin was immunohistochemically detected, although with different staining intensities, in epithelia and glands of skin and respiratory, digestive, urinary, and reproductive systems. Smooth muscle cells showed weak immunostaining, and connective tissue was negative. In the central nervous system, neuronal groups showed different intensities for reaction product. Immunoreaction was also found in ganglionic cells of both trigeminal and superior cervical ganglia and in photoreceptor, inner nuclear, and ganglionic layers of the retina. In the endocrine system, spexin immunoreaction was detected in the hypothalamic paraventricular and supraoptic nuclei; adenohypophysis, thyroid, and parathyroid glands; adrenal cortex and medulla (mainly ganglionic cells); Leydig cells; and thecal, luteal, and interstitial cells of the ovary. Because of its widespread expression, spexin is probably involved in many different physiological functions; in particular, location of spexin in neurons and endocrine cells suggests its roles as neurotransmitter/neuromodulator and endocrine factor.
Journal of Histochemistry and Cytochemistry 09/2010; 58(9):825-37. · 2.72 Impact Factor
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ABSTRACT: To investigate the macroscopic anatomy and histological characteristics of the transverse carpal ligament and the flexor retinaculum of the wrist and to investigate their anatomical relationships and define appropriate terminology.
The volar regions of the wrists of 30 unembalmed subjects were examined by dissection and by histological and immunohistochemical staining. In vivo magnetic resonance imaging studies were also carried out on 10 subjects.
The dissection study showed that the antebrachial fascia at the volar aspect of the wrist presents a reinforcement. From a histological point of view, it is composed of 3 layers of undulated collagen fiber bundles. Adjacent layers show different orientations of the collagen fibers. Many nerve fibers and Pacini and Ruffini corpuscles were found in all specimens. Under this fibrous plane is another fibrous structure, placed transversely between the ulnar-sided hamate and pisiform bones, and the radial-sided scaphoid and trapezium bones. The deeper fibrous structure shows completely different histological characteristics, having parallel, thicker collagen fiber bundles and few nerve fibers. Magnetic resonance images confirm the presence of 2 clearly distinguished fibrous structures in the wrist, the first in continuity with the antebrachial fascia and the second located in a deeper plane between the hamate and scaphoid.
Two different fibrous structures with different histological characteristics are present in the volar wrist: the more superficial one is in continuity with the antebrachial fascia and could be considered its reinforcement; the deeper one is composed of strong lamina, with histological features similar to those of a ligament. For these reasons, we suggest that the term transverse carpal ligament should be used to indicate the fibrous lamina connecting the hamate and pisiform to the scaphoid and trapezium and that the term flexor retinaculum of the wrist should be abandoned because it does not correspond to any specific, autonomous structure.
The Journal of hand surgery 03/2010; 35(5):746-53. · 1.33 Impact Factor
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ABSTRACT: A constitutive model is proposed to describe the mechanical behavior of the plantar fascia. The mechanical characterization of the plantar fascia regards the role in the foot biomechanics and it is involved in many alterations of its functional behavior, both of mechanical and nonmechanical origin. The structural conformation of the plantar fascia in its middle part is characterized by the presence of collagen fibers reinforcing the tissue along a preferential orientation, which is that supporting the major loading. According to this anatomical evidence, the tissue is described by developing an isotropic fiber-reinforced constitutive model and since the elastic response of the fascia is here considered, the constitutive model is based on the theory of hyperelasticity. The model is consistent with a kinematical description of large strains mechanical behavior, which is typical of soft tissues. A fitting procedure of the constitutive model is implemented making use of experimental curves taken from the literature and referring to specimens of human plantar fascia. A satisfactory fitting of the tensile behavior of the plantar fascia has been performed, showing that the model correctly interprets the mechanical behavior of the tissue in the light of comparison to experimental data at disposal. A critical analysis of the model with respect to the problem of the identification of the constitutive parameters is proposed as the basis for planning a future experimental investigation of mechanical behavior of the plantar fascia.
Connective tissue research 02/2010; 51(5):337-46. · 1.55 Impact Factor
