Hitherto Unknown Detailed Muscle Anatomy in an 8 Weeks Old Embryo

Total Page:16

File Type:pdf, Size:1020Kb

Hitherto Unknown Detailed Muscle Anatomy in an 8 Weeks Old Embryo UvA-DARE (Digital Academic Repository) 3D atlas of human embryology New insights in human development de Bakker, B.S. Publication date 2018 Document Version Other version License Other Link to publication Citation for published version (APA): de Bakker, B. S. (2018). 3D atlas of human embryology: New insights in human development. General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. UvA-DARE is a service provided by the library of the University of Amsterdam (https://dare.uva.nl) Download date:05 Oct 2021 CHAPTER 6.1 - HITHERTO UNKNOWN DETAILED MUSCLE ANATOMY IN AN 8 WEEKS OLD EMBRYO Moritz V Warmbrunn* Bernadette S de Bakker* Jaco Hagoort Pauline B Alefs-de Bakker Roelof-Jan Oostra * = both authors contributed equally to the manuscript. Journal of Anatomy, minor revisions Supplementary material is available online at http://www.3datlasofhumanembryology.com "It is not the strongest of the species that survives, nor the most intelligent that survives. It is the one that is the most adaptable to change." Charles Darwin (1809-1882) 3D ATLAS OF HUMAN EMBRYOLOGY Abstract Congenital muscle diseases, such as myopathies or dystrophies, occur relatively frequent with estimated incidences of up to 4.7 per 100.000 newborns. To diagnose congenital diseases in the early stages of pregnancy, and to interpret the results of increasingly advanced in utero imaging techniques, profound knowledge of normal human morphological development of the locomotor system and the nervous system is necessary. Muscular development however, is an often neglected or only generally described topic in embryology textbooks and papers. To provide the required detailed and updated comprehensive picture of embryologic muscular anatomy, three-dimensional (3D) reconstructions were created based on serial histological sections of a human embryo at Carnegie stage 23 (eight weeks of development, crown-rump length of 23.8 mm), using Amira reconstruction software. Reconstructed muscles, tendons, bones and nerves were exported in a 3D-PDF file to permit interactive viewing. Almost all adult skeletal muscles of the trunk and limbs could be individually identified in their relative adult position. The pectoralis major muscle was divided in three separate muscle heads. The reconstructions showed remarkable highly developed extraocular, infrahyoid and suprahyoid muscles at this age but surprisingly also absence of the facial muscles that were described to be present at this stage of development. The overall stage of muscle development suggests heterochrony of skeletal muscle development. Several individual muscle groups were found to be developed earlier and in more detail than was described in current literature. Introduction Congenital muscle diseases, such as myopathies or dystrophies, occur relatively frequent and form a heavy burden for society but firstly for the affected child and its family. Global incidences of congenital muscular dystrophies are unknown, but described incidences of 4.7 live born per 100.000 inhabitants in north-eastern Italy between 1979-1993 (Mostacciuolo et al. 1996) and a prevalence of 3.95 cases per 100.000 inhabitants in northern England (Norwood et al. 2009) provide an indication. An epidemiological study of neuromuscular disorders in children under the age of 16 in western Sweden showed a prevalence of 63.1 per 100.000 inhabitants (Darin, Tulinius 2000). Comprehensive understanding of congenital muscle diseases requires knowledge of muscle anatomy and physiology. In adults, imaging techniques such as ultrasound and magnetic resonance imaging (MRI) are already contributing to diagnose the type of muscle disease (Wattjes, Kley & Fischer 2010) and could therefore also be used for in-utero imaging. However, little is known about late embryonic morphological development. Since fetal medicine is developing rapidly (Danzer, Johnson 2014, Moldenhauer 2014) and prenatal diagnostics are regularly performed in modern medical practice, the need for detailed anatomical knowledge in clinical settings becomes more pressing. Because skeletal muscles contribute significantly to the total volume of the human body, they can often be used as anatomical landmarks (De Battista et al. 2011). Accurate knowledge of late embryonic and fetal spatial anatomic relations is therefore crucial for effectively interpreting high resolution prenatal imaging techniques. Procedures such as sonography or fetoscopy during prenatal 234 Hitherto unknown detailed muscle anatomy in an 8 weeks old embryo diagnostics and fetal surgery can even predict embryonic health, as it is already in use for fetal health (Hutchinson, Kieser & Kramer 2014, D'Addario et al. 2005). Morphological muscle development is an often neglected or vaguely described topic in embryology textbooks and articles (Deries, Thorsteinsdottir 2016, Pu, Huang & Brand-Saberi 2016, Schoenwolf et al. 2009, Sadler 2012). Based on our experience in creating the 3D Atlas of Human Embryology (de Bakker et al. 2016), we hypothesized that human embryonic muscle anatomy is more advanced than would be concluded from descriptions in literature. To provide a more detailed and comprehensive picture of embryonic muscular anatomy, we used Amira reconstruction software to create three-dimensional (3D) reconstructions based on serial histological sections of a human embryo at Carnegie stage 23 (CS23, eight weeks of development), the final stage of embryonic development, with a crown-rump length of 23.8 mm. Reconstructed muscles, tendons, bones and nerves were exported in a 3D-PDF file to permit interactive investigation of the morphology of skeletal muscles at CS23. Comprehensive muscle reconstructions are novel to our knowledge and were not included in previous publications from our research group. Materials and Methods 3D Reconstructions Image acquisition and alignment was done as previously described by de Bakker et al. (2016, 2012). Digital images were captured from the series of sections of a CS23 specimen number 950 of the Carnegie collection in Silver Spring, MD, USA. This male specimen was collected after a miscarriage in 1914 and has been graded by specialists of the Carnegie collection as ‘good’ (O'Rahilly, Müller 1987). This specimen was fixed in formalin, transversally sectioned in 42.71 µm and then stained with an aluminum cochineal staining (de Bakker et al. 2016, O'Rahilly, Müller 1987). Based on the section 4.2 thickness and number of slices we calculated an approximate crown-rump length of 23.8 mm. Labeling of the 557 serial sections was accomplished by trained medical students, under the supervision of a physical therapist and four experienced embryologists. Skeletal muscles and tendons were manually segmented, with a Bamboo tablet and pen (http://www.wacom.com) based on digital images of the serial sections. Segmentation of structures on the serial sections was performed on grey scale images in Amira® software (version 5.3 - 5.6, http://www.amira.com), while the high-resolution full color dataset was displayed on a second computer screen. This way, every single muscle, including its tendons, was traced from origin to insertion. The nerves and bones of this specimen were already reconstructed in previous studies (de Bakker et al. 2016, de Bakker et al. 2012) and could therefore give 6.1 information about the topographic position of muscles relative to bones or nerves. The use of bones and nerves as anatomical landmarks allowed distinction between different types of tissues and provided topographical orientation throughout the body. If demarcation between individual muscles was not possible, muscles were labeled as muscle groups. Structure identification After reconstructing, muscles and tendons were identified using adult human anatomy atlases (Gilroy et al. 2009, Netter 2014, Drake et al. 2014) by establishing their origin and insertion and topographic relation to bones, nerves and surrounding organs. English names of the muscles were used, based on ‘Terminologia Anatomica’ (Baud, Neumann & Sprumont 1998). 235 3D ATLAS OF HUMAN EMBRYOLOGY Interactive 3D-PDF Amira surface files of the 3D reconstructions were converted to a .u3d file with Fiji (ImageJ, https://imagej.net). Deep Exploration (version 6.5 CSE, part of Corel DESIGNER Technical Suite X5 http://www.corel.com) was used for grouping and labeling of structures. Finally, Adobe Acrobat XI Pro (http://www.adobe.com) allowed to create an interactive 3D-PDF file containing all reconstructed structures and a custom user interface. A 3D-PDF can be viewed with a recent version of Adobe Reader® (X or higher, freeware, http://www.adobe.com) on MS Windows or MacOS systems, with javascript and playing of 3D content enabled. The Adobe Reader program allows users to not only view the 3D-PDF file, but also to zoom in or out on a structure, to hide it or to show it transparently. It provides the user with a clear view of the embryo in a 3D interactive fashion and thus to obtain a better understanding of the spatial relations between segmented organs and structures, in this case the musculoskeletal system in the embryo. This technique has proved its usefulness in earlier publications (de Bakker et al. 2016, de Bakker et al. 2012, Sizarov et al. 2011, Sizarov et al. 2012, de Boer et al. 2011, van den Berg et al. 2009, van den Berg, Moorman 2011). Fig. 1. Transversospinal muscle reconstructions. A: Left lateral view of the head and vertebral column of a stage 23 human embryo (56-60 days of development), specimen number 950.
Recommended publications
  • An Anatomic Study on the Upper Lip Elevator Muscles in Koreans for Application of Botulinum Toxin
    An Anatomic Study on the Upper Lip Elevator Muscles in Koreans for Application of Botulinum Toxin Woo-Sang Hwang The Graduate School Yonsei University Department of Dental Science An Anatomic Study on the Upper Lip Elevator Muscles in Koreans for Application of Botulinum Toxin A Masters Thesis Submitted to the Department of Dental Science And the Graduate School of Yonsei University in partial fulfillment of the requirements for the degree of Master of Dental Science Woo-Sang Hwang July 2007 This certifies that the masters thesis of Woo-Sang Hwang is approved. Thesis Supervisor : Kee-Joon Lee Hyoung-Seon Baik Hee-Jin Kim The Graduate School Yonsei University July 2007 감사의 글 이 논문이 완성되기까지 따뜻한 배려와 함께 세심한 지도와 격려를 아끼지 않으신 이기준 지도 교수님께 먼저 깊은 감사를 드립니다. 귀중한 시간을 내주시어 부족한 논문을 살펴주신 백형선 교수님, 김희진 교수님께 감사드리며 교정학을 공부할 수 있도록 기회를 주시고 제가 이 자리에 설 수 있도록 인도해주신 손병화 교수님, 박영철 교수님, 황충주 교수님, 유형석 교수님, 차정열 교수님, 김경호 교수님, 최광철 교수님, 정주령 선생님께도 감사드립니다. 바쁜 와중에도 연구 방법과 세부적인 사항에 대해 많은 도움과 조언을 해주신 허경석, 허미선 선생님을 비롯한 해부학 교실 선생님들께 감사의 말씀을 드립니다. 이 논문이 나오기까지 격려해주고 조언해주었던 동기들, 이태연, 조용민, 서승아, 이한아, 정시내, 조선미 선생과 의국 선배님과 후배님 모두에게 이 자리를 빌어 감사의 마음을 전합니다. 마지막으로 항상 변함없는 사랑으로 돌봐주시고 저를 이끌어주신 아버지와 어머니, 대구에서 힘들게 군복무 중인 동생, 그리고 옆에서 항상 힘이 되어준 레미에게 감사의 마음을 전하며 이 작은 결실을 드립니다. 2007년 7 월 저자 씀 Table of Contents Tables and Figures ................................................................................................................... ii Abstract (English) ...................................................................................................................iii 1. Introduction .......................................................................................................................... 1 2.
    [Show full text]
  • Ear Pain in Patients with Oropharynx Carcinoma: Karlt.Beer Peter Vock How MRI Contributes to the Explanation Richard H
    Eur Radiol (2004) 14:2206–2211 DOI 10.1007/s00330-004-2340-2 HEAD AND NECK Harriet C. Thoeny Ear pain in patients with oropharynx carcinoma: KarlT.Beer Peter Vock how MRI contributes to the explanation Richard H. Greiner of a prognostic and predictive symptom Received: 22 October 2003 Abstract Reflex otalgia is a predic- glossus muscle, stylopharyngeus Revised: 11 March 2004 tive and prognostic parameter for lo- muscle, hyoglossus muscle and pre- Accepted: 5 April 2004 cal control in patients with orophar- epiglottic space. No difference was Published online: 1 May 2004 ynx carcinoma. Can a morphologic found for the muscles of mastication, © Springer-Verlag 2004 correlate of this important symptom levator and tensor veli palatini mus- be detected by MRI? Thirty-six pa- cles, styloglossus muscle, genioglos- tients were prospectively evaluated sus muscle, intrinsic muscles of the by MRI before radical radiotherapy. tongue, digastric muscles, mucosal Sixteen patients had reflex otalgia; surface of the lateral and posterior 20 did not. The oropharynx and adja- pharyngeal wall, uvula, valleculae, cent regions were analyzed. Alter- parapharyngeal space and larynx. An ation was defined as effacement of alteration of structures innervated by H. C. Thoeny (✉) · P. Vock anatomical structures, signal alter- the glossopharyngeal nerve was vi- Department of Diagnostic Radiology, ation or enhancement after contrast sualized on MRI significantly more Inselspital, χ2 University of Bern, medium administration. The -test often when reflex otalgia was pres- Freiburgstrasse 10, 3010 Bern, Switzerland was used to compare categorical pa- ent. Involvement of structures inner- e-mail: [email protected], rameters. In patients with reflex vated by other cranial nerves did not [email protected] otalgia, alteration of the following show the same association with ear Tel.: +41-31-6322939 structures innervated by the glosso- pain.
    [Show full text]
  • Volume 1: the Upper Extremity
    Volume 1: The Upper Extremity 1.1 The Shoulder 01.00 - 38.20 (37.20) 1.1.1 Introduction to shoulder section 0.01.00 0.01.28 0.28 1.1.2 Bones, joints, and ligaments 1 Clavicle, scapula 0.01.29 0.05.40 4.11 1.1.3 Bones, joints, and ligaments 2 Movements of scapula 0.05.41 0.06.37 0.56 1.1.4 Bones, joints, and ligaments 3 Proximal humerus 0.06.38 0.08.19 1.41 Shoulder joint (glenohumeral joint) Movements of shoulder joint 1.1.5 Review of bones, joints, and ligaments 0.08.20 0.09.41 1.21 1.1.6 Introduction to muscles 0.09.42 0.10.03 0.21 1.1.7 Muscles 1 Long tendons of biceps, triceps 0.10.04 0.13.52 3.48 Rotator cuff muscles Subscapularis Supraspinatus Infraspinatus Teres minor Teres major Coracobrachialis 1.1.8 Muscles 2 Serratus anterior 0.13.53 0.17.49 3.56 Levator scapulae Rhomboid minor and major Trapezius Pectoralis minor Subclavius, omohyoid 1.1.9 Muscles 3 Pectoralis major 0.17.50 0.20.35 2.45 Latissimus dorsi Deltoid 1.1.10 Review of muscles 0.20.36 0.21.51 1.15 1.1.11 Vessels and nerves: key structures First rib 0.22.09 0.24.38 2.29 Cervical vertebrae Scalene muscles 1.1.12 Blood vessels 1 Veins of the shoulder region 0.24.39 0.27.47 3.08 1.1.13 Blood vessels 2 Arteries of the shoulder region 0.27.48 0.30.22 2.34 1.1.14 Nerves The brachial plexus and its branches 0.30.23 0.35.55 5.32 1.1.15 Review of vessels and nerves 0.35.56 0.38.20 2.24 1.2.
    [Show full text]
  • Functional Anatomy of the Soft Palate Applied to Wind Playing
    Review Functional Anatomy of the Soft Palate Applied to Wind Playing Alison Evans, MMus, Bronwen Ackermann, PhD, and Tim Driscoll, PhD Wind players must be able to sustain high intraoral pressures in dition occurs because of a structural deformity, such as with order to play their instruments. Prolonged exposure to these high cleft palate. It is also associated with some other speech dis- pressures may lead to the performance-related disorder velopharyn- orders. VPI occurs when the soft palate fails to completely geal insufficiency (VPI). This disorder occurs when the soft palate fails to completely close the air passage between the oral and nasal close the oronasal cavity while attempting to blow air through cavities in the upper respiratory cavity during blowing tasks, this clo- the mouth, resulting in air escaping from the nose.5 Without sure being necessary for optimum performance on a wind instru- a tight air seal, the air passes into the nasal cavity and can ment. VPI is potentially career threatening. Improving music teach- then escape out the nose. This has a disastrous effect on wind ers’ and students’ knowledge of the mechanism of velopharyngeal playing, as the power behind the wind musicians’ sound closure may assist in avoiding potentially catastrophic performance- related disorders arising from dysfunction of the soft palate. In the relies on enough controlled expired air through the mouth. functional anatomy of the soft palate as applied to wind playing, Understandably, this disorder may potentially end the musi- seven muscles of the soft palate involved in the velopharyngeal clo- cian’s career.6 sure mechanism are reviewed.
    [Show full text]
  • Atlas of the Facial Nerve and Related Structures
    Rhoton Yoshioka Atlas of the Facial Nerve Unique Atlas Opens Window and Related Structures Into Facial Nerve Anatomy… Atlas of the Facial Nerve and Related Structures and Related Nerve Facial of the Atlas “His meticulous methods of anatomical dissection and microsurgical techniques helped transform the primitive specialty of neurosurgery into the magnificent surgical discipline that it is today.”— Nobutaka Yoshioka American Association of Neurological Surgeons. Albert L. Rhoton, Jr. Nobutaka Yoshioka, MD, PhD and Albert L. Rhoton, Jr., MD have created an anatomical atlas of astounding precision. An unparalleled teaching tool, this atlas opens a unique window into the anatomical intricacies of complex facial nerves and related structures. An internationally renowned author, educator, brain anatomist, and neurosurgeon, Dr. Rhoton is regarded by colleagues as one of the fathers of modern microscopic neurosurgery. Dr. Yoshioka, an esteemed craniofacial reconstructive surgeon in Japan, mastered this precise dissection technique while undertaking a fellowship at Dr. Rhoton’s microanatomy lab, writing in the preface that within such precision images lies potential for surgical innovation. Special Features • Exquisite color photographs, prepared from carefully dissected latex injected cadavers, reveal anatomy layer by layer with remarkable detail and clarity • An added highlight, 3-D versions of these extraordinary images, are available online in the Thieme MediaCenter • Major sections include intracranial region and skull, upper facial and midfacial region, and lower facial and posterolateral neck region Organized by region, each layered dissection elucidates specific nerves and structures with pinpoint accuracy, providing the clinician with in-depth anatomical insights. Precise clinical explanations accompany each photograph. In tandem, the images and text provide an excellent foundation for understanding the nerves and structures impacted by neurosurgical-related pathologies as well as other conditions and injuries.
    [Show full text]
  • Appendix B: Muscles of the Speech Production Mechanism
    Appendix B: Muscles of the Speech Production Mechanism I. MUSCLES OF RESPIRATION A. MUSCLES OF INHALATION (muscles that enlarge the thoracic cavity) 1. Diaphragm Attachments: The diaphragm originates in a number of places: the lower tip of the sternum; the first 3 or 4 lumbar vertebrae and the lower borders and inner surfaces of the cartilages of ribs 7 - 12. All fibers insert into a central tendon (aponeurosis of the diaphragm). Function: Contraction of the diaphragm draws the central tendon down and forward, which enlarges the thoracic cavity vertically. It can also elevate to some extent the lower ribs. The diaphragm separates the thoracic and the abdominal cavities. 2. External Intercostals Attachments: The external intercostals run from the lip on the lower border of each rib inferiorly and medially to the upper border of the rib immediately below. Function: These muscles may have several functions. They serve to strengthen the thoracic wall so that it doesn't bulge between the ribs. They provide a checking action to counteract relaxation pressure. Because of the direction of attachment of their fibers, the external intercostals can raise the thoracic cage for inhalation. 3. Pectoralis Major Attachments: This muscle attaches on the anterior surface of the medial half of the clavicle, the sternum and costal cartilages 1-6 or 7. All fibers come together and insert at the greater tubercle of the humerus. Function: Pectoralis major is primarily an abductor of the arm. It can, however, serve as a supplemental (or compensatory) muscle of inhalation, raising the rib cage and sternum. (In other words, breathing by raising and lowering the arms!) It is mentioned here chiefly because it is encountered in the dissection.
    [Show full text]
  • Anatomy of the Face] 2018-2019
    By Dr. Hassna B. Jawad [ANATOMY OF THE FACE] 2018-2019 Objective : At the end of this lecture you should be able to : 1. Identify the extent of the face. 2. Enlist the layers of the face and recognize their importance 3. Recognize the groups of the muscles of facial expression its origin ,insertion and function 4. Test the muscle of facial expression clinically 5. Discuss some clinical notes regarding the face Extends from lower border of mandible to the hair line (forehead is common for face and scalp) and laterally to the ear auricle Layers Of the Face 1.SKIN The face has elastic and vascular skin. The skin of the face has large number of sweat and sebaceous glands. The sebaceous glands keep the face greasy by their secretion and sweat glands help modulate the body temperature *Applied Anatomy :Face is also the common site for acne as a result of presence of large number of sebaceous glands in this region. 2. SUPERFICIAL FASIA It includes muscles of facial expression, vessels and nerves and varying amount of fat. The fat is absent in the eyelids but is well grown in cheeks creating buccal pad of fat, which gives rounded contour to cheeks. 3. DEEP FASCIA The deep fascia is absent in the region of face with the exception of over the parotid gland and masseter muscle that are covered by parotidomasseteric fascia. The absence of deep fascia in the face is important for the facial expression. The majority of them originate from bones of the skull and are added into the skin.
    [Show full text]
  • Anatomy and Physiology of the Velopharyngeal Mechanism
    Anatomy and Physiology of the Velopharyngeal Mechanism Jamie L. Perry, Ph.D.1 ABSTRACT Understanding the normal anatomy and physiology of the velopharyngeal mechanism is the first step in providing appropriate diagnosis and treatment for children born with cleft lip and palate. The velopharyngeal mechanism consists of a muscular valve that extends from the posterior surface of the hard palate (roof of mouth) to the posterior pharyngeal wall and includes the velum (soft palate), lateral pharyngeal walls (sides of the throat), and the posterior pharyngeal wall (back wall of the throat). The function of the velopharyngeal mechanism is to create a tight seal between the velum and pharyngeal walls to separate the oral and nasal cavities for various purposes, including speech. Velopharyngeal closure is accomplished through the contraction of several velopharyngeal muscles including the levator veli palatini, musculus uvulae, superior pharyngeal con- strictor, palatopharyngeus, palatoglossus, and salpingopharyngeus. The tensor veli palatini is thought to be responsible for eustachian tube function. KEYWORDS: Anatomy, physiology, velopharyngeal muscles, cleft palate anatomy Downloaded by: SASLHA. Copyrighted material. Learning Outcomes: As a result of this activity, the reader will be able to (1) list the major muscles of the velopharyngeal mechanism and discuss their functions; (2) list the sensory and motor innervation patterns for the muscles of the velopharyngeal mechanism; and (3) discuss the variations in velopharyngeal anatomy found in an unrepaired cleft palate. Understanding the normal anatomy and and treatment for children born with cleft lip physiology of the velopharyngeal mechanism is and palate. Most of the diagnostic and therapy the first step in providing appropriate diagnosis approaches are based on a strong foundation of 1Department of Communication Sciences and Disorders, Guest Editor, Ann W.
    [Show full text]
  • SŁOWNIK ANATOMICZNY (ANGIELSKO–Łacinsłownik Anatomiczny (Angielsko-Łacińsko-Polski)´ SKO–POLSKI)
    ANATOMY WORDS (ENGLISH–LATIN–POLISH) SŁOWNIK ANATOMICZNY (ANGIELSKO–ŁACINSłownik anatomiczny (angielsko-łacińsko-polski)´ SKO–POLSKI) English – Je˛zyk angielski Latin – Łacina Polish – Je˛zyk polski Arteries – Te˛tnice accessory obturator artery arteria obturatoria accessoria tętnica zasłonowa dodatkowa acetabular branch ramus acetabularis gałąź panewkowa anterior basal segmental artery arteria segmentalis basalis anterior pulmonis tętnica segmentowa podstawna przednia (dextri et sinistri) płuca (prawego i lewego) anterior cecal artery arteria caecalis anterior tętnica kątnicza przednia anterior cerebral artery arteria cerebri anterior tętnica przednia mózgu anterior choroidal artery arteria choroidea anterior tętnica naczyniówkowa przednia anterior ciliary arteries arteriae ciliares anteriores tętnice rzęskowe przednie anterior circumflex humeral artery arteria circumflexa humeri anterior tętnica okalająca ramię przednia anterior communicating artery arteria communicans anterior tętnica łącząca przednia anterior conjunctival artery arteria conjunctivalis anterior tętnica spojówkowa przednia anterior ethmoidal artery arteria ethmoidalis anterior tętnica sitowa przednia anterior inferior cerebellar artery arteria anterior inferior cerebelli tętnica dolna przednia móżdżku anterior interosseous artery arteria interossea anterior tętnica międzykostna przednia anterior labial branches of deep external rami labiales anteriores arteriae pudendae gałęzie wargowe przednie tętnicy sromowej pudendal artery externae profundae zewnętrznej głębokiej
    [Show full text]
  • Repair of a Large, Exposed-Cartilage Nasal Tip Defect Using Nasalis-Based Subcutaneous Pedicle Flaps and Full-Thickness Skin Grafting à DIEGO E
    RECONSTRUCTIVE CONUNDRUM Repair of a Large, Exposed-Cartilage Nasal Tip Defect Using Nasalis-Based Subcutaneous Pedicle Flaps and Full-Thickness Skin Grafting à DIEGO E. MARRA, MD, EDGAR F. F INCHER, MD, PHD, JULIE IWASAKI, BS, AND RONALD L. MOY,MD The authors have indicated no significant interest with commercial supporters. arge full-thickness nasal tip defects after Mohs A 62-year-old Caucasian man was referred Lsurgery present a challenge to the reconstructive for Mohs micrographic surgery for an surgeon. The interpolated paramedian forehead flap infiltrative basal cell carcinoma on the is the standard modality to repair such defects, nasal tip. Complete excision of the tumor especially when exposed cartilage is present.1 required five surgical stages, resulting in a Despite providing an excellent cosmetic outcome, 2.3  2-cm defect through which exposed some patients are reluctant to undergo this proce- alar cartilages and upper lateral cartilages could dure due to the associated temporary deformity, be seen (Figure 1). How would you reconstruct the permanent forehead scar, and the need for at this defect? least two stages to achieve a successful outcome. Figure 1. Surgical defect after Mohs micrographic surgery, measuring 2.3  2 cm. Exposed alar cartilages and upper lateral cartilages can be seen. ÃAll authors are affiliated with the David Geffen School of Medicine at UCLA and West Los Angeles VA Medical Center, Los Angeles, California & 2007 by the American Society for Dermatologic Surgery, Inc. Published by Blackwell Publishing ISSN: 1076-0512 Dermatol Surg 2008;34:249–253 DOI: 10.1111/j.1524-4725.2007.34046.x 249 REPAIR OF A LARGE, EXPOSED-CARTILAGE NASAL TIP DEFECT Resolution A The patient was an ideal candidate for the inter- polated paramedian forehead flap, but refused to undergo the procedure.
    [Show full text]
  • Robust User Identification Based on Facial Action Units Unaffected By
    Proceedings of the 51st Hawaii International Conference on System Sciences j 2018 Robust user identification based on facial action units unaffected by users’ emotions Ricardo Buettner Aalen University, Germany [email protected] Abstract—We report on promising results concerning the iden- we combine the biometric capture with a PIN request, which tification of a user just based on its facial action units. The is a rule in access validation systems [2,3], we reached a related Random Forests classifier which analyzed facial action very good false positive rate of only 7.633284e-06 (over unit activity captured by an ordinary webcam achieved very 99.999 percent specificity). good values for accuracy (97.24 percent) and specificity (99.92 On the basis of our results we can offer some interest- percent). In combination with a PIN request the degree of ing theoretical insights, e.g. which facial action units are specificity raised to over 99.999 percent. The proposed bio- the most predictive for user identification such as the lid metrical method is unaffected by a user’s emotions, easy to tightener (orbicularis oculi, pars palpebralis) and the upper use, cost efficient, non-invasive, and contact-free and can be lip raiser (levator labii superioris). In addition our work used in human-machine interaction as well as in secure access has practical implications as the proposed contactless user control systems. identification mechanism can be applied as a comfortable way to continuously recognize peo- 1. Introduction ple who are present in human-computer interaction settings, and Robust user identification is a precondition of modern an additional authentication mechanism in PIN entry human-computer interaction systems, in particular of au- systems.
    [Show full text]
  • Comparative Myology and Evolution of Marsupials and Other Vertebrates, with Notes on Complexity, Bauplan, and “Scala Naturae”
    RVC OPEN ACCESS REPOSITORY – COPYRIGHT NOTICE This is the peer reviewed version of: Diogo, R., Bello-Hellegouarch, G., Kohlsdorf, T., Esteve-Altava, B. and Molnar, J. L. (2016), Comparative Myology and Evolution of Marsupials and Other Vertebrates, With Notes on Complexity, Bauplan, and “Scala Naturae”. Anat. Rec., 299: 1224–1255. doi:10.1002/ar.23390 which has been published in final form at http://dx.doi.org/10.1002/ar.23390. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. The full details of the published version of the article are as follows: TITLE: Comparative Myology and Evolution of Marsupials and Other Vertebrates, With Notes on Complexity, Bauplan, and "Scala Naturae" AUTHORS: Diogo, R., Bello-Hellegouarch, G., Kohlsdorf, T., Esteve-Altava, B. and Molnar, J. L. JOURNAL TITLE: Anatomical Record: Advances in Integrative Anatomy and Evolutionary Biology PUBLISHER: Wiley PUBLICATION DATE: September 2016 DOI: 10.1002/ar.23390 Comparative myology and evolution of marsupials and other vertebrates, with notes on complexity, Bauplan, and ‘scala naturae’ Rui Diogo1, Gaelle Bello-Hellegouarch2, Tiana Kohlsdorf2, Borja Esteve-Altava1,3, Julia L. Molnar1 1 Department of Anatomy, Howard University College of Medicine, Numa Adams Building, 520 W St. NW, Washington, DC 20059, US. 2 Department of Biology, FFCLRP. University of São Paulo. Avenida Bandeirantes, 3900. Bairro Monte 7 Alegre. Ribeirão Preto, SP. Brazil. 3 Structure & Motion Laboratory, Department of Comparative Biomedical Sciences, Royal Veterinary College, Hawkshead Lane, Hatfield, Hertfordshire AL9 7TA, United Kingdom. Corresponding author: Rui Diogo. Department of Anatomy, Howard University College of Medicine, Numa Adams Building, 520 W St.
    [Show full text]