MANAGING, TRAINING AND EXPLORING ANATOMY - HABILITATION THESIS - Associate Professor STAN CRISTINEL IONEL, MD, PhD - 2019 - CONTENTS Abbreviations 3 Abstract 5 Rezumat 7 SECTION I - PROFESSIONAL, SCIENTIFIC AND ACADEMIC ACHIEVEMENTS 9 Brief overview of the academic carreer 9 CHAPTER 1. FROM HYPPOCRATES TO HARVEY - FROM FASCIES TO ARTERIES 12 1.1. State of the Art 12 1.2. Sustentaculum facies - everlasting facial youth 17 1.2.1. Introduction 17 1.2.2. Material and methods 22 1.2.3. Results 23 1.2.4. Discussions 35 1.2.5. Final remarks 40 1.3. Anatomic variations in arterries 40 1.3.1. Introduction 40 1.3.2. Material and methods 41 1.3.3. Results 42 1.3.4. Discussion 44 1.3.5. Final remarks 46 1.4. Anatomical substrate of peritoneal dialysis 47 1.4.1. Introduction 47 1.4.2. Material and methods 47 1.4.3. Results 49 1.4.4. Discussion 54 1.4.5. Final remarks 56 1.5. Perspectives in clinical applied embryology 57 1.5.1. Introduction 57 1.5.2. Material and method 58 1.5.3. Results 58 1.5.4. Discussion 62 1.5.5. Final remarks 64 CHAPTER 2. THE PHOENIX OF BONE RESTORATION – FROM PATHOLOGY TO ANATOMY 64 2.1. State of the Art 64 2.2. Plate osteosynthesis in tibial fractures 67 2.2.1. Introduction 67 2.2.2. Materials and methods 70 2.2.3. Results 71 2.2.4. Discussions 73 2.2.5. Final remark 74 2.3. New perspectives in shoulder prosthesis 75 2.3.1. Introduction 75 2.3.2. Material and methods 76 2.3.3. Results 79 2.3.4. Discussion 80 2.3.5. Final remarks 82 CHAPTER 3. MORPHOFUNCTIONAL AND APPLIED DEVELOPMENTAL RESEARCH ON THE ENDOCRINE SYSTEM 82 3.1 State of the art 82 3.2. Advances in endocrine pancreatic function research 85 3.2.1. Introduction 85 3.2.2. Materials and methods 87 3.2.3. Results 88 2.2.4. Discussion 95 3.2.5. Final remarks 97 3.3. From developmental endocrinology to clinical research 98 3.3.1. Introduction 98 3.3.2. Materials and methods 98 3.3.3. Results 99 3.3.4. Discussion 102 3.3.5. Final remarks 103 CHAPTER 4. THE PROPHECY OF SURVIVAL – ADVANCES IN TUMOURS FOLLOW UP 104 4.1. State of the Art 104 4.2. Colorectal evaluation, from an anatomic perpective 106 4.2.1. Introduction 106 4.2.2. Materials and methods 108 4.2.3. Results 109 4.2.4 Discussions 115 4.2.5. Final remarks 119 SECTION II. PLANS FOR FUTURE RESEARCH 120 SECTION III. REFERENCES 125 ABBREVIATIONS CRC Colorectal cancer SMAS Superficial musculo-aponeurotyc system CT Computed tomography MRI Magnetic resonance imaging ICCs Interstitial cells of Cajal α-SMA Α -smooth muscle actin ICC-MY Interstitial cells of Cajal intermuscular ICC-IM Interstitial cells of Cajal intramuscular ICC-SM Interstitial cells of Cajal submucosal ANO1 Anoctamin-1 NCCs Neural crest cells ETCs Endothelial tip cells PD Peritoneal dialysis FOA Fronto-orbital artery ACA Anterior cerebral artery ACoA Anterior communicating artery ARFOA Aberrant right fronto-orbital artery BCP Biphasic tricalcium phosphate ORIF Open Reduction and Internal Fixation CPC Phosphocalcic cements CaP Calcium phosphates HA Hydroxyapatite SEM Scanning electron microscope CS Chitosan medium molecular weight TPP Sodium tripolyphosphate DMSO Dimethylsulfoxide CS-M Chitosan-metformin CS-MG Chitosan-metfomin-glybenclamide CS-G Chitosan-glybenclamide FT-IR Fourier transform infrared SD Swelling degree SGF Simulated gastric fluid TEM Transmission electron microscopy STZ Streptozotocin GBM Glomerular basement membrane F Females M Males G Group 3 PDD Peritoneal dyalisis duration - years MD Mesothelial denudation STF Submesothelial stromal fibrosis FD Fibrin deposits SVH Subendothelial vascular hyalinosis VP Vascular permeability PI Perivascular inflammation Ca Calcification ESRD End stage renal disease AKI Acute kidney injury 4 ABSTRACT A habilitation thesis brings autobiographical evidence of the background of the main results in postdoctoral scientific, didactic and professional activity. It also highlights the perspectives which this background open. Academic carreer is a complex profession, which lays its success on persuasion and self-improvement, creativity and a continous search for new ideas and concepts. The gross part of my academic career have been running under the sign and perspective of scientific research opportunity. I undiluted my work on two major goals: the research of different anatomical structures and scholar and research theme which is largely addressed to the pedagogical management of students and young practitioners. My work in the Anatomy Chair has also been focused on selection and motivation of the new coworkers and to stimulate and encourage future physicians to explore these themes. The leading perspectives of my professional career are to pursue research in the two major directions already mentioned. Entire efforts made accomplishing scholarship results are about to permanently update our syllabus and to synchronize it with the one of the European Union countries. This will improve the performance of our students and our international visibility, with a huge socio-economic impact. The inducement in the research activity started with the graduation of my PhD, under the coordination of Mircea Chiriac MD PhD. The theme of my doctoral thesis was "The systemic and telomic study of the external carotid system". My academic activity materialized in approaching the most social and medical demanding current dissorders. Following this direction we have conceived and published a total of 28 scientific in extenso manuscripts which gave me the right to participate in a number of 3 grant research projects. My habilitation thesis is organised in the three major SECTIONS required by the CNATDCU, as recommended and approved criteria. The manuscript presents my entire postdoctoral academic activity within the Chair of Anatomy at ‗Gr or T Pop ‘ Un v rs ty o M n n P rm y n I SECTION I includes the abstract of the thesis. SECTION II is divided into two distinguished parts: overview of personal, professional, academic and scientific achievements and a second part formed by another four chapters. The first part is a biographical record of the most significant features of my professional achievements in all the fields of academic activity. They are the consistence of the background and the skillfulness which enable me to achieve the top of the academic career. The second part comes out of my studies performed after I graduated the PhD research, including all the projects I have conducted. Thus, in its CHAPTER 1, entitled FROM HYPPOCRATES TO HARVEY - FROM FASCIES TO ARTERIES I discuss about the disseminated research of my work in morphofunctional approach of fascias, skeletal muscle and arterial anatomical variants. 5 By the CHAPTER 2, entitled THE PHOENIX OF BONE RESTORATION - FROM PATHOLOGY TO ANATOMY I approach the current issue of osteosynthesis which affects so many orthopedic patients. This study is conducted in order to assess the biocompatibility, quality and extent of osseous healing of modern days synthetic bone substitutes. CHAPTER 3, entitled MORPHOFUNCTIONAL AND APPLIED DEVELOPMENTAL RESEARCH ON THE ENDOCRINE SYSTEM undergoes the theme of the morphofunctional study on pancreatic endocrine system. It contains also, the results of a research project I have managed in laboratory study of diabetes mellitus type 2. The last one, CHAPTER 4, entitled THE PROPHECY OF SURVIVAL - ADVANCES IN TUMOUR TRACKING approaches the issue of early diagnosis, staging and management of colorectal tumours. This theme has also a huge social and economic impact because colorectal malignancies have an increased incidence and became one the most common cause of death by cancer. The purpose of the study is to evaluate the efficiency in use of neoangiogenesis biochemical markers and different radiologic high-end techniques in order to assess early informations about tumour proliferation rate and the prognosis of the patients. All my scientific achievements so far have been outlined in books and book chapters, ISI articles in journals with impact factor and communications at congress and conferences. These would not have been possible without teamwork within Anatomy Chair and would not have been possible without the help and signature of the medical school trainers. The continuity in studying the arterial system, started with the topic of my doctoral study, opened the way for my research career and empowered me with compulsory skills of an academic carreer. The achievements of my academic activity enhance the international visibility and the reputation of the University I am part of. SECTION III presents in a detailed manner all the perspectives that my former academic activity has opened. There are described all my plans for future researches in chronological order of the originating idea. Following this thinking I started to present the subjects from the PhD studies and I finished with the most recent ones. In the last part of the habilitation thesis I added the most significant and outstanding literature works that I used in my career as a fundamental starting point for my research. 6 REZUMAT O t ză b l t r u ov utob o r ă a fundamentului principalelor r zult t în t v t t șt nț ă, t ă ș pro s on lă post o tor lă D s m n , subl n ză p rsp t v l p r st un m nt l s C r r m ă st o profesiune ompl xă, r îș ăs șt su sul în t rm n r ș uto păș r , creativitate ș ăut r ont nuă unor ș on pt no Majoritatea carierei mele academice s- s ășur t sub s mnul ș p rsp t v oportun tăț a realiza o r t r șt nț ă M - m r ț on t mun p ouă obiective m jor : r t r r t lor stru tur n tom ș temei de cercetare r s r s ză în m r măsură m n m ntulu l s stu nț ș al tinerilor practicieni.