Publications by authors named "Juan A Sanchis-Gimeno"

42 Publications

Association between ribs shape and pulmonary function in patients with Osteogenesis Imperfecta.

J Adv Res 2020 Jan 22;21:177-185. Epub 2019 Oct 22.

Giaval Research Group, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Av. Blasco Ibanez, 15, 46010 Valencia, Spain.

The aim of the present study was to test the hypothesis that ribs shape changes in patients with OI are more relevant for respiratory function than thoracic spine shape. We used 3D geometric morphometrics to quantify rib cage morphology in OI patients and controls, and to investigate its relationship with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1), expressed as absolute value and as percentage of predicted value (% pred). Regression analyses on the full sample showed a significant relation between rib shape and FEV1, FVC and FVC % pred whereas thoracic spine shape was not related to any parameter. Subsequent regression analyses on OI patients confirmed significant relations between dynamic lung volumes and rib shape changes. Lower FVC and FEV1 values are identified in OI patients that present more horizontally aligned ribs, a greater antero-posterior depth due to extreme transverse curve at rib angles and a strong spine invagination, greater asymmetry, and a vertically short, thoraco-lumbar spine, which is relatively straight in at levels 1-8 and shows a marked kyphosis in the thoraco-lumbar transition. Our research seems to support that ribs shape is more relevant for ventilator mechanics in OI patients than the spine shape.
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http://dx.doi.org/10.1016/j.jare.2019.10.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7015465PMC
January 2020

3D geometric morphometric analysis of variation in the human lumbar spine.

Am J Phys Anthropol 2019 11 15;170(3):361-372. Epub 2019 Aug 15.

Paleoanthropology Group, Museo Nacional de Ciencias Naturales (CSIC), Madrid, Spain.

Objectives: The shape of the human lumbar spine is considered to be a consequence of erect posture. In addition, several other factors such as sexual dimorphism and variation in genetic backgrounds also influence lumbar vertebral morphology. Here we use 3D geometric morphometrics (GM) to analyze the 3D morphology of the lumbar spine in different human populations, exploring those potential causes of variation.

Material And Methods: We collected 390 (semi) landmarks from 3D models of the CT scans of lumbar spines of seven males and nine females from a Mediterranean population (Spain, Israel) and seven males and either females from a South African population for geometric morphometric (GM) analysis. We carried out Generalized Procrustes Analysis, Principal Components, and Regression analyses to evaluate shape variation; and complemented these analyses with the Cobb Method.

Results: The Mediterranean sample was considerably more lordotic than the South African sample. In both populations, female lumbar spines showed proportionally narrower and more craniocaudally elongated lumbar segments than in males. In addition, the point of maximum curvature in females tended to be located more inferiorly than in males.

Discussion: Our results show that sexual dimorphism is an important factor of lumbar spine variation that mainly affects features of lumbar spine robustness (height proportions) and the structure-but not the degree-of its curvature. Differences in lordosis, however, are clearer at the inter-population level. This reflects previous conflicting studies casting doubts on pregnancy as an adaptive factor influencing lordosis. Other factors, for example, shape of the individual lumbar vertebrae and intervertebral discs and their relative proportions within the lumbar spine should be considered when exploring variation in vertebral column morphology.
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http://dx.doi.org/10.1002/ajpa.23918DOI Listing
November 2019

Differences in the shape and direction-course of the nasopalatine canal among dentate, partially edentulous and completely edentulous subjects.

Anat Sci Int 2020 Jan 23;95(1):76-84. Epub 2019 Jul 23.

School of Dentistry, Catholic University San Vicente Martir of Valencia, C/Quevedo, 2, E46001, Valencia, Spain.

We aimed to analyze the nasopalatine canal shape and anatomical variations of the buccal bone wall and compare the effect of the presence or absence of the central maxillary incisors on the nasopalatine canal. The shape of the nasopalatine canal and the dimensions of the buccal bone wall were measured in 150 patients who underwent a cone-beam computed tomography study. We found that the most prevalent shape of the nasopalatine canal was funnel (31%) and the most common direction-course was slanted-straight (33%). The buccal bone wall in relation to the nasopalatine canal was thickest at the anterior nasal spine level and narrowest at the level of the most anterior-inferior point of the buccal cortex of the maxilla. A statistically significant difference was detected between morphology and direction-course of the nasopalatine canal and dental status. In sum, the study of the nasopalatine canal showed multiple variations. Precise knowledge of these variations may help to decrease the incidence of complications during implantology treatment and during facial and dental surgery.
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http://dx.doi.org/10.1007/s12565-019-00496-0DOI Listing
January 2020

Possible Clinical Implications of Geographic Differences in Prevalence of Double Transverse Foramen.

World Neurosurg 2019 Jun 1;126:e570-e572. Epub 2019 Mar 1.

GIAVAL Research Group, Department of Anatomy and Human Embryology, University of Valencia, Faculty of Medicine, Valencia, Spain.

Background: The double transverse foramen (DBLTF) is a cervical spine anatomic variant. Current literature has presented prevalence values of DBLTF in Caucasian Mediterranean subjects that seem to be higher than those observed in other samples of subjects. Therefore we aimed to test if Caucasian Mediterranean subjects present a higher prevalence of the DBLTF than sub-Saharan African subjects.

Methods: We analyzed the presence of DBLTF in cervical spines of 100 skeletons from Caucasian Mediterranean subjects and 91 skeletons from sub-Saharan African subjects, resulting in a total of 1337 cervical vertebrae having been studied.

Results: No DBLTF was found in vertebrae C1, C2, and C3. The pattern of prevalence observed in all samples analyzed indicated the prevalence ranged from exhibiting the most to the least prevalence as C6 > C5 > C7 > C4. The sub-Saharan African subjects presented a significant reduced DBLTF prevalence of 2.2%, 14.3%, 19.8%, and 3.3% in C4 (P = 0.043), C5 (P = 0.004), C6 (P < 0.001), and C7 (P = 0.041), respectively, than that presented by Caucasian Mediterranean subjects (9.0%, 32.0%, 45.0%, 11.0% in C4, C5, C6, and C7, respectively).

Conclusions: Our study has revealed that this anatomic variation is more frequently found in Caucasian Mediterranean subjects than in sub-Saharan African subjects.
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http://dx.doi.org/10.1016/j.wneu.2019.02.096DOI Listing
June 2019

The Retrotransverse Foramen of the Atlas Is not a Modern Anatomic Variation.

World Neurosurg 2019 Mar 14;123:174-176. Epub 2018 Dec 14.

Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Auckland Park, South Africa.

Background: The retrotransverse foramen (RTF) is a nonmetric variant of the atlas vertebra that consists of an abnormal accessory foramen located on the posterior root of the transverse process and it extends from the posterior root of the transverse process to the root of the posterior arch. Its presence has been related to regional variations of the venous circulation. It is currently unknown whether the RTF is a modern or an ancient anatomic variation.

Case Description: We analyzed the skeletal remains from the late-ancient Roman necropolis (II-VI centuries ad) of La Boatella (Valencia, Spain) and we found a well-preserved individual skeleton that presented with a left retrotransverse foramen in C1.

Conclusions: The RTF is not a modern anatomic variation. As a result, ancient individuals had the same modifications in the regional circulation as modern subjects present today.
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http://dx.doi.org/10.1016/j.wneu.2018.11.241DOI Listing
March 2019

Prevalence of anatomic variations of the atlas vertebra.

Spine J 2018 11 28;18(11):2102-2111. Epub 2018 Jun 28.

Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, 7304e, John Orr Building, Johannesburg, South Africa.

Background Context: The retrotransverse foramen (RTF), arcuate foramen (AF), unclosed transverse foramen (UTF) and posterior atlas arch defects (PAAD) are anatomic variations of the atlas vertebra that surgeons must be aware of before spine surgery is performed.

Purpose: To analyze the prevalence of the AF, RTF, UTF, and PAAD.

Study Design: Ex-vivo anatomical study.

Patient Sample: Two hundred eighteen atlas vertebrae obtained from 100 Caucasian subjects and 118 sub-Saharan African subjects (48 Sotho subjects, 35 Xhosa subjects and 35 Zulu subjects).

Methods: We studied 218 atlas vertebrae from skeletons of the Raymond A. Dart Collection in order to analyze the prevalence of AF, RTF, UTF, and PAAD in both Caucasian and sub-Saharan African subjects.

Outcome Measures: Not applicable.

Results: Sixty-nine (31.2%) atlases presented anatomical variants: 64 (29.3%) presented one anatomical variant, 4 (1.8%) presented two, and 1 (0.5%) presented three. AF, RTF, UTF, Type A and Type E defects were present in 35 (16.1%), 17 (7.8%), 17 (7.8%), 5 (2.3%), and 1 (0.5%) vertebrae, respectively. The vertebrae with two anatomical variants presented a bilateral UTF and a Type A defect, a bilateral AF and a Type A defect, a right UTF and a left AF, and a right UTF and a Type E defect. The vertebra with three anatomical variants presented a bilateral RTF, a left UTF, and a left AF. No sex differences in prevalence of the RTF (p=.775), AF (p=.605), UTF (p=.408) and Type A defects (p=1.000) were found in the sub-Saharan African and Caucasian groups (RTF, p=.306; AF, p=.346; UTF, p=.121; Type A defects, p=.561). Comparison between the sub-Saharan African (all subjects) and the Caucasian group revealed no differences in the UTF (p=.105), AF (p=.144), RTF (p=.542) and Type A defects (p=.521) prevalence. Also, no differences in the prevalence of the UTF (p=.515), AF (p=.278), and RTF (p=.857) between Zulu, Xhosa and Sotho subjects were found. Neither were found sex differences in the prevalence of UTF, RTF and AF in Zulu (p=.805, p=.234, p=.129), Xhosa (p=.269, p=.181, p=.309), and Sotho subjects (p=.062, p=.590, p=.106).

Conclusions: The present study has revealed no sex differences in the prevalence of AF, UTF, RTF or PAAD in both Caucasian and sub-Saharan African subjects. This research has also indicated no differences in the prevalence of the UTF, AF and RTF between Zulu, Xhosa and Sotho subjects. In addition, this study has revealed no differences in the Type A, UTF, AF, and RTF prevalence between the sub-Saharan African (all subjects) and the Caucasian subjects. These variations may be known by surgeons before spine surgery for better planning.
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http://dx.doi.org/10.1016/j.spinee.2018.06.352DOI Listing
November 2018

Atlases with Arcuate Foramen Present Cortical Bone Thickening That May Contribute to Lower Fracture Risk.

World Neurosurg 2018 Sep 5;117:e162-e166. Epub 2018 Jun 5.

Orthopedic Surgery Service, USC University Hospital Complex, Santiago de Compostela, Spain.

Background: To date, no information about the cortical bone microstructural properties in atlas vertebrae with arcuate foramen has been reported. As a result, we aimed to test in an experimental model if there is a cortical bone thickening in an atlas vertebra which has an arcuate foramen that may play a protective role against bone fracture.

Methods: We analyzed by means of micro-computed tomography the cortical bone thickness, the cortical volume, and the medullary volume (SkyScan 1172 Bruker micro-CT NV, Kontich, Belgium) in cadaveric dry atlas vertebrae with arcuate foramen and without arcuate foramen. We also reviewed a case series of 31 posterior atlas arch fractures to correlate the possible presence in the same atlas of both fracture and arcuate foramen.

Results: The micro-computed tomography study revealed significant differences in cortical bone thickness (P < 0.001), cortical volume (P < 0.004), and medullary volume (P = 0.013) values between the arcuate foramen vertebrae and the nonarcuate foramen vertebrae. The clinical series found no coexistence in the same vertebra of a posterior atlas arch fractures and the arcuate foramen.

Conclusions: An atlas with arcuate foramen presents cortical bone thickening. This advantage in bone microarchitecture seems to contribute to a lower fracture risk compared to subjects without arcuate foramen as no coexistence in the same vertebra of a posterior atlas arch fractures and arcuate foramen was found.
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http://dx.doi.org/10.1016/j.wneu.2018.05.220DOI Listing
September 2018

Can the transverse foramen/vertebral artery ratio of double transverse foramen subjects be a risk for vertebrobasilar transient ischemic attacks?

J Anat 2018 Jun 7. Epub 2018 Jun 7.

Department of Radiology, ERESA CT and MRI Unit, Valencia, Spain.

The C6 is the cervical vertebra into which the vertebral artery enters the passage of the transverse foramen and it is the vertebra most affected by double transverse foramina. There is currently little information about the relation between the vertebral artery and the double transverse foramen in C6. We aimed to test whether subjects with a double transverse foramen in C6 have a reduced transverse foramen/vertebral artery ratio when compared with normal anatomy subjects who possess a single transverse foramen which may be a risk for transient vertebral artery stenosis. We measured the area of the transverse foramen and the vertebral artery in 27 double transverse and 56 normal anatomy subjects using computed tomography angiography. We found significant differences in the area of the transverse foramen between double transverse and normal subjects (P < 0.001) but not between the vertebral artery area of double transverse and normal subjects (P = 0.829). The subjects with double transverse foramina have a reduced transverse foramen/vertebral artery ratio, which may be a possible risk for transient vertebral artery stenosis.
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http://dx.doi.org/10.1111/joa.12839DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6081508PMC
June 2018

Corneal Thickness Response after Anesthetic Eye Drops: Our Own Results and Meta-Analysis.

Biomed Res Int 2018 5;2018:4743721. Epub 2018 Mar 5.

Ocular Anatomy Unit, Department of Anatomy and Human Embryology, University of Valencia, Faculty of Medicine, Avda. Blasco Ibanez 15, 46010 Valencia, Spain.

We aimed to test if there are different patterns in the central corneal thickness (CCT) response after instilling oxybuprocaine anesthetic eye drops and also to determine whether there is a significant change in the CCT. CCT was measured in 60 eyes of 60 healthy subjects before and during the hour after oxybuprocaine 0.4% eye drops were instilled. In addition, a systematic review and meta-analysis were carried out in order to answer the following PICO (patient, intervention, comparison, and outcome) question: What effect do anesthetic eye drops have on CCT values? We found no significant changes in the mean CCT values during the hour's observation (ANOVA, = 0.209), and the meta-analysis revealed no statistically significant changes in the CCT after anesthesia (-Value = 1.111; value = 1.000; 2 = 0.000; Tau2 = 0.000; Stderr = 0.020). However, we found three CCT response patterns 5 minutes after anesthesia: Pattern 1, subjects with no significant changes in their CCT values ( = 14, 46.7%); Pattern 2, subjects with significant CCT increases ( = 11, 36.7%); and Pattern 3, subjects with significant CCT decreases ( = 5, 16.7%). In sum, there are no significant changes in the CCT after anesthesia, but there are three different CCT response patterns 5 minutes after anesthesia.
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http://dx.doi.org/10.1155/2018/4743721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5859836PMC
September 2018

Double Retrotransverse Foramen of Atlas (C1).

World Neurosurg 2018 Jun 20;114:e869-e872. Epub 2018 Mar 20.

Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, South Africa. Electronic address:

Background: The retrotransverse foramen is a nonmetric variant of C1 that consists of an abnormal accessory foramen on the posterior root of the transverse process.

Case Description: During a study on the prevalence of the retrotransverse foramen in 150 dry C1 vertebrae, we observed an exceptional C1 (0.67%) with a right double retrotransverse foramen of the 14 C1 vertebrae (9.3%). This has not been reported previously in the literature. No osteogenic reaction and no degenerative signs were observed in this C1 with the double retrotransverse foramen.

Conclusions: Neurosurgeons should be aware of the possible presence of the "conventional" retrotransverse foramen and the "exceptional" double retrotransverse foramen so that they can safely plan to prevent surgical complications. This will thus ensure better patient management by neurosurgeons.
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http://dx.doi.org/10.1016/j.wneu.2018.03.102DOI Listing
June 2018

The Decreasing Prevalence of the Arcuate Foramen.

World Neurosurg 2018 Feb;110:521-525

Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.

Background: The arcuate foramen (AF), or ponticulus posticus, is an anatomic variant of the first cervical vertebra that consists of a complete or partial osseous bridge over the groove for the vertebral artery and extends from the posterior aspect of the superior articular facet to the superior lateral border of the posterior arch. The AF has been associated with clinical symptoms, such as headache, migraine, neck pain, shoulder pain, arm pain, and vertebral artery dissection. We aimed to test whether the prevalence of the AF has decreased in the modern human population over the past centuries as a result of reduction in inbreeding and endogamy.

Methods: Possible reduction in the prevalence of the AF was assessed by comparing a 17th century rural sample (n = 108) with a 20th century modern urban sample (n = 192).

Results: When comparing the 17th and the 20th century samples, we found a statistically significant (P = 0.003) reduction of 14.5% (95% confidence interval 4.5-24.5) in the prevalence of the AF.

Conclusions: Prevalence of the AF has been decreasing over the past centuries.
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http://dx.doi.org/10.1016/j.wneu.2017.10.037DOI Listing
February 2018

Unexpected Persistent Dentocentral Synchondrosis of C2.

World Neurosurg 2018 Mar 15;111:26-27. Epub 2017 Dec 15.

Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain.

Background: The persistence of synchondrosis in adulthood can confound diagnostic decisions made during patient management.

Case Description: A 59-year-old woman who presented neck pain, acute headache, and acute cervical myelopathy symptoms after suffering whiplash grade 3 in a car rear-end impact underwent a conventional radiologic study that revealed no fracture and no anatomic spine variations. The magnetic resonance imaging study revealed no spinal cord intensity signal changes, but it showed a persistent (remnant) dentocentral synchondrosis that was undetected in a previous conventional radiographic evaluation.

Conclusions: The localization and level of the remnant of the dentocentral synchondrosis are extremely important from the clinical viewpoint because of odontoid and C2 fractures. Neurosurgeons should thus be aware of the possible presence of a persistent (remnant) C2 dentocentral synchondrosis in adult subjects in order to avoid misdiagnosis with C2 fracture.
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http://dx.doi.org/10.1016/j.wneu.2017.12.017DOI Listing
March 2018

Retrotransverse foramen of the atlas: prevalence and bony variations.

Eur Spine J 2018 06 7;27(6):1272-1277. Epub 2017 Nov 7.

Department of Human Anatomy and Physiology, Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa.

Purpose: To analyze the prevalence of the retrotransverse foramen (RTF) and its bony variations.

Methods: One hundred ten atlases of living adult subjects, 161 twentieth century dry adult cervical atlases and four dry adult cervical atlases from medieval skeletons were studied to detect the RTF and its abnormal bony variations. The 110 living adult subjects underwent a computed tomography study to detect the RTF.

Results: In the in vivo sample (n = 110; 100%), the RTF was found in four (3.6%) atlases. It was bilateral in all cases, but three (2.7%) patients showed complete RTF and the other patient presented a complete RTF in the left transverse process and an unclosed RTF in the right transverse process. In addition, the RTF was observed in combination with an unclosed transverse foramen in two cases (1.8%). In the twentieth century skeletal sample (n = 206; 100%) the RTF was found in 15 (7.3%) C1 vertebrae. It was bilateral in three (1.5%) vertebrae and unilateral in another 12 (5.8%) vertebrae. In the medieval skeletal sample (n = 4; 100%) one cadaveric atlas (25%) presented a bilateral RTF with special bony characteristics which presented an unexpected spicula in the left RTF.

Conclusions: The RTF is a nonmetric variant of the atlas vertebra that can present non-degenerative and non-traumatic spiculae or it can be unclosed. In addition, it can be associated with the presence of unclosed transverse foramina.
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http://dx.doi.org/10.1007/s00586-017-5372-4DOI Listing
June 2018

Gonial angle growth patterns according to age and gender.

Ann Anat 2018 Jan 24;215:93-96. Epub 2017 Sep 24.

Department of Anatomy and Human Embryology, University of Valencia, Faculty of Medicine, Avda. Blasco Ibanez 15, E46010 Valencia, Spain. Electronic address:

Currently there are controversial results about gender and age differences in human gonial angle values. In this context we aimed to ascertain the gender and age differences in the gonial angle values of young Caucasian Mediterranean subjects. We tested the hypothesis of a relation between the gonial angle values and the gender and age of the subjects by means of a prospective study involving 266 subjects. Panoramic radiographs (Cranex Novus, XMIND Novus Soredex, France) were carried out in order to measure the gonial angle values. We found significant differences between females and males in the subgroups aged ≤10years old (128.6±3.4 vs 126.8±4.5, p=0.017), 16-20 years old (119.1±5.6 vs 122.3±7.7, p=0.011), 21-25 years old (117.6±5.2 vs 120.8±7.0, p=0.016) and 26-30 years old (117.5±5.4 vs 120.6±5.4, p=0.019) but not in the subgroup aged 11-15 years old (123.4±5.2 vs 123.5±5.4, p=0.927). A significant negative correlation was found between age and gonial angle values (r=-0.365, p<0.001). In sum, females under 10 years of age have significantly higher values than males. The angle values decreased until the age of 11-15 years of age when there were no significant gender differences. Thus, the males aged over 16 years old presented significantly higher values than the females. The decrease in gonial angle values seems to slow or stop from 21 years onwards. Knowledge of the pattern differences will serve for age and gender determination when analyzing human remains.
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http://dx.doi.org/10.1016/j.aanat.2017.09.004DOI Listing
January 2018

Analysis of the relationship between the double transverse foramen and the possibility of developing clinical symptoms after whiplash.

Clin Anat 2017 Sep 6;30(6):761-766. Epub 2017 Jun 6.

University San Vicente Martir, C/Espartero 7. Valencia, Valencia, Spain.

Currently, there is no information about the possibility of developing clinical symptoms after whiplash in double transverse foramen subjects. Our aim was to test whether subjects with double transverse foramen have an increased risk of presenting with an acute headache, dizziness, vertebral artery dissection, and vomiting after whiplash.We recorded the absence/presence of double transverse foramen, and the absence/presence of neck pain, acute headache, dizziness, vertebral artery dissection, and vomiting in 85 patients who had suffered whiplash injuries in car rear-end impacts in road traffic accidents. We used the odds ratio test to determine whether double transverse foramen subjects are at a higher risk of developing an acute headache, dizziness, and vomiting than non-double transverse foramen subjects.Although double transverse foramen subjects presented with more clinical symptoms after whiplash, the odds ratio test revealed that their risks of developing acute headache (P = 0.30), dizziness (P = 0.09), or vomiting (P = 0.18) were not significantly greater than in the control group.Double transverse foramen subjects are not at a higher risk of presenting acute headache, dizziness, vertebral artery dissection, and vomiting after whiplash. Clin. Anat. 30:761-766, 2017. © 2017Wiley Periodicals, Inc.
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http://dx.doi.org/10.1002/ca.22897DOI Listing
September 2017

Acute headache attributed to whiplash in arcuate foramen and non-arcuate foramen subjects.

Eur Spine J 2017 04 7;26(4):1262-1265. Epub 2016 Nov 7.

Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Valencia, Spain.

Purpose: To test the association between arcuate foramen (AF) in the first cervical vertebra with acute headache attributed to whiplash.

Methods: Retrospective study of 128 patients that suffered a whiplash. The presence or absence of AF was recorded after a radiographic study, as well as the presence or absence of acute headache after the whiplash.

Results: The frequency of AF was 17.2%. Patients with bilateral AF presented a significant (p = 0.000, Fisher's test) increase in the frequency of acute headache (90.9%) in comparison with the non-AF group (5.7%). The ratio between the presence and absence of acute headache was 166.6 times higher (IC 95% 18.2-1526.22) in subjects with bilateral AF in comparison with non-AF subjects.

Conclusions: The presence of bilateral AF is associated to an increased frequency of acute headache after suffering a whiplash, information of interest for the attention to these patients.
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http://dx.doi.org/10.1007/s00586-016-4856-yDOI Listing
April 2017

Cortical bone thickening in Type A posterior atlas arch defects: experimental report.

Spine J 2017 03 18;17(3):431-434. Epub 2016 Oct 18.

Department of Radiology, University Hospital de La Ribera, Carretera Corbera km 1, Alzira, Valencia E46600, Spain.

Background Context: To date, no information about the cortical bone microstructural properties in atlas vertebrae with posterior arch defects has been reported.

Purpose: To test if there is an increased cortical bone thickening in atlases with Type A posterior atlas arch defects in an experimental model.

Study Design: Micro-computed tomography (CT) study on cadaveric atlas vertebrae.

Methods: We analyzed the cortical bone thickness, the cortical volume, and the medullary volume (SkyScan 1172 Bruker micro-CT NV, Kontich, Belgium) in cadaveric dry vertebrae with a Type A atlas arch defect and normal control vertebrae.

Results: The micro-CT study revealed significant differences in cortical bone thickness (p=.005), cortical volume (p=.003), and medullary volume (p=.009) values between the normal and the Type A vertebrae.

Conclusions: Type A congenital atlas arch defects present a cortical bone thickening that may play a protective role against atlas fractures.
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http://dx.doi.org/10.1016/j.spinee.2016.10.012DOI Listing
March 2017

Corneal thickness differences between type 2 diabetes and non-diabetes subjects during preoperative laser surgery examination.

J Diabetes Complications 2017 01 28;31(1):209-212. Epub 2016 Aug 28.

Ocular Anatomy Unit, Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Avda. Blasco Ibanez 15, E46010, Valencia, Spain.

Aims: To evaluate the differences in corneal thickness between type 2 diabetes subjects with HbA1c under 7.0% and non-diabetes subjects during their preoperative laser surgery examinations.

Methods: The mean of five consecutive corneal thickness measurements at the central and mid-peripheral cornea was obtained by means of noncontact scanning-slit corneal topography (Orbscan Topography System II; Orbscan, Inc., Salt Lake City, UT, USA) in 35 myopic non-insulin dependent type 2 diabetes subjects (17 males and 18 females) and 48 healthy myopic controls (23 males and 25 females).

Results: The corneal thickness values at the central and mid-peripheral cornea were significantly higher in the diabetic group (p<.001). The diabetic subjects presented the highest thickness value in the superior cornea (n=22; 62.9%) followed by the nasal (n=9; 25.7%) and the temporal (n=4; 11.4%) cornea, but never in the inferior cornea. The control subjects presented the highest thickness value in the superior cornea (n=19; 39.6%) followed by the nasal (n=18; 37.5%), the inferior (n=6; 12.5%), and the temporal (n=3; 6.3%) cornea. The central corneal thickness (CCT) of the diabetes patients was not statistically correlated with their HbA1c (r=.078; p=.104), body mass index (r=.007; p=.633), and time from diagnosis of diabetes (r=.025; p=.363), but it was correlated with their corneal endothelial cell density values (r=.543; p<.001).

Conclusions: Diabetes subjects with HbA1c under 7.0% who are candidates for laser refractive surgery present thicker corneas than their age-matched control subjects. In these patients, there is a correlation between their CCT values and their corneal endothelial cell density values, so when higher CCT values were found, lower corneal endothelial cell density values were observed.
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http://dx.doi.org/10.1016/j.jdiacomp.2016.08.024DOI Listing
January 2017

Anatomic variation of the vertebral artery.

Spine J 2016 Nov 4;16(11):e737. Epub 2016 Apr 4.

CT and MRI Unit, ERESA, Department of Radiology, General University Hospital, Avda. Tres Cruces 2, E46014, Valencia, Spain.

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http://dx.doi.org/10.1016/j.spinee.2016.03.054DOI Listing
November 2016

Quantitative Anatomical Studies.

Biomed Res Int 2015 31;2015:781590. Epub 2015 Aug 31.

Department of Anatomy, Faculty of Veterinary Sciences, Uludag University, Bursa, Turkey.

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http://dx.doi.org/10.1155/2015/781590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4568322PMC
July 2016

Congenital posterior atlas arch defects.

Spine J 2015 Apr;15(4):796

Department of Anatomy and Human Embryology, Faculty of Medicine, Av. Blasco Ibanez, 15, E-46010 Valencia, Spain.

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http://dx.doi.org/10.1016/j.spinee.2014.07.027DOI Listing
April 2015

Quantitative corneal anatomy: evaluation of the effect of diabetes duration on the endothelial cell density and corneal thickness.

Ophthalmic Physiol Opt 2015 May 28;35(3):293-8. Epub 2014 Dec 28.

Optometry Research Group, Department of Optics, University of Valencia, Valencia, Spain.

Purpose: To evaluate the differences in endothelial cell density (ECD) and central corneal thickness (CCT) between type II diabetic patients and age-matched healthy controls, and determine the impact of time from diagnosis.

Methods: This is a comparative study of 77 eyes of type II diabetic patients (33 males, 44 females) and 80 eyes of healthy subjects (42 males, and 38 females) whose ages ranged from 38 to 56 years. CCT, ECD, HbA(1c) levels, and Goldmann tonometry were measured.

Results: The CCT was significantly higher and the ECD significantly lower in long-term diabetic patients (10 years + since diagnosis) when compared with short-term diabetic patients (<1 year since diagnosis) and controls (both p < 0.001). No significant differences in CCT (p = 0.30) and ECD (p = 0.31) were found between control groups. Multivariate analysis of variance indicated that there was a significant effect of the diabetes duration in CCT and ECD. In diabetic patients, a two-way analysis of variance showed that CCT was significantly different for a 7.5% HbA(1c) cut-off value, and ECD for both 7.0% and 7.5% HbA(1c) cut-off values.

Conclusion: Type II diabetes causes a significant alteration in corneal structure and function in the long term. Our study seems to confirm the effect of diabetes duration and poor glycaemic control on CCT and ECD changes.
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http://dx.doi.org/10.1111/opo.12191DOI Listing
May 2015

Corneal thickness differences between sexes after oxybuprocaine eye drops.

Optom Vis Sci 2015 Jan;92(1):89-94

*MSc †PhD ‡MD, PhD §OD, MSc Ocular Anatomy Unit, Department of Anatomy and Human Embryology, Faculty of Medicine (PF-G, LQ-G, JAS-G), and Optometry Research Group, Department of Optics (AC, CA-D, SG-L), University of Valencia, Valencia, Spain; and Pharmacology Unit, University Clinic Hospital, Valencia, Spain (PF-G).

Purpose: We aimed to analyze the corneal thickness (CT) values of female and male subjects before and after instillation of oxybuprocaine 0.4% anesthetic eye drops.

Methods: The CT of 30 female subjects and 28 male subjects was measured using scanning-slit corneal topography (Orbscan Topography System II, Orbscan, Inc, Salt Lake City, UT). Measurements were carried out before and 3 minutes after the instillation of oxybuprocaine 0.4% eye drops.

Results: The difference between the baseline values and those obtained after anesthesia ranged as follows: male subjects: central, -26 to +24 μm; superior, -24 to +23 μm; inferior, -19 to +20 μm; nasal, -25 to +30 μm; and temporal, -21 to +20 μm; female subjects: central, -16 to +24 μm; superior, -19 to +32 μm; inferior, -14 to +34 μm; nasal, -19 to +33 μm; and temporal, -36 to +16 μm. No significant differences were found in any corneal location in male subjects. The differences were significant at inferior (p = 0.001) and nasal (p = 0.011) corneal sites in female subjects.

Conclusions: Oxybuprocaine anesthetic eye drops induce significant CT increases in female subjects but not in male subjects.
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http://dx.doi.org/10.1097/OPX.0000000000000449DOI Listing
January 2015

Congenital absence of the posterior right hemiarch.

Spine J 2015 Jan 28;15(1):207. Epub 2014 Sep 28.

Department of Anatomy and Human Embryology, University of Valencia, Faculty of Medicine, University of Valencia, Av. Blasco Ibanez, 15, E-46010, Valencia, Spain.

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http://dx.doi.org/10.1016/j.spinee.2014.09.009DOI Listing
January 2015

Congenital failure of midline fusion of the posterior atlas arch with an associated unilateral cleft.

Spine J 2015 Jan 6;15(1):198-9. Epub 2014 Sep 6.

Department of Anatomy and Human Embryology, University of Valencia, Av. Blasco Ibanez 15, 46010, Valencia, Spain.

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http://dx.doi.org/10.1016/j.spinee.2014.08.450DOI Listing
January 2015

Atlantoaxial subluxation and congenital atlas arch defect.

Spine J 2014 Dec 30;14(12):3049. Epub 2014 Jul 30.

Department of Anatomy and Human Embryology, University of Valencia, Faculty of Medicine, Av. Blasco Ibanez, 15, 46010 Valencia, Spain.

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http://dx.doi.org/10.1016/j.spinee.2014.07.011DOI Listing
December 2014

Difficulties in distinguishing between an atlas fracture and a congenital posterior atlas arch defect in postmortem analysis.

Forensic Sci Int 2014 Sep 26;242:e1-e5. Epub 2014 Jun 26.

CT and MRI Unit, ERESA, Department of Radiology, General University Hospital, Valencia, Spain.

We found one atlas from a sample of 148 skeletons (0.67%) that presented different anatomical variations which made it difficult to determine whether the vertebra had an atlas fracture, an unusual Type B posterior atlas arch defect, or a combination of both. We carried out a stereomicroscopy, radiographic, and computerized tomography scan study that revealed that the dry atlas we found presented a very uncommon congenital Type B posterior atlas arch defect, simulating a fracture. In short, the present paper has revealed that differentiating Type B posterior atlas arch defects from fractures in post-mortem dry vertebrae is more difficult than expected. Thus we believe that it can be easier than expected to mistake Type B posterior arch defects for fractures and vice versa in postmortem studies.
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http://dx.doi.org/10.1016/j.forsciint.2014.06.016DOI Listing
September 2014

The effect of anesthetic eye drop instillation on the distribution of corneal thickness.

Cornea 2013 May;32(5):e102-5

Department of Anatomy and Human Embryology, Ocular Anatomy Unit, Faculty of Medicine, University of Valencia, Valencia, Spain.

Purpose: To address the effect of topical instillation of oxybuprocaine on the relative distribution of corneal thickness (CT) in young healthy subjects.

Methods: Prospective study involving 30 eyes of 30 emmetropic subjects (24 ± 3 years). Corneal thickness measurements were carried out before and 3 minutes after the instillation of oxybuprocaine 4% using slit-scanning corneal topography (Orbscan topography system II). No acoustic correction factor was applied. The mean of 5 consecutive Orbscan measurements was obtained at the center and 3 mm from the visual axis in the temporal, superior, nasal, and inferior hemimeridians.

Results: No significant mean differences were found at any corneal location after anesthesia (P > 0.05). The difference between the baseline values obtained of the central, superior, inferior, nasal, and temporal cornea and those obtained after anesthesia ranged from -15 to 16 μm, from -19 to 32 μm, from -14 to 24 μm, from -20 to 33 μm, and from -31 to 18 μm, respectively. The maximum paracentral CT was never found at the temporal location before anesthesia, whereas it was never found at the inferior location after anesthesia. The minimum paracentral CT was never found in the superior location after anesthesia.

Conclusions: Topical anesthetic eye drops induce CT increases and decreases at each corneal location; however, the differences are not significant. Nevertheless, a change in the location of the minimum and maximum paracentral thickness occurs in some individuals after corneal anesthesia.
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http://dx.doi.org/10.1097/ICO.0b013e318275e7a6DOI Listing
May 2013

White-to-white corneal diameter, pupil diameter, central corneal thickness and thinnest corneal thickness values of emmetropic subjects.

Surg Radiol Anat 2012 Mar 22;34(2):167-70. Epub 2011 Oct 22.

Department of Anatomy and Human Embryology, Faculty of Medicine, University of Valencia, Av. Blasco Ibáñez, 15, Valencia, 46010, Spain.

Purpose: This report assesses white-to-white corneal diameter, pupil diameter, central corneal thickness and thinnest corneal thickness values in a large sample of emmetropic subjects.

Methods: Three hundred and seventy-nine eyes of 379 young healthy emmetropic subjects were analyzed by means of scanning-slit corneal topography. The age of the subjects ranged from 18 to 53 years (mean ± SD = 29 ± 7). The mean of five consecutive measurements of the central corneal thickness, the thinnest corneal thickness, the white-to-white corneal diameter, and the photopic pupil diameter was recorded.

Results: The central corneal thickness ranged from 528 to 588 μm; the thinnest corneal thickness ranged from 504 to 574 μm; the white-to-white corneal diameter ranged from 11.5 to 12.3 mm; and the pupil diameter ranged from 3.0 to 4.7 mm. The central and the thinnest corneal thickness were positively correlated (r = 0.94, p < 0.001), and the pupil diameter was significantly higher in females (p < 0.001).

Conclusions: This study shows that there are no differences in white-to-white corneal diameter, central corneal thickness, and thinnest corneal thickness between emmetropic females and males. However, pupil diameters are greater in emmetropic females.
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http://dx.doi.org/10.1007/s00276-011-0889-4DOI Listing
March 2012