Is Bone Elevation in Hand Muscle Attachments Associated with Biomechanical Stress? A Histological Approach to an Anthropological Question

In anthropological sciences, muscle attachments are typically utilized for reconstructing the physical activities of past human populations. This approach relies on the concept that entheseal bone morphology is influenced by cumulative biomechanical stress. A fundamental criterion for assessing the stage of entheseal change involves the proportion of elevated bone area. However, it is not yet clear if bone elevation is associated with biomechanical forces exerted during physical activity, while the histology of the entheses of the human hand, the least-bodyweight-bearing anatomical area, is not fully investigated. Multiple previous studies on entheses have concluded that the concentration of calcified fibrocartilage reflects the level of applied forces. On this basis, if hand entheseal surface elevation was associated with the level of biomechanical stress, then a greater amount of calcified fibrocartilage would be expected in entheses' central and more projecting bone areas. More importantly, individual entheses with a greater proportion of elevated bone areas would present a higher total concentration of calcified fibrocartilage. To test these hypotheses, this pilot study conducted a histological quantitative analysis on two thumb entheses of four fully-documented body donors. Across individuals, all central entheseal regions presented greater calcified fibrocartilage, while the entheses showing additional bone elevation in their marginal areas comprised substantially higher total values. The observations of this small-scale pilot study support the concept that interindividual differences in entheseal bone morphology are related to varying levels of biomechanical loading. Furthermore, they encourage future research to compile larger sample sizes, for comparing individuals with distinct lifelong activities. Anat Rec, 302:1093–1103, 2019. © 2018 Wiley Periodicals, Inc.     

Is laparoscopy still the gold standard in infertility assessment? A comparison of fertiloscopy versus laparoscopy in infertility. Results of an international multicentre prospective trial: the 'FLY' (Fertiloscopy-LaparoscopY) study

BACKGROUND: The aim of this prospective multicentre study was to compare the two endoscopic techniques of laparoscopy and fertiloscopy in routine evaluation of the pelvis in infertile women. METHODS: A total of 92 women was selected in 14 University Hospitals to undergo fertiloscopy followed by transabdominal laparoscopy by a team of two surgeons in each hospital. RESULTS: A high degree of concordance was observed between these two techniques, in that if fertiloscopy did not detect any abnormalities, this was also confirmed by laparoscopy. Discordance was observed in similar numbers of cases: eight after laparoscopy and nine after fertiloscopy. The diagnostic index for fertiloscopy and laparoscopy was calculated; sensitivity (86 and 87% respectively) and negative predictive value (64 and 67% respectively) were similar. The kappa index was also calculated for each of the six structures/regions (right/left tube; right/left ovary; peritoneum of pouch of Douglas; posterior uterus), and concordance (0.78 to 0.91) was considered almost complete. CONCLUSIONS: These results confirm fertiloscopy as a minimally invasive safe procedure that may be considered as an alternative to diagnostic laparoscopy in the routine assessment of women without clinical or ultrasound evidence of pelvic disease. On the basis of the additional advantages of fertiloscopy, namely salpingoscopy or microsalpingoscopy, it is considered that fertiloscopy could replace laparoscopy as a routine procedure in such women.