OBJECTIVES:Enthesitis, a hallmark of psoriatic arthritis (PsA), reflects the interplay between mechanical stress and immune dysregulation at tendon-bone interfaces. This study investigates the cellular and molecular responses in entheseal tissues following interleukin (IL)-17A inhibition in patients with active PsA. METHODS:In this prospective, interventional phase 4 trial, we enrolled 10 patients with enthesitis of the lateral epicondyle, performed entheseal biopsies, and analysed tissues by imaging mass cytometry (IMC) and spatial transcriptomics before and after treatment. RESULTS:Following 24 weeks of IL-17A inhibition, 9/10 patients of the cohort clinically responded to treatment as assessed by Disease Activity in Psoriatic Arthritis (DAPSA), Spondyloarthritis research consortium of canada (SPARCC) score, and power Doppler sonography. IMC analysis showed significant reductions of enthesitis-related immune cell populations, in particular IL-17-producing CD4, CD8, CD4neg/CD8neg T cells, granulocytes, and innate lymphoid cells type 3. Spatial transcriptomics revealed that CD200+DKK3+ fibroblasts and innate lymphoid cells type 2 expanded and formed an anti-inflammatory niche upon treatment. Notably, IL-17A inhibition led to decreased osteoblast differentiation markers, suggesting a potential mechanism to inhibit pathological bone formation. CONCLUSIONS:These findings underline the pivotal role of IL-17A in enthesitis, showing that IL-17A inhibition profoundly modulates the tissue microenvironment of entheses in PsA.

Voice production has been an area of interest in science since ancient times, and although advancing research has improved our understanding of the anatomy and function of the larynx, there is still little general consensus on these two topics. This review aims to outline the main developments in this field and highlight the areas where further research is needed. The most important hypotheses are presented and discussed highlighting the four main lines of research in the anatomy of the human larynx and their most important findings: (1) the arrangement of the muscle fibers of the thyroarytenoid muscle is not parallel to the vocal folds in the internal part (vocalis muscle), leading to altered properties during contraction; (2) the histological structure of the human vocal cords differs from other striated muscles; (3) there is a specialized type of heavy myosin chains in the larynx; and (4) the neuromuscular system of the larynx has specific structures that form the basis of an intrinsic laryngeal nervous system. These approaches are discussed in the context of current physiological models of vocal fold vibration, and new avenues of investigation are proposed.

Purpose Dry eye syndrome (DES) is one of the most common diseases of the ocular surface. Affected persons suffer from different subjective complaints, with sometimes severe impairment in the quality of life. The aetiology and pathogenesis are multifactorial, multifaceted, and not yet fully understood. The present study is intended to provide deeper insights into possible triggering factors and correlating comorbidities.Materials and Methods In German ophthalmological practices, 306 persons (174 women, 132 men, age: 18 - 87 years) were interviewed by questionnaire on concomitant diseases and possible further triggering factors. DES was diagnosed by an ophthalmologist in 170 cases. The statistical comparative analysis between persons with and without DES was carried out using the chi-squared test (SPSS statistical software).Results DES occurred with significantly (p < 0.05) increased frequency in women over 40 years of age, as well as in persons exposed to screen work, air conditioning, persons with chronic ocular inflammation, myomas (hysterectomy), dry skin, arterial hypertonicity in need of medication, cardiac arrhythmias, fatty liver, gastric ulcer, appendicitis, cholecystectomy, depression, hyperlipidaemia, hyperuricaemia, osteoporosis, and nephrolithiasis.Conclusion Some of the known comorbidities and DES risk factors, e.g., computer work or depression, were confirmed. In contrast, the higher prevalence of hyperlipidaemia, hyperuricaemia, osteoporosis, nephrolithiasis, and fibroids among DES patients has not previously been reported. Additional studies should be performed on causal connections between DES and specific comorbidities.

The mechanical properties of human brain tissue remain far from being fully understood. One aspect that has gained more attention recently is their regional dependency, as the brain's microstructure varies significantly from one region to another. Understanding the correlation between tissue components and the mechanical behavior is an important step toward better understanding how human brain tissue properties change in space and time and to develop highly spatially resolved constitutive models for large-scale brain simulations. Here, we analyze the correlation between human brain tissue components quantified through enzyme-linked immunosorbent assays (ELISA) and material parameters obtained through an inverse parameter identification scheme based on a hyperelastic Ogden model and multimodal mechanical testing data for eight regions of the brain. We use neural networks as a metamodel to save computational costs. The networks are trained on finite element simulation outputs and are able to replace the simulations in the initial optimization step. We identified strong dependencies between mechanical properties and Iba1 associated with microglia cells, collagen VI, GFAP associated with astrocytes, and collagen IV. These results advance our understanding of microstructure-mechanics relations in human brain tissue and will contribute to the development of highly spatially resolved microstructure-informed constitutive models.

The lacrimal gland is crucial for maintaining ocular health by producing the aqueous component of the tear film, which hydrates and nourishes the ocular surface. Decreased production of this component results in dry eye disease, a condition affecting over 250 million people worldwide. However, the scarcity of primary human material for studying its underlying mechanisms and the absence of a cell model for human lacrimal gland epithelial cells present significant challenges. Here, we describe the generation of immortalized human lacrimal gland cell lines through the introduction of an SV40 antigen. We successfully isolated and characterized three cell clones from a female lacrimal gland donor, confirming their epithelial identity through genomic and protein analyses, including PCR, RNAseq, immunofluorescence and cultivation in a 3D spheroid model. Our findings represent a significant advancement, providing improved accessibility to investigate the molecular pathogenesis mechanisms of dry eye disease and potential therapeutic interventions. We identified the expression of typical epithelial cell marker genes and demonstrated the cells’ capability to form 2D cell sheets and 3D spheroids. This establishment of immortalized human lacrimal gland cells with epithelial characteristics holds promise for future comprehensive studies, contributing to a deeper understanding of dry eye disease and its cellular mechanisms.

Human vocalization is a complex process that is still only partially understood. Previous studies have suggested the possibility of a localized neuromuscular network of the larynx. Here we investigate this structure in human dissection specimens using multiple immunofluorescence and transmission electron microscopy (TEM). In the area of the pars interna of the thyroarytenoid muscle, muscle fibers are present that are clearly differentiated from skeletal or cardiac muscle cells and show an intermediate ultrastructure. In addition, intramuscular neurons are present that are detectable by both electron and fluorescence microscopy and may have a sensory function in a local neuronal network. Also, several types of sensory and motor synapses are detectable and distributed throughout the pars interna of the thyroarytenoid muscle, with multisynaptic muscle fibers being a common feature. These findings suggest the existence of a previously unrecognized type of muscle fiber coupled to an intramuscular neuronal network, the presence of which could explain functional peculiarities at the laryngeal level.

Electrophysiological studies of the larynx expose the mechanisms by which voice production is controlled. Previous studies have revealed certain phenomena during laryngeal oscillations that suggest a complex control mechanism. Starting from the principle of agonist-antagonist muscular pairing, the aim of this study was to gain a deeper insight into the function of the cricothyroid (CT) and thyroarytenoid (TA) muscles, both central to voice production. Electromyographic recordings were used to determine the response of the two muscles to different stimulation situations in an ex vivo animal model of the denervated larynx of pigs (n=26). Using a set of different experiments, it was shown that when one muscle (CT or TA muscle) was electrically stimulated, a response was observed in the other muscle, which in the otherwise-denervated larynx, was caused only by the applied stimulation and exhibited the characteristics of compound action potentials. This response was reproducible in all larynxes examined and was present bidirectionally. No response was registered in the absence of stimulation. The results show the existence of coactivation of the CT and TA muscles in the absence of external innervation hinting at the presence of a localized neuronal network of the larynx that has not been described previously. Further morphological investigation is needed to determine the presence of this internal laryngeal neuronal network.

The lacrimal gland produces the tear film’s aqueous component, which moistens and nourishes the ocular surface to maintain eye health. Reduced production of this component leads to dry eye disease, which affects over 250 million people worldwide. Despite the impact on patients, the availability of primary human material to study underlying disease mechanisms is severely limited and there is no cell model available for human lacrimal gland epithelial cells. After insertion of an SV40 antigen into primary human lacrimal gland epithelial cells, we selected, expanded, and characterized three epithelial cell clones from a female lacrimal gland donor. We show their epithelial character at genomic (PCR and RNAseq) and protein (immunofluorescence) levels and grow these cells in a 3D cell spheroid model. Here, we report the development of an immortalized human lacrimal gland epithelial cell line that improves accessibility to study the molecular pathogenesis mechanisms of dry eye disease and link them to causal treatments. We show the expression of typical lacrimal gland epithelial cell marker genes (e.g. PAX6, FOXC1, AQP5, CSTB, and CST6) and describe the feasibility of the cells to form 2D cell sheets and 3D cell spheroids.We successfully established immortalized human lacrimal gland cells with epithelial character. In the future, the integration of these cells into larger studies holds great potential for advancing our understanding of dry eye disease and its underlying cellular mechanisms.### Competing Interest StatementThe authors have declared no competing interest.

Aim was to compare image-guided navigation with a robot-assisted solution for performing MISS regarding precision, required time and subjective aspects. 90 pedicles were instrumented on two torsos, half with navigation, half robot-assisted. Precision analysis between both solutions didn’t show a significant difference. Time measurement showed a significantly longer duration per wire for the robot-arm on the first torso and a not significant longer duration on the second torso, where a significant reduction in the mean duration was shown. There was no significant difference in the subjective impressions comparing navigation and robot except the possibility to change the procedure. Precision of both methods is suitable for clinical use. A time advantage using the robot-arm couldn’t be demonstrated in the present study. A significant learning curve was shown, so a reduction in the longer duration on the robot can be expected. Further studies in clinical use are necessary.

Hands-on courses utilizing preserved human tissues for educational training offer an important pathway to acquire basic anatomical knowledge. Owing to the reevaluation of formaldehyde limits by the European Commission, a joint approach was chosen by the German-speaking anatomies in Europe (Germany, Austria, Switzerland) to find commonalities among embalming protocols and infrastructure. A survey comprising 537 items was circulated to all anatomies in German-speaking Europe. Clusters were established for "ethanol"-, formaldehyde-based ("FA"), and "other" embalming procedures, depending on the chemicals considered the most relevant for each protocol. The logistical framework, volumes of chemicals, and infrastructure were found to be highly diverse between the groups and protocols. Formaldehyde quantities deployed per annum were three-fold higher in the "FA" (223 L/a) compared to the "ethanol" (71.0 L/a) group, but not for "other" (97.8 L/a), though the volumes injected per body were similar. "FA" was strongly related to table-borne air ventilation and total fixative volumes ≤1000 L. "Ethanol" was strongly related to total fixative volumes >1000 L, ceiling- and floor-borne air ventilation, and explosion-proof facilities. Air ventilation was found to be installed symmetrically in the mortuary and dissection facilities. Certain predictors exist for the interplay between the embalming used in a given infrastructure and technical measures. The here-established cluster analysis may serve as decision supportive tool when considering altering embalming protocols or establishing joint protocols between institutions, following a best practice approach to cater toward best-suited tissue characteristics for educational purposes, while simultaneously addressing future demands on exposure limits.

PURPOSE:To study the tissue architecture, isthmus (connection between two lobes) of the lacrimal gland using preclinical 7T MRI in combination with histology and electron microscopy. METHODS:Ten lacrimal glands from Caucasian body donors (mean age 78.7 years) were studied using 7T-MRI (N = 5; scanned at 75-μm intervals), histology, and electron microscopy (N = 5) and 3D cinematic rendering (CR) techniques. RESULTS:3D CR images showed uniform-sized lobules (widest lobule diameter, 1.68 ± 0.19 mm in orbital lobe, 1.68 ± 0.17 mm in palpebral lobe) in both lobes, separated by septae (size, 0.29 ± 0.09 mm). The internal framework of the gland resembled a honeycoomb pattern. In CR and histology, the isthmus contained glandular acini, large blood vessels, nerves, and no more than two ducts having a tortuous course towards the conjunctival surface. On assigning a color display to the rendered lacrimal gland, all glands showed a blood vessel originating from the main lacrimal artery just 5 mm beyond the hilum and making it course to the palpebral lobe via isthmus. The distance between the conjunctiva and the central substance of the orbital and palpebral lobe was 9.4 ± 0.2 mm and 2.8 ± 0.7 mm, respectively. Electron microscopy of the palpebral lobe revealed compact subepithelial layer in the overlying conjunctiva, followed by loosely scattered collagen bundles that contained the gland lobules. CONCLUSION:3D-CR can be used to study the lacrimal gland microstructure, help fabricate a 3D scaffold for lacrimal gland bioprinting, and serve as guide for transconjunctival lacrimal gland targeted therapies i.e., 2.9 & 9 mm long needle to reach the orbital and palpebral lobe center, respectively in normal-size glands.

This dataset contains experimental data from the mechanical testing of human brain specimens. The data have been filtered (moving average and linear interpolation) and the load/unload curves averaged to approximate the hyperelastic material response for infinitely slow strain rates. Every specimen folder contains data for the three loading modes tested: cyclic compression/tension up to 15% strain as well as cyclic torsional shear experiments up to an amount of shear of 0.15 (l1) and 0.3 (l2), respectively. Furthermore, there are separate files for the first cycle (c1) and the third cycle (c3). The files for the compression/tension mode columns contain displacement [m] and normal force [N] while the torsional shear mode columns contain angular displacement [rad] and torque [Nm]. The data are also split into negative (_neg) and positive (_pos) parts for the torsional shear. The specimens are named HBE__ and their brain region can be looked up in the sample_lookup.xlsx file. The specimens were cylindrical with a diameter of ~8mm. Their height was determined from the test data and is stored in the geometry.yaml file (measurements given in m) located in each specimen's directory. Further explanation regarding the specimen preparation, experimental setup as well as the assignment of regions and governing regions can be found in Hinrichsen, J., Reiter, N., Bräuer, L. et al. Inverse identification of region-specific hyperelastic material parameters for human brain tissue. Biomech Model Mechanobiol (2023). https://doi.org/10.1007/s10237-023-01739-w.

The identification of material parameters accurately describing the region-dependent mechanical behavior of human brain tissue is crucial for computational models used to assist, e.g., the development of safety equipment like helmets or the planning and execution of brain surgery. While the division of the human brain into different anatomical regions is well established, knowledge about regions with distinct mechanical properties remains limited. Here, we establish an inverse parameter identification scheme using a hyperelastic Ogden model and experimental data from multi-modal testing of tissue from 19 anatomical human brain regions to identify mechanically distinct regions and provide the corresponding material parameters. We assign the 19 anatomical regions to nine governing regions based on similar parameters and microstructures. Statistical analyses confirm differences between the regions and indicate that at least the corpus callosum and the corona radiata should be assigned different material parameters in computational models of the human brain. We provide a total of four parameter sets based on the two initial Poisson's ratios of 0.45 and 0.49 as well as the pre- and unconditioned experimental responses, respectively. Our results highlight the close interrelation between the Poisson's ratio and the remaining model parameters. The identified parameters will contribute to more precise computational models enabling spatially resolved predictions of the stress and strain states in human brains under complex mechanical loading conditions.

Purpose: To date, there are many theories about tear transport through the canaliculi of the draining lacrimal system into the lacrimal sac but only few with supportive data. It is certain that the function of the lacrimal part of orbicularis oculi muscle (Horner-Duverney's muscle) is indispensable for the transport of "used" tears. However, the muscle's exact structure and the mechanisms of its functions are as yet unclear. To obtain deeper insights we undertook the present study. Methods: Upper and lower canaliculi (including the entrance into the lacrimal sac) from donor cadavers were dissected. Some of the specimens were prepared for scanning electron microscopy (SEM) to analyze the course of muscle fibers surrounding the canaliculi. Others were sectioned for enzyme(EHC) and immunohistochemistry (IHC) to learn about the distribution of slow and fast reacting muscle fibers in Horner-Duverney's muscle as well as to analyze the distribution of different neurotransmitters to learn more about the innervation of Horner-Duverney's muscle. Four tear duct systems taken from body donors were cut out en bloc after formalin fixation, serially sectioned and reconstructed using a newly developed technology for 3D reconstruction of histological serial sections named HiD (R) (Chimaera GmbH, Germany). Patients that had undergone dacryocystorhinostomy (DCR) were video-analyzed endonasally during active blinking, focusing on viewing the temporal wall of the lacrimal sac movement where the canaliculi penetrated the lacrimal sac. Results: SEM revealed that muscle fibers of Horner-Duverney's muscle surround the vertical parts of the upper and lower canaliculus in a scissor like pattern whereas they ran in parallel to the first two thirds of the horizontal parts surrounding the respective canaliculus. Here, the muscle fibers were embedded in dense connective tissue forming a unique network. At the nasal third, muscle fibers left the canaliculi and ran to the posterior part of the fascia of the lacrimal sac and the lacrimal bone. EHC revealed that Horner-Duverney's muscle contained nearly an equal distribution of type I and type IIb muscle fibers compared to the superior rectus muscle which contains more type I and the masseter and iliopsoas muscles with more type IIb muscle fibers. IHC indicated presence of trigeminal, catecholaminergic and cholinergic nerve endings. 3D reconstructions supported the SEM data. Endonasal video analysis of patients after DCR with a nasally open lacrimal sac revealed bulging of the temporal wall of the lacrimal sac during blinking. On the basis of these findings, a modified lacrimal pump theory is proposed. Conclusion: The results support the hypothesis that contraction of Horner-Duverney's muscle leads to closure of the canaliculi in their first two thirds based on the special arrangement of muscle fibers and connective tissue fibers. This causes the tear fluid in the canaliculi to be pressed/transported towards the lacrimal sac. The medial third of the vertical portions of the canaliculi, the canaliculus communis and the intrasaccal portion of the canaliculus are compressed by the shortening and thickening of the Horner-Duverney muscle from dorsal, which leads to a compression of the canaliculi lumens in this part of the system, thereby pushing the lacrimal fluid further towards the lacrimal sac. The mix of fast contracting and fatigue resistant muscle fibers is ideally suited for the blink mechanism that is complexly regulated by the nervous system.

OBJECTIVES:The purpose of this study was to evaluate the minimum diagnostic radiation dose level for the detection of high-resolution (HR) lung structures, pulmonary nodules (PNs), and infectious diseases (IDs).MATERIALS AND METHODS:A preclinical chest computed tomography (CT) trial was performed with a human cadaver without known lung disease with incremental radiation dose using tin filter-based spectral shaping protocols. A subset of protocols for full diagnostic evaluation of HR, PN, and ID structures was translated to clinical routine. Also, a minimum diagnostic radiation dose protocol was defined (MIN). These protocols were prospectively applied over 5 months in the clinical routine under consideration of the individual clinical indication. We compared radiation dose parameters, objective and subjective image quality (IQ).RESULTS:The HR protocol was performed in 38 patients (43%), PN in 21 patients (24%), ID in 20 patients (23%), and MIN in 9 patients (10%). Radiation dose differed significantly among HR, PN, and ID (5.4, 1.2, and 0.6 mGy, respectively; P < 0.001). Differences between ID and MIN (0.2 mGy) were not significant (P = 0.262). Dose-normalized contrast-to-noise ratio was comparable among all groups (P = 0.087). Overall IQ was perfect for the HR protocol (median, 5.0) and decreased for PN (4.5), ID-CT (4.3), and MIN-CT (2.5). The delineation of disease-specific findings was high in all dedicated protocols (HR, 5.0; PN, 5.0; ID, 4.5). The MIN protocol had borderline IQ for PN and ID lesions but was insufficient for HR structures. The dose reductions were 78% (PN), 89% (ID), and 97% (MIN) compared with the HR protocols.CONCLUSIONS:Personalized chest CT tailored to the clinical indications leads to substantial dose reduction without reducing interpretability. More than 50% of patients can benefit from such individual adaptation in a clinical routine setting. Personalized radiation dose adjustments with validated diagnostic IQ are especially preferable for evaluating ID and PN lesions.