Carlos Torres-Villar

Pediatric obesity is increasingly recognized as a biologically heterogeneous metabolic condition associated with early alterations in cardiometabolic health. Traditional clinical markers provide limited resolution for characterizing this heterogeneity, underscoring the need for more integrative approaches. Metabolomics has emerged as a powerful tool for identifying molecular phenotypes that reflect the interplay between excess adiposity, environmental and lifestyle exposures, and cardiometabolic dysfunction. This narrative review synthesizes current evidence on pediatric obesity and cardiometabolic health, with particular emphasis on metabolomic signatures, potential biological mechanisms, and early-life and lifestyle determinants. Studies using nuclear magnetic resonance spectroscopy and mass spectrometry have identified coordinated alterations in lipoprotein subclasses, triglyceride-rich particles, fatty acids and complex lipids, branched-chain and aromatic amino acids, acylcarnitines, and pathways involved in energy metabolism. These metabolic profiles are associated with insulin resistance and other adverse cardiometabolic traits. Proposed links with adipose tissue dysfunction, inflammation, mitochondrial substrate utilization, and hepatic lipid dysregulation draw partly on adult and experimental mechanistic evidence. Early-life and lifestyle exposures, including maternal health, infant feeding, dietary patterns, physical activity, sleep, and environmental factors, may further shape these metabolic phenotypes. Integrating metabolomic information with clinical and environmental data may improve the characterization of metabolic heterogeneity and help identify biological pathways associated with early cardiometabolic dysfunction. However, classification of current metabolic phenotypes does not establish prediction of future disease. Independent prospective validation, methodological harmonization, and demonstration of incremental clinical utility remain necessary before metabolomic profiling can be incorporated into routine pediatric risk assessment.

Body donation remains fundamental to anatomical education, supporting not only technical training but also the development of ethical awareness, empathy, and humanistic values among health professionals. In recent decades, the anatomical community has moved toward shared ethical standards centered on voluntary informed consent, transparency, and explicit recognition of donors. International consensus statements have promoted standardized acknowledgment practices, responsible stewardship of human remains, and the ethical use of body donor images. Across regions, sociocultural, religious, legal, and institutional factors continue to shape public perceptions and the development of body donation programs. In South America, meaningful progress has been achieved through legislative reforms and institutional initiatives; however, persistent challenges remain in regulatory harmonization, infrastructure, and public awareness. Experiences from other regions demonstrate that structured educational outreach, commemorative practices, and multidisciplinary oversight mechanisms can strengthen public trust and normalize donation as a socially valued act. These approaches highlight the importance of cultural sensitivity, ethical education, and institutional transparency in fostering sustainable body donation systems. This article synthesizes international and regional perspectives to propose strategies for strengthening ethical and operational standards in body donation in South America. Key measures include the establishment of formal ethics oversight committees, standardized consent procedures, transparent management of legacy materials, and systematic donor recognition. Ultimately, advancing ethical body donation requires sustained commitment to respect, gratitude, and public trust as the moral foundation of anatomical education.

Background/Objectives: Plastination with polyester resin is a consolidated technique for anatomical preservation, particularly valuable in neuroanatomy education and radiological correlation. This review synthesizes the principles, technical evolution, methodological variations, applications, and limitations of polyester-based sheet plastination methods (P35, P40, P45). Methods: Key documents were analyzed to trace the transition from P35, recognized for excellent gray-white matter contrast but technical complexity, to P40, offering greater transparency, lower viscosity, improved strength, and simplified UV-curing. P45 was also reviewed, especially for large body sections using water-bath curing. Innovations included vertical curing chambers, active-passive vacuum cycles, resin reformulations, and strategies to reduce tissue shrinkage. Methodological quality was assessed with the AQUA tool, which evaluates five domains: Objectives, Study Design, Methodology, Descriptive Anatomy, and Results Reporting. Results: Plastination proved applicable in medical and veterinary education, as well as morphometric and imaging-based research, improving anatomical understanding and CT/MRI correlation. AQUA analysis revealed low risk of bias in Objectives and Descriptive Anatomy, but frequent unclear or high-risk assessments in Study Design, Methodology, and Results Reporting, mainly due to limited details on sample selection, resin handling, curing, and reproducibility. Publications after 2010 showed improved methodological rigor, reflecting growing standardization and better reporting. Conclusions: Polyester sheet plastination remains a versatile, high-impact tool, though it requires specialized infrastructure, trained personnel, and strict environmental control. Future development should focus on protocol standardization, international dissemination, integration with digital technologies (3D models, virtual reality), and sustainable alternatives. Progress depends on inter-institutional collaboration, technical training, and open access to updated resources.

Myofascial pain (MFP) is one of the most frequent temporomandibular disorders (TMDs), primarily affecting the masseter and temporalis muscles. Various treatment strategies have been developed, including trigger point injections (TrP) and nerve blocks. Among these, the twin block technique has recently emerged as a promising, minimally invasive approach for simultaneously anesthetizing the masseteric and anterior deep temporal nerves through a single extraoral injection. This review presents the anatomical considerations essential for the application of the twin block technique. The course, branching patterns, and relationships of the masseteric and deep temporal nerves with adjacent vascular structures are described based on the current anatomical literature. A comparison is also made of isolated nerve blocks and the twin block, highlighting procedural protocols, clinical advantages, and safety profiles. The anatomical proximity between the masseteric and deep temporal nerves supports the rationale for a single-puncture approach, which can effectively reduce muscle tone, inhibit nociceptive input, and silence multiple trigger points simultaneously. In addition to its therapeutic benefits, the twin block can serve as a diagnostic tool to differentiate muscular from joint or odontogenic pain. In conclusion, the twin block technique offers a precise and efficient method for managing masticatory myofascial pain, provided that detailed anatomical knowledge is applied to ensure procedural accuracy, a low incidence of adverse effects, and patient safety.

Background/Objectives: The bifid mandibular condyle (BMC) is a rare anatomical variation characterized by a division of the mandibular condyle into two distinct heads. Although frequently identified through radiographic studies or in dry skulls, its etiology remains unclear, and few studies have examined its internal bone structure. This study aimed to perform a detailed morphologic and microarchitectural analysis of a right unilateral bifid mandibular condyle using micro-CT and to contrast the findings with the relevant morphological and clinical literature. Case Presentation: A human mandible from an anatomical collection was analyzed. The mandible was scanned using a Bruker 1273 micro-CT system, and a 3D reconstruction was performed. Morphometric analysis was carried out on both the bifid right and normal left condyles, evaluating cortical and trabecular components separately. Parameters included bone volume, absolute bone volume, bone surface, trabecular thickness, separation, and number. The right condyle was divided into medial and lateral heads with independent necks, displaying asymmetry in size and shape. Micro-CT revealed reduced cortical volume and greater trabecular separation in the BMC, suggesting lower bone density compared to the left condyle. Conclusions: This case reveals significant differences in bone architecture between the BMC and the contralateral condyle, indicating a potentially reduced biomechanical capacity on the affected side. These findings emphasize the importance of incorporating microstructural evaluation in anatomical and clinical assessments of BMCs and provide novel insights that may inform diagnosis, treatment planning, and understanding of temporomandibular joint disorders.

El lenguaje científico, en el ámbito de la anatomía y ciencias de la salud, se sustenta en una terminología que ha estado abierta a discusiones y modificaciones. En Terminologia Anatomica, el término ‘Lengua’ proviene del latín Lingua. Sin embargo, también existen términos que derivan del lexema griego glossa y glotta, que también significa lengua. Lo que establece hiperonimia y sinonimia entre estructuras anatómicas relacionadas con este órgano músculo-sensorial. El objetivo fue analizar la presencia de los lexemas ‘glossa’ - ‘glotta’ en Terminologia Anatomica y revisar las definiciones de términos que incluyan estos lexemas utilizando el Diccionario Manual Griego-Español VOX y Vocabulario Básico de Griego con anotaciones morfológicas y etimológicas. Para la etimología en español se utilizaron el Diccionario panhispánico de términos médicos y Diccionario médico-biológico, histórico y etimológico. También se determinó la primera vez que se ocuparon en español, utilizando Corpus Diacrónico del Español. Los lexemas estudiados aparecen citados 15 veces en Terminologia Anatomica. Estos se definen como ‘lengua, boca; habla, don de la palabra; expresión, manifestación, palabras; habla, lengua, lenguaje, idioma’. También se encuentran algunos términos derivados como Ductus thyroglossalis, epiglottis, glottis, ligamentum thyroepiglotticum y Vallecula epiglottica. Por lo que estos lexemas se consideran sinónimos. El lexema glossa se utilizó por primera vez en el ámbito médico el año 1870. Los lexemas glossa y glotta son frecuentes en Terminologia Anatomica, generando preguntas sobre el uso del doble sigma en griego jónico y doble tau en griego ático clásico. Aunque son sinónimos, su abundancia destaca la importancia del dominio del lenguaje anatómico para la comunicación efectiva y la comprensión precisa entre estudiantes, profesionales e investigadores.

The updating of anatomical terms is essential to facilitate teaching and learning as well as international communication through publications and presentations at scientific events. In the posterior wall of the axilla, the teres major, teres minor and triceps brachii muscles form three spaces through which neurovascular structures of clinical significance run. The current study seeks to define and propose terms for these spaces which have been omitted by Terminologia Anatomica. The definition of the Latin term 'Spatium' was investigated using A Latin Dicionary, while the term 'Espacio' was analyzed using Diccionario panhispánico de términos médicos (Real Academia Nacional de Medicina de España, 2023), as well as the lexemes of the words 'scapula' and 'humerus', for which the Diccionario Médico-Biológico, Histórico y Etimológico de la Universidad de Salamanca was consulted. The presence of the term 'Spatium' in the Terminologia Anatomica was also investigated. Finally, 10 anatomy textbooks in Spanish were reviewed to identify the terms used for these spaces. In reviewing the latest edition of Terminologia Anatomica, it was found that the term 'Spatium' appears 25 times in different chapters and it was evident that no terms for scapulohumeral spaces appear in the chapters on upper limb structures. Moreover, in 100 % of the anatomy textbooks reviewed, at least one term is used to describe the scapulohumeral spaces. We believe that the proposed terms: 'Spatium humerotricipitale', 'Spatium scapulotricipitale' and 'Spatium teretricipitale' more accurately describe both the location and their association with the bone/muscle structures that form them. We therefore suggest that these terms be revised for inclusion in future editions of Terminologia Anatomica.

Correct detailed description of the anatomy of the digastric muscle (DM) in different populations should be carried out to improve the teaching of anatomy, avoid misinterpretations and help to avoid intercurrences during surgical procedures in the region. The aim of this study was to carry out a study of the DM in adult Brazilian individuals. The sample consisted of 50 DM from adult individuals (22 right side and 28 left side) fixed in 10 % formaldehyde. The morphology of the DM was observed, identifying possible anatomical variations; these were characterized and classified according to the number of the muscle bellies, direction of the fibre, and points of origin and insertion. The morphometric measurements were performed using a digital calliper. Student’s t-test for dependent samples was used to measure differences between sides; one-way ANOVA was used to analyse the different classifications, and the chi-squared test to analyse qualitative variables, with significance threshold of 5 %. The anterior belly of the DM was classified as Type I in 28 samples (56 %), Type II in 20 (40 %) and Type III in 2 (4 %). The mean length was 37.8 mm, width 12.1 mm and thickness 5.39 mm, with no statistically significant differences found for these variables. The intermediate tendon of the DM was classified as Type I in 31 samples (62 %), Type II in 10 (20 %) and Type III in 9 (18 %); its mean total length was 45.1 mm. The posterior belly of the DM was Type I in 50 samples (100 %), with mean length 70.8 mm and width 8.15 mm. Anatomical variations of the DM, particularly its anterior belly, in Brazilian adults are very frequent. They must therefore be carefully identified to help avoid intercurrences during surgical procedures in the region, and to help correct evaluation of swollen lymph nodes in the submental triangle.

The anastomosis between the posterior superior alveolar artery (PSAA) and the infraorbital artery (IOA) courses along half of the lateral wall of the maxillary sinus. Risk of injury to the anastomosis between PSAA and IOA during surgical procedures has been reported. The aim of the present study was to carry out a systematic review and meta-analysis to determine the frequency, location, and diameter of the anastomosis between PSAA and IOA in imaging studies (cone-beam computed tomography, spiral cone-beam computed tomography, and computed tomography). A search was carried out in the PubMed, EMBASE, and LILACS. Original works were included reporting imaging studies to analyze the frequency, location, and diameter of the anastomosis in humans. The risks of bias were analyzed using the AQUA tool. Generalized linear mixed models were used to estimate the frequency and the 95% CI in the meta-analysis. The variance in prevalence estimates was stabilized by logit transformation. The qualitative analysis included 49 studies with 10,837 patients. The frequency of the anastomosis between PSAA and IOA was 74% (prediction interval 0.20–0.97%). The anastomosis was most frequently located in the intraosseous region (60.0%), followed by the submembranous region (33.0%), and least frequently in an extraosseous location (5.0%). Arteries with diameter of 1.0–1.9 mm were most frequent (32.0%), followed by arteries with diameter less than 1 mm (23.0%); a small number with diameter greater than 2 mm was recorded (4.0%). These data can be used as a reference to help surgeons when planning interventions in the lateral wall of the maxillary sinus. Registration number: INPLASY, number 202120071.