Anatomical Points Research Articles

Design and use of assistant robotic arm in endoscopic transnasal surgery

OBJECTIVE This study aimed to develop a robotic system with autonomous functionality for holding and manipulating the endoscope in endoscopic endonasal surgery. A cost-effective prototype was created with the goal of using robotic assistance and achieving a more efficient learning curve for endoscopic surgery. METHODS A Stewart platform–based endoscope holder and positioner robotic system, developed by the Mechatronics Engineering Department of Kocaeli University, was used in conjunction with 3D Slicer and Plus Toolkit open-source health technology software. Following initial configuration on a 3D skull model, the system was applied to a fresh-frozen cadaver. RESULTS The robotic system and its registration process proved feasible, allowing the robot to autonomously reach predetermined anatomical points during the nasal step of the surgery. Compared with a previous study by the same authors, the surgery duration was successfully shortened. The experiment yielded positive outcomes in both the artificial skull model and the cadaver. The robotic system effectively performed the nasal stage of the surgery. The integration of a robotic surgical arm in the endoscopic endonasal approach holds the potential to enhance the learning curve through shared experiences. The robot offers assistance to surgeons during the learning phase of the endoscopic endonasal approach, aiding in the identification of anatomical landmarks through preoperative planning. CONCLUSIONS This system may present advantages such as improved visualization, enhanced maneuverability, and reduced user fatigue compared with conventional methods. These findings show the potential of robotic assistance in endoscopic surgical techniques.

Arthroscopically assisted accurate location of the bone tunnel entrance for lateral ankle ligament reconstruction may be a better choice for patients with chronic ankle instability: a retrospective study

BackgroundThe anatomical location for lateral ligament reconstruction remains a significant challenge. With the development of arthroscopic technology, arthroscopic-assisted lateral ligament reconstruction can significantly facilitate the correct localization of anatomical points. However, there is limited evidence on the clinical efficacy of arthroscopic ligament reconstruction compared with percutaneous ligament reconstruction.MethodsThis study included 72 patients who underwent lateral ligament reconstruction for chronic lateral ankle instability from 2018 to 2022. The follow-up duration in the percutaneous(n = 35) and the arthroscopic(n = 37) groups was 6–30 months. The patients were evaluated before the operation, at 6 months after surgery, and at the final follow-up. The American Orthopaedic Foot and Ankle Society score (AOFAS), Karlsson-Peterson score, and Visual Analog Scale (VAS) were evaluated at each time point. The complications and the time required to return to sports were documented during the follow-up.ResultsAll clinical evaluations significantly improved after surgery in both groups. There was no significant difference between the two groups in the AOFAS score, VAS score, and complications. The Karlsson-Peterson score (85.4 vs 83.6, p = 0.044), surgical duration (50.4 min vs 60.2 min, p < 0.001), and time to return to sports (17.8 weeks vs 20.5 weeks, p = 0.033) were all improved in the arthroscopic group.ConclusionSatisfactory clinical outcomes can be achieved through both arthroscopic and percutaneous anatomic ligament reconstruction. The ligament remnant and anatomical localization point can be observed directly by using an arthroscope. Arthroscopic ligament reconstruction can be a more viable alternative for patients with chronic ankle instability due to its minimal disturbance to the stump of the ligament and reduced operative aggression.

Deep learning-based automated measurement of hip key angles and auxiliary diagnosis of developmental dysplasia of the hip

ObjectivesAnteroposterior pelvic radiographs remains the most widely employed method for diagnosing developmental dysplasia of the hip. This study aims to evaluate the accuracy of an artificial intelligence model in measuring angles in pelvic radiographs of the hip. The assessment seeks to demonstrate the efficacy of the artificial intelligence model in diagnosing both developmental dysplasia of the hip and borderline developmental dysplasia of the hip through the analysis of pelvic radiographs.MethodsA total of 1,029 patients, including 273 men and 757 women, were retrospectively included in this study. The anteroposterior pelvic radiographs were randomly divided into three sets: the training set (720 cases), the validation set (103 cases), and the test set (206 cases). Key anatomical points on the anteroposterior pelvic radiographs were identified. The Sharp, Tönnis, and Center Edge angles were calculated automatically based on the corresponding criteria. The hip development status was compared between measurements obtained from the artificial intelligence model and those defined manually by two radiologists. The area under the receiver operating characteristic curve was utilized to assess the diagnostic performance of the artificial intelligence model.ResultsThe results obtained from both manual measurements and the artificial intelligence model demonstrated no significant differences in the Sharp, Tönnis, and Center edge angles (all p > 0.05). The intra-class correlation coefficients and correlation coefficient r values exceeded 0.75, indicating that both the artificial intelligence model and manual measurements exhibited good repeatability and a positive correlation. Notably, the artificial intelligence model provided measurements more faster than those conducted by radiologists (p = 0.001). The artificial intelligence model also demonstrated high diagnostic accuracy, sensitivity, and specificity for developmental dysplasia of the hip. The performance of the artificial intelligence model in diagnosing developmental dysplasia of the hip was robust. Additionally, the results from the artificial intelligence model and manual measurements were largely consistent with clinical diagnosis results (p = 0.01). The artificial intelligence model can effectively evaluate hip conditions by measuring the Sharp, Tönnis, and Center edge angles, which are consistent closely with clinical diagnosis results.ConclusionsThe results of the artificial intelligence model measurements demonstrate a high degree of consistency with those obtained through manual measurements. The angles of Sharp, Tönnis, and Center edge, as evaluated by the deep learning-based convolutional neural network model, exhibit robust diagnostic performance in identifying both developmental dysplasia of the hip and borderline developmental dysplasia of the hip. Consequently, the artificial intelligence model has the potential to fully replace manual measurements of these critical hip angles, providing a more efficient and precise alternative for diagnosing both conditions of the hip.

Advances in upper urinary tract anatomy through imaging techniques

This scoping review was conducted based on the Joanna Briggs Institute's theoretical framework and registered with the Open Science Framework (https://osf.io/b27wc). The study analyzed 29 manuscripts published between 2013 and 2023, focusing on imaging exams to synthesize evidence on the anatomy and clinical correlations of the upper urinary tract. The results revealed significant findings, highlighting the intrarenal pelvis as a possible predictive indicator of urinary loss after partial nephrectomy. This emphasizes the importance of anatomical assessment of the renal pelvis. Brödel's avascular plane has been categorized into three types relevant to pre-surgical patient planning. Multiple renal arteries and venous variations have also been reported, including retro-aortic and circum-aortic renal veins. A movable section related to the ureter was described in the perirenal space, delimited by the point of intersection with the gonadal vessels. The ureteropelvic and ureterovesical junctions were found to be anatomical points susceptible to ureteral constriction. On the other hand, the point at which the ureter crosses the iliac vessels is no longer considered a site prone to ureteral obstruction. The authors emphasize the need to adopt a standardized terminology to describe the anatomical variations of the blood vessels related to the kidney. Using diverse and unclear terms can hinder teaching and research in this area and lead to inaccuracies. From the authors' perspective, imaging exams have enhanced anatomical accuracy, benefiting the teaching of human anatomy and significantly contributing to continuous medical breakthroughs.

Novel laser model of optic nerve transection provides valuable insights about the dynamics of optic nerve regeneration.

Optic nerve (ON) injury causes blindness in adult mammals as their retinal ganglion cells (RGCs) cannot regenerate axons. However, amphibian RGC axons do not experience the same regenerative failure. Studying the regeneration process of the ON in amphibians holds profound implications for regenerative medicine and human health. Using transgenic tadpoles and laser micro-optics, we developed a reproducible ON transection and regeneration model. Through microscopy, functional testing, TUNEL, EdU assays, and RNA-seq, we characterized the ON injury response and recovery. Our model suggests no chemoattractant gradient exists early in regeneration, with defasciculated axons sprouting in random directions from the globe-proximal cut end. Once individual axons reach the appropriate anatomical insertion point in the brain, their tract is reinforced by other regenerating axons, restoring normal ON morphology. Thus, guidance cues or scaffolding from brain-innervating axons likely support later stages of regeneration. After 14 days, the regenerated ON is morphologically indistinguishable from the naïve ON, and visual function is restored. We found no evidence of RGC death or new RGC formation in the model, suggesting that only pre-existing RGCs are involved in ON regeneration.

Associated Reconstruction Technique for the Posterolateral Corner and the Anterior Cruciate Ligament with Double Femoral Tunnel

Objectives The constant study evolution of the structures and biomechanical functioning of the posterolateral complex (PLC) of the knee show that this structure plays an extremely important role in joint stability, especially when associated with injury to the anterior cruciate ligament (ACL). Failure to detect the PLC lesion causes posterolateral rotational instability in the knee, generating an overload on the reconstructed ACL, increasing its potential for failure. Surgical treatment is the gold standard for patients with combined injuries of the PLC and ACL. However, despite the numerous reconstruction techniques described, the best technique is still controversial. This study presents a less invasive technique with fewer bone tunnels, lower cost and less surgical complexity, using four bone tunnels with a single tunnel for the ACL and lateral collateral ligament (LCL) in the lateral femoral condyle and only 04 interference screws for the anatomical reconstruction of the ACL / PLC and restoration of stability of the injured knee. Surgical technique Patient in supine position. A graft is prepared with 2 semitendinosus tendons (1 from each knee) and 1 gracilis tendon (from the knee with ligament injury). The tendons must be at least 24 cm long. The graft is prepared in quadruple for the ACL (gracilis tendon duplicated and 2 simple semitendinosus tendons) and double for the PLC (continuation of the 2 simple semitendinosus tendons). An incision is made on the lateral aspect of the knee over the lateral epicondyle, towards the head of the fibula, approximately 12cm long. The femoral insertion site of the lateral collateral ligament (LCL) is identified slightly proximal and posterior to the femoral epicondyle. The unique femoral tunnel for the ACL and LCL is performed using the outside-in technique. The guidewire must be inserted in the origin of the LCL anatomical point at the external lateral cortex towards the origin of the ACL anatomical on the medial wall of the lateral fêmur condyle. The fibular head tunnel is performed, positioned from anterolateral to posteromedial, approximately 0.5 cm below the tip of the fibular head. The fourth and last tunnel is performed l at the popliteal tendon femoral insertion. It should be directed anteriorly and proximally to avoid confluence with the ACL tunnel. The graft is passed through the tibial tunnel towards the femoral tunnel. Both semitendinosus legs exit the LCL insertion at the lateral aspect of the femur. Graft fixation at the femoral tunnel lateral cortex is performed with an interference screw. The graft is tensioned at its tibial exit with knee flexed at 20° and fixed with an interference screw, reconstructing the ACL. For PLC reconstruction, the two semitendinosus legs are passed under the iliotibial tract through the fibular head tunnel from anterolateral to posteromedial. The graft is tensioned with knee at 30° of flexion and valgus and fixed with an interference screw at the fibular tunnel, reconstructing the LCL. The remaining portion of the graft is passed below the iliotibial tract and LCL, being inserted into the femoral tunnel corresponding to the insertion of the popliteal tendon. The graft is then tensioned with knee flexed at 60° and valgus and fixed with an interference screw. Conclusion We believe that the described technique for ACL reconstruction associated with PLC injury is able to restore knee stability through a minimally invasive, reproducible and less technically challenging approach, with a lower learning curve than those currently available.

Mapping 18F-FDG PET uptake in the aortic wall and thrombus

Abstract Background Positron Emission Tomography (PET) uptake allows for the assessment of molecular activity, being 18F-FDG uptake indicative of glucose metabolism. PET uptake is commonly quantified manually by drawing regions of interest, which is subjective, poorly-reproducible and may miss relevant information. Purpose To develop and test an image analysis method to quantify and map 18F-FDG uptake on the whole aortic wall and thrombus. Methods PET-MRI was acquired in patients with thoracic or abdominal aortic aneurysms. The aorta was semi-automatically segmented in the MR angiography using 3DSlicer, generating a surface mesh that was expanded by 3 mm inward and outward. PET uptake was interpolated over this volume with a uniform spatial resolution of 1 mm. By means of 9 reference points, the aortic wall was discretized into 52 (thoracic) or 80 (thoraco-abdominal) standardized regions (i.e. wall patches). For each aortic patch and for the whole thrombus volume, the target to background Ratio (TBR) was calculated by dividing the uptake by a reference uptake in the left atrium. Two observers segmented the aorta and thrombus, located the anatomical reference points and quantified TBR. Inter-observer agreement for segmentation and aortic wall discretization was evaluated in terms of the 95% Hausdorff Distance (HD) and Dice Score Coefficient (DSC), while both median and 95% TBR in each region were tested via intra-class correlation coefficient (absolute value, single measure). Results Data from 20 patients with thoracic or abdominal aneurysms were analysed, 10 of them presented thrombus. The reproducibility of the segmentation of the aorta (median HD 3.16 IQR [2.42 - 3.94] mm, DSC 0.90 [0.89 - 0.92]) and of the thrombus (HD 4.87 [3.51 - 8.45] mm, DSC 0.85 [0.80 - 0.87]) were excellent. The inter-observer agreement in the localization of reference points was good (HD 5.10 [3.29 - 8.73] mm), resulting in excellent overlapping of the standardized aortic wall patches (HD 3.80 [2.44 - 5.08] mm). Inter-observer agreement of median and 95% TBR in each aortic patch were excellent (ICC of 0.90 and 0.93, respectively, Figure 1), with minimal bias (Figure 2). Similarly, excellent interobserver reproducibility was observed for median and 95% TBR in the thrombus (ICC of 0.97 and 0.96, respectively, Figure 2). Conclusions A robust and reproducible image analysis method to map PET uptake along the aortic wall was developed, extending the possibilities to study aortic diseases molecular activity and its association with local aortic characteristics.

Unravelling Different Water Management Strategies in Three Olive Cultivars: The Role of Osmoprotectants, Proteins, and Wood Properties

Understanding the responses of olive trees to drought stress is crucial for improving cultivation and developing drought-tolerant varieties. Water transport and storage within the plant is a key factor in drought-tolerance strategies. Water management can be based on a variety of factors such as stomatal control, osmoprotectant molecules, proteins and wood properties. The aim of the study was to evaluate the water management strategy under drought stress from an anatomical and biochemical point of view in three young Italian olive cultivars (Giarraffa, Leccino and Maurino) previously distinguished for their physiological and metabolomic responses. For each cultivar, 15 individuals in pots were exposed or not to 28 days of water withholding. Every 7 days, the content of sugars (including mannitol), proline, aquaporins, osmotins, and dehydrins, in leaves and stems, as well as the chemical and anatomical characteristics of the wood of the three cultivars, were analyzed. ‘Giarraffa’ reduced glucose levels and increased mannitol production, while ‘Leccino’ accumulated more proline. Both ‘Leccino’ and ‘Maurino’ increased sucrose and aquaporin levels, possibly due to their ability to remove embolisms. ‘Maurino’ and ‘Leccino’ accumulated more dehydrins and osmotins. While neither genotype nor stress affected wood chemistry, ‘Maurino’ had a higher vessel-to-xylem area ratio and a larger hydraulic diameter, which allows it to maintain a high transpiration rate but may make it more susceptible to cavitation. The results emphasized the need for an integrated approach, highlighting the importance of the relative timing and sequence of each parameter analyzed, allowing, overall, to define a “strategy” rather than a “response” to drought of each cultivar.

Autonomous nervous system responses to environmental-level exposure to 5G's first deployed band (3.5GHz) in healthy human volunteers.

Following the global progressive deployment of 5G networks, considerable attention has focused on assessing their potential impact on human health. This study aims to investigate autonomous nervous system changes by exploring skin temperature and electrodermal activity (EDA) among 44 healthy young individuals of both sexes during and after exposure to 3.5GHz antenna-emitted signals, with an electrical field intensity ranging from 1 to 2V/m. The study employed a randomized, cross-over design with triple-blinding, encompassing both 'real' and 'sham' exposure sessions, separated by a maximum interval of 1week. Each session comprised baseline, exposure and postexposure phases, resulting in the acquisition of seven runs. Each run initiated with a 150s segment of EDA recordings stimulated by 10 repeated beeps. Subsequently, the collected data underwent continuous decomposition analysis, generating specific indicators assessed alongside standard metrics such as trough-to-peak measurements, global skin conductance and maximum positive peak deflection. Additionally, non-invasive, real-time skin temperature measurements were conducted to evaluate specific anatomical points (hand, head and neck). The study suggests that exposure to 3.5GHz signals may potentially affect head and neck temperature, indicating a slight increase in this parameter. Furthermore, there was a minimal modulation of certain electrodermal metrics after the exposure, suggesting a potentially faster physiological response to auditory stimulation. However, while the results are significant, they remain within the normal physiological range and could be a consequence of an uncontrolled variable. Given the preliminary nature of this pilot study, further research is needed to confirm the effects of 5G exposure.

Novel Method of Measuring Pelvic Floor Muscle Motion May Improve Accessibility of Pelvic Floor Muscle Coordination Training.

Pelvic floor muscle ultrasound is an important clinical tool for improving motor coordination and even strength. Although the gold standard approach involves transperineal probe placement, this is not always feasible with sensitive populations, requires privacy owing to probe placement, and additional sonography training. This article introduces a novel transabdominal method for measuring pelvic floor muscle motion that incorporates a reference point within the bladder. The hypothesis is that the novel measurement will correlate positively with transperineal measurements. A total of 55 women (15 nulliparous, 40 parous; 20 continent, 35 incontinent) performed pelvic floor muscle contraction and strain. Transabdominal ultrasound measured bladder diagonal length (BDL) and transperineal ultrasound measured bladder neck height (BNH), levator plate length (LPL), and levator plate angle (LPA). Spearman's test measured the correlation between the measurement outcomes and an independent t test compared outcomes based on parity and stress urinary incontinence symptom status. Spearman's correlation showed moderate positive correlations between the pelvic floor measurements for both tasks, which reduced slightly when grouping by parity and symptom status. Group differences were significant for BDL during the muscle contraction, factoring in SUI symptoms (p = 0.019) and parity status (p = 0.005) and LPL during contraction, factoring in parity status (p = 0.033). BDL correlates with BNH, LPL, and LPA with slightly reduced correlation when factoring in parity and continence status. The advantages of the method include accessibility for sensitive populations, nontraditional positions due to the anatomical reference point, functional locations due to limited privacy needs, and minimal training required for pelvic floor therapists to incorporate into rehabilitation.

Automated Preoperative Planning Algorithm for Mandibular Angle Osteotomy Based on Anatomical Landmarks Detection: A Retrospective Study.

The aim of the study was to develop and evaluate an automated preoperative planning algorithm based on anatomical landmark point recognition for enhancing the efficiency and intelligence of preoperative planning for mandibular angle osteotomy. A retrospective cohort of 34 patients underwent preoperative planning with this algorithm. The present algorithm was developed using a method based on anatomical marker point recognition. The efficiency, symmetry, and safety of the automated preoperative planning and esthetics were statistically analyzed by paired t test and χ2 test. The results showed that the automated planning algorithm was able to achieve a great improvement in preoperative planning efficiency as well as safety and symmetry. A prospective case report of 2 patients is then reported, illustrating the safety and esthetics of the algorithm with 1-year postoperative follow-up and postoperative esthetic scores. This algorithm can help to improve the efficiency of preoperative planning for surgeons while ensuring safety and esthetics and can be further applied to other craniomaxillofacial personalized design surgeries in the preoperative design in the future.

Atrial septal pouch in cats: first report on interatrial septum anatomical variations.

The atrial septal pouch was first recognised in humans in 2006 and, since 2010, has been described in more detail. The first reports on the left-sided atrial septal pouch linked its occurrence with a higher risk of thromboembolic stroke resulting from left atrial thrombus formation. However, subsequent studies have challenged this theory; therefore, the consequences of septal pouch occurrence remain disputed. Currently, in veterinary species, septal pouch occurrence and morphology have been described in sheep and pigs, showing species-related differences. No studies have been conducted on cats. As cats show a species-related risk of aortic thromboembolic disease resulting from left atrial thrombus formation, we aimed to describe the interatrial septum anatomical variations as the first step in the investigation of the relationship between the septal pouch presence and left atrial thrombus formation. The study was conducted on hearts collected post mortem from 80 cats. After formalin fixation and dissection, a detailed anatomical description of the interatrial septum for all cases was followed by a histopathological analysis of the heart in 25 cases. After dissection, the specimens were embedded in paraffin blocks and stained with haematoxylin and eosin, Masson-Goldner trichrome, Picrosirius Red and Movat pentachrome in a routine manner and evaluated via light microscopy. Our study showed a very high prevalence (95%) of the left-sided septal pouch in cats with a lower incidence (29%) of the right-sided septal pouch. We noted a high morphological variety of the left-sided septal pouch and described anatomical variants not previously reported in the literature. The septal pouch is a common anatomical variation of the interatrial septum in cats. Although, based on the current study, we cannot draw further conclusions on the relationship between the left-sided septal pouch and thromboembolic events in cats, the high prevalence of this anatomical entity points to a need of further studies on the topic.

MANDI-Code: A Coding System for the human mandible

The mandible provides valuable insights into its biological identity. However, the existence of several terminologies for mandibular measurements and inconsistent language can lead to misinterpretation, confusion, and miscommunication. A standardised set of anatomical points, planes, and measurements would assist with these issues and ensure reproducibility and comparability. The proposed coding system offers a comprehensive approach for professionals and researchers in dentistry, archaeology, and anthropology.

Methodological foundations of somatoscopic research in automated decision support systems

Automated Decision Support Systems (ADSS) are widely applied in various fields of science and technology, particularly in medicine, where their role in diagnostic, prognostic, and therapeutic processes is undeniable. The use of computational technologies in medical practice has become a necessary stage in the development of the field; however, the increasing volume of data that requires processing, along with heightened demands for accuracy, speed, and reliability of recommendations, significantly complicates decision-making processes. The growing amount of data, combined with the need to minimize the risks of erroneous decisions, drives the scientific community to seek innovative information technologies that can ensure a high level of accuracy in computational operations while minimizing the time required for their execution. Somatoscopic measurements, which are a crucial element in assessing the condition of the musculoskeletal system and overall physical posture of a patient, require precise and systematic image analysis that allows the identification of critically important anatomical markers. This process involves the accurate determination of key points on images of anatomical structures, which serves as the foundation for making precise predictions about the patient's condition and subsequent treatment planning. In the context of continuously increasing volumes of medical data and stricter requirements for the quality of decisions, the implementation of innovative technologies, particularly deep learning, becomes increasingly relevant as it enhances the processes of analysis and diagnosis. The aim of this study is to conduct a comprehensive analysis of the methodological aspects of applying deep learning in the context of automating the diagnosis of the musculoskeletal system and posture assessment. The study emphasizes the use of specialized neural network architectures that enable the identification of key anatomical points on images, thereby facilitating a deeper and more accurate analysis of anatomical structures. This approach significantly improves the efficiency of diagnostic processes by minimizing the likelihood of errors in decision-making and optimizing the performance of medical systems. The results of the conducted research demonstrate the significant potential of deep learning algorithms in medical systems for the automated analysis of images, allowing for substantial improvements in the accuracy and speed of decision-making. Such automation contributes to reducing the risk of subjective errors associated with the human factor, which is particularly important in complex clinical cases. Therefore, the further development of research in this direction is of paramount importance for the medical field, as it opens new opportunities for solving complex diagnostic tasks at an innovative technological level. The integration of deep learning technologies into the processes of extracting somatoscopic data not only enhances diagnostic efficiency but also creates prerequisites for the development of new decision support systems that optimize medical practice.

Cranio-Orbital Approach and Decompression of the Optic Nerves: A 2-Stage, 4-by-4-Step Approach to Improve Vision in Sellar and Parasellar Lesions.

Despite advances in cranial base techniques, surgery of the sellar and parasellar regions remains challenging because of complex neurovascular relationships. Lesions within this region frequently present with progressive visual deterioration caused by distortion and compression of the optic chiasm and nerves. In addition to the direct mass effect from mechanical forces acting on the optic apparatus, these lesions alter blood supply and reduce vascular perfusion, prompting surgical treatment to remove the lesion, alleviate compression, and improve blood flow to the optic nerve. We sought to describe a 2-stage, 4-by-4-step approach, broken down and described as a "four-by-four" technique for optic apparatus decompression and a wide approach to different sellar and parasellar lesions. We describe the operative nuances and key anatomic points in the microsurgical removal of sellar and parasellar lesions. The technique is illustrated with examples of different cases with pre- and follow-up MRI imaging and a brief overview of visual outcomes. The described technique has been demonstrated in various lesions in 5 patients. Patients presented with bilateral visual loss in 4 (80.0%) cases and with unilateral visual loss in 1 (20.0%) case. Improvement in visual function was noted in all cases, confirmed with visual acuity and visual field testing. The transcranial approach ("from above") remains an important surgical option for patients with excellent exposure and visualization of the sellar and parasellar regions. It permits early access to the optic canal for careful microsurgical decompression and relaxation of the optic nerve to preserve and improve its microvascularization and ultimately vision. The authors augmented the 2-stage, 4-by-4-step technique of decompression with elaborate illustrations of diverse sellar and parasellar lesions to demonstrate the versatility of this approach.

The 3-Steps Approach for Lumbar Stenosis with Anatomical Insights, Tailored for Young Spine Surgeons.

Background/Objectives: Lumbar decompression surgery for degenerative lumbar stenosis is an intervention which addresses a degenerative condition affecting many patients. This article presents a meticulous three-phase surgical approach, derived from our clinical experiences and intertwining anatomical insights, offering a nuanced perspective tailored for the educational needs of young spinal surgeons. Methods: Six hundred and eighty-seven patients who underwent lumbar decompression surgery at a single institution were included in the present study. A retrospective analysis of patient demographics and surgical techniques was performed. All surgeries were performed by a consistent surgical team, emphasizing uniformity in approach. The surgical technique involves a meticulous three-phase process comprising exposure and skeletal visualization; microscopic identification and decompression; and undermining of the spinous process base and contralateral decompression. Results: Presenting results from 530 patients, the study examines demographic characteristics, health profiles, operative details, complications, and clinical assessments. The three-phase approach demonstrates low complication rates, absence of recurrences, and improved clinical outcomes, emphasizing its efficacy. Conclusions: The three-phase surgical approach emerges as a valuable educational tool for both novice and seasoned spinal surgeons. Rooted in anatomical insights, the structured methodology not only caters to the educational needs of young surgeons, but also ensures a standardized and safe procedure. The emphasis on tissue preservation and anatomical points aligns with current trends toward minimally invasive techniques, promising enhanced patient outcomes and satisfaction.

Dorsal ulnar cutaneous nerve conduction study based on nerve ultrasound

This study investigates the impact of the anatomical separation point of the dorsal ulnar cutaneous nerve (DUCN) on nerve conduction studies (NCS). Involving 25 subjects with DUCN NCS findings, it utilizes ultrasound to mark the DUCN's divergence from the ulnar nerve. NCS was performed at four points relative to the separation point. The findings indicate the maximal amplitudes occurred 2 cm distal to the separation point. The study suggests it is ideal when the stimulation is performed between the seperation point and 2 cm distal to it.

COMPARISON OF FREEWAY SPACE DISTANCE OF WILLIS METHOD WITH DIGITAL PHOTO ANALYSIS METHOD IN BANJAR TRIBE

Background: The face's vertical dimension or vertical height is the distance between two anatomical points, namely the points on the maxilla and mandible. In measuring the vertical dimension, vertical dimensions of rest (DVR) and vertical dimensions of occlusion (DVO) must be measured. The difference between the vertical dimension of rest (DVR) and the vertical dimension of occlusion (DVO) is called the freeway space (FWS) or interocclusal distance. Freeway space is a key requirement for optimal comfort and function of a partial or complete denture. Each individual's freeway space distance is the movement of muscle function, which can be measured by direct methods such as the Willis method using calipers and the digital photo analysis method using computer software. Two measurement methods can be used to measure freeway space distance direct and indirect. Purpose: To analyze the difference between freeway space distance measured by the Willis method and by digital photo analysis of Adobe Photoshop and Corel Draw graphic design software in the Banjar tribe (a review of students at the Faculty of Dentistry, Universitas Lambung Mangkurat Banjarmasin). Methods: This study is a quantitative study with an analytic observational method and a cross-sectional approach. This study was conducted by collecting data simultaneously at one time by comparing three different methods on the same sample without being given any treatment. Results: One Way ANOVA test is 0.296 (P&gt;0.05) which means there is no significant difference. Conclusion: There is no significant difference between the results of measuring freeway space distance using the Willis method with a digital caliper and digital photo analysis with Adobe Photoshop and Corel Draw software.

Ligation of anterior ethmoidal artery nasal branch: anatomical-based management of recalcitrant epistaxis.

Recurrent epistaxis, despite conservative therapies (i.e. nasal packing or direct vessel coagulation), is generally treated with ligation of the sphenopalatine artery (SPA). Indeed, the rationale behind SPA ligation lies in its ability to disrupt arterial blood supply to the nasal mucosa, thereby reducing the likelihood of recurrent bleeding episodes (1). Nevertheless, in some cases, nosebleeds persist despite appropriate SPA ligation, opening discussion of the anterior ethmoidal artery (AEA) contribution in recalcitrant epistaxis that, for some authors, is up to 28.8% (2). From an anatomical point of view, the AEA leaves the orbital cavity and passes the ethmoidal roof through the ethmoidal canal, before entering inside the anterior cranial fossa via the lateral lamella (3). Endocranially, the AEA gives posterior branches which vascularize the anterior cribriform plate, whereas its many trunk continues anteriorly and divides into two branches: the anterior meningeal branch, and a second vessel that enters inside the nasal fossa through the cribroethmoidal foramen located 2.86 ± 1.93 mm (range, 1-7 mm) (4) anteriorly to the first olfactory phylum, giving rise to the so-called nasal branch (NbAEA) (5).

Association between body condition score and abdominal fat assessed by ultrasound in Jersey cows.

Body condition score (BCS) is a subjective tool and the deposition of subcutaneous fat differs from the deposition of abdominal fat. The aim of this study was to evaluate by multivariate regression models and ultrasonography the amount of fat accumulated in different areas of the abdominal cavity in Jersey non-pregnant non-lactating cows and its association with their BCS. From a commercial farm, 21 non-pregnant non-lactating Jersey cows were selected at random. Cows were placed in a headlock line, and BCS was evaluated (scale 1-5 with a 0.25 unit increment) by the same assessor. Ultrasonographic evaluation was performed using a Sonosite machine in duplicate, considering key anatomical points of the body to predict total abdominal fat (AT), retroperitoneal fat (RT), omental fat (OT) and mesenteric fat (MT). A regression analysis for each abdominal fat depot and the BCS was run using SAS. Models from the lowest to the largest r2 are reported. The r2 for the models were MT r2=0.023; RT r2=0.1047; OT r2=0.323 and AT r2=0.369. Correlation between BCS and abdominal fat depots was positive, lower for mesenteric and retroperitoneal fat, but higher for omental and total abdominal fat. Cows were divided on the basis of the median of BCS distribution to high (≥3.5) and low (≤3.25). Those with high BCS had significantly larger amounts of fat in different anatomical areas of abdominal cavity than cows with low BCS. BCS has a low-to-moderate association with abdominal fat depots, but a high variability exists within each BCS punctuation, which supports the notion that fat accumulation patterns and metabolic turnover between abdominal and subcutaneous fat differ from each other.