Anatomical Basis Research Articles

Clinical application of the modified neck-shoulder technique based on membrane autopsy to laparoscopic totally extraperitoneal prosthesis for indirect inguinal hernia

ObjectiveTo investigate the anatomical basis and clinical application value of the modified neck-shoulder technique based on membrane autopsy in laparoscopic totally extraperitoneal prosthesis (TEP) for tension-free repairs of indirect inguinal hernia. MethodsIn this retrospective cohort study, we analyzed the clinical data of 136 patients with indirect inguinal hernia who underwent laparoscopic TEP for tension-free repairs at the Department of Gastroenterological Surgery Unit 1, the First Hospital of Putian City, Fujian Province from June 2017 to June 2020. The patients were divided into the modified neck-shoulder technique group (68 cases) and the traditional surgery group (68 cases), according to the different surgical methods. The intraoperative and postoperative conditions of the two groups were compared. ResultsBoth the modified neck-shoulder technique group and the traditional surgery group completed the herniorrhaphy. Compared with the traditional surgery group, the modified neck-shoulder technique group had a shorter operation time [(37.15 ± 5.320) min vs. (54.04 ± 5.202) min, t = 18.472, p < 0.001], less intraoperative blood loss [(5.53 ± 1.634) ml vs. (16.21 ± 3.375) ml, t = 23.544, p < 0.001], lower incidence of intraoperative peritoneal injury [3 cases (4.41%) vs. 9 cases (13.26%), χ2 = 3.29, p = 0.07], lower intraoperative conversion rate [1 case (1.47%) vs. 8 cases (11.76%), χ2 = 5.83, p = 0.016], and lower incidence of postoperative chronic pain [1 case (1.47%) vs. 12 cases (17.65%), χ2 = 10.291, p = 0.001], all of which were statistically significant (p < 0.05). Both groups were followed up for 12 months after surgery. Relapse was not observed in any case. ConclusionDrawing upon the surgical principles of the open neck-shoulder technique and the understanding of the membrane autopsy in the inguinal region, our center has summarized a set of operation procedures called the “modified neck-shoulder technique” for laparoscopic TEP in the tension-free repairs of indirect inguinal hernias. This new surgical technique could expeditiously and precisely navigate the interlayer gap in the preperitoneal space under the enlarged view of the laparoscope. It facilitated the high ligation, disconnection, or repositioning of the hernia sac, enhancing the reliability of patch placement while minimizing collateral damage, reducing postoperative complications, and shortening operation time.

Development of a Low-Cost Simulator for Training in Hemorrhoidal Ligation

Abstract Introduction Rubber band ligation is a minimally invasive outpatient hemorrhoid treatment with low cost, low complication rates, and rapid realization. It is performed with the aid of an anoscope and uses a rubber ring that surrounds the hemorrhoidal nipple, causing compression of the vascular structures of the tissue, leading to necrosis and remission of the hemorrhoid. No device for training this essential procedure for treating this pathology has been identified in the literature. Therefore, we aim to develop a low-cost simulator for training hemorrhoidal rubber ligation. Methods The model was constructed using PVC pipe wrapped in neoprene fabric. Hemorrhoidal nipples and the pectineal line were also simulated using fabric and sewing threads. The procedure is performed with conventional anoscope and ligature forceps. Conclusion The device in question is a low-cost simulation model designed to train the skills required to perform a rubber band ligation and review the basic anatomy of the anal canal during anoscopy. Given these qualities, the model can be used for academic training due to its low cost and simplicity of application.

RTMS regulates homotopic functional connectivity in the SCD and MCI patients

ObjectiveImpaired interhemispheric connectivity and corpus callosum atrophy have been linked to cognitive impairment in Alzheimer’s disease (AD). Existing evidence indicates that repetitive transcranial magnetic stimulation (rTMS) targeting the bilateral precuneus may enhance cognitive function in AD. This study aims to investigate the effects of precuneus rTMS on cognitive function, as well as alterations in interhemispheric functional connectivity (FC) and its structural basis in patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI).MethodsA total of 14 patients with SCD and 16 patients with MCI were enrolled in this study and received 10 Hz rTMS intervention on the bilateral precuneus for 2 weeks. Neurocognitive scales, structural and functional magnetic resonance imaging were collected at enrollment and after the rTMS intervention. Interhemispheric FC was assessed using mirror homotopic functional connectivity (VMHC), while the structural equation modeling (SEM) was employed to analyze the relationship between corpus callosum volume, interhemispheric connectivity, and cognitive function after rTMS intervention.ResultsThe precuneus rTMS not only enhanced episodic memory in SCD, but also improved multiple cognitive domains in MCI. Post-rTMS intervention, decreased VMHC values in the lingual cortex, middle occipital gyrus, putamen, and fusiform gyrus were observed in SCD, and an increased VMHC value in the postcentral gyrus along with reduced VMHC value in the cerebellum and putamen in MCI. After intervention, more brain regions show decreased FC in SCD and MCI patients, suggesting that precuneus rTMS may protect cerebral cortical plasticity by reducing excessive functional compensation, and thus improve cognitive function. The SEM indicated that the corpus callosum serves as the structural foundation for rTMS regulation of interhemispheric FC to further improve cognitive function.Conclusion10 Hz rTMS in the bilateral precuneus could be a promising strategy to improve cognitive function in patients with SCD and MCI. Our study implies that improvements in cognition brought about by precuneus rTMS may result from the remodeling of interhemispheric FC, with the corpus callosum possibly acting as the anatomical basis for functional modulation.

Atypical Forms of Lower Limb Varicose Vein Disease: Features of Diagnosis and Surgical Treatment

INTRODUCTION: Lower limb varicose vein disease (LLVVD) is the most common vascular disease with a predominant lesion of the main trunks of saphenous veins. At the same time, there exist atypical variants of lesion of the venous system in LLVVD, which cause difficulties in diagnosis and treatment.&#x0D; AIM: To study the incidence rate, anatomical bases of the varicose transformation, the features of reflux formation and the results of surgical treatment in atypical forms of LLVVD.&#x0D; MATERIALS AND METHODS: The study involved 600 patients with LLVVD, C2-C3 class of clinical manifestations in CEAP classification; 82 of them had atypical forms. The mean age of patients was 40.2 ± 9.2 years, duration of disease 15.0 ± 5.6 years. Duplex scanning of the lower limb venous system was conducted according to Russian recommendations for the diagnosis and treatment of chronic venous disorders of lower limbs of 2018. Patients with atypical forms of LLVVD additionally underwent computed tomography of the venous system with contrast. Surgical treatment of 50 patients with atypical forms of LLVVD included separation of the site of opening of a tributary in the area of saphenofemoral junction after preliminary marking and isolated elimination of varicose tributaries using Muller hooks; incompetent perforating veins were ligated at the epi- or subfascial levels depending on the location. The results were considered in the periods for up to two years.&#x0D; RESULTS: According to our data, the incidence of atypical forms of LLVVD was 13.7%. Lesion of the large tributaries of the main saphenous veins accounted for the highest proportion of atypical forms of LLVVD — 68.3%. Of these, varicose transformation of the anterolateral tributary made 98.2%, and of the superficial iliac circumflex vein — 1.8%. Isolated varicose transformation of perforating veins occurred in 31.7% of cases, where transformation of perforating veins of the gluteal area made 7.7%, of perforating veins of the posterolateral surface of the thigh — 46.2%, and of perforating veins of the patella region — 46.2%. The technical success in the postoperative period in the form of elimination of varicose saphenous veins and of the source of their incompetence was achieved in 100% of cases.&#x0D; CONCLUSIONS: The incidence of atypical forms of LLVVD is 13.7%, with the main trunks of saphenous veins remaining competent. The anatomical and hemodynamic basis for such forms of LLVVD is incompetence of the deep vein valves, from where the reflux is transmitted to tributaries of the saphenofemoral junction and/or perforating veins of the gluteal region, femoral region or popliteal fossa. Precise separation of varicose tributaries and perforating veins with preservation of the main trunks of subcutaneous veins is an organ-saving method of LLVVD treatment with a good effect in the follow-up period of up to two years.

Altered corollary discharge signaling in the auditory cortex of a mouse model of schizophrenia predisposition

The ability to distinguish sensations that are self-generated from those caused by external events is disrupted in schizophrenia patients. However, the neural circuit abnormalities underlying this sensory impairment and its relationship to the risk factors for the disease is not well understood. To address this, we examined the processing of self-generated sounds in male Df(16)A+/− mice, which model one of the largest genetic risk factors for schizophrenia, the 22q11.2 microdeletion. We find that auditory cortical neurons in Df(16)A+/− mice fail to attenuate their responses to self-generated sounds, recapitulating deficits seen in schizophrenia patients. Notably, the auditory cortex of Df(16)A+/− mice displayed weaker motor-related signals and received fewer inputs from the motor cortex, suggesting an anatomical basis underlying the sensory deficit. These results provide insights into the mechanisms by which a major genetic risk factor for schizophrenia disrupts the top-down processing of sensory information.

Abstract 14728: Implementation of a Resident-Led Cardiac Point-of-Care Ultrasound Curriculum for the Internal Medicine Residency Program at UT Southwestern

Introduction: The American Society of Echocardiography recommends integration of cardiac point-of-care ultrasound (cPOCUS) into training programs. There is no defined strategy on how to create and implement this on a large scale. Aim: To implement and assess the efficacy of a novel, pilot-tested, resident-led, simulation-based cPOCUS curriculum within the Internal Medicine (IM) internship at UT Southwestern (UTSW). Methods: All 62 categorical interns in the 2022-2023 class in the UTSW IM residency program completed our cPOCUS curriculum during their outpatient weeks over a three-month period. All tests and workshop guides were developed by current IM residents, cardiology fellows and faculty in a fashion that is reproducible annually, even as residents and fellows change. All interns underwent two educational workshops. Workshop 1 focused on acquisition and recognition of basic cardiac anatomy. Workshop 2 focused on abnormal cardiac pathology. Pre-and post-tests assessed their ability to identify cardiac windows, identify abnormal cardiac pathology, and rate their comfortability on a 5-point Likert scale. Results: Analysis was conducted on 39 of 62 responses containing both pre- and post-tests. Of the 39 interns, 6 (15%) scored below 70% on the pre-test. On the post-test, 38 out of 39 (97%) interns scored at least 80%. Furthermore, 4 of the 6 lowest scoring interns on the pre-test scored 100% on the post-test. There was a significant increase in the average pre- and post-test scores by 6% (p=0.02), with greatest improvement in the ability to identify LVEF &lt;40% (12% increase). Post-curriculum, 33 of 39 interns (85%) “agreed” or “strongly agreed” that they felt comfortable interpreting cPOCUS, compared to only 3 of 39 interns prior. Conclusions: Our simulation-based cPOCUS curriculum was successfully implemented within a large intern class at an academic center, with a 100% participation rate. Post-curriculum, there was a significant increase in cPOCUS interpretation scores and increased comfort with acquisition and interpretation. Our curriculum is sustainable, requires minimal cost, and serves as an archetype for the implementation of simulation-based cPOCUS curricula into “inpatient month + clinic week” block-based training programs.

An Assessment of Student's Perception of Learning Anatomy and Virtual Tools among Bangladeshi Medical Undergraduates

Introduction: The rapid advancement of virtual tools in medical education has led to a debate on the most effective methods for teaching anatomy to medical students. This study aimed to assess the perceptions of first-year medical students in Bangladesh regarding traditional cadaveric and modern virtual methods in anatomy education. Methods: This cross-sectional descriptive and analytical study was conducted among 110 first-year medical students from two medical colleges in Dhaka, Bangladesh. A pre-tested, open-ended questionnaire was administered to collect data on demographic characteristics, student preferences in anatomy learning, and their level of agreement on the use of traditional and virtual methods. Non-parametric statistical tests were performed to evaluate score differences between teaching methods. Result: The study revealed a strong preference for a blended approach, integrating both cadaveric and virtual methods. Cadaveric methods were predominantly favored for tasks requiring a deep understanding of anatomical structures (76.36%), while virtual methods were preferred for understanding the anatomical basis of functional consequences (60.91%). A significant number of students strongly agreed that cadaveric dissection is vital in anatomy learning (29.09%). Conclusion: The study suggests that both traditional cadaveric and modern virtual methods have unique strengths and weaknesses in anatomy education. A blended approach, integrating both methods, could offer the most comprehensive learning experience for students. The findings have implications for curriculum designers, educators, and policymakers in medical education.

Anatomical Foundations of Lower Eyelid Revitalization: Letter on Anatomical Basis for the Lower Eyelid Rejuvenation

Anatomical Foundations of Lower Eyelid Revitalization: Letter on Anatomical Basis for the Lower Eyelid Rejuvenation

Quality of life in lumbar spinal stenosis: Does it correlate with magnetic resonance imaging and spinopelvic parameters?

PurposeDegenerative lumbar spinal stenosis (LSS) is a common degenerative spinal disorder with debilitating symptoms that can impact quality of life (QoL). However, the anatomical basis for typical complaints has been poorly quantified. This study aims to correlate QoL assessments of patients with LSS with radiographic spinopelvic parameters and magnetic resonance imaging (MRI) measurements. MethodsWe screened 371 patients hospitalized for LSS and excluded those with a history of spine surgery. Ultimately, we analyzed the data of 34 patients retrospectively. Two independent members of our research group evaluated the alignment parameters on preoperative spinal radiographs, MRI, and classified the images according to the Pfirrmann grading. The spinopelvic alignment was then compared with the clinical QoL scores Core Outcome Measures Index (COMI) and the Oswestry Disability Index (ODI) as collected by the Spine Tango registry. In addition, the interobserver reliability was analyzed. ResultsThe individual MRI measurements correlated significantly. This correlation could not be found when compared with the spinopelvic parameters on radiographs. Neither the COMI nor the ODI scores showed a significant correlation with the MRI or radiographic imaging. ConclusionsThe severity of LSS related disability according to QoL questionnaires could not be quantified by any MRI or spinopelvic parameter that was measured. There was also no correlation of the MRI and spinopelvic parameters among themselves. Consequently, treatment recommendations for symptomatic LSS should never be based on radiological data only.

Characteristics of nutritional status in patients with chronic kidney disease

Chronic kidney disease is kidney damage that persists for three months or more due to the action of various etiological factors, the anatomical basis of which is the process of replacement of normal anatomical structures with fibrosis, leading to its dysfunction. This nosology is quite common in the modern world; it can progress and lead to disability of patients and a decrease in their quality of life. The mortality rate for this disease also remains high. About 3/4 of patients with this pathology have a terminal stage of the process, which is characterized by the development of protein-energy deficiency (due to uremia, malnutrition, acidosis and persistent inflammatory process), which significantly worsens the prognosis. Currently, the available literature contains a small number of works devoted to this problem, therefore an important part of the management of patients with chronic kidney disease (especially those on hemodialysis) is the assessment and correction of nutritional status. In this article, the authors highlight aspects of the development of protein-energy malnutrition, its possible methods of diagnosis and correction. Electrolyte disturbances, especially hyperkalemia and hyperphosphatemia, are also common complications of chronic kidney disease. Correction of these conditions, in turn, can lead to the development of deficiency of vitamins and other microelements. According to studies presented in the literature, nutritional status is one of the main factors determining the survival and degree of rehabilitation of patients on renal replacement therapy, as well as the effectiveness of dialysis treatment. Thus, a clinician’s knowledge of the nutritional status of this group of patients can improve their prognosis and quality of life.

Inadvertent Discovery of Gerstmann's Syndrome During a Skull MRI and Its Anatomical Basis: A Case Report

A rare neurological disorder in which an individual is unable to perform tasks related to language, spatial recognition,mathematics, and cognition is known as Gerstmann's syndrome(GS). Gerstmann hypothesised that the four symptoms thatmakeup Gerstmann's syndrome are caused by a shared cognitive problem (Grundstörung). Gerstmann asserted that it is a bodyschema disorder that only affects the hand and fingers. Since then, the existence of a Grundstörung has been disputed. The studyproposed a shared psychoneurological element, but it should be connected to changes in mental pictures rather than the bodilyschema. The significant facts appear to be the common simultaneous impairment of writing, computation, and bodily awarenessafter left parietal lesion, beyond the diagnostic label of "pure" and "non-pure" Gerstamann's syndrome instances. Some functionaldomains can be linked to patients' symptoms despite being heterogeneous. A 65-year-old male was brought to the hospital witha history of injury to the head and complaints of confusion, speech difficulty, inability to perform simple calculations, severeheadache, and drowsiness. The patient was sent to the radiology department of Sree Balaji Medical College and Hospital,Chennai, for a Magnetic Resonance Imaging of Skull (MRI). The MRI study revealed chronic ischemic changes in periventricularand subcortical white matter in the parietal lobes. Certain ischemic changes were also observed in the frontal lobe, suggestingage-related changes and Gerstmann's syndrome. By cutting off various portions of the inferior parietal cortex, a lesion affectingsubcortical and subangular bundles of fibers affects many circuits with distinct roles. Therefore, the deficits seen in the patientare best explained by this anatomical explanation.

MRI Workshop for Axial Spondyloarthritis 2023

MRI sacroiliac joint is a sensitive imaging modality for evaluation of inflammation and the accompanying structural changes. Assessment of SpondyloArthritis international Society (ASAS) classification criteria incorporates active inflammation of the sacroiliac joint on MRI as one of the criteria of imaging arm of axial spondylarthritis. The current lecture would cover basic imaging anatomy of sacroiliac joints, typical imaging features of sacroiliac inflammation in axial spondyloarthritis and ‘red-flags’ suggesting alternative diagnosis. The supplementary role of structural changes on MRI in aiding diagnosis of axial spondyloarthritis will also be highlighted.

Radiofrequency thalamotomy for tremor produces focused and predictable lesions shown on magnetic resonance images.

Radiofrequency thalamotomy is a neurosurgical management option for medically-refractory tremor. In this observational study, we evaluate the MRI features of the resultant lesion, their temporal dynamics, and how they vary depending on surgical factors. We report on lesion characteristics including size and location, as well as how these vary over time and across different MRI sequences. Data from 12 patients (2 essential tremor, 10 Parkinson's disease) who underwent unilateral radiofrequency thalamotomy for tremor were analysed. Lesion characteristics were compared across five structural sequences. Volumetric analysis of lesion features was performed at early (<5 weeks) and late (>5 months) timepoints by manual segmentation. Lesion location was determined after registration of lesions to standard space. All patients showed tremor improvement (clinical global impressions scale) postoperatively. Chronic side-effects included balance disturbances (n = 4) and worsening mobility due to parkinsonism progression (n = 1). Early lesion features including a necrotic core, cytotoxic oedema and perilesional oedema were best demarcated on T2-weighted sequences. Multiple lesions were associated with greater cytotoxic oedema compared with single lesions (T2-weighted mean volume: 537 ± 112 mm³ versus 302 ± 146 mm³, P = 0.028). Total lesion volume reduced on average by 90% between the early and late scans (T2-weighted mean volume: 918 ± 517 versus 75 ± 50 mm³, t = 3.592, P = 0.023, n = 5), with comparable volumes demonstrated at ∼6 months after surgery. Lesion volumes on susceptibility-weighted images were larger than those of T2-weighted images at later timepoints. Radiofrequency thalamotomy produces focused and predictable lesion imaging characteristics over time. T2-weighted scans distinguish between the early lesion core and oedema characteristics, while lesions may remain more visible on susceptibility-weighted images in the months following surgery. Scanning patients in the immediate postoperative period and then at 6 months is clinically meaningful for understanding the anatomical basis of the transient and permanent effects of thalamotomy.

Retrospective analysis of 16 cases of lumbar hernia

BackgroundThrough a retrospective analysis of 16 cases of lumbar hernia, we discussed the anatomical basis, clinical manifestations, diagnosis, and treatment of this rare condition. MethodsWe collected medical data of 15 patients with a primary lumbar hernia and one patient with a secondary lumbar hernia treated in the General Surgery Department of Wuxi No.2 People's Hospital between January 2008 and June 2021 and analysed their demographic, preoperative, and postoperative data. ResultsAll patients underwent elective surgery performed by the same treatment team for superior lumbar hernias. The median area of the hernia defect was 12 cm2. Fifteen patients underwent sublay repair, and one underwent onlay repair. The median operative time and blood loss were 48 min and 22 mL, respectively. The hernia contents were extraperitoneal fat in 15 patients and partial small intestine in one. The median visual analogue scale score on postoperative day 1 was 3. A postoperative drainage tube was placed in three cases but not used in 13. The median duration of hospital stay was 5 days. Postoperative incision infection occurred in one case. During the follow-up period, no postoperative complications, including haematoma, seroma, incision infection or rupture, recurrence, and chronic pain, occurred in the other 15 cases. ConclusionLumbar hernias are rare and can be safely and effectively treated by open tension-free repair.

Interactive audio human organ model combined with team-based learning improves the motivation and performance of nursing students in learning anatomy and physiology.

Among the basic medical sciences, anatomy and physiology (anatomy & physiology) is a fundamental subject for students majoring in nursing. Due to its diversity and difficulty, nursing students experience stress when studying it. Previous graduates generally presented lower achievements in anatomy & physiology than in other nursing-related subjects in the National Council Licensure Examination-Registered Nurse, indicating that anatomy & physiology education requires improvement. Accordingly, we examined the impact of innovative teaching on students' motivation and performance when learning anatomy & physiology through a quasi-experimental pre-/post-test design. For innovative teaching, we used the novel interactive audio human organ model, followed by team-based learning. The participants were 200 lower-grade students in the nursing department of a junior college in Taiwan, divided into two groups receiving innovative teaching (experimental group) or traditional teaching (control group). Questionnaire surveys were administered, and the collected data were statistically analyzed. The innovative teaching in anatomy & physiology improved learning motivation, especially in terms of affect, executive volition, and learning performance. The essential components of learning motivation, such as value, expectation, affect, and executive volition, were positively correlated with the reaction levels of learning performance. Regarding the improvement in academic performance, the experimental group performed significantly better than the control group. The use of innovative teaching in class enhances students' learning motivation and learning performance when studying anatomy & physiology. Interactive teaching aids enhance the enjoyment of learning anatomy & physiology while facilitating in-depth exploration of the human organs and systems.

Evaluation of Modified Thiel Soft-embalmed Cadavers as a Novel Teaching Model for Musculoskeletal Ultrasound and Anatomy among Rehabilitation Medicine Residents.

This study aimed to determine the perceptions of rehabilitation medicine resident trainees on using modified Thiel soft-embalmed cadavers as a learning tool in acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy. This descriptive cross-sectional study used total enumeration to recruit residents in training under the rehabilitation medicine department of a tertiary referral hospital. An online survey tool was self-administered to determine their perceptions on the use of MSK-UTZ on Thiel-embalmed cadavers. Pre- and post-test scores were compared to determine if their knowledge has improved. Fifteen participants were recruited, who answered the pre- and post-test, and the online survey. The mean pre-test score of participants was 5.87 (±1.68), and the mean post-test score was 6.87 (±2.00). There was no statistically significant difference (P = 0.20) using a paired t-test. At an arbitrary passing rate of 70%, only 5/15 participants passed the pre-test while 10/15 passed the post-test. A chi-square test of independence showed that there was no significant association between the number of participants who passed or failed on the pre- and post-test, X2 (1, N = 15) = 3.3, p = .0.068. Most of the perceptions of the participants were positive in terms of the use of modified Thiel soft-embalmed cadavers as a learning tool, its relevance in the training of a rehabilitation medicine resident, and the overall experience on its use. Thiel-embalmed cadavers as a learning tool was well-accepted, having generally positive perceptions from the participants mainly in terms of perceived enhancement of the understanding of the anatomical basis of musculoskeletal ultrasound, perceived improvement in skills in performing musculoskeletal ultrasound, and most even recommended that it be part of their training as rehabilitation medicine residents. In terms of acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy, no significant improvement in knowledge was noted. Further studies with larger sample sizes are recommended to yield more statistically significant improvement in knowledge and to observe trends in the perceptions of participants.

In humans, striato-pallido-thalamic projections are largely segregated by their origin in either the striosome-like or matrix-like compartments

Cortico-striato-thalamo-cortical (CSTC) loops are fundamental organizing units in mammalian brains. CSTCs process limbic, associative, and sensorimotor information in largely separated but interacting networks. CTSC loops pass through paired striatal compartments, striosome (aka patch) and matrix, segregated pools of medium spiny projection neurons with distinct embryologic origins, cortical/subcortical structural connectivity, susceptibility to injury, and roles in behaviors and diseases. Similarly, striatal dopamine modulates activity in striosome and matrix in opposite directions. Routing CSTCs through one compartment may be an anatomical basis for regulating discrete functions. We used differential structural connectivity, identified through probabilistic diffusion tractography, to distinguish the striatal compartments (striosome-like and matrix-like voxels) in living humans. We then mapped compartment-specific projections and quantified structural connectivity between each striatal compartment, the globus pallidus interna (GPi), and 20 thalamic nuclei in 221 healthy adults. We found that striosome-originating and matrix-originating streamlines were segregated within the GPi: striosome-like connectivity was significantly more rostral, ventral, and medial. Striato-pallido-thalamic streamline bundles that were seeded from striosome-like and matrix-like voxels transited spatially distinct portions of the white matter. Matrix-like streamlines were 5.7-fold more likely to reach the GPi, replicating animal tract-tracing studies. Striosome-like connectivity dominated in six thalamic nuclei (anteroventral, central lateral, laterodorsal, lateral posterior, mediodorsal-medial, and medial geniculate). Matrix-like connectivity dominated in seven thalamic nuclei (centromedian, parafascicular, pulvinar-anterior, pulvinar-lateral, ventral lateral-anterior, ventral lateral-posterior, ventral posterolateral). Though we mapped all thalamic nuclei independently, functionally-related nuclei were matched for compartment-level bias. We validated these results with prior thalamostriate tract tracing studies in non-human primates and other species; where reliable data was available, all agreed with our measures of structural connectivity. Matrix-like connectivity was lateralized (left &amp;gt; right hemisphere) in 18 thalamic nuclei, independent of handedness, diffusion protocol, sex, or whether the nucleus was striosome-dominated or matrix-dominated. Compartment-specific biases in striato-pallido-thalamic structural connectivity suggest that routing CSTC loops through striosome-like or matrix-like voxels is a fundamental mechanism for organizing and regulating brain networks. Our MRI-based assessments of striato-thalamic connectivity in humans match and extend the results of prior tract tracing studies in animals. Compartment-level characterization may improve localization of human neuropathologies and improve neurosurgical targeting in the GPi and thalamus.

Suspension of the penis – dissection, anatomical description and highlighting of anatomical risks in sectioning the suspensory ligaments

BackgroundThe suspension of the penis is provided by two ligaments: fundiform and suspensory. These ligaments are sectioned during some augmentative surgical procedures. The structure, the relations and the variability of these ligaments have been demonstrated. The penile neurovascular bundle and its relationships have also been emphasized. A clear knowledge of these details should ensure a reduction of the risk of surgical injury during augmentation procedures.ResultsWe dissected the ligaments providing the suspension of the penis in 7 formalized corpses. We identified, for each of the ligaments, the origin, the insertion and the relations. The dissection pieces were photographed and the images obtained were discussed upon. We described the variability of the anatomical distribution and highlighted the relations with the vascular and nervous structures for each of these ligaments. The anatomical variability of the fascia and the relations with the base of the penis were also emphasized. For the suspensory ligament, we identified three groups of fibers through which it is attached to the penile body.ConclusionsThe dissections were conducted in layers, corresponding to the operative steps for the penile augmentation procedures. We believe that our study highlights the anatomical basis necessary to safely perform these surgeries. The study contributes to the description of the anatomical variability of the ligaments and logically presents details that contribute to preventing most surgical incidents.

Analysis of Operating Room Personnel Perspectives to Enhance Medical Student Readiness for Surgery

We sought to better define surgical etiquette and elucidate operating room (OR) personnel expectations of medical students to determine areas for medical education improvement. A questionnaire probing medical student performance regarding elements of OR etiquette was developed. Questions were designed to obtain structured feedback through Likert scales and open-ended responses. Descriptive and thematic analysis was conducted on Likert scale and free-text responses, respectively. Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Tertiary academic center. A questionnaire was distributed to nurses, surgical and anesthesia faculty and residents. The survey was distributed via email amongst various hospitals, predominantly our home institution. We received 126 complete responses. About half of respondents (46.3%) self-identified as female. Most respondents were part of the surgical team (74.7%), with most (57.8%) from attending physicians. A majority of respondents agreed that medical students responded well to feedback. Roughly half of respondents agreed that medical students understand their role, maintain sterility, and assist in delivery of effective patient care. More than half of respondents did not believe that medical students understand traffic patterns. The majority of respondents indicated that medical students are not appropriately prepared with basic surgical skills prior to entering the OR. Two-thirds of respondents did not feel that medical students contribute towards maintaining safety in the OR. We identified 4 themes from free text responses: students should assume an active role in the OR, utilize situational awareness, understand sterility and OR workflow, and have knowledge of basic operative technique and anatomy. Medical students are not meeting OR personnel expectations and may benefit from early educational interventions to optimize the OR as a learning environment.

Dyslexia and Stuttering: An Overview of Processing Deficits and the Relationship Between Them.

Stuttering and dyslexia are two processing deficits that have an impact on a person's social and academic lives, especially as they usually affect the pediatric population more than adults. Even though they affect different domains, they have similar characteristics in their pathogenesis, epidemiology, and impact on life. Both disorders represent a considerable percentage of the population worldwide and locally in Saudi Arabia, and they have similar epidemiological trends. Family history, genetic factors, early fetal and neonatal factors, and environmental factors are all identified as risk factors for both conditions. Moreover, it has been established that both diseases share a common genetic and anatomical basis, along with a mutual disruption of diadochokinetic skills. While rehabilitative techniques can be used in both conditions, stuttering could also benefit from pharmacological interventions. This review emphasizes that extensive research should be done to explore both of these conditions as they impact different areas of one's life and the relationship between them to better understand their pathophysiological origins.