Anatomical Basis Research Articles

Improvement of the female mouse computational model developed at CDTN

Small animals, such as mice, have been used in experiments involving ionizing radiation. New preclinical experimental methods often include extensive imaging (MicroCT and/or PET/SPECT) that can result in absorbed dose values considerably high. In addition, assays with theranosticsradiopharmaceuticals administered in small animals have been used to determine the main potential adverse effects and the therapeutic efficacy. For all these mentioned cases, the precise quantification of absorbed doses and the determination of energy deposition patterns are of fundamental importance to qualify or exclude potential radiobiological effects that may interfere with in vivo experiment results. Thus, the development and improvement of mouse phantoms is essential for good small animal dosimetry. In 2021, our group segmented and implemented a female C57BL mouse phantom, called FM_BRA, in the MCNP. The objective of this work was to review the segmentation of the FM_BRA computational model and to identify and segment new organs for an improved version of this phantom. Three different researchers segmented different organs of the model. The masses of the segmented organs were compared with those of the first version. Information on mass or volume of organs from different mouse strains, and more specifically from the C57BL strain, was also obtained from the literature for comparison and to aid in segmentation. The mice image representing a female mouse of the C57BL strain weighing 26 g were kindly provided by the Turku Center for Disease and were manually segmented. The software GIMP® 2.10 was used to select and segment each organ/tissue. The IMAIOS-VET Anatomy website was used as an anatomical basis for the identification of organs/tissues. The IMAGEJ® software was applied to assemble the segmented images into a 3D stack and to convert the segmented images into binary files. The volumes of the segmented organs were measured with a C++ in house program. Corresponding human tissue densities provided in ICRP 110 were used to calculate organ mass from the calculated volumes. Data were compared with literature reports. The number of segmented organs increased from 20 in the old model to 33 in the new models. The masses of the organs segmented in this work, by the different researchers, showed agreement in most cases. However, organs such as the small intestines, bones and trachea still deserve a new round of reviewing.

Identification of a novel path for cerebrospinal fluid (CSF) drainage of the human brain.

How cerebrospinal fluid (CSF) drains from the human brain is of paramount importance to cerebral health and physiology. Obstructed CSF drainage results in increased intra-cranial pressure and a predictable cascade of events including dilated cerebral ventricles and ultimately cell death. The current and accepted model of CSF drainage in humans suggests CSF drains from the subarachnoid space into the sagittal sinus vein. Here we identify a new structure in the sagittal sinus of the human brain by anatomic cadaver dissection. The CSF canalicular system is a series of channels on either side of the sagittal sinus vein that communicate with subarachnoid cerebrospinal fluid via Virchow-Robin spaces. Fluorescent injection confirms that these channels are patent and that flow occurs independent of the venous system. Fluoroscopy identified flow from the sagittal sinus to the cranial base. We verify our previous identification of CSF channels in the neck that travel from the cranial base to the subclavian vein. Together, this information suggests a novel path for CSF drainage of the human brain that may represent the primary route for CSF recirculation. These findings have implications for basic anatomy, surgery, and neuroscience, and highlight the continued importance of gross anatomy to medical research and discovery.

Integrating Obstetric Point-of-Care-Ultrasonography (POCUS) Simulation Curriculum [ID: 1363619

INTRODUCTION: Point-of-care ultrasonography (POCUS) is increasingly used in medicine and is widely integrated into training. While obstetric (OB) ultrasound (US) is prevalent, its formal use and curriculum is often overlooked in POCUS training. METHODS: We performed a prospective comparative study of medical students who underwent formal obstetrics POCUS training and simulation. Students participated in a pre- and post-knowledge assessment of basic (presentation, placentation, fluid) and advanced (biometry and basic anatomy) knowledge. Scores were compared via Wilcoxon signed-ranks test. In addition to formal didactics, students participated in hands-on simulation training. The simulation provided one-on-one biometry training with a high-fidelity CIRS model 065-20 fetal model. Participants were evaluated on their ability to perform a complete fetal biometry. RESULTS: There were 58 participants in formal POCUS simulation training. Prior to training, only 29.7% were comfortable with a basic OB US and 8.1% were comfortable with performing biometry. Afterwards, 83.8% and 78.4% were comfortable performing basic and biometry US. Students had significantly higher basic OB US knowledge comparing before (Mdn=50.0) to after training (Mdn=83.3) (Z=5.27, P<.01). Similarly, there was a significant increase in advanced OB US knowledge comparing before (Mdn=56.3) to after (Mdn=100.0) (Z=4.99, P<.01). All participants were able to complete biometry measurements on the CIRS model. 91.9% of participants recommended this training to others. CONCLUSION: Obstetric ultrasound provides invaluable opportunity for learners to gain POCUS skills. Formal training and simulation significantly improves learning knowledge, confidence, and practical OB POCUS skills that can be used during clinical care.

The substantia nigra modulates proximal colon tone and motility in a vagally-dependent manner in the rat

Previous studies have shown that a monosynaptic pathway connects the substantia nigra pars compacta (SNpc) to neurons of the dorsal motor nucleus of the vagus (DMV). This monosynaptic pathway modulates the vagal control of gastric motility. The present study was designed to test the hypothesis that this nigro-vagal pathway also modulates the tone and motility of the proximal colon.In rats, concurrent microinjection of a retrograde tracer in the proximal colon and an anterograde tracer in the SNpc (n=4) showed that bilaterally labelled colonic-projecting preganglionic vagal motoneurons in the DMV received inputs from SNpc neurons. Activation of SNpc neurons via microinjection of the ionotropic glutamate selective agonist, NMDA, increased proximal colonic motility (187±52.6% of baseline, n=13) and tone (323±97.2mg, n=14) as measured via a strain gauge aligned with the colonic circular smooth muscle (paired t test, p<0.0001). Following transfection of SNpc neurons with pAAV-hSyn-hM3D(Gq)-mCherry, chemogenetic activation of nigro-vagal nerve terminals by brainstem application of CNO increased proximal colon motility (157±24.5% of baseline; n=3; unpaired t test; p=0.0399). The increase in colon motility following SNpc neuronal activation was abolished by brainstem pretreatment with the dopaminergic DA1-like antagonist SCH23390 (n=4; one-way ANOVA, p=0.9762 vs baseline; p=0.0159 vs NMDA alone) as well as by acute subdiaphragmatic vagotomy (94±47.9% of baseline; n=3; One-way ANOVA, p=0.9816 vs baseline and p=0.0105 vs NMDA alone). In contrast to the excitatory effects observed upon activation of brainstem D1R following SNpc stimulation, DMV microinjection of DA decreased both the tone (-81±27.3mg, n=7) and motility (49±21.6% of baseline; n=7; paired t test: p=0.0004) of the proximal colon. These inhibitory DA effects were attenuated by application of the DA2-like antagonist L741646 (tone -100±58.9mg vs 99±100.1mg; n=4; paired t test: t3=2.567, p=0.0414 and motility 63±15% vs 144±38% of baseline; n=5; one-way ANOVA, p=0462 in the absence and presence of L741646).These data suggest that a monosynaptic nigro-vagal pathway activates brainstem D1 receptors to increase proximal colon tone and motility in a vagally-dependent manner. This study provides the anatomical and mechanistic basis to explain how loss of SNpc neurons may lead to gastrointestinal dysfunction, including constipation, observed in patients with Parkinson’s Disease. no disclose This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Anatomical and biophysical basis for graft incompatibility within the Solanaceae.

Interspecies grafting is an economically relevant technique that allows beneficial shoot and root combinations from separate species to be combined. One hypothesis for the basis of graft compatibility revolves around taxonomic relatedness. To test how phylogenetic distance affects interspecific graft compatibility within the economically important Solanaceae subfamily, Solanoideae, we characterized the anatomical and biophysical integrity of graft junctions between four species: tomato (Solanum lycopersicum), eggplant (Solanum melongena), pepper (Capsicum annuum), and groundcherry (Physalis pubescens). We analyzed the survival, growth, integrity, and cellular composition of the graft junctions. Utilizing various techniques, we were able to quantitatively assess compatibility among the interspecific grafts. Even though most of our graft combinations could survive, we show that only intrageneric combinations between tomato and eggplant are compatible. Unlike incompatible grafts, the formation of substantial vascular reconnections between tomato and eggplant in the intrageneric heterografts likely contributed to biophysically stable grafts. Furthermore, we identified 10 graft combinations that show delayed incompatibility, providing a useful system to pursue deeper work into graft compatibility. This work provides new evidence that graft compatibility may be limited to intrageneric combinations within the Solanoideae subfamily. Further research amongst additional Solanaceous species can be used to test the extent to which our hypothesis applies to this family.

Knowing the Description of the Role of Anatomy Fun Game on the Anatomy Learning Process of FKIK Ukrida Students

Anatomy is a basic science in the world of medicine. Relations with surrounding structures. There is so much material that makes it difficult for students to understand and memorize Anatomy material, and that is why they are friends of Anatomy at Krida Christian University. Discourse tries a learning method to assist students in learning by making a Game Base Learning application, namely Anatomy Fun Game which is an application that aims to assist students in preparing to take the Anatomy practicum exam, helping students in memorizing body Anatomy, and the Anatomy Fun Game application can be tried repeatedly. The design of this study was an analytic study using a retrospective time technique in data collection using a recap sample of basic cardiovascular Anatomy practicum values block 8 Class of 2015-2018. The percentage of the average grade of 2015 was 46.92, the average grade of 2016 was 32.44, the average grade of 2017 was 45.34 and the average grade of 2018 was 59.20 so that the application of Anatomy fun game (AFG) to the learning process quite satisfactory, this happened because the average grade of the 2017-2018 class was higher than the 2015-2016 class.

Cadaveric Study for Safe Elevation of a Profunda Artery Perforator Flap: Anatomy of the Perforators and Obturator Nerves.

This cadaveric study aimed to describe the anatomy of the profunda artery perforators (PAPs). In total, nine free cadavers with 18 upper thighs were dissected, 12 of which were from female cadavers, and 6 were from male cadavers. The average age of the cadavers was 84.7 ± 4.2 years. Dissection was performed to evaluate the anatomic position and characteristics of the femoral PAPs. The perforator distance from the gluteal sulcus, number of perforators, perforating muscles, diameter of the perforators, origin of the perforators, and number of nerves passing above and below the perforators were determined. The average number of perforators that penetrate the adductor magnus muscle was 2.5. The average distance from the origin of the perforators to the gluteal sulcus was 71.72 ± 28.23 mm. The average numbers of the obturator nerves passing above and below the perforator in the adductor magnus muscle were 1.3 (range, 0-4) and 0.7 (range, 0-2), respectively. The results provide a detailed anatomic basis for the PAP flap. The perforators of a PAP flap may be included in a flap with a transverse design. Sacrificing the small obturator nerves during dissection may not lead to significant donor site morbidity.

An anatomical study of the suboccipital cavernous sinus and its relationship with the myodural bridge complex.

The suboccipital cavernous sinus (SCS) and the myodural bridge complex (MDBC) are both located in the suboccipital region. The SCS is regarded as a route for venous intracranial outflow and is often encountered during surgery. The MDBC consists of the suboccipital muscles, nuchal ligament, and myodural bridge and could be a power source for cerebrospinal fluid circulation. Intracranial pressure depends on intracranial blood volume and the cerebrospinal fluid. Since the SCS and MDBC have similar anatomical locations and functions, the aim of the present study was to reveal the relationships between them and the detailed anatomical characteristics of the SCS. The study involved gross dissection, histological staining, P45 plastination, and three-dimensional visualization techniques. The SCS consists of many small venous sinuses enclosed within a thin fibrous membrane that is strengthened by a fibrous arch closing the vertebral artery groove. The venous vessels are more abundant in the lateral and medial portions of the SCS than the middle portion. The middle and medial portions of the SCS are covered by the MDBC. Type I collagen fibers arranged in parallel and originating from the MDBC terminate on the SCS either directly or indirectly via the fibrous arch. The morphological features of SCS revealed in this research could serve as an anatomical basis for upper neck surgical procedures. There are parallel arrangements of type I collagen fibers between the MDBC and the SCS. The MDBC could change the blood volume in the SCS by pulling its wall during the head movement.

Genitourinary vascularized composite allotransplantation for gender affirmation in trans men: An anatomical feasibility study

Gender affirmation in trans men requires multiple staged procedures. The final masculinizing step involves phalloplasty or metoidioplasty and further incorporation of penile and testicular prostheses. However, these are functionally suboptimal and associated with high complication rates. Therefore, we sought to investigate the anatomical feasibility of one-stage genitourinary vascularized composite allotransplantation (GUVCA) for such gender-affirming surgeries. Twenty fresh cadaveric dissections were performed to delineate the neurovascular anatomy of the proposed GUVCA. Specifically, in donors (n=14), besides the penis and scrotum, the GUVCA included an inferior bladder patch with the urinary sphincter, prostate, seminal vesicles, as well as a strip of the pubic bone. In trans men recipients, osteotomies of the pubic bone to match that of the donor GUVCA were required. Five cadaveric GUVCA transplants were then performed to simulate one-stage gender affirmation surgery. The GUVCA required (1) vascular anastomoses between the recipient's deep inferior epigastric, external pudendal, and superficial circumflex iliac (or superficial inferior epigastric) vessels to the donor's internal pudendal, external pudendal and genitofemoral vessels respectively; (2) neurosynthesis between the recipient pudendal and dorsal clitoral nerves to the donor pudendal and genitofemoral nerves; and (3) urinary bladder anastomosis at the bladder neck, upstream of the urinary sphincter. Average donor measurements (length (cm), diameter (mm)) were: external pudendal artery (2.5, 2.0) and vein (2.0, 3.5), internal pudendal artery (15.0, 4.0), pudendal (15.0, 3.0) and genitofemoral nerves (8.0, 2.0). We have described the anatomical basis for a one-stage GUVCA in trans masculine genitourinary reconstruction.

Suturing Dermatotraction Techniques in Closing Fasciotomy Wounds: A Systematic Review.

A surgical patient post-fasciotomy presents a challenge to restore the cover of the muscle groups, and the use of the suturing dermatotraction techniques presents a cheap and easy means of native cover. This systematic review of case series and case-control study explored the trend of this technique, including duration of delayed primary wound closure, complications, and failure rates. A literature review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted on Medline, Embase, and Cumulative Index of Nursing and Allied Health Literature (CINAHL), yielding a combined total of 820 articles between 1946 and June 18, 2022. Human studies with suturing dermatotraction techniques were included. Sixteen (16) studies reviewed met the criteria. The basic anatomy of the dermatotraction technique involves an anchor point on the skin, a material for traction, and a suture pattern. The shoelace technique was the predominant suture pattern, with staples as skin anchor material/method and silastic vessel loops as traction sling used by 11 studies. Modifications of this method included the use of intradermal Prolene sutures and pediatric catheters. The shortest duration for skin apposition was two days, and the longest was 113 days. Complications were comparable to that of surgical wounds and thus may not be attributable to the technique itself. Studies reviewed showed that superficial and early complications were more likely than deep or delayed complications. Negative pressure wound therapy (NPWT) and skin graft salvaged a few failed closures in two studies. There are varying practices of tightening rates with reports ranging from daily to every 72 hours. The rate of tightening and disease burden may account for the wide range of reported delayed primary closure. Most of the studies reviewed closed fasciotomy wounds with this technique within an average of <10 days. It is relatively cheaper, carries a low morbidity burden, and has multiple reported successin the closure of fasciotomy wounds in this review and thus should have an increased adoption as a first approach in managing fasciotomy wounds, especially in low-income countries.

A review on approach to a twitchy tongue in neurology.

Several etiologies are responsible for presentation of a twitching tongue in clinical practice. Some of these etiologies cause an isolated hyperkinetic tongue muscle, and some others cause it along with other signs and symptoms. The present paper aims to review the causes, pathology, and presentations reported with twitchy tongue. An anatomical basis of the etiologies responsible for presentation of a twitchy tongue and hyperkinetic movement disorders of this muscle is pursued. The reporting of this systematic review was guided by the standards of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) Statement. All of the research papers conducted with keywords described in the method section between 2000 and 2022 were used, and review articles and articles without any human subject and without any described hyperkinetic movement disorders of the tongue were excluded. All of the etiologies responsible for hyperkinetic movement disorders of tongue were listed in the basis of their anatomical site of effect; cortical region, basal ganglia, cerebellum, brain stem, nucleus and nerve, and neuromuscular junction. One last remained part is the "not classified" section, which contains the etiologies with no particular anatomical origin. There are a variety of responsible etiologies for presentation of a twitchy tongue, and in the matter of a complaint of hyperkinetic tongue presentation, physicians should consider anatomical, functional, and psychological etiologies and other signs and symptoms must be participated in the diagnosis process to achieve a proper medical decision.

Early Clinical Exposure – Effectiveness and Attitude among MBBS Students

Background: In the traditional method, students learn theory without contacting patients in the initial part of MBBS. Early clinical exposure creates a scope for students to correlate basic science and clinical application. Hence, there is a need to study the effectiveness of different forms of early clinical exposure (ECE). The objectives of the study were to compare the knowledge acquired and attitude toward ECE by the students after different forms of ECE. Methodology: An observational study was done with 1st-year MBBS (n = 150) students. Based on the National Medical Council (Then Medical Council of India) II ECE document for undergraduate medical education programs, 10 topics were selected. The first six ECE sessions were conducted in the classroom, the next two at the hospital, and the last two virtually. Phase-validated structured multiple-choice questions (MCQs) and feedback were given to students before and after every ECE. The MCQ scores and feedback conducted in three forms were statistically analyzed. Results: There was a notable disparity in the mean between pre- and posttest. The mean scores of the virtual mode were better than the other two forms. As per the feedback analysis, most of the students observed ECE aid to clear conceptualization, critical thinking, and correlate anatomical basis in clinical cases. However, students also felt that it is too early to understand the topic in such detail in 1st year. Conclusion: This longitudinal study on ECE showed there is an increase in the knowledge and analytical skills of students. Hence, we recommend continuing ECE and to have a blended learning environment along with limited content to be included for a better outcome.

Sinus node dysfunction and atrial fibrillation-Relationships, clinical phenotypes, new mechanisms, and treatment approaches.

Although the anatomical basis of the pathogenesis of sinus node dysfunction (SND) and atrial fibrillation (AF) is located primarily in the left and right atria, increasing evidence suggests a strong correlation between SND and AF, in terms of both clinical presentation and formation mechanisms. However, the exact mechanisms underlying this association are unclear. The relationship between SND and AF may not be causal, but is likely to involve common factors and mechanisms, including ion channel remodeling, gap junction abnormalities, structural remodeling, genetic mutations, neuromodulation abnormalities, the effects of adenosine on cardiomyocytes, oxidative stress, and viral infections. Ion channel remodeling manifests primarily as alterations in the "funny" current (If) and Ca2+ clock associated with cardiomyocyte autoregulation, and gap junction abnormalities are manifested primarily as decreased expression of connexins (Cxs) mediating electrical impulse propagation in cardiomyocytes. Structural remodeling refers primarily to fibrosis and cardiac amyloidosis (CA). Some genetic mutations can also cause arrhythmias, such as SCN5A, HCN4, EMD, and PITX2. The intrinsic cardiac autonomic nervous system (ICANS), a regulator of the heart's physiological functions, triggers arrhythmias.In addition, we discuss arrhythmias caused by viral infections, notably Coronavirus Disease 2019 (COVID-19). Similarly to upstream treatments for atrial cardiomyopathy such as alleviating CA, ganglionated plexus (GP) ablation acts on the common mechanisms between SND and AF, thus achieving a dual therapeutic effect.

The Neandertal nature of the Atapuerca Sima de los Huesos mandibles.

The recovery of additional mandibular fossils from the Atapuerca Sima de los Huesos (SH) site provides new insights into the evolutionary significance of this sample. In particular, morphological descriptions of the new adult specimens are provided, along with standardized metric data and phylogenetically relevant morphological features for the expanded adult sample. The new and more complete specimens extend the known range of variation in the Atapuerca (SH) mandibles in some metric and morphological details. In other aspects, the addition of new specimens has made it possible to confirm previous observations based on more limited evidence. Pairwise comparisons of individual metric variables revealed the only significant difference between the Atapuerca (SH) hominins and Neandertals was a more vertical symphysis in the latter. Similarly, principal components analysis of size-adjusted variables showed a strong similarity between the Atapuerca (SH) hominins and Neandertals. Morphologically, the Atapuerca (SH) mandibles show nearly the full complement of Neandertal-derived features. Nevertheless, the Neandertals differ from the Atapuerca (SH) mandibles in showing a high frequency of the H/O mandibular foramen, a truncated, thinned and inverted gonial margin, a high placement of the mylohyoid line at the level of the M3, a more vertical symphysis and somewhat more pronounced expression of the chin structures. Size-related morphological variation in the SH hominins includes larger retromolar spaces, more posterior placement of the lateral corpus structures, and stronger markings associated with the muscles of mastication in larger specimens. However, phylogenetically relevant features in the SH sample are fairly stable and do not vary with the overall size of the mandible. Direct comparison of the enlarged mandibular sample from Atapuerca (SH) with the Mauer mandible, the type specimen of H. heidelbergensis, reveals important differences from the SH hominins, and there is no morphological counterpart of Mauer within the SH sample, suggesting the SH fossils should not be assigned to this taxon. The Atapuerca (SH) mandibles show a greater number of derived Neandertal features, particularly those related to midfacial prognathism and in the configuration of the superior ramus, than other European middle Pleistocene specimens. This suggests that more than one evolutionary lineage co-existed in the middle Pleistocene, and, broadly speaking, it appears possible to separate the European middle Pleistocene mandibular remains into two distinct groupings. One group shows a suite of derived Neandertal features and includes specimens from the sites of Atapuerca (SH), Payre, l'Aubesier and Ehringsdorf. The other group includes specimens that generally lack derived Neandertal features and includes the mandibles from the sites of Mauer, Mala Balanica, Montmaurin and (probably) Visogliano. The two published Arago mandibles differ strongly from one another, with Arago 2 probably belonging to this former group, and Neandertal affinities being more difficult to identify in Arago 13. Outside of the SH sample, derived Neandertal features in the mandible only become more common during the second half of the middle Pleistocene. Acceptance of a cladogenetic pattern of evolution during the European middle Pleistocene has the potential to reconcile the predictions of the accretion model and the two phases model for the appearance of Neandertal morphology. The precise taxonomic classification of the SH hominins must contemplate features from the dentition, cranium, mandible and postcranial skeleton, all of which are preserved at the SH site. Nevertheless, the origin of the Neandertal clade may be tied to a speciation event reflected in the appearance of a suite of derived Neandertal features in the face, dentition and mandible, all of which are present in the Atapuerca (SH) hominins. This same suite of features also provides a useful anatomical basis to include other European middle Pleistocene mandibles and crania within the Neandertal clade.

OpNotes and Clinical Exercises: Activities to Enhance the Clinical Context of the Preclerkship Anatomy Dissection Laboratory.

Despite numerous pedagogical approaches and technologies now available for medical gross anatomy, students can find it difficult to translate what occurs in a dissection laboratory into the context of clinical practice. Using complementary and collaborative approaches at 2 different medical schools, Virginia Commonwealth University (VCU) and University of Maryland (UM), we designed and implemented a series of clinical activities in the preclerkship medical gross anatomy laboratory that directly link dissected structures to clinical procedures. These activities specifically direct students to perform simulated clinically related procedures on anatomic donors during laboratory dissection sessions. The activities are called OpNotes at VCU and Clinical Exercises at UM. Each activity in the VCU OpNotes requires about 15 minutes of group activity at the end of a scheduled laboratory and involves faculty to grade the student responses submitted via a web-based-assessment form. Each exercise in UM Clinical Exercises also requires about 15 minutes of group activity during the schedule laboratory but does not involve faculty to complete grading. Cumulatively, the activities in OpNotes and Clinical Exercises both brought clinical context directly to anatomical dissections. These activities began in 2012 at UM and 2020 at VCU, allowing a multiyear and multi-institute development and testing of this innovative approach. Student participation was high, and perception of its effectiveness was almost uniformly positive. Future iterations of the program will work to assess the efficacy of the program as well as to streamline the scoring and delivery of the formative components. Collectively, we propose that the concept of executing clinic-like procedures on donors in anatomy courses is an effective means of enhancing learning in the anatomy laboratory while concurrently underscoring the relevance of basic anatomy to future clinical practice.

Measurement of bony anatomical parameters of the distal ulna based on healthy adult data: A cross-sectional study.

This study sought to conduct several three-dimensional measurements of the distal ulna in healthy Han Chinese, providing the anatomical basis for the diagnosis and treatment of hand trauma, distal ulnar disorders, and the design of wrist prostheses. 50 Han Chinese men and women that underwent computed tomography (CT) scans of the distal ulnar carpus were included in the present study. A three-dimensional digital model of the distal ulna was reconstructed using Mimics software. Moreover, the anatomical data of 10 indicators were measured using MIMICS software. Each index data was measured by 2 investigators independently, and the average value was taken. The data were stratified and compared between left and right sides and men and women. A 3D digital model of the distal ulnar bone with a realistic shape was reconstructed. The 10 anatomical parameters measured are as follows: The length of the ulnar styloid process (posterior anterior), The length of the ulnar styloid process(anterior and posterior); the transverse diameter of the ulnar head; the anteroposterior diameter of the ulnar head. The radial inclination angle of the ulna; the ulnar inclination angle; the distal space between the ulna and radius; the ulnar notch angle of the lower radius. The anterior and posterior diameters of the ulnar notch of the lower radius, and the superior and inferior diameters of the ulnar notch of the lower radius. Statistical analysis showed no significant difference after stratification by laterality and gender. our findings can providing the anatomical basis for the diagnosis and treatment of hand trauma, distal ulnar disorders and further improve currently available wrist joint prostheses. Observational, Cross-sectional study, LOE: Level II.

Review of Orthoplastic Techniques for Lower Extremity Reconstruction: Part One

Orthoplastic techniques are effective tools for limb salvage in the lower extremity. In order to apply proper techniques successfully, a surgeon must be aware of all the different types of flaps available. Proper pre-operative evaluation and patient selection are also important factors. The following review covers six papers that give surgeons a strong foundation in the anatomical basis and surgical technique of intrinsic muscle flaps and other fasciocutaneous or adipofascial flaps of the foot. These flaps, along with split thickness skin grafts, external fixation, and dermal regenerative templates, quickly close soft tissue deficits in the foot and ankle that often lead to infection and amputation. Successfully treating soft tissue defects of the foot and ankle extend life, preserve limbs, and increase function for patients.

Anatomical Basis for the Lower Eyelid Rejuvenation.

The tear trough, hollow concavity of the lower eyelid, is one of the recognizable signs of facial aging. Anatomical description is essential in improving tear through deformity for facial rejuvenation. Fifty cadaver were microdissected. Fat pad types, fat herniation and the fibrous support system of lower lid were investigated. The areas of the fat compartments were compared using photogrammetry method and ImageJ software. Lower lids develop palpebral bags as a result of herniation of orbital fat against a weak orbital septum in all cases (%100). The attachment of the arcus marginalis at the orbital edge is a large contributor to the middle-aged appearance of the midface in all cases (100%). The most common type is Type 1 (36%). In this type, three distinct fat pads were diverged by arcuate expansion at lateral, fascia of the inferior oblique muscle at medial, as central, medial and lateral. Type 2 specimens (20%) were observed with two fat pads. Double convexity contour is in Type 3 cases (%44). It is determined that the medial fat pads are located in larger areas. Also, herniation is particularly evident in the medial and mediocentral fat pads. Analysis of the lower lid morphology enables surgeons to apply safe and effective procedures. The inferior oblique muscle and arcuate expansion structures should be supported and not be damaged during surgical interventions. Surgeons should focus mainly on the anatomical data obtained, and in this sense, surgeons apply them during aesthetic and reconstructive procedures of the lower eyelids. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical characteristics of anomalous aortic origin of a coronary artery in children

Objective: To analyze the clinical characteristics, diagnosis and treatment of anomalous aortic origin of a coronary artery (AAOCA) in children. Methods: There were 17 children diagnosed with AAOCA from January 2013 to January 2022 in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine.Their clinical manifestations, laboratory and imaging data, treatment and prognosis were retrospectively analyzed. Results: These 17 children included 14 males and 3 females, with the age of (8.7±3.5) years. There were 4 anomalous left coronary artery (ALCA) and 13 anomalous right coronary artery (ARCA). Seven children presented with chest pain or chest pain after exercise, three patients presented with cardiac syncope, one complained chest tightness and weakness, and the other six patients had no specific symptoms. Cardiac syncope and chest tightness occurred in patients with ALCA. Fourteen children had the dangerous anatomical basis of myocardial ischemia caused by coronary artery compression or stenosis on imaging. Seven children had coronary artery repair, of whom two were ALCA and five were ARCA. One patient had received heart transplantation because of heart failure. The incidence of adverse cardiovascular events and poor prognosis in ALCA group was higher than that in ARCA group (4/4 vs. 0/13, P<0.05). They were followed up in the outpatient department regularly for 6 (6, 12) months; except for the one who lost visit, the rest of the patients had a good prognosis. Conclusions: Cardiogenic syncope or cardiac insufficiency usually occurs in ALCA, and adverse cardiovascular events and poor prognosis are more common in ALCA than in ARCA. Early surgical treatment should be considered for children with ALCA and ARCA accompanied by myocardial ischemia.

Anatomic Basis of Ankle Instability

The surgeon must have a thorough understanding of ankle ligamentous anatomy in order to grasp new concepts including ankle microinstability and rotational instability. The anterior talofibular ligament (ATFL) has 2 fascicles, a superior fascicle which is intra-articular and an inferior fascicle which is extra-articular. Located within the ankle joint but extrasonovial, the superior fascicle of the ATFL lacks the capacity to heal after a moderate ankle sprain. Because this fascicle controls talar internal rotation, any deficiency may lead to ankle microinstability, which in turn may lead to chronic overloading of the deltoid ligament’s most anterior fascicles and chronic rotational instability. The ATFL inferior fascicle, the calcaneofibular ligament and their connecting fibers form the lateral fibulotalocalcaneal ligament complex. An injury of the lateral fibulotalocalcaneal ligament complex will lead to classic chronic ankle instability. These new findings on the ankle ligaments have major implications for ankle instability. Level of Evidence: Diagnostic Level V — expert opinion. See Instructions for Authors for a complete description of levels of evidence.