Anatomical Changes Research Articles

Three-dimensional assessment of upper airway changes associated with mandibular positional deviations following fibula free flap reconstruction

ObjectivesFibula free flaps (FFF) are the standard approach to mandibular reconstruction after partial resection, with the goal of restoring aesthetics and masticatory function. The graft position affects both and must be carefully selected. Correlations between sagittal positioning and upper airway anatomy are known from orthognathic surgery. This study aims to evaluate changes in mandibular position and upper airway anatomy after reconstructive surgery with FFF and corresponding correlations.Materials and methodsMandibular position after reconstruction was evaluated using three-dimensional datasets of pre- and postoperative computed tomography scans of patients treated between 2020 and 2022. Three-dimensional measurements were performed on both condyles and the symphyseal region. Changes in upper airway volume and minimum cross-sectional area (minCSA) were analysed. Intra-rater reliability was assessed. Correlations between changes in upper airway anatomy and sagittal mandibular position were tested.ResultsThe analysis included 35 patients. Intra-rater reliability was good to excellent. Condylar deviations and rotations were mostly rated as small. Changes in symphyseal position were considerably greater. Median airway volume decreased in the oropharynx and hypopharynx. Posterior deviation of the symphysis was associated with a decreasing minCSA in the hypopharynx and vice versa.ConclusionsThe overall accuracy of mandibular reconstructions with FFF is high, but there is room for optimization. The focus of research should be extended from masticatory to respiratory rehabilitation.Clinical relevanceEffects on respiratory function should be considered prior to graft positioning. The clinical relevance of upper airway changes within the complex rehabilitation of reconstructive surgery patients needs to be further investigated.

ONTOGENETIC TRANSFORMATIONS OF BONES OF THE HUMAN ORBIT

Introduction. Elucidation of the sources of human orbital bones, clarifi cation of the sequence of their ossifi cation will allow to create a morphological basis for eff ective interpretation of the data of fetal condition monitoring, will contribute to early diagnosis of variants of the structure and possible malformations of the head, organ of vision and related structures.The aim of the study. The aim of this work was to fi nd out the sources of origin, the chronology of ossifi cation, the characteristics of age-related topographic and anatomical changes in the bones of the orbit.Material and methods. 18 series of histological sections of samples of human embryos and pre-fetuses at the age of 4-12 weeks of intrauterine development (4,0-80,0 mm parietal- coccygeal length) and samples of 12 fetuses at the age of 4-9 months of intrauterine development (130,0-450. 0 mm parietal- calcaneal length) using a complex of morphological research methods (anthropometry, morphometry, preparation of histological sections, dissection, three- dimensional reconstruction of series of histological sections and computer tomography, statistical analysis).The study was conducted in accordance with the main provisions of the European Union Convention on Human Rights andBiomedicine (1997), as well as the Helsinki Declaration on Ethical Principles of Medical Research Involving Human Subjects(1964-2008), EU Directive No. 609 (1986), Order of the Ministry of Health of Ukraine dated 23.09.2009 No. 690.The work was carried out within the framework of the initiative research work of the Department of Histology, Cytology andEmbryology of the Bukovinian State Medical University «Structural and functional peculiarities of tissues and organs in ontogenesis, regularities of variant, constitutional, sex and age-related and comparative human morphology». State registration number: 0121U110121. Deadlines: 01.2021-12.2025.The results. The fi rst signs of the appearance of ossifi cation centers around the main nervous and visceral contents of the rudiment of the orbit are determined in 6-week-old embryos in the form of seven cartilaginous bone models, and the fi rst centers of ossifi cation among the rudiments of bones participating in the formation of the orbit are found in the rudiment of the maxilla. In the 6th month of intrauterine development, the processes of ossifi cation of the frontal, sphenoid, ethmoid and maxillary bones begin. At the end of the 8th month of intrauterine development, due to the ossifi cation processes of the lesser wing of the sphenoid and frontal bones, the orbit acquires features of a defi nitive structure.From the beginning of the fetal period of human ontogenesis, ossifi cation of the structures of the sphenoid bone continues, which leads to morphological transformations of the orbit in 5-month fetuses – it is separated from the sphenopalatine and infratemporal fossa by a bone layer, the optic canal is formed, and in 6-month fetuses processes of ossifi cation of the frontal, sphenoid, ethmoid and maxillary bones, and Müller’s orbital muscle changes its structure into a fi brous one.The analysis of the age-related dynamics of the morphometric parameters of the orbit during the fetal period of intrauterine development made it possible to establish the peculiarities of changes in its diameter, circumference and area, which are expressed by mathematical functions: diameter of the orbit, mm = –0. 2285+0.4704*x; circumference of the orbit, mm = –0.2924+1.4595*x; area of the orbit, mm2 = –87.8597+8.0387*x, where x is the age of the human fetus in weeks.Conclusion. The critical periods of the development of the orbit are the 6th month of prenatal ontogenesis, during which there is an uneven growth rate of the horizontal size of the orbit in relation to the vertical one, and its shape returns to the mesoconchal, which was previously observed in fetuses, as well as the 8th month, during which the growth of all parameters of the orbit slows down due to intensive processes of organogenesis of its visceral structures.

INDICATORS OF MUC 5AC AND MUC 1 MUCOPOLYSACCHARIDE EXPRESSION IN THE NASAL MUCOSA OF PATIENTS WITH POSTNASAL DRIP SYNDROME AND NASAL SEPTUM DEVIATION

Introduction. Determining the cause of postnasal drip syndrome can be quite challenging. Nasal septum deformation has been recognized as one possible factor. Understanding the fundamental processes of postnasal drip syndrome is crucial for developing targeted therapeutic strategies for treating this pathology. In our study, we examined the clinical and histological features of postnasal drip syndrome in individuals with nasal septum deformation and investigated the expression of mucopolysaccharides, specifically the indicators of MUC 5AC and MUC 1.
 The aim. This study aims to investigate the clinical and histological aspects of postnasal drip syndrome (PNDS) in patients with nasal septum deformation. Specifically, the study aims to explore the expression levels of MUC5AC and MUC1 in biopsies of the nasal turbinate mucosa.
 Materials and methods. A total of 29 samples of nasal mucosa from the lower nasal turbinates were collected. These samples were divided into two groups: patients with nasal septum deviation with and without postnasal drip syndrome. Levels of MUC5AC and MUC1 were determined using Western blot analysis.
 Results. Upon analysis of histological sections, we identified a significant increase in tissue metaplasia and lymphoid infiltration in the nasal mucosa of patients with postnasal drip syndrome compared to the control group. The levels of mucopolysaccharides, MUC5AC and MUC1, were higher in the nasal mucosa of the research group compared to the control group.
 Conclusions. The obtained data suggest that anatomical changes in the nasal cavity may play a role in the development of postnasal drip syndrome through alterations in mucin secretion.

Formulation and Characterization of Glucosamine Sulphate Potassium Chloride (GSPC) Loaded Emulgel for the Treatment of Osteoarthritis.

Osteoarthritis (OA) is becoming a major medical burden worldwide due to changing lifestyles and aging populations. Osteoarthritis is a disease characterized by a variety of anatomic and physiological changes to joints, including cartilage degradation, bone remodeling, and the formation of osteophytes. These changes cause pain, stiffness, swelling, and limitations in joint function. Glucosamine serves as a fundamental constituent for cartilage, the resilient connective tissue responsible for cushioning joints. Glucosamine Sulphate Potassium Chloride (GSPC) supplementation is widely employed to mitigate symptoms linked to osteoarthritis, a degenerative joint disorder hallmarked by cartilage degradation. Palliative care aims at minimizing pain and disability and improving function, performance, and quality of life. In this study, the emulgel formulation of GSPC was developed and checked for its potential. Currently, OA does not have a definitive treatment. Since conventional dosage forms cannot deliver the active drug content at a predefined target site in a predictable manner throughout the treatment period, a new carrier system is always required. Considering their reduced size, targeting potential, and site specificity, nanocarrier-based approaches could hold an answer to shortcomings associated with conventional routes. Thus, the objective of the current study was to formulate and characterize glucosamine sulphate potassium chloride-loaded emulgel for the treatment of osteoarthritis. Microemulsion of glucosamine sulphate potassium chloride was formulated using a spontaneous emulsification method comprising of oleic acid (oil phase), Tween 80, Tween 20 (surfactant) and PEG 400, Span 80 (co-surfactant), and distilled water (aqueous phase). The microemulsions were evaluated for surface morphology, globule size, poly-dispersibility index (PDI), zeta potential, and viscosity, and the final batch of microemulsions was selected. The optimized microemulsion contained 35% co-surfactant (propylene glycol), 20% surfactant (Tween 20), and 15% oil (oleic acid) and glucosamine sulphate potassium chloride in a dose of 60 mg, which has sufficient drug loading capacity with a droplet size of 182 nm for optimized formulation. The optimized microemulsion formulation was added to gel prepared by Carbopol 934 in a 1:1 (w/w) ratio, leading to the formulation of glucosamine sulphate potassium chloride- containing emulgel. The prepared emulgel was further evaluated for viscosity, drug content, pH, and in-vitro drug release. Emulgel formulation (F6) showed 88% drug release after 6 hours, and it followed the Higuchi model. Glucosamine Sulphate Potassium Chloride (GSPC) is used in the treatment of OA by increasing the production of proteoglycans, which can cause the cartilage to break down. Emulgel formulation (F3) showed 75.41% drug release, and formulation (F6) showed 88% drug release after 6 h. Therefore, it may be concluded that an emulgel of GSPC can be used as a controlled-release dosage form of the drug for local application in OA.

National variation in guidance for the management of pregnant women presenting with major trauma.

The initial assessment of pregnant women presenting with significant injuries is more complicated than that of non-pregnant women because of physiological and anatomical changes, and the presence of the fetus. The aim of this study was to determine whether guidelines for the early management of severely injured pregnant women exist, which aspects of assessment/management they cover and to what extent there is national consistency. A freedom of information request was submitted to 125 acute National Health Service trusts in England and six in Wales. The trusts were asked to confirm whether they have a guideline for the management of major trauma in pregnant women presenting to the emergency department and what the guidelines were. In total, 96.2% of trusts responded, of which 19% have a specific guideline and 7.9% have a generic guideline for assessing pregnant women in the emergency department, irrespective of injury severity. Of the responding trusts, 19.8% have a protocol that specifies when an obstetric trauma call should be put out by the emergency department and when a pregnant woman should be transferred to a major trauma centre for definitive management. Our results found that 69.8% routinely call obstetrics or gynaecology to the trauma call compared with 36.5% calling paediatrics. The heterogeneity evident across trusts necessitates the establishment of national guidelines for the assessment of pregnant women with major trauma to standardise communication and delivery of care.

Assessing the role of meat consumption in human evolutionary changes. A review

The historical study of changes in food patterns is an integral part of the study of biological and social adaptations during the formation and further development of Homo sapiens species. For quite a long time, diets have been considered the driving force of human evolution. Changes in the type of food consumed and the way it was obtained have been associated with encephalization and the emergence of bipedalism, as well as ecological, social and cultural evolution of hominins1 . Archaeological and paleontological evidence indicates that at least about 3 million years ago, hominins increased their meat consumption and developed the necessary fabricated stone tools, while their brains and bodies evolved for a novel foraging niche and expanded hunting grounds. Animalsource foods have always been an integral part of the human diet. However, the way they are obtained and processed changed dramatically during human evolution. Meat became a common food source when systematic hunting began using technologies and tools focused on killing animals and meat cutting, which reduced the time and effort spent on chewing food, and later, on its cooking. At some point after this, humans began to hunt together, which made it possible to obtain meat from big game, and as a result, develop the social and altruistic skills to distribute the prey between sexes and ages. The eating habits of our ancestors have been studied using a variety of methods, including anthropometry, the use of archaeological data, and isotope analysis of bones and teeth to determine trophic status. The adaptive biological significance of meat-eating, which played an important role in human evolution, was analyzed, including the “expensive tissue hypothesis” draw attention to the evolutionary forces responsible for the increase in hominin brain size. Furthermore, data on changes in human anatomy, digestion and metabolism are systematized, indicating an evolutionary dependence on and compatibility with significant meat consumption. At the same time, a number of changes in the human body are associated with the skill of using fire in cooking. Heat processing of food stimulated our ancestors to overcome the food specialization intrinsic to animals. The question of what is the right diet for the human species and what are the potential consequences of limiting meat consumption is briefly addressed.

Using the gamma-index analysis for inter-fractional comparison of in-beam PET images for head-and-neck treatment monitoring in proton therapy: A Monte Carlo simulation study

Goal:In-beam Positron Emission Tomography (PET) is a technique for in-vivo non-invasive treatment monitoring for proton therapy. To detect anatomical changes in patients with PET, various analysis methods exist, but their clinical interpretation is problematic. The goal of this work is to investigate whether the gamma-index analysis, widely used for dose comparisons, is an appropriate tool for comparing in-beam PET distributions. Focusing on a head-and-neck patient, we investigate whether the gamma-index map and the passing rate are sensitive to progressive anatomical changes. Methods/materials:We simulated a treatment course of a proton therapy patient using FLUKA Monte Carlo simulations. Gradual emptying of the sinonasal cavity was modeled through a series of artificially modified CT scans. The in-beam PET activity distributions from three fields were evaluated, simulating a planar dual head geometry. We applied the 3D-gamma evaluation method to compare the PET images with a reference image without changes. Various tolerance criteria and parameters were tested, and results were compared to the CT-scans. Results:Based on 210 MC simulations we identified appropriate parameters for the gamma-index analysis. Tolerance values of 3 mm/3% and 2 mm/2% were suited for comparison of simulated in-beam PET distributions. The gamma passing rate decreased with increasing volume change for all fields. Conclusion:The gamma-index analysis was found to be a useful tool for comparing simulated in-beam PET images, sensitive to sinonasal cavity emptying. Monitoring the gamma passing rate behavior over the treatment course is useful to detect anatomical changes occurring during the treatment course.

263 Radiographic Structural Changes in Brain Anatomy of Pediatric Fetal Versus Postnatal Myelomeningocele Repair Patients

INTRODUCTION: Postnatally repaired myelomeningocele (MMC) patients have twice the risk of needing shunt treatment for hydrocephalus compared to fetally repaired patients, however it is unknown why exactly this occurs as well as what structural brain changes may be predictive of hydrocephalus. We radiographically characterized anatomic changes in fetally vs postnatally treated infants to understand early developmental anatomy. METHODS: MRIs were characterized by two board-certified neuroradiologists for the following variables: 1) The ratio of ventricular-to-subarachnoid space (VSAR) using bifrontal (BF), left frontal lobe thickness (LV), and extra-axial (EA) spaces as parameters. 2) The ratio of 2 planes within the lateral ventricle (LVR). These ratios, elongation of the choroid plexus glomus and body, and Chiari were measured. RESULTS: 54 MMC repair patients met criteria, yielding 109 MRIs. In the one-to-three month time frame, VSAR at BF and LV parameters in addition to LVR were all significantly different in the fetally repaired group (n = 14) compared to the postnatally repaired group (n = 13, p<0.05). VSAR was not significantly different in early life. Chiari was significantly different in the early life and one-to-three month time between fetal and postnatal repair cohorts (p < 0.05). CONCLUSIONS: Fetally and postnatally repaired MMC brain MRIs were examined by two neuroradiologists to characterize differences in early brain development. This study identified significant differences in the ventricular to subarachnoid space ratio during the one-to-three month time point between fetally and postnatally repaired patients. We suspect that subarachnoid anatomy may be predictive of the need for surgical treatment of hydrocephalus.

Recurrence and Mortality Rate in a 42 Patient Cohort of Giant Meningiomas

BackgroundGiant meningiomas may show special features in terms of biological behavior and management. We aimed to research recurrence and mortality of giant meningiomas. MethodsMedical files of patients with meningioma with at least one dimension of ≥5 cm in any plane in radiological investigations between December 2012 and January 2022 were retrospectively reviewed. Tumor dimensions were measured on magnetic resonance images except one. All patients except two underwent clinical follow-up at a mean of 27.19 ± 29.87 (range, 4–112) months. ResultsThere were 42 patients, 26 (61.9%) women and 16 (38.1%) men who ranged in age from 31 to 85 (mean, 60.31 ± 14.86) years. Headache (57.1%) was the most common symptom. The mean tumor size was 70.14 ± 19.03 (range, 50–152) mm. Tumors were most located at the frontal convexity (40.5%). Simpson grade I resection was achieved in 19% of the cases. The tumors were World Health Organization (WHO) grade 1 in 74% and grade 2 in 26% of the cases. Major complications developed in 26.1% of the patients. Recurrence happened in 5 (11.9%) cases. The number of WHO grade 2 tumors (p = 0.013; p<0.05) and tumor size (p = 0.006; p<0.01) were significantly higher in the recurrent cases. Mortality was % 11.9 and statistically significantly higher in the recurrence group (p = 0.025; p<0.05). ConclusionGiant intracranial meningiomas are challenging because of surgical experience, tumor size, peritumoral edema, blood supply, anatomical changes, and limited visibility. They have a high risk of recurrence and mortality.

Adapt-On-Demand: A Novel Strategy for Personalized Adaptive Radiotherapy for Locally Advance Lung Cancer

Real time adaptation of thoracic radiation plans is compelling because offline adaptive experiences show that tumor volumes and lung anatomy can change during therapy. We present and analyze a novel adaptive-on-demand (AOD) workflow combining online adaptive radiotherapy (ART) on the ETHOS system with image-guided radiotherapy (IGRT) delivery on a Halcyon unit for conventional fractionated radiotherapy of locally advanced lung cancer (LALC). We analyzed 26 LALC patients treated with the AOD workflow, adapting weekly. We timed segments of the workflow to evaluate efficiency in a real world clinic. Target coverage and OAR doses were compared between adapted plans (ADP) and scheduled plans without adaptation (SCH). Planning robustness was evaluated by the frequency of preplanning goals being achieved in ADP plans, stratified by tumor volume change. The AOD workflow was achievable within 30 min for most radiation fractions. Over the course of therapy we observed an average 26.6% ± 23.3% reduction in ITV volumes. Despite these changes, with online adaptive radiation therapy (o-ART), ITV and PTV coverage (V100%) was 99.2% and 93.9% for all members of the cohort. This represented a 2.9% and 6.8% improvement over non-adapted plans (p<0.05). For tumors that grew > 10%, V100% was 93.1% for o-ART, while it was 76.4% for non-adaptive plans, representing a median 17.2% improvement in the PTV coverage (p < 0.05). In these plans, critical OAR constraints were met 94.1% of the time, whereas in non-adapted plans it was 81.9%. This represented reductions of 1.32 Gy, 1.34 Gy, or 1.75 Gy in heart, esophagus, and lung, respectively. The effect was larger when tumors had shrunk more than 10%. Regardless of tumor volume alterations, the PTV/ITV coverage was achieved for all adaptive plans. Exceptional cases, where dose constraints were not met, were due to large initial tumor volumes or tumor growth. The AOD workflow is efficient and robust in responding to anatomical changes in LALC patients, providing dosimetric advantages over standard therapy. Weekly adaptation was adequate to keep pace with changes. This approach is a feasible alternative to conventional offline replanning workflows for managing anatomy changes in LALC radiotherapy.

Total Ankle Replacement with Built-in Antibiotic Spacer: A Paradigm Shift in the Management of Infected Ankles

Introduction/Purpose: Infection of an ankle fracture is a devastating complication that can lead to chronic pain, limited motion or amputation. Traditional treatment strategies after infection involve aggressive surgical debridement, implant removal and prolonged antibiotic therapy. Non-anatomic cement spacers for the tibiotalar joint have previously been described with mixed results. Articulating spacers have shown improved outcomes and may be used as definitive treatment. Currently, there are no prefabricated TAR spacers on the market. The use of 3D printing to create custom implants is emerging, however, there is a paucity of literature regarding their use. We present a case of post-infectious ankle arthritis in 14 year old patient treated with a 3D printed total ankle replacement with built in antibiotic spacer (TAR-AS). Methods: A CT scan was performed in accordance with computer aided design (CAD) parameters. Bilateral lower extremities were scanned to allow the unaffected side to be mirrored and be the basis for implant design. Slice spacing less than 1.25mm with pixel size of 0.5mm. The studies were in DICOM files and within a timeframe where no significant change in patient anatomy had occurred. The implants were fabricated by selective laser melting (SLM) of cobalt chrome alloy (CoCrMo) by Restor3d (Durham, NC). Our design incorporated a stacked gyroid component to facilitate antibiotic cement impregnation. In terms of surgical technique, the custom TAR-AS followed a similar approach to a patient specific TAR procedure. Prior to implantation, the gyroid component of the TAR-AS was filled with Simplex bone cement with tobramycin (Stryker). Results: At six months postoperatively, our patient reported no limitation in activities. AOFAS scores improved from 46/100 preoperatively to 83/100 at six months postoperatively. Radiographic parameters showed no signs of implant failure, loosening or change in alignment. Intraoperative cultures remained negative. Conclusion: We present a case demonstrating the utilization of 3D generated prostheses for treatment of post-infection ankle arthritis. The TAR-AS represents a significant advancement in the management of ankle infections. This innovative approach combines the benefits of joint replacement and continued antibiotic elution. With further research and continued technological advancements, the TAR-AS has the potential to become the gold standard for the treatment of infected TAR. Despite the promising results, challenges remain in the implementation of TAR-AS. Long term follow up studies are needed to evaluate the durability and longevity of the implant. Total ankle with built in antibiotic spacer Superior view of tibial tray with antibiotic cement packed in gyroid

Ayurveda Approach towards Respiratory Illness in Children

Abstract: Preventable diseases such as pneumonia, diarrhoea, and other infections are the leading causes of morbidity in children, therefore each child's physical and emotional needs differ according to their age, personality, and developmental stage. 15% of children suffer from RRTIs. Predisposing variables include immune system inadequacies, anatomic and functional changes in the respiratory tract, air pollution exposure, and poor socioeconomic conditions. RRTIs are a prevalent disorder, especially in children under the age of six, and are usually caused by poor environmental conditions. 60% of patients had bacterial growth but RRIs begin as a viral respiratory tract infection and symptoms of infection for at least 10 days.i URTI is most common known cause of morbidity in children, which causes limiting daily activities and causing school absence.

Bank erosion and erosion processes from dendrogeomorphology in southern U.S. prairie streams

AbstractStreambank erosion processes influence the amount of soil material contributed to rivers and sedimentation rates in receiving reservoirs. However, the amount of data on bank erosion rates is limited both in range and extent affecting planning for mitigation and watershed management. Dendrogeomorphology is used to determine the date of wood anatomy changes in annual growth increments of roots exposed by erosion of stream banks that when coupled with measurement of the distance of roots to the channel side can be used to calculate the bank retreat rate. Erosion rates derived from dendrogeomorphology are important because these provide erosion data over longer time scales (decades). Here, we use this method to quantify erosion for three different sized watersheds (4 to 3781 km2) located in the water‐scarce southern U.S. prairies that are heavily reliant on surface water and reservoir storage. From 49 roots from the two smaller drainages, erosion ranged from 1.5 to 25.4. For 19 roots collected from the larger subbasin erosion rates were larger ranging from 7.4 to 325.0 cm/years with the larger values and variance associated with two high‐flow events that occurred a year before sampling. We also found differences in straight and meandering portions of the streams where the distance to bank was strongly and positively correlated with the years since root exposure in straight sections. In contrast, meandering bends also showed a positive but low correlation for root exposure date and distance collected. We attribute this difference to erosional processes (i.e., scour and mass wasting) occurring at these channel locations. When compared with other erosion studies across the southern U.S. prairie, our values were similar in magnitude but with low correlation to drainage area indicating site specificity of erosion mechanisms, and watershed landcover influence for different drainages, despite being in the same ecological region.

Morphological features of the feral pigeon’s (Columba livia f. urbana) digestive system

Peculiarities of the morphological structure of the feral pigeon’s (Columba livia f. urbana) digestive system have been established. In the process of evolution, the digestive system has acquired certain anatomical changes that perform adaptive mechanisms for flying and egg-laying. In pigeons, the rostral part of the skull is represented by a beak consisting of an upper bill (maxilla) and gnathotheca (mandible) part. Due to the absence of a palatal fold, the digestive tract begins with the oropharynx, which lacks lips, teeth, and gums. The gorge is present in both sexes, consists of the right and left parts, and performs the function of accumulating fodder and secreting gorge milk, which is fed to the young through regurgitation. The mucous membrane of the esophagus forms longitudinal folds. There is a large number of digestive glands in the proventriculus. The cavity of the muscular stomach contains gastroliths, which act as teeth, ensuring grinding of food mass. The small intestine consists of the duodenum and ileum, which are joined by the mesentery and form three loops. The mucous membrane is developed, represented by numerous crypts that ensure the absorption of nutrients. The large intestine is represented by the paired rectal cecum and the rectum. The mucous membrane of the thick intestine is represented by leaf-like villi. The muscle layer is the most developed, myocytes are located in circular and longitudinal directions, forming folds

A prior-information-based automatic segmentation method for the clinical target volume in adaptive radiotherapy of cervical cancer.

Adaptive planning to accommodate anatomic changes during treatment often requires repeated segmentation. In this study, prior patient-specific data was integrateda into a registration-guided multi-channel multi-path (Rg-MCMP) segmentation framework to improve the accuracy of repeated clinical target volume (CTV) segmentation. This study was based on CT image datasets for a total of 90 cervical cancer patients who received two courses of radiotherapy. A total of 15 patients were selected randomly as the test set. In the Rg-MCMP segmentation framework, the first-course CT images (CT1) were registered to second-course CT images (CT2) to yield aligned CT images (aCT1), and the CTV in the first course (CTV1) was propagated to yield aligned CTV contours (aCTV1). Then, aCT1, aCTV1, and CT2 were combined as the inputs for 3D U-Net consisting of a channel-based multi-path feature extraction network. The performance of the Rg-MCMP segmentation framework was evaluated and compared with the single-channel single-path model (SCSP), the standalone registration methods, and the registration-guided multi-channel single-path (Rg-MCSP) model. The Dice similarity coefficient (DSC), 95% Hausdorff distance (HD95), and average surface distance (ASD) were used as the metrics. The average DSC of CTV for the deformable image DIR-MCMP model was found to be 0.892, greater than that of the standalone DIR (0.856), SCSP (0.837), and DIR-MCSP (0.877), which were improvements of 4.2%, 6.6%, and 1.7%, respectively. Similarly, the rigid body DIR-MCMP model yielded an average DSC of 0.875, which exceeded standalone RB (0.787), SCSP (0.837), and registration-guided multi-channel single-path (0.848), which were improvements of 11.2%, 4.5%, and 3.2%, respectively. These improvements in DSC were statistically significant (p<0.05). The proposed Rg-MCMP framework achieved excellent accuracy in CTV segmentation as part of the adaptive radiotherapy workflow.

Safe and Accurate Laparoscopic Total Gastrectomy for Remnant Gastric Cancer With Severe Adhesions Using Indocyanine Green Fluorescence Imaging: Guidance in Detection of the Accurate Dissection Layer to Avoid Organ Injury.

Laparoscopic total gastrectomy (LTG) for remnant gastric cancer (RGC) requires advanced techniques due to severe postoperative adhesions and anatomic changes. We performed LTG in 2 patients with RGC using intraoperative indocyanine green (ICG) fluorescence imaging. Both cases previously underwent distal gastrectomy with Billroth-I reconstruction for gastric cancer and were subsequently diagnosed with early-stage gastric cancer of the remnant stomach. Indocyanine green (2.5mg/body) was administered intravenously during surgery. The liver and common bile duct were clearly visualized during surgery using near-infrared fluorescence laparoscopy, and the adhesions between the hepatobiliary organs and remnant stomach were safely dissected. Laparoscopic total gastrectomy was successfully performed without complications, and the postoperative course was uneventful in both cases. Intraoperative real-time ICG fluorescence imaging allows clear visualization of the liver and common bile duct and can be useful in LTG for RGC with severe adhesions.

Impact of bias field correction on 0.35 T pelvic MR images: evaluation on generative adversarial network-based OARs' auto-segmentation and visual grading assessment.

Magnetic resonance imaging (MRI)-guided radiotherapy enables adaptive treatment plans based on daily anatomical changes and accurate organ visualization. However, the bias field artifact can compromise image quality, affecting diagnostic accuracy and quantitative analyses. This study aims to assess the impact of bias field correction on 0.35 T pelvis MRIs by evaluating clinical anatomy visualization and generative adversarial network (GAN) auto-segmentation performance. 3D simulation MRIs from 60 prostate cancer patients treated on MR-Linac (0.35 T) were collected and preprocessed with the N4ITK algorithm for bias field correction. A 3D GAN architecture was trained, validated, and tested on 40, 10, and 10 patients, respectively, to auto-segment the organs at risk (OARs) rectum and bladder. The GAN was trained and evaluated either with the original or the bias-corrected MRIs. The Dice similarity coefficient (DSC) and 95th percentile Hausdorff distance (HD95th) were computed for the segmented volumes of each patient. The Wilcoxon signed-rank test assessed the statistical difference of the metrics within OARs, both with and without bias field correction. Five radiation oncologists blindly scored 22 randomly chosen patients in terms of overall image quality and visibility of boundaries (prostate, rectum, bladder, seminal vesicles) of the original and bias-corrected MRIs. Bennett's S score and Fleiss' kappa were used to assess the pairwise interrater agreement and the interrater agreement among all the observers, respectively. In the test set, the GAN trained and evaluated on original and bias-corrected MRIs showed DSC/HD95th of 0.92/5.63mm and 0.92/5.91mm for the bladder and 0.84/10.61mm and 0.83/9.71mm for the rectum. No statistical differences in the distribution of the evaluation metrics were found neither for the bladder (DSC: p = 0.07; HD95th: p = 0.35) nor for the rectum (DSC: p = 0.32; HD95th: p = 0.63). From the clinical visual grading assessment, the bias-corrected MRI resulted mostly in either no change or an improvement of the image quality and visualization of the organs' boundaries compared with the original MRI. The bias field correction did not improve the anatomy visualization from a clinical point of view and the OARs' auto-segmentation outputs generated by the GAN.

Alcohol associated liver disease and bariatric surgery: Current perspectives and future directions.

Bariatric surgery is a routinely performed procedure and is associated with a reduction in all-cause mortality in patients with obesity. However, bariatric surgery has also been linked to increased alcohol use with up to 30% of these patients developing alcohol use disorder (AUD). The mechanism of AUD after bariatric surgery is multifactorial and includes anatomic, metabolic, and neurohumoral changes associated with post-surgical anatomy. These patients are at increased risk of alcohol associated liver disease and, in some cases, require liver transplantation. In this article, we provide a scoping review of epidemiology, pathophysiology, and clinical outcomes of alcohol-related health conditions after bariatric surgery.

Intraoperative MRI: A Review of Applications Across Neurosurgical Specialties.

Intraoperative MRI (iMRI) made its debut to great fanfare in the mid-1990s. However, the enthusiasm for this technology with seemingly obvious benefits for neurosurgeons has waned. We review the benefits and utility of iMRI across the field of neurosurgery and present an overview of the evidence for iMRI for multiple neurosurgical disciplines: tumor, skull base, vascular, pediatric, functional, and spine. Publications on iMRI have steadily increased since 1996, plateauing with approximately 52 publications per year since 2011. Tumor surgery, especially glioma surgery, has the most evidence for the use of iMRI contributing more than 50% of all iMRI publications, with increased rates of gross total resection in both adults and children, providing a potential survival benefit. Across multiple neurosurgical disciplines, the ability to use a multitude of unique sequences (diffusion tract imaging, diffusion-weighted imaging, magnetic resonance angiography, blood oxygenation level-dependent) allows for specialization of imaging for various types of surgery. Generally, iMRI allows for consideration of anatomic changes and real-time feedback on surgical outcomes such as extent of resection and instrument (screw, lead, electrode) placement. However, implementation of iMRI is limited by cost and feasibility, including the need for installation, shielding, and compatible tools. Evidence for iMRI use varies greatly by specialty, with the most evidence for tumor, vascular, and pediatric neurosurgery. The benefits of real-time anatomic imaging, a lack of radiation, and evaluation of surgical outcomes are limited by the cost and difficulty of iMRI integration. Nonetheless, the ability to ensure patients are provided by a maximal yet safe treatment that specifically accounts for their own anatomy and highlights why iMRI is a valuable and underutilized tool across multiple neurosurgical subspecialties.

Anatomical and functional changes of the fetal adrenal gland in intrauterine growth restriction.

The aim of this study was to demonstrate the establishment of adrenal sparing in intrauterine growth restricted (IUGR) human fetuses. IUGR fetuses are a subgroup of small for gestational age (SGA) fetuses that are unable to reach their own growth potential because of chronic hypoxia and undernutrition. We hypothesized that in IUGR fetuses the adrenal gland is relatively larger and secretion of noradrenaline (NA), adrenaline (A), and cortisol is increased. This is a prospective observational study including 65 singleton pregnancies (42 IUGR and 23 controls). Using two-dimensional ultrasound, we measured fetal adrenal diameters and adrenal/abdominal circumference (AD/AC) ratio between 25 and 37 weeks. We considered only one measurement per fetus. In 21 pregnancies we also measured NA, A, and cortisol levels in arterial and venous fetal cord blood collected at the time of delivery. The AD/AC ratio was significantly higher in IUGR fetuses than in controls. Cord NA and A levels were significantly higher in IUGR fetuses than in controls. An increase in cortisol secretion in IUGR fetuses was observed but the difference was not statistically significant. Adrenal sparing correlates with a relative increase in adrenal measurements and function.