Classic Dissection Research Articles

Prediction of Drug-Induced Liver Injury: From Molecular Physicochemical Properties and Scaffold Architectures to Machine Learning Approaches.

The process of developing new drugs is widely acknowledged as being time-intensive and requiring substantial financial investment. Despite ongoing efforts to reduce time and expenses in drug development, ensuring medication safety remains an urgent problem. One of the major problems involved in drug development is hepatotoxicity, specifically known as drug-induced liver injury (DILI). The popularity of new drugs often poses a significant barrier during development and frequently leads to their recall after launch. In silico methods have many advantages compared with traditional invivo and invitro assays. To establish a more precise and reliable prediction model, it is necessary to utilize an extensive and high-quality database consisting of information on drug molecule properties and structural patterns. In addition, we should also carefully select appropriate molecular descriptors that can be used to accurately depict compound characteristics. The aim of this study was to conduct a comprehensive investigation into the prediction of DILI. First, we conducted a comparative analysis of the physicochemical properties of extensively well-prepared DILI-positive and DILI-negative compounds. Then, we used classic substructure dissection methods to identify structural pattern differences between these two different types of chemical molecules. These findings indicate that it is not feasible to establish property or substructure-based rules for distinguishing between DILI-positive and DILI-negative compounds. Finally, we developed quantitative classification models for predicting DILI using the naïve Bayes classifier (NBC) and recursive partitioning (RP) machine learning techniques. The optimal DILI prediction model was obtained using NBC, which combines 21 physicochemical properties, the VolSurf descriptors and the LCFP_10 fingerprint set. This model achieved a global accuracy (GA) of 0.855 and an area under the curve (AUC) of 0.704 for the training set, while the corresponding values were 0.619 and 0.674 for the test set, respectively. Moreover, indicative substructural fragments favorable or unfavorable for DILI were identified from the best naïve Bayesian classification model. These findings may help prioritize lead compounds in the early stage of drug development pipelines.

Clinical Axillary Staging in Breast Cancer Patients Using Ultrasound Imaging

Introduction: The presence of axillary lymph node involvement is an important prognostic factor and has a major impact on treatment decisions in early breast cancer patients. This study aimed to determine the role of cortical thickness in axillary ultrasound (AUS) as an indicator of lymph node metastasis. Methods: 766 patients with primary breast cancer who received AUS during clinical work-up were selected for this retrospective study. Lymph nodes were defined as suspicious if they showed a cortical thickness of >3.0 mm at 11–15 MHz harmonic imaging ultrasound. Lymph node involvement was assessed by core needle biopsy (n = 150), sentinel node dissection or axillary dissection. Extensive axillary spread (EAS) was diagnosed if more than two lymph nodes showed metastatic disease in histology. Results: AUS for detecting all lymph node metastases had a sensitivity of 62.27%, a specificity of 93.15% and a negative predictive value of 81.74%. However, the resulting negative predictive value for transcapsular growth was 93.97%, and for EAS 97.52%. Conclusion: EAS – in contrast to non-palpable involvement of 1 or 2 lymph nodes – contributes relevantly to the individualization of breast cancer treatment. In combination with SNB, AUS using cortical thickness as the main distinctive parameter seems to be an easily available, robust tool of diagnosing extensive axillary metastases. If AUS proves negative, it helps to reduce the number of classic axillary dissections.

A bilateral four-headed brachialis muscle with a variant innervation: a cadaveric report with possible clinical implications.

Anterior compartment muscles of the arm present high morphological variability, with possible clinical significance. The current cadaveric report aims to describe a bilateral four-headed brachialis muscle (BM) with aberrant innervation. Emphasis on the embryological background and possible clinical significance are also provided. Classical upper limb dissection was performed on an 84-year-old donated male cadaver. The cadaver was donated to the Anatomy Department of the National and Kapodistrian University of Athens. On the left upper limb, the four-headed BM was supplied by the musculocutaneous and the median nerves after their interconnection. On the right upper limb, the four-headed BM received its innervation from the median nerve due to the musculocutaneous nerve absence. A bilateral muscular tunnel for the radial nerve passage was identified, between the BM accessory heads and the brachioradialis muscle. BM has clinical significance, due to its proximity to important neurovascular structures and frequent surgeries at the humerus. Hence, knowledge of these variants should keep orthopedic surgeons alert when intervening in this area. Further dissection studies with a standardized protocol are needed to elucidate the prevalence of BM aberrations and concomitant variants.

Quantitative study of the popliteal fossa in the human fetus.

The popliteal fossa presents an extensive diamond-shaped topographical element on the posterior aspect of the knee. With the use of classical anatomical dissection, digital image analysis of NIS Elements AR 3.0 and statistics we morphometrically analyzed the size of the popliteal fossa in human fetuses aged 17-29 weeks of gestation. Morphometric parameters of the popliteal fossa increased logarithmically with fetal age: y = -44.421 + 24.301 × ln (Age) for length of superomedial boundary, y = -41.379 + 22.777 × ln (Age) for length of superolateral boundary, y = -39.019 + 20.981 × ln (Age) for inferomedial boundary, y = -37.547 + 20.319 × ln (Age), for length of inferolateral boundary, y = -28.915 + 15.822 × ln (Age) for transverse diameter, y = -69.790 + 38.73 × ln (Age) for vertical diameter and y = -485.631 + 240.844 × ln (Age) for projection surface area. Out of the four angles of the popliteal fossa the medial one was greatest, the inferior one the smallest, while the lateral one was somewhat smaller than the medial one and approximately three times greater than the superior one, with no difference with fetal age. In terms of morphometric parameters the popliteal fossa in the human fetus displays neither male-female nor right-left differences. In the popliteal fossa, growth patterns of its four boundaries, vertical and transverse diameters, and projection surface area all follow natural logarithmic functions. All the morphometric data is considered age-specific reference intervals, which may be conducive in the diagnostics of congenital abnormalities in the human fetus.

Current status of surgical treatment for acute aortic dissection in Japan: Nationwide database analysis

ObjectiveTo clarify the current status of surgical treatment of acute aortic dissection (AAD) in Japan through the Japan Cardiovascular Database analysis. MethodsIn total, 7194 patients who underwent surgical treatment for AAD in 2021, including type A (TAAAD) (n = 6416) and type B (TBAAD) (n = 778), were investigated. ResultsThe median age was 70 years, with patients older than age 80 years constituting 21.7% and 23.4% of TAAAD and TBAAD cases. Emergency admission was 88.5% and 78.5%. Shock was found in 11.8% and 6.0%. Rupture/impending rupture occurred in 10.7%/6.0% and 24.0%/11.1%, respectively. Branch malperfusion was complicated in 10.4% and 25.2%. Open repairs were performed in 97.7% and 20.3%, whereas endovascular repairs were performed in 2.3% and 79.7%, respectively. In the increased prevalence of endografting procedures, neurological complications and renal failure occurred frequently after open repair with frozen elephant trunk for 29.9% and 50.3%. The operative mortality rate was 9.8% and 11.5% for open repair and 8.1% and 10.0% for endovascular repair. In patients with TAAAD, age older than 80 years, preoperative critical comorbidities, classical dissection, and coexisting chronic vital organ diseases were independent risk factors for mortality. In frozen elephant trunk procedures, neurologic complications and renal failure were frequent. The operative mortality was higher during the superacute phase within 1 or 2 hours from onset to arrival and between arrival and surgery. ConclusionsThe current status of surgical treatments for AAD including the increased prevalence of endografting of thoracic endovascular aortic repair and frozen elephant trunk were demonstrated with favorable outcomes in the Japan Cardiovascular Database analyses.

A new insight into superacute care for type A acute aortic dissection in the Tokyo Acute Aortic Super Network

ObjectiveTo determine the status of type A acute aortic dissection using the Tokyo Acute Aortic Super Network. MethodsData of 6283 patients with acute aortic dissection between 2015 and 2019 were collected. Data of 3303 patients with type A acute aortic dissection were extracted for analysis. ResultsOverall, 51.0% of patients were nondirect admissions. On arrival, 23.1% of patients were in shock, 10.0% in cardiopulmonary arrest, and 11.8% in deep coma or coma. Overall, 9.8% of patients were assessed as untreatable. Of 2979 treatable patients, 18.3% underwent medical treatment, whereas 80.7% underwent surgery (open [78.8%], endovascular [1.9%], and peripheral [1.1%] repair). The early mortality rate was 20.5%, including untreatable cases. Among treatable patients, in-hospital mortality rates were 8.6% for open repair, 10.7% for endovascular repair, and 25.3% for medical treatment. Advanced age, preoperative comorbidities, classical dissection, and medical treatment were risk factors for in-hospital mortality. Nondirect admission did not cause increased deaths. The mortality rates were high during the superacute phase following symptom onset. ConclusionsThis study demonstrated current practices in the emergency care of type A acute aortic dissection via the Tokyo Acute Aortic Super Network system, specifically a high rate of untreatable or inoperable cases and favorable outcomes in patients undergoing surgical treatment. High mortality rates were observed during the super acute phase after symptom onset or hospital arrival.

Clinical and imaging differences between Stanford Type B intramural hematoma-like lesions and classic aortic dissection

BackgroundIntramural hematoma (IMH) and Aortic dissection (AD) have overlapping features. The aim of this study was to explore the differences between them by comparing the clinical manifestations and imaging features of patients with acute Stanford type B IMH-like lesions and acute Stanford type B AD (ATBAD).MethodsThis study retrospectively analysed the clinical and computed tomography angiography (CTA) imaging data of 42 IMH-like lesions patients with ulcer-like projection (ULP) and 38 ATBAD patients, and compared their clinical and imaging features.Results(1) The IMH-like lesions patients were older than the ATBAD patients (64.2 ± 11.5 vs. 50.9 ± 12.2 years, P < 0.001). The D-dimer level in the IMH-like lesions group was significantly higher than that in the ATBAD group (11.2 ± 3.6 vs. 9.2 ± 4.5 mg/L, P < 0.05). The incidence rate of back pain was significantly higher in the ATBAD group than in the IMH-like lesions group (71.1% vs. 26.2%, P < 0.05). (2) The ULPs of IMH-like lesions and the intimal tears of ATBAD were concentrated in zone 4 of the descending thoracic aorta. The ULPs of IMH-like lesions and the intimal tears of ATBAD were mainly in the upper quadrant outside the lumen (64.3% vs. 65.8%, P > 0.05). (3) The maximum diameter of the ULPs in IMH-like lesions was smaller than that of the intimal tears in ATBAD (7.4 ± 3.4 vs. 10.8 ± 6.8 mm, P = 0.005). The lumen compression ratio in the ULPs plane and the maximum compression ratio of the aortic lumen in the IMH-like lesions group were smaller than that in the ADBAD group (P < 0.05). Fewer aortic segments were involved in IMH-like lesions patients than in ATBAD patients (5.6 ± 2.2 vs. 7.1 ± 1.9 segments, P < 0.005). The IMH-like lesions group had less branch involvement than that of the ATBAD group (P < 0.001).ConclusionThe degree of intimal tears, lumen compression ratio, extent of lesion involvement, and impact on branch arteries in ATBAD are more severe than that of IMH-like lesions. But for the ULPs of IMH-like lesions and intimal tears of ATBAD, they have astonishing similarities in the location of the partition and the lumen quadrant, we have reason to believe that intimal tear is the initial factor in the pathogenesis of this kind of disease, and their clinical and imaging manifestations overlap, but the severity is different. Concerning similarities between these two conditions, these two may be a spectrum of one disease.

Micro-CT imaging in species description: exploring beyond sclerotized structures in lichen moths (Lepidoptera: Erebidae, Arctiinae, Lithosiini).

X-ray micro-computed tomography imaging (micro-CT) is valuable for systematic research since it permits the non-destructive scanning and imaging of internal structures of very rare species and/or type specimens. Additionally, micro-CT allows to view the morphology and the functional anatomy of structures in their natural anatomical position, without deformations that typically occur using classical dissection protocols. In this study we provide the description of two new species of lichen moths (Lepidoptera: Erebidae, Lithosiini) from the Atlantic Forest in eastern Brazil: Nodozana heliae Moraes sp. nov. from Rio de Janeiro state and Epeiromulona pataxo Moraes & Aguiar sp. nov. from Bahia state. The male and female genitalia as well as the wing morphology were examined by means of non-destructive micro-CT, subsequent 3D model reconstruction, 360 degree spinning animations, 2D images from different angles, and those were compared against classical genitalia dissections from the same specimens. We conclude that techniques complement each other, micro-CT being particularly useful to study wing venation, sclerotized internal structures and muscles, while classical dissection is useful to study membranous structures, particularly in the female genitalia, abdominal skin and specialised scales on the male 8th sternite.

Comparison of the incisions used in neck dissection for oral squamous cell carcinoma: a systematic review

Oral cancers are a significant disease group with more than 404,000 new cases worldwide in 2002. The most common cancer of the oral cavity is the squamous cell carcinoma; constituting 95%. The 5-year survival is around 50%. Surgery can be combined with any combination of radiotherapy, chemotherapy and immunotherapy. Spread of the tumour to the cervical nodes is an early and consistent event in the natural history. The extent of cervical involvement is reflected in the staging of the tumour and has prognostic implications. Surgical dissection of the cervical lymph nodes at risk of metastasis may be undertaken as part of the management of the primary tumour. This may be accomplished by classic radical neck dissections, supra ohmohyoid neck dissection, selective neck dissection etc. The aim of the present review is to compare the clinical efficacy, the postoperative complications and the aesthetic outcome of the various incisions used in neck dissection for squamous cell carcinoma. A total of six comparative studies and randomized control studies were included in this systematic review, out of a total of 175 articles yield following the search strategy, from PubMed and Mesh databases. The incisions were compared for access, healing and cosmetic outcome. Trifurcate incisions (‘Y’ incision) were found to have the maximum incidence of wound dehiscence. The apron incision has no reported wound dehiscence and has been described as a robust flap. As far as cosmetics and access as a whole is concerned the reversed hockey stick incision is superior.

Aortic Intramural Hematoma Mimicking Acute Coronary Syndrome

Type A Aortic intramural haematoma (IMH), a variant form of classic aortic dissection, has been accepted as an increasingly recognised and potentially fatal entity of acute aortic syndrome.It is a very dangerous, fatal, and emergency condition. It is very important to recognize the symptoms of acute aortic syndrome related to appropriate management Case Illustration A 52 year old man patient suffered from chest pain with moderate intensity while he was working at home. It was sharp , tear-like sensation, in the middle of the chest radiated to the back, accompanied with cold sweating, and did not relieve by rest. Because of this condition he brought to hospital. From examination at Emergency room, he had cardiomegaly, aortic dilatation. From the Electrocardiography an st elevation at V1-V2 and T inverted V4-V6 precordial lead,I aVL extremities lead and slightly elevated cardiac enzymes with risk factors for active smoking and uncontrolled hypertension. Initially he was suspected of having acute coronary syndrome with differential diagnose acute aortic syndrome. To exclude the diagnose he had underwent cardiac catheterization, the cardiologist in charge suspicious this patient with aortic dissection because of trapping contrast durante procedure and coronary minor disease. For a better diagnosis, transtransthoracic echocardiography and Aortic Computed Tomography angiography was performed on the patient which confirmed the evidence of dissection. After being diagnosed, we treat the patient as an acute aortic syndrome and we stabilize the patient's condition. The patient was planned for cardiac surgery Discussion Acute aortic syndrome, which includes Acute Aortic Dissection, Intramural Hematoma and penetrating aortic ulcer, is difficult to diagnosed. Aortic intramural hematoma, which is one of the acute aortic syndromes, is characterized by the presence of a hematoma in the medial layer of the aortic wall without the appearance of an intimal tear. The incidence of intramural hematoma differs slightly from that of aortic dissection syndrome. Patients with intramural hematomas often occur in older patients, more often with aortic aneurysms The patient receive treatment aggressively to control blood pressure by administering a non-dihydropyridine calcium channel blocker intravenously and then beta blocker, angiotensin II receptor blockers, was also needed. Acute aortic syndrome, where an intramural aortic hematoma can present with varying symptoms of varying severity, which can lead to misdiagnosis and delay in cases of life-threatening disease. In the case of our patient, who had strong cardiac risk factors, His initial presentation described an acute myocardial infarction; the diagnosis was made after CT scan was performed and the patient remained stable Conclussion Complaints of chest pain due to symptoms of acute aortic syndrome are very important to be recognized immediately because they need proper management. Complaints in this syndrome have similarities with complaints in acute coronary syndrome, pulmonary embolism and others. Patients with aortic intramural hematoma are at high risk for developing periaortic hematoma and hemorrhagic pericardial effusion. In patients with an intramural aortic hematoma, Stanford A, the most appropriate management is surgical technique. Initial management of blood pressure control, heart rate and anti-pain can be given. In this case, the choice of a combination of surgery with endovascular may be a logical choice of therapy

Морфоадаптационные особенности кожи коротковолосых пород представителей Felidae

The article presents a comparative morphological characteristic of the skin of representatives of short-haired feline breeds (Russian blue, Burmese) and mongrel cats based on a complex of macro- and micromorphological methods, including classical and fine dissection, light-optical study of histological sections, followed by micromorphometry and statistical processing of quantitative data. The morphological patterns of the skin of the studied cats, as well as the features of the structural organization due to the breed affiliation of the animals are presented. Mestizos reach the maximum value in terms of the total thickness of the skin, dermis and hypodermis, but shorthaired cats are ahead of mongrel cats in terms of the thickness of the epidermis. Bundles of collagen fibers of both layers of the dermis reach their maximum value in mongrel representatives.

Temporomandibular Joint Osteoarthritis Exacerbates with Restored Teeth: A Cadaveric Case Report

The objective of this case report is to begin to investigate the correlations between gross signs and symptoms of osteoarthritis (OA) on cadaveric temporomandibular joints (TMJs) and the restorative care a patient experienced prior to death. Two cadaveric donors (88-years-old male and 93-years-old female) were investigated by classical dissection for gross symptoms of OA on the mandibular condyle and the mandibular fossa using a validated scale for OA disease severity. A Grade 0-4 disease severity score was awarded to the unilateral condyle and mandibular fossa for each patient. An oral exam was performed to assess restorative changes to the dentition. Both patients demonstrated Grade 4 (severe) OA on the mandibular fossa and condyle. This is a finding documented to only affect 23% (7/31) of a previous research cohort of donors; the mandibular fossa typically presents with more severe disease findings compared to the condyle. These specific donors were selected for TMJ disease assessment as a preliminary oral examination revealed substantial restorative findings. Excluding removal of the third molars, the male donor was charted to have 1 missing tooth and 11 restored teeth whereas the female donor was charted to have 17 missing teeth and 11 restored teeth. The 93-years-old female demonstrated a visibly more profound state of disease on the fossa and condyle of the TMJ compared to any other donor assessed by this protocol to date; the fossa demonstrated complete cartilage loss with a substantial concavity on the articular eminence, the condyle was flattened and the articular disc was effectively absent minus a thin fibrocartilaginous ring. It could be concluded that this substantial degree of TMJ OA disease severity, based on this specific validated scale, may relate to a high quantity of restored teeth and may manifest uniformly between the sexes.

Clinical and variational evaluation of peroneus tertius muscle.

This research was conducted to define the typology of the peroneus tertius, which is considered to be a part of the musculus extensor digitorum muscle and plays a role in dorsiflexion and eversion of the foot. In addition, another aim of the study was to examine the relationship of the peroneus tertius with the extensor digitorum longus and to investigate the possible effects of the tendon/insertio properties of the peroneus tertius on the fifth metatarsal. In this study; classical anatomical dissection was performed on 30 lower limbs. In this study, various parameters related to muscle origin, insertion, tendon and muscle dimensions were measured. It has been found that PTM was absent in 26.6% of the specimens and in 23.3% (n = 7) of the cases PTM was directly originated from the EDL. In 56.7% of the specimens (n = 17), the PTM tendon was mutually inserted into the dorsomedial surface of the 5th metatarsal and dorsolateral of the 4th metatarsal, while in 10.0% of the specimens it has thin medial bands (2 × 1mm) towards the 5th digit. At the end of the study, the PTM origin was categorized into three different types and PTM insertion was categorized into five different types. Variation of PTM, muscle morphology and tendon diameter are extremely important in terms of minimally invasive surgical technique. Since the accessory tendon must have the properties close to the tendon that will be replaced, we believe that the results of our research provide unique useful information to clinicians. This study is the cadaver research.

A comprehensive anatomical classification system of the extramuscular innervation of the gracilis muscle as guidance for free functional muscle transfer

PurposeThe gracilis muscle is one of the most frequently used muscles in reconstructive surgeries. It can be utilized as both less complex flaps and a free functional muscle flap to restore function to other muscles. As little is known of the precise extramuscular innervation of the gracilis muscle, the present study performs an accurate assessment to provide as much important anatomical information for clinicians as possible. Material and methodsA classical anatomical dissection was performed on eighty-five lower limbs (45 right, 40 left) fixed in 10% formalin solution. The variability in the extramuscular innervation of the gracilis muscle was assessed. Some morphometric measurements were collected. ResultsA four-fold classification of extramuscular innervation was created for the gracilis muscle. Type I (64.7%), the most frequent type, presented at least one proximal nerve branch. Type II (25.9%) lacked this branch. Type III (8.2%) possessed an additional neural supply from the muscular nerve branch innervating the adductor longus muscle. Type IV (1.2%) was similar to Type III, but the additional neural supply originated from the muscular nerve branch innervating the adductor magnus muscle. ConclusionClear anatomical variability was noted for extramuscular innervation of the gracilis muscle. All the presented Types seem to be suitable for splitting a muscle belly and use its part in free functional muscle transfer. However, it appears that Type III and IV may ease this procedure, because of the additional nerve branches. This classification system can deliver important information for clinicians performing complex reconstructive surgeries with the use of the gracilis muscle.

A Variant of the Deltoid Muscle and Its Clinical Implications: A Cadaveric Study

Background: The deltoid is the muscle that forms the rounded contour of the shoulder. Anatomically, it seems to be made up of three different sets of fibers. The three anatomical portions in which the deltoid muscle are typically divided into the anterior (clavicular), the mean (acromial), and the posterior (spinal). Different variations of the deltoid muscle have been described in the literature. The analysis and knowledge of these anomalies are essential for surgeons and anatomists. Methods: A total of 21 specimens (12 women and 9 men) were used with a 10% formaldehyde solution. All specimens were dissected bilaterally (the classical dissection methodology was used). Results: In one corpse, an additional bilateral belly of the deltoid muscle was found. It was observed that this additional muscular belly was related to the fascial tissue of the deltoid muscle and its muscle fibers take origin from the middle third of the inferomedial bands of infraspinatus fascia. In addition, the belly attaches to the posterior belly of the deltoid muscle. The deltoid muscle and the additional belly were innervated by the axillar nerve, which is a lateral terminal bouquet of the posterior fascicle of the brachial plexus. Conclusions: This new variation of the deltoid muscle must be considered by surgeons, as well as abnormal conditions in terms of compartment syndrome involving the shoulder. Therefore, consideration of this variant is necessary for the correct diagnosis and treatment of trauma or other shoulder pathology that may be refractory to standard treatments.

Assessment of Morphological Features and Imaging Characteristics of Patients with Intracranial Artery Dissection: A High-Resolution MRI Study

Intracranial artery dissection (IAD) is a pathological dissection of the arterial wall. .However, the morphological features and imaging characteristics of patients with intracranial artery dissection (IAD) remain poorly understood. The study reports on 70 IAD patients (30 culprit and 40 non-culprit). All participants underwent high-resolution magnetic resonance imaging (HR-MRI) scans. The morphological features and imaging characteristics of artery dissection were carefully investigated. Demographics and clinical characteristics of culprit and non-culprit patients were also collected. Apparent differences between the two groups, which could be used as biomarkers for ischemic event caused by the culprit dissection, were identified by receiver operating characteristic (ROC) curve analysis. The IAD patients studied could be classified into five different types on the basis of morphological features: classical dissection (n = 31), fusiform aneurysm (n = 2), long dissected aneurysm (n = 9), dolichoectatic dissecting aneurysm (n = 6), and saccular aneurysm (n = 22). The direct sites of artery dissection (double lumen and intimal flap) can be seen in most IAD patients on HR-MRI. Additionally, the presence of hypertension, double lumen and intimal flap were associated with culprit lesions and might be considered biomarkers for the ischemic event caused by the culprit dissection. Analysis showed that HR-MRI allowed easy visualization of abnormal morphology of artery dissection lesions. This was of great significance for the diagnosis of IAD and gave a better understanding of its pathophysiological mechanism.

A Wolf in Wolf's Clothing? The Complexities of Decision Involved with Acute Thoracic Endovascular Aortic Intervention for Penetrating Aortic Ulcer and Intramural Hematoma

This article provides a case and reviews the considerations involved in acute endovascular stent for penetrating aortic ulcers (PAU)/intramural hematoma (IMH). This case aims to highlight the decision-making and considerations in the acute endovascular management of a patient presenting with PAU and associated IMH. The literature was reviewed including Google Scholar, PubMed, and Embase. Acute aortic syndrome encompasses a spectrum of aortic disease ranging from aortic dissection to PAU and IMH. Whilst classical aortic dissection has been well studied, the PAU/IMH subset of this population is exceedingly rare. Only a handful of case reports have reported on technical considerations for repair. Despite limited natural history data, growing evidence suggests a more aggressive stance is warranted to prevent progression to rupture and late aortic-related mortality. This pathology poses unique challenges in anatomical and technical considerations of repair.

Sex-Related Differences in Clinical Features and In-Hospital Outcomes of Type B Acute Aortic Dissection: A Registry Study.

BackgroundThe association between female sex and poor outcomes following surgery for type A acute aortic dissection has been reported; however, sex‐related differences in clinical features and in‐hospital outcomes of type B acute aortic dissection, including classic aortic dissection and intramural hematoma, remain to be elucidated.Methods and ResultsWe studied 2372 patients with type B acute aortic dissection who were enrolled in the Tokyo Acute Aortic Super‐Network Registry. There were fewer and older women than men (median age [interquartile range]: 76 years [66–84 years], n=695 versus 68 years [57–77 years], n=1677; P<0.001). Women presented to the aortic centers later than men. Women had a higher proportion of intramural hematoma (63.7% versus 53.7%, P<0.001), were medically managed more frequently (90.9% versus 86.3%, P=0.002), and had less end‐organ malperfusion (2.4% versus 5.7%, P<0.001) and higher in‐hospital mortality (5.3% versus 2.7%, P=0.002) than men. In multivariable analysis, age (per year, odds ratio [OR], 1.06 [95% CI, 1.03–1.08]; P<0.001), hyperlipidemia (OR, 2.09 [95% CI, 1.13–3.88]; P=0.019), painlessness (OR, 2.59 [95% CI, 1.14–5.89]; P=0.023), shock/hypotension (OR, 2.93 [95% CI, 1.21–7.11]; P=0.017), non–intramural hematoma (OR, 2.31 [95% CI, 1.32–4.05]; P=0.004), aortic rupture (OR, 26.6 [95% CI, 14.1–50.0]; P<0.001), and end‐organ malperfusion (OR, 4.61 [95% CI, 2.11–10.1]; P<0.001) were associated with higher in‐hospital mortality, but was not female sex (OR, 1.67 [95% CI, 0.96–2.91]; P=0.072).ConclusionsWomen affected with type B acute aortic dissection were older and had more intramural hematoma, a lower incidence of end‐organ malperfusion, and higher in‐hospital mortality than men. However, female sex was not associated with in‐hospital mortality after multivariable adjustment.

Incorporation of virtual enhancement in anatomy, physiology and clinical pathology instruction in medicine and veterinary medicine basic sciences

Classic anatomic dissection of humans and animals has been an essential element of the gold standard in medical and veterinary medical education for many decades, but in recent years has encountered previously unforeseen obstacles including the COVID‐19 pandemic and restrictions in laboratory and classroom participation. Included among the factors are a decreasing availability of cadaver donations to medical schools, combined with increasing costs of obtaining suitable cadavers. Specifically, class sizes and individual participation have waned over time, as has student interest in participating in the traditionally months‐long cadaveric dissection labs, and the attendant potential chronic exposure to the noxious embalming preservatives and their possible health risks from inadvertent over‐exposure. In addition, a decreasing trend in the prevalence of graduate education in gross anatomy, a primary source of new anatomy faculty. While physical cadavers have proven their spectacular function in providing anatomy content for medical and veterinary students for decades, their limitations of delivering adequate physiology and clinical pathology content under current requirements are more limited. To this end, we redeveloped our anatomy lab to include SPOC (Small Platform Online Course) and didactic lectures in anatomy, physiology, and clinical pathology, including targeted virtual instruction in small group settings both during cadaveric dissections and with the Anatomage®, and culminating with an abbreviated cadaveric dissection employing fresh, unembalmed cadavers over structured 2 day‐long dissections with small groups of now well‐prepared students with surgical microscopy and 3‐D fabrications. The additions to this lab have provided great benefits to veterinary anatomy instruction, which can now include up to two hundred different animal species and exposure to rare species not easily visualized in an academic laboratory setting. A pioneer in medical education, William Harvey was one of the most influential physicians of all time, and recognized the crucial role of cadaveric dissections in anatomy learning and their applications to clinical medicine, but the physiologic and pathologic implications were more limited in content and application than are needed in today’s instruction. The fields of medicine and veterinary medicine have now made extraordinary advances in content and detail, requiring inclusion of ever more content at the molecular, cellular, and organismal levels within the constraints of a traditional four‐year curriculum, and where the outcomes and expectations have also increased to meet the demands and vigor of current practice standards soon after graduation. The results of our incorporation of extensive virtual anatomy and physiology modules in our curriculum have demonstrated significant increases and improvements in student participation and in content retention upon entering later phases in their academic programs.

Extra‐hepatic Glissonean approach allows safe segmental liver resection in patients with cirrhosis with hepatocellular carcinoma

AbstractAimThis study aims to report our experience with the extra‐hepatic Glissonean approach (EHGA) in liver resection in patients with cirrhosis.Patients and MethodsFrom a prospectively maintained database in Al‐Rajhi Liver Hospital, Assiut University, Egypt, all patients with cirrhosis with hepatocellular carcinoma (HCC) who had open liver resections of two or more segments from January 2014 to December 2016 were identified. As many as 49 patients received resection via the classical pedicle dissection technique (PDT) and 38 by EHGA.ResultsThere was no difference in age, sex, American Society of Anesthesiologists grade, aetiology of liver disease, alpha‐fetoprotein, tumour number, size, Child‐Turcotte‐Pugh or Model for End‐stage Liver Disease scores between groups. Patients in the EHGA group had shorter operative time (214 ± 54 vs. 249 ± 44 minutes in PDT; P = .001), lesser blood loss (647 ± 140 ml vs. 741 ± 192 ml, respectively; P = .010), wider safety margin (14 ± 3.5 mm vs. 11.5 ± 5.8 mm, respectively; P = .029), lesser decompensation (18.4% vs. 40.8%, respectively; P = .026) and shorter hospital stay (8, range 3‐26 vs. 9, range 4‐36 days, respectively; P = .015). There was no 30‐day mortalities in the EHGA group compared with two in the PDT group. There were no differences between groups in 1‐ and 3‐year overall and recurrence‐free survival rates.ConclusionsEHGA is a rapid, safe and oncologically sound approach for segmental anatomical liver resections of HCC in patients with cirrhosis.