Functional Anatomy Research Articles

MP62-13 THE PATIENT'S VOICE AT SCALE: UNDERSTANDING WHY PATIENTS ARE NOT SEXUALLY ACTIVE POST RADICAL PROSTATECTOMY THROUGH QUALITATIVE CODING OF RESPONSES ON A PATIENT REPORTED OUTCOME INSTRUMENT

You have accessJournal of UrologyCME1 Apr 2023MP62-13 THE PATIENT'S VOICE AT SCALE: UNDERSTANDING WHY PATIENTS ARE NOT SEXUALLY ACTIVE POST RADICAL PROSTATECTOMY THROUGH QUALITATIVE CODING OF RESPONSES ON A PATIENT REPORTED OUTCOME INSTRUMENT Mahmoud Hijazi, David Gandham, Alice Semerjian, Thomas Maatman, Mohammad Jafri, Kenneth Kernen, James Peabody, Arvin George, Kevin Ginsburg, and Andrew Krumm Mahmoud HijaziMahmoud Hijazi More articles by this author , David GandhamDavid Gandham More articles by this author , Alice SemerjianAlice Semerjian More articles by this author , Thomas MaatmanThomas Maatman More articles by this author , Mohammad JafriMohammad Jafri More articles by this author , Kenneth KernenKenneth Kernen More articles by this author , James PeabodyJames Peabody More articles by this author , Arvin GeorgeArvin George More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , and Andrew KrummAndrew Krumm More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003320.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While Patient reported outcome measures (PROMs) can capture the patient perspective at scale, that perspective is often constrained by available survey items. To amplify the patient′s voice as communicated through a PROM, free text, or open response, items may provide a more nuanced rendering of what a patient is experiencing. The objective of this abstract is to understand in qualitative terms, why patients are not sexually active pre- and post-radical prostatectomy. METHODS: Survey responses from the Michigan Urological Surgery Improvement Collaborative prostate cancer disease registry were collected pre-treatment and at 3-, 6-, 12-, and 24-months post-surgery. Written responses to the question “Why are you not sexually active?” beyond were independently analyzed and iteratively refined into higher-level codes. For the same question, patients could select 8 other options (“Lack of a willing partner”, “Lack of interest,” “Lack of confidence,” “No ejaculate,” “No erection,” “Urine leak during intercourse”, “Pain/discomfort during intercourse”, and "Not applicable"); a free-response option was provided next to the “Other” option. Prevalence of codes was examined after two independent raters reached agreement on code definitions. RESULTS: Between 1/2018 and 12/2021, 24,568 PROMs were collected, and 20,268 patients responded to the sexual activity question. Approximately 7% of patients provided a text response: 1,448 unique patients submitted 1,875 written responses. Table 1 summarizes the identified codes and the percent of overall responses with each code. The three most common codes were complications (e.g., treatment-specific change in anatomy of function), partner (e.g., own health and interest), and structural issues (e.g., lack of time). Other factors that patients identified included comorbidities and explicit choices not to be sexually active. CONCLUSIONS: Written responses provide a glimpse into a more nuanced view of post-treatment sexual activity that can be used to not only develop a more robust understanding of patients but also develop survey items that better capture patient concerns and hesitancies. Source of Funding: Blue Cross Blue Shield of Michigan © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e866 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mahmoud Hijazi More articles by this author David Gandham More articles by this author Alice Semerjian More articles by this author Thomas Maatman More articles by this author Mohammad Jafri More articles by this author Kenneth Kernen More articles by this author James Peabody More articles by this author Arvin George More articles by this author Kevin Ginsburg More articles by this author Andrew Krumm More articles by this author Expand All Advertisement PDF downloadLoading ...

MP60-10 FUNCTIONAL ULTRASOUND IMAGING OF HUMAN SPINAL CORD CAPTURES THE SPATIOTEMPORAL MODULATION OF SPINAL CORD HEMODYNAMICS DURING MICTURITION

You have accessJournal of UrologyCME1 Apr 2023MP60-10 FUNCTIONAL ULTRASOUND IMAGING OF HUMAN SPINAL CORD CAPTURES THE SPATIOTEMPORAL MODULATION OF SPINAL CORD HEMODYNAMICS DURING MICTURITION Aidin Abedi, Kofi Agyeman, Darrin J Lee, Evgeniy Kreydin, David Chapman, Jonathan J Russin, Wooseong Choi, V Reggie Edgerton, Charles Y Liu, and Vassilios N Christopoulos Aidin AbediAidin Abedi More articles by this author , Kofi AgyemanKofi Agyeman More articles by this author , Darrin J LeeDarrin J Lee More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , David ChapmanDavid Chapman More articles by this author , Jonathan J RussinJonathan J Russin More articles by this author , Wooseong ChoiWooseong Choi More articles by this author , V Reggie EdgertonV Reggie Edgerton More articles by this author , Charles Y LiuCharles Y Liu More articles by this author , and Vassilios N ChristopoulosVassilios N Christopoulos More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003318.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Unlike the brain, functional imaging of the spinal cord has been elusive. This is due to the small size of the spinal cord and limitations of the neuroimaging techniques. The functional ultrasound imaging (fUSI) is a novel neuroimaging technique with superior spatiotemporal properties that can detect microvascular changes correlated to changes in neural activity. The objective of this study is to determine whether fUSI can detect and characterize the spatial and temporal hemodynamic changes in the human spinal cord in response to bladder filling and emptying. METHODS: Four patients, who were undergoing standard-of-care implantation of a spinal cord stimulator, were enrolled in the study. Following exposure of the spinal cord during implantation of the spinal cord stimulator, the fUSI probe was positioned over the spinal cord at thoracic level 10. Images were acquired during two bladder-filling cycles and one emptying cycle with intermittent holding periods. The bladder pressure dynamics and power Doppler signal were correlated to determine the spinal cord regions associated with micturition. RESULTS: Several regions of interest (ROIs) exhibiting differential activation in response to changes in detrusor pressure were identified. The ROIs were primarily localized to the dorsal spinal cord. Most regions exhibited an increase in power Doppler signal during bladder filling and a decrease in signal with bladder emptying. However, other regions exhibited a reverse pattern with signal reduction during bladder filling and signal increase during emptying (Figure 1). CONCLUSIONS: This is the first in-human application of ultrafast ultrasound to study the neurovascular coupling changes that occur in the spinal cord as a result of bladder filling and emptying. The ability to characterize and correlate spinal cord hemodynamics to micturition events holds promise to help further understand functional and dysfunctional anatomy associated with lower urinary tract physiology. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e847 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aidin Abedi More articles by this author Kofi Agyeman More articles by this author Darrin J Lee More articles by this author Evgeniy Kreydin More articles by this author David Chapman More articles by this author Jonathan J Russin More articles by this author Wooseong Choi More articles by this author V Reggie Edgerton More articles by this author Charles Y Liu More articles by this author Vassilios N Christopoulos More articles by this author Expand All Advertisement PDF downloadLoading ...

Esthetic considerations for treating the patient of European descent: Thriving in diversity international roundtable series

The European esthetic experience is informative for understanding both innovation as well as how to care for patients of various backgrounds and ages. To discuss best practices for treating the European population and how these approaches may be applied to patient populations across the globe. In support of clinicians who wish to serve a diverse patient population, a 6-part, international roundtable series focused on diversity in esthetics was conducted from August 24, 2021 to May 16, 2022. In each roundtable, expert clinicians were invited to contribute and share best practices. The results of the fifth roundtable in the series, the European Patient, are described here. Key ideas include the growing number of people over the age of 65 years in Europe and the management of this more mature patient population; the role of functional anatomy in treating patients with both fillers and botulinum toxin; and the role of ultrasound in clinical practice for mapping vasculature. While there is no typical European face, there is much to be learned from thoughtful consideration of how to best manage more mature patients as well as how to use minimally invasive modalities, such as injectables, efficiently to achieve natural-looking results.

Comparative Study of Lingual Papillae, Lingual Glands and Lyssa of the Tongue of Selected Wild Felids (Carnivora, Felidae) in Biological Aspects.

Although much attention has been paid in the literature to the morphology of the tongue in various animal species, including some Felidae, it has not yet been described in detail in the vulnerable Neofelis nebulosa and Panthera leo bleyenberghi and the last concern Lynx lynx and Otocolobus manul. Therefore, the present study aimed to characterize the features of the tongue surface, lingual glands and lyssa in the above-mentioned four selected wild species of the Pantherinae and Felinae subfamilies. Macroscopic, histological, histochemical and ultrastructural analyzes were used in the present work. Comparative analyzes of the dorsal tongue surface showed the presence of mechanical lingual papillae on five subtypes of filiform papillae on the apex and body and conical papillae on the root of the tongue. Gustatory papillae in the four analyzed species were fungiform papillae and various numbers of vallate papillae. Foliate papillae were absent in P. leo bleyenberghi and L. lynx, while delicate smooth folds, which were separated by parallel grooves but without taste buds, were present in N. nebulosa. The vallate and foliate papillae were accompanied by lingual glands, which produced a serous secretion, whereas the mixed lingual glands of the lingual root were with a predominance of mucus secretions comparable to four captive Felidae species. In the median plane on the ventral surface of the apex under its epithelium and within the muscle fibers, the lyssa was also observed to a varying degree, with the least developed, and thought about the size of the entire tongue, was in P. leo bleyenberghi. The lyssa structure in the four species was dominated by adipose tissue. The obtained results contribute knowledge concerning the functional anatomy of the tongue in four selected Felidae species, especially in terms of comparative anatomy.

Redefining the Classification for Bertolotti Syndrome: Anatomical Findings in Lumbosacral Transitional Vertebrae Guide Treatment Selection

We present the Jenkins classification for Bertolotti's Syndrome, or symptomatic lumbosacral transitional vertebrae (LSTV) and compare this with the existing Castellvi classification in patients presenting for treatment. A retrospective cohort study of 150 new patients presenting for treatment of back, hip, groin, and/or leg pain from July 2012 through February 2022. Using MRI, CT, and X-Ray imaging, patients with radiographic finding of LSTV, appropriate clinical presentation, and identification of LSTV as the primary pain generator via diagnostic injections were diagnosed with Bertolotti's syndrome. Patients who failed conservative treatment and underwent surgery to address their LSTV were included. The Castellvi classification excluded two types of anatomic variants, the prominent anatomic side, and potential transverse process and iliac crest contact. 150 patients with transitional anatomy, 103(69%) were identified with Bertolotti's Syndrome under the Jenkins classification and received surgery, 46(45%) men and 57(55%) women. 90(88%) underwent minimally invasive surgery. Patients presented with pain localized to the back 101(98%), leg 79(77%), hip 51(49%), and buttock 52(50%). Only 84(82%) of the Jenkins classification patients met any Castellvi criteria. All 19(18%) patients failed Castellvi's classification had Type 1 anatomy and underwent surgery: 16(84%) decompression, 1(5%) fusion, and 2(11%) fusion/decompression procedures. 17(90%) had improved pain scores. The 19 patients who were exclusively Jenkins classification had no significant difference in improved pain compared to those under Castellvi classification. The Jenkins classification improves on the prior Castellvi classification to more comprehensively describe the functional anatomy, identify uncaptured anatomy, and better predict optimal surgical procedures to treat those with Bertolotti's Syndrome.

Review of Cha et al. (2005) on “Arthroscopic Double Bundle Anterior Cruciate Ligament Reconstruction: An Anatomical Approach”

This classic discusses the original publication ‘Arthroscopic double-bundle anterior cruciate ligament reconstruction (ACL): An anatomical approach’, the first detailed description of the surgical technique popularised by Dr Freddie Fu. The technique, in which the anteromedial and posterolateral bundles of the ACL are reconstructed individually using two grafts with independent bone tunnels, was designed to more closely recreate the function of the native ACL by more closely reproducing the functional anatomy. This reconstruction was biomechanically superior to single-bundle reconstruction, particularly with regards to rotational control, leading to great interest from ACL surgeons around the world. Clinical superiority was more difficult to demonstrate; however, and the technical difficulty of the procedure has limited its use. Nevertheless, the pursuit of improved patient outcomes through attention to functional anatomical detail continues. ‘Recreating the functional anatomy of the intact ACL remains the cornerstone of ACL reconstruction’.

Comparison of Physiotherapy Education on Course Basis in terms of Student Satisfaction During the Covid-19 Pandemic Period: Online, Hybrid, and On-Campus Education

In the study, aimed to compare three different education periods, On-Campus Education (2019), Hybrid Education (2020), and Online Education (2021), in terms of students' satisfaction within the scope of the courses offered in Physiotherapy and Rehabilitation program. The dataset of study collected as a retrospective study from the Physiotherapy and Rehabilitation Department in Health Sciences Faculty of Yeditepe University, Istanbul. The spring semester students of 2019, 2020, and 2021 (respectively, n=170; n=158; n=229) participated in the study. The assessment of students’ learning outcomes was obtained from questionnaires prepared by the research team. Answers are allowed upon a 6-point Likert scale (0:Strongly Disagree - 5:Strongly Agree). According to the Analysis of Variance (ANOVA) test results, in the Introduction to Physiotherapy Occupation, Hydrotherapy, Manipulative Therapy-II Functional Anatomy and Kinesiology-II, Neurologic Rehabilitation, Orthosis and Prosthesis Rehabilitation and Physiotherapy in Sport courses, statistically significant difference was found (respectively, p=0.005, p=0.001 p=0.009, p=0.001, p=0.018, p=0.001, p=0.001). According to the satisfaction of the Physiotherapy students at three-grade levels, the courses with high theoretical content may be given online. Therefore, the online system can be integrated into the physiotherapy education system, but it cannot replace campus education in practical courses.

Cingulate Epilepsy: A Not so Singular World.

*Montreal University Health Center, Montreal, Quebec, Canada; †Department of Neurosciences, University of Montreal, Montreal, Quebec, Canada; and ‡Canada Research Chair in Epilepsy and Functional Anatomy of the Human Brain, Montreal, Quebec, Canada.

Bayesian lesion-deficit inference with Bayes factor mapping: Key advantages, limitations, and a toolbox

Statistical lesion-symptom mapping is largely dominated by frequentist approaches with null hypothesis significance testing. They are popular for mapping functional brain anatomy but are accompanied by some challenges and limitations. The typical analysis design and the structure of clinical lesion data are linked to the multiple comparison problem, an association problem, limitations to statistical power, and a lack of insights into evidence for the null hypothesis. Bayesian lesion deficit inference (BLDI) could be an improvement as it collects evidence for the null hypothesis, i.e. the absence of effects, and does not accumulate α-errors with repeated testing. We implemented BLDI by Bayes factor mapping with Bayesian t-tests and general linear models and evaluated its performance in comparison to frequentist lesion-symptom mapping with a permutation-based family-wise error correction. We mapped the voxel-wise neural correlates of simulated deficits in an in-silico-study with 300 stroke patients, and the voxel-wise and disconnection-wise neural correlates of phonemic verbal fluency and constructive ability in 137 stroke patients. Both the performance of frequentist and Bayesian lesion-deficit inference varied largely across analyses. In general, BLDI could find areas with evidence for the null hypothesis and was statistically more liberal in providing evidence for the alternative hypothesis, i.e. the identification of lesion-deficit associations. BLDI performed better in situations in which the frequentist method is typically strongly limited, for example with on average small lesions and in situations with low power, where BLDI also provided unprecedented transparency in terms of the informative value of the data. On the other hand, BLDI suffered more from the association problem, which led to a pronounced overshoot of lesion-deficit associations in analyses with high statistical power. We further implemented a new approach to lesion size control, adaptive lesion size control, that, in many situations, was able to counter the limitations imposed by the association problem, and increased true evidence both for the null and the alternative hypothesis. In summary, our results suggest that BLDI is a valuable addition to the method portfolio of lesion-deficit inference with some specific and exclusive advantages: it deals better with smaller lesions and low statistical power (i.e. small samples and effect sizes) and identifies regions with absent lesion-deficit associations. However, it is not superior to established frequentist approaches in all respects and therefore not to be seen as a general replacement. To make Bayesian lesion-deficit inference widely accessible, we published an R toolkit for the analysis of voxel-wise and disconnection-wise data.

Investigating the quadrupedal abilities of Scutellosaurus lawleri and its implications for locomotor behavior evolution among dinosaurs.

A reversion to secondary quadrupedality is exceptionally rare in nature, yet the convergent re-evolution of this locomotor style occurred at least four separate times within Dinosauria. Facultative quadrupedality, an intermediate state between obligate bipedality and obligate quadrupedality, may have been an important transitional step in this locomotor shift, and is proposed for a range of basal ornithischians and sauropodomorphs. Advances in virtual biomechanical modeling and simulation have allowed for the investigation of limb anatomy and function in a range of extinct dinosaurian species, yet this technique has not been widely applied to explore facultatively quadrupedal gait generation. This study places its focus on Scutellosaurus, a basal thyreophoran that has previously been described as both an obligate biped and a facultative quadruped. The functional anatomy of the musculoskeletal system (myology, mass properties, and joint ranges of motion) has been reconstructed using extant phylogenetic bracketing and comparative anatomical datasets. This information was used to create a multi-body dynamic locomotor simulation that demonstrates that whil quadrupedal gaits were physically possible, they did not outperform bipedal gaits is any tested metric. Scutellosaurus cannot therefore be described as an obligate biped, but we would predict its use of quadrupedality would be very rare, and perhaps restricted to specific activities such as foraging. This finding suggests that basal thyreophorans are still overwhelmingly bipedal but is perhaps indicative of an adaptive pathway for later evolution of quadrupedality.

Functional anatomy of the perineal complex as it relates to urogenital hiatus closure

Functional anatomy of the perineal complex as it relates to urogenital hiatus closure

Bats to belugas: Functional anatomy of air versus water biosonar

Acoustic task similarities of odontocetes (toothed whales) and microchiropterans (insectivorous bats) suggest they have common biosonar mechanisms. However, media differences; e.g., sound speeds in air versus water, may have driven variations in auditory system adaptations. We examined the peripheral auditory system of an FM bat (big brown bat Eptesicus fuscus) and two toothed whale species (harbor porpoise Phocoena phocoena; bottlenose dolphin Tursiops truncatu) using ultra high resolution (11 μm) isotropic voxel microCT. Significant differences were found among species for oval window location, cochlear length, basilar membrane gradients, cochlear spiral morphometry, cochlear curvature, and basilar membrane stiffness. High and low frequency hearing range cut-offs correlate with basilar membrane thickness/width ratios and cochlear radii of curvature. These features predict species specific high and low frequency hearing limits. Harbor porpoises, the highest frequency echolocator in the study, have large basal basilar membrane ratios and a “foveal” region with a constant membrane ratio similar to those reported for some bat species, consistent with a “stretched” frequency region. Furthermore, both the bats and harbor porpoises examined displayed unusual stapedial input locations and tightly coiled cochleae, specializations that may enhance ultrasonic frequency signal resolution and diminish low frequency cochlear propagation.

Carlquist’s indices for vulnerability and mesomorphy of wood: are they relevant today?

Summary Sherwin Carlquist established xylem vessel indices and parameters to quantify the degree of mesomorphy or xeromorphy exhibited by plants. These indices were developed as part of efforts to establish a quantitative approach to plant anatomy and the developing fields of functional and ecological anatomy. In this paper, we discuss the origin of such parameters and their merits and demerits in light of current theory and practice. Vessel diameter, vessel element length, and vessel density (vessels/mm2) remain relevant anatomical characters that describe and quantify plant function and ecology. From a functional perspective, mean diameter can be replaced by hydraulic mean diameter (dh), inspired by the Hagen–Poiseuille Law. Vessel density is presumably linked to hydraulic safety through redundancy and embolism resistance and is an essential feature of xeromorphic woods that tend to have many narrow vessels. Although vessel element length strongly correlates to xeromorphy, the reasons for the link between element length and xeromorphy are unclear. The use of anatomical indices, such as those developed and proposed by Carlquist, helped shape our understanding of plant hydraulic strategies and will continue to be important as we connect plant anatomy to plant function.

"Neuro-Fiber Mapping": An Original Concept of Spinal Cord Neural Network Spatial Targeting Using Live Electrostimulation Mapping to (Re-)Explore the Conus Medullaris Anatomy.

Spinal cord (SC) anatomy is often assimilated to a morphologically encapsulated neural entity, but its functional anatomy remains only partially understood. We hypothesized that it could be possible to re-explore SC neural networks by performing live electrostimulation mapping, based on "super-selective" spinal cord stimulation (SCS), originally designed as a therapeutical tool to address chronic refractory pain. As a starting point, we initiated a systematic SCS lead programming approach using live electrostimulation mapping on a chronic refractory perineal pain patient, previously implanted with multicolumn SCS at the level of the conus medullaris (T12-L1). It appeared possible to (re-)explore the classical anatomy of the conus medullaris using statistical correlations of paresthesia coverage mappings, resulting from 165 different electrical configurations tested. We highlighted that sacral dermatomes were not only located more medially but also deeper than lumbar dermatomes at the level of the conus medullaris, in contrast with classical anatomical descriptions of SC somatotopical organization. As we were finally able to find a morphofunctional description of "Philippe-Gombault's triangle" in 19th-century historical textbooks of neuroanatomy, remarkably matching these conclusions, the concept of "neuro-fiber mapping" was introduced.

Free form deformation and symmetry constraint‐based multi‐modal brain image registration using generative adversarial nets

AbstractMulti‐modal brain image registration has been widely applied to functional localisation, neurosurgery and computational anatomy. The existing registration methods based on the dense deformation fields involve too many parameters, which is not conducive to the exploration of correct spatial correspondence between the float and reference images. Meanwhile, the unidirectional registration may involve the deformation folding, which will result in the change of topology during registration. To address these issues, this work has presented an unsupervised image registration method using the free form deformation (FFD) and the symmetry constraint‐based generative adversarial networks (FSGAN). The FSGAN utilises the principle component analysis network‐based structural representations of the reference and float images as the inputs and uses the generator to learn the FFD model parameters, thereby producing two deformation fields. Meanwhile, the FSGAN uses two discriminators to decide whether the bilateral registration have been realised simultaneously. Besides, the symmetry constraint is utilised to construct the loss function, thereby avoiding the deformation folding. Experiments on BrainWeb, high grade gliomas, IXI and LPBA40 show that compared with state‐of‐the‐art methods, the FSGAN provides superior performance in terms of visual comparisons and such quantitative indexes as dice value, target registration error and computational efficiency.

The role of neuromuscular function in sleep apnea pathogenesis and management: A consensus of experts

Study objectivesAlthough the importance of upper airway assessment in the consideration of obstructive sleep apnea (OSA) is recognized, there are current limitations in our approach to assessment.MethodsWe convened a group of experts in upper airway neuromuscular physiology and anatomy, sleep apnea endophenotypes, novel therapeutics and sleep epidemiology to summarize existing literature and delineate future opportunities to utilize and incorporate innovative and less invasive techniques focused on upper airway neuromuscular physiology to assess and manage OSA.ResultsIn OSA, genioglossus electromyogram (EMG) activity is reduced during sleep onset with higher levels observed during wakefulness compared to controls. Surface EMG recordings are limited due to distance from the actual muscle and while needle EMG offers more direct assessment, this approach is more invasive. Novel alternatives overcoming these limitations to assess upper airway neuromuscular physiology in OSA may therefore prove beneficial. Specifically, such an approach would facilitate identification of upstream prognostic biomarkers of OSA clinical trajectory and offer more informative mechanistic data. Novel approaches to neuromuscular assessment in OSA would enhance phenotyping to predict better tolerance to positive airway pressure therapy and set the stage to target neuromuscular function and upper airway anatomy. A quantifiable and repeatable neuromuscular physiologic metric has potential to facilitate a precision medicine strategy and personalize treatment, including measuring treatment response to neurophysiologic-focused interventions including hypoglossal nerve stimulation (HGNS), myofunctional therapy and neuromuscular electrical stimulation. A key area for future investigation is whether observed neuromuscular changes can identify patients at future risk of OSA, facilitating early intervention or prevention strategies.ConclusionsOverall, recognizing the critical contributions of abnormalities of upper airway neuromuscular function to the pathophysiology of OSA, it may be important to find accurate and reproducible neurophysiological assessments to address existing knowledge gaps in OSA assessment and management.

Could IVF replace reproductive surgery? No, reproductive surgery is still very much alive

Could IVF replace reproductive surgery? The answer is no. Reproductive surgery still has a place, at least in some indications that will be explored in this contribution. While IVF can offer infertile couples the chance to have a healthy baby, it should be acknowledged that reproductive surgery can heal or harm the organs where reproduction takes place. This paper reviews different diseases and conditions with an impact on fertility, which may benefit from the technological innovations of recent decades, novel applications and the skill of reproductive surgeons. Reproductive surgery is certainly not dead. It lives on with the promise of restoring the functional anatomy to enhance the chances of pregnancy. It is our responsibility to train young residents adequately in this field to provide the right treatment at the right time.

Disentangling poststroke cognitive deficits and their neuroanatomical correlates through combined multivariable and multioutcome lesion-symptom mapping.

Studies in patients with brain lesions play a fundamental role in unraveling the brain's functional anatomy. Lesion-symptom mapping (LSM) techniques can relate lesion location to cognitive performance. However, a limitation of current LSM approaches is that they can only evaluate one cognitive outcome at a time, without considering interdependencies between different cognitive tests. To overcome this challenge, we implemented canonical correlation analysis (CCA) as combined multivariable and multioutcome LSM approach. We performed a proof-of-concept study on 1075 patients with acute ischemic stroke to explore whether addition of CCA to a multivariable single-outcome LSM approach (support vector regression) could identify infarct locations associated with deficits in three well-defined verbal memory functions (encoding, consolidation, retrieval) based on four verbal memory subscores derived from the Seoul Verbal Learning Test (immediate recall, delayed recall, recognition, learning ability). We evaluated whether CCA could extract cognitive score patterns that matched prior knowledge of these verbal memory functions, and if these patterns could be linked to more specific infarct locations than through single-outcome LSM alone. Two of the canonical modes identified with CCA showed distinct cognitive patterns that matched prior knowledge on encoding and consolidation. In addition, CCA revealed that each canonical mode was linked to a distinct infarct pattern, while with multivariable single-outcome LSM individual verbal memory subscores were associated with largely overlapping patterns. In conclusion, our findings demonstrate that CCA can complement single-outcome LSM techniques to help disentangle cognitive functions and their neuroanatomical correlates.

Aortic valve fenestrations: Macroscopic assessment and functional anatomy study.

Aortic valve fenestrations are defined as a loss of aortic valve leaflet tissue. They are a common but overlooked finding with unclear significance. The aim of this study was to investigate the varied functional anatomies of aortic valve fenestrations. A total of 400 formalin-fixed autopsied human hearts were macroscopically assessed and the function of the aortic valve of 16 reanimated human hearts were imaged using Visible Heart® methodologies. Aortic valve leaflet fenestrations were present in 43.0% of autopsied hearts (in one leaflet in 24.0%, in two leaflets 16.0%, in all leaflets 3.0%). Fenestrations were mostly present in left (25.5%) followed by right (23.3%) and noncoronary leaflet (16.3%). In 93.8% of cases, the fenestrations form clusters and were mainly located at the free edge of the leaflet in the commissural area (95.4%). Hearts with aortic valve fenestrations had significantly larger aortic valve diameters and aortic valve areas (p < 0.001). The average surface area sizes of fenestrations were 23.8 ± 16.6 mm2 , and the areas were largest for left followed by right and noncoronary leaflet fenestrations (p < 0.001). The fenestration areas positively correlated with donor age (r=0.31; p=0.02). Significant hypermobility and subjective weakening of the leaflet adhesion levels of the fenestrated regions were observed. In conclusion, fenestrations of the aortic leaflets are frequent, and their sizes may be significant. They occur in all age groups, yet their size increase with aging. Fragments of leaflets with fenestrations show different behaviors during the cardiac cycle versus unchanged areas.

GluA3 subunits are required for appropriate assembly of AMPAR GluA2 and GluA4 subunits on cochlear afferent synapses and for presynaptic ribbon modiolar-pillar morphology.

Cochlear sound encoding depends on α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors (AMPARs), but reliance on specific pore-forming subunits is unknown. With 5-week-old male C57BL/6J Gria3-knockout mice (i.e., subunit GluA3KO) we determined cochlear function, synapse ultrastructure, and AMPAR molecular anatomy at ribbon synapses between inner hair cells (IHCs) and spiral ganglion neurons. GluA3KO and wild-type (GluA3WT) mice reared in ambient sound pressure level (SPL) of 55-75 dB had similar auditory brainstem response (ABR) thresholds, wave-1 amplitudes, and latencies. Postsynaptic densities (PSDs), presynaptic ribbons, and synaptic vesicle sizes were all larger on the modiolar side of the IHCs from GluA3WT, but not GluA3KO, demonstrating GluA3 is required for modiolar-pillar synapse differentiation. Presynaptic ribbons juxtaposed with postsynaptic GluA2/4 subunits were similar in quantity, however, lone ribbons were more frequent in GluA3KO and GluA2-lacking synapses were observed only in GluA3KO. GluA2 and GluA4 immunofluorescence volumes were smaller on the pillar side than the modiolar side in GluA3KO, despite increased pillar-side PSD size. Overall, the fluorescent puncta volumes of GluA2 and GluA4 were smaller in GluA3KO than GluA3WT. However, GluA3KO contained less GluA2 and greater GluA4 immunofluorescence intensity relative to GluA3WT (threefold greater mean GluA4:GluA2 ratio). Thus, GluA3 is essential in development, as germline disruption of Gria3 caused anatomical synapse pathology before cochlear output became symptomatic by ABR. We propose the hearing loss in older male GluA3KO mice results from progressive synaptopathy evident in 5-week-old mice as decreased abundance of GluA2 subunits and an increase in GluA2-lacking, GluA4-monomeric Ca2+-permeable AMPARs.