Gross Anatomy Research Articles

How students discern anatomical structures using digital three-dimensional visualizations in anatomy education.

Learning anatomy holds specific challenges, like the appreciation of three-dimensional relationships between anatomical structures. So far, there is limited knowledge about how students construct their understanding of topographic anatomy. By understanding the processes by which students learn anatomical structures in 3D, educators will be better equipped to offer support and create successful learning situations. Using video analysis, this study investigates how students discern anatomical structures. Sixteen students at different levels of education and from different study programs were recorded audiovisually while exploring 3D digital images using a computerized visualization table. Eleven hours of recorded material were analyzed using interaction analysis and phenomenography. Seven categories were identified during data analysis, describing the qualitatively different patterns of actions that students use to make sense of anatomy: decoding the image; positioning the body in space; purposeful seeking, using knowledge and experience; making use of and creating variation; aimless exploration, and arriving at moments of understanding. The results suggest that anatomy instruction should be organized to let the students decide how and at what pace they examine visualized images. Particularly, the discovery process of decoding and positioning the body in space supports a deep learning approach for learning anatomy using visualizations. The students' activities should be facilitated and not directed.

A comprehensive anatomical network analysis of human brain topology.

A network approach to the macroscopic anatomy of the human brain can be used to model physical interactions among regions in order to study their topological properties, as well as the topological properties of the overall system. Here, a comprehensive model of human brain topology is presented, based on traditional macroanatomical divisions of the whole brain, which includes its subcortical regions. The aim was to localise anatomical elements that are essential for the geometric balance of the brain, as to identify underlying phenotypic patterns of spatial arrangement and understand how these patterns may influence brain morphology in ontogeny and phylogeny. The model revealed that the parahippocampal gyrus, the anterior lobe of the cerebellum and the ventral portion of the midbrain are subjected to major topological constraints that are likely to limit or channel their morphological evolution. The present model suggests that the brain can be divided into a superior and an inferior morphological block, linked with extrinsic topological constraints imposed by the surrounding braincase. This information should be considered duly both in ontogenetic and phylogenetic studies of primate neuroanatomy.

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.

Changing the topographical anatomy among the maxilla, palatine bone, and greater palatine nerve: a histological study using human fetuses.

The palatine bone (PAL) rides over the maxilla (MX) without an end-to-end suture in the bony palate of fetuses. However, changes in the topographical relationship among bones was unknown at and along the pterygopalatomaxillary suture, including the palatine canals. Using sagittal, frontal, and horizontal histological sections of the head from 15 midterm fetuses to 12 near-term fetuses, we depicted the changes in the topographical anatomy of the MX, PAL, and greater palatine nerve (GPN). In the bony greater palatine canal of these fetuses, the medial and posterior walls facing the GPN were consistently made up of the PAL. At midterm, the entire course of the GPN was embedded in the PAL (six fetuses), or the MX contributed to the lateral wall of the nerve canal (nine). At near-term, the anterior and lateral walls showed individual variations: an MX in the anterior and lateral walls (three fetuses), an anterior MX and a lateral PAL (five), an anterior PAL and a lateral MX (two), and a PAL surrounding the GPN (four). These increasing variations suggested that the pterygopalatomaxillary suture was actually growing and that the PAL transiently expanded anteriorly and/or laterally to push the MX in fetuses. The "usual" morphology in which the GPN is sandwiched by the MX and PAL is likely established after birth, possibly during adolescence. The driving force of this change may not be produced by the masticatory apparatus. Rather, it might be triggered by the growing maxillary sinus.

The Middle Rectal Artery: Revisited Anatomy and Surgical Implications of a Neglected Blood Vessel.

Although the middle rectal artery is a relevant anatomical landmark for rectal resection and lateral lymph node dissection, descriptions of this entity are highly divergent. Dissection, visualization, morphometry, and 3-dimensional reconstruction of the middle rectal artery to facilitate its management in surgery. Macroscopic dissection, histologic study, morphometric measurements, and virtual modeling. University laboratory of applied surgical anatomy. This study includes formalin-fixed hemipelvis specimens (n=37) obtained from body donors (age, 67-97 y). The main outcome measures are photo documentation of origin, trajectory, diameter, and branching pattern; immunolabeling of lymphatics; and 3-dimensional reconstruction of the middle rectal artery. The middle rectal artery was present in 71.4% of body donors (21.4% bilateral, 50% unilateral), originated from the anterior division of the internal iliac artery, and branched either from the internal pudendal artery (45.5%), the inferior gluteal artery (22.7%), the gluteal-pudendal trunk (22.7%), or a trifurcation (9.1%). One to 3 branches of varying diameters (0.5-3.5 mm) entered the mesorectum from the ventrolateral (35.7%), lateral (42.9%), or dorsolateral (21.4%) aspect. The middle rectal artery was accompanied by podoplanin-immunoreactive lymphatic vessels and gave off additional branches (81.8%) to the urogenital pelvic organs. Three-dimensional reconstruction revealed the complex course of the middle rectal artery from the pelvic sidewall through the pelvic nerve plexus and parietal pelvic fascia into the mesorectum. Findings retrieved from body donors may be prone to age- and fixation-related processes. The investigation disclosed the rather high prevalence of the middle rectal artery, its 3-dimensional topographic anatomy, and its proximity to the autonomic pelvic nerves. These features play a role in the surgical management of this blood vessel. The data provide the anatomical rationale for the lateral lymphatic spread of rectal cancer and an anatomical basis for nerve-preserving lateral lymph node dissection.

Macroscopic anatomy of the plexus brachialis and its innervation in the common pheasant (Phasianus colchicus)

Macroscopic anatomy of the plexus brachialis and its innervation in the common pheasant (Phasianus colchicus)

A comparative analysis of lecturers' satisfaction with Anatomage and Pirogov virtual dissection tables during clinical and topographic anatomy courses in Russian universities.

Anatomy is increasingly taught using computer-assisted learning tools, including electronic interactive anatomy dissection tables. Anatomage was he first virtual anatomy dissection table introduced in Russian medical universities and gained popularity among lecturers and students. The Pirogov interactive anatomy table was recently released, but the strengths and weakness of each platform is currently unknown. The objective of this article is to survey lecturers in anatomy to understand their perspectives on the Pirogov versus Anatomage virtual dissection tables' application to teaching in medical universities. A total of 80 anatomy educators from 12 Russian universities, using Anatomage (n=40) and Pirogov (n=40) tables were surveyed regarding their satisfaction with the application of the respective tables. Using a five-point Likert scale, both tables were assessed, and responses were statistically analyzed. In addition, qualitative analysis was performed on free response comments provided by survey respondents. There was no significant difference in overall satisfaction ratings between Pirogov (4.38 ± 0.53) and Anatomage (3.94 ± 0.60) interactive tables (p > 0.05). The Anatomage table ranked significantly higher on the accuracy of displayed anatomical details, resolution of the images, and its suitability for teaching senior medical and postgraduate students. Pirogov table performed significantly better on survey items measuring ergonomics, ability to assess students' performance, and teaching basic anatomy to junior first- and second-year medical students. Thus, in summary, anatomists' responses indicated that while both tables are suitable for teaching anatomy, the Pirogov table was superior in undergraduate medical education and the Anatomage table was more beneficial for teaching more senior trainees.

In vivo prostate cancer research: Key interspecies prostate anatomical features for translation medicine.

Prostate cancer (PCa) is a prevalent malignancy affecting men worldwide. Animal models play a crucial role in studying PCa pathology and discovering novel approaches to prevent, detect and treat this disease. However, the challenge of translational medicine is the limited reproducibility and inadequate recapitulation of human conditions in animal models. Therefore, a comprehensive understanding of the macroscopic and microscopic anatomy of the prostate gland among distinct animal species is essential for better translating research findings to clinical practice. This review aims to compare and describe the macroscopic and microscopic anatomy of the prostate gland in humans, rats, and dogs, emphasizing the relevant features. Despite the anatomical differences between these species, rats are a valuable model to study human prostate diseases, once they share some features implicated in carcinogenesis in humans. Dogs, on the other hand, are considered the best model for studying PCa due to the development of spontaneous cancer with a higher incidence when compared with other animals and the development of bone metastases. Moreover, the lymphatic system and the sentinel lymph node role and mapping are similar in dogs and humans. However, it is important to recognize that no animal model can directly mimic all aspects of PCa as the human prostate is anatomically different from that of rats and dogs. Therefore, it is essential to analyze and understand the intra- and interspecies variability when translating research findings into clinical practice. This review highlights the importance of a thorough understanding of the anatomical differences between the prostate gland in humans, rats, and dogs when selecting the appropriate animal model for studying PCa.

МЕТОДОЛОГИЯ ОБСЛЕДОВАНИЯ И УЛЬТРАЗВУКОВАЯ АНАТОМИЯ ЧЕЛЮСТНО-ЛИЦЕВОЙ ОБЛАСТИ У ПАЦИЕНТОВ С КРАНИОФАЦИАЛЬНОЙ МИКРОСОМИЕЙ

The study presents findings of extended ultrasound examination of a maxillofacial area in 62 patients with craniofacial macrosomia. It was used to detect abnormalities in patients’ ultrasound anatomy and to apply a topographic anatomy option in order to advance the methodology of examination and planning for surgical procedures, namely auricle reconstruction. The following findings were detected throughout the ultrasound examination: 7 patients with a total aplasia of parotid salivary gland in a normal structure and size of salivary gland on the damaged side; all patients with a normal structure and size of submandibular salivary gland on the damaged side; and 25 patients with anatomic landmarks for auricle reconstruction using a carcass of costal cartilage autograft. An ultrasound examination of head and neck, particularly the temporal, parotid-masticatory and temporal areas on both sides, the masticatory and temporal muscles, the temporal fascia, the large salivary glands, the vessels of the temporal areas, is required for formation of unbiased assessment of the state of maxillofacial area in patients, as well as further systematization of results for detection of correlation with apparently healthy children. Based on an ultrasound examination of topographic anatomy of temporal area, a method for detection of optimal location for auricle reconstruction in patients with craniofacial macrosomia is found relevant and accessible.

Anatomia macro- e microscópica do encéfalo do calango (Tropidurus torquatus) (WIED, 1820)

Abstract Reptiles have a key role in understanding amniotes’ reproductive independence of water. Many adaptations arose, including in locomotor patterns and behaviours, and the nervous system adapted to those new habits. We have described the macroscopic anatomy and cytoarchitecture of the Amazon Lava Lizard brain (Tropidurus torquatus), an abundant lizard in South America. Fifteen specimens were captured, euthanized and their brains were dissected, eight of these were processed and stained in haematoxylin-eosin. Their main areas of the brain are the telencephalon and diencephalon, in the forebrain, tectum and tegmentum, in the midbrain and medulla oblongata and cerebellum, in the hindbrain. The main and accessory olfactory bulbs are the most rostral structure of the brain and are composed of six layers. Brain hemispheres compose the telencephalon and are divided in pallium and subpallium. Medial, dorsomedial, lateral and dorsal cortices are part of the pallium. Striatum, pallidum and septum compose the subpallium. The diencephalon is composed of thalamus, epithalamus and hypothalamus. The midbrain has a ventral tegmentum, composed of torus semicircularis and a dorsal 14 layered optic tectum. Most part of the hindbrain is composed of the medulla oblongata, and the cerebellum arises from it, forming a three-layered plate like structure. In general, the brain of Tropidurus torquatus resembles those of other lizards, with its own adaptations.

An anatomical approach to the tarsal tunnel syndrome: what can ankle’s medial side anatomy reveal to us?

BackgroundThe heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle’s medial side and if so, do they have a regular path after emerging from TN.MethodsThe distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon–McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT).ResultsThe TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter’s nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p < 0.001).ConclusionsIn our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.

Evolution of topographical anatomy and operative surgery programm on stages of educational discipline development

Evolution of topographical anatomy and operative surgery programm on stages of educational discipline development

Ревизионный остеосинтез перелома локтевой кости (клинический случай)

Fractures of the forearm bones are one of the most common injuries of the upper limb. Due to the increase in injuries, the urgency of the problem of treating these fractures is increasing. Difficulties in osteosynthesis of fractures of the forearm bones are associated with the peculiarities of the topographic anatomy of the forearm, the subtlety of the biomechanical interaction of the radius and ulna, a large number of damage options, the need for precise reposition and stable fixation, the risk of damage to tendons and nerves. The purpose of this research is to demonstrate the successful experience of treating a patient with a closed fracture of the upper third of both bones of the left forearm. Materials and Methods: description of a clinical case and a brief analysis of the literature on this topic. The experience of revision osteosynthesis of a closed fracture of the upper third of both bones of the left forearm with angular deformation of the metal structure and secondary displacement of fragments is presented. The effectiveness of treatment was evaluated based on the data of the X-ray examination method, computed tomography, as well as when assessing the function and volume of movements in the elbow joint. Results: revision osteosynthesis of the fracture of the upper third of both bones of the left forearm with a plate with angular stability with autotransplantation of bone tissue from the crest of the tibia of the left tibia was performed. The restoration of limb function and the patient’s ability to work has been achieved.

Quantitative Ultrasound: An Emerging Technology for Detecting, Diagnosing, Imaging, Evaluating, and Monitoring Disease.

Ultrasound has been a popular clinical imaging modality for decades. It is a well-established means of displaying the macroscopic anatomy of soft-tissue structures. While conventional ultrasound methods, i.e., B-mode and Doppler methods, are well proven and continue to advance technically in many ways, e.g., by extending into higher frequencies and taking advantage of harmonic phenomena in tissues, fundamentally new so-called quantitative ultrasound (QUS) technologies also are emerging and offer exciting promise for making significant improvements in clinical imaging and characterization of disease. These emerging quantitative methods include spectrum analysis, image statistics, elasticity imaging, contrast-agent methods, and flow-detection and -measurement techniques. Each provides independent information. When used alone, each can provide clinically valuable imaging capabilities; when combined with each other, their capabilities may be more powerful in many applications. Furthermore, all can be used fused with other imaging modalities, such as computed tomography (CT), magnetic-resonance (MR), positron-emission-tomography (PET), or single-photon emission computerized tomography (SPECT) imaging, to offer possibly even greater improvements in detecting, diagnosing, imaging, evaluating, and monitoring disease. This chapter focuses on QUS methods that are based on spectrum analysis and image statistics.

Kliničke i dermoskopske karakteristike lentigo maligna

Introduction/Aim. Lentigo maligna (LM) represents an in situ melanoma that develops on chronically photo-damaged skin. Clinical diagnosis of LM is often difficult, even for experienced dermatologists. The aim of the study was to analyze the clinical and dermoscopic features of patients with pathohistologically verified lentigo maligna (LM) and to determine a possible influence of anatomical topography, age and gender in the dermoscopic features of LM. Patients and methods. This retrospective study included 32 patients with 32 LM changes in total, diagnosed between 2017 and 2020. Clinical data recorded from each patient included the following: demographic features (age, gender), anatomic localization (facial or extrafacial) and clinical size (&lt; 10 mm or &gt; 10 mm). Facial area was subdivided into eight topographical sites, while extrafacial localization involved any location outside the face region. All dermoscopic images were analyzed for the presence of dermoscopic features previously described as LM. Results. In the total of 32 patients, there were 19 males and 13 females. The patients' age ranged from 34 to 80 years (median age 60.1 ± 10.4 years). Significant female predominance was observed for localization on the cheeks (p = 0.018). Localization on the nose was significantly associated with patients older than 65 (p = 0.039). The most frequent dermoscopic features were asymmetric pigmented follicular openings in 23 (71.9%) cases, gray color in 22 (68.8%) and pigmented rhomboidal structures in 15 (46.9%) cases. In relation to age and specific dermoscopic features, gray color (p = 0.035) and white scar-like areas (p = 0.012) were significantly higher in patients older than 65, while pigmented rhomboidal structures (p = 0.041) were significantly associated with younger patients. Conclusion. The observed differences in the frequency of clinical and dermoscopic features of LM have significant importance in everyday clinical practice and can assist clinicians in the early diagnosis of this malignant tumor.

Israil PERELMAN: the shore of his life, or the distance of youth lived (to the 130th of birthday)

For Professor Israil Moiseevich Perelman (1892-1954) the events of the second half of 1951 unfolded tragically. The release from the head of the department of general surgery and the appointment to the post of head of the department of topographic anatomy with operative surgery of the Yaroslavl Medical Institute deprived him of the opportunity to practice practical surgery. Such objections were not accepted, and I.M. Perelman was fired from the institute as not starting work. In the spring of 1952, the disgraced professor returned to Belarus. Having visited Minsk and found himself on the banks of the post-war Svisloch, he poignantly felt the atmosphere of Lyakhovka half a century ago. Memory brought him back to the summer of 1905, when he became a student of the Minsk real school a storehouse of knowledge for those who, following the results of their studies, were willingly enrolled in metropolitan universities. Talented teachers took an active part in shaping the personality of Israil Perelman, including Samoilo I.I., Gurvich O.Ya., Pionier L.O., Skokanek A.I. The period of adolescence was also enriched by the first charm of the soul, when Israil experienced sympathy for the one who became the secret of ardent feelings. Their reciprocity turned out to be fragile, short-lived and irretrievably gone into the distant past. In a real school, fate brought the young man to O.L. Lunts, who served here as a staff doctor. As an experienced clinician and an outstanding public figure, the doctor shared his life experience. His stories strengthened the desire to engage in healing and instilled faith in the correctness of the choice of the future profession. The logical result of seven years of study in a real school was the receipt of a certificate of complete secondary education, bringing Israil Perelman one step closer to achieving his main dream to be a doctor.

Fast Track to Full Online Education in the Medical Field

The research explores the key issues specific to the online learning format. The scholars surveyed 1540 students and teachers to collect the data. The purpose was to identify and find solutions to the distance learning problems in medical faculties. The research highlighted that 68% of students were dissatisfied with communication. Many educators have introduced ineffective teaching methods. Inadequate application of the programs prevents educators from introducing effective situation modelling, presenting medical and clinical case scenarios. It should ensure effective online communication with patients and other medical practitioners. The majority of students (62%) and teachers (68%) reported problems in these areas. The proposed online learning methods can be effective in teaching subjects such as general surgery, anatomy, pathological anatomy, topographic anatomy and operative surgery, and pathophysiology. The results can help educators to improve medical education.

The Superficial Fascia System: Anatomical Guideline for Zoning in Liposuction-Assisted Back Contouring.

Dorsal contour deformity presents with different manifestations in each part of the back, such as back rolls, iliac crest deposit, and buffalo hump. However, scant current literature exists on the anatomical basis of dorsal contour deformity. The aim of this study was to better understand the anatomical characteristics of the back, and to propose evidence-based zoning principles for liposuction-assisted back contouring. A total of 12 fresh cadavers were dissected for observation of each hierarchy in the vertical order (skin to deep fascia) and transverse comparison of the superficial fascial system (SFS) in the scapular-infrascapular-lumbar triangle region. Full-dorsum vectorial sections were used for the study of suprascapular fat deposits. The SFS acts as a bridge connecting all levels of the dorsal subcutaneous tissue. Macroscopically, it is denser in the scapular and lumbar triangle regions and looser in the infrascapular region; microscopically, the ultrastructure of the retinaculum cutis consists of loose interlobular fascia and stiff functional fascia. The regional variation pattern of the SFS in the back was consistent with observed back contour deformities in Asian female patients. A better understanding of the topographic anatomy of the back applied to evidenced zoning is the basis for improving surgical precision and avoiding dorsal contour deformity.

The role of anatomical and topographic features of angioarchitectonics and nerve gliding for its recovery

In the modern concept of treatment of patients with injuries of peripheral nerves, the main thing is to understand the mechanism of its sliding and the peculiarities of blood supply. Studying the nerve topographic anatomy, we are convinced that the mobility of the nerve exists not only in relation to the tissues surrounding it, but also at the level of its inner bundles. In this article, we report on the different degree of nerve mobility depending on its location zone, and that the ulnar and median nerves have the highest degree of mobility at the level of the forearm distal third. To calculate the change in the glide of the nerves, a mathematical model was constructed to measure their mobility during flexion and extension in the elbow joint, allowing to personalize the flap plasty depending on the length of the autograph vascular pedicle. The anatomical and topographic features of the angioarchitectonics of the nerve at various levels were studied, the presence and variability of the location of the vascular pedicle of blood-supplied autografts were studied. The obtained knowledge is necessary for carrying out revascularization of the damaged nerve zone with various types of autografts with autonomous blood flow. Conclusions. Knowledge of the anatomical and topographic features of peripheral nerves, their blood supply and mobility is necessary for their recovery for various injuries.

Use of 3D planning of HDR brachytherapy in patients with cervical cancer

Background. Combined radiation therapy is the «gold standard» for the treatment of stages IIB-IVA of cervical cancer (cervical cancer). Given the data of statistical indicators of cervical cancer, the study of new approaches to treatment and implementation in clinical practice of modern technologies of radiation therapy of widespread cervical cancer is an extremely important area.&#x0D; Purpose – evaluate the benefits of using CT topometric preparation in planning brachytherapy for cervical cancer.&#x0D; Materials and Methods. 3D planning of brachytherapy of 24 patients with locally advanced cervical cancer (FIGO IIIB stage), who underwent a radical program of combined radiation therapy (remote radiation therapy with chemical modification with cisplatin followed by HDR-brachytherapy (High dose rate brachytherapy)).&#x0D; Results. The paper presents the results of the analysis of differences in brachytherapy planning according to orthogonal images and CT images. The analysis of the influence of the constitutional features of patients revealed that there are differences in the topographic anatomy of the pelvis depending on the surface area of the body. In patients with a body surface area of up to 1,65 m2 , a more intimate fit of the intestine to the target volume of irradiation was noted. No similar planning difficulties were found in patients with a body surface area above 1,65 m2 .&#x0D; Conclusions. The use of 3D images in the planning of intracavitary irradiation in patients with cervical cancer provides precision brachytherapy by simultaneously visualizing the irradiated volumes and spatial relationships of the anatomical structures of the pelvis, the introduced endostats and the corresponding volumetric dose distributions.