Clinical Anatomy最新文献

The increasing application of generative artificial intelligence large language models (LLMs) in various fields, including medical education, raises questions about their accuracy. The primary aim of our study was to undertake a detailed comparative analysis of the proficiencies and accuracies of six different LLMs (ChatGPT-4, ChatGPT-3.5-turbo, ChatGPT-3.5, Copilot, PaLM, Bard, and Gemini) in responding to medical multiple-choice questions (MCQs), and in generating clinical scenarios and MCQs for upper limb topics in a Gross Anatomy course for medical students. Selected chatbots were tested, answering 50 USMLE-style MCQs. The questions were randomly selected from the Gross Anatomy course exam database for medical students and reviewed by three independent experts. The results of five successive attempts to answer each set of questions by the chatbots were evaluated in terms of accuracy, relevance, and comprehensiveness. The best result was provided by ChatGPT-4, which answered 60.5% ± 1.9% of questions accurately, then Copilot (42.0% ± 0.0%) and ChatGPT-3.5 (41.0% ± 5.3%), followed by ChatGPT-3.5-turbo (38.5% ± 5.7%). Google PaLM 2 (34.5% ± 4.4%) and Bard (33.5% ± 3.0%) gave the poorest results. The overall performance of GPT-4 was statistically superior (p < 0.05) to those of Copilot, GPT-3.5, GPT-Turbo, PaLM2, and Bard by 18.6%, 19.5%, 22%, 26%, and 27%, respectively. Each chatbot was then asked to generate a clinical scenario for each of the three randomly selected topics-anatomical snuffbox, supracondylar fracture of the humerus, and the cubital fossa-and three related anatomical MCQs with five options each, and to indicate the correct answers. Two independent experts analyzed and graded 216 records received (0-5 scale). The best results were recorded for ChatGPT-4, then for Gemini, ChatGPT-3.5, and ChatGPT-3.5-turbo, Copilot, followed by Google PaLM 2; Copilot had the lowest grade. Technological progress notwithstanding, LLMs have yet to mature sufficiently to take over the role of teacher or facilitator completely within a Gross Anatomy course; however, they can be valuable tools for medical educators.

This study aimed to investigate the learning outcomes and opinions about dissection and prosection methods among second-year dental students. Twenty-one dental students participated in the study. Two topographic subjects were selected from the head and neck region. Theoretical and practical pre-tests for the first subject were presented. After the theoretical lecture, the students were randomly divided into dissection and prosection groups and a practical lesson was presented. A post-test was then applied. On another day, the same steps were repeated for the second topographic topic, reversing the practice groups. A feedback questionnaire was supplied to the students at the end of the study. The questions in the first part of the feedback survey were scored using a 5-point Likert scale, and the open-ended questions in the second part were scored by creating a six-step latent thematic analysis - main themes and sub-themes. Post-test scores were higher in both subjects (p < 0.001). While there was no difference between the pre- and post-test student scores on practical questions in the first subject, the post-test practical scores were higher in the second subject (p = 0.044). There was no significant difference between the dissection and prosection groups for either subject (p > 0.05). Most of the students (n = 18, 85.71%) stated that both methods were necessary for anatomy education. Some of them (n = 12, 57.41%) found prosection more useful and some (n = 5, 23.81%) found dissection more useful. In response to the answers to the open-ended questions, four main themes were created and the results related to these main themes were collected in sub-themes. This study shows that the preferred method of cadaveric education, whether dissection or prosection, has a positive effect on both students' emotions and learning outcomes. Institutions can use both methods in a balanced way when designing anatomy curricula in dental schools.

The application of artificial intelligence (AI) in education has gained great attention recently. Integration of AI tools in anatomy teaching is currently engaging researchers and academics worldwide. Several AI chatbots have been generated, the most popular being ChatGPT (OpenAI: San Francisco, California, USA). Since its first public release in November 2022, several research papers have pointed to its potential role in anatomy education. However, it is not yet known whether it will prove superior to other available AI tools in this role. This article sheds some light on the current status of research concerning AI applications in anatomy education and compares the performances of three well-known chatbots (ChatGPT, Gemini, and Claude) in answering anatomy questions. A total of 23 questions were used as prompts for each chatbot. These questions comprised 10 knowledge-based, 10 analysis-based USMLE Step 1-type, and three radiographs. ChatGPT was the most accurate of the three, scoring 100% accuracy. However, in terms of comprehensiveness, Claude was the best; it gave very organized anatomical responses. Gemini performed less well than the other two, with a scored accuracy of 60% and less scientific explanations. On the basis of these findings, this study recommends the incorporation of Claude and ChatGPT in anatomy education, but not Gemini, at least in its current state.

Prior case reports have suggested that treating thoracic outlet syndrome (TOS) may relieve intractable migraine headaches, but there has been no case series large enough to show when underlying TOS should be suspected as a contributor to migraine burden. This observational followed by questionnaire study was performed in an outpatient neurology practice to identify clinical features of patients with migraine in which TOS contributed to migraine burden. We report the clinical features of 50 consecutive patients (48 women, 2 men, age = 43.9+/12.7 years) who were treated for chronic migraine and TOS (20 migraine with aura, 28 migraine without aura, two hemiplegic migraines). Headaches had become chronic within 1 year of onset in 21 patients (42%) with characteristics as follows (percentages are based on known data): greater severity ipsilateral to TOS limb pain (38/50=76%), presence of limb swelling (32/48=67%), and worsened by recumbency (32/38=84%). Thirty-two patients eventually needed surgery, which included percutaneous transluminal venoplasty, 1st rib removal, scalenectomy, pectoralis minor tenotomy, and/or vein patching. The mean improvement of headaches on the treated side was 72 ± 26.7%; 12 patients experienced complete resolution of headaches after treatment of TOS (follow-up 7.2 ± 5.2 months). Questionnaire responders reported significant reductions in headache days (18.3 ± 8.6 to 11.1 ± 10.8 days/month, p < 0.0016), severity (7.8+/2.5 to 5.4 ± 2.9, p < 0.00079), and need for emergency care (3.6 ± 4.0 to 0.71 ± 1.3 visits/year, p < 0.0029). Chronic migraines can be important manifestations of TOS. Early transition to a chronic state, lateralized limb pain, and headaches worsened by recumbency are clues to the contribution of TOS pathology. Addressing the TOS contribution to migraine can significantly reduce migraine headache burden.

The recently-described left atrial appendage (LAA) neck is a truncated cone-shaped structure that connects the LAA orifice to its lobe. It shows malformations in some cases, but their exact description and clinical significance are unknown. Therefore, the aim of this study was to provide a detailed anatomical and morphometric analysis of LAA neck malformations in clinical context. A total of 250 autopsied human hearts (20.0% women, 46.7 ± 18.2 years old) were examined for mural malformations: spikes and bulges. Endocardial roughness of the LAA neck with a depth <2 mm and no recognizable epicardial protrusion was defined as ectopic trabeculation. LAA neck malformations were found in 13.6%, bulges in 10.0% of the hearts examined, spikes in only 3.2%, and ectopic trabeculations in 24.8%. In one case, both a bulge and a spike were found in the LAA neck. Most LAA neck roughness was observed on the aortic and venous surfaces of the LAA neck. Those surfaces were the most common locations for malformations and ectopic trabeculations. The LAA wall was significantly thinner than the surrounding neck wall within the bulges and the ectopic trabeculations, but not in the spikes.

A proper appreciation of cardiac development can now provide the necessary background to understand the anatomical findings in the congenitally malformed heart. We recently presented an account of human cardiac development based on reconstructions of histological datasets from human embryos aged between 3.5 and 8 weeks subsequent to conception. In this review, we summarize the changes observed relative to the findings when the heart is congenitally malformed. Beginning at the stage when it is first possible to recognize the primary heart tube, we describe the looping of its ventricular component, which occurs in the 5th week. We proceed with discussion of the formation of the atrial and ventricular chambers in the 6th week. The phases are successive, albeit partially overlapping. Separation of the circulations at the venous pole is completed at stage 17, equivalent to almost 6 weeks of development. During stages representing the 7th week of development, we concentrate on the remodeling of the outflow tract. This involves initially septation, but then separation of the developing circulations. The changes involve incorporation of the proximal outflow tract into the ventricles, with formation of the arterial roots in its middle part, and addition of a distal non-myocardial component to produce the intrapericardial arterial trunks. We pay particular attention to the changes occurring during remodeling of the interventricular foramen. We show that an understanding of this process provides the basis for understanding the functionally univentricular heart, as well as the arrangement found in double outlet right ventricle.

Augmented reality (AR) has been investigated as an engaging educational tool that motivates undergraduate health science students to learn human anatomy. AR technology is developing rapidly, supporting medical education by presenting models of human anatomy as digital objects overlaid in the real world via mobile or head-mounted display (HMD). The purpose of this systematic review is to provide a post-pandemic analysis of AR compared with other methods for teaching anatomy and to determine the effects of AR on learning outcomes (LOs). Original research published between January 2020 and April 2024 was obtained from the WOS, Scopus, MEDLINE(Ovid), EMBASE, and PubMed databases, following PRISMA 2020 protocols. Articles included for analysis compared AR with alternative pedagogical methods of teaching undergraduate human anatomy. Studies that described AR as "mixed reality" (MR) were included, while those describing "virtual reality" (VR) were not considered. Risk of bias and limitations in individual studies were assessed using the Quality Assessment with Diverse Studies (QuADS) tool. Data were synthesized using a convergent integrated approach with LOs tabulated for visual analysis. A total of 17 articles were eligible for review: nine studies comparing AR via HMD hardware, and eight comparing mobile AR. The LOs of 12 studies were overwhelmingly reported as non-significant. Insufficient data precluded an accurate meta-analysis of LOs, and critical analysis revealed a considerable risk of bias and lack of justified methodology. While AR holds potential for supporting undergraduate students in learning anatomy, definitive outcomes from the current literature are limited by the heterogeneous nature of the studies and inconsistent use of terminology. It is recommended that future research employs professional AR technologies and incorporates the perspectives of university educators to ensure reliable outcomes that can direct the further development of AR technology in medical education.

Understanding the impact of depression on brain aging benefits the prognosis of this disease and of the risk that other age-related brain disorders will develop in the same population. The aim of the present study was to explore the genetic effect of depression on longitudinal changes in brain structure throughout the lifespan using a Mendelian randomization approach. Summary data from a genome-wide association study of 195,321 to 377,277 participants in the FinnGen consortium were used to predict depression, anxiety disorders, mood disorders, and antidepressant use genetically. Data from 15,640 participants in the ENIGMA consortium were included to predict changes in 15 brain structures throughout the lifespan. The causal relationship between these depressive traits and the brain structure parameters was assessed by two-sample Mendelian randomization (including inverse-variance weighted). Sensitivity analyses were conducted for quality control. Depression slowed the decrease of cortical gray matter volume significantly throughout the lifespan (p = 0.001). Depression, anxiety, and mood disorders nominally decreased the rates of change of volume in the cerebellum gray matter, lateral ventricles, and cortical gray matter throughout the lifespan (p = 0.048, p = 0.021, p = 0.038, respectively). Antidepressants did not affect these rates of change significantly (p > 0.05). Sensitivity analyses confirmed the reliability of this study. Depression and its main symptoms have a slight effect on longitudinal changes in a few brain structures throughout the lifespan at the genetic level. These findings do not support the notion that depression affects macro-aging in the brain crucially.

The aim of this study is to assess the oblique lateral interbody fusion (OLIF) corridor dimensions when the abdominal great arteries (the abdominal aorta or common iliac arteries) and psoas major are retracted. Twenty embalmed cadaveric specimens were dissected. The widths of the OLIF operative corridor at L1-2, L2-3, L3-4, and L4-5 were measured with the psoas major and abdominal great arteries in static state, with psoas retraction, and with mild retraction of the abdominal great arteries. The retractable distances of the psoas major and the abdominal great arteries at each lumbar segment were compared. In the static state, the operative corridor gradually narrowed from L1-2 to L4-5, but there was no significant difference in its width between segments (p > 0.05). There was no significant difference in the corridor width between segments after retraction of the psoas major or the abdominal great arteries (p > 0.05). However, retraction of either the psoas major or the abdominal great arteries made the corridor at the L1-5 segments significantly wider than those in the static state (p < 0.05), particularly at L4-5, and the retractable distance of the psoas major was significantly greater (p < 0.05). The cadaveric model demonstrated the use of abdominal great arteries retraction in principle. The OLIF operative corridor could be widened to some extent by retracting the abdominal great arteries, and widened further by retracting the psoas major.