Clinical Anatomy最新文献

The lungs' fissural and lobar variations are clinically and anatomically important, with direct implications for anatomists, radiologists, and thoracic surgeons. Although standard anatomical textbooks commonly describe fissures as complete, numerous studies have reported substantial variability, including incomplete, absent, and accessory fissures. These variations may complicate surgical procedures, affect disease spread, and lead to misinterpretation of imaging findings. Therefore, quantifying the prevalence of fissural and lobar variations is essential for accurate clinical planning, reliable radiologic interpretation, and effective anatomical education. A systematic search was conducted across PubMed, Hinari, Crossref, and Google Scholar, as well as relevant anatomical journals, in accordance with Evidence-Based Anatomy Workgroup recommendations and reported following PRISMA 2020 guidelines. Eligible anatomical studies were included, and study quality was assessed using a standardized appraisal tool. Meta-analysis was performed using MetaXL with a random-effects model to estimate the pooled prevalence and distribution of lung variations. Among all evaluated lungs, anatomical variations were observed in 42%, with 63% occurring on the right side. When assessed independently, variations were present in 55% of right lungs and 33% of left lungs. The right horizontal fissure was complete in 54%, incomplete in 35%, and absent in 11%, while the right oblique fissure was complete in 77%. The left oblique fissure was complete in 72%, incomplete in 26%, and absent in 2%. Accessory fissures were present in 14% of both right and left lungs, most commonly the inferior accessory fissure on the right (6%) and the left minor fissure on the left (8%). Lung fissural and lobar variations occur in nearly half of individuals, with distinct right- and left-sided patterns and variable completeness. Awareness of these variations is essential for accurate anatomical understanding, surgical planning, radiological interpretation, and minimizing complications in thoracic procedures.

Restructuring of the preclinical medical curriculum has gained renewed vigor over the last two decades. In addition, many institutions have transitioned from a categorical to a pass/fail assessment system. Our institution followed this trend in 2021, converting from a two-pass to a one-pass preclinical curriculum, shortening its length by several months, and changing from a categorical to a pass/fail assessment scheme. Using a mixed-method approach, this study analyzed student performance and satisfaction in the first block of the revised curriculum, wherein a substantial portion of cell biology and basic tissues histology was added to a condensed anatomy and embryology block. The goals of this study were to assess overall student success and satisfaction in the new block in order to remedy any deleterious outcomes from the revision as a component of ongoing programmatic evaluation. Student performance on summative assessments was analyzed by comparing quiz and exam results from the three student cohorts immediately preceding curricular revision to the first three cohorts in the new curriculum. Performance on particular assessments declined after curricular overhaul, with the added cell biology-histology content yielding low scores. General student satisfaction with the block was gauged by analyzing student survey results and remained high after curriculum revision. While satisfaction with the added cell biology/histology content was initially low, it rose dramatically by the third iteration. A variety of resources are being implemented that may improve student performance in future iterations of the block.

Lumbar multifidus (LM) muscle dysfunction is a common cause of low-back pain (LBP). Training the LM muscles improves LBP; however, understanding the shape, muscle bundle structure, and origin-insertion of the LM muscle is essential for designing an effective training program. Although the LM muscle anatomy has been largely explored, controversies persist regarding its shape, muscle bundle structure, origin, and insertion, and a detailed understanding of its anatomy remains lacking. The current study sought to elucidate the shape and bundle structure of the LM muscle, focusing on the muscle insertion, to provide a scientific basis for developing training methods for the LM muscle. The formalin-fixed remains of nine cadavers (five males and four females; mean age at death, 79.6 ± 12.9 years) were examined for gross anatomical observation of the origin and continuity of the insertion of the LM muscle. The attachment area was also observed and recorded, with the periosteum remaining. The dissection findings were corroborated by the histological observations of the origin and muscle bundle structures of the two donors. In addition, ultrasonographic evaluation of the right LM at the level of the L5 spinous process was performed in four healthy adult males and two healthy adult females (mean age: 47.3 ± 16.0 years), and the findings were compared with the gross anatomical observations. Dissection revealed two muscle bundles with unique running patterns in the LM that inserted at one of the spinous processes in the lumbar vertebrae. One muscle bundle originates from the inferior lumbar mammillary process and the lateral sacral crest. The other is a pennate muscle that originates from two directions, with some muscle bundles originating from the thoracolumbar fascia. In this study, the LM muscle was dissected from its insertion, according to the fiber run, and its shape, muscle bundle structure, origin, and insertion were clarified, which have been reported inconsistently in previous studies. These results may facilitate training and evaluating the LM muscle.

The General Medical Council (GMC) and the Royal College of Radiologists (RCR) Undergraduate Radiology Curriculum emphasize the need for medical graduates to use anatomical knowledge when interpreting imaging studies. This study evaluated a model in which Clinical Teaching Fellows (CTFs) were upskilled to deliver radiologist-designed tutorials using computed tomography (CT) imaging to facilitate the identification of key anatomical landmarks on chest and abdominal X-rays. Two tutorials, aligned with our institution's pre-clinical curriculum, were developed by radiology residents and anatomy faculty for 430 first-year and 420 s-year medical students. CTFs were trained using structured pre-learning resources and then facilitated small-group sessions where students interacted with CT scans and correlated the anatomy with X-rays. Feedback was collected from students and tutors. Response rates were high (76% first year; 88% second year). Most students (87%) reported feeling prepared, 94% found sessions enjoyable, and nearly all (99.9%) found CT imaging useful for learning X-ray anatomy. Among tutors (n = 11), confidence in teaching with CT imaging rose significantly, with those reporting themselves as quite or very confident increasing from 28% to 91%. Tutors also reported improved confidence in viewing CT scans in their own clinical practice. Radiological anatomy teaching can therefore be delivered sustainably through the upskilling of non-radiologist educators. This model enhances student understanding of clinically relevant anatomy, aligns with national guidance, and provides professional development benefits for tutors. It offers a pragmatic strategy to integrate radiology into undergraduate curricula at scale.

A thorough understanding of pelvic autonomic anatomy is essential for contemporary neuroprotective surgical techniques, which strive to balance oncological radicality with the preservation of normal tissue function. Originally developed for prostatectomy and subsequently adapted for rectal resections and hysterectomy, these approaches underscore the critical importance of precise anatomical knowledge. Most research on true pelvis autonomic nerve plexuses published after 1990 emphasizes topography from a clinical perspective, aiming to map plexus organization to minimize iatrogenic injury and safeguard pelvic organ function. In contrast, investigations examining the composition, fiber characteristics, and trajectories of autonomic nerves remain comparatively rare. This study investigated the hypogastric nerves and inferior hypogastric plexus in 50 adult cadavers (18 female, 32 male) using dissection under an operating microscope combined with immunohistochemical analysis. The macroscopic structure and variability of the plexuses were documented, and the composition of the nerve fibers was assessed. In all specimens, the inferior hypogastric plexus appeared as two independently coursing "plates," interconnected by numerous macroscopically visualized adrenergic nerve interconnections located superficially in the retroperitoneal and preperitoneal regions, and deep in the area of the pelvic diaphragm and deep perineal muscles. The hypogastric nerves consisted of several to a dozen nerve bundles, primarily DBH-positive sympathetic fibers with a smaller proportion of VAChT-positive cholinergic fibers. Along their course and within branches of the inferior hypogastric plexus, numerous VAChT-positive and, to a lesser extent, DBH-positive clusters of nerve cells forming prevertebral ganglia were encountered. These ganglia were often of mixed cholinergic-adrenergic nature, with a predominance of the cholinergic component.

Anatomical photographs are essential in medical education and research as they document fine details of human anatomy. which may support visualization of dissection material. This study investigated the feasibility of an artificial intelligence (AI)-based image enhancement system for anatomical dissection photographs and explored whether subtle visual differences could be detected under magnification. A dataset of 50 anatomical photographs taken between 2001 and 2024 with four different digital cameras was processed using Upscayl (v2.11.5) with the preset "16× REAL-ESRGAN." Processing was performed on a Casper Excalibur G770 laptop, requiring approximately 3-5 min per image. Original and enhanced images were compared at magnifications of 1×, 5×, 10×, 15×, and 20× on a 55-in. Full HD display. Forty experts, including neuroanatomists and neurosurgeons, qualitatively assessed the images with respect to anatomical accuracy, noise reduction, edge definition, and training value. The visual differences between the original and enhanced images were generally subtle. However, subtle improvements in edge definition and noise reduction became more apparent in deep anatomical regions, such as ventricular cavities, particularly at higher magnification levels. High-resolution images showed limited observable differences, whereas lower-resolution images exhibited slightly more noticeable changes under magnification. The enhancement process did not introduce distortions of anatomical structures. A key limitation was the substantial increase in file size after enhancement. AI-based image enhancement appears feasible for anatomical dissection photographs and may provide modest visual benefits in selected settings, especially for older or lower-resolution images viewed at higher magnification. Further optimization is required to reduce file size and processing time before routine educational or publication use.

Human anatomy is a fundamental core course in medical education, and its teaching effectiveness directly influences students' understanding and application of medical knowledge. However, traditional anatomy instruction often faces challenges such as limited teaching resources and the high cognitive difficulty students experience. With the rapid advancement of artificial intelligence (AI), its application in medical education is receiving increasing attention. Graphics serve as a vivid and intuitive form of communication, and learning anatomy through visual representations proves more effective than relying solely on textual information. This paper explores the integration of AI and drawing in human anatomy education, analyzing its advantages and implementation strategies. Through practical teaching cases, the effectiveness of this approach is validated, providing new perspectives and methods for the reform of anatomy teaching.

The anterior hip muscles, especially the iliocapsularis, reflected head of rectus femoris and gluteus minimus, attach to hip capsulo-ligamentous complex directly, and may contribute to anterior hip stability by increasing the tension of the capsulo-ligamentous complex by muscle contraction. However, it has not been verified whether the contraction of these muscles actually increases the tension of the capsulo-ligamentous complex in vivo. The objectives of our study were to clarify (1) whether deep hip muscle contractions increase the tension of the hip capsulo-ligamentous complex, and (2) which muscles most affect the changes in the tension of the capsulo-ligamentous complex. Twenty-eight healthy young individuals (22.8 ± 1.6 years) participated. The tasks included isometric hip flexion, abduction, adduction, and knee extension contraction and rest in a supine position. The shear elastic moduli (G) of the capsulo-ligamentous complex, iliocapsularis, rectus femoris, and gluteus minimus were measured using shear wave elastography. Higher G values correspond to increased muscle activity and tension of the capsulo-ligamentous complex. The G of the capsulo-ligamentous complex showed higher in hip abduction contraction than in the resting position (p = 0.008). The results of the multiple regression analysis showed that only the amount of change in G of the iliocapsularis was a significant variable, even when adjusted for maximum torque (R² = 0.412, β = 0.513, p = 0.009). The tension of the hip capsulo-ligamentous complex increased with isometric hip abduction, implying tension transfer between the muscle and the capsulo-ligamentous complex. Furthermore, the iliocapsularis has been suggested to play an important role in the transmission of tension.

Pelvic pain has a significant impact on quality of life, especially when associated with benign pelvic diseases, such as endometriosis or chronic conditions leading to persistent discomfort. A substantial proportion of women are affected in their reproductive years, making it a public health issue. Even though previous research has provided a map of intrauterine innervation, the origins and pathways of macro-uterine innervation are still poorly understood. A better understanding of the complex network of pelvic nerves is crucial for improving surgical techniques and patient outcomes. We performed immunohistochemistry on pelvic slices of four human fetuses by using a wide variety of neuronal markers. Then, a 3D reconstruction was performed, and the different anatomical structures were identified, as well as the path of the nerve fibers toward the uterus, and nerve specificity was determined. Our findings confirmed that the nerve fibers essential to uterine function and pelvic sensitivity mainly originate from the inferior hypogastric plexus, branching extensively to innervate the uterus, cervix, and surrounding pelvic structures. Two main pathways were identified, one medial and the other anterolateral to the ureter. Considering these pathways during surgical interventions is paramount as their integrity might inadvertently be impacted, leading to postoperative complications, such as pain or functional disorders. The implications of this research extend beyond the operating room, as they will undoubtedly enrich both clinical practice and medical education in the years to come.

The specific anatomical features of the obturator internus, particularly those of its medial surface, remain insufficiently characterized. This study investigated the morphology of the obturator internus muscle by focusing on the shape of its medial surface and potential age-related changes. Through dissection of anatomical specimens and in vivo pelvic magnetic resonance imaging (MRI) analysis, we identified a consistent groove-like structure on the medial surface of the muscle and divided it into distinct regions: a superior portion with radiating muscle fibers and an inferior portion with parallel-aligned fibers. This division was characterized by differing fascicle orientations, with interspersed adipose tissue occasionally observed at the boundary. MRI scans of 27 women aged 25-83 years demonstrated that this groove was consistently visible; its location and depth were quantified. The groove position showed a weak negative trend with age, but this relationship was not statistically significant and may have been underpowered. No significant correlation was found for groove depth. By delineating the consistent bipartite architecture of the obturator internus and identifying its age-related variation, this study provides a detailed anatomical characterization of the medial surface of the obturator internus that may serve as a reference for future anatomical and clinical investigations involving the hip-pelvic interface.