Clinical Anatomy最新文献

Although the sternoclavicular joint shares structural similarities with the knee and hip joints as a diarthrodial joint, its biomechanics differ significantly due to its non-weight-bearing nature. Nevertheless, it is subject to considerable loading, leading to increased susceptibility to osteoarthritis, a prevalent condition characterized by the degeneration of the joint's articular surfaces and fibrocartilaginous intra-articular disc. The osteoarthritic degeneration of the fibrocartilaginous and cartilaginous surfaces of the sternoclavicular joint has been investigated, considering multiple factors. These include cell count, collagen alignment, surface fibrillation, cyst formation, and glycosaminoglycan content, with the findings deemed significant. However, current treatments for osteoarthritis of the sternoclavicular joint tend to focus on symptom management rather than active prevention of disease progression. Therefore, a detailed understanding of the anatomy, biomechanics, and morphological changes of the sternoclavicular joint during all stages of the osteoarthritic disease is essential for effective management to allow for maximum patient outcomes. This review explores the current literature on the anatomy of the sternoclavicular joint, starting with its structure and comparison to surrounding joints, biomechanics, and morphology, before considering the microanatomical changes that occur due to osteoarthritic degeneration. Early identification of osteoarthritic changes within this joint can enhance treatment and management outcomes before advancing joint degeneration, improving the quality of life for those affected.

Horst Oertel was an early 20th century pathologist who began his career as an instructor of clinical pathology at the New York University and Bellevue Hospital Medical College in 1899. In 1903, he was appointed pathologist for City Hospital, an institution for indigent patients on New York City's Blackwell's Island. In 1907, Oertel became the first director of the Russell Sage Institute of Pathology, a unique new blended public-private entity based at City Hospital, that was named after a wealthy benefactor. The Institute was established to utilize the Island's indigent population to perform anatomical pathology research on diseases of aging. Oertel and the Institute thrived until 1911, when a newly-appointed New York City bureaucrat seeking patronage and graft began meddling in the Institute's governance. After press coverage of a vitriolic one-week-long exchange of charges and counter-charges between the Institute's Board of Directors and the bureaucrat, the Institute imploded. While these events meant that the Institute's tenure on Blackwell's Island would soon be coming to an end, Oertel continued to work and submit articles from the Institute throughout 1912. In May 1913, he published "The Inaccuracy of American Mortality Statistics" in American Underwriter, a bombshell article documenting low autopsy rates and high clinical diagnostic error rates at Bellevue Hospital during 1912. This, along with similar studies by Richard Cabot at Massachusetts General Hospital in Boston, highlighted fundamental problems in hospital care and medical education across America. Simultaneously, Oertel led the Public Health, Hospital and Budget Committee of the New York Academy of Medicine which reported that, in a selected series of large American hospitals, the autopsy percentage when compared to the number of deaths was one-eighth the rates in Canada, Great Britain, Austria, and Germany. This paper addresses how American autopsy rates skyrocketed and then plummeted again during the mid-20th century.

Anatomical education is transitioning from the time-honored cadaveric dissection to a blend of learner-centered and technology-enhanced learning approaches. In view of the increased use of various technologies for teaching and learning human anatomy, the aim of this study is to explore students' acceptance of four learning technologies using the technology acceptance model (TAM). This work was conducted at a graduate medical school in Singapore with first-year MD Program students. The acceptances of the four learning technologies were compared in two studies. In Study 1 (n = 46), we compared a 3D-printed (3DP) model with Primal Pictures to answer a clinical question in a Spine Anatomy Tutorial; in Study 2 (n = 55), we compared the Anatomage Table and Primal VR for a Brain Anatomy tutorial. There was a statistically significant preference (p < 0.05) for 3DP models over Primal Pictures for learning Spine Anatomy, and for Primal VR over Anatomage for learning Brain Anatomy. The perceived ease of use of any technology does not appear to influence the behavioral intention to use it. Qualitative feedback suggests that visualization and spatial relationships were among the most important facilitators of learning. Technology should be an enabler in learning but some technologies have a steeper learning curve than others. Therefore, to increase its perceived usefulness, educators must leverage the affordances of the technology when designing learning activities.

The accessory renal arteries (ARAs) are a well-described variant of the renal vasculature with clinical implications for radiologists, surgeons, and clinicians. The aim of the present systematic review with meta-analysis was to estimate the pooled prevalence of ARAs, including their variant number, origin, and termination, and to highlight symmetrical and asymmetrical morphological patterns. The systematic review used four online databases in accordance with PRISMA 2020 and Evidence-based Anatomy Workgroup guidelines. R programming software was used for the statistical meta-analysis. A total of 111 studies were considered eligible for our initial aim. The typical renal artery (RA) anatomy (a single bilateral vessel) was identified in 78.92%; the overall ARA prevalence was estimated at a pooled prevalence of 21.10%. The estimated pooled prevalence of one, two, three, and four ARAs were 18.67%, 1.80%, 0.01%, and <0.01%. The ARAs have been the subject of extensive research owing to their clinical importance, including in kidney transplantation surgery and resistant hypertension therapy. Knowledge of the typical and variant anatomy of RAs is essential for anatomists, radiologists, surgeons, and clinicians in order to avoid misunderstanding, complications, and iatrogenic injury.

X-ray computer tomography scans were carried out on 11 female and 9 male dry bony pelvises. A 512 x 512 image matrix was used with a slice thickness and separation of 2 mm. Images were transferred onto a computer and the articular cartilage marked on each relevant image. The points were connected to form a triangle mesh and the total articular cartilage area calculated by summing the area of each triangle. There was a highly significant difference (p < 0.001) between the male and female acetabular areas, 25.4 ± 2.7 cm² and 19.5 ± 2.0 cm², respectively. The mean left-right difference was 0.2 ± 0.9 cm² for males and-0.2 ± 0.47 cm² for females. When the sign of the differences are removed, the mean and standard deviations of the differences is 0.5 ± 0.46 cm² (2.3% ± 1.8%) for males and females, 0.66 ± 0.61 cm² for males and 0.4 ± 0.27 cm² for females. Each articular surface was outlined twice in order to assess the repeatability of the technique. The left-right variation in articular surface area was found to be similar to the variation in repeatability, suggesting that if any left-right difference does exist it is too small to be reliably detected by this technique. This enables the area of articular cartilage of the fragments of a fractured acetabulum to be compared directly with surface area of the contralateral intact acetabulum. Acetabular fractures can therefore be quantified by measurement of the articular surface area of the fracture components. Comparison with the clinical results will enable surface area to be developed as a prognostic factor in the management of acetabular fractures.

Understanding the distribution of nerves in the superficial layer of the face and the communication (nerve anastomosis) between them is essential for preventing paralysis during tumor removal and for planning during nerve grafting. However, communication between the peripheral branches of the trigeminal and facial nerves has not been fully elucidated owing to the delicacy of their structures and the ambiguity of definitions in previous reports. In this study, we used whole-mount nerve staining to differentiate between the two types of interaction between the trigeminal and facial nerves. "Nerve communication" is defined as an exchange of fibers between the two nerves, while "nerve crossing" indicates that only the epineuria are in close contact, with no exchange of fibers. The skin and soft tissues of six human faces were excised, and the nerves were stained using Sihler's method. The peripheral branches of the ophthalmic nerve showed no communication with the facial nerve. In half of the cases (3/6), the infraorbital nerve, representing the peripheral branch of the maxillary nerve, communicated with the facial nerve. Peripheral branches of the mandibular nerve communicated with the facial nerve via the auriculotemporal (6/6), buccal (6/6), and mental (3/6) nerves. Our findings demonstrate moderate communication between the peripheral branches of the trigeminal and facial nerves in the maxillary nerve region but more concentrated communication in the mandibular nerve region.

Myositis ossificans (MO) is a benign condition characterized by heterotrophic bone formation, most commonly within muscle tissue. Multiple types have been described, the most predominant being myositis ossificans circumscripta, which occurs in response to trauma. Myositis ossificans cases reported in the literature were reviewed systematically. The aim of the review was to examine how the condition and its management are influenced by the anatomical structures involved. The Medline and Ovid Embase online databases were searched for all papers relevant to MO between Jan 1972 and Dec 2020. Duplicate and unobtainable records were removed. The remaining records were manually assessed for relevance by three independent reviewers, initially by abstract and then by full-text screening, to ensure that all papers were suitable. Acceptance of articles was not limited by case features or study design. In total, 77 papers from the literature search were included. They contained information on 89 patients diagnosed with MO. The average age of the patients was 26.17 years (range 13 weeks to 72 years, a 71.75 year range) and 65.17% were male. The lower limb was affected more than the upper limb or spine, the most common site being the thigh. Muscle was the most commonly affected tissue, the quadricep femoris being most often involved. Diagnostic imaging varied widely among cases; X-ray alone was the most common method, followed by a combination of X-ray and MRI. Lesions in the lower limb had larger diameters than those in the upper limb or spine. More cases in the upper limb (47.83%) than in the lower limb (33.33%) required surgery. All instances of MO in the jaw, hand, and foot were symptomatic, and all required surgical management. The findings were consistent with previous research showing MO to be a predominantly male disease, with most patients being under 30 years of age. Trauma was involved in 52.81%, lower than previously reported. In this study, the vastus lateralis of the quadriceps was most often affected. MO lesions were less common and smaller in the upper limb but more required surgery. Anatomically confined sites such as the hand and foot always required surgery, probably because of earlier onset or more severe functional effects of symptoms. Further work is needed to review the anatomical predilection of MO to help identify patients who could benefit from earlier consideration of surgery. A national registry of MO cases could contribute to further research on this disease.

This article offers for the first time a facial approximation of the Ancient Egyptian Pharaoh Amenhotep III (reigned ca. 1388–1351 BC) based on photographic material of his mortal remains and anthropometric data collected at the time, and by adopting a novel technique previously used in similar research by our team. A comprehensive discussion of the mummy attributed to Pharaoh Amenhotep III is also annexed to the study, focusing on the bioarcheological and embalming aspects.

The testes and epididymis are traversed by a system of tubules in which sperm cells are generated, matured, nourished, and transported. Among these are the efferent ductules, which connect the rete testis to the duct of the epididymis. In the Terminologia Anatomica (TA), the efferent ductules are assigned to the testicles, while numerous anatomy, pathology, and urology textbooks assign them to the epididymis. Developmentally, they are derivatives of the Wolffian duct; as is the epididymal duct, which unquestionably belongs to the epididymis. Allocation of the efferent ductules to the compartment of the epididymis has been established clinically. The precise identification of tissue components of the epididymis is essential for the prognostic assessment of testicular cancers. In primary germ cell tumors of the testis, tumor infiltration into the epididymis can influence the tumor stage and can be associated with a worse clinical prognosis than localized tumor disease. Thus, it is desirable to update the TA, assigning the efferent ductules to the epididymis.