Clinical Anatomy最新文献

Opinions on the meaning of the term fascia appear to have been diverging for the past quarter century. In 1998, the definition of fascia in the international standard anatomical nomenclature was narrowed by removing the term fascia superficialis. On the other hand, fascia researchers, who continue to widely accept the term superficial fascia, have progressively broadened their definition of fascia and proposed that fasciae constitute an anatomical system, the fascial system. Here we examine competing concepts from an anatomical perspective with the goal of finding a position that could lead to a consensus among anatomists, other biomedical scientists and health practitioners with an interest in fascia. We endorse a return to the traditional view that fasciae are fibrous membranes that compartmentalize and connect parts of the body, that they are primarily composed of sheets or sheaths of dense irregular connective tissue, and that they are not parts of well-defined organs. They are prominent components of the integument, musculature, lining of the body cavities, and extraperitoneal spaces. The proposal that fibrous membranous components of the skeleton and nervous system are also fasciae merits further study and discussion.

Pancreas shape features, derived from 3D segmentation of the pancreas, might be relevant to identifying subtle disease-related changes in the pancreas. This work utilized a retrospective sample of clinical contrast-enhanced CT examinations of 140 children < 18 years of age. Manual segmentations of the pancreas were used to extract radiomic shape features and perform statistical shape modeling using a partial least squares regression approach. Age, weight, height, body surface area, and body mass index each showed significant associations with volume, surface area, surface area to volume ratio, compactness, major axis length, minor axis length, least axis length, and area density. Elastic net regression models showed that demographic variables had strong predictive power (cross-validated r² 0.71-0.89) for pancreas volume, surface area, surface area to volume ratio, major axis length, minor axis length, and least axis length. In the analysis of shape modes, only the first partial least squares regression component accounted for a statistically significant amount of the demographic variance among participants (24.8% variance explained, p < 0.001), with significant loadings for age (p < 0.001), weight (p = 0.001), and height (p < 0.001). Our results are the first to characterize pancreas shape features in children with healthy pancreatic function and set the stage for future studies to understand how disease impacts pancreas shape, beyond global changes in volume, and how changes in shape might be used to diagnose and monitor disease.

Cardiovascular disease is known to be a factor in the development of neurodegenerative diseases because of the simple fact that arteries supplying blood to the brain might be affected. However, a thorough investigation of the distribution of arteriosclerosis, particularly in the form of arterial calcification, remains lacking. Here we report a histopathological study of the left and right sides of eight vessels that contribute to the Circle of Willis for 10 individual whole body donors. Increased calcium was not found to be correlated with the incidence of cardiovascular disease being listed as a cause of death on their death certificate, yet increased calcium levels were consistently found among the males in the study, with females exhibiting much more variation. The greatest significance was found between vessels of different size categories, with larger vessels exhibiting greater calcification % scores. Though this leaves smaller vessels uninvestigated, these results suggest that arterial calcification is a greater problem for larger vessels of the Circle of Willis.

Ultrasound (US) is a clinically important imaging modality that can also enhance medical students' understanding of anatomy, physiology, and pathology. However, its integration into preclinical curricula often remains limited due to challenges such as resource constraints and instructor availability. To address these shortcomings, we implemented and evaluated a peer-assisted learning (PAL)-based US course-Summer School of Anatomy-based Sonography Heidelberg (SASH)-with a daughter course at a second institution, the University of Cambridge (Cam-SASH). Both programs focused on teaching fundamental US techniques through a structured, tutor-led curriculum including an accompanying course manual. In 2022, we evaluated both programs prospectively, including 36 medical students. Over 1 week, student tutors trained participants in B-mode abdominal US through lectures, hands-on practice, and assessments, including Objective Structured Clinical Examinations (OSCEs) and pre- and post-course multiple-choice tests of anatomical knowledge. Post-course knowledge levels were comparable between Hei-SASH and Cam-SASH participants, with no significant differences observed in multiple-choice tests or OSCE performance (p ≥ 0.17). Feedback was overwhelmingly positive, with students reporting increased confidence and proficiency in performing US scans and interpreting images. This study highlights the transferability of PAL-led US courses, with comparable outcomes between institutions. Our findings support the inclusion of such programs in undergraduate medical curricula, as they provide a cost-effective and scalable solution to resource limitations. By enabling students to gain hands-on experience with real-time imaging, these courses bridge the gap between theoretical learning and clinical application, equipping future physicians with essential diagnostic skills.

The paraneurium is a distinct connective tissue sheath that loosely envelopes the epineurium. The space between the para- and epineurium (the subparaneurial compartment) holds significant clinical relevance, serving as a target for deposition of regional anesthesia and a potential pathway for the pathological spread of cysts and tumors. However, visualization of the paraneurial layer, as a separate structure from the epineurium, remains challenging with conventional MRI, especially in the absence of pathology. This study evaluated the visualization of the paraneurium using ultra-high-field 7-Tesla (7 T) MRI compared to conventional field strengths. We assessed normal nerve anatomy and a spectrum of pathological cases, including intraneural ganglion cysts, schwannomas, intraneural perineuriomas, and metastatic melanoma. The results demonstrated that 7 T MRI provides superior resolution and delineation of the paraneurium compared to 1.5 and 3 T systems. In normal anatomy, T1-weighted and proton density (PD) sequences provided optimal contrast between the paraneurium and surrounding adipose tissue. In contrast, for pathological cases, T2-weighted sequences with fat suppression were superior for depicting the paraneurium and identifying subparaneurial involvement. In conclusion, 7 T MRI offers a significant advantage in identifying the thin paraneurial layer. This capability provides valuable insights into the pathogenesis of tumor spread and holds promise for improving pre-operative planning and clinical decision-making in peripheral nerve pathology.

Lumbosacral transitional vertebrae (LSTV) are common congenital spinal anomalies that may redistribute mechanical loads to adjacent segments. This study aims to provide a comprehensive, quantitative synthesis of the relationship between LSTV & the prevalence, anatomical distribution, and severity of lumbar spondylolisthesis. A systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched through November 2025. Studies comparing adult individuals with LSTV to those without were included. Risk of bias was assessed using ROBINS-I. Random-effects meta-analysis was used to calculate pooled odds ratios (OR) for prevalence and distribution, and mean differences for slip severity. Twelve retrospective cohort studies (n = 3929) were included. LSTV was not associated with an increased overall prevalence of degenerative spondylolisthesis (OR 1.28; 95% CI 0.86-1.91; p = 0.22). However, LSTV significantly altered the level of slippage. Patients with LSTV demonstrated strongly increased odds of spondylolisthesis at L4-L5 (OR 13.78; 95% CI 4.30-44.18; p < 0.0001) and a significant protective effect at L5-S1 (OR 0.07; 95% CI 0.02-0.23; p < 0.0001). No significant difference in slip severity was observed in pooled analyses (p = 0.31). LSTV does not increase the overall risk of spondylolisthesis but acts as a biomechanical modifier that markedly redistributes pathology. It protects the transitional segment while shifting mechanical stress and instability to the cranial adjacent level (L4-L5).

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.