Clinical Anatomy最新文献

Recently, great attention has been given to understanding the new pathogenetic mechanisms underlying aortic stenosis (AS). The study aims to understand the role of mature adipocytes in AS and their association with histologic, clinical, and echocardiographic data, an area previously overlooked in AS research. We enrolled 25 patients (15 women and 10 men) with severe AS undergoing elective aortic valve replacement. Each patient underwent clinical and transthoracic echocardiographic evaluations before surgery. We obtained AS valves and left ventricular (LV) septal biopsies to assess the presence of adipocytes within the valve using perilipin 1 (PLIN1) immunohistochemistry, and we also examined other histological characteristics of the ventricular biopsies. Adipocytes were detected in 76% of the aortic stenotic valve samples, often grouped adjacent to calcified areas. Patients with higher values of PLIN1 valvular adipocytes were generally older (p = 0.06) and had lower BMI values (p = 0.06). Moreover, the group with a higher presence of PLIN1(+) valvular adipocytes had significantly decreased mean gradient values and reduced M1 macrophage infiltration in ventricular biopsies. In a binary regression analysis, only mean gradient was significantly associated with the presence of PLIN1(+) adipocytes in the valve, regardless of age, BMI and ventricular M1 macrophage levels. These preliminary findings suggest that valvular adipocytes could be related to the progression of AS, but more investigation is necessary.

Parkinson's disease is a multifactorial neurodegenerative disorder characterized by progressive dopaminergic neuronal loss in the substantia nigra pars compacta and widespread α-synuclein pathology. Despite extensive research, the precise molecular mechanisms underlying neuronal death remain incompletely defined. Emerging evidence indicates that multiple forms of programmed cell death (PCD), including apoptosis, autophagy failure, ferroptosis, and necroptosis, contribute to dopaminergic degeneration in distinct but overlapping contexts. This review synthesizes current insights from both post-mortem human studies and experimental models to delineate the biochemical and pathological signatures of these PCD pathways in Parkinson's disease. Post-mortem findings demonstrate heterogeneous and often coexisting PCD markers, suggesting that different neuronal subsets within the substantia nigra pars compacta may follow distinct death programs depending on their metabolic profile, iron load, and inflammatory milieu. In contrast, experimental models reveal more discrete pathway-specific activation patterns: apoptosis predominates in acute toxin paradigms, autophagy failure in genetic models, ferroptosis in iron-overload and oxidative stress conditions, and necroptosis in inflammation-augmented models. The apparent discrepancies between human and experimental evidence reflect differences in temporal resolution, pathogenic drivers, and neuronal heterogeneity but together support a unified model of multifactorial, context-dependent cell death. Finally, preclinical studies targeting these pathways, through caspase inhibition, autophagy enhancement, ferroptosis suppression, or necroptosis blockade, have provided proof-of-concept neuroprotection, although translation to clinical efficacy remains elusive. Understanding how these interconnected PCD pathways converge during Parkinson's disease progression is essential for developing multimodal therapeutic strategies that move beyond symptomatic relief toward accurate disease modification.

Anatomical education and research are built on the generosity of individuals who donate their bodies to advance science. However, the terminology traditionally used to describe these individuals-"specimens," "cadavers," or "cadaveric specimens"-risks objectifying the donor and obscuring their humanity. This paper examines the historical roots of depersonalized language, its persistence in contemporary research, and the ethical implications of its continuing use. Drawing on comparisons with the organ donation and transplantation literature and on calls within anatomy for reforming terminology, we propose humanizing alternatives such as "body donor," "donor body," or "anatomical donor." The discussion emphasizes how terminology influences pedagogy, professional culture, and public trust in body donation programs. By embracing more respectful language, anatomists, surgeons, physicians, and dentists can better honor the gift of body donation and highlight the humanity of those who continue to teach us even after death, for example, Hic locus est ubi mors gaudet succurrere vitae.

The rapid expansion of large language models (LLMs), including ChatGPT, has generated interest in their potential role in medical education. Although prior studies have evaluated LLM performance in theoretical assessments and selected imaging tasks, their ability to recognize anatomical structures in a cadaver-based practical examination setting remains unclear. This study assessed the accuracy of ChatGPT-4o in identifying anatomical structures on photographs of cadaveric specimens marked in the same manner as during practical anatomy examinations. A total of 265 anatomical structures were labeled on cadaveric specimens from the Department of Anatomy of the Jagiellonian University Medical College and photographed. Using a standardized prompt, the free version of ChatGPT-4o was asked to identify each marked structure, with up to three attempts permitted and standardized feedback provided after incorrect responses. Identification was considered correct only when a valid anatomical term precisely corresponding to the indicated structure was provided. The overall accuracy was 22.26%. Correct identification occurred on the first attempt in 33 cases, on the second in 15, and on the third in 11. Accuracy was highest for osteological structures (64.71% correct within three attempts) and lowest for isolated thoracic organs (8.82%). The model frequently misidentified anatomical regions and occasionally generated non-existent anatomical terms. At its current stage of development, ChatGPT-4o does not appear to be a reliable tool for cadaver-based anatomical structure recognition or practical anatomy examination support.

Body donation remains fundamental to anatomical education, supporting not only technical training but also the development of ethical awareness, empathy, and humanistic values among health professionals. In recent decades, the anatomical community has moved toward shared ethical standards centered on voluntary informed consent, transparency, and explicit recognition of donors. International consensus statements have promoted standardized acknowledgment practices, responsible stewardship of human remains, and the ethical use of body donor images. Across regions, sociocultural, religious, legal, and institutional factors continue to shape public perceptions and the development of body donation programs. In South America, meaningful progress has been achieved through legislative reforms and institutional initiatives; however, persistent challenges remain in regulatory harmonization, infrastructure, and public awareness. Experiences from other regions demonstrate that structured educational outreach, commemorative practices, and multidisciplinary oversight mechanisms can strengthen public trust and normalize donation as a socially valued act. These approaches highlight the importance of cultural sensitivity, ethical education, and institutional transparency in fostering sustainable body donation systems. This article synthesizes international and regional perspectives to propose strategies for strengthening ethical and operational standards in body donation in South America. Key measures include the establishment of formal ethics oversight committees, standardized consent procedures, transparent management of legacy materials, and systematic donor recognition. Ultimately, advancing ethical body donation requires sustained commitment to respect, gratitude, and public trust as the moral foundation of anatomical education.

Authentic assessment is an innovative approach in anatomy education aimed at bridging the gap between theoretical knowledge and clinical application. Traditional anatomy assessments often emphasize factual recall, overlooking the integration of cognitive, psychomotor, and affective domains critical for professional practice. Authentic assessments address these limitations by engaging students in tasks that replicate real-world scenarios, fostering the development of critical thinking, practical skills, and professional competencies. However, implementing authentic assessments comes with challenges, including resource constraints, time demands, scalability, faculty and students' readiness, and subjectivity in evaluation. Strategies such as leveraging technology, incorporating formative assessments, and adopting small-scale tasks can mitigate these issues. Additionally, aligning assessments with core anatomical competencies and integrating continuous feedback loops enhances their validity, reliability, and educational impact. This paper discusses the principles, design, and challenges of authentic anatomy assessment education, emphasizing its potential to prepare students for the complexities of clinical practice while fostering deeper learning and critical thinking. A balanced and strategic approach to implementing authentic assessments is essential to address practical limitations and ensure their effective integration into anatomy education.

Leadership in academic institutions and professional societies plays a critical role in shaping the future of scholarship, governance, and educational equity. However, a persistent trend, particularly in long-established organizations, reveals that retired faculty, such as professors emeriti, often fill executive leadership roles. While emeriti may continue to offer valuable mentorship and institutional memory, their appointment to decision-making positions raises significant structural and ethical concerns. This commentary critiques the reliance on retired academics for active leadership, highlighting key risks including diminished accountability, generational disconnection, ethical incongruence, and leadership bottlenecks that impede the advancement of early- and mid-career scholars. Drawing on governance literature and demographic data, the article calls for structural reforms that promote active, inclusive, and forward-looking leadership models. Practical recommendations include revising governance bylaws, establishing advisory roles for emeriti, and fostering intergenerational partnerships to ensure sustainable academic leadership. The future of academia cannot be led solely by the past. It must be shared by those actively engaged in its present with the assistance of those who have experience in such roles before retirement.

The azygos vein (AV) is typically described as ascending vertically to the right of the vertebral column before arching anteriorly to drain into the superior vena cava. However, a small number of studies suggest that it is found leftward in older adults. A retrospective analysis of the contrast-enhanced thoracic computed tomography studies from 291 individuals was conducted with ethical approval (158 females; ages 0-100). The vertebral level (VL) of the AV arch was designated "V0" with subsequent caudal VLs designated V1-V5. At each VL, the position of the AV and thoracic aorta (TA) relative to the vertebral midpoint was recorded in degrees. A significant correlation was found between increasing age and leftward shift of the AV and aorta between V0 and V4 (Spearman's ρ correlation between 0.31 and 0.68, p < 0.001). At V5, while AV position no longer changed with age (ρ = -0.03, p > 0.05), TA shift persisted (ρ = 0.39, p < 0.001). Increased positional variability of AV with age was also observed at V1-V5 (ρ between 0.17 and 0.38, p < 0.05). This leftward shift of AV and TA could reflect age-related laxity of the posterior mediastinum or relative reduction in the VC height. Understanding of this age-related anatomical change is important for reducing the risk of vascular injury during thoracic procedures. As inclusion of age-related changes is becoming increasingly important in undergraduate anatomy teaching, our findings suggest that it may be necessary to update current texts.

A precise understanding of maxillary tooth innervation is paramount for all dental and oral surgical procedures, from routine local anesthesia to complex interventions. The three superior alveolar nerves-posterior, middle, and anterior-arise from the maxillary division of the trigeminal nerve, forming the superior dental plexus that classically innervates the maxillary teeth. However, this conventional anatomical paradigm has often failed to fully explain common clinical phenomena, such as the inconsistent efficacy of specific anesthetic techniques or the unpredictable outcomes observed in practice. Recent groundbreaking advancements in diagnostic imaging and microanatomical research have provided critical insights, addressing these long-standing clinical questions. This review comprehensively synthesizes classical anatomical knowledge with these contemporary findings. It establishes a dual innervation model that reveals a significant neurovascular supply originating from the palatal aspect, a pathway previously unhighlighted yet complementary to the well-known buccal pathways. Furthermore, it necessitates a reassessment of established palatal anesthetic techniques, such as the anterior and middle superior alveolar (AMSA) and the palatal approach anterior superior alveolar (P-ASA) nerve blocks, identifying them as localized palatal infiltrations rather than true nerve blocks. This new anatomical perspective has led to the proposal of evidence-based techniques, such as the palatal alveolar foramen injection (PAFI). Integrating this comprehensive dual innervation concept into future anatomical education and clinical training is essential to enhance surgical precision and ultimately bring greater benefits to patients.

Injury to the lateral femoral cutaneous nerve (LFCN) is a well-recognized complication of total hip arthroplasty (THA) performed via the direct anterior approach (DAA), largely due to the anatomical variability of the nerve and its proximity to surgical incision lines. The present cadaveric study aimed to quantitatively evaluate the anatomical relationship between the LFCN and commonly used skin incisions in the DAA, including the bikini and longitudinal incision lines, to identify incision-related risk patterns and potential safer zones. Seventy-three thighs from 50 fresh Korean adult cadavers were used. Prior to dissection, bony landmarks and DAA incision lines were marked on the skin using pins. Dissection was then performed to expose the fascia lata and the LFCN, after which the distance between the incision line and the nerve was measured and statistically analyzed. Two principal emergence patterns of the LFCN, stem and divided, were identified, with the divided pattern being slightly more prevalent. The bikini incision intersected the anterior branch of the LFCN in all specimens, whereas the posterior branch was spared in approximately one-quarter of cases. In contrast, longitudinal incisions rarely intersected the anterior branch but frequently overlapped with the posterior branch; this overlap was more pronounced when the incisions were placed closer to the anterior superior iliac spine. These findings indicate that the risk of LFCN injury varies according to incision type and may be reduced by lateral adjustment in both incision lines, as well as by distal adjustment in the longitudinal incision. This quantitative anatomical evidence provides a foundation for optimizing DAA incision strategies in THA and may contribute to reducing postoperative sensory complications related to LFCN injury.