Clinical Anatomy最新文献

The pathophysiology of Chiari malformation type I (CM-I) is complex, involving structural abnormalities at the craniovertebral junction that result in herniation of the cerebellar tonsils through the foramen magnum. In this study, we aim to present and evaluate current treatment options for CM-I, with a focus on evidence-based clinical outcomes and emerging surgical techniques. A comprehensive literature review was conducted using a PubMed search with MeSH terms such as "Arnold-Chiari Malformation, Type 1," "syringomyelia," and "Arnold-Chiari malformation*/surgery." Original research articles, case reports, systematic reviews, literature reviews, and meta-analyses in English discussing treatments, surgical techniques, anatomical variations, and clinical outcomes were identified to assess the indications, efficacy, and outcomes of various CM-I management strategies. A total of 108 articles were included in the final review, with the majority being retrospective cohort studies, case series, and systematic reviews. Posterior fossa decompression remains the standard surgical treatment of CM-I, with caveats. There is substantial variability in surgical techniques, particularly in clinical decision-making regarding the use of duraplasty, arachnoid dissection, and cerebellar tonsil reduction. Minimally invasive and endoscopic techniques are emerging and have demonstrated promising preliminary outcomes. For managing concurrent pathological conditions, such as hydrocephalus, craniocervical instability, and ventral brainstem compression, the surgical approach should be individualized according to patient-specific conditions. Management of CM-I requires a tailored, symptom-driven approach that should balance efficacy and safety. While posterior fossa decompression, with or without adjunctive surgical techniques depending on patient-specific clinical features and concomitant pathological conditions, remains the standard treatment option, minimally invasive procedures may represent promising alternatives and have shown favorable outcomes in selected patients.

According to textbook descriptions, branches of the femoral and obturator nerves provide the sensory innervation to the medial side of the thigh. However, as the exact prevalence of the obturator nerve's cutaneous branch is unknown, an anatomic study was conducted to reveal its role in providing cutaneous innervation to the medial thigh. Twenty-five formalin-fixed lower extremities were dissected with special attention to the nerves supplying the skin on the thigh's medial side. This study set out to determine the prevalence of the obturator nerve's cutaneous branch and its contribution to the sensory innervation of the medial thigh. The obturator nerve's cutaneous branch was observed in 24% of all cases (n = 6/25). Anastomoses between the obturator and femoral nerves were recorded in 12% of all cases. In 20% of all cases, the obturator nerve's anterior branch supplied the skin of the thigh's middle third, either by being the sole nerve supplying the skin or by forming anastomoses with femoral branches. While textbooks of anatomy have constantly created the impression that the obturator nerve plays a pivotal role in supplying the skin on the medial side of the thigh, this study supports the conclusion that, due to its inconsistent prevalence, the obturator nerve's cutaneous distribution plays a subordinate role in the sensory innervation of the thigh. We believe that our results provide refined anatomical insight that may help improve surgical approaches, diagnostic accuracy, and nerve repair strategies involving the medial thigh.

The employment of anatomy demonstrators (ADs) has grown unexpectedly over two decades to meet increasing educational demands. However, their role is poorly understood and defined. There is therefore a need to better understand ADs, to maximize their potential as educators and build the integrity and transparency of UK anatomical education. Through a mixed methods approach this study explored ADs: demographics, role descriptors, experiences within the role, barriers to the role, and the potential of ADs. An online questionnaire (n = 50) and three virtual focus groups (N = 13) were analyzed using thematic analysis to identify emerging patterns and themes. The findings highlight that ADs are generally young people from diverse backgrounds with an even gender split. The role and its responsibilities seemingly vary substantially between universities, with ADs employed in numerous different ways. Being an AD appears to be an overall positive experience and ADs enjoy their work. Furthermore, ADs care about anatomical education and want to engage in discussions to improve their role and develop medical education. This study has expanded the understanding of the UK AD role and concludes that the UK AD role is a varied and often rewarding post that is enjoyed by diverse, engaged individuals who are primarily resident doctors by background. This study provides practical recommendations for anatomy departments to improve the experience for ADs and hopes to stimulate greater interest in ADs in order to maximize their educational potential.

Understanding how pancreas size and shape change with normal aging is critical for establishing a baseline to detect deviations in type 2 diabetes and other pancreatic disease. We measure pancreas size and shape using morphological measurements from early development through aging (ages 0-90). Our goals are to (1) identify reliable clinical imaging modalities for artificial intelligence (AI) based pancreas measurement, (2) establish normative morphological aging trends, and (3) detect potential deviations in type 2 diabetes. We analyzed a clinically acquired dataset of 2533 patients imaged with abdominal computed tomography (CT) or magnetic resonance imaging (MRI). The patients did not have cancer, pancreas pathology, sepsis, or trauma. We resampled the scans to 3 mm isotropic resolution, segmented the pancreas using automated methods, and extracted 13 morphological pancreas features across the lifespan. First, we assessed pancreas volume trajectories in 1858 control patients across contrast CT, non-contrast CT, and MRI to determine which modalities provide consistent lifespan trends. Second, we characterized distributions of normative morphological patterns stratified by age group and sex. Third, we used covariate-adjusted generative additive models for location, scale, and shape (GAMLSS) regression to model pancreas morphology trends in 1350 patients matched for age, sex, and type 2 diabetes status to identify any deviations from normative aging associated with type 2 diabetes. We selected CT for the main analyses of this study, since the MRI appeared to yield different pancreas measurements than CT using our AI-based method on this dataset of clinically acquired scans. When adjusting for confounders, the aging trends for 10 of 13 morphological features were significantly different between patients with type 2 diabetes and non-diabetic controls (p < 0.05 after multiple comparisons corrections). Additionally, we characterized normative morphological aging trends of the pancreas across 13 morphological measurements. We provide lifespan trends demonstrating that the size and shape of the pancreas are altered in type 2 diabetes using 675 control patients and 675 diabetes patients. Moreover, our findings reinforce that the pancreas is smaller in type 2 diabetes. Additionally, we contribute a reference of lifespan pancreas morphology from a large cohort of non-diabetic control patients in a clinical setting.

Understanding anatomy of breast connective tissue is critical in contexts such as surgery and biomechanical modeling of breast deformations. Current descriptions remain contradictory and fail to explain breast biomechanics. We described the anatomy of breast connective tissue based on Magnetic Resonance Imaging and surgical observations. This prospective study was conducted at the breast surgery department of Montpellier University Hospital. A total of 196 patients were consecutively included between March and May 2022; 10 had breast MRI in 3 different positions (supine, prone, and lateral). Superficial fascia (SF) creates a "pocket" surrounding the breast, both anteriorly and posteriorly, as a consequence of dorsal development in the anterior body wall. SF appears to delimit two compartments of adipose tissue: a superficial and a deeper one, both crossed by retinacula cutis (RC). There is no continuity between the RC of both layers and therefore no RC running from the pectoralis major to the skin. An "anchoring ring," corresponding to a dense zone of connective tissue around the periphery of the breast, where the SF and deep fascia meet, is the main adhesion of the breast to the chest wall. Breast is shaped by the superficial fascial system and anchored to the chest wall at its periphery. It does not seem to be two distinct layers of SF and suspensory ligaments running through the breast from pectoralis major to the skin. Further studies based on these findings could evaluate the impact on biomechanical model performances. Surgeons should consider this description in order to optimize cosmetic results. Trial Registration: ClinicalTrials.gov identifier: NCT05301998.

Artificial intelligence is among the most rapidly developing branches of technology. It has proven to be a helpful tool in various fields, including medicine. Significant advances in the development of new language models prompt an evaluation of their effectiveness across various areas of medicine, including anatomy. This study aimed to assess the effectiveness of artificial intelligence in solving theoretical anatomy exams designed for medical students. The study utilized 555 multiple-choice questions (150 in Polish and 405 in English) sourced from past anatomy exams for the medical program. The models tested included: ChatGPT-4o mini, ChatGPT-4o, DeepSeek, Copilot, Gemini, and two Polish models: Bielik and PLLum. Each question was asked only once. For analysis purposes, the questions were categorized by type and by the anatomical structure they addressed. Out of 555 questions, ChatGPT-4o mini answered 394 correctly (71%), ChatGPT-4o - 461 (83.1%), DeepSeek - 427 (76.9%), Copilot - 442 (79.6%), Gemini - 439 (78.8%), Bielik - 166 (29.9%), and PLLum - 222 (40.0%). The language models performed poorest on multiple-answer questions (37.6%) and best on questions concerning the function of a given organ (75%). Most of the tested language models are capable of independently passing the exam, which should serve as a warning to teaching staff supervising students during exams and assessments. Properly formulated questions can currently hinder students relying on artificial intelligence from passing, but ongoing AI advancements may result in even higher pass rates in the future.

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.

Facial transplantation is a division of reconstructive surgery which aims to improve the function and appearance of a face that has endured severe disfigurement. Currently, the face transplant procedure uses allogenic tissue, harvested from a brain-dead donor, to replace damaged facial components. To date, 50 face transplants have been performed worldwide. Survival and functional success of the transplant is dependent on multiple factors; however, effective neurovascular recovery of the graft is arguably the most important. An effective vasculature system is essential to avoid necrosis and death of the transplanted tissue, and an effective nervous system is required for the graft to regain function. This comprehensive review examines and evaluates recommendations found in different studies to try and determine techniques for achieving optimal neurovascular graft outcomes. Sensory recovery of the graft occurs spontaneously through natural regeneration of the trigeminal nerve's cutaneous branches. Motor recovery, however, relies on precise coaptation of donor and recipient nerves using microsurgical sutures, reinforced by fibrin glue. Additional considerations, including parotid gland exclusion and use of a nerve graft, can further improve outcomes. Pre-operative vascular assessment of both the donor and recipient is another crucial consideration. Computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography can be used to plan and enable successful end-to-end or end-to-side anastomosis of vessels. If applied in future facial transplantation procedures, these techniques could enhance recovery, improve functional outcomes, and lead to a greater patient quality of life.

Innovations in histology and education are widespread. However, the field currently lacks a systematic analysis of trends. Therefore, this study employed bibliometric methods to systematically review research on histology and education, filling a gap in the field and providing a reference for further studies. We retrieved articles related to histology and education from 1900 to 2024 from the Science Citation Index-Expanded of the Web of Science Core Collection. Data on publication trends, countries, leading institutions, prolific authors, influential journals, co-cited references, and popular keywords were analyzed using Microsoft Excel 2019, CiteSpace, and VOSviewer. The analysis revealed that a total of 3004 research papers and reviews related to histology and education were published globally (1936-2024). The United States emerged as the core research power in this field. Hortsch, Michael was identified as the most prolific author. The journal "Anatomical Sciences Education" published the highest number of articles. Notably, the current hot topic is artificial intelligence technology. This research provides a comprehensive knowledge map of histology and education. As a current hot technology, artificial intelligence will see further global research in this field focus on how to more organically integrate AI technology into histology education in the future.

In recent decades, molecular biology and omics technologies have profoundly reshaped biomedical research, with genomics, proteomics, and other high-throughput approaches dominating scientific agendas and funding priorities. Within this molecular paradigm, however, the anatomical sciences face an epistemic and institutional tension: morphology, historically grounded in the study of form, structure, and spatial relationships, is increasingly framed as merely descriptive or obsolete. This Viewpoint moves beyond the familiar narrative of a "decline of anatomy" to argue for its strategic reinvention as a core scientific method. Anatomy is not simply a body of knowledge but a way of seeing and reasoning that remains essential for understanding biological systems. Morphological thinking-linking structure to function in situ-provides integrative insights that cannot be derived from molecular data alone. Based on historical perspectives, epistemology, and recent advances in imaging and integrative methodologies, we show how anatomy continues to drive hypothesis generation, biomedical innovation, and clinical decision-making. Using the Italian academic system as a case study, we highlight the growing institutional disconnect between anatomical teaching and morphologically grounded research, exacerbated by metric-driven evaluation frameworks. Finally, we propose a roadmap for embedding morphology within emerging platforms such as spatial biology, high-resolution imaging, and AI-assisted analysis, reclaiming anatomy as a methodological compass for navigating biological complexity and clinical translation.