Clinical Anatomy最新文献

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.

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.