Clinical Anatomy最新文献

Fractal geometry describes complex, self-similar patterns that repeat across spatial scales and is increasingly recognized as relevant in anatomical research. Indeed, the fractal organization is consistently observed in respiratory, cardiovascular, gastrointestinal, nervous, renal, hepatic, and dermatological systems. A comprehensive literature search was conducted on PubMed, Scopus, and Web of Science (1977 to March 2025) identifying peer-reviewed original articles, reviews, and conference proceedings addressing the fractal organization of human organs at macrostructural or microstructural levels, with structural–functional relationships and/or clinical applications. Studies were excluded if they lacked direct translational relevance to humans, were not peer-reviewed, or did not utilize explicit fractal methodology. Key findings highlight that bronchial tree fractal dimension (FD) correlates with airflow limitation in chronic obstructive pulmonary disease, while in the vascular system, retinal metrics reflect systemic microvascular health. Moreover, the fractal modeling of hepatic and renal hemodynamic models supports system-level interpretation. In the nervous system, cortical gyrification and neuronal dendritic FD are associated with cognitive capacity and disease progression. Gastrointestinal mucosal FD decreases in inflammatory and neoplastic conditions. Advances in multiscale imaging (e.g., micro-CT, MRI) and computational methods enable both in vivo and ex vivo assessment, although methodological heterogeneity remains a limiting factor. Overall, fractal analysis provides a quantitative and reproducible descriptor of anatomical complexity with demonstrated associations to functional performance and disease severity. Standardization of methodology, development of normative datasets, and validation in large prospective cohorts are essential for routine clinical practice.

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.

The scalene muscles represent a crucial muscle group in cervical anatomy, with significant clinical and functional implications. Despite their importance, studies on their embryonic and fetal development remain scarce. This study examined the morphogenesis of the scalene muscles bilaterally in 33 developing human specimens [66 sides from 12 embryos (Weeks 6-8) and 21 fetuses (Weeks 9-13)] using serial histological sections and conventional light microscopy. The scalene blastema appeared during Week 6 of development, comprising myoblasts, mesenchymal cells, and collagen fibers, and was surrounded by fibroblast-like cells and collagen fibers. The ventral rami of spinal nerves forming the brachial plexus, along with the subclavian artery, divided this blastema into two components: a medial portion (scalenus anterior muscle primordium), pierced by the phrenic nerve, and a lateral portion (scalenus medius muscle primordium), pierced by the dorsal scapular nerve and the branches forming the long thoracic nerve. The scalene triangle, through which these neurovascular elements pass, formed between the scalenus anterior and medius primordia. The scalenus minimus muscle was identified in 7 of 66 sides (10.6%). Our findings suggest that the scalene blastema originates from both hypaxial myotomes and sclerotomes of the cervical somites. The developmental relationship between the scalene blastema and adjacent neurovascular structures may help explain anatomical variations in this region with clinical significance. Furthermore, the insertion of the scalenus anterior muscle into the parietal pleura via the suprapleural membrane primordium provides new insight into its functional role in respiratory mechanics.

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.

The buccomandibular space is a potential space located within the oral and maxillofacial regions. This morphological study aimed to provide a detailed anatomical description and ultrasonographic examination of the buccomandibular space and its adjacent structures, to discuss its clinical significance-particularly in relation to pathological conditions such as the spread of odontogenic infections, complications associated with antiaging injectables, and tumor invasion-and to offer valuable insights into the understanding and management of lower face treatment and rejuvenation. Anatomical dissection was performed on 28 facial halves, including 10 from five embalmed and 18 from nine fresh-frozen Korean adult cadavers. An ultrasonographic study was conducted on 12 facial halves of six healthy Korean adult participants. In addition, targeted intraoral polycaprolactone filler injection into the buccomandibular space was performed on two fresh-frozen hemifaces to simulate the expansion of the potential space, followed by ultrasonographic validation and intraoral dissection to confirm the filler-occupied area. The buccomandibular space was bounded by six anatomical boundaries. Ultrasonographic examination at three reference points in the lower third of the face identified adjacent muscular and vascular structures. This study presented various methods for clarifying the boundaries and adjacent structures of the buccomandibular space. The detailed anatomical insights gained in our study can enhance the understanding of the buccomandibular space, including its clinical relevance and anatomical relationships with adjacent structures. These findings may also improve the interpretation of ultrasonographic imaging for healthcare professionals and students in both clinical and educational settings.

Anatomical descriptions of left-sided oblique coronary branches remain inconsistent, hindering imaging interpretation and surgical planning. To quantify the prevalence, branching patterns and morphometry of the ramus intermedius (RI) and diagonal branches, and propose a unified nomenclature. Following PRISMA guidelines, a PubMed search up to 12 June 2025 yielded 623 records. Forty-six studies involving 25,602 hearts were included, and random-effects meta-analysis was applied to pool prevalence and continuous outcomes. Overall, an additional left-main branch (RI) was present in 25.2% (95% CI: 8.7-54.5). Trifurcation dominated (22.7%), whereas quadrifurcation and pentafurcation occurred in 3.7% and 1.3% respectively. The pooled RI/diagonal diameter averaged 2.21 mm (95% CI 2.02-2.39), and mean branch length was 49.1 mm (95% CI 37.8-60.5). Methodological heterogeneity was high but consistent patterns emerged across cadaveric and imaging modalities. An oblique "diagonal artery", whether arising from the left main (RI) or anterior interventricular artery, is present in roughly 25% of hearts, averages 2.2 mm in caliber and extends to 49 mm. Recognizing this vessel family and standardizing the term "diagonal arteries" will improve coronary imaging reporting and guide revascularization strategies.

Before the Civil War, there was little scientific research and no federally funded scientific research in America. William Hammond, a US Army surgeon, organized a small group of young Philadelphia-based physicians and established the Philadelphia Biological Society while on sick leave in December 1857. It was a short-lived society that promoted self-funded biomedical research. Hammond, after his appointment as Surgeon-General during the Civil War, realized that by utilizing his new top-down authority and military funding, he could conduct scientific research and envisioned producing an all-inclusive Medical and Surgical History of the War of the Rebellion. On May 21, 1862, Hammond ordered Union Army doctors to diligently collect and forward to him "all specimens of morbid anatomy, surgical or medical, which may be regarded as valuable … in the study of military medicine or surgery." The Army Medical Museum was established on August 1, 1862, to receive these materials. In addition to the officers in charge, the Museum required a small technical staff with highly specialized skills. A German immigrant anatomy technician who had been working at the University of Pennsylvania, Frederick Schafhirt, was hired as a "bone cleaner" on July 24, 1862. Soon, his sons Adolph and Ernest were working with him. Of the little that has been written about these colorful individuals, much is historically incorrect. This paper documents their lives and work at the Museum. Frederick Schafhirt was almost certainly the first federally funded research employee, and the Army Medical Museum represents the beginning of federally funded research in America.

At the 42nd Annual Meeting of the American Association of Clinical Anatomists (AACA) in Bellevue, Washington, June 2025, two inaugural events—the Clinical Anatomy Fireside Chat (CAFC) and the Clinical Anatomy Symposium: Head and Neck 2025 (CAS)—fostered rich dialogue on the evolving role and operational definition of clinical anatomy. Experts from various clinical and anatomical disciplines explored the meaning of clinical anatomy, highlighting the absence of a universal definition despite its frequent use in education and research. Through these interdisciplinary discussions, a consensus emerged: clinical anatomy is not defined solely by the possession of clinical credentials but by the integration of anatomical knowledge and clinical relevance, achieved most effectively through collaboration. Clinical anatomy education and research require different depths of clinical knowledge depending on the audience and objective, and meaningful collaboration can bridge gaps in expertise. The symposium further illustrated that high-quality clinical anatomy emerges from mutual respect and reciprocal insight between clinicians and anatomists. This article presents a consensus statement developed by AACA representatives and invited speakers, affirming that collaboration is not only foundational to the practice of clinical anatomy but also fundamental to its definition. These conclusions aim to guide future educational models, research strategies, and interdisciplinary partnerships in the field of clinical anatomy.

Mast cells are present in all classes of Vertebrates and have emerged > 500 million years ago, long before the development of adaptive immunity. Mast cells were first identified by the Nobel Prize winner Paul Ehrlich in 1878, when he was still a medical student. Mast cells are localized at the junction point of the host and external environment at places of entry of antigens (gastrointestinal tract, skin, and respiratory epithelium). Mast cells have been recognized as crucial effectors in both innate and adaptive immune responses. Mast cells protect against bacteria, fungi, protozoa, and viruses through the release of proinflammatory and chemotactic mediators. There is evidence that mast cells exert relevant functions in tissue homeostasis, remodeling, repair, and fibrosis. Moreover, mast cells accumulate at sites of tumor growth in response to numerous chemoattractants and release a vast array of mediators, some of which have promoting and others inhibitory effects on malignancies.

The Calvarial Blooming Model (CBM) describes cranial vault growth as a Class III lever system in which patterned brain expansion supplies the effort, dural tethers act as fulcra, and sutures serve as load-transfer zones. In contrast to models emphasizing muscular loading or genetic determinism, CBM frames the cranium as a compliant, tension-sensitive structure shaped by cerebral growth, cerebrospinal fluid (CSF) buoyancy, and intracranial pulsations. Evidence from multiple sources was used to illustrate the framework. Bolton Standards cephalometric superimpositions (ages 6-18) provided conservative estimates of sutural displacement and vault surface area expansion. Cases from the AAOF Legacy Collection demonstrated late-phase remodeling often absent in standard datasets. Published finite-element analyses of sutural strain and dural tension pathways, together with clinical and histological observations, further supported the model. Perturbations of genetic and environmental regulators-including RUNX2, FGFRs, and BMPs-disrupt these strain pathways and produce craniofacial anomalies consistent with CBM predictions. Recognizing cranial vault expansion as the action of a tensioned dural hammock operating under Class III lever mechanics clarifies how patterned brain growth directs vault remodeling and suggests new approaches to craniosynostosis correction and growth modification.