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The analysis of connectivity between parcellated regions of cortex provides insights into the functional architecture of the brain at a systems level. However, there has been less progress in the derivation of functional structures from voxel-wise analyses at finer scales. We propose a novel method, called localized topo-connectivity mapping with singular-value-decomposition-informed filtering (or filtered LTM), to identify and characterize voxel-wise functional structures in the human brain using resting-state fMRI data. Here we describe its mathematical background and provide a proof-of-concept using simulated data that allow an intuitive interpretation of the results of filtered LTM. The algorithm has also been applied to 7T fMRI data as part of the Human Connectome Project to generate group-average LTM images. Functional structures revealed by this approach agree moderately well with anatomical structures identified by T1-weighted images and fractional anisotropy maps derived from diffusion MRI. Moreover, the LTM images also reveal subtle functional variations that are not apparent in the anatomical structures. To assess the performance of LTM images, the subcortical region and occipital white matter were separately parcellated. Statistical tests were performed to demonstrate that the synchronies of fMRI signals in LTM-informed parcellations are significantly larger than those of random parcellations. Overall, the filtered LTM approach can serve as a tool to investigate the functional organization of the brain at the scale of individual voxels as measured in fMRI.

Background: The relationship between anterior cruciate ligament (ACL) injury and anatomical structures is still a topic of debate. Purpose: The aim of this study was to compare knee geometry in demographically matched ACL-injured and ACL-intact athletes. Methods: We conducted a case-control study comparing 2 groups, each consisting of 55 professional athletes (44 men and 11 women): 1 group with complete ACL tears (cases) and 1 group with intact ACLs (controls). The groups were compared using magnetic resonance imaging (MRI) in terms of intercondylar notch geometry, tibial plateau characteristics, and ACL volume. Results: Among cases and controls, we found the cases had lower notch width (20.24 ± 2.68 mm vs. 22.04 ± 2.56 mm, respectively) and notch width index (0.29 ± 0.03 vs. 0.31 ± 0.03, respectively). The mean ACL volume in the cases (1181.63 mm3 ± 326 mm3) was also lower than in controls (1352.61 mm3 ± 279.84 mm3). The parameters of tibial slope geometry were comparable between groups. In addition, women had lower ACL volume than men (1254 ± 310 mm3 vs. 890 ± 267 mm3, respectively) and higher medial posterior tibial slope (4.76 ± 2.6 vs. 6.63 ± 1.83, respectively). Among cases, women had narrower notch width than men (16.9 ± 2.42 mm vs. 21.08 ± 2.03 mm). However, notch width index was comparable between male (0.3 ± 0.02) and female (0.28 ± 0.03) cases. Conclusion: Our findings suggest that narrow notch width and low ACL volume may enhance the risk of ACL injury among athletes. There was no association found between posterior tibial slope and ACL injury between athletes with injured ACLs and controls. Further study is indicated.

Medical image segmentation and registration are two tasks to analyze the anatomical structures in clinical research. Still, deep-learning solutions utilizing the connections between segmentation and registration remain underdiscovered. This article designs a joint learning framework named RSegNet that can realize concurrent deformable registration and segmentation by minimizing an integrated loss function, including three parts: diffeomorphic registration loss, segmentation similarity loss, and dual-consistency supervision loss. The probabilistic diffeomorphic registration branch could benefit from the auxiliary segmentations available from the segmentation branch to achieve anatomical consistency and better deformation regularity by dual-consistency supervision. Simultaneously, the segmentation performance could also be improved by data augmentation based on the registration with well-behaved diffeomorphic guarantees. Experiments on the human brain 3-D magnetic resonance images have been implemented to demonstrate the effectiveness of our approach. We trained and validated RSegNet with 1000 images and tested its performances on four public datasets, which shows that our method successfully yields concurrent improvements of both segmentation and registration compared with separately trained networks. Specifically, our method can increase the accuracy of segmentation and registration by 7.0% and 1.4%, respectively, in terms of Dice scores.

Ultrasound is a resource that family doctors have first-hand and that we use more and more frequently, to the point of becoming part of our physical examination. It is an easily accessible, affordable, versatile and non-invasive diagnostic technique that uses ultrasound to define the anatomical structures of our body without radiation and is performed in real time, allowing a dynamic exploration. Despite all the above, vascular ultrasound and, specifically, the supra-aortic trunks ultrasound is not as widespread in our setting, despite its important role in the field of cardiovascular prevention, which is essential in primary care. For this reason, this article aims to carry out a brief-and-clear description of the technique with the aim of extending its use in daily practice.

Fetal congenital heart disease (CHD) is a prevalent and highly complicated fetal deformity. Furthermore, the number of infants with CHD accounts for as high as 6‰–8‰ among all the living newborns in China. For the early diagnosis and screening of the fetal CHD, echocardiography technology plays a vital role in assessing anatomical structures and functions of the fetal heart. However, the prenatal detection rate of CHD is still meager due to the particularity of the fetal cardiac structures and the diversity of the fetal CHD. Hence, we propose a simple yet effective residual learning diagnosis system (RLDS) for diagnosing fetal CHD to improve diagnostic accuracy, which adopts convolutional neural networks to extract discriminative features of the fetal cardiac anatomical structures. To enhance the credibility of the RLDS, we provide a global visualizing explanation for the diagnosis process of our RLDS. Moreover, we visually explain the local feature map of the residual feature learning, making the residual learning more transparent. Extensive experiments demonstrate that our proposed RLDS is very effective in diagnosing fetal CHD. Furthermore, the proposed RLDS achieves a precision of 93% and a recall of 93% on the test set, which significantly improves the prenatal detection rate for the fetal CHD.

Background: Palatal surgeries are associated with many complications. Accessory foramina may be a cause of concern. The present study was conducted to assess the presence of and to evaluate the anatomical characteristics of accessory palatine foramina and related bony canals in cone beam CT scans. Materials and methods: The incidence, location, and types of foramina on the palate were evaluated in 170 CBCT scans. Readings from coronal, sagittal, and axial planes were recorded using a computer program and evaluated. Results: Other than nasopalatine, greater and lesser palatine foramina, 278 foramina were seen in the palate in different locations. New accessory palatine foramina were found posteriorly in 14.71% of the studied scans with wide anatomical variations. Unusual foraminal canals were seen crossing the antral floor laterally. The anterior accessory palatine foramina were seen in 73.53% of scans while bilateral accessory palatine foramina were found in 43.53% of cases. Conclusions: Accessory palatine foramina and related canals are frequently seen in CBCT with many anatomical variations. New unusual connecting canals are found passing through the antral floor from palatine foramina to the lateral antral wall. These anatomical structures should be considered in preoperative planning for local analgesia and surgical interventions in the palate.

The flipped spotters learning model is a modern student activity-based and learner-centered method in medical education. The aim of the study was to determine if the flipped spotters learning model improves students' learning. Participants were 1214 medical students of Polish (PD) and English (ED) divisions between 2013 and 2019 academic years at the University of Warmia and Mazury in Olsztyn, Poland. They were divided into a traditional group (control group) and a flipped spotters learning group (treatment group). Each flipped spotters learning group was asked to label anatomical structures on various specimens according to the structures name list prepared by the teacher on the multiple stations. The flipped spotters learning group leaders were instructed to take pictures with the appropriately marked structures on each of the human body prosections. After completion of the class, each flipped spotters team received photos for evaluation. In the flipped spotters learning model, the students strengthened their skills and knowledge by matching specimens independently as a form of practical laboratory activities. Students' performance in gross anatomy practical examinations between the group utilizing the flipped spotters learning model, and the group with the traditional teaching model was compared. Students participating in the treatment group achieved, on average 9.9 percentage points higher among PD students, and 13.0 percentage points higher among ED students than the control group in all nine practical examinations (the effect size ranging from 0.47 to 0.95). The results suggest the positive impact of flipped spotters model on improving student's performance in the practical examinations.

Objectives: In this work, a new deep learning model for relevant myocardial infarction segmentation from Late Gadolinium Enhancement (LGE)-MRI is proposed. Moreover, our novel segmentation method aims to detect microvascular-obstructed regions accurately. Material and methods: We first segment the anatomical structures, i.e., the left ventricular cavity and the myocardium, to achieve a preliminary segmentation. Then, a shape prior based framework that fuses the 3D U-Net architecture with 3D Autoencoder segmentation framework to constrain the segmentation process of pathological tissues is applied. Results: The proposed network reached outstanding myocardial segmentation compared with the human-level performance with the average Dice score of ‘0.9507’ for myocardium, ‘0.7656’ for scar, and ‘0.8377’ for MVO on the validation set consisting of 16 DE-MRI volumes selected from the training EMIDEC dataset. Conclusion: It is concluded that our approach's extensive validation and comprehensive comparison against existing state-of-the-art deep learning models on three annotated datasets, including healthy and diseased exams, make this proposal a reliable tool to enhance MI diagnosis.

Purpose There is only limited data on the application of virtual reality (VR) for the evaluation of temporal bone anatomy. The aim of the present study was to compare the VR environment to traditional cross-sectional viewing of computed tomography images in a simulated preoperative planning setting in novice and expert surgeons. Methods A novice (n = 5) and an expert group (n = 5), based on their otosurgery experience, were created. The participants were asked to identify 24 anatomical landmarks, perform 11 distance measurements between surgically relevant anatomical structures and 10 fiducial markers on five cadaver temporal bones in both VR environment and cross-sectional viewings in PACS interface. The data on performance time and user-experience (i.e., subjective validation) were collected. Results The novice group made significantly more errors (p p = 0.001) in cross-sectional viewing than the expert group. In the VR environment, there was no significant differences (errors and time) between the groups. The performance of novices improved faster in the VR. The novices showed significantly faster task performance (p = 0.003) and a trend towards fewer errors (p = 0.054) in VR compared to cross-sectional viewing. No such difference between the methods were observed in the expert group. The mean overall scores of user-experience were significantly higher for VR than cross-sectional viewing in both groups (p Conclusion In the VR environment, novices performed the anatomical evaluation of temporal bone faster and with fewer errors than in the traditional cross-sectional viewing, which supports its efficiency for the evaluation of complex anatomy.

Introduction: Metabolic Tumor Volume (MTV) and Total Tumor Lesion Glycolysis (TLG) are used in 18F-fluorodeoxyglucose Positron-Emission Tomography combined with Computed Tomography (18F-FDG PET/CT) as functional markers, indicating tracer uptake in whole tumor. MTV and TLG are not yet engaged in clinical practice, because volume measurement accuracy depends on the selected measurement method, and optimal MTV and TLG segmentation is not established.Purpose: Assessment of accuracy of metabolic tumor volume measurement ways, using 18F-FDG PET/CT in patients with Diffuse Large B-Cell Lymphoma (DLBCL).Material and methods: Baseline 18F-FDG PET/CT performed in 21 patients with DLBCL. Tumor Volume (TV), measured on contrast enhanced CT (CTTV), considered as reference. While measuring MTV, we aimed to achieve a 1:1 ratio between CTTV and MTV. If anatomical and metabolic tumor contours matched, MTV was considered true (MTVtrue). Overall MTV and TLG measurements are 254. Tumor contouring, using relative thresholds, was made around Standardized Uptake Value (SUVmax) of tracer in tumor and intact liver.Results: On CT, the size of the lesions varied from 24 to 241 mm, M = 103.4±62.3, Me = 93 (48.5–155.5). In 15 (71.4 %) foci, hypodense areas of necrosis were determined. PET imaging revealed high tracer uptake in all foci of varying degrees of intensity. SUVmax values in tumors ranged from 5.8 to 30.5, Me = 20.4 (17.3–23.2). No significant correlation was found between the size of the foci and SUVmax (ρ = 0.17, p = 0.4744). The best accuracy in measuring MTV was observed when several thresholds were applied: VOIPERCIST, VOI2.5, VOIauto-contour, as well as VOI10 %, VOI15 % and VOI20 %. The optimal absolute threshold values were SUV values in the range from 2 to 3, and relative values in the range from 10 % to 20 % of the SUVmax in the tumor. MTV underestimation was more often determined using relative cut-off indices in the range of25–50 % and SUV thresholds ≥ 5.3.Conclusion: The results obtained showed that the use of a single threshold value for MTV segmentation in patients with DLBCL is not advisable. The choice of the MTV measurement method should be carried out individually for each lesion, taking into account its shape, size and structure, as well as the intensity and uniformity of tracer uptake in the tumor and adjacent anatomical structures.

The diseases and injuries of the knee joint are the most common orthopedic disorders. Personalized knee models can be helpful in the process of early intervention and lasting treatment techniques development. Fully automatic reconstruction of knee joint anatomical structures from medical images (CT, MRI, ultrasound) remains a challenge. For this reason, most of state-of-the-art knee joint models contain simplifications such as representation of muscles and ligaments as line segments connecting two points which replace attachment areas. The paper presents algorithms for automatic detection of such points on knee CT images. This paper presents three approaches to automatic detection of ligaments and tendons attachment sites on the patients CT images: qualitative anatomical descriptions, analysis of bones curvature, and quantitative anatomical descriptions. Combinations of these approaches result in new automatic detection algorithms. Each algorithm exploits anatomical peculiarities of each attachment site, e.g., bone curvature and number of other attachments in a neighborhood of the site. The experimental dataset consisted of 26 anonymized CT sequences containing right and left knee joints in different resolutions. The proposed algorithms take into account bone surface curvatures and spatial differences in locations of medial and lateral parts of both knees. The algorithms for detection of quadriceps femoris, popliteus, biceps femoris tendons, and lateral collateral and medial collateral ligaments attachment sites are provided, as well as examples of their application. Two algorithms are validated by comparison with known statistics of ligaments lengths and also using ground truth annotations for anatomical landmarks approved by clinical experts. The algorithms simplify generation of patient-specific knee joint models demanded in personalized biomechanical models. The algorithms in the current implementation have two important limitations. First, the correctness of the produced results depends on the bones segmentation quality. Second, the presented algorithms detect a point of the attachment site, which is not necessarily its center. Therefore, manual correction of the attachment site location may be required for attachments with relatively large area.

The present dry-mandible study evaluated the presence of the mental (MF), lingual (LF), and retromolar (RMF) foramina to assess the accuracy of CBCT in detecting these anatomical structures. In total, 38 human dry mandibles were analyzed (30 men, 8 women; mean age: 61.9 ± 13.7 years). CBCT scans were taken using low-dose parameters, and LF, MF, and RMF were assessed visually and radiographically. Both the presence (yes/no) and the count (n) of each foramen were compared between CBCTs and visual assessment. For the presence assessment, only RMF exhibited a significant difference between CBCT and visual inspection (P = .035). For count, the RMF (P = .049) and paramedian LF (P = .003) exhibited differences between the two methods. The agreement between CBCT and visual inspection was excellent for the MF, moderate-excellent for the LF, and low-moderate for the RMF. Intra- and interassessor agreement varied from excellent (MF), to moderate-excellent (LF), and low-moderate (RMF). The LF and RMF represent challenging structures to identify on CBCT images due to their limited dimension. False negative findings in CBCTs in the assessment of foramina, especially LF, might lead to surgical complications during implant surgery.

Introduction: Magnetic resonance imaging (MRI) has helped clarify the relationship between pelvic anatomical structures and functional outcomes after robot-assisted radical prostatectomy (RARP). Th...

The Human Reference Atlas (HRA) aims to map all of the cells of the human body to advance biomedical research and clinical practice. This Perspective presents collaborative work by members of 16 international consortia on two essential and interlinked parts of the HRA: (1) three-dimensional representations of anatomy that are linked to (2) tables that name and interlink major anatomical structures, cell types, plus biomarkers (ASCT+B). We discuss four examples that demonstrate the practical utility of the HRA.

This study aimed to assess the quality of root canal fillings and the prevalence of periapical radiolucencies in the permanent teeth of 6-18 year-old Turkish children.CBCT images of 150 patients' 235 teeth with a mean age of 16.0 ± 2.06 years were included. Root development stage, quality of root canal filling, the presence and severity of periapical radiolucencies, and their relationship with anatomical structures were recorded. Correlations between the quality of root canal filling, periapical lesion, and lesion size were assessed using regression analyses.A total of 235 teeth (528 root canals) were evaluated. 65.5% of root canals had periapical lesions. Immature roots and mandibular teeth had the highest prevalence and the largest size of periapical radiolucencies (p 0.05). Overfilling (n = 52), underfilling (n = 93), unfilled (n = 46), inhomogeneously filled (n = 113) root canals and poor coronal restoration (n = 85 teeth) were observed in terms of technical failures of endodontic treatment. The quality of endodontic treatment was associated with the presence of periapical lesion and lesion size (p 0.05). Teeth with under-filled, overfilled or inhomogeneously filled root canals and poor coronal restoration had a periapical lesion larger than 5 mm (p 0.05). Immature teeth were most associated with the presence of lesion (OR = 4.07) and the lesion size 5 mm (OR = 3.71).The prevalence of periapical radiolucencies in young permanent teeth showed an increase when the tooth was an incisor, had incomplete root development, or the root filling had technical errors.

BACKGROUND Closure of the nasal skin defects that resulted from excision of the skin neoplasms represents a challenging problem in reconstructive surgery. Here, the use of the reading man procedure as a new alternative in reconstruction of the skin defects of the nose is presented. MATERIALS AND METHODS In this procedure, 2 local flaps designed in an unequal Z-plasty manner are used. Defect coverage is achieved by transposing the first flap to the defect area, whereas the second flap is used for closure of the first flap's donor site. In last 10 years, this technique has been used for closure of the nasal skin defects that resulted from removal of skin cancers in 28 patients (15 men and 13 women) aged from 45 to 98 years. The defects were ranging between 1.5 and 3.1 cm in diameter. RESULTS In all patients, a tension-free 1-stage closure was obtained. There was no patient with dog ear formation and/or distortion of the mobile anatomical structures, such as nasal tip, alar lobules, and nostrils. All patients healed without complications. A mean follow-up of 52 months (8 months to 6.5 years) revealed satisfactory cosmetic results in all patients. No tumor recurrence was observed. CONCLUSIONS Using the advantage of extra tissue relaxation provided by an unequal Z-plasty, the reading man procedure seems to be a useful alternative for the closure of nasal defects with alike local skin. As a critical achievement, this procedure does not require excision of additional healthy tissue. Borrowing tissue from multiple directions, it avoids dog ear formation and distortion of the mobile anatomic structures.

الملخص: أهداف البحث: إن معرفة الأجزاء التشريحية أثناء العمليات الجراحية يؤدي إلى تقليل المضاعفات، ومن هنا كان الهدف الرئيس للدراسة هو معرفة الأجزاء التشريحية التي يعتبرها أطباء الاختصاص مهمة؛ ويجب أن يكون المقيم المتدرب في مستوى السنة الثالثة قادرا على تحديدها أثناء العمليات الجراحية. بالإضافة إلى ذلك قمنا بدراسة العوامل التي قد تؤثر على آراء الأطباء الاختصاصيين. طرق البحث: شملت الدراسة أطباء اختصاصيين في التوليد والجراحة النسائية، الذين يعملون في مستشفيات يوجد فيها برامج تدريب للأطباء المقيمين وذلك في الفترة ما بين ١/٢/٢٠١٩ و٣٠/١٠/٢٠١٩. وطُلب من أطباء الاختصاص تقييم أهمية الأجزاء التشريحية التي يجب أن يكون المقيم المتدرب في السنة الثالثة قادرا على معرفتها أثناء العمليات الجراحية. ثم تم تحليل الاستجابات بناء على عمر الطبيب الاختصاصي وجنسه ونوع الممارسة إذا كانت في مستشفى عام أو خاص وعدد سنوات الخبرة وعبء العمل الجراحي. النتائج: استجاب للدراسة ١٦٥ اختصاصيا، وذلك بمعدل استجابة ٦٩.٣٪. وكان متوسط العمر ٤٦.١ سنة، ومتوسط عدد سنوات الخبرة ١٣.٤. بالإضافة إلى ذلك؛ صنف ٨٦.٦٪ من الاختصاصيين جميع الأجزاء على أنها ''أكثر أهمية''. لم تكن الأهمية حسب تصنيف االاختصاصيين مرتبطة بالجنس أو عدد سنوات الخبرة أو عبء العمل الجراحي. كما تم تصنيف أهمية ٦٣٪ من الأجزاء التشريحية ''أعلى'' من قبل الاختصاصيين المبتدئين مقارنة بالاختصاصيين الأكثر خبرة. الاستنتاجات: المعرفة بالتشريح الجراحي مهمة للتدريب في برامج الإقامة في التوليد والجراحة النسائية. إن تصور الاختصاصيين لأهمية الأجزاء التشريحية المختلفة يعكس فهمهم لمتطلبات التدريب. سلطت نتائجنا الضوء على الأجزاء التشريحية المهمة التي من المتوقع أن يعرفها الأطباء المقيمون في السنة الثالثة من التدريب أثناء العمليات الجراحية. قد يؤسس هذا البحث مدخلا لبحوث مستقبلية تشمل جميع سنوات التدريب وتعمل على تشكيل مرجعا لماهية المعرفة التشريحية المطلوبة لكل سنة تدريب. Abstract: Objectives: Intraoperative identification of anatomical structures can potentially reduce the risk of surgical complications. This study aims to report specialists' perspectives about the anatomical structures that third-year residents should be able to identify during surgical operations. In addition, the factors which may influence specialists' opinions are discussed. Materials and methods: This qualitative cross-sectional study was conducted on obstetricians and gynaecologists between 1/2/2019 and 30/10/2019. The specialists practising in a hospital with a residency programme were included, and were asked to rate the importance of structures that a third-year resident should be able to identify during operations. We performed a comparison of responses based on specialists' age, gender, practice type, years of experience, and surgical workload. Results: One hundred and sixty-five specialists were recruited with a response rate of 69.3%. The mean age of respondents was 46.1 years, and they had a mean experience of 13.4 years. Furthermore, 86.6% of specialists rated all the anatomical structures as “more important”. The importance of surgical structures, as rated by specialists, was not related to gender, years of experience, or surgical workload. The importance of 63% of the anatomical structures was rated higher by junior specialists than senior specialists. Conclusion: Knowledge of anatomical structures is vital for gynaecologic residency training. Specialist's perceptions of the importance of various anatomical structures reflect their understanding of the training requirements. Our results highlighted the important anatomical structures that third-year residents are expected to identify during surgical operations. Future research may establish a reference for the core anatomy knowledge essential for each training year.

The actual shape of the 4th ventricular choroid plexus and the relationships between its development and the normal vs abnormal development of the vermis is still to be defined. This editorial illustrates in detail what is thought to be the normal developmental process of the 4th ventricle, its choroid plexus, and the anterior and posterior membranous areas. Then, it addresses the findings that high-resolution ultrasound is able to demonstrate in the normal and abnormal development of the above mentioned anatomical structures. Finally, it focuses on the key role that the 4th ventricular choroid plexus seems to play in this development, as becoming evident in recent researches on the topic. This article is protected by copyright. All rights reserved.

The review presents the analysis of domestic and foreign literature, selecting the available scientific data on the features of constitutional and X-ray anatomy of the chest in adolescents and adults. The size and shape of the chest depends on age, sex and anthropometric parameters: height, body mass index, and also the presence of concomitant pathology. These patterns are characteristic of individual anatomical structures of the chest: sternum, ribs, spine and diaphragm. The study of constitutional anatomy is necessary for the development of morphological foundations for the interpretation of the results of intravital imaging of the chest and organs, justification of various methods of surgical access to the organ and structures of the chest and chest cavity.

Traumatic injuries of subaxial cervical spine are characterized by a wide range of possible pathomorphological changes that depend not only on the direction and intensity of the traumatic force impact, but also on the initial position of cervical spine at the moment of exposure. One of the most detailed classifications of cervical spine traumatic injuries, in which the integrated approach to assessing the type of injury considering the mechanism of injury is used, is the system developed by Ben L. Allen and published with co-authors in 1982. It is also known as the Allen-Ferguson classification and despite long history of existence, still has not lost its relevance. In the classification when characterizing the type of traumatic injury, not only visually detected signs, but also inevitably accompanying changes are given. In total, 6 types of damage were classified: compression-flexion, vertical compression, distraction-flexion, compression-extension, distraction-extension and lateral-flexion, which were divided into stages depending on the severity of pathomorphological changes. The authors of the classification note a pronounced correlation between the nature of damage to anatomical structures and neurological disorders in all patterns of damage. When writing this review, a detailed analysis of the original publication was carried out, highlighting the basic biomechanical aspects that underlie the classification and still have not lost their relevance . It is noted that the schematic images of damages found in modern literature often do not correspond to the description proposed by Ben L. Allen et al., Therefore, when preparing the illustrative material, we relied solely on the data of the original article. Along with the description of morphology, for each type and stage of injury, modern data on possible methods of treatment, both conservative and surgical are given. The complex analysis suggests that the classification developed by Ben L. Allen is a convenient tool for assessing pathomorphological changes and allows choosing the optimal method of treating the patients in each specific clinical situation.

BackgroundErector spinae plane (ESP) and retrolaminar (RL) blocks show unreliable spread. We hypothesize that the combination of ESP and RL blocks provides more extensive and reliable spread of dye than single ESP blocks. Our primary objective was to compare the spread of dye to the paravertebral spaces after the combination block and ESP block in Thiel embalmed cadavers. Spread, the primary end point, was defined as the number of paravertebral spaces colored with dye per injection.Materials and methodsA single anesthetist performed ultrasound-guided ESP (20 mL) and combination of ESP and RL (10 mL each) blocks at the third thoracic vertebra of eight soft embalmed Thiel cadavers. Tissue displacement was visualized on an adjacent strain elastography image. Cadavers were dissected 24 hours later and anatomical structures were inspected for the presence of dye.FindingsDye was visualized in more paravertebral spaces with the combination block (median 3 (IQR 3–5 (range 0–8)) vs 1.5 (IQR 0.25–2.75 (range 0–3) and difference (1.5 (0–4), p=0.04). Six out of seven (86%) combined erector spinae and RL blocks spread to at least three paravertebral spaces compared with two out of eight (25%) ESP blocks (RR 3.4, 95% CI 1.0 to 11.8; p=0.04). Contralateral spread occurred in three combination blocks and in one ESP block (OR 9.0, 95% CI 4.0 to 21.1; pConclusionsIn conclusion, the combination of ESP and RL blocks was more extensive and reliable than ESP block alone.

Aim: Our aim was to present the regenerative-reconstructive surgical treatment of a complex periodontal defect. Surgicaltreatment planning was carried out on realistic virtual hybrid models, containing all relevant anatomical structures (teeth,alveolar bone and gingiva). Additional aim was to evaluate the outcome of the surgical treatment, by the superimpositionof pre- and postoperative cone-beam computed tomography (CBCT) scans.Materials and methods: Utilizing a semi-automatic segmentation method, the 3D model of teeth and alveolar bonewas generated from the CBCT scan using the open source radiographic image processing software, 3D Slicer. Spatialregistration of the hard tissue model acquired from the CBCT scan and the digital model acquired with an intraoralscanner was performed based on anatomical landmarks. First step of the planned stepwise surgical treatment was theextraction and simultaneous alveolar ridge preservation of tooth 26. Surgery was carried out according to the extractionsite development (XSD) technique. Second step was the regenerative treatment of the horizonto-vertical periodontal defectinvolving tooth 24 and 25. Superimposition of the pre- and postoperative CBCT scans allowed to validate the volumetricand linear changes.Results: In the surgical area the cumulative hard tissue gain was 0.44 cm3. Crestal bone resorption of 0.11 cm3 occurredat the palatal and buccal aspects. Linear measurements were performed to evaluate the hard tissue fill of the periodontaldefect around tooth 24 and 26. On average the intrabony component showed a 53.88 ± 36.84% of hard tissuefill, with minor crestal bone resorption. On average a 1.22 ± 0.87 mm of gingival recession occurred around the teeth.Conclusion: It can be concluded that hybrid models acquired with the aforementioned technique allowed detailed planningof the surgical procedures. With the application of the postoperative volumetric and linear evaluation, the healingdynamics of the complex defect could be demonstrated thoroughly.

Acanthodoras is the only genus of catfish known to secrete a conspicuous and abundant milky-looking substance through an axillary pore located just below the base of the posterior cleithral process. Despite this remarkable feature, there is no published information on the anatomical structures that produce the secretion and its possible biological/ecological functions. Dissection and histological analysis of preserved specimens of A. spinosissimus revealed the presence of a saccular axillary gland with large, binuclear secretory cells, similar to those found in other poisonous catfish. Secretory cells near the lumen appear to lose nuclei and become filled with secretory products, possibly with proteinaceous elements, as indicated by their eosinophilic appearance. As far as we know, the saccular morphology of the gland appears to constitute a unique characteristic of Acanthodoras among Doradidae catfishes. Further studies are necessary to determine the chemical composition of the secretion, as well as its possible uses by the catfish in its natural environment.

Background/aim Because of close relations to important anatomical structures such as cavernous sinus and optic nerve, sphenoid sinus variations must be well trained by the Otolaryngologist who has an interest in endoscopic sinus surgery. Newly defined sphenoseptal cell (SSC) is one of those variations that may lead to insufficient endoscopic sinus surgery outcomes if not defined preoperatively with imaging studies. The present study aimed to present the main characteristics of this special type of nasal cell. Materials and methods In this study 610 paranasal sinus CT scans were analyzed and reviewed retrospectively between May 2018 and December 2019. Also, endoscopic findings of SSC, that cause a surgical catastrophe in identifying skull base and sella are presented during transnasal transsphenoidal pituitary surgery. Results According to its definition and relation to the sphenoid sinus and the skull base, an SSC was seen in 21 scans of 610 patients (3.4%), 11 were women (55%) and 10 were men (45%). Conclusion Although an SCC is a rare variation of nasal air cells, preoperative diagnosis of this cell is of paramount importance in some patients during endoscopic transnasal surgery for the identification of skull base.

Covariations between anatomical structures are fundamental to craniofacial ontogeny, maturation, and aging and yet are rarely studied in such a cognate fashion. Here, we offer a comprehensive investigation of the human craniofacial complex using freely available software and MRI datasets representing 575 individuals from 0 to 79 years old. We employ both standard craniometrics methods as well as Procrustes-based analyses to capture and document cross-sectional trends. Findings suggest that anatomical structures behave primarily as modules, and manifest integrated patterns of shape change as they compete for space, particularly with relative expansions of the brain during early postnatal life and of the face during puberty. Sexual dimorphism was detected in infancy and intensified during adolescence with gender differences in the magnitude and pattern of morphological covariation as well as of aging. These findings partly support the spatial-packing hypothesis and reveal important insights into phenotypic adjustments to deep-rooted, and presumably genetically defined, trajectories of morphological size and shape change that characterize the normal human craniofacial life-course.

Pancreatic tumors are very rare problem in children that mostly in literature presented just with case reports. Solid-pseudopapillary tumors of the pancreas are a little part, just about 1–2%, from all nonendocrine tumors of the pancreas. About 90% of all patients with this tumor are female teenagers and young women. Solid-pseudopapillary tumors of the pancreas are innocent, and mostly all of them are incidental findings. However, we can see clinical findings if patient has big size of such tumor, which compress nearest anatomical structures. In this article we present a case of incidental finding of solid- pseudopapillary tumor of body and tale of the pancreas in 11 years old girl, who was treated with distal resection of pancreas.

The palatine tonsils form an important part of the human immune system. Together with the other lymphoid tonsils of Waldeyer's tonsillar ring, they act as the first line of defense against ingested or inhaled pathogens. Although histologically stained sections of the palatine tonsil are widely available, they represent the tissue only in two dimensions and do not provide reference to three‐dimensional space. Such a representation of a tonsillar specimen based on imaging data as a 3D anatomical reconstruction is lacking both in scientific publications and especially in textbooks. As a first step in this direction, the objective of the present work was to image a resected tonsil specimen with high spatial resolution in a 9.4 T small‐bore pre‐clinical MRI and to combine these data with data from the completely sectioned and H&E stained same palatine tonsil. Based on the information from both image modalities, a 3D anatomical sketch was drawn by a scientific graphic artist. In perspective, such studies could help to overcome the difficulty of capturing the spatial extent and arrangement of anatomical structures from 2D images and to establish a link between three‐dimensional anatomical preparations and two‐dimensional sections or illustrations, as they have been found so far in common textbooks and anatomical atlases., A resected human tonsil was imaged with high spatial resolution in a 9.4 T small‐bore pre‐clinical MRI. Data were combined and co‐registered with data from the completely sectioned and H&E stained same palatine tonsil. Based on the information from both image modalities, a 3D anatomical sketch was drawn by a scientific graphic artist.

Summary Background The measurement of anatomical structures is critical in plastic and reconstructive surgery. However, few detailed and standardized measurements have been widely used in the periorbital region. This study aimed to evaluate the feasibility of a novel detailed and standardized protocol with 2D and 3D technologies, and explore the relationship between them and direct measurements. Methods Fifty healthy Caucasians (100 eyes) between 20 and 68 years old were recruited and captured for 3D photographs by VECTRA M3 3D Imaging System. Subsequently, 24 landmarks were located on each 3D photographs following a standardized protocol, and then 19 linear and 3 angular periorbital variables were measured. Furthermore, two-dimensional (2D) and direct measurements were conducted on each subject and compared with 3D measurements and one another. Results The grand r means across all measurements were 0.77, 0.78, and 0.88 for direct vs. 2D values, direct vs. 3D values, and 3D vs. 2D values, respectively. The mean absolute differences were 1 mm (ranging from 0.2 mm to 3.7 mm) between direct and 3D measurements, 1 mm (ranging from 0.04 mm to 2.4 mm) between direct and 2D measurements, and 1 mm and 6.6° (ranging from 0.04 mm or 0.5° to 3 mm or 12.8°) between 2D and 3D measurements. Conclusions This study verified the feasibility of this detailed and standardized landmark localization protocol for assessing the periorbital morphology with 2D and 3D technologies. This protocol may work as a bridge communicating with all studies involving any of the three technologies in the future.

Neurosurgical interventions in the brain are challenging due to delicate anatomical structures. During surgery, precise navigation of surgical instruments supports surgeons and allows prevention of adverse events. Here, an augmented reality-based navigation aid with automated segmentation of risk structures and path planning is presented. Superimposed patient models are visualized during neurosurgical interventions on the example of the ventricular puncture. The proposed system is experimentally validated in a realistic operating room scenario with expert neurosurgeons to determine its quality of support as well as its potential for clinical translation. The automated segmentation reaches a F1-Score of 95-99%. Paths are planned correctly in 93.4%. The entire process enables navigation aid in under five minutes. Validation shows that the system allows for a puncture success rate of 81.7% with mean accuracy of 4.8 ± 2.5 mm. A control group who performed the standard-of-care procedure reached a rate of 71.7% with 6.5 ± 2.4 mm accuracy. Acceptability analysis shows that 85.7% of the participating surgeons approve of the system’s convenience and 92.9% expect accuracy improvement. The presented navigation aid for ventricular puncture enables automated surgical planning and may improve accuracy and success rates of neurosurgical interventions.

Problem solving skills are needed by students to solve problems that arise in everyday life. Innovation in learning is needed so that students can achieve the basic competencies and apply 21st-century skills, in the form of interactive, collaborative learning models. One of the innovations is using the Project-Based Learning learning model with the E-book of plant anatomy structures. This study aims to develop an E-book of PjBL-based plant anatomy structures to practice problem-solving skills which are declared valid in terms of theoretical and empirical aspects. The theoretical aspect is viewed from the results of the validity. Empirical aspects in terms of learning outcomes, student responses, and readability. The development model used is 4D. The research was carried out at the UNESA Postgraduate Program in June-August 2020. The target of this research was an online E-book on the structure of plant anatomy based on Project Based Learning which was tested on ten students of Muhammadiyah 1 Gresik senior high school in February 2021. The instruments used were validation sheets, student response sheets, and fry chart sheets. The data were analyzed descriptively quantitatively. The results showed that the PjBL-based E-book of plant anatomical structures was theoretically feasible based on the validation results obtained an categories very valid and empirically feasible based on student learning outcomes (N-gain of moderate categories). Based on this description, a PjBL E-book of plant anatomy structures to train students' problem-solving skills is feasible theoretically and empirically.

Hancornia speciosaGomes is popularly known as mangabeira and occurs throughout Brazil. It belongs to the Apocynaceae family and is very important for its food and medicinal uses. The objective of this study was to perform the anatomical and histochemical characterization of the leaves ofH. speciosa. Microscope slides were made containing cross sections of petiole and leaf blade, as well as paradermic sections of the leaf blade. The analyses were performed under light and polarized microscopy. For the histochemical analysis, different reagents were used, according to the targeted metabolite. Through microscopic analysis, it was possible to identify the anatomical structures that provide the detailed diagnosis of the studied species. Through histochemistry, the presence of phenolic compounds, tannins, alkaloids, triterpenes and steroids, lipophilic compounds, lignin, starch, and calcium oxalate crystals was evidenced in the leaf blade. Thus, the results presented contribute to the quality control ofH. speciosa, as well as to bring unpublished data about the species and to increase knowledge about the Apocynaceae family.

The anatomical structure of phonation in the domestic chicken Gallus gallus (red jungle fowl, forma domestica) of both sexes was studied to determine sex variations in structures. Ten (10) birds, involving 5 males and 5 females were obtained from a local market for student demonstrations and used for this study. Tracheal rings were observed to be made of circular cartilages numbering thirty and above with the distal most (1/5) tracheal rings narrowed, calcified and fused as the tympanum making part of the Syrinx. The rings become calcified and somewhat collapsed through the bronchial bifurcations. When squeezed, the trachea collapsed completely between fingers but could at releasing the fingers be raised up due to elastic components separating the rings from one another. Other structures involved in vocalization includes straps of muscles. Male structures involved in respiration and vocalization were well formed compared to those of the female. Both tracheobronchialis lateralis and ventralis muscles were thicker than those of the female. Male tracheobronchialis ventralis and dorsalis muscles were well formed and spindle shaped. However, the female tracheobronchialis muscles were seen to be wider compared to the male. The vocal organs (voice box) were seen to be arbitrarily triangular in structure at the bifurcation of the trachea in both sexes. The male Syringeal walls were thinner and were seen to have marked inter Pessula space. The Pessulus mark an abrupt change from the circular trachea to strongly elliptical entrances to the bronchi. It was concluded that the differences in the thinness of syringeal walls coupled with differences between the males and females in other tracheal muscles might be responsible for the stronger vocalization in the male.

espanolLa capacidad de un ser humano para aprender no solo depende de su coeficiente Intelectual sino tambien de las diferentes estrategias a ser empleadas como materiales didacticos que se utilicen para realizar el proceso de ensenanza aprendizaje. El objetivo del estudio que se presenta es aplicar material didactico de Piezas Anatomicas Tratadas con Glicerina para mejorar el proceso de ensenanza aprendizaje de la asignatura de Morfofisiologia del Sistema Nervioso en los estudiantes de la Escuela de Medicina de la Facultad de Ciencias Medicas, “Universidad de Guayaquil” Se realizo un estudio cuasi experimental en el cual participaron dos grupos, uno de 45 estudiantes, que constituyo el grupo de control y el otro, con 44 estudiantes que conformo el cuasi experimental; se utilizaron estrategias para el aprendizaje teorico, practico asistido por el profesor, Autonomo y Colaborativo. Se aplico un test de conocimiento. Se establecieron, una hipotesis general y 4 hipotesis especificas se utilizo el Test U de Mann Whitney probandose que las estrategias utilizadas mejoraron el nivel de desempeno en la adquisicion del conocimiento, en la identificacion de estructuras anatomicas, en la resolucion de problemas clinicos, en el trabajo colaborativo y por ende en la mejora del proceso de ensenanza y aprendizaje de la asignatura de Morfofisiologia del Sistema Nervioso de los estudiantes de la escuela de Medicina de la Facultad de Ciencias Medicas Universidad de Guayaquil. EnglishThe capacity of a human being to learn not only depends on his Intellectual coefficient but also on the different strategies to be used as didactic materials that are used to carry out the teaching-learning process. The objective of the study that is presented is to apply didactic material of Anatomical Pieces Treated with Glycerin to improve the learning process of the subject of Morphophysiology of the Nervous System in the students in the School of Medicine of the Faculty of Medical Sciences, "University of Guayaquil" Conducted a quasi-experimental study in which two groups participated, one of 45 students, who constituted the control group and the other, with 44 students who formed the experimental quasi; Strategies were used for theoretical, practical, teacher-assisted, autonomous and collaborative learning. A knowledge test was applied. A general hypothesis and 4 specific hypotheses were established, all of which were tested with the Mann Whitney Test U. It was proved that the strategies used improved the level of performance in the acquisition of knowledge, in the identification of anatomical structures, in the resolution of clinical problems, in collaborative work and, therefore, in improving the teaching and learning process of the Subject of Morphophysiology of the Nervous System of the students of the medical school of the Faculty of Medical Sciences University of Guayaquil.

Owing to its intricate structural and functional anatomy, the fingertip is immensely critical for a wide range of functions like sensation, gripping and fine handling. Therefore, it is important to be familiar with such injuries and their available treatment plans to ensure satisfactory aesthetic and functional results. We present our experience on fingertip reconstruction along with a critical analysis of the employed reconstructive techniques, their outcomes and an algorithm-based approach to address fingertip injuries. A retrospective chart review of all fingertip injuries presented to the Sawai Man Singh Hospital was conducted during September 2018 and September 2020. Data on the defects size, type of reconstructive technique employed, surgical outcomes and surgical complications was recorded and analyzed. This study included 92 fingertip injuries in 80 participants, 22 injured thumbs, 21 injured index fingers, 24 injured middle fingers, 20 injured ring fingers and 5 injured little fingers were reported. The most common mechanism of injury was machine injury (n = 58, 72.5%) and electric burn (n = 12, 15%). The most common surgical techniques were the V–Y advancement flap (n = 30), Moberg flap (n = 10), reverse homodigital island flap (n = 8) and first dorsal metacarpal artery flap (n = 8). The average size of soft tissue defect was 2.1 cm. Adequate knowledge of the anatomical structures, a satisfactory analysis of the type and mechanism of injury aid in the selection of reconstructive alternatives for fingertip injury, which, in turn, prevents secondary deformities, improves functional outcomes and decreases secondary reconstructive procedures that are more complicated and have unpredictable results. Level of evidence: Level IV, therapeutic study.

HYPOTHESIS This study compares the reaching ability of two classes of transcanal endoscopic ear surgery (TEES) instruments when operating on difficult to access anatomical targets; two novel instruments with steerable flexible tips (SFT-A and SFT-B) and suction capability are compared with standard commercially available tools. BACKGROUND TEES surgeons identified the need for a new surgical instrument that can enable accessibility of all areas visualized by the endoscope. This motivated the development of the two instrument prototypes. METHODS Six temporal bone models were 3D printed based on CT data from five cholesteatoma patients. Four anatomical targets were marked on each model. Using these targets, the reaching ability while using four standard TEES instruments were compared with the SFT-A and SFT-B prototypes by five surgeon participants. Results were analysed to compare success rates of contacting each target using each tool by fitting four Firth's logistic regression models. This calculated the statistically significant differences (p

Maytenus ilicifolia (Celastraceae) é uma planta conhecida popularmente como “espinheira-santa”. A espécie é nativa da região sudeste do Brasil, se adapta melhor a climas quentes e é utilizada na medicina popular no tratamento de doenças estomacais. A fitoterapia, encontra-se em expansão no Brasil e no mundo e, devido a esta crescente busca e desordenada extração de plantas medicinais, muitos vendem espécies semelhantes como se fossem originais, comprometendo a real eficácia dos produtos utilizados. Nesse sentido, a comparação anatômica tem provado ser útil na diferenciação das espécies. Assim, o presente estudo visa avaliar a autenticidade de espinheira-santa comercializada em mercados de ervas de São Mateus-ES, por meio da caracterização de comparação anatômica foliar de amostras de M. ilicifolia in situ e comercializada. Os resultados obtidos mostram que as estruturas anatômicas foliares de M. ilicifolia in situ, comparadas com as amostras da Casa Natural e do Mercado Municipal, diferem-se quanto à disposição dos feixes vasculares na nervura central, quanto ao formato do pecíolo e presença ou ausência de grupos de fibras isolados no córtex. Por fim, diante da avaliação das amostras, pode-se observar que o material comercializado em mercado de ervas, possivelmente não condiz com a espécie M. ilicifolia.

Annotation. Determining the characteristics of certain indicators within a certain population, the relationship between certain anatomical structures and parameters of the human body is one of the key tasks of clinical anthropology. Identifying the nature, strength and direction of the interdependencies of such indicators is a key element not only for understanding human nature but also for solving clinical, including dental problems today. The aim of the study was to establish in Ukrainian young men and young women with orthognathic occlusion the peculiarities of correlations of teleradiographic parameters of tooth location determined by Bjork, Jarabak and Sassouni methods with parameters of upper and lower jaws and tooth location. Teleradiography in the mode of cephalometric examination was performed for 49 young men and 76 young women with orthognathic occlusion. Cephalometric analysis was performed using OnyxCeph³™ software, 3DPro version, Image Instruments GmbH, Germany (software license URSQ-1799). Correlation assessment was performed in the license package “Statistica 6.0” using the non-parametric Spearman method. In young men and young women, the features of multiple correlations of teleradiographic parameters of the upper and lower jaws with the parameters of the location of the teeth determined by the methods of CFT-Bjork, Roth-Jarabak and Sassouni. As a result of quantitative analysis of significant correlations between teleradiographic parameters of the upper and lower jaws with the parameters of the location of the teeth found: CFT-Bjork in young men 46.9 %, of which 5.4 % straight strong, 18.5 % straight medium and 2.3 % straight weak and 2.3 % reversible strong, 16.2 % reversible medium strength and 2.3 % reverse weak, and young women – 38.5 %, of which, 2.3 % direct strong, 15.4 % direct medium strength and 6.2 % direct weak and 0.8 % reverse strong, 7.7 % reverse medium strength and 6.2 % of reversible weak; according to the Roth-Jarabak method, 36.2 % of young men, 6.6 % of direct strong, 11.8 % of direct medium strength and 2.6 % of direct weak and 2.6 % of reverse strong, 11.8 % of reverse of medium strength and 0.7 % of reverse weak, and young women – 44.7 %, of which, 3.9 % direct strong, 15.1 % direct medium strength and 7.2 % direct weak and 0.7 % reverse strong, 8.6 % reverse medium strength and 9.2 % reverse weak; according to the Sassouni method, 42.8 % of young men have all medium-strength, and 42.8 % of young women have, of which 35.7 % have medium-strength and 7.1 % have weak straight. Manifestations of sexual dimorphism of the received correlations are established only between the indicators defined by CFT-Bjork and Roth-Jarabak methods.

Safe and effective hernia repair requires a surgeon to have the appropriate knowledge necessary to learn details of the surgical technique. Long-term results of treatment, even with the use of synthetic implants, have shown that recurrences were still a significant clinical problem concerning up to every fourth patient. Therefore, it was pointed out that the mere presence of synthetic material is not a solitary circumstance sufficient for a successful repair. A key finding in recurrence prevention has been to focus surgeons' attention on the relationship between the size of the hernia orifice and the mesh surface. An optimal ratio of these values has not been established yet, however, it is considered that the mesh surface area should be at least sixteen times larger than the area of the abdominal wall defect. In cases of medium and large hernias, in order to place an extensive mesh sheet in the appropriate anatomical space of the abdominal wall, an extensive dissection needs to be performed, including several different compartments. Therefore, a surgeon undertaking a hernia repair needs to know perfectly the anatomy and function of all the myofascial structures involved. Performing an incorrect dissection of a mistaken structure may lead to catastrophic abdominal deformities. Depriving the patient of the natural support of the abdominal wall provided by the muscles may lead to total or partial destabilization of the trunk and lead to disability. In this paper a detailed description of anatomical structures and its practical use has been presented.

Objectives To investigate how virtual reality (VR) imaging impacts decision-making in atrioventricular valve surgery. Methods This was a single-center retrospective study involving 15 children and adolescents, median age 6 years (range, 0.33-16) requiring surgical repair of the atrioventricular valves between the years 2016 and 2019. The patients' preoperative 3-dimesnional (3D) echocardiographic data were used to create 3D visualization in a VR application. Five pediatric cardiothoracic surgeons completed a questionnaire formulated to compare their surgical decisions regarding the cases after reviewing conventionally presented 2-dimesnional and 3D echocardiographic images and again after visualization of 3D echocardiograms using the VR platform. Finally, intraoperative findings were shared with surgeons to confirm assessment of the pathology. Results In 67% of cases presented with VR, surgeons reported having “more” or “much more” confidence in their understanding of each patient's pathology and their surgical approach. In all but one case, surgeons were at least as confident after reviewing the VR compared with standard imaging. The case where surgeons reported to be least confident on VR had the worst technical quality of data used. After viewing patient cases on VR, surgeons reported that they would have made minor modifications to surgical approach in 53% and major modifications in 7% of cases. Conclusions The main impact of viewing imaging on VR is the improved clarity of the anatomical structures. Surgeons reported that this would have impacted the surgical approach in the majority of cases. Poor-quality 3D echocardiographic data were associated with a negative impact of VR visualization; thus. quality assessment of imaging is necessary before projecting in a VR format.

The recent introduction of wireless head-mounted displays (HMD) promises to enhance 3D image visualization by immersing the user into 3D morphology. This work introduces a prototype holographic augmented reality (HAR) interface for the 3D visualization of magnetic resonance imaging (MRI) data for the purpose of planning neurosurgical procedures. The computational platform generates a HAR scene that fuses pre-operative MRI sets, segmented anatomical structures, and a tubular tool for planning an access path to the targeted pathology. The operator can manipulate the presented images and segmented structures and perform path-planning using voice and gestures. On-the-fly, the software uses defined forbidden-regions to prevent the operator from harming vital structures. In silico studies using the platform with a HoloLens HMD assessed its functionality and the computational load and memory for different tasks. A preliminary qualitative evaluation revealed that holographic visualization of high-resolution 3D MRI data offers an intuitive and interactive perspective of the complex brain vasculature and anatomical structures. This initial work suggests that immersive experiences may be an unparalleled tool for planning neurosurgical procedures.

Prior to microsurgery practice on patients, microsurgical skills should be learned in a simulated and controlled environment to increase success rates and reduce surgical complications. These favorable environments have historically been the microsurgery laboratories. The use of the experimental animals has allowed surgical trainees to interact with anatomical structures and physiological processes that a microsurgeon has to face in daily clinical scenarios. In recent decades, there has been an increase in simulation methods to reduce the number of animals used for training purposes and thus meet animal welfare criteria.Spain has a long history in the practice and teaching of microsurgery, this manuscript aims to highlight the importance of first educators, as well as to evaluate the current situation and future perspectives.

Összefoglaló. Bevezetés: Az emberi sziklacsont a halántékcsont része, egy bonyolult és változatos anatómiai felépítésű struktúra. A sziklacsonton végzett beavatkozások előtt, a műtéti szövődmények megelőzése érdekében, nélkülözhetetlen a biztos anatómiai tudás és kézügyesség megszerzése, valamint az egyes műtéti lépések és mozdulatok begyakorlása. A VOXEL-MAN Tempo 3D fül-orr-gégészeti szimulátor a virtuális valóság és a robotika alkalmazásával nyújt gyakorlási lehetőséget. Célkitűzés: A Szegedi Tudományegyetem 2019-ben VOXEL-MAN fül-orr-gégészeti szimulátort helyezett üzembe az Orvosi Készségfejlesztési Központban. A cikk fül-orr-gégész szakorvos szerzői a VOXEL-MAN Tempo szimulátor megismerését követően bemutatják a készüléket, és megfogalmazzák a szimulátorral végzett beavatkozásokkal szemben támasztott igényüket. Módszer: A szerzők a megfogalmazott szempontoknak megfelelően értékelik a VOXEL-MAN Tempo szimulátort, és meghatározzák, milyen szerepet szánnak neki a gyakorlati képzésben. Eredmények: A szimulátor virtuálisan, mégis valósághűen mutatja meg a sziklacsont anatómiai viszonyait, a fontos anatómiai struktúrák valós térbeli elhelyezkedését és egymástól, illetve a sebészi eszköztől mért távolságát. A rendszer lehetővé teszi a fülműtétek valósághű elvégzését (kétkezes csontmunka fúróval és szívóval, vérzés szimulálása) taktilis visszacsatolással. Az egy- vagy kétkezes feladatokkal fejleszthetjük a sebészi készségeket. A fülműtétek csontmunkája reprodukálható módon elvégezhető valódi beteg halántékcsontjáról készített rutin, nagy felbontású komputertomográfiás vizsgálat anyagából. Következtetés: Tapasztalataink alapján a szimulátor kiválóan alkalmas az egyes műtéti lépesek begyakorlására. A jövőben fontos szerepet szánunk a virtuális rendszernek a fül-orr-gégészeti graduális és a fülsebészeti posztgraduális képzésben. Orv Hetil. 2021; 162(16): 623–628. Summary. Introduction: The pars petrosa of the human temporal bone is a structure of complex and diverse anatomy. Prior to surgical interventions, in order to prevent surgical complications, it is essential to acquire sound anatomical knowledge and dexterity as well as to practice each surgical step and movement. The VOXEL-MAN Tempo 3D simulator uses virtual reality and robotics to provide an opportunity to practice. Objective: In 2019, the University of Szeged installed a VOXEL-MAN Virtual Reality simulator at the Medical Skills Development Center. After learning about the VOXEL-MAN Tempo simulator, the authors present the device and articulate their need for interventions with the simulator. Method: The VOXEL-MAN Tempo simulator is evaluated according to the formulated criteria and the role assigned to it in the practical training is determined. Results: The simulator shows the anatomical structure of the temporal bone virtually, yet realistically, the real spatial location of the important anatomical structures and their distance from each other and from the surgical instrument. The system allows ear surgery to be performed realistically (two-handed bone work with a drill and suction) with tactile (vibration) and visual (bleeding) feedback. One can improve surgical skills with one- or two-handed tasks. Bone work in ear surgeries can be performed in a reproducible manner from routine, high-resolution computer tomography of the temporal bone of a real patient. Conclusion: With reference to our experience, the simulator is excellent for practicing each surgical step. In the future, we intend to use this virtual system in undergraduate and postgraduate training in otolaryngology. Orv Hetil. 2021; 162(16): 623–628.

La laringe es un órgano extraño ubicado en la línea media del cuello, compuesto por cartílago, músculos y ligamentos. La TC y la RM se realizan como técnicas de imagen de primera elección en el estudio de laringe; sin embargo, no están exentos de limitaciones. La ecografía es un método accesible de alta resolución con una visualización relativamente buena de las diferentes estructuras de la laringe. El objetivo del trabajo fue determinar las características de estructuras anatómicas laríngeas identificables ecográficamente. En este trabajo observacional descriptivo, transversal, prospectivo, se estudiaron 20 pacientes, sin patología laríngea, con edades comprendidas entre los 20 y los 35 años, ambos sexos. La ecografía laríngea se realizó con un transductor de ultrasonido Phillips® con sonda lineal de 4 a 12 MHz, partes blandas preestablecidas. En todos los casos se pudieron identificar y medir cartílago tiroides, cricoides y epiglotis, y en un gran porcentaje de estos las cuerdas vocales, bandas ventriculares y esquina anterior. El cartílago aritenoide solo fue visible en el 85% de los casos. La ecografía se presenta como un método auxiliar útil en el estudio de la anatomía de la laringe, proponiendo el seguimiento y realización de nuevos estudios que puedan complementar este estudio y su validez.

International audience; The respiratory movements of fetal amniotic fluid areconsidered by certains cleft surgery teams to contribute to the growth of the nasal cavities (NC). To assess this functional hypothesis, we considered a group of patients with unilateral choanal atresia (CA) as a model of unilateral absence of amniotic fluid flux in the NC, and compared their NCs shape to age-matched controls. Material and methods: Three-dimensional reconstructions of NC were performed using Avizo 9.7 (Thermo Fisher Scientific, MA, USA), based on CT-scans of 32 patients with unilateral CA and 96 age-and gender-matched controls. Landmarks were placed on anatomical structures of NC. Procrustes superimpositions and principal component analysis were performed. Anatomically relevant Euclidean distances were computed using the coordinates of selected landmarks-maxillary length, piriform orifice width, choanal width-and tested using multivariate analysis. Growth rates between patients and controls for these distances were screened for correlations. Results: The atretic NC was significantly deformed when compared to the control cases: Procrustes distance was 0.28 (P < 0.0001). The maxillary length and width of the atretic choana were significantly decreased compared to controls (À2.95 mm and À1.35 mm respectively, P < 0.001). There were no differences in growth rates between CA and controls, except for the choanal width on the atretic side. Conclusion: NCs in CA were significantly different from controls. More precisely, the maxillary length was significantly reduced in the CA group. There was no other major shape difference between the NC in CA and controls. NC seems to develop despite abnormal fetal ventilation.

espanolLa Anestesia Regional se refiere a un grupo de tecnicas realizadas a nivel del neuro-eje o nervios perifericos que ocasiona insensibilidad al dolor en el cuerpo. Esto se lleva a cabo interrumpiendo selectivamente la transmision nerviosa sin alterar el estado de consciencia de paciente. La practica de anestesia regional ofrece numerosas ventajas sobre la anestesia general (AG), citandose la disminucion de la morbilidad y mortalidad, una analgesia posoperatoria superior, una excelente relacion costo beneficio y una muy baja tasa de complicaciones. El uso de la AR en vez de la AG reduce el consumo de opioides y antiemeticos, acelera la recuperacion del paciente y reduce la estadia hospitalaria, incrementando la satisfaccion del paciente. Gracias a la implementacion de la ecografia en el procedimiento, se redescubrio las ventajas que ofrece, particularmente al visualizar en tiempo real las diferentes estructuras anatomicas, el movimiento y direccion de la aguja, la relacion de las diferentes estructuras sonoanatomicas con el nervio y por ultimo la diseminacion del anestesico local en el area de puncion. La metodologia para esta investigacion, se ha seleccionado como una revision bibliografica, ya que se ha recurrido a medios electronicos como Google Academico, PubMed, Medline, entre otros. Para ubicar diferentes trabajos de investigacion que documenten sobre el tema aqui estudiado, para realizar un trabajo que sintetice lo mejor posible, la informacion encontrada, que ayude a investigaciones futuras. En los actuales momentos tanto el ecografo como el anestesiologo son un binomio, en los procesos operatorios donde sea utilizada la tecnica de anestesia regional, ya que la ecografia le brinda al anestesiologo excelentes oportunidades para seguir expandiendo sus conocimientos y accionar. La anestesia regional guiada por ecografia, garantiza una mejor evolucion post operatoria, avalada por sus altas tasas de exitos con minimas complicaciones, que la hacen dependiendo del caso, una mejor opcion que la anestesia general, y por su baja tasa de morbilidad, reduciendo el uso de opioides y antiemeticos, acortando asi la estancia hospitalaria, que esta ligada a la reduccion de costos. EnglishRegional Anesthesia refers to a group of techniques performed at the level of the neuro-axis or peripheral nerves that causes insensitivity to pain in the body. This is done by selectively interrupting nerve transmission without altering the patient's state of consciousness. The practice of regional anesthesia offers numerous advantages over general anesthesia (GA), citing decreased morbidity and mortality, superior postoperative analgesia, an excellent cost-benefit ratio, and a very low complication rate. The use of RA instead of GA reduces the consumption of opioids and antiemetics, accelerates the recovery of the patient and reduces the hospital stay, increasing patient satisfaction. Thanks to the implementation of ultrasound in the procedure, the advantages it offers were rediscovered, particularly when visualizing in real time the different anatomical structures, the movement and direction of the needle, the relationship of the different sonoanatomic structures with the nerve and finally the spread of the local anesthetic in the puncture area. The methodology for this research has been selected as a bibliographic review, since electronic media such as Google Scholar, PubMed, Medline, among others, have been used. To locate different research works that document on the subject studied here, to carry out a work that synthesizes as best as possible, the information found, which helps future research. At the present time, both the ultrasound and the anesthesiologist are a binomial, in the operative processes where the regional anesthesia technique is used, since the ultrasound gives the anesthesiologist excellent opportunities to continue expanding their knowledge and action. Ultrasound-guided regional anesthesia guarantees a better postoperative evolution, supported by its high success rates with minimal complications, which make it a better option than general anesthesia, depending on the case, and by its low morbidity rate, reducing the use of opioids and antiemetics, thus shortening the hospital stay, which is linked to cost reduction.

Background Ultrasonography (US) is highly dependent on operators’ skills. It is not only a matter of correct scan techniques; there are anatomical structures and variants, as well as artifacts, which can produce images difficult to interpret and which, if not properly understood, can be causes of errors. Objectives This paper will review relatively common US pitfalls and artifacts that can be encountered in trauma patients and will offer tips to recognize and avoid them. Discussion Normal anatomical structures and anatomical variants can mimic fluid collections or perisplenic lesions. Examination along multiple scan planes, real-time observation of movements or repetition of the study after the patient has drunk some fluid or after placing a finger on her/his body wall can help proper identification. The term artifact in US imaging refers to display phenomena not properly representing the imaged structures. This can result in images suggesting fracture lines within organs or at their borders, lung consolidations, or pleural effusions, and abdominal fluid collections. Their knowledge is the first step to recognize them; then, use of multiple scan planes or repetition of the study after voiding or changes of equipment setting can make them disappear or clarify their nature. Conclusion We present possible anatomic pitfalls and artifacts that may affect correct interpretation of US images in patients with abdominal trauma and suggest how to avoid or to clarify them during the examination. Knowing their existence, their appearances, and the reasons why they are produced is important for proper use of this diagnostic technique.