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Purpose Monte Carlo (MC) simulations are highly desirable for dose treatment planning and evaluation in radiation oncology. This is true also in emerging nuclear medicine applications such as internal radiotherapy with radionuclides. The purpose of this study is the validation of irtGPUMCD, a GPU-based MC code for dose calculations in internal radiotherapy. Methods The female and male phantoms of the International Commission on Radiological Protection (ICRP 110) were used as benchmarking geometries for this study focused on 177Lu and including 99mTc and 131I. Dose calculations were also conducted for a real patient. For phantoms, twelve anatomical structures were considered as target/source organs. The S-values were evaluated with irtGPUMCD simulations (108 photons), with gamma branching ratios of ICRP 107 publication. The 177Lu electrons S-values were calculated for source organs only, based on local deposition of dose in irtGPUMCD. The S-value relative difference between irtGPUMCD and IDAC-DOSE were evaluated for all targets/sources considered. A DVHs comparison with GATE was conducted. An exponential track length estimator was introduced in irtGPUMCD to increase computational efficiency. Results The relative S-value differences between irtGPUMCD and IDAC-DOSE were

We mapped structural and functional characteristics of muscle‐tendon units in a population exposed to very long‐term routine overloading. Twenty‐eight military academy cadets (age = 21.00 ± 1.1 years; height = 176.1 ± 4.8 cm; mass = 73.8 ± 7.0 kg) exposed for over 24 months to repetitive overloading were profiled via ultrasonography with a senior subgroup of them (n = 11; age = 21.4 ± 1.0 years; height = 176.5 ± 4.8 cm; mass = 71.4 ± 6.6 kg) also tested while walking and marching on a treadmill. A group of eleven ethnicity‐ and age‐matched civilians (age = 21.6 ± 0.7 years; height = 176.8 ± 4.3 cm; mass = 74.6 ± 5.6 kg) was also profiled and tested. Cadets and civilians exhibited similar morphology (muscle and tendon thickness and cross‐sectional area, pennation angle, fascicle length) in 26 out of 29 sites including the Achilles tendon. However, patellar tendon thickness along the entire tendon was greater (P < .05) by a mean of 16% for the senior cadets compared with civilians. Dynamically, cadets showed significantly smaller ranges of fascicle length change and lower shortening velocity in medial gastrocnemius during walking (44.0% and 47.6%, P < .05‐.01) and marching (27.5% and 34.3%, P < .05‐.01) than civilians. Furthermore, cadets showed lower normalized soleus electrical activity during walking (22.7%, P < .05) and marching (27.0%, P < .05). Therefore, 24‐36 months of continuous overloading, primarily occurring under aerobic conditions, leads to more efficient neural and mechanical behavior in the triceps surae complex, without any major macroscopic alterations in key anatomical structures.

Minimally invasive transoral surgery (TROS) aims to reduce the trauma and complications, where transoral examination with an endoscope is a vital step. Close to the critical head-neck-brain anatomical structures, the transoral procedures can be much complicated and pose significant challenges to accurate navigation requirements. Therefore, it is laborious for navigating endoscopic instruments due to the sophisticated anatomy. In this paper, we propose to use visual Simultaneous Localization and Mapping (SLAM) for endoscope navigation in an oral cavity. We create an intra-operative 3D point cloud registered to pre-operative computed tomography (CT) with the aid of semi-dense contour to enhance visualization. Moreover, we have validated our method in the phantom experiment. The corresponding navigation and registration accuracy are presented to validate the proposed approach.

The teaching of anatomy in medical education has historically been based on lectures, cadaveric dissections, and illustrated books for students. Stereoscopic 3D videos are now easily accessible via smartphone and affordable for students. This study aimed to investigate whether a 3D stereoscopic instruction video could improve learning over 2D video. A prospective controlled study on a single-site was conducted at the University of Angers. Content knowledge was assessed, followed by the presentation of an instructional neuroanatomy video. Participants watched the video in either 3D or 2D format, then they completed an anatomy written test. Pre-video and post-video performances were analyzed with independent t tests on total score, fundamental anatomical knowledge, anatomical relationships and reasoning. 175 subjects completed the study. At baseline, the 3D (n = 91) and 2D (n = 86) groups were similar, in age and class level. 3D and 2D scores were similar in the pre-test session and in the fundamental knowledge post-test (mean 73.2% vs 74.4%, p = 0.37). Average scores for the 3D group were better for the post-test regarding anatomical relationships (mean 86.4% vs. 63.5%, p = 0.004), clinical inference/reasoning (mean 76.8% vs. 67.6%, p = 0.023) and total note (mean 76.8% vs. 67.6%, p = 0.07). Regarding the 3D student’s satisfaction questionnaire (n = 91), 70 students (77%) agreed that the stereoscopic video allowed good 3D visualization of anatomical structures. The student enjoyed using the stereoscopic video (n = 75, 82.5%). Most students supported the use of this kind of stereoscopic 3D video in their normal teaching as a complementary tool (n = 78, 85%). The incorporation of 3D videos as ancillary teaching into curricula could be of interest to improve the knowledge of anatomical relationships and reasoning among students.

Introduction. According to the recommendations of Russian and international professional associations, treatment of germinomas can be initiated without histological verification of the diagnosis, since it can be based on biochemical tumor markers. However, patients with brain germinomas usually have normal levels of these markers; therefore, histological verification is required. Stereotactic biopsy and transcranial biopsy are sometimes associated with a risk of damage to crucial anatomical structures. Currently, both biopsy and total removal of sellar and parasellar tumors can be performed via endoscopic endonasal approach. The study objective is to demonstrate the possibility of using endoscopic transsphenoidal approach for biopsy and total removal of chiasmosellar germinomas. Materials and methods. Thirteen patients with primary chiasmosellar germinomas underwent endoscopic endonasal interventions in N. N. Burdenko National Medical Research Center for Neurosurgery between 2010 and 2017. The “Germinoma-2008” protocol was used in the subsequent treatment of these patients. The male to female ratio was 2.25 : 1; mean age was 21.1 years (6–38 years).Results. The surgery volume varied between biopsy (n = 4) and partial (n = 5) or complete (n = 4) tumor removal. The diagnosis was histologically verified in all patients. None of the patients developed liquorrhea and / or meningitis in the postoperative period, which suggests that the surgery was effective and safe. Conclusion. The endoscopic endonasal approach for histological verification of the diagnosis and removal of chiasmosellar germinomas is safe and effective.

The nasal cavities are complex anatomical structures with high inter-individual variability that relates to different functions. Different anatomic variants may manifest at this site, mainly belonging to the nasal septum and turbinates. Precise knowledge of the anatomy and variants is fundamental for both radiologists and ENT surgeons. This article provides an overview of the main anatomic variants and their frequency, according to the existing literature, as well as ongoing research on nasal cavity segmentation in order to obtain personal 3D models and to predict post-surgical results.

Three-dimensional (3D) printing of anatomical structures has yielded valuable models for simulation, education, and surgical planning applications. Applications for 3D printing have continued to expand to include some ultrasound applications. The goal of this effort was to evaluate if a 3D printed model of a superficial femoral artery (SFA) would have realistic ultrasound characteristics. A computed tomography scan was 3D reconstructed and segmented using TeraRecon Aquarius Intuition software (TeraRecon, Foster City, California) to obtain an atherosclerotic SFA geometry. Both the lumen geometry and calcified plaque geometry of the SFA were exported as a stereolithographic (STL) file. The STL file was printed with An Object350 Connex 3D System using 2 different materials selected based on published elastic modulus data. VeroWhite was selected for the calcified plaque and TangoPlus Clear was selected for the artery wall. After printing, the SFA model was imaged in a water bath with a Phillips IU22 duplex ultrasound console and L12-9 ultrasound probe. Ultrasound imaging of the SFA model yielded grayscale views of artery geometry. Lumen geometry of the SFA model was similar to the actual artery geometry. Ultrasound was able to discern between the 3D print materials and visualize regions with stenosis. Suboptimal ultrasound parameters of echogenicity and wave velocity noted to differ from biological tissue. Total 3D print material cost was estimated at below $20. Although the 3D printed model did not have fully accurate ultrasound characteristics, it still provided realistic imaging. With further research, 3D printed models may offer a low-cost alternative for ultrasound phantoms.

Occipitocervical instability is a life threatening and disabling disorder caused by a myriad of pathologies. Restoring the anatomical integrity and stability of the occipitocervical junction (OCJ) is essential to achieve optimal clinical outcomes. Surgical stabilization of the OCJ is challenging and technically demanding. There is a paucity of options available for anchorage in the cephalad part of the construct in occipitocervical fixation systems due to the intricate topography of the craniocervical junction combined with the risk of injury to the surrounding anatomical structures. Surgical techniques and instrumentation for stabilizing the unstable OCJ have undergone several modifications over the years and have primarily depended on occipital squama-based fixations. At present, the occipital-plate-screw-rod construct is the most commonly adopted technique of stabilizing the OCJ. In certain distinct scenarios like posterior fossa craniectomy (absence of occipital squama for screw placement), malignancy and infection of occipital squama (poor screw purchase in the diseased occipital bone) and in revision surgery for failed occipitocervical stabilization, occipital plate-based instrumentation is not feasible. To overcome these difficulties, recently, a novel technique of occipitocervical stabilization, using the occipital condyle (OC) as the cephalad anchor, namely the direct occipital condyle screw (OCS) fixation was described. Several cadaveric and biomechanical studies have suggested that OCSs are feasible options as additional augmentative anchors in a standard occipital plate-screw-rod construct or as salvage cephalad anchors in previous failed occipital-plate-screw-rod constructs. The OCS placement technique has a steep learning curve. We have done a review of the techniques of OCS fixation and have described the indications, biomechanical and technical considerations, preoperative planning, surgical technique, complications, advantages and limitations of OCS based occipitocervical fixation.

The nature of memory and the search for its localization have been a subject of interest since Antiquity. After millennia of theoretical concepts, shifting from the heart to the brain, then from the ventricles to solid parts, the core memory-related structures finally began to be identified through modern scientifically-based methods at the diencephalic and cortical (hippocampal and neocortical) levels, mostly in the late Modern period, culminating in the current state of knowledge on the subject. RESUMO A natureza da memória e a busca de sua localização tem sido objeto de interesse desde a Antiguidade. Após milênios de conceitos teóricos, mudando do coração para o cérebro e daí dos ventrículos para as partes sólidas, as estruturas centrais relacionadas com a memória finalmente começaram a ser identificadas através de métodos modernos com base científica, nos níveis diencefálico e cortical (hipocampal e neocortical), principalmente no período Moderno tardio, aproximando-se do estado atual do conhecimento sobre o tema.

Background: Inguinal hernia repair is one of the most common daily operations in general surgery. However, the anatomical structures of the region, such as the corona mortis (the crown of death), make this procedure quite challenging. A comprehensive knowledge of its anatomy is essential, since massive hemorrhage may occur if the vessel is injured. The current review of the literature aimed to report the frequency and anatomical variations of vascular corona mortis. Methods: A substantial study was coordinated through PubMed, Scopus and Google Scholar. The Prisma guidelines were used for the systematic review of the articles found. A total of 13 studies and 1,455 patients were included for the statistical analysis. Results: The results showed that corona mortis was present in about half the hemi-pelvises, and to be more accurate, the prevalence was 46%. Venous corona mortis was more frequent than the arterial type (42% vs. 25%). Conclusions: Considering the percentages mentioned above, every surgeon who schedules an operation on the retro-pubic area, especially during a hernioplasty procedure, should evaluate the possibility of the presence of corona mortis. Anatomical knowledge of the region is vital for attempting to eliminate the risk of injuring the corona mortis during surgery. J Clin Med Res. 2020;12(2):108-114 doi: https://doi.org/10.14740/jocmr4062

The macro-metastasis/organ parenchyma interface (MMPI) was previously considered an inert anatomical border which sharply separates the affected organ parenchyma from the macro-metastatic tissue. Recently, infiltrative growth of macro-metastases from various primary tumors was described in the brain, liver and lung, with significant impact on survival. Strikingly, the MMPI patterns differed between entities, so that at least nine different patterns were described. The MMPI patterns could be further classified into three major groups: displacing, epithelial and diffuse infiltrating. Additionally, macro-metastases are a source of further tumor cell dissemination in the affected organ; and these intra-organ metastatic dissemination tracks starting from the MMPI also vary depending on the anatomical structures of the colonized organ and influence disease outcome. In spite of their relevance, MMPIs and organ-specific dissemination tracks are still largely overlooked by many clinicians, pathologists and/or researchers. In this review, we aim to address this important issue and enhance our current understanding of the different MMPI patterns and dissemination tracks in the brain, liver and lung.

Background In recent years, ultrasound (US) has become more incorporated into anesthesia and intensive care medicine. The German Anesthesia Society established a modular curriculum to teach US skills. Until now, the efficacy of this modular curriculum has not been validated. Objective The main objective of this study was to determine whether there is an increase of knowledge and of psychomotor skills for the trainees in this curriculum. Material and methods After ethical committee approval, 41 anesthesia physicians were enrolled. To determine the increase of knowledge and of practical skills theoretical and practical tests performed were evaluated before and after two different US courses. Results Comparing before and after course tests, the participants showed significant improvement in theoretical multiple choice tests (p = 0.008). Regarding psychomotor skills following course 1, the trainees improved significantly in the time needed to perform the two practical tests (p = 0.03), but not in the performance of the test. Better needle visualization during simulated US-guided vessel puncture (p = 0.52) and better identification of the anatomical structures in the axillary region (p = 0.56) could not be achieved. Conclusion This study shows that although this US course curriculum has positively enhanced the trainees’ theoretical knowledge of US practice, it does not enhance the practical application of that theoretical knowledge. To improve this curriculum, a supervised clinically practical training should follow the course.

Contains fulltext : 225410.pdf (Publisher’s version ) (Closed access) Objective: Determination of the anatomical structures that should be taught to ensure safe and competent practice among general gynaecologists. Study Design: A two-round Delphi survey, face-to-face meeting in focus groups and an individual interview. Participants were medical doctors and trainees from gynaecology, surgery, urology and radiology from academic, non-academic teaching and non-academic, non-teaching hospitals in the Netherlands. Relevant structures were collected from gynaecology surgery atlas based on most common gynaecological surgeries and diseases. These structures were supplemented and critically viewed in focus groups followed by a Delphi survey. In the Delphi survey gynaecologist and trainee's gynaecology from all over the Netherlands scored the items on a Likert scale between 1 (not relevant) and 5 (highly relevant). Consensus was defined when >= 70 % of the panellist scored the item as relevant or very relevant and the average rating was >= 4. Main outcome was clinically relevant anatomical structures. Results: Consensus on 86 clinically relevant anatomical structures divided by nine categories. Conclusions: This study identified a core list of anatomical structures that are relevant to the safe and competent practice of general gynaecologists and that can be used to guide gynaecology postgraduate education. This is the first step in a much wider and complex process of becoming a competent gynaecologist. (C) 2019 Elsevier B.V. All rights reserved.

Background Surgical fixation of syndesmotic instability using quadricortical fixation, whether screws or suture-button devices, places structures on the medial side of the tibia at iatrogenic risk. This study aims to radiographically map the anatomic course of structures on the medial aspect of the distal tibia to be able to at-risk zones (ARZs) for syndesmotic fixation. Methods Eighteen fresh-frozen cadaveric ankle specimens were dissected. The saphenous neurovascular bundle (SNVB) and the posterior tibial tendon (PTT) were identified and marked with copper wiring. Standardized and calibrated lateral radiographs of the distal tibia and fibula were analyzed using a grid system consisting of 3 columnar zones from anterior to posterior and five 1-cm rows to chart the anatomic course of the SNVB and the PTT. Results The SNVB was located in the more anterior zones (1, 2, or anterior to Zone 1) in 97.3% of specimens. The SNVB traversed from posterior to anterior as it descended proximal to distal. The PTT was found in Zone 3 (most posterior zone) for all specimens. The PTT was noted to pass behind (radiographically overlap) the tibia in 83.3% (15 of 18) of specimens between 1 and 3 cm above the tibiotalar joint. Conclusions Placement of quadricortical syndesmotic fixation places structures on the medial ankle at risk. The SNVB is at considerable risk along the anterior course of the distal tibial while the PTT is only at risk in zone 3 at the distal extent of the tibia.

Background Food digestion rate and location within the gastrointestinal (GI) tract are important for human health. Ideally, food digestion studies should be performed in vivo but this is not always technically, ethically and financially possible. Thus, various in vitro digestion systems have been developed, from static mono-compartmental to dynamic multi-compartmental models, to simulate food digestive behaviors within the GI tract. Scope and approach In this review, food digestion process along the GI tract is briefly described. The current in vitro digestion systems with regards to the human GI physiology, and their advantages versus limitations in the understanding of various food digestion processes in the upper GI tract are critically discussed. There is an emphasis on the “near real” dynamic rat (DRSD) and human (DHSI) gastric-intestinal systems, which not only mimic the peristaltic movements and biochemical conditions found in vivo, but also incorporate the gastric morphology and anatomical structures. Key findings and conclusions Although some in vitro digestion systems reported in literature can be statistically correlated with certain perspectives of food digestion processes in vivo, many physiological, anatomical and geometrical factors that play important roles in determining the digestion rate and extent have been overlooked. The DRSD and DHSI are advantageous in terms of being able to resemble the gastric morphology and anatomy in the rats and humans, respectively. It is of importance that the upper GI anatomy and morphology along with the related biochemical environments and peristaltic movements occurring in vivo should be considered in the development of more advanced and biologically relevant in vitro digestion systems.

Vagal nerve stimulation (VNS) is known as an effective method of treatment in a number of neurological disorders. The low risk of side effects also makes it useful in clinical trials in other diseases. Branches of the vagal nerve innervate the anatomical structures known to be involved in memory processing. That is why it seems justified that several studies emphasize the impact of VNS on the cognitive and memory function in both healthy volunteers and patients with epilepsy and Alzheimer’s disease. Results have shown that VNS can modulate different types of memory depending the protocol of stimulation in non-demented patients after both short term and chronic VNS application. Transcutaneous vagal nerve stimulation (tVNS), which is a non-invasive method of VNS, opens up new perspectives for different clinical applications.

Aims: To investigate dental student’s perception of the augmented reality (AR) head and neck anatomy application and to determine whether the learning environment was beneficial for students compared with traditional cadaver learning. Methods: A total of 88 students participated in a self‐administered questionnaire prior to and after the use of AR. This was conducted during anatomy classes for second year dentistry students. Descriptive data analysis was performed to determine the perceptions of experience gained through AR. Results: The study revealed that over two‐thirds of participants perceived that it would assist in their learning with 52.3% of participants who agreed and 35.2% of participants who strongly agreed. After the use of HoloHuman, it was found that 43.5% of participants agreed that the 3D anatomical structures improved their understanding of anatomy and 36.5% agreed that they felt more confident about their anatomy skills. The results also demonstrated that only 34.1% agreed that it added value in training compared to relying solely on traditional methods. Overall, 75.3% of participants agreed that HoloHuman teaching should not replace traditional cadaver training. Conclusion: This study suggested that the use of AR offers an additional mean of dental anatomy training; however, it cannot be used as a replacement for traditional modes of cadaver anatomy training. AR has the potential to be used as an adjunct tool in the learning of dental head and neck anatomy as it has demonstrated increased student engagement and enjoyment however limitations with the device still remain.

O adenoma pleomórfico (AP) é o tumor benigno mais comum dentre as neoplasias das glândulas salivares. Softwares de reconstrução tridimensional oferecem ferramentas de caracterização da lesão, permitindo avaliar a morfologia da doença, analisar estruturas anatômicas isoladas, e elevar a acurácia do tratamento. O objetivo deste artigo é demonstrar como o uso da reconstrução tridimensional tem o potencial de contribuir para a elucidação da morfologia da doença, levando os profissionais da saúde à execução de um tratamento preciso e eficaz por meio de diagnóstico e planejamentos pré- operatórios virtuais. Apresenta-se um caso de um homem de 37 anos, portador de adenoma pleomófico palatino sem queixa álgica. Não apenas a morfologia da doença foi estudada, mas o volume da lesão foi calculado, medindo 2.304 mm3. O volume da doença atuou como um marcador que possibilitou avaliar a extensão da lesão e o comprometimento das regiões adjacentes. Pleomorphic adenoma (AP) is the most common benign tumor among salivary gland neoplasms. Three-dimensional reconstruction software offers tools to characterize the lesion, allowing to evaluate the morphology of the disease, analyze isolated anatomical structures, and increase the accuracy of the treatment. The objective of this article is to demonstrate how the use of three-dimensional reconstruction has the potential to contribute to the elucidation of the morphology of the disease, leading health professionals to carry out an accurate and effective treatment through diagnosis, and preoperative virtual planning. It is presented a case of a 37-year-old man with a palatal pleomorphic adenoma without pain complaints. Not only was the disease morphology studied, but the lesion volume was calculated, measuring 2,304 mm3. The volume of the disease acted as a marker that made it possible to assess the extent of the lesion and the involvement of the adjacent regions.

The effects of cadmium on the anatomical structures of different vegetative parts, namely root, stem and leaf of chickpea, Cicer arientinum L. was studied. Four different concentrations of CdCl2 e.g. 250, 500, 750 and 1000 μM were considered as treatments alongside non treated samples (control). In case of root anatomy decrease of root diameter, root cortex area, thick walled endodermal layer and reduced number of metaxylem vessels were observed compared to control. Similarly, stem diameter, cortical area, size and number of xylem vessels were decreased in Cd treated stem. However, large and increased number of trichomes had been found in Cd treated stem samples with deposition of phenolic compounds in vessels with increasing concentration of Cd. Considerable less toxic effects were observed in leaf anatomy except decrease in leaf thickness, reduced vascular area and closure of stomata in comparison to control sample. All such plant anatomical alterations indicated adverse effects as well as tolerance of chickpea up to certain concentrations of heavy metal to cope up with the changing environment. Dhaka Univ. J. Biol. Sci. 29(1): 45-52, 2020 (January)

Evaluation of 3D Dyna-CTs to improve cochlear implantation (CI) planning and intraoperative electrically elicited stapedius reflex threshold (ESRT) measurements. A prospective observational cohort study was performed. Anonymized data collection of Dyna-CTs and CI surgeries in which a retrofacial approach was implemented to access the stapedius muscle. 3D Dyna-CTs of 30 patients and the intraoperative confirmation of the predication in 5/30 patients during CI surgery were evaluated. Inter-rater reliability was also analyzed along with the predictive value of this evaluation. 36 representative structures of the middle and inner ear and 3D renderings of the Dyna-CTs were evaluated by four otoneurological surgeons. Fleiss’ kappa values for the evaluation of the visibility were high (> 0.7) for most of the anatomical structures. The stapedius muscle was visible in 90% of the cases. Using the 3D data, the retrofacial access to the stapedius muscles was estimated as feasible in 86.7%. Fleiss’ kappa value of the evaluation of the accessibility was 0.942. The intraoperative exploration of the stapedius muscle confirmed the preoperative prediction in all five selected patients (four patients with predicted accessibility and one patient with predicted inaccessibility). The use of Dyna-CT and 3D rendering is a helpful tool for preoperative planning of cochlear implantations and ESRT measurements from the stapedius muscle via the retrofacial approach.

Patients with penetrating wounds with suspected foreign bodies retained in the wound are often seen in emergency departments. Imaging studies are necessary to rule out the presence of retained foreign bodies. Plain-film X-rays, however, are only useful when the foreign bodies contain radiopaque material (metal, glass, stone, and some plastics). In cases with strong diagnostic suspicion and negative plain films, other imaging tests are necessary. Ultrasonography has proven useful in the identification and location of both radiopaque and radiotransparent foreign bodies. Ultrasonography enables excellent assessment of adjacent anatomical structures (muscles, tendons, ligaments, and neurovascular structures) and of associated lesions. The different materials found in foreign bodies have characteristic ultrasonographic patterns that are useful for diagnosis. Finally, it is important to be familiar with the diagnostic pitfalls to avoid false positives.

Objective The aim: To analyze modern research methods that allow to determine the features of the position of the tongue during the functions of swallowing and speech. Patients and methods Materials and methods: An analysis of 37 literature sources, which contains information about the methods of examination of patients with dento-maxillar anomalies. Conclusion Conclusions: The functions of the tongue (swallowing and speaking) are very complex and coordinated movements that require the activation of many anatomical structures. Therefore, the disorders of the tongue during swallowing and speech are still considered by scientists as the most difficult in terms of correction and achieving of the long-term and stable results of orthodontic treatment. The study of modern trends in the diagnosis of the state of language functions in terms of understanding the functioning of the dental-maxillary area as a masticatory organ, the work and condition of the components of which depend on many systems of the human body, is relevant. Thus, the emergence of new and modifications of existing research methods undoubtedly expand the capabilities of modern orthodontists. However, this does not reduce the importance of the clinical stage of examination of patients with disorders of the maxillofacial area, including the functions of the tongue. Therefore, it is necessary to know and understand the advantages and disadvantages of modern and existing research technologies, which will allow to choose a communicatively integrated and differentiated approach to diagnostic issues in each clinical case.

Purpose Volumetric modulated arc therapy (VMAT) can acquire projection images during rotational irradiation, and cone-beam computed tomography (CBCT) images during VMAT delivery can be reconstructed. The poor quality of CBCT images prevents accurate recognition of organ position during the treatment. The purpose of this study was to improve the image quality of CBCT during the treatment by cycle generative adversarial network (CycleGAN). Method Twenty patients with clinically localized prostate cancer were treated with VMAT, and projection images for intra-treatment CBCT (iCBCT) were acquired. Synthesis of PCT (SynPCT) with improved image quality by CycleGAN requires only unpaired and unaligned iCBCT and planning CT (PCT) images for training. We performed visual and quantitative evaluation to compare iCBCT, SynPCT and PCT deformable image registration (DIR) to confirm the clinical usefulness. Result We demonstrated suitable CycleGAN networks and hyperparameters for SynPCT. The image quality of SynPCT improved visually and quantitatively while preserving anatomical structures of the original iCBCT. The undesirable deformation of PCT was reduced when SynPCT was used as its reference instead of iCBCT. Conclusion We have performed image synthesis with preservation of organ position by CycleGAN for iCBCT and confirmed the clinical usefulness.

AIMS To assess the staining efficacy of the innovative "Pravara" stain on ground sections of human teeth under a stereomicroscope. In this study, the ground sections were stained with the innovative stain. The stain is obtained from a leafless tree called Terminalia chebula. Terminalia chebula, commonly known as Harad, is found in South Asia from India. Few species are found in the Pravara region of Maharashtra, India. MATERIALS AND METHODS A total of 40 extracted teeth were collected and ground sections of each tooth were prepared. The samples were randomly divided into two groups: group I-control (without stain), group II-study group (the samples in this group were stained with the help of innovative "Pravara" stain). The sections were graded from I to III according to the differentiation and contrast of tissues. RESULTS The ground sections in group II stained with Pravara stain demonstrated better contrast for structures within sections under a microscope in comparison with group I (control group). CONCLUSION The study demonstrates the efficacy of a new innovative Pravara stain, which is a simple, economical, quick, and effective staining method for the ground sections of the teeth. CLINICAL SIGNIFICANCE This innovative Pravara stain is cost-effective, saves time, ecofriendly, and highlights the anatomical structures more effectively and does not fade easily with time.

It is known that multivisceral resections (MVR) are associated with significant numbers of post-operative complications. However, the effectiveness of MVR in increasing the patients' life expectancy remains a matter of debate. Are the risks of extended volume resections justified? It has been previously assumed that the removal of adjacent organs could improve the prognosis of the disease, even in the absence of direct invasion. However, in the era of the big potential of chemoand radiation therapy, the implementation of an over-extensive surgical volume in the absence of tumor invasion is doubtful. In the presence of regional lymphatic nodes metastases, MVR do not improve prognosis, compared to that after palliative resections. If the patient has distant metastases, or the operation has been obviously not radical enough, MVR worsen the prognosis. In grade T4b invasion and with the absence of life threatening complications, it is optimal to start with neoadjuvant or perioperative chemotherapy. In the case of intraoperative suspicion of adjacent anatomical structures involvement, with no distant metastases, en bloc resection in combination with D2 lymphodissection is indicated. In approximately 30–60% of cases, invasion is not confirmed by histology. The only way to improve the results of surgical treatment of gastric cancer patients is to carefully assess the extension of the disease at the preoperative stage, select patients and team work of surgeons with chemotherapists, radiologists and specialists in diagnostics.

Introduction: Since the times of our ancestors, traditional medicine has existed to cure all diseases [1]. The objective of this study was to assess the complications of traditional fracture treatment. Patients and Methods: This was a prospective study extending from January 01, 2018 to June 30, 2018, duration of six months. It concerned patients who had traditionally been treated beforehand for traumas with bone lesion in a traditional therapist and who had developed a complication, the definitive management of which was made in the department. Results: This study involved 102 patients, including 71 men (69.6%), with a sex ratio of 2.2. 33 patients or 32.4% were under 15 years old. The average of our patients’ age was 29.61 years with extremes of 2 and 89 years. Pupils/students (44 pupils and 5 students) were the most represented with 49 cases or 48.1% of the cases. The majority of patients (59.8% of cases) were educated or had a basic level. The majority of patients (36.3%) came as motif for a painful swelling. Gangrene was the most common complication with 37 cases or 36.3% of cases. Conclusion: At the end of our study, we have noticed that the traditional preliminary treatment of fractures was based mainly on trial and error. Practicing with inadequate means and measures without respecting the anatomical structures, is a real source of disabling handicaps. We have recorded 38, among the 102 patients who came for a complication of traditional treatment: that is 45.2% amputation, which is deplorable.

The new three-dimensional (3D) high-definition (HD) exoscope enables surgeons to perform a precise surgical dissection of the parotid region with a real 3D magnification of the anatomical structures, with low risk for iatrogenic lesions of the facial nerve, without delay in the surgical time. The 3D-HD exoscope is a light instrument, smaller than the operative microscope, that can be easily integrated into the surgical theater. Furthermore, it shows high potential for training and educational purposes as the surgical staff can easily follow the procedure on 3D monitors and better perceive the surgeon's fine gestures. The 3D-HD exoscope is a valid alternative to the surgical loupes and the operative microscope in the parotid surgery.

Background Surgical views with high resolution and magnification have enabled us to recognize the precise anatomical structures that can be used as landmarks during minimally invasive distal pancreatectomy (MIDP). This study aimed to validate the usefulness of anatomy-based approaches for MIDP before and during the Expert Consensus Meeting: Precision Anatomy for Minimally Invasive HBP Surgery (February 24, 2021). Methods Twenty-five international MIDP experts developed clinical questions regarding surgical anatomy and approaches for MIDP. Studies identified via a comprehensive literature search were classified using Scottish Intercollegiate Guidelines Network (SIGN) methodology. Online Delphi voting was conducted after experts had drafted the recommendations, with the goal of obtaining >75% consensus. Experts discussed the revised recommendations in front of the validation committee and an international audience of 384 attendees. Finalized recommendations were made after a second round of online Delphi voting. Results Four clinical questions were addressed, resulting in 10 recommendations. All recommendations reached at least a 75% consensus among experts. Conclusions The expert consensus on precision anatomy for MIDP has been presented as a set of recommendations based on available evidence and expert opinions. These recommendations should guide experts and trainees in performing safe MIDP and foster its appropriate dissemination worldwide.

By leveraging the recent development of artificial intelligence algorithms, several medical sectors have benefited from using automatic segmentation tools from bioimaging to segment anatomical structures. Segmentation of the musculoskeletal system is key for studying alterations in anatomical tissue and supporting medical interventions. The clinical use of such tools requires an understanding of the proper method for interpreting data and evaluating their performance. The current systematic review aims to present the common bottlenecks for musculoskeletal structures analysis (e.g., small sample size, data inhomogeneity) and the related strategies utilized by different authors. A search was performed using the PUBMED database with the following keywords: deep learning, musculoskeletal system, segmentation. A total of 140 articles published up until February 2022 were obtained and analyzed according to the PRISMA framework in terms of anatomical structures, bioimaging techniques, pre/post-processing operations, training/validation/testing subset creation, network architecture, loss functions, performance indicators and so on. Several common trends emerged from this survey; however, the different methods need to be compared and discussed based on each specific case study (anatomical region, medical imaging acquisition setting, study population, etc.). These findings can be used to guide clinicians (as end users) to better understand the potential benefits and limitations of these tools.

Since majority (80%) of ovarian cancer patients present at an advanced stage, imaging performed on these patients have numerous findings. The combination of multiple findings on imaging, complexity of anatomical structures which are involved in ovarian cancer, and the need to perceive certain subtle imaging features which would impact management often makes it challenging to systematically review images of these patients. Similarly, it is difficult to effectively communicate these findings in radiology reports. Structured reporting that is geared toward clinical decision-making has been an area of recognized need. An understanding of the review areas, which aid clinical decision-making in a multidisciplinary team setting at our institution led us to the proposed structured reporting template for ovarian cancer. Through this review, the authors would like to share this reporting template with examples.

Background Commonly used ultrasound-guided internal jugular vein (IJV) cannulation techniques, short axis out of plane and long axis in-plane, have significantly reduced complications but failed to eliminate them because of technical difficulties. Objective This article describes a new anteroposterior short axis in-plane technique that combines advantage of in-plane technique to track the needle tip and short axis view of visualizing nearby anatomical structures by placing the probe on the side of the neck, oriented anteroposteriorly, perpendicular to the long axis of neck. This view visualizes IJV and its relationship to the carotid artery in short axis. The puncture needle is passed in-plane anteroposteriorly from the anterior aspect of the neck. Visualizing the needle, carotid artery, and IJV in single frame minimizes complications. Methods A prospective evaluative clinical trial was conducted in patients who require IJV cannulation for various reasons by performers experienced in ultrasound-guided IJV cannulations. The efficacy of the technique is indicated by 3 primary outcome measures: access time, number of attempts and success rate, and safety by secondary outcome measure, which is the incidence of mechanical complications. Results Seventy-five patients were enrolled. The average number of attempts was 1.17 (standard deviation 0.44), the access time was 27.12 s (standard deviation 21.47), and the success rate was 100%. This technique had 12% incidence of posterior venous wall punctures and 2.66% misplacements and no other complications. Conclusion Anteroposterior short axis in-plane technique is relatively novel and could be alternatively used safely and effectively in place of existing techniques for IJV cannulation.

Radiotherapy is one of the cornerstones for the treatment of thoracic malignancies. The goal of radiotherapy is to deliver maximal dose to the tumor while minimizing damage to surrounding normal anatomical structures. Although advances in radiotherapy technology have considerably improved radiation delivery, potential adverse effects are still common. Post radiation changes to the chest may include different structures such as the lung, heart, great vessels, and esophagus. The purpose of this manuscript is to illustrate the post radiotherapy changes to these anatomical structures resulting from external beam radiotherapy, as well as discuss imaging pitfalls to prevent radiologist's interpretation errors.

Background Traditional anatomy teaching methods are based on the models and cadaveric dissections, providing fixed views of the anatomical structures. However, in the last few years, the emerging concept of ultrasound-based teaching in anatomy has started to gain ground among medical curricula. This study aims to evaluate the integration of ultrasound as an adjunct tool to traditional anatomy teaching methods and explore students’ perceptions of whether ultrasound-based teaching enhances their interest and knowledge of anatomy. A cross-sectional study was carried out among the students of the 6-year undergraduate entry (MD) and 4-year graduate entry (MBBS) program of the University of Nicosia. A questionnaire was distributed to them after the delivery of several twenty minutes ultrasound sessions by an expert in the field during anatomy practicals. The data were analyzed utilizing SPSS software, and the statistical significance was determined as p value Results 107 MD and 42 MBBS students completed the questionnaire. Both groups agreed that their ultrasound-based learning experience was good or excellent (79.4% MD students; 92.9% MBBS students), that it enhanced their knowledge of anatomy (68.2% MD students; 90.5% MBBS students) and boosted their confidence regarding their examination skills practice (69.2% MD students; 85.7% MBBS students). Although most students desired more time allocated to the ultrasound station (72% MD students; 85.7% MBBS students), they believed that ultrasound-based teaching is a necessary adjunct to the traditional teaching methods of anatomy (89.7% MD students; 92.9% MBBS students). Conclusions Overall, MBBS students were more confident about the benefits of ultrasound-based teaching. Most of the students agreed that cross-sectional sessions of traditional teaching and ultrasound-based teaching strengthened their knowledge of anatomy and enhanced their confidence concerning their clinical examination skills. Medical schools should embrace the advantages that ultrasound-based teaching offers in order future doctors to be qualified to utilize ultrasound for procedural and diagnostical purposes.

Galls are remarkable parasite&ndash, plant interactions that develop in different organs. They are induced by various organisms which manipulate or reprogram plant development. Galls in dioecious species and their effects on the host plant are seldom described in the literature. This paper presents a novel study of galls in a dioecious plant of the neotropical region. Our study aimed to analyze gall development and describe morphological and metabolic changes in galled leaves caused by Cecidomyiidae (Diptera) in Clusia fluminensis (Clusiaceae), a dioecious plant from Brazilian restinga. We investigated male and female individuals to detect different responses and sex-biased interactions. The non-galled leaves of female and male individuals of C. fluminensis exhibited similar anatomical structures. Nevertheless, galls developed only in male individuals. The activity of the Cecidomyiidae led to several morphological and anatomical changes, such as the hypertrophy of the leaf blade, especially the chlorenchyma. Our results indicated an interesting exception for the pattern of storage of lipids and starch in Cecidomyiidae galls, and sex-biased development in a dioecious plant, with the variation of metabolic compounds, especially phenolics and flavonoids, which may inhibit gall development in female individuals.

In this article, we present a skull database containing 500 healthy skulls segmented from high-resolution head computed-tomography (CT) scans and 29 defective skulls segmented from craniotomy head CTs. Each healthy skull contains the complete anatomical structures of human skulls, including the cranial bones, facial bones and other subtle structures. For each craniotomy skull, a part of the cranial bone is missing, leaving a defect on the skull. The defects have various sizes, shapes and positions, depending on the specific pathological conditions of each patient. Along with each craniotomy skull, a cranial implant, which is designed manually by an expert and can fit with the defect, is provided. Considering the large volume of the healthy skull collection, the dataset can be used to study the geometry/shape variabilities of human skulls and create a robust statistical model of the shape of human skulls, which can be used for various tasks such as cranial implant design. The craniotomy collection can serve as an evaluation set for automatic cranial implant design algorithms.

BackgroundThe resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology.Material and MethodFour maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: 2 mm from the carotid and within the tumor or 2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared.Results3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001).ConclusionsThis preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step.

Patellar and Achilles tendinopathy commonly affect runners. Developing algorithms to predict cumulative force in these structures may help prevent these injuries. Importantly, such algorithms should be fueled with data that are easily accessible while completing a running session outside a biomechanical laboratory. Therefore, the main objective of this study was to investigate whether algorithms can be developed for predicting patellar and Achilles tendon force and impulse during running using measures that can be easily collected by runners using commercially available devices. A secondary objective was to evaluate the predictive performance of the algorithms against the commonly used running distance. Trials of 24 recreational runners were collected with an Xsens suit and a Garmin Forerunner 735XT at three different intended running speeds. Data were analyzed using a mixed-effects multiple regression model, which was used to model the association between the estimated forces in anatomical structures and the training load variables during the fixed running speeds. This provides twelve algorithms for predicting patellar or Achilles tendon peak force and impulse per stride. The algorithms developed in the current study were always superior to the running distance algorithm.

Background Translational research refers to scientific findings that have been extensively studied in models and find their way to clinical studies. In a certain sense in translational anatomy a similar application of conventional anatomical knowledge finds its way to clinics in the surgical theatre. With the propagation of endoscopic middle ear surgery there has been a renewed interest in many early anatomical terms, even many years after their discovery, which may threaten the correct and classic eponyms. Moreover, the application of robotic ear surgery executing minimal invasive keyhole accesses requires translation of anatomical knowledge to the sub-millimetric level. Purpose This review reports relevant anatomy of the temporal bone for robotic cochlear implantation reflecting also on recent revisions of terminology. Results In 2019, the Terminologia Neuroanatomica (TNA 2017) was accepted at the 19th World Congress of the International Federation of Associations of Anatomists (IFAA) in London as its official terminology for the central and peripheral nervous system and the sense organs. This review follows the terminology of in the TNA, but also compares anatomical and clinical terms to bridge the gap between both approaches, and provides brief descriptions and illustrations of relevant structures for robotic cochlear implantation and elaborates on their significance. With the emergence and more widespread use of the endoscopic ear surgery and image guided ear surgery, visualization of certain anatomical structures has improved. Coinciding, there has been a renewed interest in many early anatomical terms, even many years after their discovery, which may threaten the correct and classic eponyms. Conclusions Consequently, this review also presents an overview of eponyms associated with specific structures over the years. In Supplementary Tables, the changes in terminology are reported.

1.AbstractThis paper reviews efforts across 16 international consortia to construct human anatomical structures, cell types, and biomarkers (ASCT+B) tables and three-dimensional reference organs in support of a Human Reference Atlas. We detail the ontological descriptions and spatial three-dimensional anatomical representations together with user interfaces that support the registration and exploration of human tissue data. Four use cases are presented to demonstrate the utility of ASCT+B tables for advancing biomedical research and improving health.

INTRODUCTION: Monopolar electrocautery is the most common dissection and coagulation tool during transoral robotic surgery (TORS) but causes significant collateral tissue damage as opposed to CO2 laser. We aimed at combining both modalities in one robotic instrument arm. METHODS: We developed a steerable CO2 -laser fibre carrier serving as an add-on to the existing Endowrist® monopolar spatula of the Da Vinci Xi. Feasibility and safety were assessed in a preclinical setting. RESULTS: One radical tonsillectomy with monopolar cautery and three with the instrument prototype were performed in two cadavers by two surgeons. No serious prototype-related intra-operative difficulties were observed. Safe and efficient switching between energy sources proved possible in all simulated intra-operative bleeding events. Prototype use allowed for the identification of the majority of key anatomical structures and was scored favourably on NASA-TLX questionnaires. DISCUSSION: The reported prototype successfully combines the advantages of CO2 -laser with the advantages of TORS. ispartof: INTERNATIONAL JOURNAL OF MEDICAL ROBOTICS AND COMPUTER ASSISTED SURGERY vol:18 issue:1 ispartof: location:England status: published

BACKGROUND Lateral pterygoid muscle activity is associated with the pathological mechanisms of some temporomandibular disorders. The authors aimed to define and demonstrate a novel, practical, and safe technique for botulinum toxin type A injection to the lateral pterygoid muscle based on their findings. Their secondary aims were to standardize the injection pattern according to the variations of the lateral pterygoid muscle and its surrounding anatomical structures, and to establish its advantages over intraoral injection. METHODS Twenty cadaver heads were dissected. The lateral pterygoid muscle and its surrounding structures were investigated for anatomical variations. Based on these findings, a standardized extraoral injection protocol was defined and compared with the intraoral technique for accuracy and safety. RESULTS The average depth of the lateral pterygoid plate from the skin surface was 49.9 ± 2.2 mm, and the mean width of the lateral pterygoid plate was 10.5 ± 3.9 mm. The extraoral injection approach based on the location of the maxillary tuberosity, tragus, and lateral pterygoid plate was consistent in all dissections for the accuracy of the intramuscular injection. In the intraoral approach, standardization of the entry point of the needle through the oral mucosa is difficult, which makes adjustment of the depth of the injection challenging while increasing the risk of neurovascular injury. CONCLUSIONS The clinical significance of the lateral pterygoid muscle makes it worthwhile to implement minimally invasive treatments before considering more invasive options. The authors define a safe, accurate, and reliable approach with ease of administration in patients with temporomandibular disorders.

Distal radioulnar joint (DRUJ) arthroscopy is an advanced technique, and specialized portals are necessary for diagnostic and therapeutic procedures. The DRUJ can be conceptualized as a “Box” and can be accessed using two dorsal portals (proximal and distal), one ulnar portal (direct foveal) and two volar portals (volar and distal volar). A thorough knowledge of regional anatomical structures is necessary for safe portal placement. This chapter presents an overview of DRUJ portals and their surgical and arthroscopic anatomical aspects.

The elbow joint is a complex structure that provides important functions and forms the mechanical link in the upper extremity between the hand, the wrist and the shoulder. Its primary functions include the positioning of the hand in space, and loss of this can cause significant impairment in carrying out daily-life activities. The elbow joint is crossed by various nerve structures which may be put at risk during both arthroscopic and open surgery. This chapter describes the relevant surgical anatomy of the nerves around the elbow; the relationship of these nerves to elbow arthroscopy portals and anatomical structures that may cause nerve compression is presented.

The elbow is a complex anatomical region formed by a multilayered soft-tissue sleeve of muscles, ligaments, and neurovascular structures. The anatomical locations of these structures are unpredictable due to paucity of anatomical landmarks and frequent variations; to add to this variability, dynamic movement at the joint further changes the surface markings for most structures. The layered approach to elbow anatomy is useful during minimally invasive open, endoscopic assisted, and all-endoscopic procedures around the elbow. Each layer is formed by specific muscles and/or ligaments, and neurovascular structures course through or in between these layers from proximal to distal. The distal biceps tendon traverses the layers from superficial to deep planes, and even extends to the posterior aspect in full pronation. The “parabiceps space” is therefore a useful and safe passage across anatomic planes in the lower arm and cubital fossa for elbow endoscopy. Consistent anatomic landmarks across the four layers are useful intraoperative indicators of neurovascular structures in each layer. Lastly, the major nerves are at risk of entrapment during their course, and anatomical structures that predispose to compression must be evaluated and released during surgery.

In children and adolescents presenting with skull base sarcoma, treatment strategies will face challenging decisions due to the unique chemoresistant pathologies, limitations imposed by the not‐yet fully mature anatomical structures, and the small surgical site.

International audience; Medical image segmentation remains particularly challenging for complex and low-contrast anatomical structures. In this paper, we introduce the U-Transformer network, which combines a U-shaped architecture for image segmentation with self-and cross-attention from Transformers. U-Transformer overcomes the inability of U-Nets to model long-range contextual interactions and spatial dependencies, which are arguably crucial for accurate segmentation in challenging contexts. To this end, attention mechanisms are incorporated at two main levels: a self-attention module leverages global interactions between encoder features, while cross-attention in the skip connections allows a fine spatial recovery in the U-Net decoder by filtering out non-semantic features. Experiments on two abdominal CT-image datasets show the large performance gain brought out by U-Transformer compared to U-Net and local Attention U-Nets. We also highlight the importance of using both self-and cross-attention, and the nice interpretability features brought out by U-Transformer.