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Understanding of anatomy is based on the study of anatomical variations. Morphometric variations can have important implications in surgical practice. The sizes of some anatomical structures are affected by age; however, cadavers used in anatomical research are usually of advanced age. The main aim of this study is to quantify the mean age of samples in cadaveric studies reporting morphometric values. PubMed was searched for the last 3 years to locate cadaveric studies reporting size values, excluding histological, forensic, and osteological collections. Out of the 390 potentially relevant papers, 109 (28%) studies did not report the ages of their samples. In total, 177 studies were included for analysis comprising 4,807 subjects. The most studied structures were those of the musculoskeletal system. The mean age of the pooled sample was 71.1 ± 11.0 years. The lowest reported age was 16 while the highest was 104 years. Univariate and multivariate analyses showed no correlation with any of the following variables: country of study, anatomical region, anatomical structure, or journal type. The mean age of cadavers used to measure the sizes of human anatomical structures falls largely within the senior age category. The reported values in an aging population will not necessarily mirror other populations such as the pediatric. The outcomes of surgeries that depend to some extent on tight morphometric values such as flap surgeries, microsurgery, tendon transfer, or mini-invasive procedures could differ when they are performed on other age categories. More anatomical research is needed for better reporting of age-related morphometric changes. Clin. Anat., 33:804-808, 2020. © 2019 Wiley Periodicals, Inc.

Dyspnoea is a common emergency in birds presented to veterinary practitioners. There are a number of aetiologies and various anatomical structures that may be involved. A large proportion of these birds will be significantly compromised, thus appropriate and timely emergency management is essential. This article discusses the approach to diagnosis, decision making and emergency medical and surgical treatment in the dyspnoeic bird.

The “Barbed Snore Surgery” is one of the last technical innovations in palatal surgery for Obstructive Sleep Apnea. The availability of a low-cost surgical model able to replicate tissue consistency and main anatomical structures could be fundamental for the spreading of this surgery. The aim of this study was to assess the feasibility of an ex-vivo ovine model in the surgical training of BSS. After adequate preparation of adult lamb heads, a post-graduate student with no surgical expertise was guided by a skilled surgeon in the execution of two BSS procedures: “Barbed Roman Blinds Technique” and “Barbed Anterior Pharyngoplasty”. Anatomical limitations and similarity with the human tissue were assessed and recorded during the simulation. All the procedures were successfully completed. Despite proportional differences, the palatal tissue was assessed as similar in consistency and thickness to the human tissue. The simulation was considered satisfactory and suitable for surgical training. This ex-vivo ovine surgical model could represent the right tool for BSS training thanks to readily available and inexpensive specimens. Moreover, it appears to present the realistic anatomy and tissue consistence essential for an adequate surgical simulation.

Introduction. Professional polyneuropathy of the upper extremities is an example of the most common pathology due to physical overload and functional overstrain of the muscles of the upper extremities.The aim of the study was to study the ultrasound quantitative parameters of the anatomical structures of the arteries in normal and professional polyneuropathy.Materials and methods. Patients with polyneuropathy from physical overloads and functional overvoltage in hospital were examined by ultrasound in B-mode. The results of ultrasonic assessment of the morphological state of the main arteries of the forearm in professional polyneuropathy from physical overload and functional overvoltage are presented. The criteria for the selection of patients in the study were: the presence of severe clinical manifestations of polyneuropathy, confirmed by instrumental methods of the study, the data of sanitary and hygienic characteristics of working conditions, indicating contact with physical overload in the workplace, the absence of chronic diseases of the cardiovascular system (coronary heart disease, rheumatic, oncological, infectious diseases, heart defects, arrhythmias and conduction).Results. The study of ultrasound morphological features of the arteries of the upper extremities in professional polyneuropathy showed an increase in the intima-media complex, compaction of the structure of the vascular wall equally in the radial and ulnar arteries. The revealed changes were determined with the same frequency in men and women. The study of the right and left hands showed the presence of more pronounced changes on the side of the «working hand».Conclusions. Today the method of ultrasound examination of the main arteries of the middle caliber of the upper extremities is the only available and objective method of studying the morphological changes of the vascular system in professional polyneuropathy from functional overvoltage and physical overload. In comparison with the control group in patients with polyneuropathy, a significant decrease in the diameter of the vessels was determined on the limb, which has a predominant load. Ultrasonic changes are detected at the initial stages of professional polyneuropathy of the upper extremities.

The complex of macromicroscopic methods has revealed the features of the sulci structure of the brain’s occipital lobe medial surface. Macromicroscopic, morphometric, topographic and anatomical, statistical and mathematical analysis were used. The sulci of the medial surface of the brain's occipital lobe are classified into permanent, typical and non-permanent. The complex of anatomical structures of the medial surface of the brain's occipital lobe includes the parietooccipital sulcus, calcarine sulcus, cuneus, calcarine spur, additional sulci. The parietooccipital and calcarine sulci are divided into segments: posterior (distal process), anterior (proximal process), common (common area). The parietooccipital sulcus is connected to the anterior end of the calcarine sulcus at 98,5 %. The length of the parietooccipital sulcus is min 16,0 mm and max 58 mm, M=35,8 mm, depth is min 9,0 mm and max 43,0 mm, M=24,3 mm. It was found that in 35 % of cases, the posterior end of the calcarine sulcus does not reach the apex (angle) of the occipital lobe of the brain by min 2,0 mm and max 14,0 mm, M=7,8 mm. In 43 % the posterior end of the calcarine sulcus bifurcates. The distance between the posterior end of the calcarine sulcus and the upper end of the parietooccipital sulcus is min 18,0 mm and max 64,0 mm, M=39,8 mm. The length of the calcarine sulcus is min 37 mm and max 79 mm, M=54 mm. The depth of the anterior part of the calcarine sulcus is min 8,0 mm and max 36,0 mm, M=20,7 mm; the depth of the posterior part is min 5,0 mm and max 22,0 mm, M=12,8 mm.

Recent literature agrees that neurodegenerative processes involve both the retina and the central nervous system, which are two strictly related anatomical structures. However, the causal mechanisms of this dual involvement are still uncertain. To date, anterograde transsynaptic neurodegeneration, triggered by retinal ganglion cells’ death, and retrograde transsynaptic neurodegeneration, induced by neurodegenerative processes of the central nervous system, has been considered the major possible causal mechanisms. The development of novel neuroimaging techniques has recently supported both the study of the central stations of the visual pathway as well as the study of the retina which is possibly an open window to the central nervous system.

Primary retroperitoneal cyst formation without connection to adjacent anatomical structures is a rare and benign entity with the majority of these cysts being discovered incidentally. If symptoms develop, they are generally non-specific and related to compression of the adjacent retro-/or intraperitoneal structures. Complete resection of the cyst is curative and therefore the preferred treatment option. We report a case of giant retroperitoneal cyst for which a total surgical removal was performed.A 79-year-old female consulted our department with complaints of long lasting abdominal pain and progressive abdominal distension. CT abdomen revealed a giant retroperitoneal cyst (35 cm × 25 cm × 21 cm) without radiological features of malignancy but with severe mass effect on the surrounding intra-abdominal structures. A median laparotomy was performed with a complete excision of cyst. No signs of malignancy or atypia were observed on histological examination.Idiopathic retroperitoneal cysts can slowly grow to giant proportions and subsequently lead to chronic vague abdominal symptoms. Complete surgical excision is curative and should be pursued.

WOS: 000486066500001, Central venous catheterization of children is often a challenging procedure due to small anatomical structures. Ultrasound guidance has been shown to reduce complications and improve cannulation success as compared with the landmark-based technique. In-plane techniques allow for longitudinal visualization of the vessels and real-time visualization of needle track during its advancement. When in-plane and syringe-free techniques are combined, advancement of the guidewire can also be visualized. We aim to introduce our supraclavicular approach for brachiocephalic vein cannulation in pediatric patients. A syringe-free and in-plane technique is used to cannulate the patients. The subclavian, jugular, and the brachiocephalic veins were visualized by endocavity micro-convex ultrasound probe as a Y shape during the cannulation procedure. We present a case series of successful cannulation by using this technique.

This work discusses the development of an augmented reality (AR) interface that allows users to manipulate 3D anatomical structures (segmented and reconstructed from real medical studies) through haptic interactions by means of a five-degrees-of-freedom hand-exoskeleton. The exoskeleton allows the hand to move throughout its nominal range of motion. Our interface allows users to manipulate virtual objects more naturally thanks to its three points of contact, unlike most commercial haptic systems, which only have one point of contact. The preliminary results indicated a proper 3D segmentation and reconstruction of the anatomical structures of interest, as well as an adequate interaction between the haptic exoskeleton and the AR interface.

Objective: Neck dissections are surgical interventions where lymph nodes from specific areas of the neck, together with non-lymphatic structures – sternocleidomastoid muscle, internal jugular vein and accessory nerve are removed. Important anatomical structures could be damaged during the surgery, causing postoperative complications associated with impaired function of the musculoskeletal system of the shoulder. The aim of the present study is to determine the degree of impairment in shoulder movements (motor function), depending on the volume of surgery in neck dissection. Methods:Constant Shoulder Score (CSS) was used to evaluate the motor function of the operated patients. The results obtained were analyzed by SPSS Vers23.0. Results:A statistically significant difference was found F (2,65) = 167,733, p

This study aimed to investigate the anatomical structure and fiber quality of four lesser-used wood species namely Benuang (O. sumatrana), Duabanga (D. moluccana), Pisang Merah (H. hellwigii), and Terap (A. odoratissimus). This study evaluated its suitability for raw material in pulp and paper manufacturing. The anatomical structure was observed macro- and microscopically. Macroscopic structures were observed directly to the wood samples, while microscopic characteristics were observed through microtome specimens. Fiber dimension was measured through macerated specimens and fiber quality was analyzed following the Rachman and Siagian’s method. Results showed that these four timber species have similarity in the indistinct growth ring, diffuse porous in a radial pattern, rounded solitary vessel outline, 1 to 3 cells of ray width, deposits within the rays, fiber length, and cell wall thickness. Differences were found on vessel diameter, vessel grouping, vessel frequency, tyloses existence, type of axial parenchyma, and ray height. Based on fiber length and its derived values, the wood fibers of all species studied are suitable for pulp and paper manufacturing. They belong to the II quality class. The produced pulp and paper would have good quality, especially in tensile, folding, and tear strength. To promote their utilization, silviculture aspect of these four species has to be well understood.

Background Posterior fossa tumors are rare in adults and pose a challenge to treat due to the bony contour of the posterior fossa, complex anatomical structures including deep venous sinuses, and the proximity of the fourth ventricle and brain stem. We describe our experience with laser interstitial thermal therapy (LITT) for the management of brain metastases and radiation necrosis of the posterior fossa. Methods We retrospectively analyzed 13 patients with metastases and radiation necrosis of the posterior fossa managed with LITT. Results Thirteen patients with histopathologically confirmed radiation necrosis (n = 5) and metastases (n = 8) of the posterior fossa underwent LITT. The median preoperative tumor was 4.66 cm3, and median postoperative ablation cavity volume was 6.29 cm3. The median volume of the ablation cavity was decreased to 2.90 cm3 at a 9-month follow-up. The median volume of peritumoral edema was 12.25 cm3, which fell to a median of 5.77 cm3 at 1-month follow-up. The median progression-free survival was 7 months (range, 3–14 months) and the mean overall survival was 40 months (range, 2–49 months) after LITT. There were no intraoperative complications. One patient experienced palsy of the seventh and eighth cranial nerves on follow-up, attributable to LITT. Conclusions Lesions of the posterior fossa are challenging to treat given their proximity to the dura and venous sinuses. Our findings demonstrate that LITT ablation may be a safe and feasible option for metastases and radiation necrosis of the posterior fossa. Larger studies are needed to confirm the efficacy of this approach.

In the present study, morphological and anatomical structures of cypsela – 12 Cirsium Miller (Carduoideae, Asteraceae) taxa belonging to two sections (sect. Cirsium and sect. Cephalonoplos) were investigated in detail with using stereomicroscope and light microscope. The taxa were evaluated comparatively in the aspect of carpological variations and their anatomies were presented in here for the first time. Morphological features including size, shape and colour of cypselae were examined. From anatomical observations, anatomical structures of pericarp, as well as the structure of testa were described. Cypselae colours differ from light brown to stramineous, sometimes with blackish striations. Their shapes change from oblong to oblanceolate, rarely obovate. The largest cypselae are present in C. echinus (1.59±0.03 mm × 4.68±0.07 mm) and the smallest ones are found in C. subinerme (1.20±0.02 mm × 2.97±0.05 mm). The pericarp is characterised by almost parenchymatous cells, while the testa is composed of lignified sclerenchymatous cell lines and crushed cells group. Secretory structure in testa bundle was evaluated. Results obtained from this study were compared with the present data in literature. Overall, morphological and anatomical characteristics of cypselae provide useful taxonomic markers in their classifications of the studied taxa of Cirsium but not distinctive for their sectional levels.

Efforts to prevent iatrogenic neurovascular injuries with humeral intramedullary nailing lead to design new implants and inside to out distal locking technique using an endopin aims to provide a safer screw application. InSafeLock (TST, Istanbul, Turkey) humeral nail have been recently developed to minimize the possible screw related complications. The anatomical relationship between locking screws and neurovascular structures with the application time were compared between Trigen Humeral Nail (Smith and Nephew, Memphis, USA) and InSafeLock Humeral Nail.InSafeLock humeral nail would be safer than Trigen Humeral nail in terms of neurovascular injury.Seven cadavers were used with both shoulders and surgical application of two nails was performed as the manufacturer guide. An Insafelock humeral nail was used for each right humerus and a Trigen humeral nail was used for each left humerus. Once the nails were placed, proximal and distal region of the nails were dissected to evaluate the relationship between screws and adjacent anatomical structures. The duration of the each screw was assessed via a stopwatch.No significant finding was noted for the relationship between the neurovascular structures and proximal screws in two groups (p0.05). The distal locking of the InSafeLock humerus nail had a shorter application time and no neurovascular damage was recorded.The newly developed Insafelock humerus nails are at least as safe and effective as current humeral nails available on the market. Additional benefits include the preservation of neurovascular structures, as the Insafelock humerus nail does not require the use of an extra incision. Furthermore, surgical time is significantly shorter with using distal endopin.III, controlled laboratory study.

Situs inversus is a condition in which the anatomical viscera are placed in a reverse anatomical location, it may be partial affecting the thoracic organs or the abdominal organs, or total affecting both. A 28-year-old man who was a known case of situs inversus totalis presented with epigastric pain and left hypochondrial pain. ultrasound revealed multiple gall stones in a left-sided gall bladder, laparoscopic cholecystectomy was done successfully for him with no complications. Patient position during surgery and the sites of the laparoscopic ports greatly affect the performance during surgery. Identification of the anatomical structures which are arranged in a mirror image pattern is the key for successful surgery. The critical view of safety should be identified before any structure is clipped or divided. A right-handed surgeon will feel more impairment during surgery for a left-sided gall bladder, while a left-handed surgeon will do it with better comfort. Surgeries for such cases are better to be performed by a surgeon with massive experience in laparoscopy or by a hepatobiliary surgeon, it may not be suitable for surgeons in training. MRCP will show the biliary anatomy prior to surgery and CT-scan with dual phase contrast will help to show any associated vascular abnormalities., Highlights • Gall bladder stones are commonly diagnosed and many patients need surgical intervention. • Situs inversus patients have a mirror image anatomy. • A left-handed surgeon can perform laparoscopic cholecystectomy with more comfort than a right-handed one.

Each organ plant has been formed perfectly to support physiological processes in an unfavorable environmental condition. Rice (Oryza sativa L.) be included plants sensitive to drought conditions during a stage of growth and development. This will cause pressure (stress) resulting in a decrease in rate metabolism in leaf cells. Leaf anatomical characteristics are criteria that can be used to identify plants that are tolerant to drought. Anatomical response leaves in drought conditions inform the development of leaf photosynthetic parts carrying out changes in anatomical structure morphology includes changes in cell walls, organ size, changes in direction growth, including dropping leaves and enhancing the life cycle. The research aimed to determine the anatomic response leaves rice varieties (Oryza sativa L.) to drought stress. Five rice varieties used were given drought-stress treatment for 12 days. Identification leaf anatomical structures using microscopic slices of transverse was made according to the paraffin method. Changes in the anatomical structure of leaves of drought-stress have decreased bulliform cells increase in size, the thickness epidermis cells in an effort to retain the water content in cells, and reducing the size and total stomata with purpose process control flow of transpiration and water use efficiency.

Implant installation for replacing missing teeth is a frequent treatment procedure with high long-term survival and success rates. However, the success of implant therapy may be jeopardized by several complications related to mistakes in treatment planning, surgical procedure, management of hard and soft tissues, and infections. Increasing evidence suggests that the stability of the soft tissues surrounding osseointegrated dental implants may substantially influence long-term clinical stability and esthetics. Therefore, when implant therapy is planned, the clinician must not only be able to perform the appropriate steps to maintain/create a stable soft tissue, but also needs to be aware of the potential sources for complications and possess the adequate knowledge for their appropriate management. The present paper provides an overview of the most important aspects related to the prevention and management of soft tissue-related complications in conjunction with implant therapy. The current literature indicates that the presence of an adequate width of keratinized attached mucosa around dental implants may lead to better soft and hard tissue stability, less plaque accumulation, limited soft tissue recession, and lower incidence of peri-implant mucositis. Proper implant positioning by carefully considering appropriate mesio-distal and bucco-lingual dimensions and implant angulation may prevent the loss of interdental soft tissues and development of soft tissue recessions. To optimize the width of keratinized attached mucosa, the appropriate soft tissue augmentation protocol should be selected for each particular indication. When the use of autogenous soft tissue grafts is planned, a thorough knowledge of the anatomical structures is mandatory in order to harvest soft tissue grafts of an appropriate quality and quantity and to avoid/minimize postoperative complications. Finally, the clinician needs to master the necessary steps in order to manage complications related to extensive bleeding and tissue necrosis that may occur in conjunction with soft tissue augmentation procedures.

Ulnar-sided wrist pain is a complex entity to diagnose clinically and frequently requires imaging to help confirm or determine the diagnosis. This article reviews the imaging and the logical imaging pathway of the common causes of ulnar-sided wrist pain, and illustrates various pathologies. It also discusses appropriate imaging modalities for various conditions. The causes of ulnar-sided wrist pain are stratified according to the affected anatomical structures, such as bony, soft tissue or neurovascular aetiologies. This review provides a handy imaging framework for non-radiologist clinicians of the common conditions producing ulnar-sided wrist pain. A linked article ( 10.12968/hmed.2019.80.8.456 ) detailing the diagnosis of ulnar-sided wrist pain is included in this issue.

Cone Beam Computerized Tomography (CBCT) is an imaging technology increasingly used in dentistry. Depending on the size of the examination area, visualization of anatomical structures outside the indication area may reveal incidental findings (IF). The aims of this systematic review and meta-analysis were to 1) evaluate the frequency, location and different types of incidental findings (IF) revealed during CBCT examinations; 2) identify potential influencing factors such as gender or age; 3) highlight what the family doctor should know about CBCT and the benefits for medical care. 70 retrospective studies were included. 60% of IF are in the naso-oropharyngeal airway and paranasal sinuses. Carotid calcifications were observed with a mean prevalence of 9% CI95% [2-21]). Meta-regression showed a significant association of this prevalence with age, irrespective of gender. Given the high frequency of IF, with varying severity, the whole medical community is fully involved, and its opinion should be sought to ensure the best possible management for the patients. Physicians may also require CBCT examinations that would have been previously prescribed by a dentist, that may serve to better orientate investigations toward another imaging technique. The family doctor is therefore the dentist’s main interlocutor and the main coordinator of the follow-up of IF.

Background: Magnetic resonance imaging (MRI) provides excellent information about pelvic anatomy after ventral rectopexy, but the position of the conventional mesh is not seen constantly. Iron oxide-impregnated polyvinylidene fluoride (PVDF) meshes are proven to have MRI visibility in hernia or vaginal reconstructive surgery. This prospective pilot study was designed to assess the visualization, position, and shape of the magnetic resonance (MR)–visible synthetic pelvic mesh used in minimally invasive ventral rectopexy. Methods: Eight patients with pelvic organ prolapse were recruited for laparoscopic (LVMR) or robotic-assisted ventral mesh rectopexy (RVMR) with a synthetic MR–visible PVDF mesh. A follow-up visit was scheduled at 3 months after surgery. MR imaging was performed to evaluate the position and dimensions of the mesh and anatomical result. The visibility of the mesh in each sequence was assessed subjectively. Results: The visibility of the mesh was best on T1-weighted flash images. The mesh was also well visualized on T2-weighted sagittal images. T2-weighted images, in general, provided best visualization of the surrounding anatomical structures and enabled assessment of the mesh fixation. Conclusions: T2 sagittal and T1-weighted flash images provide the best information about the position and integrity of the iron oxide-impregnated PVDF mesh after LVMR or RVMR with a short examination time.

Introdução: O meningioma é o tumor mais frequente do sistema nervoso central sendo que atualmente o tratamento de escolha é aressecção cirúrgica total. Entretanto, para os meningiomas de base de crânio o risco cirúrgico é alto. Dessa forma, tem-se descrito aradiocirurgia como uma alternativa, embora suas indicações e resultados cirúrgicos ainda sejam controversos. Objetivo: Esse estudoprocura fornecer dados sobre a eficácia da radiocirurgia frente às abordagens cirúrgicas no tratamento dos meningiomas. Materiaise Métodos: Foi realizado um levantamento bibliográfico entre os anos 2000 e 2019 sobre abordagens cirúrgicas e radiocirúrgicas parameningiomas de base de crânio. Resultados: Foram estudados para a microcirurgia 444 pacientes. A ressecção total com margem foialcançada em 65,09% (n=289), complicações cirúrgicas de 27,03% (n=120), melhora dos sintomas em 96,62% e follow-up de 13 a128 meses. Para a radiocirurgia foram estudados 2.896 pacientes. A taxa de controle tumoral foi de 84,53% (n=2.448), a estabilizaçãoclínica ou melhora foi de 71,20% (n=2.062), déficits de pares cranianos pós-cirúrgico de 9,84% (n=285), a taxa de toxicidade foide 13,74% (n=398) e follow-up de 19 até 121 meses. Conclusão: A indicação da radiocirurgia para meningiomas de baixo graué individual a cada caso, sendo a topografia do tumor e as estruturas anatômicas adjacentes o principal determinante da escolhaterapêutica.

Objectives Testing whether the site-specific anatomical defect(s) can occur within the urethral stabilizing mechanism; determining the anatomical structure compositions of the urethral stabilizing mechanism. Study design In an international setting, fifteen human fresh female cadavers subjected to urogenital tract stratum-by-stratum macro- and micro-dissection and a case series study type utilized in this scientific research. The primary outcome measured occurrences of anatomical site-specific defects within the urethral stabilizing mechanism and the secondary outcome measured the anatomical structures of the urethral stabilizing mechanism. Results Site-specific defects occurred within the urethral stabilizing mechanism in four out of fifteen subjects (26.6%); defects most commonly identified within suburethral-paraurethral-periurethral areas. The ventral perineal membrane and distal condensations of the arcus tendineus levatoris ani defects were also present. The urethral stabilizing mechanism consists of multiple anatomical structures located in different anatomical regions. Conclusions Site-specific defects occur within the urethral stabilizing mechanism in women. The urethral stabilizing mechanism consists of multiple anatomical structures located in different anatomical regions, and they fuse with the urethral wall.

Background There is a change in the position of the remaining anatomical structures of the lower urinary tract system following radical prostatectomy. The aims of this investigation were to describe three novel methods used to measure the displacement of i) the vesico-urethral junction (VUJ), proximal membranous urethra (PMU) and anorectal junction (ARJ) and ii) the VUJ angle of displacement in men following radical prostatectomy and determine their intra- and interrater reliability. Methods Retrospective comparative measurement of twenty pre- and postoperative MRI scans was undertaken by one observer on two separate occasions and on one occasion by another observer. Three standardized midsagittal pelvimetry reference lines were used to describe three X, Y axis measurement systems. The displacement (mm) of the VUJ, PMU and ARJ, and the angle of displacement (degrees) of the VUJ was measured for each of the three methods. Interrater reliability of VUJ, PMU and ARJ displacement and the VUJ angle of displacement measurements was assessed using a two-way mixed-effects agreement intra-class correlation coefficient (ICC) with 95% confidence intervals (CI). Test-retest (intrarater) reliability was calculated using a two-way random effects consistency ICC with 95% CI for all displacement measures of the VUJ, PMU and ARJ for one observer between two days. Results The pubococcygeal line (PCL) axis measurement system demonstrated good to excellent intrarater and interrater reliability (ICC 95% interval lower bound > 0.75) for the VUJ and PMU displacement and the VUJ angle of displacement measurements. Other measurement systems were less reliable and more variable. Conclusions In this sample of 20 Korean patients with median prostate volume 27.5 mL and maximum volume 70 mL, the measurement methodology using the PCL consistently demonstrated good to excellent reliability and the lowest variability for the measurement of the displacement of the VUJ and PMU and the VUJ angle of displacement. The PCL methodology is recommended as the method of choice. Further studies should validate these results in patients with large prostate volumes.

Copious research exists regarding ankle instability, yet lateral ankle sprains (LASs) persist in being among the most common recurrent musculoskeletal injuries. Key anatomical structures of the ankle include a triform articulating structure that includes the inferior tibiofibular, talocrural, and subtalar joints. Functionally, force absorption and propulsion through the ankle complex are necessary for any task that occurs in weight bearing. For optimal ankle performance and avoidance of injury, an intricate balance between stability and mobility is necessary to ensure that appropriate force transfer occurs during sports and activities of daily living. Consideration for the many structures that may be directly or indirectly involved in LASs will likely translate into advancements in clinical care. In this clinical review, we present the structure, function, and relevant pathologic states of the ankle complex to stimulate a better understanding of the prevention, evaluation, and treatment of LASs.

Functional endoscopic sinus surgery (FESS) is the minimal-invasive standard procedure for surgical treatment of patients with chronic rhinosinusitis. FESS follows the principle to remove all pathologies within the paranasal sinuses while sparing normal mucosa and all functionally relevant anatomical structures. To understand the functional integrity and the principles of FESS, it is important to have fundamental knowledge of the anatomy of the paranasal sinuses, especially of the orifices to the different sinuses. Normally based on a computed tomography of the paranasal sinuses in two section planes, the FESS surgeon has to reproduce the individual anatomy and to plan the individual extent of the FESS. The severity of the disease and the extent of surgery can be classified. In this review the knowledge to be known by an otorhinolaryngologist is reflected and the main steps of FESS are explained. The equipment will be described. Typical complications of FESS and complication management will be elucidated.

Objective: The objective of the present study was to study the effect of adaptive image processing (GOP processing) on the visibility of anatomical structures in direct digital panoramic im...

While functional morphologists have long studied the evolution of anatomical structures, the origin of morphological novelties has received less attention. When such novelties first originate they must become incorporated into an integrated system to be rendered fully functional. Thus, developmental integration is key at the origin of morphological novelties. However, given enough evolutionary time such integration may be broken, allowing for a division of labor that is facilitated by subsequent decoupling of structures. Cypriniformes represent a diverse group of freshwater fishes characterized by several trophic novelties that include: kinethmoid-mediated premaxillary protrusion, a muscular palatal and post-lingual organ, hypertrophied lower pharyngeal jaws that masticate against the base of the neurocranium, novel pharyngeal musculature controlling movement of the hypertrophied lower pharyngeal jaws, and in a few species an incredibly complex epibranchial organ used to aggregate filtered phytoplankton. Here, we use the wealth of such trophic novelties in different cypriniform fishes to present case studies in which developmental integration allowed for the origin of morphological innovations. As proposed in case studies 1 and 2 trophic innovations may be associated with both morphological and lineage diversification. Alternatively, case studies 3 and 4 represent a situation where ecological niche was expanded but with no concomitant increase in species diversity.

Patients often take several different medications for multiple conditions concurrently. Therefore, when adverse drug events (ADEs) occur, it is necessary to consider the mechanisms responsible. Few approaches consider the mechanisms of ADEs, such as changes in physiological states. We proposed that the ontological framework for pharmacology and mechanism of action (pharmacodynamics) we developed could be used for this approach. However, the existing knowledge base contains little data on physiological chains (PCs). We aimed to investigate a method for automatically generating missing PC from the viewpoint of anatomical structures. This study was conducted to determine dysuria-related adverse events more likely to occur during multidrug administration. We adopted a systematic approach to determine drugs suspected to cause adverse events and incorporated existing data and data generated in our newly developed method into our ontological framework. The performance of automated data generation was evaluated using this newly developed system. Suspected drugs determined by the system were compared with those derived from adverse events databases. Of the 242 drugs involving suspected drug-induced urinary retention or dysuria, 26 suspected drugs were determined. Of these, five were drugs with side effects not listed in drug package inserts. The system derived potential mechanisms of action, PCs, and suspected drugs. Our method is novel in that it generates PC data from anatomical structural properties and could serve as a knowledge base for determining suspected drugs by potential mechanisms of action.

Power amplification allows animals to produce movements that exceed the physiological limits of muscle power and speed, such as the mantis shrimp’s ultrafast predatory strike and the flea’s jump. However, all known examples of nonhuman, muscle-driven power amplification involve anatomical structures that store energy from a single cycle of muscular contraction. Here, we describe a nonhuman example of external power amplification using a constructed device: the web of the triangle-weaver spider, Hyptiotes cavatus , which uses energy stored in the silk threads to actively tangle prey from afar. Hyptiotes stretches its web by tightening a separate anchor line over multiple cycles of limb motion, and then releases its hold on the anchor line when insects strike the web. Both spider and web spring forward 2 to 3 cm with a peak acceleration of up to 772.85 m/s 2 so that up to four additional adhesive capture threads contact the prey while jerking caused by the spider’s sudden stop subsequently wraps silk around the prey from all directions. Using webs as external “tools” to store energy offers substantial mechanical advantages over internal tissue-based power amplification due to the ability of Hyptiotes to load the web over multiple cycles of muscular contraction and thus release more stored energy during prey capture than would be possible with muscle-driven anatomical elastic-energy systems. Elastic power amplification is an underappreciated component of silk’s function in webs and shows remarkable convergence to the fundamental mechanical advantages that led humans to engineer power-amplifying devices such as catapults and ballistae.

The purpose of this study was to find the most suitable and safe position of the transseptal portal in anatomic anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstructions. The hypothesis of this study was that area and position of the transseptal portal are different between ACL and PCL reconstructions for the observation of native footprint. A matched-pair comparison study was conducted on the arthroscopic images of 100 consecutive patients who underwent ACL reconstruction and 50 consecutive patients who underwent PCL reconstruction. The transseptum was divided into six compartments. The opened compartments for each surgery were then evaluated to find which anatomical structures are well seen. The anterior middle and upper parts were necessary for the ACL reconstruction, whereas middle and lower portions of the anterior and posterior compartments were necessary for the PCL reconstruction. A larger opening was necessary for PCL reconstruction than that for ACL reconstruction. The ACL posterior one-third, ACL femoral attachment, and apex of the deep cartilage margin (DCM) were viewed in 100% of the patients during ACL reconstruction. The PCL posterior one-third, PCL tibial attachment, PCL fovea margin, and medial meniscus around posterior margin were always viewed during PCL reconstruction. The anterior part of the septum, from the middle to the upper portions of the transseptum, was necessary to be opened for visualization of the femoral footprint and DCM of the lateral femoral condyle during ACL reconstruction. The anterior and posterior parts of the septum, from the middle to the lower portions of the transseptum, were necessary for excellent visualization of the PCL tibial footprint during PCL reconstruction. These paths of the transseptal portal for each surgery will help surgeons obtain both anatomic footprint restoration and maximal remnant preservation through the most suitable and safe means. This is a case–control study; level of evidence is 3.

Propósito de la revisión: en el presente trabajo hacemos un análisis sobre la palatoscopía o rugoscopía como método de reconocimiento en las ciencias forenses, con el objetivo de determinar su utilidad para distinguir sexo, edad y raza; asimismo, dar a conocer si realmente es útil como método de identificación de cadáveres en diferentes tipos de catástrofes, y se indican las limitaciones de la rugoscopía como método de identificación en la medicina legal. Periodo que se abarcó, origen y tipos de publicaciones: se realizó una recopilación de información atemporal, ya que inicia con el descubrimiento de la patología odontológica forense y culmina con los últimos avances de esta. Se incluyeron publicaciones tomadas de los índices Scielo, Pubmed y Web of Sciencie, en el periodo comprendido entre 2000 y 2018. Punto de vista: la rugoscopía es una técnica totalmente fiable para el reconocimiento de cadáveres, pero no así para diferenciación sexual, determinación de raza o referencia para otras estructuras anatómicas. Conclusiones: con el nacimiento de la patología oral forense, se descubrió un nuevo rol en odontología: la colaboración interdisciplinaria en la identificación de individuos desconocidos. Una de las formas, que es la aquí presentada, estudia las variables geométricas de estos pliegues ubicados en paladar duro, únicos para cada individuo.

Radiological diagnosis of diseases of the respiratory system includes a number of methods based on various ways of obtaining information about the state of the chest organs. Most of the applied methods are aimed at identifying structural changes in the lung parenchyma, however, with the development of lung diseases, the pathological process affects all anatomical structures of the lungs, without exception, including the vascular bed of the lungs, primarily due to its microcirculatory level, therefore, this process requires special attention of specialists to the methods detecting changes in the pulmonary microvasculature. Depending on the purposes of the study, various methods of radiologic diagnosis should be used in combination. The review provides a brief anatomical characteristic of the capillary bed of the lungs. History of the study of blood circulation in a small circle is discussed, and modern methods of radiologic research are used to detect lung diseases.

Fractures of the petrous part of the temporal bone are a common lesion of the base of the skull; most of these fractures result from high-energy trauma. In patients with multiple trauma, these injuries can be detected on CT scans of the head and neck, where the direct and indirect signs are usually sufficient to establish the diagnosis. It is important to these fractures because the temporal bone has critical structures and the complexity of this region increases the risk of error unless special care is taken. This article reviews the key anatomical points, the systematization of the imaging findings, and the classifications used for temporal bone fracture. We emphasize the usefulness of identifying and describing the findings in relation to important structures in this region, of looking for unseen fractures suspected through indirect signs, and of identifying anatomical structures that can simulate fractures. We point out that the classical classifications of these fractures are less useful, although they continue to be used for treatment decisions.

Contains fulltext : 219639.pdf (Publisher’s version ) (Open Access) We aim to provide an overview of the various digital three-dimensional visualizations used for learning anatomy and to assess whether these improve medical students' understanding of anatomy compared to traditional learning methods. Furthermore, we evaluate the attitudes of the users of three-dimensional visualizations. We included articles that compared advanced newer three-dimensional anatomy visualization methods (i.e., virtual reality, augmented reality, and computer-based three-dimensional visualizations) to traditional methods that have been used for a long time (i.e., cadaver and textbooks) with regard to users' understanding of anatomy. Of the 1,148 articles identified, 21 articles reported data on the effectiveness of using three-dimensional visualization methods compared to two-dimensional methods. Twelve articles found that three-dimensional visualization is a significantly more effective learning method compared to traditional methods, whereas nine articles did not find that three-dimensional visualization was a significantly more effective method. In general, based on these articles, medical students prefer to use three-dimensional visualizations to learn anatomy. In most of the articles, using three-dimensional visualization was shown to be a more effective method to gain anatomical knowledge compared to traditional methods. Besides that, students are motivated and interested in using these new visualization methods for learning anatomical structures. Clin. Anat. 32:25-33, 2019. (c) 2019 Wiley Periodicals, Inc.

This article documents thermophysiological patterns associated with migraine episodes, where the inner canthi and supraorbital temperatures drop significantly compared to normal conditions. These temperature drops are likely due to vasoconstriction of the ophthalmic arteries under the inner canthi and sympathetic activation of the eccrine glands in the supraorbital region, respectively. The thermal patterns were observed on eight migraine patients and meticulously quantified using advance computational methods, capable of delineating small anatomical structures in thermal imagery and tracking them automatically over time. These methods open the way for monitoring migraine episodes in nonclinical environments, where the patient maintains directional attention, such as his/her computer at home or at work. This development has the potential to significantly expand the operational envelope of migraine studies.

Minor salivary gland carcinomas are rarely reported. Mucoepidermoid carcinoma (MEC) is one of the most common salivary glandmalignancies. MEC accounts for 1% to 2% of major salivary gland neoplasms and 9% of minor gland tumors. It is most commonly seenin the parotid gland and usually appears as asymptomatic swelling. However, the palate is a frequent site when it occurs in the minorsalivary glands. Follow-up of the patient is very important as local recurrence rate with conservative treatment is high. Here we arereporting a low-grade mucoepidermoid carcinoma involving palatal region in a 25-years-old female patient. The patient presented witha fast-growing swelling, invading the underlying anatomical structures and was treated successfully through the antrostomy procedure.

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. Surface registration, in which a mapping between surfaces is calculated, is a powerful tool to create patient-specific musculoskeletal and statistical shape models. However, to create these models, surface registration must assure a one-to-one correspondence between both surfaces. To enhance this process, a surface registration framework that uses a combination of manual and automatic landmark detection is presented in this study. In addition, an extensive parameter study of the framework for a femur and a clavicle is conducted. The average correspondence quality of nine femur landmarks decreased from 15.6 mm using automatic point detection to 6.1 mm by combining manually and automatically indicated landmarks. For the clavicle, the average distance of five landmarks decreased from 2.8 to 0.9 mm. Combining manual and automatic landmark detection clearly improved correspondence quality. Results confirmed the applicability of the proposed registration framework for femur and clavicle, although with different parameter settings. ispartof: Computer Methods in Biomechanics and Biomedical Engineering: Imaging and Visualization vol:8 issue:1 pages:94-102 status: published

Purpose Since Scleral Lenses (SL) rest entirely on the sclera and may affect underlying anatomical structures that may influence aqueous humor flow, it is important to determine the effect of SL wear on intra-ocular pressure (IOP). Methods Nine subjects with normal corneas were recruited for an Institutional Review Board-approved study. Best fit SL from a 15.8 mm diameter 0.4mm thick diagnostic-lens set was fitted on a randomly selected eye, with a silicone-hydrogel soft lens (soft lens) on the other eye. Three IOP measurements were taken with rebound iCare tonometer prior to lens application (baseline data measured at about 9:30AM), and immediately after lens removal (final data measured at about 5:30PM). Baseline and final lens vault was determined with anterior segment Zeiss optical coherence tomography (OCT). Mean baseline and final IOP for each eye was analyzed with a Student-t-test, 2-way repeated ANOVA, and the Bland-Altman plot. RESULTS IOP was elevated with SL wear for all subjects. Soft lens eyes showed a slight elevation for some but decreased in others. Mean IOP change was 5.81 ± 1.62 mm Hg for SL and -0.62 ± 0.88 mm Hg for soft lens eyes. When mean IOP in SL eyes was compared to soft lens eyes, unpaired t-test showed a significant difference (p

A silicified root, Amyelon bogdense Wan, Yang et Wang sp. nov., is described from the Changhsingian–Induan (?) Guodikeng Formation in south Taodonggou section, Turpan, Xinjiang Uygur Autonomous Region, northwestern China. The root consists of diarch protostele, primary xylem, secondary xylem, secondary phloem, and periderm. Primary xylem is exarch, with helical and scalariform thickenings on tracheidal walls. Secondary xylem is of the Agathoxylon-type, with alternately bi- to tetraseriate radial tracheidal pitting, uniseriate parenchymatous rays, and araucarioid cross-field pitting. Intercellular spaces occur between tracheids throughout the secondary xylem. Phloem is commonly compact. It is composed of radially aligned thick-walled cells, axial parenchyma and parenchymatous rays. Periderm consists of phelloderm, phellogen and phellem. Phelloderm cells are distributed external to the secondary phloem, with variable morphologies and sizes. Phellogen cells are commonly tabular and occasionally elongate. Phellem is distributed to the exterior of the phellogen, and is composed of 2–7, commonly 3–4 layers of radially arranged brick-shaped cells. Rootlets are elliptical to circular, less than 4 mm in diameter. Anatomical structures of rootlet are similar to those of the root. The arrangement of secondary xylem shows wedge-shaped spokes. Spaces between the secondary xylem spokes are either empty or filled with parenchyma. Some of the roots and rootlets have lenticel-like convex bodies. Lateral roots show no particular arrangement but appear to have been borne on only one side of the primary root. This is the first detailed report of the root anatomy with xylem and bark from the upper Paleozoic of the subangaran phytoprovince. The anatomical features differ from those of the previously studied stems in northwestern China, and provide additional information on the diversity of the subangaran flora.

Atlantoaxial transarticular facet screw fixation (Magerl technique) and C1 lateral mass screws combined with C2 pedicle screws fixation (Harms technique) are the most commonly used techniques for posterior internal fixation in the upper cervical spine. Upper cervical spinal surgery is a technically demanding and challenging procedure because of complicated anatomical structures and frequent occurrence of anomalies. Accurate insertion of screws allows for stable and secure internal fixation, which is necessary for both techniques. Traditional methods under fluoroscopic assistance in this region cannot meet the requirements of high levels of accuracy and security during the procedure. Robot‐assisted spinal surgery can provide accurate and reliable guidance during the screw insertion, which is evidenced in the literature. As a recently developed technique, robot‐assisted surgery is supposed to be performed by skilled surgeons who have received standard training for robotic surgery. The standardized upper cervical spinal surgery assisted by the robot system needs to be introduced to these surgeons. Based on the consensus of consultant specialists, the literature review, and our local experience, this guideline included the introduction of the robotic system, the workflow of robot‐assisted procedures, and the precautions to take during procedures. This guideline aims to provide a standardization of the robotic surgery for posterior atlantoaxial internal fixation.

Forensic imaging technology has rapidly advanced over the past several decades and is gaining increasing significance in medico-legal death investigations. Medical-grade computed tomography (CT) is now routinely used in post-mortem examinations at numerous institutions across the globe. However, the resolution of medical-grade CT is limited and unsuitable when used to depict some smaller anatomical structures or micro-trauma. High-resolution micro-CT offers up to 100× the resolution to overcome this problem but is a very recent addition to the field of forensic radiology. Few studies so far have attempted to validate the results which is an essential prerequisite for it to be used in the criminal justice process as demanded by regulatory bodies. This study directly compares micro-CT images with histology, the current gold standard. Three cases were examined: two larynges from suspected strangulations and one ribcage of a case of fatal child abuse. A strong correlation was observed between histology and micro-CT as the majority of skeletal injuries were identified correctly. This paper discusses the forensic implications of the results and how micro-CT is complementary to histology.\ud \ud

Bryophytes (non- vascular land plants) owing to their simple morphological, anatomical structures, worldwide in distribution, and forming an important component of forest ecosystem can be of immense importance in determining the prevailing edaphic conditions(hydrogen ion concentration) by their distribution patterns. Especially, mosses that are highly versatile due to their adaptability to different substrata can be used all the year round in the laboratory and in-situ to monitor the area in every season, suggesting their wider use as bio-indicators as compared to higher vascular plants which are comparatively difficult to handle.

Segmentation of epicardial and endocardial boundaries is a critical step in diagnosing cardiovascular function in heart patients. The manual tracing of organ contours in Computed Tomography Angiography (CTA) slices is subjective, time-consuming and impractical in clinical setting. We propose a novel multi-dimensional automatic edge detection algorithm based on shape priors and principal component analysis. Inspired by the work of Tsai et al. [3] and Yezzi et al. [1], we have developed a highly customized parametric model for implicit representations of segmenting curves (3D) for Left Ventricle (LV), Right Ventricle (RV), and Epicardium (Epi) used simultaneously to achieve myocardial segmentation. We have extended the Chan-Vese [4] image modeling framework to segment four regions simultaneously with high level constraints enabling the modeling of complex cardiac anatomical structures to automatically guide the segmentation of endo/epicardial boundaries. Test results on 30 short-axis CTA datasets show robust segmentation with error (mean ± std mm) of (1.46 ± 0.41), (2.06 ± 0.65), (2.88 ± 0.59) for LV, RV and Epi respectively.

Summary Introduction Many patients have haemorrhagic and neurologic complications after surgery at the symphysis region, while this area between the mental foramina is commonly considered to be risk-free because the presence of vasculo-nervous anastomoses found in the mandibular incisive canal (MIC) and lingual foramina (LF). The purpose of our study was to better analyse these anatomical structures to better identify and preserve them during surgery. Patients and methods This prospective radio-anatomical study evaluated the presence, morphology and topography of MIC and median LF (MLF) and paramedian LF (PLF) by cone-beam computed tomography according to age, gender and dentition of 50 consecutive patients. Results Among the MIC, 99% were visualized at their origin. Their visibility decreased gradually towards the symphysis. The MIC had a larger diameter and followed a significantly more superficial and more vestibular way in older patients. At least, one MLF by hemimandible was found whereas PLF were found only in 68% of the cases. The mean distance from the basal border was 7.11 mm for the lower MLF, 16.33 mm for the upper MLF and varied from 11.15 to 10.85 mm for the left and right PLF. Conclusion Our study suggests that MIC and LF are constant structures with anatomical variations and that three-dimensional topographic study of the interforaminal region would be beneficial in patients requiring surgery in this area to reduce the risk of haemorrhage and neurologic complications.

The facial malformations of Crouzon syndrome involve the entire cranio-orbito-zygomatic region. The detailed sequence of changes in orbit, zygoma, and maxilla over time, the mutual influence among these three anatomical structures, and their relationship with the cranial base were studied to determine the sequence and timing of deformity. Preoperative CT scans of 36 patients with Crouzon syndrome (mean age 10.84±14.70years; 14 male, 22 female) and CT scans of 54 control subjects (mean age 8.53±13.22years; 29 male, 25 female) were divided into five subgroups by age: 0-6 months, 6 months-2 years, 2-6 years, 6-18 years, and 18-62 years. Craniofacial morphometric cephalometrics were analyzed using Materialise software. Crouzon orbit anteroposterior length was shorter before 6 months (P=0.021) and remained shorter into adulthood (P

Anatomical e-applications are increasingly being created and used in medical education and health care for the purpose of gaining anatomical knowledge. Research has established their superiority over 2D methods in the acquisition of spatial anatomy knowledge. Many different anatomy e-applications have been designed, but a comparative review is still lacking. We aimed to create an overview for comparing the features of anatomy e-applications in order to offer guidance in selecting a suitable anatomy e-application. A systematic search was conducted. Data were retrieved from the 3D model designs (realism), software aspects and program functionality. The non-commercial e-applications focused on small body regions and received an average score of 3.04 (range 1-5) for model realism. Their average score on program functionality was 8.8 (range 0-14). The commercial e-applications covered the entire human body and received an average score of 2.85 (range 1-5) for model realism. Their average score on program functionality was 10.4 (range 0-14). Non-commercial anatomy e-applications received higher scores on realism and facilities like performing a virtual dissection, while the commercial anatomy e-applications offer a much wider range of anatomical structures available and they showed higher scores on program functionality. These scores gave good insight of the e-applications' possibilities, and may help future users to make an informed choice among the large number of available e-applications.

Abstract: Medication-related osteonecrosis of the jaw may appear as adverse effect in antiresorptive therapy. Its successful treatment is challenging. We aimed to gather the systemic and local factors playing a role in etiology, published after its recognition. Risk factors were collected from the PubMed database 1998–2018. The three main groups of risk patients are: patients starting, patients having antiresorptive therapy, osteonecrosis diagnosed patients. The dentist must recognize risk factors, determine appropriate treatment plan and frequency of check-ups. Oncological disease treated intravenously means the greatest risk. Further systemic risk factors are: supportive therapies, concomitant disease, way of life, individual factors. Local risk factors may be: dentoalveolar surgery, periapical and periodontal inflammation, ill-fitting denture, presence of some anatomical structures. The accumulation of risk factors determines the probability of the manifestation of osteonecrosis. The most favorable case is patient starting antiresorptive therapy with a dental status needing no treatment. Orv hetil. 2019; 160(7): 243–251.

Three-dimensional (3D) printing, or additive manufacturing, is now a widely used tool in pre-operative planning, surgical teaching and simulator training. However, 3D printing technology that produces models with accurate haptic feedback, biomechanics and visuals for the training surgeon is not currently available. Challenges and opportunities in creating such surgical models will be discussed in this review paper. Surgery requires proper tissue handling as well as knowledge of relevant anatomy. To prepare doctors properly, training models need to take into account the biomechanical properties of the anatomical structures that will be manipulated in any given operation. This review summarises and evaluates the current biomechanical literature as it relates to human tissues and correlates the impact of this knowledge on developing high fidelity 3D printed surgical training models. We conclude that, currently, a printer technology has not yet been developed which can replicate many of the critical qualities of human tissue. Advances in 3D printing technology will be required to allow the printing of multi-material products to achieve the mechanical properties required.

The study of human anatomy is fundamental to medical education globally. Knowledge of musculoskeletal anatomy is essential for safe and effective clinical practice, yet this topic often receives insufficient medical program time and perceptions differ regarding which knowledge is core. Given the lack of syllabuses specific to musculoskeletal anatomy, this article aims to provide a detailed syllabus for the vertebral column and limbs relevant to medical students. A Delphi panel comprising anatomists and clinicians rated 2,260 anatomical structures and concepts as "essential," "important," "acceptable," or "not required," with evaluations based around the core knowledge deemed acceptable for a competent medical student. Based on the percentage of panelist agreement for an item to be considered "essential," each item was then classified as core (≥60%), recommended (30%-59%), not recommended (20%-29%), or not core (