Kidney collecting system anatomy applied to endourology - a narrative review

ABSTRACT Objective: To evaluate the surgical anatomy of the kidney collecting system through a narrative review of the literature, highlighting its importance during diagnosis and its approach during surgical procedures for the treatment of renal stones. Material and Methods: We carried out a review about the anatomy of the kidney collecting system. We analyzed papers published in the past 40 years in the databases Pubmed, Embase and Scielo, and we included only papers in English and excluded case reports, editorials and opinions of specialists. Results: Renal collecting system could be divided in four groups: A1 - kidney midzone (KM), drained by minor calyx that are dependent on the superior or the inferior caliceal groups; A2 - KM drained by crossed calyx, one draining into the superior caliceal group and another draining into the inferior caliceal group; B1 - KM drained by a major caliceal group independent of both the superior and inferior groups; and B2 - KM drained by minor calyx entering directly into the renal pelvis. Some details and anatomic variations of the collecting system are related to clinical and radiological aspects, particularly perpendicular calyces, interpyelocalyx space, position of calyces in relation to renal border, classification of the renal collecting system, infundibular diameter and the angle between the lower infundibulum and renal pelvis. Conclusion: The knowledge of intra-renal collecting system divisions and variations as the angle between the renal pelvis and lower infundibula, position of the calices in relationship with renal edge and the diameter and position of the calyces are important for the planning of minimally invasive renal surgeries.

Platysma: Human and Comparative Anatomy, Histology, and Clinical Aspects

SUMMARY: The quest for aesthetic procedures is experiencing a steady increase in popularity, concomitant with the expanding array of available treatment options. Of notable interest is the burgeoning trend in the use of minimally invasive techniques. Among the various aspects of facial anatomy, the platysma stands as a pivotal element that significantly influences the aesthetic appearance of the neck region. It has garnered particular attention as a strategic focal point in various treatments geared towards enhancing the neck's visual appeal. Additionally, the versatility of the platysma extends beyond the realm of cosmetic improvements. Its functional significance is recognized in reconstructive surgical procedures, where it may be harnessed for specific maneuvers. Furthermore, the muscle serves as a critical access point for minimally invasive endoscopic surgeries in the neck region. While these developments hold great promise, it is crucial to underscore that safety should always take precedence in any medical or surgical approach. This applies equally to the neck region, which presents a complex and intricate anatomical landscape. An in-depth understanding and meticulous investigation of the platysma in all its diverse aspects are paramount to ensuring the success and safety of any procedure conducted in this region. This comprehensive review aspires to provide a contemporary understanding of the platysma, offering an in-depth analysis that encompasses its intricate anatomy, histological characteristics, and multifaceted clinical implications. By delving into these diverse dimensions, it aims to equip healthcare professionals and researchers with a robust foundation for informed decision-making and practice.

La búsqueda de procedimientos estéticos ha experimentado un aumento constante en popularidad, junto con la creciente gama de opciones de tratamientos disponibles. De notable interés es la creciente tendencia en el uso de técnicas mínimamente invasivas. Entre los diversos aspectos de la anatomía facial, el platisma destaca como un elemento fundamental que influye significativamente en la apariencia estética de la región del cuello. Ha ocasionado especial atención como punto focal estratégico en varios tratamientos orientados a mejorar el atractivo visual del cuello. Además, la versatilidad del platisma se extiende más allá del ámbito de las mejoras cosméticas. Su importancia funcional se reconoce en procedimientos quirúrgicos reconstructivos, donde se puede aprovechar para maniobras específicas. Además, el músculo sirve como punto de acceso crítico para cirugías endoscópicas mínimamente invasivas en la región del cuello. Si bien estos avances son muy prometedores, es fundamental subrayar que la seguridad siempre debe tener prioridad ante cualquier abordaje médico o quirúrgico. Esto se aplica igualmente a la región del cuello, que presenta un aspecto anatómico complejo e intrincado. Una comprensión profunda y una investigación meticulosa del platisma en todos sus diversos aspectos son fundamentales para garantizar el éxito y la seguridad de cualquier procedimiento realizado en esta región. Esta revisión integral aspira a proporcionar una comprensión contemporánea del platisma, ofreciendo un análisis en profundidad que abarca su intrincada anatomía, características histológicas e implicaciones clínicas multifacéticas. Al profundizar en estas diversas dimensiones, su objetivo es dotar a los profesionales e investigadores de la salud de una base sólida para la toma de decisiones y la práctica informadas.

Uso del Diseño Universal para el Aprendizaje para Mejorar la Práctica Docente y la Motivación de los Estudiantes en Anatomía: Una Propuesta de Intervención

En la asignatura de anatomía aún existen estudiantes que no se encuentran motivados con su propio proceso de aprendizaje. El rol del docente es un factor extrínseco clave que contribuye a dicha vinculación afectiva. El Diseño Universal para el Aprendizaje (DUA) es un modelo educativo que propone una serie de pautas de aplicación docente para poder activar en los alumnos sus redes neuronales afectivas, asociadas con la formación de estudiantes decididos y motivados. El objetivo de este estudio es crear una propuesta de intervención, basada en el uso selectivo de las pautas de compromiso afectivo del DUA, para mejorar la práctica docente y la motivación de los estudiantes en anatomía. Es una investigación acción que utiliza el modelo de Whitehead, implicando el cruce conceptual y metodológico entre las pautas de compromiso afectivo del DUA y las fases y factores que determinan la motivación. Corresponde a la programación de seis sesiones de laboratorio de anatomía, los instrumentos para la recopilación de la información y las técnicas de análisis de la misma. La propuesta de intervención presenta un valor teórico ya que fue diseñada a partir de un análisis exhaustivo del DUA y de las publicaciones existentes sobre la motivación, y un valor práctico que se sustenta en su aplicabilidad directa y recursiva en los laboratorios de anatomía y en la incorporación del DUA en el currículum de una asignatura de educación superior. La motivación es el motor de la educación, ya que impulsa y mantiene el quehacer académico tanto a nivel estudiantil como docente. El DUA permite que los docentes aborden la desmotivación de los estudiantes de una forma accesible, precisa y confiable, lo que llevó a considerarlo como uno de los pilares de la propuesta de intervención.

SUMMARY: In anatomy courses there are still students who are not motivated by their own learning process. The teacher´s role is a key extrinsic factor that contributes to this bonding process. Universal Design for Learning (UDL) is an educational model that proposes a series of teaching application guidelines to activate students' affective neural networks, associated with the formation of motivated students. The objective of this study is to create an intervention proposal, based on the selective use of the UDL affective commitment guidelines, to improve teaching practice and student motivation in anatomy. It is an action research that uses Whitehead's model, involving the conceptual and methodological intersection between the UDL's affective commitment guidelines and the phases and factors that determine motivation. It corresponds to the programming of six anatomy laboratory sessions, the instruments for collecting information and the techniques for analyzing it. The intervention proposal has a theoretical value since it was designed based on an exhaustive analysis of the UDL and existing publications on motivation, and a practical value that is based on its direct and recursive applicability in anatomy laboratories and in the incorporation of the UDL in the curriculum of a higher education subject. Motivation is the driving force of education, since it drives and maintains academic work at both the student and teacher level. The UDL allows teachers to address student lack of motivation in an accessible, precise and reliable way, considering this one of the pillars of the intervention proposal.

The Thyrohyoid Muscle: A Crucial Player in Deglutition and Vocalization

SUMMARY: The thyrohyoid muscle is one of the four infrahyoid muscles. Its role in vocalization and deglutition could be often overlooked, despite its crucial participation in these processes. Unlike other infrahyoid muscles, the thyrohyoid muscle receives innervation from the first cervical spinal nerves which contributes to its unique function. Its primary action involves hyolaryngeal elevation during swallowing, contributing to the opening of the upper esophageal sphincter. In conjunction with other muscles, it also protects the airway and facilitates the passage of food into the esophagus. Variations in the muscle's thickness may exist, and its function can be influenced by chewing habits. Weakened muscles involved in swallowing are often associated with dysphagia, a common complication in stroke and brain-injured patients. Advanced imaging techniques and sleep studies have provided insights into the dynamics and frequency of swallowing. This review explores the anatomic structures, function in action, diagnosis and clinical implications of this muscle. Overall, understanding the significance of the thyrohyoid muscle enhances our comprehension of the intricate interplay of laryngeal muscles during vocalization and deglutition.

El músculo tirohioideo es uno de los cuatro músculos infrahioideos. A menudo podría pasarse por alto su papel en la vocalización y la deglución, a pesar de su participación crucial en estos procesos. A diferencia de otros músculos infrahioideos, el músculo tirohioideo recibe inervación de los primeros nervios espinales cervicales, lo que contribuye a su función única. Su acción principal implica la elevación hiolaríngea durante la deglución, contribuyendo a la apertura del esfínter esofágico superior. Junto con otros músculos, también protege las vías respiratorias y facilita el paso de los alimentos al esófago. Pueden existir variaciones en el grosor del músculo y su función puede verse influenciada por los hábitos de masticación. Los músculos debilitados involucrados en la deglución a menudo se asocian con disfagia, una complicación común en pacientes con accidente cerebrovascular y lesión cerebral. Las técnicas de imagen avanzadas y los estudios del sueño han proporcionado información sobre la dinámica y la frecuencia de la deglución. Esta revisión explora las estructuras anatómicas, la función en acción, el diagnóstico y las implicaciones clínicas de este músculo. En general, comprender la importancia del músculo tirohioideo mejora nuestra comprensión de la intrincada interacción de los músculos laríngeos durante la vocalización y la deglución.

Examen Práctico Objetivo Estructurado como metodología de evaluación en la asignatura de Anatomía Humana: Experiencia de una Implementación Piloto

Aprendizajes en anatomía humana tradicionalmente han sido evaluados a través del reconocimiento de estructuras anatómicas. A pesar de su popularidad, pueden tener un componente subjetivo y memorístico. El Examen Práctico Objetivo Estructurado (EPOE) se ha presentado como una manera más global de evaluación. El objetivo de este estudio fue evidenciar el efecto en el rendimiento académico tras la implementación del EPOE en pasos prácticos. En el estudio 2312 estudiantes fueron divididos: Metodología Tradicional (n=1155) y Metodología EPOE (n=1157). A su vez, los estudiantes fueron identificados según carrera: Enfermería (n=1182); Fonoaudiología (n=185); Kinesiología (n=514) y Terapia Ocupacional (n=431). Se mantuvieron las condiciones de la asignatura en ambos grupos con tres evaluaciones prácticas. Se analizaron las calificaciones obtenidas. Evaluaciones 1 y 2 no presentaron diferencias entre grupos. Evaluación 3, que evaluó sistema nervioso, mostró disminución significativa de 0,5 puntos en el grupo EPOE. El factor tipo de metodología resultó ser significativo en evaluación 3 (p < 0,001; h2p = 0,029) y promedio de las 3 evaluaciones (p < 0,029; h2p = 0,002). El factor carrera resultó ser significativo para las tres evaluaciones. La interacción de ambos factores no mostró significancia estadística. El análisis post hoc mostró diferencias significativas entre estudiantes de Enfermería con las demás carreras, ya que obtuvieron mejores calificaciones en todas las evaluaciones (p < 0,05). Metodología EPOE no produjo drásticos cambios en el rendimiento académico de los estudiantes y tiene un amplio potencial de desarrollo por su naturaleza de evaluación integral no invasiva ni traumática. Se debe considerar la naturaleza de los contenidos en el diseño de la metodología de enseñanza-aprendizaje y en la metodología de evaluación, alineando a nivel microcurricular estos aspectos fundamentales de la formación de nuevos profesionales de la salud.

SUMMARY: Learning in human anatomy has traditionally been assessed by recognizing anatomical structures. Despite their popularity, they can have a subjective component. The Objective Structured Practical Examination (EPOE) has been presented as a more global way of assessment. The aim of this study was to demonstrate the effect on academic performance after the implementation of the EPOE in practical activities. In this study 2312 students were divided into Traditional Methodology (n=1155) and EPOE Methodology (n=1157). In turn, students were identified according to career: Nursing (n=1182), Speech Therapy (n=185), Physical Therapy (n=514), and Occupational Therapy (n=431). Subject conditions were maintained in both groups with three practical evaluations. The grades obtained were analyzed. Assessments 1 and 2 showed no differences between groups. Evaluation 3, which evaluated the nervous system, showed a significant decrease of 0.5 points in the EPOE group. The type of methodology factor was significant in evaluation 3 (p < 0.001; ?2p = 0.029) and the average of 3 evaluations (p < 0.029; ?2p = 0.002). The career factor was significant for all three evaluations. The interaction of both factors did not show statistical significance. The post hoc analysis showed significant differences between nursing students and the other careers since they obtained better scores in all evaluations (p < 0.05). EPOE methodology did not produce drastic changes in students' academic performance and had a broad potential for development due to its non-invasive and non-traumatic comprehensive assessment nature. The nature of the contents should be considered in the design of the teaching-learning methodology and the evaluation methodology, aligning at the micro-curricular level with these fundamental aspects of training new health professionals.

Terminología anatómica: un camino difíci / Anatomical terminology: a difficult pat

En el presente artículo se hace una revisión sistemática o evaluativa de carácter descriptivo-exploratorio donde se buscaron los estudios más relevantes de forma sistematizada en relación a la terminología anatómica, se abordó su historia, su evolución hasta el presente y las dificultades existentes para su correcta aplicación y difusión(AU)

In the present article a systematic or evaluative review of descriptive-exploration nature is made, where the most relevant studies searched in a systematic way in relation to the anatomic terminology, its history, its evolution to the present and the existing difficulties for its correct application and dissemination were addresse(AU)

Estrategias didácticas para la enseñanza de la anatomía humana en la Universidad Austral de Chile

La presente revisión narrativa propone caracterizar las estrategias didácticas actualmente utilizadas en el Instituto de Anatomía, Histología y Patología (IAHP) de la Universidad Austral de Chile (UACh), para la enseñanza-aprendizaje de la anatomía humana en los alumnos de las escuelas de Enfermería, Kinesiología, Medicina, Obstetricia y Puericultura, Odontología y Terapia Ocupacional de su Facultad de Medicina. Se listan las diversas estrategias didácticas implementadas y se explica la manera en que se han venido aplicando en esta institución a fin de perfeccionar la enseñanza anatómica, considerando los retos y desafíos que demandan las generaciones actuales de estudiantes y la dinámica del mundo contemporáneo.

This narrative review aims to describe the didactic strategies currently employed by the Institute of Anatomy, Histology, and Pathology at the Universidad Austral de Chile (UACh) for teaching Human Anatomy to students in the Nursing, Kinesiology, Medicine, Obstetrics and Childcare, Dentistry, and Occupational Therapy programs of its Faculty of Medicine. The implemented teaching strategies for improving anatomical teaching in this institution are listed and explained, considering the challenges posed by current generations of students and the dynamics of the contemporary world.

Microcomputed-Tomographic Analysis of the Root Canal Morphology of the Mandibular First Molars in a Malaysian Subpopulation Using Two Classification Systems / Análisis por Tomografía Microcomputada de la Morfología del Conducto Radicular de los Primeros Molares Mandibulares en una Subpoblación de Malasia Utilizando dos Sistemas de Clasificación

SUMMARY: This work investigated the morphology of the root canal system of the mandibular first molar in a Malaysian subpopulation. Using micro-computed tomography with an isotropic resolution of 22 µm, 140 mandibular first molars were scanned. MIMICS software was used for segmentation, 3-D reconstruction and analysis of the acquired images. The canal configuration was described using Vertucci [supported by the supplementary configurations proposed by Sert & Bayirli (2004)] and Ahmed et al. (2027), coding systems. The chi-square test was used to assess the association between qualitative variables. By non-considering intercanal communications, Vertucci types IV (17.1%) and I (76.4%) were the most frequently reported configurations in the mesial and distal roots, respectively. Of the reported configurations, 24.3% and 4.3% were non-classifiable by Vertucci system in the mesial and distal roots, respectively. Up to 63.6% and 9.3% of the reported configurations were non- classifiable, and type I was the most frequent when considering intercanal communications (7.1% and 76.4% in the mesial and distal roots, respectively). According to Ahmed et al., system, almost half of the sample had more than four digits (47.9%), followed by the 3-digits category (20.71%). In both systems, a significant association was found between the canal configuration and the root type (p<0.001). The mandibular first molar of this Malaysian subpopulation demonstrated a wide range of root canal morphology. When compared to the Vertucci system, the system developed by Ahmed et al., successfully classified all molars configurations despite their level of complexity. The complex canal anatomy of mandibular first molars in this subpopulation warrants special attention during root canal treatment procedures.

En este trabajo se investigó la morfología del sistema de conductos radiculares del primer molar mandibular en una subpoblación de Malasia. Utilizando tomografía microcomputada con una resolución isotrópica de 22 µm, se escanearon 140 primeros molares mandibulares. Se utilizó el software MIMICS para segmentar (enmascarar), reconstruir en 3D, visualizar y analizar las imágenes adquiridas. La configuración del canal se describió utilizando Vertucci respaldado por las configuraciones complementarias propuestas por Sert & Bayirli (2004)] y Ahmed et al. (2017, 2020), sistemas de codificación. Se utilizó la prueba de chi-cuadrado para evaluar la asociación entre variables cualitativas. Sin considerar las comunicaciones intercanales, los tipos Vertucci IV (17,1%) y I (76,4%) fueron las configuraciones reportadas con mayor frecuencia en las raíces mesiales y distales, respectivamente. De las configuraciones reportadas, el 24,3 % y el 4,3 % fueron no clasificables por el sistema de Vertucci en las raíces mesial y distal, respectivamente. Hasta el 63,6 % y el 9,3 % de las configuraciones reportadas fueron no clasificables, siendo la tipo I la más frecuente al considerar las comunicaciones intercanales (7,1 % y 76,4 % en las raíces mesiales y distales, respectivamente). Según Ahmed et al. (2017, 2020) en el sistema, casi la mitad de la muestra tenía más de cuatro dígitos (47,9 %), seguido por la categoría de 3 dígitos (20,71 %). En ambos sistemas se encontró una asociación significativa entre la configuración del canal y el tipo de raíz (p<0,001). El primer molar mandibular de esta subpoblación de Malasia demostró una amplia gama morfológica del conducto radicular. En comparación con el sistema Vertucci, el sistema desarrollado por Ahmed et al. (2017, 2020) clasificaron con éxito todas las configuraciones de los molares a pesar de su nivel de complejidad. La compleja anatomía del canal de los primeros molares mandibulares en esta subpoblación merece una atención especial durante los procedimientos de tratamiento de conducto.

Frecuencia de Ponticulus posticus en Telerradiografías Laterales de Cráneo / Frequency of Ponticulus posticus in Digital Lateral Cephalograms

En el arco posterior del atlas se describe una variación de tejido óseo denominada Ponticulus posticus (PP), la cual se ha relacionado con el desarrollo de dolor cervical. El objetivo de este estudio fue determinar la frecuencia de PP en telerradiografías laterales digitales. Este estudio correspondió a un estudio observacional descriptivo, donde se analizaron 450 telerradiografías laterales digitales obtenidas de la base de datos del Servicio de Imagenología Oral y Maxilofacial de la Facultad de Odontología de la Universidad Andrés Bello, Viña del Mar, Chile. Se analizó la presencia de PP en cada cefalograma, y se utilizó la clasificación de Cederberg y Stubbs para determinar los grados de osificación. Se aplicó la prueba de Chi-cuadrado para establecer una asociación entre la presencia de PP con el sexo y la edad. De las 450 telerradiografías laterales el 42,4 % presenta PP, con una mayor prevalencia entre el rango de 21-40 años. En cuanto al grado de osificación, el grado 2 fue el tipo más prevalente (25 %), seguido del grado 4 (9,5 %), el grado 3 (8 %). No se encontró asociación entre la presencia de PP con edad y género (P > 0,05). La PP es frecuente en la población y se observa a diferentes edades sin predilección por sexo.

SUMMARY: A bony tissue variation called Ponticulus posticus (PP) is described in the posterior arch of the atlas, which has been associated with the development of cervical pain. The aim of this study was to determine the frequency of PP in digital lateral cephalograms. This study was an observational descriptive study, in which 450 digital lateral cephalograms obtained from the database of the Oral and Maxillofacial Imaging Service of the Faculty of Dentistry of the Andrés Bello University, Viña del Mar, Chile, were analyzed. The presence of PP was analyzed in each cephalogram, and the Cederberg and Stubbs classification was used to determine the degrees of ossification. The Chi-square test was applied to establish an association between the presence of PP with gender and age. Of the 450 lateral cephalograms, 42.4 % presented PP, with a higher prevalence in the 21-40 year range. In terms of the degree of ossification, grade 2 was the most prevalent type (25 %), followed by grade 4 (9.5 %), and grade 3 (8 %). No association was found between the presence of PP with age and gender (P > 0.05). PP is common in the population and is observed at different ages without a sex preference.

Enseñanza de la Anatomía Humana en la Universidad Austral de Chile: Pasado, Presente y Futuro / Teaching of Human Anatomy at the Universidad Austral de Chile: Past, Present and Future

La presente revisión narrativa trata de caracterizar como ha sido el proceso de enseñanza de la anatomía en la Universidad Austral de Chile (UACh), presentando una visión histórica desde los inicios de la Universidad a los tiempos actuales y una reflexión sobre el futuro de la Anatomía Humana. Se describen los orígenes del Instituto de Anatomía de la UACh, primeros académicos, logros institucionales, convenios interinstitucionales; además, se detallan los métodos y estrategias educativas utilizadas en la actualidad para la enseñanza anatómica y se presenta una visión panorámica del porvenir como instituto de docencia e investigación en el campo de la Anatomía humana.

SUMMARY: This narrative review tries to characterize how the anatomy teaching process has been carried out at the Universidad Austral de Chile (UACh), presenting a historical vision from the beginnings of the University to the present time and a reflection on the future of Human Anatomy. The origins of the Human Anatomy Institute at the UACh, first academics, institutional achievements, inter-institutional agreements are described; in addition, the educational methods and strategies currently used for anatomical teaching are detailed and a panoramic vision of the future as a teaching and research institute in the field of human anatomy is presented.

Factors Associated with Site-specific Distribution of Glioblastoma / 肿瘤防治研究

The treatment of glioblastoma, the most prevalent malignant tumor in the central nervous system, poses considerable challenges. Glioblastoma multiforme, classified as a grade Ⅳ highly malignant brain glioma by the World Health Organization, is typically managed through a combination of surgery, postoperative chemotherapy, and radiotherapy. The treatment of glioblastoma is complicated by its infiltrative nature, genetic heterogeneity, and presence of the blood-brain barrier. Almost all cases of glioblastoma experience recurrence despite aggressive therapy, exploring the development of updated molecular treatment strategies that can improve overall efficacy. A crucial aspect in modern neurosurgery is the precise delineation of brain regions in terms of their anatomy and function. It serves as the fundamental basis for investigating variations in the distribution of brain gliomas. Hence, this review will elucidate the origin of glioblastomas and analyze the potential factors contributing to the spatially specific distribution of gliomas on the basis of a theoretical framework of brain connectomics research. Molecular characteristics, information pathways, tumor microenvironment landscape, and immunology will inform the analysis. We aim to identify novel biomolecular targets and therapeutic pathways to gain scientific insights for effective glioblastoma treatment.

Distal tibiofibular syndesmosis fibular notch typing and its clinical significance based on CT / 解剖学报

Objective To investigate the morphological typing and clinical significance of the distal tibiofibular syndesmosis fibular notch based on CT images. Methods According to the inclusion and exclusion ceiteria‚ the imaging data of patients undergoing ankle joint CT examination were analyzed‚ and the inferior tibiofibular joint fibula notch was classified according to the morphological characteristics. The measurements included 8 distances. There were 123 males and 102 females‚ all of whom were Han nationality‚ aged 18-60 years old. Results Retrospectively analyzed the result of 225 patients from December 2013 to December 2022. The distal tibiofibular syndesmosis fibular notch was divided into four types according to morphological characteristics‚ C-shaped (50. 67%)‚ V-shaped (26. 67%)‚ flat-shaped (15. 11%) and L-shaped (7. 56%). The angle between the anterior and posterior facets of the flat shape (145. 56 ± 9. 25)° was the largest and the angle between the anterior and posterior facets of the L shape (125. 07 ± 13. 54)° was the smallest(P< 0. 05); the depth of the notch in the flat shape (3. 11 ± 0. 83) mm was the smallest and in the L shape (4. 47±1. 11) mm was the largest(P<0. 05);The posterior facet length (13. 06 ± 3. 56) mm and anterior tibiofibular gap (3. 83±1. 49) mm on left were larger than on the right side (P<0. 05); The posterior facet length (13. 36 ± 3. 46) mm‚ fibular notch depth (3. 93 ± 1. 10) mm and vertical distance of tibiofibular overlap (9. 10 ± 2. 55) mm larger in men than in women (P<0. 05). Conclusion In this study‚ the data related to the inferior tibiofibular syndesmosis notch were measured and divided into four types according to the shape. The flat inferior tibiofibular syndesmosis notch is more likely to have chronic ankle instability‚ and the fibula is more likely to move forward during anatomical reduction. The inferior tibiofibular syndesmosis of L-shaped and C-shaped notches is more prone to posterior displacement of fibula or poor rotation reduction during anatomical reduction.

Finite element analysis of cervical intervertebral discs after removing different ranges of uncinate processes / 解剖学报

Objective To study the stress change characteristics of the cervical disc after removing different ranges of the uncinate process by establishing a three⁃dimensional finite element model of the C

Effectiveness of Multimedia Approaches in Embryology Teaching: A Scoping Review

@#Embryology is a critical subdiscipline in medical education, focusing on human body organ development and providing a foundation for understanding developmental anatomy. However, traditional teaching methods using static 2D graphics in textbooks may hinder students’ comprehension of the complex 3D embryonic growth processes. To address this, multimedia approaches, such as animations, videos, and interactive tools, have been explored for effective embryology education. This scoping review identifies five key elements of successful multimedia teaching in embryology: multimodal integrated instructional content, cognitive load-reduction strategies, cognitive engagement and physical interactivity, learner-controlled multimedia instruction, and development of tacit knowledge. These strategies promote active learning, enhance students’ understanding, and foster critical thinking skills. Future research should focus on evaluating the impact of multimedia approaches on students’ engagement, attitudes, and competency development. Embracing multimedia in embryology education can improve medical students’ clinical understanding and support effective medical practice.

Research progress in liver transplantation in patients with situs inversus totalis / 器官移植

Situs inversus totalis (SIT) is a rare congenital condition, with an extremely low incidence. There is no difference between SIT individuals without onset of diseases and healthy counterparts. However, when SIT individuals suffer from diseases, the diagnosis and treatment are highly challenging due to insufficient understanding of SIT populations, especially for those complicated with end-stage liver disease and requiring liver transplantation. It is a huge challenge for surgeons whether SIT individuals serve as donors or recipients of liver transplantation. In this article, recent case reports related to liver transplantation in SIT patients were summarized, and the development, key procedures, clinical prognosis and postoperative complications of liver transplantation in SIT patients were reviewed.

Morphophysiological changes of Acca sellowiana (Myrtaceae: Myrtoideae) saplings under shade gradient

Abstract Understanding morphological and physiological changes under different light conditions in native fruit species in juveniles stage is important, as it indicate the appropriate environment to achieve vigorous saplings. We aimed to verify growth and morphophysiological changes under shade gradient in feijoa (Acca sellowiana (O. Berg) Burret) to achieve good quality saplings adequate to improve cultivation in orchards. The saplings were grown for twenty-one-month under four shading treatments (0%, 30%, 50%, and 80%). Growth, photosynthetic pigments, gas exchanges, chlorophyll fluorescence, and leaf anatomy parameters were evaluated. Saplings under full sun and 30% shade had higher height and diameter growth and dry mass accumulation due to higher photosynthesis rate. As main acclimatization mechanisms in feijoa saplings under 80% shade were developed larger leaf area, reduced leaf blade thickness, and enhanced quantum yield of photosystem II. Even so, the net CO2 assimilation and the electron transport rate was lower and, consequently, there was a restriction on the growth and dry mass in saplings under deep shade. Therefore, to obtain higher quality feijoa saplings, we recommend that it be carried out in full sun or up to 30% shade, to maximize the sapling vigor in nurseries and, later, this light environment can also be used in orchards for favor growth and fruit production.

Resumo A verificação de mudanças morfológicas e fisiológicas sob diferentes condições luminosas em espécies frutíferas nativas em estágio juvenil é importante, uma vez que indicam o ambiente adequado para a formação de mudas com alto vigor. Objetivou-se verificar o crescimento e as alterações morfofisiológicas sob gradiente de sombreamento em mudas de feijoa (Acca sellowiana (O. Berg) Burret) para obter mudas de boa qualidade, adequadas para fomentar os plantios da espécie em pomares. As mudas foram cultivadas por vinte e um meses sob quatro tratamentos de sombreamento (0%, 30%, 50% e 80%). Foram avaliados parâmetros de crescimento, pigmentos fotossintéticos, trocas gasosas, fluorescência da clorofila e anatomia foliar. Mudas a pleno sol e 30% de sombra apresentaram maior crescimento em altura, diâmetro e acúmulo de massa seca, devido à maior taxa de fotossíntese. Como principais mecanismos de aclimatação sob 80% de sombra, as mudas desenvolveram maior área foliar, redução da espessura do limbo foliar e aumento do rendimento quântico do fotossistema II. Mesmo assim, a assimilação líquida de CO2 e a taxa de transporte de elétrons foram menores e, consequentemente, houve restrição ao crescimento e acúmulo de massa seca das mudas no maior nível de sombreamento. Portanto, para a obtenção de mudas de feijoa de maior qualidade, recomendamos que seja realizada a pleno sol ou até 30% de sombra, para maximizar o vigor das mudas em viveiros e, posteriormente, este ambiente de luz também pode ser utilizado em pomares para favorecer o crescimento e a produção de frutos.

Performance of obturation techniques in anatomical irregularities located at different thirds of the root canal system

Abstract This study aimed to compare the quality of root canal obturation (ratio of area occupied by gutta-percha (G), sealer (S), and presence of voids (V)) in different anatomical irregularities (intercanal communications, lateral irregularities, and accessory canals) located at different thirds of the root canal system of mandibular molar replicas. Sixty-seven 3D printed replicas of an accessed mandibular molar were prepared using ProGlider and ProTaper Gold rotatory systems. Three specimens were randomly selected to be used as controls and did not receive further treatment. The rest were randomly distributed in 4 experimental groups to be obturated using either cold lateral compaction (LC), continuous wave of condensation (CW), and core-carrier obturation (ThermafilPlus (TH) or GuttaCore (GC)) (n=16 per group). AHPlus® sealer was used in all groups. The three controls and a specimen from each experimental group were scanned using micro-computed tomography. The rest of the replicas were sectioned at the sites of anatomical irregularities and examined at 30× magnification. The G, S, and V ratios were calculated dividing the area occupied with each element by the total root canal area and then compared among groups using the Kruskal-Wallis test. Voids were present in all obturation techniques with ratios from 0.01 to 0.15. CW obtained a significantly higher G ratio in the irregularity located in the coronal third (0.882) than LC (0.681), TH (0.773), and GC (0.801) (p<0.05). TH and GC achieved significantly higher G ratios in those located in the apical third (p<0.05). The worst quality of obturation was observed in the loop accessory canal with all obturation techniques. Whitin the limitations of this study, it can be concluded that CW and core-carrier obturation are respectively the most effective techniques for obturating anatomical irregularities located in the coronal and the apical third.

Evaluation of the mesenteric arterial vasculature by computed tomography angiography and its implications for colorectal cancer surgery / Avaliação da vasculatura arterial mesentérica pela angiotomografia computadorizada e suas implicações na cirurgia do câncer colorretal

Abstract Objective: To determine the branching patterns of the inferior mesenteric artery (IMA) and to describe the clinical applicability of computed tomography (CT) angiography in the evaluation of these vessels to facilitate the planning of colorectal cancer surgery. Materials and Methods: We included 100 patients who underwent CT angiography of the abdomen and pelvis. The branching patterns of the IMA were examined and classified as type 1 (bifurcated), including 1A (sigmoid and left colic arteries arising from a common trunk), 1B (sigmoid and superior rectal arteries arising from a common trunk) and 1C (sigmoid arteries arising from both trunks); type 2 (trifurcated); and type 3 (no left colic branch). Results: Among the 100 patients evaluated, we found the variant to be type 1A in 9%, type 1B in 47%, type 1C in 24%, type 2 in 16%, and type 3 in 4%. Conclusion: Preoperative CT angiography for evaluating the IMA branching pattern could inform decisions regarding the surgical approach to colorectal cancer.

Resumo Objetivo: Determinar os padrões de ramificação da artéria mesentérica inferior (AMI) e descrever a aplicabilidade clínica da angiografia por tomografia computadorizada na avaliação desses vasos na elaboração das estratégias pré-operatórias de cirurgia de câncer colorretal. Materiais e Métodos: Foram incluídos 100 pacientes submetidos a angiografia por tomografia computadorizada abdominal e pélvica. Os padrões de ramificação da AMI foram examinados e classificados como tipo 1 (bifurcado), incluindo 1A (artérias sigmoide e cólica esquerda originando-se de um tronco comum), 1B (artérias sigmoide e retal superior originando-se de um tronco comum) e 1C (artérias sigmoide originando-se de ambos os troncos); tipo 2 (trifurcado); e tipo 3 (sem ramo cólico esquerdo). Resultados: Do total de participantes incluídos no estudo, a variante do tipo 1A foi observada em 9%, a do tipo 1B em 47%, e a do tipo 1C em 24%. Com relação à variante tipo 2, esta foi observada em 16% dos pacientes, e a do tipo 3, em 4% dos casos. Conclusão O uso da angiografia por tomografia computadorizada pré-operatória para avaliar o padrão de ramificação da AMI pode ajudar a escolher a abordagem cirúrgica no câncer colorretal.

Tendências investigativas contemporâneas no ensino-aprendizagem de anatomia humana no Brasil / Contemporary investigative trends in the teaching-learning of human anatomy in Brazil

RESUMO Introdução: A anatomia humana desempenha um papel central na formação de profissionais de saúde, fornecendo a base fundamental para compreender o corpo humano e suas complexidades. Isso é particularmente relevante no contexto do ensino médico, sobre o qual as Diretrizes Curriculares Nacionais (DCN) de 2014 mencionam a importância do conteúdo curricular relacionado à estrutura, de modo a influenciar a execução da anamnese, do exame físico e do diagnóstico nosológico. Desenvolvimento: Quanto ao currículo, o ensino de anatomia vem passando por mudanças significativas nas últimas décadas, buscando equilibrar abordagens tradicionais e ativas, promover a integração curricular e ampliar perspectivas bioéticas e biopsicossociais no estudo. O ensino da anatomia tem evoluído, mas ainda é frequentemente baseado em aulas expositivas e práticas em laboratório de dissecação, com foco na memorização. No entanto, há um consenso crescente de que abordagens mais interativas, práticas e integradas são necessárias, incluindo o uso de tecnologias educacionais. Sobre os métodos de aprendizagem, os recursos de estudo incluem livros-texto, atlas, peças anatômicas, tecnologias digitais e softwares especializados, e a dissecação em cadáveres e peças anatômicas naturais ainda é altamente valorizada, mas enfrenta desafios logísticos e bioéticos. Os desafios da aprendizagem incluem a grande quantidade de informações a serem memorizadas, a complexidade da nomenclatura anatômica, a necessidade de disponibilidade de horários para práticas, o aumento e a diversificação das avaliações, e a intervenção na falta de motivação discente em relação ao estudo de anatomia. Ainda, há iniciativas de integração do ensino, pesquisa e extensão na anatomia que devem ser incentivadas para os estudantes se envolverem em projetos de pesquisa desde o início do curso e desenvolverem atividades com a comunidade, como a partir de museus de ciências da vida. Considerações Finais: O ensino de anatomia está em constante evolução, e as tendências investigativas contemporâneas têm o potencial de melhorar significativamente os processos de ensino e aprendizagem da morfologia humana. A pesquisa em ensino de anatomia, especialmente no contexto brasileiro, é essencial para entender a evolução dessa disciplina e adaptá-la às mudanças nas perspectivas educacionais e tecnológicas.

ABSTRACT Introduction: human anatomy plays a central role in the training of healthcare professionals, providing the fundamental basis for understanding the human body and its complexities. This is particularly relevant in the context of medical education, where the 2014 National Curricular Guidelines (DCN) mention the importance of structure-related curricular content, influencing the execution of anamnesis, physical examination and nosological diagnosis. Development: as far as the curriculum is concerned, anatomy teaching has undergone significant changes in recent decades, seeking to balance traditional and active approaches, promote curricular integration and expand bioethical and biopsychosocial perspectives in the study. Anatomy teaching has evolved, but is still often based on lectures and practical classes in the dissection laboratory, with a focus on memorization. However, there is a growing consensus that more interactive, practical and integrated approaches are needed, including the use of educational technologies. In terms of study methods, resources include textbooks, atlases, anatomical pieces, digital technologies and specialized software; dissection on cadavers and natural anatomical pieces remains highly valued, but is faced with logistical and bioethical challenges. Learning challenges include the large amount of information to be memorized, the complexity of anatomical nomenclature, the need to have time available for practices, increased and diversified assessments and interventions in the lack of student motivation in relation to the study of anatomy. Furthermore, there are initiatives to integrate teaching, research and community outreach in anatomy that should be encouraged for students to involve themselves in research projects from the start of the course and develop activities with the community, such as life science museums. Final Considerations: anatomy teaching is constantly evolving, and contemporary investigative trends have the potential to significantly improve the teaching and learning processes of human morphology. Research into anatomy teaching, especially in the Brazilian context, is essential to understand the evolution of this discipline and adapt it to changes in educational and technological perspectives.

Transtibial Femoral Tunnel Technique in ACL Reconstruction and Osteoarthritis Incidence / Técnica do túnel femoral transtibial na reconstrução do LCA e incidência de osteoartrite

Abstract Objective: Evaluate osteoarthritis incidence in patients that undergone ACL reconstruction using the transtibial technique, with a minimum of 5 years of follow up, with isolated ACL injury. Methods: Patients who underwent ACL reconstruction by the same surgeon using the transtibial technique with hamstrings graft and with a minimum of 5 years of follow-up, without other injuries during the surgical procedure, were selected to undergo imaging exams of the operated knee to assess the incidence of osteoarthritis. The obtained data were evaluated by descriptive statistics. Results: Forty-two patients (44 knees) were evaluated, with a mean age of 31 years old (SD: 8), being 23 right knees and 28 male patients. Mean time from surgery to imaging evaluation was 94.1 months (ranging from 60 to 154 months; SD: 28). Of the evaluated knees, 37 did not have osteoarthritis (83.3%) and 7 had (16.7%). Conclusion: ACL reconstruction with femoral tunnel performed through the transtibial technique in patients without other associated injuries in the operated knee, using hamstrings graft, with a minimum of 5 years of follow up, showed an osteoarthritis incidence of 16.7% in a mean follow-up of 94.1 months. Level Of Evidence V; Case Series.

Resumo Objetivo: Avaliar a incidência de osteoartrite em pacientes submetidos à reconstrução do LCA pela técnica transtibial, com seguimento mínimo de 5 anos, com lesão isolada do LCA. Métodos: Pacientes que passaram por reconstrução LCA pelo mesmo cirurgião usando a técnica transtibial com enxerto de tendão dos músculos isquiotibiais e que foram acompanhados por no mínimo 5 anos, sem outras lesões durante o procedimento cirúrgico, foram selecionados para realizar exames de imagem do joelho operado a fim de avaliar a incidência de osteoartrite. Os dados obtidos foram avaliados por meio de estatísticas descritivas.. Resultados: Foram avaliados 42 pacientes (44 joelhos), com idade média de 31 anos (DP: 8), sendo 23 joelhos direitos e 28 pacientes do sexo masculino. O tempo médio entre a cirurgia e a avaliação por imagem foi de 94,1 meses (variando de 60 a 154 meses; DP: 28). Dos joelhos avaliados, 37 não apresentavam osteoartrite (83,3%) e 7 apresentavam (16,7%). Conclusão: A reconstrução do LCA com túnel femoral realizado por meio da técnica transtibial em pacientes sem outras lesões associadas no joelho operado, utilizando enxerto dos tendões isquiotibiais, com um acompanhamento mínimo de 5 anos, apresentou uma incidência de osteoartrite de 16,7% em um acompanhamento médio de 94,1 meses. Level of Evidence V; Case Series. Nível de Evidência V; Série de casos