"TIPS" and Technical Nuances for Digital Illustration in Neurointerventional Surgery.

Medical illustrations represent a precious resource for learning surgical anatomy and surgical techniques, allowing pre- and postoperative reviews. As traditional hand-drawn illustrations are difficult to use and expressing the area of neurointerventional surgery is time-consuming, we proposed methods for neurointerventional surgeons to create digital illustrations (DIs) for neurointerventional surgery using the iPad-exclusive Procreate application (Savage Interactive, Hobart, Australia). Dedicated "digital pens" were created and used for each endovascular device, creating straightforward representations of neurointerventional procedures and changes over time. DIs in neurointervention easily depict changes to highlighted surgical scenes for various devices with complex configurations and structures. DIs are also versatile, allowing easy intra- and inter-institutional sharing and discussion of technical tips on the manipulation of medical devices (coils, catheters, stents, etc.) among neurointerventional surgeons worldwide. DIs can be applied as educational tools not only in neurointerventional surgery, but also in craniotomy surgery and for surgical records from other specialties.

Seven new species of the subgenus Homoneura Malloch (Diptera, Lauxaniidae, Homoneura) from Jiangjin District, southwestern Chongqing, China.

Seven new species of the subgenus Homoneura are described, Homoneura (Homoneura) biconica Chen & Li, sp. nov., Homoneura (Homoneura) dilatata Chen & Li, sp. nov., Homoneura (Homoneura) jiangjinensis Chen & Li, sp. nov., Homoneura (Homoneura) microtricha Chen & Li, sp. nov., Homoneura (Homoneura) multiseta Chen & Li, sp. nov., Homoneura (Homoneura) serrulata Chen & Li, sp. nov., Homoneura (Homoneura) simianshana Chen & Li, sp. nov., which were collected from Jiangjin District, southwestern Chongqing, China and are assigned to the henanensis group. A key to all of the 53 species of this species group in China is presented.

Breaking boundaries in neurosurgery through art and technology: A historical perspective.

Introduction: Since the past, art has been used as a tool to elaborate anatomical knowledge and guide surgeons to perform surgeries. Through the eras, art has taken role by conveying the knowledge to people in forms of illustrations and models, including neuroanatomy knowledge for neurosurgical purposes. With the advancement of technology, neurosurgical trainings and care evolve more than before. Research question: How do art and technology play role in tbe education and development of neurosurgery? Materials and methods: A literature search was conducted to find the role of art and technology in forms of illustrations, models, or others in neurosurgery. Results: Illustration was known as one of the tools to understand it in the past. Now, in the modern era, neurosurgical learning, training, and teaching process have integrated both art and technology throughout the process. Not only as two-dimenional drawings, art and technology have gone as far as being developed into three-dimensional models and create specific models for surgical plannings and simulations. Artificial intelligence, virtual reality, and augmented reality have also been used to achieve accurate and efficient learning process and neurosurgical care. Discussion and conclusion: Art does take significant role in the progression of neurosurgery. When combined with technology, art give greater utility and impact through the learning, teaching process, and delivery of care in neurosurgical world.

Everyone can draw: An inclusive and transformative activity for conceptualization of topographic anatomy.

Anatomical drawing traditionally involves illustration of labeled diagrams on two-dimensional surfaces to represent topographical features. Despite the visual nature of anatomy, many learners perceive that they lack drawing skills and do not engage in art-based learning. Recent advances in the capabilities of technology-enhanced learning have enabled the rapid and inexpensive production of three-dimensional anatomical models. This work describes a "drawing on model" activity in which learners observe and draw specific structures onto three-dimensional models. Sport and exercise sciences (SES, n = 79) and medical (MED, n = 156) students at a United Kingdom medical school completed this activity using heart and femur models, respectively. Learner demographics, their perceptions of anatomy learning approaches, the value of the activity, and their confidence in understanding anatomical features, were obtained via validated questionnaire. Responses to 7-point Likert-type and free-text items were analyzed by descriptive statistics and semi-quantitative content analysis. Learners valued art-based study (SES mean = 5.94 SD ±0.98; MED = 5.92 ± 1.05) and the "drawing on model" activity (SES = 6.33 ± 0.93; MED = 6.21 ± 0.94) and reported enhanced confidence in understanding of cardiac anatomy (5.61 ± 1.11), coronary arteries (6.03 ± 0.83), femur osteology (6.07 ± 1.07), and hip joint muscle actions (5.80 ± 1.20). Perceptions of learners were independent of both their sex and their art-based study preferences (p < 0.05). Themes constructed from free-text responses identified "interactivity," "topography," "transformative," and "visualization," as key elements of the approach, in addition to revealing some limitations. This work will have implications for anatomy educators seeking to engage learners in an inclusive, interactive, and effective learning activity for supporting three-dimensional anatomical understanding.

Anatomy's missing faces: An assessment of representation gaps in atlas and textbook imagery.

Previous research suggests that underrepresentation in medical curricula perpetuates inequities in healthcare. This study aimed to quantify the prevalence of human phenotypic diversity (e.g., skin tone, sex, body size, and age) across 11 commonly used anatomy atlases and textbooks in pre-clerkship medical education, published from 2015 to 2020. A systematic visual content analysis was conducted on 5001 images in which at least one phenotypic attribute was quantifiable. Anatomy images most prevalently portrayed light skin tones, males, persons with intermediate body sizes, and young to middle-aged adults. Of the 3883 images in which there was a codable skin tone, 81.2% (n = 3154) depicted light, 14.3% (n = 554) depicted intermediate, and 4.5% (n = 175) depicted dark skin tones. Of the 2384 images that could be categorized into a sex binary, 38.4% (n = 915) depicted females and 61.6% (n = 1469) depicted males. A male bias persisted across all whole-body and regional-body images, including those showing sex organs or those showing characteristics commonly associated with a specific sex (e.g. for males, facial hair and/or muscle hypertrophy). Within sex-specific contexts, darker skin was underrepresented, but male depictions displayed greater overall skin tone variation. Although most images could not be assigned to a body size or age category, when codable, these images overwhelmingly depicted adults (85.0%; 482 of 567) with smaller (34.7%; 93 of 268) or intermediate (64.6%; 173 of 268) body sizes. Ultimately, these outcomes provide reference metrics for monitoring ongoing and future efforts to address representation inequalities portrayed in anatomical imagery.

Unsatisfactory Neurological Outcome in an Intramedullary Thoracic Intermediate-Grade Melanocytoma-Systematic Review and Illustrative Case.

BACKGROUND: Intramedullary melanocytomas are exceedingly rare, with only twenty-four cases reported up to now. They present as local invasive tumors despite their benign biological behavior. Attempting a complete safe resection often results in severe post-operative neurological deficits, as in our case presented here. METHODS: A systematic review was conducted across the PubMed and Scopus databases including studies published till February 2024. RESULTS: A total of 19 studies were included, encompassing 24 cases. A similar distribution between sexes was noted (M:F 13:11), with ages ranging from 19 to 79 years. The thoracic segment was most affected, and intermediate-grade melanocytoma (19 cases) was the most common histotype. Radiographically, intramedullary melanocytomas usually appear as hyperintense hemorrhagic lesions peripheral to the central canal with focal nodular enhancement. Intraoperatively, they are black-reddish to tan and are tenaciously adherent lesions. In the sampled studies, IONM employment was uncommon, and post-operative new-onset neurological deficits were described in 16 cases. Adjuvant RT was used in four cases and its value is debatable. Recurrence is common (10 cases), and adjuvant therapies (RT or repeated surgery) seem to play a palliative role. CASE PRESENTATION: A 68-year-old woman presented with a three-year history of worsening spastic paraparesis and loss of independence in daily activities (McCormick grade 4). An MRI revealed an intramedullary tumor from Th5 to Th7, characterized by T1-weighted hyperintensity and signs of recent intralesional hemorrhage. Multimodal neuromonitoring, comprising the D-Wave, guided the resection of a black-tan-colored tumor with hyper-vascularization and strong adherence to the white matter. During final dissection of the lesion to obtain gross total resection (GTR), a steep decline in MEPs and D-Wave signals was recorded. Post-operatively, the patient had severe hypoesthesia with Th9 level and segmental motor deficits, with some improvement during neurorehabilitation. Histopathology revealed an intermediate-grade melanocytoma (CNS WHO 2021 classification). A four-month follow-up documented the absence of relapse. CONCLUSIONS: This literature review highlights that intramedullary T1 hyperintense hemorrhagic thoracic lesions in an adult patient should raise the suspicion of intramedullary melanocytoma. They present as locally aggressive tumors, due to local invasiveness, which often lead to post-operative neurological deficits, and frequent relapses, which overwhelm therapeutic strategies leading to palliative care after several years.

Multisensory medical illustrations of Buruli ulcer for improved disease detection, help seeking behaviour and adherence to treatment.

Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans and a neglected tropical disease of the skin (skin NTD). Antibiotic treatments are available but, to be effective in the absence of surgery, BU must be detected at its earliest stages (an innocuous-looking lump under the skin) and adherence to prescribed drugs must be high. This study aimed to develop multisensory medical illustrations of BU to support communication with at-risk communities. We used a Think Aloud method to explore community health workers' (n = 6) experiences of BU with a focus on the role of their five senses, since these non-medical disease experts are familiar with the day-to-day challenges presented by BU. Thematic analysis of the transcripts identified three key themes relating to 'Detection,' 'Help Seeking,' and 'Adherence' with a transcending theme 'Senses as key facilitators of health care'. New medical illustrations, for which we coin the phrase "5D illustrations" (signifying the contribution of the five senses) were then developed to reflect these themes. The senses therefore facilitated an enriched narrative enabling the production of relevant and useful visuals for health communication. The medical artist community could utilise sensory experiences to create dynamic medical illustrations for use in practice.

The Reformation.

The most important text at the end of the Middle Ages was the Bible. It had been published in manuscript on parchment bound between wooden covers. The production of such a book was time consuming and expensive. Martin Luther's proclamation of 95 theses directed against the practice and authority of the Roman Catholic church led to a speedy opposition from the church. However, the modern availability of paper and printing together with the printing of images, resulted in a rapid distribution of the bible in German. The church authorities had banned the spreading of literacy outside the clergy, but the publishing of Luther's bible involved the use of techniques which could be applied to other disciplines, improving the quality of the information on which their activities was based. This included the practice of surgery.

The role of medical illustration in the evolution of transsphenoidal pituitary surgery.

Medical illustration played a crucial, yet often overlooked, role in the evolution of pituitary surgery. From the late 1800s to the present, many preeminent surgeons, in partnership with their surgical illustrator collaborators, developed and then shifted the paradigm of pituitary surgery, from an open procedure with high mortality and morbidity, to an endonasal approach with high success rates that is widely utilized today. This work aims to highlight the role of surgical illustrators as partners to their physician colleagues, creating artistically accessible road maps that shaped the development of the transsphenoidal approach.

Three-dimensional modeling in anatomy-Tool or terror?

Three-dimensional (3D) modeling is a recent, innovative approach to teaching anatomy. There is little literature, however, to suggest how 3D modeling is best used to teach students and whether or not students can gain the same level of understanding as they might use more traditional, hands-on, teaching methods. This study evaluated the use of a 3D modeling software in both a flipped classroom curriculum and as an active learning tool in comparison to traditional, physical model-based teaching. Pre- and post-course content-based assessments were used to evaluate students' learning. Our findings indicated no significant difference between standard and flipped classroom learning; however, the students who used 3D modeling software as an active learning tool significantly underperformed students in the standard group (F(2,1060) = 112.43, p < 0.0001). These findings suggest that these technologies may not yet be useful as a primary means of instruction. Possible explanations may include cognitive overload in navigating the system, intrinsic limitations of the software, or other factors. Further development and research of these technologies is necessary prior to their adoption into teaching practices in anatomy.

Using AI Text-to-Image Generation to Create Novel Illustrations for Medical Education: Current Limitations as Illustrated by Hypothyroidism and Horner Syndrome.

Our research letter investigates the potential, as well as the current limitations, of widely available text-to-image tools in generating images for medical education. We focused on illustrations of important physical signs in the face (for which confidentiality issues in conventional patient photograph use may be a particular concern) that medics should know about, and we used facial images of hypothyroidism and Horner syndrome as examples.

Ottoman plants, nature studies, and the attentiveness of translational labor.

Translations, whether in the form of text, illustration, or interpretive analysis, served knowledge-making in multiple ways. It offered a refuge, severed contexts, and concealed the various workers that created it. Over the course of the seventeenth century, European naturalists in Istanbul, such as Luigi Ferdinando Marsigli (1658-1730), procured illustrations of Ottoman nature as fundamental resources to identify, collect, and compare indigenous plants and newly bred varieties. Despite maintaining an actual mediation for cross-cultural interactions, these sources of virtual communication remain largely forgotten in modern scholarship. This article argues that this curious yet invisible corpus was not a nonagentive medium in an alienated leisure of a gentleman-scholar; instead, these illustrations were designed to call upon the viewer's constant attention in self-motivated scientific labor. Such handy tools responded and contributed to early modern scholars' modes of working, and in exchange they determined these sources' own function, position, and visibility - either as a by-product or as a derivative. It is therefore only when integrated into the labor history of science that the degrees of invisibility pertaining to both Ottoman nature studies and self-directed labor can come into a granular view.

Cover images of the Journal of Comparative Physiology A and the stories behind them.

The cover images of the 2023 issues of the Journal of Comparative Physiology A, as well as its logo image, are presented at full size and high resolution, together with the stories behind them. These images are testament to the artistic quality of the scientific illustrations published in the Journal of Comparative Physiology A.

Revisiting the History of Odontoma, with Special Reference to Its Original Illustration.

BACKGROUND: Practically every facet of the most common odontogenic tumor, odontoma, has been covered by an extensive volume of literature. However, uncertainty about its precise history has persisted. MATERIALS AND METHODS: The historical evolution of odontoma was traced with reference to the original illustrations that accompanied European and American reports published at the beginning of the 19th century and also at the turn of the century. RESULTS: The prevailing views regarding the first description of odontoma by Oudet of Paris in 1809 and the original designation "odontome" by Broca of Paris in 1867 are not entirely accurate. Before Broca's suggested term, "exostose dentaire" (dental exostosis) and "tumeur dentaire" (dental tumor) proposed by Oudet and Forget of Paris, respectively, were popular terms adopted in France, while in Briatin the terms "warty tooth" and "supernumerary teeth" proposed by Salter and Tomes of London, respectively, were widely coined. The original illustrations of complex odontoma were published by Wedl of Vienna in 1851, and in 1862 Tomes published the first drawing of compound odontoma denticles. Before the advent of diagnostic radiography in the early 1900s, spontaneous exposure or eruption of odontoma followed by secondary infection was very common. In 1887-1888, Bland Sutton of London criticized Broca's monumental research and formulated the first modern classification which, in essence, remains valid today. At that time, large osteomas of the maxilla were inappropriately classified as odontomas by many pathologists because of Bland Sutton's influential view. Interestingly, the first radiographic evidence of odontoma was published by the American oral surgeon Gilmer in 1899. CONCLUSION: In view of their fundamental achievements, the names of Wedl, Salter, Broca and Bland Sutton have been closely associated with the true history of odontoma.

Evaluating AI-powered text-to-image generators for anatomical illustration: A comparative study.

Medical illustration, which involves the creation of visual representations of anatomy, has long been an essential tool for medical professionals and educators. The integration of AI and medical illustration has the potential to revolutionize the field of anatomy education, providing highly accurate, customizable images. The authors evaluated three AI-powered text-to-image generators in producing anatomical illustrations of the human skulls, heart, and brain. The generators were assessed for their accurate depiction of foramina, suture lines, coronary arteries, aortic and pulmonary trunk branching, gyri, sulci, and the relationship between the cerebellum and temporal lobes. None of the generators produced illustrations with comprehensive anatomical details. Foramina, such as the mental and supraorbital foramina, were frequently omitted, and suture lines were inaccurately represented. The illustrations of the heart failed to indicate proper coronary artery origins, and the branching of the aorta and pulmonary trunk was often incorrect. Brain illustrations lacked accurate gyri and sulci depiction, and the relationship between the cerebellum and temporal lobes remained unclear. Although AI generators tended toward esoteric imagery, they exhibited significant speed and cost advantages over human illustrators. However, improving their accuracy necessitates augmenting the training databases with anatomically correct images. The study emphasizes the ongoing role of human medical illustrators, especially in ensuring the provision of accurate and accessible illustrations.

Beautiful vulvas: expanding illustrative visual imagery of female genital cutting types.

BACKGROUND: Visual imagery has been used to educate healthcare providers, patients, and the lay public on female genital cutting (FGC) typology and reconstructive procedures. However, culturally inclusive, diverse, and anatomically accurate representation of vulvas informed by women possessing lived experience of FGC is lacking. AIM: We sought to apply World Health Organization (WHO) FGC typology to the development of type-specific visual imagery designed by a graphic artist and culturally informed by women with lived experience of FGC alongside a panel of health experts in FGC-related care. METHODS: Over a 3-year process, a visual artist created watercolor renderings of vulvas with and without FGC across varying WHO types and subtypes using an iterative community-based approach. Somali women possessing lived experience of FGC were engaged alongside a team of clinician experts in FGC-related care. Women and clinicians provided descriptive input on skin color variation, texture, and skin tone, as well as the visual depiction of actions necessary in conducting a genital examination. OUTCOMES: A series of vulvar anatomic illustrations depicting WHO FGC typology. RESULTS: FGC types and subtypes are illustrated alongside culturally informed descriptors and clinical pearls to strengthen provider competency in the identification and documentation of FGC WHO typology, as well as facilitate patient education, counseling, shared decision making, and care. CLINICAL IMPLICATIONS: Ensuring equitable representation of race, gender, age, body type, and ability in medical illustrations may enhance patient education, counseling, and shared decision making in medical and/or surgical care. FGC provides a lens through which the incorporation of patient-informed and culturally relevant imagery and descriptors may enhance provider competency in the care of FGC-affected women and adolescents. STRENGTHS AND LIMITATIONS: The strengths of this study include the development of visual imagery through an iterative community-based process that engaged women with lived experience of FGC alongside clinicians with expertise in FGC-related care, as well as the representation of historically underrepresented bodies in the anatomical literature. Study limitations include the lack of generalizability to all possible forms or practices of FGC given the focus on one geographically distinct migrant community, as well as the reliance on self-report given the inability to clinically verify FGC status due to the community-based methodology employed. CONCLUSION: Patient-informed and culturally representative visual imagery of vulvas is essential to the provision of patient-centered sexual health care and education. Illustrations developed through this community-engaged work may inform future development of visual educational content that advances equity in diverse representation of medical illustrations.

Augmented Tactile Book: Design of a Multisensory Page Prototype.

In the framework of the LTA project, focusing on leisure reading for children with visual impairment, we present a prototype of multisensory illustration that will be used as a model for future accessible tactile interactive books. This multisensory illustration is based on two approaches to illustrate the storytelling. The first approach consists in embodying the character's legs with the index and middle fingers in order for the user to imitate actions such as walking. The second approach is to offer interactions feedback according to the readers actions. The main goal of this multisensory illustration prototype is to test and evaluate a selection of interactions and their associated sensors. These interactions help visually impaired readers to identify the environment of the story. They also help to understand actions behind the verbs. Readers are engaged to produce actions such as touching and imitating with their fingers. These interactions are developed according to hypotheses based on the literature. This multisensory illustration prototype was tested with a panel of children. The results comfort the idea that these interactions are useful for them.

Two new species of Amaurobius C.L. Koch, 1837 from China (Araneae, Amaurobiidae).

Two new species of the genus Amaurobius are described from China: A.guangwushanensissp. nov. (♂♀) from Sichuan and A.wulongdongensissp. nov. (♂♀) from Shaanxi. With the addition of two new species, the number of Amaurobius species endemic to China now reaches four. Morphological descriptions, photos, and illustrations of copulatory organs, as well as a map of distribution records, are provided.

Multi-Label Classification in Anime Illustrations Based on Hierarchical Attribute Relationships.

In this paper, we propose a hierarchical multi-modal multi-label attribute classification model for anime illustrations using a graph convolutional network (GCN). Our focus is on the challenging task of multi-label attribute classification, which requires capturing subtle features intentionally highlighted by creators of anime illustrations. To address the hierarchical nature of these attributes, we leverage hierarchical clustering and hierarchical label assignments to organize the attribute information into a hierarchical feature. The proposed GCN-based model effectively utilizes this hierarchical feature to achieve high accuracy in multi-label attribute classification. The contributions of the proposed method are as follows. Firstly, we introduce GCN to the multi-label attribute classification task of anime illustrations, enabling the capturing of more comprehensive relationships between attributes from their co-occurrence. Secondly, we capture subordinate relationships among the attributes by adopting hierarchical clustering and hierarchical label assignment. Lastly, we construct a hierarchical structure of attributes that appear more frequently in anime illustrations based on certain rules derived from previous studies, which helps to reflect the relationships between different attributes. The experimental results on multiple datasets show that the proposed method is effective and extensible by comparing it with some existing methods, including the state-of-the-art method.

A novel scale for the evaluation of physician drawn medical illustrations.

Effective communication is a crucial component of patient-centered care and individuals with low health literacy face significant challenges in managing their health, leading to longer hospital stays and worse outcomes. Visual aids, such as medical illustrations and pictograms, can enhance patient understanding and memory retention; however, there is a lack in the medical field of tools for evaluating and improving a physician's ability to draw clinical illustrations for their patient. This article explores an aesthetic scale created in collaboration between Boston University Medical School and the Boston University Fine-Arts department. The scale scores basic design elements that could reasonably be improved in a clinical setting. A pilot study demonstrated interrater reliability between trained artists scoring images of varying concepts and visual quality with a Cronbach's alpha of 0.95. This scale has potential use in medical visual education and clinical evaluation.