The Lazarus sign is a well-documented spinal reflex observed in brain-dead patients, characterized by involuntary upper limb movements that can resemble voluntary gestures. Initially described during the 1980s, this phen...The Lazarus sign is a well-documented spinal reflex observed in brain-dead patients, characterized by involuntary upper limb movements that can resemble voluntary gestures. Initially described during the 1980s, this phenomenon has contributed to ongoing discussions about the physiological basis of spinal reflexes and their role in assessing brain death. The Lazarus sign was once considered a diagnostic challenge, but recent research reports confirm that it originates solely from the spinal cord, independent of brainstem or cortical activity. However, recent studies also suggest that spinal reflexes in brain-dead patients, including the Lazarus sign, can be more variable than previously thought, occurring in multiple limb regions beyond the upper limbs. Prolonged survival in brain-dead patients exhibiting the Lazarus sign has also raised new questions about its physiological significance. Its recognition has helped refine brain death criteria, ensuring accurate diagnoses and minimizing misinterpretations in critical care and organ donation settings. PubMed-indexed studies and backward citations were reviewed. Studies were included if they explicitly described spinal reflexes in brain-dead patients, examined neurophysiological mechanisms, or provided clinical observations on the Lazarus sign. Exclusion criteria included studies focusing solely on brainstem activity without considering spinal reflexes or case reports lacking detailed methodology. These investigations explored the prevalence, neurophysiological mechanisms, and clinical significance of the Lazarus sign. Research highlights its variable presentation, its occurrence in up to 40% of brain-dead patients, and its potential to be misunderstood by families and healthcare providers. The sign does not indicate residual brain function, but it reinforces the need for clear communication in end-of-life care. Future research should focus on standardizing diagnostic protocols, educating clinicians, and addressing ethical concerns. Integrating this knowledge into brain death assessments will enhance clinical decision-making and patient management.
The aim of this study was to assess the effectiveness of palatal injection for managing the pulpal pain of unilateral maxillary teeth from central incisor to second premolar and to establish the anatomical basis for this...The aim of this study was to assess the effectiveness of palatal injection for managing the pulpal pain of unilateral maxillary teeth from central incisor to second premolar and to establish the anatomical basis for this technique. For this prospective observational study, 62 patients (aged 18-70 years) were included. They had been treated for carious dentine lesions, receiving prosthodontic, endodontic treatment, or extraction of any tooth/teeth in the region from central incisor to second premolar. A total of 100 teeth were treated. Cone-beam computed tomography (CBCT) scans were analyzed preoperatively to identify accessory canals (ACs) (≥ 0.5 mm in diameter) associated with canalis sinuosus (CS). The anesthetic was injected into the area of the target tooth or adjacent tooth next to the palatal openings of the AC(s) into the submucosa of the anterior hard palate. The effectiveness of anesthesia was confirmed by pulp tester readings and a survey using the Verbal descriptor and Likert scales before and during treatment. Pulpal anesthesia was successful in 100% of the treated vital teeth. In all cases, openings of ACs originating from the CS were identified on CBCT scans. Three patients underwent bilateral dental treatment under unilateral anesthesia. The bilateral communications of the CS in the midline of the upper jaw were identified in the CBCT scans of these patients. The authors have established the palatal alveolar foramen injection (PAFI) technique. Injection of an anesthetic solution into the area of the openings of CS on the palate (i.e., palatal alveolar foramina) induces pulpal anesthesia of adjacent target teeth with 100% efficiency. PAFI requires less of the anesthetic solution and is the ideal technique for restorative and prosthodontic treatment involving anterior teeth because it does not cause numbness of the lip and face.
Precision medicine relies on a thorough understanding of lumbar sympathetic anatomy and its branches to elucidate related pathophysiology and improve treatment of conditions such as low back pain, lumbopelvic pain, and v...Precision medicine relies on a thorough understanding of lumbar sympathetic anatomy and its branches to elucidate related pathophysiology and improve treatment of conditions such as low back pain, lumbopelvic pain, and vascular autonomic disorders affecting the lower limbs. This study aims to expand knowledge of fetal lumbar sympathetic anatomy by providing a detailed description and systematic classification of the communicating branches, their specific distribution to each lumbar spinal nerve, and the origin of lumbar splanchnic nerves. The lumbar and retroperitoneal regions of 25 human fetuses (50 sides) were subjected to detailed sub-macroscopic dissections. The lumbar sympathetic trunk generally comprises three ganglia. The L2 and L3 ganglia are consistently present, but accessory ganglia along certain communicating branches are rare. The 466 communicating branches examined (229 on the right, 237 on the left) comprised 144 superficial, 251 deep transverse, and 71 deep discal branches. Deep transverse branches appeared consistently across all levels, whereas superficial branches originated only from the L1, L2, and occasionally L3 ganglia. Discal branches were inconsistent across ganglionic levels. All lumbar spinal nerves received at least one communicating branch, though the distribution varied by branch type. Most lumbar splanchnic nerves originated from a single root, those having two roots or accessory splanchnic nerves being less common. The origins of splanchnic nerves were frequent at L1 and L2, less common at L3, and inconsistent at L4 and L5. There were no differences between the left and right sides regarding ganglia, origin, or distribution of sympathetic branches. In conclusion, the fetal autonomic branching patterns and connections of the lumbar sympathetic trunk are significantly variable, though they are more consistent than those in the cervical region. Detailed anatomical knowledge of this area is essential for improving the precision and effectiveness of lumbar sympathetic trunk interventions and minimizing complications in lumbar and retroperitoneal surgeries.
Anatomy instruction is enhanced when students are engaged and interested in course material, and the relevance of the subject matter to their academic success and professional careers is emphasized. We developed a learni...Anatomy instruction is enhanced when students are engaged and interested in course material, and the relevance of the subject matter to their academic success and professional careers is emphasized. We developed a learning activity for a pre-clinical anatomy course using the clinical skills of inspection and palpation of a cadaver donor to demonstrate the value of those skills in learning anatomy and to facilitate anatomical understanding in a format similar to that used in clinical practice. Students were instructed to inspect and palpate various anatomical structures and relationships on their donor cadavers to identify features that could help in recognizing potential abnormalities, understanding disease mechanisms, and learning the anatomical bases of certain medical interventions and surgical procedures. Using these techniques, a tumor mass involving the medial end of the clavicle was identified. Student interest was increased, which led to further study and subsequent pathological identification of the tumor as a rare osteochondroma. We found that the addition of inspection and palpation as methods for learning human anatomy in the dissection laboratory, methods not commonly used, facilitated both engagement and interest in a particular area of the subject. Students also developed a respect for their donors, viewing them as their first patients. In light of the diversity in lifestyles, medical conditions, and causes of death within donor populations, we believe the approach described here can contribute greatly to the value of human anatomy courses that use cadaver donors.
Anatomy education is a hallmark of many preclinical medical school curricula, but students are often unable to identify the clinical relevance of anatomy and its applications. Vertical curricula that integrate clinical c...Anatomy education is a hallmark of many preclinical medical school curricula, but students are often unable to identify the clinical relevance of anatomy and its applications. Vertical curricula that integrate clinical concepts into the preclinical basic science years and vice versa have been shown to benefit student learning and increase educational enjoyment. This study explores second-year medical students' perceptions of the integration of clinical surgical concepts and surgical faculty into a preclinical digestive system (GI) anatomy course. The GI anatomy course at Rutgers New Jersey Medical School was modified to build on traditional anatomy content by correlating it directly with clinical surgical content. This included a novel, focused anatomy and surgery correlations booklet and surgical videos relevant to anatomical topics. Additionally, practicing general surgeons came to the anatomy lab to interact with the students and provide further clinical relevance. Survey data were collected regarding students' perceptions of integrating surgical concepts and surgeons into the anatomy curriculum, and exploring factors influencing their interest in a surgical career. The data revealed that students valued both the correlations booklet and interacting with surgeons in the anatomy lab. When ranked on a five-point Likert scale, students found both surgeons in the laboratory (M = 4.15, SD = 0.86) and the surgical correlation booklet (M = 3.52, SD = 0.51) helped them in learning the anatomy curriculum. The data did not suggest a direct relationship between interacting with surgeons in the anatomy lab and student surgical career interest. Instead, students reported additional experiences (i.e., shadowing and preceptorships) and anatomical dissection as influencing their career decisions. This study provides further evidence for the benefits of a vertical medical school curriculum by integrating clinical content and formal interactions with clinicians during the preclinical curriculum. The findings also demonstrate that further research should be completed to understand the factors influencing student interest in a surgical career.
The anatomical variations of the lateral femoral cutaneous nerve (LFCN) are well documented, with several studies hypothesizing that specific variants may increase the LFCN's susceptibility to meralgia paresthetica (MP)....The anatomical variations of the lateral femoral cutaneous nerve (LFCN) are well documented, with several studies hypothesizing that specific variants may increase the LFCN's susceptibility to meralgia paresthetica (MP). This systematic review and meta-analysis aimed to compare the prevalence of LFCN anatomical variations among limbs with and without MP. It also sought to determine if the LFCN's cross-sectional area (CSA) on ultrasound differed between limbs with and without MP. PubMed, SCOPUS, CINAHL, and Cochrane databases were used to query publications from inception to June 13, 2024. Included studies had a population of living patients, with or without the diagnosis of MP, and reported on the LFCN's exit from the pelvis, branching patterns, distance from the anterior superior iliac spine (ASIS), and/or CSA on ultrasound. Eighteen studies were included, nine retrospective and nine prospective, with a total of 1512 nerves. The LFCN in limbs with MP was closer to the ASIS (p < 0.01) and the MP limbs had a higher percentage of nerves exiting the pelvis lateral to or over the ASIS (p < 0.01) when compared to healthy limbs. The CSA was larger in the nerves affected by MP compared to the unaffected nerves (p < 0.01). The results demonstrate that specific anatomical variations of the LFCN, where the nerve courses in a more lateral or superficial position, may increase its susceptibility to developing MP. The differences in nerve CSA also show the potential utility of ultrasound as a diagnostic adjunct for MP.
Several recent publications describe a "septal swell body" within the nasal cavity. We review the corresponding sinonasal anatomy and revisit early anatomical descriptions to assess whether this designation is an "anatom...Several recent publications describe a "septal swell body" within the nasal cavity. We review the corresponding sinonasal anatomy and revisit early anatomical descriptions to assess whether this designation is an "anatomical misnomer" and if the classic anatomical nomenclature should be preserved. Citations for the septal swell body and synonyms were searched using PubMed and Cochrane Library databases from inception until December 31, 2023. Classic anatomy articles and historical medical textbooks were also reviewed for references to the regional anatomy and nomenclature. Our database search revealed a variety of anatomical terms for the septal or nasal swell body. However, classic historical anatomical texts that predate the introduction of modern database searches used the terms tuberculum septi or septal tubercle. Accurate knowledge of paranasal sinus anatomy is key in surgery. Precise nomenclature, based on official terms and named anatomical entities, makes communication clear, which is essential for surgical training, medical education, and patient care. Changing anatomical nomenclature and terminology if the existing terms are not wrong can lead to confusion, misunderstanding, anatomical jargon, and misnomers. We recommend the use of tuberculum septi or its English translation "septal tubercle" to denote the thickened area of normal anterior septal anatomy described herein. We also underscore a limitation of modern electronic literature searches in anatomical research.
Developing high-quality multiple-choice questions (MCQs) for medical school exams is effortful and time-consuming. In this study, we investigated the ability of ChatGPT to generate case-based anatomy MCQs with acceptable...Developing high-quality multiple-choice questions (MCQs) for medical school exams is effortful and time-consuming. In this study, we investigated the ability of ChatGPT to generate case-based anatomy MCQs with acceptable levels of item difficulty and discrimination for medical school exams. We used ChatGPT to generate case-based anatomy MCQs for an endocrine and urogenital system exam based on a framework for artificial intelligence (AI)-assisted item generation. The questions were evaluated by experts, approved by the department, and administered to 502 second-year medical students (372 Turkish-language, 130 English-language). The items were analyzed to determine the discrimination and difficulty indices. The item discrimination indices ranged from 0.29 to 0.54, indicating acceptable differentiation between high- and low-performing students. All items in Turkish (six out of six) and five out of six in English met the higher discrimination threshold (≥ 0.30) required for large-scale standardized tests. The item difficulty indices ranged from 0.41 to 0.89, most items falling within the moderate difficulty range (0.20-0.80). Therefore, it was concluded that ChatGPT can generate case-based anatomy MCQs with acceptable psychometric properties, offering a promising tool for medical educators. However, human expertise remains crucial for reviewing and refining AI-generated assessment items. Future research should explore AI-generated MCQs across various anatomy topics and investigate different AI models for question generation.
Anatomy, a cornerstone of medical education, is crucial for cultivating clinical skills among medical students. However, traditional anatomy teaching models face challenges such as insufficient learning outcomes and inad...Anatomy, a cornerstone of medical education, is crucial for cultivating clinical skills among medical students. However, traditional anatomy teaching models face challenges such as insufficient learning outcomes and inadequate preparation for clinical application. Flipped Classroom teaching methods, which combine the flexibility of online learning with interactivity within groups, can offer new ways of addressing these challenges. In this quasi-experimental study, a convenience sample of first-year clinical medical students was recruited and divided into an experimental group (EG, n = 67) and a control group (CG, n = 59). The EG received the Flipped Classroom (FC) teaching method, while the CG received traditional Face-to-Face (F2F) teaching throughout an 18-week basic anatomy course. The study compared knowledge proficiency, self-directed learning ability, and classroom participation between the two groups. The results revealed no significant differences in knowledge proficiency scores (t = 0.938, p = 0.35), but students in the EG obtained significantly higher scores for self-directed learning ability (t = 3.078, p < 0.05) and classroom participation (t = 3.936, p < 0.001) than students in the CG. Although there were no significant differences in participants' knowledge levels, students who received the Flipped Classroom model improved significantly in self-directed learning ability and classroom participation. This study not only provides practical guidance for educational practice but also offers empirical support for research on educational theory.
Gross anatomy deals with the structure of the human body, and knowledge in this field is essential for dental staff so they can examine, diagnose, and treat patients accurately. In this study, clinical dentists were surv...Gross anatomy deals with the structure of the human body, and knowledge in this field is essential for dental staff so they can examine, diagnose, and treat patients accurately. In this study, clinical dentists were surveyed to obtain their opinions on the content and methods of gross anatomy education required for prospective dental staff and to identify differences in their perceptions in relation to their general characteristics. The study ultimately enrolled and analyzed 182 participants. The content of gross anatomy education was first divided into the whole body and the head and neck, each region being subdivided into local body parts (14 items) and detailed anatomical structures (22 items). The questions relating to gross anatomy education methods consisted of eight detailed items. Each item was quantified using a 5-point Likert scale. When the clinical dentists' opinions on the degree to which anatomy knowledge by body parts is necessary for work performance were assessed, the head received the highest score among the 14 parts (4.73 ± 0.58). In the head and neck region, the temporomandibular joint received the highest score (4.83 ± 0.55). Among gross anatomy education methods, practice using medical images such as radiographs received the highest score (4.52 ± 0.62). These results can help trainers select the content and methods of gross anatomy education needed for future dental clinical workers, strengthening their capabilities by providing knowledge that will be practically helpful in clinical work.
The retrodural space of Okada (RSO) is a potential space located posterior to the ligamentum flavum. It can complicate epidural injections owing to its communication with the epidural space and facet joints. The purpose...The retrodural space of Okada (RSO) is a potential space located posterior to the ligamentum flavum. It can complicate epidural injections owing to its communication with the epidural space and facet joints. The purpose of this study was to clarify the anatomical structures of the cervical RSO and adjacent ligamentous tissues in cadavers. Cervical spine specimens from 15 embalmed cadavers were used for serial sectional dissection, histological verification, and micro-computed tomography (micro-CT) analysis. Micro-CT images of the RSO were acquired after phosphotungstic acid preparation at the C5-7 levels. The RSO was examined meticulously on the basis of its three-dimensional (3D) topography. The 3D shape of the cervical RSO was successfully visualized using micro-CT imaging reconstruction. It had clear anatomical communications with the epidural space, facet joints, and interspinous space. Histological examination confirmed the presence of loose connective tissue within the RSO, which probably facilitates these communications. This cadaveric study demonstrated the 3D shape of the cervical RSO and its communications with adjacent anatomical structures. Further clinical studies are needed to explore the potential implications of these findings for cervical epidural injections.
Iwanaga J, Kabak SL, He P
… +12 more, Hamada Y, Kikuta S, Takeshita Y, Samrid R, Berkban T, Kitagawa N, Wada J, Toriumi T, Matsushita Y, Ibaragi S, Hur MS, Kim HJ
This article aimed to develop evidence-based anatomical terminology in dentistry agreed upon by experts in multiple fields and ultimately to bridge anatomy and clinical dentistry. A comprehensive list of dental anatomica...This article aimed to develop evidence-based anatomical terminology in dentistry agreed upon by experts in multiple fields and ultimately to bridge anatomy and clinical dentistry. A comprehensive list of dental anatomical terminology was detailed in table format, and specific terms of interest were highlighted with their respective literature review. The presence of teeth is a unique feature of the oral cavity where dental professionals work. Dentistry is a highly specialized field focusing on preserving the health of dentition and its supporting and surrounding structures. Thus, "teeth" and "mouth" related anatomical terms must be very specialized for dentistry. Many of the terms highlighted were clinical dental or alveolar-related terms that were not clearly established in the general anatomical terminology. The authors hope the evidence-based anatomical terminology in dentistry developed by a consortium of experts will be generally accepted worldwide and ultimately bridge the fields of anatomy and clinical dentistry.
Optimizing analgesia after hip surgery enables more rapid recovery. However, peripheral nerve blocks (PNBs) often fail to provide adequate pain relief in the posterolateral hip as they typically target the lateral cutane...Optimizing analgesia after hip surgery enables more rapid recovery. However, peripheral nerve blocks (PNBs) often fail to provide adequate pain relief in the posterolateral hip as they typically target the lateral cutaneous nerve of the thigh (LCNT). This study aimed to map the nerves innervating the posterolateral hip through analysis of anatomy textbooks (n = 5) and cadaveric dissections (n = 13). The subcostal (SCN), iliohypogastric (IHN), and ilioinguinal (IIN) nerves were identified as key contributors to innervating the posterolateral hip. The optimal site for ultrasound-guided PNBs to target these three nerves was identified at the "75/25" landmark: 75% horizontally along the 12th rib and 25% vertically down to the iliac crest. Ultrasound-guided dye injections in cadavers (n = 6) showed that while the "75/25" landmark effectively stained the SCN (6/6) and IHN (4/6), it inconsistently stained the IIN (2/6). A second injection in the posterolateral hip stained branches of the IHN (4/6) and IIN (4/6) but not the SCN (1/6), suggesting the IHN and IIN are the dominant nerves in the posterolateral hip. These findings recommend a more distal injection at the "100/75" landmark to consistently block the IHN and IIN, thereby optimizing postoperative analgesia after hip surgery.
Recent advances in small-joint arthroscopy and cutting-edge magnetic resonance imaging systems have enabled orthopedic surgeons to perform more complex repairs of the wrist. Such repairs can include those of the triangul...Recent advances in small-joint arthroscopy and cutting-edge magnetic resonance imaging systems have enabled orthopedic surgeons to perform more complex repairs of the wrist. Such repairs can include those of the triangular fibrocartilage complex (TFCC) of the wrist that necessitates a reappraisal of its morphometry with special emphasis on the relationship between its articular disc (AD) and surrounding tissues. The TFCC AD is a fibrocartilaginous, biconcave structure located between the ulnar styloid process and the carpal bones of the wrist. We carefully dissected and measured the ADs of 58 wrists from 34 embalmed cadavers (20 females, 14 males) and fabricated three-dimensional biofidelic plastic models of them. Precise measurements of the ADs were taken that included length, width, and thickness at five standardized points. For the entire sample, the mean length and width of left ADs were 18.09 and 9.60 mm, respectively, while right ADs averaged 18.63 mm in length and 9.93 mm in width. Significant differences were found between male and female ADs on the right and left sides (p < 0.05). After the data were further analyzed and casts fabricated, a medical illustrator created novel anatomical illustrations to clarify structures that form the TFCC and help illuminate its complex anatomy. Our study provides valuable morphometric data of the AD and detailed novel medical illustrations of the entire TFCC, enhancing our understanding of its morphology for both educational and clinical applications.
The hallmark of evidence-based anatomy (EBA) is the anatomical meta-analysis (AMA). The Critical Appraisal Tool for Anatomical Meta-Analysis (CATAM) was recently published to enable users to appraise AMAs quickly and eff...The hallmark of evidence-based anatomy (EBA) is the anatomical meta-analysis (AMA). The Critical Appraisal Tool for Anatomical Meta-Analysis (CATAM) was recently published to enable users to appraise AMAs quickly and effectively. The tool is valuable for students and clinicians who need to judge the quality of AMAs, which informs clinical decision making and results in better patient care. Subjective measures of the tool's face and content validity have been established, but establishing its reliability provides a more objective measure of the instrument's dependability. This study investigated the interrater reliability (IRR) of the CATAM between novice and expert raters. Three graduate students and three professors (two anatomists and one pharmacist) read the original CATAM paper, and then had a post hoc meeting to discuss scoring with the tool. Three recent AMAs (published between 2017 and 2022) were randomly chosen from PubMed, and all six raters scored the papers blindly. The intraclass correlation coefficient (ICC) statistic was used to calculate the interrater reliability (IRR) between all scores, and then the ICCs between novice and expert scores were compared. Cronbach's alpha (internal consistency) of the CATAM was also calculated (SPSS 25, Armonk, NY). ICC for AMA-1 was 0.999 (95% CI, 0.997-0.999), p = 0.000, and alpha was 0.999. ICC for AMA-2 was 0.994 (95% CI, 0.988-0.998), p = 0.000, and alpha was 0.994. ICC for AMA-3 was 0.998 (95% CI, 0.995-0.999), p = 0.000, and alpha was 0.998. ANOVA showed no significant differences (p > 0.05) in mean ICCs between raters. The CATAM is a robust tool with excellent IRR (ICC > 0.990) and internal consistency (alpha > 0.990). No significant difference in ICC scores between novices and experts suggests the tool does not require prior expert knowledge to be effective. Now that the reliability of the CATAM is established, it can be more widely adopted by students and physicians worldwide to evaluate the quality of AMAs. The CATAM offers widespread applicability, and can be adopted in medical education, journal clubs, and clinical seminars to critically evaluate AMAs.
In the third year of pre-clinical medicine (known as Part II of the Natural Sciences Tripos at the University of Cambridge), students have the opportunity to lead a primary research project on clinically relevant anatomy...In the third year of pre-clinical medicine (known as Part II of the Natural Sciences Tripos at the University of Cambridge), students have the opportunity to lead a primary research project on clinically relevant anatomy, often involving donor dissection. This descriptive study used a cross-sectional survey to explore the effects of undertaking an anatomical research project on students' attitudes, interests, and a variety of academic and professional skills. Of 45 students who were invited to participate in this study, 40 responded. Of these, 30 students (75%) had performed cadaveric dissection. Projects increased students' interests in academic careers (36% or 90% agreed/strongly agreed) and scientific inquiry, with 30 students (75%) undertaking subsequent research. Many students (30/40; 75%) strongly agreed their projects highlighted the importance of considering the scientific literature when providing patient care. Most (39/40; 97.5%) felt that there was scope for further anatomical research to appreciate and explore anatomical variation. Many students (32/40; 80%) strongly agreed that projects improved their self-directed learning skills. Inductive thematic analysis of free-text answers identified themes of improved academic, practical, and professional skills such as negotiation, responding to questions, presenting at conferences, and liaising with experts and non-experts. These results suggest that anatomical primary research through this program effectively fosters academic aptitude and interest, as well as the practical and professional skills necessary to thrive in academia and clinical medicine. Aspirations for a surgical career were strengthened and valuable anatomical context was provided.