Rotator Interval vs Posterior Approach Ultrasound-guided Corticosteroid Injections in Primary Frozen Shoulder: A Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To compare the efficacy of rotator interval (RI) vs posterior approach (PA) ultrasound (US) guided corticosteroid injections into the glenohumeral (GH) joint in primary frozen shoulder (PFS).

DATA SOURCES

A systematic literature search for all relevant studies on Medline, Scopus, Embase, Web of Science, and Cochrane Central, up to January 2023 was conducted.

STUDY SELECTION

Randomized controlled trials that directly compared the US-guided corticosteroid injection into the RI and GH joint using PA in patients clinically and radiographically diagnosed with PFS.

DATA EXTRACTION

The primary outcome was pain, and the secondary outcomes were function, and range of motion (ROM). Two authors independently assessed the risk of bias using the Cochrane risk-of-bias tool version 2. A random-effects model and generic inverse variance method were performed. Effect sizes were estimated using mean difference (MD) and standardized mean difference (SMD).

DATA SYNTHESIS

A total of 5 clinical trials involving 323 subjects were included for the meta-analysis. US-guided corticosteroid injections into the RI revealed significant pain relief (MD 1.33 [95% confidence interval (CI) 0.20 to 2.46]; P=.02) and significant functional improvement (SMD 1.31 [95% CI 0.11 to 2.51]; P=.03) compared with the PA after 12 weeks.

CONCLUSION

The results suggest the injection of corticosteroid into RI space is more effective than PA after 12 weeks in improving both pain and functional scores in patients with PFS.

Initial evaluation and external validation of 68Ga-PSMA-11 PET/CT in tubarial gland characterization

INTRODUCTION

Radiotracer 68Ga-PSMA-11 used in PET/CT scans allows for identification and localization of gland tissue. It allows for their consideration in clinical scenarios and to design further and stronger research to answer pertinent questions regarding their function and implications. We aimed to externally validate first reported findings of location, size, and ligand uptake of the tubarial glands using 68Ga-PSMA-11 PET/CT.

MATERIALS AND METHODS

A cross-sectional study was performed with 68Ga-PSMA-11 PET/CT studies of patients with prostate cancer confirmed diagnosis from the database of the Radiology Department from 2018 to 2022. The maximum cephalocaudal length (CCL) in the tubarial glands and the Maximum Standardized Uptake Value (SUVmax) of major glands were recorded.

RESULTS

A total of 202 patients were included (mean age 67.43 ± 8.5). The mean CCL of the tubarial glands was 37.38 ± 9.84 and a SUVmax of 6.56 ± 2.14. The rest of the glands were as follows: parotid 15.12 ± 4.43, submandibular 16.82 ± 5.43 and sublingual 5.84 ± 3.24. No differences were found between laterality. A weak correlation between age and SUVmax of tubarial glands was identified. Tubarial glands had a similar 68Ga-PSMA-11 uptake to that of sublingual glands.

CONCLUSION

This study corroborates the existence of a conglomerate of glands in the nasopharynx roof, near the posterolateral pharyngeal recess. It serves as validation in a different population with similar results in previous research. Without 68GA-PSMA-11 PET/CT the abundance, configuration and potential clinical relevance of these glands would probably not have been identified. Radiotracer uptake was similar amongst the major salivary glands, with a more similar uptake to that shown by the sublingual gland.

Assessment of burnout syndrome and associated factors among medical students during the COVID-19 pandemic

Background: Overwhelming requirements, a high degree of work, and prolonged exposure to emotionally demanding circumstances in work and life settings can lead to burnout syndrome. The purpose of the study is to assess burnout syndrome and its associated factors among medical students during the COVID-19 pandemic. Methods: A cross-sectional, prospective, descriptive study was conducted in a Mexican medical school during the last week of the spring semester of 2021 using the Maslach Burnout Inventory-Student Survey (MBI-SS) and an associated factors survey. Results: Based on the MBI-SS definition, most students (54.2%, n = 332) had burnout symptoms and high emotional exhaustion (79.6%, n = 448), high cynicism (57.3%, n = 351), and low academic effectiveness (36.4%, n = 223). After adjusting the associated factors, a significant correlation between the school year and the presence of burnout was identified (OR 1.127, 95% CI [1.023-1.241], p<0.05). Regarding the current pandemic, the death of a family member by COVID-19 also put students at risk of developing burnout (OR 1.598*, 95% CI [1.080-2.363, p<0.05]). Limitations: The main limitation of this study was the lack of a control group (before the pandemic); therefore, the high prevalence of burnout can only be hypothesized due to the pandemic but cannot be objectively evidenced. A prospective study after the pandemic is needed to resolve this question. Conclusion: The coronavirus pandemic represents a challenge to the academic and psychological stability of students. It essential to continue assessing burnout levels in medical students and the general population to treat them in time and improve mental health.

Comment on Sallam, M. ChatGPT Utility in Healthcare Education, Research, and Practice: Systematic Review on the Promising Perspectives and Valid Concerns. Healthcare 2023, 11, 887

We read with great interest and applaud the recently published review paper regarding ChatGPT and its implications in research and education [...].

Fetal-type posterior cerebral artery and association of rupture in posterior communicating artery aneurysms: A systematic review and meta-analysis

BACKGROUND

The morbidity and mortality of intracranial aneurysm rupture motivate the risk evaluation of the patient´s characteristics and aneurysm's morphology. Brain vessel variants lead to hemodynamic changes that could increase risk. This study aims to evaluate the fetal posterior cerebral artery (fPCA) as a risk factor for the formation, rupture, and recurrence of the posterior communicating artery (PComA) aneurysm.

METHODS

A search strategy was performed in MEDLINE, Scopus, Web of Science, and EMBASE databases for studies that evaluated the risk of appearance, rupture, and recurrence of PComA aneurysms with the presence of fPCA. Newcastle-Ottawa Scale and AXIS were used for quality assessment. The primary and secondary outcomes were evaluated and interpreted with an odds ratio (OR) and their 95% confidence intervals (CI).

RESULTS

A total of 577 articles were reviewed. Thirteen studies were included for the qualitative analysis, and ten studies for the meta-analysis. All cohort studies were classified as poor quality, and all cross-sectional studies with moderate risk. The unadjusted OR resulted in 1.57 (n = 6, 95% CI 1.13-2.19, p = <0.001, I² =0%) between the presence of fPCA and PComA aneurysm rupture.

CONCLUSION

There is a significant association of aneurysm formation and rupture of PComA aneurysms in the presence of fPCA. This may be triggered by the hemodynamic alterations caused by the variation, leading to changes in the vessel wall.

Payment with knowledge: A method for a training of anatomy near-peer teachers and formation of future anatomists

Near-peer teaching has been widely implemented in medical schools and the benefits for the near-peer teachers (NPTs), the students, and the institution have been well documented. However, NPT training methods and perceptions of such have been limited. A four-year clinical anatomy and surgical training program was established (est. 2019) as part of the continuous training timeline for NPTs (n > 60 total) formation at the Universidad Autónoma de Nuevo León, in Mexico. The program provides various training courses for the NPTs according to their hierarchy, including teaching skills, professional development, psychosocial aspects, and career objectives. A "Clinical Anatomy and Surgical Training Diploma" was planned with 12 modules to aid in developing these abilities, along with a higher understanding of clinical anatomy shared by expert clinical specialists, and diverse clinical and surgical skills such as suturing, catheterization, and basic surgical procedures. The program has a completion rate of approximately 15 NPTs/year. All, while creating an environment with a sense of belonging, and facilitating mentorship between fellow NPTs and educators. Near-peer teachers develop leadership, communication, and teaching skills. The program has provided a constant source of anatomy educators, avoiding any shortage.

Screws versus plate with screws for osteosynthesis of the posterior malleolus: a systematic review and meta-analysis

INTRODUCTION

fractures involving the posterior malleolus (PM) of the ankle can have significant functional and clinical implications if not properly treated. The optimal treatment approach for these fractures remains uncertain. This review aims to compare the use of cannulated screws versus plate with screw fixation in terms of their impact on the development of postoperative ankle osteoarthritis and functional outcomes in patients with PM fractures.

MATERIAL AND METHODS

a comprehensive search was conducted in PubMed, EMBASE, and Cochrane Library databases to identify studies directly comparing cannulated screws versus plate with screw fixation for PM fractures and their association with the development of postoperative osteoarthritis and functional outcomes. The quality of the included studies was assessed using appropriate assessment tools. The data on osteoarthritis development and functional outcomes were extracted and analyzed.

RESULTS

a total of 691 articles were screened, and several studies were included for analysis. The findings revealed no statistically significant difference in the development of postoperative ankle osteoarthritis between the cannulated screws and plate with screw fixation groups. Similarly, there was no significant difference in functional outcomes between the two treatment approaches.

CONCLUSION

based on the available evidence, there is no significant difference in the development of postoperative ankle osteoarthritis or functional outcomes between cannulated screws and plate with screw fixation for PM fractures. However, further research is needed to strengthen these findings and provide more conclusive evidence.

Trendelenburg position for internal jugular vein catheterization: A systematic review and meta-analysis

To determine the effect of Trendelenburg position on the diameter or cross-section area of the internal jugular vein (IJV) a systematic review and metanalysis was performed. Studies that evaluated the cross-sectional area (CSA) and anteroposterior (AP) diameter of the right internal jugular vein (RIJV) with ultrasonography in supine and any degree of head-down tilt (Trendelenburg position) were analyzed. A total of 22 articles (613 study subjects) were included. A >5° Trendelenburg position statistically increases RIJV CSA and AP diameter. Further inclination from 10° does not statistically benefit IJV size. This position should be recommended for CVC placement, when patient conditions allow it, and US-guided cannulation is not available.

In Vivo Models for the Study of Hyaluronic Acid Fillers: A Review

BACKGROUND

Hyaluronic acid (HA) filler application is one of the most frequent minimally invasive aesthetic procedures used worldwide. Its properties and characterization, performance, effects in other tissues, and response to complication treatments have been studied in several animal models. This review aims to categorize animal models considering the advantages and disadvantages regarding the purpose of the study.

METHODS

Literature research was made using MEDLINE via PubMed by two reviewers using keywords "hyaluronic acid" "filler" and "animal model". Full-text articles published in English and with an in vivo animal model were included for data extraction.

RESULTS

The rat model was the most common animal used to evaluate properties or characteristics and degradation of HA fillers. Rabbits were preferred for evaluating HA embolism treatments; however, anatomical names of the arteries differ in some studies. Mice and rats used as vascular occlusion model are challenging due to the size of the vessels and viscosity of the filler.

CONCLUSION

There is a wide variability of options of in vivo animal models to evaluate HA fillers. The animal characteristics, laboratory resources, and HA properties should be considered in accordance with the objective of the study, when choosing the ideal model.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Magnetic resonance based morphometric analysis of the tentorial notch

BACKGROUND

The study of the tentorial notch can improve the understanding of brain injury mechanisms. Tentorial morphology has been analysed primarily in cadaveric studies. However, the postmortem effect can cause variability in the measurements. The objective was to evaluate the morphometry of the tentorial notch and the third cranial nerve on living subjects using magnetic resonance imaging (MRI).

MATERIALS AND METHODS

A retrospective cross-sectional study was performed. Using consecutive cases, 60 MRI scans were analysed for tentorial notch morphology. Maximum notch width (MNW), notch length (NL), interpedunculoclival (IC) distance, apicotectal (AT) distance, third cranial nerve (CN-III) distance, and inter- CN-III angle, were obtained. For the classification of the tentorial notch quartile distribution technique for MNW, NL, AT distance, and IC distance were used.

RESULTS

According to the quartile of the MNW, patients were stratified into narrow, midrange, and wide groups. Using the NL quartile groups, they were also classified as short, midrange, and long. With these, the tentorial notch could be classified into eight types. Statistical differences between genders in the MNW and inter-CN-III angle were found, as well as a strong positive correlation between NL and AT distance, and between right and left CN-III distances.

CONCLUSIONS

There were differences between the cadaveric samples and living subjects in the CN-III distances. This difference could be explained by the dehydration of brain volume in the postmortem process which may cause nerve elongation. Morphometry of the tentorial notch and its neurovascular relations allows a better understanding of the mechanisms of brain herniation.

Trendelenburg (Head-Down Tilt) and Head Rotation: Ultrasonographic effects on the internal jugular vein for catheterization safety

Most guidelines fail to specify patient positioning during central venous catheterization. The objective was to determine the effects of head-down tilt (Trendelenburg position) and head rotation on the internal jugular vein (IJV). A prospective, observational, longitudinal, and descriptive study using healthy adult volunteers, of both sexes, was performed. The change in position and cross-sectional areas (CSA) of the right IJV and common carotid artery (CA) were measured by ultrasonography during Trendelenburg position (TP) (0°, 5°, 10°, and 15°) and contralateral head-rotation (HR) (0°, 45°, and 90°) for a total of 12 positions. The neutral supine position was first, randomizing the other 11 positions, with 5-minute rest intervals in between. Vital signs and symptoms were recorded. A total of 54 volunteers were recruited between the ages of 21 and 32, of which 30 were men. Any degree of TP or HR significantly increased the CSA. The largest area obtained was 1.78cm² with a TP15HR90 which did not have a statistical difference with TP10HR45 1.59cm² . A HR90 tended to displace the IJV medially, overlaying the CA. Any degree of TP or HR will significantly increase CSA or the right IJV. A 5° to 10° TP is recommended when the patient's condition allows it, with a 45° HR, without significantly displacing the IJV anterior to the CCA. This article is protected by copyright. All rights reserved.

Morphometric variants of the paranasal sinuses in a Mexican population: expected changes according to age and gender

BACKGROUND

There are developmental variations in the paranasal sinuses. Our objective is to determine their dimensions and volume stratified by age and sex and define the expected growth pattern.

MATERIALS AND METHODS

A retrospective, observational study was performed including computed tomography (CT) of patients between 1 and 20 years of age. The volumes of the frontal, sphenoid, and maxillary sinuses were obtained.

RESULTS

A total of 210 CT were included with a mean age of 10±6.1 years, 106(50.5%) were female. Groups were categorized in ranges of 5 years. Spearman correlation coefficients between the right and left sides were 0.843, 0.711, 0.916 for the frontal, sphenoid and maxillary sinuses. Post-hoc for the categorical age groups demonstrated statistically significant differences with values of p < 0.01, except between age groups 11-15 against ≥ 16 years of age (p = 0.8). Gender-related differences were evident with a higher air volume in girls in the 5-10-year-old group, while boys predominated in the rest of the groups.

CONCLUSIONS

CT is ideal for pre-surgical sinus assessment. The maximum volume of paranasal sinuses is reached at age 15. There is a clear volumetric difference between age and gender groups. There is a direct relationship between a volume and its contralateral counterpart.

Factors Influencing Scientific Achievements of Medical Students in the Anatomy Research Group: An Analysis From the Autonomous University of Nuevo León in Mexico

Scientific research and student involvement are critical to the formation of physicians, yet the number of medical researchers has decreased over time. To implement corrective strategies, the variables associated with positive research attitudes and productivity among medical students must be identified. The aim of this study was to evaluate the variables associated with students interested or involved in research. A validated questionnaire was applied to the student members of an established anatomy research group in a Mexican medical school with a six-year medical program. Data were collected and analyzed. A total of 85.5% (n = 77/90) students answered the survey with most respondents being second-year medical students. The majority of respondents indicated that the important component of conducting research was a contribution to the new knowledge (45.5%) and to the scientific community (42.9%). More than half of respondents mentioned a professor or a peer as the initial motivation to become involved in research. Lack of time was the main limitation (59.7%) to research involvement. Perceived benefits were knowledge and team work skills. Of those involved, most (85.7%) wished to continue participating in research as a complement to their clinical work. Professors and student colleagues were found to play an important motivational and recruitment role for medical research. These efforts in turn have developed into long-lasting mentor-mentee relationships. Students also anticipated that early involvement in research will positively influence the likelihood of future physicians' contribution and collaboration in research.

Burnout Among First-Year Medical Students During COVID-19 Pandemic in Mexico: A Cross-sectional Study

Background: The coronavirus pandemic is an international public health emergency without precedence in modern history. It represents a challenge to the academic and psychological stability of students due to the changes it can cause in daily life. This study aimed to evaluate the prevalence and level of burnout in medical students caused by the academic and psychological instability that the pandemic represents. Methods: A cross-sectional prospective study was designed using the Maslach Burnout Inventory-Student Survey (MBI-SS). This evaluated the emotional exhaustion due to study demands, cynicism, and negative self-academic efficacy. This study was based in the school of medicine of the Universidad Autonoma de Nuevo Leon (UANL), in Monterrey, Mexico during the Spring semester 2020. Results: A total of 154 (93 women and 61 men) first-year medical students participated (response rate 36.4%). Burnout was identified in 14.9% (n=23), and high emotional exhaustion in 53.9% (n=83). Burnout was almost 4 times more likely to develop in men than in women (aOR = 4.8; 95% Confidence Interval=1.7-13.3) when considering age as a covariable in the multivariable model. Conclusion: Further epidemiological studies of burnout syndrome in medical students are needed, and schools should consider promoting mental health and making programs available for their students to help overcome the emotional and social challenges during the pandemic.

Aged rats learn Morris Water maze using non-spatial search strategies evidenced by a parameter-based algorithm

Spatial learning and memory are used by all individuals who need to move in a space. Morris water maze (MWM) is an accepted method for its evaluation in murine models and has many protocols, ranging from the classic parameters of latency, distance, and number of crossings to the platform zone, to other more complex methods involving computerized trajectory analysis. Algorithm-based SS analysis is an alternative that enriches traditional classic parameters. We developed a non-computerized parameter-based Search Strategy Algorithm (SSA), to classify strategies and detect changes in spatial memory and learning. For this, our algorithm was validated using young and aged rats, evaluated by two observers who classified the trajectories of the rats based on the effectiveness, localization, and precision to reach the platform. SSA is classified into 10 categories, classified by effectiveness, initial direction, and precision. Traditional measurements were unable to show significant differences in the learning process. However, significant differences were identified in SSA. Young rats used a direct search strategy (SS), while aged rats preferred indirect ones. The number of platform crossings was the only variable to show the difference in the intermediate probe trial. The parameter-based algorithm represents an alternative to the computerized SS methods to analyze the spatial memory and learning process in young and age rats. We validate the use of SSA as an alternative to computerized SS analysis spatial learning acquisition. We demonstrated that aged rats had the ability to learn spatial memory tasks using different search strategies. The use of SSA resulted in a reliable and reproducible method to analyze MWM protocols.

Safety window for the transsphenoidal approach for pituitary tumours: a computed tomographic angiography study

BACKGROUND

The aims are to evaluate the morphometry of the sellar region and propose a safety window on the floor of the sella turcica for the transsphenoidal approach in a Hispanic population.

MATERIALS AND METHODS

We retrospectively analysed 150 computed tomographic angiography sellar region images from asymptomatic patients. The images were evaluated intraobservatory by an expert radiologist. We measured: intercarotid distance of cavernous segment; depth of sella turcica; skull base angle; anterior distance, the distance between anterior spinal nasal and floor of the sella turcica; posterior distance, the distance between anterior spinal nasal and posterior wall of the sella turcica; anterior surgical angle, formed between the floor of the nostril and superior limit of the anterior wall of the sella turcica; and posterior angle, formed between the floor of the nostril and the inferior limit of the posterior wall of the sella turcica.

RESULTS

Safety window was based on two measures: the intercarotid distance and depth. The mean of the safety window is 151.13 mm² and 147.60 mm² for men and women, respectively. The intercarotid distance was 17.83 mm. The depth of the sella turcica was 8.46 mm. The skull base angle was 112.13 grades. The anterior distance was 76.34 mm. The posterior distance was 87.59 mm. The anterior surgical angle was 32.76 grades. The posterior surgical angle was 87.59 grades.

CONCLUSIONS

The surgical approach space is smaller in females. It could significate a more complicated surgery in this population. Anatomical understanding could reduce complications in hospitals without a neuronavigation system.

Volumetric assessment of the sella turcica: a re-evaluation

BACKGROUND

The sella turcica volume is widely measured by the Di Chiro-Nelson method. The purpose is to compare the fidelity of a proposed volumetry method vs. the Di Chiro-Nelson method, using computed tomography (CT) images.

MATERIALS AND METHODS

Morphometric examination of 173 CT scans were included, of which 52.6% were female. The mean age was 53.2 ± 17.6 years. Considering the Di Chiro-Nelson method, two measurements were added for each axis in the CT evaluation: length (central, left, and right), width (central, anterior, and posterior), and height (central, left, and right).

RESULTS

The mean measurements were length: central 10.11 ± 1.44, left 7.45 ± 1.67, right 7.53 ± 1.59; width: central 12.27 ± 2.11, anterior 10.99 ± 1.92, posterior 10.10 ± 1.74; height: central 7.68 ± 1.38, left 7.16 ± 1.35, right 7.40 ± 1.41. A statistically significant difference between sexes was found only in the anterior width (p = 0.01). Using the proposed method, the volume was 342.2 ± 88.5 and 378. 6 ± 113.9 mm³, respectively for females and males (p = 0.02) vs. 476.1 ± 132.4 and 523.8 ± 186.0 mm3 (p = 0.05) using the Di Chiro-Nelson's method.

CONCLUSIONS

Women had significantly smaller sella turcica volume than men. This proposed method considers the sella turcica as a not strictly symmetrical structure and indicates reduced variation between the maximum and minimum values, compared to the Di Chiro-Nelson's. Our findings may be useful for reassessment the volume of the sella turcica as the measurements indicate a higher precision.

Cochlear morphometry in healthy ears of a mexican population: A comparison of measurement techniques

OBJECTIVE

This study describes the cochlear morphometry of a mexican population analysed by laterality and sex. The objective is to compare Cochlear Length (CL) evaluation between Alexiades et al. formula and manual method described by Würfel et al. PATIENTS: Hispanic patients from Mexico, with an age of 18 years or older, were included. Morphometric examination was performed retrospectively on 200 subjects who underwent previously temporal bone imaging for clinical purposes.

MATERIALS AND METHODS

Horos for Mac program was used to measure CL, cochlear height, distance A, and distance B. WorkStation AW Volume Share 2 was used to obtain volume. CL was measured in 400 temporal bones (228 females, 172 males).

RESULTS

The mean CL was 34.02mm±2.15mm. A significant difference was found in all variables between sex (P=≤0.05) and laterality (P=≤0.05). The Alexiades equation was used for determining CL and compared with the manual formula, with no significant differences (κ=0.71). However, the time consumption was 5 times faster with the calculated method. The Alexiades formula was demonstrated to be a reliable method measurement.

CONCLUSION

Preoperative Computed Tomography evaluation of the internal ear helps to plan the Cochlear Implants (CI) surgical approach and allows to choose an appropriate electrode length for each necessity. Our findings may be useful to facilitate and adapt preoperative management of CI surgery by considering the characteristics of cochlear morphology of Latin-American populations.

Hippocampal volume as treatment predictor in antidepressant naïve patients with major depressive disorder

Major depression disorder (MDD) limits psychosocial functioning and quality of life. One of the biological alterations is a hippocampal volume (HV) reduction. Previous prospective neuroimaging studies present inconsistencies regarding HV reductions and clinical features and response of antidepressant treatment of the participants. To clarify the relationship between antidepressant response and the HV reported, we prospectively evaluated antidepressant-naïve subjects diagnosed with MDD for the first time. We recruited twenty-one subjects and applied the Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), and the Clinical Global Impression (CGI) scale. The participants underwent brain Magnetic Resonance Imaging (MRI) scanning to measure the HV, and subsequently were treated naturalistically with first-line antidepressant medication for eight weeks. Thirteen subjects met the criteria for remission at eight weeks of treatment. The baseline right and left hippocampal volumes were larger in subjects who achieved remission (p = 0.012) and (p = 0.001), respectively. The main finding of this study is that the antidepressant naïve subjects who met the criteria for clinical remission according to the HAM-D, MADRS, and the CGI scale scores, had larger pretreatment hippocampal volumes. Our results assess the HV as a treatment outcome predictor.

Mexican Educators Survey on Anatomical Sciences Education and a Review of World Tendencies

Anatomical sciences curricula have been under constant reform over the years, with many countries having to reduce course hours while trying to preserve laboratory time. In Mexico, schools have historically been autonomous and unregulated, and data regarding structure and methods are still lacking. A national survey was sent by the Mexican Society of Anatomy to 110 anatomical sciences educators. The questionnaire consisted of 50 items (open and multiple choice) for gross anatomy, microscopic anatomy, neuroanatomy, and embryology courses in medical schools across Mexico. A clinical approach was the most common course approach in all disciplines. Contact course hours and laboratory hours were higher in Mexican anatomy education compared to other countries, with the highest reported contact hours for embryology (133.4 ± 44.1) and histology (125 ± 33.2). There were similar contact hours to other countries for gross anatomy (228.5 ± 60.5). Neuroanatomy course hours (43.9 ± 13.1) were less than reported by the United States and similar to Saudi Arabia and higher than the United Kingdom. Dissection and microscopy with histological slides predominate as the most common laboratory activities. Traditional methods prevail in most of the courses in Mexico and only a few educators have implemented innovative and technological tools. Implementation of new methods, approaches, and curricular changes are needed to enhance anatomical sciences education in Mexico.

Comparison of suturing models: the effect on perception of basic surgical skills

BACKGROUND

Acquisition of Basic Surgical Skills (BSS) are essential for medical students. The objective was to determine it's fidelity impact.

METHODS

Using four suturing models (SM) (pigskin, sponge, commercial pad, and orange), SM-quality and student-SM interaction were evaluated. After a 1-h class, participants were divided into groups and randomly assigned exercises in SM in 15-min intervals. The experiment included completing three individual simple stitches and a 3-stitch continuous suture in each SM.

RESULTS

Eighty-two medical students participated. Suturing quality was better in pigskin and sponge, which were also the preferred models (p < 0.001). Significant differences in quality between the insertion and exit point, and firmness of knots (p < 0.05) in both simple and continuous sutures, as well as between length and distance in continuous ones (p < 0.001) were identified.

CONCLUSIONS

Acquisition and quality of BSS are influenced by the intrinsic characteristics of SM. An adequate degree of resistance, consistency, and elasticity are necessary.

Occipital condyle screw fixation viability according to age and gender anatomy: A computed tomography-based analysis

OBJECTIVE

To assess the Occipital condyle morphology in an all-age population of Northeastern Mexico, and determine age and gender related changes for surgical viability.

METHODS

A total of 175 consecutive HRCT scans were included and divided into 5 age groups. The condylar length, width, height, sagittal angle, anterior, posterior and medial intercondylar distances, and intercondylar angle of the OC were measured.

RESULTS

Mean condylar length, width, and height in total population were 20.58 mm, 9.42 mm, and 9.02 mm, respectively. Differences were observed in most morphometric parameters when comparing age groups. Significant intergender differences in total population were observed in most parameters, when individualizing each age group the height remained significant in all. The group with the least height measurement was aged 5-9 years, this however, could allow the OC screw (≥6.5 mm) placement.

CONCLUSION

Differences in most morphometric parameters of OC were observed between age groups and gender, particularly patients with 5-9 years. However, all groups presented a minimum height that allows the placement of a standard screw. A preoperative imaging study is always recommended due to the variability and complexity of the region.

Proteomic profile of preeclampsia in the first trimester of pregnancy

OBJECTIVE

Preeclampsia (PE) is a leading cause of pregnancy-associated maternal and neonatal morbidity and mortality. Detection of patients at risk before the clinical onset of PE is a priority. Proteomics have become a valuable tool for the discovery of new biomarkers; however, the understanding of the underlying mechanism is necessary. The aim of the study was to determine differences between proteomic serum profiles of PE and normotensive pregnancies using quantitative and qualitative approaches.

STUDY DESIGN

Serum samples from pregnant women were taken at 10-12 weeks of gestation with follow-up to determine PE development. Samples were analyzed using nano 2-D liquid chromatography UPLC and qTOF-MS/MS.

RESULTS

A total of 136 women were recruited, of which eight (5.9%) developed PE, and eight normotensive were randomly selected as a control group for comparison. A different profile was obtained between groups. Nine proteins showed quantitative differences with fold-change over 1.5: PRRC2C (217.02), HEATR5A (179.46), ATP6 (162.38), PRRC2B (83.09), RBM25 (5.36), NUP205 (3.38), HLA-I (2.27), ZC3H13 (2.15), and SREK1 (1.66); and two under 0.66: Importin-4 (0.55) and Cytochrome b (0.26). Using bilateral Fisher's exact test for the qualitative approach, LRRK1 had statistical significance (p = .044), while PRRC2B (p = .121), PRRC2C (p = .134), and NUP205 (p = .134) showed a tendency to be present in PE.

CONCLUSION

The found proteins have plausibility with the early pathophysiological events that have been associated with this pathology. Further studies should be performed to confirm these findings and elucidate their specific roles.

Morphometry of the aortic arch and its branches. A computed tomography angiography-based study

BACKGROUND

The current study aims to determine the prevalence of variations of the aortic arch using computed tomography angiography (CTA), as well as morphometries and gender correlations.

MATERIALS AND METHODS

A retrospective, transverse, observational and descriptive study of 220 CTA was performed. The branching pattern, most cranial vertebral level of the aortic arch, area of the proximal, middle and distal segments of the arch, area of each branch, and the path of atypical arteries were recorded. Results were analysed and stratified by gender.

RESULTS

The typical aortic arch branching pattern was present in 77.7% without statistical significance between genders. The most common variant was a two-branch pattern with a common trunk and a left subclavian (13.6%), followed by a typical branching pattern with an added left vertebral artery (7.3%). T3 was the most frequent cranial level (32.3%), followed by T2-T3 (26.8%), and T3-T4 (23.2%). The mean areas of the aortic arch were 685.5 ± 183.9, 476.1 ± 124.1, and 445.0 ± 145.1 mm2 for the proximal, middle and distal segments, with statistical difference between men and women in the middle and distal segments. Three paths of atypical arteries were identified: bifurcated vertebral artery (0.5%), aberrant right subclavian artery (0.5%), and left subclavian ostium obstruction (0.5%).

CONCLUSIONS

Mexican population has one of the highest prevalence of variations in the aortic arch branching pattern. The high probability of finding these should be taken into consideration when assessing patients. A standardised classification method would contemplate future un-reported findings, without causing confusion by the different numbers assigned by each author.

Gynecological influencing factors on the rectovaginal septum's morphology

INTRODUCTION AND HYPOTHESIS

The objective was to determine the mean morphometric characteristics of the rectovaginal septum (RVS) and its variations in correlation with the number of pregnancies, method of delivery, parity, and estrogenic exposure.

METHODS

An observational, cross-sectional, retrospective, descriptive, and comparative study was carried out. Pelvic MRI of Hispanic women (≥15 years of age) from the northeast of Mexico were obtained. Age and obstetric and gynecological history were registered and the sample women were categorized by their variables. Length and thickness measurements were standardized.

RESULTS

A total of 102 MRI studies were included, with a mean age of 41; 24.5% were nulligravida, the rest primi- or multigravida. Vaginal delivery was the most common type (49.35%), 16.88% had a cesarean section, and 31.17% had mixed delivery. 74.5% of the women were premenopausal. The mean RVS length was 73.2 ± 15.3 mm, with a thickness of 2.8 ± 1.7, 2.2 ± 1.2, and 2.5 ± 1.3 mm for the upper, middle, and lower thirds respectively. There were tendencies to increase the length of the RVS, and the thickness of the upper and middle thirds in the non-pregnancy and the at-least-one-pregnancy groups; to increase the length and middle-third thickness in those with mixed delivery, and increased upper- and lower-third thickness in those with only a cesarean section. Multiparous women with vaginal delivery had significantly longer and thicker RVS than primiparous. Premenopausal women had significantly longer RVS with a tendency to lose thickness toward postmenopause.

CONCLUSIONS

The morphology of RVS can be modified by different factors such as age, number of pregnancies, number of births, and estrogenic exposure. This structure should be evaluated and taken into account in preoperative management and surgical technique planning.

Origin variations of the superior thyroid, lingual, and facial arteries: a computed tomography angiography study

PURPOSE

To determine the anatomical variations and morphology of the external carotid artery (ECA) and its anterior branches.

METHODS

Using computed tomography angiography (CTA), the origin, internal diameter, and surface laterality emergence of the superior thyroid (STA), lingual (LA), and facial (FA) arteries were evaluated retrospectively evaluated and classified. The bifurcation level of the common carotid artery (CCA) in relation to the cervical vertebrae and disc was also determined.

RESULTS

A total of 76 CTA were included in the study. STA originated from the carotid bifurcation (CB) (type I), CCA (type II) and ECA (type III) in 20.4 (31/152), 17.1 (26/152) and 50.7% (77/152) cases, respectively. Also 10.5% (16/152) arose from a shared trunk with LA as a thyrolingual trunk (TLT) (type IVa), and absent in 1.3% (2/152). LA originated in the CB in only one case. A linguofacial trunk (LFT) was present in 14.5% (22/152). Mean diameters of STA, LA and FA were 1.70, 1.95 and 2.45 mm, respectively. Meanwhile, surface laterality were predominately from anteromedial, medial, and anterior, respectively. CB was mainly on C3 or C3-C4 (55.9% of cases).

CONCLUSIONS

STA origin below the ECA is a common finding. Our population presented the highest percentage of TLT (10.5%) and high CB (9.8%) in literature. Considering these variations are important to prevent complications in neck surgical procedures.

Prevalence of facial canal dehiscence and other bone defects by computed tomography

INTRODUCTION

The facial nerve is the most vulnerable structure during otological surgeries. Facial canal dehiscence (FCD) is the main risk factor for iatrogenic injuries. Its prevalence in clinical studies ranges between 6 and 33.3%, while anatomical studies report 25-57%. The objective was to determine the prevalence of FCD stratified by age and gender in a healthy population.

MATERIALS AND METHODS

Temporal bones from high-resolution computed tomography (CT) were analyzed. Patients with a history of trauma or tumors of the temporal bone, cholesteatomas, chronic middle ear disease, and any pathology that could modify the bone's anatomy, were excluded.

RESULTS

A total of 184 temporal bones were included. FCD was observed in 94 (51.2%) of the analyzed bones. The tympanic portion was the most frequently affected site with 91 (49.5%), followed by the mastoid segment with 3 (1.6%). No dehiscence was found in the labyrinth portion. We observed 30 (31.9%) of the FCD involved the oval window. Other bone defects identified with the FCD included: 11 (11.7%) with a lateral semicircular canal fistula and 7 (7.4%) with tegmen tympani erosions.

CONCLUSION

FCD has a high prevalence among healthy patients. A pre-surgical otological evaluation using high-resolution CT should be indicated to properly assess the patient and reduce the risk of injury.

A proposed extension to the elongated styloid process definition: A morphological study with high-resolution tomography computer

The objective of the present study was to evaluate the morphology and angulation of the styloid process (SP), analyzing results stratified by gender, side and age on asymptomatic patients. We retrospectively analyzed 99 high-resolution computed tomography study images from asymptomatic patients. The images were assessed intra-observatory by a head and neck expert radiologist. Data for length, morphology, and angulation in a coronal and sagittal plane were recorded and stratified by age and gender. Morphology was classified according to the Langlais modified by Guimares classification. The mean lengths were 31.67±0.97mm and 31.64±0.90mm for the right and left sides respectively. Using the Langlais modified by Guimares classification, the normal type was the most prevalent and without a statistically significant difference when comparing between genders. A total of 27.6% presented a morphologically elongated SP (>25mm of continuous process), 49.5% presented a radiologically elongated SP (>30mm), and a total of 9.59% had a longer length than the proposed≤45mm. The right transverse angle was greater in men than women, and a statistically significant difference was found (P=0.010). We show the morphological variability of the SP. Although our results are reported with the traditional definition, the high prevalence supports the need for a new definition of elongated SP and a normal angulation ranges.

Anatomy of foot Compartments: a systematic review

INTRODUCTION

There are discrepancies regarding the anatomy of the foot which complicate standardizing foot compartment treatment. We synthesized the existing evidence regarding the compartmental anatomy of the foot MATERIALS AND METHODS: A systematic review was performed evaluating the anatomy of the foot compartments in non-pathologic specimens. The search strategy was performed in MEDLINE, Scopus, Web of Science, and EMBASE. Three reviewers worked independently and in duplicate to screen all references via a title/abstract and full-text phase. The risk of bias was assessed with the Anatomical Quality Assurance (AQUA) checklist.

RESULTS

Ten studies were included. All were performed in cadavers except one. Half of them evaluated the plantar section of the foot and the other half evaluated the whole foot. Methods employed across studies tended to vary: anatomical dissections, dye infusion, imaging studies, or a combination of these. Five studies directly addressed the anatomic limits of each compartment and eight addressed the anatomical structures inside each of them. There seems to be an agreement regarding the number of compartments in the plantar region (three major compartments divided by the medial and lateral intermuscular septum), nevertheless, disagreements across authors tend to arise when describing its dorsal section. Only two studies were ranked with an overall low risk of bias, agreeing on nine compartments.

CONCLUSION

This review provides the best available anatomical evidence regarding the anatomy of the foot compartments for compartment syndrome management. Future research should focus on settling the discrepancies highlighted to reach a more accurate anatomical description.

The Use of Clinical Reasoning Skills in the Setting of Uncertainty: A Case of Trial Femoral Head Migration

Clinical skills and medical knowledge enable physicians to overcome the uncertainty of emergent and rare clinical scenarios. Recently, a growing emphasis on evidence-based medicine (EBM) has flooded medical curricula of universities across the globe with guideline-based material, and while it has given teachers and students new tools to improve medical education, clinical reasoning must be reaffirmed in its capacity to provide physicians with the ability to solve unexpected clinical scenarios. Anatomical education in medical school should have two main objectives: to acquire anatomical knowledge and to develop the skill of applying that knowledge in clinical scenarios. The authors present a clinical scenario in which an unexpected and rare complication occurred during a routine elective hip replacement surgery. The general surgeon presiding over the case, also an anatomy professor, solved the problem using clinical reasoning and anatomical knowledge. It was a clear example of how clinical reasoning is key in approaching unprecedented, rare, or unknown complications. The intention of this scenario is to remind colleagues and medical schools that, although EBM is the standard, educators must uphold sound clinical reasoning to best prepare health care providers for their careers.

The very early inflammatory triquetral lesion by MRI - is this the first sign in Rheumatoid Arthritis?

INTRODUCTION/AIM

Rheumatoid Arthritis (RA) an autoimmune, chronic, and disabling disease if untreated, affects wrist joints, with a diagnostic delay of up to 2 years. Triquetral bone allows rotational movement that pivots over the rest wrist bones, and maintains physiological loads during mobility. Magnetic Resonance Imaging (MRI) is the most sensitive (96%) method for diagnosis, evidencing lesions as early as in the initial RA stages. Our aim was to determine the most frequently affected structures in the hand-wrist joint by MRI using the OMERACT-RAMRIS Score (2003) in three different RA stages, including clinically suspicious arthralgia (CSA) that haven't reported before.

METHODS

We performed an exploratory, transverse, observational, descriptive study in 60 patients enrolled and classified by rheumatologists as: CSA, early rheumatoid arthritis (ERA), and established RA, prior to performing a dominant hand-wrist MRI for evaluation and descriptive analysis by an expert radiologist.

RESULTS

Female predominance 83% (50), with a mean age 42+13.5 years; A total of 1,731 hand-wrist bone and joint sites were evaluated using EULAR-OMERACT Atlas (2005), identifying 56% (964 sites) with typical RA lesions: synovitis, erosions, and bone marrow edema (BME or osteitis); synovitis was the most frequent with 46% (445 site-lesion), and triquetral synovitis the most frequent each clinical group: CSA 87% (20/23), ERA 91% (20/22), and RA 93% (14/15).

CONCLUSION

Synovitis and triquetral synovitis were the most prevalent lesion in three-studied phases. This could suggest the triquetrum as the first morphological site to be affected by RA; so it's assessment should be considered in the RA evaluation when it´s clinically suspected.

Uncommon variant of pre-axial polydactyly and its surgical management: a case report

We report the case of an adult patient with thumb polydactyly. The pre-axial thumb is in a non-functional flexion, while the 1st thumb maintains normal function. X-ray of the hand reveals a “T” shape 1st metacarpus bone, giving origin to the pre-axial polydactyly. Although this variation is not specifically described in the Wassel classification, we classify it as a type V of the Rotterdam´s classification. Patient is managed surgically, using a dynamic incision for polydactyly amputation. The polydactyly thumb has no identifiable muscle/tendon structures responsible of this unique deformation. The procedure results in good post-operative evolution with aesthetic scaring, and integral thumb function.

Collaborative mentoring for effective medical research groups

This article was migrated. The article was marked as recommended. Research benefits professors and students, mentors and mentees, however, many Universities lack formal programs, especially in basic sciences such as anatomy. Faculty, many times, lack the time, resources, and a well-structured program. Mentoring and collaborative work, have played an important role in creating an effective environment that inspires its members into scientific production, enhances research skills, while gaining experience. The authors presented a student anatomy research group (Grupo de Investigación en Anatomía [GIA]) model that integrates faculty from basic and clinical fields through a collaborative mentoring and tightly organized structure that increases training, experience, and scientific output. The transformation stages described shows the progress, reporting the fundamental elements for integration of the model, with results presented at 16 years of experience of the group in the Anatomy department. Results evidence a steady increase in student/professor involvement, scientific publishing, presentations in meetings (national/international), and cites.

Neuronavigation-guided Endoscopic Endonasal Excision of Schwannoma-like Chordoma of Meckel's Cave: A Case Report

Chordomas are locally aggressive malignant tumors due to their recurrence potential and originate from embryonic notochord remnants. Chordomas can originate anywhere on the axial skeleton. They are extradural and spread by bone destruction. Chordomas are locally aggressive tumors that invade the dura mater, and may also present with secondary intradural growth. The Meckel's cave location of chordomas has been very rarely reported in the literature. Chordomas located in Meckel's cave can be radiologically confused with trigeminal schwannomas. Herein, we report a case of Meckel's cave chordoma that was successfully excised through neuronavigation-guided endoscopic endonasal excision, a technique commonly used in skull base surgeries.

Schwann Cell Precursor Transplant in a Rat Spinal Cord Injury Model

Background

Differentiation of mesenchymal stem cells into Schwann cell precursors could reverse established lesions and sequelae of medullary transection.

Objective

The objective of this study was to study the clinical response of mesenchymal stem cell transplantation with Schwann precursor cell transplantation in a rat spinal cord injury model, using motor function and histopathologic studies.

Materials and Methods

A total of 28 Sprague-Dawley rats were randomly divided among four groups (n = 7 in each): sham group, control group, mesenchymal stem cell transplant group, and Schwann cell precursor transplant group. The surgical procedure was a laminectomy with transection of the spinal cord at the T11 level in the transplant groups and the injury control group. After 1 week, the transplant groups received stem cells directly in the injury site. Hind limb motor function was assessed using the locomotive scale of Basso, Beattie, and Bresnahan. 1 month after transplantation, all specimens were sacrificed to make a histopathologic description of sections taken from the site of injury and where stem cells were transplanted. Mean scores of mobility were compared using analysis of variance (ANOVA) of one factor with 95% reliability between groups and ANOVA of repetitive measures to evaluate evolution in the same group.

Results

We observed that the control group had statistically greater mobility than the other groups (p < 0.0001) and that the group with spinal injury without treatment had the lowest mean mobility. The mobility score values from the Schwann cell precursor group were statistically higher than the group treated with mesenchymal stem cells (p < 0.0001).

Conclusion

Schwann precursor cells had a greater effect on locomotive function than mesenchymal stem cells.