Who really needs a Metaverse in anatomy education? A review with preliminary survey results.

The term Metaverse ("meta" defined as beyond, transcendence or virtuality, and "verse" meaning universe or world) denotes a "virtual reality space" for anatomy teaching. To ascertain how many anatomists are familiar or are using this adjunct in teaching, we conducted a short survey at the 2022 annual meeting of the American Association of Clinical Anatomists (AACA). Interestingly, only six respondents (9.4%) had used a Metaverse for teaching anatomy. Moreover, the vast majority of attendees were anatomy educators or basic science faculty, but not practicing physicians/surgeons or other actively practicing health care professionals; a group where this technology has been used much more commonly. The present manuscript was authored by anatomy educators, practicing physicians and other actively practicing health care professionals with backgrounds in diverse medical fields, that is, anatomists, medical doctors, physician assistants, dentists, occupational therapists, physical therapists, chiropractors, veterinarians, and medical students. Many of these authors have used or have been exposed to a Metaverse in the clinical realm. Therefore, the aim of the paper is to better understand those who are knowledgeable of a Metaverse and its use in anatomy education, and to provide ways forward for using such technology in this discipline.

A comprehensive study of the abdominal ganglia part 2: Aorticorenal ganglia.

Investigation into reports of pain treatment for abdominal cancer and abdominal pain syndromes revealed the lack of human studies on some of the abdominal sympathetic ganglia. Recent studies on renal artery denervation therapy as treatment for resistant hypertension has made the aorticorenal ganglia of particular importance. The aim of this study was to investigate the location, morphology, interconnections, and histological nature of aorticorenal ganglia. We dissected nine abdominal cavities and harvested 37 aorticorenal ganglia. Hematoxylin and Eosin, and Masson's staining techniques were used to study the histological structure. Additionally, ganglia harvested from five individuals were stained with immunohistochemical techniques to test for tyrosine hydroxylase activity. All aorticorenal ganglia were located in proximity to the renal artery, and the majority were close to the vessel origin. Identification of multiple aorticorenal ganglia was the norm, and ranged from 2 to 4 on the left and 1 to 3 on the right. While the pattern of aorticorenal ganglia seemed to be unique in each individual case, the interconnections between these and other ganglia were vast. The aorticorenal ganglia shared direct connections with the celiac, gonadal, inferior mesenteric, and first lumbar sympathetic trunk ganglion. Contributions from the greater, lesser, and least thoracic splanchnic nerves were also observed. While the results of our study may not have direct clinical implications in isolation, the vast number of interconnections with the other abdominal ganglia may cause complications in procedures such as celiac ganglion block. In addition, aorticorenal innervation interruption may lead to hypotension.

The Critical Appraisal Tool for Anatomical Meta-analysis: A framework for critically appraising anatomical meta-analyses.

The hallmark of evidence-based medicine is the meta-analysis (MA). For much of its rich history, the field of anatomy has been dominated by descriptive, cadaveric studies. In the last two decades, quantitative measurements and statistical analyses have frequently accompanied such studies. These studies have directly led to the publication of anatomical MAs, which have ushered in the exciting field of evidence-based anatomy. Although critical appraisal tools exist for clinical MAs, none of them are specifically tailored for anatomical MAs. Therefore, the purpose of this article is to provide a framework by which clinical anatomists and others can critically appraise anatomical MAs using the Critical Appraisal Tool for Anatomical Meta-analysis (CATAM). Using a running example from a recently published MA, we show how to use the CATAM rubric in a step-by-step fashion. Each scored section of the CATAM rubric is summated into a total score (maximum 50 points). This score is then referenced to a conversion chart, which assigns a qualitative value to the MA in a range from "very good" to "poor." Future studies can investigate the interrater reliability of the instrument, and possibly subject the CATAM rubric to a Delphi panel. As anatomical MAs become more commonplace at surgical grand rounds and journal clubs in academic medical centers throughout the world, we hope that the CATAM rubric can help facilitate meaningful discussions about the quality and clinical relevance of anatomical MAs.

Frequency of Urinary Tract Infections, Gonorrhea, and Chlamydia in Emergency Department Patients With Acute Scrotal Pain.

BACKGROUND: Acute scrotal pain has many causes. According to the American Urological Association recommendations: history, physical examination, and ultrasound are key in diagnosing acute scrotal pain. OBJECTIVE: The primary objective of this study was to evaluate the frequency of urinary tract infections (UTI) on routine Urinalysis (UA) in patients presenting with acute scrotal pain to the emergency department (ED). METHODS: We conducted a multicentered retrospective chart review of patients who presented to the ED with acute scrotal pain. Patient visits from February 1, 2018 to November 1, 2019 from 13 EDs were analyzed. Demographic data, UA interpretation, urine culture, gonorrhea and chlamydia (GC) testing, clinical findings, treatment outcomes, and ultrasounds were recorded. Patients who did not have a UA and scrotal ultrasound performed or who had a diagnosis of scrotal cellulitis or soft tissue infection were excluded. RESULTS: There were 2,392 patients included in the study. A UTI was present in 173 (7.2%) patients. Of the patients who were found to have a UTI, 100/173 (57.8%) had a concomitant ultrasound diagnosis of epididymitis/orchitis. Also, 731 patients underwent GC testing in addition to standard UA collection, and ultrasound, seven were positive for gonorrhea (0.95%), and 30 were positive for chlamydia (4.10%). CONCLUSIONS: Routine UA collection of patients presenting to the ED with acute scrotal pain should be considered, especially in patients with a concomitant ultrasound diagnosis of epididymo-orchitis. GC testing has limited yield without symptoms suggestive of sexually transmitted infections and a normal ultrasound.

A comprehensive review of the great auricular nerve graft.

The great auricular nerve (GAN) is a superficial branch of the cervical plexus that innervates parts of the mandible, auricle, and earlobe. Over the past 30 years, the GAN has become the nerve graft donor of choice for many surgeons for reconstructing injured facial nerves. In this review, we discuss the anatomy and function of the GAN, while focusing on surgical landmarks and the characteristics that make it a suitable nerve graft donor. In addition, we present and summarize published case reports on use of the GAN for grafting. We hope that this review will provide surgeons with an up-to-date and concise reference.

An Observational Study of Vaping Knowledge and Perceptions in a Sample of U.S. Adults.

Background Vaping is the use of e-cigarettes that contain inhalants such as nicotine, tetrahydrocannabinol, and cannabidiol. Vaping is associated with e-cigarette or vaping product use associated lung injury (EVALI) and is a recognized public health crisis. Despite rising numbers of hospitalizations due to EVALI, public knowledge and perceptions of the dangers of vaping require further investigation. Objectives This exploratory study assessed knowledge and perceptions of vaping in U.S. adults. Methods This study was approved by an ethical board, and informed consent was obtained from all participants. A cohort of U.S. adults was recruited by shared links on social media. Participants completed an anonymous online survey that contained vaping knowledge and perceptions items. An a priori power analysis was conducted at 95% power and alpha = 0.05. Statistics were calculated using IBM SPSS Statistics Version 26 (IBM Corp., Armonk, NY, USA). Results A sample of 413 (N = 413) U.S. adults participated in the survey. The majority of participants (79.18%) were females, and 65.62% were between 18 and 24 years of age. Over half (62.71%) of participants were never asked about vaping use by a clinician at any visit, and 56.51% agreed that vaping can reduce stress. Of all participants, 70.91% agreed that drinking alcohol makes someone more inclined to vape. Significant positive Spearman's rho correlations were found between vaping and the use of cannabis, cocaine, ecstasy, hallucinogens, and inhalants (p < 0.05). Conclusions We found a significant correlation between vaping and drug use. We also found that if the dangers of vaping are discussed by their health care providers, participants are more inclined to quit vaping. Unfortunately, many physicians report that they avoid discussing vaping with their patients due to lack of vaping knowledge. Our results illuminate the communication gap between patients and physicians. All clinicians need to counsel patients on the dangers of vaping, which might help prevent EVALI and related conditions.

Anatomico-radiological Study of the Bifurcate Ligament of the Foot with Clinical Significance.

Introduction Lateral ankle sprain caused by forcible plantar flexion and inversion of the foot commonly damages the anterior talofibular ligament and other ligaments. Unfortunately, involvement of the bifurcate ligament (BL) is often overlooked when assessing such injuries in clinical practice and identification of this ligament on magnetic resonance (MR) scans can be challenging. Anatomically, the BL is a Y-shaped structure with two bands: the calcaneonavicular ligament (CNL) and calcaneocuboid ligament (CCL). There are few anatomical studies on the morphometric characteristics of the BL and even fewer biomechanical studies. Therefore, the objective of this anatomico-radiological study was to investigate the morphology of the BL using a multifaceted approach, and classify the fiber characteristics of the CNL and CCL. Materials and methods We measured the length and the width of 53 embalmed cadaveric feet. Meticulous dissection of each foot was performed to expose the BL. Measurements of the length, width, thickness, and shape of the CNL and CCL were taken using a digital caliper. We also documented the fiber orientation of each ligament, and used a goniometer to measure the bifurcation angle between the CNL and CCL via two methods. Confirmatory histologic analysis of the ligaments was performed and digital radiographs of the ligaments with attached radiopaque monofilament were taken. We also included an MR scan of the BL. Using descriptive and inferential statistics, we documented any significant relationships between the variables. Results  Mean (range) age at death of cadavers was 76 (42-94) years. The CNL was found in all the feet and the CCL was not present in 9.4% of the feet. Mean (standard deviation) length of the CNL and CCL was 22.7 (4.12) mm and 10.9 (2.53) mm, respectively. Mean (standard deviation) thickness of the CNL and CCL was 3.23 (1.56) mm and 1.48 (0.71) mm, respectively. Related to ligament morphology, the CNL was most frequently cord shaped (67.92%) and the CCL was most frequently flat shaped (83.33%). The mean bifurcation angle measured 32.75o and 29.31o in methods 1 and 2, respectively. The correlation between the two measured angles was very strong (p < 0.001). Discussion We found that 90.6% of feet had both the CNL and CCL, 9.4% had the CNL and no CCL, and none (0%) had the CCL and no CNL. These frequencies are similar to a recent Japanese study. Our sample of donors were American and predominantly white. Whether the difference in frequencies between the studies is related to ethnicity is unknown and requires future investigation. Interestingly, on average the CNLs were twice as long and twice as thick as the CCLs. The CCLs tended to be wider distally and tapered compared to the CNLs. Conclusions Our findings better classify the morphology and fiber orientation of the BL. Coupled with the radiographs and MR scan, our data may be of particular value to radiologists and surgeons. Our BL fiber orientation classification system and angle measurements can pave the way for future biomechanical studies to investigate any relationships between fiber type, angle, and strength of the constituent bands. More accurate descriptions of the BL should lead to improved diagnosis and treatment of ligamentous injuries of the foot.

An evidence-based approach to learning clinical anatomy: A guide for medical students, educators, and administrators.

The amount of information that medical students learn is voluminous and those who do not use evidence-based learning strategies may struggle. Research from cognitive and educational psychology provides a blueprint on how best to learn science subjects, including clinical anatomy. Students should aim for high-cognitive learning levels as defined in the SOLO taxonomy. Using a real-world example from a modern clinical anatomy textbook, we describe how to learn information using strategies that have been experimentally validated as effective. Students should avoid highlighting and rereading text because they do not result in robust learning as defined in the SOLO taxonomy. We recommend that students use (1) practice testing, (2) distributed practice, and (3) successive relearning. Practice testing refers to nonsummative assessments that contain questions used to facilitate retrieval (e.g., flashcards and practice questions). Practice questions can be fill-in, short-answer, and multiple-choice types, and students should receive explanatory feedback. Distributed practice, the technique of distributing learning of the same content within a single study session or across sessions, has been found to facilitate long-term retention. Finally, successive relearning combines both practice testing and distributed practice. For this strategy, students use practice questions to continue learning until they can answer all of the practice questions correctly. Students who continuously use practice testing, distributed practice, and successive relearning will become more efficient and effective learners. Our hope is that the real-world clinical anatomy example presented in this article makes it easier for students to implement these evidence-based strategies and ultimately improve their learning. Clin. Anat., 2018. © 2018 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.

Arcuate Foramen: Anatomy, Embryology, Nomenclature, Pathology, and Surgical Considerations.

BACKGROUND: The arcuate foramen is an anatomic variant that is thought to arise from ossification of the posterior atlanto-occipital membrane. Owing to potential entrapment of the vertebral artery segment that traverses the foramen, vertebrobasilar ischemia may occur, and the person may experience vertigo, headache, or neck pain. METHODS: We reviewed the literature regarding anatomy (both human and comparative), embryology, nomenclature, pathology, and surgery of the arcuate foramen. RESULTS: Surgically, the presence of an arcuate foramen is important when placing screws into lateral masses of the atlas. In these cases, the screws can damage the V3 segment of the vertebral artery and/or the suboccipital nerve. CONCLUSIONS: It is important to review the current literature on the arcuate foramen to further understand its morphology and clinical relevance.

Morphometric analysis of temporomandibular joint elements.

PURPOSE: To study the morphology of temporomandibular joint (TMJ) elements and examine the feasibility of a novel biofidelic articular disc casting technique. METHODS: 18 formalin-fixed cadavers (77.8% female, 22.2% male) with mean (SD) death age of 71.9 (13.7) years were used for this study. In each specimen the masseter muscle, mandibular ramus, and articular disc were dissected bilaterally and measured for length, width, and thickness. All anatomic measurements were made using a digital slide caliper (Hawk Inc., Cleveland, OH). Further, a novel method for the creation of biofidelic articular disc models was established through trial and error. Models were measured for accuracy against their biological counterparts. RESULTS: Left articular disc length and thickness were inversely correlated (r = -0.58, p < 0.049). Direct correlations existed between right disc and ramus thickness (r = 0.56, p < 0.039), masseter length and thickness (r = 0.59, p < 0.009), and masseter width and thickness (r = 0.66, p < 0.003). Comparison of the model measurements with their biological counterparts found no significant differences. DISCUSSION: These observed correlations between elements of the TMJ hold relevance for oral-maxillofacial surgeons and researchers examining disorders of the TMJ. Additionally, our casting technique proved accurate in modeling human articular discs.

Surgical relevance of the lateral costotransverse ligament in relation to the dorsal root ganglion.

The lateral costotransverse ligament, a short band that stabilizes the costovertebral joint, is found in close proximity to the dorsal root ganglion. This ligament is an important surgical landmark during tumor resections or nerve blocks in the paravertebral space. The purpose of this study was to quantitatively and qualitatively describe the morphology of the lateral costotransverse ligament and its relation to the dorsal root ganglion at all levels of the thoracic spine. The thoracic spines of eight embalmed cadavers were dissected bilaterally. The length, width, and thickness of the ligament were measured. The distance from the inferolateral aspect of the ligament to the lateral aspect of the dorsal root ganglion was also measured. Three bilateral groups of lateral costotransverse ligaments, top (on ribs 1-2), middle (on ribs 3-10), and bottom (on ribs 11-12), were compared based on anatomic distinctions between the costotransverse joints, which can influence ligament morphology. Among the three groups, the differences between the length, width, and thickness were not statistically significant. However, the distance from the lateral costotransverse ligament to the dorsal root ganglion differed significantly (P = 0.000), with the middle group having the longest distance, and the bottom group having the shortest distance. This finding can help clinicians and surgeons avoid iatrogenic injuries of neural structures during thoracic spine surgery, or when performing nerve blocks in the paravertebral space.

Penetrating Orbital Injuries: A Review.

Penetrating injuries to the orbit represent a small but very complicated portion of head injuries. Because of the close proximity to many vital structures, any penetrating orbital injury requires a multidisciplinary follow-up. Cases of penetrating injuries have flooded the literature, but no one has presented a systematic approach to the complications associated with these types of injuries. Herein, we present the complications associated with each orbital entry mode: superior, inferior, medial, lateral rims of the orbit, and extraorbital entry.

Xiphoid Process Variations: A Review with an Extremely Unusual Case Report.

The xiphoid process is a small bony feature of the anterior thoracic wall just inferior to the sternum corpus. Although the xiphoid process is commonly represented as a straight, fully ossified bone in educational textbooks, reports of anomalous processes flood the literature. The xiphoid process can be broad, thin, monofid, bifid, trifid, curved, or deflected and contain foramina. Variations can be mistaken for epigastric masses. Herein, we report an extremely unusual bifid xiphoid process that is deflected anteriorly. This case is discussed in the context of the misdiagnosis of xiphoid process variations and its importance to the clinician.

Chiari I Malformation and Spinal Cord Ischemia in a Cadaver.

With advanced imaging, the Chiari I malformation (CIM) is more frequently diagnosed than in the past when this entity was identified most commonly at autopsy. Herein, we report the rare case of an adult cadaver found not only to have CIM but also adjacent spinal cord ischemia. This case is discussed in the context of chronic compression of the spinal cord by a CIM and the need for close monitoring of these patients.