Obturator Nerve Block: An Anatomical Perspective.

Background A comprehensive understanding of the anatomy of the obturator nerve after its emergence from the obturator foramen is essential when undertaking an obturator nerve block effectively. This study was conducted to provide precise anatomical guidance of the obturator nerve block with surface landmarks in the inguinal region. Materials and methods A cross-sectional observational study was carried out on 34 dissected embalmed cadaveric lower limbs to investigate anatomic variability of obturator nerve localization concerning bony/ligamentous landmarks viz. the pubic tubercle, anterior superior iliac spine, inguinal ligament, and femoral artery as well as the adductor longus. Results The pubic tubercle and inguinal ligament were found to be the "least variable indicator" and palpable landmark for localization of the main trunk of the obturator nerve exhibiting lesser standard deviation of the mean distance from the obturator nerve exit. Among the soft tissue (vessel/muscle) parameters, the shortest distance of the adductor longus muscle from the obturator nerve exit was found to have the lowest standard deviation, thus making it the most reliable parameter for obturator nerve localization. Conclusion High anatomic variability in the obturator nerve's localization does exist, and this explains the difficulty frequently encountered in the application of regional anesthetic techniques. The pubic tubercle and inguinal ligament points were found to be the least variable and most reliable landmarks for localization of the main trunk of the obturator nerve.

Accuracy of ChatGPT in Neurolocalization.

Introduction ChatGPT (OpenAI Incorporated, Mission District, San Francisco, United States) is an artificial intelligence (AI) chatbot with advanced communication skills and a massive knowledge database. However, its application in medicine, specifically in neurolocalization, necessitates clinical reasoning in addition to deep neuroanatomical knowledge. This article examines ChatGPT's capabilities in neurolocalization. Methods Forty-six text-based neurolocalization case scenarios were presented to ChatGPT-3.5 from November 6th, 2023, to November 16th, 2023. Seven neurosurgeons evaluated ChatGPT's responses to these cases, utilizing a 5-point scoring system recommended by ChatGPT, to score the accuracy of these responses. Results ChatGPT-3.5 achieved an accuracy score of 84.8% in generating "completely correct" and "mostly correct" responses. ANOVA analysis suggested a consistent scoring approach between different evaluators. The mean length of the case text was 69.8 tokens (SD 20.8). Conclusion While this accuracy score is promising, it is not yet reliable for routine patient care. We recommend keeping interactions with ChatGPT concise, precise, and simple to improve response accuracy. As AI continues to evolve, it will hold significant and innovative breakthroughs in medicine.

Endoscopic sleeve gastroplasty: stomach location and task classification for evaluation using artificial intelligence.

PURPOSE: We have previously developed grading metrics to objectively measure endoscopist performance in endoscopic sleeve gastroplasty (ESG). One of our primary goals is to automate the process of measuring performance. To achieve this goal, the repeated task being performed (grasping or suturing) and the location of the endoscopic suturing device in the stomach (Incisura, Anterior Wall, Greater Curvature, or Posterior Wall) need to be accurately recorded. METHODS: For this study, we populated our dataset using screenshots and video clips from experts carrying out the ESG procedure on ex vivo porcine specimens. Data augmentation was used to enlarge our dataset, and synthetic minority oversampling (SMOTE) to balance it. We performed stomach localization for parts of the stomach and task classification using deep learning for images and computer vision for videos. RESULTS: Classifying the stomach's location from the endoscope without SMOTE for images resulted in 89% and 84% testing and validation accuracy, respectively. For classifying the location of the stomach from the endoscope with SMOTE, the accuracies were 97% and 90% for images, while for videos, the accuracies were 99% and 98% for testing and validation, respectively. For task classification, the accuracies were 97% and 89% for images, while for videos, the accuracies were 100% for both testing and validation, respectively. CONCLUSION: We classified the four different stomach parts manipulated during the ESG procedure with 97% training accuracy and classified two repeated tasks with 99% training accuracy with images. We also classified the four parts of the stomach with a 99% training accuracy and two repeated tasks with a 100% training accuracy with video frames. This work will be essential in automating feedback mechanisms for learners in ESG.

A Bayesian Network Meta-Analysis and Systematic Review of Guidance Techniques in Botulinum Toxin Injections and Their Hierarchy in the Treatment of Limb Spasticity.

Accurate targeting of overactive muscles is fundamental for successful botulinum neurotoxin (BoNT) injections in the treatment of spasticity. The necessity of instrumented guidance and the superiority of one or more guidance techniques are ambiguous. Here, we sought to investigate if guided BoNT injections lead to a better clinical outcome in adults with limb spasticity compared to non-guided injections. We also aimed to elucidate the hierarchy of common guidance techniques including electromyography, electrostimulation, manual needle placement and ultrasound. To this end, we conducted a Bayesian network meta-analysis and systematic review with 245 patients using the MetaInsight software, R and the Cochrane Review Manager. Our study provided, for the first time, quantitative evidence supporting the superiority of guided BoNT injections over the non-guided ones. The hierarchy comprised ultrasound on the first level, electrostimulation on the second, electromyography on the third and manual needle placement on the last level. The difference between ultrasound and electrostimulation was minor and, thus, appropriate contextualization is essential for decision making. Taken together, guided BoNT injections based on ultrasound and electrostimulation performed by experienced practitioners lead to a better clinical outcome within the first month post-injection in adults with limb spasticity. In the present study, ultrasound performed slightly better, but large-scale trials should shed more light on which modality is superior.

Local anatomy, stimulation site, and time alter directional deep brain stimulation impedances.

Directional deep brain stimulation (DBS) contacts provide greater spatial flexibility for therapy than traditional ring-shaped electrodes, but little is known about longitudinal changes of impedance and orientation. We measured monopolar and bipolar impedance of DBS contacts in 31 patients who underwent unilateral subthalamic nucleus deep brain stimulation as part of a randomized study (SUNDIAL, NCT03353688). At different follow-up visits, patients were assigned new stimulation configurations and impedance was measured. Additionally, we measured the orientation of the directional lead during surgery, immediately after surgery, and 1 year later. Here we contrast impedances in directional versus ring contacts with respect to local anatomy, active stimulation contact(s), and over time. Directional contacts display larger impedances than ring contacts. Impedances generally increase slightly over the first year of therapy, save for a transient decrease immediately post-surgery under general anesthesia during pulse generator placement. Local impedances decrease at active stimulation sites, and contacts in closest proximity to internal capsule display higher impedances than other anatomic sites. DBS leads rotate slightly in the immediate postoperative period (typically less than the angle of a single contact) but otherwise remain stable over the following year. These data provide useful information for setting clinical stimulation parameters over time.

Corrigendum: LeGUI: A Fast and Accurate Graphical User Interface for Automated Detection and Anatomical Localization of Intracranial Electrodes.

[This corrects the article DOI: 10.3389/fnins.2021.769872.].

LeGUI: A Fast and Accurate Graphical User Interface for Automated Detection and Anatomical Localization of Intracranial Electrodes.

Accurate anatomical localization of intracranial electrodes is important for identifying the seizure foci in patients with epilepsy and for interpreting effects from cognitive studies employing intracranial electroencephalography. Localization is typically performed by coregistering postimplant computed tomography (CT) with preoperative magnetic resonance imaging (MRI). Electrodes are then detected in the CT, and the corresponding brain region is identified using the MRI. Many existing software packages for electrode localization chain together separate preexisting programs or rely on command line instructions to perform the various localization steps, making them difficult to install and operate for a typical user. Further, many packages provide solutions for some, but not all, of the steps needed for confident localization. We have developed software, Locate electrodes Graphical User Interface (LeGUI), that consists of a single interface to perform all steps needed to localize both surface and depth/penetrating intracranial electrodes, including coregistration of the CT to MRI, normalization of the MRI to the Montreal Neurological Institute template, automated electrode detection for multiple types of electrodes, electrode spacing correction and projection to the brain surface, electrode labeling, and anatomical targeting. The software is written in MATLAB, core image processing is performed using the Statistical Parametric Mapping toolbox, and standalone executable binaries are available for Windows, Mac, and Linux platforms. LeGUI was tested and validated on 51 datasets from two universities. The total user and computational time required to process a single dataset was approximately 1 h. Automatic electrode detection correctly identified 4362 of 4695 surface and depth electrodes with only 71 false positives. Anatomical targeting was verified by comparing electrode locations from LeGUI to locations that were assigned by an experienced neuroanatomist. LeGUI showed a 94% match with the 482 neuroanatomist-assigned locations. LeGUI combines all the features needed for fast and accurate anatomical localization of intracranial electrodes into a single interface, making it a valuable tool for intracranial electrophysiology research.

Descriptive Analysis of Patients with Gastric Tumors Referred to the Largest Emergency Hospital in Oltenia Region-Romania, Between 2015-2020.

Gastric cancer represents the third most frequent cause of death worldwide, with the treatment being impaired also by the fact that patients present in the late stages of disease progression. We have aimed here to evaluate the main clinical and pathological features of all recorded cases of gastric tumor patients presented between January 2015 and December 2020 within the Emergency County Hospital of Craiova. Our retrospective analysis identified a total number of 745 cases, and showed a relative homogenous distribution of the age of the patients / year, with the peak age at presentation of 70-80 years old, and with males having a slightly higher prevalence compared to females. There was no correlation of the number of hospitalization days with the localization of the tumor, but the patients in the age group 60-70 years of age tended to show longer hospitalization times compared to the rest of the age groups. Also, pyloric/ antral tumors tended to present at younger ages compared to other localizations, and interestingly, these patients also represented most of the casuistry. Altogether, the distribution of gastric cancer patients' features did not change significantly in the last 5 years despite treatment advances (especially chemo-and radiotherapy), and the advanced stage of presentation call for a more aggressive detection and increased awareness of the population for this frequent pathology.

Neurology and the clinical anatomist.

Clinical examination allows the neurologist to test hypotheses generated by their interpretation of the patient's story. By eliciting abnormal clinical signs, the examining doctor works out a differential diagnosis for the part of the nervous system affected and, using information from the clinical history, a differential diagnosis of the pathology. Clinical examination also allows the clinician to observe and quantify function, hear more story and provide reassurance. The focus of the examination should be dictated by the hypothesis being tested, the patient's clinical state and the situation. Examination of the different parts of the nervous system remains very important in all clinical situations as the best available index of function of the nervous system as a whole.

Estudio epidemiológico de cáncer de piel del Hospital Regional de Iquique, Región de Tarapacá de Chile (2006 – 2010) / Epidemiological study of skin cancer in the Hospital of Iquique (2006-2010)

Introducción: El cáncer de piel es actualmente una patología de alta prevalencia y ha llegado a constituir un real problema de salud pública. El objetivo de este trabajo fue analizar las tasas de incidencia y características clínicas e histopatológicas del Carcinoma Basocelular (CBC), Espinocelular (CEC) y Melanoma Maligno (MM) en el hospital Regional de Iquique en el período 2006-2010. Metodología: Se analizaron 25.338 informes histopatológicos correspondientes a biopsias realizadas en el Servicio de Anatomía Patológica del Hospital Regional de Iquique, durante los años 2006-2010. Se obtuvieron 257 informes compatibles con cáncer de piel. Para cada tipo de tumor se analizaron las variables de sexo, edad, raza, localización anatómica, servicio de derivación y tipo histológico. El análisis estadístico se realizó a través de STATA®. Resultados: Se obtuvo un 65 por ciento de CBC, 28 por ciento de CEC y un 7 por ciento de MM. Las tasas de incidencia del total de cáncer cutáneo fueron fluctuantes, CBC (entre 11.07 y 22.10/ 100.000 habitantes), CEC (entre 5.03 y 9.33)/ 100.000 habitantes), MM ( 5-9/100.000). En relación con la edad, la edad promedio de CBC fue de 69.8+/- 14.9, CEC fue de 76.9+/-10.3 y MM fue de 64.7+/-15 años. En cuanto a la localización anatómica se encontró CBC, 75 por ciento en cabeza; 14 por ciento en tronco, 3 por ciento en extremidades. En el caso del CEC, 32 por ciento en cabeza, 30 por ciento en tronco, 34 por ciento en extremidades. MM se localizaba en un 38,8 por ciento en extremidades, 33,3 por ciento en cabeza y 11 por ciento en tronco. Discusión: En nuestro estudio se observaron similitudes en la clínica y en las características histopatológicas del cáncer de piel con otras regiones de Chile (Santiago, Concepción); sin embargo, se observó un mayor porcentaje de CEC y la localización anatómica del CEC de esta población difiere de análisis tanto de estudios nacionales como internacionales, encontrando...

Introduction: Skin cancer incidence rates have increased in the last decades. The purpose of this investigation was to study the incidence rates and the clinical and histopathological pattern of Basal Cell Carcinoma (BCC), Squamous cell Carcinoma (SCC) and Malignant Melanoma (MM) in the National Health Service Hospital of Iquique, Chile. Methodology: 25.338 histopathological reports from the Anatomical Pathology Department were analyzed during the period 2006-2010. 257 skin tumors were found. The variables: sex, age, race, anatomical localization and histopathological types of each tumour were also studied. The statistical analysis was performed by STATA®. Results: 65 percent of BCC, 28 percent SCC, 7 percent of MM were found. The skin cancer incidence rates obtained in our study changed from year to year. BCC (changed between 11.07 and 22.1 / 100.000 inhabitants), SCC ( changed between 5.03 and 9.33/ inhabitants), MM ( changed between 5 and 9 /100.000 inhabitants). Regarding the age, the average age of BCC was 69.8+/- 14.9, of SCC was 76.9+/-10.3 and of MM was 64.7+/-15 years old. Concerning the anatomical location of the tumours, 75 percent of BCC were located in the head; 14 percent in trunk, 3% in lower and upper extremities. In the case of SCC, 32 percent were located in the head, 30 percent in the trunk, and 34 percent in lower and upper extremities. Furthermore, a 38.8 percent of MM percent were located in the lower and upper extremities, 33.3 percent of MM in the head and 11 percent in the trunk. Discussion: In this study, the clinical and histopathological pattern of the cutaneous tumours were similar to those found in other cities of Chile (Santiago, Concepción); however; we found a different anatomical location of SCC in this study, different of national and international results. We observed a higher location of SCC in trunk and extremities. Also, it is important to establish that in this study, we observed a higher percentage of SCC...

Clinical utility of SPECT-CT co-registration imaging

The interpretation of nuclear medicine studies is largely based on function. However, this interpretation becomes more accurate and reliable when there is a corresponding precise anatomical localization. Hybrid systems are opening up a new era in SPECT imaging. A tertiary hospital in the Philippines has acquired the country's first hybrid imaging device combining a dual-detector, variable angle gamma camera with a low dose X-ray tube attached to the same gantry. This study evaluates the clinical utility of a hybrid imaging system, SPECT/CT for functional mapping with selected radiotracers. SPECT data were first interpreted alone and then re-assessed with the addition of SPECT/CT co-registered images. Patients referred for various nuclear medicine procedures with SPECT components in the first six months of operation studied for various clinical situations were evaluated in the study. Our study included sixty-four (64) patients in the first year of operation of SPECT/CT co-registered imaging systems. This included 23 with I-131, six with sulfur colloid, four with Gallium 67, five with Tc99m Sestamibi and 26 with Tc99m HOP. The pathologic sites in 28 out of 64 (44 percent) patients were noted in both SPECT and SPECT/CT co-registered images. Additionally, SPECT/CT co-registered images provided the precise anatomical localization in 12 (19 percent) patients not clearly evident in SPECT images alone and enabled the exclusion of disease in sites of physiologic tracer deposition in 16 (25 percent) patients found suspicious in SPECT alone leading to a change in the therapeutic approach. SPECT/CT allows a more precise interpretation of scintigraphic studies using selected radiotracers for various clinical situations. It provides additional information that improves diagnostic accuracy of SPECT and impacts on patient management indicating that SPECT/CT co-registered systems are suited for routine use in clinical practice.

Reappraisal and Practical Application of International League Against Epilepsy ( ILAE 1989 ) Classification of Localization-Related Epilepsies in Adult

BACKGROUND: Since 1985 when ILAE proposed its first classification system of epilepsy, many studies have reported the practical applicability of the system. However, its limitations have been elucidated. In order to find out the applicability and limitations of the ILAE classification system and the role that diagnostic parameters (semiology, EEG and MRI) take in the anatomical localization of localization-related epilepsies (LREs), we investigated the clinical data of adult patients with LRE in step-wise way. METHOD: We recruited 173 patients with newly-referred/diagnosed LRE from our departmental data registry. Idiopathic epilepsies were excluded. We evaluated the anatomical localization rate(LR) according to each diagnostic parameter, the concordant localization rate(CLR) between two parameters and between three parameters. LR in total patients by any one of three diagnostic parameters was also evaluated. MRI abnormalities were evaluated in those patients showing concordant localization between semiology and EEG. RESULTS: The highest anatomical LR(67.1%) was reported in the semiological parameter. CLR between semiology and EEG was 28.9%. CLR between three parameters was 16.2%. MRI abnormalities were seen in 60% of patients with concordant localization between semiology and EEG. Fifty six percent of electroclinically concordant patients showed concordant localization with an MRI and 79% of them were concordantly localized in the temporal lobe. The LR in total patients was 71.7%. In each of the evaluation steps, the temporal lobe LR was the highest. CONCLUSIONS: Total lobar LR by any one diagnostic parameter in all the patients was high according to the ILAE diagnostic criteria. Semiology was the best localizing parameter, however, combined evaluation with either EEG or MRI reduced the localizability. Even though the MRI study showed a significant discordance rate in patients with electroclinical localizations, it could identify the underlying etiology in a major proportion of the patients. This study showed the importance of an imaging study in the lobar localization of LREs combined with an electroclinical localization by the ILAE classification system.