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1.
Int. j. morphol ; 38(2): 292-298, abr. 2020. tab, graf
Artículo en Inglés | LILACS | ID: biblio-1056437

RESUMEN

Trans-obturator tape (TOT) and tension free vaginal tape (TVT) procedures are efficient treatment options, which reduce the surgical complications and provide adequate support to urethra in case of increased abdominal pressure to prevent stress urinary incontinence (SUI). The aim of this study is to evaluate the effect and efficacy of 3D printed female anatomical model on the training of TOT and TVT procedures. A 3D printed female anatomical model was produced for MedTRain3DModSim, Erasmus+ European Union project led by Turkey with the participation of Greece, Italy, Czech Republic and South Korea. Face and content validities of the model evaluated by the participants and the experts respectively. During two learning & teaching & training activities and a multiplier event of the project between 2016 and 2018; 41 medical students, 30 residents and 19 specialists of urology and gynecology were educated and performed TOT and TVT procedures with this model under the mentorship of 3 experts. All participants were assessed and scored for their achievement on both procedures with model according to 7 parameters by the experts. There was no statistical difference between the students and residents for each parameter. All the parameters of the students and specialists were statistically different. 3D anatomical models produced from real data and mimicking different types of tissues are suitable for basic anatomy education of students and residents, hands on training for junior surgeons before cadaveric courses in hybrid education system, surgical planning of the surgeons and informing the patients before the operation.


Los procedimientos de cinta transobturadora (TOT) y cinta vaginal sin tensión (TVT) son opciones de tratamiento eficientes, que reducen las complicaciones quirúrgicas y proporcionan un soporte adecuado a la uretra en caso de aumento de la presión abdominal para prevenir la incontinencia urinaria de esfuerzo (IUE). El objetivo de este estudio fue evaluar el efecto y la eficacia del modelo anatómico femenino impreso en 3D en el entrenamiento de los procedimientos TOT y TVT. Se produjo un modelo anatómico femenino impreso en 3D para MedTRain3DModSim, proyecto Erasmus + de la Unión Europea dirigido por Turquía con la participación de Grecia, Italia, la República Checa y Corea del Sur. Validez facial y de contenido del modelo fueron evaluados por los participantes y los expertos respectivamente. Durante dos actividades de aprendizaje, enseñanza y capacitación y un evento multiplicador del proyecto entre 2016 y 2018; 41 estudiantes de medicina, 30 residentes y 19 especialistas en urología y ginecología fueron capacitados y realizaron procedimientos TOT y TVT de este modelo bajo la tutoría de 3 expertos. Todos los participantes fueron evaluados y calificados por los expertos, por su logro en ambos procedimientos con el modelo de acuerdo con 7 parámetros. No hubo diferencia estadística entre los estudiantes y los residentes para cada parámetro. Todos los parámetros de los estudiantes y especialistas fueron estadísticamente diferentes. Los modelos anatómicos en 3D producidos a partir de datos reales e imitando diferentes tipos de tejidos son adecuados para la educación básica de anatomía de estudiantes y residentes. Además de ofrecer una capacitación práctica para los cirujanos antes de los cursos cadavéricos en el sistema educativo, y una planificación quirúrgica de los cirujanos e información para los pacientes antes de la cirugía.


Asunto(s)
Humanos , Femenino , Incontinencia Urinaria de Esfuerzo , Sistema Urinario/anatomía & histología , Cabestrillo Suburetral , Modelos Anatómicos , Impresión Tridimensional
2.
Dement. neuropsychol ; 14(1): 75-79, Jan.-Mar. 2020. tab
Artículo en Inglés | LILACS | ID: biblio-1089812

RESUMEN

ABSTRACT The nature of memory and the search for its localization have been a subject of interest since Antiquity. After millennia of theoretical concepts, shifting from the heart to the brain, then from the ventricles to solid parts, the core memory-related structures finally began to be identified through modern scientifically-based methods at the diencephalic and cortical (hippocampal and neocortical) levels, mostly in the late Modern period, culminating in the current state of knowledge on the subject.


RESUMO A natureza da memória e a busca de sua localização tem sido objeto de interesse desde a Antiguidade. Após milênios de conceitos teóricos, mudando do coração para o cérebro e daí dos ventrículos para as partes sólidas, as estruturas centrais relacionadas com a memória finalmente começaram a ser identificadas através de métodos modernos com base científica, nos níveis diencefálico e cortical (hipocampal e neocortical), principalmente no período Moderno tardio, aproximando-se do estado atual do conhecimento sobre o tema.


Asunto(s)
Humanos , Neocórtex , Diencéfalo , Hipocampo , Memoria , Modelos Anatómicos
3.
Medicine (Baltimore) ; 99(7): e19046, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-32049803

RESUMEN

INTRODUCTION: It is well known that the main segments of spinal fracture is thoracolumbar (T11-L11). Therefore, in addition to the lumbar, the lower thoracic vertebra (T9-T12) often has the clinical needs of implantation of cortical bone trajectory (CBT) screws. However, the anatomic parameters of the lower thoracic vertebrae are quite different from those of the lumbar vertebrae, which means that if CBT screws are to be implanted in the lower thoracic vertebrae, the selection of the screw entry point, the length, diameter, angle and path of the screws in each segment need to be redefined. Methods In this part, 3-dimensional finite element model was established to analyze the stress and fixation efficiency of CBT screws in thoracic vertebrae after 5000 times of fatigue loading of normal model and osteoporosis model. Discussion If the outcomes indicate the trial is feasible and there is evidence to provide some basic anatomical parameters for CBT screw implantation in the lower thoracic spine, so that the ideal insertion point, length, diameter, and angle of CBT screw in different segments of the lower thoracic spine were determined.Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026915.Registered on September 26, 2019.


Asunto(s)
Procedimientos Ortopédicos/instrumentación , Fracturas de la Columna Vertebral/cirugía , Vértebras Torácicas/cirugía , Adulto , Fenómenos Biomecánicos , Tornillos Óseos , Hueso Cortical/anatomía & histología , Hueso Cortical/cirugía , Estudios de Factibilidad , Femenino , Análisis de Elementos Finitos , Humanos , Masculino , Persona de Mediana Edad , Modelos Anatómicos , Vértebras Torácicas/anatomía & histología , Adulto Joven
5.
World Neurosurg ; 136: 49-57, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31926358

RESUMEN

BACKGROUND: At present, no consensus has been reached on the compartmental subdivision of the jugular foramen (JF), which can complicate surgical planning in this area and hinder understanding of foraminal tumor growth patterns. The extradural neural axis compartment (EDNAC) might aid in producing a standardized model in the future. In the present review, we have summarized the models of JF compartmentalization and analyzed how sound they are anatomically. METHODS: The present narrative review identified the key studies and supporting reports that had discussed, referenced, or first presented models of JF compartmentalization. RESULTS: Three intraforaminal components serve as the basis for JF compartmentalization: the fibro-osseous bridge, neurovascular contents, and EDNAC. A total of 4 models have been proposed to date. These include the 2-part (bipartite) models by Hovelacque (1934) and Shapiro (1972) and the 3-part (tripartite) subdivisions by Katsuta (1997) and Bernard (2018). CONCLUSIONS: The bipartite model has been criticized as being oversimplified and lacking surgical validity. However, support for this compartmentation has persisted despite the increasing popularity of the tripartite model. The 3-part subdivision of Bernard can be considered the most anatomically faithful model to date owing to the consideration of the dura and EDNAC. It is important that future studies consider the entire anatomy of the JF, which may generate an anatomically accurate and surgically applicable compartmental model.


Asunto(s)
Foramina Yugular/anatomía & histología , Nervio Accesorio/anatomía & histología , Senos Craneales/anatomía & histología , Duramadre/anatomía & histología , Nervio Glosofaríngeo/anatomía & histología , Humanos , Venas Yugulares/anatomía & histología , Modelos Anatómicos , Hueso Occipital/anatomía & histología , Hueso Petroso/anatomía & histología , Nervio Vago/anatomía & histología
6.
Comput Methods Biomech Biomed Engin ; 23(4): 138-142, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31928213

RESUMEN

The progresses in fast simulations of the hepatic flow in subject-specific vascular tree have created new toolkits for pre-surgical planning. The aim of this short communication is to introduce a computational pipeline that integrates several recently developed in silico liver models and algorithms. Firstly, a semi-automatic segmentation pipeline is used to digitise hepatic vessels. Then, a constructive constraint optimisation (CCO) algorithm is used to extend the digitised vascular tree, and also to compute the blood pressure and flow velocity in the tree. Couinaud segments are simulated from the diffusion zones of the portal venous tree. The constructed surgical planning model is then deployed cross-platform for use in various scenarios.


Asunto(s)
Simulación por Computador , Hemodinámica/fisiología , Hígado/cirugía , Algoritmos , Humanos , Procesamiento de Imagen Asistido por Computador , Hígado/irrigación sanguínea , Modelos Anatómicos
7.
Med Hist ; 64(1): 116-141, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31933505

RESUMEN

In early twentieth-century France, syphilis and its controversial status as a hereditary disease reigned as a chief concern for physicians and public health officials. As syphilis primarily presented visually on the surface of the skin, its study fell within the realms of both dermatologists and venereologists, who relied heavily on visual evidence in their detection, diagnosis, and treatment of the disease. Thus, in educational textbooks, atlases, and medical models, accurately reproducing the visible signposts of syphilis - the colour, texture, and patterns of primary chancres or secondary rashes - was of preeminent importance. Photography, with its potential claims to mechanical objectivity, would seem to provide the logical tool for such representations. Yet photography's relationship to syphilographie warrants further unpacking. Despite the rise of a desire for mechanical objectivity charted in the late nineteenth century, artist-produced, three-dimensional, wax-cast moulages coexisted with photographs as significant educational tools for dermatologists; at times, these models were further mediated through photographic reproduction in texts. Additionally, the rise of phototherapy complicated this relationship by fostering the clinical equation of the light-sensitive photographic plate with the patient's skin, which became the photographic record of disease and successful treatment. This paper explores these complexities to delineate a more nuanced understanding of objectivity vis-à-vis photography and syphilis. Rather than a desire to produce an unbiased image, fin-de-siècle dermatologists marshalled the photographic to exploit the verbal and visual rhetoric of objectivity, authority, and persuasion inextricably linked to culturally constructed understandings of the photograph. This rhetoric was often couched in the Peircean concept of indexicality, which physicians formulated through the language of witness, testimony, and direct connection.


Asunto(s)
Anatomía Artística/historia , Ilustración Médica/historia , Modelos Anatómicos , Fotograbar/historia , Sífilis/historia , Atlas como Asunto/historia , Distinciones y Premios , Dermatología/educación , Dermatología/historia , Francia , Historiografía , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Sífilis/patología , Sífilis Congénita/historia , Venereología/educación , Venereología/historia
8.
PLoS One ; 15(1): e0219954, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31990914

RESUMEN

A new methodology was developed to quickly generate whole body models with detailed neck musculoskeletal architecture that are properly scaled in terms of anthropometry and muscle strength. This method was implemented in an anthropometric model generation software that allows users to interactively generate any new male or female musculoskeletal models with adjustment of anthropometric parameters (such as height, weight, neck circumference, and neck length) without the need of subject-specific motion capture or medical images. 50th percentile male and female models were developed based on the 2012 US Army Anthropometric Survey (ANSUR II) database and optimized with a novel bilevel optimization method to have strengths comparable to experimentally measured values in the literature. Other percentile models (ranging from the 1st to 99th percentile) were generated based on anthropometric scaling of the 50th percentile models and compared. The resultant models are reasonably accurate in terms of both musculoskeletal geometry and neck strength, demonstrating the effectiveness of the developed methodology for interactive neck model generation with anthropometric scaling.


Asunto(s)
Antropometría/métodos , Modelos Anatómicos , Sistema Musculoesquelético/anatomía & histología , Cuello/anatomía & histología , Adulto , Estatura , Peso Corporal , Femenino , Humanos , Contracción Isométrica/fisiología , Masculino , Fuerza Muscular/fisiología , Cuello/fisiología , Programas Informáticos
9.
Khirurgiia (Mosk) ; (1): 40-45, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-31994498

RESUMEN

OBJECTIVE: To improve the results of treatment of patients undergoing laparotomy by using of a new method of aponeurosis suturing after laparotomy. MATERIAL AND METHODS: Training process for a new method of aponeurosis suturing after laparotomy was organized on the patented medical simulator for learning the technique of laparotomy closure. The method was introduced into surgical practice later. The study involved 130 patients who underwent emergency abdominal surgery through median laparotomy. The main group consisted of 70 patients (laparotomy closure using the proposed method (RF patent No.2644846 dated 02/14/18). Interrupted sutures were applied for aponeurosis suturing in the control group. RESULTS: Duration of laparotomy closure was similar in both groups. Postoperative ventral hernias in 1 year after surgery occurred in 5 (8%) patients of the main group and in 11 (18%) patients of the control group. CONCLUSION: The proposed method of aponeurosis suturing after laparotomy is mastered by students and serves as effective method for prevention of postoperative ventral hernias and eventration.


Asunto(s)
Técnicas de Cierre de Herida Abdominal/educación , Aponeurosis/cirugía , Hernia Ventral/prevención & control , Hernia Incisional/prevención & control , Laparotomía/efectos adversos , Técnicas de Sutura/educación , Fascia , Hernia Ventral/etiología , Humanos , Hernia Incisional/etiología , Laparotomía/educación , Modelos Anatómicos
10.
World Neurosurg ; 133: e722-e729, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31589981

RESUMEN

OBJECTIVE: To evaluate the usefulness of 3-dimensional (3D) printed models as an aid for the treatment of complex CVJ anomalies. METHODS: 3D printed models were fabricated for 21 patients with complex CVJ anomalies, including vertebral artery anomaly, thin C2 pedicle, vertical atlantoaxial facet joint, or rotational dislocation combined with atlantoaxial dislocation and basilar invagination. Preoperative planning, surgical simulation, and intraoperative reference were achieved using the 3D model during the surgical treatment. The usefulness of 3D printed models, and postoperative clinical and radiological outcomes were assessed. RESULTS: Direct posterior reduction and atlantoaxial fixation were achieved in 19 patients. Transoral odontoidectomy followed by posterior fixation was implemented for 2 patients with vertical facet joint and rotational dislocation. All screws were safely inserted with no complication, and 90% patients achieved a >60% reduction of both horizontal and vertical dislocation. Clinical symptoms improved in all patients, with the averaged Japanese Orthopedic Association scores increasing from 11.14 to 14.43 (P < 0.01). CONCLUSIONS: The patient-specific 3D printed model would be an effective tool for evaluation of the reducibility of the atlantoaxial dislocation and basilar invagination, decision making in choosing the optimal surgical approach and way of fixation, and precise placement of the screw while protecting the vertebral artery and spinal cord. The risk of neurovascular injury was minimized, and encouraging outcomes were achieved with the aid of this technique.


Asunto(s)
Articulación Atlantoaxoidea/cirugía , Articulación Atlantooccipital/cirugía , Modelos Anatómicos , Impresión Tridimensional , Cirugía Asistida por Computador/métodos , Adolescente , Adulto , Anciano , Articulación Atlantoaxoidea/anomalías , Articulación Atlantooccipital/anomalías , Tornillos Óseos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fusión Vertebral/métodos , Arteria Vertebral , Adulto Joven
11.
Int J Oral Maxillofac Surg ; 49(1): 143-148, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31300302

RESUMEN

This study was performed to determine whether an in-house printed mandible model is sufficiently accurate for daily clinical practice. Ten example mandible models were produced with a desktop 3D printer (fused filament fabrication, FFF) and compared with 10 equivalent mandible models fabricated using a professional-grade 3D printer (selective laser sintering, SLS). To determine the precision of the printed models, each model was scanned with an optical scanner. Subsequently, every model was compared to its original standard tessellation language (STL) file and to its corresponding analogue. Mean±standard deviation and median (interquartile range) differences were calculated. Overall these were -0.019±0.219mm and -0.007 (-0.129 to 0.107) mm for all 10 pairs. Furthermore, correlation of all printed models to their original STL files showed a high level of accuracy. Comparison of the SLS models with their STL files revealed a mean difference of -0.036±0.114mm and median difference of -0.028 (-0.093 to 0.030) mm. Comparison of the FFF models with their STL files yielded a mean difference of -0.055±0.227mm and median difference of -0.022 (-0.153 to 0.065) mm. The study findings confirm that in-house 3D printed mandible models are economically favourable as well as suitable substitutes for professional-grade models, in particular considering the geometric aspects.


Asunto(s)
Modelos Anatómicos , Impresión Tridimensional , Algoritmos , Humanos , Mandíbula
12.
World Neurosurg ; 133: e327-e341, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31520760

RESUMEN

BACKGROUND: Medical implications of 3-dimensional (3D) printing technology have evolved and are increasingly used. Surgical spine oncology involves at times complex resection using various surgical approaches and unique spinal reconstruction. As high general complication rates, including hardware failure, are reported, careful preoperative planning and optimized fixation techniques should be performed. 3D printing technology allows the improvement of preoperative planning, practice and exploration of various surgical approaches, and designing customized surgical tools and patient specific implants. OBJECTIVE: To investigate the use of 3D printing technology in complex spine surgeries. METHODS: Between 2015 and 2018, all complex spine oncological cases were evaluated and assessed for the possible benefit of use of 3D printing technology. Following high-quality imaging, a computerized integrated 3D model was created. Based on the planned procedure considering the various surgical steps, a customized 3D model was planned and printed, and in select cases a 3D custom-made implant was designed and printed in various sizes with matching trials. RESULTS: A total of 7 cases were selected for the use of a 3D printing technology. For all, a custom-made model was created. In 3 of these cases, a customized 3D-printed implant was used. Special customized intraoperative instruments were made for 2 cases, and a simulated surgical approach was performed in 5 cases. In 2 cases, pre-bent rods were made based on the model created and were used in surgery later on. CONCLUSIONS: For complex spine oncology cases, the use of 3D printing allowed better preoperative planning, simplified the operative procedure, and enabled improved reconstruction.


Asunto(s)
Imagen por Resonancia Magnética , Modelos Anatómicos , Impresión Tridimensional , Prótesis e Implantes , Procedimientos Quirúrgicos Reconstructivos/métodos , Neoplasias de la Columna Vertebral/cirugía , Cirugía Asistida por Computador/métodos , Tomografía Computarizada por Rayos X , Adolescente , Adulto , Trasplante Óseo , Carcinoma Ductal de Mama/diagnóstico por imagen , Carcinoma Ductal de Mama/secundario , Carcinoma Ductal de Mama/cirugía , Carcinoma de Células Renales/diagnóstico por imagen , Carcinoma de Células Renales/secundario , Carcinoma de Células Renales/cirugía , Condrosarcoma/diagnóstico por imagen , Condrosarcoma/patología , Condrosarcoma/cirugía , Diseño de Equipo , Femenino , Tumores de Células Gigantes/diagnóstico por imagen , Tumores de Células Gigantes/patología , Tumores de Células Gigantes/cirugía , Hemangioma/diagnóstico por imagen , Hemangioma/patología , Hemangioma/cirugía , Humanos , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/patología , Vértebras Lumbares/cirugía , Masculino , Persona de Mediana Edad , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/patología , Osteoma Osteoide/cirugía , Procedimientos Quirúrgicos Reconstructivos/instrumentación , Sarcoma de Ewing/diagnóstico por imagen , Sarcoma de Ewing/secundario , Sarcoma de Ewing/cirugía , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/secundario , Cirugía Asistida por Computador/instrumentación , Instrumentos Quirúrgicos , Vértebras Torácicas/diagnóstico por imagen , Vértebras Torácicas/patología , Vértebras Torácicas/cirugía , Adulto Joven
13.
World Neurosurg ; 133: e356-e368, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31521759

RESUMEN

BACKGROUND: Intracranial aneurysms (IAs) located in the midline region represent formidable challenge owing to their deep location. The objective of this study was to assess feasibility and identify the limitations of endoscopic endonasal clipping of IAs. We further aimed to describe the locations and characteristics of aneurysms that may be amenable for endoscopic endonasal clipping; thus outlining the indications of these approaches. METHODS: Fifteen latex-injected cadaveric heads were used for endoscopic endonasal exposure of anterior and posterior cerebral circulations. An aneurysm simulator model with 2 different sizes was used at the common sites for IAs to emulate a real surgery. Key measured parameters included "exposure of vessels and their respective perforators," "ability to gain proximal/distal control," and "possibility of clip placement" according to the size, direction, and location of the aneurysm model. Maneuverability of instruments and the need for pituitary gland transposition were assessed and recorded as well. RESULTS: Exposure of the anterior communicating artery complex and the common sites of posterior circulation aneurysms were feasible. The size, location, and direction of the aneurysm model had an impact on obtaining proximal and/or distal control, and the ability of clip placement. CONCLUSIONS: Clipping of midline aneurysms of the posterior circulation is feasible via endoscopic endonasal approach. Small-sized ventrally and medially directed aneurysm models carried a better probability of getting proximal and/or distal control, as well as better overall ability to place a clip. The endonasal route seems to provide a limited condition for proper management of anterior circulation aneurysms.


Asunto(s)
Arterias Cerebrales/anatomía & histología , Aneurisma Intracraneal/cirugía , Cirugía Endoscópica por Orificios Naturales/métodos , Neuroendoscopía/métodos , Cadáver , Circulación Cerebrovascular , Estudios de Factibilidad , Humanos , Modelos Anatómicos , Cavidad Nasal , Cirugía Endoscópica por Orificios Naturales/instrumentación , Neuroendoscopía/instrumentación
14.
Proc Natl Acad Sci U S A ; 117(1): 43-51, 2020 01 07.
Artículo en Inglés | MEDLINE | ID: mdl-31843921

RESUMEN

Brachiopods and mollusks are 2 shell-bearing phyla that diverged from a common shell-less ancestor more than 540 million years ago. Brachiopods and bivalve mollusks have also convergently evolved a bivalved shell that displays an apparently mundane, yet striking feature from a developmental point of view: When the shell is closed, the 2 valve edges meet each other in a commissure that forms a continuum with no gaps or overlaps despite the fact that each valve, secreted by 2 mantle lobes, may present antisymmetric ornamental patterns of varying regularity and size. Interlocking is maintained throughout the entirety of development, even when the shell edge exhibits significant irregularity due to injury or other environmental influences, which suggests a dynamic physical process of pattern formation that cannot be genetically specified. Here, we derive a mathematical framework, based on the physics of shell growth, to explain how this interlocking pattern is created and regulated by mechanical instabilities. By close consideration of the geometry and mechanics of 2 lobes of the mantle, constrained both by the rigid shell that they secrete and by each other, we uncover the mechanistic basis for the interlocking pattern. Our modeling framework recovers and explains a large diversity of shell forms and highlights how parametric variations in the growth process result in morphological variation. Beyond the basic interlocking mechanism, we also consider the intricate and striking multiscale-patterned edge in certain brachiopods. We show that this pattern can be explained as a secondary instability that matches morphological trends and data.


Asunto(s)
Exoesqueleto/anatomía & histología , Exoesqueleto/crecimiento & desarrollo , Bivalvos/anatomía & histología , Bivalvos/crecimiento & desarrollo , Morfogénesis/fisiología , Animales , Evolución Biológica , Bivalvos/clasificación , Fenómenos Mecánicos , Modelos Anatómicos , Modelos Teóricos , Filogenia
15.
Clin Anat ; 33(1): 25-33, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31087400

RESUMEN

We aim to provide an overview of the various digital three-dimensional visualizations used for learning anatomy and to assess whether these improve medical students' understanding of anatomy compared to traditional learning methods. Furthermore, we evaluate the attitudes of the users of three-dimensional visualizations. We included articles that compared advanced newer three-dimensional anatomy visualization methods (i.e., virtual reality, augmented reality, and computer-based three-dimensional visualizations) to traditional methods that have been used for a long time (i.e., cadaver and textbooks) with regard to users' understanding of anatomy. Of the 1,148 articles identified, 21 articles reported data on the effectiveness of using three-dimensional visualization methods compared to two-dimensional methods. Twelve articles found that three-dimensional visualization is a significantly more effective learning method compared to traditional methods, whereas nine articles did not find that three-dimensional visualization was a significantly more effective method. In general, based on these articles, medical students prefer to use three-dimensional visualizations to learn anatomy. In most of the articles, using three-dimensional visualization was shown to be a more effective method to gain anatomical knowledge compared to traditional methods. Besides that, students are motivated and interested in using these new visualization methods for learning anatomical structures. Clin. Anat. 32:25-33, 2019. © 2019 Wiley Periodicals, Inc.


Asunto(s)
Anatomía/educación , Simulación por Computador , Educación Médica/métodos , Imagenología Tridimensional , Modelos Anatómicos , Entrenamiento Simulado/métodos , Humanos
16.
Clin Anat ; 33(1): 66-76, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31573101

RESUMEN

The anatomy of the pallidothalamic tracts, including the ansa lenticularis, lenticular fasciculus, and thalamic fasciculus (field H1 of Forel), should be elucidated by neurosurgeons and neuroscientists who study deep brain stimulation. In this study, serially sectioned images of a human cadaver head were employed to overcome the limitations of existing methods to observe the pallidothalamic tracts. Owing to the high resolution and real color of the sectioned images, 28 structures, including the pallidothalamic tracts and mammillothalamic fasciculus, were identified. The structures were segmented and made into surface models, which are helpful in improving the stereoscopic understanding. Observing the sectioned images and surface models may help in understanding the detailed anatomy of the pallidothalamic tracts. The new findings, such as the spatial relationship of the tracts, were summarized in a schematic figure. Moreover, to elucidate the anatomical structures along the course of deep brain stimulation, virtual electrodes were inserted into the surface models. The sectioned images and surface models of this study are expected to enhance the understanding of the pallidothalamic tract anatomy. A portable document format file containing the surface models and the sectioned images can be freely downloaded from the authors' homepage. Clin. Anat. 32:66-76, 2019. © 2019 Wiley Periodicals, Inc.


Asunto(s)
Globo Pálido/anatomía & histología , Modelos Anatómicos , Vías Nerviosas/anatomía & histología , Subtálamo/anatomía & histología , Tálamo/anatomía & histología , Cadáver , Humanos , Procesamiento de Imagen Asistido por Computador , Imagenología Tridimensional
17.
Clin Anat ; 33(1): 124-127, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31581311

RESUMEN

Anatomical knowledge is a key tenet in graduate medical and surgical education. Classically, these principles are taught in the operating room during live surgical experience. This puts both the learner and the patient at a disadvantage due to environment, time, and safety constraints. Educational adjuncts such as cadaveric courses and surgical skills didactics have been shown to improve resident confidence and proficiency in both anatomical knowledge and surgical techniques. However, the cost-effectiveness of these courses is a limiting factor and in many cases prevents implementation within institutional training programs. Anatomical simulation in the form of "desktop" three-dimensional (3D) printing provides a cost-effective adjunct while maintaining educational value. This article describes the anatomical and patient-centered approach that led to the establishment of our institution's 3D printing laboratory for anatomical and procedural education. Clin. Anat. 32:124-127, 2019. © 2019 Wiley Periodicals, Inc.


Asunto(s)
Anatomía/educación , Educación de Postgrado en Medicina/métodos , Imagenología Tridimensional , Modelos Anatómicos , Impresión Tridimensional , Entrenamiento Simulado/métodos , Cirugía General/educación , Humanos
18.
Gait Posture ; 75: 129-136, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31678694

RESUMEN

BACKGROUND: Task-specific loading of the limbs-termed as functional resistance training-is commonly used in gait rehabilitation; however, the biomechanical and neuromuscular effects of various forms of functional resistance training have not been studied systematically. This information is crucial for correctly selecting the appropriate mode of functional resistance training when treating individuals with gait disorders. RESEARCH QUESTION: To comprehensively evaluate the biomechanical (i.e., joint moment and power) and muscle activation changes with different forms of functional resistance training that are commonly used in clinics and research using biomechanical simulation-based analyses. METHODS: We developed simulations of functional resistance training during walking using OpenSim (Gait2354, 23 degrees of freedom and 54 muscles) and custom MATLAB scripts. We investigated five modes of functional resistance training that have been commonly used in clinics or in research: (1) a weight attached at the ankle, (2) an elastic band attached at the ankle, (3) a viscous device attached to the hip and knee, (4) a weight attached at the pelvis, and (5) a constant backwards pulling force at the pelvis. Lower-extremity joint moments and powers were computed using inverse dynamics and muscle activations were estimated using computed muscle control while walking with each device under multiple resistance levels: normal walking with no resistance, and walking with 30, 60, and 90 Newtons of resistance. RESULTS: The results indicate that the way in which resistance is applied during gait training differentially affects the internal joint moments, powers, and muscle activations as well as the joints and phase of the gait cycle where the resistance was experienced. SIGNIFICANCE: The results highlight the importance of understanding the joints and muscles that are targeted by various modes of functional resistance training and carefully choosing the best mode of training that meets the specific therapeutic needs of the patient.


Asunto(s)
Contracción Muscular/fisiología , Músculo Esquelético/fisiología , Entrenamiento de Resistencia/métodos , Caminata/fisiología , Fenómenos Biomecánicos , Simulación por Computador , Marcha/fisiología , Humanos , Modelos Anatómicos , Soporte de Peso/fisiología
19.
J Surg Res ; 245: 99-106, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31415935

RESUMEN

BACKGROUND: Brainstem hemorrhage is an acute and severe neurosurgical disease. Cerebral hemorrhage is surgically treated via hematoma puncture drainage because of its minimally invasive nature. However, the placement of puncture must be extremely accurate due to the special anatomical location of the brainstem and its physiological functions. The present study aimed to evaluate whether the application of a three-dimensional (3D)-printed navigation mold achieved good outcomes in the surgical treatment of brainstem hemorrhage. MATERIAL AND METHODS: The present study included seven patients (three men and four women aged 40-56 y) who underwent 3D print-assisted hematoma puncture drainage between June 2016 and March 2018 at Binzhou Medical University Hospital. The amount of brainstem hemorrhage was 15-47 mL. We analyzed the basic surgical conditions, deviation distance, and postoperative clinical improvement. RESULTS: In all cases, the operation was completed successfully; no patient died or contracted an infection intraoperatively. The end of the puncture tube was located in the hematoma cavity in all cases. The deviation distance ranged from 2.5 to 7.2, and this distance gradually reduced with improvements in the technique. The hematoma drainage achieved satisfactory postoperative outcomes, with improvements in symptoms such as respiratory failure and hyperthermia. CONCLUSIONS: Use of a 3D-printed navigation mold for puncture drainage of brainstem hemorrhage realized the purpose of individualized and precision medicine, which is important in maintaining the vital signs of patients with severe brainstem hemorrhage.


Asunto(s)
Hemorragia Cerebral/cirugía , Drenaje/instrumentación , Hematoma/cirugía , Modelos Anatómicos , Impresión Tridimensional , Punciones/instrumentación , Adulto , Tronco Encefálico/irrigación sanguínea , Tronco Encefálico/diagnóstico por imagen , Tronco Encefálico/cirugía , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/diagnóstico , Drenaje/métodos , Femenino , Hematoma/diagnóstico , Hematoma/etiología , Humanos , Masculino , Persona de Mediana Edad , Punciones/métodos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
20.
J Laryngol Otol ; 134(1): 14-19, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31865920

RESUMEN

OBJECTIVE: Three-dimensional printing is a revolutionary technology that is disrupting the status quo in surgery. It has been rapidly adopted by otolaryngology as a tool in surgical simulation for high-risk, low-frequency procedures. This systematic review comprehensively evaluates the contemporary usage of three-dimensional printed otolaryngology simulators. METHOD: A systematic review of the literature was performed with narrative synthesis. RESULTS: Twenty-two articles were identified for inclusion, describing models that span a range of surgical tasks (temporal bone dissection, airway procedures, functional endoscopic sinus surgery and endoscopic ear surgery). Thirty-six per cent of articles assessed construct validity (objective measures); the other 64 per cent only assessed face and content validity (subjective measures). Most studies demonstrated positive feedback and high confidence in the models' value as additions to the curriculum. CONCLUSION: Whilst further studies supported with objective metrics are merited, the role of three-dimensional printed otolaryngology simulators is poised to expand in surgical training given the enthusiastic reception from trainees and experts alike.


Asunto(s)
Procedimientos Quirúrgicos Otológicos/educación , Impresión Tridimensional/instrumentación , Competencia Clínica , Humanos , Modelos Anatómicos , Entrenamiento Simulado
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