Terminology surrounding fascia has expanded considerably following renewed interdisciplinary interest in connective tissues, surgical anatomy, mechanotransduction, manual therapies, and movement science. Motivation for this publication arose from the observed disparity between formal anatomical nomenclature and widespread terminology usage. Commonly used expressions in current literature include "the fascial system" and "the superficial fascial system." Widespread adoption of such terminology has occurred with limited or no critical examination regarding its anatomical validity or its lack of consistency with internationally recognized anatomical nomenclature standards. This review critically evaluates the recurring classification of fascia as a "system" within scientific and clinical literature. Drawing upon established anatomical principles and the terminological frameworks promoted by the International Federation of Associations of Anatomists and the Federative International Programme for Anatomical Terminologies, it is argued that fascia does not satisfy the defining criteria associated with anatomical systems. Fascia demonstrates continuity across regional, structural, and functional boundaries, resisting reduction into discrete organ-based hierarchies. A narrative review methodology was employed to identify representative examples within peer-reviewed literature in which fascia was described as a "system" and analyzed in relation to accepted anatomical definitions and broader principles of biological organization. The paper further examines how repeated uncritical use of the term through publication and peer review has contributed to conceptual ambiguity in anatomy education, clinical communication, and fascia research. Consistent with the nomenclature principles and classifications recognized by the International Federation of Associations of Anatomists and its terminological frameworks, fascia should not be described as a "system".
Generative artificial intelligence (GAI) is increasingly being applied in biomedical sciences and medical education, including anatomy, where text-to-image generators may facilitate rapid creation of visual materials. However, the anatomical accuracy of such generated illustrations remains uncertain. The present study evaluated the performance of selected GAI models in generating anatomically correct representations of human anatomical structures. Six text-to-image generators (DALL-E, Gemini, Freepik, Midjourney, DeepAI, and Canva) were assessed using a standardized prompt ("Generate the most anatomically accurate image of the human [name of anatomical structure]"). For each anatomical region, two images were generated. The evaluated structures included the liver, femur, scapula, aortic arch, arm muscles, sacrum, humerus, thigh muscles, celiac trunk, kidney, brainstem, and lumbar plexus. All images were analyzed using reference tables based on Terminologia Anatomica, with individual structures assessed for presence and physiological correctness by four independent reviewers. Statistical analysis included calculation of structure-level proportions with 95% confidence intervals, pairwise inter-rater agreement using Cohen's κ, and exploratory logistic regression with robust standard errors clustered by generated image to evaluate the effects of model, anatomical region, and evaluator. A total of 144 images were analyzed. DALL-E demonstrated the highest overall proportion of structure-level entries scored as present (56.7%, 95% CI: 53.8-59.5) as well as the highest proportion of physiologically correct entries among those present (66.0%, 95% CI: 62.2-69.5). When both criteria were combined, the proportion of fully correct structure-level entries remained limited across all models, with the highest value observed for DALL-E (37.4%). Considerable variability in performance was noted across anatomical regions, with particularly low accuracy observed for complex structures such as the lumbar plexus and celiac trunk. Inter-rater agreement ranged from moderate to almost perfect. Overall, current GAI models demonstrate substantial limitations in producing anatomically accurate illustrations. Although certain models outperform others, the reliability of generated images remains insufficient, and expert verification is necessary before their application in medical education or scientific contexts.
Salt stress is an major abiotic factor limiting yield formation and quality improvement in spring wheat. Previous studies on wheat salt tolerance have mainly focused on shoot injury, ion homeostasis, biomass reduction, or whole-root morphological traits. However, these approaches generally treat the root system as a whole and rarely distinguish whether salt tolerance is associated with the maintenance of deeper roots or with specific anatomical remodeling within root tissues. To address this gap, a high-throughput paper-based cultivation platform was used to assess the shoot phenotypes, root architectural traits, and root anatomical characteristics in 28 spring wheat genotypes under control and salt-stress conditions. Salt tolerance coefficients were calculated for multiple traits and integrated using principal component analysis, membership function analysis, contribution-rate-based weighting, and comprehensive D-value clustering. Genotypes with contrasting salt tolerance were then selected for further comparison of stratified root architecture and root anatomical responses. The results showed that salt stress significantly inhibited both shoot and root growth in spring wheat. The first five principal components explained 81.37% of the total variation, and the integrated evaluation framework effectively distinguished genotypic differences in salt tolerance. Plant height, total root length, average root length, cortex/stele area ratio, and lacuna/cortex area ratio were identified as candidate phenotypic and anatomical indicators associated with variation in salt tolerance. Further correlation and stratified root analyses showed that the maintenance of root architecture and anatomical adjustment were significantly associated with shoot growth performance under salt stress. In the deeper root layer, salt-tolerant genotypes maintained relatively more stable root traits, with root surface area reduced by 18.68%-38.61%, whereas the corresponding reductions in salt-sensitive genotypes ranged from 28.57% to 90.00%. Meanwhile, salt-tolerant genotypes exhibited a more coordinated pattern of cortical contraction, stele maintenance, and lacuna adjustment, suggesting that salt tolerance in spring wheat seedlings may be associated with the combined maintenance of deeper roots and anatomical remodeling rather than with a single root structural trait. This study advances the evaluation of salt tolerance in wheat by linking whole-plant performance with stratified root architecture and root anatomical organization. The results suggest that salt tolerance in spring wheat seedlings is associated not simply with total root size, but with the coordinated maintenance of deeper roots and anatomical remodeling of cortex, stele, and lacuna tissues. These findings provide a more refined root trait framework for salt-tolerant germplasm screening and root-based improvement of spring wheat.
Background/Objectives: Efficacy endpoint selection in adult primary central nervous system (CNS) tumor trials remains challenging because conventional solid tumor frameworks do not adequately capture the anatomical, radiographic, and biological complexity of brain tumors. In particular, postoperative irregular residual lesions, non-enhancing tumor components, and treatment-related imaging changes complicate the interpretation of objective response and progression. This narrative review examines the current landscape of endpoint selection in adult primary CNS tumor trials and discusses strategies for standardization in the Response Assessment in Neuro-Oncology (RANO) 2.0 era from integrated regulatory science and clinical perspectives. Methods: This study was conducted as a narrative review intended to provide a regulatory science-oriented synthesis of efficacy endpoint evaluation in adult primary CNS tumor trials. The literature search primarily utilized PubMed and ClinicalTrials.gov, supplemented by major consensus guidelines, pivotal clinical trials, and regulatory documents from the major regulatory authorities, including those in the United States, Europe, and Japan, published over the past two decades. Search terms included combinations of keywords such as "brain tumor," "glioblastoma," "meningioma," "Phase I," "Phase II," "efficacy endpoint," and "RANO". In addition to the literature synthesis, this review incorporates findings from our previously published empirical analyses regarding endpoint selection in Phase II glioblastoma trials, Phase II meningioma trials, and Phase I brain tumor trials. Results: Response Evaluation Criteria in Solid Tumors-based response assessment remains fundamentally limited in neuro-oncology. Across recent early-phase trials, substantial heterogeneity persists in endpoint selection and in the operational definitions of objective response rate, progression-free survival, and progression. RANO 2.0 is intended to provide a more unified and implementation-oriented framework by refining baseline definition, progression confirmation, non-enhancing lesion interpretation, and the role of minor response, while improving compatibility with contemporary molecular classification and immunotherapy-era trial design. However, important implementation challenges remain, including potential reproducibility concerns in complex imaging assessments, operational complexity, imaging standardization, and the need for independent central review. Conclusions: Standardization of endpoint strategies in adult primary CNS tumor trials should move beyond simple adoption of conventional solid tumor metrics toward a disease-specific, harmonized framework integrating imaging, clinical context, tumor biology, and regulatory interpretability. This review provides a regulatory science-oriented synthesis linking response assessment criteria, early-phase adult primary CNS tumor trial endpoint trends, empirical analyses, and emerging endpoint frameworks. RANO 2.0 represents an important step toward this goal, but it should be regarded as an evolving framework that requires continued validation, international collaboration, and implementation-focused refinement.
To develop an international consensus on terminology for adult pathologic myopia based on contemporary imaging, with emphasis on optical coherence tomography (OCT). An international panel of 32 experts in myopia and retinal disease from 13 countries was assembled. The writing group reviewed existing classification systems and the published literature and developed candidate statements organized into six domains: atrophic, mechanical expansion, tractional, neovascular, optic nerve, and retinal detachment. A Delphi process with anonymous voting was used. Consensus was defined a priori as ≥75% agreement (Agree or Strongly Agree). Statements not reaching consensus were revised based on structured feedback and re-voted. Forty-four consensus statements were developed that met the predefined threshold for agreement after iterative revision. The mean agreement was 90.9% (median 92.5%). The framework emphasizes structural definitions derived from OCT and multimodal imaging rather than fundus appearance. The classification organizes manifestations of pathologic myopia into six domains reflecting distinct but often overlapping anatomical and biomechanical processes. Key elements include the central role of choroidal thinning in visual function, recognition of focal chorioretinal loss as a structural endpoint across multiple pathways, and integration of mechanical, tractional, and vascular mechanisms in disease expression. This consensus establishes a unified, imaging-based lexicon for adult pathologic myopia grounded in structural anatomy and contemporary imaging. By organizing disease features into six domains and defining entities using OCT, the framework reduces ambiguity, improves reproducibility, and provides a foundation for future classification systems, clinical studies, and therapeutic trials.
Endoscopic submucosal dissection (ESD) enables en bloc resection of early gastrointestinal cancers and provides specimens suitable for precise pathological risk assessment. However, reporting remains variable for key parameters that determine curative resection and the need for additional treatment, including submucosal invasion depth and breadth, margin status, lymphovascular invasion, tumour budding, differentiation and use of ancillary stains. To develop practical international standards for pathology assessment and reporting of invasive carcinoma in ESD specimens. An international panel of 42 experts, including 28 gastrointestinal pathologists and 14 therapeutic endoscopists from 15 countries, participated in a modified Delphi consensus process. Statements addressed measurement of invasion, margin assessment, staining, specimen handling, prognostic histological features and clinically relevant reporting. 56 recommendations reached consensus across seven domains. The panel recommends using Sm1-Sm3 subclassification only when the muscularis propria is present; otherwise, submucosal invasion depth should be reported in micrometres, rounded to the nearest 100 µm. Submucosal invasion breadth should be reported in millimetres as an adjunct metric for future validation. Margin positivity should be defined as direct tumour contact with the inked surface, supported by standardised pinning, inking, complete embedding and parallel sectioning. H&E remains the baseline stain, with selective immunohistochemistry or elastic stains for equivocal lymphovascular invasion, distorted architecture or difficult margin interpretation. Tumour budding should be reported according to International Tumour Budding Consensus Conference criteria, and differentiation, histological subtype, lymphovascular invasion, perineural invasion and margin status should be integrated into composite risk assessment. These consensus standards provide immediately implementable, synoptic-ready pathology reporting criteria after ESD. By standardising measurement landmarks, margin terminology, ancillary stain use and reporting of adverse histological features, they aim to reduce interinstitutional variability, improve multidisciplinary decision-making and support future validation of risk models in early gastrointestinal cancer.
To evaluate the performance of an ARARAT radiomics-based artificial intelligence model using T2-weighted magnetic resonance imaging (MRI) for posthistological stratification of prostate cancer aggressiveness. A retrospective analysis of 112 biopsy-proven prostate cancer lesions (International Society of Urological Pathology [ISUP] <3 vs ≥ 3) from the PROSTATEx dataset was performed. Fixed 5-mm spherical region of interests (ROIs) were placed on axial T2-weighted MRI at radiologist-defined lesion sites, and 107 radiomic features were extracted using PyRadiomics. Machine-learning models were trained with 10-fold cross-validation and patient-level holdout testing. Model performance and feature importance of ARARAT were assessed using standard classification metrics and SHapley Additive exPlanations (SHAP). The cohort comprised 112 lesions, including 77 ISUP < 3 (68.8%) and 35 ISUP ≥ 3 (31.2%). ISUP 1 and 2 accounted for 32.1% and 36.6% of cases, respectively, while ISUP 3, 4, and 5 represented 17.9%, 7.1%, and 6.3%, respectively. Lesions were located in the peripheral zone (44.6%), anterior stroma (40.2%), and transition zone (15.2%), with no association between anatomical zone and ISUP category (P = 0.639). The random forest achieved the highest performance on the holdout set, with an area under the curve (AUC) of 0.84 (95% confidence interval [CI]: 0.63-0.98), average precision (AP) 0.70 (95% CI: 0.35-0.97), sensitivity of 85.7%, specificity of 78.6%, accuracy of 81.0%, and an F1-score of 0.75. The Brier score was 0.18, and calibration improved after isotonic regression, reducing the expected calibration error from 0.168 to 0.099. First-order and grey-level size zone matrix features were the dominant predictors. T2-weighted MRI-based radiomics enables accurate posthistological stratification of prostate cancer aggressiveness, supporting further external validation.
Medication use during pregnancy has increased significantly worldwide. However, detailed evidence on prescribing patterns during pregnancy remains limited. This scoping review aimed to summarize and provide a comprehensive global overview of the patterns/types of medications used during pregnancy. The Joanna Briggs Institute (JBI) methodology was followed. PubMed, Ovid MEDLINE, Scopus, Web of Science, and EMBASE were searched for population-based and large multicentre observational studies published between January 2010 and April 2024. The included studies focused on pregnant women, investigated and quantified medications use during pregnancy. Identified medications were summarized narratively using the Anatomical Therapeutic Chemical (ATC) and the United States Food and Drug Administration (US-FDA)/Australian Therapeutic Goods Administration (AU-TGA) risk classification systems, and stratified by trimesters. Of 7,552 studies, 83 were eligible. The most frequently reported ATC categories were alimentary tract and metabolism (A, 0-96%), blood and blood-forming organs (B, 0-84.5%), nervous system (N, 0-73.3%), anti-infectives (J, 0-56%), and respiratory system (R, 0-51.3%). However, limited research provided trimester-specific information. Additionally, risk category A exhibited the widest prevalence range, 0-73.1%, while the higher-risk categories, D and X, were at 0-22.6% and 0-8.3%, respectively. This review highlights the need for further trimester-specific studies.
Robot-assisted pancreatoduodenectomy (RPD) is increasingly performed for cancer in the pancreatic head. Randomised evidence confirming its oncological safety and efficacy is lacking. The DIPLOMA-2x2 trial aims to compare the oncological safety of RPD versus OPD in terms of radicality (microscopically radical resection [R0] resection). We hypothesise that RPD is non-inferior to OPD in terms of radicality and superior regarding time to functional recovery. The DIPLOMA-2x2 trial is an investigator-initiated, international, multicentre, patient- and assessor-blinded randomised non-inferiority trial. The trial was conducted as a roll-over of the DIPLOMA-2 trial and includes 20 high-volume tertiary referral hospitals in 7 countries. Minimum surgeon's experience is 60 RPD and 60 OPD, with a minimum annual centre volume of 30 RPD prior to trial initiation. Eligible patients are adults (≥18 years) with suspected or proven upfront resectable pancreatic ductal adenocarcinoma (PDAC) and distal cholangiocarcinoma (DCC) without any vascular involvement. Participants are randomised in a 2:1 ratio to RPD or OPD, respectively, stratified by tumour indication (proven PDAC versus other) and preoperative pancreatic fistula risk (high versus low). In total, 413 patients will be included, of which 137 previously randomised in DIPLOMA-2 and 276 newly recruited in DIPLOMA-2x2. Patients are blinded up to postoperative day 5. Primary outcome is pathological R0-resection rate (pR0; >1 mm tumour clearance at surgical resection margins and anatomical surfaces, 0 mm clearance at anterior surface), tested for non-inferiority with a -7% margin. Pathological assessment is blinded, and a randomly selected 10% of specimen will undergo central review. The key secondary outcome, tested for superiority, is time to functional recovery. Other secondary outcomes include lymph node retrieval, initiation/completion of adjuvant therapy, time to start of adjuvant therapy, disease-free and overall survival, quality of life, and cost-effectiveness. Safety outcomes include major complications (Clavien-Dindo grade ≥ III), serious adverse events, and 90-day mortality. Primary analyses will be based on the modified intention-to-treat principle, including all patients who underwent resection. Postoperative follow-up is up to 90 days for short-term outcomes and up to 60 months for survival. The DIPLOMA-2x2 trial evaluates whether RPD is oncologically safe compared to OPD in patients with upfront resectable PDAC and DCC in experienced high-volume centres. ISRCTN27483786. Registered: January 11, 2021 (updated: February 6, 2025). First enrolment: January 3, 2021. Expected completion of enrolment: May 2026.
Awake tracheal intubation is recommended for the anticipated difficult airway, but its application worldwide is poorly understood. We performed an international survey to understand more about the current global utilisation of awake tracheal intubation and barriers to its more widespread implementation. The online survey consisted of 34 multiple-choice questions and three open questions available for 13 months. Each participant agreed to anonymised data collection and analysis before undertaking the survey. Data were collected from 102 countries with 4728 responses. In total, 3190/4184 (76.2%) respondents stated that they were performing awake tracheal intubation independently and 2512/3035 (82.8%) used awake tracheal intubation for a combination of predicted anatomical difficulty and physiological risk. A decrease in awake tracheal intubation use was perceived by 1733/4204 (41.2%) following the widespread implementation of videolaryngoscopy. There were 2867/3695 (77.6%) respondents who felt that indications for awake tracheal intubation should be reassessed, although only 1844/3831 (48.1%) reported being familiar with awake tracheal intubation guidelines. Most used a combination of topical airway anaesthesia and systemic medications to facilitate awake tracheal intubation. There were 2521/3039 (83.0%) respondents who preferred to use a flexible endoscope, although a lack of skill in using flexible bronchoscopy was reported by 586/966 (60.7%) as limiting their confidence in awake tracheal intubation. Despite guidelines recommending use of awake tracheal intubation for the predicted difficult airway, its application is heterogeneous. Our data suggest that a lack of physician exposure to awake tracheal intubation, possibly associated with expanding use of videolaryngoscopy, may adversely impact clinician confidence in performing the procedure. Most respondents consider awake tracheal intubation to be a core skill for anaesthetists and, furthermore, videolaryngoscopy can be used to perform some awake tracheal intubations. We made an online questionnaire with lots of questions and shared it with doctors around the world. It was open for over a year. In total, 4728 people from 102 countries answered. We asked them how often they use a method called awake tracheal intubation (putting a breathing tube in while the patient is still awake), what tools they use, and what makes it easier or harder to do. Doctors are told to use this method when they think putting in a breathing tube might be difficult. But we didn't know how often it is really used in different countries, or what problems doctors face when trying to use it. We also wanted to see if newer tools, like using video cameras, have changed how often this method is used. Most doctors said they use awake tracheal intubation when they expect problems with the patient's airway or health. However, many felt they are using it less now because of newer video tools. Most also thought the rules about when to use it should be reviewed, but only about half knew the current guidelines well. Doctors usually used numbing medicine and other drugs to help patients stay comfortable. Many preferred using a flexible camera, but a lot said they were not confident with this skill. Overall, use of this method varies a lot, and some doctors may not feel confident because they do not get enough practice.
This study aimed to assess the relationship between the roots of the maxillary molars and the maxillary sinus floor in a Saudi subpopulation using cone-beam computed tomography (CBCT). The study was conducted at the Dental University Hospital of King Saud University in Riyadh, Saudi Arabia. A sample of 220 Saudi patients who attended the Dental University Hospital between January 2009 and January 2024 and had CBCT images was included. The vertical relationship between the maxillary sinus floor and the root apices of the maxillary molars was assessed using the classification of Kwak et al. Vertical distances were recorded on both sides for each maxillary molar root. A total of 880 maxillary molars and 2640 individual roots were analyzed. The linear mixed-effects model showed a significant effect for tooth root on root-to-sinus distance (p < 0.001). Age group demonstrated a significant overall effect in the model; however, no pairwise comparisons between age groups remained statistically significant after Bonferroni correction. No significant effect of gender was observed. The roots of the maxillary second molars are closer to the maxillary sinus. Type 2 was the most frequently observed relationship among maxillary molars in both genders. The shortest root-to-sinus distance was observed among the roots of the maxillary second molars. These findings highlight the value of CBCT imaging in preoperative clinical assessment for identifying high-risk cases, thereby modifying treatment planning and reducing the likelihood of sinus-related complications.
Children with cleft palate often experience impaired speech due to atypical velopharyngeal anatomy following palate repair surgery. While surgical repair aims to restore the function of the palate, more than one-third of cases result in continued velopharyngeal insufficiency (VPI) and require reoperation, which can result in negative psychosocial impacts and financial burden. Common surgical approaches for primary palatoplasty, including intravelar veloplasty and double-opposing Z-plasty, have similar reported rates of VPI. Furthermore, procedure selection occurs without any presurgical imaging and varies by operating surgeon. Surgical decisions are often based on intraoperative judgment rather than objective measures. Structural and functional variables have been associated with speech outcomes in this population, but these data exist independently of one another until the school-age years, failing to establish a direct connection between anatomy and functionality of the velopharynx in toddlers. The current clinical paradigm misses a critical window of opportunity for earlier diagnosis of VPI. The purpose of this study is to (1) establish which presurgical anatomical variables are predictive of surgical procedure selection based on perceptual assessment of intraoperative tension for palate repair and (2) determine which postsurgical anatomical features are associated with the greatest diversity in oral stop consonant production at 18 months in children with a repaired cleft palate. A total of 30 infants with cleft palate will be recruited prior to palate repair. Within 2 weeks of repair, participants will undergo nonsedated magnetic resonance imaging (MRI) of the velopharynx and produce a home-based speech recording. Participants will complete the same protocol after palate repair at 18 months of age. Data will be analyzed by independent raters following completion of a training protocol. Anatomical dimensions of the velopharynx will be extracted from the MRI scans. The number and diversity of oral stop consonants will be extracted from the speech recordings. Interrater and intrarater reliability will be assessed. Logistic regression will be used to evaluate which presurgical anatomical measurements are predictive of surgical procedure selection. Analysis of covariance will be used to examine whether postsurgical anatomical measurements are associated with diversity of oral stop consonant production. This project was funded in August 2024. Data collection began in April 2025. As of April 4, 2026, a total of 8 participants had been enrolled, and data analysis had not begun. Results are anticipated in 2027. This study will use nonsedated MRI to investigate how velopharyngeal anatomy influences surgical decision-making and early speech outcomes. Such knowledge may be useful for presurgical planning and early monitoring of postsurgical speech outcomes in children with cleft palate. DERR1-10.2196/97206.
To evaluate the incidence, characteristics, and perioperative outcomes of pulmonary artery (PA) injury during lung cancer surgery using data from the Japanese National Clinical Database (NCD). We analyzed patients who underwent lobectomy or segmentectomy for clinical stage I-III primary lung cancer registered in the NCD between 2018 and 2021. The clinicopathological features and perioperative outcomes were compared between patients with and without PA injury. Subgroup analyses were performed according to blood loss categories and the causes of mortality. PA injury occurred in 1,325 of 142,343 patients (0.9%). It was more frequent in older patients, those with a higher BMI, advanced-stage disease, and left upper lobe resections. PA injury was associated with longer operative duration, greater blood loss, and higher transfusion rates. Postoperative complications were more frequent in the PA injury group. Thirty-day mortality (1.2% vs. 0.4%) and operative mortality (1.5% vs. 0.6%) rates were higher. Mortality was notably higher when intraoperative blood loss exceeded 2000 mL, regardless of PA injury. A female sex, obesity, and cN0 status were more common among patients with PA injury-related mortality. Intraoperative PA injury occurred in nearly 1% of resections and it was associated with poor outcomes. A hemorrhage exceeding 2000 mL may therefore be a critical mortality marker.
Background/Objectives: This study aimed to compare the visualization rates of fetal anatomical structures with standard 2D ultrasound examination versus a single 3D volume acquired during the first trimester. Methods: This multicenter prospective study was performed in nine tertiary referral centers, by experienced sonographers. A standard protocol was adopted in both 2D and 3D modalities to assess the 17 anatomical structures listed in the national and international guidelines. The included cases were non-anomalous fetuses from women booked for combined screening test between 11 + 0 and 13 + 6 weeks. Results: Two hundred and thirty-nine women were included in the study. The mean gestational age at ultrasound examination was 12 weeks ± 5 days (±5.4 SD). All the 17 structures were seen in 155/239 fetuses (64.85%) at 2D evaluation and in 84/239 (35.15%) at 3D evaluation (p = 0.001). Comparing 2D and 3D visualization, the following anatomical structures showed a statistical difference: posterior fossa (92% vs. 74%, p < 0.005); neck (94.2% vs. 87.2%, p < 0.001); orbits (93% vs. 85.6%, p < 0.001); nasal bone (93% vs. 88.8%, p = 0.016); lung fields (99.5% vs 96.7%, p = 0.046); cardiac axis (99.5% vs. 83.9%; p < 0.001); bladder (97.5% vs. 91.7%, p < 0.001); abdominal wall (98.7% vs. 94.2%, p < 0.001). For the other anatomical portion, no statistically significant differences were found. Conclusions: Our study demonstrates that a full assessment of fetal anatomy is best performed using 2D ultrasound, while 3D ultrasound showed lower overall visualization rates, with comparable performance for selected structures, suggesting a potential supplementary use in specific clinical contexts.
The carotid body is a small, highly vascularized organ located at the bifurcation of the common carotid artery and serves as the primary peripheral detector of arterial oxygen tension in mammals. Although its physiological role in ventilatory and autonomic reflexes has been extensively investigated, these functions are fundamentally dependent on its specialized anatomical organization. Objective: This review provides a comprehensive overview of the anatomical organization of the carotid body, highlighting how its gross morphology, microvascular architecture, cellular composition, and innervation support rapid oxygen sensing and chemosensory signal transmission. Current evidence from anatomical, histological, ultrastructural, developmental, comparative, and experimental studies was critically reviewed to summarize the structural organization of the carotid body across mammalian species. Particular emphasis was placed on the relationships between vascular organization, cellular arrangement, and neural connectivity, as well as structural adaptations associated with chronic hypoxia and disease. The carotid body is characterized by an exceptionally dense capillary network, intimate neurovascular coupling, and glomerular clusters composed of excitable type-1 (glomus) cells surrounded by supportive type-2 (sustentacular) cells. These structural features facilitate efficient oxygen delivery, rapid detection of changes in arterial oxygen tension, and effective transmission of chemosensory information to the central nervous system. Comparative and developmental studies further demonstrate species-specific anatomical differences and substantial structural plasticity in response to chronic hypoxia, aging, and pathological conditions. The specialized anatomy of the carotid body forms the structural basis of its remarkable sensitivity to changes in arterial oxygen tension. Integrating current knowledge of its vascular, cellular, and neural organization provides important insight into peripheral chemoreception and establishes an anatomical framework for understanding carotid body dysfunction in cardiopulmonary and metabolic diseases.
In our previous research, we found that the subcompartments formed by the cervical fascia in the supraclavicular region (levels IV, Vb, and lower VI) effectively define the boundaries of the nodal clinical target volume (CTV) for nasopharyngeal carcinoma (NPC). This study aimed to determine whether the same anatomical approach could be applied to the middle neck region (levels III, Va, and upper VI). We enrolled 100 patients with NPC who had positive lymph nodes throughout the neck, including the supraclavicular region. Their pretreatment images were systematically reviewed. We analyzed lymph node distribution patterns in relation to both the 2013 International Consensus node-level definitions and the cervical fascia-based subcompartments proposed in our previous study. Based on our findings, we recommend several modifications to the 2018 international CTV consensus guidelines. Our analysis confirmed that the cervical fascial subcompartments effectively define nodal CTV borders. Based on the observed lymph node distribution patterns, we propose several specific optimizations for the middle neck. The lateral border of level Va can be retracted from the skin and platysma to the line connecting the posterior margin of the sternocleidomastoid muscle (SCM) and the anterior margin of the trapezius muscle (TM). Medially, the border can be safely retracted to an anterior-posterior line bisecting the center of the common carotid artery (CCA), as the space medial to this line is consistently devoid of nodes. In addition, the anterior boundary of the CTV may be defined by the lymph nodes located anterior to the carotid sheath; otherwise, the carotid sheath itself serves as the boundary. Cervical fascial anatomy provides valuable insight into the distribution patterns of lymph nodes in the middle neck region in patients with NPC. Based on these anatomical considerations, appropriate modifications to the nodal CTV defined by the 2018 consensus can be implemented for the middle neck region.
Diabetic tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy is a vision-threatening complication that may require pars plana vitrectomy in selected cases, particularly when the macula is threatened or detached. Silicone oil tamponade is commonly used in complex cases, although tamponade choice varies according to surgical findings and surgeon preference. To evaluate surgical outcomes associated with adjunctive dexamethasone implant during pars plana vitrectomy with silicone oil or heavy silicone oil tamponade for diabetic tractional retinal detachment. A comprehensive literature search of PubMed, Scopus, Web of Science, and ClinicalTrials.gov was performed from inception through 2025. Randomized and non-randomized comparative studies assessing PPV with silicone oil with or without adjunctive dexamethasone implant were considered. Definitions of postoperative PVR and retinal redetachment were accepted as reported by the original studies; no individual-level imaging or independent photographic regrading was available. The anatomical outcome was an exploratory composite of study-reported postoperative proliferative vitreoretinopathy (PVR) and/or retinal redetachment outcomes. Because definitions and follow-up time points differed across studies, this outcome was not treated as a uniformly graded PVR endpoint. Randomized and non-randomized comparative studies were identified; randomized trials were prioritized for the main analysis, while the non-randomized study was considered separately because of serious risk of bias. Secondary outcomes included best-corrected visual acuity (BCVA), central subfield thickness (CST), ocular hypertension, and postoperative complications. The protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD420261283105) prior to the commencement of the review. Four studies involving 305 eyes were included. In the main randomized-trial analysis, two studies comprising 123 eyes contributed to the exploratory study-reported postoperative proliferative/redetachment composite. The pooled estimate was highly imprecise (RR 0.20, 95% CI 0.00 to 16.06; I² = 0%) and did not provide conclusive evidence of benefit. In an exploratory sensitivity analysis including the non-randomized study, the estimate favored dexamethasone implant, but this analysis was subject to serious risk of bias. BCVA and CST findings were limited by small sample sizes, heterogeneity, and inconsistent reporting. Intraocular-pressure outcomes were not pooled because definitions and assessment time points differed across studies. Current evidence is insufficient to support routine adjunctive dexamethasone implant use during vitrectomy with silicone oil for diabetic tractional retinal detachment. The available studies provide only a hypothesis-generating signal of fewer study-reported postoperative proliferative or redetachment events. Use should remain selective and individualized until adequately powered randomized trials with standardized anatomical outcomes are available. Not applicable.
To evaluate visual and anatomical outcomes after switching to aflibercept 8 mg in eyes with neovascular age-related macular degeneration (nAMD), and to assess outcomes according to the clinical indication for switching. Multicentre retrospective observational study including 300 eyes with nAMD previously treated with anti-vascular endothelial growth factor therapy and switched to aflibercept 8 mg for non-response (n:74, 24.7%), suboptimal response (n:159, 53.0%), or durability-driven reasons (n:67, 22.3%). Longitudinal data from the 6 months preceding the switch and post-switch visits at 3 and 6 months were analyzed. The primary outcome was change in best-corrected visual acuity (BCVA, ETDRS letters) from the switch visit to the 3-month post-switch visit. Secondary outcomes included changes in central subfield thickness (CST) and retinal fluid status. During the pre-switch period, mean BCVA declined by - 1.9 ± 8.2 letters and CST increased. At 3 months after switching, BCVA improved by + 2.0 ± 9.2 letters (95% CI, + 0.8 to + 3.2; p < 0.01), with greater gains in eyes switched for non-response (+ 2.8 ± 12.6 letters). Mean CST decreased by - 45.3 ± 79.8 µm (95% CI, - 55.4 to - 35.2; p < 0.001), with corresponding reductions in retinal fluid. Anatomical improvements were more pronounced in eyes switched for non-response, whereas more modest but consistent changes were observed in suboptimal and durability-driven groups. Visual and anatomical outcomes were maintained at 6 months. In previously treated nAMD eyes, switching to aflibercept 8 mg was associated with reversal of pre-switch anatomical worsening, reduction in retinal fluid, and modest visual gains. Greater responses were observed in eyes with inadequate pre-switch disease control, supporting its role as a treatment escalation strategy in clinical practice.
This prospective repeated-measures quasi-experimental educational study, conducted across two consecutive first-year medical school cohorts, aimed to develop and implement case-based learning (CBL) modules using three-dimensional (3D) models and magnetic resonance imaging (MRI) within an extended reality (XR) environment. The intervention integrated anatomical variations and anomalies to enhance immediate learning and long-term knowledge retention. MRI data from selected donors at the John A. Burns School of Medicine (JABSOM) were used to create XR-CBL modules. First-year medical students from the classes of 2024 (Cohort 2021) (n = 61) and 2025 (Cohort 2022) (n = 67) participated. Before the session, students received an email detailing the activity. During the gross anatomy laboratory, they accessed a website to explore cases featuring learning objectives, clinical and radiological data, 3D models, and MRIs. The XR experience utilized desktop-based XR technology. An assessment was administered before, immediately after, and eight weeks post-intervention. Students also completed a mixed-format feedback survey. A repeated-measures ANOVA revealed a significant effect of the intervention on student performance across both cohorts. For Cohort 2021, Wilks' Lambda = 0.384, F (2, 59) = 47.27, p < 0.001, partial η² = 0.616. For Cohort 2022, Wilks' Lambda = 0.30, F (2, 65) = 72.72, p < 0.001, partial η² = 0.691. Follow-up pairwise comparisons with Bonferroni adjustments indicated significant improvements from pre-test to post-test and from pre-test to post-post-test for both cohorts (p < 0.01). There was no significant difference between the post-test and post-post-test scores (p = 1.00). In Cohort 2021, mean scores significantly increased from pre-test (3.9 ± 1.9) to post-test (6.2 ± 2.6) and were maintained at post-post-test (6.3 ± 1.7). Similarly, Cohort 2022 demonstrated significant gains from pre-test (4.3 ± 1.6) to post-test (7.6 ± 2.2), with high retention at post-post-test (6.3 ± 2.4). Pairwise comparisons confirmed that improvements from baseline were significant (p < 0.01), while no significant decay occurred between post- and post-post-assessments (p = 1.00). Incorporating multimodal resources, including anatomical variations and anomalies through CBL, into the gross anatomy laboratory was associated with significant score improvements and positive student perceptions. Learners reported that the interactive, imaging-based tools helped them better understand complex anatomical relationships, particularly when anatomical variability was highlighted.
Chordoma is a rare malignant bone tumor with high local recurrence, metastatic spread in 40% to 60% of patients over the disease course, and significant morbidity. Because of its rarity, anatomical complexity, and prolonged natural history, high-quality evidence to guide management is limited. International consensus guidelines for localized chordoma were first published in 2015; however, advances in pathology, imaging, surgery, radiotherapy, and supportive care since then necessitate updated multidisciplinary recommendations. To update and expand the 2015 consensus recommendations on the diagnosis, treatment, and follow-up of pediatric and adult patients with primary, localized chordoma. In June 2025, a meeting of the Global Chordoma Consensus Group was held in Milan, Italy, that included experts from all relevant specialties as well as patient representatives. A comprehensive literature review guided structured discussions on the management of primary localized disease. Levels of evidence and grades of recommendation were assigned. A total of 305 articles were included in the literature review. Management strategies were stratified by anatomical site (skull base, mobile spine, and sacrum). The central principal of care was treatment at experienced, multidisciplinary centers, with maximally safe surgery followed by high-dose, highly conformal radiotherapy. Guidance was provided on diagnosis, surgical approaches, and radiotherapy planning for each anatomical site. Systemic therapy options; long-term, risk-adapted follow-up; and supportive, palliative, and rehabilitative care were also addressed. This global consensus statement provided updated multidisciplinary guidance for the management of primary, localized chordoma. It aimed to harmonize clinical practice, support shared decision-making, and identify priorities for future collaborative research in this rare and challenging disease.