What is the Role of Ultrasound in Anatomy Learning?

Ultrasound is a well-established medical imaging technique that has been routinely used in clinical practice for many years. Point-of-care ultrasound (POCUS) has become the norm with bedside and pre-hospital scanning performed by non-specialists. This is partly due to ultrasound providing real time non-invasive visualisation of anatomical structures without exposing patients to any radiation. Ultrasound aids the diagnostic process and enables healthcare providers to perform safely invasive procedures such as central venous catheterisation and chest drain insertion. Mastering the skill of ultrasound scanning along with becoming familiar with its knobology and proficient at image interpretation requires training and takes time (1). Early exposure to hands-on scanning and understanding of what constitutes ‘normal’ anatomy could be one way of allowing budding healthcare providers to enhance such skills. Research has shown that integration of ultrasound into the medical curriculum allows students to improve their knowledge (2). In addition to this, ultrasound teaching has helped them feel more confident about anatomy learning (3) and students have been found to be more motivated to improve their knowledge (4). Student feedback has highlighted that they would like more training incorporated into the curriculum (2) with ultrasound regarded as a valuable tool which will help them in clinical practice (5). Embedding of ultrasound teaching into a curriculum requires availability of resources, that are not only limited to the machines, appropriate infrastructure including trained staff and consideration of incidental findings (6). More research is required into this area to better delineate the role of ultrasound in anatomy learning

Identifying the emergence of the superficial peroneal nerve through deep fascia on ultrasound and by dissection:Implications for regional anesthesia in foot and ankle surgery

Regional anesthesia relies on a sound understanding of anatomy and the utility of ultrasound in identifying relevant structures. We assessed the ability to identify the point at which the superficial peroneal nerve (SPN) emerges through the deep fascia by ultrasound on 26 volunteers (mean age 27.85 years ± 13.186; equal male: female). This point was identified, characterized in relation to surrounding bony landmarks (lateral malleolus and head of the fibula), and compared to data from 16 formalin‐fixed human cadavers (mean age 82.88 years ± 6.964; equal male: female). The SPN was identified bilaterally in all subjects. On ultrasound it was found to pierce the deep fascia of the leg at a point 0.31 (±0.066) of the way along a straight line from the lateral malleolus to the head of the fibula (LM‐HF line). This occurred on or anterior to the line in all cases. Dissection of cadavers found this point to be 0.30 (±0.062) along the LM‐HF line, with no statistically significant difference between the two groups (U = 764.000; exact two‐tailed P = 0.534). It was always on or anterior to the LM‐HF line, anterior by 0.74 cm (±0.624) on ultrasound and by 1.51 cm (±0.509) during dissection. This point was significantly further anterior to the LM‐HF line in cadavers (U = 257.700, exact two‐tailed P < 0.001). Dissection revealed the nerve to divide prior to emergence in 46.88% (n = 15) limbs, which was not identified on ultrasound (although not specifically assessed). Such information can guide clinicians when patient factors (e.g., obesity and peripheral edema) make ultrasound‐guided nerve localization more technically challenging.PostprintPeer reviewe

Developing a Methodology Protocol for Identifying the Superficial Peroneal Nerve in Living Models Sonographically and Formalin-Fixed Cadavers Morphologically: a Proof of Concept Study

The superficial peroneal nerve (SPN) provides cutaneous innervation to the distal anterolateral leg and dorsum of foot.1 Knowing the position where the SPN penetrates the deep fascia, to become superficial, is useful in clinical practice (e.g. ankle blocks and internal fixation of distal fibular fractures). However, there is variability in the literature as to where the SPN penetrates the deep fascia as well as the methodology to identify it with no standardised guidelines. Our primary aim was to identify this point and create a methodology protocol that could be implemented in clinical practice. The study involved sonography of living healthy adult volunteers and dissection of formalin-fixed cadavers with no past history of pathology or surgery affecting the SPN. During sonography, the bony prominences of the fibular head and lateral malleolus were identified and marked with a straight line. A 6-12 MHz linear array ultrasound probe was positioned anterior to the lateral malleolus and moved proximally to identify the location where the SPN penetrates the deep fascia to lie in a superficial plane. The lateral malleolus-fibular head (length of fibula) and lateral malleolus-SPN distances were measured. The distance of emergence from the deep fascia of the SPN anterior or posterior to the length of fibula was measured (fig 1). In the cadavers, a skin incision was made from the tibial tuberosity to the anterior intermalleolar line and the skin reflected laterally to a line posterior to fibula. The superficial fascia was explored to identify the SPN and branches (fig 2). The same bony landmarks/measurements as in the sonography were marked and measured to allow for comparison with the sonographic methodology. We successfully developed a protocol that can provide standardisation for identifying the SPN. This can reduce incorrect identification and improve success rates of clinical procedures, though individual variation must be considered. Reference: 1. STANDRING, S (Editor) 2008. Gray’s Anatomy The Anatomical Basis of Clinical Practice (Fortieth Edition). London: Churchill Livingstone ELSEVIER, page 1427. Acknowledgements: For their help and support in this study, we would to thank the volunteers, the anatomy technical staff, and the clinical skills suite manager from the University of St Andrews Medical School

Developing a Methodology Protocol for Identifying the Superficial Peroneal Nerve in Living Models Sonographically and Formalin-Fixed Cadavers Morphologically: a Proof of Concept Study

The superficial peroneal nerve (SPN) provides cutaneous innervation to the distal anterolateral leg and dorsum of foot.1 Knowing the position where the SPN penetrates the deep fascia, to become superficial, is useful in clinical practice (e.g. ankle blocks and internal fixation of distal fibular fractures). However, there is variability in the literature as to where the SPN penetrates the deep fascia as well as the methodology to identify it with no standardised guidelines. Our primary aim was to identify this point and create a methodology protocol that could be implemented in clinical practice. The study involved sonography of living healthy adult volunteers and dissection of formalin-fixed cadavers with no past history of pathology or surgery affecting the SPN. During sonography, the bony prominences of the fibular head and lateral malleolus were identified and marked with a straight line. A 6-12 MHz linear array ultrasound probe was positioned anterior to the lateral malleolus and moved proximally to identify the location where the SPN penetrates the deep fascia to lie in a superficial plane. The lateral malleolus-fibular head (length of fibula) and lateral malleolus-SPN distances were measured. The distance of emergence from the deep fascia of the SPN anterior or posterior to the length of fibula was measured (fig 1). In the cadavers, a skin incision was made from the tibial tuberosity to the anterior intermalleolar line and the skin reflected laterally to a line posterior to fibula. The superficial fascia was explored to identify the SPN and branches (fig 2). The same bony landmarks/measurements as in the sonography were marked and measured to allow for comparison with the sonographic methodology. We successfully developed a protocol that can provide standardisation for identifying the SPN. This can reduce incorrect identification and improve success rates of clinical procedures, though individual variation must be considered. Reference: 1. STANDRING, S (Editor) 2008. Gray’s Anatomy The Anatomical Basis of Clinical Practice (Fortieth Edition). London: Churchill Livingstone ELSEVIER, page 1427. Acknowledgements: For their help and support in this study, we would to thank the volunteers, the anatomy technical staff, and the clinical skills suite manager from the University of St Andrews Medical School

A Multidisciplinary Approach To Patient Care

Powerpoint showcasing a collaborative case reflection: Students utilized interprofessional team collaboration to develop skills among allied health professions to create the best plan of care for our Telehealth patient, and her family.https://dune.une.edu/caiepfall2023/1003/thumbnail.jp

Identifying variant anatomy during ultrasound-guided regional anaesthesia:opportunities for clinical improvement

No abstract available

Brain hyperintensities in magnetic resonance imaging of patients with mild acute focal neurology

Purpose: Hyperintensities are common in neuroimaging scans of patients with mild acute focal neurology. However, their pathogenic role and clinical significance is not well understood. We assessed whether there was an association between hyperintensity score with diagnostic category and clinical assessments/measures. Methods: One hundred patients (51 ± 12 years; 45:55 women:men), with symptomatology suggestive of short duration ischemia referred for magnetic resonance imaging, were prospectively recruited in NHS Grampian between 2012 and 2014. Hyperintensities were quantified, on T2 and FLAIR, using the Scheltens score. Results: The most frequent diagnosis was minor stroke (33%), migraine (25%) and transient ischemic attack (17%). The mean total Scheltens score was 28.49 ± 11.93 with all participants having various loads of hyperintensities. Statistically significant correlations between hyperintensity scores and clinical assessments/measures (age, systolic blood pressure, pulse pressure, MoCA) at the global level were also reflected regionally. These provide further supporting data in terms of the robustness of the Scheltens scale. Conclusion: Hyperintensities could serve as a diagnostic and prognostic imaging biomarker for patients, presenting with mild acute focal neurology, warranting application of automated quantification methods. However, larger cohorts are required to provide a definitive answer especially as this is a heterogenous group of patients

Learning to generalise but not segment an artificial language at 17 months predicts children’s language skills 3 years later

We investigated whether learning an artificial language at 17 months was predictive of children’s natural language vocabulary and grammar skills at 54 months. Children at 17 months listened to an artificial language containing non-adjacent dependencies, and were then tested on their learning to segment and to generalise the structure of the language. At 54 months, children were then tested on a range of standardised natural language tasks that assessed receptive and expressive vocabulary and grammar. A structural equation model demonstrated that learning the artificial language generalisation at 17 months predicted language abilities – a composite of vocabulary and grammar skills – at 54 months, whereas artificial language segmentation at 17 months did not predict language abilities at this age. Artificial language learning tasks – especially those that probe grammar learning – provide a valuable tool for uncovering the mechanisms driving children’s early language development

Development of SNP markers present in expressed genes of the plant-pathogen interaction: Theobroma cacao - Moniliophtora perniciosa

We report the detection, validation and analysis of SNPs in the plant-pathogen interaction between cacao and Moniliophthora perniciosa ESTs using resequencing. This analysis in 73 EST sequences allowed the identification of 185 SNPs, 57% of them corresponding to transversion, 29% to transition and 14% to indels. The ESTs containing SNPs were classified into 14 main functional categories. After validation, 91 SNPs were confirmed, categorized and the parameters of nucleotide diversity and haplotype were calculated. Haplotype-based gene diversity and polymorphic information content (PIC) ranged from 0.559 to 0.56 and 0.115 to 0.12; respectively. Also, it was the advantage when considering haplotypes structure for each locus in place of single SNPs. Most of the gene fragments had a major haplotype combined to a series of low frequency haplotypes. Thus, the re-sequencing approach proved to be a valuable resource to identify useful SNPs for wide genetic applications. Furthermore, the cacao genome sequence availability allow a positional selection of DNA fragments to be re-sequenced enhancing the usefulness of the discovered SNPs. These results indicate the potential use of SNPs markers to identify allelic status of cacao resistance genes through marker-assisted selection to support the development of promising genotypes with high resistance to witch's broom disease. (Résumé d'auteur