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Journal of Visualized Experiments : JoVE Dec 2020Cerebellum plays an important role in several key functions including control of movement, balance, cognition, reward, and affect. Imaging studies indicate that distinct...
Cerebellum plays an important role in several key functions including control of movement, balance, cognition, reward, and affect. Imaging studies indicate that distinct cerebellar regions contribute to these different functions. Molecular studies examining regional cerebellar differences are lagging as they are mostly done on whole cerebellar extracts thereby masking any distinctions across specific cerebellar regions. Here we describe a technique to reproducibly and quickly dissect four different cerebellar regions: the deep cerebellar nuclei (DCN), anterior and posterior vermal cerebellar cortex, and the cerebellar cortex of the hemispheres. Dissecting out these distinct regions allows for the exploration of molecular mechanisms that may underlie their unique contributions to balance, movement, affect and cognition. This technique may also be used to explore differences in pathological susceptibility of these specific regions across various mouse disease models.
Topics: Animals; Cerebellum; Dissection; Fructose-Bisphosphate Aldolase; Gene Expression Regulation; Humans; Image Processing, Computer-Assisted; Mice, Inbred C57BL; RNA
PubMed: 33346205
DOI: 10.3791/61922 -
Brain Structure & Function Jan 2021The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for... (Review)
Review
The aim of this literature review is to present a summary of the published literature relating the details of the different modifications of specimen preparation for white matter dissection with the Klingler technique. For this review, 3 independent investigators performed an electronic literature search that was carried out in the Pubmed, Scopus and Web of Science databses up to December 2019. Furthermore, we performed citation tracking for the articles missed in the initial search. Studies were eligible for inclusion when they reported details of at least the first 2 main steps of Klingler's technique: fixation and freezing. A total of 37 full-text articles were included in the analysis. We included original anatomical studies in which human white matter dissection was performed for study purposes. The main three steps of preparation are the same in each laboratory, but the details of each vary between studies. Ten percent formalin is the most commonly used (34 studies) solution for fixation. The freezing time varied between 8 h and a month, and the temperature varied from - 5 to - 80 °C. After thawing and during dissections, the specimens were most often kept in formalin solution (13), and the concentration varied from 4 to 10%. Klingler's preparation technique involves three main steps: fixation, freezing and thawing. Even though the details of the technique are different in most of the studies, all provide subjectively good quality specimens for anatomical dissections and studies.
Topics: Brain; Dissection; Humans; White Matter
PubMed: 33165658
DOI: 10.1007/s00429-020-02157-9 -
Developmental Medicine and Child... Aug 2004
Topics: Autopsy; Cadaver; Dissection; Humans; Pathology
PubMed: 15287239
DOI: 10.1017/s0012162204000842 -
World Journal of Gastroenterology Oct 2015Endoscopic submucosal dissection (ESD) has been invented in Japan to provide resection for cure of early cancer in the gastrointestinal tract. Professional level of ESD... (Review)
Review
Endoscopic submucosal dissection (ESD) has been invented in Japan to provide resection for cure of early cancer in the gastrointestinal tract. Professional level of ESD requires excellent staging of early neoplasias with image enhanced endoscopy (IEE) to make correct indications for ESD, and high skills in endoscopic electrosurgical dissection. In Japan, endodiagnostic and endosurgical excellence spread through personal tutoring of skilled endoscopists by the inventors and experts in IEE and ESD. To translocate this expertise to other continents must overcome two fundamental obstacles: (1) inadequate expectations as to the complexity of IEE and ESD; and (2) lack of suitable lesions and master-mentors for ESD trainees. Leading endoscopic mucosal resection-proficient endoscopists must pioneer themselves through the long learning curve to proficient ESD experts. Major referral centers for ESD must arise in Western countries on comparable professional level as in Japan. In the second stage, the upcoming Western experts must commit themselves to teach skilled endoscopists from other referral centers, in order to spread ESD in Western countries. Respect for patients with early gastrointestinal cancer asks for best efforts to learn endoscopic categorization of early neoplasias and skills for ESD based on sustained cooperation with the masters in Japan. The strategy is discussed here.
Topics: Clinical Competence; Dissection; Education, Continuing; Education, Medical, Graduate; Endoscopy, Gastrointestinal; Gastrointestinal Neoplasms; Humans; Japan; Learning Curve; Mentors; Referral and Consultation; Treatment Outcome; Western World
PubMed: 26523097
DOI: 10.3748/wjg.v21.i40.11209 -
Acta Neurochirurgica Apr 2021The human white matter pathway network is complex and of critical importance for functionality. Thus, learning and understanding white matter tract anatomy is important...
BACKGROUND
The human white matter pathway network is complex and of critical importance for functionality. Thus, learning and understanding white matter tract anatomy is important for the training of neuroscientists and neurosurgeons. The study aims to test and evaluate a new method for fiber dissection using augmented reality (AR) in a group which is experienced in cadaver white matter dissection courses and in vivo tractography.
METHODS
Fifteen neurosurgeons, neurolinguists, and neuroscientists participated in this questionnaire-based study. We presented five cases of patients with left-sided perisylvian gliomas who underwent awake craniotomy. Diffusion tensor imaging fiber tracking (DTI FT) was performed and the language-related networks were visualized separated in different tracts by color. Participants were able to virtually dissect the prepared DTI FTs using a spatial computer and AR goggles. The application was evaluated through a questionnaire with answers from 0 (minimum) to 10 (maximum).
RESULTS
Participants rated the overall experience of AR fiber dissection with a median of 8 points (mean ± standard deviation 8.5 ± 1.4). Usefulness for fiber dissection courses and education in general was rated with 8 (8.3 ± 1.4) and 8 (8.1 ± 1.5) points, respectively. Educational value was expected to be high for several target audiences (student: median 9, 8.6 ± 1.4; resident: 9, 8.5 ± 1.8; surgeon: 9, 8.2 ± 2.4; scientist: 8.5, 8.0 ± 2.4). Even clinical application of AR fiber dissection was expected to be of value with a median of 7 points (7.0 ± 2.5).
CONCLUSION
The present evaluation of this first application of AR for fiber dissection shows a throughout positive evaluation for educational purposes.
Topics: Adult; Augmented Reality; Craniotomy; Diffusion Tensor Imaging; Dissection; Female; Glioma; Humans; Male; Neural Pathways; White Matter
PubMed: 33026532
DOI: 10.1007/s00701-020-04545-w -
Gut and Liver Sep 2015Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an... (Review)
Review
Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multi-purpose flexible endoscope is therefore considered a socially urgent issue.
Topics: Dissection; Gastrointestinal Neoplasms; Health Care Costs; Humans; Medical Illustration; Mouth; Natural Orifice Endoscopic Surgery; Upper Gastrointestinal Tract
PubMed: 26343069
DOI: 10.5009/gnl14380 -
International Journal of Surgery... Dec 2009Surgical excision of the submandibular gland (SMG) is commonly indicated in patients with neoplasms, and non-neoplastic conditions such as chronic sialadenitis,... (Review)
Review
OBJECTIVES
Surgical excision of the submandibular gland (SMG) is commonly indicated in patients with neoplasms, and non-neoplastic conditions such as chronic sialadenitis, sialolithiasis, ranula and drooling. Traditional SMG surgery involves a direct transcervical approach. In the recent past, alternative approaches to SMG excision have been described in effort to offer minimally invasive options or better cosmetic results. The purpose of this article is to describe the surgical approaches to the SMG and present relevant surgical anatomy via cadaveric dissection and a systematic review of literature to compare and contrast each technique.
STUDY DESIGN
Cadaveric dissection with fresh human cadaver heads followed by a review of the literature.
METHODS
Cadaver heads were dissected via both the transcervical and transoral approaches to the submandibular gland with the use of endoscopic assistance when indicated. Key landmarks and anatomic relationships were recorded via photo documentation. A review of the literature was conducted using a Medline search for approaches to SMG excision, including indications, results and complications.
RESULTS
While the traditional SMG excision remains a direct transcervical approach, many other methods of excision are described that include open, endoscopic, and robot assisted resections. The approaches vary from being transcervical, submental, transoral or retroauricular.
CONCLUSIONS
Alternative approaches to the SMG are feasible but should be tailored to the individual patient based on factors such as pathology, patient preferences, availability of technology, and the experience and skill of the surgeon.
Topics: Cadaver; Dissection; Endoscopy; Female; Humans; Male; Minimally Invasive Surgical Procedures; Otorhinolaryngologic Surgical Procedures; Sensitivity and Specificity; Submandibular Gland; Submandibular Gland Diseases
PubMed: 19782158
DOI: 10.1016/j.ijsu.2009.09.006 -
Trials Feb 2022Endoscopic submucosal dissection (ESD) is widely accepted as a local treatment for gastrointestinal tract tumors. As a simplified endoscopic procedure, hybrid ESD...
Comparison of the procedure time differences between hybrid endoscopic submucosal dissection and conventional endoscopic submucosal dissection in patients with early gastric neoplasms: a study protocol for a multi-center randomized controlled trial (Hybrid-G trial).
BACKGROUND
Endoscopic submucosal dissection (ESD) is widely accepted as a local treatment for gastrointestinal tract tumors. As a simplified endoscopic procedure, hybrid ESD (H-ESD) has been performed for colorectal neoplasms in recent times. However, whether H-ESD is superior to conventional ESD (C-ESD) for patients with early gastric neoplasms (EGN) remains unclear. In this trial, we will compare the treatment outcomes of H-ESD and C-ESD. We hypothesize that the procedure time for H-ESD is shorter than that for C-ESD.
METHODS
This is an investigator-initiated, multi-center, prospective, randomized, open-label, parallel-group trial to be conducted beginning in August 2020 at nine institutions in Japan. We will determine if H-ESD is superior to C-ESD in terms of procedure time in patients with EGN diagnosed as macroscopically intramucosal (T1a) differentiated carcinoma ≤ 20 mm in diameter without ulcerative findings according to current Japanese gastric cancer treatment guidelines. A total of 82 patients will be recruited and randomly assigned to either the C-ESD or the H-ESD group. The primary outcome is ESD procedure time. Secondary outcomes include mucosal incision, time and speed of submucosal dissection, en bloc resection, complete resection, curability, adverse events related to the ESD procedure, extent of dissection before snaring, volume of injection solution, number and time of hemostasis, thickness of the submucosal layer in the resected specimen, and handover to another operator. The stated sample size was determined based on the primary outcome. According to a previous report comparing the procedure times of C-ESD and H-ESD, we hypothesized that H-ESD would provide a 0.2 reduction in logarithmically concerted procedure time (-37%). We estimated that a total of 82 participants were needed to reach a power of 80% for a t-test with a significance level of 0.05 and considering a 10% dropout.
DISCUSSION
This trial will provide high-quality data on the benefits and risks of H-ESD for EGN patients. The results of this study could lead to improved outcomes in patients with EGN undergoing ESD. The results will be presented at national and international meetings and published in peer-reviewed journals.
TRIAL REGISTRATION
UMIN-CTR UMIN000041244 . Registered on July 29, 2020.
Topics: Colorectal Neoplasms; Dissection; Endoscopic Mucosal Resection; Humans; Multicenter Studies as Topic; Prospective Studies; Randomized Controlled Trials as Topic; Stomach Neoplasms; Treatment Outcome
PubMed: 35189939
DOI: 10.1186/s13063-022-06099-x -
Folia Morphologica 2023The sternocleidomastoid muscles (SCM) are prominent paired muscles of the neck connecting proximally the manubrium sterni and the clavicle to the mastoid process and the... (Review)
Review
The sternocleidomastoid muscles (SCM) are prominent paired muscles of the neck connecting proximally the manubrium sterni and the clavicle to the mastoid process and the occipital bone distally. Following their points of attachment sternomastoid, sternooccipital, cleidomastoid and cleidooccipital portions of this muscle have been described. Altogether 23 case reports from year 2000 till 2020 with 29 subjects related to the SCM supernumerary variations were searched and analysed where parameters such as supernumerary proximal variation types (sternal vs. clavicular), insertional variation, unilaterality/bilaterality of the variation, study type, reported gender of the subjects and the country of research were extracted. The research shows that 48.3% of the subjects had bilateral presentation of SCM variations. If present unilaterally, three quarters of the cases were on the left side. The most frequent variation is located at the clavicular side of the proximal SCM head whereas isolated sternal sided proximal head variation or an insertional variation alone are very rare. Interestingly, with 96.6%, most of cases in the literature were discovered in cadavers during anatomical dissections. Male gender represented with 82.8% higher prevalence than females. The higher male prevalence in the body donor system, predominantly in the Asian continent could play a decisive role in the outcome as more than half of the reported cases stemmed from India in this period. Importantly, the knowledge of different anatomical variations of the SCM is highly relevant for surgical, clinical or radiological approaches in the neck.
Topics: Female; Humans; Male; Neck Muscles; Neck; Dissection; Sternum; Clavicle
PubMed: 35607877
DOI: 10.5603/FM.a2022.0045 -
Scientific Reports Jan 2023Advances in the techniques for assessing human cerebral white matter have recently contributed to greater attention to structural connectivity. Yet, little is known...
Advances in the techniques for assessing human cerebral white matter have recently contributed to greater attention to structural connectivity. Yet, little is known about the vascularization of most white matter fasciculi and the fascicular composition of the vascular territories. This paper presents an original method to label the arterial supply of macroscopic white matter fasciculi based on a standardized protocol for post-mortem injection of colored material into main cerebral arteries combined with a novel fiber dissection technique. Twelve whole human cerebral hemispheres obtained post-mortem were included. A detailed description of every step, from obtaining the specimen to image acquisition of its dissection, is provided. Injection and dissection were reproducible and manageable without any sophisticated equipment. They successfully showed the arterial supply of the dissected fasciculi. In addition, we discuss the challenges we faced and overcame during the development of the presented method, highlight its originality. Henceforth, this innovative method serves as a tool to provide a precise anatomical description of the vascularization of the main white matter tracts.
Topics: Humans; White Matter; Dissection; Arteries; Nerve Tissue
PubMed: 36646713
DOI: 10.1038/s41598-022-26227-6