Ana Carrera

Background: Lymphatic surgery of the head and neck has been proposed as a potential approach to prevent, delay, or treat Alzheimer’s disease. This exploratory anatomical study undertook to map and evaluate potential targets for surgical feasibility studies. Methods: This exploratory anatomical and preliminary laboratory study was supported by fresh cadaver dissection, with indocyanine green (ICG) lymphography to visualize the drainage pathway. Immunohistochemistry was used to confirm the presence of lymphatic tissues and to detect β-amyloid in lymphatic tissues from a cadaver with confirmed dementia. A simulated lymph-node-to-vein anastomosis (LNVA) was performed using robotic-assisted supermicrosurgery with the Symani Surgical System (Medical Microinstruments, Inc., Jacksonville, FL, USA). Results: After injection of ICG at the dural meninges, fluorescence progressed toward the skull base to the Level II deep cervical lymph nodes (dCLNs). When injected at the parietal lymphatics, ICG drained past the deep digastric point to the Level II CLNs. Veins localized adjacent to dCLNs at the deep digastric point and Level II suggested candidate surgical targets for LNVA. Histology of lymph nodes from a dementia-confirmed cadaver identified β-amyloid at Level II dCLNs but not at lower levels or the groin. A robotic-assisted microsurgical LNVA was shown to be feasible. Conclusions: This study found evidence supporting a posterior pathway from human dural meninges to the deep cervical lymph nodes and identified potential surgical candidates for Alzheimer’s disease intervention. Further research is warranted to build on the feasibility of this approach.

The navicular bone and the proximal fifth metatarsal (M5) play a vital role in maintaining the structural integrity and biomechanical stability of the foot's medial and lateral columns, respectively. Both bones' unique anatomical configuration, intricate mechanical environment and limited vascular supply make specific locations particularly vulnerable to stress fractures. Moreover, the combination of mechanical loading patterns and restricted perfusion in the navicular and proximal M5 further contributes to delayed healing, nonunion and refracture. Therefore, finding suitable treatment options for the different damage patterns involving both bones is critical for reducing complications and improving clinical results. This paper aims to clarify the anatomical and biomechanical features underlying these fractures to improve diagnosis, prevention, and clinical management in high‐risk populations. Level of Evidence: N/A.

Transforaminal epidural steroid injections (TFESIs) are frequently used to treat lumbar and radicular pain. Although ischemic complications are extremely rare, their severity—often resulting in irreversible paraplegia—necessitates a thorough understanding of the anatomical and procedural risk factors. This review carefully examines the vascular anatomy of the lumbar intervertebral foramen, the distribution and risks associated with radiculomedullary arteries, and reported cases of severe complications related to lumbar TFESIs. Anatomical and radiological data indicate that radicular arteries are particularly rare below the L2–L3 level and are more common on the left side. The upper third of the intervertebral foramen, especially at T12–L3, is the most likely site of arterial involvement, raising concerns about the safety of traditional subpedicular approaches. Kambin's triangle appears to be a safer alternative, reducing arterial contact while still enabling effective drug delivery. The use of particulate corticosteroids, especially methylprednisolone and triamcinolone, is strongly associated with ischemic events owing to their larger particle sizes. Non‐particulate options such as dexamethasone are preferred, particularly at higher spinal levels. Although rare, venous punctures and hematomas require vigilance and careful steroid selection. Test doses of local anesthetics remain controversial and do not provide clear protective benefits. Current evidence indicates that adjusting techniques—including needle placement, imaging guidance, and corticosteroid choice—can help reduce risks while maintaining the effectiveness of lumbar TFESIs.

Anatomical education and research are built on the generosity of individuals who donate their bodies to advance science. However, the terminology traditionally used to describe these individuals—“specimens,” “cadavers,” or “cadaveric specimens”—risks objectifying the donor and obscuring their humanity. This paper examines the historical roots of depersonalized language, its persistence in contemporary research, and the ethical implications of its continuing use. Drawing on comparisons with the organ donation and transplantation literature and on calls within anatomy for reforming terminology, we propose humanizing alternatives such as “body donor,” “donor body,” or “anatomical donor.” The discussion emphasizes how terminology influences pedagogy, professional culture, and public trust in body donation programs. By embracing more respectful language, anatomists, surgeons, physicians, and dentists can better honor the gift of body donation and highlight the humanity of those who continue to teach us even after death, for example, Hic locus est ubi mors gaudet succurrere vitae .

The posterolateral region of the knee or so‐called posterolateral corner of the knee or posterolateral angle is an anatomical entity that remains relatively unknown. A clinical consensus relative to the evaluation, diagnosis and treatment of posterolateral corner injuries has recently been published. However, there are still knowledge gaps as to the precise anatomy and variability of all the structures that are part of this anatomical region. There is also paucity relative to their precise histological characteristics and their function. In addition, the nomenclature used in the literature for the posterolateral corner structures is sometimes confusing. A narrative review of the research focused on the posterolateral corner of the knee over the last hundred years was conducted. The main objective of this work was to synthesize and to bring order to the existing knowledge of the main ligamentous and tendinous components of the posterolateral corner of the knee. Twenty fresh‐frozen human knees from a body donor programme were dissected to obtain anatomical images from each one of the posterolateral corner structures. Currently, there is no consensus regarding the anatomical descriptions of some of the posterolateral corner structures. Their nomenclature is still confusing, and the anatomical descriptions are not sufficiently complete. However, the images taken of each of the posterolateral corner structures show their main morphological characteristics. This work will help to develop a common framework and a consensus on the anatomy of these structures. Currently, the lack of consensus relative to the anatomy of the posterolateral region of the knee makes it difficult to resolve issues around injuries to them, their diagnosis, and the treatment of these structures. Level of Evidence: N/A.

Nowadays, consent to use donor bodies for medical education and research is obtained from the body donors and their families before the donation. Recently, the International Federation of Associations of Anatomists (IFAA) published guidelines that could restrict the appearance of cadaveric images in commercial anatomical resources such as textbooks and other educational products. These guidelines state that the donor must expressly consent to using such images for this purpose. Cadaveric photos and drawings made from dissections of cadavers have been used in anatomy textbooks and atlases for hundreds of years. They are invaluable for anatomy students and clinical/surgical practitioners. The IFAA guidelines should not restrict the use of those older books; to do so would infringe the rights of those seeking knowledge from these resources. As the images in such textbooks and atlases are anonymized and are used for teaching and research, and the donors and their families are informed about this before the donation, we believe no additional consent is needed. It is impossible to separate educational from “commercial” usage entirely in any situation, e.g., publications from publishers and the use of cadavers in medical schools. Therefore, our best efforts to avoid unethical use of cadaveric images by following traditional consent processes are still needed so that more people will reap the benefits from them. As senior textbook/atlas authors/editors from over 10 countries, we believe that using cadaveric images in anatomy textbooks is appropriate, and no additional consent should be necessary. Such usage falls within the good faith of professionals using these invaluable gifts.

Applying existing sexing methodologies to different populations, and reporting these findings is important to enhance their applicability and accuracy in real cases across the world. DSP was published in 2005 (Murail et al., 2005) and updated as a DSP2 in 2017 (Brůžek et al., 2017) based on a database of 10 pelvic measurements from 2040 individuals worldwide. These tools have been applied subsequently to various populations, however, its applicability to a dry Spanish population is lacking. 303 hipbones belonging to 157 individuals from the School of Legal Medicine from the University Complutense of Madrid (Spain), of which 140 individuals were documented, were analyzed to investigate the reliability, applicability and accuracy of the DSP2 sex estimation methodology, examining side and sex-based potential differences for the first time. In most of the DSP variables, intra-rater reliability showed excellent results and % applicability was higher than 85.0%. Overall % accuracy was higher than 94.0% regardless of the number or discriminant power of the utilized DSP variables. However, % sexing decreased when less variables or less discriminant ones were used for estimations, reaching 45.51% (left) and 43.31% (right). Regarding sexual dimorphism, females’ results of % applicability, % sexing and % accuracy were higher compared to males. In addition, left os coxae achieved better outcomes (aforementioned percentages) in most of the cases in the sex-pooled sample. Decreasing the mandatory posterior probability by 10% yielded an increase in the % sexing but reduced % accuracy, and thus, does not seem to enhance the approach’s performance. The present study validates the applicability and reliability of DSP for sexing a Spanish population. Future investigations will attempt to assess its applicability within virtual anthropology.

In infectious meningitis, pathogens preferentially attack the leptomeninges (pia mater and arachnoid) rather than the pachymeninges (dura mater). This study aims to provide ultra‐anatomical insights from our extensive collection of electron microscopy images and propose mechanisms, highlighting structures that favor the introduction, adherence, colonization, and proliferation of microorganisms leading to spinal meningitis. Over several years, we analyzed an extensive collection of transmission and scanning electron microscopy images of human spinal meninges captured in our laboratories. Upon examining 378 of those images, we identified potential sites for the iatrogenic or hematogenic introduction and adherence of microorganisms, as well as sites for their colonization and proliferation. These included the outer surface of the spinal dural sac, structures within the epidural space, and the spinal dural sac itself, which comprises compact dura mater with interwoven collagen fibers and tightly bound arachnoid cells. Also, the subdural (extra‐arachnoid) compartment, consisting of fragile neurothelial cells prone to rupture under force, formed an acquired spinal subdural space, a new subarachnoid compartment, limited by arachnoid trabeculae, that surrounded the nerve roots and spinal cord and the pia mater. Macrophages, fibroblasts, mast cells, and plasma cells were also observed within the dura mater, arachnoid layer, arachnoid trabeculae, and pia mater. These images illustrate how the characteristics of the meningeal layers could contribute to bacterial adhesion and proliferation at various locations, inducing selective inflammation during (iatrogenic) spinal meningitis. In addition, the images help to explain why magnetic resonance imaging enhancement appears preferentially at specific sites.

Histological observation under light microscopy has long been used in human cadaveric studies. However, it can distort the interpretations of findings if not used appropriately; there is no guide for its proper use. The aim of this article is to revisit and discuss the correct use of histology in human cadaveric studies, following discussions with experts in multiple fields of medicine, and to create the first guide for such usage. We reached a consensus with the experts, agreeing that when this principle (structure, quantification, interaction, position: SQIP) is applied to histological observations, the findings will be interpreted correctly. Appropriate use of this recommendation can make human cadaveric studies more accurate and informative. This is the first histology guide for human cadaveric studies.

Personalization of learning is an educational strategy rooted in metacognition and is significant in academic training. This is especially true in medical contexts. This study explored the relationship between the metacognitive profile of students of human anatomy, the classification of questions according to their difficulty, and the anatomical domain. It also covered the integration of educational technologies to create personalized learning environments. The identification of metacognitive profiles (“Active”, “Pragmatic”, “Theoretical”, and “Reflective”) has been highlighted as a critical influence on students' responses to different pedagogical approaches. Personalized adaptation based on these profiles has shown potential for improving grades and increasing student satisfaction and engagement with learning. The results revealed variations in student performance in relation to different pedagogical approaches, learning units, and evaluation modalities. The “Experience” evaluation modality, personalized according to metacognitive profiles, level of competence, and learning objectives, resulted in higher average scores. However, there was significant variability in the results. Those findings confirm the effectiveness of metacognitive adaptation in improving academic performance. Furthermore, they provide a solid basis for formulating personalized and effective pedagogical strategies in medical education. They recognize the influence of metacognitive profiles on student performance and contribute to advancing medical pedagogy.