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Anatomy has been the cornerstone of medical education for centuries. However, given the advances in the Internet of Things, this landscape has been augmented in the past decade, shifting toward a greater focus on adopting digital technologies. Digital anatomy is emerging as a new discipline that represents an opportunity to embrace advances in digital health technologies and apply them to the domain of modern medical sciences. Notably, the use of augmented or mixed and virtual reality as well as mobile and platforms and 3D printing in modern anatomy has dramatically increased in the last 5 years. This review aims to outline the emerging area of digital anatomy and summarize opportunities and challenges for incorporating digital anatomy in medical science education and practices. Literature searches were performed using the PubMed, Embase, and MEDLINE bibliographic databases for research articles published between January 2005 and June 2021 (inclusive). Out of the 4650 articles, 651 (14%) were advanced to full-text screening and 77 (1.7%) were eligible for inclusion in the narrative review. We performed a Strength, Weakness, Opportunity, and Threat (SWOT) analysis to evaluate the role that digital anatomy plays in both the learning and teaching of medicine and health sciences as well as its practice. Digital anatomy has not only revolutionized undergraduate anatomy education via 3D reconstruction of the human body but is shifting the paradigm of pre- and vocational training for medical professionals via digital simulation, advancing health care. Importantly, it was noted that digital anatomy not only benefits in situ real time clinical practice but also has many advantages for learning and teaching clinicians at multiple levels. Using the SWOT analysis, we described strengths and opportunities that together serve to underscore the benefits of embracing digital anatomy, in particular the areas for collaboration and medical advances. The SWOT analysis also identified a few weaknesses associated with digital anatomy, which are primarily related to the fact that the current reach and range of applications for digital anatomy are very limited owing to its nascent nature. Furthermore, threats are limited to technical aspects such as hardware and software issues. This review highlights the advances in digital health and Health 4.0 in key areas of digital anatomy analytics. The continuous evolution of digital technologies will increase their ability to reinforce anatomy knowledge and advance clinical practice. However, digital anatomy education should not be viewed as a simple technical conversion and needs an explicit pedagogical framework. This review will be a valuable asset for educators and researchers to incorporate digital anatomy into the learning and teaching of medical sciences and their practice.

An improved quantitative science would emphasize the use of confidence intervals (CIs), and especially CIs for effect sizes. This article reviews some definitions and issues related to developing these intervals. Confidence intervals for effect sizes are especially valuable because they facilitate meta-analytic thinking and the interpretation of intervals via comparison with the effect intervals from related prior studies. Several recommendations for the thoughtful use of such CIs are presented.

Physical activity is important for the control of high blood pressure (hypertension). We aimed to investigate the associations of current physical activity levels, sedentary time, knowledge of and attitude towards physical activity with blood pressure in people with hypertension in a rural area in Bangladesh. A total of 307 adults aged 30 to 75 years with hypertension were recruited from the Banshgram Union of Narial district as part of a cluster-randomized control trial. Current blood pressure was measured as the outcome variable. Associated variables included physical activity at work, travel to and from places, recreational activity, metabolic equivalent task (MET)-min, sedentary time, and awareness of and attitudes towards physical activity. Rasch analysis was used to compute a combined score from the five awareness of and attitudes towards physical activity items and categorized into 0-40 (towards negative attitude), 41-60 score (mixed attitude) and 61-100 (positive attitude). We used a generalised linear model to analyze the data. Participants (n = 68, 22.1%) who engaged in vigorous-intensity physical activity that causes large increases in breathing or heart rate like carrying or lifting heavy loads, digging or construction work for at least 10 minutes continuously had lower systolic blood pressure (SBP) (mean (95% confidence interval (CI)), 143.6 (140.1, 147.2)) compared to those who did not take part in a vigorous-intensity physical activity (mean (95% CI), 150 (147.6, 152.3)). MET-min less than 600 min/week was significantly associated with higher SBP 153.8 (148.1, 159.6) than MET-min 600-2999 min/week 148.0 (143.0, 152.9) and MET-min>3000 min/week 146.9 (144.5, 149.3), p = 0.001 for trend. Sitting time more than four hours a day was associated with higher DBP 91.4 (89.7, 93.0) compared to those who had sitting time less than fours a day 88.6 (87.1, 90.1). People with positive attitudes were associated with a reduced SBP of 10.6 (0.36, 20.8) mmHg and DBP 5.88 (0.47, 11.3) compared to the people who had a negative attitude towards taking part in physical activity. Participating in high physical activity and positive attitudes towards physical activity were associated with lower blood pressure levels. Physical activity awareness programs should be implemented to increase awareness of health benefits and increase participation in high physical activity.

The burden of chronic obstructive pulmonary disease (COPD) is increasing, yet there are limited data on early life risk factors. To investigate the role of childhood lung function in adult COPD phenotypes. Prebronchodilator spirometry was performed for a cohort of 7-year-old Tasmanian children (n = 8,583) in 1968 who were resurveyed at 45 years, and a selected subsample (n = 1,389) underwent prebronchodilator and post-bronchodilator spirometry. For this analysis, COPD was spirometrically defined as a post-bronchodilator FEV /FVC less than the lower limit of normal. Asthma-COPD overlap syndrome (ACOS) was defined as the coexistence of both COPD and current asthma. Associations between childhood lung function and asthma/COPD/ACOS were examined using multinomial regression. At 45 years, 959 participants had neither current asthma nor COPD (unaffected), 269 had current asthma alone, 59 had COPD alone, and 68 had ACOS. The reweighted prevalence of asthma alone was 13.5%, COPD alone 4.1%, and ACOS 2.9%. The lowest quartile of FEV at 7 years was associated with ACOS (odds ratio, 2.93; 95% confidence interval, 1.32-6.52), but not COPD or asthma alone. The lowest quartile of FEV /FVC ratio at 7 years was associated with ACOS (odds ratio, 16.3; 95% confidence interval, 4.7-55.9) and COPD (odds ratio, 5.76; 95% confidence interval, 1.9-17.4), but not asthma alone. Being in the lowest quartile for lung function at age 7 may have long-term consequences for the development of COPD and ACOS by middle age. Screening of lung function in school age children may identify a high-risk group that could be targeted for intervention. Further research is needed to understand possible modifiers of these associations and develop interventions for children with impaired lung function.

The beating heart is known to produce pressure and airflow oscillations in the lungs of mammals. This phenomenon is often disregarded as detailed measurement of its effects in the lung have hitherto not been possible. Previous studies have attempted to measure the effect of these oscillations on gas mixing. However, the results have proven inconclusive, due to the lack of a direct measurement tool capable of flow measurement throughout the entire bronchial tree. Here we present the first detailed measurement of cardiogenic oscillations, using synchrotron-based dynamic lung imaging of live mechanically ventilated mice. The results demonstrate large flow oscillations and pendelluft in the airways due to the mechanical action of the beating heart. Using a virtual tracer modelling analysis we show that cardiogenic oscillations produced up to 4 times increased gas mixing, but only in the absence of tidal ventilation. The results highlight the importance of considering this often-disregarded phenomenon when investigating lung function, particularly in situations where tidal ventilation is reduced or absent.

Respiratory diseases are leading causes of death and disability in the world. While early diagnosis is key, this has proven difficult due to the lack of sensitive and non-invasive tools. Computed tomography is regarded as the gold standard for structural lung imaging but lacks functional information and involves significant radiation exposure. Lung magnetic resonance imaging (MRI) has historically been challenging due to its short T2 and low proton density. Hyperpolarised gas MRI is an emerging technique that is able to overcome these difficulties, permitting the functional and microstructural evaluation of the lung. Other novel imaging techniques such as fluorinated gas MRI, oxygen-enhanced MRI, Fourier decomposition MRI and phase-resolved functional lung imaging can also be used to interrogate lung function though they are currently at varying stages of development. This article provides a clinically focused review of these contrast and non-contrast MR imaging techniques and their current applications in lung disease.

Rationale Bronchial thermoplasty (BT) is a treatment option for patients with severe asthma. Despite demonstrated sustained symptomatic benefits, its mechanism of action remains unclear, with emerging evidence suggesting a reduction in ventilation heterogeneity. Objective This study aims to determine if BT reduces ventilation heterogeneity as measured by phase-resolved function lung magnetic resonance imaging (PREFUL MRI). Methods Twenty-one patients with severe asthma and 14 healthy volunteers (HV) were recruited. Patients were assessed at baseline and 6-months after BT. Data collected included asthma control questionnaire (ACQ-5), exacerbation frequency, and short-acting beta-agonist (SABA) and oral corticosteroid (OCS) use. Both HV and patients also underwent lung function tests and PREFUL MRI. Ventilation heterogeneity was assessed using ventilation defect percentage (VDP) of static regional ventilation (RVent) and dynamic flow-volume loop cross-correlation metric (FVL-CM), and interquartile distance (IQD) of the ventilation distribution. Results At baseline, patients had a significantly higher RVent VDP (20.0 ± 14.5 vs 3.8 ± 2.2%, p  < 0.001), FVL-CM VDP (23.7 ± 17.8 vs 2.4 ± 2.3%, p  < 0.001), and IQD (0.61 ± 0.27 vs 0.32 ± 0.05, p  < 0.001) than HV. Post BT, significant reductions in RVent VDP (15.5 ± 11.7 vs 20.0 ± 14.5%, p  < 0.001), FVL-CM VDP (18.7 ± 13.9 vs 23.7 ± 17.8%, p  < 0.001), and IQD (0.53 ± 0.22 vs 0.61 ± 0.27, p  < 0.001) were observed in patients, along with significant improvements in ACQ-5, exacerbation frequency, SABA and OCS use. No change in lung function was seen. Significant correlations were observed between ΔACQ and ΔRVent VDP (ρ = 0.50, p  = 0.02), ΔFVL-CM VDP (ρ = 0.51, p  = 0.02), and ΔIQD (ρ = 0.45, p  = 0.04). Conclusions Clinical benefits post BT are accompanied by a reduction in ventilation heterogeneity that are undetected by lung function test. These findings provide valuable insights into the mechanisms of action of BT and highlight the complementary role of functional lung imaging in the study of pulmonary diseases for which traditional lung function tests may be insensitive at detecting therapeutic response.

Concurrent advances in imaging, particularly the use of hyperpolarized 129Xe and 3He gases as contrast media for functional magnetic resonance imaging (MRI), have facilitated the measurement of distal lung ventilation reflecting small-airways disease (6). The results show that MRI ventilation defects improved with salbutamol inhalation, indicating an airway smooth-muscle response as previously described (9), and this was observed in all patients irrespective of whether or not they had higher levels of sputum eosinophils. The interpretation is that the dynamic response in ventilation defects results from improved airflow with airway smooth-muscle relaxation, but persistent luminal obstruction is due to other factors such as cellular debris, edema, and mucus associated with uncontrolled airway inflammation. [...]although the persistence of ventilation defects due to the aforementioned factors associated with uncontrolled airway inflammation may lead to persistent airway luminal obstruction, other factors, such as airway remodeling, bronchiectasis, and atelectasis, may also contribute.