A cerebral gyrus is made up of an external layer of folded cortex and an inner core of white matter. The architecture of the core has specific features that make it distinct from the white matter of the deep brain regions. Limited externally by the grey matter that covers the top of the gyrus and the neighbouring sulci, this gyral white matter is made up of a mix of fibre populations with multiple directions and destinations. The presence of densely packed fibres with multiple crossings, the proximity to the cortex and the existence of inter-regional and inter-individual variations make the task of depicting this microanatomy extremely challenging. The topic is, however, of paramount relevance for both fundamental and applied neurosciences. This fibre colocalization is crucial for the functional role of each cerebral region and is key to clinical manifestations in cases of parenchymal damage. As track tracing, imaging and dissection are based on different biological or physical principles, it is natural for their results to sometimes be different, but they are often complementary. As the amount of available information increases, it becomes fragmented due to the multiplicity of methods, target phenomena and studied species. In this scoping review, we present the key concepts and map the primary sources of evidence regarding identifying the fibre pathways that compose the gyral white matter, enabling the discussion of avenues for future research. The general pattern in which these pathways are distributed in the gyral white matter was detailed, and the main variations as a function of brain topography were explained and illustrated with typical examples. et al. review the organization of gyral white matter, consisting of superimposed strata of association and striatal fibres surrounding a core of commissural and projection fibres. The proportion of each fibre type varies across brain gyri, relating to the functional role of each site.Dannhoff   The architecture of the core has specific features that make it distinct from the white matter of the deep brain regions. Limited externally by the grey matter that covers the top of the gyrus and the neighbouring sulci, this gyral white matter (GWM) is made up of a mix of fibre populations with multiple directions and destinations. Short ‘U’ association and longer association, projection and commissural fibres are combined in variable proportions and reflect the specificities of each brain area.3-5Significant methodological difficulties have hindered the in-depth study of this microanatomy. Among the main ones is the apparently homogeneous character of the white matter, which is usually depicted as amorphous by conventional anatomical or neuroimaging techniques. Moreover, the presence of densely packed fibres with multiple crossings, the proximity to the cortex and inter-regional and inter-individual variations make the task extremely challenging.7The topic is, however, of paramount relevance for both fundamental and applied neurosciences. The aforementioned fibre colocalization is crucial for the functional role of each cerebral region in the context of the connectome and is key to the clinical manifestations in cases of parenchymal damage. For instance, the signs and symptoms of a stroke very frequently result from lesions that concern both the cortex and the underlying white matter. In the field of neuro-oncology, white matter architecture has been acknowledged as a significant influencer on the direction of tumour infiltration in cerebral gliomas.in vivo or ex vivo.8 In short, the main technical feature sought is the ability of the method to demonstrate tissue architecture on a scale that allows the acquisition of 3D data sets in large specimens (or the whole brain) but still depicts tiny white matter bundles. When this approach is insufficient, higher-resolution microscopic techniques may be applied to answer specific questions.Untangling the anatomy of the GWM is, therefore, a research endeavour of great importance but difficult to access. Histology does not solve the problem since it shows the myriad of fibres but does not allow the operator to place them efficiently in the connectome. Among the recent efforts to decipher the subcortical white matter, the so-called mesoscopic techniques stand out, whether 2 In human anatomy, fibre dissection gained much popularity and was combined with the surgical microscope.9 In in vivo imaging, both the acquisition and post-treatment of diffusion-weighted magnetic resonance images underwent significant advances, among which we can mention the increased magnetic field strength, diffusion gradient and angular resolution. In ex vivo imaging, the possibility of performing a prolonged acquisition opened a new avenue for future research, such as in the development of sequences, and significantly promoted the imaging of smaller structures.We have witnessed important technical advances in this line in the last three decades. Some may contribute to depicting the connective identity of brain areas in the midterm, but they are scattered across varied research fields. In non-human primates, radioisotope tracking and autoradiography have allowed important insights and have been in favour of a relatively consistent organization of the GWM for a given cerebral location.The present paper is an effort to summarize this multi-source and sparse material on the GWM. Since track tracing, imaging and dissection are based on different biological or physical principles, it is natural for their results to differ in some aspects, but they are complementary. As the amount of information increases, it is fragmented due to the multiplicity of methods, target phenomena and studied species. Therefore, critical interpretation of new information is necessary and requires both neuroscientific and methodological knowledge.In this scoping review, we present the key concepts and map the primary sources of evidence regarding identifying the fibre pathways that compose the GWM, enabling the discussion of avenues for future research.10 The following descriptors were used: [architecture (title) OR anatomy (title) OR structure (title) OR morphology (title) AND (‘white matter’ OR fiber OR fibers) AND (gyrus OR gyri)]. Seminal publications on the topic were manually included regardless of whether they existed in the aforementioned databases. Publications that focused on the pathological aspects only, without any information on normal fibre anatomy, were excluded. For data synthesis, the authors used a shared computerized database with the publications retrieved and online documents, whose editions were discussed through regular  meetings.A search was performed using MEDLINE/PubMed, Embase and Web of Science databases to identify articles in English on the structure of the white matter of the cerebral gyri in humans or non-human primates without restrictions related to publication date. A review protocol was drawn according to the Preferred reporting items for systematic reviews and meta-analyses statement for scoping reviews.As this review paper did not involve the collection or analysis of primary data from human subjects or animals, ethical assessment from an institutional review board was not applicable.The initial search produced 596 different records after duplicates were removed. After analysing the titles and abstracts, we excluded 494 articles because they did not correspond to the study proposal, or they were not retrieved because they corresponded to referencing errors in the databases or were incompletely published. After examining the full texts of the 102 retrieved publications, we excluded 62 works that did not correspond to the study proposal. Another 33 documents were manually included after examination of reference lists and other sources, given their relevance to the topic. Finally, 73 publications were included in the review .The existing body of literature shows that the organization of the GWM is not homogeneous. Although a general pattern is acknowledged and applicable to most cerebral gyri, variations exist concerning the relative composition of terminations of projection, association or commissural fibres, even among regions of the same lobe. The following sections present these general aspects of the GWM organization, followed later by the particularities encountered in different brain regions.2 A general arrangement is observed, with the relative position of fibres within the GWM being significantly associated with the group to which they belong.Six layers and a fine myeloarchitectural network make up the grey matter of the neocortex. These layers establish simultaneous connections with a great variety of sites, including adjacent or distant gyri and even more distant centres in the neuraxis, such as the thalamus, basal ganglia, brainstem or spinal cord.Autoradiographic studies using radiolabeled tracers in non-human primates have revealed details of this relationship between anatomical position in the GWM and the nature of the connection with the other parts of the brain . A first2According to the results of autoradiography, a second group comprises striatal fibres, which travel deeper than the association ones when they penetrate the base of the GWM. As they advance from the base to more superficial areas of the gyrus, significant intermingling (with the association fibres) is seen. These pathways connect the caudate nucleus, putamen and claustrum. A third group lies in the central axis of the GWM in the form of a well-defined core containing commissural and projection fibres that travel from and to deep regions of the cerebral hemisphere and beyond. In this subset, projections to the thalamus, brain stem and spinal cord are observed. Because of its central location, this group has been referred to in autoradiography studies as ‘the cord fibers’.11-13 allows precise dissection of WM tracts rendered macroscopically discernable. In terms of the disposition of association fibres, the results of fibre dissection studies agree with those of autoradiography: short U fibres lie superficially to longer ones, and regional association fibres tend to get progressively longer as the operator advances to the depth.14-19 The short ‘U’ association fibre terminations seem more abundant at the top of the gyri than in their bases or the cortex of the adjacent sulci.18 This arrangement continues until a large fasciculus is reached .20Taking advantage of the effects of water crystallization through one or more freeze–thaw cycles, Klingler’s technique21-25 temporal,27 parietal,28-30 and occipital lobe.31-33 Other works focused on topographical white matter aspects in defined regions of interest34-38 and bordering a surgical corridor40 or described the detailed anatomy of a specific tract with some topographic information.41-47 These studies give a global overview of the fasciculi converging to a given gyrus, but the intragyral organization of the elicited tracts is usually not depicted due to either methodological difficulties or the fact that the topic was not the subject of study.A few studies based on fibre dissection have taken an interest in depicting white matter connections converging in a specific gyrus in various regions of the human brain. These works brought valuable insights regarding fibres that are expected to be found within specific gyri within the frontal,18A significant contribution of fibre dissection is the capability to study the 3D shape of subcortical white matter after removing the cortical grey matter, which is rendered brittle by the preparation. The same applies to more complex structures that result from the convergence of fibre bundles. That is the case of the so-called ‘pyramid shape crossings’ , resultiet al.18 detailed this arrangement using fibre dissection and highlighted the importance of exhuming the intragyral U fibres. The authors describe three types of junction areas according to their shape: three-way junctions, wide plate-like junctions and small ridge junctions. While intergyral U fibres pave the sulcal floors, intragyral U fibres are closer to the top of the gyrus and lie within the same white matter ridge. In the ridge junction areas, packages of intra- and intergyral U fibres converge at common sites, forming pyramidal shapes inside the GWM. Based on their trajectories and terminations, two general types of intergyral U fibres are possible, depending on whether they connect these convergence sites. This tridimensional organization of short association fibres combined with longer tracts colocated beneath one given gyrus gives rise to complex structures. These structures have been modelled by Catani et al.49 in the motor hand-knob region as a ‘poppy flower’ shape, with layers of U fibres diverging from the pyramidal core being analogous to the flower’s petals and the central cord fibres being analogous to its stem.After removing the cortex, the exposed GWM takes the form of ridges that reproduce the gyral anatomy of the brain. Shinohara in vivo exploration of WM anatomy, diffusion-weighted imaging allows tractography to be performed via various algorithms. MRI tractography can confront anatomical data in humans with those of autoradiography in monkeys,50 and refine understanding of complex fibre tracts anatomy.51 To establish clear parcellation and systematic labelling, Oishi et al.48 used axonal fibre alignment information from diffusion tensor imaging to delineate the peripheral white matter, considering its relationships with the cortex and the deep white matter. The authors used the population-averaged tensor map to identify common features across subjects. The concept of a blade-like morphological unit (or simply ‘blade’) was proposed.48 Nine such large units were identified, which were further parcellated into 21 subregions based on the cortical anatomy. The subparcellated regions in each blade have been referred to as ‘gyrus name WM’. Four large groups of intergyral U fibres were described as central for interblade connections and identified as frontal , frontocentral , central  and parietal . Another study on comparative anatomy from the same group suggested that the U fibres interconnecting the superior parietal to the occipital blade are present in humans but not in the macaque brain.52Regarding 53-55The general pattern described above varies with the topography of the studied gyrus. The main situations and those for which evidence from the literature is available are described below. The study of the short association bundles formed by clusters of U-shaped fibres with diffusion imaging is a field that has notably developed in recent years and provides a clear illustration of how the organization of superficial white matter is prone to intra- and inter-individual variations. Numerous surface bundles, ranging from 29 to 50 per hemisphere, have recently been described in an ongoing effort to systematize.56 and axonal tension-based theories either pushing out or pulling in.57 Besides the logical role of cortical expansion leading to folding, the role of axonal wiring in determining cortical folding is likely. It has been demonstrated that the maximum density of axonal fibres in humans and non-human primates is found in the gyral region compared to the sulci,5 which is concordant with most observations in fibre dissection and diffusion imaging. Moreover, the complexity of the gyri’s connections has been significantly linked with fibre densities, as three-hinge gyri show much higher fibre densities than two-hinge gyri.58 These findings suggest a potential role for fibre connections as an inducing factor in gyrification schemes, underscoring the close relationship between surface anatomy variations and underlying white matter structure.Among the current hypotheses regarding cerebral gyrification are the differential growth of cortical regions 60 a major factor for local variations of GWM. Examining data sets of 90 subjects from the Human Connectome Project, Bodin et al.63 identified plis de passage linking adjacent gyri, formerly described by Gratiolet and Broca, as cortical landmarks62 associated with regions of accrued short-range connectivity. Bajada et al.,64 studying fibre length profiles, demonstrated a concentration of shorter fibres (<40 mm) in primary cortices, notably the somatomotor cortex.Short-range connectivity is particularly relevant when taking an interest in the morphology of GWM, as it represents around 60% of total white matter volume,65 In the central region, pre-central and post-central GWM blades are linked by U fibres for their entire length.52 This consistent line of U-shaped fibres is situated between two large contingents of projection fibres that belong to the corticospinal tract anteriorly and to the thalamic radiations of the ventral posterolateral nucleus of the thalamus posteriorly.As a factor that may impact the understanding of short-range connections, variation in the brain’s gyrification pattern must be taken into account, which prevents conclusions from being drawn from isolated cases and imposes the study of many subjects. For this reason, some cerebral regions are more susceptible to this type of assessment than others. The central sulcus is almost always continuous and relatively deep, leading to lower structural inter-subject variability in motor areas.49 This short fibre connective system linking pre-central and post-central gyri might modulate the clinical outcome following subcortical stroke, a concept associated with variations in the shape of the central sulcus,67 which is itself directly correlated with U-shaped fibre anatomy. Some correlations between morphological landmarks and function localization were proposed in line with these theories. That is the case of the pli de passage moyen described by Broca, which has been associated with accrued short-range connectivity between the hand motor activation and the hand sensory regions.69 The association between manual dexterity and the structural features of these bundles in the hand area indicates their potential role in fine motor control.70 In pathological conditions, one could finally easily infer, in the light of these descriptions, how the clinical signs of a Jacksonian seizure would progress along this superficial network of the somatomotor region, as already suggested in early anatomical works.71Unraveling local variations of the GWM organization also brings valuable insights into the functional specificities of a given region. Such inferences are greatly illustrated by pre- and post-central gyri—the terminations of prominent projection fasciculi—where U-shaped fibres adopt the functional arrangement of Penfield’s homunculus.et al.72 identified five major bundles crossing the central sulcus in both the left and right hemispheres. In accordance with previous descriptions, the authors described a consistent organization of these bundles according to the somatotopy of the central region: one bundle for the tongue , three for the hand and one for the foot region .73 Precise systematization of this anatomy, however, has been prone to discussion, with a possible subdivision of the ventral interconnections in two subbundles,49 as a possible interindividual variation.72 Furthermore, variations in the position of each bundle may be related to functional aspects. In this line, a dorsal translation of the hand bundle has been suggested to be associated with handedness.74Using diffusion imaging and a technique called unsupervised clustering, Pron 75 Moreover, these fibres support communication between streams within the visual system, namely, the dorsal ‘where’ recently renamed ‘how’ pathway76-78 and the ventral ‘what’ pathway. Focal damage to these white matter pathways may lead to selective impairments of the complex visual processing such as the associative visual agnosia defined by Lissauer.79Another example of a consistent anatomical relationship between adjacent projection and short association fibres with functional implications is that observed in the primary visual cortex. The medial occipital lobe, made of the cuneus and lingual gyrus, is implicated in visual processing. These gyri show a large contingent of short association fibres around the calcarine fissure, namely, the stratum calcarinum of Sachs, which is likely to be a key structure in transmission from primary visual areas to associative areas.80 More superficially, short association fibres are observed and follow the sulcogyral anatomy of the insula and the inner opercular surface .73A particular case is that of the superficial white matter around the lateral (Sylvian) fissure. The extreme capsule ensures continuity between the subcortical opercular white matter and that of the insula, an arrangement similar to that of the subcortical white matter around the shallower sulci on the brain surface. Operculo-opercular connections through the extreme capsule have been characterized in the Rhesus monkey thanks to autoradiography. A clearly continuous layer of white matter extending from the extreme capsule to both opercula and vice versa is observed in human dissection and neuroimaging studies, even if the actual content of opercula–opercular pathways is not detailed.The GWM arrangement in the insula is marked by accrued short-range connectivity. Being the insula situated at the depth of the Sylvian fissure, this organization rich in short insulo-insular tracts is completed by insulo-opercular connections. The frontoparietal and temporal opercula are regions of prominent association fibre, bearing the colocalization of U-fibres and converging and passing long fibres, primarily concentrated in the language network. As a result, the frontal operculum concentrates short association fibres originating in the pre-central gyrus, middle frontal gyrus and upper anterior insula. This short-range connectivity is reinforced by the intralobar frontal aslant tract and by the anterior terminations of the SLF-III, itself a part of the SLF/AF complex. The role of the insula in language production is still a matter of debate but may result more from this particular connectional position than from a dedicated cortical role.82 The general aspect of the core white matter is then that of a compact longitudinal fasciculus, although it actually comprises several subcomponents with different terminations and functions and an important contingent of diencephalic projections to the limbic lobe. U fibres surround this core, connecting the cingulate cortex with the orbitofrontal, prefrontal, parietal and temporal cortices, but are absent in the portions where the cingulum makes direct contact with the corpus callosum without the interposition of the cerebral cortex. Abnormality in the morphology of these U fibres has been implicated in neuropsychiatric disorders such as autism spectrum disorders.83 Such prominence of longitudinal fibres in the GWM is observed to varying extents in other locations, such as the anterior portion of the parahippocampal gyrus ,33 and the limen insulae .A particular variant of the GWM arrangement is the prominence of longitudinal long-association fibres inside the GWM. The component of projection and commissural fibres is consequently smaller. The cingulate gyrus, part of the limbic lobe, is the most typical example. It is implicated in a wide range of functions, such as memory, emotion, motivation, higher cognition and motor control. The cingulum bundle runs longitudinally within this gyrus, providing multiple interconnections to areas located inside or outside the limbic lobe.corona radiata and dorsal callosal radiations in those regions forms a compact central scaffolding with a vertical orientation. Although these two components are intermingled, both diffusion imaging and fibre dissection agree that projection fibres predominate laterally and commissural callosal fibres medially. Short and regional association fibres are abundant on either side of this barrier. Some diffusion imaging and autoradiography studies favoured a robust long longitudinal fasciculus crossing all of these gyri. This arrangement has been the subject of debate in fibre dissection and other diffusion imaging studies in humans regarding both its appearance and exact path.85 Long longitudinal pathways have been, however, demonstrated in a more ventral (cingular or paracingular) location.87An almost opposite arrangement is observed along the upper border of the cerebral hemisphere. That is the case for the superior frontal, pre-central and post-central gyri (superior extremity), paracentral lobule and superior portion of the precuneus. The robustness of the contingent of projection and commissural fibres originating from the ex vivo high-field magnetic resonance imaging, are promising, but studies employing these techniques in the superficial white matter are still scarce. The lack of precise anatomical descriptions and the lack of systematization of GWM in humans contrast sharply with the topic’s functional relevance and potential clinical applications.In the present study, we performed a scoping review to identify key concepts and current sources of evidence regarding the architecture of GWM in humans and non-human primates so that avenues for future research can be discussed. Historically, two fundamental techniques have allowed studies of the composition of GWM: autoradiography in non-human primates and fibre dissection in humans. Emerging mesoscopic techniques, such as plis de passage); (iii) presence of anatomically evident intragyral short association bundles. In these situations, the general pattern can be absent on one or both banks of the gyrus. In an effort to synthesize this information, we propose a classification of the human GWM structure based on these patterns, which is detailed in A general pattern for the organization of the GWM has been proposed based mainly in autoradiography data from the Rhesus monkey brain. This pattern is, however, subject to variations in the proportion of the different GWM subcomponents . In the human telencephalon, more drastic changes may be observed related to one or more of the three following phenomena: (i) prominence of one or two subcomponents, (ii) convergence of short association bundles  in which in vivo or ex vivo MRI data sets could be compared to the results of fibre dissection. With the help of a surface laser scanner, which is applied iteratively to the cerebral specimen after each dissection step, the operator can follow, manually segment and reconstruct the dissected white matter tracts in the reference space of the MRI. This method allows the comparison of dissection to in vivo and ex vivo tractography. Since it requires optimal exposition of the target area to the surface scanner, the depth of the sulci and the secondary gyri are less accessible to this technology.The great reliance, simplicity and applicability of fibre dissection in the study of the 3D anatomy of the brain led it to be designated by some authors as the gold standard of white matter study from an anatomical perspective. Though of great morphological interest, this technique has the disadvantage of being destructive. Hence, each dissection step deprives the operator of a quantity of information from the previous step. Moreover, aggressive dissection—especially when metallic microinstruments are used—can generate spurious tracts delivering artifactual anatomical data. These limitations are particularly strong regarding the GWM, as it may have been injured during the first dissection steps. Indeed, superficial fibres are often sacrificed hastily in order to quickly shift the focus to more obvious deep tracts in most anatomical papers. Some authors have proposed digitization techniques enabling the storage of 3D data from dissection, allowing the possibility to easily ‘look behind’ and contextualize dissection in light of the superficial layers. In 2014, Zemmoura in vivo.90 However, since the method is indirect, it has some limitations, especially near the crossings and the cerebral cortex.91 Performing accurate tractography can be challenging in both situations, as the anisotropy fraction is typically reduced. Moreover, classical deterministic tractography based on diffusion tensor imaging can be considered reductionist since it identifies one preferential direction of diffusion inside a relatively large portion of space (the voxel), which may contain different populations of fibres.Diffusion-weighted imaging provides non-invasive access to structural connectivity 92 Q-ball imaging94 and generalized q-sampling imaging95 are among the main approaches in this group, which are also particularly relevant in pathological conditions exhibiting complex diffusion patterns.91 Spherical deconvolution methods97 benefit from deconvolution kernels to resolve fibre orientations, bearing a high potential for addressing crossing fibers.98 In all cases, however, fibre anatomy is deduced as a function of diffusion directions and indirect character that, added to the complexity of the tissue weave, claims for validation studies against ground truth anatomical data.Several mathematical models have been proposed to overcome this limitation in the last two decades. Some model different fibre populations within the same voxel, estimating orientation distribution functions and enabling better mapping of crossing fibers.ex vivo MRI has some advantages over in vivo MRI. Ex vivo ultra-high-field MRI combines ultra-powerful gradients (11.7 T) with virtually unlimited acquisition time and the absence of physiological, motion or thermal noise. This technique can produce T2-weighted and diffusion-weighted images in mesoscopic resolution, as high as 100 µm of voxel size or smaller. This increase in resolution makes it possible to discern less visible structures in clinical imaging, but they do not present with the same signal as in vivo MRI. There are several reasons for this change, the main one being that the anatomical specimen is generally fixed in formalin, which modifies (reduces) relaxation times. To overcome these concerns, the interest in stronger magnetic fields in ex vivo imaging is undeniable.In the detailed study of brain anatomy, et al. in 1991 to study the eye. In recent years, it has been applied to rodent and human brains. This imaging technique relies on the optical properties of the tissues—mainly fibres and neurons—and has a resolution of a few micrometers. The images exhibit excellent contrast, reliably differentiating cortical layers, nuclei and tracts. Since optical coherence tomography can only probe a few hundred microns in depth, Magnain et al.99 suggested coupling the system to a vibratome to allow for iterative acquisition.Recent microscopic methods that are not (or less) applicable to the study of the whole brain are promising for investigating specific questions, especially in complex regions or those for which the techniques mentioned above were deemed insufficient. That is the case with optical coherence tomography, a method developed by Fujimoto 3 in a few hours. The sample is illuminated with a thin light sheet, and the fluorescence emission is collected along a perpendicular axis. It confines the excitation light to the focal plane, allowing optical sectioning and imaging with cellular resolution. To obtain a good reconstruction, light-sheet microscopy requires the sample to be transparent or coupled with clearing procedures. The SWITCH immunostaining technique with the refractive index matching medium TDE  was recently combined with light-sheet microscopy, obtaining an efficient method for larger volumes of human brain parenchyma, an advance that creates the possibility of studying the 3D architecture of a tissue fragment, including fibre bundles within their natural environment.101Light-sheet microscopy is another promising tool for reconstructing the 3D architecture with micron-scale resolution. This approach allows for the 3D mapping of the neuronal organization of a slab of 10 × 10 × 0.05 cm103 3D-PLI does not require staining or labelling because it uses an intrinsic tissue property, birefringence, to modify the polarization state of the light. 3D-PLI capitalizes on the birefringence of myelinated and unmyelinated fibres, determining their spatial orientation at microscopic resolution. Based on the non-linear registration of serial fibre orientation images, virtual 3D models of fibre structures are created. As a microscopic (and not mesoscopic) technique, 3D-PLI resolution is exceptionally high, which generates large data sets. It is currently appropriate for the study of tissue samples but less suitable for the whole length of a long fasciculus or an entire human brain. It comes up against the availability of these methods, such as brain optical coherence tomography and light sheet microscopy, which are limited to a small number of expert centres.3D-polarized light imaging (3D-PLI) is another neuroimaging technique that has opened up new avenues to study fibres in post-mortem brains.104-106 Abnormalities in superficial connectivity have been described in schizophrenic patients, ranging from functional alterations107 to focal structural differences, such as an increased density in specific brain regions.109 Short-range connectivity abnormalities have been identified in patients affected by autism spectrum disorder as well, notably as a potential correlate of social deficits.110As the organization of the GWM is a reflection of a gyrus role in the brain circuitry, it has immediate clinical applications, ranging from understanding mechanisms at stake in normal aging to identifying abnormal connectivity or even clarifying plasticity mechanisms. Pathways for future research in these domains are numerous. Some psychiatric syndromes have been correlated with alterations of the superficial white matter network, particularly those linked to emotion regulation in bipolar disorder.111 and as a marker of neurodegenerative disorders such as Huntington’s disease and in the asymptomatic phase.112 Extensive damage to the superficial white matter has been identified in patients suffering from auto-immune encephalitis with incomplete cognitive recovery.113 The characterization of the GWM could thus lead to a better understanding of the functions at stake and the identification of preclinical markers.Several clinical and radiological observations suggest a role for superficial white matter in cognitive processes. Alterations of superficial white matter have been associated with cognitive decline in aging patients114-116 Historically, the scarcity of anatomical data has regrettably led most neurosurgeons to plan cortical incisions without considering superficial fibres. A better understanding of the complex GWM anatomy could lead to a rethinking of trans-parenchymal approaches and tailor cortical incisions to maintain the integrity of both superficial and deep white matter pathways117 and favour neuroplasticity mechanisms.Thanks to recent advances in unraveling brain connectomics, understanding white matter functional anatomy has become mandatory for the modern brain surgeon in order to optimize surgical approaches, bearing in mind a ‘zero-footprint’ ideal.The advent of increasingly complex structural connectivity models—though scientifically appealing—may hinder accessibility and applicability in everyday practice. Since it is paramount for clinicians and researchers to remain able to maintain a mental picture of the white matter anatomy, our graphical classification of GWM is a convenient way to approach structural connectivity from a topographic perspective. As clinicians commonly deal with superficial brain landmarks in day-to-day practice, this classification is intended to provide a simple representation of the general macroscopic organization of the underlying structural connectivity, which can be used in many contexts. Among the main examples is the planning of surgical approaches to the cerebral parenchyma and the understanding of main pathways at play in a pathological process affecting a gyrus.Although the present work broadly addresses the under-evaluated subject of GWM, it has some limitations. It suffered from the paucity of robust data currently available in the literature. Many papers included in the present study were not aimed directly at describing GWM but did contain important information. This status as an indirect subject can lead to more difficulty in detecting hidden information. For this reason, the research equation included a wide range of terms to screen as many articles as possible. The abstracts and contents of the selected articles were carefully screened, and references were checked to target any significant contribution. Being the first review on this topic, one of its strengths is its interdisciplinary character that favours cross-fertilization of the results obtained with different research techniques.According to the results of the present review, the gyri of the human brain are key topographical arrangements of the convergence of white matter tracts, with a common overall organization that appears similar to that of non-human primates. However, current data already point out the multitude of regional adaptations in specified regions of the cerebrum, bearing enlightening morphofunctional correlations. The most drastic changes in the general pattern are fundamentally due to differences in the proportion of fibres that populate this gyral white matter. Variants are numerous but most often fall into one of the following categories: prominent association fibres, prominent projection fibres, prominent projection and commissural fibres and prominent short association fibres. In order to better understand this complex hodotopical organization, a thorough understanding of this tridimensional colocalization of white matter fibres is paramount.in vivo. Recent technological advances offer scarce data but raise hopes for thorough studies in the years to come. The clinical importance of the GWM thenceforth hints at great interest and will undoubtedly benefit from such detailed anatomical studies, with the promise of unraveling a whole new aspect of neuroanatomy and brain connectomics.Although several techniques are currently available for studying white matter anatomy, they suffer from methodological limitations, making the detailed study of superficial white matter difficult, especially


Editorial on the Research TopicCase reports in cardiovascular imaging: 2022Technical developments with several cardiovascular imaging techniques, including echocardiography, cardiac magnetic resonance (CMR), cardiac computed tomography angiography (CCTA) and positron emission tomography (PET) contributed to the profound understanding of cardiac physiology, as well as to precise diagnostic classification and risk stratification of patients with different cardiovascular disorders. Together with the wider availability of cardiovascular imaging and continuous training of cardiologists and radiologists in terms of image acquisition, analysis and interpretation within the clinical context, imaging techniques may not only provide the correct diagnosis, but also aid the monitoring of treatment strategies. In addition, artificial intelligence may standardize and harmonize the diagnostic processes, further enhancing the role of cardiovascular imaging in clinical practice. This taken together, along with continuous spread of knowledge among experts from different disciplines, like with the case series presented herein, will contribute to improved diagnostic work-up, patient management and outcomes.Yang D. et al. where using contrast echocardiography, CCTA and PET-CT a cardiac lymphoma was suspected. Using this multimodality imaging approach, the localization of the tumor in relation to neighboring structures of the heart could be verified, while extra cardiac spread helped classifying the structure as malignant, providing important information for the subsequent clinical treatment of the patient.The role of multimodality imaging is highlighted in the article by Punzo et al. where CCTA and CMR aided determination of lesion morphology, anatomical localization, and tissue characterization in a patient with cardiac paraganglioma. Cardiac paragangliomas are rare extra-adrenal tumors, which arise from chromaffin cells of sympathetic ganglia and are frequently diagnosed incidentally in the absence of limiting clinical symptoms. The role of CMR, together with other imaging modalities, in the sense of a multimodal approach for the diagnosis of cardiac tumors has already been highlighted in a recent multi-center study  in the right ventricle by CMR was indicative of sarcoidosis, whereas PET confirmed intense cardiac uptake in the septum and in the right ventricle. Imaging was used to guide endomyocardial biopsy, which indeed confirmed the presence of epithelioid nodules and lymphocytes indicative for cardiac sarcoidosis. Thereafter, the patient received immunosuppressive treatment with prednisolone, which led to resolution of the limiting symptoms and regression of the original lesion by PET.In another interesting case report, Sharifkazemi et al. reported on 2 patients with large coronary artery fistulas, one from the left circumflex artery to the coronary sinus and one to the superior caval vein, which were both diagnosed using transesophageal echocardiography, CCTA and coronary angiography. This combined assessment by multimodality cardiovascular imaging helped to establish the diagnosis and estimate the exact course of the artery fistulas, which may help to predict the disease course and select the most suitable treatment option for the individual patient.In the same direction, Nguyen et al. underlines the role of integration of clinical, multimodal imaging and histologic data for the diagnosis of concomitant intramyocardial and intrahepatic hydatic cysts in a young female patient with echinococcosis. The initial abdominal ultrasound revealed a large cyst in the liver, whereas echocardiography detected a cyst within lateral wall of the left ventricle. CCTA and CMR helped to localize and define typical features of the intramyocardial cyst, which was then treated by cardiac surgery and adjunctive pharmacotherapy.Another interesting case report by Ngoc Le et al. were able to detect two large heterogeneous masses in the left ventricular wall and in the apical myocardium of a patients presenting with suspected acute ST-elevation myocardial infarction. This completely changed the initial diagnosis, modifying the treatment strategy in a patient with metastatic oesophageal carcinoma, where subsequent CCTA confirmed the presence of multiple cardiac and lung metastases.Another promising development in the section of cardiovascular imaging is the increasing use of point-of-care ultrasound imaging for decision making in acute settings. Hong et al. a case of focal renal artery fibromuscular dysplasia was detected, which gradually progressed to a branch of the main renal artery 8 years after the initial treatment with a bare metal stent. Intravascular imaging has been used to evaluate vascular pathology in the renal arteries , a form of non-bacterial thrombotic endocarditis (NBTE) that may develop in the presence of a hypercoagulable state, such as antiphospholipid antibody syndrome (APS)  and an implanted valvular prosthesis . Both cases demonstrated how a detailed imaging assessment may allow a proper characterization of the endocarditis and of its complications, guiding the subsequent patient management.Given the wide epidemiology of inflammatory heart diseases and the relevant central role of cardiovascular imaging, six articles of the collection involved such cases, five of which involved valvular endocarditis. Interestingly, two papers reported cases of Libman-Sacks (LS) endocarditis (me (APS) . AnotherLi Y. et al. reported the characteristics and clinical course of the relatively rare Loeffler disease in a patient with multisystemic involvement of eosinophilic granulomatosis with polyangiitis (EGPA), where state-of-the-art cardiac magnetic resonance imaging allowed an in-depth depiction of disease progression.Moving from valvular bacterial to autoimmune eosinophilic endocarditis, a paper by Fukudome et al. the management of a patients with a very rare bronchogenic cyst in the right atrium was reported, describing the typical imaging features of the tumor and its preferential management strategy. In a second article, Li R. et al. reported on the clinical presentation, multimodality imaging assessment and final management strategy of a patient with a giant left atrial appendage aneurysm (LAAA). Another rare CHD with multi-chamber cardiac involvement was reported by Ge et al. In their article, a fatal case of double-chambered right ventricle associated with hypertrophic cardiomyopathy and incessant atrial flutter was described, and the specific role of the different cardiac imaging modalities was further discussed in this context. The possible risks of non-cardiac surgery in patients with unknown complex vascular malformations are outlined in the article by Zhang et al. reporting the 8th known case of azygos continuation of the inferior vena cava in a patient undergoing esophagectomy, indicating the benefit of a thorough pre-procedural vascular evaluation to avoid possibly fatal post-procedural complications.Seven articles, on the other hand, dealt with cases of congenital heart diseases (CHD), each outlining the importance of a multiparametric imaging assessment to guide both diagnosis and patient management. Two papers described rare congenital anomalies involving the atrial chambers. In one case by Deng et al. describes the finding of double orifice mitral valve by echocardiography. Despite its impressive visual appearance, this anomaly does not require a specific treatment unless combined with significant stenosis or insufficiency. In the case of Tang et al. a simple chest radiograph performed for non-specific symptoms led to the discovery of the rare finding of supracardiac total anomalous pulmonary venous return, which was combined with a large atrial septal defect (ASD). The latter was assessed by a combination of TTE, CCTA, and cardiac catheterization, confirming the functional significance of the disorder and guided successful surgical correction. Finally, the case of Ma et al. illustrated how CCTA and TTE provided incremental information to the invasive angiogram for the diagnosis of a rare case of STEMI with cardiogenic shock in an acute setting. This condition was attributed to the rupture of a giant right sinus of Valsalva aneurysm, causing right coronary artery compression. Despite emergent surgical treatment the outcome was unfavourable in this patient, indicating the severity and poor prognosis of such a condition.In three articles of the current collection, non-invasive imaging identified the presence of congenital heart conditions that had been asymptomatic until late in the adulthood. The case by Zhou et al. underscore the need for vigilance and echocardiographic follow-up post neochord implantation. Two patients experienced recurrent dyspnoea due to early-intermediate rupture of neochords and were managed by elective reoperation. In another series by Wang et al. the management of the dislodgement of left atrial appendage closure (LAAC) devices is described. The authors used a combination of echocardiography and CCTA to identify the migration of two different devices used for LAAC, and managed to successfully retrieve them percutaneously through the femoral artery in one case and the femoral vein in the other case. Both interventions for complication management were guided using transoesophageal echocardiography.The use of imaging for the identification and management of complications following cardiac interventions is demonstrated in two articles of the collection. The cases presented by Carrabba et al. In this interesting case, the authors used CCTA to reconstruct and print a 3d model of the left ventricle (LV) in a patient with ischemic LV dysfunction and LV aneurysm, scheduled for CABG and aneurysmatectomy. The printed model enhanced the 3D conceptualization of the procedure, leading to an improved LV function on this patient, with good agreement of the predicted and surgically attained residual LV volumes. Of course, the clinical value of this promising strategy still merits further investigation in future clinical trials.The novel concept of using three-dimensional printing for procedural planning is illustrated in the article of Liao et al. presented a rare case of contrast-induced encephalopathy (CIE) with extreme manifestations due to contrast administered during a percutaneous coronary intervention. Further neuroimaging studies by brain CT, brain MRI and MRA disclosed the presence of moyamoya disease that in combination with electrolyte and thyroid function abnormalities were speculated to play a role in the severity and duration of the encephalopathy that eventually recovered following a standard treatment regimen for CIE. In the cases by Du et al. the issue of the “watershed” phenomenon in patients with mechanical circulatory support devices is highlighted. The sites of flow mix by cardiac output and mechanical circulatory support devices may be identified by CCTA as an arc-shaped low-attenuation filling defect that needs to be differentially diagnosed by thrombus. In such cases, repeating the examination in a different body position may lead to disappearance of the filling artifact and identification of the “watershed” site.In two of the articles of the collection, specific potential issues of imaging are addressed. Ye et al. demonstrates the incremental value of CT angiography for the diagnosis of thrombotic foci in a patient with myocardial infarction due to histologically documented essential thrombocytosis and for guiding the type and duration of additional antithrombotic treatment, while the case by Li X et al. demonstrates the utility of multimodality imaging by colour Doppler ultrasound, CT angiography and digital subtraction angiography in the diagnosis, procedural planning and follow-up of a rare case of abdominopelvic arteriovenous malformation.Finally, two articles illustrate the value of CT angiography in diagnosing vascular pathologies. The article by In conclusion, recent advances with non-invasive and invasive imaging are immense and decisive in modern cardiovascular medicine. The correct choice and interpretation of cardiovascular images enable precise diagnostic work-up of patients with cardiac diseases, guiding timely and efficient treatment. In addition, intracardiac or transesophageal imaging can effectively guide cardiac interventions during complications, which may occur during coronary or structural heart interventions. Many of the cases reported in our collection are very nice examples, showing how multimodality imaging can be incorporated in the daily clinical practice to improve patient care and resultant outcomes.


Tele-exercise could represent an alternative for remote care in individuals with spinal cord injury at this time of the pandemic of coronavirus disease 2019. However, the differences regarding the training loads and implementation between synchronous and asynchronous types are not yet known. The purpose of this study was to compare the implementation and training load between synchronous and asynchronous tele-exercise programs in individuals with spinal cord injury.Forty individuals with spinal cord injury were recruited and stratified into tetraplegia and paraplegia groups. All subjects performed 3 weeks of both the synchronous and asynchronous tele-exercise programs, after two weeks of familiarization with the exercises, remote connection tools and methods to record information. The primary outcomes were training load  and implementation (adherence and successful exercise recording). Demographic characteristics were obtained from participants' electronic medical records.Weekly mean workload, total workload, adherence and successful exercise recording presented significantly higher values in the synchronous compared to asynchronous tele-exercises. Average daily workload did not present significant differences between the tele-exercises.The training load for each training session presented no differences between synchronous and asynchronous tele-exercises. Both adherence and successful data recording showed more favourable implementation values for synchronous training, thus allowing greater weekly training loads . Therefore, planning for access to health and social isolation are important measures for individuals with SCI during the pandemic. On the other hand, physical inactivity can also cause harmful health effects. In addition, physical inactivity and strenuous exercise are related to depression of the immune system, while moderate exercise is associated with a reduced incidence of infections.813 In particular, for individuals with SCI to present the benefits of exercise to health promotion, aerobic exercise is recommended at least twice a week for 20 min, in addition to the practice of muscle strengthening exercises, twice a week, both with moderate to high intensity. Thus, creating physical activity prescription methods for individuals with SCI during the pandemic is important for maintaining the health benefits provided by exercise.Individuals with spinal cord injury (SCI) are at a higher risk of contracting and developing morbidities due to COVID-19, arising from the difficulty of early diagnosis due to physiological alterations caused after SCI,16 With regard to individuals with SCI, telehealth has been shown to help in the treatment of pressure injuries and implementation of strategies to promote healthy behaviours. A subdivision of telehealth is tele-exercise, defined as interventions that offer physical training and are provided remotely. Lai et al. found high acceptability for an aerobic exercise program, which was attributed to its accessibility, convenience and interpersonal interaction with the professional.In order to provide alternative health-related interventions, recent innovations allow healthcare professionals to provide services remotely through communication technologies , known as telehealth. The second is the asynchronous model that provides an alternative to traditional synchronous technologies, allowing communication without the need for real time   .19 One2023 One way of monitoring the training sessions to measure the intensity of the exercise and to avoid the risk of injury is to control the internal load that enables the evaluation of physiological and psychological stresses imposed on the practitioner.2426 On the other hand, the external load is the amount of the workload regardless of the internal characteristics.27 One of the methods to monitor the internal load was proposed by Foster et al., using the rating of perceived exertion (RPE) associated with training session time. RPE is characterised as the perception of how strenuous a physical task is.For both synchronous and asynchronous tele-exercises, control of the training load can assist in its prescription, aiming to avoid very low intensities of physical activity which will not provide the expected health benefits, as well as high intensities of training which can lead to a risk of injury. In addition, it is relevant to verify the differences between the types of tele-exercise with the aim of providing a greater basis in relation to the implementation of these new technologies and how they can be monitored through the analysis of the training load, avoiding situations of strenuous exercises in the context of the COVID-19 pandemic.Tele-exercise could represent an alternative for remote care in individuals with SCI at this time of the COVID-19 pandemic, however, the differences regarding the training loads and implementation between synchronous and asynchronous types are not yet known. Recently, Bombardier et al. suggested studies with more objective indicators of physical activity frequency, intensity and duration.Thus, the objective of the present study was to compare the implementation and training load between synchronous and asynchronous tele-exercise in individuals with SCI. The hypothesis of the present study was that the outcomes related to the training load and implementation would be greater in synchronous training compared to asynchronous training.Forty men and women with SCI were consecutively recruited from the rehabilitation programme of the Network Centre of Rehabilitation Hospitals. Data were collected in May and June 2020. The study was approved by the institutional Ethics Committee (protocol n. 4.268.841). All participants were outpatients and provided written informed consent. ranges to A or B (complete motor injury); (d) participants with Internet access with sufficient capacity to follow the video lessons; and (e) those who had participated in at least 2 weeks of tele-exercise practices in synchronous form. Participants were excluded if they had a history of metabolic disorders, cardiovascular, cardiac or orthopaedic surgery that would hamper performance in the tele-exercises. Participants were stratified into paraplegia and tetraplegia groups.Inclusion criteria were: (a) adult individuals (from 18 years old) of both sexes; (b) individuals who participated in a spinal cord rehabilitation programme in person prior to the COVID-19 pandemic; (c) diagnosis of at least 1 year of traumatic or non-traumatic (non-progressive) SCI with classification of the severity (i.e. completeness) of injury by the American Spinal Injury Association Impairment Scale (AIS)The present study used the checklist Template for Intervention Description and Replication (TIDieR).The participants performed synchronous and asynchronous tele-exercises for 6 weeks, three times a week, with the objective of training muscle strength. The synchronous exercises were performed in the first place to ensure the safety of the participants in the asynchronous tele-exercises. Synchronous tele-exercise were delivered using the free teleconference application (app) (Google Meets software) and asynchronous tele-exercise were delivered using the free message app (WhatsApp software). The groups of tele-exercises were private and the professional sent the link for each training session and controlled the access of the participants. The participants performed the synchronous tele-exercises at their own residence in the paraplegia or tetraplegia group according to their level of injury. The paraplegia group had one teacher and the tetraplegia group had another teacher. These teachers were physical educators with spinal cord injury expertise and these teachers were the same in all sessions.The exercises involved the muscle groups of the anterior and posterior trunk  using implements such as dumbbells, shin guards or the body mass itself. In both tele-exercises, three sets of 10–15 repetitions were performed according to the implements available at the participant's residence. The activities were part of the rehabilitation programme proposed by the Network Center of Rehabilitation Hospitals, during the COVID-19 pandemic.Initially, 2 weeks of familiarization and preparation were allowed, in which the participants were informed about how to recording of the data, in addition to performing synchronous training to learn the exercises and become familiar with the scales and the software related to the video call. Next, the participants underwent 3 weeks of synchronous tele-exercises followed by another 3 weeks of asynchronous tele-exercises. Synchronous tele-exercises took place in groups through video calls, accompanied by the physical education teacher. In asynchronous tele-exercises, patients performed the same exercises practised in the three synchronous weeks, individually, without the real-time presence of the teacher during the moment of execution. The recordings were made through a questionnaire link on the Internet provided by a message on the cell phone or by sending direct messages via the cell phone with the requested data . In addition, participants could send direct messages via the cell phone or communicate via the Internet link available in all tele-exercise sessions.In all tele-exercise sessions, participants were asked about the presence of a disabling injury or pain, defined as any condition that would prevent participation in the exercise programme. . Training intensity was measured using the Borg scale of perceived exertion 33 30 min after the end of each session, as proposed by Foster et al. to calculate the internal training load. The internal training workload was expressed in arbitrary units (AU) in three ways: (a) average daily workload (average training workload performed during the week); (b) average weekly workload (average weekly training workload performed for the 3 weeks); and (c) total weekly training workload .The internal training workload was calculated for each training day using the method proposed by Foster et al. Similar to the RPE, the scale aims to assess the perceived recovery of the participants before the training sessions, in order to adjust daily training intensities, thereby minimising risks of injury, overreaching or overtraining. The PRS is a numerical scale from 0–10, where zero corresponds to ‘very poorly recovered/extremely tired’ and 10 to ‘very well recovered/highly energetic’.Immediately before the training sessions, the participants performed an assessment using the PRS.The implementation was evaluated by the variable adherence and successful registration of data.Adherence to the intervention was defined as the percentage of exercise sessions performed in relation to the total sessions proposed. through completion of an Internet link or by sending direct messages via cell phone. A successful recording of the exercise required that all training session data were successfully saved, including RPE, PRS and total training time.Successful data recording was defined as the percentage of sessions that were monitored and recordedPatients and/or the public were not involved in the design, conduct, reporting or dissemination of the plans of this research.The primary outcomes were implementation (adherence and successful exercise recording) and training load .Demographic characteristics  were obtained from participants' electronic medical records.Sample size was calculated based on the Wilcoxon signed-rank test, considering an effect size of 0.50, α of 5%, and power (1–β) of 85%, demonstrating that 40 individuals were required to compare synchronous and asynchronous tele-exercises.The Kolmogorov-Smirnov test was used to assess the data distribution. Descriptive data are presented as median and interquartile (25th and 75th percentiles) for all outcomes. The within-group analysis (synchronous vs asynchronous teleexercises) was conducted using the Wilcoxon test. The Mann-Whitney test compared the primary outcomes between paraplegia and tetraplegia groups. A chi-square test was used to compare the frequency proportions of SCI level and aetiology between paraplegia and tetraplegia. Outlier values were calculated by the difference between the 25th and 75th percentiles multiplied by a factor (2.2). The result was then subtracted from the 25th percentile and added to the 75th percentile.The outlier labelling rule was used to detect outliers and discrepancies.p ≤ 0.05; two-tailed).The IBM SPSS Statistics package  and G*Power statistical power analysis software  were used. Statistical significance was set at 5% . There were no significant differences between paraplegia and tetraplegia groups .Average weekly and total workload were significantly higher in the synchronous compared to asynchronous tele-exercises . Average daily workload did not present significant differences between the tele-exercises .In comparisons between paraplegia and tetraplegia groups, all training load variables in the synchronous format showed significantly higher values in the paraplegia group compared to the tetraplegia group. In asynchronous tele-exercise, there were no significant differences between paraplegia and tetraplegia groups for the training load variables .The synchronous training presented more favourable implementation values, but the daily training load did not demonstrate any difference between the tele-exercises. In addition, the weekly and total values were higher in synchronous training since they were corrected by adherence, which was significantly higher in this form of tele-exercise. These results are important in view of the weekly training load ratios for beneficial effects on health promotion. The training load variables were higher in the paraplegia group, as expected, but there was no difference for implementation when compared with the tetraplegia group. Compared to these data, the present study showed lower values; however, we included a larger sample (40 participants) and also the absence of rescheduling. Despite these differences, it can be inferred that synchronous tele-exercises, both individually and in groups, lead to greater adherence compared to asynchronous tele-exercises. Bombardier et al. also reported low exercise participation in a 16-session telehealth asynchronous programme.The implementation outcome was evaluated using two variables: adherence and successful data recording. Adherence showed significantly higher values in synchronous tele-exercise (66.7%) when compared to asynchronous tele-exercise (50.0%). In a previous study, Lai et al. included four participants and found 100% adherence, with 8% of the training sessions rescheduled. Although there was no systematic assessment of the reasons in the present study, the participants reported 'forgetting' as a factor for the lack of data recording. One of the aspects that can be highlighted is that individuals with tetraplegia could have greater difficulty in recording data due to the greater severity of SCI. However, the level of SCI did not interfere in the data recording, considering that there was no significant difference between the tetraplegia and paraplegia groups.With respect to the successful recording of data, significantly higher values were found in the synchronous format (100.0%) than in the asynchronous format (71.4%). A previous study found values of 85%, with the reasons for the percentage difference being instability of Internet connection and mistaken recording of data. Asynchronous communication also enables the participant in the tele-exercise programme to remain guided by the professional even if they do not participate in activities in real time, avoiding the feeling of not being supervised.37 On the other hand, in terms of longitudinal monitoring, the asynchronous format may have limitations, since the weekly and total training load values were lower than in the synchronous tele-exercise. This is due to the impact on the training load associated with lower adherence to asynchronous tele-exercise. For example, to obtain cardiometabolic benefits related to exercise, it is estimated that a weekly training load of at least approximately 270–360 AU is necessary . In this context, weekly training loads closest to the desired levels were achieved in the synchronous training, although still below the level estimated for the population with SCI. Thus, despite the advantages described above regarding the use of the asynchronous approach, this method should be considered with caution in view of the limitations in chronic gains that can arise from lower adherence. Future studies evaluating different forms of monitoring asynchronous training may provide alternatives for an increase in the weekly and total training load in this form of tele-exercise.The daily training load did not show any significant difference between the synchronous and asynchronous tele-exercise formats. This finding offers consistency for the use of asynchronous tele-exercise, since this intervention format offers an opportunity for unstable Internet connection contexts in which exercise data can be saved after disconnecting from the Internet and resumed when the connection is restored.39 Dysautonomia is a most common issue in individuals with tetraplegia, compromising, for example, an increase in heart rate,39 and may consequently underestimate the values of RPE. Specific alterations according to the levels of injury can thus provide greater recruitment of muscle mass and cardiac demand and, as a consequence, higher values of RPE and training load compared to the tetraplegic group in synchronous tele-exercise. With respect to the absence of differences in training load in the asynchronous format, it can be inferred that paraplegics had greater difficulty in maintaining training intensity with the absence of the professional in real time. The relationship with the professional who conducts synchronous tele-exercise is considered a critical component for motivation in the activity, a fact which was more evident in the paraplegia group, to maintain higher values of RPE.Another finding refers to the absence of a significant difference in the training load between the paraplegia and tetraplegia groups in asynchronous tele-exercise, in addition to the higher values for the paraplegia group in the synchronous format. Individuals with paraplegia have greater muscle strength (greater preserved muscle mass), better body composition and less autonomic changes compared to individuals with tetraplegia.40 For collective tele-exercise, a study with Tai Chi exercises was found with older adults and another using adapted dance in individuals with Parkinson's disease. Thus, the present study provides an alternative, using tele-exercise muscle strength training in groups for individuals with different levels of SCI. In addition, the intervention was shown to be safe, since no adverse effects were reported by the participants.A differential aspect of this study was that it is the only one found in the literature that presents muscle strength training by synchronous tele-exercise collectively and not individually. Only studies on synchronous tele-exercise with SCI on an individual basis were found.Some characteristics of the sample must be considered before extrapolating conclusions regarding implementation. Participants had already taken part in a face-to-face rehabilitation programme and were young adult individuals, which may have favoured implementation due to the ease of accessibility to technological tools. Besides that, the present study performed a crossover without randomization that could have biased the results and, probably, this methodological approach might have increased the implementation data. Future studies could evaluate groups with different age groups and participants with follow-up in an exclusively remote rehabilitation programme associated with training and implementation loads.The training load for each training session did not differ between synchronous and asynchronous tele-exercises in individuals with SCI. Both adherence and successful data recording implementation values were more favourable in synchronous training, thus allowing greater weekly training loads . In this way, synchronous tele-exercise provides training load values that can more adequately correlate with beneficial effects to health promotion and with greater ease of implementation. One suggestion is to expand the forms of monitoring in asynchronous training in an attempt to promote greater adherence and, thus, higher weekly training loads. In addition, this analysis should be weighted by the level of injury, given that individuals with paraplegia achieved higher values in all outcomes related to training load compared to individuals with tetraplegia.


Osteoma is a benign, and usually asymptomatic bone tumor normally found in the skull and facial bones, although it can occasionally occur in the long bones and spine.In this article, we present a 49-year-old male patient who experienced progressive neck pain accompanied by left-sided radicular pain symptoms. Clinical investigation using various imaging techniques confirmed a bone-forming lesion located within the C1 vertebrae region. Treatment involved performing hemilaminectomy of C1 along with resection for complete removal of this extradural bone lesion, ultimately achieving symptom relief. Histopathological examination of the resected specimen leads to the diagnosis of osteoma. Along with reporting this case, we conducted a comprehensive literature review of the previously reported spinal osteoma cases.Histopathological examination confirmed the diagnosis of osteoma. A comprehensive literature review was conducted, revealing 16 previously reported cases of spinal osteoma. Among these, only one case involved the C1 vertebra and presented similar neurological symptoms. The review underscores the rarity of spinal osteomas and the importance of surgical intervention for symptom relief.Spinal osteomas are rare but should be considered in the differential diagnosis of patients presenting with neck pain and radicular symptoms. Surgical removal of the lesion is often necessary for symptom relief, as highlighted by our case and supported by the literature review. This case adds to the limited body of evidence on spinal osteomas and emphasizes the importance of a multidisciplinary approach for optimal patient outcomes. •Osteomas are benign bone lesions, mostly near sinuses, but infrequent in the upper cervical spine•Surgical intervention often necessary for symptomatic upper cervical spine osteomas•Case study: 49-year-old male with neck pain and left-sided radicular symptoms•Successful relief through hemilaminectomy and lesion resection•Rarity of upper cervical spine osteomas necessitates continuous reporting and analysis•Personalized management is essential considering diverse treatment modalities OsteomaHere, we present a case study involving a patient who experienced neck pain radiating to his left hand due to an osteoma in their C1 vertebra. Both complaints were successfully resolved without any complications through hemilaminectomy and resection of an extradural bone lesion. Moreover, we conducted a comprehensive literature review of the 14 reported cases of spinal osteomas in the literature, with only one located in the C1 vertebra. This highlights the rarity of our case and underscores the need for reporting and analyzing such unique occurrences to enhance our understanding of osteomas in the upper cervical spine.This work has been reported in line with the SCARE criteria to ensure standardized and high-quality reporting .2A 49-year-old man was referred to the neurosurgery department in Chamran Hospital, Fars, Shiraz, Iran, complaining of progressive neck pain and left-sided radicular pain persisting for a period of 6 months. Additionally, the patient experienced hypoesthesia and paresthesia in the left hand approximately two weeks before seeking medical attention. The patient denied any history of trauma prior to the onset of symptoms. Notably, the pain did not extend to the lower back or hips, and no numbness in the lower extremities was reported. Past medical and drug history was unremarkable, as was the patient's social history. The patient also reported no congenital abnormalities in the upper cervical spine. The patient exhibited normal cranial nerve function, muscle power, and gait.Computed tomography (CT) scan displayed a well-delineated ovoid bony mass on the left side of C1 pedicle that mildly extended into the spinal canal, with cortical density on bone window without evidence of significant cord compression . MagnetiHistopathological examination of the resected specimens revealed fragments of mature cortical type bone architecture with areas of endochondral ossification, showing no cellular atypia or necrosis. The diagnosis of the specimens and extradural bone lesion was suggestive of osteoma . The pat3In this article, a case of osteoma in the C1 region is presented with upper cervical canal stenosis. Hemilaminectomy of C1 and complete resection of the extradural bone lesion was performed. Accurate diagnosis of osteomas in this anatomical region poses significant challenges as they have radiologic and clinical overlap with other medical conditions, making them difficult to detect . Kanaya We conducted a literature review of all cases of spinal osteoma, listed in In conclusion, our case report and comprehensive literature review enhance the understanding of osteomas in the upper cervical spine. By presenting a rare case of osteoma in the atlas and analyzing existing studies, we contribute to the body of knowledge surrounding the accurate diagnosis and surgical management of these lesions.C1First cervical vertebraC2Second cervical vertebraC3third cervical vertebraCTComputed TomographyMRIMagnetic Resonance ImagingThe present study was approved by the Medical Ethics Committee of XXX University of Medical Sciences. The purpose of this report was completely explained to the patient and written inform consent was obtained from the patient.Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.Data of the patient can be requested from authors. Please write to the corresponding author if you are interested in such data.No source of funding.SAN and SSN drafted the manuscript.MK collected the data and revised the manuscript. SHJ collected and reported the imaging data. DF proofread the manuscript and did the English language editing of the manuscript. AD revised the final version of the manuscript and supervised the study. All authors read and approved the final version of the manuscript.Seyed ali nabavi zadeh accept full responsibility for the work and/or the conduct of the study,had access to the data, and controlled the decision to publish.The authors declare that they have no competing interests.


Animal cognition and ethology, the scientific study of animal behaviour, have long captivated the human imagination. From the intricate social structures of ant colonies  to the aThe ‘GeoDanceHive’  offers aIn recent years, a wave of technological innovation has revolutionised the field of ethology and animal cognition, propelling our understanding of non-human minds and behaviours to new heights. The eleven groundbreaking studies of this special issue exemplify the transformative impact of these cutting-edge technologies. One notable innovation is the ‘GeoDanceHive’, a hive prototype equipped with sensors and recording devices that enable real-time observation of honeybee dances in their natural environment . This noEthical considerations are paramount in animal research ,33, and The collective body of research presented in this special issue represents a significant leap forward in our understanding of animal cognition and ethology. Through innovative technologies and ethical research practices, these studies have illuminated the intricate workings of non-human minds and behaviours, offering profound insights into the natural world. These studies have harnessed cutting-edge tools to explore the cognitive capabilities and behavioural intricacies of a diverse array of animal species. Moreover, ethical considerations have been at the forefront of these investigations, with researchers prioritising the welfare and well-being of the animals involved. Non-invasive methods have allowed for the study of animal behaviour without causing harm or stress to the subjects. This is the future of animal research.


These glands have different functions in various animals. The information about the enzyme histochemical nature of prenatal orbital glands in Indian buffalo seems to be unavailable. Therefore, the study was planned on orbital glands of six full term recently died fetuses from animals with dystocia.The orbital glands, The frozen sections of all these glands were subjected to standard localization protocols for Alkaline Phosphatase (AKPase), Glucose 6 phosphatase (G-6-Pase), Lactate dehydrogenase (LDH), Succinate dehydrogenase (SDH), Glucose 6 phosphate dehydrogenase (G-6-PD), Nicotinamide Adenine Dinucleotide Hydrogen Diaphorase (NADHD), Nicotinamide Adenine Dinucleotide Phosphate Hydrogen diaphorase (NADPHD), Dihydroxy phenylalanine oxidase (DOPA-O), Tyrosinase, non-specific esterase (NSE) and Carbonic anhydrase (CAse).The results revealed a mixed spectrum of reaction for the above enzymes in LG, SGT and HG which ranged from moderate (for LDH in SGT) to intense . However, DOPA-O, Tyrosinase and CAse did not show any reaction. From the present study, it can be postulated that the orbital glands of fetus have a high activity of metabolism as it has many developmental and functional activities which were mediated with the higher activity of the enzymes involved. Enzyme histochemistry is a sensitive dynamic technique where visualization is accomplished with an insoluble dye product which mirrors even early metabolic imbalances in an organism. It can be combined with the advantage of histotopographic enzyme localization to understand the entire mechanism . In termviz., lacrimal gland, superficial gland (Glandula Profunda) and deep gland (Harderian glands) of the third eyelid , are important for normal eye functions. Among these glands, the superficial gland (SGT) is observed in mammals with a third eyelid  for release of dystocia or for necropsy at postmortem hall of Guru Angad Dev Veterinary and Animal Sciences University (GADVASU), Ludhiana, India or from the local slaughter houses (in emergency slaughters). None of these fetuses was collected in live condition therefore, the ethical permission was not required. They were ranged from 89.0 cm Crown Vertebral Rump Length (CVRL) to 94.0 cm CVRL (274 to 286 days of gestation). The estimation of the gestational age was done with following formula :viz., -- for negative, + for weak positive, ++ for moderate positive and +++ for strong positive reactions. The same grades were allotted to each image until the distinct differences were seen among the intensity of reactions.phatases , lactatephatases , NADH & phatases  DOPA oxiphatases  and carbphatases . The posFollowing the incubation for AKPase, the alveoli of all three orbital glands showed strong AKPase activity . The reaUnder dehydrogenases, cryosections of lacrimal gland showed a strong positive reaction for LDH activity  whereas When these tissues were incubated for the reaction of NADHD, both the glands of third eyelid and lacrimal gland demonstrated intense activity . The reaSince, these glands develop in the close vicinity of the eyelids therefore the tissues from these glands were also incubated for the reaction of DOPA-O and tyrosinase activity to evaluate for any reaction or evidence of melanin activity. The results revealed that the activity of both the enzyme was absent in all three orbital glands .Incubation for activity of nonspecific esterase resulted in strong activity of the nonspecific esterase in all three glands .The activity of carbonic anhydrase could not be seen in any of these three glands . The obsThe strong activity of AKPase and G-6-Pase was observed in alveoli of all three orbital glands in present study. However, a weak reaction of AKPase was reported in the alveoli and their ducts in lacrimal gland of neonatal buffalo calves, while a moderate to strong reaction for G-6-Pase was also observed in the alveoli of lacrimal gland in neonatal buffalo calves . The AKPThe activity of LDH, SDH and G-6-PD was strong in lacrimal and deep gland of third eyelid but LDH activity was moderate in superficial gland of third eyelid of buffalo fetus. These enzymes are the important catalysts in oxidative metabolism and are involved in Krebs’s cycle. The role of G-6-PD was also linked with high activity of cellular proliferation and differentiation . A preseThe glands of third eyelid and lacrimal gland demonstrated intense activity for NADHD but for NADPHD, the lacrimal and superficial glands of third eyelid showed intense reaction while deep glands showed strong activity. Earlier, a moderate to strong activity of NADHD was noticed in the acini of lacrimal gland in neonatal buffalo calves . The simviz. DOPA-O and Tyrosinase. However, any activity of these enzymes could not be observed in any of the orbital gland which indicated the absence of any component of melanin synthesis. The lacrimal gland had intense activity for the nonspecific esterase which showed the active involvement of lipid metabolism in the gland.The orbital glands have a close association with the eyelids which have melanin therefore, the orbital gland tissues were checked for the enzyme related to melanin synthesis The presence of bicarbonates in the tear was already reported. The tears are secreted from orbital glands especially from the lacrimal gland . TherefoFrom the present investigation, it can be concluded that the cellular proliferation, differentiation and growth were the prominent factors in fetal orbital glands of buffalo for which the activities of enzymes related to energy metabolism, phosphate transfers between the molecules and lipid metabolism were high. Also, even being in close association with the eyelids, the activity of enzymes related to melanin synthesis was not witnessed. The absence of activity of CAse showed that bicarbonate metabolism may not be present during fetal life and that justifies that the tear formation starts after birth only.