Study of social awareness regarding body donations for scientific and educational purposes

BACKGROUND

The basis of teaching anatomy is the understanding of the body's structures using human cadavers. Body donation should be a fully conscious and voluntary act. There is a growing demand for human cadavers in medical universities. To meet these demands, it is necessary to understand the societal awareness regarding body donation.

MATERIALS AND METHODS

The study utilized a proprietary single-choice questionnaire while maintaining the anonymity of the respondents. The study included 1004 individuals, comprising 700 women and 304 men. The analysis employed the Mann-Whitney test, Pearson's chi-squared test with calculation of the Cramer's V coefficient.

RESULTS

Among the respondents, 56.37% consider donating their bodies for scientific and educational purposes. Among the concerns associated with donation, fear of lack of proper respect for the remains by students (18.23%), family opposition (16.24%), and religious reasons (9.16%) were highlighted. Non-religious individuals are more inclined to donate their bodies for scientific and educational purposes than religious individuals (p < 0.001). Residents of rural areas and small towns are less likely to consider donating their bodies for scientific and educational purposes than residents of large cities (p = 0.002). As many as 85.76% of respondents believe that human remains are essential for effective anatomy education.

CONCLUSIONS

Increasing public awareness of cadaver donation may contribute to increasing the effectiveness of anatomy teaching at medical universities.

Efficacy of plastinated specimens in anatomy education: A systematic review and meta-analysis

Plastination, a permanent preservation method for human tissues and organs, is increasingly being used in anatomy education. However, there is a paucity of systematic reviews and meta-analyses summarizing the educational efficacy of plastinated specimens. This meta-analysis compared the assessment scores of students exposed to plastinated specimens against those exposed to other common instructional methods. A systematic search was conducted through four databases, from 2000 to July 2022. Titles and abstracts of the retrieved records were screened according to predetermined eligibility criteria. Of the 159 records screened, 18 were subjected to full-text review. Among the 18 studies, five articles reported post-intervention test scores for intervention (plastinated) and control (other modalities) groups. Studies were subjected to GRADE quality assessment, and four studies with moderate to high ratings were included for meta-analysis. Students' perceptions (n = 15 studies) were qualitatively analyzed using an inductive narrative analysis. No significant effect was detected between the intervention (n = 417) and control groups (n = 422) (standardized mean difference = 0.08; 95% CI [-0.36, 0.52]; p = 0.73). Four themes emerged from students' perceptions: ease of use, motivation to study, spatial understanding, and learning preference. Overall, student performance outcomes comparing the use of plastinated specimens versus other instructional modalities are very limited. This meta-analysis suggests that knowledge gained from plastinated specimens is comparable to learning achieved through other modalities; though this outcome should be interpreted with caution as there is currently insufficient evidence for definitive conclusions.

Honoring human body donors: Five core themes to consider regarding ethical treatment and memorialization

Dissection of human body donors is a common component of anatomy curricula, as it provides opportunities for tactile and intellectual engagement unmatched otherwise. Additionally, interaction with human body donors contributes to the "hidden curriculum" of allowing students to begin to ethically practice patient care with empathy, respect, and compassion. With this, there have been various proposed guidelines for the ethical treatment of human body donors, with most focusing on student reflections and a final ceremony for honoring the donors, but there are numerous other ways throughout the course to incorporate ethical values and to guide students to consider the humanity of the donor. This article proposes that institutions consider the incorporation of five easily implemented formalized ethical themes for working with human body donations into daily practices: (1) reflect the donor as possessing human dignity, (2) recognize the donor's role of the "First Patient" or "Silent Teacher," (3) honor the gift of human body donation, (4) recognize the decedent's family, and (5) consider inclusivity in memorialization practices. Multiple recommendations for integrating these five themes throughout the course are provided. The incorporation of these five core themes can assist in alleviating the psychological stress that some students struggle with in dissection courses, foster the feelings and attributes that comprise the hidden curriculum and are the desired characteristics of a caring medical provider, and discourage misuse and mistreatment of donors.

Metal component of dental restorations and fixed prostheses in the oral cavity of 43 cases of adults aged 55 years or older in forensic autopsy

Characterization of the metal component of dental restorations and fixed prostheses is useful for the treatment of dental metal allergies and personal identification. This study aimed to describe the composition of metal elements in dental restorations and fixed prostheses in the oral cavity of 43 cadavers of Japanese adults aged 55 years or older in forensic autopsies conducted at a university. In this study, Ag-Pd-Au alloys were most frequently detected, and the percentage of Ni alloys was smaller than that reported in patients with dental metal allergies. Furthermore, alloys containing other elements, such as Fe or Hg, were also detected in some cases.

Perceptions and Attitudes of Jordanian Medical Students on Using 3D Interactive Anatomy Dissection in Teaching and Learning Anatomy

BACKGROUND AND AIMS

This study evaluates the use of virtual anatomy dissection (Anatomage Table) in teaching anatomy for Jordanian medical students. The study also highlights any gender differences in students' perception on this method of teaching anatomy.

METHODS

This is a cross-sectional questionnaire-based study that was carried out on medical students enrolled in Al-Balqa Applied University, a Jordanian public university. A group of expert anatomists designed a questionnaire that investigates the students' perceptions and attitudes toward using virtual anatomy dissection. The questionnaire also investigated student's opinions and expectations on the impact of using this method on the academic achievement of students.

RESULTS

The findings of the study showed that most students agreed that Anatomage Table helped them better understand (64.3%) and memorize (64%) anatomy lectures. In addition, most students were interested in using this learning method in lab groups (72.3%). However, the didactic approach that combined anatomical models and the Anatomage Table was preferred over the unilateral approach that included only the Anatomage Table (80.5% vs 30.2%, p<0.001, r=0.9). Of note, there was a statistically significant difference between males and females in their preference for Anatomage Table (p<0.001), and in their perceptions on the impact of Anatomage Table on understanding of lectures (p<0.001) and memorization of anatomical structures (p=0.004).

CONCLUSION

The Anatomage Table is a powerful teaching and learning method in undergraduate medical education. Its application to Al-Balqa Applied University has proven to be effective so far. It can be used to overcome the problems facing anatomical education in the college of medicine in Al-Balqa Applied University and perhaps other universities in Jordan, but this needs better cooperation between universities and stakeholders to provide adequate funding for this method.

Habituation for professional learning: a qualitative study of physiotherapy students' experiences working with anatomy cadavers

INTRODUCTION

Cadaveric dissection shapes the ways in which healthcare students understand the human body and the attitudes, identities and behaviors they exhibit as health professionals. There is however a paucity of related research with physiotherapy (PT) students.

PURPOSE

The purpose of this interpretivist study was to investigate PT students' conceptions of the human body in relation to experiences with human cadavers in anatomy education.

METHODS

Ten semi-structured interviews were conducted with PT students along with four optional written reflections completed. Data was thematically analyzed.

RESULTS

Students engaged in a continuous process of habituation involving oscillation between "humanization" and "dehumanization" of cadavers in the anatomy lab. We describe the contextual mediators that shaped the process, the multi-sensory and emotional experience of the students, and the "interruptions" that contributed to the variability in their conceptions over time and contexts. Students ultimately habituated toward dehumanization which had multiple effects on learning and professionalization.

CONCLUSION

Study findings highlight the complexity of PT students' experiences and learning within the cadaver lab outside of the formal goals of anatomy education. We discuss the implications for anatomy curricula, including the potential advantages of incorporating a biopsychosocial approach.

COVID-19 and brain-heart-lung microbial fingerprints in Italian cadavers

Introduction: The fact that SARS-CoV-2, the coronavirus that caused COVID-19, can translocate within days of infection to the brain and heart and that the virus can survive for months is well established. However, studies have not investigated the crosstalk between the brain, heart, and lungs regarding microbiota that simultaneously co-inhabit these organs during COVID-19 illness and subsequent death. Given the significant overlap of cause of death from or with SARS-CoV-2, we investigated the possibility of a microbial fingerprint regarding COVID-19 death. Methods: In the current study, the 16S rRNA V4 region was amplified and sequenced from 20 COVID-19-positive and 20 non-COVID-19 cases. Nonparametric statistics were used to determine the resulting microbiota profile and its association with cadaver characteristics. When comparing non-COVID-19 infected tissues versus those infected by COVID-19, there is statistical differences (p < 0.05) between organs from the infected group only. Results: When comparing the three organs, microbial richness was significantly higher in non-COVID-19-infected tissues than infected. Unifrac distance metrics showed more variance between control and COVID-19 groups in weighted analysis than unweighted; both were statistically different. Unweighted Bray-Curtis principal coordinate analyses revealed a near distinct two-community structure: one for the control and the other for the infected group. Both unweighted and weighted Bray-Curtis showed statistical differences. Deblur analyses demonstrated Firmicutes in all organs from both groups. Discussion: Data obtained from these studies facilitated the defining of microbiome signatures in COVID-19 decedents that could be identified as taxonomic biomarkers effective for predicting the occurrence, the co-infections involved in its dysbiosis, and the evolution of the virus.

Louis Farabeuf (1841-1910): Anatomist and inventor of surgical procedures and instruments

Louis Hubert Farabeuf (1841-1910) was a reformer of clinical, surgical, and topographic human anatomy studies during the second half of the 19th century. Over 30 years as a professor of Anatomy, Farabeuf wrote outstanding anatomical textbooks. As the head of Anatomic Studies in the Faculty of Medicine in Paris, he succeeded in leading a profound restructuring of the way anatomy and surgery were taught. As a result of his work and research, several anatomical terms, clinical signs, and surgical instruments were named after him. For his outstanding career in anatomy, he was elected to the Academy of Medicine in 1897.

Microsurgical Anatomy of the Incisive Canals

BACKGROUND

The purpose of this study was to investigate the structure of the incisive canal using dry maxillae harvested from human cadavers.

METHODS

Seven dry maxillae were harvested from adult Caucasian human cadavers. The incisive canals in all specimens were observed from an intraoral viewpoint with the naked eye and under a surgical microscope with 20× magnification.

RESULTS

All specimens had a single incisive foramen leading to different numbers of canals. Two specimens had a single canal (Type I), two were double (Type II), and three had triple canals (Type III). In both type I specimens, the canal was centered in the incisive foramen. Type II had a septum between the two canals. This septum was irregular in shape near the entrance of the canal but smooth inside the canal. The canals were positioned asymmetrically within the foramen. Type III had two septa between the three canals. Again, those located near the entrance of the canal were irregular while those inside the canal were smooth. The orientation of the lumina differed from one another in the type III canals.

CONCLUSION

The study identified morphological variations in the anatomy of the incisive canal, underscoring the importance of pre-surgical planning in the administration of local anesthesia, placement of dental implants, or removal of impacted teeth in the anterior maxillary region.

Presence of Contagious Bacterial Flora in Formalin-Fixed Cadavers: A Potential Health Hazard to Medical Professionals

Cadaveric dissection is the most important learning tool in anatomy. Although many new modalities are coming up for learning anatomy, cadaveric dissection outstands all of these as it helps students to visualize the human body and remains the most realistic way of learning anatomy. The cadavers are preserved using formalin, a potent disinfectant. Even after embalming in 5-10% formalin, the cadaver might still be infectious while using it in the dissection hall (anatomy department). Numerous bacterial species and infectious pathogens might still be seen despite using fixative agents. Several disease-causing agents may remain viable. Earlier reports suggest that there are cases where students and the working staff got infected by HIV, viral hepatitis, tuberculosis, and prion diseases. The main objective of this study is to determine if bacterial species could be recovered from cadavers that are formalin-fixed. Specific regions in the body such as the axilla, perineum, finger clefts, and oral and nasal cavities were chosen for microbiological examination to detect bacterial species. The presence of skin folds in these regions makes them potential sites for the growth of bacteria. Formalin-fixed cadavers can still act as regions for the growth of viable bacteria that can be pathogenic and affect the health of students and anatomists handling them. Proper care should be taken regarding this because students and anatomists working with these cadavers may get exposed to pathogenic organisms which may become harmful or sometimes life-threatening. Some precautions for proper dissemination of cadavers should be taken to provide a complete, safe, and healthy ambiance in the dissection hall.

Flipped spotters learning model: An innovative student activity-based strategy. A preparation tool for anatomy practical examinations in medical education

The flipped spotters learning model is a modern student activity-based and learner-centered method in medical education. The aim of the study was to determine if the flipped spotters learning model improves students' learning. Participants were 1214 medical students of Polish (PD) and English (ED) divisions between 2013 and 2019 academic years at the University of Warmia and Mazury in Olsztyn, Poland. They were divided into a traditional group (control group) and a flipped spotters learning group (treatment group). Each flipped spotters learning group was asked to label anatomical structures on various specimens according to the structures name list prepared by the teacher on the multiple stations. The flipped spotters learning group leaders were instructed to take pictures with the appropriately marked structures on each of the human body prosections. After completion of the class, each flipped spotters team received photos for evaluation. In the flipped spotters learning model, the students strengthened their skills and knowledge by matching specimens independently as a form of practical laboratory activities. Students' performance in gross anatomy practical examinations between the group utilizing the flipped spotters learning model, and the group with the traditional teaching model was compared. Students participating in the treatment group achieved, on average 9.9 percentage points higher among PD students, and 13.0 percentage points higher among ED students than the control group in all nine practical examinations (the effect size ranging from 0.47 to 0.95). The results suggest the positive impact of flipped spotters model on improving student's performance in the practical examinations.

Standardized Statement for the Ethical Use of Human Cadaveric Tissues in Anatomy Research Papers: Recommendations from Anatomical Journal Editors-in-Chief

Human cadaveric donors are essential for research in the anatomical sciences. However, many research papers in the anatomical sciences often omit a statement regarding the ethical use of the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To rectify this issue, 21 editors-in-chief of anatomical journals, representing 16 different countries, developed standardized and simplified language that can be used by authors of studies that use human cadaveric tissues. The goal of these editor recommendations is to standardize the writing approach by which the ethical use of cadaveric donors is acknowledged in anatomical studies that use donor human cadavers. Such sections in anatomical papers will help elevate our discipline and promote standardized language use in others non anatomy journals and also other media outlets that use cadaveric tissues.

Classification of the Superior Mesenteric Artery

The aim of this study was to characterize the branching pattern and morphology of the superior mesenteric artery (SMA), and also to create a new SMA classification, which seems necessary for clinicians performing surgery in this anatomical area. The anatomical variations in the branching patterns of the SMA were examined in 30 cadavers fixed in 10% formalin. Morphometric measurements were then obtained twice by two researchers. In the proposed classification system, Type I, characterized by all normal branches - inferior pancreatoduodenal artery, ileocolic artery, right colic artery, middle colic artery and intestinal arteries - occurred in 53.33% of the specimens. Type II, characterized by absence of the inferior pancreatoduodenal artery, was present in 26.67%. Type III, characterized by absence of the right colic artery, was present in 3.33%. Type IV, characterized by a common trunk for the inferior pancreatoduodenal artery and middle colic arteries, was observed in 3.33%. Type V, characterized by an aberrant hepatic artery and absence of the inferior pancreatoduodenal artery, was observed in 13.33%. The origin of the SMA was at the Th12/L1 level in 10% of cases, at L1 in 43.33%, at L1/L2 in 36.67%, and at L2 in 10%. The SMA is characterized by high morphological variability, the variants being associated with distinct clinical aspects. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.

The Past, Present, and Future: A Discussion of Cadaver Use in Medical and Veterinary Education

Cadaver usage in medical training, although controversial, has persisted over centuries. In veterinary education various methods have been proposed to either improve cadaver preservation, reduce cadaver use, or to replace cadavers entirely, but to date few have gained popularity. This manuscript seeks to: (i) describe the history of cadavers in medical and veterinary education; (ii) compare available cadaveric preservation methods; (iii) reflect on applications of cadaver use in the educational setting; (iv) discuss alternatives to traditional cadaver use; and (v) consider the perceptions of the stakeholders who use them.

Virtual dissection of the real brain: integration of photographic 3D models into virtual reality and its effect on neurosurgical resident education

OBJECTIVE

Virtual reality (VR) is increasingly being used for education and surgical simulation in neurosurgery. So far, the 3D sources for VR simulation have been derived from medical images, which lack real color. The authors made photographic 3D models from dissected cadavers and integrated them into the VR platform. This study aimed to introduce a method of developing a photograph-integrated VR and to evaluate the educational effect of these models.

METHODS

A silicone-injected cadaver head was prepared. A CT scan of the specimen was taken, and the soft tissue and skull were segmented to 3D objects. The cadaver was dissected layer by layer, and each layer was 3D scanned by a photogrammetric method. The objects were imported to a free VR application and layered. Using the head-mounted display and controllers, the various neurosurgical approaches were demonstrated to neurosurgical residents. After performing hands-on virtual surgery with photographic 3D models, a feedback survey was collected from 31 participants.

RESULTS

Photographic 3D models were seamlessly integrated into the VR platform. Various skull base approaches were successfully performed with photograph-integrated VR. During virtual dissection, the landmark anatomical structures were identified based on their color and shape. Respondents rated a higher score for photographic 3D models than for conventional 3D models (4.3 ± 0.8 vs 3.2 ± 1.1, respectively; p = 0.001). They responded that performing virtual surgery with photographic 3D models would help to improve their surgical skills and to develop and study new surgical approaches.

CONCLUSIONS

The authors introduced photographic 3D models to the virtual surgery platform for the first time. Integrating photographs with the 3D model and layering technique enhanced the educational effect of the 3D models. In the future, as computer technology advances, more realistic simulations will be possible.

Morphometry and Contents of the Suprascapular Notch with Potential Clinical Implications: Α Cadaveric Study

Background  The suprascapular notch (SN) represents the point along the route of the suprascapular nerve (SSN) with the greatest potential risk for injury and compression. Thus, factors reducing the area of the notch have been postulated for suprascapular neuropathy development.

Methods  Thirty-one fresh-frozen shoulders were dissected. The contents of the SN were described according to four types as classified by Polguj et al and the middle-transverse diameter of the notch was measured. Also, the presence of an ossified superior transverse scapular ligament (STSL) was identified.

Results  The ligament was partially ossified in 8 specimens (25.8%), fully ossified in 6 (19.35%), and not ossified in the remaining 17 (54.85%). The mean middle-transverse diameter of the SN was 9.06 mm (standard deviation [SD] = 3.45). The corresponding for type-I notches was 8.64 mm (SD = 3.34), 8.86 mm (SD = 3.12) was for type-II, and 14.5 mm (SD = 1.02) was for type III. Middle-transverse diameter was shorter when an ossified ligament was present (mean = 5.10 mm, SD = 0.88 mm), comparing with a partially ossified ligament (mean =7.67 mm, SD = 2.24 mm) and a nonossified one (mean = 11.12 mm, SD = 2.92 mm). No statistically significant evidence was found that the middle-transverse diameter depends on the number of the elements, passing below the STSL.

Conclusion  Our results suggest that SSN compression could be more likely to occur when both suprascapular vessels pass through the notch. Compression of the nerve may also occur when an ossified transverse scapular ligament is present, resulting to significant reduction of the notch's area.

Optimal recording electrode placement for radial motor nerve conduction study using extensor indicis muscle: Cadaver and electrophysiological studies

INTRODUCTION/AIMS

The aim of this study was to determine the optimal combination of active (E1) and reference (E2) recording electrode placements for the radial motor nerve conduction study recording over the extensor indicis muscle using surface electrodes.

METHODS

Thirty-six upper limbs from 18 fresh frozen cadavers were dissected to determine the midpoint of the extensor indicis muscle. Radial nerve conduction study was performed in 112 arms of 56 healthy subjects. Six combinations of three E1 and two E2 sites were studied. The stimulation site was 8 cm proximal to the E1 electrode.

RESULTS

The optimal combination of placement sites for the E1 and E2 electrodes to provide the largest amplitude is E1 electrode at the distal 1/4 point of the forearm length and E2 electrode at the extensor indicis tendon point in the wrist.

DISCUSSION

Optimal recording electrode placement may increase the accuracy and reproducibility of radial motor nerve conduction studies.

Types of inferior mesenteric artery: a proposal for a new classification

BACKGROUND

The inferior mesenteric artery (IMA) is the third main branch of the abdominal aorta and arises at the level of L3, supplying the large intestine from the distal transverse colon to the upper part of the anal canal. The aim of this study was to characterize the course and morphology of the terminal branches of the IMA, and also creating a new IMA classification, which seems to be necessary for clinicians performing surgery in this area.

MATERIALS AND METHODS

The anatomical variations in the branching patterns of the inferior mesenteric artery were examined in 40 cadavers fixed in a 10% formalin solution. Morphometric measurements were then obtained twice by two researchers.

RESULTS

Due to the proposed classification system, Type I characterized by a common trunk preceding bifurcation into sigmoidal branches and the superior rectal artery after giving LCA - Left Colic Artery occurred in 57.5% of cases, Type II, Trifurcation Type, in 25%, Type III with the superior rectal arteries originating firstly from the IMA in 5%, Type IV with the ascending lumbar artery in 10% of cases and Type V, a novelty, in 2.5%. The origin of IMA was observed at the level of L2/L3 in 22.5% of cases, at L3 in 25% of cases, at L3/L4 in 15% of cases, at L4 in 35% of cases and at the level of L5 in 2.5% of cases. More than one third (38.1%) of total cases with additional arteries and rapidly bifurcating branches occurred in Type III, IV, and V. In women only, the IMA and LCA were significantly narrower than in men. Only the diameter of the IMA correlated with the diameter of the superior rectal artery.

CONCLUSIONS

The IMA is characterized by high morphological variability. The introduction of a new, structured, anatomical classification seems necessary for all clinicians.

Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors

Research within the anatomical sciences often relies on human cadaveric tissues. Without the good will of these donors who allow us to use their bodies to push forward our anatomical knowledge, most human anatomical research would come to a standstill. However, many research papers omit an acknowledgement to the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To remedy this problem, 20 editors-in-chiefs from 17 anatomical journals joined together to put together official recommendations that can be used by authors when acknowledging the donor cadavers used in their studies. The goal of these recommendations is to standardize the writing approach by which donors are acknowledged in anatomical studies that use human cadaveric tissues. Such sections in anatomical papers will not only rightfully thank those who made the donation but might also encourage, motivate, and inspire future individuals to make such gifts for the betterment of the anatomical sciences and patient care.

Kinematics of inboard-leaning occupants in frontal impacts

Objective: Up to one-half of drivers swerve before a crash, which may cause vehicle motions that displace an occupant from a normal seated position. How these altered postures affect occupant restraint in a crash is unknown. The goal of this study was to quantify the effect of an initial inboard lean on occupant kinematics in a frontal impact.Methods: 30 km/h frontal impact tests were performed with three postmortem human subjects (PMHS) seated in a neutral, upright posture and in a 20° inboard-leaning posture identified from simulated swerving tests with human volunteers.Results: In comparison to the upright posture, the inboard-leaning posture increased the initial distance from the D-ring to the belted shoulder by 105-156 mm. In the inboard-leaning tests, the occupant's head displaced 45-70 mm farther forward than in the upright tests and was also located 123-147 mm farther inboard at the time of maximum forward excursion. The peak resultant velocity of the occupant's head relative to the vehicle interior increased 1.40-1.54 m/s in the inboard-leaning tests.Conclusions: The posture-induced increase in the distance between the D-ring and the shoulder permitted the increased maximum forward head displacement and increased maximum head resultant velocity relative to the vehicle interior. Thus, an initial inboard lean in a frontal impact may increase the risk and severity of a head strike to the vehicle interior, and alter the location, timing, and nature of airbag engagement.

Time Spent in Practicing Dissection Correlated with Improvement in Anatomical Knowledge of Students: Experimental Study in an Integrated Learning Program

Introduction and aim

Cadaveric dissection has long been used as the main domain for teaching anatomy in medical schools. However, recently with a limited number of cadavers and time for practicing dissection, prosections and anatomical models are widely used and may replace traditional dissection. We aimed to explore the possible association between practicing dissection and test results among medical students and to determine whether there are differences in achievements between students who studied anatomy by cadaveric dissection and those who used prosections and anatomical models.

Methods

The study was conducted at the University of Bisha, College of Medicine, Saudi Arabia, during the period from March to August 2017. Students were randomly assigned to one of two groups (50 in each). The first group studied anatomy (upper limb course) by practicing dissection while the other studied it by using prosections and anatomical models. Both groups were subjected to the same final assessments. Scores of both groups were compared by using the Student’s t-test. Correlation analysis between time spent in practicing dissection (carefully registered using a predesigned portfolio and an attendance logbook) and assessment grades was implemented using the rank-based Pearson correlation coefficient.

Results

Students practicing dissection achieved higher grades (169 ± 1.99) than those who studied anatomy by only using prosections and anatomical models (142 ± 1.78, p<0.001). There was an association between the time spent in practicing dissections and overall anatomy summative assessments (r²=0.841, p<0.001). Students expressed positive responses towards the effectiveness and value of practicing dissection.

Conclusions

We concluded that practicing dissection helps students to achieve higher results than learning using only models and prosections. Time spent in practicing dissection correlated with final assessment results. Further research is required to measure not only the statistical significance of results but also their educational effectiveness and long term learning outcomes.

Traumatic Brain Injury and the Importance of Neurosurgical Care: 10-year Retrospective Study on Cadavers

OBJECTIVE

Traumatic brain injury (TBI) due to transport accidents is a serious cause of death and disability. In every case, however, quick response and a proper health care are required.

MATERIALS AND METHODS

We collected 10-year data retrospectively from the laboratory of forensic science and toxicology in Montana, Bulgaria with the intention to show the importance of neurosurgical care in the traumatology and its connection to mortality rate.

RESULTS

124 cadavers were included with significant male predominance. The data analysis shows that the mortality rate at the hospitals without neurosurgical facilities and the mortality at the scene of the accident is the same for traffic brain injuries. Furthermore, we found that the age has no correlation with the mortality rate.

CONCLUSION

Road injuries are the most common type of brain injury. We believe that the outcome of these TBIs depends on the availability of a neurosurgical unit.

Morphometric profile of tendocalcaneus of South Africans of European ancestry using a cadaveric approach

BACKGROUND

Tendocalcaneus is a strong tendon that is vital for bipedalism in humans. Despite its tremendous strength, the tendocalcaneus is prone to damage and degeneration causing mobility problems and pain. Morphometric dimension of the tendocalcaneus is of benefit to the surgical repair and reconstruction of the damaged tendon. Cadaveric approach provides a realistic method for determining tendocalcaneus morphometry and as at present only two cadaveric studies on Indian population is available. Thus this study presents data on tendocalcaneus morphometry in South Africans of European ancestry using a cadaveric approach.

MATERIALS AND METHODS

A total of 66 lower limbs (32 left and 34 right legs) sourced from 49 male and female cadavers were used. After careful dissection of the posterior aspect of leg, the medial and lateral length, distal width, distal circumference and proximal width of the tendocalcaneus were measured.

RESULTS

The data showed a high degree of reproducibility indicating that the measurements obtained using cadaveric approach were precise and accurate. There was no difference in measurements between the sides. Measurements in the males were generally higher than in the females. Strong associations were observed between the paired measurements of the medial and lateral tendon length and between the distal width and distal circumference.

CONCLUSIONS

The data obtained will be useful in predicting tendocalcaneus size during the surgical reconstruction of the tendocalcaneus.

Ultrasound as a Diagnostic Tool in the Assessment of Lisfranc Joint Injuries

OBJECTIVES

Ligamentous Lisfranc injuries are frequently overlooked because of subtle clinical presentations and diagnostic difficulties. The dorsal Lisfranc ligament (DLL) is easily visualized with ultrasound (US), which can provide quick, cost-effective diagnoses of disorders but is not considered standard clinical practice. This study sought to compare DLL measurement accuracy between US and cadaveric dissection.

METHODS

Ultrasound images of 22 embalmed cadaveric feet were obtained with an M-Turbo US machine and a 6-13-MHz linear array (FUJIFILM SonoSite, Inc, Bothell, WA). Images were measured in the US unit and again with ImageJ software (National Institutes of Health, Bethesda, MD). Specimens were dissected, and DLL morphologic characteristics were recorded.

RESULTS

Twenty-two specimens were scanned, however 4 were excluded, leaving a sample of 11 male and 7 female cadaveric specimens (mean age ± SD, 80.3 ± 14.03 years). The DLL length differences between SonoSite (8.39 ± 1.27 mm) and ImageJ (8.25 ± 1.84 mm) were not significant (P > .05). Both US DLL measurements significantly differed from the gross dissection measurement (10.8 ± 1.85 mm; P < .001). The morphologic characteristics of the DLL at dissection were consistent. Overall, 70% to 80% of the ligament length was represented by US compared to dissection. The dorsal joint space did not differ significantly between SonoSite (2.19 ± 0.49 mm) and ImageJ (2.05 ± 0.52; P > .05). Both US measurements were also significantly larger than dissection measurements (1.04 ± 0.24; P < .001). Intraclass correlation coefficients indicated good reliability for the DLL length (0.835) and moderate reliability for the dorsal joint space (0.714).

CONCLUSIONS

The DLL is underrepresented but easily distinguished by US, demonstrating its utility in Lisfranc injury diagnosis. Thus, we propose a 4-component assessment involving US, which may provide more rapid, cost-effective diagnoses of subtle Lisfranc injuries.

Myofascial chains of the upper limb: A systematic review of anatomical studies

The presence of structural in-series continuity between skeletal muscles has been confirmed in the trunk and lower extremity. However, it is not yet clear whether the same architecture can be found in the upper limb. Therefore, the aim of the present study was to review the available literature considering the existence of myofascial chains in the shoulder-arm region. Two independent investigators performed a systematic literature search using MEDLINE (PubMed) and Google Scholar (each 1900-2019). Peer-reviewed anatomical dissection studies reporting myofascial in-series continuity in the upper extremity were included. The methodological quality of the included studies was assessed by the QUACS scale. Thirteen studies were included in the review. Analysis of these papers led to the identification of three myofascial chains: the ventral arm chain (pectoralis major, brachial fascia/biceps brachii, flexor carpi ulnaris/brachioradialis/supinator, based on five studies); the lateral arm chain (trapezius, deltoideus, lateral intermuscular septum/brachialis, brachioradialis, four studies); and the dorsal arm chain (latissiumus dorsi/teres minor/infraspinatus, triceps brachii, anconeus, extensor carpi ulnaris, six studies). There is good evidence for direct serial tissue continuity extending from the neck and shoulder region to the forearm. Despite this intriguing finding, which could have implications for health professionals and the treatment of musculoskeletal disorders, further research is needed to establish the mechanical relevance of the identified myofascial chains. Clin. Anat. 32:934-940, 2019. © 2019 Wiley Periodicals, Inc.

Turkish Undergraduate Veterinary Students' Attitudes to Use of Animals and Other Teaching Alternatives for Learning Anatomy

This study aimed to investigate the views of first-year veterinary students in Turkey from six veterinary faculties on their anatomy courses and to evaluate their perceptions of the uses of animals and other teaching alternatives from an ethical perspective. The study sample included a total of 293 veterinary students studying in the provinces of Ankara, Burdur, Diyarbakır, Kars, Konya, and Tekirdağ. The 38-item instrument tool developed by the researchers consisted of three sections and was administered to volunteer student participants. All the data were statistically analyzed, and normal distribution of the scores obtained in the attitude scales was determined using the Kolmogorov-Smirnov Z test (KSZ). The 20 items in the Anatomy Scale had an arithmetic mean of 3.48 and thus indicated an average rating of agree. The most challenging topic was found by 40.9% to be "the nervous system." The most useful material in facilitating the learning process was rated by 24.1% to be "the anatomy book." The 11 items in the Cadaver Scale had an arithmetic mean of 3.77, indicating an average rating of agree. The highest arithmetic mean score was for the item "Using cadavers is a must for the anatomy course" with a mean of 4.66, indicating their strong agreement with this view. The veterinary students' perspective emphasized that the combination of cadavers and the anatomy book contributed to their learning of anatomy.

Morphometric parameters and histological study of the filum terminale of adult human cadavers and magnetic resonance images

BACKGROUND

Morphology and histology of filum terminale (FT) has a role in the pathophysiology of tethered cord syndrome (TCS). This research was implemented to investigate the morphometric parameters and histological structure of normal FT in adult human cadavers and magnetic resonance imaging (MRI) scans to correlate them with the pathophysiology of TCS.

MATERIALS AND METHODS

Twenty five adult human cadavers (15 males, 10 females) and 100 MRI echo scans of lumbosacral region (50 males and 50 females), were used in this study. MRI patients were divided into 21-40 and 41-60 age groups. The cadavers were dissected at the prone position to explore their fila. The length of FT, filum terminale internum (FTI), filum terminale externum (FTE), vertebral level of beginning, dural piercing and termination of FT, and the initial, midpoint, and mid-FTE diameters were determined. Four segments were excised from lower conus, upper, middle, and lower thirds of FT. The specimens were processed for light microscopic examination. Statistical analysis was done for these parameters.

RESULTS

MRI morphometrical parameters of FT, except FTI length, revealed no age effect or sex differences, where length of FTI, FTE, initial diameter, level of conus medullaris termination (CMT) and dural sac termination (DST) were 174.1 ± 16.8, 75.8 ± 9.5, 1.6 ± 0.21, L1-2 and S2U in males and 166.9 ± 18.9, 74.1 ± 9.3, 1.53 ± 0.25, L1-2 and S2M vertebrae in females, respectively. However, non-significant sex difference was observed in morphometric parameters of cadaveric FT, where length of FTI and FTE, initial diameter, CMT and DST levels were 164.2 ± 11.6, 76.7 ± 8.1, 1.7 ± 0.14, L1L and S2U vertebrae in males and 159.2 ± 10.1, 71.02 ± 7.3, 1.6 ± 0.29, L1L and S2U in females, respectively. Moreover, CMT below L2 vertebra was seen in 5% of MRI scans and 8% of cadavers. Also, the initial diameter of FT > 2 mm was recorded in 7% of MRI and 8% of cadaveric cases. Histologically, the structure of FT showed gradual reduction in nervous, glial, and vascular tissues with converse increase in collagen content in FTE compared with those of FTI.

CONCLUSIONS

Knowledge of the morphometric parameters and the histological structure of FT are necessary for clinicians who dealing with diagnosis or treatment of tethered cord syndrome.

Variations of the cephalic vein anterior to the clavicle in humans

BACKGROUND

Clinicians should understand that jugulocephalic vein (JCV) variants may be occasionally found. This study aims to classify JCV variants and obtain their frequency.

MATERIALS AND METHODS

We investigated anatomical variants of the cephalic vein in 55 human cadavers during a gross anatomy course at our medical school.

RESULTS

The percentage of JCVs that pass through the anterior part of the clavicle and anastomose to the jugular vein as per previous studies and our study was 2-5%. Five cases with anastomosis between the cephalic and external jugular veins that pass through the anterior part of the clavicle were found. The courses were classified into 1A, 1B, 2A, and 2B. Type 1 extends beyond the clavicle and anastomoses with the external jugular vein. Type 2 follows the same course as type 1, but anastomoses with the subclavian vein. Subtype A does not have a branch that anastomoses with the axillary vein, whereas subtype B does. We encountered two cases of type 1A and three of type 1B.

CONCLUSIONS

Four anatomical variants of the cephalic vein around the clavicle were identified. Clinicians' knowledge of these variants is expected to decrease possible complications if venous access via the cephalic vein is needed.

Role of age and injury mechanism on cervical spine injury tolerance from head contact loading

OBJECTIVE

The objective of this study was to determine the influence of age and injury mechanism on cervical spine tolerance to injury from head contact loading using survival analysis.

METHODS

This study analyzed data from previously conducted experiments using post mortem human subjects (PMHS). Group A tests used the upright intact head-cervical column experimental model. The inferior end of the specimen was fixed, the head was balanced by a mechanical system, and natural lordosis was removed. Specimens were placed on a testing device via a load cell. The piston applied loading at the vertex region. Spinal injuries were identified using medical images. Group B tests used the inverted head-cervical column experimental model. In one study, head-T1 specimens were fixed distally, and C7-T1 joints were oriented anteriorly, preserving lordosis. Torso mass of 16 kg was added to the specimen. In another inverted head-cervical column study, occiput-T2 columns were obtained, an artificial head was attached, T1-T2 was fixed, C4-C5 disc was maintained horizontal in the lordosis posture, and C7-T1 was unconstrained. The specimens were attached to the drop test carriage carrying a torso mass of 15 kg. A load cell at the inferior end measured neck loads in both studies. Axial neck force and age were used as the primary response variable and covariate to derive injury probability curves using survival analysis.

RESULTS

Group A tests showed that age is a significant (P < .05) and negative covariate; that is, increasing age resulted in decreasing force for the same risk. Injuries were mainly vertebral body fractures and concentrated at one level, mid-to-lower cervical spine, and were attributed to compression-related mechanisms. However, age was not a significant covariate for the combined data from group B tests. Both group B tests produced many soft tissue injuries, at all levels, from C1 to T1. The injury mechanism was attributed to mainly extension. Multiple and noncontiguous injuries occurred. Injury probability curves, ±95% confidence intervals, and normalized confidence interval sizes representing the quality of the mean curve are given for different data sets.

CONCLUSIONS

For compression-related injuries, specimen age should be used as a covariate or individual specimen data may be prescaled to derive risk curves. For distraction- or extension-related injuries, however, specimen age need not be used as a covariate in the statistical analysis. The findings from these tests and survival analysis indicate that the age factor modulates human cervical spine tolerance to impact injury.

Cranial Backspatter Pattern Production Utilizing Human Cadavers

A backspatter pattern results from blood drops that travel retrograde to an applied external force. Historically, an array of animals and nonhuman objects have been used to create and study backspatter patterns. In this study, backspatter patterns captured on foam core targets that were placed 45.72 cm (18 in) behind the impact site (occipital area of the skull) were produced by cranial gunshots to human cadavers that were reinfused with fresh defibrinated bovine blood. These patterns were compared to the backspatter patterns produced by shooting blood-soaked sponges, a typical simulant used in controlled studies of backspatter pattern production and characteristics. The backspatter pattern produced by shooting an actual human head was found to be different than those of blood-soaked sponges in the number of stains produced, the size and size range of the stains, and the stain dispersion patterns.

Ureterorenoscopy training on cadavers embalmed by Thiel's method: simulation or a further step towards reality? Initial report

Introduction

The technique of ureterorenoscopy has a significant learning curve. Cadavers embalmed by the Thiel method have been successfully used for simulation training in a number of surgical specialties. Here we present our experience of the first use of Thiel cadavers in a formal ureteroscopy training course.

Material and methods

The inaugural ‘Masterclass in Flexible Ureterorenoscopy’ was run with participants performing ureterorenoscopy on three Thiel cadavers under expert supervision. A qualitative questionnaire was delivered to the participants and faculty. Assessed domains were tissue characteristics of the cadaveric urinary tract, anatomical features and procedural aspects. A five-point Likert score was used to assess responses. Data regarding participant experience in endourology were also collected.

Results

8 questionnaires were collected. All participants completed cadaveric ureterorenoscopy. Three-quarters reported the overall quality of tissue in the cadaveric bladder, ureters and pelvicalyceal system as high or excellent. Half reported the cadaveric bladder as being softer than in a live patient, whilst five out of eight thought that the cadaveric ureter was softer and more prone to trauma. Seven out of eight were satisfied with the overall quality of the cadaveric model. The quality of vision and irrigation in the upper urinary tracts was reported as high.

Conclusions

Thiel cadavers have been shown to have excellent tissue characteristics, as well as being durable and reusable. We have described the first use of Thiel cadavers in a designated ureterorenoscopy course, with high levels of delegate satisfaction. Further work is required to develop the role of Thiel cadavers as part of an integrated, modular urology training.

Maintaining the anonymity of cadavers in medical education: Historic relic or educational and ethical necessity?

Throughout the modern history of anatomical dissection by medical and other health science students, cadavers have been anonymized. This has meant that students have been provided with limited, if any, information on the identities or medical histories of those they are dissecting. While there was little way around this when the bodies were unclaimed, this need not be the case when the bodies have been donated. However, with a few exceptions, no efforts have been made to change this model. Recent attempts to move anatomy teaching in a more humanistic direction, by emphasizing the cadaver as the students' first patient and with the growth of commemoration services following the dissecting process, raise the question of whether cadavers should continue to be anonymized. In laying a basis for discussion of this matter, we outline what appear to be the virtues of anonymity, and the form that alternatives to anonymity might take. The options identified are nonidentification, low information; nonidentification, moderate information; and identification, full information. The virtues and drawbacks of each of these possibilities are assessed by analyzing their value for students, and also for donors and their families. Policy issues raised by alternatives are also considered. This article provides a basis for continued discussion and suggestions for further research in this area. Anat Sci Educ 10: 87-97. © 2016 American Association of Anatomists.

A new method to assess the deformations of internal organs of the abdomen during impact

OBJECTIVES

Due to limitations of classic imaging approaches, the internal response of abdominal organs is difficult to observe during an impact. Within the context of impact biomechanics for the protection of the occupant of transports, this could be an issue for human model validation and injury prediction.

METHODS

In the current study, a previously developed technique (ultrafast ultrasound imaging) was used as the basis to develop a protocol to observe the internal response of abdominal organs in situ at high imaging rates. The protocol was applied to 3 postmortem human surrogates to observe the liver and the colon during impacts delivered to the abdomen.

RESULTS

The results show the sensitivity of the liver motion to the impact location. Compression of the colon was also quantified and compared to the abdominal compression.

CONCLUSIONS

These results illustrate the feasibility of the approach. Further tests and comparisons with simulations are under preparation.

Neck forces and moments of human volunteers and post mortem human surrogates in low-speed frontal sled tests

OBJECTIVE

The objective of this study was to quantify the effects of active muscles (e.g. conscious bracing, resting tone, and reflex response) and acceleration severity on the neck forces and moments generated during low-speed frontal sled tests with adult male human volunteers and post mortem human surrogates (PMHSs).

METHODS

A total of 24 frontal sled tests were analyzed including male volunteers of approximately 50th percentile height and weight (n = 5) and PMHSs (n = 2). The tests were performed at two acceleration severities: low (∼2.5 g, Δv ≈ 5 kph) and medium (∼5.0 g, Δv ≈ 10 kph). Each volunteer was exposed to two impulses at each severity, one relaxed and one braced, while each PMHS was exposed to one impulse at each severity. Linear acceleration and angular velocity of the head were measured at a sampling rate of 20kHz, then filtered using SAE Channel Frequency Class 180 and 60, respectively, and transformed to the head center of gravity (CG). The location of the head CG, external auditory meatus, and occipital condyle (OC) were approximated using pretest photos and literature values. Neck forces (Fx and Fz) and sagittal plane moments (My) were calculated at the OC by applying the equations of dynamic equilibrium to the head.

RESULTS

Peak Fx, Fz, and My increased significantly with increasing acceleration severity (p < 0.1). Minimal differences were observed between the magnitudes of the peak forces and moments for each subject type. Qualitatively, differences in the timing of peak neck forces and moments and the overall shape of the time histories were evident. Maximum Fx, Fz, and My occurred earliest in the event for the braced volunteers and latest for the PMHSs. However, these differences were not supported statistically for the volunteers (p > 0.05). The timing of neck loading was visibly augmented by the increased stiffness of the volunteer necks as a result of muscle activation. Although differences were observed between the volunteer muscle conditions, the volunteer subsets were more similar to each other than the PMHSs.

CONCLUSIONS

This study examined the effects of active muscles, in the form of conscious and reflexive muscle activity, on the biomechanical response of occupants in low-speed frontal sled tests. Although active bracing did not result in significantly different peak neck loads or moments, the timing of these peak values were affected by muscle condition. The findings of this study provide insight to the kinetics experienced during low-speed sled tests and are important to consider when refining and validating computational models and ATDs used to assess injury risk in automotive collisions.

The fascial suspension of the prostate: A cadaveric study

AIMS

Analysis and description of the supporting fascial structure around the prostate and urethra, which needs to be preserved or restored during radical prostatectomy (RP).

METHODS

Anatomical dissection of 10 male cadavers was performed and the supporting fascial structures of bladder neck, prostate, and proximal urethra were investigated. The cadavers were embalmed according to Thiel's method, which preserves a natural texture and color of tissues.

RESULTS

Anteriorly, the puboprostatic ligament (PL), the dorsal vein complex, and the urethropelvic ligament form an integral structure that suspends and stabilizes the prostatic apex. Laterally, the fascia originates from the fascial tendinous arch of the pelvis and stabilizes the prostate in the central position. In the posterolateral aspect, we could demonstrate a tendineous dorsal raphe, which represents an important stabilization structure of the urethra.

CONCLUSIONS

The anterior and posterior pelvic fascial structure seems to be important stabilizer for the prostate and proximal urethra. Their preservation or reconstruction during RP is mandatory to restore the anatomic and functional continuity of the bladder neck and urethra. Neurourol. Urodynam. 36:1131-1135, 2017. © 2016 Wiley Periodicals, Inc.

Analysis of Dual Mobility Liner Rim Damage Using Retrieved Components and Cadaver Models

BACKGROUND

The objective of this study was to assess the retentive rim of retrieved dual mobility liners for visible evidence of deformation from femoral neck contact and to use cadaver models to determine if anterior soft tissue impingement could contribute to such deformation.

METHODS

Fifteen surgically retrieved polyethylene liners were assessed for evidence of rim deformation. The average time in vivo was 31.4 months, and all patients were revised for reasons other than intraprosthetic dislocation. Liner interaction with the iliopsoas was studied visually and with fluoroscopy in cadaver specimens using a dual mobility system different than the retrieval study. For fluoroscopic visualization, a metal wire was sutured to the iliopsoas and wires were also embedded into grooves on the outer surface of the liner and the inner head.

RESULTS

All retrievals showed evidence of femoral neck contact. The cadaver experiments showed that liner motion was impeded by impingement with the iliopsoas tendon in low flexion angles. When observing the hip during maximum hyperextension, 0°, 15°, and 30° of flexion, there was noticeable tenting of the iliopsoas caused by impingement with the liner.

CONCLUSION

Liner rim deformation resulting from contact with the femoral neck likely begins during early in vivo function. The presence of deformation is indicative of a mechanism inhibiting mobility of the liner. The cadaver studies showed that liner motion could be impeded because of its impingement with the iliopsoas. Such soft tissue impingement may be one mechanism by which liner motion is routinely inhibited, which can result in load transfer from the neck to the rim.

Use of 3D printed models in medical education: A randomized control trial comparing 3D prints versus cadaveric materials for learning external cardiac anatomy

Three-dimensional (3D) printing is an emerging technology capable of readily producing accurate anatomical models, however, evidence for the use of 3D prints in medical education remains limited. A study was performed to assess their effectiveness against cadaveric materials for learning external cardiac anatomy. A double blind randomized controlled trial was undertaken on undergraduate medical students without prior formal cardiac anatomy teaching. Following a pre-test examining baseline external cardiac anatomy knowledge, participants were randomly assigned to three groups who underwent self-directed learning sessions using either cadaveric materials, 3D prints, or a combination of cadaveric materials/3D prints (combined materials). Participants were then subjected to a post-test written by a third party. Fifty-two participants completed the trial; 18 using cadaveric materials, 16 using 3D models, and 18 using combined materials. Age and time since completion of high school were equally distributed between groups. Pre-test scores were not significantly different (P = 0.231), however, post-test scores were significantly higher for 3D prints group compared to the cadaveric materials or combined materials groups (mean of 60.83% vs. 44.81% and 44.62%, P = 0.010, adjusted P = 0.012). A significant improvement in test scores was detected for the 3D prints group (P = 0.003) but not for the other two groups. The finding of this pilot study suggests that use of 3D prints do not disadvantage students relative to cadaveric materials; maximally, results suggest that 3D may confer certain benefits to anatomy learning and supports their use and ongoing evaluation as supplements to cadaver-based curriculums. Anat Sci Educ 9: 213-221. © 2015 American Association of Anatomists.

An anatomical study of the superficial palmar communicating branch between the median and ulnar nerves

The palmar communicating branch between the median and ulnar nerves was investigated in 98 hands with the aim of outlining its most common branching patterns and describing its relationship to well-defined anatomical landmarks, including the bistyloid line, wrist crease and flexor retinaculum. Five branching patterns were identified and classified based on their proximal and distal attachments. The palmar communicating branch was found to lie between 26%-79% of the total distance between the metacarpophalangeal joint of the long finger and the wrist crease, and 35%-75% of the total distance between the metacarpophalangeal joint of the long finger and the middle of the bistyloid line. With the aid of the morphometric indices obtained from this study, a risk area where the palmar communicating branch is most likely to be found is outlined. Knowledge of the branching patterns and location of the palmar communicating branch can help clinicians to better assess variations in the patterns of sensation, preserve the nerve during surgical interventions to the palm and better assess post-operative complications involving the branch.

Optimal number of atlases and label fusion for automatic multi-atlas-based brachial plexus contouring in radiotherapy treatment planning

BACKGROUND

The present study aimed to define the optimal number of atlases for automatic multi-atlas-based brachial plexus (BP) segmentation and to compare Simultaneous Truth and Performance Level Estimation (STAPLE) label fusion with Patch label fusion using the ADMIRE® software. The accuracy of the autosegmentations was measured by comparing all of the generated autosegmentations with the anatomically validated gold standard segmentations that were developed using cadavers.

MATERIALS AND METHODS

Twelve cadaver computed tomography (CT) atlases were used for automatic multi-atlas-based segmentation. To determine the optimal number of atlases, one atlas was selected as a patient and the 11 remaining atlases were registered onto this patient using a deformable image registration algorithm. Next, label fusion was performed by using every possible combination of 2 to 11 atlases, once using STAPLE and once using Patch. This procedure was repeated for every atlas as a patient. The similarity of the generated automatic BP segmentations and the gold standard segmentation was measured by calculating the average Dice similarity (DSC), Jaccard (JI) and True positive rate (TPR) for each number of atlases. These similarity indices were compared for the different number of atlases using an equivalence trial and for the two label fusion groups using an independent sample-t test.

RESULTS

DSC's and JI's were highest when using nine atlases with both STAPLE (average DSC = 0,532; JI = 0,369) and Patch (average DSC = 0,530; JI = 0,370). When comparing both label fusion algorithms using 9 atlases for both, DSC and JI values were not significantly different. However, significantly higher TPR values were achieved in favour of STAPLE (p < 0,001). When fewer than four atlases were used, STAPLE produced significantly lower DSC, JI and TPR values than did Patch (p = 0,0048).

CONCLUSIONS

Using 9 atlases with STAPLE label fusion resulted in the most accurate BP autosegmentations (average DSC = 0,532; JI = 0,369 and TPR = 0,760). Only when using fewer than four atlases did the Patch label fusion results in a significantly more accurate autosegmentation than STAPLE.

Formaldehyde exposure and its effects during pregnancy: Recommendations for laboratory attendance based on available data

Formalin is commonly used in fixation of cadaveric specimens. Exposure to formaldehyde, a component of formalin and a known carcinogen, during gross anatomy laboratory dissection is a continuing concern for pregnant students and instructors. Since there is little literature on this specific topic, the current review was compiled in the hope of offering recommendations to pregnant students and instructors who are engaged in human anatomical dissection where formalin is used. Relevant articles were obtained through searches of PubMed and Google Scholar for the terms "formaldehyde," "pregnant," "formalin," and "exposure." A literature search was conducted for chemical information and articles about exposure as issued by government regulatory agencies and chemical companies that produce formaldehyde. This led to the compilation of 29 articles each of which included references to previous, relevant, human research. The reviewed literature contains data strongly suggesting that pregnancy can be affected by formaldehyde exposure. Therefore, on the basis our analysis, female students who might be pregnant should avoid formaldehyde exposure, including that in a gross anatomy laboratory. Instructors should find other means of ensuring anatomical competence for these students.

All Eyes on Egypt: Islam and the Medical Use of Dead Bodies Amidst Cairo's Political Unrest

Using dead bodies for medical purposes has long been considered taboo in Egypt. Public health campaigns, physicians' pleas, and the urgings of religious scholars all failed to alter public opinion regarding the donation of dead bodies either for instructional material or for therapeutic treatments. Yet in 2011, amid revolutionary turmoil in Egypt, a campaign was launched for people to donate their eyes upon death; this time, people readily signed up to be donors. Focusing on mass eye trauma that occurred in Egypt amid the political uprisings of 2011, I raise questions about when and why Islam can explain people's attitudes and behaviors, particularly toward death and medicine. The case of mass eye trauma in Egypt and citizens' reformulations of questions once jealously controlled by state-aligned doctors, politicians, and religious scholars unsettles the boundaries between 'religion' and 'secularism' in medical practice. [Formula: see text].

Time- and temperature-dependent changes in cytochrome c oxidase activity and cyanide concentration in excised mice organs and mice cadavers

Postmortem stability of cyanide biomarkers is often disputed. We assessed the time and temperature-dependent changes in cytochrome c oxidase (CCO) activity and cyanide concentration in various organs of mice succumbing to cyanide. Immediately after death, excised mice organs and mice cadavers were stored at room temperature (35°C ± 5°C) or in frozen storage (-20°C ± 2°C). At various times after death, CCO activity and cyanide concentrations were measured in excised mice organs or organs removed from mice cadavers. The study revealed that (i) measuring both the biomarkers in mice cadavers was more reliable compared to excised mice organs, (ii) measuring temporal CCO activity and cyanide concentration in vital organs from mice cadavers (room temperature) was reliable up to 24 h, and (iii) CCO activity in the brain and lungs and cyanide concentration in organs from mice cadavers (frozen) were measurable beyond 21 days. This study will be helpful in postmortem determination of cyanide poisoning.

The production of anatomical teaching resources using three-dimensional (3D) printing technology

The teaching of anatomy has consistently been the subject of societal controversy, especially in the context of employing cadaveric materials in professional medical and allied health professional training. The reduction in dissection-based teaching in medical and allied health professional training programs has been in part due to the financial considerations involved in maintaining bequest programs, accessing human cadavers and concerns with health and safety considerations for students and staff exposed to formalin-containing embalming fluids. This report details how additive manufacturing or three-dimensional (3D) printing allows the creation of reproductions of prosected human cadaver and other anatomical specimens that obviates many of the above issues. These 3D prints are high resolution, accurate color reproductions of prosections based on data acquired by surface scanning or CT imaging. The application of 3D printing to produce models of negative spaces, contrast CT radiographic data using segmentation software is illustrated. The accuracy of printed specimens is compared with original specimens. This alternative approach to producing anatomically accurate reproductions offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form.

The production of anatomical teaching resources using three-dimensional (3D) printing technology

The teaching of anatomy has consistently been the subject of societal controversy, especially in the context of employing cadaveric materials in professional medical and allied health professional training. The reduction in dissection-based teaching in medical and allied health professional training programs has been in part due to the financial considerations involved in maintaining bequest programs, accessing human cadavers and concerns with health and safety considerations for students and staff exposed to formalin-containing embalming fluids. This report details how additive manufacturing or three-dimensional (3D) printing allows the creation of reproductions of prosected human cadaver and other anatomical specimens that obviates many of the above issues. These 3D prints are high resolution, accurate color reproductions of prosections based on data acquired by surface scanning or CT imaging. The application of 3D printing to produce models of negative spaces, contrast CT radiographic data using segmentation software is illustrated. The accuracy of printed specimens is compared with original specimens. This alternative approach to producing anatomically accurate reproductions offers many advantages over plastination as it allows rapid production of multiple copies of any dissected specimen, at any size scale and should be suitable for any teaching facility in any country, thereby avoiding some of the cultural and ethical issues associated with cadaver specimens either in an embalmed or plastinated form.

Attitudes of Australian chiropractic students toward whole body donation: a cross-sectional study

Cadavers play an important role in anatomy education. In Australia, bodies for anatomy education are acquired only through donations. To gain insight into educational dynamics in an anatomy laboratory as well as to facilitate body donation programs and thanksgiving ceremonies, it is important to understand students' attitudes toward body donation. In this cross-sectional study, the attitudes of Macquarie University's first, second, and fifth year chiropractic students toward body donation were investigated. Macquarie University chiropractic students have a four semester long anatomy program, which includes cadaver-based instruction on prosected specimens. A questionnaire was used to record respondents' demographics and attitudes toward body donation: personal, by a relative, and by a stranger. It was found that ethnicity and religion affect attitudes toward body donation, with Australian students being more willing to donate a stranger's body and atheists and agnostics being more willing to donate in general. Furthermore, willingness to donate one's own or a family member's body decreases as year of study increases, suggesting a possible negative impact of exposure to cadavers in the anatomy laboratory. This was only true, however, after controlling for age. Thus, the impact of viewing and handling prosected specimens, which is the norm in anatomy classes in Australia, may not be as strong as dissecting cadavers. It is suggested that anatomists and educators prepare students for cadaver-based instruction as well as exhibit sensitivity to cultural differences in how students approach working with cadavers, when informing different communities about body donation programs and in devising thanksgiving ceremonies.

The Hybrid III upper and lower neck response in compressive loading scenarios with known human injury outcomes

OBJECTIVE

Physical biomechanical surrogates are critical for testing the efficacy of injury-mitigating safety strategies. The interpretation of measured Hybrid III neck loads in test scenarios resulting in compressive loading modes would be aided by a further understanding of the correlation between the mechanical responses in the Hybrid III neck and the probability of injury in the human cervical spine. The anthropomorphic test device (ATD) peak upper and lower neck responses were measured during dynamic compressive loading conditions comparable to those of postmortem human subject (PMHS) experiments. The peak ATD response could then be compared to the PMHS injury outcomes.

METHODS

A Hybrid III 50th percentile ATD head and neck assembly was tested under conditions matching those of male PMHS tests conducted on an inverted drop track. This includes variation in impact plate orientation (4 sagittal plane and 2 frontal plane orientations), impact plate surface friction, and ATD initial head/neck orientation. This unique matched data with known injury outcomes were used to evaluate existing ATD neck injury criteria.

RESULTS

The Hybrid III ATD head and neck assembly was found to be robust and repeatable under severe loading conditions. The initial axial force response of the ATD head and neck is very comparable to PMHS experiments up to the point of PMHS cervical column buckle or material failure. An ATD lower neck peak compressive force as low as 6,290 N was associated with an unstable orthopedic cervical injury in a PMHS under equivalent impact conditions. ATD upper neck peak compressive force associated with a 5% probability of unstable cervical orthopedic injury ranged from as low as 3,708 to 3,877 N depending on the initial ATD neck angle.

CONCLUSIONS

The correlation between peak ATD compressive neck response and PMHS test outcome in the current study resulted in a relationship between axial load and injury probability consistent with the current Hybrid III injury assessment reference values. The results add to the current understanding of cervical injury probability based on ATD neck compressive loading in that it is the only known study, in addition to Mertz et al. (1978), formulated directly from ATD compressive loading scenarios with known human injury outcomes.

Computed tomography-enhanced anatomy course using enterprise visualization

Rapid changes in medical knowledge are forcing continuous adaptation of the basic science courses in medical schools. This article discusses a three-year experience developing a new Computed Tomography (CT)-based anatomy curriculum at the Sackler School of Medicine, Tel Aviv University, including describing the motivations and reasoning for the new curriculum, the CT-based learning system itself, practical examples of visual dissections, and student assessments of the new curriculum. At the heart of this new curriculum is the emphasis on studying anatomy by navigating inside the bodies of various living individuals utilizing a CT viewer. To assess the students' experience with the new CT-based learning method, an anonymous questionnaire was administered at the end of the course for three consecutive academic years: 2008/2009, 2009/2010, 2010/2011. Based upon the results, modifications were made to the curriculum in the summers of 2009 and 2010. Results showed that: (1) during these three years the number of students extensively using the CT system quadrupled (from 11% to 46%); (2) students' satisfaction from radiologists involvement increased by 150%; and (3) student appreciation of the CT-based learning method significantly increased (from 13% to 68%). It was concluded that discouraging results (mainly negative feedback from students) during the first years and a priori opposition from the teaching staff should not weaken efforts to develop new teaching methods in the field of anatomy. Incorporating a new curriculum requires time and patience. Student and staff satisfaction, along with utilization of the new system, will increase with the improvement of impeding factors.

Microscopic clusters of sensory neurons in C1 spinal nerve roots and in the C1 level of the spinal accessory nerve in adult humans

This study examined C1 spinal nerve roots and their anastomotic connections with the spinal accessory nerve for histological evidence of sensory neurons in adult humans. C1 spinal nerves and roots with the adjacent segments of the spinal accessory nerve and the spinal cord were dissected en bloc from cadaveric specimens, and prepared for histological study. Results show that in 39.3% of specimens studied, no sensory component to the C1 spinal nerve could be identified. The C1 dorsal root was present 35.7% of the time, and when present it always contained neuronal cell bodies. In the remaining specimens, the sensory contribution to the C1 spinal nerve came through an anastomotic connection with the spinal accessory nerve. The investigators were able to identify clusters of neuronal cell bodies along the spinal accessory nerve at the level of C1 in 100% of the specimens examined.

"They increase in beauty and elegance": transforming cadavers and the epistemology of dissection in early nineteenth-century American medical education

This paper investigates the origins of the practice of dissection in American medical education in order to both understand the function of dissection in medical education and challenge conventional wisdom about that function. In the late eighteenth and early nineteenth centuries, American medical schools increasingly made human dissection a crucial part of their curricula, privileging use of the human cadaver over any other anatomical model. In this paper, I break apart the claims that American physicians made at that time regarding the unique pedagogic usefulness of the cadaver, and I juxtapose those claims against the realities of the dissection process. In doing so, I show how the realities of dissection differed sharply from the depictions given by physicians. In the conclusion, I argue that the cadaver still remained epistemologically and ontologically useful to the medical profession, although not necessarily for the reasons physicians explicitly stated.

The relationship of the number of Meissner's corpuscles to dermatoglyphic characters and finger size

This study investigated the relationships between the density of Meissner's corpuscles and the dermatoglyphic characteristics of human fingers. Dermatoglyphic prints and tissue samples were collected from the index (II) and ring (IV) fingers of 28 cadavers from the Medical School, University of Adelaide. Pattern types, pattern intensity, total ridge count and ridge breadth, were determined for each sample and the density of Meissner's corpuscles established by recording the mean number of Meissner's corpuscles underlying a 10 mm long line on the skin surface. No relationship was found between the density of Meissner's corpuscles and pattern type, pattern intensity or total ridge count. Negative correlations were found for the density of Meissner's corpuscles with both ridge width and size of fingers. Males were found to have significantly larger fingers, larger ridge breadth, and a lower density of Meissner's corpuscles per 10 mm compared with females. However, there was no difference between the total number of Meissner's corpuscles per finger in males and females. No significant differences were found in either the density of Meissner's corpuscles between antimeres or between the index and ring fingers. These results suggest that for both the left and right hand in males and females, there is a similar number of Meissner's corpuscles for both the index and ring fingers.