Posterior subscapular dissection: An improved approach to the brachial plexus for human anatomy students

Students of human anatomy are required to understand the brachial plexus, from the proximal roots extending from spinal nerves C5 through T1, to the distal-most branches that innervate the shoulder and upper limb. However, in human cadaver dissection labs, students are often instructed to dissect the brachial plexus using an antero-axillary approach that incompletely exposes the brachial plexus. This approach readily exposes the distal segments of the brachial plexus but exposure of proximal and posterior segments require extensive dissection of neck and shoulder structures. Therefore, the proximal and posterior segments of the brachial plexus, including the roots, trunks, divisions, posterior cord and proximally branching peripheral nerves often remain unobserved during study of the cadaveric shoulder and brachial plexus. Here we introduce a subscapular approach that exposes the entire brachial plexus, with minimal amount of dissection or destruction of surrounding structures. Lateral retraction of the scapula reveals the entire length of the brachial plexus in the subscapular space, exposing the brachial plexus roots and other proximal segments. Combining the subscapular approach with the traditional antero-axillary approach allows students to observe the cadaveric brachial plexus in its entirety. Exposure of the brachial dissection in the subscapular space requires little time and is easily incorporated into a preexisting anatomy lab curriculum without scheduling additional time for dissection.     

超声容积导航引导经腰椎间孔穿刺的应用解剖

目的:在尸体上应用实时超声图像与CT图像融合的容积导航引导经椎间孔穿刺并评估其准确性并探讨超声容积导航技术引导椎间孔穿刺应用于临床的可行性。方法:在5具尸体上,应用容积导航技术引导双侧椎间孔穿刺,每具均进行双侧L1/2~L4/5椎间孔穿刺,共进行40次穿刺。记录配准误差、超声所能观察到针尖的最后位置距靶点距离(DNT)及总穿刺时间(包括配准及放置穿刺针时间),CT测量穿刺误差(导航到位后经CT验证针尖到目标靶点的距离),以此验证超声引导穿刺的准确性。结果:尸体实验中,配准误差为(2.78±0.87)mm,DNT为(20.24±1.69)mm,穿刺误差为(2.89±1.18)mm,总穿刺时间为22。3 min±4.5 min,其中图像配准时间19.1 min±4.3 min,放置穿刺针时间3.3 min±0.7 min。结论:与传统C臂机导航相比,利用实时超声图像与CT、图像融合的容积导航技术可准确引导腰椎经皮后外侧入路椎间孔穿刺,将该技术应用于临床,能明显减少X线辐射量,在经皮内窥镜下腰椎间盘切除术椎间孔穿刺中有着广阔的应用前景。     

Saturated salt solution: a further step to a formaldehyde‐free embalming method for veterinary gross anatomy

In the field of veterinary anatomy, most of the specimens used in practical sessions are perfused with fixatives. Thus, they can be used for a longer time_, reducing the number of animals for educational purposes. Formalin is the most commonly used fixative, consisting of a 37% formaldehyde solution. However, formaldehyde is a powerful irritant of the eyes and airways and is considered carcinogenic, causing nasopharyngeal cancer in exposed workers and professionals. In the present study, we explored an alternative method to avoid the use of formaldehyde in specimens used for gross anatomy practical sessions. We propose an inexpensive, non‐toxic fixative that is available worldwide, such as sea salt. This method consists of a continuous perfusion of saturated salt solution for a period of 6–8 h, enabling drainage of the solution to avoid a weight increase of the specimen, and allowing salt to be retained in the tissue. The method is based on recirculation of the saturated salt solution instead of maceration. Perfused specimens retained their natural consistency and joint mobility, with no blood, resembling a piece of meat from the slaughterhouse. They could be used immediately without a maceration period, or stored in the fridge until use and then kept in a bath of saturated salt solution for future conservation. In the case of the former, no refrigeration was needed. The specimens did not have an irritating or offensive smell, and could be used for long sessions (several hours per day) and stored for long periods. However, the blood vessels used for perfusion determine the results: a less invasive approach (through common carotid arteries) gave good preservation of the musculoskeletal system, whereas more invasive access to cannulate the abdominal aorta and vena cava caudalis was required to achieve better preservation of the viscera. In conclusion, we propose that perfusion followed by immersion in a saturated salt solution is a good alternative method for the preservation of specimens used in the practical teaching of gross veterinary anatomy. It is a very simple and inexpensive technique, and is much healthier for users than traditional formalin. Moreover, specimens can be preserved for prolonged periods, and maintain a similar appearance and consistency to fresh material.     

Freeze-dried specimens for gross anatomy teaching

As more and more emphasis is placed on the use of prosected specimens to support teaching and learning of gross anatomy, consideration must be given to developing new methods to preserve human cadaveric material, and in ways which will resist the wear and tear to which they are necessarily subjected. Taxidermists have developed techniques for freeze-drying whole small animals as a method of long term preservation (Metcalf, 1981). We have explored the use of this methodology to preserve small prosected specimens for use in the teaching of gross anatomy. The technique we report here was tested initially on larynges (Fig. 1) but has since been applied with equal success to other structures, including pieces of small intestine dissected to show the arterial arcades (Fig. 2). We have used material from cadavers which were preserved using our standard embalming procedure (O'Sullivan & Mitchell, 1993).     

在人体解剖学教学中如何开展启发式教学

<正>启发式教学法是以激发学生的积极性和主动性为出发点,按照思维发展的规律阐述书本知识,科学地引导学生开动脑筋,积极思考,融会贯通地掌握知识,增强技能,发展智力。其教学效果明显优于传统的灌注式教学法。很多人认为解剖学是对人体形态的客观描述,它的内容较"死板",讲授时难以进行启发和诱导。实际上人体是物质运动发展的高级形式,它的形态结构亦是活生生的,具有深刻的内涵。它的教学不仅可以而且必须     

Development of multimedia learning modules for teaching human anatomy: application to osteology and functional anatomy

Computer-assisted learning (CAL) is growing quickly within academic programs. Although the anatomical commercial packages that are available for this learning have attractive advantages, they also have drawbacks: they are frequently not in the local language of the students, they do not perfectly answer the needs of the local academic program, and their cost is frequently more than students can afford. This study describes a relatively inexpensive method to create CAL tutorials, whose content can be fully customized to local academic needs in terms of both program and language. The study describes its use in creating multimedia learning modules (MLMs) about Osteology and joint kinematics. The pedagogical content in these modules was collected from objective experiments to give students the opportunity to access new scientific knowledge during their education. It can be replaced, as desired, by almost any content due to the flexibility of the production method. Each MLM consists of two complementary subelements: a multimedia theoretical lecture and a three-dimensional interactive laboratory. Such MLMs are in use at both the University of Brussels (ULB) and the National University of Rwanda (NUR). The development of this work was part of the VAKHUM project, and the pedagogical validation is currently being performed as part of the MULTIMOD project.     

以创新为理念的临床应用解剖学教学改革

为了适应21世纪解剖教学改革的趋势,培养研究生的动手能力、创新意识和创新能力,北京协和医学院研究生院临床应用解剖学课程从2010年开始改革,经过5年的教学实践,对所获得的经验及存在的问题进行总结,以期为未来的课程发展提供借鉴.     

微创临床局部解剖学教学体系的建立和探索

目的随着临床医学中微创手术的广泛开展,传统局部解剖学的教学模式明显不切合于现在的临床应用,我们在近3年的局部解剖学教学中,尝试建立基础与临床相结合的临床微创局部解剖学教学体系,实现了医学生培养上的多赢。方法在北京大学医学部的3个年级临床医学专业的医学生中,分成传统局部解剖学(局解组)和微创局部解剖学(微创局解组)。微创局解组同学借助模拟腔镜等微创手术器械,开展微创临床解剖学的教学。结果与传统局解组相比,微创局解组同学在学习兴趣,学习的主动性,知识的牢固性,解剖动手能力,临床思维能力,解剖和临床知识的互补性,讨论及交流能力和师生互动等方面均有不同程度的提高。结论微创解剖学教学体系不仅能够满足医学生尤其是临床医学生早期接触临床微创手术及手术器械的需要,并且还可以促进解剖学老师深入了解临床手术的进展,有利于进一步明确教学目的,并促进了基础解剖与临床进展的交流。     

关于加强断层影像解剖学教学的对策

医学影像学的快速发展和以临床应用为导向的基础医学的改革，对解剖学教学提出了新的要求，进行断层影像解剖学教学已势在必行。结合我校的实际情况，现就如何加强断层影像解剖学教学提出几点意见。     

成人医学教育解剖学教学改革的探讨

成人医学高等教育是医学教育事业的一部分，担负着医药卫生人员毕业后继续教育的重任。解剖学作为医学中的重要基础学科，要想切实保证解剖学的教学质量，就必需针对不同层次学生的特点，制定不同的教学方案。鉴于此，本文对2002级的专升本成人学生的解剖学教学进行了改革，以确保教学质量的提高。     

The use of brainstorming for teaching human anatomy

Interactive teaching techniques have been used mainly in clinical teaching, with little attention given to their use in basic science teaching. With the aim of partially filling this gap, this study outlines an interactive approach to teaching anatomy based on the use of "brainstorming." The results of the students' critique of the teaching techniques are also included. Seventy-five students from the first-year nursing curriculum were tested by a structured questionnaire after three brainstorming sessions. The overall response to these sessions was very positive, indicating that students perceived this interactive technique as both interesting and useful. Furthermore, this approach may provide a useful strategy when learning the clinical courses of the upcoming academic years.     

An improved dinitrosalicylic acid method for determining blood and cerebrospinal fluid sugar levels

A development of a technique for estimating sugar in blood, cerebrospinal fluid, etc., is described, using 3:5-dinitrosalicylic acid (D.N.S.A.) originally introduced by Sumner (1921).     

系统解剖学sandwich教学法教案编写体会

解剖学虽是医学课程中的基础课程,但占有非常重要的地位。目前许多医学院对解剖学的教学采用了整合式的课程模式、以器官系统为中心的课程模式、采用PBL（以问题为基础的教学方式）或以任务为基础的教学方式等。这些教学方法存在各自的优点,但就解剖学的教学来说都有一定的局限性。Sandwich教学法,即通常所说的“三明治”教学法,即通过教师与学生、学生与学生之间不断交流、沟通,充分调动学生主动学习的积极性,采用多途径、多手段的教学方法…。本文以系统解剖学中端脑的内部结构为例,具体谈谈Sandwich教案的编写体会。