Rethinking gross anatomy in a compressed time frame: Clinical symptoms,not case studies,as the basis for introductory instruction

The goal of this observational study was to develop effective approaches to introduce first year medical students to gross anatomy/embryology in a compressed time frame. Pedagogical reorganization of anatomy instruction in the regions of Lower Extremity and Head and Neck was based upon core clinical conditions taught in second‐year and USMLE Step 1 board review courses. These conditions were not presented as clinical problems, as many students had limited prior training in medical terminology, but focused upon clinical symptoms, allowing for direct correlation of structure and function. Instruction stressed vocabulary acquisition and was extended to prepare for laboratory dissections. Overall methodology was multimodal, including “flipped” and traditional lectures, study of prosections/radiographs and small group laboratory review sessions. Content was significantly reduced: knowledge of muscle actions and innervations was required, not muscle origins and insertions. Performance was evaluated by criterion‐based written examinations that included a set of questions (34) asked repetitively over an 8 year period (n = 606 students) and by regional practical exams. Mean scores in all areas were sustained or numerically improved, despite the compression of instruction duration. Analysis showed no significant differences based upon question format or instructional modality. Despite the high performance levels, students needing assistance in learning could be identified by score distributions. A survey of students indicated that these changes effectively decreased stress and facilitated review for the USMLE Step 1 Board examination. These results suggest that training in gross anatomy can be modified to a compressed duration by instruction in the context of clinical symptomatology.     

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.     

Abdominal aortic calcification is associated with decline in handgrip strength in the U.S. adult population ≥40 years of age

Background and aimsThe present study investigated the association between abdominal aortic calcification (AAC) and handgrip strength (HGS) and the ability of HGS to predict an increased AAC phenotype in adults.Methods and resultsThe analysis consisted of data for 3140 men and women aged ≥40 years (51.7% women) from the 2013–2014 NHANES. Lateral scans of the thoraco-lumbar spine (L1–L4) were scored for AAC using a validated 8-point scale (AAC-8); subjects with a score of ≥3 were considered at increased risk for cardiovascular disease due to a high AAC phenotype. HGS was assessed using a grip dynamometer. The prevalence of severe AAC in the population was 9.0%. Decline in HGS was associated with higher AAC-8 scores in men and women (p < 0.001). General linear model analysis showed that HGS levels were negatively associated with high AAC (p < 0.001) and AAC-8 status for both sexes. Likewise, for each 5-kg higher HGS, there lower odds of a high AAC phenotype (in men OR = 0.73, CI95%, 0.64–0.84) and (women OR = 0.58, CI95%, 0.47–0.70). Receiver operating characteristic curve analysis showed that the HGS threshold value to detect high risk of AAC in adults was ≥37.3 kg (AUC = 0.692) in men and 25.1 kg (AUC = 0.705) in women.ConclusionLower muscular strength, as measured by HGS, is associated with higher AAC scores in the U.S. population ≥40 years of age. Accordingly, maintenance of muscular strength during aging may protect adults against vascular calcification, an independent predictor of cardiovascular events. HGS measurement seems to be a valid screening tool for detecting a high ACC phenotype in adults.     

经主动脉窦途径射频消融心动过速临床研究

目的:探讨经主动脉窦途径导管射频消融治愈的快速性心律失常患者的心电图特点及射频消融情况.方法:回顾性分析17例室性心动过速/室性期前收缩、前间隔房性心动过速及前间隔旁路等该类患者的体表心电图、及消融成功时靶点电图等心电生理学特征.结果:经主动脉窦途径导管射频消融治愈室性心动过速/室性期前收缩12例,其中起源于左冠状动脉窦(左冠窦)10例、右冠状动脉窦(右冠窦)2例;源于无冠状动脉窦(无冠窦)的局灶性前间隔房性心动过速3例及前间隔旁路2例.室性心动过速/室性期前收缩心电图特点:Ⅱ、Ⅲ和aVF导联为高大R波,胸导联R波移行较早,V1导联r/S波振幅比≥30%,r波时限(82.2±16.4)ms,V1导联中r/QRS波时限比≥50%,V5、V6导联为高振幅R波、无s波.有效消融靶点心内电图示心室波明显比体表心电图QRS波提前(35.2±21.6)ms.前间隔房性心动过速均能被心房刺激反复诱发和终止,其心电图特点:房性心动过速时P波间期明显窄于窦律时P波间期,Ⅰ、aVL导联P波正向,Ⅱ、Ⅲ和aVF导联P呈负正双向.在心房标测中提示最早的心房激动在希氏(His)束区,但在主动脉无冠窦内标测的心房激动较His束区的心房波提前,其解剖定位于His束上后方,消融靶点无His束电位.前间隔旁路心电图示:窦性心律时呈窄QRS波形,未见预激波,心动过速呈窄QRS形,在无冠窦内记录到最早心房激动点,且无His束电位.17例均消融成功.结论:源于主动脉窦内的室性心动过速/室性期前收缩、前间隔房性心动过速和前间隔旁路具有相对的心内电生理学特征,常规心内膜途径消融困难时应该考虑从主动脉窦途径标测消融策略,把握消融导管与冠状动脉的关系,导管消融治疗安全而有效.     

术中经食道超声心动图在急性Stanford A型主动脉夹层手术中的应用价值

目的 探讨术中经食道超声心动图（Transesophageal Echocardiography,TEE）在急性Stanford A型主动脉夹层（AAD）手术中的应用价值。 方法 选取经全主动脉CTA诊断为ADD的患者41例,术前行TEE检查,根据TEE检出主动脉根部受累情况分为三组：夹层未累及主动脉根部组（A组）16例,主动脉根部轻-中度受累组（B组）9例,主动脉根部重度受累组（C组）16例。均行术前TEE检查观察主动脉根部形态、夹层受累情况,包括主动脉瓣叶形态、功能,测量并比较各组主动脉瓣环内径、主动脉窦部内径、窦管交界内径及可显示升主动脉段的最大内径,观察冠状动脉起始段形态;术后TEE即刻观察手术效果。并将TEE结果与术中所见进行比较。结果 41例患者术前TEE对升主动脉内撕裂的内膜片显示阳性率为100%。B、C组主动脉窦部内径均大于A组,C组主动脉窦部内径大于B组,差异均有统计学意义（P＜0.05）;A、B、C三组患者主动脉瓣环及升主动脉内径比较差异均无统计学意义。经手术证实,术前TEE诊断夹层累及冠状动脉的特异性为62.5%,敏感性为56%。术后TEE可评估人工主动脉瓣或修复主动脉瓣形态、功能,以及人工血管、冠状动脉等吻合情况。结论 术前TEE能准确评估AAD主动脉根部及冠状动脉受累情况,术后TEE可即刻评估手术效果,具有重要的临床应用价值。