BACKGROUND:The prevalence of gallstones is low in Asians.In Iran,many factors influence the prevalence of this disease.The aim of this study was to determine the prevalence of gallbladder stones and their chemical cha...BACKGROUND:The prevalence of gallstones is low in Asians.In Iran,many factors influence the prevalence of this disease.The aim of this study was to determine the prevalence of gallbladder stones and their chemical characteristics in a population by the study of cadavers. METHODS:In this cross-sectional study,autopsies were performed on 253 cadavers of more than 13 years old.The cadavers were studied to determine the number,location of stone formation,chemical composition,dry weight,and mean diameter of stones in the gallbladder and common bile duct. RESULTS:The prevalence of gallstone disease in these cadavers was 6.3%(men 4.7%,women 8.6%,not significantly different,P=0.216).There was a positive relationship between the age and prevalence of gallstone disease(P=0.033).The most common stone compositions were cholesterol and oxalate.The mean diameter (P=0.0058)and dry weight(P<0.0001)of stones were higher in the gallbladder than in the common bile duct. Positive relations between the amount of oxalate and mean diameter,and between the amount of oxalate and mean dry weight of gallstones were found,but the relationship between the amount of cholesterol and mean diameter was inverse. CONCLUSIONS:The prevalence of gallstones differed among age groups.Diameter and dry weight of gallstones were dependent on location of stone formation and chemical composition.展开更多
Background: The AmbuAuraGain is a new single-use supraglottic airway device with gastric channel designed to facilitate intubation. The aim of the study was to assess the anatomic position and the performance of the A...Background: The AmbuAuraGain is a new single-use supraglottic airway device with gastric channel designed to facilitate intubation. The aim of the study was to assess the anatomic position and the performance of the AuraGain in fresh cadavers compared to that of the Intersurgical i-gel and LMA Supreme New Cuff. Methods: The 3 devices were inserted in random order in 7 fresh cadavers without difficult airway criteria. The assessed items were: Insertion time, number of attempts and ease of insertion, airway seal pressure, ease of gastric tube insertion, endoscopic view of vocal cords, efficacy of guided tracheal intubation through the AuraGain and i-gel, and anatomic fit by lateral X-ray and neck dissections. Results: All devices were successfully inserted within 3 attempts, except for one case of the LMA Supreme. Adjusting manoeuvres were often required to accomplish correct insertion. A 16 G gastric tube was easily advanced through all AuraGain and LMA Supreme devices. Fiberoptic tracheal intubation was effectively achieved through all AuraGain and i-gel devices in less than 60 s. Lateral X-ray and neck dissections confirmed optimal alignment of all devices with the respiratory and digestive tracts. Conclusions: Insertion of the new AmbuAuraGain required adjusting manoeuvres in some cases, as observed with the other two devices, and achieved similar airway seal pressures. Passage of a large bore gastric tube was as fast as with the LMA Supreme and ease of guided intubation was similar to that of the i-gel.展开更多
Visual Cadavers is anemerging study method which promotes medical education and practical applications.It is benefited from other techniques and evaluated as having huge advantages,which is not only accelerating teach...Visual Cadavers is anemerging study method which promotes medical education and practical applications.It is benefited from other techniques and evaluated as having huge advantages,which is not only accelerating teaching and learning,but also improving scientific study,nevertheless,with limited cons.展开更多
Introduction:Storage of specimens sampled from human remains for pathological testing,embalming for burial purposes,and for human identification often requires formalin fixation and/or paraffin embedding.Current knowl...Introduction:Storage of specimens sampled from human remains for pathological testing,embalming for burial purposes,and for human identification often requires formalin fixation and/or paraffin embedding.Current knowledge in molecular biology techniques and forensic DNA analysis makes it possible to optimize the extraction of amplifiable DNA from formalin-fixed tissues by improving the pre-treatment,optimizing the digestion condition of proteinase K,simplifying the extraction protocol and purifying the extracted DNA with optimized volumes of alcohol.Aim:This research sought to extract amplifiable DNA from thirteen brain,bone marrow and cartilage samples from four formalin embalmed human cadavers.Materials and Methods:Brain,cartilage and bone marrow samples were taken from four different cadavers at autopsy at the Ghana Police Hospital mortuary in Accra,Ghana sixty-two days after embalming.An optimized preparation and DNA extraction protocol was carried out on all the samples.Brain samples were also taken from a non-formalin treated fifth cadaver of known STR profile,and standard DNA extraction performed to serve as positive control.Results:Our optimized protocol yielded detectable quantities of DNA from the samples when quantified with the 7500 Real-Time PCR equipment.The extracted DNA also yielded full STR profiles with varying peak heights for forensic identification purposes.The measured degradation indexes of the DNA samples were greater than 1.0,with peak heights of generated STR profiles above the limits of detection of the 3500 genetic analyzer.Conclusion:Our current study demonstrated an optimized method of DNA extraction from tissues(brain,cartilage and bone marrow)sampled from formalin embalmed human cadavers.The optimized protocol reduced the concentration of formalin fixation residues in extracted DNA from formalin-fixed tissues,thereby improving the amplification efficiency for STR profiling.Brain,bone marrow and cartilages can be a good source of DNA from embalmed and degraded human remains,though for skeletonized human remains together with teeth and long bones.展开更多
Objective:Critically appraise the current state of alternate temporal bone training techniques(virtual reality(VR)simulation,3D-printed models,and mental practice(MP))compared to traditional and cadaver methods.Databa...Objective:Critically appraise the current state of alternate temporal bone training techniques(virtual reality(VR)simulation,3D-printed models,and mental practice(MP))compared to traditional and cadaver methods.Databases Reviewed:PubMed,Cochrane,Web of Science.Methods:Search terms utilized“temporal bone training”,“temporal bone surgical modalities”,and“training modalities temporal bone surgery”with“3D”,“rapid prototyp*”,“stereolithography”,“additive manufact*”,“plaster”,“VR”,“virtual reality”,“animal model”,“animal temporal bone”,and“synthetic”with“AND”for all literature.Exclusion criteria:non-ENT,non-English,and did not compare against alternative/traditional methods.Results:10 studies were included with 322 participants(83.9%ENT residents and 16.1%medical students).Costs include the FDM printer($300),materials($5/3D model),and<$5,000 for freeware simulator hardware.The Welling scale was used in 50%of studies.Alternate methods produced comparable or improved assessment scores to traditional and cadaver methods.Injuries were reported in three VR studies,with two reported significantly lower injury scores in the intervention groups.Time to completion was not significantly different in four VR studies,except for one finding that the time to visualize the incus was significantly lower in the intervention group.Performance after MP was not statistically different.Conclusion:More data are needed to assess whether the alternate methods are comparable to cadaveric dissection in temporal bone training.3D models and VR simulation demonstrate promising potential for novel trainees to acquire the basic skills and produce performance comparable to or significantly better than traditional methods of lectures,textbooks,CT images,and operative videos.展开更多
AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diame...AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diameters of the portal vein(PV),the inferior vena cava(IVC),and distance between the two structures were measured.Similar measurements were performed on 20 adult corpses.The feasibility of portacaval shunt based on those measurements was analyzed.First stage of the extrahepatic portacaval shunt using MCT was performed on five cadavers.Specifically,the PV and IVC were exposed through an abdominal incision of the cadavers.The parent magnet was introduced from the femoral vein and was delivered into the IVC by an anchor wire and a 5F Cook catheter.The daughter magnet was introduced into the PV through the splenic vein using aninterventional guide wire.When the daughter magnet met the parent magnet,they automatically clipped together and the first stage of the portacaval shunt was set up.RESULTS: The average diameters of the PV and the IVC measured from the 30 CT image were 14.39 ± 2.36 mm and 18.59 ± 4.97 mm,respectively,and the maximum and minimum distances between the PV and the IVC were 9.79 ± 4.56 mm and 9.50 ± 4.79 mm,respectively.From 20 cadavers,the average diameters of the PV and the IVC were 14.48 ± 1.47 mm and 24.71 ± 2.64 mm,and the maximum and minimum distances between the PV and the IVC were 10.14 ± 1.70 mm and 8.93 ± 1.17 mm,respectively.The distances between the PV and the IVC from both the CT images and the cadavers were within the effective length of portacaval anastomosis using MCT(30.30 ± 4.19 mm).The PV and IVC are in close proximity to each other with no intervening tissues or structures in between.Simulated surgeries of the first stage using MCT on five cadavers was successfully performed.CONCLUSION: Anatomically,extrahepatic portacaval shunt employing MCT is highly feasible in humans.展开更多
AIM： To evaluate whether urokinase perfusion of non-heart-beating cadaveric donor livers reduces the incidence of intrahepatic ischemic-type biliary lesions （IITBLs）. METHODS： A prospective study was conducted to ...AIM： To evaluate whether urokinase perfusion of non-heart-beating cadaveric donor livers reduces the incidence of intrahepatic ischemic-type biliary lesions （IITBLs）. METHODS： A prospective study was conducted to investigate potential microthrombosis in biliary microcirculation when non-heart-beating cadaveric livers were under warm or cold ischemic conditions. The experimental group included 140 patients who underwent liver transplantation during the period of January 2006 to December 2007, and survived for more than 1 year. The control group included 220 patients who received liver transplantation between July 1999 and December 2005 and survived for more than 1 year. In the experimental group, the arterial system of the donor liver was perfused twice with urokinase during cold perfusion and after trimming of the donor liver. The incidence of IITBLs was compared between the two groups. RESULTS： In the control group, the incidence of IITBLs was 5.9% （13/220 cases） after 3-11 mo of transplantation. In the experimental group, two recipients （1.4%） developed IITBLs at 3 and 6 mo after transplantation, respectively. The difference in the incidence between the two groups was statistically significant （P 〈 0.05）. CONCLUSION： Double from non-heart-beating perfusion of cadaveric livers donors with urokinase may reduce the incidence of IITBLs.展开更多
The last two decades of the twentieth century have witnessed increasingly successful rates of liver transplantation. The number of liver transplantations has increased steadily while the number of organ donors has rem...The last two decades of the twentieth century have witnessed increasingly successful rates of liver transplantation. The number of liver transplantations has increased steadily while the number of organ donors has remained relatively constant. Thus a great disparity has developed between the demand and supply of donor organs and remains a major limiting factor for further expansion of liver transplantation. Although many procedures, such as split liver[1] , living-related transplantation[2] , and xenotransplantation[3], have been attempted clinically to overcome the shortage, it is hoped that livers harvested from non-heart-beating donors (NHBDs) would alleviatethe problem of organ shortage, which again becomes the focus of attention[4-9]. However, sensitivity of the liver to warm ischemia remains a major worry for use of theNHBDs. The aim of this animal study was to assess if murine liver could tolerate prolonged period of warm ischemia and to determine the optimum timing of intervention in the cadaver donor in order to preserve liver viability.展开更多
OBJECTIVE： This study aims to investigate the relationship between major signal points （MaSPs） of the lower extremities used in court-type Thai traditional massage （CTTM） and the corresponding underlying anatomic...OBJECTIVE： This study aims to investigate the relationship between major signal points （MaSPs） of the lower extremities used in court-type Thai traditional massage （CTTM） and the corresponding underlying anatomical structures, as well as to determine the short-term changes in blood flow and skin temperature of volunteers experiencing CTTM. METHODS： MaSPs were identified and marked on cadavers before acrylic color was injected. The underlying structures marked with acrylic colors were observed and the anatomical structures were determined. Then, pressure was applied to each MaSP in human volunteers （lateral side of leg and medial side of leg） and blood flow on right dorsalis pedis artery was measured using duplex ultrasound while skin temperature changes were monitored using an infrared themographic camera. RESULTS： Short-term changes in the blood flow parameters, volume flow and average velocity, compared to baseline （P 〈 0.05）, were observed on MaSP of the lower extremity, ML4. Changes in the peak systolic velocity of the area ML5 were also observed relative to baseline. The skin temperature of two different MaSPs on the lateral side of leg （LL4 and LL5） and four on the medial side of leg （ML2, ML3, ML4 and ML5） was significantly increased （P 〈 0.05） at 1 rain after pressure application. CONCLUSION： This study established the clear correlation between the location of MaSP, as defined in CTTM, and the underlying anatomical structures. The effect of massage can stimulate skin blood flow because results showed increased skin temperature and blood flow characteristics. While these results were statistically significant, they may not be clinically relevant, as the present study focused on the immediate physiological effect of manipulation, rather than treatment effects. Thus, this study will serve as baseline data for further clinical studies in CTTM展开更多
AIM: To evaluate the pudendal nerve segments that could be identified on magnetic resonance neurography(MRN) before and after surgical marking of different nerve segments.METHODS: The hypothesis for this study was tha...AIM: To evaluate the pudendal nerve segments that could be identified on magnetic resonance neurography(MRN) before and after surgical marking of different nerve segments.METHODS: The hypothesis for this study was that pudendal nerve and its branches would be more easily seen after the surgical nerve marking. Institutional board approval was obtained. One male and one female cadaver pelvis were obtained from the anatomy board and were scanned using 3 Tesla MRI scanner using MR neurography sequences. All possible pudendal nerve branches were identified. The cadavers were then sent to the autopsy lab and were surgically dissected by a peripheral nerve surgeon and an anatomist to identify the pudendal nerve branches. Radiological markers were placed along the course of the pudendal nerve and its branches. The cadavers were then closed and rescanned using the same MRN protocol as the premarking scan. The remaining pudendal nerve branches were attempted to be identified using the radiological markers. All scans were read by an experienced musculoskeletal radiologist.RESULTS: The pre-marking MR Neurography scans clearly showed the pudendal nerve at its exit from the lumbosacral plexus in the sciatic notch, at the level of the ischial spine and in the Alcock's Canal in both cadavers. Additionally, the right hemorrhoidal branch could be identified in the male pelvis cadaver. The perineal and distal genital branches could not be identified. On post-marking scans, the markers were used as identifiable structures. The location of the perineal branch, the hemorroidal branch and the dorsal nerve to penis(in male cadaver)/clitoris(in female cadaver) could be seen. However, the visualization of these branches was suboptimal. The contralateral corresponding nerves were poorly seen despite marking on the surgical side. The nerve was best seen on axial T1W and T2W SPAIR images. The proximal segment could be seen well on 3D DW PSIF sequence. T2W SPACE was not very useful in visualization of this small nerve or its branches.CONCLUSION: Proximal pudendal nerve is easily seen on MR neurography, however it is not possible to identify distal branches of the pudendal nerve even after surgical marking.展开更多
Sciatic nerve tissue was obtained from the gluteus maximus muscle segment of normal human cadavers and amniotic membrane tissue was obtained from healthy human puerperant placentas. Both tissues were analyzed for thei...Sciatic nerve tissue was obtained from the gluteus maximus muscle segment of normal human cadavers and amniotic membrane tissue was obtained from healthy human puerperant placentas. Both tissues were analyzed for their stress relaxation and creep properties to determine suitability for transplantation applications. Human amniotic membrane and sciatic nerve tissues had similar tendencies for stress relaxation and creep properties. The stress value of the amniotic membrane stress relaxation group decreased to a greater extent compared with the sciatic nerve stress relaxation group. Similarly, the stress value of the amniotic membrane creep group increased to a greater extent compared with the sciatic nerve creep group. The stress relaxation curve for human amniotic membrane and sciatic nerve showed a logarithm correlation, while the creep curve showed an exponential correlation. These data indicate that amniotic membrane tissue has better stress relaxation and creep properties compared with sciatic nerve tissue.展开更多
Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of ...Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of different internal fixations in open-wedge HTO using the two currently available locking plates. Methods: Eight paired fresh-frozen cadaveric lower extremities were vertically embedded in steel boxes. The axial compression load was applied to the legs using the mechanical testing machine. The axial compression load test from 0 N to 550 N and the failure test were performed before and after HTO. One side of the leg of a specimen was fixed with the Puddu locking plate and the other side was fixed with the TomoFix plate to compare the two plates using the same specimen. A mode of failure and vertical displacement of the medial and lateral parts of the tibia at the osteotomy gap was recorded using a video camera in the failure test. The load–displacement data were analyzed to calculate stiffness, failure load, and displacement at failure. Results: The mean failure load was 1471.4 N and 1692.3 N and total vertical displacement at failure was 3.1 mm and 2.9 mm with the Puddu and TomoFix plates, respectively. During axial compression loading, displacements mainly occurred at the lateral osteotomy gap, while the medial gap was well preserved. No significant differences were observed in the failure load, displacement, or mode of failure between the two plates. Conclusions: The Puddu and TomoFix plates had similar biomechanical properties in open-wedge HTO. The results indicated reliable stability after open-wedge HTO without fibular osteotomy.展开更多
Contrary to freezing preservation and formalin embalming,Thiel embalmed cadaver presents soft texture and color very close to that of living organism,and many applications based on Thiel embalmed cadavers have been re...Contrary to freezing preservation and formalin embalming,Thiel embalmed cadaver presents soft texture and color very close to that of living organism,and many applications based on Thiel embalmed cadavers have been reported.However,Thiel embalmed cadavers cannot be used as reliable evaluation model for radiofrequency ablation(RFA)due to dramatic changes of electrical conductivity in the embalmed tissue.To address this issue,we investigated various modifications of the original Thiel embalming solution.By altering the chemicals' species and concentration we figured out a formula that can greatly reduce the embalming fluid's electrical conductivity without significantly compromising the 18-day embalmed kidney samples' suppleness and color.We also investigated a two-stage embalming technique by first submerging the kidney sample into original Thiel's tank fluid for 28 days,then the sample was withdrawn from the tank fluid and placed into modified dilution fluids for additional two weeks.Stiffening and discoloration occurred in these diluted samples implying the reversibility of Thiel-embalmed tissues' suppleness and color with the removal of the strong electrolytes.This study presents a modified embalming method which could be used for RPA evaluation and also helps our understanding of the mechanism of embalmment process.展开更多
AIM:To evaluate the frequency of bacterial flora of conjunctiva after death(cadaver eyes) which will give information about the bacterial contamination of donor eyes,and the in-vitro sensitivity of isolated bacteria t...AIM:To evaluate the frequency of bacterial flora of conjunctiva after death(cadaver eyes) which will give information about the bacterial contamination of donor eyes,and the in-vitro sensitivity of isolated bacteria to the commonly used antibiotics in ophthalmic practice.METHODS:Conjunctival swabs were taken from the cadavers(motor vehicle accident deaths and patients who died in the hospital),within 6h after death,and sent for culture and sensitivity test.Conjunctival swabs,taken from the healthy conjunctiva of patients admitted for cataract surgery,were sent for culture and sensitivity as controls(eyes in those of living status).The bacterial isolates were tested against the commonly used antibiotics(chloramphenicol,gentamicin,ciprofloxacin) in ophthalmology practice.RESULTS:Bacteria were isolated in 41 out of 100 conjunctival swabs(41%),taken from 50 cadavers(study group).Coagulase negative staphylococcus was the most common bacteria isolated(15%),followed by pseudomonas aeruginosa(5%).Gentamicin was effective against majority of the bacterial isolates(82%).Bacteria were isolated from 7 out of 100 conjunctival swabs taken as control group(eyes in living state).Coagulase negative staphylococcus was the most common organism(5%) isolated in control group;the others were staphylococcus aureus(1%) and beta hemolyticus streptococci(1%).CONCLUSION:Bacteria were isolated from 41% of the cadaver eyes.High percentage sensitivity of the bacterial isolates to gentamicin(82%) supports the practice of thorough irrigation of the eyes with gentamicin solution before starting the procedure of enucleation followed by immersion of the enucleated eyeballs in gentamycin solution,to prevent the bacterial contamination.展开更多
Human cadaver dissection remains a core and preferred method of anatomical instruction at most low- and middle-income health professional training institutions. Dissection, which is both traumatic and stressful, sets ...Human cadaver dissection remains a core and preferred method of anatomical instruction at most low- and middle-income health professional training institutions. Dissection, which is both traumatic and stressful, sets the tone of the students’ responses to later and or similar stressful learning opportunities like the post-mortems or care for terminally ill patients. Partial least squares structural equation modelling was used to determine the effect of the students’: personality, perception of the learning environment, learning approach, and effect of the environment on the student, on undergraduate health professional student’s activity in the human cadaver dissection room. This was a secondary analysis of previously collected data from a cross sectional survey of undergraduate health professional students. We found that personality type and perception of the environment had a positive effect on dissection room activity. Approach to learning and being affected by the dissection room experience (impact), had a negative effect on dissection room activity. All the above effects on dissection room activity were not significant. This study showed that personality, perception of the learning environment, learning approach and effect of the environment on the student, had effects on undergraduate health professional student’s activity in the human cadaver dissection room. The modelled effects are opportunities for educational interventions aimed at increasing student activity in the dissection room.展开更多
Subculture Helicoverpa armigera nuclear polyhedrosis virus （HaNPV） is an entomopathogenic virus isolated from cadaver of Helicoverpa armigera larvae, and is successfully produced in Spodoptera litura larvae as an al...Subculture Helicoverpa armigera nuclear polyhedrosis virus （HaNPV） is an entomopathogenic virus isolated from cadaver of Helicoverpa armigera larvae, and is successfully produced in Spodoptera litura larvae as an alternate host. These viral agents have been used to control the population of three species insect pests Spodoptera litura, Crocidolomia pavonana and Plutella xyllostella, which were infested in cabbages plantation. The concentration of virus of 4 × 10^7 polyhedra/mL was sprayed in cabbage leaves 24 h before infested of larva and every four days after. The research used randomized design which consisted of one factor （three species of second instar larvae, S. litura, C. pavonana, P. xyllostella） and eight replications. The result showed that the three species of larvae were sensitive against subculture HaNPV infection. The mortality of each larval species （S. litura, C. pavonana and P. xyllostella） was 100%, 97.5% and 98.7%, respectively. Subculture HaNPV can be utilized to control the population of three species of insect pests in cabbage plantation.展开更多
As the elderly population continues to grow, the number of patients with low back pain is gradually increasing. Among them, Lumbar Degenerative Diseases (LDD) is one of the major contributors to low back pain. Biomech...As the elderly population continues to grow, the number of patients with low back pain is gradually increasing. Among them, Lumbar Degenerative Diseases (LDD) is one of the major contributors to low back pain. Biomechanical in vivo studies of the lumbar spine are mainly performed by implants or imaging data to record the real-time changes of form and stress on the intervertebral disc during motion. However, the current developments are slow due to the technological and ethical limitations. In vitro experiments include animal experiments and cadaver experiments, which are difficult to operate or differ greatly from normal human structures, and the results still need to be verified repeatedly to test their accuracy. As for finite element method, it is relatively low cost and can repeat the experimental results. Therefore, we believe that finite element analysis plays an extremely important role in biomechanical research, especially in analyzing the relationship between different surgical models and the degeneration caused by different mechanics.展开更多
Phalloplasty is a complex set of procedures used in efforts to improve the anatomical,physiological,and aesthetic deficiencies caused by loss or absence of the penis.Methods have evolved significantly,and the use of f...Phalloplasty is a complex set of procedures used in efforts to improve the anatomical,physiological,and aesthetic deficiencies caused by loss or absence of the penis.Methods have evolved significantly,and the use of free tissue transfer has become common amongst reconstructive surgeons.The inclusion of bone autograft,usually radius or fibula,within the neophallus has caused significant morbidity,and efforts continue to find the optimal solution.We present a novel approach using a pre-fabricated,radial forearm fasciocutaneous free flap containing cadaveric bone graft for phalloplasty following traumatic penis amputation.展开更多
<strong>Objectives:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Urinary tract injuries ...<strong>Objectives:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">% </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.80% of procedures and most commonly involving the bladder. Appropriate identification, evaluation, treatment, and follow-up by gynecologic surgeons are important to reduce the associated long-term morbidities.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to implement a comprehensive cadaver curriculum in cystotomy repair for OBGYN residents. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This was a prospective observational cohort study including 10 OBGYN residents (PGY1-3) at a single institution in 2020 (56% of the 18 eligible residents). The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: 1) knowledge, 2) surgical skills, and 3) confidence. Knowledge, confidence, and resident satisfaction were evaluated with pre- and post-surveys. The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the curriculum. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Across all three PGY levels, statistically significant improvements were observed in knowledge, surgical skills, and confidence after didactic and cadaver education (p = 0.001, p < 0.02, and p = 0.009 respectively). The largest increases in confidence occurred in residents’ ability to describe and perform cystotomy repairs. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Educating and training OBGYN residents to manage and repair cystotomies can be challenging given the low incidence of injury in the operating room. The cadaver surgical skills curriculum was an effective training module and remains an important component of skills training in conjunction with simulation and traditional didactic sessions</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span>展开更多
Background: The difficulty of learning curve in different microsurgical regions is one of the most challenging factors that affect neurosurgeon’s life. Two of the delicate areas are the suprasellar intraventricular a...Background: The difficulty of learning curve in different microsurgical regions is one of the most challenging factors that affect neurosurgeon’s life. Two of the delicate areas are the suprasellar intraventricular and pontocerebellar region. High level of microsurgery or endoscopic surgery requires virtuosity, which can not be learnt only by assisting. Even among the well skilled neurosurgeons who work in big centers we can often hear “in spite of centralization there are not enough operations available to keep the high level of our skills”. The situation of surgeons working at mid centers is more difficult especially on duties. Methods: Huge number of scientific articles demonstrate the importance of different types of cadaver practice, but always did not pay enough attention to the daily fast fresh cadaver exercises. Focusing on lifelong every day practice we examined the difficulties of learning curve in intraventricular and pontocerebellar region and try to give some useful advice for practicing on fresh cadavers on a daily basis. We offer a simple endovascular fresh cadaver model for practicing. Results: We have performed more than 800 quick (60 - 90 minutes long) routine practice sessions in these two regions during last 18 years. We found that implantation a modelized pathology and removing it by microscopical or endoscopic way without causing injuries to sensitive structures seems to be the most practical way of fast everyday training. Nerves and vascular bypass sutures are also excellent practical method. Conclusions: We have focused on daily fast fresh cadaver practice as a novel training method like used in professional sport and art. After 18 years experience we can state that, for mastering the microsurgery of pontocerebellar and intraventricular region, which is one of the most challenging regions minimum 100 fresh cadaver practice sessions need before performing the operation. We believe this region should be part of fast fresh cadaver microsurgical practice routine programme on daily bases, minimum one time/week/person.展开更多
文摘BACKGROUND:The prevalence of gallstones is low in Asians.In Iran,many factors influence the prevalence of this disease.The aim of this study was to determine the prevalence of gallbladder stones and their chemical characteristics in a population by the study of cadavers. METHODS:In this cross-sectional study,autopsies were performed on 253 cadavers of more than 13 years old.The cadavers were studied to determine the number,location of stone formation,chemical composition,dry weight,and mean diameter of stones in the gallbladder and common bile duct. RESULTS:The prevalence of gallstone disease in these cadavers was 6.3%(men 4.7%,women 8.6%,not significantly different,P=0.216).There was a positive relationship between the age and prevalence of gallstone disease(P=0.033).The most common stone compositions were cholesterol and oxalate.The mean diameter (P=0.0058)and dry weight(P<0.0001)of stones were higher in the gallbladder than in the common bile duct. Positive relations between the amount of oxalate and mean diameter,and between the amount of oxalate and mean dry weight of gallstones were found,but the relationship between the amount of cholesterol and mean diameter was inverse. CONCLUSIONS:The prevalence of gallstones differed among age groups.Diameter and dry weight of gallstones were dependent on location of stone formation and chemical composition.
文摘Background: The AmbuAuraGain is a new single-use supraglottic airway device with gastric channel designed to facilitate intubation. The aim of the study was to assess the anatomic position and the performance of the AuraGain in fresh cadavers compared to that of the Intersurgical i-gel and LMA Supreme New Cuff. Methods: The 3 devices were inserted in random order in 7 fresh cadavers without difficult airway criteria. The assessed items were: Insertion time, number of attempts and ease of insertion, airway seal pressure, ease of gastric tube insertion, endoscopic view of vocal cords, efficacy of guided tracheal intubation through the AuraGain and i-gel, and anatomic fit by lateral X-ray and neck dissections. Results: All devices were successfully inserted within 3 attempts, except for one case of the LMA Supreme. Adjusting manoeuvres were often required to accomplish correct insertion. A 16 G gastric tube was easily advanced through all AuraGain and LMA Supreme devices. Fiberoptic tracheal intubation was effectively achieved through all AuraGain and i-gel devices in less than 60 s. Lateral X-ray and neck dissections confirmed optimal alignment of all devices with the respiratory and digestive tracts. Conclusions: Insertion of the new AmbuAuraGain required adjusting manoeuvres in some cases, as observed with the other two devices, and achieved similar airway seal pressures. Passage of a large bore gastric tube was as fast as with the LMA Supreme and ease of guided intubation was similar to that of the i-gel.
文摘Visual Cadavers is anemerging study method which promotes medical education and practical applications.It is benefited from other techniques and evaluated as having huge advantages,which is not only accelerating teaching and learning,but also improving scientific study,nevertheless,with limited cons.
文摘Introduction:Storage of specimens sampled from human remains for pathological testing,embalming for burial purposes,and for human identification often requires formalin fixation and/or paraffin embedding.Current knowledge in molecular biology techniques and forensic DNA analysis makes it possible to optimize the extraction of amplifiable DNA from formalin-fixed tissues by improving the pre-treatment,optimizing the digestion condition of proteinase K,simplifying the extraction protocol and purifying the extracted DNA with optimized volumes of alcohol.Aim:This research sought to extract amplifiable DNA from thirteen brain,bone marrow and cartilage samples from four formalin embalmed human cadavers.Materials and Methods:Brain,cartilage and bone marrow samples were taken from four different cadavers at autopsy at the Ghana Police Hospital mortuary in Accra,Ghana sixty-two days after embalming.An optimized preparation and DNA extraction protocol was carried out on all the samples.Brain samples were also taken from a non-formalin treated fifth cadaver of known STR profile,and standard DNA extraction performed to serve as positive control.Results:Our optimized protocol yielded detectable quantities of DNA from the samples when quantified with the 7500 Real-Time PCR equipment.The extracted DNA also yielded full STR profiles with varying peak heights for forensic identification purposes.The measured degradation indexes of the DNA samples were greater than 1.0,with peak heights of generated STR profiles above the limits of detection of the 3500 genetic analyzer.Conclusion:Our current study demonstrated an optimized method of DNA extraction from tissues(brain,cartilage and bone marrow)sampled from formalin embalmed human cadavers.The optimized protocol reduced the concentration of formalin fixation residues in extracted DNA from formalin-fixed tissues,thereby improving the amplification efficiency for STR profiling.Brain,bone marrow and cartilages can be a good source of DNA from embalmed and degraded human remains,though for skeletonized human remains together with teeth and long bones.
文摘Objective:Critically appraise the current state of alternate temporal bone training techniques(virtual reality(VR)simulation,3D-printed models,and mental practice(MP))compared to traditional and cadaver methods.Databases Reviewed:PubMed,Cochrane,Web of Science.Methods:Search terms utilized“temporal bone training”,“temporal bone surgical modalities”,and“training modalities temporal bone surgery”with“3D”,“rapid prototyp*”,“stereolithography”,“additive manufact*”,“plaster”,“VR”,“virtual reality”,“animal model”,“animal temporal bone”,and“synthetic”with“AND”for all literature.Exclusion criteria:non-ENT,non-English,and did not compare against alternative/traditional methods.Results:10 studies were included with 322 participants(83.9%ENT residents and 16.1%medical students).Costs include the FDM printer($300),materials($5/3D model),and<$5,000 for freeware simulator hardware.The Welling scale was used in 50%of studies.Alternate methods produced comparable or improved assessment scores to traditional and cadaver methods.Injuries were reported in three VR studies,with two reported significantly lower injury scores in the intervention groups.Time to completion was not significantly different in four VR studies,except for one finding that the time to visualize the incus was significantly lower in the intervention group.Performance after MP was not statistically different.Conclusion:More data are needed to assess whether the alternate methods are comparable to cadaveric dissection in temporal bone training.3D models and VR simulation demonstrate promising potential for novel trainees to acquire the basic skills and produce performance comparable to or significantly better than traditional methods of lectures,textbooks,CT images,and operative videos.
基金Supported by Key Project of Clinical Discipline of Ministry of Health Subordinates of China,No.2010105
文摘AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diameters of the portal vein(PV),the inferior vena cava(IVC),and distance between the two structures were measured.Similar measurements were performed on 20 adult corpses.The feasibility of portacaval shunt based on those measurements was analyzed.First stage of the extrahepatic portacaval shunt using MCT was performed on five cadavers.Specifically,the PV and IVC were exposed through an abdominal incision of the cadavers.The parent magnet was introduced from the femoral vein and was delivered into the IVC by an anchor wire and a 5F Cook catheter.The daughter magnet was introduced into the PV through the splenic vein using aninterventional guide wire.When the daughter magnet met the parent magnet,they automatically clipped together and the first stage of the portacaval shunt was set up.RESULTS: The average diameters of the PV and the IVC measured from the 30 CT image were 14.39 ± 2.36 mm and 18.59 ± 4.97 mm,respectively,and the maximum and minimum distances between the PV and the IVC were 9.79 ± 4.56 mm and 9.50 ± 4.79 mm,respectively.From 20 cadavers,the average diameters of the PV and the IVC were 14.48 ± 1.47 mm and 24.71 ± 2.64 mm,and the maximum and minimum distances between the PV and the IVC were 10.14 ± 1.70 mm and 8.93 ± 1.17 mm,respectively.The distances between the PV and the IVC from both the CT images and the cadavers were within the effective length of portacaval anastomosis using MCT(30.30 ± 4.19 mm).The PV and IVC are in close proximity to each other with no intervening tissues or structures in between.Simulated surgeries of the first stage using MCT on five cadavers was successfully performed.CONCLUSION: Anatomically,extrahepatic portacaval shunt employing MCT is highly feasible in humans.
文摘AIM： To evaluate whether urokinase perfusion of non-heart-beating cadaveric donor livers reduces the incidence of intrahepatic ischemic-type biliary lesions （IITBLs）. METHODS： A prospective study was conducted to investigate potential microthrombosis in biliary microcirculation when non-heart-beating cadaveric livers were under warm or cold ischemic conditions. The experimental group included 140 patients who underwent liver transplantation during the period of January 2006 to December 2007, and survived for more than 1 year. The control group included 220 patients who received liver transplantation between July 1999 and December 2005 and survived for more than 1 year. In the experimental group, the arterial system of the donor liver was perfused twice with urokinase during cold perfusion and after trimming of the donor liver. The incidence of IITBLs was compared between the two groups. RESULTS： In the control group, the incidence of IITBLs was 5.9% （13/220 cases） after 3-11 mo of transplantation. In the experimental group, two recipients （1.4%） developed IITBLs at 3 and 6 mo after transplantation, respectively. The difference in the incidence between the two groups was statistically significant （P 〈 0.05）. CONCLUSION： Double from non-heart-beating perfusion of cadaveric livers donors with urokinase may reduce the incidence of IITBLs.
基金Shanghai Science and Technology Development Fund,№964119027.
文摘The last two decades of the twentieth century have witnessed increasingly successful rates of liver transplantation. The number of liver transplantations has increased steadily while the number of organ donors has remained relatively constant. Thus a great disparity has developed between the demand and supply of donor organs and remains a major limiting factor for further expansion of liver transplantation. Although many procedures, such as split liver[1] , living-related transplantation[2] , and xenotransplantation[3], have been attempted clinically to overcome the shortage, it is hoped that livers harvested from non-heart-beating donors (NHBDs) would alleviatethe problem of organ shortage, which again becomes the focus of attention[4-9]. However, sensitivity of the liver to warm ischemia remains a major worry for use of theNHBDs. The aim of this animal study was to assess if murine liver could tolerate prolonged period of warm ischemia and to determine the optimum timing of intervention in the cadaver donor in order to preserve liver viability.
基金supported by the Siriraj Research Fund(No.R015631018)
文摘OBJECTIVE： This study aims to investigate the relationship between major signal points （MaSPs） of the lower extremities used in court-type Thai traditional massage （CTTM） and the corresponding underlying anatomical structures, as well as to determine the short-term changes in blood flow and skin temperature of volunteers experiencing CTTM. METHODS： MaSPs were identified and marked on cadavers before acrylic color was injected. The underlying structures marked with acrylic colors were observed and the anatomical structures were determined. Then, pressure was applied to each MaSP in human volunteers （lateral side of leg and medial side of leg） and blood flow on right dorsalis pedis artery was measured using duplex ultrasound while skin temperature changes were monitored using an infrared themographic camera. RESULTS： Short-term changes in the blood flow parameters, volume flow and average velocity, compared to baseline （P 〈 0.05）, were observed on MaSP of the lower extremity, ML4. Changes in the peak systolic velocity of the area ML5 were also observed relative to baseline. The skin temperature of two different MaSPs on the lateral side of leg （LL4 and LL5） and four on the medial side of leg （ML2, ML3, ML4 and ML5） was significantly increased （P 〈 0.05） at 1 rain after pressure application. CONCLUSION： This study established the clear correlation between the location of MaSP, as defined in CTTM, and the underlying anatomical structures. The effect of massage can stimulate skin blood flow because results showed increased skin temperature and blood flow characteristics. While these results were statistically significant, they may not be clinically relevant, as the present study focused on the immediate physiological effect of manipulation, rather than treatment effects. Thus, this study will serve as baseline data for further clinical studies in CTTM
文摘AIM: To evaluate the pudendal nerve segments that could be identified on magnetic resonance neurography(MRN) before and after surgical marking of different nerve segments.METHODS: The hypothesis for this study was that pudendal nerve and its branches would be more easily seen after the surgical nerve marking. Institutional board approval was obtained. One male and one female cadaver pelvis were obtained from the anatomy board and were scanned using 3 Tesla MRI scanner using MR neurography sequences. All possible pudendal nerve branches were identified. The cadavers were then sent to the autopsy lab and were surgically dissected by a peripheral nerve surgeon and an anatomist to identify the pudendal nerve branches. Radiological markers were placed along the course of the pudendal nerve and its branches. The cadavers were then closed and rescanned using the same MRN protocol as the premarking scan. The remaining pudendal nerve branches were attempted to be identified using the radiological markers. All scans were read by an experienced musculoskeletal radiologist.RESULTS: The pre-marking MR Neurography scans clearly showed the pudendal nerve at its exit from the lumbosacral plexus in the sciatic notch, at the level of the ischial spine and in the Alcock's Canal in both cadavers. Additionally, the right hemorrhoidal branch could be identified in the male pelvis cadaver. The perineal and distal genital branches could not be identified. On post-marking scans, the markers were used as identifiable structures. The location of the perineal branch, the hemorroidal branch and the dorsal nerve to penis(in male cadaver)/clitoris(in female cadaver) could be seen. However, the visualization of these branches was suboptimal. The contralateral corresponding nerves were poorly seen despite marking on the surgical side. The nerve was best seen on axial T1W and T2W SPAIR images. The proximal segment could be seen well on 3D DW PSIF sequence. T2W SPACE was not very useful in visualization of this small nerve or its branches.CONCLUSION: Proximal pudendal nerve is easily seen on MR neurography, however it is not possible to identify distal branches of the pudendal nerve even after surgical marking.
文摘Sciatic nerve tissue was obtained from the gluteus maximus muscle segment of normal human cadavers and amniotic membrane tissue was obtained from healthy human puerperant placentas. Both tissues were analyzed for their stress relaxation and creep properties to determine suitability for transplantation applications. Human amniotic membrane and sciatic nerve tissues had similar tendencies for stress relaxation and creep properties. The stress value of the amniotic membrane stress relaxation group decreased to a greater extent compared with the sciatic nerve stress relaxation group. Similarly, the stress value of the amniotic membrane creep group increased to a greater extent compared with the sciatic nerve creep group. The stress relaxation curve for human amniotic membrane and sciatic nerve showed a logarithm correlation, while the creep curve showed an exponential correlation. These data indicate that amniotic membrane tissue has better stress relaxation and creep properties compared with sciatic nerve tissue.
文摘Introduction: Recently, new plates with locking screws have been developed and used for medial open-wedge high tibial osteotomy (HTO). The purpose of this study was to evaluate and compare biomechanical properties of different internal fixations in open-wedge HTO using the two currently available locking plates. Methods: Eight paired fresh-frozen cadaveric lower extremities were vertically embedded in steel boxes. The axial compression load was applied to the legs using the mechanical testing machine. The axial compression load test from 0 N to 550 N and the failure test were performed before and after HTO. One side of the leg of a specimen was fixed with the Puddu locking plate and the other side was fixed with the TomoFix plate to compare the two plates using the same specimen. A mode of failure and vertical displacement of the medial and lateral parts of the tibia at the osteotomy gap was recorded using a video camera in the failure test. The load–displacement data were analyzed to calculate stiffness, failure load, and displacement at failure. Results: The mean failure load was 1471.4 N and 1692.3 N and total vertical displacement at failure was 3.1 mm and 2.9 mm with the Puddu and TomoFix plates, respectively. During axial compression loading, displacements mainly occurred at the lateral osteotomy gap, while the medial gap was well preserved. No significant differences were observed in the failure load, displacement, or mode of failure between the two plates. Conclusions: The Puddu and TomoFix plates had similar biomechanical properties in open-wedge HTO. The results indicated reliable stability after open-wedge HTO without fibular osteotomy.
文摘Contrary to freezing preservation and formalin embalming,Thiel embalmed cadaver presents soft texture and color very close to that of living organism,and many applications based on Thiel embalmed cadavers have been reported.However,Thiel embalmed cadavers cannot be used as reliable evaluation model for radiofrequency ablation(RFA)due to dramatic changes of electrical conductivity in the embalmed tissue.To address this issue,we investigated various modifications of the original Thiel embalming solution.By altering the chemicals' species and concentration we figured out a formula that can greatly reduce the embalming fluid's electrical conductivity without significantly compromising the 18-day embalmed kidney samples' suppleness and color.We also investigated a two-stage embalming technique by first submerging the kidney sample into original Thiel's tank fluid for 28 days,then the sample was withdrawn from the tank fluid and placed into modified dilution fluids for additional two weeks.Stiffening and discoloration occurred in these diluted samples implying the reversibility of Thiel-embalmed tissues' suppleness and color with the removal of the strong electrolytes.This study presents a modified embalming method which could be used for RPA evaluation and also helps our understanding of the mechanism of embalmment process.
基金University of Malaya,Kuala Lumpur,short term research grant(No.F0704/2002D)
文摘AIM:To evaluate the frequency of bacterial flora of conjunctiva after death(cadaver eyes) which will give information about the bacterial contamination of donor eyes,and the in-vitro sensitivity of isolated bacteria to the commonly used antibiotics in ophthalmic practice.METHODS:Conjunctival swabs were taken from the cadavers(motor vehicle accident deaths and patients who died in the hospital),within 6h after death,and sent for culture and sensitivity test.Conjunctival swabs,taken from the healthy conjunctiva of patients admitted for cataract surgery,were sent for culture and sensitivity as controls(eyes in those of living status).The bacterial isolates were tested against the commonly used antibiotics(chloramphenicol,gentamicin,ciprofloxacin) in ophthalmology practice.RESULTS:Bacteria were isolated in 41 out of 100 conjunctival swabs(41%),taken from 50 cadavers(study group).Coagulase negative staphylococcus was the most common bacteria isolated(15%),followed by pseudomonas aeruginosa(5%).Gentamicin was effective against majority of the bacterial isolates(82%).Bacteria were isolated from 7 out of 100 conjunctival swabs taken as control group(eyes in living state).Coagulase negative staphylococcus was the most common organism(5%) isolated in control group;the others were staphylococcus aureus(1%) and beta hemolyticus streptococci(1%).CONCLUSION:Bacteria were isolated from 41% of the cadaver eyes.High percentage sensitivity of the bacterial isolates to gentamicin(82%) supports the practice of thorough irrigation of the eyes with gentamicin solution before starting the procedure of enucleation followed by immersion of the enucleated eyeballs in gentamycin solution,to prevent the bacterial contamination.
文摘Human cadaver dissection remains a core and preferred method of anatomical instruction at most low- and middle-income health professional training institutions. Dissection, which is both traumatic and stressful, sets the tone of the students’ responses to later and or similar stressful learning opportunities like the post-mortems or care for terminally ill patients. Partial least squares structural equation modelling was used to determine the effect of the students’: personality, perception of the learning environment, learning approach, and effect of the environment on the student, on undergraduate health professional student’s activity in the human cadaver dissection room. This was a secondary analysis of previously collected data from a cross sectional survey of undergraduate health professional students. We found that personality type and perception of the environment had a positive effect on dissection room activity. Approach to learning and being affected by the dissection room experience (impact), had a negative effect on dissection room activity. All the above effects on dissection room activity were not significant. This study showed that personality, perception of the learning environment, learning approach and effect of the environment on the student, had effects on undergraduate health professional student’s activity in the human cadaver dissection room. The modelled effects are opportunities for educational interventions aimed at increasing student activity in the dissection room.
文摘Subculture Helicoverpa armigera nuclear polyhedrosis virus （HaNPV） is an entomopathogenic virus isolated from cadaver of Helicoverpa armigera larvae, and is successfully produced in Spodoptera litura larvae as an alternate host. These viral agents have been used to control the population of three species insect pests Spodoptera litura, Crocidolomia pavonana and Plutella xyllostella, which were infested in cabbages plantation. The concentration of virus of 4 × 10^7 polyhedra/mL was sprayed in cabbage leaves 24 h before infested of larva and every four days after. The research used randomized design which consisted of one factor （three species of second instar larvae, S. litura, C. pavonana, P. xyllostella） and eight replications. The result showed that the three species of larvae were sensitive against subculture HaNPV infection. The mortality of each larval species （S. litura, C. pavonana and P. xyllostella） was 100%, 97.5% and 98.7%, respectively. Subculture HaNPV can be utilized to control the population of three species of insect pests in cabbage plantation.
文摘As the elderly population continues to grow, the number of patients with low back pain is gradually increasing. Among them, Lumbar Degenerative Diseases (LDD) is one of the major contributors to low back pain. Biomechanical in vivo studies of the lumbar spine are mainly performed by implants or imaging data to record the real-time changes of form and stress on the intervertebral disc during motion. However, the current developments are slow due to the technological and ethical limitations. In vitro experiments include animal experiments and cadaver experiments, which are difficult to operate or differ greatly from normal human structures, and the results still need to be verified repeatedly to test their accuracy. As for finite element method, it is relatively low cost and can repeat the experimental results. Therefore, we believe that finite element analysis plays an extremely important role in biomechanical research, especially in analyzing the relationship between different surgical models and the degeneration caused by different mechanics.
文摘Phalloplasty is a complex set of procedures used in efforts to improve the anatomical,physiological,and aesthetic deficiencies caused by loss or absence of the penis.Methods have evolved significantly,and the use of free tissue transfer has become common amongst reconstructive surgeons.The inclusion of bone autograft,usually radius or fibula,within the neophallus has caused significant morbidity,and efforts continue to find the optimal solution.We present a novel approach using a pre-fabricated,radial forearm fasciocutaneous free flap containing cadaveric bone graft for phalloplasty following traumatic penis amputation.
文摘<strong>Objectives:</strong> <span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">Urinary tract injuries are a known complication of gynecologic surgery, occurring in 0.18</span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">% </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">-</span></span></span><span><span><span style="font-family:""> </span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">0.80% of procedures and most commonly involving the bladder. Appropriate identification, evaluation, treatment, and follow-up by gynecologic surgeons are important to reduce the associated long-term morbidities.</span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">The purpose of this study was to implement a comprehensive cadaver curriculum in cystotomy repair for OBGYN residents. </span><b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This was a prospective observational cohort study including 10 OBGYN residents (PGY1-3) at a single institution in 2020 (56% of the 18 eligible residents). The curriculum consisted of a one-hour didactic lecture and one-hour hands-on surgical skills training with fresh frozen cadavers. Residents were evaluated in three domains: 1) knowledge, 2) surgical skills, and 3) confidence. Knowledge, confidence, and resident satisfaction were evaluated with pre- and post-surveys. The bladder model, derived from the ACOG Simulation Working Group, was used to evaluate surgical skills at baseline and at completion of the curriculum. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">Across all three PGY levels, statistically significant improvements were observed in knowledge, surgical skills, and confidence after didactic and cadaver education (p = 0.001, p < 0.02, and p = 0.009 respectively). The largest increases in confidence occurred in residents’ ability to describe and perform cystotomy repairs. </span><b><span style="font-family:Verdana;">Conclusions: </span></b><span style="font-family:Verdana;">Educating and training OBGYN residents to manage and repair cystotomies can be challenging given the low incidence of injury in the operating room. The cadaver surgical skills curriculum was an effective training module and remains an important component of skills training in conjunction with simulation and traditional didactic sessions</span></span></span></span><span style="font-family:Verdana;"><span style="font-family:Verdana;"><span style="font-family:Verdana;">.</span></span></span>
文摘Background: The difficulty of learning curve in different microsurgical regions is one of the most challenging factors that affect neurosurgeon’s life. Two of the delicate areas are the suprasellar intraventricular and pontocerebellar region. High level of microsurgery or endoscopic surgery requires virtuosity, which can not be learnt only by assisting. Even among the well skilled neurosurgeons who work in big centers we can often hear “in spite of centralization there are not enough operations available to keep the high level of our skills”. The situation of surgeons working at mid centers is more difficult especially on duties. Methods: Huge number of scientific articles demonstrate the importance of different types of cadaver practice, but always did not pay enough attention to the daily fast fresh cadaver exercises. Focusing on lifelong every day practice we examined the difficulties of learning curve in intraventricular and pontocerebellar region and try to give some useful advice for practicing on fresh cadavers on a daily basis. We offer a simple endovascular fresh cadaver model for practicing. Results: We have performed more than 800 quick (60 - 90 minutes long) routine practice sessions in these two regions during last 18 years. We found that implantation a modelized pathology and removing it by microscopical or endoscopic way without causing injuries to sensitive structures seems to be the most practical way of fast everyday training. Nerves and vascular bypass sutures are also excellent practical method. Conclusions: We have focused on daily fast fresh cadaver practice as a novel training method like used in professional sport and art. After 18 years experience we can state that, for mastering the microsurgery of pontocerebellar and intraventricular region, which is one of the most challenging regions minimum 100 fresh cadaver practice sessions need before performing the operation. We believe this region should be part of fast fresh cadaver microsurgical practice routine programme on daily bases, minimum one time/week/person.
