bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Core Principles in Physiology and Pathology to Guide Spiraled Biomedical Curriculum Development
Authors: Selinfreund Richard H , Rodenbaugh David W , Osborne David L
Published: November 2023

Determining the content and order of instruction can be challenging when developing an integrated medical physiology curriculum. It is easy to fall into the trap to teach everything when selecting content required for the first two year curriculum. There is a real need to develop tools that allow for the critical integration of content and flow among faculty. One integration method is developing a set of “core principals” (top‐down guiding principles) for each course. The crucial step is for faculty to develop and agree upon the essential guiding principles that are the “core principals”. While no top‐down central guiding theme can be considered most appropriate for all situations one benefit of pre‐identifying core principles is that it helps faculty self‐regulate with respect to what students are learning. Internally asking the question, “Why am I having the students learn this?” forces faculty members working on curricular development to see the forest through the trees. Using “core principal” themes provides the following: prioritizes content selection, defines flow of content, allows for planning in a spiral curriculum, promotes self‐correction when selecting content and most importantly, provides conceptual scaffolding for students. Specifically, themes guide student instruction in the classroom and answer the classic question “Why do I need to know this?”. An example from renal physiology during the first year of medical school, would be the use of water, ionic and glucose homeostasis as core principles to guide the integration of content development for the renal system. This becomes useful during the second year when students are dealing with concepts related to the use of diuretics in clinical medicine. Using “core principals” provides tools for creating an effective integrated classroom environment. Lastly, the self‐directed student learner can also use the provided “core principles” to refine their mental models as they learn new material.
The Use of High Fidelity Patient Simulations to Improve Critical Thinking Skills in First Year Medical Students
Authors: Harris David M , Schuster Amanda , Kay Denise , Kibble Jonathan D
Published: November 2023

Many businesses and universities have stated that current Millennial students are lacking in critical thinking and analytical skill development compared to previous generations. Some attribute this to the ability to “google” information quickly and interact with social networks to make daily decisions. Millennials also comprise most of the medical students enrolled in the US and many instructors have noted that this generation seems to lack critical thinking skills. However, medical educators may be missing an opportunity to leverage the Millennials’ strength of team work. High fidelity patient simulations (HFPS) may provide a place to harness the strength of the team in a controlled learning environment in order to engage students and facilitate critical skill development. However, many factors may play a role in this experience and a “best practices” approach needs to be developed. For example, lack of foundational knowledge could negatively affect their HFPS performance. Likewise, their emotional feelings or engagement in a situation could affect the learning project. The goal of this study is to evaluate the effects of baseline knowledge and core effect on the development of critical thinking skills in first year medical students in physiology based HFPS.

Methods

Students are placed in groups of 6 and participate in 3 HFPS and observe 1. Before each simulation, a pre‐quiz is given to determine a base‐line knowledge for all the teams. After participation in a HFPS activity, students are given a card with feelings based upon activation and pleasure (core effect). Videos of the HFPS will be evaluated by faculty with a validated test instrument based on principles from Insight Assessment and Critical Thinking: What it is and why it counts.

Results

Faculty scores from the test instrument will be correlated with core affect and baseline pre‐quiz scores for each of the teams.

Discussion

HFPS may provide a platform to engage first year medical students as well as facilitate development of critical thinking skills. Factors such as lack of basic knowledge or misconceptions, especially of physiology, could affect critical skill development. Discovering factors that play a role in critical skill development through a best practices approach could help HFPS become more effective in teaching and learning the Millennial generation.
Combining Physiology and Health Care Professions Education in High School‐aged students: High Tech PhUn!
Authors: Gurovich Alvaro N , Coovert Daniel , Storms Brittney Millspaugh , Terry Kim
Published: November 2023

According to the Area Health Education Center (AHEC), there is a shortage of health care professionals in the country, especially in rural and underserved areas. In addition, and according to the National Science Foundation (NSF), there is a shortage of students choosing science careers as their professional path. To tackle these problems, the American Physiological Society (APS) and AHEC have created programs to increase the likelihood of high school students to choose science and health care professions paths, respectively. APS has a K‐12 outreach program that helps increasing awareness about STEM education called Physiology Understanding (PhUn) week, while AHEC has competitive grants to outreach students in high school science classes. Here, we combined PhUn week, health education, and high technology to show 3 physiological systems: musculoskeletal (MS), neuromuscular (NM), and central nervous system (CNS). Three hands‐on activities, one per system, were designed using a Biopac MP40 system and Biopac Science Lab software. These activities were performed by students attending a rural high school and guided by undergraduate and graduate students from health care professional curriculums. The activity was divided in 6 different sessions, three per senior science class, in three different days. Eleven undergraduate and 16 graduate students worked as facilitators, reaching 49 science students. Each class was divided in 6 small 4‐student groups with the following general activity set‐up: First day, short presentation about PhUn week and hand‐on activity focused on reaction time on dominant and non‐dominant forearm (NM); second day, hand‐on activities focused on brain activity during 4 different activities (CNS) and muscle recruitment at different forearm workloads (MS); and third day, analysis of collected data and overall final discussion including translation to health care education. By the end of PhUn week, students collected data from all 49 class mates in all three activities and the science teacher had enough physiological data to enhance their science curriculum. Motivating students from rural areas to choose STEM or health care professions path is not an easy task. Here, we developed a program that used three key components: 1) science curriculum, 2) PhUn week, and 3) applied high tech activities. Based on the level of engagement of all students, especially from the rural high school, we strongly suggest using applied high tech activities, such as this PhUn week activity, to improve likelihood of STEM and health care professions path in rural high school students.

Support or Funding Information

Supported by IU AHEC 15/16 #PIU081 and APS PhUn week program
The Starling Actuator – the Implementation of Starling's Law of the Heart within a Mechanical Model of the Cardiovascular System
Authors: Strauss Graham L. , Sweeney Terrence Edward
Published: November 2023

We recently developed the Scranton Cardiovascular Model1 (SCM), a computer‐driven, fluid pumping mechanical model of the cardiovascular system. The visual and tactile approach of the model, coupled with quantitative, multi‐parameter data collection and powerful analytical capabilities, greatly facilitate the teaching of cardiovascular physiology. However, a shortcoming of the SCM has been its inability to faithfully reproduce Starling's Law of the Heart2, a critical determinant of cardiac performance. This limitation of the SCM was due to the lack of coupling between the SCM's end‐diastolic ventricular volume (EDV) and the computer generated signal that controls cardiac contraction strength. Starling's Law behavior in the SCM has now been accomplished through construction of a device that we have coined the Starling Actuator. Visual approximation of EDV by the SCM user has always been possible, as the model's latex balloon heart operates within a clear acrylic chamber. The Starling Actuator exploits the user's visual estimation of EDV to enable volume‐dependent modulation of cardiac contraction strength without affecting heart rate or systolic duration. Employing the Starling Actuator, the user adjusts a dial to reflect the perceived degree of ventricular filling, which was determined to be within 10% of actual EDV. The Actuator dial, linked to a potentiometer, alters the baseline of the computer‐generated square wave signal controlling cardiac contraction strength, thereby modulating ejection force in an EDV‐dependent manner. Coupling visual approximation of ventricular volume with use of the Starling Actuator, we generated data that replicates the characteristic EDV‐stroke volume Starling curve3. The Starling Actuator thus enables the SCM to more faithfully model cardiovascular function under conditions that alter ventricular filling. The electronic signal from the Starling Actuator also shows promise in enabling the generation of ventricular pressure‐volume loops from SCM data.

Support or Funding Information

Supported by the University of Scranton
A Mathematical Model of the Cardiovascular System Based on the Scranton Cardiovascular Model
Authors: Frederick Norman E , Jimenez Joshua Ray N. , Graham Jason M. , Sweeney Terrence Edward
Published: November 2023

The complexity of the cardiovascular system has led to the development of mathematical models to understand and predict physiological function and dysfunction. The unique model that we describe here is designed to match the Scranton Cardiovascular Model (SCM), a mechanical model that we recently developed1 to be used as a teaching tool. The mathematical model, a lumped parameter model run in MATLAB, consists of 24 ordinary differential equations that represent the left ventricular, aortic, arterial, arteriolar, capillary, venular, peripheral venous, and central venous segments of the SCM. Resistance, compliance, and volume parameters dictate the function of each segment, and we have fine‐tuned these parameters to produce numerical simulations that match the data output of the SCM. Specific alteration of the parameters allows for mathematical modeling of disease states. The similarity between the results of the mathematical model and the SCM data should allow us to engineer new components for the SCM. Dysfunctional aortic valves, which have already been employed in the SCM, will be further engineered with the aid of the predictive mathematical model. The SCM, with increased functional diversity, becomes a better teaching tool due to improvements generated by the mathematical model. Further, the mathematical model itself aids in the understanding of cardiovascular function and dysfunction.

Support or Funding Information

Supported by The University of Scranton
Animating the Kidney: Temporal and Spatial Integration of Complex Renal Mechanisms
Authors: Guttmann Geoffrey D , Guttmann David R , Mallet Robert T
Published: November 2023

The kidneys are the body's central homeostatic organs and are essential for maintaining arterial blood pressure, body fluid osmolality, electrolyte concentrations and acid‐base balance, as well as eliminating metabolic waste products. Within the basic sciences healthcare professional curriculum, it has been necessary to isolate the physiological processes that the kidney performs. But the healthcare professional student has to apply these concepts within the context of the whole organism, i.e. the human body, and in a time integrative fashion as none of these processes operate in isolation. The traditional educational approach has been to present these concepts in a stepwise manner, which implies they occur sequentially, yet in fact, they occur simultaneously. Presentation and mastery of renal physiology are challenged by, a) structural complexity of the glomerular filtration membrane, nephron tubular epithelium, renal microcirculation, and interstitial fluid; b) the integrated function of these components; and c) their responses to numerous neuro‐hormonal factors. To illustrate these dynamic concepts, we have developed and will present sophisticated animations depicting three of the most conceptually challenging mechanisms of renal physiology: a) the impact of glomerular filtration, tubular reabsorption and secretion on renal solute handling and clearance; b) the generation and maintenance of the solute concentration gradient within the medullary interstitium and its essential role in achieving water balance; and c) the micturition reflex, including its initiation by tension in the bladder wall and its modulation by autonomic function and higher centers of the brainstem and cerebral cortex. We have created animations and artwork, utilizing Inkscape™ to make the new images, Gimp™ to import frames to make a .gif, and Anime Studio™ software to create animations. By depicting the integrated function of the component processes, these animations are intended to foster comprehension of complex renal physiology. These animations are suitable for inclusion in lectures, small group study sessions, or individual study. Individual and small group sessions can use podcasts, which include the animations. These podcasts enable students to replay the animations at their leisure and, thus, facilitate mastery of renal physiology.

Support or Funding Information

UNTHSC Innovations in Teaching Using Technology Grant
Exploring Oxygen Transport by Hemoglobin: A Computer Simulation for Students
Authors: Christmas Kevin , Chirillo Michael , Silverthorn Dee U
Published: November 2023

One of the more difficult aspects of respiratory physiology for students is understanding the cause‐effect relationships between dissolved oxygen in plasma, the PO2 of plasma, percent saturation of hemoglobin, inspired oxygen, and the amount of available hemoglobin. We use a 5‐step process to help students explore oxygen transport in the blood: (1) predict what happens when certain parameters change, (2) test the predictions with an interactive spreadsheet and record the data, (3) graph the data, (4) compare their predictions to the data, and (5) apply their understanding to solve problems they have not seen before. We created the spreadsheet by adapting previously developed equations for calculating oxygen saturation of hemoglobin across a range of partial pressures of oxygen. Students use a self‐directed activity that allows them to change different parameters. The first activity has hemoglobin concentration fixed at 15 g/dL blood and allows students to vary the PO2 of arterial blood. The spreadsheet calculates the dissolved oxygen (mL O2/dL blood), hemoglobin saturation (%), and total oxygen content of blood (mL O2/dL blood). The second activity allows students to change the hemoglobin concentration, atmospheric pressure, and partial pressure of oxygen in the atmosphere. The program calculates atmospheric and arterial PO2, hemoglobin saturation (%), dissolved oxygen (mL O2/dL blood), and total oxygen content of blood (mL O2/dL blood). Using the program students discover for themselves how changing altitude and anemia affect oxygen transport in the blood. Feedback indicates that interaction with the program helps students grasp the relationships among the parameters.
An Interdisciplinary Approach Combines Physiology, Engineering, and Computer Science to Increase Awareness of STEM Professions among Middle School Students
Authors: Halpin Patricia A. , Tavares Sean , Sabin Mihaela
Published: November 2023

Including Science, Technology, Engineering, and Math (STEM) learning experiences in afterschool programs positively impacts the participating youth's excitement and engagement in these fields. Offered at the University of New Hampshire's STEM Discovery Lab, Design Make Code is an afterschool program for middle school learners in the Manchester School District who belong to groups underrepresented in STEM degree programs and careers, including English Language learners (ELL), racial and ethnic minorities, and children from low‐income families. Design Make Code participants engage weekly in problem solving, engineering design, science practices, and computational thinking to develop their STEM skills. To improve students’ self‐perception as potential contributors to the STEM enterprise, faculty members from three STEM disciplines, Biological Sciences, Mechanical Engineering Technology, and Computer Science, collaborated to design and facilitate learning experiences that integrate professional aspects of these disciplines through relevant lab experiments. The exercise physiology experiment teaches students the connection between the pulmonary and cardiovascular system. Students perform an experiment testing the effects of exercise on heart rate, breathing rate and blood pressure. The connection between healthy eating, active living and disease prevention is discussed. The aeronautical engineering experiment teaches students to make and fly a glider which despite being of simple design, has the potential for good flight performance when carefully made and adjusted. The students learn through hands‐on experience about the roles that proper balance and adjustment of aerodynamic control surfaces play in achieving stable and controlled flight. The computing activity empowers learners to create an augmented reality controller around a game they code. Students use the Scratch programming language, Makey Makey boards, alligator clips, recycled materials and arts supplies to design and make ingenious controllers that students use to play their games. Students engage with basic electrical engineering and programming concepts and techniques as they build, test, and demonstrate their projects. Undergraduate biology, computing, and engineering students participate as teaching assistants. The opportunity to interact directly with STEM professionals and undergraduate students pursuing career paths in STEM increases students’ understanding of value of STEM in society and awareness of STEM professions.
Light‐Sheet Microscopy to Elucidate Hemodynamic Forces and Modulation of Cardiac Trabeculation: Implications for Embryonic Contractile Function
Authors: Lee Juhyun , Sevag Packard Rene R. , Xu Hao , Kang Hanul , Baek Kyung In , Jen Nelson , Jay Kuo C. C. , Chi Neil C , Ho Chih‐ming , Li Rongsong , Hsiai Tzung
Published: November 2023

Hemodynamic forces are intimately linked with cardiac morphogenesis. Trabeculation develops after cardiac looping, and mutations in Notch signaling result in congenital heart defects. The mechanotransduction mechanisms underlying trabeculation remain elusive. We assessed whether shear stress up‐regulated Notch signaling to modulate trabeculation with implications for contractile function. We implemented the light‐sheet method Selective Plane Illumination Microscopy (SPIM) for fast imaging and high axial resolution of myocardium (3‐D+time) in live zebrafish embryos. 3‐D quantification revealed attenuation in trabeculated myocardium in response to reduced viscosity and shear stress by Gata1a‐morpholino oligonucleotides (MO) micro‐injection and in the absence of atrial contractions in wea mutants. However, co‐injection with Nrg‐1 mRNA rescued trabeculation and restored mRNA expression of Notch ligands (Dll4, Jagged‐1 and Jagged‐2), receptor (Notch 1b), and signaling components (Nrg‐1 and ErbB2). Trabeculation was inhibited in response to 1) arresting hemodynamic forces by blocking cardiac Troponin T type 2a via Tnnt2a‐MO, and 2) depleting endocardium via the use of the cloche mutant. Tnnt2a‐MO down‐regulated Notch target genes to a greater extent than did Gata1a‐MO and exhibited a thin ventricular wall without trabeculation, and cloche mutant expressed low levels of Notch‐related genes. A pulsatile flow system (taverage=23 dyn·cm−2 at 1 Hz) corroborated shear stress activation of Notch target genes. Gata1a MO and the ErbB2 inhibitor AG1478 further reduced ventricular strain and fractional shortening, coupled with increased systolic and diastolic volume. Gata1a MO micro‐injection and wea mutant resulted in an attenuation of trabecular network in the ventricle in association with a reduction in WSS. However, rescuing notch signaling by Nrg‐1 mRNA partially restored trabeculation. Cloche mutant and tnnt2a MO also resulted in a significant reduction in trabeculation. The 4‐D optical SPIM technique has provided an unprecedented spatial and temporal resolution to link hemodynamics with development of trabeculationin live zebrafish embryos. Thus, light‐sheets elucidate hemodynamic modulation of trabeculation by activation of Notch signaling with translational implications in contractile function in ventricular non‐compactionin zebrafish model.

Support or Funding Information

This study was supported by the National Institutes of Health HL118650 (T.K.H.), HL083015 (T.K.H.), HD069305 (N.C.C., T.K.H.), HL111437 (T.K.H., N.C.C.), T32HL007895 (R.R.S.P.), and AHA Pre‐Doctoral Fellowship 15PRE21400019 (J.L.).
Genotype Discrimination Using Facial and Body Anthropometry among Hausas
Authors: Taura Magaji Garba , Adamu Lawan Hassan , Gudaji Abdullahi
Published: November 2023

Individual's genotype can be classified as normal, carrier or sickle cell patient when it is AA, AS and SS respectively. Several researches attempted to discriminate the sickle cell patient with normal subject using anthropometry, however less attention is paid to the discrimination of an individual with normal genotype from carrier especially among Hausa population. The present study aimed at discriminating between normal and carrier from Hausa ethnic population using body and facial anthropometry. A total of 219 participants with mean age of 20.41 ± 2.94 years were involved. The genotype analyses revealed 197 and 22 participants as normal and carrier respectively. Direct anthropometry was used to measure the height, weight and 17 facial features. Independent sample t – test was used for the test of differences. Binary logistic regression (BLR) analysis was used to obtain a model for genotype discrimination. The predicted probabilities of BLR for the variables that contributed best to the prediction were analyzed using Receiver Operating Characteristic (ROC) curve. The results indicated that none of the facial features showed significant difference between normal and carrier. Of the three parameters of height, weight and BMI only weight exhibited significant differences between the groups. The model prediction accuracy with all variables in the equation was 90.9% with only 19.7% contribution to the prediction (Nagelkerke R Square = 0.197). Using stepwise BLR only weight was included in the equation (GENOTYPE= 0.058×WT −1.001, cut value is 0.5, Wald statistics= 5.022, p = 0.025) with overall accuracy of 90%. The ROC curve analyses for the weight only showed the area under curve (AUC) of 0.654 indicating 65.4% best prediction probability of the model. In conclusion, weight demonstrated a superior potential in discriminating the genotype over other variables considered in the study among Hausas of Nigeria.
Trapped Lung Secondary to Cardiomegaly in a 78 year‐old Male with Congestive Heart Failure
Authors: Amabile Amy Helen , DePhilip Robert M. , Moffatt‐Bruce Susan D
Published: November 2023

Introduction/Objective

Although the etiologies of both trapped lung and cardiomegaly are well‐established, co‐presentation of the two conditions, and possible interactions between them, are much rarer. The objective of this report is to describe our findings during cadaver dissection, consider possible interactions between the two conditions, and discuss issues related to decision‐making for imaging and clinical interventions.

Case Report

During routine dissection of a 78 year‐old male cadaver we found a trapped left lung and enlarged heart almost completely occupying the left pleural cavity. The subject's past medical history included heart failure, hypertension, and pleural effusion, and was consistent with a diagnosis of both conditions. A trapped lung is a shrunken lung surrounded by a cortex of fibrotic visceral pleura, typically formed as a consequence of chronic pleural effusion. This subject's left lung was deformed, and markedly diminished compared with the right lung, particularly in the lower lobe. His cardiothoracic ratio was 0.54, consistent with a diagnosis of cardiomegaly. Ventricular wall thickness measurements indicated substantial biventricular hypertrophy. During the final week of his life he underwent multiple chest radiographs showing persistent opacification of the left pleural cavity and the presence of pleural effusion. Both before and after thoracentesis neither the trapped lung, nor the enlarged heart, were identified.

Clinical Considerations/Conclusions

Was the presence of both a trapped lung and enlarged heart in the present subject a coincidence, or was there some sort of causation? Although no direct causal connection has been established between the two conditions, analogies can be found in the literature. Compression of the heart on the left lung due to post‐surgical edema after coronary artery bypass grafting has been shown to cause decreased gas volumes in the lower lobe. Conversely, after pneumonectomy, the increased afterload resulting from a decreased pulmonary vascular bed has been shown to cause right ventricular hypertrophy. It is possible that similar mechanisms played a role in the development of either the trapped lung or enlarged heart in the present subject.

This subject may have benefitted from earlier identification of his trapped lung in the years prior to his death. This would have offered additional treatment options, such as surgical decortication. Early identification also would have prevented the cost, discomfort and risks of repeat thoracentesis. Thoracentesis is not recommended in the case of trapped lung, as the pleural cavity will immediately refill due to the negative pleural pressure. Greater awareness, and a higher overall index of suspicion among clinicians for the presence of trapped lung and its sequelae, would lead to more routine use of CT scans in similar cases, and likely overall improved, and potentially more efficient, patient care.

Support or Funding Information

N/A
Surgical radiologic anatomy of aberrant right subclavian artery (arteria lusoria). A study on 160 CT scans.
Authors: Settembre Nicla , Malikov Sergueï , Jeannon Fanette , Bouziane Zakariyae
Published: November 2023

Introduction

The Arteria lusoria (AL) is the most common anatomical variation of the supra‐aortic trunks. The symptomatic forms are rare and occur by compression of the oesophagus (dysphagia lusoria) or aneurismal transformation of the AL with a risk of rupture or embolism including posterior stroke or ischemia of the hand. The AL may be involved in aortic aneurismal pathology type or dissection and may complicate endovascular management. The aim of this study is to firstly clarify the morphology of the AL and the situation of its ostium in relation to nearby arteries; secondly we assessed the feasibility of interventional treatment in patients requiring intervention.

Patients and methods

we analyzed 160 Angio‐CT scan from patients with this anatomical variation. We made multiple measurements of diameter and distance, and collected different morphological data, by a standardized protocol. The Student test was used to compare our results. Throughout these results we assessed the practical feasibility of this method.

Results

AL is associated with the presence of a bicarotidien common trunk in 49% of cases, and has a conical expansion at its ostium (diverticulum Kommerell) in 66% of patients. The average distance between the right and left subclavian arteries is 2.4 mm. The diameter of the AL is compatible with endovascular occlusion systems. The presence of a diverticulum Kommerell requires the use of permanent materials to prevent migration into the aorta. By using these data we were able to treat 4 patients with symptomatic AL, the feasibility of the hybrid surgery was confirmed with good results.

Conclusion

We were able to identify the morphological characteristics of the AL, we found a significant difference in diameter between the two subclavian arteries. The presence of a Kommerell diverticulum is frequent.

Our work helps to plan the endovascular or hybrid treatment and to anticipate the technical limitations of those interventions.
Retrospective Computed Tomography Angiogram Investigation on the Subclavian Artery Branching Pattern and Origin
Authors: Ryu Juwan , Scallan Oonagh , Johnson Marjorie , Wilson Tim , Power Adam
Published: November 2023

Intro

The subclavian artery (SCA) is a substantial vessel with several branches and therefore potential branching patterns. Knowledge of the subclavian artery and its associated branches is important in vascular surgeries of the upper extremity and aorta in order to avoid bleeding and injury. Typical branching order off the SCA is Vertebral (VA), Internal Thoracic (ITA), Thyrocervical (TCT), Costocervical (CCT) and Dorsal Scapular Artery (DSA), however, significant variations to this traditional understanding may exist. The purpose of this study is to characterize the variations in the origin and branching pattern of SCA branches using measurements from patient Computed Tomography Angiograms (CTAs).

Methods

Head & neck and upper limb CTAs from 55 patients (bilaterally, 110 scans) were retrospectively reviewed on 3D visualizing software TeraRecon. Of these, 101 CTAs displaying left (n=49) and right (n=52) SCAs of sufficient resolution and clarity were selected. Measurements were taken of the distance at which SCA branches originated from the aorta using the software's distance measuring tool and manually tracing the path of SCA to each branch origin. Also, the number of branches and their respective order were counted.

Results

Five branches originated directly from the SCA with the highest frequency: VA (97.0%), ITA (91.1%), TCT (90.1%), CCT (77.2%), and DSA (57.4%). Only 13 SCAs (12.9%) were observed to have exhibited the typical pattern. VA originated first in 80.2% of SCAs, with ITA arising second (41.3%), TCT as third (47.3%), CCT as fourth (43.6%) and DSA as the fifth branch (56.9%). Common aberrant branches that arose directly from the SCA were Ascending Cervical (4.9%), Deep Cervical (9.9%), Inferior Thyroid (7.9%) and Supreme Intercostal Artery (8.9%).

Discussion

The subclavian artery branching order and pattern may present significant variation from the typical order. Our findings demonstrate that, within our sample, ITA and TCT arise 2nd (41.1%) and 3rd (46.9%), respectively. These arteries may frequently swap in order for ITA to originate 3rd (32.6%), and TCT to originate 2nd (31.9%). However, VA reliably originates as the most proximal branch (80.2%). The variability in subclavian artery branching pattern poses a challenge in subclavian artery surgery such as SCA‐Common Carotid Artery bypass and transposition. The findings of this study will be used to define the optimal patient position for safe and maximal exposure of the SCA in the supraclavicular surgical window.
A Tale of Two Arches
Authors: Wilson Brittany M , Williams James M
Published: November 2023

When the pharyngeal arches appear during the 4th and 5th weeks of development they receive an artery known as an aortic arch. These aortic arches appear, become modified or regress in a cranial to caudal direction to result in the normal arrangement of an aortic arch with a brachiocephalic trunk, left common carotid and left subclavian arteries. On occasion different patterns of the aortic arches may arise. This paper describes the occurrence of two aortic arch variations found during a routine dissection in a human anatomy course.

Aortic arch 1: Left vertebral artery arises directly from arch

Four major branches can be observed originating from the aortic arch in this individual. The initial branch is the brachiocephalic trunk, which contains right common carotid and right subclavian arterial branches. The left common carotid artery arises subsequent to the brachiocephalic trunk. Contrary to the typical pattern, the left vertebral artery arises next directly from the aortic arch and traverses posteriorly toward the cervical transverse foramina. The final branch originating from the aortic arch is the left subclavian artery. This variation was described by Thomson1 in 1893 and reported to have occurred in 27 of 500 cases.

Aortic arch 2: Right subclavian artery traverses posterior to trachea and esophagus

Again, four branches can be observed originating from the aortic arch. The first branch, however, is not the brachiocephalic trunk and instead the right common carotid artery originates directly from the aortic arch. The next branch is the left common carotid artery followed by the left subclavian artery. The right subclavian artery originates after the left subclavian artery and traverses posterior to the trachea and esophagus towards the right clavicle. As the right subclavian artery passes posterior to the esophagus, the right vertebral artery originates. An additional contribution to the right vertebral artery arises from the right common carotid artery. The two vertebral artery contributions join and a single vertebral artery can be seen diving posterior toward the cervical transverse foramina. This aortic arch variation was found to occur in 4 of 500 individuals1.

Anatomy courses vary with respect to giving the cause of death of the cadaver prior to dissection. Some courses give the students an opportunity to attempt to determine the cause of death based upon what is identified during the dissection process. Unfortunately, the stated cause of death rarely tells a complete story as numerous “abnormalities” or variations can exist in a body that do not relate to the cause of death. It is uncertain that the aortic arch variations contributed to the cause of death in these two cases and quite possible that they had little impact on the general health of the individuals.
Perforator Angiosomes of the anterior knee region
Authors: Hirtler Lena , Lübbers Anke
Published: November 2023

Introduction

In reconstructive surgery, skin and muscle flaps are raised on the basis of their blood supply. Various perforator angiosomes of different regions (e.g. medial side of the arm, abdomen) have already been described in literature, however, information concerning perforator angiosomes of the anterior knee region is scarce. Therefor, the aim of this study was to describe the individual vascular supply and position of pediculated perforator flaps in the anterior knee region.

Material and methods

Twenty lower extremities of fresh frozen specimen donated to the anatomic institute were obtained. After identifying the femoral artery in the middle third of the thigh, 10 ml methylene blue was injected to facilitate the dissection of the different branches. After identification of the different perforators, a cannula was inserted into each perforator and injected with alternating colored solutions to color the appendant perforator angiosome. The width, length, position in relation to the middle of the patella, the diameter of the supplying artery and the diameter of the leg were measured. Every perforator angiosomes was recorded photographically. Afterwards all angiosomes were digitalized and graphically analyzed.

Results

A total of 122 perforator angiosomes were found in 20 legs, there were 6,1 perforator angiosomes per leg in average. The perforator angiosomes measured 7,45 ± 3,42 cm in length, 7,18 ± 2,92 cm in width and the average arterial diameter was 1,52 ± 0,55 mm. The size of the perfused perforator angiosomes had a range from 1cm2 to 28cm2.

Conclusion

A highly variable arrangement of the different perforator angiosomes in the anterior knee region was observed. Size and shape are highly variable, however the location of the perforator is by contrast very consistent. This information could be helpful in planning reconstructive surgery in this region.

Support or Funding Information

The authors have nothing to declare.
Deletion of Estrogen Receptor Alpha in Rats Speeds up Liver regeneration After CCl4‐ induced Liver Injury
Authors: McGreal Steven , Rumi M.A Karim , Soares Michael , Apte Udayan
Published: November 2023

Estrogen receptor alpha (Esr1) is one of the two cognate receptors for Estrogen and is expressed by hepatocytes. The role of ESR1 in liver regeneration is not completely clear. We studied the role of ESR1 in liver regeneration after CCl4‐induced liver injury using type (WT) and ESR1 knockout (ESR1‐KO) rats. Two‐three month old female WT and ESR1‐KO rats were treated with 1ml/kg CCl4 and euthanized over a time course of 0–48 hr. Liver Injury measured by serum ALT and histopathology increased substantially after CCl4 treatment but no significant difference in liver injury between WT and ESR1‐KO was noted. H&E staining shows an early increase in hepatic inflammation starting at 12 hr post CCl4 along with moderately higher mRNA for various inflammatory markers. Histopathological analysis indicated a rapid recovery in ESR1‐KO mice resulting in significantly lower necrosis at 48 hr after CCl4 treatment. Immunohistochemistry shows an early appearance of PCNA positive cells in KO livers as compared to WT livers, which sustained through 24 hr. Western blot analysis showed an elevated level of Cyclin D1 and phosphorylated Rb protein in the KO rats at 12 and 24 hr. Further analysis revealed faster activation of canonical Wnt/β‐catenin signaling in ESR1‐KO rats characterized by higher activated β‐catenin accompanied with increased phosphorylated GSK3β at 12 hr after CCl4 treatment. Taken together, these data indicate that signaling via ESR1 inhibits liver regeneration by down regulation of Wnt signaling resulting in lower Cyclin D1 activation after chemical induced liver injury.

Support or Funding Information

T32 training grant (5T32ES007079‐34), R01DK098414, and Pilot Grant from Institute for Reproductive Health and Regenerative Medicine (IRHRM) of KUMC
Stem Cell‐based Biliary Organoids and Gallbladder‐like Structures for Disease Modeling of Primary Sclerosing Cholangitis and Alagille Syndrome
Authors: Contreras Deisy , Irudayam Joseph Ignatius , Annamalai Alagappan W , Klein Andrew , French Samuel W , Arumugaswami Vaithi
Published: November 2023

Cholangiopathies such as primary sclerosing cholangitis (PSC), Alagille Syndrome (AS), polycystic liver disease and cholangiocarcinoma result in end‐stage liver disease. To understand the cell and molecular basis of these progressive disorders, a cell‐based interface would be very useful. Availability of human primary cholangiocytes is a limiting factor, and pluripotent stem cells provide an exciting option of generating unlimited quantity of cholangiocytes for in vitro disease modeling purposes. Our goal is to develop and in vitro platform using stem cell‐derived cholangiocytes to model the pathogenesis of PSC and AS. We established a three stage differentiation program to differentiate pluripotent stem cells to biliary epithelial cells. The first stage involves hepatoblast formation by definitive endoderm induction; a second phase entails biliary specification prompting cholangiocyte progenitors and the final third stage of cholangiocyte maturation. At 16 days post‐differentiation, the expression of biliary markers SOX9, CFTR, cytokeratin 7 (CK7) and CK19 were verified by RT‐qPCR and immunofluorescence assay. Marker expression was similar to that of human gallbladder tissue. Day 16 cells were induced to form organoids in 3D matrigel culture. The cells were organized to become branched tubular structures. The histology of these organoids showed the formation of duct‐like structures which are cytokeratin 19 and CK 8/18 positive with a defined collagen IV positive basement membrane. The tubules were surrounded by connective tissue‐like structures. By day 33, pear‐shaped gallbladder‐like cystic structures emerged. Immunohistochemistry of these tubular organoids showed polarized columnar cells lining the ductular structures. Zo‐1 tight junction proteins were localized to the apical side of the cells facing the lumen. In conclusion, we have developed a 3D in vitro platform to study the bile duct structure formation based on stem cell‐derived cholangiocytes. This system is currently being investigated for studying the effect of primary sclerosing cholangitis risk genes and the deregulation of NOTCH signaling pathway of Alagille Syndrome model.
Protracted withdrawal from cocaine: a role for mGlu2/3 receptors in the vmPFC?
Authors: Shin Christina B , Ruppert‐Majer Micaela A , Serchia Michela M , Kippin Tod E , Szumlinski Karen K
Published: November 2023

Relapse to drug‐taking is a reoccurring phenomenon impairing addiction recovery that can be triggered by the elicitation of intense drug craving upon re‐exposure to drug‐paired cues. Cue‐elicited drug‐craving increases in a time‐dependent manner during drug abstinence ‐a phenomenon termed “incubation of craving”. The neural substrates of this phenomenon are not fully understood but are thought to involve glutamate mechanisms in the ventromedial prefrontal cortex (vmPFC) as the capacity of cocaine‐paired cues to increase glutamate release within vmPFC incubates during protracted withdrawal in concert with behavior. We hypothesize that incubated cue‐elicited glutamate release within vmPFC might drive incubated behavior. To test this hypothesis, male Sprague‐Dawley rats were trained to lever‐press for cocaine (0.25 mg/infusion; 6 h/day) for 10 consecutive days. At 30 days withdrawal, animals were infused intra‐vmPFC (0.5 μl /side) with either vehicle or 50μM of the mGlu2/3 autoreceptor agonist APDC and underwent a 30‐min test for cue‐elicited cocaine‐seeking. A control group was infused with vehicle at 3 days withdrawal to provide a base‐line response. Vehicle‐infused animals exhibited a time‐dependent intensification of cue‐reinforced responding, indicating incubation. However, the magnitude of this incubation was not influenced by 50μM APDC. As mGlu2/3 receptor down‐regulation is reported within the medial PFC of rats withdrawn from non‐contingent cocaine treatment, current studies seek to characterize mGlu2/3 expression within the vmPFC following a history of excessive cocaine intake to better understand the molecular mechanism(s) underpinning the cue hyper‐reactivity of vmPFC glutamate that presumably drives incubated cocaine‐seeking.
Extended‐access and yoked‐access to cocaine self‐administration have distinct behavioral and molecular profiles.
Authors: Ploense Kyle Lawrence , Vieira Philip , Kippin Tod E.
Published: November 2023

Cocaine addiction is a chronic disorder that involves escalation of intake over time. Both humans and rodents will self‐administer escalating doses of cocaine when the drug is readily available. However, when cocaine access is restricted, escalation of intake is not apparent in rodents. Here, we investigated escalation of cocaine intake and active lever responding in rats as a function of control over intake. Rats were implanted with a permanent jugular catheter and then allowed to lever press to self‐administer (FR1, 20s time‐out with a 20s light cue paired with each infusion) saline vehicle (0.1 ml/infusion) cocaine (0.25 mg/infusion) under 4 conditions: limited‐access (1 h/ day) to saline, limited‐access to cocaine, extended‐access (6 h/day) to cocaine condition, and limited‐access + yoked‐access (1h/day + 5 h/day, respectively) to cocaine. Based on the first 10 min and first hour of daily access, we observed rapid escalation of cocaine intake in both the extended‐access and limited‐access + yoked conditions (ps < 0.05). We also observed a delayed escalation of cocaine intake in the limited‐access condition within the first 10 min of self‐administration (p < 0.05), but not within the first 1 h of self‐administration. Interestingly, escalation of cocaine intake in the limited access + yoked‐access rats was much faster than in the extended access rats. However, relative to the other cocaine conditions, the limited‐access + yoked group exhibited markedly less efficient self‐administration (i.e. more non‐reinforced relative to reinforced lever responses) during both the first 10 min and 1 h of daily self‐administration (ps<0.05). Additionally, post‐mortem quantification of homer2 (a gene implicated in cocaine cued learning) mRNA expression within the dmPFC indicated elevation only in the extended‐access conditions (p<0.05). Together, these findings indicate that either contingent or non‐contingent “excessive” cocaine exposure supports escalation but has distinct effects on the temporal patterning of operant responsiveness as well as molecular correlates of escalation.

Support or Funding Information

NARSAD

NIH (R21DA027115)

Keck Award
Morphometry of the corpus callosum and its possible clinical correlations
Authors: Camara Eduardo Poletti , de Souza Pinto Antonio José Assis Xavier , Tavares Marcelo Rodrigo , Fazan Valéria Paula Sassoli , Amorim Milena , de Fátima Oliveira Nadimila , de Paula Hebert Rodarte
Published: November 2023

Introduction

The corpus callosum is a brain structure located in the longitudinal fissure, responsible for the connection between the right and left cerebral hemispheres. It has the largest amount of white matter in the brain, has from 200 to 250 million contralateral axon projections.

Objective

To carry out the morphometry of the amplitude of the corpus callosum in search of a standardization of its measurement and its possible relevant clinical relations.

Materials and Methods

The authors conducted the morphology of the corpus callosum by manual caliper in 30 human brains (n = 30), in the anatomical center I of University José do Rosário Vellano (Alfenas‐MG), set by local conservation methods. The pictures were taken with a camera of 8 MP and a resolution of 3264 × 2448 pixel.

Results

it was found that there was a predominant value of 72 mm for the full extent of the corpus callosum, there are corresponding 16,66% incidence.

Conclusion

The study aims to carry out the standardization of the measurement of the corpus callosum and its prevalence rate in human brains of the population, it was hypothesized a possible change of morphology in the corpus callosum of individuals who have experienced trauma. Since the demand for ancient corpses guess necropsy, which generally evidenced head trauma accompanied by increased intracranial pressure, subdural hematoma and compression of longitudinal fissure.