Implementing and integrating computer‐based activities into a problem‐based gross anatomy curriculum

A problem‐based learning curriculum in gross anatomy was begun for a limited number of students to address unsuccessful methodology inherent in a traditional instructional approach. To eliminate some concerns associated with the laboratory component, computer‐based instruction and other computer‐ related activities were actively integrated into the total instructional process. Prosections, directions, quizzes, images, and grades were provided in lab at table‐side computer workstations, in the library, and on the web. Results were assessed through questionnaires in which students rated their learning experience according to a Likert‐type scale. Success was measured by quantitative improvements in student perception. In this three‐year study, observations and measurements have suggested increasingly positive student attitudes toward educational technology, for networks as a faster and more effective method of student/faculty communication, and in the utilization of computer‐based instruction for greater flexibility and efficiency in learning. This allowed a rethinking of the structure and content of the curriculum by the faculty, which permitted reduced laboratory time, more small‐group activity, and less reliance on staff. Clin. Anat. 12:191–198, 1999. © 1999 Wiley‐Liss, Inc.     

Undergraduate coursework in anatomy as a predictor of performance: comparison between students taking a medical gross anatomy course of average length and a course shortened by curriculum reform

The performance of students taking medical gross anatomy at the University of California at Davis during a 4-year period (1999-2002) was correlated with prior undergraduate anatomy coursework. Significant correlations were observed between class rank in medical anatomy and taking any undergraduate anatomy as well as the total number of undergraduate anatomy units (P<0.01). Taking human gross anatomy and an anatomy laboratory course were significantly correlated with medical anatomy class rank (P<0.01) as were grades in human anatomy, comparative vertebrate anatomy and anatomy laboratory courses (P<0.05). The medical anatomy course offered in 1999-2000 was 172 hr long, and the course offered in 2001-2002 was 135 hr long, with most of the difference made by decreasing lecture time while sparing the dissection laboratory. The reduction in course length was the consequence of a curriculum-wide cap in weekly contact hours. In the 172-hr medical anatomy course there were significant correlations between the students who took undergraduate anatomy and both class rank and the score on the final examination (P<0.01). These correlations did not exist for the 135-hr course. This may be explained by previous anatomy experiences helping students learn from lecture more than from dissection laboratory, as well as the extra study time available to students in the reformed medical curriculum. Pre-medical students and health science advisors need to consider that the benefits of taking anatomy as an undergraduate may be dependent on the configuration of a medical school's curriculum.     

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

Formalin is commonly used in fixation of cadaveric specimens. Exposure to formaldehyde, a component of formalin and a known carcinogen, during gross anatomy laboratory dissection is a continuing concern for pregnant students and instructors. Since there is little literature on this specific topic, the current review was compiled in the hope of offering recommendations to pregnant students and instructors who are engaged in human anatomical dissection where formalin is used. Relevant articles were obtained through searches of PubMed and Google Scholar for the terms “formaldehyde,” “pregnant,” “formalin,” and “exposure.” A literature search was conducted for chemical information and articles about exposure as issued by government regulatory agencies and chemical companies that produce formaldehyde. This led to the compilation of 29 articles each of which included references to previous, relevant, human research. The reviewed literature contains data strongly suggesting that pregnancy can be affected by formaldehyde exposure. Therefore, on the basis our analysis, female students who might be pregnant should avoid formaldehyde exposure, including that in a gross anatomy laboratory. Instructors should find other means of ensuring anatomical competence for these students. Clin. Anat. 28:972–979, 2015. © 2015 Wiley Periodicals, Inc.     

Exposure to formaldehyde and phenol during an anatomy dissecting course: sensitizing potency of formaldehyde in medical students

BACKGROUND: The sensitizing potency of formaldehyde and phenol during anatomy dissecting was investigated. The objective was to determine whether exposure induces specific IgE or IgG against formaldehyde-albumin or phenol-albumin. METHODS: In 27 medical students, specific IgE against formaldehyde-albumin by RAST plus ELISA and specific IgE against phenol-albumin by ELISA were assessed. In addition, specific IgG against formaldehyde-albumin was assessed in 23 students. Symptoms before and during dissecting were assessed, and indoor formaldehyde and phenol were measured. RESULTS: Mean indoor formaldehyde was 0.265 +/- 0.07 mg/m3, and mean indoor phenol was 4.65 +/- 2.96 mg/m3. Specific IgE/IgG against formaldehyde-albumin was not found at the beginning. Four students developed specific IgE against formaldehyde-albumin (RAST classes of > or =2.0), and all four also had specific IgE in the ELISA, but IgG against formaldehyde-albumin was not found. Specific IgE against phenol-albumin was not seen. Itch and paresthesia of the hands (P<0.00001), dizziness (P<0.008), burning eyes (P<0.01), headache, sneezing, epistaxis, gingival bleeding, oral or pharyngeal itch, and shortness of breath were experienced. CONCLUSIONS: Formaldehyde exposure during dissecting may induce specific IgE, but not IgG, against formaldehyde-albumin. Sensitization did not correlate with symptoms.     

Effect of formaldehyde and its aminomethylol derivatives on strains ofEscherichia coli with various defects of DNA repair systems

Aminomethylol compounds formed by the reaction between formaldehyde and amino acids, like formaldehyde itself, have a marked lethal action on strains ofEscherichia coli with various defects of DNA repair systems. Correlation was found between the degree of depurinization of DNA caused by different aminomethylol derivativesin vitro and the inactivating action of these derivatives on bacteria. It is suggested on the basis of the results that the inactivating effect of formaldehyde and its aminomethylol derivatives is evidently due to the formation of depurinized regions in the bacterial DNA rather than to dimerization of the purine bases.Plague Research Institute, Rostov-on-Don. Research Institute of Medical Radiology, Academy of Medical Sciences of the USSR, Obninsk. (Presented by Academician of the Academy of Medical Sciences of the USSR M. P. Chumakov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 87, No. 5, pp. 466–468, May, 1979.     

Role of complement in neutralization of respiratory syncytial virus

Serum neutralizing antibody titers to respiratory syncytial virus (RSV) are higher when assayed with guinea pig complement. A number of different mechanisms have been suggested for enhancement of neutralization by complement. The most straightforward is that complement-antibody complexes present a greater steric hindrance to viral entry than with antibody alone. To define the implications of measuring serum neutralizing antibody with and without complement, sera from adults, young children, infants, and cord bloods were run in plaque neutralization assays with representative viruses of the RSV A and B subgroups. Although titers of neutralizing antibody were higher in the presence of complement, the addition of complement did not increase the ability to detect antibody rises after natural infection. Some of the complement effect may be attributable to an inhibition of RSV replication by complement alone. While these observations do not address the role for complement in the pathogenesis of RSV infection, they suggest that neutralization assays performed without complement may be most reflective of physiologic conditions in the respiratory tract.     

Evaluation of methods to reduce formaldehyde levels of cadavers in the dissection laboratory

Dissection of conventionally embalmed cadavers exposes students, staff, and faculty to formaldehyde, a probable carcinogen. Therefore, prudent practices should seek to minimize formaldehyde exposure. In this study, we evaluated two commercially available chemicals, InfuTrace and Perfect Solution, for their effectiveness in reducing ambient formaldehyde levels. Four cadavers embalmed conventionally with formaldehyde and/or with the above agents were compared for their formaldehyde levels under conditions that strictly controlled for air circulation and for locations and methods of testing, and during activities that simulated student dissecting. For InfuTrace, one cadaver was reinfused with InfuTrace after initial standard perfusion with formaldehyde; a second cadaver had InfuTrace injected into the thoracic and abdominal body cavities after formaldehyde perfusion. For Perfect Solution, the product was used for embalming a third cadaver in lieu of formaldehyde. For a control, a fourth cadaver was embalmed with the standard formaldehyde solution. Testing of personal and ambient room air samples and of fluid obtained from the cadavers was performed and analyzed in a blinded fashion. Results indicated that both Perfect Solution, substituted for standard formaldehyde embalming, and InfuTrace infused through the vasculature after formaldehyde embalming, resulted in lower concentrations of formaldehyde than embalming with formaldehyde solution alone or in combination with body cavity injection of InfuTrace. These differences in formaldehyde concentrations are consistent across measuring methods, for example, of room air, of breathing zone air during cadaver handling and dissection, and of liquid samples obtained from the cadavers. Perfect Solution yielded suboptimum fixation and a different texture, color, and smell than the formaldehyde treatments.     

The relationships between learning outcomes and methods of teaching anatomy as perceived by medical students

The best method to teach anatomy continues to be widely debated. Many UK medical schools have recently changed their course structure with the use of cadaveric dissection declining. A recent study by Patel and Moxham ([ 2008] Clin. Anat. 21:182-189) found that professional anatomists viewed dissection to be the most suitable method to fulfil anatomical learning outcomes. The opinion of 580 second year medical students across two UK medical schools was surveyed. A methodology similar to that employed by Patel and Moxham ([ 2008] Clin. Anat. 21:182-189) aimed to explore which teaching methods students considered best to fulfil a prescribed set of anatomical learning outcomes. A total of 302 responses were returned (52%). Difference in students' opinion with regard to the teaching methods was statistically significant (P < 0.0001). A statistically significant agreement was found between the opinions of students from Imperial and Nottingham, and between the anatomists and the students, regarding the effectiveness of all teaching methods at meeting learning outcomes. Dissection was overall most "fit for purpose" in meeting learning outcomes, but no single teaching modality met all aspects of the curriculum. Dissection should remain a leading teaching modality in modern medical school anatomy courses. In addition to its role in the teaching of anatomy, it enables learning in a social context and holds broader learning opportunities to help future doctors best fulfill Good Medical Practice guidelines (General Medical Council, 2006). This, however, should be in the context of a multi-modal approach to the teaching of anatomy.     

Pathological analysis of cadavers for educational dissection by using postmortem imaging

This study was performed primarily to clarify whether pathological analysis of cadavers for anatomical dissection is possible using postmortem imaging (PMI), and whether this is worthwhile. A total of 33 cadavers that underwent systematic anatomical dissection at our medical school also underwent PMI. Fixative solution was injected into the corpus 3–4 days after death. PMI was then performed using an 8‐slice multi‐detector CT scanner 3 months before dissection. Before dissection, a conference was held to discuss the findings of the PMI. First, two radiologists read the postmortem images without any medical information and deduced the immediate cause of death. Then, the anatomy instructor revealed the medical information available. Based on this information, the radiologist, anatomy instructor, and pathologists suggested candidate sampling sites for pathological examination. On the last day of the dissection period, the pathologists resected the sample tissues and processed them for pathological examination. In 12 of 33 cases, the presumed causes of death could be determined based on PMI alone, and revision of the cause of death described in the death certificate was considered in five (15.2%) cases, based on PMI and pathological analysis. This article presents a novel method of pathological analysis of cadavers for anatomical dissection using PMI without disturbing the anatomy education of medical students.     

Technical aspects of gaseous formaldehyde as a sterilant

The design of a sterilizer for sterilization of heat sensitive items using gaseous formaldehyde and steam is described. The sterilizer is able to create a constant formaldehyde-steam concentration over a period of at least one hour. It is further able to operate at formaldehyde concentrations close to saturation with only small residues on sterilized plastic materials. The autoclave is used for measurement of formaldehyde solubility in polyolefines and poly(vinyl chloride) being approx. 15 and 250 ppm, respectively, at 70 degrees C and 30 mg HCHO I-1. The diffusion coefficient of formaldehyde in poly(vinyl chloride) is measured and is in the same order of magnitude as for ethylene oxide in poly(methyl methacrylate) i.e. 10(-10) cm2 s-1. Measurements of airborne formaldehyde in front of different sterilizers show that it is possible to design facilities meeting occupational exposure limits.     

Longitudinal study of serum neutralization of HIV-1 in infected plasma donors.

Earlier studies provided suggestive evidence about the effectiveness of passive immunotherapy for AIDS patients using plasma donated by healthy HIV-1 infected individuals and revealed beneficial effects of plasmapheresis for the immune system of the donors. In this study, anti-HIV-1 neutralizing activity in 31 healthy HIV-1 infected donors of plasma participating in a passive immunotherapy study was investigated as a function of time. Average studied period was 33 months. Using the highly cytopathic HIV-1 NDK strain and MOLT4 cells, it was shown by means of syncytia formation inhibition assay and polyclonal HIV-1 antigen-capture assay that viral neutralizing titers tend either to remain unchanged or increase over time. These findings support the notion that the immune system is not affected adversely in HIV-1 infected plasma donors and lend further support to the feasibility of passive immunotherapy for AIDS patients.     

Use of chimeric adenoviral vectors to assess capsid neutralization determinants

In order to elucidate the relative importance of neutralizing determinants on each of the three major adenoviral capsid components, we have generated chimeric vectors where the hexon protein, or the fiber protein, or both hexon and fiber proteins of one serotype (Simian Adenovirus 24/Pan 7) have been replaced by those of another (Simian Adenovirus 23/Pan 6). The effect of each replacement was evaluated by neutralization assays and by attempted vector re-administration into mice. Both hexon and fiber were found to harbor neutralization epitopes although in vivo transduction was more severely affected by anti-hexon antibodies.     

Formaldehvde and Dhenol exposure during an anatom; dissecdon course: a Dossible source of IgE-mediated sensitizkion?

The sensitizing potency of formaldehyde and phenol exposure during 4 weeks of an anatomy dissection course was assessed in 45 medical students. Specific IgE against formaldehyde by RAST and by ELISA and specific IgE against phenol by ELISA were assessed before and after the course. At the start of the course. symptoms, type I allergy, respiratory diseases, and smoking habits were noted. At the end of the course, only symptoms experienced during the dissection lessons were assessed. Indoor formaldehyde levels were measured continuously. The mean indoor formaldehyde level was 0.124±0.05 ppm, with a minimum of 0.059 ppm and a maximum of 0.219 ppm. Specific IgE against formaldehyde or phenol was found in none of the subjects at the beginning of the course, and no student showed specific IgE against formaldehyde or phenol after the course. Assessment of primarily irritant symptoms during the lessons revealed itch and paraesthesia of hands in 33/45 students (P<0.00005), headache in 15/45 students, burning eyes in 13/45 students (P<0.02), dizziness in 8/45 students (P<0.008), sneezing in 4/45 students, epistaxis in 2/45 students, and shortness of breath in 1/45 students. According to our data, l-month exposure to formaldehyde and phenol during an anatomy dissection course does not induce specific IgE against formaldehyde or phenol.     

Antibody-mediated neutralization of flaviviruses: a reductionist view

Flaviviruses are a group of ~ 70 small RNA viruses responsible for significant morbidity and mortality across the globe. Efforts to develop effective vaccines for several clinically important flaviviruses are underway. Antibodies are a significant component of the host's protective response against flavivirus infection with the potential to contribute to immunity via several distinct mechanisms, including an ability to directly neutralize virus infection. Conversely, virus-reactive antibodies have been implicated in the increased risk of severe clinical manifestations following secondary dengue virus infection. In this review, we will discuss recent progress toward understanding the molecular basis of antibody-mediated neutralization of flaviviruses. Neutralization requires engagement of the virion with a stoichiometry that exceeds a required threshold. From this perspective, we will discuss viral and host factors that impact the number of antibody molecules bound to the virus particle and significantly modulate the potency of neutralizing antibodies.     

Femoral Morphology and Femoropelvic Musculoskeletal Anatomy of Humans and Great Apes: A Comparative Virtopsy Study

Scheme of virtual dissection (virtopsy). Volume data visualization was performed for CT data of a formalin‐preserved juvenile chimpanzee (id: AIMUZH‐7283) to visualize muscles and skeleton. See Figure 2B and 2C in Morimoto et al., on page 1437, in this issue.     

A laboratory exercise in the study of the gross structure of the eye

The dissection of the bovine eye, when it is based on procedures used in ophthalmic surgery, results in an enthusiastic reception by medical students. © 1996 Wiley-Liss, Inc.     

Molecular assessment of the role of envelope-associated structural proteins in cross neutralization among different PRRS viruses

To assess the role of each envelope-associated protein (i.e., ORFs 2–6 products) of type 2 PRRSV in cross neutralization mediated by antibody, chimeric mutants were generated by replacing ORFs of a VR2332-based infectious clone with those of JA142, SDSU73, PRRS124, or 2M11715 that are genetically and antigenically distinct from VR2332 and two-way neutralization assays were performed on those mutants using VR2332, JA142, SDSU73, or PRRS124 antisera. All ORF 5-replaced mutants showed increased susceptibility or resistance against homologous or heterologous antisera, respectively, in comparison to that of the donor strains, but failed to achieve a complete reversion of cross neutralization. In contrast, substitution of ORFs 3–6 completely reversed the susceptibility of the virus to neutralization by antibody. Changes in ORFs 3, 5, and 6 were additively responsible for reversion of the susceptibility, suggesting that the genetic similarity of these ORFs should be considered for better cross neutralization between two different type 2 PRRS viruses.