Advances in procedural techniques--antegrade.

There have been many technological advances in antegrade CTO PCI, but perhaps most importantly has been the evolution of the "hybrid' approach where ideally there exists a seamless interplay of antegrade wiring, antegrade dissection re-entry and retrograde approaches as dictated by procedural factors. Antegrade wire escalation with intimal tracking remains the preferred initial strategy in short CTOs without proximal cap ambiguity. More complex CTOs, however, usually require either a retrograde or an antegrade dissection re-entry approach, or both. Antegrade dissection re-entry is well suited to long occlusions where there is a healthy distal vessel and limited "interventional" collaterals. Early use of a dissection re-entry strategy will increase success rates, reduce complications, and minimise radiation exposure, contrast use as well as procedural times. Antegrade dissection can be achieved with a knuckle wire technique or the CrossBoss catheter whilst re-entry will be achieved in the most reproducible and reliable fashion by the Stingray balloon/wire. It should be avoided where there is potential for loss of large side branches. It remains to be seen whether use of newer dissection re-entry strategies will be associated with lower restenosis rates compared with the more uncontrolled subintimal tracking strategies such as STAR and whether stent insertion in the subintimal space is associated with higher rates of late stent malapposition and stent thrombosis. It is to be hoped that the algorithms, which have been developed to guide CTO operators, allow for a better transfer of knowledge and skills to increase uptake and acceptance of CTO PCI as a whole

Medical Student Dissection of Cadavers Improves Performance on Practical Exams but not on the NBME Anatomy Subject Exam

We have examined whether cadaver dissection by first year medical students (MIs) affected their performance in two test measures: the NBME Gross Anatomy and Embryology Subject Exam (dissection-relevant questions only), and practical exams given at the end of each major section within the course. The dissections for the entire course were divided into 18 regional dissection units and each student was assigned to dissect one third of the regional units; the other two-thirds of the material was learned from the partner-prosected cadavers. Performance for each student on the exams was then assessed as a function of the regions those students actually dissected. While the results indicated a small performance advantage for MIs answering questions on material they had dissected on the NBME Subject Exam questions relevant to dissection (78-88% of total exam), the results were not statistically significant. However, a similar, small performance advantage on the course practical exams was highly significant

Identity change and the human dissection experience over the first year of medical training

The aim of this study is to explore identity change in medical students over their first year of medical training, particularly in relation to their experience of human dissection. Each of our four participants completed two repertory grids at the end of term one and, again, towards the end of term three. One grid tapped their identity construction, and the other, their experience of human dissection. Our participants were optimistic about becoming similar to a doctor they admired and, towards the end of term three, began to develop a stable identity as a medical student. Their identity constructs involved three common themes: dedication, competence, and responsibility. However, the data also revealed negative reactions to the demands of training, such as feeling driven and stressed. Three major themes were apparent in their experience of human dissection: involvement, emotional coping, and ability. Our participants’ dedication to their studies was reflected in their appreciation of the need to become involved actively in the process of dissection but some experienced an erosion of their self-confidence and perceived some of their colleagues to have lost much of their enthusiasm for learning. Emotional coping could be an additional challenge within this context and their reaction tended to reflect distancing processes previously identified in the literature. In all, we see a development of a vulnerable sense of professionalism alongside a frustration of losing out potentially on wider aspects of personal development due to the high work demands

A case of acute aortic dissection type b associated with cushing's syndrome

We report a case of a 63-year-old man, with a previous history of hypertension and glucose intolerance associated troncular obesity that was emergently admitted to our Institution for evaluation of a severe, constant posterior chest pain which radiated anteriorly and dyspnoea with a suspected diagnosis of acute aortic dissection. A CT scan of thorax and abdomen demonstrated a dissection starting just below left succlavian artery and extending downward to the left renal artery, involving the celiac tripod and superior mesenteric artery. The dissection was classified as Stanford B, De Bakey III. Moreover, CT scan of abdomen revealed incidentally a left adrenal tumor of 25 mm of diameter. An emergent prosthetic graft was placed just below the origin of the left succlavian artery up-to the diaphragmatic hiatus. Furthermore, a diagnostic evaluation of the mass revealed an increase of cortisol production, and a diagnosis of Cushing's syndrome was done and the patient underwent an adrenalectomy via laparotomic approach. We report an association of acute aortic dissection of acute aortic dissection type B associated to Cushing's syndrome. Cushing's syndrome; Adrenocortical adenoma; Aortic dissection type B

Digital dissection of the model organism Xenopus laevis using contrast-enhanced computed tomography

The African clawed frog, Xenopus laevis, is one of the most widely used model organisms in biological research. However, the most recent anatomical description of X. laevis was produced nearly a century ago. Compared with other anurans, pipid frogs – including X. laevis – exhibit numerous unusual morphological features; thus, anatomical descriptions of more ‘typical’ frogs do not detail many aspects of X. laevis skeletal and soft‐tissue morphology. The relatively new method of using iodine‐based agents to stain soft tissues prior to high‐resolution X‐ray imaging has several advantages over gross dissection, such as enabling dissection of very small and fragile specimens, and preserving the three‐dimensional topology of anatomical structures. Here, we use contrast‐enhanced computed tomography to produce a high‐resolution three‐dimensional digital dissection of a post‐metamorphic X. laevis to successfully visualize: skeletal and muscular anatomy; the nervous, respiratory, digestive, excretory and reproductive systems; and the major sense organs. Our digital dissection updates and supplements previous anatomical descriptions of this key model organism, and we present the three‐dimensional data as interactive portable document format (PDF) files that are easily accessible and freely available for research and educational purposes. The data presented here hold enormous potential for applications beyond descriptive purposes, particularly for biological researchers using this taxon as a model organism, comparative anatomy and biomechanical modelling

A variant of nested dissection for solving n by n grid problems

Nested dissection orderings are known to be very effective for solving the sparse positive definite linear systems which arise from n by n grid problems. In this paper nested dissection is shown to be the final step of incomplete nested dissection, an ordering which corresponds to the premature termination of dissection. Analyses of the arithmetic and storage requirements for incomplete nested dissection are given, and the ordering is shown to be competitive with nested dissection under certain conditions