Interactive versus Reproductive Learning, a Comparison of Medical School Graduates with Participants of a Postgraduate CPD Session

Aims: In order to develop the e-learning teaching material for medical professionals who are not physicians, we compared solution-based interactive and reading-based reproductive learning with regard to the increase of knowledge. Furthermore we tried to identify additional factors influencing learning

Interactive versus Reproductive Learning, a Comparison of Medical School Graduates with Participants of a Postgraduate CPD Session

Aims: In order to develop the e-learning teaching material for medical professionals who are not physicians, we compared solution-based interactive and reading-based reproductive learning with regard to the increase of knowledge. Furthermore we tried to identify additional factors influencing learning

Detection of articular perforations of the proximal humerus fracture using a mobile 3D image intensifier – a cadaver study

Abstract Background The purpose of this study was to investigate the accuracy of perforation detection with multiplanar reconstructions using a mobile 3D image intensifier. Methods In 12 paired human humeri, K-wires perforating the subchondral bone and placed just below the cartilage level were directed toward five specific regions in the humeral head. Image acquisition was initiated by a fluoroscopy scan. Within a range of 90°, 45° external rotation (ER) and 45° internal rotation (IR). The number and percentage of detected perforating screws were grouped and analyzed. Furthermore, the fluoroscopic images were converted into multiplanar CT-like reconstructions. Each K-wire perforation was characterized as “detected” or “not detected”. Results In the series of fluoroscopy images in the standard neutral position at 30° internal rotation, and 30° external rotation, the perforations of all K-wires (n = 56) were detected. Twenty-nine (51.8%) of them were detected in one AP view, 22 (39.3%) in two AP views, and five (8.9%) in three AP views. All K-wire perforations (100%, n = 56) were detected in multiplanar reconstructions. Conclusion In order to reveal all of the intraoperative and postoperative screw perforations in a “five screw configuration”, conventional AP images should be established in both the neutral positions (0°), at 30° internal rotation and 30° external rotation. Alternatively, the intraoperative 3D scan with multiplanar reconstructions enables a 100% rate of detection of the screw perforations

Human vagus nerve branching in the cervical region

Background: Vagus nerve stimulation is increasingly applied to treat epilepsy, psychiatric conditions and potentially chronic heart failure. After implanting vagus nerve electrodes to the cervical vagus nerve, side effects such as voice alterations and dyspnea or missing therapeutic effects are observed at different frequencies. Cervical vagus nerve branching might partly be responsible for these effects. However, vagus nerve branching has not yet been described in the context of vagus nerve stimulation. Materials and methods: Branching of the cervical vagus nerve was investigated macroscopically in 35 body donors (66 cervical sides) in the carotid sheath. After X-ray imaging for determining the vertebral levels of cervical vagus nerve branching, samples were removed to confirm histologically the nerve and to calculate cervical vagus nerve diameters and cross-sections. Results: Cervical vagus nerve branching was observed in 29%of all cases (26% unilaterally, 3% bilaterally) and proven histologically in all cases. Right-sided branching (22%) was more common than left-sided branching (12%) and occurred on the level of the fourth and fifth vertebra on the left and on the level of the second to fifth vertebra on the right side. Vagus nerves without branching were significantly larger than vagus nerves with branches, concerning their diameters (4.79mm vs. 3.78mm) and cross-sections (7.24 mm2 vs. 5.28mm2). Discussion: Cervical vagus nerve branching is considerably more frequent than described previously. The side-dependent differences of vagus nerve branching may be linked to the asymmetric effects of the vagus nerve. Cervical vagus nerve branching should be taken into account when identifying main trunk of the vagus nerve for implanting electrodes to minimize potential side effects or lacking therapeutic benefits of vagus nerve stimulation

X-rays obtained from the cervical spine of a 69 year-old male in the anterior-posterior (3a) and in the lateral projection (3b).

<p>Metal needles indicate the most cranial and caudal part of the vagus nerve that could be visualized with the surgical approach to the carotid triangle. d = dorsal, l = left, r = right, v = ventral; scale bar = 10 mm.</p

Hematoxylin-eosin stained histology samples obtained from the vagus nerve (2a) and from a vagus nerve branch (2b) for evaluating the existence of nerve fibers.

<p>A = arterial branch from the inferior thyroid artery, E = epineurium; scale bar = 500 μm.</p

Statistical comparison of vagus nerve diameters and cross-sections (mean value ± standard deviation).

<p>Statistical comparison of vagus nerve diameters and cross-sections (mean value ± standard deviation).</p

Images taken during dissection of the cervical vagus nerve (CVN) in the carotid sheath.

<p>Fig. 1a shows a left-sided CVN without branching and Fig. 1c-d CVN with branches on the left side (1b) or on the right side (1c,d). Arrows indicate the branches. C = (common or internal) carotid artery, J = internal jugular vein, O = superior venter of the omohyoideus muscle; cd = caudal, cr = cranial, m = medial, l = lateral; scale bar = 15 mm (a,b), 12 mm (c,d).</p