3D reconstruction and heat map of porcine recurrent laryngeal nerve anatomy: branching and spatial location

Recurrent laryngeal nerve palsy is a common post-operative complication of many head and neck surgeries. Theoretically, the best treatment to restore partial function to a damaged recurrent laryngeal nerve would be reinnervation of the posterior cricoarytenoid muscle via anastomosis of the recurrent laryngeal and phrenic nerves. The pig is an excellent model of human laryngeal anatomy and physiology but a more thorough knowledge of porcine laryngeal anatomy is necessary before the pig can be used to improve existing surgical strategies, and develop new ones. This study first identifies the three most common recurrent laryngeal nerve branching patterns in the pig. Secondly, this study presents three-dimensional renderings of the porcine larynx onto which the recurrent laryngeal nerve patterns are accurately mapped. Lastly, heat maps are presented to display the spatial variability of recurrent laryngeal nerve trunks and primary branches on each side of 15 subjects (28 specimens). We intend for this study to be useful to groups using a porcine model to study posterior cricoarytenoid muscle reinnervation techniques.

Examination of LGBTQIA+-Inclusive Recommendations Issued by Professional Medical Associations Across Healthcare Fields

LGBTQIA+ populations persistently experience discrimination and limited access to informed, quality, and patient-centered healthcare. The gap between population needs and provider competence can be attributed to the inadequate education of healthcare professionals, suggesting the need for educational reform not just within medical schools, but also in physician assistant, nursing, and emergency medical services programs. To create the most widespread change across all these programs, it is imperative that the leading, most influential professional medical associations (PMAs) in each field take steps to make LGBTQIA+-focused healthcare education a priority, provide actionable statements and plans, and encourage educational institutions to ardently take up their recommendations. This paper provides an overview of the recent statements, recommendations, and actions published by several of the leading PMAs across multiple healthcare professions. Through narrative and content analysis, these publications are evaluated for depth, quality, and actionability. From this evaluation, a call to action is made for the leading PMAs of each healthcare profession to actively engage in the educational reform required to begin eliminating these long-standing disparities to ultimately improve the experiences and health outcomes of individuals in LGBTQIA+ populations

A New Approach to Learning How to Teach: medical students as instructional designers

As students at the David Geffen School of Medicine at UCLA, the student authors were given the opportunity to develop their own creative projects which would be used to teach future medical students. They chose their own topics, planned and researched their projects, and then implemented the projects in interactive digital Adobe Flash files. In the first project they created interactive case-based radiology teaching files. In the second project they integrated photographic images into the existing illustrative anatomy files. Students in subsequent years have learned from these files on computers both at home and in the school's anatomy lab. The experience of creating the files served as an opportunity for hands-on learning for the student authors, both of the material and of the practice of teaching. In this paper they describe why they undertook these projects, what exactly they did, and the impact their creation had on them. The projects demonstrate that student-driven educational materials are both possible and beneficial. Furthermore, their experience has allowed them to conclude that faculty at other medical schools should consider providing students with opportunities to develop their own creative projects that contribute to the curriculum

Who is the Teacher and Who is the Student? The Dual Service- and Engaged-Learning Pedagogical Model of Anatomy Academy

Anatomy Academy is a simultaneous service-learning experience for preprofessional school undergraduate students and preclinical professional students acting as classroom paraprofessional teachers (Mentors), and engaged-learning experience for fourth to sixth grade elementary school children (Students). Using didactic and kinesthetic active learning teaching strategies in small-group classroom environments, Mentors taught anatomy, physiology, and nutrition concepts to Students. In this study of the program's early years (2012-2014), overall objectives of improving Mentors' pedagogical confidence; and Students' science interest, science knowledge, and exercise self-efficacy were assessed. Mentors showed (89% response of 595 surveyed) improvement in content delivery (P < .001), student engagement (P < .001), classroom management (P < .001), and professionalism (P = .0001). Postprogram Mentor reflections were categorized into 7 major themes that demonstrated personal growth through the service-learning opportunity: (1) realization of an ability to make a difference in the world now; (2) acknowledgment of the importance of listening in teaching; (3) recognition that lives can and will change with "a little love"; (4) insight into the effectiveness of guiding Students through material rather than lecturing; (5) awareness of the value of respect in the learning environment; (6) cognizance of the power of individualized attention to motivate Students; and (7) reflection of one's own personal growth through the open influence of Students. Students showed (88% response of 1259 surveyed) improvement in science knowledge (P = .014) and exercise self-efficacy (P = .038), but not science interest (P = .371). Thus, while Students are learning more science and becoming more aware of their health, we need to be more overt in our presence as scientists in the educational arena

Exposure to ACGME Core Competencies through Mentored Basic Science Research: A Pilot Analysis

Since 1998, the Short-Term Training Program (STTP) at the David Geffen School of Medicine at the University of California, Los Angeles has nearly tripled (from 30 to 89) in the number of first-year undergraduate medical students participants. STTP supports mentored research projects in the areas of basic sciences, clinical sciences, medical education, and public health (local and international). Although projects can be very specific in scope, the overall experience in STTP exposes students to some, if not all, of the Accreditation Council for Graduate Medical Education (ACGME) six core competencies–-Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and Systems-based Practice. Thus, STTP has been an important aspect of medical education to prepare our students for residency programs. We describe and analyze the STTP as a model system to introduce the ACGME core competencies at an early point in undergraduate medical education. We conclude with a call to provide more mentored anatomical sciences basic and clinically applied research opportunities

Magnetic resonance imaging quantification of dehydration and rehydration in vocal fold tissue layers.

Clinicians commonly recommend increased hydration to patients with voice disorders. However, effects on clinical voice outcome measures have been inconsistent. Hydration-induced change within different layers of vocal fold tissue is currently unknown. Magnetic Resonance Imaging (MRI) is a promising method of noninvasively measuring water content in vocal folds. We sought to image and quantify changes in water content within vocal fold mucosa and thyroarytenoid muscle after dehydration and rehydration. Excised porcine larynges were imaged using proton density (PD) weighted MRI (1) at baseline and (2) after immersion in one of five hypertonic, isotonic, or hypotonic solutions or in dry air. Larynges dehydrated in hypertonic solutions or dry air were rehydrated and imaged a third time. Scans revealed fluid-rich vocal fold mucosa that was distinct from muscle at baseline. Baseline normalized signal intensity in mucosa and muscle varied by left vs. right vocal fold (p < 0.01) and by anterior, middle, or posterior location (p < 0.0001). Intensity changes in the middle third of vocal fold mucosa differed by solution after immersion (p < 0.01). Hypertonic solutions dehydrated the middle third of mucosa by over 30% (p < 0.001). No difference from baseline was found in anterior or posterior mucosa or in muscle after immersion. No association was found between intensity change in mucosa and muscle after immersion. After rehydration, intensity did not differ by solution in any tissue, and was not different from baseline, but post-rehydration intensity was correlated with post-immersion intensity in both mucosa and muscle (p < 0.05), suggesting that degree of change in vocal fold water content induced by hypertonic solutions ex vivo persists after rehydration. These results indicate that PD-MRI can be used to visualize large mammalian vocal fold tissue layers and to quantify changes in water content within vocal fold mucosa and thyroarytenoid muscle independently

Evidence for the functional compartmentalization of the temporalis muscle: A 3-dimensional study of innervation

Purpose: The temporalis muscle is commonly used for functional transfer. It is architecturally complex, but few studies have examined its intramuscular innervation and none has used 3-dimensional modeling techniques. Understanding neuromuscular compartmentalization may allow the design of local muscle transfers to minimize donor-site morbidity. The purpose of the present study was to document the intramuscular innervation patterns throughout the volume of the temporalis muscle and define functional units within the muscle. Materials and Methods: In 10 formalin-embalmed cadaveric specimens, the foramen ovale was exposed and the branches of the mandibular nerve were identified. Each branch was digitized in short segments extramuscularly and intramuscularly. Three-dimensional models were reconstructed from the digitized data using Maya software, and the innervation patterns were documented. Results: The temporalis muscle was found to have superior and inferior parts that were further grouped by innervation into regions, with each receiving its innervation from 1 primary nerve. The nerves originated directly from the mandibular nerve, except in 3 specimens, where the posterior deep temporal nerve arose from the masseteric nerve. Conclusion: These results provide a detailed mapping of innervation patterns and suggest there are at least 5 functional compartments. Each of these has the capacity for selective activation, 3 of which have clinical value. These findings may allow for decreased donor-site morbidity and more functionally sophisticated designs in clinical practice

Student Perceived Value of Anatomy Pedagogy, Part II: Clinical Practice and Assessment

We describe student beliefs of how anatomy education influenced their preparation for standardized clinical assessments and clinical skills. We conducted three annual surveys of students of the David Geffen School of Medicine (DGSOM) at the University of California Los Angeles (UCLA) and students of the University of California, Riverside (UCR)/UCLA Thomas Haider Program in Biomedical Sciences from 2010 to 2012. Students were asked, “What specific knowledge or skills did you learn from your gross anatomy experience that helped you prepare for USMLE board exams, third-year clerkships, and physical examination skills?” All students who responded to the survey viewed anatomy as a highly valued part of the medical curriculum. Almost all students felt that anatomy knowledge in general was useful for their success with United States Medical Licensing Examination (USMLE) exams, how they perceived their physical exam skills, and how they perceived their preparation for third- or fourth-year clerkships. On the other hand, when asked about how the anatomy curriculum helped prepare students for fourth-year clerkships, there was a downward trend over a three-year period with each subsequent class. Although anatomy is a highly valued part of the medical school experience, students value integration of the anatomical and clinical sciences, as evidenced by a perceived diminishing value of anatomy pedagogy taught outside of clinical context with subsequent classes over the course of three years

Q-ball imaging of macaque white matter architecture

Diffusion-weighted magnetic resonance imaging holds substantial promise as a technique for non-invasive imaging of white matter (WM) axonal projections. For diffusion imaging to be capable of providing new insight into the connectional neuroanatomy of the human brain, it will be necessary to histologically validate the technique against established tracer methods such as horseradish peroxidase and biocytin histochemistry. The macaque monkey provides an ideal model for histological validation of the diffusion imaging method due to the phylogenetic proximity between humans and macaques, the gyrencephalic structure of the macaque cortex, the large body of knowledge on the neuroanatomic connectivity of the macaque brain and the ability to use comparable magnetic resonance acquisition protocols in both species. Recently, it has been shown that high angular resolution diffusion imaging (HARDI) can resolve multiple axon orientations within an individual imaging voxel in human WM. This capability promises to boost the accuracy of tract reconstructions from diffusion imaging. If the macaque is to serve as a model for histological validation of the diffusion tractography method, it will be necessary to show that HARDI can also resolve intravoxel architecture in macaque WM. The present study therefore sought to test whether the technique can resolve intravoxel structure in macaque WM. Using a HARDI method called q-ball imaging (QBI) it was possible to resolve composite intravoxel architecture in a number of anatomic regions. QBI resolved intravoxel structure in, for example, the dorsolateral convexity, the pontine decussation, the pulvinar and temporal subcortical WM. The paper concludes by reviewing remaining challenges for the diffusion tractography project