Assessment in anatomy

From an educational perspective, a very important problem is that of assessment, for establishing competency and as selection criterion for different professional purposes. Among the issues to be addressed are the methods of assessment and/or the type of tests, the range of scores, or the definition of honour degrees. The methods of assessment comprise such different forms such as the spotter examination, short or long essay questions, short answer questions, true-false questions, single best answer questions, multiple choice questions, extended match questions, or several forms of oral approaches such as viva voce examinations.Knowledge about this is important when assessing different educational objectives; assessing educational objectives from the cognitive domain will need different assessment instruments than assessing educational objectives from the psychomotor domain or even the affective domain.There is no golden rule, which type of assessment instrument or format will be the best in measuring certain educational objectives; but one has to respect that there is no assessment instrument, which is capable to assess educational objectives from all domains of educational objectives.Whereas the first two or three levels of progress can be assessed by well-structured written examinations such as multiple choice questions, or multiple answer questions, other and higher level progresses need other instruments, such as a thesis, or direct observation.This is no issue at all in assessment tools, where the students are required to select the appropriate answer from a given set of choices, as in true false questions, MCQ, EMQ, etc. The standard setting is done in these cases by the selection of the true answer

The anatomy of the small saphenous vein: Fascial and neural relations, saphenofemoral junction, and valves

PurposeVaricose veins are a frequent burden, also in the small saphenous system. Yet its basic anatomy is not described consistently. We therefore investigated the fascial and neural relationships of the small saphenous vein (SSV) as well as the frequency and position of valves and the different junctional patterns, also considering the thigh extension.Materials and MethodsWe dissected the legs of 51 cadavers during the regular dissection course held in winter 2007 at Innsbruck Medical University, with a total of 86 SSVs investigable proximally and 94 SSVs distally.ResultsA distinct saphenous fascia is present in 93 of 94 cases. It starts with a mean distance of 5.1 cm (SD 1.2 cm) proximal to the calcaneal tuber, where the tributaries to the SSV join to form a common trunk. The neural topography at the level of the gastrocnemius muscle's origins shows the medial sural cutaneous nerve in 88% medially and in 12% laterally to the SSV, the tibial nerve in 64% medially and in 36% laterally, and the common fibular nerve in 98% medially and in 2% laterally to the vein. The saphenopopliteal junction (SPJ) resembled in about 37% type A (UIP-classification), 15% type B, and 24% type C. A total of 17% of specimens showed a venous web or star at the popliteal fossa and 6% had a doubled junction. A thigh extension could be demonstrated in about 84%. A most proximal valve was present in only 94% at a mean distance of 1.2 cm (SD 1.4 cm) to the SSVs orifice. A consecutive distal valve was only present in 65% with a mean distance of 5.1 cm (SD 2.3 cm).ConclusionTwo fascial points or regions can be described in the SSVs' course and its own saphenous fascia is demonstrated macroscopically in almost all cases. The neural topography is highly individual. The SPJ is highly individual where we found hitherto unclassified patterns in a remarkable number of veins. Venous valves are not as frequent as we supposed them to be. Furthermore, not all most proximal valves seem to be terminal valves.Clinical RelevanceOur study's aim is to support the basic understandings of the small saphenous system by providing exact anatomic data. This will help to understand physiology as well as pathophysiologic possibilities at the small saphenous system. On the other hand, our study especially can provide assistance for the vascular surgical approach at the popliteal fossa and also distally to the beginning of the trunk of the short saphenous vein itself

Anatomy of the great saphenous vein and its clinical relevance

The great saphenous vein (GSV) is probably the commonest sick vessel of man; for example, among 1031 Sicilians, only 330 (32 %) showed healthy GSVs. Despite of this clinical relevance, knowledge on this vessel is meagre. This starts with the appropriate terminology of this vessel and its tributaries. The GSV passes through the saphenous hiatus and terminates in the common femoral vein (CFV). In this terminal section of the GSV, several major superficial tributary veins (MSTVs) may enter, the superficial epigastric vein (SEV; 78 %), the superficial external pudendal vein(s) (SEPV; 90 %), the superficial circumflex iliac vein (SCIV; 83 %), and the anterior accessory saphenous vein (AASV; 51 %). These MSTVs enter the GSV either separated or by forming common trunks at an average distance of 1 to 2 cm of the GSV’s orifice. On the contrary, the posterior accessory saphenous vein (PASV; 68 %) enters the GSV at an average distance of 7 cm. The saphenofemoral junction of the GSV is delimited by several valves. Within the CFV, there is a suprasaphenic (71 %) and an infrasaphenic valve (87 %). Within the GSV, a terminal valve, situated between the most proximal orifice of a MSTV and the GSV’s termination, in 87 %, and a preterminal valve, situated distally to the MSTVs - but not the PASV, in 90 %. Valves do show a distinct closure cycle, but this cycle correlates neither with the heart nor the breathing rate. The wall of a healthy GSV consists of three different layers: the tunica intima, media and externa. The intima-media limit is formed by the internal elastic lamina (IEL), whereas the media-externa limit is formed by the outermost circular muscle layer. The intima has a variable thickness and consists of endothelium, thin elastic fibres, collagen fibres, single smooth muscle cells and the IEL. The media is composed of an inner longitudinal media and an outer circular media. The externa consists of dense collagenous fibres, longitudinal, dense elastic fibres and longitudinal muscle bundles. At the venous valve the IEL runs along the luminal part of the vein wall, the agger and the vein cusps. The sinusal wall contains a much thinner IEL with no connection to the first one

Max Clara and Innsbruck - The origin of a German Nationalist and National Socialist career.

This investigation aims to summarize hitherto scattered pieces of evidence of the early biography of Max Clara, especially considering his connections with the Histological Institute of the University of Innsbruck. Max Clara was born in 1899 in South Tyrol, at that time part of the Habsburg Empire. After high school in Bozen and his participation in World War I, Clara studied medicine in Innsbruck, Austria and Leipzig, Germany, graduating from Innsbruck University in 1923. He joined the Corps Gothia, a German Student Corps, at the start of his studies and became socialized as a German nationalist. When the Tyrolean Parliament conducted an illegal referendum in 1921, in which a majority voted for the merger of Tyrol with Germany, the active members of the Gothia spontaneously removed the border barriers between Austria and Bavaria in the municipality of Scharnitz. They brought them to Innsbruck to be deposited in the statehouse. Clara's participation in this activity is not documented but is very likely. Seventy-four per cent of the members of this corps joined the Nazi party (Nationalsozialistische Deutsche Arbeiterpartei, NSDAP), even before the annexation of Austria by National Socialist (NS) Germany in 1938. Clara likely met Maximinian de Crinis, an SS officer and high-ranking member of the NS health administration, through contacts within their respective corps. De Crinis supported Clara decisively in the anatomist's appointments as chair of anatomy at the University of Leipzig and later at the University of Munich. Initially, Clara began his academic career at the Institute of Histology and Embryology in Innsbruck as (student) demonstrator, and in 1923 as an assistant. In December 1923 Clara had to leave Innsbruck for Blumau, South Tyrol to take over the medical surgery of his father, who had passed away unexpectedly. Back in Italy, he continued his histological research in his spare time and published a large number of scientific papers. His connections with Innsbruck and especially with histologist Jurg Mathis never ceased

The academic career of Max Clara in Padova.

The aim of the following investigation was to explore Max Clara's (1899-1966) early academic activity in Italy at the University of Padua. While Clara's career during the National-Socialist Party dictatorship was extensively studied in literature, little to no information is available regarding Clara's early academic years, with particular regard to his role at the University of Padua during his time in Italy. The scientific and didactic activities held by Clara during this timespan could sheld a light on his appointment as Professor of Anatomy at the University of Leipzig, clarifying the academic motives and political pretences behind it. To this end, systematic research has been conducted at the Historical Archives of the University of Padua, where our findings have revealed detailed records of Clara's teaching and research activity from 1929 to 1935. Our findings confirm that Clara held a paid position as free lecturer at the University of Padua, and was likely under the tutelage of Prof. Tullio Terni, who directed the Institute of Histology and General Embryology until 1933. Max Clara's didactic activity focused mainly on the teaching of microscopical anatomy, which was distinct from histology and considered within the field of anatomy. Even though Clara had a minimal amount of lectures assigned, our records suggest that he conducted part of his research in the laboratories of the University of Padua whilst also working independently in his private medical practice in Blumau (South Tyrol). It is therefore possible to speculate that the teaching of Microscopical Anatomy, rather than Histology, could have represented the pretext for appointing Clara as Professor of Anatomy, justifying his new, politically-driven role at Leipzig

Common single nucleotide polymorphisms in genes related to immune function and risk of papillary thyroid cancer

Accumulating evidence suggests that alterations in immune function may be important in the etiology of papillary thyroid cancer (PTC). To identify genetic markers in immune-related pathways, we evaluated 3,985 tag single nucleotide polymorphisms (SNPs) in 230 candidate gene regions (adhesion-extravasation-migration, arachidonic acid metabolism/eicosanoid signaling, complement and coagulation cascade, cytokine signaling, innate pathogen detection and antimicrobials, leukocyte signaling, TNF/NF-kB pathway or other) in a case-control study of 344 PTC cases and 452 controls. We used logistic regression models to estimate odds ratios (OR) and calculate one degree of freedom P values of linear trend (P(SNP-trend)) for the association between genotype (common homozygous, heterozygous, variant homozygous) and risk of PTC. To correct for multiple comparisons, we applied the false discovery rate method (FDR). Gene region- and pathway-level associations (P(Region) and P(Pathway)) were assessed by combining individual P(SNP-trend) values using the adaptive rank truncated product method. Two SNPs (rs6115, rs6112) in the SERPINA5 gene were significantly associated with risk of PTC (P(SNP-FDR)/P(SNP-trend) = 0.02/6×10(−6) and P(SNP-FDR)/P(SNP-trend) = 0.04/2×10(−5), respectively). These associations were independent of a history of autoimmune thyroiditis (OR = 6.4; 95% confidence interval: 3.0–13.4). At the gene region level, SERPINA5 was suggestively associated with risk of PTC (P(Region-FDR)/P(Region = )0.07/0.0003). Overall, the complement and coagulation cascade pathway was the most significant pathway (P(Pathway) = 0.02) associated with PTC risk largely due to the strong effect of SERPINA5. Our results require replication but suggest that the SERPINA5 gene, which codes for the protein C inhibitor involved in many biological processes including inflammation, may be a new susceptibility locus for PTC

Potential Risks of Excess Iodine Ingestion and Exposure: Statement by the American Thyroid Association Public Health Committee

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140261/1/thy.2014.0331.pd

Intrauterine growth restriction is associated with persistent aortic wall thickening and glomerular proteinuria during infancy

Low birth weight, caused either by preterm birth or by intrauterine growth restriction, has recently been associated with increased rates of adult renal and cardiovascular disease. Since aortic intima–media thickening is a noninvasive marker of preclinical vascular disease, we compared abdominal aortic intima–media thickness among intrauterine growth restricted and equivalent gestational age fetuses in utero and at 18 months of age. The relationship between intrauterine growth restriction, fetal aortic thickening, and glomerular function during infancy was measured by enrolling 44 mothers with single-fetus pregnancies at 32 weeks gestation: 23 growth restricted and 21 of appropriate gestational age as controls. Abdominal aortic intima–media thickness was measured by ultrasound at enrollment and again at 18 months of age. Fetuses with intrauterine growth restriction had significantly higher abdominal aortic intima–media thickness compared with age controls when measured both in utero and at 18 months. At 18 months, the median urinary microalbumin and median albumin–creatinine ratio were significantly higher in those infants who experienced intrauterine growth restriction compared to the controls. Our results show that intrauterine growth restriction is associated with persistent aortic wall thickening and significantly higher microalbuminuria during infancy

Natural and Orthogonal Interaction framework for modeling gene-environment interactions with application to lung cancer

Objectives: We aimed at extending the Natural and Orthogonal Interaction (NOIA) framework, developed for modeling gene-gene interactions in the analysis of quantitative traits, to allow for reduced genetic models, dichotomous traits, and gene-environment interactions. We evaluate the performance of the NOIA statistical models using simulated data and lung cancer data. Methods: The NOIA statistical models are developed for additive, dominant, and recessive genetic models as well as for a binary environmental exposure. Using the Kronecker product rule, a NOIA statistical model is built to model gene-environment interactions. By treating the genotypic values as the logarithm of odds, the NOIA statistical models are extended to the analysis of case-control data. Results: Our simulations showed that power for testing associations while allowing for interaction using the NOIA statistical model is much higher than using functional models for most of the scenarios we simulated. When applied to lung cancer data, much smaller p values were obtained using the NOIA statistical model for either the main effects or the SNP-smoking interactions for some of the SNPs tested. Conclusion: The NOIA statistical models are usually more powerful than the functional models in detecting main effects and interaction effects for both quantitative traits and binary traits. Copyright (C) 2012 S. Karger AG, Base

Visualization of the Membranous Labyrinth and Nerve Fiber Pathways in Human and Animal Inner Ears Using MicroCT Imaging

Design and implantation of bionic implants for restoring impaired hair cell function relies on accurate knowledge about the microanatomy and nerve fiber pathways of the human inner ear and its variation. Non-destructive isotropic imaging of soft tissues of the inner ear with lab-based microscopic X-ray computed tomography (microCT) offers high resolution but requires contrast enhancement using compounds with high X-ray attenuation. We evaluated different contrast enhancement techniques in mice, cat, and human temporal bones to differentially visualize the membranous labyrinth, sensory epithelia, and their innervating nerves together with the facial nerve and middle ear. Lugol’s iodine potassium iodine (I2KI) gave high soft tissue contrast in ossified specimens but failed to provide unambiguous identification of smaller nerve fiber bundles inside small bony canals. Fixation or post-fixation with osmium tetroxide followed by decalcification in EDTA provided superior contrast for nerve fibers and membranous structures. We processed 50 human temporal bones and acquired microCT scans with 15 μm voxel size. Subsequently we segmented sensorineural structures and the endolymphatic compartment for 3D representations to serve for morphometric variation analysis. We tested higher resolution image acquisition down to 3.0 μm voxel size in human and 0.5 μm in mice, which provided a unique level of detail and enabled us to visualize single neurons and hair cells in the mouse inner ear, which could offer an alternative quantitative analysis of cell numbers in smaller animals. Bigger ossified human temporal bones comprising the middle ear and mastoid bone can be contrasted with I2KI and imaged in toto at 25 μm voxel size. These data are suitable for surgical planning for electrode prototype placements. A preliminary assessment of geometric changes through tissue processing resulted in 1.6% volume increase caused during decalcification by EDTA and 0.5% volume increase caused by partial dehydration to 70% ethanol, which proved to be the best mounting medium for microCT image acquisition