Ascending and descending axon-collaterals from cervical spinal neurons : a retrograde fluorescent double-labeling study in the rat.

In order to gain insight into the function of the central nervous system it is of importance to know the lay-out of fiber connections between its constituent cells and cell-groups. Much is already known of the anatomy of the spinal cord and its afferent and efferent fibers; this will be reviewed in Chapter 2. A large part of the spinal neuronal network consists of propriospinal connections representing the anatomical basis for integration of information within the spinal cord itself. The present study was undertaken to investigate propriospinal neurons in more detail. Specifically, a search was made for neurons which project to more than one target area by way of divergent side-branches, or collaterals, of their axon. Earlier anatomical findings already suggested that such "branching" neurons' might be present within the spinal cord. Thus retrograde HRP studies in the cat [254, 286, 288, 359, 416] identified the spinal neurons which give rise to descending propriospinal fibers. The distribution of these neurons largely overlaps that of the neurons giving rise to ascending propriospinal and supraspinal fibers [286, 288]. Therefore some of these neurons may be "branching" neurons which give rise to ascending and descending collaterals. In fact, such neurons were already noted in several Golgi studies [68, 242, 344], but their collaterals could be traced only over short distances. Electrophysiological studies [9, 146, 173, 360] supported these Golgi findings, indicating that some cervical spinal neurons projecting to lumbar levels also give rise to ascending supraspinal collaterals. In the present series of experiments in the rat, an attempt was made: a) to determine the location and relative numbers of such branching neurons in the cervical cord, and b) to approximate the rostral and caudal extent of projection of their collaterals. To this purpose we used the retrograde fluorescent double-labeling method (described in Chapter 3). The results of the first set of experiments (Chapter 4), in which tracer injections were made at various spinal levels, indicated that many neurons in the cervical grey matter in the rat are branching neurons, distributing ascending collaterals to upper cervical or supraspinal levels, and descending collaterals to thoracic or lumbosacral levels. Most descending collaterals of the branching cervical neurons were found to terminate at short distances, i.e. in the upper thoracic cord. On the other hand, the majority of the ascending collaterals were distributed to supraspinal levels. Although the findings suggested that many of these collaterals projected to the caudal brainstem, it remained unsettled whether the supraspinally ascending fibers specifically belonged to any of the various ascending tracts. Therefore, further sets of experiments were designed to clarify this issue, investigating the presence and relative numbers of supraspinal collaterals to the cerebellum (Chapter 5), the thalamus and tectum (Chapter 6) and the dorsal medulla (Chapter 7). Summarizing, the results of the latter series of experiments indicate that relatively many of the supraspinally ascending collaterals are distributed to the medulla, only few to the thalamus and tectum and extremely few to the cerebellum

Approach to lymphoma diagnosis and management in South Africa

Lymphoma is a cancer of the lymphoid cells, with a hugely variable mode of clinical presentation, which includes constitutional symptoms, lymphadenopathy, superficial or deep-seated masses, effusions, and full blood count abnormalities such as anaemia and lymphocytosis. Lymphoma can infiltrate any organ of the body, although it typically involves lymphoid tissue or bone marrow, or both. In this article an overview is given of the diagnostic pathway and clinical diagnostic subsets that determine treatment. The treatment approach according to these subsets is best understood as: indolent lymphoma, where treatment is not urgent and the disease is not curable; aggressive lymphoma, where rapid diagnosis and treatment are of the utmost importance, with the majority of cases curable; and very aggressive lymphoma, where patients are at high risk of death at presentation, but with rapid diagnosis and treatment there is an excellent chance of long-term cure. The past decade has seen an explosion of targeted (as opposed to classic chemotherapeutic) treatments for lymphoma. These drugs target certain molecules or receptors in the tumour pathway, often with spectacularly beneficial effects that open up new horizons for cure

Perioperative glucose management in patients undergoing cardiac surgery

C

A campus wide setup of Question Mark Perception (V2.5) at the Katholieke Universiteit Leuven (Belgium) – facing a large scale implementation

The first part of this paper outlines the drawbacks of a large scale implementation of Question Mark Perception’s assessment software (QMP). The default publishing procedures offered by QMP, i.e. ODBC or disk sharing, do not meet the needs of global Internet accessibility and security. Academic staff members had to upload their session files by completing a web form; publishing requests were handled manually by members of the Computing Center’s staff. As on the server side all question and session records were stored in one single database, and graphics and multimedia files reside in one directory on the server, a cumbersome system of naming conventions was necessary to prevent files and database records from being overwritten. While creating questions with QMP’s authoring application – Question Manager – authors wanting to refer to graphics or multimedia files had to insert in a non-intuitive way the pathname of the graphics directory on the server. Moreover QMP’s server software never commits a delete transaction in the question database. This caused major problems for authors reloading assessments to the central database after having deleted one or more questions. To cope with these problems the Computing Centre of Leuven University has developed an upload application for use by the academic staff members. This application, which is described in detail in the second part of this paper, meets the constraints of a campus wide setup of QMP’s assessment software

Enhancing the connection between the classroom and the clinical workplace:A systematic review

Introduction Although medical students are increasingly exposed to clinical experiences as part of their training, these often occur parallel with, rather than connected to, their classroom-based learning experiences. Additionally, students seem to struggle with spontaneously making the connection between these spheres of their training themselves. Therefore, this systematic review synthesized the existing evidence about educational interventions that aim to enhance the connection between learning in the classroom and its application in the workplace. Methods Electronic databases (AMED, CINAHL, EMBASE, ERIC, Medline, RDRB, PsycINFO and WoS) were screened for quantitative and qualitative studies investigating educational interventions that referenced a connection between the classroom and workplace-based experiences within undergraduate, graduate or postgraduate medical education. Results Three types of interventions were identified: classroom to workplace interventions, workplace to classroom interventions, and interventions involving multiple connections between the two settings. Most interventions involved a tool (e.g. video, flow chart) or a specific process (e.g. linking patient cases with classroom-based learning content, reflecting on differences between what was learned and how it works in practice) which aimed to enhance the connection between the two settings. Discussion Small-scale interventions can bring classroom learning and workplace practice into closer alignment. Such interventions appear to be the necessary accompaniments to curricular structures, helping bridge the gap between classroom learning and workplace experience. This paper documents examples that may serve to assist medical educators in connecting the classroom and the workplace