Comparison of In-person VS remote learning modalities for ultrasound-guided knee arthrocentesis training using formalin-embalmed cadavers.

OBJECTIVES: This study aims to compare the efficacy of remote versus in-person training strategies to teach ultrasound guided knee arthrocentesis using formalin embalmed cadavers. METHODS: 30 first-year medical student participants were randomly assigned to remote or in-person training groups. Pre- and post- training surveys were used to evaluate participant's self-confidence in their ability to perform the procedure. Participants were asked to watch a 30-minute training video and then attend a skills training workshop. The workshops consisted of 20 min of hands-on instruction followed by a skills assessment. RESULTS: Following training, participant self-confidence increased significantly across all survey items in both groups (p = 0.0001). No significant changes in participant self-confidence were detected between the groups. Skills and knowledge-related metrics did not differ significantly between the groups with the exception of the "knowledge of instruments" variable. CONCLUSIONS: Our data suggests that remote ultrasound-guided procedure training, although logistically complex, is a viable alternative to traditional in-person learning techniques even for a notoriously hands on skill like ultrasound guided knee arthrocentesis. Novice first-year medical student operators in the remote-training group were able to significantly increase their confidence and demonstrate competency in a manner statistically indistinguishable from those trained in-person. These results support the pedagogical validity of using remote training to teach ultrasound guided procedures which could have implications in rural and global health initiatives where educational resources are more limited.

Validation and motion analyses of laparoscopic radical nephrectomy with Thiel-embalmed cadavers.

PURPOSE: Our aim was to develop practical training for laparoscopic surgery using Thielembalmed cadavers. Furthermore, in order to verbalize experts' motion characteristics and provide objective feedback to trainees, we initiated motion capture analyses of multiple surgical instruments simultaneously during the cadaveric trainings. In the present study, we report our preliminary results. METHODS: Participants voluntarily joined the present cadaveric simulation trainings, and performed laparoscopic radical nephrectomy. After the trainings, scores for tissue similarity (face validity) and impression of educational merit (content validity) were collected from participants based on a 5-point Likert scale (tissue similarity: 5: very similar, 3: average, 1: very different; educational merit: 5: very high, 3: average, 1: very low). In addition, after the additional IRB approval, we started motion capture (Mocap) analyses of 6 surgical instruments (scissors, vessel sealing system, grasping forceps, clip applier, right-angled forceps, and suction), using an infrared trinocular camera (120-Hz location record). Mocap-metrics were compared according to the previous surgical experiences (experts: ≧50 laparoscopic surgeries, intermediates: 10-49, novices: 0-9), using the Kruskal-Wallis test. RESULTS: A total of 9 experts, 19 intermediates, and 15 novices participated in the present study. In terms of face validity, the mean scores were higher than 3, other than for the Vena cava(mean score of 2.89). Participants agreed with the training value (usefulness for future skill improvement: mean score of 4.57). In terms of Mocap analysis, faster speed-related metrics (e.g., velocity, the distribution of tip velocity, acceleration, and jerk) in the scissors and vessel sealing system, a shorter path length of grasping forceps, and fewer dimensionless squared jerks, which indicated more purposeful motion of 4 surgical instruments (vessel sealing system, grasping forceps, clip applier and suction), were observed in the more experienced group. CONCLUSIONS: The Thiel-embalmed cadaver provides an excellent training opportunity for complex laparoscopic procedures with participants' high level of satisfaction, and may become a promising tool for a better objective understanding of surgical dexterity. In order to enrich formative feedback to trainees, we are now proceeding with Mocap analysis.

Teaching medical students ultrasound-guided needle aspiration of synthetic cysts: effect of a formalin-embalmed cadaver simulation model.

BACKGROUND: Standard training for ultrasound-guided cyst needle aspiration is currently performed on live patients during residency. This practice presents risk of iatrogenic injury to patients and provides a high-stress learning environment for medical trainees. Simulation training using synthetic cysts in a formalin-embalmed cadaver model may allow for realistic, practical, and effective training free from patient risk. METHODS: Thirty first-year medical students viewed an orientation video, then attended a skills workshop to perform cyst needle aspiration in formalin-embalmed cadaver tissue under ultrasound guidance. Participants were randomly assigned to one of three ultrasound-trained instructor-types which included a medical student, clinical anatomist, or an ultrasound fellowship trained emergency medicine physician. After training, participants underwent a 5-min skills test to assess their ability to drain a synthetic cyst independently. Pre- and post-training self-confidence surveys were administered. RESULTS: Ultrasound images of synthetic cysts in formalin-embalmed tissue were clear and realistic in appearance, and sonographic needle visualization was excellent. Participants took an average of 161.5 s and 1.9 attempts to complete the procedure. Two of the 30 participants could not complete the procedure within the time limit. Participants' self-reported confidence with respect to all aspects of the procedure significantly increased post-training. Mean confidence scores rose from 1.2 (95% CI 0.96 to 1.39) to 4.4 (95% CI 4.09 to 4.53) (P < 0.0001) Procedure time, number of attempts, performance scores, and self-confidence outcomes were not significantly affected by instructor type. CONCLUSIONS: The use of synthetic cysts in formalin-embalmed cadaveric tissue is feasible, realistic, and efficacious for the teaching of ultrasound-guided needle aspiration to novice medical trainees. This simulation training method can be delivered effectively by multiple instructor types and may allow medical trainees to increase their tactical skill and self-confidence prior to performing ultrasound-guided cyst needle aspiration on live patients.

Quantitative and qualitative assessment of airborne microorganisms during gross anatomical class and the bacterial and fungal load on formalin-embalmed corpses.

Mold growth on body donations remains an underreported yet serious issue in anatomical teaching. Bacterial and fungal growth pose health risks to lecturers and students, alongside with ethical and aesthetic concerns. However, limited information exists on the presence of bacteria and fungi on body donations and their underlying causes. To investigate the potential impact of airborne germs on body donation contamination, we conducted indoor air measurements before, during, and after our anatomical dissection course, with outdoor measurements serving as a control. Tissue samples from the dissected body donations were collected to assess the germ load, with qualitative and quantitative microbiological analyses. Air samples from the dissection hall contained no fungi, but various fungal species were identified in the adjacent stairways and outdoors which implies that fungal occurrence in the dissection hall air was independent of lecturers' and students' presence. Moreover, our results indicate that adequate ventilation filters can effectively reduce indoor fungal germs during courses, while the bacterial load in room air appears to increase, likely due to the presence of lecturers and students. Additionally, the tissue samples revealed no bacterial or fungal germs which implies that our ethanol-formalin-based embalming solution demonstrates an effective long-term antimicrobial preservation of corpses.

Assessment of formalin preserved and fresh frozen quadriceps tendon graft-suture constructs for load to failure testing: a biomechanical cadaveric study.

PURPOSE: Fresh-frozen specimen availability and cost may be a barrier for initiation of biomechanical studies where soft tissue is used in a construct with other medical devices. The impact of soft tissue preservation method on the outcomes of biomechanical studies in the specific case of graft-suture constructs is relatively unexplored. This study aimed to observe peak loads and failure modes in biomechanical testing of fresh-frozen (FF) versus formalin embalmed (FE) quadriceps tendon (QT) graft-suture constructs for soft tissue fixation in ACLR and assess suitability of FE QT graft constructs for load-to-fail testing. METHODS: Twenty QT grafts were harvested from human cadaver specimens. Ten grafts came from fresh-frozen donors and 10 from embalmed donors. All grafts were prepared with the modified Prusik knot using a braided composite suture and subjected to tensile loading. Comparisons between the biomechanical properties of the graft-suture constructs were made with unpaired t tests with α = 0.05. RESULTS: FE and FF constructs displayed similar peak loads and failure modes. FF constructs had greater elongation after pre-tensioning than FE (7.3 vs. 5.5 mm, p = 0.02) and greater elongation after cyclic loading than FE constructs (17.5 vs. 10.5 mm, p = 0.01). Hysteresis was greater for FF constructs at the 50th, 100th, 150th, and 200th cycle (p = 0.02, p = 0.07, p < 0.001, p = 0.004, respectively). FE constructs were stiffer than fresh-frozen (103 vs. 84 N/mm, p < 0.001). CONCLUSION: FE constructs were significantly stiffer but displayed similar peak load and failure mode to FF which was reflective of the strength of the suture material. FE grafts can offer an alternative to FF grafts in graft-suture constructs for biomechanical studies where load at failure and knot security and strength is of main interest.

A South African case study on anatomical embalming for human body donation programmes with toxicological considerations.

Body embalming, a practice with deep historical roots across various cultures, forms the backbone of contemporary human body donation educational programmes. In this study, we explored current embalming practices within six South African human anatomical dissection programmes, focusing on the use and volumes of key chemicals-formalin, phenol, and alcohol-and their associated health risks and potential toxicity. We measured and compared aspects of embalming practices such as the duration of body preservation and the annual intake of bodies. Variations in embalming practices and chemical ratios across different South African universities were found. However, the consistent use of formalin, phenol and alcohol were observed across all six programmes. Formaldehyde concentrations used in South African dissection programmes were within the generally acceptable international range. Regarding arterial embalming, South African dissection programmes showed widespread adherence to international embalming practices, with one programme using a substantially lower concentration of formalin. The dual nature of formaldehyde as both an effective preservative and a recognised carcinogen was underscored in relation to human health regarding chemical toxicity. Phenol, like formaldehyde, was consistently used as it is important for the inhibition of bacterial and fungal growth. Alcohol was also consistently used, but there was much greater variation in its volume across South African institutions. Our data showed a slight positive relationship between storage duration and the volumes of formalin and phenol in human embalming fluid. South African regulators enforce stricter exposure limits than those set by the World Health Organisation and various European agencies. While South African institutions operate within internationally acceptable ranges of chemical use that both maximise preservation and minimise toxicity, we acknowledge that these data are preliminary. Further investigation is encouraged to ensure embalming practices effectively protect all those involved and support the educational goals of human anatomical dissection programmes in South Africa.

Technical note: Temperature estimation accuracy based on colourimetry of embalmed human and fresh non-human burned bone.

Estimation of the exposure temperature of skeletal remains can be done by means of colourimetry and a previously published decision model for the colourimetric data, resulting in clusters that represent a range of exposure temperature. The method was based on thermally altered freshly burned human skeletal remains. However, in practice the origin or pre-burning condition of (possibly fragmentary) burned remains can be unknown. Further, in order to use the colourimetric analysis, and accompanying decision model, it is important to have a reference or test set. Fresh human material is not available for this purpose in all countries. Hence, the classification accuracy of the decision model was tested for, in some countries more readily available substitutes for fresh bone; embalmed human bone and non-human bone. The model yielded high accuracies for these sample materials, making it possible to create a reference or test set from fresh non-human and embalmed human bone as substitute for human, and also to use the decision model for these deviating samples in practice.

Anatomic evaluation to compare the dye spread with ultrasound-guided pericapsular nerve group (PENG) injection with or without an additional suprainguinal fascia iliaca (SIFI) injection in soft embalmed cadavers.

BACKGROUND: Novel interfascial plane blocks like PEricapsular Nerve Group (PENG) and SupraInguinal Fascia Iliaca (SIFI) blocks are effective for management of hip fracture pain. We compared the difference in the distribution of the dye injected and nerves stained by the addition of the SIFI block to the PENG block. METHODS: A total of 24 designated dye injections were performed in eight soft-embalmed cadavers. Under ultrasound guidance 20 ml green ink injected bilaterally in PENG block and 30 ml methylene blue dye was injected in the SIFI block on the right side. The cadavers were dissected 24 h later to assess the extent of dye spread. RESULTS: Extensive spread of dyes was seen on both side of iliacus muscle on the right side, but blue dye was not visible medial to the psoas tendon. The subcostal and iliohypogastric nerves were stained green in the infra-inguinal region. On the left side (PENG alone), the anterior division of the obturator, femoral and saphenous nerve (7/8) and iliohypogastric nerves (3/8) were stained in the infrainguinal region. In the suprainguinal region, the femoral nerve (5/8), accessory obturator nerve (3/8), lateral femoral cutaneous (1/8) and nerve to rectus femoris (4/8) were stained. The main obturator nerve trunk was spared with both injections while its anterior branch and accessory obturator nerve were stained with the PENG injection. CONCLUSION: The study findings indicate that combined PENG + SIFI injections lead to an extensive craniocaudal and longitudinal spread along the iliacus muscle. We perceive that the combination of these two injections will have a superior clinical outcome.

Investigation of the use of gelatine-glycerine and gelatine-polyvinyl alcohol mixtures as tissue consistency preservatives in cadavers fixed with modified SEFS solution.

This study aimed to improve the effectiveness of SEFS, a fixing solution composed of soap and ethanol. This was achieved by modifying the formulation of SEFS. Additionally, this study aimed to preserve the consistency of organs by perfusing cadavers with mixtures of gelatine-glycerin (gelatine-Gls) and gelatine-polyvinyl alcohol (gelatine-PVA) through vascular access. The modified SEFS embalmed cadavers were divided into two groups: Group I was treated with gelatine-glycerin, and Group II was treated with gelatine-polyvinyl alcohol and each group comprised of two goats and three rabbits. Over one year, cadavers were objectively assessed for hardness, colour, and joint range of motion. Additionally, the cadavers were subjectively evaluated after dissection and palpation. For the modified SEFS embalmment haptic and optic examinations of the muscles revealed they maintained a vivid colour tone, closely resembling their natural colour. The thoracic organs displayed natural colour, with the lungs retaining their shape without collapse. Notably, the walls of the atrium and ventricles of the heart remained intact without inward collapse. The use of gelatine-PVA yielded better outcomes than gelatine-Gls in preserving the volumes of both chest and abdominal organs. This was particularly evident in the heart, lungs, liver, spleen, and kidney. Overall, the modified SEFS and gelatin-PVA mixtures were superior in maintaining certain properties better than expected from cadavers.

Exploring alternatives for securing anatomical structures in capturing digital images: A comparative analysis.

Teaching veterinary anatomy using digital platforms requires improved image quality, which may influence the fixation process. This study aimed to compare four embalming solutions for high-colour-quality images of different tissues compared to the original image. Four equine left pelvic limbs were cut into metameres and divided equally for application of 10% formaldehyde, 96% glycerine, 33% hypersaturated NaCl solution and modified Larssen solution, respectively, which was maintained for 3 days. After drying for 3 days at room temperature, photographs were obtained at time 0 (T0), without any fixation process (original colour); time 1 (T1), immediately after removal from the solutions; and every 24 h for 3 days (T2-T4). The image colour quality was investigated by digitally evaluating the cortical bone, tendon and bone marrow using histograms and CIEDE2000 as well as by 10 specialists in an online survey. CIEDE2000 and histograms revealed that all fixation solutions changed the original tissue colour at all the time points (p < 0.0001). According to the specialists, the 33% saline solution produced the best results compared to the original one. The modified Larssen solution demonstrated better results for the tendon, marrow and cortical bone at T3 (p = 0.0015). Considering the colour of digital images, the modified Larssen solution provided the best results; however, the visual evaluation by the specialists revealed the 33% saline solution as the best.

Morphological changes in striated muscle fibres caused by components of the Thiel embalming method.

BACKGROUND: Thiel-fixed body donors are highly valued for surgical training courses. The pronounced flexibility of Thiel-fixed tissue has been postulated to be caused by histologically visible fragmentation of striated muscle. The aim of this study was to analyse whether a specific ingredient, pH, decay, or autolysis could cause this fragmentation in order to modulate the Thiel solution to adapt specimen flexibility specifically to the needs of different courses. MATERIALS AND METHODS: Striated muscle of the mouse was fixed for different time periods in formalin, Thiel solution, and its individual ingredients, and analysed by light microscopy. Further, pH-values of Thiel solution and its ingredients were measured. In addition, unfixed muscle tissue was histologically analysed including Gram staining to investigate a relationship between autolysis, decomposition, and fragmentation. RESULTS: Muscle fixed with Thiel solution for 3 months was slightly more fragmentated than muscle fixed for 1 day. Fragmentation was more pronounced after 1 year of immersion. Three individual salt ingredients showed slight fragmentation. Decay and autolysis had no effect on fragmentation, which occurred regardless of the pH of all solutions. CONCLUSIONS: Fragmentation of Thiel-fixed muscle is dependent on fixation time and most likely occurs due to salts present in the Thiel solution. Adjustment of the salt composition in the Thiel solution with verification of the influence on the fixation effect, fragmentation and flexibility of the cadavers could be performed in further studies.

Análise clínica da atividade de trabalho de agentes funerários no nordeste brasileiro / A clinical activity analysis of funeral agents' work in the brazilian northeast / Análisis clínico de la actividad laboral de agentes funerarios en el nordeste de Brasil

Especializados na gestão dos processos da morte e do morrer, os agentes funerários são uma categoria profissional indispensável na sociedade contemporânea. Estudar esses profissionais, marcados por alto grau de invisibilidade social, torna-se extremamente relevante, sobretudo concebendo-os como sujeitos ativos no processo de análise de sua atividade. Nesse sentido, este artigo teve como objetivo analisar a atividade de trabalho de agentes funerários a partir das contribuições teórico-metodológicas da Clínica da Atividade. Para o desenvolvimento desta pesquisa-intervenção foram realizadas 23 observações participantes no local de trabalho, 15 entrevistas individuais e seis entrevistas em grupo, mediadas pelo uso da técnica de Instruções ao Sósia, com agentes funerários que trabalham em um grande grupo funerário no interior do nordeste brasileiro. A análise da atividade de trabalho nos levou à compreensão de que o fazer desses trabalhadores é muito mais do que lidar meramente com o corpo inerte, sem vida, mas demanda deles alto grau de habilidades para lidar com suas emoções e prestar apoio às famílias enlutadas. O gênero profissional da atividade dos agentes funerários fornece importantes maneiras desses trabalhadores se portarem. Diante das imprevisibilidades e impedimentos presentes nas rotinas de trabalho, cada agente funerário age de um jeito, estiliza seu fazer, mas há aqueles modos de agir que são compartilhados, o que permite a construção do modo coletivo do agir profissional, tornando a atividade do agente funerário uma constante mescla do coletivo e do singular.(AU)

Specialized in the management of death processes, funeral agents are an indispensable professional category in contemporary society. It is extremely relevant to study these professionals who endure a high degree of social invisibility, especially by considering them as active subjects in the process of analyzing their own activities. Thus, this study aimed to analyze the work activity of funerary agents using the theoretical-methodological contributions of Clinical Activity. To develop this research-intervention, 23 participant-observations at their workplace, 15 individual interviews, and six group interviews, mediated by the use of the Instructions to the Double technique were carried out with funeral agents who work in a large funeral group in the inner Brazilian northeast. The analysis of work activity led us to understand that these workers' job prescriptions exceeds dealing with inert lifeless bodies. These workers have a high demand of socio-emotional skills, especially to cope and support grieving families. The professional genre in funeral agents' activity provide important ways for these workers to behave. As a result of the unpredictability and impediments in their work routines, funerary agents find their own way to meet the demands of work. However, their shared conducts enable them to construct the collective mode of professional action, making funerary agents' activity a constant mixture of collective and singular contributions.(AU)

Especializados en la gestión de los procesos de la muerte y del morir, los agentes funerarios son una categoría profesional indispensable en la sociedad contemporánea. Estudiar estos profesionales, caracterizados por el alto grado de invisibilidad social, se convierte en algo extremamente relevante, principalmente considerándolos como sujetos activos en el proceso de análisis de su actividad. En este sentido, este artículo tuvo como objetivo analizar la actividad laboral de agentes funerarios a partir de las contribuciones teórico-metodológicas de la Clínica de la Actividad. Para el desarrollo de esta investigación-intervención fueron realizadas 23 observaciones participantes en el local de trabajo, 15 encuestas individuales y seis grupales, mediadas por el uso de la técnica de instrucción al doble, con agentes funerarios que trabajan en un grupo funerario en el interior del Nordeste de Brasil. El análisis de la actividad laboral destaca que estos profesionales desempeñan una labor que va más allá del cuerpo inerte, sin vida, que les requiere un alto grado de habilidades para lidiar con las emociones y fornecer apoyo a las familias en duelo. El tipo profesional de la actividad de los agentes funerarios les proporciona a estos trabajadores importantes modos de portarse. Ante lo imprevisible y las dificultades en sus rutinas de trabajo, cada agente funerario actúa a su manera, pero hay modos de actuar compartidos, lo que permite la construcción del modo colectivo del actuar profesional, transformando la actividad del agente funerario en una constante mezcla entre lo colectivo y lo singular.(AU)

Anatomical and Clinical Education in Physical and Occupational Therapy: Influence of Integration and Soft Preservation / Educación Anatómica y Clínica en Terapia Física y Ocupacional: Influencia de la Integración y la Preservación Blanda

SUMMARY: Anatomy and clinical skills are taught separately to physical and occupational therapy students. Formaldehyde is the primary chemical used to embalm donors which creates a challenge in integrating clinical skills into the anatomy curriculum. This study aimed to evaluate the integration of clinical skills into anatomical education using Imperial College London- Soft Preservation (ICL-SP) and formaldehyde embalming through the evaluation of student perceived learning and confidence. Students were invited to complete a survey after dissecting an ICL-SP and formaldehyde embalmed donors and perform clinical tests. It was easier to dissect and identify neurovascular structures on ICL-SP donors compared to formaldehyde. Clinical tests, like measuring range of motion and ligament tests were also more realistic on ICL-SP donors. The integration of clinical skills in the anatomical curriculum increased student perceived understanding of associated anatomy (p < 0.001), gave better understanding of how anatomy is important to their professions (p < 0.001) and increased motivation to learn anatomy (p < 0.001). The integration of clinical skills into anatomical education can facilitate student learning with higher confidence performing clinical skills and is complemented by the utilization of the new ICL-SP methodology instead of the traditional formaldehyde preservation.

Las habilidades anatómicas y clínicas se enseñan por separado a los estudiantes de terapia física y ocupacional. El formaldehído es el químico principal que se usa para embalsamar a los donantes, lo que crea un desafío para integrar las habilidades clínicas en el plan de estudios de anatomía. Este estudio tuvo como objetivo evaluar la integración de habilidades clínicas en la educación anatómica utilizando Imperial College London-Soft Preservation (ICL-SP) y embalsamamiento de formaldehído a través de la evaluación del aprendizaje y la confianza percibidos por los estudiantes. Se invitó a los estudiantes a completar una encuesta después de diseccionar un ICL-SP y donantes embalsamados formolizados y realizar pruebas clínicas. Fue más fácil diseccionar e identificar estructuras neurovasculares en donantes ICL-SP en comparación con los fijados en formaldehído. Las pruebas clínicas, como la medición del rango de movimiento y las pruebas de ligamentos, también fueron más realistas en los donantes de ICL-SP. La integración de habilidades clínicas en el plan de estudios anatómico aumentó la comprensión percibida por los estudiantes de anatomía asociada (p < 0,001), dio una mejor comprensión de cómo la anatomía es importante para sus profesiones (p < 0,001) y aumentó la motivación para aprender anatomía (p < 0,001). La integración de las habilidades clínicas en la educación anatómica puede facilitar el aprendizaje de los estudiantes con mayor confianza en el desempeño de las habilidades clínicas y se complementa con la utilización de la nueva metodología ICL-SP en lugar de la conservación tradicional con formaldehído.

Psyche and human thought from the anatomies of the past.

De Blasio's research focuses on the anthropology of the late 19th and early 20th centuries. His investigations extend from criminalistics to ancient mummies, driven by his passion for archaeology and human history. He delves into the intricate relationship between anatomy and the human psyche, intertwining disciplines like archaeology, anthropology, and history. His examination of ancient human remains, though lacking modern tools, reveals insights into embalming practices and cultural beliefs. De Blasio's interest in craniology leads to the exploration of cranial deformations, considering as cultural factors. By connecting anthropology with psychology, he questions the cognitive effects of cranial deformations and even associates certain traits with skull morphology. This interplay showcases his ability to merge natural and cultural sciences, offering unique perspectives on human development and cultural practices.

Quantification and persistence of COVID-19 virus in recently deceased individuals before and after embalming.

The COVID-19 pandemic severely affected the medical education worldwide. The infection risk for medical students and healthcare personnel who work with COVID-19 positive cadavers or tissues remains unclear. Moreover, COVID-19 positive cadavers have been rejected by medical schools, adversely impacting the continuum of medical education. Herein, the viral genome abundance in tissues from four COVID-19 positive donors before and after embalming were compared. Tissue samples were collected from the lungs, liver, spleen, and brain both pre- and postembalming. The possible presence of infectious COVID-19 was determined by inoculating human tissue homogenates onto a monolayer of human A549-hACE2 cells and observing for cytopathic effects up to 72 h postinoculation. A real- time quantitative reverse transcription polymerase chain reaction was performed to quantify COVID-19 present in culture supernatants. Fully intact viral genome sequence was possible to obtain in samples with higher levels of virus, even several days postmortem. The embalming procedure described above substantially reduces the abundance of viable COVID-19 genomes in all tissues, sometimes even to undetectable levels. However, in some cases, COVID-19 RNA can still be detected, and a cytopathic effect can be seen both pre- and postembalmed tissues. This study suggests that embalmed COVID-19 positive cadavers might be used safely with appropriate precautions followed in gross anatomy laboratories and in clinical and scientific research. Deep lung tissue is the best specimen to test for the virus. If the tests on the lung tissues are negative, there is a very low likelihood that other tissues will show positive results.

Undergraduate medical student perceptions and learning outcomes related to anatomy training using Thiel- and ethanol-glycerin-embalmed tissues.

Anatomical dissection is known to serve as an integral tool in teaching gross anatomy, including postgraduate training. A variety of embalming techniques exist, resulting in different haptic and optical tissue properties. This study aimed to objectify learning outcomes and medical student perceptions related to the use of two widely used embalming techniques, namely Thiel and ethanol-glycerin embalming. Between 2020 and 2022, first- and second-year medical students enrolled in the course on topographic anatomy participated in this study. Objective structured practical examinations were carried out for the head, neck, thorax, abdomen, pelvis, and extremity regions following regional dissection just before the oral examinations began. Six to ten numbered tags were marked in prosections of each region in Thiel- and ethanol-glycerin-embalmed specimens. Following the examinations, the students were surveyed regarding the suitability of the two embalming techniques with respect to preservation, colorfastness, tissue pliability, and the suitability in preparing for their anatomy examinations. Consistently higher scores were achieved for the thoracic and abdominal regions in ethanol-glycerin-embalmed specimens when compared to Thiel. No benefit was found for Thiel-embalmed upper or lower extremities. Tissues embalmed with ethanol-glycerin were rated higher for preservation and suitability to achieve the learning objectives, tissue pliability was rated higher for Thiel-embalmed tissues. Ethanol-glycerin embalming appears to offer certain advantages for undergraduate students in recognizing visceral structures, which may align with students' ideas on tissue suitability for their learning. Consequently, the benefits reported for Thiel embalming for postgraduate study unlikely reflect its suitability for novices.

The chemicals between us-First results of the cluster analyses on anatomy embalming procedures in the German-speaking countries.

Hands-on courses utilizing preserved human tissues for educational training offer an important pathway to acquire basic anatomical knowledge. Owing to the reevaluation of formaldehyde limits by the European Commission, a joint approach was chosen by the German-speaking anatomies in Europe (Germany, Austria, Switzerland) to find commonalities among embalming protocols and infrastructure. A survey comprising 537 items was circulated to all anatomies in German-speaking Europe. Clusters were established for "ethanol"-, formaldehyde-based ("FA"), and "other" embalming procedures, depending on the chemicals considered the most relevant for each protocol. The logistical framework, volumes of chemicals, and infrastructure were found to be highly diverse between the groups and protocols. Formaldehyde quantities deployed per annum were three-fold higher in the "FA" (223 L/a) compared to the "ethanol" (71.0 L/a) group, but not for "other" (97.8 L/a), though the volumes injected per body were similar. "FA" was strongly related to table-borne air ventilation and total fixative volumes ≤1000 L. "Ethanol" was strongly related to total fixative volumes >1000 L, ceiling- and floor-borne air ventilation, and explosion-proof facilities. Air ventilation was found to be installed symmetrically in the mortuary and dissection facilities. Certain predictors exist for the interplay between the embalming used in a given infrastructure and technical measures. The here-established cluster analysis may serve as decision supportive tool when considering altering embalming protocols or establishing joint protocols between institutions, following a best practice approach to cater toward best-suited tissue characteristics for educational purposes, while simultaneously addressing future demands on exposure limits.

A technique for decreasing reflection during cadaveric photography.

To create anatomical educational materials that can be viewed in three dimensions using stereo photographs and photogrammetry, multiple photographs must be taken from different directions. In this process, shadows and reflections from different positions in each photograph are undesirable for creating three-dimensional (3D) anatomy educational materials. Although a ring flash eliminates shadows, allowing light to enter from all directions, reflections cannot be eliminated. In particular, Thiel-embalmed cadavers, which are widely used in clinical anatomy, are highly wet and exhibit strong specular highlights. In this study, a straight polarization filter was attached to a handheld camera lens and ring flash, and shooting was performed using cross-polarization photography. Consequently, even in Thiel-embalmed cadavers, the details lost due to the effects of reflections and shadows can be recovered, and good results can be obtained when taking stereo photos or creating a 3D model using photogrammetry.

Use of Thiel-embalmed cadavers in urology training and their ability to retain real-life anatomy: a systematic review.

BACKGROUND: Thiel-embalmed cadavers (TeCs) have been proposed as an alternative and probably safer method of surgical training, compared to formalin-embalmed cadavers. We aimed to perform a systematic review on the use of TeCs in urology training and their ability to represent real-life anatomy. METHODS: PubMed, SCOPUS and Cochrane databases were searched for articles with purpose to explore the use of TeCs in urology training, without date restrictions, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. From each paper, we evaluated the type of procedure, the number of participants, the type of study, the educational outcomes and their level, according to Kirkpatrick hierarchy. RESULTS: Of the 225 records initially retrieved, eight articles were eventually included. All studies evaluated participants' perceptions about the procedure. Overall, urology trainees and specialists have positively commented on the educational value of TeCs, which have been also found able to adequately mimic real-life conditions. In all the eight studies, trainees stated that tissue quality of TeCs was adequately realistic and considered TeCs as a useful surgical training tool. CONCLUSION: Although the use of TeCs in urology training has so far been limited, their value as a surgical training tool has been positively perceived. These outcomes suggest that TeCs may also enhance urology trainees' surgical skills and may encourage their implementation as a simulation tool in urology training.

Development of the McMaster Embalming Scale (MES) to assess embalming solutions for surgical skills training.

Human cadavers used for surgical training are embalmed using various methods to facilitate tissue storage and longevity while preserving the natural characteristics required to achieve high fidelity functional task alignment. However, there are no standardized means to evaluate the suitability of embalming solutions for this purpose. The McMaster Embalming Scale (MES) was developed to assess the extent to which embalming solutions allow tissues to achieve physical and functional correspondence to clinical contexts. The MES follows a five-point Likert scale format and evaluates the effect of embalming solutions on tissue utility in seven domains. This study aims to determine the reliability and validity of the MES by presenting it to users after performing surgical skills on tissues embalmed using various solutions. A pilot study of the MES was conducted using porcine material. Surgical residents of all levels and faculty were recruited via the Surgical Foundations program at McMaster University. Porcine tissue was unembalmed (fresh- frozen) or embalmed using one of seven solutions identified in the literature. Participants were blinded to the embalming method as they completed four surgical skills on the tissue. After each performance, participants evaluated their experience using the MES. Internal consistency was evaluated using Cronbach's alpha. Domain to total correlations and a g-study were also conducted. Formalin-fixed tissue achieved the lowest average scores, while fresh frozen tissue achieved the highest. Tissues preserved using Surgical Reality Fluid (Trinity Fluids, LLC, Harsens Island, MI) achieved the highest scores among embalmed tissues. The Cronbach's alpha scores varied between 0.85 and 0.92, indicating a random sample of new raters would offer similar ratings using the MES. All domains except odor were positively correlated. The g-study indicated that the MES is able to differentiate between embalming solutions, but an individual rater's preference for certain tissue qualities also contributes to the variance in scores captured. This study evaluated the psychometric characteristics of the MES. Future steps to this investigation include validating the MES on human cadavers.