Standardization of robot-assisted pelvic lymph node dissection-Development of a common understanding of regional anatomy and surgical technique based on cross-disciplinary discussion among colorectal surgery, urology, and gynecology.

BACKGROUND: Pelvic lymph node dissection is a procedure performed in gastroenterological surgery, urology, and gynecology. However, due to discrepancies in the understanding of pelvic anatomy among these departments, cross-disciplinary discussions have not been easy. Recently, with the rapid spread of robotic surgery, the importance of visual information in understanding pelvic anatomy has become even more significant. In this project, we attempted to clarify a shared understanding of pelvic anatomy through cross-disciplinary discussions. METHOD: From May 2020 to November 2021, a total of 11 discussions were held entirely online with 5 colorectal surgery specialists, 4 urologists, and 4 gynecologists. The discussions focused on evidence from each specialty and surgical videos, aiming to create a universally understandable pelvic anatomical illustration. RESULTS: The common area of dissection recognized across the three departments was identified as the obturator lymph nodes. A dynamic illustration of pelvic anatomy was created. In addition to a bird's-eye view of the pelvis, a pelvic half view was developed to enhance understanding of the deeper pelvic anatomy. The following insights were incorporated into the illustration: (1) the cardinal ligament in gynecology partly overlaps with the vesicohypogastric fascia in colorectal surgery; (2) the obturator lymph nodes continue cephalad into the fossa of Marcille in urology; and (3) the deep uterine vein in gynecology corresponds to the inferior vesical vein in colorectal surgery. CONCLUSION: Based on the dynamic illustration of pelvic anatomy from cross-disciplinary discussions, we anticipate advancements in pelvic lymph node dissection aiming for curative and safe outcomes.

Measurement of Clavicular Symmetry in Healthy Subjects Using Tomographic Database of Public Hospitals / Mensuração de simetria clavicular em indivíduos saudáveis utilizando-se de banco de dados tomográficos de hospitais públicos

Abstract Objective This study aimed to perform an imaging evaluation to prove the existence or not of symmetry between the clavicles of healthy subjects from Curitiba, Paraná, Brazil, and identify potential factors influencing the clavicular length. Method The study analyzed chest computed tomography (CT) scans of 211 patients with no clavicular fracture or malformations (100 women and 111 men). We measured the greatest clavicular diagonal on both sides, and the software automatically generated the maximum distance in millimeters. Relative and absolute frequencies described qualitative variables and mean values; quantitative variables used a 95% confidence interval. Value comparisons employed the student's t-test, and correlations determinations used Pearson's correlation coefficient. The significance level adopted was 5%. Results There was a significant difference between the clavicular length (right clavicle, 143.58 mm; left clavicle, 145.72 mm; p = 0.037), indicating asymmetry. On average, the left clavicle was 3.71 mm larger. Asymmetry was significant for both men and women (p < 0.001). The average difference was 4.13 mm for men and 3.23 mm for women. Seventy-three percent of the sample had < 5 mm of asymmetry, 23.7% had 5 to 10 mm, and 3.3% had > 10 mm of asymmetry. Conclusion The studied population did not present clavicular symmetry. On average, the left clavicle was longer than the right clavicle, with differences of 3.71 mm in the general sample, 3.23 mm in women, and 4.13 mm in men. The only significant factor was gender since men presented longer clavicles and higher differences than women.

Resumo Objetivo Realizar avaliação imagiológica com intuito de comprovar a existência ou não de simetria entre as clavículas de indivíduos saudáveis da cidade de Curitiba/PR, aliada à identificação de possíveis fatores de influência no comprimento clavicular. Método Foram analisadas tomografias computadorizadas de tórax de 211 pacientes sem fratura ou malformações na clavícula (100 mulheres e 111 homens). A maior diagonal clavicular foi medida em ambos os lados e o software gerou automaticamente a máxima distância em milímetros. Foram utilizadas frequências relativas e absolutas para descrever variáveis qualitativas e a média e intervalo de 95% de confiança para as quantitativas. As comparações foram feitas com o teste t de Student e correlações calculadas pelo coeficiente de correlação de Pearson. O nível de significância adotado foi de 5%. Resultados Verificou-se diferença significativa entre o comprimento das clavículas (direita 143.58mm e esquerda 145.72mm, p = 0.037), indicando assimetria. Em média, o lado esquerdo é 3.71mm maior. A assimetria foi significativa tanto para homens quanto para mulheres (p < 0.001). A diferença média foi de 4.13mm para homens e 3.23mm para mulheres. 73% da amostra apresentou <5mm de diferença, enquanto 23.7% apresentou 5-10mm e 3.3% apresentou >10mm de assimetria. Conclusão Não foi possível encontrar simetria nas clavículas da população de Curitiba/PR. Em média, a clavícula esquerda é maior que a direita, com diferenças de 3.71mm na amostra geral, 3.23mm para mulheres e 4.13mm para homens. O único fator significativo foi o sexo, com homens tendo maiores comprimentos claviculares e maiores diferenças em comparação às mulheres.

[Piriform aperture as a cause of nasal obstruction. Part 2. A systematic review of the methods of surgical treatment]. / Grushevidnaya apertura kak prichina nazal'noi obstruktsii. Chast' 2. Sistematicheskii obzor sposobov khirurgicheskogo lecheniya.

The article presents a systematic review of publications on the methods of piriform aperture (PA) surgery in the treatment of nasal obstruction. Various surgical techniques are reviewed critically in terms of topographic anatomy and the effectiveness of the method. The contradictory opinions about the access to the piriform aperture and the methods of its correction are revealed. The topic of surgery of the PA as an area of the internal nasal valve in the treatment of nasal obstruction is equally interesting for ENT and plastic surgeons. The analysis of the literature showed the effectiveness and safety of operations to expand the PA. None of the authors in the studied works notes any changes in the appearance of the nose during observation in the postoperative period. The biggest challenge in understanding PA surgery, which has yet to be understood, is determining the indications for a particular method of surgery, which justifies the continuation of the search, taking into account the clinical features of the patient and the topographic level of the disorder. In the future, we need studies with objective measurements, control and long-term careful observation to better study the effect of the expansion of the piriform aperture on the relief of nasal obstruction.

Panoramic radiography and cone-beam computed tomography to measure distances between root apexes and anatomical structures / Radiografía panorámica y tomografía computarizada de haz cónico para medir distancias entre ápices radiculares y estructuras anatómicas

Aim: To compare the accuracy of the panoramic radiography with cone-beam computed tomography (CBCT) scans in measuring the distances between root apexes and the adjacent anatomical structures including the maxillary sinus and the mandibular canal. Material and Methods: A total of 200 CBCT scans (100 maxillary and 100 mandibular) from patients who also had corresponding panoramic radiography were selected. Linear measurements (in mm) presenting centralized image were made between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus, and between the apexes of the mandibular teeth and the superior border of the mandibular canal by using specific software for panoramic radiography and the measurements on the coronal sections in CBCT scans. Data were submitted to inferential statistical analysis and Student's t-test for comparison between measurements. Results: CBCT scans were significantly more accurate than panoramic radiography to measure the distances between the apexes of the maxillary teeth and the inferior wall of the maxillary sinus (p<0.05) and between the apexes of the mandibular teeth and the superior border of the mandibular canal or mental foramen (p<0.05). Conclusion: CBCT scans present more accurate measurements than panoramic radiography.

Objetivo: Comparar la precisión de la radiografía panorámica con las exploraciones de la tomografía computarizada dental de haz en cónico (CBCT) para medir las distancias entre los vértices radiculares y las estructuras anatómicas adyacentes, incluidos el seno maxilar y el canal mandibular. Material y Métodos: Se seleccionaron un total de 200 tomografías CBCT (100 maxilares y 100 mandibulares) de pacientes que además tenían la correspondiente radiografía panorámica. Se realizaron mediciones lineales (en mm) que presentaban imagen centralizada entre los ápices de los dientes maxilares y la pared inferior del seno maxilar, y entre los ápices de los dientes mandibulares y el borde superior del canal mandibular mediante software específico para radiografía panorámica. y las mediciones en las secciones coronales en escaneos CBCT. Los datos se sometieron a análisis estadístico inferencial y prueba t de Student para comparación entre mediciones. Resultados: Las exploraciones CBCT fueron significativamente más precisas que la radiografía panorámica para medir las distancias entre los ápices de los dientes maxilares y la pared inferior del seno maxilar (p<0,05) y entre los ápices de los dientes mandibulares y el borde superior de los dientes mandibulares. canal o agujero mentoniano (p<0.05). Conclusión: Las exploraciones CBCT presentan mediciones más precisas que la radiografía panorámica.

Effects of open board lecture videos on anatomy / Efectos de los videos de conferencias de tablero abierto sobre anatomía

SUMMARY: COVID-19 has forced anatomists to perform non-face-to-face education using lecture videos. A Korean anatomist has given (white and black) board lectures and distributed lecture videos to the public for many years. This study was to verify the effects of open board lecture videos in the anatomy field. A questionnaire survey was carried out with the help of medical students who were exposed to the board lecture videos. The video provider uploaded the lecture videos on YouTube, where the viewing numbers were counted. At a medical school where the video provider belonged, the students mainly watched the lecture videos before the anatomy class. The watching hours of the lecture videos were related to the written examination scores. Students gave positive and negative comments on the board lectures. At the other two medical schools, students partly watched the lecture videos regardless of the teacher who delivered the lectures. The results suggested that students understood the board lectures themselves. On YouTube, the lecture videos were viewed by approximately 1,000 students. This paper introduces the desirable aspects of open board lecture videos on anatomy. The videos could enhance the quality of both students and teacher.

RESUMEN: COVID-19 ha obligado a los anatomistas a realizar una enseñanza no presencial mediante videos de conferencias. Un anatomista coreano ha impartido conferencias (en blanco y negro) y ha distribuido videos de conferencias al público durante muchos años. El objetivo de este estudio fue verificar los efectos de los videos de conferencias de pizarra abierta en el campo de la anatomía. Se llevó a cabo una encuesta con la ayuda de estudiantes de medicina que habían sido expuestos a los videos de conferencias de la pizarra. El proveedor de videos subió los videos de las conferencias a YouTube, donde se contabilizó el número de visualizaciones. En una facultad de medicina a la que pertenecía el proveedor de videos, los estudiantes vieron principalmente los videos de conferencias antes de la clase de anatomía. Las horas de revisión de los vídeos de las conferencias se relacionaron con las puntuaciones de los exámenes escritos. Los estudiantes dieron comentarios positivos y negativos sobre las conferencias de la pizarra. En las otras dos facultades de medicina, los estudiantes vieron parcialmente los videos de las clases, independientemente del profesor que las impartiera. Los resultados sugerían que los estudiantes entendieron las conferencias de la pizarra por sí mismos. En YouTube, los videos de las conferencias fueron vistos por aproximadamente 1000 estudiantes. Este artículo presenta los aspectos deseables de los videos de conferencias abiertas sobre anatomía. Los videos podrían mejorar la calidad tanto de los estudiantes como del profesor.

Dissecção do plexo cervical na formação médica: aplicabilidades clínicas e cirúrgicas / Dissection of the cervical plexus in medical training: clinical and surgical applicabilities

A Anatomia da região cervical é de particular importância para os clínicos e cirurgiões de diversas especialidades médicas. Em se tratando da organização nervosa presente na região anterolateral do pescoço, encontra-se o plexo cervical, formado pelos ramos anteriores dos nervos cervicais C1 a C4, cuja função é promover a sensibilidade da pele anterolateral cervical, torácica anterossuperior e do couro cabeludo posterior, na cabeça, além de controlar a musculatura infra-hióidea e diafragmática. Logo, lesões a essa estrutura nervosa e aos seus ramos podem causar graves complicações ao corpo humano. Esse trabalho objetivou utilizar a dissecção da região anterolateral do pescoço como uma ferramenta pedagógica para o estudo das relações anatômicas dos nervos do plexo cervical observados durante essa prática, assim como relatar algumas de suas importâncias clínicas e cirúrgicas. O presente estudo é caracterizado como qualitativo/descritivo. A dissecção foi realizada semanalmente, durante o segundo semestre de 2018 e o primeiro semestre de 2019, com a supervisão do professor responsável e auxílio do técnico de laboratório, no Laboratório de aulas práticas da Universidade Estadual de Londrina (UEL). Considera-se que a dissecção da região anterolateral do pescoço permitiu a visualização de diversos nervos cutâneos e musculares do plexo cervical, assim como de alguns de seus ramos e suas relações anatômicas. Também contribuiu para o conhecimento da topografia em que se encontravam tais estruturas e sua organização em camadas. Esse conhecimento anatômico é essencial para a prática médica, tanto clínica quanto cirúrgica.(AU)

The anatomy of the cervical region is of particular importance for surgeons and physicians of different medical specialties. The cervical plexus can be found in the anterolateral region of the neck, formed by the anterior branches of the cervical nerves C1 to C4, whose function is to promote the sensitivity of the cervical anterolateral skin, anterosuperior thoracic skin, and posterior scalp, on the head, in addition to controlling the infrahyoid and diaphragmatic muscles. Therefore, injuries to this nervous structure and its branches may cause serious complications to the human body. This work aimed at using the dissection of the anterolateral neck region as a pedagogical tool for the study of the anatomical relationships of the cervical plexus nerves observed during this practice, as well as to highlight some of its clinical and surgical importance. This is a qualitative/descriptive study. The dissection was performed weekly, during the second semester of 2018 and the first semester of 2019, with the supervision of the professor in charge and the assistance of the laboratory technician at the Laboratory of Practical Classes at the State University of Londrina (UEL). It is considered that the dissection of the anterolateral neck region allowed the visualization of several cutaneous and muscular nerves present in the cervical plexus. It also contributed to the knowledge of the topography in which these structures were found and their organization in layers. This anatomical knowledge is essential for both clinical and surgical medical practice.(AU)

Septocutaneous gluteal artery perforator flap in breast reconstruction: An insight into the related anatomy and preoperative imaging.

BACKGROUND: Although without a widespread popularity, the septocutaneous gluteal artery perforator flap (sc-GAP) can be an excellent choice in breast reconstruction. The purpose of the article is to further study the preoperative imaging anatomy and surgical technique for a safe operation. PATIENTS AND METHODS: A clinical experience in four unilateral breast reconstructions is reported, and an analysis is made of the computed tomography angiography (CTA) variables (36 studies/72 sides) that might define the microsurgical consistency and reliability of the technique. RESULTS: After a careful preoperative imaging evaluation, the surgical operation confirmed a predictable, although not straightforward, anatomy. All the flaps were raised in the supine position. With a remarkably quick postoperative recovery, the resulting scar was well hidden and did not significantly distort the gluteal aesthetics although contralateral contouring liposuction might be desirable in unilateral cases. Good aesthetic results were obtained in all the patients. In the evaluation of the CTA studies, a right/left septocutaneous perforator arising from the superficial branch of the superior gluteal artery could be found in 80.6% of the patients, with a few patients having 2-3 perforators on one side. Although with an overall suitable pedicle length (mean 7.4 cm), the arterial diameter at the suture site was found to be small (mean 1.6 mm). CONCLUSION: Given the adequate body habitus and reconstructive requirements, the sc-GAP can be a good choice even in large breasts. However, the technique requires the appropriate surgical expertise and mandates a thorough preoperative imaging evaluation that defines whether the technique should be done in a particular patient.

Blood supply of the male breast nipple-areola complex evaluated by CTA.

PURPOSE: In addition to women, men also undergo breast surgeries, and early studies on the blood supply of breasts are nearly all conducted in female subjects. The vasculature of the male breast is seldom studied. Understanding the male-specific blood supply of the breast is important for pre-operative planning and reducing complications. The purpose of this retrospective study is to fill the gap in the literature by describing the main blood supply and its orientation in the male breast. METHODS: We retrospectively evaluated thoracic computed tomographic angiography (CTA) data from January 1, 2017 to July 30, 2019. Single or multiple dominant arteries and their origins were traced, and the artery route and orientation related to the nipple-areola complex (NAC) were revealed through data analysis of the images. RESULTS: Totally, 284 breasts were included. Most breasts were supplied by a single dominant artery (196, 69%), among which the lateral thoracic artery (LTA; 119, 41.9%; type I) and internal thoracic artery (ITA; 63, 22.2%; type II) were the most common arteries. A minority of breasts were supplied by vascular anastomoses formed by dual arteries (17, 6.0%; type III), and in 25.0% of breasts, no specific dominant artery was found (type IV). The predominant artery distribution was evaluated. CONCLUSION: This study cohort of male thoracic CTA provided and analysed the elaborate vascular anatomy of the NAC region. Our results favour inferior periareolar incision in regard to diminished vascular-related complications in male surgeries without pre-operative vascular evaluation. This study also suggests that super-lateral or lower-lateral-based pedicles can reserve more vasculature.

Anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior lesions: A cadaveric study and preliminary report.

OBJECTIVE: This study aims to investigate the anatomical relationships of the transmuscular portal to its surrounding structures in arthroscopic treatment of superior labrum anterior posterior (SLAP) lesions in a human cadaveric model. METHODS: In this anatomic study, bilateral shoulder girdles of 12 adult formalin embalmed cadavers were used. All cadavers were male, and the mean age was 63.4±7.3 years. The portal entry point was determined as midway between the anterior and posterior borders of the acromion, approximately 1 cm lateral from the edge of the acromion. After a guidewire was placed in the glenoid cavity at the 12 o'clock position where the SLAP lesion typically occurs, a switching stick was inserted there. Each glenoid was then drilled with a 2.4 mm drill through an arthroscopic cannula. Subsequently, anatomical dissection was executed to assess the relationship of the transmuscular portal with the suprascapular nerve, axillary nerve, supraspinatus tendon, acromion, and biceps tendon. Lastly, the shortest distance between the aforementioned structures with the drill was measured by a sensitive caliper to determine whether there was a penetration of the structures. Differences between the right and left sides were analyzed. RESULTS: The mean distance between the portal and the axillary nerve was 55.5 mm±6.0 mm, and the mean length of the suprascapular nerve was 61.2 mm±7.0 mm. The mean distance between the portal and the supraspinatus tendon was 2.8 mm±1.5 mm. No penetration of the axillary nerve, suprascapular nerve, and supraspinatus tendon was observed in any cadaver. No differences were detected for measured anatomical parameters between the right and left sides (p>0.05). CONCLUSION: Findings from this cadaveric study revealed that the transmuscular portal may allow for a reliable anchor placement without any nerve or tendon penetration during arthroscopic SLAP repair. LEVEL OF EVIDENCE: Level V.

Topographic anatomy of the internal branch of the superior laryngeal nerve.

PURPOSE: The aim of this study was to investigate the surgical and topographical anatomy of the internal branch of the superior laryngeal nerve (ibSLN) in laryngectomy patients. METHODS: Patients aged 36-90 years old who underwent a total laryngectomy operation with a diagnosis of laryngeal carcinoma participated in the study. Fifteen patients who underwent a total laryngectomy operation between June 2015 and November 2016 were included in the study. A total of 29 superior laryngeal nerves (SLN) of 15 patients were studied. The position of the nerve was photographed before the thyrohyoid membrane (THM) was passed during dissection. The relationship and course of the ibSLN with respect to the superior laryngeal artery (SLA) were observed. The distance to adjacent formations and branching variants were examined along the course of the nerve. RESULTS: Of the total 29 ibSLN, 17 were divided into three branches and 12 into two branches. In all cases except for one, the ibSLN course after piercing the THM was determined. The ibSLN penetrated the THM at a mean of 12.0 ± 2.61 mm (6-16 mm) from the superior border of the thyroid cartilage. The ibSLN penetrated the THM with a mean distance of 9.34 ± 1.65 (6-12) mm from the inferior border of the hyoid bone. CONCLUSION: Our study demonstrated the surgical and topographical features of the ibSLN with respect to the THM, and provided a more precise knowledge of its anatomy in laryngectomy patients. It thus may help head and neck surgeons identify this nerve.

The feasibility analysis of calculating proptosis by simple Pythagorean theorem.

PURPOSE: We propose a new method to analyze the feasibility of calculating proptosis on the basis of simple Pythagorean theorem. METHOD: This is a non-inferiority trial, and the registration number is ChiCTR1900026490. The absolute value of proptosis of two eyes of patients without eye injury or diseases visiting our clinic from December 2017 to June 2019 was measured by computed tomography, Hertel exophthalmometer, and by simple Pythagorean theorem. With the application of MedCalc software version 19.0.4, the differences between these methods in two eyes were showed by Bland and Altman plot. RESULTS: A 95% limit of agreement between computed tomography and Hertel exophthalmometer is -0.7 to 0.62 mm in right eye proptosis. A total of 4.44% (4/90) points were outside 95% limit of agreement. Similarly, the same method was used to compare the proptosis between computed tomography and other ways. We also compared the proptosis measured by homolateral and heterolateral simple Pythagorean theorem method in order to find out the consistence between them. The points in all Bland and Altman plots were lower than 5%, which means that the results of comparison between any two methods had a good consistency in the measurement of proptosis of both eyes. CONCLUSION: Pythagorean theorem can be applied to evaluate proptosis and has a good consistency comparing with computed tomography and the Hertel exophthalmometer. The method can be used for measuring proptosis of unilateral orbital, maxillofacial trauma, and dysplasia accurately. It is practical in clinical use of proptosis assessment because of its accuracy, reliability, and simplicity.

Teaching Middle Ear Anatomy and Basic Ear Surgery Skills: A Qualitative Study Comparing Endoscopic and Microscopic Techniques.

OBJECTIVE: Endoscopic ear surgery is gaining popularity as a minimally invasive surgical technique for middle ear diseases. Its ongoing implementation into clinical routine has consequences regarding teaching of middle ear anatomy and surgery. To improve undergraduate and postgraduate training, we investigated the perception of and preference for endoscopy as compared with microscopy at different educational levels. STUDY DESIGN: Qualitative study based on a thematic analysis approach. SETTING: Tertiary academic medical center. METHODS: After a standardized curriculum was run on endoscopic and microscopic anatomy and surgical skills education, 5 focus groups were held. The interviews were conducted, video recorded, transcribed, and analyzed. Analysis of the data gave rise to 11 themes showing the participants' perceptions and preferences. RESULTS: Five medical students, 11 otorhinolaryngology residents, and 3 staff members participated in this qualitative study. For anatomy teaching, there was a clear preference for the endoscopic technique. The main advantages were the enhanced overview and perception of the anatomic details provided through endoscopy. For skills acquisition, the perceived advantages of the techniques were the same view of the surgical field for endoscopy and the 2-handed surgical technique for microscopy. However, there was no clear preference between the techniques for skills acquisition. CONCLUSION: The endoscopic technique was generally judged more beneficial for teaching anatomy, especially due to the greater visualization of the complex middle ear anatomy. Given that both techniques will remain important to future surgeons, the relative unique benefits of each must be considered when designing and optimizing curricula for otologic education.

Individualized design of double skin paddle anterolateral thigh perforator flaps to repair complex soft tissue defects of the extremities: An anatomical study and retrospective cohort study.

This study describes our experience using individually designed double skin paddle anterolateral thigh perforator (ALTP) flaps to reconstruct complex soft tissue defects. An anatomical study of double skin paddle ALTP flaps was conducted in six fresh cadavers (12 thighs). We also performed a retrospective cohort study of 36 patients who underwent reconstruction using double skin paddle ALTP flaps from January 2009 to June 2019. The soft tissue defects were large or non-adjacent defects that could not be repaired by a single flap. Three types of double skin paddle ALTP flaps were designed. In type I, separate perforators supplied each flap: one perforator from the transverse branch of the lateral circumflex femoral artery (LCFA) and one from the descending branch of the LCFA (d-LCFA). In type II, both perforators were from the d-LCFA. In type III, a single perforator from the d-LCFA had two branches that each supplied one flap. In the cadaver study, type I was observed in 11 thighs, type II in 10, and type III in six. All patients were successfully treated using double skin paddle ALTP flaps. Four patients received type I flaps, 23 received type II, and nine received type III. Vascular compromise occurred in one patient, and the flap was saved by emergency revascularization. Most patients had satisfactory contours and functional recovery during follow-up. Individually designed double skin paddle ALTP flaps is a reliable option for reconstructing complex soft tissue defects. Moreover, we created an algorithm for microvascular reconstruction of complex soft tissue defects.

Design of Bio-Impedance Electrode Topologies for Specific Depth Sensing in Skin Layer.

Bio-impedance analysis provides non-invasive estimation of body composition. Recently, applications based on bio-impedance measurement in skin tissue such as skin cancer diagnosis and skin composition monitoring have been studied. For scanning the electrical properties along the skin depth, the relationship between the electrode topologies and the depth sensitivity should be clarified. This work reports a systematic analysis on designing line electrode topologies to measure the bio-impedance of the skin layer at specific depth using a finite element method (FEM). Four electrodes consisting of two outer current electrodes and two inner voltage electrodes in the form of Wenner-Schlumberger array were employed on the top of a collagen layer as a skin model. The numerical results demonstrate a change in the effective depth of measurement depending on the electrode topologies, which also have a good agreement with an analytic solution. This study suggests a decision guideline for designing the electrode topologies to achieve target depth sensitivity in bio-impedance measurement of skin tissue.Clinical Relevance-This establishes the effect of electrode topologies on depth sensitivity in bio-impedance measurements in skin layer.

A new holistic assessment system and its impacts on student performance in regional anatomy / Un nuevo sistema de evaluación holística y sus impactos en el rendimiento de los estudiantes en anatomía regional

Summative and formative assessments are two overlapping complementary ways of assessing student progress in regional anatomy teaching and learning. Our present study was designed to create a new holistic assessment system that embraces both summative and formative assessments, and evaluate its impacts on student performance of regional anatomy. A collection of five formative assessment tests were designed and introduced into the teaching process of regional anatomy, and their performances were combined with scores of the summative assessment taken at the end of the semester to form the holistic assessment. And an anonymous survey was conducted to gather student perceptions regarding the assessments. We found, compared to summative assessment scores, students' overall average points are higher by 4.67 points (P<0.05) and 9.23 points (P<0.01) when evaluated by the holistic and formative assessment; formative assessment scores are positively correlated to summative assessment scores, and the Pearson correlation is 0.624. Questionaire investigation showed 57.65 % of the students wishes to be assessed by the holistic assessmen, and 97.9 % of the students think that the holistic assessment can promote the frequency of student-teacher communication, which helps them form the right learning attitude and improve the performance. The results indicated that holistic assessment is a more reflective and practical approach of evaluating student performance in regional anatomy teaching, which can increase studentteacher communication and enhance the self-directed learning among students.

Las evaluaciones sumativas y formativas son dos formas complementarias superpuestas de evaluar el progreso de los estudiantes en la enseñanza y el aprendizaje de la anatomía regional. El presente estudio fue diseñado para crear un sistema nuevo de evaluación integral que abarque tanto las evaluaciones sumativas como las formativas, y evalúe sus impactos en el rendimiento de los estudiantes de la anatomía regional. Se diseñó e introdujo una colección de cinco pruebas de evaluación formativa en el proceso de enseñanza de la anatomía regional, y sus desempeños se combinaron con los puntajes de la evaluación sumativa tomada al final del semestre para formar la evaluación holística. Además, se realizó una encuesta anónima para recopilar las percepciones de los estudiantes con respecto a las evaluaciones. Encontramos que, en comparación con los puntajes de la evaluación sumativa, los puntos promedio generales de los estudiantes son más altos en 4,67 puntos (P <0,05) y 9,23 puntos (P <0,01) cuando se evalúan mediante la evaluación holística y formativa; los puntajes de las evaluaciones formativas se correlacionan positivamente con los puntajes de las evaluaciones sumativas, y la correlación de Pearson es 0,624. La investigación del cuestionario mostró que el 57,65 % de los estudiantes desea ser evaluado por los evaluadores holísticos, y el 97,9 % de los estudiantes piensa que la evaluación holística puede promover la frecuencia de la comunicación entre estudiantes y maestros, útil para formar una actitud correcta de aprendizaje y mejorar el rendimiento. Los resultados indicaron que la evaluación holística es un enfoque más reflexivo y práctico para evaluar el desempeño de los estudiantes en la enseñanza de anatomía regional, lo que puede aumentar la comunicación entre estudiantes y maestros y mejorar el aprendizaje autodirigido entre los estudiantes.