Communicating Branches of the Facial Nerve: Descriptions and Clinical Considerations.

BACKGROUND: Major branching patterns of the facial nerve have been extensively studied because damage to branches of the nerve is associated with complications ranging from weakness to paralysis. However, communicating branches of the facial nerve have received far less attention despite being hypothesized as a means of motor recovery following facial nerve injury. OBJECTIVES: The aim of this study was to characterize the frequency of communicating branches of the facial nerve to provide clarity on their anatomy and clinical correlations. METHODS: Bilateral facial dissections were completed on cadaveric donors (n = 20) to characterize the frequency and location of communicating branches across terminal branches of the facial nerve. Statistical analyses were employed to analyze differences between the location of communications by side and whether the communicating branches were more likely to occur on the left or right side (P < 0.05). RESULTS: Communicating branches were identified among all terminal branches of the facial nerve and their frequencies reported. The highest frequencies of communicating branches were identified between the buccal-to-marginal mandibular and zygomatic-to-buccal branches, at 67.5% (27 comm/40 hemifaces). The second highest frequency was identified between the temporal-to-zygomatic branches in 62.5% (25/40) of donors. The marginal mandibular-to-cervical branches had communicating branches at a frequency of 55% (22/40). Location or sidedness of communicating branches did not significantly differ. CONCLUSIONS: Our characterization more accurately defines generalizable areas in which communicating branches are located. These locations of branches, described in relation to nearby landmarks, are fundamental for clinical and surgical settings to improve procedural awareness.

Management of Obesity Using Telemedicine During the COVID-19 Pandemic.

IMPORTANCE: During the COVID-19 pandemic, telemedicine visits increased to provide safer access to healthcare. METHODS: To evaluate the role of telemedicine in obesity management during COVID-19, we conducted a systematic review to identify barriers in using this approach to patient care. CONCLUSION: While necessary, the management of obesity through telemedicine was met with patient-specific and healthcare-specific barriers. Increased awareness of these barriers may allow physicians to better understand patient interactions via virtual medical visits.

Mutations in Hedgehog acyltransferase (Hhat) perturb Hedgehog signaling, resulting in severe acrania-holoprosencephaly-agnathia craniofacial defects.

Holoprosencephaly (HPE) is a failure of the forebrain to bifurcate and is the most common structural malformation of the embryonic brain. Mutations in SHH underlie most familial (17%) cases of HPE; and, consistent with this, Shh is expressed in midline embryonic cells and tissues and their derivatives that are affected in HPE. It has long been recognized that a graded series of facial anomalies occurs within the clinical spectrum of HPE, as HPE is often found in patients together with other malformations such as acrania, anencephaly, and agnathia. However, it is not known if these phenotypes arise through a common etiology and pathogenesis. Here we demonstrate for the first time using mouse models that Hedgehog acyltransferase (Hhat) loss-of-function leads to holoprosencephaly together with acrania and agnathia, which mimics the severe condition observed in humans. Hhat is required for post-translational palmitoylation of Hedgehog (Hh) proteins; and, in the absence of Hhat, Hh secretion from producing cells is diminished. We show through downregulation of the Hh receptor Ptch1 that loss of Hhat perturbs long-range Hh signaling, which in turn disrupts Fgf, Bmp and Erk signaling. Collectively, this leads to abnormal patterning and extensive apoptosis within the craniofacial primordial, together with defects in cartilage and bone differentiation. Therefore our work shows that Hhat loss-of-function underscrores HPE; but more importantly it provides a mechanism for the co-occurrence of acrania, holoprosencephaly, and agnathia. Future genetic studies should include HHAT as a potential candidate in the etiology and pathogenesis of HPE and its associated disorders.

The clinical anatomy fellowship: A participants' perspective.

Kansas City University offers a Clinical Anatomy Fellowship which enrolls nine medical students during each academic year and provides training in research, teaching, and advanced anatomical topics. The Fellows practice as novice educators, working alongside Anatomy faculty to teach medical students in the Gross Anatomy laboratory. However, little has been reported related to Fellowship participation and success outcomes. This survey-based study was designed to explore (1) student motivation(s) for pursuing the Fellowship, (2) benefits of participation, and (3) the perceived impact on residency applications and career success. Three unique populations were surveyed. The most important factors driving application to the Fellowship were a desire to increase competitiveness in the residency application process (Likert mean score 4.7-5.0) and a passion for Anatomy (Likert mean score 4.3-4.7). Taking a year away from the College of Osteopathic Medicine curriculum (Likert mean score 4.4) and delaying clinical exposure (Likert mean score 4.2) were the most important deterrents to application. The most reported benefits after program completion included opportunities to build a strong residency application (44% and 50% of Fellows), conduct research (44% and 45% of Fellows), and participate in teaching (11% and 50% of Fellows). 73% of past Fellows matched into their top specialty of choice. Flexibility in the program allows participants to individualize their Fellowship experience to address their personal goals related to residency applications and careers as future physicians. As the results suggest, the Clinical Anatomy Fellowship benefits Fellows, signaling other medical institutions to consider adopting a similar program.

The Clinical Anatomy Fellowship: Revolutionizing curricular experiences for faculty and students.

Fellows completing the Clinical Anatomy Fellowship at Kansas City University assist Anatomy faculty in the Gross Anatomy laboratory, complete robust research projects, and support other departments. The program's positive impact on participants has been reported; however, the impact on individuals interfacing with Fellows has not been investigated. A follow-up, survey-based (Likert scale, multiple-choice, open-ended) study was conducted to evaluate faculty, staff, and student perceptions of the program. Ninety-five percent of surveyed faculty and staff (n = 22) perceived the Fellows as beneficial to students, faculty, and the university (p < 0.05) by acting as role models (95%) and mentors (90%), contributing to educational processes (90%), and reducing faculty work burden (81%) (p < 0.05). Student responses (n = 95) were also positive: 97% perceived interactions with Fellows as beneficial (p < 0.05). A passion for Anatomy (mean, 4.6; p < 0.05) and the opportunity to increase competitiveness for residency (mean, 4.5; p < 0.05) were the most important factors driving interest in the Fellowship (Cronbach's alpha, 0.766). In contrast, diverting a year from the school's curriculum (mean, 4.4; p < 0.05) and delaying clinical experiences (mean, 4.3; p < 0.05) were the most important deterrents (Cronbach's alpha, 0.505). Additionally, the financial investment required by the program is lower than that associated with hiring full-time faculty. Analysis comparing employment of Fellows versus associate-level faculty identified annual net savings of $370,000. Not only does the Fellowship augment faculty and student experiences at the university, but it also allows for substantial cost savings. Collectively, these data are evidence for other health professional institutions to consider adopting a similar program.

Achilles Allograft Fiber Track Graft Preparation Technique for Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament rupture is a common orthopaedic injury, with reconstruction the treatment of choice for active individuals. Graft selection is an important consideration for surgical planning. Achilles tendon allograft is a graft choice most likely used in cases of revision anterior cruciate ligament reconstruction. This technical note discusses an approach to Achilles tendon allograft preparation that respects and follows the rotation of the fibers of the Achilles tendon. Key considerations in the use of this technique include (1) identifying the rotational fiber tracks, (2) performing careful dissection along the identified tracks of the fibers, and (3) ensuring an appropriate graft width based on patient size, all of which are crucial for the success of this unique technique. The preservation of the rotational fibers provided by this technique may have the potential to result in increased tensile strength and better clinical outcomes.

Battle of the sections: Student outcomes and course feedback support combined prosection and dissection laboratory formats to maximize student success.

Gross anatomy laboratories frequently utilize dissection or prosection formats within medical curricula. Practical examination scores are consistent across the formats, yet these examinations assessed larger anatomical structures. In contrast, a single report noted improved scores when prosection was used in the hand and foot regions, areas that are more difficult to dissect. The incorporation of prosected donors within "Head and Neck" laboratories provided an opportunity to further characterize the impact of prosection in a structurally complex area. Retrospective analysis of 21 Head and Neck practical examination questions was completed to compare scores among cohorts that utilized dissection exclusively or incorporated prosection. Mean scores of practical examination questions were significantly higher in the prosection cohort (84.27% ± 12.69) as compared with the dissection cohort (75.59% ± 12.27) (p < 0.001). Of the 12 questions that performed better in the prosection cohort (88.42% ± 8.21), 10 items mapped to deeper anatomical regions. By comparison, eight of nine questions in the dissection cohort outperformed (88.44% ± 3.34) the prosection cohort (71.74% ± 18.11), and mapped to anatomically superficial regions. Despite the mean score increase with positional location of the questions, this effect was not statically significant across cohorts (p = 1.000), suggesting that structure accessibility in anatomically complex regions impacts performance. Student feedback cited structure preservation (71.5%) and time savings (55.8%) as advantages to prosection; however, dissection was the perceived superior and preferred laboratory format (88.6%). These data support combined prosection and dissection formats for improving student recognition of deeply positioned structures and maximizing student success.

Destination integration: linking physiology, histology, and embryology content in foundational sciences.

Anatomy and physiology are tightly linked disciplines that complement each other, however, in medical education delivery of this content is often siloed and divided. To address this, we created combined anatomy and physiology content for the female reproductive system, and team-taught designated histology and embryology topics integrated with the physiology content. Collectively, this created a more holistic incorporation of topics for student learning. Here we describe the format and approach for this teaching innovation.

Usage of Student-Created Anatomical Diagrams Shared on Social Media.

Social media (SoMe) is a resource for electronic materials in medical education, but has been particularly relevant for anatomy education due to the visual nature of the discipline. Although the distribution of expert/faculty-created anatomy content has been documented, the usefulness of novice/student-created content distributed via SoMe remains undetermined. To address this, original anatomical diagrams (n = 127) created by a novice educator were disseminated via the Anatomy Adventures Instagram account and evaluated for their usefulness. Audience engagement was evaluated using descriptive statistics, with a mean number of likes for all posts (n = 61) of 62.54 + 15.70. Statistically significant differences in the number of likes across content topics were assessed using a Kruskal-Wallis test (H(41.09) = 4, p < 0.005). An 11-item survey (10.6% response rate) explored the (1) population demographics, (2) diagram utility, and (3) suggestions for improvement. Responses were converted to percent frequencies and assessed with chi-square. Descriptive codes were applied to open-ended responses according to published methods. Of the 111 survey responses, 95% of participants were 18-30 years, with the majority of participants being medical students (69.3%), undergraduate/graduate students (16.2%), and fully employed (12.6%). Participants report using the diagrams to study for coursework or board examinations (54%), while non-medical use (42.4%) included leisure viewing or reviewing for their occupation. The usefulness of the diagrams was attributed to their (1) simplicity (43%), (2) style (24.6%), and (3) color-coding (12.3%) (p = 0.0025). These data indicate that Instagram may be utilized by novice educators to provide accurate and accessible resources. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01736-9.

Student perceptions of remote versus on-campus gross anatomy laboratories during COVID-19.

At Kansas City University, anatomy laboratories were delivered via remote (REM) or on-campus (OC) formats due to COVID-19, creating an opportunity to evaluate student perceptions of differences in laboratory delivery format. A six-item survey of Likert scale and open-ended questions explored the utility of anatomy software, prelab instruction handouts, and prosection reviews. Likert scale validity was analyzed using Cronbach's α; responses were compared among REM and OC formats using Chi-square. Descriptive codes were applied to summarize responses, which were grouped and converted into percentages. Statistically significant differences in REM versus OC formats were determined for the helpfulness of the prelab handouts (χ2 , 28.00; df, 4; p < 0.001) and effectiveness of cadavers in learning anatomy (χ2 , 20.58; df, 4; p < 0.0004). Trends in responses noted disagreement in the effectiveness of anatomy software (REM, 69.8%; OC, 51.08%), but agreement with the helpfulness of prosection reviews (REM, 85.9%; OC, 61.6%) (Cronbach α: REM, 0.648; OC, 0.646). Themes from narrative REM comments (n = 496) noted anatomy software was difficult to use (33.1%) and had issues with orientation (15.5%), as well as a student preference for OC laboratories (12.5%). The OC format responses (n = 456) noted poor software design (47.9%), unnecessary for studying (35.4%), and preference for in-person laboratories (7.4%). Qualitative analysis of narrative comments detailed other resources used, including Complete Anatomy™ and YouTube™. Trends highlighted the prelab handouts and prosection reviews for learning, the ineffectiveness of anatomy software, and a preference for OC laboratories. We highlight student perspectives of REM versus OC laboratory formats in response to COVID-19.

An analysis of anatomy education before and during Covid-19: August-December 2020.

Coronavirus disease-2019 (Covid-19) disrupted the in-person teaching format of anatomy. To study changes in gross anatomy education that occurred during August-December, 2020 compared to before the pandemic, an online survey was distributed to anatomy educators. The 191 responses received were analyzed in total and by academic program, geographic region, and institution type. Cadaver use decreased overall (before: 74.1 ± 34.1%, during: 50.3 ± 43.0%, P < 0.0001), as well as across allopathic and osteopathic medicine, therapy, undergraduate, and veterinary programs (P < 0.05), but remained unchanged for other programs (P > 0.05). Cadaver use decreased internationally and in the US (P < 0.0001), at public and private (P < 0.0001) institutions, and among allopathic medical programs in Northeastern, Central, and Southern (P < 0.05), but not Western, US geographical regions. Laboratories during Covid-19 were delivered through synchronous (59%), asynchronous (4%), or mixed (37%) formats (P < 0.0001) and utilized digital resources (47%), dissection (32%), and/or prosection (21%) (P < 0.0001). The practical laboratory examination persisted during Covid-19 (P = 0.419); however, the setting and materials shifted to computer-based (P < 0.0001) and image-based (P < 0.0001), respectively. In-person lecture decreased during Covid-19 (before: 88%, during: 24%, P = 0.003). When anatomy digital resources were categorized, dissection media, interactive software, and open-access content increased (P ≤ 0.008), with specific increases in BlueLink, Acland's Videos, and Complete Anatomy (P < 0.05). This study provided evidence of how gross anatomy educators continued to adapt their courses past the early stages of the pandemic.

A phenotype-driven ENU mutagenesis screen identifies novel alleles with functional roles in early mouse craniofacial development.

Proper craniofacial development begins during gastrulation and requires the coordinated integration of each germ layer tissue (ectoderm, mesoderm, and endoderm) and its derivatives in concert with the precise regulation of cell proliferation, migration, and differentiation. Neural crest cells, which are derived from ectoderm, are a migratory progenitor cell population that generates most of the cartilage, bone, and connective tissue of the head and face. Neural crest cell development is regulated by a combination of intrinsic cell autonomous signals acquired during their formation, balanced with extrinsic signals from tissues with which the neural crest cells interact during their migration and differentiation. Although craniofacial anomalies are typically attributed to defects in neural crest cell development, the cause may be intrinsic or extrinsic. Therefore, we performed a phenotype-driven ENU mutagenesis screen in mice with the aim of identifying novel alleles in an unbiased manner, that are critically required for early craniofacial development. Here we describe 10 new mutant lines, which exhibit phenotypes affecting frontonasal and pharyngeal arch patterning, neural and vascular development as well as sensory organ morphogenesis. Interestingly, our data imply that neural crest cells and endothelial cells may employ similar developmental programs and be interdependent during early embryogenesis, which collectively is critical for normal craniofacial morphogenesis. Furthermore our novel mutants that model human conditions such as exencephaly, craniorachischisis, DiGeorge, and Velocardiofacial sydnromes could be very useful in furthering our understanding of the complexities of specific human diseases.

An Analysis of Anatomy Education Before and During Covid-19: May-August 2020.

Coronavirus disease 2019 (Covid-19) created unparalleled challenges to anatomy education. Gross anatomy education has been particularly impacted given the traditional in-person format of didactic instruction and/or laboratory component(s). To assess the changes in gross anatomy lecture and laboratory instruction, assessment, and teaching resources utilized as a result of Covid-19, a survey was distributed to gross anatomy educators through professional associations and listservs. Of the 67 survey responses received for the May-August 2020 academic period, 84% were from United States (US) institutions, while 16% were internationally based. Respondents indicated that in-person lecture decreased during Covid-19 (before: 76%, during: 8%, P < 0.001) and use of cadaver materials declined (before: 76 ± 33%, during: 34 ± 43%, P < 0.001). The use of cadaver materials in laboratories decreased during Covid-19 across academic programs, stand-alone and integrated anatomy courses, and private and public institutions (P ≤ 0.004). Before Covid-19, cadaveric materials used in laboratories were greater among professional health programs relative to medical and undergraduate programs (P ≤ 0.03) and among stand-alone relative to integrated anatomy courses (P ≤ 0.03). Furthermore, computer-based assessment increased (P < 0.001) and assessment materials changed from cadaveric material to images (P < 0.03) during Covid-19, even though assessment structure was not different (P > 0.05). The use of digital teaching resources increased during Covid-19 (P < 0.001), with reports of increased use of in-house created content, BlueLink, and Complete Anatomy software (P < 0.05). While primarily representing US institutions, this study provided evidence of how anatomy educators adapted their courses, largely through virtual mediums, and modified laboratory protocols during the initial emergence of the Covid-19 pandemic.

The HistoHustle: Supplemental Histology Sessions to Enrich Student Learning and Self-Efficacy.

Anatomical education has minimal reports describing the creation and usage of supplemental resources for content review. The HistoHustle was developed to increase student engagement and retention of histology content in our curriculum. Qualitative feedback suggests that it has great benefit to student perception of their success and content integration.

Associations between Pregnane X Receptor and Breast Cancer Growth and Progression.

Pregnane X receptor (PXR, NR1I2) is a member of the ligand-activated nuclear receptor superfamily. This receptor is promiscuous in its activation profile and is responsive to a broad array of both endobiotic and xenobiotic ligands. PXR is involved in pivotal cellular detoxification processes to include the regulation of genes that encode key drug-metabolizing cytochrome-P450 enzymes, oxidative stress response, as well as enzymes that drive steroid and bile acid metabolism. While PXR clearly has important regulatory roles in the liver and gastrointestinal tract, this nuclear receptor also has biological functions in breast tissue. In this review, we highlight current knowledge of PXR's role in mammary tumor carcinogenesis. The elevated level of PXR expression in cancerous breast tissue suggests a likely interface between aberrant cell division and xeno-protection in cancer cells. Moreover, PXR itself exerts positive effect on the cell cycle, thereby predisposing tumor cells to unchecked proliferation. Activation of PXR also plays a key role in regulating apoptosis, as well as in acquired resistance to chemotherapeutic agents. The repressive role of PXR in regulating inflammatory mediators along with the existence of genetic polymorphisms within the sequence of the PXR gene may predispose individuals to developing breast cancer. Further investigations into the role that PXR plays in driving tumorigenesis are needed.