Anatomic Variation of Rami Communicantes in the Upper Thoracic Sympathetic Chain: A Human Cadaveric Study.

BACKGROUND: Hyperhidrosis is secondary to over activation of the sympathetic nervous system and surgical sympathectomy is the treatment of choice when other modalities have failed. This study investigated anatomic variation in the upper thoracic sympathetic chain and associated rami communicantes among cadaveric specimens. It considers the implications of these findings on surgical techniques to treat hyperhidrosis. METHODS: The upper 4 thoracic sympathetic ganglia, intercostal nerves, and connecting rami were dissected, measured and mapped in 40 sides of 20 adult human cadavers. Ganglia location was recorded. The incidence, orientation, and distance travelled by rami communicantes was compared across different ganglionic levels and between sides. RESULTS: The percentage of ganglia located below their associated intercostal space was 6.25% with stellate ganglions present in 70% of specimens and Kuntz fibers noted in 40%. There was a stepwise reduction in incidence of rami from superior to inferior placed ganglia. The number of rami identified across all levels was significantly greater on the right (P = 0.03). The horizontal distance between the sympathetic chain and union of the rami on the intercostal nerves was significantly greater on the right across all levels (P = 0.04). CONCLUSIONS: There was substantial variation in the rami communicantes across the upper 4 ganglia and between right and left sides. Consideration of this variation should be given when planning surgical sympathectomy for hyperhidrosis particularly to avoid symptom recurrence.

The intelligent anatomy spotter: A new approach to incorporate higher levels of Bloom's taxonomy.

The spotter test is an assessment that has been used widely to test practical knowledge of anatomy. Traditional spotter formats often focus solely on knowledge recall, in addition to being an onerous marking burden on staff where consistency in marking free text responses can be questioned. First-year optometry students at the University of Manchester study the functional anatomy of the eye in the first semester of their first year. Included in the assessment of this unit is a spotter examination worth 45% of the total unit mark. Due to the factors listed above, a new spotter format was designed. Students had to answer three questions per specimen where the answers to the questions were the labeled structures themselves (A, B, C, or D). They had to work out the answer to the question and then work out which of the labeled structures was the correct structure, negating the "cueing effect" of standard multiple choice questions. Examination results were analyzed over a six-year period (control groups 2008/2009, 2009/2010, 2010/2011; treatment groups 2011/2012, 2012/2013, 2013/2014). There were no significant differences between marks obtained for the new spotter format when compared with the traditional format. The new format spotter tested comprehension rather than just knowledge, and facilitated marking because subjectiveness was erased, and less time was spent determining whether an answer was correct or not. Anat Sci Educ 9: 440-445. © 2015 American Association of Anatomists.

The use of electronic media to develop transferable skills in science students studying anatomy.

Transferable skills such as team working, communication, information gathering, critical thinking, and peer assessment are essential for graduates seeking employment in the competitive jobs market. Use of online discussion boards have grown to allow students to communicate with each other at a time and location of their choosing. This study aimed to develop transferable skills using specially developed online components supported by discussion boards and chat rooms. Students enrolled in the Human Anatomy and Histology module at the University of Manchester were put into groups of six or seven students (26 groups in total). Two e-learning components were constructed to develop transferable skills. Each group had a discussion board and chat room available to assist communication in completion of the components. Peer marking was also done on this media. Data collected showed the discussion boards were heavily utilized (average number of posts per group was 48). Eighty-three percent of students found the discussion boards useful to complete the tasks. Students felt their team building and critical analysis skills had improved. Peer assessment was well received by students. Using online discussion boards proved an excellent way to develop transferable skills in a large group of science students.

Use of interactive sessions and e-learning in teaching anatomy to first-year optometry students.

Students enrolled in the Optometry program at the University of Manchester are required to take a functional anatomy course during the first year of their studies. Low mean scores in the written examination of this unit for the past two academic years energized staff to rethink the teaching format. Interactive sessions lasting 20 minutes each were introduced during the two hour lecture sessions. In these sessions students reinforced their anatomical knowledge learned in lectures, through playing games such as anatomy bingo and solving anatomical anagrams. In addition, five e-learning modules were also introduced for students to complete in their own time. A pre- and postcourse questionnaire were distributed to obtain student views on their expectations of the course and interactive sessions. Comparisons were made between written examination results from 2008 to 2009 to written examination results from the previous five academic years to see if the interactive sessions and e-learning modules had any impact on student knowledge. In addition, comparisons were made between student performances on the functional anatomy course with their performance in all of the other assessments taken by the students during their first year of study. Analysis of the questionnaires showed that student's expectations of the course were fulfilled and the interactive sessions were well received by the majority. There was a significant increase (P < or = 0.01) in the mean examination score in 2008-2009 after introduction of the interactive sessions and e-learning modules compared with scores in previous years. The introduction of interactive sessions has increased student enjoyment of the module and along with the e-learning modules have had a positive impact on student examination results.

A cross-cultural comparison of anatomy learning: learning styles and strategies.

Cultural influences on anatomy teaching and learning have been investigated by application of a questionnaire to medical students in British and Chinese Medical Schools. Results from the responses from students of the two countries were analyzed. Both groups found it easier to understand anatomy in a clinical context, and in both countries, student learning was driven by assessment. Curriculum design differences may have contributed to the British view wherein students were less likely to feel time pressure and enjoyed studying anatomy more than their Chinese counterparts. Different teaching approaches resulted in British students being more likely to recite definitions to learn, and the Chinese students found learning from cross-sectional images easy. Cultural differences may account for the observation that British students were more inclined to ask questions in class, and the preference of Chinese students to study in small groups. The findings give evidence to show how 'cultures of learning' influence students' approaches and indicate the importance of cultural influences as factors amongst international and home learner groups.

Staff and student perceptions of computer-assisted assessment for physiology practical classes.

Effective assessment of laboratory practicals is a challenge for large-size classes. To reduce the administrative burden of staff members without compromising the student learning experience, we utilized dedicated computer software for short-answer question assessment for nearly 300 students and compared it with the more traditional, paper-based method of assessment of the same student cohort. Students were generally favorably disposed toward computer-assisted assessment (CAA): 75% of the students responded that for future assignments, they either had no preference for the method of assessment or would prefer CAA. Advantages were perceived to be remote access to the questions and ease of submission. The most common disadvantage cited was lack of internet access. Various advantages of CAA were mentioned by staff members: notably, the reduction in marking time and reduction of paperwork as well as the potential for the software to detect plagiarism and to administer anonymous marking. Disadvantages to CAA were the need to tailor questions to the technology, having to adapt to reading answers and marking onscreen, and the quality of feedback to students. All of the disadvantages could be overcome by training and improved versions of CAA software, currently under development. The use of CAA has proved to be a welcome addition to the tools available to staff members for the assessment of practical classes, and future improved versions of the software will increase the utility of this assessment method.

Renal renin-angiotensin system activity in naturally reared and cross-fostered spontaneously hypertensive rats.

BACKGROUND: Young (4 week) spontaneously hypertensive rats (SHR) exhibit greater renal responses to angiotensin II (Ang II) than normotensive Wistar Kyoto (WKY) rats. SHR pups cross-fostering to a WKY dam at birth (SHRX) are less sensitive to Ang II and have lower adult blood pressure. The aim of this study was to compare renal renin-angiotensin system activity in young naturally reared and cross-fostered SHR pups. METHODS: SHR and WKY rats were reared either by their natural mothers or by a foster mother of the opposite strain. At 5, 10, and 15 days of age, renal tissue renin activity and Ang II concentration were measured by radioimmunoassay. Renin-secreting cells were identified by in situ hybridization and AT(1) receptor expression was compared using Western blots. Ang II-mediated cAMP generation was measured in isolated proximal tubules. CONCLUSIONS: Tissue renin activity and numbers of renin-secreting cells did not differ, but Ang II was higher in SHRX. The AT(1) receptor expression was significantly lower in SHRX compared with SHR. Basal and Ang II-stimulated cAMP was lower in SHR tubules compared with WKY and SHRX tubules.Cross-fostering reversed the increased renal sensitivity of the SHR to Ang II. These data suggest that renal AT(1) receptor expression can be manipulated during the postnatal period and that this may affect adult blood pressure.