Adaptaciones de la Enseñanza Anatómica Durante el COVID-19 en la Universidad Complutense de Madrid. Evaluación de los Estudiantes / Adaptations of Anatomical Teaching During COVID-19 at the University Complutense of Madrid. Evaluation by the Students

Las restricciones por la pandemia del COVID-19 supusieron la transición abrupta a una enseñanza online tanto del contenido teórico como práctico y de la evaluación final de las asignaturas que imparte el departamento en varias titulaciones. En previsión de que el siguiente curso académico 2020-21 se vería totalmente afectado, se desarrollaron una serie de materiales didácticos propios, como la elaboración de guiones de teoría y práctica que incorporaron imágenes de modelos anatómicos, prosecciones, anatomía radiológica y anatomía ecográfica. La percepción de esta innovación fue evaluada por los estudiantes a través de una encuesta en línea y sus respuestas mediante una escala tipo Likert. Participaron 346 estudiantes de las titulaciones de Fisioterapia (n= 66), Medicina (n= 169), Podología (n= 44) y Terapia Ocupacional (n= 67). Las puntuaciones medias más altas correspondieron a los estudiantes de Podología y Terapia Ocupacional, ambas presentaron diferencias significativas con los otros tres subgrupos de alumnos (p<.0001). El puntaje promedio más bajo correspondió a los estudiantes de Medicina de segundo año académico que presentó significancia con los otros cuatro subgrupos de estudiantes (p<.0001). Se analizaron las carencias del sistema educativo en la Universidad Complutense de Madrid reveladas por la pandemia del Covid19. Esta crisis ha puesto de manifiesto la necesidad de que los educadores médicos en general y los anatomistas en particular estén capacitados en el uso de la tecnología disponible y en la creación de sus propios materiales didácticos multimedia.

SUMMARY: Restrictions due to COVID-19 pandemic meant an abrupt transition to online teaching. This change affected teaching, practical sessions and assessments of the subjects taught by the department in various degrees. In anticipation that the following academic year 2020-21 would be totally affected, a series of didactic materials were therefor developed. These materials included the preparation of theory and practice scripts that incorporated images of anatomical models, pro-sections, radiological anatomy, and ultrasound anatomy. Perceptions by the students of these innovations were recorded through an online survey and their responses evaluated through a Likert-type scale. 346 students from Physiotherapy (n= 66), Medicine (n= 169), Podiatry (n= 44) and Occupational Therapy (n= 67) degrees participated. The highest average scores corresponded to the students of Podiatry and Occupational Therapy, both presented significant differences with the other three subgroups of students (p<.0001). The lowest average score corresponded to medical students in their second academic year, which presented significance with the other four subgroups of students (p<.0001). The shortcomings of the educational system of the Complutense University of Madrid that were highlighted by the COVID-19 pandemic were analyzed. This crisis underscored the need for medical educators in general, and anatomists in particular, to be trained in the use of available technology and to produce their own multimedia teaching materials.

Development of synovial membrane in the temporomandibular joint of the human fetus.

The development of the synovial membrane was analyzed in serial sections of 21 temporomandibular joints of human fetuses at 9 to 13 weeks of gestation. Sections of two fetuses at 12 weeks of development were used to perform immunohistochemical expression of the markers CD68 and Hsp27 on the synovial lining. Macrophage-like type A and fibroblast-like type B cells, which express CD68 and Hsp27, respectively, were observed at the twelfth week of development. Our results suggest that the development of the synovial membrane is related to the vascularization of the joint and the formation of the articular cavities.

Prevalence of fenestrated basilar artery with magnetic resonance angiography: a transversal study.

Fenestration of the basilar artery (BA) is a rare anatomical variation in comparison to those of the other intracranial arteries constituting the cerebral arterial circle. The incidence is difficult to ascertain and data vary according to type of series and modalities of detection. Basilar artery fenestration (BAF) has been reported in association with arteriovenous malformations, vascular variants, other developmental anomalies and neurovascular conflicts as a consequence of relations between the arterial branches of the BA and the nerves and other structures in the posterior cranial fossa. However, the real clinical interest of BAF is due to the possible formation of an aneurysm at the junction of the fenestrated segment and less frequently to the thrombosis of the vessels. With the aim to establish the prevalence of BAF in our population, we made a transversal pilot study of the first 200 MR angiographies performed on patients attending for the first time to control their base pathology (vascular or not). We have described three patients with this condition (representing a prevalence of 1.5 % on MR angiography) to shed additional light on this anomaly, two cases located at 1/3 proximal end (type 1-BAF) and one case located at joint 1/3 medium-1/3 distal end, locating distal to the anterior inferior cerebellar artery (type 4-BAF). In neither case was any other lesion found (i.e. aneurysm, infarctions, ischemia or thromboembolism). The pertinent clinical anatomy and embryological basis for this variation are reviewed, and the possible clinical implications and associated findings are discussed.

A case of a type II proatlantal artery with arteriovenous malformation.

We describe a 64-year-old woman evaluated with angiography a case of persistence of a proatlantal artery (type II) with an arteriovenous malformation associated to the posterior cerebral artery. This association has been reported once in the literature consulted. The proatlantal artery arises from external carotid artery, cranial to the origin of facial artery at the level of C4 vertebra, anteromedial to the internal carotid artery, laying on it during its course cranial, lateral and posterior. After making a loop at the level of the transverse process of C3 vertebra, it enters into the transverse foramen of C3 vertebra and continuing its course, through the transverse foramen of C2 and C1 vertebra, as vertebral artery. Winds behind the superior articular process of the atlas enters the skull through the foramen magnum and, at the lower border of the pons, joins with the vessel of the opposite side to form the basilar artery. The internal carotid artery is normal. This variation is associated with congenital arteriovenous malformations that represent the persistence of an embryonic pattern of congenital vessels.

Morgagni-Larrey parasternal diaphragmatic hernia in the adult.

With a prevalence of 0.3-0.5/1000 births, congenital diaphragmatic hernia (CDH) remains a serious, poorly understood abnormality with a high mortality rate that cannot always be effectively managed. Its reported frequency in Spain is 0.69%00 with a yearly decreasing trend of 0.10%00 during the period 1980-2006. Up to 5% of cases are incidentally identified in adults undergoing studies for other reasons.We report the case of a 74-year-old woman with vomiting for three months due to parasternal diaphragmatic hernia of Morgagni-Larrey (retrochondrosternal, retrocostoxyphoid, retrosternal, subcostal, substernal or subcostosternal hernia), which allowed us to report an update on this condition in the adult, and on thoracoabdominal diaphragm morphogenesis. It is in the embryology of the diaphragm where an explanation may be found for some morphological changes and clinical manifestations, even though a number of uncertainties remain. We also analyze the extent of controversy persisting on some aspects of surgical treatment (access routes, mesh use, hernial sac reduction). Overall, minimally invasive techniques predominate. We consider laparoscopy the approach of choice for adult patients with parasternal hernia eligible for surgery.

Hernia diafragmática paraesternal de Morgagni-Larrey en adulto / Morgagni-Larrey parasternal diaphragmatic hernia in the adult

Con una prevalencia de 0,3-0,5/1.000 nacimientos, la hernia diafragmática congénita (HDC) sigue siendo una anomalía grave, no bien entendida, alta mortalidad y tratamiento no siempre efectivo. En España se ha informado de una frecuencia del 0,69%oo con una tendencia decreciente en el periodo 1980-2006 del 0,10%oo por año. No obstante, hasta un 5% se diagnostican en adultos durante la realización de un reconocimiento por otra causa. Presentamos un cuadro de vómitos de tres meses de evolución en una mujer de 74 años por hernia diafragmática paraesternal de Morgagni-Larrey (retrocondroesternal, retrocostoxifoidea, retroesternal, subcostal, subesternal o subcostoesternal), que nos ha permitido realizar una actualización de esta patología en adultos y de la morfogénesis del diafragma toracoabdominal. Es en la embriología del diafragma donde encontramos explicación de algunas de sus alteraciones morfológicas y características clínicas, si bien persisten aspectos confusos de la misma. También analizamos el grado de controversia que persiste en algunos aspectos de su tratamiento quirúrgico (vías de acceso, uso o no de mallas y reducción o no del saco herniario). Por lo general priman las técnicas mínimamente invasivas. Consideramos el abordaje laparoscópico como de elección en pacientes adultos con hernia paraesternal candidatos a la cirugía(AU)

With a prevalence of 0.3-0.5/1000 births, congenital diaphragmatic hernia (CDH) remains a serious, poorly understood abnormality with a high mortality rate that cannot always be effectively managed. Its reported frequency in Spain is 0.69%oo with a yearly decreasing trend of 0.10%oo during the period 1980-2006. Up to 5% of cases are incidentally identified in adults undergoing studies for other reasons. We report the case of a 74-year-old woman with vomiting for three months due to parasternal diaphragmatic hernia of Morgagni-Larrey (retrochondrosternal, retrocostoxyphoid, retrosternal, subcostal, substernal or subcostosternal hernia), which allowed us to report an update on this condition in the adult, and on thoracoabdominal diaphragm morphogenesis. It is in the embryology of the diaphragm where an explanation may be found for some morphological changes and clinical manifestations, even though a number of uncertainties remain. We also analyze the extent of controversy persisting on some aspects of surgical treatment (access routes, mesh use, hernial sac reduction). Overall, minimally invasive techniques predominate. We consider laparoscopy the approach of choice for adult patients with parasternal hernia eligible for surgery(AU)

Adquisición de competencias transversales en alumnos de pregrado de Ciencias de la Salud en la Universidad Complutense: una experiencia positiva / Acquisition of general skills in undergraduate students in Health Sciences in the Complutense University: a positive experience

Introducción. Presentamos los resultados de la evaluación de las Jornadas Complutenses de Investigación para alumnos de pregrado en Ciencias de la Salud, una actividad académica con dos años de experiencia y una participación de 1.434 alumnos, creada en nuestra universidad para impulsar en los alumnos de pregrado habilidades comunicativas y de metodología en investigación. Sujetos y métodos. Mediante una encuesta anónima se evaluó en los alumnos el grado de satisfacción e interés(aprender metodología científica, aprender a hablar en público, etc.) y también en los moderadores de mesas(originalidad, planteamiento metodológico, presentación iconográfica, exposición oral, viabilidad y relevancia de las comunicaciones presentadas). Resultados. En las I Jornadas se inscribieron 500 alumnos, todos de la Universidad Complutense de Madrid (UCM), y se presentaron un total de 169 comunicaciones (129 orales, 40 pósters). En las II Jornadas lo hicieron 934 alumnos, 838 de la UCM y 96 de otras nueve universidades, y se presentaron un total de286 comunicaciones (180 orales, 106 pósteres). Conclusiones. Es una actividad en la que el alumno pasa a ser un gestor activo y difusor de aprendizaje, y potencia de una manera dinámica habilidades en comunicación científica. También tiene beneficios para el profesorado y la institución universitaria, que la convierten en una ‘terapia pedagógica holística’ (AU)

Introduction. We present here the results of the appraisal of the Complutense Conference on Research for undergraduate students in Health Sciences, an academic activity which has been running for two years, with the participation of 1,434students. It was set up in this University to encourage communication skills and research methodology among undergraduate students. Subjects and methods. By means of an anonymous survey, the levels of satisfaction and interest of the students were evaluated (learning scientific methodology, learning to speak in public, etc.); similarly, that of the panel moderators (originality, methodological approach, iconographic presentation, oral presentation, viability and relevance of presentations given). Results. The First Conference had 500 registered students, all from the Complutense University of Madrid (UCM), with a total of 169 presentations(129 oral, 40 poster). In the Second Conference there were934 students, 838 from the UCM and 96 from nine other universities, with a total of 286 presentations (180 oral, poster106). Conclusions. This is an activity in which the student becomes an active manager and imparter of learning, and dynamically reinforces his or her skills in science communication. It also has benefits for teachers and the University itself, making it a ‘holistic pedagogical therapy’ (AU)

Embryonic cardiac morphometry in Carnegie stages 15-23, from the Complutense University of Madrid Institute of Embryology Human Embryo Collection.

AIMS: We performed a morphometric study of cardiac development on human embryos to complement the scarce data on human embryonic cardiac morphometry and to attempt to establish, from these, algorithms describing cardiac growth during the second month of gestation. METHODS: Thirty human embryos from Carnegie stages 15-23 were included in the study. Shrinkage and compression effects from fixation and inclusion in paraffin were considered in our calculations. RESULTS: Growth of the cardiac (whole heart) volume and volume of ventricular myocardium through the Carnegie stages were analysed by ANOVA. Linear correlation was used to describe the relationship between the ventricular myocardium and cardiac volumes. Comparisons of models were carried out through the R2 statistic. The relationship volume of ventricular myocardium versus cardiac volume is expressed by the equation: cardiac volume = 0.6266 + 2.4778 volume of ventricular myocardium. The relationship cardiac volume versus crown-rump length is expressed by the equation: cardiac volume = 1.3 e(0.126 CR length), where e is the base of natural logarithms. CONCLUSION: At a clinical level, these results can contribute towards the establishment of a normogram for cardiac development, useful for the design of strategies for early diagnosis of congenital heart disease. They can also help in the study of embryogenesis, for example in the discussion of ventricular trabeculation.

Estudio atraumático de la actividad simpática, sensibilidad de los baroreceptores y del volumen sistólico, decúbito y ortostatismo en sujetos sanos, maniobra de Valsalva. Para su aplicación en el estudio del síncope. Posibilidades de indicación terapéuticas / Non invasive assesment of sympathetic activity, baroreflex sensitivity and stroke volume in orthostatic and supine positions as well as after Valsalva´s maneuver to be used in the study of syncope and it´s therapeutic application

La hipotensión ortostática(HO) ha sido estudiada escasamente de forma atraumática. Valoramos el índice de actividad simpática(IAS), la sensibilidad de los baroreceptores( SBR) por análisis espectral. Registro continuo de la presión arterial(PA)(finapres). Resistencias periféricas totales(RPT) y del volumen sistólico(VS) con cardiografía con impedancia. Hemos realizado dos estudios, Tipo I: en 24 sujetos sanos, con ortostatismo(O) vs supino: IAS aumenta de 0,601 + 0,10 a 2,214 + 0,43 U(p<0,001) y la SBR disminuye de 17,72 + 2,28 vs 7,83 + 0,75 mseg/mmHg(p<0,05). Estudio II 14 sanos: Supino presentan PA:127,46± 3,52/80,38 ± 1,54mmHg,pulso: 68,52 ±2,10 lpm,VS/m2: 40,92± 4,50 ml/m2,RPT/m2: 0,71± 0,16mmHg/ml/m2. En O el descensomáximo de la PA -33,39± 6,20 / -15,95± 3,66 mmHg(p< 0,001). Las cifras medias a los 5´O vs supino PAM:95,95± 4,05 mmHg(ns),pulso: 75,60 ±3,06 lpm(ns),VS/m2:30,05 ±2,24 ml/m2(ns), RPT/m2: 0,92± 0,10mmHg/ml/m2(ns). Con el Test.Valsalva. basal vs F.II_E condescenso de PA:- 25,86± 5,19 / 8,72 ±3,42 mmHg(p<0,001) y de VS/m2: -19,95± ,67ml (p<0,05),aumento de pulso:9,36± 2,70 lpm(p<0,05), índice baroreflejo cardiaco r= -0,87(p<0,01) Estos datos facilitan posteriores estudios de pacientes con síncope,siendo un método incruento. Se ha empleado análisis estadístico pareado no paramétrico Wilcoxon y prueba deNewman-Keuls entre grupos

There is little knowledge in the field of orthostatic hypotension (OH) based on non invasive procedures. Sympathetic activity index (SAI), baroreflex sensitivity (BRS) were measured by spectral analysis. Blood preasure (BP) by continuous recording with Finapres. Lastly, Total peripheral resistances (TPR) and systolic stroke volume (SV) by impedance cardiography. Two protocols were performed, I: 24 healthy volunteers in orthostatic position vs supine: SAI increases 0,601 + 0,10 a 2,214 + 0,43 U(p<0,001). In addition, BRS decreases in supine 17,72 + 2,28 vs 7,83 + 0,75 ms/mmHg(p<0,05). Protocol II,14 healthy volunteers were included: variables in supinewere: BP::127,46± 3,52/80,38 ± 1,54mmHg, Heart rate(HR):68,52 ±2,10 bpm, SV/m2: 40,92± 4,50 ml/m2,TPR/m2: 0,71± 0,16mmHg/ml/m2. Maximum drop in BPorthostatic position -33,39± 6,20 / -15,95± 3,66mmHg (p< 0,001). Mean variables after 5 minutes in orthostatic position vs supine were: MAP: 95,95± 4,05mmHg(ns), HR: 75,60 ±3,06 bpm(ns),SV/m2:30,05±2,24 ml/m2(ns), TPR/m2: 0,92± 0,10 mmHg/ml/m2(ns). After Valsalva´s maneuver: baseline vs F.II_E BP diminishes:- 25,86± 5,19 / 8,72 ±3,42 mmHg(p<0,001) as well as SV/m2: -19,95± ,67ml (p<0,05), HR increases: 9,36± 2,70 bpm(p<0,05), baroreflex cardiac index r= -0,87(p<0,01). Statistics were calculate by paired non parametric Wilcoxon and Newman- Keuls tests in between groups. These results will help, as reference, to study those patients with syncope, by means of non invasive methods (AU)

Epidemiología de las malformaciones congénitas y de sus factores de riesgo / Epidemiology of congenital malformations and their risk factors

Las malformaciones congénitas son importantestanto por su prevalencia como por la mortalidad infantily la minusvalía que, gran parte de ellas, ocasionan.Si bien al estudiar la evolución temporal de la mortalidady prevalencia, en nuestro país, ha descendido,hay que considerar que desde que se aprobó la Ley9/1985 la Interrupción Voluntaria del Embarazo es legal.Al estudiar sus factores de riesgo, se considerahabitualmente 4 grupos etiológicos: de causa desconocida,genéticos, ambientales y multifactoriales (enlos que hay interacción entre los factores genéticos yambientales). En nuestro país, las embriofetopatíasmás frecuentes son las producidas por estas dos últimascausas, la alcohólica y las derivadas de la diabetescrónica y la terapia antiepiléptica, hecho a considerarpor la posibilidad de actuación frente a ellas. Enesta revisión, se habla también de los diferentes factoresde riesgo relacionados con estos procesos; finalmente,se trata sobre la prevención primaria de losdefectos del cierre del tubo neural mediante el consumo,previo a la concepción, de ácido fólico, y la controversiagenerada al respecto

Congenital malformations are important not onlybecause of their prevalence, but for the infantilemortality and the disability that most of them cause.The study of the temporary evolution of mortalityand prevalence in Spain shows a decrease of thesefacts; however, we should consider the possibleinfluence that the prevailing law 9/1985 about thevoluntary interruption of the pregnancy may havecaused on these figures .When studying the riskfactors of congenital malformations, four etiologicalgroups are usually taken into consideration: unknowncause, genetic cause, environmental causeand multifactorial cause (in which there is an interactionbetween genetic and environmental factors).On the other hand, the most frequent embryopathiesin Spain are caused by the alcohol, thechronic diabetes and anticonvulsant drugs. Thesefactors facilitate a preventive action against thesediseases. This review talks about the different riskfactors related to these processes. Finally, the textdeals with the primary prevention of the neural tubedefects by the folic acid supplementation, previousto the conception, and the controversy generatedby this fact

Left musculus sternalis.

During routine dissection in the Morphological Sciences Department II of the Universidad Complutense de Madrid, the presence of a sternalis muscle was observed in the left hemithorax of a 70-year-old male cadaver. We report on its position, relationships, and innervation, as well as its clinical relevance, indicating some guidelines for its physical examination. We also present a brief overview of the existing literature regarding the nomenclature, historical reports, and incidence of this muscle.

Cardiac developmental onomatology: the real heart of the matter.

There has been much controversy regarding Cardiac Embryology since the 19th Century; this has brought up contradictions over many studies on Cardiac Development, and stems mainly from semantic differences rather than from scientific observations. In 1998, FCAT published the 1st Edition of Terminologia Anatomica, which did not include Terminologia Embryologica, and to this day, we do not have a thorough compilation of Terminology related to Cardiac Development (O'Rahilly and Müller 1996). In the present study we have reviewed the literature from the 19th and 20th Centuries gathering the terms proposed by those scientists who influenced Prenatal Cardiac Terminology. Our aim is to bring to the attention of clinicians and researchers of cardiac morphogenesis the need to undertake a reform of the Developmental Cardiac Terminology. We believe an International Consensus on the terminology to be used during the developmental stages is urgent; it should be meaningful both to the experimental embryologist and to the cardiologist, without being ambiguous or controversial. We must not forget that a terminology is of value only when it is properly used.

Anatomic relationships of the orbital muscle of Müller in human fetuses.

A study was carried out in twenty human fetuses on the relationships of the orbital muscle of Müller. This muscle forms a lamina of smooth muscle fibres that cover the inferior orbital fissure. The latter is very wide during the fetal period because ossification of the bones that delimit this region is still incomplete. Some fibres of the orbital muscle extend along the superior orbital fissure under the inferior ophthalmic vein and the lower wall or floor of the cavernous sinus. This association suggests a possible influence on autonomically mediated vascular dynamics.

A duplicated Meckel's cartilage in a human fetus.

An exceptional case of a duplicate Meckel's cartilage in a human fetus, with a C-R length of 57 mm, is studied. Another small cartilage, isolated from Meckel's, of rounded morphology, was observed in a small region between the temporomandibular joint and the middle ear. This cartilage was only present on the right side.

A computerised technique for morphometry and 3D reconstruction of embryological structures.

In the last decade we have witnessed the development of software technology capable of image analysis and morphometry [1, 8-12]. Although these methods are sometimes difficult to master in a practical sense, they are tremendously efficient and precise when applied to the study and measurement of developing biological structures, particularly in the field of embryology. In this study we describe the application on human embryos of an image analyzing system that enables one to perform quantitative analyses of the morphology and size of developing organs and structures as well as their ultimate three-dimensional reconstruction (3DR).