A comparison of virtual reality anatomy models to prosections in station-based anatomy teaching.

Immersive virtual reality (i-VR) is a powerful tool that can be used to explore virtual models in three dimensions. It could therefore be a valuable tool to supplement anatomical teaching by providing opportunities to explore spatial anatomical relationships in a virtual environment. However, there is a lack of consensus in the literature as to its effectiveness as a teaching modality when compared to the use of cadaveric material. The aim of our study was to compare the effectiveness of i-VR in facilitating understanding of different anatomical regions when compared with cadaveric prosections for a cohort of first- and second-year undergraduate medical students. Students (n = 92) enrolled in the MBBS program at Queen Mary University of London undertook an assessment, answering questions using either Oculus i-VR headsets, the Human Anatomy VR™ application, or prosection materials. Utilizing ANOVA with Sidak's multiple comparison test, we found no significant difference between prosections and i-VR scores in the abdomen (p = 0.6745), upper limb (p = 0.8557), or lower limb groups (p = 0.9973), suggesting that i-VR may be a viable alternative to prosections in these regions. However, students scored significantly higher when using prosections when compared to i-VR for the thoracic region (p < 0.0001). This may be due to a greater need for visuospatial understanding of 3D relationships when viewing anatomical cavities, which is challenged by a virtual environment. Our study supports the use of i-VR in anatomical teaching but highlights that there is significant variation in the efficacy of this tool for the study of different anatomical regions.

Are foundation doctors equipped with the skills necessary for the assessment and referral of a patient presenting with a suspected facial skin malignancy?

BACKGROUND: The incidence of skin cancer (SC) has increased in recent years with it being the most common cancer within the UK. The management of SC requires a multidisciplinary approach involving dermatologists and surgical specialities. OBJECTIVES: To assess the confidence of current foundation trainees (FTs) in the assessment of facial SC and referral for surgical management and reconstruction. METHODS: An online survey was distributed via social media and completed by 142 FTs across 13 deaneries. Two higher training respondents were excluded. RESULTS: We found that 50% (71/142) of trainees had only examined one or two patients with SC and 25.3% (36/142) had no experience in SC assessment. Most FTs were not confident in performing a full skin examination (90.2%, 119/132), formulating differential diagnoses for a pigmented facial lesion (45.3%, 64/141) or investigating a facial SC (87.9%, 124/141). Facial defects requiring reconstruction (87.3%, 124/142) were more likely to be referred to plastic surgery. CONCLUSIONS: FTs were not confident in performing full skin examinations nor formulating diagnoses for pigmented lesions. This is concerning given that the majority of FTs will enter general practice and therefore exposure to SC will be common. This may in turn place greater burden on secondary care services such as dermatology and allied surgical specialities resulting in a greater caseload in an already stretched service in the UK. The integration of the British Association of Dermatology undergraduate syllabus into the medical school curriculum should improve confidence in the detection and management of SC at both undergraduate and postgraduate levels.

Multi-pedicled long fasciocutaneous free flaps in complex lower extremity reconstruction.

Fasciocutaneous free tissue transfer is an established limb salvage modality in lower extremity reconstruction. In severe cases, defect coverage is challenging due to the size and extent of the injury which may surpass the dimensions of most commonly utilized fasciocutaneous donor sites. This is further complicated by the considerable length between the recipient pedicle and most distal segment of the defect requiring coverage. Available donor sites that are able to provide free fasciocutaneous flaps extended length (>40 cm) are combinations between the lateral thoracic, lower abdomen/groin and lateral thigh regions. Advantages of this include a single donor site that can be closed primarily, the ability to utilize healthy vessels outside the zone of trauma/injury for microvascular anastomosis and single stage reconstruction. In addition, from a logistical perspective, single flap harvest would theoretically be more efficient and less resource intensive than harvesting two separate flaps or performing large skin grafts. Herein, we present current available donor sites that allow harvest of long fasciocutaneous free flaps incorporating multiple pedicles with a single skin paddle for lower extremity reconstruction.

Sub-toxic levels of Co2+ are anti-inflammatory and protect cartilage from degradation caused by IL-1ß.

BACKGROUND: Cobalt ions from some orthopaedic implants induce a dose-dependent cytotoxic and pro-inflammatory response. Recent studies show that sub-toxic levels of cobalt influence actin organisation regulating fibroblasts and macrophages behaviour. However little is known about the influence of sub-toxic levels of cobalt on articular cartilage biology and biomechanics. Previously, we have reported that IL-1ß signalling in chondrocytes, is regulated by primary cilia and associated intraflagellar transport. Since primary cilia expression is modulated by actin organisation, we set out to test the hypothesis that sub-toxic levels of cobalt regulate cilia expression and IL-1ß signalling thereby influencing articular cartilage degradation. METHODS: Isolated chondrocytes and bovine cartilage explants were subjected to Co2+ in the presence and absence of IL-1ß. Primary cilia were monitored by confocal immunofluorescence. Nitric oxide and PGE2 release were used to monitor IL-1ß signalling. Degradation of cartilage matrix was assessed by the release of sGAG and the biomechanical properties of the tissue in uniaxial unconfined compression. FINDINGS: Sub-toxic levels of Co2+ (50 µM) blocked IL-1ß-induced primary cilia elongation in isolated chondrocytes. This was associated with disruption of pro-inflammatory signalling in both isolated chondrocytes and cartilage explants, and inhibition of cartilage matrix degradation and loss of biomechanical properties. INTERPRETATION: This study reveals that low levels of cobalt ions are anti-inflammatory, preventing cartilage degradation in response to IL-1ß. This mechanism is associated with regulation of primary cilia elongation. These observations provide new insight into the potential beneficial role of cobalt and may lead to novel mechanisms for controlling cartilage inflammation.