Medical Student Instruction in Peripheral Nerve Blockade Utilizing Fresh Cadaver Limbs in a Simulation Center.

Background: Ultrasound imaging is increasingly used in medical practice, but many institutions have room for growth regarding its incorporation into medical education. An elective hands-on course was developed for preclinical medical students using ultrasound to review and enhance their understanding of anatomy as well as to teach ultrasound-guided nerve blocks on cadaver extremities. The hypothesis was that after 3 instructional sessions students would be able to identify 6 anatomic structures, representing 3 types of tissue, in cadaver upper extremities. Methods: Students received didactic instruction on ultrasound and regional anatomy at the beginning of each class, followed by hands-on practice, including ultrasound use with phantom task trainers, live models, and fresh cadaver limbs. The primary outcome was the students' ability to correctly identify anatomic structures using ultrasound. Secondary outcomes included their ability to perform a simulated nerve block in the cadaver extremities in comparison with a standardized checklist, as well as their response to a post-course survey. Results: Overall, the students had a 91% success rate in identifying anatomic structures and showed capability of performing simulated nerve block with occasional instructor prompting. The post-course survey revealed that the students felt strongly that both the ultrasound and cadaveric components of the course were beneficial to their education. Conclusion: Ultrasound instruction with live models and fresh cadaver extremities in a medical student elective course resulted in a high degree of recognition of anatomic structures, as well as permitted a valued clinical correlation in the form of simulated peripheral nerve blockade.

Oncolytic HSV virotherapy in murine sarcomas differentially triggers an antitumor T-cell response in the absence of virus permissivity.

Multiple studies have indicated that in addition to direct oncolysis, virotherapy promotes an antitumor cytotoxic T cell response important for efficacy. To study this phenomenon further, we tested three syngeneic murine sarcoma models that displayed varied degrees of permissiveness to oncolytic herpes simplex virus replication and cytotoxicity in vitro, with the most permissive being comparable to some human sarcoma tumor lines. The in vivo antitumor effect ranged from no or modest response to complete tumor regression and protection from tumor rechallenge. The in vitro permissiveness to viral oncolysis was not predictive of the in vivo antitumor effect, as all three tumors showed intact interferon signaling and minimal permissiveness to virus in vivo. Tumor shrinkage was T-cell mediated with a tumor-specific antigen response required for maximal antitumor activity. Further analysis of the innate and adaptive immune microenvironment revealed potential correlates of susceptibility and resistance, including favorable and unfavorable cytokine profiles, differential composition of intratumoral myeloid cells, and baseline differences in tumor cell immunogenicity and tumor-infiltrating T-cell subsets. It is likely that a more complete understanding of the interplay between the immunologic immune microenvironment and virus infection will be necessary to fully leverage the antitumor effects of this therapeutic platform.