Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic Review.

Simulation training has become increasingly relevant in the educational curriculum of surgical trainees. The types of simulation models used, goals of simulation training, and an objective assessment of its utility and effectiveness are highly variable. The role and effectiveness of cadaveric simulation in cardiothoracic surgical training has not been well established. The objective of this study was to evaluate the current medical literature available on the utility and the effectiveness of cadaveric simulation in cardiothoracic surgical residency training. A literature search was performed using PubMed, Cochrane Library, Embase, Scopus, and CINAHL from inception to February 2019. Of the 362 citations obtained, 23 articles were identified and retrieved for full review, yielding ten eligible articles that were included for analysis. One additional study was identified and included in the analysis. Extraction of data from the selected articles was performed using predetermined data fields, including study design, study participants, simulation task, performance metrics, and costs. Most of these studies were only descriptive of a cadaveric or perfused cadaveric simulation model that could be used to augment clinical operative training in cardiothoracic surgery. There is a paucity of evidence in the literature that specifically evaluates the utility and the efficacy of cadavers in cardiothoracic surgery training. Of the few studies that have been published in the literature, cadaveric simulation does seem to have a role in cardiothoracic surgery training beyond simply learning basic skills. Additional research in this area is needed.

Kyphoplasty versus vertebroplasty to increase vertebral body height: a cadaveric study.

PURPOSE: To prospectively compare the vertebral height restoration achieved with kyphoplasty and vertebroplasty in fresh cadavers by using multi-detector row computed tomography (CT). MATERIALS AND METHODS: Institutional review board approval was not required because the donors had registered in and consented to an anatomic gift program prior to their death. Thirty-seven vertebrae were harvested from four donated cadavers of elderly female individuals (mean age, 82 years; age range at death, 73-87 years). The vertebrae were dissected free of the surrounding muscles and imaged with multi-detector row CT. Compression fractures were induced, and the vertebrae were again imaged. The vertebrae were randomized to be treated with kyphoplasty (n = 19) or vertebroplasty (n = 18) and were then imaged at multi-detector row CT. The anterior, central, and posterior vertebral body heights and wedge angles were measured in the midsagittal plane of the reformatted images. The amount of cement injected was determined by weighing the vertebrae before and after treatment. The statistical significance of changes in vertebral body height, wedge angle, and weight with the two treatment techniques was evaluated with the independent t test or Mann-Whitney U test. RESULTS: The increase in vertebral height was greater with kyphoplasty than with vertebroplasty (5.1 mm vs 2.3 mm, respectively; P < .05). The original vertebral height was restored in 93% of vertebrae with kyphoplasty and in 82% with vertebroplasty (P < .05). There was a greater decrease in wedge angle with kyphoplasty than with vertebroplasty (3.1 degrees vs 1.6 degrees, respectively); however, this difference was not significant (P > .05). There was no significant difference in the amount of cement injected with kyphoplasty and vertebroplasty (P > .05). CONCLUSION: Kyphoplasty increased vertebral body height more than vertebroplasty in this model of acutely created fractures in fresh cadaver specimens.

Pregnancy alters lateral parabrachial nucleus but not hypothalamic Fos expression following hypotensive hemorrhage.

The goal of these experiments was to determine if hemorrhage-induced Fos expression in the hypothalamus and lateral parabrachial nucleus (LPBN) is altered by reproductive cycle phase or pregnancy. Conscious unrestrained female Sprague-Dawley rats were subjected to a 16 ml/kg hemorrhage on the morning of the metestrus or proestrus phases of the estrous cycle, or on day 12-14 of pregnancy (mid-gestation). Hemorrhage induced a significant increase (p < 0.01) in the number of Fos-immunoreactive cell nuclei in the supraoptic nucleus, and in both the magnocellular and parvicellular components of the paraventricular hypothalamic nucleus, that did not differ between groups. In virgin females, hemorrhage also induced a significant increase in LPBN Fos expression that did not differ between metestrus and proestrus. In pregnant animals, there was an increase in basal LPBN Fos expression, but hemorrhage induced no further increase in the number of Fos-immunoreactive neurons in the LPBN. Mean arterial pressure decreased (p < 0.001) and plasma renin activity increased (p < 0.01) to a similar extent in all three groups after 16 ml/kg blood loss. In summary, the number of paraventricular and supraoptic nucleus neurons activated by hemorrhage is unaffected by estrous cycle phase or pregnancy. In contrast, pregnancy significantly attenuates the LPBN response to hemorrhage.