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.

The juxta-oral organ of Chievitz (organum yuxtaorale) updated: Embryology, anatomy, function and pathology.

BACKGROUND: The Chievitz's organ or juxta-oral organ is a mysterious bilateral structure, phylogenetically preserved, which develops from the mouth epithelium as an invagination that loses connection to it in the prenatal period. It is located laterally to the walls of the oral cavity in an imprecise anatomical location and receives abundant innervation from the buccal nerve. Structurally it consists of non-keratinizing squamous-like neuroepithelial cells surrounded by two layers of connective tissue with nerve fibers and different morphotypes of sensory corpuscles. Its function is completely unknown although based on its rich innervation it is assumed that works as a mechanoreceptor. METHODS: We have performed immunohistochemistry for axonal and Schwann cells, and the putative mechanoproteins ASIC2, TRPV4 and Piezo2 in sections of fetal juxta-oral organ. RESULTS: Intraparenchymatous nerve fibers and sensory corpuscles were observed as well as immunoreactivity for Piezo2 in both nerve fibers and epithelial parenchymatous cells. CONCLUSIONS: We add indirect evidence that the juxtaoral organ is a mechanoreceptor because in addition to its dense innervation, the epithelial cells and sensory nerve fibers display immunoreactivity for the mechanogated ion channel Piezo2. Based on current knowledge, the functional and clinical importance of the juxta-oral organ should be further investigated.

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.

Development of the ciliary body: morphological changes in the distal portion of the optic cup in the human.

This study seeks to determine the main events that occur in the development of the ciliary body (CB) in the 5-14th week of development. The CB develops from the distal portion of the optic cup (OC) and the neighboring mesenchyme. During the 5th week of development, 4 zones were observed in the distal portion of the OC: in zone 1, the epithelia of the outer and inner layers of the OC came into contact. This contact coincided with the appearance of mainly apical granule pigments. This zone corresponded to the anlage of the epithelial layers of the CB. In zone 2, the cells surrounded the marginal sinus and contained scarce pigment granules and nuclei in the basal position. This zone corresponded to the anlage of the iris. Zone 3 was triangular in shape and its vertex ran towards the marginal sinus and corresponded to common cell progenitors. Zone 4 corresponded to the retinal pigment epithelium anlage and the neural retina anlage. We determined the onset of the stroma and the ciliary muscle anlage at the end of the 7th week. In the 13-14th week, we observed the anlage of the orbicularis ciliaris (pars plana of the CB) and corona ciliaris (pars plicata of the CB), in addition to the anlage of the ciliary muscle. Our study, therefore, establishes a precise timetable of the development of the CB.

Development of the platysma muscle and the superficial musculoaponeurotic system (human specimens at 8-17 weeks of development).

There is controversy regarding the description of the different regions of the face of the superficial musculoaponeurotic system (SMAS) and its relationship with the superficial mimetic muscles. The purpose of this study is to analyze the development of the platysma muscle and the SMAS in human specimens at 8-17 weeks of development using an optical microscope. Furthermore, we propose to study the relationship of the anlage of the SMAS and the neighbouring superficial mimetic muscles. The facial musculature derives from the mesenchyme of the second arch and migrates towards the different regions of the face while forming premuscular laminae. During the 8th week of development, the cervical, infraorbital, mandibular, and temporal laminae are observed to be on the same plane. The platysma muscle derives from the cervical lamina and its mandibular extension enclosing the lower part of the parotid region and the cheek, while the SMAS derives from the upper region. During the period of development analyzed in this study, we have observed no continuity between the anlage of the SMAS and that of the superficial layer of the temporal fascia and the zygomaticus major muscle. Nor have we observed any structure similar to the SMAS in the labial region.

Development of the human tensor veli palatini: specimens measuring 13.6-137 mm greatest length; weeks 6-16 of development.

The present study seeks to determine the main events that occur in the development of the tensor veli palatini (TVP). A light microscope was used on serial sections of 60 human specimens from weeks 6 to 16 of development. The TVP becomes visible in an embryo of 14.5 mm greatest length (GL; week 6) from a common blastema with the medial pterygoid muscle. In embryos of Carnegie stage 20 (week 7), the TVP is differentiated and relates to the anlage of the pterygoid hamulus. At week 8 of development, when the palatal shelves become horizontal, the presence of the anlage of the palatine aponeurosisis distinguished and is reached by the TPV. In an embryo of 30 mm GL, the chondrification nucleus of the pterygoid hamulus and the synovial bursa of the TVP are identifiable. At week 9, the TVP is continuous with the palatine aponeurosis. At week 13, a connective tissue lamina appears between the TVP and the intramembranous ossification center for the anterior process of the malleus, which we know as the goniale and interpret as an attachment of the muscle to the primary vertebrate jaw or incudomalleal joint. The TVP from its origin, innervation and relation to the goniale appears to be a muscle of mastication that, at the end of the embryonic period, reaches the palatine aponeurosis anlage and the mesenchyme of the auditory tube and specializes in the movements of the soft palate and the auditory tube.

Histological study of the extratympanic portion of the discomallear ligament in adult humans: a functional hypothesis.

This study was carried out on histological aspects of the extratympanic portion of the discomallear ligament (DL) in adult humans. The temporomandibular joint (TMJ) was dissected bilaterally in 20 cadavers; in 15 cases the articular disc (AD) and the retroarticular tissue were extirpated. The extratympanic portion of the DL had the shape of a base-down triangle, in relation to the AD, and an upper vertex, in relation to the petrotympanic fissure. In five cases, the base, measured bilaterally, had an average length of 6.4 mm, while the distance from the base to the upper vertex averaged 9.3 mm in length. The extratypanic portion of the DL is an intrinsic ligament of the TMJ, composed of collagen fibres and abundant elastic fibres. We propose that this ligament could act as a tensor of the synovial membrane in movements of the TMJ.

Immunohistochemical expression of types I and III collagen antibodies in the temporomandibular joint disc of human foetuses.

The objective was to study the morphology of the articular disc and analyse the immunohistochemical expression of types I and III collagen markers in the temporomandibular joint (TMJ) disc of human foetuses of different gestational ages. Twenty TMJ from human foetuses supplied by Universidade Federal de Uberaba with gestational ages from 17 to 24 weeks were studied. The gestational age of the foetuses was determined by measuring the crown-rump (CR) length. Macroscopically, the foetuses were fixed in 10% formalin solution and dissected by removing the skin and subcutaneous tissue and exposing the deep structures. Immunohistochemical markers of type I and III were used to characterize the existence of collagen fibres. Analysis of the immunohistochemical markers of types I and III collagen revealed the presence of heterotypical fibril networks.

Incidence and development of the human supracochlear cartilage.

The supracochlear cartilage is known as an accessory cartilage of the chondrocranium situated between the otic capsule and the trigeminal ganglion. Although claimed to appear regularly during human development, its incidence and development have been reported only scarcely in the literature. The aim of this study was to describe the position and relationships of the supracochlear cartilage during its development. This study was made in 96 human specimens of 7-17 weeks of development, belonging to a collection of the Embryology Institute of Complutense University of Madrid. In addition, three-dimensional reconstruction of the supracochlear cartilage was made from 1 specimen. This cartilage, spherical in shape, appeared bilaterally in 23 specimens and unilaterally (left side) in 5. In our results, the supracochlear cartilage was found in 26.5% of the cases and was related to the trigeminal ganglion, the dura mater of the trigeminal cavity and the otic capsule. In 4 specimens, bilaterally, the supracochlear cartilage was continuous with the otic capsule. This work suggests that, based on the structures to which the supracochlear cartilage is related, it could be derived from the cranial neural crest.

Development of the stapedius muscle and unilateral agenesia of the tendon of the stapedius muscle in a human fetus.

The objective was to analyze the development of the stapedius muscle to understand an isolated unilateral absence of the tendon of the stapedius muscle in a human fetus. The study was made on 50 human embryos and fetuses aged 38 days to 17 weeks post-conception. The stapedius muscle was formed by two anlagen, one for the tendon, which derives from the internal segment of the interhyale and another for the belly, located in the second pharyngeal arch, medially to the facial nerve and near the interhyale. In the interhyale, two segments were observed forming an angle and delimited by the attachment of the belly of the stapedius muscle. The internal segment will form the tendon. The lateral segment of the interhyale was attached to the cranial end of the Reichert's cartilage (laterohyale), and normally it disappears at the beginning of the fetal period. The right unilateral agenesia of the tendon of the stapedius muscle, observed for the first time in a human fetus of 14 weeks post-conception development (PCd), was brought about by the lack of formation or the regression of the internal segment of the interhyale. It presented a belly of the stapedius muscle with an anomalous arrangement, and with a pseudo tendon originated by the persistence of the external segment of the interhyale.

Embryonic anastomosis between hypoglossal nerves.

This article presents two cases of anastomosis of hypoglossal nerves in the suprahyoid region in human embryos of CR length 10.75 and 17.5 mm. This variation was studied in two human specimens at this stage of development and compared with the normal arrangement of the hypoglossal nerves in embryos at the same stage. The anastomotic branches were of similar caliber to the main trunks. In both cases the anastomosis was located dorsal to the origin of the geniohyoid muscles and caudal to the genioglossus muscles, lying transversally over the cranial face of the body of the hyoid bone anlage. The anastomosis formed a suprahyoid nerve chiasm on the midline in the embryo of 10.75 mm CR length.

Anatomical relationships of the cleidoatlanticus muscle. Interpretation about its origin.

An unusual muscular variation, the cleidoatlanticus muscle, was observed on the right-hand side of the lateral cervical region. The upper third of the muscle was concealed by the sternocleidomastoid muscle. There was a loop of nerves surrounding the muscle, formed by an anastomosis between the transverse cervical nerve and the greater auricular nerve. A fine vascular-nervous pedicle (formed by a small branch from the transverse cervical artery and by a branch from the medial supraclavicular nerve) entered the deep surface of the muscle at the junction of its middle and lower thirds. Taking into account the relationships that presented with the superficial branches of the cervical plexus, we consider that the cleidoatlanticus muscle is derived from the sternocleidomastoid muscle.

Development of the mandibular condylar cartilage in human specimens of 10-15 weeks' gestation.

This study analyses some morphological and histological aspects that could have a role in the development of the condylar cartilage (CC). The specimens used were serial sections from 49 human fetuses aged 10-15 weeks. In addition, 3D reconstructions of the mandibular ramus and the CC were made from four specimens. During weeks 10-11 of development, the vascular canals (VC) appear in the CC and the intramembranous ossification process begins. At the same time, in the medial region of the CC, chondroclasts appear adjacent to the vascular invasion and to the cartilage destruction. During weeks 12-13 of development, the deepest portion of the posterolateral vascular canal is completely surrounded by the hypertrophic chondrocytes. The latter emerge with an irregular layout. During week 15 of development, the endochondral ossification of the CC begins. Our results suggest that the situation of the chondroclasts, the posterolateral vascular canal and the irregular arrangement of the hypertrophic chondrocytes may play a notable role in the development of the CC.

Morphogenesis of the human excretory lacrimal system.

The aim of this study was to determine the principal developmental stages in the formation of the excretory lacrimal system in humans and to establish its morphogenetic period. The study was performed using light microscopy on serial sections of 51 human specimens: 33 embryos and 18 fetuses ranging from 8 to 137 mm crown-rump length (CR; 5-16 weeks of development). Three stages were identified in the morphogenesis of the excretory lacrimal system: (1) the formative stage of the lacrimal lamina (Carnegie stages 16-18); (2) the formative stage of the lacrimal cord (Carnegie stages 19-23); and (3) the maturative stage of the excretory lacrimal system, from the 9th week of development onward. A three-dimensional reconstruction of the excretory lacrimal system was performed from serial sections of an embryo at the end of the embryonic period (27 mm CR).

Origin of the styloglossus muscle in the human fetus.

The origin of the styloglossus muscle was histologically studied bilaterally in nine human fetuses (18 sides). In all cases, the muscle originated in Reichert's cartilage, which gives rise to the temporal styloid process. We identified three types of variation: type A, an accessory muscle fascicle originating from the mandibular angle, found in 7 cases (12 sides); type B, where the styloglossus muscle was attached to the mandibular angle by fibrous tracts, found in three cases (4 sides); and type C, where an accessory muscle fascicle arose from the fibrous tract connecting Reichert's cartilage to the mandibular angle; found in one case. In all cases (2 sides), the styloglossus muscle was innervated by the hypoglossal nerve. Relationships between the styloglossus muscle and vasculonervous elements of the prestyloid and retrostyloid spaces were analysed.

Morphogenesis of the second pharyngeal arch cartilage (Reichert's cartilage) in human embryos.

This study was performed on 50 human embryos and fetuses between 7 and 17 weeks of development. Reichert's cartilage is formed in the second pharyngeal arch in two segments. The longer cranial or styloid segment is continuous with the otic capsule; its inferior end is angulated and is situated very close to the oropharynx. The smaller caudal segment is in contact with the body and greater horn of the hyoid cartilaginous structure. No cartilage forms between these segments. The persistent angulation of the inferior end of the cranial or styloid segment of Reichert's cartilage and its important neurovascular relationships may help explain the symptomatology of Eagle's syndrome.

Immunocytochemical developmental patterns of the thoracolumbar sympathetic chain in the chick and a comparison with its adrenal counterpart.

The immunocytochemical development of the thoracolumbar sympathetic ganglion and its adrenal counterpart was studied in the chick from days 3.5 to 12 of incubation, using antibodies to 17 separate antigens, including antibodies to pan-neuroendocrine markers, catecholamine-synthesizing and proprotein-processing enzymes, and neuropeptides. Some of the antigens studied (Go protein-alpha subunit, thyrosine hydroxylase, and galanin) were strongly expressed from the first days of development, whereas others (chromogranin-A, chromogranin-B, 7B2 protein, and somatostatin) showed a diverse immunoreactive expression at different stages. Three different patterns were found in the development of both adrenal medulla and thoracolumbar sympathetic ganglion. In the first (chromogranin-A and B, Go protein-alpha subunit, tyrosine hydroxylase, HNK-1, and galanin), virtually all medullary and thoracolumbar sympathetic ganglion cells were strongly immunostained from day 4 onward. Except for HNK-1, chromogranin-A and B, there was a steady increase in immunoreactive cells for all the remaining antigens up to day 12. In the second (7B2 protein, proprotein convertase 2, and secretogranin II), full antigenic expression was reached in medullary and thoracolumbar sympathetic ganglion cells by day 10. In the third pattern (proprotein convertase 3, somatostatin, dopamine-beta-hydroxylase, neuron-specific enolase, vasoactive intestinal polypeptide, and met-enkephalin), differences in immunoreactivity were observed between the medullary and thoracolumbar sympathetic ganglion cells.

Morphogenesis of the juxtaoral organ in humans.

The juxtaoral organ was studied using light microscopy in 55 human embryos and 90 fetuses at different stages of development. The juxtaoral organ arises from the epithelium at the bottom of the transverse opening of the primitive mouth during O'Rahilly stage 16 and becomes detached from the epithelium after O'Rahilly stage 18. The juxtaoral organ is innervated by the buccal nerve from O'Rahilly stage 20 onward, and its connective tissue capsule is clearly visible after week 11 of development. This study enabled us to describe three main periods of juxtaoral organ development: (1) the period of epithelial condensation and invagination, at O'Rahilly stages 16-17; (2) the period during which the juxtaoral organ becomes detached from the oral epithelium and is innervated, at O'Rahilly stages 18-23; and (3) the period during which the connective tissue capsule is formed, after week 11 of development. We also analysed the juxtaoral organ of five additional fetuses by immunohistochemistry with anti-NF-200 to verify their innervation. The results show that the juxtaoral organ may have a function in the mechanical activity of the region.

Morphogenesis of the human lacrimal gland.

The aim of this study was to determine the main stages of the lacrimal gland's developmental process in humans and to establish its precise morphogenetic timetable. Its onset is generally assumed to take place at O'Rahilly's stage 21, arising from an epithelial thickening of the superior extreme of the temporary conjunctival fornix. However, the present study points to a prior stage in the process: the presence of epithelial-mesenchymal changes in embryos at O'Rahilly's stage 19. The study was performed using light microscopy on serial sections of 37 human specimens: 23 embryos and 14 fetuses ranging from 15 to 137 mm crown-rump length (7-116 weeks of development). Three stages in lacrimal gland morphogenesis were identified: (1) the presumptive glandular stage, O'Rahilly's stages 19-20, characterized by a thickening of the superior fornix epithelium together with surrounding mesenchymal condensation; (2) the bud stage, generally assumed to be the first manifestation of glandular origin, characterized initially by the appearance of nodular formations in the region of the superior conjunctival fornix and concluding with the appearance of lumina within the epithelial buds; and (3) the glandular maturity stage, weeks 9-16, the period in which the gland begins to take on the morphology of adulthood.

Axillary arch: potential cause of neurovascular compression syndrome.

During routine bilateral dissection of 64 upper limbs in 32 adult human cadavers, four cases of an axillary arch, a muscular anomaly, were found. In one case, the axillary arch presented on both sides and in two cases it presented unilaterally on the right side. The innervation and relationships of the axillary arches are reported and the surgical significance of the anomaly is discussed.