Gibbs, Christopher M.

Radiology is often incorporated into medical school anatomy courses. Radiology education furthers understanding of anatomical relationships and prepares students to apply anatomical knowledge in clinical practice. The aim of this study was to investigate how cognitive performance on the radiology components (RC) of a first‐year medical school anatomy course are related to performance on non‐radiological components (NRC). We hypothesized that there is no correlation between these two performance variables, because they rely on different cognitive skills. Thus, anatomy education alone will not prepare students for the interpretation of normal anatomy on radiological images. Medical students (n=51) enrolled in a first‐year anatomy course at Mayo Clinic School of Medicine were included in this study. Assessment data from three lab practical examinations were collected, and RC and NRC questions were compared. A bivariate linear regression and statistical tests were conducted. A subgroup analysis was used to compare students whose RC performance was greater than their NRC performance (RC>NRC, n=33) to students whose RC performance was less than their NRC performance (RC<NRC, n=18). When considering all three exams, students correctly answered 71.1% of the RC questions and 68.3% of NRC questions (p=0.047). Bivariate linear regression demonstrated a moderate positive correlation between RC and NRC performance (p<0.01, r= 0.51); however, performance on RC questions only accounted for 24% of the variability of NRC scores. Additionally, students in the RC>NRC group had significantly higher scores on RC questions than the students in the RC<NRC group (74% vs 66%, p<0.02). Conversely, students in the RC>NRC group had significantly lower scores on NRC questions than the students in the RC<NRC group (61% vs 74%, p=0.001). These results indicate that while RC performance has some influence on NRC performance it does not account for the majority of the difference observed. Such results suggest that the cognitive skills involved in both radiology and anatomy education are different. Therefore, dedicated radiology education is an important component of an anatomy course as it fosters the development of novel skills that are necessary when interpreting normal anatomy on radiological images in a clinical setting. Support or Funding Information None

Ultrasound has been used more frequently in the anatomical sciences to reinforce core anatomy concepts in the classroom and introduce commonly applied imaging technologies encountered in a clinical setting. Interprofessional Education (IPE) is being incorporated into health sciences training as a learning model for real world interactions. The primary objective of the current study was to determine the impact of an IPE ultrasound curriculum on students' anatomy and ultrasound knowledge, as well as attitudes towards interprofessional collaboration. We hypothesized that students who participated in an IPE experience would have improved recall of anatomical and ultrasound concepts as well as improved attitudes and perceptions towards IPE when compared to students who did not participate in an IPE session. First year medical students (MD, n = 40) and first year physical therapy students (PT, n = 25) were randomly assigned to PT‐only, MD‐only, or mixed PT‐MD ultrasound instruction groups studying the shoulder. Students were assessed using an anatomy and ultrasound knowledge test and University of the West of England Interprofessional Questionnaire (UWEIPQ) prior to and following the session. The results of this study suggest that while ultrasound instruction significantly improves ultrasound post‐test scores when compared to pre‐test scores regardless of group assignment (PT‐only: p < 0.001; MD‐only: p = 0.007; PT‐MD: p < 0.001), learning in an interprofessional PT‐MD group did not significantly impact knowledge recall of ultrasound concepts when compared to non‐IPE groups. Interestingly, students in PT‐MD groups had significantly higher anatomy post‐test scores when compared to the MD‐only groups (PT‐MD post‐test = 93.2%; MD‐only post‐test = 84.1%; p = 0.041), but not when compared to the PT‐only groups. Additionally, the results of the UWEIPQ are consistent with the impression that students who participate in an IPE experience are more likely to be cognizant of inherent biases in the interactions between different health professionals as well as demonstrate increased confidence in their interprofessional relationships. In conclusion, our study reinforces that IPE programs should quantify knowledge recall in order to assess the effectiveness of a specific program. Furthermore, such endeavors should assess important competencies including communication, teamwork, and interdisciplinary respect that are necessary to succeed in a multidisciplinary health care team. Support or Funding Information Department of Anatomy, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN; Social Science and Humanities Research Council, Government of Canada

Introduction: Long QT syndrome (LQTS) is the most common, autosomal dominant, sudden death predisposing cardiac channelopathy. Although 17 LQTS genes have been discovered, 20% of LQTS remains genetically elusive. Whole exome sequencing (WES) followed by a strategic, knowledge-based variant filtration approach may elucidate novel LQTS-susceptibility genes. Methods: A LQTS family with multiple sudden deaths was referred for genetic evaluation. The index case was a 21-year-old male who died suddenly but had a pre-mortem ECG with marked QT prolongation. The decedent’s mother also showed QT prolongation. Only paraffin embedded tissue (PET) was available from the decedent, so the mother’s DNA was analyzed by WES. Following WES, variants were filtered using Ingenuity Variant Analysis (IVA) software. Only non-synonymous variants with a quality score >20, read-depth >10, and absent in ExAC were considered. Further filtration was performed using IVA’s biological context pathway analysis set to capture genes most likely related to LQTS. Electrophysiological studies were performed on the variant with highest probability of pathogenicity. Results: Following WES and variant filtration, only a CALR frame-shift variant (R376fs/10) remained as a probable LQTS mutation. No radical CALR variants reside in ExAC’s 60,000+ exomes. The mutation was confirmed in the decedent’s PET-derived DNA. CALR-encoded calreticulin (CRT) is a Ca2+ binding chaperone of the endoplasmic reticulum. Both knockout and over-expression of CRT exert extreme effects on the murine cardiac system, including sudden death. Recently, CRT has been linked with altered L-type calcium (LTCC) ion channel activity. Wild-type (WT)-CALR reduced Cav1.2 peak current density by 43.1%. In contrast, CALR-R376fs/10 mutation reversed this Cav1.2 inhibition and caused a net gain-of-function of Cav1.2 channel current compared with CALR-WT co-expression (64.2% increase). No pathogenic variants in CALR were identified in 25 additional, unrelated, genetically elusive LQTS cases. Conclusion: Mutations in CALR-encoded calreticulin may be a rare cause of autosomal dominant LQTS precipitated in part by an accentuation of the LTCC, thereby potentially mimicking CACNA1C-mediated LQTS.

Background: The objective of the study was to evaluate and compare the clinical outcomes of in situ decompression with subcutaneous and submuscular transpositions for surgical management of advanced (McGowan stage III) cubital tunnel syndrome (CuTS). Methods: A retrospective review of patients in our institution undergoing primary surgery for CuTS from February 1989 to May 2009 was performed. Patients with advanced CuTS with a minimum of 12 months of follow-up without any previous bony or soft tissue procedures around the elbow were included. Seventy-four patients underwent 80 primary ulnar nerve surgeries. Patients’ demographics, presenting symptoms, physical examination, electrodiagnostic findings, and perioperative complications were recorded. Primary surgical techniques were compared and the risk factors for revision surgery were assessed. Results: Of the 80 surgical procedures, there were 17 decompressions (21%), 47 subcutaneous transpositions (59%), and 16 submuscular transpositions (20%). Fifty-two percent of patients had resolution of their symptoms after primary surgery. The overall complication rate after primary surgery was 12.5%. Nineteen patients (24%) had revision surgery at a median of 30 months after their primary procedure. Eight patients (42%) had symptomatic improvement after revision surgery. Patients with their dominant extremity affected, static 2-point discrimination (S2PD) greater than 10 mm, and age less than 50 years at presentation had a higher rate of revision surgery. Three patients had a second revision surgery and neurolysis for persistent symptoms. Conclusions: The overall revision rate in advanced CuTS was 24%. Forty-two percent of patients had reported subjective symptomatic improvement after revision surgery. Younger age at presentation and a greater S2PD were associated with a higher rate of revision surgery.

A “perineal” branch of the sciatic nerve has been visualized during surgery, but there is currently no description of this nerve branch in the literature. Our study investigates the presence and frequency of occurrence of perineal innervation by the sciatic nerve and characterizes its anatomy in the posterior thigh. Fifteen cadavers were obtained for dissection. Descriptive results were recorded and analyzed statistically. Twenty‐one sciatic nerves were adequately anatomically preserved. Six sciatic nerves contained a perineal branch. Five sciatic nerves had a branch contributing to the perineal branch of the posterior femoral cutaneous (PFC) nerve. In specimens with adequate anatomical preservation, the perineal branch of the sciatic nerve passed posterior to the ischial tuberosity in three specimens and posterior to the conjoint tendon of the long head of biceps femoris and semitendinosus muscles (conjoint tendon) in one. In specimens in which the perineal branch of the PFC nerve received a contribution from the sciatic nerve, the branch passed posterior to the sacrotuberous ligament in one case and posterior to the conjoint tendon in three. Unilateral nerve anatomy was found to be a poor predictor of contralateral anatomy (Cohen's kappa = 0.06). Our study demonstrates for the first time the presence and frequency of occurrence of the perineal branch of the sciatic nerve and a sciatic contribution to the perineal branch of the PFC nerve. Clinicians should be cognizant of this nerve and its varying anatomy so their practice is better informed. Clin. Anat. 31:357–363, 2018. © 2018 Wiley Periodicals, Inc.

Background: Muscle bellies of the hamstring muscles are intimately associated with the sciatic nerve, putting the sciatic nerve at risk of injury associated with proximal hamstring avulsion. There are few data informing the magnitude of this risk, identifying risk factors for neurologic injury, or determining neurologic outcomes in patients with distal sciatic symptoms after surgery. Purpose: To characterize the frequency and nature of sciatic nerve injury and distal sciatic nerve–related symptoms after proximal hamstring avulsion and to characterize the influence of surgery on these symptoms. Study Design: Cohort study; Level of evidence, 3. Methods: This was a retrospective review of patients with proximal partial or complete hamstring avulsion. The outcome of interest was neurologic symptoms referable to the sciatic nerve distribution below the knee. Neurologic symptoms in operative patients were compared pre- and postoperatively. Results: The cohort consisted of 162 patients: 67 (41.4%) operative and 95 (58.6%) nonoperative. Sciatic nerve–related symptoms were present in 22 operative and 23 nonoperative patients, for a total of 45 (27.8%) patients (8 [4.9%] motor deficits, 11 [6.8%] sensory deficits, and 36 [22.2%] with neuropathic pain). Among the operative cohort, 3 of 3 (100.0%) patients showed improvement in their motor deficit postoperatively, 3 of 4 (75.0%) patients’ sensory symptoms improved, and 17 of 19 (89.5%) patients had improvement in pain. A new or worsening deficit occurred in 5 (7.5%) patients postoperatively (2 [3.1%] motor deficits, 1 [1.5%] sensory deficit, and 3 [4.5%] with new pain). Predictors of operative intervention included lower age (odds ratio [OR], 0.952; 95% CI, 0.921-0.982; P = .001) and complete avulsion (OR, 10.292; 95% CI, 2.526-72.232; P < .001). Presence of neurologic deficit was not predictive. Conclusion: Sciatic nerve–related symptoms after proximal hamstring avulsion are underrecognized. Currently, neurologic symptoms are not considered when determining whether to pursue operative intervention. Given the high likelihood of improvement with surgical treatment, neurologic symptoms should be considered when making a decision regarding operative treatment.

Purpose To determine the rate of return of young amateur athletes to sport after hip arthroscopy, their clinical outcomes, and pathologic risk factors for worse outcomes 2 years after surgery. Methods This study included all patients between age 13 and 23 who participated in a sport prior to surgery with intent to return who underwent hip arthroscopy after failure of comprehensive nonoperative management for whom 2‐year outcome scores were available. Outcomes collected retrospectively included modified Harris Hip Score (mHHS) and the Hip Outcome Scores (HOS) subscales for activities of daily living (ADL) and sport (HOS Sport). In addition, sport played, return to sport rates, and Tegner Scores were measured preinjury and postoperatively. Descriptive statistics were used to present demographic data. A priori analysis was used to determine the sample size needed to show minimal clinically important differences for mHHS, HOS ADL, and HOS Sport. Results The study population included 50 patients with a mean age of 17.8 years. Athletes returned to sport at a rate of 92% (46/50). At a mean follow‐up of 34 months, the mean mHHS, HOS ADL, and HOS Sport outcome scores were 85, 91, and 80 for the entire study group; 87, 92, and 84 for the group that returned to sport; and 67, 82, and 41 for the group that did not return to sport, respectively. Median preinjury and postoperative Tegner levels were 8 and 7, respectively. Labral takedown and reattachment was associated with lower HOS ADL ( P = .01) and HOS Sport scores ( P = .02). Conclusions Athletes returned to sport at a high rate (92%; 46/50) after hip arthroscopy and perform activities at near preinjury levels. In this group of athletes, arthroscopic labral repair with chondrolabral preservation, which reflected less severe chondrolabral pathology, performed better than labral repair with takedown and reattachment. Level of Evidence Level IV, therapeutic case series.