ABSTRACT The vertebral nerve (VN) is a postganglionic sympathetic structure that arises from the cervicothoracic ganglion, ascends alongside the vertebral artery, and provides sympathetic innervation to the upper limb via the brachial plexus. Despite its anatomical relevance, it remains largely unknown to anesthesiologists and pain clinicians. The stellate ganglion block (SGB) is the current standard for upper‐limb sympatholysis but produces nonselective effects, including Horner's syndrome and potential cardiac involvement. A more selective approach targeting the VN could achieve equivalent upper‐limb sympatholysis while potentially offering a superior safety profile. We conducted a comprehensive anatomical review of the VN, covering its origin, trajectory, branching patterns, and communications with both the cervical spinal nerves and the vertebral plexus. Using this anatomical framework, we describe an ultrasound‐guided technique for selective VN blockade at the C7 level, validated with fluoroscopic contrast confirmation. We objectively evaluated clinical efficacy using infrared thermography and laser Doppler flowmetry. The VN is an anatomically consistent and sonographically accessible target for selective upper‐limb sympathetic blockade. At this target, effective sympatholysis can be achieved with minimal injectate volumes, thereby avoiding the nonselective effects of conventional SGB. Further studies are needed to compare efficacy, optimal technique parameters, and complication rates with existing approaches.
ABSTRACT To better understand (abnormal) colonic anatomy on imaging, data on normal colonic anatomy in the unaffected population are crucial. We assessed colon lengths in children without constipation on MRI. This retrospective study included patients (< 18 years), who underwent MRI‐enterography between 2016 and 2020 for suspected inflammatory bowel disease, and did not meet Rome‐IV criteria for functional constipation. Patients with colonic inflammation were excluded. Primary outcome was the mean total colon length/BSA (cm/m 2 ) (95% CI; ±2SD), and the secondary outcomes were total colon length (cm), rectosigmoid length/BSA (cm/m 2 ), and rectosigmoid length (cm). Colon segments were independently measured on coronal T2‐weighted MRI using 3D multiple‐point measurements. Linear regression was used to evaluate associations between total colon length and sex, age, height, weight, body surface area (BSA). Eighty‐one patients (median age 15 years; range 11–17; 53% male) were included. The mean total colon length/BSA was 72.9 ± 21.0 cm/m 2 . Mean total colon length was 115.8 ± 13.8 cm, mean rectosigmoid length/BSA was 24.2 ± 12.3 cm/m 2 , and mean rectosigmoid length was 38.2 ± 7.9 cm. Additionally, we assessed colonic segments per age group. Colon length significantly correlated with age ( p = 0.03), height ( p < 0.001), weight ( p < 0.001), and BSA ( p < 0.001). In a multivariable linear regression analysis, BSA was significantly correlated with total colon length (95% CI 21.4–49.4; p < 0.0001). This study provides data on colon and rectosigmoid lengths in children, aged 11–17 years, without constipation measured on MRI‐enterography. This knowledge can be used for the identification of abnormal colonic anatomy in children with therapy‐resistant constipation on imaging.
ABSTRACT Open reduction of posterior malleolar fractures (PMFs) increasingly employs direct posterior approaches. The posterolateral and posteromedial approaches both develop the deep posterior compartment in the plane between the fibular and posterior tibial arteries, placing the fibular artery communicating branch (FACB) within the operative field; inadvertent injury to this branch has been associated with limb‐threatening ischemia. This study quantified the prevalence of the FACB and of fibular artery dominance (FAD), a configuration in which the fibular artery provides the principal distal supply because the posterior tibial artery is atretic or absent, and considered the implications for surgical approach selection. In a single‐center cross‐sectional study, 916 consecutive lower‐limb computed tomography angiograms performed over 1 year were screened; 726 met the inclusion criteria and were assessed by trained reviewers for the FACB, FAD, laterality and clinical indication. An FACB was identified in 280 patients (38.6%, 95% CI 35.1–42.2). Its prevalence varied with clinical indication (χ 2 = 33.67, p < 0.001), being highest in peripheral vascular disease (45.1%) and lowest in other vascular referrals (16.4%). FAD occurred exclusively in FACB‐positive limbs, in 28 patients (10.0% of FACB‐positive limbs; 3.9% of the whole cohort, 95% CI 2.7–5.5), and its distribution did not differ by indication (Freeman–Halton exact p = 0.81). Because the FACB lies within the field of the posterolateral and posteromedial approaches but posterior and lateral to the medial‐posteromedial (MPM) approach, the MPM approach avoids the at‐risk plane. These findings support anatomically informed approach selection and caution when a posterolateral or posteromedial approach is planned, particularly in patients with peripheral vascular disease.
Active learning has become increasingly important in anatomy education, yet evidence on creative student-generated learning activities remains limited, particularly regarding their influence on motivation, and knowledge retention. This study examined the educational value of a rap-based student-generated learning activity in teaching Peripheral Nervous System anatomy to dental students using an explanatory sequential mixed-methods design. The study was conducted in two stages: parallel test development and experimental implementation. In the first stage, pretest and posttest item pools were prepared based on course content and relevant literature. Content validity was evaluated by six field experts and one language expert using Content Validity Ratio and Content Validity Index calculations. After expert review and pilot testing with 125 students, item difficulty, discrimination indices, and reliability coefficients were examined, resulting in two parallel 20-item test forms. Exploratory factor analysis demonstrated acceptable structural validity, with explained variance ranging between 57% and 59%. In the experimental phase, 108 dental students were assigned to experimental and control groups (54 each). Since no significant difference was observed in pretest scores, random allocation was applied. The experimental group completed a rap-song writing activity, whereas the control group received conventional instruction. Posttest scores were analyzed using paired-samples and independent-samples t-tests. Qualitative data were collected through four open-ended questions and analyzed by content analysis. Themes and codes were developed independently, and inter-rater agreement was evaluated using Cohen's kappa coefficient. Although academic achievement was comparable between groups, students in the rap-based learning group reported greater engagement and motivation. Student-generated music-based activities may therefore offer a useful complementary strategy for supporting retention and active participation in anatomy education. Importantly, no statistically significant superiority over conventional instruction was observed, indicating that the intervention should be interpreted as a supplementary rather than a replacement strategy.
Cadaver-based anatomy education represents a unique biological and sensory experience that may elicit significant physiological responses. However, little is known about the anticipatory phase prior to initial exposure, particularly when evaluated using objective biomarkers. This study aimed to assess anticipatory physiological responses in first-year medical students before their initial cadaver exposure. Ninety students were evaluated using a within-subject design comparing physiological measures obtained under standardized conditions at baseline (before a routine anatomy session without cadaver exposure) and immediately prior to their first entry into the dissection room (anticipatory condition), before any direct contact. Measures included systolic and diastolic blood pressure, heart rate, and salivary cortisol. Compared with baseline, the anticipatory phase was associated with significant increases in systolic blood pressure (116.9 +/- 13.6 vs. 123.8 +/- 13.4 mmHg, p < 0.001), heart rate (74.6 +/- 13.1 vs. 82.9 +/- 15.2 bpm, p < 0.001), and salivary cortisol levels (4.2 +/- 2.1 vs. 5.3 +/- 3.2 ng/mL, p < 0.001), indicating activation of both sympathetic and hypothalamic-pituitary-adrenal pathways. No significant changes were observed in diastolic blood pressure. These changes were associated with moderate effect sizes for systolic blood pressure (d = 0.51), heart rate (d = 0.58), and salivary cortisol (d = 0.41). Physiological responses were not influenced by sex or sociocultural factors. These findings indicate that physiological stress activation is already present during the anticipatory phase preceding first cadaver exposure, supporting the existence of a distinct anticipatory component of cadaver-based anatomy education characterized by coordinated autonomic and endocrine responses. This anticipatory phase represents a distinct physiological component of cadaver-based anatomy education and provides objective evidence of biological activation occurring before first cadaver exposure. Recognizing this early physiological response may contribute to a better understanding of students' initial adaptation to cadaver-based learning experiences.
