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Tissue clearing techniques are frequently used in the observation and description of anatomical structures and pathways without altering the three-dimensional layout of the anatomical specimen. Tissue optical clearing promotes preservation of three-dimensional structures, which allows the study of the internal anatomy in its original position and original spatial interaction. Among these techniques, Potassium Hydroxide (KOH) maceration clearing is one of the most widely used. However, the histological changes of tissue after KOH maceration have yet to be fully understood. Our aim is to describe the microscopical differences between macerated and normal tissue. To better understand said changes, two human fetuses with a gestation period of 16 to 28 weeks were cleared and processed for histological analysis. Microtome slides of the fetuses' lower limbs were obtained and stained with Hematoxylin & Eosin, Periodic Acid Schiff (PAS), and Masson's trichrome with the purpose of observing the histological and macromolecule composition changes in cleared tissue. Remarkable differences at a histological level regarding the composition of the cellular structures, since diaphanized tissues showed a predominance of extracellular matrix composed of collagen fibers with the absence of most of the nucleated cellular tissue. Phospholipid's saponification, nucleic acids degradation and a change on proteins structural properties are the main factors inducing clearing. At the same time, molecular stability of collagen in alkaline conditions allows the specimen to maintain its shape after the process. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the radiographic features of the medial depression of the human mandibular ramus (MDMR) on CT images. The radiographic features of the depression were assessed on multiplanar reformatting (MPR) section of CT scans of eighteen mandibles with 36 MDMRs. The MDMR was observed to be a smooth bone concavity with intact medial and lateral cortical plate located on the medial aspect and anterior to the greatest depth of the sigmoid notch. The average mediolateral depth of the depression was 1.64 mm (Std Dev 0.63 mm), while the average thickness of the thinnest area of the mandibular ramus at the site of the depression was 1.08 mm (Std Dev 0.33 mm). The average anterioposterior width of the depression was 10.39 mm (Std Dev. 3.36 mm). The soft tissue window images showed that the temporalis tendon inserts at the depression in all cases. MDMRs have CT features that help in its identification. [ABSTRACT FROM AUTHOR]

PURPOSE:To investigate the structural and functional changes induced by corticosterone (CORT) in the ventral prostrate (VP) of rats in order to study chronic stress effects in the prepubertal phase.METHODS:Wistar rats received daily saline or CORT injections during the pubertal period from the 5th to 25th day of postnatal life. The animals were distributed into four groups: 1 - Control (n=5); 2 - Control 99mTc-P (n=5); 3 - Treated with CORT (n=14); 4 - Treated with CORT and 99mTc-P (n=10). All rats were sacrificed at two months of age. Technical tissue uptakes of 99mTc-P were used to evaluate the functional and stereological methods for morphological analysis.RESULTS:Acini distribution in the group treated with CORT differed significantly (p

The majority o f the pupils of Giuseppe Levi were formed during his long years of scientific teaching in Turin (1919-1948). Of his numerous Turin pupils amongst whom are included T. Terni, O.M. Olivo, L. Bucciante, R. Amprino, A. Bairati, S. Luria, R. Dulbecco, R. Levi Montalcini, G. Godina, G. Filogamo, F. Vigliani, we recall in particular Rodolfo Amprino (1912- 2007, human anatomist at Bari University), and Giovanni Godina (1912- 2000, veterinary anatomist at Turin University), who remained close to Levi for over thirty years up to 1965. Amprino followed the teaching o f the Master from the age of seventeen and acquired renown for researches into cartilage tissue, bone tissue, and experimental embryology. In addition to being recalled for his works on bone tissue and nerve tissue, Godina is recalled for his researches into in vitro culture of various tissues and o f nerve tissue in particular, studied using phase-contrast microcinematography. [ABSTRACT FROM AUTHOR]

Objectives: To assess retrospectively whether diffusion-weighted magnetic resonance imaging (DW-MRI) allows physicians to determine the severity of histopathologic findings in biopsies of renal allograft patients with deteriorating renal function.Methods: Forty consecutive kidney transplant patients underwent DW-MRI and biopsy. Patients were assigned to one group with severe and to another group with normal or mild histopathologic findings. These two groups were compared based on a qualitative DW-MRI assessment (homo-/heterogeneity) and the combination of qualitative and quantitative DW-MRI parameters (ADC, and intravoxel incoherent motion, IVIM, parameters: D, f, D*). Sensitivity, specificity, and accuracy were determined for each parameter.Results: Biopsy findings were severe in 25 patients and normal or mild in 15 patients. Qualitative DW-MRI led to a sensitivity of 44.0% and a specificity of 93.3%. Combined qualitative and quantitative DW-MRI led to an accuracy of 80% for both the minimal ADC (ADCmin) and the minimal perfusion fraction (fmin) with a sensitivity of 84.0% and 92.0% and a specificity of 73.3% and 60.0%, respectively.Conclusion: Combined qualitative and quantitative DW-MRI might allow physicians to determine the severity of histopathologic findings in biopsies of a high number of kidney transplant patients.Key Points: • Qualitative DW-MRI is highly specific when predicting the severity of kidney transplant biopsy. • Allografts appearing heterogeneous on ADC are associated with severe histopathologic findings. • Combining qualitative and quantitative DW-MRI parameters improves the classification's sensitivity and accuracy. • Kidney transplant biopsies might be spared by combining qualitative and quantitative DW-MRI. [ABSTRACT FROM AUTHOR]

Background: This study aimed to develop a classification that precisely describes the extensor carpi ulnaris (ECU) groove morphology. Methods: Reconstructed axial plane computed tomography scans of the wrists of 200 patients were reviewed. Three groups of groove shape were created based on the position of the deepest point: deviated to the ulnar side (Type U), in the middle of the groove (Type M), and deviated to the radial side (Type R). Groove depth, width, carrying angle, and radius of the curvature were measured using the Picture Archiving and Communication System in a slice in which the ulnar head was the largest. Results: Type U was present in 88 patients (44%), Type M in 74 patients (37%), and Type R in 38 patients (19%). The average depth, width, carrying angle, and radius of curvature were 2.2 mm, 9.2 mm, 135.8° and 7.0 mm, respectively. Depth, width, and carrying angle were normally distributed. Both depth and width were statistically correlated with the carrying angle; groove depth and width were not correlated. ECU groove shape and depth showed excellent intra- and inter-observer reliabilities; the reliabilities for the width were poor. Therefore, depth subgroups were defined using cutoffs of ±2 standard deviations (SD): d1 (≤-2 SD), ≤1.0 mm; d2 (±SD), 1.1-3.3 mm; and d3 (≥+2 SD), ≥3.4 mm. The 200 wrists were classified as follows: 0.5% Ud1, 40.2% Ud2, 1.3% Ud3, 0.8% Md1, 38.3% Md2, 0.8% Md3, 1.5% Rd1, 16.4% Rd2, and 0.2% Rd3. Conclusions: The detailed morphology of the ECU groove was classified using three major types and depth subgroups. The Type R ECU groove, which lacks a medial bony buttress, might be more prone to ECU-related injuries. This classification helps to understand the ECU tendon-related injury pathologies and may provide valuable information for treatment decisions; however, further research is necessary. [ABSTRACT FROM AUTHOR]

PURPOSE: The objective of this study was to analyze the effects of Pressure Controlled Ventilation mode (PCV-C) and PSV mode in diaphragm muscle of rats. METHODS: Wistar rats (n=18) were randomly assigned to the control group or to receive 6 hours of PCV and PSV. After this period, animals were euthanized and their diaphragms were excised, frozen in liquid nitrogen and stored in at -80º C for further histomorphometric analysis. RESULTS: Results showed a 15% decrease in cross-sectional area of muscle fibers on the PCV-C group when compared to the control group (p0.05). CONCLUSION: Short-term controlled mechanical ventilation seems to lead to muscular atrophy in diaphragm fibers. The PSV mode may attenuate the effects of VIDD.OBJETIVO: Avaliar os efeitos do modo ventilatório controlado por pressão controlada (PCV-C) e do modo PSV sobre o músculo diafragma de ratos. MÉTODOS: Ratos (n = 18) da linhagem Wistar foram distribuídos no grupo controle (RE) ou para receber AVM por 6 horas no modo PCV-C e no modo PSV. Após esse período, os animais foram eutanasiados, o diafragma retirado e encaminhado para a análise histológica e morfométrica. RESULTADOS: Os resultados revelaram uma redução da área das fibras musculares de 15% no grupo PCV-C em comparação ao controle (p0,05). CONCLUSÃO: O grupo PCV-C apresentou atrofia muscular em um período curto de ventilação mecânica. O modo PSV parece atenuar os efeitos da DDIV.

OBJETIVO: Comparar a reconstrução do LCA com posicionamento anatômico dos túneis entre os tendões flexores e o tendão patelar. MÉTODOS: Foram avaliados 52 pacientes prospectivamente submetidos à reconstrução do LCA segundo a técnica de Chambat, com o posicionamento anatômico dos túneis realizados de fora para dentro. Foram divididos em grupo A, 27 pacientes, utilizando-se o tendão patelar como enxerto, e grupo B, 25 pacientes, utilizando-se os tendões flexores. RESULTADOS: No grupo A, 26 pacientes estavam muito satisfeitos ou satisfeitos, e um insatisfeito; no grupo B, 25 pacientes estavam muito satisfeitos ou satisfeitos (p = 0,990). Segundo a escala de Lysholm, o grupo A atingiu a média de 96,11 e o grupo B, 95,32 (p = 0,594). Quanto ao IKDC pré-operatório, 100% dos pacientes do grupo A e 92% do grupo B eram IKDC C ou D (p = 0,221); na avaliação com mínimo de dois anos de seguimento, 96% do grupo A e 92% do grupo B eram IKDC A ou B (p = 0,256). O teste de Lachman, pivot shift, o retorno às atividades esportivas e o diferencial comparativo da translação anterior (RolimeterTM) também não apresentaram diferença estatisticamente significante. No grupo A, 5 pacientes (18,5%) não conseguiam ajoelhar em superfície rígida; nenhum paciente do grupo B apresentou essa queixa. CONCLUSÃO: A reconstrução do LCA apresenta resultados semelhantes utilizando-se os tendões flexores ou tendão patelar com o posicionamento anatômico dos túneis. A perfuração de fora para dentro do túnel femoral é uma opção reprodutível e precisa no posicionamento correto do túnel femoral.OBJECTIVE: To compare ACL reconstruction with anatomical positioning of the tunnels using the hamstring or patellar tendons. METHODS: We prospectively evaluated 52 patients who underwent ACL reconstruction using the Chambat's technique, with anatomical positioning of the tunnels drilled outside in. They were divided into group A, with 27 patients, using the patellar tendon as a graft, and group B, with 25 patients, using the hamstring. RESULTS: In group A 26 patients were very satisfied or satisfied and 1 unhappy, in group B. 25 patients were very satisfied or satisfied with the procedure (p = 0.990). According to the Lysholm scale, group A had a mean score of 96.11 and group B, 95.32 (p = 0.594). In relation to preoperative IKDC, 100% of the patients in group A and 92% of those in group B were IKDC C or D (p = 0.221); in the assessment with a minimum of two-year follow-up, 96% of group A and 92% of group B were IKDC A or B (p = 0.256). The Lachman test, pivot shift, return to sports activities, and the comparative difference in anterior translation (RolimeterTM) also showed no statistically significant difference. In group A, 5 patients (18.5%) were unable to kneel on a hard surface, whereas no patient in group B had this complaint. CONCLUSION: The anterior cruciate ligament reconstruction presents similar results using the hamstring or patellar tendon with anatomical positioning of the tunnels. Drilling the femoral tunnel outside in is a reproducible and accurate option in the correct placement the femoral tunnel.

OBJETIVO: Avaliar e comparar o posicionamento dos túneis ósseos na cirurgia de reconstrução do ligamento cruzado anterior (LCA) pela técnica artroscópica e pela técnica aberta através da artrotomia. MÉTODO: Foi realizado um estudo retrospectivo comparativo de 70 pacientes acometidos por lesão do LCA. Trinta e cinco pacientes foram submetidos à reconstrução do LCA por via aberta e 35 por via artroscópica utilizando a técnica via portal anteromedial. Todos os pacientes foram submetidos à reconstrução do LCA usando enxerto autólogo do terço central do tendão patelar fixado com parafusos de interferência. As radiografias pós-operatórias foram revisadas e o posicionamento do túnel femoral foi avaliado pelos métodos propostos por Harner e Aglietti, enquanto o túnel tibial foi avaliado pelo método proposto por Staubli e Rauschning. RESULTADOS: Foram observados 54 pacientes do sexo masculino e 16 do sexo feminino. A média de idade na ocasião do procedimento foi de 34 anos e três meses, variando de 17 a 58 anos. A técnica artroscópica mostrou-se mais precisa que a técnica aberta quanto ao posicionamento dos túneis ósseos, tanto femoral quanto tibial. CONCLUSÃO: Através da análise radiológica dos joelhos submetidos à reconstrução do LCA, observou-se que o posicionamento dos túneis ósseos, tanto femoral quanto tibial, apresenta menor variação quando a cirurgia é feita pela via artroscópica.OBJECTIVES: To evaluate and compare bone tunnel positioning in anterior cruciate ligament (ACL) reconstruction surgery using the arthroscopic technique and the open technique consisting of arthrotomy. METHOD: A comparative retrospective study on 70 patients with ACL lesions was conducted. Thirty-five patients underwent ACL reconstruction by means of the open technique and 35 by means of the arthroscopic technique using an anteromedial portal. All the patients underwent ACL reconstruction using an autologous graft from the middle third of the patellar tendon, fixed using interference screws. The postoperative radiographs were reviewed and the positioning of the femoral tunnel was evaluated using the methods proposed by Harner and Aglietti, while the tibial tunnel was assessed using the method proposed by Rauschning and Staubli. RESULTS: Fifty-four of the patients were male and 16 were female. Their mean age at the time of the procedure was 34 years and 3 months, with a range from 17 to 58 years. The arthroscopic technique was shown to be more accurate than the open technique for positioning both the femoral and the tibial bone tunnels. CONCLUSIONS: Radiological analysis on the knees subjected to ACL reconstruction showed that the positioning of both the femoral and the tibial bone tunnels presented less variation when the surgery was performed arthroscopically.

Estudio descriptivo, analítico, y comparativo, realizado en cadáveres de embriones, fetos y adultos del género masculino, pertenecientes al laboratorio de Anatomía de la Facultad de Medicina. Transcribir los hallazgos embriológicos del descenso testicular normal y darnos cuenta que la gónada masculina fue el asiento de la mayoría de las patologías encontradas en nuestros pacientes y resueltas felizmente por los procedimientos quirúrgicos y médicos correspondientes, que he considerado complemento del estudio primario de las disecciones anatómicas. Ojala, este trabajo el primero de su género en este medio, permita que nuestra Facultad sea conocida fuera del contexto regional.A descriptive, analytical, and comparative study performed on cadavers of fetuses and adults of the male gender in the Anatomy Laboratory of the Medical School. We inform the embryological findings related with the normal testicular descent and highlight the fact that most pathological entities found in these patients originate in the male gonad, and that they were successfully resolved by means of surgical and medical treatment modalities, considering that this constitutes a complement of the primary study derived from anatomical dissection. We expect that this work, the fist of its kind in our region, will allow a better recognition of our Faculty of Medicine outside its original context.

The purpose of this study was to compare, in vitro, by means of computerized analysis of digital radiographic images, the anatomic alterations produced in the mandibular molar tooth dentinal walls of mesiobucal canals with severe curvature by three different endodontic techniques: Progressive Preparation, Staged and Serial Preparation. A selection was made of 45 extracted, human, mandibular molars, with root curvatures greater than 25°. They were divided into three groups for every technique studied, which were then sub-divided into three sub-groups in accordance with the position of the curvature along the root: cervical, median or apical. After access surgery and tooth length determination, the canals were filled with 100% Barium Sulphate radiological contrast and the teeth were then radiographed with a direct digital radiography system, using a special apparatus capable of keeping the samples in the same spatial position during the different radiographic takes. After the above-mentioned endodontic techniques had been performed, the teeth were again filled with Barium sulphate and were also radiographed under the same previously mentioned conditions. The pre- and post-operative digital images were then analyzed in two computerized programs, AutoCAD 2004 and CorelDraw 10, to assess, respectively, the areas and the horizontal alterations which occurred in the internal and external walls of the root canals. The results indicated that although no significant differences among the techniques were shown in the statistical analysis, in a descriptive analysis the Progressive Preparation technique was shown to be more regular, uniform and effective.Objetivou-se comparar, in vitro, através de análise computadorizada de imagens radiográficas digitais, as alterações anatômicas promovidas nas paredes dentinárias de canais mésio-vestibulares com curvatura severa de molares inferiores por três técnicas endodônticas diferentes: Preparo Progressivo, Escalonada e Seriada. Foram selecionados 45 molares inferiores humanos extraídos, com curvaturas radiculares superiores a 25°, que foram divididos em três grupos para cada técnica estudada e subdivididos em três subgrupos de acordo com a posição da curvatura ao longo da raiz: cervical, mediana ou apical. Após cirurgia de acesso e odontometria, os canais foram preenchidos com contraste radiológico de sulfato de Bário a 100% e os dentes então foram radiografados por um sistema de radiografia digital direta, utilizando-se um aparato capaz de manter as amostras na mesma posição espacial nas diferentes tomadas radiográficas. Após a realização das técnicas endodônticas supracitadas, os dentes foram novamente preenchidos com o sulfato de Bário e radiografados nas mesmas condições anteriores. As imagens digitais pré e pós-operatórias foram então analisadas em dois programas computadorizados, o AutoCAD 2004 e o CorelDraw 10, para verificar, respectivamente, as áreas e as alterações horizontais ocorridas nas paredes internas e externas dos canais radiculares. Apesar de não ter havido diferenças significantes entre as técnicas na análise estatística, em uma análise descritiva a técnica do Preparo Progressivo mostrou-se mais regular, uniforme e eficaz.

Abstract Introduction The purpose of this resource is to help the student learn basic cardiac anatomy and also how the anatomy relates to the interpretation of an EKG when diagnosing acute ST segment elevation myocardial infarction. This module was created as a supplementary learning resource for medical students on clinical rotations at our institution to connect basic physiology and anatomy to common clinical concepts. Methods This resource contains a series of short video tutorials that heavily use cartoons to review coronary anatomy, basic EKG interpretation, and how this is integrated into acute ST elevation myocardial infarction. These types of videos foster individualization of the learning process and can be assigned for viewing prior to a lecture or active learning session. These videos were shared with our medical students on clinical rotations. Results The students had access to a number of videos and topics, but among them, the Coronary Anatomy and MI videos were rated as very useful by a group of three to four students in a focus group. As a result, we have created more videos to form a library that can be easily accessed during the clinical rotation years at our institution. These videos have not been evaluated in a rigorous, quantitative study. However, we used these videos along with others in a classroom setting while teaching medical physiology. In this classroom setting with 108 students who had access to multiple learning resources, 59% of the students rated our videos as being the “MOST helpful” resource compared to live lectures, or course notes/textbooks. Discussion These particular videos work best when assigned for viewing in conjunction with the clinical care of a patient with acute myocardial infarction (AMI) or suspected AMI and would be an excellent resource to students on a general medicine ward rotation, emergency medicine rotation, inpatient cardiology ward rotation, or cardiac care unit rotation (among others) who would likely encounter patients with actual or suspected AMI.

Abstract Introduction This is an exam resource designed for use with previously published self-guided study modules and daily short presentations for normal human radiological anatomy (although the resource is suitable for use with any instruction of human radiological anatomy). Questions were designed to test various depths of learning based on the well-validated principles of Bloom's Taxonomy and were validated previously at our institution. Methods Each exam is 18 questions long, presented in PowerPoint slides. There are six different exams covering the entire body in the following modules: thorax, abdomen, pelvis, head and neck, upper extremities, lower extremities. Using these specific questions in conjunction with the associated study guides and daily cadaver/radiology lab instructional sessions reinforces the deeper learning concepts and allows for a complementary curriculum from objectives to exams. Results Students initially were apprehensive about the exam, but felt more relaxed anecdotally after the thorax mock exam. We did not receive any direct concerns from students. The questions were tested at a single institution during a single year. Sample size was 98 students (of 102) at an urban teaching hospital, which is not broadly representative. Discussion The exams are designed to be summative evaluations except for the mock thorax exam, which is intended to be a formative evaluation. The benefit to students and instructors of using the exams as they are is the continuity in curriculum from objectives alignment of the study guides and daily lab instruction with the exam questions.

The aim of the current study was to use gene therapy to attenuate or reverse the degenerative process within the intervertabral disc. The effect of survivin gene therapy via lentiviral vector transfection on the course of intervertebral disc degeneration was investigated in the current study in an in vivo rabbit model. A total of 15 skeletally mature female New Zealand White rabbits were randomly divided into three groups: Punctured blank control group (group A, n=5), punctured empty vector control group (group B, n=5) and the treatment group (group C, n=5). Computed tomography-guided puncture was performed at the L3-L4 and L4-L5 discs, in accordance with a previously validated rabbit annulotomy model for intervertebral disc degeneration. After 3 weeks, a lentiviral vector (LV) carrying survivin was injected into the nucleus pulposus. The results demonstrated that through magnetic resonance imaging, histology, gene expression, protein content and apoptosis analyses, group A and B were observed to exhibit disc degeneration, which increased over time, and no significant difference was observed between the two groups (P>0.05). However, there was reduced disc degeneration in group C compared with the punctured control groups, and the difference was statistically significant (P<0.05). Overall, the results of the present study demonstrated that injection of the LV carrying survivin into punctured rabbit intervertebral discs acted to delay changes associated with the degeneration of the discs. Although data from animal models should be extrapolated to the human condition with caution, the present study suggests potential for the use of gene therapy to decelerate disc degeneration. [ABSTRACT FROM AUTHOR]

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Abstract Introduction This enhanced podcast (narration to slides) explores the basics of ankle radiography, including standard views and positioning and normal ankle anatomy. The enhanced podcast format integrates visual and auditory learning into a portable and easily navigable product. Outside the classroom, learners can view the podcast as many times as necessary to feel comfortable with its content, including rewinding, or advancing to specific sections. This resource is intended for junior radiology residents, medical students, and non-radiology physicians. Methods The residents were sent the podcast 5 days prior to attending a conference on Ankle and Hindfoot Trauma, with instructions to download and view at least once, though they were encouraged to review as many times as desired to feel comfortable with the material. After attending the conference, they were asked to complete an anonymous survey, the results of which are summarized below. This publication includes the podcast, suggestions for facilitation, and a set of eight multiple-choice questions that can be administered either before and after, or only after, viewing the podcast to assess comprehension. Results Six of ten residents responded to the post-conference survey. Of the five who viewed the podcast, two were first-year radiology residents, and three had completed at least one year of residency. All five reported the level of the material to be “just right for where I am right now” and improved their ability to engage in the subsequent conference material. One resident specifically commented: “Very high quality material. The format ensures that I can replay until I get it, rather than having it fly over me high as would happen were the same material presented in a live conference…” Residents all reported an excellent (no issues) or good (minor issues) rating of the podcast format (i.e., slide layout, text size, image quality, annotations), audio quality (i.e., sound level, and narrative speed), and content (i.e., length, clarity, and accuracy). Discussion The podcast is designed to be small enough (15.4 MB) that it could be distributed as an email attachment, posted in a location to be downloaded, or played online. In order to attain the smaller file size, some degree of image quality might be sacrificed, but when polled residents favored (4:2) a smaller file over a larger one containing higher quality images that they would have to download from a website.

Abstract The 2008 Institute of Medicine report advocated that healthcare professionals integrate geriatric content into medical training to prepare for the rapidly increasing geriatric population and its impact on all aspects of health care. In addition, physicians and educators are encouraged to integrate basic science and clinical content into medical education. Given the fact that the average cadaver age is 73-years-old, we created this “first patient” introduction to identify and building upon the connections between human anatomy and physical diagnosis skills, and incorporate the age of the cadaver as a geriatric learning opportunity. This resource includes a facilitator's guide for a 15-20 minute small-group exercise during the anatomy class' unveiling of the cadaver. Clinical faculty introduce students to their first patient, the cadaver, and teach students how to investigate the patient's clinical history. Students thoroughly inspect the patient's surface anatomy and discuss the relevance of physical findings as attributable to normal aging or common age-associated conditions. Students also discuss their ideas on the clinical implications of findings on the patient's daily life: symptoms, functional impact (i.e., ADLs, IADLs, and AADLs) and possible means of compensation.

Abstract Introduction We recognized a need at our institution for a resource to facilitate self-learning of basic gastrointestinal (GI) histology and pathology. In particular, we sought to produce an aid for GI clinical fellows participating in GI pathology biopsy rounds and preparing for their exams. We also wanted to develop a self-learning tool for other off-service/clinical residents rotating through pathology and junior-level pathology residents (within their first 2 years of residency). An interactive, web-based learning module was determined to be an ideal type of educational tool. Methods The GI Biopsy Crash Course consists of two file folders, GI Path Module and GI Crash Quiz, contained in one module, as well as an Instructor's Guide. Students work through GI Path Module, which is the teaching module, first; they then take the GI Crash Quiz after completing the teaching module. The quiz consists of 10 questions. Approximately 1-2 hours are required to work through GI Path Module and GI Crash Quiz, with most of that time spent in the teaching module. Results We have implemented the GI Biopsy Crash Course with GI clinical fellows participating in GI pathology biopsy rounds and with junior-level pathology residents going through their initial GI pathology rotations. The performance of students completing the module, although not formally evaluated, has improved noticeably. Feedback from students who have used the module has been very positive. Discussion The level of material in the GI Biopsy Crash Course is mainly introductory. We hope to create additional, higher level modules that deal with more advanced topics in GI pathology in the future.

Purpose: Recent studies have suggested that decreased serum potassium level may contribute to various metabolic disorders in adult patients including nonalcoholic fatty liver disease (NAFLD). We aimed to study the correlation between serum potassium levels and the histologic severity of NAFLD in children. Methods: Pediatric patients with biopsy-proven NAFLD were included in this study. Demographic, clinical, and histopathological data were obtained. Multivariable logistic regression analysis was used to assess whether potassium levels are associated with the presence of nonalcoholic steatohepatitis (NASH) or fibrosis after adjusting for possible confounders. A p-value <0.05 was considered statistically significant. Results: Among 125 biopsies, 49.6% (62) had evidence of NASH while 66.4% (83) had some degree of fibrosis (stage 1-3). Mean serum potassium was significantly lower in NASH group as compared to non-NASH group (4.4±0.42 mmoL/L vs. 4.8±0.21, p<0.001). Higher potassium level had negative correlation with presence of steatosis, ballooning, lobular inflammation, fibrosis and NAFLD activity score (p<0.05). On multivariable analysis and after adjusting for the metabolic syndrome and insulin resistance, higher potassium level was significantly associated with lower likelihood of having a histological diagnosis of NASH on biopsy (odds ratio [OR], 0.12; 95% confidence interval [95% CI], 0.05-0.28; p<0.001). Similarly, the likelihood of having fibrosis decreases by 76% for every 0.5 mmoL/L increase in potassium (OR, 0.24; 95% CI, 0.11-0.54; p<0.001). Conclusion: Our study shows an inverse relationship between serum potassium levels and the presence of aggressive disease (NASH and fibrosis) in children with NAFLD. [ABSTRACT FROM AUTHOR]

Abstract Short podcast (