Once believed to be limited to articular cartilage, osteoarthritis is now considered to be an organ disease of the “whole joint.” Damage to the articular surface can lead to, be caused by, or occur in parallel with, damage to other tissues in the joint. The relationship between cartilage and the underlying subchondral bone has particular importance when assessing joint health and determining treatment strategies. The articular cartilage is anchored to the subchondral bone through an interface of calcified cartilage, which as a whole makes up the osteochondral unit. This unit functions primarily by transferring load-bearing weight over the joint to allow for normal joint articulation and movement. Unfortunately, irreversible damage and degeneration of the osteochondral unit can severely limit joint function. Our understanding of joint pain, the primary complaint of patients, is poorly understood and past efforts toward structural cartilage restoration have often not been associated with a reduction in pain. Continued research focusing on the contribution of subchondral bone and restoration of the entire osteochondral unit are therefore needed, with the hope that this will lead to curative, and not merely palliative, treatment options. The purpose of this narrative review is to investigate the role of the osteochondral unit in joint health and disease. Topics of discussion include the crosstalk between cartilage and bone, the efficacy of diagnostic procedures, the origins of joint pain, current and emerging treatment paradigms, and suitable preclinical animal models for safety and efficacy assessment of novel osteochondral therapies. The goal of the review is to facilitate an appreciation of the important role played by the subchondral bone in joint pain and why the osteochondral unit as a whole should be considered in many cases of joint restoration strategies. Impact Statement In this comprehensive review, we are providing a holistic overview of osteochondral tissue development, disease, pain localization, as well as structural evaluation and current repair strategies. This review is intended to serve as a broad introduction to this multidisciplinary research area. It is a thorough examination of the biological aspects of the osteochondral unit from a tissue engineering perspective, highlighting the importance of the subchondral bone in chondral and osteochondral lesion repair and pain relief.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Dissection‐based human anatomy is an inherently time‐consuming process. Accordingly, students must use their time in the laboratory as efficiently as possible. There are many commercial resources that are currently available to students for pre‐laboratory preparation at home; however, preliminary data gathered from student questionnaires (n = 217) indicate that a significant proportion of third‐year undergraduate students enrolled in human anatomy at the University of Guelph choose not to use these resources to prepare for their laboratory sessions (p<0.01). Anecdotal student feedback revealed that their avoidance of the resources was because the students typically perceived the commercial resources to be overly text‐based and lacking alignment with the course curriculum. Therefore, we created a preparatory dissection‐based laboratory manual as a part of an ongoing project in which we are developing, evaluating, and refining educational tools to enhance our human anatomy program. To maximize the potential impact of all such laboratory resources, we aim to develop the dissection‐based laboratory manual to: 1) specifically target the University of Guelph's human anatomy course and laboratory learning objectives, 2) bridge lecture and laboratory content, and 3) enable students to address basic practical and clinical applications of anatomy. To achieve these objectives, the manual incorporates various educational components, including dissection‐based cadaveric images, digital illustrations and schematics, dissection instructions, and active‐learning exercises. These components will be integrated to help students visualize and understand concepts such as: 1) the origins and pathways of nerves and arteries that are initially discovered and examined in distal sites, 2) compartmentalization of the limbs, and 3) relative levels of depth between structures and their organization within the human body. In addition, the manual targets course concepts that are not easily visualized or understood with a regional anatomy approach, given the time constraints and the schedules of our dissection‐based courses. By making this resource available to students outside of the laboratory, our goal is to promote student preparedness for each session and enhance the quality of learning within the human anatomy laboratory itself. Student feedback sessions will be used to inform further development of the laboratory companion and improve future editions of the resource.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
The University of Guelph offers dissection‐based human anatomy courses to a large cohort of over 1000 undergraduate students per academic year. The third‐year class is the largest, comprised of students enrolled in the Human Kinetics and Bio‐Medical Sciences degree programs. Students attend weekly lectures that introduce the anatomy in a regional‐based approach. Lectures are taught using PowerPoint slides supplemented with interactive activities, including progressive schematic drawings demonstrating anatomical structures and relationships. Weekly cadaver‐based laboratories follow.Literature indicates extensive benefits to drawing in human anatomy education. Its integration has been positively associated with visual literacy and hand‐eye coordination. Drawing improves student awareness of anatomical details, by facilitating reasoning and deeper understanding of anatomical concepts. Additionally, drawing could promote peer teaching, for example, by encouraging students to create anatomical illustrations for their peers to use as study resources, therefore mutually benefiting both the illustrator‐instructor and learner.Registered course students with interest in drawing were invited to attend weekly sessions (n=48). The first half an hour involved a surface anatomy review lesson in tandem with the weekly laboratory goals. Participants were then allotted two hours to explore and draw from various cadaveric prosections related to the discussed region. Moreover, to promote peer teaching, students worked one‐on‐one with a graduate student to design an illustration‐based learning resource for their fellow peers of a region the student perceived as challenging.Preliminary results suggest a positive correlation between drawing and the understanding of anatomical structures, depth, relationships, and overall concepts. Additionally, the production and use of peer‐developed learning tools presents similar benefits.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
Neuromuscular dysfunction of the pelvic floor and perineum can negatively impact several populations including the elderly, parous women, and athletes. Pelvic health physiotherapists assess and treat neuromuscular dysfunction of the perineal and pelvic diaphragmatic regions using targeted physical therapy techniques. Consequently, they must rely on their understanding of the complex anatomy of the pelvic floor to guide them during the assessment and treatment of their patients. In Canada, physiotherapists who choose to specialize in pelvic health enroll in continuing education courses to learn clinical concepts and techniques associated with the specialty. However, an initial pilot study revealed that the majority of physiotherapists attending these entry‐level pelvic health courses had limited prior knowledge of the anatomy relevant to the specialty. Since pelvic anatomy is foundational to the pelvic health specialty, entering the course with insufficient anatomical knowledge may limit the physiotherapists' abilities to learn and execute more advanced clinical procedures.To improve baseline pelvic anatomy knowledge, a cadaver‐based online teaching resource, the Pelvic Health Anatomy Module (PHAM), was created and evaluated in the present study. The study was conducted to assess: (1) the efficacy of the PHAM to enhance physiotherapists' anatomical knowledge before entering a pelvic health course, and (2) if having stronger anatomical knowledge prior to the onset of the course impacted their understanding of the course concepts. Physiotherapists (n = 23) were given one of two anatomy education resources to review before the beginning of an entry‐level pelvic health certification course – the experimental group received the novel PHAM resource, while the control groups reviewed a traditionally‐used online video resource.Participants who received the PHAM perceived it as “very useful”, while the control group perceived the traditional videos as “useful”. The average for the group who reviewed the PHAM was higher for the anatomy scores at the beginning, end, and one week after completion of the course than the group who reviewed the control resource. Furthermore, the average for the group who reviewed the PHAM was higher on evaluations of course concepts compared to the groups who reviewed the control resource. The initial results of this study support the development and use of comprehensive and purposeful anatomy resources for continuing education courses in healthcare, particularly physiotherapy, to enhance foundational knowledge and facilitate better application of course concepts.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
A pelvic fracture is a life‐threatening injury that requires accurate pre‐hospital care. Pelvic binding is an effective, non‐invasive procedure that can manage haemorrhages associated with most pelvic fractures. However, pelvic binding is a high precision skill that requires proper training to ensure proficiency. Previous studies have shown that pelvic binding is both irregularly and inaccurately performed at several tiers of emergency medicine. One plausible explanation for this competency issue is that training associated with pelvic binding is often brief and does not clearly explain the ‘why’ behind the procedure. Using a compilation of cadaveric images that emphasized the important anatomy related to pelvic binding, a cadaver‐based video resource was created to supplement traditional teaching of this skill. The present study examined the effect of this cadaver‐based video resource on the pelvic binding competencies of emergency responders, specifically firefighters. The study used a double‐blinded approach – participants (n = 16) were sorted into two groups that were balanced according to their previous first‐aid experience. The control group was given 20 minutes to practice the skill of pelvic binding, while the intervention group was given a three‐minute cadaver‐based video resource that focused on the anatomy of the pelvis and pelvic binding, followed by 17 minutes to practice the skill of pelvic binding. Over three visits, participants performed three written and three clinical competency tests to assess their pelvic binding knowledge and their ability to apply a pelvic binder. The first set of tests were administered one week prior to the intervention to record baseline competency. The second set of tests were administered post‐intervention to measure any changes in scores. The final set of tests were administered three weeks after the intervention to assess knowledge retention. The primary outcome measures evaluated criteria related to the proper placement of the pelvic binder. The written tests assessed whether the participant knew the location at which the pelvic binder should be applied, while the clinical competency tests assessed whether the participant could translate that knowledge and successfully apply the pelvic binder to a subject. Preliminary results showed a positive trend in both knowledge of pelvic binding and performance of the skill favouring the group who had access to the video resource. According to Fisher's Exact test, a significant difference in scores associated with pelvic binding accuracy was observed (p=0.026) between the control and intervention groups. The intervention group identified the correct landmark for binder placement with 100% accuracy, while the control group correctly identified the landmark only 37.5% of the time. These findings suggest that targeted cadaver‐based training videos may be valuable tools for the development of clinical competencies. Overall, this study may offer insights into the development of cadaver‐based educational resources to supplement training protocols and enhance the understanding of emergency responders. By explaining the anatomy involved in emergency procedures, the ‘why’ behind clinical protocols can be clarified.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.
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