The combination of the modified Charles procedure with vascularized transferring of lymph node flap is an effective method for treatment of advanced stage lymphedema.

BackgroundThe exponential growth of image-based diagnostic and minimally invasive interventions requires a detailed three-dimensional anatomical knowledge and increases the demand towards the undergraduate anatomical curriculum. This randomized controlled trial investigates whether musculoskeletal ultrasound (MSUS) or arthroscopic methods can increase the anatomical knowledge uptake.MethodsSecond-year medical students were randomly allocated to three groups. In addition to the compulsory dissection course, the ultrasound group (MSUS) was taught by eight, didactically and professionally trained, experienced student-teachers and the arthroscopy group (ASK) was taught by eight experienced physicians. The control group (CON) acquired the anatomical knowledge only via the dissection course. Exposure (MSUS and ASK) took place in two separate lessons (75 minutes each, shoulder and knee joint) and introduced standard scan planes using a 10-MHz ultrasound system as well as arthroscopy tutorials at a simulator combined with video tutorials. The theoretical anatomic learning outcomes were tested using a multiple-choice questionnaire (MCQ), and after cross-over an objective structured clinical examination (OSCE). Differences in student’s perceptions were evaluated using Likert scale-based items.ResultsThe ASK-group (n = 70, age 23.4 (20–36) yrs.) performed moderately better in the anatomical MC exam in comparison to the MSUS-group (n = 84, age 24.2 (20–53) yrs.) and the CON-group (n = 88, 22.8 (20–33) yrs.; p = 0.019). After an additional arthroscopy teaching 1% of students failed the MC exam, in contrast to 10% in the MSUS- or CON-group, respectively. The benefit of the ASK module was limited to the shoulder area (p < 0.001). The final examination (OSCE) showed no significant differences between any of the groups with good overall performances. In the evaluation, the students certified the arthroscopic tutorial a greater advantage concerning anatomical skills with higher spatial imagination in comparison to the ultrasound tutorial (p = 0.002; p < 0.001).ConclusionsThe additional implementation of arthroscopy tutorials to the dissection course during the undergraduate anatomy training is profitable and attractive to students with respect to complex joint anatomy. Simultaneous teaching of basic-skills in musculoskeletal ultrasound should be performed by medical experts, but seems to be inferior to the arthroscopic 2D-3D-transformation, and is regarded by students as more difficult to learn. Although arthroscopy and ultrasound teaching do not have a major effect on learning joint anatomy, they have the potency to raise the interest in surgery.

Objectives Here we aimed to clarify the role of CXCR2 in the macrophage migration inhibitory factor (MIF)-mediated effects after myocardial ischemia and reperfusion (I/R). As a pleiotropic chemokine-like cytokine, MIF has been identified to activate multiple receptors including CD74 and CXCR2. In models of myocardial infarction (MI), MIF exerts both pro-inflammatory effects and protective effects in cardiomyocytes. Likewise, CXCR2 displays opposing effects in resident versus circulating cells. Approach and results Using bone marrow (BM) transplantation, we generated chimeric mice with CXCR2−/− BM-derived inflammatory cells and wild-type resident cells (wt/CXCR2−/−), with CXCR2−/− cardiomyocytes and wild-type BM-derived cells (CXCR2−/−/wt) and wild-type controls reconstituted with wild-type BM (wt/wt). All groups were treated with anti-MIF or isotype control antibody before they underwent myocardial I/R. Blocking MIF increased infarction size and impaired cardiac function in wt/wt and wt/CXCR2−/− mice but ameliorated functional parameters in CXCR2−/−/wt mice, as analyzed by echocardiography and Langendorff perfusion. Neutrophil infiltration and angiogenesis were unaltered by MIF blockade or CXCR2 deficiency. Monocyte infiltration was blunted in wt/CXCR2−/− mice and reduced by MIF blockade in wt/wt and CXCR2−/−/wt mice. Moreover, MIF blockade attenuated collagen content in all groups in a CXCR2-independent manner. Conclusions The compartmentalized and opposing effects of MIF after myocardial I/R are largely mediated by CXCR2. Whereas MIF confers protective effects improving myocardial healing and function through CXCR2 in resident cells, complementing paracrine effects through CD74/AMPK, it exerts detrimental effects on CXCR2-bearing inflammatory cells, increasing monocyte infiltration and impairing heart function. These dichotomous findings should be considered, when developing novel therapeutic strategies to treat MI.