Separate Courses Research Articles

Examining and Supporting Mechanistic Explanations Across Chemistry and Biology Courses.

Causal mechanistic reasoning is a thinking strategy that can help students explain complex phenomena using core ideas commonly emphasized in separate undergraduate courses, as it requires students to identify underlying entities, unpack their relevant properties and interactions, and link them to construct mechanistic explanations. As a crossdisciplinary group of biologists, chemists, and teacher educators, we designed a scaffolded set of tasks that require content knowledge from biology and chemistry to construct nested hierarchical mechanistic explanations that span three scales (molecular, macromolecular, and cellular). We examined student explanations across seven introductory and upper-level biology and chemistry courses to determine how the construction of mechanistic explanations varied across courses and the relationship between the construction of mechanistic explanations at different scales. We found non-, partial, and complete mechanistic explanations in all courses and at each scale. Complete mechanistic explanation construction was lowest in introductory chemistry, about the same across biology and organic chemistry, and highest in biochemistry. Across tasks, the construction of a mechanistic explanation at a smaller scale was associated with constructing a mechanistic explanation for larger scales; however, the use of molecular scale disciplinary resources was only associated with complete mechanistic explanations at the macromolecular, not cellular scale.

End-to-End Technologies in Medicine, Pharmacy and Biology

The article raises the topical issue of the use of end-to-end technologies for medicine, pharmacy, and biology. The analysis of the use of new technologies in these areas is carried out at the present time. The authors are looking for ways to solve the problem of teaching humanities and natural sciences at a medical university using the capabilities of modern technologies. A random sampling method using the capabilities of Goole forms was used to conduct a survey of 2nd year students of the medical university and teachers working with them. The level of training, the needs of students for new knowledge on modern end-to-end technologies, and the possibilities of implementing training programs are discussed. The survey showed that despite the widespread introduction of end-to-end technologies, the knowledge of students and teachers in this area is extremely limited. Students have a need to acquire new knowledge that can be applied in their future profession. Several solutions to the problem of teaching student’s new technologies and their practical application in medicine, pharmacy, and biology are proposed. The survey also showed that there are two possible options: 1) the introduction of a separate optional course into the curriculum; 2) teachers can talk about the possibilities of new technologies and their use during the study of the discipline. For effective teaching, teachers must improve their skills in a timely manner by taking courses. With an integrated approach, a quick and effective solution to the task is possible.

Educational data mining in a university using LMS Moodle

Educational data mining is a technology for processing big data collected through educational portals and used for assessing the quality of educational content and predicting educational outcomes. Various data analysis methods are applied in the implementation of this technology, including anomaly detection, association rule mining, classification, cluster analysis, regression analysis, and factor analysis. Each of these methods uses special tools, such as spreadsheets, high­level programming languages (Python or R), low­code platforms (Loginom, Orange), or specialized analytics modules integrated into educational portals. The article reveals the features of the “Analytics” module embedded in LMS Moodle for tracking and optimizing the educational process. The authors provide recommendations for configuring and using this module in the educational process. The module “Analytics” allows to create forecasts of the success rate of mastering a separate training course without programming skills , does not require data preprocessing for analysis, and allows to quickly take measures to improve the educational process based on the results of the forecast. However, the module has a number of disadvantages (limited attributes and forecasting models, high requirements for computing power to run model training and build forecasts), so often administrators of educational portals disable this module. In this regard, an experiment was conducted to train a classification model for predicting students’ examination scores based on students’ activities on the educational portal of Nosov Magnitogorsk State Technical University. In the course of the experiment, data on students’ activity on the university’s educational portal for one academic year were taken, and machine learning models were built to predict examination scores for an individual student and subject. The results of the experiment showed F1 74 % in predicting the score that the students would receive on the intermediate assessment. This confirms the effectiveness of using educational data mining based on user data from educational platforms.

Medical Students' Knowledge, Perceptions, and Expectations Regarding Telemedicine Education

Aim: This study aims to determine the knowledge levels and perceptions of medical faculty students about telemedicine, as well as their willingness to be prepared for telemedicine before graduation from their own perspectives. In line with this aim, the current situation was comprehensively analyzed to develop solution proposals. Method: In this study, which employs a cross-sectional survey design, data were collected using both qualitative and quantitative questions. Participants were asked direct questions (e.g., yes/partially, undecided/no; very low=1 to very high=5), followed by follow-up questions (direct or open-ended) related to these questions, aiming to gain in-depth information about their perspectives. The data obtained from open-ended questions, which were designed to allow participants to express their thoughts freely and in detail, were analyzed using content analysis techniques, including categorical and frequency analysis. Results: The study results indicated that although the number of students taking courses related to telemedicine or telemedicine applications in their current medical education processes is quite low, nearly half of the students stated that they have at least a low level of knowledge about this subject. Specifically, 48.2% of the students reported having no knowledge of the telemedicine concept, while 33.4% indicated partial knowledge. Despite this, 67.8% of the students expressed that telemedicine should be included in the curriculum. Moreover, students who had taken a course related to telemedicine reported significantly more knowledge (M=3.74) compared to those who have not taken such a course but claim to have some knowledge (M=2.29) (F(1, 268) = 291.841, p < 0.01). These findings emphasize the necessity of including telemedicine education in the curriculum. Discussion: As medicine continues to incorporate telemedicine technologies into patient care, it is important for medical faculties to introduce students to the care methods they will use in the future, allowing them to analyze the advantages and disadvantages. The results of this study also showed that the majority of students are aware of the importance of telemedicine and its education. While the majority of students expressed positive views about the inclusion of telemedicine courses in the medical faculty curriculum, a significant portion also stated that it should be integrated into other courses. This indicates that students are interested in telemedicine and believe that it should be taught either as a separate course or integrated into other courses within the curriculum. Therefore, the curriculum should be updated to accommodate digitalization and telemedicine technologies. It is important to provide necessary education before graduation so that medical students, who will play a key role among future health professionals, are prepared for the digitalized health system. To achieve this, the curriculum should be updated to include courses that contribute to their digital competencies or integrate relevant achievements into other courses. Additionally, efforts should be increased and education provided to protect against risks associated with the use of telemedicine and its processes.

Diverse Contributing Body

In 1962, the CCCC released a report titled “The Freshman Whose Native Language is Not English.” In this report, the chair argued for separate courses dedicated to teaching language-diverse students and staffed by instructors specially trained in Linguistics. Paul Kei Matsuda (1999; 2013) argues that this moment marks the institutional divide between U.S. Composition and Applied Linguistics that would go on to create a vacuum of knowledgeable peers in Composition. This vacuum meant that new composition theories interested in language learning were not held accountable by scholarship in Applied Linguistics. If Matsuda’s assessment of this division of labour is correct, it begs the question: does the same division of labour exist in a Canadian context between Writing Studies and L2 writing? How have these two fields related historically, and what implications does this relationship (or lack thereof) have on the future of writing instruction in Canada’s increasingly language-diverse classrooms? The purpose of this paper is to construct a narrative of the history of the relationship between Writing Studies and L2 Writing as it pertains to one of Canada’s two writing organizations: the Canadian Association for Studies in Language and Literature, also known as Inkshed. To that end, this paper excavates the Inkshed newsletters and conference programs from 1980 onward for archival research elucidating any potential cross-pollination between Writing Studies and L2 Writing. To further explore the relationship between these two fields in Inkshed’s past, this research builds on the work of Miriam E. Horne who composes a rich picture of Inkshed’s development in her book, Writing in a Community of Practice: Composing Membership in Inkshed. The findings from this paper reveal that not only did Writing Studies and L2 Writing scholarship “cross-fertilize” during the tenure of Inkshed, these two fields remained closely linked through the decades. In other words, at the writing of this paper, there does not appear to have ever been an institutional division of labour between Writing Studies and L2 Writing in the Canadian context. Ultimately, these findings contribute to the broader narrative of how Writing Studies has professionalized in a Canadian context. They also contribute to the ongoing conversation regarding how writing instructors, writing program administrators, and writing centre professionals can best support culturally and linguistically diverse writers in Canadian classrooms. By drawing on this longstanding relationship with L2 Writing, Writing Studies scholars and practitioners are uniquely situated to move into the future of higher education equipped with language-based writing theories that are rooted in a community of knowledgeable L2 Writing peers.

Fractionated external-beam radiation therapy in elderly patients.

e13764 Background: To review the outcome of elderly patients treated with fractionated external-beam radiation therapy (RT) at a privately-owned, multi-disciplinary cancer center. Methods: From January 7, 2019, to August 22, 2023, 63 elderly patients were treated with fractionated RT at California Cancer Associates for Research and Excellence (“cCARE”), a privately-owned, multi-disciplinary cancer center in Fresno, California. The median age at the time of RT was 90 y/o (range, 85-98 y/o). Twenty-three patients were female and 40 were male. Forty-six patients identified as white and 17 as non-white. Treatment sites/histologies included primary lung 10, non-melanomatous skin 6, bone metastases 6, breast 5, esophagus 5, H&N 5, prostate 4, primary CNS 3, brain metastases 3, rectum 3, bladder 2, Merkel tumor 2, sarcoma 2, anus 1, liver 1, melanoma 1, multiple myeloma 1, NHL 1, pancreas 1 and stomach 1. Results: Thirty-two of the patients (51%) were treated with curative intent. The remaining 31 patients were treated for palliation. All patients were treated with fractionated RT. However, 4 patients also received a separate course of single-fraction RT. Twenty-seven patients received more than one course of RT. The median RT course was 10 fractions (range, 1-35 fractions). Most patients had previously been treated with systemic therapy. Nearly one third (31%) received systemic therapy concurrent with their RT. The majority of the patients (73%) completed their prescribed course(s) of RT. Many patients (61%) required one or more treatment breaks. The median duration of a treatment break was 1 day (range, 1-29 days). There were no grade 3 or higher RT toxicities recorded. The median follow-up since RT was 5 months (range, 1-59 months). Twenty-four patients have expired. The mediation duration from RT to death was 5 months (range, 1-32 months ). Of the remaining 39 patients, 92% were scored as clinically stable at the time of their last f/u visit. Conclusions: In our experience at cCARE, fractionated RT was administered to elderly patients and the majority completed their prescribed treatment courses. None of the patients in our review experienced clinically significant side effects (Grade 3 or higher) during their RT even in the cohort (31%) who were treated with concurrent systemic therapy. Clearly, careful patient selection and state-of-the-art RT administration is paramount. It is also highly advantageous for patients to be treated in a multi-disciplinary setting such as cCARE where seamless coordination of cancer care among radiation oncologists, medical oncologists and surgeons excels. A companion study is in process comparing the outcome of similarly matched elderly patients from our center who were treated with systemic therapy alone. We anxiously await the outcome of this vital comparison review.

Teachers’ knowledge and views on developing zero waste education within the sustainable development goals framework

The Zero Waste Project is a powerful tool for individuals to raise awareness about waste management and ensure sustainable development. Education is the key to disseminating the Zero Waste Project and raising awareness in individuals. Sustainable development has a complex structure with strong links to different fields. It is, therefore, crucial to consider the insights and perspectives of educators from diverse backgrounds on zero waste education within the context of a sustainable development framework. Thus, necessary arrangements can be made in line with the experiences and suggestions of these teachers, and the development of zero waste education can be facilitated. This study aims to reveal the knowledge and opinions of teachers about the development of zero waste education. This qualitative research was conducted with 20 teachers from different disciplines, including mathematics, science, social studies, and language teachers. The data was collected during the 2022-2023 academic year. The results revealed that teachers have limited knowledge about sustainable development and zero waste. Consequently, while all teachers concurred on the necessity of providing education on zero waste to students, teachers, and parents, they emphasized the importance of implementing this education as a separate course and utilizing novel methodologies. It is anticipated that the findings of this research will facilitate the development of zero-waste education within the context of sustainable development.

Enhancing active learning through collaboration between human teachers and generative AI

To address the increasing demand for AI literacy, we introduced a novel active learning approach that leverages both teaching assistants (TAs) and generative AI to provide feedback during in-class exercises. This method was evaluated through two studies in separate Computer Science courses, focusing on the roles and impacts of TAs in this learning environment, as well as their collaboration with ChatGPT in enhancing student feedback. The studies revealed that TAs were effective in accurately determining students’ progress and struggles, particularly in areas such as “backtracking”, where students faced significant challenges. This intervention’s success was evident from high student engagement and satisfaction levels, as reported in an end-of-semester survey. Further findings highlighted that while TAs provided detailed technical assessments and identified conceptual gaps effectively, ChatGPT excelled in presenting clarifying examples and offering motivational support. Despite some TAs’ resistance to fully embracing the feedback guidelines-specifically their reluctance to provide encouragement-the collaborative feedback process between TAs and ChatGPT improved the quality of feedback in several aspects, including technical accuracy and clarity in explaining conceptual issues. These results suggest that integrating human and artificial intelligence in educational settings can significantly enhance traditional teaching methods, creating a more dynamic and responsive learning environment. Future research will aim to improve both the quality and efficiency of feedback, capitalizing on unique strengths of both human and AI to further advance educational practices in the field of computing.

Early increase in HbA1c trajectory predicts development of severe microangiopathy in patients with type 1 diabetes: the VISS study

IntroductionTo study the HbA1c trajectory from the time of diagnosis to examine if patients at the greatest risk for severe microangiopathy can be identified early allowing clinicians to intervene as...

How Do Accounting Students Respond to Integrated Learning In Sustainability Accounting?

The aim of this research is to analyze the content of the curriculum and the messages conveyed by students in order to adapt the integrated curriculum for sustainability accounting courses. The research method used is content analysis which uses information from key informants as research data. In addition, a survey was conducted on sixty students taking social and environmental accounting courses. The sampling technique was carried out using simple random sampling. The results of the research are that sustainability accounting is considered important to be implemented in the accounting education curriculum at bachelor's and master's levels. Students are interested in sustainability accounting because it is a new paradigm in the field of accounting which focuses on social and environmental transactions. The main contribution of the research is aimed at improving the accounting study program curriculum to adopt sustainability accounting as a separate course following the development of the accounting profession.

Assessing Quality Variations in Early Career Researchers’ Data Management Plans

This paper aims to better understand early career researchers’ (ECRs’) research data management (RDM) competencies by assessing the contents and quality of data management plans (DMPs) developed during a multi-stakeholder RDM course. We also aim to identify differences between DMPs in relation to several background variables (e.g., discipline, course track). The Basics of Research Data Management (BRDM) course has been held in two multi-faculty, research-intensive universities in Finland since 2020. In this study, 223 ECRs’ DMPs created in the BRDM of 2020 - 2022 were assessed, using the recommendations and criteria of the Finnish DMP Evaluation Guide + General Finnish DMP Guidance (FDEG). The median quality of DMPs appeared to be satisfactory. The differences in rating according to FDEG’s three-point performance criteria were statistically insignificant between DMPs developed in separate years, course tracks or disciplines. However, using content analysis, differences were found between disciplines or course tracks regarding DMP’s key characteristics such as sharing, storing, and preserving data. DMPs that contained a data table (DtDMPs) also differed highly significantly from prose DMPs. DtDMPs better acknowledged the data handling needs of different data types and improved the overall quality of a DMP. The results illustrated that the ECRs had learned the basic RDM competencies and grasped their significance to the integrity, reliability, and reusability of data. However, more focused, further training to reach the advanced competency is needed, especially in areas of handling and sharing personal data, legal issues, long-term preserving, and funders’ data policies. Equally important to the cultural change when RDM is an organic part of the research practices is to merge research support services, processes, and infrastructure into the research projects’ processes. Additionally, incentives are needed for sharing and reusing data.

대학 교양으로서 일반생물학 수업에서 ‘기후 변화’ 교육

Climate change is an urgent and important problem that all humanity must solve. Therefore, it is indisputable that climate change education should be provided in universities, especially as part of liberal education. This study explored possible climate change education in biology. For this purpose, we analyzed the contents of the general biology curriculum in the general education curriculum and investigated and analyzed the topics of the general biology curriculum offered by public and private universities in the metropolitan area and local regions. As a result we came to the conclusion that general biology classes as a liberal arts subject must, in principle, include an ecology unit in the curriculum. However, most universities in Korea do not include this unit in their general biology curriculum. As a countermeasure, even if the entire ecology unit cannot be included in the curriculum for one or two semesters, the class can connect five to six topics related to climate change to other units. Otherwise, like some universities, there is a need to open a separate ecology course. Alternatively, other science courses that include climate change could be offered. In this case, though, guidance is needed for students to take the courses, and the need for climate change education for teachers in charge of course guidance remains an issue. In addition, various other liberal arts education subjects, including not only biology but also natural sciences, humanities, and social sciences, should also make such attempts to help solve the problem of climate change. Moreover, we propose adding content on climate change to the ‘Purpose of Liberal Education’ statement established by the Korea National Institute for General Education.

End-to-end Technologies in Medicine, Pharmacy, Biology

The article raises the topical issue of the use of end-to-end technologies for medicine, pharmacy, and biology. The analysis of the use of new technologies in these areas is carried out at the present time. The authors are looking for ways to solve the problem of teaching humanities and natural sciences at a medical university using the capabilities of modern technologies. A random sampling method using the capabilities of Goole forms was used to conduct a survey of 2nd year students of the medical university and teachers working with them. The level of training, the needs of students for new knowledge on modern end-to-end technologies, and the possibilities of implementing training programs are discussed. The survey showed that despite the widespread introduction of end-to-end technologies, the knowledge of students and teachers in this area is extremely limited. Students have a need to acquire new knowledge that can be applied in their future profession. Several solutions to the problem of teaching student’s new technologies and their practical application in medicine, pharmacy, and biology are proposed. The survey also showed that there are two possible options: 1) the introduction of a separate optional course into the curriculum; 2) teachers can talk about the possibilities of new technologies and their use during the study of the discipline. For effective teaching, teachers must improve their skills in a timely manner by taking courses. With an integrated approach, a quick and effective solution to the task is possible.

Rearranging equations to develop physics reasoning

Researchers generally agree that physics experts use mathematics in a way that blends mathematical knowledge with physics intuition. However, the use of mathematics in physics education has traditionally tended to focus more on the computational aspect (manipulating mathematical operations to get numerical solutions) to the detriment of building conceptual understanding and physics intuition. Several solutions to this problem have been suggested; some authors have suggested building conceptual understanding before mathematics is introduced, while others have argued for the inseparability of the two, claiming instead that mathematics and conceptual physics need to be taught simultaneously. Although there is a body of work looking into how students employ mathematical reasoning when working with equations, the specifics of how physics experts use mathematics blended with physics intuition remain relatively underexplored. In this paper, we describe some components of this blending, by analyzing how physicists perform the rearrangement of a specific equation in cosmology. Our data consist of five consecutive forms of rearrangement of the equation, as observed in three separate higher education cosmology courses. This rearrangement was analyzed from a conceptual reasoning perspective using Sherin’s framework of symbolic forms. Our analysis clearly demonstrates how the number of potential symbolic forms associated with each subsequent rearrangement of the equation decreases as we move from line to line. Drawing on this result, we suggest an underlying mechanism for how physicists reason with equations. This mechanism seems to consist of three components: narrowing down meaning potential, moving aspects between the background and the foreground and purposefully transforming the equation according to the discipline’s questions of interest. In the discussion section we highlight the potential that our work has for generalizability and how being aware of the components of this underlying mechanism can potentially affect physics teachers’ practice when using mathematics in the physics classroom.

Pseudomonas aeruginosa ventricular assist device infections: findings from ineffective phage therapies in five cases.

Left ventricular assist devices (LVAD) are increasingly used for management of heart failure; infection remains a frequent complication. Phage therapy has been successful in a variety of antibiotic refractory infections and is of interest in treating LVAD infections. We performed a retrospective review of four patients that underwent five separate courses of intravenous (IV) phage therapy with concomitant antibiotic for treatment of endovascular Pseudomonas aeruginosa LVAD infection. We assessed phage susceptibility, bacterial strain sequencing, serum neutralization, biofilm activity, and shelf-life of phage preparations. Five treatments of one to four wild-type virulent phage(s) were administered for 14-51 days after informed consent and regulatory approval. There was no successful outcome. Breakthrough bacteremia occurred in four of five treatments. Two patients died from the underlying infection. We noted a variable decline in phage susceptibility following three of five treatments, four of four tested developed serum neutralization, and prophage presence was confirmed in isolates of two tested patients. Two phage preparations showed an initial titer drop. Phage biofilm activity was confirmed in two. Phage susceptibility alone was not predictive of clinical efficacy in P. aeruginosa endovascular LVAD infection. IV phage was associated with serum neutralization in most cases though lack of clinical effect may be multifactorial including presence of multiple bacterial isolates with varying phage susceptibility, presence of prophages, decline in phage titers, and possible lack of biofilm activity. Breakthrough bacteremia occurred frequently (while the organism remained susceptible to administered phage) and is an important safety consideration.

Converting acoustical demonstrations into in-class experiments

Teaching acoustical principles to non-science students invites extensive use of classroom demonstrations to help clarify concepts. Ideally, a separate laboratory course opens up many more opportunities for active learning for improved student understanding. However, observing and hearing a demonstration is distinct from performing the activity directly. Moreover, the addition of a laboratory course impacts departmental teaching load and may impact enrollment. In this paper I will discuss laboratory and demonstration activities that have been converted into group activities that are implemented as a classroom activity. The opportunity to add these elements to the course hinge on being able to build or purchase a large number of replicas of equipment needed for the planned activities. The two examples I will discuss in detail are the use of two stringed monochords and pvc trumpets. In addition, I will share a simple mechanical demonstration based on vibrating bars to visualize the location dependent resonances of the basilar membrane.

From Private to Public: Using Authentic Audiences to Support Undergraduate Students’ Learning and Engagement

The purpose of this article is to explore the use of authentic audiences in higher education to support undergraduate learning. To explore the results of integrating authentic audiences in higher education, we present a collective case study in which the use of authentic audiences was employed in separate undergraduate courses at two different higher education institutions in the Eastern and Midwestern United States (N = 75). In one case, Wikipedia was employed as an authentic audience and in the other case, experienced secondary educators as well as Twitter were embedded. The goal of implementing authentic audiences in both settings and courses was to increase student engagement and foster critical thinking. Results suggest that integrating authentic audiences through these means can enhance undergraduate students’ engagement and learning and may serve to capture, but not necessarily foster, students’ critical thinking. Concurrently, an instructor’s pedagogy must also align with tenets associated with authentic audiences, including a commitment to a co-construction of knowledge and the purposeful selection of authentic audiences who are engaged, willing to partner, and have the necessary expertise and resources to contribute to students’ learning.

Liver toxicity following reirradiation and multiple-target SBRT for primary hepatocellular carcinoma.

514 Background: Stereotactic body radiation therapy (SBRT) is increasingly used to treat hepatocellular carcinoma (HCC), but its safety in the treatment of multiple synchronous or recurrent lesions is underreported. We aim to better characterize SBRT-related hepatic toxicity in this population. Methods: We conducted a retrospective analysis of patients with primary HCC who underwent SBRT for 2 or more synchronous or recurrent liver lesions. We collected patient characteristics and dosimetric data (mean liver dose, cumulative effective volume [Veff], cumulative volume of liver receiving 15Gy [V15Gy], and cumulative planning target volume [PTV]) along with liver-related toxicity (measured by albumin-bilirubin [ALBI] and Child-Pugh [CP] scores). We employed a linear mixed-effects model to assess the effect of multi-target SBRT on changes in ALBI. Results: There were 25 patients and 56 lesions with median follow-up of 29 months. Eleven patients had synchronous lesions and 14 had recurrent lesions treated with separate SBRT courses. Eight local failures occurred at a median of 8 months (range: 4 – 25 months) after SBRT. Among those receiving multiple SBRT courses, there were 7 lesions with overlap of V15Gy (median V15Gy overlap: 35mL, range: 0.5 – 388mL). There was no association between cumulative Veff, V15Gy, or PTV and change in ALBI. Four of 25 patients an increase of Child-Pugh (CP) score by ≥ 2 points, within 3 to 6 months after SBRT. Neither increase in CP nor ALBI were associated with cumulative Veff, V15Gy, and PTV. Comparing the groups that received SBRT in a single course versus multiple courses revealed no statistically significant differences in liver toxicity. Conclusions: LiverSBRT for multiple lesions in a single or in separate courses results in worsening of CP scores or ALBI in a small percentage of patients, suggesting a low risk of RILD. Prospective studies with a larger cohort are needed to better characterize safety in this population.

Anatomy of the pudendal nerve in clinically important areas: a pictorial essay and narrative review.

The pudendal nerve is an anatomical structure arising from the ventral branches of the spinal roots S2-S4. Its complex course may be affected by surrounding structures. This may result in irritation or entrapment of the nerve with subsequent clinical symptoms. Aim of this study is to review the anatomy of the pudendal nerve and to provide detailed photographic documentation of the areas with most frequent clinical impact which are essential for surgical approach. Major medical databases were searched to identify all anatomical studies investigating pudendal nerve and its variability, and possible clinical outcome of these variants. Extracted data consisted of morphometric parameters, arrangement of the pudendal nerve at the level of roots, formation of pudendal nerve, position according to sacrospinal and sacrotuberal ligaments and its terminal branches. One female cadaver hemipelvis was dissected with common variability of separate course of inferior rectal nerve. During dissection photodocumentation was made to record course of pudendal nerve with focus on areas with recorded pathologies and areas exposed to iatrogenic damage during surgical procedures. Narrative review was done to provide background for photodocumentation. Unique photos of course of the pudendal nerve was made in areas with great clinical significance. Knowledge of anatomical variations and course of the pudendal nerve is important for examinations and surgical interventions. Surgically exposed areas may become a site for iatrogenic damage of pudendal nerve; therefore, unique picture was made to clarify topographic relations.

Biochemical Safety of SBRT to Multiple Intrahepatic Lesions for Hepatocellular Carcinoma.

We aim to better characterize stereotactic body radiation therapy (SBRT)-related hepatic biochemical toxicity in patients with multiple intrahepatic lesions from hepatocellular carcinoma (HCC). We conducted a retrospective analysis of patients with HCC who underwent SBRT for 2 or more synchronous or metachronous liver lesions. We collected patient characteristics and dosimetric data (mean liver dose [MLD], cumulative effective volume [Veff], cumulative volume of liver receiving 15 Gy [V15Gy], and cumulative planning target volume [PTV]) along with liver-related toxicity (measured by albumin-bilirubin [ALBI] and Child-Pugh [CP] scores). A linear mixed-effects model was used to assess the effect of multi-target SBRT on changes in ALBI. There were 25 patients and 56 lesions with median follow-up of 29 months. Eleven patients had synchronous lesions, and 14 had recurrent lesions treated with separate SBRT courses. Among those receiving multiple SBRT courses, there were 7 lesions with overlap of V15Gy (median V15Gy overlap: 35 mL, range: 0.5-388 mL). There was no association between cumulative MLD, Veff, V15Gy, or PTV and change in ALBI. Four of 25 patients experienced non-classic radiation-induced liver disease (RILD), due to an increase of CP score by ≥2 points 3 to 6 months after SBRT. Sixteen of 25 patients experienced an increase in ALBI grade by 1 or more points 3 to 6 months after SBRT. Comparing the groups that received SBRT in a single course versus multiple courses revealed no statistically significant differences in liver toxicity. Liver SBRT for multiple lesions in a single or in separate courses is feasible and with acceptable risk of hepatotoxicity. Prospective studies with a larger cohort are needed to better characterize safety in this population.