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12 I ЭКСПЕРИМЕНТАЛДЫ ЖЗНЕ КЛИНИКАЛЫК, ЗЕРТТЕУЛЕР
UDC: 614.2:378.661:001.89
PALMERINI MARIA GRAZIA1, GULMIRA ZHURABEKOVA2, YELTAY RAKHMANOV24, ARU BALMAGAMBETOVA2, SAPARGALI RAKHMANOV2, ALBORE MARCO1, CERQUOZZI FEDERICA1, COCCIA ALBERTO1, DE BERARDINIS LUCA1, MARCHETTI GIORGIA1, STEFANIA ANNARITA NOTTOLA3 AND MACCHIARELLI GUIDO1.
THE COOPERATION AGREEMENT BETWEEN THE UNIVERSITY OF L'AQUILA, ITALY AND THE MARAT OSPANOV WEST-KAZAKHSTAN STATE MEDICAL UNIVERSITY, THE REPUBLIC OF KAZAKHSTAN: A SUCCESSFUL STORY FROM ACADEMY TO BENCH
'University of L'Aquila, L'Aquila, Italy 2West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan 3La Sapienza University, Rome, Italy 4Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Department of Life, Health and Environmental Sciences project, activated in the framework of the
Palmerini Maria Grazia- PhD e-mail: [email protected]; | Cooperation Agreement, was finalized to
Macchiarelli Guido- MD, Professor; ^ _ .
§ study the female reproductive toxicity, Albore Marco, Cerquozzi Federica, \
Coccia Alberto, De Berardinis Luca, | with a morphological approach, of one
Marchetti Giorgia- Students; ^ of the most persistent pesticide found in
Department of Normal and Topographical Anatomy I the Aral Sea area, the y-exachloroexane
Gulmira Zhurabekova - MD, PhD, e-mail:[email protected]; ^ ,. , , , . „ .
, ^ js or Lindane. Thank to the use of Scanning
Aru Balmagambetova - PhD Candidate; §
Sapargali Rakhmanov- MD, PhD; | Electron Microscopy and Transmission
Department of Normal and Topographical Anatomy, Department of Orthopaedics ^ Electron Microscopy of the Centre for
Yeltay Rakhmanov- PhD Candidate; I Electron Microscopies, University of
Department of Anatomy, Histology, Forensic Medicine and Orthopaedics § , . _,
^ .. § L'Aquila and the Laboratory of Electron Stefania Annarita Nottola - MD, PhD, Professor. §
^ Microscopy "Pietro Motta", La Sapienza
THE HISTORY OF COOPERATION ^ two Universities was welcomed by the ^ University of Rome, it have been producing
BETWEEN THE UNIVERSITY OF L'AQUILA ^ Italian counterpart and both parties ^ evidences of the dose-dependant harmful
AND THE MARAT OSPANOV WEST- ^ started the academic and bureaucratic ^ effects against granulosa cells and oocytes
KAZAKHSTAN STATE MEDICAL UNIVERSITY. | process that, after two visits of the Italian | in mammals. Part of results has been used
The Cooperation Agreement Coordinator to Aktobe, leaded to signing for an undergraduate thesis and a PhD
between the University of L'Aquila | the Agreement in 2013. After almost | dissertation. The study is still ongoing but
(L'Aquila, Italy) and the Marat Ospanov ^ three years from the official signature, ^ preliminary results have been diffused
West-Kazakhstan State Medical University | the balance of past, ongoing and future | to national (Italian) and international
(Aktobe, Kazakhstan) was signed on planned education and research activities Congresses as oral communication and
June 2013, to further development of | is certainly positive. | poster presentations. Manuscripts to be
the cooperation in accordance with submitted in peer reviewed journals are
RESEARCH ACTIVITIES UNDER THE a mutual interest in a program of | | in preparation.
X AGREEh/IEMT
academic exchange, and for the purpose
of establishing a long-term mutually | During the spring-summer of 2014, | EDUCATION ACTMTIES UNDER THE beneficial association. Instituted with the | the first exchange program foreseen the | AGREEMENT
spirit to promote education and research, I research mobility from Kazakhstan to I The ^aff member mobility from
the Cooperation Agreement involves the | Italy. An academic staff member and a 1 ^"a t0 Aktobe occurred twice in
exchange of academic staff members and | PhD student of the Marat OspanoV West- | 2013 and 2014. The Coordrnator of the students. | Kazakhstan State Medica| University I Agreement visited the Marat Ospanov
Preliminary and fruitful contacts I spent three months of research internship | West-Kazakhstan State Medical University
were previously initiated by Kazakh to the Laboratories of Reproductive for the purposes to participate
academic and student members, visitors | Biotechnology, University of L'Aquila. | congresses, for education and to present to the University of L'Aquila during | The research topic focused on one of the | research topics to Kazakh students and 2012, within the framework of Erasmus | most dramatic environmental problems, | academic staffs, also published on the
Mundus TOSCA Program and "Bolashaq" | the desiccation of the Aral Sea, which | issue 1/41/2013 of the Medical Journal of International Scholarship of the President | is having serious effects on the human | West Kazakhstan.
of the Republic of Kazakhstan. The will I health due to the consequent abuse of | The mobility from |taly to to create an Agreement between the I pesticides for agricultural purposes. The | Kazakhstan started in 2015 and involved
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the participation of five undergraduate medical students of the University of L'Aquila. They were enrolled in a human dissection course organized in Aktobe from May 18th to 29th, providing theoretical and practical parts, according to the general program described in the following table.
In detail, the introductory lecture was presented by Prof. Lyubov Ivanova and focused on anatomical studies, dissecting practices, type and use of dissection tools. The hands-on approach on the cadaver started with the first incision on the skin and its separation from underlying connective tissues,
starting from the proximal part of the upper limb, by using surgical forceps, to keep flap of skin, and the scalpel, to separate the internal face of the skin layer (epidermis and dermis) from the deeper subcutaneous tissue. Muscles and other connective tissues were exposed.
The region of the head was studied by means of brain prosection, after scalp and skull removal to show the underlying brain and its meningeal envelopes. After separation of the dura mater and arachnoid mater, brain gyri and sulci were revealed. The pia mater was strongly linked to the brain surface and, indeed, not dissectible. Then, eyes and oral
cavity were studied in detail. A lecture on brain vascularization, especially about the Willis' circle completed the study program. Students could, then, identify by themselves major cerebral vessels, appreciate the morphological differences between arteries and veins (size, colour, texture and course) and separate meninges from the underlying parenchyma using anatomical forceps. They also experienced a cutting tool usually used to cut the soft tissues, the encephalotome. Frontal, sagittal and transversal cuts were made to analyze corpus callosum, basal nuclei and brain ventricles but also the cerebellum, with a
Day Time Subjects.
1 09.00-09.30 Introduction. Theoretical part (presentation of theme).
09.30-12.30 Practical part. Organization of dissection (general guidelines- work place, instruments, method and technique of dissection).
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. Stages of dissection process. Application of cuts, dissection of skin flaps. Isolation of surface and deep neurovascular elements depending on their relationships with the fascia, muscles, skeleton parts within certain areas of the human body.
2 09.00-09.30 Regions of head. Theoretical part (presentation of theme).
09.30-12.30 Practical part. Exposure of vessels and nerves of the region of the head. Topographic and anatomical reasoning of cuts areas on face in purulent processes.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. The procedure and technique of prosection the brain. Exposure of meninges. Sulci and gyri of surfaces and base of the brain, cerebral nerves.
3 09.00-09.30 Theoretical part (presentation of theme).
09.30-12.30 Practical part. Resection of brain stem, cerebellum, diencephalon, finding their connections.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. Resection of brain (mid-sagittal, frontal, horizontal). Detection of anatomical structures of gray and white matter of the telencephalon. Approaches and research the systems of cavities (ventricles).
4 09.00-09.30 Regions of neck. Theoretical part (presentation of theme).
09.30-12.30 Practical part. Exposure of the content of triangles of the neck (practical relevance). Detection and dissection of the main vascular nerve tract of neck.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. Exposure and dissection of the larynx. Topographic and anatomic study of approaches in tracheostomy, abscesses and phlegmon of the neck, ligation of the arteries.
5 09.00-09.30 Regions of chest and back. Theoretical part (presentation of theme).
09.30-12.30 Practical part. The procedure and technique of prosection of breast. Detection and operative exploration of derivatives of the pleura. Exposure of neurovascular tracts of intercostal nerves.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. Isolation of the content of the lung hilum. Exposure and dissection of structural elements of bronchial tree.
6 09.00-09.30 Theoretical part (presentation of theme).
09.30-12.30 Practical part. Defining the boundaries and contents of the mediastinum. Exposure of the major vessels of the heart and aortic arch branches. Prosection of chambers, examination of cardiac valvular apparatus. Exposure and dissection of the coronary arteries and their variant anatomy.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. Exposure and dissection of vessels and nerves of the dorsal soma.
Медицинский журнал Западного Казахстана
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7 09.00-09.30 The abdominal region. Theoretical part (presentation of theme).
09.30-12.30 Practical part. The procedure and technique of prosection the abdominal cavity. Detection and inspection derivatives of peritoneum, visualization of the organs relationship to the peritoneum.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. Prosection of lesser omentum and exposure of the content of the porta hepatis. Exposure and dissection of tubular structures of the hepatobilioduodenal zone and their variant anatomy.
8 09.00-09.30 Theoretical part (presentation of theme).
09.30-12.30 Practical part. Resection of blind intestine, consideration of options of the appendix location.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part.Isolation and dissection of the parietal and visceral (paired and unpaired) branches of the abdominal aorta.
9 09.00-09.30 Cavitas pelvis. Theoretical part (presentation of theme).
09.30-12.30 Practical part. Determination of topographic and anatomic features of the pelvis. Prosection of the urinary bladder and rectum.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. Prosection of the isolated complex containing the uterus, fallopian tubes, ovaries and their appendages. Isolation of the ligamentous apparatus of the uterus.
10 09.00-09.30 Theoretical part (presentation of theme).
09.30-12.30 Practical part. Sagittal section of the pelvis. Detection and dissection of branches of the sacral plexus.
13.30-14.00 Theoretical part (presentation of theme).
14.00-17.00 Practical part. Exposure and dissection of vascular fascicles of pelvis, variant anatomy of the arteria obturatoria.
17.00 CONCLUSION.
special attention to its nuclei. Dissection went on by studying the neck, its fascias and cranial nerves.
Different muscles of the neck were identified after platysma and sternocleidomastoid muscles removal. Suprahyoid and infrahyoid muscles were finally identified.
Dissection moved on the respiratory system. After separating the lungs from two main bronchi, by making two cuts at the hilar level, trachea and larynx were dissected to show the internal surface. The bronchial tree was separated from the parenchyma and pulmonary vessels. During dissection, a non pathological cavity, defined as "anatomical variation", was found in one of the lungs. Attention was, then, paid to isolating bronchial tissue from parenchyma in a proximal-to-distal direction to show tissue changing from cartilaginous to fibro-elastic structure.
After a brief note about the anatomy of the abdominal cavity, dissection focused to the trunk. A trunk preparate was opened from its anterior wall to expose the abdominal cavity. Aortic branches (Coeliac trunk, Lumbar
and Genital arteries) were isolated and ^ the kidney hilum structures analyzed. ^ ^ The main abdominal aortic branches ^ were found, then individuating the ^
^ coeliac trunk (in the absence of the usual i| common hepatic artery) and the origin of the ovarian artery from the superior ^ mesenteric artery. ^
^ In the last days, the human dissection ^ course foreseen the study of the anterior and posterior tight cavities, anatomical regions including Scarpa's triangle, thigh vascularization. The evident anastomosis in the retro-pubic space, the so called
^ Iliac artery or the inferior epigastric artery i| with the obturator artery, was shown. Clinically, this is relevant to orthopedic ^ surgery. Students removed the fascia lata ^ that, in median position, specialises into the fascia cribrosa. At this level, it was possible to follow the deepest course of several blood vessels, like the great saphenous vein ending in the femoral vein. After the Sartorius removal, the ^ Hunter's canal was dissected to identify ^ the femoral artery and femoral vein continuing into the popliteal cavity. The
^ origin of two hepatic arteries from the ^
r.......
s with the obturator artery, was shown.
^ Corona Mortis, between either external ^ ^ Iliac artery or the inferior epigastric artery ^
posterior side of the thigh was dissected by a median cut from the middle of the buttock until a trasversal cut under the crease of the knee. Cutaneus and subcutaneus tissues were removed and muscles (both the caput lateralis of the biceps femoris and the semitendinosus muscle) were cleaned by their fascia. The two muscles were separated to show the sciatic nerve and isolate its branches from their fascia, from the buttock until the superior angle of the popliteal fossa. Finally, the femoral artery and the femoral vein, coming out from the Hunter's canal were isolated.
The theoretical lecture about knee vascularization and its complicated anastomosis, anticipated the dissection of the knee joint, popliteal cavity, posterior leg and foot. The posterior aspect of the knee was analyzed by dissecting, from superficial to deep, different structures composing the popliteal cavity, as tibial nerve, common peroneal nerve, popliteal arteries and veins and popliteal lymph nodes. The clinical meaning of Lisfranc and Chopart joints were illustrated. Finally, the structure of the heart and the coronary system were observed, after the
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Батыс Казахстан медицина журналы
Figure 1. Moments of the practical and theoretical sessions of the human dissection course, held in Aktobe (Kazakhstan) on May 2015.
lecture of Professor Sapargali Rakhmanov about the Thebesian veins, formed by many sinusoidal vessels that end up, through small orifices, into the nearest cardiac chamber. These vessels have an important clinical application, because they reduce the risk of an infarction where they result patent by allowing a myocardial blood supply directly from the cardiac chambers. Each student could was allowed to practice on a sheep heart. After
removal of the parietal pericardium, from ^ apex to base, the underlying tissue was
^ exposed and coronary arteries dissected. ^
^ Ventricular and atrial chambers were ^ ^ opened to highlight the conus arteriosus ^ ^ of the pulmunary trunk, atrioventricular ^
^ valves and chordae tendineae. ^
CONCLUSIVE REMARKS AND
FUTURE PERSPECTIVES.
Students participating to the ^ first human dissection course were ^
enriched by this precious and invaluable opportunity for their future career as physicians. They also appreciated the kind hospitality reserved for them during the two weeks in Aktobe, which allowed them to make a unique and unforgettable cultural exchange.
On November 17th, 2015 the Coordinator of the Agreement organized in L'Aquila the 6th International Seminar entitled "From Internship to Research: the
Медицинский журнал Западного Казахстана
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ЭКСПЕРHМЕНТАA4bI ®9HE KAHHHKÄAbl^ 3EPTTEyAEP
Figure 3. The 6th International Seminar, University of LAquila, November 17th, 2015.
Bilateral Projects of Anatomy@Univaq" ^ morphological study on the reproductive ¡|
with the purpose of diffusing, among ^ toxicity of major pesticide found in the ^
students and academic staff members, | Aral Sea will also include an experimental |
the products of research and education | part in vivo that will be made in the next |
activities under Agreements. The Kazakh ^ years in Kazakhstan. Coordinator of the Agreement joined ^ Thank to this
Cooperation ^
the Seminar to presented data on the | Agreement, cultural, academic and |
H scientific exchanges between the two ^
research made under the Agreement.
Future planned activities under ^ countries will surely be enhanced with ||
the Agreement will include: a) the ^ great mutual benefits.
second dissection course for the Italian ^
AKNOWLEDGEMENTS.
Inverardi and the Rector of the Marat Ospanov West-Kazakhstan State Medical University, Prof. Yerbol Bekmukhambetov for having believed and sustained the Cooperation Agreement. The Authors acknowledge the Pro-Rector for the Internationalization, Prof. Anna Tozzi and the staff of the International Relation Office, University of L'Aquila, coordinated by Dr. Fausta Ludovici for their continuous and invaluable help.
students, which will be held on March ^
2016 in Aktobe and b) the Kazakh student |
. .... . .. . , , .. ... -p. ^ the University of L'Aquila, Prof. Paola
mobility in Italy for research activities. The ^
Special thanks to the Rector of ^
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