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Kerner AM, Biedermann U, Bräuer L, Caspers S, Doll S, Engelhardt M, Filler TJ, Ghebremedhin E, Gundlach S, Hayn-Leichsenring GU, Heermann S, Hettwer-Steeger I, Hiepe L, Hirt B, Hirtler L, Hörmann R, Kulisch C, Lange T, Leube R, Meuser AH, Müller-Gerbl M, Nassenstein C, Neckel PH, Nimtschke U, Paulsen F, Prescher A, Pretterklieber M, Schliwa S, Schmidt K, Schmiedl A, Schomerus C, Schulze-Tanzil G, Schumacher U, Schumann S, Spindler V, Streicher J, Tschernig T, Unverzagt A, Valentiner U, Viebahn C, Wedel T, Weigner J, Weninger WJ, Westermann J, Weyers I, Waschke J, Hammer N. The chemicals between us-First results of the cluster analyses on anatomy embalming procedures in the German-speaking countries. ANATOMICAL SCIENCES EDUCATION 2023; 16:814-829. [PMID: 37183973 DOI: 10.1002/ase.2285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/16/2023]
Abstract
Hands-on courses utilizing preserved human tissues for educational training offer an important pathway to acquire basic anatomical knowledge. Owing to the reevaluation of formaldehyde limits by the European Commission, a joint approach was chosen by the German-speaking anatomies in Europe (Germany, Austria, Switzerland) to find commonalities among embalming protocols and infrastructure. A survey comprising 537 items was circulated to all anatomies in German-speaking Europe. Clusters were established for "ethanol"-, formaldehyde-based ("FA"), and "other" embalming procedures, depending on the chemicals considered the most relevant for each protocol. The logistical framework, volumes of chemicals, and infrastructure were found to be highly diverse between the groups and protocols. Formaldehyde quantities deployed per annum were three-fold higher in the "FA" (223 L/a) compared to the "ethanol" (71.0 L/a) group, but not for "other" (97.8 L/a), though the volumes injected per body were similar. "FA" was strongly related to table-borne air ventilation and total fixative volumes ≤1000 L. "Ethanol" was strongly related to total fixative volumes >1000 L, ceiling- and floor-borne air ventilation, and explosion-proof facilities. Air ventilation was found to be installed symmetrically in the mortuary and dissection facilities. Certain predictors exist for the interplay between the embalming used in a given infrastructure and technical measures. The here-established cluster analysis may serve as decision supportive tool when considering altering embalming protocols or establishing joint protocols between institutions, following a best practice approach to cater toward best-suited tissue characteristics for educational purposes, while simultaneously addressing future demands on exposure limits.
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Affiliation(s)
- Alexander Michael Kerner
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Uta Biedermann
- Institute of Anatomy I, University Hospital Jena, Jena, Germany
| | - Lars Bräuer
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Svenja Caspers
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Sara Doll
- Department of Anatomy and Cell Biology, Heidelberg University, Heidelberg, Germany
| | - Maren Engelhardt
- Institute of Anatomy and Cell Biology, Johannes Kepler University, Linz, Austria
| | - Timm J Filler
- Institute for Anatomy I, Medical Faculty & University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Stefanie Gundlach
- Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | | | - Stephan Heermann
- Institute for Anatomy and Cell Biology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Laura Hiepe
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Lena Hirtler
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | - Romed Hörmann
- Department of Anatomy, Histology and Embryology, Institute of Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Kulisch
- Institute of Functional Anatomy, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Lange
- Institute of Anatomy I, University Hospital Jena, Jena, Germany
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rudolf Leube
- Department of Anatomy and Cell Biology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Annika Hela Meuser
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | | | | | - Peter H Neckel
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Ute Nimtschke
- Institute of Anatomy, Technical University Carl Gustav Carus Dresden, Dresden, Germany
| | - Friedrich Paulsen
- Institute of Functional and Clinical Anatomy, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Prescher
- Department of Anatomy and Cell Biology, University Hospital RWTH Aachen University, Aachen, Germany
| | - Michael Pretterklieber
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Stefanie Schliwa
- Institute of Anatomy, Anatomy and Cell Biology, University of Bonn, Bonn, Germany
| | - Katja Schmidt
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Andreas Schmiedl
- Functional and Applied Anatomy, Hannover Medical School, Hannover, Germany
| | - Christof Schomerus
- Institute of Anatomy, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Gundula Schulze-Tanzil
- Institute of Anatomy and Cell Biology, Paracelsus Medical University, Nuremberg and Salzburg, Nuremberg, Germany
| | - Udo Schumacher
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Schumann
- Institute of Anatomy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Volker Spindler
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Johannes Streicher
- Department of Anatomy and Biomechanics, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Thomas Tschernig
- Institute of Anatomy and Cell Biology, Saarland University, Homburg, Germany
| | - Axel Unverzagt
- Chair of Vegetative Anatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Ursula Valentiner
- Institute of Anatomy and Experimental Morphology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Janet Weigner
- Institute of Veterinary Anatomy, Freie Universität Berlin, Berlin, Germany
| | - Wolfgang J Weninger
- Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
| | | | - Imke Weyers
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Jens Waschke
- Chair of Vegetative Anatomy, Institute of Anatomy, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology Dresden, Dresden, Germany
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Aung WY, Sakamoto H, Sato A, Yi EEPN, Thein ZL, Nwe MS, Shein N, Linn H, Uchiyama S, Kunugita N, Win-Shwe TT, Mar O. Indoor Formaldehyde Concentration, Personal Formaldehyde Exposure and Clinical Symptoms during Anatomy Dissection Sessions, University of Medicine 1, Yangon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020712. [PMID: 33467564 PMCID: PMC7830549 DOI: 10.3390/ijerph18020712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/10/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022]
Abstract
The formaldehyde (FA) embalming method, the world's most common protocol for the fixation of cadavers, has been consistently used in medical universities in Myanmar. This study was designed to examine the indoor FA concentrations in anatomy dissection rooms, an exposed site, and lecture theater, an unexposed control site, and to access personal exposure levels of FA and clinical symptoms of medical students and instructors. In total, 208 second year medical students (1/2019 batch) and 18 instructors from Department of Anatomy, University of Medicine 1, participated. Thirteen dissection sessions were investigated from February 2019 to January 2020. Diffusive sampling devices were used as air samplers and high-performance liquid chromatography was used for measurement of FA. Average indoor FA concentration of four dissection rooms was 0.43 (0.09-1.22) ppm and all dissection rooms showed indoor concentrations above the occupational exposure limits and short-term exposure limit for general population. Personal FA exposure values were higher than indoor FA concentrations and the instructors (0.68, 0.04-2.11 ppm) had higher exposure than the students (0.44, 0.06-1.72 ppm). Unpleasant odor, eye and nose irritations and inability to concentrate were frequently reported FA-related symptoms, and the students were found to have significantly higher risks (p < 0.05) of having these symptoms during the dissection sessions than during lecture.
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Affiliation(s)
- Win-Yu Aung
- Department of Physiology, University of Medicine 1, Yangon 11014, Myanmar; (W.-Y.A.); (E.-E.-P.-N.Y.); (Z.-L.T.); (O.M.)
| | - Hironari Sakamoto
- Faculty and Graduate School of Engineering, Chiba University, Chiba 263-8522, Japan; (H.S.); (A.S.); (S.U.)
| | - Ayana Sato
- Faculty and Graduate School of Engineering, Chiba University, Chiba 263-8522, Japan; (H.S.); (A.S.); (S.U.)
| | - Ei-Ei-Pan-Nu Yi
- Department of Physiology, University of Medicine 1, Yangon 11014, Myanmar; (W.-Y.A.); (E.-E.-P.-N.Y.); (Z.-L.T.); (O.M.)
| | - Zaw-Lin Thein
- Department of Physiology, University of Medicine 1, Yangon 11014, Myanmar; (W.-Y.A.); (E.-E.-P.-N.Y.); (Z.-L.T.); (O.M.)
| | - Myint-San Nwe
- Department of Anatomy, University of Medicine 1, Yangon 11014, Myanmar; (M.-S.N.); (N.S.); (H.L.)
| | - Nanda Shein
- Department of Anatomy, University of Medicine 1, Yangon 11014, Myanmar; (M.-S.N.); (N.S.); (H.L.)
| | - Htin Linn
- Department of Anatomy, University of Medicine 1, Yangon 11014, Myanmar; (M.-S.N.); (N.S.); (H.L.)
| | - Shigehisa Uchiyama
- Faculty and Graduate School of Engineering, Chiba University, Chiba 263-8522, Japan; (H.S.); (A.S.); (S.U.)
- Department of Environmental Health, National Institute of Public Health, Saitama 351-0197, Japan
| | - Naoki Kunugita
- School of Health Sciences, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan;
| | - Tin-Tin Win-Shwe
- Center for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba-City 305-8506, Japan
- Correspondence: ; Tel.: +81-29-850-2542
| | - Ohn Mar
- Department of Physiology, University of Medicine 1, Yangon 11014, Myanmar; (W.-Y.A.); (E.-E.-P.-N.Y.); (Z.-L.T.); (O.M.)
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