Anatomy Education and Classroom Versus Laparoscopic Dissection-Based Training: A Randomized Study at One Medical School

Purpose Anatomy education on embalmed specimens is presumed to have added educational value. However, although embalmed specimens have been used for anatomy education for years, there is little evidence on the added educational value of dissection-based teaching. The objective of this randomized study is to examine the added value of dissection-based teaching, using models of the inguinal region in embalmed specimens. Method In 2011, medical students at Erasmus Medical Center, The Netherlands, were randomly assigned to three groups. Group I attended lectures, group II attended dissection-based training using laparoscopic dissection models, and group III attended lectures as well as dissection-based laparoscopic training. To assess the improvement of anatomical knowledge, all students had to complete a practical test before, immediately after, and two weeks after training. Data were analyzed with mixed modeling. Results Forty-six students participated in this study. No significant difference in results was observed among the three groups before the start of training. Immediately after the course, groups II and III scored significantly higher than group I (P < .001; P < .001), and group II scored higher than group III (P = .009). The difference between group I and groups II and III persisted during follow-up (P = 012; P = .001). The difference between groups II and III disappeared. Conclusions Three-dimensional anatomy education with dissection models enhances anatomy learning by medical students. Students who received dissection-based training scored higher in the short- and long term compared with students who did not receive this type of education

Intérêt de la mesure de l'inflammation en clinique dans l'asthme.

peer reviewe

Analyse de l’expectoration induite dans l’asthme réfractaire

peer reviewedInduction of sputum by inhalation of hypertonic or isotonic fluid makes possible the safe and noninvasive harvesting of airway cells from patients with asthma, regardless of disease severity. Analysis of sputum cells has helped to identify different phenotypes of refractory asthma and shown that such asthma can be eosinophilic, neutrophilic, or both. Elevated eosinophil levels in sputum indicate a risk of exacerbation if the corticosteroid dose is reduced in stabilized patients. Surveillance of eosinophilia levels as an indicator for corticosteroid adjustment in refractory asthma makes it possible to reduce the frequency of severe exacerbations

Timing of metamorphosis and the onset of the negative feedback loop between the thyroid gland and the pituitary is controlled by type II iodothyronine deiodinase in Xenopus laevis

Two important features of amphibian metamorphosis are the sequential response of tissues to different concentrations of thyroid hormone (TH) and the development of the negative feedback loop between the pituitary and the thyroid gland that regulates TH synthesis by the thyroid gland. At the climax of metamorphosis in Xenopus laevis (when the TH level is highest), the ratio of the circulating precursor thyroxine (T(4)) to the active form 3,5,3′-triiodothyronine (T(3)) in the blood is many times higher than it is in tissues. This difference is because of the conversion of T(4) to T(3) in target cells of the tadpole catalyzed by the enzyme type II iodothyronine deiodinase (D2) and the local effect (cell autonomy) of this activity. Limb buds and tails express D2 early and late in metamorphosis, respectively, correlating with the time that these organs undergo TH-induced change. T(3) is required to complete metamorphosis because the peak concentration of T(4) that is reached at metamorphic climax cannot induce the final morphological changes. At the climax of metamorphosis, D2 expression is activated specifically in the anterior pituitary cells that express the genes for thyroid-stimulating hormone but not in the cells that express proopiomelanocortin. Physiological concentrations of T(3) but not T(4) can suppress thyrotropin subunit β gene expression. The timing and the remarkable specificity of D2 expression in the thyrotrophs of the anterior pituitary coupled with the requirement for locally synthesized T(3) strongly support a role for D2 in the onset of the negative feedback loop at the climax of metamorphosis

Inhaled and Systemic Corticosteroid Response in Severe Asthma Assessed by Alveolar Nitric Oxide:a randomised crossover pilot study of add-on therapy

AIMS: Alveolar nitric oxide (CA(NO)) is a potential biomarker of small airway inflammation. We investigated effects on CA(NO) of the addition of coarse and fine particle inhaled corticosteroids to standard therapy in severe asthma. METHODS: Severe asthmatics taking ≥1600 µg day(−1) budesonide or equivalent performed a randomized open-label crossover study. Subjects with FEV(1) < 80%, gas trapping and CA(NO)≥2 ppb entered a 6 week dose-ramp run-in of fluticasone/salmeterol(FPSM) 250/50 µg twice daily for 3 weeks, then 500/50 µg twice daily for 3 weeks. Patients then received additional HFA-beclomethasone diproprionate (BDP) 200 µg twice daily or FP 250 µg twice daily for 3 weeks in a crossover. Participants then received prednisolone(PRED) 25 mg day(−1) for 1 week. Nitric oxide, lung function, mannitol challenge, systemic inflammatory markers and urinary cortisol were measured. RESULTS: Fifteen completed per protocol: mean (SD) age 51 (12) years, FEV(1) 58 (13)% predicted, residual volume 193 (100)% predicted and mannitol(PD10) 177 (2.8) µg. There was no significant difference between FPSM and add-on therapy for CA(NO). FPSM/BDP and FPSM/PRED suppressed broncial flux (Jaw(NO)) and FE(NO) compared with FPSM alone, but there was no significant difference between FPSM/BDP and FPSM/FP. ECP, e-selectin and ICAM-1 were suppressed by FPSM/PRED compared with FPSM and FPSM/FP but not FPSM/BDP. Plasma cortisol was significantly suppressed by FPSM/PRED. CONCLUSION: In severe asthma, CA(NO) is insensitive to changes in dose and delivery of inhaled corticosteroids and is not suppressed by systemic corticosteroids. Additional inhaled HFA-BDP reduced FE(NO) and Jaw(NO) without adrenal suppression. There was a trend to reduction in FE(NO) and Jaw(NO) with additional FP but this did not reach statistical significance. PRED reduced FE(NO) and Jaw(NO) with suppression of systemic inflammatory markers and urinary cortisol