Teambasert læring – en studentaktiviserende og lærerstyrt undervisningsform

Sammendrag Bakgrunn: Studentaktiviserende undervisning er viktig for å oppnå god læring. I teambasert læring (TBL) aktiviseres studentene individuelt, gruppevis og i plenum under ledelse av faglærer. TBL er i liten grad prøvd ut og evaluert i medisinsk utdanning i Norge. Vi ville derfor undersøke hvorvidt TBL kan være egnet som undervisningsform i grunnutdanningen av leger. Materiale og metode: Vi arrangerte TBL i generell patologi for andreårs medisinstudenter i 2013 og 2014. TBL-sesjonen varte i tre timer og inkluderte individuell og gruppevis oppvarmingstest, gruppearbeid, plenumsdiskusjon og oppsummering fra faglærer. Svarene på oppgavene ble samlet inn for å sammenlikne individuelle og gruppevise prestasjoner på testene. Studentene ble også bedt om å evaluere undervisningen. Resultater: Gruppenes prestasjoner var bedre enn eller like gode som 84 % (2013) og 72 % (2014) av de individuelle prestasjonene. TBL ble av studentene oppfattet som en engasjerende og lærerik undervisningsform som egner seg til oppsummering og som tilbakemelding på eget kunnskapsnivå. Til tross for at tidsbruken ble beskrevet som unødvendig lang, var studentene tydelige på at TBL burde integreres i medisinstudiet. Fortolkning: Vi anbefaler TBL som undervisningsform i grunnutdanningen i medisin

Trends in forensic autopsy rates in Central Norway during the period 2007–2017: Can media attention impact autopsy practices?

The knowledge base regarding the frequency of forensic autopsies is limited. A Norwegian study investigated the practice of forensic autopsies in two neighbouring counties in Central Norway, Sør-Trøndelag and Nord-Trøndelag, in 2007–2009. This study revealed low autopsy rates for several manners of death and substantial regional differences. In 2013 the findings from this study received attention in Norwegian national media. The aim of our study was to evaluate the impact of this media attention by investigating the forensic autopsy rates in the same two counties over the time period 2007–2017, and, in particular, comparing the autopsy rates before and after the media attention in 2013. Data was retrieved anonymously from the Norwegian Cause of Death Registry, and analysed using the Chi square test. We found that the media attention in 2013 may have had a temporary effect on the forensic autopsy rates in Nord-Trøndelag, but overall there has been no noteworthy or lasting impact in either of the counties, and regional differences remain. The total forensic autopsy rate for unnatural deaths has declined from 40 % to 30 % over the time period 2007–2017, which is neither adequate nor in accordance with national legislation

Neuron-Specific Enolase as an Immunohistochemical Marker Is Better Than Its Reputation

The diagnosis of neuroendocrine neoplasms (NENs) may be challenging and is based on typical morphological features and positive staining for antibodies of neuroendocrine differentiation. Neuron-specific enolase (NSE) being a cytosolic marker may be useful in this setting. NSE is by many considered nonspecific, due to the finding of this marker in tumors considered not to be of neuroendocrine origin. Our aim was to determine whether this is true and whether NSE is more specific than previously realized. We examined 178 tumors (carcinomas and NENs) from breast, lung, stomach, and kidney using immunohistochemistry with the following markers: chromogranin A, synaptophysin, CD56, secretagogin, and NSE. Expression of NSE was compared with that of the other markers. NSE was expressed in 138 (78%) of all tumors. Of the NSE-expressing tumors, 95 (68%) cases expressed one or more additional neuroendocrine markers. The staining intensity and number of NSE-expressing tumor cells were highest among tumors of neuroendocrine origin and clear cell renal cell carcinomas. A positive association was found between NSE expression and the number of additional neuroendocrine markers expressed in each of the tumors. Practically all tumors positive for an accepted neuroendocrine marker also expressed NSE

Expression of erythropoietin and neuroendocrine markers in clear cell renal cell carcinoma

The aim of the study was to investigate the expression of erythropoietin and neuroendocrine markers in clear cell renal cell carcinoma (CCRCC). We retrospectively reviewed the medical records and re-evaluated histopathological specimens of 33 patients with CCRCC and compared with those of 11 cases of non-CCRCC. All patients were treated with a partial or radical nephrectomy at St. Olavs Hospital, Trondheim University Hospital, between 2010 and 2016. Thirty-three patients who were diagnosed with CCRCC had a total of 35 tumours, where 34 of the tumours were CCRCC and one was papillary adenoma. Thirty-three (97%) of 34 CCRCCs were positive for erythropoietin, and the same 33 (97%) tumours demonstrated strong expression for neuron-specific enolase (NSE). Two (6%) of 34 CCRCCs had a positive reaction for synaptophysin, and three (9%) of 34 were positive for CD56. Erythropoietin and NSE were negative in non-CCRCCs, and chromogranin A was negative in all tumours. The above findings suggest that there is a strong association between CCRCC and the expression of erythropoietin and NSE

Expression of the Cholecystokinin-B Receptor in Neoplastic Gastric Cells

Gastric cancer is an important disease due to its high mortality. Despite the decline in frequency, most cases are discovered late in its course, and most of the cancer patients die within a few years of diagnosis. In addition to Helicobacter pylori gastritis, gastrin is considered an important factor in the development of this disease, and thus, cholecystokinin-B receptor (CCKBR) becomes of interest. The aim of our study was to explore whether CCKBR is expressed in stomach cancers. Thirty-seven tumors from 19 men and 18 women diagnosed with either adenocarcinoma or neuroendocrine neoplasm (NENs) were included in this study. The tumors were classified into 29 adenocarcinomas and eight NENs. Immunohistochemistry with antibodies against chromogranin A (CgA), synaptophysin and CCKBR, and in situ hybridization with probes against CgA, CCKBR and histidine decarboxylase were used to further explore these tumors. Thirty-three (89%) of the tumors expressed CCKBR protein, whereas only 20 (54%) of all tumors expressed CCKBR mRNA. Of the 20 tumors expressing CCKBR mRNA, eight were NENs and 12 were adenocarcinoma. The highest amount of CCKBR was expressed in NEN. Interestingly, a high degree of co-expression of CCKBR and CgA was observed when the two markers were examined together with in situ hybridization. In conclusion, we found that all eight NENs expressed CCKBR and neuroendocrine markers in a majority of tumor cells. The same markers were also expressed in a proportion of adenocarcinomas supporting the view that gastrin is important in the development of gastric cancer

Dynamics of immune effector mechanisms during infection with Mycobacterium aviumin C57BL/6 mice

Opportunistic infections with non-tuberculous mycobacteria such as Mycobacterium avium are receiving renewed attention because of increased incidence and difficulties in treatment. As for other mycobacterial infections, a still poorly understood collaboration of different immune effector mechanisms is required to confer protective immunity. Here we have characterized the interplay of innate and adaptive immune effector mechanisms contributing to containment in a mouse infection model using virulent M. avium strain 104 in C57BL/6 mice. M. avium caused chronic infection in mice, as shown by sustained organ bacterial load. In the liver, bacteria were contained in granuloma-like structures that could be defined morphologically by expression of the antibacterial innate effector protein Lipocalin 2 in the adjoining hepatocytes and infiltrating neutrophils, possibly contributing to containment. Circulatory antimycobacterial antibodies steadily increased throughout infection and were primarily of the IgM isotype. Highest levels of interferon-c were found in infected liver, spleen and serum of mice approximately 2 weeks post infection and coincided with a halt in organ bacterial growth. In contrast, expression of tumour necrosis factor was surprisingly low in spleen compared with liver. We did not detect interleukin-17 in infected organs or M. avium-specific T helper 17 cells, suggesting a minor role for T helper 17 cells in this model. A transient and relative decrease in regulatory T cell numbers was seen in spleens. This detailed characterization of M. avium infection in C57BL/6 mice may provide a basis for future studies aimed at gaining better insight into mechanisms leading to containment of infections with non-tuberculous mycobacteria