Operieren und Lehren [Operating and Teaching]

[english] According to the legal regulations of medical education (10/01/2003) in Germany students have to pass at least one week of surgical training in a block practical. We show the 12-months-experience with this new educational model in our surgery department. All practical lessons have been organized in a three-weeks-block practical for 75 students. Alternating with other specialties the block practical takes part four times a year for a total of 300 students. In the first week, the so-called skills-training week, medical students are trained in techniques of skin-suturing and hand-sewn enteral anastomoses, osteosynthesis, wound dressings and plaster bandage in newly designed seminars. These practical techniques are applied in the second and third week, the so-called tutor-coaching weeks. Students randomly rotate through all available wards, clinics and operating rooms on a day-by-day basis. After completion of the block practical students have the opportunity to evaluate every single teaching session through online marks. Apart from the organization 95% of the students rated the first week with practical seminars with highest marks. The daily rotation through the different clinics has been well accepted by the students. It has to be emphasized that the students felt much more welcome and taken seriously in the new educational model of the block practical than in former surgery courses. <br>[german] Kurzdarstellung: Die Umsetzung der neuen Approbationsordnung (1.10.2003) für Ärzte erforderte eine erhebliche Umstellung der Studierendenausbildung. An einer chirurgischen Universitätsklinik wurde der gesamte praktische Unterricht in ein dreiwöchiges Blockpraktikum, bestehend aus Skilltraining und Tutorcoaching integriert. Vorgestellt werden die Erfahrungen mit den veränderten Lehrformen in den letzten 12 Monaten. Zusammenfassung: In der neuen Approbationsordnung (1.10.2003) wurde für das Fach Chirurgie die Durchführung eines mindestens einwöchigen Blockpraktikums in der klinischen Ausbildung festgelegt. Am Beispiel einer Chirurgischen Universitätsklinik wird die Erfahrung der ersten 12 Monate mit den neuen Lehrformen vorgestellt. Alle praktischen Lehrveranstaltungen der chirurgischen Klinik wurden innerhalb eines dreiwöchigen Blockpraktikums für jeweils 75 Studierende integriert. Alternierend mit den anderen Fächern findet das Blockpraktikum insgesamt viermal im Jahr für 300 Studierende statt. In der ersten Woche dem sogenannten Skilltraining werden praktische Fähigkeiten in völlig neu konzipierten Seminaren über Naht- und Knotentechnik, Osteosynthesetechniken, Verbands- und Gipstechnik und Anastomosen mit selbstständig durchgeführten praktischen Übungen durchgeführt. In der zweiten und dritten Woche werden im Rahmen des Tutorcoachings die erlernten Fähigkeiten im klinischen Alltag angewendet. Die Studierenden rotieren täglich durch alle verfügbaren Stationen, Ambulanzen und Operationssäle. Nach Abschluss des Blockpratikums erfolgte die online Evaluation einzelner Lehrveranstaltungen durch die Studierenden. Neben der Organisation wurde vor allem die erste Woche des rein praktisch orientierten Skilltrainings mit bis zu 95% der Studierenden mit sehr gut und gut bewertet. Auch die Verteilung über die verschiedenen chirurgischen Kliniken fand sehr große Zustimmung bei den Studierenden. Hervorgehoben wird, dass sich die Studierenden im Gegensatz zu den bisher stattfindenden Lehrveranstaltungen der alten Approbationsordnung innerhalb des Blockpraktikums willkommen und ernst genommen gefühlt haben

Исследование химического состава биологически активных веществ S. controversa (Asterceae), эффективных при остеомиелите

Объектом исследования являются листья соссюреи спорной. Целью работы явилось химическое исследование надземной части S. controversa DC. для выявления групп БАВ, обладающих остеогенной и иммуномодулирующей активностью. Охарактеризован химический состав полисахаридов листьев с. спорной, установлена их принадлежность к арабиногалактанам. Выделены два новых гликозида -: кверцетин-7-О-?-D-глюкопиранозил-3-О-?-L-рамнопиранозид и кверцетин-3-О-?-D-диглюкопиранThe object of the study are leaves saussurei controversial. The aim of the work was a chemical study of the aboveground part of S. controversa DC. to identify groups of biologically active substances having osteogenic and immunomodulatory activity. The chemical composition of polysaccharides of the leaves of S. spornaya was characterized, and their belonging to arabinogalactan was established. Two new glycosides were identified: quercetin-7-O-?-D-glucopyranosyl-3-O-

Epidermal growth factor receptor (EGFR) is an independent adverse prognostic factor in esophageal adenocarcinoma patients treated with cisplatin-based neoadjuvant chemotherapy.

Neoadjuvant platin-based therapy is accepted as a standard therapy for advanced esophageal adenocarcinoma (EAC). Patients who respond have a better survival prognosis, but still a significant number of responder patients die from tumor recurrence. Molecular markers for prognosis in neoadjuvantly treated EAC patients have not been identified yet. We investigated the epidermal growth factor receptor (EGFR) in prognosis and chemotherapy resistance in these patients. Two EAC patient cohorts, either treated by neoadjuvant cisplatin-based chemotherapy followed by surgery (n=86) or by surgical resection (n=46) were analyzed for EGFR protein expression and gene copy number. Data were correlated with clinical and histopathological response, disease-free and overall survival. In case of EGFR overexpression, the prognosis for neoadjuvant chemotherapy responders was poor as in non-responders. Responders had a significantly better disease-free survival than non-responders only if EGFR expression level (p=0.0152) or copy number (p=0.0050) was low. Comparing neoadjuvantly treated patients and primary resection patients, tumors of non-responder patients more frequently exhibited EGFR overexpression, providing evidence that EGFR is a factor for indicating chemotherapy resistance. EGFR overexpression and gene copy number are independent adverse prognostic factors for neoadjuvant chemotherapy-treated EAC patients, particularly for responders. Furthermore, EGFR overexpression is involved in resistance to cisplatin-based neoadjuvant chemotherapy

Factors predicting prognosis and recurrence in patients with esophago-gastric adenocarcinoma and histopathological response with less than 10 % residual tumor

PURPOSE: Neoadjuvant treatment is an accepted standard approach for treating locally advanced esophago-gastric adenocarcinomas. Despite a response of the primary tumor, a significant percentage dies from tumor recurrence. The aim of this retrospective exploratory study from two academic centers was to identify predictors of survival and recurrence in histopathologically responding patients. METHODS: Two hundred thirty one patients with adenocarcinomas (esophagus: n = 185, stomach: n = 46, cT3/4, cN0/+, cM0) treated with preoperative chemotherapy (n = 212) or chemoradiotherapy (n = 19) followed by resection achieved a histopathological response (regression 1a: no residual tumor (n = 58), and regression 1b < 10 % residual tumor (n = 173)). RESULTS: The estimated median overall survival was 92.4 months (5-year survival, 56.6 %) for all patients. For patients with regression 1a, median survival is not reached (5-year survival, 71.6 %) compared to patients with regression 1b with 75.3 months median (5-year survival, 52.2 %) (p = 0.031). Patients with a regression 1a had lymph node metastases in 19.0 versus 33.7 % in regression 1b. The ypT-category (p < 0.001), the M-category (p = 0.005), and the type of treatment (p = 0.04) were found to be independent prognostic factors in R0-resected patients. The recurrence rate was 31.7 % (n = 66) (local, 39.4 %; peritoneal carcinomatosis, 25.7 %; distant metastases, 50 %). Recurrence was predicted by female gender (p = 0.013), ypT-category (p = 0.007), and M-category (p = 0.003) in multivariate analysis. CONCLUSION: Response of the primary tumor does not guarantee recurrence-free long-term survival, but histopathological complete responders have better prognosis compared to partial responders. Established prognostic factors strongly influence the outcome, which could, in the future, be used for stratification of adjuvant treatment approaches. Increasing the rate of histopathological complete responders is a valid endpoint for future clinical trials investigating new drugs