Prognostic significance of cytochemical analysis of leukemic M2 blasts

Cytochemical analysis of leukemic blasts from 46 patients with acute myeloblastic M2 leukemia (according to the FAB classification) was performed before and after cytostatic therapy, and compared with findings obtained in 20 age- and sex-matched control subjects. Cytochemical findings for myeloperoxidase (MPO), Sudan black B, acid phosphatase and alpha-naphthyl-acetate esterase (ANAE) were related to the achievement of the first complete remission (CR),i.e. data were compared after the patients had been divided into CR and non-CR groups. The analysis clearly showed that a high proportion of myeloperoxidase- and, to a lesser extent, Sudan black B-positive blasts before treatment may have constituted a significantly unfavourable prognostic factor.     

Low levels of immunoglobulin A in children with intrinsic asthma: a possible protection against atopy

Immunoglobulin A and G (IgA, IgG) serum concentrations were detected in children with nonallergic/intrinsic (36 children) or allergic/extrinsic asthma (43 children) and in age-matching control children (40 children). Asthmatic children with allergic asthma had lower IgA (1.36+/-0.54 g/L) and higher IgG (10.48+/-2.77 g/L) levels than the age-matching control children group (1.63+/-0.69 vs. 9.01+/-2.32 g/L). Children with nonallergic/intrinsic asthma had lower IgA (1.03+/-0.41 g/L) ( p = 0.004) and IgG (8.38+/-1.93 g/L) (p = 0.001) levels than the allergic/extrinsic asthma group (1.36+/-0.54 vs. 10.48+/-2.77 g/L). Low IgA levels were found in children with nonallergic/intrinsic asthma and high IgG levels were found in those children with allergic/extrinsic childhood asthma. The hypothesis is that the increased incidence of asthma in the population may be caused by a decrease in childhood infections (hygiene hypothesis). Frequent infections in early life boost the immune system, stimulating Th1-type response in young children and reducing the risk of atopic diseases. Our hypothesis is that low IgA (and/or IgG) levels in our patients might be responsible for infection development among those children with nonallergic/intrinsic asthma. These infections stimulate the normal development of immune system in young children, reducing risk of atopy, so that those children do not get allergic/extrinsic childhood asthma. Intrinsic childhood asthma=nonallergic (nonatopic) childhood asthma. Extrinsic childhood asthma=allergic (atopic) childhood asthma.     

Transition from Longitudinal to Block Structure of Preclinical Courses: Outcomes and Experiences

Aim

To evaluate the transition from a longitudinal to block/modular structure of preclinical courses in a medical school adapting to the process of higher education harmonization in Europe.

Methods

Average grades and the exam pass rates were compared for 11 preclinical courses before and after the transition from the longitudinal (academic years 1999/2000 to 2001/2002) to block/modular curriculum (academic years 2002/2003 to 2004/2005) at Zagreb University School of Medicine, Croatia. Attitudes of teachers toward the 2 curriculum structures were assessed by a semantic differential scale, and the experiences during the transition were explored in focus groups of students and teachers.

Results

With the introduction of the block/modular curriculum, average grades mostly increased, except in 3 major courses: Anatomy, Physiology, and Pathology. The proportion of students who passed the exams at first attempt decreased in most courses, but the proportion of students who successfully passed the exam by the end of the summer exam period increased. Teachers generally had more positive attitudes toward the longitudinal (median [C]±intequartile range [Q], 24 ± 16) than block/modular curriculum (C±Q, 38 ± 26) (P = 0.001, Wilcoxon signed rank test). The qualitative inquiry indicated that the dissatisfaction of students and teachers with the block/modular preclinical curriculum was caused by perceived hasty introduction of the reform under pressure and without much adaptation of the teaching program and materials, which reflected negatively on the learning processes and outcomes.

Conclusion

Any significant alteration in the temporal structure of preclinical courses should be paralleled by a change in the content and teaching methodology, and carefully planned and executed in order to achieve better academic outcomes.The adoption of the Bologna Declaration on the European Higher Education Area in 1999 (1) initiated a wave of curriculum reforms at universities across Europe (2). The process of modernization of higher education supported by the European Commission has begun in countries surrounding the European Union even earlier, in the beginning of 1990s, and has since expanded to a total of 27 countries, including some in Central Asia, North Africa, and Middle East (3). Medical schools joined the process at a slower pace (4), taking into account their specifics, such as costliness of medical education and the long, one-tier structure of medical curricula (5). Changes in the curriculum design mostly related to the integration of preclinical and clinical courses and the introduction of problem-based learning (PBL) (6).While an increasing number of European medical schools accepted a combination of subject-based and integrated problem-based approaches (6), medical schools in the Southeast Europe mostly retained the traditional curricula with Anatomy, Physiology, and Pathology as dominant courses in the first 3 years of medical study (7). The School of Medicine at the University of Zagreb, Croatia, was the only school in the region delivering some case-based modules with a degree of integration, but only in the last (clinical) year of the study (7). Despite the expected reluctance of the teaching staff to accept reforms of the curriculum (8), the leadership of the Zagreb University School of Medicine decided in 2001 to change the structure of preclinical courses in the first 3 years of study from the longitudinal, spread-out form to block/modular form. Clinical courses in the last 3 years of study had already been taught in blocks. The change in the structure of preclinical courses was intended to be the first step in a broader process of the curriculum reform initiated and conducted in cooperation with the Harvard Medical International and the Ludwig Maximilian University from Munich, Germany (9) and a part of the general modernization of medical curricula in Croatia (10).Many reports have dealt with the curricular reforms in medical schools, mostly describing the introduction of PBL (11,12) and integration of preclinical and clinical courses (13). Previous studies have compared PBL and traditional curriculum (14,15), PBL and a hybrid form of curriculum (16,17), or PBL and some other type of interactive learning (18). No study has yet explored the effects of the transition from the longitudinal to block/modular structure of preclinical courses, without any other substantial change in the curriculum design or content. The case of University of Zagreb School of Medicine is representative of adjusting traditional curriculum to the requirements of the Bologna Process doing the least changes possible. As this phenomenon may occur in other medical schools, especially in the Southeast Europe, it is important to explore its effects and the related experiences of all involved educational actors.The first aim of our study was to compare the outcomes of 2 curriculum structures (the longitudinal vs block/modular) in the preclinical years of medical study and to identify their advantages and drawbacks. The second aim was to assess the attitudes of the teaching staff toward the longitudinal and block/modular form of teaching.     

Reconstituted basement membrane (Matrigel) promotes the survival and influences the growth of murine tumors.

The effects of reconstituted basement membrane (Matrigel) on in vivo survival and growth of several murine tumors were studied. Survival of tumor cells was enhanced in all experiments which resulted in increased incidence and/or in increased tumor mass. While basement membrane enhanced the in vivo growth of B16F6 melanoma cells, survival of these mice was prolonged. Basement membrane increased the incidence but reduced the growth of Ehrlich ascites tumor. Walker-256 hypercalcemic breast carcinosarcoma growth was enhanced and glandular-like structures were observed when grown on Matrigel. The results indicate that the enhanced survival of tumor cells in the presence of basement membrane is not unequivocally linked with increased malignancy.     

Teaching students how to read and write science: a mandatory course on scientific research and communication in medicine.

The authors describe the development and introduction of a course on scientific methodology and communication into the medical curriculum in a country outside of the mainstream scientific world. As editors of a general medical journal in Croatia, they learned that their colleagues had important and interesting data but no skills for presenting them in a scientific article. To alleviate the lack of education in research methodology and writing, the authors developed and introduced a mandatory course in scientific methodology and communication into the medical curriculum of the largest Croatian medical school. The course is structured into lectures, medium-sized-group discussions, and problem-solving small-group work, and is focused on (1) principles of scientific research; (2) access to medical literature and bibliographic databases; (3) study design and analysis and presentation of data; (4) assessing and writing a scientific article; and (5) responsible conduct of research. The course has been running since 1995-96 and is already showing results, visible in the more positive attitude of students toward scientific research and evidence-based medicine, and a significant number of students working on research projects and publishing scientific papers. The authors and colleagues also run continuing education courses for young academic physicians and an annual advanced workshop on scientific writing, involving academic physicians from all of southeastern Europe. The long-term goal is to create a critical mass of academic physicians with critical appraisal skills needed for evidence-based medicine and with skills for effectively communicating their research to the international scientific community.