Medical dramas on television: a brief guide for educators.

The popularity of medical television dramas is well-established and medical educators are beginning to recognize the power of medical media as a potential tool for education. The purpose of this study was to view a number of medical dramas and consider their potential use in medical education. A total of 177 episodes from eight popular television medical dramas produced between 1990 and 2009 were systematically viewed and analyzed and a brief guide was developed for each drama. The dramas analyzed contained a wealth of material applicable to medical education. In our experience, each drama may be best suited to a particular educational use: for example, clips from "ER" and "Scrubs" offer more examples of teaching and learning than "House" and "Grey's Anatomy", which are perhaps better suited for topics on ethics or team work. We hope that this brief guide will encourage others to consider integrating this material into their teaching, and to explore how television drama may be used most effectively in medical education.

Cochlear distribution of Na,K-ATPase and corticosteroid receptors in two mouse strains with congenital hearing disorders.

As corticosteroid hormones, via their receptors, and Na,K-ATPase are thought to be involved in the regulation of endolymph production, two mouse models were used to investigate whether degeneration of the stria vascularis (SV) and disturbed endolymph composition are correlated with changes in the amounts and distribution of corticosteroid receptors and Na,K-ATPase in the cochlea. Both the shaker-2 mouse and the newly discovered mix mouse are deaf at birth and show vestibular dysfunction. In both mouse strains, the SV is degenerated and endolymph production is severely disturbed. In the shaker-2 mouse, using the C57Bl mouse as a normal control, immunohistochemical staining of mineralo- and glucocorticoid receptors (MR and GR) and the Na,K-ATPase subunits alpha1, alpha3 and beta1 showed a weaker reaction in all structures of the cochlea. The inner ear morphology of the mix mouse is described and compared to that of asymptomatic littermates. Immunostaining of MR, GR and the different Na,K-ATPase subunits in this mouse was considerably weaker in the SV, while staining intensities were normal in the remaining cochlea. The reduced corticosteroid receptor levels may lead to a reduction in Na,K-ATPase expression in the same tissues, although this conclusion should be treated with caution. The conclusion that reduced Na,K-ATPase levels in both mouse strains may be an important mechanism of the disturbed endolymph production is less controversial.

Na,K-ATPase expression in the mouse cochlea is not dependent on the mineralocorticoid receptor.

This study was performed in order to test the hypothesis that the mineralocorticoid hormone stimulates the expression of Na,K-ATPase in the cochlea of the mouse. Immunohistochemistry was used to investigate the distribution of the mineralocorticoid receptor (MR) in the cochlea of the C57Bl/J6 mouse at different ages between gestational day 19 and postnatal day 30, and the occurrence and distribution of Na,K-ATPase in the inner ear of a mouse with a null mutation of the MR. Adult patterns of staining for MR were found as early as on gestational day 19 in the cochlea, with small changes thereafter. MR was detected in the same structures in the cochlea as Na,K-ATPase in earlier studies, where the amount of Na,K-ATPase increased after postnatal day 4. Thus there is latency between the increase of MR and the increase of Na,K-ATPase. In the cochlea of the MR deficient mouse, antibody labelling of Na,K-ATPase showed no significant difference as compared to the control wild type mouse. The hypothesis that mineralocorticoid hormone alone via MR stimulates the formation of Na,K-ATPase in the inner ear could not be confirmed by this study, and other regulating mechanisms must be considered.

Labeling of the glucocorticoid receptor and Na,K-ATPase in a rat otitis media model.

HYPOTHESIS: Glucocorticoid hormones exert an influence on the inflammatory response of the middle ear during acute otitis media. Rats with experimentally induced purulent otitis media were given either glucocorticoid hormones in excess or a glucocorticoid hormone blocker that deprived the animals of the hormone. BACKGROUND: Acute otitis media is a common inflammatory disease among children. Streptococcus pneumoniae is the most usual causative agent. The standard treatment today is phenoxymethylpenicillin. The role of glucocorticoid hormones in inflammatory reactions in the middle ear has been widely debated. METHODS: In an otitis media model, a suspension of pneumococci was inoculated into the bulla of the rat, after the animals were pretreated with either a dose of corticosteroid hormones or the glucocorticoid receptor blocking agent RU 486. Rats with induction of otitis media only, but no pretreatment, were used as control subjects, as were the left control-operated ears of all rats. The inflammatory response in the inner ear and in the middle ear was evaluated. The presence of glucocorticoid receptors and the enzyme Na,K-ATPase was investigated with immunohistochemistry. RESULTS: The inflammatory response in the animals with untreated otitis media and in the group with otitis media in rats pretreated with the receptor blocker was much more extensive than in the group of animals pretreated with corticosteroids. In the corticosteroid-treated group, the tympanic membrane and the mucous membrane of the middle ear were less edematous, but the middle ear cavity contained more pus. Only a few lymphocytes were found in the inner ears of these rats. When the inner ear was labeled with antibodies against glucocorticoid receptors, there seemed to be no difference between the labeling patterns in the three groups. This was also the case for antibody labeling against Na,K-ATPase. CONCLUSION: The present results indicate that the reaction in the middle ear mucous membrane is more pronounced in rats that had been pretreated with the hormone receptor blocking drug. An increase of corticosteroid hormone levels during the inflammatory process seem to diminish the reaction in the tympanic membrane and the middle ear mucosa. Neither the hormone receptor blocking drug nor the steroid hormones change the content of glucocorticoid receptors and Na,K-ATPase in the inner ear in the otitis media rat model.

Distribution of Na,K-ATPase is normal in the inner ear of a mouse with a null mutation of the glucocorticoid receptor.

This study was performed in order to test the hypothesis that the glucocorticoid hormone stimulates the formation of Na,K-ATPase in the inner ear of the mouse. An immunohistochemical study with respect to the presence and distribution of glucocorticoid receptors (GR) and Na,K-ATPase in the vestibular and cochlear regions of the inner ear was performed on a C57BL mouse with a null mutation of the glucocorticoid receptor (GR mutant mouse). The wild type C57BL mouse and the CBA mouse served as normal controls. As expected, the homozygous GR mutant mouse showed no specific staining for GR in the inner ear. The heterozygous GR mutant mouse showed faint staining of GR in the spiral limbus, the spiral ganglion, the organ of Corti and the utricle. This staining was markedly less than in the wild type C57BL mouse. Antibody labelling of Na,K-ATPase in the inner ear showed no significant difference between the homozygous and the heterozygous GR mutant mouse as compared to the control wild type C57BL mouse or the CBA mouse. Although earlier studies have shown a positive correlation between levels of glucocorticoid hormone in serum and the concentration of Na,K-ATPase in the inner ear, the hypothesis that glucocorticoid hormones alone stimulate the formation of Na,K-ATPase in the inner ear could not be confirmed by this study. Thus other regulating substances must be considered.

Na,K-ATPase alpha- and beta-isoforms in the developing cochlea of the mouse.

Immunohistochemistry was used to investigate the presence of Na,K-ATPase alpha- and beta-subunits isoforms (alpha 1, alpha 2, alpha 3, beta 1 and beta 2) in the cochlea of the mouse at different ages between embryological day (E) 19 and postnatal day (P) + 30. alpha 1 was mainly found in the stria vascularis and in the spiral ligament; it increased steadily from p+4. These data correlates well with the morphological and electrophysiological maturation of the cochlea. alpha 3 predominated in the spiral ganglia and the cochlear nerve. This finding is well in accordance with reports that alpha 3 seems to be associated with the nervous system. The beta-subunit was found mainly in those tissues where staining of the alpha-subunit also was seen. Both subunits were localized in tissue regions where fluid regulation is expected to play an important role. For some isoforms, the expression pattern of Na,K-ATPase during development in the mouse is different from that in the rat. The expression of Na,K-ATPase and that of glucocorticoid receptors during development in the inner ear of the mouse show a similar pattern, which may indicate that glucocorticoid receptors could be involved in regulating the expression of Na,K-ATPase.

Appearance of glucocorticoid receptors in the inner ear of the mouse during development.

CBA mice were sacrificed at different ages of developments at embryonic day 13 (E13), E14, E16, E19, E20 and postnatal day 1 (P1), P2, P3, P4, P6, P8, P10, P14, P16, P18, P20 and P30. The temporal bones were quickly removed and deep frozen in order to prepare cryosections for immunohistochemical staining with polyclonal antibodies against glucocorticoid receptors. The avidin-biotin, ABC-method was used to visualize binding. Both the vestibular and the cochlear regions of the inner ear were analysed. A faint staining of the crista ampullaris, the utricle and the cochlear duct was seen at E19; and staining became clearly visible at P1. A decrease in labelling was found at day 2-5 post partum whereafter an increased staining was again noticed until postnatal day 14 when an adult pattern was observed. The appearance of glucocorticoid receptors in the inner ear during development does not follow a linear curve. Further, the labelling pattern may indicate an impact of glucocorticoid receptors on the embryologic maturation itself as well as a functional role in the adult ear.

Animal experimentation in Norway. The licensing and control system.

The laws and regulations relevant to the use of live animals for experimental purposes within research and related activities in Norway are explained. Such experiments may only be carried out in facilities approved by governmental authorities and by personnel working under a personal or establishment licence. In the latter case, all experiments need the prior approval of an authorized responsible person. Control and reporting are carried out by governmental officials.