Performance of International Medical Students In psychosocial medicine.

BACKGROUND: Particularly at the beginning of their studies, international medical students face a number of language-related, social and intercultural challenges. Thus, they perform poorer than their local counterparts in written and oral examinations as well as in Objective Structured Clinical Examinations (OSCEs) in the fields of internal medicine and surgery. It is still unknown how international students perform in an OSCE in the field of psychosocial medicine compared to their local fellow students. METHODS: All students (N = 1033) taking the OSCE in the field of psychosocial medicine and an accompanying written examination in their eighth or ninth semester between 2012 and 2015 were included in the analysis. The OSCE consisted of four different stations, in which students had to perform and manage a patient encounter with simulated patients suffering from 1) post-traumatic stress disorder, 2) schizophrenia, 3) borderline personality disorder and 4) either suicidal tendency or dementia. Students were evaluated by trained lecturers using global checklists assessing specific professional domains, namely building a relationship with the patient, conversational skills, anamnesis, as well as psychopathological findings and decision-making. RESULTS: International medical students scored significantly poorer than their local peers (p < .001; η2 = .042). Within the specific professional domains assessed, they showed poorer scores, with differences in conversational skills showing the highest effect (p < .001; η2 = .053). No differences emerged within the multiple-choice examination (p = .127). CONCLUSION: International students showed poorer results in clinical-practical exams in the field of psychosocial medicine, with conversational skills yielding the poorest scores. However, regarding factual and practical knowledge examined via a multiple-choice test, no differences emerged between international and local students. These findings have decisive implications for relationship building in the doctor-patient relationship.

"Peer-assisted learning" (PAL) in the Skills-Lab--an inventory at the medical faculties of the Federal Republic of Germany.

BACKGROUND: Over multiple years, the didactic concept of "peer-assisted learning" (PAL) has proved to be valuable for medical education. Particularly in the field of the nowadays widely established Skills-Labs, the assignment of student tutors is both popular and effective. The aim of the underlying study is to assess the current status of PAL programs within German medical faculties' Skills-Labs regarding their distribution, extent, structure and content based on a nation-wide survey. METHODS: All 36 medical faculties in Germany were contacted and asked for their participation (via telephone or in written form) in the survey encompassing 16 central questions as to the structure of established PAL programs. Data obtained were subject to quantitative and qualitative analysis. RESULTS: 35 of 36 (97.2%) medical faculties participated in the survey. A PAL program was shown to be established at 33 (91.7%) faculties. However, the results show distinct differences between different faculties with respect to extent and content of the PAL programs. CONCLUSIONS: Among German medical Skills-Labs, PAL has been established almost ubiquitously. Further studies on the conception and standardization of training concepts appear to be pivotal for the advancement of PAL in the context of Skills-Labs.

MicroRNA-21 targets tumor suppressor genes ANP32A and SMARCA4.

MicroRNA-21 (miR-21) is a key regulator of oncogenic processes. It is significantly elevated in the majority of human tumors and functionally linked to cellular proliferation, survival and migration. In this study, we used two experimental-based strategies to search for novel miR-21 targets. On the one hand, we performed a proteomic approach using two-dimensional differential gel electrophoresis (2D-DIGE) to identify proteins suppressed upon enhanced miR-21 expression in LNCaP human prostate carcinoma cells. The tumor suppressor acidic nuclear phosphoprotein 32 family, member A (ANP32A) (alias pp32 or LANP) emerged as the most strongly downregulated protein. On the other hand, we applied a mathematical approach to select correlated gene sets that are negatively correlated with primary-miR-21 (pri-miR-21) expression in published transcriptome data from 114 B-cell lymphoma cases. Among these candidates, we found tumor suppressor SMARCA4 (alias BRG1) together with the already validated miR-21 target, PDCD4. ANP32A and SMARCA4, which are both involved in chromatin remodeling processes, were confirmed as direct miR-21 targets by immunoblot analysis and reporter gene assays. Furthermore, knock down of ANP32A mimicked the effect of enforced miR-21 expression by enhancing LNCaP cell viability, whereas overexpression of ANP32A in the presence of high miR-21 levels abrogated the miR-21-mediated effect. In A172 glioblastoma cells, enhanced ANP32A expression compensated for the effects of anti-miR-21 treatment on cell viability and apoptosis. In addition, miR-21 expression clearly increased the invasiveness of LNCaP cells, an effect also seen in part upon downregulation of ANP32A. In conclusion, these results suggest that downregulation of ANP32A contributes to the oncogenic function of miR-21.

Celebrating fifty years of the Biometrical Journal.

The publication of Volume 50 of the Biometrical Journal (formerly Biometrische Zeitschrift) in 2008 provides the perfect opportunity to describe the history of the present journal. We report on the long period of preparation for the journal within the German Region (DR) of the International Biometric Society (IBS). A special paragraph is dedicated to the first ten volumes. We emphasize the role of the journal as a bond between German biometricians on both sides of the border between the two German nations and IBS regions at that time. Furthermore, we report on the development of its thematic spectrum and impact factors and provide citation frequencies.

Wearable approach for continuous ECG--and activity patient-monitoring.

The paper describes an approach to monitor a person's ECG and activity continuously with functional clothing. A belt with integrated electronics has been developed and has proven long-term robustness of all electrical components. A low-power module measures the ECG signal as well as the acceleration (2-axis) and stores data continuously up to two days. A user test has been performed to evaluate the belt according to system performance at different daily-life activities like sleeping, walking and so on. System parameters are ECG-signal quality, system up-time, and ECG-signal coverage during a day.

Helicobacter pylori and gastric cancer:current status of the Austrain Czech German gastric cancer prevention trial (PRISMA Study).

AIM: To test the hypothesis that Helicobacter pylori eradication alone can reduce the incidence of gastric cancer in a subgroup of individuals with an increased risk for this fatal disease. METHODS: It is a prospective, randomized, double blind, placebo controlled multinational multicenter trial. Men between 55 and 65 years of age with a gastric cancer phenotype of Helicobacter pylori gastritis are randomized to receive a 7 day course of omeprazole 2 X 20mg, clarithromycin 2 X 500mg, and amoxicillin 2 X 1g for 7 days, or omeprazole 2 X 20mg plus placebo. Follow-up endoscopy is scheduled 3 months after therapy, and thereafter in one-year intervals. Predefined study endpoints are gastric cancer, precancerous lesions (dysplasia, adenoma), other cancers, and death. RESULTS: Since March 1998, 1524 target patients have been screened, 279 patients (18.3%) had a corpus dominant type of H. pylori gastritis, and 167 of those were randomized (58.8%). In the active treatment group (r = 86), H. pylori infection infection was cured in 88.9% of patients. Currently, the cumulative follow-up time is 3046 months (253.38 patient years, median follow up 16 months). So far, none of the patients developed gastric cancer or any precancerous lesion. Three (1.8%) patients reached study endpoints other than gastric cancer. CONCLUSION: Among men between 55 and 65 years of age, the gastric cancer phenotype of H. pylori gastritis appears to be more common than expected. Further follow up and continuing recruitment are necessary to fulfil the main aim of the study.

The AXS battery and "neurological fingerprints": meeting the challenge of individual differences in human brain/behavior relations.

A new test battery, the Auditory Cross-Section (AXS) Battery, offers a relatively inexpensive, noninvasive means of describing a "neurological fingerprint" for each individual. The battery's "access to axes" combines physiological and behavioral measures so that a large set of dependent variables can be used to profile an individual and can serve as a context for additional anatomical, behavioral, and physiological data for the same subject. Physiological tests included in the battery described here include (1) otoacoustic emissions (OAEs); (2) the repeated evoked potentials version of the auditory brainstem response (REPs/ABR); and (3) quantitative electroencephalography (qEEG). Complementary behavioral tests were chosen to assess capabilities related to functional asymmetries, such as phonemic awareness and fine motor control, and/or to demonstrate temporal correlations that link behavioral and neural function. Applications of the AXS battery include (1) documentation of individual differences and similarities in neural organization that are related to specific behaviors, such as learning styles or clinical symptoms; (2) provision of contextual data for neuroimaging studies that aid in interpreting individually specific patterns of activation; and (3) development of a neurotypology of human brain/behavior relations, linking characteristics of neuroanatomy and neurophysiology with features of behavior, and general body health.

[Statistical analysis of quality assurance studies]. / Statistische Bearbeitung von Qualitätssicherungsstudien.

A proposal for the multivariate analysis of quality control data is presented. This approach combines exact mathematical evaluation with great clarity of interpretation.

The handshaking model of brain function: notes toward a theory.

John Hughlings Jackson described the system-level organization of the nervous system in terms of functional-control relations between neural centers. His model emphasized hierarchical organization along a rostral-caudal dimension, with applications primarily to cases of clinical disorders such as epilepsy and motor paralysis. This paper outlines a new systems-level model of brain function, updating Jackson's original idea to account for all three orientations of body/brain organization, and additional, non-hierarchical types of relations. The approach may provide a powerful tool for addressing many aspects of human brain and behavior, ranging from normal characteristics (such as individual differences and gender differences), to cases of frank neurological injury, to other conditions, such as hyperactivity and chronic pain, conventionally considered as 'neurologically silent'.

Physiological and behavioral effects of an antivertigo antihistamine in adults.

12 neurologically normal adults were tested before and after administration of meclizine, an over-the-counter medication for motion sickness. A battery of four tests was used: (1) distortion-product otoacoustic emissions, (2) the Repeated Evoked Potentials version of the Auditory Brainstem Response, (3) quantitative electroencephalography measured over the left and right sides of the auditory cortex, and (4) a hand-eye coordination task. The battery required approximately 1.5 hr. to complete. Each subject was tested with the battery in each of eight longitudinal sessions: three times on a control day (9 am, 1 pm, 3 pm--no medication); the same times on a second day one week later (medication at approximately 11:30 am), and 24- and 48-hr. check-up sessions following the medication day. Analysis indicated changes in all components, with details suggesting the site(s) of action of this type of antihistamine. The cross-section of the auditory system yielded by this battery makes it possible to observe effects at the periphery, in the brainstem, and in the cortex, including evidence linking otoacoustic emissions with central auditory physiology. Implications range from cautions regarding the use of antihistamines to physiological support for employing such medications to enhance patients' response to vestibular rehabilitation as well as to improve performance in learning-disordered children.

[The bioequivalence of a new amitriptyline tablet formulation in comparison with a reference preparation]. / Untersuchungen zur Bioäquivalenz einer neuen Amitriptylin-Tablettenformulierung im Vergleich zu einer Referenzzubereitung.

An investigation of the bioequivalence of a new tablet formulation (amitriptylin 25 von ct) with 28.3 mg amitriptyline hydrochloride (CAS 549-18-8) was performed in a two-way cross-over study with 18 subjects. The relative bioavailability with respect to a reference preparation for AUC related to amitriptyline (CAS 50-48-6) was 99.3% and for Cmax 100.4%. A positive decision for bioequivalence derived from the usual confidence intervals for both parameters related to amitriptyline and the metabolite nortriptyline (CAS 72-69-5), respectively tmax showed no difference. The new formulation was bioequivalent to the reference.

Neuroimaging and the trimodal brain: applications for developmental communication neuroscience.

New details generated by neuroimaging and other methods for studying the neural correlates of behavior have led to the formulation of a new model of brain organization, the Trimodal Brain. The model incorporates current biochemical; anatomical, and physiological concepts of prenatal brain growth and combines them with findings on right/left functional asymmetries. It provides a means of relating a wide range of human behaviors and clinical states according to a common base of neural organization, and stresses the utility of an organizational rather than a lesion model for understanding developmental communication disorders.

[Study of the bioequivalence of a new isosorbide dinitrate tablet formulation compared with the standard preparation]. / Untersuchungen zur Bioäquivalenz einer neuen Isosorbiddinitrat-Tablettenformulierung im Vergleich zu einer Referenzformulierung.

An investigation in the bioequivalence of a new tablet formulation with 5 mg isosorbide dinitrate (CAS 87-33-2, ISDN 5 von ct) was performed in a two-way cross-over study with 18 subjects. The relative bioavailability with respect to a reference preparation for AUC related to isosorbide dinitrate was 107.5% and for Cmax 112.5%. A positive decision for bioequivalence derived from the usual confidence intervals for both parameters related to isosorbide dinitrate and the metabolites isosorbide-2-nitrate and isosorbide-5-nitrate, respectively. The difference in tmax showed no clinical relevance. The new formulation was bioequivalent to the reference.

[The bioequivalence of a new allopurinol tablet formulation in comparison to a reference formulation]. / Untersuchungen zur Bioäquivalenz einer neuen Allopurinol-Tablettenformulierung im Vergleich zu einer Referenzformulierung.

An investigation of the bioequivalence of a new allopurinol formulation with 300 mg allopurinol (CAS 315-30-0, allo 300 von ct) was performed in a two-way cross-over study with 18 subjects. The relative bioavailability with respect to a reference preparation for AUC related to oxipurinol was 98.1% and for Cmax 91.7%. A positive decision for bioequivalence derived from the usual confidence intervals for both parameters related to allopurinol and the metabolite oxipurinol, respectively, tmax showed no difference regarding oxipurinol. The new formulation was bioequivalent to the reference.

Amplitude stability of auditory brainstem responses in two groups of children compared with adults.

A recent report indicated that patterns of systematic variation may be observed in ABR peak latency of children from two age groups, and that comparisons of the children's latency data with similar findings in adults suggest new evidence for developmental changes in the human central auditory nervous system persisting as late as 12 years of age. The current report examines the stability of auditory brainstem response (ABR) peak amplitude for the same three groups of subjects, including: (1) across-age comparisons of absolute amplitude, between-subjects group stability, and within-subjects group stability; (2) documentation of individual differences in amplitude stability by peak and by ear; and (3) demonstration of the degree of replicability of amplitude stability patterns. Results indicate that the same observations are to made for ABR amplitude as for latency; that is, systematic patterns of stability at all three ages, with details that provide additional evidence for developmental changes in brainstem-mediated auditory electrophysiological response continuing into the second decade of life.