Clinical Laboratory Immunology Research Articles

Online flipped classroom with team-based learning promoted learning activity in a clinical laboratory immunology class: response to the COVID-19 pandemic

BackgroundGiven the rapid development of clinical immunology technologies, students majoring in laboratory medicine should master the technological principles and application of clinical laboratory immunology. However, many are required to take online courses due to COVID-19 restrictions, which highlights the need to revisit teaching strategies. Recently, various medical education courses (such as Biochemistry, Physiology, etc.) have implemented the flipped classroom (FC) and team-based learning (TBL) methods, resulting in more positive teaching evaluations. To promote the students' mastery of the difficult knowledge effectively during the online teaching work, we evaluated the performance of online FC-TBL in a clinical laboratory immunology course.Methods Sixty-two third-year students from two classes majoring in Laboratory Medicine were recruited and divided into two groups, including one group with traditional lecture-based learning teaching strategy (LBL group) and the other group with LBL or online FC combined with TBL teaching strategy (FC-TBL group). We selected three chapters to conduct FC-TBL teaching in class. All participants took in-class quizzes and final examinations that targeted the same knowledge points. Finally, all participants completed anonymous questionnaires asking for their perceptions of the respective teaching models. In addition, we conducted a survey of teaching suggestions by a FC-TBL class of students majoring in Laboratory Medicine.ResultsThe FC-TBL group (vs LBL group) had significantly higher scores on the in-class quizzes and final examinations, and also reported high satisfaction with the FC-TBL model. These findings indicate that FC-TBL is suitable for clinical laboratory immunology, as the participants quickly gained essential knowledge. Specifically, FC-TBL helped to “increase learning motivation,” “promote self-directed learning skills,” “extend more related knowledge,” “enhance problem-solving abilities,” “enhance clinical reasoning abilities,” and “enhance communication skills.” For participants’ suggestions, 48.38% (15/31) students held positive attitude to FC-TBL teaching strategy compared to 25.81% (8/31) students who considered FC-TBL teaching strategy still needs continuous improvement, and 25.81% (8/31) students reported that they believed FC-TBL teaching strategy was perfect and no further suggestions.ConclusionsOnline FC-TBL effectively enhanced learning activity among students of a clinical laboratory immunology course. This is particularly useful in the COVID-19 context.

Updates in diagnostic and clinical laboratory immunology from the 30th annual meeting of the Association of Medical Laboratory Immunologists (AMLI)

Updates in diagnostic and clinical laboratory immunology from the 30th annual meeting of the Association of Medical Laboratory Immunologists (AMLI)

Comparison of student perception and performance between case-based learning and lecture-based learning in a clinical laboratory immunology course

AbstractBackground:Case-based learning (CBL), an educational method of problem-based learning, provides students with a venue to relate content learned in the classroom to performance in professional practice. This study compared CBL in the teaching of a clinical laboratory immunology (CLI) course to lecture-based learning (LBL), and evaluated the effect on students regarding the CBL.Methods:Data were collected from senior students (n=85; 46% males, 54% females) at Lanzhou University in China. The students were divided into two groups, one group was offered CBL, while the other LBL as a teaching instrument. After intervention, perceptions of both the groups about their respective teaching method were evaluated using questionnaires, the resulting scores were compared to those obtained in the LBL group.Results:The CBL group showed significantly better scores in course examination (p<0.05) as compared to the LBL group. Seventy-seven (90.6%) students in the CBL group opined that CBL improved their learning and clinical problem-solving skills. CBL also provided them with better understanding (90.6%) and preparation for examinations (90.6%). CBL group improved markedly in comparison to the LBL group with regard to learning motivation (p=0.040), clinical reasoning ability (p=0.023) and clinical problem-solving ability (p=0.022).Conclusions:Our findings demonstrate that CBL is a more effective teaching strategy as compared to LBL in a CLI course. Consequently, the implementation of CBL in teaching a CLI course helps students to improve their learning motivation, problem solving abilities and mastery of knowledge.

Editorial introductions

Editorial introductions

Clinical laboratory immunology: an indispensable player in laboratory medicine.

Clinical laboratory immunology affects practically every aspect of medicine. Accordingly, appropriately trained, board-certified clinical laboratory immunologists are key contributors to the diagnosis and management of patients with various immune-mediated conditions. This review highlights the availability of postdoctoral level training programs for clinical laboratory immunology and identifies possible career tracks. Fundamental elements for doctoral level clinical laboratory immunologists are identified and the critical components of diagnostic immunology training as well as career opportunities in and out of academia are described. Relative to other disciplines in laboratory medicine, little emphasis has been given to clinical laboratory immunology in medical, graduate, and postgraduate training. Formal postgraduate fellowship programs and board certification examinations are available, yet there remains a significant lack of awareness in the medical education community about the value and necessity of training in this field. It is anticipated that sharing this knowledge will increase awareness of the discipline of clinical laboratory immunology at the postdoctoral level with implications for the practice of laboratory medicine.

Practice of case-based PBL teaching model in clinical immunology and laboratory teaching

Objective To train medical students' competence of independent thinking and problem solving and to improve the quality of teaching.Methods The case-based PBL teaching model was introduced to teaching practice for 25 undergraduates majoring in medical laboratory.The teaching process included pre-class mobilization,question,self-study,discussion and summary.Effectiveness of teaching was evaluated with questionnaire.Results For these medical students,the enthusiasm of learning ( 83.3％ ),ability of self-learning and information seeking ( 79.2％ ),ability of discussing and problem solving ( 79.2％ ),ability of scientific thinking and clinical reasoning ( 79.2％ ) were significantly improved.Teaching satisfaction rate of case-based PBL teaching model was up to 95.8％.Conclusion Better results of teaching were achieved and the case-based PBL teaching model is worth spreading. Key words: Medical education; Case teaching; Problem-based learning; Clinical immunology and laboratory immunology

Editorial introductions

Editorial introductions

Clinical Immunology Society: the Early Years 1984–1989

The Clinical Immunology Society (CIS) developed in two broad contexts: (1) as a component of immunology research and education with human relevance, and (2) as a component of clinical medicine, i.e., disease identification, pathogenesis, treatment, and prevention. Indeed, a purpose of the CIS was to bring these two areas closer together. Initial goals included uniting the clinical investigators from the wide array of clinical fields and providing information on scientific and clinical advances. There was also the intent to enhance the framing and scope of immune-based therapies. Conversations were initiated in 1984 to develop a society for bringing together the leadership of the many clinical and laboratory contexts of clinical immunology. From 1979 to 1984, I had been on the National Advisory Council for Allergy and Infectious Diseases, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), the senior advisory group to the NIAID, which met three times each year to review recommendations for research grant awards. In those years, I became acquainted, at least by name and field of interest, with almost all of the leading immunologists in the USA. Many I knew from my own research defining human andmurine immunoglobulins in the 1960s, immunology and cancer studies in the 1970s, and description and characterization of AIDS in the 1980s. The discussions from 1984 to 1986 involved more than 50 immunologists in the USA (Table I) and with a dozen more from other countries. The leading relevant organizations were consulted. These included the American Association of Immunology (AAI), the NIH, especially the NIAID, and other health-related organizations. Initial discussions identified several individuals who became major partners in advancing this enterprise: Noel Rose, Gary Fathman, Max Cooper, and Bernard Janicki. Noel Rose made special contributions and was a cofounder. His experience included AAI committees, advocacy of the American Board of Medical Laboratory Immunology within the American Society of Microbiology, as editorin-chief of the Manual of Clinical Laboratory Immunology, and as editor of the journal, Clinical Immunology and Immunopathology. He shared administrative responsibilities in the first years and has recounted some of the early events (Noel Rose, The inception of the Clinical Immunology Society—see http://www.clinimmsoc.org/about/history. php). Gary Fathman was prominent with his knowledge of the emergence of immunology in many clinical subspecialties and his own contributions at this interface. Max Cooper was a leader in both pediatric and fundamental immunology and was en route to becoming president of the AAI. Bernard Janicki was central to immunology communication at the NIH and communication with NIAID leadership.

The state and the problems of the education in the sphere of clinical laboratory diagnostics in Ukraine

The question of the medical laboratories staff training is currently in the focus of attention in Ukraine. Laboratory technicians with a college degree are prepared in the medical colleges for two or four years depending on school educational level. During their practice they are assessed every five years on completing the additional improving course. The position and their job responsibilities are defined by the Ministry of Health Protection. Bachelors of clinical laboratory diagnostics (CLD) are trained in medical universities obtaining the appropriate license. The position and their job responsibilities are similar to laboratory technicians' ones. The CLD specialists are prepared by the CLD departments in the medical academies of postgraduate education or medical universities' faculties of postgraduate studies. Those graduates, who have already acquired a degree in Medicine or Biology are eligible for the training program. Biologists pass courses of specialization for five month whereas doctors pass the specialization for ten month including four month practice. If the doctors wish, they can do the masters degree program within doing the specialization. However, because their position and job responsibilities are not determined by the Ministry of Health Protection of Ukraine, masters are allowed to practice their profession at the level of specialists. The specialists that practice clinical biochemistry, laboratory immunology, microbiology and medical genetics have to take the additional appropriate two-three month specialization courses. During their practice, specialists are assessed every five years. For assessment the commission takes into account the quantity of credits that a specialist has received within five years. Credits are earned for attending the scientific conferences, publishing scientific works, books or handbooks, professional training and pre-assessment module courses. The position and their responsibilities are defined by the Ministry of Health Protection of Ukraine. Currently there is no system in Ukraine for higher academic education for professionals in clinical laboratory diagnostics. We are aware of this fact and are committed to the improvement of the Ukrainian teaching clinical laboratory diagnostics system.

Low-Dose Total Body Irradiation and Fludarabine Conditioning for HLA Class I-Mismatched Donor Stem Cell Transplantation and Immunologic Recovery in Patients with Hematologic Malignancies: A Multicenter Trial

HLA-mismatched grafts are a viable alternative source for patients without HLA-matched donors receiving ablative hematopoietic cell transplantation (HCT), although their use in reduced intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT has been not well established. Here, we extended HCT to recipients of HLA class I-mismatched grafts to investigate whether NMA conditioning can establish stable donor engraftment. Fifty-nine patients were conditioned with fludarabine (Flu) 90 mg/m(2) and 2 Gy total body irradiation (TBI), followed by immunosuppression with cyclosporine (CsA) 5.0 mg/kg twice a day and mycophenolate mofetil (MMF) 15 mg/kg 3 times a day for transplantation of granulocyte colony-stimulating factor (G-CSF)-mobilized peripheral blood stem cells (PBSCs) from related (n = 5) or unrelated donors (n = 54) with 1 antigen +/- 1 allele HLA class I mismatch or 2 HLA class I allele mismatches. Sustained donor engraftment was observed in 95% of the evaluable patients. The incidence of grade II-IV acute and extensive chronic graft-versus-host disease (aGVHD, cGVHD) was 69% and 41%, respectively. The cumulative probability of nonrelapse mortality (NRM) was 47% at 2 years. Two-year overall and progression-free survival (OS, PFS) was 29% and 28%, respectively. NMA conditioning with Flu and low-dose TBI, followed by HCT using HLA class I-mismatched donors leads to successful engraftment and long-term survival; however, the high incidence of aGVHD and NRM needs to be addressed by alternate GVHD prophylaxis regimens.

Some key issues in immunologica; surveillance and its clinical application

Immunological surveillance, analysis including cells to biological is one of the important components in clinical laboratory immunology. This paper focuses on three issues. First of all is the measurement of antigen-specific T cell, which is very important for understanding the pathogenesis of immunological related diseases because of the central role played by T cell in immune response. It is optional to adopt different assays according to different facilities and puroposes such as flow cytometer or the number or function of T cells. Secondly, it is no doubt that positive autoantibodies are key bio-markera in the diagnosis of autoimmune diseases. And what is more autoantibodies could predict the occurrence of certain autoimmune diseases. More and more researches showed that autoantibodies could be detected in patients with tumors, which help for either diagnosis of tumors or screening of therapeutic target markers. Finally, the application of cytokine measurement is discussed. Clarification of cytokine profiles is the way to understanding pathogenesis of immunological related diseases, it is also in favor of monitoring severity of the diseases, But there are shortages concerning organ or tissue specific, as well as good quality control. Key words: T-lymphocytes; Immunoassays; Autoantibody profile

Standardisation in clinical laboratory medicine: an ethical reflection

Many efforts have been undertaken to standardise diagnostic tests. For example, the introduction of CRM-470, an international reference preparation for proteins in human serum1 has reduced the among-laboratory variance of...

A community-based, time-matched, case-control study of respiratory viruses and exacerbations of COPD

Respiratory viruses are associated with severe acute exacerbations of chronic obstructive pulmonary disease (COPD) in hospitalized patients. However, exacerbations are increasingly managed in the community, where the role of viruses is unclear. In community exacerbations, the causal association between viruses and exacerbation maybe confounded by random fluctuations in the prevalence of circulating respiratory viruses. Therefore, to determine whether viral respiratory tract infections are causally associated with community exacerbations, a time-matched case-control study was performed. Ninety-two subjects (mean age 72 yrs), with moderate to severe COPD, (mean FEV(1) 40% predicted), were enrolled. Nasopharyngeal swabs for viral multiplex polymerase chain reaction and atypical pneumonia serology were obtained at exacerbation onset. Control samples were collected in synchrony, from a randomly selected stable patient drawn from the same cohort. In 99 weeks of surveillance, there were 148 exacerbations. Odds of viral isolation were 11 times higher in cases, than their time-matched controls (34 discordant case-control pairs; in 31 pairs only the case had virus and in three pairs only control). Picornavirus (26), influenza A (3), parainfluenza 1,2,3 (2), respiratory syncytial virus (1), and adenovirus (1) were detected in cases while adenovirus (1) and picornavirus (2) were detected in controls. In patients with moderate or severe COPD the presence of a virus in upper airway secretions is strongly associated with the development of COPD exacerbations. These data support the causative role of viruses in triggering COPD exacerbations in the community.

CLINICAL AND VACCINE IMMUNOLOGY ( formerly Clinical and Diagnostic Laboratory Immunology)

CLINICAL AND VACCINE IMMUNOLOGY ( <i>formerly</i> Clinical and Diagnostic Laboratory Immunology)

The Serendipity of Life, Medicine, and Science

Dr. Robert Schooley, a graduate of Washington and Lee University, obtained his medical degree from The Johns Hopkins University School of Medicine in 1974 and completed a residency in internal medicine at The Johns Hopkins Hospital in 1976. Subsequently, he became a clinical associate in the Laboratory of Clinical Investigation at the National Institute of Allergy and Infectious Diseases (NIAID). While at the National Institutes of Health (NIH) from 1976 until 1979, he studied viral pathogenesis and therapy, specifically cellular immunity in Epstein-Barr virus infection. He then completed a clinical and research fellowship in the Infectious Disease Unit at the Massachusetts General Hospital (MGH) in 1981. From 1981 until 1990, he was on staff as attending physician at the MGH. Dr. Schooley developed the novel concept of evaluating the cellular immune response to what later became known as human immunodeficiency virus (HIV) in patients. In 1990, he was named head of the Division of Infectious Diseases at the University of Colorado Health Sciences Center in Denver, Colorado. Dr. Schooley has served on the AIDS Clinical Trials Group–first as Chairman for the Immune Based Therapy Working Group from 1989 to 1992, then as Chairman of the Core Immunology Committee from 1993 to 1995, and most recently as Chairman of the Executive Committee from 1995 to the present. In addition, he has served as chair of the Scientific Program Committee for the Infectious Diseases Society of America (IDSA) in 1997 and on advisory committees for the American Foundation for AIDS Research (AMFAR) and the National Hemophilia Foundation. Dr. Schooley has also served on the editorial boards of Antimicrobial Agents and Chemotherapy, Biotherapy, Journal of Acquired Immune Deficiency Syndromes, AIDS, and Clinical and Diagnostic Laboratory Immunology. Dr. Schooley has been awarded the New Investigator Award at NIAID as well as the John Enders Memorial Lectureship by the IDSA in 1991. In 1999, he was awarded the Bonfils-Stanton Foundation Award for his remarkable scientific work. In addition, he was named among the Best Doctors in America from 1995 to 1999.

Myiasis Due to Hypoderma lineatum Infection Mimicking the Hypereosinophilic Syndrome

Myiasis Due to Hypoderma lineatum Infection Mimicking the Hypereosinophilic Syndrome

Interleukin 4 in Systemic Sclerosis: Not Just an Increase

Interleukin 4 in Systemic Sclerosis: Not Just an Increase

Clinical and diagnostic laboratory immunology: evolution of the field and birth of a journal

The roots of clinical and diagnostic laboratory immunology are deeply embedded in the history of bacteriology and subsequently microbiology, immunology, and the associated clinical disciplines. Insights into host-microbe interactions in these areas led to tests for the antibodies to infectious agents, autoantibodies, and subsequently cellular immunity. Clinical needs for laboratory testing for the competence of T cells, B cells, macrophages, and natural killer cells have led to the proliferation of the clinical immunology laboratories. During the past half century, such laboratories were initiated primarily through research enterprises. Over the past decade, standardization, quality control, and quality assurance emerged at the same time as the field of clinical and diagnostic laboratory immunology emerged from microbiology laboratories and from research immunology laboratories. During the 1980s and due in part to the rapidly developed need for information about HIV and AIDS, cellular immunology laboratories have been established throughout the world. Early on, the American Society for Microbiology (ASM) recognized the growing importance of laboratory immunology and fostered its growth in several domains. In 1974, a committee was founded by the late Irwin Neter which led to the creation of the American Board of Medical Laboratory Immunology in 1978. During the same period, the American Society for Microbiology published the first edition of the Manual of Clinical Immunology, having initiated this important endeavor with Noel R. Rose and Herman Friedman. In addition, the society under the direction of the late Mario Escobar, founded Division V—Clinical and Diagnostic Immunology. These landmark events provided a certifying board, a basis for setting and monitoring standards and performance criteria, and a forum within ASM for members of this growing field. During the same period, articles on diagnostic laboratory immunology were submitted and published more frequently in the Journal of Clinical Microbiology, in sibling journals of ASM, and elsewhere. From, 1983 to 1993, I had the privilege of serving as the immunology editor for the Journal of Clinical Microbiology under the editorship of Henry D. Isenberg. Because the field had expanded significantly, Barbara Iglewski, chair of the ASM Publications Board, formed a committee chaired by James D. Folds in 1993 to examine the possibility of creating a journal devoted exclusively to clinical laboratory immunology. The committee rapidly determined that there was a need for such a publication and recommended that ASM proceed. Thus, Clinical and Diagnostic Laboratory Immunology was created. It garnered material from outside traditional ASM sources and from both the Journal of Clinical Microbiology and Infection and Immunity with encouragement from the respective editors in chief, Richard C. Tilton and Vincent A. Fischetti. I was honored to be appointed editor in chief and with major efforts from many individuals in this field who serve(d) as editors (James D. Folds, David E. Normansell, Noel R. Rose, Stanley A. Schwartz, Steven C. Specter, Daniel P. Stites, and Theresa L. Whiteside), editorial board members, and contributors, Clinical and Diagnostic Laboratory Immunology was launched in January 1994 and continues to prosper. The journal, which is bimonthly, has not ceased evolving and sets the pace for the field. Just as ASM has evolved during its first century, the field of clinical immunology as well as its literature has emerged from classical immunochemistry into a new era of cellular immunology. Clinical and Diagnostic Laboratory Immunology too will evolve, addressing the increasing utilization of laser technology, molecular diagnostics, robotics, and unique immune-based therapies in the next millennium.

Clinical laboratory immunology: the future.

Preparation for the future has two elements. One is to look at the dynamics operating at the present time to estimate where these are heading. The second is to have an open but prepared mind to discern important new elements that will arise to impact on the practice of clinical laboratory immunology. The future is going to be a foreign land, as has been pointed out by Herbert Hooijkaas (1). The language will be different from that which we are used to. The terms of reference will be different. The areas of importance will be different and the assumptions of professional knowledge and responsibility may be different. Clearly, meeting the conditions required for successful performance and communication in a foreign land or era will require continual attention. Readiness to learn as well as preparation in the basics will be needed for effective participation in the future world.

Monocytes/macrophages in diagnosis and immunopathogenesis.

This article summarizes studies of human monocytes/macrophages carried out in my laboratory over a period of more than three decades. Modern studies of mammalian phagocytes began with Metchnikoff in the late 19th century. The early history of this field is summarized in Table ​Table1.1. In vivo and in vitro studies in animal systems led to the concept of the mononuclear-phagocyte system as a cell system involved in host defenses, phagocytosis, and antigen presentation and processing (11). Following Metchnikoff’s development of phagocyte theory, Wright described opsonins as factors in serum that facilitated phagocytosis. Aschoff defined the reticuloendothelial system as a cellular system in which tissue macrophages and monocytes share important functional characteristics, namely, phagocytic ability and adhesiveness to glass. Subsequently, the histologic development of silver stains by Del Rio-Hortega defined a type of macrophage-related cell in the brain, the microglia. In the mid-1960s, the late Zanvil Cohn and his collaborators carried out seminal studies of mononuclear phagocytes leading to concepts of macrophage differentiation, activation, secretion, and the relationship of macrophages to antigen presentation and processing. My laboratory has had a long-standing commitment to the investigation of human monocytes/macrophages, their normal structure and function, their role in the immunopathogenesis of various disorders, and their functional abnormalities in diseases. TABLE 1 Early history of research on mononuclear phagocytes (This report was presented as the Abbott Award Lecture in Clinical and Diagnostic Laboratory Immunology at the 97th General Meeting of the American Society for Microbiology, Miami, Fla., May 1997.)