Histology Course Research Articles

Classroom Clickers Provide Reliable Formative Feedback: Three years experience in gross and microscopic anatomy curriculum

The goal of our study was to evaluate the effectiveness of the audience response system (ARS) as a tool for providing formative feedback to first year medical students. Over a three year period, we collected data from anatomy and histology courses in which students answered clinically oriented multiple choice questions using the ARS. We compared each student's cumulative ARS and final exam scores and we calculated a correlation coefficient between these two values. In addition, we conducted a questionnaire to evaluate the students' perception on ARS. According to our results, students saw ARS as useful for providing feedback on performance with a mean of 3.61 (1‐5 scale). There was a strong positive correlation between ARS and final exam scores. R values for the ARS and NBME Anatomy subject exam was R=.9556; and for the Anatomy/Radiology written exams, R=.9882. Students believed that ARS improved their performance with a mean of 3.94 (1‐5 scale). Students also preferred more frequent ARS quizzes with fewer questions to less frequent sessions with more questions (mean=3.74). In conclusion, students use ARS as a feedback tool and can rely on it as a good predictor of final course performance. We have found that ARS feedback motivates students to seek help from faculty when appropriate. It is user friendly, interacts well with PowerPoint, and is not time consuming for faculty.Grant Funding SourceAAA

Clinico‐Histologic Conferences (CHC): A New Endeavor in Teaching Histology

Clinico‐Histologic Conferences were developed for the histology course in the first year of medical school to: enhance the relevance of histology by providing a clinical context, foster peer teaching and learning through teamwork, and promote longitudinal integration and application of medical knowledge. Twenty‐four groups of six students each were assigned a disease and created a 10 min presentation with a handout with the objective of teaching the class about that disease. The students' oral presentation and handout focused on the salient features of the disease, i.e. description of the disease, including symptoms, findings, incidence (US & other countries), age or gender or other predisposing factors and outcomes (morbidity, life expectancy); etiology of the disease (cause or origin of the disease, the basis of the cellular manifestation of the disease, and if known, the molecular/genetic defect.); diagnosis (lab tests, histological tests). A 5 min Q and A was at the end of each presentation with an expert MD facilitator present. The facilitator evaluated the students on their oral presentation (choice of content, format, and discussion to facilitate student understanding of the disease) and handouts (quality of information, format, clarity of information and graphics of histology/pathology of disease). There were also questions on the midterm and final exams related to the content taught in the CHCs.

Effect of problem based approach on medical students’ learning satisfaction and understanding in the histology course topics

Background and purpose: Problem-based learning (PBL) is a term used within education for a range of teaching approaches that encourage students to learn through the structured exploration of a problem. Histology comes early in the curriculum and the medical students seem unable to see the value of the content, they don't appear to be motivated to learn the content. This project used PBL to help the students make the connection between the content and clinical aspects. Methods: Thirty six undergraduate medical students, 22 female and 14 male, enrolled in the histology course during the spring s emester of 2008. A survey which collected information relative to gender, course load, and workload and study time was used. The subjects were accessory glands of digestive system histology. The course is designed into four units: tree units of salivary glands, pancreas and gall bladder histology, were presented in a traditional lecture format; the fourth unit, liver was presented in a problem-based format that used clinical practice. Assessment focused on three issues of a. student engagement, b. lesson assessment in terms of clarity, interest and usefulness and c. student understanding. Results: Student comments collected during PBL class periods indic ate engagement in the topic. In PBL method of teaching most of responses were consistent with the aim of teaching but in traditional classes few responses relate to the objectives at hand. Students had more active partnership in PBL class. Students found PBL class more useful, interesting and clear in terms of subject material than traditional method. Conclusions: In t his project student comments collected during PBL class periods indicated more engagement in the topic. Students’ understanding of material were significantly higher and students’ partnership in PBL class was more than traditional classes.

Hepatitis C virus and glucose and lipid metabolism

The hepatitis C virus (HCV) is a major cause of chronic liver disease worldwide. Its spectrum of severity, however, varies widely, as does its rate of progression towards cirrhosis. This depends on several host-related cofactors, such as age, gender, alcohol consumption, over weight and co-infections. The objective of this review is to discuss two of these cofactors: steatosis and insulin resistance. Although both may occur independently of HCV, a direct role of HCV infection in their pathogenesis has been reported. Whereas the virus-induced steatosis does not seem to have major clinical consequences, the so-called ‘metabolic’ steatosis and underlying insulin resistance may not only modify the clinical and histological course of chronic hepatitis C, but may also influence the response to interferon alpha-based therapy.

A new paradigm for teaching Histology laboratories in Canada's first distributed medical school

To address the critical problem of inadequate physician supply in rural British Columbia, The University of British Columbia (UBC) launched an innovative, expanded and distributed medical program in 2004-2005. Medical students engage in a common curriculum at three geographically distinct sites across B.C.: in Vancouver, Prince George and Victoria. The distribution of the core Histology course required a thorough revision of our instructional methodology. We here report our progress and address the question "How does one successfully distribute Histology teaching to remote sites while maintaining the highest of educational standards?" The experience at UBC points to three specific challenges in developing a distributed Histology curriculum: (i) ensuring equitable student access to high quality histological images, (ii) designing and implementing a reliable, state-of-the-art technological infrastructure that allows for real-time teaching and interactivity across geographically separate sites and (iii) ensuring continued student access to faculty content expertise. High quality images--available through any internet connection--are provided within a new virtual slide box library of 300 light microscopic and 190 electron microscopic images. Our technological needs are met through a robust and reliable videoconference system that allows for live, simultaneous communication of audio/visual materials across the three sites. This system also ensures student access to faculty content expertise during all didactic teaching sessions. Student examination results and surveys demonstrate that the distribution of our Histology curriculum has been successful.

A new paradigm for teaching histology in Canada's first distributed medical school

To address the critical problem of inadequate physician supply in rural British Columbia, the University of BC launched an expanded and distributed medical program in 2005. Medical students engage in a common curriculum at 3 geographic sites across BC, in Vancouver, Prince George and Victoria. The distribution of the core Histology course required a thorough revision of our instructional methodology. We here report our progress and address the question “How can Histology be distributed to remote sites while maintaining the highest of educational standards?” Experience at UBC points to 3 specific challenges: (i) ensuring equitable student access to quality histological images, (ii) implementing a technological infrastructure that allows for real‐time teaching and interactivity across sites, and (iii) ensuring student access at all sites to Faculty expertise. High quality images (available through any internet connection) are provided within a new virtual slide box library of 300 light microscopic and 190 electron microscopic images. Our technological needs are met through a videoconference system that allows for live, interactive sharing of visual/audio materials across the 3 sites. This system also ensures student access to Faculty expertise during didactic teaching sessions. Student examination results and surveys demonstrate that the distribution of our Histology curriculum has been successful.

A phase I clinical trial of interferon‐beta gene therapy for high‐grade glioma: novel findings from gene expression profiling and autopsy

High-grade gliomas are highly lethal neoplasms representing approximately 20% of all intracranial tumors. Cationic liposome-mediated interferon-beta (IFN-beta) gene transfer has been found to induce regression of experimental glioma. We have previously performed a pilot clinical trial to evaluate the safety and effectiveness of this IFN-beta gene therapy in five patients with high-grade glioma. Two patients showed more than 50% reduction while others had stable disease 10 weeks after treatment initiation. To identify alterations in gene expression in brain tumors 2 weeks after the gene therapy trial, we used a microarray technology and Gene Ontology analysis. The results were validated by patients' clinical course and findings of histology and autopsy. Using hierarchical clustering and principal component analysis, five series of gene therapy trials were classified according to the response to IFN-beta gene therapy. Significant changes in gene expression related to immunoresponse and apoptosis were observed. Moreover, novel patterns of altered gene expression, such as inhibition of neovascularization, were identified, suggesting the involvement of pathways reported previously as not involved. Autopsy and histological examinations revealed dramatic changes in the tumor tissues after therapy in all patients. Many tumor cells showed necrotic changes, and immunohistochemistry identified numerous CD8-positive lymphocytes and macrophages infiltrating the tumor and surrounding tissues; these were probably the effects of therapy. Simultaneously, CD34-immunoreactive vessels were notably decreased in the vector-injected brain. This study facilitates the understanding of the antitumor mechanism and helps identify candidate target molecules for new approaches. However, additional clinical trials are warranted.

A Case of Intermediate Grade Bronchial Mucoepidermoid Carcinoma and Review in Korean Cases

Bronchial mucoepidermoid carcinoma is uncommon, representing 0.2% of all lung tumors. The disease usually presents with symptoms of airway obstruction and recurrent pneumonia. It is commonly classified into two grades in Korea, low and high. We report a case of a bronchial mucoepidermoid carcinoma in a 40-year-old woman who complained of symptoms of an upper respiratory infection. The histological grade after a bronchoscopic biopsy was intermediate. A left upper lobectomy was performed as treatment. The TNM stage of this case was IA (T1N0M0). In addition, 25 cases of bronchial mucoepidermoid carcinoma from 1984 in Korea are also reviewed from the viewpoint of the relationship between the histological grade, TNM stage and clinical course of the tumor.

Chemotherapy for advanced gastric cancer--our possibilities in 2007

Gastric cancer is the fourth most common malignancy in Hungary. Surgery remains the mainstay of any curative treatment, however, approximately two-thirds of patients diagnosed with gastric cancer have unresectable (locally advanced and/or metastatic) disease. In that stage, palliative chemotherapy is of crucial importance. Gastric cancer is heterogeneous regarding location, etiology, histology and natural course. This diversity is reflected in the results of randomized controlled trials as well. Patient selection, location of primary, stage and pretreatment of the tumor, as well as the reference treatment, patient stratification and endpoints have varied among trials. Based on the results of the clinical trials of the past decades, gastric cancer is chemosensitive, however, patient prognosis remains very poor, with a median survival of less than one year, and therapy-associated toxicity remains an issue. Based on the aforementioned, no standard regimens have yet been established worldwide. New compounds and targeted biological treatment make the development of more effective, less toxic, individualized treatment modalities possible.

Diagnostic performance of CT, PET, side-by-side, and fused image interpretations for restaging of non-Hodgkin lymphoma

The purpose of this study was to compare the diagnostic performance of positron emission tomography (PET) alone, computed tomography (CT) alone, side-by-side reading, and fused images for restaging or follow-up of patients with malignant lymphoma. Fifty patients with histologically confirmed non-Hodgkin lymphoma underwent an (18)fluoro-2-deoxyglucose (FDG)-PET scan, followed by a CT scan. CT alone, PET alone, side-by-side reading, and fused images were interpreted separately and visually using a five-point grading scale for the following eight regions: cervical, supraclavicular, axillary, mediastinal, para-aortic to iliac, mesenteric, inguinal, and extra-nodal. Diagnostic accuracy was compared on the basis of the final diagnoses determined by histological confirmation and/or clinical course. For all regions combined, the interpretation of PET alone (sensitivity = 86.1%, specificity = 99.4%, accuracy = 91.0%), side-by-side reading (96.0%, 99.4%, 98.9%), and fused images (98.0%, 99.4%, 99.2%) yielded significantly higher diagnostic performance than that of CT alone (59.4%, 96.1%, 91.0%; P < 0.001). The cervical, supraclavicular, and extra-nodal regions were more accurately diagnosed with PET (P < 0.05), whereas the para-aortic to iliac regions were diagnosed more accurately with side-by-side reading and fused images than with CT alone or PET alone (P < 0.05). Although fused images are clinically valuable, side-by-side reading showed equivalent performance, whereas the interpretation of PET alone yielded reasonably high diagnostic performance for restaging or follow-up of patients with malignant lymphoma.

Comparison of metabolic activity in mantle cell lymphoma at biospy site and other tumor sites using 18F-FDG PET

18529 Background: Mantle cell lymphoma (MCL) is a mature B-cell non-Hodgkin’s lymphoma (NHL) with a variable clinical course ranging from indolent to aggressive. Treatment for MCL is complicated by this variability, as systemic chemotherapy for NHL is directed by the aggressiveness of the lymphoma. Previous attempts have been made to correlate clinical outcome in MCL with histologic features. More recently, measurement of metabolic activity using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) was found to be highly correlative with the aggressiveness of NHL. Given the clinical heterogeneity of MCL, the search for the true metabolic status in MCL is important in prognostication and management. We propose to study the metabolic activity in MCL by comparing the maximum SUV at the site of biopsy with the highest SUV in other MCL areas of the body. Methods: 12 patients with newly diagnosed MCL and having staging by FDG-PET were identified. PET(CT) body scans were obtained in the usual fashion. The SUVs, defined as tumor activity divided by dose injected per lean body mass, from the PET and PET-CT cameras were cross validated to produce the same value in a given phantom and patient. Maximum biopsy SUV was measured by searching the maximum value within a volume of interest over the known biopsy site, and highest body SUV was similarly searched in known tumor sites in other body areas. Results: One patient was excluded because the tumor at the biopsy site had been completely resected. The remaining 11 patients (M:F=8:3, age=63±8 yrs) were analyzed. The SUV at biopsy sites ranged from 2.1 to 9.8 (mean=5.2±2.3). The SUV in other tumor sites ranged from 4.8 to 18.6 (mean=8.9±4.1), which was significantly higher when compared to the respective biopsy site (p=0.0036). Conclusions: As the SUV of MCL at the biopsy site may not represent the highest SUV, it is important to search other tumor sites in the body for the highest SUV to help in grading, managing, and subsequent monitoring of MCL. Perhaps FDG-PET can direct biopsies to tumor sites with the highest SUV and subsequently provide useful histologic detail for predicting clinical course. Future study is needed to correlate the maximal SUV of MCL with histology and clinical course. No significant financial relationships to disclose.

Ribavirin with either standard or pegylated interferon to treat recurrent hepatitis C after liver transplantation

To investigate the efficacy of two anti-viral protocols in hepatitis C virus-reinfected liver transplant recipients. In this prospective study, 26 liver transplant patients were treated with standard interferon-alpha2b for 12 months or standard interferon-alpha2b for 3 months followed by pegylated interferon-alpha2b for 9 months. Interferon was combined with ribavirin in all patients. The histological course of the study population was compared with an untreated historic control group (n = 38) with similar baseline characteristics. The sustained virological response rates in the standard interferon group and in the pegylated interferon group were 27.3% and 26.7%, respectively. Only 29% of patients with sustained virological response had end of treatment histological response, whereas 47% of viral non-responders showed end of treatment histological response. The percentage of patients with histological improvement was significantly higher in the study population when compared to the controls. Univariate analysis indicated that hepatitis C virus genotype non-1, high baseline alanine aminotransferase, the time interval between liver transplant and interferon therapy and the body mass index predicted sustained virological response. In the multivariate model, baseline alanine aminotransferase and the body mass index remained a significant predictor of sustained virological response. Both treatment regimens offer similar efficacy profiles. Failure to eradicate hepatitis C virus should not lead to treatment discontinuation if serial liver biopsies demonstrate histological response.

Promoting rapid learning in the histology laboratory by integrating technology

A challenging aspect for students in histology courses is to locate specific morphological structures found on glass slides using light microscopes. One-on-one instructor demonstrations can be time consuming in laboratory classes with high student enrollment. Here, I tested the teaching impact of (a) verbal instruction by the faculty combined with high-resolution video imaging (HRVI) versus (b) written descriptions alone. Questions included: which type of student (one with a one-semester histology course background or little-to-no background) would be able to find specific histological structures more rapidly, regardless of teaching method used (HRVI versus written descriptions)? and would students be able to find specific histological structures more rapidly using HRVI versus written descriptions? The results showed that students with a one-semester histology course background were able to locate more quickly specific histological structures than students who had little-to-no background. Students could locate more quickly specific histological structures using the HRVI method. This was the case regardless of their previous histological background. The data demonstrate that the use a compound light microscope connected with HRVI for instruction enhances student learning in histology courses.

Assessment of online pre‐laboratory quizzes in the instruction of oral histology

Web-based technology has many attributes and is considered a useful tool for teaching outside the classroom due to its networking capability and broad accessibility. For many instructors web-based technology serves as the mechanism for course delivery, while in other instances online activities may simply enhance traditional classroom instruction. Presently we utilize Blackboard, an integrated web-based support system that enables students to access grades and course material online. Over the last two years we have increased the amount of online material in our Oral Histology course. While the course still utilizes light microscopy as the primary method of laboratory instruction we now have supplemented these teaching methods with online digital laboratories and pre-laboratory quizzes. The implementation of online material was designed to promote self-directed learning and facilitate structure identification during lab. Due to the format change we sought to evaluate the effectiveness of online lab material as a supplement to traditional teaching, and assess the outcome of administering pre-laboratory quizzes on student performance. In the present study student performance was assessed over a two year period. In the first year, the course was taught to 67 dental students using traditional methods of laboratory instruction. In the second year, students with equivalent GPA and DAT scores were instructed using web-based materials as a supplement to traditional methods and took a pre-lab quiz. Both groups of students were evaluated using light-microscopy based lab exams. There was no difference on student performance between students using traditional methods and students using web-based material

A study of student performance on self-scheduled, computer-based examinations in a medical histology course: is later better?

Background: Student self-scheduling of computer-based examinations during a defined window of opportunity is a protocol used by some medical school courses and licensing bodies. Students scheduling late have more time to prepare, which may provide them with an unfair advantage.Methods: ANOVA was used to compare the average scores of three different cohorts of test-takers (early, middle and late) on 13 Microscopic Anatomy exams taken over a 3-year period (2003–2005) at the University of Arkansas for Medical Sciences.Results: On 11 of the 13 exams, the average score of students who took the exam last was lower than that of students who took the exam first. These differences were significant for eight (73%) exams. There were two exams on which the average score of students who took the exam last was higher than that of students who took the exam first, but these differences were not significant.Conclusions: Scheduling exams late in the window of opportunity does not appear to provide a performance advantage and may even be detrimental since these students are responsible for new content information in the course and in other concurrently running courses while they are preparing for a ‘late’ exam.

Liver transplantation worldwide

Liver transplantation worldwide

Spontaneous regression in recurrent epithelial ovarian cancer

Although spontaneous regression has been reported in several cancers, it is generally believed that this rare phenomenon does not occur in epithelial ovarian cancer. We presented a stage IV epithelial ovarian cancer patient with long-term disease-free survival after palliative local irradiation alone against recurrence. The recurrent supraclavicular lymph node was almost completely necrotic, and the swelling of the para-aortic lymph node spontaneously regressed. The histologic features and unexpected clinical course in this patient strongly suggest that spontaneous regression occurred in recurrent epithelial ovarian cancer.

Effectiveness of an Electronic Histology Tutorial for First‐Year Dental Students and Improvement in “Normalized” Test Scores

The effectiveness of an electronic histology tutorial (EHT) as a mode of learning was assessed by comparing performance on two term tests for an EHT class of sixty-nine students and five prior classes (n=347) who learned by traditional methods. The aims of this study were to 1) develop and introduce a self-instructional, computer-aided approach to guide student learning in the first-year histology course at the University of Toronto Faculty of Dentistry; 2) evaluate the effectiveness of the self-study electronic histology tutorial by comparing students' test scores for the EHT group to students' scores in previous years; and 3) evaluate students' acceptance of this novel mode of learning by means of a satisfaction questionnaire. The EHT group performed significantly better on both the general histology and oral histology term tests than the five prior control years (p<0.001), yet there were no significant differences in overall GPA between the groups, suggesting that the improvement was specific to the EHT/histology course grades (p=0.1 to 0.47). A statistically significant improvement in performance per unit overall GPA was noted in the test group, which demonstrated an increase in this test score normalized ratio (TSNR) of 3-18 percent in the general histology term test and 7-21 percent in the oral histology term test over the control groups. In addition to determining the effects of the EHT on grade performance, this study sought to evaluate students' acceptance of this alternative mode of learning in comparison to the standard teaching model by means of a satisfaction questionnaire. Overall, students' responses to the questionnaire were positive with an overall mean level of agreement for all ten responses of 4.5 out of 5 (90 percent).

Virtual Microscopes in Podiatric Medical Education

In many medical schools, microscopes are being replaced as teaching tools by computers with software that emulates the use of a light microscope. This article chronicles the adoption of "virtual microscopes" by a podiatric medical school and presents the results of educational research on the effectiveness of this adoption in a histology course. If the trend toward virtual microscopy in education continues, many 21st-century physicians will not be trained to operate a light microscope. The replacement of old technologies by new is discussed. The fundamental question is whether all podiatric physicians should be trained in the use of a particular tool or only those who are likely to use it in their own practice.

Virtuelle Mikroskopie

Only recently fast-paced developments in computer technology allowed for the digitization of complete histologic slides. The resulting virtual slides may be viewed via webbrowser by any number of pathologists or students independent of time and location. Usage of a virtual microscope simply requires a computer workstation with a fast internet connection, which opens this technology to a broad public. A virtual microscopy system consists of three components: acquisition, server and client. Such systems are under development by different commercial and academic bodies worldwide. We have developed a virtual microscope system called vMic (http://www.vmic.unibas.ch) which provides virtual slides of very high image quality. Several successfully held online slide seminars and a histology course for students in dentistry are freely accessible in the internet. With the commercial availability of ultra rapid and easy-to-use slide scanners and the fast improvements of technology virtual microscopy will offer many applications in teaching, research and diagnostics. Thanks to additional functionalities, real microscopes will most likely be replaced by computer workstations in a couple of years.