CD44 expression in patients with combined hepatocellular cholangiocarcinoma

PURPOSE: Combined hepatocellular cholangiocarcinoma (ChC) is a rare type of primary liver cancer, which is thought to have a poorer prognosis than hepatocellular carcinoma (HCC). Cancer stem cells are associated with tumorigenesis, tumor progression, recurrence, metastasis, and poor prognosis in several malignancies including HCC. The aim of this study was to investigate the expression pattern of cancer stem cell markers in ChC and HCC, and to evaluate whether this pattern correlated to patient prognosis. METHODS: Thirteen patients who underwent curative hepatic resection for ChC and 13 patients who underwent curative hepatic resection for HCC (matched control cases) were included. Immunohistochemical staining for cancer stem cell markers (cytokeratin [CK]7, CK19, C-kit, cluster of differentiation [CD] 44, CD133, and epithelial cell adhesion molecule) was performed and clinical outcomes were analyzed retrospectively. RESULTS: There was no significant difference in cancer stem cell marker expression between ChC and HCC. In ChC, the group that expressed CD44 showed earlier recurrence than the group that did not express CD44 (P = 0.040). CONCLUSION: The expression of cancer stem cell markers in ChC did not show a different pattern compared to that found in HCC. The expression of cancer stem cell marker CD44 was associated with poor prognosis in patients with ChC.

Cyclic AMP prolongs graft survival by suppressing apoptosis and inflammatory gene expression in acute cardiac allograft rejection

This study was designed to investigate the effects of cAMP on immune regulation and apoptosis during acute rat cardiac allograft rejection. We found that the production of immune markers such as inflammatory cytokines (IL-1beta, IL-6, and TNF-alpha), iNOS expression, and nitric oxide (NO) production, was significantly increased in the blood and transplanted hearts of allograft recipients, but not of isograft controls. These increases were effectively suppressed by the administration of the membrane permeable cAMP analog dibutyryl cAMP (db-cAMP). Administration of db-cAMP reduced allograft-induced elevation of several biochemical markers, such as adhesion molecule expression, iron-nitrosyl complex formation, caspase-3 activation, and apoptotic DNA fragmentation in an animal model. Furthermore, treatment of allograft recipients with db-cAMP prolonged median graft survival to 11 days compared with a median graft survival time of 8 days in saline-treated allograft recipients. These results suggest that db-cAMP exerts a beneficial effect on murine cardiac allograft survival by modulating allogeneic immune response and cytotoxicity.

Multiple Mini-Interview in Selecting Medical Students / 한국의학교육

PURPOSE: Selecting medical students through interviews seems difficult and the reliability of the results is one of the major concerns. The purpose of this study was to investigate the reliability and acceptability of the Multiple Mini-Interview (MMI) in selecting medical students of Kangwon National University. METHODS: Eighty-four applicants participated in the MMI which consists of 3 8-minute stations that have 9 checklist items and 3 global items. The 3 domains that we chose were motivation to become a doctor, communication and interpersonal skills, and ethical decision-making. We placed 2 interviewers in each room. The interviewers were chosen from our faculty. We analyzed the reliability of the MMI with urGENOVA for PC. We conducted a survey of these applicants and interviewers. RESULTS: The reliability was 0.791. Students answered that the interview was impressive and enjoyable. Students were also satisfied with the level and quality of the MMI cases. They described that they were evaluated objectively. Interviewers also responded positively. They stated that more stations and more efforts to develop the cases were needed to improve the reliability and validity. CONCLUSION: The MMI was acceptable to our applicants and faculty. It is reliable for assessing medical school applicants in Korea. We should develop more stations and better cases to increase the reliability and validity of the MMI.

Implementation of Student Internship with Intern-Level Responsibility / 한국의학교육

PURPOSE: The aim of the study is to evaluate the possibility of giving student interns intern- level responsibilities and to discuss the various obstacles. METHODS: Modifications were made to the student internship program, including rotations through major departments, for 4th-year medical students and was conducted at the College of Medicine, Kangwon National University. We surveyed 49 students for the evaluation of the program, administered a checklist evaluation for their performance, and interviewed two focus groups of faculties and residents to find out the obstacles of the program. RESULTS: Most of the students answered that the program was satisfactory and necessary. Of the students, 71.4% performed as an acting intern. The mean score of the students' performance was 84.1. The students had the most difficulty with time management and making diagnostic and management decisions. Initially, at the start of the program, both students and residents were somewhat confused about the student interns' duties. They suggested that definite learning objectives, legal and institutional support to students' clinical practice, and announcements to patients and hospital staff should be put in place prior to the implementation of such a program. CONCLUSION: We discovered that it was possible for student interns to perform at the level of interns. We suggest that systemic improvements continue for the establishment of such student internship program.