Small team-based medical imaging of human cadavers: an innovative tool for interdisciplinary learning inHuman Gross Anatomy andRadiologic Sciences

The purpose of this study was to develop an interdisciplinary activity that merged the disciplines of human gross anatomy and radiology early in the educational process of doctors and radiographers allowing students to use human cadavers to learn anatomy and medical imaging (technique and in-terpretation) through small-group problem-solving sessions. Over 10 years, 734 student doctors and radiographers were divided into small groups and assigned cadavers. Images of cadavers included x-rays, CT and MRI regional and full-body series. Students problem-solved radiographic parameters and interpreted images. Student radiographers completed a semester project labeling anatomical structures in a CT or MRI series. Student doctors used images during dissection and presented radiographic series to demonstrate understanding of anatomy, radiology and skilled use of image analysis software. Participants completed a 100-question LIKERT Scale survey. Data were ana-lyzed based on overall group, cadaver experience, and radiography experience. Students produced high-quality images for use in the laboratory andclassroom, and 95% agreed that this activity helped them to learn anatomy and radiography. Students agreed that x-rays, CT and MRI scans were 92.0%, 91.1% and 90.1% beneficial, respectively, in learning anatomy and radiology, and 90% of participants documented that this program had a positive impact in knowledge and competency development for his or her chosen career. Both radiography and medical students reported that working on interprofessional teams enhanced their knowledge of anatomy and radiology and under-scored the importance of partnerships in healthcare. This program serves as a novel model for interdisciplinary team-based-learning of human anatomy and radiology

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The weight of obesity on the human immune response to vaccination.

Despite the high success of protection against several infectious diseases through effective vaccines, some sub-populations have been observed to respond poorly to vaccines, putting them at increased risk for vaccine-preventable diseases. In particular, the limited data concerning the effect of obesity on vaccine immunogenicity and efficacy suggests that obesity is a factor that increases the likelihood of a poor vaccine-induced immune response. Obesity occurs through the deposition of excess lipids into adipose tissue through the production of adipocytes, and is defined as a body-mass index (BMI) ≥ 30 kg/m(2). The immune system is adversely affected by obesity, and these "immune consequences" raise concern for the lack of vaccine-induced immunity in the obese patient requiring discussion of how this sub-population might be better protected.

The impact of immunosenescence on humoral immune response variation after influenza A/H1N1 vaccination in older subjects.

BACKGROUND: Although influenza causes significant morbidity and mortality in the elderly, the factors underlying the reduced vaccine immunogenicity and efficacy in this age group are not completely understood. Age and immunosenescence factors, and their impact on humoral immunity after influenza vaccination, are of growing interest for the development of better vaccines for the elderly. METHODS: We assessed associations between age and immunosenescence markers (T cell receptor rearrangement excision circles - TREC content, peripheral white blood cell telomerase - TERT expression and CD28 expression on T cells) and influenza A/H1N1 vaccine-induced measures of humoral immunity in 106 older subjects at baseline and three timepoints post-vaccination. RESULTS: TERT activity (TERT mRNA expression) was significantly positively correlated with the observed increase in the influenza-specific memory B cell ELISPOT response at Day 28 compared to baseline (p-value=0.025). TREC levels were positively correlated with the baseline and early (Day 3) influenza A/H1N1-specific memory B cell ELISPOT response (p-value=0.042 and p-value=0.035, respectively). The expression and/or expression change of CD28 on CD4+ and/or CD8+ T cells at baseline and Day 3 was positively correlated with the influenza A/H1N1-specific memory B cell ELISPOT response at baseline, Day 28 and Day 75 post-vaccination. In a multivariable analysis, the peak antibody response (HAI and/or VNA at Day 28) was negatively associated with age, the percentage of CD8+CD28 low T cells, IgD+CD27- naïve B cells, and percentage overall CD20- B cells and plasmablasts, measured at Day 3 post-vaccination. The early change in influenza-specific memory B cell ELISPOT response was positively correlated with the observed increase in influenza A/H1N1-specific HAI antibodies at Day 28 and Day 75 relative to baseline (p-value=0.007 and p-value=0.005, respectively). CONCLUSION: Our data suggest that influenza-specific humoral immunity is significantly influenced by age, and that specific markers of immunosenescence (e.g., the baseline/early expression of CD28 on CD4+ and/or CD8+ T cells and T cell immune abnormalities) are correlated with different humoral immune response outcomes observed after vaccination in older individuals, and thus can be potentially used to predict vaccine immunogenicity.

Detection of influenza A/H1N1-specific human IgG-secreting B cells in older adults by ELISPOT assay.

B cells play an important role in humoral immunity and antibody production. Use of a B cell ELISPOT assay to quantify antigen-specific B cells can assist other assays to achieve a more complete profile of the humoral immune response after vaccination. We utilized a B cell ELISPOT assay to measure the number of influenza A/H1N1-specific B cells at key timepoints after seasonal influenza vaccination in 106 older adults (50-74 years of age). Blood was drawn from these subjects on Day 0, Day 3, Day 28, and Day 75 after vaccination to represent baseline, early, peak, and late response, respectively, of influenza A/H1N1-specific B cells. A significant increase in A/H1N1-specific B cells (median 36 spot-forming units/SFUs per 200,000 cells, p<0.0001) was seen on Day 28 compared to baseline and Day 3, and this number decreased (23 SFUs, p<0.0001) by Day 75, but not to baseline level. These data suggest that the B cell ELISPOT can be used to profile and monitor the humoral immune responses in older subjects after influenza vaccination, and serve as an immune signature marker.