[Mortui vivos docent?--experienced burdens of medical students in the gross anatomy course]. / Mortui vivos docent?--Subjektives Belastungserleben von Studierenden im Kursus Makroskopische Anatomie.

The dissection course (here abbreviated: PK) is still an obligatory part of medical schools in Germany. In this study we investigated the experiences and burdens of medical students in gross anatomy, especially "distancing from the human body".This study was carried out three times with the self-composed questionnaire BF-PK: before, while and after PK. In total 371 students participated in the PK. 297 students participated at measurement 1. In advance 25-30% of the medical students reported anxiety and emotional inhibition, during the course only 7-10%. The coping strategy "distancing from the human body" was prominent. Anxiety, emotional inhibition and disgust remained for 5-10% of the participants.The gross anatomy course causes emotional stress for a considerable amount of medical students. For those students that were not able to overcome the mental stress themselves service offers should be implemented.

No evidence for mutation of B-RAF in urothelial carcinomas of the bladder and upper urinary tract.

Mutational activation of the MAP kinase pathway is frequently found in various cancers. Recently, activating mutations in the B-RAF gene, an important activator of this pathway, have been described in several tumor types including melanoma, colorectal and papillary thyroid cancer. The most frequent mutation in exon 15 (V599E), as well as several other mutations within exons 11 and 15 result in constitutive activation of the oncoprotein. In addition, a significant association between mismatch-repair (MMR) deficiency and the V599E mutation in colorectal tumors has been found. The aim of our study was to investigate B-RAF mutations in 121 urothelial carcinomas of the urinary bladder (ranging from pTaG1 to pT4aG3) and 27 tumors from the upper urinary tract (UUT), including 16 tumors of the renal pelvis and 11 tumors of the ureter). Twelve of 27 UUT tumors were MMR-deficient and showed microsatellite instability. The V599E mutation was screened for by allele-specific PCR (PASA) and exons 11 and 15 of B-RAF including intron-exon-boundaries were sequenced. Overall, 116/121 bladder tumors and 23/27 tumors of the UUT were successfully investigated by PASA. None of the tumors showed the V599E mutation. Sequence analysis of exons 11 and 15 was successful in 46 urothelial tumors (bladder, n=31; UUT, n=15). No mutations within the coding region of exons 11 and 15 and the intron-exon junctions were found. The most frequent alterations in the B-RAF gene do not seem to be involved in urothelial carcinogenesis, and there is no correlation between MMR-deficiency and B-RAF mutations in urothelial tumors.

The gross anatomy course: an analysis of its importance.

The gross anatomy dissection course is a cost-intensive piece of undergraduate medical education that students and professionals alike describe as very important within the overall medical curriculum. We sought to understand more explicitly students' valuation of gross anatomy as an "important" course and so developed a quantitative longitudinal questionnaire. Medical students (n = 124) enrolled in the winter term 2006/2007 gross anatomy course at the Ulm University Faculty of Medicine were surveyed anonymously prior to, in the middle of, and at the end of the dissection course. Subgroups of students expressing rising or falling opinions of course value were identified and correlated with student opinions about the course's ability to convey professional competencies. Five-point Likert scales were used for each survey item, which included such standardized instruments as the NeoFFI, BSI, and FBM. The study confirmed that medical students believe dissection to be valuable. Students indicated that participation in the course facilitated acquisition of anatomy knowledge as well as skills related to teamwork, coping with stress, and, to a lesser extent, time management. Students also noted that they developed less empathy than expected beforehand. Significant subgroup differences were observed relative to the competencies of teamwork, stress coping strategies, and empathy, as well as in students' stress levels associated with having to take a dissection course. Our study builds on previous work that has shown dissection courses help students develop professional competencies. The increase in professionalism might be a reason for the generally high value students place on the gross anatomy dissection course.

How can we deal with mental distress in the dissection room?-An evaluation of the need for psychological support.

The dissection course (DC) is an essential part of the preclinical medical curriculum that mediates professionalism. The process of dissecting, however, has an inherent additional stress potential. Our study determined student mental stress, their need of psychological support and factors influencing this need. A quantitative longitudinal query before, during and after the DC was performed including the Brief Symptom Inventory (BSI) as well as self-formulated questions used a 5-point Likert scale. Half of the students who anticipated dissection to be a stress factor reported that this declined significantly over time. Instead, student fear of not being able to cope with the work load increased significantly. As many as 64% of the students favored psychological support on the first course day, while 75% rejected this during the period of dissection and 39% appreciated this after the course. Moreover, 42% emphasized the importance of the funeral ceremony. Additionally, 75% documented their need for support in coping with stress and learning strategies. Gender, previous medical training, and BSI levels were identified as psychosocial influence factors. A majority of students named friends, members of their family or workmates as partners with whom they could talk about mental stress. Our results document the need to develop an optimum support during the DC taking into account the ascertained indicators. Exemplarily the Institute of Anatomy and Cell Biology at Ulm University suggests several options like a step by step approach for optimization. These measures reduce mental stress and help students to cope with it by the development of "detached concern" towards their "first patient" as this will decisively influence their future professional behavior.

Prediction of progression of non-muscle-invasive bladder cancer by WHO 1973 and 2004 grading and by FGFR3 mutation status: a prospective study.

OBJECTIVES: The clinical management of non-muscle-invasive urothelial cell carcinoma of the bladder (UCC) is challenging, as it has a marked tendency to recur and to progress. Aim of this study was to investigate the prognostic value of the WHO 1973 and 2004 grading systems and biomarkers FGFR3, CK20 and Ki-67. METHODS: In a prospective study, tumours from 221 patients were studied for the expression of CK20 and Ki-67 by immunohistochemistry, and FGFR3 status by SNaPshot mutation detection. Staging and grading were performed according to the WHO classification systems of 1973 and 2004. RESULTS: : Median follow-up was 35 mo. Recurrence occurred in 72 of 221 patients. None of the parameters was able to predict disease recurrence. CK20, Ki-67, FGFR3 mutation, molecular grade using FGFR3 mutation analysis and Ki-67, and histological grading and staging were significantly associated with disease progression in stage. In multivariable analyses, WHO 1973 and 2004 grading systems remained statistically significant and independent predictors of progression, with p=0.005 for WHO 1973 and p=0.004 for 2004. FGFR3 status was able to discriminate progressors from nonprogressors in a subset of patients with high-grade UCC (p=0.009). CONCLUSIONS: This is the first prospective study comparing the WHO 1973 and 2004 grading systems. We show that both grading systems contribute valuable independent information. Therefore, it should be considered whether a better grading system could be developed that incorporates essential elements from both. The combination of WHO 2004 grading with FGFR3 status allows a better risk stratification for patients with high-grade non-muscle-invasive UCC.