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Junga A, Schmidle P, Pielage L, Schulze H, Hätscher O, Ständer S, Marschall B, Braun SA. New horizons in dermatological education: Skin cancer screening with virtual reality. J Eur Acad Dermatol Venereol 2024. [PMID: 38497674 DOI: 10.1111/jdv.19960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/08/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Technological advances in the field of virtual reality (VR) offer new opportunities in many areas of life, including medical education. The University of Münster has been using VR scenarios in the education of medical students for several years, especially for situations that are difficult to reproduce in reality (e.g., brain death). Due to the consistently positive feedback from students, a dermatological VR scenario for skin cancer screening was developed. OBJECTIVES Presentation and first evaluation of the skin cancer screening VR scenario to determine to what extent the technical implementation of the scenario was evaluated overall by the students and how their subjective competence to perform a skin cancer screening changed over the course of the teaching unit (theory seminar, VR scenario, theoretical debriefing). METHODS Students (n = 140) participating in the curricular pilot project during the 2023 summer term were surveyed throughout the teaching unit using several established questionnaires (System Usability Scale, Simulation Task-Load-Index, Realism and Presence Questionnaire) as well as additional questions on cybersickness and subjective learning. RESULTS (i) The use of VR is technically feasible, (ii) students evaluate the VR scenario as a useful curricular supplement, and (iii) from the students' subjective perspective, a good learning outcome is achieved. Although preparation and follow-up appear to be important for overall learning, the greatest increase in subjective competence to perform a skin cancer screening is achieved by the VR scenario. CONCLUSIONS Technically feasible and positively evaluated by students, VR can already be a useful addition to dermatology education, although costs are still high. As a visual discipline, dermatology offers special opportunities to create VR scenarios that are not always available or comfortable for patients in reality. Additionally, VR scenarios guarantee the same conditions for all students, which is essential for a high-quality education.
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Affiliation(s)
- Anna Junga
- Institute of Education and Student Affairs, University of Münster, Münster, Germany
- Department of Urology, Stiftungsklinikum PROSELIS, Recklinghausen, Germany
| | - Paul Schmidle
- Department of Dermatology, Medical Faculty, University of Münster, Münster, Germany
| | - Leon Pielage
- Institute for Geoinformatics, University of Münster, Münster, Germany
| | - Henriette Schulze
- Institute of Education and Student Affairs, University of Münster, Münster, Germany
| | - Ole Hätscher
- Institute of Education and Student Affairs, University of Münster, Münster, Germany
- Department of Psychology, University of Münster, Münster, Germany
| | - Sonja Ständer
- Department of Dermatology, Medical Faculty, University of Münster, Münster, Germany
| | - Bernhard Marschall
- Institute of Education and Student Affairs, University of Münster, Münster, Germany
| | - Stephan Alexander Braun
- Department of Dermatology, Medical Faculty, University of Münster, Münster, Germany
- Department of Dermatology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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Junga A, Babenko T, Fedirko P, Pilmane M. Distribution and appearance of myosin, dystrophin, and collagen IV in strabismus-affected extraocular muscle tissue compared with control tissue. J Int Med Res 2024; 52:3000605241233521. [PMID: 38436252 PMCID: PMC10913506 DOI: 10.1177/03000605241233521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE Extraocular muscles have complex development processes. The present study aimed to analyze the presence of myosin, dystrophin, and collagen IV in the strabismus-affected extraocular muscle. METHODS This research was an observational case-control study. Myosin, dystrophin, and collagen IV were detected by histological and immunohistochemical analyses of extraocular muscle samples from concomitant strabismus patients and controls. A semi-quantitative grading method and statistical analysis were used. RESULTS In the strabismus-affected extraocular muscle, morphological analysis demonstrated different-sized muscle fibers. Immature muscle fibers and an increased amount of connective tissue were also noted. Strong positive correlations were identified between myosin and collagen IV and between dystrophin and collagen IV. CONCLUSIONS The presence of newly formed muscle fibers, increased connective tissue, and variable diameters of skeletal striated muscle fibers indicate the decreased quality of extraocular muscles in strabismus cases. Reduced levels of myosin and dystrophin and a near absence of collagen IV in strabismus-affected skeletal striated muscle fibers characterized the muscular dystrophy of strabismus. Adjuvant therapy aimed at normalizing the metabolism of these muscles may be appropriate alongside concomitant strabismus treatment.
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Affiliation(s)
- Anna Junga
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Rīga, Latvia
| | - Tetyana Babenko
- Institute of Radiation Hygiene and Epidemiology, Kyiv, Ukraine
| | - Pavlo Fedirko
- Institute of Radiation Hygiene and Epidemiology, Kyiv, Ukraine
| | - Mara Pilmane
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Rīga, Latvia
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Mergen M, Junga A, Risse B, Valkov D, Graf N, Marschall B. Immersive training of clinical decision making with AI driven virtual patients - a new VR platform called medical tr.AI.ning. GMS J Med Educ 2023; 40:Doc18. [PMID: 37361242 PMCID: PMC10285366 DOI: 10.3205/zma001600] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/10/2022] [Accepted: 01/11/2023] [Indexed: 06/28/2023]
Abstract
Background Medical students need to be prepared for various situations in clinical decision-making that cannot be systematically trained with real patients without risking their health or integrity. To target system-related limitations of actor-based training, digital learning methods are increasingly used in medical education, with virtual reality (VR)- training seeming to have high potential. Virtually generated training scenarios allow repetitive training of highly relevant clinical skills within a protected, realistic learning environment. Thanks to Artificial Intelligence (AI), face-to-face interaction with virtual agents is feasible. Combining this technology with VR-simulations offers a new way of situated context-based, first-person training for medical students. Project goal and method The authors' aim is to develop a modular digital training platform for medical education with virtual, interactable agents and to integrate this platform into the medical curriculum. The medical tr.AI.ning platform will provide veridical simulation of clinical scenarios with virtual patients, augmented with highly realistic medical pathologies within a customizable, realistic situational context. Medical tr.AI.ning is scaled to four complementary developmental steps with different scenarios that can be used separately and so each outcome can successively be integrated early within the project. Every step has its own focus (visual, movement, communication, combination) and extends an author toolbox through its modularity. The modules of each step will be specified and designed together with medical didactics experts. Perspective To ensure constant improvement of user experience, realism, and medical validity, the authors will perform regular iterative evaluation rounds.Furthermore, integration of medical tr.AI.ning into the medical curriculum will enable long-term and large-scale detection of benefits and limitations of this approach, providing enhanced alternative teaching paradigms for VR technology.
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Affiliation(s)
- Marvin Mergen
- Saarland University, Department of Pediatric Oncology and Hematology, Homburg, Germany
| | - Anna Junga
- University of Münster, Institute of Education and Student Affairs, Münster, Germany
- Stiftungsklinikum PROSELIS, Department of Urology, Recklinghausen, Germany
| | - Benjamin Risse
- University of Münster, Institute for Geoinformatics, Münster, Germany
- University of Münster, Computer Vision & Machine Learning Systems Group, Münster, Germany
| | - Dimitar Valkov
- Saarland University, Department of Computer Science, Homburg, Germany
- German Research Center for Artificial Intelligence (DFKI), Saarbrücken, Germany
| | - Norbert Graf
- Saarland University, Department of Pediatric Oncology and Hematology, Homburg, Germany
| | - Bernhard Marschall
- University of Münster, Institute of Education and Student Affairs, Münster, Germany
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Junga A, Siņicins I, Pētersons A, Pilmane M. Evaluation of PGP 9.5, NGFR, TGFβ1, FGFR1, MMP-2, AT2R2, SHH, and TUNEL in Primary Obstructive Megaureter Tissue. J Histochem Cytochem 2022; 70:139-149. [PMID: 34915763 PMCID: PMC8777373 DOI: 10.1369/00221554211063515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Primary obstructive megaureter (POM) morphogenesis is not fully known. The aim of the study was to evaluate the appearance of different factors that might take part in the pathogenesis of POM. Megaureter tissues of 14 children were stained with hematoxylin and eosin as well as with immunohistochemistry for protein gene product 9.5, nerve growth factor receptor, transforming growth factor beta 1 (TGFβ1), fibroblast growth factor receptor 1 (FGFR1), matrix metalloproteinase 2 (MMP-2), angiotensin 2 receptor type 2, and sonic hedgehog (SHH) protein. Apoptosis was detected by terminal dUTP nick-end labeling reaction. POM tissues revealed transitional epithelium with scattered vacuolization, submucosa with inflammatory cells, and focally vacuolized and chaotically organized muscle layers. Apoptosis, appearance of MMP-2, FGFR1, and SHH prevailed, but TGFβ1 positive cell number was lower in patients. Correlation between MMP-2 in epithelium and endothelium, FGFR1 and MMP-2 in epithelium, and TGFβ1 in epithelium and connective tissue in patients was detected. POM morphopathogenesis involves an apoptotic cell death of epithelium and smooth muscle as well as tissue degradation in epithelium and connective tissue of the ureter wall. The decrease of tissue growth through diminished TGFβ1 expression and stimulation of FGFR1 and MMP-2 suggests a disbalance of tissue remodelation in the megaureter wall.
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Affiliation(s)
- Anna Junga
- Anna Junga, Institute of Anatomy and
Anthropology, Riga Stradins University, Kronvalda bulv 9, Riga LV-1010, Latvia.
E-mail:
| | - Ivo Siņicins
- Institute of Anatomy and Anthropology, Riga
Stradins University, Riga, Latvia
| | - Aigars Pētersons
- Department of Children Surgery, Riga Stradins
University, Riga, Latvia
| | - Māra Pilmane
- Institute of Anatomy and Anthropology, Riga
Stradins University, Riga, Latvia
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Kreicberga I, Junga A, Pilmane M. Investigation of HoxB3 and Growth Factors Expression in Placentas of Various Gestational Ages. J Dev Biol 2021; 10:jdb10010002. [PMID: 35076557 PMCID: PMC8788416 DOI: 10.3390/jdb10010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 12/04/2022] Open
Abstract
An evaluation of transforming growth factor beta (TGFβ), hepatocyte growth factor (HGF), basic fibroblast growth factor (FGF-2), fibroblast growth factors receptor 1 (FGFR1) and Hox-positive cells in the human placenta, and their correlation with gestational time at delivery and pregnancy outcomes, may provide not only a better understanding of the role of Hox genes and growth factors in human development, but also may be of clinical importance in reproductive medicine. This study analyzed the immunohistochemical identification of TGFβ, HGF, FGF-2, FGFR1 and HoxB3 in placentas of various gestational ages. We found few (+) TGFβ, moderate (++) FGF-2 and numerous (+++) HGF and FGFR1 positive structures. Occasional (0/+) to numerous (+++) HoxB3-positive structures were detected in different types of placental cells specifically, cytotrophoblasts, syncytiotrophoblast, extravillous trophoblasts, and Höfbauer cells. Correlating the appearance of HoxB3 staining in placentas with neonatal parameters, we found a statistically significant negative correlation with ponderal index (r = −0.323, p = 0.018) and positive correlation with neonate body length (r = 0.541, p = 0.046). The number of HoxB3-positive cells did not correlate with growth factors and gestational age, but with neonatal anthropometrical parameters, indicating the role of HoxB3 not only in placental development, but also in the longitudinal growth of the fetus. TGFβ and FGF-2 did not play a significant role in the development of the placenta beyond 22nd week of pregnancy, while HGF and FGFR1 immunoreactive cells increased with advancing gestation, indicating increasingly evolving maturation (growth, proliferation) of the placenta, especially in the third trimester.
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Kreicberga I, Junga A, Pilmane M. Assessment of apoptosis and appearance of hepatocyte growth factor in placenta at different gestational ages: A cross-sectional study. Int J Reprod Biomed 2021; 19:505-514. [PMID: 34401645 PMCID: PMC8350851 DOI: 10.18502/ijrm.v19i6.9372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/10/2020] [Accepted: 10/31/2020] [Indexed: 11/24/2022] Open
Abstract
Background Fetal growth is determined by the interaction between mother and fetus using the placental interface throughout the pregnancy. Objective To research apoptosis and appearance of hepatocyte growth factor (HGF) in placentas of different gestational ages and to describe the anthropometrical and clinical indices of mothers and newborns. Materials and Methods The study material was obtained from 53 human immunodeficiency virus negative pregnant women of legal age without systemic diseases. The staining of placental apoptotic cells was processed by a standard in situ cell death detection kit. The detection of HGF was provided by the ImmunoCruz goat ABC Staining System protocol sc-2023. Relative distribution of positive structures was evaluated using the semiquantitative counting method. Results The mean rank value of the amount of HGF-containing cells (cytotrophoblasts, syncytiotrophoblasts, extravillous trophoblasts, Höfbauer cells, and cells of extraembryonic mesoderm) was 1.61 ± 0.94. Apoptotic cells (cytotrophoblasts, syncytiotrophoblasts, extravillous trophoblasts, and cells of extraembryonic mesoderm) were found in all placental samples of various gestational ages (term 13.00 ± 13.05 and preterm 27.00 ± 18.25); in general, their amount decreased with advancing gestational age of the placenta (p < 0.01). Conclusion Weight of a placenta directly depends on the gestational age and correlates with the main fetal anthropometrical parameters (weight, length, and head and chest circumferences). The decrease in HGF-containing and apoptotic cells with advancing gestation depends on the adaptation potential of the placenta, proving the other ways of cellular disposition.
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Affiliation(s)
- Ilze Kreicberga
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Riga, Latvia
| | - Anna Junga
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Riga, Latvia
| | - Māra Pilmane
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Riga, Latvia
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Junga A, Pilmane M, Ābola Z, Volrāts O. Tumor necrosis factor α, protein gene product 9.5, matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-2 presence in congenital intra-abdominal adhesions in children under one year of age. Arch Med Sci 2021; 17:92-99. [PMID: 33488860 PMCID: PMC7811308 DOI: 10.5114/aoms.2020.101184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/19/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The regulatory role of cytokines and extracellular matrix remodeling factors in congenital intra-abdominal adhesions has not yet been defined. The aim of this study was to assess the presence and relative distribution of tumor necrosis factor α (TNF-α), protein gene product 9.5 (PGP 9.5), matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-2 (TIMP-2) in adhesions. MATERIAL AND METHODS TNF-α, PGP 9.5, MMP-2 and TIMP-2 were detected using immunohistochemical methods and their relative distribution was evaluated by means of the semiquantitative counting method. The results were analyzed using non-parametric statistical methods. RESULTS A moderate number of TNF-α positive macrophages and fibroblasts was found. A positive correlation was observed between the immunoreactive structures for TNF-α and PGP 9.5. A positive reaction for PGP 9.5 was observed in nerve fibers and shape modified fibroblasts. In control group tissues, positive structures were seen in significantly higher counts for PGP 9.5. Few to moderate numbers of MMP-2 positive macrophages, epithelioid cells, fibroblasts and endotheliocytes were detected. There was no significant difference between the groups. A positive reaction for TIMP-2 was seen in fibroblasts, macrophages and endotheliocytes. In control group tissues, positive structures were found in significantly higher counts for TIMP-2. CONCLUSIONS The positive correlation between the immunoreactive structures for TNF-α and PGP 9.5 suggests that nerve in-growth into intraabdominal adhesions might be induced by TNF-α and PGP 9.5 could have a role in maintaining inflammation. The down-regulation of PGP 9.5 suggests that pathogenesis of congenital intraabdominal adhesions may be related to hypoxia induced damage. The imbalance between MMP-2 and TIMP-2 may prove tissue fibrosis as a response to congenital peritoneal adhesions.
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Affiliation(s)
- Anna Junga
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Riga, Latvia
| | - Māra Pilmane
- Institute of Anatomy and Anthropology, Rīga Stradiņš University, Riga, Latvia
| | - Zane Ābola
- Department of Children Surgery, Rīga Stradiņš University, Riga, Latvia
| | - Olafs Volrāts
- Department of Children Surgery, Rīga Stradiņš University, Riga, Latvia
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