Ewing's tumors with primary lung metastases: survival analysis of 114 (European Intergroup) Cooperative Ewing's Sarcoma Studies patients

PURPOSE

To analyze event-free survival (EFS) and prognostic factors in patients who present with Ewing's tumors (ET) of bone and synchronous pulmonary and/or pleural metastases (ppm).

PATIENTS AND METHODS

Of 1,270 patients (pts) registered at the continental office of the German/European Intergroup Cooperative Ewing's Sarcoma Studies (CESS81, CESS86, EICESS92), 114 were diagnosed ET with ppm. Patients underwent neoadjuvant therapy and local treatment of the primary tumor. Whole-lung irradiation 15 to 18 Gy was applied to 75 ppm-pts. EFS and 95% confidence intervals (CIs) were estimated according to the Kaplan-Meier method, and prognostic factors were analyzed by log-rank tests and Cox and logistic regression procedures.

RESULTS

On November 1, 1997, at a median time under study of 5.9 years, the 5-year EFS was 0.36 (95% CI, 0.26 to 0.46) and the 10-year EFS was 0.30 (95% CI, 0.19 to 0.41). Thirty-seven of 59 (63%) first relapses involved lung and/or pleura, and the lungs were the only site of relapse in 26 of 59 (44%) ppm-pts. Risk factors identified in univariate and multivariate tests were poor response of the primary tumor toward chemotherapy, metastatic lesions in both lungs, and treatment without additional lung irradiation.

CONCLUSION

Chemotherapy response of the primary tumor is a prognostic factor in patients with ET with ppm. Strategies of treatment intensification warrant further evaluation.

The influence of the crystallinity of lipid nanoparticles on their occlusive properties

The aim of this study was the investigation of the correlation between the degree of crystallinity of solid lipid nanoparticle (SLN) dispersions and their occlusive effects. SLN dispersions with different crystallinity indices of the lipid matrix were produced, physicochemically characterized and their occlusion factor was determined after 6, 24 and 48 h. This study is based on the in vitro occlusion test by de Vringer. It could be shown that the occlusion factor depends strongly on the degree of crystallinity of the lipid matrix, i.e. this effect is proportional. Further, it could be shown that noncrystalline lipid nanoparticles, i.e. supercooled melts have no occlusive properties. Therefore, the desired degree of occlusivity can be achieved by choosing suitable lipids for the matrices of topical SLN formulations.

Influence of high pressure homogenisation equipment on nanodispersions characteristics

In this study a comparison of the influence of the homogenising equipment supplied by different manufacturers on the quality of the lipid nanodispersions is given. An Avestin EmulsiFlex-B3 (B3) and APV Micron Lab 40 (LAB 40) were used for high pressure homogenisation. Particle size and particle size distribution were chosen as quality parameters. The influence of different process parameters was evaluated. The two homogenisers were compared in their quality of nanoparticles-production by hot and cold homogenisation technique and in processing nanoemulsions. Working with the B3 appeared as useful for preformulation studies and processing of expensive or rare drugs and excipients. This first scaling up within laboratory scale is evaluated and the problems and remarkable aspects working with the B3 are pointed out.

The development of an improved carrier system for sunscreen formulations based on crystalline lipid nanoparticles

The aim of this study was the in vitro evaluation of the efficacy of two different carrier systems for the molecular sunscreen benzophenone-3. One carrier system was a conventional o/w emulsion, the other consisted of highly crystalline lipid nanoparticles (CLN). It was observed that CLN act as physical sunscreens themselves and show improved photoprotection compared with a placebo emulsion with the same lipid content. Incorporation of a molecular sunscreen further improves the protection level in a synergistic way. This in vitro study based on the Transpore test by Diffey showed that the amount of molecular sunscreen can be decreased by up to 50% while maintaining the UV protection efficacy. Therefore, the use of CLN as an active carrier for sunscreens is a promising innovation.

An investigation into the use of stepwise isothermal high sensitivity DSC as a means of detecting drug-excipient incompatibility

The use of stepwise isothermal high sensitivity differential scanning calorimetry (HSDSC) as a novel means of detecting excipient incompatibility is described using aspirin mixes with magnesium stearate and stearic acid as model systems. Aspirin, magnesium stearate and stearic acid alone and as mixes were studied in scanning mode using conventional DSC and were then subjected to a stepwise heating programme using HSDSC, whereby the samples were heated to temperatures between 45 and 70 degrees C and held for 1 h, during which the heat flow to or from the sample was measured. The data indicated that while no thermal events were detected for the individual components or mixes with stearic acid other than melting of stearic acid, 50% w/w mixes of magnesium stearate showed a marked endothermic response at temperatures above 55 degrees C. The data were fitted to an adaptation of an existing kinetic model for the degradation process and a reasonable correlation found. Mixes of the drug with the two excipients were then studied at 60 degrees C over 6 h at concentrations between 1 and 50% w/w. Incompatibilities with magnesium stearate concentrations as low as 1% w/w could be detected using this approach. Compacts of magnesium stearate and aspirin were also studied, with considerably more pronounced thermal events taking place compared to the powder mixes. It is concluded from these studies that while the study has highlighted certain limitations of the approach, stepwise isothermal DSC represents a potentially highly useful means of detecting excipient incompatibilities.

A humanized monoclonal antibody against interleukin-2 that can inactivate the cytokine/receptor complex

Inhibition of the interleukin-2 (IL-2) pathway has potent immunosuppressive activity in humans as is evident from the broad therapeutic utility of cyclosporine, rapamycin, tacrolimus, and monoclonal antibodies blocking the high-affinity subunit of the IL-2 receptor (CD25). Here we describe a humanized antibody, MT204, interfering with IL-2 signaling by a novel mechanism. Although MT204 did not prevent IL-2 from binding to CD25, it potently antagonized downstream signaling events of IL-2 at sub-nanomolar concentrations, such as STAT3 tyrosine phosphorylation, expression of CD124, production of gamma-interferon and cell proliferation. While MT204 and the anti-CD25 mAb daclizumab were equally effective in inhibiting autocrine growth of human CD4(+) T cells, MT204 was far superior in preventing proliferation of NKL lymphoma cells, production of gamma-interferon by natural killer (NK) cells and proliferation of primary NK cells. MT204 has potential as a novel immunosuppressive and anti-proliferative therapy with an apparently broader spectrum of activities than anti-CD25 antibodies.

Teaching clinical practical and communication skills of the clinical skills lab of the University of Veterinary Medicine Hannover, Foundation, Germany during the COVID-19 pandemic

Objective: The aim of the project is to teach clinical practical and communication skills in the Clinical Skills Lab (CSL) of the University of Veterinary Medicine Hannover, Foundation (TiHo) during the COVID-19 pandemic. Methodology: As a measure to limit potential SARS-CoV2 infections, the CSL learning stations were digitised and made available on the Moodle learning platform of the TiHo. Online quiz stations were also developed, as well as improvisations that allowed students to practise practical skills at home using everyday materials. Courses for Practical Year (PY) students were digitised and again combined with classroom exercises throughout the year. The teaching formats could be evaluated by the students by means of a questionnaire using a Likert scale (1=agree; 4=disagree). Results: A total of 24.92% of students (n=1272) completed the learning stations with improvisations. The quiz stations were completed with a percentage of 75.08%. Students indicated that the improvisations were easily implementable from home (M=1.33) and assisted in learning the practical skills in question (M=1.89). The quiz stations were considered helpful (M=1.40) and complementary to previous CSL offers (M=1.13). The PY students found the amount of teaching materials adequate (M=1.76) and described communication with the lecturers as problem-free (compulsory electives=1.24). Conclusions: Digital teaching is suitable as a supplement to existing face-to-face courses at the CSL, but cannot replace on-site training under the guidance of trained personnel. The CSL will continue to strive for a combination of online and face-to-face courses for some learning stations in the future.

Interprofessional survey on communication skills in veterinary and veterinary-related education in Germany

BACKGROUND

Communication is an indispensable skill in the everyday working life of a veterinary team. In German higher educational institutions, communication skills training is explicitly mentioned in the curricula of veterinary assistants, including veterinary nurses and veterinary technicians, and of animal keepers, but not for undergraduate veterinary medicine. Little is known about interprofessional education in veterinary medicine and related professions. Therefore, the purpose of this study is to describe and explore the current interprofessional state of knowledge regarding communication skills of the aforementioned groups in Germany.

METHODS

To explore the perception, assess the knowledge and identify the attitude regarding communication skills and interprofessional training, an online survey was distributed. The survey was sent to all five veterinary higher educational institutions, 38 schools for veterinary assistants and 15 schools for animal keepers throughout Germany.

RESULTS

In total, 294 veterinary students, 111 veterinary assistant trainees and 62 animal keeper trainees participated. The majority of participants (98.07%, n = 458) perceived communication skills as highly important for their everyday work. In total, 413 participants (88.44%) felt that their communication skills needed improvement and more than half admitted having difficulties in effective communication (59.31%; n = 277). In addition, 62.74% of respondents (n = 293) were not sufficiently informed about the training content of their future colleagues. Most were convinced that training could positively influence on their communication with clients (95.72%; n = 447) and the team (92.29%; n = 431), and 76.45% of respondents (n = 357) wished to participate in an interprofessional training.

CONCLUSIONS

Results of this study confirm that communication skills are perceived as highly important for professional life. Students and trainees show a great interest in communication skills and interprofessional training. The findings indicate that appropriate adjustments to existing curricula are necessary in Germany.

Practical Tips for Setting Up and Running OSCEs

Objective structured clinical examinations (OSCEs) are used to assess students' skills on a variety of tasks using live animals, models, cadaver tissue, and simulated clients. OSCEs can be used to provide formative feedback, or they can be summative, impacting progression decisions. OSCEs can also drive student motivation to engage with clinical skill development and mastery in preparation for clinical placements and rotations. This teaching tip discusses top tips for running an OSCE for veterinary and veterinary nursing/technician students as written by an international group of authors experienced with running OSCEs at a diverse set of institutions. These tips include tasks to perform prior to the OSCE, on the day of the examination, and after the examination and provide a comprehensive review of the requirements that OSCEs place on faculty, staff, students, facilities, and animals. These tips are meant to assist those who are already running OSCEs and wish to reassess their existing OSCE processes or intend to increase the number of OSCEs used across the curriculum, and for those who are planning to start using OSCEs at their institution. Incorporating OSCEs into a curriculum involves a significant commitment of resources, and this teaching tip aims to assist those responsible for delivering these assessments with improving their implementation and delivery.

Use of Actors or Peers as Simulated Clients in Veterinary Communication Training

Using simulated clients is an effective teaching method for training and assessing communication skills in veterinary education. The aim of this study is to evaluate the use of actors and peers in communication skills training in veterinary medicine. For this purpose, the subjective perception of the use of actors was assessed in a first study using a paper-based self-evaluation survey. In a second study, different groups of veterinary students who trained their communication skills with actors or peers were compared in an electronic Objective Structured Clinical Examination (eOSCE) assessment with regard to their outcomes of communication proficiency. All participants reported the actors to be helpful and supportive in learning communication skills. Above all, participants highly rated the achieved authenticity when using actors as well as feedback sessions. Regarding the comparison of actors and peers as teaching methods, no significant difference in the performance of veterinary students in an eOSCE was identified. Despite the lack of objective evidence, both methods may be considered valuable and accepted teaching tools. Training with peers gives students an opportunity to learn how to conduct structured history interviews and to understand pet owners' motives at an early stage of undergraduate veterinary training. Change of perspective is considered a positive training element. However, when portraying authentic and standardized emotions and reactions and giving formative feedback based on the pet owners' internal perspectives, actors are beneficial for training advanced veterinary students and graduates in difficult conversation topics.

Simulator-Assisted Training of Abomasal Surgery-A Pilot Study Using Blended Learning and Face-to-Face Teaching

Two stimulators were developed, one simplified and one realistic, in the present study for learning abomasal surgery for veterinary students. The simulators were tested in a pilot study: The upcoming blended learning format was compared with traditional face-to-face teaching. A total of 21 5th-year students participated in the study. While one group learned the surgical technique in traditional face-to-face simulator training, the second group completed interactive video training asynchronously. Afterwards, skills were examined in person. The results showed that the different groups did not lead to different performance results. Participation in the study increased self-assessment of skills by an average of about 7 of 36 points, as well as the learning success and motivation of students in both groups. The simulators developed were well liked by the students and rated as appropriate by 12 practicing bovine veterinarians. The pilot study indicates that blended learning could be a suitable alternative to traditional face-to-face teaching. This should be followed by further research to support the use of blended learning in the veterinary education of clinical skills.

Investigations on the occlusive properties of solid lipid nanoparticles (SLN)

Skin hydration can be influenced to a great extent by occlusive compounds. Conventional highly occlusive compounds tend to have an unacceptable appearance. Therefore, the development of innovative occlusive topicals is an essential issue regarding the formulation of cosmetic and pharmaceutical preparations. Solid lipid nanoparticles (SLN) represent a novel carrier system for controlled release of topical cosmetic and pharmaceutical compounds. In addition to their controlled release characteristics, it has been found that SLN have an occlusive effect. The extent of the occlusive effect depends on various factors such as particle size, applied sample volume, lipid concentration, and crystallinity of the lipid matrix. These factors have been investigated in detail by an in vitro test, and the obtained data give insight into their importance.

Integration and potential of teaching communication skills in the study of veterinary medicine in Germany

Goal: Presentation of the current range of courses regarding communication at the five German educational institutions for veterinary medicine. In addition to learning objectives and individual solutions, possible potential for future developments are presented. Methods: Interviews with communication educators at the five German education institutions and subsequent synopsis. Results: To date, there are no binding education guidelines regarding communication in veterinary medicine. Nevertheless, communication education has been introduced at all five education institutions, albeit depth and formats vary considerably. The learning objectives are largely consistent and based on the recommendations for day-one-skills made by the European Association of Establishments for Veterinary Education. Communication is not recognized as a fully-fledged subject in the curricula of any of the education institutions. All education institutions clearly fall short of teaching the recommended 150 lecture hours. Conclusion: To ensure communication skills in veterinary medicine graduates, binding education guidelines should be agreed upon. Communication education should be integrated into all veterinary curricula as a fully-fledged subject with longitudinally increasing depth.

Evaluation of an Interprofessional Blended Learning Course Focusing on Communication within Veterinary Teams

Based on the importance of communication and teamwork in veterinary practice, we explored the impact of a blended learning course designed to enhance interprofessional communication skills among veterinary students and apprentice assistants. The blended learning course design included online modules, synchronous (online) seminars, and simulation training sessions. The asynchronous online elements should complement the varied schedules of different professions and meet the individual needs of participants, especially considering the challenges posed by the COVID-19 pandemic. The course structure, evaluations, and outcomes were documented, showing a positive impact on knowledge gain concerning communication and self-assessment in communication skills. In the pretest, the participants scored 43.18% correct answers to a knowledge test, whereas 71.50% correct answers were given in the posttest. Some participants indicated an improvement in the self-assessment of their skills. For example, before the training only 13.64% answered the question "How prepared do you feel regarding your communication skills for entering the profession?" with "Very good" or "Good", versus 50.00% in the posttest. There were also only 22.73% of participants who agreed to having sufficient understanding of the roles of other professional groups, while in the posttest, 81.82% agreed. The evaluations highlighted positive feedback on the organization, learning environment, and overall course structure. However, challenges such as limited resources, especially time and financial constraints, influenced the implementation and ongoing development of the course. Subsequent runs of the course could gather more data to further improve the teaching of veterinary interprofessional communication. This ongoing data collection would allow continuous insights into and adjustments to the teaching methods, ensuring maximum benefit for veterinary students and apprentice assistants.

Evaluation of equine perineural anesthesia simulators with integrated success control for veterinary education

The skills necessary to perform diagnostic perineural anesthesia in equids belongs to one of the Day One Competences of a veterinarian, so every veterinary graduate should be able to perform them correctly. For logistical, hygienic and ethical reasons, practical exercises on cadaver limbs are not accessible to all students. Two equine distal limb simulators were developed and evaluated as an additional instructional tool to train the required skills. Both simulators were designed and built with an integrated success control, with Simulator I (S1) designed to be a simplified anatomical model and Simulator II (S2), a more realistic model. The simulators were tested by 68 students in the 5th year who were divided into two groups. Thirty-four students received a training session using the simplified anatomical model (S1) and the other 34 students one on cadaver limbs, the usual instructional tool. The practical learning success of both groups was validated using S2. Additionally, data on self-efficacy were collected. The results show that the two groups did not differ significantly in their practical learning success, whereas self-efficacy of both groups increased significantly after the sessions. An evaluation performed by 7 veterinarians and 49 students of the 5th year indicate that the simulators are suitable for teaching perineural anesthesia in the equine distal limb. However, S2 could be more realistic. The simulators will be used as a supplement to exercises on cadaver limbs to enable all students to practice perineural anesthesia.

Evaluation of the eOSCE for testing clinical skills

The OSCE is a proven instrument for testing practical skills of students, not only in the (veterinary) medical field. At the University of Veterinary Medicine Hannover, Foundation (TiHo), students must complete a 10-week rotation in one of the university’s own clinics during the practical year in the 9th and 10th semesters in addition to other practical training. Within this framework, the first training for acquiring clinical practical skills with a formative examination (OSCE; Objective Structured Clinical Examination) was developed in the Clinical Skills Lab (CSL) in 2014. Since 2018, the TiHo has been the first veterinary medical training institution in Germany to conduct electronic OSCEs (eOSCEs). In the future, eOSCEs will also be introduced as a summative examination at the TiHo. For this reason, students in the practical year of the winter semester 2021/2022 and summer semester 2022 as well as former and current examiners were surveyed regarding their satisfaction with the eOSCE examination format as part of this study. The 175 analyzed questionnaires from students and 27 analyzed questionnaires from examiners showed a high level of satisfaction with the eOSCE overall, but at the same time indicated problems that should be ironed out before it is introduced as a summative examination in the state examination. In addition to its standardization and objectivity, the examination format also convinced with its quality-assurance review procedure and the direct feedback possibility with regard to the students’ performance.

Come out of Your Shell-A Comparative Pilot Study for Teaching the Central Plastrotomy in Chelonians Using a 3D-Printed Simulator and a Virtual 3D Simulation

A pilot study was conducted with 5th-8th semester students comparing a 3D-printed simulator and a virtual 3D simulation. This study's aim was the comparison of these two resources in three different settings. Assessment of the resources' suitability as teaching devices for performing a central plastrotomy in chelonians took place. One group used the simulator, while the other group used the simulation to practice this method in a preparation course. Afterwards, the practical skills of 28 students were validated in an objective structured clinical examination (OSCE). The students evaluated their respective resources (simulator and simulation). Additionally, 10 practicing veterinarians evaluated the simulator and rated its fidelity as suitable for practicing a plastrotomy. Furthermore, the self-efficacy of the two student groups was compared with each other. An increase in subjective self-assessment of skills in both groups was identified. Students trained on the simulator achieved better results in the OSCE and self-assessment of skills than those trained with the simulation. However, the differences between the groups regarding these aspects were mostly not significant. This study indicates that a 3D-printed chelonian simulator serves as an appropriate teaching device for veterinary students and is a useful addition to established teaching methods, like using cadavers.