Dietary fat differentially modulates the response of bone marrow-derived macrophages to TLR4 and NOD2 agonists

Consumption of diets high in fat has been linked to the development of obesity and related metabolic complications. Such associations originate from the enhanced, chronic, low-grade inflammation mediated by macrophages in response to translocated bacteria, bacterial products, or dietary constituents such as fatty acids (FAs). Nucleotide-binding Oligomerization Domain 2 (NOD2) senses muramyl dipeptide (MDP), a component of bacterial peptidoglycan. The inability to sense peptidoglycan through NOD2 has been demonstrated to lead to dysbiosis, increased bacterial translocation, inflammation and metabolic dysfunction. Currently, it is unknown how consumption of HFDs with different FA compositions might influence NOD2-dependent responses. In this study, we subjected WT mice to a control diet or to HFDs comprised of various ratios of unsaturated to saturated fats and determined the macrophage response to TLR4 and NOD2 agonists. A HFD with equal ratios of saturated and unsaturated fats enhanced subsequent responsiveness of macrophages to LPS but not to MDP. However, a high-unsaturated fat diet (HUFD) or a high-saturated fat diet (HSFD) both decreased the responsiveness to NOD2 agonists compared to that observed in control diet (CD) fed mice. These data suggest that dietary fatty acid composition can influence the subsequent macrophage responsiveness to bacterial products.

Mind Power: Thought-controlled Augmented Reality for Basic Science Education

The integration of augmented reality (AR) and brain-computer interface (BCI) technologies holds a tremendous potential to improve learning, communication, and teamwork in basic science education. The current study presents a novel interface technology solution to enable AR-BCI interoperability and allow learners to control digital objects in AR using neural commands.

A Spoonful of Eponyms Helps the Pathology Go Down: Using Food Eponyms and Visual Mnemonics in Preclinical Pathology Education

Food eponymophilia in medicine describes a phenomenon by which diseases or pathologies are named for food items, such as "oat cell carcinoma" or "coffee bean nucleus." Some argue that these metaphors enrich medical education by providing familiar analogies to communicate pathology that is otherwise difficult to describe. Others argue that these metaphors are esoteric, burdensome, culturally irrelevant, and outdated. Few studies have ever focused on the use of metaphors in medical education, and even fewer have focused particularly on pathology or food eponyms. We aim to investigate the use of food eponyms in undergraduate medical education, particularly in pathology education, at the University of Central Florida College of Medicine. We used an interactive learning module to objectively assess whether or not students learn and retain pathology knowledge better using food eponyms, and a post-module survey to assess student perception of the use of these visual mnemonics within pathology educational activities. Results suggest that students not only learn and retain pathology knowledge through this type of activity, but that they also find these eponyms and mnemonics useful as they prepare for their USMLE step 1 exam, clinical clerkship, and future practice. This study is the first of its kind to investigate the usefulness of food eponymophilia in medical education and suggests that students empirically benefit from the use of these memory aids and find this form of learning enjoyable. Preclinical pathology education should make use of these tools in an effort to make pathology as palatable as possible.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01474-w.

Virtual Self-learning Modules Integrating Pharmacology Concepts into a Geriatric Elective

Given barriers to vertical integration during clinical rotations, many struggle with employing effective virtual strategies to revisit foundational sciences during clerkship. To address this, we developed virtual geriatric pharmacology self-learning modules (SLMs) for a fourth-year geriatric elective using cases, interactive exercises, resources, feedback, and quizzes. To evaluate effectiveness, learners were administered a pre- and post-elective quiz with survey. Learners improved performance after using SLMs, valued pharmacology clerkship integration and reinforcement, and agreed SLMs improved understanding, confidence, and attitudes. Thus, SLMs were an effective virtual method for integrating pharmacology that could be modified to teach other foundational sciences during clerkships.

Effects of voluntary attendance patterns on first-year medical students' wellness and academic performance during COVID-19

There is increasing evidence that attendance is not a reliable predictor of academic performance, which invites the question of whether attendance may have alternative positive effects such as increased student wellness. While conducting an observational cohort study on the relationship of attendance to performance and wellness, the COVID-19 pandemic lockdown changed the ability of students to attend class. Matriculating medical students were recruited to participate at the beginning of their first year in August 2019. In-person attendance was collected prospectively until the lockdown began in March 2020. This was then correlated with performance on course final examinations and responses to two separate incidences of a survey on stress, burnout, social isolation, and loneliness. The first survey was deployed January through February 2020 (pre-COVID) and the second June 2020 (during COVID lockdown). Attendance declined across the year (76.0%-25.0%). There was a small positive correlation of attendance to performance in module 1 (r = 0.235, P = 0.035) with none in the remaining two modules (P = 0.870, P = 0.410). The high attenders at the time of the lockdown had no decline in their performance when attendance was no longer possible. Attendance negatively correlated with stress and loneliness but not with the remainder of the wellness metrics. There was no significant change in any of the wellness metrics between the pre-COVID and during COVID time points. While the data support the conclusion that attendance is not required to maintain performance in this population, these data suggest a small protective effect against stress and loneliness.

The association between post-treatment surveillance testing and survival in stage II and III colon cancer patients: An observational comparative effectiveness study

BACKGROUND

The best strategy for surveillance testing in stage II and III colon cancer patients following curative treatment is unknown. Previous randomized controlled trials have suffered from design limitations and yielded conflicting evidence. This observational comparative effectiveness research study was conducted to provide new evidence on the relationship between post-treatment surveillance testing and survival by overcoming the limitations of previous clinical trials.

METHODS

This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims (SEER-Medicare). Stage II and III colon cancer patients diagnosed from 2002 to 2009 and between 66 to 84 years of age were eligible. Adherence to surveillance testing guidelines-including carcinoembryonic antigen, computed tomography, and colonoscopy-was assessed for each year of follow-up and overall for up to three years post-treatment. Patients were categorized as More Adherent and Less Adherent according to testing guidelines. Patients who received no surveillance testing were excluded. The primary outcome was 5-year cancer-specific survival; 5-year overall survival was the secondary outcome. Inverse probability of treatment weighting (IPTW) using generalized boosted models was employed to balance covariates between the two surveillance groups. IPTW-adjusted survival curves comparing the two groups were performed by the Kaplan-Meier method. Weighted Cox regression was used to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for the relative risk of death for the Less Adherent group versus the More Adherent group.

RESULTS

There were 17,860 stage II and III colon cancer cases available for analysis. Compared to More Adherent patients, Less Adherent patients experienced slightly better 5-year cancer-specific survival (HR = 0.83, 95% CI 0.76-0.90) and worse 5-year noncancer-specific survival (HR = 1.61, 95% CI 1.43-1.82) for years 2 to 5 of follow-up. There was no difference between the groups in overall survival (HR = 1.04, 95% CI 0.98-1.10).

CONCLUSIONS

More surveillance testing did not improve 5-year cancer-specific survival compared to less testing and there was no difference between the groups in overall survival. The results of this study support a risk-stratified, shared decision-making surveillance strategy to optimize clinical and patient-centered outcomes for colon cancer patients in the survivorship phase of care.