Results: The overall prevalence of depression was 23.9% (n = 256). Depression was more prevalent

in women with only 4-7 years of education, in selleck inhibitor women who belong to socioeconomic class D or E, in those who abuse or are dependent on alcohol, or in women who showed an anxiety disorder or suicide risk (p < 0.050). Discussion: Based on these findings, we emphasize the integration of mental health care into primary care through diagnostic evaluations and treatment protocols that cover depression and its comorbidities. Molina MRAL, et al. / Rev Psiq Clin. 2012; 39(6): 194-7″
“Aberrant redeployment of the ‘transient’ events responsible for bone development and postnatal longitudinal growth has been reported in some diseases in what is otherwise inherently ‘stable’ cartilage. Lessons may be learnt from the molecular mechanisms underpinning transient check details chondrocyte differentiation and function, and their application may better identify disease aetiology. Here, we review the current evidence supporting this possibility. We firstly outline endochondral ossification and the cellular and physiological mechanisms

by which it is controlled in the postnatal growth plate. We then compare the biology of these transient cartilaginous structures to the inherently stable articular cartilage. Finally, we highlight specific scenarios in which the redeployment of these embryonic processes may contribute to disease development, with the foresight that deciphering those mechanisms regulating pathological changes and loss of selleck chemicals cartilage

stability will aid future research into effective disease-modifying therapies.”
“Increased insulin-like growth factor (IGF) signalling has been observed in breast cancer, including endocrine-responsive cancers, and has been linked to disease progression and recurrence. In particular, IGF-1 has the ability to induce and promote lymphangiogenesis through the induction of vascular endothelial growth factor C (VEGFC). In the present study, we analyzed serum and tumour samples from 60 patients with endocrine-positive breast cancer to determine the expression and the possible relationship of circulating IGF-1, IGF binding protein 3 (IGFBP3), and VEGFC with the presence of lymphatic metastasis and other immunohistochemical parameters. The analysis revealed a clear and significant correlation between high basal levels of IGF-1, IGFBP3, and VEGFC and lymph node metastasis in endocrine-responsive breast cancer. In addition, expression of those molecules was significantly higher in breast cancer patients than in healthy control subjects. Those findings may enable more accurate prediction of prognosis in patients with breast cancer.”
“Purpose of review\n\nTopics relating to the spondyloarthropathies have been reviewed recently, but the detailed roles of Chlamydia trachomatis and C.

Conservative therapy and close follow-up seem to suffice for most.”
“Pseudo tumours are amongst the rare yet pathognomonic complications of haemophilia. They are old, encapsulated haematomas which due to their sometimes enormous size can cause massive complaints. These haematomas are surrounded by a thick fibrous capsule. They are attributed to persistent bleedings. The pathophysiology of pseudo tumors is not conclusively established yet. Some believe that they originate from bone material or the periosteum, while others suggest their development from soft tissue. They spread aggressively, displace the surrounding tissue, and

cause secondary periosteal erosion of the bone. This results in bone resorption and destruction of surrounding muscular and soft tissue. Pseudo tumours develop slowly over many years. They occur primarily in adults SBI-0206965 and are largely Wnt inhibitor unresponsive to conservative treatment. Case: A 48-year-old man with moderate hemophilia A (FVIII: C 2%) and no FVIII inhibitor. Due to recurrent bleeding into the muscle of the right thigh diagnosis

of two pseudo tumours (psoas, adductor magnus). In 2004 tumour extirpation with subsequent relapse; because of high local bleeding tendency (despite permanent prophylaxis with FVIII concentrate and adjusted lifestyle) surgical revision in 02/2008. Postoperatively, no recurrent bleeding; the patient is fully fit for work three months later. Conclusion: in order to reduce the complication rate when a pseudo tumor is suspected, patients should be treated in a specially equipped interdisciplinary center with adequately trained and experienced surgeons and haemostaseologists.”
“This Citarinostat research compares the observed seismogram of the PNG earthquake, C051099C with its synthetics in UGM, Wanagama, Indonesia, PMG, Port Moresby, PNG and CHTO, Chiang May, Thailand. The synthetic seismogram is calculated using preliminary

earth model, which are the IASPEI91 and the anisotropic version of PREM. The seismogram comparison is conducted after imposing a low pass filter whose corner frequency is fixed at 20 mHz. We have found a real discrepancy on the travel time and waveform of some wave phases, namely P, S and Rayleigh and Love surface waves, by seismogram comparison in time domain. To correct the discrepancies, we need to adjust the earth structures, which include the depth of the Moho reflector, the velocity gradient of b(h), and the propagation velocity of the P and S waves. The correction has been conducted in the earth layering system from the upper mantle down to the CMB, so that the excellent seismogram fitting was obtained for nearly all phases of the targeted waves. The used wave length for analysing is about 150 km. It turns out that the waveform of the body and surface waves is sensitive to the change of velocity structure.

Among 1023 buffalo sera tested, 77 (7.5%) had detectable virus neutralising antibodies. The assay had high intra-

and inter-plate repeatability in routine runs. At a cut-off optimised by the TG-ROC at 95% accuracy level, the diagnostic sensitivity of the I-ELISA was 98.7% and diagnostic specificity 99.36% while estimates for the Youden’s index (J) and efficiency (Ef) were 0.98 and 99.31%. When cut-off values determined by traditional statistical approaches PD98059 mouse were used, the diagnostic sensitivity was 100% but estimates of J, Ef and other combined measures of diagnostic accuracy were lower compared to those based on cut-off value derived from the TG-ROC. Results of the study indicate that the I-ELISA based on the rNp would be useful for seroepidemiological studies of RVFV infections in African buffalo. (c) 2007 Elsevier B.V. All rights reserved.”
“P>Over one-third of the world population is infected with parasitic helminths, Strongyloides ssp. accounting for approximately 30-100 million infected people. In this study, we employ the experimental system of murine Strongyloides ratti infection to investigate the interaction of this pathogenic nematode with its mammalian host.

We provide a comprehensive kinetic description selleck compound of the immune response to S. ratti infection that was reflected by induction GSK923295 molecular weight of antigen-specific IgM and IgG1, mast cell activation and a Th2-like cytokine response. T cells derived from infected mice displayed an increased IL-3, IL-4, IL-5, IL-13 and IL-10 response to CD3-engagement in comparison with T cells derived from naive mice. The IFN-gamma response to CD3-engagement that was well detectable in T cells derived from naive mice, however, was suppressed in

T cells derived from infected mice. Both, the induction of the S. ratti-specific Th2 response and the suppression of pro-inflammatory cytokines were transient and observed in strict correlation to the course of infection and the number of infective larvae used. Finally, comparing artificial infections induced by subcutaneous injection of larvae to natural infections, we observed similar antigen-specific T cell responses although the natural infection led to a significantly lower worm burden.”
“The site of Hummal is one of several artesian springs in the El Kowm area (Central Syria) that became the focus of archaeological research at the beginning of the 1980s. The archaeological sequence spans the whole Paleolithic period and the spring is therefore a reference site for the Paleolithic in the interior part of the Levant. Archaeological remains are found in a more than 15 m thick succession of deposits that contain Lower, Middle and Upper Paleolithic assemblages.

Alcohol abuse and addiction are devastating and costly problems worldwide. This study puts forward the possibility that cabergoline might be

an effective treatment for these disorders.”
“Jared Diamond has hypothesized that guns, germs and steel account for the fate of human societies. Here I propose an extension of Diamond’s hypothesis and put click here it in other terms and dimensions: gold, coal and oil account not only for the fate of human societies but also for the fate of mankind through the bodily accumulation of anthropogenic arsenic, an invisible weapon of mass extinction and evolutionary change. The background is clear; arsenic species fulfill seven criteria for a weapon of mass extinction and evolutionary change: (i) bioavailability to all living organisms; (ii) imperceptibility; (iii) acute toxicity; (iv) bioaccumulation and chronic

toxicity; (v) adverse impact on reproductive fitness and reproductive outcomes and early-age development and growth in a wide Vorinostat in vivo range of microbial, plant and animal species including man; (vi) widespread geographical distribution, mobility and ecological persistence on a centennial to millennial basis and (vii) availability in necessary and sufficient amounts to exert evolutionarily meaningful effects. The proof is becoming increasingly feasible as human exploitation of gold, coal and oil deposits cause sustainable rises of arsenic concentrations in the biosphere. Paradoxically, humans are among the least arsenic-resistant organisms because humans are long-lived, encephalized and complex social metazoans. An arsenic accumulation model is presented here to describe how arsenic accumulates in the human body with increasing age and at different provisionally safe exposure levels. Arsenic accumulates in the human body even at daily exposure levels which are within the lowest possible WHO provisional tolerance limits, yielding bodily arsenic concentrations which are above WHO provisional limits. Ongoing consequences of global

scale arsenic poisoning of mankind include age-specific rises in morbidity and mortality followed by Torin 1 adaptive changes. The potential rise of successful forms of inborn resistance to arsenic in humans will make it certain that a number of other hardly won, nicely balanced human-specific adaptednesses will decline. These include a decline of encephalization and lifespan, and consequentially intelligence and longevity. These changes are likely to have far-reaching impacts on biological and Cultural evolution of mankind. The only efficient way of reducing chronic global exposure to arsenic and avoiding further human losses is the inactivation of important sources of anthropogenic arsenic such as hard rock mining and burning of fossil fuels. (C) 2009 Elsevier Ltd. All rights reserved.”
“Objective:\n\nRobotic-assisted laparoscopic radical prostatectomy (RALP) is gaining popularity for treating localized prostate cancer.

Furthermore, it also suggests that the regional differences are regulated by different expression levels of TGF-beta 3 in those astrocytes preparations from different derivations.”
“The selleck screening library aim of the study was to investigate the levels of cerebrospinal fluid (CSF) cytokines during chemotherapy of acute lymphoblastic leukaemia (ALL). Examination of 12 ALL child (6 boys and 6 girls) patients evidenced significant increases in interleukin-6 (IL-6) and monocyte chemotactic protein-1 (MCP-1) after induction treatment and significant increases in IL-6, tumour necrosis factor-alpha

(TNF-alpha) and MCP-1 levels during the consolidation phase, as compared to their values at the time of diagnosis. There were no significant differences learn more in CSF IL-6, TNF-alpha and MCP-1 concentrations after therapy. Our data suggest

that standard ALL treatment may cause a subclinical inflammation and neurotoxicity.”
“Purpose: Surgery in frontal lobe epilepsy (FLE) has a worse prognosis regarding seizure freedom than anterior lobectomy in temporal lobe epilepsy. The current study aimed to assess whether intracranial interictal and ictal EEG findings in addition to clinical and scalp EEG data help to predict outcome in a series of patients who needed invasive recording for FLE surgery. Methods: Patients with FLE who had resective surgery after chronic intracranial EEG recording were included. Outcome predictors were compared in patients with seizure freedom (group 1) and those with recurrent seizures (group 2) at 1924 months after surgery. Key Findings: Twenty-five patients (16 female) were included in this study. Mean age of patients at epilepsy surgery was 32.3 +/- 15.6 years (range 1270); mean duration of epilepsy was 16.9 +/- 13.4 years (range 148). In each outcome group, magnetic resonance imaging revealed frontal lobe click here lesions in three patients. Fifteen patients (60%) were seizure-free (Engel class 1), 10 patients (40%) continued to have seizures (two were class II, three were class III, and five were class IV). Lack of seizure freedom was seen more often in patients with epilepsy surgery on the left frontal lobe (group 1, 13%; group 2, 70%; p = 0.009) and on the dominant

(27%; 70%; p = 0.049) hemisphere as well as in patients without aura (29%; 80%; p = 0.036), whereas sex, age at surgery, duration of epilepsy, and presence of an MRI lesion in the frontal lobe or extrafrontal structures were not different between groups. Electroencephalographic characteristics associated with lack of seizure freedom included presence of interictal epileptiform discharges in scalp recordings (31%; 90%; p = 0.01). Detailed analysis of intracranial EEG revealed widespread (>2 cm) (13%; 70%; p = 0.01) in contrast to focal seizure onset as well as shorter latency to onset of seizure spread (5.8 +/- 6.1 s; 1.5 +/- 2.3 s; p = 0.016) and to ictal involvement of brain structures beyond the frontal lobe (23.5 +/- 22.4 s; 5.8 +/- 5.4 s; p = 0.

Pigs were randomized to receive a mandibular block with

either bupivacaine (bupivacaine Selleckchem OICR-9429 group) or saline (control group). A nerve stimulator was used for administration of the block with observation of masseter muscle twitch to indicate the injection site. Invasive BP and HR were measured with the aid of an arterial catheter in eight pigs. A rescue analgesic protocol consisting of fentanyl and lidocaine was administered if HR or BP values increased 20% from baseline. Postoperative pain was quantified with a customized ethogram. HR and BP were evaluated at base line, pre-rescue, 10 and 20 min post-rescue. Results: Pre-rescue mean BP was significantly increased (p = .001) for the bupivacaine group. Mean intraoperative HR was significantly lower (p = .044) in the bupivacaine versus saline selleck compound group. All other parameters were not significant. Conclusion: Addition of a mandibular nerve block to the anesthetic regimen in the miniature pig

condylectomy model may improve variations in intraoperative BP and HR. This study establishes the foundation for future studies with larger animal numbers to confirm these preliminary findings.”
“Object. The authors prospectively studied the occurrence of clinical and nonclinical electroencephalographically verified seizures during treatment with an intracranial pressure (ICP)-targeted protocol in patients with traumatic brain injury (TBI).\n\nMethods. All patients treated for TBI at the Department of Neurosurgery, University

Hospital Umea, Sweden, were eligible for the stud. The inclusion was consecutive and based on the availability of the electroencephalographic (EEG) monitoring equipment. Patients were included irrespective of pupil size, pupil reaction, or level of consciousness as long as their first measured cerebral perfusion pressure was > 10 mm Hg. The patients were treated in a protocol-guided manner with an ICP-targeted treatment based on the Lund concept. The patients were continuously sedated with midazolam, fentanyl, propofol, or thiopental, or combinations thereof. Five-lead continuous EEG monitoring was performed with the electrodes at F3, F4, P3, P4, and a midline reference. Sensitivity was set at 100 mu V per cm and filter settings 0.5-70 Hz. Amplitude-integrated EEG recording and relative band power trends were displayed. The trends were analyzed offline by trained clinical neurophysiologists.\n\nResults. GDC-0973 in vivo Forty-seven patients (mean age 40 years) were studied. Their median Glasgow Coma Scale score at the time of sedation and intubation was 6 (range 3-15). In 8.5% of the patients clinical seizures were observed before sedation and intubation. Continuous EEG monitoring was performed for a total of 7334 hours. During this time neither EEG nor clinical seizures were observed.\n\nConclusions. Our protocol-guided ICP targeted treatment seems to protect patients with severe TBI from clinical and subclinical seizures and thus reduces the risk of secondary brain injury. (DOI: 10.

72).\n\nCONCLUSION:

Sample age is the best predictor of successful mRNA profiling of FFPE material, and miRNA profiling overcomes the limitation of age and copes well with older samples. British Journal of Cancer (2012) 107, 684-694. doi:10.1038/bjc.2012.294 www.bjcancer.com Published online 17 July 2012 (C) 2012 Cancer Research UK”
“Understanding the underlying qualitative features of memory deficits in mild cognitive impairment (MCI) can provide critical information for early detection of Alzheimer’s disease SNS-032 (AD). This study sought to investigate the utility of both learning and retention measures in (a) the diagnosis of MCI, (b) predicting progression to AD, and (c) examining their underlying brain morphometric correlates. A total of 607 participants were assigned to three MCI groups I��B/IKK inhibitor (high learning-low retention; low learning-high retention; low learning-low retention) and one control group (high learning-high retention) based on scores above or below a 1.5 SD cutoff on learning and retention indices of the Rey Auditory Verbal Learning Test. Our results demonstrated that MCI individuals with predominantly a learning deficit showed a widespread pattern of gray matter loss at baseline, whereas individuals with a retention deficit showed more focal gray matter loss. Moreover, either learning or retention measures provided good predictive value for longitudinal clinical outcome over two years, although

impaired learning had modestly better predictive power than impaired retention. As expected, impairments in both measures provided the best predictive power. Thus, the conventional practice of relying solely on the use of delayed recall or retention measures in studies of amnestic MCI misses an important subset of older adults at risk of developing AD. Overall. our results highlight the importance of including learning measures in addition to retention measures when making TGF-beta inhibition a diagnosis of MCI and for predicting clinical outcome. (C)

2009 Elsevier Ltd. All rights reserved.”
“Background: Neutropenia is a common adverse effect of the treatment of chronic hepatitis C with pegylated interferon and ribavirin. However, the mechanism involved is unknown. The present study aimed to investigate the cause of treatment-induced neutropenia by determining cytokine levels in plasma and in bone marrow smears. Methods: Fifteen patients with chronic hepatitis C were enrolled in this study. Plasma cytokine levels were determined using the Luminex assay before and during treatment. We simultaneously determined the levels of granulocyte colony-stimulating factor (G-CSF), granulocyte- macrophage colony-stimulating factor (GM-CSF), and 7 other cytokines, and performed bone marrow cytology when blood cell counts indicated neutropenia. Results: Only 1 bone marrow smear indicated a low cell proliferation level, whereas active proliferation was observed in the remaining 14 patients.

Inclusion of bone marrow fibrosis in patient assessment may further aid in risk-adapted therapeutic decisions.”
“The exposure and toxicological data used in human health risk assessment are obtained from diverse and heterogeneous sources. Complex mixtures found on contaminated sites

can pose a significant challenge to effectively assess the toxicity potential see more of the combined chemical exposure and to manage the associated risks. A data fusion framework has been proposed to integrate data from disparate sources to estimate potential risk for various public health issues. To demonstrate the effectiveness of the proposed data fusion framework, an illustrative example for a hydrocarbon mixture is presented. The Joint Directors of Laboratories Data Fusion Staurosporine architecture was selected as the data fusion architecture and Dempster-Shafer Theory (DST) was chosen as the technique for data fusion. For neurotoxicity response analysis, neurotoxic metabolites toxicological data were fused with predictive toxicological data and then probability-boxes (p-boxes) were developed to represent the toxicity of each compound. The neurotoxic response was

given a rating of “low”, “medium” or “high”. These responses were then weighted by the percent composition in the illustrative F1 hydrocarbon mixture. The resulting p-boxes were fused according to DST’s mixture rule of combination. The fused p-boxes were fused again with toxicity data for n-hexane. The case study for F1 hydrocarbons illustrates how data fusion can help in the assessment of the health effects for complex mixtures with limited available data. (C) 2012 Elsevier Ireland Ltd. All rights reserved.”
“The occurrence of Giardia and Cryptosporidium was investigated in cetacean specimens stranded on the northwestern coast of Spain (European Atlantic coast) by analysis of 65 samples of large intestine from eight species.

The parasites were identified by direct immunofluorescence antibody test (IFAT) and by Sapitinib price PCR amplification of the beta-giardin gene, the ITS1-5.8S-ITS2 region and the SSU-rDNA gene of Giardia and the SSU-rDNA gene of Cryptosporidium. Giardia and Cryptosporidium were detected in 7 (10.8 %) and 9 samples (13.8 %), respectively. In two samples, co-infection with both parasites was observed. Giardia duodenalis assemblages A, C, D and F, and Cryptosporidium parvum were identified. This is the first report of G. duodenalis in Balaenoptera acutorostrata, Kogia breviceps and Stenella coeruleoalba and also the first report of Cryptosporidium sp. in B. acutorostrata and of C. parvum in S. coeruleoalba and Tursiops truncatus. These results extend the known host range of these waterborne enteroparasites.

Removal of IL-7 restored the suppressive function of Tregs. Preblocking of the IL-7R on the

Tregs also restored suppressor function, indicating that IL-7 directly affected Treg function. Thus, prolonged periods of homeostatic expansion NU7441 can temporarily release natural regulatory brakes on T cells, thereby providing an additional mechanism for activating and expanding alloreactive and autoreactive T cells. The Journal of Immunology, 2012, 189: 5649-5658.”
“Background: Vulvo-cervico-vaginal involvement has rarely been reported in pemphigus vulgaris (PV) and has not been reported in pemphigus foliaceus (PF).\n\nObjectives: We sought to evaluate genital lesions and Papanicolaou (Pap) smears in female patients with PV and PF.\n\nMethods: This prospective study includes all consecutive

cases of female patients with PV and PF seen from May 2009 buy Salubrinal to February 2010. Gynecologic examination was performed and Pap smears were collected for cytologic analysis from each patient.\n\nResults: A total of 56 patients were given a diagnosis of pemphigus (41 PV and 15 PF). Genital involvement was observed in 9 patients with PV (22%) and the vulva was the most common genital site of involvement. Of these 9 patients, 8 presented with active skin/mucous lesions. Four of 15 patients with PF had genital lesions and vulva was the exclusive site of involvement. Three of 4 patients with PF and genital involvement also showed active cutaneous lesions. Six of 56 patients (5 PV and 1 PF) presented with atypical squamous cells of undetermined significance in Pap smear analysis. Upon further pathologic review, acantholytic cells were seen, confirming the diagnosis of pemphigus.\n\nLimitations: A small number of PF cases were studied.\n\nConclusions: Vulvar lesions were the second most frequent site of mucous membrane PV. Herein we report the first case to our knowledge of symptomatic genital lesions in a patient with PF. Moreover, acantholytic cells in Pap smears were found in a patient with PF who was in complete remission off therapy with no clinical genital lesions and no GSK2879552 circulating anti-desmoglein-1 and anti-desmoglein-3 autoantibodies.

Gynecologic evaluation in patients with pemphigus, including a careful evaluation of Pap smears, should be recommended. (J Am Acad Dermatol 2012;67:409-16.)”
“The urine excretion of L-carnitine (LC), acetyl-L-carnitine (ALC) and propionyl-Lcarnitine (PLC) and their relations with the antioxidant activities are presently unknown. Liquid L-carnitine (2.0 g) was administered orally as a single dose in 12 healthy subjects. Urine concentrations of LC, ALC and PLC were detected by HPLC. Superoxide dismutase (SOD), total antioxidative capacity (T-AOC), malondialdehyde (MDA) and nitrogen monoxidum (NO) activities were measured by spectrophotometric methods. The 0 similar to 2 h, 2 similar to 4 h, 4 similar to 8 h, 8 similar to 12 h, 12 similar to 24 h excretion of LC was 53.13 +/- 31.36 mu mol, 166.93 +/- 76.

Our disaggregation landscape and kinetics analyses indicate that tetramers probably act as the transition state in both the hexamer and the 12-mer simulations. In addition, the 12-mer Selleckchem ACY-738 simulations show that the initial aggregation nucleus is with eight peptides. Furthermore, the landscape is rather flat from 8-mers to 12-mers, indicating the absence of major barriers once the initial

aggregation nucleus forms. Thus, the likely aggregation pathway is from monomers to the initial nucleus of 8-mers with tetramers as the transition state. Transition state structure analysis shows that the two dominant transition state conformations are tetramers in the 3-1 and 2-2 arrangements. The predominant nucleus conformations are in peptide

arrangements maximizing dry side-chain contacts. Landscape and kinetics analyses also indicate that the parallel beta-sheets form 3-MA cell line earlier than the dry side-chain contacts during aggregation. These results provide further insights in understanding the early fibrils aggregation.”
“The synthesis, structure, and reactivity of thorium oxo and sulfido metallocenes have been comprehensively studied. Heating of an equimolar mixture of the dimethyl metallocene [eta(5)-1,2,4-(Me3C)(3)C5H2](2)ThMe2 (2) and the bis-amide metallocene [eta(5)-1,2,4(Me3C)(3)C5H2](2)Th(NH-p-tolyl)(2) (3) in refluxing toluene results in the base-free imido thorium metallocene, [eta(5)-1,2,4-(Me3C)(3)C5H2](2)Th=N(p-tolyl) (4), which is a useful precursor for the preparation of oxo and sulfido thorium metallocenes BMS-754807 concentration [eta(5)-1,2,4-(Me3C)(3)C5H2](2)Th=E (E = O (5) and S (15)) by cycloaddition-elimination reaction with Ph2C=E (E = O, S) or CS2. The oxo metallocene 5 acts as a nucleophile toward alkylsilyl halides, while sulfido metallocene 15 does not. The oxo metallocene 5 and sulfido metallocene 15 undergo a [2 + 2] cycloaddition reaction with Ph2CO, CS2, or Ph2CS, but they show no reactivity with alkynes.

Density functional theory (DFT) studies provide insights into the subtle interplay between steric and electronic effects and rationalize the experimentally observed reactivity patterns. A comparison between Th, U, and group 4 elements shows that Th4+ behaves more like an actinide than a transition metal.”
“Introduction: Diagnostic reasoning is a core skill in teaching and learning in undergraduate curricula. Diagnostic grand rounds (DGRs) as a subform of grand rounds are intended to train the students’ skills in the selection of appropriate tests and in the interpretation of test results. The aim of this study was to test DGRs for their ability to improve diagnostic reasoning by using a pre-post-test design.\n\nMethods: During one winter term, all 398 fifth-year students (36.1% male, 63.9% female) solved 23 clinical cases presented in 8 DGRs.