This report describes a multiple-marker real-time RT-PCR, which is able to provide quantitative data on melanoma markers in the peripheral blood of melanoma patients. Measurement of the studied molecular markers in our hands represents a prognostic factor and a useful method for early detection of metastasis and treatment response of melanoma patients.

The effect of positive end-expiratory pressure (PEEP) ventilation on the pancreas was studied in 22 anesthetized minipigs. Five pigs were treated with intermittent positive pressure ventilation (IPPV) for 21 h (Group I) and six pigs were treated with a PEEP of 15 cm H2O for 21 h (Group II). We next explored the influence of PEEP ventilation while stimulating the pancreas with Ceruletide, a synthetic cholecystokinin (CCK) analog, at 2.3 micrograms/kg per h.i.v. for 3 h. Ventilation with IPPV for 4 h (n = 5, group III) was compared with PEEP of 15 cm H2O for 4 h (n = 6, group IV). Changes in serum-lipase were observed in all groups. The average lipase level rose from 12.6 U/l to 67 U/l group I and from 15.1 U/l to 129.2 U/l in group II (P = 0.025 for group I vs group II). In group IV (PEEP and Ceruletide), the mean lipase level rose about six times more than in group III (IPPV and Ceruletide). The difference was significant (P less than 0.00005). By three-factor ANOVA analysis, effects due to the drug (P less than 0.000006) and to PEEP (P less than 0.038) as well as a threefold interaction could be demonstrated, i.e., using Ceruletide a greater PEEP effect on lipase than without the drug (P less than 0.023) took place. There were no significant histological changes of the pancreas in groups I and III. In group II (21 h PEEP), vacuolization of acinar cells was evident; on the ultrastructural level, indication was given that these vacuoles derived both from the Golgi apparatus and from fusion of individual zymogen granules. In group IV (PEEP and Ceruletide), the focal appearance of fatty-tissue necrosis and acinar cells as well as hemorrhage of the gland was observed. We conclude that PEEP ventilation impairs the function of the pancreas and produces even more deleterious effects when the gland is stimulated. These effects should be considered when PEEP is used in clinical practice in the treatment of acute pancreatitis.

Background In light of the COVID-19 pandemic, dramatic change in the graduate medical education (GME) trainee recruitment process was required. Kotter's 8-Step Change Model is a change management framework that has been successfully applied to a variety of GME initiatives but not for recruitment redesign. Objective To implement major change in program recruitment during the COVID-19 pandemic while maintaining Match outcomes and a high-quality candidate experience. Methods In 2020, we applied Kotter's 8 steps to implement major changes to program recruitment for a department of internal medicine including 15 GME programs (1 internal medicine residency and 14 subspecialty fellowships). We collected each program's Match fill rates and used Google Analytics to collect monthly website traffic for the year prior to our change process and the subsequent 2 years. Standardized post-interview survey questions were created, and these results were reviewed for descriptive analysis. Results We successfully used Kotter's 8 steps to change recruitment to a virtual format. Program fill rates remained high after implementation. Website engagement improved with peak monthly page rates doubling over previous values. During the highest traffic month, the average time on site increased for 7 programs, while the bounce rate decreased by more than half for 10 programs. Candidate descriptive feedback was positive. Conclusions The application of Kotter's 8 steps guided major changes to GME recruitment for 15 programs and was associated with maintained Match fill rates and increased website engagement.

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