Our study provides novel evidence indicating that synergy between the leptin/Ob-Rb/STAT3 signalling pathway and the HER2 receptor protects tamoxifen-treated HER2 over-expressing cells from the inhibitory effect of tamoxifen through differential regulation of apoptosis-related genes.

Although leptin has been found to be implicated in obesity-related breast carcinogenesis in postmenopausal women, the molecular mechanisms involved are yet to be defined. Recently, the antiapoptotic gene survivin has been recognized as a target gene for leptin in breast cancer. The aim of this study was to investigate the effect of leptin on the expression of survivin and on the transcriptional activity of its promoter in MCF-7 breast cancer cells. We also studied the potential involvement of SOCS-3 (a negative regulator of leptin's main signaling pathway JAK2/STAT3) in the expression of leptin-mediated survivin. Our results showed a significant increase in the mRNA (dose-dependent increase of 40-70%) and protein expression levels of survivin 24 h post-leptin treatment, which was followed by a significant decrease at 48 and 72 h (of 60-70%). In accordance, a chromatin immunoprecipitation assay revealed an initial strong binding of STAT3 to the survivin promoter, which was no longer detected after 24 h. Myc/mad/max network proteins and histone H3 acetylation status were not found to contribute to the expression of leptin-mediated survivin. Furthermore, a protein immunoprecipitation assay detected an enhanced SOCS-3 binding to the long isoform of leptin's receptor (Ob-Rb) 48 and 72 h after leptin administration, thus conferring inhibition to leptin signaling. In conclusion, our findings suggest, for the first time to our knowledge, that the effect of leptin on the antiapoptotic gene survivin is limited by the inhibitory role of SOCS-3 in the leptin-activated JAK2/STAT3 signaling pathway in MCF-7 breast cancer cells.

Evidence has shown that the physician-patient relationship may affect patients in several dimensions, particularly in patients' self-efficacy in managing chronic disease. This cross-sectional study assessed the association of the perceived physicianpatient relationship on perceived self-efficacy in self-managing chronic disease in 253 female patients aged 18-55 years from six primary care clinics in Riyadh, Saudi Arabia. The data were collected using two standard questionnaires (PDRQ-9 and SEMCD) and analysis was performed using the Kruskal-Wallis test (SPSS Software). Our findings showed that overall the patients perceived the physician-patient relationship as somewhat satisfactory. Participants' self-efficacy in managing their chronic diseases was also shown to be moderate. The association between the physician-patient relationship and patient self-efficacy in self-managing chronic diseases was found to be statistically significant (p=0.047). The group of patients with high satisfaction with the physician-patient relationship (HSG) was found to have statistically significant higher self-efficacy compared to the group with low satisfaction (LSG) (p=0.014). These findings suggest that strengthening the physician-patient relationship can be an important element towards enhancing patients' self-efficacy in order to further improve the self-management and health of patients with chronic diseases in Saudi Arabia.

Background: Exports of entire educational programs from countries with established universities to other countries are increasing rapidly. Scant literature exists on education exports and related educational and pedagogical knowledge transfer. Evidence in this area helps us to develop better and more cost-effective future export programs, render knowledge transfer more efficiently and enhance intercultural learning in general-all important in the current globalized world. Aim: To share the experiences and lessons learned during the educational export project of two Bachelor of Science programs in health sciences from a Danish university to a newly established Saudi Arabian university. Methods: There were two contract periods: one of 4.5 years and another 1-year extension. An accredited program from Denmark was exported with the goal of gradually transferring the knowledge of the exporting staff to the local staff. Teams of one senior and two juniors traveled from the exporting university to the receiving university to deliver courses lasting 4 weeks each. Implicit knowledge comes from the personal experiences of the authors in the preparation, collaboration, administration, management and teaching of the two BSc programs. Explicit, written data come from the evaluation reports, for which 24 students and 31 staff members were interviewed, and from a review of document filing and administrative course material. Analysis was conducted based on the Neville and Warren theory of knowledge transfer in educational settings and using SWOT analysis. Analysis and Conclusion: Opportunities for knowledge transfer were not fully implemented; however, during the contract years, exchange and collaboration between the staff groups increased. The successful and well-received education export with sustainable knowledge transfer requires thorough and collaborative preparation and needs-based implementation. Learning to know each other's working culture and creating mutual trust and acceptance take time and readiness to exchange expectations, views and experiences on equal footing.

Introduction A student-centered teaching method engages the student to take responsibility for his/her own learning. In this pedagogical approach, the role of the teacher has become to be a supportive coach rather than an authority and one-way superior knowledge provider. A teacher with good teaching skills actively involves and engages students in the learning process. Qualified teacheŕs competence consists of the substance of the subject taught, pedagogical skills as well as of the teaching experience gained after teacher training. Lessons learnt In our case we organized a 9-day workshop to enhance the teaching skills of teachers in one department of our collaborator university in Saudi Arabia (KSA). The workshop included lectures on-site and individual and group assignments such as integrating active learning methods into teaching. The pedagogical workshop was a part of the cross-cultural knowledge transfer project between SDU and (case 1) university in KSA in the Bachelor level education in 2013-2017. The project disclosed the cultural differences in teaching and learning and the different traditions of education. We found that there was a strong tradition of memorizing among students in KSA, which reflected into the attitudes of both teachers and students. This workshop was the first pedagogical training for the most of participants and it revealed that they lacked theoretical knowledge on teaching, e.g. the concepts of student-centered teaching were new to the participants. However, they had extensive teaching experience and strong knowledge of the content of the subjects taught. The acquired knowledge of the basic approaches of student-centered teaching expanded participantś thoughts on how they could better interact with students instead of one-way lecturing. In the workshop, dialogue was used as a teaching method, and participants found the sharing of learning experiences in a peer group a useful and new way to learn at work.