The potential of members of the epidermal growth factor receptor (ErbB) family as drug targets in cholangiocarcinoma (CCA) has not been extensively addressed. Although phase III clinical trials showed no survival benefits of erlotinib in patients with advanced CCA, the outcome of the standard-of-care chemotherapy treatment for CCA, gemcitabine/cisplatin, is discouraging so we determined the effect of other ErbB receptor inhibitors alone or in conjunction with chemotherapy in CCA cells. Materials and Methods ErbB receptor expression was determined in CCA patient tissues by immunohistochemistry and digital-droplet polymerase chain reaction, and in primary cells and cell lines by immunoblot. Effects on cell viability and cell cycle distribution of combination therapy using ErbB inhibitors with chemotherapeutic drugs was carried out in CCA cell lines. 3D culture of primary CCA cells was then adopted to evaluate the drug effect in a setting that more closely resembles in vivo cell environments. Results CCA tumors showed higher expression of all ErbB receptors compared with resection margins. Primary and CCA cell lines had variable expression of erbB receptors. CCA cell lines showed decreased cell viability when treated with chemotherapeutic drugs (gemcitabine and 5fluorouracil) but also with ErbB inhibitors, particularly afatinib, and with a combination. Sequential treatment of gemcitabine with afatinib was particularly effective. Co-culture of CCA primary cells with cancer-associated fibroblasts decreased sensitivity to chemotherapies, but sensitized to afatinib. Conclusion CANCER RESEARCH AND TREATMENT (CRT) 4

No abstract

Histology is an essential field in the education of medical students, and competent knowledge in histology is very important when studying pathology. Current teaching methods for histology in medical schools involve using a conventional light microscope (CM) with or without a virtual microscope (VM). This review aims to present advantages and disadvantages of using CM and VM in terms of teaching and learning histology in the context of undergraduate medical education. One major advantage of the traditional CM histology learning method in laboratory practice is that this allows students to practice using a light microscope; however, study flexibility is limited as the students cannot take the microscope back home for self-study after the histology class has finished. Costly repairs and maintenance must also be considered when using CM. By contrast, VM technology can provide flexibility and convenience for both students and staffs. This method allows students to both self-study and group-study almost anywhere at any time. This review emphasizes that histology learning in undergraduate medical education using VM is no longer confined to the classroom. However, the basic skill of how to operate a conventional light microscope is still important for medical students because CM is commonly used in the hospital laboratories and some hospitals may not be equipped with VM technology.

Anatomy is an essential pre-clinical subject of undergraduate medical education. The traditional practical studies on cadavers are widely used in medical schools. It enhances active and deep learning, preparing students for clinical practice. However, the high costs, the time-consuming, and the health problems, which the staff exposed to chemical hazards are considered. Computer-based learning (CBL) technologies can increase the efficiency of students in understanding anatomy. This review provides an overview of CBL technologies such as Anatomage table 7.0, zSpace, Complete Anatomy app, and 4D Interactive Anatomy that prepare Ramathibodi (RA) medical students for enhanced anatomical understanding and self-learning. The integration methods between traditional cadaveric dissection and the CBL in the curriculum can enhance the classroom experience, student engagement, learning, retention, and improvement of RA medical student's knowledge in anatomy.

Occipital condyles (OC) are two bony structures located laterally to the foramen magnum (FM) on the inferior surface of the occipital bone. It is commonly described as an ovoid structure. Craniovertebral junction (CVJ) is an area that connects the cranium to the upper cervical spine. It is bounded laterally by the jugular foramen (JF), hypoglossal canal (HC), and OC. Lesions at CVJ are difficult to manage because of their location and complex anatomic relations. Stability of CVJ after surgery in depends mainly on the resection of OC. HC has been used as a landmark for the extent of OC resection. It was claimed to locate in the middle part of OC. OC resection should not extend beyond HC to prevent CVJ instability. However, previous study showed that the HC was not always located at the middle part of OC. This study aimed to focus on the measurement of OC and its relation to HC in dry skull collected from Thailand for improving the successful surgical outcome. One hundred dry skulls of equal number of both sex were examined for the shape and dimension of each OC. The location of intra and extra cranial orifice of HC (iHc and eHC) related to OC length and the distance to the posterior edge of OC (OCPE‐iHC, OCPE‐eHC) were determined. The results showed that the most prevalence of OC shape was oval‐like (33%) and the least was ring like (1%). Symmetrical OC shape was found in 46% of cases. The mean OC length was 22.13+2.51mm in male and 20.50+ 2.08 mm in female with a significant difference between sex (p=000). The OC width and height were 10.41+1.48 and 7.45+ 1.14 mm in male, 10.62+ 1.34 and 7.34+ 1.13 mm in female. No statistical significant difference of OC width and OC height between sex was found. The dimension of OC did not show any significant difference between sides. The location of iHC was mostly related to middle 1/3 of OC in 54% on the left side and located at the junction between anterior and middle 1/3 of OC in 36% on the right side. In contrast, eHC was located at anterior 1/3 of OC in 81% and 67% on the left and right side, respectively. None was related to posterior 1/3 of OC. Symmetrical location of iHC and eHC was found in 36% and 64% of cases, respectively. The distance OCPE‐iHC, OCPE‐eHC was 9.16+ 1.56, 14.1.0 + 1.98 mm in male and 8.83+ 1.62, 13.30+ 2.4 mm in female. Statistical significant difference between sex was found in OCPE‐eHC (p=0.011). In conclusion, the OC length is longer in male, the eHC located more anteriorly than iHC, therefore resection of the OC should not beyond posterior 1/3 of the OC length or about 7 mm from the posterior edge of OC. These morphometric data might be a benefit for surgical planning on resection of the occipital condyle to avoid injury to neurovascular structure and reserve the stability of craniovertebral junction.

Anatomical knowledge of the occipital condyle (OC) and its relationships to surrounding structures is important for avoiding injury during craniovertebral junction (CVJ) surgeries. This study was conducted to evaluate the morphology and morphometry of OC and its relationship to foramen magnum, jugular foramen (JF), and hypoglossal canal (HC). Morphometric parameters including length, width, height, and distances from the OC to surrounding structures were measured. The oval-like condyle was the most common OC shape, representing for 33.0% of all samples. The mean length, width and height of OC were 21.3±2.4, 10.5±1.4, and 7.4±1.1 mm, respectively. Moreover, OC was classified into three types based on its length. The most common OC length in both sexes was moderate length or type II (62.5%). The mean distance between anterior tips and posterior tips of OC to basion, and opisthion were 11.5±1.4, 39.1±3.3, 25.2±2.2, and 27.4±2.7 mm, respectively. The location of intracranial orifice of HC was commonly found related to middle 1/3 of OC in 45.0%. JF was related to the anterior 2/3 of OC in 81.0%, the anterior 1/3 of OC in 12.5%, and the entire OC length in 6.5%. These morphological analysis and morphometric data should be taken into consideration before performing surgical operation to avoid CVJ instability and neurovascular structure injury.