Medical School Students’ Knowledge of Pain and Palliative Care: An Observational Study

Background: Pain and palliative care are a reality in daily routines of medical treatment. However, the theoretical-practical curricula of traditional medical school course still unsatisfactorily contemplate pain management, as well as the palliative care approach. Objective: To assess the knowledge of medical students about pain and palliative care, as well as to identify their perception of teaching these topics during hospitalization. Methods: A cross-sectional observational study, with a descriptive and exploratory approach, data collection for which was carried out between August and November 2020. The target population was medical students, who responded to an online survey of a quantitative, anonymous and follow-up nature. The survey study variables concerned knowledge about pain management and palliative care. Results: An expressive majority of academics showed difficulty in understanding the pathophysiology of pain related to prescribing drugs for pain management purposes, and all of them believe that it is necessary to acquire more knowledge about pain treatment. In parallel, only 9.3% report having received sufficient information regarding palliative care during medical school. Conclusion: The results suggest a certain lack of knowledge and insecurity among medical school students with respect to pain management and care for patients receiving palliative care. The didactical approach to this theme is still deficient in the medical curriculum and requires immediate improvement and new proposals that address the training of these professionals in a more specific and effective way.

Could school programs based on social-emotional learning prevent substance abuse among adolescents?

In this editorial,we comment on the article Adolescent suicide risk factors and the integration of social-emotional skills in school-based prevention programs by Liu et al.While the article focused on the issue of suicide and social-emotional learning programs as a possible intervention,we here discuss evidence of other reported outcomes and if it could be an effective way to prevent substance abuse among adolescents.

Mindfulness training in medical education as a means to improve resilience,empathy,and mental health in the medical profession

The high rates of depression,burnout,and increased risk of suicide among medical students,residents,and physicians in comparison with other careers signal a mental health crisis within our profession.We contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction between a challenging environment and the mental capital of individuals.Additionally,we posit that mindfulness-based practices are instrumental for the development of major components of mental capital,such as resilience,flexibility of mind,and learning skills,while also serving as a pathway to enhance empathy,compassion,self-awareness,conflict resolution,and relational abilities.Importantly,the evidence base supporting the effectiveness of mindfulness-based interventions has been increasing over the years,and a growing number of medical schools have already integrated mindfulness into their curricula.While we acknowledge that mindfulness is not a panacea for all educational and mental health problems in this field,we argue that there is currently an unprecedented opportunity to gather momentum,spread and study mindfulness-based programs in medical schools around the world as a way to address some longstanding shortcomings of the medical profession and the health and educational systems upon which it is rooted.

Evaluation of large language models for the classification of medical device software

Amidst the rapidly expanding integration of large language models(LLMs)across various sectors(ranging from everyday applications to specialized fields demanding stringent regulatory adherence),our investigation seeks to determine how well these models can support medical device software classification.Medical device classification functions to systematically categorize devices according to their designated use,associated risk levels,and requisite regulatory oversight,thereby providing a structured framework for ensuring safety and efficacy as mandated by regulatory authorities.

Surgical or medical treatment of obesity-associated type 2 diabetesan increasing clinical conundrum

In this editorial,we comment on the article by He et al,specifically in relation to the efficacy of bariatric surgery vs glucagon-like peptide-1 receptor agonist(GLP-1RA)therapy in the management of type 2 diabetes(T2D)associated with obesity.Bariatric surgery has now also been shown to be safe and effective in pre-teens and teenagers with obesity and T2D,but information on newer GLP-1RAs in these groups is predictably limited.In older individuals(age>65 years),both bariatric surgery and GLP-1RA therapy improve cardiovascular outcomes.Baria-tric surgery is not infrequently associated with post-operative postprandial hypoglycemia,which is not the case with GLP-1RAs and,paradoxically,there is evidence that GLP-1RAs may reduce both the frequency and severity of postprandial hypoglycemia.Comparative trials of the long-term efficacy of bariatric surgery and GLP-1RAs are indicated.

Function and biomedical implications of exosomal microRNAs delivered by parenchymal and nonparenchymal cells in hepatocellular carcinoma

Small extracellular vesicles(exosomes)are important components of the tumor microenvironment.They are small membrane-bound vesicles derived from almost all cell types and play an important role in intercellular communication.Exosomes transmit biological molecules obtained from parent cells,such as proteins,lipids,and nucleic acids,and are involved in cancer development.MicroRNAs(miRNAs),the most abundant contents in exosomes,are selectively packaged into exosomes to carry out their biological functions.Recent studies have revealed that exosome-delivered miRNAs play crucial roles in the tumorigenesis,progression,and drug resistance of hepatocellular carcinoma(HCC).In addition,exosomes have great industrial prospects in the diagnosis,treatment,and prognosis of patients with HCC.This review summarized the composition and function of exosomal miRNAs of different cell origins in HCC and highlighted the association between exosomal miRNAs from stromal cells and immune cells in the tumor microenvironment and the progression of HCC.Finally,we described the potential applicability of exosomal miRNAs derived from mesenchymal stem cells in the treatment of HCC.

Management of regional citrate anticoagulation for continuous renal replacement therapy:guideline recommendations from Chinese emergency medical doctor consensus

Continuous renal replacement therapy(CRRT)is widely used for treating critically-ill patients in the emergency department in China.Anticoagulant therapy is needed to prevent clotting in the extracorporeal circulation during CRRT.Regional citrate anticoagulation(RCA)has been shown to potentially be safer and more effective,and is now recommended as the preferred anticoagulant method for CRRT.However,there is still a lack of unified standards for RCA management in the world,and there are many problems in using this method in clinical practice.The Emergency Medical Doctor Branch of the Chinese Medical Doctor Association(CMDA)organized a panel of domestic emergency medicine experts and international experts of CRRT to discuss RCA-related issues,including the advantages and disadvantages of RCA in CRRT anticoagulation,the principle of RCA,parameter settings for RCA,monitoring of RCA(mainly metabolic acid-base disorders),and special issues during RCA.Based on the latest available research evidence as well as the paneled experts'clinical experience,considering the generalizability,suitability,and potential resource utilization,while also balancing clinical advantages and disadvantages,a total of 16 guideline recommendations were formed from the experts'consensus.

A national longitudinal cohort study of factors contributing to UK medical students’mental ill-health symptoms

Background The mental health of current medical students is predictive of their mental health as future doctors.The prevalence of anxiety,depression and burnout is high among medical students,but less is known about the occurrence of other mental ill-health symptoms,such as eating or personality disorders,and factors contributing to mental ill-health.Aims(1)To explore the prevalence of various mental ill-health symptoms in medical students and(2)to investigate what medical school factors and students’attitudes contribute to these mental ill-health symptoms.Methods Between November 2020 and May 2021,medical students from nine geographically spread medical schools in the UK participated by completing online questionnaires at two points in time,approximately 3 months apart.Results Of the 792 participants who filled in the questionnaire at baseline,over half experienced medium to high somatic symptoms(50.8%;402)and drank alcohol at hazardous levels(62.4%;494).Adjusted longitudinal data analysis of 407 students who completed the follow-up questionnaire demonstrated that less supportive educational climates that were more competitive and less centralised around the students,lower feelings of belongingness,greater stigma towards mental ill-health and lower intentions to seek help for mental ill-health,all contributed to students’mental ill-health symptoms.Conclusions Medical students experience a high prevalence of various mental ill-health symptoms.This study suggests that medical school factors and students’attitudes towards mental ill-health are significantly associated with students’mental health.

Break Free from Depression:Implementation and Outcomes of a School-Based Depression Awareness Program

The objective of this study was to evaluate the impact of Break Free from Depression(BFFD),a school-based depression awareness curriculum,in comparison to a wait list control group.A total of 13 eighth grade classrooms participated in either an intervention or control group and completed pre-,post-,and three-month follow-up surveys.Students participating in BFFD(N=6 classrooms,166 students)demonstrated enhanced knowledge of and more adaptive attitudes towards depression compared to the control group(N=7 classrooms,155 students).Participants in the BFFD intervention also demonstrated increases in their confidence in knowing how to seek help for depression and in their intent to seek this help if needed.Slight decreases were found at a three-month follow-up in all scales except for intent to seek help.BFFD was effective regardless of gender,ethnicity,or identification as a member of the LGBTQ community.There was a delayed effect on measured constructs for Black students with gains apparent at three-month follow-up.The findings demonstrated that BFFD had a small but significant positive impact on students’knowledge,skills,and attitudes in seeking support for themselves and for others when faced with signs of depression.The implementation of depression awareness curricula in schools hold promise in promoting student mental health,and it is important to consider factors that might have an impact on outcomes.

COVID-19 Downgraded Already Impaired Mental Health of Medical Undergraduates during the Pandemic Years

Background: Measures to contain the COVID-19 transmission reached teaching routines of universities worldwide with possible mental health consequences for anxiety. This study assessed prevalence and risk factors for stress, depression, and anxiety (SDA) in medical students during quarantine by COVID-19. Methods: A cross-sectional observational study of medical students by means of the DASS-21 questionnaire. Risk factors for SDA were assessed based on epidemiologic questions related to COVID-19. Receiver Operating Characteristics (ROC) curves were calculated for each predictor, as well as sensitivity and specificity. Results: This survey reached 1009 responses. A prevalence of 77.5% for some SDA disorder was found, 63% being severe. Previous diagnosis of psychiatric disorder was a factor of risk for anxiety (OR 2.78 CI95% 1.44 - 14.25, p = 0.044), as well as for depression (OR 3.37 CI95% 1.98 - 6.02, p Conclusion: Psychiatric conditions as well as chronic illnesses were risk factors for high prevalence of anxiety, depression and stress during the COVID-19 pandemic among medical students.

3D Bioprinting for Biomedical Applications

Three-dimensional(3D)printing,referring to a type of additive manufacturing,has emerged as a promising fabrication technique in the past decades since it can create 3D objects with desired architecture by precise control over the deposition of successive layers of various materials.Benefiting from these advantages,3D printing has been extensively applied in varied areas of science and engineering.

Bridging the gap between data mining and medical applications

Artificial Intelligence(AI)is one of the most promising and rapidly evolving fields in modern science.It is increasingly being applied to a wide range of domains,including medicine,where it holds enormous potential for improving patient care,reducing costs,and enhancing clinical decision-making.One area of AI that has shown great promise in the medical domain is data mining,which is the process of extracting useful information and knowledge from large data sets.

儿童常见实体肿瘤分子学进展

儿童肿瘤包含一大类罕见肿瘤,虽然只占全年龄段肿瘤患者的极小比例,但却是儿童患者致死的主要原因。成人恶性肿瘤主要起源于上皮,儿童肿瘤通常来源于中胚层或神经外胚层,在肿瘤的发生、发展、治疗和预后等均与成人肿瘤明显不同,WHO(2023)肿瘤分类中首次将儿童肿瘤进行独立归类。研究者认为肿瘤的本质是一种基因病,2018年有文献从基因层面指出儿童肿瘤和成人肿瘤有诸多不同[1-2]:成人由于后天环境等因素的影响,使细胞长期连续遭遇“打击”(大部分为基因突变),最终发展为肿瘤。

Mitochondrial dysfunction and quality control lie at the heart of subarachnoid hemorrhage

The dramatic increase in intracranial pressure after subarachnoid hemorrhage leads to a decrease in cerebral perfusion pressure and a reduction in cerebral blood flow.Mitochondria are directly affected by direct factors such as ischemia,hypoxia,excitotoxicity,and toxicity of free hemoglobin and its degradation products,which trigger mitochondrial dysfunction.Dysfunctional mitochondria release large amounts of reactive oxygen species,inflammatory mediators,and apoptotic proteins that activate apoptotic pathways,further damaging cells.In response to this array of damage,cells have adopted multiple mitochondrial quality control mechanisms through evolution,including mitochondrial protein quality control,mitochondrial dynamics,mitophagy,mitochondrial biogenesis,and intercellular mitochondrial transfer,to maintain mitochondrial homeostasis under pathological conditions.Specific interventions targeting mitochondrial quality control mechanisms have emerged as promising therapeutic strategies for subarachnoid hemorrhage.This review provides an overview of recent research advances in mitochondrial pathophysiological processes after subarachnoid hemorrhage,particularly mitochondrial quality control mechanisms.It also presents potential therapeutic strategies to target mitochondrial quality control in subarachnoid hemorrhage.

Amyloid-beta and tau protein beyond Alzheimer's disease

The aggregation of amyloid-beta peptide and tau protein dysregulation are implicated to play key roles in Alzheimer's disease pathogenesis and are considered the main pathological hallmarks of this devastating disease.Physiologically,these two proteins are produced and expressed within the normal human body.However,under pathological conditions,abnormal expression,posttranslational modifications,conformational changes,and truncation can make these proteins prone to aggregation,triggering specific disease-related cascades.Recent studies have indicated associations between aberrant behavior of amyloid-beta and tau proteins and various neurological diseases,such as Alzheimer's disease,Parkinson's disease,and amyotrophic lateral sclerosis,as well as retinal neurodegenerative diseases like Glaucoma and age-related macular degeneration.Additionally,these proteins have been linked to cardiovascular disease,cancer,traumatic brain injury,and diabetes,which are all leading causes of morbidity and mortality.In this comprehensive review,we provide an overview of the connections between amyloid-beta and tau proteins and a spectrum of disorders.

Biomaterials and tissue engineering in traumatic brain injury:novel perspectives on promoting neural regeneration

Traumatic brain injury is a serious medical condition that can be attributed to falls, motor vehicle accidents, sports injuries and acts of violence, causing a series of neural injuries and neuropsychiatric symptoms. However, limited accessibility to the injury sites, complicated histological and anatomical structure, intricate cellular and extracellular milieu, lack of regenerative capacity in the native cells, vast variety of damage routes, and the insufficient time available for treatment have restricted the widespread application of several therapeutic methods in cases of central nervous system injury. Tissue engineering and regenerative medicine have emerged as innovative approaches in the field of nerve regeneration. By combining biomaterials, stem cells, and growth factors, these approaches have provided a platform for developing effective treatments for neural injuries, which can offer the potential to restore neural function, improve patient outcomes, and reduce the need for drugs and invasive surgical procedures. Biomaterials have shown advantages in promoting neural development, inhibiting glial scar formation, and providing a suitable biomimetic neural microenvironment, which makes their application promising in the field of neural regeneration. For instance, bioactive scaffolds loaded with stem cells can provide a biocompatible and biodegradable milieu. Furthermore, stem cells-derived exosomes combine the advantages of stem cells, avoid the risk of immune rejection, cooperate with biomaterials to enhance their biological functions, and exert stable functions, thereby inducing angiogenesis and neural regeneration in patients with traumatic brain injury and promoting the recovery of brain function. Unfortunately, biomaterials have shown positive effects in the laboratory, but when similar materials are used in clinical studies of human central nervous system regeneration, their efficacy is unsatisfactory. Here, we review the characteristics and properties of various bioactive materials, followed by the introduction of applications based on biochemistry and cell molecules, and discuss the emerging role of biomaterials in promoting neural regeneration. Further, we summarize the adaptive biomaterials infused with exosomes produced from stem cells and stem cells themselves for the treatment of traumatic brain injury. Finally, we present the main limitations of biomaterials for the treatment of traumatic brain injury and offer insights into their future potential.

Role of transforming growth factor-βin peripheral nerve regeneration

Injuries caused by trauma and neurodegenerative diseases can damage the peripheral nervous system and cause functional deficits.Unlike in the central nervous system,damaged axons in peripheral nerves can be induced to regenerate in response to intrinsic cues after reprogramming or in a growth-promoting microenvironment created by Schwann cells.However,axon regeneration and repair do not automatically result in the restoration of function,which is the ultimate therapeutic goal but also a major clinical challenge.Transforming growth factor(TGF)is a multifunctional cytokine that regulates various biological processes including tissue repair,embryo development,and cell growth and differentiation.There is accumulating evidence that TGF-βfamily proteins participate in peripheral nerve repair through various factors and signaling pathways by regulating the growth and transformation of Schwann cells;recruiting specific immune cells;controlling the permeability of the blood-nerve barrier,thereby stimulating axon growth;and inhibiting remyelination of regenerated axons.TGF-βhas been applied to the treatment of peripheral nerve injury in animal models.In this context,we review the functions of TGF-βin peripheral nerve regeneration and potential clinical applications.

Metastatic clear cell sarcoma of the pancreas:A rare case report

BACKGROUND Clear cell sarcoma(CCS)is a rare soft-tissue sarcoma.The most common metastatic sites for CCS are the lungs,bones and brain.CCS is highly invasive and mainly metastasizes to the lung,followed by the bone and brain;however,pancreatic metastasis is relatively rare.CASE SUMMARY We report on a rare case of CCS with pancreatic metastasis in a 47-year-old man.The patient had a relevant medical history 3 years ago,with abdominal pain as the main clinical manifestation.No abnormalities were observed on physical examination and the tumor was found on abdominal computed tomography.Based on the medical history and postoperative pathology,the patient was diagnosed with CCS with pancreatic metastasis.The patient was successfully treated with surgical interventions,including distal pancreatectomy and sple-nectomy.CONCLUSION This report summarizes the available treatment modalities for CCS and the importance of regular postoperative follow-up for patients with CCS.

Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma

BACKGROUND The efficacy and safety of transarterial chemoembolization(TACE)combined with lenvatinib plus programmed cell death protein-1(PD-1)for unresectable hepato-cellular carcinoma(HCC)have rarely been evaluated and it is unknown which factors are related to efficacy.AIM To evaluate the efficacy and independent predictive factors of TACE combined with lenvatinib plus PD-1 inhibitors for unresectable HCC.METHODS This study retrospectively enrolled patients with unresectable HCC who received TACE/lenvatinib/PD-1 treatment between March 2019 and April 2022.Overall survival(OS)and progression-free survival(PFS)were determined.The objective response rate(ORR)and disease control rate(DCR)were evaluated in accordance with the modified Response Evaluation Criteria in Solid Tumors.Additionally,the prognostic factors affecting the clinical outcome were assessed.RESULTS One hundred and two patients were enrolled with a median follow-up duration of 12.63 months.The median OS was 26.43 months(95%CI:17.00-35.87),and the median PFS was 10.07 months(95%CI:8.50-11.65).The ORR and DCR were 61.76%and 81.37%,respectively.The patients with Barcelona Clinic Liver Cancer Classification(BCLC)B stage,early neutrophil-to-lymphocyte ratio(NLR)response(decrease),or early alpha-fetoprotein(AFP)response(decrease>20%)had superior OS and PFS than their counterparts.CONCLUSION This study showed that TACE/lenvatinib/PD-1 treatment was well tolerated with encouraging efficacy in patients with unresectable HCC.The patients with BCLC B-stage disease with early NLR response(decrease)and early AFP response(decrease>20%)may achieve better clinical outcomes with this triple therapy.

Upadacitinib for refractory ulcerative colitis with primary nonresponse to infliximab and vedolizumab:A case report

BACKGROUND Many patients with ulcerative colitis(UC)do not respond well to,or tolerate conventional and biological therapies.There is currently no consensus on the treatment of refractory UC.Studies have demonstrated that the selective Janus kinase 1 inhibitor upadacitinib,a small-molecule drug,is effective and safe for treating UC.However,no studies have revealed that upadacitinib is effective in treating refractory UC with primary nonresponse to infliximab and vedolizumab.CASE SUMMARY We report the case of a 44-year-old male patient with a chief complaint of bloody diarrhoea with mucus and pus,in addition to dizziness.The patient had recurrent disease after receiving mesalazine,prednisone,azathioprine,infliximab and vedolizumab over four years.Based on the endoscopic findings and pathological biopsy,the patient was diagnosed with refractory UC.In particular,the patient showed primary nonresponse to infliximab and vedolizumab.Based on the patient’s history and recurrent disease,we decided to administer upadacitinib.During hospitalisation,the patient was received upadacitinib under our guidance.Eight weeks after the initiation of upadacitinib treatment,the patient’s symptoms and endoscopic findings improved significantly.No notable adverse reactions have been reported to date.CONCLUSION Our case report suggests that upadacitinib may represent a valuable strategy for treating refractory UC with primary nonresponse.