bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utilization of high-fidelity simulation to address challenges with the basic science immunology education of preclinical medical students
Authors: Cavuoto Petrizzo Marie , Barilla-LaBarca Maria-Louise , Lim Youn Seon , Jongco Artemio M. , Cassara Michael , Anglim James , Stern Joel N.H. 
Published: September 2019

Abstract

Background
Immune function and dysfunction are highly complex basic science concepts introduced in the preclinical medical school curriculum. A challenge for early learners is connecting the intricate details and concepts in immunology with clinical manifestations. This impedes relevance and applicability. The impetus in medical education reform is promoting consolidation of basic science and clinical medicine during the first two years of medical school. Simulation is an innovation now widely employed in medical schools to enhance clinical learning. Its use in basic science curriculums is largely deficient. The authors piloted simulation as a novel curricular approach to enhance fundamental immunology knowledge and clinical integration.

Methods
The authors introduced a Primary Immunodeficiency Disease (PIDD) simulation during a basic science immunology course for second-year medical students at the Zucker School of Medicine at Hofstra/Northwell. The simulation tasked small groups of students with evaluating, diagnosing and managing an infant with previously undiagnosed immunodeficiency. Joint facilitation by clinical and science faculty during terminal debriefings engaged students in Socratic discussion. Debriefing aimed to immerse basic science content in the context of the clinical case. Students completed a post-simulation Likert survey, assessing utility in reinforcing clinical reasoning, integration of basic science and clinical immunology, enhanced knowledge and understanding of immunodeficiency, and enhanced learning. A summative Immunodeficiency Objective Structured Clinical Examination (OSCE) question was created by faculty to assess students’ recognition of a PIDD and clinical reasoning.

Results
The simulation was well received by students with > 90% endorsing each of the objectives on the post-simulation survey. The authors also determined a statistically significant score variance on the summative OSCE question. Higher scores were achieved by the cohort of students completing the OSCE post-simulation versus the cohort completing the OSCE pre-simulation.

Conclusions
The innovative use of simulation in a highly complex basic science immunology course provides relevance and consolidation for preclinical learners. Additional data will be collected to continuously assess application of concepts and proficiency stemming from this novel curricular intervention. The authors advocate the initiation and/or expansion of simulation in non-clinical basic science courses such as immunology to bridge the gap between theory and practice.
Strategic elements of residency training in China: transactional leadership, self-efficacy, and employee-orientation culture
Authors: Deng Guangwei , Zhao Di , Lio Jonathan , Chen Xinyu , Ma Xiaopeng , Liang Liang , Feng Chenpeng 
Published: September 2019

AbstractBackgroundThe standardized training of resident physicians in China is significant and robust. During the training, clinical teachers act as leaders. The training taking place in public hospitals requires a transactional leadership style (TLS), but existing research studies seldom analyze how to promote residents’ performance from this perspective.MethodsTwo hundred and ninety six new residents undertaking standardized training were recruited from five tertiary hospitals in two provinces of China. Hierarchical moderated and mediated regression analyses were used to test the hypotheses. The hypotheses include that TLS is positively related to the training performance; mediating effect of self-efficacy and moderating effect of employee-orientation organizational culture (EOC) are significant.Results(1) Two kinds of teachers’ TLS, punishment and reward, have significant positive influence on residents’ performance. (2) Self-efficacy of residents partly mediates the positive relationship. (3) EOC moderates the relationship between the punitive behavior of clinical teachers with TLS and the self-efficacy of the residents.ConclusionsEmpirical evidence has shown the positive relationship between teachers’ TLS and residents’ performance outcomes in China. Teachers can enhance training performance by promoting self-efficacy of residents. This study also advances our understanding of EOC by examining the demonstrated moderating effects of cultural background in the relationship between teachers’ TLS and the self-efficacy of residents.
Relationship between students’ perceptions of the adequacy of M1 and M2 curricula and their performance on USMLE step 1 examination
Authors: Khalil Mohammed K. , Wright William S. , Spearman Kelsey A. , Gaspard Amber C. 
Published: September 2019

AbstractBackgroundPerformance on United States Medical Licensing Exam® (USMLE®) Step 1 examination (Step 1) is an important milestone for medical students. It is necessary for their graduation, and selection to interview for the National Resident Match Program®. Success on Step 1 examination requires content alignment, and continuous evaluation and improvement of preclinical curriculum. The purpose of this research was to observe the association between students’ perceptions of deficits in the curriculum based on core disciplines and organ systems in relation to students’ performance in those disciplines and systems on USMLE® Step 1 examination.MethodsAn anonymous survey with closed-ended and open-ended questions was sent to 174 medical students, the class of 2018 (77), and 2019 (97) within 2–3 weeks of taking Step 1 examination. Students’ feedback as well as students’ performance on Step 1 examination were organized into disciplines and organ systems to allow for more specific curriculum analyses. The closed-ended questions provide three selections (yes, no and not sure) regarding students’ agreement to the adequacy of M1 and M2 curricula to prepare students for Step 1 examination. Students’ responses on the closed-ended questions were reviewed in conjunction with their Step 1 performance. The open-ended feedback was qualitatively analyzed for emergent themes or similarity with closed-ended questions in identifying any shortcoming of the curriculum.ResultsThe data show an apparent relationship between students’ evaluations and students’ performance on Step 1 examinations. A high percentage of students’ disagreement of the curriculum adequacy was also reflected in a lower performance on Step 1 examination. Additionally, the themes that emerged from the qualitative analysis have confirmed the areas of curricular deficiency.ConclusionThe data collected from this research provides insight into the degree of usefulness of students’ evaluations as a way of assessing curriculum deficits in preparing students for their Step 1 examination.
Adding to the debate on the numbers of options for MCQs: the case for not being limited to MCQs with three, four or five options
Authors: Tweed Mike 
Published: September 2019

Abstract

Background
There is a significant body of literature that indicates that the number of options for single-best answer multiple choice questions (MCQs) can be reduced from five to three or four without adversely affecting the quality of the questions and tests. Three or four options equates to two or three distractors respectively.

Maintext
Whilst these arguments may be true when focusing on psychometric aspects of questions, we should also focus on educational and clinical authenticity aspects of questions. I present reasons for MCQs in tests to have a variable number of options which will usually be more than three, four, or five. These include: decisions related to broad clinical scenarios cannot be limited to a small number of options; options lists should include all possible combinations of option elements; and options that are rarely chosen can provide information regarding students and/or for students.

Conclusion
Finally, given computer based delivery, longer option lists are not impractical for examinees. In the contexts that are appropriate, it is time to consider a move to adopting appropriate and variable numbers of MCQ options and not be limited to MCQs with three, four or five options.
Acquisition of basic ear surgery skills: a randomized comparison between endoscopic and microscopic techniques
Authors: Anschuetz Lukas , Stricker Daniel , Yacoub Abraam , Wimmer Wilhelm , Caversaccio Marco , Huwendiek Sören 
Published: September 2019

AbstractBackgroundEndoscopic ear surgery is gaining increasing popularity and has an important impact on teaching middle ear anatomy and basic surgical skills among residents and fellows. Due to the wide-angled views offered, the approach significantly differs from the established microscopic technique. This randomized study compares the acquisition of basic ear-surgery skills using the endoscopic and microscopic technique under standardized conditions. We aim to investigate the required surgical times, attempts and accidental damages to surrounding structures (errors) in surgeons with different training levels.MethodsFinal-year medical students (n = 9), residents (n = 14) and consultants (n = 10) from the Department of Otorhinolaryngology, Head and Neck Surgery at the University Hospital of Bern, Switzerland were enrolled in the present study. After randomization every participant had to complete a standard set of grasping and dissecting surgical tasks in a temporal bone model. After the first session the participants were crossed over to the other technique.ResultsTime required for completion of the surgical tasks was similar for both techniques, but highly dependent on the training status. A significant increase in the number of damages to the ossicular chain was observed with the microscopic as compared to the endoscopic technique (p < 0.001). Moreover, students beginning with the endoscopic technique showed an overall significantly lower amount of time to complete the tasks (p = 0.04). From the subjective feedback a preference towards the endoscopic technique mainly in medical students was observed.ConclusionsThe endoscopic approach is useful and beneficial for teaching basic surgical skills, mainly by providing a reduction of damage to surrounding tissues with similar operating times for both techniques. Moreover, medical students performed significantly faster, when first taught in the endoscopic technique. Especially for young surgeons without previous training in ear surgery, the endoscope should be considered to improve surgical skills in the middle ear.
CCDC74A/B are K-fiber crosslinkers required for chromosomal alignment
Authors: Zhou Haining , Zheng Tao , Wang Tianning , Li Qi , Wang Fulin , Liang Xin , Chen Jianguo , Teng Junlin 
Published: September 2019

Abstract

Background
Spindle microtubule organization, regulated by microtubule-associated proteins, is critical for cell division. Proper organization of kinetochore fiber (K-fiber), connecting spindle poles and kinetochores, is a prerequisite for precise chromosomal alignment and faithful genetic material transmission. However, the mechanisms of K-fiber organization and dynamic maintenance are still not fully understood.

Results
We reveal that two previously uncharacterized coiled-coil domain proteins CCDC74A and CCDC74B (CCDC74A/B) are spindle-localized proteins in mammalian cells. They bind directly to microtubules through two separate domains and bundle microtubules both in vivo and in vitro. These functions are required for K-fiber organization, bipolar spindle formation, and chromosomal alignment. Moreover, CCDC74A/B form homodimers in vivo, and their self-association activity is necessary for microtubule bundling and K-fiber formation.

Conclusions
We characterize CCDC74A and CCDC74B as microtubule-associated proteins that localize to spindles and are important K-fiber crosslinkers required for bipolar spindle formation and chromosome alignment.
Sialic acid metabolism as a potential therapeutic target of atherosclerosis
Authors: Zhang Chao , Chen Jingyuan , Liu Yuhao , Xu Danyan 
Published: September 2019

AbstractSialic acid (Sia), the acylated derivative of the nine-carbon sugar neuraminic acid, is a terminal component of the oligosaccharide chains of many glycoproteins and glycolipids. In light of its important biological and pathological functions, the relationship between Sia and coronary artery disease (CAD) has been drawing great attentions recently. Large-scale epidemiological surveys have uncovered a positive correlation between plasma total Sia and CAD risk. Further research demonstrated that N-Acetyl-Neuraminic Acid, acting as a signaling molecule, triggered myocardial injury via activation of Rho/ROCK-JNK/ERK signaling pathway both in vitro and in vivo. Moreover, there were some evidences showing that the aberrant sialylation of low-density lipoprotein, low-density lipoprotein receptor and blood cells was involved in the pathological process of atherosclerosis. Significantly, the Sia regulates immune response by binding to sialic acid-binding immunoglobulin-like lectin (Siglecs). The Sia-Siglecs axis is involved in the immune inflammation of atherosclerosis. The generation of Sia and sialylation of glycoconjugate both depend on many enzymes, such as sialidase, sialyltransferase and trans-sialidase. Abnormal activation or level of these enzymes associated with atherosclerosis, and inhibitors of them might be new CAD treatments. In this review, we focus on summarizing current understanding of Sia metabolism and of its relevance to atherosclerosis.
Variations in hepatic lipid species of age-matched male mice fed a methionine-choline-deficient diet and housed in different animal facilities
Authors: Rein-Fischboeck Lisa , Haberl Elisabeth M. , Pohl Rebekka , Feder Susanne , Liebisch Gerhard , Krautbauer Sabrina , Buechler Christa 
Published: September 2019

AbstractBackgroundNon-alcoholic steatohepatitis (NASH) is a common disease and feeding mice a methionine-choline-deficient (MCD) diet is a frequently used model to study its pathophysiology. Genetic and environmental factors influence NASH development and liver lipid content, which was studied herein using C57BL/6 J mice bred in two different animal facilities.MethodsAge-matched male C57BL/6 J mice bred in two different animal facilities (later on referred to as WT1 and WT2) at the University Hospital of Regensburg were fed identical MCD or control chows for 2 weeks. Hepatic gene and protein expression and lipid composition were determined.ResultsNASH was associated with increased hepatic triglycerides, which were actually higher in WT1 than WT2 liver in both dietary groups. Cholesterol contributes to hepatic injury but was only elevated in WT2 NASH liver. Ceramides account for insulin resistance and cell death, and ceramide species d18:1/16:0 and d18:1/18:0 were higher in the NASH liver of both groups. Saturated sphingomyelins only declined in WT1 NASH liver. Lysophosphatidylcholine concentrations were quite normal in NASH and only one of the 12 altered phosphatidylcholine species declined in NASH liver of both groups. Very few phosphatidylethanolamine, phosphatidylserine, and phosphatidylinositol species were comparably regulated in NASH liver of both animal groups. Seven of these lipid species declined and two increased in NASH. Notably, hepatic mRNA expression of proinflammatory (F4/80, CD68, IL-6, TNF and chemerin) and profibrotic genes (TGF beta and alpha SMA) was comparable in WT1 and WT2 mice.ConclusionsMice housed and bred in different animal facilities had comparable disease severity of NASH whereas liver lipids varied among the groups. Thus, there was no specific lipid signature for NASH in the MCD model.
New insights into different adipokines in linking the pathophysiology of obesity and psoriasis
Authors: Kong Yi , Zhang Suhan , Wu Ruifang , Su Xin , Peng Daoquan , Zhao Ming , Su Yuwen 
Published: September 2019

AbstractPsoriasis is a chronic, systemic, hyper-proliferative immune-mediated inflammatory skin disease. The results of epidemiological investigations have shown that psoriasis affects around 2% of the general population worldwide, and the total number of psoriasis patients is more than 6 million in China. Apart from the skin manifestations, psoriasis has been verified to associate with several metabolic comorbidities, such as insulin resistance, diabetes and obesity. However, the underlying mechanism is still not elucidated. Adipocytes, considered as the active endocrine cells, are dysfunctional in obesity which displays increased synthesis and secretion of adipokines with other modified metabolic properties. Currently, growing evidence has pointed to the central role of adipokines in adipose tissue and the immune system, providing new insights into the effect of adipokines in linking the pathophysiology of obesity and psoriasis. In this review, we summarize the current understanding of the pathological role of adipokines and the potential mechanisms whereby different adipokines link obesity and psoriasis. Furthermore, we also provide evidence which identifies a potential therapeutic target aiming at adipokines for the management of these two diseases.
The role of collagen in cancer: from bench to bedside
Authors: Xu Shuaishuai , Xu Huaxiang , Wang Wenquan , Li Shuo , Li Hao , Li Tianjiao , Zhang Wuhu , Yu Xianjun , Liu Liang 
Published: September 2019

AbstractCollagen is the major component of the tumor microenvironment and participates in cancer fibrosis. Collagen biosynthesis can be regulated by cancer cells through mutated genes, transcription factors, signaling pathways and receptors; furthermore, collagen can influence tumor cell behavior through integrins, discoidin domain receptors, tyrosine kinase receptors, and some signaling pathways. Exosomes and microRNAs are closely associated with collagen in cancer. Hypoxia, which is common in collagen-rich conditions, intensifies cancer progression, and other substances in the extracellular matrix, such as fibronectin, hyaluronic acid, laminin, and matrix metalloproteinases, interact with collagen to influence cancer cell activity. Macrophages, lymphocytes, and fibroblasts play a role with collagen in cancer immunity and progression. Microscopic changes in collagen content within cancer cells and matrix cells and in other molecules ultimately contribute to the mutual feedback loop that influences prognosis, recurrence, and resistance in cancer. Nanoparticles, nanoplatforms, and nanoenzymes exhibit the expected gratifying properties. The pathophysiological functions of collagen in diverse cancers illustrate the dual roles of collagen and provide promising therapeutic options that can be readily translated from bench to bedside. The emerging understanding of the structural properties and functions of collagen in cancer will guide the development of new strategies for anticancer therapy.
Locomotor skill acquisition in virtual reality shows sustained transfer to the real world
Authors: Kim Aram , Schweighofer Nicolas , Finley James M. 
Published: September 2019

Abstract

Background
Virtual reality (VR) is a potentially promising tool for enhancing real-world locomotion in individuals with mobility impairment through its ability to provide personalized performance feedback and simulate real-world challenges. However, it is unknown whether novel locomotor skills learned in VR show sustained transfer to the real world. Here, as an initial step towards developing a VR-based clinical intervention, we study how young adults learn and transfer a treadmill-based virtual obstacle negotiation skill to the real world.

Methods
On Day 1, participants crossed virtual obstacles while walking on a treadmill, with the instruction to minimize foot clearance during obstacle crossing. Gradual changes in performance during training were fit via non-linear mixed effect models. Immediate transfer was measured by foot clearance during physical obstacle crossing while walking over-ground. Retention of the obstacle negotiation skill in VR and retention of over-ground transfer were assessed after 24 h.

Results
On Day 1, participants systematically reduced foot clearance throughout practice by an average of 5 cm (SD 4 cm) and transferred 3 cm (SD 1 cm) of this reduction to over-ground walking. The acquired reduction in foot clearance was also retained after 24 h in VR and over-ground. There was only a small, but significant 0.8 cm increase in foot clearance in VR and no significant increase in clearance over-ground on Day 2. Moreover, individual differences in final performance at the end of practice on Day 1 predicted retention both in VR and in the real environment.

Conclusions
Overall, our results support the use of VR for locomotor training as skills learned in a virtual environment readily transfer to real-world locomotion. Future work is needed to determine if VR-based locomotor training leads to sustained transfer in clinical populations with mobility impairments, such as individuals with Parkinson’s disease and stroke survivors.
Combining transcranial direct-current stimulation with gait training in patients with neurological disorders: a systematic review
Authors: de Paz Rubén Hernández , Serrano-Muñoz Diego , Pérez-Nombela Soraya , Bravo-Esteban Elisabeth , Avendaño-Coy Juan , Gómez-Soriano Julio 
Published: September 2019

Abstract

Background
Transcranial direct-current stimulation (tDCS) is an easy-to-apply, cheap, and safe technique capable of affecting cortical brain activity. However, its effectiveness has not been proven for many clinical applications.

Objective
The aim of this systematic review was to determine whether the effect of different strategies for gait training in patients with neurological disorders can be enhanced by the combined application of tDCS compared to sham stimulation. Additionally, we attempted to record and analyze tDCS parameters to optimize its efficacy.

Methods
A search in Pubmed, PEDro, and Cochrane databases was performed to find randomized clinical trials that combined tDCS with gait training. A chronological filter from 2010 to 2018 was applied and only studies with variables that quantified the gait function were included.

Results
A total of 274 studies were found, of which 25 met the inclusion criteria. Of them, 17 were rejected based on exclusion criteria. Finally, 8 trials were evaluated that included 91 subjects with stroke, 57 suffering from Parkinson’s disease, and 39 with spinal cord injury. Four of the eight assessed studies did not report improved outcomes for any of its variables compared to the placebo treatment.

Conclusions
There are no conclusive results that confirm that tDCS can enhance the effect of the different strategies for gait training. Further research for specific pathologies, with larger sample sizes and adequate follow-up periods, are required to optimize the existing protocols for applying tDCS.