The nuclear receptor Nurr1 (NR4A2) is a transcriptional regulator of inflammatory homeostasis, but its systemic effects on orchestrating inter-organ communications are largely unknown. Here we show that Nurr1 haplo-insufficiency results in a lethal coupled disorder across the liver-gut axis. Using a CRISPR-Cas9 generated murine model, we find that metabolically-activated heterozygous deficiency of Nurr1 results in profound hepatocellular necrosis and marked hepatic activation of inflammatory and pro-fibrotic genes coupled with dysregulation of the intestinal barrier, and severe small-intestinal dysbiosis. Multi-omics integration reveals a highly penetrant transcriptional signature of this herein termed liver-gut disorder, achieving up to 0.950 accuracy (SVM-RBF, 10-fold cross-validation) in classifying genotypes from integrated multi-omics features. Notably, we also demonstrate that these gene level perturbations in Nurr1 haplo-insufficiency can be thought of as learnable tissue 'morphologies' detectable by AI. Next, we created deep convolutional neural networks that accurately classify genotype from routine histopathology. Our algorithm achieves 99.50% accuracy in classifying hepatic fibrosis (Sirius Red), 99.20% in liver inflammation (H&E) and 92.31% in intestine (H&E). We provide the first multi-omics phenotype of Nurr1 deficiency, revealing its pivotal regulatory role in coordinating liver-gut homeostasis, and establishing a histopathological AI-driven framework. Grad-CAM saliency analysis confirms biological interpretability. Translational relevance is supported by human transcriptomic data (E-GEOD-61260) showing concordant upregulation of COL1A1 (log2FC= + 0.725, p < 0.01), TGFB1 (+ 0.429, p < 0.05), and MMP9 (+ 0.969, p < 0.01) alongside reduced NR4A2/NURR1 in human liver disease.
Following ischemic stroke (IS), endogenous protective mechanisms are activated to mitigate brain injury. Adenosine (ADO), a key endogenous immunomodulator, is implicated in this response, yet the precise regulatory pathways linking upstream ischemic injury to ADO-mediated protection remain incompletely elucidated. We integrated single-cell RNA sequencing (scRNA-seq) data (GSE174574) and bulk RNA-seq data (GSE140275) from IS models. After preprocessing and t-SNE-based clustering, we conducted analyses of cell communication and differential expression. Differentially expressed genes were intersected with ADO metabolism-related genes from the GeneCards database to identify candidate regulators. The roles of these candidates in modulating ADO metabolism, oxidative stress, and apoptosis were functionally validated in vitro using qRT-PCR, Western blot, ELISA, and gene silencing in BV2 cells. Unsupervised clustering of scRNA-seq data identified 14 cell types, with microglia displaying extensive intercellular communication, particularly via the CCL and TNF signaling pathways. Cross-database analysis identified four candidate molecules: HMBS, UCP2, POR, and TNF. These were positively correlated with pro-ADO metabolic genes in middle cerebral artery occlusion (MCAO) models and were upregulated in LPS-stimulated BV2 cells, coinciding with increased inflammation, oxidative stress, and ADO levels. Silencing HMBS or POR reversed these effects. Exogenous ADO reduced oxidative stress and apoptosis in BV2 cells and promoted M2 microglia polarization. Our findings suggest that ischemic injury upregulates specific molecules (HMBS, UCP2, POR, and TNF) potentially associated with ADO metabolism, which may, in turn, alleviate oxidative stress and apoptosis while favoring anti-inflammatory microglial polarization. This supports the hypothesis that enhanced adenosine metabolism represents a potential endogenous protective mechanism activated in response to upstream ischemic insult. HMBS or POR silencing upregulated adenosine deaminase/adenosine kinase (ADA/ADK) and downregulated SLC29A1/A2 in LPS-stimulated BV2 cells. The protective effects of ADO were abolished by A2aR antagonist SCH 58261, confirming the functional link between HMBS/POR and ADO-mediated neuroprotection.
The integration of clinical skills and humanistic literacy is a paramount objective in modern medical education. This study evaluates a novel tutorial-based model designed to promote early clinical-humanities integration for first-year medical students. A cross-sectional study was conducted at Zhejiang University School of Medicine. A self-reported questionnaire was administered to first-year medical students enrolled in the "Whole Life Cycle Health I" course (N = 275). The questionnaire assessed their adaptation to this model, learning interest, perceived promotion of clinical-humanities integration, module effectiveness, and self-rated competency improvement. Most students reported good adaptation (90.9%) and increased learning interest (88.0%). Although adaptation levels were comparable between genders, male students expressed significantly stronger agreement regarding enhanced interest and the model's effectiveness in fostering integration (p < 0.05). Key practical modules-including "Simulated Outpatient Role-Playing," "AI-Powered Science Video Production," and "Postpartum Home Visits"-were rated as highly effective. Students reported substantial improvement in patient communication (87.3%) and teamwork (85.1%), despite challenges like time constraints and task integration difficulties. The tutorial-based model is perceived by students as a feasible, promising, and well-received strategy for early clinical-humanities integration, demonstrating significant potential for broader implementation in medical education reform.
Extracellular vesicles (EVs) are nanoscale membranous vesicles that mediate intercellular communication via the transport of bioactive cargos. With context-dependent intrinsic targeting, source- and cargo-dependent favorable biocompatibility and loading capacity, EVs represent promising acellular therapeutic platforms with context-dependent translational potential. However, their clinical application is hindered by source-associated functional heterogeneity, unclear matching relationships between administration routes and disease indications, as well as imperfect quality control specifications and fragmented global regulatory frameworks alongside insufficient clinical trial data. This review systematically summarizes the biological features of EVs originating from mesenchymal stem cells, immune cells, tumor cells, plants, milk, microbes and platelets, and compares the pros and cons and applicable scenarios of intravenous, oral, nasal, inhaled, and multiple local injection delivery modalities. We further recapitulate the research progress of EV therapeutics across regenerative medicine, immunotherapy, oncology, neurological and metabolic disorders, and analyze worldwide regulatory policies while sorting out the up-to-date industrial-sponsored global clinical pipeline updated to April 2026. Centered on a core five-dimensional matching framework integrating EV sources, administration routes, disease indications, critical quality attributes (CQAs) and global regulatory requirements, this work elaborates current translational bottlenecks and commercialization obstacles of EV products. This review provides theoretical support for precision EV therapy optimization, unified quality criterion establishment, international regulatory coordination and accelerated clinical and industrial transformation of EV-based medicines.
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In pediatric clear cell sarcoma of the kidney, ultrasound and CT are valuable for identifying renal-origin malignant features, but imaging alone does not fully communicate oncologic risk. Future case reports should connect imaging and histopathology with staging basis, nodal pathology, margin/spillage status, treatment protocol, radiotherapy rationale, response assessment, and surveillance planning.
Stuttering affects approximately 1% of adults. Therapies based on imitation offer only modest benefits when individuals observe external models. Neurobiological research reveals a key asymmetry: some studies suggest self-face recognition activates ventral tegmental area (VTA) reward circuits more strongly than observing others' faces, and positron emission tomography (PET) research shows increased dopamine synthesis in some people who stutter. The Synthetic Self Hypothesis (SSH) proposes that this increase reflects misdirected effort toward maladaptive targets rather than pathological excess. AI-generated fluent self-models may reroute dopaminergic reinforcement signals via two linked mechanisms: self-referential reward tagging, where VTA activation during self-face recognition boosts learning signals, and improved motor chunk consolidation, where phasic dopamine reinforcement strengthens fluent movement sequences. This framework leads to testable neural and behavioral predictions, including increased VTA-ventral striatum connectivity compared to VTA-dorsal striatum connectivity, larger reductions in stuttering frequency than waitlist controls, and outcomes mediated by increased communication self-efficacy. Baseline dopamine synthesis capacity is expected to influence treatment response, with those with higher synthesis capacity experiencing greater benefits from redirection-based therapies. In this view, the neurobiology of stuttering is considered a failure of dopamine targeting rather than dopamine pathology, offering a mechanistic basis for personalized AI-driven intervention while recognizing that metabolic constraints may set limits on treatment success.
The use of generative artificial intelligence tools such as ChatGPT has transformed various academic practices in higher education, generating interest in understanding its perceived impact on the development of students' communicative and analytical skills. This study aimed to validate the Student Perception of ChatGPT instrument. A non-experimental quantitative design with an instrumental and comparative approach was applied to a sample of 2,579 students with prior experience using ChatGPT, from Ecuador, Mexico, Chile, Brazil, Colombia, and Guatemala. The questionnaire included 18 items organized into two key dimensions, communicative skills and analytical skills, measured on a five-point Likert scale. Internal consistency analyses (α = 0.943; ω = 0.944), as well as exploratory and confirmatory factor analyses, were conducted. The results confirmed high reliability and a coherent two-factor structure, with consistent groupings among items related to academic writing, digital communication, critical thinking, and problem-solving. These findings provide empirical evidence of the instrument's validity to measure students' perceptions of ChatGPT's contribution to the development of such skills. It is recommended to conduct longitudinal, mixed-method, and performance-based studies to more precisely examine its actual effect on university learning.
Public acceptance of gene editing remains an important consideration for the adoption of biotechnology in agriculture and medicine. This study presents findings from the final phase of a multi-stage research project designed to identify the communication strategies most effective at shaping public opinions on the safety of gene editing. A nationally recruited sample of 3,200 U.S. respondents participated in a randomized survey experiment. Participants were assigned to view one of eight videos developed from prior focus groups and three earlier surveys conducted as part of the broader research project. The videos varied across three communication attributes: messenger (researcher or blogger), message framing (emphasizing either the number of years of biotechnology use without adverse events or the number of studies demonstrating safety), and application context (agriculture or medicine). Between-subject analyses evaluated differences in communication effectiveness across treatment conditions, with outcomes focused on opinion change and knowledge retention. Respondents were generally receptive to the video interventions, suggesting that brief communication messages can influence perceptions of gene-editing safety. The application context of the video significantly affected knowledge retention, with respondents demonstrating stronger retention when the information aligned with the specific field emphasized in the communication. In contrast, differences in messenger type and message framing had comparatively limited effects on knowledge outcomes, suggesting that these communication features were less influential in shaping responses. These findings suggest that the context in which gene editing is presented may be more important than the specific messenger or message framing for communicating biotechnology safety to the public. The results offer practical insights for science communicators, industry stakeholders, and policymakers seeking to improve public understanding and acceptance of gene editing technologies across agricultural and medical applications.
To explore the psychological journey and core needs of People living with HIV (PLWH) intending to disclose their status to sexual partners, providing a theoretical basis for constructing a disclosure support system. A descriptive qualitative study was conducted using semi-structured interviews with 15 People living with HIV at a hospital in Changzhou, China. Thematic analysis was used to analyze the interview data. Five themes were identified regarding disclosure to sexual partners: (1) disclosure motivation and internal drivers; (2) risk perception during the disclosure process; (3) preparation and perceived capacity for disclosure; (4) safety protection strategies; and (5) external and social support needs. These themes reveal a multidimensional and interwoven risk perception system in disclosure decision-making, including fears of discrimination, relationship breakdown, social stigma, and threats to economic security. They further systematically outline the proactive and strategic safety behaviors individuals employ to mitigate such risks, including scenario selection, information control, and exit planning. The findings highlight that the decisions of People living with HIV to disclose their status to sexual partners involve a dynamic interplay of emotional, ethical, and stigma-related pressures. Clinical care should establish dedicated disclosure counseling roles, provide role-play-based communication skills training, and build multidisciplinary support networks.
Extracellular vesicles (EVs), lipid bilayer nanoparticles released by virtually all cells, serve as essential messengers for intercellular communication. Due to their involvement in several pathophysiological processes, EVs have recently gained considerable attention as potentially diagnostic and prognostic biomarkers for various illnesses. The widespread distribution of EVs across all biofluids positions them as ideal, minimally invasive biomarkers for disease progression using a liquid biopsy approach. Among biofluids, saliva is uniquely accessible and has a low soluble protein content, making its EV population a highly promising source of diagnostic biomarkers. Salivary EVs have been investigated for their promising potential for diagnosing local and systemic diseases, including cancers, autoimmune diseases and neuropsychiatric disorders. In this review, we present a synopsis of the current landscape related to salivary EVs, highlighting the unique characteristics and potential of these vesicles, the technical challenges related to their application, and their future prospects for clinical translation as powerful diagnostic tools.
Therapeutic resistance remains a major barrier to durable cancer control and cannot be fully explained by tumor-intrinsic genetic and epigenetic alterations alone. Increasing evidence indicates that resistance emerges within a dynamic tumor microenvironment in which immune cells actively instruct tumor cell behavior through ligand-receptor (LR) signaling. These immune-tumor communication axes link inflammatory cues, checkpoint-associated signals, chemokine networks, and metabolite-derived messages to adaptive tumor phenotypes. In particular, these axes may contribute to metabolic reprogramming across glucose, lipid, amino acid, and redox pathways, thereby supporting tumor-cell proliferation, therapeutic stress tolerance, and immune evasion. Lactate-centered signaling, macrophage-derived cytokine and chemokine axes, and checkpoint-associated pathways such as PD-L1-related signaling have emerged as major regulators of this process. These LR-mediated circuits are increasingly associated with tumor metabolic remodeling, immune suppression, phenotypic plasticity, and reduced responsiveness to chemotherapy and immune checkpoint blockade. Recent advances in single-cell transcriptomics, spatial omics, multiplex imaging, metabolomics, and computational modeling are accelerating the mapping of these communication networks in situ and revealing clinically relevant resistance niches. In this review, we synthesize current evidence on how immune-tumor cell LR axes drive metabolic adaptation and therapeutic resistance across cancers, discuss the technologies enabling their dissection, and highlight their translational potential as biomarkers and therapeutic targets. Understanding these communication systems may provide new opportunities to disrupt resistant tumor ecosystems and improve the durability of cancer therapy.
Cancer care in India is increasingly complex, requiring surgical oncologists with advanced multidisciplinary skills. This article proposes a standardised national curriculum for Surgical Oncology training to ensure consistent training, academic excellence, and improved patient outcomes. The framework integrates surgical expertise, oncologic principles, research aptitude, and holistic care, aligned with global standards yet adapted to India's healthcare realities. Consensus was achieved through online and in-person deliberations among senior surgical oncology leaders from institutes such as AIIMS and other major centres. Several participants have served as subject experts for the National Board of Examinations, the National Medical Commission, and the Indian Council of Medical Research. The framework, informed by global and Indian models, was mapped across cognitive, psychomotor, and affective domains. It incorporated disease-specific competencies, research training, multidisciplinary exposure, and subspecialty rotations. Evaluation strategies included both formative and summative assessments, with inter-institutional exchange where facilities were limited. The three-year curriculum includes academic activities, thesis and database project, logbook maintenance, and rotations in medical oncology, radiation oncology, palliative care, ICU, and basic sciences. Training spans core surgical principles and advanced procedures across organ systems, with emphasis on community health, translational research, digital health, and artificial intelligence. Competency-based progression, structured assessments, and holistic training in ethics, communication, and survivorship are integral features. The proposed curriculum provides a structured, competency-based model for surgical oncology training in India. It strengthens clinical, academic, and research capacities, outlines a roadmap for future organ-based subspecialisation, and offers a framework adaptable to low- and middle-income countries. The online version contains supplementary material available at 10.1007/s13193-025-02433-2.
Evidence-based nutrition guidance for female athletes remains limited relative to that available for males; in part, this has contributed to widespread reliance on social media for dietary information. Whilst social media can enhance health communication, it also facilitates the rapid dissemination of unverified, commercially driven nutrition claims. This narrative review critically synthesises the current scientific literature underpinning four prevalent claims targeting nutrition close to exercise for active females; (1) fasted training is harmful for all females, (2) menstrual cycle-related hormonal fluctuations require sex-specific hydration strategies, (3) carbohydrate differences by sex and menstrual cycle phase, and (4) precise protein timing is essential for optimal adaptation in females. Despite social media and 'influencer' claims of no evidence in humans for many of the claims, there is some, albeit limited, evidence. This review evaluates the available research and the evidence supporting these claims to provide practical advice for active females. Collectively, this review demonstrates that many widely circulated nutrition claims directed at active females lack robust scientific support. The findings emphasise the importance of individual context, including training load, energy availability, environmental conditions and total dietary intake, over rigid, sex-specific nutrition rules. Improved translation of female-specific sports nutrition research into accurate, accessible public messaging is urgently needed to counter persistent misinformation in digital media.
The invasion of Ukraine has severely disrupted medical education. This study evaluated a blended digital intervention to support medical students and examined factors influencing students' experiences under the conditions. Two blended online modules (Medical Communication and Clinical Reasoning) were co-developed by the University of Würzburg and two Ukrainian medical universities. The modules combined asynchronous learning materials with synchronous online sessions, including simulated patients alongside case-based discussions. Displaced Ukrainian physicians contributed as instructors. A cross-sectional mixed-methods evaluation was conducted at the end of teaching using an online questionnaire with 15 Likert-scale items and open-ended questions. Quantitative data were analysed using descriptive statistics, exploratory factor analysis, and regression analyses with interaction terms. Qualitative responses underwent thematic content analysis. In total, 376 valid questionnaires were completed (response rate: 28.8% of 1,306 module participations). Factor analysis identified three perceived outcome dimensions: teaching quality, learning gain, and module experience. These accounted for 54% of the total variance and captured students' perceived effectiveness of the modules. Ratings were high for organisation, clarity, and interactivity, while perceived learning gain was positive but lower for compensating missing practical training. War- and infrastructure-related interruptions were negatively associated with ratings, with a significant interaction of study location indicating stronger effects in Ternopil than in Vinnytsya. Qualitative comments corroborated these findings and highlighted practical relevance, cultural adaptation, and participants' exposure to different professional practices. The blended online modules were positively evaluated, and represent a scalable and resilient approach to sustaining medical training in conflicts and other resource-limited contexts. Die Invasion der Ukraine hat die medizinische Ausbildung erheblich beeinträchtigt. Ziel dieser Studie war es, eine digitale Blended-Learning-Intervention zur Unterstützung von Medizinstudierenden zu evaluieren und Einflussfaktoren auf die studentischen Erfahrungen unter diesen Bedingungen zu untersuchen. Zwei Blended-Online-Module („Ärztliche Kommunikation“ und „Klinische Entscheidungsfindung“) wurden gemeinsam von der Universität Würzburg und zwei ukrainischen medizinischen Universitäten entwickelt. Die Module kombinierten asynchrone Lernmaterialien mit synchronen Online-Sitzungen, einschließlich Simulationspersonen und fallbasierter Diskussionen. Geflüchtete ukrainische Ärztinnen und Ärzte wirkten als Lehrende mit. Am Ende der Module wurde eine querschnittliche Mixed-Methods-Evaluation mittels eines Online-Fragebogens durchgeführt, der 15 Likert-skalierte Items und offene Fragen umfasste. Die quantitativen Daten wurden deskriptiv sowie mittels explorativer Faktorenanalyse und Regressionsanalysen mit Interaktionstermen ausgewertet. Die qualitativen Antworten wurden inhaltsanalytisch aufbereitet. Insgesamt wurden 376 gültige Fragebögen ausgewertet (Rücklaufquote: 28,8 % von 1.306 Modulteilnahmen). Die Faktorenanalyse identifizierte drei Ergebnisdimensionen: Lehrqualität, Lernzuwachs und Modulbewertung. Diese erklärten 54 % der Gesamtvarianz und bildeten die wahrgenommene Effektivität der Module ab. Die Bewertungen fielen insbesondere hinsichtlich Organisation, Verständlichkeit und Interaktivität hoch aus. Der wahrgenommene Lernzuwachs wurde ebenfalls positiv bewertet, jedoch geringer im Hinblick auf die Kompensation fehlender praktischer Ausbildung. Kriegs- und infrastrukturbedingte Unterbrechungen waren negativ mit den Bewertungen assoziiert; eine signifikante Interaktion mit dem Studienort zeigte stärkere Effekte in Ternopil im Vergleich zu Vinnytsya. Die qualitativen Rückmeldungen bestätigten diese Ergebnisse und hoben darüber hinaus die praktische Relevanz, die kulturelle Anpassung sowie Einblicke in unterschiedliche berufliche Praxis hervor. Die Blended-Online-Module wurden insgesamt positiv bewertet und stellen einen skalierbaren und resilienten Ansatz zur Sicherung medizinischer Ausbildung in Konflikt- und ressourcenlimitierten Kontexten dar.
Postprostatectomy incontinence (PPI) reduces quality of life, yet remains undertreated despite effective surgical options. Persistently low intervention rates in Europe for PPI suggest a care gap. This study assessed patients' knowledge of surgical PPI treatments and barriers to treatment uptake. Cross-sectional baseline analysis of ProKontinenz trial. Men with persistent PPI for ≥12 mo after radical prostatectomy (≥2 pads/d, no prior incontinence surgery) from 34 certified prostate cancer centers were surveyed during January-June 2025, using validated questionnaires and 24-h pad test. The primary outcome was knowledge of incontinence surgery; secondary outcomes included information sources, treatment barriers, and associations with symptom burden/quality of life. Associations with knowledge were assessed using logistic regression. A total of 526 of 692 men participated (90% response rate). Among the participants, common reasons for not considering incontinence surgery were satisfaction with incontinence products (79%), concerns about surgical risks (53%), and doubts about success of surgery (51%). Fifty-nine percent men reported no knowledge of surgical PPI treatment. Independent predictors of lacking knowledge were low urine loss (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.3-4.7), less severe King's Health Questionnaire (KHQ)-score "role limitation" (OR 2.2, 95% CI 1.1-4.3), concerns about treatment success (OR 2.2, 95% CI 1.2-4.1), and missing information from the urologist (OR 4.2, 95% CI 1.1-16.7) or partner (OR 2.0, 95% CI 1.2-3.8). Limitations of the study include self-reported data and a nonvalidated definition of "knowledge." Among patients with PPI for ≥12 mo after radical prostatectomy, more than half did not have any knowledge of potentially effective surgery. Information deficits and symptom severity influence knowledge. Strengthening guideline-based information and clinician-patient communication may help close this gap.
Fetal-type posterior communicating artery (PcomA) aneurysms remain a difficult subgroup in the flow-diverter era. In these lesions, the PcomA supplies a substantial portion of the posterior cerebral artery territory because the ipsilateral P1 segment is absent, hypoplastic, or functionally insufficient. The branch therefore functions as a major outflow channel, and persistent distal demand may maintain circulation through the aneurysm-neck complex after flow diversion. This review summarizes the anatomical basis of fetal-type PcomA aneurysms and the current evidence for clipping, coiling, intrasaccular devices, and flow diversion. Among PcomA aneurysms treated with flow diverters, non-fetal lesions generally show better angiographic outcomes than fetal-type lesions. In a recent meta-analysis, complete occlusion at final follow-up was 77% in non-fetal aneurysms versus 42% in fetal-type aneurysms. A multicenter comparative cohort similarly reported complete occlusion in 81.8% versus 43.7%, with a markedly shorter median time to occlusion in non-fetal lesions (6 vs. 51 months). Earlier fetal-type series often showed persistent aneurysm filling and low complete occlusion rates, whereas more recent selected cohorts have reported complete or near-complete occlusion in 60%-80% of cases, suggesting that flow diversion can still be effective in carefully selected anatomies and with tailored strategies. Overall, clipping and coiling remain important branch-preserving options, and intrasaccular treatment may be reasonable in selected lesions with favorable geometry. Flow diversion should be considered selectively, particularly for large, recurrent, broad-necked, or morphologically complex aneurysms, while recognizing that robust fetal circulation may delay or limit aneurysm occlusion. Current evidence remains constrained by small retrospective series, inconsistent definitions of fetal anatomy, and heterogeneous device strategies.
Interprofessional collaboration is considered a key determinant of patient care quality and safety, yet it remains only partially embedded in the curricula of healthcare professions. The IPAPA project, developed at the University Hospital Bonn, addresses this gap through the design of a simulation-based interprofessional training programme for final-year medical students in their elective anaesthesiology rotation and trainee anaesthesia assistants, based on the evidence-informed TeamSTEPPS® programme. This project report aims to describe the curricular development, implementation, and instructional design of the IPAPA teaching concept and to contextualise initial experiences from the accompanying evaluation. The teaching intervention was developed in accordance with Kern's six-step approach to curriculum development. Interprofessional learning objectives were derived from the National Competence-Based Learning Objectives Catalogue for Medicine and the German training and examination regulations for anaesthesia assistants and operating theatre technicians (ATA-OTA-APrV), and translated into an adapted TeamSTEPPS® 3.0-based teaching and learning concept with simulation-based components. Implementation was complemented by an accompanying evaluation. The IPAPA concept, comprising eight teaching units, was integrated as a mandatory course into both the final-year elective rotation in anaesthesiology and the training programme for trainee anaesthesia assistants. Initial qualitative feedback from participants suggests high acceptance of the format, particularly with regard to the practical simulations and the structured interprofessional communication. Joint participation of both professional groups was described as realistic and conducive to mutual role understanding. This project report illustrates how an interprofessional, simulation-based team training programme can be developed and implemented within an anaesthesiology training context. IPAPA thus contributes to the structured integration of interprofessional teaching formats and may serve as a model for comparable educational settings. Interprofessionelle Zusammenarbeit gilt als wesentlicher Faktor für Patient:innenversorgung, ist jedoch in der Ausbildung medizinischer Berufsgruppen bislang nur begrenzt curricular verankert. Das am Universitätsklinikum Bonn entwickelte IPAPA-Projekt adressiert diesen Bedarf durch die Konzeption eines simulationsbasierten interprofessionellen Trainings für PJ-Studierende im Wahltertial Anästhesiologie und Anästhesietechnische Assistenz-Auszubildende auf Basis des evidenzbasierten TeamSTEPPS®-Programms. Ziel des Projektberichts ist die Darstellung der curricularen Entwicklung, Implementierung und didaktischen Ausgestaltung des IPAPA-Lehrkonzepts sowie die Einordnung erster begleitender Evaluationserfahrungen. Die Entwicklung der Lehrveranstaltung erfolgte entlang der sechs Schritte der Curriculumsentwicklung nach Kern. Interprofessionelle Lernziele wurden aus dem Nationalen Kompetenzbasierten Lernzielkatalog Medizin und der Ausbildungs- und Prüfungsordnung ATA-OTA abgeleitet und in ein angepasstes TeamSTEPPS® 3.0- basiertes Lehr-/Lernkonzept mit simulationsgestützten Anteilen überführt. Die Implementierung wurde durch eine begleitende Evaluation ergänzt. Das IPAPA-Konzept wurde mit acht Unterrichtseinheiten als verpflichtende Lehrveranstaltung in das Praktisches Jahr-Wahltertial Anästhesiologie sowie die Ausbildung zur Anästhesietechnischen Assistenz-Ausbildung integriert. Erste qualitative Rückmeldungen der Teilnehmenden deuten auf eine hohe Akzeptanz des Formats hin, insbesondere hinsichtlich der praxisnahen Simulationen und der strukturierten interprofessionellen Kommunikation. Die gemeinsame Teilnahme beider Berufsgruppen wurde als realitätsnah und förderlich für das gegenseitige Rollenverständnis beschrieben. Der Projektbericht zeigt exemplarisch, wie ein interprofessionelles, simulationsbasiertes Teamtraining im anästhesiologischen Ausbildungskontext curricular entwickelt und implementiert werden kann. IPAPA leistet damit einen Beitrag zur strukturierten Integration interprofessioneller Lehrformate und kann als Modell für vergleichbare Ausbildungskontexte dienen.
Fibromyalgia (FM) is a chronic disease characterised by small fibre pathology and autonomic dysfunction. Sympathetic Skin Response (SSR) can be easily obtained in clinical practice as a marker of autonomic dysfunction. This study aims to assess SSR abnormalities in small fibre pathology associated with FM. This was a retrospective, observational, single-centre, cross-sectional study including 393 patients with FM, who underwent skin biopsy from the thigh and ankle, SSR obtained with a standard electromyographic active electrode attached to the right palm and sole, and clinical evaluation. SSR at the hand and foot was similarly absent in patients with both normal and abnormal skin biopsy results. Hand amplitude was reduced in patients with denervation (Wilcoxon z = 1.89, p = 0.029), while latencies were similar between groups (z = 1.12, p = 0.13). Foot latency was prolonged in patients with abnormal skin biopsy (z = 2.17, p = 0.014), while amplitudes were similar between groups (chi-square = 2.28, p = 0.21). SSR showed low predictive performance for skin biopsy results (r2 = 0.04). Latency of SSR at the foot and Intraepidermal Nerve Fibre Density (IENFD) correlated with the score for associated symptoms. Amplitude of SSR at the foot also negatively correlated with anxiety, depression, and fatigue scores. SSR abnormalities did not correspond to small fibre impairment detected by skin biopsy in patients with FM. SSR and skin biopsy may capture different aspects of the complex clinical picture of FM, including psychopathological features and fatigue, and therefore represent complementary yet distinct biomarkers of the disease.
To report a case of retinoschisis associated with retinal detachment, documented with ultra-widefield optical coherence tomography (OCT), and to highlight subtle vitreoretinal interface changes not previously described. A patient with retinoschisis was evaluated using multimodal imaging, including ultra-widefield OCT. Serial OCT scans were reviewed to assess structural alterations of the outer and inner retinal layers, vitreoretinal interface, and hyaloid status. Ultra-widefield OCT demonstrated the development of a retinal detachment secondary to an isolated outer retinal hole within the region of retinoschisis, occurring in the context of traction from a thickened inner retinoschisis leaf, without evidence of communication with an inner retinal hole. Additionally, undulations on the inner surface of the outer leaf of the retinoschisis cavity were observed possibly representing residua of a tractional separation between the outer and inner leaf of the retinoschisis cavity. These subtle features were only appreciable through the extended coverage of ultra-widefield OCT imaging. Ultra-widefield OCT provided critical structural insights into the progression from retinoschisis to a retinal detachment. It revealed the development of an isolated outer retinal hole with associated inner leaf traction and undulations on the inner surface of the outer leaf of the retinoschisis cavity without detectable inner leaf holes, underscoring OCT's value in detecting and better understanding subtle vitreoretinal changes in this condition.