Johns Hopkins University School of Medicine (JHUSOM) has been a leader in medical education since its inception in 1893. The influence of John Dewey on the founders of the school is evident in the design of the curri...Johns Hopkins University School of Medicine (JHUSOM) has been a leader in medical education since its inception in 1893. The influence of John Dewey on the founders of the school is evident in the design of the curriculum,which included serious study of basic science for two years,followed by 'learning by doing' in the 3d and 4th clinical years. After the Flexner report in 1910 which lauded the school as an exemplary model,this became the standard curricular structure of undergraduate medical education in the US. Since its founding Hopkins,like other medical schools,has struggled with burgeoning biomedical knowledge and the tension between time and content. The last curricular revision was implemented in 1992,and had several themes,including:(1) decreased lecture time and increased small group learning; (2) early clinical experience and more ambulatory clinical experience; (3) integration of the basic sciences to improve learning and reduce redundancy; (4) development of a longitudinal course for the social sciences,(named 'The Physician and Society' course); (5) a required thesis project for graduation. All but the last were implemented. Our students have done well in this curriculum. 98-100% pass the licensing board exams,and over 90% obtain their first choice for residency positions,often in highly competitive programs such as Dermatology,Neurosurgery and Ophthalmology. Approximately 30% of graduates are listed in the AAMC faculty roster-one of the highest percentages of graduates going to academic medicine in the country.展开更多
The Retrovirus Epidemiology Donor Study (REDS) was established in 1989 with funding from the National Heart,Lung,and Blood Institute ( NHLBI ) of the National Institutes of Health in the United States.The initial prog...The Retrovirus Epidemiology Donor Study (REDS) was established in 1989 with funding from the National Heart,Lung,and Blood Institute ( NHLBI ) of the National Institutes of Health in the United States.The initial program coordinated activities in five large US blood centers in San Francisco,Los Angeles,Oklahoma City,Detroit,and Baltimore with a coordinating center Westat in Rockville MD.展开更多
Glaucoma service of Johns Hopkins University is currently involved in a range of research projects.This overview will cover the major clinical activities currently underway.
Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories.Research on narrative medicine training suggests that it conveys ben...Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories.Research on narrative medicine training suggests that it conveys benefits such as improved communication skills and personal and professional growth to physicians,medical students,and other health care providers.Narrative medicine can promote empathy and trust between patients and physicians and foster self-care.In 2014,the author and a colleague started an ongoing inter-disciplinary narrative medicine program in the Children’s Center of the Johns Hopkins Hospital called AfterWards.The program,which meets monthly,is open to all on a volunteer basis.Through literature,art,and writing,AfterWards nurtures empathy,encourages reflective practice,and builds community among a diverse group of health care providers.Through a series of lectures and workshops at Johns Hopkins Medicine,Peking Union Medical College,and Fudan Hospital in Shanghai,the author has introduced AfterWards to Chinese medical educators and clinicians.Working with Dr.Marta Hanson,she created an AfterWards Facilitator’s Guide for the use of Chinese practitioners.A recent White Paper on Chinese health care indicates that an infusion of humanities-based education,of which narrative medicine forms a part,can help rebuild patient-physician trust.Recently,there has been an increase in interest in narrative medicine in the United States and China.However,more research is needed to demonstrate the impact of programs like AfterWards.Challenges to the implementation of narrative medicine programs remain,most significantly in terms of expertise,resources,and time.展开更多
Objectives:Teachers are facing unprecedented new challenges leading them to face an increasing number of tasks that are not part of their job,as well as having to cope with the additional skills acquisition that comes...Objectives:Teachers are facing unprecedented new challenges leading them to face an increasing number of tasks that are not part of their job,as well as having to cope with the additional skills acquisition that comes with non-traditional forms of teaching and learning,and increased work pressure leading to an increase in the rate of teachers leaving the profession.Therefore,this study aims to explore the mechanism of the career calling on job burnout through career adaptability and work engagement.Methods:This study conducted a cross-sectional survey of 465 primary and secondary school teachers(PSST)in China's Mainland from the perspective of work adjustment and used structural equation modeling(SEM)to examine the mediating roles of career adaptability and work engagement in the relationship between teachers’career calling and job burnout.Results:The results show that PSSTs are above average in career calling,career adaptability,and work engagement,while job burnout is below average.A significant positive or negative correlation exists between career calling,career adaptability,work engagement,and job burnout.The result of path analysis indicates that career adaptability and work engagement exert an indirect influence on the job burnout of PSST through three paths:namely,the independent intermediary role of career adaptability(EV=−0.144),the independent intermediary role of work engagement(EV=0.172)and the chain intermediary role of the two(EV=0.176).Conclusion:This study emphasizes the importance of career adaptability and work engagement in teacher development in regulating career calling and job burnout.Therefore,on the one hand,we think that if managers want to reduce teachers’job burnout,they need to pay more attention to teachers’career adaptability and work engagement,rather than relying solely on teachers’career calling.On the other hand,it is to remind teachers not to rely on their adjustment to adapt to the work,but also to need outside help as much as possible.展开更多
Peripheral neuropathy is a common complication in diabetes,affecting around 50%of the diabetic population.Co-occurrence of diabetic peripheral neuropathy(DPN)and diabetic bone disease has led to the hypothesis that DP...Peripheral neuropathy is a common complication in diabetes,affecting around 50%of the diabetic population.Co-occurrence of diabetic peripheral neuropathy(DPN)and diabetic bone disease has led to the hypothesis that DPN influences bone metabolism,although little experimental evidence has yet supported this premise.To investigate,mice were fed a high-fat diet(HFD)followed by phenotyping of skeletal-innervating neurons and bone architectural parameters.Results showed that HFD feeding resulted in a marked decrease in skeletal innervation(69%–41%reduction in Beta-III-Tubulin-stained nerves,38%reduction in CGRP-stained nerves in long bone periosteum).展开更多
Calvarial nerves,along with vasculature,influence skull formation during development and following injury,but it remains unclear how calvarial nerves are spatially distributed during postnatal growth and aging.Studyin...Calvarial nerves,along with vasculature,influence skull formation during development and following injury,but it remains unclear how calvarial nerves are spatially distributed during postnatal growth and aging.Studying the spatial distribution of nerves in the skull remains a challenge due to a lack of methods to quantify 3D structures in intact bone.To visualize calvarial 3D neurovascular architecture,we imaged nerves and endothelial cells with lightsheet microscopy.展开更多
Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics cl...Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures.Step 1:A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion(DRG)and the spinal nerve,a common cause of low back pain(LBP).Step 2:The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw,followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients.The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy.However,rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw,impaired gait,and reduced spontaneous exploration activity,indicating CPSS.Patch clamp recording revealed a significant augmentation in the intrinsic excitability of smalldiameter DRG neurons in CPSS rats.Administration of Dermorphin[D-Arg2,Lys4](1–4)amide(DALDA,5mg/kg,i.p.),a peripherally acting mu-opioid receptor(MOR)-preferred agonist,attenuated pain hypersensitivity,capsaicin-induced[Ca^(2+)]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats.Our findings suggest that this new model,which mirrors the nature of CPSS developed in patients,may be useful for future studies of the underlying mechanisms.展开更多
The United States Food and Drug Administration's(FDA's)August 2024 determination that an additional phase Ⅱ study will be required to consider the approval of midomafetamine for the treatment of posttraumatic...The United States Food and Drug Administration's(FDA's)August 2024 determination that an additional phase Ⅱ study will be required to consider the approval of midomafetamine for the treatment of posttraumatic stress disorder(PTSD)could delay the potential approval of this promising treatment by several years.展开更多
The inability to access brain tissue has greatly hindered our ability to study and care for individuals suffering from psychiatric and neurological conditions.Critics have questioned efforts to develop peripheral bloo...The inability to access brain tissue has greatly hindered our ability to study and care for individuals suffering from psychiatric and neurological conditions.Critics have questioned efforts to develop peripheral blood biomarkers in neurological and psychiatric disorders based on the assertion that disease pathology is limited to the brain.The discovery that all tissues,including the brain,release extracellular vesicles(Raposo and Stoorvogel,2013)and cell free DNAs(Chan et al.,2013)into various body fluids has provided a potential way to measure activity from inaccessible tissues like the central nervous system(CNS)and has given rise to the term“liquid biopsy.”The development of liquid biopsies that can diagnose and predict the course of psychiatric and neurological disorders would be transformative.The ability to predict episodic events such as mania,depression,and risk for suicide would be particularly useful for psychiatric care as it would enable the development of interventions that prevent mortality and improve outcomes.Additionally,biomarkers that are informative about drug response and aid in treatment decisions would be a significant advance in psychiatric care as it would prevent patients from having to endure multiple courses of ineffective treatments and side effects.展开更多
Background: In the global burden of non-communicable diseases, the top slot among them all is occupied by various cardiovascular diseases (CVD), which also claim primacy in mortality rates. Generally speaking, the pat...Background: In the global burden of non-communicable diseases, the top slot among them all is occupied by various cardiovascular diseases (CVD), which also claim primacy in mortality rates. Generally speaking, the pathophysiological pathway frequently involves either (or a combination of) elevated serum cholesterol levels, predominantly attributed to dietary patterns characterized by extremely high levels of saturated and trans-fat consumption. Day-to-day nutritional epidemiology among university students suggests that they represent a crucial demographic for the study of preventive interventions. Objective: This in-depth study and investigation were specifically aimed to quantitatively assess and compare prevailing patterns of dietary fat consumption between female students enrolled in health sciences and non-health sciences programs at major universities in Riyadh, Saudi Arabia. Methodology: This cross-sectional study was comprised of 434 Saudi female university students (age range: 18 - 25 years), utilizing a validated Block Dietary Fat Screener accompanied by anthropometric measurements and comprehensive demographic data collection. The sampling methodology consisted of a snowball technique that was spread across three major academic institutions in Riyadh. Results: Statistical analysis revealed a significant association between academic specialization and patterns of dietary fat consumption (p = 0.012). Paradoxically, students of health science exhibited a higher prevalence of very high fat intake (41.9%) compared with their non-health sciences counterparts (27.6%). Surprisingly, anthropometric stratification revealed that it was the underweight students who demonstrated very high levels of fat consumption. A notable socioeconomic gradient was observed, with students from households earning 15,000 - 20,000 SR monthly showing the highest prevalence of very high-fat consumption (47.1%), although this association did not achieve statistical significance (p = 0.104). Conclusion: These findings challenge the conventional assumption that health sciences education correlates with superior dietary behaviors. The data suggests a critical need for enhanced education in nutrition, as well as intervention using various behavioral programs across all academic disciplines, particularly those addressing the disconnect between nutritional knowledge and dietary practices among students of health sciences. Future longitudinal studies are warranted in order to elucidate the temporal relationship between academic specialization and dietary behaviors.展开更多
Schools are an important avenue to tackle the rising prevalence of uncorrected refractive error among children.School-based vision programs are an innovative approach of vision care delivery in the urban school settin...Schools are an important avenue to tackle the rising prevalence of uncorrected refractive error among children.School-based vision programs are an innovative approach of vision care delivery in the urban school setting in the United States.These programs are effective in improving vision outcomes and advancing health equity,especially among the disadvantaged school districts.While most school-based vision programs provide vision screening,eye examinations,and eyeglasses prescription to students directly in schools,different mechanisms and models have been reported.In this paper,we describe two large-scale school-based vision programs,Vision for Baltimore and Helen Keller International’s United States Vision Program,representing national and regional efforts to partner with local communities in improving access to pediatric vision care.These programs also serve as data collection platforms and provide evidence to inform public health policy and guide best practice.Collectively,these two programs showed that one in three students failed vision screening.The prevalence of uncorrected refractive error was high and the demand for eyeglasses was great among those who failed vision screening.While most of the students’uncorrected refractive errors could be addressed in the school setting,one in seven needed additional eye care.We found that schools with more socioeconomically disadvantaged students had greater needs of school-based vision program services.We hope this knowledge helps to maximize the impact of school-based vision programs and promote a system that ensures better health outcomes for all children.展开更多
Although with aggressive standards of care like surgical resection,chemotherapy,and radiation,high-grade gliomas(HGGs)and brain metastases(BM)treatment has remained challenging for more than two decades.However,techno...Although with aggressive standards of care like surgical resection,chemotherapy,and radiation,high-grade gliomas(HGGs)and brain metastases(BM)treatment has remained challenging for more than two decades.However,technological advances in this field and immunotherapeutic strategies have revolutionized the treatment of HGGs and BM.Immunotherapies like immune checkpoint inhibitors,CAR-T targeting,oncolytic virus-based therapy,bispecific antibody treatment,and vaccination approaches,etc.,are emerging as promising avenues offering new hope in refining patient’s survival benefits.However,selective trafficking across the blood-brain barrier(BBB),immunosuppressive tumor microenvironment(TME),metabolic alteration,and tumor heterogeneity limit the therapeutic efficacy of immunotherapy for HGGs and BM.Furthermore,to address this concern,the NanoBioTechnology-based bioinspired delivery system has been gaining tremendous attention in recent years.With technological advances such as Trojan horse targeting and infusing/camouflaging nanoparticles surface with biological molecules/cells like immunocytes,erythrocytes,platelets,glioma cell lysate and/or integrating these strategies to get hybrid membrane for homotypic recognition.These biomimetic nanotherapy offers advantages over conventional nanoparticles,focusing on greater target specificity,increased circulation stability,higher active loading capacity,BBB permeability(inherent inflammatory chemotaxis of neutrophils),decreased immunogenicity,efficient metabolism-based combinatorial effects,and prevention of tumor recurrence by induction of immunological memory,etc.provide new age of improved immunotherapies outcomes against HGGs and BM.In this review,we emphasize on neuro-immunotherapy and the versatility of these biomimetic nano-delivery strategies for precise targeting of hard-to-treat andmost lethal HGGs and BM.Moreover,the challenges impeding the clinical translatability of these approaches were addressed to unmet medical needs of brain cancers.展开更多
The gastrointestinal(GI)tract is essential for digestion,absorption,excretion,and protection,supported by a diverse microbial ecosystem.Traditional in-vitro models often fall short in capturing the physiological compl...The gastrointestinal(GI)tract is essential for digestion,absorption,excretion,and protection,supported by a diverse microbial ecosystem.Traditional in-vitro models often fall short in capturing the physiological complexity of the GI tract,limiting their translational applications.A comprehensive approach is needed to bridge the gap between simple cell cultures and more complex systems used in translational research.This review explores the limitations of conventional twodimensional cell cultures and emphasizes the emerging use of three-dimensional and microfluidic systems that better replicate the GI tract’s structure and functions.It highlights the importance of incorporating patient-derived cells and engineered microenvironments to enhance model relevance and support personalized medicine.The review also discusses advanced fabrication techniques such as micro-extrusion and laser-assisted bioprinting,which enable the creation of sophisticated tissue models capable of simulating critical GI processes,including molecular transport,peristalsis,and liver coupling.Advancing the complexity of in-vitro systems will help replicate the GI tract’s interactions and physiological phenomena,thus improving the translational potential of GI research.This review provides valuable insights into the advancements and challenges in GI modeling,serving as a comprehensive guide for developing models that bridge the gap between basic cell cultures and clinically relevant systems.展开更多
The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic ...The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.展开更多
Blindness affected 45 million people globally in 2021,and moderate to severe vision loss a further 295 million.[1]The most common causes,cataract and uncorrected refractive error,are generally the easiest to treat,and...Blindness affected 45 million people globally in 2021,and moderate to severe vision loss a further 295 million.[1]The most common causes,cataract and uncorrected refractive error,are generally the easiest to treat,and are among the most cost-effective procedures in all of medicine and international development.[1-2]Thus,vision impairment is both extremely common and,in principle,readily manageable.展开更多
Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with prim...Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with primary health services.This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework.Methods:The evaluation was conducted using the Donabedian model,focusing on three key dimensions:safety and quality,accessibility,and affordability.Longitudinal data were collected from 2016 to 2022 through government annual reports,the medical insurance bureau,and hospital information systems.Preprogram and postprogram outcome measurements were compared to assess differences and trends,providing a clear picture of the program's effectiveness.Results:Accessibility improved significantly,with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022.The availability of general practitioners(GPs)also rose markedly,from 0 per 10,000 residents in 2017 to 6.27 in 2022.Regarding safety and quality,the proportion of complex medical procedures conducted within the New District expanded substantially,from 7.35%in 2017 to 38.11%in 2021.Additionally,there was an enhancement in the standardized management rate of chronic diseases.Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021.By 2021,75.02%of medical patients were covered by medical insurance,representing an increase of approximately 44 percentage points from 31.19%in 2012.Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility,safety and quality,and affordability.Future initiatives will focus on advancing the“Dapeng Mode”to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations.The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group,complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.展开更多
BACKGROUND Liver transplant(LT)is one of the main treatment options in selected patients with hepatocellular carcinoma(HCC).Overall,macrovascular invasion has been shown to be associated with an increased risk of tumo...BACKGROUND Liver transplant(LT)is one of the main treatment options in selected patients with hepatocellular carcinoma(HCC).Overall,macrovascular invasion has been shown to be associated with an increased risk of tumor recurrence and mortality after LT in HCC.Macrovascular invasion detected on imaging is often considered a contraindication for LT in HCC.AIM To investigate the effect of macrovascular invasion in explant on post-LT survival in HCC patients using a large national transplant database in the United States.METHODS LT recipients with HCC between the years 2012 and 2022 were identified by using the United Network for Organ Sharing/Organ Procurement Transplant Network database.Patients who underwent deceased-donor LT with available liver explant pathology data were included.Kaplan-Meier curves were used for survival analysis,and multistep regression analysis was used to determine the predictors of mortality.RESULTS A total of 13638 LT recipients with HCC and available explant pathology were included.Of these,254(1.8%)showed macrovascular invasion,1712(12.6%)had microvascular invasion,and 11672(85.6%)had absent invasion.Poor tumor differentiation was more common with macrovascular invasion than with microvascular or absent invasion(22.4%,17.7%,and 5.1%,respectively,P<0.001).Post-transplant survival at 1 year,3 years,and 5 years was lower in the macrovascular group than in the microvascular and absent invasion cohort(83.6%,66.6%,55.7%vs 90.8%,76.2%,66.6%vs 93.9%,86.8%,80.7%,P<0.001).Similarly,transplant recipients whose explants were poorly differentiated had worse 1-year,3-year,and 5-year survival than those with well-differentiated tumors and those with complete necrosis(86.1%,67.1%,60.4%vs 94.3%,87.7%,81.9%vs 94.8%,89.7%,84.2%,P<0.001).In multivariable modeling,macrovascular invasion was associated with higher mortality risk compared to absent invasion[hazard ratio(HR)=2.3,95%CI:1.9–2.7],and poor differentiation carried greater mortality risk than complete necrosis(HR=2.3,95%CI:2.0–2.7).CONCLUSION Macrovascular invasion accounted for a minority of cases at 1.8%.Macrovascular invasion and poor tumor differentiation on liver explants in patients with HCC were associated with significantly higher post-LT mortality,meaning that the extent of tumor involvement and tumor biology are important predictors of post-LT survival in HCC.However,the overall 5-year survival in patients with macrovascular invasion may still be within an acceptable range.展开更多
Pulmonary hypertension associated with congenital heart disease represents a significant challenge for clinicians due to its complex pathophysiology and diverse presentation.This patient population exhibits a broad sp...Pulmonary hypertension associated with congenital heart disease represents a significant challenge for clinicians due to its complex pathophysiology and diverse presentation.This patient population exhibits a broad spectrum of anatomical and hemodynamic abnormalities,with congenital heart disease-associated pulmonary arterial hypertension(PAH-CHD)comprising a significant proportion of pediatric pulmonary hypertension(PH)cases.Although progress in diagnostic methods and treatment options has been made,PH continues to be a major contributor to illness and death among affected pediatric patients,especially when diagnosis or treatment is postponed.This review aims to equip non-specialist clinicians with a better understanding of PH associated with congenital heart disease,focusing on its pathophysiology,clinical presentation,and diagnostic criteria.Key recommendations for evaluating and managing this fragile population are presented,emphasizing the importance of early recognition and multidisciplinary collaboration.As an increasing number of congenital heart disease patients reach adulthood,understanding its lifelong impacts becomes crucial for improving outcomes and creating tailored treatment approaches.展开更多
文摘Johns Hopkins University School of Medicine (JHUSOM) has been a leader in medical education since its inception in 1893. The influence of John Dewey on the founders of the school is evident in the design of the curriculum,which included serious study of basic science for two years,followed by 'learning by doing' in the 3d and 4th clinical years. After the Flexner report in 1910 which lauded the school as an exemplary model,this became the standard curricular structure of undergraduate medical education in the US. Since its founding Hopkins,like other medical schools,has struggled with burgeoning biomedical knowledge and the tension between time and content. The last curricular revision was implemented in 1992,and had several themes,including:(1) decreased lecture time and increased small group learning; (2) early clinical experience and more ambulatory clinical experience; (3) integration of the basic sciences to improve learning and reduce redundancy; (4) development of a longitudinal course for the social sciences,(named 'The Physician and Society' course); (5) a required thesis project for graduation. All but the last were implemented. Our students have done well in this curriculum. 98-100% pass the licensing board exams,and over 90% obtain their first choice for residency positions,often in highly competitive programs such as Dermatology,Neurosurgery and Ophthalmology. Approximately 30% of graduates are listed in the AAMC faculty roster-one of the highest percentages of graduates going to academic medicine in the country.
文摘The Retrovirus Epidemiology Donor Study (REDS) was established in 1989 with funding from the National Heart,Lung,and Blood Institute ( NHLBI ) of the National Institutes of Health in the United States.The initial program coordinated activities in five large US blood centers in San Francisco,Los Angeles,Oklahoma City,Detroit,and Baltimore with a coordinating center Westat in Rockville MD.
文摘Glaucoma service of Johns Hopkins University is currently involved in a range of research projects.This overview will cover the major clinical activities currently underway.
基金The study is financed by the grant of Johns Hopkins University School of Medicine,Baltimore,Maryland,USA.
文摘Narrative medicine is a multidisciplinary field of inquiry and practice based on the premise that medical care takes place in the context of stories.Research on narrative medicine training suggests that it conveys benefits such as improved communication skills and personal and professional growth to physicians,medical students,and other health care providers.Narrative medicine can promote empathy and trust between patients and physicians and foster self-care.In 2014,the author and a colleague started an ongoing inter-disciplinary narrative medicine program in the Children’s Center of the Johns Hopkins Hospital called AfterWards.The program,which meets monthly,is open to all on a volunteer basis.Through literature,art,and writing,AfterWards nurtures empathy,encourages reflective practice,and builds community among a diverse group of health care providers.Through a series of lectures and workshops at Johns Hopkins Medicine,Peking Union Medical College,and Fudan Hospital in Shanghai,the author has introduced AfterWards to Chinese medical educators and clinicians.Working with Dr.Marta Hanson,she created an AfterWards Facilitator’s Guide for the use of Chinese practitioners.A recent White Paper on Chinese health care indicates that an infusion of humanities-based education,of which narrative medicine forms a part,can help rebuild patient-physician trust.Recently,there has been an increase in interest in narrative medicine in the United States and China.However,more research is needed to demonstrate the impact of programs like AfterWards.Challenges to the implementation of narrative medicine programs remain,most significantly in terms of expertise,resources,and time.
基金funded by Humanities and Social Sciences Foundation and Natural Science Foundation of Nanjing University of Posts and Telecommunications(NYY222055,NY224176)General Subject of Educational Science Planning in Jiangsu Province(C/2024/01/76)National Natural Science Foundation of China(62307025).
文摘Objectives:Teachers are facing unprecedented new challenges leading them to face an increasing number of tasks that are not part of their job,as well as having to cope with the additional skills acquisition that comes with non-traditional forms of teaching and learning,and increased work pressure leading to an increase in the rate of teachers leaving the profession.Therefore,this study aims to explore the mechanism of the career calling on job burnout through career adaptability and work engagement.Methods:This study conducted a cross-sectional survey of 465 primary and secondary school teachers(PSST)in China's Mainland from the perspective of work adjustment and used structural equation modeling(SEM)to examine the mediating roles of career adaptability and work engagement in the relationship between teachers’career calling and job burnout.Results:The results show that PSSTs are above average in career calling,career adaptability,and work engagement,while job burnout is below average.A significant positive or negative correlation exists between career calling,career adaptability,work engagement,and job burnout.The result of path analysis indicates that career adaptability and work engagement exert an indirect influence on the job burnout of PSST through three paths:namely,the independent intermediary role of career adaptability(EV=−0.144),the independent intermediary role of work engagement(EV=0.172)and the chain intermediary role of the two(EV=0.176).Conclusion:This study emphasizes the importance of career adaptability and work engagement in teacher development in regulating career calling and job burnout.Therefore,on the one hand,we think that if managers want to reduce teachers’job burnout,they need to pay more attention to teachers’career adaptability and work engagement,rather than relying solely on teachers’career calling.On the other hand,it is to remind teachers not to rely on their adjustment to adapt to the work,but also to need outside help as much as possible.
基金supported by NIH/NIAMS(P01 AG066603,R01 AR079171,R21 AR078919)NIH/NIDCR(R01 DE031488,R01 DE031028)+4 种基金Alex’s Lemonade Stand Foundation(22-26743)American Cancer Society(DBG-23-1155131-01-IBCD)the Maryland Stem Cell Research Foundation(2021-MSCRFD-5641),and Department of Defense(USAMRAA HT9425-24-1-0051)MC is supported by Merkin Peripheral Neuropathy and Nerve Regeneration Center(23-DF/C2/260)M.K.is supported by NIH(T32HD044355).
文摘Peripheral neuropathy is a common complication in diabetes,affecting around 50%of the diabetic population.Co-occurrence of diabetic peripheral neuropathy(DPN)and diabetic bone disease has led to the hypothesis that DPN influences bone metabolism,although little experimental evidence has yet supported this premise.To investigate,mice were fed a high-fat diet(HFD)followed by phenotyping of skeletal-innervating neurons and bone architectural parameters.Results showed that HFD feeding resulted in a marked decrease in skeletal innervation(69%–41%reduction in Beta-III-Tubulin-stained nerves,38%reduction in CGRP-stained nerves in long bone periosteum).
基金supported by funding from NIDCR(1R01DE027957)Maryland Stem Cell Research Fund(2022-MSCRFV-5782)the NSF GRFP and NCI(5R01CA237597-05,2R01CA196701-06A1).
文摘Calvarial nerves,along with vasculature,influence skull formation during development and following injury,but it remains unclear how calvarial nerves are spatially distributed during postnatal growth and aging.Studying the spatial distribution of nerves in the skull remains a challenge due to a lack of methods to quantify 3D structures in intact bone.To visualize calvarial 3D neurovascular architecture,we imaged nerves and endothelial cells with lightsheet microscopy.
基金supported by the Neurosurgery Pain Research Institute at Johns Hopkins University and by the Lehner Family Foundation.
文摘Chronic pain after spine surgery(CPSS)is a complex disorder characterized by multifactorial pathogenesis that occurs in 8%–40%of patients undergoing lumbar spine surgery.We aimed to develop a rat model that mimics clinical CPSS conditions by taking two sequential surgical procedures.Step 1:A plastic rod was inserted into the left L5 intervertebral foramen to produce a steady compression on the dorsal root ganglion(DRG)and the spinal nerve,a common cause of low back pain(LBP).Step 2:The rod was removed after 7 days when rats exhibited mechanical and heat hypersensitivity in the ipsilateral hindpaw,followed by a full L5 laminectomy to mimic spine decompression surgery in LBP patients.The retention of the rod induced a prolonged LBP-like behavior but was quickly resolved after rod removal without laminectomy.However,rats that received laminectomy after rod removal developed heightened mechanical and heat sensitivity in the hindpaw,impaired gait,and reduced spontaneous exploration activity,indicating CPSS.Patch clamp recording revealed a significant augmentation in the intrinsic excitability of smalldiameter DRG neurons in CPSS rats.Administration of Dermorphin[D-Arg2,Lys4](1–4)amide(DALDA,5mg/kg,i.p.),a peripherally acting mu-opioid receptor(MOR)-preferred agonist,attenuated pain hypersensitivity,capsaicin-induced[Ca^(2+)]i rising and the increased intrinsic excitability of DRG neurons from CPSS rats.Our findings suggest that this new model,which mirrors the nature of CPSS developed in patients,may be useful for future studies of the underlying mechanisms.
文摘The United States Food and Drug Administration's(FDA's)August 2024 determination that an additional phase Ⅱ study will be required to consider the approval of midomafetamine for the treatment of posttraumatic stress disorder(PTSD)could delay the potential approval of this promising treatment by several years.
基金supported by Department of Defense grant HT9425-24-1-0030 a grant from the Stanley Medical Research Institute(to SS).
文摘The inability to access brain tissue has greatly hindered our ability to study and care for individuals suffering from psychiatric and neurological conditions.Critics have questioned efforts to develop peripheral blood biomarkers in neurological and psychiatric disorders based on the assertion that disease pathology is limited to the brain.The discovery that all tissues,including the brain,release extracellular vesicles(Raposo and Stoorvogel,2013)and cell free DNAs(Chan et al.,2013)into various body fluids has provided a potential way to measure activity from inaccessible tissues like the central nervous system(CNS)and has given rise to the term“liquid biopsy.”The development of liquid biopsies that can diagnose and predict the course of psychiatric and neurological disorders would be transformative.The ability to predict episodic events such as mania,depression,and risk for suicide would be particularly useful for psychiatric care as it would enable the development of interventions that prevent mortality and improve outcomes.Additionally,biomarkers that are informative about drug response and aid in treatment decisions would be a significant advance in psychiatric care as it would prevent patients from having to endure multiple courses of ineffective treatments and side effects.
文摘Background: In the global burden of non-communicable diseases, the top slot among them all is occupied by various cardiovascular diseases (CVD), which also claim primacy in mortality rates. Generally speaking, the pathophysiological pathway frequently involves either (or a combination of) elevated serum cholesterol levels, predominantly attributed to dietary patterns characterized by extremely high levels of saturated and trans-fat consumption. Day-to-day nutritional epidemiology among university students suggests that they represent a crucial demographic for the study of preventive interventions. Objective: This in-depth study and investigation were specifically aimed to quantitatively assess and compare prevailing patterns of dietary fat consumption between female students enrolled in health sciences and non-health sciences programs at major universities in Riyadh, Saudi Arabia. Methodology: This cross-sectional study was comprised of 434 Saudi female university students (age range: 18 - 25 years), utilizing a validated Block Dietary Fat Screener accompanied by anthropometric measurements and comprehensive demographic data collection. The sampling methodology consisted of a snowball technique that was spread across three major academic institutions in Riyadh. Results: Statistical analysis revealed a significant association between academic specialization and patterns of dietary fat consumption (p = 0.012). Paradoxically, students of health science exhibited a higher prevalence of very high fat intake (41.9%) compared with their non-health sciences counterparts (27.6%). Surprisingly, anthropometric stratification revealed that it was the underweight students who demonstrated very high levels of fat consumption. A notable socioeconomic gradient was observed, with students from households earning 15,000 - 20,000 SR monthly showing the highest prevalence of very high-fat consumption (47.1%), although this association did not achieve statistical significance (p = 0.104). Conclusion: These findings challenge the conventional assumption that health sciences education correlates with superior dietary behaviors. The data suggests a critical need for enhanced education in nutrition, as well as intervention using various behavioral programs across all academic disciplines, particularly those addressing the disconnect between nutritional knowledge and dietary practices among students of health sciences. Future longitudinal studies are warranted in order to elucidate the temporal relationship between academic specialization and dietary behaviors.
文摘Schools are an important avenue to tackle the rising prevalence of uncorrected refractive error among children.School-based vision programs are an innovative approach of vision care delivery in the urban school setting in the United States.These programs are effective in improving vision outcomes and advancing health equity,especially among the disadvantaged school districts.While most school-based vision programs provide vision screening,eye examinations,and eyeglasses prescription to students directly in schools,different mechanisms and models have been reported.In this paper,we describe two large-scale school-based vision programs,Vision for Baltimore and Helen Keller International’s United States Vision Program,representing national and regional efforts to partner with local communities in improving access to pediatric vision care.These programs also serve as data collection platforms and provide evidence to inform public health policy and guide best practice.Collectively,these two programs showed that one in three students failed vision screening.The prevalence of uncorrected refractive error was high and the demand for eyeglasses was great among those who failed vision screening.While most of the students’uncorrected refractive errors could be addressed in the school setting,one in seven needed additional eye care.We found that schools with more socioeconomically disadvantaged students had greater needs of school-based vision program services.We hope this knowledge helps to maximize the impact of school-based vision programs and promote a system that ensures better health outcomes for all children.
文摘Although with aggressive standards of care like surgical resection,chemotherapy,and radiation,high-grade gliomas(HGGs)and brain metastases(BM)treatment has remained challenging for more than two decades.However,technological advances in this field and immunotherapeutic strategies have revolutionized the treatment of HGGs and BM.Immunotherapies like immune checkpoint inhibitors,CAR-T targeting,oncolytic virus-based therapy,bispecific antibody treatment,and vaccination approaches,etc.,are emerging as promising avenues offering new hope in refining patient’s survival benefits.However,selective trafficking across the blood-brain barrier(BBB),immunosuppressive tumor microenvironment(TME),metabolic alteration,and tumor heterogeneity limit the therapeutic efficacy of immunotherapy for HGGs and BM.Furthermore,to address this concern,the NanoBioTechnology-based bioinspired delivery system has been gaining tremendous attention in recent years.With technological advances such as Trojan horse targeting and infusing/camouflaging nanoparticles surface with biological molecules/cells like immunocytes,erythrocytes,platelets,glioma cell lysate and/or integrating these strategies to get hybrid membrane for homotypic recognition.These biomimetic nanotherapy offers advantages over conventional nanoparticles,focusing on greater target specificity,increased circulation stability,higher active loading capacity,BBB permeability(inherent inflammatory chemotaxis of neutrophils),decreased immunogenicity,efficient metabolism-based combinatorial effects,and prevention of tumor recurrence by induction of immunological memory,etc.provide new age of improved immunotherapies outcomes against HGGs and BM.In this review,we emphasize on neuro-immunotherapy and the versatility of these biomimetic nano-delivery strategies for precise targeting of hard-to-treat andmost lethal HGGs and BM.Moreover,the challenges impeding the clinical translatability of these approaches were addressed to unmet medical needs of brain cancers.
基金Supported by Javna Agencija za Raziskovalno in Inovacijsko Dejavnost RS,No.P3-0036,No.I0-0029,No.J3-50098,and No.N1-0305University medical center Maribor,No.IRP-2021/02-05Swiss National Science Foundation(SNF)Postdoctoral Fellowship,No.P500PM217647/1.
文摘The gastrointestinal(GI)tract is essential for digestion,absorption,excretion,and protection,supported by a diverse microbial ecosystem.Traditional in-vitro models often fall short in capturing the physiological complexity of the GI tract,limiting their translational applications.A comprehensive approach is needed to bridge the gap between simple cell cultures and more complex systems used in translational research.This review explores the limitations of conventional twodimensional cell cultures and emphasizes the emerging use of three-dimensional and microfluidic systems that better replicate the GI tract’s structure and functions.It highlights the importance of incorporating patient-derived cells and engineered microenvironments to enhance model relevance and support personalized medicine.The review also discusses advanced fabrication techniques such as micro-extrusion and laser-assisted bioprinting,which enable the creation of sophisticated tissue models capable of simulating critical GI processes,including molecular transport,peristalsis,and liver coupling.Advancing the complexity of in-vitro systems will help replicate the GI tract’s interactions and physiological phenomena,thus improving the translational potential of GI research.This review provides valuable insights into the advancements and challenges in GI modeling,serving as a comprehensive guide for developing models that bridge the gap between basic cell cultures and clinically relevant systems.
文摘The management of portal hypertension and its complications,such as variceal bleeding,in patients with cirrhosis often involves the use of nonselective betablockers(NSBBs)and a transjugular intrahepatic portosystemic shunt(TIPS).Both treatment modalities have demonstrated efficacy;however,each presents distinct challenges and benefits.NSBBs,including propranolol,nadolol,and carvedilol,effectively reduce portal pressure,but are associated with side effects such as bradycardia,hypotension,fatigue,and respiratory issues.Additionally,NSBBs can exacerbate conditions such as refractory ascites,hepatorenal syndrome,and hepatic encephalopathy.In contrast,TIPS effectively reduces the incidence of variceal rebleeding,controlling refractory ascites.However,it is associated with a significant risk of hepatic encephalopathy,shunt dysfunction,and procedurerelated complications including bleeding and infection.The high cost of TIPS,along with the need for regular follow-up and potential re-intervention,poses additional challenges.Furthermore,patient selection for TIPS is critical,as inappropriate candidates may experience suboptimal outcomes.Future studies comparing NSBBs and TIPS should focus on refining the patient selection criteria,enhancing procedural techniques,optimising combination therapies,and conducting long-term outcome studies.Personalised treatment approaches,costeffectiveness analyses,and improved patient education and support are essential for maximising the use of these therapies.
文摘Blindness affected 45 million people globally in 2021,and moderate to severe vision loss a further 295 million.[1]The most common causes,cataract and uncorrected refractive error,are generally the easiest to treat,and are among the most cost-effective procedures in all of medicine and international development.[1-2]Thus,vision impairment is both extremely common and,in principle,readily manageable.
文摘Background:An urban medical group in Dapeng New District was established in 2017 with the objective of enhancing outcomes for common diseases and reinforcing primary care by integrating high‐level hospitals with primary health services.This study aimed to evaluate the performance of the urban medical group using the triangular value chain framework.Methods:The evaluation was conducted using the Donabedian model,focusing on three key dimensions:safety and quality,accessibility,and affordability.Longitudinal data were collected from 2016 to 2022 through government annual reports,the medical insurance bureau,and hospital information systems.Preprogram and postprogram outcome measurements were compared to assess differences and trends,providing a clear picture of the program's effectiveness.Results:Accessibility improved significantly,with the number of hospital beds per 1000 residents increasing from 2.62 in 2017 to 3.76 in 2022.The availability of general practitioners(GPs)also rose markedly,from 0 per 10,000 residents in 2017 to 6.27 in 2022.Regarding safety and quality,the proportion of complex medical procedures conducted within the New District expanded substantially,from 7.35%in 2017 to 38.11%in 2021.Additionally,there was an enhancement in the standardized management rate of chronic diseases.Affordability assessments showed that the proportion of medical income derived from the medical insurance fund increased by nearly 22.81 percentage points between 2012 and 2021.By 2021,75.02%of medical patients were covered by medical insurance,representing an increase of approximately 44 percentage points from 31.19%in 2012.Conclusions:The implementation of the urban medical group in Dapeng New District has led to substantial improvements in healthcare accessibility,safety and quality,and affordability.Future initiatives will focus on advancing the“Dapeng Mode”to generate exemplary healthcare outcomes and minimize disparities in basic health services and health status between urban and rural populations.The reform agenda includes piloting payment reforms and innovative payment models within the Dapeng group,complemented by a health assessment and performance incentive system aimed at encouraging healthcare institutions to prioritize health management.
文摘BACKGROUND Liver transplant(LT)is one of the main treatment options in selected patients with hepatocellular carcinoma(HCC).Overall,macrovascular invasion has been shown to be associated with an increased risk of tumor recurrence and mortality after LT in HCC.Macrovascular invasion detected on imaging is often considered a contraindication for LT in HCC.AIM To investigate the effect of macrovascular invasion in explant on post-LT survival in HCC patients using a large national transplant database in the United States.METHODS LT recipients with HCC between the years 2012 and 2022 were identified by using the United Network for Organ Sharing/Organ Procurement Transplant Network database.Patients who underwent deceased-donor LT with available liver explant pathology data were included.Kaplan-Meier curves were used for survival analysis,and multistep regression analysis was used to determine the predictors of mortality.RESULTS A total of 13638 LT recipients with HCC and available explant pathology were included.Of these,254(1.8%)showed macrovascular invasion,1712(12.6%)had microvascular invasion,and 11672(85.6%)had absent invasion.Poor tumor differentiation was more common with macrovascular invasion than with microvascular or absent invasion(22.4%,17.7%,and 5.1%,respectively,P<0.001).Post-transplant survival at 1 year,3 years,and 5 years was lower in the macrovascular group than in the microvascular and absent invasion cohort(83.6%,66.6%,55.7%vs 90.8%,76.2%,66.6%vs 93.9%,86.8%,80.7%,P<0.001).Similarly,transplant recipients whose explants were poorly differentiated had worse 1-year,3-year,and 5-year survival than those with well-differentiated tumors and those with complete necrosis(86.1%,67.1%,60.4%vs 94.3%,87.7%,81.9%vs 94.8%,89.7%,84.2%,P<0.001).In multivariable modeling,macrovascular invasion was associated with higher mortality risk compared to absent invasion[hazard ratio(HR)=2.3,95%CI:1.9–2.7],and poor differentiation carried greater mortality risk than complete necrosis(HR=2.3,95%CI:2.0–2.7).CONCLUSION Macrovascular invasion accounted for a minority of cases at 1.8%.Macrovascular invasion and poor tumor differentiation on liver explants in patients with HCC were associated with significantly higher post-LT mortality,meaning that the extent of tumor involvement and tumor biology are important predictors of post-LT survival in HCC.However,the overall 5-year survival in patients with macrovascular invasion may still be within an acceptable range.
文摘Pulmonary hypertension associated with congenital heart disease represents a significant challenge for clinicians due to its complex pathophysiology and diverse presentation.This patient population exhibits a broad spectrum of anatomical and hemodynamic abnormalities,with congenital heart disease-associated pulmonary arterial hypertension(PAH-CHD)comprising a significant proportion of pediatric pulmonary hypertension(PH)cases.Although progress in diagnostic methods and treatment options has been made,PH continues to be a major contributor to illness and death among affected pediatric patients,especially when diagnosis or treatment is postponed.This review aims to equip non-specialist clinicians with a better understanding of PH associated with congenital heart disease,focusing on its pathophysiology,clinical presentation,and diagnostic criteria.Key recommendations for evaluating and managing this fragile population are presented,emphasizing the importance of early recognition and multidisciplinary collaboration.As an increasing number of congenital heart disease patients reach adulthood,understanding its lifelong impacts becomes crucial for improving outcomes and creating tailored treatment approaches.
